Question: DIABETOLOGIST & ENDOCRINOLOGIST

Dear Doctor,
Kindly go through this lengthy letter to you with patience and kindly advise me proper advise to clear my mind .
DIABETES AND MILD HYPERTENSION
I am 72 year old male from XXXXXXX and strictly Vegetarian.I am not sedentary type and walks 4 ½ km every day in the morning and always active.
IHD and BP
I have had IHD (T wave inversion) in the year 1977 and mild hypertension in 1981. The doctor who has attended on me prescribed Aten 50. Since then I have been using Aten 50 in one form or other like Aten 50/Atenlol/Stamlobeta. 37 long years have passed with out any problem with either of these two conditions . My BP is quite normal 120/80 and some times 110/70 and some times on very few occassions 140/80 or 90 and my pulse rate will be around 58 to 65 most of the time . My BP on the day of the visting my physician is 140/80 as on 12th dec 2014.
The attending physician who is an MD has prescribed Cresar 40 mg (Telmisartan) and asked me to stop taking Stamlobeta 50 mg which i am taking from 2006 and further said since i am using this Amlodipine combined Atenlol ,its time to change the medicine and Cresar will also take care of the diabetes and kidneys and heart (IHD) besides BP.Kindly advise on the following.

1. Since I am taking Stamlobeta since 2006 and prior to that Aten 50 from 1977 to 2006., do I have to taper stamlobeta dosage besides taking Cresar 40 mg?

2.Or do I have to continue taking Atenlol or Amlodipine or both in small dosage along with Cresar 40 mg?.If so in which dosage do I have to take? Do you recommend Cresar 40 mg or 20 mg to me?

3.Is there any harm if I do not take Cresar and continue taking Stamlobeta which I have been taking as of now? Does this Stamlobeta take care of the kidneys and heart also?

DIABETES TYPE II
I had Type two diabetes in the year 2010 which is asymptomatic .I have been taking Glycomet 250 mg twice
a day. Right from the begining my fasting level is more than normal and oscillates between 110 to 120 and on very few occassions 125. During this year my blood glucose level (measured with one touch ultra meter) shown between 110 to 125 (12 times) and above 125 (3 times) PP level below 140 (10 times) and above 140 (4 times) . My pp levels are quite normal below 140. I have recently undergone blood test at the laboratory and my FBS is 125 and PP 140 and HB A 1 C IS 6.9 . I have family history in daibetes.

The attending physician asked me to increase Glycomet to 500 mg during night instead of 250 mg . As on 12th july 2014 my Lipid profile is very normal. Cholestrol 123 , Tryglycerides 141 ,HDL 53 and VLDL 23.
Please advise me on the following

1.Do I have to increase the Glycomet dosage to 500 mg during night? Why fasting level is more? If I take a snack or two at bed time, does this level goes to normal without increasing the dosage.? Do you call this somojyi effect or not in my case ?

Please do not form the impression that i have no confidence in my Physician. But i have a tendency to go for second opinion on new drugs before starting a new one. I do not blindly or in hasty manner take any new medicine .Hence I require an expert advise in the matter on the following.

HYPOTHYROIDSM

Further in 2011 I am told that have hypothyroidsm which is asymptomatic. When undergone 1st blood test for hypothyroidsm the levels are (5/8/2011} T3 1.6 , T4 6.5 and TSH 10.1.I have started taking 25 mcg thyronorm, then my doctor has since been changing the dosage to 50 mcg to 100 mcg then to 75 mcg and then to 88mcg .The T3 and T4 levels have not changed over these 3 years. The latest level as on 12th Dec 2014 is T4 9.8 and TSH 0.5. In july 2014 , the TSH is 0.4 . I have lost weight of 3 kgs in 3 years from the onset of hypothyroidsm i.e from 2011 till date. My weight gained by ½ kg this year. I feel I lost some fat also from my body.My weight now is 65 kgs.My BMI is 22.5 and 5ft 7 in tall.

Now I would like to have your expert advise in the following.

1 My hypothyroidsm is asymptomatic. Do I have to continue taking 88 mcg even when TSH is 0.5.?(Normal is (0.35 to 5.5) or reduce to a lower dosage?
2.Does my weight loss and body fat loss is due to the 88mcg of thyronorm?
3.Do I really have hypothyroidsm?

If you require any further info, kindly advise me.

sincerely
somayajulu

Dear Doctor,
I thank you very much for your advise. I wish to express one doubt. As I am perfectly maintaing by BP level in quite normal and at any one time ihve never experienced the rise in BP,why do i have to add one more medicine Bisoprolol in addition to Telma H 40. In case if it is necessary do i have to take it at dinner time or in the evening say at 65 pm?.I never had any sleep disturbances with Atenlol.
AS advised by you i shall start taking Glycomet 500 mg in the morning and Tab janumet in the night.I wish to say that i am a non smoker and non drinker.As i said earlier i walk for 4 1/2 km every day.Cant i do away with bisoprolol for BP and janumet for diabetes.Kindly advise