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Suggest Treatment For Psoriasis In An Elderly Person In A Diabetic
Question: I am a 57 year old female with MS, psoriasis, and on many medications. I was diagnosed with a Type 2 diabetes in April, but with the little exercise I can do and revamping my diet, I am no longer diabetic. I started at 205 lbs. and got down to 158. I seem to get oral Thrush often because of my weakened immune system, but it goes away after a couple rounds of fluconazole. But my biggest frustration is my weight in the past 8-10 days has gone up 7 pounds and today I weigh 165 (I am 5'6"). I don't feel I'm doing anything different. I'm having constipation problems too. I can take a stool softener with a stimulant Laxative, and it takes a day or two to work. Any suggestions? I would value your opinion! Thank you!
Brief Answer:
Check thyroid
Detailed Answer:
Sorry to learn about your bothersome weight regain.
Sometimes an under-active thyroid can lead to weight gain.
When I see someone like you in my practice, I typically order the following blood tests in addition to a detailed physical examination:
CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid)
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
None of these tests require any fasting and can be done at any time of the day Correct diagnosis and treatment requires the opportunity to examine the patient so you must see an endocrinologist in-person.
Check thyroid
Detailed Answer:
Sorry to learn about your bothersome weight regain.
Sometimes an under-active thyroid can lead to weight gain.
When I see someone like you in my practice, I typically order the following blood tests in addition to a detailed physical examination:
CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid)
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
None of these tests require any fasting and can be done at any time of the day Correct diagnosis and treatment requires the opportunity to examine the patient so you must see an endocrinologist in-person.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I am on medication for hypo-thyroid. I also had a bunch of bloodwork done a couple weeks ago and everything was fine except for low potassium. I am now taking a potassium pill every morning. I just today started with fluconazole for oral thrush as I begin some major dental work in a month. My A1c is now 5.9, down from 7.2. I eat a lot of fruit but not a big fan of vegetables so I do my best. My main issue is getting this weight loss back on track. I ride stationary bike pedals but with left-sided MS my right side does all the work. I go to PT for frozen shoulder (left side MS again). Should I maybe cut back on the fruit, drink more water, ??? I snack on popcorn which probably isn't the best diet food. Could the weight gain be due to the constipation? I'm about ready to give myself an enema. Thanks
Brief Answer:
Follow up
Detailed Answer:
I see.
HEALTHFUL EATING (also called MNT = Medical Nutrition Therapy) has proven to reduce HbA1c and result in cost savings
Please see a DIETITIAN at least once to get an Individualized plan based on your nutrition needs, personal and cultural preferences, health literacy and access to healthful foods
GENERAL GUIDELINES:
1 Eat a variety of NUTRIENT dense foods in appropriate PORTION sizes, in order to achieve and maintain the following 4 goals:
TARGET 1 body weight, 2 blood glucose, 3 blood pressure and 4 cholesterol
And also to delay/ prevent diabetic complications.
It is important to maintain the pleasure of eating while making practical food choices.
2 Try to REPLACE refined carbohydrates (like muffins, pastries, cookies, sugary cereals) and added sugars with
Whole grains like whole wheat bread and roti and brown rice
Legumes
Vegetables and
Fruits
3 AVOID sugar sweetened beverages (ie pepsi, coke, thums up, fanta, limca etc ) and sucrose (table sugar) containing foods (examples are frosted cornflakes, chocolate milk, sweetened fruit juices and drinks, sweetened yoghurt and ice cream, popular dessert items like chocolate mousse)
4 Learn from a dietitan how to include Mono Unsaturated Fatty Acids (MUFAs) and long chain omega 3 fatty acids (fatty fish, nuts and seeds) in your daily intake.
5 Alcohol is best avoided but if you must, then moderation is key. (one drink per day for women and two for men)
6 Sodium is to restricted to less than 2300 mg a day and even less if you have high blood pressure
7 Vitamins , minerals , herbs, spices, anti oxidant (vitamin E and C and carotene) or omega 3 dietary supplements have shown no benefit.
if you have high cholesterol levels in your blood (HYPERLIPIDEMIA or DYSLIPIDEMIA), ask the Dietitian how to reduce
SATURATED FAT (BEEF, MUTTON, LAMB, PORK, CHICKEN WITH SKIN, WHOLE MILK, CREAM, BUTTER, CHEESE, ICE CREAM, FRIED AND BAKED FOODS)
, TRANS FAT ( Doughnuts, cookies, crackers, muffins, pies and cakes )
and CHOLESTEROL
And increase
Omega 3 fatty acids (NUTS, SEEDS AND Oily fish LIKE – salmon, tuna, mackerel, herring and trout ),
viscous fiber (BLACK BEANS, asparagus, Brussels sprouts, sweet potatoes, turnips, apricots, mangoes, oranges, legumes and oat bran)
and plant stanols/sterols (grains, vegetables, fruits, legumes, nuts, and seeds)
Follow up
Detailed Answer:
I see.
HEALTHFUL EATING (also called MNT = Medical Nutrition Therapy) has proven to reduce HbA1c and result in cost savings
Please see a DIETITIAN at least once to get an Individualized plan based on your nutrition needs, personal and cultural preferences, health literacy and access to healthful foods
GENERAL GUIDELINES:
1 Eat a variety of NUTRIENT dense foods in appropriate PORTION sizes, in order to achieve and maintain the following 4 goals:
TARGET 1 body weight, 2 blood glucose, 3 blood pressure and 4 cholesterol
And also to delay/ prevent diabetic complications.
It is important to maintain the pleasure of eating while making practical food choices.
2 Try to REPLACE refined carbohydrates (like muffins, pastries, cookies, sugary cereals) and added sugars with
Whole grains like whole wheat bread and roti and brown rice
Legumes
Vegetables and
Fruits
3 AVOID sugar sweetened beverages (ie pepsi, coke, thums up, fanta, limca etc ) and sucrose (table sugar) containing foods (examples are frosted cornflakes, chocolate milk, sweetened fruit juices and drinks, sweetened yoghurt and ice cream, popular dessert items like chocolate mousse)
4 Learn from a dietitan how to include Mono Unsaturated Fatty Acids (MUFAs) and long chain omega 3 fatty acids (fatty fish, nuts and seeds) in your daily intake.
5 Alcohol is best avoided but if you must, then moderation is key. (one drink per day for women and two for men)
6 Sodium is to restricted to less than 2300 mg a day and even less if you have high blood pressure
7 Vitamins , minerals , herbs, spices, anti oxidant (vitamin E and C and carotene) or omega 3 dietary supplements have shown no benefit.
if you have high cholesterol levels in your blood (HYPERLIPIDEMIA or DYSLIPIDEMIA), ask the Dietitian how to reduce
SATURATED FAT (BEEF, MUTTON, LAMB, PORK, CHICKEN WITH SKIN, WHOLE MILK, CREAM, BUTTER, CHEESE, ICE CREAM, FRIED AND BAKED FOODS)
, TRANS FAT ( Doughnuts, cookies, crackers, muffins, pies and cakes )
and CHOLESTEROL
And increase
Omega 3 fatty acids (NUTS, SEEDS AND Oily fish LIKE – salmon, tuna, mackerel, herring and trout ),
viscous fiber (BLACK BEANS, asparagus, Brussels sprouts, sweet potatoes, turnips, apricots, mangoes, oranges, legumes and oat bran)
and plant stanols/sterols (grains, vegetables, fruits, legumes, nuts, and seeds)
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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