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Suggest Treatment For Severe Abdominal Pain While On Glyburide

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Posted on Wed, 9 Nov 2016
Question: Hello I am Type 2 diabetic taking Glyburide along with Metmorphin. I had a few botched surgeries like going through simple colonoscopy into colostomy. Amazing. The surgeon who put the stoma bag failed to reverse it and finally got it reversed by another surgeon. With this fiasco I developed severe abdominal pain and all Rx medication did not help me. I went to pain clinic and the pain doctor gave me nerve blocking ablation. After the treatment my blood sugar level started going up and my PCP doubled my dosage , I had total of four ablation and even after the ablation my BS is very high reaching a range of 270 . My doctor wants me to put on insulin which I am against. I feel the medication like steroids used to numb the nerve might have a caused my BS to go high. What is your take

Also my question id the nerve blocking procedure might be the cause of my high BS. My AIC before I went to the pain doctor was 6.2 but now it is around 8.5 My doctor doubled the dosage from 5 mg to 10 mg BID. I strongly feel the steroidal medication might have contributed to my blood sugar elevation. Moreover my PCP wants me appl;y and try Medical Marijuana for my Ab and rib cage pain. I am against it. Your take on this subject is well appreciated.
doctor
Answered by Dr. Mirjeta Guni (2 hours later)
Brief Answer:
I agree with your treating physician.

Detailed Answer:

Hello,
Sorry to learn about your bothersome symptoms.

Of course the cause of the raise in blood sugar during these months has been the corticosteroids treatment.
If you have stopped taking them, than your blood sugar will get back to normal within a few weeks.
If the blood sugar persists high even 2 months after having stopped the corticosteroids then treatment should be changed. One of the main causes that contributes on keeping high the blood sugar is the pain.

The only treatment that can lower the HbA1C level by 2% (from 8.5 to 6.5%) is the insulin. So, I agree with your physician at this point.

Regarding the pain treatment with Marijuana I would agree too if the intensity of the pain is still high, even after nerve ablation and if all other pain killers have failed.

Please do not hesitate to ask if you have still queries.
Wishing you good health,
Kind Regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Mirjeta Guni (54 minutes later)
My diabetic problem was age related not genetic as my parents had no trace of diabetic in either families. I developed about 4 years ago. I was on mailtenance dose of 5 Mg Gluburide and 500 mg Metmorphin. Now my doctor pumped the dosage to 10 mg Glyburide BID with 500 mg Metmorphin BID. I feel the effect of cortizone compound might stay in my system perhaps for months before it gets back to normal. I was in very good health but the Stupid surgeon turned routine colonoscopy into colostomy which is unheard of and it happened to me. Although the phenomena is reversed the Abdominal pain still percists after more than a year since the reversal. I was on Norco for a few months and I cannot tolerate the drug. Now I do not take any Rx excepting OTC tylenol. Don't you think my PCP should wait perhaps for a week or two so that all remnants of steroid will get out my system? Jumping into sudden conclusion might make me uncomfortable. I am a person I ask too many question after the colostomy fiasco. Sometimes, I have problem in agreeing with my Physician although she is good but not all doctors are research oriented. Regarding M/M I am quite apprehensive as I do not want to get addicted as the cost is prohibitive. I was under the impression M/M is for severe ailments like MS. I need your take to get myself comfortable. Also I am confused about insulin as I don't want to be with the drug for ever. If it is just for a month or so to bring my BS to an amicable range, I might go for it. Still I feel my doctor should wait. 3 months ago I AIC was 6.2 now my I phone calculates my AIC at 8.5. I keep track of BS level in a medical APP. How can AIC suddenly jump from 6.2 to 8.5 30% fluctuation? Thanks for your input. XXXXXXX
doctor
Answered by Dr. Mirjeta Guni (9 hours later)
Brief Answer:
Insuline treatment will be periodical.

Detailed Answer:
Welcome back!
The treatment with insuline is meant to be periodic of course, until the effect of corticosteroids is washed out.
Your diabetes has been controlled perfectly with low doses of oral tablets, it means that you are not at the point to start insuline permanently. Of course it is raised by corticosteroids and the pain.
The effect of the steroids in raising the blood sugar within 3 months is tremendous.
You may wait three months to see the effect of dose changing but if the blood sugar persists high i would suggest not to wait that long.
I feel sorry about the rare complication that happened to you and i can imagine how do you feel but now we should think to keep under control the situation.
Pain is also a very important component that we should try to avoid as much as possible, probably a center specialized in treating the pain would be of help. Pain persisting after nerve ablation is rare and needs high qualified specialists in this field.
Wishing you good health!
Regards,
Dr.Mirjeta


Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Mirjeta Guni (10 hours later)
Dear Doctor. I hate to bother you. I have two questions namely does the elevated blood sugar makes you Dizzy? Also my pain doctor after four nerve blocking procedure want to try INTERCOASTAL RADIOFREQUECY NERVE ABLATION TO ALLEVIATE my rib cage pain. The pain started after my first nerve block. All the tests like Ct scan, Bone scan to name a few came out fine. He feels it might help me but however he feels the needle to inject the fluid might penetrate my lungs. He also feels that the procedure might numb my right side rib cage. What is your take on it. I am kind of losing the integrity of the doctors who are treating me like an ENT surgeon injecting gentamicin an otto nephro toxic drug to my right ear and I have lost my balance and hearing. I feel if a doctor is not sure of himself putting me as a scapegoat is not appropriate. Please give me your honest take on this.
Thanks.
doctor
Answered by Dr. Mirjeta Guni (1 hour later)
Brief Answer:
Try all available alternatives before deciding for another ablation.

Detailed Answer:
Hello,
It is not bothersome for me dealing with patients.
So, do not hesitate to ask if you have queries.
I can understand your concern regarding to possible side effects of intercostal radio frequency ablation, as you have had the rarest side effects of medical procedures and medications. Really a bad luck!!
Have you talked with the pain doctor to combine 2 or more pain killers?
Before deciding to another interventional procedure i would suggest to combine some pain killers in maximum dose and see the effect.
Than marijuana is the last alternative of noninvasive treatment.
Try to talk in more details about the above each alternative with your treating doctor. But before deciding for an invasive procedure you should be sure that no other alternative is left.

Wish you good luck!
Best wishes,
Dr.Mirjeta
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.

Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Mirjeta Guni

Endocrinologist

Practicing since :2006

Answered : 2414 Questions

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Suggest Treatment For Severe Abdominal Pain While On Glyburide

Brief Answer: I agree with your treating physician. Detailed Answer: Hello, Sorry to learn about your bothersome symptoms. Of course the cause of the raise in blood sugar during these months has been the corticosteroids treatment. If you have stopped taking them, than your blood sugar will get back to normal within a few weeks. If the blood sugar persists high even 2 months after having stopped the corticosteroids then treatment should be changed. One of the main causes that contributes on keeping high the blood sugar is the pain. The only treatment that can lower the HbA1C level by 2% (from 8.5 to 6.5%) is the insulin. So, I agree with your physician at this point. Regarding the pain treatment with Marijuana I would agree too if the intensity of the pain is still high, even after nerve ablation and if all other pain killers have failed. Please do not hesitate to ask if you have still queries. Wishing you good health, Kind Regards, Dr.Mirjeta