instruction: hello doctor I am a year old male my height is 167 am and weighs about 71 keg I am a diabetic type since 12 years family history my father is a diabetic and expired due to cardiac arrest I am currently on humalog lispro 100 insulin via medtronic pump I take both vegetarian and non vegetarian diet my blood work shows fbi 16 hba1c 6 uric acid lipid profile total cholesterol 27 my do trigycerides 70 my do hel cholesterol direct 5 my do lil cholesterol direct 94 46 my do vldl cholesterol 94 my do cool hel ratio 12 lil hel ratio 12 stress test report attached doctor has prescribed tritace ramipril 5 my tablet once every night for three months my problems are unable to eat wheat or carbs as sugar shoots up to 250 300 and takes time to come down pain in the fingers of both hands unable to close fist easily after sleeping sometimes pain in the arms I need to get diagnosis of pain and long term solution medications for sugar
output: hello welcome to icliniq com I will provide you the outline of management in your case however actual changes in treatment regimen should be done after discussing with treating doctor firstly your heart looks alright with no evidence of blockages however blood pressure is an issue which needs to be taken care of you are started on ramipril but you should check it frequently at home as 5 my alone less likely to completely normalize your be so if home be remains elevated more than 140 90 mhg after 5 my ramipril then it has to make twice daily next regarding sugar it is not very well controlled especially post meals now I do not know whether you were tried initially on any medications or not if not then medications should be tried now metformin is a basic and most important medication for it so you should discuss with your doctor regarding initiating it also you will need add on drugs as metformin alone will not be sufficient which includes teneliglipitin and glimepiride which comes in combination of metformin if medications are not feasible at the moment then dose of bolus insulin which is delivered with each meals should be increased by two units in order to take care of post meals surge so that you are able to have proper diet also regarding pains it is likely a neuropathy due to deranged sugars for that sugars should be tightly controlled and you will need supplements like neurobion forte once daily if this does respond to multivitamin supplements then you will need nerve stabilizers like pregabalin etc also your triglycerides level is too much elevated for that you need to have a healthy lifestyle like avoiding fatty oily foods have regular exercises like brisk walking for at least 30 minutes a day this will also bring your sugar level down also you will need medications here to control triglycerides like tablet fenofibrate 145 my bedtime daily for eight weeks there are some issues and there is good scope for improvement also you should undergo tit treadmill test at regular intervals of three to four years also considering your family history of heart disease it is better you also undergo it computed tomography coronary angiography once as it has got very high sensitivity and can tell us if even minute blockages and preventive medications can be started I hope this helps