#1---Let's start from the beginning. You were diabetic on diet and exercise control then your doctor placed you on an oral hypoglycemic (metformin) which you had arm numbness so "you" decided it was due to the metformin and therefore take only half of your prescription which makes your arm numbness go away.
You began drinking lemon juice and vinegar. ***The lemon juice and vinegar helped to lower the glycemic index*** of the food that you ate so that you could reduce your metformin dosage without suffering hyperglycemia. Lemon juice and vinegar are the reason that you could lower your metformin dose effectively. They are NOT the cause of hyperthyroidism or diabetes.
Citric acid is a weak organic acid found in lemon juice. It is an intermediate in the citric acid cycle and therefore occurs in the metabolism of most living things including all humans. Citric acid is most concentrated in lemons (8% of total).
Acetic acid bacteria (apple cider vinegar) are bacteria that derive their energy from the oxidation of ethanol to acetic acid during respiration. They are Gram-negative, aerobic, rod-shaped bacteria. A good source of acetic acid bacteria is apple cider vinegar.***The acetyl group, derived from acetic acid, is fundamental to the biochemistry of virtually all forms of life.*** When bound to coenzyme A it is central to the metabolism of carbohydrates and fats. The concentration of free acetic acid in cells is kept at a low level to avoid disrupting the control of the pH of the cell contents.
#2---Hyprava contains celery, hawthorn berry, rosemary leaf, echinacea, purpurea tops, garlic root, ginkgo leaf, meadowsweet, St. John's Wort, Valerian Root, Mate, and magnesium stearate is listed as "other ingredients". St. John's Wort may be beneficial for mild to moderate depression. This combination of ingredients could be effective in controlling your hypertension. If this supplement is beneficial to treat your hypertension, then I can see nothing wrong with it. I do have concerns about taking herbal supplements that aren't approved by the FDA. But, heh, there are numerous drugs that are used "off-label" and therefore not approved by the FDA. Always inform your doctor that you are taking these herbal supplements because they will affect the dosage of your medications e.g. metformin and anti-hypertensive meds. St. John's wort may increase CNS serotonin and, in very high doses, acts like a monoamine oxidase inhibitor. Dose is 300 to 600 mg by mouth once per day of a preparation standardized to 0.2 to 0.3% hypericin, to 1 to 4% hyperforin, or to both (usually). Valerian Root is sometimes used by some people as a sedative and sleep aid. Valerian may prolong the effect of other sedatives. Strong scientific evidence supports use of ginkgo for symptomatic relief of claudication, although exercise and cilostazol may be more effective. Garlic is said to have favorable effects on several cardiac risk factors, including reduction of blood pressure and serum lipid and glucose levels. Garlic inhibits platelets in vitro.
#3---Your arm numbness is caused by diabetic neuropathy not by Metformin. Your Diabetes Mellitus type 2 is the cause of the numbness in your arm. Your fasting blood sugar and hemoglobin A1c (ie, glycosylated hemoglobin): Hemoglobin A1c may be high, although no direct correlation has been established between the severity of the elevation and the severity of the diabetic neuropathy.
Neuropathies are characterized by a progressive loss of nerve fibers that can be assessed noninvasively by several tests of nerve function, including electrophysiology, quantitative sensory testing, and autonomic function tests. Hyperglycemia causes increased levels of intracellular glucose in nerves, leading to saturation of the normally used glycolytic pathway.
Different clinical neurologic scales are used to assess the stage of diabetic polyneuropathy, including Neuropathy Impairment Scale (NIS), Vibration Detection Threshold (VDT), Code Detection Scale (CDT), and Heel Pain (HP). You have Stage N2a diabetic polyneuropathy.
Staging of diabetic polyneuropathy is as follows:
NO - No neuropathy
N1a - Asymptomatic neuropathy detected as nerve conduction abnormality in at least 2 nerves
N1b - N1a and abnormal neurologic examination
N2a - Symptomatic mild diabetic polyneuropathy; sensory, motor, or autonomic symptoms; patient able to heel walk
N2b - Severe symptomatic diabetic polyneuropathy (as in N2a, but patient unable to heel walk)
N3 - Disabling diabetic polyneuropathy
Tight and stable glycemic control can provide symptomatic relief as well as slow the progression of your arm numbness and neuropathic symptoms. Because blood glucose flux, with rapid swings from hypoglycemia to hyperglycemia, has been suggested to aggravate and induce neuropathies, the stability rather than the actual level of glycemic control may be more important in relieving neuropathy. Tight blood sugar control decreases the risk of neuropathy by 60% in 5 years.
#4---You have hyperthyroidism and diabetes which are causing hypertension which is causing your renal disease and elevated creatinine level. Creatinine levels of 120 to 150 micro mol/L represent a loss of kidney glomerular filtration function of more than 50%. Most patients with mildly elevated serum creatinine levels have lost about 50% of their renal filtration function and have mild to moderate renal insufficiency. Obstruction of the urinary tract is easy to diagnose with ultrasound and is treatable with urological intervention. Inflammatory renal diseases can be treated with immunotherapy if diagnosed before irreversible scarring occurs. A kidney biopsy is required to diagnose and guide therapy. decisions.
#5---Diovan (valsartan) does not cause alopecia (loss of hair). I cannot find anywhere in any of the most recent literature on this drug that states that hair loss (alopecia) is an adverse effect from taking Diovan. Diovan is an angiotensin II receptor blocker which is one of the most useful drugs for patients such as yourself who have type 2 Diabetes with nephropathy.
Antihypertensives for high-risk patients with coexisting conditions e.g. diabetes and chronic kidney disorders are diuretics, B-blockers, angiotensin II receptor blockers, and Calcium channel blockers.
Telmisartan and hydrochlorothiazide are given in combination for hypertension. Telmisartan 40 mg/hydrochlorothiazide 12.5 mg, or maximum dose: Telmisartan 80 mg/hydrochlorothiazide 12.5 mg.
Telmisartan 40 or 80 mg with hydrochlorothiazide is appropriate for you. Telmisartan is an angiotensin II receptor blocker and hydrochlorothiazide is a diuretic. This is a similar combination to your original medication valsartan/hydrochlorothyiazide. Other antihypertensive Angiotensin II receptor blockers and diuretic combinations that you can take are: Losartan/hydrochlorothiazide, Irbesartan/hydrochlorothiazide, and Candesartan/hydrochlorothiazide.
You should NOT be taking Lisinopril or Triamterene. Lisinopril is an ACE inhibitor. Ace inhibitors increase Creatinine and BUN therefore they are contraindicated in diabetic nephropathy. Also, Triamterene is a potassium-sparing diuretic which is not appropriate for you.
You should understand hair loss. Let me explain. A symptom of hyperthyroidism and diabetes can be hair loss especially lack of body hair on the extremities due to poor circulation. Circulation is important to grow hair. Without nutrients carried by the blood, then obviously hair cannot grow. I recommend brushing your hair with a soft-bristled brush just to stimulate the circulation in your scalp but not enough to cause abrasions or pain on your scalp. Massaging the scalp is important to bring blood to the scalp. Hanging your head over the side of your bed while you brush your hair and massage your scalp will bring blood to your scalp and this will help your hair to grow.
Hair grows in cycles. Each cycle consists of a long growing phase (anagen) followed by a short resting phase (telogen). At the end of resting phase, the hair falls out (catagen) and a new hair starts growing in the follicle, beginning the cycle again. Eyebrows and eyelashes have a growing phase of 2 to 6 months, and scalp hairs of 2 to 6 years. Normally, about 100 scalp hairs reach the end of resting phase each day and fall out. When significantly more than 100 hairs/day go into resting phase (telogen effluvium), clinical hair loss may occur; Hair growth in both men and women is regulated by androgens. Telogen effluvium refers to loss of scalp hair caused by synchronicity of hair cycle so that many hairs enter the resting or telogen phase at once. At the end of this resting phase, usually several months after the inciting event, a significant increase in hair shedding is noticed. Drugs are a common cause, including especially anti-proliferative chemotherapeutic agents, warfarin, H2-blockers, oral contraceptives, ACE inhibitors, B-blockers, and lithium. Other drugs that can precipitate telogen effluvium are fluorobutyrophenone, clofibrate, bezafibrate, lamine, ibuprofen, interferon, ranitidine, sulindac, tamoxifen, terfenadine, and thiamphenicol. Telogen effluvium is also common with nutritional deficiencies, after physiologic or psychologic stress, and with pathologic (hypothyroidism or hyperthyroidism) or physiologic (postpartum, menopause) endocrine changes.
Therapeutic options for male-pattern alopecia are limited and include, in order of increasing efficacy, topical 2% minoxidil solution, topical 5% minoxidil solution, oral finasteride 1 mg/day, and when all else fails there's always surgical intervention (hair transplantation). These treatments may be used alone or in combination. Oral finasteride, an inhibitor of type II 5- reductase, is the most effective nonsurgical therapy. I have patients who've had success using finasteride.
#6---Symptoms of hyperthyroidism (Grave's Disease) include fatigue, weight loss (despite a good appetite), rapid heart beat, heat intolerance, muscle weakness, palpitation, increased bowel activity, emotional lability, and restlessness. Free T4 and Free T3 is elevated, while TSH is suppressed due to negative feedback. An elevated protein-bound iodine level may be detected. Treatment of hyperthyroidism may be with methimazole or propylthiouracil (PTU), which reduce the production of thyroid hormone, or with radioactive iodine. Surgical removal of the thyroid is another option, but still requires preoperative treatment with methimazole or PTU to render the patient "euthyroid" (i.e. normothyroid) before surgery since operating on a hyperthyroid patient is dangerous.
Grave's disease is an example of a type II hypersensitivity autoimmune disorder due to the production of autoantibodies that bind to the TSH receptor, which is present on the follicular cells of the thyroid (the cells that produce thryoid hormone). These antibodies activate the cells in the same fashion as TSH itself, leading to an elevated production of thyroid hormone.
Viral infection may trigger antibodies against its epitopes, which cross-react with the human TSH receptor. There appears to be a genetic predisposition for Graves' disease, suggesting that some people are more prone than others to develop TSH receptor activating antibodies due to a genetic cause.
#7---You are at stage 3 diabetic nephropathy (overt, or dipstick-positive diabetes). Hypertension typically develops during stage 3. An estimated 5% to 15% of type 2 Diabetic cases progress through five stages of diabetic nephropathy, but the timeline is not clear. Some patients advance through the stages very quickly.
Stage 1 (very early diabetes) Increased demand upon the kidneys is indicated by an above-normal glomerular filtration rate.
Stage 2 (developing diabetes) The GFR remains elevated or has returned to normal, but glomerular damage has progressed to significant microalbuminuria (small but above-normal level of the protein albumin in the urine). Patients in stage 2 excrete more than 30 mg of albumin in the urine over a 24-hour period. Significant microalbuminuria will progress to end-stage renal disease. Therefore, all diabetes patients should be screened for microalbuminuria on a routine (yearly) basis.
Stage 3 Glomerular damage has progressed to clinical albuminuria. The urine is "dipstick positive," containing more than 300 mg of albumin in a 24-hour period. Hypertension (high blood pressure) typically develops during stage 3.
Stage 4 (late-stage diabetes) Glomerular damage continues, with increasing amounts of protein albumin in the urine. The kidneys' filtering ability has begun to decline steadily, and blood urea nitrogen (BUN) and creatinine (Cr) has begun to increase. The glomerular filtration rate (GFR) decreases about 10% annually. Almost all patients have hypertension at stage 4.
Stage 5 (end-stage renal disease, ESRD) GFR has fallen to approximately 10 milliliters per minute (<10 mL/min) and renal replacement therapy (i.e., hemodialysis, peritoneal dialysis, kidney transplantation) is needed.
Often a person with abnormal glucose tolerance will be found to have at least one or more of the other cardiovascular disease risk components. This clustering has been labeled as Syndrome X, the Insulin Resistance Syndrome, or the Metabolic Syndrome.