Conversation: The conversation between human and AI assistant.
[|Human|] Hi, I was diagnosed with diabetes several years ago and was on metformin. Recently, I lost my health care and couldn t get metformin anymore, but then I also started a diet (it s not low carb or calorie deprivation-I eat @ 1300-1400 a day in 3 hr intervals) and have lost 25 lbs so far. I m still overweight, but I ve felt my sugar has been under control enough that, even though I have a few pills left, I haven t had to use any. Anyway, I ate my normal meals today, and right after eating dinner (fish & asparagus), I felt very faint and confused. I checked my sugar and it was 86. Is this normal? I haven t had any sugar symptoms since starting dieting except the other day, I felt like my sugar was high, so I took half a pill. First time in months. Could this half a pill have affected me that much? Is there anything else that would cause a low reading like that right after eating?
[|AI|]  Hi, After going through your case details, I want to know-1) Your Age.2) Your Height and weight (It is very encouraging that you have lost significant weight with diet and exercise) to evaluate degree of overweight.3) Family history of obesity, diabetes.4) Current medicines other than metformin if any.5) Any associated high blood pressure or cholesterol problem. I would like to advise you - 1) Continue Low calorie diet and regular exercise.2) Better to avoid discontinuation or taking medicine on the basis of your own interpretation or symptoms.3) Quarterly check your HbA1c level that give much better idea regarding your diabetes control. Also check Blood sugar level Fasting and postprandial once in a month or two months.4) If it is feasible for you to do Self monitoring of blood sugar level (BSL done by glucometer at different times of the day (Fasting, 2 hours after breakfast, before lunch, 2 hours after lunch, before dinner, 2 hours after dinner, early morning sugar 3am) all sugar not daily but whole profile in a week at least once in a month. If there are symptoms of low BSL or High BSL you should confirm it.5) Regular BP check, clinical examination to rule out microvascular complications of diabetes (retinopathy - endoscopy, foot examination for neuropathy)6) Check your Lipid profile, it is advisable to take statin (lipid lowering Chat Doctor. 7) It better for you to take metformin in maximal tolerated dose, as it will help in reducing insulin resistance which is a basic pathology of diabetes. Metformin is weight neutral (may help in decreasing weight) and rarely causes hypoglycemia. 8) Depending upon your BSL control and HbA1c level other antidiabetic medicines that are either weight neutral or help in reducing weight can be added. Hypoglycemic blood sugar level in diabetic patient is depended on duration of diabetes, control of diabetes, associated complications. At blood sugar level of 86 you have symptoms of low blood sugar level, so it can be hypoglycemia for you.Also, there are rare chances of developing hypoglycemia after taking metformin alone.