### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I am a 64 year old man with type 2 diabetes, sleep apnea, and asthma. Apnea is controlled with use of a CPAP. Asthma is controlled with Advair. Diabetes is not controlled, although I am taking metformin and byetta for it.  I am about 50 lbs overweight.  I also have erectile dysfunction.  I have several high stress jobs including practicing law, professional music, and personnel management for a symphony. I am recently having moderate sharp stabbing pain that lasts less than one second in my right temple. These recur. I have timed them and the frequency ranges from 4 to 25 second intervals. This has been going on for about a week. Ibuprofen helps sometimes, but not always. the only trigger I have noticed is that sometimes when I turn my head quickly to the right, as in driving, this triggers it, but not always.  They become less noticeable when I am fully engaged, for example in a music performance or a court hearing.I am also experiencing unusual fatigue.  Sometimes routine tasks are very hard to do.  I have also experienced loss of balance generally over the last few years. Also loss of strength. For example until a few years ago I routinely did 40-60 pushups per day, now I struggle to do 2 or 3.  Lately I feel as if I am sometimes confused and disoriented. My cognitive functions feel impaired.  Routine tasks like driving, and playing my instrument are normal.

### output:

Hello, Thanks for the query. I have gone through the details given, and I do understand your concern. I have following few suggestions: 1) You will have to give a re-look at your diabetes treatment. Because if blood glucose is not well controlled then excess loss of glucose through urine (glycosidic) does lead to loss of energy and tiredness and constant fatigue. 2) Present treatment looks to be inadequate, some additional Chat Doctor.  (since no blood levels or HbA1c% is mentioned, it is difficult to be specific). 3) Weight reduction is also very important as excess weight (fat) is the main cause for Insulin resistance. Even a 5% reduction in present weight can help in improving blood glucose control. 3) Take a diet that helps better blood glucose control, avoid junk foods, high fat food products, increase intake of green leafy vegetables and salads, yogurt and low fat cheese. 4) Increase your time spent on exercise to abut 1 hour or more per day 5) Get a thyroid function test done, to rule out if there is hypothyroidism. 6) Lastly learn some relaxing techniques like Silva Mind Control Methods an alpha level relaxation which will definitely help in managing stress. Even ED which is a major long term complication of uncontrolled diabetes can be helped with better blood glucose control. Plus some medications also may be needed. I hope I have ad