July 26, 2002
Diabetes Insipidus
Question from Lexington, Kentucky, USA:
I have had Polycystic Ovary Syndrome with insulin resistance for some time, about two years ago I was put on [metformin], and I lost about 20 pounds. However, last Fall, I stopped taking it regularly, gained 70 pounds, and I have also recently been diagnosed with sleep apnea. Because the sleep disorders doctor wanted me to lose weight, I asked for a referral to a nutritionist and was sent to a diabetes education class. I learned a lot there. When I told the nurse there that I did not have diabetes, but had insulin resistance syndrome and that the highest blood sugar I had tested (when I did so for a short period a couple of years ago) was 187 mg/dl [10.4 mmol/L], she said that I indeed had diabetes because my blood sugar would not be going that high otherwise.
Since the class, I’ve gotten a prescription for glucose testing strips and have been testing my blood sugar, trying to get into a regular pattern as outlined in our book. I’ve found that sometimes when I thought I was low, I was actually running high. It has been in the 150s [mg/dl, 8.3mmol/L] before I’ve eaten anything in the morning at all, so I’m thinking she may be right.
I’ve talked to my doctor’s office and we’re setting up an A1c so we can get a better idea, and I’ll be seeing her for a regular checkup in a couple of months. In the meantime, I’ve been taking my medicine regularly for a couple of months and been walking every day to and from work for three.
For the last three weeks I’ve been coming home and feeling immensely tired, and it comes on pretty quickly. I’m crashing on the couch by 6:00-7:00 pm and sleeping until morning — about five out of seven days. I’ve been using my C-PAP [ED: a breathing device] for the sleep apnea faithfully. I also have problems with depression and anxiety, and I recently switched from regular Paxil to the time-release version. I am waking up feeling like I have no energy at all; like I could just crumple and die. I don’t feel sleepy — just so almost transparent.
Could I be so tired because my blood sugar has been running high? Could the change in Paxil have affected my blood sugar at all? Does this sound more like a change in depression than blood sugar issue? When my depression was at its worst I was sleepy but not like this. Any ideas?
Answer:
All these are possibilities. Fluctuations in blood sugar can make you feel bad, as you have already found out. Your depression can impact your sleep cycle. Incomplete treatment of the sleep apnea can cause daytime somnolence.
As far as your blood sugars are concerned, they do sound like they are high and put you at high risk for having diabetes. I would remind you that the diagnosis of diabetes requires a blood glucose test on more than one occasion where the fasting value is greater than 126mg/dl [7 mmol/L]. This is the gold standard. Hemoglobin A1c tests are not necessarily the gold standard. They are helpful if they are more than 1% above the normal range. However, if you are within 1% or so of the upper limit, you really need lab tests of your glucose values. The other way to diagnose would be with an oral glucose tolerance test.
JTL
