December 19, 2005
Aches and Pains
Question from Dayton, Ohio, USA:
I am a 32 year old Caucasian male and have been a diabetic since age 14. My muscles get sore whenever my blood sugar is too high. I am not currently working out or under any great physical strain. The soreness usually hits my body symmetrically (both triceps, both biceps, both sides of abdominal muscles, etc.), and sometimes hits many body areas simultaneously. It started a few years ago, only in the anterior flexors of my lower leg, but has since spread to my thighs and, lately, my upper body. It does not happen when I am active, but only when I have been stationary for a length of time (like sitting through a movie). It started only when the blood sugar was very high but, now, I know whenever my blood sugar is above 180 mg/dl [10.0 mmol/L], because I start getting fatigue and unusual soreness in my muscles.
I keep my blood sugar under great control, and have never had any complications with diabetes. I do not smoke or drink. I usually work out, but over the last six months I have been lazy. So, this weirdness with muscle pain is disconcerting.
I am also experiencing insulin resistance over the last month, suddenly requiring much higher levels of insulin to bring down high blood sugar levels. In addition to Humalog and Lantus, I take Synthroid, and testosterone injections
Do you have any ideas what is happening, biochemically, in the muscles to cause pain in the presence of high blood sugar? Can insulin resistance be a contributor? Is insulin resistance reversible with exercise?
Answer:
There are some autoimmune diseases that can affect muscles and be associated with type 1 diabetes. I would first ask if you have ever had any levels checked of your CPK, a muscle enzyme that is elevated in response increased inflammation in the muscle. This is also an uncommon syndrome called “stiff man syndrome” associated with very high levels of anti-GAD antibodies in the serum. You may also recognize this blood test as a test done to determine whether a new-onset case of diabetes is type 1 diabetes or not, with higher than normal levels of anti-GAD antibodies associated with type 1 diabetes. With stiff man syndrome, these antibody levels are way out and very high. You can have muscle symptoms with too much or too little thyroid hormone replacement, so, make sure this is up to date. Finally, make sure you speak with your physician about this issue. He/she can examine you for evidence of muscle dysfunction.
JTL
