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October 27, 2007

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Question from Danbury, Connecticut, USA:

I am 30 years old, a pump user, and have had type 1 for the last five years. Lately, I have been having a problem with SEVERE fatigue after meals. Usually, it occurs an hour or so after meals, despite being careful with carbohydrate counting and using Symlin. It’s really frustrating because I am literally fighting to keep myself awake while at work, where a lot of my job is based on my productivity. Needless to say, I am not meeting my productivity goals and am at risk of losing my job. I don’t know what to do about this issue. I have been to both my endocrinologist and to my primary care physician (PCP) and neither had an answer.

My endocrinologist suggests that I get my blood sugar under better control, which I know I need to do (my last A1c was 8.2) and that will most likely make me feel better. However, this is how my control has been now for a while, so I don’t think that is the main culprit. Why would it hit me so hard now? But he also says, well, maybe it’s not the diabetes.

Well, I went to my PCP, and unfortunately, was met with the opposite reaction, that, yes, it probably is my diabetes that is affecting me this way, especially since it’s mainly after eating where I face this fatigue. She ran blood tests anyway, just to rule out other things. Luckily, everything came back fine. My CBC, thyroid, liver function, Lyme test, and celiac test, all were normal. Yes, this is good news, but I’m at a loss of what to do now.

I want answers to what is going on in my body and no one seems to have any. My instincts tell me that there is more going on and I want to figure out what exactly that is. I don’t know if there is any kind of health specialist whose focus is fatigue, being that it is a component of so many different things, but what do you suggest I do now? I just feel like I cannot keep on dealing with this issue. It’s affecting too many aspects of my life and making things very difficult.

Answer:

From: DTeam Staff

I hear opinions, but have no information about how those opinions were determined. An A1c of 8.2% is a bit high. If the post-meal period is the problem, what are your postprandial blood sugars? Yes, it could be your diabetes. However, the answer is in the blood sugars. If you want action, get the results into your physician’s hands so that definitive answers can be given. If the blood sugars are good after meals, and I would say they should be less than 160 mg/dl [8.9 mmol/L] two hours after meals, then look for something else. Patients with type 1 diabetes are also at increased risk for adrenal insufficiency. This can be discussed with your physician. Have you tried a walk after meals? This might also help. Physical fitness, in general, may help to decrease the fatigue. Glad to hear the baseline labs were okay.

JTL