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What Causes Drowsiness And Fatigue When Blood Sugar Levels Are Normal?
Question: Hello,
My Father is aged 63 and had been a diabetic for last 20 years. His sugar levels have been constantly on a bit higher level (200-220) for last many years but he doesn't want to bring them down as whenever the levels come down to safe range (100-140) he feels sleepy and tired and can't do his daily works.
Also, he wants to stick to tablets and doesn't want to use Insulin Injections as he has this peculiar problem of starting having diarrhea when he uses Insulin Injections. He spent some time in hospital last year for this and the Docs were not able to find any reason or connection between Insulin and diarrhea.
But the recently the levels have gone shooting to 450 + and he was admitted to hospital for 3 days. Even during his stay and after discharge, the levels are constantly keeping at 300-350.
What should be next steps ? Should he get admitted again with some Diabetic specialist hospital (eg. Fortis C-DOC etc.) ? Is there any explanation about diarrhea related to Insulin use ?
My Father is aged 63 and had been a diabetic for last 20 years. His sugar levels have been constantly on a bit higher level (200-220) for last many years but he doesn't want to bring them down as whenever the levels come down to safe range (100-140) he feels sleepy and tired and can't do his daily works.
Also, he wants to stick to tablets and doesn't want to use Insulin Injections as he has this peculiar problem of starting having diarrhea when he uses Insulin Injections. He spent some time in hospital last year for this and the Docs were not able to find any reason or connection between Insulin and diarrhea.
But the recently the levels have gone shooting to 450 + and he was admitted to hospital for 3 days. Even during his stay and after discharge, the levels are constantly keeping at 300-350.
What should be next steps ? Should he get admitted again with some Diabetic specialist hospital (eg. Fortis C-DOC etc.) ? Is there any explanation about diarrhea related to Insulin use ?
Brief Answer:
Please share with me the current medication details.
Detailed Answer:
Hi XXXX,
Welcome to HCM.
I need few more details to answer your questions
1. What are the medications he is on?
2. What about the blood tests {HbA1C - (3 month average blood glucose), kidney and liver functions}
3. Does he have other diabetic complications - Diabetic retinopathy (Eye), neuropathy (nerves), heart disease, kidney disease?
With whatever details you have provided I will try to answer your questions.
Next steps:
1. Since the sugars are grossly elevated - the next step will be to increase the oral medications and if not controlled start on insulin. If he have problem with a particular insulin, change of type or brand of insulin may help.
2. Since his body is used to blood sugars in range of 300+, when the sugars are normalised, he will experience hypoglycaemic symptoms (Low sugars). This is called relative hypoglycaemia. One step for this is to bring down the sugars gradually over a period of 2-3 months. That is instead of bringing down the sugars to normal bring it down to 200+ for 1 month and then 100+ the next month.
Admission:
It is always to better to control sugars in a hospital setting as we can know about the complications. The hospitals you have suggested are good.
Diarrhoea and insulin:
No explanation for diarrhoea and insulin injection.
Hope I have answered your question. If you have any further questions I will be happy to help.
Regards
Dr Ajish TP
Consultant Endocrinologist
Please share with me the current medication details.
Detailed Answer:
Hi XXXX,
Welcome to HCM.
I need few more details to answer your questions
1. What are the medications he is on?
2. What about the blood tests {HbA1C - (3 month average blood glucose), kidney and liver functions}
3. Does he have other diabetic complications - Diabetic retinopathy (Eye), neuropathy (nerves), heart disease, kidney disease?
With whatever details you have provided I will try to answer your questions.
Next steps:
1. Since the sugars are grossly elevated - the next step will be to increase the oral medications and if not controlled start on insulin. If he have problem with a particular insulin, change of type or brand of insulin may help.
2. Since his body is used to blood sugars in range of 300+, when the sugars are normalised, he will experience hypoglycaemic symptoms (Low sugars). This is called relative hypoglycaemia. One step for this is to bring down the sugars gradually over a period of 2-3 months. That is instead of bringing down the sugars to normal bring it down to 200+ for 1 month and then 100+ the next month.
Admission:
It is always to better to control sugars in a hospital setting as we can know about the complications. The hospitals you have suggested are good.
Diarrhoea and insulin:
No explanation for diarrhoea and insulin injection.
Hope I have answered your question. If you have any further questions I will be happy to help.
Regards
Dr Ajish TP
Consultant Endocrinologist
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Hello Doc,
Thanks,
He was earlier on :-
1. Diamicron XR 60 - 2 per day (Morning - Evening Before Meal)
2. Glyciphage SR 1gm - 1 per day (Morning After Meal)
3. Saxaglipitin (Onglyza) 5 mg - 1 per day (Morning after meal)
4. Neogaba M 75 - 1 per day (Night before sleeping)
Now he is on :-
1. Inj Lispro - 5-6 Units - 3 times a day
2. Inj Lantus - 10 Units - 1 per day (Night before sleep)
3. Neogaba M 75 - 1 per day (Night before sleep)
4. Tab Dulane 20 mg - 1 per day (Night before sleep)
HbA1C (2nd Dec) - 11.3
Cholestrol - 222
He has been diagnosed with Neuropathy and has a problem of involuntary jerk movement of feet even while sleeping.
I have uploaded his recent reports.
Please suggest if the current medication is adequate because the sugar level is still hovering at 300 +
Also, any other suggestions that you may have after seeing his reports
Thanks,
XXXX
Thanks,
He was earlier on :-
1. Diamicron XR 60 - 2 per day (Morning - Evening Before Meal)
2. Glyciphage SR 1gm - 1 per day (Morning After Meal)
3. Saxaglipitin (Onglyza) 5 mg - 1 per day (Morning after meal)
4. Neogaba M 75 - 1 per day (Night before sleeping)
Now he is on :-
1. Inj Lispro - 5-6 Units - 3 times a day
2. Inj Lantus - 10 Units - 1 per day (Night before sleep)
3. Neogaba M 75 - 1 per day (Night before sleep)
4. Tab Dulane 20 mg - 1 per day (Night before sleep)
HbA1C (2nd Dec) - 11.3
Cholestrol - 222
He has been diagnosed with Neuropathy and has a problem of involuntary jerk movement of feet even while sleeping.
I have uploaded his recent reports.
Please suggest if the current medication is adequate because the sugar level is still hovering at 300 +
Also, any other suggestions that you may have after seeing his reports
Thanks,
XXXX
Brief Answer:
Need to adjust insulin dose to bring sugars down
Detailed Answer:
Hi XXXX,
Welcome back.
I have gone through the reports.
Impression:
Grossly uncontrolled diabetes
Dyslipidemia
Normal kidney function
Medications like diamicron won't work at this high HbA1c. But Glyciphage SR and Onglyza will still work. This will help to decrease the insulin dose needed to bring the sugars to normal. Please discuss with your diabetologist.
He is currently started on small doses of insulin probably out of fear of hypoglycaemia. We can go slow and steady on insulin dose. Increase the lispro insulin by 1-2 units every day and Lantus by 2-4 units if the sugars and not controlled
Good health
Dr Ajish TP
Need to adjust insulin dose to bring sugars down
Detailed Answer:
Hi XXXX,
Welcome back.
I have gone through the reports.
Impression:
Grossly uncontrolled diabetes
Dyslipidemia
Normal kidney function
Medications like diamicron won't work at this high HbA1c. But Glyciphage SR and Onglyza will still work. This will help to decrease the insulin dose needed to bring the sugars to normal. Please discuss with your diabetologist.
He is currently started on small doses of insulin probably out of fear of hypoglycaemia. We can go slow and steady on insulin dose. Increase the lispro insulin by 1-2 units every day and Lantus by 2-4 units if the sugars and not controlled
Good health
Dr Ajish TP
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
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