Confusion over tiredness

cz_dave

Well-Known Member
Messages
448
Type of diabetes
Type 1
Treatment type
Insulin
When I underestimate carbs in a meal and inject an insufficient dose of insulin, I am sometimes overcome by an intense feeling of tiredness. When my numbers are spot on, I feel very energized and can get by with a 6-hour sleep without feeling tired.
 

rosedreams

Member
Messages
18
Type of diabetes
Type 1
Treatment type
Insulin
Hello cz-dave, I think it's a peculiarity thing with me and tiredness, it's peculiar to me with my diabetes, feeling tired even with spot on numbers. I feel like I haven't slept in days today despite having slept enough last night, got up at 5 a.m., shot my doses and had 5.6 result beforehand, kept it going within range before and after low carb lunch at 1 p.m, still working, will finish and go home, my sugar just now is a decent 6.3, yet I feel worn out, like a pile of dung actually.

I do an hour on a bike before work in the morning and another hour in the evening. I don't smoke, drink or eat things I'd love to eat putting my BG balance before pleasure....my diet is so boring, but we do what we have to do. I'm not 'depressed', so no explanation for feeling so tired. I responded to your post because I'm on a tea break and have felt the tiredness issue extra strongly today.

Life goes on though. It's a thankless challenge diabetes, in a fantasy world I hope one diabetes gets prosecuted and punished for cruelty. But hey, I'm still alive and hanging on to my sanity.

I look like **** but pretend to be OK for my work; funny how we can pretend and carry on. I suppose it could be worse.
 

djfm

Member
Messages
18
Type of diabetes
Type 1
Treatment type
Insulin
Dislikes
pain
I get tired a lot. Maybe it had to do with my broken sleep, which seems to raise my levels.
It doesn't help I do long shifts, this has caused me pain in my eyes with them getting slightly blood shot with headaches.
Result I have be told to discuss my eye results I just got back
No treatment needed but they have changed.
I need to stop doing 72 hours a week, 3 day 3 nights 3 off it killing me.
 

Lulu9101112

Well-Known Member
Messages
378
Type of diabetes
Type 1
Treatment type
Insulin
Dislikes
Football, Rugby, Sweede, Parsnips, Beetroot
You can get tired for different reasons.
Like daily life is just tiring anyway like school, college work, stress etc...
 

Wurst

Well-Known Member
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1,126
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Narcissistic forum members
What are your Iron and Hemoglobin levels like ? I suffered from tiredness for a long time until my GP put me on Iron supplements recently. I'm approaching 3 weeks of taking them and the tiredness has almost gone. I do a lot of exercise and it started to be real effort but now I'm actually looking forward to my next training run. I can breath properly again and am more alert.
 

rosedreams

Member
Messages
18
Type of diabetes
Type 1
Treatment type
Insulin
You can get tired for different reasons.
Like daily life is just tiring anyway like school, college work, stress etc...
Yes, day to day life can definitely take it out of us, stress especially. I can be positive and pro-active about fighting the tirednes but yesterday my "I'll carry on no matter what" policy took a day off. A new day today
 

rosedreams

Member
Messages
18
Type of diabetes
Type 1
Treatment type
Insulin
I get tired a lot. Maybe it had to do with my broken sleep, which seems to raise my levels.
It doesn't help I do long shifts, this has caused me pain in my eyes with them getting slightly blood shot with headaches.
Result I have be told to discuss my eye results I just got back
No treatment needed but they have changed.
I need to stop doing 72 hours a week, 3 day 3 nights 3 off it killing me.
Good on you for staying committed to work despite long shifts and the effects of broken sleep. I hope you get helpful intervention with your eye results; good medical attention is a precious blessing nowadays, but it can make all the difference to our confidence when swimming in the sea of diabetes.
 

rosedreams

Member
Messages
18
Type of diabetes
Type 1
Treatment type
Insulin
What are your Iron and Hemoglobin levels like ? I suffered from tiredness for a long time until my GP put me on Iron supplements recently. I'm approaching 3 weeks of taking them and the tiredness has almost gone. I do a lot of exercise and it started to be real effort but now I'm actually looking forward to my next training run. I can breath properly again and am more alert.
I get HB bloods done once a year, the last being in February 2017, it was 13.6, which is normal for a female. For most of my adult life I've included vitamins and nutrition in my diet to avoid defficiencies, I get my potassium, iron etc.., I exercise daily (less strenuously than I did in my 20s and 30s when I used to climb and cycle a lot), I've toned it down because of work demands/time. Thankfully I don't have any nutrition defficiencies. Yet I sometimes feel as though I'm low on something or just pulling myself through, which is demoralising but not the end of the world.

I became aware of 'odd' tiredness at around age 6 (I was diagnosed T1 at age 5), I remember going to bed at night feeling tired and waking up tired but still active like most kids. That's when blood defficiency tests started, to rule out anaemia/cancer/low calcium etc...Always shown normal which is why I harp on about accepting my tiredness as a part of living. I 'cope' with it and live actively (as a gesture towards diabetes) but some days are worse than others and I can become a Moaner Lisa about it. Yesterday was on those bad days, like yesterday. By 8 p.m I was practically singing the blues about the meaning of life.

I regularly insist on follow up tests, especially for anaemia, and if refused due to cutbacks I'll pay for a test. Nothing to prove a reason for concern.

It's fantastic that your iron tablets have made such a difference to your breathing and tiredness. I take several supplements as a precaution, including 60 mg iron daily, but my tiredness is just there, it's more like a drained feeling. It's an enigma, a complete mystery - but life goes on, does it not!
 

faujidoc1

Member
Messages
11
Type of diabetes
Parent
Treatment type
I do not have diabetes
Hi Everyone!
I am a doctor and a parent of a T1, my daughter who was diagnosed just 5 days ago after going into DKA while on a trip to NY.
Reached here while searching for an answer to the tiredness she is experiencing, even though her levels are now 'better' on paper.
So just a thought which struck me and perhaps someone could check up on...

A normal person needs about 300 gms of carbs to feel active and healthy (2000 Cal daily requirement). Less than this and they get tired and irritable after a few days. Just see what happens to normal people who Starve for some reason.
In a T1, irrespective of the BS level, what matters is how many actionable carbs the body is actually receiving.
So if one is actually receiving less than 300 gms of actionable carbs, one will feel tired ... No matter if BS is normal.
So a possible solution may be to up the carb allowance as well as the insulin dose, getting more actionable carbs through, while maintaining the BS levels near normal???

Nothing in the books about this at all, nor is this professional advice, it's just a theory by a concerned parent!
 

librarising

Well-Known Member
Messages
1,116
Type of diabetes
LADA
Treatment type
Insulin
Hi Everyone,

A little confused by differing opinions on tiredness for type 1s. I am very tired a lot. I have no underlying conditions and no deficiencies and sleep and eat fine. My sugars are largely under control aside from the odd blip or really hot weather like we have just had. My DSN has said that its just part of the condition which is totally ok but.....when on this forum, people tend to say that we shouldnt be tired just because of diabetes so I am a bit confused.

Do any of you suffer this tiredness with no other explanations? Ive read up on it and fatigue has been attributed to type 1 even when well managed so not sure why thats not more commonly said in other threads.
My experience is that over a decade ago I started getting tireder and tireder. Even went to the GP, standard blood tests, nothing wrong with you blah blah blah. Continued to get tireder.
12/2011 got dx'd diabetic.
05/2012 GP (at diabetic review) agreed to test for thyroid antibodies. Positive result. Crickets ...
02/2013 after writing to GP and asking to be referred, saw consultant who started me on levothyroxine. Started to see improvement of my tiredness.

T1 is an auto-immune condition.
Thyroidism can be auto-immune.
Auto-immune conditions often co-exist
https://www.ncbi.nlm.nih.gov/pubmed/21121384

**WARNING** many GPs test for TSH. If within range, you'll get told you're fine ! I had to push all the way.
Perhaps read up about subclinical hypothyroidism.
Good luck with pursuing this,
Geoff
 

librarising

Well-Known Member
Messages
1,116
Type of diabetes
LADA
Treatment type
Insulin
My experience is that over a decade ago I started getting tireder and tireder. Even went to the GP, standard blood tests, nothing wrong with you blah blah blah. Continued to get tireder.
12/2011 got dx'd diabetic.
05/2012 GP (at diabetic review) agreed to test for thyroid antibodies. Positive result. Crickets ...
02/2013 after writing to GP and asking to be referred, saw consultant who started me on levothyroxine. Started to see improvement of my tiredness.

T1 is an auto-immune condition.
Thyroidism can be auto-immune.
Auto-immune conditions often co-exist
https://www.ncbi.nlm.nih.gov/pubmed/21121384

**WARNING** many GPs test for TSH. If within range, you'll get told you're fine ! I had to push all the way.
Perhaps read up about subclinical hypothyroidism.
Good luck with pursuing this,
Geoff
Final line from the linked study :
"Thyroid auto-immunity is frequently associated with type 1 diabetes mellitus and patients should undergo antibody screening to detect the same and to find out assosiated undiagnosed thyroid dysfunction."
Geoff
 

Lynz84

Well-Known Member
Messages
344
Type of diabetes
Type 1
My experience is that over a decade ago I started getting tireder and tireder. Even went to the GP, standard blood tests, nothing wrong with you blah blah blah. Continued to get tireder.
12/2011 got dx'd diabetic.
05/2012 GP (at diabetic review) agreed to test for thyroid antibodies. Positive result. Crickets ...
02/2013 after writing to GP and asking to be referred, saw consultant who started me on levothyroxine. Started to see improvement of my tiredness.

T1 is an auto-immune condition.
Thyroidism can be auto-immune.
Auto-immune conditions often co-exist
https://www.ncbi.nlm.nih.gov/pubmed/21121384

**WARNING** many GPs test for TSH. If within range, you'll get told you're fine ! I had to push all the way.
Perhaps read up about subclinical hypothyroidism.
Good luck with pursuing this,
Geoff
Thanks Geoff! Definitely will as thyroid runs in my family so will push a wee bit harder just in case!
 

Lynz84

Well-Known Member
Messages
344
Type of diabetes
Type 1
Hi Everyone!
I am a doctor and a parent of a T1, my daughter who was diagnosed just 5 days ago after going into DKA while on a trip to NY.
Reached here while searching for an answer to the tiredness she is experiencing, even though her levels are now 'better' on paper.
So just a thought which struck me and perhaps someone could check up on...

A normal person needs about 300 gms of carbs to feel active and healthy (2000 Cal daily requirement). Less than this and they get tired and irritable after a few days. Just see what happens to normal people who Starve for some reason.
In a T1, irrespective of the BS level, what matters is how many actionable carbs the body is actually receiving.
So if one is actually receiving less than 300 gms of actionable carbs, one will feel tired ... No matter if BS is normal.
So a possible solution may be to up the carb allowance as well as the insulin dose, getting more actionable carbs through, while maintaining the BS levels near normal???

Nothing in the books about this at all, nor is this professional advice, it's just a theory by a concerned parent!
Hi faujidoc1!

How is your daughter feeling? Coping ok? Hope she recovers well!
You have posed an interesting theory but maybe this is me being stupid (apologies) but what are actionable carbs? X
 

faujidoc1

Member
Messages
11
Type of diabetes
Parent
Treatment type
I do not have diabetes
Hi faujidoc1!

How is your daughter feeling? Coping ok? Hope she recovers well!
You have posed an interesting theory but maybe this is me being stupid (apologies) but what are actionable carbs? X
Thank you so much for your good wishes @Lynz84!
My daughter was discharged today morning.... recovering well, with God's grace.
I guess my post shows you all just how little we 'experts' know.... Being unable to answer questions like this one, we tend to dismiss/ avoid discussion.
This really hits home when disease affects the doctor personally!
But back to my theory... Please keep in mind that it is just a stab in the dark and not in any sense true!

See, insulin is required for the T1 diabetics body cells to actually use glucose, else the body is in starvation mode even though there is excess glucose in the bloodstream.
For want of any suitable term, I am calling these carbs which are actually getting through into the cells as 'Actionable carbs'. The quantity of these will depend on the amount of insulin available to the cells, irrespective of blood sugar.
If the T1 keeps the total insulin dose too low, the number of Actionable carbs will be restricted. If at the same time the diet is also restricted, blood glucose may fall into normal range, even though the actual amount of glucose(energy) available to the body is less than optimal-- ergo, tiredness!
Perhaps it may be overcome by allowing more carbs in the diet while simultaneously increasing insulin to keep the BS in range???
We calculate the basal insulin depending on the patients body weight and estimating their requirement but perhaps we are not adequately accounting for individual variation in drug response?

BTW, I tried discussing this theory with my endo colleague but got the brush off!
 

Scott-C

Well-Known Member
Messages
2,474
Type of diabetes
Type 1
My daughter was discharged today morning.... recovering well, with God's grace.

That's good, fauji. Welcome to the forum. DKA is a serious assault on the body and takes a while to recover from. Her tiredeness is due to recovering from the dka. I've only been dka once, at dx (it really didn't help that I'd been taken to hospital severely ill and been sent home with a diagnosis of "exam stress". They took it a bit more seriously when I was taken back the next day unconscious - the junior doc got a b*llocking! He came up to say sorry, so fair do's). I was 21 but toddling about like a pensioner for a while till I recovered.

Like I say, only been dka once in 29 years: it's relatively easy to avoid if one pays attention to glucose levels, so don't worry that it's going to happen a lot. Of course, if no attention is paid to bolusing, or she goes into denial, that's a different story - dka can develop remarkably quickly if no insulin is taken.

Dx is normally a big shock, but there's plenty of folk on this site who'll testify to going on to live relatively unrestricted lives, provided they have a think about how much insulin for each meal - that sounds tedious but it becomes second nature after a while. Me? I've been away backpacking for months on end, ski-ing, sailing, cycle-touring, wild camping. You can be reassured your kid will not be hindered to any real extent by this provided she learns the basic T1 rules and fits them into her life.

I'd encourage you to not over-analyse the carb amount aspect. There's enough to get to grips with in the early days without being told that serious adjustments need to be made to normal eating routines (there's obvious exceptions - diet drinks only, not sugar ones, and lay off the snickers and doughnuts!).

There's a place for lchf, keto, etc., but those are choices which can only be made after a bit of experience.

I don't regard myself as a low carber, but I think you're way overstating 300g as a requirement. I get by quite happily on way less than that without feeling tired - frequently about 100g to 130g per day or less (I'm about 70kg, been there or there abouts for decades). I don't do low carb meals by design - sometimes I just fancy some chicken broth with some toast to dip, then some lamb chops, then raspberries, and hey presto, it's technically a low carb meal. That and whatever else I eat that day would take me nowhere near your suggested 300g, but I've never felt remotely famished or tired doing that. It's the calories more than the carbs. Fat has more energy per g than carbs. At the same time, if I fancy a bowl of tortellini or lasagne, I'll have no qualms about eating those either, because I know how much insulin to take for it.

In short, while I would never criticise some T1 food regimes, as it's all a matter of personal choice (even though I would regard them as too restrictive for my lifestyle), I think it is important for newly dx'd to appreciate that they can, within reason, with moderation, eat a fairly unrestricted and varied diet and have decent energy levels without sticking to a definite number of carbs, whether that be 30, 100, or 200.
 
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faujidoc1

Member
Messages
11
Type of diabetes
Parent
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I do not have diabetes
I'd encourage you to not over-analyse the carb amount aspect.
I don't regard myself as a low carber, but I think you're way overstating 300g as a requirement.

The 300g carb/day is the US FDA recommendation for a balanced diet for a normal healthy adult taking 2000 Cal/day. I don't mean to suggest that this number is inviolate or necessarily correct for a diabetic.
Of course, many people are fine with much less, and this is especially true for diabetics.... No argument there!
Yes, tiredness after starting insulin and normalizing BS could be due to the effect of stress hormones, associated thyroid or vitamin deficiency etc.
Yet there are many reports on this forum, such as that of the OP who have tiredness for years, for no obvious cause. All investigations are normal, they are not in depression, their BS is well controlled...So why?
I also read a few reports where people switched the basal insulin from Glargine to Determir (and vice versa too) and the tiredness vanished! This lead me to think that in those having tiredness for no obvious reason, perhaps the response of the body to insulin is the reason.
Does the tiredness indicate insufficient calorie intake? If the T1 is taking sufficient calories orally (I won't quibble over the carb/protein/fat ratios) ... then does the tiredness indicate the insufficient uptake of the ingested calories due to a relative deficiency in the action of the basal insulin in this particular person? Remember, insulin is required for the cells to actually be able to metabolize glucose, irrespective of whether the glucose came from carbs, protein or fat. Switching the type of basal insulin would then entail a different drug response and perhaps better relative efficacy.... This would explain why some people cured their tiredness by switching the insulin.
Another way might be to increase the dose of insulin to make more calories 'available' to the body. But that would lead to dipping BS, which would have to be offset by increasing the intake of carbs/ protein/fat... I chose carbs as it was the easiest way to explain without getting into the nitty gritty of gluconeogenesis!
Like I said, only a theory... I was just trying to figure out why an apparently perfectly treated T1 with no other identifiable comorbidity should feel tired for years.
Peace!
 

rosedreams

Member
Messages
18
Type of diabetes
Type 1
Treatment type
Insulin
Hello faujidoc1, I hope your daughter continues to recover well, and I like what Scott-C said about adapting and managing to live a full life despite the blasted T1, he's so right.

I do have unexplained tiredness and have had several trials of different insulins, and to be perfectly frank I remember becoming intensely more aware of the tiredness when I became a guinea pig for human insulin at the Institute of Child Health, London in 1981. Perhaps going from ox insulin (since 1974 aged 5) to human, triggered something in my body?

I not eat more than 120 gm carbs a day even in my 20s, and now it's 30g a day, that works for me. I feel better with less carbs. All diabetics are different, we don't have the same height, weight, stamina or routine. It's a matter of finding what suits best.

The dieticians who used to guide me as a kid and teenager insisted on carbs, and what used to be considered 'essential' never really was, it was trial and error for me. I remember being told off by an obese dietician once when I was 7, she read my BS results that I wrote in my little book and tried hard to keep stable, she waved her finger at me and told me to 'stop being naughty with food" and to eat my carbs properly, whatever that meant, and I saw her two packets of Jaffa Cakes on the desk and thought "How dare you, at least I don't need Jaffa Cakes to work in an office!" even though I was obviously still at school and not working. But it did make me angry, her presumptive cockiness.

Having learned what's better for me over the years, my metabolism is more compatible with less carbs, and I know I'm not defficient in nutirents or protein/calcium/B12 etc.., from tesrs, and my food intake revolves around vitamins and nutrients.

I used to do a lot of rock climbing, mountain hikes, cycling etc.., so rock on Scott-C in the great outdoors! I only cycle daily now, I spend a lot of time on my work and despite moaning about tiredness I think I'm lucky, very lucky, especially when I see far worse health problems afflicting other people.

I don't think for one minute every T1 diabetic should feel tired, I get tired, but it doesn't stop me from wanting to live my life, so I accept it because multiple tests, and research told me there's nothing 'wrong' with me so I had to accept it.

Please take this with the utmost respect from me: it's a blessing that your perspective on Diabetes has been enhanced and personalised because of your daughter; we need more doctors to truly feel the reality of diabetes when they talk about it with us.

If more doctors knew the true ins and outs of it, living with it, there'd be far more changes in how its dealt with by the professionals. I mean changes such as talking to a newly diagnosed patient using positive, encouraging words like those of Scott-C about your daughter's diagnosis. Encouraging, not going on at you about everything that could go wrong, or making her fear its consequences before she's even adjusted to it . Not looking at it as a death sentence and prescribing restrictions for life. I've had doctors and specialist nurses predict things for me that would make someone want to jump off a cliff, casually saying things they 'assume' happen to all diabetics as a final scenario, making the mind fear the worst and dread the day of reckoning, whereas I've always tried to grab life by the horns and consider myself a self-regulating active diabetic living fully and healthily. OK, a bit tired, it's not debilitating, and nobody needs extra doom and gloom at the clinic about what is essentially their life.

Wishing your daughter a beautiful life - she will be a strong survivor - and wishing you the peace of mind and strength that every loving parent deserves.
 
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faujidoc1

Member
Messages
11
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Parent
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I do not have diabetes
Thank you ever so much for your support, rosedreams and Scott-C! I am still wrapping my mind around my daughter's diagnosis.... and you are right rosedreams, one's perspective totally changes when it becomes personal rather than professional.
In my opinion, a person living day in and out with a disease is far more expert and experienced about it than we healthcare professionals can ever hope to be! We need to work together, merging professional knowledge with personal experience to find solutions.
This issue of long term tiredness in otherwise well T1s is an example of the patient-professional disconnect..... Professionals feel 'no big deal, after all you are sick' and patients feel frustrated by the dismissive attitude of their healthcare provider to what they are personally experiencing.
You can be sure MY perspective has radically changed for the better. Hopefully, over the next few years I can learn more about diabetes and we can all work together to defeat it.