Diabetes fatigue?

Hi @Shannon27 sorry but supplements and vitamins are not going to be effective for you in getting your blood glucose levels down, you need to work on those numbers by using your insulin to manage your levels. Having excessive glucose in your system is going to give you brain fog and make you tired and by using a correction dose of quick acting you will help your body manage the glucose more efficiently. Do you know why you're struggling to keep your levels down ?

Hi Shannon27
I do sympathise.
As a driver myself I wouldn't want to do the regular long journeys you do.
High readings are as dangerous as low ones but for different reasons and you appear to be suffering from tiredness caused by highs.
How long before journeys do you test?Are you able to do so at work?
Do you work Monday to Friday and if so is it worse on Thursday/Fridays?
Yes you need to bring your levels down but look at the other factors too.
You might just be knackered and it not be your diabetes at all?

Passengers in my car often moan as I don't use the heater and this is partly due to coldness keeping me more alert?
Loud music?

A few things to consider and I wish you well.

Tony

Whilst your HbA1C indicates a need to reduce your BG overall, I assume your immediate concern is a high BG whilst driving.
Can you do anything before/during your journey to avoid the high BG over the 50 miles? For example,
- take a BG reading 30 minutes before you set off and give yourself a corrective dose
- avoid eating high carby meals before you drive
- relax whilst driving ... not too much though As you mention, stress will raise your BG: this is both long term stress (such as your job) as well as long term stress (such as that plonker changing lanes in front of you without indicating). Listening to music/plays/comedy whilst driving may help.
- driving at a different time when there are less cars on the road. Yeah, I know that one's a stretch but some employers may be sympathetic and allow you to adjust your work hours to avoid the traffic
- an alternative to driving. This does not have to be the whole journey. It could mean driving to a train station and catching the train or parking a mile from your place of work and walking the last mile (the additional exercise could help with reduce the stress of work at the end of the day).

I wouldn't recommend topping up on coffee. I used to have a 200 mile (each way) weekly commute and used red bull to stay alert. I wouldn't recommend it: the extra caffeine made me cranky later and affected my sleep which added to my stress.

Hi @Shannon27 Don't be afraid of taking the 'correct' correction dose, it takes around 10-20 minutes to start working and the maximum effect lasts around 1-3 hours, so after taking your correction plan a stop say 30-40 minutes into your journey to do a test, this will help your confidence as well as checking you are ok to continue your journey, the more confident you get the more likely you will be able to manage your glucose levels better, unfortunately running high is counter productive so getting back into single figures is really important.

Shannon27 said:

Thanks @Juicyj I need to get myself into a routine, it will take time but hopefully I'll reap the rewards of being a confident driver again in the end! My journey is normally around 1 hour so I may start doing this next week.
Speaking of corrections, what's the standard correction dose? I know it varies on the person but I'm currently working on 1 unit to 4 grams of carbs, and 1 unit for every 2mmol above 7 when I check. Seems an awful lot compared to a lot of people?

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That does seem a bit high. I take 1 unit/6g carbs (this has been changing a lot recently due to exercise) and for corrections, 1 unit will drop me by 4mmol/L. I think most people have a 1:3 ratio (1 unit drops them by 3), or at least that was what I was told in pump training.

Hi @Shannon27 Sometimes with managing type 1 it feels easy to slip into a comfortable routine which may be detrimental to your blood glucose levels, so taking more a proactive approach will help you feel more confident and in control, if you taking a correction dose and are stopping to do a test then you are limiting the opportunity of going hypo whilst driving and you will also know where your levels are so giving you the chance to take action if necessary. Your correction dose is something you need to discuss with your nurse/consultant as it's completely unique to you, for a guide use the 100 rule:

So divide 100 by your total daily dose (TDD - which includes basal and bolus), this will give you the amount that 1 unit of insulin will drop your BG by, for example if your TDD is 80 units then it would be 100/80 so works out 1 unit of insulin = 1.25 mmol/l drop.

Using a pump is fine for freedom of movement but generally your team will want to see that you are already managing your MDI routine well first, using a pump doesn't automatically ensure you will get good BG levels, it requires effort and input from you to manage it, you only get out of it what you put in, so if you are keen to go down that route then you need to showing better control now.

Have you thought about trying the Abbott Libre to review your t1 management ? It's a useful too for seeing the effect of carbs/insulin on your BG levels, as well as spotting trends, it's useful for driving as you simply scan your sensor so would take some of the stress out of the driving, could be a useful tool in reigning in those high BG levels.

U

Shannon27 said:

I think a lot of it is stress, as I noticed when I went away recently that my sugars were much better behaved. They stayed that way for a while after I got home and started working again, and I felt a lot more alert. I've considered insulin resistance, as I was diagnosed at 4 years old, I'm now 21. Considering changing from Novorapid to Fiasp, as it sounds like it may be more effective for me. Recently changed from Lantus to tresiba and noticed a change almost immediately. Might be a load of rubbish but I'm willing to give it a try!

Shannon27 how did you find the change from lantus to tresiba in terms of dosing? Thanks

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Shannon27 said:

I've suffered from what I believe was diabetes fatigue for a while now, never wanting to admit that it was to do with my diabetes. It started when I noticed myself getting drowsy on the long journey to work, but when I pulled over to check my readings, they were high.

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I don't think you're suffering from "diabetes fatigue". But tiredness is a symptom of hyperglycaemia. A hba1c of 82 translates to an average blood sugar of 12.8, which is definitely hyperglycaemic. What sort of numbers do you see when driving and test to see high readings?

I would initially consider stress and qty of driving. You are young and is there any chance of changing your job to nearer home and less stress?

I agree with your thoughts on not correcting pre driving. I almost lost my licence from a hypo whilst driving... so know the angst that can cause.

However, I would explain all of your lifestyle to Consuktant/DSN and ask for help... either changing to tresiba for background or a pump. I got a pump Immediately after my driving incident and was fantastic.
Saying that, a pump needs management and time and needs to be able to fit into your life. You need to know how to adjust and be willing to manage it alone after training.. ie you can have hourly basal rates-but its down to you to set them and to manage them after training. You need to be able to give time to looking at your trends, basal testing initially and ongoing occasionally.

You need to address tge reasons why your levels are high? Is it because of fear of hypo's, dont know how to basal test, no time made to ubderstand and persevere at getting levels lower?

Get the book "think like a pancreas" and start by addressing one thing at a time.. do some basal testing. Perhaps on workdays you may need more background insulin than on days off/holidays etc..

Tiredness can be linked to high levels. I take it that you have had your b12 and folate checked and D3?

Shannon27 said:

@phdiabetic I've been considering the pump, what it like for freedom of movement etc?

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I really like the pump! I've had it for almost a year now and it's made my diabetes management so much easier (my basal is very different at different times of day, and I need to turn it off completely to exercise). The only complaint is that sometimes it gets an air bubble/bent cannula/other weird stuff gone wrong and so you get really high and can't figure it out. But that doesn't happen too much. It doesn't get in the way and unless I'm using it I hardly notice it's there.

To get a pump you need to address highs though and tried everything.

People with high levels are less likely to get than those with hypo's. A previous consultant of mine would not give a pump to someone who had a dka within 12 months.

Some consultants do give but they will want you to have tried different mdi regimes and really put effort in to reducing levels down.

Shannon27 said:

I've suffered from what I believe was diabetes fatigue for a while now, never wanting to admit that it was to do with my diabetes. It started when I noticed myself getting drowsy on the long journey to work, but when I pulled over to check my readings, they were high. Blood tests have come back clear, I'm not suffering from anemia and i dont have any vitamin and mineral deficiencies. I've since had several near misses on the way to work, pulling over each time to check and each time I've been high. My hbA1c at last check was 82, which I'm working to get down with more frequent checks and a better diet. In the meantime I'm getting drowsy every time I make the 50mile journey to and from work. Can anyone recommend anything short term, supplements, vitamins etc that may be able to help me while I work at getting my A1c down?

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Reading what you're going through is exactly what I have been going through for years. I am sorry to say no solution has ever been found. You must try not to put too much pressure on yourself to manage things which are beyond your control. Try to keep things simple, if you need to rest, go to bed , the most important thing is making your employer understand what your conditions entail, they will be a lot more helpful if your honest.