Fatigue/ aches/ exhaustion

[AndyStein]

I‘m an unmedicated 61 yo T2 man…My weight is stuck around 16 stones +

Over the winter my glucose got way out-of-control, but I have wrestled my values down to beween 7mmoll and 12 mmo/l through diet and exercise, In fact, my morning ’highs’ are lower than ever and I am not excreting sugar in my urine anymore and most typical symptoms - hunger, blurry eyesight, desire to pee and such-like - are largely resolved.

However….

I get regular bouts of exhaustion/ fatigue with terrible muscle aches and joint discomfort. This is really debilitating. Any ldea why, and what I can do about it? Is it likely a diabetic trait or possibly something else (my Thyroid TSH value was tested fine today)?

Should I perhaps add a bit more carbs to my diet and exercise more? Or is it time for medication… I am finding weight loss particularly difficult now, even though I have cut-out alcohol, calorific drinks and largely all cereal-based carbs like bread…

Also, I have just ‘shaken-off‘ a terribly chronic sinus and ear problem which lasted months and wondered whether this might have been a fungal candida type issue ?

Any feedback would be gratefully received, especially regarding the body aches and the sinus problem

 

[TriciaWs]

What do you eat in an average day, and how many carbs do you aim for? Do you have recent data for before and then 2 hours after meals?

 

[AndyStein]

What do you eat in an average day, and how many carbs do you aim for? Do you have recent data for before and then 2 hours after meals?

Over the winter my food intake including ridiculous milkshakes and sweet yoghurts was out of control, as were my sugars. Now I have cut carbs and I eat frugally with small portions and exercise alot. This brought me down from around 20mmol/l or more, to no more than 12mmol/l (maximum) 2 hours after a meal. In fact, I find I am around 7mmol/l to maybe 10mmol/l most of the time and have none of the old symptoms, but I get hit by this awful aching bodily fatigue. I wonder if it is a sort of false hypo-like situation which comes about through my much reduced calorie intake (???). I had it today, went for a walk feeling really cruddy and came back feeling much better….Explain LOL

I have even considered thyroid issues, stress or dehydration (?)

 

[ajbod]

Forget the concept of calories, all that matters is carbohydrates. Your ear infection would have had an impact on your blood sugars. If you are prediabetic, those readings are far too high, so i would suggest seeing your doctor.

 

[AndyStein]

The concept of calorific energy is vitally important when the thread discussion is speciifically on fatigue and muscle aches…I would imagine you cannot suddenly starve yourself of energy without some symptomatic evidence….I agree my values are too high but very much improved and I am seeing the diabetic nurse at the end of the month, but my initial question was about having bouts of muscle ache and pains, which your kind response hasn’t really touched upon….I have no typical symptoms of diabetes anymore, which I explain in my first posting albeit I do agree I have to get my sugars down further, ideally through further weight loss. Do you know anything about such a sudden onset condition in relation to diabetes, involving arthritis-like aches? It may for instance be dehydration-related…

 

[JoKalsbeek]

I‘m an unmedicated 61 yo T2 man…My weight is stuck around 16 stones +

Over the winter my glucose got way out-of-control, but I have wrestled my values down to beween 7mmoll and 12 mmo/l through diet and exercise, In fact, my morning ’highs’ are lower than ever and I am not excreting sugar in my urine anymore and most typical symptoms - hunger, blurry eyesight, desire to pee and such-like - are largely resolved.

However….

I get regular bouts of exhaustion/ fatigue with terrible muscle aches and joint discomfort. This is really debilitating. Any ldea why, and what I can do about it? Is it likely a diabetic trait or possibly something else (my Thyroid TSH value was tested fine today)?

Should I perhaps add a bit more carbs to my diet and exercise more? Or is it time for medication… I am finding weight loss particularly difficult now, even though I have cut-out alcohol, calorific drinks and largely all cereal-based carbs like bread…

Also, I have just ‘shaken-off‘ a terribly chronic sinus and ear problem which lasted months and wondered whether this might have been a fungal candida type issue ?

Any feedback would be gratefully received, especially regarding the body aches and the sinus problem

Your blood sugars are still pretty high, and being above 8,5 regularly can indeed induce severe fatigue. (The kind where you can barely lift a fork) You mention starving yourself of energy, but if you drop carbs, you're supposed to give your body other fuel to go on, like fats and protein... Just an adjustment in proportions, not just cutting it out and not replacing it. The higher blood sugars can also explain why the infection just wouldn't go away. Those thrive on glucose in blood and sweat, whether it was a bacterial or fungal issue. So, no I wouldn't advise tossing more carbs in there... That's putting out the fire with gasoline, to quote Bowie. It's better to have one or two proper, filling meals a day rather than have frugal little bits and pieces several times a day, as your pancreas never gets to rest if you keep eating throughout.

Keep in mind though that when there are problems with muscles and joints, you might want to get checked for rheumatoid type conditions and vitamine D deficiency. It's easy to just blame everything on the high blood sugars, but there might be something else going on as well. Don't let it go if you don't find a solution soon-ish.

 

[Robbity]

Cutting carbs does not (necessarily!) mean cutting calories. Are you still eating enough protein, and have you increased your fat consumption to be your main source of fuel for energy now that you've cut down on your carbs?

 

[ajbod]

High blood sugars are inflammatory, and could easily be your cause of aches, pains and fatigue. These don't necessarily occur at the same sugar level in everyone. We are not machines, and the calorie in calorie out concept is flawed.
Diabetic fatigue, if that is what you are suffering, is caused by the cells being starved of energy, due to Insulin resistance. That is the overriding symptom in type 2 diabetes, why our blood sugars are high in the first place. Reducing our carb intake, reduces our sugars, but we need to compensate for the energy deficiency with Proteins and good fats. By reducing our sugars, Insulin resistance usually improves a bit, allowing more of what we eat into the cells.

If you can go low enough on the carbs, your body adapts to fat burning much better. At a cellular level we are dual fuel entities, Glucose, of which we have a problem utilising, and the excess has to be peed out , or stored away as fat. And Ketones which are no such problem, in fact when properly fat adapted, we are then in a position to use that flawed calorie counting, to force our bodies to use its own fat stores. This is how primates evolved to survive feast and famine.

If you are having false hypos, it is because your body has been used to much higher sugar levels, and is panicking, trying to get you to eat, to raise your levels to what it thinks they should be. But we know that figure is out of whack, and needs resetting back to or as close to the normal, 4 to 6ish as we can get, again we're all different, and will have a variety of outcomes. Whilst our bodies think we need higher sugar levels, our Livers are producing Glucose to raise it, making it even more important to get that "normal level" back again.

To lose weight, you have to be fat adapted, or at the very least to have greatly reduced your Insulin blood level. This is the hormone that stores fat, and more importantly where weight loss is desired, stops its usage. The only way to have any idea of your Insulin level, is your blood sugar level, type 2s are hyperinsuliemic. We over produce, to try to combat the sugar levels, this in itself causes more Insulin resistance. Each time we eat anything, the saliva we produce contains Amylase, a signalling chemical that tells the pancreas to release Insulin. this happens with fat and protein as well as carbs. But the digestion of carbs causes a second higher release of Insulin. this is the underlying reason many of us eat low carb, again a very arbitrary figure, we are all different, and require various different levels to suit OUR own bodies. Without really thinking about it, our goal is actually to reduce the Insulin level.

Exercise helps with sugar levels, but pales into insignificance compared to restricting carbs, and using what evolution gave us as a tool to survive. It gave us another tool, that if calories are restricted for too long, our metabolism shuts off non essential processes to save fuel. Then your calorie reduction becomes the new normal, and weight loss stops.

Most of your problems could be explained by inflammation due to high sugar levels, but we cannot diagnose, they may be something else, hence my saying you need to see your doctor. your profile says prediabetic, but your figures say something else. so an Hba1c test is needed i think.

Either way, we are all here to help, we cannot diagnose, but we do have experiences we can pass on.

One last comment, FORGET EVERYTHING YOU WERE EVER TOLD ABOUT HEALTHY EATING. As a type 2 diabetic, they are totally wrong.

 

[AndyStein]

This is a very kind and pitched perfectly to my level, thanks !

So, I am aware that my recent bouts of aches and fatigue could be either the adoption of my rather strict keto-style diet or periods of glucose highs. You have re-enforced all that in your excellent commentary (above), so thanks again.

I understand it is all relative, and each person has differing tolerances and symptoms. I like the inflammation verdict very much, since my condition is reminiscent of flu-like symptoms. I have been bed-ridden with ithis and it responds well to ibuprofen and naproxene. This makes sense.

Until I consider other factors and scenarios….Including the fact my glucose levels have been significantly lower of late….Both highs and lows.

So, this takes me back to the false hypo situation and struggling with bodily aches at ‘low’ levels. Take today for instance. I took the train to Cambridge and went to the Zoology Museum. Places were too busy to sit down and eat, so I ended up having two flapjacks for lunch ! Very definitely not my normal routine, but they were fibre-rich - which is at least something - but nonetheless, sweet. No idea what they did to my molar blood glucose but on the train a few hours later I started with the dreaded aches. So, I thought, maybe this is a case of the ‘flapjack highs’. However, when I got home my sugars were an amazing 7.5mmol/l - which to most might seem unacceptable, but is presently a very good low for me. So, either I had late onset lag inflammation from my earlier sweet lunch….Or, I am feeling rough when my values are low (for me)…

I will resolve this by recording my sugars every hour or two and generating an excel graph indicating periods when I feel rough. Then try to achieve some form of meaningful correlation between values and symptoms.

i also think that an exercise regime after each meal and before bed will help alot. I often feel achey in the morning on awakening. Which confuses the issue yet more, since I have often dumped glucagon/ glucose from my liver and tissue at night and have morning highs. So, that once again suggests inflammation is at play ! Holey-moley.

Anyway, enough of this waffle. More data needed ! I also note my eyesight now gets blurrier when my sugars are lower, not higher…Ohh cripes. One thing that can be said for diabetes is that it is a tricky and somewhat unpredictable beast to read. DATA needed !!!

Once again, thanks…Your help is very much appreciated….

 

[AndyStein]

Your blood sugars are still pretty high, and being above 8,5 regularly can indeed induce severe fatigue. (The kind where you can barely lift a fork) You mention starving yourself of energy, but if you drop carbs, you're supposed to give your body other fuel to go on, like fats and protein... Just an adjustment in proportions, not just cutting it out and not replacing it. The higher blood sugars can also explain why the infection just wouldn't go away. Those thrive on glucose in blood and sweat, whether it was a bacterial or fungal issue. So, no I wouldn't advise tossing more carbs in there... That's putting out the fire with gasoline, to quote Bowie. It's better to have one or two proper, filling meals a day rather than have frugal little bits and pieces several times a day, as your pancreas never gets to rest if you keep eating throughout.

Keep in mind though that when there are problems with muscles and joints, you might want to get checked for rheumatoid type conditions and vitamine D deficiency. It's easy to just blame everything on the high blood sugars, but there might be something else going on as well. Don't let it go if you don't find a solution soon-ish.

Good advice. Thanks. What fats do you recommend? Not sure my hiatal hernia likes this sound advice I am having my thyroid checked out…My TSH seems OK, but I am having T4 thyroxine done as well. I have often wondered about rheumatoid arthritis.

 

[JAT1]

I have had periods in my diabetic past in which my diet was high-carb - after a month-long hospital stay and the recommended 'diabetic' diet was rich in carb; so I know I get joint inflammation in my hands to the point where I can hardly move them. My sister has rheumatoid arthritis and is not diabetic at all and she has serious pain and inflammation caused by sugar. Carbs convert quickly to sugar, so are difficult for non-diabetics as well.

 

[JoKalsbeek]

Good advice. Thanks. What fats do you recommend? Not sure my hiatal hernia likes this sound advice I am having my thyroid checked out…My TSH seems OK, but I am having T4 thyroxine done as well. I have often wondered about rheumatoid arthritis.

Just "healthy" fats.... Fatty fish for instance, like salmon. Butter (steer clear from margerine if possible), olive oil, avocado's. Chicken thighs with the fat still on, meats with naturally occuring fats, cheeses... I don't know whether those things would aggravate reflux and such related to the hernia, but all in all... If it's not overly processed, it's usually a-okay.

 

[ajbod]

I would say avoid margerine at ALL COSTS.
I suffer from bad reflux, and have nearly died 5 times in the past from aspiration whilst sleeping. I do take a PPI for it, which works really well, and my high fat diet has no affect on me at all, in that respect. likewise my diverticular disease should be worse because of high fat, but guess what, greatly improved.

 

[Bludnok]

This is a very kind and pitched perfectly to my level, thanks !

So, I am aware that my recent bouts of aches and fatigue could be either the adoption of my rather strict keto-style diet or periods of glucose highs. You have re-enforced all that in your excellent commentary (above), so thanks again.

I understand it is all relative, and each person has differing tolerances and symptoms. I like the inflammation verdict very much, since my condition is reminiscent of flu-like symptoms. I have been bed-ridden with ithis and it responds well to ibuprofen and naproxene. This makes sense.

Until I consider other factors and scenarios….Including the fact my glucose levels have been significantly lower of late….Both highs and lows.

So, this takes me back to the false hypo situation and struggling with bodily aches at ‘low’ levels. Take today for instance. I took the train to Cambridge and went to the Zoology Museum. Places were too busy to sit down and eat, so I ended up having two flapjacks for lunch ! Very definitely not my normal routine, but they were fibre-rich - which is at least something - but nonetheless, sweet. No idea what they did to my molar blood glucose but on the train a few hours later I started with the dreaded aches. So, I thought, maybe this is a case of the ‘flapjack highs’. However, when I got home my sugars were an amazing 7.5mmol/l - which to most might seem unacceptable, but is presently a very good low for me. So, either I had late onset lag inflammation from my earlier sweet lunch….Or, I am feeling rough when my values are low (for me)…

I will resolve this by recording my sugars every hour or two and generating an excel graph indicating periods when I feel rough. Then try to achieve some form of meaningful correlation between values and symptoms.

i also think that an exercise regime after each meal and before bed will help alot. I often feel achey in the morning on awakening. Which confuses the issue yet more, since I have often dumped glucagon/ glucose from my liver and tissue at night and have morning highs. So, that once again suggests inflammation is at play ! Holey-moley.

Anyway, enough of this waffle. More data needed ! I also note my eyesight now gets blurrier when my sugars are lower, not higher…Ohh cripes. One thing that can be said for diabetes is that it is a tricky and somewhat unpredictable beast to read. DATA needed !!!

Once again, thanks…Your help is very much appreciated….

Flapjack anticipated high ... possibly offset by lots of walking if you were at the Zoology Museum? That certainly affects my trends.