Controlling Diabetes & Low Energy Diabetic

by Jennifer




Quick Answer
Extreme tiredness, nausea and being very difficult to wake are not symptoms to manage with juice, soup or exercise alone. In a person using insulin who has survived four heart attacks and triple-bypass surgery, these symptoms could reflect severe low or high blood sugar, a heart problem, sleep apnea, kidney disease, anemia, infection or medication effects. If he is currently difficult to wake, confused, fainting, having chest discomfort, shortness of breath or sweating, seek emergency help now.


Answer by Dr. Albana Greca, MD, MMedSc



Hi Jennifer,



Your boyfriend’s symptoms require prompt medical assessment. Diabetes can contribute to fatigue, but it should not be assumed to be the only cause. His unusually young age, repeated heart attacks, bypass surgery, insulin use, nausea and episodes when he is hard to awaken make this especially important.



What to Do If He Is Difficult to Wake



If he is difficult to wake now, check his glucose immediately if this can be done without delaying emergency care.




  • If he is awake and can swallow safely and glucose is below 70 mg/dL, give 15 grams of fast-acting carbohydrate and recheck after 15 minutes.

  • If he is unconscious, having a seizure, unable to swallow or too confused to treat himself, do not give food or drink by mouth.

  • Use glucagon if it is available and you know how to administer it, then call emergency services.

  • If glucose is extremely high with vomiting, abdominal pain, deep breathing, confusion or ketones, seek emergency care.




Call emergency services now for chest pressure or pain, shortness of breath, cold sweating, fainting, new confusion, severe weakness, blue lips, an irregular heartbeat, or inability to wake him normally.


Could Poorly Controlled Diabetes Cause This?



Both low and high glucose can cause fatigue and impaired thinking. Too much insulin, missed meals, alcohol, unusual activity or reduced kidney function may produce hypoglycemia. Persistent hyperglycemia can cause tiredness, thirst, frequent urination, blurred vision, dehydration and nausea.



However, symptoms alone cannot distinguish low glucose from high glucose. Checking at the time of symptoms is more useful than assuming the cause.



Review the warning signs in low blood glucose causes and treatment and compare readings with the blood sugar level chart.



Heart Disease Must Be Considered



Severe fatigue, nausea, reduced ability to function, breathlessness, swelling, dizziness or confusion may occur with heart failure or another cardiovascular problem. Heart attacks can also present with nausea, unusual fatigue, lightheadedness or shortness of breath, sometimes with mild or intermittent chest discomfort.



Because he has already had four heart attacks and bypass surgery, new or worsening symptoms should be discussed urgently with his cardiology team rather than attributed only to weight, diet or inactivity.



Other Possible Causes




  • Sleep apnea: Obesity, loud snoring, pauses in breathing, choking during sleep, morning headaches and daytime sleepiness are important clues.

  • Medication effects: Some heart, blood-pressure, pain, anxiety or sleep medicines can cause fatigue, dizziness or nausea.

  • Kidney disease: Diabetes, heart disease and some medicines can affect kidney function and alter insulin needs.

  • Anemia or thyroid disease: Both may cause persistent weakness and low energy.

  • Infection, depression or poor sleep: These can worsen fatigue but should be diagnosed rather than assumed.



What His Clinician Should Review



Arrange an urgent appointment with his doctor or cardiologist. Bring his complete medicine list, insulin names and doses, glucose meter or CGM report, and a record of when the sleepiness and nausea occur.



Depending on the examination, the clinician may consider:




  • glucose patterns and HbA1c;

  • electrocardiogram and assessment for heart failure or ischemia;

  • kidney function, electrolytes and liver tests;

  • complete blood count and thyroid testing;

  • review of every prescription, over-the-counter medicine and supplement;

  • sleep-apnea evaluation when symptoms suggest it.




Do not adjust insulin blindly: Recurrent lows or severe sleepiness may require a dose or timing change, but this should be based on glucose records and professional review.


Food and Activity Advice



Do not routinely give fruit juice to “boost energy.” Juice is appropriate as measured fast-acting carbohydrate for a confirmed low, but frequent juice may raise glucose unnecessarily.



He should not begin strenuous exercise until his cardiac condition and severe fatigue have been reviewed. After medical clearance, a cardiac-rehabilitation or supervised activity plan may be safer than starting exercise independently.



A balanced meal plan and gradual weight management may help long-term health, but they do not replace investigation of these symptoms. Read more about diabetes meal planning and safe exercise with diabetes.



My Advice



Please do not wait for a routine lifestyle change to solve this. If he is currently difficult to wake or has any cardiac or severe glucose warning sign, call emergency services. Otherwise, arrange prompt evaluation with his diabetes and cardiology clinicians.



Ask for a written hypoglycemia plan, ready-to-use glucagon and consideration of continuous glucose monitoring. The cause may be treatable, but it first needs to be identified.



Hope this helps.



Dr. Albana Greca



Related Questions





Related Resources





References






Educational only — not personal medical advice. Difficulty waking, severe hypoglycemia, heart-attack symptoms or severe hyperglycemia requires emergency medical care.


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