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Having difficulty in sleeping, extreme muscle fatigue, exhaustion. Hemoglobin count and BP is less. What these symptoms suggest?

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I have been unable to work for the last 3.5 weeks. I initially saw a doctor because of difficulty sleeping. I believed this was due to having overextended myself at work. I stopped doing that but the not sleeping much (avg 4-5 hrs per night despite trying numerous things like diet changes, lifestyle changes, short term use of prescribed lorazepam, ambien, usage of natural remedies such as sustained release melatonin, etc) did not help. The first doctor who ran my lab work said he had never seen anything like my hemoglobin a1c count. It was less than 4. My other lab work appears to be within normal ranges. I had the hemoglobin a1c rerun. It indicated my mean GLU was 64.1 but I do not have many symptoms of hypoglycemia such as confusion, inability to focus, irritability, disorientation, etc. My pcp sent me to the er a few weeks ago because of perceived tachycardia. I am waiting to hear back from an endocrinologist. I saw him last week and after his examination he said my blood pressure was too low laying down and that my pulse was feint. I have been to the ER three times but they can't find anything off besides the hemoglobin a1c when they run their CBC. They administered IV fluids because they suspected dehydration but the IV fluids did not improve how I felt and gave me the runs for 4 days until I finally took an immodium. My symptoms include but are not limited to: extreme muscle fatigue, exhaustion, sleeping between 2-5 hrs per night. 11 lbs weight loss in the last 2.5 weeks. Loss of appetite, weird sensation in my legs when lying down. Headaches. Difficulty with balance when turning too quickly, dizziness when watching things move quickly (ex. scrolling a web page too fast), dropping things a lot. My blood sugar has been tested by my pcp, and by the er and is always coming out somewhere in the 90s regardless of how symptomatic I am.
Posted Sun, 5 Aug 2012 in General Health
Answered by Dr. Anil Grover 6 hours later
Thanks for writing in.
I am a medical specialist with an additional degree in cardiology.
Your doctor was right that he had not seen HbA1C <4; in fact 70% of cardiac disease patients have diabetics and we do this investigation in all. I have not come across this value in decades. Even HBA1C corresponding with sugar of 64. Your loss of weight in two weeks time and the other symptoms will raise the suspicion of insulin secreting tumor (either in Liver or in Pancreas), if your doctor agrees with me I would urge that you be investigated for the same. Tachycardia supports the diagnosis though low blood pressure does not point to it. How had been your blood sugar levels otherwise- apart from the value of 90 in ER , do you have other fasting or random reports? For I suspect the main cause of your lack of sleep and inability to work can be related to lack of fuel for the body that is glucose. I urge you to see your doctor with the suggestions and let us see how things work out. If you have any further query, I will be most happy to answer as soon as possible.
Hi there,

Thanks for writing in.
I am qualified and certified in medicine and cardiology. I read your question with diligence.
In general, I recommend honestly telling about illness especially, to an elderly person.
Facts can be cruel one need not be in cruel in telling them.

How do you know he has renal disease as a result of hypertension? What diagnosis the doctor has told you? What is his creatinine and urea? How much urine he brings out a day? What kind of diet he should take? These are the questions, answers to which is entitled to know, rather than what caused his renal damage or his blood pressure. If for some reasons doctor can not communicate to him properly, you understand from the doctor and then explain to him in your own way. That would be my suggestion. Be truthful whether hypertension had been responsible first you find out it is so, explain to him that doctor says so.

Swelling in legs in kidney disease is because of two reasons. One is loss of protein and second is rise in total body fluid volume. Most which can not be retained inside the vascular space. It is then accommodated in outside the vascular space and called edema. Causes swelling of ankles.

Number of pack years is no packets of cigarettes he has smoked per day on an average multiplied by number of years he had smoked. One packet a day for 30 years is 30 pack years.

Please let me know more facts in your follow up query, I shall be able to help you in answer nearest to truth and not so hurtful. For example cigarette smoking has not much role to play in kidney disease past or future, so it can be downplayed.
With Best Wishes.

Dr Anil Grover,
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
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