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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for fatigue, tiredness and neuropathy

Answered by
Dr. Praveen Jeyapathy


Practicing since :2005

Answered : 324 Questions

Posted on Thu, 10 Sep 2015 in Diabetes
Question: Dear Doctor

My son complained about fatigue, tiredness and neuropathy.

I tested him after he binged on chocolate chip cookies and took a nap. 5 hours after his snacking i measured his blood sugar was 5.8

after dinner of a big plate of brown rice and veges, his sugar went up to 7.5 in 1 hour .

in the morning his blood sugar can go from usually
5.3 to 6.0 sometimes

i am worried that he might be treading a fine line of becoming a diabetic, he always snacked on unhealthy sugary foods and drinks. his bmi is normal but he has a bit of a belly.

I have since modified our home meals to cut down carbs and restricted sugar in the house .

He measures around 4.3 to 4.9 in the morning now,
and is around 5.3 to 6 randomly throughtout the day.

but still spikes up to 6.9 if we let him have some just a little amount of sugar or carby food.

He is 19 and i am worried if sugar levels like that is going to be a sign of diabetes

He told me the neuropathy is from lifting too much weight and hurting his fingers nerves. But i am not sure.
Answered by Dr. Praveen Jeyapathy 36 minutes later
Brief Answer:
Its a good intervention that you have made

Detailed Answer:
Thanks for writing to HCM. Noted your concern.

Your son has some amount of impairment in glucose metabolism. You mentioned the fasting sugars going up to 6 prior to the diet change which indicates that. The normal fasting glucose should be less than 5.5 and the post meal/random sugars should be less than 7.7.

To diagnose it correctly you need to do a GTT (glucose tolerance test) and a Hba1c.

In my opinion, he has a very mild increase in fasting sugars which has responded excellently to your diet change. Please convince him to stick to it. It would be good if he could avoid binging snacks during the day. Please ask him to work out and loose about 7% of his present body weight. That should do.

I understand how concerned you are but what you are doing is the right thing and that will take care of it. I will be happy to answer if there are any more queries. Wishing him good health.
Warm regards
Dr Praveen
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
Follow up: Dr. Praveen Jeyapathy 56 minutes later
Thank You Doctor XXXXXXX

My son is also concerned with his condition, and is cooperating with the changes .

We have been reading in metabolic syndrome and would greatly appreciate help with some questions.

1. Can a patient expect to reverse impaired glucose metabolism by intensive diet and exercise interventions?

2. Can the beta cells restore its functionality if the patient is able to maintain healthy levels of blood glucose with diet and exercise? Can the body regenerate new healthy beta cells to replace the impaired beta cells that die, therefore leading to normalized metabolic functions?

3. My son sometimes have a carby dinner and wake up with higher fbg, what is happening in his body that causes the glucose to not get metabolized? When he goes to the gym after dinner he wakes up with lower fbg.
Answered by Dr. Praveen Jeyapathy 4 hours later
Brief Answer:
Details as follows

Detailed Answer:
You are welcome. Sorry for the delay in reply.

Glad to know that your son is with you in adapting to the changes in lifestyle. It will be totally worth it.

1. Yes. Your impairment in glucose metabolism can be reversed with diet and exercise.

2. The beta cells like any other cell in the body constantly is in the process where old cells are consumed and new ones regenerate. In patients with abnormal glucose metabolism the apoptosis (removal) is higher than regeneration and then there is the formation of a substance called amyloid which renders the cell ineffective. By reducing the beta cell stress via a good diet and exercise and maintaining ideal weight we give the beta cells to go back to the normal process. This helps regeneration as in the normal process. The issue is in most patients, the intervention of diet exercise etc is adopted late in life when the chances of recovery are slimmer. Your son is not so and that is a great thing.

3. The fasting sugar is partly due to the dinner and also partly due to the release of sugar from the liver. You see the brain needs glucose when we are asleep and nature has this fine mechanism where glucose is produced in the liver (from its stores) for this purpose. This is controlled by insulin. Its like a good task master. It regulates the release of glucose finely so that it remains less than 5.5. When there is lesser action of insulin over the liver due to insulin resistance the fasting sugars tend to rise. You need to have a diet less in carbs at night. That will help. The reason why the sugars are better after going to the gymn is because the best was to beat insulin resistance ... that is regain insulin sensitivity is through exercise. It enhances the action of insulin over the liver, fat and muscle.

Hope this helps. I will be happy to answer if there are any more queries.
Warm regards.
Dr Praveen
Above answer was peer-reviewed by : Dr. Prasad

The User accepted the expert's answer

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