How to manage diabetes and fatigue with thalassemia minor?

Question

Hi doctor,

I have been diabetic for the last 9 years and have thalassemia minor as well. Recently, the fatigue symptoms have increased, especially when I am not able to sleep properly. I am 45 years old.

My height is 65 inches, and my weight is 187 pounds. Being thalassemia minor, is my HbA1c test reliable to decide my diabetic medication? If the doctor increases the dose of medication, then my sugar levels drop below 70.

Rarely, in the last 9 years, my blood sugar level has crossed 200 on two or three occasions. My fasting sugar level is normally between 130 and 140 or less. Postprandial is also surprisingly the same. Owing to the HbA1c test, the doctor changed my medicines three days back and prescribed Glycomet GP 2 forte, Zemiglo 50, and Voglibose 0.2. Earlier, I had Glycomet GP 2, Voglibose 0.2, and Janumet 50/500. I have also attached my recent blood test report.

I also have a BP problem for the last four months and am on medication too. Can you please elaborate on what I should do?

I have read HbA1c test in thalassemia minor is not reliable. I am a female and heading towards menopause. I underwent gallstone surgery 20 years ago. The symptoms of fatigue have increased, and it has started hampering my physical activity, which is a must for diabetes.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query.

The main concern you are currently experiencing is fatigue and sleeplessness, or insomnia. Sleep greatly affects our cognitive abilities, including thinking, reaction time, memory, and problem-solving skills.

I would like to gather some information about your sleep history.

How long have you been having sleep problems?
How many consecutive days do you experience disturbed sleep?
Do you struggle with falling asleep or staying asleep?
Do you have excessive daytime sleepiness?
Are you experiencing any of the following symptoms: missing work, making bad decisions, difficulty concentrating, irritability, or depression?

Now, let us discuss some manifestations of fatigue. Please let me know if you have any of the following symptoms: weakness or low energy, lack of motivation, poor performance, memory problems, decreased productivity, increased tendency to make errors, mistakes, or accidents, feelings of depression, or a reduced interest in socializing.

If you answered yes to any of the questions above, your fatigue may be related to a lack of sleep. Improving the quality and quantity of your sleep can help alleviate your fatigue.

Regarding the HbA1c test, it may not be as reliable in diagnosing diabetes mellitus in patients with anemia. Variant hemoglobins can influence the results, leading to either high or low readings. Therefore, its reliability is highly variable. Instead, laboratory tests such as fasting blood sugar (FBS), postprandial blood sugar (PPBS), and oral glucose tolerance test (OGTT) are considered more credible for diagnosing diabetes.

There are alternative glycated proteins, such as glycated albumin or fructosamine, that can be used to monitor glucose control. However, they are more expensive and mainly used for evaluating glucose control over the previous two weeks.

Regarding your new medication, how do you feel since starting it? Have you experienced any episodes of hypoglycemia? Have any tests been conducted following those episodes? If you are experiencing symptoms of hypoglycemia or your blood sugar levels are consistently low, it may be necessary to adjust your medication.

Remember to maintain a healthy and nutritious diet, engage in physical activity or yoga, take your medication on time, read uplifting books, and prioritize getting a good night's sleep.

I hope it helps.

Please let me know if I can assist you further.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

The primary purpose of HbA1c is to identify the average plasma glucose concentration over a period of three months. HbA1c levels reflect blood glucose levels over the past six to eight weeks and do not capture daily fluctuations or depict the daily ups and downs of blood glucose. That is why the criteria for diagnosis and management of diabetes include fasting blood sugar (FBS) and postprandial blood sugar (PPBS), rather than relying on HbA1c alone. It provides a more holistic view of the patient's condition. If you wish to calculate your HbA1c from daily readings, you can do so by averaging twelve weekly readings and then using an A1c and average blood glucose conversion calculator. Remember, good sleep is crucial for maintaining a healthy and sound mind.

I hope it helps.

Revert in case of any doubts.

Thank you.