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Diabetes - Adult Type II (Expert Forum)
Declining exercise tolerance and hypoglycemia - possibly pituitary or adrenal issue?
Answered by
Anita Ramsetty, MD - GeneralEndocrinology, Diabetes Type 1, Diabetes Type 2, Thyroid Disorders, AdrenalInsufficiency, CF-Related Diabetes
Endocrine Care Group
Questions in the Adult Type II Diabetes forum are answered by Dr. Anita Ramsetty. Topics covered include Type 2 Diabetes, blood glucose monitoring, diabetes and heart disease, diabetes and pneumonia, diabetes and pregnancy,
diabetes and vision problems, diabetes and wound healing, diabetic complications, hyperglycemia, hypoglycemia, and insulin.
Declining exercise tolerance and hypoglycemia - possibly pituitary or adrenal issue?
by edancer, Mar 31, 2008 12:14AM
I will try to keep this as brief as possible, though I have a lot to say!
I am a 28 year old female, 5'7 & 120 lbs. I take ballet class 3 times a week and do cardio type exercise a few times a week. Exercise is my stress relief (well, it was). I work full time and am in graduate school full time. I have Asthma & ADHD and take medication for both (Asmanex at night and pirbuterol inhaler for day for Asthma and Adderall 20 mg XR in AM, 20 mg IR in PM for the ADHD).
For the past year or so, I have had trouble exercising. Initially I get pale and lightheaded after cardio exercise. For the past 6 months, I have additionally had a lot of trouble with my ballet classes.
The ballet classes are more isometric/anaerobic type exercise, but I feel I should be able to handle them, as I have been dancing consistently for 8 years. During the classes, I am getting very shaky, nauseous, pale, experience extreme sweating, have muscle weakness, some confusion and fatigue. After class, I feel somewhat disoriented, very tired, sometimes my lips tingle, my urine is sometimes dark yellow, and when I try to talk to people, my words get jumbled sometimes. I also have what feels like urethral spasms and occasional flank pain. I talked to some people at the studio, who suggested it may be low blood sugar. I agreed that this was likely the case, as I seem to remember my pediatrician telling my parents that I tended towards hypoglycemia as a child. I have experienced symptoms as an adult too, but have always been able to manage it with my diet (until now). I have experimented with eating different combinations of protein, carbs, fat, etc. before class and during class, as well as sports drinks and lots of water during class. Nothing seems to be helping. I do not generally have these symptoms with cardio unless I cross over into the anaerobic type work (high intensity).
I have also recently had Asthma flares and Bronchitis (twice) since November, and had to be on Prednisone 20 mg each time. The first time I abruptly stopped the Prednisone midway through. The second time I stopped for a day or two and then finished the dose with the correct taper. The third time I finished it properly. I did not know originally that you are not supposed to stop abruptly. Each time I took it, I felt much better. The third time all of my exercise symptoms were alleviated until I started the taper. During the last taper I had extreme withdrawals (muscle aches, nausea, extreme fatigue, headaches, facial pain, etc.). I have felt progressively worse in general since these symptoms started. My blood sugar is lowest the week I am not taking my Birth Control Pills (in 50s and 60s when fasting). I also have extreme irritability, sadness, and fatigue that week. In general, it seems to always be in the 60s in the morning and in the 50s or 60s before I eat dinner (lunch is around 12 or 1, dinner around 6 or 7). It seems like my personality has changed a little bit in the past few weeks - I have been impatient, moody, melancholy, extremely tired & irritable, unmotivated, basically miserable.
My diet is good - I keep a food journal to ensure that I am getting enough calories and the right balance of nutrients. I tend to get 1800-2300 calories a day, with approx 55-60% carbs, 30% fat, 10-15% protein daily. I try to eat as many fruits/veggies as possible, eat complex carbs and limit sugars when possible.
History: Multiple kidney infections/bladder infections and irritable bowel since 2000. Asthma since 1998. On and off extreme fatigue since 2002. I spent most of 2006 visiting doctors for my continuous stomach pain (bloating, pressure, pain in upper abdomen), flank pain, low grade fevers, pelvic pain, low libido, irregular periods, upper back pain, extreme fatigue, etc. I ended up being diagnosed with Endometriosis (and having it removed) and I had gallbladder dyskinesia and/or cholesterolosis (sp?) --ejection fraction of 4.96%. Both were removed in 2006. Periods irregular since 2006 (while on the pill), hair loss on and off for the past year. Since 2002, I have lost about 35 lbs (slowly, just watching portions and exercising). I am not currently trying to lose weight, just maintaining. My stomach issues got a little better after the gallbladder was removed, but were not totally gone. Interestingly, I started taking the Adderall in August, and it greatly improved the pressure and bloating/gas pain. I do recognize that the stomach issues could be stress related, however.
I also have had weird skin discolorations for the past year or so - my hands & feet will either get white (like when I hold a can of coke), bright red, or purple, especially the knucles and toes. My knees and elbows also get this way. I have also had some trouble with melasma for the past couple of years, and itchy patches on my scalp, alleviated with anti-fungal shampoo (also seemed to help the hair loss).
In February, I visited my doctor, who took blood. My fasting glucose was 62. My TSH level was also low normal (0.92) - this has declined steadily year by year from 2.92 in November of 2002. My lympocytes were also very low - I want to say around 8-10 and neutrophils were high - I think around 90 . He sent me to an endocrinologist, and I had an insulin induced hypoglycemia test on Wednesday (3/12). When I went for the initial visit, my blood pressure was 108/45. On the next visit, even with being extremely nervous before the IIH test, my BP was still normal (115/75). During the test, the doctor gave me 10% less insulin than specified to be on the safe side, but my sugars still plummeted into the 30s pretty quickly. I had all the typical hypo symptoms plus my entire body was shaking uncontrollably. As he was trying to give me glucose, my vein burst, so he had to switch arms. Once I ate a lot of sugar and got the glucose, I felt better, but then got very cold and sleepy. He said that the rate at which I dropped indicates a real problem.
I am still waiting for the results and am feeling worse and worse. He has mentioned adrenal insufficiency, pituitary adenoma, hyperinsulin, gut hormone deficiencies, etc. as possibilities. I guess I am just looking fideas or recommendations for exercise and an idea of what this might be. I have done a lot of online research and it seems like the most likely scenario is hypopituitarism, secondary hypothyroidism and/or adrenal insufficiency.
I am a 28 year old female, 5'7 & 120 lbs. I take ballet class 3 times a week and do cardio type exercise a few times a week. Exercise is my stress relief (well, it was). I work full time and am in graduate school full time. I have Asthma & ADHD and take medication for both (Asmanex at night and pirbuterol inhaler for day for Asthma and Adderall 20 mg XR in AM, 20 mg IR in PM for the ADHD).
For the past year or so, I have had trouble exercising. Initially I get pale and lightheaded after cardio exercise. For the past 6 months, I have additionally had a lot of trouble with my ballet classes.
The ballet classes are more isometric/anaerobic type exercise, but I feel I should be able to handle them, as I have been dancing consistently for 8 years. During the classes, I am getting very shaky, nauseous, pale, experience extreme sweating, have muscle weakness, some confusion and fatigue. After class, I feel somewhat disoriented, very tired, sometimes my lips tingle, my urine is sometimes dark yellow, and when I try to talk to people, my words get jumbled sometimes. I also have what feels like urethral spasms and occasional flank pain. I talked to some people at the studio, who suggested it may be low blood sugar. I agreed that this was likely the case, as I seem to remember my pediatrician telling my parents that I tended towards hypoglycemia as a child. I have experienced symptoms as an adult too, but have always been able to manage it with my diet (until now). I have experimented with eating different combinations of protein, carbs, fat, etc. before class and during class, as well as sports drinks and lots of water during class. Nothing seems to be helping. I do not generally have these symptoms with cardio unless I cross over into the anaerobic type work (high intensity).
I have also recently had Asthma flares and Bronchitis (twice) since November, and had to be on Prednisone 20 mg each time. The first time I abruptly stopped the Prednisone midway through. The second time I stopped for a day or two and then finished the dose with the correct taper. The third time I finished it properly. I did not know originally that you are not supposed to stop abruptly. Each time I took it, I felt much better. The third time all of my exercise symptoms were alleviated until I started the taper. During the last taper I had extreme withdrawals (muscle aches, nausea, extreme fatigue, headaches, facial pain, etc.). I have felt progressively worse in general since these symptoms started. My blood sugar is lowest the week I am not taking my Birth Control Pills (in 50s and 60s when fasting). I also have extreme irritability, sadness, and fatigue that week. In general, it seems to always be in the 60s in the morning and in the 50s or 60s before I eat dinner (lunch is around 12 or 1, dinner around 6 or 7). It seems like my personality has changed a little bit in the past few weeks - I have been impatient, moody, melancholy, extremely tired & irritable, unmotivated, basically miserable.
My diet is good - I keep a food journal to ensure that I am getting enough calories and the right balance of nutrients. I tend to get 1800-2300 calories a day, with approx 55-60% carbs, 30% fat, 10-15% protein daily. I try to eat as many fruits/veggies as possible, eat complex carbs and limit sugars when possible.
History: Multiple kidney infections/bladder infections and irritable bowel since 2000. Asthma since 1998. On and off extreme fatigue since 2002. I spent most of 2006 visiting doctors for my continuous stomach pain (bloating, pressure, pain in upper abdomen), flank pain, low grade fevers, pelvic pain, low libido, irregular periods, upper back pain, extreme fatigue, etc. I ended up being diagnosed with Endometriosis (and having it removed) and I had gallbladder dyskinesia and/or cholesterolosis (sp?) --ejection fraction of 4.96%. Both were removed in 2006. Periods irregular since 2006 (while on the pill), hair loss on and off for the past year. Since 2002, I have lost about 35 lbs (slowly, just watching portions and exercising). I am not currently trying to lose weight, just maintaining. My stomach issues got a little better after the gallbladder was removed, but were not totally gone. Interestingly, I started taking the Adderall in August, and it greatly improved the pressure and bloating/gas pain. I do recognize that the stomach issues could be stress related, however.
I also have had weird skin discolorations for the past year or so - my hands & feet will either get white (like when I hold a can of coke), bright red, or purple, especially the knucles and toes. My knees and elbows also get this way. I have also had some trouble with melasma for the past couple of years, and itchy patches on my scalp, alleviated with anti-fungal shampoo (also seemed to help the hair loss).
In February, I visited my doctor, who took blood. My fasting glucose was 62. My TSH level was also low normal (0.92) - this has declined steadily year by year from 2.92 in November of 2002. My lympocytes were also very low - I want to say around 8-10 and neutrophils were high - I think around 90 . He sent me to an endocrinologist, and I had an insulin induced hypoglycemia test on Wednesday (3/12). When I went for the initial visit, my blood pressure was 108/45. On the next visit, even with being extremely nervous before the IIH test, my BP was still normal (115/75). During the test, the doctor gave me 10% less insulin than specified to be on the safe side, but my sugars still plummeted into the 30s pretty quickly. I had all the typical hypo symptoms plus my entire body was shaking uncontrollably. As he was trying to give me glucose, my vein burst, so he had to switch arms. Once I ate a lot of sugar and got the glucose, I felt better, but then got very cold and sleepy. He said that the rate at which I dropped indicates a real problem.
I am still waiting for the results and am feeling worse and worse. He has mentioned adrenal insufficiency, pituitary adenoma, hyperinsulin, gut hormone deficiencies, etc. as possibilities. I guess I am just looking fideas or recommendations for exercise and an idea of what this might be. I have done a lot of online research and it seems like the most likely scenario is hypopituitarism, secondary hypothyroidism and/or adrenal insufficiency.
Doctor's Answer
by Anita Ramsetty, MD, Apr 02, 2008 02:45PM
, Apr 02, 2008 02:45PM
Hi,
The conditions that you mentioned, hypopituitarism, secondary hypothyroid and hypoadrenal, would be the most likely endocrine causes of your symptoms. fasting glucoses even down to the 50's are quite common and considered normal in young slender women, so that itself is not much of a red flag.neither is the fact that your blood pressure was normal--this is also common in young fit adults. Your decrease in exercise tolerance is the most concerning, given that you were otherwise healthy and have been for some time. I suspect that your steroids may have had some affect on your adrenals, and if this is the case the good news is that you will likely recover.
You should definitely follow up on your test results with your Endo. Those diagnoses hinge on the correct laboratory testing, so it is very important to know those results. In the meantime, do not stress yourself with anything including exercise. I think you should rest and take care of yourself until you know what is going on.
take care.
The conditions that you mentioned, hypopituitarism, secondary hypothyroid and hypoadrenal, would be the most likely endocrine causes of your symptoms. fasting glucoses even down to the 50's are quite common and considered normal in young slender women, so that itself is not much of a red flag.neither is the fact that your blood pressure was normal--this is also common in young fit adults. Your decrease in exercise tolerance is the most concerning, given that you were otherwise healthy and have been for some time. I suspect that your steroids may have had some affect on your adrenals, and if this is the case the good news is that you will likely recover.
You should definitely follow up on your test results with your Endo. Those diagnoses hinge on the correct laboratory testing, so it is very important to know those results. In the meantime, do not stress yourself with anything including exercise. I think you should rest and take care of yourself until you know what is going on.
take care.
Glucose, Serum - before test (draw 1) - 9:30 AM: 69 mg/dl - insulin injected after draw
Glucose, Serum - (draw 2) 9:45 AM: 23 mg/dl (verified by repeat analysis) - I believe this is when he gave me IV glucose & I started to eat something, but I'm not 100% sure - the details are fuzzy at that point
Glucose, Serum - (draw 3) 10:00 AM: 41 mg/dl (verified by repeat analysis)
Glucose,