Fatigue, Mood and Diabetes

[kangaroojohn]

I am new posting but I have read a lot here and it is fantastic support. My position is that I began treatment for PMR with 15mg Pred daily on 25th May 2023 and have been tapering, most recently on a 1mg/month basis, and am now on 5mg. I have just seen my rheumatologist who wants me to stay on the 5mg for at least a further six months.(Ouch!) My bloods were OK.

I have had no pain symptoms at all since the first dose of Pred but I am suffering from daily fatigue and mood swings which mean I have to have an enforced nap (sometimes two) every day. Often I am quite exhausted after small physical or mental tasks- if I get them done.

I am a type two diabetic. My HbA1C was recently up from 7.9 to 8.4 and my GP is threatening to add to my metformin (Ouch!) I do not have increased appetite and I have cut out "bad" foods, but my weight simply will not go down. I am 80.

Can you possibly please help with: 1. What might I expect will happen to my fatigue (and mood swings) during the next six months? 2. Can you suggest any technical reason my weight will not go down? 3. Any other comments please?

Thanks

[DorsetLady PMRGCAuk volunteer]

You have got down to 5mg quickly… too quickly many would say… never mind what bloods indicate.

Staying at 5mg will help give your adrenals a chance to catch up - and your symptoms sound very much like them struggling - maybe have a look at this link to help you understand more -

healthunlocked.com/pmrgcauk...

To help your weight you really need to cut carbs - drastically - others will be along to give more advice.

[Merryfield]

Get on the diabetes meds, please! Follow the mantra; cut alcohol, sweets, white stuff and red meat. I too had an a1c at 8.4 and doc put me on Ozempic. Off that now but still on metformin and jardiance. a1c now below 7. Diabetes can be dangerous.

[Merryfield]

PS: sometimes i want a nap mid-morning and generally always in the afternoon. you are not alone.

[SnazzyD]

Hello, I don’t know what you mean by “bad food”, but in the case of taking Pred, that means carbohydrates. Pred causes your liver to convert its glycogen stores into glucose and that’s before you eat anything. Very low carb will both keep your blood sugars down, you should also lose weight because you’re not having big insulin spikes as your body desperately tries to keep your blood sugar down and converting it to fat. If you are already on low carb, then you may well need medication asap.

Do read DL’s link about adrenal gland insufficiency. Your symptoms have all the hallmarks of low cortisol levels. It is normal to have to slow your reductions once under 10mg.

[piglette]

It sounds like you have hit the point where your adrenals have got to start working again as the steroids are no longer giving them enough support any more and you are suffering from that. If you stay at 5mg it should improve as the adrenals slowly realise they are going to have to start standing in their own feet again.

[PMRpro Ambassador]

Hi and welcome!

What a sensible rheumy to want you to stay at 5mg pred for 6 months - it will let your body catch up, in particular the adrenal function which is probably the cause of your fatigue.

The secret to weight management - and avoiding higher a1cs - when on pred is to cut carbs, drastically! In particular avoid processed carbs and added sugar and limit fruit. Some need to cut carbs more than others but it does work. One lady, Koalajane reversed her Type 2 diabetes by doing so despite pred.

[Raewynne]

Yes prednisolone can cause depression and mood swings.Try to get some help for that.Anxiety too.You are not wrong about what you are feeling.Tiredness happens too .I find some days better than others.We need to make sure we get a good rest at night time.i would definitely get some help for the mood swings or depression.I think prednisolone causes imbalances in us.

[Blearyeyed]

Are you on any other medications as well as Pred? Do you have any other conditions as well as Type 2 Diabetes?

You should definitely take the advice to begin Metformin as well as getting advice on the best Diet and Exercise Management to help with the condition.

There are great resources for advice and diet plans in the Diabetes UK official website.

Taking pills isn't a sign of failure . Being pill free isn't a sign of success if you have symptoms which could be helped by taking them. Medication is there to help you build up a proactive and sensible Self Care method that helps you and brings your quality of life back.

You are down to 5 mg pretty quickly and you are hitting the Adrenal Phase , or period when your Adrenals begin to take back control from Pred of your Cortisol release. This can mean that your Fatigue and Mood Changes can increase because your body is not as speedy at reacting to the changes it needs to do to react to activity or everyday stress.

5mg is actually an ideal time to get baseline tests of your blood ranges for certain nutrients, especially if you are having these symptoms , are about to start Metformin and haven't been taking supplements or having nutritional guidance since you began Steroids.

Steroids , and the extra wear and tear on your body from inflammation, can cause vitamin and mineral Deficiencies that add to the symptoms of Tiredness , Fatigue , Brain Fog , Mood Changes and stiffness.

You need to ask your GP if you can have tests of Liver Function, Kidney Function ( Electrolytes) , Ferritin, Total Cholesterol, Vitamin B 12 , Folates and Vitamin D.

You can request these tests under NICE guidelines if you are on steroids , PPis or Metformin and various antidepressants every six months ( every year for Vitamin D) or every three months if you have low or Deficienct levels with symptoms. This is because all of these medications can affect how well your absorb B vitamins which can reduce how well you are and how well you absorb Vitamin D and Iron from food .

Request the results even if they say you are in normal range , because if your levels are borderline or very low these can still add to your symptoms ( and still be heading down) so it's a good idea to take some separate supplements to speed up bringing your nutrient levels up at the same time as adding in more foods to your diet that are packed with the vitamins you are low in.

Increasing your fluid intake to recommended daily levels also improves these symptoms and helps to regulate your blood sugar.

As does decreasing processed sugar to occasional treats and avoiding artificial sweeteners altogether if possible. Cut carbs moderately but reduce white carbs to very rare treats .

Substitute them with small portions of complex carbohydrates instead like fibrous fruit, wholewheat or seeded, oats , brown or wild rice , spuds with skins or alternatives of pulses, nuts, beans and grains.

Increase the variety of vegetables you eat , especially green leafy varieties and fruits with a lower sugar content.

Increase lean proteins ( fish , white meats) and dairy or dairy free products and eggs and choose healthy fats or oils . And avoid processed foods as much as possible.

Try eating smaller portions five times a day instead of three big meals and timing your meals just after or an hour before exercise to help with insulin release .

Calorie intake still counts with Diabetes Management so it's good to know your weight and BMI and try to reduce calories so that you only take in what you are using each day if you are at your ideal weight , or you take in less calories than you use each day if you need to reduce your weight.

The Diabetes website will help you with more healthy options to aid you in reversing your Type 2 blood levels. You may not be on Metformin forever with the right approach.

My husband is Type 1 , but I've helped a number of relatives and friends with this advice over the years to reverse their Type 2 or get back to Diet Maintained Type2 levels.

Fatigue breeds Fatigue and inactivity can make regulating blood sugar levels harder so try and just have a few minutes stroll and gentle stretch each hour to increase your energy levels and make it easier for you to gradually build in more activity, walks and movement. This will also help you to improve your mood. Trying relaxation and breathing exercises also helps with the symptoms of physical anxiety and Fatigue.

Good Luck with your journey and keep posting to update us with your progress , we love to hear people's good news as well as advise people when we can , take care , Bee