Could My Symptoms Indicate Diabetes? Blood Sugar Levels and Weight Loss

Q: Could My Symptoms Indicate Diabetes? Blood Sugar Levels and Weight Loss

Dear Ms. <br>NN：<br>1. <br>Zoloft® (Sertraline) is classified as a selective serotonin reuptake inhibitor (SSRI) because it specifically inhibits the reuptake of serotonin, exhibiting a selectivity for serotonin transporters that is 300 to 3000 times greater compared to norepinep

Could this indicate the possibility of diabetes?

Hello, Doctor.
In mid-May of this year, I had a blood test that showed a hemoglobin A1c of 5.0 and a fasting blood glucose level of 86.
From the end of May until today, my height and weight changed from 160 cm/55 kg to 160 cm/52 kg over the course of about a month.
Due to high work stress, my appetite has been poor this past month, and I sometimes consume less than 1200 calories a day.
However, just a few days ago, my appetite suddenly improved, and I felt hungry easily, but in the last two days, my appetite has decreased again due to being busy.
Recently, I have also noticed increased frequency of urination and a larger urine volume, although I drink about 1000 to 1500 cc of water a day.
I sleep about 7 to 8 hours each night, but I'm not sure if it's due to stress or shallow sleep, as I feel like I’m not well-rested.
I would like to ask: 1.
I have been taking Zoloft for about a month; could the medication be causing my appetite issues? 2.
Could the frequent urination and increased urine volume be related to spending long hours in an air-conditioned room (previously, I only used it at work, but now I even use it while sleeping)? 3.
With increased urination, weight loss, but normal food and water intake, along with the blood test results from a month and a half ago, is there a significant possibility of diabetes? Thank you, Doctor.

NN, 20~29 year old female. Ask Date: 2017/06/29

Dr. Xiao Yongxun reply Internal Medicine

Dear Ms.
NN:
1.
Zoloft® (Sertraline) is classified as a selective serotonin reuptake inhibitor (SSRI) because it specifically inhibits the reuptake of serotonin, exhibiting a selectivity for serotonin transporters that is 300 to 3000 times greater compared to norepinephrine transporters.
It is a crucial and commonly used medication in the field of neuropsychiatry.
Indications include depression, anxiety disorders, panic disorder, premenstrual dysphoric disorder, and binge eating disorder, among others.
Side effects may include nausea, vomiting, dyspepsia, sexual dysfunction, sleep disturbances (insomnia or drowsiness), and drug interactions.
Therefore, decreased appetite is a possible side effect.
However, it is essential to discuss this with your treating physician for confirmation.
2.
During winter or when spending extended periods in air-conditioned environments, reduced sweating may lead to increased urine output; this is predictable.
However, many medications can also cause side effects such as urinary retention or incontinence, which should also be considered.
Therefore, it is important to discuss this with your treating physician for clarification.
3.
According to the diagnostic criteria for diabetes set by the American Diabetes Association: a.
Fasting plasma glucose ≥ 126 mg/dl after fasting for at least 8 hours, b.
2-hour plasma glucose ≥ 200 mg/dl during an oral glucose tolerance test, c.
HbA1c ≥ 6.5% (this must be confirmed with a method that is NGSP certified and meets the DCCT standards), and the above criteria a, b, and c must be confirmed on two separate occasions.
d.
If there are clinical symptoms of diabetes (such as polyuria, polydipsia, polyphagia, and unexplained weight loss), a random plasma glucose ≥ 200 mg/dl is sufficient for diagnosis (this only needs to be confirmed once).
Therefore, based on the information you provided, there is currently no evidence to suggest that you have diabetes.

Reply Date: 2017/06/29

More Info

Your symptoms and recent blood test results raise some important questions regarding the possibility of diabetes. Let's break down your situation and address your concerns systematically.

1. Blood Sugar Levels and Weight Loss: Your blood test results from mid-May show a hemoglobin A1c (HbA1c) of 5.0% and a fasting blood sugar of 86 mg/dL. These values are well within the normal range, indicating that you are not currently diabetic. Typically, an HbA1c of less than 5.7% is considered normal, while levels between 5.7% and 6.4% indicate prediabetes, and 6.5% or higher suggests diabetes. Your weight loss from 55 kg to 52 kg over the month, combined with decreased appetite due to stress, is concerning but does not directly indicate diabetes given your normal blood sugar levels.

2. Symptoms of Frequent Urination: Increased urination can be caused by various factors, including high fluid intake, certain medications, or even environmental factors like prolonged exposure to air conditioning. In your case, you mentioned drinking about 1000 to 1500 cc of water daily, which is reasonable but could contribute to increased urination, especially if you are in a cool environment that might lead to less fluid retention. Additionally, Zoloft (sertraline), an antidepressant, can have side effects that include changes in appetite and urination patterns. It’s essential to discuss these potential side effects with your prescribing physician.

3. Potential Diabetes Risk: While your symptoms of increased urination and weight loss can be concerning, the absence of elevated blood sugar levels and your recent HbA1c results suggest that diabetes is unlikely at this time. However, it’s crucial to monitor your symptoms closely. Stress and lifestyle changes can significantly impact your appetite and overall health. If your symptoms persist or worsen, it would be wise to consult with your healthcare provider for further evaluation.

4. Impact of Stress and Sleep: Chronic stress can lead to various physical symptoms, including changes in appetite, sleep disturbances, and even metabolic changes. If you are experiencing shallow sleep and feel unrested, this could further exacerbate your symptoms. Sleep is vital for overall health and can influence hormonal balance, including those hormones that regulate appetite and metabolism.

5. Next Steps: Given your current situation, it would be prudent to keep a close eye on your symptoms. If you continue to experience frequent urination, significant weight loss, or changes in appetite, it may be beneficial to undergo further testing, including a repeat blood glucose test or an evaluation of your kidney function. Additionally, consider discussing your current medication with your healthcare provider to assess whether it may be contributing to your symptoms.

In conclusion, while your symptoms warrant attention, the current blood test results do not indicate diabetes. Lifestyle factors, stress, and medication side effects may be playing a significant role in your symptoms. Regular follow-ups with your healthcare provider will help ensure that any potential issues are addressed promptly.

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