Sweating it Out

Readers ask about excessive perspiration, weight gain, and thyroid nodules.

Theresa Garnero By Theresa Garnero, APRN, BC-ADM, MSN, CDE

This month's column will feature four situations posed by our dLife family: sweating without cause, gaining weight in the face of starting an exercise program, and soaring glucose values associated with thyroid nodules.

Q: I have type 2 diabetes and I have a terrible time with sweating. Whenever I walk, I sweat so badly and my face turns red — everyone around me keeps asking if I'm okay. I have to carry something with me to wipe the sweat off. What can cause this? The doctors haven't been able to find a cause.

A. One possible explanation may fall under the label of autonomic neuropathy, a condition where hyperglycemia interferes with the nerves that control involuntary functions The autonomic nervous system manages several systems automatically. Some examples include bladder control, heart rate, the ability to detect hypoglycemia, and ability to sweat appropriately. Light exercise can trigger unbelievable sweating in some people who have autonomic neuropathy. For other people, eating a particular food can cause this reaction (called gustatory sweating in response to spicy foods or cheese which can often be helped with a scopolamine patch).

Sweating profusely is not normal and can point to other risks, primarily with the cardiovascular system. Are there other signs and symptoms? Do you have an infection, cancerous tumor, thyroid issues, or pain? Is the sweating mainly on one side or both? Does it involve your palms, soles and/or arm pits? Do you sweat while you sleep? What's going on with your glucose when this happens?

This may sound weird, but check your feet to be sure there are no cracks for being excessively dry, a condition that tends to happen simultaneously with excessive sweating. Which doctors have you consulted? I'd suggest seeing a neurologist or endocrinologist who is familiar with "hyperhidrosis" or excessive sweating to unravel your mystery.

Q: I was recently diagnosed with type 2 diabetes and am sweating all the time, especially at night. I watch my carbs but I stay thirsty. I was also diagnosed with sleep apnea and use a CPAP machine at night. My sugar levels are fine in the day but go up to 135 at night. What am I doing wrong? I am more hydrated than I was before, but still have a dry mouth and take lots of trips to the bathroom. I am drinking diet green tea during the day. Could this be the cause?

A. Unless the weather is hot, or you're having hot flashes, night sweats are not normal. They are always a cause for concern for people with diabetes. Have you checked your glucose value during one of these sweating episodes? Could it be a reaction to diabetes medication? Is your doctor aware? A glucose value of 135 may be higher than what you had previously, but it is in the target range.

Check the diet green tea ingredients. Green tea often has caffeine, less than coffee, but if you are drinking a lot, it'll dehydrate you. The CPAP machine also can cause mouth dryness, as can dental disease. It's important to have the sweating looked into. You want to be sure your kidneys are in good order and that we're not missing something.

Q. My blood sugars have continued to increase over the last month in spite of being on maximum doses of metformin and starting an exercise program. I am interested in Byetta but the doctor says since my A1C is 5.4 there is no need to change anything. What do you think of Byetta? How do doctors make a decision as to when to change or add new medications? Do they just go by the A1C or do they include other factors as well?

A. How frustrating (and congrats on the A1C)! You make that step to get with an exercise program and the scale is not cooperating. Keep in mind that working out can increase muscle mass and therefore weight, to a small degree. If you've noticed a marked increase, check with your doctor about your thyroid and see a dietitian about ways to maximize your nutritional approach to losing weight.

Byetta, is very useful for a lot of people struggling to manage their type 2 diabetes. Byetta is not cleared for use a weight loss remedy. Many factors are taken into account when adding or changing medicines: A1C, glucose patterns, kidney, liver and heart function, potential side effects, cost and benefit to the person.

Q. I have diabetes type 2 and also a thyroid with several nodules. One of the nodules has increased in size even though I am being treated. My blood glucose numbers were okay but have now gone up. Can you tell me what effect the growth of these nodules may have on my blood glucose numbers?

A. Studies show a link between diabetes and thyroid disorders, both of which involve a dysfunction of the endocrine system, the group of glands throughout the body responsible for metabolism. Typically, nodules on the thyroid can cause it to be hyperactive (causing hyperthyroidism). An overactive thyroid may affect glucose control. Other factors to consider: stress of dealing with the treatment of these thyroid nodules, length of time with diabetes, effectiveness of diabetes medications, alterations in activity level, and changes in weight as a result of a thyroid gland that's on the blink. Please discuss your concerns with your physician to best investigate why your glucose values are going the wrong direction.

Sometimes we need to sweat the small stuff so it doesn't turn into big stuff. And if you're not sure whether or not your situation is big or small, just ask — it's more dangerous not to pose a question when the answer could make a big difference in your health.

Read Theresa's bio here.

Read more of Theresa Garnero's columns.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

Last Modified Date: May 24, 2013

All content on dLife.com is created and reviewed in compliance with our editorial policy.

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