After a decade and a half with Type 2 diabetes, you might think its complications would no longer surprise me. But after waking up tired for no reason — again — I went looking for answers. Was it another of those things diabetes does to us, or was it something else?
There can be many causes for feeling tired, but Type 2 diabetes is definitely a major culprit. One reason is depression. It tops the lists of causes for fatigue because people with diabetes are twice as likely to deal with depression.
Depression leads to overwhelming exhaustion along with a sense of hopelessness and pessimism. This happened to me when I was diagnosed with Type 2, and it kept me from dealing with the disease for years.
At first, the idea that I could defeat diabetes kept me out of depression, but when Lyme disease wreaked havoc on my blood sugar, forcing me onto insulin, I gave up.
Finding out we have a chronic disease can pull the rug out from under our feet if we have been living with the illusion that we are in charge of our circumstances. So many things are beyond our control.
There is really only one thing we have real choice about. We get to choose what we will do about what happens to us. Until I adjusted my expectations and accepted this, I was stuck.
The worst thing about depression is that it sneaks up on you. I wish doctors warned us at the time we were given the diagnosis of diabetes that we might face bouts of depression.
It would be good to know the symptoms, things like feelings of guilt, fatigue and decreased energy, loss of interest in things, irritability and restlessness, overeating or loss of appetite, sleeping too little or too much.
Before you think you are depressed, remember that there are other causes for fatigue and not sleeping well. It is wise to get tested for sleep apnea, since having diabetes puts us at greater risk for this, and treating it has immediate benefits for energy levels as well as for improving both Type 1 and Type 2.
Thyroid problems are often found along with diabetes, which is why your doctor gives you blood tests for them. Regulating thyroid can improve your energy levels too. Anemia is another underlying cause of fatigue that can only be caught with blood tests.
If your blood sugar is not well controlled for any reason, fatigue can be a side effect. Your cells are deprived of the energy they need because of insulin resistance, and too much sugar in your bloodstream can make you sluggish. The dehydration from excessive urination caused by high blood sugar also makes you feel tired.
Low blood sugar can hit you fast, causing brain fog and irritability that affect how you react to even tiny stresses. Fatigue can linger for hours and even days after a hypoglycemic event. Waking up tired may be a sign that your blood sugar dropped low during the night.
Any underlying illness will cause you more problems because you have diabetes. You are more likely to need a trip to the hospital from the flu and its complications than people without diabetes. You may not bounce back as quickly as they do either, so pay attention to that sense of fatigue. Give yourself time to get well.
If it is depression, what then?
A certified diabetes educator named Brett Ives from Mount Sinai Diabetes Center confirmed the link between diabetes, fatigue, and depression, though he admitted that the reason for the connection is not clear. But he warned that when you are depressed, “no amount of diabetes management will help you feel less tired.”
The depression needs to be treated. This is why it is important not to ignore fatigue. Chase down the reason for it by ruling out sleep apnea, thyroid problems, underlying illness, blood sugar problems, and other potential causes.
Make sure you are eating well, not skipping meals or eating too many high-glycemic foods. See your doctor regularly and get the blood tests that evaluate your thyroid, liver, and kidneys.
If you are stressed, find ways to deal with it. Get enough sleep — for most adults, about seven to nine hours is ideal. Do some kind of exercise every day. This is even more important when you feel fatigued, because moving around actually helps.
Chronic fatigue is improved with mild exercise, so do something even if it hurts a bit. I use a swimming pool because it causes less pain to move around there. Exercise improves depression by the release of chemicals such as endorphins, and it improves your blood sugar control too.
For all these reasons you need to make exercise a priority no matter how tired you feel. Talk to your doctors about medication you can take to make exercise less painful for you.
Never ignore fatigue that does not go away, because if the cause is depression you will need some help to fight it. Tell your doctors about it and do not give up. If one doctor does not take you seriously, talk to another one. A diabetes specialist should know how important this is to your outcomes with diabetes.
You have diabetes. The harder you have to work to control your blood sugars, the more likely you will have fatigue just from that battle, so please do not simply give up. It is all right to ask for help. You cannot do this alone.
Dealing with pain from diabetes? Bookmark DiabetesSelfManagement.com and tune in tomorrow to find out how to manage it without drugs from nurse David Spero.