Recovering From Diabetes Fatigue

Fatigue is so important. I was going to write a whole book about it, but I’m too tired. So what to do? Fortunately, it turns out there are many ways to overcome fatigue.


That’s good news, because people with diabetes are often fatigued, and it’s disabling. As I discussed two weeks ago, blood sugar levels that are too high or too low will cause fatigue. Other diabetes-related causes are inflammation, lack of sleep, insulin resistance, infections, circulation problems, medication side effects, depression, and stress. Low thyroid and low testosterone levels also cause fatigue and are common in people with diabetes.

So what to do depends partly on the causes. Still, many fatigued people would benefit from moving more. I know that sounds crazy. When you’re exhausted, who wants to exercise? But I’m not talking about vigorous training for a triathlon kind of exercise. I’m talking about treating yourself gently, and moving your body in ways that feel good. Studies show that gentle exercise reduces fatigue by up to 65%. Gentle exercise is actually more energizing than vigorous exercise, according to this University of Georgia study.

It could be tai chi or qigong, water exercise, yoga, walking, or seated exercises, or anything else that feels good. I have a lake near me, where it’s fun to go watch the birds. Maybe you have a place like that to walk. Or a mall or something.

Being completely sedentary makes you more tired. You get more out of shape, so it gets harder and harder to move. To feel better, you don’t even need formal exercise. Housework can be turned into a form of exercise just by concentrating on the movements as you do them, instead of stressing about how dirty everything is. Fatigue specialist Majid Ali, MD, says that exercise should be “slow, sustained, and nontraumatic.”

In fact, I think treating fatigue means being gentle. All the demands we put on ourselves help cause the fatigue in the first place. Can we cut back on work or other demands to make space for activity, pleasure, self-care, and rest? If we only slow down when our bodies stop us through fatigue or pain, it’s pretty likely they will do that more often. That also applies to being gentle with our feelings. Beating yourself up is a good way to tell your body that it’s not worth trying very hard.

Nutrition is another key to energy level. Refined carbs are known for causing fatigue, after an initial energy rush. A reader named Kat commented that since she started “juicing green leafy vegetables in the morning, with some wheatgrass…and started eating lots of protein [in the morning]…eating a higher protein/fat, lower carbohydrate diet, I have shaken off that really sleepy/extreme fatigue that I used to have every day.”

And Carol posted that vitamin B12 and chromium were helping her energy. Low magnesium seems to tire people and throw blood sugar levels off, so you might want to try supplementing that. Same for vitamins B12 and D.

Fatigue can be hard to separate from depression. If you don’t feel you have a reason to get out of bed, or if you think that most things are going to be unpleasant and/or hard, you might just as well stay asleep. One reader commented, because of depression, “my motivation is almost nil.”

But having something you love to do can energize. I know an artist named Albert who started doing ceramic sculpture at the age of 75, when he was already sick and disabled with diabetes complications. He loves it so much that he says, “I can’t wait to get out of bed in the morning.” He just had his first gallery show at 84 years of age. Children and animals are good motivators and sources of love for many of us.

Some Ideas for Overcoming Fatigue
• Keep a log with four columns: date/time, energy level on a scale of 1–10 (with 10 being Superman and 1 being exhausted), what you ate, and what else was happening. If you check your blood sugar levels, put those in too. Record your levels three or four times a day.

• See what you notice; share it with your doctor, coach, educator, or friend.

• If your blood glucose levels are high (or too low), ask what you can do to bring them in line, whether it’s diet, exercise, or medicines.

• Get checked for anemia, as well as thyroid and testosterone deficiencies.

• Check with your pharmacist or doctor and research online whether the medicines you are taking can cause fatigue.

• Breathe — try to stop what you’re doing every couple of minutes and focus on your breathing for a few breaths.

• Do some kind of gentle movement like walking or tai chi.

• Think about what’s stressing you and see if you can improve the situation. Get help with it.

• Do some relaxation. Take breaks. Rest. Breathe.

• If possible, spend time with people or animals who make you feel alive, not the ones who wear you out. Maybe you can find a support group like that.

• Resist the madness — our society is all about more, more, more. Faster, faster. This approach would fatigue anyone. Let’s focus on quality of life over quantity of stuff done or acquired. Find your personal balance between work, play, improvement, and rest.

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  • Sheri

    Hi David,
    thanks for this article. My husband has a number of health challenges and this article reminds me to gently help him get more movement in his life. Also, I’m glad to see you back on this forum. I read a goodbye letter from you and was sad, because I like reading what you write. So I’m glad you’re back (even if the whole problem was that I misunderstood your intentions.) Your writing attracts me to this site.

  • Sandra Worbell

    Diabetic people’s work are usually affected by being too lazy at work, you can even feel that even though you have a complete 6 to 8 hours of sleep you can easily get tired. I currently take a supplement recommended by my friend and a doctor whic I got from where they said it is an effective one that may protect my heart and may help me feel more energetic everyday. Is this one really effective?

  • Joe

    Sandra: Astaxanthin is a pigment found in various sea creatures. It’s primary commercial use is in animal feed to enhance coloration. It turns salmon flesh pink and makes egg yolks darker yellow. It has some function as an antioxidant, although lycopene is thought to be more effective and more readily available.

    Personally, I would be inclined to skip it and eat more cooked tomato products.

    As for diabetics being too lazy at work, I hope you meant to say too inactive, because the majority of diabetics I know are anything but lazy, even if their work is primarily sedentary.


    I am a 79 yr. old Diabetic with acurrent problem of Winter inertia.I have had 5 falls since 1988 and sustained broken bones. For some maddening reason this year I lost the oomph to continue.I do appreaciate your articles and the comments of your readers. Thanks a bunch!!!

  • Debbie Baker

    I am IDDM on 32 units of lantus bid, with glucose checks twice daily. Also taking po Metformin 500 mgs. po bid. Today I have noticed that I am just so tired, I walked to the grocery store behind my home and I was so stiff. We had a severe wind storm last night and cloudy and rainy today. I had to go on disability, because I have been diagnosed with alzheimer’s. I try to walk at least a mile a day, and I watch my grandkids at least 4 days a week. This is the first time I ran across your column on my computer. I enjoyed reading your column and look forward to reading more. I would like to go to the Family Sports center and get in the hot tub, but now money is an issue. I take at least 2-3 hot bathes a day to feel relaxed again. I have to admit I don’t always eat the way I should, but I’m getting better. I am 59 yrs old, a retired Labor/Delivery RN, I can’t even get interested in my knitting or counted cross stitch that I loved to do. Any suggestions? Thanks for all your help.

  • Pam Houdyshell

    Debbie, sounds like depression for you to loose interest in your hobbies. This happens to me, so get some advise from your doctor about this. I take a low level of Paxil. Works like a charm! Perhaps knitting hats for the homeless can boast your spirits a bit?!

  • linda

    You are very correct about the exercise. I never feel like I have enough energy to start exercising. But if I miss the exercise, I don’t want to move at all. Protein and healthy carbs do get the energy level up some. The best thing is to never give into the fatigue.

    I have found that a brisk 10-15 minute walk, multiple times a day really helps to keep my stamina up. I do this on my breaks at work or just around the block at home.

  • Denise

    Have you come across any research regarding Black Raspberry supplement? It was recently spotlighted on Dr. OZ to help with fatigue. I am an insulin resistent Type II Diabetic. I’m on 70 units/twice a day of Lantus and take 1.2 units of Vitoza in the am.

    I’m tired just thinking of what I have to take (I am also bipolar) and then watch everything I eat.

    What words of wisdom do you have.

  • David Spero RN

    Denise and Debby,

    You are both on a lot of medicines. I don’t know if this is realistic for you, but you might try cutting way, way down on refined carbs (sugars and flours.) They may be raising your sugars, which increases inflammation, which causes fatigue.

  • Linda


  • David Spero RN


    That’s a tough situation. I don’t think you should take medicines that make you sick. (Cancer chemotherapy might be an exception.) I would look for another doctor or nurse practitioner. Perhaps you can increase exercise and eat more green vegetables.

  • Gloria

    I am a 63 year old diabetic with RA. My blood sugar is undercontroll with an A1c of 6.5. I often have a problem with fatigue. I try to keep my body moving even if it’s walking up and down the stares in my home. The problem for me is, is the fatigue coming from the RA or the diabetes?

  • HeathCliff

    My mother appears to have late-stage Diabetes Type 2. She is also 92. She’s been in good health, and the diabetes has appeared, and she monitors her blood sugar, which is stable, but still she’s suddenly she is suffering from extreme fatigue.

    One can say it’s just age, but she has felt fine until the last few weeks. I’m wondering – beyond the blood sugar monitoring – whether there’s something else to either take or consider?

    I feel helpless, and think it’s something else beside age. She’s had every test under the sun.

  • David Spero RN

    Heathcliff, there are many causes for fatigue, as I wrote in a February blog called “What Causes Diabetes Fatigue?” In old people, anemia and low thyroid levels should be checked first. If all her tests were normal, depression and worry are two other factors. If her glucose control is pretty good, it’s probably not the diabetes. Perhaps she needs to get out in the sun more or exercise more, or see more people.

    And she is 92. Maybe she just needs to rest.

  • Peter

    Eating poorly does a lot of tghins any of these are bad feel free to expand on the fact that if you get them when you’re young, the longer your body will be living with these symptoms, the worse your health can be: Risk of premature death High blood pressure Increased adipose (fat) tissue Therefore, Higher resting heart rate. (Someone who is healthy will have a heart rate that needs to beat about 25,000 40,000 times LESS per DAY than someone who isn’t. That’s saving your heart 6 9 hours per day of beating time) Increased bad Cholesterol (LDL) and decreased good cholesterol (HDL) Increased risk of diabetes Makes day to day activities more difficult. BODY image!! (

  • hariprabhu

    I reached 60 years since last 15 years diabetic problem.i am doing regular exercise like yoga walking 5km. perday,aerobic exercise etc.though ifeel tired and sometime feel frshness,and comfort. what I want to say exercise should be feel endorpin, such exercise be done.(individual should select segregate the exercise or select and follow)in my experience yoga light weightlift it will helpful body feel refreshment.walking for somebody kneepain will come.Mind relaxation meditation helpful,Daily two eggs(withoutyolk) evening dont feel tiredness.

  • IMan

    Was diagnosed with Diabetes T2 in August. My numnbers are completly under control. I am my doctor’s poster child for doing it right – However I am tired. Completely fatigued most of the time. I hit a wall in the afternoon and there’s nothing I can do except sleep for an hour or two. I have lost weight, exercise gently but regularly and have a fantastic diet. On Metformin and anti-depressent just in case it is related (but it is not). It is making it very difficult to function at my job.. anyone here have to change jobs due to the diabetes?

  • David Spero RN

    Iman, I would ask two things to start. How are you sleeping? And how are your blood glucose levels running? Do you notice a connection between glucose numbers and fatigue? Also, as the article said, check for thyroid and anemia problems and possible medication side effects from your antidepressant.

  • Jitender Sehgal

    I am 66 years, male,and had blood sugar fasting was 96 and had blood sugar fasting 106 last month,after a month now it is 107 and after meals and after four hours 119.If any one guides me seriously to bring my blood sugar level to normalI shall be highly obliged and shall pray to almighty GOD for his/her healthy,wealthy & long happy life.Jitender Sehgal.21 August,2013. 7.30P.M.

  • David Spero RN

    Hi Jitender,

    Thanks for writing. I’d have to say your numbers aren’t that bad. You are in the prediabetic range. How do you feel? Are there any symptoms?

    There are a lot of things you could try to bring these numbers down to the normal range. These include: eating less starch and sugar; taking a teaspoon of vinegar with meals; taking an herb such as cinnamon, bitter melon, salacia, or many others; getting more exercise; and reducing the stress in your life.

    I’m trying to say you have choices. Many of them you can research on our web site or on others. No need to panic about this. You will be OK. Your faith is a point in your favor.

  • Nabeel

    I am 37 male and patient of type-1 diabetes for last 23 years with a good control over my blood glucose level . I am father of 4. Every thing was under control till 2-3 months back but now i am feeling lack of energy in my body. Feeling sleepy and lazy all the time please help me to get rid of this situation.

    I take 24 units 70/30 insulin in morning and 20 units in evening along with 1gm metformin twice daily.

  • David Spero RN

    Hi Nabeel,

    As I wrote about in Part 1, there are many causes of fatigue. Some are related to diabetes and some are not. Start with that article and see if you can find some ideas that make sense for you.

  • joy oh

    hi david. i just want to thank you for your blog. i’m learning a lot and comforts me to hear from others.

  • Preety

    My father is having diabetes type 2.These days his blood sugar levels is fluctuating
    between 150- 250.He is feeling weakness and fatigued.He is most of the time bloated and constipated.He goes for walk daily and takes insulin 2 times daily.Any recommendations for weakness and constipations.
    Thanks !!!

    • AUSTaxpayer

      You can try adding more fresh fruit and non starchy vegetables to his diet. Also ensure that his breakfast consists of less starch and more fruit and protein to get him off to a good start on his energy level. If he is not counting carbs for each meal then he needs to start. Try to limit carb intake to 40 carbs per meal when his glucose is above 160 and no more than 60 carbs when his glucose is below 115. Greek Yogurt can help a lot with the constipation and is always a good addition to his meals.

  • Kathleen Shea

    I agree with your article. When my Blood sugar is high I am very tired and when it is low I can’t move so working with my Dr., reading, going to workshops to refresh, diet and walking are all part of my plan. These are things that everyone should do,but when you have diabetes it is imperative. Thank you David for being part of my plan for many years.

  • Bill

    I didn’t find this “smorgasbord” of remedies very helpful. Most people simply cannot just go out and do all these things.. some of these hearsay remedies don’t even apply to most people, some are just anecdotes and not remedies. Can’t there be a more statistically relevant answer provided than just a listing of every unquantified thing the author has ever heard of that might address diabetic fatigue?

    In my case if I even look at carbs, i.e. eat even 15 g or less at a meal, my blood sugar skyrockets above 240. If I eat a meal entirely of protein and “good” fat in modest portions (say 400 cal total) – my blood sugar skyrockets over 240 within an hour, Most of the time when I get up in the morning after 8 hours sleep my blood sugar is at between 180 and 200 before I even get out of bed. (Liver flush) I am heavily fatigued all the time – just eating my usual breakfast of 1 c egg whites, 1/2 avocado and 1/4 c of complex carb so exhausts me that I have to lay down. I am medicated with 1000 mg metformin each evening and 500 mg metformin, 5 mg glipizide and thyroid supplementation each morning. I have to urinate, on average, every 20 min to hour, at night every 2 or 3 hours.

    My MD is an endocrinologist whose idea of Type 2 diabetes treatment is metformin, glipizide and more metformin – he doesn’t have a clue about macronutrients and refers all nutrition questions to a “nutritionist” who doesn’t have a clue about diabetes. As long as my hA1c is below 6.7 he literally doesn’t care what I experience and treats my concerns like hypochondria – especially frequent urination and fatigue.

    On my own, since there is just no real specific useful EXPERIENCE out there, as opposed to smorgasbords of hearsay, I have started testing myself constantly to see what my own body reacts to. That has occasioned push back from the medical insurance (Medicare) for my “excessive” use of test strips and lancets… the insurance fights my request for refills every time. Nevertheless, I have managed to document my hypersensitivity to carbs and that, in some cases, huge amounts of water can start to slightly alleviate fatigue.. i mean close to 2 gallons a day, taken in constant intervals throughout the day. Interestingly, this huge water intake seems to reduce urination frequency – makes sense if it is diluting sugar in my blood. But what else is it diluting?

    I force myself to go to the gym for 1 to 2 hours of weight training and 20 min high intensity interval/cardio each day… But this regime (fluids, workout, and trying to eat on schedule in between) is almost impossible to maintain. I have no time left for any semblance of a normal “life” without staying up ridiculously late, and subsequently getting up really late. Isn’t there any better understood and documented (statistically relevant) treatment for fatigue, or do doctors and diabetes “pundits” everywhere simply either ignore it or pass on hearsay: “ya might try this.. it worked for my second cousin’s brother’s parakeet who has diabetes..”???

    Yes, frustrated, Thanks for reading this far.

  • Al

    I get so tired of advice from so-called experts who always try to put me to work doing something that makes absolutely no sense, as if I am so kind of a grade school or junior high school student who needs to do homework on top of suffer from diabetes.