If you’re feeling fatigued, join the club. Fatigue is a common symptom that affects almost everyone with diabetes — whether they have type 1 or type 2. Ginger Viera, who has lived with type 1 diabetes since 1999, wants to nap when her blood glucose (sugar) drops. “It makes my muscles so tired and weakens my mental energy as well,” she said. “The best naps are after severe low blood sugar, but I rarely have time for that with two kids and a busy work life.”
Whether you call it “being tired,” “sleepiness,” “exhaustion” or “lacking energy,” fatigue can wreak havoc with your life. Fatigue is a serious issue for many — even though there is limited research related to fatigue and diabetes. However, in one survey of 361 insulin-treated people with diabetes, fatigue ranked fifth among the 16 most commonly reported symptoms. Fatigue can make even the simplest activities feel like major tasks, leaving you feeling wiped out and making it hard to accomplish routine things while remaining focused. Another study from 2015 reported that about 40% of people with type 1 diabetes have fatigue that lasts longer than six months.
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“Sometimes my uncontrolled blood sugar can make me feel acutely fatigued, and that feels disruptive to my everyday life,” said Scott Johnson, who has type 1 and works as a patient success manager at mySugr in San Diego. “For example, I notice that when my blood sugar is spiking after a meal, I feel sleepy, which makes it hard to concentrate at work.”
Causes of fatigue
Many factors can cause fatigue. Some of the more common ones include dehydration, anemia, sleep apnea, hypothyroidism, and kidney and liver problems. The 24/7 aspect of managing diabetes can also contribute to fatigue and feelings of burnout.
“If someone is feeling burned out, it’s going to be harder for them to take care of themselves, and that’s when depression and fatigue can really set in,” said psychologist Mark Heyman, PhD, CDE, director of the Center for Diabetes & Mental Health in San Diego, in a previous interview.
The most common cause of fatigue in people with diabetes is poorly controlled blood glucose. “With hyperglycemia (high blood glucose), someone with diabetes may feel fatigued because their body is not processing glucose, so there is an excess amount in their bloodstream, and their cells are not able to make the energy that the body needs,” explained George “Joe” Trotter Jr., BSN, RN, CDE, of Floyd Medical Center in Rome, Georgia.
“Understanding what is causing fatigue is the most critical step,” said Joel Zonszein, MD, director of the Clinical Diabetes Center at the University Hospital of the Albert Einstein College of Medicine, Montefiore Health System in the Bronx, New York. When fatigue is a concern among his patients, he will often screen for anemia and hyperthyroidism through a physical exam and tests. Anemia is a condition marked by lack of red blood cells, the carriers of oxygen throughout the body, resulting in less stamina and fatigue. Anemia caused by iron deficiency can be treated with iron supplements and iron-rich foods, such as red meat, beans, egg yolk and whole-grain products.
People with diabetes are at increased risk for thyroid diseases, especially hypothyroidism, which is a condition in which the thyroid gland doesn’t make enough hormone to keep the body running normally. Standard treatment for hypothyroidism involves daily use of oral medicines that restore hormone levels. “Many patients start feeling better after they begin treatment,” said Zonszein.
Poor sleep and stress also worsen fatigue. There are numerous studies connecting sleep problems and diabetes. In one study, researchers reported that 31% of people with type 1 diabetes had poor sleep quality, and those levels were even higher at 42% among those living with type 2 diabetes.
Sleep apnea is also a problem among those with type 2 diabetes. “Some studies show that sleep apnea can lead to insulin resistance, which is [a hallmark of] type 2 diabetes, so the body may lose its ability to use its insulin effectively,” explained Trotter. “Also, with higher blood sugar levels, your body may cause you to wake up frequently during the night to use the bathroom or get a drink of water, so your sleep is interrupted.”
“As an inpatient diabetes care and education specialist, we talk about good sleep habits when the issue of fatigue is mentioned,” said Chris Memering, RN, BSN, CDE, with CarolinaEast Medical Center in New Bern, North Carolina. Memering recommends several approaches to patients to improve their sleep patterns, such as stress-relief practices, exercise and better nutrition. Sleep studies are oftentimes recommended for patients to help them better understand what’s happening at nighttime.
To reduce fatigue and your risk of other symptoms and complications, experts recommend working with your healthcare team to make sure you properly manage your diabetes and make healthy lifestyle choices.
A successful diabetes management plan should address diabetes and fatigue together, and not as separate conditions, explained Trotter: “Healthier eating, being active and doing exercise are paramount to not only combating fatigue but managing diabetes.”
When fatigue is related to endurance issues because of diabetes or related conditions, grouping daily activities together with periods of rest can help combat fatigue, added Memering. “Participation in programs like cardiac or pulmonary rehab can help build endurance.”
“Making a best effort is key for the management of diabetes and fatigue,” said Trotter. “If you are struggling with your medication, if you are having a hard time figuring out carbs or what may be a healthy food choice, reach out to your doctor, a diabetes care and education specialist, or your endocrinologist’s office for help.”