Diabetes Fatigue: Causes and Management

“Fatigue” and “tiredness” are often used interchangeably. But there’s a distinct difference between the two.

Everyone feels tired from time to time—and usually, all it takes to “cure” tiredness is a nap or a good night’s sleep.

With fatigue, the feeling of lethargy doesn’t go away, even with plenty of sleep. It’s relentless. Fatigue makes carrying out simple tasks much more difficult and can greatly interfere with normal, everyday functioning.

Now, imagine having to deal with fatigue along with another chronic condition. This is the case for millions of people who have diabetes-related fatigue.

What’s the Link

Diabetes and fatigue have a bidirectional relationship. They feed on and worsen each other, and both are exacerbated by various outside factors.

There are numerous reasons why diabetes can lead to fatigue. A top cause is blood sugar fluctuation.

According to Laura Hieronymus, M.D., vice president of health care programs at the American Diabetes Association, “Fatigue is a symptom of hyperglycemia (high blood glucose). When blood glucose levels are too high, the body is not processing glucose as energy; therefore, tiredness or fatigue may occur.”

Fatigue can also coexist with other conditions. These include:

• Unhealthy lifestyle habits: Poor diet/skipping meals, lack of exercise, excessive caffeine or alcohol intake

• Insomnia/poor sleep quality

• Obesity

• Widespread chronic inflammation

• Diabetic complications such as neuropathy, myopathy, cardiovascular disease, stroke, and renal failure

• Medication side effects: Corticosteroids, statins, diuretics, beta-blockers, and certain diabetes drugs are known to cause fatigue

More to Diabetes

Other Diabetes Symptoms

Fatigue is just one of several indicators of diabetes. If you have fatigue along with the following symptoms, talk to your health care provider about getting tested for diabetes.

• Frequent urination

• Constant thirst and/or hunger

• Blurry vision

• Numbness or tingling in hands or feet

• Dry skin

• Slow-healing sores

• Chronic infections

Complications

Diabetes Complications That Can Cause Fatigue

Along with blood sugar imbalances, certain diabetic complications contribute to feelings of fatigue. These complications include:

• Kidney disease or failure

• Heart failure

• Nerve damage/neuropathy

• Myopathy (muscle weakness)

Other Causes

Other Possible Causes of Fatigue

Fatigue can be a symptom of many other conditions outside of diabetes. Some of the top non-diabetes-related culprits are:

• Anemia

• Autoimmune conditions (multiple sclerosis, inflammatory bowel disease, etc.)

• Chronic fatigue syndrome

• Chronic or undiagnosed infections (for instance, Lyme disease)

• Endocrine disorders (hypothyroidism, Addison’s disease, hormonal imbalances)

• Fibromyalgia

• Nutritional deficiencies

• Side effect of treatments for other conditions like cancer

Research

Research on Diabetes and Fatigue

Several studies confirm a link between diabetes and fatigue, though more research is needed to thoroughly determine the how’s and why’s.

One study found that people with diabetes were 10 times more likely to experience fatigue compared to those with normal blood sugar functions. Among the study participants, 68% claimed to have had fatigue.

A review of existing research concluded that diabetes-related fatigue is likely caused by the interplay of physiological, psychological, and lifestyle factors. It acknowledged that a common definition of fatigue in diabetes was needed, however, to even begin to study the issue further.

As a Side Effect

Adverse Effects of Diabetes Medications

There are several classes of diabetes medications, each with different ways they work to help stabilize blood sugar. Some have side effects such as fatigue.

In general, the job of diabetes medication is to reduce high blood sugar. If it does this too well, you could end up with hypoglycemia—blood sugar that’s too low. Chronic hypoglycemia can lead to fatigue.

Your health care provider should do regular bloodwork to keep an eye out for this. But be sure to share if you feel chronically fatigued, as this could mean you need to adjust your medication dosage.

The following diabetes drugs may cause fatigue in other ways:

• Biguanides like metformin (Glucophage, Fortamet, Riomet) work by improving the way your body handles glucose. Metformin boosts insulin sensitivity and reduces sugar in the intestines, which means less sugar in the blood. One of the side effects of metformin is vitamin B12 deficiency, which can manifest as severe fatigue. You can prevent this by working with your doctor to take a B12 supplement and get your blood levels checked periodically.

• Meglitinides such as nateglinide (Starlix) and repaglinide (Prandin) help the pancreas produce more insulin. Though rare, fatigue has been reported as a side effect.

• Thiazolidinediones like pioglitazone (Actos) and rosiglitazone (Avandia) activate certain receptors, which trigger a cascade of events that result in better blood sugar metabolism. However, these drugs tend to cause excess fluid retention, which increases the risk of heart failure. Relentless fatigue is a big indicator of heart failure.

Fatigue and Your Brain

Mental and Emotional Health

People with diabetes deal with not only a lot of physical complications, but mental health concerns as well. Anger, denial, and depression are all very real emotions normally experienced after a diabetes diagnosis and while navigating treatment options.

Depression is two to three times more common in people with diabetes, yet only about a quarter to a half of them get diagnosed and treated. And while it affects both sexes, studies show women with diabetes are at higher risk of depression.

What does this have to do with fatigue?

Well, fatigue also happens to be a well-known sign of depression. For some, depression causes difficulty sleeping, which snowballs into exhaustion during the day. For others, there’s just not enough hours to sleep, and they end up spending their entire day in bed.

Weight and Fatigue

How Being Overweight Can Contribute to Diabetes Fatigue

Obesity is a factor in nearly half of new diabetes cases in the US each year.

Being overweight or obese increases the risk of the following conditions—all of which contribute to fatigue:

• Sleep apnea

• Hormonal imbalance

• Chronic inflammation, which can eventually result in sleep-hindering conditions like high blood pressure and arthritis

Management Tips

How to Manage Diabetes Fatigue

Fatigue can be frustrating, and managing it can seem impossible. After all, who wants to put effort into anything when they’re bone tired?

But diabetes-related fatigue is treatable. The first order of business is making sure your blood sugar remains within the target range.

“Fatigue related to hyperglycemia can best be managed by monitoring blood glucose levels,” says Dr. Hieronymus. “People with diabetes can talk with their health care provider about a plan to manage hyperglycemia. The plan should be unique to the person, which may be determined by the type of diabetes they have, their age, how long they have had diabetes, their treatment plan, and other individual characteristics.”

Here are a few additional lifestyle changes that can help manage fatigue:

• Treat depression. It can go a long way in fighting fatigue. Get evaluated by a mental health professional if you or your loved ones feel you might have depression.

• Improve your diet. If you have diabetes, you should already be watching what you eat. But if you aren’t, now is the time to start. Cutting back on carbohydrates and sweets will prevent the blood sugar roller coaster that leads to major slumps in energy. Focus on eating low-glycemic fruits and vegetables, high-protein meats like poultry and fish, and healthy fats such as olive oil and avocados. Dietary fat happens to be the body’s slowest-burning fuel source, so eating health-promoting monounsaturated fats provides a long, steady stream of energy.

• Exercise. It seems counterintuitive to tell someone who is chronically fatigued to go exercise, but physical activity is one of the best natural energy boosters available. One study found that engaging in low-intensity exercise (like a leisurely walk) helped sedentary people decrease their fatigue by 65%.If walking doesn’t appeal to you, find a low-impact activity that does—dancing, yoga, biking, elliptical, and swimming are all excellent choices. As a bonus, exercise can help you lose weight.

• Address vitamin deficiencies. Low levels of iron and vitamins B12 and D are some leading nutritional causes of fatigue. It’s not unusual for people with diabetes to have these and other nutritional deficiencies.

• Audit your medications. Check to see how many of your daily meds list fatigue as a possible side effect. If possible, find alternatives or ask your health care provider if you can wean off some of these meds. It may not be possible, but it’s worth exploring. (Don’t stop taking any medication without consultation, however.)

• Balance your thyroid hormones. Fatigue can often be attributed to low levels of thyroid hormones. Have your thyroid function checked to make sure your levels aren’t out of range.

When It’s Serious

When to See a Doctor for Diabetes Fatigue

Without a doubt, fatigue can be debilitating and challenging. But struggling in silence only creates more frustration and negativity.

As soon as you start experiencing symptoms of fatigue, be sure to discuss it with your health care provider so that you can make a plan of action. They can help you figure out what’s causing it and how to fix it.

Notes: This article was originally published December 22, 2022 and most recently updated January 24, 2023.

Kalra S, Sahay R. Diabetes Fatigue Syndrome. Diabetes Ther. 2018;9(4):1421-1429. doi: 10.1007/s13300-018-0453-x

Diabetes Symptoms: https://www.cdc.gov/diabetes/basics/symptoms. html

Nesto RW, Bell D, Bomow RO, et al. Thiazolidinedione use, fluid retention, and congestive heart failure. Circulation. 2003;108(23):2941-2948. doi: 10.1161/01.CIR.0000103683.99399.7E.

Diabetes and Mental Health: https://www.cdc.gov/diabetes/managing/mental-health.html

Roy T, Lloyd CE. Epidemiology of depression and diabetes: A systematic review. J Affect Disord. 2012;142:S8-S21. doi:10.1016/S0165-0327(12)70004-6

Our Review Process

Diabetes Fatigue: Causes and Management

“Fatigue” and “tiredness” are often used interchangeably. But there’s a distinct difference between the two.

Everyone feels tired from time to time—and usually, all it takes to “cure” tiredness is a nap or a good night’s sleep.

With fatigue, the feeling of lethargy doesn’t go away, even with plenty of sleep. It’s relentless. Fatigue makes carrying out simple tasks much more difficult and can greatly interfere with normal, everyday functioning.

Now, imagine having to deal with fatigue along with another chronic condition. This is the case for millions of people who have diabetes-related fatigue.

What’s the Link

Diabetes and fatigue have a bidirectional relationship. They feed on and worsen each other, and both are exacerbated by various outside factors.

There are numerous reasons why diabetes can lead to fatigue. A top cause is blood sugar fluctuation.

According to Laura Hieronymus, M.D., vice president of health care programs at the American Diabetes Association, “Fatigue is a symptom of hyperglycemia (high blood glucose). When blood glucose levels are too high, the body is not processing glucose as energy; therefore, tiredness or fatigue may occur.”

Fatigue can also coexist with other conditions. These include:

• Unhealthy lifestyle habits: Poor diet/skipping meals, lack of exercise, excessive caffeine or alcohol intake

• Insomnia/poor sleep quality

• Obesity

• Widespread chronic inflammation

• Diabetic complications such as neuropathy, myopathy, cardiovascular disease, stroke, and renal failure

• Medication side effects: Corticosteroids, statins, diuretics, beta-blockers, and certain diabetes drugs are known to cause fatigue

More to Diabetes

Other Diabetes Symptoms

Fatigue is just one of several indicators of diabetes. If you have fatigue along with the following symptoms, talk to your health care provider about getting tested for diabetes.

• Frequent urination

• Constant thirst and/or hunger

• Blurry vision

• Numbness or tingling in hands or feet

• Dry skin

• Slow-healing sores

• Chronic infections

Complications

Diabetes Complications That Can Cause Fatigue

Along with blood sugar imbalances, certain diabetic complications contribute to feelings of fatigue. These complications include:

• Kidney disease or failure

• Heart failure

• Nerve damage/neuropathy

• Myopathy (muscle weakness)

Other Causes

Other Possible Causes of Fatigue

Fatigue can be a symptom of many other conditions outside of diabetes. Some of the top non-diabetes-related culprits are:

• Anemia

• Autoimmune conditions (multiple sclerosis, inflammatory bowel disease, etc. )

• Chronic fatigue syndrome

• Chronic or undiagnosed infections (for instance, Lyme disease)

• Endocrine disorders (hypothyroidism, Addison’s disease, hormonal imbalances)

• Fibromyalgia

• Nutritional deficiencies

• Side effect of treatments for other conditions like cancer

Research

Research on Diabetes and Fatigue

Several studies confirm a link between diabetes and fatigue, though more research is needed to thoroughly determine the how’s and why’s.

One study found that people with diabetes were 10 times more likely to experience fatigue compared to those with normal blood sugar functions. Among the study participants, 68% claimed to have had fatigue.

A review of existing research concluded that diabetes-related fatigue is likely caused by the interplay of physiological, psychological, and lifestyle factors. It acknowledged that a common definition of fatigue in diabetes was needed, however, to even begin to study the issue further.

As a Side Effect

Adverse Effects of Diabetes Medications

There are several classes of diabetes medications, each with different ways they work to help stabilize blood sugar. Some have side effects such as fatigue.

In general, the job of diabetes medication is to reduce high blood sugar. If it does this too well, you could end up with hypoglycemia—blood sugar that’s too low. Chronic hypoglycemia can lead to fatigue.

Your health care provider should do regular bloodwork to keep an eye out for this. But be sure to share if you feel chronically fatigued, as this could mean you need to adjust your medication dosage.

The following diabetes drugs may cause fatigue in other ways:

• Biguanides like metformin (Glucophage, Fortamet, Riomet) work by improving the way your body handles glucose. Metformin boosts insulin sensitivity and reduces sugar in the intestines, which means less sugar in the blood. One of the side effects of metformin is vitamin B12 deficiency, which can manifest as severe fatigue. You can prevent this by working with your doctor to take a B12 supplement and get your blood levels checked periodically.

• Meglitinides such as nateglinide (Starlix) and repaglinide (Prandin) help the pancreas produce more insulin. Though rare, fatigue has been reported as a side effect.

• Thiazolidinediones like pioglitazone (Actos) and rosiglitazone (Avandia) activate certain receptors, which trigger a cascade of events that result in better blood sugar metabolism. However, these drugs tend to cause excess fluid retention, which increases the risk of heart failure. Relentless fatigue is a big indicator of heart failure.

Fatigue and Your Brain

Mental and Emotional Health

People with diabetes deal with not only a lot of physical complications, but mental health concerns as well. Anger, denial, and depression are all very real emotions normally experienced after a diabetes diagnosis and while navigating treatment options.

Depression is two to three times more common in people with diabetes, yet only about a quarter to a half of them get diagnosed and treated. And while it affects both sexes, studies show women with diabetes are at higher risk of depression.

What does this have to do with fatigue?

Well, fatigue also happens to be a well-known sign of depression. For some, depression causes difficulty sleeping, which snowballs into exhaustion during the day. For others, there’s just not enough hours to sleep, and they end up spending their entire day in bed.

Weight and Fatigue

How Being Overweight Can Contribute to Diabetes Fatigue

Obesity is a factor in nearly half of new diabetes cases in the US each year.

Being overweight or obese increases the risk of the following conditions—all of which contribute to fatigue:

• Sleep apnea

• Hormonal imbalance

• Chronic inflammation, which can eventually result in sleep-hindering conditions like high blood pressure and arthritis

Management Tips

How to Manage Diabetes Fatigue

Fatigue can be frustrating, and managing it can seem impossible. After all, who wants to put effort into anything when they’re bone tired?

But diabetes-related fatigue is treatable. The first order of business is making sure your blood sugar remains within the target range.

“Fatigue related to hyperglycemia can best be managed by monitoring blood glucose levels,” says Dr. Hieronymus. “People with diabetes can talk with their health care provider about a plan to manage hyperglycemia. The plan should be unique to the person, which may be determined by the type of diabetes they have, their age, how long they have had diabetes, their treatment plan, and other individual characteristics.”

Here are a few additional lifestyle changes that can help manage fatigue:

• Treat depression. It can go a long way in fighting fatigue. Get evaluated by a mental health professional if you or your loved ones feel you might have depression.

• Improve your diet. If you have diabetes, you should already be watching what you eat. But if you aren’t, now is the time to start. Cutting back on carbohydrates and sweets will prevent the blood sugar roller coaster that leads to major slumps in energy. Focus on eating low-glycemic fruits and vegetables, high-protein meats like poultry and fish, and healthy fats such as olive oil and avocados. Dietary fat happens to be the body’s slowest-burning fuel source, so eating health-promoting monounsaturated fats provides a long, steady stream of energy.

• Exercise. It seems counterintuitive to tell someone who is chronically fatigued to go exercise, but physical activity is one of the best natural energy boosters available. One study found that engaging in low-intensity exercise (like a leisurely walk) helped sedentary people decrease their fatigue by 65%.If walking doesn’t appeal to you, find a low-impact activity that does—dancing, yoga, biking, elliptical, and swimming are all excellent choices. As a bonus, exercise can help you lose weight.

• Address vitamin deficiencies. Low levels of iron and vitamins B12 and D are some leading nutritional causes of fatigue. It’s not unusual for people with diabetes to have these and other nutritional deficiencies.

• Audit your medications. Check to see how many of your daily meds list fatigue as a possible side effect. If possible, find alternatives or ask your health care provider if you can wean off some of these meds. It may not be possible, but it’s worth exploring. (Don’t stop taking any medication without consultation, however.)

• Balance your thyroid hormones. Fatigue can often be attributed to low levels of thyroid hormones. Have your thyroid function checked to make sure your levels aren’t out of range.

When It’s Serious

When to See a Doctor for Diabetes Fatigue

Without a doubt, fatigue can be debilitating and challenging. But struggling in silence only creates more frustration and negativity.

As soon as you start experiencing symptoms of fatigue, be sure to discuss it with your health care provider so that you can make a plan of action. They can help you figure out what’s causing it and how to fix it.

Notes: This article was originally published December 22, 2022 and most recently updated January 24, 2023.

Kalra S, Sahay R. Diabetes Fatigue Syndrome. Diabetes Ther. 2018;9(4):1421-1429. doi: 10.1007/s13300-018-0453-x

Diabetes Symptoms: https://www.cdc.gov/diabetes/basics/symptoms.html

Nesto RW, Bell D, Bomow RO, et al. Thiazolidinedione use, fluid retention, and congestive heart failure. Circulation. 2003;108(23):2941-2948. doi: 10.1161/01.CIR.0000103683.99399.7E.

Diabetes and Mental Health: https://www.cdc.gov/diabetes/managing/mental-health.html

Roy T, Lloyd CE. Epidemiology of depression and diabetes: A systematic review. J Affect Disord. 2012;142:S8-S21. doi:10.1016/S0165-0327(12)70004-6

Our Review Process

Symptoms of latent diabetes? ⋆ Prof. Dr. Alper Celik

Latent diabetes is a common term among the people. However, if there is no mention of diabetes in your life history, then latent diabetes will be just a term for you. In fact, it may seem complicated, but it’s not as difficult as it sounds. This is the case when a person’s blood sugar values ​​are not in the range that is above normal, but can be considered diabetic. The values ​​obtained as a result of the analysis in these patients are not in the normal range. However, it is not high enough to diagnose type 2 diabetes. In such cases, latent diabetes is diagnosed. Although patients with occult diabetes are not considered diabetics, they are in fact a candidate for diabetes. Therefore, it is very important to take the necessary measures. Being in a high-risk group can be annoying. However, if measures are taken, there will be no problems.

In determining latent diabetes, comparisons are made by looking at both fasting blood sugar and satiety blood sugar. In such patients, while the values ​​are normal in a blood sugar test performed on an empty stomach, the values ​​during satiety are higher than normal. Thus, latent diabetes that manifests itself can be controlled by a balanced diet. As you can see from here, simply checking your fasting blood sugar will not be enough to diagnose hidden sugar. These tests will give correct and reliable results when done after eating foods with carbohydrates, fats and sugary ingredients.

Symptoms of latent diabetes

Although the diagnosis of latent diabetes will be assessed by looking at fasting and satiety values, there are certain reasons that lead patients to this stage. Differences a person feels about themselves can lead them to wonder if they have latent diabetes. The most common of these differences is constant hunger and fast food. Patients with occult diabetes actually have diabetic symptoms in part because of their predisposition to diabetes. Particularly intolerance to hunger and tension also occurs in diabetic patients. As can be seen from the differentiation of fasting and satiety blood sugar values, an imbalance in blood sugar levels may be due to a lack of sugary foods. Although we do not notice these shortcomings in our daily lives, it may actually give us few signals. The signals that latent diabetes sends us are not really details that can be seen in the routine of life. Because these symptoms are often found in the lives of ordinary people. However, if you are facing the problem of latent diabetes, the sensations and symptoms in your body will certainly be different from normal life. In other words, the patient can definitely notice it. For example, conditions such as inclination to sleep after eating, weakness and exhaustion, which can happen to anyone. However, if it is due to latent diabetes, you will certainly feel a little different. If you’re experiencing instability, if you’re unsure of yourself, it’s always good to meet with your doctor and get checked out. One of the most accurate symptoms of latent diabetes is weakness and drowsiness. Feels suddenly tired after eating and wants to sleep.

Physical symptoms of occult diabetes

There are also visible signs of occult diabetes. Especially significant sweating on the head, neck and sudden tantrums in the face of problems are one of the symptoms. People who have these symptoms are often overweight than usual. In this process, there may be rapid weight gain and even faster weight loss than usual. We talked about the similar characteristics of latent diabetes and diabetes. Diabetes and occult diabetes share similar characteristics. If the mother or father has diabetes or latent diabetes, even if you do not have symptoms, it is helpful to have the necessary examinations after a certain period of time. In this way, you will diagnose diabetes problems that may arise early and, accordingly, you will be able to take the necessary measures at an early stage.

Hypoglycemia is the most noticeable in patients who come for examinations of latent diabetes; sudden spikes in sugar. Within your normal flow of life, eating intervals are approximately 4 to 5 hours, and in latent diabetes, this period is reduced to 2 hours. If the patient ignores these signals and continues to eat in his old routine between 4-5 hours; When it’s time to eat, sugar will drop to a minimum and hunger will peak. In this case, it will cause the patient to eat much faster or have a lack of blood sugar. The source of the rumor that chocolate, which is common in society, brings happiness, is based on this. Due to the sugar in chocolate, the hypoglycemia table is regulated. If your satiety reference range is over 140, then you should always see your doctor and follow your doctor’s advice.

EARLY SIGNS OF DIABETES

Publication date: November 16, 2020 .

As you know, there are several types of diabetes mellitus: type 1, type 2, gestational (pregnancy diabetes) and specific. For each type there are characteristic symptoms, however, there are common signs. The effectiveness of future diabetes treatment will depend on how quickly the first symptoms are noticed and the correct diagnosis is made.

There are several signs that can clearly indicate that you are developing or have already developed diabetes:

1. Sudden weight loss is one of the first signs of a developing disease that should alert. You seem to eat as usual, do not sit on a strict diet and do not torture yourself with daily exercises in the gym, but at the same time you are melting right before your eyes. At first, weight loss can be encouraging. But the joy will be short-lived, because rapid weight loss is a sure sign of some kind of disease. In the case of diabetes, weight is lost due to a lack of insulin that the body needs, which breaks down food and promotes the absorption of valuable substances and calories.
2. Thirst. Constant dry mouth does not go away even with the consumption of large volumes of liquid. You are always thirsty, and it doesn’t matter if it’s a hot summer outside or a frosty winter.
3. Incredible fatigue. Just one “beautiful” day, waking up, you suddenly realize that you can not get out of bed. Loss of physical strength, weakness, exhaustion are some of the sure symptoms of diabetes.
4. Constant feeling of hunger. You suddenly have a brutal appetite, you greedily pounce on food, although only an hour has passed after a hearty dinner. Even when eating a lot of food, you are constantly hungry. The cause of increased appetite is a violation of the metabolic processes of sugar in the body.
5. Frequent urination. You constantly want to go to the toilet. A similar situation occurs with cystitis. But in this case, the cause is not inflammation of the kidneys, but the inability of the body to cope with high blood sugar. Attempts to remove excess sugar lead to a constant urge to urinate.
6. “Sand in the eyes” and visual impairment. The eyes may suddenly begin to double or there is a feeling of fog. Visual impairment in diabetes is caused by a disorder in the function of the retina due to an increase in blood sugar.
7. Non-healing wounds and abrasions. Have you noticed that even small wounds and abrasions do not go away for a very long time and give you a lot of inconvenience and discomfort? Or are you worried about itching in some places of the body, often intimate? As a rule, with such symptoms, women go to a dermatologist or gynecologist, but they can be signs of diabetes.

The main thing is to be on time. Elevated blood glucose levels can only be detected in the laboratory, that is, by passing a blood test for sugar. Even without obvious symptoms of diabetes, a sugar test will accurately determine its presence. Self-control is also needed in order to detect prediabetes in time – a condition in which carbohydrate metabolism is already impaired, but not yet to the extent that the pathology turns into diabetes mellitus.

If a borderline condition is caught in time, the situation can be corrected with the right diet, even without resorting to medications. In order not to get sick, you will have to reconsider your diet in favor of healthy food, vegetables and fruits, go in for sports to reduce body weight, increase physical activity – walk more in the fresh air and sit less on the couch in front of the TV with a plate of sweets. If you make some effort and change your lifestyle, the likelihood of developing diabetes will decrease by almost 70%.