If you have diabetes and are plagued by fatigue, you are not alone. Many factors can contribute to your lethargy including: physical factors such as swings in glucose levels and being overweight; psychological factors like depression caused by the intensity of managing this chronic disease; and lifestyle choices like being too sedentary.

According to the American Diabetes Association, if you have insulin-dependent diabetes, your cells don't get the glucose they need for energy and your body begins burning an alternative fuel (such as fat) to glucose. This can cause ketones (acids) to build up in the blood and result in a serious condition known as diabetic ketoacidosis (DKA). An excess of ketones can lead to diabetic coma (passing out for an extended period of time) and even death. Constant fatigue is one of the signs of ketoacidosis. Other early symptoms include thirst or dry mouth, frequent urination, high blood glucose levels, and high levels of ketones in the urine.

While fatigue may be a symptom of blood sugar levels that are too high (hyperglycemia) or too low (hypoglycemia), at least one study shows that fatigue is not just associated with blood sugar levels.

When researchers compared 214 people with diabetes to the same number of healthy participants, 40 percent of the diabetes patients reported chronic fatigue versus 7 percent of the controls (the study only demonstrates association, not causation). Younger patients, those with sleeping problems and lower self-reported physical activity, and patients with other co-existing conditions or clinically relevant depressive symptoms were more likely to be fatigued.

People with diabetes are also at greater risk for depression or diabetes burnout, caused by the daily stress and complications associated with managing their problem. Fatigue and loss of energy are classic signs of both conditions.

What You Can Do

Avoid getting caught up in a vicious cycle. Take charge of your diabetes—and increase your energy level—with these simple steps:

Manage your blood sugar. Avoid swings in your blood sugar that may lead to fatigue, ketoacidosis, hunger, and overeating. Make sure you calculate your insulin doses accurately.

Get moving with exercise. Physical activity actually lessens fatigue and will help you sleep better at night.

Rule out—or treat—depression. If your physician decides there's no physical cause for depression, get a referral to a mental health professional who can treat you. Diabetes expert Amber Taylor, MD, says treating these conditions is important and appropriate therapy can lead to higher satisfaction with life and better self-care for diabetes.

Remember, failure to manage your health and your diabetes will put you at greater risk for complications associated with diabetes. "Getting healthy is your own responsibility," says Taylor who is the director of diabetes at Mercy Medical Center in Baltimore, MD . "Be your own best health advocate. Make a decision that your health is a priority. If you're not sure where to start, ask your doctor."

Amber Taylor, MD, reviewed this article.


Amber Taylor, MD, director of diabetes. Center for Endocrinology at Mercy Medical Center in Baltimore, MD. American Diabetic Association, "Depression," Web. Accessed 4 November 2013. http://www.diabetes.org/living-with-diabetes/complications/mental-health/depression.html

American Diabetic Association, "Hyperglycemia," Web. Accessed 4 November 2013. http://www.diabetes.org/living-with-diabetes/parents-and-kids/planet-d/new-to-diabetes/hyperglycemia.html

Cynthia Fritschi, PhD, RN, and Laurie Quinn, PhD, RN, "Fatigue in Patients with Diabetes: A Review."

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