Rose was recently diagnosed with diabetes, so she made an appointment to talk with Sally, a registered dietitian nutritionist (RDN). Rose has been feeling tired and attributed it to the fact she was about to turn 70, not thinking that it could be attributed to her diabetes, diet or other lifestyle habits.
According to the American Diabetes Association, research shows that 61 percent of people with newly diagnosed type 2 diabetes report fatigue as a symptom.1 High blood glucose levels could be responsible as they contribute to slowing blood circulation and preventing cells from getting the oxygen they need. High blood glucose levels can also cause inflammation which leads to the infiltration of immune cells into the nervous system. When this happens, the brain receives a signal to sleep and this results in fatigue. Low blood glucose, on the other hand, prevents cells from getting the fuel that they need to function well. Knowing that many conditions and medications can lead to fatigue, Sally encouraged Rose to consult her physician with her concerns of unusual tiredness.
Rule Out Common Causes of Fatigue
If you have clients/patients that are feeling low-energy, or unusually tired, here are some important things to rule out:
Fatigue is a common symptom of depression and can also cause feelings of helplessness, hopelessness, loss of interest in things one used to enjoy, appetite or weight changes, sleep changes, anger or irritability, reckless behavior, trouble concentrating, strong feelings of worthlessness or guilt, and unexplained aches and pains.2 Encourage clients/patients to seek professional help as soon as possible if symptoms of depression are noticed.
Diabetes contributes to a higher risk for having sleep apnea, a potentially dangerous condition that causes breathing pauses or shallow breaths during sleep. Sleep apnea increases the risk of high blood pressure, heart attack, and stroke, as well as obesity.3 Besides fatigue, other signs and symptoms include morning headaches, memory problems, an inability to concentrate, mood changes and waking up frequently throughout the night to urinate. Treatment may include mouthpieces, breathing treatments, or surgery.3
Infections are a common cause of both morbidity and mortality in people with diabetes.4 Infections can cause poor blood glucose control, which in turn can lead to the development of infection. Skin infections and urinary tract infections are especially likely to occur in people with poorly controlled diabetes.
Caffeine can be potentially dangerous secondary to the rebound effect of caffeine causing fatigue. Some research suggests that caffeine disrupts glucose metabolism and may contribute to the development and poor control of diabetes.5 Other research has shown some benefits to consuming caffeine when you have diabetes. Howevver, it is worth trying to cut back gradually on caffeine intake to see if energy levels improve.
It is easy to pack too much into daily schedules, causing stress which can increase the risk of high blood glucose levels. The combination of stress and high blood glucose can cause tiredness. Stress increases insulin resistance, heart rate, and blood pressure, as well as causing the muscles to tense up.6 As a result, this wastes even more energy. Stress even interferes with breathing and decreases oxygen delivery to the cells in your body.
Individuals that are sedentary have higher levels of fatigue. Adults, with or without diabetes, need at least 150 minutes of moderate-intensity physical activity per week.7 Additional recommendations include moving at least every 30 minutes to avoid long periods of sitting. Movement can include something as simple as a short walk or some light stretches – it all counts. Of course, individuals should get their physician’s approval prior to starting any exercise program.
Steps to Manage Diabetes and Fatigue
Rose ruled out all of the above potential causes of fatigue with her physician, and working with her doctor and RDN, she implemented the following changes to help manage her diabetes and fatigue:
- Eating a balanced diet that provides adequate amounts of vitamin D, B vitamins, calcium, and magnesium.
- Eating a good breakfast and consuming something containing both carbohydrates and protein every four hours.
- Taking 20-40 minute naps as needed during the day.
- Reaching out to friends and family for social support, which is important to maintain a healthy mental outlook.
Becky Dorner & Associates offers a number of continuing professional education courses on diabetes. Click here for more information.
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- Drivsholm T, de Fine Olivarius N, Nielsen A, Siersma V. Symptoms, signs and complications in newly diagnosed type 2 diabetic patients, and their relationship to glycaemia, blood pressure and weight. Diabetologia 2005;48:210–214pmid:15650820.
- Diabetes and depression: Coping with the two conditions. Mayo Clinic web site. https://www.mayoclinic.org/diseases-conditions/diabetes/expert-answers/diabetes-and-depression/faq-20057904. Accessed October 22, 2019.
- What is sleep apnea? National Heart, Lung, and Blood Institute web site. http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea. Accessed October 22, 2019.
- Infection in patients with diabetes mellitus. Medscape web site. http://emedicine.medscape.com/article/2122072-overview#a2. Accessed October 22, 2019.
- Caffeine and diabetes: helpful or harmful? Science Daily web site. https://www.sciencedaily.com/releases/2011/04/110407171728.htm. Accessed October 22, 2019.
- Stress and diabetes mellitus. National Center for Biotechnology web site. https://www.ncbi.nlm.nih.gov/pubmed/1425110. Accessed October 22, 2019.
- Physical activity and diabetes. Academy of Nutrition and Dietetics web site. https://www.eatright.org/health/diseases-and-conditions/diabetes/physical-activity-and-diabetes. Accessed October 22, 2019.