However, the most common cause, by far, is uncontrolled blood glucose, says 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. With type 2 diabetes, poor blood sugar control typically results in hyperglycemia or high blood sugar, which can cause fatigue among other symptoms. But Dr. Zonszein notes that high blood glucose isn’t the only cause. “Some people — especially the elderly — get dehydrated because their blood sugars are so high [and this leads to increased urination]. The fatigue, in part, comes from the dehydration,” he says. “It can also come from kidney disease.” Underlying conditions and diabetes-related complications are additional factors that can contribute to tiredness. Dr. Zonszein explains that when people have had type 2 diabetes for a long time, they can develop damage in their kidneys, heart, and liver. “Abnormalities in these organs can also cause fatigue,” he says. He will also check the thyroid hormone level. People with diabetes are at increased risk for thyroid diseases, especially hypothyroidism. “A sluggish thyroid together with diabetes can be another cause,” says Zonszein. Medications should also be reviewed, as fatigue can be a side effect in some, especially those used to control blood pressure like beta blockers. Type 2 diabetes is a complex disease that is associated with numerous co-morbidities, including obesity, high cholesterol, high blood pressure, and high blood sugar. People with diabetes who neglect their health because of fatigue and other symptoms put themselves at greater risk of developing complications, according to a review of literature focused on diabetes-related fatigue that was published in the July 2010 issue of the Journal of Psychosomatic Research. Often neglected are psychological factors, such as depression or feeling overwhelmed by their diagnosis or complexity of medical care, that can contribute greatly to feeling “low energy.” To reduce fatigue and your risk of other symptoms and complications, it’s important to work with your health care team to make sure you’re properly managing your diabetes and any co-morbid conditions — and that includes making healthy lifestyle choices. “People who have a healthy lifestyle — who exercise every day, eat well, drink a lot of water, and take their medications properly — tend to feel well,” says Zonszein. “It is the ones who are a little bit sluggish with exercising, or they over-eat, or they don’t eat all day and then they eat too much at night, and they forget their medications, those are the ones who often start to get complications.” Fatigue and headaches are the most common complications of patients who are not well-treated, he says. If you’re feeling abnormally tired in between your regular doctor visits and you don’t seem to be getting better, call your doctor and make an appointment to get examined sooner.
