If you have diabetes, it’s not unusual to feel tired. Members of DiabetesTeam say fatigue can be a constant companion — one that doesn’t go away with sleep and that interferes with all aspects of daily life.

One DiabetesTeam member wrote, “I almost fell asleep at work last week. Regardless of how much sleep I get, I’m always tired.” Learning the causes of fatigue associated with diabetes can help you understand your condition and make changes to combat it.

What Causes Diabetes Fatigue?

Fatigue is a common diabetes symptom that is often reported to health care professionals. There are several reasons why fatigue occurs, including fluctuating blood sugar levels, having other underlying health conditions, sleep quality, and taking certain medications. Together, these factors cause the condition called diabetes fatigue syndrome.

Blood Sugar Levels

One of the most common causes of fatigue in people with diabetes is unregulated blood sugar levels (blood glucose levels). People with both type 1 diabetes and type 2 diabetes (diabetes mellitus) deal with fluctuating levels, which are often managed with insulin. High blood sugar levels (hyperglycemia) and low blood sugar levels (hypoglycemia) have been found to contribute to fatigue, along with decreased cognition and mood changes.

“Fatigue is a big one for us. Our energy levels are affected by our sugar levels,” suggested a DiabetesTeam member. “I’ve been extremely fatigued and frustrated for several days because my sugar is higher than normal,” added another. “I think it’s directly related.”

Underlying Medical Conditions

Diabetes is a complex disease, and people living with it may also have other underlying health issues and conditions. Diabetes complications may contribute as well. These include:

• Heart disease or heart failure
• Anemia and vitamin deficiencies
• Thyroid or adrenal problems
• Kidney disease (diabetic nephropathy)
• Nerve pain from chronic high blood sugar levels
• High HbA1c levels, even when blood sugar levels are under control
• Depression or anxiety
• Chronic inflammation

Many of these conditions affect day-to-day activities and are associated with low energy levels and general fatigue. This is especially true in the case of depression and anxiety, which widely affect those with type 2 diabetes.

Medications

Individuals with diabetes and underlying health conditions often take multiple medications. These can include statins, beta-blockers, and diuretics. Although these are all effective at treating their respective conditions, they can cause fatigue as a side effect.

Statins are cholesterol-lowering medications given to help lower levels of “bad” cholesterol. However, these medications may raise blood sugar levels, which can contribute to fatigue. Beta-blockers and diuretics are used to treat high blood pressure. Beta-blockers work by slowing down the central nervous system to lower the heart rate and, as a result, cause tiredness. Diuretics work by helping the body clear excess fluid to lower blood pressure. However, diuretics can also interfere with salt balance in the body, leading to extreme fatigue. Mild dehydration from losing sugar and water from the kidneys in times of hyperglycemia can also contribute to fatigue.

DiabetesTeam members sometimes cite other medications as the cause of their fatigue. “I wasn’t this fatigued until I started on insulin,” said one member. “My tiredness is from the meds I’m on. Duloxetine (Cymbalta) is the main one that causes me fatigue.”

Quality of Sleep

Getting a good night’s sleep is one way to limit fatigue. However, per an article in the journal Acta Diabetologica, studies show that up to half of people with type 2 diabetes have trouble sleeping due to disease complications from high or low blood sugar episodes during the night.

High blood sugar levels may lead to frequent urination, and you may have to wake up in the middle of the night to go to the bathroom. Other side effects of high blood sugar, such as increased thirst and headaches, may make it difficult to fall back asleep once you are awake. Low blood sugar levels can cause irritation, sweating, and confusion, along with nightmares, which may make it hard to sleep.

Sleep apnea may also be a cause of fatigue in people with diabetes. In fact, the American Diabetes Association estimates that around 25 percent of people with type 2 diabetes have obstructive sleep apnea. This condition is associated with loud snoring and pauses in breathing, fatigue throughout the day, and waking up several times throughout the night.

Sleep apnea prevents you from breathing properly during the night, which increases carbon dioxide in the blood. As a result, this can cause:

• High blood pressure
• Headaches first thing in the morning
• Insulin resistance, leading to an increase in blood sugar levels
• Increased risk of heart disease and other cardiovascular problems

Managing sleep apnea is important, not only for your overall health, but for treating diabetes as well. If you suspect that you have sleep apnea, talk to your doctor about a sleep test. They may prescribe using a continuous positive airway pressure (CPAP) machine to support proper breathing during sleep.

Managing Diabetes Fatigue

Taking steps to better manage your diabetes can help you fight fatigue. This includes making lifestyle changes, such as adopting a healthy diet, getting more exercise, and monitoring blood sugar levels more closely. These changes support your overall well-being, addressing diabetes and underlying health conditions to boost energy levels so you can feel your best.

Healthy Diet

Following a healthy diet is an important part of diabetes management in general, but it can also help combat fatigue. Incorporating a well-balanced diet of complex carbohydrates, fruits, vegetables, and lean proteins can help you manage your blood sugar levels, preventing spikes that may lead to fatigue. Try to avoid sugary snacks, as these cause a spike in insulin levels and then a drop in energy afterward. Choosing sweet fruits with added fiber can provide a boost while satisfying cravings.

DiabetesTeam members also link post-meal energy slumps to blood sugar fluctuations. One member started “interval eating” to get off the blood sugar roller coaster. “I used to ‘crash’ at 2 p.m,” they said. “Now, I eat either a meal or snack at regular intervals, three to four hours throughout the day. It helps me maintain and stabilize my energy.”

“There’s nothing worse than extreme fatigue in the afternoon,” agreed another member. “Snacks between meals really help, especially some type of protein, fruit, or vegetable.”

Physical Activity

It may seem difficult at first, but adding regular exercise to your daily routine can help you boost energy levels and fight fatigue. Exercising increases your heart rate and gets the blood pumping so it can better deliver nutrients and oxygen to muscles around the body. As you begin to move regularly, this process becomes more efficient, giving you more endurance and leads to less fatigue. Regular exercise also assists with weight loss and may help treat underlying health conditions like depression, anxiety, and high blood pressure.

Some DiabetesTeam members say physical activity has reduced after-meal fatigue for them. One member, who always felt sluggish after eating, started walking during lunch breaks. “I’ve been walking 45 minutes every day for the past six months and feel so much better,” they wrote. “My numbers are great and exercise makes a difference.”

Even those who sometimes feel too fatigued to exercise admit that a little movement makes a big difference. “It’s hard to exercise when you just feel like lying down,” said one member. “But once I started walking, the fatigue went away. It takes about 10 minutes before I feel better, though.”

Glucose Monitoring

Monitoring your blood sugar is vital in managing diabetes. Checking your levels consistently to avoid spikes and the blood sugar “roller coaster” can help you avoid fatigue and other side effects of high or low blood sugar levels. It also helps avoid further health complications like stroke and heart attack.

To best keep track of your levels, use a continuous glucose monitor. These devices help identify patterns in your levels and avoid blood sugar spikes or levels dipping too low.

Speak to Your Doctor About Diabetes Fatigue

If you are experiencing chronic fatigue but aren’t sure where to start, talk to your doctor. They will develop a treatment plan with you that can include manageable lifestyle changes like diet and exercise. They may also address other health conditions, if you have any, and make changes to medications to help prevent fatigue.

Talk With Others Who Understand

DiabetesTeam is the social network for people with diabetes and their loved ones. On DiabetesTeam, more than 123,000 members come together to ask questions, give advice, and share their stories with others who understand life with diabetes.

Have you found ways to be active while living with diabetes? Do you have trouble staying motivated? Share your experience in the comments below, or start a conversation by posting on your Activities page.