If you have diabetes, feeling tired all the time is pretty common. Many members of DiabetesTeam say they feel worn out, no matter how much they sleep, and it can really get in the way of daily life.

Hyperglycemia (high blood sugar) is one reason people with diabetes often feel fatigued. You may feel tired if your blood sugar goes up and down a lot. In addition, long-term complications from hyperglycemia can lead to other symptoms and conditions that make you feel tired.

One DiabetesTeam member wrote, “I almost fell asleep at work last week. Regardless of how much sleep I get, I’m always tired.” Learning how hyperglycemia contributes to fatigue can help you find ways to get your energy back.

What Causes Diabetes Fatigue?

Fatigue is a common diabetes symptom. There are a few different reasons why this happens. Some people may even have a condition called diabetes fatigue syndrome, where tiredness becomes a long-term issue.

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 type 1 diabetes and type 2 diabetes (diabetes mellitus) often deal with these changes. In severe cases, people with severe blood sugar swings are said to have brittle diabetes, which is linked to frequent hospitalizations.

Both high blood sugar levels (hyperglycemia) and low blood sugar levels (hypoglycemia) contribute to fatigue. They also affect brain function and mood.

“I’ve been extremely fatigued and frustrated for several days because my sugar is higher than normal,” said a DiabetesTeam member. “I think it’s directly related.”

Underlying Medical Conditions

Diabetes is a complicated disease. It often comes with other health problems that can also make you feel tired. These may include:

• Heart disease or heart failure
• Anemia (low iron) or vitamin deficiencies
• Thyroid or adrenal problems
• Kidney disease (diabetic nephropathy)
• Nerve pain from chronic high blood sugar levels
• Depression or anxiety
• Chronic inflammation
• Liver problems

Many of these conditions affect day-to-day activities, causing low energy levels. One example is fatty liver disease. This includes metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH). These are health problems where fat builds up in the liver. These conditions are linked to type 2 diabetes and high blood sugar levels. Fatigue is a common symptom of MASLD and MASH. If left untreated, MASLD and MASH can lead to permanent liver damage.

Medications

People with diabetes and underlying health conditions often take multiple medications to manage their health. Some of these can cause fatigue as a side effect.

For example, beta-blockers and diuretics are used to treat high blood pressure. Beta-blockers lower the heart rate and, as a result, cause tiredness. Diuretics, also called water pills, help remove extra fluid from the body. They can also cause fatigue as a side effect by lowering sodium, potassium, calcium, and magnesium levels.

In addition, diabetes medications known as SGLT2 inhibitors, prescribed to help control high blood sugar, can cause low blood pressure as a side effect. This can make you feel tired, too.

DiabetesTeam members sometimes mention other medications as causing their fatigue. “I wasn’t this fatigued until I started on insulin,” one member said. “My tiredness is from the meds I’m on.”

Still, taking your diabetes medications as prescribed is important to help you feel your best. For example, insulin therapy has been shown to help reduce fatigue after six months of use. Newer medications, like tirzepatide (Mounjaro and Zepbound), help control blood sugar levels. They may help with type 2 diabetes symptoms and also treat related conditions that cause fatigue, including obesity and sleep apnea.

Quality of Sleep

Getting a good night’s sleep is one of the best ways to fight fatigue. However, studies show that up to 76 percent of people with type 2 diabetes have trouble sleeping.

High blood sugar levels may lead to frequent urination, which can cause you 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 asleep or stay asleep. Low blood sugar levels can also wake you up. They can cause irritation, sweating, confusion, and nightmares, which may make it hard to sleep.

Another common cause of fatigue in people with diabetes is sleep apnea. This is a condition where your breathing stops and starts while you sleep. It often causes loud snoring, fatigue throughout the day, and waking up throughout the night. The American Diabetes Association estimates that around 25 percent of people with type 2 diabetes have obstructive sleep apnea.

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

• High blood pressure and heart disease
• Morning headaches
• Insulin resistance (which can raise blood sugar levels)

If you think you might have sleep apnea, talk to your doctor. A sleep test can help find out if you have it. Your treatment will depend on how severe it is and whether your airway is obstructed.

Managing Fatigue With Diabetes

Managing your diabetes better can help you fight fatigue. You can feel more energetic by making lifestyle changes, such as eating well, exercising more, and keeping your blood sugar levels steady. These habits support your overall well-being. They also help manage diabetes and underlying health conditions to boost your energy levels.

Healthy Diet

Following a healthy diet is an important part of diabetes management, and it can also help reduce fatigue. A well-balanced diet of complex carbohydrates, fruits, vegetables, and lean proteins can help you manage your blood sugar levels. Avoid sugary snacks, which can cause your blood sugar to spike and crash. That crash can leave you feeling extra tired. Instead, go for sweet fruits with fiber, like apples or berries, which can give you energy without the crash while satisfying cravings.

DiabetesTeam members also link energy slumps after meals 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 a 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,” said another member. “Snacks between meals really help, especially some type of protein, fruit, or vegetable.”

Physical Activity

It might feel hard to get moving when you’re tired, but exercise can really help with fatigue. Exercise raises your heart rate and gets your blood pumping, which gives you more energy. Exercise can also help with blood sugar levels, weight loss, and may help with other conditions that cause fatigue, like depression, anxiety, and high blood pressure.

Some DiabetesTeam members say physical activity helps them feel less tired after meals. 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 people who feel too tired to exercise say 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.”

Talk to your healthcare provider before starting a new exercise program. They can give you advice on how exercise fits into your diabetes care plan.

Glucose Monitoring

Checking your blood sugar regularly can help keep you off the blood sugar “roller coaster” and support more stable energy levels. A continuous glucose monitor can make it easier to track your numbers. Ask your healthcare provider if a CGM could be a good option for you.

Speak to Your Doctor About Diabetes Fatigue

If you’re experiencing chronic fatigue, talk to your doctor. They can develop a treatment plan with you that can include lifestyle changes like diet and exercise. Your doctor can also check for other health conditions that might be making you feel tired and make changes to medications to help prevent fatigue if needed.

Talk With Others Who Understand

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

What symptoms of diabetes affect your daily life? Do diabetes complications from high blood sugar affect your energy levels? Share your experience in the comments below, or start a conversation by posting on your Activities page.