Fatigue and diabetes

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Fatigue and diabetes
Gary R. Pepper, MD
YourTotalHealth.com

Fatigue is often a symptom of diabetes. People with type 1 diabetes may experience fatigue because their bodies do not produce enough insulin, a hormone that regulates glucose (blood sugar). Insulin allows glucose to enter the cells, where it is converted into energy and used to fuel bodily processes. Without sufficient insulin stores, the body lacks energy and becomes fatigued.

People with type 2 diabetes may experience fatigue because they are prone to a condition called insulin resistance, which affects about 90 percent of individuals with type 2 diabetes. Insulin resistance occurs when the body is unable to detect or properly use insulin. Because the body is unable to convert glucose into energy, fatigue often results. Other forms of diabetes involving insulin resistance include gestational diabetes.

Many diabetic complications and conditions can cause fatigue as well. These include:

* Hypoglycemia (low blood glucose). When less glucose is available, the body is unable to produce sufficient energy to fuel the muscles and bodily processes. This results in feelings of tiredness or fatigue.

* Hyperglycemia (high blood glucose). Hyperglycemia occurs when the body has insufficient insulin or when the body cannot use insulin properly. As a result, elevated levels of glucose remain in the bloodstream instead of entering the cells and being converted to energy. Therefore, individuals with hyperglycemia often experience fatigue.

* Obesity. Most people with type 2 diabetes are overweight or obese. Excess weight reduces physical functioning, often reduces the desire to exercise and can be wearying.

* Diabetic ketoacidosis (a condition of severe hyperglycemia and buildup of ketones in the blood). Individuals with ketoacidosis often experience profound fatigue because their body does not have adequate insulin and therefore cannot use glucose for energy, and the buildup of ketones also disrupts basic bodily functions.

* Dehydration. A symptom of diabetes, dehydration can accompany hyperglycemia, polyuria, ketoacidosis and hyperosmolar hyperglycemia nonketotic syndrome. Lack of fluids impairs functioning throughout the body. In extreme cases, dehydration in association with elevated blood glucose levels can lead to diabetic coma.

* Autonomic neuropathy (damage to the autonomic nervous system, which controls involuntary functions such as digestion). Individuals with this form of diabetic neuropathy may experience low blood pressure (hypotension), which often produces feelings of fatigue.

* High blood pressure. Fatigue can accompany hypertension as well as hypotension.

Diabetic neuropathy is nerve damage that can affect sensation, muscle strength or both. Heart attack is heart muscle damage due to lack of oxygen, usually resulting from artery disease.

*Coronary artery disease (CAD, characterized by hardening of the heart’s arteries). CAD is a type of heart disease that occurs when the coronary arteries become narrowed and clogged, restricting the flow of blood to the heart. Patients with CAD are likely to develop fatigue because their weakened heart muscle is unable to pump enough blood and oxygen to support regular body functions. Some heart medications and blood pressure medications (antihypertensives) may also cause fatigue.

* Heart failure. Individuals with heart failure are more prone to fatigue because a weakened heart muscle does not have the ability to pump sufficient blood and oxygen for normal body function. People with diabetes have an increased risk of CAD and heart failure. For more information, see Heart Conditions & Diabetes.

* Peripheral arterial disease (PAD). The American Diabetes Association estimates that one-third of diabetic individuals over age 50 have PAD, a disease state in which fatty plaque in the arteries (atherosclerosis) reduces blood flow, typically in the legs. Severe PAD can lead to the need for amputation of a lower limb.

* Diabetic nephropathy is kidney damage resulting from diabetes. It can lead to kidney failure.Kidney disease. Renal disorders such as diabetic nephropathy cause a buildup of waste products in the body and can cause anemia (decreased number of red blood cells). Kidney diseases and anemia are both generally accompanied by fatigue.