Diabetes can disrupt sleep directly; for example, low or high blood sugar causes you to wake up in a cold sweat in the middle of the night. Continuous glucose monitor (CGM) alarms can disrupt sleep. And higher blood sugar may lead to excessive urination — more nocturnal wake-ups — and type 2 diabetes’ well-established link to sleep apnea causes people to sleep in a way that is hardly restful or restorative.
Fatigue and Diabetes Complications
Joel Zonszein, MD, a professor emeritus of medicine at Albert Einstein College of Medicine in New York City, says that diabetes complications can also cause tiredness. “Some people — especially the elderly — get dehydrated because their blood sugars are so high. The fatigue, in part, comes from the dehydration,” he says. “It can also come from kidney disease.”
Dr. Zonszein says 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. Type 2 diabetes is a complex disease that is associated with numerous complications, including cardiovascular disease.
Zonszein 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.
Diabetes Drugs and Fatigue
Tiredness is a very common side effect of prescription medications, including some of the drugs used to treat type 2 diabetes. Other medications that cause drowsiness, such as beta-blockers to control blood pressure, are often used by people with type 2 diabetes.
Here is an incomplete list of medications commonly used by people with type 2 diabetes which list fatigue or tiredness as adverse reactions:
- Metformin: The most commonly used medication for type 2 diabetes can increase the risk of vitamin B12 deficiency, which can cause people to feel tired or weak. If you take metformin and experience extreme tiredness, your doctor may want to test your B12 levels.
- GLP-1 receptor agonists: Some medications in this category, like semaglutide (Ozempic), list fatigue as an adverse reaction.
- Statins: These medications can help lower cholesterol levels, but feeling tired and experiencing sleep problems can be side effects.
- Selective serotonin reuptake inhibitors (SSRIs): Medications in this group help treat common mental illnesses like anxiety and depression. One possible side effect is sleep disturbances.
- Antihypertensives: These medications help lower blood pressure. Fatigue can be a side effect of several antihypertensive types including ARBs, ACE inhibitors, and beta-blockers.
If you suspect that your medications could be causing your fatigue, you may want to talk to your healthcare provider.
How to Beat Diabetes Fatigue
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 related 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 overeat, 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.
When talking to your doctor about how you feel, don’t just say, “I’m tired all the time.” Tell your doctor, ‘I’m too tired to go for a walk or go grocery shopping,’” says Cynthia Fritschi, PhD, CDCES, an associate professor of biobehavioral nursing science at the University of Illinois in Chicago. Let your doctor know that exhaustion is preventing you from doing activities that are important to keeping you healthy.
Dr. Fritschi suggests keeping a journal to track your symptoms: How many times do you get up at night to go to the bathroom? Are you skipping meals because you’re too tired to stand and prepare them? Take detailed notes on your daily habits and use your journal to talk to your doctor or diabetes educator about concerns that make living with type 2 diabetes harder for you, she says.
Here are some other ideas that can help fight fatigue:
- Follow a healthy diet in line with diabetes management goals.
- Exercise regularly. You don’t have to perform intense workouts to enjoy an energy and mood boost from exercise. Set small, achievable activity goals, such as taking a daily walk, and increase your movement goals as you feel able.
- Take stress seriously — it’s vital for optimal type 2 diabetes success. Mental health issues such as depression and anxiety deserve professional attention: You may want to ask your doctor for a recommendation to a specialist.
- Track the precise symptoms of your fatigue to help doctors identify underlying problems.
- Improve your sleep hygiene and habits to help get a better night’s sleep.
- Consider asking for an evaluation to see if you have sleep apnea, especially if you snore or have obesity.
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.
The Takeaway
There are many potential reasons why people with type 2 diabetes experience fatigue, and it can be a complex problem with multiple causes. But it really pays to collaborate with your care team to figure out exactly why you’re feeling tired and how to fix it. If you feel fresh and energetic, it will put you in a far better position to manage your health and thrive with diabetes.
Additional reporting by Beth W. Orenstein, K. Aleisha Fetters, and Jen Laskey.
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