Aging Diabetes

Fatigue: Diabetes, Lifestyle, or Aging?

Rose was recently diagnosed with diabetes, so she made an appointment to talk with Sally, an RD. Rose has been feeling tired and attributed it to the fact she was about to turn 70, not thinking that it could be attributed to her diabetes, diet, or other lifestyle habits.

According to the American Diabetes Association, research shows that 61% of people with newly diagnosed type 2 diabetes report fatigue as a symptom. High blood glucose levels could be responsible, as they contribute to slowing blood circulation and preventing cells from getting the oxygen they need. High blood glucose levels also can cause inflammation, which leads to the infiltration of immune cells into the nervous system. When this happens, the brain receives a signal to sleep, and this results in fatigue. Low blood glucose, on the other hand, prevents cells from getting the fuel they need to function well. Knowing that many conditions and medications can lead to fatigue, Sally encouraged Rose to consult her physician with her concerns of unusual tiredness.

If you have clients/patients that have low energy, or are unusually tired, the following are some important factors to rule out.

People with diabetes have a higher risk of developing depression. Fatigue is a common symptom of depression and can cause or worsen other symptoms such as feelings of helplessness, hopelessness, loss of interest in things one used to enjoy, appetite or weight changes, sleep changes, anger or irritability, reckless behavior, trouble concentrating, strong feelings of worthlessness or guilt, and unexplained aches and pains. Encourage clients and patients to seek professional help as soon as possible if symptoms of depression are noticed.

Sleep Apnea
Diabetes contributes to a higher risk of sleep apnea, a potentially dangerous condition that causes breathing pauses or shallow breaths during sleep. Sleep apnea increases the risk of high blood pressure, heart attack, stroke, and obesity. Besides fatigue, other signs and symptoms include morning headaches, memory problems, an inability to concentrate, mood changes, and waking up frequently throughout the night to urinate. Treatment may include mouthpieces, breathing treatments, or surgery.

Infections are a common cause of both morbidity and mortality in people with diabetes. This relationship is bidirectional; infections may cause poor blood glucose control, and poor blood glucose control can lead to the development of infection. Skin infections and urinary tract infections are especially likely to occur in people with poorly managed diabetes.

Some research suggests that caffeine disrupts glucose metabolism and may contribute to the development and poor control of diabetes. It also can cause fatigue due to its rebound effect. However, other research has shown some benefits to people with diabetes consuming caffeine. It’s worth trying to cut back gradually on caffeine intake to see whether energy levels improve.

It’s easy, even for older adults who may be retired and not have young children at home, to pack too much into daily schedules, causing stress. Stress can increase the risk of high blood glucose levels, and the combination of stress and high blood glucose can cause fatigue. Stress also increases insulin resistance, heart rate, blood pressure, and muscle tension, depleting more energy.

Sedentary individuals have higher levels of fatigue. Adults, with or without diabetes, need at least 150 minutes of moderate-intensity physical activity per week. Additional recommendations include moving at least every 30 minutes to avoid long periods of sitting. Movement can include something as simple as a short walk or light stretching—it all counts. Of course, individuals should get their physician’s approval prior to starting any exercise program.

Rose ruled out all of the above potential causes of fatigue with her physician, and, working with her doctor and RDN, implemented the following lifestyle changes to help manage her diabetes and fatigue:

  • Eating a balanced diet that provides adequate amounts of vitamin D, B vitamins, calcium, and magnesium.
  • Eating a good breakfast and consuming something containing both carbohydrates and protein every four hours.
  • Taking 20- to 40-minute naps as needed during the day.
  • Reaching out to friends and family for social support, which is important to maintain a healthy mental outlook.

Additional Resources
Becky Dorner & Associates offers a number of continuing professional education courses on diabetes. For more information visit

— Becky Dorner, RDN, LD, FAND, is widely known as one of the nation’s leading experts on nutrition and long term health care. Her company, Becky Dorner & Associates, Inc, is a trusted source of valuable continuing education, nutrition resources, and creative solutions. Visit to sign up for free news and information.

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