Type 1 diabetic patients have this complain most of the time. They feel tired or fatigue and they can’t even do their daily works. It leads them to just go to bed and sleep and sleep and sleep.
The causes for fatigue in diabetes have identified by researchers and those are,
- Changes in blood glucose levels ( both hypoglycaemia and hyperglycaemia )
- Psychological issues
- Neuropathic pain and other diabetes related complications
- Decreased physical activity and increased BMI
- Lack of sleep
- Other endocrine diseases associated with type 1 diabetes
Before getting to review these causes in detail, let’s see what is fatigue ?
What is fatigue or tiredness ?
Fatigue is defined as physical and/or mental exhaustion that is triggered by stress, overwork, medication or mental and physical disease or illness.
Fatigability means how fast someone get exhausted. The easy fatigability means a person get fatigue in little mental or physical stress that normal person doesn’t. It is harmful for quality of life of a person.
The Molecular Basis of Fatigue in Diabetes
The mechanism of fatigue is identified up to body’s molecular levels. According to that our muscles contractile ability is controlled by an tiny electrical current. This electrical activity is maintained by changes of the inorganic ions in body.
The power supply to muscle functions comes from ATP molecules which is produced by cellular energy producing pathways. The main substrate for this pathways are glucose.
Once our glucose levels are over body convert glycogen which is the stored form of glucose to produce glucose.
But there are less amount of glycogen storage in diabetic people. So the next choice is fat.
But the problem with fat is it has slow energy production ability compared to glucose. So less energy means our body get fatigue.
In addition to that there are accumulation of hydrogen ions, inorganic phosphate and potassium ions are identified in fatigue muscles by researches. Science proves that excessive collection of these ions is harmful for ATP production in human cells.
Hypoglycaemia and hyperglycaemia
Hyperglycaemia is so related to fatigue that doctors even say the fatigue is a symptom when our blood glucose is high.
In hypoglycaemia also our body become fatigue most probably due to lack of energy substrate.
Type 1 diabetic patients are very prone to have this glucose instability. They even fear for this situation. That worsen the condition because fear release stress hormones which ultimately changes our blood glucose levels.
Some young adults with type 1 diabetes are very sensitive for exogenous insulin. So they tend to have a sudden drop of blood glucose levels once they take their insulin shots.
A cohort study of 192 adults showed that 28% of them get fatigued due to hypoglycaemia.
The type 1 diabetes have a strong relationship with psychological problems. There are depression, anxiety, low self esteem and distress associated with diabetes.
Most of the people are very anxious about their diabetic control. This it self cause to break the person’s mind.
And researches have shown that depression in diabetic people is associated with high blood HbA1C levels as well.
Diabetic related complications
Diabetes related complications has a huge impact on person’s life. Heart diseases and diabetic kidney disease has an account on increased fatigability. The uraemia associated with kidney failure has a direct impact over this.
And also most people have micro and macro nutrient deficiencies. May be this happens that people are strictly controlling their meals or poor control leading to diabetic gastropathy.
Anyway people with chronic fatigue are more prone to have anaemia and multivitamin deficiencies as well.
Not only this, the neuropathic pain is one of the other common distressing complication that causes lack of sleep and low mood in diabetic patients. It causes functional impairment in a person and also negative impact on daily activities.
Decreased physical activity
There are large number of type 1 diabetic population have high BMI. Even researches show that having a high BMI itself is a risk factor of getting diabetes in near future.
High BMI and less engaging with physical activities may also associated with tiredness. Because of this our body muscle tend to get wasted as they are not get used. Therefore body get tired even with a low intense works.
Also these two factors have a direct relationship with diabetic macro vascular complications as well.
Sleep interruption is one of the common problem with type 1 diabetic patients. The most common cause for this low quality sleep is their fear for nocturnal hypoglycaemia.
Some patients with insulin tend to become hypoglycaemic at night, few hours after their night insulin injection. This is a very troublesome situation for them, so it ultimately leads to poor sleep.
Because of the low quality sleep at night they develops daytime sleepiness and tiredness.
Other endocrine problems
Type 1 diabetes is an autoimmune disease which our own antibodies attack to our cells. Most of the time autoimmune diseases are coexisting with several other autoimmune diseases.
Hypothyroidism, Addison’s disease and Cushing’s syndrome are three most common disease conditions that type 1 diabetic patient can get. All these conditions cause the person tired and less active. Therefore it’s better to investigate for those conditions also, if a type 1 diabetic patient develops fatigue.
How to overcome tiredness ?
Proper management of psychological issues are the key features in solving this problem. Diabetic distress has a major impact as discussed earlier. Therefore it showed that four steps method to overcome this issue.
Enhancing self-perception, enhancing coping skills, minimizing the discomfort of change and utilizing external support are the well established strategy to reduce diabetic related fatigue.
As well as lifestyle modifications like healthy dietary habits, engaging with daily physical activities and stress management is also important.
Proper blood glucose control with regular follow up is one of the other important aspect in managing fatigue. It will helps to identify other associated endocrine disorders and optimise body’s metabolic functions as well.
- Fatigue Among Adults With Type 1 Diabetes Mellitus and Implications for Self-Management by Stephanie Griggs, PhD, RN and Nancy S. Morris, PhD, ANP-BC
- Diabetes Fatigue Syndrome by Sanjay Kalra and Rakesh Sahay