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Wednesday, April 16, 2014

Diabetes Positive Approach Newsletter #1404 on Fatigue

Welcome to Diabetes Positive Approach Newsletter #1404 issue on fatigue. We may be tired today especially dealing with the topic Fatigue on this issue, but we will not forget the different ways we have been building our self image. I must confess that my main purpose is for you to accept yourself because once you accept yourself, it is not important anymore when you feel others do not accept you.

At this point you will feel welcome wherever you go. Why? Because anyone who meets you will see the real you. It is not someone who is pretending to be somebody else. The real one is the much nicer person not the one who is trying hard to conform. This is when your conduct changes to be better. Never mind all that fatigue stuff. There is now more spring to your walk!

In This Issue: Fatigue Among PWD (People With Diabetes)"

What is Fatigue?

Fatigue has different meanings as many as the people are suffering from it. People use such words as tiredness, sleepiness, no energy and exhausted interchangeably. And no wonder, for even in the world of science, the definitions of fatigue can differ greatly due to inability to differentiate properly the signs, causes and effects. What the scientists do agree is that it is complex and has many aspects including physiological, situational and psychological.

For us laymen people, fatigue is a normal part of every day life, usually happening when we are physically and mentally tired and are not able to sleep well. This is referred to sometimes as a healthy type of fatigue because our body is telling us to rest. If we are smart enough to follow the body’s call to get rested, then this type of fatigue heals itself.

What are the Types of Fatigue?

But the trouble is the chronic type of fatigue is very stubborn and does not easily go away with rest. This is the type that is linked to diseases like cancer, arthritis, depression and also plays a role in diabetes. Fatigue has been differentiated as central or peripheral but its details are not within the scope of this report. However, if you write to me at the address below the authors’ names I can send you the literature on this very topic.

Some experts believe that fatigue has a psychological foundation. Defining psychological fatigue however is not giving the experts an easy time. Thank goodness for that because I don‘t want anyone to say that we are complaining about being tired because we are just being emotional or some other related psychological insinuations.

What Are The Effects of Fatigue?

Even the so-called healthy people without diabetes have been known to have lower quality of life and as well, fatigue negatively affects their self-rated health. Physical functioning is decreased and so is the ability to manage the daily routine. How much more will the PWD‘s feel with so many things they have to deal with in managing their diabetes?

What scares me the most is when fatigue gets in the way of the diabetics trying to promote and act on healthy behaviors like involving themselves in self-care as in eating healthy and moving more. Can anyone blame them when they get so tired taking care of their diabetes and this fatigue comes rolling in like a thief in the night?

It is a slippery road indeed if they disconnect themselves from self-care and let everything slide. This is what scares me the most because then they will be setting themselves up for complications down the road for they will certainly not thrive if they get frustrated and just put everything on auto pilot.

What can we do to help these people live a near-normal life?

I am glad therefore that the researchers are studying this area and finding out that all these effects of fatigue is still a problem that challenges the health care teams. Because fatigue is not specific and is a universal symptom, the clinicians are stuck in diagnosing and treating this problem.

How can they when the researchers have not even come up with a definitive definition and the measurement of the criteria for diagnosis? This therefore makes it difficult for those involved in further understanding fatigue in diabetes. How much harder is this for the diabetics when they are faced with challenges day after day?

What is Fatigue in Diabetes Like?

Just like with the other conditions, fatigue among the PWDs is more likely to have many sides to it among which are physiological, aspects of lifestyle and psychological are noted. The reason for fatigue in diabetes is the variation in blood glucose level. The complications of diabetes like cardiac disease, neuropathy and retinopathy are also linked with increased fatigue.

Research has shown that the rise in glucose levels can predict the presence of the symptoms that includes fatigue. This is also reported when hyperglycemia is of lower level even before such symptoms as excessive thirst and urination are observed. Even the newer studies reported that hyperglycemia was linked to lower cognitive function and change in mood states that includes severe fatigue.

In another study, the morning after an acute hypoglycemic episode, the subjects reported more fatigue syndromes and lower level of well-being. They were also more prone to get tired easily during an exercise session than when the blood glucose levels were maintained within the target level. Chronic hyperglycemia has been believed to cause fatigue but this has not been supported by the available data.

One study examined the connection between glucose control and physical indications, well- being and mood conducted among 188 type 2 diabetic Dutch patients. They used two instruments to measure the fatigue and found using one measurement, there is a relationship between A1c and fatigue thus concluding that persistent hyperglycemia may be a factor in fatigue.

The second type of measurement did not find a correlation between the A1c and fatigue but the researchers found a link between increase in insulin dosage and complaint scores including fatigue, anger, displeasure signifying increased emotional fatigue probably due to more hypoglycemic events and the burden of having to inject everyday.

Variations in glucose levels can also lead to psychological fatigue. Those who have roller coaster readings may feel they fail at maintaining their self-management. They can feel burned out or worn out from the everyday task they have to do for diabetes and this is where I am scared that they may stop taking care of themselves altogether which could make the blood sugar control worse and that could lead to the complications, later on.

Complications and Fatigue

Fatigue is associated with many chronic complications of diabetes. Duh, tell us what we don’t know. The side effect of damage in the kidney, for instance, is anemia which leads to increased fatigue. Anemia, by the way, occurs more often in the diabetic than to those without diabetes. Needless to say, quality of life is negatively affected even during the earliest stage of kidney impairment despite very small amount of urinary protein is present.

Neuropathy is also linked to symptoms of general and physical fatigue. Symptoms related to diabetes have also been found to be associated with fatigue that is more prolonged than those without diabetes. The studies also reported that this fatigue may have harmful effects on the job though they didn’t make a distinction between type 1 and type 2.

Psychological Factors and Fatigue in Diabetes

There are two important psychological issues that are most related with fatigue in diabetes. They are diabetes emotional distress and depressive symptoms. Diabetes emotional distress is related to the complicated regimen the diabetics have to do for their self-care. They are burned out and overwhelmed with the burden of daily care they have to do.

As for the depressive symptoms, research has shown that PWDs are two times more prone to become depressed than the rest of the population. Researchers have found that higher depressive symptoms are present in 11% of the cases while major depression is present in 31% among those with diabetes. They better offer some solutions to this.

Lifestyle Factors and Fatigue in Diabetes

While it is true that lifestyle factors have an effect on fatigue, what is most strongly linked are low level of physical activity and overweight. In fact, overweight and obesity have been connected with higher level of fatigue even in the general population. A lot of literature supports the idea that increased body mass index may be an important factor on the fatigue level.

Let me tell you a personal story of mine. Long time ago when I was young and foolish and suffering from hyperthyroidism, I was always tired. So I decided that what I needed was rest. So I rested, but the more I rested, the more tired I got. I could not understand it so I took the matter in my hands and rebellious as I was, I did the opposite and walked when I got tired.

You know what, things got better from then on. And that’s how exercise became part of my life: 15 minutes of yoga, 15 minutes of tai chi and 15 minutes of aerobic exercises every morning, every day even when I am in the airport waiting to catch a plane (not Flight 370, my prayers for those people and their families!)

That is why I so believe in what the researchers found that regular physical activity can ease the symptoms of fatigue. The age group of between 20 and 59 years who have low physical activity were more prone to feel tired and exhausted even after a night’s sleep. Even those who are physically fit and exercised for 6 hours a week felt tired more easily when they stopped their exercise routine.

Effects of Fatigue in PWDs

The top four symptoms that affect the women’s quality of life include fatigue. There have been studies on the bad effects of fatigue among the people with diabetes. African-American women who participated in the study reported that fatigue restricted their ability to increase the physical activity.

Women living in Australia who participated in a study used such words as “overwhelming tiredness”, “sleeping through most days”, and “I can’t do what I want, I feel weak, I am lonely”. Fatigue was among the top concerns of these women so much so that they have limited their activities to only the necessary ones.

You can tell from the studies that the effect of fatigue in diabetes is far-reaching. The consequence from this is serious as diabetes is a self-managed disease. This self-care requires the physical and mental energy in order to fully participate in the tasks involved to ensure the best health possible.

More Studies are Needed on Fatigue and Diabetes

Only 18% of the studies included the ways to measure the important outcomes in the life of the diabetics like their quality of life that is related to health. I must say that instead of spending money on studies after studies, just go out there and help the diabetics. Organize groups who will take the diabetics in a walk around the shopping mall. Do what Pope Francis advocates to throw away your desks and chairs and get out there and do pastoral work.

A Working Model to Research Fatigue in Diabetes

Physiologic variables on acute hyper/hypoglycemia, chronic hyperglycemia, glucose variability and diabetes symptoms are found to increase fatigue in PWDs. Then there are the psychological variables of diabetes like the emotional distress and depressive symptoms and the lifestyle variables of increased body mass index and reduced physical activity. All these lead to increased fatigue.

More importantly, I would like to add this. How can we help the diabetics in facing all the above challenges? Without this important part to improve the life of the diabetics, a study will just be a study. Nothing will change in the life of the diabetics. They will continue on as usual, waging a war against diabetes and losing it in the process.


There you have all the aspects of the variables that just enhance the fatigue the diabetics feel in the management of their condition. Fatigue is identified as both cause and effect of inadequate self-care. There is nothing there that will help them turn this around that will make their life better. This I am going to attempt in the Q&A section of this Positive Diabetes Approach Newsletter.

How about you? What are your thoughts on this? Write down your thoughts in the comment box below.

Reference: Research funded in part by National Institutes of Health and National Institute for Nursing Research.

Chronic Fatigue Part 2: Diabetes Video 2. Must-Reads from Around the Web

Sharpening My Routine on Trashing Used Diabetes Supplies

Diabetes Support Groups

What to Do When You're Feeling Defeated

7 Ways to Relieve Stress in Under an Hour

3. Alerts I Can’t Resist To Send You

Drinking and Diabetes

Your A1C and the Blood Sugar Roller Coaster

Eating Well With Diabetes on a Budget

6 Sugar Substitutes For Diabetes

Mari Ruddy Says ANYONE Can be an Athlete with Diabetes

4. A Success Quotation of the Month"

“The most certain way to succeed is always to try just one more time.” Thomas Edison

5. Dessert Recipe

Zucchini Bread

6. Some Humour - Let's laugh together at the joke below even if it's not funny. Since I am not good at this sort of thing, why not join a laughter yoga group or a local laughter club? You will be asked to participate playfully and imitate sounds of laughter and breathing, until the pretend laughter becomes the real thing. You will then feel the humor and the physical feeling of deep laughs and get healed.

Play Ball

Can anyone tell me what is funny with this joke? I can’t for the life of me know what it is.

Play Ball
Speaker Words Spoken
Ron: Hey Don, let’s play ball.
Don: Okay, what‘s the game about?
Ron: We’ll throw the ball at each other.
Don: Whoever the ball hits loses.
Ron: Without catching it of course.
Don: Right!
Ron: Here it is. (Throws the ball, boomerang and hit him.)
Don: Ha! It hit you; you lose!
Ron: Oops! That was just practice.

7. Do you have a question or comment for the team?

Drop us a line at Put on the subject line “Diabetes Positive Approach” so no one can mistake it as spam. Write your questions or comment there.

You may see your question answered in an upcoming issue of Diabetes Positive Approach like this one below.

7. Q&A: What Can We Do to Prevent or Fight Fatigue in Diabetes?"

Answer: Reach out and get help. I believe one of the links above will get to diabetes support. When you get there, click the state you are in and they will show the support groups near your residence. Then change your heart and mind for whatever we think will affect the way you feel. Try to be optimistic and life will be a little bit brighter.

A Study on Fatigue and Depression

Some 214 patients from 18 years old to 75 years old were matched with a controlled group.. All finished the fatigue scale to assess the severity of their fatigue according to this 8-item checklist and a score of 35 and up was considered severe. Other questionnaires were also used to determine other factors that are related to diabetes. Here’s what they found.

The presence of chronic fatigue is found in 40% of the type 1 diabetics compared to just 7% in the control group. The advice is that if you’re already taking the medication and it is still not working, discuss it with your doctor who may help you find the right medicine for you. As well, sticking to a diabetic diet and regular exercise will help.

Are fatigue and lightheadedness diabetes symptoms? An expert replied to this question with a qualified yes. Because the body is unable to create insulin which is in charge of getting the sugar to the blood cells to create energy, you just end up feeling tired and woozy. It feels like all the energy is sapped from your body.

No wonder 85% of the diabetics experience being tired. They feel tired and sluggish with no energy or just a little bit of it. Sometimes they fall asleep during the day and sleep longer at night for managing diabetes is so demanding. They have to keep track of a lot of things: blood sugar level, portion sizes in food along with carb content and medication doses plus exercise. Who would not feel overwhelmed at this and feel tired every day?

Because fatigue is high among the diabetics, it is important for the diabetes care team to assess it and talk about it with the patients and more importantly develop interventions. In this connection behavioral modification has been found to be useful in treating fatigue in diabetes. Aside from this, what else can help this widespread problem? This brings us to the next subtopic.

What is the Treatment for Fatigue?

If you wake up tired, it is a good idea to check your blood glucose level to see if the fatigue stems from that. But since tiredness is a sign of an underlying condition, the treatment has to depend on what is causing it. So if it is from anemia once the red blood cells count goes up, the fatigue severity goes down. If the underlying condition is infectious mononucleosis then it may take weeks.

While there is no solution there are ways to fight fatigue. Eat healthy as fatty and junk foods can make fatigue worse. Consume a balanced diet with plenty of fruits and vegetables. Eat only healthy fats like nuts. Light exercises like swimming and walking will help. Also reduce caffeine consumption. Taking a break too will help along with taking vitamin supplements especially vitamin B12 and iron pill as deficient supply of iron causes anemia and fatigue. Sleep is important so keep a regular schedule of sleep.

If the feeling of tiredness is severe, make sure you see your doctor. If the fatigue is less serious, there are some home remedies: Herbs can help with diabetes like Fenugreek seed, Asian Ginseng and Gymnema that can lower blood sugar levels. In addition, Gymnema also helps the pancreas make insulin for type 2 diabetics. Then there’s bitter melon that has anti-diabetic properties. And let’s not forget good old cinnamon that makes the cells respond to insulin better. It also blocks free radicals so sprinkle them on your bowl of whole grain oatmeal.

The company that makes supplements for the diabetics, DRSI or Diabetica Research Solutions Inc. said that only very few diabetics use Energy Drinks and rightly so. They therefore offered supplement without caffeine, but I don’t know for sure if this will work out. I am going to have to wait to learn more about it before making a suggestion on this.

Can We Prevent Fatigue?

Eat a well balanced diet and light exercise can help. Since it is caused by many other conditions, prevention is not an issue. If it is recognized early then the underlying cause can be revealed. Sometimes though fatigue comes gradually so you will have to rely on friends and relatives to observe the gradual decline in your body performance .

8. Got something to say? Please write down your questions and comments in Facebook.

Just go to the Just copy and paste that on your browser. Facebook will want you to join me first before you can send me a message.

Don't you find that despite all this fatigue stuff, we can feel better if we just be a little cheerful? The tension disappears and we stop sweating the small stuff. Because we are more secure of ourselves we find the things that used to bug us are not there anymore. We are more confident and our relationships with others will improve.

Then when we accept ourselves, it is easier to accept other people. We have to be careful here though. We can accept anybody and even understand how they feel but it does not mean that we agree with them. There is a world of difference between the two. Accepting is just understanding others but it does not mean it is embracing what they believe in.


Now, what can we take away from all of these? We admit that there may be a time when we get just plain tired. Don’t let the feeling of tiredness take over your diabetes self-care. It’s okay to rest a bit before taking that walk, eating that apple and all the rest we have to do, but don’t altogether give up.

How about you? Have you ever gotten tired? What did you do to make things better? Please share them with us at the email address below the authors’ names so we can help all the others.

Warm Regards,

Roger and Evelyn Guzman

Try this: Unconditionally Guaranteed to Normalize Your Blood Sugar Levels and Reverse The Root Cause of Diabetes!

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This newsletter is copyright 2014 Roger Guzman, M.D.

Remember that all these are for your information only. They do not take the place of the treatment and advice of health care professionals. You should continue to consult and work with them.

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