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May 18th, 2011
07:23 AM ET

Can diabetes cause fatigue, body ache?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesdays, it's Dr. Otis Brawley, chief medical officer at the American Cancer Society.

Asked by Mike from Tennessee

Can diabetes be a (possible) cause of fatigue, leg and lower back aches? I have had bursts of energy for 10 to 15 minutes, but then need to sit for about 10 minutes, and I'm ready to go full steam again. PLEASE, Thank You, Mike

Expert answer

Dear Mike:

Thanks for an important question, as a lot of people with diabetes complain of these symptoms. The answer is that diabetes itself probably is not the cause of your fatigue, lower back and leg aches. The things that cause type 2 diabetes (also called adult onset diabetes), such as a weight problem and lack of exercise, are commonly the cause these symptoms.

Fatigue incorporates three components: 1. The inability to initiate activity. 2. Reduced ability to maintain activity. 3. Difficulty with concentration and memory.

Fatigue should be distinguished from sleepiness, shortness of breath on exertion and muscle weakness, although these can also be associated with fatigue. Fatigue lasting six months or more is referred to as chronic fatigue. Chronic fatigue is not necessarily the entity known as chronic fatigue syndrome, which is a diagnosis after exclusion of all other causes.

Fatigue in anyone should be evaluated by a health care provider to exclude all possible causes and to get counseling on how to treat it. Other medical causes of fatigue are the side effect of drugs, thyroid dysfunction, high calcium levels, rheumatologic illnesses, adrenal, kidney or liver problems.

Some infections such as tuberculosis or hepatitis can cause fatigue, and indeed, fatigue can be their only symptom. Depression is also a major cause of fatigue.

While unusual, uncontrolled diabetes can be the cause of fatigue. These patients generally also have other symptoms of diabetes such as excess thirst, frequent urination and blurred vision. Some drugs used to treat diabetes can cause fatigue by causing anemia or a metabolic change known as lactic acidosis. These are unusual side effects.

Many patients use the word fatigue to complain of sleepiness. A significant proportion of adults and especially a significant proportion of those who who are obese have obstructive sleep apnea. This is a condition in which the sleeping person literally stops breathing for a few seconds, several times a night. Each time, they wake up to start breathing again.

People with obstructive sleep apnea usually do not realize that they disrupted their sleep several times during the night. This leads to sleepiness throughout the day because the person literally did not get a good night's sleep. Sleep apnea is commonly treated with a continuous positive airway pressure machine, commonly known as CPAP, which increases the pressure of air breathed in during the night.

If a root cause of the fatigue cannot be found, it can often be treated with cognitive behavioral therapy or graded exercise therapy. A regimen of activity and exercise is frequently successful.

While your complaints do not sound like it, many diabetics with pain in the feet and lower legs have it because of diabetic damage to nerves. This is known as diabetic neuropathy. Diabetic neuropathy can also manifest itself as numbness in the feet and lower leg. Diabetic neuropathy is very common and can be treated.

Nonspecific pains in the lower back and legs are most commonly because of muscle weakness. Strengthening of the abdominal and low back muscles can frequently bring amazing relief to a lot of low back pain. Pains running down the back into the legs are possible signs of nerve irritation and even impingement in the spine. This, too, can often be treated with appropriate exercise supervised by a physical therapist.

As you see, this can be very complicated and involve several different problems. An internal medicine or family practice physician can usually begin the evaluation and determine whether a specialist needs to be consulted.


soundoff (27 Responses)
  1. Heather

    I was diagnosed by a rheumatologist with fibromyalgia, which is very similar to chronic fatigue syndrome. I have non-restorative sleep. I "sleep" for 8 hours but wake up feeling like I had just closed my eyes (without medications). With sleep medications, eight hours of sleep equates to what I imagine a healthy person would feel like after 5 or 6 hours of sleep. I have no sleep apnea - have been through a sleep study that showed my sleep is 73% efficient. I believe I'm lacking in deep sleep (stages 3 &4 sleep). It is, like chronic fatigue syndrome, a diagnosis of exclusion. Treatments are becoming more varied and include more than the FDA approved medications of which there are three: Lyrica, Savella and Cymbalta. I've benefited from a low-dose tricyclic and a muscle relaxant for sleep (I have muscle spasms as a symptom). I also take magnesium to reduce muscle spasms (check with a doc before trying this because it is not healthy for people with certain health issues). It took me many years and a few different doctors before I got the diagnosis. Now, my diagnosis ended up being supported by a few doctor's assessments. Take the time to rule out any other potential causes of your symptoms and be sure to advocate for yourself. Arthritis can also disrupt sleep at night for some folks, I think - and can show up in tests. Autoimmune diseases like Lupus had to be ruled out for me, as well. All the best to you.

    May 18, 2011 at 07:47 | Report abuse | Reply
    • Tom B

      Heather, I have had tremendous success dealing with my sleep-related fatigue problems (non-restorative sleep) and significantly reduced my fibromyalgia by taking a low dose (30mg to 40mg) of desipramine just before bedtime. Desipramine is a low dose antidepressant and been in use for years. I have been using it for the last 18 years with great success. Your symptoms sound exactly like mine just before I started this treatment. Just a suggestion.

      May 18, 2011 at 16:54 | Report abuse |
    • John Williams

      It is important to note that at its early stages, diabetes does not cause many symptoms and may pass unnoticed. But the disease develops silently, causing damage to eyesight, kidneys and the cardiovascular system.

      By http://www.williamsdiabetes.com

      June 5, 2011 at 21:48 | Report abuse |
  2. Heather

    PS – men can also have fibromyalgia. It is either underdiagnosed (possibly) or may be more common in women. I know a few men who have been diagnosed. Not enough is known about it to make the assumption that it doesn't occur more often (than diagnosed) in men.

    May 18, 2011 at 07:51 | Report abuse | Reply
  3. Bill

    I am in the Marine Corps and need to run atleast 3 milesbut can't run 1/2 mile anymore. I am on a Beta blocker for chest pain and atrial tach. I lift weights and I try to run but have a shortness of breath while attempting to run, yard work, and walking up one flight of stairs. Cardiologist says all is good with my heart no obstructions. What else could be causing my shortness of breath.

    May 18, 2011 at 08:05 | Report abuse | Reply
    • Jorge

      Have you been to a cardiologist who ran a stress-test scan on your heart? That particular test lets the examiner look at your hear function under duress. Your problem may be respiratory-related, maybe you should see a pneumologist, as compromized lung function may tax your heart and give you chest pain. Also, you might want to lay off the weights until somebody finds out what's wrong, weights stress the heart in a particular way that's not healthy for it unless it's in tip top shape and you can make up for it with rest and cardio workouts.

      May 18, 2011 at 08:37 | Report abuse |
  4. amylynn

    The Anti Obesity drug makers and diabetes drug makers take in 10 billion$$$$ every year with no cure!!

    Food Chemicals are the cause of the diabetes and obesity crisis

    The FDA and Drug makers know this and are laughing to the Billionaire$$$ bank

    The food chemicals break the gut(insulin) and this is the cause of the diabetes and obesity crisis

    A filmmaker has been reversing diabetes and Obesity in now 10 countries and the drug makers do not promote the story

    just google SPIRIT HAPPY DIET

    May 18, 2011 at 10:24 | Report abuse | Reply
  5. Brad8888

    This article was plainly written by someone who has not experienced diabetes in his own life and has not been around very many diabetics, at least with an eye toward engaging in analytical thought processes.

    I, and many other diabetics, believe that there is a connection, though it is difficult to convince internists (and even endocrinologists) of this at times.

    We notice that after eating a meal with even a normal amount of carbohydrates that as our blood sugar begins to spike about a half hour or so after finishing the meal that nearly inevitably there is a period of time that we become "drowsy" and end up losing consciousness ("sleeping") for a period while our bodies attempt to process the carbohydrates. After such episodes, there is a period where we begin to "wake" back up, during which our hearts often beat more rapidly than usual, we have a headache, and generally feel bad (kind of like a hangover) for a short period of time. Then, we return to normal as our bodies complete their adjustments.

    Also, during relatively long term high blood sugar episodes coming from eating a lot of complex carbs like breads, pastas, and pizza (crust), our short term memory is often impaired, our reflexes and judgement is impacted, and our threshold for pain gets much lower (pain intensity increases). This also comes back to a more normal state when our blood sugar returns to a more normal state.

    Even the Bureau of Motor Vehicles recognizes that there is a connection between high blood sugar and reflex and judgement impairment with respect to driving large trucks that require CDL's. These drivers are rightly required to have an annual physical, and those who have poorly controlled blood sugar are not permitted to have their license due to this very effect (as well as a similar effect when the blood sugar gets too low).

    As far as an answer to correct the problem, yes, diet and exercise is important, but the cycle of addiction to the carbohydrates caused by the body trying to maintain balance at high blood sugar levels must somehow be broken as well. Just like any other addiction, different methods work for different people. The "cold turkey" method of switching to a low carb diet might work for some, but for others that will lead to a rubberband effect when the person gives in to the cravings and leads them to eat even more carbs. Also, the act of exercising can lead to better control, but it can also lead to the body sensing a blood sugar "crash" coming and lead it to compensate with more cravings.

    A very gradual lifestyle change with gradual changes in physical activity and lower carb diet where the body has a chance to adjust slowly to a new reality where lower blood sugar is considered to be "normal" for it reflexively is likely the best bet for most in my opinion. It is just easier said than done.

    May 18, 2011 at 12:21 | Report abuse | Reply
    • Tony

      Brad888: That was a good post. I am a 10 year Type 2 and my observations are pretty much identical to yours. I have been a controlled diabetic with a recent A1C of 5.6. The problem is that is difficult to maintain the discipline necessary to maintain that. I think that your recommendation and observation in the last two paragraphs are right on the mark, particularly your last sentence.

      May 18, 2011 at 13:17 | Report abuse |
    • Type1Diabetic

      Hah! Typical know-it-all! I have been a type-1 diabetic for over 25 years and have never experienced the symptoms you are talking about. And my family has several type-2 diabetics and none of them have mentioned about this either. Just because you have it doesn't mean every diabetic in the world would too. Your comment only shows your arrogance!

      May 18, 2011 at 15:14 | Report abuse |
    • HealthisWealth

      I sympathize with you but, Dr.Gupta did say not to confuse fatigue with sleepiness. What you are describing appears to be just a case of sleepiness due to hypo-glycemia where when the blood sugar drops, you feel little woozy and may also pass out at times. And on waking up, rapid heart beats, headache etc. I used to have that when my BS was not in control. I went on a pump sometime ago and have had things under control. Get yourself checked by a good endocrinologist! Good luck!

      May 18, 2011 at 15:32 | Report abuse |
    • runswithbeer

      Why on earth would a Type II Diabetic eat a load of carbs in the first place. Yes if you drive your blood sugar into the 200's or higher you will feel BAD. STOP EATING CARBS. No more than 4 OZS at any meal. Yes I am a Type II and yes I feel BAD if I load up on Carbs.

      May 18, 2011 at 15:57 | Report abuse |
    • Response to Type1 Diabetic

      The only arrogant post on this thread is yours. There is nothing that Brad8888 said that is arrogant. The fact that you don't have these issues is fine, but the original poster was referring to himself and those he knows who have the same symptoms. I think that there are a lot of people who use these blogs just to vent their speen on others. I wonder what disease that is a symptom of.

      May 18, 2011 at 17:26 | Report abuse |
    • Jeff

      Interesting, in the last six months I have had the same problem. I will frequently get exhausted after eating a meal, even if it is breakfast and after a night of sleep.

      My last A1C was good, I have type 1 and have had it for 20 years.

      May 18, 2011 at 20:19 | Report abuse |
  6. KAL

    As this article clearly shows, undifferentiated fatigue means something different to everyone. Which is the problem with the name chronic fatigue syndrome – it's rather like calling emphysema chronic cough. More importantly, while undifferentiated fatigue is a symptom of many many diseases and some none diseases such as depression. Post exertional exhaustion lasting 24 hrs or longer unrelieved by rest upon minimal exertion however is unique to ME/CFS and a cardinal symptom. Neither CBT or GET have been shown to work specifically with patients with post exertional malaise – adaptive pacing is much better for this specific group according to the scientists who study it.

    May 18, 2011 at 14:44 | Report abuse | Reply
  7. sapsxy

    Diabetes,(type two) is a world health epidemic thats set to explode in many countries,both rich and poor.Diabetes is
    one deadly disease that "covertly" attacks both physical and mental human body.It not only makes you physically
    tiring,it at the same time,kills all your "mental strength and focus" slowly and slowly.And the unfortunate part is to
    why so many people get it is : poor diet and lack of exercise,daily. Once you get it,it may be hard to undo or get
    rid of these disease,then it becomes a life time of "managing it",with good diet,exercise and pills.Genetics does
    play a huge role in particular ethnic communities having as the main health problem but by and large,it has to do
    with poor diet and lack of daily exercise.Hope those who are not encaging in daily exercise and consuming healthy
    foods,will start taking this disease very seriously.

    May 18, 2011 at 19:44 | Report abuse | Reply
  8. Dr. Starr

    did that quack really say-in print- that weight gain and lack of exercise CAUSES type 2 diabetes??? Somebody put him under review! What a hurtful, archaic, and utterly ridiculous thing to say!!! Billions of people have lousy diets, dont exercise, and even gain weight and are NOT diabetic. Diabetes is a hormone related DISEASE, not a consequence of poor habits (although those habits exacerbate the diabetes.)
    Research shows increasingly that stubborn weight gain is related to the defects leading to type 2 diabetes, problems with glucagon, defects in receptor cells, etc. What this man said is nothing less than malpractice.

    May 18, 2011 at 22:27 | Report abuse | Reply
  9. lori

    When i was taking ACTOS, I noticed that I had horrible swelling and that when i got up from sitting for even 10 minutes, i would have pain in my joints and I would have to walk 3 or 4 feet before I chould straighten up. Since getting off ACTOS, no more joint and bone problems. I also noticed that 3,000 mg of cinnamon kept my bg from jumping up.

    p.s., Dr. Starr, my diabetes is related to both family and Polycystic Ovaries.

    May 25, 2011 at 13:38 | Report abuse | Reply
  10. Odalice Feliz

    Eating a well balance meal low on sugar and exercising can help treat.

    June 3, 2011 at 09:49 | Report abuse | Reply
  11. John Williams

    What Causes Diabetes? Find Out Everything There is to Know About the Causes of Diabetes!

    By http://www.williamsdiabetes.com

    June 3, 2011 at 20:14 | Report abuse | Reply
  12. Romaine Muhlestein

    blood sugars vary depending on the carbohydrate load of what you eat. ..

    Remember to view our very own website
    <a href=" http://www.foodsupplemendigest.com/betaine-hcl/ "

    January 8, 2013 at 11:41 | Report abuse | Reply
  13. jack

    i have un controled diabetes and bad nuropathy and take meds like you would not believe. in the last year it has been so bad that i have not been able to even work. im in constant pain and fatigue all the time. i cant believe that this can just one day after having diabetes for 15 yrs take a toll on my body to this effect. i wish there was a doctor who can tell me if the diabetes is the only cause for my problem. i feel that it is the major cause but there has to be more. like diabetes and fibromyalgia together. i need a doctor to run test to find the underline problem and not just an opinion if only they could feel the all day 24 hour non stop pain. they would know what is is like .. i have uncontrolled diabetes and we have tried to get it lowered by eating as well as meds neither is working .. if anyone else is going thru the problems i face please help me out

    March 26, 2013 at 16:58 | Report abuse | Reply
  14. SitWabGantind

    Payday Money Online payday loans with low fees http://www.payday-money-online.net payday loan with no telecheck [url=http://www.payday-money-online.net]Payday Money Online[/url] payday loans with savings

    April 9, 2013 at 23:59 | Report abuse | Reply
    • trueblvr

      This site is not for advertisements

      June 7, 2013 at 18:38 | Report abuse |
  15. trueblvr

    amylynn,
    I totally agree, so does my husband. we have been saying for years that the junk they feed our food sources, and the cross breeding...like cauliflower/broccoli have wrecked havoc with our bodies...cancer rampant, diabetes, flu, a whole bunch of diseases are out of control. My husband and I are getting a greenhouse. We are lucky that we live in the country and have room for just a little one so we can eat healthy and share with loved ones...
    Beware FDA...FOOD and DRUG....sell messed with food, make the masses sick, and up the amt. of medications necessary at outrageous prices....both are in the same pocket...ok, that's my rant

    June 7, 2013 at 18:27 | Report abuse | Reply
  16. achhar

    I feel pain in legs then this pain goes to head and circulate in whole body . Why this happan? All blood test are normal.

    June 10, 2013 at 14:23 | Report abuse | Reply
  17. chowhanjeet

    Yes it can. Particularly abdominal discomfort, and leg pain. You should be excersizing for at leat 15 to 20 minutes twice a day. walking is the best because it maintains the very long muscles and blood vessels where you pain most likely begins, and it increases sugar metabolism as well.

    November 6, 2013 at 01:00 | Report abuse | Reply

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.