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.

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