Ensuring your blood sugar is balanced will prevent diabetes.
But did you know that irregularities or fluctuations in your blood sugar could also lead to chronic fatigue syndrome?
The blood sugar-fatigue connection is not as simple as the relationship between cortisol and insulin. A quick reminder for new readers, insulin is a hormone that is excreted in response to rising blood sugar levels. After you eat, your blood sugar rises. Insulin helps lower your blood sugar back into healthy ranges.
Diabetes is characterized by insensitivity to insulin. Insulin is no longer able to lower blood sugar levels back to healthy ranges. This results in chronically elevated blood sugar levels.
Cortisol does the opposite of insulin. It raises your blood sugar. If you’re feeling hangry, cortisol is excreted to help raise your blood sugar back into healthy ranges.
When you’re healthy, cortisol and insulin levels are nicely balanced. In turn, your blood sugar is balanced. Balanced blood sugar ensures your body’s energy levels are in harmony. Imbalanced blood sugar leads to fatigue. I’ve written about blood sugar/diabetes effect on fatigue here, here, here, and here.
While it should come as no surprise that blood sugar imbalance and/or diabetes lead to fatigue, the way in which fatigue develops may be different than you thought. Blood sugar imbalances affect more than just your cortisol-insulin balance. Your blood sugar also has a dramatic effect on your gut health.
Blood sugar’s connection to your gut
If you’re wanting to overcome fatigue, optimizing the health of your gut is absolutely essential. Research has shown that those with CFS have:
- Reduced diversity in their microbiomes. (1)
- Increased numbers of bacterial species that are known to be pro-inflammatory.
- Elevation of blood markers for bacterial translocation (leaky gut). (2)
- Increased likelihood of developing IBS or SIBO.
- Lowered levels of short-chain fatty acids. (3)
But what about those with blood sugar imbalance(s), are they at increased risk of developing chronic fatigue?
Research suggests they just might be. A leaky gut is thought to predispose one to develop fatigue. We’re not sure if leaky gut causes CFS or if CFS causes leaky gut. But we do know they’re connected. If you’re wanting to prevent fatigue from ever occurring, you should ensure you’re taking the necessary steps to ensure your gut isn’t leaking.
New research suggests that those with diabetes are at increased risk for leaky gut. (4) Diabetics have significantly higher levels of lipopolysaccharides (LPS) in their blood compared to their non-diabetic peers. (5) Remember, LPS are not something you want in your blood. LPS in your blood are indicative of bacteria translocating from your gut into your blood. This causes a wide range of inflammatory immune responses.
The most common symptom of a chronic inflammatory immune response is fatigue. This could explain why diabetics often cite fatigue as one of their main symptoms. Inflammation from a leaking gut could be to blame. The same study I cited above also found that type 2 diabetics had increased inflammatory markers of:
- Tumor necrosing factor alpha (TNF-insert alpha)
- Interleukin 6 (IL-6)
LPS, IL-6, and TNF- all indicate your body is undergoing an inflammatory response. And Inflammation could be the hidden cause of your fatigue.
But how do altered blood sugar levels cause a leaky gut or inflammatory response?
Blood sugar and a leaky gut
Researchers are not sure why diabetics have increased gut issues. It could be that diabetes is a pro-inflammatory state. And a leaking gut is the resulting effect of that inflammation. (6) Or, it could be that a leaking gut in diabetics is what causes the inflammatory state. (7)
Those with diabetes will typically have lower levels of HDL cholesterol (you may know HDL as the good cholesterol). (8) HDL cholesterol is thought to be the main factor involved in the detoxification/neutralization of LPS.
Your good cholesterol (HDL) is what helps your liver clear the bad bacteria that is found in your blood when your gut is leaking (LPS). (9) Studies have shown that a simple infusion of good (HDL) cholesterol reduces the negative effects of LPS. (10, 11)
Researchers are unsure if low levels of HDL cholesterol cause diabetes. But they are confident the two are positively correlated. For those of you with chronic fatigue or a leaky gut, you’re going to want to get your HDL cholesterol levels increased. Otherwise, your body is going to struggle to repair its leaking gut.
This is so important that high levels of LPS (leaky gut) combined with low levels of good (HDL) cholesterol have been shown to significantly increase your risk of heart disease. (12) A second study reported that high levels of LPS in the blood were strongly associated with the components of metabolic syndrome, dyslipidemia, insulin resistance, obesity, and chronic inflammation. (13)
Could a leaky gut actually cause diabetes?
It’s certainly plausible. One study showed that the injection of LPS into a human leg increased the leg muscle’s resistance to insulin. (14) Remember insulin resistance is what happens in diabetes! The simple injection of LPS seemed to cause a diabetic-like state!
Other studies have shown that a leaky gut is what precedes a diabetes diagnosis. Do you remember the zonulin protein? Zonulin is a protein measured to determine whether or not your gut is leaking. But zonulin is also correlated with the poor glycemic control and elevated inflammatory markers. Yet another indication that a leaking gut could very well be contributing to diabetes. (15, 16)
If a leaky gut is contributing to diabetes, you can be certain it’s going to have an effect on your energy levels.
Diabetes fatigue syndrome
Diabetes fatigue syndrome is defined as a multifactorial syndrome of fatigue or easy fatigability that occurs in persons with diabetes. (17) It may be caused by a variety of lifestyle, nutritional, medical, psychological,diabetes-related, and endocrine factors. What’s most confounding is that fatigue can occur in diabetics even after their blood sugar levels are balanced (through medication or dietary changes).
Unfortunately, most healthcare providers are fixated on balancing blood sugar – they care that your blood sugar readings are within range. Increasing your energy or ensuring your energy is well balance is not a part of their treatment plan. Clinicians often forget to view your body as a complex, interconnected whole. Naturally, this can lead to a great deal of frustration.
Why do you feel so tired even after your blood sugar is balanced?
Whether your diabetes is type 1 or type 2, fatigue is a common symptom. (18, 19) Fatigue is so prevalent that researchers have even created a scale specifically for measuring fatigue in a diabetic person. (20) Diabetes and fatigue seem to have a bidirectional relationship. This means that fatigue tends to worsen diabetes and diabetes tends to worsen fatigue. Together, they create a vicious cycle known as diabetes fatigue syndrome.
What causes diabetes fatigue syndrome?
I’ve already given you a possible explanation for diabetes fatigue – a leaky gut leading to high levels of inflammation. But a leaking gut does not explain fatigue in all diabetics. Some people with diabetes have a perfectly healthy gut.
As always, the root cause of fatigue comes back to your mitochondria. In diabetes, there are decreased levels of ions needed by the mitochondria. This decreases their ability to produce energy (ATP). (20) Lowered levels of ATP production will most certainly result in fatigue.
And then there are the psychological challenges of being diabetic. Diabetes can come with additional health challenges like numbness/tingling in the hands or feet (peripheral neuropathy), eye issues (retinopathy), cognitive decline (Alzheimer’s disease), depression, anxiety, celiac disease, and high blood pressure. Any of these co-morbid illnesses will decrease your psychological well-being. When your psychological well-being decreases, your energy is likely to decrease along with it. (21)
Below is a brief summary of the potential causes of diabetes fatigue:
- Medical causes
- This includes conditions like iron deficiency, B12 deficiency, and/or vitamin D deficiency.
- Psychological causes
- This is characterized by extreme apprehension, discomfort, or dejection due to a prescribed inability to cope with the challenges and demands of living with diabetes. (22)
- Endocrine causes
- Those with diabetes are more prone to diseases of the endocrine system. Diseases such as hypothyroidism, Addison’s disease, Cushing‘s syndrome, and hypothyroidism.
- If any of the above are left untreated, they will worsen diabetes fatigue syndrome.
- Diabetes-related causes
- This is often due to challenges in regulating blood sugar levels.
- Drug-related causes
- Medications prescribed for the treatment of diabetes can be an insidious cause of fatigue.
- Beta-blockers (blood pressure medication), diuretics (blood pressure medication), and statins (cholesterol medication) are all known to cause fatigue.
How to best manage diabetes fatigue syndrome
I believe the most important step is to avoid shortsightedness. If your hemoglobin A1c (HbA1c) and blood sugar readings are within healthy ranges but you still feel fatigued, further investigation needs to occur. While balancing blood sugar and HbA1c is important, you cannot use that as the sole metric to determine the success of treatment. You need balanced blood sugar readings AND balanced energy levels.
Simple blood tests like vitamin D, vitamin B12, and iron levels will help to rule out obvious nutritional deficiencies. Should vitamin therapy not improve energy levels, looking at your endocrine system is the next step. Adrenal fatigue can be a consequence of blood sugar imbalance. Therefore, testing of the HPA axis is always a great idea. Additionally, ensuring healthy thyroid function is absolutely essential.
If fatigue is still occurring, a closer look at your medications is warranted. Look over the common side-effects of your medication. If fatigue is a listed symptom, speak to your doctor about altering your dose or brand of medication.
Finally, you need to take steps to balance your stress. In periods of high stress, your body elevates its blood sugar to ensure you have a proper fight-or-flight response. Should this occur for a long period of time, you’re likely going to experience fatigue (and challenges regulating your blood sugar). Make sure you’re taking time every day to spend a few minutes in a nearby park or nature reserve. The simple act of spending time in a natural environment has consistently shown to help lower stress levels. (23)
If you’re confused about nutritional advice (especially in the context of overcoming diabetes fatigue), we’ve developed a simple 4-step method to help increase your energy and balance your blood sugar at the same time.
Now, I want to hear from you!
What has helped you overcome diabetes fatigue? Leave your messages in the comments section below!
Also published on Medium.