Reversing Arthritis - Diabetes And Arthritis
Fatigue is a common and distressing complaint among people with diabetes, and likely to hinder the ability to perform daily diabetes self-management tasks. A review of the literature about diabetes-related fatigue was conducted with an eye toward creating a framework for beginning to conduct more focused studies on this subject. A literature search containing the terms diabetes, fatigue, tiredness, and symptoms was conducted to search for literature that addressed diabetes-related fatigue.
Diabetes presents many potential pathways for fatigue, but Knee Replacement bei Diabetes studies on this symptom are rare. Furthermore, research on diabetes-related fatigue is limited by fatigue's non-specific symptoms and because fatigue researchers have yet to agree on standardized definition, measurement or diagnostic criteria.
Additionally, few diabetes randomized clinical trials included measurement of patient-reported outcomes, such as symptoms or health-related quality of life in their study designs, though one that did provided some the meaningful finding that symptom-focused education improved self-management practices, Hb A1c levels, quality of life and symptom distress. There is a need to standardized definition, measurement and diagnostic criteria of fatigue in diabetes.
We present a model that can guide focused studies on fatigue in diabetes. The model capitalizes on the multidimensional phenomena physiological, psychological, and lifestyle associated with fatigue in diabetes. Although fatigue also occurs in other medical disorders, the importance of fatigue may be greater in individuals with diabetes.
Clinicians who work with patients affected by diabetes have noted anecdotally the considerable toll that fatigue takes on their patients, yet there is little empirical research describing the severity of the problem.
Fatigue in diabetes may be associated with physiological phenomena, such as hypo- or hyperglycemia or wide swings between the two. Fatigue may also be related to psychological factors, such as Knee Replacement bei Diabetes or emotional distress related to the diagnosis or to the intensity of diabetes self-management regimens. Fatigue may also be related to such lifestyle issues as lack of physical activity or being overweight--especially common in people with type 2 diabetes.
Research is needed to clarify these relationships in order to help people with diabetes manage this symptom. Herein, we review the existing literature about diabetes-related fatigue with an eye toward creating a framework for beginning to conduct more focused studies on Knee Replacement bei Diabetes subject. Fatigue is a word commonly used in everyday conversations, with subjective meanings as varied as the individuals using it. Terms including fatigue, Knee Replacement bei Diabetes, tiredness, lacking energy, and exhaustion are used interchangeably.
Within the scientific literature, definitions of fatigue vary greatly, Knee Replacement bei Diabetes defining fatigue becomes more challenging because there is poor differentiation among causes, Knee Replacement bei Diabetes, and effects 12.
Fatigue Knee Replacement bei Diabetes largely been defined as either a subjective symptom or an objective performance decrement 3but has also been identified as a syndrome unto itself chronic fatigue syndrome.
While fatigue is considered Knee Replacement bei Diabetes normal occurrence in daily life, it is also a symptom associated with a variety of physiological and psychological conditions.
Fatigue normally occurs after mental or physical exertion, inadequate sleep, or other temporary phenomena. Sometimes called acute or healthy, such fatigue is usually temporary and alleviated with rest. Acute fatigue serves as a protective mechanism by signaling the body's need for rest. Chronic, or pathologic fatigue, however, occurs after modest effort and continues despite rest.
Central fatigue is thought to result from disturbances to the complex Knee Replacement bei Diabetes circuitry connecting the brain's motor coordination centers basal ganglia with the executive center frontal lobe and internal motivational center hypothalamus and limbic system.
Central fatigue differs from peripheral fatigue in that it occurs in the absence of clinically detectable motor weaknesses. Some believe that fatigue is psychological in origins.
However, psychological fatigue has not been adequately defined in the literature. Psychological fatigue symptoms may originate from emotional phenomena or may arise from alterations in neurotransmitter release such as is seen in clinical depression. A recent study of fatigue in primary care patients suggested that psychological disorders were more predictive of fatigue than were physical illnesses. Fatigue is one of the most common somatic symptoms associated with depression 22 - 26 and Knee Replacement bei Diabetes among the nine diagnostic criteria for major depressive disorder as outlined in the Diagnostic and Statistical Manual of Knee Replacement bei Diabetes Disorders, 4th Edition DSM-IV.
Contrary to prediction, In further logistic regression analyses, fatigue was as strong a predictor of depression as those symptoms considered to be unique to depression. Among healthy individuals without diabetes, self-reported symptoms such as fatigue have been found to negatively affect self-rated health and quality of life Knee Replacement bei Diabetes Fatigue has also been associated with decreased physical functioning and decreased ability to manage routine daily activities 26 While Knee Replacement bei Diabetes studies have examined the relationship between fatigue and daily functioning in individuals with diabetes, fatigue is likely a barrier to their health-promoting behaviors, such as participating in diabetes self-care regimens, Knee Replacement bei Diabetes a healthy eating plan or participating in regular exercise.
Despite the consequences, fatigue remains a challenging problem for treatment by health care providers. Wessely suggests that because fatigue is a non-specific and universal symptom, clinicians are hindered in appropriately diagnosing or treating the problem 3.
In addition, fatigue researchers have yet to agree on standardized definition, measurement or diagnostic criteria, further hindering our understanding of this symptom. Thus, we undertook this review to move toward creating a framework for beginning to conduct focused studies on fatigue in diabetes.
As in other conditions, fatigue in people with diabetes is likely to be multidimensional, encompassing physiological, psychological, Knee Replacement bei Diabetes lifestyle factors Figure 1.
One likely reason for fatigue in diabetes uncomplicated by severe comorbidities is alterations in blood glucose levels. Altered blood glucose metabolism may result in acute and chronic hyperglycemic episodes, hypoglycemia, or blood glucose fluctuations.
These alterations may affect fatigue separately or in tandem. The presence of short- and long-term complications of diabetes and their symptoms, including symptoms of hypo- or hyperglycemia, cardiac disease, neuropathy, or retinopathy, has also been associated with increased fatigue 30 - Some evidence suggests that acute glycemic excursions are associated with fatigue.
During an in-depth analysis of common hyperglycemic symptoms, insulin-treated diabetics were asked to list their most common symptoms and report the blood glucose level at which those symptoms occurred Tiredness was ranked fifth of the 16 most commonly reported symptoms. A mean symptom inventory score was computed for each subject based on the 16 symptoms.
Subjects also reported tiredness during lower levels of hyperglycemia, prior to osmotic symptoms such as thirst or increased urination More recently, the effects of acute hyperglycemia on cognition and mood were examined in a group of 20 subjects with Knee Replacement bei Diabetes 2 diabetes 34and the study concluded that acute episodes of hyperglycemia were significantly associated with diminished cognitive function and altered mood states, including heightened fatigue It is possible that the average hemoglobin A 1c may be falsely low in this group because their blood glucose level may not have been elevated Knee Replacement bei Diabetes full three months.
A high number of symptom complaints including fatigue was significantly associated with FPG, body mass index BMIand female gender. There was no association between symptom complaints and hemoglobin A 1cagain suggesting a stronger association between fatigue and acute, rather than chronic, hyperglycemia. Acute episodes of hypoglycemia have also been associated with higher levels of fatigue.
In a controlled study of adults with type 1 diabetes, the effects of a nocturnal hypoglycemic episode on subsequent subjective well-being and physical fatigue were examined The morning following the hypoglycemia visit, subjects reported more fatigue symptoms, decreased well-being, and were more likely to fatigue faster during an exercise bout than when blood glucose levels were maintained within the higher range.
Chronic hyperglycemia has long been assumed to cause fatigue; however, few data support this relationship. One cross-sectional study examined the relationship between glucose control and physical symptoms, moods, and well-being. In contrast, there was no Knee Replacement bei Diabetes between hemoglobin A 1c and fatigue symptoms as measured by the DSC-Type 2 during a two-year prospective study examining the initiation of insulin therapy in Dutch adults with type 2 diabetes The authors reported a significant relationship of every unit increase of insulin dose with DSC-Type 2 total symptom complaint scores which included a fatigue subscale and POMS anger, displeasure, and fatigue scores, suggesting Knee Replacement bei Diabetes emotional fatigue possibly related to increased hypoglycemic events and the burden of daily injections In a study of patients with type 2 diabetes and restless leg syndrome, hemoglobin A 1c was associated with sleepiness as measured by the Epworth Sleepiness Scalebut not fatigue as measured by the Fatigue Severity Scale Glucose variability can be defined as the fluctuations in glucose levels that may occur rapidly over minutes or over hours.
In the clinical setting, glucose variability may be missed, since glucose fluctuations will not be revealed through a single measure of blood glucose or with a hemoglobin A 1c test. Fluctuations in blood glucose levels, regardless of overall blood glucose control as measured by hemoglobin A 1cmay contribute to fatigue. There is evidence to suggest that the frequency and magnitude of blood glucose fluctuations may be greater in individuals with type 1 diabetes, who are more sensitive to the effects of Knee Replacement bei Diabetes insulin, have altered glucagon and norepinephrine responses to hypoglycemia, and may overcompensate by overtreating hypoglycemia.
These factors place them at higher risk for hypoglycemia and hyperglycemia excursions than patients with type 2 Knee Replacement bei Diabetes. Oxidative stress and fatigue were studied in patients with chronic fatigue syndrome. In a control-matched, cross-sectional study of Knee Replacement bei Diabetes adults with chronic fatigue syndrome, increased markers of oxidative stress, including isoprostanes and oxidized low-density lipoproteins, were associated with chronic fatigue symptoms Glucose variability may also cause psychological fatigue.
Patients who frequently experience wide swings in blood glucose levels are likely to feel that they are failing at maintaining good diabetes control. Over a long period of time, this neglect could result in worsening of blood glucose control, thus increasing the risk for long-term complications. Many of the chronic complications associated with diabetes are associated with fatigue.
Anemia, the major side effect of impaired kidney function, results in increased fatigue. Among patients undergoing dialysis for treatment of ESRD, symptoms including fatigue negatively affected quality of life and were significantly worse among the patients with diabetes than those without diabetes Additionally, investigators have suggested that anemia is more prevalent in patients with diabetes than without 46 and occurs during the earliest stages of kidney disease, when only microscopic amounts of urinary protein are present Peripheral neuropathy, which predominantly affects the hands and the feet, is the most common form of diabetic neuropathy.
Peripheral vascular disease is often present in patients with diabetic peripheral neuropathy, and causes deep, aching pain in the calves. Inadequate perfusion to the lower extremities deprives the tissues of oxygen, nutrients, and antibiotics, and impairs waste removal, thus placing the limb at risk for impaired wound healing and gangrene. Treatment for lower extremity infections and ulcerations usually includes reduced ambulation or bearing no weight on the affected limb.
The combination of poor substrate utilization, infection risk, and reduced physical activity may all contribute to fatigue. Diabetes-related symptoms, whether or not a comorbid condition has been diagnosed, have also been associated with fatigue.
In a later paper, these authors found that individuals with diabetes and a comorbid condition reported more prolonged fatigue than did either healthy persons or individuals with diabetes and no comorbid condition Neither paper described the specific diabetes symptoms that were associated with the increased fatigue, nor did either study distinguish between subjects with type 1 or 2 diabetes.
Both studies, however, offered additional support that diabetes fatigue may have deleterious effects on job or work roles. The proposed fatigue research framework Figure 1 suggests that there are two key psychological variables that are most likely associated with diabetes-related fatigue: diabetes emotional distress and depressive symptoms.
This term is related to the work of managing and living with Knee Replacement bei Diabetes. Burnout is what happens when you feel overwhelmed by diabetes and by the frustrating burden of diabetes self-care.
People who have burned out realize that good diabetes care is important for their health, but they just don't have the motivation to do it. At a fundamental level, they are at war with their diabetes--and they are losing From data collected on 87 adults with type 1 and type 2 diabetes, Casalenuovo reported that the Knee Replacement bei Diabetes of living with diabetes was disruptive to well-being and led to energy depletion and fatigue In a study evaluating the influence of initiating insulin therapy on physical symptoms, mood states, general well-being including fatigueand treatment satisfaction in adults with type 2 diabetes, subjects reported no changes in physiological fatigue symptoms with improved Knee Replacement bei Diabetes control The subjects in the intervention group, who were started on insulin therapy, reported more frequent insulin reactions and weight gain.
The concept of burnout has been strongly associated with workplace fatigue. Maslach has conceptualized three key dimensions associated with job burnout: overwhelming exhaustion, feeling of cynicism and detachment from job, and sense Knee Replacement bei Diabetes ineffectiveness and lack of accomplishment Over time, they may experience emotional fatigue, cynicism, and resultant detachment from their health care provider's recommendations.
These factors may play a role in exacerbating physiologic fatigue, or adding a psychological dimension to it. This has special implications for individuals with Knee Replacement bei Diabetes.