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2005 Aug;30(4):412-4

In diabetes, prolonged periods of elevated blood sugar levels can lead to nerve damage

Adequate B12 allows normals RBC formation (preventing anemia-related fatigue) and keeps nerves myelinated

These symptoms include: Persistent unexplained fatigue Waking unrefreshed after a good nights sleep Brain fog Impaired memory Muscle aches and joint pains Tiring easily after minor exertion Decreased capacity to handle stress Mild depression Irritability Low libido Frequent infections However it turns out that science does not support the concept of adrenal fatigue, that stress causes low cortisol release from the adrenals that then leads to the list of symptoms described