Diabetes and Nausea

Diabetes can be associated with an increased risk of nausea.  There are several reasons why a diabetic might have more nausea when compared to those without diabetes.  Some things that contribute to nausea in diabetics include the following:

Diabetic medications.

Some of the injectable medications used in the management of diabetes will increase the risk of nausea.  Common injectable diabetic medications include Symlin (pramlintide), Victoza (liraglutide), and Byetta (exenatide). There is some evidence to suggest that the nausea associated with these medications is temporary and will go away the longer you take the medications.  Your physician may also try a lesser dose of the medication in the beginning to try and lessen the risk of nausea.

Hypoglycemia or Hyperglycemia.

Both elevated blood glucose levels (hyperglycemia) and low blood glucose levels (hypoglycemia) carry the risk of developing nausea. In order to reduce the incidence of nausea, you need to check your blood glucose levels on a regular basis and use insulin (or other diabetic medications) to keep your blood sugar within the normal range. Besides medications for blood sugar control, you can avoid the nausea of blood glucose abnormalities, you need to eat a healthy diet and exercise—both surefire ways of controlling the blood sugar levels.  One other thing you can do is avoid doing any type of exercise when the environment is too hot or too cold.  Drink cold water or electrolyte solution while exercising outdoors in order to maintain adequate hydration and to keep your blood sugars in good control.

Diabetic ketoacidosis

Diabetic ketoacidosis.

One of the signs that you might have diabetic ketoacidosis is the presence of nausea.  Diabetic ketoacidosis happens when the blood sugar cannot enter the cells so that the cells of the body must break down fat in order to use the fat for fuel.  A byproduct of fatty acid metabolism is the presence of ketones in the blood and urine, which can lead to metabolic acidosis and secondary complications, including nausea.  Other symptoms you need to look out for as being signs of diabetic ketoacidosis include abdominal pain, fatigue or weakness, frequent urination, excessive thirstiness, fruity odor to the breath, confusion, shortness of breath, and sometimes unconsciousness or coma.

You can prevent the onset of diabetic ketoacidosis by regularly monitoring your blood glucose levels, testing your urine for the presence of ketones (especially if you are under physical or emotional distress and during illnesses), and taking your diabetic medications as prescribed.  As diabetic ketoacidosis can be life threatening, any time you have nausea or other signs of diabetic ketoacidosis, you will want to see your doctor for evaluation and treatment before the symptoms become too much for you to manage on your own.

Diabetic medications

Gastroparesis.

Gastroparesis is a GI complication commonly seen in diabetics. Gastroparesis means that the stomach does not empty properly when you are eating.  The food isn’t digested promptly and nausea can ensue.  Other symptoms of gastroparesis besides nausea include changes in blood sugar levels, swelling of the abdomen, pain in the area of the stomach, decreased appetite, heartburn, and malnutrition.

Gastroparesis cannot be cured; however, there are things you can do in order to manage your symptoms.  These include the following:

  • Avoid lying down after you have eaten. Try sitting up after a meal or taking a short walk to enhance digestion and decrease nausea.
  • Eat several meals per day rather than just three large meals. This will cut down on nausea because your stomach will have less food to digest per meal and the incidence of nausea will go way down.
  • Talk to your doctor about your insulin dosage. Sometimes it helps to take your insulin after eating rather than before eating.  This simple change in diabetes management can lessen the degree of nausea after meals.

Under normal conditions, you chew and swallow your food, and drink liquids as part of your meal.  The stomach makes digestive enzymes that break down the products of eating and sends the partially digested liquid and solid food into the duodenum and small intestines, where it is absorbed into the bloodstream.  When you have gastroparesis, the food does not leave the stomach fast enough (because of autonomic neuropathy in the gastrointestinal system) and the end result is gastroparesis and nausea.

Having gastroparesis means that the contractions in the stomach that normally send the food from the stomach to the duodenum become weakened.  The food isn’t thoroughly digested and the food doesn’t properly empty into the duodenum.  This results in the retaining of partially digested food in the stomach so that there is delayed gastric emptying and secondary nausea.

Gastroparesis is normally caused by having uncontrolled blood sugars in type 1 or type 2 diabetes. The high blood glucose levels affect the vagus nerve, which supplies the nerves responsible for normal contractions of the stomach after introducing food into the stomach. When the vagus nerve is damaged, the muscles of the stomach fail to contract the way they are supposed to and the end result is gastroparesis and delayed stomach emptying.  While there can be other causes for gastroparesis, diabetes mellitus is the most common cause of this disorder.

Other causes of gastroparesis besides diabetes include mineral imbalances (including imbalances of magnesium, phosphate, calcium, and potassium), the use of narcotic pain medications, and low thyroid conditions.  Sometimes no reason for the gastroparesis can be found and then it is termed “idiopathic gastroparesis”.  Idiopathic gastroparesis is the number two cause of gastroparesis after type 1 diabetes.

So how do you know if you have gastroparesis from diabetes?  Be on the lookout for the telltale signs of gastroparesis, which include feeling full shortly after starting to eat, nausea and vomiting, weight loss (from being unable to eat large meals and vomiting), abdominal bloating and swelling, and abdominal pain.  The main complication of gastroparesis is malnutrition from being unable to keep food down, and continual nausea and vomiting.

Most of the time, the nausea and vomiting of gastroparesis happens shortly after eating a large meal; however, as the disease progresses, you can have nausea and vomiting on an empty stomach from a buildup of gastric secretions that don’t pass out of the stomach fast enough.  The peak time of nausea and vomiting from gastroparesis is a few hours after eating because this is when the stomach is maximally filled out from gastric secretions and the food you ate. Because the food is not digested properly, you end up having the vomiting of food that isn’t digested and will look like food rather than the typical vomitus you’d otherwise expect.

If you think you might be suffering from gastroparesis as a cause of your nausea, see your doctor for evaluation.  The doctor may order a nuclear medicine test known as a “gastric emptying study”. In this test, you eat a slightly radioactive meal and a scanner is placed over the stomach to see how fast the food is passed from the stomach to the duodenum.  If the gastric emptying study is abnormal, it probably means you have gastroparesis as a cause of your nausea.

If you have nausea secondary to diabetic gastroparesis, there are things you can do to decrease the symptoms.  You need to eat a diet that is high in foods that are more easily digestible, keep your blood sugars in good control, activate muscle activity in the stomach so that food is more easily digested and emptied out of the stomach, and try to eat foods that are the most nutritious in small enough quantities that doesn’t induce nausea and vomiting.

Pancreatitis.

Diabetics who have uncontrolled blood sugar levels are at an increased risk of developing inflammation of the pancreas, known as pancreatitis.  The main signs and symptoms of pancreatitis include upper abdominal pain, elevated triglyceride levels, and nausea and vomiting. You can decrease the chances of developing pancreatitis in diabetes by keeping the blood sugars in good control, staying away from alcohol, and quitting smoking.

References:

  1. Is diabetes causing my nausea? http://www.healthline.com/health/diabetes/is-diabetes-causing-my-nausea#1.
  2. http://www.medicinenet.com/gastroparesis/article.htm
  3. Pancreatitis. http://www.niddk.nih.gov/health-information/health-topics/liver-disease/pancreatitis/Pages/facts.aspx
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