Diabetes and Shortness of Breath: What's the Connection?

Shortness of breath doesn't top the list of the most common symptoms you may experience with diabetes. However, it's important to know that the two are connected.

Shortness of breath (and related dizziness) can occur when blood sugar is dangerously high or low, and it can also indicate a serious complication of diabetes called diabetic ketoacidosis. New or worsening shortness of breath can also be a sign of another health issue that diabetes has put you at greater risk for, such as kidney failure or heart attack.

This article discusses why diabetes may lead to shortness of breath, and why close monitoring and treatment by a healthcare professional specialized in diabetes is essential.

Diabetic Ketoacidosis

Diabetes is a condition in which the body makes too little insulin or resists insulin. This is the hormone, produced in the pancreas, that's needed to break down carbohydrates from food and convert it into energy in the form of glucose. 

Since the entire body requires energy, diabetes can affect every part of it.

Diabetic ketoacidosis (DKA) occurs when the body is not producing enough insulin and cannot convert carbohydrates into glucose for energy. The body then begins to break down fats for energy. When this happens, it creates a waste byproduct called ketones. 

Ketones are cleared out of the body by the kidneys and expelled through urine. In DKA, ketones build up faster than the kidneys can remove them from the body. This results in a buildup of ketones, which is toxic. The body may try to use the lungs to expel the excess ketones, which causes shortness of breath.

Meanwhile, because of the lack of insulin, glucose levels in the blood rise. In addition to shortness of breath, a person affected by DKA will often have dizziness, nausea and vomiting, a very dry mouth, and sometimes fruity breath. People can quickly become unconscious as ketone levels rise in the body, so seeking immediate medical care is often necessary. 

Initial treatment to reverse this condition is to give fluid through a vein and provide insulin either as an injection under the skin or into a vein. Sometimes people are admitted to the hospital for close monitoring and continued treatment until ketone levels decline and insulin levels are stabilized. 

Close follow-up with your personal diabetes care provider is needed to ensure insulin balance is maintained to prevent DKA.

Diabetic Coma

People who have diabetes may feel short of breath because of high blood glucose, which is called hyperglycemia, or too little glucose, which is called hypoglycemia. Similar to ketoacidosis, too much or too little glucose can affect lung function and breathing. Other symptoms may include:

• Drowsiness
• Abdominal pain
• Dry mouth
• Extreme thirst
• Shakiness, weakness, or dizziness
• Confusion 

An extremely high or low blood sugar level can lead to a life-threatening emergency called a diabetic coma, where a person becomes unconscious and unresponsive to their environment. 

For hypoglycemia, the initial treatment is fluids through a vein and giving glucose through a vein. For hyperglycemia, the initial treatment is administration of fluid through a vein and to administer insulin. 

In both hypoglycemia and hyperglycemia, patients are closely monitored for a period of time and possibly admitted to the hospital for closer observation and prevention of a repeat episode.

After initial treatment is completed, patients need to follow up with their diabetic care provider to come up with strategies for preventing hypoglycemia and hyperglycemia. Among the ways to achieve this are:

• Close monitoring of glucose levels
• Keeping emergency glucose tablets available
• Having medical identification, such as a medical bracelet, for potential emergencies

Heart Attack and Stroke

For people with diabetes, shortness of breath can be an indication of heart disease. Cardiovascular disease is the top cause of death for people living with diabetes, who are twice as likely to have a heart attack or stroke than those who don't have the condition.

People living with diabetes, even with careful monitoring, can have times when their blood glucose levels are elevated. Over time, these elevated levels of blood glucose can cause damage to the network of blood vessels and nerves throughout the body, especially the delicate blood vessels and nerves around the heart.

Shortness of breath may be one of the first signs of a heart attack or stroke. Other symptoms people may experience include:

• Sweating
• Indigestion
• Nausea
• Dizziness
• Pain or discomfort in the arms, jaw, chest, upper abdomen, or back
• Droopy eyelid or smile on one side of the face
• Slurred speech 

Any of these symptoms should be evaluated immediately. Your healthcare provider will perform a complete physical exam, including a blood pressure reading, and will likely order lab tests to review your cholesterol levels and blood sugar, like a hemoglobin A1C test.

They may recommend prescription medications to manage your diabetes and prevent heart disease complications, such as heart failure.

Kidney Failure

People living with diabetes are at a higher risk of a condition known as nephropathy, also known as kidney disease. Over time, diabetes can damage the ability of the kidneys to filter waste properly and cause significant damage to the kidneys. 

As the kidneys lose their ability to function properly, fluid builds up in the body and can back up into the heart and lungs, which may lead to shortness of breath. Other possible symptoms include:

• Swelling of the feet, hands, ankles, and eyes
• Loss of appetite
• Nausea and vomiting
• Confusion and difficulty concentrating
• Persistent itch
• Fatigue

It is important to bring any of these symptoms to your healthcare provider’s attention as soon as possible. They will likely order lab tests and even have you see a nephrologist, a kidney specialist, to determine the extent of any kidney damage.

When to See a Healthcare Provider

If you have diabetes and experience shortness of breath, it's important to see a healthcare professional immediately for evaluation and treatment.

In general, you should expect to have them perform a thorough physical exam and obtain a medical history. Often, lab tests are done to assess blood glucose levels, the presence and severity of ketoacidosis, and kidney function.

Depending on other medical conditions you have or could have, your healthcare provider may also order an electrocardiogram (ECG) to assess for any heart damage or computed tomography (CT) scans to assess for any signs of stroke.