Diabetes and Shortness of Breath: What Does It Mean?

Diabetes is a condition in which the body makes too little insulin or resists insulin. Insulin is the hormone our bodies need to break down carbohydrates from the food we eat into energy, in the form of glucose. Without insulin, our bodies cannot function effectively.

Since our entire body requires energy, diabetes can affect every part of it. Over time, especially if diabetes is not properly monitored, treated, and controlled, it can lead to other health conditions. Some of the body’s systems that are more susceptible to the impact of diabetes are the kidneys and cardiovascular system.  

Close monitoring and treatment by a healthcare professional specialized in diabetes, such as an endocrinologist, is important. Anyone living with diabetes should let their healthcare professional know when they notice new symptoms or changes in their overall health. One symptom that is important to bring to your healthcare provider’s attention quickly is new or worsening shortness of breath.

woman experiencing shortness of breath

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What Shortness of Breath Could Mean

New or worsening shortness of breath in a person living with diabetes could be a sign of a potentially serious condition.

Diabetic Ketoacidosis

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 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 emergent 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.

Heart Attack and Stroke

For people with diabetes, shortness of breath can be an indication of heart disease. Cardiovascular disease is the number one cause of death for people with diabetes: They 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 or nausea, pain or discomfort in the arms, jaw, chest, upper abdomen, or back, droopy eyelid or smile on one side of the face, or slurred speech. Any of these symptoms should be evaluated emergently.

Since people living with diabetes are at higher risk of heart attacks and strokes, seeing a healthcare provider regularly is important. 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 will also likely recommend prescription medications to manage your diabetes and prevent heart disease complications, such as heart failure.

Diabetic Coma

People who have diabetes can have a 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 cause people to feel short of breath. Other symptoms may include drowsiness, abdominal pain, dry mouth, extreme thirst, shakiness or weakness, or 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 of hypoglycemia or hyperglycemia. 

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, such as close monitoring of glucose levels, having emergency glucose tablets available, and having medical identification, such as a medical bracelet, for potential emergencies.

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, and 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 Your Healthcare Provider

For people living with diabetes, high and low levels of blood glucose can cause serious, even life-threatening, medical conditions. New or worsening shortness of breath may be one of the initial symptoms. It is important for people living with diabetes who are experiencing new or worsening shortness of breath to see a healthcare professional immediately for evaluation and treatment.

In general, people living with diabetes who seek immediate treatment for new or worsening shortness of breath should expect to have a healthcare professional 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 the conditions you 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.

A Word From Verywell

Complications of diabetes can be overwhelming. It is important for you to be able to recognize new or worsening symptoms and seek immediate treatment from a healthcare professional. The best way to prevent complications of diabetes is to find a healthcare professional who specializes in treating diabetes. Seeing your healthcare professional routinely and adhering to a healthy lifestyle consisting of exercise, a proper diet, and regular blood sugar monitoring can help lower your chances of having serious conditions as a result of diabetes.

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Article Sources
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  6. Cleveland Clinic. Diabetic coma. Updated December 2, 2020.

  7. American Diabetes Association. Kidney disease (nephropathy).