Why Does Diabetes Cause Nausea and Vomiting?

Experiencing nausea and vomiting with diabetes may be related to blood sugar, treatments for diabetes, or an effect of complications associated with diabetes. While these symptoms are common and can be managed once their cause is discovered, sometimes they are an indication of a serious condition associated with your diabetes.

Nausea and vomiting can be caused by different effects diabetes has on your body. Experiencing low and high blood sugars, diabetic ketoacidosis, pancreatitis, gastroparesis, low blood pressure, and bezoars can all cause you to feel nauseous or vomit. Even some diabetes medications can have these same effects.

Most of these conditions can be managed with self-monitoring or guidance from your doctor. However, some conditions like diabetic ketoacidosis or extremely low blood sugar that is untreated can lead to hospitalization.

Understanding how each of these syndromes occurs with diabetes can help you gain better control of your symptoms and help you treat and manage nausea and vomiting.

Low or High Blood Sugar

Low blood sugar (hypoglycemia) occurs when your blood glucose drops below your target range. This usually happens at less than 70 mg/dl, but everyone’s range is different. It is best to talk to your doctor about what is healthy for you. Often, when you experience low blood sugar, you will need to take action to fix it quickly.

Causes

Low blood sugar can be caused by too much insulin, food (not eating enough carbohydrates or eating fewer carbs than usual but not adjusting the amount of insulin), and physical activity.

High blood sugar (hyperglycemia) occurs when your blood glucose elevates higher than your target range. This usually happens when the body has too little insulin or can’t use the insulin properly.

Other factors can affect your blood sugar as well. If you eat more than planned or exercise less, or experience stress or an illness, your blood sugar may rise.  

Other Symptoms

When you experience low or high blood sugar, you may also have the following symptoms, along with nausea or vomiting.

Low blood sugar symptoms:

• Feeling shaky
• Sweating, clamminess
• Fast heartbeat
• Feeling lightheaded
• Blurred vision
• Headaches
• Seizures

High blood sugar symptoms:

• Frequent urination
• Increased thirst

Treatment

To treat low blood sugar, it is recommended to follow the 15-15 rule:

1. Have 15 grams of simple carbohydrates like a tablespoon of sugar or 4 ounces of juice to raise your blood sugar.
2. Wait 15 minutes to recheck your levels.
3. If your blood sugar is still below 70 mg/dl, have another serving and wait 15 minutes more.
4. Repeat these steps until your blood sugar reaches 70 mg/dl.

Although you may be tempted to eat as much as you can until you feel better, try to resist as this can cause your blood sugar to elevate too high.

To treat high blood sugar, exercise can help. However, if your blood sugar is above 240 mg/dl, you need to check your urine for ketones. If ketones are present, do not exercise, as this can make your blood sugar rise even higher.

If your blood sugar remains high, ketones are present, and you are experiencing nausea or vomiting, you may have entered a state of diabetic ketoacidosis, which is a serious condition.

Diabetic Ketoacidosis

Left untreated, diabetic ketoacidosis (DKA) can lead to coma or death. DKA occurs when your cells can no longer get the glucose they need for energy and your body begins to burn fat instead. This process produces ketones, which build up in the blood and make it more acidic.

High levels of ketones can poison the body. Most doctors recommend you check for ketones if your blood sugar is higher than 240 mg/dl.

Symptoms

The warning signs of ketoacidosis are similar to those of high blood sugar:

• Thirst
• Frequent urination
• Elevated blood sugar

When ketoacidosis progresses, you may experience:

• Nausea
• Vomiting
• Abdominal pain
• Difficulty breathing
• Fruity odor on breath
• A hard time paying attention
• Dry or flushed skin

Treatment

Treating diabetic ketoacidosis usually requires a trip to the hospital and careful monitoring by medical professionals. However, you can help prevent DKA by learning the warning signs, checking your blood sugars regularly, and managing your diabetes as instructed.

Pancreatitis

Having diabetes puts you more at risk for pancreatitis, an inflammation of the pancreas. The pancreas’ function is to make insulin and digestive enzymes, which help you digest food.

Symptoms

Pancreatitis can begin with pain in your upper abdomen that might spread to the back. This can be mild or severe and cause nausea and vomiting. Most people who experience pancreatitis will look and feel very sick and need to see a doctor right away.

Treatment

Treatment for pancreatitis depends on severity. For mild acute pancreatitis, rest and treatment with IV fluids or antibiotics can get you back to feeling normal within a few days. For more severe pancreatitis, you may need surgery to remove your gallbladder or relieve pressure in the pancreatic duct.

To help prevent pancreatitis, avoid heavy drinking and smoking. Eat a healthy diet that focuses on low-fat, high-protein foods rich in vitamins and minerals, and remain active.

Diabetes Medication

Some prescription medications, such as GLP-1 receptor agonists like Trulicity (dulaglutide), cause nausea or vomiting. This may be due in part to a delay in gastric emptying.

Other injectable medications like Byetta (exenatide) may also cause nausea or vomiting. This usually occurs when you first begin the drug but will decrease as your body gets used to it.

With some medications, you may also experience diarrhea. If you experience vomiting, you may need to check your blood sugar more often to ensure that you are taking the proper doses of your medication.

To manage nausea or vomiting caused by medication, your doctor may start you on a low dose and gradually increase it.

Do not discontinue your medication without speaking to your doctor. Your doctor has determined that the benefits of your medication outweigh the side effects. However, if you have any concerns, talk to your doctor or diabetes care team.

Gastroparesis

Diabetic gastroparesis is a severe complication of diabetes that can cause nausea, vomiting, and weight loss. Gastroparesis is a delayed gastric emptying, which means the time it takes for your food to move from the stomach to the small intestine is slower.

Symptoms

Food that sits in your stomach longer than it’s supposed to can cause nausea. Gastroparesis can cause other symptoms as well such as:

• Feeling full after starting a meal
• Feeling full long after eating a meal
• Bloating
• Belching
• Poor appetite

Management

To manage gastroparesis, you may try eating five or six small meals a day instead of three large ones. Avoid alcohol and carbonated beverages, and try not to lay down for two hours after a meal. Be sure to continue to manage your blood sugars, as hyperglycemia can cause a further delay of stomach emptying and more nausea.

For more serious cases of gastroparesis, such as those with diabetic gastroparesis, surgery to relieve pressure in your stomach may be recommended.

Low Blood Pressure

When blood sugar decreases, you can experience low blood pressure. Low blood pressure occurs when your blood moves through your veins and arteries at lower than normal pressures.

Symptoms

Low blood pressure can cause nausea as well as other symptoms such as:

• Confusion
• A feeling of lightheadedness
• Headache
• Blurry vision

Management

To manage low blood pressure, check your blood glucose. If your numbers are off, you may need to raise or lower your blood sugar either through food or medication.

Bezoars

A bezoar is a mass of indigestible materials that accumulates and forms in the stomach. These masses occur with high-fiber vegetable diets and certain medications. They also occur more frequently in patients with gastroparesis or delayed stomach emptying. Since diabetes can cause gastroparesis, you are more at risk for a bezoar.

Symptoms

The most common symptoms of a bezoar are nausea and vomiting, but can also include:

• Abdominal pain
• Weight loss
• Indigestion

Treatment

Often bezoars will pass through the digestive tract on their own with time. However, you may need further treatment. Initial efforts involve trying to dissolve the bezoar with treatments like Coca-Cola irrigations and enzymes.

Your doctor may also perform an endoscopy where they can biopsy the bezoar or take parts of it out. With large bezoar formations, surgery may be recommended to remove them.

A Word From Verywell

If you live with diabetes, it is important to follow your doctor’s and healthcare team’s recommendations to control your disease and enjoy better overall health.

By managing your blood glucose levels, blood pressure, and cholesterol, you can reduce the disease’s effects on your body. Managing your diabetes can help keep symptoms like nausea and vomiting under control.

While nausea with diabetes is common, it is important not to ignore symptoms, and to speak to your doctor if you are experiencing extreme high or low blood sugars or any of the conditions listed above.

When it comes to living with diabetes, remember that you are the most important member of your diabetes care team, and knowing the signs and symptoms of more serious complications of diabetes keeps you in control of your health.

Following your diabetes meal plan, staying active, and taking your medications as directed can help you better control your condition.