Can Nausea Be a Symptom of Diabetes?

Diabetes can often cause nausea and vomiting. These symptoms may be related to blood sugar, diabetes treatments, or complications related to your condition.

Low and high blood sugars, diabetic ketoacidosis, pancreatitis, gastroparesis, and low blood pressure 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 healthcare provider. However, some conditions like diabetic ketoacidosis or extremely low blood sugar that is untreated can lead to hospitalization.

This article discusses how and why diabetes can lead to nausea and vomiting, how you can manage these symptoms, and when to seek help from your care provider.

What Is Nausea?

Nausea may seem self-explanatory, but you might feel it in different ways. It is basically feeling sick to your stomach and like you're going to vomit. The feeling may be mild or severe. Sometimes it is accompanied by other symptoms, including but not limited to:

• Sweating
• Fever
• Clammy skin
• Lightheadedness

Is Nausea a Symptom of Diabetes?

Nausea and vomiting are common symptoms of diabetes for a variety of reasons, mostly related to blood sugar and digestive issues.

Potential causes of diabetes-related nausea and vomiting may include:

• Hypoglycemia also known as low blood sugar
• Hyperglycemia also known as high blood sugar
• Diabetic ketoacidosis, when ketones in your blood increase to dangerous levels
  
• Pancreatitis, which is swelling of the pancreas
• Gastroparesis, or partial paralysis of the stomach

Hypoglycemia (Low 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 healthcare provider about what is healthy for you. Often, when you experience low blood sugar, you will need to take action to fix it quickly.

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.

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.

Low blood sugar symptoms include:

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

Hyperglycemia (High Blood Sugar)

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.

While everyone's target range may be different, hyperglycemia is generally considered a blood sugar level higher than 125 mg/dL while fasting and higher than 180 mg/dL two hours after eating. 

Other factors can affect your blood sugar include eating more than planned, exercising less, high levels of stress, and illness.  

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

• Frequent urination
• Increased thirst
• Fatigue or tired feeling
• Blurred vision
• Frequent infection (skin, bladder, etc.)

Diabetic Ketoacidosis

If your blood sugar remains high without treatment, it could lead to diabetic ketoacidosis. This a serious condition and requires emergency care. Left untreated, diabetic ketoacidosis can cause a coma or death.

Diabetic ketoacidosis can cause nausea and vomiting, along with:

• Shortness of breath
• Fruity smell to breath
• Extremely dry mouth
  

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.

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 healthcare provider right away.

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.

Along with nausea, gastroparesis symptoms include:

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

Nausea From Diabetes Medications

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 healthcare provider may start you on a low dose and gradually increase it.

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

Treatments and Management of Nausea

Treatment options may vary depending on the cause of your nausea, whether it's related to blood sugar, pancreatitis, or gastroparesis.

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

If you have low blood sugar, 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. Instead, it is recommended to follow the 15-15 rule:

1. Have 15 grams of simple carbohydrates like a tablespoon of sugar or four 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.
   

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 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.

Lifestyle Changes

It can be hard to manage nausea related to diabetes, as many of the foods that reduce nausea can often lead to blood sugar spikes (bananas, applesauce, rice, etc.). There are, however, dietary changes you can make to help reduce this symptom that will keep your blood sugar in check: 

• Get your carbs mostly from unprocessed non-starchy vegetables
• Avoid or limit heavy, spicy, or deep-fried foods 
• Involve your healthcare professional in your meal-planning 
• Eat smaller and more frequent meals 

Foods rich in protein as well as clear broths, herbal teas, and ginger are all helpful foods to eat when nauseous. 

Nausea Medications

There are multiple over-the-counter (OTC) and prescription medications that can help treat nausea: 

OTC 

• Pepto-Bismol (bismuth subsalicylate)
• Antihistamines such as Dramamine (dimenhydrinate)

Prescription 

• Zofran (ondansetron) 
• Promethegan (promethazine) 
• Reglan (metoclopramide) . 
• Compro (prochlorperazine) 
• Transderm Scop (scopolamine)

Be sure to talk to your healthcare provider about the risks, benefits, and side effects of these medications, and whether or not they’re right for you.

When to See Your Healthcare Provider

Diabetes should always be managed by your healthcare provider to ensure your insulin levels and blood sugar are in safe range and that you're managing your condition properly. There may be times, however, when diabetes-related nausea and vomiting may warrant medical care, including:

• You have difficulty regulating blood sugar.
  
• You have nausea and vomiting for more than a day.
• Nausea or vomiting is accompanied by fever, sweating, or fatigue.
• You can't keep solids or liquids down

Seek emergency care for nausea if:

• Nausea is accompanied by sharp pain.
• You're vomiting blood or oddly colored discharge.
• You're experiencing high fever or blurred vision.
• You're finding it hard to breathe.
• You experience fainting or loss of consciousness.

Summary

Nausea and vomiting with diabetes can occur for several reasons, but it can also be managed when these causes are kept in check. Keep working with your healthcare professional to address the diabetes-related causes of your nausea and to develop a long-term and everyday management plan.

A Word From Verywell

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