“Dizzy, I’m so dizzy, my head is spinnin;’ like a whirlpool it never ends,” sang Tommy Roe, a pop singer back in 1969. The tune is catchy, for sure, but if you suffer from dizziness, you’re not exactly up to dancing or doing much of anything. Dizziness is one of the most common reasons that people visit their providers, and according to Timothy Hain, MD, it affects about 15% of the population. Medical literature estimates the incidence of dizziness ranges from between 10% and 40% of people over the age of 65. Perhaps not surprisingly, people who have diabetes may be more prone to having dizziness compared with people without diabetes. But what causes dizziness and are there ways to prevent it?
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What is dizziness?
Dizziness is the sensation of feeling lightheaded, woozy or disoriented. You may also feel weak or unsteady when you’re dizzy. Standing up, walking or moving your head can bring on symptoms of dizziness, and you may even feel nauseated. Dizziness that comes on quickly or that is severe may force you to sit or lie down.
Dizziness, in and of itself is not a disease; rather, it’s a symptom of any number of disorders. In case you’re wondering, vertigo is different than dizziness, although it can cause it. Vertigo is a sudden sensation of spinning or feeling of being off balance. It may also feel like things are moving when they’re not.
Causes of dizziness
Dizziness can occur due to a number of conditions and factors. These include:
· Inner ear disorders: Meniere’s disease, benign paroxysmal vertigo (BPPV), infection
· Brain-related conditions: head or brain injury, migraine, multiple sclerosis
· Heart and vascular conditions: poor circulation, low blood pressure, arrhythmia, stroke
· Psychogenic disorders: anxiety, depression, panic disorder, hyperventilation, agoraphobia
· Alcohol use
· Medications: anti-seizure drugs, antidepressants, blood pressure drugs
· Vision problems
· Carbon monoxide poisoning
· Iron-deficiency anemia
Dizziness in diabetes
If you have diabetes, you may be prone to having episodes of dizziness as a result of several factors.
The American Diabetes Association defines hypoglycemia (low blood sugar) as a blood sugar that is less than 70 mg/dl. Blood sugar can drop due to taking too much diabetes medicine (insulin or certain types of diabetes pills), not eating enough carbohydrate, skipping or delaying meals, or doing unplanned physical activity. Common symptoms of hypoglycemia are:
· Feeling shaky
· Feeling anxious or irritable
· Fast heartbeat
· Blurred vision
· Feeling lightheaded or dizzy
You may not have all of these symptoms if your blood sugar drops too low. But if dizziness does occur, it’s because the brain does not have enough glucose to function properly. Once you treat hypoglycemia with a form of glucose, such as glucose tablets or gel, juice or regular soda, the dizziness should subside, as well as any other symptoms you may have.
Otherwise known as high blood sugar, hyperglycemia is when blood sugar is above 130 mg/dl fasting and before meals, or greater than 180 mg/dl two hours after a meal. High blood sugar can result from eating too much carbohydrate, not doing your usual amount of physical activity, illness, or skipping or not taking enough diabetes medication. Symptom of hyperglycemia generally don’t occur until the blood sugar level is about 240 mg/dl or higher, and include:
· Increased thirst and/or hunger
· Frequent urination
· Blurry vision
· Weight loss
· Cuts that are slow to heal
Dizziness associated with hyperglycemia can result from dehydration and other effects of high glucose levels. Treatment of hyperglycemia includes taking diabetes medication as prescribed, staying hydrated, following an eating plan, and staying physically active.
Low blood pressure
Also called hypotension, low blood pressure is generally considered to be a reading of lower than 90 over 60. Some people feel fine when their blood pressure is on the lower side, but a blood pressure that is too low can be life-threatening. The blood pressure goal for most people with diabetes is less than 140/90 or possibly less than 130/80 if the person is at higher risk for heart disease. Some people have orthostatic (postural) hypotension, which is low blood pressure that happens when going from a sitting to a standing position. Symptoms of low blood pressure include:
· Dizziness or lightheadedness
· Blurry vision
· Weak and rapid pulse
· Cold, clammy skin
Dizziness happens because the brain is deprived of enough blood. Treatment of low blood pressure may include decreasing the amount of high blood pressure medication or taking medication to prevent low blood pressure, drinking more water, possibly increasing the amount of sodium in the diet, and wearing compression stockings. If low blood pressure is recurrent, your provider will need to determine the underlying cause. Examples include heart problems, infection, low thyroid, allergic reaction and nutritional deficiencies.
Certain medications that many people with diabetes take may cause dizziness. These include:
· Blood pressure-lowering medications (e.g., ACE inhibitors, beta blockers, calcium channel blockers, diuretics)
· Some antibiotics (e.g., ciprofloxacin, erythromycin)
· Some antifungals (e.g., fluconazole, amphotericin B)
· Pain-relievers for neuropathy (e.g., amitriptyline, duloxetine, pregabalin)
· Prescription non-steroidal anti-inflammatory drugs (e.g., celecoxib, indomethacin)
· Antidepressants (e.g., fluoxetine, trazodone)
· Sleeping pills (e.g., diphenhydramine, temazepam, eszopiclone)
In addition, a class of diabetes medications called SGLT2 inhibitors may cause dizziness by lowering blood pressure. Sulfonylureas, such as glipizide, glyburide and glimepiride, can cause dizziness, too. This may be a good thing in those with high blood pressure, but is concerning if you don’t have high blood pressure or if you are taking medication to lower your blood pressure.
If you think any of your medications may be causing dizziness, talk with your healthcare provider before stopping them.
Peripheral neuropathy results from damage to the peripheral nervous system which includes the network of nerves outside of the brain and the spinal cord. Injury, infection, cancer and exposure to toxins can cause peripheral neuropathy, but one of the most common causes is chronic high blood sugar due to diabetes. Sensory nerves (those that control sensation from temperature, pain, vibration or touch), motor nerves that control movement, and autonomic nerves that control blood pressure, heart rate and digestion can all be affected. Symptoms of peripheral neuropathy will vary, depending on which nerves are impacted, but may include:
· Numbness or tingling in the hands and feet
· Sharp stabbing or burning pain
· Lack of coordination
· Muscle weakness
· Excess sweating or not being able to sweat
· Digestive problems
· Bladder problems
Dizziness from peripheral neuropathy may result from changes in blood pressure and can lead to a loss of balance and frequent falls. Treatment of peripheral neuropathy may involve medication to reduce symptoms, as well as transcutaneous electrical nerve stimulation (TENS), physical therapy, plasma exchange and surgery to reduce the pressure on nerves. Aiming to get and keep your blood sugar and A1C levels within your target range is key part of preventing and slowing the progression of peripheral neuropathy.
The vestibular system involves the inner ear and brain to control balance and eye movements. A disorder of the system can lead to:
· Vision disturbance
· Loss of balance
· Hearing changes
A study published in the journal Clinical Diabetes in 2014 showed that vestibular dysfunction “is present in a high percentage of people with diabetes.” The 2001-2004 U.S. NHANES study showed that having diabetes increased the risk of vestibular dysfunction and it was found in 54% of people with diabetes, compared with 33% of those without diabetes. Treatment of vestibular dysfunction can include medication, repositioning maneuvers, exercises for eye and head stabilization, and, less frequently, surgery.
Having occasional dizziness may not be concerning. But if it is recurrent, sudden, severe or prolonged, be sure to see your healthcare provider. Also, if dizziness occurs along with any of the following symptoms, seek immediate medical care:
· Chest pain
· Sudden, severe headache
· Difficulty breathing
· Numbness or paralysis of the face, arms or legs
· Rapid or irregular heartbeat
· Confusion or slurred speech
· Trouble walking
· Double vision
· Ongoing vomiting
Want to learn about avoiding falls with diabetes? Read “Preventing Falls.”