Nausea can be a symptom of many diseases, either as a primary symptom, a complication arising from the disease, or caused by treatment strategies. With type 2 diabetes, there are a number of factors that can result in nausea. In this article, we'll look at the ways in which your diabetes diagnosis may be contributing to your upset stomach and what you can do about it.
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Diabetes is a disease that disrupts the way the body uses sugar and is hallmarked by an excess of blood sugar. For someone without diabetes, when blood sugar levels get too high, insulin is released that tells the body to absorb the sugar and use it as energy or store it as fat.
In people with diabetes, this process is interrupted. There are two types of diabetes:
Type 1 diabetes occurs when the body doesn't produce enough insulin to process the sugar.
Type 2 diabetes usually develops later in life and is caused when the body becomes resistant to the effects of insulin. Although your body produces enough insulin, if you have type 2 diabetes, that insulin isn't working effectively enough in the body to process the sugar in your blood.
Having diabetes can result in an upset stomach. This could be a side effect of the disease or complications that arise because of it. For each cause, a list of causes, other symptoms, and treatments will be provided to help you narrow down what may be causing your nausea and help you determine what information may be useful for your doctor.
Diabetes reduces the amount of blood sugar that gets absorbed into the body to be used as energy. Diabetic ketoacidosis is a severe diabetes complication that results when the body is unable to use enough blood sugar and has to resort to using chemicals called 'ketones' for energy which then build up in the blood. It typically occurs with type 1 diabetes, whose body does not produce enough insulin. However, it can also occur with type 2 diabetes. Nausea and vomiting are among the symptoms of diabetic ketoacidosis.
Your body needs energy. When it doesn't have enough insulin or doesn't respond well enough to the insulin it has, it cannot get the energy it needs from blood sugar, as this sugar is unable to be taken into the cells to be used for energy. Instead, it must rely on breaking down fat for fuel instead of carbs.
This produces ketones, some of which are acidic. When too many ketones build up too quickly, it can be dangerous.
Medical conditions such as heart attacks, strokes, or physical injuries may increase the chance of ketoacidosis, as can alcohol, illegal drugs, certain medications, or inadequate or inappropriate insulin therapy.
Before nausea kicks in, early signs of diabetic ketoacidosis include extreme thirst or excessive urination. The condition develops slowly. As it does, more symptoms will occur. In addition to nausea, vomiting, and abdominal pain, these include:
Quickened, deeper breathing
Flushing of the face
Diabetic ketoacidosis is treated in the hospital. Because excessive urination is one of the early signs of the condition, doctors will replace the fluids and electrolytes that you've lost. This process will also help to dilute the excess blood sugar that's built up in your body as a result of not having enough insulin.
You'll be given insulin so that your body can begin processing the blood sugar that it has instead of relying on burning ketone-producing fat for fuel. If the ketoacidosis was caused by a medical condition, you'd be treated for the underlying cause as well.
People with diabetes are more likely to develop gastroparesis, another condition that can cause nausea. Diabetes is the most frequent systemic disease causing gastroparesis. During digestion, your stomach muscles break up food and push it into the intestines for further processing.
People with gastroparesis have stomachs that take too long to empty and don't move the food along the body to the intestines fast enough. Food stays in the stomach much longer than it should.
Digestion in your stomach is controlled by the vagus nerve, along with a number of cells known as pacemaker cells. One of the effects of diabetes on the body is to affect the vagus nerve, causing reduced gastric tone and pylorospasm, among other things. This is due to direct glucose toxicity, and impaired postprandial release of hormones and leads to slow emptying of solids.
The symptoms of gastroparesis are what you may expect from having a stomach that doesn't empty quickly enough. You may feel full sooner than normal while eating or for a longer time after eating. You may find that you aren't hungry as often as you should be, that you're unusually bloated, or that you belch frequently. In addition to nausea and vomiting, you may feel heartburn or pain in the upper abdomen.
For diabetics, getting their blood sugar under control is an important step in treating gastroparesis. Your doctor might also recommend that you change your diet to ensure you're getting the essential nutrients for proper digestive function.
The amount or timing of your insulin schedule may also be changed to accommodate the condition. Nausea and other discomforts can be reduced with medicine. You'd also likely be prescribed a prokinetic agent, which is a medication designed to help increase stomach motility.
While ketoacidosis is the result of very high blood sugar and an excess of ketones, the diabetic hyperglycemic hyperosmolar syndrome is a complication of diabetes that involves very high blood sugar without the ketones.
Hyperglycemic hyperosmolar syndrome is caused when you have extremely high blood sugar and are not getting enough water. When blood sugar levels get too high, the kidneys try to release glucose through urination. This causes you to urinate more than you normally would. Without enough water to compensate, your kidneys are unable to remove enough of the glucose.
In the early stages of the syndrome, you'll notice an increase in urination and, as your body tries to compensate, an increase in thirst. Along with the thirst, you may experience a dry throat or dry mouth.
Other symptoms include:
The goal of treating hyperglycemic hyperosmolar syndrome is to reduce blood sugar levels and increase fluids in the body. This is accomplished through the use of intravenous (IV) fluids and insulin.
The examples above have all been the result of the condition itself or from complications that may arise as a result of the condition. However, sometimes the treatment for your type 2 diabetes can also give you nausea. Let's look at some of the ways that can happen.
Diabetes causes hyperglycemia – high blood sugar. However, the treatment of diabetes requires taking medications, such as insulin, that are designed to lower your blood sugar levels. This requires a careful balancing act to ensure your blood levels don't go too low. When they go lower than they should, it's known as hypoglycemia. One of the symptoms of hypoglycemia is nausea.
Hypoglycemia is more common in people with type 1 diabetes, though those with type 2 can also have blood sugar levels that are too low. There are a couple of causes of these drops in blood sugar. As we've already seen, a common cause is the insulin medication, by either:
Taking too much
Injecting it the wrong way
Taking the wrong type
As a diabetic, you'll need to be careful about your carbohydrate intake. Most people know that diabetics need to be careful not to eat too many carbs, but they must also be careful about not getting enough. This mostly goes back to the insulin.
Your insulin dose will be calibrated to a certain carbohydrate intake, so eating significantly fewer carbs than usual equates to taking too much insulin, and it will lower your blood sugar. The proportion of fat, protein, carbs, and other nutrients in your food can also affect how well your body absorbs carbs.
The American Diabetes Association lists several other symptoms associated with low blood sugar. They caution that everyone responds differently to hypoglycemia and that you should document how your body reacts when your blood sugar gets too low. The list is presented in order of severity:
Lack of energy
Low blood sugar is treated by consuming more carbohydrates. Doctors will typically recommend that you consume 15–20g of fast-acting carbohydrates, wait 15 minutes for the food to enter your bloodstream, and then measure your blood sugar levels again. The goal is to get your blood sugar levels to 70mg/dL or higher.
If your blood sugar is lower than that after the 15-minute wait, repeat the process until the levels normalize, followed by a long-acting carbohydrate, i.e., a meal or a snack.
Several medications used in the treatment of diabetes may have side effects that result in nausea. If you experience an upset stomach while taking one of these medications, inform your doctor as soon as possible. For some of them, nausea may go away after time.
In other instances, the doctor might recommend a different medicine. The diabetes medications below are known to cause nausea in some patients:
Metformin: One of the first drugs doctors use in the treatment of diabetes, Metformin helps the body reduce the amount of glucose the liver produces as well as works to increase insulin response.
Sulfonylureas: This is a class of drugs that dates back to the 1950s. Sulfonylureas¹ work by stimulating insulin production within the body. They are often used in conjunction with Metformin.
Exenatide: This drug belongs to a class known as short-acting GLP-1 receptor agonists. Exenatide² is an injectable drug that, much like sulfonylureas, works to increase insulin production in the body.
Liraglutide: Another injectable drug, liraglutide, is from a class of drugs known as incretin mimetics, i.e., a longer-acting GLP-1 receptor agonist. It works by helping the pancreas release the increased amounts of insulin in response to blood sugar levels.
Alogliptin: Taken in pill form and from a class of drugs called DDP-4 inhibitors, alogliptin also works by increasing the amount of insulin secreted in the body.
SGLT2 inhibitors: This newer class of drug includes canagliflozin, dapagliflozin, and empagliflozin. These drugs cause the kidneys to release more glucose through urination.
There are a number of artificial sweeteners out there. Sugar alcohols, such as xylitol and erythritol, are among the most common. These substances provide the sweetness sugar does, but with fewer calories and without the spike in blood sugar. This makes them an ideal candidate for diabetics who still have a sweet tooth.
You'll often find these ingredients in products labeled 'sugar-free' or on their own as a direct replacement for sugar.
Although an early study showed no signs of nausea from the use of sugar alcohols, later studies³ have shown that some people do experience an upset stomach when consuming them. Diarrhea was another common complaint from the intake of sugar alcohols.
If you've begun to experience nausea shortly after adding sugar alcohols to your diet, discontinuing their use can be a good way to rule them out as a culprit.
As we've seen, there are quite a few reasons you may be experiencing nausea after you've been diagnosed with type 2 diabetes. If you are experiencing frequent nausea, tell your doctor so they can help you find the cause and treatment.
If any of the information you've read here seems applicable to you, make some notes to share what you've learned with your physician.
Sulfonylureas | StatPearls
Exenatide | StatPearls
Gastrointestinal disturbances associated with the consumption of sugar alcohols with special consideration of xylitol: Scientific review and instructions for dentists and other health-care professionals (2016)
Type 2 diabetes | Center for Disease Control and Prevention
Diabetic ketoacidosis | Center for Disease Control and Prevention
Definition & facts for gastroparesis | National Institute of Diabetes and Digestive and Kidney Diseases
Hypoglycemia (Low blood sugar) | American Diabetes Association
High-intensity sweeteners | U.S. Food and Drug