Dizziness and Diabetes

Dizziness and Diabetes

Summary

Dizziness is a disorientating sensation that often leads to a loss of balance. Almost everyone has felt dizzy or lightheaded at some point. Feelings of dizziness can be attributed to minor factors, such as excess consumption of caffeine or having blood drawn, as well as more serious underlying factors, such as diabetes and some other endocrine disorders.

Dizziness is related to the body’s sense of balance. Maintaining a sense of balance or equilibrium depends on the central nervous system’s ability to process a variety of information from sensory systems including the inner ears, eyes and sensory receptors in skin, muscles and joints.

Dizziness occurs when these sensory systems malfunction or the brain cannot process their signals. Symptoms that often accompany dizziness include faintness, lightheadedness, nausea and visual difficulties.

Physicians typically associate four disorders with dizziness: vertigo, disequilibrium, presyncope and nonspecific dizziness. Individuals can often treat infrequent or minor episodes of dizziness by sitting or lying down and reducing consumption of stimulants such as caffeine and tobacco.

However, experts believe that if serious symptoms such as loss of consciousness occur, or if dizziness last more than a few days, patients should contact their physician immediately. The many potential causes of dizziness include dehydration, anemia, hypoglycemia, irregular blood pressure, heart conditions and stroke.

The physician will conduct a physical examination and may perform tests such as a glucose test. Treatment methods typically address the underlying cause of dizziness, rather than the dizziness itself.

About dizziness

Dizziness is a sensation of spatial disorientation that can lead to a loss of balance. The term dizzy is frequently used to describe feelings of weakness, faintness and lightheadedness. Dizziness may also be accompanied by any combination of the following symptoms:

  • Unsteadiness, wooziness or giddiness
  • Nausea
  • Sweating
  • Headache
  • Visual difficulties
  • Confusion or poor concentration
  • Fatigue

Dizziness is related to the body’s sense of balance or equilibrium. Maintaining a sense of balance depends on the ability of the central nervous system (composed of the brain and spinal cord) to process a variety of information from sensory systems including:

  • Vestibular system. The inner ears monitor directions of motion, such as turning, up and down, forward and backward and side-to-side movements.
  • Visual system. The eyes monitor the body’s position in space, such as right side up or upside down, as well as directions of motion.
  • Proprioceptive system. Sensory receptors in the skin, muscles, ligaments and joints provide awareness of the position and movement of the parts of the body. This sense is known as proprioception.

Balance relies on functioning of at least two of these sensory systems. For instance, individuals can close their eyes while washing their hair in the shower without losing their balance. This is because signals from the sensory nerves and inner ear help ensure that a person remains upright.  

Dizziness and loss of balance can also result when:

  • The brain is unable to process signals from the sensory systems
  • The messages sent by the sensory systems are contradictory

Dizziness typically occurs while moving the head, standing or walking, and the sensation may be alleviated by sitting or lying down. Most causes of dizziness are not critical, and the condition, which often dissipates on its own, is often easily treated.

Physicians generally associate four disorders with dizziness:

  • Vertigo. The patient feels as though the surrounding environment is moving, or experiences a sensation of spinning or falling. Vertigo is frequently accompanied by nausea and vomiting. The two types of vertigo are:
    • Peripheral. Vertigo caused by a problem in the vestibular labyrinth, the part of the inner ear that controls balance.
    • Central. Vertigo caused by an abnormality of the brain, particularly in the cerebellum (lower back section of the brain) or brainstem.

  • Disequilibrium. Disequilibrium is described as a sense of imbalance or a feeling that a fall is imminent. This sensation, which typically involves the legs rather than the upper torso and head, occurs most often while the patient is standing and can be alleviated by sitting or lying down.
  • Presyncope. People who experience presyncope feel as though they are about to faint. This sensation may begin with ringing in the ears (tinnitus) or diminished vision.
  • Nonspecific dizziness. This term is given to vague sensations of lightheadedness or wooziness that cannot be identified as vertigo, disequilibrium or presyncope.

Experts recommend that individuals experiencing dizziness need to be careful not to injure themselves or others, and should avoid participating in potentially dangerous activities, such as driving a car or operating heavy machinery.

Potential causes of dizziness

Vertigo, disequilibrium, presyncope and nonspecific dizziness may result from various underlying conditions, including diabetes. Dizziness is a common symptom of diabetic complications, including:

  • Hypoglycemia (lowblood glucose) or insulin shock
  • Diabetic neuropathy (nerve damage), including autonomic neuropathy, which can cause postural hypotension, and peripheral neuropathy, which can cause numbness and weakness in the legs
  • Cardiovascular diseases (disorders that affect the heart and blood vessels), such as:
    • High blood pressure (hypertension)
    • Low blood pressure (hypotension)
    • Heart attack
    • Stroke or transient ischemic attack (“mini-stroke”)
    • Arrhythmia (an irregular heart rhythm)
    • Sudden cardiac death (abrupt cessation of the heart)
    • Valvular heart diseases (abnormality or dysfunction of the heart’s valves)
    • Cardiomyopathy (enlargement or stiffening of heart muscle)
    • Heart failure
    • Dehydration or hyperosmolar hyperglycemic nonketotic syndrome

In addition to diabetes, dizziness can also result from other endocrine disorders, such as Addison’s disease, acromegaly or thyroid dysfunction, including a serious, advanced form of hypothyroidism called myxedema.

Other causes of dizziness may include:

  • Inner-ear disorders, such as benign paroxysmal positional vertigo (BPPV), acute labyrinthitis and Meniere’s disease
  • Anemia (insufficient number of red blood cells)
  • Heat stroke
  • Many medications, including antihypertensives, anesthetics, diet pills and some birth control pills
  • Drug abuse or withdrawal
  • Anxiety, panic attacks or other mental disorders
  • Migraines or other headaches
  • Concussion
  • Nervous system disorders (e.g., Parkinson’s disease)
  • Aging
  • Pregnancy or preeclampsia
  • Menopause
  • Arthritis in the neck
  • Shock
  • Seizures
  • Hyperventilation
  • High altitudes (typically above 5,000 feet)
  • Strenuous coughing
  • Fright (vasovagal episodes)
  • Having blood drawn
  • Excess consumption of caffeine or alcohol
  • Excessive stomach acid or indigestion
  • Food poisoning
  • Usher syndrome (a genetic condition that impairs hearing and vision)

Diagnosis methods for dizziness

Individuals who experience dizziness are generally advised to sit or lie down immediately and wait for the sensation to pass. They should avoid the use of caffeine, alcohol and tobacco, which can worsen symptoms, and refrain from operating motor vehicles and other heavy machinery.

A physician should be contacted immediately if any of the following occur:

  • The person loses consciousness.
  • Vision, hearing or speech are impaired or lost.
  • There are symptoms such as chest pain, tingling, numbness or weakness in a limb.
  • The room appears to spin.
  • Dizziness interferes with daily activities.
  • Lightheadedness lasts for more than a few days.
  • Dizziness occurs after taking a certain medication.

Diagnosing dizziness begins with a medical provider taking a medical history and performing a physical examination. The physician will examine the patient’s eyes, ears and reflexes, and attempt to pinpoint the nature of the dizziness by asking questions such as:

  • When did the dizziness begin?
  • How often does the dizziness occur?
  • Is the dizziness accompanied by other symptoms, such as fainting, nausea or vomiting?
  • Does the patient feel as though the room is spinning?
  • Is the dizziness interfering with activities?

The physician may recommend additional tests, such as:

  • Glucose test. A blood test that identifies abnormal levels of glucose (blood sugar).
  • Other blood work, such as a complete blood count or thyroid blood test.
  • Hearing tests. Identify hearing deficiencies.
  • Cranial CAT scan (computed axial tomography). A type of x-ray test that can identify stroke and brain tumor.
  • Cranial MRI (magnetic resonance imaging). Uses magnets and radio waves to produce images of brain tissues.
  • Electroencephalogram (EEG). Measures brain waves.
  • Echocardiogram. Produces ultrasound images of the heart.
  • Electrocardiogram (EKG or ECG). Monitors the heart’s electrical activity.
  • Electronystagmogram (ENG). Detects damage to the inner ear and abnormal eye movements.
  • Holter monitor. Instrument worn by the patient records the heart’s electrical activity for 24 consecutive hours.

Treatment options for dizziness

Treatment of dizziness is directed at its cause. For instance, people with diabetes who have hypoglycemia (low blood glucose) may alleviate dizziness by drinking fruit juice or consuming a sugary snack, as advised by their physician. Those with anemia may require a blood transfusion to increase their red blood cells. Patients with anxiety may benefit from medication and counseling.

Patients with certain forms of vertigo, such as benign paroxysmal positional vertigo (BPPV), may be instructed in body positioning techniques and exercises they can perform at home to control dizziness. These techniques include the modified Epley procedure (MEP) and modified Semont maneuver (MSM). They involve briefly placing the head and body in certain specific positions to reduce or halt symptoms. These maneuvers work by helping remove debris from the ear’s sensitive posterior canal.

Individuals with severe cases of dizziness, such as those caused by Meniere’s disease, may require surgery to alleviate symptoms.

Almost everyone who experiences dizziness will eventually recover. However, individuals with rare cases of chronic dizziness may benefit from medical intervention. 

Questions for your doctor regarding dizziness

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about dizziness:

  1. At what point does my dizziness require medical attention?
  2. Is my dizziness a sign of diabetes, hypoglycemia or some other condition?
  3. What are other causes of dizziness that could be related to my complaints?
  4. What diagnostic tests might I need to undergo, and what do they involve?
  5. What do my test results show?
  6. What are my treatment options?
  7. Should I avoid driving or other activities?
  8. How soon do you expect my dizziness to resolve?
  9. What choices are there if my dizziness becomes chronic?
  10. Can techniques such as the modified Epley procedure control my vertigo? If so, how do I perform this?
  11. Can I do anything to prevent dizziness?
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