Is nausea a symptom of diabetes?

In this article:

• Diabetes and nausea
• Nausea from medications
• Nausea management
• The bottom line

In this article

• Diabetes and nausea
• Nausea from medications
• Nausea management
• The bottom line

Diabetes mellitus is a chronic condition that causes high blood sugar levels. As the body struggles to control elevated blood glucose, you may experience increased thirst, frequent urination, and fatigue. Vision changes, dehydration, and slow-healing sores can also occur. 

Although it’s not a direct cause of diabetes, nausea can occur due to blood sugar fluctuations and other diabetes complications. Here’s what to know about diabetes-related nausea, including why it happens and how to prevent and treat it.

Does diabetes cause nausea?

“Yes, nausea can be a sign of diabetes, but it’s not one of the most common symptoms like frequent urination or excessive thirst,” says Raj Dasgupta, MD, internist and program director at Huntington Health Hospital in California. It often shows up when blood sugar levels are either too high or too low, when complications from diabetes arise, or when you’re experiencing side effects from your diabetes medication.

If you’re experiencing nausea and you have diabetes, David Nazarian, MD, a board-certified internist at My Concierge MD in Beverly Hills, California, recommends checking your blood glucose levels and consulting your healthcare provider. They can help figure out which of the following is causing your nausea and how to treat it.

Hypoglycemia

Hypoglycemia is a severe drop in blood sugar (defined as less than 70 mg/dL). “Fluctuations in blood sugar are common with diabetes, and hypoglycemia is particularly common in people who take diabetes medications that lower blood glucose, such as insulin, thiazolidinediones, or sulfonylureas,” explains Jennie Stanford, MD, a double board-certified family and obesity medicine physician and medical contributor for Drugwatch.

Low blood sugar triggers a stress response in the body, releasing hormones like adrenaline and causing a range of side effects. In addition to nausea, hypoglycemia can lead to symptoms like:

• Fatigue
• Sweating
• Shakiness
• Fast heartbeat
• Lightheadedness
• Blurred vision

Dr. Stanford adds that if glucose levels aren’t corrected quickly, complications like loss of consciousness, coma, and seizures can occur.

Hyperglycemia

Hyperglycemia, or high blood sugar levels, happens when the body doesn’t produce enough insulin or isn’t using insulin efficiently, causing sugar to build up in the blood. It is defined as fasting blood glucose greater than 125 mg/dL or 180 mg/dL two hours after a meal. It’s typically caused by eating too many carbohydrates, not getting enough physical activity, and being stressed or sick. Dr. Dasgupta says that hyperglycemia can cause dehydration, which can result in nausea.

According to the American Diabetes Association, symptoms of hyperglycemia include:

• High blood glucose levels
• High levels of glucose in the urine
• Frequent urination
• Increased thirst

Diabetic ketoacidosis

Untreated hyperglycemia causes diabetic ketoacidosis, a serious and potentially life-threatening condition that happens when there’s not enough insulin in the body, so glucose can’t be broken down for fuel. Instead, fat is broken down for energy, resulting in acidic waste products called ketones, which accumulate in the blood. Dr. Dasgupta says this can make you feel sick to your stomach.

Early warning signs of diabetic ketoacidosis include:

• Increased thirst and urination
• Vomiting
• Stomach pain
• Weakness and fatigue
• Shortness of breath
• Fruity-scented breath
• Confusion

The condition is typically seen in individuals with Type 1 diabetes but can occur in those with Type 2 diabetes due to increased stress, illness, poorly managed diabetes, or insufficient insulin.

Gastroparesis

Diabetic gastroparesis occurs as a result of nerve damage (neuropathy) in the gut caused by poorly controlled blood sugar levels over time. “The result is that the stomach is unable to empty, or is paralyzed, according to the term ‘paresis,’” Dr. Stanford explains. The condition impairs the stomach’s ability to empty its contents (delayed stomach emptying), leading to nausea. In a study of 156 diabetic individuals with gastroparesis, 96% experienced nausea.

Other symptoms of gastroparesis include:

• Vomiting
• Early satiety (feeling full after eating a small amount)
• Postprandial fullness (feeling uncomfortably full after a normal-sized meal)
• Heartburn
• Gas and bloating

Pancreatitis

The pancreas is an organ in the abdomen that produces hormones like glucagon and insulin to maintain healthy blood sugar levels. In people with diabetes, the pancreas struggles to keep up with insulin production, ultimately leading to cell damage. As a result, individuals with Type 2 diabetes are at increased risk of developing pancreatitis (inflammation of the pancreas). Additionally, certain medications like glucagon-like peptide-1 receptor agonists (GLP-1s) can occasionally cause pancreatitis as a side effect.

In addition to nausea, pancreatitis causes the following symptoms:

• Abdominal pain
• Fever
• Rapid pulse
• Weight loss
• Swollen abdomen
• Diarrhea

Pancreatitis is a serious medical condition that requires immediate attention. If you experience these symptoms, consult a healthcare professional immediately for medical advice.

RELATED: Your guide to diabetes complications

Diabetes medications

Diabetes medications can trigger nausea, too. A study of 130 Japanese patients found that being female, having diabetic retinopathy, and taking glucagon‐like peptide‐1 receptor agonists in combination with proton pump inhibitors (PPIs) or histamine‐2 receptor antagonists (H2RAs) correlated with a higher incidence of nausea.

Certain diabetes medications are known to cause nausea, especially when you first start taking them. Medications like metformin or injectable GLP-1 receptor agonists like Ozempic and Mounjaro affect how your stomach works or how your body uses sugar, which sometimes leads to an upset stomach.

If you’re experiencing nausea from metformin, Dr. Stanford suggests taking it with food. For persistent cases, consult your healthcare provider. They can advise you on lowering your dose,  suggest alternative medications, or recommend nausea-reducing strategies.

RELATED: Why does Ozempic cause nausea?

Managing nausea with diabetes

Managing nausea with diabetes often involves a combination of dietary strategies, medication, and lifestyle adjustments. Dr. Dasgupta emphasizes determining the root cause first. “If your nausea is from low blood sugar, eating something with quick carbs (like juice or a snack) can help. If high blood sugar is causing it, sticking to your medication and diet plan can make a big difference,” he says, and If you have gastroparesis, eating smaller, more frequent meals can help.

Here are tips for managing or preventing nausea if you have diabetes:

• Regularly monitor your blood sugar levels to avoid highs and lows.
• Take your medication with food to reduce gastrointestinal discomfort.
• Stay hydrated to prevent dehydration, which can cause nausea.
• Eat many small meals instead of three big ones.
• Avoid trigger foods like spicy, greasy foods. Instead, choose bland foods like crackers, rice, bananas, and toast when you’re feeling nauseous.
• Practice stress-reduction techniques like deep breathing or gentle yoga to avoid nausea from stress.
• Sip on unsweetened ginger or peppermint tea to settle your stomach.
• Consult a provider about prescription antinausea medications like Zofran (ondansetron) and Reglan (metoclopramide).

RELATED: 28 nausea medications and remedies

The bottom line

While nausea isn’t usually a direct symptom of diabetes, it can be related to blood sugar fluctuations and complications of diabetes. To navigate your symptoms, Dr. Nazarian urges communicating with your healthcare provider. “We can help determine the underlying cause and recommend appropriate treatment strategies. By working together, we can effectively manage your symptoms and improve your overall well-being.”