Dizziness in Type 2 Diabetes: Not Just a Symptom, but an Important Signal
Dizziness (vertigo) is a common and alarming symptom in people with type 2 diabetes. It is not a separate disease, but an important indicator that may point to both acute and chronic complications of diabetes. Ignoring it is dangerous, as it can lead to falls, injuries, and a deterioration in overall health.
Why does dizziness occur in diabetes? Main causes
The causes can be divided into two main groups: those related to fluctuations in blood glucose levels and those associated with diabetes complications.
1. Direct consequences of abnormal blood glucose levels
• Hypoglycemia (low blood sugar) — a VERY COMMON cause.
This condition occurs when blood glucose falls below 3.9 mmol/L. The brain, the main consumer of glucose, begins to “starve.” Dizziness is one of the earliest and most prominent symptoms.
Associated symptoms: severe weakness, trembling, sweating, paleness, hunger, confusion, rapid heartbeat.
Causes in people with diabetes: overdose of insulin or glucose-lowering tablets, skipping meals, unusual physical exertion, alcohol intake.
• Hyperglycemia (high blood sugar), especially a rapid rise.
At very high levels (often above 13–15 mmol/L), the blood becomes thicker and microcirculation is impaired, including in cerebral vessels. This can cause a feeling of “fog,” lightheadedness, and instability.
Associated symptoms: intense thirst, dry mouth, frequent urination, weakness, nausea.
Dangerous condition: if hyperglycemia progresses, it can develop into diabetic ketoacidosis (DKA) or a hyperosmolar state, in which dizziness progresses to confusion and coma.
2. Diabetes complications that lead to dizziness
• Arterial hypertension (high blood pressure).
Diabetes and hypertension often go hand in hand. A sudden rise in blood pressure (hypertensive crisis) is often accompanied by severe dizziness, headache, and ringing in the ears.
• Hypotension (low blood pressure), especially orthostatic hypotension.
This is a condition in which blood pressure drops sharply when standing up from a sitting or lying position.
Cause in diabetes: autonomic neuropathy — damage to the nerves that control vascular tone and heart rate. Blood vessels do not constrict quickly enough, blood “drains” from the head, causing visual darkening, dizziness, and even fainting.
• Diabetic neuropathy (peripheral and vestibular).
Nerve damage may affect not only the legs, but also the nerves responsible for transmitting signals from the vestibular system (the organ of balance) to the brain. This causes a feeling of unsteadiness, spinning, or motion sickness.
• Cardiovascular diseases.
Atherosclerosis, coronary artery disease, and heart rhythm disorders (arrhythmias) can impair cerebral blood supply, manifesting as dizziness during physical exertion or stress.
• Dehydration.
Chronically high blood sugar causes fluid loss through urine. Dehydration reduces blood volume and lowers blood pressure, leading to dizziness.
• Medication side effects.
Some glucose-lowering drugs (especially at the start of treatment) and blood pressure medications may cause dizziness as a side effect.
What to do if dizziness occurs? Action algorithm
1. IMMEDIATELY measure your blood glucose level.
This is the first and most important step. It immediately determines further actions.
If the level is low (hypoglycemia):
Immediately take 15–20 grams of fast-acting carbohydrates: 3–4 sugar cubes, 150 ml of fruit juice or a sweet drink (not “diet”!), or 2–3 glucose tablets.
Recheck blood sugar after 15 minutes. If it has not risen above 4.0 mmol/L, repeat intake.
After normalization, eat complex carbohydrates (a slice of bread, an apple) to maintain the level.
If the level is high (hyperglycemia):
Drink sufficient amounts of sugar-free water.
Check for ketones in the urine (using test strips) if you are prone to ketoacidosis.
Contact your doctor to adjust therapy.
2. If blood sugar is normal, act according to the situation:
If dizziness occurs when standing up: rise slowly and in stages — first sit on the bed, sit for a minute, then stand up slowly while holding onto support.
Measure blood pressure at rest and during symptoms.
Sit down or lie down to avoid falling. Ensure fresh air.
Drink water.
When should you seek URGENT medical attention?
Seek immediate medical help if dizziness:
Is severe and does not resolve at rest.
Is accompanied by numbness or weakness in the face, arm, or leg, speech disturbances, or a sudden severe headache (signs of stroke).
Is accompanied by chest pain, shortness of breath, or strong palpitations (signs of a heart attack).
Occurs with confusion, vomiting, or high fever.
Appears after a head injury.
Repeats regularly, even with normal blood sugar readings.
Prevention and treatment
Treatment focuses on eliminating the cause, not the symptom:
Achieving and maintaining target blood glucose levels — the basis for preventing all complications, including neuropathy and angiopathy.
Control of blood pressure and cholesterol levels.
Regular follow-ups with an endocrinologist, cardiologist, and neurologist.
Adequate hydration.
Treatment of neuropathy: the doctor may prescribe alpha-lipoic acid preparations, B-group vitamins, and medications for neuropathic pain (gabapentin, etc.).
Therapeutic exercise and vestibular rehabilitation (for neurogenic dizziness).
Conclusion
Dizziness in type 2 diabetes is a serious warning signal that requires immediate analysis of the situation. Always check your blood glucose level first. Persistent or recurrent dizziness is a direct indication that your diabetes management plan needs to be reviewed and optimized together with your healthcare provider. Careful attention to this symptom can help prevent severe consequences.