Diabetes and abnormal sweating: What is the connection?

[young man outside with heat exhaustion]

Jennifer Huizen | Medical News Today

Many people with diabetes will experience times when they sweat too much, too little, or at odd times.

Diabetes-related nervous system damage and low blood sugars cause these commonly experienced sweating conditions in people with diabetes.

Sweating complications can be a sign of poor diabetes management. Maintaining healthy blood sugar levels is crucial to both prevention and treatment.

Diabetes and sweating problems

People sweat for a variety of reasons. Some of these reasons are normal and some are not.

Sweating is a natural response to physical and emotional stress. But excessive sweating, when the reason is unclear, is often a sign that something is not right. Some people with sweating conditions will sweat even on a cold day or during minimal activity.

Low blood sugar levels and diabetes-related nervous system damage cause the most commonly experienced sweating conditions in people with diabetes.

Extremely low blood sugars cause a fight-or-flight response, triggering the release of hormones that increase sweating.

When blood sugar levels are too high for too long, a loss of nerve function can occur. This condition is known as diabetic neuropathy. The American Diabetes Association (ADA) claim that around half of people with diabetes experience some form of neuropathy.

If the nerves that control the sweat glands are damaged, they may send the wrong message to sweat glands, or none at all. In most cases, neuropathies cause either excessive sweating or an inability to sweat.

Sweating caused by hypoglycemia

Hypoglycemia is a term to describe abnormally low blood sugar levels.

For most adults, blood glucose levels below 70 milligrams per deciliter are considered hypoglycemic. Individual targets can vary, however.

Many diabetes management medications, especially insulin, can cause dips in blood sugar levels when dosages are higher than sugar intake. Some people are also more sensitive to management medications, so recommended average doses are overdoses for them.

When blood sugars dip too low, the body takes action to raise levels. It releases the hormone epinephrine, better known as adrenaline. Adrenaline stimulates the release of glucagon, a form of glucose, from the liver.

The hormone also makes some tissues less sensitive to insulin to help keep glucose in circulation.

Adrenaline can cause varying side effects, including excessive or inappropriate sweating. Mild cases of hypoglycemia can cause tiredness, while severe cases can lead to coma and even death.

Common signs of hypoglycemia include:

  • anxiety

  • shakiness

  • sweating or chills

  • racing heartbeat

  • irritability, stubbornness, impatience

  • blurred or altered vision

  • tiredness or weakness

  • dizziness or lightheadedness

  • nausea

  • intense hunger pains or cramps

  • headache

  • lack of coordination or sudden clumsiness

  • anger or sadness

  • tingling in the tongue, lip, or mouth

  • nightmares

  • mild confusion

  • night sweats

If any of the above symptoms become severe, people should see a doctor immediately.

Hypoglycemia symptoms that require medical attention include:

  • intense confusion

  • loss of consciousness or going in and out of consciousness

  • lack of response to surroundings

  • seizures

Managing blood sugar levels is the best way to treat hypoglycemia. If hypoglycemia goes untreated the body can enter into a coma to preserve energy.

People with diabetes who experience hypoglycemic symptoms should test their blood glucose levels as soon as possible. If testing is not possible, it is usually better to treat symptoms than face possibly severe complications.

If hypoglycemia is detected, the ADA recommend consuming 15-20 grams of simple carbohydrates then retesting after 15 minutes. If the low levels continue, people should repeat the process until levels return to normal.

If unconsciousness occurs, a paramedic, doctor, or friend can administer glucagon injections. Foods, fluids, or insulin should be avoided until consciousness is restored. Most people recover within 5-15 minutes after the injection.

Excess sweating caused by neuropathies

When the body gets too warm, the nervous system signals the sweat glands to release sweat to cool it down.

In some people with diabetic nerve damage, the nerves that control sweat glands are, essentially, always “on.” This causes excess sweating known as hyperhidrosis.

People with diabetes-related hyperhidrosis experience symptoms that include:

  • excessive sweating even while doing minor chores or activity

  • excessive sweating while sleeping

  • sweating even when cold or in cold places

  • sweating even after trying to get warm by wearing extra clothing or seeking a heat source

Nervousness or stress can intensify the symptoms of hyperhidrosis, especially in people with diabetes.

Not every case of excessive sweating is caused by diabetes. Other common conditions that can cause excessive sweating include:

  • overactive thyroid glands

  • some forms of cancer

  • obesity

  • heart conditions

  • menopause and hot flashes

  • certain medications

  • infections

  • many infectious diseases

To confirm hyperhidrosis, a person will need to see a skin specialist. Laboratory and sweat tests are also necessary. Treatment options for hyperhidrosis include:

  • Clinical strength or prescription antiperspirants. Containing aluminum chloride at high doses, these medications block sweat pores. Skin irritation is the most common side effect.

  • Nerve-blocking medications. Often administered orally, these medications interfere with the nerve signals that stimulate the release of sweat. Dry mouth, bladder problems, dehydration, and blurred vision are common side effects.

  • Botox (Botulinum toxin) injections. Botox can block sweat-producing nerve signals. Side effects include short-term muscle weakness near the injection site and target area.

  • Certain antidepressants.

In extreme cases, surgery and electrical current therapy may be used.

Home therapy options for managing symptoms include:

  • keeping good body hygiene

  • changing socks daily or when they become sweaty

  • not wearing the same pair of shoes day after day

  • going barefoot when possible and making sure feet get air throughout the day

  • picking natural fabrics for clothing and shoes, such as cotton and leather that allow air movement

  • wearing materials that move moisture away from the body for exercise or intense activity

Excessive facial sweating caused by neuropathies

Gustatory sweating, or gustatory hyperhidrosis, is a term used to describe sweating on the face, scalp, neck, and, occasionally, the chest.

Sweating in these regions is normal after eating hot or spicy foods. For people with diabetes-related nerve problems, however, gustatory sweating can be excessive.

Most people with the condition will sweat and become red in the face while eating, regardless of the temperature or spiciness of foods. Some will even start to sweat simply by thinking about eating or food.

The most common places that people experience symptoms include:

  • forehead and temples

  • cheeks

  • lips

  • scalp

  • neck

  • chest

Treatment options for diabetes-related gustatory sweating are good blood sugar management, topical antiperspirants, and Botox injections.

Gustatory sweating can also be caused by damage or surgery to the glands that produce saliva. Over time, the combination of facial sweating and flushing can injure these glands, causing a condition known as Frey’s Syndrome.

Inability to sweat caused by neuropathies

Anhidrosis is a term used to describe an inability to sweat.

As with excessive sweating, damage to the nerves that control the sweat glands results in inappropriate sweating. In cases of anhidrosis, the sweat glands do not get the signal to sweat, even when they should.

People with diabetes-related anhidrosis experience symptoms that can include:

  • trouble staying warm or cool enough

  • little or no perspiration

  • trouble cooling down, even after minor tasks

  • becoming overheated during minor physical tasks

  • easily overheating in warmer settings

  • dizziness

  • facial flushing

  • muscle cramp and weakness

  • racing heartbeat

  • nausea

The inability to maintain a consistent or healthy body temperature can cause serious health complications, such as heat exhaustion and heat stroke.

If the above symptoms are severe or affect large areas of the body, people should see a doctor. Most treatment options for anhidrosis revolve around cooling the body, such as drinking cool fluids or taking a cold shower.

Other causes of anhidrosis may include:

  • dehydration

  • conditions that have affected the sweat glands from birth

  • skin damage

  • other causes of nerve damage, such as alcoholism

  • certain pain and psychosis medications

  • many metabolic conditions

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