Diabetes & Sweating: Cause, Treatment, and the Connection

Diabetes is a multi-systemic disorder that can cause hormonal imbalances, making it difficult for your body to maintain a stable temperature and generate the ideal amount of sweat. Hence, people with diabetes mellitus may experience excessive sweating (hyperhidrosis) or insufficient sweating (anhidrosis).

Observing your sweating pattern as a person with diabetes is crucial since sweating complications may signal the need to review your diabetes management for adequate blood sugar levels.

So, you may want to ask some essential questions: what is "excessive" sweating? Why am I sweating excessively? What causes sweating-related problems among people with diabetes? You will soon find the answers to these crucial questions and more.

Key Facts

Causes of Excessive Sweating in People With Diabetes

People with diabetes may sweat more often than the average person for many reasons. Some of these factors are due to minor or severe health complications. They are: 

Low blood sugar levels (hypoglycemia)

Managing blood sugar levels can be tricky since the same meds that reduce your blood glucose can also make it too low for your body, leading to a sudden bout of sweating.

Low blood glucose levels (hypoglycemia) in diabetic people may happen when you eat less than usual after taking your standard insulin dose. Too much exercise can also increase the risk of hypoglycemia in diabetic people.

Apart from sweating profusely, other symptoms of low blood sugar include,

• Feeling anxious or nervous
• Confusion and coordination problems
• Shaky feeling
• Chills and clamminess (often associated with profuse sweating)
• Irritability
• Faster heartbeats
• Dizziness and lightheadedness
• Nauseousness
• Hunger
• Numbness or tingling sensation in the lips, tongue, or cheeks
• Blurry vision
• Headaches
• Pallor skin
• Sleepiness
• Nightmares
• Low energy levels
• Seizures

Diabetes sweating may be one of the first symptoms that indicate declining blood sugar. However, others may experience lightheadedness, trembling, hunger, irritability, and tiredness before sweating symptoms appear.

Autonomic neuropathy

Another major cause of excessive sweating in diabetic people is a form of nerve damage called Autonomic Neuropathy.

This condition occurs when the nerves that control automatic body functions become dysfunctional, altering the messages sent between the brain and other areas of the autonomic nervous system, including the heart, blood vessels, and sweat glands.

When this happens, you don't only sweat excessively but also have issues with your blood pressure, digestion, temperature control, bladder function, and even sexual performance.

Autonomic neuropathy can cause various symptoms depending on which nerves are affected. These might include:

• Feeling dizzy or fainting: Your blood pressure can suddenly drop when you stand up quickly.
• Bladder issues: You might have trouble starting to pee, feel like you can't fully empty your bladder, or lose control over your bladder, leading to frequent infections. 
• Sexual problems: Men might struggle with getting or keeping an erection or have ejaculation issues. Women might experience vaginal dryness, low sex drive, or difficulty reaching orgasm. 
• Digestive troubles: You could feel full after just a few bites, lose your appetite, have diarrhea or constipation, feel bloated, get nauseous, vomit, have trouble swallowing, or suffer from heartburn. 
• Missing low blood sugar warnings: When your blood sugar is low, you might not notice typical signs like shakiness.
• Sweating too much or too little: This can make it hard to control your body temperature.
• Vision changes: Your eyes might adjust slowly to changes in light, making it hard to see in the dark, especially when driving at night.
• Difficulty with exercise: Your heart rate might not increase with activity, making physical exercise hard.

Thyroid disorder

Hyperthyroidism is a common thyroid issue among diabetic people — usually due to unmanaged high blood sugar levels. There is an overactive thyroid that produces excess hormones and causes excessive sweating.

Hyperthyroidism (Graves' disease) is more predominant among type 2 diabetes patients, and some of the symptoms include:

• Hot flashes
• Excessive sweating
• Weight fluctuations (gain or loss)
• Irritability and mood swings
• Fast heart rate
• Trembling or shaking hands
• Increased appetite
• Low energy
• Insomnia
• Women may experience miscarriages and irregular menstruation.

Heart problems

Cardiovascular conditions associated with diabetes (like heart attack and heart failure) may come with excessive sweating.

If you have diabetes and suddenly start sweating profusely, you may want to pay attention to your cardiovascular health.

Obesity

There is a strong relationship between obesity and type 2 diabetes (with insulin resistance). Obesity is a primary risk factor for type 2 diabetes.

When your body resists insulin for too long, your blood sugar drops too low, forcing increased production of adrenaline, which causes excessive sweating.

Another possible cause of profuse sweating among obese people is their very small Body Surface Area (BSA) compared to their overall weight. This cause implies that obese people have more difficulty eliminating body heat, and sweating becomes their next resort for managing body heat.

What is Excessive Sweating?

Excessive sweating (hyperhidrosis) is a term that describes extreme, abnormal sweating that is usually unrelated to body temperature or exercise.

Diabetic people tend to sweat more excessively in the upper body than in the lower body. You may experience underarm, neck, chest, and facial sweating that could soak through your clothes or drip off your hands. It is worrisome when this happens on a chilly, snowy day or at night when you are engaged in little or no physical activities.

Although profuse sweating can be a strong indicator of diabetes, a few other causes aren't due to underlying disease. Examples include rigorous exercise, a sauna session, a hot environment, or a response to emotional stress.

The two major causes of unusual sweating in people with diabetes are low blood sugar levels and diabetic nervous system damage.

Sweat hormones produce more sweat when blood sugars drop to as low as 70 milligrams per deciliter (mg/dl). When blood glucose levels stay high for too long, nerve functions could be affected, leading to diabetic neuropathy.

Unfortunately, over 50% of diabetic people are affected by nerve damage, which can ultimately affect sweat glands' nerves, causing them to sweat too much or too little when they ordinarily shouldn't.

Types of Excessive Sweating

Diabetes-related sweating can come in various forms, such as hyperhidrosis, Gustatory sweating, and night sweats.

Hyperhidrosis

Hyperhidrosis is a general term for profuse and constant sweating without influence from factors like exercise or extreme temperatures.

The two types of hyperhidrosis include,

• Primary hyperhidrosis
• Secondary hyperhidrosis

Primary hyperhidrosis is excessive sweating unrelated to any known underlying cause. In contrast, secondary hyperhidrosis is a symptom of other health conditions or a side effect of certain foods or drugs.

Diabetic people who sweat uncontrollably, have bladder control problems, have unusual heart rates, or have blood pressure issues may also have autonomic neuropathy - nerve damage that impairs automatic body functions. Obese diabetics are also at a higher risk of showing hyperhidrosis symptoms.

Night sweats

Night sweats are episodes of very heavy sweating that repeatedly occur during sleep. They are severe enough to soak your pajamas and bed sheets.

Although night sweats can be primary, they signify low blood glucose at night (nocturnal hypoglycemia). This situation is common among diabetic people taking insulin or diabetes medications classified as sulfonylureas. Extremely low blood sugar can trigger excess adrenaline production, which causes profuse sweating.

When you have night sweats, you may wake up in a pool of sweat, even when the weather is neither too hot nor are you sleeping under too many blankets.

Your healthcare provider can help manage night sweats related to blood glucose levels by recommending lifestyle, diet, and medication adjustments.

Gustatory sweating

The term "Gustatory" refers to the sense of taste. The signs of gustatory sweating are severe sweating during or after food ingestion. It can happen for no apparent reason in some people. Still, in most cases, it's due to an underlying condition like diabetes complications, Parkinson's disease, or viral infections affecting the face, such as shingles or Bell's palsy.

According to the American Diabetes Association, diabetic Gustatory sweating results from nerve function damage, which makes you sweat at the sight, smell, or taste of food. Gustatory sweating is similar but NEVER the same as sweating when you eat hot, spicy foods. With Gustatory sweating, barely thinking about food makes you sweat uncontrollably.

Some typical symptoms of Gustatory sweating include redness of the face while eating food (whether hot, cold, spicy, or not) and sweating in the face, forehead, scalp, cheeks, lips, neck, and chest.

What is Anhidrosis?

Anhidrosis is the body's inability to produce sweat due to damage to the nerves that control the sweat glands. This condition causes the sweat glands not to receive the signal to produce sweat, even in situations that trigger sweating.

How Do Doctors Treat Autonomic Neuropathy?

The treatment plan for excessive sweating depends on the root cause of the problem. In most cases, the patient will improve as the underlying health issue is addressed.

However, since the nerve damage that causes most diabetes sweating is irreversible, excessive sweating, in that case, can not be cured. Your healthcare provider can only recommend a few treatment options to manage the situation, including:

Medications

• Nerve blocking medicines
• Botox injections
• Prescription antiperspirants or aluminum chloride 15% to 25%.
• Glycopyrrolate (for gustatory sweating).
• Antidepressants

Lifestyle changes

• Avoid wearing clothes made of synthetic materials.
• Choose clothes that match your activity.
• Choose lighter clothes.
• Bathe daily and apply antiperspirant.
• Change your socks as often as possible to keep your feet dry.
• Lose weight if you are obese.
• To manage stress-related sweating, rest and relax more.
• Stay in a ventilated or relaxed environment.
• Avoid spicy foods, caffeine, and alcohol since they trigger excessive sweating.
• Pay attention to whatever triggers your sweating and avoid such.

Procedures

If the above sweat management options have failed, the last resort may be the following procedures:

• Iontophoresis (applying an electrical current).
• Sweat gland removal (to eliminate armpit sweating).
• Nerve surgery (when other treatment options fail).

When Should You See a Doctor?

Excessive sweating may only require home remedies if it doesn't drastically affect your quality of life. However, you should visit your doctor if you have diabetes, experience heavy sweating, and other signs and symptoms of autonomic neuropathy.

You need immediate attention if you have chest pains, issues with your heart rate, lightheadedness, trouble breathing, or any other symptoms.

The American Diabetes Association recommends yearly screening for autonomic neuropathy once you are diagnosed with type 2 diabetes.

Frequently Asked Questions

Conclusion

Sweating is a normal metabolic process that every healthy person must experience from time to time. It is a process through which the body releases excess metabolic heat.

Thus, sweating doesn't necessarily indicate serious health challenges, especially when exposed to well-known triggers like hot temperatures or spicy foods.

But if you have diabetes and suddenly have excessive sweating for no apparent reason, you may want to see your doctor to rule out any severe diabetes complications.