Diabetes and Night Sweats: What You Need To Know

Diabetes mellitus, commonly known as diabetes, is a group of metabolic disorders associated with an impaired ability to regulate blood sugar.

Type 1 Diabetes

Type 1 diabetes used to be called juvenile diabetes because it was mostly diagnosed in children and young teenagers.¹ It is marked by no insulin production in the pancreas due to the destruction of islet cells that produce it. Type 1 diabetes always requires the administration of insulin externally since it is not produced in the body.

Type 2 Diabetes 

Type 2 diabetes is often diagnosed in adults. It usually involves a combination of insulin resistance and some deficiency of insulin. Although the causes of type 2 diabetes are not entirely understood at the moment, numerous studies suggest the following risk factors for type 2 diabetes:

• obesity
• cardiovascular disease
• sedentary lifestyle (spending most days sitting)
• dietary habits
• lifestyle habits, such as smoking and excessive alcohol consumption
• genetics (type 2 diabetes running in the family)

Unlike type 1 diabetes, type 2 diabetes can be treated in several ways, including medications other than insulin, and changing your diet and lifestyle.

Can diabetes cause night sweats, and is it normal?

Recent research has established an association between diabetes and problems in temperature regulation, and night sweats are quite a common occurrence in diabetic patients.² Sweating is a mechanism of the body required to maintain body temperature, and may affect the underarms, face, neck, hands and feet.³ Diabetes may affect this mechanism due to the associated low blood sugar levels and diabetes-related nerve damage. Certain diabetes medications can alter the level of sugar in the blood, potentially resulting in issues with heat metabolism. Blood sugar regulation issues lead to trouble sleeping, acid reflux problems, and excessive sweating at night.

What is the science behind night sweats in diabetes?

Diabetes is a metabolic disease, which means that it affects how the body manages its energy. Diabetes affects several hormones that can affect many organ systems in the body, and it promotes changes associated with the fluid balance within the body, thereby affecting thermoregulation.

Thermoregulation is the process by which the body maintains the ideal temperature to carry out essential activities.¹ Sweating is a natural effect of thermoregulation. Excessive sweating at night (night sweats) are a consequence of changes in sugar metabolism caused by diabetes. The two primary mechanisms behind this are associated with blood sugar/blood glucose levels. In nondiabetic individuals, the blood glucose concentration is regulated by normally functioning mechanisms. However, in patients with diabetes, the hormonal regulation of sugar is impaired and, with it, thermoregulation.

Low Blood Glucose (Blood Sugar)

Low blood sugar can cause an imbalance in the fluids in the body. It manifests in symptoms such as shaking, anxiety, confusion, hunger, dizziness, nervousness, and sweating. Although sweating is a vital symptom of low blood sugar, it rarely appears alone. It is a part of the fight or flight response induced by the hormones affected by blood sugar levels. It can occur with an increase in the administration of insulin or a lack of carbohydrates. 

Nerve Damage

Diabetic individuals are likely to suffer from nerve damage, commonly referred to as diabetic neuropathy. This occurs when the blood sugar levels are higher than what is normal. Excess glucose can induce nerve damage by damaging blood vessels. Blood vessels carry nutrients that are supplied to nerves for maintaining and regulating good function. As nutrient supply to the nerves diminishes, the nerve fibres are increasingly damaged and eventually die. If nerve damage occurs near the sweat glands, it can impair their function, leading to abnormal sweating. 

What are the triggers for night sweats in diabetics?

Both low blood glucose levels and diabetic neuropathy can lead to night sweats. 

Low blood glucose levels

• Medication: excess insulin; sulfonylureas to lower blood sugar (such as glibenclamide and gliclazide) taken by type 2 diabetics; glinides (repaglinide and nateglinide) for insulin secretion within the body; antiviral medicines to treat hepatitis C
• Skipping an important meal or having large breaks between meals
• Lack of carbohydrates, such as potatoes, bread, pasta, cereals in the diet
• Unplanned intense exercise
• Alcohol consumption

Diabetic Neuropathy 

• High levels of blood glucose
• Lifestyle habits, such as alcohol consumption and smoking
• Low levels of vitamin B12
• Use of metformin (medication used in the treatment of type 2 diabetes) 
• Mechanical injury to the nerves (e.g. carpal tunnel syndrome)
• High cholesterol levels, caused by unhealthy eating habits

Additional Triggers

• Use of antidepressants
• Emotional sweating
• Intoxication
• Abuse of chemical substances
• Withdrawal of alcohol or other chemical substances
• Malignancies (e.g. cancers, myeloproliferative syndromes, Hodgkin’s disease)
• Infections
• Other endocrine disturbances (e.g. menopause, hyperthyroidism, hyperpituitarism, pregnancy)

What are the different types of sweating?

Hyperhidrosis

Hyperhidrosis is the medical term for excessive sweating. It refers to sweating more than normal while going about your daily activities, presenting as wet patches near the underarms, back, and palms. It can also occur throughout other parts of the body. If sweating occurs continually, it is most likely hyperhidrosis. 

Night sweating

Night sweating refers to excessive sweating occurring specifically at night-time. It can disturb sleep patterns and affect the quality and quantity of sleep, thereby causing fatigue and the disruption of daily activities both externally and internally within the body. Night sweats can be related to hypoglycemia in diabetic individuals with diabetic neuropathy. 

Gustatory sweating

Gustatory sweating is associated with eating. This type of sweating involves sweat concentrated around the head, face and neck, whilst or after eating. It is not common, but a rare complication of diabetes. If you think you have gustatory sweating, contact your local healthcare provider. 

What are the preventive measures for night sweats in diabetic patients?

Since night sweats are primarily associated with low glucose sugar levels and diabetic neuropathy, it is important to try and prevent them.

Preventing low blood glucose levels

If you have diabetes, monitoring and maintaining your blood sugar levels is extremely important. 

• Check your blood glucose level regularly using portable home kits or other monitoring devices, as suggested by your healthcare provider, and be on the lookout for the symptoms associated with low blood glucose levels
• Always carry a snack or drink with high glucose or sugar, glucose tablets, powdered glucose or a glucagon injection kit to ease and treat the symptoms of low blood glucose levels
• Avoid skipping meals and large gaps between your meals
• Be mindful of your alcohol consumption
• Nocturnal hypoglycemia causes changes in blood sugar levels during the night time when the body is usually at rest. It is associated with night sweats. This can be eased by consuming a carbohydrate snack before going to bed.
• Monitor how your body reacts to exercise and consume a carbohydrate-rich food item before exercise. Exercise increases metabolism in the body. Carbohydrates, if consumed before the exercise session, will be broken down to balance the blood glucose levels instead of using up the glucose stores in muscles and the liver. 

Preventing diabetic neuropathy 

• Stop smoking: Smoking is associated with lower levels of oxygen. It creates free radicals, which cause cell damage, cell death and subsequent hardening of the blood vessels. Changes in the structure of these blood vessels reduce the nutrient supply to them and damage them. This leads to a lack of supply to nerve endings, causing them to be damaged and leading to night sweats, amongst other health risks.

• Maintain a good source of vitamin D and vitamin B12: These can be supplements or dietary items, such as eggs, cheese, mushrooms, tuna, salmon, mackerel, red meat, orange juice, soy milk, and cereals.

• Emerging developmental studies indicate the importance of alpha-lipoic acid (ALA) and acetyl-L-carnitine in nerve protection and repair. They are antioxidants with therapeutic potential. However, it is vital to check with your doctor before you begin to use them.

What are the treatments for night sweats in diabetic patients?

The treatment is based on assessing the type, severity, and pattern of sweats. Treatment for excessive sweating may be local, surgical, or systemic.

Local Treatment

• The local treatment involves topical applicants in the form of aluminium salts in freely available antiperspirants, at concentrations between 1% to 2%, or in the form of medications containing aluminium chloride in concentrations between 15% to 25%. This has to be repeated regularly. The aim of this is to reduce or stop the activity of the sweat secreting cells in the sweat glands.

• For hyperhidrosis of the hands and palms, iontophoresis treatments could be conducted.⁴ It involves electrodes in the water or moist electrodes placed on the patients’ hands and feet. Continuous direct current or alternating currents travels through these electrodes into the body. This is done to disrupt the transport of ions (small nutrients essential to the cells) in the secretory mechanistic actions of the sweat glands, thereby reducing the amount of sweat secreted and produced. 

• Botulinum toxin, or botox injection, is an effective non-surgical treatment option for hyperhidrosis.⁵ Botulinum toxin is a neurotoxin formed by the bacteria Clostridium botulinum. Botulinum toxin is injected into the skin to stop the release of substances within the body that cause sweating. It is highly efficient, especially in treating sweating in the underarms.

Surgical Treatment

• Endoscopic thoracic sympathectomy involves the cutting of the sympathetic ganglia of the nerves that control the sweat glands in the upper parts of the body. It can be useful in treating excessive sweating of the hands and armpits.

• Removal of the axillary sweat gland via incision or liposuction.⁶ This is an extremely rare suggestion only done in complex cases.

Systemic Treatment

• Administration of anticholinergic drugs, such as methanthelinium bromide, for treating excessive sweating in the underarm area.

• Use of tricyclic antidepressants, such as amitriptyline and paroxetine.

• Administering antihypertensive drugs e.g. beta-blockers, phentolamine and clonidine, and calcium channel blockers, such as diltiazem. 

How can you manage night sweats caused by diabetes?

Dealing with excessive sweating is challenging and can make you feel uncomfortable, especially when away from home. Therefore, it may be advisable to consider the following:

Dress appropriately

It is advisable to dress in layers that can easily be taken off. Colours can also play an important role; you may want to stick to lighter colours on hot sunny days. Additionally, fabrics such as synthetic, resin and other tight materials could be replaced by breathable materials like cotton.

Use the right antiperspirant

Using the right antiperspirant can help ease the severity of sweating. Your doctor will be able to advise you on an antiperspirant suitable to your needs.

‍Keep your room cool at night

It can help to keep the room cool and to use a fan, cooler, or air conditioning device. If you feel hot at night, try using fewer or thinner blankets, and change your sheets to those made of cotton.

FAQs 

Can high blood sugars cause night sweats?

High blood sugar is associated with neuropathy i.e. nerve damage. This can lead to the impairment of sweat gland function and abnormal sweating.

Does high blood sugar make you hot and sweaty?

High blood sugar is associated with fluid and hormonal imbalance in the body. A disturbance in homeostasis (the balance of internal conditions) causes an imbalance in temperature maintenance. This homeostatic imbalance also causes hormonal disturbances associated with reversible alterations in the cardiovascular and motor systems. All these factors together can cause an increase in body temperature. 

When should I be concerned about night sweats?

If you have diabetes and you experience low blood sugar and night sweats, it is vital to check your glucose values using a fingerstick test immediately. If night sweats are a regular occurrence, you should contact your healthcare provider, monitor your diet and medication, and regularly check your glucose levels. 

How do you feel when your blood sugar is too high?

High blood sugar, or hyperglycaemia, is associated with symptoms of increased thirst, increased frequent urination, tiredness, fatigue, blurred vision, weight loss, recurrent infections due to increased susceptibility, abdominal pain and fruity breath. 

When should I get medical help? 

It is advisable to discuss your pattern, severity and incidence of night sweats with your healthcare provider to treat the symptoms, underlying causes and other complications associated with it. It is important to seek immediate medical attention if you experience these symptoms - it could indicate a serious underlying disorder, such as a high fever, chills, chest pain, light-headedness, confusion, nausea or vomiting.

What to do when a diabetic is sweating?

If a diabetic individual is sweating, it is important to help them relax and cool down, and offer them a glucose-based product. It is also important to monitor their signs and symptoms in case they worsen, in which case you must immediately seek medical assistance.