Earthquake-like shaking and nausea in type 1 diabetes: what causes it?

Get well soon. The "my body is shaking like an earthquake" feeling you described, along with the nausea that accompanies it, can most commonly occur in Type 1 diabetes due to the following causes:

• Hypoglycemia (low blood sugar): Internal tremors/shaking sensations, sweating, palpitations, and nausea are very common. This can be particularly exacerbated by insulin, skipping meals, eating late, overdosing, or increased nicotine/caffeine intake.
• Anxiety/panic attacks: May cause internal tremors, palpitations, and nausea; it is triggered by stress.
• Vestibular dizziness (e.g., BPPV): Head movement causes a "shaking/spinning" sensation lasting seconds to minutes, along with nausea.
• Hormonal problems such as hyperthyroidism: Tremors, palpitations, weight loss, and heat intolerance may occur.
• Arrhythmias, electrolyte imbalances, or excess nicotine/caffeine can also cause internal tremor-like sensations.

First, things you can do at home: Check your blood sugar immediately during an attack. If it's below 70 mg/dL, take 15-20 grams of fast carbohydrates (glucose tablets/gels, fruit juice). If it's still below 70 mg/dL, take another 15-20 grams of carbohydrates (glucose tablets/gels, fruit juice). If it's still below 70 mg/dL, repeat the test. Then, have a small snack. Keep glucagon on hand for very low levels and teach your loved one how to use it.

Keep a symptom diary: Time, duration of the attack, current blood sugar, your insulin doses that day, when and how many grams of carbohydrate you last consumed, caffeine/energy drink/nicotine status, and any accompanying symptoms (sweating, palpitations, dizziness, tinnitus, etc.).

Reduce caffeine and nicotine; drink enough water, sleep regularly, and avoid skipping meals.

Physician evaluation and recommended tests: Endocrinology and Metabolic Diseases: Review of insulin doses, hypoglycemia awareness training, continuous glucose monitoring system (CGM) evaluation. HbA1c and frequent hypoglycemia checks.

• Thyroid function checks with TSH and free T4.
• Complete blood count, electrolytes, and kidney function.
• Cardiology evaluation (ECG/Holter) if significant palpitations occur with attacks.
• Ear, nose, and throat examination (positional maneuvers) if a sensation of spinning lasting seconds with head movements predominates.
• Neurology evaluation if there is a persistent/visible tremor.

A few quick questions (if you can answer, I can guide you more clearly):

• How long does this shaking last (seconds, minutes)? What time of day does it occur?
• Have you checked your blood sugar during an attack? What is it?
• Do you experience sweating, palpitations, hand tremors, blurred vision, dizziness, or a feeling of the room spinning during those times?
• Do you skip meals or eat late after insulin injections?
• Have you recently experienced significant weight loss, heat intolerance, or persistent palpitations? - Are your caffeine/energy drink consumption and cigarette consumption related to attacks?

If you experience any urgent warning signs, go to the emergency room immediately:

• Fainting, confusion, severe headache, or neurological weakness/numbness
• Chest pain, shortness of breath, very fast/irregular heartbeat
• Blood sugar levels below 54 mg/dL and not improving
• Severe nausea and vomiting, abdominal pain, and a ketone/acetone odor accompanying blood sugar levels above 250 mg/dL. As a first step, measuring your blood sugar during an attack and keeping a brief log can be very helpful in making a diagnosis. I recommend making an appointment with an Endocrinologist and Metabolic Diseases specialist afterward.

I am not a doctor, and this is not a medical diagnosis.