I have Type 1 diabetes and for about a month I've had repeated episodes where my body feels like it's shaking and I feel nauseous — what might be causing this?

If any of the following occur, go to the emergency department or call emergency services without delay: fainting or loss of consciousness; severe chest pain or difficulty breathing; sudden focal neurological deficits such as weakness, numbness or speech disturbance; or persistent, severe blood‑glucose abnormalities that do not improve during episodes.

• Fainting or loss of consciousness
• Severe chest pain or shortness of breath
• Sudden focal neurological weakness or numbness
• Persistent severe blood-sugar problems during episodes

Common categories that can produce a sensation of internal shaking and nausea include:

• Blood-glucose fluctuations (especially hypoglycemia)
• Anxiety / panic attack
• Benign Paroxysmal Positional Vertigo (BPPV) or other vestibular disorders
• Hyperthyroidism or other metabolic issues
• arrhythmia / heart rhythm disorder or electrolyte imbalances

In non‑emergency situations, simple low‑risk observations can help clinicians: measure your blood glucose during an episode if you can; keep a log for each episode with time, duration, glucose reading, last insulin dose, meals eaten or missed, and any caffeine/nicotine intake. Stay well‑hydrated, aim for regular sleep and meals, and avoid excessive stimulants. If you do not have a hypoglycemia action plan, ask your diabetes team or pharmacist about one.

• Measure blood glucose during episodes and record results
• Note time, duration, insulin/dose, meals and stimulant intake for each episode
• Maintain regular sleep, fluid intake and meal schedule
• Discuss a hypoglycemia action plan with your diabetes care team or pharmacist

Start with Endocrinology and Metabolic Diseases to review your insulin regimen, assess hypoglycemia awareness and consider continuous glucose monitoring. Depending on symptoms and findings, referrals may include Cardiology (if palpitations or rhythm concerns), Otorhinolaryngology (if positional vertigo suspected), Neurology (if persistent tremor or other neurological signs), or Mental Health and Illnesses (if anxiety or panic is suspected). Tests commonly considered include HbA1c, serum electrolytes and kidney function, thyroid function tests, ECG or Holter monitoring, and an ENT or vestibular evaluation. The clinician will decide which tests are appropriate.

• Endocrinology and Metabolic Diseases as first contact
• Cardiology, Neurology, Otorhinolaryngology, Mental Health and Illnesses as indicated
• Possible tests: HbA1c, thyroid function, electrolytes, ECG/Holter