Dr. Ashwin Subramaniam talks about the common causes of giddiness and fainting and what needs to be done in an emergency.

Doctor I am 45 years old and I am a diabetic. I get giddiness often. What could be the reason?

Since you are a diabetic your giddiness could be due to Low sugars or High sugars. Low sugars are usually as a result of your food intake not balancing your insulin requirements or it could be because you have taken your medications without having your food or there could be an underlying infection. High sugars could be because you have not been detected so far with diabetes or the sugar controls have not been matched by adequate physical activity, diet, and drugs. In addition, there are other few causes for the giddiness, which diabetic patients can get. It can be due to transient ischemic attacks. Since diabetes itself is a clot promoting state, it could compromise your blood supply in the brain or it could be because of an underlying heart problem which could transiently cause giddiness.

Being a diabetic on regular medications, how can I prevent this repeated episode of giddiness?

Basically the preventive strategy depends on whether it is a low sugar or high sugar. If it is going to be recurrent episodes of low sugar it should make an adjustment in your drug intakes. If you are taking insulin and drugs, then it is important to make sure that the right dose is being taken and it matches your food intake. Another common problem is in the insulin administration technique, which you must be familiar with. In case of high sugar, make sure that your diet, physical activity and drug intake are balanced. Wrong technique and wrong site of insulin administration can also be contributory factors. Consult your doctor for the same.

My neighbour is 75 years old and one day morning suddenly he developed giddiness and fell down and could not move his arms and legs. Everybody told that he had stroke. What should one do in this situation?

The first thing you should do when you see somebody with stroke is to bring him to the emergency department immediately. The doctor will evaluate the time frame in which the stroke had happened. Say for example if the onset of stroke within 4 1/2 hours then there are chances that you can actually break the clot which is in the brain with thrombolytic agents. Thrombolytic agents reduce the clot or breaks down the clot in your brain so that particular area of the brain will resume its blood supply and the weakness can go away. In case if you are not sure what is happening then the concerned doctor will decide what would be required further. Thrombolytic therapy is again not without risks. Your doctor would decide whether you are a fit candidate for such therapy. He would be putting you on drugs which prevent future attacks and you will also require physiotherapy. Moreover all strokes are not always due to blood clots. It could also be due to a bleed in the brain. It is very important to differentiate this since the treatment is totally different.

Particularly, the people who have risk of getting stroke include patients with Diabetes Mellitus, High blood pressure, Transient ischemic attacks, High Cholesterol and triglycerides & Valvular heart disease.

Young people (those less than 40 years) can also develop stroke in the absence of the above risk factors. In these patients, an intrinsic blood clot promoting state has to be excluded.

Can stroke be prevented by taking aspirin?

It depends on the underlying cause for stroke. Say for example, if somebody has developed a transient ischemic attack, then they should take aspirin since they are at risk of developing stroke in future. If the stroke is due to a bleed in the brain, then aspirin is not indicated.

Will anyone get giddiness because of ear problem?

Yes one can get giddiness because of ear problems, but the giddiness due to ear problem is slightly different. If it is due to the ear, you will feel the world spinning around you. You might also find the symptom getting worse when you move your head. This is what we call vertigo. Again vertigo can be due to a neurological cause and you might require imaging of your brain to differentiate both.

Is surgery necessary to cure this giddiness caused by ear problems?

Most of the time, you may not require any surgery because the giddiness due to ear problem is usually due to benign causes.

Are all the episodes of fainting due to serious illnesses?

No, most of them are not serious or rather I would say they are benign but again it depends on the underlying condition. For example if you have diabetes or if you have heart disease, or high blood pressure then the giddiness could be serious in nature. So please get evaluated immediately.

The other day I saw one gentleman fainting in the shopping mall. In those circumstances what should one do?

Since you do not know the gentleman and he had fainted in front of you, it could be quite difficult for you to identify the cause. Say for example he was a diabetic, he could he having low sugars or he could have been a hypertensive who could have developed a bleed or he could had a seizure attack or it could be just a simple faint. If there is someone accompanying him, you could ask a brief history of what exactly arc his major medical illness is as I have told above. It could be either a serious or a benign cause. So the best thing you can do is to transfer him to the nearest hospital and get him evaluated.

Dr. A.Ashwin Subramaniam -Oct-26-2015-02-25-39-Ashwin

Article by Dr. Ashwin Subramainiam,
Consultant General Medicine & Diabetology,
Kauvery Hospital