Low blood pressure

I have a new symptom come on suddenly. I have been experiencing low blood pressure when standing up. I have never been able to tolerate any vaso dialators because I’m sensitive to it. So I have just plugged along with normal bp

Now I’m getting low Bp when I stand. I try to drink more water and had my cortisol checked. It was 5.0 in the evening which is normal but the cut off is 3.
My sugars are pretty ok. My a1c runs mid 6,s
All other blood work is normal.

My pressures can be as low as 100/55. Normally 118/80
My doctor keeps telling me that I’m dehydrated but I just can’t be at this point. I drink so much water I can’t stand it.
Has anyone else experienced this.?

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@Timothy - I’ve experienced low blood pressure periodically for the past couple of years. I’m in my early 60’s, and have been T1D for 56 years.

Typically the hypotension occurs when I stand up (Orthostatic or postural hypotension).

My BP falls to the point where I collapse. When this happened last week, I fell and broke my hip. During the surgical recovery at hospital, BP’s as low as 60/28 were observed.

They eliminated all my BP meds, as well as dermal nitro (taken as a vasodilator). I’m taking things day by day (released Monday). I also found taking electrolyte supplements is essential if you’re on a low carb diet (SaltStick).

Be very careful, falls can be dangerous as I found out

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Oh my goodness Jim, I am so sorry that you fell and broke your hip! I hope that you heal quickly.

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Timothy are you on a low carb diet by any chance? When I was eating 30 carbs daily, I started passing out when getting out of bed. I stopped eating low carb, and my blood pressure rose. Now I have to take blood pressure meds, but I no longer pass out.
I don’t know your age, but for seniors, passing out is quite common when getting out of bed. Doctors recommend sitting on the side of the bed before standing up.

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You taking meds? Its time for a med adjustment. “Drink more water,” is not an adequate response. Your gonna loose consciousness and your gonna get hurt.

@Jim_in_Calgary Hey Jim, I’m so sorry to hear about your recent surgery, but I very glad you’re on the mend and off the bp meds! I’ll send good thoughts and prayers your way that recovery is smooth for you.

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If you are drinking a lot, is it just water? You need water + electrolytes to manage orthostatic hypotension. Gatorade Zero is a sugar free option, and there are some stevia sweetened powdered options. You can also make your own with sea salt and your sweetener/flavorings of choice. Another option is taking salt pills (look for the Salt Stick ones on Amazon or such). Water or fluids alone will not do the trick.

Also eating low carb, as mentioned above, increases the need for both water and salts/electrolytes—if eating very low carb/keto, definitely increase your salt intake dramatically.

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Oh my gosh, Jim…I’m so sorry to hear this. I hope your recovery goes smoothly, but please, do be careful.

Years ago I was put on a massive overdose of bp meds (I have high blood pressure due to renal stenosis.) Every time I stood up, I’d get dizzy and usually fell. finally got on better meds and haven’t had the problem for years. BUT…orthostatic hypOtension (rapidly falling blood pressure when you stand up) can be lethal. If you’re not on bp meds and still have it, or if you are taking bp meds and have that side effect, the best way to deal with it is to always make sure that you stand slowly, preferably holding on to something. The problem can at least be minimized by rising slowly…first to a kind of crouching stand, without raising your head yet, and then gradually straightening up. I had two concussions before I figured it out.

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Jim: So sorry to hear about this as if there was not enough to worry about these days. Take good care of yourself as we all hold you in our thoughts.

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@Jim_in_Calgary OMG, so sorry you fell and broke your hip. So dangerous, and the observed BP of 60/28 is incredibly low. Thank goodness you were already under doctor care. I hope you have a smooth and pain free recovery.

@Timothy I also experience orthostatic hypotension for many years now but don’t know what to contribute it to either. My normal BG is usually 100/60. I don’t know what it drops to when rising quickly from stooping over, but it takes me a moment or two to recover. Maybe as @cardamom mentioned electrolytes like salt stick would help.

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I take no other meds. I only take insulin. I’m trying to eat more salt. I am low carb for the greater world not so much for diabetics. I eat 60-80 per day. But I’ve always eaten the same. I’m 54. I was diagnosed w t1 at 21. This orthostatic Pressure issue is new however. I thought my pressure would increase w age not decrease. I trained myself to stand up and hold on. I don’t want to end up in Jim’s predicament. But for me I don’t pass out I just get light headed and sometimes my vision goes dark of a quick second.
I just don’t know if this is diabetes related. My doctor said no.

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Just eating more salt may not be nearly enough—I would try either drinking electrolyte drinks and/or taking salt pills. I have POTS (orthostatic tachycardia) which is treated similarly, and doing that made a tremendous difference. For me that meant drinking at least one, sometimes two 32 oz Gatorade Zeros a day, plus other non-electrolyte-containing fluids, to try to hit 80 oz total, while also eating plenty of salt. Worth a shot!

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I get it from time to time. Have had it for years even passed out about 3 different times before I learned to ID the early signs. For me I can chalk it up to stress. When life gets stressful it happens. I generally have low blood pressure. Every nurse that takes it asks if I am an athlete. Now when I feel it I know what it is and make sure I sit down and rest for a minute and realize I need to manage my stress better

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@Jim_in_Calgary . So sorry to hear about your hip. That’s one of the things that scares me the most as I have mild osteopenia in my left hip.

Dizziness on standing started happening to me about 18 months ago. It only happens occasionally but when it does I’m caught off guard. I haven’t lost consciousness but I do feel dizzy.

I’ve been on low dose BP meds for years. I’m not hypertensive but my endo wants my BP running in the low-normal range to protect kidney function. We decided to lower my BP med dose slightly and start standing up slowly. So far it’s working.

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So sorry to hear that. Be well.

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Hi Timothy I have suffered from orthostatic hypotension off and on for years. Before my diagnosis of LADA. My PCP said to stay off of ladders. I went to see him after I passed out and hit my head. Usually I would just get wobbly legs and have to sit right away sometimes on the floor. Then it would go away for awhile. Recently it got pretty bad and I found out my sodium was low. Was plenty hydrated. I started putting a scoop of Ultima electrolytes powder in my water. My sodium Is now almost normal. But sorry to say I still have orthostatic hypotension. Not all the time but enough that I am careful getting out of bed. I should mention that my BP runs on the low side naturally. Hope I don’t fall Jim. Sorry to read that. Hope you are doing well.

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High blood pressure and orthostatic hypotension are not mutually exclusive.

Orthostatic hypotension causes can include autonomic neuropathy but it more broadly includes blood vessels getting stiffer as we get older.

Although the most well studied complications of high blood sugar are the microvascular ones like retinopathy and kidney disease that seem to be highly correlated to high blood sugars, there are other macrovascular effects of having diabetes that are not so well studied and are not so tightly tied to high average blood sugars.

I first complained to my doc probably 15 years ago (in my late 30’s ) about orthostatic hypotension after starting blood pressure medications. He taught me a few hints about avoiding it. And to tell you the truth, since taking his hints, I don’t notice it anymore.

Although taking salt may help, it’s also important to get more hydration too.

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