Getting dizzy on standing? Could it be low blood pressure?

IMT11 said:

Every now and then, when I stand up after lying on a couch or bed, I get a sudden spell of dizziness and feel really light headed, and I have to sit down again briefly. What's odd is that this never occurs when I first get out of bed in the morning.

This is definitely something new for me, and I'm unsure whether it's from the reta itself or possibly my diet (more of an indirect factor).

I haven't really seen this discussed much, and searching didn't turn up much either.

I was wondering if any of the knowledgeable folks here had any ideas, or if there's anything I should be adding to my diet or improving to prevent it.
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What you're describing sounds a lot like postural hypotension. Why it doesn't show up in the morning is unclear to me, though I suspect blood pressure tends to run a little higher then. It's something that shows up often alongside weight loss.

Before I lost weight I had high blood pressure, but once the weight came off I began having my vision go grey when I stood up, along with some dizziness, and that has stuck around for the last few years.

Weight loss brings blood pressure down for a few reasons: you'll be holding less fluid overall, reta lowers blood pressure as a drug effect, and the weight loss itself reduces blood pressure because there's less back pressure on the veins in your legs and abdomen — with less fat pressing on those veins, there's less resistance to blood being pushed upward against gravity.

A basic medical opinion is probably worth getting, mainly for advice, but before that, pick up a blood pressure monitor and take readings while lying, sitting and standing. That way you can confirm and keep track of what's going on, and it gives a doctor something useful to look at.

If you think there's any chance you could fall, the first thing to know is to get your head down fast so you don't pass out. For me, just leaning over slightly for a few seconds does the job. When blood flow to the brain stays too low for too long, the vasovagal reflex takes over and forces you horizontal by making you faint — it drops blood pressure suddenly as a way of bringing brain blood flow back (after you've gone down).

Compression stockings may help, and it's important to keep fluid and electrolyte intake adequate. Rising in stages — from lying to sitting to standing — can also help. And if you're on blood pressure medication, the dose may need adjusting or the drug may need to be stopped.
 
Since beginning GLP1s, I've noticed an increase in light headedness. At the moment I'm using a combination of TRZ and RETA, and my suspicion is that Reta brought it down even more, though I wasn't tracking it so I have no real evidence. All I can say for sure is that my reading right now is 102/64, and yes, I experience light headedness 1 or 2 times per day.
 
IMT11 said:

Just remembered there's a whoop lying around in a drawer somewhere, so I'll put it back on and check whether it tells me anything useful

To be clear, I've never had low BP before and I'm not taking any BP medication, plus I've "only" dropped about 15lbs, so it's not like I've had some crazy amount of weight loss or a sudden drop that I'd expect to trigger something like this.
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If you've never had low blood pressure issues, aren't taking any BP medications, and have only dropped roughly 15 lbs, I wouldn't jump straight to blaming the weight loss.

Here's the sequence I'd probably work through:

  1. Electrolytes/sodium.... particularly because you're taking in plenty of water without adding electrolytes.
  2. Calorie intake.... check that your deficit isn't too aggressive and that protein and overall nutrition are adequate.
  3. Orthostatic BP READINGS... this is simple to do at home if you have a BP cuff. Search "orthostatic blood pressure test" online and follow the steps.
  4. Blood sugar swings ... CGMs are fairly affordable these days, and they'd let you spot significant highs or lows quickly.
  5. Labs.... such as anemia, iron deficiency, B12 deficiency, etc., if nothing above explains it.
Starting with electrolytes is likely the simplest option. If you haven't done so yet, I'd also calculate what a reasonable calorie deficit would be given your size and activity level, just to confirm you're fueling your body sufficiently. Should symptoms persist after those adjustments, that's when I'd look into BP readings and blood glucose.... and eventually, lab work.
 
Jfrick11 said:

IMT11 said:

Just remembered there's a whoop lying around in a drawer somewhere, so I'll put it back on and check whether it tells me anything useful

To be clear, I've never had low BP before and I'm not taking any BP medication, plus I've "only" dropped about 15lbs, so it's not like I've had some crazy amount of weight loss or a sudden drop that I'd expect to trigger something like this.
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If you've never had low blood pressure issues, aren't taking any BP medications, and have only dropped roughly 15 lbs, I wouldn't jump straight to blaming the weight loss.

Here's the sequence I'd probably work through:

  1. Electrolytes/sodium.... particularly because you're taking in plenty of water without adding electrolytes.
  2. Calorie intake.... check that your deficit isn't too aggressive and that protein and overall nutrition are adequate.
  3. Orthostatic BP READINGS... this is simple to do at home if you have a BP cuff. Search "orthostatic blood pressure test" online and follow the steps.
  4. Blood sugar swings ... CGMs are fairly affordable these days, and they'd let you spot significant highs or lows quickly.
  5. Labs.... such as anemia, iron deficiency, B12 deficiency, etc., if nothing above explains it.
Starting with electrolytes is likely the simplest option. If you haven't done so yet, I'd also calculate what a reasonable calorie deficit would be given your size and activity level, just to confirm you're fueling your body sufficiently. Should symptoms persist after those adjustments, that's when I'd look into BP readings and blood glucose.... and eventually, lab work.
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Thanks for laying it all out. I've already given electrolytes a shot. I don't want to make this sound bigger than it is — it was showing up roughly 1-2x/week, but since I've just started a new medication, I'm watching closely for anything that shifts.

Looking back on it, I suspect calories might be playing a role. During my first few weeks on reta, getting enough food down was genuinely hard. Lately I've been eating more, and things have been fine so far (though it could also be the elctrolytes doing something, idk).

If these symptoms stick around, I'll follow up on the other suggestions.
 
IMT11 said:

Every now and then, when I stand up after lying on a couch or bed, I get a sudden spell of dizziness and feel really light headed, and I have to sit down again briefly. What's odd is that this never occurs when I first get out of bed in the morning.

This is definitely something new for me, and I'm unsure whether it's from the reta itself or possibly my diet (more of an indirect factor).

I haven't really seen this discussed much, and searching didn't turn up much either.

I was wondering if any of the knowledgeable folks here had any ideas, or if there's anything I should be adding to my diet or improving to prevent it.
Click to expand...

Is BP really the culprit here? As another person mentioned in this thread, take a reading while lying down in the morning, and then take another one after getting up. That could point to something, but of course you should still have a doctor - a cardiologist - take a look. Not medical advice, just a suggestion!

The same thing happens to me: lightheadedness and dizziness, plus my heart pounds when I stand, yet my BP doesn't budge. POTS is a possibility, but I'm still going through more thorough testing.

Whatever it turns out to be, they'll put you on something - a beta blocker worked somewhat for me, and now I'm trying a different option.

Once you figure out what's going on, tell us - others here might have additional suggestions.
 
Gr33dyOctopus said:

Ugh, after dropping a huge amount of weight I was still taking losartan at a high dose ( 75mg every day ) and the dizziness kicked in. Then one time I went down onto a table, hit a chair on the way, and landed on the floor surrounded by people. My reaction? Why is everyone down here on the floor???

That happened three weeks ago, and now I can hardly lie on my right side — I'm fairly sure a few ribs are cracked. It could have turned out much worse. Needless to say, I lowered the losartan ( 25mg daily ) and had a conversation with my dr.

Have a conversation with your dr too. That way you won't become me, or perhaps take an even nastier tumble.
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At 2:30 am I was on my way to the bathroom, and I figure I must have woken up right as my forehead and nose both struck the floor at the same time. My nose ended up broken, there was a lot of blood, and so on. The light headedness that others have mentioned was something I had already been dealing with. It wasn't until that spectacular faceplant that I really gave it much thought. I went to see my doctor, and we're looking into it now!
 
I brought this up with my doctor, and their take was that dehydration was the probable culprit. In their view, it was doubtful my blood pressure had dropped enough to bring it on. Once I began taking in more fluids, the problem stopped. That's the place to begin, since it costs the least and takes the least effort.
 
harradm said:

Gr33dyOctopus said:

Ugh, after dropping a huge amount of weight I was still taking losartan at a high dose ( 75mg every day ) and the dizziness kicked in. Then one time I went down onto a table, hit a chair on the way, and landed on the floor surrounded by people. My reaction? Why is everyone down here on the floor???

That happened three weeks ago, and now I can hardly lie on my right side — I'm fairly sure a few ribs are cracked. It could have turned out much worse. Needless to say, I lowered the losartan ( 25mg daily ) and had a conversation with my dr.

Have a conversation with your dr too. That way you won't become me, or perhaps take an even nastier tumble.
Click to expand...
At 2:30 am I was on my way to the bathroom, and I figure I must have woken up right as my forehead and nose both struck the floor at the same time. My nose ended up broken, there was a lot of blood, and so on. The light headedness that others have mentioned was something I had already been dealing with. It wasn't until that spectacular faceplant that I really gave it much thought. I went to see my doctor, and we're looking into it now!
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Same here!!! That kind of fainting has never happened to me before, it's pretty wild!
 
agussie said:

Yes, I ended up halving my Lisinopril dose
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My dose of that is a low 10mg, plus 50mg of Metoprolol. Ever since I spent 2 weeks in ICU followed by a week in a regular room 3.5 years ago, my cardiologist has kept me on this. I came down with a severe case of double fungal and viral pneumonia, which triggered AFIB, and because I was lying down for so long, I developed blood clots. The AFIB hasn't returned at any point, and that's the reason he continues me on it.
 
At 445lbs I was taking Lisinopril because my blood pressure was high. These days I weigh 210lbs, I've stopped the BP medication, and every so often I get extremely dizzy, with my vision going grey and tunnel-like, typically right after I stand up following heavy lifting at the gym. Once it starts, I go straight down onto my knees and lower my head so I don't faint. In my case, the cause is low blood pressure. My readings now tend to be 85/50. A doctor's visit is something I need.
 
Following this thread. I've dealt with the same thing plus a few other symptoms that I think could stem from significant insulin resistance — my body keeps releasing insulin even when my glucose is low. I actually missed this discussion and started a separate one recently. Wish I'd come across this one first.
 
ambot88 said:

Feeling light headed can happen because of low blood pressure, though dehydration or low blood sugar are more probable causes. Perhaps your system isn't adjusted to the small amount of calories you're taking in, which might leave you slightly light headed. Try drinking electrolytes, but to be honest, if it's only mild dizziness I would just tough it out and it will go away—I went through this and it stopped once my body got used to things.
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That's true. Still, when someone is using metformin or insulin, adding glp1s can push blood sugar even lower.
 
Following one of my fainting spells, I saw that my hip had nearly popped out of place. I didn't feel a thing while it was happening, but once I regained consciousness I understood the situation was more hazardous than I'd assumed. I had a hip replacement only 2 years back, so that area worries me a bit
 
Neurogroot said:

Following this thread. I've dealt with the same thing plus a few other symptoms that I think could stem from significant insulin resistance — my body keeps releasing insulin even when my glucose is low. I actually missed this discussion and started a separate one recently. Wish I'd come across this one first.
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Wasn't it established that this isn't insulin resistance, but rather insulin hypersensitivity along with glucose dysregulation? Insulin resistance refers to the situation where even large quantities of insulin fail to lower hyperglycemia, like in T2Diabetes. By the way, were you able to get it resolved?
 
Glenn said:

At 445lbs I was taking Lisinopril because my blood pressure was high. These days I weigh 210lbs, I've stopped the BP medication, and every so often I get extremely dizzy, with my vision going grey and tunnel-like, typically right after I stand up following heavy lifting at the gym. Once it starts, I go straight down onto my knees and lower my head so I don't faint. In my case, the cause is low blood pressure. My readings now tend to be 85/50. A doctor's visit is something I need.
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My own situation was pretty close to that. After going from 145kg down to 64kg, my bp shifted from 140/95 to roughly 110/65, and I was able to stop taking the blood pressure pills. On top of that, when I stand up my vision goes grey, it fluctuates somewhat, and it has stayed that way ever since the weight came off 3 years ago.

When I looked into it, the only thing I could really turn up was that this shows up very often following bariatric surgery, where big weight reductions are the norm, and it hit somewhere around half of those patients. When weight loss is that large, the likely cause is that the back pressure once provided by fat pressing on the veins in the gut and legs is gone. Now, on standing, those veins are still present, gravity pulls blood into them, less blood returns to the heart, and blood pressure to the brain falls. Given the starting weight, some level of autonomic dysfunction could also be involved.

A BP of 85/50 is genuinely very low, and it is fortunate you have not collapsed because of it. Still, it is absolutely worth seeking an expert opinion, perhaps a cardiologist instead of a general doctor, since bp that low may actually warrant treatment to raise blood pressure. And with your starting weight, an expert view on cardiovascular damage that may already exist, plus the need to avoid future damage, is probably worth pursuing.
 
It's quite possible that low BP is the cause. My blood pressure dropped significantly and fast after starting tirz. In my case that was a positive, since it had been elevated — something that occurs whenever I gain weight. Still, I'll need to keep an eye on it, because further reductions will come as my weight returns to normal. Should my BP fall too far, say below 100\65, standing up quickly would leave me lightheaded and almost fainting, which means I'd have to reduce or stop the BP medication — all fine — but caution is required.
 
Lack of fluids can bring on that woozy, spinning sensation. Only yesterday I was out doing heavy yard work while it was extremely hot and muggy. A wave of dizziness hit me and it seemed like I might black out. Figuring my BP was elevated, I took a reading: 70/54, with a heart rate of 109, even though I'd already been seated for over 20 min. I rang my sister, a nurse, while my wife consulted Doctor Google, and both gave the same answer — dehydration is the culprit.
 
Meritocrat said:

Neurogroot said:

Following this thread. I've dealt with the same thing plus a few other symptoms that I think could stem from significant insulin resistance — my body keeps releasing insulin even when my glucose is low. I actually missed this discussion and started a separate one recently. Wish I'd come across this one first.
Click to expand...
Wasn't it established that this isn't insulin resistance, but rather insulin hypersensitivity along with glucose dysregulation? Insulin resistance refers to the situation where even large quantities of insulin fail to lower hyperglycemia, like in T2Diabetes. By the way, were you able to get it resolved?
Click to expand...
About 20 minutes after I started my thread, I wrote this. At that point, I attempted to follow the suggestions people gave me somewhat. I got a Continuous Glucose Monitor (it still runs low more frequently than I would prefer). I'm adding strength and muscle building workouts. Slightly reducing the GLP dose (bringing it down to 8 mg from 9). If anything shifts, my guess is it will take a couple of weeks.

The doctor doesn't seem interested. Though to be fair, she's a resident physician who will be leaving for the real world in 5-6 weeks. My issues aren't part of her senior spring mindset at the moment.
 
BlueDog55 said:

Lack of fluids can bring on that woozy, spinning sensation. Only yesterday I was out doing heavy yard work while it was extremely hot and muggy. A wave of dizziness hit me and it seemed like I might black out. Figuring my BP was elevated, I took a reading: 70/54, with a heart rate of 109, even though I'd already been seated for over 20 min. I rang my sister, a nurse, while my wife consulted Doctor Google, and both gave the same answer — dehydration is the culprit.
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I've experienced the same thing. I was outside in hot weather, digging a hole for a concrete base for my flagpole, and I had to take a seat. The same happened while hauling and pouring the concrete into the hole. After speaking with my son, who is a paramedic and RN, I brought up electrolytes. Blood work came back showing low sodium and another marker indicating dehydration.
 
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