It was a typical morning. My mother was getting ready; this was her usual routine: bustling around the house. When she suddenly stopped and shouted, blood was oozing from her nose. As kids, my siblings and I were terrified. We scrambled to help, but it wasn't until later that we learned the cause of that alarming moment: high blood pressure. That day was our first lesson in the silent yet powerful effects of hypertension. Nosebleeds, or epistaxis, are common, and nearly everyone experiences at least one in their lifetime.

While most are minor and often caused by dry air or irritation, some can signal underlying health concerns. One recurring question is whether high blood pressure causes nosebleeds or is merely coincidental.

Where Exactly Does a Nosebleed Occur?

The nose is covered by a rich plexus of small blood vessels, making it prone to bleeding. Most nosebleeds are anterior in origin, occurring at the front of the nose, and are relatively benign. They often occur because of irritants such as dry air, frequent nose-blowing, or trauma.

On the other hand, posterior nosebleeds are caused by a source that is located deeper within the nasal cavity. They are less common but more severe, as the blood tends to flow backward into the throat, making them more difficult to control. Common causes of posterior nosebleeds include trauma, medical conditions, or high blood pressure.

Connection Between Nosebleeds and High Blood Pressure

Hypertension is the condition whereby the pressure of blood against the arterial walls is consistently too high. Over time, this may damage the fine blood vessels in the nose, causing them to rupture more easily.

Significant studies have shown a strong relationship between hypertension and severe cases of nosebleeds necessitating urgent care. A certain study showed that patients diagnosed with high blood pressure had 2.7-fold increased chances of having nosebleeds that were not slight.

However, it should be noted that mild hypertension by itself does not cause nosebleeds. Nosebleeds are more likely to happen during a hypertensive crisis when the blood pressure suddenly rises to above 180/120. A hypertensive crisis can also have other symptoms such as a severe headache, shortness of breath, and anxiety. Therefore, it is considered a medical emergency.

Why Does Hypertension Increase the Risk?

Chronic hypertension makes the walls of blood vessels weaker and less elastic, which easily causes them to tear. In the nose, this is especially vulnerable because the blood vessels are close to the surface. Sudden surges in blood pressure, such as in a hypertensive crisis, can cause tears in these weakened vessels, resulting in nosebleeds.

While hypertension is a contributing cause, nosebleeds occur infrequently as the only manifestation of high blood pressure. This makes regular monitoring for blood pressure all the more crucial, as hypertension has the reputation of being the "silent killer" since people often do not present symptoms until the disease has run its course.

Other Causes of Nosebleeds

• Dry Air: Cold weather or house heating dries out membranes that line the nose, hence susceptible to cracking.
• Trauma: Blows in the nose, nose picking or excessive nose blowing can traumatize blood vessels.
• Intrinsic Disease: Liver disease and kidney disease and drug therapy that affect clotting such as blood thinners enhance the risk of nose bleeding.
• Foreign Bodies: Children especially tend to insert objects up their noses, which can be irritating and bleed.
• Allergies or Infections: Chronic nasal inflammation resulting from allergies or colds causes irritation to the nasal mucosa.

Managing Nosebleeds at Home

For most nosebleeds, you can manage them yourself at home:

1. Sit up and lean slightly forward to prevent swallowing blood.

2. Press your nostrils together for at least 10 minutes.

3. Use a cold compress on the bridge of your nose to constrict blood vessels.

4. If the bleeding continues, use a nasal decongestant spray.

Consult a doctor if the bleeding persists beyond 20 minutes, is heavy, or follows a head injury.

Preventing Nosebleeds

Preventive measures can decrease the incidence of nosebleeds:

• Use a humidifier to maintain moisture in the air.
• Apply saline sprays or gels to keep nasal passages hydrated.
• Avoid nasal trauma by being gentle when blowing your nose.

For patients with hypertension, managing blood pressure is the best way to minimize the risk of complications. A combination of lifestyle changes, such as maintaining a healthy diet, regular exercise, and prescribed medications, can help keep blood pressure in check.

When to Worry About Nosebleeds

Most nosebleeds are harmless, but they can sometimes be signs of an underlying health condition. In adults with high blood pressure, frequent or severe nosebleeds should never be ignored. A health provider should be consulted in order to rule out any serious conditions and ensure appropriate treatment.

Regular check-ups, a healthy lifestyle, and awareness about the relationship between nosebleeds and high blood pressure would go a long way to protect your health. Indeed, prevention is always better than cure.

Epistaxis and hypertension. Post Graduate Medical Journal. 1977

GLP-1 receptor agonists have established themselves as one of the most sought-after treatment methods to manage type 2 diabetes. Conversations around these drugs often focus on their ability to improve blood sugar control, promote weight loss and support metabolic health. However, what happens after a patient takes the first dose deserves equal attention.

These medications, which include semaglutide, liraglutide and dulaglutide, mimic a naturally occurring hormone called GLP-1. They stimulate insulin release when blood glucose is high, suppress glucagon, slow stomach emptying and promote a feeling of satiety to reduce cravings.

While there are plenty of benefits, GLP-1 medications are not suitable for everyone. Existing digestive conditions, other diabetes medications, kidney function and even retina health can influence how safely a patient responds to treatment.

On World Diabetes Day, doctors explain why starting GLP-1 therapy requires more than checking blood sugar levels, and what patients should know about its complications. They also discuss lesser-known side effects a patient may face after the first dose.

Who Can And Cannot Take GLP-1 Drugs To Manage Diabetes?

Also read: Why Does Type 2 Diabetes Increase The Risk Of Alzheimer’s Disease? Neurologist Explains

Before initiating GLP-1 treatment, doctors need to understand a patient's overall health, diabetes as well as medication history. This includes checking HbA1c levels, blood glucose patterns, kidney function and any history of pancreatitis, gallbladder disease or gastrointestinal problems.

Dr Bibhu Anand, Internal Medicine Specialist at Sir Ganga Ram Hospital, told HealthandMe that treatment decisions must be made according to the patient’s history.

He said, "We see the patient's HbA1c, blood glucose profile, kidney function, medicine history, and medicine prior to the first dose in detail. We specifically identify patients already receiving insulin or sulfonylureas, as these doses may require modification to reduce the risk of hypoglycemia.”

Patients with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 are generally advised against using these medications.

Dr Anand said that those with a history of pancreatitis, severe gastrointestinal disease or gallbladder problems may also need assessment. The objective is generally to establish whether the benefits outweigh the risks.

GLP-1 GI Side Effect Or Diabetic Gastroparesis?

Also read: Stopping Mounjaro & Zepbound May Trigger Hallucinations, Mania & Other Psychiatric Symptoms

Nausea, bloating, vomiting, constipation and diarrhoea are among the commonly reported gastrointestinal effects of GLP-1 medications. These symptoms are expected in the initial weeks of treatment or after an increase in dose. However, constant digestive discomfort in someone with diabetes should not be neglected.

Dr Richa Chaturvedi, Senior Consultant and Endocrinologist at Indraprastha Apollo Hospitals, Delhi, told HealthandMe that diabetic gastroparesis can cause symptoms that closely resemble gastrointestinal side effects due to GLP-1 drugs.

Gastroparesis develops when nerve damage related to diabetes affects food movement through the stomach. Patients may experience frequent nausea, early fullness, vomiting food consumed several hours earlier and unpredictable blood glucose levels. Unlike discomfort due to medicines, these symptoms may already exist before treatment begins.

"The key difference lies in the onset and pattern of symptoms. GLP-1 medications slow gastric emptying, meaning food remains in the stomach longer. This can cause nausea, bloating, belching and early fullness, particularly when treatment begins or the dose increases. These symptoms may settle as the body adapts."

Dr Chaturvedi emphasises that gastrointestinal symptoms should be assessed before starting treatment, especially in patients with chronic diabetes.

A gastric emptying study can be done if symptoms suggest gastroparesis. GLP-1 medications are generally not recommended for patients with severe gastroparesis, as they can further delay stomach emptying and affect nutritional intake.

Pancreatitis, Gallstones And Dehydration Risk

Also read: Semaglutide May Lower Fetal Oxygen Levels During Pregnancy, Sheep Study Finds

Although mild digestive discomfort may improve as the body adjusts to treatment, certain symptoms require immediate attention.

Severe pain in the upper abdomen or pain radiating towards the back, can indicate pancreatitis. Repeated vomiting, an inability to retain fluids, significant dizziness, reduced urination and upper-right abdominal pain accompanied by fever are other warning signs.

Dr Chaturvedi explains that pancreatitis has been reported during GLP-1 treatment, although it is uncommon and a causal relationship has not been established.

She said, “Gallbladder complications, including gallstones and inflammation, have a more established association with GLP-1 treatment. Rapid weight loss is an important contributing factor, as it can increase the likelihood of gallstone formation. Changes in gallbladder emptying may also play a role.”

Another concern is kidney injury due to dehydration. Persistent nausea and vomiting can reduce fluid intake, potentially affecting kidney function, particularly in patients who already have kidney disease.

Patients should therefore not dismiss severe abdominal pain or prolonged vomiting as routine side effect of the drug.

Diabetics Need Eye Testing Before Starting GLP-1 Therapy

Also read: Stopping Ozempic or Wegovy May Double Your Risk Of Heart Attack, Death

Digestive complications are not the only concern after starting GLP-1 medications. For patients with diabetes, retina health also warrants attention.

Dr Parul Maheshwari Sharma, Principal Director and Head of Ophthalmology at FMRI Gurgaon, told HealthandMe that a rapid improvement in blood glucose levels can sometimes cause an initial, temporary worsening of diabetic retinopathy. This phenomenon is known as early worsening of diabetic retinopathy.

Dr Sharma explained, “When blood sugar levels fall substantially over a short period, changes in retinal blood flow and vascular regulation may affect blood vessels that are already damaged. The concern is particularly relevant for patients with poorly controlled diabetes, high baseline HbA1c levels or pre-existing retinopathy.”

Patients with long-standing or poorly controlled diabetes, existing retinopathy or high HbA1c levels should ideally undergo a dilated retinal examination before initiating treatment, especially when substantial glucose reduction is anticipated.

Rare Vision Complication Patients Should Know About

Another emerging area of concern is non-arteritic anterior ischaemic optic neuropathy (NAION), a rare condition caused by reduced blood supply to the optic nerve that can result in sudden, permanent vision loss.

Some observational studies have reported an association between GLP-1 medications, particularly semaglutide, and NAION. However, a direct cause-and-effect relationship has not been established, and the evidence is still evolving.

Dr Sharma explains that this condition is different from diabetic retinopathy. While retinopathy affects the blood vessels in the retina, NAION involves damage to the optic nerve due to reduced blood supply.

Patients should be aware of warning signs such as sudden, painless blurring or loss of vision, particularly in one eye. Patients experiencing sudden visual changes should not wait for symptoms to resolve on their own.

She said, “Other symptoms include dark patches or blind spots in the visual field, distorted colour perception and difficulty seeing centrally. Sudden flashes, floaters or a curtain-like shadow across the vision also warrant urgent ophthalmological assessment. These symptoms could indicate conditions such as NAION, retinal complications or other sight-threatening emergencies.”

HbA1c, also known as hemoglobin A1c or glycated hemoglobin, is a widely used blood test to diagnose and monitor diabetes. However, ahead of World Diabetes Day, experts have warned that the test may not be accurate for everyone.

HbA1c measures how much glucose is attached to hemoglobin in red blood cells, providing an estimate of average blood sugar levels over the previous two to three months.

Certain medical conditions and blood disorders can affect its accuracy, making readings appear higher or lower than actual blood sugar levels.

Who May Get Inaccurate HbA1c Results?

Conditions such as anemia and hemoglobin disorders can affect HbA1c readings by altering the lifespan of red blood cells.

"HbA1c can be misleading when conditions alter red blood cell lifespan. Iron, B12 or folate deficiency may falsely elevate HbA1c. Conversely, hemolytic anemia, certain hemoglobinopathies, chronic blood loss, recent transfusion and some kidney conditions can lower it falsely," Dr Manisha Arora, Director of Internal Medicine at CK Birla Hospital, Delhi, told HealthandMe.

Dr Sandeep Kharb, Senior Consultant – Endocrinology at Asian Hospital, added that iron-deficiency anemia can also lead to falsely high HbA1c readings.

Experts also cautioned that HbA1c is not a direct measure of insulin resistance. A person may be insulin resistant even before their HbA1c reaches the prediabetes threshold.

What Medical Conditions And Medications Can Affect HbA1c?

Iron, vitamin B12 and folate deficiencies, chronic alcohol use, high-dose aspirin and severe hypertriglyceridemia may contribute to falsely elevated readings.

Falsely low results can occur with hemolytic anemia, hemoglobin disorders, blood loss, transfusions, pregnancy, kidney disease and erythropoietin therapy.

Certain medicines, including dapsone, ribavirin and some antiretroviral drugs, can also affect HbA1c interpretation. The direction of the error depends on the underlying condition and the testing method.

Can Fasting Blood Sugar Be Normal While HbA1c Is High?

Dr Himika Chawla, Senior Consultant, Endocrinology and Diabetology at PSRI Hospital, told HealthandMe HbA1c reflects average blood sugar over two to three months, while fasting blood sugar measures glucose at a particular point in time.

A person may have normal fasting glucose but experience repeated blood sugar spikes after meals, pushing their HbA1c higher. The reverse mismatch can also occur.

Doctors therefore consider both results and the patient's overall clinical picture before making a diagnosis.

What Test Should Be Used To Diagnose Diabetes?

When HbA1c may not be reliable, doctors can use blood glucose-based tests, including fasting plasma glucose and the oral glucose tolerance test (OGTT).

"First test it should be oral glucose tolerance test," Dr Anoop Misra told NDTV.

For the test, a person eats their usual meals for three days and then fasts for eight to 10 hours before their fasting blood glucose is measured. They then drink 75 grams of glucose mixed in water, followed by another blood test two hours later.

Misra explained that fasting glucose below 100 mg/dL and a two-hour reading below 140 mg/dL are normal. Fasting levels of 100–125 mg/dL or two-hour readings of 140–199 mg/dL indicate prediabetes. Fasting glucose of 126 mg/dL or higher, or a two-hour reading of 200 mg/dL or higher, falls in the diabetes range.

A new review of studies has found that people living with type 2 diabetes have a significantly higher risk of developing Alzheimer's disease.

Researchers from Curtin University conducted a systematic review and meta-analysis of 40 studies. They estimated that if 1,000 people with type 2 diabetes were followed for a year, an average of 4.7 would develop Alzheimer's disease.

Published in Alzheimer's Research & Therapy, a separate analysis found that type 2 diabetes was associated with a 53% higher adjusted relative risk of Alzheimer's disease compared with people without the condition.

How Does Blood Sugar Affect Memory?

Ahead of World Diabetes Day, Dr Sudhir Kumar, neurologist at Apollo Hospitals, Hyderabad, in a post on X, explained that several overlapping mechanisms may link type 2 diabetes to Alzheimer's disease. These include:

• Brain insulin resistance: Brain cells become less responsive to insulin, potentially impairing their ability to use glucose for energy and clear amyloid and tau proteins.
• Vascular damage: High blood sugar can damage large and small blood vessels in the brain, increasing the risk of strokes and vascular dementia.
• Chronic inflammation: Peripheral inflammation and lipid abnormalities can weaken the blood-brain barrier and trigger neuroinflammation.

How Does Diabetes Increase The Risk Of Dementia?

According to Alzheimer's Society UK, diabetes is an established risk factor for dementia. The risk also increases with the duration and severity of diabetes. However, having diabetes does not mean a person will necessarily develop dementia.

With diabetes and Alzheimer's disease cases rising globally, understanding the link between the two conditions is becoming increasingly important.

Insulin helps regulate blood sugar by enabling the body's cells to use glucose for energy. In people with diabetes, the body either does not produce enough insulin or cannot use it effectively, causing blood sugar levels to rise.

Studies have linked type 2 diabetes to an increased risk of dementia. In people with type 1 diabetes, severe and repeated episodes of high or low blood sugar have also been associated with a higher risk.

Diabetes and Alzheimer's disease may share certain underlying mechanisms. In both conditions, brain cells can become less responsive to insulin, potentially affecting brain function and contributing to the accumulation of amyloid and tau proteins associated with Alzheimer's disease.

How Can People With Diabetes Protect Their Brain Health?

Dr Kumar recommended the following measures for people living with type 2 diabetes:

• Maintain blood sugar levels: Aim to keep glucose within your target range.
• Avoid extreme fluctuations: Prevent prolonged high blood sugar (HbA1c of 7% or higher) and severe, repeated episodes of low blood sugar (hypoglycemia).
• Manage other health conditions: Keep blood pressure and cholesterol under control.
• Prioritise a healthy lifestyle: Eat whole foods, including vegetables, fruits and whole grains, and engage in regular physical activity to improve insulin sensitivity.

"Early detection, consistent blood sugar management, and working closely with your healthcare team can help safeguard your cognitive future," he said.