Diabetes, one of the country’s most prolific and damaging diseases, affects over 30 million Americans. Essentially, it’s a disease in which blood sugar levels are too high, either due to a lack of or resistance to an enzyme that gets your sugar under control after eating. Both Type 1 Diabetes and Type 2 Diabetes have certain characteristic symptoms that often act as warning signs that should push an alert individual to seek out medical care and a diagnostic workup. What are some of the common symptoms diabetic patients may come across? It’s important to remember that physicians often construct “differentials” when they come across a set of symptoms.
This means that if you receive a piece of information or come across a certain physical finding on exam, they think through the possibilities that might be causing it. For instance, fatigue can be attributed not only to diabetes, but also to anemia, autoimmune conditions, a lack of sleep, HIV infection, and many other conditions. Constructing a differential is important, therefore a patient should head to the doctor to confirm the underlying cause of their condition.
Self-diagnosis can be a dangerous and misleading process. If you end up experiencing any of these symptoms and they persist, it’s worth paying a visit to the doctor, who can order some relatively simple workup tests to gauge whether you have diabetes, or may be headed for it. One of the most important markers is known as Hemoglobin A1C (HA1C). Basically, your doctor looks at your blood and determines long-term glucose control (over the course of months). It’s an especially effective test, because folks who simply consume excess sugar once in awhile (say during major events or family gatherings), are unlikely to exhibit a drastically elevated HA1C. However, someone who consistently has elevated blood sugar levels will display an elevated HA1C upon testing. In addition, they can run easy exams like the glucose tolerance test, which assesses how your body will react to sugar intake. An inability to metabolize the sugar properly could also lead to a diagnosis.
1. Increased Thirst
Over years of research and experience, experts and patients have come to describe a series of common signs and symptoms that may suggest the onset of the disease. Everyone is different, and experiences symptoms in different ways, but certain trends may be common across populations. One example we can start with is increased thirst, also known as polydipsia. An individual with Polydipsia may find themselves drinking excessive amounts of water and other fluids (even outside of scenarios where they would normally find themselves thirsty, such in a post-exercise state or after sweating profusely).
Even after taking a drink, the thirst doesn’t seem to go away. You might find that your mouth feels dry. This is a common sign and may be attributed to the actions of glucose in the body. With excessive sugar buildup, the glucose ends up acting as a diuretic, which means that it leads to more urination. With the subsequent water loss, an individual is left feeling more thirsty. Dehydration activates parts of the brains that act as thirst centers, which basically alert the body to the need for more fluid. If you begin experiencing a strange, newfound increase in thirst, let your physician know so that they are aware and can arrange for a more thorough examination. Additionally, it’s worth remembering some of the potential causes of excess thirst.
These include, but are not limited to, dehydration, certain medications (particularly ones known as “anticholinergics”), brain injuries, and psychiatric conditions (Psychogenic Polydipsia). Next, we’ll explore an important coexisting symptom that ties into excess thirst. When you mention this to your physician, they may arrange for an electrolyte panel, which simply looks at your blood and measures the levels of key chemical components in the body (such as Sodium, Potassium, Chloride, Glucose, Bicarbonate, Blood Urea Nitrogen, Creatinine, Calcium, etc.). Excess water and fluid intake can contribute to altered electrolytes, which may lead to other unwanted side effects. Too much or too little of any essential electrolyte can have harmful effects on a wide swath of organ systems.
2. Frequent Urination
Next, let’s look at increased urination, which often accompanies the symptom of increased thirst mentioned previously. Increased urine production, technically dubbed polyuria, is a major symptom that causes significant discomfort for patients. You may find yourself going to the bathroom over and over again. You may feel the urge to pass urine all throughout the day, and even at night, which leads to the disruption of sleep. Why do diabetics have to remove so much urine? As noted earlier, the excess glucose in the body has major physiological effects. To remove the extra sugar from the body, an effective method is urination.
In turn, the removal of water can lead to thirst. A thirsty individual, primed by brain receptors in the hypothalamus, may feel prompted to drink more, which continues the cycle of frequent urination. In fact, tasting urine for its sweetness used to be a sort of test for determining whether someone had diabetes (way back in the day). There are noninvasive, simple tests your physician can order to check your urine for potential causes. For instance, a “Urinalysis” can check for the presence of glucose in the urine, as well as ketone bodies, which are relevant for a complication known as “Diabetic Ketoacidosis.”
If your urine has more sugar in that normal, that could be a sign. Using the same urine sample collected for Urinalysis, a lab can also check something called “Urine Specific Gravity.” Depending on the results, you can gain more information (i.e. if the urine is dilute, if the patient is dehydrated, and so on). Oftentimes, some of the common symptoms seen in diabetes are lumped together as the three Ps: Polyuria, Polydipsia, and Polyphagia. Even one pertinent symptom, in the right context, may warrant visiting your primary care physician’s office for further workup. If you experience several symptoms at the same time, it’s worth keeping the condition in the back of your mind and exploring your diagnosis further.
3. Hunger
Hunger, known technically as hyperphagia or polyphagia, is a warning sign for diabetes that can exacerbate problems at a quick pace. Since several of the conditions that can lead to an increased appetite tend to be less common (e.g. Hyperthyroidism, the genetic disease Prader-Willi syndrome, or the neurologic problem Kleine-Levin syndrome), an unusual change in appetite warrants further exploration for diabetes. If you find yourself eating more frequently than normal, and still end up incredibly hungry shortly afterwards, you might fit the bill. The cravings can be relentless and would be seen consistently (so more than just over the course of a single day). Since the body is unable to employ the enzyme used to control blood sugar to absorb glucose into its cells, that extra sugar floats around elsewhere (and then subsequently causes other complications).
Your blood sugar would increase post-meal, which would entail the negative effects of hyperglycemia on the various regions of the body (eyes, kidneys, distal limbs, etc.) However, if your cells aren’t receiving glucose, which is the key ingredient needed to provide the body with adequate energy for its various functions, you end up feeling hungry for more food to fulfill the need. This becomes a toxic cycle. Excess caloric intake that does not lead to satiation nonetheless leads to more consumption than needed, which can have negative health impacts (particularly if the food being consumed is unhealthy, such as high-sugar and high-sodium meals). If the hunger really is due to diabetes, you’ll need the proper medications and treatment regimens to get things in order.
Some diabetics take enzyme replacement medication, while others (particularly Type 2 diabetics), can choose from a wide range of medications that assist with metabolism and glucose uptake. A physician can help point you in the right direction based on whatever is appropriate for you.
4. Fatigue
Fatigue is a common symptom that may indicate diabetes. Additionally, several conditions, such as anemia (due to many different causes), HIV infection, malignancy, Hypothyroidism, Depression, chronic renal failure, Mononucleosis (AKA “Mono”), COPD, obstructive sleep apnea, fibromyalgia, nutritional deficiencies, sleep disruptions, and many others also cause one to exhibit fatigue. Thus, some of the exams and lab tests that may be ordered by your physician include a CBC (Complete Blood Count) and B12 levels. TSH levels can be used to see if thyroid gland function is playing a role in the fatigue.
In diabetes, fatigue tends to be seen for a longer stretch on presentation with individuals dealing with Diabetes Mellitus, Type 1, but it can ultimately be observed in both major types of Diabetes. You might feel more tired than you used to. There may be increasing feelings of frustration due to a lack of energy to make it through the day and carry out all the various tasks you’re responsible for. In terms of the underlying mechanisms causing the symptom to manifest, researchers have discussed a number of different potential pertinent details. Fatigue might be a multifactorial manifestation of different factors related to diabetes. These include a lack of physical activity, being overweight, and physiological phenomena (i.e. hyperglycemia, hypoglycemia, and fluctuations in blood sugar levels).
One epidemiological study found that upwards of 60% of newly diagnosed type 2 diabetics were found to have fatigue, and the symptom was associated with elevated fasting plasma glucose (sugar) levels. It’s important to address, particularly for diabetics, since a lack of energy may lead to decreased physical activity. Particularly early on for Type 2 Diabetes, physicians recommend increasing physical activity, since patients can benefit from losing weight and getting their blood sugar levels under control. Another important point to consider is that diabetes, when untreated, can lead to certain complications over time. In turn, those complications themselves can lead to additional fatigue.
Let’s take the example of End Stage Renal Disease. Over years, diabetes leads to protein loss in the urine via damage to the basement membrane of the kidneys. Over time, the hyper filtration (meaning extra work the kidney has to engage in) leads to significant damage and failure of function. It’s not uncommon to see diabetics forced to seek out transplants or dialysis regimens in the later years of their life. Kidneys, which are responsible for producing chemicals that support the production of new blood cells, are essential for healthy bodies and when damaged, can lead to fatigue from the loss of this new cell production.
5. Blurred Vision
Like fatigue, blurred vision is a common symptom that can be attributed to a variety of conditions. Since it affects a pivotal function of the human body (sight), it’s essential to visit a doctor and an ophthalmologist for further work up. An ophthalmologist can examine the eyes in detail and determine if certain characteristic changes attributed to diabetes are affecting the eyes. It’s possible that you’ve had diabetes for years and were unaware. In that time, diabetes can cause damage to the blood vessels in the retina.
The tissue then swells up, which can lead to blurry vision. In addition, high blood sugar levels can lead to fluid accumulation within the lens of the eye. This too can lead to blurred vision. Any changes in vision merit a visit to the doctor. You want to make sure you can see clearly and nip any potential problems in the bud early (whether the underlying cause is diabetes or something else entirely). If the problem is the early development of retinopathy or other diabetes-related conditions, it’s particularly essential to get treated quickly, as longstanding retinopathy can eventually progress to blindness.
Getting to a doctor ensures that you know what’s happening, can begin taking the appropriate medications if needed, and can receive advice on how to avoid worsening conditions. In fact, it’s well-known that diabetics are advised to get an eye exam on an annual basis. Detecting the problem early can help avoid more severe complications. At the end of the day, if you feel like your sight is getting blurry, that peripheral vision is becoming hazier (potentially a sign of glaucoma), or you are simply not seeing the way that you used to, head on over to a doctor so that you can take the next steps for your health and well-being.
