Diabetes Symptoms

Symptoms of type 1 diabetes are often dramatic and come on very suddenly.

• Type 1 diabetes is usually recognized in childhood or early adolescence, often in association with an illness (such as a virus) or injury.
  
  
• The extra stress can cause diabetic ketoacidosis.
  
  
• Symptoms of ketoacidosis include nausea and vomiting. Dehydration and often-serious disturbances in blood levels of potassium follow.
  
  
• Without treatment, ketoacidosis can lead to coma and death.

Symptoms of type 2 diabetes are often subtle and may be attributed to aging or obesity.

• A person may have type 2 diabetes for many years without knowing it.
  
  
• People with type 2 diabetes can develop hyperglycemic hyperosmolar nonketotic syndrome.
  
  
• Type 2 diabetes can be precipitated by steroids and stress.
  
  
• If not properly treated, type 2 diabetes can lead to complications like blindness, kidney failure, heart disease, and nerve damage.

Common symptoms of both major types of diabetes

• Fatigue: In diabetes, the body is inefficient and sometimes unable to use glucose for fuel. The body switches over to metabolizing fat, partially or completely, as a fuel source. This process requires the body to use more energy. The end result is feeling fatigued or constantly tired.
  
  
• Unexplained weight loss: People with diabetes are unable to process many of the calories in the foods they eat. Thus, they may lose weight even though they eat an apparently appropriate or even excessive amount of food. Losing sugar and water in the urine and the accompanying dehydration also contributes to weight loss.
  
  
• Excessive thirst (polydipsia): A person with diabetes develops high blood sugar levels. The body tries to counteract this by sending a signal to the brain to dilute the blood, which translates into thirst. The body encourages more water consumption to dilute the high blood sugar back to normal levels and to compensate for the water lost by excessive urination.
  
  
• Excessive urination (polyuria): Another way the body tries to get rid of the extra sugar in the blood is to excrete it in the urine. This can also lead to dehydration because excreting the sugar carries a large amount of water out of the body along with it.
  
  
• Excessive eating (polyphagia): If the body is able, it will secrete more insulin in order to try to deal with the excessive blood sugar levels. Also the body is resistant to the action of insulin in type 2 diabetes. One of the functions of insulin is to stimulate hunger. Therefore, higher insulin levels lead to increased hunger and eating. Despite increased caloric intake, the person may gain very little weight and may even lose weight.
  
  
• Poor wound healing: High blood sugar levels prevent white blood cells, which are important in defending the body against bacteria and also in cleaning up dead tissue and cells, from functioning normally. When these cells do not function properly, wounds take much longer to heal and become infected more frequently. Also, long-standing diabetes is associated with thickening of blood vessels, which prevents good circulation and our body tissues from getting enough oxygen and other nutrients.
  
  
• Infections: Certain infection syndromes, such as frequent yeast infections of the genitals, skin infections, and frequent urinary tract infections, may result from suppression of the immune system by diabetes and by the presence of glucose in the tissues, which allows bacteria to grow well. They can also be an indicator of poor blood sugar control in a person known to have diabetes.
  
  
• Altered mental status: Agitation, unexplained irritability, inattention, extreme lethargy, or confusion can all be signs of very high blood sugar, ketoacidosis, or hyperosmolar hyperglycemia nonketotic syndrome or hypoglycemia (low sugar). Thus, any of these merit the immediate attention of a medical professional. Call your health care provider or 911.
  
  
• Blurry vision: Blurry vision is not specific for diabetes but is frequently present with high blood sugar levels.

Diabetes Causes

Type 1 diabetes is believed to be an autoimmune disease. The body's immune system attacks the cells in the pancreas that produce insulin.

• A predisposition to develop type 1 diabetes may run in families but much less so than for type 2.
  
  
• Environmental factors, such as certain types of viral infections, may also contribute.
  
  
• Type 1 diabetes is most common in people of non-Hispanic white persons of Northern European descent, followed by African Americans and Hispanic Americans. It is relatively rare in those of Asian descent.
  
  
• Type 1 diabetes is slightly more common in men than in women.

Type 2 diabetes: Type 2 diabetes is believed to have a strong genetic link, meaning that it tends to run in families. Several genes are being studied that may be related to the cause of type 2 diabetes. Risk factors for developing type 2 diabetes include the following:

• High blood pressure
  
  
• High blood triglyceride (fat) levels
  
  
• Gestational diabetes or giving birth to a baby weighing more than 9 pounds
  
  
• High-fat diet
  
  
• High alcohol intake
  
  
• Sedentary lifestyle
  
  
• Obesity or being overweight
  
  
• Ethnicity: Certain groups, such as African Americans, Native Americans, Hispanic Americans, and Japanese Americans, have a greater risk of developing type 2 diabetes than non-Hispanic whites.
  
  
• Aging: Increasing age is a significant risk factor for type 2 diabetes. Risk begins to rise significantly at about age 45 years, and rises considerably after age 65 years.

What factors increase my risk for type 2 diabetes?

To find out your risk, check each item that applies to you.

• I am 45 or older.
  
  
• I am overweight or obese (see the body mass index [BMI] in table 4).
  
  
• I have a parent, brother, or sister with diabetes.
  
  
• My family background is African American, American Indian, Asian American, Pacific Islander, or Hispanic American/Latino.
  
  
• I have had gestational diabetes, or I gave birth to at least one baby weighing more than 9 pounds.
  
  
• My blood pressure is 140/90 or higher, or I have been told that I have high blood pressure.
  
  
• My cholesterol levels are not normal. My HDL cholesterol ("good" cholesterol) is 35 or lower, or my triglyceride level is 250 or higher.
  
  
• I am fairly inactive. I exercise fewer than three times a week.

Checking My Weight

BMI is a measure used to evaluate body weight relative to height. You can use BMI to find out whether you are underweight, normal weight, overweight, or obese. Use table 4 to find your BMI.

• Find your height in the left-hand column.
• Move across in the same row to the number closest to your weight.

The number at the top of that column is your BMI. Check the word above your BMI to see whether you are normal weight, overweight, or obese. If you are overweight or obese, talk with your doctor about ways to lose weight to reduce your risk of diabetes or pre-diabetes.

How are diabetes and pre-diabetes diagnosed?

The following tests are used for diagnosis:

• A fasting plasma glucose test measures your blood glucose after you have gone at least 8 hours without eating. This test is used to detect diabetes or pre-diabetes.
  
  
• An oral glucose tolerance test measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a glucose-containing beverage. This test can be used to diagnose diabetes or pre-diabetes.
  
  
• In a random plasma glucose test, your doctor checks your blood glucose without regard to when you ate your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes.

Positive test results should be confirmed by repeating the fasting plasma glucose test or the oral glucose tolerance test on a different day.

Fasting Plasma Glucose (FPG) Test

The FPG is the preferred test for diagnosing diabetes due to convenience and is most reliable when done in the morning. Results and their meaning are shown in table 1. If your fasting glucose level is 100 to 125 mg/dL, you have a form of pre-diabetes called impaired fasting glucose (IFG), meaning that you are more likely to develop type 2 diabetes but do not have it yet. A level of 126 mg/dL or above, confirmed by repeating the test on another day, means that you have diabetes.

Table 1. Fasting Plasma Glucose Test

Plasma Glucose Result (mg/dL)	Diagnosis
99 and below	Normal
100 to 125	Pre-diabetes (impaired fasting glucose)
126 and above	Diabetes*

Oral Glucose Tolerance Test (OGTT)

Research has shown that the OGTT is more sensitive than the FPG test for diagnosing pre-diabetes, but it is less convenient to administer. The OGTT requires you to fast for at least 8 hours before the test. Your plasma glucose is measured immediately before and 2 hours after you drink a liquid containing 75 grams of glucose dissolved in water. Results and what they mean are shown in table 2. If your blood glucose level is between 140 and 199 mg/dL 2 hours after drinking the liquid, you have a form of pre-diabetes called impaired glucose tolerance or IGT, meaning that you are more likely to develop type 2 diabetes but do not have it yet. A 2-hour glucose level of 200 mg/dL or above, confirmed by repeating the test on another day, means that you have diabetes.

Table 2. Oral Glucose Tolerance Test

2-Hour Plasma Glucose Result (mg/dL)	Diagnosis
139 and below	Normal
140 to 199	Pre-diabetes (impaired glucose tolerance)
200 and above	Diabetes*

Table 3. Gestational Diabetes: Above-Normal
Results for the Oral Glucose Tolerance Test

When	Plasma Glucose Result (mg/dL)
Fasting	95 or higher
At 1 hour	180 or higher
At 2 hours	155 or higher
At 3 hours	140 or higher

Random Plasma Glucose Test

A random blood glucose level of 200 mg/dL or more, plus presence of the following symptoms, can mean that you have diabetes:

• increased urination
• increased thirst
• unexplained weight loss

Other symptoms include fatigue, blurred vision, increased hunger, and sores that do not heal. Your doctor will check your blood glucose level on another day using the FPG or the OGTT to confirm the diagnosis.

What is pre-diabetes?

In pre-diabetes, blood glucose levels are higher than normal but not high enough to be characterized as diabetes. However, many people with pre-diabetes develop type 2 diabetes within 10 years. Pre-diabetes also increases the risk of heart disease and stroke. With modest weight loss and moderate physical activity, people with pre-diabetes can delay or prevent type 2 diabetes.

Types of Diabetes

The three main types of diabetes are type 1, type 2, and gestational diabetes.

• Type 1 diabetes, formerly called juvenile diabetes, is usually first diagnosed in children, teenagers, or young adults. In this form of diabetes, the beta cells of the pancreas no longer make insulin because the body's immune system has attacked and destroyed them.
  
  
• Type 2 diabetes, formerly called adult-onset diabetes, is the most common form. People can develop it at any age, even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which muscle, liver, and fat cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals.
  
  
• Gestational diabetes develops in some women during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life. Gestational diabetes is caused by the hormones of pregnancy or by a shortage of insulin.
  

What if I already have diabetes?

If you already have diabetes, you can lessen your chance of developing kidney disease by keeping your blood sugar under control. Some ways to do this are to:

• Check your blood sugar often.
• Ask your doctor about a blood test called “hemoglobin A1C.” This tests how your normal blood sugars have been over the past 2 or 3 months. It is a kind of “report card” for your blood sugar.
• Follow your doctor’s advice about insulin injections, medicines, diet and exercise.

You can also reduce your risk for kidney failure if you:

• Monitor your blood pressure. If your blood pressure is high, talk to your doctor about taking an ACE inhibitor.
• Have your doctor check your urine for protein.
• Ask your doctor to calculate your eGFR (estimated glomerular filtration rate). This number is based on the creatinine level in your blood, as well as your age, sex and race.

What can I do to prevent diabetes?

Healthy eating and exercise habits are the best way to prevent diabetes. These are also great ways to help keep diabetes in control if you already have it.

To eat healthy, pick foods that are nutrient-rich. This means that they have many vitamins, but not much fat or sugar. When it comes to foods that are high in sugar, like ice cream or cookies, make sure that you are not overeating. You can still eat these foods, but eat them in moderation.

Exercising three or four times a week is another way to lower your risk of developing diabetes. For example, you might go for walks, run, bike, swim, join a local sports team or try a dance class. The key here is to start small and find something that you enjoy.

How will I know if I have diabetes?

Diabetes often has no symptoms or warning signs. The only way to be sure is to have your blood tested for glucose (blood sugar). If symptoms do appear, they might include:

• Feeling tired
• Feeling irritable
• Urinating more than normal
• Being very thirsty
• Being very hungry
• Unexplained weight loss
• Blurred vision

If you are experiencing some of these symptoms or think that you might be at risk for diabetes, be sure to talk to your doctor about getting tested.

Who is at risk?

Anyone can develop diabetes, but some people are more at risk than others. You are at greater risk for diabetes if you:

• Are over 45 years old.
• Are overweight.
• Are African American, Hispanic/Latino, Asian, Pacific Islander or American Indian.
• Have a family history of diabetes.
• Have high cholesterol.
• Have had gestational diabetes during pregnancy.
• Have given birth to a baby that weighed more than 9 lbs.
• Exercise less than 3 times a week.

While you cannot change some of these factors, you can change others. For example, you cannot change your age, but you can exercise more often. These kinds of changes will help reduce your risk of developing diabetes.

What is diabetes

Diabetes happens when the body cannot make or use insulin correctly. Insulin is a hormone that turns the sugars in the foods we eat into energy. When a person has diabetes, too much sugar stays in the blood. This can damage different parts of the body, including the heart, blood vessels, eyes, nerves and kidneys. There are a few different types of diabetes:

Type 1: The body cannot make insulin. It is also called “juvenile diabetes”.
Type 2: The body cannot use the insulin that it makes, or the insulin that it makes does not work correctly.
Gestational: Diabetes during pregnancy.

The good news is that diabetes can often be prevented by healthy habits like a good diet and exercise. If someone already has diabetes, he or she can learn to control it and reduce the risk of complications.