Diabetes Basics.
Last updated Thursday, February 10, 2005
SymptomsWhat parts of the body does diabetes basics affect? Diabetes can affect almost every organ in some way or another. There
appears to be several ways high glucose levels attach to tissues, and
since the blood flows throughout the body, the effects of the high
glucose can be seen everywhere.
The most common sites include the eyes, the nerves, the kidney, the
heart, the blood vessels, the skin, the joints, the liver, the stomach,
and even the brain. What are some initial warning signs of diabetes basics? Many patients with type 2 diabetes have no symptoms or signs. Others
realize they were fatigued after they were treated. The most common
symptom, however, is frequent urination and thirst. Blurry vision,
yeast infections in women, and numb feet are also often seen.
Type 1 diabetes usually presents in a more dramatic fashion:
frequent urination, thirst, weight loss (often severe), and hunger are
all common. If blood glucose levels are high enough and ketoacidosis is
present, the presentation may include coma although this is less common
now than in the past. What are symptoms of diabetes basics? High glucose levels "spill" into the urine resulting in water
following the glucose. This results in the frequent urination and
thirst. If insulin levels are too low in the blood, fat is burned for
energy and this may result in the ketones, a byproduct of the fat
metabolism. High ketones in the blood, called ketoacidosis, is a life
threatening condition which usually only occurs in type 1 diabetes.
With this, one may develop stupor or coma. Often there is a fruity
breath that can be smelled by family members.
As noted above, type 2 diabetes may have no symptoms at all but at
the very least, usually has a much less dramatic presentation.
For both type 1 and type 2 diabetes, if it is well controlled there
should be no symptoms. For those requiring insulin therapy, the most
common symptom is low blood glucose (hypoglycemia). The presenting
symptom of this usually relates to a surge of epinephrine (adrenalin).
These symptoms include a fast heart rate, tremor, and increased
anxiety. Other symptoms include a cold sweat and hunger. For more
severe hypoglycemia one can see blurry vision, nausea, and mental
confusion. Often family members pick up on these more subtle symptoms
before the patient does. If some type of food is not eaten the symptoms
may progress to extreme lethargy or seizures (convulsions).
Hypoglycemia is the major side effect of superb glucose control but the
risk can be dramatically reduced with frequent home blood glucose
monitoring and a complete understanding of how the different insulins
work (the timing of their "peaks"). Strategies to minimize the risk of
hypoglycemia, especially in the middle of the night, should be
discussed frequently with a health care team. How do the symptoms of diabetes basics change over time? The symptoms of high blood glucose (frequent urination and thirst)
do not change over time. Unfortunately, many people with diabetes lose
many of their symptoms of low blood glucose (hypoglycemia), which means
they must be aware of the more subtle clues of low blood glucose and
more frequent home blood glucose monitoring may be indicated.
Also, if complications of diabetes occur over time, these may result
in new symptoms. As noted above, this may involve swelling of the feet
(edema) for kidney disease or heart failure, blurry vision for eye
disease which could include bleeding of the retina (retinopathy) or
cataract formation. Neuropathy may have many different symptoms: pain
or tingling of the feet, numbness of the feet, sweating with eating any
types of foods, nausea and feeling "full" after eating a small amount
of food (this is called gastroparesis), and dizziness with standing
(called orthostasis). If any of these occur they should be discussed
with a health care provider.
Perhaps the most important point is the LACK of symptoms
accompanying heart disease for many people with diabetes. People
without diabetes often get chest pain ("angina"), which indicates that
there is a blockage in one of the arteries leading to the heart. People
with diabetes often have no symptoms or any warning that they have
these blockages, and many people with diabetes have heart attacks with
no symptoms at all. Others get shortness of breath with minimal
exertion as their only symptom of heart disease. For these reasons the American Diabetes Association
recommends regular stress testing for high risk individuals for heart
disease. Again, this should be discussed in detail with a health care
provider. What are the indirect effects of diabetes basics? Much of the discussion above relates to the effects of blood glucose
(sugar) on the various organs of the body: the eyes, the kidneys, the
nerves, and the vascular system including the heart and all of the
blood vessels. However, many other effects of diabetes also need to be
considered.
For example, people with diabetes have an increased risk for
depression and anxiety disorders. Some of this is directly related to
the diabetes (depression due to the diabetes or one of the
complications) whereas for others, the depression would have been
present anyway. Importantly, those that are depressed have a much more
difficult time taking care of their diabetes with self-management
skills. Often, after the depression is controlled with either
medication or counseling, the diabetes control improves. There is
recent research also noting that depression may be a risk factor for
heart disease, similar to high cholesterol levels or smoking. Much more
research on this last point is needed.
Other secondary effects are numerous. For example, diabetes can
cause a variety of different skin lesions. It can also cause joint
problems so that the joints are not as mobile as usual. With poorly
controlled diabetes, blood fats (triglycerides in particular) may rise
to very high levels. Sexual dysfunction is common both in men and in
women. High blood sugars increase the risk of infection, especially
urinary tract infections and yeast infections in women. People with
frequent hypoglycemia resulting in loss of consciousness or seizures
may have difficulty with thought processing. Although this is not a
complete list, it should be clear that diabetes has many secondary
effects!
What conditions have similar sympoms or might be confused with diabetes basics? In considering the symptoms of high blood glucose (hyperglycemia)
only, there are only a few conditions with similar symptoms. Urinary
tract infections in women may be associated with frequent urination,
but these types of infections usually also result in pain with
urination and thirst. A more rare condition called diabetes insipidus
results when a hormone (chemical) from the pituitary gland called
vasopressin is absent. Without vasopressin one can also get frequent
urination and thirst, similar to what is seen with high blood glucose
from diabetes mellitus (the word mellitus means "sweet" or "honey").
The combination of thirst, frequent urination, and weight loss is
uncommon except with diabetes (mellitus).
For low blood glucose (hypoglycemia), which may be common in
patients with type 1 diabetes who are striving for near-normal blood
sugar levels, there are a variety of symptoms that can be similar to
other conditions. Anxiety and hyperthyroidism (high thyroid hormone
levels) are seen when adrenalin (epinephrine) levels rise in response
to the hypoglycemia. More concerning are the symptoms which occur when
the brain does not receive enough glucose. These symptoms include
forgetfulness, confusion, nausea, seizure disorders, and personality
changes. Hypoglycemia usually resolves quickly after eating something
that is absorbed quickly (glucose tablet, orange juice) and with the
use of home blood glucose monitoring it should be an easy diagnosis to
make.
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