Last updated: February 21, 2017

Symptoms of Diabetes

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Symptoms of Diabetes:
What is the most common symptom of diabetes? No symptom at all!

Image courtesy: American Diabetes Association

Symptoms of diabetes depend on the type of diabetes and the unique characteristics of the patient who develops diabetes. In general, Type 2 diabetes is the most common type of diabetes in adults. The table above is taken taken from the American Diabetes Association. It lists the common symptoms of diabetes in patients with both type 1 and type 2 diabetes. If you look at the table carefully, you will notice that the most important piece of information is in the footnote which says,”Often, people with type 2 diabetes have no symptoms.” This is the most important thing to remember about the symptoms of diabetes in adults. Type 2 diabetes is the most common form of diabetes in adults. Most people with type 2 diabetes have no symptom at all. This is also the most under-reported fact about the symptoms of diabetes. Why do you think ADA put that information in the footnote instead of putting it in the headline? Because, traditionally that is how symptoms of any disease are described –with a list of the common symptoms. With the traditional view of diseases and symptoms, people are looking for a list of symptoms to match it with their own symptom to see if they are likely to have that disease. But that kind of thinking will not help most people with diabetes. I will explain why it is important to understand how diabetes can destroy your organs without producing any symptom.To understand how symptoms of diabetes develop, you need to understand what diabetes is and how it affects your body.

Type 2 Diabetes: Long period with no symptom

The basic problem in all diabetes is the lack of blood sugar control. In most type 2 diabetics, the lack of blood sugar control develops slowly. Before you understand the mechanism of type 2 diabetes, you need to understand how blood sugar is regulated. Do not worry, I will make it easy for everyone to understand. I will not be using any medical terms. This information is for patients and other people interested to learn more about diabetes. As I am not talking to my fellow health care providers, I will explain everything in a language that does not require any pre-existing medical knowledge. Yes, it is possible to learn body mechanisms without any medical knowledge.

Symptoms of diabetes: role of insulin

Symptoms of Diabetes

Image courtesy of: National Kidney & Urologic Diseases Information Clearinghouse (NKUDIC)

Insulin plays the key role in regulating blood sugars in our body. Insulin is a substance that is made in our pancreas. Pancreas in an organ that sits near our stomach. When we eat food and sugar gets absorbed into our blood, it stimulates the release of insulin into our blood. Insulin then drives the blood sugar down by pushing it into different organs. But, food is not the only source of sugar in our body.
Our body needs sugar to survive. That does not mean that we need to eat sugar to survive. Our body has a mechanism to convert other nutritional elements such as other carbohydrate, protein and fat into sugars. Carbohydrates are broken down into sugars inside our intestine but the processing of fats and protein takes place in the liver. Liver is like our big chemistry plant. It performs many of the different chemical reactions required to convert different types of chemicals into different forms as required to maintain our bodily function.
Insulin controls both the utilization and production of sugar. When our blood sugar rises, insulin is released into our blood and suppresses sugar formation in the liver and promotes the utilization of sugar already in the blood. Sugar is utilized by two main ways- pushing it into our organs and converting it into fat in the liver. Our muscles take up the sugar and convert it into energy to move the muscles. The liver changes the excess sugar into fat and send it our for storage. Insulin promotes both these actions. At the same time, insulin stops the liver from changing fat into sugar.

Type 2 Diabetes: What happens when you wait for symptoms to appear

Many people think that the symptoms of diabetes are caused by a lack of insulin. In type 2 diabetes, many patients have normal or even higher levels of insulin in the blood. The main problem in type 2 diabetes is not the lack of insulin but the body’s resistance to it. The organs do not respond to insulin like they are supposed to. They require a higher and higher levels of insulin to achieve the same effect. Normal amount of insulin is just not enough to force the sugar into the organs. The result is a slow rise in the blood glucose level. This rise in blood sugar is sufficient to cause slow toxic reactions in several different internal organs but the rise is not rapid enough to cause any noticeable symptoms. On the surface, the patient feels perfectly normal and no visible signs of diabetes can be identified. But, on the inside, the story is completely different. Small blood vessels inside the major body organs start to corrode and blood flow gets compromised. Healing powers of the organs slowly deteriorate and they start to degenerate from inside. This goes on very slowly and progresses over many years. In the end, something catastrophic happens to one of the affected organs and the patient gets some major symptom requiring a doctor visit. Then they do some basic blood work and discover that the patient has diabetes. This is how the diagnosis of most type 2 diabetes is done when the patient waits for the “symptoms of diabetes” to appear before he/she gets tested for diabetes.

Types 2 Diabetes: Get tested before the symptoms appear

I just described what happens when you do not get tested for diabetes. Now, I will describe what should ideally happen. Everyone above the age of 45 needs to be tested for diabetes at least once every three years. If someone has a strong family history of diabetes or has any other risk factors for diabetes, then that person needs to be tested at least once every three years regardless of the age. It is not difficult to diagnose diabetes. A simple blood test that is almost always routinely done at most regular check-ups can alert to the possible diagnosis of diabetes. when you are able to detect the presence of diabetes before the development of any symptom, you have ample opportunity to fight it and control it before it can cause any damage to your body. When you keep your blood sugars well controlled, you may not get any complications from diabetes and may never experience any symptoms of diabetes.

Type 2 diabetes symptoms: A 52 year old female with swelling all over the body

Mrs Y is a very cheerful 52 year old high school teacher and a mother of 4 kids. She is always busy with her work and taking care of her children and her house. She always puts other’s need before her own. She had been happy and healthy all her life. She had not been to a doctor for the last 12 years.
In the last month or so, she has not felt very well. She seemed to have developed some generalized weakness and is overall not feeling well. Her appetite has gone down and she feels nauseated at times. She has noticed that her clothes do not fit her anymore and she had to buy a new pair of shoes as her legs seemed to be getting bigger. She was getting more puffier everyday. She tried her best to hide her symptoms as far as she could as she did not want to bother anyone. But her husband noticed the changes and was very concerned. Her took her to the doctor. The doctor run some blood tests and immediately sent the patient out to the hospital for further investigation.
I went to her hospital bedside, looked at the blood work and asked her a few more questions to see if she had any symptoms in the past. She told me the only symptoms she had was the tiredness, swelling and some nausea. She also insisted that everything started about a month ago. She denied ever having any other symptoms prior to that.

On the blood tests, patient had a very low albumin. Albumin is a kind of protein that flows in our blood. Among several other functions, albumin helps to keep our blood inside our blood vessels. Our blood is composed of both solid and liquid parts. Water is the most important liquid component of our blood. Albumin helps prevent the leakage of water from our blood vessels. When the albumin is low, our tissue absorbs more than normal amounts of water from the blood and that reduces our circulating blood volume. That can cause weakness. At the same time, the leaked water causes our body to swell up.
I then ran some tests on her urine and that gave me a quick answer about where all the albumin went. It all went out in her urine. She had a very large amount of albumin in her urine. It could account for all the albumin lost from her blood.
The most common symptom of diabetesHer blood sugars were high but not too high to cause any problem or symptom in the short term. But, she had an elevated HgA1c. Hemoglobin A1c (HgA1c) is a test that gives you an estimate of the average blood sugars for the last three months. This patient probably had diabetes for many years. Her elevated blood sugars probably affected many of her internal organs and slowly damaged them internally. In her kidneys, the long term elevation of blood sugar caused progressive damage of the lining of the filter that filters out urine. Normally, this filter keeps the albumin from crossing over from the blood into the urine. With the slow destruction of the filter, it starts to let the albumin squeeze through to the urine. As that happened, her blood albumin went down progressively and she started to have the symptoms of low albumin.

After further investigation, it was clear that diabetes had affected several of her other organs. She had no idea how diabetes was damaging her organs without ever causing any symptoms.
Medically, the symptoms of Mrs Y can be summarized as nephrotic syndrome. Nephrotic syndrome is a set of symptoms related to loss of significant amount of protein in the urine. Diabetes is the most common cause of nephrotic syndrome. In addition, diabetes can cause several other types of kidney disease and can lead to end stage kidney failure requiring dialysis treatment.
I hope this sad story of a wonderful woman helped you learn that the most common symptom of diabetes is no symptom at all. I hope this will encourage you to get tested for diabetes and avoid complications of undiagnosed and uncontrolled diabetes.