Diabetes
Signs and symptoms of
Diabetes
Type 2
diabetes
almost always has a slow onset (often
years), but in
type 1 diabetes, particularly
in children, onset may be quite fast (weeks or
months).
Early
symptoms of
type 1
diabetes
are often polyuria (frequent
urination) and polydipsia (increased thirst, and
consequent increased fluid intake). There may
also be
weight loss
(despite normal or increased eating), increased
appetite, and irreduceable fatigue. These symptoms
may also manifest in
Type 2 diabetes
in patients who present with
frank poorly controlled diabetes. Thirst develops
because of osmotic effects —
sufficiently high
glucose
(above the 'renal threshold') in the
blood is excreted by the kidneys but this requires
water to carry it and causes increased fluid loss,
which must be replaced. The lost blood volume will
be replaced from water held inside body cells,
causing dehydration.
Another common
presenting symptom of diabetes is altered
vision.
Prolonged high
blood glucose
causes changes in the shape of the lens in
the eye, leading to blurred vision and,
perhaps, a visit to an optometrist.
All unexplained quick changes in eyesight should
force a fasting blood glucose test. These are
now quick (less than 5 minutes total), inexpensive
(materials less than US$1), and can be safely
performed by almost anyone with trivial training.
Especially dangerous symptoms in diabetics
include the smell of acetone on the patient's breath
(a sign of ketoacidosis), Kussmaul breathing (a
rapid, deep breathing), and any altered state of
consciousness or arousal (hostility and mania are
both possible, as is confusion and lethargy).
The
most dangerous form of altered consciousness is the
so-called "diabetic coma" which produces
unconsciousness.
Early symptoms of impending
diabetic coma include polyuria, nausea, vomiting and
abdominal pain, with lethargy and somnolence a later
development, progressing to unconsciousness and
death if untreated.
Diabetes Diagnostic approach
The diagnosis of
type 1 diabetes
and many cases
of type 2
diabeyes is usually prompted by
recent-onset
symptoms of excessive urination
(polyuria) and
excessive thirst (polydipsia), often accompanied by
weight loss. These symptoms typically worsen over
days to weeks; about 25% of people with new
type 1
diabetes have developed a degree of
diabetic ketoacidosis by the time the
diabetes is recognized.
The diagnosis of other types of diabetes is made in
many other ways. The most common are
(1) health
screening, (2) detection of hyperglycemia when a
doctor is investigating a complication of
longstanding, unrecognized diabetes, and less
commonly (3) new signs and symptoms attributable to
the diabetes.
1. Diabetes screening is recommended for many
types of people at various stages of life or with
several different risk factors. The screening test
varies according to circumstances and local policy
and may be a random glucose,
a fasting glucose and
insulin, a glucose 2 hours after 75 g of glucose, or a formal glucose tolerance test. Many health care
recommendations for adults recommend
universal
screening at age 40 or 50 years, and sometimes
occasionally thereafter. Earlier screening is
recommended for those with risk factors such as
obesity, family history of diabetes, high risk
ethnicity (Hispanic [Latin American], American
Indian, African American, Pacific Island, and South
Asian ancestry).
2. Many medical conditions are associated with a
higher risk of various types of diabetes and warrant
screening. A partial list includes:
high blood
pressure, elevated cholesterol levels,
coronary
artery disease, past gestational
diabetes,
polycystic ovary syndrome, chronic pancreatitis,
hepatic steatosis (fatty liver), cystic fibrosis,
several mitochondrial neuropathies and myopathies,
myotonic dystrophy, Friedreich's ataxia, some of the
inherited forms of neonatal hyperinsulinism and many
others. Risk of
diabetes is higher with chronic use
of several medications, including high dose glucocorticoids, some
chemotherapy agents
(especially L-asparaginase), and some of the
antipsychotics and mood stabilizers (especially phenothiazines and some atypical antipsychotics).
3. Diabetes is often detected when a person
suffers a problem frequently caused by diabetes,
such as a heart attack, stroke, neuropathy, poor
wound healing or a foot ulcer, certain eye problems,
certain fungal infections, or delivering a baby with macrosomia or hypoglycemia.
Criteria for
Diabetes Diagnosis
Diabetes mellitus is characterized by recurrent
or persistent hyperglycemia, and is diagnosed by
demonstrating any one of:
- two
fasting plasma glucose levels
above 7 mmol/l
(125 mg/dl) on different days;
-
plasma glucose
above 11.1 mmol/l (200 mg/dl)
two hours after a 75 g glucose load; or
- symptoms of diabetes and
a random glucose
above 11 mmol/l (200 mg/dl). While not used for
diagnosis, an elevated glucose bound
to hemoglobin,
HbA1c, of 6.0% or higher (2003 revised US
standard); is a screening and treatment-tracking
test reflecting average blood glucose levels over
the preceding 90 days (approximately).
Diabetic
Ketoacidosis and Coma
Diabetic ketoacidosis
(DKA) is an acute, dangerous complication and is
always a medical emergency. Without prompt proper
treatment, diabetic ketoacidosis leads to death.
DKA occurs more commonly in
type 1 diabetes
because the
insulin deficiency
is more severe,
though it can occur rarely in
type 2 diabetes. In
about a quarter of young people who develop type 1
diabetes, the insulin deficiency and
hyperglycemia
lead to ketoacidosis before the disease is
recognized and treated.
This can occur at the onset of
type 2 diabetes
as
well, especially in young people.
When a person is
known to have diabetes and is being adequately
treated, DKA (Diabetic Ketoacidosis) usually results from omission of
insulin, mismanagement of acute gastroenteritis (the
"flu"), or an overwhelming new health problem (e.g.,
bacterial infection, myocardial infarction).
Insulin deficiency
switches many aspects of
metabolic balance in a catabolic direction. The
liver becomes a net producer of glucose by way of gluconeogenesis and glycogenolysis. Fat in adipose
tissue is reduced to triglycerides and fatty acids
by lipolysis. Muscle is degraded to release amino
acids for gluconeogenesis. The rise of fatty acid
levels is accompanied by a rise of ketones (acetone, acetoacetate and beta-hydroxybutyrate). As the
ketosis worsens, it produces a metabolic acidosis,
with anorexia, abdominal distress, and eventually
vomiting. The
rising level of glucose
increases the
volume of urine produced by the kidneys (an osmolar
diuresis). The high volume of urination (polyuria)
also produces increased losses of electrolytes,
especially sodium, potassium, chloride, phosphate,
and magnesium. Reduced fluid intake from vomiting
combined with amplified urination produce
dehydration. As the metabolic acidosis worsens, it
induces obvious hyperventilation (termed Kussmaul
respiration).On presentation to hospital,
the patient in DKA
(Diabetic Ketoacidosis)
is typically dehydrated and breathing both fast and
deeply.
Abdominal pain is common and may be severe.
The level of consciousness is normal until late in
the process, when obtundation may progress to coma.
The dehydration can become severe enough to cause
shock. Laboratory tests typically show hyperglycemia,
metabolic acidosis, normal or elevated potassium,
and severe ketosis. Many other tests can be
affected. At this point the patient is urgently in
need of intravenous fluids.
The basic principles of DKA treatment
are:
- Rapid restoration of adequate circulation and
perfusion with isotonic intravenous fluids
- Gradual rehydration and restoration of
depleted electrolytes (especially sodium and
potassium)
- Insulin to reverse the ketosis and
lower the
glucose
- Careful monitoring to detect and treat
complications Treatment usually results in full
recovery, though death can result from inadequate
treatment or a variety of complications.
Hyperosmotic
Diabetic Coma
Hyperosmotic diabetic coma is another acute
problem associated with improper management of
diabetes mellitus. It has some symptoms in common
with DKA (Diabetic
Ketoacidosis), but a different cause, and requires
different treatment. In anyone with
very high blood
glucose levels (usually considered to be above 300
mg/dl) water will be osmotically driven out of cells
into the blood. The kidneys will also be "dumping"
glucose into the urine, resulting in concomitant
loss of water, causing an increase in blood
osmolality. The osmotic effect of high glucose
levels combined with the loss of water will
eventually result in such a high serum osmolality
that the body's cells may become directly affected
as water is drawn out from them. Electrolyte
imbalances are also common. This combination of
changes, especially if prolonged, will result in
symptoms similar to ketoacidosis, including loss of
consciousness. As with DKA
(Diabetic
Ketoacidosis),
urgent medical treatment
is necessary. This is the diabetic coma to which
type 2 diabetics
are prone; it is less common in
type 1 diabetics.
Hypoglycemia
in Diabetic Patients
Hypoglycemia in
diabetic patients almost always
arises as a result of poor management of the disease
either from too much or poorly timed insulin or oral hypoglycemics or too much exercise, not enough food,
or poor timing of either. If blood glucose levels
are low enough, the patient may become agitated,
sweaty, and have many symptoms of sympathetic
activation of the autonomic nervous system - they
may experience feelings similar to dread and
immobilized panic. Consciousness can be altered, or
even lost, in extreme cases, leading to coma and/or
seizures or even death and brain damage. Experienced
diabetics can often recognise the symptoms early on
- all diabetics should always carry something sugary
to eat or drink as these symptoms can be rapidly
reduced if treated early enough. In the case of
children, this can be a type of candy disliked by
the patient, to prevent concerns about unnecessary
use.
Other ways of treating hypoglycemia include an
injection of glucagon which causes the liver to
convert its internal stores of glycogen to be
released as glucose into the blood. Oral or
intravenous dextrose can also be given. In most
cases, recovery is rapid and trouble free.
Longstanding hypoglycemia may require hospital
admission to allow supervised recovery and
adjustment of diabetic medications.
Long-term
Complications in
Diabetes
Among the major risks of the disorder are chronic
problems affecting multiple organ systems which will
eventually arise in patients with poor glycemic
control. Many of these arise from damage to the
blood vessels. These illnesses can be divided into
those arising from large blood vessel diseases,
macroangiopathy, and those arising from small blood
vessel disease, microangiopathy. Interestingly,
small vessel disease is minimized by
tight blood
glucose control, but large vessel disease is
unaffected by tight blood glucose control.
Small vessel disease complications:
- ischemic
heart disease
caused by both large and small vessel disease
- stroke
- peripheral
vascular disease which contributes to foot ulcers
and the risk of amputation
Diabetes mellitus is the most common cause
of adult kidney failure worldwide. It also
the most common cause of amputation in the US,
usually toes and feet, often as a result of
gangrene, and almost always as a result of
peripheral vascular disease. Retinal damage (from
microangiopathy) makes it the most common cause of
blindness among non-elderly adults in the US.
By: The Medical Symptoms
Database
Natural Diabetes
Treatment
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