Symptoms of Diabetes

Most people are well-known with common symptoms of diabetes but in almost 50% patient’s diabetes may be present without any obvious symptoms. In such patients diabetes is diagnosed incidentally or when some serious complication of diabetes has occurred.

Early diagnosis of diabetes is important so as to prevent the long-term complications of diabetes.

The symptoms of diabetes can be divided into 3 groups:

1. Symptoms due to increased blood glucose level:
When the level of glucose in blood rises above a certain limit, it changes the osmotic pressure of blood.

Some diabetes symptoms include:

• Frequent urination
• Excessive thirst
• Extreme hunger
• Unusual weight loss
• Increased fatigue
• Irritability
• Blurry vision

A decrease in vision is also an important symptom of diabetes. Increased glucose level in the blood leads to change in the shape of the lens distorted vision. Once the blood glucose level comes to normal the shape of the lens also comes back to normal & the person’s vision becomes normal again. If a person uses spectacles & becomes diabetic he may have frequent changes in his spectacles power. It is suitable to get the spectacle number corrected only when blood glucose is normal.

2. Symptoms due to non-availability of Glucose in cells:
Tiredness, weakness, irritability, body ache, tingling, increased appetite and weight loss are common symptoms.

3. Symptoms of Complications of Diabetes:
Increased level of glucose in the blood causes damage to various organs leading to symptoms like numbness in hands and legs, pain in the eyes, swelling (edema) in the feet, pricking sensation, tingling, aches and pains, blurred vision, impotence, swelling in body Chest pain (angina) etc.

When alarming symptoms given by the body are ignored and the same status is maintained, it starts damaging body organs, such as heart, kidney, eye, feet, and skin.

Symptoms of diabetes also depend on the type of diabetes. If the patient has Type 1 Diabetes weight loss is very rapid. Frequency of urine is also much more. A child may have complaints of bed-wetting. During Ketoacidosis, unconsciousness may also occur in Type 1 diabetes. Whereas symptoms may be soft in Type 2 diabetes.

Common Symptoms of Diabetes:

• Weight loss
• Increased frequency of urination
• Increased thirst
• Tiredness
• Itching in private parts
• Increased appetite
• Tiredness and easy fatigue ability
• Non healing wounds

Diabetes Risk Factors

Increased mental stress and decreased physical activity anybody can be affected by diabetes. Although the being of certain risk factors increases the possibility of having diabetes. Following are the persons at a greater risk of having diabetes:

1. Family History of Diabetes:
Family history of diabetes is the greatest risk factor for developing diabetes. Persons with first degree blood relatives having diabetes like father, mother, and brother, sister are at the greatest risk of having diabetes.

Following table shows risk of developing diabetes:

2. Obesity:
Obesity causes insulin conflict, which increases the possibility of having diabetes. The risk of having diabetes is more in persons with central obesity

Obesity can be defined in two ways:
I. A Body Mass Index (B.M.I.) greater than 25
II. Increased Waist Hip Ratio
The Body Mass Index (B.M.I.) is calculated by the following formula

Weight grading according to Body Mass Index:

Central Obesity:
For calculating central obesity, waist and hip size are taken and theWaist Hip Ratio i.e. WHR is obtained. For example if the waist of a man measures 90 cm and his hip measures 80 cm then the WHR is 1.12.

For males risk of diabetes is greater if WHR is more than 0.90
For females risk of diabetes is greater if WHR is more than 0.85

OR

If in males waist is more than 102 cm and in female’s waist is more than 88 cm, risk of diabetes is more.

3. Lack of Physical Activity
4. High Cholesterol
5. High Blood Pressure
6. History of Gestational Diabetes
7. Female with history of having high birth weight baby
8. Polycystic Ovary Syndrome in women
9. Person with Low Birth Weight

Different Causes of Diabetes

Diabetes is of many types. The cause of diabetes depends on the type of diabetes.

Type 1 Diabetes:
Type 1 diabetes is much less common than type 2 diabetes. It is mostly found in children and young adults. Type 1 Diabetes is a result of an autoimmune disorder. Type 1 diabetes is associated with lack of insulin. Such patients have a specific type of HLA gene on their chromosomes. Infection in genetically inclined individual leads to commencement of immune system which cannot distinguish between self and non-self cells which leading to damage of insulin producing beta cells.

Type 2 Diabetes:
It is caused by interaction of hereditary factors and environmental factors, resulting in decreased efficacy of insulin and after a few years the ability of pancreas to produce insulin is also decreased. There are several factors, such as genetics, obesity, and physical inactivity that can increase a person's risk of developing type 2 diabetes. Type2 diabetes occurs when the pancreas doesn't make enough insulin or the cells of the body become resistant to insulin.

Insulin binds to insulin receptors on body cells and this insulin-receptor binding cause activation of complex metabolic processes e.g. GLUT activation, protein synthesis and lipid metabolism etc. More than 100 genes are involved in this process. One or more defective genes can lead to destruction of insulin action and hence development of diabetes. In diabetes many genes can turn defective and each patient can have a set of different defective genes. Any defects in the genetic makeup leads to irreparable changes that affect the functioning of insulin. Lack of physical activity, stress and obesity further worsens this situation. After some time production of insulin also diminishes. These changes ultimately lead to the development of diabetes in a person. The figure below explains the working of insulin:

Various Types of Diabetes

American Diabetic Association and World Health Organization have divided diabetes into following types:

Type 1 Diabetes:
Type 1diabetes is an auto-immune disease caused by a serious damage to beta cells found in the pancreas. This type of diabetes is also known as juvenile-onset diabetes accounts for 10-15% of all people with the disease. It is trigged by environmental factors like viruses, diet or chemicals in people heritably predisposed. This leads to the production of antibodies, which destroy the invading organism. At the same time these antibodies damage the beta cells, thinking them to be foreign cells as the immune system fails to recognize host cell.

The presence of special type of HLA genes in the body and immune response which does not be familiar with own body cells and damages beta cells lead to this type of condition. People with specific subtype of HLA genes can get this type of diabetes once the immune system is activated following infection. So beta cells are innocent victims of an immune assault occurring in genetically prone people. Here, it is important to stress that all people with HLA genes subtype do not get type 1 diabetes. Type 1 diabetes is a result of the combination of genetic predisposition and an environmental trigger.

Nowadays it is possible to identify people with HLA subtype, which can help in determining people at high risk of getting Type 1 Diabetes and this type of diabetes the production of insulin almost stops due to damage to beta cells and the patients develop acute symptoms of diabetes like rapid weight loss, weakness, ketones in urine, coma due to ketoacidosis. This type of diabetes is commonly found in children and young adults, although practically any age group can be affected. Before 1921(Pre-Insulin era) this type of diabetes meant sure death.

Availability of insulin has changed the scenario and now people with Type 1 Diabetes can live a near normal life span.

Type 2 Diabetes:
This type of diabetes also known as late-onset diabetes. This type of diabetes occurs when the body stops recognizing the insulin secreted by the pancreas. Initially in such patient’s overproduction of insulin is found leading to a condition called Hyperinsulinemia. This high level of insulin compensates for insulin resistance and thus maintains blood glucose in normal range.
With passage of time the beta cells get exhausted and insulin levels decline, thus blood glucose level starts rising leading to diabetes.

In such patients the number of beta cells decreases after a few years leading to decreased production of insulin. Therefore it can be said that Type 2 Diabetes starts off as reduced efficacy in the working of insulin but later on there is decreased production of insulin as well.

Type 2 diabetes can affect people of any age, even children. Of late this type of disorder has been increasing in young adults. Fatness, high-sugar diet, lack of exercise and increased mental stress give rise to insulin resistance and thus diabetes. The symptoms in Type 2 Diabetes are much less severe than Type 1 Diabetes. This is the reason why many patients of Type 2 Diabetes are unaware of their ailment until it takes a serious form. In our country more than 95% of the patients are Type 2 Diabetes. This type of diabetes is commonly associated with high blood pressure and cholesterol problems

Gestational Diabetes:
Like type 2, is a form of insulin conflict that occurs in the later stages of pregnancy. The hormonal changes in pregnancy lead to insulin resistance leading to Gestational Diabetes. These hormones may get in the way with the mother’s ability to produce and use her own insulin.

It is mostly temporary. It is commonly found in those females who are either overweight or have a family history of diabetes. This diabetes generally disappears after delivery, but such females are at a higher risk for developing diabetes in future life.

Gestational Diabetes is different from Pre-Gestational Diabetes. If a female who is already diabetic and becomes pregnant then such a condition is called Pre-Gestational Diabetes.

Other types of diabetes:

1. Genetic defects in Beta cells.
2. Defects in Insulin receptors.
3. Disorders of Pancreas.
4. Hormonal disorders.
5. Diabetes due to medicines or toxins.
6. Diabetes due to viral infections.
7. Recurrent inflammation (swelling) in pancreas leads to destruction of beta cells causing diabetes. Excess of alcohol intake is the commonest cause of pancreatitis.