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Signs and Symptoms Of Diabetes Mellitus
As you might have already concluded the signs and symptoms of diabetes mellitus are
numerous and commonly insidious; such that only those of us who are closely in tune with our bodily functions are aware that the disease might exist. As mentioned above, there are over 15 million
Americans diagnosed with diabetes mellitus. In addition, most authorities estimate that there exist an additional 10 to 15 million case yet undiagnosed. This is particularly disturbing, since most of
us view the subtle changes of symptoms, associated with this disease, as part of the aging process.
It would, therefore, behoove most of us to become acutely aware of the early signs and symptoms of diabetes. For the sake of our discussion I will lump signs and
symptoms together, unlike that which might be characteristic of any good medical teaching system. I will, however, divide them into early and late onset; hopefully, this will make the early detection of
diabetes mellitus easier for most of us:
Early
Changes
As suggested earlier diabetes is a dysregulation of glucose metabolism
which results in impaired carbohydrate utilization and alterations of lipid (fat) and protein biochemical processes. The reasons for these adverse changes vary from inherited traits for the Type I (IDDM)
to poor life style habits for the Type II (NIDDM).
Type I (IDDM)
Most will have a family history of
diabetes mellitus and will develop signs and symptoms before age 40 years---usually before their second decade of life. The hallmarks of this form of diabetes mellitus are genetic origin, lack of
insulin and ketoacidosis (accumulation of ketone metabolic products causing a potentially fatal state of acidosis). There is an ever evolving body of evidence that infectious or toxic environmental
pollutants may be the responsible agent in the genetically disposed individuals: The following summarizes changes that might be expected or observed:
Onset of signs and symptoms before age 40 years. Frequently associated family history of early onset diabetes mellitus. Certain HLA's (Human Lymphocyte Antigens) commonly demonstrated. The most common presenting symptoms is polydipia (excessive thirst). Most will have polyuria (frequent urination) and nocturia (urination at night).
Many feel it is more common in males than females; this is not as yet proven.
Fatigue is a common presenting symptom. More common in Scandinavia and their decedents. Usually accompanied by unexplained weight loss. Most develop Retinopathies, Neuropathies and Cardiovascular complications. Most have polyphagia (excessive food consumption or hunger). Circulating blood insulin is virtually absent. Ketones (metabolites of abnormal metabolism) are frequently seen in the urine,
especially in early diagnosis. Glucosuria (glucose in urine), especially in early diagnosis. Plasma glucose levels of 140 mgs/dl or greater following an overnight fast. Elevated glycosylated hemoglobin (A1 c) (a specific fraction of hemoglobin).
Type II (NIDDM)
This the most common form of diabetes mellitus. As indicated earlier 90 percent of the 14 million
diabetes in this county fall in this classification. Most are adults over the age of 40 years. Although some researcher have suggest there might be a genetic link, most of us view this forms of
diabetes as a disease of perpetual life style abuse and neglect.
These are those of us who feel that God put the fast food markets on every corner; these are the people who have come to believe that the four basic food groups
are: Burger King, MacDonalds, Wendy's and Taco Bell; to say the least, this is, of course, comical--- but I think you get the picture. Diabetes mellitus (Type II), then, is a disease that didn't have to
happen. Unfortunately, it did and does happen; therefore, we must now deal with it. And, we must become aware of the subtle changes in our bodies as this disease develops; we have to begin to know when our
body is trying to communicate with our brains to warn us of this insidious disorder. The following signs and symptoms are similar to but characteristically different from those of Type I (IDDM):
Onset of signs and symptoms usually after age 40 years. Not commonly associated with a genetic history of diabetes mellitus but may have a
familial disposition. Rarely seen in unindustrialized nations. Patients are often asymptomatic. Most patients are obesity, especially of the abdomen and upper body areas. Polyuria, Polydipisia, Polyphagia and Fatigue are uncommon presenting symptoms.
Patients often present with Blurred vision, Vulvovaginitis and pruritus (itching).
Especially true in females. The delivery of a large baby (usually over 10 lbs). Chronic skin infections are common. Skin tags, especially in obese men, are common. Poor or slow healing of simple skin injuries is strongly suggestive. Neuropathy (usually involving nerves of the extremities) is the most common presenting symptoms. Many patients present with cardiovascular disorders. Mild hypertension is frequently observed. Retinopathies, Nephropathies and Cardiovascular complications develop, especially in
poorly controlled patients. Most of these patients are discovered by routine physical and blood chemistry
evaluations. Most can be controlled by diet and/or oral hypoglycemic agents. Many will have an elevated blood insulin level. Most will be found to have an increase blood glycosylated hemoglobin (A1c). Fasting blood glucose levels are commonly over 140 mgs/dl. Glucosuria is seen primarily in Type II patients who have become insulin dependent or
those who are poorly controlled.
Later Changes
When we address the subject of later signs and symptoms of diabetes mellitus one need not place a major emphasis on its type or classification. In the later stages
of diabetes mellitus most of the complications become far advanced. We now begin to emphasize mostly the disorders caused by the underlining diabetes mellitus, since attempts to differentiate origins are
blurred. Therefore, there little need to discuss inadequate or absolute insulin deficiency, autoimmune destruction of tissue or genetics---the end results is often the same. We do, of course, have to
emphasize that professional and self monitoring of the diabetes mellitus must be continued.
This is where we need to address the life threatening complications associated diabetes
mellitus. For the sake of our discussion I will attempt to place these in order of decreasing severity, keeping in mind that any ranking of severity of a disorder may have different meanings to each of
us. Regardless of our weighting of severity, keep in mind that most disorders of late stage diabetes mellitus result in major bodily impairment and/or death.
Degenerative Vascular Disease
This collective disorder accounts for the major death rate from diabetes mellitus. It is certainly the
most well known to practitioner and the patient. Diabetic vascular disease results in many numerous vascular surgical procedure such heart bypass and amputation of lower extremities for gangrene. Most
authorities feel that coronary artery disease, peripheral vascular and strokes are the end result of hyperglycemia, hyperinsulinemia (high blood levels of insulin), dyslipidemia (abnormal blood fats)
and hypertension. It has a tendency to occur earlier in Type I (IDDM) patients.
Impotence, in men, is more common that not. Most authorities place this disorder under vascular complication of diabetes mellitus. Some, on the other hand, feel
that it might be a neuropathy. In any event the end result is the same---the impotence is permanent.
The majority of these patients will be on
numerous drugs such as anti-hypertensives, vascular dilating agents and blood thinners to mention only a few.
Diabetic Nephropathy (Kidney)
About 25 percent of all diabetics develop kidney disease---an estimated 4000 patients in the United States die of endstage renal failure yearly. It has also
been observed that end-stage renal failure is much more common in the United States. It also appears to be more prevalent and to occur at an earlier age in Type I patients.
Ocular Disorders
Premature development of senile-cataracts is a common problem to the diabetic. More debilitating is
the early onset of diabetic retinopathy resulting from impaired micro-circulation; these patients develop micro-aneurysms (secular ballooning), hemorrhages, exudates (pus) and swelling of the retinal
vessels. Most progress to blindness. In fact, this one of the most common causes of blindness in this country.
Glaucoma
This occurs in about 6 percent of all diabetics in the United States. Here, again, impaired
circulation of the micro-circulation of the iris is involved.
Neuropathies
This is probably to most common
non-fatal complication of diabetes mellitus. Remember, this is a term that literally mean a perceptual change in sensation that might be manifest as pain, burning, numbness, coldness, dullness,
hypersensitivity to touch and loss of vibration. It may be constant or intermittent. It might involve autonomic (not under ones control) nerves.
More common than not, the
peripheral (under voluntary control) nerves are involved. Therefore the name, peripheral neuropathy. In most cases the onset is insidious and involves the extremities, especially the lower; usually, one
develops a 'stocking and glove' distribution of symptoms.
The symptoms of neuropathies are significantly more accentuated during the night. In fact, they become
the primary focus to the diabetic patient. Unfortunately, there is little medicine has to offer the patient in the way of therapy.
Chronic Skin Manifestations
Recurrent and difficult to treat bacterial and fungal skin infection are a constant problem for the diabetic patient. Eruptive xanthoma (plaques) of the skin
are common---these are associated with poor glucose and fat metabolism. So called 'skin spots' are also common---these are brownish, rounded and painless lesions of the skin usually seen over the front
of the legs. Women get frequent vaginal fungal (yeast) infections. As a rule the treatment of most of these annoying problems is difficult and temporary.
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