SIGNS AND SYMPTOMS OF DIABETES

Diabetes is a chronic disease. And it is slowly progressive .it passes through a phase of almost nil to mild non specific symptoms to a stage of multi organ damage involving almost all the vital organs of the body. Hence we will try to focus of symptoms according to the status of a diabetic patient.

Before onset of overt diabetes there is a phase of Prediabetes which may last for a few months to a few years. Prediabetics may have no symptoms at all. However certain symptoms like repeated skin infections, tingling sensation over feet (due to peripheral neuropathy), erectile dysfunction, altered lipid profile and even coronary artery disease may occur in a prediabetic phase.

Early in the course of diabetes, patients may experience the three cardinal features namely

Polyphagia-excess hunger

Polydidpsia-excess thirst.

Polyuria- excess urination

Add to this patient may have nocturia (excess urination at night). diabetics develop two major types of problems. One which is directly linked to increased or decreased blood sugar viz hyperglycemia leading to ketoacidosis or hyperosmolar coma and hypoglycemia or low blood sugar leading to altered behaviors, drowsiness progressing to unconsciousness and endangering life as the hypoglycemia worsens. High blood sugar also causes increased risk of infections like respiratory, skin and urinary infections. Prolonged uncontrolled high blood sugar may lead to end organ damages viz , damage to the eyes(cataract and retinopathy),kidney( diabetic nephropathy),heart( coronary artery disease) and heart failure, nerves( peripheral neuropathy).

Nerve damage leads to tingling and numbness over feet and this can lead to non healing ulcers over feet. In the bowels nerve damage leads to sluggish bowels causing alternate constipation and loose stools due to gastroparesis.poor blood flow leads to long term damage to skin and muscles. Skin may become shriveled and weak with repeated skin infections and carbuncles (pus filled boils over skin). Muscle may lose its bulk (atrophy). Muscles of arms and lower limbs become thin (proximal myopathy). Loss of muscle mass further worsens the diabetes status. Bones become weak and dimeneralised leading to osteoporosis. Weak bones and weak supporting muscles lead to osteoarthritis of knee joints and lumbar spondylosis (slip disc).Diabetic retinopathy is the commonest cause of blindness in the world. Also commonest reason for end stage renal (kidney) disease is diabetes.

For a diabetologist in Mumbai, (a large metropolis) the challenge is to adequately educate patients about all the above aspects of diabetes and also to motivate them to get their sugar back to normal. Diabetes on an average can knock off around 7 years of your life. The good news however is that with very good sugar control diabetics might lead a normal prolonged life with much fewer complications. Also the better the control in initial years of diabetes the lesser is the long term complications. Hence for a diabetes specialist in Mumbai, the challenge is to motivate patients to achieve good control in the initial years of diabetes itself. Due to ignorance, prejudice, distrust in allopathic medicine and negative conditioning by proponents of alternative medicine about unrealistically blaming all diabetes complications as side effects of allopathic drugs, many people initially ignore their blood sugar values

Initially patients do not have many symptoms and hence tends to ignore their diabetes. And by the time complications set in it’s generally a little late. Hence diabetic doctor has to carefully examine a patient clinically and ascertain as to what stage of diabetes patient is in. And then diabetologist will carefully and meticulously plan your therapy aiming for a good control of blood sugar and attempting to rectify and /or delay any complications. Uncontrolled long term diabetics have a plethora of diabetic end organ damage and symptoms will become a mix of various co morbidities. So cardiac patients and renal dysfunction will be puffed up and fluid overloaded and breathless. Leg tingling and pain and leg wounds happen with diabetics with peripheral neuropathy and peripheral vascular disease. Lowered immunity can lead to respiratory and renal and urinary infections.

Many patients having unexplained weight loss turn out to be diabetics. Skin infections over genital areas are also common. Fungal infections in perineal area may be the presenting symptom. Similarly some patients come with erectile dysfunction due to autonomic nerve affection. Typically a diabetic may develop a broad mid segment i.e. abdominal obesity and gradually thinning upper and lower limbs. This is due to gradual loss of muscle mass and deposition of fats over abdomen.

Thus symptoms of diabetes depend upon the stage of diabetes and whether the patient has other co morbidities. Good treatment and adequate control helps in preventing or delaying most of the complications.