Early Signs of Diabetes—Could You Have It and Not Know?
A few years ago I worked in a diabetes clinic at a local hospital as a medical social worker. Naturally, I had to be well-versed not only in the early signs of diabetes, but also the symptoms of poorly manages diabetes. One of the greatest gifts you can give yourself is an early diagnosis. Sadly, many of the people we met came into the hospital with a life-threatening condition called diabetic ketoacidosis. They did not know they were diabetic until they became gravely ill. It is surprisingly easy to overlook the early warning signs. Many people are unaware of some simple detection measures. In fact, a few you can actually see with your very eyes.
There are an estimated 24 million people with diabetes. One out of every three, or 8 million people, are unaware they have it.— Joslin Diabetes Center
Early Signs of Diabetes: Skin Changes
Most people have probably never heard the term Acanthosis Nigricans. I know I hadn't until I worked in the clinic and saw it with my very own eyes. Basically, this is a skin condition where there are patches of hyper-pigmented skin. We're not talking about age spots on your face here. The patches will be irregular and darker than your normal skin color. The skin itself normally has a different texture as well. The patches will have somewhat of a velvety feel and appearance, again unlike the rest of the skin.
You will normally find Acanthosis Nigricans in the folds and creases on your skin. Common locations are the arm pits, neck area and groin. You may also find them on your knees, elbows, on the palms of your hands or soles of your feet, over the finger joints and even on your lips.
This skin condition is associated with disorders that affect insulin levels, normally ones causing high blood sugar, or hyperglycemia. If you find Acanthosis Nigricans on your skin, it doesn't necessarily mean you have diabetes, however it's certainly a red flag alerting you to get in to see your doctor.
Dry and Itchy Skin can be caused by yeast infections, dry skin or poor blood circulation. Yeast infections of the skin, particularly Candidiasis are relatively common in diabetics. Examples are thrush and Erosio interdigitalis blastomycetica, a candidal infection seen in the webbing between the fingers. Women with type II diabetes are more susceptible to vaginal yeast infections.
Poor Healing of Cuts and Scrapes is caused by poor circulation, immune system deficiencies, and nerve damage in people with long-standing diabetes. Immune cells can't function as well when blood sugar levels are elevated. The dry, cracked skin diabetics are prone to can also increase the chances of developing an infection, which of course takes longer to heal.
Increased Thirst, Hunger, and Weight Loss
Take heed if you're experiencing unexplained hunger and thirst... your body might be warning you about high blood sugar levels. Okay, quick overview of the role of insulin and glucose in the body... We produce a hormone called insulin in a part of our pancreases called the Islets of Langerhans. Insulin is vital in breaking down glucose, which gives our bodies fuel. For one reason or another, diabetics either don't produce insulin (Type I Diabetes), or they don't produce enough or produce enough but are unable to properly utilize it (Type II Diabetes). Either way, they cannot properly break down glucose. The result is devastating: the body doesn't have enough fuel for its trillions of cells. As a result, your body feels hungry... hungry for the fuel it isn't getting.
You will probably also experience excessive thirst, also called polydipsia. Your kidneys go on over-drive attempting to rid the body of the excess glucose. The body works hard trying to pull out all the extra sugar from the body and excrete it through the urine. It needs to grab a lot of fluid from your tissues to make this possible. Naturally, you will become dehydrated.
You will also probably experience frequent urination, called polyuria. This is a natural consequence of the body's excessive production of urine to decrease blood sugar. If your blood sugar is high enough, you will spill ketones into your urine. This occurs when your body begins to burn fat for energy instead of glucose. Producing ketones are more common in Type I diabetes.
Weight loss is a common early symptom as well. The body will begin breaking down muscle and fat in a desperate attempt to get the energy it needs. Excessive urination will also lead to weight loss.
Loss of Energy/Fatigue
There are a number of reasons a diabetic may experience fatigue. Naturally, you will feel tired since your body doesn't have enough of its designated fuel. There's also a good chance your body is dehydrated from all the efforts its making trying to rid itself of the ample glucose. Bottom line, most of the processes in your body are working overtime attempting to compensate for a sorely lacking energy source. They are also working to rid your body of all the unwanted sugar circulating throughout it.
I wasn't kidding when I said hyperglycemia affects many parts of the body. The eyes are no exception. High blood sugar can cause the eye lenses to swell, affecting your sight. You may begin to notice yourself squinting and straining to see things. Driving may become difficult. You may notice it's harder to see the words in a book. Of course, just because you have blurred vision it doesn't mean you have diabetes. However, it's cause for a visit to the doctor and a diabetes screening, particularly if you're experiencing other symptoms.
Aches and Pains
The reasons for a diabetics increased bone and joint problems isn't always clear. Many people with Type II diabetes are overweight which can lead to increased musculoskeletal problems, like osteoarthritis, but obviously this isn't caused directly by the diabetes itself. Farther along in the course of the disease peripheral neuropathy can develop, which is a painful condition. This results from nerve damage caused by high blood sugar levels.
However, some painful conditions are associated with diabetes, but it's not clear whether or not there's a causal relationship. For example, diabetes is a risk factor for a painful condition called frozen shoulder (adhesive capsulitis). There's still research being done on the relationship.
When your body is constantly pulling fluid out of your tissues, you become dehydrated. You may not produce enough saliva, so you may experience that unpleasant "cottonmouth" sensation. You may also find your mouth feels irritated, particularly the corners.
Saliva plays a very important role in your mouth. It serves to control the levels of bacteria in your mouth as well as protecting and lubricating the teeth and tissues in your mouth. Without enough saliva, you are at an increased risk of developing a yeast infection inside your mouth called thrush.
As I've already noted, diabetes affects the circulatory system. Problems with decreased blood flow are responsible for male impotence in diabetic men. According to WebMD, estimates have shown 35% to 75% of men with diabetes will suffer from impotence during their lifetime.
Increased or Unusual Infections
Diabetes can impair your body's ability to fight infection. As I've already mentioned, it renders your immune system less effective. Hyperglycemia can allow bacteria to grow and thrive more readily than in non-diabetics. Coupled with compromised wound healing, infections become a real threat. Common sites for these infections are:
What is Prediabetes, Then?
Prediabetes means you have elevated blood glucose levels, but not high enough to qualify for a Type II diabetes diagnosis. According to the American Diabetes Association, it's estimated there are an astonishing 79 million people in the U.S. with prediabetes. If you have prediabetes it doesn't mean you will naturally go on to develop Type II diabetes, though. There are things you can do to prevent its development. Most namely, it's been shown that losing 7% of your body weight will decrease your risk. Exercise has also been shown to decrease the chances, just 30 minutes per day at least 5 times per week is enough.
We saw many people with prediabetes in our clinic. Many of them were able to turn their blood sugar around by eating a healthy diet and exercising.
Who Should Be Tested? How is Diabetes Diagnosed?
The American Diabetes Association recommends everyone 45 years of age and older should be tested for diabetes and re-tested every 3 years. If you fall into one of the following high risk groups, you should be screened for diabetes:
- A woman who had gestational diabetes
- A woman who had a baby weighing over 9 pounds
- Siblings of people with diabetes
- People with a parent or parents with diabetes
- Members of certain ethnic groups: African American, Hispanic American, Native American, Asian American or Pacific Islander
- You have low HDL cholesterol levels ( 35 mg/dl or less)
- You have high triglycerides ( 250 mg/dl or above)
- You have high blood pressure
- You've been diagnosed with Polycystic Ovarian Syndrome
- You've been tested before and had impaired glucose tolerance or impaired fasting tolerance.
How is Diabetes Diagnosed?
A simple blood test is all you need to diagnose diabetes. You will be given either a Fasting Plasma Glucose Test or a Casual or Random Glucose Test. With the fasting test you will be asked to fast overnight and will be tested in the morning. A result of 126 mg/dl or above is indicative. With the Casual or Random Glucose Test, no fasting is involved. A glucose level of 200 mg/dl or above is indicative of diabetes. If you "fail" either of these tests, additional testing will be required. If you've had the fasting test, it will be repeated on another day. If you've had the casual/random test, it's likely you'll need to have the fasting test or what's called an Oral Glucose Tolerance Test.
When I had gestational diabetes, I of course failed what's called the initial Oral Glucose Challenge Test. I had to drink this less than palatable, sugary, syrupy drink, wait and hour and then have my blood drawn. Turned out, my blood sugar was high. So, I had to go back to the hospital, drink an even more sugary awful concoction (part of the Oral Glucose Tolerance Test) and spend the next three hours getting my blood drawn every hour, on the hour.
Have you ever been tested for diabetes?
Your Call to Action...
If you are experiencing early diabetes signs, it's imperative you see your doctor and discuss your symptoms. Undiagnosed diabetes can lead to some very serious problems, not the least of which is death.
I implore you to take the time to get screened. Follow the recommendations set forth by the American Diabetes Associations for who needs to get screened. Early diagnosis can spare you life-altering complications.
In addition to the articles I've linked to above, here is another very informative article: How Is Diabetes Diagnosed? (written by the Joslin Diabetes Center).