The Symptoms of Diabetes

This is another article that I wrote when the Free Fitness Tips Blog was just getting started. However, after reviewing it I have decided it is due for a significant rewrite. So here is the new and improved version of ‘The Symptoms of Diabetes’…

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As I have discussed in my previous diabetes articles the symptoms of diabetes are often quite difficult to notice. However, if you know what to look for you have a much greater chance of identifying the symptoms. In this article I am going to discuss with you the major symptoms of diabetes and explain why they occur.

1) HYPERGLYCAEMIA (High Blood Sugar/Glucose):- Hyperglycaemia occurs when your blood sugar (the body’s main source of energy) levels become higher than normal, usually due to a lack of insulin. Insulin helps the body convert blood sugar into energy. If the body is not getting enough insulin this blood sugar cannot be broken down and instead stays in the blood stream, causing blood sugar levels to rise.

Hyperglycaemia can also be caused by eating too many sugars and carbohydrates (which release extra glucose into your blood stream), failing to exercise (which can reduce the effectiveness of insulin) and by being physically or mentally stressed (which can lead to the body producing extra glucose).

Blood sugar levels are said to reach hyperglycaemic levels when they are consistently above 126 milligrams per decilitre (mg/dL). When your blood sugar reaches hyperglycaemic levels the following symptoms may develop:

- Blurred Vision.
- Increased Hunger Levels.
- Increased Need to Urinate.
- Increased Susceptibility to Infection.
- Increased Thirst Levels.
- Nausea.
- Weakness/Tiredness.
- Weight Loss.

Hyperglycaemia can affect all diabetics and can be managed in two ways, depending upon the severity of the condition. Mild hyperglycaemia can usually be self treated by injecting insulin. More serious hyperglycaemia can lead to diabetic ketoacidosis and hyperosmotic non-ketotic acidosis (HONK) (see below for further details) for which you will need urgent hospital treatment.

2) HYPOGLYCAEMIA (Low Blood Sugar/Glucose):- Hypoglycaemia occurs when your blood glucose levels drop to lower than normal levels, usually because there is excessive insulin in your body. The presence of this extra insulin means that too much glucose is converted into energy and as a result your blood sugar levels start to decline.

Hypoglycaemia can also be caused by not consuming enough calories to meet the body’s energy requirements, either on a day to day basis or before exercise (your body burns extra calories during exercise so you need to make sure these additional calories are made available in the foods you eat prior to exercising). Alcoholic beverages also lower blood sugar levels and excessive alcohol consumption often causes hypoglycaemia.

Blood sugar levels are said to be hypoglycaemic when they are consistently below 70 mg/dL. When your blood sugar drops to hypoglycaemic levels the following symptoms may develop:

- Blurred Vision.
- Coma.
- Confusion.
- Convulsions
- Dizziness.
- Fatigue.
- Hunger Pangs.
- Increased Heart Rate.
- Paleness.
- Shaking.
- Sweating.
- Weakness.

Hypoglycaemia can affect all diabetics but it is more prevalent in people suffering from type 1 diabetes because they have to inject insulin regularly. If they inject too much insulin this often causes hypoglycaemia. Mild hypoglycaemia can normally be self treated by consuming approximately 10g - 20g of sugar. Glucose tablets are available for this specific purpose. More serious hypoglycaemia will often lead to a loss of consciousness and requires medical attention. In this case paramedics will often inject glucagon to raise blood sugar back to normal levels.

3) DIABETIC KETOACIDOSIS (DKA):- Diabetic ketoacidosis occurs when there are a high concentration of ketone bodies in your blood stream. When your body does not get the glucose it requires (usually because of a lack of insulin) it starts to break down fat and muscle for energy instead. Ketones (fatty acids) are released into the blood stream when fat is broken down for energy. If your body uses fat for energy over a prolonged period, these ketones build up in your blood stream and this leads to a state of diabetic ketoacidosis.

The main cause of diabetic ketoacidosis is a lack of insulin which means the body cannot break down glucose properly and so it is forced to turn to fat and muscle for energy. However, it can also be brought on by illness and infection.

The symptoms of diabetic ketoacidosis include:

- Abdominal Pain.
- Confusion.
- Fruity Smelling Breath (similar to the smell of nail polish remover).
- Hot and Dry Skin.
- Loss of Appetite.
- Vomiting.

All diabetics can suffer from diabetic ketoacidosis but it is much more prevalent amongst type 1 diabetics, especially when they fail to inject insulin regularly. Unlike hyperglycaemia and hypoglycaemia, there are no mild forms of diabetic ketoacidosis. It is a very serious medical condition and needs to be addressed immediately. Untreated diabetic ketoacidosis can be fatal so if you notice any of the symptoms described you must seek immediate medical treatment.

4) HYPEROSMOTIC NON-KETOTIC ACIDOSIS (HONK):- This is a type of diabetic coma also known as nonketotic hyperosmolar coma, nonketotic hyperglycaemia and hyperosmolar hyperglycemic nonketotic coma (HHNKC). It is brought on by a lack of insulin in the body which causes glucose levels to rise excessively. The body responds by passing more urine to remove this excessive glucose from the blood. Failure to consume enough fluids can lead to extreme dehydration and eventual hyperosmotic non-ketotic acidosis.

Like with diabetic ketoacidosis, the main cause of hyperosmotic non-ketotic acidosis is a lack of insulin. However, it can also be triggered by illness or infection. The symptoms of hyperosmotic non-ketotic acidosis include:

- Dry Skin (that does not sweat).
- Fever with a Temperature.
- Hallucinations.
- Increased Thirst (which does not disappear despite adequate fluid consumption).
- Sleeplessness.
- Weakness in one side of the body.

Hyperosmotic non-ketotic acidosis can affect all diabetics but is more common amongst type 2 diabetics. Like with diabetic ketoacidosis, it is a very serious condition and requires immediate hospital treatment.

5) PERIPHERAL NEUROPATHY:- Peripheral neuropathy describes the loss of nerve functions in the arms and/or legs. It is usually brought on by nerve damage caused by diabetes. However, it can also be caused by alcoholism, exposure to poisons (usually from certain medication), other diseases (including kidney disease and liver disease), pressure on the nerves (especially when the peripheral neuropathy is affecting a single nerve) and vitamin deficiency (with vitamin B being particularly important for nerve health).

The major symptoms of peripheral neuropathy include:

- Extreme Sensitivity to Touch.
- Lack of Co-Ordination.
- Numbness and Tingling in your Hands and Feet (which may spread upwards into your arms and legs).
- Sharp, Jabbing Pains.

Peripheral neuropathy can affect all diabetes sufferers and the symptoms can range from mild to severe. Peripheral neuropathy can usually be managed by eating a healthy diet which is high in B vitamins. However, painkillers may also be used for treatment if the condition starts to cause prolonged pain.

6) DIABETIC RETINOPATHY:- Diabetic retinopathy describes damage to the blood vessels of the light sensitive tissue located on the retina. This damage is caused by high blood sugar levels which initially cause the lens in your eye to swell (and may lead to blurred vision) and eventually cause permanent damage to the capillaries which supply your retina with blood.

The symptoms of diabetic retinopathy include:

- Blurred Vision.
- Dark Streaks which Block your Vision.
- Floating Spots in your Vision.
- Loss of Vision.
- Poor Night Vision.

All diabetics are susceptible to diabetic retinopathy. The symptoms can be reduced by managing your diabetes effectively, eating a healthy diet and exercising regularly. However, for severe diabetic retinopathy corrective laser surgery may be required.

As you can see there are a lot of potential symptoms that can act as warning signs for diabetes. Generally, any symptoms develop gradually in type 2 diabetics and much more rapidly in type 1 diabetics. However, many of the symptoms are not caused exclusively by diabetes. Even if your blood sugar levels are low or your vision is blurred, this does not necessarily mean that you have diabetes. The only way to be sure is to get tested by your doctor. They will be able to make an accurate diagnosis and confirm whether you have pre-diabetes, gestational, type 1 or type 2 diabetes.

Whilst every intention has been made to make this article accurate and informative, it is intended for general information only. Diabetes is a medical condition and this article is not intended as a substitute for the advice of your doctor or a qualified medical practitioner. If you have any concerns regarding any form of diabetes you should seek the advice of your doctor immediately.

Sources:
Blood Glucose/Sugar Information (Wikipedia)
Diabetes and Hyperglycaemia Information (Diabetes.co.uk)
Diabetes and Hypoglycaemia Information (Diabetes.co.uk)
Diabetic Ketoacidosis Information (Yahoo Health)
Diabetic Retinopathy Information (Mayo Clinic)
Glucagon Information (Wikipedia)
Hyperglycaemia Information (NHS Direct)
Hypoglycaemia Information (NHS Direct)
Hyperosmotic Non-Ketotic Acidosis Information (Diabetes Wikia)
Insulin Information (Wikipedia)
Peripheral Neuropathu (Mayo Clinic)

Testing for Diabetes

I originally published this blog post on October 16th 2007. However, since then this blog has come along way and so has my writing (or at least I hope it has). After re-reading some of my initial posts I identified this one as a post that I could improve a lot. So without further ado, please read the new, improved version of ‘Testing for Diabetes’.

Diabetes is a disease which develops when the cells in your body are no longer getting enough insulin (a hormone which helps your cells convert glucose into energy). There are a number of causes which vary depending upon the type of diabetes. There are also a number of symptoms which can indicate that you are suffering from diabetes. However, the problem with these symptoms is that in a lot of cases they are quite hard to spot. The only way to be certain that you have diabetes is to get yourself tested by a qualified medical practitioner. There are a number of tests available and whilst there is no universal standard by which diabetes is measured, certain tests have become more popular than others. In this article I will discuss 6 tests that can be used to look for diabetes.

1) FASTING PLASMA GLUCOSE (FPG) TEST:- This test measures glucose (the body’s main source of energy) levels in a person’s blood following a period of fasting (not eating). It is one of the most popular diabetes tests but is only given to non-pregnant adults. Therefore, it can be used to test for pre-diabetes, type 1 diabetes and type 2 diabetes BUT it cannot be used to test for gestational diabetes.

You will usually have to fast for eight hours prior to the FPG test. Following your fast a blood sample will then be taken (usually from a vein in your arm). This blood sample will then be used to measure your blood glucose levels and the results will indicate whether or not you have diabetes:

- A blood sugar reading of 99 milligrams per decilitre (mg/dL) or below is considered normal.
- A blood sugar reading of between 100 mg/dL and 125 mg/dL indicates that you have impaired fasting glucose (a form of pre-diabetes).
- A blood sugar reading of 126 mg/dL or above indicates that you have either type 1 or type 2 diabetes. If this is the case you will be given another FPG test and the results of the two will be compared. If the results are consistent your doctor will diagnose you with diabetes and investigate further to determine whether it is type 1 or type 2.

2) ORAL GLUCOSE TOLERANCE TEST (OGTT):- This test measures blood sugar levels following the consumption of a sugary drink containing glucose. Unlike FPG this test can be used to diagnose all forms of diabetes including gestational diabetes (although the methodology does change slightly when testing for gestational diabetes).

If the OGTT is being used to test for pre-diabetes, type 1 diabetes or type 2 diabetes then it acts as an extension to the FPG test. You will be required to fast for eight hours and then have a blood sample taken (as you would for the FPG test). After this your doctor will give you a sugary drink that contains a measured amount of glucose (which should be between 75g and 100g). Following consumption of the glucose your doctor will take blood samples at regular intervals (usually one hour, two hours and three hours after consumption).

If the OGTT is being used to test for gestational diabetes the same procedure will be followed except you will not be required to fast before the test. However, your doctor may recommend that you perform the test first thing in the morning before you have eaten anything.

Whichever type of diabetes the OGTT is measuring, the final blood sample will provide a good indicator as to whether you have diabetes or not:

- A blood sugar reading of 140 mg/dL or below is considered normal.
- A blood sugar reading of between 140 mg/dL and 199 mg/dL indicates that you have impaired glucose tolerance (a form of pre-diabetes).
- A blood sugar reading of 200 mg/dL or above indicates that you have either type 1, type 2 or gestational diabetes. If this is the case your doctor will either diagnose you with gestational diabetes (if the OGTT was to test for gestational diabetes) or investigate further and diagnose you with either type 1 or type 2 diabetes.

3) RANDOM BLOOD GLUCOSE (RBG) TEST:- Unlike the above tests, a RBG test can be performed at any time regardless of when you ate. It can also be performed at home, without the assistance of a doctor, using a glucose meter (a medical device which calculates the approximate level of glucose in the blood). No fasting is required for this type of test. The idea behind this is that although eating does affect blood sugar levels they should not fluctuate hugely if tested at random intervals during the day. This test can be used to test for all forms of diabetes but should not be used as the only basis for diagnosis because there are concerns regarding the accuracy of RBGs.

This test is relatively simple compared with the above tests. You simply prick your finger using a lancing device (a device which pricks your skin in a very controlled way to draw a small drop of blood) then place a single drop of blood on a disposable test strip. You then place this test strip into your glucose meter and it will give you an approximate blood sugar reading. Diagnosis from a RBG is very similar to an FBG with a blood sugar level of 200 mg/dL or over indicating that you have diabetes.

Although this type of test is easier and more convenient than other tests, there are problems with accuracy. Glucose meters are believed to have just 10% of the accuracy of a laboratory test. This is because their main function is to monitor blood sugar levels in diabetics - NOT diagnosing diabetes. Therefore, home RBG tests should only be used to identify the warning signs of diabetes. If this home testing indicates that you may have diabetes do not attempt to self diagnose. Instead, consult your doctor immediately and they will be able to perform further, more accurate tests and give you a proper diagnosis.

4) KETONE TEST:- This test looks for ketones (substances produced by the body when it breaks down fat for energy) in your urine or your bloodstream. The presence of ketones indicates that your body is burning too much fat because; you are not getting enough carbohydrates in your diet OR your body is not using glucose properly. High levels of ketones in your body are a warning sign for all types of diabetes. However, type 1 diabetics are the most likely to experience this because their body produces no insulin (people suffering from gestational diabetes and type 2 diabetes often produce limited insulin). The presence of excessive ketones can also be a sign of diabetic ketoacidosis, a potentially life threatening blood chemical imbalance.

You can test for ketones using either a blood test or a urine test. The blood test is the more accurate but the urine test is the most commonly used because it is more convenient. Blood testing is performed by your doctor and involves a blood sample being taken from your arm. Your doctor will then take this blood sample and test it for the presence of ketones. If ketones are found in your bloodstream your doctor will investigate to determine the cause and then give you further advice.

The urine test can be performed at home using special test strips that are available from your doctor and over the counter at some chemists. It involves urinating in a clean container and then placing a test strip into the urine. If the test strip changes colour there are ketones present in your urine and you should seek the advice of your doctor immediately. They will then be able to investigate further and determine the cause of the ketones in your urine.

5) URINE GLUCOSE TEST:- Urine usually contains little to no glucose. However, when blood sugar levels start to reach 180 mg/dL and above, glucose starts to spill over into the urine. The urine glucose test is not an accurate way to diagnose diabetes because glucose can also appear in the urine when your kidneys get damaged or diseased. However, it does indicate possible diabetes and your doctor will usually follow up with one of the above blood glucose tests if sugar is found in your urine.

To perform a urine test you urinate in a plastic container and then give it to your doctor who will pass it on to the laboratory for analysis. As I mentioned above, the urine test is not used to diagnose diabetes. The chances are that you will be having a urine test for something completely unrelated. If the analysis uncovers glucose in your urine you will then be given further tests for diabetes as a precaution.

6) GLYCOSYLATED HAEMOGLOBIN TEST:- When glucose binds with haemoglobin in the blood, glycosylated haemoglobin is created. The glucose stays attached to the haemoglobin for the life of the blood cell (usually between two to four months). Glycosylated haemoglobin levels increase in people who are not managing their diabetes properly. Therefore, the glycosylated haemoglobin test can be used to measure a person’s blood sugar levels over the last two to four months and check how effective any diabetes treatments have been.

This test is performed in the same way as a normal blood test. Your doctor will take a blood sample (usually from a vein in your arm) and the levels of glycosylated haemoglobin in this sample are then measured. Your doctor will interpret the results as follows:

- Non-diabetics should have a glycosylated haemoglobin level of between 4% and 6%.
- Diabetics who are treating the condition effectively should have glycosylated haemoglobin of less than 7%.
- Levels of glycosylated haemoglobin above 7% indicate that your current diabetes treatment is not performing effectively and needs to be changed. However, the results will need to be further interpreted by your doctor because other factors can affect your glycosylated haemoglobin levels.

As you can see there are a lot of ways that you can test for diabetes with some being more accurate and others being more convenient. However, the best way to test for diabetes is by consulting your doctor. All the tests discussed above measure the number of ketones or the level of glucose in your body. Whilst high blood sugar and high levels of ketones are a good indicator of diabetes there can be other factors affecting them. For example, your blood sugar levels often rise when you are unwell and ketones may be present in your blood if you are not eating enough. Your doctor has the professional skills to look at these signs, determine the cause and make the call as to whether it is diabetes or not.

Whilst every intention has been made to make this article accurate and informative, it is intended for general information only. Diabetes is a medical condition and this article is not intended as a substitute for the advice of your doctor or a qualified medical practitioner. If you have any concerns regarding any form of diabetes you should seek the advice of your doctor immediately.

Sources:
Blood Sugar/Glucose Information (Wikipedia)
Blood Sugar Test Results Information (Mayo Clinic)
Diabetes and Ketones Information (Diabetes.co.uk)
Diabetic Ketoacidosis Information (Yahoo Health)
Fasting Plasma Glucose Test (Diabetes Self Management)
Glucose Meter Information (Wikipedia)
Glucose Urine Test Information (Web MD)
Glycosylated Haemoglobin Information (Med Terms)
Glycosylated Haemoglobin Test (Health A to Z)
Haemoglobin Information (Wikipedia)
Impaired Fasting Glucose Information (Wikipedia)
Insulin Information (Wikipedia)
Ketone Test (Web MD)
Oral Glucose Tolerance Test (Web MD)
Screening for Diabetes (Patient UK)
Type 1 Diabetes Diagnosis Information (Health A to Z)
Type 2 Diabetes Diagnosis Information (Health A to Z)