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4
DIAGNOSING DIABETES
Signs, Symptoms, Screening and Substantiation
With more than half of all diabetics not realizing that they have the disease, thousands of people are heading for some of the serious complications of diabetes without even knowing it.
In the small percentage of people with type I diabetes, the symptoms may appear suddenly and dramatically. For those with type II diabetes, however, the signs and symptoms may come on very slowly, possibly escaping notice for several years.
Sometimes diabetes is discovered during a routine physical examination, when the doctor finds that a person has a high blood sugar level. On the other hand, unfortunately, diabetes is often first diagnosed when a person seeks treatment for one of its complications—an eye condition, a severe foot infection, high blood pressure, kidney disease, or other health problems.
Many of these serious complications can be delayed or even prevented if diabetes is diagnosed and treated as soon as possible. Diabetes researchers are constantly looking for ways to detect diabetes and its complications earlier. But how can average people like you and me know if we have diabetes? Let us look at some of the warning signals.
If you have more than one or two of the following signs or symptoms, you should consult your doctor for a thorough check for the possibility of diabetes, especially if someone in your family is already a diabetic.
Some of the symptoms are found in both insulin-dependent (type I) and non-insulin-dependent (type II) diabetes. Others are more common only in type II diabetes. Let us first take an overview of the signs and symptoms of both types of diabetes, then we’ll look a bit more closely at some of them.
Excessive Thirst and Frequent Urination
Two of the earliest symptoms of diabetes are feeling thirsty much of the time and having to pass urine frequently. In young children, frequent bedwetting may be an indication of diabetes. We saw earlier that the kidneys act as the “policemen” to help control the amount of sugar in the blood. As the amount of glucose in the blood begins to rise, the kidneys begin to filter it out into the urine. This causes a person to urinate more often than usual. Then, because the body has lost this fluid in the urine, he will feel very thirsty.
When Larry was 37, he had no idea that he was a diabetic. He kept telling his wife that his weight loss and fatigue were simply the result of overwork and stress. But Larry’s secretary noticed something else—the tremendous amount of water he was drinking. She finally got him a large glass, which she labeled, “For the biggest drinker in the office!” Soon after that, Larry went to a doctor. Laboratory tests showed that his blood sugar level was very high, and the doctor diagnosed his condition as diabetes.
Signs and Symptoms of Diabetes
Insulin-dependent Non-insulin-dependent
Type I Type II
(Usually begins suddenly) (May develop quite slowly)
Excessive thirst Any or all of the same signs and symptoms as in type I
Frequent urination and/or
Itchiness, especially in the
Extreme hunger genital area
Unexplainable weight loss Slow healing of scratches and cuts
Irritability
Frequent, slow-healing
Lack of energy infections of the skin,
gums, or bladder
Weakness and fatigue
Pain, numbness or tingling
Nausea and vomiting in the legs, feet or hands
Ants in the toilet Blurred vision
Ants Around the Toilet
As the kidneys filter out the excess sugar from the blood and it “spills over” into the urine, the diabetic’s urine will be sweet. You and I might not be aware of the urine’s sweetness, but the ants around the toilet are likely to notice.
My young friend Simon had not realized that his mother was a diabetic until one day he noticed the ants in the toilet at home. He had learned about diabetes at school, and suddenly he knew that someone in the family had diabetes.
As a matter of fact, the very name diabetes mellitus describes the disease well. Diabetes comes from the Greek word meaning “fountain” or “siphon”, referring to the frequent passing of urine. Mellitus is from the Latin word for “honey”. Strange as it may seem, the earliest test for diagnosing diabetes was to smell and taste the urine to see if it was sweet!
Nowadays, many cases of diabetes are discovered when a doctor asks a patient to send some urine to the laboratory for routine testing. If the report shows sugar in the urine, it does not always mean that the person has diabetes. However, if there is sugar in the urine, the doctor will often order a blood glucose test to see whether diabetes is the cause.
Unexplainable Weight Loss
A person with diabetes is likely to lose weight for not apparent reason, even though his appetite seems normal. In type I diabetes especially, the person may feel extremely hungry and eat a lot of food. Yet, in spite of the increased amount of food he eats, he may lose weight. The weight loss may be very rapid—as much as six or seven kilograms in two weeks.
Roger Lee has always loved to play soccer ever since he was very young. When he was 14, Roger was playing on his school team. But then he began needing a candy bar at every half time and another at the end of each game. By the end of a game, he was moving in slow-motion. Then came a special holiday when Roger spent most of his time eating all the delicious food that the ladies of the family had prepared. But in two days’ time, in spite of the tremendous amount of food he was eating, Roger lost more than four kilograms. The family knew that something was really wrong! It was—the doctor very quickly diagnosed—insulin-dependent diabetes.
More Infections and Slow Healing of Cuts
A person with diabetes is likely to have more frequent infections, especially of the skin or urinary tract. Cuts or other wounds—especially on the feet—usually heal much more slowly in a diabetic.
Check on Yourself
Another way that some people discover that they have diabetes is by taking a simple screening test at home. Answer each of the following questions on pp. 54-55, score yourself, and see how you come out.
Because early diagnosis is so important in helping to prevent some of the serious complications of diabetes, more and more screening programs are now becoming available.
Some of the programs are trying to find previously undiagnosed diabetics. Other programs are attempting to screen as many as possible of the 50,000 to 60,000 already diagnosed diabetics for complications such as the eye condition called retinopathy, which can lead to blindness. After diagnosis of diabetes, all diabetics should have their eyes checked at least once a year—more often if there are any eye problems.
Any woman who is pregnant should also have her blood glucose level checked for signs of diabetes between the 24th and 28th weeks of pregnancy.
Do You Have Diabetes?
Answer every question by checking either “Yes” or “No”. At the end, add up all the “Yes” answers.
Yes No
- Do you regularly have any of the
following symptoms
Feel very thirsty / / / /
Pass urine very often / / / /
Feel extremely tired / / / /
Have blurry vision / / / /
- Are you over 30 years old? / / / /
- Do you have a parent with diabetes? / / / /
- Do you have a brother or sister
with diabetes? / / / /
- Have you lost weight for no
apparent reason? / / / /
- Do you have high blood pressure / / / /
- Do you have a high blood
cholesterol level? / / / /
- Are you overweight? / / / /
- Do cuts and scratches seem to heal
more slowly than normal? / / / /
- Do you have pain, numbness or tingling
in your feet, legs or hands? / / / /
For women only:
- Have you ever given birth to a baby
which weighed more than 4.5 kg.
(10 pounds)? / / / /
- Have you ever had high blood sugar levels
during pregnancy? (Have you ever had
gestational diabetes?)
- Are you at least 24 weeks pregnant now? / / / /
Total number of questions answered Yes ___________*
*If you answered “yes” to at least two of the questions above, you should see your doctor soon and arrange to have your blood sugar tested.
Diagnosing Diabetes
Whether it is by a screening test, or by a regular visit to your doctor, how will the doctor know if you have diabetes?
In a screening program, the doctor or nurse may use a glucose meter, sometimes called a reflectance meter, to check your blood sugar level. A drop or two of blood—usually taken from a little prick in your fingertip—is put onto a special chemically-treated strip of testing paper. Within one to three minutes, depending on what type of glucose meter is used, the strip is put into the meter. A small screen on the meter then shows a digital readout of the blood sugar level.
The accuracy of such machines depends on a variety of factors, including the kind of machine itself and the technique of the person using it. As we will see later, glucose meters can be very helpful for home monitoring of blood sugar levels. However, they are not generally used for actually diagnosing diabetes.
The most accurate way to diagnose diabetes is by checking your blood glucose level in the laboratory on at least one occasion. Sometimes two or three tests are necessary for a definite diagnosis.
Initially, the doctor may take a random blood glucose test, meaning that it can be done at any time of day, whether or not you have had anything to eat or drink. Or the doctor may ask you to fast during the night—taking nothing but plain water for 10 to 12 hours before the blood test. This is called a fasting blood sugar or fasting blood glucose test. To be the most accurate, it should be done the first thing in the morning.
When the doctor sees the results of your blood sugar test, he will decide whether or not further tests are necessary. A normal blood sugar level would be approximately 60-120 mg/dl, or 3.1-6.6 mmol/l.—depending on which measurement terminology your doctor uses.
There are two different measurements of blood glucose level, and the doctor may report your test results in either one or the other, depending partly on where you live. In the past, blood glucose was generally measured in milligrams per deciliter (mg/dl). In places which have adopted the new terminology, however, it is measured in millimoles per liter (mmol/l). The main advantage to the new mmol/l measurement is that the numbers are much smaller than when dealing with mg/dl.
Your blood glucose level would naturally be nearer to one of the lower figures mentioned above if you have been fasting, and nearer the highest figures if you have eaten within the previous two or three hours.
If, however, your random blood glucose test measures at least 200 mg/dl (11.1 mmol/l), or if your fasting blood glucose test measures 140 mg/dl (7.8 mmol/l) or more, you may have diabetes. If you have several of the usual symptoms of diabetes and your blood glucose tests are that high, the doctor may well confirm the diagnosis of diabetes immediately.
But if you have never had any of the signs and symptoms of diabetes, the doctor will undoubtedly ask you to take an oral glucose tolerance test to determine whether or not you actually have diabetes. For the oral glucose tolerance test, you will have to come to the laboratory to the first thing in the morning, after fasting for 10 to 12 hours.
First the laboratory will test your blood while you are still fasting. Immediately after drawing the blood for the first test, you will receive a special glucose solution to drink. Your blood will be checked again one hour and two hours after the drink. While you wait between tests, you should sit down and relax, but you should not smoke. If you have never had any of the signs of diabetes, you may be asked to wait one more hour for still another blood glucose test.
Certain medicines can affect the blood glucose tests, so you should tell your doctor before the test about any medicines that you are taking.
Nowadays, in addition to a diagnosis of either diabetic or nondiabetic, doctors have added a third category called impaired glucose tolerance. Of those who fall into this category on any glucose tolerance test, one-third will eventually become diabetics. Another one-third will go back to a normal glucose tolerance level. And the other one-third will remain with an impaired glucose tolerance ability.
Doctors feel that it is important to identify those with impaired glucose tolerance because they have a higher-than-normal risk of developing not only diabetes but also heart attacks, strokes, and other blood vessel disease. If they know early that they are in this group, they can take steps to change their lifestyle and reduce their risk of these dangerous diseases.
Many people begin to develop type Ii diabetes as long as nine to 12 years before diagnosis. Might you be one of them? Finding out now may help you prevent serious trouble later. If in doubt, go find out!