Diabetes mellitus, or diabetes, is a disease that is, unfortunately, becoming more well-known.
The incidence of diabetes is increasing; according to the World Health Organization (WHO), the number of people with diabetes has risen from 108 million people in 1980 to 422 million in 2014.
Unfortunately, many people with diabetes may not even know they have it. In fact, of the 34.2 million adults with diabetes in 2018, 26.8 million were diagnosed, and 7.3 million were undiagnosed. Going along with undiagnosed diabetes can increase the risk of diabetes complications.
Knowing the diabetes symptoms can help provide an earlier diagnosis, which can preserve both health and quality of life.
While there are several diabetes symptoms, there are three common physical symptoms that usually cue the person with undiagnosed diabetes to seek medical attention.
What is diabetes?
Diabetes mellitus, or diabetes, is a disease affecting the pancreas and its ability to produce the hormone insulin. More specifically, the beta cells of the pancreas are responsible for producing insulin.
Diabetes occurs when the pancreas’ beta cells are destroyed when the beta cells don’t produce enough insulin to keep blood sugar levels regulated, or when the body doesn’t respond to insulin effectively. There are different types of diabetes, including type 1, type 2, and gestational diabetes.
Type 1 diabetes is an autoimmune condition that causes the cells of the pancreas to be destroyed. The only treatment for type 1 diabetes is the lifelong use of insulin.
Type 1 diabetes is the rarest of the types of diabetes, affecting about 2-5% of the world’s population and about 1 in 300 American adults before the age of 18. Type 1 usually occurs before age 18, so it’s also referred to as juvenile diabetes. Type 1 diabetes risk factors don’t tend to be as well-known as type 2 diabetes.
Type 2 diabetes is more closely related to lifestyle habits and body composition and is the most prevalent type of diabetes. Risk factors for developing type 2 diabetes include being overweight or obese, not being physically active, having a family history, or having prediabetes.
Prediabetes is when blood sugar levels are elevated, but not enough to be diagnosed as diabetes. Having prediabetes is a major risk factor for developing type 2 diabetes later on.
Gestational diabetes occurs specifically during pregnancy and is often resolved after pregnancy. However, people with gestational diabetes are at increased risk of developing type 2 diabetes later in life. Gestational diabetes is usually diagnosed between the 24th and 28th weeks of pregnancy and is caused by hormonal shifts leading to increased insulin resistance.
Insulin helps blood glucose (blood sugar) enter our cells, used as fuel to support all of the body’s functions. Without enough insulin, sugar remains in the bloodstream and can become dangerously high. Having high blood sugar over a prolonged period of time is detrimental to health. Our bodies make sugar, and we also obtain it from certain foods we eat, such as carbohydrates.
High blood sugar damages arteries and blood vessels, which supply blood to our organs and body systems. It also damages nerves and can result in loss of sensation in limbs, leading to serious wounds and amputations. The main goal of managing diabetes is to prevent long-term complications such as these.
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What causes diabetes?
The most common cause of diabetes is insulin resistance, such as type 2 and gestational diabetes. Insulin resistance means that the body doesn’t use insulin as effectively as it should, and the body can start to make less insulin than it needs.
Without enough insulin working properly, blood sugar levels rise to unhealthy levels. From there, the insulin resistance worsens because the body tries to lower the increased blood sugar levels by pumping out more insulin. This can tax the pancreas over time, leading to more insulin resistance.
In type 1 diabetes, the cause is due to an overactive immune system that mistakes the beta cells of the pancreas (the ones that make insulin) as a threat. The body then destroys the pancreas cells, which means there isn’t enough insulin produced to keep blood sugar levels in a healthy range.
What are the 3 most common symptoms of undiagnosed diabetes?
There are many symptoms of diabetes; some of them are physical, and some are diagnosed with blood tests. Typically, people with undiagnosed diabetes present with three major physical symptoms that bring them into their healthcare provider.
Excessive urination (polyuria): Elevated blood glucose levels cause an imbalance of dissolved particles in the urine. When there is a lot of sugar in the urine, the body attempts to dilute the sugar by pulling fluid from the body. The result is increased urine volume due to less water being absorbed by the kidney and more being excreted through the bladder. People usually notice polyuria when they wake up several times per night to urinate, especially without increasing their fluid intake.
Excessive thirst (polydipsia): Excessive thirst is connected to increased urination. When someone is losing more fluids due to increased urination, it can be dehydrating. Dehydration stimulates thirst, which then contributes to the increased urination from increased urine volume. Because the thirst is due to high blood sugar levels and dehydration, drinking more water may not quench thirst as it does in people without undiagnosed diabetes. These two symptoms have a cyclic effect and feed off of each other, worsening both symptoms.
Unintentional weight loss: Cells require sugar (glucose) for energy; glucose is the preferred energy source over other sources. Cells have insulin receptors, which insulin attaches to in order to let the sugar in. An easier way to think of it is that the cells have doors, the insulin receptors are the doorknobs, and insulin is the key to open the doorknob to allow sugar in to feed the cells.
Without enough insulin to provide glucose to feed the cells, the body starts burning fat and muscle for energy instead. This leads to unintentional weight loss, and can also result in increased hunger to try to provide enough energy for the body to function.
Diagnosis
These physical symptoms of undiagnosed diabetes usually bring patients into their healthcare provider, where a formal diabetes diagnosis can be made.
Diabetes can be diagnosed using a number of different tests. These tests are often done in a laboratory or a healthcare provider’s office and must be ordered by your healthcare provider.
- Hemoglobin A1c: This test measures the average blood sugar over the last 60-90 days. It’s reported in a percentage, with a normal A1c being less than 5.7%. Diabetes is diagnosed with a hemoglobin A1c of 6.5% or higher. An A1c above 7% usually means blood sugar levels haven’t been well-controlled.
- Fasting blood sugar: Blood sugar is tested when the person hasn’t eaten anything for at least eight hours. A normal fasting blood sugar is below 100 mg/dL. Diabetes is diagnosed when the fasting blood sugar is greater than or equal to 126 mg/dL.
- Random plasma glucose test: A blood sugar of 200 mg/dL or greater at any time can be used to diagnose diabetes, though most providers prefer to order a hemoglobin A1c as well to ensure it wasn’t a one-time high blood sugar.
- Oral glucose tolerance test: The individual being tested drinks a solution with 75 grams of glucose in it. A blood test measures how much glucose is in the blood two hours after consuming the drink. A normal result is 139 mg/dL or lower, whereas diabetes is diagnosed when 200 mg/dL or higher.
For gestational diabetes screening and diagnosis, a one-hour glucose test is usually done first. If it’s failed, then a three-hour test is ordered.
- Antibody tests: Because type 1 diabetes is an autoimmune disease, there are specific antibody tests that can be ordered, including C-peptide, IAA, IA-2A, ZnT8Ab, ICA, GADA, or anti-GAD.
Conclusion
Diabetes occurs when the pancreas doesn’t produce enough insulin to keep blood sugar levels in a healthy range. This can result from an autoimmune condition such as type 1 diabetes, which is the more rare form of diabetes. Diabetes can also be caused by insulin resistance, such as in the case of type 2 diabetes and gestational diabetes.
Some of the major physical symptoms of undiagnosed diabetes include increased urination, increased thirst, and unintentional weight loss.
When blood sugar levels are high, the body attempts to flush out the extra sugar by increasing the urine volume. This can cause dehydration, which in turn increases thirst. When the cells aren’t able to use sugar for energy from inadequate insulin levels, the body starts burning fat and muscle for energy, which results in weight loss.
There are many ways diabetes can be officially diagnosed, including the hemoglobin A1c test, a fasting plasma blood glucose test, a random blood glucose test, a glucose tolerance test, and antibody tests (for type 1 diabetes). If you suspect that you have undiagnosed diabetes, it’s best to seek prompt medical attention from your healthcare provider.
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