Signs and Symptoms of Diabetes

Signs and Symptoms of Diabetes: A Comprehensive Guide

By Naeem Mustafa, Pharmacist

Pharmaservepk

Diabetes mellitus is one of the most prevalent chronic diseases worldwide, affecting millions of people across all age groups. As a pharmacist, I frequently counsel patients who present with early symptoms or have recently been diagnosed. Recognizing the signs and symptoms of diabetes early can lead to timely diagnosis, effective management, and prevention of serious complications.

Signs and Symptoms of Diabetes

This article provides a detailed overview of the signs and symptoms of diabetes, including differences between types, less common presentations, and important considerations for patients and healthcare professionals.

Understanding Diabetes

Diabetes occurs when the body cannot properly regulate blood glucose levels due to insufficient insulin production, ineffective use of insulin, or both. The main types are:

Type 1 Diabetes: 

An autoimmune condition where the pancreas produces little or no insulin. Usually diagnosed in children and young adults.

Type 2 Diabetes: 

The most common form (90–95% of cases), characterized by insulin resistance and relative insulin deficiency. Often associated with lifestyle factors and obesity.

Gestational Diabetes: 

Develops during pregnancy and usually resolves after delivery, but increases future risk of Type 2 diabetes.

Other Types: Includes monogenic diabetes, secondary diabetes (e.g., due to pancreatitis or certain medications), and LADA (Latent Autoimmune Diabetes in Adults).

Chronic hyperglycemia in diabetes can damage blood vessels, nerves, eyes, kidneys, and the heart if left uncontrolled.

Classic Signs and Symptoms (The "Three Polys" and More)

The hallmark symptoms of undiagnosed or poorly controlled diabetes are often referred to as the three polys:

Polyuria (Frequent Urination)

High blood glucose exceeds the renal threshold (approximately 180 mg/dL), causing glucose to spill into the urine. This draws water out osmotically, leading to increased urine volume. Patients may notice urinating more frequently, especially at night (nocturia), which disrupts sleep.

Polydipsia (Increased Thirst)

Excessive fluid loss through urine triggers thirst mechanisms in the brain. Patients often feel persistently thirsty and drink large amounts of water, yet still feel dehydrated.

Polyphagia (Increased Hunger)

Despite eating normally or more than usual, cells cannot utilize glucose effectively due to lack of insulin action. The body perceives this as starvation, stimulating appetite.

Additional Common Symptoms

Unexplained Weight Loss

Particularly prominent in Type 1 diabetes. The body breaks down fat and muscle for energy when glucose cannot enter cells, leading to rapid weight loss despite increased food intake.

Fatigue and Weakness

Cells are starved of glucose, their primary energy source, resulting in persistent tiredness, lethargy, and reduced physical stamina.

Blurred Vision

High blood glucose causes fluid shifts in the lens of the eye, altering its shape and affecting focus. Vision usually improves once blood sugar is controlled, but prolonged hyperglycemia can lead to diabetic retinopathy.

Slow Healing of Wounds

Elevated glucose impairs white blood cell function and reduces blood flow, delaying wound healing and increasing infection risk.

Recurrent Infections

Common sites include urinary tract infections, yeast infections (candidiasis, especially vaginal in women), skin infections, and gum infections. Glucose-rich urine and impaired immunity create a favorable environment for pathogens.

Tingling, Numbness, or Burning in Hands and Feet

Early sign of peripheral neuropathy caused by nerve damage from prolonged high glucose levels.

Dry Skin and Itching

Dehydration and poor circulation contribute to dry, itchy skin, sometimes leading to cracks and secondary infections.

Symptoms Specific to Type of Diabetes

Type 1 Diabetes

Symptoms typically develop rapidly over weeks or months and are often severe:

Sudden onset of the classic symptoms

Weight loss is prominent

Nausea, vomiting, abdominal pain

Fruity odor on breath (due to ketones)

Rapid breathing, confusion, or loss of consciousness in severe cases (diabetic ketoacidosis – DKA – a medical emergency)

Type 2 Diabetes

Symptoms develop gradually over years and may be subtle or absent:

Mild versions of the classic symptoms

Fatigue and blurred vision are common presenting complaints

Acanthosis nigricans: Velvety, dark patches of skin, usually on the neck, armpits, or groin – a marker of insulin resistance

Erectile dysfunction in men

Polycystic ovary syndrome (PCOS) symptoms in women Many patients are diagnosed during routine blood tests rather than symptomatic presentation.

Gestational Diabetes

Most women have no obvious symptoms. Diagnosis is made through routine glucose screening between 24–28 weeks of pregnancy. Rarely, mild polyuria or polydipsia may occur but are difficult to distinguish from normal pregnancy changes.

Less Commonly Recognized Symptoms

Irritability or mood changes

Headaches

Difficulty concentrating

Gum disease or frequent mouth ulcers

Balanitis (inflammation of the foreskin) in uncircumcised men

Increased susceptibility to boils or styes

When to Seek Medical Attention

Consult a doctor immediately if you experience:

Multiple classic symptoms together

Unexplained weight loss with increased appetite

Symptoms of diabetic ketoacidosis (vomiting, abdominal pain, rapid breathing, confusion)

Persistent blurred vision or recurrent infections

Routine screening is recommended for:

Adults over 45 years

Overweight individuals with additional risk factors (family history, sedentary lifestyle, hypertension, dyslipidemia, history of gestational diabetes, PCOS)

Children with obesity and family history

Role of the Pharmacist

As pharmacists, we play a vital role in:

Identifying at-risk patients during medication counseling

Educating patients about symptoms and the importance of screening

Supporting diabetes management through medication adherence counseling, blood glucose monitoring guidance, and lifestyle advice

Referring symptomatic patients for medical evaluation

Early detection and proper management can significantly reduce the risk of complications such as cardiovascular disease, kidney failure, blindness, and amputations.

Final Note: If you or someone you know is experiencing any of these symptoms, please consult your physician for proper testing (fasting plasma glucose, HbA1c, or oral glucose tolerance test). Diabetes is manageable, and with early intervention, individuals can lead healthy, fulfilling lives.

Naeem Mustafa

Pharmacist

Pharmaservepk