Every week I diagnose people with diabetes who have likely had it for 5 years or more and yet had no idea what was happening to them! They may already have complications like eye disease or nerve damage from high sugars but are always surprised that they did not notice any symptoms. Typically, people hear that the signs and symptoms of diabetes are feeling thirsty and going to the bathroom a lot. This certainly can be true but people will only experience this if the sugars are high enough for the kidneys to spill sugar into the urine. (See the chart at the bottom of this blog). Blood sugar levels can be high enough to cause damage to the body, yet low enough that the individual has no symptoms at all.
Individuals will only have thirst and an increase in urination once they are spilling sugar from the blood into the urine. This usually happens at about a blood sugar of 15 mmo/L. As sugar spills over into the urine, it draws water with it like a sponge, leading to dehydration and causing the individual to make more urine. When the body becomes dehydrated, people may feel thirsty or have a dry mouth. They may notice a change in their vision as the lens in the eye also dehydrates and their focal length (the distance at which you need to hold the newspaper to read) may change. With dehydration, people may feel fatigued. Often the fatigue can come on quickly after meals when the sugars are higher. Some people report falling asleep in their chairs after eating a big meal.
You can see that all these symptoms, especially if they happen slowly, can be chalked up to “old age”: fatigue, getting up at night to pee and changes in how far away they have to hold the newspaper to read!
Another symptom can be recurrent yeast or fungal infections. For women, vaginal yeast infections are fairly common in the non-diabetic population and may not be a trigger for them or their doctors to think about diabetes. However, in people with uncontrolled diabetes with high blood sugars, the yeast infection is very difficult to treat and usually doesn’t go away until the sugars are managed.
Men with high sugars can get yeast overgrowth at the end of the penis. Yeast infections are less common in men and should alert health care providers to look for diabetes.
Seniors often have very little in the way of typical symptoms. They will often not have a sense of thirst, even when they are dehydrated. The first symptoms of diabetes may be confusion, falls or incontinence.
In children, the symptoms may come on very quickly. They more commonly have type 1 diabetes than older adults and will need insulin. It is important not to delay a diagnosis if you think they may have diabetes. If they are younger, they may start wetting the bed as a sign. They will usually lose weight and will be thirsty and peeing more often. If the symptoms escalate and they are getting sicker and heading towards diabetic ketoacidosis where the body is burning fat and not sugars, they may complain of stomach aches and have a “fruity” smell. This is the smell of “ketones”, which happens when the body is burning fat.
One of the best ways of knowing if you are at risk of diabetes is to take this quiz. If you are at increased risk, see your health care provider to be screened by a blood test.