Symptoms of diabetes
Thirst, polydipsia, and polyuria
• Severe thirst, including at night. A few patients, often elderly, ignore their thirst for fear of increasing urination. This causes dehydration and may precipitate hospital admission. Sugary drinks worsen hyperglycaemia.
• Polyuria (frequent passage of large volumes of urine, usually dilute).
• Nocturia with sleep disturbance.
• Urinary incontinence, bed-wetting, or sodden nappies (children).
• Stress incontinence.
• Urinary retention in men with prostatism.
• The severity of the polyuria, or the thirst and polydipsia, may not match the degree of hyperglycaemia.
• Polyuria without glycosuria is not due to diabetes mellitus. Seek other causes.
• Some weight loss is due to dehydration. The rest is due to reduction of adipose tissue by fat and muscle breakdown to fuel gluconeogenesis.
• Obese patients may be pleased, not realizing that weight loss is because of diabetes. On treatment, lost weight may be regained.
• Classically, the weight loss of diabetes mellitus is associated with normal
or even increased appetite. A few patients crave sweet foods.
• Cachexia may develop rapidly in patients with type 1 diabetes who were slim to start with or in whom the diagnosis has been delayed.
• Some patients with type 2 diabetes do not lose weight.
• In patients with steroid-induced diabetes the weight gain of steroid excess may balance the weight loss of untreated diabetes.
Tiredness and malaise
• Tiredness is an insidious but frequent symptom.
• Treated patients may now recognize previous non-specific malaise.
• People may complain that the patient is irritable and hard to live with.
• Dehydration may cause constipation, perhaps severe in the elderly.
• Lack of pancreatic enzyme may cause steatorrhoea.
Recurrent or refractory infections
• Boils, cellulitis, abscesses. Consider nasal carriage of Staphylococcus aureus.
• Candida may recur despite antifungals—thrush or balanitis.
• Recurrent urinary tract or chest infections.
• Changes in blood glucose concentrations may alter the refractive index of the lens, aqueous humour, and cornea, and cause blurred vision.
• New spectacles may be useless once the hyperglycaemia resolves.
• Pins and needles in hands and feet; may resolve on treatment of the diabetes.
• Peripheral nerve damage may persist or worsen.
Pruritus vulvae is a common presenting feature caused by candidal infection.
Generalized pruritus is not a feature of diabetes alone. There are other causes including, rarely, pancreatic malignancy.
Patients with uncontrolled diabetes often complain of cramp, especially in
the legs. If persistent it can be relieved by quinine sulfate.
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