During prediabetes and the early stages of diabetes, the majority of patients are asymptomatic. As a result, obtaining a diagnosis may be delayed for many years if routine screening measures for diabetes, such as laboratory work, are not performed during regular healthcare visits.

Typically, patients with type 1 diabetes mellitus (T1DM) present with symptomatic hyperglycemia and sometimes with diabetic ketoacidosis (DKA). DKA is defined as an acute metabolic complication of diabetes distinguished by hyperglycemia, hyperketonemia, and metabolic acidosis. DKA occurs primarily in T1DM and is less common in T2DM; it can present with nausea, vomiting, and abdominal pain and cause cerebral edema, coma, and death. DKA may be the initial presentation in an estimated 25% of adults with T1DM. The most common symptoms associated with T1DM are polyuria, polydipsia, and polyphagia, along with lethargy, nausea, and blurred vision, all of which result from the hyperglycemia.

The onset of symptoms may be abrupt. Polyuria is caused by osmotic diuresis secondary to hyperglycemia. In young children, severe nocturnal enuresis secondary to polyuria could be a warning sign of diabetes onset. In T1DM, thirst is a response to the hyperosmolar state and dehydration. The American Diabetes Association notes that adults with new-onset T1DM may present with a short duration of illness of 1 to 4 weeks or more, a gradually progressing process that can be misinterpreted as type 2 diabetes mellitus (T2DM). Patients with T1DM may also present with fatigue, weakness, and weight loss despite normal appetite.

Patients with T2DM may present with symptomatic hyperglycemia but are frequently asymptomatic for diabetes, and T2DM is often discovered during routine checkups and laboratory testing. Classic symptoms of T2DM include polyuria, polydipsia, polyphagia, and weight loss. Other symptoms that may suggest hyperglycemia include blurred vision, lower-extremity paresthesia, and delayed wound healing. In some patients, initial symptoms may actually be indicative of diabetic complications (such as neuropathy, retinopathy, skin acanthosis, and recurring Candida infections), signifying that the T2DM has been present for some time. This highlights the need for routine screening, especially in high-risk patient populations. In some patients, a hyperosmolar hyperglycemic state occurs initially, particularly during a period of extreme stress or when glucose metabolism is further impaired by use of certain pharmacologic agents, such as corticosteroids.

Since early diagnosis and clinical intervention are essential for preventing and/or reducing the complications associated with poorly controlled diabetes, patients should be reminded to maintain routine healthcare and seek medical care if they are experiencing any symptoms associated with hyperglycemia.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

 « Click here to return to Diabetes Awareness.