SYMPTOM: It is the thing described by the patient. For example, pain is something what the patient tells a doctor.
SIGN: It is what the doctor finds or elicits in a patient. For example, Pallor or paleness of the conjunctiva and the nail beds indicates Anemia. This is what the doctor finds or notices in a patient.
TYPE 2 DIABETES SYMPTOMS:
The signs and symptoms are common for all types of Diabetes Mellitus. These include both Type 2 Diabetes and Type 1 Diabetes. The symptoms of type 2 diabetes in general are:
1. Polyuria: The excess urine formation with increase in frequency of voiding urine is called polyuria. It is caused due to osmotic diuresis which is due to increase in blood sugar levels.
2. Polydipsia: The increase in water intake is called polydipsia. The excess loss of water from the body due to increased voiding of urine leads to increase in salt content in the body which in turn stimulates the thirst center in the Hypothalamus which in turn increases the water intake.
3. Polyphagia: The excess intake of food is called polyphagia which is another most prominent symptom of Diabetes Mellitus.
4. Asthenia: The loss of strength is called asthenia. The person becomes very weak. There is loss of energy in the patient. Asthenia is caused because of depletion of proteins in the body which is due to lack of insulin. There is an increase in breakdown of proteins during the absence of insulin. In the absence of glucose availability to the tissues due to lack of insulin, the proteins in the tissue are used up for getting energy by the tissues. This is also one of the mechanisms leading to asthenia.
5. Glucosuria: Loss of glucose in urine is called glucosuria. When the glucose level in the blood crosses 180 mg/dl, then it is excreted in urine. Since 180mg/dl is called the renal threshold for glucose, this is the maximum blood
glucose level which the kidneys can reabsorb. Beyond this the kidneys cannot reabsorb glucose thereby leading to its excretion in urine.
6. Osmotic Diuresis: Presence of excess glucose in renal tubules i.e. the glucose which could not be reabsorbed by the kidneys, causes an osmotic gradient which leads to secretion of water into renal tubules. It also prevents the re-absorption of water by renal tubules. This water is excreted as urine. In this way, the excess glucose in diabetes leads to osmotic diuresis which is the reason for polyuria and thereby polydypsia.
7. Ketosis: Lack of availability of glucose to tissues which may be either due to insulin deficiency or insulin resistance leads to utilization of the fat. A large amount of fat is broken down to meet the energy requirements of the body which leads to ketosis or increased concentration of ketoacids in the blood which leads to ketoacidosis.
Ketonuria may also be seen, because this excess ketoacids are excreted through urine. The ketoacids are excreted along with sodium ions, these sodium ions are in turn exchanged with hydrogen ions in renal tubules which add further to the acidosis of the body.
8. Acetone Breathing: In severe diabetic ketoacidosis, acetone is expired in the air. This acetone gives it characteristic acetone or fruity odour which is a symptom of rather prolonged diabetes. It is a life threatening condition.
9. Kussmaul Breathing: It is the increase in rate and depth of respiration which occurs during severe acidosis.
10. Circulatory Shock: It occurs in severe diabetes when there is severe dehydration due to osmotic diuresis.
11. Coma: In severe cases of diabetes due to kussmaul breathing there is loss of large amount of carbon dioxide which further leads to reduction in bicarbonate concentration in the body which leads to severe acidosis and coma.
Even hyperosmolar coma may be seen sometimes which is due to increase in glucose concentration of the blood.
If a diabetic patient has tremors all over the body associated with nervousness and sweating, it is an indication of hypoglycaemia i.e. reduction of blood glucose level to less than 50 mg/dl. It is an emergency situation and if not treated immediately leads to clonic convulsions and unconciousness. Later the convulsions stop and it leads to coma.
This situation is called Hypoglycaemic Shock or Insulin Shock which may be due to excess insulin administered during course of treatment or lack of food since a long period.
Treatment: Immediately the patient should be given a sweet candy or sugar to chew which compensate for the deficiency of glucose and restore the blood glucose levels.
REASONS FOR THE SYMPTOMS:
The symptoms and signs of diabetes mellitus are because of:
1. Increased blood sugar levels due to reduced utilization by tissues.
2. Mobilization of fats from adipose tissue for energy leading to increased concentration of fatty acids in the blood. This may also lead to atherosclerosis.
3. Depletion of proteins from tissues.
The above ones are the chief manifestations, symptoms and signs of Diabetes Mellitus, whether it is type 1 or type 2 diabetes. Besides the above, several other symptoms are associated with the complications caused by diabetes
mellitus which we shall see in the topic on complications of type 2 diabetes.