Recognizing the Signs of Diabetes Can Save Lives

Pharmacy Times, July 2021, Volume 87, Issue 7

Early intervention by pharmacists can help stave off condition's serious consequences.

Diabetes is a chronic health condition that affects how the body turns food into energy.

Once most foods are digested, they are turned into glucose and released into the bloodstream. This signals the pancreas to release insulin, which then sends the glucose into the body’s cells for use as energy.

Diabetes means that the body either does not make enough insulin or cannot use the insulin it makes effectively. This leads to a buildup of glucose in the blood and can lead to serious health issues.

Approximately 34.2 million adults in the United States have diabetes, according to the CDC.

Diabetes is the seventh-leading cause of death in the United States and the No. 1 cause of adult blindness, kidney failure, and lower-limb amputations. Unfortunately, the number of adults who have received a diagnosis of diabetes has more than doubled in the past 20 years.1

There are 3 main types of diabetes: type 1 diabetes (T1D), type 2 diabetes (T2D), and gestational diabetes.

T1D is most common in children, adolescents, and young adults. T1D is thought to be caused by an autoimmune reaction in the pancreas, and it usually develops quickly. This type of diabetes cannot be prevented and requires lifelong insulin therapy.1

T2D results when the body does not use insulin effectively. This is usually found in adults and develops over many years. Approximately 90% to 95% of individuals who receive a diagnosis of diabetes have T2, which can be delayed or prevented with healthy lifestyle changes.1

Gestational diabetes develops during pregnancy in patients who have never had diabetes before. This usually subsides after pregnancy, but it increases the risk for T2D later in life in both the child and the mother.1

During the development of T2D, there is a syndrome called prediabetes when the blood glucose levels are higher than normal but not high enough to be diagnosed as T2D. If lifestyle changes do not take place, the development of T2D is imminent.1

Diabetes Signs and Symptoms

Prediabetes very often does not have signs or symptoms. Their absence often causes prediabetes to go undetected until serious health problems, such as T2D, occur. Some individuals with prediabetes, however, experience blurred vision, excess hunger, fatigue, frequent urination, and increased thirst.2,3 Another possible sign of prediabetes is the darkening of skin in certain areas, including the armpits, elbows, knees, knuckles, and neck.4

T1D signs and symptoms can appear suddenly and are often subtle but can become severe. These include the following5-7:

Bedwetting: An increased need to urinate can cause bedwetting in a child who has been dry at night.

Blurry vision: High blood glucose levels affect the tiny blood vessels in the eyes, causing fluid to seep into the lens of the eye.

Dry mouth: High blood glucose levels tend to decrease saliva flow.

Extreme thirst: This is tied to high blood glucose levels and exacerbated by frequent urination.

Fatigue: The body feels as if it does not have enough energy due to improper insulin activity.

Frequent infections of the skin, urinary tract, or vagina: High blood glucose levels cause white blood cells to have difficulty traveling. This lowers the body’s ability to fight off infections.

Irritability and mood changes: Fluctuations in blood glucose levels can wreak havoc with moods.

Polyphagia or increased hunger: This is especially pronounced after eating. Because the body cannot absorb glucose, it is constantly looking for more fuel.

Polyuria or frequent urination: When kidneys cannot process the high amount of glucose, they allow some glucose to go into the urine, causing a higher volume of urine.

Unexplained weight loss: The blood excretes extra glucose into the urine, causing weight loss even though the patient is eating more.

Upset stomach and vomiting: Nerve damage may prevent the body from moving food from the stomach to the intestines in an efficient manner. Food can then build up in the stomach and cause nausea and vomiting.

Signs of an emergency that may require immediate medical attention include abdominal pain, breath that smells fruity, confusion, loss of consciousness, rapid breathing, and shaking.6

T2D has signs and symptoms similar to those of T1D with a few important differences, including:

Slow-healing sores: Blood glucose can build up on the inside of arteries, causing them to narrow. This can restrict the amount of nutrients and oxygen being delivered to help repair damage.7

Neuropathy: The nerves are starved for nutrients and oxygen, causing nerve damage. This can be an extremely painful condition. There are 4 types of neuropathies associated with diabetes: autonomic neuropathy affecting the internal organs, such as the eyes or heart; focal neuropathy affecting a single nerve, such as those in the hands, head, legs, or torso; peripheral neuropathy, affecting the feet and legs and sometimes the arms and hands; and proximal neuropathy, which is very rare, affecting the buttocks, hips, or thighs.8

Most pregnant women do not experience signs or symptoms of gestational diabetes. The only way to know is if a patient has the condition is to perform a blood glucose test, typically given at 24 to 28 weeks gestation. However, some women may have dry mouth, fatigue, and increased thirst.9

Pharmacists can be on the lookout by evaluating the questions patients ask, reviewing medication histories, and doing a visual assessment. Pharmacists can also remind patients to get annual physicals that include laboratory work for glycated hemoglobin A1c. Signs and symptoms may go unnoticed until a serious condition develops, but pharmacists can do their part to help the growing incidence of diabetes.

Pharmacists can also promote eating healthy foods and getting regular exercise, as well as recommend weight-loss regimens that have been proven to decrease the risk of developing T2D, such as the Mediterranean or Paleolithic diets.

Kathleen Kenny, PharmD, RPh, has more than 25 years of experience as a community pharmacist and is a freelance clinical medical writer based in Colorado Springs, Colorado.

REFERENCES

  1. What is diabetes? CDC. Updated June 11, 2020. Accessed June 12, 2021. https://www.cdc.gov/diabetes/basics/diabetes.html
  2. Schaeffer J. Understanding borderline diabetes: signs, symptoms, and more. September 29, 2018. Accessed June 21, 2021. https://www.healthline.com/health/diabetes/borderline-diabetes-know-the-signs
  3. Dorfner M. What is pre-diabetes? Mayo Clinic. November 13, 2015. Accessed June 12, 2021. https://newsnetwork.mayoclinic.org/discussion/what-is-pre-diabetes/
  4. Prediabetes. Mayo Clinic. September 22, 2020. Accessed June 21, 2021. https://www.mayoclinic.org/diseases-conditions/prediabetes/symptoms-causes/syc-20355278
  5. Type 1 diabetes. Mayo Clinic. March 27, 2021. Accessed June 12, 2021. https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011
  6. Type 1 diabetes. CDC. Updated March 25, 2021. Accessed June 22, 2021. https://www.cdc.gov/diabetes/basics/type1.html
  7. Higuera V. 12 unusual symptoms of diabetes. Healthline. January 27, 2020. Accessed June 12, 2021. https://www.healthline.com/health/diabetes/unusual-symptoms-of-diabetes
  8. What is diabetic neuropathy? National Institute of Diabetes and Digestive and Kidney Disease website. Updated February 2018. Accessed June 12, 2021. https:// www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/what-is-diabetic-neuropathy
  9. Gestational diabetes. American Pregnancy Association. April 26, 2020. Accessed June 12, 2021. https://american-pregnancy.org/healthy-pregnancy/pregnancy-complications/gestational-diabetes-855/
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