Spotting the Early Warning Signs of Diabetes and Related Complications

Pharmacists are in a strong position to identify the early warning signs of diabetes because they are often the most accessible and frequently visited members of the health care team.

According to the National Institutes of Health, it is estimated that there are approximately 7.3 million people living in the United States with undiagnosed diabetes, which equates to more than one-fifth of all people with the condition.1 And the prevalence of diabetes is only expected to grow over the next decade.

In addition, there are nearly 27 million people living with a diabetes diagnosis and most will generally see their endocrinologist 2 to 4 times a year. This highlights the important role others in the health care ecosystem can play in identifying the early warning signs of diabetes and associated complications, which could ultimately lead to earlier opportunities to improve patient outcomes and lower overall health care costs.

In the United States, pharmacists are in a strong position to offer this type of support, because they are often the most accessible and frequently visited members of the health care team. Their training incorporates pathophysiology, therapeutics and technology, clinical problem-solving, medication use and laboratory monitoring, and they have significant experience in leveraging this training in their day-to-day customer interactions.

However, there are some key considerations to optimize their ability to provide this support. First, it is important to foster a collaborative 2-way conversation, remembering that the person with diabetes should be considered a partner in their own health care and therefore taking the time to really listen to the patient is crucial.

Consider their cultural, emotional, and socioeconomic position. Ensure that the language used in the conversation is encouraging, engaging, and avoids judgment or stigma.

Sharing key facts and practical points so the person they are talking to can make informed shared decisions. The iDEAL Diabetes Group in the UK has prepared some useful guidelines on effective consultations, which are applicable worldwide.

With these considerations in mind, let’s turn the focus to where pharmacists can play a proactive role in diabetes prevention and management. As we know there many people living with undiagnosed diabetes, most of whom will have type 2 diabetes, and this is the condition for which pharmacists are most likely to be able to spot the early warning signs.

This is not only because it is the most prevalent type of diabetes, but it is also a condition that tends to develop more slowly. In type 1, people often go from being well to being extremely unwell and usually hospitalized within a very short timeframe.

That said, if someone presents at the pharmacy with type 1 symptoms such as sudden weight loss and extreme hunger (despite eating large amounts), fatigue, irritability, blurred vision and/or increased thirst and urination, pharmacists would are advised to encourage them to visit their physician as soon as possible.

Similarly, if a parent talks about a child who had previously been dry at night but who has recently started wetting the bed again, this can be an early indication of type 1 diabetes. The 4 Ts is a useful way of remembering the symptoms of type 1 diabetes: Toilet, Tired, Thinner, Thirsty.

In type 2, the early warning signs are similar and well documented, but the changes are typically less marked. As a result, the disease is often diagnosed only when long-term complications related to diabetes have started to appear.

One such complication is neuropathy, so in addition to those symptoms outlined earlier, someone with undiagnosed type 2 may report issues with slow healing cuts and bruises or a tingling, numbness, or pain in their hands and/or feet. Spotting these signs of complications are also important in people already diagnosed with either type 1 or type 2 diabetes.

Although many living with the condition are informed and aware of the signs, this is another area that pharmacists can provide support on the day-to-day management. They can play an important role, both as an educator and as someone who has their ears pricked up to listen out for the red flags that come out of their conversations with customers and with the ability to provide advice and recommendations where appropriate.

Finally, if we look at prediabetes—which is generally not easy to catch based on symptoms alone—if caught early enough, it may be reversible if certain behavioral changes are adopted. Therefore, it is an area in which pharmacists can certainly help with early identification by offering, for example, on-site random blood glucose testing.

Although many people have a device at home to monitor blood pressure, very few people who do not have diabetes have purchased a blood glucose monitoring system to simply keep an eye on their blood glucose levels. Even if they do have a device at home, are they aware of how and when to check their glucose levels?

If pharmacists offer such as service, it opens an easy, accessible, and cost-effective way for people to keep regular oversight of their blood glucose levels. If someone’s levels are beginning to be on the high side (i.e., fasting plasma glucose >100 mg/dL or random plasma glucose >200 mg/dL2) during a single test, then they should be advised to visit their physician.

Although diabetes is a condition on the rise, through collective action from those within the health care community there should be an opportunity to both improve the early detection of this disease and support the self-management efforts of those who have been diagnosed to help them optimize their outcomes.

Pharmacists certainly have a central role to play here and should be encouraged to ensure they are fully informed to help tackle the ongoing rise in the number of people living with the condition.

For those interested, there are several free and paid for courses available, including those from the International Federation of Diabetes and the American Pharmacists Association, the latter of which offers a certified Pharmacist and Patient-Centered Diabetes Care training program.

About the Author

James Richardson is a pharmacist and an expert in Pharmaceutical Medicine according to the Swiss Association of Pharmaceutical Professionals. He is presently the Medical Lead for Blood Glucose Monitoring Mature Markets at Ascensia Diabetes Care. Additionally he mentors MBA students at Durham University, UK. Previously, he was an Officer in the British Army.


  1. last visited 19 July, 2021
  2. Standards of Medical Care in Diabetes—2021, Diabetes Care 2021 Jan; 44(Supplement 1): S15-S33.