Diabetes is a group of metabolic disorders with hypoglycemia as a principal complication which may either result from defect in insulin secretion or insulin action or both. It is further classified into 2 types - a) type 1 diabetes 2) type 2 diabetes. Type 1 diabetes occurs due to beta cell destruction which may be immune mediated or idiopathic usually leading to absolute insulin deficiency. That is why type1 diabetes is also called as Insulin dependent Diabetes Mellitus. Type 2 diabetes may range from predominantly resistance to insulin along with insulin deficiency to predominantly secretory defect with insulin resistance. It is also called Non Insulin dependent diabetes mellitus. In all, diabetes develops due to variable combination of total insulin deficiency caused by pancreatic cell dysfunction and tissue insulin resistance due to decreased cellular responsiveness. Signs of type 1 and type 2 are similar in many respects as in both these conditions there is too much glucose present in blood but not enough present inside the cells. In Insulin dependent or type 1 diabetes there is abrupt onset of severe symptoms while in Non insulin dependent or type 2 diabetes there are asymptomatic or only moderate symptoms present. The cardinal symptoms of diabetes mellitus are polyuria, polydipsia, and weight loss without effort. The presence of these symptoms should always result in an immediate test for blood glucose and urine for ketones. Important signs and symptoms are as follows - Polyuria - Hyperglycemia causes increased excretion of urine because if insulin is absent or not effective then kidneys are not able to filter glucose back to blood so they take out extra water from the blood in order to dilute the glucose. Hence, there is regular filling of bladder and regular desire of voiding of urine arises. Polydipsia - Due to increased urinary excretion, excessive thirst develops which forces the person to drink more water causing polydipsia. Polyuria and polydipsia are termed as â€Osmotic Symptomsâ€. Weight Loss - Weight loss in a person of more than 5% should be considered clinically important if the person is not deliberately attempting to lose weight. Weight loss is a common symptom in type 1 diabetes because in type 1 diabetes there is marked insulin deficiency so cells desperately starve for glucose. Type 2 proceeds gradually so symptoms of weight loss are not as noticeable as type 1. Lethargy and Fatigue - They occur particularly in type 2 diabetes because in type 2 symptoms are present since some time. Tingling or Numbness in Extremities - Consistently high glucose blood level damages the nervous system and especially in the extremities. This symptom often improves if controlled glucose levels are maintained. Skin Troubles - In patients with poor glycemic control skin infections occur such as Staphylococcal infections leading to boils, Carbuncles or Abscesses which are often recurrent. Oral and genital candidiasis can also be a presenting feature of diabetes mellitus. Genital candidiasis in women leads to a thick white discharge and vaginal soreness. In men it can lead to severe Balanitis (infection of glans penis). Visual Disturbance - Hyperglycemia leads to blurred vision owing to the osmotic changes within the aqueous humor of lens of eye. This symptom settles once normoglycemia is achieved.
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