Diabetes mellitus is a chronic metabolic disorder primarily caused by abnormal insulin secretion or action, leading to persistently elevated blood glucose levels. Its symptoms can vary significantly depending on the degree of blood sugar control. Early symptoms may be mild or overlooked, but as the disease progresses, symptoms related to complications will gradually manifest. Understanding the pattern of key symptom changes can aid in early diagnosis and treatment.
The symptoms of diabetes can be divided into two main categories: typical and atypical. Typical symptoms such as polyuria, polydipsia, and unexplained weight loss are usually directly related to elevated blood glucose levels. Atypical symptoms like fatigue or blurred vision may be mistaken for other health issues. The frequency and severity of these symptoms depend on the rate of blood sugar increase and individual differences.
The early stage of diabetes may only present as mild physiological changes, often mistaken for general fatigue or dietary issues. Typical early signs include frequent thirst, where patients repeatedly drink water but still feel dry, known as "polydipsia." Another common sign is increased nighttime urination, especially when blood sugar is uncontrolled, as the kidneys excrete excess glucose, leading to polyuria.
This stage may also be accompanied by unexplained weight loss, even if appetite is normal or increased, because the body cannot effectively utilize glucose and breaks down fats for energy. Some patients experience persistent fatigue despite adequate rest. Notably, type 1 diabetes patients may develop these symptoms rapidly within weeks, whereas type 2 diabetes symptoms may develop slowly or remain asymptomatic for years.
Some patients may experience dry or itchy skin, particularly around the genital area, which could be related to bacterial or fungal infections caused by high blood sugar. Female patients may have recurrent vaginal infections, while males might experience penile itching or balanitis. These symptoms are often mistaken for simple skin issues, delaying blood glucose testing.
When blood glucose levels persistently exceed 10 mmol/L, core symptoms of diabetes gradually appear. Polyuria is the most common complaint, with adult patients urinating more than 8 times a day, and increased nocturia potentially affecting sleep quality. Polydipsia is a natural response to dehydration, with patients consuming over 3 liters of water daily yet still feeling thirsty.
Weight changes can be paradoxical: type 1 diabetes patients often lose 5-10% of their body weight rapidly, while type 2 patients may experience continuous weight gain due to insulin resistance. This paradox is directly related to differences in insulin secretion function. Additionally, about 50% of type 2 diabetes patients have no obvious symptoms at diagnosis, highlighting the importance of regular blood glucose screening.
Long-term hyperglycemia can cause systemic effects, such as:
Some patients may show warning signs of diabetic ketoacidosis, such as rapid deep breathing and fruity odor on the breath. These symptoms are acute complications of type 1 diabetes and require immediate medical attention.
Untreated diabetes undergoes a three-stage process of symptom worsening. The first stage involves mild symptoms like occasional thirst or nocturia; the second stage includes persistent symptoms such as significant weight loss and visual disturbances; the third stage may involve complications like arteriosclerosis or renal damage, presenting with chest pain, lower limb edema, and other new symptoms.
The most apparent changes occur in microvascular complications: early retinopathy may cause visual fluctuations, while late-stage retinopathy can lead to retinal detachment and permanent blindness. Neuropathy symptoms may progress from tingling in extremities to complete loss of pain sensation, increasing the risk of foot ulcers. Kidney disease symptoms evolve from microalbuminuria to microscopic hematuria.
During rapid blood sugar elevation, symptoms can change explosively. Diabetic ketoacidosis (DKA) patients may deteriorate from mild nausea to altered consciousness within hours, with fruity odor on the breath. Hyperosmolar hyperglycemic state (HHS) can cause severe dehydration, presenting with dry mouth, loss of skin turgor, and other dehydration signs.
Chronic complications tend to have more insidious symptom changes but have broader impacts. Cardiovascular symptoms may progress from intermittent claudication to angina. Renal damage may initially present as increased nocturia, eventually leading to end-stage renal disease requiring dialysis. These symptom transition patterns vary among individuals and require blood glucose monitoring and regular check-ups for tracking.
Seek immediate medical attention if any of the following symptoms occur: rapid deep breathing with fruity odor, altered consciousness or coma, sudden severe hypotension with vomiting. These may be signs of diabetic ketoacidosis requiring insulin therapy within 2 hours.
Non-urgent but important symptoms to evaluate include: unexplained weight loss exceeding 5% within two weeks, blurred vision lasting more than three days, foot wounds not healing after two weeks. It is recommended to perform fasting blood glucose or HbA1c testing within 48 hours of symptom onset.
Children may have difficulty describing symptoms accurately; parents should watch for increased bedwetting or sudden decline in school performance. Elderly individuals may present with nonspecific symptoms such as unexplained fever or disorientation, which can be confused with cerebrovascular accidents. Blood glucose screening should be especially emphasized in these cases.
Pregnant women with gestational diabetes may experience recurrent vaginal infections in the third trimester or hypoglycemia in newborns. Although these symptoms do not directly affect maternal subjective feelings, they have significant impacts on maternal and infant health and should be monitored through oral glucose tolerance tests at 24 weeks of pregnancy.
If frequent thirst is accompanied by significant increases in urine volume and drinking water does not alleviate dehydration, it may be related to high blood sugar causing the kidneys to excrete excess glucose. Continuous blood glucose monitoring and recording urination frequency and water intake are recommended. An oral glucose tolerance test can be performed for confirmation.
Can avoiding all sugar in the diet control diabetes?Simply avoiding refined sugars is not sufficient. Overall carbohydrate intake should be controlled, paying attention to the glycemic index (GI) of foods. A divided meal approach to spread calorie absorption, combined with high-fiber foods to slow blood sugar rise, is recommended. Consulting a nutritionist for a personalized diet plan is advised.
What blood sugar fluctuations should be monitored during exercise for diabetic patients?Exercise promotes muscle glucose consumption, which may trigger hypoglycemia, especially in those using insulin or hypoglycemic agents. Blood sugar should be tested before and after exercise, avoid exercising on an empty stomach, and carry sugary foods for emergencies. Moderate aerobic exercise (such as brisk walking) can improve insulin sensitivity but should be adjusted according to individual health conditions.
Can early symptoms of diabetic complications disappear on their own?Symptoms such as numbness from neuropathy or blurred vision from retinopathy usually do not resolve spontaneously and may worsen over time. Early medication or laser treatment can delay damage, but blood sugar, blood pressure, and blood lipid control are essential. Regular eye and foot examinations are recommended.
Are artificial sweeteners safe for diabetic patients?Artificial sweeteners (such as aspartame, stevia) do not directly raise blood sugar, but excessive intake may affect gut microbiota or induce appetite, indirectly impacting blood sugar control. Natural sweeteners like stevia are recommended, and total intake should be controlled. Avoid relying solely on artificial sweeteners and neglecting overall dietary balance.
%201.svg)
Copyright © 2025 MedFrontiers. All Rights Reserved.
