Type 1 Diabetes Symptoms

The symptoms of type 1 diabetes result from high blood sugar levels. The symptoms develop suddenly and severely, and may include:

• Increased thirst
• Frequent urination
• Extreme hunger
• Weight loss
• Nausea, vomiting, and abdominal pain
• Fatigue

Uncontrolled blood sugar levels can lead to diabetes complications. Short-term complications often develop and worsen quickly. In contrast, the long-term complications take years to develop. Fortunately, diabetes complications are less likely to occur and are less severe in people who control their blood sugar.

Short-Term Complications

The following short-term complications develop when people are unable to regulate their blood sugar or insulin levels:

• Hypoglycemia (low blood sugar)
• Hyperglycemia and diabetic ketoacidosis (high blood sugar and blood acid)

Hypoglycemia

• Skip meals.
• Increase their exercise level without increasing their food intake.
• Take too much insulin.

The symptoms of hypoglycemia may include:

• Confusion
• Fatigue
• Headache
• Hunger
• Nervousness
• Rapid heart rate
• Sweating

Low blood sugar levels can be increased quickly by consuming hard sugar candy, fruit juice, non-diet soda, glucose tablets, or glucose gels. If blood sugar levels drop too low, people may experience drowsiness, confusion, and eventually lose consciousness (hypoglycemic coma).

If people lose consciousness, the only treatment is an injection of glucagon, which is a hormone that stimulates an increase in blood sugar levels. Glucagon emergency kits with instructions are available by prescription. Family and friends should read the instructions in advance so they know how to give a glucagon injection.

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Hyperglycemia and diabetic ketoacidosis

• Eat too much.
• Exercise too little.
• Forget to take their insulin.
• Have increased insulin needs due to infection, injury, heart attack, stroke, surgery, or trauma.

Without sufficient insulin, the body's cells have trouble absorbing the glucose in the blood. People develop hyperglycemia (high blood sugar) and may experience the following symptoms:

• Blurred vision
• Extreme thirst
• Extreme hunger
• Frequent urination
• Weakness

Because the body's cells can't absorb sufficient glucose, they start metabolizing fat instead. The byproducts of fat metabolism are toxic acids called ketones, which build up in the blood and make the blood too acidic. People develop diabetic ketoacidosis (the body's chemical balance becomes dangerously acidic) and the following additional may symptoms:

• Abdominal pain
• Decreased consciousness
• Dry mouth
• Fruity breath odor
• Nausea and vomiting
• Rapid breathing
  

New cases or undiagnosed cases of type 1 diabetes are often first diagnosed when the symptoms of diabetic ketoacidosis cause people to visit a doctor.

People with type 1 diabetes can prevent hyperglycemia and diabetic ketoacidosis from developing by monitoring their blood sugar levels throughout the day. Although exercise can lower a person's blood sugar level, exercise is not advisable once diabetic ketoacidosis has developed. People with type 1 diabetes should ask their doctor for the safest way to lower high blood glucose levels.

The treatment for diabetic ketoacidosis is intravenous fluid replacement (into a vein), which typically requires hospitalization. If left untreated, diabetic ketoacidosis can lead to coma and may be fatal.

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Prevention

• Higher than 300 mg/dL
• Higher than 240 mg/dL for more than 24 hours

People should also test their urine for ketones if:

• Their blood glucose level is above 240 mg/dL.
• They are sick, injured, or experience symptoms of diabetic ketoacidosis.

Low blood sugar remedies (from sugar candy to glucagon emergency kits) and insulin should be available at all times. Because these short-term complications develop suddenly, it's advisable for people with type 1 diabetes to wear a tag or bracelet that indicates they have diabetes.

Long-Term Complications

The following long-term complications can be prevented or delayed by the careful management of blood sugar levels:

• Heart disease and stroke
• Kidney disease
• Diabetic retinopathy
• Peripheral vascular disease
• Diabetic neuropathy
• Erectile dysfunction
• Gastroparesis
• Liver Disease
• Skin problems

Heart disease and stroke

People with diabetes are also more likely to develop the following heart and blood vessel conditions:

• Atherosclerosis
  Atherosclerosis is the narrowing and thickening of the artery walls caused by a build up of fatty deposits.
• Cerebral vascular disease
  Cerebral vascular disease (or stroke) is the decreased blood supply to the brain.
• Coronary artery disease
  Coronary artery disease is the hardening or thickening of the blood vessel walls.
• Heart failure
  Heart failure is the inability of the heart to pump enough blood to the body.
• High blood pressure
  High blood pressure is an above normal force of blood pushing against the walls of arteries.
• Peripheral vascular disease
  Peripheral vascular disease is a narrowing of the blood vessels in the extremities (especially the legs).

These conditions may be prevented by controlling the following risk factors:

• Abnormal blood lipid levels (such as cholesterol, lipoproteins, and triglycerides)
• Hypertension (high blood pressure)
• Central obesity (weight around the waist)
• Smoking

Optimal blood lipids

• Low-density lipoprotein (LDL) cholesterol
  High blood levels of LDL cholesterol are associated with an increased risk of heart disease and stroke.
• Triglycerides
  High blood levels of triglycerides are also associated with an increased risk of heart disease and stroke.
• High-density lipoproteins (HDL) cholesterol
  High levels of HDL cholesterol are associated with a decreased risk of heart disease and stroke.

High blood sugar levels increase LDL cholesterol and triglycerides, and lowers HDL. Lifestyle changes and medications can help people with diabetes control their blood lipid levels. The goal is to lower LDL ("bad") cholesterol and triglycerides, and raise HDL ("good") cholesterol.

Optimal blood lipid levels in adults are:

• Total cholesterol less than 200 mg/dL
  • Low-density lipoprotein (LDL) cholesterol less than 100 mg/dL (milligrams per deciliter)
  • High-density lipoprotein (HDL) cholesterol greater than 40 mg/dL
  • Triglycerides less than 150 mg/dL

Optimal blood pressure

If the condition is left untreated, people develop high blood pressure (hypertension). Chronic high blood pressure can lead to heart disease, stroke, and kidney failure. It also makes it difficult for the blood to circulate to a person's extremities.

Blood pressure is written as a fraction (such as 120/80) and is measured in millimeters of mercury (mmHg), which is a standard measure of force. Desirable blood pressure readings in adults are:

• Systolic blood pressure (top number) consistently below 120 mmHg (millimeters of mercury)
• Diastolic blood pressure (bottom number) consistently below 80 mmHg

People can lower their blood pressure by:

• Eating less salt
• Exercising
• Losing weight
• Not drinking or smoking
• Taking medications if necessary

Central obesity

Smoking

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Kidney disease

Uncontrolled high blood sugar and high blood pressure can damage the kidneys. When this occurs, waste products and fluids remain in the blood instead of being excreted in the urine.

The symptoms of kidney disease may include:

• Decreased or increased urine output
• Fatigue
• Fluid retention
• Loss of appetite
• Nausea and vomiting

People can lessen the likelihood of developing kidney disease (nephropathy) by controlling their blood sugar and blood pressure. Although most people with diabetes don't develop kidney failure, diabetes is the most common reason for the kidneys to fail.

Kidney failure may be treated with:

• Dialysis (a procedure that cleans and filters the blood)
• Transplantation (surgery that replaces diseased kidneys with healthy donor kidneys)

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Diabetic retinopathy

• Poorly controlled blood sugar levels
• High blood pressure
• High blood cholesterol

There are two types of diabetic retinopathy:

• Nonproliferative diabetic retinopathy (NPDR)
  Early in the disease, balloon-like swellings develop in the retina's blood vessels. As the disease progresses, damaged blood vessels swell and leak fluid.
• Proliferative diabetic retinopathy (PDR)
  During the later stages of the disease, the body grows abnormal blood vessels along the retina. If they leak blood, severe vision loss and even blindness can result.

The symptoms of diabetic retinopathy may include:

• Blurred vision
• Floaters (spots in front of the eye)
• Poor night vision

If left untreated, diabetic retinopathy may eventually lead to blindness. Because many people experience no symptoms of diabetic retinopathy, it's important for people with diabetes to have their eyes examined regularly. Early detection and treatment; yearly eye exams; and controlling blood sugar, blood lipid levels, and blood pressure can save a person's sight.

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Peripheral vascular disease

• Coldness or numbness of the legs or feet at rest
• Leg pain during exercise, which is relieved with rest (intermittent claudication )
• Loss of hair on the legs or feet
• Muscle pain in the legs or feet
• Paleness or blueness due to lack of oxygen in the tissue (cyanosis)
• Weak or absent pulse in the leg

Exercise can improve poor circulation by stimulating blood flow to the legs and feet.

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Diabetic neuropathy

Peripheral neuropathy damages the nerves in the extremities (such as the feet). When this occurs, people feel intermittent numbness, tingling, or pain. The pain gradually worsens and becomes more constant. Eventually, people may lose their ability to sense pain entirely and are no longer warned when an extremity has become injured. Untreated injuries may develop into serious infections without warning.

Diabetic neuropathy affects the nerves that operate automatically, such as the nerves that control blood glucose levels, the heart, and regulate blood pressure. It also affects the nerves that regulate the body's vital functions, such as the cardiovascular, digestive, and urinary systems.

The symptoms of diabetic neuropathy may include:

• Constipation or diarrhea
• Dizziness or faintness
• Facial drooping
• Erectile dysfunction
• Loss of bladder control
• loss of typical heart attack warning signs
• Loss typical low blood sugar warning signs
• Muscle cramps
• Numbness or tingling in an extremity
• Speech impairment
• Swallowing problems
• Vision changes

Strict glucose monitoring and control can help prevent the progression of diabetic neuropathy. Regular foot exams can identify minor infections and prevent them from progressing to the point that amputation is required.

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Erectile dysfunction

There are many causes of erectile dysfunction, such as other medical conditions (cardiovascular disease), medications (beta blockers), and psychological problems (stress). Erectile dysfunction due to uncontrolled diabetes results from damage to the blood vessels and nerves needed to control a firm erection.

Controlling blood levels can prevent the blood vessel and nerve damage that can cause erectile dysfunction. An urologist may recommend medications, a penile prosthesis, or a vacuum device to help men who are unable to maintain an erection.

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Gastroparesis

The symptoms of gastroparesis may include:

• Abdominal bloating
• Gastroesophageal reflux
• Heartburn
• Nausea and vomiting
• Weight loss

Although gastroparesis is a chronic condition, most cases can be treated with diet, exercise, and prescription medications. The most severe cases may require feeding tubes and intravenous feeding.

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Liver Disease

The symptoms of cirrhosis of the liver may include:

• Dark urine
• Fatigue
• Jaundice (yellow skin and eyes)
• Nausea and vomiting

Liver damage may also result from some of the medications used for the other complications of diabetes (such as high cholesterol medications).

People can prevent or delay liver disease by:

• Avoiding alcohol and unnecessary medications.
• Controlling their blood sugar and lipid levels.
• Eating a healthy diet.
• Exercising at least 30 minutes a day.
• Maintaining a healthy weight.

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Skin problems

Insufficient blood flow to the skin and diminished sensation due to nerve damage may lead to chronic skin problems and poor healing. As a result, bacterial and fungal skin infections are common in people with diabetes.

Bacterial skin infections include:

• Styes (eyelids)
• Boils (hair follicles)
• Carbuncles (deep skin tissues)

Fungal infections on the surface of the skin due to tinea (or ringworm) include:

• Athlete's foot (feet; tinea pedia)
• Jock itch (groin area; tinea cruris)
• Onychomycosis (under the fingernails or toenails; tinea unguium)
• Ringworm of the scalp (head; tinea capitis)

People with diabetes can avoid skin problems by:

• Drinking fluids
• Washing carefully with mild soap and water.
• Using skin creams and lotions.
• Checking the skin regularly for signs of infections.
• Seeking medical help if infections develop.

Although fungal infections are more difficult to treat than bacterial infections, most skin conditions can be prevented or successfully treated when caught early.