Type 2 Diabetes Symptoms
People with type 2 diabetes usually don't have any symptoms. Eventually, the following symptoms may develop:
- Increased thirst
- Frequent urination
- Increased appetite
- Fatigue
- Blurred vision
- Frequent or slow-healing infections
- Erectile dysfunction
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 level:
Hypoglycemia
Hypoglycemia (low blood sugar) sometimes occurs in people with type 2 diabetes who take medications to lower their blood sugar. The condition may develop when they: - Skip meals.
- Increase their exercise level without adjusting their food intake.
- Need to adjust their diabetes medications.
The symptoms of hypoglycemia may include:
- Confusion
- Fatigue
- Headache
- Hunger
- Nervousness
- Rapid heart rate
- Sweating
People can quickly raise their blood sugar 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 of people with type 2 diabetes who take medications should read the instructions in advance so they know how to give a glucagon injection.
back to top
Diabetic hyperglycemic hyperosmolar coma (DHHC)
Diabetic hyperglycemic hyperosmolar coma (also called nonketotic hyperglycemic hyperosmolar coma) develops when a person's: - Blood sugar (glucose) level becomes very high (hyperglycemia).
- Blood ketone (byproduct of fat metabolism) levels remain normal.
(In diabetic ketoacidosis the ketone levels become dangerously high.)
DHHC typically develops after an infection or illness. The condition also may occur in people with undiagnosed diabetes, in people over 60, or in people who are unable to control their blood sugar levels.
The high blood sugar level causes people to urinate frequently. The kidneys fail to eliminate the excess sugar from the blood, which causes their blood sugar levels to rise to dangerous levels (over 600 mg/dL). Although people increase their fluid intake, they become extremely dehydrated.
The symptoms of DHHC include:
- Increased thirst
- Weakness and lethargy
- Confusion
- Nausea
- Convulsions
- Coma
The treatment for DHHC is intravenous (into a vein) fluid replacement and insulin, which typically requires hospitalization. If left untreated, the condition may be fatal.
back to top
Diabetic ketoacidosis
Diabetic ketoacidosis develops when a person's blood insulin level gets too low. Although diabetic ketoacidosis rarely occurs in people with type 2 diabetes, it sometimes results from increased insulin needs due to infection, injury, heart attack, stroke, surgery, or trauma. When a person's blood insulin level gets too low, the body's cells have trouble absorbing the glucose in the blood. Although the blood sugar level rises, the cells can't absorb sufficient glucose and start metabolizing fat instead. The byproducts of fat metabolism are toxic acids called ketones, which build up in the blood and make the blood dangerously acidic.
The symptoms of diabetic ketoacidosis may include:
- Extreme thirst
- Frequent urination
- Weakness and lethargy
- Nausea and vomiting
- Muscular stiffness
- Rapid breathing
- Fruity breath odor
- Decreased consciousness
- Coma
The treatment for diabetic ketoacidosis is intravenous fluid replacement (into a vein), which typically requires hospitalization. If left untreated, the condition may be fatal.
back to top
Prevention
The best prevention for the short-term complications of type 2 diabetes is regular monitoring of blood sugar levels, proper balancing of diet and exercise, and medications if prescribed. People who become sick should test their blood sugar levels more often and contact a doctor if their blood sugar level reading is: - 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 ketoacidosis (abdominal pain, nausea, and vomiting).
Low blood sugar remedies (from sugar candy to glucagon emergency kits) and medications for high blood sugar should be available at all times. Because short-term complications may develop suddenly, it's advisable for people with type 2 diabetes who have trouble managing their blood sugar 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
Diabetes dramatically increases a person's risk of heart disease and stroke (sudden brain cell death due to reduced blood flow). People with diabetes develop these conditions at an earlier age. Moreover, the heart attacks are more serious and more likely to result in death. 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)
- High blood pressure (hypertension)
- Central obesity (weight around the waist)
- Smoking
Optimal blood lipids
People with diabetes often develop abnormal blood lipid levels (fatty organic compounds). Whereas some blood lipids increase a person's risk of heart disease and stroke, others lower the risk. - 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
People with diabetes are more likely to develop atherosclerosis, which is a narrowing and thickening of the arteries due to a build up of fatty deposits (plaques made of cholesterol and lipids) on the inner walls. The fatty deposits make it difficult for blood to flow through the arteries and increase the pressure in the arteries. 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
Central obesity occurs when a person's primary body fat is located around the abdomen and upper body. People with central obesity a have higher incidence of heart disease, hypertension, high lipid levels, insulin resistance, and type 2 diabetes. Losing weight can significantly lower a person's risk of developing these conditions. Smoking
Both diabetes and smoking narrow blood vessels, which makes it especially important for people with diabetes not to smoke. According to the American Heart Association, a smoker's risk of developing heart disease is 2 to 4 times that of nonsmokers. back to top
Kidney disease
The kidneys are a pair of organs located at the back of the abdominal cavity. They maintain the body's water and chemical balance, and filter waste products from the blood. The waste products are then excreted as urine. 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)
back to top
Diabetic retinopathy
Diabetic retinopathy is damage to the blood vessels of the retina (the light-sensitive outer layer of the eye) caused by long-term diabetes. Almost everyone who has had diabetes for more than 30 years has some sign of diabetic retinopathy. Additional risk factors include: - 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.
back to top
Peripheral vascular disease
Peripheral vascular disease is a group of diseases that reduce circulation in a person's extremities. The condition is usually caused by atherosclerosis (narrowing and thickening of the arteries due to fatty deposits on their inner walls). The symptoms may include: - 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.
back to top
Diabetic neuropathy
Diabetic neuropathy is nerve damage that results from chronic high blood sugar levels due to uncontrolled diabetes. Half of the people with diabetes develop nerve damage 10 to 20 years after their diabetes has been diagnosed. Peripheral neuropathy damages the nerves in the extremities (mainly 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 internal organs, and may lead to cardiovascular, digestive, sexual, and urinary problems.
The symptoms of diabetic neuropathy may include:
- Constipation or diarrhea
- Dizziness
- Facial drooping
- Erectile dysfunction
- Loss of bladder control
- Muscle cramps
- Numbness
- Speech impairment
- Swallowing problems
- Tingling
- Vision changes
- Weakness
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.
back to top
Erectile dysfunction
Erectile dysfunction (or impotence) is the repeated inability to get or maintain an erection firm enough for sexual intercourse. It is a common complication for men with diabetes. Between 35% to 50% of men with diabetes experience erectile dysfunction and they develop the condition 10 to 15 years earlier.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.
back to top
Gastroparesis
Gastroparesis is a condition in which the stomach takes too long to empty its contents into the small intestine. The most common cause of gastroparesis is diabetes, which damages the nerves that control the stomach muscles. The digestive problems caused by gastroparesis make it even more difficult for people with diabetes to control their blood sugar levels. 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.
back to top
Liver disease
People with diabetes or pre-diabetes who are unable to control their blood sugar, blood lipid levels, or weight may develop nonalcoholic fatty liver disease (steatohepatitis). People usually have no symptoms for years. If left untreated, steatohepatitis can lead to permanent scarring of the liver (nonalcoholic cirrhosis). The treatment for liver cirrhosis is liver transplantation, which replaces the diseased liver with a healthy donor liver. 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:
- Controlling their blood sugar and lipid levels.
- Eating a healthy diet.
- Exercising at least 30 minutes a day.
- Maintaining a healthy weight.
- Avoiding alcohol and unnecessary medications.
back to top
Skin problems
When blood sugar levels remain high, the body loses fluids, and the skin may become dry and itchy. Cracks may develop in the skin and become infected. 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.
