What clinical features might we see in PEOPLES that might make suspicious that they’re developing diabetes?
We’re going to discuss two types of diabetes: type 1 and type 2 diabetes together.
The clinical features of diabetes mellitus can be similar it’s more a question of how quickly it comes on.
In type 1 you’re gonna get a much more acute feature.
in type 2 it can be over months or years that the features develop very gradually.
The first thing to mention is the classic triad
Now the classic triad in the clinical symptoms of diabetes is
Polyuria | Thirst | Weight loss
Particularly in type 1 diabetes, this classic triad can present really quite acutely.
This is really basic stuff weight loss, polyuria, thirst you’ve got to think of the possibility of diabetes.
Now we know why you get the Polyuria it’s as a result of the osmotic diuresis.
Very large volumes of urine can be passed and when you do test that you know and you will find that the sugar in it.
The fact that the patient is passing large volumes of urine means that that water is coming out of the body, therefore, the patient is going to develop dehydration.
So the polyuria causes the dehydration
and it’s the dehydration that causes the thirst
So these patients are thirsty because they have a polyuria
Well in very basic terms the mitochondria inside the cells can’t get glucose so they have to metabolize fats and proteins instead and that means the number of fats and proteins in the number goes down.
In diabetes is going to be lower amounts particularly in type one is going to be lower amounts of insulin but the amount of glucagon stays the same and the glucagon is unopposed by the action of the insulin.
Now glucagon is catabolic that is it breaks things down.
So the effect of the glucagon means that fat is going to be broken down that’s called lipolysis and also protein is going to be broken down so that so there can be loss of muscle mass.
This means that there’s a lot of free fatty acids in the blood because the lack of insulin and the increased amounts of glucagon allows the facts to leak out of the adipocytes into the blood as free fatty acids.
In the liver, the free fatty acids will actually be converted to ketones.
Now ketones are good in one sense because you can use them as energy.
So it’s actually the ketones that are used as energy.
So what happens is there’s too much glucagon relatively.
Fat goes to the liver > the liver converts it to ketone bodies > the ketone bodies are used to produce energy certainly by by most cells
As well as that if there’s not enough insulin and too much glucagon the liver will produce more glucose the process of gluconeogenesis.
Even more, glucose is produced and that can be lost in the urine so this energy rich molecule is lost in the urine.
The body can’t get glucose or the body cells can’t get glucose therefore they use fats and the use proteins instead and there’s going to be weight loss.
Lack of Energy
Very often these patients complain of lack of energy and the lack of energy is not surprising for two reasons
1 is that the osmolarity of the blood is abnormal because there’s very high levels of glucose in the blood.
but as well as that even though there’s very high levels of glucose in the blood remember that this glucose can’t get into the cells to be used by the mitochondria so the mitochondria do not have a supply of glucose so they can’t make energy as quickly and hence the muscles can’t make energy as quickly.
The brain doesn’t seem to make energy as quickly although glucose just go into the blood but these people do complain of being tired overall because there’s high levels of glucose in the blood but ironically very low levels of glucose in liver cells muscle cells and fat cells.
in other words these patients are becoming poorly that they’re unwell that they’re tired and lack energy
another common Clinical symptom of diabetes is
Now if you get some pure water in a glass and hold it up to the light it will distort the light but the light will pass straight through that water.
If you add sugar to that water and stir it up the light rays enough to go through the sugar as well as the water and that distorts the light rays and makes them blurred.
The same thing happens in the our eyes if you remember that in the front of the eyes you’ve got some humor
What do you call the humor in the front of the eyes I think that was a curious humor isn’t it and then at the back you’ve got the vitreous humor and as well as that you’ve got some fluids in the lens and sugar goes into these humors and because the sugar in these humors that means the light from the outside world has got to go through sugary mediums to get to the retina and it’s these sugary mediums that cause it to become blurred.
You get blurred vision and we notice this patients will complain of blurred vision will start lowering their blood glucose levels and within a few weeks when the blood glucose levels are lowered the vision goes back to all they can get full restoration of their vision.
Because they’ve got rid of the glucose because you’ve lowered the amount of glucose in the blood when the amount of glucose in the blood is low the glucose from the eyes will diffuse back into the blood and it will go back down to normal levels.
Itching and Irritation on body
Piratas just means itching very often. These patients complain of itching.
Probably what actually happens is that there’s high levels of glucose in the blood therefore there’s high levels of glucose in the tissue fluids and that includes the tissue fluids of the dermis the lower layer of the skin and this contains the sensory receptors and these are irritated by the alteration of the osmotic effects in the sensor in your lungs.
At least that makes sense that probably does account for thee for the a check for the paratus.
It is another problem you can get this in the mouth but in women, it’s common in the vagina or in the vaudeville area Candida infections.
So a woman might complain of persistent or ongoing episodes of bull Vitus, inflammation of the vulva area because of this fungal infection.
What’s happening here is that the secretions in the area are going to contain more sugar and that acts as a very good medium for fungal infections and they can get these repeated infections.
So if a woman is complaining of repeated or Vitus yes we need to treat it with anti-fungal agents but why not just do a blood sugar test to eliminate the possibility of developing diabetes.
So thinking about clinical signs of diabetes mellitus polyuria, thirst and weight loss that’s the classic triad we must know about.
We must always arouse suspicions lack of energy, blurred vision, / riotous itchiness, Candida infections
So misremembered men get an infection called balanitis as well fungal infection or balanitis for the same reason it’s really a complication at the glucose urea because this high amounts of glucose in the urine and balanitis in men describes inflammation of the glans penis.
As a result of that usually as a result of Candida infection.
Now these next three points the hypoglycemia, the glucose urea, and the ketones of all things we will look for by testing.
So we know why there’s a hyperglycemia in type one it’s lack of insulin and in type two at least in the initial stages it’s going to be the insulin resistance.
Hyperglycemia is very easy to test for with fingerprint tests or as we’ve mentioned we can do the hba1c test to look at a longer term average.
Whenever the renal threshold is exceeded there’s going to be a glucose urea and again easy to test for without dipsticks we can quickly see if there’s any glucose present in the urine.
The ketones were little more complicated
Ketones are a problem in type 1 diabetes not really a problem in type 2 diabetes
In type 1 diabetes there’s going to be insolent lack but there’s going to be unopposed glucagon.
That’s going to allow fat to leak out of adipocytes because that’s what glucagon does it’s catabolic it breaks things down, the high levels of glucagon and the low levels of insulin mean that lots of fat is released from fat cells and goes into the blood as free fatty acids.
Then the liver converts that into ketones.
Now the ketones used to be called ketone bodies.
They actually describe three chemicals that are present in the blood once called acetyl acetic acid one’s called beta hydroxy butyric acid and the other one is acetone.
The acetone is a volatile component can actually smell that on the patient’s breath sometimes described as paired glops is kind of a sick sweetly smell but you’ll certainly recognize
This happens because there’s a lot of ketones present in the patient’s blood the patient develops a ketosis.
The Osito acetic and the hydroxy butyric acid are assets so the blood can become acidic if the levels are very high this will be keto acidosis.
So having some ketones in the blood is good because the body can use them as an energy source.
There’s an overproduction of ketones in badly controlled type 1 diabetes because of the incident lack So there’s far too many ketones in the blood causing ketosis because of this overproduction and that’s good because like muscle cells, and liver cells and fat cells can actually use ketone bodies as a fuel source but they can only use it very slowly.
They can use glucose quickly but of course they can’t get the glucose because the glucose can’t get through the cell membranes but you can only use that the ketone bodies slowly.
That means that the cells can make some energy slowly but it means that ketones are going to accumulate in the blood causing ketoacidosis.
The main clinical reason this is important is that it allows us at least in the recognition of early diabetes or in the diagnosis of diabetes to differentiate between type 1 and type 2.
The absence of key the absence of ketones in the blood and urine is indicative of type 2 diabetes
So some clinical features Of diabetes to look out for have a high index of suspicion if we see these features and simply test the blood and the urine for glucose levels and we can recognize if diabetes is presented.
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