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A Quick Reference Guide to Signs and Symptoms Associated with Diabetes Mellitus

A Quick Reference Guide to Signs and Symptoms Associated with Diabetes Mellitus

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Osmosis Team

Introduction

You’ve probably heard of diabetes, know someone with diabetes, or have been diagnosed with it yourself, as it’s one of the most common conditions in the United States, with 11% of the population diagnosed, and Singapore (10.5%), Malta (10%), and Portugal (10%) following close behind. 

Diabetes mellitus, commonly referred to as just “diabetes,” describes a group of chronic metabolic disorders characterized by elevated blood glucose levels. There are two types of diabetes: type 1 and type 2. Type 1 is characterized by an absence of insulin production due to an autoimmune attack on the cells within the pancreas responsible for producing insulin. In type 2, the pancreas can still produce a small amount of insulin, but the cells in the body – like muscle, fat, and liver cells – are resistant and don’t respond to the insulin. There are a variety of signs and symptoms related to uncontrolled diabetes, like hypoglycemia, hyperglycemia, acanthosis nigricans, and vascular changes. 

Let’s take a closer look at some of these signs and symptoms commonly associated with diabetes. 

Human figure indicating dizziness with their hand to their head.

Hypoglycemia

Hypoglycemia occurs when blood glucose levels drop below 70 milligrams per deciliter (mg/dL) in adults. Hypoglycemia can be life-threatening as glucose is the main energy source in the body, and lack of glucose can lead to death if not treated promptly. Hypoglycemia typically occurs as a side effect when an individual takes their antidiabetic medication without eating, is on a dosage too high for their current health status, or engages in strenuous exercise. This can occur more commonly with the use of insulin or sulfonylureas (e.g., glyburide). 

Signs and symptoms of hypoglycemia include hunger, fatigue, shaking (i.e., tremors), excessive sweating (i.e., diaphoresis), pale skin, headache, and dizziness. If hypoglycemia persists, symptoms can worsen, thereby causing confusion, slurred speech, fainting, and coma. 

A diagnosis is made by evaluating blood glucose and is confirmed if levels are below 70 mg/dL. Treatment involves increasing levels back within a normal range by eating or drinking 15 grams of fast-acting carbohydrates (e.g., glucose tablets and fruit juice). In severe cases, some individuals may be unable to tolerate oral intake, so injectable medications (e.g., glucagon) can be given to increase glucose. Following treatment, glucose should be rechecked in 15 minutes, and treatment can be repeated as needed until levels stabilize. 

Figure indicating they have a headache, holding a glass of water, thinking about needing to urinate.

Hyperglycemia

Conversely, hyperglycemia occurs when blood glucose levels are greater than 125 mg/dL while fasting or greater than 180 mg/dL two hours after eating. Hyperglycemia can be due to disorders of the pancreas (e.g., chronic pancreatitis, cancer), endocrine disorders (e.g., Cushing syndrome), or the use of certain medications (e.g., corticosteroids). However, diabetes is the most common cause of hyperglycemia. Normally, when glucose levels increase, like after eating a meal, insulin is released and attaches to insulin receptors on the body’s cells. This allows glucose to move from the blood and into the body’s tissues, which decreases the amount of glucose in the blood. But when insulin levels are low or absent, or if the cell’s insulin receptors cannot respond properly to the insulin, the amount of glucose in the blood increases. 

Signs and symptoms of hyperglycemia include increased thirst (i.e., polydipsia), increased urination (i.e., polyuria), increased hunger (i.e., polyphagia), and unexplained weight loss. Eventually, neurological symptoms, such as fatigue and altered mental status, can occur. There are two types of life-threatening medical emergencies associated with hyperglycemia: diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). DKA occurs when glucose levels are greater than 250 mg/dL, and there’s no insulin for the body’s cells to use. In response, the body starts to break down fat to use as fuel, which causes a buildup of acids in the blood called ketones. Signs and symptoms of DKA include dehydration, nausea, vomiting, and altered mental status. Kussmaul respirations may also be observed, which are rapid, deep breaths that occur at a consistent pace in an attempt to breathe out the excess acid in the form of carbon dioxide. On the other hand, HHS occurs when blood glucose levels are greater than 600 mg/dL with an increased serum osmolality but without ketoacidosis. 

Diagnosis of hyperglycemia can be made by obtaining a blood glucose level and is confirmed if the patient’s fasting plasma glucose is greater than 125 mg/dL or greater than 180 mg/dL two hours after eating. A hemoglobin A1C, which is a blood test that can provide an average of the blood glucose over the three prior months, may also be done and can confirm hyperglycemia secondary to diabetes if levels are greater than 6.5%. Treatment for hyperglycemia depends on the underlying cause; in the setting of type 1 diabetes, treatment typically involves insulin and proper nutrition. Treatment of type 2 diabetes includes lifestyle modifications, like diet and exercise, as well as oral or injectable antidiabetic medications, as needed. 

Acanthosis Nigricans

Acanthosis nigricans refers to a dark discoloration and thickening of the skin that can occur anywhere on the body but is most commonly located in skin folds. It’s frequently associated with type 2 diabetes, as well as other metabolic disorders, like polycystic ovary syndrome, that are characterized by insulin resistance. Insulin resistance can stimulate the proliferation of skin cells, which leads to this characteristic appearance of the skin. 

Individuals with acanthosis nigricans typically present with dark (i.e., dark brown or black), velvety, and thickened patches of skin on body folds, such as the armpits, neck, and groin. Individuals may report associated itchiness, though typically, there are no other symptoms. 

Diagnosis of acanthosis nigricans is based on a physical examination. However, further tests are typically performed to identify the underlying cause, including blood glucose and hemoglobin A1C to assess for diabetes, specifically. 

Treatment of acanthosis nigricans primarily involves treating the underlying condition, and once the underlying condition is managed, the skin is typically restored. For rapid improvement of acanthosis nigricans, individuals may be prescribed retinoic acid derivatives, like tretinoin gel; vitamin D analogs, like calcipotriol cream; or oral retinoids, such as isotretinoin. 

Illustration of vascular structure.

Vascular Changes

Lastly, vascular changes are commonly seen in long-standing, uncontrolled diabetes and involve damage to blood vessels that supply oxygen and nutrients to particular structures, like the eyes and kidneys. Both microvascular (i.e., small blood vessels, like capillaries) and macrovascular (i.e., medium to large blood vessels, like arteries and veins) changes can occur. Microvascular changes include retinopathy, or damage to the retina of the eye; nephropathy, or damage to the kidney(s); and neuropathy, which is damage to nerves, most commonly peripheral nerves. Macrovascular complications include atherosclerosis involving plaque buildup in arteries, such as those that supply blood to the heart and brain, leading to coronary artery disease and cerebrovascular disease, respectively.

Signs and symptoms of vascular changes depend on the blood vessel(s) affected. For example, retinopathy may present with loss of vision or total blindness. Neuropathy may present with decreased sensation in the fingers and toes. Chest pain or discomfort may be the first sign of coronary artery disease and transient ischemic attacks (i.e., “mini-strokes”), or a stroke may be the first presenting sign of cerebrovascular disease. 

Similarly, diagnosis depends on the affected vessel(s). A comprehensive dilated eye examination can be performed to diagnose retinopathy; neuropathy is typically diagnosed using physical examination; and coronary artery disease can be diagnosed by using various methods, including coronary angiography and cardiac stress testing. Cerebrovascular disease can be diagnosed by various imaging methods, such as computed tomography (CT) or magnetic resonance imaging (MRI). Treatment of all vascular changes seen with diabetes begins with controlling diabetes through lifestyle modifications and medications to prevent progression. Further treatments depend on the severity of the condition and affected vessel(s). 

Explore Other Common Conditions

About the Author

Alyssa Haag, BA, MS-4, obtained a Bachelor of the Arts in Integrative Biology and Education from the University of California, Berkeley, in 2019. She then spent a year as a Medical Assistant at a primary care office in New York City before entering medical school at Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine in Fort Lauderdale, FL. She will be obtaining her Doctor of Medicine degree (MD) in May of 2024 and is currently in the process of applying for a Family Medicine residency. Her passion for education and accessible patient education brought her to Osmosis, where she works as a scriptwriter and editor for the Osmosis Q&A project.

Reviewers

Kelsey LaFayette, DNP, ARNP, FNP-C, Nursing Content Manager
Lisa Miklush, PhD, RN, CNS, Senior Content Editor

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