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Thursday, 28 November 2013

Diabetes – The Symptoms

Diabetes is defined as a condition caused by insufficient insulin entering the bloodstream to regulate the glucose. It is either caused by cells in pancreas dying off or receptor sites clogged up by fat and cholesterol. In some cases, diabetes is also caused by allergic reactions of cells in the immune system.
I. Symptoms
If you have the below symptoms, please check with your family doctor. You might have diabetes:
1. Frequent urination
 If you feel that you are needing to urinate more often than usual or a compelling urge to urinate, along with discomfort in your bladder. According to the study by Departamento de Ginecologia, Instituto Fernandes Figueira, Fundação Oswaldo Cruz, in the study of seventy-seven patients (13.3%), researchers found that type 2 diabetes was predominant (96.1%). Stress urinary incontinence was the most frequent urodynamic diagnosis (39%) in diabetic patients, followed by detrusor overactivity (23.4%). The prevalence of urodynamic alterations was associated with diabetes (PR=1.31; 95%CI=1.17-1.48). Changes in detrusor contractility (over- or underactivity) were diagnosed in 42.8% diabetic patients and in 31.5% non-diabetic patients(1). 
2. Excessive thirst, Unexplained weight loss
The urge to drink too much beyond a certain limit may be a symptom of high blood sugar in your bloodstream , and can be an important clue in detecting diabetes. Loss of body weight can occur due to various conditions ranging from eating disorders to severe metabolic conditions including diabetes. Drastic weight loss of more than 5 to 10 pounds when you’re not trying to, requires medical attention because it may be a sign of diabetes.According to the research team lead by Khan N, in a data on 168 university students (47 males and 121 females) included in the analysis. Of the participants, 25% were overweight or obese and only 27% exercised regularly. Regarding their knowledge of DM, 70% knew that it is characterised by high blood sugar levels and identified family history as a major risk factor. Surprisingly, only just over half could link obesity and physical inactivity as risk factors for developing DM, or could identify an excessive feeling of thirst, frequent urination, and weight loss as symptoms(2).
3. Gastrointestinal symptoms
Diabetes mellitus (DM), such as stomach pain, heartburn, diarrhea, constipation, nausea and vomiting, has been associated with neuronal changes in the enteric, peripheral and/or central nervous system with abnormal visceral sensation and gastrointestinal (GI) symptoms are seen in up to 75% of patients. According to the study by Department of Gastroenterology & Hepatology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Diabetic patients had higher stimulus intensities to evoke painful sensation (p ≤ 0.001), longer latencies of N2 and P2 components (both p ≤ 0.001), and lower amplitudes of P1-N2 and N2-P2 complexes (p ≤ 0.001; p = 0.02). Inverse modelling of brain sources showed deeper bilateral insular dipolar source localization (p = 0.002). Symptom score index was negatively correlated with the depth of insular activity (p = 0.004) and positively correlated with insular dipole strength (p = 0.03)(3).
4. Depression
Depression is a normal response as part of our daily lives such as the loss of s job, the death of a love one, and illness. Over 30 million Americans suffer from depression and the amount is increasing in an alarming rate. It is common in people with diabetes, and related to higher HbA(1c) levels(4).
5. Sleeping difficulties, appetite problems and suicidal ideation
If you are experiencing the drive to eat excessively due to emotional and physical causes then it is an emotion disorder that compels you to eat even after you are full. Increased appetite can be an early symptom of diabetes. According to the study conducted in three tertiary diabetes clinics in the Netherlands of a  total of 288 out of 646 subjects with diabetes (45%) reported one or more depressive symptom(s). Depressed mood (β = 0.11, P = 0.005), sleeping difficulties (β = 0.16, P < 0.001), appetite problems (β = 0.15, P < 0.001) and suicidal ideation (β = 0.14, P = 0.001) were significantly related to higher baseline HbA(1c) values. Furthermore, depressed mood (β = 0.09, P = 0.03) sleeping difficulties (β = 0.12, P = 0.004), appetite problems (β = 0.11, P = 0.01) and psychomotor agitation/retardation (β = 0.09, P = 0.04) were significantly related to higher HbA(1c) values at 1-year follow-up. Associations were more pronounced in Type 1 diabetes than in Type 2 diabetes(4).
6. Emotion stress
Emotion stress in diabetes patient is associsted to significantly poorer glycaemic control.
Diabetes-distress mediated the relation between depression and glycaemic control and not differently for both disease types. Post-hoc analyses revealed that patients depressed and distressed by their diabetes were in significantly poorer glycaemic control relative to those not depressed nor distressed (HbA(1c) 8.7 +/- 1.7 vs. 7.6 +/- 1.2% in those without depressive symptoms, 7.6 +/- 1.1% in depressed only and 7.7 +/- 1.1% in the distressed only, P < 0.001). Depressed patients without elevated diabetes-distress did not show a significantly increased risk of elevated HbA(1c), according to the study EMGO Institute for Health and Care Research, VU University Medical Centre(5).
7. Vulvovaginal symptoms and Candida colonization
Women with type 2 diabetes mellitus (T2DM) are atgreater risk for vaginal Candida colonization, as a result of  glucosuria. In a double-blind study, subjects with T2DM and inadequate glycemic control on metformin were randomized to placebo; canagliflozin 50, 100, 200, 300 mg daily or 300 mg twice daily; or sitagliptin 100 mg daily for 12 weeks, researchers found that  23/198 (12%) females had vaginal cultures positive for Candida (C. glabrata: 14; C. albicans: 5; other: 4), with age ≤55 years associated with increased risk (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.1-10.7)(6)..
5. Nonrefractive visual impairment
This is a symptom of great concern. If the blood sugar levels are too high, sugar builds up in your eye, This excess sugar also draws in fluid, changing the shape of the lens and making blurry vision. Certain types of blurry vision can be a medical emergency where delay can lead to loss of sight. In the study to estimate prevalence of nonrefractive visual impairment and to describe its relationship with demographic and systemic risk factors including diagnosed diabetes, showed that prevalence of nonrefractive visual impairment was significantly higher in 2005-2008 than in 1999-2002 and may be attributable, in part, to higher prevalence of diabetes, an associated risk factor that increased in prevalence during this time period(7).
6. Fear, Behavior and Worry
Behavior and Worry scores were positively related to psychological symptoms, perceived stress, and previous experiences with hypoglycemia. Fear was significantly higher for patients who had greater variability and lower mean daily blood glucose, according to the study by University of Virginia Health Sciences Center(8).
7. Reduced awareness
Reduced awareness may be associated to patient with diabetes, depending to experienced hypoglycemia(9).
8. Increased fatigue
Unlike the tiredness experienced by a healthy person, sudden increase of fatigue is a bad thing in people with symptoms of diabetes. Most Type II diabetes are caused by uncontrolled diet that are high in saturated fat. In the case of the cells of the pancreas dying off, experts believe it is caused by excessive drinking of alcohol. According to the study by INRA, Laboratory of Nutrition and Integrative Neurobiology (NutriNeuro), Fatigue is frequent in patients with diabetes and this symptom appears to be more prominent in type 2 rather than type 1 diabetic subjects. Chronic inflammation represents one characteristic of type 2 diabetes that may contribute to fatigue symptoms(10).
9. Slow wound healing
Slow wound healing is associated with poor wound healing in patient with diabetes as a result of weakened immune function. According to Dr. Prosdocimi M, and Dr. Bevilacqua C, the mechanisms underlying tissue repair are altered in the diabetic patient with respect to a healthy individual, namely for a diminished response of the keratinocytes and a reduced capacity of the endothelial cells to form new vessels (neoangiogenesis)(11).
10. Dry skin
In the study to evaluate the efficacy of a new product (Neuropad repair foam(®)) in promoting skin hydration of the foot in type 2 diabetes, found that  there was no difference in skin capacitance between right and left foot (P = 0·186). However, skin capacitance was significantly higher on the right versus left foot, both after 7 days (P < 0·001) and after 14 days of treatment (P < 0·001). In conclusion, results with the new foam appear encouraging in ameliorating skin dryness in the diabetic foot(12).
11. Etc.
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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/22282030
(2) http://www.ncbi.nlm.nih.gov/pubmed/22912923
(3) http://www.ncbi.nlm.nih.gov/pubmed/23239083
(4) http://www.ncbi.nlm.nih.gov/pubmed/23181742
(5) http://www.ncbi.nlm.nih.gov/pubmed/20636961
(6) http://www.ncbi.nlm.nih.gov/pubmed/22632452
(7) http://www.ncbi.nlm.nih.gov/pubmed/23232894
(8) http://www.ncbi.nlm.nih.gov/pubmed/1582382
(9) http://www.ncbi.nlm.nih.gov/pubmed/7821167
(10) http://www.ncbi.nlm.nih.gov/pubmed/22469909
(11) http://www.ncbi.nlm.nih.gov/pubmed/23229372
(12) http://www.ncbi.nlm.nih.gov/pubmed/21449930