Diabetes damage Kidney from diabetes (diabetic nephropathy)

Diagnosis and Tests

How is diabetes diagnosed?

Healthcare providers diagnose diabetes by checking your glucose level in a blood test. Three tests can measure your blood glucose level:

• Fasting blood glucose test: For this test, you don’t eat or drink anything except water (fast) for at least eight hours before the test. As food can greatly affect blood sugar, this test allows your provider to see your baseline blood sugar.
• Random blood glucose test: “Random” means that you can get this test at any time, regardless of if you’ve fasted.
• A1c: This test, also called HbA1C or glycated hemoglobin test, provides your average blood glucose level over the past two to three months.

Symptoms

Diabetes symptoms depend on how high your blood sugar is. Some people, especially if they have prediabetes, gestational diabetes type 2 diabetes, may not have symptoms. In type 1 diabetes, symptoms tend to come on quickly and be more severe.

Some of the symptoms of type 1 diabetes and type 2 diabetes are:

• Feeling more thirsty than usual.
• Urinating often.
• Losing weight without trying.
• Presence of ketones in the urine. Ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough available insulin.
• Feeling tired and weak.
• Feeling irritable or having other mood changes.
• Having blurry vision.
• Having slow-healing sores.
• Getting a lot of infections, such as gum, skin and vaginal infections.

Type 1 diabetes can start at any age. But it often starts during childhood or teen years. Type 2 diabetes, the more common type, can develop at any age. Type 2 diabetes is more common in people older than 40. But type 2 diabetes in children is increasing.

When to see a doctor

• If you think you or your child may have diabetes. If you notice any possible diabetes symptoms, contact your health care provider. The earlier the condition is diagnosed, the sooner treatment can begin.
• If you've already been diagnosed with diabetes. After you receive your diagnosis, you'll need close medical follow-up until your blood sugar levels stabilize.

Causes

To understand diabetes, it's important to understand how the body normally uses glucose.

How insulin works

Insulin is a hormone that comes from a gland behind and below the stomach (pancreas).

• The pancreas releases insulin into the bloodstream.
• The insulin circulates, letting sugar enter the cells.
• Insulin lowers the amount of sugar in the bloodstream.
• As the blood sugar level drops, so does the secretion of insulin from the pancreas.

The role of glucose

Glucose — a sugar — is a source of energy for the cells that make up muscles and other tissues.

• Glucose comes from two major sources: food and the liver.
• Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
• The liver stores and makes glucose.
• When glucose levels are low, such as when you haven't eaten in a while, the liver breaks down stored glycogen into glucose. This keeps your glucose level within a typical range.

The exact cause of most types of diabetes is unknown. In all cases, sugar builds up in the bloodstream. This is because the pancreas doesn't produce enough insulin. Both type 1 and type 2 diabetes may be caused by a combination of genetic or environmental factors. It is unclear what those factors may be.

Diabetes Symptoms: Recognizing the Early Signs

Diabetes is a chronic medical condition that affects the way your body processes blood sugar (glucose). Glucose is a vital energy source for your body’s cells, and insulin, a hormone produced by the pancreas, helps regulate its levels. When insulin production is inadequate or the body becomes resistant to it, glucose levels in the blood rise, leading to diabetes. The two most common types of diabetes are Type 1 and Type 2, and while both share common symptoms, their causes and treatments may differ.

Understanding the symptoms of diabetes is crucial for early detection and management. Below are some of the most common signs of the condition.

1. Frequent Urination (Polyuria)

One of the hallmark symptoms of diabetes is frequent urination. High blood sugar levels cause the kidneys to filter excess glucose, which results in more urine production. As a result, individuals with diabetes often find themselves needing to urinate more frequently, especially during the night. This condition is known as polyuria.

2. Excessive Thirst (Polydipsia)

Due to frequent urination and the loss of fluids, individuals with diabetes may experience extreme thirst. This is a compensatory mechanism as the body attempts to restore lost fluids. Individuals may drink excessive amounts of water and still feel thirsty, which can significantly disrupt daily activities.

3. Unexplained Weight Loss

Unexplained weight loss is another common symptom, especially in Type 1 diabetes. When the body cannot properly utilize glucose due to insufficient insulin, it starts breaking down fat and muscle for energy. This leads to a noticeable loss of weight, even if the person is eating normally.

4. Increased Hunger (Polyphagia)

Despite eating regular meals, individuals with diabetes may feel constantly hungry. This is because the body is not able to effectively use glucose as an energy source, prompting the body to send hunger signals in an effort to gain more fuel. Even after eating, blood sugar levels remain elevated, leading to persistent feelings of hunger.

5. Fatigue

Excessive tiredness is a common symptom of diabetes. When the body cannot efficiently convert food into energy due to insulin resistance or insufficient insulin production, it leads to constant fatigue. The feeling of being drained, even after rest, can be debilitating and interfere with daily activities.

6. Blurred Vision

High blood sugar levels can lead to changes in the lens of the eye, causing blurry vision. This happens because the lens swells due to increased fluid in the eye, affecting the ability to focus. Although blurry vision is common with diabetes, it can be a temporary symptom and should be addressed promptly to avoid more severe complications.

7. Slow Healing of Wounds

Diabetes can impair the body’s ability to heal wounds and fight infections. High blood sugar levels can weaken the immune system, making it harder for the body to recover from cuts, bruises, and other injuries. If you notice that cuts or sores are taking longer to heal than usual, it could be a sign of uncontrolled blood sugar.

Risk factors

Risk factors for diabetes depend on the type of diabetes. Family history may play a part in all types. Environmental factors and geography can add to the risk of type 1 diabetes.

Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes immune system cells (autoantibodies). If you have these autoantibodies, you have an increased risk of developing type 1 diabetes. But not everyone who has these autoantibodies develops diabetes.

Race or ethnicity also may raise your risk of developing type 2 diabetes. Although it's unclear why, certain people — including Black, Hispanic, American Indian and Asian American people — are at higher risk.

Prediabetes, type 2 diabetes and gestational diabetes are more common in people who are overweight or obese.

Complications

Long-term complications of diabetes develop gradually. The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. In fact, prediabetes can lead to type 2 diabetes. Possible complications include:

• Heart and blood vessel (cardiovascular) disease. Diabetes majorly increases the risk of many heart problems. These can include coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you're more likely to have heart disease or stroke.
• Nerve damage from diabetes (diabetic neuropathy). Too much sugar can injure the walls of the tiny blood vessels (capillaries) that nourish the nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.
  Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.
• Kidney damage from diabetes (diabetic nephropathy). The kidneys hold millions of tiny blood vessel clusters (glomeruli) that filter waste from the blood. Diabetes can damage this delicate filtering system.
• Eye damage from diabetes (diabetic retinopathy). Diabetes can damage the blood vessels of the eye. This could lead to blindness.
• Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of many foot complications.
• Skin and mouth conditions. Diabetes may leave you more prone to skin problems, including bacterial and fungal infections.
• Hearing impairment. Hearing problems are more common in people with diabetes.
• Alzheimer's disease. Type 2 diabetes may increase the risk of dementia, such as Alzheimer's disease.
• Depression related to diabetes.Depression symptoms are common in people with type 1 and type 2 diabetes.
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To screen for and diagnose gestational diabetes, providers order an oral glucose tolerance test.

The following test results typically indicate if you don’t have diabetes, have prediabetes or have diabetes. These values may vary slightly. In addition, healthcare providers rely on more than one test to diagnose diabetes.

Type of Test

Fasting blood glucose test

In-range (mg/dL)

Less than 100.

Prediabetes (mg/dL)

100 to 125.

Diabetes (mg/L)

126 or higher.

Random blood Glucose Test

In-range (mg/dL)

N/A.

Prediabetes (mg/dL)

N/A.

Diabetes (mg/L)

200 or higher (with classic  symptoms of hyperglycemia or hyperglycemic crisis).

A1c

In-range (mg/dL)

Less than 5.7%.

Prediabetes (mg/dL)

5.7% to 6.4%.

Diabetes (mg/L)

6.5% or higher.