The blood glucose of a normal person ranges between a level of 80 and 140 mg/DL. The lower level is seen when he is in the fasting state, as on waking in the morning, and the higher level two hours after a meal (post-prandial blood glucose). The range of this blood glucose is fairly constant. In the diabetic patient, the blood glucose can rise to fairly high levels. Levels greater than 200 mg/DL is not uncommonly seen in diabetic patients. This high blood glucose level makes the blood “thick” (blood viscosity is increased). Different mechanisms in the body sense this change in blood viscosity. One results is that the diabetic feels thirst and drinks water in large amounts to dilute the blood.
He will also feel a need to pass large volumes of urine both in the day and quite often throughout the night. The excessive amounts of glucose in the blood that filters through the kidney draws with it a large volume of water to form as dilute a urine as possible. This results in the production of large volumes of urine which compounds the thirst that the patient feels because of the loss of this water in the urine. Many diabetics, just as physicians of old, would diagnose their own diabetes mellitus by tasting their urine which is sweet. The urine is seldom infected and it is quite safe to taste one’s own urine. However, especially in older woman, contamination of the areas of the vagina and upper groin (perineum) through leakage of this sweet urine promotes the growth of bacteria and fungus. Infection of the skin and the vagina is common and causes local discomfort and painful micturition (dysuria).
Diabetics also complain of weight loss when they first see their doctor. This phenomenon of weight loss has been described by the Greeks. The cause of their weight loss is due to their inability to utilize glucose. They then begin to burn up their own body tissue, fat stores and muscles for energy. This leads to weight loss that is sometime quite excessive.
Type II diabetics are usually rather obese before they present with the symptoms of diabetes and weight loss. Type II diabetics have initially very high levels of insulin in their blood. Insulin, at these high levels, induces hunger and leads to the building up of body stores, especially body fat. When the insulin falls to much lower levels, there will be insufficient insulin to build up body stores, but instead, weight loss and other symptoms of diabetes begin to appear.
Weakness and tiredness is not a common complaint of the diabetic. This is because the onset and deterioration of the disease is often slow. It allows time for the body to adjust to a slower pace of life. The patient has, quite often, accommodated to his weakness and tiredness, and when asked by his doctor for these symptoms often blame stress and overwork for his discomfort. When his diabetic state is alleviated with treatment, the diabetic would often remark that he has “never felt better in his life”.
One serious presentation of diabetes mellitus is coma. It is life threatening and is the common cause of death in diabetic patients. Coma develops when the brain of the diabetic is dehydrated and blood flow is sluggish. The blood glucose in a comatose diabetic is usually very, very high (usually more than 700 mg/DL). At the same time the rest of the body has not been able to utilize glucose because of a lack of insulin. The body then metabolizes fats for fuel. Metabolism of fat for fuel adds acids to the blood. The breath of the diabetic is aromatic and his breathing is laboured. The condition is known as keto-acidotic coma of diabetes mellitus. Death often results if the patient is not treated promptly.
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