Let's Talk About Symptoms of Diabetes
Despite its common occurrence, signs of this disease can be surprisingly difficult to spot, as many clues are subtle (if visible at all). Learn more about possible ways to tell if you have diabetes.
Diabetes can show up in many different ways—and some of them are easy to miss. In fact, of the 30 million Americans who have diabetes, nearly one-quarter of them don’t know it. That’s why paying attention to early signs is so important. If diabetes runs in your family or the symptoms below sound familiar, it’s probably a good time to check in with your doctor. Early and accurate diagnosis will give you a head start at beating this disease.
Our Pro Panel
We went to some of the nation’s top experts in diabetes to bring you the most up-to-date information possible.
Anthony Nguyen, D.O.
Family Medicine Physician, Diabetes Health Initiative
Providence Hospital/Ascension Health
Stelios Mantis, M.D.
Rush University Medical Center
Katherine Araque, M.D.
Director of Endocrinology
Pacific Neuroscience Institute at Providence Saint John’s Health Center
Santa Monica, CA
Classic symptoms are increased thirst and having to pee a lot. Other symptoms include fatigue, headaches, skin infections, and darker, velvety patches of skin. The disease can also cause tingling in your extremities, blurry vision, and sores on the feet.
Type 1 diabetes cannot be cured, and people with the disease need to take insulin every day. Type 2 diabetes is treatable with diet and exercise changes and medications that lower the levels of sugar in the blood.
People with diabetes often feel tired even when they get plenty of rest. That’s because glucose, one of your body’s most important sources of energy, remains stuck in the bloodstream instead of nourishing your cells if you have the disease, making you feel tired.
Everyone’s body reacts differently to foods and diet plans, so there’s no magic bullet. But vegetarian and vegan diets, a traditional Mediterranean diet rich in vegetables and seafood, and low-carbohydrate diets have all been shown to lower blood sugar.
What Is Diabetes Again?
Diabetes mellitus is a disorder that causes people to have higher-than-normal levels of sugar—or, glucose—in their blood. There are three main types of diabetes: type 1, type 2, and gestational diabetes.
Here’s how it happens: After you eat a meal, your food is broken down into glucose (among other things) that serves as your entire body’s source of energy. Glucose enters the bloodstream and in response your pancreas releases insulin, a hormone that helps move glucose into fat and muscle cells so they can use it for energy.
In people with diabetes, though, glucose struggles to get out of your blood. This is because either your pancreas doesn’t produce enough insulin to help move glucose into your cells (type 1 diabetes), or because your body isn’t able to use insulin efficiently (type 2 and gestational diabetes), so you need to make more and more of it.
Either way, glucose begins to build up in the blood. Over time, high blood sugar causes inflammation and other major health troubles.
What Are the Symptoms of Diabetes?
Despite their differing causes, type 1, type 2, and gestational diabetes have similar symptoms. But because signs of the disease are often mild and develop slowly, they’re easy to miss or dismiss.
Classic Signs of Diabetes
There are two “signature” symptoms of the disease:
Thirst: When there’s too much sugar in the bloodstream, your body pulls water from surrounding tissues to try to dilute it, leaving you dehydrated and parched. Some people with diabetes feel like no matter how much they drink, they can’t quench their thirst.
Frequent urination: Feeling thirsty makes you to drink more, increasing the need to pee. Plus, diabetes causes the kidneys to work overtime removing sugar from the blood. The kidneys dump this sugar into your urine, creating more pee. And in more advanced stages of the disease, damaged nerves around the bladder may cause some people to feel the urge to pee frequently, even if little or nothing comes out.
Kids with diabetes may suddenly start to have accidents at night or even during the day, even if they’ve been potty trained for years.
Early Diabetes Symptoms
Frequent urination and thirst often occur when blood sugar is already significantly elevated. But there are a few less obvious signs that can show up earlier on.
Fatigue and muscle weakness: Glucose is one of your body’s most important sources of energy—but in diabetes, much of it remains in the bloodstream instead of nourishing your cells, making you feel tired.
Feeling hungrier: To try to get the energy it needs to function, your brain ramps up hunger signals and cravings. Eating more doesn’t help, though, because the glucose from the food remains trapped in the bloodstream.
Common Symptoms of Diabetes
Along with feelings of thirst and hunger, as well as fatigue and the frequent need to pee, there are other clues that could possibly indicate diabetes. As always, having one or more of these symptoms doesn’t mean you have the disease. But it’s a good idea to see a doctor to have things checked out if you are experiencing:
Headaches: When you body finds itself short of the glucose it needs to function, your central nervous system may send pain signals, in the form of headaches, as a warning sign. In addition, dehydration from excessive urination may also lead to headache pain, although the exact mechanism remains unclear. Also, high blood sugar may lead to increased production of epinephrine and norepinephrine, hormones that can constrict blood vessels in the brain, causing headaches.
Weight Loss: Some people, especially those with type 1 diabetes, may experience unexpected weight loss, even though they are eating more. When insulin is lacking or there is resistance to it, your body breaks down more fat, causing you to shed pounds.
Rash: People with diabetes are more likely to get fungal skin infections from organisms like yeast. An overgrowth of yeast on the skin can trigger an itchy, scaly rash in warm nooks and crannies like the underarms or between the toes.
Skin Changes: In type 2 diabetes, your pancreas pumps out large amounts of insulin to try and move glucose from your blood into your body’s cells for energy. High levels of insulin can cause skin cells to multiply rapidly, resulting in darkened, velvety-feeling patches of skin called acanthosis nigricans. They can occur anywhere on your body, but are often found in skinfolds of the neck, groin, or armpit.
Ketoacidosis: In an effort to get the fuel it needs, your body may start to break down its own fat stores. This floods the bloodstream with substances called ketones, making the blood acidic and become toxic. Ketoacidosis causes shortness of breath, confusion, extreme fatigue, and nausea, and requires immediate treatment. It’s more common in type 1 diabetes, but it can also happen in people with type 2.
Numbness: The longer blood sugar stays high—and the higher it spikes—the more damage is done to nerves, blood vessels, and other organs in the body. Over time, excess blood sugar can damage nerve endings and lead to tingling, burning, or numbness in the fingers and toes.
Diarrhea: Sometimes high blood sugar can damage nerves in the intestinal tract. If this kind of damage—called autonomic neuropathy—happens, a person might swing back and forth between periods of diarrhea and constipation.
Should I Get Tested for Diabetes?
The U.S. Preventive Services Task Force recommends that anyone over age 40 with a BMI of 25 or more should be screened for diabetes, then checked every three years thereafter. People with additional risk factors—like a strong family history of diabetes or autoimmune disorders—should be screened earlier and more often.
The first step in getting a diabetes diagnosis is a blood test. If you are diagnosed with the disease, your doctor may want to perform additional tests to find out which type it is. Correct diagnosis is important since treatment differs for the different types.
A1C (or glycated hemoglobin) blood test: This test measures what percentage of your red blood cells have been coated with glucose over the past two to three months. It’s the most common test for diabetes. The higher your blood sugar, the higher your score. An A1C result below 5.7 is considered normal; 5.7 to 6.4 is prediabetic; 6.5 or above suggests diabetes.
Fasting blood sugar test: Blood will be drawn first thing in the morning before you eat or drink anything other than water. A result under 100 milligrams per deciliter is normal; 100 to 125 mg/dL is prediabetic; 126 mg/dL indicates diabetes. Your doctor will likely want to do the test twice before officially diagnosing you.
Random blood sugar test: Blood is drawn at any time of day, whether you’ve eaten recently or not. A result of 200 mg/dL indicates diabetes.
Antibody test: To further differentiate between type 1 and type 2 diabetes, your doctor may also want to draw blood for an “autoantibody” test to see if your immune system is attacking your pancreas, as happens in type 1 diabetes. People with type 1 often test positive for several specific autoantibodies, while those with type 2 (or the rare monogenic diabetes) won’t.
Urine Ketones Test
Your doctor may want to test your urine for ketones, chemicals your body produces when it has to break down fat for energy. The test can generally be done at home, or in a lab or doctor’s office by peeing into a specimen cup. If you’re doing the test at home, it will come with paper test strips to dip into the urine.
Extremely high levels of ketones are a sign of ketoacidosis, a potentially fatal complication of diabetes that requires emergency treatment. Ketones usually happen in type 1 diabetes, but on rare occasions, it can occur with type 2, too.
The good news, no matter what your symptoms may be, is that if you do have diabetes, the disease is highly manageable. Through daily insulin injections, medications, and modifications to your diet and exercise routine, you can stay one step ahead of this condition.
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Diabetes Definition: National Institute of Diabetes and Digestive and Kidney Diseases. (2019). “What is Diabetes?” niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes
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Diabetes and Skin Infections: American Academy of Dermatology. (2020.) “Diabetes: 12 Warning Signs that Appear on Your Skin.” aad.org/diseases/a-z/diabetes-warning-signs
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Diabetes and Ketoacidosis: U.S. National Library of Medicine MedlinePlus. (2020.) “Diabetic Ketoacidosis.” medlineplus.gov/ency/article/000320.htm
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Diabetes and Diagnostic Tests: Mayo Clinic. (2019). “Diabetes.” mayoclinic.org/diseases-conditions/diabetes/diagnosis-treatment/drc-20371451
Ketones Urine Test: US National Library of Medicine/MedlinePlus. (2019). “Ketones in Urine.” medlineplus.gov/lab-tests/ketones-in-urine/