ELDER TIP Because their thirst mechanism functions less effectively, older adults may not report polydipsia, a hallmark of diabetes in younger adults.
In ketoacidosis and hyperosmolar hyperglycemic nonketotic syndrome, dehydration may cause hypovolemia and shock. Wasting of glucose in the urine usually produces weight loss and hunger in type 1 diabetes, even if the patient eats voraciously.
Long-term effects of diabetes may include retinopathy, nephropathy, atherosclerosis, and peripheral and autonomic neuropathy. Peripheral neuropathy usually affects the hands and feet and may cause numbness or pain. Autonomic neuropathy may manifest itself in several ways, including gastroparesis (leading to delayed gastric emptying and a feeling of nausea and fullness after meals), nocturnal diarrhea, impotence, and orthostatic hypotension.
Because hyperglycemia impairs the patient’s resistance to infection, diabetes may result in skin and urinary tract infections (UTIs) and vaginitis. Glucose content of the epidermis and urine encourages bacterial growth.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Diabetic complications during pregnancy:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Indications for diagnostic screening for maternal diabetes mellitus during pregnancy include obesity, excessive weight gain, excessive hunger or thirst, polyuria, recurrent monilial infections, glycosuria, previous delivery of a large neonate, polyhydramnios, maternal hypertension, and a family history of diabetes.
Uncontrolled diabetes in a pregnant female can cause stillbirth, fetal anomalies, premature delivery, and birth of a neonate who’s large or small for gestational age. Such neonates are predisposed to severe episodes of hypoglycemia shortly after birth and may also develop hypocalcemia, hyperbilirubinemia, and respiratory distress syndrome.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Diabetic ketoacidosis:
Signs and Symptoms
(Professional Guide to Diseases (Eighth Edition))
Acetone breath, Kussmaul’s respirations, dehydration, weak and thready pulse, nausea, vomiting, altered level of consciousness, dry mucous membranes, serum glucose level of 300 to 1,500 mg/dl
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Hereditary fructose intolerance:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Typically, clinical features of hereditary fructose intolerance appear shortly after dietary introduction of foods containing fructose or sucrose. Symptoms are more severe in infants than in older people and include hypoglycemia, nausea, vomiting, pallor, excessive sweating, cyanosis, and tremor. In neonates and young children, continuous ingestion of foods containing fructose may result in failure to thrive, hypoglycemia, jaundice, hyperbilirubinemia, ascites, hepatomegaly, vomiting, dehydration, hypophosphatemia, albuminuria, aminoaciduria, seizures, coma, febrile episodes, substernal pain, and anemia.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Diabetes insipidus:
Signs and symptoms
(Handbook of Diseases)
The patient’s history typically shows an abrupt onset of extreme polyuria (usually 4 to 16 L/day of dilute urine, but sometimes as much as 30 L/day). As a result, the patient is extremely thirsty and drinks great quantities of water to compensate for the body’s water loss. This disorder may also result in hourly nocturia.
If the patient is unable to obtain adequate quantities of water, features of diabetes insipidus include signs and symptoms of dehydration (poor tissue turgor, dry mucous membranes, constipation, muscle weakness, dizziness, and hypotension). Polyuria usually begins abruptly, commonly appearing within 1 to 2 days after a basal skull fracture, a stroke, or surgery.
Relieving cerebral edema or increased intracranial pressure may cause all of these symptoms to subside just as rapidly as they began.
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Source: Handbook of Diseases, 2003
Diabetes mellitus:
Signs and symptoms
(Handbook of Diseases)
Diabetes may begin dramatically with ketoacidosis in type 1 or insidiously. Its most common symptom is fatigue, from energy deficiency and a catabolic state. However, many patients with type 2 diabetes may be asymptomatic.
Insulin deficiency or resistance causes hyperglycemia, which pulls fluid from body tissues, causing osmotic diuresis, polyuria, dehydration, polydipsia, dry mucous membranes, and poor skin turgor. In ketoacidosis and hyperglycemic hyperosmolar nonketotic state, dehydration may cause hypovolemia and shock. Wasting of glucose in the urine usually produces weight loss and hunger in uncontrolled type 1 diabetes, even if the patient eats voraciously.
Long-term effects
In diabetes, long-term effects may include retinopathy, nephropathy, atherosclerosis, and peripheral and autonomic neuropathy.
Peripheral neuropathy usually affects the hands and feet and may cause numbness or pain. Autonomic neuropathy may manifest itself in several ways, including gastroparesis (leading to delayed gastric emptying and a feeling of nausea and fullness after meals), nocturnal diarrhea, impotence, and postural hypotension.
Because hyperglycemia impairs the patient’s resistance to infection, diabetes may result in skin and urinary tract infections and vaginitis. Glucose content of the epidermis and urine encourages bacterial growth.
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Source: Handbook of Diseases, 2003
Diabetic complications during pregnancy:
Signs and symptoms
(Handbook of Diseases)
All women should receive diagnostic screening for maternal diabetes mellitus during pregnancy. Women at higher risk or with a history of gestational diabetes, fetal or birth problems, may warrant early screening in the second trimester using a formal glucose tolerance test.
Uncontrolled diabetes in a pregnant woman can cause stillbirth, fetal anomalies, premature delivery, and birth of an infant who is large or small for gestational age. Such infants are predisposed to severe episodes of hypoglycemia shortly after birth. These infants may also develop hypocalcemia, hyperbilirubinemia, and respiratory distress syndrome.
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Source: Handbook of Diseases, 2003
Drug abuse and dependence:
Signs and symptoms
(Handbook of Diseases)
Indications of acute intoxication vary, depending on the drug.
Clinical tip The drug user seldom seeks treatment specifically for his drug problem. Instead, he may seek emergency treatment for drug-related injuries or complications.
Friends, family members, or law enforcement officials may bring the patient to the hospital because of respiratory depression, unconsciousness, acute injury, or a psychiatric crisis.
Physical examination
Examine the patient for signs and symptoms of drug use or drug-related complications as well as for clues to the type of drug ingested. For example, fever can result from stimulant or hallucinogen intoxication, from withdrawal, or from infection from I.V. drug use.
Inspect the eyes for lacrimation from opioid withdrawal, nystagmus from central nervous system (CNS) depressants or phencyclidine intoxication, and drooping eyelids from opioid or CNS depressant use. Constricted pupils occur with opioid use or withdrawal; dilated pupils, with the use of hallucinogens or amphetamines.
Examine the nose for rhinorrhea from opioid withdrawal and the oral and nasal mucosa for signs of drug-induced irritation. Drug sniffing can result in inflammation, atrophy, or perforation of the nasal mucosa. Dental conditions commonly result from the poor oral hygiene associated with chronic drug use. Also inspect under the tongue for evidence of I.V. drug injection.
Inspect the skin. Sweating, a common sign of intoxication with opioids or CNS stimulants, also accompanies most drug withdrawal syndromes. Drug use sometimes induces a sensation of bugs crawling on the skin, known as formication; as a result, the patient’s skin may be excoriated from scratching.
Needle marks or tracks are an obvious sign of I.V. drug abuse. Keep in mind that the patient may attempt to conceal or disguise injection sites with tattoos or by selecting an inconspicuous site, such as under the nails.
In addition, self-injection can sometimes cause cellulitis or abscesses, especially in patients who also are chronic alcoholics. Puffy hands can be a late sign of thrombophlebitis or of fascial infection from self-injection on the hands or arms.
Auscultation may disclose bilateral crackles and rhonchi caused by smoking and inhaling drugs or by opioid overdose. Other cardiopulmonary signs of overdose include pulmonary edema, respiratory depression, aspiration pneumonia, and hypotension.
CNS stimulants and some hallucinogens may precipitate refractory acute-onset hypertension or cardiac arrhythmias. Withdrawal from opioids or CNS depressants can also provoke arrhythmias and, occasionally, hypotension.
During opioid withdrawal, the patient may report abdominal pain, nausea, or vomiting. Opioid abusers also commonly complain of hemorrhoids, a consequence of the constipating effects of these drugs. Palpation of an enlarged liver, with or without tenderness, may indicate hepatitis.
Neurologic symptoms of drug abuse include tremors, hyperreflexia, hyporeflexia, and seizures. Abrupt withdrawal may precipitate signs of CNS depression (ranging from lethargy to coma), hallucinations, or signs of overstimulation, including euphoria and violent behavior.
Medical history
Carefully review the patient’s medical history. Suspect drug abuse if he reports a painful injury or chronic illness but refuses a diagnostic workup. In his attempt to obtain drugs, the dependent patient may feign illnesses, such as migraine headaches, myocardial infarction, and renal colic; claim an allergy to over-the-counter analgesics; or even request a specific medication.
Also, be alert for a previous history of overdose or a high tolerance for potentially addictive drugs. I.V. drug users may have a history of hepatitis or human immunodeficiency virus (HIV) infection from sharing dirty needles. Female drug users may report a history of amenorrhea.
A patient who abuses drugs may give you a fictitious name and address, be reluctant to discuss previous hospitalizations, or seek treatment at a medical facility across town rather than in his own neighborhood. If possible, interview family members to verify his responses.
If the patient admits to drug use, try to determine the extent to which this behavior interferes with his normal functioning. Note whether he expresses a desire to overcome his dependence on drugs.
If possible, obtain a drug history consisting of substances ingested, amount, frequency, and last dose. Expect incomplete or inaccurate responses. Drug-induced amnesia, a depressed level of consciousness, or ignorance may distort the patient’s recollection of the facts; he also may deliberately fabricate answers to avoid arrest or to conceal a suicide attempt.
The hospitalized drug abuser is likely to be uncooperative, disruptive, or even violent. He may experience mood swings, anxiety, impaired memory, sleep disturbances, flashbacks, slurred speech, depression, and thought disorders.
Some patients resort to plays on sympathy, bribery, or threats to obtain drugs. They may also try to manipulate caregivers by pitting one against another.
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Source: Handbook of Diseases, 2003
Article Excerpts About Symptoms of Type 1 diabetes:
Diabetes Overview: NIDDK (Excerpt)
Symptoms of type 1 diabetes usually
develop over a short period, although beta cell destruction can begin
years earlier.
Symptoms include increased thirst and urination, constant hunger,
weight loss, blurred vision, and extreme fatigue. If not diagnosed and
treated with insulin, a person can lapse into a life-threatening diabetic
coma, also known as diabetic ketoacidosis.
(Source: excerpt from Diabetes Overview: NIDDK)
Endocrine Diseases: NWHIC (Excerpt)
Increased thirst, increased urination, weight loss,
fatigue, nausea, vomiting, frequent infections.
(Source: excerpt from Endocrine Diseases: NWHIC)
Type 1 diabetes as a Cause of Symptoms or Medical Conditions
When considering symptoms of Type 1 diabetes, it is also important to consider Type 1 diabetes as a possible cause of other medical conditions.
The Disease Database lists the following medical conditions that Type 1 diabetes may cause:
- (Source - Diseases Database)
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