Early Signs of Type 2 Diabetes (SQ-144)
There is a reason why type 2 diabetes is also known as ‘silent disease’. The symptoms of type 2 diabetes take years to develop as the disease progresses gradually. In fact, most affected people show very mild or no symptoms in the beginning, but often go on to develop full-fledged type 2 diabetes over several years, without realizing they have a problem.
But if you know what symptoms to watch out for, especially when you have a family history of disease, are overweight or have excessive belly fat, it is possible to get a diagnosis before the disease has progressed to a dangerous level, which also increases your risk of many disabling and even life threatening health complications such as heart disease, nerve damage, kidney failure, blindness, depression, and fungal infections.
The purpose of this blog is to understand these early signs of diabetes as timely diagnosis and treatment can help slow down or even prevent the development of serious complications that may affect the quality of your life in a huge way. But first, let’s understand what happens in type 2 diabetes and what are the major risk factors involved in the disease development.
What is Type 2 Diabetes?
Your body depends on sugar (glucose) as its primary source of energy. When you eat a meal, the level of sugar in your blood goes up. Sugar coursing the bloodstream signals the pancreas to release insulin, a hormone produced by beta cells of the pancreas. Insulin tells the cells of your muscle, liver, fat and other tissues to absorb this glucose, thus reducing its level in the blood. This is how insulin keeps the blood sugar levels within a normal, healthy range.
In type 2 diabetes, the body is either not able to make sufficient amounts of insulin or it doesn’t respond too well to the insulin (insulin resistance). Obesity, especially excessive belly fat, a diet rich in carbohydrates and an inactive lifestyle are the main causes of insulin resistance, where the cells develops resistance to the insulin pumped by the pancreas. When this happens, the available sugar fails to enter the cells and there is excessive build-up of sugar in the blood. Insulin resistance sets the stage for getting pre-diabetes (where the blood sugar levels are high but not too high to cause any noticeable symptoms). If not detected and controlled in time, this may lead to the development of type 2 diabetes.
Type 2 diabetes usually runs in the family. Besides genetics, factors such as obesity, high blood pressure, high LDL levels, prediabetes, high blood triglyceride, polycystic ovary syndrome (PCOS), old age, gestational diabetes and sedentary lifestyle are considered important risk factors.
Type 2 diabetes is a metabolic disorder where your body either can’t produce sufficient insulin or it is not able to use insulin efficiently, resulting in high blood sugar levels.
Early signs of Type 2 Diabetes
1. Frequent urination (polyuria) and excessive thirst (polydipsia)
Excess of glucose in your bloodstream makes you pee more. This happens because the kidneys are now working overtime and producing more urine to flush out excess of sugar from the blood. You may even feel the need to wake up at night to urinate.
Frequent urination also makes your thirsty as your body is losing so much of water. Drinking more water will further increase your need to pee, creating a disturbing cycle of frequent urination and excessive thirst, two very important symptoms of type 2 diabetes that can be caught at an early stage.
In addition, high blood sugar also damages millions of small blood vessels in your kidneys. These tiny blood vessels work as filters to remove waste material from the blood and retain useful substances such as proteins. Excessive blood sugar damages these filtering units and impairs the ability of the kidneys to filter the blood. Diabetic kidney damage or diabetic nephropathy does not happen overnight, and one can take steps to reduce the risk or slow down kidney damage by controlling their blood sugar level.
Diabetes may also cause nerve damage in the bladder, which makes it difficult to fully empty one's bladder. Urine pressure can cause bladder dysfunction and further kidney damage. People with diabetes are also more prone to developing urinary tract infection.
High blood sugar levels forces the kidneys to produce more urine to get rid of excess sugar, which makes you pee more frequently. It also makes you dehydrated and thirsty. Excessive blood sugar also damages tiny blood vessels in the kidneys.
2. Excessive hunger (polyphagia)
Increase in hunger is a hallmark sign of diabetes, where glucose can’t enter the cells due to insulin resistance. This makes your cells energy deficient. This lack of energy triggers feelings of hunger, leaving you with strong food cravings. Depression, anxiety and stress can also cause an increase in appetite.
When cells can’t use glucose, the lack of energy makes you feel hungry even after eating. It can also lead to sudden and intense food cravings.
Are you feeling tired all the time? According to a study by American Diabetes Association, chronic fatigue is one of the main symptoms in people with a newly diagnosed type 2 diabetes.  Other studies too show fatigue as a persistent symptom in this metabolic disorder. 
There are many reasons why a diabetic person may experience excessive feelings of fatigue and sluggishness, which can adversely impact the quality of life. It happens when the cells can’t use glucose to create energy. In addition, other signs of type 2 diabetes such as frequent urination, increased thirst and increased hunger may also make a person with high blood sugar levels feel tired all the time.
Untreated and uncontrolled diabetes may also lead to other complications, such as kidney disease, that contribute to the feeling of being tired and unwell. Some medications used to treat diabetes also cause fatigue as a side effect.
Unexplained, persistent fatigue could be a sign you have diabetes, especially when you have other signs such as increased thirst and increased need to pee that also contribute to feelings of fatigue.
4. Blurred vision
Diabetes can affect your eyes in many ways. In fact, blurry vision is one of the earliest signs in people with diabetes and it often develops quickly. High blood sugar level causes the fluid to move into the lens of the eye, causing swelling in the eye. This impairs the ability of the eye to focus and make out the fine details, resulting in blurry vision. There is no need to panic though as this is a temporary problem and usually goes away within weeks when blood sugar levels fall back within normal range.
Blurred vision can also be a sign of something more serious. High sugar levels in chronic and uncontrolled diabetes damage blood vessels in the retina, a thin layer of tissue that lines the back of the eye. This is known as diabetic retinopathy with symptoms such as blurred vision, dark floaters that look like cobwebs, poor night vision and fading colors. Excessive damage to the retina may also cause blindness.
Blurred vision and other symptoms of diabetic retinopathy are permanent but can be managed or slowed down with treatment. Diabetes also increases the risk of cataracts (cloudy lens), that causes blurry vision among other symptoms.
High blood sugar level changes fluid levels in the lens, causing blurry vision. Fuzzy sight can also be a result of a more serious diabetic retinopathy that damages the blood vessels in the retina.
5. Numbness or tingling sensation in feet or hands
High blood sugar causes a type of nerve damage, called diabetic peripheral neuropathy. It usually affects the nerves in your hands and feet, causing numbness or tingling sensation in these parts. It can also cause symptoms such as sharp or burning pain, which can be debilitating and may affect sleep. This diabetic nerve pain can also cause depression.
High blood sugar, along with high blood pressure and high triglycerides, damage the small blood vessels that carry oxygen and nutrients to the nerves. Studies show that people with prediabetes or newly diagnosed type 2 diabetes had early signs of peripheral neuropathy. 
Excessive glucose in the bloodstream can damage the peripheral nerves, leading to numbness and tingling sensation in the feet or hands
6. Wounds that do not heal easily
Wounds or sores that tend to heal slowly can be a sign of undiagnosed diabetes. Abnormally high blood glucose levels cause blood vessel damage, nerve damage, chronic inflammation and poor immunity. 
All these factors impair the body's ability to heal wounds and injuries, putting people with diabetes at a very high risk for complications such as bacterial and fungal infections, which may require emergency care. Wounds, if left untreated, can even become gangrenous, requiring surgical removal of the affected area or perhaps a limb in severe cases.
High glucose level in the blood causes premature narrowing and hardening of the arteries. This causes poor blood circulation, reducing the supply of oxygen and nutrients reaching the damaged tissue for healthy wound healing. As a result, wounds take a long time to heal.
Neuropathy plays a threatening role in the growth of wounds in diabetes. Nerve damage that causes numbness in the periphery further complicates the wound healing in people with diabetes as they don't feel the pain from a cut or injury due to loss of sensation, particularly in their limbs.
Wounds often go unnoticed, increasing the risk of infections without timely treatment. People with diabetes need to closely monitor their feet for cuts, calluses and minor wounds to prevent diabetic foot ulcers that can quickly progress into other complications like gangrene and sepsis.
High blood sugar also disturbs the immune function by affecting the production of enzymes and hormones. This slows down the wound healing. Poor immunity also increases the risk of bacterial infections. Poor immunity, poor functioning of white blood cells, chronic inflammation and reduced collagen production are some important reasons why wounds tend to heal slowly in diabatic patients.
Wounds, especially recurring foot ulcers, that take forever to heal are often a sign of diabetes. Elevated blood sugar damages the blood vessels that carry oxygen and nutrients to the site of injury, thus affecting wound healing. Poor immunity, not being aware of the pain due to nerve damage and chronic inflammation also slows down healing of cuts and wounds.
7. Unexplained weight loss
Sudden and unintentional drop in your body weight could be a warning sign of diabetes, according to Diabetes.co.uk. While it is usually more common in Type 1 diabetes, unexplained weight loss can also occur in people with Type 2 diabetes, where the cells are not able to efficiently use glucose due to insufficient insulin or insulin resistance.
When this happens, the body compensates for energy deficiency by burning fat and muscle. This can lead to significant and unexpected weight loss without trying too hard. Thyroid disorders, which can coexist with diabetes, cancer, nutritional deficiencies and conditions like celiac disease and Crohn's disease can also lead to unexplained weight loss. The best way to confirm this is to visit your health care provider.
Sudden weight loss, though a more typical symptom of Type 1 diabetes, can also occur in Type 2 diabetes where the body begins to burn fat and muscle to get its energy.
8. Dry and itchy skin
Is itchy skin a sign of diabetes? Persistent itching, especially in the feet and ankles, and when occurs with other signs of diabetes could be blamed on high blood sugar levels.
What causes dry and itchy skin in diabetes? People with diabetes are often more prone to develop conditions such as bacterial infection, fungal infections, skin dryness, poor circulation and diabetic neuropathy, which all contribute to itching in one way or the other. People with poorly controlled diabetes also experience kidney and liver complications, which can also cause itching.
Itching in the feet and ankles is a common sign of diabetes. Other conditions common to this condition, such as kidney damage, nerve damage and fungal infections, also cause itching.
9. Yeast infections
Recurring yeast infections could be an alarming sign of diabetes, especially when coupled with other symptoms such as blurry vision, increased thirst and fatigue. It gives rise to itching that feels like extreme burning.
Candida albicans is a yeast like fungus that causes yeast infections and excessive sugar levels in the body given the ideal environment to grow and flourish. And people with diabetes also suffer from a weakened immune system that also make them prone to developing fungal infections.
Fungal infections mostly occur in the warm and moist environment and that's why areas like groin, under the breast, feet and toes are more susceptible. Women with diabetes are at a high risk for vaginal yeast infection as they tend to pass more sugar in their urine, creating a thriving environment for the yeast. This causes extreme itching and even burning sensation around the vagina, especially while peeing or having sex. Other common fungal infections include jock itch and athlete's foot.
Excessive blood sugar level causes fungal infections such as vaginal yeast infection, jock itch, and athlete’s foot.
10. Acanthosis nigricans
Acanthosis nigricans is a condition where a person develops thick, dark brown patches on the skin. These velvety patches often appear on skin folds such as armpits, back of the neck, groin, elbow and lips.
Usually too much insulin is the culprit behind this skin condition. High levels of insulin (such as in insulin resistance associated with diabetes and obesity) causes skin cells to reproduce faster than normal, causing an increase in melanin. Presence of acanthosis nigricans could mean a warning sign of a more serious underlying disease such as prediabetes, diabetes, thyroid or adrenal glands disorder. Losing weight and controlling blood sugar levels usually corrects the discoloration if excess insulin is the cause.
High insulin levels increase melanin and cause dark and thick patches on the skin. This condition, called acanthosis nigricans, is common in people with obesity and prediabetes due to insulin resistance. It indicates a higher risk for developing type 2 diabetes.
Controlling blood sugar levels with lifestyle changes, such as diet and exercise, can go a long way in reducing your risk of progressing from prediabetes to diabetes, which may not only need more aggressive treatment but also puts you at a higher risk of disabling conditions. Knowing these early signs could be helpful in taking corrective actions sooner and reducing your risk of all sorts of diabetes associated complications.
- Goedendorp et al. Chronic Fatigue in Type 1 Diabetes: Highly Prevalent but Not Explained by Hyperglycemia or Glucose Variability. Diabetes Care. 2014
- Singh et al. Fatigue in Type 2 Diabetes: Impact on Quality of Life and Predictors. PLoS One. 2016.
- Lee CC, Perkins BA, Kayaniyil S, et al. Peripheral Neuropathy and Nerve Dysfunction in Individuals at High Risk for Type 2 Diabetes: The PROMISE Cohort. Diabetes Care. 2015
- Patel et al. Mechanistic insight into diabetic wounds: Pathogenesis, molecular targets and treatment strategies to pace wound healing. Biomedicine & Pharmacotherapy. 2019.