Evaluating Early Signs of Diabetes: A Look at Asymptomatic Patients

Written by John Buse, M.D., Ph.D.
ReachMD Host 

Evaluating Early Signs of Diabetes: A Look at Asymptomatic Patients

The problem is that for most of the four to five million people with diabetes in the United States who are undiagnosed, they have no symptoms or signs of diabetes. Diabetes is generally asymptomatic until the blood sugars rise to around 200 mg/dL when you start seeing things like excessive urination, particularly nocturia, problems with blurred vision, and issues with skin infections like rashes and vaginal yeast infections. Some people have symptoms such as dehydration, thirst, dizziness, and fatigue early on. But in general, for most people, symptoms don’t present themselves until later in the course of diabetes. 

Now, in regard to signs, patients can present with neuropathy as a physical exam finding. On some occasions, less commonly today than a few decades ago, people would present with renal disease, retinopathy, or even advanced complications. Somewhere from one-third to half of patients with new onset cardiovascular symptoms have unrecognized diabetes with a greater proportion with prediabetes or the metabolic or insulin resistance syndrome.

The main rationale for the current recommendations around screening relate to the issue that diabetes is generally asymptomatic. Today, the recommendations are that everybody over the age of 45 and anyone past the age of puberty with risk factors for diabetes (which are very common) should be screened for diabetes at least every three years. For people who have early abnormalities of glucose tolerance, often called “prediabetes” such as a fasting glucose between 100 and 125, a hemoglobin A1C between 5.7 and 6.4, or an abnormal glucose tolerance test with two-hour values greater than 140, they should undergo screening every year.