Clinical presentation of different types of diabetes

Diabetes whether type 1 or 2 has been associated with persistently raised serum glucose levels. However, clinical signs and symptoms vary and early diagnosis of these presentations may lead to early preventive measures and management interventions. Type 1 diabetes or primary diabetes occurs at an early age. Patients have family history, genetic and immunological factors in the development of disease state as compared to type 2 in which environmental factors play the foremost role in the development of diabetes. The clinical presentation of different types of diabetes would be different according to patients’ condition.

Important signs and symptoms in type 1 diabetics include frequent urination that is in turn is due to osmotic diuresis secondary to sustained hyperglycemia when blood glucose level exceeds the renal threshold. There is increased thirst, weight loss, blurring of vision, postural hypotension, dysfunction of peripheral sensory nerves manifesting as numbness and tingling sensations, and diabetic ketoacidosis. These are the main line of signs manifested in type 1 diabetic patients.

Patients with type 2 diabetes may have history of increased urination and thirst but majority of them are asymptomatic initially. Type 2 patients usually present with lack of energy, lethargy, fatigue, delayed wound healing, loss of visual acuity, and increased incidence of infections such as urinary tract infections, vaginal infections or prostatitis. Deterioration of vision is due to retinopathy, whereas diabetic foot accounts for increased incidence of ulceration as a result of neuropathy, infection and peripheral vascular disease. Myocardial infarction and heart diseases are also seen in long run in patients of type 2 as a result of atherosclerosis.

Besides these differences in the clinical presentation of different types of diabetes mellitus, there is also clear cut difference in the pathogenesis of the two disease processes. Type 1 results from autoimmune destruction of the pancreatic islet beta cells with absolute loss of insulin secretion while type 2 results from a combination of insulin resistance and insulin secretory defects. Therefore, type 1 patients are commenced with insulin therapy as they are insulin dependent and have no improvement with oral hypoglycemic agents or diet alone. Whereas type 2 diabetics are initially non-insulin dependent and henceforth they are treated with diet and drug regimens and insulin only in uncontrolled diabetic indices.

Moreover the onset of disease also varies in both types of diabetes. Patients with type 1 present with acute and sudden symptoms of classic hyperglycemic features as polyuria, thirst, weight loss, pruritus, blurred vision and ketoacidosis. However, clinical presentation in type 2 patients is sub-acute in which disease is often present for many years (on average 4-7 years) before diagnosis. This chronic hyperglycemic state thus in turn leads to the increased susceptibility of infections and slow wound healing as seen in these patients.

Though the clinical presentation varies in both types of diabetes but diagnosis involves the same criteria of presence or absence of hyperglycemia, appearance of one or more common signs and symptoms and features of complications. Whether, type 1 or 2; immediate offset of treatment and diet adjustments is crucial to void off the chances of disease progression and to attain health state comparable to normal.


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