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Symptoms and Diagnosis

It was said earlier that diabetes is a complicated subject. Like all disturbances in the body's chemistry, it requires a basic understanding of what the body needs for its survival, its function and its existence. Unfortunately it is not as simple as a mechanical object for example, a car although there are some similarities if you compare a car's engine that runs out of petrol with a diabetic's body that also runs out of its fuel. The difference is that the diabetic has the fuel available, but cannot use it.

The onset of diabetes is rapid in a young person or child, and slow or more insidious in an adult or more mature person. In a child, the symptoms, in at least 60 per cent of cases, develop over only the previous month or so, and in some cases over only a matter of a week or two. In older people, the symptoms can have been present for many months, sometimes even a year or more, before something caused them to consult a doctor and have a check-up done.

One of the first signs of diabetes is the development of an excess of urination with, almost simultaneously, an increasing thirst which progresses until it becomes unreasonable (in some, the liquid intake can be as high as 5-7 pints [3-4 litres] a day in addition to what they normally drink). In the young toilet-trained child, the sudden onset of bed-wetting as a result of the increased thirst and development of diabetes. There is also an increase in appetite, but a marked loss of weight and strength. The older person will complain of tiredness, unusual fatigue and the rapidity of physical exhaustion coming on as a result of tasks they could formerly cope with easily. Aches and pains occur in the muscles, particularly when they are used, sometimes there is a reduction in eyesight and the skin becomes dry and a little shrunken as weight loss progresses. As the Greeks called it, a 'melting down' disease seems to be developing

The reason for the thirst is once again chemical the blood is full of unusable sugars and fatty acids and, to maintain its normal balance between such 'solids' and its fluid-like serum, the body needs an increased input of water. Put the water in and the kidneys will respond by putting it out as well, for the body tries to keep itself in a permanent state of fluid balance. Similarly, because the sugars are pouring out of the kidneys into the urine, they are taking with them an increased amount of water, too, so the body's thirst increases further. The reason for the loss of weight is obvious the body is breaking down its stores. Sometimes more than 14 lb (6.35 kg) is lost in a month, and in a young child with few stores to break down the appearance of illness is ofter dramatic as it wastes visibly before the parents' eyes. Lack of energy can be explained since the sugar taken in by mouth cannot be made available to the cells, and the bad temper, irritability and general feeling of weariness is due to the fact that the brain and the central nervous system is being deprived of its essential nutrients.

Fortunately it is a simple matter to administer a urine test to check for the presence of sugar. A few years ago, before the development of the modern testing tablets and coated sticks, a sample of urine had to be boiled by the doctor or nurse and certain chemicals added to see if a colour change developed. Nowadays it takes less than 30 seconds to do the 'dipstick' test on a freshly passed urine specimen. If sugar is present the end of the stick changes colour, and the doctor will then arrange for the routine of blood tests and treatment to commence.

The diagnosis of diabetes does not depend simply and solely on a urine test that demonstrates sugar to be present. It is the most likely diagnosis but, as will be recalled, a lowered renal (kidney) 'threshold' to its excretion may be responsible. To confirm it, therefore, or in the more rare case to disprove it, a blood test is undertaken and this can be done: at random (any time); after fasting (after eight hours with no food); two hours after a normal meal; or as part of a sugar tolerance test. The random blood sugar will, in a diabetic, quite probably come out to be higher than normal (and thus above, say, 120 or 130 mg per 100 ml), and the fasting blood sugar will certainly be higher for there is not enough insulin in the diabetic's system to lower the blood sugar to normal.

The glucose- or sugar-tolerance test is one of the most common forms of confirming a diagnosis, however, and is also useful in excluding diabetes in doubtful cases. This is usually done in hospital, where the patient is made to rest comfortably for the duration of the test (about three hours). After fasting for eight hours, the patient is given a dose (ofter as a drink) of pure glucose in water at the rate of one gram of glucose per kilogram of body weight, all mixed in one drink. The blood and urine are tested immediately before the drink is given, then one hour and two hours afterwards. In the diabetic, the blood sugar does not return to normal and the urine becomes loaded with sugar. In the normal person the fasting level is achieved in two hours and no sugar appears in the urine.

The problem emerges, however, in those and there are a large number of them who have a 'lag' curve in the blood sugar results; they are not quite diabetics, yet not quite normal. This group, who used to be called 'pre-diabetics', need no treatment, but do need dietary advice (to avoid all extra sugar in their diet and to avoid obesity) and periodic re-testing (perhaps every five years) of either blood, urine or both. This special glucose-tolerance test can be conducted by means of the sugary drink, or else, for those made sick by sweet foods, by means of an injection into a blood vessel of the appropriately calculated amount of glucose solution.

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