Internal medicine and rheumatology specialist Siobhan Deshauer, MD, goes over the visual physical signs that a patient might have diabetes.
Following is a partial transcript of the video (note that errors are possible):
Deshauer: Today, we're breaking down the subtle signs of undiagnosed diabetes, signs you may be able to spot on yourself. But why should you care? Well, 1 in 4 American adults with diabetes are completely unaware they have it. If we catch it early, we can prevent all of the issues we're about to discuss. By the end of this video, you'll know exactly what to look out for so you can take charge of your health.
Okay. What is diabetes? Simply put, diabetes is a condition where your body has trouble managing blood sugar levels. Normally, a hormone called insulin moves sugar from your blood into your cells where it can be used for energy. But when you have diabetes, either your pancreas stops making insulin, which we call type 1 diabetes, or your cells become resistant to insulin and stop responding properly, which we call type 2 diabetes. In both cases, sugar builds up in your blood over time and this causes irreversible damage to your blood vessels, nerves, and organs. Since type 2 diabetes is far more common, that's what we're going to focus on in this video.
All right. Let's get into the symptoms. One of the most common signs of diabetes is frequent urination, also known as polyuria. Patients tell me this is most noticeable at night when they are suddenly waking up multiple times a night to go to the bathroom. This happens because as blood sugar levels rise, your kidneys have to work harder to filter and absorb that excess glucose. At a certain point, they can't keep up and excess glucose spills out into your urine, dragging water with it. This not only leads to increased urination, but also a state of dehydration and increased thirst. It's a vicious cycle, pee more, drink more. As you can imagine, trying to hydrate with sugary drinks like juice or pop just makes this worse.
Okay. Now, grab a mirror because we're going to focus on some signs of diabetes that you can see on your skin. First up, acanthosis nigricans. This is a skin condition characterized by dark, velvety patches that you can usually find on the back of the neck, armpit, or groin. Most of the time when you see this it's a sign of insulin resistance. Basically, your cells stop responding to normal insulin levels, so your pancreas responds by producing even more insulin. When insulin levels rise, they activate insulin-like growth factor receptors in the skin. This stimulates the growth of skin cells like keratinocytes and fibroblasts, particularly in areas with high friction, like the armpits. That's what causes the thickening and hyperpigmentation of the skin. If you notice these changes, it could be an early warning sign of diabetes.
Here's another sign to look out for: skin tags. Just like acanthosis nigricans, these little skin flaps can show up in areas of friction where skin folds together, like the neck, armpits, and groin. While they're usually harmless, having multiple skin tags can be a sign of insulin resistance.
All right. Now, let's talk about infections. Diabetes can create the perfect environment for bacteria and fungi to thrive because high blood sugar levels literally feeds these little organisms, helping them grow and spread. Plus, consistently high sugar levels significantly weakens your immune system. This can show up on the skin as abscesses or yeast infections, but it doesn't stop there. Remember how excess glucose can spill out into the urine? Well, that's one reason that people with diabetes are far more likely to develop urinary tract infections. And yes, that affects both men and women.
Did you know that high blood glucose can literally cause your tendons to become coated in sugar? So what would that feel like? Let's start with a quick test. Put your hands together like you're about to pray. This is normal. But if your fingers can't fully straighten or your palms aren't touching, this is abnormal and it's called a positive prayer sign. This can be caused by diabetic cheiroarthropathy, also known as diabetic stiff hand syndrome, and it's directly related to high blood sugar. Excess sugar actually binds to the proteins in your skin and tendons in a process called glycosylation. Remember this term because we're going to talk about it more later. The sugar-coated soft tissues in your hand become thick and less flexible, which limits the range of movement. On a few occasions, I have actually seen this mistaken for arthritis.
Let's take a look at this published case report. A 52-year-old woman came into the office with pain and stiffness in her hands. This is the x-ray of her hands. Her joints look totally normal with no sign of arthritis. Although her joints were fine, the pain and stiffness was coming from the sugar-coating of her tendons and soft tissue of the hand.
Another common issue that can be triggered by diabetes is called trigger finger. It occurs when one of the tendons that bends your finger gets inflamed. Patients will often come in with their finger stuck in this position and then when they try to extend it, it sort of snaps into place. The condition got its name from that unmistakable snapping sensation. Once again, this is caused by glycosylation of the tendon, this time impairing the tendon from gliding smoothly.
When I'm examining a patient with trigger finger, I can usually feel a lump at that level of the first crease of the finger. That's the A1 pulley, and that's usually where the tendon is getting caught. I'll typically treat it with a steroid injection to decrease the inflammation around the tendon. But in some cases, that doesn't work and it requires surgery to get that tendon moving smoothly again. Something similar can happen to the shoulder called adhesive capsulitis, or frozen shoulder, and that can cause a tremendous amount of pain and stiffness, which can last for years.
But beyond joints and tendons, diabetes can seriously impact your nerves. High sugar levels are toxic to the nerves themselves and also to the tiny blood vessels that supply nutrients and oxygen to the nerves. As the nerves become damaged, you might experience numbness, tingling, or pain, particularly in the hands and feet. This is known as neuropathy.
Watch the video above for more.
Siobhan Deshauer, MD, is an internal medicine and rheumatology specialist in Toronto. Before medicine, she was a violinist, which is why her YouTube channel is called Violin MD.
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