Clinical features of type 1diabetes mellitus

In clinical practice, history, examination and investigations are important to diagnose the disease. History and examinations are the fundamental things and they give evidence of the condition.

History

Polyuria (increased frequency of urination), polydipsia (thirst), and polyphagia (Increased appetite) are the cardinal features of type 1 diabetes. Patients can have other features like lassitude, nausea and blurred vision as well. These symptoms are due to the hyperglycemic state. Usually the onset is sudden. Disease maybe diagnosed following an infection. Usually patients are lean and present with features of ketoacidosis. History may reveal following features;

1. Polyuria: this is due to osmotic diuresis secondary to hyperglycemia.
2. Thirst is due to the hyperosmolar state and dehydration.
3. Polyphagia with weight loss: The weight loss with a normal or increased appetite is due to depletion of water and a catabolic state with reduced glycogen, proteins, and triglycerides.
4. Fatigue and weakness: This may be due to muscle wasting from the catabolic state of insulin deficiency, hypovolemia, and hypokalemia.
5. Muscle cramps: This is due to electrolyte imbalance.
6. Nocturnal enuresis: Severe enuresis secondary to polyuria can be an indication of onset of diabetes in young children.
7. Blurred vision: This also is due to the effect of the hyperosmolar state on the lens and vitreous humor. Glucose and its metabolites cause dilation of the lens, altering its normal focal length.
8. Gastrointestinal symptoms: Nausea, abdominal discomfort or pain, and change in bowel movements may accompany acute DKA. Acute fatty liver may lead to distention of the hepatic capsule, causing right upper quadrant pain. Persistent abdominal pain may indicate another serious abdominal cause of DKA, eg, pancreatitis. Chronic gastrointestinal symptoms in the later stage of diabetes are due to visceral autonomic neuropathy.
9. Patients may maintain their normal weight or exhibit wasting, depending on the interval between the onset of the disease and initiation of treatment.
10. Peripheral neuropathy: It presents as numbness and tingling in both hands and feet, in a glove and stocking pattern. It is bilateral, symmetric, and ascending neuropathy, which results from many factors, including the accumulation of sorbitol in peripheral sensory nerves due to sustained hyperglycemia.
11. Symptoms at the time of the first clinical presentation usually can be traced back several days to several weeks; however, beta cell destruction may have started months, or even years, before the onset of clinical symptoms.

Examination findings

Usually physical examination is normal. If the patient present with diabetes ketoacidosis, signs of Kussmaul respiration, dehydration, hypotension will be there.
In established cases, patients should be examined every 3 months for macrovascular and microvascular complications. They should have funduscopic examination for retinopathy and monofilament testing for peripheral neuropathy.