Clinical picture and symptoms of Diabetes Mellites

History
The most common symptoms of type 1 diabetes mellitus (DM) are polyuria, polydipsia, and polyphagia, along with lassitude, nausea, and blurred vision, all of which are due to the hyperglycemia itself. The disease onset may be sudden, with the presentation of an infection. It is not unusual for type 1 DM to present with ketoacidosis; it may occur de novo or develop with the stress of illness or surgery. An explosive onset of symptoms in a young lean patient with ketoacidosis always has been considered diagnostic of type 1 DM.

  * Polyuria and thirst:
Polyuria is due to osmotic diuresis secondary to hyperglycemia. Thirst is due to the hyperosmolar state and dehydration.

  * 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.

  * Fatigue and weakness:
This may be due to muscle wasting from the catabolic state of insulin deficiency, hypovolemia, and hypokalemia.

    * Muscle cramps:
This is due to electrolyte imbalance.
    * Nocturnal enuresis:
Severe enuresis secondary to polyuria can be an indication of onset of diabetes in young children.
 
 * 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.

  * 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.

  * Patients may maintain their normal weight or exhibit wasting, depending on the interval between the onset of the disease and initiation of treatment.
  * Peripheral neuropathy:
This 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.  * Symptoms at the time of the first clinical presentation
  can usually 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.