Introduction, Diagnosis and Complications

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To understand diabetes, we must first acknowledge that diabetes mellitus is not the only form of diabetes. Actually, the origin of the word Diabetes comes from the ancient Greek word syphon. That is because people with diabetes urinated a lot. So, basically, diabetes means «to urinate a lot».

Not all forms of diabetes are related with high blood sugar. There is diabetes insipidus and diabetes mellitus. Diabetes insipidus is quite a rare disease, and is associated with pituitary or kidney malfunction, and characterized by the excretion of large volumes of diluted urine. On the other hand, diabetes mellitus - the most common form of diabetes - was previously characterized by the excretion of large volumes of sweet urine. In ancient times, doctors tasted urine to make the diagnosis of diabetes. Luckily for them, not anymore!

Why should we use the past tense, that it was previously characterized by the excretion of large volumes of urine? Because, in nowadays, the refinement of diagnosis related technology (ie blood tests, medical imaging, citology, etc) allowed us to better understand how we should define diabetes, in order to prevent its complications.

So, in the XXI century, diabetes mellitus is defined according to the concentration of blood glucose:

  • Fasting glucose greater than or equal to 7.0 mmol/L (126 mg/dL)

  • Glucose greater than or equal to 11.1 mmol/L (200 mg/dL) during an oral glucose tolerance test

  • Glucose greater than or equal to 11.1 mmol/L (200 mg/dL) in an individual with symptoms of high blood sugar

If the individual has no symptoms, there should be two criteria at same time point or tests should be later repeated to confirm the diagnosis. Symptoms of high blood sugar include polyuria (ie to urinate a lot, usually more than 3 L per day), polydipsia {ie to drink lots of water], or weight loss). If the patient is diagnosed during a high blood sugar crisis, that also confirms the diagnosis.

References

American Diabetes Association Professional Practice Committee; 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2024Diabetes Care 1 January 2024; 47 (Supplement_1): S20–S42. https://doi.org/10.2337/dc24-S002

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