Diabetes mellitus - diagnosis -

Diabetes mellitus in numbers

Classic symptoms of hyperglycemia:

• Polyuria, 
• Polydipsia, nocturia,
• Blurred vision,  weight loss.

Glycated haemoglobin between 42 and 47 mmol/mol or fasting plasma glucose between 5.5 and 6.9 mmol/L  indicates a high risk of diabetes.

Risk factors for diabetes:

• Drugs: thiazide diuretics, betablockerare,  antipsichotics, steroids.
• Comorbidities: cardiovascular disease or mental health problems), shift working, stress, smoking.

For suspected diabetes test fasting glucose or HBA1C.

Falsely increased HBA1c might be seen in iron deficiency anaemia, renal failure, HIV treatment, hypertriglyceridaemia, hyperbilirubinaemia.

Falsely low HbA1c: blood loss, hemoglobinopathies.

For hypertension is preferred to start with ACEI, avoid thiazide diuretics.


Rarely adults with type 2 diabetes can present with a hyperosmolar hyperglycemic state, characterized by marked hyperglycemia without ketoacidosis, severe dehydration, and obtundation.

Diabetic ketoacidosis [hyperglicemia positive urine and blod ketones, pH>7.3, anion gap >10, serum bicarb 10-15ve] may be the initial presentation in approximately 25% of adults with newly diagnosed DM1.
Diabetic ketoacidosis (DKA) as the presenting symptom of type 2 diabetes is also uncommon in adults but may occur under certain circumstances (usually severe infection or other illness) and in non-Caucasian ethnic groups.