[176] Diseases and Symptoms Associated with Type 1 Diabetes

1. Acute symptoms due to daily blood glucose fluctuations

Immediate physical reactions caused by the imbalance between daily insulin and blood glucose levels.

• Thirst, polydipsia, and polyuria: Abnormal thirst and frequent urination caused by high blood glucose increasing blood osmotic pressure, leading to water being excreted as urine.

• General malaise and weight loss: Severe fatigue and weight loss resulting from the inability to use glucose as energy due to insulin deficiency, causing the body to break down fat and muscle.

• Delayed wound healing: A condition where minor wounds are difficult to heal due to poor blood flow from high blood glucose and decreased immune function.

• Autonomic symptoms (warning signs of hypoglycemia): A state where the sympathetic nervous system is stimulated to alert the body to falling blood glucose levels, causing cold sweats, palpitations, tachycardia, finger tremors, intense hunger, and facial pallor.

• Central nervous system symptoms (severe hypoglycemia): A state where brain energy deficiency causes headaches, intense drowsiness, difficulty concentrating, visual disturbances, dysarthria (slurred speech), confusion, and convulsions.

• Symptoms of blood glucose spikes: A state where rapid post-meal blood glucose rises and sharp drops (reactive hypoglycemia) cause autonomic nervous system disturbances such as intense drowsiness, irritability, anxiety, mood swings, dizziness, lightheadedness, and nausea.

2. Acute complications and sick day-related conditions

Highly urgent conditions that worsen rapidly in a short period and can be life-threatening if appropriate treatment is delayed.

• Diabetic Ketoacidosis (DKA): A dangerous state where insulin is severely deficient, causing ketone bodies to accumulate in the blood due to fat breakdown, leading to blood acidity (including infection-induced cases).

• Hyperosmolar Hyperglycemic State: A condition involving significant hyperglycemia and severe dehydration, resulting in extremely concentrated blood and impaired consciousness.

• Hypoglycemic coma: A life-threatening state where severe hypoglycemia causes brain function to cease, leading to a complete loss of consciousness.

• Dehydration and acute kidney injury: A state where body fluids are rapidly lost due to sick days such as fever or diarrhea, or abnormal polyuria, leading to a temporary sharp decline in kidney function.

• Severe infections: A state where even mild colds or gastroenteritis can rapidly become severe due to weakened immunity.

3. Chronic complications: Microvascular complications (the three major complications) and related organs

Specific complications that occur when small blood vessels (capillaries) throughout the body are damaged by long-term high blood sugar.

• Diabetic retinopathy: A disease where blood vessels in the fundus are damaged. It progresses from simple to pre-proliferative to proliferative stages, and may lead to blindness due to complications such as diabetic macular edema or neovascular glaucoma.

• Cataracts and extraocular muscle palsy: Eye disorders such as the accelerated progression of cataracts, where the lens becomes cloudy, or double vision caused by paralysis of the nerves that move the eyes.

• Diabetic nephropathy: A disease where the filtration function of the kidneys declines. It progresses from early to overt stages, eventually leading to uremia or end-stage renal failure requiring dialysis.

• Diabetic polyneuropathy: Damage to the peripheral nerves in the hands and feet, causing numbness, pain, leg cramps, and muscle weakness. As it progresses, the ability to feel pain may be lost.

• Hypoglycemia unawareness: A very dangerous state where the progression of neuropathy makes it difficult to feel warning symptoms of hypoglycemia, such as cold sweats or palpitations.

4. Macrovascular complications and specific cardiovascular conditions

A group of diseases where atherosclerosis progresses in large arteries, causing serious damage to organs by cutting off blood flow. The generation of reactive oxygen species associated with blood sugar spikes also accelerates this progression.

• Ischemic heart disease (angina pectoris, acute myocardial infarction): A disease where the coronary arteries that supply blood to the heart muscle are narrowed or completely blocked.

• Painless myocardial infarction: A dangerous condition where a myocardial infarction occurs without feeling chest pain due to autonomic neuropathy, often leading to delayed detection.

• Cerebrovascular disease: Includes atherothrombotic cerebral infarction where large brain vessels are blocked, lacunar infarction where small vessels are blocked, and cerebral hemorrhage where vessels rupture.

• Arteriosclerosis obliterans: A condition where blood vessels in the legs are blocked, causing pain during walking, numbness, and a sensation of coldness.

• Resting tachycardia and diabetic cardiomyopathy: A condition where the pulse is fast even at rest due to autonomic neuropathy, or a disease where the heart muscle itself loses function due to the effects of high blood sugar, even in the absence of vessel blockages.

5. Autonomic neuropathy of the digestive, urinary, and reproductive systems

Dysfunction of various organs caused by damage to the autonomic nerves that regulate internal organ function.

• Diabetic gastroenteropathy and esophageal motility disorders: A state characterized by recurring issues such as gastroparesis (reduced stomach function), a sensation of food getting stuck, constipation, and chronic diarrhea (especially nocturnal watery stools).

• Gallbladder dysfunction (cholelithiasis): A condition where the gallbladder's contractile function decreases, making it easier for gallstones to form.

• Defecation and urination disorders: Fecal incontinence due to anal sphincter dysfunction, or neurogenic bladder where bladder sensation is dulled, preventing voluntary urination (can lead to urinary retention as it progresses).

• Reproductive system dysfunction: In men, erectile dysfunction (ED) or retrograde ejaculation where semen flows back into the bladder; in women, sexual pain due to vaginal dryness or decreased sexual arousal (FSD) occurs.

6. Commonly Co-occurring Autoimmune Diseases

A group of diseases that are likely to co-occur because the immune system mistakenly attacks its own cells, similar to the pathogenesis of type 1 diabetes.

• Thyroid diseases (Hashimoto's disease, Graves' disease): Diseases where thyroid function decreases (Hashimoto's) or increases (Graves'), causing systemic metabolic abnormalities.

• Addison's disease: A disease where adrenal cortex function decreases, causing chronic fatigue, skin hyperpigmentation, and hypotension.

• Digestive system autoimmune diseases: Celiac disease reacting to gluten such as wheat, autoimmune gastritis attacking the stomach lining, and autoimmune hepatitis (AIH) or primary biliary cholangitis (PBC) attacking the liver or bile ducts.

• Skin and other autoimmune diseases: Vitiligo where skin pigment is lost, alopecia areata where hair falls out, pernicious anemia due to vitamin B12 malabsorption, myasthenia gravis, rheumatoid arthritis, systemic lupus erythematosus, IgA nephropathy, etc.

7. Mental Disorders and Psychological/Eating Disorders

Mental and behavioral disturbances triggered by the endless pressure and fear of blood glucose management.

• Mood and anxiety disorders: Depression, dysthymia, generalized anxiety disorder, panic disorder, specific phobia of severe hypoglycemia, adjustment disorder, etc.

• Sleep disorders: Insomnia or decreased sleep quality due to blood glucose fluctuations (such as nocturnal hypoglycemia) or mental stress.

• Eating disorders: Anorexia nervosa, bulimia nervosa, binge eating disorder, etc.

• Diabulimia: An eating disorder specific to type 1 diabetes involving insulin omission, where the patient intentionally reduces or skips insulin doses to avoid weight gain.

8. Infectious Diseases

Diseases that are more likely to occur and become severe due to decreased white blood cell function and impaired blood flow caused by hyperglycemia.

• Urinary and reproductive tract infections: Cystitis, pyelonephritis, and vaginal candidiasis, where bacteria and fungi thrive due to the presence of sugar in the urine.

• Skin, oral, and tissue infections: Oral candidiasis, tinea (athlete's foot), cellulitis (purulent inflammation of deep skin layers), and extremely severe and life-threatening necrotizing fasciitis.

• Systemic and respiratory infections: Pneumonia and fatal sepsis, where bacteria enter the bloodstream and spread throughout the body.

9. Skin, bone, and joint diseases

Abnormalities caused by the accumulation of glycated proteins (AGEs), blood flow impairment, and local reactions to insulin injections.

• Joint and tendon abnormalities: Carpal tunnel syndrome (numbness due to nerve compression in the wrist), trigger finger (stenosing tenosynovitis), frozen shoulder, and Dupuytren's contracture (thickening and shrinking of the palm skin).

• Specific skin lesions: Pigmentation on the shins (diabetic dermopathy), unexplained blisters (diabetic bullae), eruptive xanthoma due to lipid abnormalities, granuloma annulare, necrobiosis lipoidica, scleredema, and severe generalized itching (pruritus).

• Abnormalities at insulin injection sites: Dents in subcutaneous fat (insulin lipoatrophy) or hard lumps (amyloidosis) caused by repeated injections in the same area.

• Bone metabolic disorders: Osteoporosis, where bone quality declines, making them brittle and prone to fractures.

10. Foot lesions and otorhinolaryngological/oral diseases

Local problems caused by a combination of reduced sensation due to neuropathy and impaired blood flow.

• Diabetic foot lesions: Foot ulcers and gangrene that progress from minor wounds, and Charcot joint (neuropathic arthropathy), where foot joints are deformed and destroyed due to neuropathy.

• Oral and dental diseases: Xerostomia (dry mouth) due to reduced saliva, taste disorders, and marginal periodontitis (gum disease), which tends to become severe and further worsens glycemic control.

• Ear diseases: Sensorineural hearing loss, where high-frequency sounds become difficult to hear due to damage to the tiny blood vessels in the inner ear.

11. Metabolic disorders, cognitive function, and other issues

Pathological conditions caused by life stages, the accumulation of long-term metabolic abnormalities, and strain on the pancreas.

• Double Diabetes: A condition where a person with type 1 diabetes also develops insulin resistance (a factor in type 2 diabetes) due to weight gain or other factors, leading to a dramatic increase in insulin requirements and further exhausting the pancreas.

• Specific diseases of childhood and adolescence: Mauriac syndrome, which involves growth retardation (short stature) and hepatomegaly when poor control is prolonged, and delayed puberty.

• Cognitive impairment: Alzheimer's-type dementia or vascular dementia caused by damage to the brain from repeated severe hypoglycemia or arteriosclerosis.

• Organ metabolism and electrolyte abnormalities: Metabolic dysfunction-associated steatotic liver disease (MASLD), hyperuricemia (gout) associated with insulin deficiency or decreased renal function, and electrolyte abnormalities such as potassium and sodium that can occur during DKA treatment.

Wow, that's scary.

Diabetes is a disease where the "blood vessels and nerves throughout the body" are damaged. Because blood vessels and nerves are spread throughout the entire body from the tips of the toes to the brain, symptoms can appear in every possible place, including the eyes, kidneys, heart, skin, and even mental health. While the "pain and suffering of complications" must be difficult, the "invisible pressure of management (mental load) that continues 24/7, 365 days a year for life" is also tough.

This list is a collection of diseases and conditions associated with type 1, but I feel like about 80% of it would also apply to type 2. How about you, type 2 patients??

I'm waiting for your likes, comments, and DMs~