Could You Have Diabetes and Not Know It?
From blurry vision to family history — understanding diabetes risk.
Millions of people are living with diabetes without knowing it. The condition, in which the body cannot regulate blood sugar effectively, can develop unnoticed for years, causing damage long before a diagnosis is made.
That is one reason Kate Shaper, DNP, wants people to know what to watch for. Shaper works in endocrinology at University of Vermont Health-UVM Medical Center and focuses on inpatient diabetes management, caring for people hospitalized with complications related to the disease.
“Type 2 diabetes is a lot like high blood pressure at times,” Shaper says. “You can ignore it for a period of time and not have terrible consequences. Then, all of a sudden, the consequences start to show up.”
Awareness is key. Diabetes is serious, but it is also treatable. Recognizing symptoms, understanding risk factors and knowing when to ask about screening can help people get care earlier, before long-term damage occurs.
What are common signs of diabetes?
Symptoms vary. Type 2 diabetes and prediabetes may develop slowly, and some people do not notice symptoms at first. Type 1 diabetes symptoms often come on more quickly and can become severe.
Some signs to pay attention to include:
- Increased thirst
- Frequent urination
- Increased hunger
- Blurry vision or other vision changes
- Tingling or numbness in the hands or feet
- Fatigue or generally feeling unwell
- Unexplained weight loss
Shaper says vision changes can be an early sign of high blood sugar. Some people also notice tingling or numbness in their hands or feet. She also points to what clinicians sometimes call the “three Ps”: polyuria, or urinating more; polydipsia, or drinking more; and polyphagia, or eating more.
“One concerning sign is when people notice that they’re getting really, really thirsty,” she says.
One symptom by itself does not mean someone has diabetes. But new or ongoing symptoms, or symptoms that occur together are a good reason to check in with a clinician.
Type 2 diabetes is a lot like high blood pressure at times. You can ignore it for a really long time and not have terrible consequences. Then, all of a sudden, the consequences start to show up.
Can diabetes develop without symptoms?
Prediabetes and type 2 diabetes can be present before someone feels anything is wrong. Elevated blood sugar may first appear on routine lab work.
If a glucose level is high, a provider may order an A1C test, which shows average blood sugar over time.
Shaper says people should not interpret a single lab result on their own, especially because fasting status can affect glucose levels. But results above the normal range are worth discussing.
What is an A1C test?
An A1C test measures average blood sugar over two to three months. The American Diabetes Association defines these general ranges:
- Below 5.7% is normal
- 5.7% to 6.4% indicates prediabetes
- 6.5% or higher falls indicates diabetes
Clinicians may also use other tests, including fasting blood glucose or an oral glucose tolerance test.
Who should ask about diabetes screening?
Screening depends on age, weight, medical history and other risk factors. Many clinicians recommend screening adults ages 35 to 70 with overweight or obesity. Screening may happen earlier for those at higher risk. People may want to ask a clinician about screening if they have:
- A parent or sibling with Type 2 diabetes
- Excess weight
- High blood pressure
- High cholesterol
- A history of gestational diabetes
- Low levels of physical activity
- Polyendocrine Metabolic Ovarian Syndrome (also known as PCOS)
- Certain racial or ethnic backgrounds associated with higher rates
Family history is especially important, Shaper says.
“Type 2 diabetes is a heritable disease,” she says. “In fact, it has a stronger link to family history and genetics than Type 1 diabetes. Unfortunately, in our culture, people with Type 2 diabetes receive the message that they developed their illness purely due to bad choices they made. This perpetuates shame around the diagnosis and can actually prevent people from seeking care."
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Is Type 2 diabetes always caused by lifestyle?
No. Lifestyle can affect risk, but Type 2 diabetes is influenced by genetics, age and other health conditions. “We’re learning more and more about genetic predisposition,” Shaper says. “Some people have to work extra hard compared to others to prevent and control diabetes.”
Can type 1 diabetes happen in adults?
Yes. While often associated with children and young adults, type 1 diabetes can develop later in life. Type 1 diabetes is an autoimmune disease, and symptoms tend to be more severe. “Usually in Type 1, we see a more extreme presentation,” Shaper says. That may include fatigue, significant weight loss, intense thirst and persistent hunger. By comparison, Type 2 diabetes can be easier to overlook.
Type 2 diabetes is a heritable disease. In fact, it has a stronger link to family history and genetics than Type 1 diabetes.
What changes can help reduce risk?
Unfortunately, in the general population there is little to do to prevent the onset of Type 1 diabetes. To prevent Type 2 diabetes, the best place to start is one manageable change. Shaper often asks patients to choose from a “menu” of options. Reducing smoking, increasing protein and fiber in the diet, cutting back on sugary drinks and increasing physical activity can all help, says the American Diabetes Association. Moderate activity — such as 30 minutes a day, five days a week — can lower risk.
When should someone call their doctor?
Anyone with symptoms such as increased thirst, frequent urination, blurry vision or unexplained weight loss should contact a clinician. People with risk factors should also ask whether screening is appropriate. Diabetes can cause serious complications when untreated. But when it is caught early, people have more options to protect their health.
