Dr Grant replies: Yes, these two symptoms of excessive thirst (polydipsia) and urinary frequency (polyuria) are classic symptoms of diabetes.
These symptoms are driven by both the thirst centre in the brain and the kidney as it tries to get rid of excess glucose (sugar) in the bloodstream by passing abnormally large amounts of urine.
The brain responds to dehydration and activates the thirst centre in the hypothalamus to trigger intense (often unquenchable) thirst.
Despite being of normal body weight, your husband may not be healthy, as many people have poor body composition, meaning low muscle mass and elevated body fat.
Other symptoms of new onset diabetes include increased hunger (polyphagia), fatigue, unintended weight loss and blurred vision (as high blood sugars affect the lens in the eye).
In new onset type 1 diabetes (autoimmune mediated) these symptoms come on rapidly over days to short weeks. Type 1 diabetes often occurs in children/young adults and in families with autoimmune diseases such as Hashimoto’s thyroid disease, Graves’ disease (of the thyroid), coeliac disease or rheumatoid arthritis.
In new onset type 2 diabetes, symptoms develop gradually over months to short years and may be mild. Some patients may notice slow-healing cuts/infections, frequent skin or urinary infections, numbness or tingling in the hands/feet and darkened skin folds in the neck/armpits called acanthosis nigricans.
Type 2 diabetes can also run in families – other risk factors include advancing age, polycystic ovarian syndrome (PCOS), being overweight/obese, low levels of physical activity, poor diet and poor sleep.
There is another form of autoimmune diabetes called latent autoimmune diabetes in adults (LADA) that sits between type 1 and type 2 diabetes.
In LADA the autoimmune attack on the insulin-secreting beta cells in the pancreas is slower and more gradual than in type 1 diabetes. Age of onset is usually between 30-50 and symptoms may be mild initially, not requiring insulin at diagnosis but often needing it within a few months to years.
Doctors often suspect LADA when someone has normal (or even low) body weight; initially appears to have type 2 diabetes but shows poor response to typical type 2 diabetes medication; and exhibits unexplained weight loss and a progressive need for insulin.
The more muscle on your body, the longer you live because it increases your basal metabolic rate meaning you burn more glucose even at rest
Tests that help to diagnose LADA include a C-peptide test, as this measures how much insulin your body makes and is often low or gradually declining in LADA.
Autoimmune diabetes is confirmed when blood tests are positive for GAD antibodies and IA-2 antibodies.
A condition called normal-weight metabolic obesity or metabolically obese normal weight (MONA) points to someone with a genetic predisposition to developing high levels of visceral fat around the organs, namely the stomach, liver, pancreas, kidney and even heart. MONA can lead to impaired glucose regulation, insulin resistance and type 2 diabetes, despite not being overweight.
Typically, these people have low muscle mass. Muscle is the main tissue that stores and uses glucose, removing up to 80pc of glucose from the bloodstream after a meal.
The more muscle on your body, the longer you live because it increases your basal metabolic rate, meaning you burn more glucose even at rest.
Having a high muscle mass means you are more metabolically active. It’s estimated that about 1 in 10 Americans have diabetes with 90-95pc of them being type 2 diabetic and over 45 years old.
Pre-diabetes may be present for five to 10 years before diabetes is diagnosed. Your GP can assess you for both prediabetes and diabetes by checking your urine for glucose and doing two blood tests, a fasting blood glucose and HbA1c blood test that measures your average blood sugars over the past 10-12 weeks.
Glucose sticks to haemoglobin (oxygen-carrying red blood cells).
Since red blood cells live for up to 12 weeks, they get recycled mainly by the liver and spleen, the amount of sugar-coated haemoglobin in your bloodstream reflects your average glucose exposure over the last 10-12 weeks.
Dr Jennifer Grant is a GP with Beacon HealthCheck