Could you have diabetes and not even know it? It happens more often than you think. Watch for these stealthy symptoms.
Diabetes is a growing concern for people of any age, but older adults are hit the hardest. An estimated 4 percent of adults ages 18 to 44 have diabetes, but that number grows to 25 percent of those 65 and older, according to the Centers for Disease Control and Prevention (CDC).
The uptick happens for a variety of reasons, including things like reduced activity, weight gain, an increase in inflammation, or simply changes to your body as you age, explains Liselle Douyon, M.D., an assistant professor of endocrinology at the University of Michigan.
One such age-related change: Your pancreas may not function as efficiently as it did when you were younger, Dr. Douyon says.
Your pancreas is responsible for making a hormone called insulin, which helps blood sugar, or glucose, enter into your cells so they can use it for energy. If your body doesn’t make enough insulin or can’t use it effectively, the blood sugar can’t absorb into your cells. As a result, your blood sugar levels rise. And if they rise high enough, it indicates prediabetes or diabetes.
How high is too high? The answer depends on which test your doctor uses. For two of the most common measurement methods—the A1C test and the fasting plasma glucose test—the National Institute of Diabetes and Digestive and Kidney Diseases says:
Normal: A1C below 5.7 percent; fasting plasma glucose 99 mg/dL or below
Prediabetes: A1C 5.7 to 6.4 percent; fasting plasma glucose 100 to 125 mg/dL
Diabetes: A1C 6.5 percent or above; fasting plasma glucose 126 mg/dL or above
This is helpful if you’ve recently been tested, but the problem is that many people haven’t—and they may have diabetes and not even know it. According to the CDC, out of the 25 percent of older adults who have the condition, more than 4 percent have not yet been diagnosed.
“In older patients, a lot of times they don’t have the typical symptoms,” Dr. Douyon says. “And people may think some of the symptoms they do experience are of aging and not related to diabetes.”
Here are eight symptoms you should know that may point to diabetes. If you’re experiencing any, talk to your doctor about getting tested. If you’re 65 or older and overweight, have high blood pressure, or a history of abnormal cholesterol, you should also get screened regularly for diabetes.
The good news: If you do have diabetes, getting your blood sugar under control can help improve symptoms.
Sign #1: Frequent Urination
Hitting the bathroom more than usual can be a hallmark sign of diabetes, Dr. Douyon says. When you have a high concentration of blood sugar in your bloodstream, your kidneys may not be able to keep up with filtering out the excess. The blood sugar pulls water from your tissues, and you excrete the excess blood sugar and water through your urine.
“A change from what you are accustomed to would be something concerning, something to get checked out with a primary care provider,” she says. “For example, you urinate every four to six hours, then all of a sudden you are urinating every one to two hours, or the volume of urine increases a lot, then that is a big change.”
If you’ve noticed a worsening of incontinence, that can also signal high blood sugar levels, Dr. Douyon says.
Sign #2: Excessive Thirst
Excessive thirst, or thirst that can’t be quenched, is another common sign of diabetes.
“I’ve had patients tell me, ‘Oh, I’m so thirsty, I have to have cold water,’ or they’ll drink 32 ounces of fluid within a short period of time because they are just so thirsty,” Dr. Douyon says.
An increase in thirst is actually a protective mechanism to try to improve the blood sugar concentration in your blood.
“When you have high blood sugar, you become thirstier because your body is trying to dilute all that glucose in the bloodstream,” Dr. Douyon explains.
Excessive thirst, which typically leads to drinking more fluids, often goes hand in hand with frequent urination. But sometimes in older adults, the thirst mechanism doesn’t work as efficiently. So even though you may be urinating more, you may not feel the urge to drink more to replace fluids. As a result, you may become dehydrated.
Sign #3: Memory Problems
High blood sugar can raise your risk of dementia. According to a 2016 analysis in Diabetes Care, diabetes is linked to a 60 percent higher risk of dementia among both men and women.
“Chronically elevated blood sugar seems to reduce generalized blood flow into the brain, and there you get reduced brain volume and the appearance of dementia,” says Alan Garber, M.D., Ph.D., a professor of endocrinology, diabetes, and metabolism at Baylor College of Medicine. “Memory goes first, because it’s most sensitive to the current nutritional health of the brain. If the brain is not functioning properly, you don’t store short-term memory, and you can’t recall it.”
Diabetes also raises your risk of something called multi-infarct dementia, or multiple small strokes that damage parts of the brain due to a disruption of blood flow. Sometimes, these strokes can be silent, meaning you may not experience visible symptoms. But the damage is occurring nonetheless, and it can lead to problems with short-term memory and concentration. It also makes a large-scale stroke more likely, which can cause cognitive problems, as well as motor issues like difficulty walking or talking.
Sign #4: Unexplained Weight Loss
Dropping pounds when you’re not trying to lose them can be a concerning sign for diabetes, Dr. Douyon says.
With diabetes, you may not be able to metabolize nutrients like carbohydrates, fat, and protein as effectively as you used to.
“Now you start using your own fat stores to try to give your body the energy it needs to do its normal bodily functions,” she says. “You are not putting on the calories—you are just peeling everything off.”
Doctors may use different criteria to judge how much weight loss is considered a red flag, but benchmarks like 10 percent of your total bodyweight or 10 pounds can be a cause for concern, Dr. Garber says.
Sign #5: Tingling in Extremities
Diabetes can mess with the nerves in your body, causing something known as neuropathy. You may notice this as tingling, burning, numbness, or sharp or dull pain that often hits nerves in your feet or hands.
“The best way to think about it is to think of your nervous system as an electrical conduction system where everything gets sugarcoated,” Dr. Douyon says. “With that extra coating you didn’t have previously, the nerve conduction is changed and different.”
This can affect a single nerve or a large group of nerves. While those in your feet and hands are the most commonly affected, diabetes can mess with any nerves in your body, including those that control your heart rate.
Sign #6: Erectile Dysfunction
Men with erectile dysfunction were more than twice as likely to have undiagnosed diabetes than those who did not have problems with their erections, according to a 2015 study in the Annals of Family Medicine.
Issues with nerve signaling can contribute to erectile dysfunction. People with diabetes also often have poor vascular systems and blood flow problems, which can also lead to erectile difficulties, Dr. Douyon says.
Sign #7: Vision Problems
High levels of blood sugar can cause macular edema, or a swelling in the center of your retina that occurs due to fluid buildup. When this swelling occurs, you may notice a decreased sharpness in your vision or vision loss, Dr. Garber says.
Chronically elevated blood sugar can also limit oxygen to the retinas, which triggers the release of something called vascular endothelial growth factor, a substance that encourages the growth of tiny blood vessels in the eye. These blood vessels are fragile and bleed easily, which can distort vision and lead to vision loss.
Only an ophthalmologist can diagnose these conditions. Treatment by either a laser or an injection is often necessary to save central vision, Dr. Garber says.
Sign #8: Delayed Wound Healing
If a cut that would normally heal in a week is sticking around for three or four, that could be a sign of diabetes. Another sign: if a small cut gets infected—badly and fast.
These could be related to nerve issues or blood flow problems, where nutrients needed to heal the area are not getting where they need to be.
“One effect of having an area that is bathed in glucose is your healing cells do not react the way they should react,” Dr. Douyon says. “They may repair in a very slow way, or they don’t repair as effectively as they should.”