DIABETES MELLITUS usually starts much earlier than the patients becomes aware of it. The first symptoms are vague and general to such a degree that they may be applied to other diseases, especially to diseases of the digestive organs. Consequently we have to examine the urine in all cases whatsoever, before giving any advice or any treatment. Not to do o, I must say, would be an inexcusable mistake.
Diabetes mellitus begins with disorders of the digestive organs. The patient at first complains of uneasiness, painful sensations and tightness in the region of the liver and of the stomach, accompanied by irregular opening of the bowels, sometimes by acid eructation and vomiting of a brownish, very bitter tasting liquid. The patient complains of headache, sleeplessness, intense fatigue, giddiness, buzzing in the ears, weakness of the eyes, palpitation of the heart, burning sensations in the heads and feet; simultaneously the mental condition of the patient gets entirely altered.
Certainly all these symptoms are of an entirely general nature and may be found also in many other diseases. But if the disease progresses, we get confronted with a very characteristic symptoms, i.e. the strikingly increased thirst, especially after eating and during the night.
Naturally the patient is constantly seeking to allay it, and the quantity of liquid consumed is proportional to the amount of urine passed.
According to the increased secretion of urine the patient has to urinate very often, especially during the night, again and again interrupting the patients sleep. As a rule the average quantity of the urine during twenty-four hours amounts to 3-5 pints. But there are cases in which the quantity may be much greater. I remember patients secreting nearly 12 pints urine daily. The urine is usually clear, pale in colour, has a sweet taste and is of high specific gravity (1030 to 1050).
When diabetic urine is boiled with cupric salt, which has a bluish of green color, the latter is reduced to a cuprous salt having a brown or yellow colour, and a process depending upon this chemical reaction from the usual method of recognizing and estimating the amount of sugar present in the urine. The sugar can also be tested by measuring the amount of carbonic acid gas set free on fermentation by yeast and by the extent to which a specimen of the urine rotates the pane of polarized light.
The quantity of sugar passed in twenty-four hours may vary from a few ounces to several pounds, and it is, of course, markedly increased after sugary or starchy food has been taken. In light cases of diabetes the urine contains only 2 to 1 per cent. sugar, in the most serious cases 10 per cent. or even more; in these serious cases there is also albumen in the urine.
In such serious cases the urine contains two other components, i.e. acetone and acetone-acetic acid; their presence in the urine we may conclude already from the winy smell of the urine or from the patients breath. If the patients breath has the characteristic unpleasant pomaceous smell, we may be sure that acetone and acetone-acetic acid are not only in the breath, but also in the urine of the patient. Whoever has repeatedly perceived that smell will always recognize it, hence it is called the acetone-smell.
As a rule the skin of the diabetic patient is dry and harsh with a peculiar papery consistency. Owing to the poor vitality of the tissues, various skin eruptions appear, boils and carbuncles being especially common and, in the fact, sometimes giving the first signs of the presence of the disease.
The sugar deposited from the urine is very liable to cause itching about the groins and eczema of various parts of the body is set up by the presence of sugar in the sweat. There is a special tendency to gangrene of the skin of the feet, commencing with the toes, and this from is a very serious complication of diabetes and a not uncommon from of fatal issue.
Regarding the nervous symptoms I have already mentioned the general symptoms as there are a certain feebleness, exhaustion, dislike of physical or intellectual work, great weakness after the slightest exertion, sensation of formication and numbness in the limbs, headache, depression.
But one symptom of the nervous system is a very characteristic one, i.e. the typical neuralgia, especially frequently affecting the sciatic nerve, usually called ischias or sciatica. Whenever it affects both sides, it may be an early symptom of the diabetes; besides the sciatica there are also cases with neuralgia in the occiput or in the face as well as cases of a specific migraine (sick headache). In other cases of diabetes we find paralysis of the limbs.