The classic presentation of uncontrolled diabetes is the
“polys” – polyphagia (eating too much), polydipsia (drinking too much) and
polyuria (urinating too much) accompanied by weight loss. The underlying cause
is that the blood sugar level is too high for the kidneys and sugar leaks out
into the urine.
The body tries hard to hold onto sugar since in earlier days
it was hard to get enough food for survival and the kidneys would reclaim
glucose as they filtered blood so as not to waste calories. However, once the
blood sugar level is greater than about 180 the system gets overwhelmed and
sugar leaks out. The sugar molecules attract water leading to increased urine
volume. The body needs to replace the water lost via urination leading to
increased thirst. Weight loss can be dramatic and the thirst relentless.
The whole idea of losing weight by peeing it out is enticing
but creates metabolic havoc. The high blood sugar is toxic to small blood
vessels, especially in the eyes and the kidneys. The liver attempts to
compensate by storing excess blood damage; this creates another set of
problems.
A new class of diabetes medications “tricks” the kidneys
into allowing glucose into the urine without setting off a bad cascade of
events. While useful these medications can have significant side effects.
The National Diabetes Education Initiative has many excellent PDF downloads that discuss many of the newer medications as well as advice on diabetes management.
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