Classical Triad of Diabetes

3 Early Symptoms of Diabetes that should Ring Alarm Bells!

[dropcap]U[/dropcap]nderstanding the signs and symptoms as well as how Diabetes is diagnosed is critical. Awareness of these will help stay alert, if at risk, and reach out to healthcare practitioners and facilities for an early assessment. For those who are already diagnosed, early detection of these symptoms imply earlier beginning of treatment and lower complications in the long run. If there is a family history of diabetes and if you are experiencing any or all of the following classical triad diabetes –

  1. increased thirst (Polydipsia),
  2. increased urinary frequency (Polyuria) or
  3. increased hunger (Polyphagia),

please rush to the nearest healthcare facility or diagnostic center to check your blood glucose and HbA1C levels.


Water is essential to regulate the body temperature and remove waste. Drinking 4-5 liters of water every day is recommended by many and does wonders to our well-being on a sustainable basis. It is absolutely normal to feel thirsty several times during the day. However, persistent thirst throughout the day and even after drinking water are serious warning signs. This abnormal thirst is often accompanied by brief or sustained dryness of mouth called Xerostomia. Polydipsia is excessive thirst, hallmark of Diabetes and warrants an assessment of Blood Glucose Levels.

One of the three ‘classic triad’ symptoms of Diabetes, Polydipsia,  sets in gradually over time and is difficult to identify in the early stages. It becomes noticeable only well after other signs and symptoms of diabetes begin to throw up.

Why in Diabetes?

  • Consistently elevated glucose levels in blood raises the osmolarity, making the blood thicker or more concentrated.
  • When glucose levels cross 200mg/dl (the actual impacting level may vary in each individual) the normal functioning of kidneys begins to trail.  Kidneys cannot absorb almost all the water and glucose back into blood from urine, like they do in normal conditions.

So it is a double whammy – concentrated blood (due to high blood sugars & the resultant high osmolarity) and diluted urine (inability to absorb the water back from urine) – making the diabetics increasingly dehydrated, forcing the compulsive drinking. Please note that severe dehydration in Diabetics, if unchecked, is a medical emergency.


Polyuria is frequent urination, often even in the middle of the night and is a warning sign of Diabetes. Waking up in the night to urinate, often more than once, which you never had to earlier, is an alarm bell for an urgent visit to the Doctor. Frequent passage of large volumes of urine, often more than 3 liters a day, compared to the normal daily urine output of about 1-2 liters in adults, is called Polyuria and is one of the main symptoms of both type 1 and type 2 diabetes. If unchecked, this can lead to severe dehydration and derailed kidney function. Glucose-induced Urination and Polydipsia are the main causes. Consumption of drinks laced with caffeine or alcohol also contribute to the excessive urination.

Why in Diabetes?

During filtration, the first step in the formation of urine, large volumes of water and small molecules flow out from the plasma into bowman’s capsule (the first part of the nephron) followed by kidney tubules. This is non-specific filtration and to prevent the loss, all the useful substances such as glucose, amino acids, and certain ions along with water have to be actively resorbed back by the cells lining kidney tubules.

In normal individuals, 100% of the glucose is reabsorbed, by custom transport proteins in cells lining kidney tubules. However, the high levels of glucose in diabetics floods the tubular proteins beyond their capacity leading to incomplete resorption and hence copious glucose in the urine.  As glucose is a solute that draws water into the urine by osmosis, the hyperglycemia leads to high volume of glucose-containing urine.


Polyphagia is excessive hunger and eating. Though there is persistent hyperglycemia in Diabetes, cells bathing in Glucose, the body fuel, it is ironical that fatigue is one of the commonest symptoms of Diabetes. There are reasons for this phenomenon.  Persistent Excessive hunger, regardless of how recently, or how much, you have eaten is one of the three Classical Triad of Diabetes. This abnormal hunger leads to uncontrollable food cravings, resulting in a dramatic increase in appetite and is called as Polyphagia.

Why in Diabetes?

There are two main reasons for Polyphagia in Diabetics:

  • Loss of glucose in urine which creates artificial shortage and craving for more glucose (food). Check Polyuria for more details.
  • Body cells are starved of Glucose.

Glucose cannot enter cells from blood due to either a lack of insulin (Type 1 Diabetes) or insulin resistance (Type 2 Diabetes). The body can’t convert the glucose (derivative of food) into energy. Glucose starvation at the cellular level leads to marked lack of energy. Cells via hormones including Hypocretin/Orexin, Ghrelin and Leptin convey their Glucose-Deprived status to brain to stimulate the hypothalamus of the brain, to trigger the desire to eat more.

However, this sets up a vicious cycle –

  • Eat more to feed more Glucose to starved cells; but
  • Increased consumption leads to hyperglycemia which further worsens the Insulin Resistance and
  • Higher the insulin resistance, the lower the amount of Glucose that can get into the already starved cells.
  • Starving increases & hunger goes up even more.

This vicious cycle explains why mere eating to satiate hunger will not help get rid of polyphagia. Tackling high glucose levels (by switching to low carb diet) and Insulin resistance (by rigorous Physical exercise) is the best way forward to dismantle polyphagia.

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