About the three main symptoms of diabetes in Sinhala 😱

Ruwan (age 45), a software engineer, came to my clinic last Wednesday morning. He sat in his chair, looking very anxious and helpless.

"Dr. Priya, I have been feeling unbearably thirsty lately. Even though I drink 5-6 liters of water a day, my thirst is not quenched. Also, I have to go to the toilet every 30-45 minutes. I have to wake up 5-6 times at night to go to the toilet. In addition, no matter how much I eat, my hunger does not go away. I feel incredibly hungry. But despite all this, my weight has decreased by about 4 kilos in the last month," Ruwan explained his discomfort.

I looked at Ruwan's blood sugar test report and explained: "Ruwan, your fasting blood sugar has increased to 280 mg/dL. The symptoms you are describing are what medical science calls the 3 Ps of Diabetes . These are:
1. Polyuria: Frequent urination.
2. Polydipsia: Feeling excessively thirsty.
3. Polyphagia: Feeling excessively hungry.

"Today, let's simply talk about why these 3 symptoms occur due to high sugar in your body and how to avoid them."

🚨 Red Flags that require immediate medical attention

When the 3 Ps of diabetes are present, especially in patients with Type 1 Diabetes, uncontrolled high blood sugar levels can lead to a life-threatening condition called Diabetic Ketoacidosis (DKA) . If you experience the following symptoms, you should immediately go to the emergency department of your nearest hospital:

• A fruity or acetone-like odor on the breath (Fruity breath odor).
• Continuous rapid and deep breathing (Kussmaul breathing).
• Nausea and vomiting with severe stomach cramps.
• Extreme drowsiness, drowsiness, confusion, or loss of consciousness.
• Blood sugar levels above 250 mg/dL and the presence of ketones in the urine.

The scientific background behind the 3 Ps of diabetes

These three symptoms are caused by interrelated body functions:

1. Polyuria - frequent urination

When the blood glucose level exceeds 180 mg/dL (Renal Threshold), the kidneys cannot reabsorb all of the glucose back into the blood. The excess glucose is then excreted in the urine. When glucose is excreted, it also draws a large amount of water from the body towards itself due to osmotic pressure. This process is called Osmotic Diuresis . As a result, the patient urinates frequently and in large quantities.

2. Polydipsia - Excessive thirst

When a large amount of water is lost from the body due to polyuria, the body's cells become dehydrated. The thirst center in the brain (Hypothalamus) is then stimulated, causing excessive thirst to maintain the body's water balance. No matter how much water you drink, this thirst does not go away until your blood sugar level drops.

3. Polyphagia - Excessive hunger

In a healthy body, the hormone insulin is essential for glucose to enter the cells and produce energy. However, in diabetes, due to the lack of insulin or insulin resistance, glucose cannot enter the cells. As a result, even though there is plenty of sugar in the blood, the cells remain hungry. The brain constantly receives the message "not enough energy", so the patient becomes extremely hungry. Since the cells do not receive energy, the body begins to break down fat and muscle, which leads to weight loss.

Other health conditions related to the 3 Ps

Do's & Don'ts

Scientific sources (References)

• 📚 Diabetes - NHS
• 📚 New diagnostic approaches for patients with polyuria polydipsia syndrome - PMC