**2. Presentation and diagnosis**

Suspicion of the diagnosis of diabetes mellitus begins with the presence of clinical features, then doing random capillary blood glucose to confirm the diagnosis. Glycated hemoglobin supports the diagnosis. Urine glucose is important for diagnosis, especially in settings where laboratory support and glucometers are a challenge. However, the criteria involve having the symptoms of hyperglycemia and high levels of blood glucose.

The commonest symptoms are tiredness, polyuria, polydipsia, and weight loss despite polyphagia; however, there are other subtle symptoms that may indicate diabetes mellitus, including skin infections such as boils and recurrent fungal infections. Most of the occasions for diagnosis within the context of an acute illness.

It is common to measure random blood glucose either by using capillary blood (using glucometers) or venous blood where laboratory facilities are available. In settings where there are in the diagnosis, the most common form is the severe form of diabetes, where a patient presents with diabetes ketoacidosis (hyperglycemia, acidosis, and ketonemia/ketonuria). At this point, the diagnosis will involve random blood glucose for hyperglycemia greater than 11.1 mmol/L and urine dipstick to look for ketonuria of 2+ or more, weakness, unclear poor growth for children, neglects, and anger of youth.

The finger prick at any time should be the same or exceed 11.1 mmol/L along with clinical symptoms of short duration of loss of weight, polyuria, and polydipsia. This can be done in sick patients or outpatients. Thus, the diagnosis of diabetes is confirmed when:


Note: If there are no symptoms, there should be two blood glucose readings tested at different times.

At initial diagnosis, glycated hemoglobin (HbA1c) is an important parameter, but a normal value does not rule out the diagnosis of diabetes. HbA1c is used for monitoring hyperglycemia in 3 monthly checks because of its variation in availability.

Since type 1 diabetes is an autoimmune condition, the likelihood of other autoimmune conditions is high; hence, screening for other autoimmune conditions is important. These include: thyroid profile (TSH, FT4, and FT3) ± coeliac disease. Most of the times, patients in sub-Saharan Africa delay the diagnosis, resulting in a lot of loss in follow-up; therefore, there is need for screening for complications of diabetes, that is, urine examination for micro-albumin, lipid profile—triglycerides and lipoproteins, and renal function tests (serum creatinine, blood urea nitrogen) as well as the assessment for neuropathy using filament touch for sensation.
