Diabetes mellitus, or diabetes, is a disease that is, unfortunately, becoming more well-known.
The incidence of diabetes is increasing; according to the World Health Organization (WHO), the number of people with diabetes has risen from 108 million people in 1980 to 422 million in 2014.
Diabetes is a disease affecting the pancreas and its ability to produce the hormone insulin. When the insulin-producing cells of the pancreas “are destroyed, or when the body doesn’t respond to insulin as well as it should, blood sugar (blood glucose) levels rise, and diabetes can develop.
Insulin helps blood glucose (blood sugar) enter our cells, where it’s used as fuel to support all of the body’s functions. Without enough insulin, sugar remains in the bloodstream and can become dangerously high. Having high blood sugar over a prolonged period is detrimental to health.
Unfortunately, many people with diabetes may not even know they have it. Of the 34.2 million adults with diabetes in 2018, 26.8 million were diagnosed, and 7.3 million were undiagnosed. Going along with undiagnosed diabetes can increase the risk of diabetes complications.
Knowing the symptoms of diabetes can help provide an earlier diagnosis, which can preserve both health and quality of life. One of the symptoms of diabetes is polyphagia, or increased appetite and hunger.
What is polyphagia?
Polyphagia comes from Greek root words poly- meaning “many” and phagia meaning “eating,” and is the term for excessive or extreme hunger and eating. With normal hunger, eating a meal usually helps ease the urge to eat and satisfies the appetite. In the case of polyphagia, excessive hunger returns more quickly and isn’t satisfied with normal eating habits.
Polyphagia is usually associated with diabetes but can also be a sign of other health conditions.
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Causes of polyphagia
Diabetes
Polyphagia can be a sign of undiagnosed diabetes or blood sugar problems. When cells are starved of glucose for energy (due to lack of insulin or insulin resistance), it can increase the sensation of hunger to try to compensate and gain enough calories to use for fuel.
People with undiagnosed diabetes may notice that they are hungrier than usual and still losing weight due to uncontrolled blood sugar levels. On the other hand, low blood sugar (hypoglycemia) can trigger the sensation of hunger in order to help correct the low levels of sugar in the blood through eating.
Along with polyphagia, other symptoms of diabetes include:
- Urinating (peeing) more often than usual (Polyuria)
- Increased thirst (Polydipsia)
- Unintentional weight loss
- Blurry vision
- Numb or tingling hands or feet
- Fatigue
- Dry skin
- Slowly-healing sores or wounds
- Increased rate of infections
Hyperthyroidism
This condition occurs when the thyroid produces too much of a thyroid hormone, impacting metabolism (the rate at which the body uses energy from food). It is also called overactive thyroid. Besides increased hunger, other signs of hyperthyroidism include:
- Unintentional weight loss, even with good or increased appetite and food intake
- Rapid heartbeat (tachycardia)
- Irregular heartbeat (arrhythmia)
- Pounding of the heart (palpitations)
- Nervousness, anxiety, and irritability
- Tremor
- Sweating
- Changes in menstrual patterns
- Increased sensitivity to heat
- Changes in bowel patterns, especially more frequent bowel movements
- An enlarged thyroid gland (goiter), which may appear as a swelling at the base of the neck
- Fatigue, muscle weakness
- Difficulty sleeping
- Skin thinning
- Fine, brittle hair
Grave’s Disease is an autoimmune disease that attacks the thyroid and causes hyperthyroidism. It’s the leading cause of hyperthyroidism in the United States and impacts 1 in 200 people.
Cushing disease
Cushing(‘s) Disease or Cushing syndrome is a rare disease of the pituitary gland, a part of the brain which helps produce hormones. People impacted by Cushing’s Disease produce too much cortisol, a stress hormone. Cortisol can increase appetite and eating, leading to weight gain and in some cases, obesity. Other signs of Cushing’s Disease include:
- Round, red face
- Hump on back of neck
- Purple stretch marks, especially on the chest, armpits, and belly
- Skin changes, such as acne, excessive facial hair, and easy bruising
- Unusual, rapid weight gain, especially around the belly
Premenstrual syndrome (PMS)
Changing hormones during the menstrual cycle can increase estrogen and progesterone levels, which can increase appetite and eating. Other symptoms of PMS include:
- irritability and mood swings
- bloating
- gassiness
- fatigue
- diarrhea
Hunger and hyperglycemia
When blood sugar levels are high, such as uncontrolled diabetes, glucose can’t enter the cells to provide energy due to low insulin levels. Insulin is a hormone responsible for allowing glucose (sugar) to enter the cells from the bloodstream. People with diabetes either don’t produce enough insulin, or their body doesn’t respond to insulin the way it should, which is called insulin resistance.
High blood sugar is considered to be greater than 100 mg/dL in the fasting state (no eating for at least 8-12 hours) and greater than 140 mg/dL within two hours of eating a meal for those without diabetes. Blood sugars are considered high if they are greater than 180 mg/dL after eating in those with diabetes, or if blood sugar is ever greater than 200 mg/dL.
Hunger and hypoglycemia
Hypoglycemia is the term for low blood sugar, or when blood glucose falls below 70 milligrams per deciliter (mg/dL). When blood sugar is low, it causes negative and disruptive symptoms. Prolonged periods of severe hypoglycemia can cause insulin shock. Insulin shock can be life-threatening and lead to coma and death if it’s not treated quickly.
Having low blood glucose levels can trigger hunger, along with other symptoms such as:
- Feeling shaky and/or dizzy
- Sweating
- Feeling irritable or moody
- Feeling anxious or nervous
- Headache
The treatment for hypoglycemia is to consume a food or drink containing 15 grams of carbohydrates. Sugary drinks and hard candies are preferred as they turn into sugar quickly. Not much juice is needed to get to 15 grams of carbohydrates; about one-half cup is enough.
After taking some carbohydrates, blood sugar should be rechecked in 15 minutes. If it’s still below 70 mg/dL, the treatment should be repeated and blood sugar re-tested in another 15 minutes.
If blood sugar levels don’t rise despite treatment or are dangerously low, a glucagon emergency kit may be used. A medical professional must prescribe glucagon, and it’s in the form of an injection. Glucagon is a hormone that helps convert the body’s stored sugar (glycogen) into blood sugar.
Diagnosing polyphagia
Diagnosing polyphagia is fairly straight-forward. Once someone notices they are hungrier than normal with no other possible causes, they may seek medical advice. A medical professional will take a history of the person’s symptoms and will most likely run a series of diagnostic blood tests, including blood sugar and thyroid function.
If the polyphagia isn’t suspected to be due to a medical issue (such as increased hunger from increased physical activity, PMS, etc.), then it wouldn’t require further diagnostic testing.
Treatment for polyphagia
Diabetes
If the reason for polyphagia is because of diabetes, then there are several treatment options available. There are both lifestyle changes and medications that can be used to treat diabetes.
Treating diabetes will also help reduce polyphagia since it’s related to blood sugar imbalances. Avoiding high and low blood sugars will help promote normal appetite and eating in someone previously experiencing polyphagia from diabetes.
- Eating consistent, balanced meals: When you eat a balance of carbohydrates, protein, and fat (otherwise known as the Plate Method), blood sugar tends to rise more slowly and not drop quickly. Foods rich in fiber help promote stable blood sugars, such as whole grains, fruits, vegetables, legumes, nuts, and seeds. Having a good source of protein with carbohydrates is also good for promoting healthy blood sugar levels. Some protein sources include meat, eggs, fish, dairy products, legumes, nuts, and seeds. Eating protein with carbohydrates can also help reduce reactive hypoglycemia (low blood sugar after eating, especially carbohydrate-based foods) in people without diabetes.
- Exercise regularly: Being active helps lower both insulin resistance and blood sugars. Muscles take up sugar for energy, so doing a mix of cardiovascular exercises like walking and weight training (bodyweight exercises or lifting weights) is ideal. Increasing muscle mass can help reduce insulin resistance as well since muscle tissue takes up glucose regardless of how much insulin is present.
- Take medications as prescribed: It’s important to take diabetes medications as prescribed. Skipping doses, or taking more than prescribed, can be detrimental. Never adjust diabetes medications on your own; always consult with a healthcare provider.
- Check blood sugar regularly: People who check their blood sugar regularly tend to have better-controlled blood sugar overall. Checking blood sugar levels at home helps people become aware of their blood sugar trends. It can also help people identify how their lifestyle habits affect their blood sugar and make adjustments to achieve better blood sugar control.
- Practice good sleep hygiene: Poor sleeping habits and shift work have been associated with increased blood sugar levels. Lack of sleep or a disrupted circadian rhythm seems to interfere with the body’s insulin response, leading to insulin resistance.
- Manage stress: Some studies have suggested a link between stress and the increased risk of developing type 2 diabetes. Stress stimulates our body’s fight or flight response, resulting in increased blood sugar levels and insulin resistance. Stress can also lead to poor eating habits, low-quality sleep, and other aspects of reduced self-care, contributing to higher blood sugars. Finding ways to manage stress can help improve both mental and physical health.
- Watch your weight: Being at a higher weight (“overweight” or “obese” according to body mass index) is associated with an increased risk of insulin resistance. Studies have found that a 5% reduction in body weight in those considered overweight or obese significantly reduced their risk of developing type 2 diabetes. Losing weight can also help reduce blood sugar levels in people with existing diabetes.
Hyperthyroidism
For polyphagia related to hyperthyroidism, available treatments include:
- Radioactive iodine. Taken by mouth, radioactive iodine is absorbed by the thyroid gland, causing the gland to shrink. Symptoms usually subside within several months. Excess radioactive iodine disappears from the body in weeks to months.
- Anti-thyroid medications. These medications gradually reduce symptoms of hyperthyroidism by preventing the thyroid gland from producing excess amounts of hormones. There are risks to taking any medications, and several anti-thyroid medications come with serious potential side effects.
- Beta-blockers. Beta-blockers are usually used to treat high blood pressure and don’t affect thyroid levels, they can ease hyperthyroidism symptoms, such as tremors, rapid heart rate, and palpitations. Healthcare providers may prescribe them to help until thyroid levels are closer to normal.
- Surgery (thyroidectomy). For pregnancy or people who otherwise can’t tolerate anti-thyroid drugs and don’t want to or can’t have radioactive iodine therapy, they may be candidates for thyroid surgery, although this is rarer.In a thyroidectomy, most of the thyroid gland is removed. Risks of this surgery include damage to vocal cords and parathyroid glands, which help control calcium level in the blood.
Cushing’s Disease
Depending on the cause of Cushing’s Disease, there are several approaches to treating Cushing’s-related polyphagia. Some treatments for Cushing’s Disease include:
- Cutting back on steroid medications
- Surgery to remove the tumor on the pituitary gland, if present
- Radiation therapy to shrink tumor on the pituitary gland, if present
- Medication use to help control the amount of cortisol produced
- Removal of the pituitary gland if all other forms of treatment fail or aren’t an option
Conclusion
Polyphagia is the term for increased hunger and eating not explained by normal causes such as increased activity level. It’s usually a symptom of diabetes but can also occur due to other conditions like hyperthyroidism and Cushing’s Disease.
Avoiding both high and low blood sugars is the main goal when managing diabetes. Polyphagia is a sign of low and high blood sugar, so effectively managing blood glucose levels will help reduce polyphagia symptoms.
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