Frequent urination, unquenchable thirst, extreme fatigue and unexplained weight loss are the four signs that could point to undiagnosed diabetes, according to Diabetes UK. Known as the 4Ts, these symptoms may present differently across age groups, and spotting them early is critical to prevent serious complications.
What are the 4Ts?
The 4Ts stand for Toilet, Thirsty, Tired and Thinner. They are the most common symptoms of both type 1 and type 2 diabetes. In type 1, an autoimmune condition where the body stops making insulin, symptoms tend to develop quickly, usually over days or weeks. Early recognition is vital to prevent diabetic ketoacidosis (DKA), a life-threatening emergency caused by a severe lack of insulin.
In type 2 diabetes, the 4Ts can also occur but often develop more slowly, over weeks, months or sometimes years, making them easier to miss. Although the 4Ts originate from the same underlying biological cause – high blood glucose – they may present slightly differently depending on a person's age.
Signs in babies and under 5s
Type 1 diabetes is often diagnosed in childhood, and the latest data indicates that the proportion of children presenting in DKA at diagnosis is increasing, with the highest rates in children aged under five. In under 5s, symptoms may appear alongside common illnesses such as flu or gastroenteritis, allowing type 1 diabetes to go undetected.
Parents and carers should look out for nappies becoming unusually heavy or leaking urine, children becoming more irritable and wanting feeds or drinks more often, lethargy and increased sleep, and clothes suddenly seeming looser or a child not reaching growth targets.
Signs in schoolchildren and teenagers
Around 38,000 young people under 19 in the UK live with diabetes, and roughly 96% have type 1. Symptoms can occur rapidly in this age group and may be mistaken for common illnesses. An increasing number of children and teenagers are also being diagnosed with type 2, with the rise thought to be driven by higher rates of childhood and adolescent obesity.
Those under 18 living with type 2 diabetes are around five times more likely to be from the most deprived areas. Warning signs include frequent trips to the toilet during lessons, drinking lots of drinks incredibly fast, reduced energy affecting school or sport, and sudden visible weight loss despite eating as much as usual.
Signs in adults
Type 2 diabetes accounts for roughly 90% of all diagnosed cases and is more common in adults. Adults over 40 are at increased risk, as are people from African Caribbean, Black African or South Asian backgrounds. Having a family history of type 2 diabetes or living with overweight or obesity also increases the risk.
In adults, symptoms include getting up during the night to urinate, a persistent parched feeling or constant dry mouth, profound fatigue that doesn't improve with sleep, and unexplained weight loss. These signs can be misattributed to stress, ageing or other health conditions, causing delays in diagnosis that can lead to serious and sometimes irreversible complications, including sight loss, kidney damage and cardiovascular disease.
If any of the 4Ts are noticed, contact a GP immediately for an urgent blood sugar test or call NHS 111.
