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This story originally appeared on Health.com by Amanda MacMillan.
Many people who develop type 2 diabetes have no idea they’re sick until a blood test shows abnormal blood sugar levels, or until their disease progresses and serious complications start to occur. “For the most part, diabetes is silent and insidious,” says Ronald Tamler, MD, director of the Mount Sinai Clinical Diabetes Institute. “Most of the time people have no symptoms early on.”
In some cases, though, there are sneaky signs. Some early diabetes symptoms are well-known: constant thirst, excessive urination, or sudden weight gain or loss, for example. Others, like the ones below, are more easily missed—by medical professionals and patients alike. If you’re experiencing any of these, be sure to bring them up with your doctor.
Periodontitis—also known as gum disease—may be an early sign of type 2 diabetes, according to new research published in the journal BMJ Open Diabetes Research & Care. The study found that people with gum disease, especially those with severe cases, had higher rates of diabetes (both diagnosed and undiagnosed) and pre-diabetes than those without.
The connection between gum disease and diabetes isn’t new, says Dr. Tamler, and it appears to go both ways: Having either condition seems to increase the risk of developing the other. “Inflammation caused by gum disease eggs on the same factors that are responsible for high blood sugar that cause diabetes,” he says.
“Long before you actually get diabetes, you may notice a dark discoloration on the back of your neck,” says Dr. Tamler. This is called acanthosis nigricans, and it’s usually a sign of insulin resistance—a loss of sensitivity to the hormone the body uses to regulate glucose—that can eventually lead to full-blown diabetes.
In rare cases, acanthosis nigricans can also be caused by ovarian cysts, hormonal or thyroid disorders, or cancer. Certain drugs and supplements, including birth control pills and corticosteroids, can also be responsible.
About 10% to 20% of people who are diagnosed with diabetes already have some nerve damage related to the disease. In the early stages, this may be barely noticeable, says Dr. Tamler: “You may feel a strange, electric tingling in your feet, or have decreased sensation or decreased balance.”
Of course, these strange sensations could be caused by something as simple as wearing high heels or standing in one place for too long. But they could also be caused by other serious conditions—like multiple sclerosis—so it’s important to mention them to your doctor.
This article originally appeared on Health.com