type 2 dm is the most common form of dm . the symptoms that commonly indicate hyperglycemia are polyuria , polydipsia , weight loss , fatigue , weakness , blurry vision , frequent skin infections , and slow healing of skin lesions after minor trauma . taste disorders like ageusia ( taste loss ) , hypogeusia ( decrease in taste ) , and dysgeusia ( abnormal taste ) form an important but neglected part of presentation of dm . we report a unique case of a housewife presenting with altered taste as the initial symptom of dm . a 50-year - old educated housewife , presented with complaints of altered taste of all kinds of food on and off for a period of 2 months . there was no history of rhinitis , sinusitis , head injury , denture use , or any gastrointestinal disorders . history excluded thyroid disorders , liver or kidney disorders , use of alcohol , tobacco , local radiation therapy , or drugs associated with altered taste . there was no personal or family history of hypertension or dm . on examination , she was afebrile with blood pressure of 124/80 mmhg and body mass index ( bmi ) of 26.6 kg / m given the complaints , a random blood sugar level test was performed , which revealed a level of 291 mg / dl . hence , the patient was advised dietary changes and routine investigations to look for any systemic disorder and confirm diagnosis of dm . fasting and postprandial blood sugar levels ( fbsl and ppbsl ) were found to be 146 and 188 mg / dl , respectively . fundus examination of the eye showed no signs of retinopathy . based on laboratory values , patient was diagnosed as a case of type 2 dm ( american diabetes association , 2007 ) . the laboratory values repeated after 2 months showed fbsl - 122 mg / dl , ppbsl - 175 mg / dl , and hba1c - 7.6% . over 2 months after 5 months of regular exercise and diet , the values of fbsl , ppbsl , and hba1c dropped down to 118 mg / dl , 151 mg / dl , and 6.6% , respectively . the patient has been advised to continue with diet / exercise and follow - up every 3 monthly with fbsl , ppbsl , and hba1c reports . studies that have shown an increase in prevalence of diabetes in india have also reported a very high prevalence of undiagnosed diabetes in the community . the individuals who are unaware of their disease status are left untreated only to present at a later stage with complications . patients with xerostomia , sjgren 's syndrome , and zinc deficiency also experience taste loss . other conditions in which taste loss may occur include liver and kidney disorders , dm , depression , and surgical procedures around the chorda tympani or glossopharyngeal nerve . numerous drugs ( methotrexate , dexamethasone , antihypertensives , and antimicrobial agents ) have been associated with taste loss . le floch et al . , in 1989 had mentioned about the decrease of the diabetic individual 's ability to detect and recognize the primary taste modalities . an indian study in 2012 evaluating 50 cases of dm with oral complications found taste impairment in 20% cases . another indian study found that taste alteration was more common in uncontrolled diabetics than in controlled diabetics . electrogustometric examination in 73 patients from czech republic showed that about 40% of type 2 dm have hypoguesia and 5% have aguesia . a 2009 spanish study concluded that hyperglycemia induces a concentration - dependent impairment of sweet taste perception in diabetic patients as the result of an adaptation of the sensory cell to elevated circulating concentrations of glucose . newly - diagnosed dm patients have a blunted taste response with a preference for sweet - tasting foods , which is partially reversed after correction of hyperglycemia , and is independent of somatic or autonomic nerve function . many mechanisms are being considered , but a specific cause for taste sense alteration is still not known . it is believed that in diabetic patients with complications ; neuropathy involving taste nerve tracts and microangiopathy involving taste buds may be responsible for the decreased taste sensation . but in newly diagnosed dm cases without complications , defects in the taste receptor may be responsible . disturbance of taste is mostly transient and does not often appear in daily practice . also patients do not associate taste disturbance with chronic diseases like diabetes or hypertension . in our case , a taste disturbance helped us to diagnose a case of dm before the complications could set in . it is very essential that we specifically ask patients for history of altered taste whenever other risk factors for diabetes are present . also it is important to give attention to complaints related to taste by any vigilant patient . the risk of indian patients getting diabetes is evaluated using the indian diabetes risk score based on factors such as age , obesity , physical inactivity , family history of diabetes , etc . changes in taste thresholds in type 2 dm if systematically analyzed and documented , may provide an additional diagnostic , screening , and monitoring tool for dm in the future . as seen in this case , rather than being an indicator of duration or complications of disease , it could be an indicator of fluctuations in blood sugar levels .
diabetes mellitus ( dm ) is a common disease which usually manifests in the form of polyuria , polydipsia , weight loss , fatigue , weakness , blurry vision , frequent skin infections , and slow healing of skin lesions . 
 taste disturbances like ageusia , hypogeusia and dysgeusia have been associated with dm . 
 the early diagnosis of dm based on these symptoms is very important to start treatment early and thereby prevent complications . 
 we present an interesting case of a female presenting with altered taste as the first symptom of dm .