3 P's
Cardinal Symptoms of Diabetes
The classic triad — ask about all three in any glucose workup.
For the FNP boards, the 3 P's are the symptom triad you ask about in any glucose workup and the answer to any new-onset diabetes vignette. Polyuria from osmotic diuresis once serum glucose exceeds the renal threshold near 180 mg/dL, Polydipsia from the resulting volume loss, and Polyphagia from cellular starvation despite hyperglycemia. Type 1 typically presents with all three plus weight loss and DKA risk; type 2 may present with one or none and be caught on routine screening. AANP exam vignettes pair the 3 P's with a glucose value or A1C to test recognition and the diagnostic threshold (fasting 126+, A1C 6.5+, random 200+ with symptoms).
- PPolyuriaFrequent urination from osmotic diuresis (glycosuria drags water along).
- PPolydipsiaExcessive thirst compensating for fluid loss.
- PPolyphagiaIncreased hunger — cellular glucose starvation despite high serum levels.
Clinical Context
Classic presenting triad of new-onset diabetes, especially type 1. Type 2 more often presents insidiously with vague fatigue, blurry vision, recurrent infections, or slow-healing wounds rather than the 3 P's. Screening glucose, HbA1c, or random glucose confirms the diagnosis.
In a pediatric patient with recent-onset 3 P's + weight loss, think type 1 DKA — test for ketones and look for Kussmaul respirations and fruity breath. AANP loves pairing the 3 P's with weight loss in a young patient as a DKA presentation, then asking about initial management (IV fluids → insulin drip → electrolyte monitoring).
Related Mnemonics
- MUDPILES — Anion Gap Metabolic Acidosis
Sources
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