Diabetes mellitus (DM) is a multifactorial disease.
Pathology is associated with the impossibility of glucose utilization by tissues due to insulin deficiency or due to a decrease in the susceptibility of target cells to the action of pancreatic hormone.
Identify metabolic disease according to the results of several tests. Clinical guidelines provide clear indications of the values for which sugar diabetes is diagnosed.
SD proceeds in two large forms. The manifest picture is manifested by vivid symptoms that become a reason for in-depth research. There is also a latent course of diabetes that impedes the early detection of metabolic disorders.
Hidden diabetes often becomes an accidental find during a routine examination or when a patient is treated for a different pathology.
Regardless of the age of clinical examination, patients with overweight and the presence of one of the following factors should be considered:
- lack of motor activity. Hypodynamia is a major trigger for metabolic disorders;
- hereditary burden. Proven genetic predisposition to insulin resistance and the formation of autoimmune processes against pancreatic antigens;
- history of gestational diabetes. The likelihood of diabetes in women with identified glucose-related metabolic disturbances during pregnancy increases in fold;
- arterial hypertension. The pressure of 140/90 mm Hg. Art. people with a BMI of 25 kg / m2 are often accompanied by an increase in blood sugar. The combination of these manifestations is metabolic syndrome;
- dyslipidemia. An increase in the fractions of atherogenic proteids and a decrease in HDL less than 0.9 can fit into the pattern of DM;
- cardiovascular pathology;
- reduced glucose tolerance or actual fasting hyperglycemia.
Routine techniques include glucose testing on an empty stomach and a standard urine test. Blood for sugar in the planned appointment should be donated after an 8-14 hour break in the meal. The subject is prohibited to smoke in the morning before taking the analysis, it is allowed to drink water without gas.
An extended blood test includes a glucose tolerant test (OGTT or OGTT). The study is conducted with questionable results of simple blood sampling for sugar.
Three days before the PHTT, the patient observes his usual physical activity and eating behavior. The daily menu at this stage of preparation should contain about 150 g of carbohydrates.
On the eve of the surveyed dinner no later than 20:00. Full starvation before the test is at least 8 hours. In the treatment room, the patient is given a glass of diluted glucose (75 g of dry residue of pure sugar). The entire solution must be drunk in 5 minutes. Two hours later, blood is drawn.
To determine the level of glycemic compensation, the content of glycated hemoglobin is studied. HbA1c reflects the average blood sugar concentration that has persisted over the past three months. The analysis does not require special training and fasting, has less variability in relation to previous injuries and infections.
The negative side of the study is the high probability of distortion of the result in anemia and hemoglobinopathy. The study of C-peptide and some serological markers allows to differentiate diabetes type I and type II, as well as to predict the likelihood of developing pathology.
Signs of disease
The clinic of diabetes mellitus is directly related to the high content of glucose, the lack of its absorption by the tissues and the alteration of the metabolism.
There are three "big" symptoms of diabetes:
- polydipsia. The person has a strong thirst. To quench the need for drinking, the patient has to consume up to 3-5 liters of fluid per day;
- polyuria. Hyperglycemia leads to an increase in urine production by the kidneys. Glucose as an osmotic active substance literally pulls water along with it. A diabetic patient notes frequent urination. The condition is accompanied by the need for night trips to the toilet (nocturia);
- polyphagia. Since the assimilation of the main energy product turns out to be untenable, the person remains hungry. A diabetic appetite increases. Patients with type II diabetes externally look fat. Persons suffering from an insulin-dependent condition, at the beginning of the disease quickly lose weight.
The remaining signs of diabetes are detected in different qualities. The breakdown of protein helps to reduce muscle mass and the occurrence of destructive changes in the bones. The risk of developing osteoporosis and fractures "on level ground" is increasing.
Increased atherogenic lipoproteins together with the damaging effects of hyperglycemia provoke micro- and macroangiopathies. Paretic damage to the skin vessels is manifested by redness of the cheeks, chin, forehead.
Eyesight deteriorates. The morphological basis of retinopathy consists of a bundle of arterioles and capillaries, hemorrhages and the formation of unnatural retinal vessels.
Many patients report decreased memory and mental performance. Weakness, fatigue, headaches, an attack of dizziness are signs of insufficient nutrition of the brain. Diabetes becomes the backdrop for the development of strokes and heart attacks. The defeat of the coronary arteries provokes attacks of chest pains.
Complications of nerve structures manifest in the form of polyneuropathy. A change in tactile, painful sensitivity causes trauma to the feet and fingers. The deterioration of tissue trophism leads to the formation of difficult-to-repair wounds. There is a tendency to develop panaritsiy and paronychia.
Chronic hyperglycemia adversely affects the body's immune reactivity.
Patients with diabetes are prone to frequent infections of various locations. Patients are often tormented by gingivitis, caries, periodontal disease. Easily join staphylo-and streptoderma.
Recurrent thrush, dry skin and mucous membranes, itchy perineum are pathognomonic manifestations of hyperglycemia.
Indicators of the presence of the diseaseThe main marker, which reflects the level of glycemia at the time of the analysis, is the concentration of sugar in the blood on an empty stomach.
Values exceeding 6.1 mmol / l when taking a biomaterial from a finger or heel and 7.0 mmol / l from a vein indicate diabetes mellitus.
Confirms the diagnosis of the test for glucose tolerance: 2 hours after PGTT indicator reaches 11.1 mmol / l.
For verification of metabolic disorders, glycated hemoglobin is measured. HbA1c more than 6.5% indicates a long-term presence of hyperglycemia. The value of the indicator in the range from 5.7 to 6.4% is prognostically significant regarding the risks of developing diabetes in the near future.
Possible identification of other disorders of glucose metabolism:
|condition||Capillary blood||From vein|
|Norm||fasting <5,6||2 hours after PGTT <7.8||<6,1||<7,8|
|Impaired glucose tolerance||fasting 5.6-6.1||after PGTT 7.8-11.1||fasting 6.1-7.0||after PGTT 7.8-11.1|
|Impaired fasting glucose||fasting 5.6-6.1||after PGTT <7.8||fasting 5.6-6.1||after PGTT <7.8|
Blood biochemistry reflects violations of protein and lipid-carbohydrate metabolism. The level of urea, cholesterol, LDL, VLDL increases.
About the criteria for diagnosis in the video:
According to laboratory tests and the clinical picture, you can reliably establish the diagnosis. Additional study of C-peptide, autoantibodies to its own proteins, genetic diagnostics help to determine the nature and mechanism of the disease in a particular patient. A systematic assessment of indicators over time allows you to monitor the correctness of treatment, and if necessary, correct the therapy.