Differential diagnosis of diabetes mellitus with other diseases. Laboratory Diagnosis of Diabetes Mellitus Type 1 Diabetes Clinical Diagnosis

Type 1 diabetes is an autoimmune disease.

Any diseases of the autoimmune group are characterized by the fact that they destroy the internal organs and tissues of the body under the influence of their own immune system, which was originally designed to protect us by normalizing all natural processes. At the same time, killer cells are produced that attack healthy human organs.

In type 1 diabetes, killer cells attack the pancreas. As a result, a hormonal failure occurs, which entails a number of negative consequences: the normal production of insulin, which is involved in carbohydrate metabolism and normalizes blood glucose levels, stops.

Therefore, the only decision that a diabetic can make together with an endocrinologist is to maintain life with constant insulin injections and maintain strict self-control.

With any violation, it is important to make the correct diagnosis in time, but with insulin-dependent diabetes, this is extremely difficult to do. Everything is complicated by the fact that the mechanisms that trigger the development of this type of diabetes have not yet been identified. It is believed that it is born at lightning speed and it is still impossible to predict the surge in its development. With latent diabetes, the process of diagnosing occurs at a critical moment, when there is no longer any doubt, and only actual confirmation is required - blood donation for analysis.

Flowing imperceptibly, it may not show itself for several years, only at the most crucial moment it will demonstrate itself in all its glory. If in type 2 diabetes mellitus it is preceded by prediabetes, which are the result of an unhealthy lifestyle, then in type 1 diabetes there may not be any third-party disorders.

It can be provoked by trauma, poor ecology, exposure to toxic toxic substances on the body, past infectious diseases, poor heredity, and a number of others. They mainly fall ill with children or adolescents with poor heredity, weak immunity (or against the background of some kind of hormonal disorder as a result of growing up), but at the same time they can have a normal weight and physique characteristic of this age, outwardly be completely healthy.

We can safely say that conducting a primary history with clarification in differential diagnosis is not the best solution, because it is necessary to prescribe treatment as soon as possible - the better, and the symptoms are so multifaceted, ambiguous and poorly expressed that more than 1000 other complications can fall under these symptoms and diseases. This type of diagnosis can be attributed rather to primary, secondary.

Moreover, this disease has a long latent "incubation" period, which cannot be accurately diagnosed. The patient does not experience any noticeable discomfort, and those that manifest themselves seem insignificant. For example, dizziness, weakness, slight malaise, sudden change in mood, etc. All this can be attributed to the consequence of a difficult, overly emotional and stressful day.

To speed up this diagnostic process, you need to donate blood for tests.

In autoimmune diseases, urine is sometimes required in order to check it for the presence of protein components or half-life products in lipid metabolism (check for the presence of cholesterol). Although, the second type of analysis is rather characteristic, because obesity is diagnosed with it, in which, of course,.

If the slightest signs of autoantibodies are found in the blood, then with a repeated decisive test, a final and correct diagnosis is already made -.

Types of analyzes and tests

I. Methods for the study of metabolic processes (in case of metabolic disorders)

This group includes all types of tests and analyzes for glucose tolerance and the determination of the level of glycosylated hemoglobin. They seem to put a person before a fact, therefore, for the most part, they cannot be the only true way of diagnosing. It is important to apply the second type of technique to them - screening for genetic predisposition (plus the presence of markers of autoimmune disorders that provoke type 1 diabetes)

Glycosylated or glycated hemoglobin (HbA1c)

The ideal value is between 4.2 - 4.6% of the glycosylated hemoglobin content in blood plasma, which corresponds to an average glucose level of 4.0 - 4.8 mmol / liter.

Typically, people with these values ​​have a normal weight, a lean, lean physique and lead an active lifestyle (for example, go to the gym 2-3 times a week and devote at least 1.5-2 hours a day to training).

However, this type of test is completely unsuitable for pregnant women, because in their special situation, the prediction of results will be shown only at the 7th or 8th month of pregnancy, i.e. actually before childbirth. This happens due to the fact that the test reflects the level of hemoglobin during the 3 months preceding the analysis, and blood sampling should be done at 4 or 5 months of actual pregnancy. Predicting future processes or changes in both the mother's body and the fetus and their further prevention or relief will be impossible, because they may already be running. After receiving the results, it will be too late to change anything. With early blood sampling (before or in the first months of pregnancy), the results will be unreliable, because in the process of bearing a child in the mother's body, a lot of qualitative changes occur, aimed at the consumption of all maternal reserves (this is why all ladies in the position are prescribed a serious vitamin complex).

Simply put, a pregnant woman carrying a child is like a universe in which the process of the birth of a new universe with numerous small young galaxies is brewing and accelerating.

Therefore, to draw some parallels, patterns before the beginning of the birth of the universe, and even more so to predict something, is a completely meaningless, insignificant and empty task. At this stage of inception, it is important to conduct one-time quick tests that would show an express result.

These include a two-hour glucose tolerance test.

Glucose tolerance test

This test is colloquially referred to as the "sugar load". It is carried out in several stages and lasts for several hours, but, unfortunately, this type of analysis is very capricious. Any little thing can affect the final results.

For example, the fasting period should be between 8 and 12 hours. Before donating blood, you should not, respectively, eat, drink coffee or any other drinks, including alcohol. If a person has caught a cold, has a runny nose, has recently been ill or still has not recovered, had an operation a few weeks ago, is taking some medication, etc., then this will also affect the result. On the eve of the test, you can not go to the gym and it is advisable not to be very nervous or worried, do not smoke. This test should also not be taken by women during menstruation.

It is carried out in several stages:

I. Blood sampling from a vein in the morning on an empty stomach.

It is supposed to drink sweetened water in which 75 grams of sugar are dissolved. Pregnant women are invited to drink sweetened water, in which 100g have been dissolved. glucose, because when carrying a child, energy consumption is somewhat increased. For children, a solution is prepared at the rate of 1.75 g per kg of body weight, but not exceeding the dosage intended for adults.

All people suffering from asthma, who have angina pectoris or had a stroke, a heart attack, instead of a glucose solution, a different load is offered: it is recommended to consume simple carbohydrates (dosage - 20 g).

III. Within 60 minutes, several more blood samples will be taken in order to monitor glycemic fluctuations.

All the steps described above must be repeated, because only a comparison of the data obtained will make it possible to compose a more accurate forecast. Usually the patient is invited to retake the analysis after a few days. This is done in order to refute or confirm the diagnosis.

The norm for a glucose tolerance test after receiving the results

II. Methods for studying genetic predisposition

PCR restriction analysis

These types of tests can detect type 1 diabetes at an early stage. More precisely, not even to identify the disease as such, but allows you to calculate the risk of developing the disease in a particular person.

As a rule, special emphasis is placed on gene typing (typing of HLA group II - human leukocytes), which reveals specific "mutations" of genes on the sixth chromosome, which is responsible for the human immune system. The protein encoded by the HLA genes is responsible for one of the most important functions in type 1 diabetes - it is involved in the recognition of foreign viruses, bacteria and other "invaders", helps to create a specific logical chain in the immune response. Any mutations lead to a failure in the protective functions of the body.

The typing process takes place in several stages, during which a test of gene predisposition is carried out, when the patient is tested for the presence or absence of genes associated with type 1 diabetes. If parents have diabetes or their immediate family has had diabetes, the risk of diabetes is very high. The test will allow you to understand how high this risk is.

For the test, about 2-3 ml of whole blood is taken and a PCR restriction analysis is performed. As a rule, it takes a long time to wait for the results. Within a month.

Prediction by antigenic markers

Antigens that can be found in a person's blood at the time of testing also play an important role in predicting diabetes.

Conducted analyzes to search for antigens to:

• cells of the islets of Langerhans (to pancreatic β-cells)
• tyrosine phosphatase
• insulin
• decorboxylase glutamic acid

allow labeled results. If autoantibodies to pancreatic cells, to insulin, and to glutamic acid decorboxylase are detected, the risk of developing diabetes increases by 50% and can develop within 5 years. With a longer-term forecast (10 years ahead), the risk rises to 80%.

Thus, the diagnosis of type 1 diabetes comes down to predicting the development of this type of disease at an early stage and starting preventive actions in time in order to increase life expectancy without “diabetes disease”, which can manifest itself at the most unexpected moment. At the same time, the first two types of tests (from the metabolic group) are more suitable for diagnosing type 2 diabetes, and in insulin-dependent diabetes they are used only as confirming the presence of the disease after it has already manifested itself.

But few people pay attention to such “little things” (the symptoms are mild), and they obviously will not take expensive tests, because the rapid development of type 1 diabetes is actually a far-fetched opinion. This type of diabetes can be prevented in advance, because its predisposition is imprinted at the gene level, and the incubation period lasts for 5 to 15 years or even longer.

Diagnosis results after studying whole blood

It is worth noting in advance that the results described below are only valid for testing whole blood. If the tests were performed on the basis of individual blood components, then the final results will always be overestimated.

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Allowing not only to distinguish diabetes from other diseases, but also to determine its type and prescribe the correct and effective treatment.

Criteria for making a diagnosis

The World Health Organization has established the following:

• the blood glucose level exceeds 11.1 mmol / l with a random measurement (that is, the measurement is carried out at any time of the day without taking into account);
• (that is, not less than 8 hours after the last meal) exceeds 7.0 mmol / l;
• the concentration of glucose in the blood exceeds 11.1 mmol / l 2 hours after a single intake of 75 g of glucose ().

In addition, the classic signs of SD are:

• - the patient not only often "runs" to the toilet, but much more urine is formed;
• polydipsia- the patient is constantly thirsty (and he drinks a lot);
• - not observed in all types of pathology.

Differential diagnosis of type 1 and type 2 diabetes mellitus

At some point, there is too little insulin to break down glucose, and then.

That is why type 1 diabetes appears suddenly; often the initial diagnosis is preceded by. Basically, the disease is diagnosed in children or adults under 25 years old, more often in boys.

The differential signs of type 1 diabetes are:

• almost complete absence of insulin;
• the presence of antibodies in the blood;
• low level of C-peptide;
• patient weight loss.

type 2 diabetes

A distinctive feature of type 2 diabetes is insulin resistance: the body becomes insensitive to insulin.

As a result, glucose breakdown does not occur, and the pancreas tries to produce more insulin, the body spends energy, and.

The exact causes of the incidence of type 2 pathology are unknown, however, it has been established that in about 40% of cases the disease.

Also, people with an unhealthy lifestyle are more likely to suffer from it. - Mature people over 45, especially women.

The differential signs of type 2 diabetes are:

• elevated insulin levels (may be normal);
• elevated or normal levels of C-peptide;
• noticeable .

Often, type 2 diabetes is asymptomatic, manifesting itself already in the later stages with the appearance of various complications: they begin, the functions of internal organs are disturbed.

Table of differences between insulin-dependent and non-insulin-dependent forms of the disease

Since the cause of type 1 diabetes is insulin deficiency, it is called. Type 2 diabetes is called non-insulin dependent because the tissues simply do not respond to insulin.

Related videos

About the differential diagnosis of type 1 and type 2 diabetes in the video:

Modern methods of diagnosing and treating diabetes allow, and subject to certain rules, it can be no different from the life of people who do not suffer from the disease. But to achieve this, correct and timely diagnosis of the disease is necessary.

Type 1 diabetes - juvenile, insulin-dependent diabetes - a dangerous chronic disease, mainly occurring in young people under 35 years of age. The disease affects the kidneys, heart, blood vessels and vision, reducing the quality of life and leading to early death.

What is type 1 diabetes, why is it dangerous?

Juvenile type 1 diabetes (DM1) is a disease associated with a metabolic disorder, namely, a deficiency of the hormone insulin and an increased concentration of glucose in the blood. It is an autoimmune disease in which the immune system mistakenly destroys the body's own cells, making it difficult to treat. The disease affects both adults and children. A baby can become insulin dependent after a virus or infection. If we compare statistics by, DM1 occurs in about one out of 10 cases.

Type 1 diabetes is dangerous with severe complications - it gradually destroys the entire vascular system. For example, DM1 significantly increases the risk of developing cardiovascular disease: people suffering from hyperglycemia are more likely to have strokes and heart attacks. The life expectancy of a woman with type 1 diabetes is 15 years less than that of a healthy peer. Patients with hyperglycemia men live to an average of 50-60 years and die 15-20 years earlier than their peers.

Diabetics must follow a diet and daily routine all their lives, take insulin and monitor blood sugar levels. If you follow all the recommendations of the endocrinologist, namely this doctor treats type 1 and type 2 diabetes, you can avoid dangerous complications and live a normal life.

How Type 1 Diabetes Develops

What is the trigger for the development of type 1 diabetes, like all autoimmune diseases, there is still no exact answer. But the main cause of the disease is known - a lack of insulin occurs due to the death of cells in the islets of Langerhans. The islets of Langerhans are areas on the tail of the pancreas that produce endocrine cells that are involved in various life processes.

The role of endocrine cells is extensive, to be convinced of this, it is enough to consider a few examples:

• Alpha cells produce glycogen, which stores energy in the liver. This polysaccharide is the main form of glucose storage: glycogen stores in the liver in a healthy person can reach 6% of the total body weight. Glycogen from the liver is available to all organs and can quickly make up for the lack of glucose in the body.
• Beta cells produce insulin, which converts glucose from the blood into energy. With an insufficient number of beta cells or their poor performance, there is not enough insulin, so glucose remains unchanged in the blood.
• Delta cells are responsible for the production of somatostatin, which is involved in the work of the glands. Somatostatin limits the secretion of somatotropin - growth hormone.
• PP cells stimulate the production of gastric juice, without which it is impossible to fully digest food.
• Epsilon cells secrete a secret that stimulates appetite.

The islets of Langerhans are capillary, innervated by the vagus and peripheral nerves, and have a mosaic structure. Islets that produce certain cells are interconnected. Beta cells that produce insulin inhibit the production of glycogen. Alpha cells suppress the production of beta cells. Both islets reduce the amount of somatostatin produced.

Failure of the immune mechanisms leads to the fact that the immune cells of the body attack the cells of the islets of Langerhans. Due to the fact that 80% of the surface of the islets is occupied by beta cells, they are the most destroyed.

Dead cells cannot be restored, the remaining cells produce too little insulin. It is not enough to process the glucose that enters the body. It remains only to take insulin artificially in the form of injections. Diabetes mellitus becomes a sentence for life, it is not curable, and leads to the development of concomitant diseases.

Causes of Type 1 Diabetes

The development of type 1 diabetes is provoked by the following diseases:

• severe viral infections(rubella, chickenpox, cytomegalovirus, hepatitis, mumps). In response to an infection, the body produces antibodies, which, simultaneously with the cells of the virus, destroy beta cells, in many ways similar to the cells of the infection. In 25% of cases, after suffering rubella, a person is diagnosed with diabetes mellitus.
• Autoimmune diseases of the thyroid and adrenal glandshormone-producing: autoimmune thyroiditis, chronic adrenal insufficiency.
• Hormonal diseases: Itsenko-Cushing's syndrome, diffuse toxic goiter, pheochromocytoma.
• Long-term use of certain medications. Antibiotics, anti-rheumatism pills, selenium supplements are dangerous - they all provoke hyperglycemia - high blood glucose.
• Pregnancy. Hormones produced by the placenta increase blood sugar levels. The pancreas is overworked and unable to produce insulin. This is how gestational diabetes develops. This disease requires observation and can pass without a trace after childbirth.
• Stress.When a person is very nervous, a large amount of adrenaline and glucocorticosteroids are released into the bloodstream, destroying beta cells. In patients with a genetic predisposition, it is after stress that they are diagnosed with type 1 diabetes mellitus.

Causes of type 1 diabetes in children and adolescents

Many parents are mistaken in thinking that diabetics got sick because they ate a lot of chocolate and sugar. If you limit the child in sweets, it is more likely to be protected from diathesis than from diabetes. Children develop diabetes at an early age, not because of malnutrition. This is evidenced by the findings of scientists studying this problem.

• A severe viral infection transferred at the age of 0-3 years leads to the development of type 1 diabetes mellitus in 84%, and the pathology is more often diagnosed when the child reaches the age of 8.
• SARS in acute form, carried by infants up to 3 months, causes diabetes in 97% of cases.
• In children with a hereditary predisposition to hyperglycemia, the risk of developing the disease increases depending on nutritional factors (nutrition): artificial feeding, early consumption of cow's milk, high birth weight (above 4.5 kg).

There are two peak ages for detecting diabetes in children - 5-8 years old and adolescence (13-16 years old). Unlike adults, childhood diabetes develops very quickly and rapidly. The disease manifests itself with an acute form of ketoacidosis (poisoning with ketone bodies formed in the liver) or diabetic coma.

With regard to heredity, the probability of transmission of type 1 diabetes is low. If the father has diabetes 1, the risk of transmission to children is 10%. If the mother, then the risks are reduced to 10%, and in late birth (after 25 years) to 1%.

Identical twins have different risks of getting sick. If one child is sick, then the second disease occurs no more than 30-50%.

Complications of type 1 diabetes

In addition to diabetes itself, its complications are no less dangerous. Even with a slight deviation from the norm (5.5 mmol / liter on an empty stomach), the blood thickens and becomes viscous. Vessels lose their elasticity, and deposits in the form of blood clots form on their walls (atherosclerosis). The internal lumen of the arteries and blood vessels narrows, the organs do not receive sufficient nutrition, the removal of toxins from the cells is slowed down. For this reason, places of necrosis, suppuration appear on the human body. There is gangrene, inflammation, rash, blood supply to the limbs worsens.

Elevated blood sugar disrupts the work of all organs:

• kidneys. The purpose of paired organs is to filter the blood from harmful substances and toxins. At a sugar level of more than 10 mmol / liter, the kidneys stop doing their job efficiently and pass sugar into the urine. Sweet environment becomes an excellent base for the development of pathogenic microflora. Therefore, hyperglycemia is usually accompanied by inflammatory diseases of the genitourinary system - cystitis (inflammation of the bladder) and nephritis (inflammation of the kidneys).
• The cardiovascular system.Atherosclerotic plaques, formed due to increased blood viscosity, line the walls of blood vessels and reduce their throughput. The heart muscle, the myocardium, ceases to receive adequate nutrition. So comes a heart attack - necrosis of the heart muscle. If a sick person does not suffer from diabetes, he will feel discomfort and burning in the chest during a heart attack. In a diabetic, the sensitivity of the heart muscle decreases, he may die unexpectedly. The same goes for vessels. They become brittle, which increases the risk of stroke.
• Eyes. Diabetes damages small blood vessels and capillaries. If a blood clot blocks a large vessel of the eye, partial death of the retina occurs, and detachment or glaucoma develops. These pathologies are incurable and lead to blindness.
• Nervous system.Malnutrition, associated with severe restrictions in type 1 diabetes, leads to the death of nerve endings. A person stops responding to external stimuli, he does not notice the cold and freezes the skin, does not feel the heat and burns his hands.
• Teeth and gums.Diabetes is accompanied by diseases of the oral cavity. The gums soften, tooth mobility increases, gingivitis (inflammation of the gums) or periodontitis (inflammation of the inner surface of the gums) develops, which leads to tooth loss. The effect of insulin-dependent diabetes on the teeth of children and adolescents is especially noticeable - they rarely have a beautiful smile: even the front teeth deteriorate.
• gastrointestinal tract. In diabetes, beta cells are destroyed, and with them the PP cells responsible for the production of gastric juice. Patients with diabetes often complain of gastritis (inflammation of the gastric mucosa), diarrhea (diarrhea due to poor digestion of food), gallstones are formed.
• Bone and joint problems. Frequent urination leads to leaching of calcium, as a result of which joints and the skeletal system suffer, and the risk of fractures increases.
• Leather. Elevated blood sugar causes the skin to lose its protective functions. Small capillaries become clogged with sugar crystals, causing itching. Dehydration makes the skin wrinkled and very dry. Patients in some cases develop vitiligo - the breakdown of skin cells that produce pigment. In this case, the body is covered with white spots.
• female reproductive system. The sweet environment creates favorable ground for the development of conditionally pathogenic microflora. In type 1 diabetes, frequent recurrences of thrush are typical. In women, vaginal lubrication is poorly secreted, which makes sexual intercourse difficult. Hyperglycemia adversely affects the development of the fetus in the first 6 weeks of pregnancy. Diabetes also leads to premature menopause. Early menopause occurs at 42-43 years.

Type 1 Diabetes Symptoms

Outward signs help to determine diabetes, because the disease affects the work of the whole organism. In young people under 18 years of age, diabetes develops very quickly and rapidly. It often happens that 2-3 months after a stressful event (ARVI, moving to another country), a diabetic coma occurs. In adults, symptoms may be milder, gradually worsening.

The following signs are cause for concern:

• Frequent urination, the person goes to the toilet several times a night.
• Weight loss (diet and the desire to lose weight during adolescence is fraught with the rapid development of hyperglycemia).
• The appearance of wrinkles beyond age, dry skin.
• Increased feeling of hunger with a lack of weight.
• Lethargy, apathy, the teenager quickly gets tired, he has painful thoughts.
• Fainting, severe headache, vision problems.
• Constant thirst, dry mouth.
• The specific smell of acetone from the mouth, and in severe condition from the body.
• Night sweats.

If at least a few symptoms have been noticed, the patient should be immediately sent to an endocrinologist.

The younger the body, the faster the coma occurs.

Diagnosis of diabetes

The endocrinologist will definitely prescribe the following:

• Blood glucose test. Blood sampling is carried out on an empty stomach, the last meal should be no earlier than 8 hours before. The norm is considered to be below 5.5 mmol / liter. An indicator of up to 7 mmol / liter indicates a high predisposition, 10 mmol / liter and above indicates hyperglycemia.
• Oral glucose tolerance test. This test is done in those who are at risk of developing diabetes. On an empty stomach, the patient takes a glucose solution. Then, after 2 hours, blood is taken for sugar. Normally, the indicator should be below 140 mg / dl. A blood sugar level above 200 mg/dl confirms diabetes mellitus.
• Glycosylated hemoglobin A1C test. Excess sugar in the blood reacts with hemoglobin, so the A1C test shows how long the body's sugar level has been above normal. Monitoring is carried out every 3 months, the level of glycated hemoglobin should not exceed 7%.
• Blood test for antibodies. Type 1 diabetes is characterized by an abundance of antibodies to cells of the islets of Langerhans. They destroy the cells of the body, which is why they are called autoimmune. By identifying these cells, determine the presence and type of diabetes.
• Urinalysis - microalbuminuria. Detects protein in urine. It appears not only with kidney problems, but also with damage to blood vessels. High levels of albumin protein lead to a heart attack or stroke.
• Screening for retinopathy. High glucose content leads to blockage of small vessels and capillaries. The retina of the eye does not receive nourishment, it exfoliates over time and leads to blindness. Special digital equipment allows you to take pictures of the back surface of the eye and see the damage.
• Thyroid hormone analysis.The increased activity of the thyroid gland leads to hyperthyroidism - excessive production of hormones. Hyperthyroidism is dangerous because the breakdown products of thyroid hormones increase the level of glucose in the blood, diabetes is accompanied by acidosis (high levels of acetone in the urine), osteoporosis (leaching of calcium from the bones), arrhythmia (heart rhythm failure).

Treatment of type 1 diabetes

Type 1 diabetes is not curable because beta cells cannot be restored. The only way to maintain normal blood sugar levels in a sick person is to take insulin, a hormone produced by the beta cells of the islets of Langerhans.

According to the speed of exposure and the duration of the effect, drugs with insulin are divided into categories:

• Short acting (Insuman Rapid, Actrapid). They begin to act 30 minutes after ingestion, so they should be taken half an hour before meals. When the drug is administered intravenously, it is activated after a minute. The duration of the effect is 6-7 hours.
• Ultrashort action (Lizpro, Aspart).They begin to work 15 minutes after the injection. The action lasts only 4 hours, so the drug is used for pump administration.
• Medium duration (Insuman Bazal, Protafan).The effect occurs an hour after administration and lasts 8-12 hours.
• Long-term exposure (Tresiba).The drug is administered once a day, it does not have a peak of action.

Medications are selected individually for the patient in combination with other drugs that prevent the negative effects of high blood glucose.

New treatments for type 1 diabetes

Now scientists offer new methods for the treatment of insulin-dependent diabetes mellitus. For example, the method of beta-cell transplantation or the replacement of the entire pancreas is of interest. Also tested or are in development are genetic therapy, stem cell therapy. In the future, these methods may replace daily insulin injections.

Physical activity in diabetes

Physical activity in type 1 diabetes is simply necessary, although there are restrictions regarding the type of sport. Exercise normalizes blood pressure, improves well-being, and normalizes weight. But in some cases, exercise causes spikes in blood glucose levels.

With type 1 diabetes, you can’t overload yourself, so training should not exceed 40 minutes a day. The following sports are allowed:

• walking, cycling;
• swimming, aerobics, yoga;
• table tennis, football;
• exercise in the gym.

Any load is contraindicated if ketones, products of protein breakdown, are found in the urine, as well as increased blood pressure or problems with blood vessels.

Where is type 1 diabetes diagnosed and treated in St. Petersburg, prices

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Diabetes is one of the most common endocrine diseases in humans. The main clinical characteristic of diabetes mellitus is a prolonged increase in blood glucose concentration, as a result of impaired glucose metabolism in the body.

The metabolic processes of the human body are entirely dependent on the metabolism of glucose. Glucose is the main energy resource of the human body, and some organs and tissues (brain, red blood cells) use only glucose as an energy source. The decay products of glucose serve as a material for the synthesis of a number of substances: fats, proteins, complex organic compounds (hemoglobin, cholesterol, etc.). Thus, a violation of glucose metabolism in diabetes mellitus inevitably leads to a violation of all types of metabolism (fat, protein, water-salt, acid-base).

We distinguish two main clinical forms of diabetes mellitus, which have significant differences both in terms of etiology, pathogenesis and clinical development, and in terms of treatment.

Type 1 diabetes(insulin-dependent) is characteristic of young patients (often children and adolescents) and is the result of an absolute insufficiency of insulin in the body. Insulin deficiency occurs as a result of the destruction of the endocrine cells of the pancreas that synthesize this hormone. The causes of death of Langerhans cells (pancreatic endocrine cells) can be viral infections, autoimmune diseases, stressful situations. Insulin deficiency develops abruptly and is manifested by the classic symptoms of diabetes: polyuria (increased urine output), polydipsia (unquenchable thirst), and weight loss. Type 1 diabetes is treated exclusively with insulin.

Type 2 diabetes on the contrary, it is typical for older patients. The factors of its development are obesity, sedentary lifestyle, malnutrition. Hereditary predisposition also plays a significant role in the pathogenesis of this type of disease. Unlike type 1 diabetes, in which there is absolute insulin deficiency (see above), in type 2 diabetes, insulin deficiency is relative, that is, insulin is present in the blood (often in concentrations exceeding physiological), but sensitivity body tissues to insulin is lost. Type 2 diabetes is characterized by a long subclinical development (asymptomatic period) and a subsequent slow increase in symptoms. In most cases, type 2 diabetes is accompanied by obesity. In the treatment of this type of diabetes, drugs are used that reduce the resistance of body tissues to glucose and reduce the absorption of glucose from the gastrointestinal tract. Insulin preparations are used only as an additional remedy in the event of true insulin deficiency (with exhaustion of the endocrine apparatus of the pancreas).

Both types of the disease come with serious (often life-threatening) complications.

Methods for diagnosing diabetes

Diagnosis of diabetes implies establishing an accurate diagnosis of the disease: establishing the form of the disease, assessing the general condition of the body, determining concomitant complications.

Diagnosis of diabetes mellitus involves establishing an accurate diagnosis of the disease: establishing the form of the disease, assessing the general condition of the body, determining concomitant complications.
The main symptoms of diabetes are:

• Polyuria (excess urine) is often the first sign of diabetes. The increase in the amount of urine excreted is due to glucose dissolved in the urine, which prevents the reabsorption of water from the primary urine at the level of the kidneys.
• Polydipsia (intense thirst) - is a consequence of increased loss of water in the urine.
• Weight loss is an intermittent symptom of diabetes, more common in type 1 diabetes. Weight loss is observed even with enhanced nutrition of the patient and is a consequence of the inability of tissues to process glucose in the absence of insulin. "Starving" tissues in this case begin to process their own reserves of fats and proteins.

The above symptoms are more typical for type 1 diabetes. In the case of this disease, the symptoms develop quickly. The patient, as a rule, can name the exact date of the onset of symptoms. Often the symptoms of the disease develop after a viral illness or stress. The young age of the patient is very characteristic of type 1 diabetes.

In type 2 diabetes, patients most often go to the doctor in connection with the onset of complications of the disease. The disease itself (especially in the initial stages) develops almost asymptomatically. However, in some cases, the following low-specific symptoms are noted: vaginal itching, inflammatory skin diseases that are difficult to treat, dry mouth, muscle weakness. The most common reason for going to the doctor is the complications of the disease: retinopathy, cataracts, angiopathy (ischemic heart disease, cerebrovascular accident, damage to the vessels of the extremities, renal failure, etc.). As mentioned above, type 2 diabetes is more typical for adults (over 45 years old) and occurs against the background of obesity.

When examining a patient, the doctor pays attention to the condition of the skin (inflammatory processes, scratching) and the subcutaneous fat layer (decrease in case of type 1 diabetes, and increase in type 2 diabetes).

If diabetes is suspected, additional examination methods are prescribed.

Determination of the concentration of glucose in the blood. This is one of the most specific tests for diabetes mellitus. The normal concentration of glucose in the blood (glycemia) on an empty stomach ranges from 3.3-5.5 mmol / l. An increase in glucose concentration above this level indicates a violation of glucose metabolism. In order to establish the diagnosis of diabetes, it is necessary to establish an increase in the concentration of glucose in the blood on at least two consecutive measurements taken on different days. Blood sampling for analysis is carried out mainly in the morning. Before taking blood, you need to make sure that the patient did not eat anything on the eve of the examination. It is also important to provide the patient with psychological comfort during the examination in order to avoid a reflex increase in blood glucose levels as a response to a stressful situation.

A more sensitive and specific diagnostic method is glucose tolerance test, which allows you to identify latent (hidden) disorders of glucose metabolism (impaired tissue tolerance to glucose). The test is carried out in the morning after 10-14 hours of overnight fasting. On the eve of the examination, the patient is advised to give up increased physical exertion, drinking alcohol and smoking, as well as drugs that increase the concentration of glucose in the blood (adrenaline, caffeine, glucocorticoids, contraceptives, etc.). The patient is given to drink a solution containing 75 grams of pure glucose. The determination of the concentration of glucose in the blood is carried out after 1 hour and 2 after the use of glucose. The normal result is a glucose concentration of less than 7.8 mmol / l two hours after ingestion of glucose. If the glucose concentration ranges from 7.8 to 11 mmol / l, then the condition of the subject is regarded as impaired glucose tolerance (prediabetes). The diagnosis of diabetes is established if the glucose concentration exceeds 11 mmol / l two hours after the start of the test. Both a simple determination of the concentration of glucose and a glucose tolerance test make it possible to assess the state of glycemia only at the time of the study. To assess the level of glycemia over a longer period of time (about three months), an analysis is performed to determine the level of glycated hemoglobin (HbA1c). The formation of this compound is directly dependent on the concentration of glucose in the blood. The normal content of this compound does not exceed 5.9% (of the total hemoglobin content). An increase in the percentage of HbA1c above normal values ​​indicates a prolonged increase in the concentration of glucose in the blood over the past three months. This test is carried out mainly for quality control of treatment of patients with diabetes.

Determination of glucose in urine. Normally, there is no glucose in the urine. In diabetes mellitus, an increase in glycemia reaches values ​​that allow glucose to penetrate the renal barrier. Determination of glucose in the blood is an additional method for diagnosing diabetes.

Determination of acetone in urine(acetonuria) - often diabetes is complicated by metabolic disorders with the development of ketoacidosis (accumulation in the blood of organic acids of intermediate products of fat metabolism). The determination of ketone bodies in the urine is a sign of the severity of the patient's condition with ketoacidosis.

In some cases, to clarify the cause of diabetes, the fraction of insulin and the products of its metabolism in the blood are determined. Type 1 diabetes is characterized by a decrease or complete absence of the fraction of free insulin or peptide C in the blood.

To diagnose the complications of diabetes and make a prognosis of the disease, additional examinations are carried out: fundus examination (retinopathy), electrocardiogram (ischemic heart disease), excretory urography (nephropathy, renal failure).

Bibliography:

• Diabetes. Clinic, diagnostics, late complications, treatment: Study guide, M. : Medpraktika-M, 2005
• Dedov I.I. Diabetes mellitus in children and adolescents, M. : GEOTAR-Media, 2007
• Lyabakh N.N. Diabetes mellitus: monitoring, modeling, management, Rostov n/a, 2004

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Diagnosis of diabetes in most cases is not difficult for the doctor. Because usually patients turn to the doctor late, in a serious condition. In such situations, the symptoms of diabetes are so pronounced that there will be no mistake. Often a diabetic for the first time gets to the doctor not on his own, but on an ambulance, being unconscious, in a diabetic coma. Sometimes people find themselves or their children early and go to the doctor to confirm or refute the diagnosis. In this case, the doctor prescribes a series of blood tests for sugar. Based on the results of these tests, a diagnosis of diabetes is made. The doctor also takes into account what symptoms the patient is experiencing.

First of all, they do a blood test for sugar and / or an analysis for glycated hemoglobin. These analyzes may show the following:

• normal blood sugar, healthy glucose metabolism;
• impaired glucose tolerance - prediabetes;
• blood sugar is high enough to diagnose type 1 or type 2 diabetes.

What do blood sugar test results mean?

Table notes:

• Officially, it is recommended to diagnose diabetes mellitus only on the basis of laboratory blood tests. But if the patient has clearly expressed symptoms and an accurate imported glucometer is used for a blood test from a finger, then you can immediately begin to treat diabetes without waiting for the results from the laboratory.
• Random determination - at any time of the day, regardless of the meal time. It is carried out in the presence of pronounced symptoms of diabetes.
• Drinking a glucose solution is an oral glucose tolerance test. The patient drinks 75 g of anhydrous glucose or 82.5 g of glucose monohydrate dissolved in 250-300 ml of water. After that, after 2 hours, his blood is checked for sugar. The test is performed in doubtful cases to clarify the diagnosis. Read more about it below.
• If the sugar is elevated in a pregnant woman, then the diagnosis of gestational diabetes is made immediately, already according to the results of the first blood test. This tactic is officially recommended in order to quickly start treatment without waiting for confirmation.

What is called impaired glucose tolerance, we consider full-fledged type 2 diabetes. Doctors in such cases do not diagnose diabetes so as not to bother with the patient, but calmly send him home without treatment. However, if the post-meal sugar level exceeds 7.1-7.8 mmol/L, complications of diabetes develop rapidly, including problems with the kidneys, legs, and vision. High risk of dying from a heart attack or stroke within 5 years. If you want to live, then study and diligently fulfill it.

Features of type 1 diabetes

Type 1 diabetes usually has an acute onset, and the patient quickly develops severe metabolic disorders. Diabetic coma or severe acidosis is often immediately observed. Type 1 diabetes symptoms begin spontaneously or 2 to 4 weeks after infection. Suddenly, the patient observes dry mouth, thirst up to 3-5 liters per day, increased appetite (polyphagia). Urination also increases, especially at night. This is called polyuria or diabetes. All of the above is accompanied by severe weight loss, weakness, itching of the skin.

The body's resistance to infections decreases, and infectious diseases often become protracted. Visual acuity often decreases in the first weeks of type 1 diabetes. It is not surprising that against the background of such severe symptoms, libido and potency decrease. If type 1 diabetes is not diagnosed in time and treatment is not started, then a child or an adult diabetic goes to the doctor in a state of ketoacidotic coma due to insulin deficiency in the body.

Clinical picture of type 2 diabetes

Type 2 diabetes usually develops in people over 40 years of age who are overweight, and its symptoms increase gradually. The patient may not feel or pay attention to the deterioration of his health for a long time, up to 10 years. If all this time diabetes is not diagnosed and treated, then vascular complications develop. Patients are dominated by complaints of weakness, short-term memory loss, fatigue. All these symptoms are usually attributed to age-related problems, and the detection of high blood sugar occurs by chance. Regular scheduled dispensary examinations of employees of enterprises and government agencies help to diagnose type 2 diabetes in time.

Almost all patients diagnosed with type 2 diabetes have risk factors:

• the presence of this disease in close relatives;
• family tendency to obesity;
• in women - the birth of a child weighing more than 4 kg, there was increased sugar during pregnancy.

Specific symptoms associated with type 2 diabetes are thirst up to 3-5 liters per day, frequent urge to urinate at night, wounds do not heal well. Also skin problems - itching, fungal infections. Usually, patients pay attention to these problems only when they already lose 50% of the functional mass of pancreatic beta cells, i.e., diabetes is severely advanced. In 20-30% of patients, type 2 diabetes is diagnosed only when they are hospitalized for a heart attack, stroke, or vision loss.

If the patient has severe symptoms of diabetes, then a single test that showed elevated blood sugar is enough to make a diagnosis and begin treatment. But if the blood sugar test turned out to be bad, but the person has no symptoms at all or they are weak, then diagnosing diabetes is more difficult. In people without symptoms of diabetes, the test may show elevated blood sugar due to an acute infection, injury, or stress. In this case, hyperglycemia (high blood sugar) is often transient, i.e. temporary, and soon everything returns to normal without treatment. Therefore, official guidelines prohibit diagnosing diabetes on the basis of a single failed test if there are no symptoms.

In such a situation, it is additionally carried out to confirm or refute the diagnosis. First, a blood test for fasting sugar is taken from the patient in the morning. After that, he quickly drinks 250-300 ml of water, in which 75 g of anhydrous glucose or 82.5 g of glucose monohydrate are dissolved. After 2 hours, blood is taken again for sugar analysis.

The result of OGTT is the figure “plasma glucose after 2 hours” (2hGP). It means the following:

• 2hGP< 7,8 ммоль/л (140 мг/дл) — нормальная толерантность к глюкозе
• 7.8 mmol/L (140 mg/dL)<= 2чГП < 11,1 ммоль/л (200 мг/дл) — нарушенная толерантность к глюкозе
• 2hGP >= 11.1 mmol/l (200 mg/dl) - a preliminary diagnosis of diabetes mellitus. If the patient is asymptomatic, then it should be confirmed by OGTT 1-2 more times in the following days.

Since 2010, the American Diabetes Association has officially recommended the use of a blood test to diagnose diabetes ( Submit this analysis! recommend!). If a value of this HbA1c >= 6.5% is obtained, then diabetes should be diagnosed, confirming it with a repeat test.

Differential diagnosis of diabetes mellitus type 1 and 2

No more than 10-20% of patients suffer from type 1 diabetes. Everyone else has type 2 diabetes. Patients with type 1 diabetes have acute symptoms, abrupt onset, and usually no obesity. Patients with type 2 diabetes are more often obese people of middle and old age. Their condition is not so acute.

Additional blood tests are used to diagnose type 1 and type 2 diabetes:

• on the C-peptide to determine if the pancreas produces its own insulin;
• on autoantibodies to self antigens of pancreatic beta cells - they are often found in patients with type 1 autoimmune diabetes;
• on ketone bodies in the blood;
• genetic research.

We bring to your attention algorithm for the differential diagnosis of type 1 and type 2 diabetes mellitus:

This algorithm is given according to ed. I. I. Dedova, M. V. Shestakova, M., 2011

In type 2 diabetes, ketoacidosis and diabetic coma are extremely rare. The patient responds to, while in type 1 diabetes there is no such reaction. Please note that since the beginning of the 21st century, type 2 diabetes mellitus has become very “younger”. Now this disease, although rare, occurs in adolescents and even in 10-year-old children.

Requirements for diagnosing diabetes

The diagnosis may be:

• type 1 diabetes;
• type 2 diabetes;
• diabetes mellitus due to [specify cause].

The diagnosis describes in detail the complications of diabetes that the patient has, i.e., lesions of large and small blood vessels (micro- and macroangiopathy), as well as the nervous system (neuropathy). Read the detailed article "". If there is, then note it, indicating its shape.

Lesions of large main blood vessels:

• If there is coronary heart disease, then indicate its form;
• Heart failure - indicate its functional class according to NYHA;
• Describe the cerebrovascular accidents that have been found;
• Chronic obliterating diseases of the arteries of the lower extremities - circulatory disorders in the legs - indicate their stage.

If the patient has high blood pressure, then this is noted in the diagnosis and the degree of hypertension is indicated. Give the results of blood tests for bad and good cholesterol, triglycerides. Describe other diseases that accompany diabetes.

Diseases that are often associated with diabetes

Due to diabetes, people have reduced immunity, so colds and pneumonia are more likely to develop. In diabetics, respiratory tract infections are especially difficult, and can become chronic. People with type 1 and type 2 diabetes are much more likely to develop tuberculosis than people with normal blood sugar. Diabetes and tuberculosis mutually burden each other. Such patients need lifelong observation by a phthisiatrician, because they always have an increased risk of exacerbation of the tuberculosis process.

With a long course of diabetes, the production of digestive enzymes by the pancreas decreases. The stomach and intestines work worse. This is because diabetes affects the vessels that feed the gastrointestinal tract, as well as the nerves that control it. Read the article "" for more details. The good news is that the liver does not suffer from diabetes, and damage to the gastrointestinal tract is reversible if good compensation is achieved, that is, maintaining a stable normal blood sugar.

In type 1 and type 2 diabetes, there is an increased risk of infectious diseases of the kidneys and urinary tract. This is a difficult problem, which has 3 causes at the same time:

• reduced immunity in patients;
• development of autonomic neuropathy;
• the more glucose in the blood, the more comfortable pathogenic microbes feel.