How do doctors diagnose diabetes? The diagnosis of diabetes is based on the abnormal increase of blood sugar. If fasting blood glucose is simply checked, the missed diagnosis rate of diabetes is high, postprandial blood glucose should be supplemented, and oral glucose tolerance test should be carried out if necessary.
Diagnostic clues:? Three more and one less? Symptoms, namely polyuria, polydipsia, polyphagia and weight loss. Patients newly diagnosed with various acute and chronic complications of diabetes or accompanying diseases. High risk group: history of impaired glucose regulation; Age? 45 years old; Overweight or obese; First-degree relatives of type 2 diabetes; History of gestational diabetes; Polycystic ovary syndrome; Long-term treatment with antidepressants. In addition, people over the age of 45 should be routinely examined for diabetes when they have a physical examination or are hospitalized for various diseases and operations.
Diagnostic criteria: diabetic symptoms plus random blood sugar? 11.1mmol/l or fasting blood glucose 7.0mmol/L or oral glucose tolerance test for 2 hours? 1 1. 1 mmol/L. (If there is no typical? Three more and one less? Symptoms need to be tested again for confirmation before the diagnosis can be confirmed. )
What diseases does diabetes need to distinguish from? Pay attention to identify urine glucose positive caused by other reasons.
After gastrojejunostomy for hyperthyroidism, the postprandial 1/2 ~ 1 hour blood glucose may be too high, and diabetes may occur, but the fasting blood glucose and oral glucose tolerance test are normal for 2 hours.
In severe liver disease, hepatic glycogen synthesis is blocked and hepatic glycogen storage is reduced. After meals 1/2 ~ 1 hour blood sugar is too high, and diabetes occurs, but fasting blood sugar is low, and blood sugar is normal or lower than normal 2 ~ 3 hours after meals.
Stress state: Many stress states, such as cardiovascular and cerebrovascular accidents, acute infection, trauma, surgery, etc., may lead to a transient increase in blood sugar, which can be recovered within 1 ~ 2 weeks after the stress factors are eliminated.
A variety of endocrine diseases, such as acromegaly, Cushing's syndrome, hyperthyroidism, pheochromocytoma and glucagon tumor, can cause secondary diabetes. In addition to elevated blood sugar, there are other characteristic manifestations, which are not difficult to distinguish.
Postprandial hyperglycemia has the following characteristics: ① Diabetic patients can be in postprandial hyperglycemia state for 2/3 ~ 3/4 of the time within 1 day.
② Postprandial hyperglycemia has the dual characteristics of chronic hyperglycemia and acute hyperglycemia fluctuation. We should not only pay attention to the degree of hyperglycemia, but also pay attention to the duration of chronic hyperglycemia and the fluctuation of blood sugar per unit time.
③ 2 hours postprandial blood glucose is not the peak of postprandial blood glucose in normal people, people with impaired glucose tolerance and most diabetic patients, so the estimation method of postprandial blood glucose peak still needs to be improved.
④ Postprandial hyperglycemia can cause postprandial metabolic disorder and abnormal function of tissues and cells, which may be harmful to individuals.
It is of great significance to control postprandial hyperglycemia. Poor blood sugar control in diabetic patients will bring various complications, including retinopathy, renal failure, macroangiopathy, neuropathy and amputation, among which macroangiopathy has become the main cause of death in diabetic patients. With the continuous progress of academic research, the harm of postprandial hyperglycemia has been unanimously recognized by the global diabetes community.
Effective control of postprandial hyperglycemia can not only improve the overall blood sugar control level, but also reduce the occurrence of cardiovascular events and improve the prognosis of diabetes. In 2007, the International Diabetes Federation (IDF) issued guidelines for postprandial blood glucose management based on evidence-based medical evidence, suggesting that more effective measures should be taken to control postprandial blood glucose, so as to optimize diabetes management and reduce complications of diabetic patients.
This is the first guideline for postprandial blood glucose management in the world, which reflects the importance of postprandial blood glucose in the diagnosis and treatment of diabetes and the importance attached by international diabetes organizations to postprandial blood glucose. This is a milestone in the understanding of postprandial blood sugar.