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Laosheng often talks about diabetic editors to analyze again

【Overview】

Diabetes Mellitus is a set of common metabolic endocrine diseases: original and secondary. The former accounts for the vast majority, with genetic tendencies. Its basic pathophysios are absolute or relative or relative insulin secretion and the increased metabolic disorders caused by the increased sugar activity, including sugar, protein, fat, water and electrolytes, etc., which often cause acidic acid to often cause acidic acid Alkali balance is abnormal; it is characterized by high blood sugar, diabetes, decreased glucose tolerance, and abnormal insulin release test. In the early stages of clinical practice, there were only symptoms, drinking, diuretic, thirst, hunger, weight loss, obesity, fatigue, weakness, and weakness in the symptoms. Nerves and other lesions. Severe cases or stress can cause keto acid poisoning, hypertonic coma, lactic acid poisoning and threatening life, often susceptible to purulent infections, urinary tract infections, tuberculosis, etc.

【diagnosis】

Typical cases have triteromyal groups to indicate the disease. The diagnosis of mild symptoms depends entirely on testing, often discovered in health examinations or accidentally due to other diseases. Many patients first discovered complications, and then traced back to the disease. However, regardless of whether there are symptoms or complications, the key is to first consider the possibility of the disease and perform urine and blood glucose examination before diagnosis.

(1) Pay attention to the following situations when judging the results of diabetes judgment. The results of urine sugar are for diagnosis reference only, and diagnosis must be determined by blood glucose.

1. If there are a small amount of diabetes, and occasionally, those who occur after meals should conduct blood glucose and sugar tolerance tests, and notice that copper sulfate in the spotted solution reacts to copper monotonous and reacts. Many drugs , Such as morphine, salicylic acid, hydrochloride, amino pestinus, citic acid, uric acid, etc., and many other sugars can also occur for false positive results. Therefore, the urine sugar trials made of glucose oxidase are currently widely used, which can avoid false positive results.

2. Clinically, when there are diabetic signs or suspects, when diabetes repeatedly negative, you should pay attention to determining blood sugar for 2 hours after meals in order to remove rising renal sugar thresholds.

(2) There are three commonly used methods for blood glucose to measure blood glucose: venous plasma glucose (VPG), capillary blood vessels (CBG), and venous blood glucose (VBG). Among them, the previous two were most commonly used. The results measured in different methods are slightly different. The results measured by the VPG method are 10%higher than that of CBG, about 15%higher than VBG. When analyzing the blood glucose report, it is necessary to pay attention to other situations that cause increased glucose concentration, such as after injection, various endocrine diseases, brain lesions, and stress, etc., and later, it will be described. Light or early stage, especially those with type II patients, can be used normally, and should not be easily removed. It must be tested 2 hours after meals.

(3) Patients who have the normally or high or higher diabetes of the glucose tolerance test, or patients with suspected diabetes (such as a positive family history, or repeated small yields, premature birth, death, giant babies, dystocia, abortion Those who have been sparked and bloated by maternals, etc.) must conduct glucose tolerance tests. However, the diagnosis of severe explicit cases with significantly increased blood glucose can be determined. A large amount of glucose can increase the burden and should be exempted.

1. Oral glucose tolerance test (OGTT) is the most commonly used. In the past, adults used 100G once. In recent years, WHO is recommended to use 75G (or the total weight of adults or children per KG, and the total amount does not exceed 75G). Extract venous hemogenous sugar 1/2, 1, 2, and 3 hours at the time of oral sugar, and collect urinary signs to check urine sugar at the same time.

Results: Normal people (age 15-50 years) The empty stomach blood glucose is 70 ~ 100 mg/dl (real sugar method such as glucose oxidase). 170mg/dl, 2 hours of blood glucose concentration return to normal range, and can be reduced to normal in 3 hours. Ureucartia negative. The 100G and 75G methods are not much different, and the latter’s blood sugar is returned to normal earlier. For those over the age of 50, sugar tolerance often reduces the physiological rationality, and the peak of 1 hour increases by 10 mg/dl for each year of blood sugar.

Diagnostic standards: At present, most of the temporary standards proposed by WHO in 1985 are as follows:

There are symptoms of diabetes. At any time, intravenous plasma glucose ≥200mg/dl (11.1 mmol/L) and analogenic venous plasma glucose ≥140mg/dl (7.8 mmol/L) can be diagnosed as diabetes.

进行 If the results are suspicious, OGTT should be performed (75g of glucose in the population). Children weigh 1.75g ​​per kg, the total amount does not exceed 75g), 2 hours of blood glucose ≥200mg/dl (11.1 mmol/L) can be diagnosed as diabetes. Blood glucose> 140mg/dl ~ <200mg/dl is a decrease in sugar tolerance (TGT).

(3) If the symptoms of diabetes are not diagnosed, in addition to the above two diagnostic standards, another indicator must be added to help diagnosis, that is, 1 ° or 2 ° blood glucose ≥200mg/dl or another fasting blood glucose ≥140mg/dl on the OGTT curve.

尿 Pregnancy diabetes can also adopt this diagnostic standard.

The above diagnostic standards can be summarized as Table 1.

Table 1 Interim Standards for Diabetes of Diabetes (WHO) Diabetes

Diagnosis of diabetic fashion must be except for a variety of factors that affect sugar tolerance, including endocrine diseases such as pituitary anterior lobe, adrenal cortex, hyperthyroidism, obesity, liver disease, multiple drugs (such as thiazide diuretics, female contraceptives, glucocorticoid hormone hormones, glucocorticoid hormones, Phenytoin sodium, chlorophenzozide, etc.), stress status (such as fever, infection, acute myocardial infarction, surgical treatment, etc.), potassium loss and so on.2. After meals, blood glucose measurement is equivalent to 100g of glucose sugar foods such as 2h or two or rice after 2H. After 2H, blood glucose is measured. For example, those with more than 140 mg/dl are reduced tolerance, and those with ≥200mg/dl are diabetes.

Because the low sugar diet or hunger can reduce the sugar tolerance, the 3D before the test should pay attention to adjusting the diet so that the sugar is not less than 250g/d to get the reliable results.

<!-2586: Diabetic terminal page

When some patients need to estimate their β cell function or blood glucose control status, the following measurement can still be made:

1. Emptor plasma insulin testing Our hospital to determine the normal range of analogenic plasma insulin in the radiological immune method is 5-20.

(Intern editor: Wuying)

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