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Elevated blood glucose levels, glucose in urine. Diabetes. Living with her is not sweet, however. Untreated or inadequately treated, it leads to many complications and is one of the leading causes of death in developed countries. Do you want to have it under control? Make friends with the medical lab!
Do i have diabetes?
Increased urination, increased thirst and food intake, along with weight loss, may be symptoms of diabetes mellitus. For its diagnosis, however, a blood test is necessary, hence a visit to the laboratory is inevitable.
The basic test is the level mark fasting blood glucose in the early morning hours. It is recommended not only when disturbing symptoms are observed, but also as part of periodic health checks – due to the fact that disturbances in carbohydrate metabolism (the use and transformation of sugars supplied with food and produced in the body) do not immediately manifest as a full-blown disease .
Detecting the glucose level above 7mmol / l twice allows the doctor to make a diagnosis of diabetes. The “yellow card” can be compared to a situation in which the concentration of fasting glucose is elevated, but does not exceed 7mmol / l. In this case, the doctor should order the so-called oral glucose tolerance test (DTTG or OGTT). This test checks how the body is handling the use of externally supplied glucose. Blood for the determination of the glucose level is drawn on an empty stomach, after which the patient is administered a strictly defined amount of glucose (75 g). After 2 hours from this load, although it may happen that the doctor prescribes other time points (e.g. additional measurement after 1 hour), blood is sampled again and blood glucose is determined. DTTG is also used in the diagnosis of carbohydrate disorders that appear during pregnancy (gestational diabetes).
The analysis of fasting glucose and DTTG results allows the differentiation of diabetes from pre-diabetes: impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). [diagram1]
Where does this diabetes come from?
Elevated glucose levels in the blood (hyperglycaemia) is the result of a malfunction of the regulatory mechanisms carbohydrate metabolism. They are controlled by hormones, of which produced by pancreas insulin. Its insufficient production or tissue insensitivity to its action (insulin resistance) results in diabetes.
In the first case, the patient’s survival depends on insulin supplementation, a condition known as type 1 diabetes. Its development is caused by genetic predisposition, environmental factors (including infections with rubella viruses and CMV), and finally autoimmune reactions causing the death of insulin-producing pancreatic cells.
Usually this disease is diagnosed in childhood, but it also happens that the autoimmune process is less intense and the disease develops in adulthood (so-called LADA diabetes). Autoantibodies (auto p / c) related to the disease process can be detected in the patient’s blood several months or even years before the onset of the disease. Their determination is therefore useful not only for confirming the type of diabetes, but also for determining the probability of the disease, e.g. in relatives of a diabetic. The risk increases with the number of specific types of autoantibodies detected simultaneously and with their concentration. The main p / c values determined during the diagnosis of diabetes include:
- anti-GAD – p / c anti-glutamic acid decarboxylase, especially helpful in distinguishing LADA type from type II diabetes;
- anti-IA2 – p / c anti-tyrosine phosphatase, the presence of which is an indicator of a very high risk of developing diabetes;
- ICA – p / c against pancreatic islets, occurring in 75-90% of patients with type I diabetes, also found in approx. 10% of patients with type II diabetes.
People with diabetes known as type 2 diabetes do not require insulin administration for survival, but it is often essential for proper carbohydrate metabolism. This disease is classified as a civilization disease, because obesity, improper diet and a sedentary lifestyle are most often responsible for its development. These factors contribute to development insulin resistance – insulin does not fulfill its functions, which is initially compensated by its increased secretion, but with time it leads to the exhaustion of the pancreatic cells that produce it and the need to supply this hormone from the outside. Insulin resistance can be tested by marking fasting and glucose-overloaded insulin levels (analogous to the DTTG test).
Insufficient insulin release by the pancreas may be caused by damage to, e.g. as a result of chronic inflammation of this organ. The production of the hormone is best judged by determination C-peptide, protein cleaved from proinsulin during the production of the right hormone. Its level corresponds to the level of endogenous insulin.
I have diabetes – what next?
Changing the diet and lifestyle, timely therapy can effectively prevent the development of diabetes complications and improve the quality of life of patients. Blood tests allow you to assess the effectiveness of the treatment taken. It is necessary to regularly assess the level of glucose in the blood with a glucose meter, supported by periodic measurements of this parameter in the laboratory – also in order to checking the correctness of the meter readings. An indicator of the instability of diabetes is finding the presence of ketones and / or glucose in the urine.
Determination of proteins modified by excess blood glucose – glycosylated hemoglobin (HbA1C) i fruktozaminy (glycated plasma proteins) gives reliable information on the total blood glucose level in the period preceding the test, 3 months and 2 weeks, respectively. HbA1C is a more reliable test, but in some situations (e.g. anemia, defects in the hemoglobin structure or diabetes in a pregnant woman) it is recommended to assess fructosamine.
Chronic hyperglycemia can also lead to the dysfunction of the blood vessel walls, which results in it chronic complications of diabetes, incl. nephropathy and atherosclerosis. Laboratory tests help detect kidney problems early, leading to nephropathy. They manifest themselves in passing a small amount initially albumin in urine (so-called microalbuminuria) and elevated levels creatinine, urea and uric acid in blood. Diabetes also contributes to development of atherosclerosiswhich, in combination with the accompanying metabolic disorders, can lead to serious cardiovascular diseases. Hence, the criteria for the control of diabetes include the control of blood lipids (lipidogram). [table1]
The above article does not exhaust the issues related to the metabolic changes in diabetes, the multiplicity of complications of the disease or its newly identified subtypes. However, it explains the invaluable role of simple and widely available laboratory tests in the diagnosis and monitoring of this serious disease.
Sugar curve in pregnancy
Dr n. med. Emilia Martin
DIAGNOSTICS Medical laboratories