Diagnosis of diabetes mellitus type 2

As we know, diabetes is not a separate “sore” – it is a whole group of endocrine diseases. There are several varieties that differ, including in symptomatology. But type 2 diabetes is insidious! – for a long time can proceed without symptoms at all.

“The latent course of type 2 diabetes mellitus can last for years, undermining the work of all organs and systems,” notes endocrinologist Elena Kulikova. – Against its background, atherosclerosis and coronary heart disease develop faster, the course of hypertension worsens. Late detection of diabetes mellitus or a frivolous attitude to pre-diabetic conditions leads to a significant deterioration in the patient’s quality of life, contributes to the development of events such as myocardial infarction and stroke, and shortens life. It should be remembered that the disease is always easier and cheaper to prevent than to treat it. The best problem is the one that didn’t happen.

And how to identify and start treating diabetes mellitus in time if it attacks on the sly?

Methods for diagnosing type 2 diabetes

Firstly, there is some risk group: type 2 diabetes is typical for adults over 30-40 years old and in the vast majority of cases is observed against the background of overweight or obesity. But, of course, these are not mandatory conditions.

And secondly, there are other factors that signal about increased sugar for a reason.

“The clinical picture in many cases includes complaints of thirst, frequent urination and weight loss,” says Dr. Kulikova. “However, in more than half of the cases, diabetes mellitus is detected actively, against the background of a worsening course of other pathologies. In addition, often with a latent course of type 2 diabetes, patients complain of long-term non-healing wounds and scratches, deterioration in general well-being, fatigue and fatigue, decreased quality of vision, and unstable blood pressure. The range of complaints is quite wide, and therefore a doctor of any specialty should remember about diabetes.

But still, if the patient himself or his doctor (for example, the same therapist) suspected diabetes mellitus, a person has a direct road to an endocrinologist. The specialist will pay attention not only to the clinical signs of type 2 diabetes – there are laboratory diagnostic methods that will help determine the presence of the disease.

These include:

1. Determination of fasting blood glucose levels.
2. Determination of glucose levels during the so-called oral glucose tolerance test (OGTT).
3. Determination of glycated hemoglobin (HbA1c)

– Currently, the determination of the level of glucose in the urine is not used to diagnose diabetes. However, if sugar is detected in the urine, it is necessary to contact an endocrinologist and undergo an examination to confirm or exclude the diagnosis of diabetes, our expert notes.

Determining the level of glucose in the blood on an empty stomach

The test is simple: the patient comes to the clinic early in the morning and donates blood on an empty stomach. “Hungry stomach” in this case should be considered the absence of food intake at least 8 hours before blood donation.

By the way, blood can be taken both from a finger and from a vein. Only the diagnostic criteria will be different.

So, for example, normal blood sugar is less than 5,6 mmol / l (blood from a finger) or less than 6,1 mmol / l (from a vein). And if the analysis showed 6,1 mmol / l or more (from a finger) or from 7 mmol / l (from a vein), this may already indicate diabetes.

Intermediate indicators indicate impaired glucose tolerance and impaired fasting glycemia.

“Such people should be attentive to their diet, regularly monitor blood sugar levels and be aware of the risk of developing diabetes,” our expert explains.

Oral glucose tolerance test (OGTT)

The methodology for this analysis is a bit more complicated. Three days before the test, the patient eats plenty and moves as usual, and immediately 8-14 hours before the test, not a crumb in the mouth is allowed – only plain water. Moreover, in the evening on the eve you can eat only 30-50 g of carbohydrates.

– After blood sampling on an empty stomach, the subject should drink 5 g of anhydrous glucose (dry powder is sold in a pharmacy) dissolved in 75-250 ml of water in no more than 300 minutes. For children, the load is 1,75 g of anhydrous glucose (or 1,925 g of glucose monohydrate) per kg of body weight, but not more than 75 g, says the endocrinologist. We’ll wait two more hours. And yes, no smoking is allowed during this time. Two hours later, blood is taken again.

The numbers denoting diagnostic criteria when taking blood on an empty stomach are the same as in the previous test we described. But after ingestion of “sweet” – in any case, they increase. Logically. However, if a person is healthy, after ingesting a glucose solution, the test will show less than 7,8 mmol / l (both from a finger and from a vein is the same). But if he has type 2 diabetes, then the indicators will be from 11,1 mmol / l.

Determination of glycated hemoglobin (HbA1c)

“Glycated hemoglobin is a specific compound of red blood cell hemoglobin with glucose, the concentration of which reflects the average blood glucose level over about three months,” says Dr. Kulikova.

By the way, you might also come across such terms as glycohemoglobin, hemoglobin A1c, HbA1c or glycosylated hemoglobin – these are all synonyms, you can call it whatever you like.

By itself, glycated hemoglobin is normally found in every person – but in a small amount. And as the blood sugar level rises, so does the HbA1c level.

– So, a characteristic indicator for overt diabetes mellitus is 6,4%. However, the level of HbA1c 6,0 – 6,4% does not exclude the presence of diabetes mellitus at the stage of its latent course, – says our expert. – In this case, the diagnosis can be confirmed on the basis of two numbers that are in the diabetic range. For example, the determination of HbA1c and a single determination of blood glucose levels.

So, with glycated hemoglobin less than 6,5%, fasting blood glucose will be less than 6,5 mmol / l, and two hours after eating – less than 8 mmol / l. And, for example, if HvA1c is less than 8,0%, fasting glucose will be less than 8 mmol/l, and after eating it will be less than 11 mmol/l.

“These and other diagnostic criteria are accurate and are included in the clinical guidelines “Algorithms for Specialized Medical Care for Patients with Diabetes Mellitus,” says Dr. Kulikova. – They are suitable for the detection of type 2 diabetes in adults and children. And for the diagnosis during pregnancy, more stringent criteria are used.

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