What Tests are needed to Diagnose Diabetes?
The diagnosis of diabetes is mainly based on blood sugar
levels. Diagnosis if there are diabetes-related symptoms (dry mouth,
polydipsia, polyuria, polyphagia, weight loss) and abnormal blood glucose
(fasting blood glucose ≥7.0mmol / L and / or 2 hours postprandial blood glucose
≥11.1mmol / L) Diabetes.
If there are no symptoms, physical examination reveals
abnormal blood glucose. After repeated examinations, blood glucose is still
abnormal (fasting blood glucose ≥7mmol / L and / or postprandial blood glucose
≥11.1mmol / L) can also be diagnosed.
Does fasting blood glucose refer to the pre-meal blood glucose of each meal, or does it refer to the pre-meal blood glucose in the morning only? Does postprandial blood glucose refer to after each meal?
Fasting blood glucose refers to the morning pre-meal blood
glucose, fasting 8 to 10 hours, postprandial blood glucose refers to the blood
glucose value of 2 hours after each meal.
In addition, some foreign diagnostic
criteria also include glycated hemoglobin, which means that the reaction takes
2-3 months.
The average blood glucose level can be diagnosed if ≥6.5%, but
currently glycated hemoglobin is not used as a diagnostic standard for diabetes
in most countries of the world.
The diagnostic significance of fasting blood glucose and
postprandial blood glucose is different.
Postprandial blood glucose is highly
sensitive, blood sugar with high sugar load is easy to be high, and diabetes is
more likely to be found.
Fasting blood glucose is more specific and the
accuracy of diabetes diagnosis is better. So patients do diabetes during the
diagnostic test, fasting blood glucose and postprandial blood glucose need to
be checked together to avoid missed diagnosis.
Usually adopts the international general diabetes diagnostic
test-oral glucose tolerance test (OGTT test):
Fasting blood is drawn after 8-10
hours of fasting, then 75g of anhydrous glucose powder is dissolved in 200 - 300ml of water, drink within 5 minutes.
Follow the sugar Blood was drawn 2
hours after the first bite.
If fasting blood glucose ≥7mmol / L and / or
postprandial blood glucose ≥11.1mmol / L, diabetes can be diagnosed.
There are three conditions in pre-diabetes. One is abnormal
fasting blood glucose (fasting blood glucose 6.1mmol / L - 7.0mmol / L).
The
second is abnormal blood glucose after a meal, also known as impaired glucose
tolerance (glucose 2 hours after a meal 7.8mmol / L - 11.0 mmol / L).
Third,
both impaired fasting blood glucose and abnormal glucose tolerance.
How to diagnose the situation of high and low blood sugar before and after meals?
It is mainly divided into 2 situations. First, if the patient
has the typical symptoms of diabetes such as polydipsia, polyuria, polyphagia,
weight loss, vulvar itching, blurred vision, etc.
It meets the standards of
fasting blood glucose and postprandial blood glucose.
Diabetes can be diagnosed
if satisfied.
Secondly, if there are no symptoms or signs, blood glucose needs
to be tested at different times.
If all tests are abnormal, diabetes can be
diagnosed. If not, the diagnosis cannot be confirmed.
Fasting blood glucose is
the blood glucose level in the basic state, which is less affected by the
action of insulin, mainly affected by hepatic gluconeogenesis and other
hormones, and has high accuracy. The 2-hour postprandial blood glucose is the
blood glucose after load, and the sensitivity is better.
The reserve and
function of pancreatic islets, if the reserve and function of insulin is poor,
it is easy to postprandial blood sugar high.
In clinical practice, many
diabetic patients have fasting blood glucose less than 6.1mmol / L, and
postprandial blood glucose ≥ 11.1mmol / L.
How can we understand the Diabetes inspection report?
The
inspection report needs to understand several key indicators: The first
blood glucose index, fasting blood glucose, postprandial blood
glucose and glycated hemoglobin. Especially for patients with insulin,
the
blood glucose index needs to be monitored.
If the blood glucose control is
poor, the monitoring frequency needs to be increased.
If the blood glucose
control is good, Properly reduce the frequency of monitoring.
The second blood
pressure indicator, high blood pressure has a great impact on diabetes, and the
normal blood pressure should be less than 140 / 90mmHg.
Diabetic patients need
to control blood pressure more strictly, it is better to control below 130 /
85mmHg, the elderly and patients with long-term hypertension can be relaxed.
The third blood lipid index, such as cholesterol, triglycerides, high density
lipoprotein, low density Lipoprotein, etc.
The fourth weight index, weight
should be as normal or close to normal as possible.
In addition, attention
should also be paid to the examination of complications, such as
electrocardiogram, lower extremity vascular examination, fundus, proteinuria,
nerves, etc.
Only one examination is required. If there are complications, the
frequency of examinations should be increased appropriately.
Once diabetes is diagnosed, it is necessary to screen for
diabetic complications and evaluate metabolic indicators to comprehensively
consider the severity of diabetes.
The severity of diabetes complications can be used as an
indicator of diabetes control.
There are two reasons for this. One is related
laboratory tests, which can provide a reference for the subsequent treatment
effect. The other is that diabetes complications can be found early to avoid
serious The consequences.
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