Increased glucose tolerance treatment. NTG - impaired glucose tolerance: causes, symptoms and correction methods. Prediabetic condition: complications

Rise 7.00 - a glass of water (after 30 minutes you can have breakfast)

1st breakfast   (early, around 7.30 in the morning) - 150 gr. cottage cheese, scrambled eggs with vegetables or another breakfast without carbohydrates (for example, boiled eggs with fish or salad with breast, or green beans with an egg). For the first breakfast in the morning, it is better to do without carbohydrates, many grow sugar for the first morning carbohydrates. I have if the morning I start with oatmeal then all day sugar fly.

If the first breakfast is protein, you can by the way after it and lie down.

Between meals you can have tea, tea with milk, weak coffee with milk (coffee is better only once a day). Water is also best drunk between meals. In general, water of at least 1.5 liters per day is needed.

2nd breakfast   (carbohydrate, around 9.00 in the morning). Any cereal on which sugar does not rise, but not more than 4 tablespoons: oatmeal in water or milk, buckwheat, multi-cereal porridge - about 4 tablespoons of prepared porridge

After a carbohydrate breakfast, it’s better to do something around the house for 15-20 minutes, not sit and go to bed.

Snack:around 11.30 in the morning - fruit, better than one type, which does not rise sugar. I prefer one green apple and a few pieces of almonds or nuts (sometimes a combination with nuts gives a jump in sugar, you need to check). Can a glass of berries, 2 kiwi, 1/2 grapefruit

Lunch: at 13.30first you need to eat a large salad, leafy, you can add cucumbers and tomatoes + a spoonful of olive oil and at 13.45 approximately start eating the main lunch: vegetable soup (without potatoes), 150 grams of grilled vegetables or in the oven, 100 g. boiled meat and 100 grams of finished buckwheat, or 100 grams of pearl barley, or 100 grams of hard pasta (those carbohydrates for which sugar does not increase)

After lunch, do not sit, do something about 15-20 minutes.

Snack:around 16.30 Sandwich on bran bread (a slice of 25-30 gr.) with 1 or 2 slices of cheese or boiled meat, you can add a tomato, or a cucumber and salad leaves.

Dinner:around 18.40 eat a large salad and at 19.00 dinner. For dinner, boiled meat or fish (you can in the oven) and about 4 tablespoons (100 gr.) Side dish + vegetables in the oven (except carrots and beets).

After dinner, an hour walk

22.00 A glass of kefir(if in the morning sugar is not high you can with a slice of bread or a cracker) and sleep

Important:   cottage cheese should never be combined with carbohydrates. Carrots are better for a raw snack. Boiled carrots and beets in general, tin - better not to eat.

If you eat by the clock and eat portions as indicated, then you will not be hungry. Even at the beginning it seems a lot. But if you do not eat carbohydrates, then ketones will appear.

In general, all day you need to eat at least 13 XE to a pregnant woman, but so that sugar does not rise. The main meals should be no more than 3-4 XE and snacks no more than 1-2 XE.

For instance:

Slice of bread 25 gr. - 1 XE

100 gr. boiled buckwheat - 2 XE (about 4 tablespoons with a small pot)

150-200 gr. vegetables in the oven - 1 XE

Liquid oatmeal porridge 100 g - 1.7 XE

Oatmeal porridge on water 100 gr - 1.8 XE

Pearl barley porridge on water 100 gr - 2.7 XE (my sugar does not rise sharply on it)

Boiled pasta 100 gr. - 2.4 XE (but takes off for pasta)

Apple 100 gr - 1.3 XE

Well, it makes sense to manage to eat at least 13 XE per day, but so that sugar does not fly up. Usually after a week of diet you begin to understand what’s what.

For the calculation of XE there are tables, and programs for smartphones.

I wish you never to face this, but if you have already encountered it, then keeping a sugar diet is difficult, of course, it breaks down myself, then I am ashamed in front of the kid.

p.s. By the way, you can sit on such a diet and when you just need to lose weight during pregnancy, without harm to the milking child

Impaired glucose tolerance is a real problem in the modern world. Cases of detecting such a violation have become much more frequent and the reason for this is a change in the rhythm of modern life.

The main factor-provocateur is physical inactivity. After a hard working day, a person does not have the strength to walk or visit the fitness center, and it is much more convenient for him to relax on a comfortable sofa in front of his own TV screen.

The next factor, literally sneaking up on the previous one, is malnutrition. A hearty and certainly fatty, high-calorie dinner allows you to instantly cope with hunger that cannot be satisfied during the day.

A person believes that he did not eat all day, but only spent calories, therefore he can afford it. But the body does not agree with him.

Impairment of glucose tolerance is a pathological change, the manifestation of which can be prevented, how to do it and most importantly, how to detect the change in time? Answers to the main questions are presented to the reader.

The fact that diabetes is an incurable disease is known to everyone. But its danger is often underestimated. People don’t understand that diabetes is the need for regular monitoring of blood sugar throughout life, and overall well-being largely depends on the number on the meter.

Many do not think about the dangerous complications of the disease that arise when non-compliance with the basic recommendations for diabetics. It is impossible to cure diabetes, but it is possible to prevent its development.

In this regard, the optimal means of prevention is the timely detection of impaired glucose tolerance. With the early detection and adoption of the necessary measures, you can prevent the development of a dangerous disease or delay the manifestation of the disease for many years.

The carbohydrates consumed in food are broken down into glucose and fructose during the digestion process. glucose immediately enters the bloodstream. An increase in blood sugar concentration enhances the activity of the pancreas, it produces the hormone insulin, which helps sugar get from the blood to the cells of the body. Glucose in the cells is a source of energy and provides an adequate flow of metabolic processes.

For a healthy person, the norm of time given for the assimilation of a portion of glucose is no more than 2 hours. After this interval, sugar indicators return to normal again. In case the marks remain extreme, a violation of tolerance is diagnosed.

Attention! Diabetes mellitus can be diagnosed if, after 2 hours after the test, the sugar norm has not stabilized, but remains in the limit of about 11 mmol / L.

Prediabetes is a violation of glucose tolerance. Such a violation implies the manifestation of a complex of changes:

• against the background of a violation of the process of insulin production by pancreatic cells, the concentration of the hormone in the body decreases;
• the sensitivity of membrane proteins to insulin is significantly reduced.

It is worth remembering that a blood test for sugar with NTG delivered on an empty stomach in most cases shows the norm.

This is due to the fact that over night, the human body is still able to qualitatively process glucose received in the blood. Based on this information, it can be concluded that such a study is not enough to detect prediabetes.

An impaired fasting glycemia is diagnosed when the blood sugar levels exceed the permissible norms, but do not reach the levels that make it possible to diagnose the development of diabetes mellitus.

Causes of the violation

The cause of NTG may be due to some factors:

What factors can provoke impaired glucose tolerance
Factor	Description	Characteristic photo
Excess weight	Patients whose BMI (body mass index) exceeds 27 are in a special risk group. This is due to the fact that providing a “large” organism takes a lot of energy and, as a result, organs such as the heart, kidneys, and pancreas suffer in the first place, that is wear out quickly.
Hypodynamia	The patient's consumption of high-calorie, carbohydrate-rich food leads to the body working in an overly active rhythm. The pancreas produces insulin spasmodically, in significant doses. A significant mass of excess glucose entering the blood is converted to fat.
Genetics	Diabetes in one or both parents increases the likelihood of a child developing a disease. Nevertheless, the statistics are quite adequate - subject to all recommendations, the risks of developing the disease do not exceed 5%. The most unfavorable prognosis for the identification of type 2 diabetes in the twin - the risk is 90%.
Gender	Female representatives over 45 years old are more likely to experience NTG.
Pancreatic lesions	The list of predisposing factors include pancreatitis, the presence of tumors, cysts and all kinds of injuries of the pancreas.
Pathology ES	Pathologies of the endocrine system often lead to imbalance in hormones, which in turn becomes the cause of metabolic failures.
Gynecological diseases	Impaired glucose tolerance is often detected in patients with polycystic ovary syndrome.

The video in this article will introduce readers to the causes of NTG in more detail.

How is impaired glucose tolerance?

Intensive disorders that can indicate the development of NTG are absent. In case of impaired glucose tolerance, blood sugar rises slightly and for a short period of time, because any characteristic changes indicating the development of pathology can in this case appear only after a few years.

In this case, NTG is detected in conjunction with the patient's diagnosis of type 2 diabetes.

Symptoms of NTG can be represented in the following form, but the patient should remember that they do not always appear:

• the use of fluid in large ones, due to the constant presence of dryness in the oral cavity - in this way, the body tries to reduce the concentration of sugar in the blood;
• frequent urination against the background of active use of fluid;
• the patient complains of a feeling of fever, nausea and dizziness after eating;
• periodic headaches.

The listed symptoms are not specific, therefore, their manifestation cannot indicate the development of NTG in the patient. The data obtained as a result of using a home blood glucose meter are also not always informative and their accuracy must be confirmed by a laboratory test.

Attention! Diagnosis of impaired glucose tolerance involves a special test to determine whether the patient suffers from metabolic disorders.

Diagnostics

Glucose tolerance test allows you to establish the fact of the presence of violations. For the examination, the patient needs venous blood donated on an empty stomach.

Attention! Further testing is only possible if a fasting blood test does not indicate diabetes. A glucose tolerance test for diabetics is not carried out - it is not informative and may harm the patient's health.

If fasting sugar does not exceed the norm, conduct a load test. Such a study requires the use of patients 75 g of glucose dissolved in 300 ml of water. It takes time to assimilate the product. Repeated blood sampling is repeated after 2 hours.

There is another, less common, but more accurate option for testing for glucose tolerance. For such a test, it is not oral administration of the composition that is used, but intravenous administration of glucose.

Test Rules

The instruction providing correct results can be presented in the following form:

1. Blood sampling is carried out in the morning on an empty stomach, the period of time elapsed from the last dose should be at least 8 hours.
2. It is forbidden to drink alcohol at least one day before the test.
3. 3 days before the examination, oral contraceptives, vitamins and other medicines are canceled. This is due to the fact that such compositions can cause distortion of the test result. Women taking oral contraceptives should choose another way to prevent an unwanted pregnancy.

Danger present

The main danger of impaired glucose tolerance is the development of type 2 diabetes in the patient. Statistical data indicate that in about 30% of cases, the human body independently cope with violations and any external intervention is not required.

In 70% of cases, people who do not suspect a violation of TG live with a similar change, which gradually turns into acquired diabetes. In order to reduce the likelihood of developing a disease that has many complications, it is worthwhile to conduct an annual examination to identify glucose tolerance indicators.

Attention! Patients at risk of developing the disease should regularly visit an endocrinologist.

Principles of Therapy

A glucose tolerance test may indicate the development of disorders of carbohydrate metabolism in the human body. Patients who have received similar results should treat their health with great attention. It is mandatory to register with the endocrinologist. The doctor will monitor the progress of the recovery process.

Attention! Treatment of NTG is hard work. The patient will carefully review his own lifestyle and change his attitude to bad habits, completely abandoning them.

Proper nutrition

The main reason for impaired glucose tolerance is an excess of insulin in the blood produced by pancreatic cells as a response to carbohydrate intake. To restore the sensitivity of cells and the resumption of their ability to assimilate the hormone, its concentration should be reduced. This is extremely simple - the patient should limit the use of food containing sugar.

Attention! The instructions drawn up by a nutritionist require a sharp reduction in the amount of carbohydrates consumed by the patient. From the menu it is worth eliminating foods with a high glycemic index. The price of non-compliance with these rules is high.

1. The patient should eat often, but in small portions.
2. It is worth paying attention to the need to count calories. The permissible food norm is divided into 4-5 approaches.
3. The patient should consume enough water.
4. The basis of the diet can be vegetables and fruits - that is, zero-calorie foods.

The patient's menu should be balanced, but carbohydrates should make up a smaller proportion of the diet. If this rule is not observed, therapy will be ineffective.

Sport

In order to reduce the likelihood of diabetes, the patient must completely change their own rhythm of life for the better. Change also requires daily exercise.

Running, morning exercises will benefit the patient’s body. If possible, Nordic walking and swimming in the pool is an acceptable sport.

After exercise, the patient should not feel excessive fatigue. All exercises should be fun and satisfying.

The attention of patients with impaired glucose tolerance should be stopped on the fact that resorting to the use of medications to stabilize well-being is possible only on an emergency basis. In some cases, such drugs harm the patient’s body and can cause the development of diabetes, that is, accelerate the course of an already running process.

Questions to a specialist

Lyubichenko Alyona, 26 years old, Saratov

Good afternoon. Please help me sort out the issue. I don’t have diabetes and didn’t have it. Now I’m pregnant and have been prescribed a glucose tolerance test, why? My gynecologist, who was familiar with me at the same time, didn’t tell her why, why? Can't this test provoke diabetes in me? Does he harm the child?

Good afternoon, Alena. According to the rules, such a examination is prescribed to all pregnant women in the second trimester and is mandatory. Such a test simply allows one to be sure that there is no development of gestational diabetes, which, as a result, can flow into type 2 diabetes.

The study must be prescribed to women who are overweight. Why the test is not recommended to pass your friend, I can not say. The test is completely safe for you and the child.

Nikolaenko Tatyana, 36 years old, Pemza

Good afternoon. I took a tolerance test that year, but it’s very difficult for me to drink this composition, is there an alternative test method?

Good afternoon, Tatyana. Find out in your city’s medical centers about the potential for intravenous glucose.

Problems with carbohydrate metabolism precede the development of diabetes. Having noticed abnormalities, you should immediately begin treatment. Patients should know: impaired glucose tolerance - what it is and how to cope with this condition. First of all, it is necessary to find out how this disease manifests itself.

Characteristic

A violation of tolerance (NTG) is a condition in which the concentration of sugar in the blood is not significantly increased. With this pathology, patients do not yet have a basis for diagnosing diabetes, but there is a high risk of developing problems.

Specialists should know the code for ICD 10 for NTG. According to the international classification, the code R73.0 is assigned.

Previously, such disorders were considered diabetes (its initial stage), but now doctors isolate them separately. This is a component of the metabolic syndrome, it is observed simultaneously with an increase in the amount of visceral fat, hyperinsulinemia and increased pressure.

Every year, 5-10% of patients with impaired carbohydrate tolerance are diagnosed with diabetes. Usually this transition (disease progression) is observed in people suffering from obesity.

Usually problems arise when the process of insulin production is disrupted and the sensitivity of tissues to this hormone decreases. When eating, pancreatic cells begin the process of insulin production, but it is released, provided that the concentration of sugar in the bloodstream increases.

In the absence of disorders, any increase in glucose levels provokes tyrosine kinase activity. But if the patient has prediabetes, then the process of breaking the binding of cell receptors and insulin begins. Because of this, the process of transporting glucose into cells is disrupted. Sugar does not provide energy to tissues in the required volume, it remains in the bloodstream and accumulates.

Signs of pathology

In the initial stages, the disease does not manifest itself. You can identify it during the passage of the next physical examination. But often it is diagnosed in patients suffering from obesity or the presence of excess body weight.

Symptoms include:

• the appearance of dry skin;
• development of genital and skin itching;
• periodontal disease and bleeding gums;
• furunculosis;
• problems with wound healing;
• menstrual irregularities in women (up to amenorrhea);
• decreased libido.

In addition, angioneuropathy can begin: small joints are affected, the process is accompanied by impaired blood flow and damage to nerves, a violation of the process of conducting impulses.

When such signs appear in patients suffering from obesity, it should be examined. As a result of the diagnosis, it can be established that:

• on an empty stomach in humans, normoglycemia or indicators are slightly increased;
• sugar is absent in urine.

When the condition worsens, signs of diabetes develop:

• intense obsessive thirst;
• dry mouth
• increased urination;
• impaired immunity, manifested by fungal and inflammatory diseases.

Almost every patient can prevent the transition of increased glucose tolerance to diabetes. But for this you need to know about the methods of preventing disorders of carbohydrate metabolism.

It should be remembered that even in the absence of signs of pathology, it is necessary to periodically check the effectiveness of metabolic metabolism for people with a predisposition to the development of diabetes. In the second half of pregnancy (between 24 and 28 weeks), a tolerance test is recommended for all women over 25 years of age.

Reasons for the development of problems

Deterioration in the process of carbohydrate absorption may occur in everyone with a genetic predisposition and provoking factors. The reasons for NTG include:

• severe stress;
• obesity, overweight;
• significant intake of carbohydrates into the patient;
• low physical activity;
• deterioration of the process of insulin production in case of gastrointestinal disorders;
• endocrine diseases accompanied by the production of contra-hormonal hormones, including thyroid dysfunction, Itsenko-Cushing's syndrome.

This disease also appears during pregnancy. After all, the placenta begins to produce hormones, because of which the susceptibility of tissues to the action of insulin decreases.

Provocative factors

In addition to the reasons for the development of carbohydrate metabolism disorders, patients should know who is more at risk of reducing tolerance. Patients with a genetic predisposition should be most careful. But the list of provoking factors also includes:

• atherosclerosis and increased blood lipids;
• problems with the liver, kidneys, blood vessels and heart;
• hypothyroidism;
• gout
• inflammatory diseases of the pancreas, due to which insulin production is reduced;
• increase in cholesterol concentration;
• the appearance of insulin resistance;
• taking certain medications (hormonal contraceptives, glucocorticoids, etc.);
• age after 50 years.

Particular attention is paid to pregnant women. Indeed, in almost 3% of expectant mothers, gestational diabetes is detected. Provoking factors are:

• overweight (especially if it appeared after 18 years);
• age over 25-30 years;
• genetic predisposition;
• PCOS;
• development of diabetes in previous pregnancies;
• the birth of children weighing more than 4 kg;
• increased pressure.

Patients at risk should periodically check their sugar levels.

Pathology diagnostics

It is possible to determine the disease only with the help of laboratory diagnostics. Capillary or venous blood can be taken for research. Observe the basic rules for collecting material.

3 days before the planned study, patients should follow a familiar lifestyle: it is not worth changing a diet to a low-carb one. This can lead to a distortion of the actual results. You should also avoid stress before taking blood and do not smoke half an hour before the test. After a night shift, donating blood for glucose is impossible.

To establish a diagnosis of NTG should:

• donate blood on an empty stomach;
• take a glucose solution (300 ml of pure liquid is mixed with 75 glucose);
• 1-2 hours after taking the solution, repeat the analysis.

The data obtained makes it possible to determine whether there are problems. Sometimes you need to take a blood sample every half hour to understand how glucose levels in the body change.

To determine impaired tolerance in children, they are also tested with a load: 1.75 g of glucose is taken for each kilogram of their weight, but not more than 75 g.

Fasting sugar counts should be no more than 5.5 mmol / L if capillary blood is tested, and 6.1 if venous.

2 hours after drinking glucose in the absence of problems, sugar should not be more than 7.8, regardless of the place of blood sampling.

In cases of tolerance disorders, the indices in an empty stomach study will be up to 6.1 for capillary and up to 7.0 for venous blood. After taking a glucose solution, they will rise to 7.8 - 11.1 mmol / L.

There are 2 main research methods: the patient can be given a drink or injected intravenously. With oral fluid intake, the stomach should first go through, and only then the process of enriching blood with glucose will begin. When administered intravenously, it immediately enters the bloodstream.

Selection of treatment tactics

Having established that there are problems, you should contact the endocrinologist. This doctor specializes in this kind of disorder. He can tell what to do if glucose tolerance is impaired. Many refuse to consult a doctor, fearing that he will prescribe insulin injections. But it is too early to talk about the need for such treatment. With NTG, another therapy is practiced: lifestyle changes, dietary changes.

Only in extreme cases, drug therapy is required. In most patients, improvements occur if:

• switch to fractional nutrition (food is taken 4-6 times a day, the calorie content of the last meals should be low);
• minimize the amount of simple carbohydrates (remove cakes, pastries, buns, sweets);
• achieve weight loss of at least 7%;
• drink at least 1.5 liters of clean water daily;
• minimize the amount of animal fats, vegetable fats should come in a normal amount;
• include a significant amount of vegetables and fruits in the daily diet, with the exception of grapes, bananas.

Particular attention is paid to physical activity.

Compliance with these principles of nutrition in combination with adequate physical activity is the best way to treat prediabetes.

They talk about drug therapy if such therapy fails. To evaluate the effectiveness of the treatment, not only a glucose tolerance test is done, but also the level of glycated hemoglobin is checked. This study allows you to estimate the sugar content over the past 3 months. If a downward trend is visible, then diet therapy is continued.

If concomitant problems or diseases are found that provoke a deterioration in the absorption of insulin by the tissues, adequate treatment of these diseases is necessary.

If the patient follows a diet and fulfills all the instructions of the endocrinologist, but there is no result, then drugs that are used in the treatment of diabetes can be prescribed. It can be:

• thiazolidinediones;
• α-glucosiad inhibitors;
• sulfonylurea derivatives.

The most popular drugs for treating carbohydrate metabolism disorders are metformin derivatives: Metformin, Siofor, Glucofage, Formetin. If the desired result is not achieved, then in combination with these drugs, other drugs are prescribed that are intended for the treatment of diabetes.

Subject to recommendations, restoration of normal blood sugar levels is observed in 30% of patients with an established diagnosis of NTG. But at the same time, a high risk of developing diabetes in the future remains. Therefore, even with the removal of the diagnosis, it is impossible to completely relax. The patient should monitor his diet, although periodic relief is allowed.

Expert Commentary:

adiabet.ru

Hyperglycemia. The most common disorders of carbohydrate metabolism, characterized by an increase in blood glucose levels - hyperglycemia. With the first detected increase in blood glucose, it is first necessary to determine what category of carbohydrate metabolism disorders this patient belongs to. According to the latest criteria for carbohydrate metabolism disorders, there are three main categories of hyperglycemia.

Only a fasting glucose test is used for screening. This is done when contacting the clinic for a variety of reasons. Upon receipt of indicators exceeding the norm, the study is repeated.

if the indicator in whole venous blood again exceeds the figure of 6.1 mmol / l, the doctor has the right to make a diagnosis of diabetes mellitus. Further studies of glycemia during the day are necessary to resolve the issue of the need for drug therapy and the appointment of the right drugs. In case of accidental detection of glycemia in whole blood from 5.6 to 6.1 mmol / L, further clarification of the variant of carbohydrate metabolism disturbance is required. For this, either an oral glucose tolerance test is used, or a measurement of glycemia after a meal with a sufficient content of carbohydrates.

These studies allow us to differentiate impaired fasting glycemia and impaired glucose tolerance.

All diagnostics of diabetes should be carried out without the use of a diet with a restriction of carbohydrates, in a period that excludes stressful increases in blood glucose (acute period of myocardial infarction, cerebrovascular accident, fever, trauma, nervous stress). Fasting glycemia - determined on an empty stomach after nightly fasting for 8-10 hours. Postprandial glycemia - 2 hours after a meal. Rules for the Oral Glucose Tolerance Test (OTTG)

The oral glucose tolerance test should be performed according to the following rules:
  The patient should not limit himself in the use of carbohydrates (at least 150 g of carbohydrates per day) within 3 previous days.
  The test is carried out after complete fasting for 10-14 hours, while the use of water is not limited.
  During the test, the patient does not perform any physical activity, does not eat, does not smoke, does not take medications.

  Drink plain water.
  The subject takes capillary blood from a finger to determine the initial glucose content.
  After that, he drinks 75 g of glucose dissolved in 250-300 ml of water for 5-15 minutes (for children - 1.75 g / kg, but not more than 75 g).
  The second blood sample is taken 2 hours after taking glucose, in some cases - an hour later.

The determination of glucose in the urine is not a diagnostic test, but this study is important for the further algorithm for the study of carbohydrate disorders.

Glycosuria depends on the renal threshold of glucose. Typically, with a blood glucose of more than 10 mmol / L (180 mg%), glucose is also found in urine. With age, the renal threshold for glucose rises. With a positive test of glucose in the urine, blood tests are further performed according to the scheme proposed above. Diagnosis of diabetes mellitus by the level of glycated Hb has not been accepted, since precise digital criteria have not been developed. It is not used for the diagnosis of diabetes IV test with glucose, although in special scientific research this is possible.

The use of glucometers to establish the initial presumptive diagnosis of diabetes is possible, but confirmation of the diagnosis by the above-described measurement of glycemia level is required, since glucometers have a large scatter of indicators. Depending on the glycemia indicators, the type of carbohydrate metabolism disorder is determined. Commenting on the table of diagnostic criteria for diabetes and other disorders of carbohydrate metabolism, it can be emphasized that two types of pathological conditions, manifested by an increase in blood glucose levels, were previously distinguished:
  - impaired glucose tolerance (NTG);
  - diabetes mellitus (DM).

In the criteria for carbohydrate disorders (1999), a third was added to the two indicated types of pathology of carbohydrate metabolism - impaired fasting glycemia.

For each of these conditions, clear quantitative criteria for the level of glucose in the blood (whole blood - venous and capillary, and in plasma - venous and capillary) are defined. It should be noted that these indicators are somewhat different from each other. Therefore, the term "glycemia" in the exact quantitative determination of glucose in the blood is not authorized. It is necessary to precisely indicate “glucose in capillary, venous blood” or “glucose in capillary plasma” or “in venous plasma”. This is especially important for the diagnosis of variants of carbohydrate metabolism disorders, as well as for research work. Venous whole blood has the lowest glucose values, the highest rates are in capillary blood plasma.

Normal blood glucose readings:
  On an empty stomach, from 3.3 to 5.5 mmol / L (59-99 mg%) in whole venous and capillary blood, from 4.0 to 6.1 mmol / L (72-110 mg%) in plasma - venous and capillary.
  2 hours after a meal or glucose tolerance test, blood glucose level: in venous blood - up to 6.7 mmol / l (120 mg%), in capillary blood - up to 7.8 mmol / l (140 mg%), in capillary plasma - up to 8.9 mmol / l (160 mg%).

Fasting glycemia:
The fasting glucose level exceeds 5.6 mmol / L (100 mg%), but less than 6.1 mmol / L (110 mg%) in whole blood (both venous and capillary). But in plasma, this indicator should be greater than 6.1 mmol / L (110 mg%), but less than 7.0 mmol / L (126 mg%).
  2 hours after a meal or glucose tolerance test, blood glucose levels should be normal (up to 6.7 mmol / L (120 mg% in venous blood), up to 7.8 mmol / L (140 mg% in capillary blood) , in capillary plasma, up to 8.9 mmol / L (160 mg%).

Impaired glucose tolerance:
  The fasting glucose level is more than 5.6 mmol / L (100 mg%), but less than 6.1 mmol / L (110 mg%) in both venous and capillary blood, less than 7.0 mmol / L (126 mg% ) in venous and capillary plasma (as in case of impaired fasting glycemia).
  2 hours after a meal or glucose tolerance test or at any time of the day, the glucose level is more than 6.7 mmol / L (120 mg%), but less than 10.0 mmol / L (180 mg%) in venous blood; in capillary blood, more than 7.8 mmol / L (140 mg%), but less than 11.1 mmol / L (200 mg%); in capillary plasma, more than 8.9 mmol / L (160 mg%), but less than 12.2 mmol / L (220 mg%).

Diabetes:
  Fasting - glucose of more than 6.1 mmol / l (110 mg%) in both venous and capillary blood, more than 7.0 mmol / l (126 mg%) in venous and capillary plasma.
  2 hours after a meal or glucose tolerance test or at any time of the day - more than 10.0 mmol / l in venous blood and more than 11.1 mmol / l in capillary blood and venous plasma, more than 12.2 mmol / l (220 mg%) in capillary plasma.

Thus, the diagnosis of diabetes can be made only on the basis of laboratory data on the glucose content. It could be:
  an increase in glucose of capillary or venous blood above 6.1 mmol / l twice (if in doubt - three times);
  an increase in glucose of capillary blood above 11.1 mmol / l or venous blood above 10.0 mmol / l 2 hours after OTTG, or a meal with a sufficient content of carbohydrates, or with a random determination of blood glucose at any time.

The difference in glucose content in venous, capillary whole blood, in venous, capillary plasma creates certain difficulties in interpreting these results to determine the category of disorders of carbohydrate metabolism. It must be remembered that when determining glucose in plasma, normal values \u200b\u200bare 13-15% higher. After obtaining such results, the presence of diabetes should be noted, however, this diagnosis can only be considered as a preliminary. The data obtained should be confirmed by re-determining the level of glucose in the blood on other days. It should be borne in mind that today the normal fasting blood glucose is significantly reduced compared to what it was before. It can be assumed that this circumstance will make it possible to detect carbohydrate metabolism disorders at the earliest stages and increase the effectiveness of the fight against this pathology. However, an increase in established diagnoses of diabetes by 15% is expected, and this must be taken into account when calculating financial and other costs.

Having established the diagnosis of diabetes by indicators of glucose in the blood or plasma, then it is necessary to try to determine the type of diabetes. At the first stage of differentiation of diabetes syndrome, the following clarification should be made: whether the violation of carbohydrate metabolism is independent, primary, or whether it is caused by the presence of another disease, being a consequence of specific removable causes, that is, secondary. In clinical practice, it is easier to start with the exclusion or confirmation of secondary diabetes.

The causes of secondary diabetes are most often:
  1) pancreatic disease;
  2) hormonal abnormalities that occur in a number of endocrine diseases (acromegaly, Cushing's syndrome, pheochromocytoma, etc.);
  3) drug or chemically induced disorders of carbohydrate metabolism (taking catecholamines, glucocorticoids, cytostatics, etc.);
  4) tumors - glucagonoma, somatostatinoma, vipoma, etc .;
  5) chronic stresses - “stressful hyperglycemia” in case of a burn disease, myocardial infarction, multiple complex surgical interventions, etc .;
  6) disorders of carbohydrate metabolism in genetic syndromes, such as myotonic dystrophy, ataxia-telangiectasia, lipodystrophy, etc .;
  7) disorders in the structure of insulin receptors.

In determining the history of the disease and detailing the patient's complaints, it is possible to suspect a pancreatic lesion (especially in alcohol abusers), to suggest the presence of a hormone-active tumor. In this case, it is possible to obtain information about the patient taking certain medications that can induce hyperglycemia. However, it should be remembered that cases of simulation or aggravation of the disease are possible. In these cases, identifying a drug as a cause of hyperglycemia will be a daunting task.

Cases of secondary diabetes due to impaired insulin sensitivity of cell receptors can be very difficult. It is especially difficult to recognize cases of autoimmune blockade of insulin receptors located on the liver cells. In these cases, the explanation of the cause of diabetes can be carried out only with a special examination in a specialized institution. But suspicions of the presence of a similar situation should appear in a doctor who observes the lack of effect of a variety of therapies, especially when treated with insulin. After eliminating the presence of secondary diabetes, the nature of the syndrome of primary violation of carbohydrate metabolism is clarified.

A statement of reliable detection of carbohydrate metabolism disorders by the type of hyperglycemia cannot be the completion of the doctor’s work on the differential diagnosis of this syndrome. From a practical point of view, it seems necessary to quickly determine the presence or absence of dependence of carbohydrate metabolism disorders on insulin. For many years there was a clear division of patients with similar disorders of carbohydrate metabolism into groups. Groups of patients with insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus were allocated. However, experience shows that it is not always easy to predict the dependence of the patient's pathology on insulin. Many individuals whose appearance suggested that they had type 2 diabetes and who initially responded well to treatment that did not include insulin further demonstrated a clear need for insulin. Without it, they often fell into a ketoacidotic coma. In this regard, it was suggested that patients with the presence of diabetes syndrome should be distinguished depending on the presence of a tendency to develop ketoacidotic conditions requiring insulin therapy, in those suffering from diabetes, prone to ketoacidosis, and diabetes, not prone to ketoacidosis.

Modern studies of the pathogenesis of diabetes have led to the recognition that it is advisable to find the dependence of diabetes on immune mechanisms, and a desire has been expressed to note its presence or absence in the diagnosis. It was recommended to subdivide the diabetes mellitus syndrome into autoimmune diabetes and autoimmune day C. During such differentiation, the doctor needs to quickly make the right decision about the necessary therapy for a particular patient. We emphasize once again that modern knowledge obliges us to know that the concept of “diabetes mellitus” does not reflect any particular disease, but only speaks of the phenomenon of diabetes syndrome, which can be caused by many different reasons.

In practical terms, it seems necessary to quickly determine the presence or absence of dependence of disorders of carbohydrate metabolism on insulin. Since 1989, there has been a clear division of patients into the groups IDDM (insulin-dependent diabetes mellitus) and NIDDM (non-insulin-dependent diabetes mellitus). The current pathogenetic classification of diabetes has undergone certain changes. Due to the fact that so far the majority of practitioners continue to use the domestic classification of 1989, we present both - the old classification and the classification of diabetes, proposed by the WHO Expert Committee in 1999, for comparison, and not for recommending the use of the previous classification .

Articles from the Diabetology section:

Why can diabetes lead to kidney failure and stroke if not controlled?

medkarta.com

What is glucose tolerance

Each person needs carbohydrates, which are subject to transformation in the digestive tract with the formation of glucose. They contain almost all products. The more sugar in food, the more glucose the body will receive, but this is an easily digestible food, from which there is little need for a person.

Here are the products that pose the greatest threat:

• non-durum wheat pasta;
• bakery products of premium flour;
• muffin (rolls, pies, bagels, donuts);
• sweets (cakes, pastries, creme rolls).

This is not to say that these products will lead to diabetes directly, but at the same time, weight gain and obesity lead to a change in metabolic processes, but this is the first factor in impaired glucose uptake. It is about the development of a violation of type 2.

Glucose tolerance is a concept that characterizes the body’s ability to metabolize glucose from food in such a way that its excess does not occur.

The glucose distribution mechanism is as follows:

1. After the breakdown of food, glucose is absorbed by the vessels of the stomach and intestines and enters the bloodstream.
2. Since glucose is the main food for the brain, part of it goes there.
3. Other cells that need energy take the monosaccharide through protein transport systems.
4. For muscles and fat cells, this transport system is insulin. The brain receives a signal that there is an excess amount of glucose in the blood and instructs the cells of the pancreas to produce insulin.
5. Insulin cells strictly correspond to glucose molecules like a key-lock system, they fit and capture it, transfer it to cells and tissues. The release of insulin strictly corresponds to an excess of glucose.

This ensures the concentration of glucose in normal values.

If for some reason there is insufficient secretion of insulin, then there is always an excess of glucose in the blood, and increased indicators appear in the analysis. But these numbers are not high enough to diagnose diabetes in a patient. This condition is called impaired glucose tolerance.

The concept of pathology

Here it’s time to figure it out. Impairment of glucose tolerance - what is it: earlier this syndrome was attributed to one of the stages of diabetes mellitus, and now it has been allocated in a separate name.

If a person has fasting glucose closer to the upper limit of normal or from 5.5 to 6 mmol / l, then the question arises - where does the source of glucose come from?

There are 2 options left:

• the person has violated the rules for preparing the test;
• there really was a problem.

To confirm, the test is repeated, and if it again has the same indicators, then a glucose tolerance test is prescribed.

Tolerance test

This study is done by taking glucose solution internally. Registration of the result occurs after a certain time. His choice is not accidental: data are known on how much time after eating a decrease in blood sugar occurs. The lengthening of this time allows us to conclude that a violation has occurred.

Here is a list of some of the limitations for testing:

• alcohol and smoking on the eve and during testing;
• period during and after stress;
• eating
• diseases leading to exhaustion, childbirth, recovery from fractures;
• gI diseases are also contraindications, in which glucose absorption is impaired (cirrhosis, gastritis and gastroduodenitis, colitis);
• oncological diseases;
• diet (there may be a violation of the interpretation of the results);
• menstruation.

For pregnant women, the study is conducted with certain features. For women in position, a solution of a lower concentration is used.

If there are disorders with the absorption of the gastrointestinal tract, then the test is carried out not orally, but intravenously.

The preparation for the study must be correct so that the results are informative.

On the eve of the study, there is no need to reduce glucose intake, but it is not worth increasing. If the amount of carbohydrates is less than 120-150 g, then during the test, a higher value of sugar will be observed, and it will fall more slowly.

It is necessary to monitor physical activity before the study and adhere to the usual regimen. A more intense load causes an increased consumption of monosaccharides not only from the blood, but also the consumption of its reserves from liver glycogen. This forms a carbohydrate hunger: the body requires replenishment from stocks. Therefore, the result of GTT may be distorted.

You should be aware that on the eve of the study they stop taking psychotropic, hormonal, stimulants, contraceptives, diuretics.

The technique of its implementation is simple:

1. A man comes to the clinic in the morning, gives a fasting blood test from a finger or vein. In addition, a urinalysis is given.
2. After that, he drinks a glass of glucose solution, where 75 g of sugar is dissolved in warm water.
3. Every 30 minutes, a measurement of glucose in the blood and urine.
4. After 2 hours, the result is evaluated.

If after 2 hours the indicator is 7.8 mmol / l, then this is the normal value. With a value between this indicator and 11.0, a violation of tolerance is observed, and above this value it talks about diabetes.

During testing, a person may become ill, then it must be laid. To ensure a sufficient amount of urine, he is allowed to drink warm water. After testing, the patient needs to eat tightly, the food should contain carbohydrates.

Causes and symptoms

The reasons for the deviations may be different:

1. Genetic predisposition, which is more characteristic for diabetes, which begins after a violation of tolerance.
2. Damage to the pancreas, which causes a lack of insulin production. It is released into the bloodstream, but is not able to capture glucose molecules.
3. The development of insulin resistance.
4. Overweight, obesity.
5. Lack of motor activity.
6. Prescribing long-term use of drugs that affect carbohydrate metabolism.
7. Disorders in the activity of the endocrine glands (hypothyroidism, Cushing's syndrome).
8. Pressure increase.
9. High cholesterol for a long time.
10. Gout.

Studies have found that deviations are most often observed in people over 45 years old and in some pregnant women. They have a violation of tolerance is temporary and ends after childbirth.

Violation of tolerance is also called prediabetes, since a person can only feel some symptoms characteristic of diabetes, but there is no clinical evidence of it:

1. Blood glucose can remain normal even on an empty stomach.
2. Urine does not detect glucose.

The disease may not manifest itself for a long time.

Symptoms of tolerance may include the following symptoms:

• dry mouth and thirst, and it is not possible to quench it;
• itchy skin;
• more frequent urination;
• change in appetite in both directions;
• damage to the skin and mucous membranes does not heal for a long time;
• in women there are deviations in the menstrual cycle, menstruation can stop completely;
• vascular disease of an inflammatory nature;
• sudden onset of vision problems.

boleznikrovi.com

Prediabetic condition: causes

The main causes of impaired glucose tolerance are as follows.:

• significant excess weight, in the development of which the main factors are transmission and a sedentary lifestyle;
• genetic predisposition: it was proved that family members where someone was ill or suffering from diabetes are also at risk, which made it possible to isolate certain genes responsible for the production of high-grade insulin, the sensitivity of peripheral tissue receptors to insulin and other factors;
• age and gender: most often prediabetes and diabetes are diagnosed in women over the age of 45;
• other diseases: it is primarily about diseases of the endocrine system leading to hormonal and metabolic failure, as well as diseases of the gastrointestinal tract (stomach ulcers, due to which glucose absorption can be impaired) and diseases of the cardiovascular system (atherosclerosis, high blood pressure, high cholesterol, etc.). For women, polycystic ovary disease may be a risk factor;
• complicated pregnancy: often prediabetes, turning into type 2 diabetes, also occurs after gestational diabetes, which occurs in women during pregnancy. Usually problems with blood sugar occur in the case of late pregnancy or large fetus.

It should also be remembered that the prediabetic state can be diagnosed not only in adults, but also in children. Prediabetes in a child usually occurs as a consequence of an infectious disease, less commonly, surgical intervention, which makes it necessary to pay special attention to the period of rehabilitation of the child after an illness or surgery.

Prediabetic condition: complications

The main complication of this condition is, of course, its possible transition to acquired type 2 diabetes, which is much more difficult to control. In addition, the presence of excess blood sugar, albeit not at a critical level, leads to an increase in blood density, which can cause plaque formation, clogging of blood vessels and, as a result, problems with the cardiovascular system, namely heart attacks and strokes.

In turn, the transition of the prediabetic state to diabetes entails the possible defeat of other body systems, including the kidneys, vision, nervous system, decreased immunity and general body resistance.

Prediabetic condition: symptoms

Since the violation of tolerance is not yet a disease as such, it is most often asymptomatic. The presence of any symptoms most often indicates latent (latent) diabetes mellitus or very close to this condition that requires treatment.

The presence of the following symptoms suggests a glucose tolerance test:

• dry mouth, thirst, especially with emotional and mental stress and, as a result, increased daily fluid intake: the body feels the need for more water to dilute thick blood;
• frequent urination, including with an increase in urine volume, single and daily: consumption of more water forces the body to excrete it more often;
• severe hunger, including nighttime, which usually leads to overeating and weight gain: there is an accumulation of insulin, a hormone that lowers blood sugar.
• fast fatiguability;
• fever, dizziness after eating: occur due to a sharp change in blood sugar;
• headaches: can be caused by narrowing of the vessels of the brain due to the formation of plaques in them.

As you can see from the list, the signs of prediabetes are quite blurred (only thirst and frequent urination can be considered a specific symptom), therefore, diagnosis is of particular importance in this case.

dcenergo.ru

General information

The impaired glucose tolerance associated with a decrease in the absorption of blood sugar by the body's tissues was previously considered the initial stage of diabetes (latent diabetes mellitus), but recently it has been allocated as a separate disease.

This disorder is a component of the metabolic syndrome, which is also manifested by an increase in visceral fat mass, arterial hypertension and hyperinsulinemia.

According to existing statistics, impaired glucose tolerance was detected in approximately 200 million people, and often this disease is detected in combination with obesity. Prediabetes in the United States is observed in every fourth full-bodied child aged 4 to 10 years, and every fifth complete child aged 11 to 18 years.

Every year, 5-10% of people with impaired glucose tolerance experience a transition of this disease to diabetes mellitus (usually such a transformation is observed in patients with overweight).

Development reasons

Glucose as the main source of energy provides metabolic processes in the human body. Glucose enters the body due to the consumption of carbohydrates, which, after decay, are absorbed from the digestive tract into the bloodstream.

Insulin (a hormone that is produced by the pancreas) is required for the absorption of glucose by the tissues. Due to the increased permeability of plasma membranes, insulin allows tissues to absorb glucose, lowering its level in the blood 2 hours after eating to normal (3.5 - 5.5 mmol / l).

Causes of impaired glucose tolerance may be due to hereditary factors or lifestyle. Factors contributing to the development of the disease are:

• genetic predisposition (the presence of diabetes mellitus or prediabetes in close relatives);
• obesity;
• arterial hypertension;
• elevated blood lipids and atherosclerosis;
• diseases of the liver, cardiovascular system, kidneys;
• gout
• hypothyroidism;
• insulin resistance, in which the sensitivity of peripheral tissues to the effects of insulin decreases (observed with metabolic disorders);
• pancreatic inflammation and other factors contributing to impaired insulin production;
• increased cholesterol;
• sedentary lifestyle;
• diseases of the endocrine system, in which contrainsular hormones are produced in excess (Itsenko-Cushing's syndrome, etc.);
• abuse of foods that contain a significant amount of simple carbohydrates;
• taking glucocorticoids, oral contraceptives and some other hormonal drugs;
• age after 45 years.

In some cases, a violation of glucose tolerance in pregnant women is also detected (gestational diabetes, which is observed in 2.0-3.5% of all cases of pregnancy). Risk factors for pregnant women include:

• excess body weight, especially if excess weight appeared after 18 years;
• genetic predisposition;
• age over 30 years;
• the presence of gestational diabetes in previous pregnancies;
• polycystic ovary syndrome.

Pathogenesis

Impaired glucose tolerance results from a combination of impaired insulin secretion and decreased tissue sensitivity.

The formation of insulin is stimulated by food intake (it does not have to be carbohydrates), and its release occurs when the blood glucose level rises.

Insulin secretion is enhanced by the effects of amino acids (arginine and leucine) and certain hormones (ACTH, HIP, GLP-1, cholecystokinin), as well as estrogens and sulfonylureas. Increased insulin secretion and with an increased content in plasma of calcium, potassium or free fatty acids.

Decreased insulin secretion occurs under the influence of glucagon, a hormone of the pancreas.

Insulin activates the transmembrane insulin receptor, which refers to complex glycoproteins. The constituents of this receptor are two alpha and two beta subunits connected by disulfide bonds.

The alpha subunits of the receptor are located outside the cell, and the transmembrane protein of the beta subunit is directed inside the cell.

An increase in glucose levels normally causes an increase in tyrosine kinase activity, but in prediabetes there is a mild violation of the binding of the receptor to insulin. The basis of this violation is a decrease in the number of insulin receptors and proteins that provide glucose transport into the cell (glucose transporters).

The main target organs exposed to insulin include the liver, adipose and muscle tissue. The cells of these tissues become insensitive (resistant) to insulin. As a result, glucose uptake in peripheral tissues decreases, glycogen synthesis decreases, and prediabetes develops.

The latent form of diabetes can be caused by other factors affecting the development of insulin resistance:

• a violation of the permeability of capillaries, which leads to a violation of the transport of insulin through the vascular endothelium;
• accumulation of altered lipoproteins;
• acidosis;
• accumulation of hydrolase class enzymes;
• the presence of chronic foci of inflammation, etc.

Insulin resistance may be associated with a change in the insulin molecule, as well as with increased activity of contrainsular hormones or pregnancy hormones.

Symptoms

Violation of glucose tolerance at the initial stages of the development of the disease is not clinically manifested. Patients are often overweight or obese, and the examination reveals:

• fasting normoglycemia (glucose in peripheral blood is normal or slightly higher than normal);
• lack of glucose in the urine.

Prediabetes may be accompanied by:

• furunculosis;
• bleeding gums and periodontal disease;
• skin and genital itching, dry skin;
• long non-healing skin lesions;
• sexual weakness, menstrual irregularities (amenorrhea is possible);
• angioneuropathy (lesions of small vessels accompanied by impaired blood flow, combined with nerve damage, which is accompanied by impaired conduction of impulses) of various severity and localization.

As the violations worsen, the clinical picture may be supplemented:

• feeling of thirst, dry mouth and increased water intake;
• frequent urination;
• a decrease in immunity, which is accompanied by frequent inflammatory and fungal diseases.

Diagnostics

Impairment of glucose tolerance in most cases is detected by chance, since patients do not present any complaints. The basis for the diagnosis is usually the result of a blood test for sugar, which shows an increase in fasting glucose to 6.0 mmol / L.

Diagnostics includes:

• history analysis (data on concomitant diseases and relatives suffering from diabetes are being specified);
• general examination, which in many cases reveals the presence of excess body weight or obesity.

The basis of the diagnosis of “prediabetes” is a glucose tolerance test, which assesses the body’s ability to absorb glucose. In the presence of infectious diseases, increased or decreased physical activity for the day before the test (does not correspond to the usual) and taking drugs that affect the level of sugar, the test is not performed.

Before taking the test, it is recommended that you do not limit your diet for 3 days, so that carbohydrate intake is at least 150 g per day. Physical activity should not exceed standard loads. In the evening, before taking the analysis, the amount of carbohydrates consumed should be from 30 to 50 g, after which the food is not consumed for 8-14 hours (drinking water is allowed).

The analysis includes:

• fasting blood sampling for sugar analysis;
• intake of glucose solution (for 75 g of glucose, 250-300 ml of water is needed);
• repeated blood sampling for sugar analysis 2 hours after taking glucose solution.

In some cases, additional blood samples are taken every 30 minutes.

During the test, smoking is prohibited so that the analysis results are not distorted.

Violation of glucose tolerance in children is also determined using this test, but the “load” of glucose on a child is calculated based on its weight - 1.75 g of glucose is taken for each kilogram, but in total no more than 75 g.

The impaired glucose tolerance during pregnancy is checked by an oral test between 24 and 28 weeks of pregnancy. The test is carried out using the same methodology, but it involves an additional measurement of blood glucose levels one hour after the glucose solution has been taken.

Normally, the glucose level during repeated blood sampling should not exceed 7.8 mmol / L. A glucose level of 7.8 to 11.1 mmol / L indicates a violation of glucose tolerance, and a level above 11.1 mmol / L is a sign of diabetes.

With a re-detected fasting glucose level above 7.0 mmol / L, the test is not practical.

The test is contraindicated in individuals whose fasting glucose concentration exceeds 11.1 mmol / L and those who have had a recent myocardial infarction, surgery or childbirth.

If it is necessary to determine the secretory reserve of insulin, the doctor may conduct a determination of the level of C-peptide in parallel with the glucose tolerance test.

Treatment

The treatment of prediabetes is based on non-drug effects. Therapy includes:

• Diet adjustment. Diet for impaired glucose tolerance requires the exclusion of sweets (sweets, cakes, etc.), limited intake of easily digestible carbohydrates (flour and pasta, potatoes), limited consumption of fats (fatty meats, butter). A fractional meal is recommended (small servings about 5 times a day).
• Strengthening physical activity. Recommended daily physical activity, lasting 30 minutes - an hour (sports should be conducted at least three times a week).
• Body weight control.

In the absence of a therapeutic effect, oral hypoglycemic drugs are prescribed (a-glucosidase inhibitors, sulfonylureas, thiazolidinediones, etc.).

Treatment measures are also carried out to eliminate risk factors (the thyroid gland normalizes, lipid metabolism is corrected, etc.).

Forecast

In 30% of people with a diagnosis of impaired glucose tolerance, blood glucose levels subsequently return to normal, but in most patients there is a high risk of this disorder becoming type 2 diabetes.

Prediabetes can contribute to the development of diseases of the cardiovascular system.

Prevention

Prevention of prediabetes includes:

• A proper diet, which eliminates the uncontrolled use of sweet foods, flour and fatty foods, and increases the amount of vitamins and minerals.
• Adequate regular physical activity (any sports or long walks. The load should not be excessive (the intensity and duration of physical exercises increase gradually).

Body weight control is also necessary, and after 40 years, a regular (every 2-3 years) check of blood glucose levels.

liqmed.ru

What is prediabetes?

What is prediabetes? This is an intermediate state between diabetes and the normal state of normal pancreatic function. Those. when pancreatic cells still secrete insulin, but they secrete it either very little or not correctly. As you know, this function of the pancreas works for us automatically, i.e. depending on glucose entering the blood, the required amount of insulin is released for its processing automatically. In case of malfunctions or diseases of the pancreas, a condition such as prediabetes or a violation of tolerance to carbohydrates occurs. At this step, I will tell my feelings and symptoms about how to recognize prediabetes, and in the following articles I will describe in more detail how to eat in case of chronic pancreatitis and how to treat this condition. By the way, with the right approach, this condition can be cured and become a normal person, or exacerbated and become a diabetic. Only on your behavior depends on the result of what this disease will turn out for you.

Prediabetes symptoms. Personal experience.

1. Sleep disturbance. With a violation of tolerance to glucose, the hormonal background changes, the amount of insulin decreases. The body responds to these changes with insomnia. Everything is normal in your birthplace, but you cannot fall asleep. Sleep does not occur and you fall into mutual responsibility without sleep.
2. Itching in the anus. Due to the fact that glucose in the body does not work at the right time, the blood becomes thick and gets stuck in small vessels of copilars. A large number of these vessels are in the anus and intestines, as well as in the eyes. What causes itching. It is very well felt in people predisposed to varicose veins.
3. Visual impairment. As in the previous paragraph, the violation is due to the fact that the blood supply to small vessels is disturbed, which leads to loss of vision. Flickering stars and other signs associated with visual impairment.
4. Thirst and rapid urination. Thirst arises due to the fact that the body fights high blood sugar with the help of moisture contained in the body, i.e. all moisture is taken from the body to dilute thick blood. From here there is a strong thirst, and subsequently a strong urination. The process passes until the blood sugar reaches the level of 5.6-6 mol.
5. Headache. Prediabetes is a disease that is strongly reflected in the vessels, so frequent headaches in the morning or evening are logical for impaired carbohydrate tolerance.
6. Heat at night. Personally, night was my most disliked time. Since in the afternoon violations are still not noticeable. And at night, because of high blood sugar, I warmed up like a stove. It's winter outside, and you have your windows open and you're hot.
7. Strong weight loss. Insulin is a hormone that opens the cell and lets glucose in. Thus, glucose is either converted into energy or stored in reserve by our body. The cells in our body feed on glucose. With prediabetes, there is little insulin and glucose does not work during and hangs in the blood not processed. Actually, we have high blood sugar. I lost 10 kg in 3 months.
8. Muscle cramps at night. Muscle cramps occur at night due to poor nutrition of muscle tissue.
9. Elevated blood sugar 2 hours after a meal.
10. Disturbed indicators in blood tests, especially in mineral composition.

With this set of symptoms, I lived for six months in the fight against prediabetes. Well, all the same, we do not live in Africa and can identify these symptoms in the analyzes. I will tell you what to do and what tests to pass in order to understand if you have prediabetes.

Blood on sugar on an empty stomach - measure glucose on an empty stomach.

The first thing to do is go to the doctor. Go directly to the endocrinologist, the therapist can only lose time. Although if he gives you a blood test for sugar, it will help you. We remember, we donate blood for sugar on an empty stomach in our clinic. The normal indicator is 5, if 6.7 and above all run to the doctor. But I had an indicator of 5 mol. Because the clinic is not located near the house and while I was driving and sitting in line, glucose had time to digest. As a result, the therapist did not find anything. I also didn’t eat after 19-00 it was hot for me to sleep and artificially reduced my glucose level. To determine the disease of prediabetes, you need to pass a glucose tolerance test. This method will give an 80% answer if you have impaired glucose uptake. The test cannot be performed if your pancreas hurts. Since you get a carbohydrate shock and inflame the gland even more. The test is carried out on an empty stomach. You are given 75g of glucose to drink and then blood sugar levels are measured. It turns out a carbohydrate curve. If, after 1 hour, your blood sugar is more than 11, and after 2 hours more than 6, then you have prediabetes or even worse diabetes. What to do if your pancreas hurts and you can’t do a glucose tolerance test. You must donate blood for the c-peptide and insulin. If one of the indicators, or more often two, is below the norm, then you have impaired glucose tolerance or prediabetes develops. I recommend reading my next post and finding out how a diet helps with pancreatitis.

Examination of the pancreas. Analyzes

If you want to check your pancreas, I recommend taking the following tests. You can write them on a leaflet (name) and go to the doctor. The therapist needs to be given a sheet, let him write out the necessary directions. Many doctors do not really know this organ and give general tests that may not show anything at the initial stage, and the disease will already develop in your body.

Analyzes

They are prescribed for if a pancreatic lesion is suspected.

1. α-amylase
2. Amylase Pancreatic
3. Lipase
4. Glucose
5. Insulin

The following profile will assess the degree of disorders of carbohydrate and lipid metabolism, liver and kidney function, and conduct differential diagnosis of type I and type II diabetes mellitus. It is very important. Remember, you can lose time and let the cells die. This cannot be allowed or then there is no turning back.

1. General urine analysis
2. Microalbumin in the urine
3. Glucose
4. Glycated Hemoglobin
5. Insulin
6. C peptide
7. Cholesterol

Additionally:
Antibodies to islet cells of the pancreas. This is a complex analysis I did not do.
  Not every doctor can write such a profile. If this is problematic, get tested for a fee.

midleast.net

What is a similar violation?

What is impaired glucose tolerance? With a similar condition, a person has an increase in blood glucose. The amount of sugar is higher than normal, but at the same time lower than that in which patients are diagnosed with type 2 diabetes mellitus.

Thus, impaired tolerance is one of the risk factors. Recent research findings have shown that approximately one third of patients eventually develop diabetes. Nevertheless, subject to certain rules and well-chosen medication, metabolism is normalized.

The main reasons for the development of glucose tolerance

Not in all cases, doctors can determine why the patient developed such a disease. Nevertheless, it was possible to find out the main causes of impaired glucose tolerance:

• First of all, it is worth mentioning the genetic predisposition, which takes place in many cases. If one of your close relatives has diabetes, the likelihood of developing such a condition increases significantly.
• In some patients, the so-called insulin resistance is detected during the diagnosis process, in which the sensitivity of cells to insulin is impaired.
• In some cases, impaired glucose tolerance develops as a result of pancreatic diseases in which its secretory activity is impaired. For example, problems with carbohydrate metabolism can appear against the background of pancreatitis.
• The causes can also include some diseases of the endocrine system, which are accompanied by metabolic disorders and increased blood sugar (for example, Itsenko-Cushing's disease).
• One of the risk factors is obesity.
• A sedentary lifestyle also negatively affects the body.
• Sometimes a change in the amount of sugar in the blood is associated with taking medications, in particular hormones (in most cases, glucocorticoids become the “culprits”).

Glucose tolerance disorder: symptoms

Unfortunately, such a pathology in most cases is asymptomatic. Patients rarely complain of deterioration of health or simply do not notice it. By the way, for the most part, people with a similar diagnosis are overweight, which is associated with a violation of normal metabolic processes.

With the aggravation of carbohydrate metabolism disorders, characteristic signs begin to appear, which are accompanied by impaired glucose tolerance. Symptoms in this case are thirst, a feeling of dry mouth and increased fluid intake. Accordingly, in patients there is also frequent urination. Against the background of hormonal and metabolic disorders, a significant decrease in immune defense is observed - people become extremely susceptible to inflammatory and fungal diseases.

Why is this disorder dangerous?

Of course, many patients with this diagnosis are interested in questions about the danger of impaired glucose tolerance. First of all, such a condition is considered dangerous because, if untreated, the risk of developing a well-known insidious disease, namely type 2 diabetes, is very high. On the other hand, such a disorder increases the likelihood of developing diseases of the cardiovascular system.

Basic diagnostic methods

The diagnosis of “impaired glucose tolerance” can only be made by a doctor. To begin with, a specialist will conduct an examination and collect an anamnesis (the presence of certain complaints from the patient, information about previously transmitted diseases, the presence of people with diabetes in the family, etc.).

In the future, a standard blood test for sugar level is performed. Samples are taken in the morning, on an empty stomach. A similar procedure is carried out in any clinic. As a rule, the glucose level in such patients exceeds 5.5 mmol / L. However, to establish an accurate diagnosis, a special glucose tolerance test is needed.

Test and indications for its implementation

Such a study is by far one of the most accessible and effective methods for diagnosing a condition called “impaired glucose tolerance”. But although testing is fairly straightforward, proper preparation is crucial here.

For several days before taking the blood, the patient is advised to avoid stress and increased physical activity. The procedure is carried out in the morning and on an empty stomach (not earlier than 10 hours after the last meal). First, a portion of blood is taken from the patient, after which they offer to drink glucose powder dissolved in warm water. After 2 hours, a repeated blood sampling is performed. In laboratory conditions, the sugar level in the samples is determined and the results are compared.

If before glucose intake the blood sugar level was 6.1-5.5 mmol, and after two hours it jumped sharply to 7.8-11.0 mmol / l, then we can already talk about a violation of tolerance.

In fact, experts recommend that everyone undergo such testing at least once every two years - this is a very effective preventative precaution that will help to identify the disease at an early stage. However, there are some risk groups for which analysis is mandatory. For example, people with a genetic predisposition to diabetes, as well as patients suffering from obesity, arterial hypertension, high cholesterol, atherosclerosis, neuropathy of unknown origin, are often sent for testing.

Glucose tolerance disorder: treatment

If the tolerance test gives a positive result, then you should immediately contact an endocrinologist. Only a specialist knows which therapy requires impaired glucose tolerance. Treatment at this stage, as a rule, is not medical. However, the patient needs to change his usual lifestyle as soon as possible.

It is imperative to ensure that body weight is within normal limits. Naturally, sitting on strict diets or draining the body with intense physical activity is not worth it. It is necessary to deal with extra pounds, gradually changing the diet and increasing physical activity. By the way, training should be regular - at least three times a week. It is worth giving up smoking, as this bad habit leads to narrowing of blood vessels and damage to pancreatic cells.

Of course, you need to carefully monitor the blood sugar level, regularly undergo examinations by the endocrinologist and take the necessary tests - this will make it possible to determine the presence of complications in time.

If this treatment is ineffective, your doctor may prescribe some medications that lower your blood sugar. But it is worthwhile to understand that a universal panacea for such a disease does not exist.

Proper nutrition is an integral part of therapy

Of course, in the treatment of such a pathology, nutrition plays an extremely important role. Impaired glucose tolerance requires a special diet. First of all, it is worth changing the eating regimen. Patients are advised to eat 5-7 times a day, but the portions should be small - this will help relieve the burden on the digestive system.

What other changes does glucose tolerance impairment require? The diet in this case must necessarily exclude sweets - sugar, sweets, sweet pastries are prohibited. In addition, it is worth limiting the amount of products containing digestible carbohydrates - these are bread and bakery products, pasta, potatoes, etc. Experts also recommend reducing fat - do not abuse fatty meats, butter, lard. At the time of rehabilitation, it is also worth giving up coffee and even tea, because these drinks (even without sugar) tend to increase blood glucose levels.

What should the patient's diet consist of? First of all, these are vegetables and fruits. They can be eaten raw, boiled, baked. The required amount of protein can be obtained by entering in the menu low-fat varieties of meat and fish, nuts, legumes, milk and sour-milk products.

Basic preventive measures

Impaired glucose tolerance can be extremely dangerous. And in this case, it is much easier to avoid such a disorder than to face the risk of developing diabetes. To maintain the normal functioning of the body, you need to follow only some simple rules.

For starters, you should adjust the diet. Specialists recommend fractional nutrition - eat 5-7 times a day, but always in small portions. The daily menu should limit the amount of sweets, pastries and excessively fatty foods, replacing it with fresh fruits, vegetables and other healthy products.

It is important to monitor body weight and provide the body with the necessary physical activity. Of course, excessive physical activity can also be dangerous - loads need to be increased gradually. Of course, physical education should be regular.

A complete lack of exercise, evenings in front of a computer with a huge portion of a very tasty dinner, extra pounds ... We calm down with chocolate, have a bun or a sweet bar, because they are easy to eat without distracting from work - all these habits inexorably bring us closer to one of the most common diseases of the 21st century.

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Diabetes is incurable. These words sound like a sentence, changing the whole habitual way. Now every day you will have to measure blood sugar, the level of which will determine not only well-being, but also the length of your remaining life. It is possible to change this not very pleasant prospect if a violation of glucose tolerance is detected in time. Taking measures at this stage can prevent or greatly postpone diabetes, and these are years, or even decades, of a healthy life.

Impaired glucose tolerance - what does it mean?

Any carbohydrates in the digestive process are broken down into glucose and fructose, glucose immediately enters the bloodstream. Increased sugar levels stimulate the pancreas. It produces the hormone insulin. It helps sugar from the blood to get into the cells of the body - it boosts membrane proteins that transport glucose into the cell through cell membranes. In cells, it serves as a source of energy, allows for metabolic processes, without which the functioning of the human body would become impossible.

An ordinary person takes about 2 hours to absorb a portion of glucose that enters the bloodstream. Then the sugar returns to normal and is less than 7.8 mmol per liter of blood. If this number is higher, this indicates a violation of glucose tolerance. If sugar is greater than 11.1, then we are talking about diabetes.

The impaired glucose tolerance (NTG) is also called "".

This is a complex pathological metabolic disorder, which includes:

• a decrease in insulin production due to insufficient functioning of the pancreas;
• decrease in the sensitivity of membrane proteins to insulin.

A blood test for sugar, which is performed on an empty stomach, with NTG usually shows the norm (), or glucose is increased very slightly, since the body manages to process all the sugar that enters the blood the night before taking the analysis.

There is another change in carbohydrate metabolism - impaired fasting glycemia (IHF). This pathology is diagnosed when the concentration of sugar on an empty stomach exceeds the norm, but less than the level that allows you to diagnose diabetes. After glucose enters the blood, it manages to be processed in 2 hours, unlike people with impaired glucose tolerance.

External manifestations of NTG

There are no pronounced symptoms that could directly indicate the presence in a person of a violation of glucose tolerance. Blood sugar levels during NTG increase slightly and for short periods of time, so changes in organs occur only after a few years. Often alarming symptoms appear only with a significant deterioration in glucose uptake, when you can talk about the onset of type 2 diabetes.

Pay attention to the following changes in well-being:

1. Dry mouth, drinking more fluid than usual - the body is trying to reduce the concentration of glucose by diluting the blood.
2. Frequent urination due to increased fluid intake.
3. Sudden rises in blood glucose after a meal rich in carbohydrates cause a feeling of heat and dizziness.
4. Headaches caused by circulatory disorders in the vessels of the brain.

As you can see, these symptoms are not at all specific and it is simply impossible to detect NTG on their basis. Indications of a home glucometer are also not always informative, the increase in sugar revealed with its help requires confirmation in the laboratory. For the diagnosis of NTG, special blood tests are used, based on which it can be accurately determined whether a person has metabolic disorders.

Identification of violation

Violations of tolerance can be reliably determined using. During this test, fasting blood is taken from a vein or finger and the so-called “fasting glucose level” is determined. In the case when the analysis is repeated, and the sugar again exceeds the norm, we can talk about established diabetes. Further testing is impractical in this case.

If sugar on an empty stomach is very high (\u003e 11.1), continuation will also not follow, since taking an analysis further may be unsafe.

If fasting sugar is determined within the normal range or slightly exceeds it, the so-called load is carried out: they give a glass of water with 75 g of glucose to drink. The next 2 hours will have to be spent within the laboratory, waiting for the sugar to digest. After this time, the glucose concentration is again determined.

Based on the data obtained as a result of this blood test, we can talk about the presence of metabolic disorders of carbohydrates:

Glucose testing time	Glucose levelGLUmmol / l
	Finger blood	Vein blood
Norm
On an empty stomach	GLU< 5,6	GLU< 6,1
After loading	GLU< 7,8	GLU< 7,8
On an empty stomach	GLU< 6,1	GLU< 7,0
After loading	7.8 ≤ GLU< 11,1	7.8 ≤ GLU< 11,1
On an empty stomach	5.6 ≤ GLU< 6,1	6.1 ≤ GLU< 7,0
After loading	GLU< 7,8	GLU< 7,8
Diabetes
On an empty stomach	GLU ≥ 6.1	GLU ≥ 7.0
After loading	GLU ≥ 11.1	GLU ≥ 11.1

There is another option for a glucose tolerance blood test, which uses not the oral, but the intravenous method of administering sugar. This test is considered more accurate., since its results are not affected by the digestive organs, which can interfere with the absorption of glucose.

How to take a glucose tolerance test:

1. In the morning, only on an empty stomach. The time elapsed after the last meal should be 8-14 hours.
2. The day before the analysis is impossible.
3. Three days before the analysis, oral contraceptives, vitamins and other drugs that can affect the results are canceled. The cancellation of drugs prescribed by a doctor can be done only after agreement with him.
4. A few days before the test, you need to adhere to your usual diet with the usual amount of carbohydrates.

A glucose tolerance test is mandatory during pregnancy, at 24-28 weeks. Thanks to him, they diagnose which occurs in some women during the bearing of a child and disappears on their own after childbirth. Impaired glucose tolerance during pregnancy is a sign of predisposition to NTG. The risk of type 2 diabetes in these women is significantly higher.

Causes of the problem

The cause of changes in carbohydrate metabolism and the occurrence of impaired glucose tolerance is the presence of one or more of these factors in a person’s history:

1. Overweight, particular risk   - in people with a mass index (weight, kg / square of height, m) above 27. The larger the body occupies, the more cells have to be energized, maintained, removed dead in time and grow new ones in return. The pancreas, cardiovascular system and other organs function with increased load, which means they wear out faster.
2. Not enough movement   and excessive enthusiasm for carbohydrate foods with a high glycemic index force the body to work in a difficult mode for it, produce insulin spasmodically in huge quantities and process large amounts of excess glucose into fat.
3. Heredity   - the presence among one of the next of kin of one or more patients with diabetes or having impaired glucose tolerance. The likelihood of developing type 2 diabetes is on average about 5%. When the father is sick, the risk is 10%, when the mother is up to 30%. Twin brother’s diabetes means that with a probability of up to 90% you will also have to face this disease.
4. Age and gender - The highest risk of metabolic disorders is in women over 45 years old.
5. Pancreas problems   - pancreatitis, cystic changes, tumors, injuries, which lead to a decrease in insulin production.
6. Endocrine system diseases   - affecting the metabolism, diseases of the gastrointestinal tract (for example, with a stomach ulcer, glucose absorption is disrupted), heart and blood vessels (high blood pressure, atherosclerosis, high cholesterol).
7. Polycystic ovary, complicated pregnancy   - there is a higher likelihood of impaired tolerance in women who have given birth to a large child after 40 years, especially if during pregnancy they have gestational diabetes.

What could be the danger of NTG

The main danger of NTG is acquired type 2 diabetes mellitus. According to statistics, in about 30% of people, impaired glucose tolerance disappears over time, the body independently copes with metabolic disorders. The remaining 70% live with NTG, which over time worsens and becomes diabetes.

This disease is also fraught with a number of problems due to painful changes in the vessels. Excess glucose molecules in the blood cause an organism's response in the form of an increase in the amount of triglycerides. The density of blood increases, it becomes more dense. It is more difficult for the heart to drive such blood through the veins, it is forced to work in an emergency mode. As a result, hypertension occurs, plaques and blockages in the vessels are formed.

Small vessels also do not feel the best way: their walls are overstretched, the vessels burst from excessive tension, and minor hemorrhages occur. The body is forced to constantly grow a new vascular network, organs begin to be worse supplied with oxygen.

The longer this condition lasts - the glucose exposure is sadder for the body. To prevent these consequences, you need to conduct a glucose tolerance test every year, especially if you have some risk factors for NTG.

Treatment for impaired glucose tolerance

If a glucose tolerance test (test) indicates incipient carbohydrate metabolism disorders, you should immediately go to an endocrinologist. At this stage, the process can still be stopped and tolerance restored to the cells of the body. The main thing in this matter is a strict adherence to the doctor's recommendations and tremendous willpower.

From this point on, you will have to get rid of many bad habits, change the principles of nutrition, add movement, and maybe sports, to life. Doctors can only help to achieve the goal, but the patient himself has to perform all the main work.

Diet and proper nutrition with NTG

Nutritional adjustment for NTG is simply necessary. Otherwise, sugar cannot be normalized.

The main problem with impaired glucose tolerance is the huge amount of insulin produced in response to sugar entering the bloodstream. To restore the sensitivity of cells to it and enable them to receive glucose, insulin must be reduced. Safe for health, this can be done in the only way - to reduce the amount of food containing sugar.

Diet for impaired glucose tolerance provides for a sharp decrease in the amount of carbohydrates. It is especially important to exclude it as much as possible, since glucose from them is thrown into the blood quickly, in large portions.

Diet for violation of tolerance should be constructed as follows:

Squirrels	As a rule, there are not enough proteins in the diet, and it is precisely they - the basis for building all the tissues in the body. The proportion of proteins should be brought up to 15-20%, increasing them by increasing the consumption of lean meat, fish, cottage cheese and other fermented milk products, legumes.
Fats	The proportion of fats should not exceed 30%, their main amount is recommended to be obtained from vegetable oils and fish.
Carbohydrates	Must be reduced to 50%. It is advisable to completely eliminate sugar, confectionery, juices. Preference should be given to foods with a large amount of fiber - glucose from them enters the body more evenly, as it is digested. These are raw vegetables, bran bread, coarse cereals from minimally processed grains.

Food should be fractional, 4-5 equal portions, high-carb food is evenly distributed throughout the day. Attention must be paid to adequate water intake. Its required amount is calculated based on the ratio: 30 g of water per kilogram of weight per day.

A diet with impaired cell tolerance should not only limit the amount of carbohydrates, but also help to reduce excess weight. Ideally, reduce body weight to normal (BMI< 25) , but even a 10-15% weight reduction significantly reduces the likelihood of diabetes.

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The basic principle of losing weight is to reduce your daily calorie intake.

To calculate the desired calorie content, you need to determine the value of the main metabolism:

With average physical activity, this indicator is increased by 30%, with high - by 50%. The result is reduced by 500 kcal. It is due to their lack that weight loss will occur. If the daily calorie content is less than 1200 kcal for women and 1500 kcal for men, it needs to be raised to these values.

What exercises can help

Lifestyle changes for metabolic correction also include daily exercise. They not only strengthen the heart and blood vessels, but also directly affect the metabolism. Aerobic exercise is recommended to treat impaired cell tolerance. This is any physical activity that, although it increases the pulse, but allows you to engage in quite a long time, from 1/2 to 1 hour per day. For example, brisk walking, jogging, any activity in the pool, a bicycle in the fresh air or an exercise bike in the gym, team sports, dancing.

You can choose any type of physical activity, taking into account personal preferences, level of fitness and associated diseases. You need to start the exercises gradually, from 10-15 minutes, during classes, monitor the heart rate (HR).

Maximum heart rate is calculated as 220 minus age. During training, the pulse should be at a level of 30 to 70% of the maximum heart rate.

Exercise must be joined by a doctor

You can control the pulse manually, stopping at short intervals, or using special fitness bracelets. Gradually, as the fitness of the heart improves, the duration of the exercises is increased to 1 hour 5 days a week.

For a better effect in case of impaired glucose tolerance, it is worth giving up smoking, since nicotine harms not only the lungs, but also the pancreas, inhibiting the production of insulin.

It is equally important to establish a full sleep. Constant lack of sleep makes the body work under conditions of stress, putting off every unused calorie in fat. At night, the release of insulin physiologically slows down, the pancreas rests. Restricting sleep overloads her excessively. That is why night snacks are especially dangerous and fraught with the highest increase in glucose.

Drug treatment

In the initial stages of impaired glucose tolerance, use drugs that lower sugar, not recommended. It is believed that taking pills prematurely can speed up the development of diabetes. NTG should be treated with a strict diet, physical activity and monthly sugar control.

If the patient is well with self-control, after a few months, blood glucose stops growing above normal levels. In this case, the diet can be expanded to include previously banned carbohydrates and live a normal life without the risk of diabetes. It is good if you can maintain proper nutrition and sport after treatment. In any case, people who have experienced impaired glucose tolerance and have successfully dealt with it, will have to do glucose tolerance testing twice a year.

If you can’t change your lifestyle due to concomitant diseases, high-grade obesity, a patient’s lack of willpower and blood sugar levels worsen, treatment with hypoglycemic drugs may be prescribed. An endocrinologist can be prescribed tonorma, acarbose, amaryl, glucobai and other drugs. Their action is based on a decrease in the absorption of glucose in the intestine, and consequently, a decrease in its level in the blood.

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Impaired glucose tolerance is a fairly common problem. That is why many people are interested in additional information about what constitutes such a condition. What are the causes of violations? What symptoms are accompanied by pathology? What treatments does modern medicine offer?

What is a similar violation?

What is impaired glucose tolerance? In this condition, a person has an increase in the amount of sugar - higher than normal, but at the same time lower than that in which patients are diagnosed with type 2 diabetes mellitus.

Thus, impaired tolerance is one of the risk factors. The results of recent scientific studies have shown that approximately one third of patients eventually develop, subject to certain rules and correctly selected drug treatment, metabolism normalizes.

The main reasons for the development of glucose tolerance

Not in all cases, doctors can determine why the patient developed such a disease. Nevertheless, it was possible to find out the main causes of impaired glucose tolerance:

• First of all, it is worth mentioning the genetic predisposition, which takes place in many cases. If one of your close relatives has diabetes, the likelihood of developing such a condition increases significantly.
• In some patients, the so-called insulin resistance is detected during the diagnosis process, in which the sensitivity of cells to insulin is impaired.
• In some cases, impaired glucose tolerance develops as a result of pancreatic diseases in which its secretory activity is impaired. For example, problems with carbohydrate metabolism can appear against the background of pancreatitis.
• The causes can also include some diseases of the endocrine system, which are accompanied by metabolic disorders and an increase in blood sugar (for example,
• One of the risk factors is obesity.
• A sedentary lifestyle also negatively affects the body.
• Sometimes a change in the amount of sugar in the blood is associated with taking medications, in particular hormones (in most cases, glucocorticoids become the “culprits”).

Glucose tolerance disorder: symptoms

Unfortunately, such a pathology in most cases is asymptomatic. Patients rarely complain of deterioration of health or simply do not notice it. By the way, for the most part, people with a similar diagnosis are overweight, which is associated with a violation of normal metabolic processes.

With the aggravation of carbohydrate metabolism disorders, characteristic signs begin to appear, which are accompanied by impaired glucose tolerance. Symptoms in this case are thirst, a feeling of dry mouth and increased fluid intake. Accordingly, in patients, there is also a significant decrease in immune defense against the background of hormonal and metabolic disorders - people become extremely susceptible to inflammatory and fungal diseases.

Why is this disorder dangerous?

Of course, many patients with this diagnosis are interested in questions about the danger of impaired glucose tolerance. First of all, such a condition is considered dangerous because, if untreated, the risk of developing a well-known insidious disease, namely type 2 diabetes, is very high. On the other hand, such a disorder increases the likelihood of developing diseases of the cardiovascular system.

Basic diagnostic methods

The diagnosis of glucose tolerance disorder can only be made by a doctor. To begin with, a specialist will conduct an examination and collect an anamnesis (the presence of certain complaints from the patient, information about previously transmitted diseases, the presence of people with diabetes in the family, etc.).

In the future, a standard blood test for sugar level is performed. Samples are taken in the morning, on an empty stomach. A similar procedure is carried out in any clinic. As a rule, the glucose level in such patients exceeds 5.5 mmol / L. However, to establish an accurate diagnosis, a special glucose tolerance test is needed.

Test and indications for its implementation

Such a study is by far one of the most accessible and effective methods for diagnosing a condition called “impaired glucose tolerance”. But although testing is fairly straightforward, proper preparation is crucial here.

For several days before taking the blood, the patient is advised to avoid stress and increased physical activity. The procedure is carried out in the morning and on an empty stomach (not earlier than 10 hours after the last meal). First, a portion of blood is taken from the patient, after which they offer to drink glucose powder dissolved in warm water. After 2 hours, a repeated blood sampling is performed. In laboratory conditions, the sugar level in the samples is determined and the results are compared.

If before glucose intake the blood sugar level was 6.1-5.5 mmol, and after two hours it jumped sharply to 7.8-11.0 mmol / l, then we can already talk about a violation of tolerance.

In fact, experts recommend that everyone undergo such testing at least once every two years - this is a very effective preventative precaution that will help to identify the disease at an early stage. However, there are some risk groups for which analysis is mandatory. For example, people with a genetic predisposition to diabetes, as well as patients suffering from obesity, arterial hypertension, high cholesterol, atherosclerosis, neuropathy of unknown origin, are often sent for testing.

Glucose tolerance disorder: treatment

If the tolerance test gives a positive result, then you should immediately contact an endocrinologist. Only a specialist knows which therapy requires impaired glucose tolerance. Treatment at this stage, as a rule, is not medical. However, the patient needs to change his usual lifestyle as soon as possible.

It is imperative to ensure that body weight is within normal limits. Naturally, sitting on strict diets or draining the body with intense physical activity is not worth it. It is necessary to deal with extra pounds, gradually changing the diet and increasing physical activity. By the way, training should be regular - at least three times a week. It is worth giving up smoking, as this bad habit leads to narrowing of blood vessels and damage to pancreatic cells.

Of course, you need to carefully monitor the blood sugar level, regularly undergo examinations by the endocrinologist and take the necessary tests - this will make it possible to determine the presence of complications in time.

If this treatment is ineffective, your doctor may prescribe some medications that lower your blood sugar. But it is worthwhile to understand that a universal panacea for such a disease does not exist.

Proper nutrition is an integral part of therapy

Of course, in the treatment of such a pathology, nutrition plays an extremely important role. Impaired glucose tolerance requires a special diet. First of all, it is worth changing the eating regimen. Patients are advised to eat 5-7 times a day, but the portions should be small - this will help relieve the burden on the digestive system.

What other changes does glucose tolerance impairment require? The diet in this case must necessarily exclude sweets - sugar, sweets, sweet pastries are prohibited. In addition, it is worth limiting the amount of products containing digestible carbohydrates - these are bread and bakery products, pasta, potatoes, etc. Experts also recommend reducing fat - do not abuse fatty meats, butter, lard. At the time of rehabilitation, it is also worth giving up coffee and even tea, because these drinks (even without sugar) tend to increase blood glucose levels.

What should the patient's diet consist of? First of all, these are vegetables and fruits. They can be eaten raw, boiled, baked. The required amount of protein can be obtained by entering in the menu low-fat varieties of meat and fish, nuts, legumes, milk and sour-milk products.

Basic preventive measures

Impaired glucose tolerance can be extremely dangerous. And in this case, it is much easier to avoid such a disorder than to face the risk of developing diabetes. To maintain the normal functioning of the body, you need to follow only some simple rules.

For starters, you should adjust the diet. Specialists recommend fractional nutrition - eat 5-7 times a day, but always in small portions. The daily menu should limit the amount of sweets, pastries and excessively fatty foods, replacing it with fresh fruits, vegetables and other healthy products.

It is important to monitor body weight and provide the body with the necessary physical activity. Of course, excessive physical activity can also be dangerous - loads need to be increased gradually. Of course, physical education should be regular.