Diabetes testing, diagnosis, and differential diagnosis
This article will explain in detail what tests should be performed for diabetes and what diabetes screening items are routinely utilized. And how to diagnose, recognize, and confuse diabetes.
Diabetes screening tests include:
Common tests include blood glucose, blood lipid testing, waist hip ratio, urine glucose (Glu), glucose cortione tolerance testing, serum glucagon (PG), C-peptide (c-pr), 75g glucose tolerance testing, abnormal oral glucose tolerance testing, fasting blood glucose, 50g glucose tolerance testing, self blood glucose monitoring, blood glucose meter test strip method, blood glucose 2 hours after meal (2hPG, PBG), anti islet cell antibody (ICA), blood phospholipid (PL), urine volume (PV) Blood glucose, steamed bread meal test, cerebrospinal fluid glucose, high density lipoprotein 2-cholesterol, and triglyceride levels were all measured.
C-peptide Release Test, apolipoprotein A II, very low density lipoprotein cholesterol, plasma tissue plasminogen activator antigen detection, serum angiotensin I invertase activity, norepinephrine (nm), serum cholinesterase (CHE), urinary microalbumin (ma1b) Cholinesterase, urine color (UCO), diabetes urine routine, platelet aggregation test (PAgT), physical examination of subhealth
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1. sugar in urine
In normal humans, the glucose filtered from the renal tubules is almost fully absorbed by the renal tubules, and only a tiny quantity of glucose (32 90mg) is discharged from the urine every day, which cannot be detected by a conventional qualitative glucose test. Diabetes is often defined as the excretion of more than 150mg of glucose in the urine on a daily basis. Blood glucose levels in healthy persons surpass 8.9 10mmol/L (160 180mg/dl). When urine sugar can be detected, this blood sugar level is referred to as the renal sugar threshold. The renal sugar threshold rises in the elderly and people with renal disorders.
When there is no diabetes when blood glucose reaches 10mmol/L, or even 13.9 16.7mmol/l; on the contrary, the renal sugar threshold drops in pregnant women and certain renal tubular or renal interstitial lesions, and diabetes can emerge when blood glucose is normal.
Ban's technique is widely used for testing diabetes (through a reduction reaction of copper sulfate) and glucose oxidase, among other things. Ban's method is frequently affected by drugs such as lactose, fructose, pentose, ascorbic acid, vancomycin, isoniazid, and salicylate in urine, resulting in false positive and inconvenient operation, and has been gradually eliminated; glucose oxidase method has high specificity because the enzyme only reacts to glucose, but when taking large doses of ascorbic acid, salicylic acid, and methyl methacrylate, Kidob Urine glucose is not utilized as a diabetes diagnostic indicator.
It is commonly used as a monitoring indication for diabetes control and may be a signpost for additional diabetes evaluation. The volume of urine and the rate at which the bladder empties are two parameters that influence urine glucose.
2. Urinary ketone body determination
It detects insulin shortage and notifies diabetic individuals who may or may not be in ketoacidosis. It advises that blood ketone bodies and blood gas analysis be determined further. Sodium ketone is used to react with acetoacetic acid to generate a purple material that signals the presence of urine ketone bodies.
However, no sodium nitroprusside-based reaction can be found in ketone bodies (acetone, acetoacetic acid). - Hydroxybutyric acid) is the predominant component in terms of amount. It has been observed that the usage of sulfhydryl-containing medicines, such as captopril, can result in false positives, whereas urine samples can result in false negatives if exposed to air for an extended period of time.
Patients with diabetes, particularly type 1 diabetes, should have ketone body tests performed if they have other acute or severe stress conditions, are pregnant, or have unidentified causes of gastrointestinal symptoms such as stomach discomfort, nausea, and vomiting.
3. Urinary albumin determination
It can accurately indicate the extent of diabetic kidney impairment.
4. C-peptide in the urine
Islet B cells release C-peptide and insulin, which are then divided by proinsulin. Measuring C-peptide concentrations can also reveal information about the reserve function of islet B cells.
5. Urine in tubules
It is more common in diffuse glomerulosclerosis, particularly transparent tube type and granular tube type, and is frequently encountered in conjunction with a considerable quantity of proteinuria.
6. Microscopic hematuria and other conditions
There are typically a considerable number of white blood cells in instances of hypertension, glomerulosclerosis, arteriosclerosis, pyelonephritis, necrosis of the kidney, or heart failure, which often suggest urinary tract infection or pyelonephritis, which are more common in diabetic individuals.
Blood
The majority of the patients who did not have issues had normal blood work, however they exhibited the following biochemical changes:
1. Blood glucose levels
The fasting blood glucose of moderate and mild type II cases can be normal, often exceeding 200mg / dl (11.1mmol / L) after meal, whereas that of severe and type I cases is significantly increased, often ranging from 200 to 400mg / dl (11.1 22.0mmol / L), sometimes exceeding 600mg / dl (33.0mmol / L). One patient at our hospital had a blood sugar level of 1200mg/dl (66.0mmol/L). However, such individuals frequently have hypertonic coma and diabetic ketosis, as well as significant water loss.
2. Lipids in the blood
Individuals with hyperlipidemia and hyperlipoproteinemia, especially type II obese people, are frequently accompanied by hyperlipidemia and hyperlipoproteinemia in the absence of effective management or therapy, although emaciated patients can also occur. Plasma can be a milky white turbid liquid with elevated fat components, including triglycerides, cholesterol, and free fatty acids. The top layer is chylomicrons, with a milky cream overlay on occasion. The majority of them are high-fat eggs. Type V leukemia.
Triglycerides can rise 4-6 times over normal levels, while free fatty acids can rise more than twice as high, as can total cholesterol, phospholipids, and low density lipoprotein (LDL) They all increased dramatically. The rise in lipids was more noticeable in patients with arteriosclerotic cardiovascular disease and renal disease, whereas simple diabetes rose. The rise in free fatty acids was more suggestive of an increase in lipolysis, which suggested poor diabetes management and was directly associated to an increase in blood sugar. It had a higher sensitivity than triglyceride. HDL2Ch, particularly subtype 2, apo A1 and A2 levels, were reduced.
3. In joint portions such as ketoacidosis, hypertonic coma, lactic acidosis, and renal illness, changes in blood ketone, electrolyte, pH, CO2 binding force, and non protein nitrogen (urea nitrogen) will be explained.
The above is a description of the diabetic material that should be completed. Here's how diabetes should be distinguished, and diabetes is perplexing.
How do you recognize diabetes?
Recognize
The following cases must be ruled out in terms of differential diagnosis:
1. Urine containing no glucose
Lactose, for example, is present in nursing women, pregnant women, and young neonates. Fructose and pentose urine can arise after consuming a substantial amount of fruit. This is a very uncommon congenital illness. When diabetes is discovered to be positive, it should be evaluated and graded based on the clinical circumstances. It is not suitable to diagnose diabetes mellitus right away. Biochemical and fermentation testing are among the identifying procedures.
2. glucose in non-diabetics Uria
(1) Starvation diabetes: when hunger is really high, a huge amount of sugar meal is abruptly introduced in the future, and insulin secretion is unable to adapt for the present, resulting in diabetes and impaired glucose tolerance. During the identification process, pay close attention to the illness analysis, diet history, and overall amount of food consumed. Fasting blood glucose levels are frequently normal or even low.
(2) Post-food diabetes: diabetes develops after consuming a significant amount of sugary food, or as a result of quick absorption, when blood glucose concentration briefly exceeds the renal glucose threshold, although fasting blood glucose and glucose tolerance tests are normal.
(3) Renal diabetes: Because of the reduced capacity of the renal tubules to absorb carbohydrate, the low sugar level of the kidneys, normal blood sugar, and the existence of diabetes, a small proportion of pregnant women with a drop in the temporary renal glucose threshold require postpartum follow-up. Nephritis and nephropathy, which can induce renal diabetes owing to renal tubular reabsorption inefficiency, should be distinguished from diabetic glomerulosclerosis. Diabetes, like Fanconi syndrome, is caused by a rare malfunction in the renal tubular enzyme system.
Fasting blood glucose levels and a glucose tolerance test are both perfectly acceptable. For identification, the renal glucose threshold and maximal glucose absorption rate of renal tubules can be determined.
(4) Nervous diabetes can be found in cerebral hemorrhage, brain tumor, intracranial fracture, hypoxia, and anesthesia. Diabetes can cause temporary elevated blood glucose levels, which can be detected during illness follow-up.
3. diabetes mellitus secondary
Patients with pancreatitis, malignancy, or a subtotal gastrectomy should be evaluated in conjunction with a medical history review. Hemochromatosis patients suffer pigmentation, hepatomegaly, hyperglycemia, and iron metabolism problems. Differentiation should be prioritized. Other endocrine illnesses, on the other hand, have distinct features. They are often not challenging when paired with disease analysis. Stress hyperglycemia and gestational diabetes mellitus should be monitored and distinguished. It can recover 2 weeks after the stress has passed, or it can be confirmed at the post-delivery check-up.