医学

Diaes is a group characterized by high blood sugar and metabolic diseases. Hyperglycemia is due to defects in insulin secretion or action of biological damage, or both cause. Longstanding diaes high blood sugar, leading to a variety of organizations, particularly chronic damage to the eyes, kidneys, heart, blood vessels, nerves, and dysfunction.
Cause of disease
1. genetic factors
Type 1 or type 2 diaes are significant genetic heterogeneity. Diaes onset familial tendency, 1/4 to 1/2 patients have a family history of diaes. Clinically, there are at least 60 or more kinds of genetic syndromes may be associated with diaes. Type 1 diaes has multiple DNA sites involved in the pathogenesis, which DQ polymorphism loci HLA antigen genes most closely. In type 2 diaes has found a variety of mutations in specific genes, such as the insulin gene, insulin receptor gene, glucokinase genes, mitochondrial genes.
2. envirnmental factor
Eating too much physical activity to reduce obesity leads to type 2 diaes is the most important environmental factors that make individuals with susceptibility to type 2 diaes genetic morbidity. Type 1 diaes patients with immune system abnormalities, after some viruses such as coxsackie virus, rubella virus, parotid gland virus infection leads to autoimmune reactions, destroy the insulin β cells.
Clinical manifestations
1. Polydipsia, polyuria, polyphagia and weight loss
The typical "little" severe symptoms of high blood sugar, more common in type 1 diaes. When ketosis or ketoacidosis, "a little" more obvious symptoms.
2. Fatigue, weakness, obesity
More common in type 2 diaes. Type 2 diaes often before the onset of obesity, if not timely diagnosis, weight will gradually decline.
an examination
1. blood sugar
It is the Sole Criterion for the diagnosis of diaes. Obviously "a little" symptoms, as long as the abnormal blood glucose level can be diagnosed once. Asymptomatic diaes diagnosis requires two abnormal blood glucose level. Suspects to be done to 75g glucose tolerance test.
2. Urine
Often positive. Positive urine when blood glucose concentration exceeds the renal threshold for glucose (160 to 180 mg / dl). Renal glucose threshold increased blood sugar even reach a diagnosis of diaes can be negative. Therefore, urine is not measured as diagnostic criteria.
3. Ketone
Positive urine ketone ketosis or ketoacidosis.
4. Glycosylated hemoglobin (HbA1c)
Is a non-enzymatic reaction of glucose and hemoglobin product of the reaction is not reversible, stable HbA1c levels reflect the average blood glucose level before taking the blood of two months. Analyzing the state of glycemic control is the most valuable indicators.
5. Glycated serum protein
It is a non-enzymatic reaction with glucose serum albumin product of the combination, before taking reflect the average blood glucose level of 1 to 3 weeks.
6. Serum insulin and C-peptide levels
Reflect reserve islet β cells. Type 2 diaes early or obese normal or elevated serum insulin, as the disease progresses, islet function gradually decline, decreased insulin secretion.
7. Lipid
Diaic dyslipidemia common in poorly controlled blood sugar especially. Expressed as triglycerides, total cholesterol, elevated LDL cholesterol levels. Reduce high-density lipoprotein cholesterol levels.
8. Immune Indexes
Islet cell antibodies (ICA), insulin autoantibodies (IAA) and glutamic acid decarboxylase (GAD) antibodies are type 1 diaes humoral immune abnormalities of three important indicators, which GAD antibody positive rate, long duration of 1 Great value diaes diagnosis. In type 1 diaes in first-degree relatives also have some positive rate, meaning there is prediction of type 1 diaes.
9. Urinary albumin excretion, RIA or enzyme-linked method
Can be easily detected by urinary albumin excretion, early diaic nephropathy urinary albumin increased slightly.
diagnosis
Diaes diagnosis usually is not difficult, fasting blood glucose greater than or equal to 7.0 mmol / l, and / or two-hour postprandial blood glucose greater than or equal to 11.1 mmol / l can be confirmed. After the diagnosis of diaes to be typing:
1.1 diaes
Age of onset of light, mostly <30 years, sudden onset, polydipsia and polyuria more food weight loss symptoms, high blood sugar levels, many patients with ketoacidosis as the first symptom, serum insulin and C-peptide levels low, ICA, IAA or GAD antibody positive. Oral medication alone is invalid, required insulin therapy.
2.2 diaes
Common in the elderly, a high incidence of obesity, often associated with hypertension, dyslipidemia, atherosclerosis and other diseases. Insidious onset, early without any symptoms, or only mild weakness, thirst, blood sugar tolerance test were not obvious to be done to confirm the diagnosis. Serum insulin levels normal or increased early and late low.