fasting hypoglycemia
Introduction
Introduction Fasting blood glucose (GLU) refers to the blood taken before breakfast after overnight fasting (at least 8-10 hours without any food, except drinking water). The blood sugar value measured is the most commonly used test for diabetes, and it responds to islet cells. Function, generally representing the secretory function of basal insulin. The fasting blood glucose level of normal people is 3.89-5.83 mmol/L. If it is greater than 5.83 mmol/L and less than 7.0 mmol/L, the fasting blood glucose is impaired. If it is greater than or equal to 7.0 mmol/L, consider diabetes, such as blood glucose below 2.8 mmol/L. The clinical symptoms associated with it are called "hypoglycemia."
Cause
Cause
The symptoms of hypoglycemia on the fasting are mainly related to some diseases, such as endocrine diseases, severe liver diseases, and advanced stages of kidney disease. Let's take a closer look at the relevant content below. The causes of fasting hypoglycemia are:
1. Excessive glucose utilization:
(1) hyperinsulinemia: insulinoma; neonates with obese diabetics (mother with hyperinsulinemia); drugs (such as excessive use of insulin, sulfonylureas, hypoglycemic agents, salicylates, propranolol, double Isopropylbenzylamine, monoamine oxidase inhibitor), insulin autoimmune hypoglycemia.
(2) Tumors: such as giant stromal tumors, primary liver cancer, gastrointestinal tumors and lymphosarcoma.
2. Insufficient glucose production:
(1) Endocrine diseases: anterior pituitary dysfunction; adrenal insufficiency; hypothyroidism.
(2) Hepatic glycogen accumulation disease.
(3) severe liver disease and liver congestion.
(4) End stage renal disease.
(5) Galactosemia (due to deficiencies in galactose 1 phosphate uridine invertase, galactose cannot be converted to glucose).
(6) Others: long-term alcoholism (inhibition of gluconeogenesis); sepsis; starvation; cachexia; strenuous exercise.
Examine
an examination
Related inspection
C-peptide release test blood glucose urinary C peptide
Fasting blood glucose is best taken at 6:00 ~ 8:00 in the morning, no blood sugar drugs, no breakfast, no exercise before blood collection. If the time of fasting blood is too late, the measured blood sugar value is difficult to truly reflect the patient's treatment effect, and the result may be higher or lower.
Some patients mainly show elevated postprandial blood glucose, while fasting blood glucose is normal, so it is necessary to measure postprandial blood glucose to truly understand the condition. The blood sugar control of diabetes is full-time, that is, not only the fasting blood sugar should reach the standard, but also the postprandial blood sugar should be reduced to a certain level.
[Commonly used chemical diagnostic methods]
Folin-Wu Constitution
O-toluidine method
GOD-POD method (glucose oxidase coupled colorimetry)
Diagnosis
Differential diagnosis
This disease is caused by a variety of reasons, it should be promptly in-depth examination, especially to identify islet -cell tumor or hyperplasia of functional and unexplained hypoglycemia. In general, the latter are mostly lighter, with only obvious sympathetic or adrenaline hypertrophy syndrome; while the former has obvious neurological and psychiatric symptoms. Laboratory and other special tests can be combined to confirm the diagnosis.
1. For episodes (especially on an empty stomach) with psycho-neural abnormalities, convulsions, behavioral abnormalities, disturbances of consciousness or coma, especially for diabetic patients treated with insulin or oral hypoglycemic agents, the possibility of hypoglycemia should be considered. Check blood sugar in time. It is worth noting that some patients with hypoglycemia have normal blood glucose at the time of presentation, and there is no symptoms of hypoglycemia. They often only show the sequela of chronic hypoglycemia, such as hemiplegia, dementia, epilepsy, mental disorders, and children with significantly lower IQ. As a result, clinical diagnosis is often misdiagnosed as mental illness, epilepsy or other organic encephalopathy (such as encephalitis). Therefore, it should be differentiated from other diseases of the central nervous system organic diseases, such as encephalitis, multiple sclerosis, cerebrovascular accident, epilepsy, diabetic ketoacidosis coma, diabetes non-ketotic hyperosmolar coma, psychosis, drugs Poisoning and so on.
2. Hypoglycemia with sympathetic excitation as the main manifestation of fasting, hours after meal or physical activity, and diseases with sympathetic excitation, such as hyperthyroidism, pheochromocytoma, autonomic dysfunction, Identification of diabetic autonomic neuropathy, menopausal syndrome, etc.
3. Hypoglycemia after alcoholism should be differentiated from alcoholism. Ethanol can not only cause hypoglycemia, but also cause ketosis. Sometimes hypoglycemia and ketosis caused by ethanol can be mistaken for diabetic ketoacidosis. This is a diagnosis. Need to pay attention to.
