sugar level (glucose) in the blood or blood glucose - one of the most important constants controlled body defines homeostasis and reflects the state of carbohydrate metabolism.Glucose is the main source of energy for all organs and tissues of the human body (particularly for red blood cells and nerve cells) undergoing complex biochemical intracellular mitochondria transform cells by molecular oxygen.
The blood glucose level is regulated by the nervous and endocrine system (hormones: insulin, glucagon, epinephrine, corticosteroids and steroid hormones), as well as the basic physiological processes - glycogenolysis and gluconeogenesis, the concentration of blood sugar is maintained within the strict limits (from3.3 to 5.5 mmol / l).
- 1 physiological regulation of blood sugar concentration
- 2 Causes of pathological changes in blood glucose levels
- 2.1 main regulatory mechanisms of normal levels of sugar in the blood
- 3 The rate of blood sugar levels in women and men
- 4 blood Norma sugar in children
- 5 research Methods for determining the level of blood sugar
- 6 reasons for elevated blood sugar
- 7 Whatdiabetes, and some types are?
- 8 gestational diabetes
- 9 Pathogenesis improve blood sugar levels in diabetes mellitus type 1
- 10 Mechanisms of increase in blood glucose levels in diabetes mellitus type II
- 11 Clinical signs of diabetes
- 12 acute complications arising from the increased level of blood
- 13 Chronic sugar complications of diabetes
- 14 signs of lowering blood sugar levels
Physiological regulation of the concentration of sugar in the blood
Glucose enters the body of the food composition is easily digestible (complex) carbohydrates which are cleaved in the gastrointestinal tract and enter the blood or by cleavage of polysaccharides (starch) in an intestine of other productssupply.Came from the digestive tract glucose only partially utilized by cells, and its main part is deposited in the form of glycogen in the liver cells and kidney cortex.If necessary (with increased physical or emotional stress, with insufficient intake of energy material from the gastrointestinal tract) is split accumulated glycogen (glycogenolysis) and glucose enters the blood stream.Glycogen can also be formed (synthesized) of the molecules of organic compounds (lactic acid, glycerol, amino acids) resulting in metabolic reactions (gluconeogenesis), and also deposited in the liver.glucose output processes of the organs where it accumulates (kidney and liver) - glycogenolysis, independent of its synthesis in the body (gluconeogenesis) and absorbed by the cells controlled by a complex system of neuroendocrine regulation of the main center, located in the hypothalamic-pituitary system, and pancreas andthe adrenal glands.
Causes of pathological changes in the blood sugar level
concentration of glucose in the blood can be broken:
- in diseases of the digestive tract due to lower absorption of glucose in the blood;
- with severe hepatic dysfunction;
- when dieting disorders (eating carbohydrates in large quantities);
- with active catabolism (increased energy metabolism), associated with increased physical activity, stress management, or with an increase in body temperature;
- in violation of intracellular glucose receipt of the capillary bed as a result of various diseases;
- in violation of the neuroendocrine regulation of glucose utilization in connection with endocrine, nervous and inflammatory diseases of the hypothalamus, pituitary, adrenal, or pancreas.
main regulatory mechanisms of normal levels of blood sugar
Significant fluctuations in blood glucose as its decrease (below 3.1 mmol / L), and an increase (more than 30 mmol / l) - leadto life-threatening conditions, which clinically manifested seizures and the development of coma, accompanied by disturbances of cardiac activity and respiration.Therefore, any fluctuations in blood glucose levels included defense mechanisms aimed at the normalization of glycemia, and maintaining it at a certain level.
main hormone regulating glucose levels permissible in the blood are hormones which are secreted by the endocrine pancreas device (Langergantsa islets) - insulin (produced by the beta cells) and glucagon (produced by the alpha cells).They operate simultaneously and oppositely adjusting exchange energosubstatov (carbohydrates, proteins and fats), recycling and deposit energy sources and maintaining glycemia at a stable level, necessary for normal functioning of all organs and body systems.
With increasing glucose concentration in blood increases insulin secretion as a result of its stimulating effect on the receptor apparatus Langergantsa islets are localized in the pancreas and by activating the parasympathetic nervous system is mediated through the sensory receptors glucose, located in the hypothalamus.Insulin activates processes of glucose utilization, the cells of the organism by stimulating the processes of hepatic gluconeogenesis, resulting in a lowering of blood sugar.
main antagonist of insulin, glucagon is secreted by the alpha cells of endocrine pancreas in lowering blood sugar levels.He activates the breakdown of glycogen and promotes glucose output from the depot.Also, there are hormones - norepinephrine and epinephrine, which are produced by the adrenal medulla, thyroxine (thyroid hormone) and growth hormone, secreted by the pituitary gland.
Activation of the sympathetic nervous system (under stress, intense physical exertion) - increases the level of glucose in the blood, and the predominance of parasympathetic parts of the nervous system there is a decrease in blood glucose levels (early morning and late at night marked physiological hypoglycemia, normalizing after breakfast).
Norma blood sugar levels in women and men
normal rate of blood sugar in women and men is a glucose concentration of 3.3 to 5.5 mmol / l (in the morning on an empty stomach).The deviation in the range of 5.6 to 6.6 mmol / L and is a borderline condition, when the patient needs a diet correction and re-examination.
Improving this indicator fasting 6.7 mmol / L or more is grounds to suspect the presence or formation of diabetes (especially if hereditary predisposition).
In this case, carry out additional tests - oral test to determine glucose tolerance.
In this survey:
- the concentration of sugar in the blood to 7.7 mmol / L is defined as the normal rate;
- glucose at rates from 7.8 - 11.1 mmol / l - diagnosed with impaired glucose tolerance;
- for the index of 11.2 mmol / l and above - in a patient diagnosed with diabetes.
is believed that the rate of blood sugar levels in women is the same as men, and doctors do not discriminate based on gender.However, during pregnancy (especially in women over 30 and with the excess weight), blood sugar levels can rise significantly.Then we are talking about so-called gestational diabetes.But let's talk about this a little later.
Norma blood sugar in children
distinctive feature of infants is physiological hypoglycaemia (a tendency to reduce the level of blood glucose), which is associated with a lack of differentiation of regulatory systems homeostasis and activation of parasympathetic part of the nervous system.
In terms of blood glucose between 5.5 and 6.1 mmol / l in the pediatric indication is mandatory to conduct the oral test determining glucose tolerance, due to the fact that these figures are significantly higher in children and the incidence of diabetes 1type grows from year to year.Increasing the rate from 7.7 mmol / L or higher after stress test is a diagnostic criterion for diabetes.
Methods for determining the level of blood sugar
blood glucose is determined in plasma or whole blood in the morning on an empty stomach (with a break of at least 8 hours a meal and liquid), after the glucose load (oral or intravenous glucose tolerance test, or IVGTT OGTT).The main methods of determining blood sugar levels are laboratory (automated) methods (colorimetric and enzyme), and with the help of portable glikometrov for self-monitoring of blood glucose in diabetic patients.The most accurate methods are by far the determination of glucose concentration in a biochemical laboratory immediately after collection of blood, which is especially important in the diagnosis of early disorders of carbohydrate metabolism blood glucose is in the border ranges of norm and pathology of diabetes, or the initial stages of carbohydrate metabolism.
oral glucose tolerance test is conducted :
- for the differential diagnosis of diabetes and other diseases, with an increase in the indicator of blood glucose on an empty stomach, as well as family history of this disease and the metabolic syndrome.
- epidemiological studies the prevalence of impaired glucose tolerance and type 2 diabetes.
This survey is not carried out:
- with a high level of hyperglycemia greater than 7.0 mmol / L, which is a clear sign of diabetes, and confirmation of this indicator in repeated trials;
- acute somatic diseases in a patient, which reduces sensitivity to insulin;
- the treatment with diuretics, corticosteroids, propranolol, biphenyl and other drugs that reduce insulin sensitivity.
Application portable glikometrov shown for continuous monitoring of blood sugar levels in diabetes mellitus, impaired glucose tolerance, and metabolic syndrome to correct the doses of drugs and do not miss the pathological changes that threaten life and health (development of hyper- or hypoglycemic conditions).
reasons for elevated blood sugar
physiological processes that cause an increase in blood glucose levels occur after ingestion of easily digestible carbohydrates or polysaccharides, for intensive mental and / or physical activity.
Abnormal transient increase in the concentration of blood sugar occurs:
- when expressed pain syndrome;
- for burns;
- in connection with the development of an epileptic seizure;
- in acute myocardial infarction or severe angina attacks.
Reduced glucose tolerance develops:
- pathological conditions caused by surgery on the stomach and duodenum, which lead to the rapid absorption of glucose from the intestine;
- with traumatic brain injuries with damage to the hypothalamus, due to lower tissue ability to utilize glucose;
- with organic lesions of the liver (hepatitis, cirrhosis, gepatozah) synthesis occurs decrease glycogen (glucose and other substances) and the depletion of the depot.
Long persistent increase in blood sugar levels are diagnosed as diabetes mellitus (sugar diabetes).
What is diabetes and what are the types?
Diabetes - is a group of metabolic diseases that are associated with impaired secretion and / or action of insulin and are accompanied by chronic hyperglycemia.Chronic hyperglycemia leads to damage and dysfunction of various organs (eyes, kidneys, blood vessels, nerves, the heart), thus causing chronic complications.
Depending on the etiological factor is isolated primary (direct damage of endocrine pancreas - Langergantsa islands) or secondary (in various diseases that lead to a violation of carbohydrate metabolism) diabetes.
term "primary diabetes mellitus" includes two separate nosological forms - the first type diabetes (type 1 diabetes) and diabetes type II diabetes (T2D).In T1D formed absolute and deficits are insulin secretion with typical symptoms (thirst, frequent urination, and progressive weight loss).For type 2 diabetes is characterized by a resistance (reduced sensitivity) insulin-dependent tissues to insulin.This type of diabetes is characterized erased the clinical picture and the gradual development.
Other specific types of diabetes are:
- diabetes, which occurs in severe disease of the pancreas (malignant tumors of the pancreas, severe pancreatitis, cystic fibrosis, and the removal of the pancreas), resulting in a absolute insulin deficiency;
- with endocrinopathy (disease with increased levels of insulin secretion antagonists):
- glucagon (the formation of tumor glucagonomas);
- growth hormone (with gigantism and acromegaly);
- thyroid hormones (in severe forms of hyperthyroidism);
- adrenaline (in pheochromocytoma);
- adrenal hormones (the syndrome of Cushing).
- chronic administration of drugs (thiazide diuretics, corticosteroids, some antihypertensive and psychotropic drugs, estrogensoderjath drugs (oral contraceptives) and catecholamines).
- as complications from infectious diseases (congenital rubella, cytomegalovirus infection, mumps).
According to the new WHO classification is allocated a separate nosological form - gestational diabetes (diabetes in pregnancy).
during pregnancy in women undergoing complex processes of adjustment related to changes in hormonal levels (high placental and ovarian steroids and increased secretion of cortisol), which leads to the development of physiological resistance of tissues to insulin action.In this case, developing gestational diabetes mellitus, which was first diagnosed in women during pregnancy in laboratory parameters (elevated fasting blood sugar of 6.1 mmol / L or higher with an increase in blood glucose concentrations after oral administration increased glucose tolerance test, 7.8 mmol/ l and above) without clinical manifestations.An important moment in the formation of this disease is the development of the risk of developing diabetic fetopathy the fetus (malformations) at an early manifestation of hyperglycemia and organic lesions of organs and systems (cerebral palsy, heart defects, congenital cataract) with late manifestation of gestational diabetes mellitus and hyperglycemia without compensation.
gestational diabetes develops in the second and third trimester (between 4 to 8 months of pregnancy), so women at risk, it is necessary to constantly monitor the blood sugar level indicators.
At risk are women with hereditary predisposition (diabetes in the immediate family), with increased body weight, hypertension, complicated obstetric history (miscarriage, stillbirth or large fetus during previous pregnancies), polycystic ovaries.