Insulin resistance (IR): The cellular effect of unit concentration of insulin is weakened, that is, the body's biological response to normal concentrations of insulin is reduced.

Characteristics of type 2 diabetes

It is a metabolic syndrome characterized by fasting and postprandial hyperglycemia.

Pancreatic beta cell dysfunction

Characteristics of type 1 diabetes

Most damage is mediated by T cells, and 60% to 80% of newly diagnosed T1DM patients have autoantibodies (ICA, IAA).

autoimmune reaction Chemical material Viral infection

diagnosis:

Refers to diabetes detected during pregnancy. Including any degree of impaired glucose tolerance and onset of diabetes, but known diabetes associated with pregnancy does not exclude this type.

This type of diabetes is often secondary to other diseases, with many causes but fewer patients.

type

Diabetes is a group of metabolic diseases caused by insufficient insulin secretion or low insulin action. It is characterized by hyperglycemia, the typical symptoms of which are: polyuria, polyuria, and weight loss.

Hyperglycemia: fasting blood glucose concentration exceeds 7.0mmol/L

Hyperglycemia (exceeding the renal glucose threshold) can be excreted by the kidneys, Causes glycosuria and produces osmotic diuresis

Due to increased production of acetoacetate and beta-hydroxybutyrate, Depletion of the blood buffer system leading to acidosis

Protein and fat synthesis decrease and decomposition accelerates

Glucose oxidase method (common method)

Hexokinase method (HK, reference method)

Folin Wu Method (Pioneer Method)

o-Toluidine method (deprecated method)

Oxidative decomposition→ATP

Synthesis of liver and muscle glycogen

convert to fat

gluconeogenesis

① Blood sugar is the main energy substance for human life activities. Blood sugar balance ensures sufficient energy supply for various human tissues and organs.

②Insufficient blood sugar will lead to insufficient energy supply in the human body.

③ Diabetes may occur when blood sugar concentration is too high.

Digestion and absorption of sugars in food

Conversion of fats and other non-sugar substances

hepatic glycogenolysis

Alpha cells (increase blood sugar) → secrete glucagon → promote the decomposition of liver glycogen into glucose and the conversion of non-sugar substances into glucose

Beta cells (lower blood sugar) → secrete insulin

The liver is the main organ that regulates blood sugar concentration

The liver is also the main organ for gluconeogenesis

Lateral hypothalamic nucleus→pancreatic beta cells→insulin

ventromedial hypothalamic nucleus

Methodological evaluation: It has high precision, good specificity, simple operation, suitable for fully automatic biochemical analysis, and low cost.

Detection principle: Hemoglobin beta chain (protease)—→N-terminal-glycylglutamine Glycylglutamine (FPOX)—→H₂O₂

reference interval HbA₁c4%~6% (HPLC method)

Detection principle: GHb and HbA can be eluted in stages using phosphate buffers of different pH. The corresponding Hb chromatogram was obtained and expressed as a percentage.

Methodological evaluation: Ion exchange HPLC method is the gold standard for HbA₁C detection. The cation exchange resin micro-column method is mainly used in China

HbA₁c≥6.5% Diabetes

5.7%~6.4% prediabetes

8%~9% control is not ideal

Greater than 9%, blood sugar control is poor

③Blood sugar two hours after a meal can better reflect the amount of food eaten and whether the use of hypoglycemic drugs is appropriate. It cannot be replaced by checking fasting blood sugar.

②Blood sugar >11.1mmol/L two hours after a meal is prone to chronic complications of diabetes such as eyes, kidneys, and nerves.

①Reflects the reserve function of pancreatic islet β cells and the ability of pancreatic islet β cells to secrete insulin after eating.

Glucose tolerance test after oral administration of 75 g anhydrous glucose

Eat 100g of steamed buns

Blood sugar <7.8mmol/L two hours after a meal

Preparation before experiment: Three days before the test, the sugar content in the daily food should not be less than 150 grams, and normal activities should be maintained. Drugs that may affect the test should be stopped three days before the test, and an empty stomach should be fasted for 10 to 16 hours before the test.

Experimental procedure: Within 5 minutes after taking blood while seated, drink 250 ml of sugar water containing 75 grams of anhydrous glucose. After that, blood was taken every 30 minutes for a total of 4 times. Finally draw a glucose tolerance curve. Collect urine every 1 hour for glycosuria measurement

Give subjects a certain loading dose orally or intravenously After glucose, by measuring the blood glucose concentration at different times, Understand the subject's ability to regulate blood sugar.

Including OGTT and IGTT

Symptoms of hypoglycemia in newborns and infants

Fasting hypoglycemia in adults

diabetic hypoglycemia

postprandial hypoglycemia