Analyzes in diabetes mellitus - a list of necessary studies for diagnosis of the disease

What is diabetes mellitus

This is a disease of the endocrine system, in which the development of insulin or the sensitivity of body tissues is impaired. The popular name for diabetes mellitus( DM) is a "sweet disease", since it is believed that sweets can lead to this pathology. In reality, the risk factor for developing diabetes is obesity. The disease itself is divided into two main types:

• Diabetes of the first type( insulin-dependent).This disease, in which there is insufficient synthesis of insulin. Pathology is typical for young people under 30 years.
• Type 2 diabetes( non-insulin dependent).Caused by the development of immunity of body tissues to insulin, although its level in the blood remains normal. Insulin resistance is diagnosed in 85% of all cases of diabetes. It causes obesity, in which fat blocks the susceptibility of tissues to insulin. Type 2 diabetes is more prone to elderly people, as glucose tolerance gradually decreases as adults grow.

type 1 develops due to autoimmune pancreatic lesions and destruction of insulin-producing cells. Among the most common causes of this disease are the following:

• rubella;
• viral hepatitis;
• epidemic parotitis;
• toxic effects of drugs, nitrosamines or pesticides;
• genetic predisposition;
• chronic stressful situations;
• diabetogenic effect of glucocorticoids, diuretics, cytostatics and some antihypertensive drugs;
• chronic adrenocortical insufficiency.

Diabetes of the first type develops rapidly, the second - on the contrary, gradually. In some patients, the disease proceeds secretly, without bright symptoms, because of which pathology is detected only when analyzing blood and urine for sugar or examining the fundus. Symptoms of the two types of diabetes are somewhat different:

• type 1 diabetes. It is accompanied by a strong thirst, nausea, vomiting, weakness and frequent urination. Patients suffer from increased fatigue, irritability, constant hunger.
• Type 2 diabetes. It is characterized by pruritus, visual impairment, thirst, fatigue and drowsiness. The patient does not heal well, there are skin infections, numbness and paresthesia of the legs.

Why take tests for diabetes

The main goal is to accurately diagnose. If you suspect a diabetes, you should consult a therapist or an endocrinologist - an expert and prescribe the necessary instrumental or laboratory tests. The list of diagnostic tasks also includes the following:

• the correct choice of the dosage of insulin;
• monitor the dynamics of the prescribed treatment, including diet and compliance regimen;
• definition of changes in the stage of compensation and decompensation of diabetes mellitus;
• self-monitoring of sugar level;
• tracking the functional state of the kidneys and pancreas;
• control of treatment during gestation with gestational diabetes;
• revealing the existing complications and the degree of deterioration of the patient.

What tests need to pass

The main tests for determining diabetes mellitus involve the surrender of blood and urine to patients. These are the main biological fluids of the human body, in which various changes are observed in diabetes - for their detection and analysis. Blood is taken to determine the level of glucose. The following tests help in this:

• common;
• biochemical;
• study for glycated hemoglobin;
• test for C-peptide;
• study for serum ferritin;
• is a glucose-tolerant test.

In addition to a blood test, the patient is prescribed and urinalysis. With it, all toxic compounds, cellular elements, salts and complex organic structures are excreted from the body. Due to the study of urine indicators, it is possible to detect changes in the state of internal organs. The main analyzes of urine for suspected diabetes are:

• general clinical;
• daily;
• determination of the presence of ketone bodies;
• determination of microalbumin.

There are also specific tests for the detection of diabetes mellitus - they pass in addition to blood and urine. Such studies are conducted when the doctor has doubts about the diagnosis or wants to study the disease in more detail. These include the following:

• The presence of antibodies to beta cells. Normally, they should not be present in the patient's blood. When antibodies to beta-cells are detected, diabetes is confirmed or a predisposition to it.
• For antibodies to insulin. They are autoantibodies that the body produces against their glucose, insulin, and specific markers of diabetes.
• On the concentration of insulin. For a healthy person, the norm is the glucose level of 15-180 mmol / l. Values ​​less than the lower limit indicate type 1 diabetes, above type 2 diabetes.
• On the determination of antibodies to GAD( glutamate decarboxylase). It is an enzyme that is a brake mediator of the nervous system. It is present in its cells and beta cells of the pancreas. Analyzes in type 1 diabetes suggest the detection of antibodies to GAD, as in most patients with this disease they are identified. Their presence reflects the process of destruction of beta cells in the pancreas. Anti-GAD are specific markers that confirm the autoimmune origin of type 1 diabetes.

Blood tests

Initially, a general blood test for diabetes, for which it is taken from the finger. The study reflects the level of qualitative indicators of this biological fluid and the amount of glucose. Further, biochemistry of the blood is performed to identify pathologies of the kidneys, gallbladder, liver and pancreas. In addition, lipid, protein and carbohydrate metabolic processes are examined. In addition to general and biochemical studies, blood is taken for some other tests. It is often given in the morning and on an empty stomach, because the accuracy of diagnosis will be higher.

General

This blood test helps to determine the basic quantitative indicators. Deviation of the level from normal values ​​indicates pathological processes in the body. Each indicator reflects certain violations:

• Elevated hemoglobin indicates dehydration, which causes a person a strong thirst. When studying
• platelet levels can be diagnosed thrombocytopenia( increase in number) or thrombocytosis( decrease in the number of blood cells).These deviations indicate the presence of diabetes-related pathologies.
• An increase in the number of leukocytes( leukocytosis) also indicates the development of inflammation in the body.
• An increase in hematocrit indicates erythrocytosis, a decrease in anemia.

The general blood test for diabetes mellitus( UAC) is recommended to be taken at least once a year. In the case of complications, the study is conducted much more often - up to 1-2 times in 4-6 months. UAC rates are presented in the table:

Indicator	Rate for men	Norm for women
Reduction rate of erythrocytes, mm / h	1-10	2-15
Hemoglobin, g / l	130-170	120-140
Leukocyte count,* 10 ^ 9 / l	4-9	4-9
boundaries changes in hematocrit,%	40-52	35-42
number of platelets, 10 ^ 9 / l	180-320	150-400

blood biochemistry

In diabetes, the most common study is a biochemical blood test. The procedure helps to assess the degree of functionality of all body systems, determine the risk of developing a stroke or a heart attack. Diabetics show a sugar level exceeding 7 mmol / l. Among other abnormalities indicating diabetes, there are:

• increased cholesterol levels;
• increase in the amount of fructose;
• dramatic increase in triglycerides;
• decrease in the number of proteins;
• increase or decrease in the number of white and red blood cells( white blood cells, platelets and erythrocytes).

Biochemistry of capillary or blood from the vein, too, need to take at least once in six months. The study is conducted in the morning on an empty stomach. When interpreting the results of doctors use the following standards indicators blood biochemistry:

Indicator	Normal values ​​
Total protein, g / l	64-83
Glucose, mmol / l	3,2-5,5
Total cholesterol, mmol / l	Prior 5,2
Triglycerides, mmol / l	0,55-1,65
creatinine, mmol / l for	62-115 53-97
men women Total bilirubin, mmol / l	3,7-17,1
Fructosamine, mmol / l Before
280 Sodium, mmol / l	134-150
Potassium, mmol / l Chlorides	3,6-5,4
mml / l	95-110
Calcium, mmol / l	2-2,8
Zinc. mu.mol / l	11-18
Iron. mu.mol / l	11,64-30,43
Homocysteine, umol / l	6.2-15

On glycosylated hemoglobin

By hemoglobin is meant the red respiratory pigment of blood, which is contained in red blood cells. Its function is to transfer oxygen to tissues and carbon dioxide from them. In hemoglobin there are several fractions - A1, A2, etc. D. Some of it is associated with glucose, contained in the blood. Their connection is stable and irreversible, such a hemoglobin is called glycated. It is designated as HbA1c( Hb - hemoglobin, A1 - its fraction, c - subfraction).

A study for hemoglobin HbA1c reflects the average level of glucose in the blood in the last quarter. The procedure is often carried out with a periodicity of 3 months, because such an amount of time live red blood cells. Taking into account the therapy scheme, the frequency of this analysis is determined in different ways:

• If the patient is treated with insulin preparations, then such an examination for diabetes should be performed up to 4 times per year.
• When the patient does not receive these medications, blood donation is prescribed 2 times throughout the year.

The HbA1c assay is performed for the primary diagnosis of diabetes mellitus and for monitoring the effectiveness of its treatment. The study determines how many blood cells are associated with glucose molecules. The result is reflected in percentage - the higher it is, the heavier the form of diabetes. This shows glycated hemoglobin. Its normal value in an adult should not exceed 5.7%, in a child it can be 4-5.8%.

On the C-peptide

This is a very accurate method that is used to detect the extent of pancreatic damage. The C-peptide is a special protein that is separated from the "proinsulin" molecule when insulin is formed from it. At the end of this process, it penetrates into the blood. When this protein is found in the bloodstream, it is confirmed that its own insulin is still being formed.

The pancreas works better, the higher the C-peptide level. A strong increase in this indicator indicates a high level of insulin - hypersensulinism. Study on the C-peptide is given at an early stage of diabetes. In the future, you can not do it. At the same time, it is recommended to measure the level of sugar in the plasma with a glucometer. The norm of the C-peptide on an empty stomach is 0.78-1.89 ng / ml. These tests for diabetes mellitus can have the following results:

• Increased level of C-peptide against the background of normal sugar. Indicates insulin resistance or hyperinsulinism in the early stage of type 2 diabetes.
• An increase in the amount of glucose and C-peptide indicates an already progressive insulin-independent diabetes.
• A small amount of C-peptide and an elevated level of sugar indicate a serious damage to the pancreas. This is confirmation of the launched type 2 diabetes or type 1 diabetes.

Serum ferritin

This indicator helps to detect insulin resistance. Its definition is carried out if there is a suspicion of the patient having anemia - lack of iron. This procedure helps determine the stocks in the body of this trace element - its deficiency or excess. Indications for its conduct are as follows:

• a constant sense of fatigue;
• tachycardia;
• fragility and bundle of nails;
• nausea, heartburn, vomiting;
• pain and swelling of the joints;
• hair loss;
• profuse menstruation;
• pale skin;
• pain in the muscles without physical exertion.

These signs indicate an elevated or decreased level of ferritin. To assess the extent of its reserves more convenient to use the table:

Decoding results	ferritin concentration, mg / L
age 5	age from 5 years
women	men	women	men
Lack	iron Less than 12	Less than 12	Less than 15	Less than 15
Excess iron content	Over 140	Over 140-	Over 180	Over 300
Norm	12-140	12-140	22-180	30-300

Glucose Tolerance

This survey method reflects fromChanges that occur when the body is stressed against diabetes mellitus. Scheme of the procedure - the patient's blood is taken from the patient's finger, then the person drinks a glucose solution, and after an hour the blood collection is repeated. The possible results are shown in the table:

Fasting glucose, mmol / L	Glucose after 2 hours of glucose, mmol / l	Decoding
5.5-5.7	7.8	No LED
7.8	7,8-11	Impairment of glucose tolerance
7,8	11,1	In a patient with diabetes

Urinalysis

Urine is an indicator that reacts to any changes in the functioning of body systems. On the substances that are excreted in urine, a specialist can determine the presence of the disease and the degree of its severity. When suspected of diabetes mellitus, special attention is paid to the level in sugar urine, ketone bodies and the pH( pH).The deviation of their values ​​from the norm indicates not only the diabetes, but also its complications. It is important to note that single detection of violations does not indicate the presence of the disease. Diabetes is diagnosed with a systematic excess of indicators.

General clinical

Urine for this assay should be collected in a clean sterile container.12 hours before the collection it is required to exclude the taking of any medicines. Before urinating, you need to wash your genitals, but without soap. For the study, take an average portion of urine, i.e.skipping a small amount in the beginning. The urine laboratory should be delivered within 1.5 hours. Morning piss is collected for delivery, physiologically accumulated during the night. Such material is considered optimal, and the results of its examination are accurate.

The purpose of a general urine test( OAM) is the detection of sugar. Normally, urine should not contain it. It is allowed only a small amount of sugar in the urine - in a healthy person it does not exceed 8 mmol / l. With diabetes, the level of glucose is slightly different:

Type of diabetes	Sugar level on an empty stomach, mmol / l	Sugar level after 2 hours after eating, mmol / l
Type 1 diabetes	4-7	From 8,5
Type 2 diabetes	4-7	From 9

If the above normal values ​​are exceeded, the patient will need to pass a 24-hour urine test. In addition to detecting sugar, OAM is necessary for studying:

• kidney function;
• the quality and composition of urine, its properties, such as the presence of sediment, hue, the degree of transparency;
• chemical properties of urines;
• presence of acetone and proteins.

In general, OAM helps to evaluate several indicators, which determine the presence of type 1 or type 2 diabetes and its complications. Their normal values ​​are shown in the table:

Characteristics of urine	Norm
Color	Straw yellow
Transparency	Clear
Smell	Unsharp
pH	From 4 to 7
Density	1012-1022 g / l
Protein	None. Allowed up to 0.033 g / l.
Glucose	Not available. Allowed up to 0.8 mmol / l
Hemoglobin	None
Salts	None
Erythrocytes	Up to 3 in the field of view in women, single - for men.
Leukocytes	Up to 6 in the field of view in women, up to 3 - in men.

Daily

If necessary, clarify the results of OAM or confirm their reliability. The first portion of urine after awakening is not taken into account. The count is already from the second collection of urine. With each urination throughout the day, urine is collected in one dry, clean container. They store it in the refrigerator. The next day, the urine is mixed, after which 200 ml is poured into another dry clean jar. This material is carried for daily study.

This technique helps not only to diagnose diabetes, but also to assess the severity of the disease. During the study, the following indicators are determined:

Indicator name	Normal values ​​
Creatinine	5.3-16 mmol / day.- for women 7-18 mmol / day.- for men
Urea	250-570 mmol / day.
Protein	0,08-0,24 g / day.
Glucose	Less than 1.6 mmol / day.
Oxalates	228-626 μmol / day.
Methanephrine	55% of the total adrenaline-adrenal hormone

metabolism. Determination of the presence of ketone bodies.

. Under ketone bodies( in simple terms, acetone), medicine is understood as the products of metabolic processes. If they appear in urine, this indicates the presence in the body of violations of fat and carbohydrate metabolism. A general clinical blood test can not detect ketone bodies in the urine, so the results say they are not. To identify acetone, a qualitative study of urine is carried out using specific methods, including:

• Nitroprusside tests. It is carried out with the help of sodium nitroprusside - a highly effective peripheral vasodilator, i.e.means, dilating blood vessels. In an alkaline medium, this substance reacts with ketone bodies, forming a complex of pink-lilac, lilac or violet.
• The test of Gerhardt. It is added to the urine of ferric chloride. Ketones color it in wine color.
• The method of Natherson. It is based on the displacement from the urine of ketones due to the addition of sulfuric acid. As a result, acetone with salicylic aldehyde forms a red compound. The intensity of the color is measured photometrically.
• Express tests. This includes special diagnostic strips and kits for rapid determination of ketones in the urine. Such agents include sodium nitroprusside. After dipping the tablet or strip into the urine, it is dyed violet. Its intensity is determined by the standard color scale in the set.

You can check the level of ketone bodies even at home. To control the dynamics, it is better to buy several test strips at once. Next, you need to collect morning urine, skipping a small amount of it at the beginning of urination. Then the strip is lowered in urine for 3 minutes, after which the color is compared with the scale in the kit. The test shows the concentration of acetone from 0 to 15 mmol / l. You can not get exact figures, but you can determine the approximate value by color. Critical is the situation when the shade on the strip is purple.

In general, the collection of urine is carried out both for general analysis. The norm of ketone bodies is their complete absence. If the result of the study is positive, then an important criterion is the amount of acetone. Depending on this, the diagnosis is determined:

• With an insignificant amount of acetone in the urine, ketonuria is established-the presence of ketones in urine alone.
• At a ketone level from 1 to 3 mmol / l, ketone is diagnosed. With her, acetone is also found in the blood.
• If the level of ketones exceeds 3 mmol / l, the diagnosis is ketoacidosis in diabetes mellitus. This is a violation of carbohydrate metabolism due to insulin deficiency.

Definition of microalbumin

By microalbumin( or simply albumin) is meant a kind of protein circulating in the human body. Its synthesis occurs in the liver. Albumin accounts for the majority of proteins in the serum. A healthy person with urine releases only a small amount of this substance, and the smallest fraction of it, which is called microalbumin. This is because the renal glomeruli are impermeable to larger molecules of albumin.

OAM for microalbumin protein detection is the only test that determines the presence of diabetic nephropathy and hypertension( high blood pressure), even at an early stage. These diseases are characteristic of insulin-dependent diabetics, i.e.with type 1 diabetes. If tests for diabetes mellitus type 2 show the presence of albumin in the urine, then the patient may have cardiovascular pathologies. In norm for a day should not be allocated more than 30 mg of this protein. Depending on the results obtained, the patient is diagnosed with such kidney pathologies:

Quantity of microalbumin protein	Diagnosis
20-200 mg / l	Microalbuminuria( MAU)
more than 300 g / l	Proteinuria is a condition developing after microalbuminuria

At the stage of microalbuminuria, changesKidney glomeruli are still reversible, so the effect will bring the right treatment. With proteinuria, therapy is aimed only at stabilizing the patient's condition. To accurately assess the amount of microalbumin being excreted, a general or daily urinalysis is used. Collection is carried out according to the rules of these studies, described above.

Price

The cost of research is determined by their complexity. Prices in different private clinics may be slightly different. Some medical institutions offer a set of procedures at once, which can cost a little less than doing each analysis for diabetes alone. Examples of prices are shown in the tables:

analysis type	cost, rubles
Blood
General	450
Biochemical	1600-2000
on glycated hemoglobin	400
On	720
C-peptide on serum ferritin	300
glucose tolerance	660
Urine
overall clinical	350
Daily	300
On	200
ketone bodies on the protein microalbumin	500
Specific
For the presence of antibodies to beta cells	1300
On antibodies to insulin	700
On the insulin concentration	680
On the determination of antibodies to GAD( glutamate decarboxylase)	1600

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