Ntg disease. Diet for Impaired Glucose Tolerance

Even in a perfectly healthy person, the level of fasting blood glucose increases by 1 mg% (0.06 mmol / l) every 10 years, and the increase in this level during a standard glucose tolerance test is 5 mg% (0.28 mmol /l). According to the American Diabetes Association (ADA) criteria, some degree of glucose intolerance occurs in almost 10% of elderly and old people. This may be due to changes in body chemistry, diet, physical activity, and insulin secretion and action.
As we age, lean body mass decreases and body fat increases. There is a direct correlation between body fat percentage and fasting serum glucose, insulin, and glucagon levels. If we exclude this factor (obesity), then the dependence of the basal levels of these hormones on age disappears. However, in old age, the mechanisms to counteract hypoglycemia (counterregulation) are disrupted, which is associated with a weakening of the glucagon response. In addition, age-related changes in the impulse nature of insulin secretion are possible.
Reduced physical activity and a low-carbohydrate diet also lead to impaired glucose tolerance. Patients with type 2 diabetes mellitus have a combination of insulin resistance, impaired insulin secretion, and increased hepatic glucose production. In the absence of obesity in elderly diabetic patients, insulin secretion is impaired to a greater extent than its effect on glucose utilization. In obesity, on the contrary, insulin resistance plays the main role, while insulin secretion remains almost normal. In both cases, hepatic glucose production changes slightly. In addition, age-related changes in glucose metabolism depend on sex: in old age, anaerobic glycolysis is impaired in men, but not in women. However, modifiable factors such as diet, drugs, and physical inactivity play a major role in carbohydrate intolerance in the elderly.

Diabetes

Clinical manifestations
With age, the prevalence of diabetes increases. According to the National Health and Nutrition Survey (NHANES), conducted in the United States in 1999-2000, 38.6% of people over 65 years of age suffer from diabetes. This disease is especially common among African Americans, Hispanics and Indians. In addition, older people are much more likely to have metabolic syndrome, characterized by at least three of the five features: abdominal obesity, hypertension, low HDL cholesterol, high triglycerides, and elevated fasting glucose. If in the age group of 20-30 years the frequency of this syndrome is 6.7%, then in 60-70 years - 43.5%. Metabolic syndrome is associated with insulin resistance and an increased risk of cardiovascular disease. Most older people with diabetes have type 2 diabetes. Its manifestations at this age are often atypical. For example, many patients do not have polyuria or polydipsia because glomerular filtration rate and thirst decrease with age and the renal threshold for glucose increases. Non-specific manifestations of diabetes mellitus in the elderly include general weakness, fatigue, weight loss, and frequent infections. Neurological disorders are also observed - cognitive impairment, acute attacks of disorientation in time and space, or depression. The frequency of abrasions and abrasions increases and the pain threshold decreases. In a survey of more than 3,000 residents of nursing homes, it turned out that diabetes had not been previously diagnosed in almost 30% of them.
According to the ADA guidelines (1998), for the diagnosis of diabetes, it is sufficient to detect a fasting blood glucose level of more than 126 mg% on two random determinations (in the absence of acute diseases). A 2-hour glucose tolerance test is optional. Polyuria, polydipsia, unexplained weight loss, and a plasma glucose level of more than 200 mg% in a single determination also indicate diabetes mellitus. The ADA recommends screening all individuals over 45 years of age at least every 3 years; if there are risk factors (family history of coronary heart disease, smoking, arterial hypertension, obesity, kidney disease and dyslipidemia), examinations should be performed more frequently. Since the renal threshold for glucose rises with age, glucosuria should not be targeted. An increase in the level of glycated hemoglobin confirms the diagnosis, but this indicator is more often used to assess the effectiveness of treatment than in the initial diagnosis.
Complications of diabetes depend on the duration of the illness. Therefore, with an increase in life expectancy, the elderly develop the same complications (neuropathy, nephropathy and retinopathy) as at a younger age. The British Diabetes Prospective Study (UKPDS) evaluated the impact of improved glycemic control on complications. In a group of 3067 patients with type 2 diabetes (mean age 54 years), the incidence of complications was compared with conventional therapy and intensive treatment with sulfonylurea derivatives and insulin (which maintains glycemia at the level< 108 мг%). Больных наблюдали в среднем 10 лет. В подгруппе интенсивного лечения частота микрососудистых осложнений (ретинопатии, нейропатии и нефропатии) оказалась на 25% меньшей. Результаты лечения производными сульфонилмочевины и инсулином не различались. Макрососудистые осложнения встречались в обеих подгруппах с равной частотой, хотя на фоне интенсивной терапии зарегистрирована тенденция к уменьшению числа инфарктов миокарда.
Hypoglycemia in the elderly and old people leads to severe consequences. Such concerns should not be a reason for the abolition of sulfonylurea or insulin derivatives, but require close monitoring of patients. As noted above, counterregulatory responses to hypoglycemia are impaired in old age and, more importantly, the ability to sense hypoglycemia (and therefore take the necessary measures to correct it) decreases. Due to the decrease in the reserve capacity of the brain (due to strokes, amyloid angiopathy or Alzheimer's disease), it is more difficult for the functions of the cerebral cortex in old people to recover from episodes of hypoglycemia.

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Treatment
The goal of treating diabetes in the elderly and senile is to maintain fasting blood glucose levels below 150 mg% (8.3 mmol/l), and after meals - below 220 mg% (12.2 mmol/l). This is sometimes difficult to achieve because older people are forced to take many drugs (eg, thiazide diuretics, phenytoin, glucocorticoids) that increase blood glucose levels. Treatment should be aimed at eliminating the symptoms of hyperglycemia and preventing infections and the development of hyperosmolar coma. It is also important to control blood pressure and blood lipid levels.
As at a younger age, you should start with diet correction, weight loss (if it is in excess) and individually selected physical activity. If mild or moderate hyperglycemia persists [fasting blood glucose 150–300 mg% (8.3–16.7 mmol/l)], oral hypoglycemic agents are used. Chlorpropamide should be excluded because, due to its long half-life in the body, it contributes to the development of hypoglycemia and hyponatremia. Second-generation sulfonylurea derivatives, glipizide and glyburide, are often prescribed. These substances are well tolerated by patients, increase insulin secretion, increase the number of insulin receptors and reduce hepatic glucose production. The half-life of glipizide in the blood is shorter than glyburide, and therefore the likelihood of developing hypoglycemia with its use is less. Glimepride can be used with insulin. This drug is characterized by a rapid onset and a longer duration of action. In case of allergy to sulfonylurea derivatives, meglitinide (repaglinide) is used. However, it has a short half-life, requiring it to be taken before every meal. Nateglinide is another insulin secretagogue that rarely causes hypoglycemia. It is taken with food. Repaglinide and nateglinide increase the first phase of insulin secretion in response to food intake. Two classes of compounds reduce insulin resistance - biguanides (metformin) and thiazolidinediones (pioglitazone and rosiglitazone). Metformin preferentially limits hepatic glucose production without affecting insulin secretion. In addition, this drug reduces peripheral insulin resistance and improves the lipid profile. However, it cannot be used in renal failure [plasma creatinine > 1.5 mg% (132 µmol/L) in men and > 1.4 mg% (124 µmol/L) in women], which limits its use in the elderly sick. Hypoglycemia with metformin is rare. The combination of metformin with sulfonylurea derivatives contributes to better glycemic control. Side effects of metformin include diarrhea, nausea, and loss of appetite, which also limits its use in the elderly and senile. Thiazolidinediones reduce hepatic glucose production and increase its peripheral utilization. However, thiazolidinediones can cause fluid retention in the body, aggravating the course of congestive heart failure. Therefore, elderly patients prefer to prescribe other oral hypoglycemic agents. α-glucosidase inhibitors (acarbose and miglitol) reduce postprandial hyperglycemia. These drugs are used either alone or in combination with sulfonylurea derivatives. However, in the first case, they are about half as effective as sulfonylurea derivatives. Side effects include abdominal discomfort and flatulence. The combination of low doses of drugs with different mechanisms of action allows for better glycemic control than with monotherapy, and is accompanied by fewer side effects. Thus, there are currently many oral hypoglycemic drugs that can be used alone or together, but information about their use in older people is very limited. When choosing one or another of them, the possibility of side effects, including hypoglycemia, as well as the cost of treatment, should be taken into account.
If blood glucose levels remain above 150 mg% (8.3 mmol/L) despite diet, exercise, and oral antihyperglycemic agents, then insulin therapy (with or without oral agents) should be initiated. Insulin monotherapy is started with 15-30 units of neutral protamine Hagedorn (NPH) or other medium-acting agents. Usually one injection per day is sufficient. Since the elderly and old patients often do not have symptoms of hypoglycemia, at the beginning of insulin therapy, it is necessary to check the levels of fasting blood glucose, after meals and at bedtime, regardless of the presence of such symptoms. Finally, as in younger patients, it is extremely important to control arterial hypertension and stop smoking, since both contribute to the development of vascular complications of diabetes mellitus. In addition, for the primary prevention of such complications in patients at high risk, as well as for their secondary prevention (in patients who have had a myocardial infarction, stroke, in the presence of angina attacks or peripheral vascular disease), the ADA recommends taking aspirin (81-325 mg per day). Annual ophthalmological examinations and preventive examinations of the feet are also recommended. Recommendations for the prevention of hyperglycemia in hospitalized patients remain important. Careful control of glycemia in such conditions reduces the complications of various diseases and therapeutic measures and reduces mortality.
Diabetic ketoacidosis in the elderly is extremely rare. The strategy of its treatment does not differ from that of younger patients. Particular attention should be paid to the correction of electrolyte and water metabolism.

Hyperosmolar coma without ketosis

Clinical manifestations
Hyperosmolar coma without ketosis occurs almost exclusively in patients of older age groups. Factors predisposing to its development include an insufficient decrease in insulin secretion during hyperglycemia and a weakening of its action in the periphery, which contributes to an increase in blood glucose levels. Due to the age-related increase in the renal threshold for glucose, osmotic diuresis develops only with very high hyperglycemia; Decreased thirst also contributes to dehydration. The concentration of glucose in the blood often exceeds 1000 mg% (55.5 mmol / l), which is accompanied by a sharp increase in plasma osmolality in the absence of ketosis.
This syndrome is often observed in patients with type 2 diabetes in nursing homes, who do not always consume the required amount of fluid. However, in almost a third of cases, hyperosmolar coma develops in the absence of a history of diabetes mellitus. Most often (in 32-60% of cases) it is provoked by infectious diseases, and among them - pneumonia. Drugs (eg, thiazides, furosemide, phenytoin, glucocorticoids) and any acute condition may also be the direct cause of hyperosmolar coma. Patients lose their orientation in time and space, they develop drowsiness, weakness and, finally, coma. Generalized or focal convulsions are possible, as well as signs of acute cerebrovascular accident. Characterized by a sharp decrease in intravascular volume, orthostatic hypotension and prerenal azotemia.

Treatment
The deficit of extracellular fluid is on average 9 liters. It is first replenished with saline (especially in the presence of orthostatic hypotension). After the introduction of 1-3 liters of isotonic solution, it is changed to 0.45% saline solution. Half of the fluid and ion deficit must be replenished in the first 24 hours, and the rest within the next 48 hours.
Insulin therapy begins with intravenous administration of small doses (10-15 units), and then the hormone is administered drip at a rate of 1-5 units per hour. The introduction of insulin should not replace infusion therapy, since under its influence glucose moves into the cells and the deficit of extracellular fluid increases, which leads to a further deterioration in kidney function. As soon as the patient begins to excrete urine, it is necessary to start replenishing the potassium deficiency. Measures should be taken to eliminate or treat precipitating factors and diseases (acute myocardial infarction, pneumonia, or certain medications). Although metabolic shifts can be eliminated in 1-2 days, mental disorders sometimes persist for weeks. More than a third of patients may not need further insulin therapy, but the high risk of relapse requires careful monitoring.

Impaired glucose tolerance indicates risk of developing diabetes mellitus 2 type or so-called metabolic syndrome(a complex of dysfunctions of the cardiovascular system, metabolic processes).
The main complication of carbohydrate metabolism disorders and metabolic syndrome is the development of cardiovascular diseases (hypertension and myocardial infarction), leading to premature death, so the glucose tolerance test should become the same mandatory procedure for every person as measuring blood pressure.

Carrying out a glucose tolerance test allows you to identify people who may suffer from serious diseases in the future, give recommendations in advance in order to prevent them, and thereby preserve their health and prolong their years of life.

Usually type 2 diabetes goes through three main stages of development: prediabetes(significant risk groups), impaired glucose tolerance(latent diabetes mellitus) and obvious diabetes.
Typically, patients initially there are no "classic" signs of the disease(thirst, weight loss, excessive urination).
The asymptomatic course of type 2 diabetes mellitus explains the fact that complications specific to diabetes, such as retinopathy (damage to the fundus vessels) and nephropathy (damage to the vessels of the kidneys), are detected in 10-15% of patients already at the initial examination of the patient.

What diseases cause impaired glucose tolerance?

The absorption of glucose into the blood stimulates the secretion of insulin by the pancreas, which leads to the uptake of glucose by tissues and a decrease in blood glucose levels as early as 2 hours after exercise. In healthy people, the glucose level 2 hours after a glucose load is less than 7.8 mmol / l, in people with diabetes - more than 11.1 mmol / l. Intermediate values ​​are referred to as impaired glucose tolerance or "prediabetes".
Impaired glucose tolerance is explained by a combined impairment of insulin secretion and a decrease in tissue sensitivity (increased resistance) to insulin. Fasting glucose levels in impaired glucose tolerance may be normal or slightly elevated. In some people with impaired glucose tolerance, it can subsequently recover to normal (in about 30% of cases), but this condition may persist, and in people with impaired glucose tolerance, there is a high risk of increased carbohydrate metabolism disorders, the transition of these disorders to diabetes type 2.
Impaired glucose tolerance usually occurs in association with interrelated risk factors for cardiovascular disease (high blood pressure, high cholesterol and triglycerides, high low-density lipoprotein, low high-density lipoprotein cholesterol).
If impaired glucose tolerance is identified, certain measures can help prevent increase in carbohydrate metabolism disorders: increased physical activity, weight loss (body weight), a healthy balanced diet.
The test is inappropriate to perform with a re-confirmed fasting glucose level above the diagnostic threshold for diabetes mellitus (7.0 mmol / l). Its implementation is contraindicated in individuals whose fasting glucose concentration is more than 11.1 mmol / l. At the discretion of the physician, the test can be performed with a parallel determination of the level of C-peptide on an empty stomach and 2 hours after a glucose load to determine the secretory reserve of insulin.

In a group of people at risk of developing diabetes requiring examination and a mandatory glucose tolerance test include:

• close relatives of diabetic patients-
• persons with overweight(BMI>27 kg/m2)-
• women who had miscarriages, premature births, stillbirths or large fetuses(over 4.5 kg) -
• mothers children with developmental disabilities-
• women who had during pregnancy gestational diabetes mellitus
• people suffering arterial hypertension(>140/90 mm Hg) -
• persons with a level cholesterol - high density lipoproteins> 0.91 mmol/l-
• people who have triglyceride level reaches 2.8 mmol/l-
• persons with atherosclerosis, gout and hyperuricemia-
• persons with episodic glucosuria and hyperglycemia detected in stressful situations(operations, injuries, diseases) -
• people with chronic diseases of the liver, kidneys, cardiovascular system-
• persons with manifestations metabolic syndrome(insulin resistance, hyperinsulinemia, - dyslipidemia, arterial hypertension, hyperuricemia, increased platelet aggregation, androgenic obesity, polycystic ovaries) -
• patients with chronic periodontal disease and furunculosis-
• persons with neuropathies unclear etiology
• persons from spontaneous hypoglycemia-
• sick, long-term diabetogenic drug users(synthetic estrogens, diuretics, corticosteroids, etc.) -
• healthy people over the age of 45(It is advisable for them to be examined at least once every two years).

All people who are included in the listed risk groups need to determine glucose tolerance, even if the fasting blood glucose levels are within the normal range. In order to avoid errors, the study should be double. In doubtful cases, a glucose tolerance test with intravenous glucose is required.

When conducting a glucose tolerance test, the following conditions must be observed:

• Examined for at least three days before the test should follow the usual diet (with a carbohydrate content> 125-150 g per day) and adhere to the usual physical activity;
• the study is carried out in the morning on an empty stomach after an overnight fast for 10-14 hours (at this time you can not smoke and take alcohol) -
• during the test, the patient should lie or sit quietly, do not smoke, do not overcool and do not engage in physical work;
• the test is not recommended after and during stressful effects, debilitating diseases, after operations and childbirth, with inflammatory processes, alcoholic cirrhosis of the liver, hepatitis, during menstruation, with gastrointestinal diseases with impaired glucose absorption;
• before the test, it is necessary to exclude medical procedures and medication (adrenaline, glucocorticoids, contraceptives, caffeine, thiazidine diuretics, psychotropic drugs and antidepressants) -
• false positive results are observed with hypokalemia, liver dysfunction, endocrinopathies.

After the first blood sampling from a finger, the subject ingests 75 g of glucose in 250 ml of water for 5 minutes. When testing in obese individuals, glucose is added at the rate of 1 g per 1 kg of body weight, but not more than 100 g. To prevent nausea, it is advisable to add citric acid to the glucose solution. The classic glucose tolerance test involves examining fasting blood samples and 30, 60, 90, and 120 minutes after glucose ingestion.

Impaired glucose tolerance is a real problem in today's world. Cases of detection of such a violation have become much more frequent and the reason for this is the change in the rhythm of modern life.

The main factor provocateur is hypodynamia. After a hard work, a person does not have the strength to walk or visit a fitness center and it is much more convenient for him to relax on a comfortable sofa in front of his own TV screen.

The next factor, literally creeping up on the previous one, is malnutrition. A hearty and certainly fatty, high-calorie dinner allows you to cope with hunger that is not satisfied during the day in an instant.

A person believes that he has not eaten all day, but only expended calories, so he can afford it. But the body will not agree with him.

Impaired glucose tolerance is a pathological change, the manifestation of which can be prevented, how to do this and, most importantly, how to detect the change in time? Answers to the main questions are presented to the attention of the reader.

Everyone knows that diabetes is an incurable disease. But its danger is often underestimated. People do not understand that diabetes is the need for regular monitoring of blood sugar throughout life, and the general well-being largely depends on the number on the glucometer.

Many do not think about the dangerous complications of the disease that occur when the basic recommendations for diabetics are not followed. There is no cure for SD, but it is possible to prevent its development.

In this matter, the optimal means of prevention is the timely detection of impaired glucose tolerance. With early detection and taking the necessary measures, it is possible to prevent the development of a dangerous disease or postpone the manifestation of the disease for many years.

Carbohydrates consumed in food are broken down into glucose and fructose during the digestion process. glucose immediately enters the bloodstream. An increase in the concentration of sugar in the blood increases the activity of the pancreas, it produces the hormone insulin, which helps sugar get from the blood to the cells of the body. Glucose in cells is a source of energy and ensures an adequate course of metabolic processes.

For a healthy person, the norm of time given for the absorption of a portion of glucose is no more than 2 hours. After this period, the sugar levels return to normal. If the marks remain marginal, a violation of tolerance is diagnosed.

Attention! Diabetes mellitus can be diagnosed if, after 2 hours after the test, the sugar rate has not stabilized, but remains in the range of about 11 mmol / l.

Prediabetes is impaired glucose tolerance. Such a violation implies the manifestation of a complex of changes:

• against the background of a violation of the process of insulin production by pancreatic cells, the concentration of the hormone in the body decreases;
• the sensitivity of membrane proteins to insulin is significantly reduced.

It is worth remembering that a blood test for sugar with NTG taken on an empty stomach in most cases shows the norm.

This is due to the fact that during the night, the human body is still able to qualitatively process the glucose that has entered the bloodstream. Based on this information, it can be concluded that such a study is not enough to detect prediabetes.

Violation of fasting glycemia is diagnosed in the case when the blood sugar levels exceed the permissible limits, but do not reach the levels that allow diagnosing the fact of the development of diabetes mellitus.

Reasons for the violation

The cause of NTG may be due to several factors:

What factors can provoke impaired glucose tolerance
Factor	Description	Feature photo
Excess weight	Patients whose BMI (body mass index) exceeds 27 are in a special risk group. This is due to the fact that a lot of energy is spent on providing a “large” organism and, as a result, organs such as the heart, kidneys and pancreas suffer in the first place, that is wear out quickly.
Hypodynamia	The patient's consumption of high-calorie, carbohydrate-rich food leads to an overly active rhythm of the body. The pancreas produces insulin spasmodically, in significant doses. A significant amount of excess glucose entering the blood is converted into fat.
Genetics	Diabetes in one or both parents increases the child's chance of developing the disease. Nevertheless, the statistics are quite adequate - if all the recommendations are followed, the risks of developing the disease do not exceed 5%. The most unfavorable prognosis is when type 2 diabetes is detected in a twin - the risk is 90%.
gender	NTG is more common among females over the age of 45.
Pancreatic lesions	The list of predisposing factors includes pancreatitis, the presence of tumors, cysts and all kinds of injuries of the pancreas.
Pathologies of ES	Pathologies of the endocrine system often lead to an imbalance of hormones, which in turn cause metabolic failures.
Gynecological diseases	Impaired glucose tolerance is often found in patients with polycystic ovary syndrome.

The video in this article will acquaint readers with the causes of the manifestation of NTG in more detail.

How is impaired glucose tolerance manifested?

Intensive disorders that can indicate the development of IGT are absent. In case of impaired glucose tolerance, blood sugar rises slightly and for a short period of time, therefore, any characteristic changes indicating the development of pathology may in this case appear only after a few years.

In this case, NTG is detected in conjunction with the diagnosis of type 2 diabetes mellitus in the patient.

Symptoms of NTG can be represented as follows, but the patient must remember that they do not always appear:

• drinking large amounts of liquid, due to the constant presence of dryness in the oral cavity - thus, the body tries to reduce the concentration of sugar in the blood;
• frequent urination against the background of active fluid intake;
• the patient complains of feeling hot, nausea and dizziness after eating;
• recurrent headaches.

The listed symptoms are not specific, therefore their manifestation cannot indicate the development of NTG in a patient. The data obtained as a result of using a home glucometer is also not always informative and their reliability must be confirmed by a laboratory test.

Attention! Diagnosis of impaired glucose tolerance involves a special test that allows you to identify whether the patient suffers from metabolic disorders.

Diagnostics

Glucose tolerance test allows you to establish the presence of violations. The examination requires the patient's venous blood taken on an empty stomach.

Attention! Further testing is possible only if the blood test obtained on an empty stomach does not indicate the development of diabetes. Glucose tolerance test for diabetics is not carried out - it is not informative and can harm the patient's health.

If fasting sugar does not exceed the norm, a load test is performed. Such a study requires patients to consume 75 g of glucose dissolved in 300 ml of water. It takes time to get used to the product. Repeated blood sampling is repeated after 2 hours.

There is another, less common, but more accurate option for testing glucose tolerance. To conduct such a test, not oral administration of the composition is used, but intravenous administration of glucose.

Test Rules

An instruction that provides correct results can be presented in the following form:

1. Blood sampling is carried out in the morning on an empty stomach, the period of time elapsed from the last dose should be at least 8 hours.
2. At least one day before the test, it is forbidden to drink alcoholic beverages.
3. 3 days before the examination, oral contraceptives, vitamins and other medicines are canceled. This is due to the fact that such compounds can cause distortion of the test result. Women taking oral contraceptives should choose another way to prevent unwanted pregnancy.

Danger Present

The main danger of impaired glucose tolerance is the development of type 2 diabetes in a patient. Statistics indicate that in about 30% of cases the human body copes with violations on its own and no outside intervention is required.

In 70% of cases, people who are unaware of a violation of TG live with a similar change, which gradually turns into acquired DM. In order to reduce the likelihood of developing a disease that has many complications, it is worth conducting an annual examination to identify indicators of glucose tolerance.

Attention! Patients at risk of developing the disease should regularly visit an endocrinologist.

Principles of therapy

A glucose tolerance test may indicate the development of carbohydrate metabolism disorders in the human body. Patients who have received similar results should treat their health with great attention. It is mandatory to register with an endocrinologist. The doctor will oversee the recovery process.

Attention! Treating NTG is hard work. The patient will have to carefully reconsider his own lifestyle and change his attitude to bad habits, completely abandoning them.

Proper nutrition

The main cause of impaired glucose tolerance is an excess of insulin in the blood, produced by pancreatic cells as a response to eating carbohydrates. To restore the sensitivity of cells and resume their ability to absorb the hormone, its concentration should be reduced. It is extremely simple to do this - the patient must limit the intake of food containing sugar.

Attention! The instruction, drawn up by a nutritionist, requires the patient to drastically reduce the amount of carbohydrates consumed. From the menu it is worth eliminating foods with a high glycemic index. The cost of not following these rules is high.

1. The patient should eat often, but in small portions.
2. It is worth paying attention to the need to count calories. The allowable food intake is divided into 4-5 approaches.
3. The patient must drink enough water.
4. The basis of the diet can be vegetables and fruits - that is, products with zero calorie content.

The patient's menu should be balanced, but carbohydrates should make up a smaller proportion of the diet. If this rule is not followed, the therapy will be ineffective.

Sport

In order to reduce the likelihood of diabetes, the patient must completely change his own rhythm of life for the better. Change also requires daily exercise.

Running, morning exercises will benefit the patient's body. When available, Nordic walking and pool swimming are allowed sports.

After class, the patient should not feel excessive fatigue. All exercises performed should bring pleasure and satisfaction.

The attention of patients with impaired glucose tolerance should be stopped on the fact that it is possible to resort to the use of medications to stabilize well-being only on an emergency basis. In some cases, such drugs harm the patient's body and can cause the development of diabetes, that is, accelerate the course of an already running process.

Questions for a specialist

Lyubichenko Alena, 26 years old, Saratov

Good afternoon. Please help me understand the issue. I don't have diabetes and never have. I am now pregnant and have been prescribed a glucose tolerance test, why? Familiar with me at the same time and the gynecologist did not tell her not a forehead, why is that? Can't this test give me diabetes? Will it harm the child?

Good afternoon, Alena. According to the rules, such an examination is prescribed for all pregnant women in the second trimester and is mandatory. Such a test simply allows you to make sure that there is no development of gestational diabetes, which can subsequently flow into type 2 diabetes.

The study is mandatory for women who are overweight. Why your friend wasn't recommended to take the test, I can't say. The test is completely safe for you and your child.

Nikolaenko Tatiana, 36 years old, Pumice

Good afternoon. I took a tolerance test that year, but it’s very difficult for me to drink this composition, is there an alternative method of testing?

Good afternoon, Tatyana. Find out in the medical centers of your city about the possibility of intravenous administration of glucose.

Impaired glucose tolerance, or prediabetes, is a condition that involves elevated blood sugar levels, but the levels are not as high as in the case of overt type 2 diabetes. At the same time, this condition is borderline, therefore, without appropriate intervention from both the specialist and the patient, it can go directly into diabetes, and also cause other serious complications. With the right influence, it can be corrected.

Medical Diagnostic Center "Energo" - a clinic where they provide services for the treatment of many diseases, including the endocrine system. Careful diagnostics allows developing an individual treatment regimen and correcting the patient's condition, thereby avoiding the serious consequences of a prediabetic condition.

Pre-diabetic state: causes

The main causes of impaired glucose tolerance are the following:

• significant overweight, in the development of which the main factors are transmission and a sedentary lifestyle;
• genetic predisposition: it has been proven that family members where someone has had or has diabetes are also at risk, which made it possible to isolate certain genes responsible for the production of full-fledged insulin, the sensitivity of peripheral tissue receptors to insulin and other factors;
• age and gender: most often prediabetes and diabetes are diagnosed in women over the age of 45;
• other diseases: we are talking primarily about diseases of the endocrine system, leading to hormonal and metabolic failure, as well as diseases of the gastrointestinal tract (gastric ulcers, due to which the process of glucose absorption can be impaired) and diseases of the cardiovascular system (atherosclerosis, high blood pressure, high cholesterol, etc.). For women, polycystic ovaries can become a risk factor;
• Complicated pregnancy: It is not uncommon for prediabetes to develop into type 2 diabetes after gestational diabetes, which occurs in women during pregnancy. Usually, problems with blood sugar levels occur in case of late pregnancy or a large fetus.

It should also be remembered that the pre-diabetic condition can be diagnosed not only in adults, but also in children. Prediabetes in a child usually occurs as a consequence of an infectious disease, less often a surgical intervention, which makes it necessary to pay special attention to the period of rehabilitation of the child after an illness or operation.

Pre-diabetic state: complications

The main complication of this condition is, of course, its possible transition to acquired type 2 diabetes, which is much more difficult to control. In addition, the presence of excess sugar in the blood, albeit not at a critical level, leads to an increase in blood density, which can cause plaque formation, blockage of blood vessels and, as a result, problems with the cardiovascular system, namely heart attacks and strokes.

In turn, the transition of a pre-diabetic state to diabetes entails a possible damage to other body systems, including the kidneys, vision, nervous system, a decrease in immunity and overall body resistance.

Prediabetic state: symptoms

Since the violation of tolerance is not yet a disease as such, it is most often asymptomatic. The presence of any symptoms most often indicates latent (hidden) diabetes mellitus or a condition very close to this condition that requires treatment.

The presence of the following symptoms indicates the need to undergo a glucose tolerance test:

• dry mouth, thirst, especially during emotional and mental stress and, as a result, an increase in daily fluid intake: the body needs more water to dilute thick blood;
• frequent urination, including with an increase in the volume of urine, one-time and daily: the consumption of more water forces the body to excrete it more often;
• severe hunger, including at night, which usually leads to overeating and weight gain: there is an accumulation of insulin, a hormone that lowers blood sugar.
• fast fatiguability;
• fever, dizziness after eating: occur due to a sharp change in blood sugar levels;
• headaches: can be caused by narrowing of cerebral vessels due to the formation of plaques in them.

As can be seen from the above list, the signs of prediabetes are rather vague (only thirst and frequent urination can be considered a relatively specific symptom), so diagnosis is of particular importance in this case.

Pre-diabetic condition: treatment

Experts recommend checking blood sugar levels about twice a year, and in case of symptoms of high blood sugar levels or the presence of risk factors for the development of the disease, you should contact.

Primary appointment

The initial appointment with a specialist involves a preliminary collection of anamnesis based on the patient's complaints, as well as information about the presence or absence of diabetes and other diseases in the family. In addition, the initial examination includes an examination of the patient and, necessarily, the appointment of laboratory tests that allow you to accurately establish a violation of tolerance.

The diagnosis of problems with the breakdown and absorption of sugar is based on a glucose tolerance test (glucose test), which is a blood sampling for analysis in several stages:

• on an empty stomach: usually at least 10 hours after the last meal;
• an hour and two hours after a special carbohydrate load: the patient will need to drink a glucose solution containing 75 grams of this carbohydrate;

At the same time, it must be remembered that the effective conduct of a glucose tolerance test requires compliance with a number of requirements, which include the absence of physical exertion and stress immediately before and during the test, as well as the absence of viral diseases, recent operations, etc. During the test, you can not smoke. Failure to comply with these rules distorts the test results both positively and negatively. Before the test, you should consult with your doctor.

In addition to biochemical blood tests, the diagnosis of a prediabetic condition also involves a urine test for cholesterol and uric acid levels, especially if there are suspicions of concomitant diseases from the risk group (atherosclerosis, etc.).

Further treatment regimen

If, during tests, suspicions of a diagnosis of prediabetes (impaired glucose tolerance) or latent diabetes are confirmed, the treatment prescribed by a specialist will be complex (diet, exercise, less often taking drugs) and is aimed at eliminating the causes, and at the same time - symptoms and signs of the disease.

Most often, the general condition of the patient can be corrected by a change in lifestyle, primarily a change in eating habits, which aims to normalize metabolic processes in the body, which in turn will help reduce weight and return blood glucose levels to acceptable limits.

The basic principles of nutrition in a diagnosed pre-diabetic condition suggest:

• complete rejection of easily digestible carbohydrates: bakery and flour products, sweets such as desserts and sweets, potatoes;
• reduction in the amount of hard-to-digest carbohydrates (rye and gray bread, cereals) and their even distribution throughout the day
• reduction in the amount of animal fats consumed, primarily fatty meat, lard, sausages, mayonnaise, butter, fatty meat broths;
• an increase in the consumption of vegetables and fruits with a high fiber content and low sugar content: preference should be given to sour and sweet and sour fruits, as well as beans, legumes, etc., as they contribute to the rapid saturation of the body;
• reducing the amount of alcohol consumed, if possible - refusing it, during the period of rehabilitation;
• increasing the number of meals up to 5 - 6 per day in small portions: such a diet allows less load on the digestive organs, including the pancreas, and avoid overeating.

In addition to diet, to correct a pre-diabetic condition, it is also necessary to change lifestyle, which involves:

• daily physical activity (starting from 10-15 minutes a day with a gradual increase in the duration of classes);
• a more active lifestyle;
• smoking cessation: nicotine negatively affects not only the lungs, but also the cells of the pancreas responsible for the production of insulin;
• control of blood sugar levels: delivery of control tests is carried out a month or a half after the start of treatment. Control tests allow you to establish whether the blood sugar level has returned to the normal range and whether it can be said that impaired glucose tolerance has been cured.

In some cases, with a low effectiveness of the diet and active physical activity, a specialist may also prescribe drugs that help reduce sugar and cholesterol levels, especially if the control of the pre-diabetic state also involves the treatment of concomitant diseases (often the cardiovascular system).

Usually, with the timely diagnosis of a violation of tolerance, as well as with the patient following all the doctor's prescriptions regarding diet and exercise, the blood sugar level can be stabilized, thereby avoiding the transition of a pre-diabetic state to type 2 diabetes.
Pre-diabetic state: prevention

Due to the fact that most often the pre-diabetic condition is caused by external factors, it can usually be avoided or diagnosed in the early stages if the following preventive measures are followed:

• control weight: in the presence of excess weight, it must be lost under the supervision of a doctor so as not to deplete the body;
• balance the diet
• to refuse from bad habits;
• lead an active lifestyle, do fitness, avoid stressful situations;
• women with gestational diabetes or polycystic ovaries regularly check their blood sugar levels by taking a glucose test;
• take a glucose test for preventive purposes at least 1-2 times a year, especially in the presence of diseases of the heart, gastrointestinal tract, endocrine system, as well as in the presence of cases of diabetes in the family;
• at the first sign of a violation of tolerance, make an appointment with a specialist and undergo a diagnosis and possible subsequent treatment for prediabetes.

You can make an appointment with a specialist at the Energo clinic either by phone or by using a special form for patients, which can be filled out on the clinic’s website.

Impaired glucose tolerance is a common problem. That is why many people are interested in additional information about what such a condition is. What are the causes of violations? What symptoms are accompanied by pathology? What treatments does modern medicine offer?

What is such a violation?

What is Impaired Glucose Tolerance? In such a condition, a person has an increase in the amount of sugar - higher than normal, but at the same time lower than that in which patients are diagnosed with type 2 diabetes.

Thus, the violation of tolerance is one of the risk factors. The results of recent scientific studies have shown that about a third of patients eventually develop, subject to certain rules and well-chosen drug treatment, the metabolism returns to normal.

The main reasons for the development of glucose tolerance

Not in all cases, doctors can determine why the patient has developed a similar disease. Nevertheless, it was possible to find out the main causes of impaired glucose tolerance:

• First of all, it is worth mentioning the genetic predisposition, which occurs in many cases. If one of your close relatives has diabetes, the likelihood of developing such a condition increases significantly.
• In some patients, the so-called insulin resistance is detected during the diagnostic process, in which the sensitivity of cells to insulin is impaired.
• In some cases, impaired glucose tolerance develops as a result of diseases of the pancreas, in which its secretory activity is impaired. For example, problems with carbohydrate metabolism may appear against the background of pancreatitis.
• The reasons can also include some diseases of the endocrine system, which are accompanied by metabolic disorders and an increase in blood sugar levels (for example,
• One of the risk factors is obesity.
• A sedentary lifestyle also negatively affects the functioning of the body.
• Sometimes a change in the amount of sugar in the blood is associated with taking medications, in particular, hormonal drugs (in most cases, glucocorticoids become the “culprits”).

Impaired glucose tolerance: symptoms

Unfortunately, this pathology in most cases is asymptomatic. Patients rarely complain of a deterioration in well-being or simply do not notice it. By the way, for the most part, people with a similar diagnosis suffer from overweight, which is associated with a violation of normal metabolic processes.

As carbohydrate metabolism disorders worsen, characteristic signs begin to appear that accompany impaired glucose tolerance. Symptoms in this case are thirst, a feeling of dry mouth and increased fluid intake. Accordingly, patients are observed and Against the background of hormonal and metabolic disorders, a significant decrease in immune defense is observed - people become extremely susceptible to inflammatory and fungal diseases.

Why is this disorder dangerous?

Of course, many patients with such a diagnosis are interested in questions about the dangers of impaired glucose tolerance. First of all, such a condition is considered dangerous because, if left untreated, the risk of developing a well-known insidious disease, namely type 2 diabetes, is very high. On the other hand, such a disorder increases the likelihood of developing diseases of the cardiovascular system.

Basic diagnostic methods

The diagnosis of "impaired glucose tolerance" can only be made by a doctor. To begin with, the specialist will conduct an examination and collect an anamnesis (the presence of certain complaints from the patient, information about previous diseases, the presence of people with diabetes in the family, etc.).

In the future, a standard blood test for sugar levels is performed. Samples are taken in the morning on an empty stomach. A similar procedure is carried out in any clinic. As a rule, the glucose level in such patients exceeds 5.5 mmol / l. However, a specific glucose tolerance test is needed to establish an accurate diagnosis.

Test and indications for its implementation

Such a study is by far one of the most accessible and effective methods for diagnosing a condition called “impaired glucose tolerance”. But although testing is quite simple, proper preparation is extremely important here.

For several days before blood sampling, the patient is advised to avoid stress and increased physical activity. The procedure is carried out in the morning and on an empty stomach (not earlier than 10 hours after the last meal). First, a portion of blood is taken from the patient, after which they are offered to drink glucose powder dissolved in warm water. After 2 hours, a second blood sampling is carried out. In laboratory conditions, the sugar level in the samples is determined and the results are compared.

If, before taking glucose, the blood sugar level was 6.1-5.5 mmol, and after two hours it jumped sharply to 7.8-11.0 mmol / l, then we can already talk about a violation of tolerance.

In fact, experts recommend that every person undergo such testing at least once every two years - this is a very effective preventive precaution that will help identify the disease at an early stage. However, there are some risk groups for which analysis is mandatory. For example, people with a genetic predisposition to diabetes, as well as patients suffering from obesity, arterial hypertension, high cholesterol, atherosclerosis, and neuropathy of unknown origin are often sent for testing.

Impaired glucose tolerance: treatment

If the tolerance test gave a positive result, then you should immediately contact an endocrinologist. Only a specialist knows what therapy requires a violation of glucose tolerance. Treatment at this stage is usually non-medical. However, the patient needs to change his usual way of life as soon as possible.

It is extremely important to ensure that body weight is within the normal range. Naturally, you should not go on strict diets or deplete the body with intense physical activity. You need to fight extra pounds by gradually changing the diet and increasing physical activity. By the way, training should be regular - at least three times a week. It is worth giving up smoking, as this bad habit leads to vasoconstriction and damage to pancreatic cells.

Of course, you need to carefully monitor the level of sugar in the blood, regularly undergo examinations by an endocrinologist and take the necessary tests - this will make it possible to determine the presence of complications in time.

If these treatments have not worked, your doctor may prescribe certain medications to lower your blood sugar levels. But it should be understood that there is no universal panacea for such a disease.

Proper nutrition is an integral part of therapy

Of course, nutrition plays an extremely important role in the treatment of such a pathology. Impaired glucose tolerance requires a special diet. The first thing to do is change your eating habits. Patients are advised to eat 5-7 times a day, but portions should be small - this will help relieve the burden on the digestive system.

What other changes does impaired glucose tolerance require? The diet in this case must necessarily exclude sweets - sugar, sweets, sweet pastries are prohibited. In addition, it is worth limiting the amount of foods containing easily digestible carbohydrates - these are bread and bakery products, pasta, potatoes, etc. Experts also recommend reducing the amount of fat - do not abuse fatty meats, butter, lard. During rehabilitation, it is also worth giving up coffee and even tea, because these drinks (even without sugar) tend to increase blood glucose levels.

What should the patient's diet consist of? First of all, these are vegetables and fruits. They can be consumed raw, boiled, baked. The required amount of protein can be obtained by introducing lean meats and fish, nuts, legumes, milk and dairy products into the menu.

Basic preventive measures

Impaired glucose tolerance can be extremely dangerous. And in this case, it is much easier to avoid such a disorder than to face the risk of developing diabetes. To maintain the normal functioning of the body, you need to follow only a few simple rules.

The first thing to do is adjust your diet. Experts recommend fractional meals - eat 5-7 times a day, but always in small portions. In the daily menu, it is worth limiting the amount of sweets, pastries and overly fatty foods, replacing them with fresh fruits, vegetables and other healthy foods.

It is important to monitor body weight and provide the body with the physical activity it needs. Of course, excessive physical activity can also be dangerous - the load should be increased gradually. Of course, physical education should be regular.