Impaired glucose tolerance diet. Impaired glucose tolerance: what is it and the causes of violations. Basic preventive measures

Content

In addition to diabetes, there is a variety of it - a latent form, when the clinical symptoms of the disease do not appear, but blood sugar increases, slowly decreasing. This condition is referred to as impaired glucose tolerance (IGT), stands out as a separate disease with its own ICD code - R73.0, requires an accurate diagnosis and mandatory correct treatment, since the problem of impaired carbohydrate metabolism is fraught with the development of serious diseases.

What is Impaired Glucose Tolerance

Prediabetes, intolerance is a borderline condition of the patient with an insignificant concentration of sugar in the blood. There is no basis for the diagnosis of type 2 diabetes yet, but the likelihood of developing problems is high. NTG indicates a metabolic syndrome - a complex deterioration in the functioning of the cardiovascular system and the metabolic processes of the body. Violation of carbohydrate metabolism is dangerous as complications of cardiovascular diseases (hypertension, myocardial infarction). For this reason, passing a glucose tolerance test should become mandatory for any person.

The reasons

IGT occurs when there is a change in insulin production and a decrease in sensitivity to this hormone. Insulin produced during meals is only released when blood sugar rises. If there are no failures, with an increase in glucose, enzymatic activation of tyrosine kinase occurs. In the pre-diabetic state, the binding of insulin to cellular receptors and the absorption of glucose into cells are impaired. Sugar stays and accumulates in the bloodstream.

Impaired tolerance to carbohydrates develops against the background of such factors:

• overweight, obesity with insulin resistance;
• genetic predisposition;
• age and gender characteristics (more often diagnosed in women after 45 years);
• pathologies of the endocrine, cardiovascular, hormonal systems, diseases of the pancreas and gastrointestinal tract;
• complicated pregnancy.

Symptoms

At the initial stage, a decrease in sugar levels is often asymptomatic. You should be puzzled by the need to undergo a glucose tolerance test in the presence of such symptoms:

• frequent thirst, dry mouth, thirst, increased fluid intake;
• frequent urination;
• severe hunger;
• fast fatiguability;
• dizziness, feeling hot after eating;
• headache.

Violation during pregnancy

In 3% of expectant mothers, gestational diabetes is detected, which, as a rule, indicates pregestational diabetes in pregnant women. This threatens the expectant mother with premature birth, stillbirth, infectious complications after childbirth, and in the fetus, hyperglycemia causes the development of malformations. Patients need to control their sugar levels and learn about chronic diseases even before pregnancy, which can then be compensated as much as possible with competent treatment. The development of the disease is provoked:

• age (over 30 years);
• genetic predisposition;
• polycystic ovary syndrome;
• the presence of diabetes in previous pregnancies;
• development of a large fetus;
• an increase in pressure.

Diagnostics

Knowing what glucose tolerance is, it becomes obvious: people at risk need to take a special test to determine the secretory reserve of insulin. Before the analysis, it is necessary to observe the usual mode of exercise and nutrition. Venous blood is given on an empty stomach, it is not recommended for stress, after operations and childbirth, against the background of inflammatory processes, during menstruation. Before the test, medical procedures, taking certain medications are excluded. The diagnosis of IGT is determined if two or more laboratory tests show an elevated glucose concentration.

Treatment

The main therapy for IGT is to review the diet and lifestyle. Much attention is paid to physical activity. A glucose intolerance diet combined with exercise is the best treatment for latent diabetes. Medications are connected if such therapeutic methods are ineffective, additionally evaluating the effectiveness of treatment by the level of glycated hemoglobin.

Diet

First of all, metabolic processes allow you to normalize a change in nutrition. Diet principles include:

• completely abandon easily digestible carbohydrates (white bread, pastries, sweets, potatoes);
• reduce with even distribution in the daily diet difficult to digest carbohydrates (cereals, rye, gray bread);
• reduce the consumption of animal fats (fatty meat and broths, sausage, butter, mayonnaise);
• increase the consumption of vegetables and fruits with a preference for legumes, sour fruits;
• reduce alcohol intake;
• fractionally eat small portions;
• drink at least 1.5 liters of water per day;
• observe BJU in a ratio of 1: 1: 4.

Physical exercises

Physical activity well helps to get rid of extra pounds, speed up metabolism and normalize carbohydrate metabolism. Loads should be increased gradually, you can do exercises, do daily cleaning at a fast pace, walk more. Physical activity should begin with 10-15 minutes every day, gradually increasing the duration of classes, then move on to regular (three times a week) light running, swimming.

Most patients at the stage constantly hear the same phrase that diabetes mellitus (DM) can develop due to impaired glucose tolerance, and if no action is taken now, then a bitter disease with such a sweet name will provide you with a long and not very blissful life together.

However, most people are not afraid of such words and they continue to persist in their deeds, constantly indulging in damn pleasant weaknesses.

The basis of this condition is a problem in which there is an accumulation of glucose in the blood.

NTG is closely related to another concept - with a violation of fasting glycemia (IGN). Very often, these concepts may not be indirectly separated, since in the diagnosis or as such of diabetes, these two criteria are usually interdependent.

They mature at the moment when one of the metabolic processes begins to fail - at which the consumption or utilization of glucose by the cells of our entire body decreases.

According to ICD - 10, this state corresponds to the number:

• R73.0 - Increased blood glucose or abnormal results of glucose tolerance test

To understand the state of a person at the stage of metabolic disorders, the criterion of blood glycemia is used.

With IGT, blood sugar will be higher than normal, but not so much as to exceed the diabetic threshold.

But how, then, to distinguish between impaired glucose tolerance and impaired fasting glycemia?

In order not to be confused in these two concepts, it is worth asking for help from the standards of WHO - the World Health Organization.

According to the WHO criteria, NTG is defined as an elevated plasma sugar level 2 hours after exercise, consisting of 75 g of glucose (dissolved in water), provided that the fasting plasma sugar concentration does not exceed 7.0 mmol / liter.

NGN is diagnosed if fasting (i.e., on an empty stomach) is ≥6.1 mmol/l and does not exceed 7.0 mmol/l, provided that glycemia 2 hours after exercise is<7.8 ммоль/л.

Those. the basis of NGN, as the name implies, is to determine the level of sugar on an empty stomach, when its threshold exceeds the allowable norm for a healthy person, and with IGT, fasting glycemia can be relatively normal, but after eating carbohydrates, their absorption will be significantly slowed down, which lead to an increase in glycemia.

Thus, these two concepts are one of the main criteria in the diagnosis of metabolic disorders, and are also included in the list of risks that can lead to development. Unfortunately, such problems have recently become characteristic of the younger generation.

Impaired glucose tolerance can now be detected in children, which previously seemed impossible in principle. However, now obesity has become the scourge of modern society. When present, natural metabolism tends to slow down, increasing the risk of developing type 2 diabetes in school-age children and adolescents.

Overweight children are more prone to cardiovascular diseases, they have dyslipidemia (), shortness of breath, slow development, reduced immunity. And if earlier diabetes at their age was hereditary, now it is rather a consequence of the wrong way of life and the artificially instilled habit of eating in catering places.

Frequent snacking on buns, hot dogs, hamburgers bear fruit a few years after the first opening of McDonald's in Russia in Moscow (it was opened on January 13, 1990 and 26 years have passed since then, and the memory of this event is still alive , as it is reflected in the Guinness Book of Records).

Unlike existing DM, people with IGT can still make a difference. There is a fairly simple technique that allows you to completely normalize the metabolism of both carbohydrates and other substances in the body.

The reasons

Unfortunately, it is still not exactly clear what leads to such a state with a 100% guarantee. However, it is generally accepted that several events are immediately to blame for this, which can (we repeat - MAY) cause a failure in carbohydrate metabolism.

• Poor heredity plays an important role

If your next of kin had diabetes, then this automatically increases the risk of failures in the metabolism of carbohydrates. However, even if both parents, say, have diabetes, this does not mean that their baby will also have the same disease or any problems with metabolic processes both at birth and throughout his subsequent life.

A cell that does not "recognize" insulin as its benefactor (only this hormone delivers glucose to cells, which no other substance can do) inevitably begins to experience hunger. If it is not fed, then the process of alternative nutrition will start at the expense of, for example, fats. However, this will not help, but rather harm, since insulin still cannot “reach out” to the cells that are distraught with hunger.

As a result, it may develop. If you do not intervene in time, then a person may die, as the cells begin to gradually die off, and the blood becomes toxic due to an excess of glucose and begins to poison the entire body from the inside.

• Problems with the pancreas (disease, injury, tumor)

With them, its main secretory function (production of hormones) is disrupted, which can also cause a violation of glucose tolerance. Pancreatitis is one such disease.

• A number of certain diseases accompanied by failures in metabolic processes

For example, Itsenko-Cushing's disease, which is characterized by the presence of hyperfunction of the pituitary gland, as a result of a traumatic brain injury, a severe mental disorder, etc. With this disease, there is a violation of mineral metabolism.

In our body, everything is interconnected and a failure in one system inevitably leads to a violation in other areas. If there are “programs for eliminating” such failures “built-in” in our brain, a person may not immediately find out about health problems, which will slow down his treatment, because he will not seek help from a doctor in time, but only at the very last moment, when he realizes that there is clearly something wrong with him. Sometimes by this time, in addition to one problem, he had already managed to collect another dozen others.

• Obesity

It also contributes to the development of NTG, even in some way to a greater extent, since an obese body requires more energy-consuming content from the most hardworking organs: the heart, lungs, gastrointestinal tract, brain, kidneys. The higher the load on them, the faster they will fail.

• Sedentary lifestyle

To put it simply, a little active person does not train, and what does not train - atrophies as unnecessary. As a result, numerous health problems appear.

• Taking hormonal drugs (in particular glucocorticoids)

In medicine, there have been more than once such patients who have never followed a diet, led a sedentary lifestyle, abused sweets, but at the same time, according to their state of health, doctors included them in the list of absolutely healthy people without the slightest sign of a brewing metabolic syndrome. True, it didn't last that long. Sooner or later, this way of life made itself felt. Especially in old age.

Symptoms

So we got to the least informative point in our story, since it is simply impossible to independently determine that a person develops impaired glucose tolerance. It is asymptomatic, and the condition worsens already at the moment when it is time to make another diagnosis - diabetes.

It is for this reason that the treatment of patients is late, since a person at this stage is not aware of any problems. Meanwhile, NTG is easily treatable, which cannot be said about diabetes, which is a chronic disease and is not yet subject to treatment. With diabetes, one can only delay the multiple early and late ones, which cause the death of patients, and not the unfortunate diabetes itself.

As glucose intolerance develops, a person may develop some symptoms that are also characteristic of diabetes:

• intense thirst (polydipsia)
• dry mouth
• and consequently increased fluid intake
• increased urination ()

To say for sure that a person with such symptoms is sick, you see, is impossible. Such a condition can also occur with an infectious disease that occurs without an increase in body temperature, as well as in summer in extreme heat, heat, or after intense training in the gym.

In addition, any failure in the metabolism of substances sooner or later leads to a decrease in the human immune system, since the rate of development of protective mechanisms depends on the metabolic rate, which are regulated primarily by two systems: nervous and endocrine.

If metabolic processes are disturbed for some reason, then the process of tissue regeneration also slows down. A person has multiple problems with skin, hair, nails. He is more vulnerable to infectious diseases and, accordingly, often more, more physically weak and psychologically less unstable.

Why is glucose intolerance dangerous?

Many have already understood that NTG is not such a harmless condition, since, in the literal sense of the word, it hits the most essential in the human body.

Although, what can be insignificant in all this inner microcosm of a person is hard to say. Here everything is important and everything is interconnected.

Meanwhile, if you let everything take its course, then diabetes will be provided to the careless owner of such a body. However, problems with the absorption of glucose entail other problems - vascular.

The blood circulating through the veins is the main conductor of biologically significant and valuable substances that are dissolved in it. Vessels with a whole web braid all the particles, even the smallest ones of our whole body and have access to any internal organ. This unique system is extremely vulnerable and dependent on the composition of the blood.

Most of the blood consists of water, and thanks to the aquatic environment (blood itself, intercellular and cellular protestantism), a constant, subsecond, instantaneous exchange of information is provided, which is ensured by chemical reactions of organ cells with blood and the surrounding aquatic environment. Each such medium has its own set of control levers - these are molecules of substances responsible for certain processes. If some substances are not enough or there is an overabundance, then the brain will instantly know about it, which will immediately respond.

The same thing happens at the time of accumulation of glucose in the blood, the molecules of which, when they are overabundant, begin to destroy the walls of blood vessels because, firstly, they are quite large, and secondly, they begin to interact with other substances dissolved or trapped in the blood in response to . This accumulation of various substances affects the osmolarity of the blood (i.e., it becomes thicker) and due to the chemical interaction of glucose with other substances, its acidity increases. The blood becomes acidic, which essentially makes it poisonous, toxic, and the protein components circulating with the blood are exposed to glucose and gradually sugared - a lot appears in the blood.

Thick blood is more difficult to distill through the veins - heart problems arise ( develops). Thick it causes the walls of blood vessels to expand even more, and in places where they have lost their elasticity for one reason or another (for example, with calcification, atherosclerosis, or as a result), they may simply not withstand such a load and burst. The bursting vessel is quickly healed, and new vessels are formed in its place, which cannot fully fulfill the role of the lost one.

We have painted far from the entire chain of the harmful effects of an excess of glucose on the body, because. in violation of glucose tolerance, the concentration of sugar is not so high as to entail such dire consequences. But!

The more it is and the longer hyperglycemia lasts, the more significant, the more noticeable the consequences after it become.

Diagnostics

You may have already guessed that you can learn about NTG only through a laboratory blood test under certain conditions.

If you take blood from a finger using a home portable device - a glucometer, then this will not be a significant indicator of anything. After all, it is important to take blood at a certain moment and check the speed and quality of glucose uptake after consuming carbohydrates. Therefore, your personal measurements will not be enough for diagnosis.

Any endocrinologist will definitely take an anamnesis (learn about the patient's condition, ask about relatives, identify other risk factors) and refer the patient for a series of tests:

• blood for fasting sugar

But the most significant analysis in our case is the GTT:

Which is supposed to be taken by all pregnant women at about 24 - 25 weeks of pregnancy, in order to exclude other health problems. After passing such an analysis during pregnancy, both NTG and NGN can be detected. If, after taking control blood, fasting glycemia is increased in a pregnant woman, then doctors will not continue the glucose tolerance test. The woman will be sent for additional studies to the endocrinology department, or the test will be repeated again, but after a few days.

Such a test is carried out in several stages:

1. Fasting blood draws (these are glycemic benchmarks that doctors will rely on when making a diagnosis)
2. Glucose load (the patient will have to drink a sweet drink in which the amount of glucose required for the test is dissolved)
3. After 2 hours, blood will be taken again (to check how quickly carbohydrates are absorbed)

According to the results of such a test, several disorders of carbohydrate metabolism can be detected at once.

Criteria	Glucose concentration in mmol/liter
	Blood
	capillary	Venous
Normal performance
on an empty stomach and	<5.6	<6.1
2 hours after	<7.8	<7.8
Diabetes
Fasting or	≥6.1	≥7.0
after 2 hours or	≥11.1	≥11.1
random definition	≥11.1	≥11.1
Fasting (if determined) and	<6.1	<7.0
In 2 hours	≥7.8 and<11.1	≥7.8 and<11.1
Impaired fasting glucose
on an empty stomach and	≥5.6 and<6.1	≥6.1 and<7.0
after 2 hours (if determined)	<7.8	<7.8

Such an analysis can be carried out by two types of OGTT - oral and VVGTT - intravenous.

In the first case, a person is invited to drink an aqueous solution of glucose, and in the second case, the solution is administered intravenously. The second version of the test is more convincing, since the sweet solution enters directly into the blood and it does not need to first pass through the walls of the stomach, and then enrich the blood with glucose.

The VGTT or insulin-modified intravenous glucose tolerance test may be performed on a number of patients who have GI problems or who are pregnant while suffering from toxicosis.

Our table contains the data obtained as a result of the OGTT.

How to treat NTG

After a disappointing positive test for NTG is obtained, it is worth seeking a detailed consultation with an endocrinologist who will prescribe the appropriate treatment.

Do not be afraid, no one will start stuffing you with pills, because to eliminate this condition, it is enough to change your lifestyle.

If you are overweight, you will need to strive to get in shape in two harmless ways:

• eat right small meals
• increase physical activity

When treating impaired glucose tolerance, the doctor sets several tasks for the patient at once:

1. weight loss
2. achieving clear metabolic control (i.e. it is important to monitor glycemia)
3. in case of a problem with blood pressure - monitor it during the day and achieve normal blood pressure
4. prevent possible cardiovascular complications
5. giving up bad habits (alcohol, smoking)

If for a long period of time a person cannot lose weight on his own (provided that he clearly followed all the recommendations), then the doctor may include in therapy and some medicines with the active substance, which are not sold without a doctor's prescription. For example, with the active ingredient sibutramine. But these are already quite extreme measures, since they entail other problems that significantly affect health, since more than one “miracle pill” is not without side effects.

Otherwise, the most effective method of weight loss is one way - energy deficiency.

In other words, the patient must learn to compose his diet and training regimen so that energy expenditure prevails over its intake.

In this mode, fat reserves begin to be more intensively consumed, as there is a carbohydrate deficit, which is covered by the "melting" of lipids.

After weight loss, all efforts should be aimed at maintaining and consolidating the results achieved, which means that you will have to adhere to the set pace constantly - all your life.

Keeping a food diary with surgery and applying additional knowledge, for example, such as:

Of course, one way or another, a person will be forced to switch to a low-carbohydrate diet, the basis of which was laid by the Pevzner nutrition system - developed back in Soviet times.

A hypocaloric diet in case of impaired glucose tolerance is built taking into account the individual characteristics of people: age, gender, intensity and frequency of physical activity, existing diseases, and others. Therefore, it is best to formulate your diet under the supervision of a nutritionist or qualified nutritionist.

To make the task a little easier, we suggest that you familiarize yourself with the calculations of the calorie content of the daily diet from the leading Russian nutritionists.

Proper nutrition in violation of glucose tolerance

Calculation of calories consumed per day

• The value of the main exchange

• depending on the level of physical activity, the result obtained is necessary:

At minimum load it remains low, at medium load x (multiply) by a factor of 1.3, at high load x 1.5

• multiply the calculated daily caloric content:

For 500 kcal if the body mass index (BMI) is 27 - 35, for 600 - 1000 if BMI> 35

For women, in the end, it should be at least 1200 kcal / day, for men - 1500 kcal / day.

Fats	In the diet, fats should account for no more than 30% of the daily norm (saturated fats should not exceed 7 - 10%). Give preference to vegetable fats.
Squirrels	The main structural elements of tissues and cells of the whole organism must be present in the diet in the amount of 15-20% of the daily norm. But only if a person does not have problems with the kidneys. If the excretory function of the kidneys is impaired, then it is recommended to adhere to
Carbohydrates	They should not be more than 50%. It may be worth replacing regular sugar with sweeteners (,)

• meals at least 3 times a day
• the main amount of lipids consumed should come from vegetable and fish fats (low-fat fish, milk, dairy products, legumes, cottage cheese, some lean meat)
• consume more complex carbohydrates, preferably with (its d / b is not less than 40 grams per day) due to raw vegetables, whole grain bread, bran, etc.
• with arterial hypertension, the amount of sodium decreases to 2.0 - 2.5 g / day (this is about 1 teaspoon)
• drink 30 ml of water per 1 kg of body weight daily (if there are no contraindications)

Physical exercises

This type of training includes: tennis, walking, running, swimming, cycling, skating, skiing, basketball, dancing, fitness.

The intensity of the load must be controlled by a qualified specialist. At the same time, the heart rate achieved during the exercise is calculated in relation to the maximum heart rate (MHR) recommended for a given age, according to the following formula:

MHR = 220 - (age)

Depending on this, the physiologist selects a low (30 - 50% MHR), medium (50 - 70%) or intense (> 70%) load. In addition, during classes, doctors often practice alternating the intensity of the load in order to achieve faster results with minimal patient overwork.

The complex begins, as a rule, with a 10-15 minute run (walking on a treadmill). Then the load increases (the pace of running accelerates) and continues for 40-60 minutes with periodic alternation (10 minutes of running, 5 minutes of walking). The most important thing is not to stop, but to keep doing the exercises.

However, this type of training is contraindicated in patients with arterial hypertension (AH).

Medical treatment

A doctor can include medications in treatment only when BMI is >30 kg/m2 and/or there are concomitant diseases.

A relatively safe agent in the treatment of carbohydrate metabolism disorders with IGT is acarbose. It is an alpha-glucosidase inhibitor.

The drug is able to influence the postprandial glucose level (after a meal), as a result, its concentration decreases, and also has a beneficial effect on the main cardiovascular risk factors - overweight, postprandial hyperglycemia and hypertension.

How does this substance work?

It prevents the rapid absorption of sugars through the gastrointestinal tract. There is a violation of the enzymatic breakdown of carbohydrates to simple sugars.

At the beginning of therapy, the dose of acarbose does not exceed 50 mg / day, which is divided into 3 doses before or during meals. If a person tolerates such treatment well, then the dose is increased to 100 mg / day.

If you prescribe a large dose to the patient at once, then the medication can cause digestive problems (flatulence, diarrhea).

It is dangerous to prescribe the drug to people with a stomach disease: ulcers, diverticula, cracks, stenosis, as well as pregnant women and people under 18 years of age.

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Glucose is a simple carbohydrate that no cell in the body can do without. This is a substance that provides it with the energy necessary for life. How the body uses glucose can be figured out by tolerance.

Glucose tolerance is the ability of the body to carry out the process of metabolism of a substance from incoming food so that its excess does not appear. Impaired glucose tolerance (IGT) is an alarming signal of a possible predisposition to diabetes or other pathological processes in the body. It is important to diagnose such a condition in time to prevent the threat of development of disorders.

The need to determine the NTG

Studies have shown that when a violation of tolerance is detected in 30% of patients, this condition develops into. A third of patients manage to normalize metabolic processes. Thus, the importance of testing for IGT is that they can identify the risk of developing diabetes and prevent its progression. It used to be called NTG. This term is hardly used today.

Indications for a glucose tolerance test:

• diagnosis of diabetes;
• obesity;
• hypertonic disease;
• relatives with diabetes.

Samples are carried out if glucosuria was accidentally detected, when measured, and there are also symptoms of diabetes with a normal sugar level.

Glucose tolerance test

A glucose tolerance test helps confirm or refute IGT. First, blood is taken from the subject on an empty stomach. After that, he should drink glucose diluted in water (75 g per 1-1.5 cups). If the test is carried out in people with obesity, then the calculation of glucose is as follows: 1 g per 1 kg of weight (but not more than 100 g). After 2 hours, blood sampling is repeated. During this time, you can not be subjected to physical exertion, temperature changes, do not eat or drink alcohol.

If a person is healthy, then for 20-60 minutes the level of glucose rises rapidly due to its absorption into the intestine. After the release of insulin, the concentration begins to decrease. It should drop to the initial level in 1.5-2 hours. Between 2.5 and 3 hours, sugar drops to its original level. If there is a violation, then the glucose level after the required time does not stabilize to the initial values.

Preparing for testing

To make the test results more reliable, before taking a blood test for glucose tolerance, the patient must first undergo certain preparation:

• Stick to the usual diet for a few days before the analysis (at least 130-150 carbohydrates per day).
• Do moderate exercise the night before. Excessive exercise can cause an increase in sugar content.
• You can eat no later than 10-12 hours before testing.
• Refrain from alcohol 3 days before the test and from smoking 3 hours before.
• Stop taking medications that can distort the results of the analysis (hormones, caffeine, morphine, diuretics, and others).
• Notify the doctor about the presence of existing endocrine problems ( , ), if the patient knows about them.
• It is better to postpone the analysis if the day before there were strong stressful effects, with exacerbation of inflammatory processes, hepatitis and cirrhosis of the liver, during menstruation.

On a note! If there are violations of the function of the gastrointestinal tract, then glucose is administered intravenously.

Causes and symptoms of indicator deviations

IGT is a condition characterized by a slight increase in a substance in the blood. According to the international classification of diseases, the ICD 10 status code is R73.0.

The concentration of glucose should be 3.3-5.5 mmol / l. When conducting a glucose tolerance test, normal values ​​​​after drinking a sweet solution should be up to 7.8 mmol / l. You can talk about NTG with figures of 7.8-11 mmol / l.

Absorption of carbohydrates can worsen for various reasons:

• hereditary predisposition;
• overweight;
• hypodynamia;
• diseases of the gastrointestinal tract;
• violation of the synthesis of insulin by the pancreas;
• Itsenko-Cushing's disease;
• atherosclerosis;
• liver disease;
• gout;
• taking certain medications;
• age from 50 years.

NTG can occur in pregnant women. This is due to the fact that the placenta performs the function of synthesizing hormonal substances that reduce tissue resistance to insulin. About 3% of pregnant women experience gestational diabetes. As a rule, this phenomenon is temporary, and after childbirth, the amount of glucose stabilizes.

At the initial stage, increased glucose tolerance may not manifest itself in any way. You can identify the violation in the course of a laboratory blood test. Gradually, the pathology progresses and manifests itself with characteristic symptoms:

• dry skin;
• itching in the genital area;
• long healing wounds;
• frequent urination;
• strong thirst;
• decrease in sexual desire;
• loss of appetite;
• failure of the menstrual cycle in women;
• vascular damage;
• deterioration of vision.

Even in the absence of symptoms of a disorder, with a high risk of developing diabetes, it is necessary from time to time to donate blood for glucose tolerance.

Effective Treatments

As a rule, NTG involves the correction of lifestyle and nutrition without the involvement of drugs. The appropriateness of the use of drugs is determined by the doctor, based on the clinical course of the pathology.

• eat fractionally in small portions, food should not be high-calorie;
• reduce the amount of simple carbohydrates in the diet, animal fats;
• with obesity, stabilize weight to normal levels;
• observe a plentiful drinking regimen;
• increase the amount of vegetables and fruits (except grapes, bananas).

Proper nutrition should be supplemented with moderate physical activity. If comorbidities that contribute to IGT are identified, they should be treated.

• thiazolidinediones;
• means with sulfonylurea;
• metformin derivatives.

Glucose tolerance is an indicator that enables early diagnosis of carbohydrate metabolism disorders. With NTG 30%, patients manage to completely stabilize their sugar levels. But we must not forget that the risk of developing diabetes may persist in the future. It is important to constantly monitor blood sugar, eat right and move more.

Impaired glucose tolerance indicates a risk of developing type 2 diabetes or metabolic syndrome. Carrying out a glucose-tolerance test allows you to identify individuals who may suffer from serious diseases in the future, to give recommendations in advance in order to prevent them. Find out more by watching the following video:

At least once in a lifetime, every person has to undergo a glucose tolerance test. This is a fairly common test that allows you to identify and monitor impaired glucose tolerance. This condition fits under the ICD 10 (international classification of diseases of the 10th revision)

What is it, why is it carried out and when is it really necessary? Do I need a diet and treatment if the glucose concentration is elevated?

Violation of tolerance as a concept

In a normal daily routine, a person eats several times, not counting snacks.

Depending on how often and what kind of food was consumed, whether the diet is followed, the level of sugar in the blood changes. This phenomenon is completely normal. But sometimes the concentration of glucose increases or decreases unreasonably sharply, and such a condition is already fraught with danger according to ICD 10.

An increase in blood sugar levels for no apparent reason is a violation of glucose tolerance. The difficulty is that it can be detected only with a clinical study of blood or urine according to ICD 10.

Often, impaired glucose tolerance does not manifest itself in any way. And only in some cases, including during pregnancy, there are symptoms similar to those of diabetes:

• Dry skin;
• Drying of the mucous membrane;
• Sensitive, bleeding gums;
• Long healing wounds and abrasions.

This is not a disease yet, but treatment is already required. The body signals that not everything is proceeding normally, and you need to pay attention to your diet and lifestyle. Usually a special diet is prescribed, if the violations are serious - drug treatment according to ICD 10.

Important: impaired glucose tolerance is not always, but often becomes the impetus for the development of diabetes. In this case, you should not panic, but contact a specialist and undergo all the necessary examinations.

If at the same time the amount of insulin in the body remains normal, the main actions should be aimed at preventing the development of acquired diabetes mellitus.

Treatment with folk remedies gives good results - this is an alternative option during pregnancy, when medication is undesirable, although ICD 10 does not particularly involve treatment with folk remedies.

How is a glucose tolerance test done?

In order to establish whether there is a violation of glucose tolerance, two main methods are used:

1. Capillary blood sampling.
2. Venous blood sampling.

The introduction of glucose intravenously is required when the patient suffers from diseases of the digestive system or metabolic disorders. In this case, glucose cannot be absorbed if taken orally.

A glucose tolerance test is prescribed in such cases:

• If there is a hereditary predisposition (close relatives suffer from type 1 or type 2 diabetes);
• If there are symptoms of diabetes during pregnancy.

If, with strict observance of all the rules for conducting the analysis, the indicators differ from the norm, the patient has a violation of glucose tolerance.

A similar phenomenon can lead to the development of type 2 diabetes mellitus, and if alarm signals are further ignored, to insulin-dependent diabetes. This is especially dangerous during pregnancy, treatment is necessary, even if there are no clear symptoms yet.

Why is glucose tolerance impaired?

The reasons for an unreasonable increase or decrease in blood sugar levels can be:

1. Recent stress and nervous shocks.
2. hereditary predisposition.
3. Overweight and obesity as a diagnosis.
4. Sedentary lifestyle.
5. Abuse of confectionery and sweets.
6. Loss of sensitivity of cells to insulin.
7. During pregnancy.
8. Insufficient production of insulin due to disorders of the gastrointestinal tract.
9. Dysfunction of the thyroid gland and other organs of the endocrine system, leading to an increase in blood sugar levels.

The lack of preventive measures in the presence of these factors inevitably leads to the development of type 2 diabetes mellitus - that is, acquired.

Methods for the treatment of impaired glucose tolerance

Two tactics of therapy are used: drug and alternative. With timely diagnosis, treatment by alternative methods, without taking medication, is often sufficient.

Non-drug treatment of impaired glucose tolerance is built on the following basic principles:

1. Fractional nutrition in small portions. You need to eat 4-6 times a day, while evening meals should be low-calorie.
2. Minimizing the use of flour products, pastries, as well as sweets.
3. Strictly control weight, avoiding the deposition of fat.
4. Make vegetables and fruits the main foods, excluding only those that contain a large amount of starch and carbohydrates - potatoes, rice, bananas, grapes.
5. Be sure to drink at least 1.5 liters of mineral water per day.
6. If possible, exclude the use of fats of animal origin, giving preference to vegetable oil.

Usually, following these dietary rules gives a good result. If it is not achieved, special drugs are prescribed to help normalize glucose metabolism and. Taking drugs containing hormones is not necessary in this case.

The most popular and effective drugs prescribed to improve glucose metabolism in the body:

• Glucophage;
• Tonorma;
• Metformin;
• Glucophy;
• Amaril.

All appointments must be made strictly by a doctor. If, for some reason, taking medication is undesirable or impossible, for example, during pregnancy, impaired glucose tolerance is treated with folk recipes, in particular, with a variety of herbal infusions and decoctions.

Such medicinal plants are used: blackcurrant leaves, horsetail, burdock root and inflorescences, blueberries. Steamed buckwheat is very popular in treatment.

There are a fairly large number of methods to combat unstable blood sugar levels. But it is important to maintain a healthy lifestyle, especially during pregnancy and breastfeeding.

Quitting smoking and drinking alcohol, walking outdoors, playing sports, dieting - all this significantly affects the body's tolerance to glucose and can help avoid the transformation of a small disorder into pathology, especially during pregnancy.

An equally important point is the state of the nervous system. Constant stress and anxiety can be a decisive factor. Therefore, if necessary, it is worth contacting a psychologist. He will help to pull himself together, stop worrying, and if necessary, he will prescribe medications that help strengthen the nervous system.

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.