Glucosuric profile
In healthy people, glucose falling into the primary urine, almost completely reabsorbed in the renal tubules and in the urine by conventional methods is not determined. With an increase in the concentration of glucose in the blood above the renal threshold( 8.88-9.99 mmol / l), it begins to enter the urine - there is a glucosuria. The appearance of glucose in the urine is possible in two cases: with a significant increase in glycemia and with a decrease in the renal threshold of glucose( renal diabetes).Very rarely, episodes of mild glucosuria are possible in healthy people after significant nutritional loads with foods high in carbohydrates.
Usually, the percentage of glucose in the urine is determined, which in itself carries insufficient information, since the amount of diuresis and, accordingly, the true loss of glucose in the urine can vary widely. Therefore, it is necessary to calculate daily glucosuria or glucosuria in individual portions of urine.
In patients with diabetes mellitus, a glucosuria study is conducted to evaluate the effectiveness of the treatment and as an additional measure of disease compensation. The decrease in daily glucosuria indicates the effectiveness of therapeutic measures. The criterion com
is the puncture of type 2 diabetes mellitus - the achievement of aglucosuria. In type 1 diabetes mellitus( insulin-dependent), a loss of 20-30 g glucose per day is permissible in the urine.
It should be remembered that in patients with diabetes mellitus the renal glucose threshold can significantly change, which makes it difficult to use these criteria. Sometimes glucosuria persists with persistent normoglycaemia, which should not be considered an indication for increased hypoglycemic therapy. On the other hand, with the development of diabetic glomerulosclerosis, the renal glucose threshold increases, and glucosuria may be absent even with very pronounced hyperglycemia.
To select the correct mode of administration of antidiabetic drugs, it is advisable to examine glucosuria in three portions of urine. The first portion is collected from 8 to 16 hours, the second from 16 to 24 hours and the third from 0 to 8 hours the following day. Each portion is determined by the amount of glucose( in grams).Based on the daily profile obtained, glucosuria increases the dose of antidiabetic drug, the maximum of which will occur during the period of the greatest glucosuria [Medvedev VV, Volchek Yu. Z., 1995].Insulin patients with diabetes mellitus are administered from the calculation of 1 ED per 4 g of glucose( 22.2 mmol) in urine.
It should be remembered that with age, the renal threshold for glucose increases, in older people it can be more than 16.6 mmol / l. Therefore, in elderly people, a urine test for glucose to diagnose diabetes is ineffective. Calculate the necessary dose of insulin for glucose in the urine can not.