Diabetes mellitus is a group of metabolic diseases characterized by elevated plasma glucose (referred to as blood glucose) levels. The pathogenesis of diabetes can be summarized as a defective secretion of pancreatic β-cells and/or insufficient insulin action in peripheral tissues due to different etiologies. Defective insulin secretion can be due to functional defects in the transmission of signals that excite insulin secretion and synthesis in pancreatic β-cell tissues, or due to autoimmunity, infection, chemical toxins and other factors that lead to the destruction of pancreatic β-cells and decrease in their number.
Insufficient insulin action can be caused by any defect in the complex insulin action signaling channels in the peripheral tissues. The consequences of insufficient insulin secretion and action are disorders in the metabolism of substances such as sugar, fat and protein. Impaired sugar utilization in insulin-dependent peripheral tissues (muscle, liver and adipose tissue) and increased hepatic glycogen isomerization lead to increased blood glucose, increased oxidative breakdown of fatty acids in adipose tissue, increased formation of hepatic ketone bodies and increased synthesis of triglycerides; the rate of muscle protein breakdown exceeds the rate of synthesis, resulting in negative nitrogen balance.
These metabolic disorders are the pathophysiological basis for the development of diabetes and its complications and co-morbidities. Undisease is an intermediate state between diseased and healthy, and is the dynamic evolution of the disease. The undiseased stage of diabetes is pre-diabetes. Pre-diabetes is the development of normal glucose regulation into impaired glucose regulation (IGR), where blood glucose is elevated but does not yet meet the diagnostic criteria for diabetes. It includes impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), both of which can occur separately or in combination. Among them, IGT is an important risk factor for diabetes, and the risk is even greater if it is accompanied by obesity, hypertension, and dyslipidemia.
IGT was first recognized as a disease state, or subclinical state, by the WHO Diabetes Expert Committee of the National Diabetes Research Group in 1979. According to the latest statistics, the prevalence of pre-diabetes among adults in China is 50.1%, and the number of diabetic patients has reached 113.9 million, almost all type 2 diabetic patients have to go through the IGT stage. It is imperative to actively prevent and treat pre-diabetic patients.
Pre-diabetes belongs to the category of “spleen disease” and “food depression” in Chinese medicine. The disease is caused by the combination of qi, blood, phlegm, fire, dampness and food stagnation, especially food stagnation as the basis for its occurrence.
I. Diagnosis
1.Clinical manifestations
Generally, there are no clinical symptoms, mostly found during physical examination or examination for other diseases, and oral glucose tolerance test can confirm the diagnosis. The following manifestations may also occur
(1) Disorders of substance metabolism
Patients may suffer from polyuria, thirst and excessive drinking due to osmotic diuresis caused by increased urinary sugar excretion after blood glucose elevation. Tissue glucose utilization disorders lead to increased fat and protein catabolism, resulting in weakness and weight loss, and in children, growth and development may be impaired. Insufficient supply of energy to tissues may lead to easy hunger and overeating. In addition, hyperglycemia causes changes in the osmolarity of the lens of the eye and affects the refractive power, resulting in blurred vision.
(2) Organ dysfunction
Patients may be found to have elevated blood glucose when they first visit the clinic due to complications or co-morbidities such as eye, kidney, neurological and cardiovascular diseases that lead to organ dysfunction.
(3) Infection
Patients may be diagnosed with elevated blood glucose due to complications of skin, vulva, urinary tract infections or tuberculosis.
(4) No diabetic symptoms
Patients do not have any diabetic symptoms and are only found during routine health checkups, before surgery or during routine pregnancy tests.
2.The natural course of the disease
The onset of prediabetes can be rapid or slow, and the progression varies. One third of patients develop diabetes, one third become normal, and one third remain in the pre-diabetic stage.
Most of the pre-diabetic form is overweight or obese, with a strong appetite, seemingly robust, and reduced energy and strength; no typical diabetic symptoms; normal or slightly high fasting glucose, but postprandial hyperglycemia and glycosuria, abnormal oral glucose tolerance test, and mostly high blood lipids; may be accompanied by obesity and hypertension.
Pre-diabetes – impaired glucose regulation
This stage refers to the period when an individual develops from normal glucose regulation to impaired glucose regulation (IGR), with elevated blood glucose but not yet reaching or exceeding the diagnostic cut-off point, manifested as impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). In terms of common type 1 and type 2 diabetes, patients at this stage have genetic defects that lead to diabetes and confer genetic susceptibility to the occurrence of diabetes, resulting in defects in insulin secretion and insulin action at an early stage in type 2 diabetes and autoimmune abnormalities at an early stage in type 1 diabetes.
3.Diagnostic criteria.
Check venous fasting blood glucose and OGTT 2 hours blood glucose
1.IFG Fasting plasma glucose (FPG) level ≥6.1 mmol/l (110 mg/dl) and <7.0mmol/l (126mg/dl); and 2 hours post-load glucose <7.8mmol/l (140mg/dl)
2.IGT Fasting plasma glucose (FPG) level <7.0mmol/l (126mg/dl), 2hPG level ≥7.8mmol/l (140mg/dl) and <11.1 mmol/l (200mg/dl) in oral glucose tolerance test (OGTT)
The diagnostic criteria for children are the same as those for adults
II. Differential diagnosis
Uremia
It is a group of syndromes characterized by severe deficiency or partial deficiency of antidiuretic hormone (arginine pressor hormone) (called central uremia) or renal insensitivity to antidiuretic hormone (nephrogenic uremia), resulting in dysfunction of renal tubular water absorption, which causes polyuria, thirst, polyhydramnios, low specific gravity urine and hypotonic urine. Urogyelia can occur at any age, mostly in adolescents, more in males than females, and the ratio of males to females is 2 to 1.
Polycystic ovary syndrome (PCOS)
PCOS is characterized by varying degrees of menstrual abnormalities (scarcity, low volume, amenorrhea, dysfunctional uterine bleeding) and infertility, hirsutism, acne, obesity, etc. Examination reveals polycystic ovarian changes, hyperandrogenemia and increased luteinizing hormone/folliculopoietin ratio, often accompanied by insulin resistance or hyperinsulinemia, elevated glucose and hyperlipidemia.
Auxiliary examinations
1. General examination: height, weight, blood pressure, pulse rate, heart rate, body mass index and related examinations.
2. Routine examination: blood, urine, stool routine, liver function, kidney function, electrocardiogram
3.Specific indexes: fasting blood glucose, postprandial blood glucose, glycated hemoglobin, blood lipids, insulin, C-peptide, glucagon release test, glucose clamp test, insulin measurement, insulin sensitivity index measurement, autoimmune antibody measurement if necessary
4.Complication index: urine microalbumin, urine protein quantification, electrocardiogram, echocardiogram, ambulatory electrocardiogram, blood rheology, limb vascular multispectral ultrasound, electromyography, limb hemogram, fundus light microscopy, fluorescence angiography. Cerebral hemogram, cranial CT, cranial MRI.
Chinese medicine treatment
Pre-diabetes belongs to the category of “spleen disease” and “food depression” in Chinese medicine.
1. Diagnosis (refer to the State Drug Administration “Guidelines for Clinical Research on New Chinese Medicines”)
Pre-diabetes is usually not clinically symptomatic, and is mostly found during health check-ups or examinations for other diseases, and is diagnosed as prediabetes by oral glucose tolerance test (OGTT). Many patients are often found first or also have hypertension, obesity, dyslipidemia, etc.
2. Differential diagnosis.
(1) Gall disease: the type of gall disease in which qi stagnates and turns into fire and yin deficiency and fire is exuberant, with symptoms such as overeating and easy hunger and growing thin, but emotional agitation, palpitations, protrusion of the eyes, and tangible gall swelling in front of the neck are distinct from it.
(2) Xerostomia: A clinical symptom of thirst for water, which can occur in a variety of disease processes and is especially common in external febrile diseases. It has corresponding symptoms according to the respective basic disease evidence and is not accompanied by easy hunger, polyphagia, polyuria and other characteristics.
3.Chinese medicine treatment
(1) Basic treatment
Eat less fatty, sweet and thick, fried and barbecued food and puffed food and carbonated drinks, and eat a light diet with appropriate coarse grains and more green vegetables.
Simple pre-diabetes strong people can use running, hiking, swimming, playing ball and other more intense sports, weak people can use taijiquan, eight duanjin and other less intense activities.
(2) Identification and treatment of internal treatment method
Pre-diabetes focuses on early prevention and advocates treating the “untreated”. Among them, obese or overweight people are mostly phlegmatic, while medium-sized or thin people are mostly Yin deficiency. The treatment for those with phlegm and turbidity is always to eliminate cream and turn turbidity; for those with qi stagnation and phlegm blockage, the treatment is to regulate qi and resolve phlegm; for those with spleen deficiency and phlegm-dampness, the treatment is to strengthen the spleen and resolve phlegm; for those with heat, the treatment is to nourish yin and regulate qi; for those who are thin, do not forget to nourish yin.
(3) Other treatments
①Foot bath therapy
Foot bath has an auxiliary effect on controlling blood glucose and preventing complications, especially for the first diagnosis of pre-diabetic patients, by foot bath, can effectively assist in lowering blood glucose, slowing down blood glucose fluctuations, improving clinical symptoms and reducing the dose of medication. The formula is composed of Shengdi, Gouge, Angelica, Danshen and Safflower.
②Acupuncture
Ear acupuncture and body acupuncture can be used for appetite suppression and weight loss.
③Body acupuncture
Main acupoints: Spleen Yu, Diaphragm Yu, Pancreas Yu, Foot San Li, and Sanyinjiao.
Matching points: Lung Yu, Stomach Yu, Liver Yu, Zhongbei, Guan Yuan, Shen Men, Rangu, Yinlingquan, etc.
Method: 2 main acupoints and 1-2 supporting acupoints are selected each time, and the acupuncture is performed with the milli-needle routine, with a flat tonic and a flat diarrhea, and the acupuncture is retained for 30 min, 2 times/day, 6 days as a course of treatment.
④Auricular acupuncture therapy
Acupuncture points: for upper consumption, take endocrine, lung and thirst points; for middle consumption, take endocrine and stomach; for lower consumption, take endocrine, kidney and bladder.
Method: medium stimulation, take 3-4 points each time, leave the needle for 10 minutes, once every other day. 10 times for a course of treatment.
⑤ Acupuncture point iontophoresis
Acupuncture points: Lung Yu, Lianquan, Hegu, Yuzhishan, Shenmen, Sanyinjiao, Shouhai, Neiting, Zhongfu, and Zaimen.
Method: set the intensity to the patient just do not feel pain; each acupuncture point treatment for 4 minutes, eight points automatically switch; treatment pulse frequency 1HZ; millimeter wave irradiation frequency 36GHZ
⑥Massage
Perform abdominal massage is good for weight loss.