A patient with first-onset diabetes was hospitalized and his doctor prescribed a lot of tests. He was very confused and thought that the doctor was writing indiscriminate checklists in order to cheat him out of his money, is this really the case? Take a look at this relatively professional article below and you’ll know the answer. Missing out on these diseases can sometimes be fatal. Secondary diabetes In some cases, the body develops symptoms that resemble diabetes. We know that diabetes is the result of an absolute or relative insufficiency of insulin secretion and a decrease in insulin action, i.e. insulin resistance, and we call it diabetes; however, some problems that resemble diabetes are not due to insufficient insulin secretion, but are caused by other factors, and people call them secondary diabetes. Because the pathogenesis of the two is different, the principles of treatment are different. In the case of diabetes mellitus, the treatment should be focused on insulin insufficiency and insulin resistance, while in the case of secondary diabetes mellitus, the main treatment should be the primary cause and the corresponding measures should be taken for the relevant factors. Therefore, in order to avoid misdiagnosis and mistreatment that may lead to adverse consequences, attention should be paid to the differentiation of elevated blood glucose. Several common causes of secondary diabetes mellitus are described below. Acromegaly is caused by excess secretion of growth hormone due to anterior pituitary pathological factors, resulting in disorders of glucose metabolism. The main points of differentiation are: (1) the symptoms of diabetes mellitus appear after the symptoms of acromegaly (such as large size or tongue, thickened fingers, thickened palms, and reduced vision in severe cases); (2) blood sugar and urine sugar are not easily controlled by insulin or oral hypoglycemic drugs; (3) the symptoms of diabetes mellitus may resolve or disappear on their own in some patients, most of which are due to degenerative lesions or atrophy of the anterior pituitary gland. Hyperthyroidism can accelerate the blood flow in the intestinal wall and increase the absorption of glucose in food, so the postprandial blood glucose increases significantly and diabetes occurs. The presence of symptoms characteristic of hyperthyroidism, such as protruding eyes, excessive sweating, anxious temperament, tremor of the extremities and increased basal metabolic rate, can be distinguished. In pheochromocytoma, the secretion of epinephrine and norepinephrine in large quantities causes the degradation of glycogen in the form of glucose stores in the liver into glucose in the bloodstream, resulting in an increase in blood glucose. In addition, adrenaline can excite the brain and increase the secretion of adrenocorticotropic hormone in the pituitary gland, which is another reason for the increase of blood sugar and urine sugar. This tumor can cause high and low blood pressure, fluctuating greatly. Therefore, if you find paroxysmal hypertension with elevated blood glucose, you should consider the possibility of pheochromocytoma, and further examination should be done accordingly. Cushing’s syndrome Cushing’s syndrome (also known as cortisolism) is a condition in which adrenocorticotropic hormone can cause a high level of gluconeogenesis (the process of converting other non-sugar substances such as triglycerides and certain amino acids into glucose), so it can inhibit the use of glucose and fight insulin. Glucose-insulin tolerance test can be used to differentiate the difference. Adrenocorticotropic hormone In the process of treating a disease with adrenocorticotropic hormone, blood glucose can be raised. The clinical characteristic is that the increase in blood glucose is reversible, and blood glucose and urine sugar can return to normal after stopping corticosteroids. Pancreatic islet alpha cells produce glucagon, which can rapidly mobilize liver glycogen and raise blood glucose, and its effect is stronger than that of adrenocorticotropic hormone. In this tumor, pancreatic glucagon is secreted in large amounts, and therefore blood glucose may rise. For the diagnosis of this tumor, sometimes a mass (tumor) can be palpated in the abdomen; there are often episodes of epigastric pain; increased glucagon can be measured in the serum; and the tumor can be detected by CT or MRI of the pancreas. Pancreatic cancer Secondary diabetic symptoms may be a manifestation of pancreatic cancer in the early stages or during the course of the disease. In both acute and chronic pancreatitis, decreased glucose tolerance may occur during the course of the disease, usually transiently, but in a very small number of patients it may become permanent diabetes. The kidney has a low glucose threshold because of the reduced ability of the renal tubules to reabsorb sugar. In addition, this “low renal glucose threshold” is occasionally seen in a small number of pregnant women, and must be followed up postpartum for identification. In severe liver disease, due to liver dysfunction, a large amount of glucose cannot be converted into hepatic glycogen and stored in the liver after eating, resulting in elevated blood glucose and positive urine glucose, and a tolerance curve similar to that of diabetes. However, blood glucose often decreases during fasting, and hypoglycemic symptoms may occur. Starvation When starvation occurs after a considerable period of time, a large amount of food with high sugar content is suddenly introduced, and insulin secretion cannot adapt to it for a while, resulting in an increase in blood glucose and urine sugar, as well as a decrease in glucose tolerance test. The main point of differentiation is that if you eat normally for several days, the diabetes-like symptoms may disappear. Pregnancy In women, diabetes can sometimes be triggered after pregnancy. The mechanism may be due to the high secretion of growth hormone, estrogen and ACTH-like hormone in the placenta, which causes a relative lack of insulin. The main point of differentiation is that the symptoms of secondary diabetes usually recover spontaneously after delivery. Infections Almost any infection can increase insulin requirements, especially septic infections. In addition to the hyperactivity of the nerves and pituitary-adrenal glands in response to stress, other factors such as the production of antagonists such as antibodies and reduced binding of insulin receptors in ketoacidosis are also important factors. When infectious diseases are present, secondary diabetes can occur due to the relative lack of insulin secretion, but can be cured when the infection is controlled. Stress stimulation Stress stimulation can occur when you are under stress such as myocardial infarction, serious infectious disease, cranio-cerebral disease, trauma, burns, shock, hemorrhage, etc. This can cause disorders of glucose metabolism through the neuro-pituitary-adrenal axis and accelerate the decomposition of hepatic glycogen and isogenesis, which can lead to increased blood glucose and positive urine sugar. Chronic nephritis diabetes mellitus Patients with chronic nephritis may sometimes develop diabetes mellitus due to impaired glucose reabsorption by the renal tubules, but the blood glucose is normal. In neurological diseases, temporary hyperglycemia and positive urine glucose may occur in cases of cerebral hemorrhage, brain tumor, skull fracture, asphyxia, anesthesia, etc. After the condition improves or recovers, secondary diabetes may be reduced or disappear. So many causes can cause diabetes, it seems that doctors are not really good, we have not studied medicine will think very simple, patients and doctors respectively from different angles and depth to face the problem, naturally there will be a lot of differences, sometimes there will be some misunderstanding of the doctor, and even medical disputes, I hope to see people can share their thoughts and views, to create harmony between doctors and patients, to create a good medical environment! I hope that those who see it can share their thoughts and opinions to create harmony between doctors and patients and to create an excellent medical environment!