Overview
Higher than normal blood glucose or urine glucose, but not actually diabetes mellitus Cannot be distinguished from diabetes mellitus based on symptoms alone Treat the cause of the condition, which may require hypoglycemic therapy Prognosis is closely related to the primary cause of the condition
Definition
Pseudodiabetes mellitus is not a standardized description and there is no such thing as pseudodiabetes mellitus.
Pseudodiabetes mellitus is a colloquial term that refers to a condition in which blood glucose or urine glucose is higher than normal, but there is no diabetes mellitus. It can be caused by a variety of factors, such as stress hyperglycemia due to surgery, infections, and trauma, secondary diabetes mellitus due to conditions such as hyperthyroidism, Cushing’s syndrome, and pheochromocytoma, and elevated urinary glucose due to renal disorders. The elevation of urinary glucose caused by the disease.
Blood glucose usually returns to normal after the relevant triggers or causes are eliminated [1-3].
The opposite of “pseudo-diabetes” is “true diabetes”, which generally refers to type 1 diabetes and type 2 diabetes.
Questions you may have
What is the difference between pseudo-diabetes and diabetes mellitus?
Pseudodiabetes mellitus is not a standardized description, and there is no such thing as pseudodiabetes mellitus. It is different from diabetes mellitus in terms of definition, clinical presentation and treatment, but it is difficult to distinguish by clinical presentation.
1. Definition: People think of “pseudo-diabetes”, mostly refers to the state of higher than normal blood glucose or urinary glucose, but in fact is not suffering from diabetes, to be related to the elimination of the causative factors or causes of blood glucose can generally return to normal; and diabetes is a group of chronic hyperglycemia as the characteristics of the disease, the existence of insulin secretion and/or use of the defects, such as type 1 diabetes and type 2 diabetes. Deficiency, such as type 1 diabetes mellitus and type 2 diabetes mellitus.
2. Clinical manifestations: pseudo-diabetes is characterized by elevated blood glucose or urinary glucose, without the typical symptoms of “three more and one less” (more drinking, more urination, more food, weight loss), and there may be symptoms of the original disease, such as palpitations, sweating, irritability, etc. Diabetes can be characterized by “three more and one less” symptoms, and may also have the symptoms of “three more and one less”, and may also have the symptoms of “three more and one less”. Diabetes can present “three more and one less” symptoms, may also have symptoms of diabetes complications, such as blurred vision, numbness of the hands and feet, and so on.
3. Treatment: The treatment of pseudo-diabetes is to actively remove the triggers and treat the related causes, supplemented by hypoglycemic treatment. Diabetes generally requires long-term dietary control, rational exercise and medication to lower sugar and other treatments.
Causes
Causes
Pseudo-diabetes mellitus is used to describe the state of not having diabetes mellitus but having elevated blood glucose and urinary glucose, which can be seen in a variety of disease factors and non-disease factors.
Disease-related factors
Stress hyperglycemia
Stress diabetes mellitus is mainly seen in various critical patients, such as hyperthermia, acute myocardial infarction, cerebral hemorrhage, cerebral thrombosis, major surgery, bone fracture, severe burns and other stressful states.
Stress hyperglycemia is a short-term hyperglycemic state exhibited by the body in order to get through the critical period and mobilize the stress response of various systems, which is a manifestation of self-protection mechanism [4-7].
Secondary diabetes mellitus
For example, in hyperthyroidism, excessive secretion of thyroid hormones; Cushing’s syndrome, abnormal increase in secretion of glucocorticoids; pheochromocytoma, increased secretion of catecholamines.
All of these hormones have a glucose-raising effect and can lead to a secondary increase in blood glucose. After treatment of the primary disease, blood glucose often returns to normal.
Kidney disease
Kidney disease can cause increased renal urinary glucose, also known as renal diabetes or normoglycemic diabetes.
There are many types of kidney diseases that cause renal glycosuria, including congenital ones called familial renal glycosuria, such as Fanconi syndrome, and acquired renal glycosuria seen in chronic interstitial nephritis.
Non-disease factors
Elevated blood glucose of medical origin
Long-term high-dose glucocorticoid use can lead to elevated blood glucose.
Phenytoin sodium, use of anesthetic inducers and sedatives can inhibit the action of insulin and can also lead to elevated blood glucose.
Excessive glycemic load
If a large amount of sugary foods, carbohydrates, beverages, or large amounts of hypertonic glucose solution are consumed or infused intravenously, glucose in the blood rises rapidly, exceeding the ability of the kidneys to reabsorb glucose, and a positive urine glucose may occur.
Special Population
For example, newborns may have positive urine sugar due to imperfect renal tubular function.
Women may also develop positive urine glucose during pregnancy due to increased blood volume and increased glomerular filtration rate, which exceeds the ability of the kidneys to reabsorb glucose.
Pathogenesis
The pathogenesis of pseudodiabetes mellitus includes elevated glucagon levels and decreased tubular reabsorption of glucose.
Elevated glucagon levels
Under stressful conditions such as severe trauma and infection, the body increases the secretion of glucagon, adrenaline, growth hormone, cortisol and other glucagon, which accelerates glycogenolysis and inhibits insulin secretion, leading to stress hyperglycemia [9-11].
Endocrine diseases such as hyperthyroidism and Cushing’s syndrome lead to an abnormal increase in glucagon hormones, such as thyroid hormone and glucocorticoids, resulting in elevated blood glucose.
Decreased renal tubular reabsorption of glucose
Some kidney diseases, such as chronic interstitial nephritis, lead to a decrease in the ability of renal tubules to reabsorb glucose, and positive urine glucose can occur.
One-time intake of large amounts of glucose or intravenous administration of glucose at too high a concentration and at too fast a rate can lead to a rapid rise in blood glucose, which will result in transient urine glucose when the renal glucose threshold is exceeded.
Symptoms
Main Symptoms
Pseudodiabetes mellitus is mainly characterized by elevated blood glucose or positive urine glucose, but normal urinary ketone bodies, and there is no polydipsia, polyuria, polyphagia, or weight loss.
Accompanying Symptoms
Pseudodiabetes mellitus can be caused by a variety of reasons and, therefore, may show symptoms of the primary disease in addition to the main symptoms.
In hyperthyroidism, there may be palpitations, excessive sweating, fear of heat, and irritability.
Those with Cushing’s syndrome may have a face as round as a full moon or a buffalo’s back with fat accumulation in the neck and shoulders.
Chronic interstitial nephritis may be associated with polyuria, nocturia, lethargy, and pallor of the face and eyelids.
Consultation
Department of Medicine
Endocrinology
If you find elevated blood sugar or urine sugar, you may first consult the Department of Endocrinology.
Nephrology
If you find elevated urine sugar, you may also consult the Nephrology Department.
Obstetrics and Gynecology
Pregnant women with positive urine sugar are advised to consult the Obstetrics and Gynecology Department.
Preparation
Consultation: Registration, Preparation of documents, Frequently Asked Questions
Tips for the doctor
Blood tests may be required. Loose clothing is recommended.
Preparation Checklist
Symptom list
Pay particular attention to the time of onset of symptoms, special manifestations, etc.
Any polyuria, polydipsia, polyphagia and weight loss?
Any high fever, fatigue, mental depression?
Any palpitations, sweating, irritability, etc.?
Any symptoms such as face as round as full moon, fat accumulation on neck, shoulder and back?
Any symptoms such as polyuria, increased nocturia, lethargy, pale face and eyelids?
List of medical history
Are there any stressful conditions such as burns, fractures, brain hemorrhage, surgery, etc.?
Any medications such as glucocorticoids (e.g., methylprednisolone, prednisone), phenytoin sodium, etc.?
Any kidney disease, such as chronic interstitial nephritis, Fanconi syndrome, etc.?
Any short-term consumption of large amounts of sugary foods or intravenous infusion of large amounts of hypertonic glucose?
Is the patient currently pregnant?
Checklist
Test results from the last 1 week, which can be carried to the doctor’s office
Laboratory tests: intravenous blood glucose, urine routine, thyroid function tests, etc.
Diagnosis
Diagnosis based on
Medical history
Patients with this disease may have the following conditions:
A history of endocrine disease such as hyperthyroidism and Cushing’s syndrome.
A history of kidney disease such as chronic interstitial nephritis and Fanconi syndrome.
Have a history of surgery, severe infection, burns, etc.
History of conditions such as large intravenous infusions of glucose.
History of glucocorticoid administration, etc.
Clinical manifestations
Elevated blood glucose or positive urine glucose without ketonuria, symptoms of polydipsia, polyphagia, polyuria, and weight loss.
General Laboratory Tests
Blood glucose
Elevated blood glucose may be present, with fasting blood glucose levels greater than 7.0 mmol/L or random blood glucose greater than 11.1 mmol/L.
Glycated hemoglobin
Glycated hemoglobin is usually not elevated because blood glucose or urine sugar is temporarily elevated and glycated hemoglobin reflects the average blood glucose level over a 3-month period.
Electrolytes
Disorders of glucose metabolism may cause hypokalemia.
Urine routine
Urine routine may be positive for urine sugar, but urine ketone bodies are usually normal.
Other
If there is a primary disease, tests related to the primary disease may be abnormal.
For example, liver and kidney function, coagulation function, C-reactive protein and other indicators may be abnormal in critical infections.
If hyperthyroidism is present, free thyroid hormone may be elevated and thyroid stimulating hormone may be lowered.
In the case of hypercortisolism there may be disturbances in the rhythm of cortisol secretion and elevated levels of cortisol, which are not suppressed by the low-dose dexamethasone suppression test. Pheochromocytoma may present with elevated plasma catecholamine metabolites.
Decreased urine specific gravity and osmolality and a small amount of proteinuria may be present if chronic interstitial nephritis is present.
Differential diagnosis
It is mainly differentiated from type 1 or type 2 diabetes mellitus, which can be determined by fasting blood glucose, glucose tolerance test, glycosylated hemoglobin, glycosylated plasma albumin, and pancreatic β-cell function tests.
Treatment
Aim of treatment: remove the causative factors, treat the original disease, and restore blood glucose and urine sugar.
Treatment Principle: Treat the cause of the disease.
Glucose-lowering treatment
Not all pseudo-diabetes require immediate glucose-lowering treatment. If the degree of elevation of blood glucose and urinary glucose is judged to be serious, timely glucose-lowering is required.
Stress hyperglycemia due to critical illness requires temporary insulin therapy, either subcutaneously or intravenously [12-13].
Secondary diabetes mellitus such as hyperthyroidism and Cushing’s syndrome can be treated with temporary application of glucose-lowering therapy such as metformin and acarbose.
Counter-causal treatment
The treatment of pseudodiabetes mellitus is based on allopathic management.
Intravenous glucose infusion should be temporarily discontinued or reduced according to the condition, the speed of glucose infusion should be strictly controlled, and insulin may be added appropriately.
Stress hyperglycemia caused by critical illness requires active treatment of the original disease, such as anti-infection, antipyretic and rehydration.
Elevated urinary glucose caused by renal disease should be actively treated to correct acidosis, anemia, hyperphosphatemia, and so on.
Those caused by hyperthyroidism should actively take antithyroid medication, and if necessary, iodine 131 treatment.
If it is caused by adrenal adenoma, it can be treated by surgery.
Prognosis
Cure
In most cases, blood glucose can generally recover gradually after the factors causing pseudo-diabetes are treated or cured.
Glucocorticosteroids, phenytoin sodium, and other medications are used for a short period of time, and blood glucose usually recovers gradually after the medication is discontinued.
The elevation of urine sugar caused by eating a large amount of sugary food or intravenous infusion of large amounts of glucose is usually transient, and after the removal of the causative factor, the blood sugar or urine sugar can be returned to normal very quickly.
Urine sugar usually returns to normal after the tubules of the newborn mature or after delivery in pregnant women.
Secondary diabetes mellitus, such as hyperthyroidism and Cushing’s syndrome, can return to normal after curing the primary disease.
However, stress hyperglycemia caused by critical illness and elevated urine glucose caused by chronic kidney disease, etc., blood glucose may remain elevated and the prognosis may be poor due to the harm caused by the primary disease.
Daily
Daily management
Regular testing of blood glucose and urine glucose is recommended for diseases with elevated blood glucose or urine glucose, such as hyperthyroidism and Cushing’s syndrome.
According to the condition, appropriate control of food intake with high glycemic index, such as rice porridge and fruit juice drinks.
Fish, chicken, beef and lamb can be eaten in moderation to reduce the intake of fatty meat, and less smoked, baked, pickled and other processed meat products.
Dietary attention to the order of meals, according to the order of vegetables – meat – staple food meals, can help control blood sugar.
Prevention
Non-disease-induced pseudo-diabetes can be prevented by avoiding large amounts of sugary foods, carbohydrates, and beverages, reducing the amount of glucose input by intravenous glucose infusion, and strictly controlling the speed of glucose infusion.
For disease-induced pseudo-diabetes, it is generally difficult to prevent, it is recommended to actively treat the primary disease, there are factors secondary to elevated blood glucose recommended regular measurement of blood glucose.