Additional methods of examination dm

Clinical blood analysis reveals inflammatory changes (leukocytosis, neutrophilia in case of infections complication). Anemia may be detected in patients with renal failure.

Clinical urine analysis may identify the kidney function during examination of physical properties of the urine. Poiyuria or oligyria, low specific urine gravity indicate to appearance of renal failure. Chemical study of urine includes assessment of glucose, ketone bodies and protein. Glucosuria is a specific sign of diabetes. Ketone bodies are determined in patients with decompensation and presence of ketoacidosis. Microalbuminuria and proteinuria indicate to development of diabetic nephropathy. Patients with diabetes should be screened for albuminuria. Given the insidious onset. INDDM patients should be screened for albuminuria at the time of the initial diagnosis. Patients with IDDM should be screened within 5 years of diagnosis.

Microalbuminuria is defined as a urinary albumin excretion (UAE) of 30-300 mg in a 24-hour collection period; albuminuria is defined as a UAE >300 mg/24 hours. Albuminuria is the clinical hallmark of the development of nephropathy.

Biochemical blood analysis. According to modern determination of glucose should be performed in venous plasma for diagnostics of diabetes.

Criteria of diabetes: fasting plasma glucose ≥7,0 mmol/L. A standardized oral glucose tolerance test (OGTT) performed in the morning, after an overnight fast (8-14 h); one blood sample should be taken before and one 120 min after intake of 75 g glucose dissolved in 250-300 mL water in a course of 5 min (note: timing of the test is from the beginning of the drink). Impaired glucose tolerance (IGT) can be recognized by the result of OGTT only: 2-h post-load plasma glucose (2hPG) ≥7,8 and < 11,1 mmol/L (≥ 140 and <200mg/dL).

Special test for diagnostic of diabetes is glycated hemoglobin. Glycated hemoglobin (HbAlc), a useful measure of metabolic control and the efficacy of glucose-lowering treatment, is an integrated summary of circadian blood glucose during the preceding 6-8 weeks, equivalent to the lifespan of erythrocytes. It provides a mean value but does not reveal any information on the extent and frequency of blood glucose excursions. HbA1c has never been recommended as a diagnostic test for diabetes. A primary reason is the lack of a standardized analytical method and therefore lack of a uniform, non-diabetic reference level between various laboratories. A high HbA1c may only identify a fraction of asymptomatic people with diabetes. HbA1c is insensitive in the low range and a normal HbA1C cannot exclude the presence of diabetes or IGT.

Serum creatinin concentration increased in patients with diabetic nephropathy.

ECG is revealed the signs of ischemia (inverted T), arrhythmia (extrasystole).

Echo-CG- sign of left ventricular hypertrophy, decreased ejection fraction.

Renal biopsy in patient with end-stage renal disease should be directed at the detection of primary kidney disease or renal complication of diabetes.

Ophtalmoscopic examination of the fundus is required for evaluation of diabetic retinopathy.

Instrumental invasive examination of the coronary, kidney, peripheral arteries is required for detecting the macroangiopathy.

Predominantly thyroxin (T⁴), only small amount of triiodothyronine (T³) is produced by the thyroid gland. Approximately 85% of T³ is produced in liver, muscle and kidney. T⁴ may be regarded as prohormone, because it is not metabolically active until converted to T³. Production of T³ and T⁴ in the thyroid gland is stimulated by thyrotrophin (thyroid-stimulating hormone, TSH) a glycoprotein released from the thyrotroph cells of the anterior pituitary in response to the hypothalamic tripeptide, thyrotrophin-releasing hormone (TRH).

Hormones of thyroid gland play an important biological role in organism:

• metabolic (enhanced tissue oxidation and responsible for energy balance);

• take part in the synthesis of protein;

• regulate energy production by changing of metabolism carbohydrate;

• interfere in metabolism carbohydrate in intestine, stimulate glyconeogenesis, glycogenolysis, promotes lipolysis;

• take part in metabolism of fats, accelerates, lipolysis;

• regulate the function of cardiovascular, nervous and reproductive systems;

• regulate the vitamins metabolism.

In pathological conditions may be decreasing and increasing function of the thyroid gland: hypothyroidism and hyperthyroidism.