What numbers are considered normal?
- Fasting venous plasma glucose: normal up to 6.1 mmol/l; 6.1–6.9 — impaired fasting glycemia; 7.0 and above - diabetes
- Glucose 2 hours after exercise: normal up to 7.8; 7.8–11.0 — impaired tolerance; 11.1 and above - diabetes
- Glycated hemoglobin (HbA1c): normal up to 5.7%; 5.7–6.4% - prediabetes; 6.5% and above - diabetes
- Random glucose 11.1 or higher in the presence of symptoms - diagnosis can be made immediately
Гликированный гемоглобин показывает средний уровень сахара за 3 месяца и не зависит от того, что вы ели вчера. Именно он — main показатель контроля, а не единичное измерение глюкометром.
Symptoms that are often missed
- Thirst and dry mouth, increased urine volume, night trips to the toilet
- Fatigue, drowsiness after eating
- Slow healing of wounds and scratches
- Frequent fungal infections, itching in the perineum, recurrent thrush
- Boils, skin inflammation
- Deterioration of vision, “fog” before the eyes
- Numbness and tingling in the feet
Classic thirst and weight loss are characteristic of severe hyperglycemia. In type 2 diabetes, they are often absent at all - therefore, people over 45 years of age and anyone who is overweight are recommended to undergo testing regularly, even if they are feeling excellent.
Who's at risk
- Excess body weight, especially with belly fat deposits
- Age over 45 years
- Diabetes in parents, brothers or sisters
- Previous history of gestational diabetes or birth of a baby weighing more than 4 kg
- Arterial hypertension and lipid metabolism disorders
- Polycystic ovary syndrome
- Sedentary lifestyle
Treatment
Treatment rests on three pillars, and the first two are no less important than the pills.
- A weight loss of 5–10% significantly improves performance, and by 15% or more leads to remission in some patients
- Controlling blood pressure and cholesterol in diabetes is as important as controlling sugar
- Smoking cessation is a prerequisite for the prevention of vascular complications
- Питание: ограничение быстрых углеводов и сахаросодержащих напитков, контроль порций, достаточно клетчатки и белка. Полный отказ от углеводов не нужен и вреден.
- Физическая активность: не менее 150 минут в неделю умеренной нагрузки плюс силовые упражнения 2 раза в неделю. Мышцы забирают глюкозу без участия инсулина.
- Медикаменты: метформин как базовый препарат, далее — современные группы, часть которых дополнительно защищает сердце и почки и способствует снижению веса. Инсулин при необходимости.
Важно понимать: цель лечения не «сбить сахар today», а не допустить осложнений через 10–20 лет. Поэтому main показатель — HbA1c, а целевое значение врач подбирает индивидуально с учётом возраста и сопутствующих болезней.
Mandatory examinations
- HbA1c - every 3 months until the goal is reached, then every 6 months
- Examination by an ophthalmologist with a dilated pupil - annually (diabetic retinopathy develops asymptomatically)
- Creatinine with GFR calculation and albumin in urine - annually
- Examination of the feet with sensitivity testing - at each visit, independently - daily
- Lipid spectrum and blood pressure control
- ECG and cardiovascular risk assessment
