Is it possible to cure impaired glucose tolerance? What is the main reason for the development of impaired glucose tolerance. Causes and symptoms

When blood sugar levels periodically increase for no apparent reason, we can talk about a phenomenon called impaired glucose tolerance. In itself, it is not yet a disease, but only an alarming symptom that signals a person’s predisposition to diabetes, strokes and heart disease.

It is very difficult to track such fluctuations, so diagnosing such a symptom is quite difficult. But if it has already been identified, it cannot be ignored. A proper diet will help prevent the development of diabetes and its accompanying complications.

The diet for impaired glucose tolerance is aimed at stabilizing blood sugar levels and reducing excess weight, since such people usually have it. The result is achieved by moderately limiting the daily calorie intake and excluding from it foods that provoke a sharp increase in glucose levels in the body.

Organization of the daily routine and food intake should help activate metabolism. This can only be achieved through a combination of diet and moderate physical activity. The amount of fluid consumed should be sufficient, but not excessive. And you will have to adhere to such a diet until your sugar level returns to normal and completely stabilizes.

Without diet and medication, no more than one year passes from the moment of determining intolerance to diagnosing diabetes. So those who want to regain their health should follow all the rules and restrictions strictly.

It is imperative to spend at least one hour in the fresh air. It is better if this time is spent moving. Let it be walking or cycling. Only such an integrated approach will give good results and prevent the development of a dangerous disease.

Full menu

The menu is compiled independently. All products that are not included in the “red list”, which is small and intuitive, are allowed for consumption. It includes everything fatty, fried, sweet and floury. If we talk about prohibited products in more detail, then the following should be excluded from the menu:

Milk and dairy products are very healthy, but you need to choose those that have a reduced fat content. Nuts and seeds - in extremely small quantities. Honey - no more than one teaspoon per day. Sprouted grains and green leafy vegetables are beneficial.

An approximate daily menu for the treatment of glucose intolerance may be as follows:

Breakfast: porridge with milk or cottage cheese casserole; cup of cocoa.
Second breakfast: 1 large fruit or fruit dessert.
Lunch: soup or borscht in low-fat broth; boiled or baked meat; vegetable salad; a piece of black bread; compote or fruit drink.
Afternoon snack: fruit jelly or milk pudding.
Dinner: fish dish with a side dish of fresh or baked vegetables (only vegetables in any form are allowed); tea or rose hip decoction with lemon and biscuits.
Before bed: a glass of kefir or fermented baked milk.

Most patients at this stage constantly hear the same phrase, that due to impaired glucose tolerance, diabetes mellitus (DM) can develop, and if no measures are taken now, then a bitter disease with such a sweet name will provide you with a long and not very blissful coexistence.

However, most people are not afraid of such words and they continue to persist in their actions, constantly indulging in damned pleasant weaknesses.

The basis of this condition is a problem in which glucose accumulates in the blood.

IGT is closely related to another concept - impaired fasting glucose (IFG). Very often, these concepts may not be indirectly separated, since in the diagnosis or diabetes mellitus itself, these two criteria are usually interdependent.

They mature at the moment when one of the metabolic processes begins to fail - during which the consumption or utilization of glucose by the cells of our entire body decreases.

According to ICD-10, this condition corresponds to the number:

R73.0 - increased blood glucose or abnormal results of a glucose tolerance test

To understand the state of a person at the stage of metabolic disorders, the blood glycemia criterion is used.

With IGT, blood sugar will be higher than normal, but not so much as to exceed the diabetic threshold.

But how then can we differentiate between impaired glucose tolerance and impaired fasting glucose?

In order not to be confused in these two concepts, you should consult the standards of the WHO - the world health organization.

According to the accepted WHO criteria, IGT is defined by an increased level of sugar in the blood plasma 2 hours after a load consisting of 75 g of glucose (dissolved in water), provided that the fasting plasma sugar concentration does not exceed 7.0 mmol/liter.

NGN is diagnosed if fasting (i.e. on an empty stomach) is ≥6.1 mmol/l and does not exceed 7.0 mmol/l, provided that glycemia 2 hours after exercise is<7.8 ммоль/л.

Those. the basis of IGT, as the name implies, is to determine the sugar level on an empty stomach, when its threshold exceeds the permissible norm for a healthy person, and with IGT, fasting glycemia may be relatively normal, however, after consuming carbohydrates, their absorption will be significantly slower, as will lead to an increase in glycemia.

Thus, these two concepts are one of the main criteria in the diagnosis of metabolic disorders, and are also included in the list of risks that can lead to the development. Unfortunately, similar problems have recently become common among the younger generation.

Impaired glucose tolerance can now be detected in children, which previously seemed impossible in principle. However, obesity has now become the scourge of modern society. When present, natural metabolism tends to slow down, which increases the risk of developing type 2 diabetes in school-aged children and adolescents.

Overweight children are more susceptible to cardiovascular diseases, they have dyslipidemia (), shortness of breath, slow development, and reduced immunity. And if earlier diabetes at their age was hereditary, now it is more likely a consequence of an unhealthy lifestyle and an artificially instilled habit of eating in public catering places.

Frequent snacking on buns, hot dogs, and hamburgers bears fruit several years after the first opening of McDonald's in Russia in Moscow (it was opened on January 13, 1990, and 26 years have passed since then, and the memory of this event is still alive , since it is reflected in the Guinness Book of Records).

Unlike existing diabetes, people with IGT can still change everything. There is a fairly simple technique that allows you to completely normalize the metabolism of both carbohydrates and other substances in the body.

Reasons

Unfortunately, it is still not clear exactly what leads to this condition with a 100% guarantee. However, it is generally accepted that several events are to blame for this, which can (we repeat - CAN) cause a malfunction in carbohydrate metabolism.

Bad heredity plays an important role

If your immediate family had diabetes, this automatically increases the risk of problems with carbohydrate metabolism. However, even if both parents, say, have diabetes, this does not mean that their baby will also have the same disease or any problems with metabolic processes both at birth and throughout his subsequent life.

A cell that does not “recognize” insulin as its benefactor (only this hormone delivers glucose to cells, which no other substance can do) inevitably begins to experience hunger. If you don’t feed her, then the process of alternative nutrition will start due to, for example, fats. However, this will not help, but rather harm, since insulin still cannot “reach” the cells that have gone mad from hunger.

As a result, it may develop. If you do not intervene in time, the person may die, as the cells begin to gradually die, and the blood becomes toxic due to an excess of glucose and begins to poison the entire body from the inside.

Problems with the pancreas (disease, injury, tumor)

When they occur, its main secretory function (hormone production) is disrupted, which can also cause impaired glucose tolerance. Pancreatitis is one of these diseases.

A number of certain diseases accompanied by disruptions in metabolic processes

Let's say, Itsenko-Cushing's disease, which is characterized by the presence of hyperfunction of the pituitary gland as a result of traumatic brain injury, severe mental disorder, etc. With this disease, there is a violation of mineral metabolism.

Everything in our body is interconnected and a failure in one system inevitably leads to disruption in other areas. If we have “built-in” programs for eliminating such failures in our brain, a person may not immediately find out about health problems, which will slow down his treatment, because he will not seek help from a doctor in time, but only at the very last moment, when he understands, that there was clearly something wrong with him. Sometimes by this time, in addition to one problem, he had already managed to collect a dozen others.

Obesity

It also contributes to the development of IGT, even to a somewhat greater extent, since an obese body requires more energy-intensive maintenance from the most hardworking organs: the heart, lungs, gastrointestinal tract, brain, kidneys. The higher the load on them, the faster they will fail.

Sedentary lifestyle

To put it simply, a less active person does not train, and what does not train atrophies as unnecessary. As a result, numerous health problems arise.

Taking hormonal medications (in particular glucocorticoids)

In medicine, more than once we came across such patients who never followed a diet, led a sedentary lifestyle, and abused sweets, but at the same time, according to their state of health, doctors included them in the list of absolutely healthy people without the slightest signs of impending metabolic syndrome. True, it didn't last that long. Sooner or later, this way of life made itself felt. Especially in old age.

Symptoms

Now we have reached the least informative point in our story, since it is simply impossible to independently determine that a person is developing impaired glucose tolerance. It is asymptomatic, and the condition worsens at the moment when it is time to make another diagnosis - diabetes.

It is for this reason that treatment of patients is delayed, since a person at this stage is not aware of any problems. Meanwhile, IGT is easily treatable, which cannot be said about sugar disease, which is a chronic disease and cannot yet be treated. With diabetes, you can only delay multiple early and late symptoms, which become the cause of death of patients, and not the ill-fated diabetes itself.

As impaired glucose tolerance develops, a person may experience some symptoms that are also characteristic of diabetes:

extreme thirst (polydipsia)
dry mouth
and, as a result, increased fluid consumption
increased urination ()

It is impossible to say for sure that a person with such symptoms is sick. This condition can also occur with an infectious disease that occurs without an increase in body temperature, as well as in the summer during intense heat, heat, or after an intense workout in the gym.

In addition, any failure in the metabolism of substances sooner or later leads to a decrease in the human immune system, since the rate of development of protective mechanisms, which are regulated primarily by two systems: nervous and endocrine, also depends on the speed of metabolism.

If metabolic processes are disrupted for some reason, then the process of tissue regeneration slows down. A person experiences multiple problems with skin, hair, and nails. He is more vulnerable to infectious diseases and, accordingly, is often more physically weak and psychologically less unstable.

What are the dangers of impaired glucose tolerance?

Many have already realized that IGT is not such a harmless condition, since, in the literal sense of the word, it hits the most essential thing in the human body.

Although, it is difficult to say what may be insignificant in all this inner microcosm of a person. Everything is important here and everything is interconnected.

Meanwhile, if you let everything take its course, diabetes will be guaranteed to the careless owner of such a body. However, problems with the absorption of glucose entail other problems - vascular ones.

Blood circulating through the veins is the main conductor of biologically significant and valuable substances that are dissolved in it. The vessels, in a whole web, intertwine all the particles, even the smallest ones, of our entire body and have access to any internal organ. This unique system is extremely vulnerable and dependent on the composition of the blood.

Blood mostly consists of water, and thanks to the aqueous environment (the blood itself, intercellular and cellular protest), a constant, subsecond, instantaneous exchange of information is ensured, which is ensured through chemical reactions of organ cells with the blood and the surrounding aquatic environment. Each such environment has its own set of control levers - these are molecules of substances responsible for certain processes. If there is a shortage of some substances or an excess of them, the brain will instantly know about this and react immediately.

The same thing happens when glucose accumulates in the blood, the molecules of which, when in excess, begin to destroy the walls of blood vessels because, firstly, they are quite large, and secondly, they begin to interact with other substances dissolved or entering the blood in response to . This accumulation of various substances affects the osmolarity of the blood (i.e., it becomes thicker) and, due to the chemical interaction of glucose with other substances, its acidity increases. The blood becomes acidic, which essentially makes it poisonous, toxic, and the protein components circulating in the blood are exposed to glucose and gradually become sugary - a lot appears in the blood.

Thick blood is more difficult to move through the veins - heart problems arise (develops). Thickness causes the walls of blood vessels to expand even more, and in places where they have lost their elasticity for one reason or another (for example, with calcification, atherosclerosis, or as a result) they may simply not withstand such a load and burst. A burst vessel is quickly healed, and in its place new vessels are formed that cannot fully fulfill the role of the lost one.

We have not described the entire chain of the harmful effects of excess glucose on the body, because in case of impaired glucose tolerance, the concentration of sugar is not so high as to entail such dire consequences. But!

The more it is and the longer hyperglycemia lasts, the more significant and noticeable the consequences become after it.

Diagnostics

You may have already guessed that you can find out about IGT only through a laboratory blood test under certain conditions.

If you take blood from your finger using a home portable device - a glucometer, then this will not be a significant indicator of anything. After all, it is important to take blood at a certain point and check the speed and quality of glucose absorption after consuming carbohydrates. Therefore, your personal measurements will not be enough for diagnosis.

Any endocrinologist will definitely take an anamnesis (find out about the patient’s condition, ask about relatives, identify other risk factors) and refer the patient to undergo a series of tests:

fasting blood sugar test

But the most significant analysis in our case is the GTT:

Which is supposed to be given to all pregnant women at approximately 24 - 25 weeks of pregnancy, in order to exclude other health problems. After undergoing such a test during pregnancy, both IGT and NGN may be detected. If, after taking control blood, the pregnant woman has an increased fasting glycemia, then doctors will not continue the glucose tolerance test. The woman will be referred for additional tests to the endocrinology department, or the test will be repeated again, but a few days later.

This test is carried out in several stages:

Fasting blood draw (these are the glycemic benchmarks that doctors will rely on during the diagnosis process)
Glucose load (the patient will have to drink a sweet drink in which the amount of glucose required for the test is dissolved)
After 2 hours, blood will be taken again (to check how quickly carbohydrates are absorbed)

Based on the results of such a test, several carbohydrate metabolism disorders can be identified at once.

Criteria	Glucose concentration in mmol/liter
	Blood
	Capillary	Venous
Normal indicators
On an empty stomach and	<5.6	<6.1
2 hours after	<7.8	<7.8
Diabetes mellitus
On an empty stomach or	≥6.1	≥7.0
in 2 hours or	≥11.1	≥11.1
random determination	≥11.1	≥11.1

Fasting (if determined) and	<6.1	<7.0
in 2 hours	≥7.8 and<11.1	≥7.8 and<11.1
Impaired fasting glucose
On an empty stomach and	≥5.6 and<6.1	≥6.1 and<7.0
after 2 hours (if determined)	<7.8	<7.8

A similar analysis can be carried out in two types of OGTT - oral and IVGTT - intravenous.

In the first case, the person is asked to drink an aqueous solution of glucose, and in the second case, the solution is administered intravenously. The second version of the test is more convincing, since the sweet solution enters directly into the blood and there is no need for it to first pass through the walls of the stomach and then enrich the blood with glucose.

The IVGTT or insulin-modified intravenous glucose tolerance test may be used in some patients who have gastrointestinal or pregnancy problems while suffering from toxicosis.

Our table shows the data obtained as a result of OGTT.

How to treat NTG

After a disappointing positive test for IGT is received, you should seek detailed advice from an endocrinologist who will prescribe appropriate treatment.

Don’t be afraid, no one will start feeding you pills, since to eliminate this condition it is enough to change your lifestyle.

If you are overweight, you will need to strive to get in shape in two harmless ways:

eat properly in small portions
increase physical activity

When treating impaired glucose tolerance, the doctor sets several tasks for the patient:

weight loss
achieving tight metabolic control (i.e. important to monitor glycemia)
if there is a problem with blood pressure, monitor it throughout the day and achieve normal blood pressure
prevent possible cardiovascular complications
giving up bad habits (alcohol, smoking)

If for a long period of time a person cannot lose weight on his own (provided that he strictly followed all the recommendations), then the doctor may include in the therapy some medications with an active substance that are not sold without a doctor’s prescription. For example, with the active ingredient sibutramine. But these are completely extreme measures, since they entail other problems that significantly affect health, since more than one use of “miracle pills” is not without side effects.

Otherwise, the most effective method of losing body weight is one way - energy deficit.

In other words, the patient must learn to structure his diet and exercise regimen so that energy expenditure prevails over its intake.

With this regime, fat reserves begin to be consumed more intensively, as a carbohydrate deficiency is noted, which is covered by the “melting” of lipids.

After losing body weight, all efforts should be aimed at maintaining and consolidating the achieved results, which means that you will have to adhere to the given pace constantly - throughout your life.

Keeping a food diary with surgery and the use of additional knowledge, for example, such as:

Of course, a person will one way or another be forced to switch to a low-carbohydrate diet, the basis of which was laid by the Pevzner nutrition system, developed back in Soviet times.

A hypocaloric diet for impaired glucose tolerance is built taking into account the individual characteristics of people: age, gender, intensity and frequency of physical activity, existing diseases, etc. Therefore, it is best to plan your diet under the supervision of a nutritionist or qualified nutritionist.

To make the task a little easier, we suggest that you familiarize yourself with calculations of the caloric content of the daily diet from leading nutritionists in Russia.

Proper nutrition for impaired glucose tolerance

Calculation of calories consumed per day

Basal metabolic rate

Depending on the level of physical activity, the result obtained is:

At minimum load it remains low, at medium load - x (multiply) by a factor of 1.3, at high load - x 1.5

multiply the calculated daily calorie content:

For 500 kcal if body mass index (BMI) is 27 - 35, for 600 - 1000 for BMI >35

For women, in the end, it should be at least 1200 kcal/day, for men - 1500 kcal/day.

Fats	In the diet, fat should account for no more than 30% of the daily requirement (saturated fat no more than 7 - 10%). Give preference to vegetable fats.
Squirrels	The main structural elements of tissues and cells of the whole body must be present in the diet in the amount of 15 - 20% of the daily norm. But only if the person does not have kidney problems. If the excretory function of the kidneys is impaired, it is recommended to adhere to
Carbohydrates	There should not be more than 50%. It may be worth replacing regular sugar with sweetener substitutes (,)

meals at least 3 times a day
the bulk of lipids consumed should come from vegetable and fish fats (lean fish, milk, fermented milk products, legumes, cottage cheese, some lean meat)
consume more complex carbohydrates, preferably (at least 40 grams per day) through raw vegetables, whole grain bread, bran, etc.
with arterial hypertension, the amount of sodium is reduced to 2.0 - 2.5 g/day (this is approximately 1 teaspoon)
drink 30 ml of water per 1 kg of body weight daily (if there are no contraindications)

Exercise

This type of training includes: tennis, walking, running, swimming, cycling, skating, skiing, basketball, dancing, fitness.

The intensity of the load must be controlled by a qualified specialist. In this case, the heart rate achieved during the exercises is calculated in relation to the maximum heart rate (MHR), recommended for a given age, using the following formula:

MHR = 220 – (age)

Depending on this, the physiologist selects a low (30 - 50% MHR), medium (50 - 70%) or intense (>70%) load. In addition, during classes, doctors often practice alternating the intensity of the load in order to achieve faster results with minimal fatigue to the patient.

The complex usually begins with a 10-15 minute run (walking on a treadmill). Then the load increases (the running pace accelerates) and continues for 40 - 60 minutes with periodic alternation (10 minutes of running, 5 minutes of walking). The most important thing is not to stop, but to continue doing the exercises.

However, this type of training is contraindicated in patients with arterial hypertension (AH).

Drug treatment

A doctor can include medications in treatment only when BMI is >30 kg/m2 and/or there are concomitant diseases.

Acarbose is a relatively safe treatment for carbohydrate metabolism disorders with IGT. It is an alpha-glucosidase inhibitor.

The drug is able to influence postprandial glucose levels (after meals), as a result, its concentration decreases, and also has a beneficial effect on the main cardiovascular risk factors - excess body weight, postprandial hyperglycemia and hypertension.

How does this substance work?

It prevents the rapid absorption of sugars through the gastrointestinal tract. There is a violation of the enzymatic breakdown of carbohydrates into simple sugars.

At the beginning of therapy, the dose of acarbose does not exceed 50 mg/day, which is divided into 3 doses before or during meals. If a person tolerates this treatment well, then the dose is increased to 100 mg/day.

If you prescribe a large dose to a patient at once, the medication may cause digestive problems (flatulence, diarrhea).

Prescribing the drug is dangerous for people with stomach diseases: ulcers, diverticula, fissures, stenoses, as well as for pregnant women and persons under 18 years of age.

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A serious condition for the body is a decrease in glucose tolerance. The danger of the pathology lies in the hidden nature of the manifestation.

Due to untimely treatment, you may miss the development of serious diseases, including. Only timely treatment gives a chance to get rid of possible problems.

Decreased glucose tolerance: what is it?

Under a normal daily routine, a person manages to eat several times a day, not counting snacks.

Depending on what food was consumed and how often, blood sugar levels are subject to change. This is quite normal.

But it will not be so critical and will not be the basis for diagnosing. Insulin is produced without obvious signs of endocrine system disruption.

In almost all cases, if you do not delay going to the doctor and start therapy on time, you can prevent it. It may take 5-10 years before the patient develops diabetes.

The patient will be admitted to the hospital if the test shows a positive result. Therefore, the importance of performing a glucose tolerance test is obvious.

Pregnancy and pseudodiabetes

In medical practice, there are statistics that show that in 90% of cases, changes in the body after the birth of a child provoke the development of type 2 diabetes.

Reasons for violation

The causes of violations are both lifestyle and lifestyle.

Factors contributing to the development of the disease are:

genetic factor (if any of your relatives has diabetes or prediabetes);
gout;
hypothyroidism;
low ;
insulin resistance, when the sensitivity of peripheral tissues to the effects of insulin decreases;
diseases of the endocrine system;
hormonal drugs;
age after 45 years.

the likelihood of such a violation arises:

with increased body weight;
hereditary predisposition;
reaching the age of 30;
diagnosis of prediabetes in previous pregnancies;

The blood glucose level of even healthy people increases with age by 1 mg/% every 10 years.

When performing a glucose tolerance test - by 5 mg/%. Thus, almost 10% have prediabetes. The main reason is considered to be changing chemical composition with age, physical activity, diet and changes in insulin action.

The aging process causes lean body mass to decrease and the amount of fat to increase. It turns out that the levels of glucose, insulin, glucagon and the percentage of fat directly depend on each other.

If a person is not obese in old age, then there is no relationship between hormones. In old age, the counteraction process is disrupted, this is due to a weakening of the glucagon reaction.

Symptoms

There are no signs of such a violation at the initial stage.

The patient is usually overweight or obese, and examination reveals:

absent;
normoglycemia on an empty stomach.

In a state of prediabetes, the following are observed:

periodontal disease and bleeding gums;
furunculosis;
, disorders of the menstrual cycle in women;
, dryness;
longer than usual;
angioneuropathy.

As the situation worsens, the following are additionally observed:

decreased immunity, which can often lead to fungal and inflammatory processes.

How is the analysis carried out?

In order to know whether there is a violation of glucose tolerance, blood sampling procedures are carried out.

A test may also be prescribed for verification; this is done in the following cases:

there are relatives who are sick, that is, if there is a hereditary factor;
presence during pregnancy.

The test requires some preparation on the part of the patient. necessary 10-12 hours before the test. When taking medications, you should consult with an endocrinologist about the possibility of their influence on the test result.

The ideal time for the test is considered to be from 7.30 a.m. to 10 a.m.

The test process is as follows:

the first time blood is taken on an empty stomach;
given to the patient for consumption;
blood is donated again after an hour;
After another hour, blood is drawn.

The test takes 2 hours to complete; eating is prohibited during this period; it is advisable to be in a calm state, sitting or lying down.

It is unacceptable to take other tests, as this can be a decisive factor in reducing blood sugar levels. To confirm the result obtained, the test is repeated after 2-3 days.

Analysis is not carried out if:

liver cirrhosis;
condition;
increase . Every day, 30-60 minutes should be allocated for this;
weight control.

If compliance with these rules does not produce results, a specialist will prescribe sugar-lowering medications.

Video on the topic

Is it possible to treat impaired glucose tolerance? Answer in video:

Most do not attach importance to the symptoms of the disease and do not realize that such a pathology can be life-threatening. To prevent the development of this terrible disease, it is important to be examined by a doctor annually.

Get up 7.00 - glass of water (after 30 minutes you can have breakfast)

1st breakfast(early, around 7.30 am) - 150 gr. cottage cheese, an omelet with vegetables or another breakfast without carbohydrates (for example, boiled eggs with fish or salad with breast, or green beans with an egg). It is better to do without carbohydrates for the first breakfast in the morning; for many, sugar increases with the first carbohydrates in the morning. For me, if I start the morning with oatmeal, then the sugars fly all day.

If your first breakfast is high in protein, by the way, you can lie down after it.

Between meals you can have tea, tea with milk, weak coffee with milk (coffee is best only once a day). It is also better to drink water between meals. In general, you need at least 1.5 liters of water per day.

2nd breakfast(carbohydrate, around 9.00 am). Any cereal on which sugar does not rise, but no more than 4 spoons: oatmeal with water or milk, buckwheat, multigrain porridge - about 4 spoons of ready-made porridge

After a carbohydrate breakfast, it is better to do something around the house for 15-20 minutes, do not sit or lie down.

Snack: around 11.30 am - fruit, preferably one type that does not raise sugar. I prefer one green apple and a few almonds or nuts (sometimes the combination with nuts gives a sugar spike - you need to check). You can have a glass of berries, 2 kiwis, 1/2 grapefruit

Lunch: at 13.30 First you need to eat a large salad, leafy, maybe with the addition of cucumbers and tomatoes + a spoonful of olive oil, and at about 13.45 start eating the main lunch: vegetable soup (without potatoes), 150 grams of vegetables on the grill or in the oven, 100 gr. boiled meat and 100 grams of ready-made buckwheat, or 100 grams of pearl barley, or 100 grams of hard-ground pasta (those carbohydrates that do not increase sugar)

After lunch, don’t sit, do something for 15-20 minutes.

Snack: about 16.30 Sandwich on bran bread (25-30 g piece) with 1 or 2 pieces of cheese or boiled meat, you can add a tomato, or cucumber and lettuce.

Dinner: At about 18.40 eat a large salad and at 19.00 dinner. For dinner, boiled meat or fish (can be in the oven) and about 4 spoons (100 g) of side dish + vegetables in the oven (except carrots and beets).

After dinner, walk for an hour

22.00 A glass of kefir(if your sugar levels are not high in the morning, you can have a piece of bread or a cracker) and go to bed

Important: Cottage cheese should never be combined with carbohydrates. Carrots are best eaten raw as a snack. Boiled carrots and beets are generally terrible - it’s better not to eat them.

If you eat by the hour and eat in portions as indicated, you will not be hungry. Even at first it will seem like a lot. But if you don't eat carbohydrates, ketones will appear.

In general, a pregnant woman needs to eat at least 13 XE throughout the day, but so that the sugars do not rise. Main meals should be no more than 3-4 XE and snacks no more than 1-2 XE.

For example:

A piece of bread 25 gr. - 1 XE

100 gr. boiled buckwheat - 2 XE (about 4 spoons with a small heap)

150-200 gr. vegetables in the oven - 1 HE

Liquid oatmeal milk porridge 100 g - 1.7 XE

Oatmeal porridge with water 100 g - 1.8 XE

Pearl barley porridge with water 100 g - 2.7 XE (my sugar does not rise sharply with it)

Boiled pasta 100 gr. - 2.4 XE (but it flies up on pasta)

Apple 100 gr - 1.3 XE

Well, the point is to manage to eat at least 13 XE a day, but so that your sugar levels don’t skyrocket. Usually after a week of dieting you begin to understand what's what.

There are tables and programs for smartphones to calculate XE.

I wish you never have to deal with this, but if you already have, then it’s difficult to control sugar with a diet, of course, I break down myself, then I’m ashamed in front of the child.

p.s. By the way, you can go on such a diet when you just need to lose weight during pregnancy, without harming the baby

Impaired glucose tolerance indicates risk of developing diabetes mellitus 2 type or so-called metabolic syndrome(a complex of dysfunctions of the cardiovascular system and metabolic processes).
The main complication of impaired carbohydrate metabolism and metabolic syndrome is the development of cardiovascular diseases (hypertension and myocardial infarction), leading to premature death, therefore a glucose tolerance test should become as mandatory a procedure for every person as measuring blood pressure.

Carrying out a glucose tolerance test allows us to identify people who may suffer from serious diseases in the future, give recommendations in advance to prevent them, and thereby preserve their health and extend their life years.

Usually diabetes mellitus type 2 goes through three main stages of development: prediabetes(valid risk groups), impaired glucose tolerance(latent diabetes mellitus) and obvious diabetes mellitus.
As a rule, initially in patients “classical” signs of the disease do not occur(thirst, weight loss, excess urine output).
The asymptomatic course of type 2 diabetes mellitus explains the fact that diabetes-specific complications, such as retinopathy (damage to the fundus vessels) and nephropathy (damage to the kidney vessels), are detected in 10-15% of patients already during the initial examination of the patient.

What diseases cause impaired glucose tolerance?

Impaired glucose tolerance is explained by a combined impairment of insulin secretion and decreased tissue sensitivity (increased resistance) to insulin. Fasting glucose levels in patients with impaired glucose tolerance may be normal or slightly elevated. In some people with impaired glucose tolerance, it can subsequently be restored to normal (in approximately 30% of cases), but this condition can persist, and in people with impaired glucose tolerance there is a high risk of increased carbohydrate metabolism disorders, the transition of these disorders to type diabetes 2.
Impaired glucose tolerance usually occurs against the background of interrelated risk factors for cardiovascular disease (high blood pressure, high cholesterol and triglycerides, high low-density lipoprotein cholesterol, low high-density lipoprotein cholesterol).
If impaired glucose tolerance is identified, certain measures may help. prevent increase in carbohydrate metabolism disorders: increased physical activity, weight loss (body weight), a healthy balanced diet.
The test is not advisable to perform if the fasting glucose level is reconfirmed above the diagnostic threshold for diabetes mellitus (7.0 mmol/l). Its use is contraindicated in persons whose fasting glucose concentration is more than 11.1 mmol/l. At the discretion of the physician, the test can be performed with a parallel determination of the level of C-peptide on an empty stomach and 2 hours after a glucose load to determine the secretory reserve of insulin.

In the group of people at risk of developing diabetes mellitus that require examination and a mandatory test for glucose tolerance include:

loved ones relatives of diabetics;
faces with overweight(BMI >27 kg/m2);
women who had miscarriages, premature birth, stillbirth or large fetus(over 4.5 kg);
mothers children with developmental defects;
women who had a gestational diabetes mellitus;
people suffering arterial hypertension(>140/90 mmHg);
persons with level cholesterol - high density lipoproteins> 0.91 mmol/l;
people who have triglyceride levels reaches 2.8 mmol/l;
faces with atherosclerosis, gout and hyperuricemia;
faces with episodic glucosuria and hyperglycemia, detected in stressful situations(surgeries, injuries, diseases);
people with chronic diseases of the liver, kidneys, cardiovascular system;
persons with manifestations metabolic syndrome(insulin resistance, hyperinsulinemia, dyslipidemia, arterial hypertension, hyperuricemia, increased platelet aggregation, androgenic obesity, polycystic ovary syndrome);
patients with chronic periodontal disease and furunculosis;
faces with neuropathies unknown etiology;
persons with spontaneous hypoglycemia;
sick, long-term patients receiving diabetogenic drugs(synthetic estrogens, diuretics, corticosteroids, etc.);
healthy people over 45 years of age(it is advisable for them to be examined at least once every two years).

for at least three days before the test, subjects must follow a normal diet (containing carbohydrates >
the study is carried out in the morning on an empty stomach after an overnight fast for 10-14 hours (during this time you should not smoke or drink alcohol);
During the test, the patient should lie or sit quietly, not smoke, not be overcooled, and not engage in physical work;
the test is not recommended to be carried out after and during stress, debilitating diseases, after operations and childbirth, during inflammatory processes, alcoholic cirrhosis of the liver, hepatitis, during menstruation, in gastrointestinal diseases with impaired glucose absorption;
before the test, it is necessary to exclude medical procedures and medications (adrenaline, glucocorticoids, contraceptives, caffeine, thiazidine diuretics, psychotropic drugs and antidepressants);
false positive results are observed with hypokalemia, liver dysfunction, and endocrinopathies.

After the first blood draw from a finger, the subject takes 75 g of glucose orally in 250 ml of water for 5 minutes. When conducting a test in obese individuals, glucose is added at the rate of 1 g per 1 kg of body weight, but not more than 100 g. To prevent nausea, it is advisable to add citric acid to the glucose solution. The classic glucose tolerance test involves examining blood samples on an empty stomach and 30, 60, 90 and 120 minutes after taking glucose.

Prediabetes: impaired glucose tolerance, symptoms.

What is prediabetes? This is an intermediate state between diabetes and the normal state of normal pancreas function. Those. when pancreatic cells still secrete insulin, but they secrete it either very little or incorrectly. As you know, this function of the pancreas works automatically for us, i.e. depending on the entry of glucose into the blood, the necessary amount of insulin is released automatically for its processing. When there is a malfunction or disease of the pancreas, a condition such as prediabetes or impaired carbohydrate tolerance occurs. At this step, I will tell you my feelings and symptoms of how to recognize prediabetes, and in the following articles I will describe in more detail how to eat with chronic pancreatitis and how to treat this condition. By the way, with the right approach, this condition can be cured and you can become a normal person, or it can be aggravated and you can become a diabetic. The result of how this disease will turn out for you depends only on your behavior.

Prediabetes symptoms. Personal experience.

Sleep disturbance. When glucose tolerance is impaired, hormonal levels change and the amount of insulin decreases. The body responds to these changes with insomnia. Everything is fine with you, but it’s not possible to fall asleep. Sleep does not come and you find yourself in a circle without sleep.
Itching in the anus. Due to the fact that glucose in the body is not processed at the right time, the blood becomes thick and gets stuck in small blood vessels. A large number of these vessels are located in the anus and intestines, as well as in the eyes. What causes itching? It feels very good in people predisposed to varicose veins.
Visual impairment. As in the previous paragraph, the violation is due to the fact that the blood supply to small vessels is disrupted, which leads to loss of vision. Flashing stars and other signs associated with visual impairment.
Thirst and frequent urination. Thirst occurs due to the fact that the body fights high blood sugar with the help of moisture contained in the body, i.e. All moisture is taken from the body to dilute the thick blood. This causes intense thirst, and subsequently strong urination. The process continues until the blood sugar level reaches 5.6-6 moles.
Headaches. Prediabetes is a disease that greatly affects blood vessels, so frequent headaches in the morning or evening are logical for impaired carbohydrate tolerance.
Fever at night. Personally, night was my least favorite time. Since during the day the violations are not yet noticeable. And at night, due to high blood sugar, I warmed up like a stove. It's winter outside, but your windows are open and you're hot.
Strong weight loss. Insulin is a hormone that opens the cell and lets glucose in. Thus, glucose is either converted into energy or stored in reserve by our body. The cells of our body feed on glucose. With prediabetes, there is little insulin and glucose does not work on time and hangs around in the blood unprocessed. In reality, we have high blood sugar. I lost 10 kg within 3 months.
Muscle cramps at night. Due to poor nutrition of muscle tissue, muscle cramps occur at night.
Elevated blood sugar 2 hours after eating.
Abnormal indicators in blood tests, especially in mineral composition.

I lived with this set of symptoms for six months in the fight against prediabetes. Well, after all, we don’t live in Africa and we can identify these symptoms during tests. I will tell you what you need to do and what tests you need to take to understand if you have prediabetes.

Blood test for fasting sugar: We measure fasting glucose levels.

The first thing to do is go to the doctor. Go straight to an endocrinologist; you can only waste time with a therapist. Although if he gives you a blood test for sugar, it will help you. Remember, we donate blood for sugar on an empty stomach in our clinic. The normal indicator is 5, if 6.7 and above, run to the doctor. But my reading was 5 moles. Because the clinic is not located near the house and while I was driving and sitting in line, the glucose had time to be absorbed. As a result, the therapist found nothing. I also didn’t eat after 19-00 because... I was hot to sleep and I artificially reduced my glucose levels. To determine the disease prediabetes, you need to undergo a glucose tolerance test. This method will provide an 80% answer if you have problems with glucose absorption. The test cannot be performed if you have pain in the pancreas. Because you will get carbohydrate shock and inflame the gland even more. The test is carried out on an empty stomach. You are given 75g of glucose to drink and then your blood sugar levels are measured. This results in a carbohydrate curve. If after 1 hour your blood sugar is more than 11, and after 2 hours it is more than 6, then you have prediabetes or worse, diabetes. What to do if your pancreas hurts and you can’t do a glucose tolerance test. You must donate blood for c-peptide and insulin. If one of the indicators, or more often two, is below normal, then you have impaired glucose tolerance or are developing prediabetes. I recommend reading my next post and finding out how diet helps with pancreatitis.

Examination of the pancreas. Analyzes

If you want to check your pancreas, I recommend taking the following tests. You can write them down on a piece of paper (names) and go to the doctor. You need to give the therapist a sheet, let him write out the necessary directions. Many doctors don’t really know this organ and give general tests that may not show anything at the initial stage, and the disease will already develop in your body.

Analyzes

They are prescribed for suspected pancreatic damage.

α-amylase
Pancreatic amylase
Lipase
Glucose
Insulin

The following profile will allow you to assess the degree of disturbances in carbohydrate and lipid metabolism, liver and kidney function, and conduct a differential diagnosis of diabetes mellitus types I and II. This is very important. Remember, you can waste time and let the cells die. This cannot be allowed or there is no turning back.

General urine test
Microalbumin in urine
Glucose
Glycated hemoglobin
Insulin
C-peptide
Cholesterol

Additionally:
Antibodies to pancreatic islet cells. I did not do this complex analysis.
Not every doctor can prescribe such a profile. If this is problematic, get tested for a fee.

Impaired glucose tolerance

The absorption of glucose into the blood stimulates the secretion of insulin by the pancreas, which leads to the absorption of glucose by tissues and a decrease in blood glucose levels within 2 hours after exercise. In healthy people, the glucose level 2 hours after a glucose load is less than 7.8 mmol/l, in people with diabetes it is more than 11.1 mmol/l. Intermediate values are referred to as impaired glucose tolerance or “prediabetes.”

Impaired glucose tolerance is also often caused by a complex of interrelated risk factors for cardiovascular disease (high blood pressure, high cholesterol and high low-density lipoprotein cholesterol, low high-density lipoprotein cholesterol), which are referred to as “metabolic syndrome” or “resistance syndrome.” to insulin" or "syndrome X". If impaired glucose tolerance is identified, certain measures can help prevent the worsening of carbohydrate metabolism disorders: increased physical activity, weight loss (body weight), and a healthy, balanced diet.

The test is not advisable to perform if the fasting glucose level is reconfirmed above the diagnostic threshold for diabetes mellitus (7.0 mmol/l). Its use is contraindicated in persons whose fasting glucose concentration is more than 11.1 mmol/l, as well as in those who have recently undergone surgery, myocardial infarction, or childbirth. At the discretion of the physician, if necessary, the test can be performed with a parallel determination of the level of C-peptide on an empty stomach and 2 hours after a glucose load to determine the secretory reserve of insulin.

The group of people at risk of developing diabetes mellitus who require examination and mandatory glucose tolerance testing includes:
- close relatives of people with diabetes;
— persons with excess body weight (BMI >27 kg/m2);
- women who have had miscarriages, premature births, stillbirths or large fetuses (over 4.5 kg);
— mothers of children with developmental defects;
- women who had gestational diabetes mellitus during pregnancy;
— people suffering from arterial hypertension (>140/90 mm Hg);
- persons with high-density lipoprotein cholesterol levels > 0.91 mmol/l;
- people whose triglyceride levels reach 2.8 mmol/l;
- persons with atherosclerosis, gout and hyperuricemia;
- persons with episodic glucosuria and hyperglycemia, detected in stressful situations (surgeries, injuries, illnesses);
— people with chronic diseases of the liver, kidneys, and cardiovascular system;
- individuals with manifestations of metabolic syndrome (insulin resistance, hyperinsulinemia, dyslipidemia, arterial hypertension, hyperuricemia, increased platelet aggregation, androgenic obesity, polycystic ovary syndrome);
— patients with chronic periodontal disease and furunculosis;
— persons with neuropathies of unknown etiology;
- persons with spontaneous hypoglycemia;
- patients receiving diabetogenic drugs for a long time (synthetic estrogens, diuretics, corticosteroids, etc.);
- healthy people over the age of 45 (it is advisable for them to be examined at least once every two years).

All people who are included in these risk groups need to have their glucose tolerance determined, even if their fasting blood glucose levels are within the normal range. To avoid errors, the study must be done twice. In doubtful cases, a glucose tolerance test with intravenous glucose is required.

Considering all of the above, it becomes obvious that the problem of glycemic control is relevant in the practice of an endocrinologist, cardiologist, neurologist, and general practitioner.

When performing a glucose tolerance test, the following conditions must be met:
— subjects must follow a normal diet (carbohydrate content > 125-150 g per day) and adhere to the usual physical activity for at least three days before the test;
- the study is carried out in the morning on an empty stomach after an overnight fast for 10-14 hours (during this time you cannot smoke or drink alcohol);
— during the test, the patient should lie or sit quietly, not smoke, not be overcooled, and not engage in physical work;
— the test is not recommended after and during stress, debilitating diseases, after operations and childbirth, during inflammatory processes, alcoholic cirrhosis of the liver, hepatitis, during menstruation, in gastrointestinal diseases with impaired glucose absorption;
- before the test, it is necessary to exclude medical procedures and medications (adrenaline, glucocorticoids, contraceptives, caffeine, thiazidine diuretics, psychotropic drugs and antidepressants);
— false positive results are observed with hypokalemia, liver dysfunction, endocrinopathies.

After the first drawing of blood from a finger, the examinee ingests 75 g of glucose in 250 ml of water for 5 minutes (children - 1.75 g per 1 kg of body weight). When conducting a test in obese individuals, glucose is added at the rate of 1 g per 1 kg of body weight, but not more than 100 g. To prevent nausea, it is advisable to add citric acid to the glucose solution. After taking glucose, capillary blood is collected after 1 and 2 hours, since these periods are most indicative of characterizing the functional state of the insular apparatus. The classic glucose tolerance test involves examining blood samples on an empty stomach and 30, 60, 90 and 120 minutes after taking glucose.