Glucose metabolism disorder

Introduction The disorder of glucose metabolism is ketotoxicity caused by diabetes and combined arteriosclerosis and microvascular changes, which are also related to the occurrence of mental disorders. Before the application of insulin and antibiotics, the main cause of death in diabetic patients is ketoacidosis and co-infection. Nowadays, chronic vascular disease has become the main cause of diabetic neuropsychiatric symptoms and death. Vascular lesions include large and medium blood vessels and microvessels, mainly due to the abnormal function of various systems and organs caused by arteriosclerosis, and the pathophysiological changes of various physical, neurological and psychiatric organs.

Cause

The nutritional value of sugar is mainly to supply energy, and sugar is also an important component of the human body. One of the central problems of glucose metabolism in normal humans is to maintain a relatively constant blood glucose concentration. Clinically important disorders of glucose metabolism are also caused by excessive blood glucose levels (hyperglycemia) and hypoglycemia (hypoglycemia), or certain structures or functions of hormones or enzymes caused by congenital factors or tissues or organs. The lesion.

an examination

Related inspection

Whole blood glucose Hb glucagon blood pyruvate

1. There is a basis for abnormal glucose metabolism (diabetes or hypoglycemia) in physical diseases.

2. The appearance of psychiatric symptoms is temporally related to the progression of abnormalities in somatic glucose metabolism (diabetes or hypoglycemia). Generally, physical illness is first, and psychiatric symptoms occur later. However, some physical illnesses are difficult to find in the early stage, which are relatively concealed or fail to attract attention, and cause the illusion that mental symptoms appear first.

3. Psychiatric symptoms often improve with the relief of abnormal glucose metabolism (diabetes or hypoglycemia), or worsen as it worsens.

4. Mental symptoms cannot be attributed to other mental illnesses.

5. Severity reached: 1 The actual test ability decreased; 2 Social function decreased.

Laboratory tests: Laboratory tests for abnormal glucose metabolism (diabetes or hypoglycemia).

Differential diagnosis

Differential diagnosis of disorders of glucose metabolism:

Diabetes: metabolic disorders such as absolute deficiency of insulin and/or elevated blood glucose caused by decreased biological effects of insulin, as well as chronic complications such as blood vessels and nerves.

Hypoglycemia: Many reasons can lower plasma glucose, lower than 3.4mmol / L (60mg / dL), such as insulin secretion from insulinoma, excessive use of oral hypoglycemic agents and insulin, pituitary-adrenal function Reduced, chronic hunger, excessive consumption of litchi, long-term heavy drinking, severe liver disease, and malignant tumors adjacent to the pancreas can be caused.

Fructose Metabolism Disorder: Fructose is an important source of sugar in the diet. The liver, kidney and small intestine are the main parts of fructose metabolism, and adipose tissue is also involved in its metabolism. Intravenous injection of large amounts of fructose is toxic and can cause hyperlactemia and changes in the ultrastructure of liver and intestinal cells. The main types of fructose metabolism disorders are the following types, all of which are autosomal recessive.

Glycogen storage disease: The lack of certain enzymes in the process of glycogen decomposition causes the glycogen to accumulate in organs such as liver, muscle and kidney, causing hypertrophy and dysfunction of these organs, causing related diseases.

Galactose metabolism disorders: generally seen in newborn children. Two autosomal recessive diseases are currently known, caused by a deficiency in 1-phosphogalururosyltransferase and galactose kinase, respectively. These two enzymes are required for the conversion of 1-galactose to glucose 1-phosphate. If these two enzymes are deficient, the ingested galactose accumulates in the blood circulation, producing galactosemia. In the absence of 1-galactosylgalactosyltransferase, excessive galactose enters tissues such as liver, brain, kidney, heart and lens, causing symptoms of poisoning: nausea, vomiting, diarrhea, malnutrition, growth retardation, liver disease, cataract Mental retardation; blood glucose in children is reduced, often showing symptoms of hypoglycemia, such as palpitation, sweating, increased heart rate, and mental disorders. When galactose kinase is deficient, it mainly manifests as cataract. Galactose is found in blood and urine to aid diagnosis; if the lack of the above enzymes in peripheral blood cells can be confirmed, it can be diagnosed. Patients with this disease should eat galactose-free foods, otherwise it can lead to progressive liver failure and death.

Pyruvate metabolism disorder: Pyruvate metabolism is an important part of glucose metabolism. Pyruvate dehydrogenase catalyzes the oxidation of pyruvate to carbon dioxide and acetyl-CoA. Pyruvate carboxylase promotes the formation of oxaloacetate with carbonic acid and pyruvate. Any of these two enzymes are congenitally deficient and can cause pyruvate. Metabolic obstruction, accumulation of pyruvic acid and its derivatives (lactic acid, etc.) in the blood, causing neurological diseases such as ataxia, naive movement, mental retardation, dementia, and lactic acidosis. Infection can also reduce the activity of these two enzymes. Pyruvate metabolism disorders can be secondary to vitamin B deficiency, shock and so on.

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