What Is Secondary Diabetes?

Secondary diabetes refers to a chronic hyperglycemic state due to a known primary disease, and diabetes is a complication of these primary diseases. Generally speaking, after the primary disease is cured, secondary diabetes can be cured.

Secondary diabetes

Definition of secondary diabetes

Secondary diabetes refers to a chronic hyperglycemic state due to a known primary disease, and diabetes is a complication of these primary diseases. Generally speaking, after the primary disease is cured, secondary diabetes can be cured.

Common secondary diabetes

Pancreatic disease and secondary diabetes

In addition to secreting pancreatic juice to participate in digesting proteins and fats, the pancreas is also an endocrine organ of insulin. Severe pathological changes in the pancreas can cause impaired insulin production and secretion, leading to diabetes.

Drugs and secondary diabetes

Certain drugs can cause impaired glucose tolerance and even diabetes. Common drugs include diuretics, glucocorticoids, oral contraceptives, and some antihypertensive drugs. However, the incidence of hyperglycemia caused by drugs is low. In addition to drug factors, the patient's own internal factors also play a role.

Endocrine disease and secondary diabetes

1: growth hormone tumor

This is a syndrome caused by excessive growth hormone secretion, which can be manifested as giant disease in children, and acromegaly in adults.

2: hypercortisolism

This is a syndrome caused by adrenal hyperplasia or excessive secretion of cortisol by the tumor, manifested as concentric obesity, hypertension, diabetes, etc.

3: aldosteronism

This is because the adrenal glands secrete too much aldosterone, which causes high blood pressure and hypokalemia. Hypokalemia can damage the secretory function of the islets, resulting in hyperglycemia.

4: Pheochromocytoma

This is due to the adrenal medulla or sympathetic pheochromocytoma-producing tumors that secrete too much epinephrine and norepinephrine, leading to hypertension and hyperglycemia.

In addition, hyperthyroidism can be accompanied by hyperglycemia.

Causes of secondary diabetes

Therefore, attention should be paid to the identification of diabetes to prevent secondary diabetes from being treated as primary diabetes by mistake, or vice versa. If a treatment error occurs, it will lead to adverse consequences. Therefore, it is very important to recognize these two types of diabetes and correctly identify and distinguish them. Here are some of the diseases and factors that can cause secondary diabetes and the points of identification, as follows. ^[1]

1.hyperthyroidism

Hyperthyroidism can accelerate the blood flow in the intestinal wall and increase the absorption of glucose in food. Therefore, postprandial blood glucose is significantly increased and diabetes occurs. The glucose tolerance test can be abnormal, but it is not diabetes. The identification with diabetes is as follows:

(1) Symptoms specific to hyperthyroidism, such as exophthalmia, sweating, irritability, low fever (up and down 37.5 degrees), tremor tremor;

(2) Hyper appetite, weight loss, and increased basal metabolic rate;

(3) shortness of breath, palpitations, sudden and slow heartbeat, too much weight without eating;

(4) Female menstrual disorders, less menstruation, and even amenorrhea.

2.Acromegaly

Due to pathological factors in the anterior pituitary gland, excessive growth of secreted growth stimulated the disorder of glucose metabolism. The main points of identification are:

(1) Acromegaly is characterized by being tall or having large tongues (unclear language), thick fingers, thickened palms, ugly faces, and severe vision loss

(2) Symptoms of diabetes (three more, one less, etc.) appear after symptoms of acromegaly;

(3) blood sugar and urine sugar are not easily controlled by insulin or oral hypoglycemic drugs;

(4) In some patients, the symptoms of diabetes may resolve or disappear on their own.

Pheochromocytoma

Identification of this disease and diabetes:

(1) This tumor can cause large fluctuations in blood pressure, so when paroxysmal hypertension is found clinically with diabetes, the possibility of pheochromocytoma should be considered and further corresponding examinations should be done;

(2) special phenotype, which can be high fever, shock, acute diarrhea;

(3) Increased catecholamines and catecholamine metabolites in blood and urine during the onset;

(4) Intravenous pyelography, renal B-ultrasound, and CT, the kidney may be found to be compressed, displaced, and massed by the tumor.

4.Adrenal corticosteroids

In the course of treating certain diseases with adrenocortical hormones, if it is used in large quantities for a long time, it can cause blood sugar to rise and urine sugar to be positive, just like diabetes. The point of differentiation from diabetes is that its blood sugar is elevated and urine glucose positive is reversible. Once the adrenal corticosteroid is stopped, blood glucose and urine glucose can return to normal.

5. Kexing's syndrome

This sign is also called cortisol, because adrenal corticosteroids can make gluconeogenesis strong, can inhibit the use of glucose and fight against insulin, so diabetes can occur when the disease persists. The disease has the following characteristics without diabetes, and the two can be distinguished: full moon face, neck fat uplift, centripetal obesity, increased body hair, purple skin atrophy, muscle atrophy, easy fractures, infection, acne, hyposexuality, mental Symptoms (such as insomnia, depression, irritability, fantasies, memory loss, etc.).

6, islet a cell tumor

Islet a cells produce glucagon, which can quickly mobilize the breakdown of liver glycogen and raise blood sugar, which is stronger than adrenal corticosteroids. When suffering from this tumor, a large amount of glucagon is secreted, so blood glucose may rise. The differential diagnosis of this tumor and diabetes is mainly:

(1) Sometimes the mass can be touched on the abdomen;

(2) Frequent epigastric pain;

(3) Increased glucagon can be detected in the serum;

(4) Tumor can be found by B-ultrasound, CT or MRI pancreas scan.

7.Pancreatitis

No matter it is acute or chronic pancreatitis, there may be diabetes and impaired glucose tolerance in the course of the disease, which is usually transient, but there are also very few patients who develop permanent diabetes. The point of identification is pancreatitis first, followed by diabetes, which diminishes or disappears with the improvement or cure of pancreatitis.

8.Pancreatic cancer

The symptoms of diabetes may be the manifestation of pancreatic cancer in the early stage or course of disease. According to research, pancreatic cancer and diabetes are causal to each other. Pancreatic cancer can induce diabetes, and diabetes can also be accompanied by pancreatic cancer. The identification method is such a disease, which can disappear after radical cancer treatment.

Hemochromatosis

This is a congenital metabolic disorder, often accompanied by an increase in blood sugar and a positive urine glucose. The main point of identification is that the disease may include liver enlargement, hair loss, testicular atrophy, skin pigmentation, sexual dysfunction, and cardiac insufficiency, which can be identified.

10, renal glucose threshold disorders

Due to the reduced ability of the renal tubules to reabsorb sugar, urine glucose tests can be positive although the blood glucose concentration is normal. This phenomenon is called "low renal glucose threshold": in contrast, due to the reduced filtration ability of the renal tubules, the blood glucose is not high. Increased, this phenomenon is called "renal glucose threshold", is a congenital physiological defect in renal function. Identification points, such as normal blood glucose, urine glucose positive, or urine glucose negative blood glucose is higher, we must consider that the renal glucose threshold is defective. In addition, this kind of "low and high renal glucose threshold" can also be seen in a small number of pregnant women. Postpartum follow-up must be performed for identification.

11.Hunger

When starvation occurs for a considerable period of time, a large number of foods with high sugar content are rushed in, and insulin secretion cannot be adapted for a while, which can lead to increased blood glucose and urine glucose, and reduced glucose tolerance test. The main points of identification are: if you eat normally after hunger, the symptoms similar to diabetes can disappear.

12, pregnancy

Women can sometimes induce diabetes after pregnancy. The mechanism may be due to the strong secretion of growth prolactin, estrogen, ACTH-like hormones in the placenta, resulting in relatively insufficient insulin secretion. The main point of identification is that the symptoms of secondary diabetes after childbirth usually recover on their own.

13, liver dysfunction

When suffering from severe liver disease, due to liver dysfunction, a large amount of glucose cannot be converted into liver glycogen after eating and stored in the liver, resulting in an increase in blood glucose and urine glucose positive, and a glucose tolerance curve similar to diabetes can appear. The authentication points are:

(1) There are often severe liver diseases;

(2) Blood sugar tends to decrease when fasting;

(3) Hypoglycemia may occur. The above phenomenon is different from diabetes.

14, nourishing urine sugar

Under normal circumstances, when the blood glucose increases, the liver quickly takes up glucose and converts it into glycogen storage. However, a small number of people eat a lot of carbohydrates, especially glucose. Due to excessive absorption, the blood glucose concentration temporarily exceeds the renal excretion threshold and urine sugar appears. It is called nourishing urine sugar. The point of identification is that there is a large history of eating; after normal diet, urine sugar disappears quickly.

15, chronic nephritis

Patients with chronic nephritis may sometimes have diabetes due to renal tubular reabsorption dysfunction, but normal blood sugar, which is the distinguishing feature of the disease.

16.Nervous system diseases

When suffering from cerebral hemorrhage, brain tumor, skull fracture, suffocation, anesthesia, etc., there may be temporary high blood sugar and urine glucose positive. After the condition improves or recovers, secondary diabetes can be reduced or disappeared.

17. Drug and chemical poisoning

Certain drugs and chemical agents, such as caffeine, theophylline, morphine drugs, carbon monoxide and various heavy metal poisoning, can occasionally cause secondary diabetes. The points of identification are: first, the above medication or poisoning history; second, secondary diabetes is transient and returns to normal quickly.

18.Infection

Infection can increase insulin requirements, especially for purulent infections. When suffering from infectious diseases, due to the relative lack of insulin secretion, secondary diabetes may occur. The point of identification is that when the infection is controlled or cured, diabetes can heal without cure.

19.Stress stimulation

When under stress, such as suffering from myocardial infarction, severe infectious diseases, craniocerebral diseases and trauma, burns, shock, major bleeding, etc., stress stimuli can be generated, and the nerve-pituitary-adrenal axis pathway can cause glucose metabolism disorders and liver Glycogen decomposition and heterogeneous acceleration. This can lead to elevated blood sugar and positive urine glucose. The point of identification is that secondary diabetes caused by stress stimuli has a short duration (usually no more than 3 months), the stress phenomenon disappears, and blood sugar can return to normal.

Characteristics of secondary diabetes

A characteristic of secondary diabetes is that there is a cause for investigation of hyperglycemia. After removing these causes, hyperglycemia can be corrected. For example, high blood pressure and diabetes caused by pheochromocytoma, blood pressure and blood sugar can return to normal after surgical removal of the tumor; hyperglycemia caused by drugs often disappears after drug withdrawal.