Zhang Dage, who is in his forties, often feels that he does not have enough to eat recently, so he eats more than others every day. Even so, his weight has obviously dropped by nearly 10 kg. People around him said that he may have diabetes. They went to the community hospital for a check. Fasting blood sugar was 7.5 mmol/L (normal reference range: 3.33 ~ 6.11 mmol/L). Blood sugar did rise, so they began to treat diabetes.
However, half a month has passed, and his condition has not improved, but has worsened. The whole person is not energetic and his weight has lost a few pounds. Accompanied by his family, he is going to go to the endocrinology department of the big hospital to have a look.
He came to the endocrine clinic. The doctor found that in addition to eating too much, easily hungry, weak and weight loss symptoms after careful inquiry, Zhang Dage was also afraid of heat, sleep was not good, and the neck was swollen. Under the doctor’s advice, he did thyroid function tests, and the results came out after hyperthyroidism.
Now he and his family are wondering, is it not diabetes but hyperthyroidism?
Is it diabetes or hyperthyroidism?
According to the blood sugar test results and thyroid function test results of Zhang Dage, Zhang Dage does have diabetes and hyperthyroidism, and the two diseases coexist.
These two diseases can occur at the same time, or hyperthyroidism or diabetes can occur first. Diabetes and hyperthyroidism coexist in two forms: hyperthyroidism secondary diabetes, hyperthyroidism combined with type 1 diabetes or hyperthyroidism combined with type 2 diabetes.
Among them, hyperthyroidism secondary diabetes is more common.
Diabetes caused by hyperthyroidism
Thyroid hormone is a hormone that raises blood sugar.
This hormone can promote the absorption of glucose and lactose in the small intestine. Promote the conversion of fat, protein and other substances into glucose and increase the source of glucose; Glycogen stored in the liver can also be used to further raise blood sugar.
In addition to increasing the source of glucose, thyroid hormone can also hinder the process of reducing glucose in the body, such as reducing the oxidation and utilization of glucose by the body, so that insulin, which reduces blood sugar in the body, cannot play a good role.
In the final analysis, thyroid hormones cause blood sugar to rise through various ways.
In normal people, it interacts with other hormones that raise or lower blood sugar to stabilize the blood sugar in the body within the normal range. However, in patients with hyperthyroidism, the secretion of thyroid hormones in the body increases, breaking the original balance and showing an increase in blood sugar.
Not only that, the metabolism of hyperthyroidism patients is also very vigorous, which accelerates the degradation of insulin, that is, insulin is laid off shortly after it starts to work, which leads to relatively insufficient insulin in the body.
On the one hand, the hormone that raises blood sugar increases, and on the other hand, the hormone that lowers blood sugar decreases, thus causing the blood sugar to rise further.
This increase in blood sugar is caused by hyperthyroidism and belongs to secondary diabetes. Of course, sometimes blood sugar rises, but it does not reach the level of diabetes, which belongs to the early stage of diabetes, that is, impaired glucose tolerance.
Diabetes caused by hyperthyroidism often improves with the improvement of hyperthyroidism. After hyperthyroidism is cured, most blood sugar will be normal and long-term use of drugs is not required.
Hyperthyroidism complicated with diabetes
Hyperthyroidism complicated with diabetes may be type 1 diabetes or type 2 diabetes. After the disease condition of hyperthyroidism is controlled, diabetes still exists. Without hypoglycemic drugs, blood sugar cannot drop to normal.
- Hyperthyroidism combined with type 1 diabetes is more common in young people, and is most common in autoimmune thyroid diseases, such as Graves disease and Hashimoto thyroiditis. Hyperthyroidism combined with type 2 diabetes, such patients are often older, diabetes mostly exists before suffering from hyperthyroidism, or hyperthyroidism only appears after many years.
Some clinical symptoms of hyperthyroidism and diabetes are similar, such as eating too much, easily feeling hungry, weak, weight loss, etc., but they also have their own characteristic manifestations. Generally, clues can be found through careful inquiry and identification.
1. Typical manifestations of hyperthyroidism
The typical manifestations of hyperthyroidism patients are hypermetabolic syndrome, i.e. Palpitation, fear of heat, hyperhidrosis, emotional excitement, anxiety and insomnia, etc. Tremor often occurs in hands and eyelids, neck swelling or thickening, exophthalmos and edema in front of lower legs may also occur.
2. Typical manifestations of diabetes
Diabetes patients often feel dry mouth, which is typically characterized by [more than three and less than one] symptoms, i.e. Drinking too much, eating too much, urinating too much, and losing weight. When these typical manifestations occur, diagnosis is easier.
However, when hyperthyroidism and diabetes occur at the same time, the clinical manifestations of most patients are atypical, and the manifestations of one disease are the main ones, which easily leads to missed diagnosis of the other disease.
For hyperthyroidism patients, after regular treatment, symptoms such as hunger, overeating, emaciation and fatigue do not improve. When the disease worsens, blood sugar should be checked in time, and glucose tolerance test should be conducted when necessary to assist in diagnosis of diabetes.
This is the case with Zhang Dage mentioned at the beginning of the article.
Although he mainly felt that he ate too much and was prone to hunger and weight loss, in fact he had been afraid of heat and insomnia after careful questioning. However, the possibility of hyperthyroidism at that time was ignored because the examination found high blood sugar in the community.