Sugar (glucose) in the urine in diabetes

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Why does sugar appear in the urine of diabetes and how is it dangerous?

Glucose in the urine with diabetes mellitus is always detected, since diabetics have an excess of the renal threshold, as a result of which sugar is excreted through urine. This process is called glycosuria. If insulin secretion does not exceed 5.5 mmol / l, then the sugar through the urine is excreted in minimal quantities. This happens usually in healthy people.

In diabetes, a problem arises due to a violation of sugar metabolism. This is due to the lack of production of the hormone insulin by the body. For this reason, excess glucose is excreted through the kidneys through urine. Therefore, elevated sugar in urine is always celebrated.

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If glucose in the urine is found in an amount of a maximum of 1 mmol, then this indicates a complete absence of diabetes. If the values ​​range from 1 to 3 mmol, there is a pathological change in sugar tolerance. If more than 3 mmol, then this indicates the presence of diabetes. In principle, this is the normal amount of sugar in the diabetic urine. If the indicator exceeds 10 mmol / l, then this is already a dangerous condition for a patient with diabetes.

The presence of glycosuria in diabetes contributes to such complications:

  • dependence on insulin, that is, the 2nd type of the disease goes into the 1st,
  • disturbance in contractility of the heart muscle, arrhythmia,
  • diabetic coma and nephropathy,
  • dullness, fainting,
  • kidney and heart failure
  • pathological abnormalities in the brain,
  • ketoacidosis and polyuria.

Urine appears in the filtration process of the blood fluid in the kidneys. Therefore, the composition of urine depends on the functional abilities of the tubules of the kidneys and the amount of sugar in the blood. If the glucose is too much, then the circulatory system is trying to push it out of the vessels. Therefore, sugar is released into the urine during its formation. In addition to diabetes, in which glucose is not processed by insulin, because it is not enough, there are other reasons for the increase in sugar in the urine:

  • drug therapy, which use drugs that suppress the renal system,
  • genetic predisposition
  • hormonal disbalance,
  • pregnancy,
  • malnutrition and, in particular, caffeine abuse,
  • intoxication of the body through chemicals and psychotropic drugs,
  • severe stress causes the release of glucose into the urine,
  • some mental pathologies in acute form,
  • extensive burns
  • renal failure.

With the development of type 2 diabetes mellitus, an excess of glucose in the urine can be provoked by an excess of insulin, an overuse of carbohydrate foods, and a failure of hormonal levels.

For glycosuria (also known as glucosuria), a sharp excess of glucose level in human urine is characteristic. This is especially dangerous with diabetes mellitus of both the 1st and 2nd type. The main reason for the development of this pathology in diabetics is an excess of glucose in the blood liquid and the inability of sugar to reach the cells.

Glycosuria is easily detected when analyzing urine for sugar.

From this video you can find out in more detail what glucosuria is and what causes its development.

The clinical picture with an increased level of sugar in the urine is characterized by the following features:

  • constant thirst that cannot be quenched,
  • frequent urination,
  • dryness of the oral mucous membranes,
  • weakness of the body and fatigue,
  • muscle pain syndromes
  • increased hunger,
  • diarrhea,
  • dizziness
  • excessive sweating,
  • cognitive impairment.

During glycosuria, nutrients are actively washed out with urine, which is why the whole body suffers. In this case, the patient begins to overeat, but still loses pounds, that is, losing weight.

Therapy is prescribed on the basis of the survey and the cause of glycosuria:

Recipes of traditional medicine will help to get rid of glycosuria. They significantly reduce the level of sugar in urine, act gently and are completely safe for the body.

The best recipeswhich are used in complex treatment:

  1. This recipe involves the use of dry or fresh leaves of such plants - nettle, blueberry. You will also need a dandelion root. Combine the crushed ingredients in an equal ratio, measure 2 tablespoons and pour boiling water in a volume of 400 ml. It is advisable to insist to use a thermos. Insist 20-30 minutes. Then the broth is filtered and consumed 3 times a day, 70-80 ml.
  2. Buy unrefined oat grains in the amount of one cup. Connect with 1 liter of water and put on fire. Boil 60 minutes after boiling. Strain after cooling the broth and consume inside 100 ml before each meal.
  3. Brew blueberry leaves in water. For 1 cup of boiling water you will need one and a half tablespoons of leaves. Drink half a glass (100 ml) three times a day before consuming food.
  4. Eat cinnamon. It can be added to tea drinks, kefir, yogurt, and so on. On the day it is allowed to eat up to half a teaspoon of cinnamon. More information about the therapeutic properties of cinnamon for a diabetic can be found here.

If you are serious about treating and controlling the level of glucose in the blood fluid and urine, you can quickly get rid of glycosuria. Be sure to consult your doctor, and then your health will not be threatened with complications.

Glucose in the urine with diabetes mellitus: causes of elevated levels

An indicator of normal secretion of insulin is to maintain the level of glucose in the blood not higher than 5.5 mmol / l when measured on an empty stomach. This concentration is an obstacle to the excretion of glucose by the kidneys, so healthy people in the urine may have minimal (trace) amounts of sugar, which are not detected during a normal urine test.

In diabetics, when the renal threshold is exceeded, glucose begins to be released from the body along with a significant amount of fluid. Such a sign of diabetes is called glucosuria.

The appearance of glucose in the urine in diabetes indicates insufficient compensation of the disease, if all the rules of the study are observed.

Urine in the body is formed by filtration of the blood by the kidneys. Its composition depends on the state of metabolic processes, the work of the renal tubules and glomeruli, from the drinking and food regime.

Initially, the primary urine is formed, in which there are no blood cells and large protein molecules. Then toxic substances must be removed completely with secondary urine, and the amino acids necessary for metabolic processes, glucose, and trace elements are returned back to the blood.

For glucose there is a critical level of its content in the blood, at which it does not enter the urine. It is called the renal threshold. For an adult healthy person - this is 9-10 mmol / l, while with age the renal threshold may be lower. In children under 12 years old, this level is 10-12 mmol / l.

Not only the glucose content in the blood, but also the condition of the kidney filtering system affects the reabsorption violation, therefore, in diseases, especially in chronic nephropathy, glucose may appear in the urine with normal blood glucose.

Normally, glucose can appear in the urine with a significant intake of simple carbohydrates from food, large amounts of caffeine, and also under intense stress, after physical overstrain. Such episodes are usually short-lived and with repeated research, urine analysis shows the absence of sugar.

Catching corticosteroids, thiazide diuretic drugs, anabolic steroids, and estrogens can also cause temporary glucosuria. After discontinuation of such drugs, the sugar in the urine returns to normal.

The appearance of glucose in the urine is noted in pregnant women in the third trimester. These women need additional laboratory tests to rule out gestational diabetes. In his absence, after birth, glucosuria disappears without a trace.

The cause of carbohydrate metabolism disorders in pregnant women is the release of hormones by the placenta, which act opposite to insulin. At the same time, insulin resistance develops, and its secretion increases compensatory. Symptoms that are associated with elevated blood sugar and glucosuria include:

  • Increased appetite and thirst.
  • Vaginal infections.
  • High blood pressure.
  • Frequent urination.

They may be manifestations of gestational diabetes.

The risk group includes women who have had a miscarriage, a large fetus from a previous birth, a genetic predisposition to diabetes, and overweight.

Renal diabetes is a pathology of the reabsorption of glucose in the tubules of the kidneys, which is a consequence of diseases of the renal system. In renal-induced glucosuria, sugar in the urine may be at a normal level of glycemia.

When this renal threshold of glucose is reduced, it can be present in the urine even with hypoglycemia. Such glycosuria is most often observed in children with congenital genetic abnormalities and is called primary renal glucosuria.

It includes: Fanconi syndrome, in which the structure of the tubules of the kidneys and tubulo-interstitial diseases of the kidneys, in which the kidney tissue is destroyed, are disrupted. Such diseases lead to the appearance of protein in the urine and high pH of the urine.

Secondary glucosuria appears in such pathological conditions:

  • Nephrosis.
  • Chronic glomerulonephritis.
  • Nephrotic syndrome.
  • Renal failure.
  • Glomerulosclerosis in diabetes mellitus.

In cases of kidney diseases, urine has a low specific gravity; erythrocytes, leukocytes, and protein are determined.

With the exception of renal pathology, diseases of the pituitary and thyroid glands, adrenal glands, it can be assumed that the appearance of glucose in the urine reflects its steady increase in the blood during diabetes.

In the tubules of the kidney, glucose absorption occurs with the participation of the enzyme hexokinase, which is activated with the participation of insulin, therefore, with an absolute deficiency of insulin, the renal threshold decreases, therefore, in patients with type 1 diabetes, the level of glucosuria does not reflect the degree of increase in blood sugar.

With the development of diabetes mellitus complications in the form of diabetic nephropathy, normal kidney tissue is replaced by connective tissue; therefore, even with high blood sugar, it is not detected in the urine.

In typical cases of diabetes mellitus by the presence of glucose in the patient's urine, one can judge the success of compensation for diabetes, its appearance is an indication for revising the dose of glucose-lowering tablets or insulin upwards.

In diabetes mellitus, glucose, due to its ability to attract fluid from tissues, causes the following symptoms of dehydration:

  • Increased need for water, hard to quench thirst.
  • Dry mouth for diabetes.
  • Heightened urination.
  • Dry skin and mucous membranes.
  • Increased weakness

The loss of glucose in the urine when it is impossible for it to be absorbed by the tissues leads to the fact that carbohydrates cannot serve as a source of energy, as in a healthy organism. Therefore, patients, despite increased appetite, have a tendency to loss of body weight.

In the body with a lack of glucose, ketone bodies that are toxic to the brain begin to form in the cells.

In addition to diabetes, skull and brain injuries, acute encephalitis, meningitis, hemorrhagic stroke, and prolonged anesthesia can cause the appearance of glucose in the excreted urine. In these conditions, there is an increase in blood glucose due to increased glycogen breakdown in the liver.

Temporary hyperglycemia and glycosuria accompany acute pancreatitis, while its appearance reflects the extent of the inflammatory process and its prevalence. As a rule, with successful treatment of the underlying disease, glucose disappears in the urine.

Glycosuria can be in diseases that are accompanied by high body temperature, viral and bacterial inflammatory diseases, as well as poisoning with strychnine, morphine, carbon monoxide.

If urine glucose is completely absent, then this may be a sign of bacterial infection of the urinary tract, but such a sign does not have an independent diagnostic value.

A urinalysis test for sugar can be prescribed in the diagnosis of diabetes mellitus and in evaluating the effectiveness of its treatment, as well as determining the function of the kidneys or in diseases of the endocrine system and pancreas.

2 days before the analysis, it is not recommended to use diuretics, and for a day alcohol, emotional and physical loads, as well as food saturated with carbohydrates is excluded. The result of the study may be affected by drugs, so their reception should be coordinated with your doctor.

For the diagnosis of diabetes mellitus, the determination of glucosuria is an auxiliary method and is evaluated in conjunction with the patient's complaints and blood glucose testing, glucose tolerance test and other biochemical studies.

At home, you can use test strips for testing for glucosuria. This rapid method allows for 3-5 minutes to assess the presence of sugar in the urine, which may be an indirect sign of an increase in blood sugar.

The video in this article will tell you about the phenomenon that is common among diabetics - the presence of glucose in the urine.

Glucose is a vital substance that the human body needs for energy. This component enters the bloodstream after the breakdown of carbohydrates that come with food. In healthy people, a sufficient amount of insulin is produced, which ensures the absorption of sugar by the cells, the rest of the glucose is retained by the renal tubules. Therefore, normal sugar in the urine (glycosuria) is not detected, its appearance and elevated levels in adults and children can be caused by several reasons.

During normal kidney function, glucose is completely absorbed in the proximal renal tubules and from there enters the bloodstream, that is, it should not be in the urine. With an increase in blood sugar concentration (above 9.9 mmol / l), the kidneys do not cope with their work, and part of the glucose enters the urine.

Why does urine sugar appear when tested, what does it mean? Another cause of glucosuria may be a decrease in the renal threshold, which is observed with age or in chronic kidney disease.

The factors causing the appearance of pathological glucose in the urine, which exceeds the level of the norm in men and women:

  • The most common cause is diabetes mellitus type 1 or 2. With the development of this disease, hyperglycemia is present in the blood.
  • Kidney diseases: pyelonephritis, nephrosis, renal failure, glomerulonephritis.
  • Pathology of the liver: Girke disease, hepatitis, cirrhosis.
  • Brain ailments: meningitis, encephalitis, cancer, traumatic brain injury.
  • Endocrine diseases: hypothyroidism, hormonal imbalance, thyrotoxicosis.
  • Hemorrhagic stroke.
  • Acute pancreatitis.
  • Chemical poisoning with phosphorus, morphine derivatives, chloroform, strychnine.

Physiological urine glucose has an increased concentration in stressful situations, active physical exertion and overwork. Treatment with some anti-inflammatory drugs has a side effect - glucosuria. High levels of blood glucose and urine can be observed if you eat lots of sweets just before taking the test.

What is the rate of sugar in the urine in adult women and men, which means if the glucose level is elevated? The permissible daily urine test is 2.8 mmol / l, in the morning portion the glycemia should not exceed 1.7 mmol / l.

Urine analysis is of several types:

  • daily diuresis,
  • morning portion
  • Nechiporenko analysis.

The renal threshold for each person is individual, with age it rises. Therefore, the level of 10 mmol / l per day is allowed for the elderly. For children and pregnant women, glycosuria should not exceed 7 mmol / l.

When taking a general clinical analysis of sugar in the composition of the urine should not be allowed single traces of glucose, not exceeding the threshold of 0.083 mmol / l in adults.

How can urine sugar be reduced before testing? A false-negative response is obtained if the patient ate ascorbic acid (vitamin C) before conducting a laboratory study.

How can home detect sugar in the urine of a child and an adult, what are the main symptoms of the pathology?

  • constant thirst, drying of mucous membranes in the mouth,
  • frequent urination,
  • general weakness, fatigue,
  • heavy sweating
  • high blood pressure
  • constant hunger or, conversely, lack of appetite.

If sugar is found in the composition of urine in women, what does this mean and how is pathology manifested? In addition to the above symptoms, women may experience itching and burning of the external genital organs, develop fungal diseases, accompanied by abundant vaginal discharge.

High sugar in the composition of urine in men, what does it mean, what are the symptoms of elevated glucose? In men, this pathology can be observed with inflammation of the prostate gland. The disease is most often diagnosed in men over 45 years of age, but in recent years the disease has become younger and occurs even in thirty-year-olds.

  • Symptomatic develops after eating carbohydrates at home before testing, amid stress, physical exertion.
  • The causes of pancreatic glucosuria include insufficiency of the insular apparatus (pancreatitis, type 1 and 2 diabetes).
  • Renal is associated with impaired renal function, reduced glomerular glucose clearance.
  • Hepatic is characterized by a malfunction of the liver.

Treatment of glycosuria is prescribed based on its type and on the basis of additional examinations. The most common diabetic form of pathology. At the same time, patients with diabetes mellitus have frequent urination, the volume of excreted fluid is significantly increased. Urine turbid, thick, can have an unpleasant smell.

What does the appearance of sugar in the composition of urine in a pregnant woman? If this pathology was identified once, then a glucose jump is not dangerous. This may be due to the nutrition of the expectant mother (carbohydrate consumption before analysis), toxicosis, or an unstable psycho-emotional state.

When pathology is diagnosed repeatedly, additional examinations should be performed. This symptom may indicate the development of gestational diabetes or renal impairment. If, according to the results of the analysis, except for glucose, urine contains protein, this indicates a clear inflammation of the kidneys, cystitis, or an acute infectious disease. Consultation of a nephrologist, an endocrinologist is necessary for correct diagnosis and treatment.

Why does high sugar in the urine of a child appear, what does it mean, what causes high glucose levels? In children, pathology is detected against the background of metabolic processes, autoimmune diseases, malnutrition, long-term treatment with certain drugs. The norm values ​​in decoding analyzes are identical to those in adults.

Babies conduct additional blood tests for fasting glucose, daily urine. If necessary, do the glucose tolerance test.

How to cure a child and remove sugar from the urine, what consequences can such violations have in childhood? To cure the symptoms of glyucusia, it is necessary to eliminate the cause of its occurrence. If it is caused by a violation of carbohydrate metabolism, diabetes mellitus, then the treatment is prescribed by the endocrinologist, taking into account the type of pathology. When treating an insulin-dependent form, children are given injections of a hormone injection, and a low-carb diet is prescribed. Patients of the second type have enough diet therapy and physical exertion, in some cases it is necessary to compensate for the ailment with hypoglycemic drugs.

Why does sugar increase in the composition of urine in type 2 diabetes mellitus, is urine glucose dangerous? A large concentration of sugar in the excreted fluid occurs if the blood level is also elevated. If the patient manages to achieve compensation for the disease, then the glucosuria decreases accordingly.

How can you reduce urine sugar in diabetes, what treatment is needed? Therapy is prescribed by an endocrinologist. To normalize blood glucose, a low-carb diet, exercise, and sugar-reducing medications are prescribed. Type 1 diabetics are given insulin injections. At observance of recommendations of the doctor glucose level is gradually stabilized.

In the urine high sugar, what to do, how can it be reduced? Glycosuria, first of all, indicates a violation of the metabolic processes of the body. Therefore, the patient must have a balanced diet, establish a daily regimen, and limit the consumption of food rich in easily digestible carbohydrates. Exercise has great efficiency. They help the body absorb glucose better.

If you are overweight, low-calorie foods should be preferred. Losing weight reduces the risk of developing diabetes and its complications. The patient is advised to stop smoking and alcohol, since bad habits aggravate the course of many diseases.

Urinalysis is an important laboratory test, which allows you to identify the causes of the disruption of many organs and systems. Glycosuria warns of carbohydrate metabolism failures, diseases of the kidneys, liver, brain. Timely diagnosis and treatment of pathological processes will avoid serious complications.

Sugar in the urine in diabetes. Urinalysis for sugar (glucose)

A urine test for sugar (glucose) is simpler and cheaper than a blood test. But it is almost useless to control diabetes. Nowadays, all diabetics are advised to use the meter several times a day, and do not worry about sugar in the urine. Consider the reasons for this.

Urine glucose testing is useless for diabetes control. Measure your blood sugar with a glucometer, and more often!

The most important thing. Sugar in the urine appears only when the concentration of glucose in the blood is no longer just increased, but very significant. In this case, the body tries to remove excess glucose from the urine. The diabetic feels intense thirst and frequent urination, including at night.

Glucose in the urine appears when its concentration in the blood exceeds the “renal threshold”. This threshold averages 10 mmol / l. But diabetes is well compensated, if the average level of sugar in the blood does not exceed 7.8-8.6 mmol / l, which corresponds to a glycated hemoglobin figure of 6.5-7%.

Worse, for some people, the renal threshold is elevated. And he often rises with age. In individual patients, it can be up to 12 mmol / l. Therefore, urinalysis for sugar can not really help anyone from diabetics to select an adequate dose of insulin.

Analysis of sugar in the urine: norms, causes of increase and methods of stabilizing indicators

When a patient is tested, he sometimes finds heightened sugar in the urine.

This may be a symptom of the development of diabetes mellitus or another equally serious disease.

Therefore, in such cases a detailed examination is required.

If, due to the high content of sugar in the urine, the ability of the kidneys to filter decreases, then glucosuria occurs in humans.

There are several forms of glycosuria:

  • alimentary. With this variety, the sugar concentration rises briefly. As a rule, it is provoked by eating foods high in carbohydrates,
  • pathological. An increase in the amount of sugar in the urine may occur if too much of it is synthesized in the blood,
  • emotional. It develops due to an increase in glucose levels as a result of the stress experienced or chronic depression. Such a disease often occurs in pregnant women.

Many factors can affect the development of glycosuria. This is acute pancreatitis, and poisoning with certain substances, and various diseases of the kidneys.ads-mob-1

Is there sugar in the urine with type 1 and type 2 diabetes?

An increase in the level of glucose in urine in type 2 diabetes is usually observed if the disease progresses.

At the same time, increased sugar in the blood and urine appears in proportion. If the protein level also rises, this may be evidence of kidney damage.

But practice shows that most often the indicators increase in patients with type 1 diabetes who are insulin-dependent. Ad-mob-2

Decoding the analysis: the norm by age and the reasons for the increase

If the figures are greater, the patient is usually sent for examination.

In men, this rate is slightly higher - 3.0 mmol. In older people, it can also be enhanced. When the analysis is done to a child, a measure of 2.8 mmol is considered acceptable, as in adults.

The reasons for its excess in babies are usually different. This is the abuse of fast food, sweets and other junk food that children love so much. In the most severe cases, an increase in urine glucose can cause encephalitis or meningitis.

Increasing the concentration of sugar in the blood and urine is characterized by the following symptoms:

In addition, significant pressure drops can occur during the day.

Glycosuria and hyperglycemia are not always observed simultaneously.

When diabetes in a person is in the initial stage, hyperglycemia may not be accompanied by an increase in urine sugar levels.

However, glycosuria and abnormal carbohydrate metabolism are usually interrelated.

Glycosuria in women who are in a position often speaks of their unstable emotional state or severe toxicosis.

Sometimes this can be the result of malnutrition, if the expectant mother consumes a lot of carbohydrate-containing foods.

When the fluctuations of sugar occur constantly, it is necessary to undergo an additional examination.

If such an increase is a single case, there is no particular cause for concern.

When this happens constantly, and the sugar level exceeds the normal level of more than 12 mmol per liter, this indicates the presence of diabetes.

With a constant high concentration of sugar in the urine can develop heart disease, the condition of the vessels is worsening. The liver is seriously suffering, the work of the urinogenital system is deteriorating. In addition, it will adversely affect the condition of the skin.

It is especially important to control the protein and glucose levels during pregnancy, since abnormalities cause pathologies in the baby. Ad-mob-1

A healthy lifestyle, a suitable diet, and the use of medications help to reduce sugar levels.

When glycosuria is useful to drink green tea with lemon

Patients have to avoid products containing glucose, including fresh fruit. Drinking alcohol is strictly not recommended, but green tea with a slice of lemon that dilutes the blood is what you need.

The appearance of sugar in the urine of diabetics suggests a lack of compensation for the disease.

The concentration of glucose in the blood at the same time should not be just elevated, but significant. If the urine sugar is detected, the doctor prescribes a study.

It will help identify the cause of the problem and prescribe a course of therapy. Diabetes treatment is also likely to have to be adjusted. .Ads-mob-2

To remove the symptoms of the disease and remove extra sugar will help folk remedies. The simplest, but quite effective - decoction or infusion of blueberry leaves. It is enough to take three large spoons of raw materials, pour boiling water and keep them in a thermos for 4-5 hours. Strained infusion drink 0.5 glass about half an hour before meals.

There are a few popular recipes that will help remove sugar from urine:

  • take in equal parts the roots of dandelion, blueberry leaves and nettle. All this pour boiling water, steam for 10 minutes and strain. Drink a means of very small doses - 15 ml. It is necessary to take 3 times a day, the duration of treatment is 10 days,
  • rinse oat seeds, boil for an hour. Water should be five times more. After filtering, the decoction is consumed a glass before a meal,
  • The use of raw beans, which have been soaked overnight, will help to remove unpleasant symptoms.

In order to never meet with such an unpleasant phenomenon as glycosuria, as well as to cope with the disease in case of its development, it is necessary to follow a diet.

You need to eat small portions, but often, at least four times a day. So carbohydrates will be absorbed more slowly, which prevents the increase in sugar.

Oily food, sweet and salty will have to be excluded from the diet. The menu should contain more fiber and dietary fiber, which will have a positive effect on the lipid spectrum and will help reduce the concentration of glucose.

Why is there urine sugar in diabetes? Answers in the video:

Urinalysis - an important study that allows to identify abnormalities in the body and promptly start treatment. Glycosuria can indicate the presence of problems with the liver, kidneys, and brain. If measures are taken in time, it is usually possible to cope with the disease and prevent serious complications.

  • Stabilizes sugar levels for long
  • Restores insulin production by the pancreas


  1. Weixin Wu Wu Lin. Diabetes: a new look. Moscow - SPb., Publishing House “Neva”, “OL-MA-Press”, 2000., 157 pp., Circulation 7000 copies. A reprint of the same book entitled Healing Recipes: Diabetes. Moscow - SPb., Publishing House “Neva”, “OLMA-Press”, 2002, 157 pages, circulation of 10,000 copies.

  2. Kamysheva, E. Insulin resistance in diabetes mellitus. / E. Kamysheva. - Moscow: World, 1977. - 750 c.

  3. Kamysheva, E. Insulin resistance in diabetes mellitus. / E. Kamysheva. - Moscow: World, 1977. - 750 c.
  4. "Drugs and their use," directory. Moscow, LLP "Avenir-Design", 1997, 760 pages, circulation of 100,000 copies.

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Watch the video: Diagnosis of Type 2 Diabetes (February 2020).