Diabetes mellitus - an endocrine disease caused by a lack of the hormone insulin or its low biological activity. It is characterized by a violation of all types of metabolism, damage to large and small blood vessels and is manifested by hyperglycemia.
The first who gave the name of the disease - "diabetes" was a doctor Aretius, who lived in Rome in the second century AD. er Much later, in 1776, the doctor Dobson (an Englishman by birth), examining the urine of patients with diabetes, found that she had a sweetish taste that spoke of the presence of sugar in it. So, diabetes began to be called "sugar".
In any type of diabetes, blood sugar control becomes one of the primary tasks of the patient and his doctor. The closer the sugar level to the limits of the norm, the less the symptoms of diabetes, and less the risk of complications
Why does diabetes, and what is it?
Diabetes mellitus is a metabolic disorder that occurs due to insufficient education in the patient's body of its own insulin (type 1 disease) or due to a violation of the effects of this insulin on tissue (type 2). Insulin is produced in the pancreas, and therefore patients with diabetes mellitus are often among those who have various disabilities in the work of this organ.
Patients with type 1 diabetes are called “insulin-dependent” - they are the ones who need regular insulin injections, and very often they have a congenital disease. Typically, the disease of type 1 is already manifested in childhood or adolescence, and this type of disease occurs in 10-15% of cases.
Type 2 diabetes develops gradually and is considered “elderly diabetes”. This kind of children almost never occurs, and is usually characteristic of people over 40 years, suffering from overweight. This type of diabetes occurs in 80-90% of cases, and is inherited in almost 90-95% of cases.
What it is? Diabetes mellitus can be of two types - insulin-dependent and insulin-independent.
- Type 1 diabetes occurs in the face of insulin deficiency, which is why it is called insulin-dependent. With this type of disease, the pancreas does not function properly: it either does not produce insulin at all, or it produces it in a volume that is insufficient for processing even the minimum amount of incoming glucose. As a result, an increase in blood glucose occurs. As a rule, thin people under the age of 30 fall ill with type 1 diabetes. In such cases, patients are given additional doses of insulin to prevent ketoacidosis and maintain a normal standard of living.
- Type 2 diabetes mellitus affects up to 85% of all patients with diabetes mellitus, mainly those over 50 (especially women). For patients with diabetes of this type, overweight is characteristic: more than 70% of such patients are obese. It is accompanied by the production of a sufficient amount of insulin, to which the tissues gradually lose their sensitivity.
The causes of diabetes type I and II are fundamentally different. In people with type 1 diabetes, beta cells that produce insulin break down due to viral infection or autoimmune aggression, which causes its deficiency with all the dramatic consequences. In patients with type 2 diabetes, beta cells produce enough or even an increased amount of insulin, but tissues lose the ability to perceive its specific signal.
Diabetes is one of the most common endocrine disorders with a constant increase in prevalence (especially in developed countries). This is the result of a modern lifestyle and an increase in the number of external etiological factors, among which obesity stands out.
The main causes of diabetes include:
- Overeating (increased appetite) leading to obesity is one of the main factors in the development of type 2 diabetes. If among persons with normal body weight, the incidence of diabetes is 7.8%, then with an excess of body weight by 20%, the frequency of diabetes is 25%, and with an excess of body weight by 50%, the frequency is 60%.
- Autoimmune diseases (an attack of the body’s immune system on the body’s own tissues) - glomerulonephritis, autoimmune thyroiditis, hepatitis, lupus, etc., can also be complicated by diabetes.
- Hereditary factor. As a rule, diabetes is several times more common in relatives of patients with diabetes. If both parents are sick with diabetes, the risk of having diabetes for their children is 100% throughout their lives, one parent ate 50%, and 25% in the case of diabetes with a brother or sister.
- Viral infections that destroy pancreatic cells that produce insulin. Among the viral infections that can cause the development of diabetes can be listed: rubella, viral parotitis (mumps), chicken pox, viral hepatitis, etc.
A person who has a hereditary predisposition to diabetes may not become a diabetic throughout his life if he controls himself, leading a healthy lifestyle: proper nutrition, physical activity, medical supervision, etc. Typically, type 1 diabetes occurs in children and adolescents.
As a result of research, doctors have come to the conclusion that the causes of diabetes mellitus in 5% depend on the mother’s line, 10% on the father’s side, and if both parents have diabetes, the likelihood of transmitting a predisposition to diabetes rises to almost 70% .
Signs of diabetes in women and men
There are a number of signs of diabetes, characteristic of both type 1 and type 2 disease. These include:
- Feelings of unquenchable thirst and frequent urination, which lead to dehydration;
- Also one of the signs is dry mouth;
- Increased fatigue;
- Yawning drowsiness;
- Wounds and cuts heal very slowly;
- Nausea, possibly vomiting;
- Breathing is frequent (possibly with the smell of acetone);
- Genital itching and skin itching;
- Weight loss;
- Frequent urination;
- Visual impairment.
If you have the above signs of diabetes, then it is necessary to measure the level of sugar in the blood.
Symptoms of diabetes
In diabetes, the severity of symptoms depends on the degree of decrease in insulin secretion, the duration of the disease and the individual characteristics of the patient.
As a rule, the symptoms of type 1 diabetes are acute, the disease begins suddenly. In type 2 diabetes, the state of health worsens gradually, and at the initial stage the symptoms are poor.
- Excessive thirst and frequent urination are classic signs and symptoms of diabetes. With the disease, excess sugar (glucose) accumulates in the blood. Your kidneys are forced to work intensively in order to filter and absorb excess sugar. If your kidneys fail, excess sugar is excreted in the urine with fluid from the tissues. This causes more frequent urination, which can lead to dehydration. You will want to drink more fluid to quench your thirst, which again leads to frequent urination.
- Fatigue can be caused by many factors. It can also be caused by dehydration, frequent urination, and the body's inability to function properly, because less sugar can be used for energy.
- The third symptom of diabetes is polyphagia. This is also a thirst, however, not for water, but for food. A person eats and at the same time feels not satiety, but filling the stomach with food, which then quickly turns into a new hunger.
- Intensive weight loss. This symptom is mainly inherent in type 1 diabetes (insulin-dependent) and is often at first girls are happy about it. However, their joy passes when they find out the true cause of weight loss. It is worth noting that weight loss takes place against a background of increased appetite and abundant nutrition, which can not but alarm. Quite often, weight loss leads to exhaustion.
- Symptoms of diabetes can sometimes include vision problems.
- Slow wound healing or frequent infections.
- Tingling in arms and legs.
- Red, swollen, sensitive gums.
If at the first symptoms of diabetes do not take action, then over time there are complications associated with malnutrition of tissues - trophic ulcers, vascular diseases, changes in sensitivity, reduced vision. A severe complication of diabetes mellitus is diabetic coma, which occurs more often with insulin-dependent diabetes in the absence of sufficient treatment with insulin.
Degrees of severity
A very important rubric in the classification of diabetes is its severity.
- It characterizes the most favorable course of the disease to which any treatment should strive. With this degree of process, it is fully compensated, the glucose level does not exceed 6-7 mmol / l, glucosuria is absent (urine excretion of glucose), glycated hemoglobin and proteinuria indices do not go beyond normal values.
- This stage of the process indicates partial compensation. There are signs of complications of diabetes and damage to typical target organs: eyes, kidneys, heart, blood vessels, nerves, lower extremities. The level of glucose is raised slightly and amounts to 7-10 mmol / l.
- Such a course of the process speaks about its constant progression and the impossibility of drug control. At the same time, the level of glucose varies between 13-14 mmol / l, persistent glucosuria (excretion of glucose in the urine), high proteinuria (presence of protein in the urine) are noted, there are obvious unfolded manifestations of target organ damage in diabetes mellitus. Visual acuity decreases progressively, severe hypertension persists, sensitivity decreases with the appearance of severe pain and numbness of the lower extremities.
- This degree characterizes the absolute decompensation of the process and the development of severe complications. At the same time, the level of glycemia rises to critical numbers (15-25 or more mmol / l), and is difficult to correct by any means. Development of a renal failure, diabetic ulcers and gangrene of extremities is characteristic. Another criterion for grade 4 diabetes is the tendency to develop frequent diabetic patients.
Also, there are three states of compensation of carbohydrate metabolism disorders: compensated, subcompensated and decompensated.
If the following signs coincide, the diagnosis of diabetes is made:
- The concentration of glucose in the blood (on an empty stomach) exceeded the norm of 6.1 millimoles per liter (mol / l). After eating two hours later - above 11.1 mmol / l;
- If the diagnosis is in doubt, the glucose tolerance test is performed in the standard repetition, and it shows an excess of 11.1 mmol / l;
- Excess glycated hemoglobin level - more than 6.5%;
- The presence of sugar in the urine;
- The presence of acetone in the urine, although acetonuria is not always an indicator of diabetes.
What indicators of sugar are considered the norm?
- 3.3 - 5.5 mmol / l is the norm of blood sugar regardless of your age.
- 5.5 - 6 mmol / l is prediabetes, impaired glucose tolerance.
If the sugar level showed a mark of 5.5 - 6 mmol / l - this is a signal from your body that a violation of carbohydrate metabolism has started, all this means that you have entered the danger zone. The first thing you need to do is to reduce the level of sugar in the blood, get rid of excess weight (if you have excess weight). Limit yourself to 1800 kcal per day, include diabetic foods in your diet, discard sweets, cook for a couple.
The consequences and complications of diabetes
Acute complications are conditions that develop within days or even hours, in the presence of diabetes.
- Diabetic ketoacidosis is a serious condition that develops as a result of the accumulation in the blood of products of intermediate metabolism of fats (ketone bodies).
- Hypoglycemia - a decrease in the level of glucose in the blood below the normal value (usually below 3.3 mmol / l), is due to an overdose of glucose-lowering drugs, concomitant diseases, unusual exercise or malnutrition, and drinking strong alcohol.
- Hyperosmolar coma. It occurs mainly in elderly patients with type 2 diabetes with or without a history of diabetes and is always associated with severe dehydration.
- Lactic acid coma in patients with diabetes mellitus is caused by the accumulation of lactic acid in the blood and more often occurs in patients over 50 years of age against the background of cardiovascular, hepatic and renal failure, reduced oxygen supply to the tissues and, as a result, accumulation of lactic acid in the tissues.
Late consequences are a group of complications, the development of which requires months, and in most cases, years of the disease.
- Diabetic retinopathy is a retinal lesion in the form of microaneurysms, punctate and spotted hemorrhages, hard exudates, edema, the formation of new vessels. Ends with hemorrhages in the fundus, can lead to retinal detachment.
- Diabetic micro- and macroangiopathy is a violation of vascular permeability, an increase in their fragility, a tendency to thrombosis and the development of atherosclerosis (occurs early, mainly small vessels are affected).
- Diabetic polyneuropathy - most often in the form of bilateral peripheral neuropathy of the type "gloves and stockings", starting in the lower parts of the limbs.
- Diabetic nephropathy - kidney damage, first in the form of microalbuminuria (discharge of albumin from the urine), then proteinuria. Leads to the development of chronic renal failure.
- Diabetic arthropathy - joint pain, crunching, limiting mobility, reducing the amount of synovial fluid and increasing its viscosity.
- Diabetic ophthalmopathy, in addition to retinopathy, includes the early development of cataracts (lens opacities).
- Diabetic encephalopathy - changes in the psyche and mood, emotional lability or depression.
- Diabetic foot - the defeat of the feet of a patient with diabetes mellitus in the form of purulent-necrotic processes, ulcers and osteo-articular lesions, occurring against the background of changes in peripheral nerves, vessels, skin and soft tissues, bones and joints. It is the main cause of amputations in patients with diabetes.
Also, diabetes has an increased risk of developing mental disorders - depression, anxiety disorders, and eating disorders.
How to treat diabetes
Currently, the treatment of diabetes in the vast majority of cases is symptomatic and is aimed at eliminating the existing symptoms without eliminating the cause of the disease, since effective treatment of diabetes has not yet been developed.
The main tasks of the doctor in the treatment of diabetes are:
- Compensation of carbohydrate metabolism.
- Prevention and treatment of complications.
- Normalization of body weight.
- Patient education.
Depending on the type of diabetes, patients are prescribed insulin administration or ingestion of drugs with a sugar-reducing effect. Patients must follow a diet, the qualitative and quantitative composition of which also depends on the type of diabetes.
- In diabetes mellitus type 2 prescribe a diet and drugs that reduce the level of glucose in the blood: glibenclamide, glurenorm, gliclazide, glibutid, metformin. They are taken orally after an individual selection of a specific drug and its dosage by a doctor.
- In type 1 diabetes mellitus, insulin therapy and diet are prescribed. The dose and type of insulin (short, medium or long-acting) is selected individually in the hospital, under the control of sugar content in the blood and urine.
Diabetes mellitus must be treated without fail, otherwise it is fraught with very serious consequences that were listed above. The earlier diabetes is diagnosed, the greater the chance that the negative consequences can be completely avoided and live a normal and full life.
Diet for diabetes is a necessary part of treatment, as well as the use of glucose-lowering drugs or insulins. Without compliance with the diet is not possible compensation of carbohydrate metabolism. It should be noted that in some cases with type 2 diabetes, only a diet is sufficient to compensate for carbohydrate metabolism, especially in the early stages of the disease. With type 1 diabetes, dieting is vital for the patient, breaking the diet can lead to hypo-or hyperglycemic coma, and in some cases to the death of the patient.
The task of diet therapy in diabetes mellitus is to ensure uniform and adequate physical exertion intake of carbohydrates into the patient's body. The diet should be balanced in protein, fat and calories. Easily digestible carbohydrates should be completely excluded from the diet, except in cases of hypoglycemia. With type 2 diabetes, it is often necessary to correct body weight.
The basic concept in the diet of diabetes is a bread unit. A bread unit is a conditional measure equal to 10-12 g of carbohydrates or 20-25 g of bread. There are tables that indicate the number of bread units in various foods. During the day, the number of bread units consumed by the patient should remain constant; on average, 12-25 bread units are consumed per day, depending on body weight and physical activity. For one meal, it is not recommended to consume more than 7 bread units, it is desirable to organize food intake so that the number of bread units in different food intakes is approximately the same. It should also be noted that drinking alcohol can lead to distant hypoglycemia, including hypoglycemic coma.
An important condition for the success of diet therapy is that the patient keeps a food diary, all food eaten during the day is entered into it, and the number of bread units consumed in each meal and in general per day is calculated. Keeping such a food diary makes it possible in most cases to identify the cause of the episodes of hypo- and hyperglycemia, it helps to educate the patient, helps the doctor to select an adequate dose of hypoglycemic drugs or insulin.
See more: proper nutrition in diabetes for every day. Menus and recipes.
Self-control of blood glucose levels is one of the main measures that allow to achieve effective long-term compensation of carbohydrate metabolism. Due to the fact that it is impossible at the current technological level to completely imitate the secretory activity of the pancreas, blood glucose levels fluctuate during the day. This is influenced by many factors, the main ones include physical and emotional stress, the level of carbohydrates consumed, concomitant diseases and conditions.
Since it is impossible to keep the patient in the hospital all the time, the monitoring of the condition and the slight correction of the short-acting insulin doses is on the patient. Glycemia self-control can be done in two ways. The first one is approximate with the help of test strips, which determine the level of glucose in the urine with the help of a qualitative reaction. If there is glucose in the urine, the urine should be checked for acetone. Acetonuria is an indication for hospitalization and evidence of ketoacidosis. This method of glycemia assessment is rather approximate and does not allow to fully monitor the state of carbohydrate metabolism.
A more modern and adequate method of assessing the state is the use of blood glucose meters. The meter is a device for measuring the level of glucose in organic liquids (blood, cerebrospinal fluid, etc.). There are several measurement techniques. Recently, portable blood glucose meters for home measurements have become widespread. It is enough to place a drop of blood on a disposable indicator plate attached to the glucose oxidase biosensor apparatus, and after a few seconds the level of glucose in the blood (glycemia) is known.
It should be noted that the readings of two blood glucose meters from different companies may differ, and the glycemia level indicated by the blood glucose meter, as a rule, is 1-2 units higher than the real one. Therefore, it is desirable to compare the readings of the meter with the data obtained during the examination in the clinic or hospital.
Insulin treatment is aimed at maximally compensating for carbohydrate metabolism, preventing hypo- and hyperglycemia, and thus preventing complications of diabetes. Insulin treatment is vital for people with type 1 diabetes and can be used in a number of situations for people with type 2 diabetes.
Indications for prescribing insulin therapy:
- Type 1 diabetes
- Ketoacidosis, diabetic hyperosmolar, hyper laccemic coma.
- Pregnancy and childbirth with diabetes.
- Significant decompensation of type 2 diabetes.
- The lack of effect of treatment by other methods of diabetes mellitus type 2.
- Significant weight loss in diabetes.
- Diabetic nephropathy.
Currently, there are a large number of insulin preparations, differing in duration of action (ultrashort, short, medium, extended), according to the degree of purification (monopic, monocomponent), species specificity (human, pig, bovine, genetically engineered, etc.)
In the absence of obesity and strong emotional stress, insulin is prescribed in a dose of 0.5-1 units per 1 kg of body weight per day. The introduction of insulin is designed to mimic the physiological secretion in connection with the following requirements:
- The dose of insulin should be sufficient to utilize the glucose entering the body.
- Injected insulins should mimic the basal secretion of the pancreas.
- Injected insulins should mimic postprandial insulin secretion peaks.
In this regard, there is the so-called intensified insulin therapy. The daily dose of insulin is divided between extended and short-acting insulin. Extended insulin is usually administered in the morning and evening and mimics the basal secretion of the pancreas. Short-acting insulins are administered after each meal containing carbohydrates, the dose may vary depending on the bread units eaten at a given meal.
Insulin is injected subcutaneously using an insulin syringe, syringe pen or a special pump-dispenser. Currently in Russia, the most common method of administering insulin with a syringe pen. This is due to the greater convenience, less pronounced discomfort and ease of administration compared to conventional insulin syringes. The pen allows you to quickly and almost painlessly enter the required dose of insulin.
Sugar-reducing tablets are prescribed for non-insulin dependent diabetes mellitus in addition to the diet. According to the mechanism of reducing blood sugar, the following groups of glucose-lowering drugs are distinguished:
- Biguanides (metformin, buformin, etc.) - reduce the absorption of glucose in the intestine and contribute to the saturation of peripheral tissues. Biguanides can raise the level of uric acid in the blood and cause the development of a serious condition - lactic acidosis in patients over 60 years of age, as well as those suffering from hepatic and renal failure, chronic infections. Biguanides are more often prescribed for non-insulin dependent diabetes mellitus in young obese patients.
- Sulfonylurea preparations (glycvidone, glibenclamide, chlorpropamide, carbutamide) - stimulate insulin production by pancreatic β cells and promote the penetration of glucose into tissues. The optimally selected dosage of drugs in this group maintains a glucose level not> 8 mmol / l. Overdose may develop hypoglycemia and coma.
- Alpha-glucosidase inhibitors (miglitol, acarbose) - slow down the increase in blood sugar by blocking the enzymes involved in the absorption of starch. Side effects - flatulence and diarrhea.
- Meglitinides (nateglinide, repaglinide) - cause a decrease in sugar levels, stimulating the pancreas to insulin secretion. The action of these drugs depends on the sugar content in the blood and does not cause hypoglycemia.
- Thiazolidinediones - reduce the amount of sugar released from the liver, increase the susceptibility of fat cells to insulin. Contraindicated in heart failure.
Also, a beneficial therapeutic effect in diabetes has a weight loss and individual moderate exercise. Due to muscular effort, glucose oxidation increases and its content in the blood decreases.
Currently, the prognosis for all types of diabetes mellitus is conditionally favorable, with adequate treatment and compliance with the diet, the ability to work remains. The progression of complications slows down significantly or stops completely. However, it should be noted that in most cases as a result of treatment, the cause of the disease is not eliminated, and therapy is only symptomatic.