diabetes (
Next, you will learn: what is diabetes mellitus, its main types, symptoms and treatment methods.
Types of diabetes mellitus (classification)
Type 1 diabetes- characterized by an absolute lack of insulin in the blood:
- Autoimmune - antibodies attack pancreatic β-cells and completely destroy them;
- Idiopathic (no known cause);
Type 2 diabetes- relative lack of insulin in the blood. This means that the quantitative indicator of the insulin level remains in the normal range, but the number of receptors for the hormone in the membranes of the target cells (brain, liver, adipose tissue, muscles) decreases.
Gestational diabetes- an acute or chronic condition that manifests itself in the form of hyperglycemia during a woman's pregnancy.
Other (situational) causes of diabetes- impaired glucose tolerance caused by reasons unrelated to the pathology of the pancreas. They can be temporary or permanent.
drugs;
contagious;
genetic defects in the insulin molecule or its receptors;
associated with other endocrine pathologies:
- Itsenko-Cushing's disease;
- adrenal adenoma;
- Graves' disease.
Light form- Hyperglycemia not exceeding 8 mmol / l is characterized by slight daily fluctuations in sugar level, absence of glucosuria (sugar in the urine). Pharmacological correction with insulin is not required.
Often, there may be no clinical manifestations of the disease at this stage, but early forms of typical complications with damage to peripheral nerves, retinal microvessels, kidneys and heart are already detected during instrumental diagnostics.
Moderate severity- the level of glucose in the peripheral blood reaches 14 mmol / l, glucosuria appears (up to 40 g / l), including
ketoacidosis - a sharp increase in ketone bodies (metabolites of fat breakdown).Ketone bodies are formed due to energy starvation of cells. Almost all glucose circulates in the blood and does not enter the cell, and it begins to use fat stores to produce ATP. At this stage, the glucose level is controlled by dietary therapy and the use of oral hypoglycemic drugs.
Clinically, it manifests itself with disorders of the kidneys, cardiovascular system, vision, and neurological symptoms.
Heavy course- blood sugar more than 14 mmol / l, fluctuations up to 20-30 mmol, glycosuria more than 50 mmol / l. Complete dependence on insulin therapy, serious dysfunction of blood vessels, nerves, organ systems.
Compensation- diet or insulin therapy allows achieving normal blood glucose levels. Angiopathy and neuropathy do not develop. The general condition of the patient remains satisfactory for a long time. Disruption of sugar metabolism in the kidneys, lack of ketone bodies, acetone. Glycosylated hemoglobin does not exceed the value of "5%";
Subcompensation- treatment does not completely correct blood parameters and clinical manifestations of the disease. Blood glucose is not more than 14 mmol / l. Sugar molecules damage erythrocytes and glycosylated hemoglobin appears, damage to microvessels in the kidneys manifests itself in the form of a small amount of glucose (up to 40 g/l) in the urine. Acetone is not detected in the urine, but mild manifestations of ketoacidosis are possible;
Decompensation- the most severe stage of diabetes patients. It usually occurs in the later stages of the disease or in general damage to the pancreas and insulin receptors. It is characterized by a general severe condition of the patient up to coma. It is impossible to correct the glucose level with the help of medicines. drugs (more than 14 mmol / l). A high amount of sugar in the urine (more than 50 g / l), acetone. Glycosylated hemoglobin significantly exceeds the norm, hypoxia occurs. With a long course, this condition leads to coma and death.
Causes of diabetes
Diabetes mellitus (abbreviated DM) is a polyetiological disease.
There is no single factor that can cause diabetes in all people with this pathology.
The most important reasons for the development of the disease:
Genetic causes of diabetes:
- congenital deficiency of pancreatic β-cells;
- hereditary mutations in genes responsible for insulin synthesis;
- Genetic predisposition to autoaggression of immunity to β-cells (closest relatives have diabetes);
Infectious causes of diabetes are pancreatotropic (pancreas-affecting) viruses: rubella, herpes type 4, parotitis, hepatitis A, B, C. Together with these viruses, human immunity begins to destroy pancreatic cells, which causes diabetes mellitus.
- heredity (presence of diabetes in a close family);
- visceral obesity;
- age (usually over 50-60 years old);
- low fiber intake and high intake of refined fats and simple carbohydrates;
- hypertensive disease;
- atherosclerosis.
Precipitating factors
This group of factors does not cause the disease in itself, but if there is a genetic predisposition, it significantly increases the chance of its development.
- physical inactivity (passive lifestyle);
- obesity;
- to smoke;
- excessive alcohol consumption;
- the use of substances that affect the pancreas (for example, drugs);
- excess fat and simple carbohydrates in the diet.
Symptoms of diabetes
Diabetes is a chronic disease, so symptoms never appear suddenly. Symptoms in women and symptoms in men are almost the same. Manifestations of the following clinical signs with the disease are possible in different degrees.
Constant weakness, decreased performance - develops as a result of chronic energy starvation of brain cells and skeletal muscles;Dryness and itching of the skin - due to constant loss of liquid in the urine;Dizziness, headaches - symptoms of diabetes - due to lack of glucose in the circulating blood of cerebral vessels;Frequent urination - occurs due to damage to glomeruli capillaries of kidney nephrons;Decreased immunity (often SARS, long-term non-healing of wounds on the skin) - The activity of T-cell immunity is disturbed, the skin performs its barrier function worse;Polyphagia - a constant feeling of hunger - this condition develops due to the rapid loss of glucose in the urine and insufficient transport to the cells;Decreased vision - cause - damage to microscopic retinal vessels;Polydipsia - constant thirst due to frequent urination;Numbness of limbs - long-term hyperglycemia leads to specific polyneuropathy - damage to sensory nerves throughout the body;Pain in the heart region - narrowing of coronary vessels as a result of atherosclerosis leads to a decrease in blood supply to the myocardium and spastic pains;Decreased sexual function - is directly related to poor blood circulation in organs that produce sex hormones.
Diabetes diagnosis
Diagnosing diabetes is often not difficult for a qualified specialist. A doctor may suspect the disease based on the following factors:
- A diabetic patient complains of polyuria (increased daily urine output), polyphagia (constant hunger), fatigue, headache, and other clinical symptoms.
- During a preventive blood test for glucose level, the indicator was above 6. 1 mmol / l on an empty stomach or 11. 1 mmol / l 2 hours after eating.
If this symptomatology is detected, a number of tests are performed to confirm / deny the diagnosis and find the causes.
Laboratory Diagnosis of Diabetes
Oral Glucose Tolerance Test (OGTT)
A standard test to determine the functional ability of insulin to bind glucose and maintain normal blood levels.
The essence of the method:in the morning, on the background of 8-hour fasting, blood is taken to assess the fasting glucose level. After 5 minutes, the doctor gives the patient 75 g of glucose dissolved in 250 ml of water. After 2 hours, blood is taken again and the sugar level is determined again.
During this period, the initial symptoms of diabetes usually appear.
Criteria for evaluation of OGTT analysis:
| Norm | |
| on an empty stomach | < 5. 6 |
| 2 hours after the OGTT | < 7. 8 |
| Diabetes mellitus (differential diagnosis is required for types of diabetes) | |
| on an empty stomach | ≥ 6. 1 |
| 2 hours after the OGTT | ≥ 11. 1 |
| casual definition | ≥ 11. 1 |
Determination of the level of glycosylated hemoglobin (C - HbA1c)
The norm is up to 6%.
- Doubtful result - 6-6, 4%;
- In diabetes mellitus - more than 6. 4%.
C-peptide level determination
Norm: 0, 79-1, 90 ng / ml (SI: 0, 27-0, 64 mmol / l).
Determination of proinsulin level
This test allows you to distinguish between various diseases of the pancreas and diabetes. An increase in proinsulin in the blood most often indicates an endocrine tumor - insulinoma (a rather rare pathology). Also, a high concentration of proinsulin molecules can indicate type 2 diabetes.
The norm is 3, 3-28 pmol / l.
Determination of the level of antibodies against beta cells of the pancreas
It is one of the most accurate tests to determine the presence and causes of diabetes. The test is carried out in risk groups (people prone to diabetes, for example, if close relatives have this disease), as well as in patients with impaired glucose tolerance during OGTT.
The higher the titer of specific antibodies, the greater the autoimmune etiology of the disease, and the faster beta cells are destroyed and the level of insulin in the blood decreases. In diabetic patients, it usually exceeds 1: 10.
Norm - Titer: less than 1: 5.
If the antibody titer remains within the normal range, but the fasting glucose concentration is above 6. 1, the diagnosis is type 2 diabetes mellitus.
Insulin antibody level
Another specific immunological analysis. It is performed for differential diagnosis in patients with diabetes (type 1 diabetes and type 2 diabetes). If glucose tolerance is impaired, blood is taken and a serological examination is performed. It can also indicate the causes of diabetes.
AT norm for insulin is 0-10 IU / ml.
- If C (AT) is higher than normal, the diagnosis is type 1 diabetes. autoimmune diabetes mellitus;
- If C (AT) is within the reference values, the diagnosis is type 2 diabetes.
GAD (Glutamic Acid Decarboxylase) Antibody Test
GAD is a specific membrane enzyme of the central nervous system. The logical correlation between the concentration of antibodies against GAD and the development of type 1 diabetes is still not clear, but these antibodies are detected in the blood in 80-90% of patients. Analysis for AT GAD is recommended in risk groups for the diagnosis of prediabetes and the appointment of preventive diet and pharmacological therapy.
Norm AT GAD - 0-5 IU / ml.
- A positive result with normal glycemia indicates a high risk of type 1 diabetes;
- A negative result with a high blood glucose level indicates the development of type 2 diabetes.
Blood insulin test
The norm of insulin concentration is 2. 6-24. 9 mU/ml
- Below the norm - possible development of diabetes and other diseases;
- Above normal - tumor of the pancreas (insulinoma).
Instrumental diagnosis of diabetes
Ultrasound of the pancreas
The method of ultrasound examination allows to detect morphological changes in the tissues of the gland.
Usually, diffuse damage is determined in diabetes mellitus (areas of sclerosis - replacement of functionally active cells with connective tissue).
Also, the pancreas can be enlarged, there are signs of edema.
Angiography of the veins of the lower extremities
Arteries of lower extremities are target organs in diabetes mellitus. Prolonged hyperglycemia leads to an increase in blood cholesterol and atherosclerosis, which leads to a decrease in tissue perfusion.
The essence of the method is the introduction of a special contrast agent into the bloodstream while simultaneously monitoring the patency of the vessels in computer tomography.
If the blood supply at the level of the feet of the lower extremities is significantly reduced, the so-called "diabetic foot" occurs. The diagnosis of diabetes mellitus is based on this research method.
Ultrasound of the kidneys and ECHO KG of the heart
Methods of instrumental examination of the kidneys, which allow to assess the damage of these organs in the case of a diagnosis of diabetes.
Microangiopathies develop in the heart and kidneys - damage to blood vessels with a significant decrease in their lumen and, therefore, deterioration of functional abilities. The method allows preventing complications of diabetes mellitus.
Retinography or angiography of retinal vessels
Microscopic vessels of the retina are the most sensitive to hyperglycemia, so the development of damage in them begins even before the first clinical signs of diabetes mellitus.
With the help of contrast, the degree of narrowing or complete occlusion of the vessels is determined. Also, the most important symptom of DM will be the presence of microerosions and ulcers in the fundus.
The diagnosis of diabetes mellitus is a complex measure based on the history of the disease, an objective examination by a specialist, laboratory tests and instrumental studies. Using only one diagnostic criterion, it is impossible to make a 100% correct diagnosis.
If you are at risk, be sure to consult your doctor to find out what diabetes is and what to do with such a diagnosis.
Treatment
Treatment of diabetes mellitus is a complex of measures to correct the level of glycemia, cholesterol, ketone bodies, acetone, lactic acid, prevent the rapid development of complications and improve the quality of human life.
A very important aspect in diabetes is the use of all treatment methods.
- pharmacological therapy (insulin therapy);
- diet;
- regular physical activity;
- Preventive measures to prevent the development of the disease and the development of complications;
- Psychological support.
Type 1 Diabetes Treatment
Pharmacological correction with insulin
The need for insulin injection in patients with diabetes, its type and frequency of administration are strictly selected individually and by specialists (therapist, endocrinologist, cardiologist, neuropathologist, hepatologist, diabetologist). They always pay attention to the symptoms of diabetes, carry out differential diagnosis, screening and evaluation of the effectiveness of drugs.
Types of insulin:
fast movement (ultra-short action) - begins to act immediately after administration and works within 3-4 hours. It is used before or immediately after meals;short action - has an effect 20-30 minutes after application. It should be applied strictly 10-15 minutes before meals;medium term - is used for continuous administration and acts within 12-18 hours after injection. Helps prevent complications of diabetes;Long-acting insulin - requires constant daily use. Valid for 18 hours to 24 hours. It is not used to reduce the blood glucose level, but it controls its daily concentration and does not allow it to exceed normal values;Mixed insulin - contains different ratios of ultra-short and long-acting insulins. It is mainly used in the intensive therapy of type 1 diabetes.
Diet therapy for diabetes
Diet - 50% success in glycemic control in a patient with diabetes mellitus.
What foods should be consumed?
- Fruits and vegetables with low sugar level and high vitamin and mineral concentration (apples, carrots, cabbage, beets);
- Meat with a small amount of animal fat (beef, turkey, quail);
- Cereals and cereals (buckwheat, wheat, rice, barley, barley);
- fish (preferably sea);
- From drinks, it is better to choose weak tea, fruit infusions.
What should be thrown away:
- sweets, pasta, flour;
- concentrated juices;
- fatty meat and dairy products;
- spicy and smoked foods;
- Alcohol.
Type 2 Diabetes Treatment
In the initial stages, type 2 diabetes mellitus, like type 1 diabetes, is well treated with diet therapy. If the diet is not followed, also with a long course of the disease, pharmacological therapy with hypoglycemic drugs is applied. More rarely, patients with type 2 diabetes are prescribed insulin.
Hypoglycemic drugs
- a drug that stimulates the production of insulin in the pancreas.
- stimulates beta cells to produce insulin.
- works in the intestine, inhibiting the activity of small intestinal enzymes that break down polysaccharides into glucose.
- drug for the prevention of polyneuropathy, micro- and macroangiopathy of the kidneys, heart and retina.
Folk remedies for the treatment of diabetes
Folk methods include the preparation of various decoctions from herbs, fruits and vegetables that correct the level of glycemia to one degree or another.
kryphea amur - ready extract from moss. The use of Criphea leads to an increase in the synthesis of pancreatic hormones: lipase, amylase, protease. It also has an anti-allergic and immunomodulatory effect, reduces the main symptoms of diabetes.Parsley root + lemon peel + garlic - these products contain a large amount of vitamins C, E, A, selenium and other trace elements. All this should be crushed, mixed and brewed for about 2 weeks. Use 1 teaspoon orally before meals.oak acorns - contains tannin, which is a very effective remedy for diabetes. This substance stimulates the immune system, has an anti-inflammatory and anti-edema effect, strengthens the wall of blood vessels, and relieves symptoms. Acorns should be powdered and taken 1 teaspoon before each meal.
Physical exercise in diabetes
In diabetes mellitus, regular physical activity is a very important aspect in the treatment and prevention of diabetes complications. Morning exercises, running, swimming help prevent obesity, improve blood supply to muscles and organs, strengthen blood vessels and stabilize the nervous system.
Disease prevention
It is impossible to prevent the disease with genetic predisposition. However, people at risk should take several measures to manage glycemia and the rate at which diabetes complications develop.
- Children with unfavorable heredity (parents, grandparents have diabetes) should check their blood sugar level once a year, as well as monitor their condition and the appearance of the first signs of the disease. Also, annual consultations with an ophthalmologist, neuropathologist, endocrinologist, and cardiologist will be an important measure to identify the first signs of diabetes and prevent complications of diabetes.
- People over 40 should check their glycemic levels annually to prevent type 2 diabetes;
- All diabetics must use special devices - glucometers - to monitor blood sugar levels.
You also need to learn everything about diabetes - what is possible and what is not, from its type to the causes of the disease, specifically for you, for this you need a long conversation with a doctor, he will consult and guide. you need to pass the necessary tests and prescribe treatment.
recovery forecast
Diabetes mellitus is an incurable disease, so the prognosis for recovery is poor. However, modern advances in pharmacological insulin therapy can significantly prolong the life of a diabetic patient, and regular diagnosis of typical disorders of organ systems leads to an improvement in the patient's quality of life.