diabetes (
Then 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 within normal limits, but the number of receptors for the hormone on the membranes of target cells (brain, liver, fat tissue, muscles) decreases.
Gestational diabetes- acute or chronic condition that manifests itself in the form of hyperglycemia during pregnancy.
Other (situational) causes of diabetes- Impaired glucose tolerance caused by causes unrelated to pancreatic pathology. They can be temporary or permanent.
medicine;
contagious;
genetic defects in the insulin molecule or its receptors;
associated with other endocrine pathologies:
- Itsenko-Cushing's disease;
- adenoma of the adrenal gland;
- Graves' disease.
Light form- characterized by hyperglycemia no more than 8 mmol/l, slight daily fluctuations in sugar level, absence of glucosuria (sugar in the urine). It does not require pharmacological correction with insulin.
Often, at this stage, clinical manifestations of the disease may be absent, however, during instrumental diagnostics, the initial forms of typical complications with damage to peripheral nerves, microvessels of the retina, kidneys and heart are already detected.
Moderate weight- the level of glucose in the peripheral blood reaches 14 mmol/l, glucosuria appears (up to 40 g/l), incoming
ketoacidosis - sudden increase of 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 reserves to produce ATP. In this phase, the glucose level is controlled with the help of dietary therapy, the use of oral hypoglycemic drugs.
It is clinically manifested by impaired functioning of the kidneys, cardiovascular system, vision, and neurological symptoms.
A tough course- blood sugar exceeds 14 mmol/l, with fluctuations up to 20-30 mmol, glycosuria over 50 mmol/l. Complete dependence on insulin therapy, severe dysfunction of blood vessels, nerves, and organ systems.
Compensation- diet or insulin therapy allow reaching normal blood glucose levels. Angiopathy and neuropathy do not progress. The general condition of the patient remains satisfactory for a long time. There are no violations of sugar metabolism in the kidneys, absence of ketone bodies, acetone. Glycosylated hemoglobin does not exceed the value of "5%";
Subcompensation- the treatment does not completely correct the blood count and clinical manifestations of the disease. Glucose in the blood is not higher than 14 mmol / l. Sugar molecules damage erythrocytes and glycosylated hemoglobin appears, damage to micro-vessels in the kidneys is manifested in the form of a small amount of glucose in the urine (up to 40 g/l). Acetone in the urine was not detected, however, mild manifestations of ketoacidosis are possible;
Decompensation- the most difficult phase of diabetics. It usually occurs in the later stages of the disease or total damage to the pancreas and insulin receptors. It is characterized by a generally severe condition of the patient up to coma. Glucose levels cannot be corrected with medication. drugs (over 14 mmol/l). High number of sugar in urine (over 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 causes diabetes in all people with this pathology.
The most significant causes of disease development:
Genetic causes of diabetes:
- congenital pancreatic β-cell insufficiency;
- inherited mutations in genes responsible for insulin synthesis;
- genetic predisposition for immune autoaggression against β-cells (closest relatives are diabetics);
Infectious causes of diabetes mellitus are pancreatotropic (infecting the pancreas) viruses: rubella, herpes type 4, mumps, hepatitis A, B, C. Human immunity begins to destroy pancreatic cells together with these viruses, which causes diabetes mellitus.
- heredity (presence of diabetes in the immediate family);
- visceral obesity;
- age (usually older than 50-60 years);
- low fiber intake and high intake of refined fats and simple carbohydrates;
- hypertensive disease;
- atherosclerosis.
Precipitating factors
This group of factors by itself does not cause the disease, but significantly increases the chances of its development, if there is a genetic predisposition.
- physical inactivity (passive lifestyle);
- obesity;
- smoking;
- excessive alcohol consumption;
- 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 are possible in different degrees of the disease.
Constant weakness, reduced 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 fluid in the urine;Dizziness, headache - signs of diabetes - due to the lack of glucose in the circulating blood of the cerebral vessels;Frequent urination - occurs due to damage to the glomerulus capillaries of the kidney nephrons;Decreased immunity (frequent SARS, prolonged non-healing of skin wounds) - the immune activity of T-cells is impaired, the skin performs its protective function less well;Polyphagia - constant feeling of hunger - this condition develops due to the rapid loss of glucose in the urine and its insufficient transport into the cells;Reduced vision - cause - damage to the microscopic blood vessels of the retina;Polydipsia - constant thirst due to frequent urination;Numbness of limbs - prolonged hyperglycemia leads to specific polyneuropathy - damage to sensory nerves throughout the body;Pain in the region of the heart - narrowing of the coronary vessels due to atherosclerosis leads to a decrease in blood supply to the myocardium and spastic pain;Reduced sexual function - is directly related to poor blood circulation in the organs that produce sex hormones.
Diagnosis of diabetes
Diagnosing diabetes usually does not cause difficulties for a qualified specialist. The doctor may suspect the disease based on the following factors:
- A patient with diabetes complains of polyuria (increased amount of daily urine), polyphagia (constant hunger), weakness, 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 a meal.
If this symptomatology is detected, a series of tests is carried out to confirm / refute the diagnosis and find out 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 an 8-hour fast, blood is taken to assess the fasting glucose level. After 5 minutes, the doctor gives the patient to drink 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 evaluating the OGTT analysis:
| Norm | |
| on an empty stomach | < 5. 6 |
| 2 hours after OGTT | < 7. 8 |
| Diabetes mellitus (requires differential diagnosis for types of diabetes) | |
| on an empty stomach | ≥ 6. 1 |
| 2 hours after OGTT | ≥ 11. 1 |
| random definition | ≥ 11. 1 |
Determination of the level of glycosylated hemoglobin (C - HbA1c)
The norm is up to 6%.
- Doubtful result - 6-6, 4%;
- With diabetes mellitus - more than 6. 4%.
Determination of C-peptide levels
Normal: 0. 79-1. 90 ng/ml (SI: 0. 27-0. 64 mmol/l).
Determination of proinsulin levels
This test allows you to distinguish between different diseases of the pancreas and diabetes. An increase in proinsulin in the blood most often indicates an endocrine tumor - insulinoma (rare pathology). Also, high concentrations of proinsulin molecules can indicate type 2 diabetes.
The norm is 3. 3-28 pmol / l.
Determination of the level of antibodies to pancreatic beta cells
One of the most accurate tests for determining the presence and cause of diabetes. The test is performed in risk groups (people with a predisposition to diabetes, for example, if the closest relatives have this disease), as well as in patients with impaired glucose tolerance during the OGTT.
The higher the titer of specific antibodies, the more probable the autoimmune etiology of the disease, and the faster beta cells are destroyed and the level of insulin in the blood decreases. In diabetics, it usually exceeds 1: 10.
Norma - Titer: less than 1: 5.
If the antibody titer is 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 test. It is done for differential diagnosis in patients with diabetes (diabetes type 1 and diabetes type 2). If glucose tolerance is impaired, blood and a serological test are taken. It can also indicate the causes of diabetes.
Norm AT according to insulin is 0-10 IU / ml.
- If C (AT) is higher than normal, the diagnosis is diabetes type 1. 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 GAD antibodies and the development of type 1 diabetes is still not clear, however, in 80-90% of patients these antibodies are detected in the blood. AT GAD analysis is recommended for risk groups to diagnose prediabetes and prescribe preventive diet and pharmacological therapy.
Norma AT GAD - 0-5 IU / ml.
- A positive result with normal glycemia indicates a high risk of type 1 diabetes;
- A negative result with an elevated blood glucose level indicates the development of type 2 diabetes.
Blood insulin test
The norm of insulin concentration is 2. 6-24. 9 mcU / ml
- Below the norm - possible development of diabetes and other diseases;
- Above normal - pancreatic tumor (insulinoma).
Instrumental diagnosis of diabetes
Ultrasound of the pancreas
The method of ultrasound scanning allows you to detect morphological changes in the tissues of the gland.
Usually, in diabetes mellitus, diffuse damage is determined (areas of sclerosis - replacement of functionally active cells by connective tissue).
Also, the pancreas can be enlarged, have signs of edema.
Angiography of blood vessels of the lower extremities
Arteries of the lower extremities are the target organ in diabetes mellitus. Prolonged hyperglycemia causes 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 with the simultaneous control of vascular patency on a computerized tomograph.
If the blood supply is significantly reduced at the level of the legs of the lower extremities, the so-called "diabetic foot" occurs. The diagnosis of diabetes mellitus is based on this research method.
Kidney ultrasound and ECHO KG heart
Methods of instrumental examination of the kidneys, which enable the assessment of damage to these organs in the presence of a diagnosis of diabetes mellitus.
Microangiopathies develop in the heart and kidneys - damage to blood vessels with a significant reduction in their lumen, and thus deterioration of functional abilities. The method enables the prevention of 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 blood vessels is determined. Also, the most important sign of DM will be the presence of microerosions and ulcers on the fundus.
The diagnosis of diabetes mellitus is a complex measure based on the anamnesis 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% accurate diagnosis.
If you are at risk, be sure to consult your doctor to learn more about what diabetes is and what to do with such a diagnosis.
Treatment
Treatment of diabetes mellitus is a set 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.
In diabetes, a very important aspect is the application of all treatment methods.
- Pharmacological therapy (insulin therapy);
- Diet;
- Regular physical activity;
- Preventive measures to prevent disease progression and development of complications;
- Psychological support.
Treatment of type 1 diabetes
Pharmacological correction with insulin
The need for insulin injections in patients with diabetes, its type and frequency of administration are strictly individual and are chosen 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 acting (ultra-short action) - starts working immediately after application and works within 3-4 hours. It is used before or immediately after a meal;short action - works 20-30 minutes after application. It should be applied strictly 10-15 minutes before eating;of medium duration - they are used for continuous reception and work within 12-18 hours after the injection. It helps prevent diabetes complications;Long-acting insulin - requires constant daily use. It is valid from 18 to 24 hours. It is not used to lower the level of glucose in the blood, but only controls its daily concentration and does not allow it to exceed normal values;Combined insulin - contains insulins of ultra-short and prolonged action in different proportions. It is mainly used in the intensive care of type 1 diabetes.
Diet therapy for diabetes
Diet - 50% success in controlling glycemic levels in patients with diabetes mellitus.
What foods should be consumed?
- Fruits and vegetables with a low level of sugar and a high concentration of vitamins and minerals (apples, carrots, cabbage, beets);
- Meat containing a small amount of animal fat (beef, turkey, quail meat);
- Cereals and cereals (buckwheat, wheat, rice, barley, barley);
- Fish (preferably sea);
- From drinks, it is better to choose weak tea, fruit decoctions.
What to discard:
- Sweets, pasta, flour;
- concentrated juices;
- Fatty meat and dairy products;
- Spicy and smoked food;
- Alcohol.
Treatment of type 2 diabetes
In the initial stages, type 2 diabetes mellitus is well treated with diet therapy, as is the case with type 1 diabetes. If the diet is not followed, as with the long-term course of the disease, pharmacological therapy with hypoglycemic drugs is used. Even less often, 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.
- it works in the intestines, inhibiting the activity of small intestine enzymes that break down polysaccharides into glucose.
- medicine 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 of herbs, fruits and vegetables, which to one degree or another correct the level of glycemia.
kryphea amur - finished moss extract. The use of Criphe causes an increase in the synthesis of pancreatic hormones: lipase, amylase, protease. It also has an anti-allergic and immunomodulatory effect, reducing 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 must be crushed, mixed and soaked for about 2 weeks. Use orally 1 teaspoon before meals.oak acorn - they contain tannin, a very effective medicine for diabetes. This substance stimulates the immune system, has anti-inflammatory and anti-edematous effects, strengthens the wall of blood vessels, relieves severe types. Acorns must be ground into powder and taken 1 teaspoon before each meal.
Physical activity in diabetes
Regular physical activity in diabetes mellitus is a very important aspect in the treatment and prevention of complications of diabetes mellitus. Morning exercises, running, swimming help to avoid obesity, improve blood supply to muscles and organs, strengthen blood vessels and stabilize the nervous system.
Disease prevention
With a genetic predisposition, the disease cannot be prevented. However, people who are at risk must take a number of measures to control glycemia and the rate of development of diabetes complications.
- Children with an unfavorable inheritance (parents, grandparents suffering from diabetes) should be tested for blood sugar level once a year, as well as monitor their condition and the appearance of the first symptoms of the disease. Also, an important measure will be annual consultations with an ophthalmologist, neuropathologist, endocrinologist, and cardiologist in order to determine the first symptoms of diabetes and prevent diabetes complications.
- People over the age of 40 must check their glycemic levels annually to prevent type 2 diabetes;
- All diabetics must use special devices for monitoring blood sugar levels - glucometers.
You also need to find out everything about diabetes - what is possible and what is not, starting with the type and ending with the causes of the disease especially for you, for this you need a long conversation with a doctor, he will consult, instruct you to undergo the necessary tests and prescribe treatment.
recovery forecast
Diabetes mellitus is an incurable disease, so the prognosis for recovery is poor. However, modern progress in pharmacological insulin therapy can significantly prolong the life of diabetics, and regular diagnosis of typical disorders of organic systems leads to an improvement in the quality of life of patients.