Clinic and diagnosis of diabetes

The diagnosis of diabetes mellitus begins with the detection of the main signs - symptoms. Despite the similarity of the clinical manifestations of the disease, each diabetes has its own specific characteristics.

Diabetes mellitus was described by the ancient Egyptians about a thousand and a half years ago as an independent nosological unit. At that time, the diagnosis was made using various methods, which are not used today because of their irrelevance. For example, Hippocrates told his patients that they had diabetes mellitus, whose clinic was great if the urine tasted sweet when tested. In Chinese medicine, insects were used to diagnose this insidious disease - flies, wasps, which, in the presence of sugar in the urine, sat on the container in which the urine was placed.

Classification

Diabetes itself is a pathology of the endocrine system. In addition, the concentration of sugar in the blood is constantly increasing for various reasons. It is usually a lack of insulin, which can be absolute or relative. This hormone is produced in beta cells located in the tail of the pancreas.

The result of this process is always a violation of the metabolism of the human organism at all levels, which ultimately leads to severe complications on the cardiovascular and nervous systems to a greater extent, while the remaining functional units of the body suffer somewhat less.

To date, there are several types of diseases that have completely different approaches to treatment. At the same time, whatever diabetes mellitus is, the clinic of this condition is almost always the same.

The most common classification in the literature is:

1. At a young age, as in children, the most common is diabetes mellitus with an absolute lack of insulin. It's called the first guy.
2. Insulin-dependent diabetes occurs more often in adulthood and is characterized by a relative lack of insulin. Type 2 diabetes usually occurs in older people, but there are cases when the pathology also affects young people. It is much more common than the first type, and one of the provoking factors of the pathology is excess weight.
3. Symptomatic. This type of disease can appear against the background of other pathological processes, so it is also called secondary.
4. Gestational diabetes that occurs during pregnancy. It often disappears on its own after childbirth.
5. Along with malnutrition, a pathology such as diabetes mellitus can also develop.

It should be noted once again that the first and second type of pathology differ in the development of absolute and relative insulin deficiency, respectively. Therefore, it is the first type of disease that requires constant administration of insulin from the outside. And when the pancreas is exhausted, especially in the case of long-term type 2 diabetes, such a need arises.

In itself, another type of disease can be characterized by sufficient insulin production, but the cells of the body are insensitive to it for various reasons: the organelles responsible for this process can be blocked or their number is insufficient for effective communication. As a result, the cells develop a shortage of sugar, which serves as a signal for increased insulin production, which has little effect. As a result, the amount of insulin produced begins to decrease, which leads to an increase in glycemic indicators.

Reasons

The basis of absolute insulin insufficiency, which leads to the first type of disease, is an autoimmune process. It is caused by a violation of the immune system, which causes the production of its own antibodies aimed at fighting the beta cells of the islets of Langerhans. This leads to their destruction.

The main provoking factors of disorders of the immune system with the subsequent production of antibodies are often various viral infections, among which the most aggressive can be rubella, chicken pox, mumps. There is a genetic predisposition to the pathology.

It should be borne in mind that a substance such as selenium increases the likelihood of another type of pathology. But this is far from the most important factor in the development of the process. This includes the same hereditary predisposition and the presence of excess weight. These factors should be considered in more detail.

1. The higher the degree of obesity, the greater the risk of diabetes, while in the third degree it increases 10 times. Abdominal obesity, i. e. when fat deposits are located in the stomach area, can be a consequence of metabolic disorders, i. e. prediabetes.
2. Hereditary predisposition indicates an increase in the risk of diabetes by several times with this pathology in blood relatives. It doesn't matter whether an older or a younger relative suffers from an illness. Sometimes there is a tendency for the disease to be passed down from generation to generation, but this is just a coincidence.

It should be remembered that if diabetes mellitus is detected, the clinic will develop very slowly and gradually, which makes it difficult to diagnose in time.

Secondary diabetes mellitus usually develops against the background of the following processes:

1. Organic pathologies of the pancreas - inflammatory or oncological process, trauma, damage to integrity due to resection.
2. Other hormonal pathologies - diseases of the thyroid gland, adrenal glands, pituitary gland.
3. Toxic effects of drugs and other chemical agents.
4. Change in sensitivity to insulin against the background of any pathological process.
5. The patient has a genetic disease.

Gestational diabetes and diabetes due to malnutrition are somewhat different because they can be reversible processes.

What happens in the body

Due to one or more of the above reasons, a process occurs in the body in which excess sugar in the form of glycogen in the muscle tissue and liver stops being deposited. Sugar that the body could not process is still in the bloodstream, and only a small part is excreted through the kidneys. It has an extremely negative effect on absolutely all organs and systems of the body.

Since glucose does not enter the cells, they begin to actively break down fats to get energy. This leads to increased formation of nitrogenous residues - ketone bodies, which disrupts all metabolic processes.

Clinical picture

The most characteristic symptoms of a pathology that has not yet been diagnosed or with a pronounced increase in sugar can be:

• excessive thirst, accompanied by excruciating dryness in the mouth;
• increased urination during the day and at night;
• appearance of general weakness, drowsiness, fatigue and heaviness in muscles;
• appetite increases significantly;
• itching of the skin and genitals;
• wound surfaces take a long time to heal;
• with type 1 diabetes, patients lose a lot of weight, and with type 2 diabetes, on the contrary, patients gain it rapidly.

Usually, with the development of type 1 diabetes, clinical symptoms develop at lightning speed, and the second type of pathology is characterized by a gradual increase in the clinic, sometimes the symptoms can be wavy (the normal state alternates with the clinical picture of diabetes).

Complications of the disease

Both types of pathology are characterized by the development of complications that usually develop in a person in old age. Diabetes also contributes to the earlier development of such conditions.

1. Serious diseases of the cardiovascular system: atherosclerosis, ischemic conditions.
2. Development of microangiopathies in the lower extremities, kidneys, eyes.
3. Damage to the nervous system, which manifests itself in the form of dry skin, severe pain and cramps in the legs, reduces sensitivity to pain.
4. Reduced vision.
5. Damage to the kidneys with a violation of their function and an increase in protein excretion.
6. Ulcerative defects develop on the feet, which ultimately leads to necrotic and purulent processes. The basis for this is the development of neuropathy and angiopathy of the lower extremities.
7. Development of infectious complications on the skin - abscesses, fungal infections.
8. Due to poor glycemic control, comatose states with high or low sugar can develop. It is noted that the condition of hypoglycemia (low sugar) is much more difficult to treat than hyperglycemia (high sugar).

Sometimes in type 1 diabetes there is a deterioration of well-being, which is accompanied by general weakness. It can be accompanied by pain in the abdomen until vomiting, the smell of acetone can be felt from the mouth. These changes are explained by the accumulation of ketone bodies that must be removed from the blood as soon as possible. If this does not happen, ketoacidotic coma develops.

Maybe a coma with improper dosing of insulin, when too much is given. To prevent the development of any type of diabetic coma, you need to constantly monitor your blood sugar level and choose insulin doses appropriately.

Diagnostics

Patients diagnosed with diabetes are under the control of an endocrinologist. Pathology diagnosis includes the following tests:

1. Glycemic profile analysis.
2. Glucose tolerance test.
3. Urine analysis for the presence of sugar and acetone, there are special test strips for this.
4. A blood test for glycated hemoglobin, in healthy people, never exceeds the norm.
5. Determination of C-peptide, which decreases in the first type of pathology. In the second type, it may stay within the normal range.

Treatment

To treat the process, patients need:

1. Follow the dietary recommendations. They mean limiting foods that contain fast carbohydrates. The diet should be reconsidered, five meals a day are preferred.
2. Insulin therapy is prescribed for patients with type 1 or secondary insulin-dependent diabetes. It is injected subcutaneously with a syringe or special syringes. Sometimes patients have an implanted insulin pump. To this day, the development of an artificial pancreas is ongoing, which can measure sugar and inject the right amount of insulin.
3. Another type of illness involves taking sugar-lowering tablets.
4. Special physiotherapy exercises are prescribed, because physical activity helps normalize glycemia and helps fight obesity.

It must be remembered that this disease is treated for life. The higher the patient's level of self-control, the fewer life-threatening complications the patient will develop and their progression will be significantly slowed.