Diabetes (
Then you will learn: what is diabetes mellitus, its main types, symptoms and methods of treatment.
Types of diabetes mellitus (classification)
Type 1 diabetes- is characterized by an absolute deficiency of insulin in the blood:
- Autoimmune - antibodies attack the β-cells of the pancreas and destroy them completely;
- Idiopathic (no known cause);
Type 2 diabetes- relative deficiency of insulin in the blood. This means that the quantitative indicator of the level of insulin remains within normal limits, but the number of receptors for the hormone on the membranes of the target cells (brain, liver, fat tissue, muscles) decreases.
Gestational diabetes- an acute or chronic condition manifested in the form of hyperglycemia during a woman's pregnancy.
Other (situational) causes of diabetes- impaired glucose tolerance caused by reasons not related to pancreatic pathology. They can be temporary or permanent.
medicine;
infectious;
genetic defects in the insulin molecule or its receptors;
associated with other endocrine pathologies:
- Itsenko-Cushing disease;
- adrenal adenoma;
- Graves' disease.
Light form- characterized by hyperglycemia no more than 8 mmol / l, slight daily fluctuations in sugar levels, absence of glucosuria (sugar in the urine). It does not require pharmacological correction with insulin.
Quite often, at this stage, the clinical manifestations of the disease may be absent, but during instrumental diagnostics, the initial forms of typical complications with damage to the 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 - 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 reserves to produce ATP. At this stage, the glucose level is controlled with the help of diet therapy, the use of oral hypoglycemic drugs.
Clinically, it manifests itself with impaired function of the kidneys, the cardiovascular system, vision, and neurological symptoms.
A tough course- blood sugar over 14 mmol/l, with fluctuations up to 20-30 mmol, glycosuria over 50 mmol/l. Complete dependence on insulin therapy, serious dysfunction of blood vessels, nerves, organ systems.
Compensation- diet or insulin therapy allows you to achieve normal blood sugar levels. Angiopathy and neuropathy do not progress. The general condition of the patient remains satisfactory for a long time. There is no violation of sugar metabolism in the kidneys, lack of ketone bodies, acetone. Glycosylated hemoglobin does not exceed the value of "5%";
Subcompensation- the treatment does not completely correct the blood count and the clinical manifestations of the disease. Blood glucose does not exceed 14 mmol / l. Sugar molecules damage erythrocytes and glycosylated hemoglobin appears, damage to the microvessels 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 is not detected, but mild manifestations of ketoacidosis are possible;
Decompensation- the most severe phase in patients with diabetes. It usually appears in the later stages of the disease or with complete damage to the pancreas and insulin receptors. It is characterized by a general severe condition of the patient up to coma. Glucose levels cannot be corrected with medication. drugs (above 14 mmol / l). High values of sugar in the 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 (DM for short) is a polyetiological disease.
There is no single factor that causes diabetes in all people with this pathology.
The most important reasons for the development of the disease:
Genetic causes of diabetes:
- congenital insufficiency of β-cells of the pancreas;
- hereditary mutations in the genes responsible for insulin synthesis;
- genetic predisposition to autoaggression of immunity to β-cells (the closest relatives are diabetics);
Infectious causes of diabetes mellitus are pancreatotropic (affecting the pancreas) viruses: rubella, herpes type 4, mumps, hepatitis A, B, C. Human immunity begins to destroy pancreatic cells along with these viruses, which causes diabetes mellitus.
- heredity (presence of diabetes in the immediate family);
- visceral obesity;
- age (usually over 50-60 years);
- low fiber intake and high intake of refined fats and simple carbohydrates;
- hypertensive disease;
- atherosclerosis.
Precipitating factors
This group of factors in itself does not cause the disease, but significantly increases the chances of its development if there is a genetic predisposition.
- lack of physical activity (passive lifestyle);
- obesity;
- smoking;
- excessive consumption of alcohol;
- 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. In the disease, manifestations of the following clinical signs are possible to varying degrees.
Persistent weakness, reduced productivity - develops as a result of chronic energy starvation of brain cells and skeletal muscles;Dry and itchy skin - due to constant loss of fluid with urine;Dizziness, headache - signs of diabetic disease - due to lack of glucose in the circulating blood of the cerebral vessels;Frequent urination - occurs due to damage to the capillaries of the glomeruli of the nephrons of the kidneys;Reduced immunity (frequent SARS, prolonged non-healing of skin wounds) - the activity of T-cell immunity is impaired, the skin performs the barrier function worse;Polyphagia - a constant feeling of hunger - this condition develops due to the rapid loss of glucose in the urine and its insufficient transport in the cells;Reduced vision - cause - damage to microscopic vessels of the retina;polydipsia - constant thirst due to frequent urination;Numbness of the limbs - prolonged hyperglycemia leads to specific polyneuropathy - damage to the sensory nerves throughout the body;Pain in the region of the heart - the narrowing of the coronary vessels due to atherosclerosis leads to a decrease in blood supply to the myocardium and spastic pain;Decreased sexual function - has a direct connection with poor blood circulation in the organs producing sex hormones.
Diagnosis of diabetes
Diagnosing diabetes most often does not create difficulties for a qualified specialist. The doctor may suspect the disease based on the following factors:
- A patient with diabetes complains of polyuria (increase in the amount of daily urine), polyphagia (constant hunger), weakness, headache and other clinical symptoms.
- During a preventive blood test for glucose levels, the indicator is above 6. 1 mmol / l on an empty stomach or 11. 1 mmol / l 2 hours after a meal.
If this symptom is detected, a series of tests is conducted to confirm / refute the diagnosis and to establish 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 75 g of glucose dissolved in 250 ml of water to drink. After 2 hours, blood is taken again and the sugar level is determined again.
During this period, the initial symptoms of diabetes usually appear.
Evaluation criteria of 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 |
| arbitrary definition | ≥ 11. 1 |
Determination of the level of glycosylated hemoglobin (C - HbA1c)
The rate is up to 6%.
- Doubtful result - 6-6, 4%;
- In diabetes mellitus - more than 6. 4%.
Determination of the level of C-peptide
Normal: 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 (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 to determine the presence and causes of diabetes. The study is conducted in risk groups (people with a predisposition 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 more likely 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.
Norm - Titer: less than 1: 5.
If the antibody titer remains within normal limits, but the fasting glucose concentration is above 6. 1, the diagnosis is type 2 diabetes mellitus.
Level of insulin antibodies
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 test is performed. It can also indicate the causes of diabetes.
The norm of AT 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 connection between the concentration of antibodies against GAD and the development of type 1 diabetes is still not clear, but in 80-90% of patients these antibodies are detected in the blood. The analysis for AT GAD is recommended in risk groups for the diagnosis of prediabetes and the prescription of a 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 an elevated blood sugar level indicates the development of type 2 diabetes.
Blood test for insulin
The norm of insulin concentration is 2. 6-24. 9 mcU / ml
- Below the norm - the possible development of diabetes and other diseases;
- Above the norm - 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 with connective tissue).
Also, the pancreas can be enlarged, have signs of edema.
Angiography of the vessels of the lower extremities
The 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 simultaneous control of vascular patency on a computer tomograph.
If the blood supply is significantly reduced at the level of the feet of the lower limbs, the so-called "diabetic foot" is formed. The diagnosis of diabetes mellitus is based on this research method.
Ultrasound of kidneys and ECHO KG of heart
Methods of instrumental examination of the kidneys, allowing to assess the damage of these organs in the presence of a diagnosis of diabetes mellitus.
In the heart and kidneys, microangiopathies develop - damage to blood vessels with a significant reduction in their lumen, and hence a deterioration in functional abilities. The method allows to prevent the complications of diabetes mellitus.
Retinography or angiography of retinal vessels
The microscopic vessels of the retina are 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 the contrast, the degree of narrowing or complete occlusion of the vessels is determined. Also, the most important sign of DM will be the presence of microerosions and ulcers in the fundus.
The diagnosis of diabetes mellitus is a complex measure that is 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 establish a 100% correct 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 use of all treatment methods.
- Pharmacological therapy (insulin therapy);
- Diet;
- Regular physical activity;
- Preventive measures to prevent the progression of the disease and the 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) - begins to act immediately after application and acts within 3-4 hours. It is used before or immediately after a meal;short action - acts 20-30 minutes after intake. It must be applied strictly 10-15 minutes before meals;average duration - are used for long-term administration and act within 12-18 hours after the injection. Helps prevent diabetes complications;Long-acting insulin - requires constant daily use. Valid from 18 to 24 hours. It is not used to lower blood sugar levels, but only controls its daily concentration and does not allow exceeding normal values;Combination insulin - contains in different ratios ultrashort and long-acting insulins. It is mainly used in the intensive treatment of type 1 diabetes.
Diet therapy for diabetes
Diet - 50% success rate in controlling the level of glycemia in a patient with diabetes mellitus.
What foods should be consumed?
- Fruits and vegetables with low sugar content and 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 marine);
- From drinks, it is better to choose weak tea, fruit decoctions.
What should be discarded:
- Confectionery, pasta, flour;
- concentrated juices;
- Fatty meats and dairy products;
- Spicy and smoked foods;
- Alcohol.
Treatment of type 2 diabetes
In the initial stages, diabetes mellitus type 2 is well treated with dietary therapy, the same as for diabetes type 1. If the diet is not followed, as well as with a long 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.
- acts in the intestines, inhibits the activity of enzymes in the small intestine 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 of herbs, fruits and vegetables, to one degree or another correcting the level of glycemia.
carp carp - ready moss extract. The use of Criphea leads to an increase in the synthesis of pancreatic hormones: lipase, amylase, protease. In addition, it has an anti-allergic and immunomodulating effect, reduces the main symptoms of diabetes.Parsley root + lemon peel + garlic - these products contain a large amount of vitamin C, E, A, selenium and other trace elements. All this should be crushed, mixed and infused for about 2 weeks. Take 1 teaspoon orally before meals.oak acorns - contain tannin, a very effective remedy for diabetes. This substance stimulates the immune system, has anti-inflammatory and anti-edematous effects, strengthens the walls of blood vessels, relieves the expressed types. Acorns should be ground into powder and taken 1 teaspoon before each meal.
Exercise in diabetes
Regular physical activity in diabetes mellitus is a very important aspect in the treatment and prevention of diabetes complications. 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 should take a number of measures to control glycemia and the rate of development of diabetes complications.
- Children with unfavorable heredity (parents, grandparents are sick with diabetes) should be examined for blood sugar levels once a year, as well as monitor their condition and the appearance of the first symptoms of the disease. Annual consultations with an ophthalmologist, neuropathologist, endocrinologist, cardiologist will also be an important measure to determine the first symptoms of diabetes, to prevent complications of diabetes.
- People over 40 should check their glycemic levels every year to prevent type 2 diabetes;
- All diabetics must use special devices to monitor blood sugar levels - glucometers.
You also need to understand everything about diabetes - what is possible and what is not, starting with the type and reaching the causes of the disease specifically for you, for this you need a long conversation with the doctor, he will consult, guide you to passnecessary tests and to 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, and regular diagnosis of typical disorders of organ systems leads to an improvement in the patient's quality of life.