Clinic and diagnosis of diabetes

Diagnosing diabetes mellitus begins with establishing 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 one and a half thousand years ago as an independent nosological unit. Then the diagnosis was established with various methods, which are not used today due to their irrelevance. For example, Hippocrates told his patients that they have diabetes mellitus, the clinic of which is bright if the urine has a sweet taste on examination. 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 vessel where the urine was placed.

Classification

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

The result of this process is always a violation of the metabolism of the human body at all levels, which ultimately leads to severe complications of the cardiovascular and nervous systems to a greater extent, and the rest of the functional units of the body suffer a little 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, diabetes mellitus with absolute insulin deficiency is most common. It is called the first type.
2. Insulin-dependent diabetes occurs more often in adulthood and is characterized by a relative lack of insulin. Type 2 diabetes usually occurs in the elderly, but there are cases when the pathology also affects young people. It occurs much more often than the first type, and one of the provoking factors for the pathology is excess weight.
3. Symptomatic. This type of disease can occur against the background of other pathological processes, so it is called secondary.
4. Gestational diabetes that occurs during pregnancy. It often goes away on its own after birth.
5. Malnutrition can also develop a pathology such as diabetes mellitus.

It should be noted once again that the first and second types of pathology are distinguished by the development of absolute and relative insulin deficiency, respectively. Therefore, this is the first type of disease that requires constant introduction of insulin from the outside. And when it comes to exhaustion of the pancreas, especially with a long course of type 2 diabetes, such a need arises.

In itself, the second 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 sugar deficit, which serves as a signal for increased insulin production, which has little effect. As a result, the amount of insulin produced begins to fall, which leads to an increase in glycemic indicators.

The reasons

The basis of absolute insulin deficiency leading to the first type of disease is an autoimmune process. It is caused by a disorder of the immune system, which provokes 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 for disruption of the immune system with 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 pathology.

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

1. The higher the degree of obesity, the higher the risk of diabetes, while in the third degree it increases 10 times. Abdominal obesity, that is, when fat deposits are located in the abdomen, can be the result of metabolic disorders, that is, prediabetes.
2. Hereditary predisposition implies an increase in the risk of diabetes several times with this pathology in blood relatives. It does not matter whether the older or the younger relative suffers from the disease. Sometimes there is a tendency for the disease to be passed down through the generations, but this is just a coincidence.

It should be borne in mind that if diabetes mellitus is detected, the clinic will develop very slowly and gradually, which complicates the diagnosis over time.

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

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

Gestational diabetes and diabetes due to malnutrition are slightly different in that they can be reversible processes.

What happens in the body

Due to one or more of the above reasons, a process takes place in the body in which the excess sugar in the form of glycogen in the muscle tissue and the liver stops being deposited. The sugar that the body has not been able to process remains in the bloodstream and only a small part of it is excreted by the kidneys. This 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 fat 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;
• the appearance of general weakness, drowsiness, fatigue and heaviness in the muscles;
• appetite increases significantly;
• skin and genital itching;
• wound surfaces heal for a very long time;
• in type 1 diabetes, patients lose a lot of weight, and in type 2 diabetes, on the contrary, patients quickly gain it.

Usually, with the development of type 1 diabetes, clinical symptoms develop in a flash, and the second type of pathology is characterized by a gradual increase in the clinic, sometimes the symptoms can be wave-like (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 an elderly person. 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 limbs, kidneys, eyes.
3. Damage to the nervous system, which manifests itself in the form of dry skin, severe pain and leg cramps, reduces sensitivity to pain.
4. Reduced vision.
5. Damage to the kidneys with a violation of their function and increased excretion of proteins.
6. Ulcerative defects develop on the legs, which ultimately leads to necrotic and purulent processes. The basis for this is the development of neuropathy and angiopathy of the lower extremities.
7. The 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 abdominal pain up to vomiting, there is an acetone smell from the mouth. These changes are explained by the accumulation of ketone bodies, which must be removed from the blood as quickly as possible. If this does not happen, ketoacidotic coma develops.

Perhaps a coma with incorrect dosing of insulin when an excessive amount is administered. To prevent the development of any type of diabetic coma, you must constantly monitor blood sugar levels and adequately choose insulin doses.

Diagnosis

Patients who are diagnosed with diabetes are under the control of an endocrinologist. The diagnosis of the pathology includes the following studies:

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

Treatment

To treat the process, patients need:

1. Adhere to dietary recommendations. They mean limiting foods containing fast carbohydrates. The diet should be revised, preferring five meals a day.
2. Insulin therapy is prescribed for patients with type 1 or secondary insulin-dependent diabetes. It is injected subcutaneously with a syringe or special pens for syringes. Sometimes patients have an insulin pump installed. To date, the development of an artificial pancreas that can measure sugar and inject the right amount of insulin by itself is underway.
3. The second type of disease involves taking sugar-lowering tablets.
4. Special physical therapy exercises are prescribed, as physical activity helps normalize glycemia and helps fight obesity.

It should be borne in mind that this disease is treated for life. The higher the patient's level of self-control, the less life-threatening complications the patient will develop and their progression will be significantly slowed.