diabetes (
Further, 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 destroy them completely;
- 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 the normal range, but the number of receptors for the hormone in the membranes of target cells (brain, liver, adipose 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- impairment of glucose tolerance, caused by causes unrelated to pancreatic pathology. They can be temporary or permanent.
drugs;
infectious;
genetic defects in the insulin molecule or its receptors;
associated with other endocrine pathologies:
- Itsenko-Cushing disease;
- adrenal adenoma;
- Graves' disease.
Easy form- characterized by hyperglycemia not more than 8 mmol / l, slight daily fluctuations in sugar levels, lack of glucosuria (sugar in the urine). It does not require pharmacological correction with insulin.
Very 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, retinal microvessels, kidneys and heart have already been detected.
Moderate severity- the level of glucose in the peripheral blood reaches 14 mmol / l, glucosuria appears (up to 40 g / l), an entry
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 begins to use fat stores to produce ATP. At this stage, the glucose level is controlled with the help of dietary therapy, the use of oral hypoglycemic drugs.
Clinically, it manifests with impaired kidney function, cardiovascular system, vision, neurological symptoms.
Heavy course- blood sugar exceeds 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 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, lack of ketone bodies, acetone. Glycosylated hemoglobin does not exceed the "5%" value;
Undercompensation- The treatment does not completely correct the blood count and the 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 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 urine is not detected, however, mild manifestations of ketoacidosis are possible;
Decompensation- the most severe phase of patients with diabetes. It usually occurs in the later stages of the disease or total damage to the pancreas and insulin receptors. It is characterized by a severe general condition of the patient up to coma. The glucose level cannot be corrected with the help of drugs. 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 as DM) is a polyetiological disease.
There is no single factor that would cause diabetes in all people with this pathology.
The most important causes of the development of the disease:
Genetic causes of diabetes:
- congenital insufficiency of pancreatic β cells;
- hereditary mutations in genes responsible for insulin synthesis;
- genetic predisposition to immune autoaggression against β cells (the closest relatives are diabetics);
Infectious causes of diabetes mellitus are pancreatotropic viruses (that affect the pancreas): 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.
Provocative factors
This group of factors does not itself cause the disease, but significantly increases the chances of its development, if there is a genetic predisposition.
- physical inactivity (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. With the disease, manifestations of the following clinical signs are possible in varying degrees.
Persistent 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 the constant loss of liquids 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 capillaries of the glomeruli of the nephrons of the kidneys;Reduced immunity (frequent SARS, prolonged non-healing of skin wounds) - the immune activity of T cells is impaired, the skin performs a 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 to the cells;Reduced view - cause - damage to the microscopic vessels of the retina;Polydipsia - constant thirst due to frequent urination;Numbness of the 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;Decreased sexual function - is directly related to poor blood circulation in the organs that produce sex hormones.
Diabetes diagnosis
Diagnosing diabetes most often does not cause difficulties for a qualified specialist. The doctor may suspect the disease, based on the following factors:
- A diabetic patient complains of polyuria (increased daily urine output), polyphagia (constant hunger), weakness, headache and other clinical symptoms.
- During a preventive blood test for glucose levels, 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 are performed to confirm/disprove the diagnosis and discover 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:
| rate | |
| 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 rate is up to 6%.
- Doubtful result - 6-6, 4%;
- In diabetes mellitus - more than 6. 4%.
Determination of C-peptide level
Rate: 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, high concentrations of proinsulin molecules can indicate type 2 diabetes.
The rate 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 test is performed in risk groups (people with a predisposition to diabetes, for example, if 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 blood insulin level decreases. In diabetics, it usually exceeds 1: 10.
Rate - Titre: 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.
The level of insulin antibodies
Another specific immunological analysis. It is used 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 rate 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 correlation between the concentration of antibodies to GAD and the development of type 1 diabetes is not yet clear, however, 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.
Rate AT GAD - 0-5 IU / ml.
- A positive result with normal blood sugar 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 rate of insulin concentration is 2. 6-24. 9 mcU / ml
- Below the norm - possible development of diabetes and other diseases;
- Above normal - a tumor of the pancreas (insulinoma).
Instrumental diagnosis of diabetes
Ultrasound of the pancreas
The method of ultrasound scanning allows you to detect morphological changes in the tissue 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
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 in a computerized tomography.
If the blood supply is significantly reduced at the level of the feet of the lower extremities, the so-called "diabetic foot" is formed. 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, allowing 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 decrease in their lumen, and consequently a deterioration of functional abilities. The method allows you to prevent complications of diabetes mellitus.
Retinography or angiography of retinal vessels
The microscopic vessels of the retina are the most sensitive to hyperglycemia, so the development of damage to them begins even before the first clinical signs of diabetes mellitus appear.
With the help of the contrast, the degree of narrowing or complete closure of the vessels is determined. Also, the most important sign of DM will be the presence of microerosions and ulcers on the bottom.
The diagnosis of diabetes mellitus is a complex measure, which 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 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
The 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, the type and frequency of its administration are strictly individual and are chosen by specialists (therapist, endocrinologist, cardiologist, neuropathologist, hepatologist, diabetologist). They always pay attention to the symptoms of diabetes, perform a differential diagnosis, review and evaluate the effectiveness of drugs.
Types of insulin:
quick action (ultra short action) - begins to act immediately after administration and acts within 3-4 hours. It is used before or immediately after a meal;short action - acts 20-30 minutes after administration. It is necessary to apply strictly 10-15 minutes before meals;average duration - are used for continuous intake and act within 12-18 hours after injection. Helps prevent complications of diabetes;Long-acting insulin - requires continuous daily use. Valid from 18 to 24 hours. It is not used to reduce the level of glucose in the blood, but only controls its daily concentration and does not allow exceeding normal values;Combined insulin - contains different ratios of ultra-short-acting and long-acting insulin. It is mainly used in the intensive care of type 1 diabetes.
Diet therapy for diabetes
Diet - 50% success in controlling the level of glycemia in a patient with diabetes mellitus.
What foods should be consumed?
- Fruits and vegetables with low levels of sugar and high concentrations of vitamins and minerals (apples, carrots, cabbage, beets);
- Meat containing 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 decoction.
What to discard:
- Sweets, pasta, flour;
- concentrated liquids;
- Fatty meat and dairy products;
- Spicy and smoked foods;
- Alcohol.
Treatment of type 2 diabetes
In the initial stages, type 2 diabetes mellitus is well treated with diet therapy, just like for type 1 diabetes. If the diet is not respected, 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.
- works in the intestine, inhibits the activity of small intestinal enzymes that break down polysaccharides into glucose.
- a drug for the prevention of polyneuropathy, micro- and macroangiopathy of the kidneys, heart and retina.
Folk remedies for the treatment of diabetes
Popular methods include the preparation of various decoctions of herbs, fruits and vegetables, to one degree or another correcting the level of glycemia.
kryphea amur - ready extract from moss. The use of Criphea causes 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 vitamin C, E, A, selenium and other trace elements. All this should be crushed, mixed and injected for about 2 weeks. Use orally 1 teaspoon before meals.oak acorns - contain tannin, a very effective medicine for diabetes. This substance stimulates the immune system, has anti-inflammatory and anti-edematous effects, strengthens the walls of blood vessels, relieves stress. Liches should be ground into powder and taken 1 teaspoon before each meal.
Physical exercise 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 should take a number of measures to control blood sugar and the rate of development of diabetes complications.
- Children with unfavorable inheritance (parents, grandparents are sick with diabetes) should be tested for the level of sugar in the blood 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, cardiologist to determine the first symptoms of diabetes, to prevent diabetes complications.
- People over 40 should check their blood sugar levels every year 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, what is not, starting from the type and ending with the causes of the disease specifically for you, for this you need a long conversation with the doctor, he will consult, directpass the necessary tests and prescribe the treatment.
prognosis of recovery
Diabetes mellitus is an incurable disease, so the prognosis for recovery is poor. However, modern advances in pharmacological therapy with insulin 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.