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 features.

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

Distribution

Diabetes mellitus is a pathology of the endocrine system, associated with insulin deficiency.

Diabetes itself is a pathology of the endocrine system. With it, the concentration of sugar in the blood increases continuously for various reasons. This 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 body at all levels, which ultimately leads to serious complications from the cardiovascular and nervous systems to a greater extent, and 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 the diabetes mellitus, the clinic of this condition is almost always the same.

The most common classification in the literature is:

  1. At a young age, as well as in children, diabetes mellitus with an absolute lack of insulin is the 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 is much more common than the first type and one of the provoking factors of the pathology is obesity.
  3. Symptomatic. This type of disease can occur against the background of other pathological processes, therefore it is also called secondary.
  4. Gestational diabetes that occurs during pregnancy. It often goes away on its own after birth.
  5. 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 are distinguished by the development of absolute and relative insulin deficiency, respectively. Therefore, it is the first type of disease that requires continuous administration of insulin from the outside. And when the exhaustion of the pancreas is reached, especially in the case of a long course of type 2 diabetes, such a need also 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, cells develop a lack of sugar, which serves as a signal to increase 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.

reason

Obesity is one of the main causes of diabetes

The basis of absolute insulin deficiency, which leads to the first type of disease, is an autoimmune process. It is caused by a violation 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 of the breakdown 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 like selenium increases the likelihood of a 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 should 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, i. e. when fat deposits are located in the abdomen, can be the result of metabolic disorders, i. e. prediabetes.
  2. Hereditary predisposition suggests a several-fold increase in the risk of diabetes 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 transmitted through the generation, 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 in time.

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

  1. Organic pathologies of the pancreas - an inflammatory or oncological process, trauma, violation of integrity due to removal.
  2. Other hormonal pathologies - diseases of the thyroid gland, adrenal gland, pituitary gland.
  3. Toxic effect of drugs and other chemical agents.
  4. Change in insulin sensitivity 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

In diabetes, there is a marked increase in blood sugar

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 muscle tissue and the liver stops being stored. The sugar that the body could not process continues to be 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 fats in order to get energy. This leads to an increase in the formation of nitrogenous waste - 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 marked increase in sugar, can be:

  • excessive thirst, accompanied by excruciating dryness in the mouth;
  • increased urination during the day and night;
  • the appearance of general weakness, drowsiness, fatigue and heaviness in the muscles;
  • appetite increases significantly;
  • itching of the skin and genitals;
  • 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 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 appearance of diabetes).

Complications of the disease

Diabetes can lead to complications that require hospitalization

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 early development of such conditions.

  1. Serious diseases of the cardiovascular system: atherosclerosis, ischemic state.
  2. The 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 view.
  5. Kidney damage with a violation of their function and an increase in protein secretion.
  6. Ulcerative defects develop on the legs, which eventually lead 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 may develop. It is noted that the condition of hypoglycemia (low sugar) is much more difficult to treat than hyperglycemia (high sugar).

Sometimes with 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 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 soon as possible. If this does not happen, a ketoacidotic coma develops.

Perhaps a coma with the wrong dosage 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 choose insulin doses adequately.

Diagnosing

To diagnose diabetes, a blood glucose test is performed.

Patients who have been diagnosed with diabetes are under the control of an endocrinologist. Diagnosis of the pathology includes the following tests:

  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, 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 that contain fast carbohydrates. The diet should be reviewed, five meals a day are preferred.
  2. Insulin therapy is prescribed for patients with type 1 diabetes or secondary insulin-dependent diabetes. It is injected subcutaneously with a syringe or special pens. Sometimes patients have an insulin pump installed. To date, an artificial pancreas is being developed, which itself can measure sugar and inject the right amount of insulin.
  3. The second type of disease involves taking drugs with tablets to reduce sugar.
  4. Special physiotherapy exercises are prescribed, as physical activity helps normalize blood sugar and helps fight obesity.

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