Diabetes (
Then you will find out: 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 the β-cells of the pancreas and completely destroy them;
- 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 on the membrane of the target cells (brain, liver, fat tissue, muscles) decreases.
Gestational diabetes- an acute or chronic condition that manifests itself in the form of hyperglycemia during pregnancy.
Other (situational) causes of diabetes- reduced glucose tolerance caused by causes unrelated to pancreatic pathology. They can be temporary or permanent.
drug;
infectious;
genetic defects of the insulin molecule or its receptors;
related to other endocrine pathologies:
- Itsenko-Cushing disease;
- adrenal adenoma;
- Graves' disease.
Easy form- it is characterized by hyperglycemia of up to 8 mmol / l, slight daily fluctuations in sugar levels, and the absence of glucosuria (sugar in the urine). It does not require pharmacological correction with insulin.
At this stage, it often happens that the clinical manifestations of the disease are absent, however, during instrumental diagnostics, the initial forms of typical complications with damage to peripheral nerves, retinal microvessels, kidneys and heart are already detected.
Moderate severity- peripheral blood glucose level reaches 14 mmol / l, glucosuria appears (up to 40 g / l), incoming
ketoacidosis - a sharp increase in the number of 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. In this stage, the glucose level is controlled by using diet therapy and oral hypoglycemic drugs.
Clinically, it manifests itself in impaired functioning of the kidneys, cardiovascular system, vision, and neurological symptoms.
Severe discharge- the blood sugar level exceeds 14 mmol / l, its fluctuation is 20-30 mmol, glycosuria is above 50 mmol / l. Complete dependence on insulin therapy, severe dysfunction of blood vessels, nerves, and organ systems.
Compensation- diet or insulin therapy makes it possible to achieve normal blood sugar levels. Angiopathy and neuropathy do not progress. The general condition of the patient remains satisfactory for a long time. No violations of sugar metabolism in the kidneys, no ketone bodies, acetone. Glycosylated hemoglobin does not exceed "5%";
Undercompensation- the treatment does not completely correct the blood count and the clinical manifestations of the disease. The blood sugar level does not exceed 14 mmol / l. Sugar molecules damage erythrocytes and glycosylated hemoglobin appears, damage to microvessels in the kidneys appears in the form of a small amount of glucose in the urine (up to 40 g / l). Acetone is not detected in the urine, but mild manifestations of ketoacidosis are possible;
Decompensation- the most severe phase of diabetes patients. It usually occurs in the later stages of the disease or in complete damage to the pancreas and insulin receptors. It is characterized by the general serious condition of the patient up to the point of coma. Glucose levels cannot be corrected with medication. drugs (above 14 mmol / l). A large amount 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 (abbreviated DM) is a polyetiological disease.
There is no single factor that causes diabetes in all people with this pathology.
The most significant causes of the disease:
Genetic causes of diabetes:
- congenital insufficiency of β-cells of the pancreas;
- hereditary mutations of the genes responsible for insulin synthesis;
- genetic predisposition to autoaggression of immunity against β-cells (closest relatives have diabetes);
Infectious causes of diabetes mellitus are pancreatotropic (pancreatic) viruses: rubella, herpes type 4, mumps, hepatitis A, B, C. Together with these viruses, human immunity begins to destroy pancreatic cells, which causes diabetes.
- 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;
- arteriosclerosis.
Provocative factors
This group of factors alone does not cause the disease, but in the case of a genetic predisposition, it significantly increases the chance of its development.
- physical inactivity (passive lifestyle);
- obesity;
- smoking;
- excessive alcohol consumption;
- the use of substances that affect the pancreas (such as drugs);
- excess fat and simple carbohydrates in the diet.
Symptoms of diabetes
Diabetes is a chronic disease, so symptoms never appear suddenly. Women's symptoms and men's symptoms are almost identical. Manifestations of the following clinical symptoms are possible with the disease to varying degrees.
Constant weakness, reduced 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 fluid 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 kidney nephrons;Decreased immunity (common SARS, long-term non-healing of wounds on the skin) - the activity of T-cell immunity is impaired, the skin performs a worse barrier function;Polyphagia - 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 vision - cause - damage to the microscopic blood 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 - the narrowing of the coronary arteries due to atherosclerosis leads to a decrease in blood supply to the heart muscle and spasmodic pain;Decreased sexual function - is directly related to poor blood circulation in the organs that produce sex hormones.
Diagnosis of diabetes
Diagnosing diabetes most often does not cause difficulties for a qualified specialist. The doctor may suspect the disease based on the following factors:
- Diabetic patients complain of polyuria (increased daily urine volume), polyphagia (constant hunger), weakness, headache, and other clinical symptoms.
- During the preliminary blood test of the glucose level, the indicator was 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 are performed to confirm/disprove the diagnosis and explore the causes.
Laboratory diagnostics of diabetes
Oral Glucose Tolerance Test (OGTT)
A standard test to determine the functional ability of insulin to bind glucose and to maintain normal blood levels.
The essence of the method:in the morning, after 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. After 2 hours, we take blood again and determine the sugar level again.
During this period, the initial symptoms of diabetes usually appear.
Criteria for evaluating the OGTT analysis:
| Norm | |
| On an empty stomach | < 5. 6 |
| 2 hours after OGTT | < 7. 8 |
| Diabetes mellitus (differential diagnosis is required for types of diabetes) | |
| On an empty stomach | ≥ 6. 1 |
| 2 hours after OGTT | ≥ 11. 1 |
| random definition | ≥ 11. 1 |
Determination of glycosylated hemoglobin (C - HbA1c) level
The norm is no more than 6%.
- Doubtful result - 6-6, 4%;
- In diabetes mellitus - more than 6. 4%.
Determination of C-peptide level
Norm: 0. 79-1. 90 ng/ml (SI: 0. 27-0. 64 mmol/l).
Determining the level of proinsulin
This test makes it possible to distinguish between various diseases of the pancreas and diabetes. An increase in the level of proinsulin in the blood most often indicates an endocrine tumor - an insulinoma (a rather rare pathology). In addition, high concentrations of proinsulin molecules may indicate type 2 diabetes.
The norm is 3. 3-28 pmol / l.
Determination of the level of antibodies against pancreatic beta cells
One of the most accurate tests to determine the presence and causes of diabetes. The test is performed in risk groups (for example, people prone to diabetes, if their closest relatives have this disease), as well as in patients with impaired glucose tolerance during the OGTT.
The higher the titer of specific antibodies, the more likely the autoimmune etiology of the disease, and the faster the beta cells are destroyed, and the faster the insulin level in the blood decreases. In diabetics, it usually exceeds 1: 10.
Norm - Titer: 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.
Insulin antibody level
Another specific immunological test. It is performed for the differential diagnosis of diabetic patients (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 AT norm of insulin is 0-10 IU / ml.
- If C (AT) is higher than normal, the diagnosis is type 1 diabetes. 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 in the central nervous system. The logical connection between the concentration of antibodies against GAD and the development of type 1 diabetes is still unclear, however, in 80-90% of patients, these antibodies can be detected in the blood. Analysis of AT GAD is recommended for the diagnosis of prediabetes and the prescription of preventive diet and drug therapy in risk groups.
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 insulin test
The norm of insulin concentration is 2. 6-24. 9 mcU / ml
- Below the norm - possible development of diabetes and other diseases;
- Above normal - tumor of the pancreas (insulinoma).
Instrumental diagnostics of diabetes
Ultrasound of the pancreas
The method of ultrasound scanning makes it possible to detect morphological changes in the tissues of the gland.
Diffuse damage is usually determined in diabetes mellitus (areas of sclerosis - replacement of functionally active cells with connective tissue).
In addition, the pancreas may become enlarged, with signs of edema.
Angiography of the vessels of the lower limbs
The arteries of the lower limb are the target organs of 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 material into the bloodstream while simultaneously controlling the permeability of blood vessels on a computer tomograph.
If the blood supply at the level of the feet of the lower limbs is significantly reduced, the so-called "diabetic foot" develops. The diagnosis of diabetes mellitus is based on this research method.
Ultrasound of the kidneys and heart ECHO KG
Methods of instrumental examination of the kidneys, which allow the assessment of damage to these organs in the case of a diagnosis of diabetes mellitus.
Microangiopathies develop in the heart and kidneys - damage to the blood vessels, with a significant reduction in their lumen, and thus a deterioration in functional abilities. The method makes it possible to prevent the 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 in them begins even before the first clinical signs of diabetes mellitus.
With the help of contrast, the degree of narrowing or complete blockage of blood vessels is determined. The most important sign of DM is also the presence of microerosions and ulcers in the fundus.
The diagnosis of diabetes mellitus is a complex measure based on medical history, an objective examination by a specialist, laboratory tests and instrumental tests. It is impossible to make a 100% correct diagnosis using only one diagnostic criterion.
If you are at risk, be sure to contact 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 aimed at correcting the level of glycemia, cholesterol, ketone bodies, acetone, lactic acid, preventing the rapid development of complications and improving the quality of human life.
In the case of diabetes, it is very important to use 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, type and frequency of insulin injections for diabetic patients are strictly individual and are chosen by specialists (therapist, endocrinologist, cardiologist, neuropathologist, hepatologist, diabetologist). They always pay attention to the symptoms of diabetes, perform differential diagnosis, screening and evaluate the effectiveness of medications.
Types of insulin:
fast acting (ultra-short effect) - starts working immediately after administration and takes effect within 3-4 hours. It is applied before or immediately after a meal;short sale - takes effect 20-30 minutes after administration. It must be used strictly 10-15 minutes before meals;medium duration - they are used for continuous reception and take effect within 12-18 hours after the injection. Helps prevent diabetes complications;Long-acting insulin - requires continuous daily use. Valid from 18: 00 to 24: 00. It is not used to reduce blood sugar, but only regulates its daily concentration and does not allow it to exceed normal values;Combined insulin - contains different proportions of ultra-short-acting and long-acting insulins. It is mainly used in the intensive therapy of type 1 diabetes.
Diabetes diet therapy
Diet - 50% success in controlling glycemic levels in patients with diabetes.
What foods should be eaten?
- Fruits and vegetables with a low sugar level and a high concentration 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);
- Among the drinks, it is better to choose weak tea and fruit juices.
What to throw away:
- Sweets, pasta, flour;
- concentrated fruit juices;
- Fatty meat and dairy products;
- Spicy and smoked foods;
- Alcohol.
Treatment of type 2 diabetes
In the initial stage, type 2 diabetes mellitus can be well treated with diet therapy, just like type 1 diabetes. If the diet is not followed, as well as in the case of 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.
- exerts its effect in the intestine, inhibiting 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
Folk methods include the preparation of various decoctions of herbs, fruits and vegetables, which to some extent correct the level of glycemia.
kryphea amur - ready extract from moss. The use of Criphea increases the synthesis of pancreatic hormones: lipase, amylase, protease. It also has an antiallergenic and immunomodulating effect, reducing the main symptoms of diabetes.Parsley root + lemon peel + garlic - these products contain large amounts of vitamins C, E, A, selenium and other trace elements. All this must be crushed, mixed and infused for about 2 weeks. Take 1 teaspoon orally before meals.oak acorn - they contain tannin, which is a very effective medicine for the treatment of diabetes. This substance stimulates the immune system, has an anti-inflammatory and anti-edema effect, strengthens the walls of blood vessels, and relieves severe types. Acorns should be ground into a 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 complications of diabetes mellitus. Morning exercises, running, and swimming help to avoid obesity, improve blood supply to muscles and organs, strengthen blood vessels, and stabilize the nervous system.
Disease prevention
In the case of a genetic predisposition, the disease cannot be prevented. However, people at risk need to take a number of measures to control glycemia and the rate at which diabetes complications develop.
- Children with unfavorable heredity (parents, grandparents with diabetes) should have their blood sugar tested once a year, and their condition and the appearance of the first symptoms of the disease should be monitored. An annual consultation with an ophthalmologist, neuropathologist, endocrinologist, and cardiologist will also be an important measure to determine the first symptoms of diabetes in order to prevent diabetes complications.
- People over the age of 40 should have their glycemic levels checked annually to prevent type 2 diabetes;
- All diabetics must use special devices to control blood sugar - glucometers.
You also need to know everything about diabetes - what is possible and what is not, starting from the type of the disease and the causes specifically for you, this requires a long conversation with the doctor, he consults and manages. you must pass the necessary tests and prescribe the treatment.
recovery prognosis
Diabetes mellitus is an incurable disease, so the prognosis for recovery is poor. However, the modern development of pharmaceutical insulin therapy can significantly prolong the life of a diabetic patient, and the regular diagnosis of typical organ system disorders results in an improvement of the patient's quality of life.