Clinic and diagnosis of diabetes

The diagnosis of diabetes mellitus begins with the discovery of the main signs - symptoms. Despite the similarity of the clinical manifestations of the disease, each type of diabetes has its own characteristics.

Diabetes mellitus was described by the ancient Egyptians as an independent nosological entity about one and a half thousand years ago. The diagnosis was then made using various methods, which are no longer used due to their irrelevance. For example, Hippocrates told his patients that they were suffering from diabetes, whose clinic was clear if the urine tasted sweet during the examination. In Chinese medicine, to diagnose this insidious disease, insects were used - flies, wasps, which, in the presence of sugar in the urine, sat on the container where the urine was placed.

Classification

Diabetes itself is a pathology of the endocrine system. Due to this, the concentration of sugar in the blood continuously rises due to various reasons. This is usually insulin deficiency, which can be absolute or relative. This hormone is produced in beta cells 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 a greater degree of serious complications from the cardiovascular system and nervous system, and the remaining functional units of the body suffer somewhat less.

To date, there are many diseases that use completely different approaches to their 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. Diabetes mellitus with absolute insulin deficiency is the most common in young people and children. 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 older people, 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 excess weight.
3. Symptomatic. This type of disease can also occur against the background of other pathological processes, so it is also called secondary.
4. Gestational diabetes during pregnancy. It often goes away on its own after giving birth.
5. In the case of malnutrition, a pathology such as diabetes mellitus may develop.

It should be noted once again that the pathology of the first and second types is distinguished by the development of absolute and relative insulin deficiency. Therefore, it is the first disease that requires constant administration of insulin from the outside. And when pancreatic exhaustion is reached, especially in the long-term course of type 2 diabetes, such a need arises.

The second type of the disease itself is also characterized by sufficient insulin production, but the body's cells are insensitive to it for various reasons: it may happen that the organs responsible for this process are blocked or their number is insufficient for effective communication. As a result, there is a lack of sugar in the cells, which serves as a signal for increased insulin production, which has no effect. As a result, the amount of insulin produced begins to decrease, which leads to an increase in glycemic indicators.

The reasons

Absolute insulin deficiency leading to the first type of diseases is based on an autoimmune process. It is caused by a violation of the immune system, which triggers the production of its own antibodies, which are aimed at fighting the beta cells of the islets of Langerhans. This leads to their destruction.

The main provoking factors of the disruption of the immune system with the subsequent production of antibodies are often various viral infections, the most aggressive of which can be rubella, chicken pox, and mumps. I have a genetic predisposition to pathology.

It should not be forgotten that a substance like 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 overweight. These factors should be considered in more detail.

1. The higher the level of obesity, the greater the risk of diabetes, while it increases 10 times for the third degree. 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 refers to a multiple increase in the risk of diabetes in blood relatives with this pathology. It does not matter if the relative is older or younger. Sometimes there is a tendency for the disease to pass through generations, but this is just a coincidence.

It should not be forgotten that if diabetes is detected, the clinic develops very slowly and gradually, which complicates the diagnosis in time.

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

1. Organic pathologies of the pancreas - inflammatory or oncological process, trauma, violation of integrity due to resection.
2. Other hormonal pathologies - diseases of the thyroid gland, adrenal gland, pituitary gland.
3. Toxic effects of drugs and other chemicals.
4. Changes in insulin sensitivity in the background of any pathological process.
5. The patient has a genetic disease.

Gestational diabetes and diabetes due to malnutrition are slightly different because 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 excess sugar ceases to be deposited in the form of glycogen in muscle tissue and the liver. The sugar that the body has not been able to process remains in the bloodstream and only a small amount is excreted through 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 to obtain energy. This leads to increased formation of nitrogen-containing residues - ketone bodies - which disrupts all metabolic processes.

Clinical picture

The most typical symptoms of a pathology that has not yet been diagnosed or is accompanied by a pronounced increase in sugar levels may be the following:

• excessive thirst accompanied by painful dry mouth;
• increased urination during the day and at 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 weight rapidly.

Usually, with the development of type 1 diabetes, the clinical symptoms develop very quickly, and the second type of pathology is characterized by a gradual increase in the clinic, sometimes the symptoms can be fluctuating (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, which usually develop in old age. Diabetes also contributes to the earlier development of such conditions.

1. Serious diseases of the cardiovascular system: arteriosclerosis, ischemic conditions.
2. Formation 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 pain sensitivity.
4. Reduced vision.
5. Damage to the kidneys with a violation of their function and an increase in protein excretion.
6. Ulcerative defects develop on the legs, which ultimately lead to necrotic and purulent processes. This is based on the development of neuropathy and angiopathy of the lower limbs.
7. Development of infectious complications on the skin - abscesses, fungal infections.
8. Coma states with high or low sugar levels can develop due to poor glycemic control. It should be noted that the condition of hypoglycemia (low sugar) is much more difficult to treat than hyperglycemia (high sugar).

Sometimes in type 1 diabetes, well-being deteriorates, accompanied by general weakness. It may be accompanied by abdominal pain that extends to vomiting, and 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 improper dosing of insulin, if an excessive amount is given. To prevent the development of any type of diabetic coma, you need to constantly monitor your blood sugar and choose the right dose of insulin.

Diagnostics

Patients diagnosed with diabetes are under the supervision of an endocrinologist. Diagnosis of pathology consists of the following tests:

1. Glycemic profile analysis.
2. Glucose tolerance test.
3. Urinalysis for the presence of sugar and acetone, there are special test strips for this.
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. With the second type, it can stay within the normal range.

Treatment

To manage the process, patients need:

1. Follow the dietary recommendations. They mean limiting foods containing fast carbohydrates. The diet should be reviewed, five meals a day are preferred.
2. Insulin therapy is prescribed for patients with type 1 or secondary insulin-dependent diabetes. The subcutaneous injection should be given with a syringe or a special pen. Sometimes patients are fitted with an insulin pump. To this day, the development of an artificial pancreas is underway, which can measure sugar and administer the right amount of insulin.
3. The second type of the disease involves taking tablets to reduce sugar levels.
4. Special physiotherapy exercises are prescribed, as physical activity helps normalize blood sugar and helps fight obesity.

It should not be forgotten that this disease is treated for life. The higher the patient's self-control, the less life-threatening complications develop in the patient, and the patient's progress slows down appreciably.