Diabetes mellitus is perhaps the most common disease in the world: according to official statistics, about 6% of the world's population suffers from it. And most doctors agree that these data do not reflect reality: more than half of the cases have not been diagnosed. Meanwhile, early detection of diabetes can significantly increase the life expectancy of patients and prevent the development of many complications. We will talk about what signs indicate elevated blood glucose levels and what research should be done to be sure that there is no disease.
Diabetes manifests itself, regardless of its type, it is always the same - the cells stop “extracting” energy from glucose and the substance in its undigested form accumulates in the body. Disruption of metabolic processes due to a lack of the hormone insulin, which is responsible for the absorption of sugars. However, the causes, characteristics and symptoms of different types of diabetes are different.
With type 1 diabetes Insulin is not produced by the body due to significant damage to the beta cells of the pancreas during an autoimmune attack. The appearance of the disease is often preceded by viral infections. Typically, this type of diabetes does not depend on the patient's body and occurs at an early age - in children, adolescents and young people under 25 years old.
To Type 2 According to various sources, up to 95% of all cases of diabetes are reported. Unlike type 1, the body continues to produce insulin, but it is incorrectly perceived by the cells and is not absorbed. It provokes the development of the disease obesity (especially the accumulation of fat in the abdomen and waist), hereditary factors, inactive lifestyle, poor diet. Type 2 diabetes is a disease of a mature age; citizens over 45 years of age are more susceptible to it.
Gestational diabetes - quite rare and, fortunately, a temporary type that develops exclusively during pregnancy and disappears with its termination. The development of the disease can be considered an individual reaction of the organism: hormones produced block insulin's perception of the cells of the expectant mother. In some cases, the pancreas simply does not cope with the double production of insulin - the result is gestational diabetes. Risk factors include the late age of the woman in labor (over 40 years), smoking, overweight, heredity.
Clinical signs of diabetes
Diabetes is one of the most insidious diseases, according to doctors: its early stages are rarely accompanied by painful sensations and do not always have pronounced symptoms. To notice the first signs of diabetes, you need to listen carefully to your body and, of course, know which violations should be paid attention to.
In general, the symptoms of all types of diabetes are similar and do not depend on gender and age: the occurrence of certain signs of the disease in men, women and children are very individual.
Symptoms of type 1 diabetes
Type 1 diabetes develops rapidly and has pronounced manifestations. The patient, despite the increased appetite, quickly loses weight, feels constant fatigue, drowsiness, thirst. Frequent urge to urinate make him wake up in the middle of the night several times, the amount of urine is much higher than normal. Symptoms occur suddenly and with careful attention do not go unnoticed.
Symptoms of type 2 diabetes
The second type of diabetes mellitus is the most common and at the same time the most difficult to recognize.The disease is slow, and, despite the large number of possible symptoms, they are usually mild.
For diabetes of the second type are peculiar:
- dry mouth and thirst, the patient can consume up to three to five liters of fluid daily,
- weight loss,
- excessive urination,
- constant fatigue, drowsiness, feeling of weakness, irritability,
- tingling sensation in the fingers, numbness of the limbs,
- significant sudden weight loss despite high appetite
- nausea, sometimes vomiting,
- skin is dry, severe itching is possible, long healing of wounds and abrasions,
- urinary tract infections,
- high blood pressure.
Both types of diabetes considered are fraught with serious complications. So, hyperosmolar and lacticidotic coma, hypoglycemia, ketoacidosis can develop literally within two to three hours and in some cases lead to death.
Also, diabetes is the cause of vision problems (up to complete blindness), heart, kidney, nervous system, skin, blood vessels. Thrombosis, atherosclerosis, renal failure, myocardial infarction, stroke - these are just a small part of the list of dangerous diseases that can be observed with late diagnosis and improper treatment of diabetes.
Symptoms of Gestational Diabetes
This type of disease very rarely has external symptoms: it is usually detected only during routine examinations, including urine and blood tests. In cases where the manifestations are still noticeable, they are similar to signs of type 1 and 2 diabetes: weakness, nausea, thirst, infections of the urinary tract.
Gestational diabetes, although it does not pose a direct threat to the life of the child, still adversely affects the condition of the mother and baby: the higher the blood glucose levels, the stronger the impact of the disease. As a rule, a baby is born with a weight exceeding the norm, in the future it remains prone to obesity, diabetes. There is a small risk of delayed fetal development, as well as hypoglycemia, jaundice and other diseases in the first weeks of a child’s life.
Laboratory signs of diabetes in men, women and children
Reliable confirmation of the diagnosis is possible only after conducting a series of laboratory tests that allow to assess the level of sugar (glucose) in the blood:
- Random analysis of glucose in the blood plasma usually carried out during mass surveys and clinical examinations, as well as, if necessary, conduct an emergency study of indicators. A critical value can be considered as 7 mmol / l or more.
- Fasting blood glucose test - the most common type of analysis, though not characterized by absolute accuracy, but simple in execution. As a rule, it is carried out in the morning, while the patient should not eat food within 8-12 hours before the study. As with any blood test, you should not drink alcoholic beverages the day before, and also smoke one hour before taking the material. It is considered a good indicator if the glucose level does not exceed 5.5 mmol / l. With 7 mmol / l or more, the patient will be referred for additional examination.
- Glucose Tolerance Test usually prescribed to clarify the results of the above analyzes. The test allows you not only to accurately answer the question about the presence of diabetes, but also to diagnose impaired glucose tolerance. To do this, the patient is taken blood on an empty stomach, then he has to drink a glass of water with sugar dissolved in it (75 g for adults, 1.75 g per 1 kg of the child’s weight), and two hours later - repeat the analysis. In the normal state of the body, the first indicator is below 5.5 mmol / l, and the second is less than 7.8 mmol / l. Values from 5.5 to 6.7 mmol / l and from 7.8 to 11.1 mmol / l, respectively, indicate the presence of pre-diabetes. Values above these numbers indicate diabetes.
- Research on glycated hemoglobin - A modern reliable test recommended by the World Health Organization for the detection of diabetes.His results show the average value of blood glucose over the past 90 days, while the accuracy is not affected by meals, or the time of taking the material, or many other external factors. Normally, the indicator will be less than 6.5% HbA1C, which corresponds to a glucose level of 7.8 mmol / l, a value above this is a clear sign of the disease. At 6% (7 mmol / l), the risk of diabetes is considered elevated, but the situation can still be corrected by a change in lifestyle.
Modern methods of treatment in combination with the prescribed diet can make the life of a patient with diabetes full and comfortable, as well as avoid the appearance of many complications. The biggest problem is the timely diagnosis of this disease: many patients go to the clinic only in the late stages of diabetes. To avoid irreversible effects on the body, doctors recommend at least once a year to undergo an examination, especially if there are “risk factors” in history and even more so when the first signs of diabetes appear.
What is diabetes?
They knew about the disease in ancient times, but then the main symptom of diabetes was considered only thirst, combined with frequent urination, and people did not have an idea about endocrine changes. Later, the disease was repeatedly investigated, although it has not yet been fully established why it occurs, and there is also no way to finally get rid of an existing pathology.
The general characteristics of diabetes mellitus are pathological changes relative to the basic assimilation of glucose and any sugars. This change can be absolute, that is, insulin stops being released altogether, or relative, depending on how much the pancreas loses the ability to produce a hormone, which is responsible for the conversion of sugar into energy - insulin.
During the development of the disease the following occurs:
- Pancreatic cells either stop producing insulin altogether, or its production decreases to a critical level. As a result, severe starvation of all body systems occurs, since glucose is the main source of energy. All incoming sugar remains in the blood without undergoing further metabolic transformation.
- In another case, insulin production does not decrease, but the cells that must take this hormone and absorb glucose, appear to be resistant to the substance - that is, they cease to "notice" it.
- A paradoxical situation arises: the body, on the one hand, is hungry due to the fact that the incoming sugars are not processed into nutrients, and on the other, the glucose content in the blood increases, which has a destructive effect on the cells.
- Diabetes mellitus refers to diseases of the endocrine system, in which absolutely all organ systems of the human body are affected. The degree of involvement depends on the complexity of the course of the disease, measures and therapy.
- The early signs of diabetes can go unnoticed for a long time, most often, people come to the doctor already with a difficult, running process that is much more difficult to correct.
Diabetes is dangerous both because of its complications, which affect absolutely all organs, and the risk of coma. Many doctors say that this is not so much a disease as a lifestyle: you cannot finally cure it, but if you adhere to the correct regimen, take medicine depending on the type, constantly monitor your condition and the percentage of sugar in the blood plasma, you can live a long time without experiencing characteristic effects.
Also, doctors say that now there is a real epidemic of diabetes in the world.In varying degrees, it is found in almost every third person, and, if previously diagnosed either in children or in the elderly, depending on the type, now almost everyone is at risk.
Causes of Diabetes
Medicine has not yet established whether there is any single cause that provokes the disease. Currently, only factors that increase the risk of diabetes development will be identified.
Among them are the following:
- Genetic predisposition - it has a particularly significant effect on the emergence of "childhood" diabetes of the first type, if the parents were diagnosed with the disease, then the child will inherit it with a high degree of risk.
- Another factor pointing to the danger of an early onset of the disease: a large fetal weight. Normally, a newborn weighs 2.5-3.5 kg, if this indicator is increased, then endocrinologists immediately begin to observe the baby.
- In children, the development of pancreatic pathology provokes viral diseases, or rather their complications. Often, the death of pancreatic cells occurs against the background of measles, rubella, even a harmless disease like chicken pox.
- Adults get diabetes due to malnutrition and lifestyle. It is believed that overweight with a body mass index of more than 30 increases the risk of insulin resistance by half. With a BMI of 35 and above, the incidence of diabetes reaches one hundred percent.
- Even a small excess weight, in which fat deposits are located around the abdomen - abdominal type, is recognized as one of the key factors in the development of diabetes.
- The disease can be triggered by other endocrine pathologies, for example: Itsenko-Cushing syndrome, diffuse toxic goiter, acromegaly.
- Any diseases or injuries of the pancreas, an organ that produces enzymes and insulin, are fraught with complications such as diabetes, more often than the first type.
Factors may overlap, increasing the risk of disease. However, no doctor will give an absolute “guarantee” that even a perfectly healthy person with normal weight, diet and the absence of pancreatic pathologies will never develop diabetes. At present, there is even a theory that this is a viral and quite contagious disease.
Outside the framework of scientific disputes and discussions, doctors can only recommend that people monitor their condition, pay attention to even small changes, take timely measures.
The first signs of diabetes
My name is GalinaI'm 63 years old and I have type 2 diabetes.
I have been sick for 10 years already, over the years that I have done nothing. Infinite tests, going to the pharmacy, taking pills before leaving the house, I always checked if I took the medications, but thanks to this article I managed to lower my blood sugar, thank you!
The early symptoms of diabetes can be mild, especially if we are talking about the second type or insulin resistance. Manifestations go unnoticed until they pass into a more serious stage.
In this regard, it is worth paying attention to these early signs of the disease:
- Feeling of dry mouth, which may not be strong, and a person blames it on the summer heat and other factors.
- Dry skin causing minor discomfort. This feature is most pronounced on the palms, elbows, heels. The skin feels coarse and drained due to dehydration and lack of nutrition.
- The feeling of hunger increases, a person can gain weight. This is associated with a decrease in the ability of cells to receive nutrients from incoming food.
- Urination increases, while increasing the amount of excreted fluid. A person gets up to the toilet at night two or three times.
- Subjectively, there is fatigue, rapid fatigue, unwillingness to do the usual work - a characteristic feeling of "weakness." The “popular” chronic fatigue syndrome can sometimes be an early sign of diabetes.
The severity of symptoms may be very weak. Most noticeable are dry mouth and thirst. If at the same time a person is overweight, the habit of eating unhealthy foods, then it makes sense to go to an endocrinologist and analyze the body's ability to absorb glucose. It must be remembered that a single blood sample does not give a complete picture, for the purpose of diagnosis, a stress test for glucose resistance and other measures are carried out.
There are different forms of the disease, depending on the pathogenesis that occurs in the body. Determining the type is extremely important since the method of treatment differs radically.
In addition to the two main ones, there are other subspecies, but, as a rule, they speak about the following:
It is a disease of children and young people, caused, as most scientists believe, genetically. Sometimes the first type can develop after a severe attack of pancreatitis or even pancreatic necrosis, when a person can be saved, but the pancreatic functions are hopelessly lost. The first type is the absence of insulin in the body, so it is administered artificially.
Type II or Insulin Resistance
With this type of disease, the pancreas continues to produce insulin, and its amount may be even greater than that of healthy people. However, the cells responsible for the perception of the hormone, no longer "understand" it. Metabolic syndrome and diabetes of the second type is adjusted without the introduction of the hormone, with the help of specific therapy and diet.
Radical treatment does not exist. Lifetime patient support is possible with constant monitoring of his condition. Therapy is selected depending on the form of the disease.
The first type provides:
- Injection of insulin.
- Also currently there are special insulin patches or pumps.
- The patient must constantly monitor blood sugar levels.
- It is also important to remember that with the first type, hypoglycemia - lack of glucose with an excess of insulin - is even more dangerous than hyperglycemia. People are advised to always carry a few candies with them, cookies for an “emergency” case for a quick increase in the level of glucose.
The newest methods of treating diabetes of the first type involve the transplantation of pancreatic sites. However, these surgeries are still rare.
The second type is more common, and if the first type is typical for children and adolescents, then insulin resistance develops in people over 35 years old, although there is currently a tendency for a decrease in age.
Therapy for such diabetes includes:
- Strict diet with restriction of carbohydrates and fats.
- Measures for weight loss.
- Sugar-lowering drugs - Glipizid, glimepirid.
- Biguanides - substances that contribute to the natural restoration of normal glucose metabolism by reducing liver glucogenesis, - Metformin, Glucofarge.
- Alpha-glucosidase inhibitors that block the increase in blood sugar - Miglitol, Acarbose.
Therapy with the second type allows you to not use external sources of insulin. The idea of treatment is to maintain the normal balance in the body as much as possible, without resorting to serious intervention. Drug therapy always serves only as a basis for treatment, because the main part of responsibility for his health lies with the patient, his ability to adhere to proper nutrition, recommended in this disease, and also to monitor his condition.
Consequences and complications of diabetes
Diabetes is dangerous in and of itself, and its complications.The first type gives the worst prognosis for life in the long term, while the compensated illness of the second type can occur “background” without compromising the quality of life.
Consequences and complications include emergency:
- Hypersolar coma - occurs on the background of dehydration, if you do not take enough fluid that continues to be eliminated from the body.
- Hypoglycemic coma - occurs in patients with type 1 diabetes, with an incorrect dosage of insulin.
- Lactic acid coma - occurs on the background of the accumulation of lactic acid caused by diabetes and, as a rule, renal failure, also provoked by this disease.
- Ketoacidosis is the accumulation of ketone bodies, products of fat metabolism, in the blood.
These conditions - emergency, threaten the life of the patient. Hypoglycemic coma is especially dangerous, because without the urgent introduction of glucose it can be fatal in 30-40 minutes.
There are also long-term effects of diabetes:
- Diabetic neuropathy and encephalopathy - the destruction of the nervous system, both central and peripheral. Manifestations are wide - from muscle pain to memory impairment and reduced intelligence. This is one of the most common long-term complications of the disease, occurs in every eighth person suffering from diabetes. The process begins with the arms and legs, forming the characteristic symptoms of “gloves”, and further the pain spreads to the whole body, capturing the central nervous system as well.
- Diabetic retinopathy - reduced vision on the background of retinal damage, up to complete blindness. During this disease, retinal degeneration and detachment occur. It is also an extremely common pathology, and each year, the disease adds 10% to the risk of developing this complication.
- Diabetic nephropathy - kidney damage until the development of severe renal failure on the background of the constant need to carry out fluid, often containing excess glucose.
- Diabetic angiopathy is a violation of the permeability of small and large vessels due to the fact that they are “clogged” by undigested glucose. This pathology causes severe complications, including heart failure, blood clots.
- The defeat of the legs, "diabetic foot" - the appearance of purulent-necrotic processes in the lower extremities. It starts with small ulcers that heal very poorly. Subsequently, edemas develop, the process ends with wet gangrene with the necessity of amputation of the affected limb.
Severe consequences develop only with the decompensated form of the disease. It develops against the background of a systematic violation of the diet, improper selection of drug therapy, inattention of the patient to the level of glucose in the blood. Even one-time violations of the food regime can provoke a sharp deterioration, so there can be no “loosening” and “holidays” in diabetes.
Prevention consists in timely vaccinations against viral diseases in children, and in adults - to the normalization of body weight, diet. It is recommended to eat green vegetables, unsweetened fruits, limit sweet and fatty foods. Moderate exercise also serves as a preventive measure.
A healthy lifestyle, proper nutrition, avoidance of stress are all excellent methods to avoid not only diabetes, but many other diseases. Of course, not everyone is able to maintain an ideal daily regimen, but you can always reduce the amount of fast food and simple sugars in your diet, replacing them with slow carbohydrates, fiber, protein foods.
Spread of the disease
There is an opinion that diabetes is an exclusively modern disease, the scourge of our civilization and the price paid for a high standard of living, leading to a wide availability of food rich in carbohydrates. However, this is not the case, since diabetes mellitus was well known in the ancient world, in ancient Greece and Rome. The term "diabetes" itself has a Greek origin. Translated from the Greek language, it means "passing through." This interpretation reflects the main signs of diabetes mellitus - irrepressible thirst and abundant urination. Therefore, the impression was created that all the liquid consumed by man passes through his body.
Ancient doctors were able to determine what type of diabetes a patient had, the first type of disease was considered incurable and leading to early death, and the second was treated with diet and exercise. However, the relationship of diabetes in humans with the pancreas and the hormone insulin was established only in the 20th century. Then managed to get insulin from the pancreas of livestock. These discoveries have led to the widespread use of insulin in diabetes.
Diabetes today is one of the most common ailments. Worldwide, there are approximately 250 million people with diabetes (mostly of the second type), and the number of those with it is constantly increasing. This makes diabetes not only a medical, but also a social problem. In Russia, the disease is observed in 6% of the population, and in some countries it is recorded in every tenth person. Although doctors believe that these figures may be significantly underestimated. After all, for those who are sick with the second type of the disease, in the early stages, the signs of pathology are very weak. The total number of patients with diabetes, taking into account this factor, is estimated at 400 million. Most often diabetes is diagnosed in adults, but about 0.2% of children also suffer from the disease. Projections for the spread of diabetes in the future are disappointing - it is expected that in 2030 the number of patients will double.
There are racial differences in the incidence of type 2 diabetes. Diabetes mellitus affects the representatives of the Mongoloid and Negroid races much more often than Caucasians.
The prevalence of carbohydrate metabolic diseases in the world
|The percentage of patients from the world population||total, million|
|Impaired glucose tolerance||7,5||308|
The disease is classified as endocrine. This means that diabetes mellitus is based on the pathogenesis of disorders associated with the functioning of the endocrine glands. In the case of diabetes, we are talking about reducing the effects on the human body of a special substance - insulin. In diabetes, the tissues feel its lack - either absolute or relative.
So, the onset of diabetes is closely related to insulin. But not everyone knows what the substance is, where it comes from and what functions it performs. Insulin is a special protein. Its synthesis is performed in a special endocrine gland, located under the human stomach - the pancreas. Strictly speaking, not all pancreatic tissue is involved in the production of insulin, but only a part of it. The gland cells that produce insulin are called beta cells and are located in special islets of Langerhans, located among the tissues of the gland. The word "insulin" comes from the word insula, which is translated from the Latin language means "island".
The functions of insulin are closely related to the metabolism of such important substances for the body as carbohydrates. A person can get carbohydrates only with food. Since carbohydrates are a source of energy, many physiological processes occurring in cells are impossible without carbohydrates. True, not all carbohydrates are absorbed by the body. In fact, the main carbohydrate in the body is glucose.Without glucose, the cells of the body will not be able to get the required amount of energy. Insulin is not only involved in glucose uptake. In particular, its function is to synthesize fatty acids.
Glucose belongs to the category of simple carbohydrates. Also included in this category is fructose (fruit sugar), which is contained in large quantities in berries and fruits. Fructose entering the body is metabolized in the liver to glucose. In addition, simple sugars (disaccharides) are sucrose, which is part of products such as regular sugar, and lactose, which is part of dairy products. These types of carbohydrates are also broken down to glucose. This process occurs in the intestines.
In addition, there are a number of polysaccharides (carbohydrates) with a long molecular chain. Some of them, such as starch, are poorly absorbed by the body, and other carbohydrates, such as pectin, hemicellulose, and cellulose, are not broken down in the intestine at all. Nevertheless, these carbohydrates play an important role in digestive processes, contributing to the proper absorption of other carbohydrates and maintaining the necessary level of intestinal microflora.
Despite the fact that glucose is the main source of energy for cells, most tissues are not able to get it directly. For this purpose, cells need insulin. Bodies that cannot exist without insulin are insulin-dependent. Only very few tissues are capable of producing glucose without insulin (these include, for example, brain cells). Such tissues are called insulin-independent. For some organs, glucose is the only source of energy (for example, for the same brain).
What are the consequences of a situation when, for some reason, the cells lack insulin? This situation manifests itself in the form of two main negative consequences. First, cells will not be able to receive glucose and will experience starvation. Therefore, many organs and tissues will not be able to function properly. On the other hand, unused glucose will accumulate in the body, primarily in the blood. This condition is called hyperglycemia. True, excess glucose is usually stored in the liver as glycogen (from where it can, if necessary, flow back into the blood), but insulin is also needed for the process of converting glucose to glycogen.
The normal value of blood glucose ranges from 3.3 to 5.5 mmol / l. The definition of this value is made when blood is taken on an empty stomach, since the ingestion of food always causes an increase in the level of sugar for a short time. Excess sugar accumulates in the blood, which leads to serious changes in its properties, the deposition of sugar on the walls of blood vessels. This leads to the development of various pathologies of the circulatory system and, ultimately, to the dysfunctions of many body systems. It is this process - the accumulation of excess glucose in the blood is called diabetes.
Causes of diabetes and its varieties
The mechanism of the pathogenesis of the disease is reduced to two main types. In the first case, a decrease in insulin production by the pancreas leads to the appearance of excess glucose. This phenomenon can appear due to various pathological processes, for example, due to inflammation of the pancreas - pancreatitis.
Another type of diabetes is observed when insulin production is not reduced, but is within the normal range (or even slightly higher). The pathological mechanism of development of diabetes in this case is another - loss of insulin sensitivity of the tissues.
The first type of diabetes is called diabetes mellitus of the first type, and the second type of the disease is diabetes of the second type. Sometimes type 1 diabetes is also called insulin-dependent, while type 2 diabetes is called insulin-dependent.
There are also other types of diabetes - gestational, MODY-diabetes, latent autoimmune diabetes, and some others. However, they are much less common than the two main types.
In addition, diabetes insipidus should be considered separately from diabetes. This is the type of disease, in which there is increased urination (polyuria), but it is not caused by hyperglycemia, but by other types of causes, such as kidney or pituitary diseases.
Despite the fact that diabetes mellitus has unifying characteristics, the symptoms and treatment of diabetes in both main varieties are generally very different.
Two types of diabetes - distinctive features
|Sign||type 1 diabetes||type 2 diabetes|
|Age of patients||usually less than 30 years||usually older than 40 years|
|Gender of patients||Mostly men||Mostly women|
|The onset of diabetes||Sharp||gradual|
|Insulin secretion||at the initial stage - reduced, with severe diabetes - absent||at the initial stage - increased or normal, with severe diabetes mellitus - reduced|
|Insulin Treatment for Diabetes||is necessary||at the initial stage is not required, in case of severe course - it is necessary|
|Body weight||initially, normal, then lowered||usually elevated|
Insulin-dependent diabetes mellitus
This diabetes occurs in every tenth patient out of the total number of patients with this disease. However, of the two types of diabetes mellitus, diabetes mellitus of the first type is considered the most severe and can often lead to life-threatening complications.
The first type of diabetes, as a rule, is an acquired pathology. It is caused by a malfunction of the pancreas. The malfunction of the gland is followed by a decrease in the amount of insulin produced, which leads to diabetes. Why does iron cease to function? This phenomenon is able to appear due to a large number of causes, but most often it occurs due to inflammation of the gland. Most often, it can be caused by acute systemic viral infections and subsequent autoimmune processes when the immune system starts attacking pancreatic cells. Also, the first type of diabetes often occurs as a result of cancer. A serious factor favoring the development of the disease is a genetic predisposition. In addition, other factors play a role in the emergence of the first form of diabetes:
- stresses to which the person was exposed
- hypoxia of pancreatic cells,
- improper diet (high-fat, low-protein food).
Most often, the development of insulin-dependent occurs at a young age (up to 30 years). However, older people are not immune from this disease.
How does type 1 diabetes manifest?
The disease is characterized by an acute initial stage, so the first signs of diabetes mellitus are usually easy to notice. The main symptoms of diabetes are intense thirst, consuming large amounts of water. Accordingly, the volume of excreted urine increases (polyuria). The patient's urine usually has a sweet taste, due to the high content of glucose in it. This symptom is an increase in the concentration of glucose in the urine, called glucosuria. The development of glucosuria is observed in the case when the concentration of sugar in the blood exceeds 10 mmol / l. At the same time, the renal filters start not to cope with the removal of glucose and it begins to flow into the urine. However, in some renal pathologies, sugar in the urine is often observed even with normal blood sugar levels, so this parameter — elevated glucose in the urine — is not a defining sign of diabetes mellitus.
Also, diabetes is manifested by a pathological increase in appetite (polyphagia). This phenomenon is simply explained, because due to the fact that glucose does not enter the cells, the body suffers a constant lack of energy and starving tissues signal this to the brain. With constant food intake, however, the patient does not gain weight, but loses it. Other signs of the disease - severe fatigue and weakness, itching of the skin, persistent headaches, increased blood pressure, visual impairment. When analyzing urine, acetone is detected in it, which is a consequence of the use of fat stores by the cells. However, acetone is often excreted in the urine and in many other diseases, such as inflammation. Especially often acetone in urine appears in children. Therefore, this circumstance should not be considered as a defining feature of diabetes.
Fluctuations in the level of glucose in the blood often lead to its abnormally high or low values, and as a result - to hypoglycemic or hyperglycemic coma. These conditions often end with the death of the patient.
A common diabetes syndrome is Raynaud's syndrome, including:
- thromboangiitis obliterans,
- coldness and numbness of the limbs,
- pains in hands.
The first form of diabetes is not only incurable, but also potentially fatal. If the patient does not receive treatment, his insulin-dependent diabetes will go into complications such as ketoacidosis or diabetic coma, which inevitably end in death. Depending on the blood sugar concentration, the stage of diabetes will be considered mild, severe or moderate.
Stages of insulin-dependent diabetes mellitus
|Stages of diabetes||The concentration of glucose in the blood of the patient, mmol / l||the values of the level of glycosuria, g / l|
Diagnosis of diabetes
If the first symptoms of the disease have occurred, then this is a reason for seeking medical help as soon as possible. Only a doctor is able to diagnose the presence of the first form of diabetes, and determine which means can be used to treat it. If the treatment of diabetes started at the initial stage, it reduces the likelihood of complications.
However, some suspicions about the presence of the disease is not enough, requires accurate diagnosis. A number of methods are used to diagnose diabetes. First of all, it is the determination of fasting blood glucose, insulin levels. With diabetes, accompanied by high levels of glucose in the body, sugar begins to be excreted in the urine. This is due to the fact that the kidneys do not cope with the filtration of glucose, and it appears in the urine. Thus, with a urine glucose test, the presence of diabetes can be determined.
How to treat diabetes?
Unfortunately, diabetes mellitus today is one of the incurable pathologies, including the initial stage, since no effective therapies have been developed to address the dysfunctions of the pancreas. However, this does not mean that the prognosis of the disease is fatal. Nevertheless, the therapy is exclusively symptomatic in nature - stabilization of the glucose level in the body, treatment of diabetes accompanying pathologies.
Insulin therapy diabetes
With this type of diabetes, treatment consists mainly of administering insulin to the patient. Insulin helps the tissues to absorb glucose and reduces its level in the blood. The introduction of insulin is carried out only by the parenteral (subcutaneous) method, since insulin is decomposed when passing through the gastrointestinal tract.
For the introduction of insulin in diabetes of the first variety, common syringes are most often used. Although at the present time improved compact pen syringes appeared. Also widely distributed syringes pump.This type of syringe allows you to accurately control the flow of insulin into the blood, and prevents the occurrence of such dangerous complications as hypoglycemia. The popularity of syringes-pump every year is becoming higher.
There are different types of insulin, which can differ from each other according to different criteria:
- action speed
- purification rate
- biological origin.
Medical insulin has a concentration of 40 or 100 IU (international units).
Patient education as part of therapy
An important element in the treatment of diabetes is patient education. The patient should know what he needs to do, if there is a state of hypoglycemia or hyperglycemia, how to constantly monitor the level of glucose in the blood, how to change the diet. Similar information should be available and close to the patient.
Diabetes mellitus is an exchangeable disease. Therefore, a vital method of treatment is a diet, which is based on the principle of limiting the amount of carbohydrates in food. Without compliance with the diet, the patient risks dying as a result of the development of severe hyper- and hypoglycemia.
A diet for the disease of insulin-dependent diabetes mellitus should be based on strict adherence to the norms of carbohydrates entering the patient's body. For convenience, the counting of carbohydrates in the practice of treatment of diabetes mellitus introduced a special unit of measure - the bread unit (XE). One XE contains 10 g of simple carbohydrates, or 20 g of bread. The amount of XE consumed per day is determined by the doctor individually, taking into account physical exertion, the weight of the patient and the severity of the disease. Sugar insulin-dependent diabetes is strictly prohibited alcohol consumption.
Non-insulin dependent diabetes mellitus
This type of diabetes is most common. According to statistics, it is found in about 85% of diabetics. Type 2 diabetes rarely occurs at a young age. It is more common in middle-aged adults and the elderly.
Type 2 disease is not caused by a lack of insulin production, but a violation of the interaction between insulin and tissues. Cells no longer absorb insulin and glucose begins to accumulate in the blood. The causes of this phenomenon are not fully elucidated, but, as scientists believe, a significant role in the pathogenesis of diabetes mellitus is played by:
- change in the rate of glucose absorption in the intestine,
- accelerating the process of breaking down insulin
- decrease in the number of insulin receptors in cells.
In particular, in certain pathologies, the immune cells of the body can perceive insulin receptors as antigens and destroy them.
The main factor affecting the likelihood of developing diabetes is obesity. This is evidenced by statistics, since 80% of patients with insulin-dependent diabetes are overweight.
Among the factors contributing to the development of the disease, you can also highlight:
- sedentary lifestyle,
- lack of physical activity
- wrong diet
- taking certain medications, for example, glucocorticosteroids.
A significant role is also played by genetic predisposition and heredity. If at least one of the parents is sick with insulin-independent diabetes, then the probability that the child in adulthood will develop this ailment is 80%.
There is a misconception that an immoderate consumption of sweets can lead to diabetes, even once. In fact, this is not the case; a healthy person can eat quite a lot of sweets at a time, and this will not affect his health. Another thing is that the constant consumption of sweets often leads to obesity, but overweight is already capable of causing the processes leading to diabetes.
Signs of diabetes
Insulin-dependent diabetes mellitus develops slowly over many years.Therefore, patients often do not pay attention to the first signs of diabetes, attributing them to age-related changes, fatigue. In the early stages, the symptoms of diabetes are often absent. Thus, the first signs of diabetes are manifested only with a serious increase in blood glucose levels.
There is a set of symptoms typical of insulin-independent diabetes. The patient begins to be disturbed by intense thirst, frequent urination, insomnia at night, fatigue, weakness and drowsiness during the day.
Also, the first signs of diabetes include the following phenomena:
- slow wound healing
- blurred vision
- episodic or persistent dizziness,
- numbness or tingling of the limbs
On the other hand, similar phenomena often develop in other pathologies, therefore, the diagnosis and determination of the type of diabetes should be handled by the doctor, not the patient himself.
In the absence of treatment, severe forms of complications begin - neuropathy, nephropathy, retinopathy, angiopathy.
Hidden symptoms of changes in carbohydrate metabolism are slowing down the synthesis of proteins and fatty acids. With the progression of the disease, signs of pathology develop and become more and more visible. Ultimately, an increased level of glucose in the blood begins to influence the work of the pancreas, insulin synthesis processes are disturbed. Ketoacidosis develops, the loss of water and electrolytes with urine increases.
Sulfonyl Urea Derivatives
Another common class of drugs are drugs, from a chemical point of view, related to sulfonylurea derivatives (tolbutamide, glibenclamide, glimepiride). They are used in diabetes of moderate severity, when the patient is not helped by metformin or his use for some reason is impossible. The principle of action of sulfonylurea derivatives is based on the stimulation of pancreatic cells, due to which they begin to produce more insulin. Secondary mechanisms are associated with the suppression of glucagon synthesis processes and the release of glucose from the liver. The lack of these funds is a high probability of hypoglycemia with improper dosage.
Diet is one of the most important elements in the treatment of non-insulin-dependent diabetes at any stage of the disease. The main principle of the diet is to reduce the amount of carbohydrates consumed. First of all, it concerns refined sugar, which is easier for the body to assimilate. An increase in the use of indigestible fiber is recommended, since it prevents the absorption of simple carbohydrates, stabilizes digestive processes, and improves the composition of the intestinal microflora.
When treating non-insulin dependent diabetes, you should stop drinking alcohol. This is due to the fact that alcohol violates the natural metabolic processes, including the processes of insulin production and glucose uptake by tissues.
Types of diabetes mellitus (classification)
Classification of diabetes by reason of:
- Type 1 diabetes mellitus - characterized by an absolute deficiency of insulin in the blood
- Autoimmune - antibodies attack the β - cells of the pancreas and completely destroy them,
- Idiopathic (without clarified cause)
- Type 2 diabetes mellitus is the relative insufficiency of insulin in the blood. This means that the quantitative indicator of insulin levels remains within the normal range, but the number of hormone receptors on the cell membranes - targets (brain, liver, adipose tissue, muscles) - decreases.
- Gestational diabetes is an acute or chronic condition, manifested as hyperglycemia during a woman's fetus.
- Other (situational) causes of diabetes mellitus - impaired glucose tolerance caused by causes not related to pancreatic pathology. May be temporary and permanent.
Types of diabetes:
- genetic defects of the insulin molecule or its receptors,
- associated with other endocrine pathologies:
- Itsenko - Cushing's disease,
- adrenal adenoma,
- Graves disease.
Classification of diabetes by severity:
- Easy form - characterized by hyperglycemia no more than 8 mmol / l, slight daily fluctuations in sugar levels, the absence of glucosuria (sugar in the urine). Does not require pharmacological correction of insulin.
Quite often, at this stage, clinical manifestations of the disease may be absent, however, during instrumental diagnostics, initial forms of typical complications with damage to the peripheral nerves, micro - vessels of the retina, kidneys, and heart are already detected.
- Moderate severity -peripheral blood glucose level reaches 14 mmol / l, glycosuria appears (up to 40g / l), incoming one develops ketoacidosis - a sharp increase in ketone bodies (metabolism of fat splitting).
Ketone bodies are formed due to the energy starvation of cells. Almost all of the glucose circulates in the blood and does not penetrate the cell, and she begins to use the reserves of fat to produce ATP. At this stage, the glucose level is controlled using diet therapy, the use of oral hypoglycemic drugs (metformin, acarbose, etc.).
Clinically manifested violation of the kidneys, cardiovascular system, vision, neurological symptoms.
- Heavy current - blood sugar exceeds 14 mmol / l, with fluctuations up to 20–30 mmol, glycosuria over 50 mmol / l. Full dependence on insulin therapy, serious dysfunctions of blood vessels, nerves, organ systems.
Classification by level of compensation for hyperglycemia:
Compensation - it is conditionally the normal state of the body, in the presence of a chronic incurable disease. The disease has 3 phases:
- Compensation - diet or insulin therapy allows you to achieve normal numbers of glucose in the blood. Angiopathies and neuropathies do not progress. The general condition of the patient remains satisfactory for a long time. There is no violation of sugar metabolism in the kidneys, the absence of ketone bodies, acetone. Glycosylated hemoglobin does not exceed the value of "5%"
- WITHcompensation compensation - treatment does not fully correct blood counts and clinical manifestations of the disease. Blood glucose is not higher than 14 mmol / l. Sugar molecules damage red blood cells and glycated hemoglobin appears, microvascular lesions in the kidneys manifest as insignificant amount of glucose in the urine (up to 40g / l). Acetone in the urine is not detected, however, there may be mild manifestations of ketoacidosis,
- Decompensation - The most severe phase of diabetic patients. It usually occurs in the late stages of the disease or total lesion of the pancreas, as well as insulin receptors. It is characterized by the general severe condition of the patient up to a coma. The glucose level is not amenable to correction with the help of farm. drugs (over 14 mmol / l). High numbers of sugar in the urine (over 50g / l), acetone. Glycosylated hemoglobin significantly exceeds the norm, hypoxia occurs. With a long course of this condition leads to coma and death.
Causes of diabetes
Diabetes mellitus (abbreviated as diabetes) is a polyetiological disease.
There is no single factor that would cause diabetes in all people with this pathology.
The most significant causes for the development of the disease:
Type I diabetes:
- Genetic causes of diabetes:
- congenital β-cell pancreatic insufficiency
- hereditary mutations in the genes responsible for insulin synthesis,
- genetic predisposition to autoagression of immunity on β - cells (immediate relatives have diabetes),
- Infectious causes of diabetes:
- pancreatotropic (infecting the pancreas) viruses: rubella, type 4 herpes, parotitis, hepatitis A, B, C. Human immunity begins to destroy pancreatic cells along with these viruses, which causes diabetes.
Type 2 diabetes has the following causes:
- heredity (the presence of diabetes in the next of kin),
- visceral obesity,
- Age (usually over 50 - 60 years),
- low fiber intake and high consumption of refined fats and simple carbohydrates,
- hypertonic disease,
This group of factors does not in itself cause the disease, but significantly increases the chances of its development, if there is a genetic predisposition.
- hypodynamia (passive lifestyle),
- excessive drinking,
- use of substances affecting the pancreas (for example, drugs)
- excess fat and simple carbohydrates in the diet.
Diagnosis of 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 (an increase in the amount of daily urine), polyphagia (constant hunger), weakness, headache and other clinical symptoms.
- During a prophylactic blood glucose test, the indicator was above 6.1 mmol / l on an empty stomach, or 11.1 mmol / l 2 hours after a meal.
In case of detection of this symptom, a series of tests are conducted to confirm / refute the diagnosis and to determine the causes.
Laboratory diagnosis of diabetes
Oral glucose tolerance test (PGTT)
Standard test to determine the functional ability of insulin to bind glucose and maintain its normal levels in the blood.
The essence of the method: in the morning, on the background of an 8-hour fast, blood was 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, the blood is taken again and the sugar level is again determined.
The initial symptoms of diabetes usually appear during this period.
Criteria for evaluating the PGT analysis:
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 level of insulin in the blood decreases. In diabetics, it usually exceeds 1:10.
Norma - Caption: 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 made - type 2 diabetes mellitus.
Insulin Antibody Level
Another specific immunological analysis. It is carried out for differential diagnosis in patients with diabetes (type 1 DM and type 2 DM). In case of impaired glucose tolerance, blood is taken and a serological examination is performed. May also indicate the causes of diabetes.
Norm AT to insulin - 0 - 10 U / ml.
- If C (AT) is higher than normal, the diagnosis is type 1 DM. Autoimmune diabetes,
- If C (AT) is within the reference values, the diagnosis is type 2 DM.
Level testantibodies toGAD(Glutamic Acid Decarboxylase)
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 mellitus is still unclear, but in 80% - 90% of patients, these antibodies in the blood are determined. Analysis of GAD at AT is recommended in risk groups for the diagnosis of prediabetes and the appointment of a prophylactic diet and pharmacological therapy.
Norm AT GAD - 0 - 5 IU / ml.
- A positive result with normal glycemia indicates a high risk of diabetes mellitus type 1,
- A negative result with an elevated blood glucose level indicates the development of type 2 DM.
Blood Insulin Test
Insulin - highly active hormone of the endocrine pancreas, synthesized in the beta - cells of the islets of Langerhans. Its main function is the transport of glucose into somatic cells. Reducing insulin levels is the most important link in the pathogenesis of the disease.
The normal concentration of insulin - 2.6 - 24.9 MCED / ml
- Below the norm - the possible development of diabetes and other diseases,
- Above the norm - a tumor of the pancreas (insulinoma).
Instrumental diagnosis of diabetes
Ultrasound of the pancreas
The method of ultrasound scanning allows to detect morphological changes in the tissues of the gland.
Typically, diabetes mellitus is determined by diffuse damage (areas of hardening - replacement of functionally active cells with connective tissue).
Also pancreas can be increased, have signs of edema.
Angiography of the vessels of the lower extremities
The arteries of the lower extremities - the target organ with diabetes. Prolonged hyperglycemia causes an increase in blood cholesterol and atherosclerosis, which leads to a decrease in tissue perfusion.
The essence of the method consists in the introduction of a special contrast agent into the bloodstream with simultaneous control of the vascular permeability on a CT scanner.
If the blood supply is significantly reduced at the level of the legs of the lower extremities, the so-called "diabetic foot" is formed. Diagnosis of diabetes is based on this method of research.
Ultrasound of the kidneys and echocardiogram of heart
Methods of instrumental examination of the kidneys, allowing to assess the damage of these organs in the presence of a diagnosis of diabetes mellitus.
Microangiopathy develops in the heart and kidneys - vascular lesion with a significant decrease in their lumen, and therefore a deterioration in functional abilities. The method allows you to prevent complications of diabetes.
Retinography or angiography of retinal vessels
Microscopic vessels of the retina are most sensitive to hyperglycemia, so the development of damage in them begins even before the first clinical signs of diabetes.
Using contrast, determine the degree of narrowing or complete occlusion of blood vessels. Also the most important sign of diabetes will be the presence of micro-erosion and ulcers in the fundus.
Diagnosis of diabetes - a comprehensive event, which is based on data from the history of the disease, an objective examination of a specialist, laboratory tests and instrumental studies. Using only one diagnostic criterion, it is impossible to establish 100% correct diagnosis.
If you belong to a risk group, be sure to consult your doctor to find out more about what diabetes is and what needs to be done with such a diagnosis.
Diabetes treatment is a set of measures to correct the glycemic level, 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 treatments.
Methods used in the treatment of diabetes
- Pharmacological therapy (insulin therapy),
- Regular exercise
- Preventive measures to prevent the progression of the disease and the development of complications
- Psychological support.
Pharmacological Insulin Correction
The need for insulin injections for patients with diabetes, its type and frequency of use are strictly individual and selected by specialists (therapist, endocrinologist, cardiologist, neuropathologist, hepatologist, diabetologist). They always pay attention to the symptoms of diabetes, conduct a differential diagnosis, screening and evaluation of the effectiveness of drugs.
Types of insulin:
- High-speed (ultrashort action) - begins to act immediately after the introduction and works for 3 - 4 hours.Used before or immediately after a meal. (Insulin - Apidra, Insulin - Humalog),
- Short action - valid after 20 - 30 minutes after administration. It is necessary to apply strictly in 10 - 15 minutes prior to food intake (Insulin - Actrapid, Humulin Regular),
- Average duration - are used for continuous administration and are valid for 12–18 hours after the injection. Allows to prevent complications of diabetes mellitus (Protafan, Humodar),
- Long acting insulin - requires daily constant use. Valid from 18 to 24 hours. It is not used to lower blood glucose, but only controls its daily concentration and does not allow the normal values to be exceeded (Tujeo Solostar, Basaglar),
- Combinedinsulin - contains in various ratios insulins of ultrashort and prolonged action. It is used mainly for intensive therapy of type 1 diabetes (Insuman Combe, Novomix).
Diet therapy in diabetes
Diet - 50% of success in controlling the blood glucose level of a patient with diabetes.
What foods should be consumed?
- Fruits and vegetables with low sugar and high concentrations of vitamins and minerals (apples, carrots, cabbage, beets
- Meat containing a small amount of animal fat (beef, turkey, quail meat)
- Cereal and cereals (buckwheat, wheat, rice, barley, barley)
- Fish (best sea)
- From the drinks it is better to choose not strong tea, decoctions of fruit.
What should be discarded
- Sweets, pasta, flour
- Concentrated Juices
- Fatty meat and dairy products
- Spicy and smoked products
- Glibenclamide - a drug stimulating insulin production in the pancreas.
- Repaglinide - stimulates beta cells to insulin synthesis
- Acarbose - works in the intestine, inhibits the activity of enzymes of the small intestine, which break down polysaccharides to glucose.
- Pioglitazone - drug for the prevention of polyneuropathy, micro - macroangiopathy of the kidneys, heart and retina.
Folk remedies for the treatment of diabetes
By popular methods include the preparation of various decoctions of herbs, fruits and vegetables, to some extent correcting the level of glycemia.
- Krifeya Amur - ready extract of moss. The use of Krifei causes an increase in the synthesis of pancreatic hormones: lipase, amylase, protease. It also has antiallergic and immunomodulatory effects, reduces the main symptoms of diabetes.
- Parsley root + lemon peel + whole gland- these products contain a large amount of vitamin C, E, A, selenium and other trace elements. Everything this it is necessary to grind, mix and insist about 2 weeks. Use orally for 1 teaspoon before meals.
- Oak acorns- contain tannin, a very effective remedy for diabetes. This substance stimulates the immune system, has anti-inflammatory and anti-edema effects, strengthens the vascular wall, removes pronounced types. Acorns must be crushed into powder and take 1 teaspoon before each meal.
Diabetes mellitus is an incurable disease, so the prognosis for recovery is unfavorable. However, modern advances in pharmacological therapy with insulin can significantly prolong the life of a diabetic, and regular diagnosis of typical organ system disorders leads to an improvement in the patient’s quality of life.
Among the common metabolic disorders, diabetes is in second place after obesity. In the world of diabetes mellitus, about 10% of the population suffers, however, considering the latent forms of the disease, this figure may be 3-4 times more.Diabetes mellitus develops due to chronic insulin deficiency and is accompanied by disorders of carbohydrate, protein and fat metabolism. Insulin production occurs in the pancreas by ß-cells of the islets of Langerhans.
Participating in the metabolism of carbohydrates, insulin increases the flow of glucose into the cells, promotes the synthesis and accumulation of glycogen in the liver, inhibits the breakdown of carbohydrate compounds. In the process of protein metabolism, insulin enhances the synthesis of nucleic acids, protein and inhibits its breakdown. The effect of insulin on fat metabolism consists in activating glucose uptake in fat cells, energy processes in cells, the synthesis of fatty acids and the slowing down of fat breakdown. With the participation of insulin increases the process of admission to the cell sodium. Disorders of metabolic processes controlled by insulin may develop with insufficient synthesis (type I diabetes) or insulin resistance of the tissues (type II diabetes).
Causes and mechanism of development
Type I diabetes is more often detected in young patients under 30 years of age. Disruption of insulin synthesis develops as a result of autoimmune damage to the pancreas and the destruction of insulin-producing β-cells. In most patients, diabetes mellitus develops after a viral infection (mumps, rubella, viral hepatitis) or toxic effects (nitrosamines, pesticides, drugs, etc.), the immune response to which causes pancreatic cell death. Diabetes mellitus develops if more than 80% of the insulin-producing cells are affected. Being an autoimmune disease, diabetes mellitus type I is often combined with other processes of autoimmune genesis: thyrotoxicosis, diffuse toxic goiter, etc.
In diabetes mellitus type II, insulin resistance of tissues develops, i.e., their insensitivity to insulin. The content of insulin in the blood may be normal or elevated, but the cells are immune to it. The majority (85%) of patients revealed type II diabetes. If the patient is obese, the insulin susceptibility of the tissues is blocked by adipose tissue. Type II diabetes mellitus is more susceptible to older patients who experience a decrease in glucose tolerance with age.
The occurrence of type II diabetes mellitus may be accompanied by the following factors:
- genetic - the risk of developing the disease is 3-9%, if relatives or parents have diabetes,
- obesity - with an excessive amount of adipose tissue (especially the abdominal type of obesity), there is a noticeable decrease in the sensitivity of tissues to insulin, contributing to the development of diabetes,
- eating disorders - predominantly carbohydrate diet with a lack of fiber increases the risk of diabetes,
- cardiovascular diseases - atherosclerosis, arterial hypertension, ischemic heart disease, reducing tissue insulin resistance,
- chronic stressful situations - in the state of stress in the body increases the number of catecholamines (noradrenaline, adrenaline), glucocorticoids, contributing to the development of diabetes,
- diabetic effects of certain drugs - glucocorticoid synthetic hormones, diuretics, certain antihypertensive drugs, cytotoxic drugs, etc.
- chronic adrenal insufficiency.
When insufficiency or insulin resistance decreases the flow of glucose into the cells and increases its content in the blood. In the body, activation of alternative ways of glucose digestion and digestion is activated, which leads to accumulation of glycosaminoglycans, sorbitol, glycated hemoglobin in tissues.The accumulation of sorbitol leads to the development of cataracts, microangiopathies (dysfunctions of capillaries and arterioles), neuropathy (disturbances in the nervous system), glycosaminoglycans cause damage to the joints. To get the cells of the missing energy in the body begins the processes of protein breakdown, causing muscle weakness and dystrophy of skeletal and cardiac muscles. Fat peroxidation is activated, the accumulation of toxic metabolic products (ketone bodies) occurs.
Hyperglycemia in the blood in diabetes mellitus causes an increase in urination to remove excess sugar from the body. Together with glucose, a significant amount of fluid is lost through the kidneys, leading to dehydration (dehydration). Along with the loss of glucose, the body’s energy reserves are reduced, so patients with diabetes mellitus have weight loss. Elevated sugar levels, dehydration and accumulation of ketone bodies due to the breakdown of fat cells causes a dangerous condition of diabetic ketoacidosis. Over time, due to the high level of sugar, damage to the nerves, small blood vessels of the kidneys, eyes, heart and brain develop.
For conjugation with other diseases, endocrinology distinguishes diabetes symptomatic (secondary) and true diabetes.
Symptomatic diabetes mellitus accompanies diseases of the endocrine glands: pancreas, thyroid, adrenal glands, pituitary gland and is one of the manifestations of primary pathology.
True diabetes can be of two types:
- insulin type I (AERO type I), if insulin of its own is not produced in the body or produced in insufficient quantities,
- non-insulin type II (INSSD Type II), if insulin insensitivity of tissues to insulin is observed with its abundance and excess in blood.
There are three degrees of diabetes mellitus: mild (I), moderate (II) and severe (III), and three states of compensation of carbohydrate metabolism disorders: compensated, subcompensated and decompensated.
The development of diabetes mellitus type I occurs rapidly, type II - on the contrary gradually. Often there is a hidden, asymptomatic course of diabetes mellitus, and its detection occurs by chance when examining the fundus or laboratory determination of blood sugar and urine. Clinically, diabetes mellitus type I and type II manifest themselves in different ways, but the following symptoms are common to them:
- thirst and dry mouth, accompanied by polydipsia (increased fluid intake) up to 8-10 liters per day,
- polyuria (heavy and frequent urination),
- polyphagia (increased appetite),
- dry skin and mucous membranes, accompanied by itching (including the crotch), pustular infections of the skin,
- sleep disturbance, weakness, decreased performance,
- cramps in the calf muscles,
- visual impairment.
Manifestations of type I diabetes are characterized by severe thirst, frequent urination, nausea, weakness, vomiting, increased fatigue, constant hunger, weight loss (with normal or elevated diet), irritability. A sign of diabetes in children is the appearance of nocturnal incontinence, especially if the child has not urinated into bed before. In diabetes mellitus type I, hyperglycemic (with a critically high blood sugar level) and hypoglycemic (with a critically low blood sugar level) conditions requiring emergency measures develop more often.
In diabetes mellitus type II, pruritus, thirst, blurred vision, marked drowsiness and fatigue, skin infections, slow wound healing processes, paresthesia, and numbness of the legs predominate. Patients with type 2 diabetes mellitus are often obese.
The course of diabetes mellitus is often accompanied by hair loss on the lower limbs and an increase in their growth on the face, the appearance of xanthomas (small yellowish growths on the body), balanoposthitis in men and vulvovaginitis in women. As diabetes mellitus progresses, the violation of all types of metabolism leads to a decrease in immunity and resistance to infections. A long course of diabetes causes a lesion of the skeletal system, manifested by osteoporosis (bone loss). There are pains in the lower back, bones, joints, dislocations and subluxations of the vertebrae and joints, fractures and deformation of the bones, leading to disability.
The course of diabetes may be complicated by the development of multiorgan disorders:
- diabetic angiopathy - increased vascular permeability, their fragility, thrombosis, atherosclerosis, leading to the development of coronary heart disease, intermittent claudication, diabetic encephalopathy,
- diabetic polyneuropathy - damage to peripheral nerves in 75% of patients, resulting in impaired sensitivity, swelling and chilliness of the limbs, burning sensation and crawling. Diabetic neuropathy develops years after diabetes mellitus, is more common with insulin-independent type,
- diabetic retinopathy - the destruction of the retina, arteries, veins and capillaries of the eye, decreased vision, fraught with retinal detachment and complete blindness. With diabetes mellitus type I manifests itself in 10-15 years, with type II - previously detected in 80-95% of patients
- diabetic nephropathy - damage to the renal vessels with impaired renal function and the development of renal failure. It is noted in 40-45% of patients with diabetes mellitus in 15-20 years from the onset of the disease,
- diabetic foot - poor circulation of the lower limbs, pain in the calf muscles, trophic ulcers, destruction of the bones and joints of the feet.
Diabetic (hyperglycemic) and hypoglycemic coma are critical, acutely occurring conditions in diabetes mellitus.
Hyperglycemic condition and coma develop as a result of a sharp and significant increase in blood glucose levels. The forerunners of hyperglycemia are increasing general malaise, weakness, headache, depression, loss of appetite. Then there are pains in the abdomen, noisy breathing of Kussmaul, vomiting with the smell of acetone from the mouth, progressive apathy and drowsiness, a decrease in blood pressure. This condition is caused by ketoacidosis (accumulation of ketone bodies) in the blood and can lead to loss of consciousness - diabetic coma and death of the patient.
The opposite critical condition in diabetes mellitus - hypoglycemic coma develops with a sharp drop in blood glucose levels, often due to insulin overdose. The increase in hypoglycemia sudden, rapid. There is a sharp feeling of hunger, weakness, tremors in the limbs, shallow breathing, arterial hypertension, the patient's skin is cold, wet, and seizures sometimes develop.
Prevention of complications in diabetes mellitus is possible with continued treatment and careful monitoring of blood glucose levels.
Prognosis and prevention
Patients with diagnosed diabetes are put on the account of an endocrinologist. When organizing the right way of life, nutrition, treatment, the patient can feel satisfactory for many years. They aggravate the prognosis of diabetes and shorten the life expectancy of patients with acute and chronically developing complications.
Prevention of diabetes mellitus type I is reduced to increasing the body's resistance to infections and the exclusion of the toxic effects of various agents on the pancreas. Preventive measures of diabetes mellitus type II include the prevention of obesity, correction of nutrition, especially in people with a burdened hereditary history.Prevention of decompensation and complicated course of diabetes mellitus consists in its proper, systematic treatment.
Diabetes of pregnant women (gestational) - a disease that occurs only in women in the process of carrying a fetus. The course and symptoms of gestational diabetes are similar to non-insulin dependent diabetes mellitus. This disease occurs in 2-5% of pregnant women. A typical prognosis of pathology is its spontaneous disappearance after the completion of pregnancy. However, this is not always the case. It has also been established that gestational diabetes increases the risk of insulin-independent diabetes in women. In addition, gestational diabetes can adversely affect the course of pregnancy, cause various abnormalities in the development of the fetus, and lead to an increased mass of the newborn baby. Gestational diabetes should be distinguished from the usual diabetes mellitus of the first and second variants, which appeared before the onset of pregnancy.
It is similar in characteristics to insulin-dependent diabetes, however, it has some features of insulin-independent diabetes. This is an autoimmune pathology, accompanied by a decrease in insulin production. It is believed that among all patients with diabetes, about 5% have this kind of illness. Pathology often manifests itself in adolescence. Compared with typical insulin-dependent diabetes in a MODY variant of diabetes, the patient's need for insulin is not so high.
Diabetes mellitus is a pathology that usually develops gradually. There are three stages of diabetes. The main parameter by which these stages can be distinguished is the concentration of glucose in the blood plasma.
Stages of diabetes and blood glucose levels
|Stages of diabetes||sugar level on an empty stomach from a finger, mmol / l|
|Pre-diabetes (impaired glucose tolerance)||5,5-6,5|
Another classification criterion is the body's resistance to pathology. Given this parameter, it is possible to distinguish the compensated, subcompensated and decompensated stages. A special feature of the decompensated stage is the presence of acetone in the urine and high levels of glucose concentration in the blood, which react poorly to drug therapy.
This condition, which is often called impaired glucose tolerance, is characterized by borderline parameters of glucose concentration in the blood. It is not yet fully developed pathology or one of its stages, but can lead to diabetes over time. That is, the usual prediction of prediabetes is full diabetes.
Prognosis for diabetes
The prognosis depends on the stage of the pathology and the form of diabetes. The prognosis also takes into account the associated diabetes pathology. Modern methods of therapy can completely normalize blood sugar levels, or, if this is not possible, maximally prolong the life of the patient. Another factor that affects the prognosis is the presence of certain complications.
Ketoacidosis is a complication in which the products of fat metabolism, ketone bodies, accumulate in the body. Ketoacidosis most often occurs in a diabetic with comorbidities, injuries, malnutrition. Ketoacidosis entails a violation of many vital functions of the body and is an indication for hospitalization.
Hypoglycemia is a complication in which an abnormally low amount of glucose is contained in the blood. Since glucose is the most important source of energy for cells, this state threatens the cessation of the functioning of many organs, and in the first place, the brain. Typically, the threshold value below which hypoglycemia is fixed is 3.3 mmol / l.
Hypoglycemic crises usually accompany cases of insulin-dependent diabetes mellitus.They can be triggered by stress, alcohol intake or hypoglycemic drugs. The main method to combat hypoglycemia is the quickest use of sugar-containing products (sugar, honey). If the patient has lost consciousness, it is necessary to inject him with vitamin B1 subcutaneously and then intravenously 40% glucose solution. Or, glucagon preparations are administered intramuscularly.
This condition most often happens with older people suffering from non-insulin dependent diabetes mellitus and is associated with severe dehydration. Coma is usually preceded by prolonged polyuria. The condition most often appears in older people due to the fact that with age, the feeling of thirst is often lost, and the patient does not compensate for the loss of fluid due to drinking. Hyperosmolar coma is a vital indication for inpatient treatment.
Retinopathy - the most common complications of diabetes. The cause of the pathology is the deterioration of the blood supply to the retina. This process often affects other areas of the eye. Cataract development is often observed. In patients with diabetes, every year ailment increases the likelihood of retinopathy by 8%. After 20 years of illness, almost every diabetic suffers from a similar syndrome. The danger of retinopathy is the development of blindness, possible eye hemorrhages, retinal detachment.
Polyneuropathy often causes a loss of skin sensitivity (pain and temperature), especially in the limbs. In turn, this leads to the formation of difficult-to-heal ulcers. Symptoms of polyneuropathy are numbness of the limbs, or a burning sensation in them. These phenomena usually intensify at night.
Blood circulation disturbance caused by diabetes is most acutely felt in areas as far from the heart as possible. In humans, these areas are the foot. Diabetic foot syndrome includes the development of purulent and necrotic processes, ulcers, and bone tissue abnormalities in the foot area. With advanced cases of pathology, the only method of treatment can be amputation of the foot.