- 2014 - “Therapy” full-time continuing education courses on the basis of the Kuban State Medical University.
- 2014 - “Nephrology” full-time continuing education courses on the basis of GBOUVPO “Stavropol State Medical University”.
Symptoms of diabetes mellitus are a combination of clinical manifestations specific to a given disease, which indicates to doctors and patients the onset or progression of the pathological process.
Diabetes mellitus is recognized as one of the most widespread diseases in the world; today it affects 347 million people worldwide. According to statistics, in just two decades, the number of cases has increased by more than 10 times. About 90% of these people have type 2 diabetes.
If pathology is detected in the initial stages, a huge number of serious complications can be avoided. That is why it is so important to know what is indicative of the onset of the disease, and how it is necessary for a person to be examined in order to be able to control this severe endocrinological pathology.
Manifestations of diabetes do not depend on its type. The human body is able to understand when a sufficient level of energy stops coming from the glucose necessary in this case, to the results of a violation of its metabolism, and it remains in excess in the bloodstream, causing tremendous irreversible harm to systems and organs. Disturbed metabolic processes in the body are provided by a lack of insulin, which is responsible for the process of glucose metabolism. But the features of the pathogenesis of diabetes mellitus of the first and second types have significant differences, therefore, it is necessary to know exactly the symptoms of each of them.
A lack of insulin in the blood or a decrease in the sensitivity of insulin-dependent cells to the action of insulin in the body leads to a high concentration of glucose in the blood. In addition to this symptom, which is considered to be the main one in diabetes, there are other signs that are detected during medical observation of the patient. If there is the slightest suspicion of the presence of this disease, you should seek medical help, since an early detection of the disease is subject to treatment, and in the modern world even school-age children begin to suffer from diabetes.
Doctors name a number of specific symptoms as the first manifestations of diabetes. In diabetes, patients always experience polyuria - rapid and abundant urination due to high glycemia and glucose in the urine. It is glucosuria that is the reason that prevents the absorption of fluid by the renal structures. Polyuria is always accompanied by thirst, in which a person is able to consume up to 10 liters of fluid per day.
Despite consuming so much fluid, there is always a feeling of dry mouth. With the onset of diabetes mellitus of the second type, along with thirst, a feeling of constant hunger also appears. This is due to the fact that the insulin produced by the pancreas in large quantities circulates in the blood and, if not used for its intended purpose, sends signals to the brain about the feeling of hunger.
High glycemia causes serious harm to the body. Damage to nerve fibers leads to diabetic polyneuropathy. The first sign of such a complication is the numbness of the toes and hands and the occurrence of severe pain in the limbs.If you start to act on the level of glucose in the blood in a timely manner, the development of this process can be stopped and the pain syndrome, if you do not stop at all, will not be so pronounced. However, if you miss the beginning of the progression of the pathology, you can wait for very serious consequences - severe pain, disturbance of innervation, trophic ulcers and other things.
With damage to the high glycemia of the vessels of the eyes, diabetic angiopathy develops. Clinically, at the beginning of the disease, this is manifested by a feeling of foggy with a high concentration of glucose in the blood, then a decrease in visual acuity and even complete blindness in the absence of therapy. The occurrence of any of the above symptoms, and especially their complex, should force the patient to be urgently examined for insulin deficiency.
Among the external signs, there are also those that indicate the occurrence of insulin resistance and high glycemia. For example, a sharp occurrence of dry skin, itching and peeling can be such a symptom. It is especially important to pay attention to such skin manifestations against the background of concomitant thirst. Also, with diabetes, itching often occurs on the mucous membranes of the genitals, due to the irritating effect of glucose in the urine. No discharge is observed, which is a hallmark of diabetes.
Also, a signal about the onset of type 1 diabetes is a sharp weight loss. In this case, it is necessary to observe for the presence of some other symptoms of pathology, so as not to make hasty conclusions. Obesity and overweight are not a symptom of type 2 diabetes, but rather may be the cause. In any case, if a person’s weight is rapidly changing in any direction for no apparent reason, you should pay attention to it and undergo a medical examination.
Type 1 diabetes is very rapid in its development. He has his own specific manifestations, which should be paid attention to.
The patient has a history of increased appetite, but at the same time he only loses weight, is exhausted, suffers from drowsiness. Frequent urge to the toilet does not let you sleep peacefully at night, forcing you to get up several times. The amount of urine increases significantly, as does the feeling of thirst.
Such symptoms can not go unnoticed, because it occurs very sharply and suddenly. It is accompanied by nausea, vomiting and severe irritability. It is especially important to pay attention to the constant urge to use the toilet at night in children, if this has not been observed before.
The main problem of type 1 diabetes mellitus is the fact that the level of glucose in the blood can both increase critically and decrease dramatically. Both of these conditions are dangerous to health and have their own characteristics and manifestations, which must be carefully monitored.
The most common is type 2 diabetes. Its manifestations are very diverse, they appear gradually, so it is difficult to immediately grasp and recognize them. Weakly expressed symptoms usually do not lead to the fact that a person, having discovered it in himself, immediately begins to sound the alarm.
The second type of diabetes is characterized by the occurrence of dry mouth, thirst, excessive urination, weight loss, fatigue, weakness and drowsiness. A feature of this type of disease in the early stages is the presence of tingling in the fingers and numbness of the extremities, hypertonic manifestations, the occurrence of infectious processes in the urinary system. Similarly, with the first type of diabetes, the patient may be disturbed by nausea and vomiting, dryness and itching of the skin, skin infections.
It is important to remember that the gradual development of symptoms leads to the development of the disease itself. Diabetes in the late stages is fraught with the occurrence of hyperosmolar coma, lactic acidosis, ketoacidosis, hypoglycemia, which gain momentum in a couple of hours and can even lead to the death of the patient. Also, as a result of advanced diabetes, patients often have serious vision problems, which subsequently lead to complete blindness, renal or heart failure, and pathologies of the vascular and nervous systems.
Gestational diabetes is rarely manifested by some specific external signs. Most often, its presence is revealed during routine examinations, which are carried out regularly by pregnant women. The main indicators are data from blood and urine tests.
In the presence of external signs of a gestational type of disease, all of them are very similar to the symptoms of diabetes of the first two types - nausea, vomiting, weakness, thirst, infections in the genitourinary system are not individually signs of toxicosis and other pathologies, but indicate the occurrence in the second and third trimesters of pregnancy gestational diabetes.
The gestational form of pathology does not pose a direct threat to the life of a mother or child, however, it can affect the general course of pregnancy, well-being of both the expectant mother and the fetus. High levels of glucose in the blood lead to the birth of a baby with a high weight (more than 4 kilograms), which in the future will be a prerequisite for his obesity or the incidence of diabetes at any age. Also, a delay in the development of the child, hypoglycemia, jaundice in the first stages of the life of the newborn can be slightly manifested.
In diabetic foot in medicine is meant a complex anatomical and functional change in the tissues of the distal lower extremities in patients with diabetes. This is the most formidable complication of the pathology under consideration, often leading to gangrene, amputation of the extremities and disability.
If you have a history of diabetes mellitus, you need to monitor your foot health very carefully. There are three main forms of a diabetic foot: neuropathic (primary damage to the nerves), ischemic (primary damage to the vessels and impaired blood flow), mixed.
Among the complaints of patients preceding the diabetic foot, experts identify unpleasant feelings, burning and stitching in the legs, goosebumps, a feeling of discharge of current. If these troubles disappear when walking, this indicates the beginning of the development of the neuropathic form of the diabetic foot. It is also important to pay attention if the sensitivity of the feet periodically disappears. If painful sensations arise directly when walking or at night (you can calm down only by hanging limbs from the edge of the bed), this means the beginning of the development of an ischemic form of a diabetic foot called “ischemic foot”.
Among the signs indicating the start of the development of the diabetic foot, experts single out blanching of the skin on the legs or the appearance of age spots, peeling and dryness of the skin in this area, the appearance of multi-sized vesicles on the skin with a clear liquid, often corns, cracks between the fingers, deformation of the nail plates on the legs, thickening of the keratinization of the skin of the feet, spontaneous fractures of small bones on the legs. If a person notices at least a few of these signs, he should urgently seek medical help.
Signs of Retinopathy
Diabetic ophthalmology is manifested by a change in blood vessels in the retina, leading to a violation of microcirculation in it. Such a violation leads to the occurrence of diabetic retinopathy.Such a complication develops gradually and even in the later stages it can be almost invisible to humans.
The main signs of diabetic retinopathy are:
- the appearance of "flies" before the eyes,
- blurred vision
- decreased visual acuity in the later stages,
- vitreous hemorrhages and retina.
In this case, diabetic ophthalmology can manifest itself in two main forms - non-proliferative (background), or proliferative retinopathy of the retina. With background retinopathy, pathology relates, first of all, to the retina itself. With violations in the capillary vessels of the retina, hemorrhages, retinal edema, deposition of metabolic products occur. Background retinopathy is common in older patients with diabetes. It provokes a gradual decrease in visual acuity.
Based on the background, proliferative retinopathy develops if the oxygen deficiency of the retina continues to grow. In this case, a pathological formation of new blood vessels arises, sprouting from the retina to the vitreous body. This process leads to hemorrhages in the vitreous body and a sharp increase in the progression of a drop in vision in humans and irreversible blindness. In adolescence, such a transition of complications from one form to another can occur in a couple of months, followed by retinal detachment and a complete lack of vision.
Signs of Encephalopathy
Diabetic encephalopathy occurs as a complication of diabetes, due to diffuse degenerative damage to the brain. The prevalence of encephalopathy is directly dependent on the type of diabetes, and its symptoms are dependent on the duration of the disease and its severity. It refers to late complications and appears 10-15 years after the onset of diabetes.
Its immediate cause is metabolic disorders typical of diabetes, leading to damage to brain tissues and blood vessels. The above processes lead to impaired brain activity, a decrease in cognitive functions. The development of encephalopathy is very slow, which leads to the difficulty of identifying its symptoms in the early stages.
The main symptoms of diabetic encephalopathy are:
- headaches and dizziness,
- emotional instability, high fatigue, sleep disorders and other neurasthenic disorders,
- instability of a person’s gait,
- bifurcation of objects when looking at them, blurred vision, flickering of "flies" before the eyes,
- mental, depressive disorders,
- confused consciousness
- deterioration of mental activity, memory, ability to concentrate,
- strokes, transient ischemic attacks, other pathologies of cerebral circulation,
- the occurrence of seizures.
At the initial stages, there are practically no complications of the clinic, and with the development of encephalopathy, the symptoms begin to manifest more clearly. Symptoms are identical in both types of diabetes.
Atherosclerosis, hypertension, and obesity are common diabetes companions. In connection with vascular obliteration in the event of atherosclerosis, the risk of ischemic strokes and heart attacks increases. In case of impaired microcirculation in the renal vessels, irreversible renal failure occurs, which eventually leads to a complete cessation of renal function. This in turn leads to the need for replacement therapy for renal failure by lifelong dialysis.
Diabetic coma means a serious metabolic disturbance in the body of a patient suffering from diabetes. A coma can occur both with a strong increase, and with a strong decrease in the level of sugar in the blood of a person. This condition requires urgent medical attention, since in its absence serious complications and even death are possible.
A coma develops in stages, but rather rapidly. The first sign of falling into a coma can be a fainting state, a rapid increase in blood sugar, nausea and vomiting, drowsiness, pain in the abdomen for a day or more before a direct coma. Another symptom of a diabetic coma may be a sharp smell of acetone from the patient's mouth. Seizures, thirst, and sensitivity may also occur.
With a hypoglycemic coma, the concentration of sugar in the blood decreases sharply. The indicator can reach the level of 2.5 mmol per liter and below. Among the obvious symptoms of such a coma are causeless anxiety, patient fear, a feeling of weakness, cramps, a drop in blood pressure, and loss of consciousness. The harbingers of hypoglycemic coma may be:
- general malaise
- lack of appetite,
- diarrhea or constipation,
- dizziness, headaches, tachycardia.
Lack of assistance in this condition can lead to extremely serious consequences. Since hypoglycemic coma develops rapidly, the assistance provided should be rapid.
Ordinary people can diagnose a diabetic coma by a sharp decrease in the patient’s blood pressure, weakening of the pulse, and softness of the eyeballs. Only a qualified doctor can bring a person to life in this state, therefore an ambulance call should be followed as soon as possible.
Reliably know the patient’s diagnosis is possible only after all the necessary laboratory tests. Any laboratory tests for diabetes are aimed at determining blood glucose indicators.
It is possible to accidentally detect blood sugar during mass examinations of a person before hospitalization or in the urgent determination of other indicators.
The most common is a fasting blood sugar test. Before surrendering, you can’t eat anything for 8-12 hours. Also, you can not drink alcohol and an hour before blood donation you can not smoke. In this case, a level of up to 5.5 mmol per liter will be considered a normal indicator. If the indicator turns out to be equal to 7 mmol per liter, the patient will be sent for additional examination. To this end, glucose tolerance testing is performed. For this, the patient donates blood on an empty stomach, then he drinks a glass of water with sugar (75 grams for an adult per 200 milliliters of water), and after 2 hours after that he re-takes a blood test.
If the body is in a normal state, then the first analysis will show the result up to 5.5 mmol per liter, and the second - up to 7.8 mmol per liter. If the indicators are in the range of 5.5-6.7 and 7.8-11.1 mmol per liter, respectively, this will tell doctors about the development of prediabetes in the patient. Indicators in excess of these numbers indicate diabetes.
It is also customary to conduct a study on glycated hemoglobin, which demonstrates the average value of glucose in human blood over the last 3 months of life. The norm is below 5.7%. If the value is in the range of 5.7-6.4%, then this suggests that there is a risk of developing type 2 diabetes. In this case, you should discuss with your doctor measures to reduce this risk. If the level of glycated hemoglobin is more than 6.5%, a diagnosis of diabetes is likely, but it requires confirmation. The recommended level of glycated hemoglobin in people with diabetes is less than 7%, if this level is higher, you need to discuss the situation with your doctor. It should be borne in mind that the level of glycated hemoglobin above 7% can be evaluated by the doctor as optimal.
Symptoms in a child
Diabetes can manifest at any age, including early childhood. Even newborn diabetes is found. This is a rare case of the congenital nature of the disease. Most often, the manifestation in children falls on 6-12 years.Metabolic processes in children during this period are much faster, and the state of the unformed nervous system can affect the level of glucose in the blood. The younger the baby, the more difficult diabetes is.
Among the main symptoms that parents need to pay attention not to miss the development of diabetes, doctors distinguish among children:
- thirst and dry mouth
- nausea with vomiting
- frequent urination with sticky urine,
- weight loss and high appetite at the same time,
- visual acuity
- fatigue, weakness and irritability.
If a child has at least one of the above symptoms, this is an occasion to consult a doctor. If several symptoms are detected at the same time, contacting a doctor should be immediate.
Also among the symptoms in children, typical and atypical signs of diabetes can occur. Doctors attribute polyuria to typical symptoms, which parents of infants often confuse with age-related urinary incontinence, polydipsia, polyphagia, dryness and itching of the skin, genital itching after urination, the amount of sugar in the blood is more than 5.5 mmol per liter during fasting blood tests. Timely diagnosis in case of suspicion will help to identify the disease at an early stage and begin the necessary therapy, which will not allow complications to develop.
Definition of diabetes at home
The course of diabetes can be completely asymptomatic. You can identify it randomly when visiting an optometrist or any other doctor. However, there are many signs by which the presence of pathology can be guessed independently. At the same time, at home, you can even accurately determine the type of disease.
With a healthy body, after a meal, blood sugar rises. 2-3 hours after this, this indicator should return to its original borders. If this does not happen, then a person has a number of symptoms that cannot be overlooked. This has already been considered dry mouth, thirst, very frequent and profuse urination, increased appetite, apathy, cramps, and nebula of consciousness. Gradually, a person begins to notice dry skin, which previously did not manifest itself.
Also at home, you can suspect the onset of diabetes due to various strange sensations that a person had not previously observed. In the second type of diabetes, this is poor healing of wounds and scratches, the development of obesity. With the first type of pathology, a person, on the contrary, can lose weight dramatically, although the appetite is quite high. Also, with all types of the disease, itching of the skin, increased growth of facial hair, the formation of xanthomas (small yellow growths on the skin), hair loss on the limbs and others can occur.
Timely identification of signs of diabetes should be the reason for going to the doctor.
Only if you start the treatment of diabetes in the early stages, you can hope for compensation of the disease and a normal quality of life in the future.
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Specialty: therapist, nephrologist.
Total length of service: 18 years .
Place of work: Novorossiysk, medical center "Nefros".
Education: 1994-2000 Stavropol State Medical Academy.
- 2014 - “Therapy” full-time continuing education courses on the basis of the Kuban State Medical University.
- 2014 - “Nephrology” full-time continuing education courses on the basis of GBOUVPO “Stavropol State Medical University”.
Among the metabolic disorders, diabetes is in second place after obesity. About 10% of the population in the world suffers from diabetes, however, if we take into account the latent forms of the disease, this figure may be 3-4 times greater.Diabetes mellitus develops due to chronic insulin deficiency and is accompanied by disorders of carbohydrate, protein and fat metabolism. The production of insulin occurs in the pancreas by ß-cells of the islets of Langerhans.
Participating in the metabolism of carbohydrates, insulin increases glucose uptake into cells, promotes the synthesis and accumulation of glycogen in the liver, and 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 is to enhance the flow of glucose into fat cells, energy processes in cells, the synthesis of fatty acids and slow down the breakdown of fats. With the participation of insulin, the process of entering the sodium cell is enhanced. Disorders of metabolic processes controlled by insulin can develop with insufficient synthesis (type I diabetes mellitus) or with tissue immunity to insulin (type II diabetes mellitus).
Reasons and mechanism of development
Type I diabetes is more often detected in young patients under 30 years of age. Violation of the synthesis of insulin develops as a result of damage to the pancreas of an autoimmune nature and the destruction of insulin-producing ß cells. In most patients, diabetes develops after a viral infection (mumps, rubella, viral hepatitis) or toxic effects (nitrosamines, pesticides, drugs, etc.), the immune response to which causes death of pancreatic cells. Diabetes mellitus develops if more than 80% of insulin-producing cells are affected. Being an autoimmune disease, type I diabetes mellitus is often combined with other processes of autoimmune origin: thyrotoxicosis, diffuse toxic goiter, etc.
In type II diabetes mellitus, insulin resistance of tissues develops, i.e., their insensitivity to insulin. In this case, the insulin content in the blood can be normal or elevated, however, the cells are immune to it. Most (85%) patients have type II diabetes mellitus. If the patient is obese, tissue susceptibility to insulin is blocked by adipose tissue. Type II diabetes mellitus is more susceptible to elderly patients who have a decrease in glucose tolerance with age.
The occurrence of type II diabetes mellitus may be accompanied by the influence of the following factors:
- genetic - the risk of developing the disease is 3-9% if relatives or parents are sick with diabetes,
- obesity - with excess adipose tissue (especially abdominal type of obesity), there is a noticeable decrease in tissue sensitivity to insulin, contributing to the development of diabetes mellitus,
- eating disorders - predominantly carbohydrate nutrition with a lack of fiber increases the risk of diabetes,
- cardiovascular disease - atherosclerosis, arterial hypertension, coronary heart disease, reducing tissue insulin resistance,
- chronic stress - in a state of stress in the body increases the number of catecholamines (norepinephrine, adrenaline), glucocorticoids that contribute to the development of diabetes,
- diabetogenic effects of certain drugs - glucocorticoid synthetic hormones, diuretics, some antihypertensive drugs, cytostatics, etc.
- chronic adrenal cortex insufficiency.
In case of insufficiency or resistance to insulin, glucose intake into the cells decreases and its content in the blood increases. The body activates alternative ways of processing and assimilation of glucose, which leads to the accumulation in the tissues of glycosaminoglycans, sorbitol, glycated hemoglobin.The accumulation of sorbitol leads to the development of cataracts, microangiopathies (dysfunctions of capillaries and arterioles), neuropathy (dysfunctions of the nervous system), glycosaminoglycans cause joint damage. To obtain the missing energy in the body, the processes of protein breakdown begin, causing muscle weakness and degeneration of skeletal and cardiac muscles. The peroxidation of fats is activated, the accumulation of toxic metabolic products (ketone bodies).
Hyperglycemia in the blood with diabetes causes increased 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). Together with the loss of glucose, the energy reserves of the body decrease, so patients with diabetes mellitus experience weight loss. Elevated sugar levels, dehydration and accumulation of ketone bodies due to the breakdown of fat cells cause a dangerous state of diabetic ketoacidosis. Over time, due to high sugar levels, damage to nerves, small blood vessels of the kidneys, eyes, heart, and brain develop.
In conjunction with other diseases, endocrinology distinguishes symptomatic (secondary) and true diabetes mellitus.
Symptomatic diabetes mellitus is associated with diseases of the endocrine glands: pancreas, thyroid, adrenal gland, pituitary gland and is one of the manifestations of the primary pathology.
True diabetes can be of two types:
- type I insulin dependent (ISDI type I), if your own insulin is not produced in the body or is produced in insufficient quantities,
- type II non-insulin-dependent (NIDDM type II), if tissue insensitivity to insulin is noted with its abundance and excess in the blood.
There are three degrees of diabetes mellitus: mild (I), moderate (II) and severe (III) and three states of compensation for carbohydrate metabolism disorders: compensated, subcompensated and decompensated.
Type I diabetes is developing rapidly, type II diabetes - on the contrary gradually. Often there is a latent, asymptomatic course of diabetes mellitus, and its detection occurs by chance when examining the fundus or laboratory determination of sugar in the blood and urine. Clinically, type I and type II diabetes mellitus manifest themselves differently, 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 (excessive and frequent urination),
- polyphagy (increased appetite),
- dry skin and mucous membranes, accompanied by itching (including perineum), 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 increased nutrition), and irritability. A sign of diabetes in children is the appearance of bedwetting, especially if the child has not previously urinated in bed. In type I diabetes mellitus, hyperglycemic (with a critically high blood sugar level) and hypoglycemic (critically low blood sugar) conditions more often develop that require emergency measures.
In type II diabetes mellitus, itching, thirst, visual impairment, severe drowsiness and fatigue, skin infections, slow wound healing, paresthesia and numbness of the legs predominate. Patients with type II diabetes are often obese.
The course of diabetes is often accompanied by hair loss on the lower extremities and increased growth on the face, the appearance of xanthomas (small yellow growths on the body), balanoposthitis in men and vulvovaginitis in women. As diabetes progresses, disruption of all types of metabolism leads to a decrease in immunity and resistance to infections. A prolonged course of diabetes causes damage to the skeletal system, manifested by osteoporosis (rarefaction of bone tissue). Pain in the lower back, bones, joints, dislocation and subluxation of the vertebrae and joints, fractures and deformation of the bones leading to disability.
The course of diabetes can be complicated by the development of multiple organ disorders:
- diabetic angiopathy - increased vascular permeability, fragility, thrombosis, atherosclerosis, leading to the development of coronary heart disease, intermittent claudication, diabetic encephalopathy,
- diabetic polyneuropathy - damage to the peripheral nerves in 75% of patients, as a result of which there is a violation of sensitivity, swelling and chilliness of the extremities, a burning sensation and "crawling" goose bumps. Diabetic neuropathy develops years after the onset of diabetes mellitus, is more common in non-insulin-dependent type,
- diabetic retinopathy - destruction of the retina, arteries, veins and capillaries of the eye, decreased vision, fraught with retinal detachment and complete blindness. In type I diabetes, it manifests itself in 10-15 years, in type II - earlier, it is 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 after 15-20 years from the onset of the disease,
- diabetic foot - impaired blood circulation of the lower extremities, pain in the calf muscles, trophic ulcers, destruction of bones and joints of the feet.
Critical, acute conditions in diabetes mellitus are diabetic (hyperglycemic) and hypoglycemic coma.
The hyperglycemic state and coma develop as a result of a sharp and significant increase in blood glucose levels. The harbingers of hyperglycemia are increasing general malaise, weakness, headache, depression, loss of appetite. Then there are abdominal pains, Kussmaul's noisy breathing, vomiting with the smell of acetone from the mouth, progressive apathy and drowsiness, and a decrease in blood pressure. This condition is caused by ketoacidosis (the accumulation of ketone bodies) in the blood and can lead to loss of consciousness - a diabetic coma and death of the patient.
The opposite critical condition in diabetes mellitus - a hypoglycemic coma develops with a sharp drop in blood glucose levels, more often in connection with an overdose of insulin. The increase in hypoglycemia is sudden, rapid. There is a sharp feeling of hunger, weakness, trembling in the limbs, shallow breathing, hypertension, the patient's skin is cold, wet, and sometimes convulsions develop.
Prevention of complications of diabetes is possible with continuous treatment and careful monitoring of blood glucose levels.
The presence of diabetes mellitus is evidenced by fasting capillary blood glucose in excess of 6.5 mmol / L. Normally, glucose in the urine is absent, because it is retained in the body by the renal filter. With an increase in blood glucose levels of more than 8.8-9.9 mmol / L (160-180 mg%), the renal barrier fails and passes glucose into the urine. The presence of sugar in the urine is determined by special test strips. The minimum blood glucose at which it begins to be detected in the urine is called the "renal threshold."
Screening for suspected diabetes includes determining the level of:
- fasting glucose in capillary blood (from the finger),
- glucose and ketone bodies in the urine - their presence indicates diabetes mellitus,
- glycated hemoglobin - significantly increased in diabetes mellitus,
- C-peptide and insulin in the blood - with type I diabetes mellitus, both indicators are significantly reduced, with type II diabetes - practically unchanged,
- conducting a stress test (glucose tolerance test): determination of fasting glucose and 1 and 2 hours after ingestion of 75 g of sugar dissolved in 1.5 cups of boiled water. A negative (not confirming diabetes mellitus) test result is considered for samples: on an empty stomach 6.6 mmol / l at the first measurement and> 11.1 mmol / l 2 hours after glucose loading.
To diagnose complications of diabetes mellitus, additional examinations are carried out: ultrasound of the kidneys, lower limb rheovasography, rheoencephalography, brain EEG.
Implementation of the recommendations of a diabetologist, self-monitoring and treatment for diabetes are carried out for life and can significantly slow down or avoid complicated variants of the course of the disease. Treatment of any form of diabetes is aimed at lowering blood glucose levels, normalizing all types of metabolism and preventing complications.
The basis for the treatment of all forms of diabetes is diet therapy, taking into account the gender, age, body weight, physical activity of the patient. Training is being given to the principles of calculating caloric intake, taking into account the content of carbohydrates, fats, proteins, vitamins and trace elements. In case of insulin-dependent diabetes mellitus, the consumption of carbohydrates at the same hours is recommended to facilitate the control and correction of glucose by insulin. With type I diabetes, intake of fatty foods that contribute to ketoacidosis is limited. With non-insulin-dependent diabetes mellitus, all types of sugars are excluded and the total calorie content of food is reduced.
Food should be fractional (at least 4-5 times a day), with a uniform distribution of carbohydrates, contributing to a stable level of glucose and maintaining basic metabolism. Special diabetic products based on sweeteners (aspartame, saccharin, xylitol, sorbitol, fructose, etc.) are recommended. Correction of diabetic disorders using only one diet is used in the mild degree of the disease.
The choice of drug treatment for diabetes is determined by the type of disease. Patients with type I diabetes mellitus are indicated for insulin therapy, for type II - diet and hypoglycemic agents (insulin is prescribed for the ineffectiveness of taking tablet forms, the development of ketoazidosis and precomatous state, tuberculosis, chronic pyelonephritis, liver and kidney failure).
The introduction of insulin is carried out under the systematic control of the level of glucose in the blood and urine. The mechanism and duration of insulin are of three main types: prolonged (extended), intermediate and short-acting. Long-acting insulin is administered 1 time per day, regardless of food intake. More often, prolonged insulin injections are prescribed together with intermediate and short-acting drugs, allowing to achieve compensation for diabetes.
The use of insulin is dangerous overdose, leading to a sharp decrease in sugar, the development of hypoglycemia and coma. The selection of drugs and the dose of insulin is carried out taking into account changes in the patient’s physical activity during the day, stability of blood sugar level, caloric intake, food fragmentation, insulin tolerance, etc. With insulin therapy, local development (pain, redness, swelling at the injection site) is possible and general (up to anaphylaxis) allergic reactions. Also, insulin therapy can be complicated by lipodystrophy - “dips” in adipose tissue at the injection site of insulin.
Sugar-lowering tablets are prescribed for non-insulin-dependent diabetes mellitus in addition to diet.The following groups of sugar-lowering drugs are distinguished by the mechanism of lowering blood sugar:
- sulfonylurea preparations (glycidone, glibenclamide, chlorpropamide, carbutamide) - stimulate the production of insulin by β cells of the pancreas and promote the penetration of glucose into the tissues. An optimally selected dosage of this group of drugs supports a glucose level of not> 8 mmol / L. With an overdose, the development of hypoglycemia and coma is possible.
- biguanides (metformin, buformin, etc.) - reduce the absorption of glucose in the intestine and contribute to the saturation of peripheral tissues. Biguanides can increase the level of uric acid in the blood and cause the development of a serious condition - lactic acidosis in patients older than 60 years, as well as people suffering from liver and kidney failure, chronic infections. Biguanides are more commonly prescribed for non-insulin-dependent diabetes mellitus in young obese patients.
- meglitinides (nateglinide, repaglinide) - cause a decrease in sugar levels, stimulating the pancreas to secrete insulin. The effect of these drugs depends on the blood sugar and does not cause hypoglycemia.
- alpha glucosidase inhibitors (miglitol, acarbose) - slow down the increase in blood sugar, blocking the enzymes involved in the absorption of starch. Side effects - flatulence and diarrhea.
- thiazolidinediones - reduce the amount of sugar released from the liver, increase the sensitivity of fat cells to insulin. Contraindicated in heart failure.
In diabetes mellitus, it is important to teach the patient and his family members the skills to control the well-being and condition of the patient, first aid measures for the development of precomatous and coma states. The beneficial therapeutic effect in diabetes has a reduction in excess weight and individual moderate physical activity. Due to muscle efforts, glucose oxidation is increased and its content in the blood decreases. However, exercise cannot be started at a glucose level> 15 mmol / L, first you must wait for it to decline under the influence of drugs. With diabetes, physical activity should be evenly distributed across all muscle groups.
Forecast and Prevention
Patients with diagnosed diabetes mellitus are registered with the endocrinologist. When organizing the right lifestyle, nutrition, treatment, the patient can feel satisfactory for many years. It complicates the prognosis of diabetes and reduces the life expectancy of patients with acute and chronically developing complications.
Prevention of type I diabetes reduces to increasing the body's resistance to infections and eliminating the toxic effects of various agents on the pancreas. Preventive measures for type II diabetes include preventing the development of obesity, nutrition correction, especially in people with a hereditary history. Prevention of decompensation and the complicated course of diabetes mellitus consists in its correct, systematic treatment.
What is diabetes?
Diabetes mellitus is a violation of the metabolism of carbohydrates and water in the body. The consequence of this is a violation of the functions of the pancreas. It is the pancreas that produces the hormone called insulin. Insulin is involved in the processing of sugar. And without it, the body can not carry out the conversion of sugar into glucose. As a result, sugar accumulates in our blood and is excreted in large quantities from the body through urine.
In parallel, water exchange is disrupted. Tissues cannot hold water in themselves, and as a result, a lot of inferior water is excreted through the kidneys.
If a person has a blood sugar (glucose) higher than normal, then this is the main symptom of the disease - diabetes. In the human body, pancreatic cells (beta cells) are responsible for the production of insulin.In turn, insulin is a hormone that is responsible for ensuring that glucose is supplied to the cells in the right amount. What happens in the body with diabetes? The body produces insufficient amounts of insulin, while the blood sugar and glucose are elevated, but the cells begin to suffer from a lack of glucose.
This metabolic disease can be hereditary or acquired. Poor and other skin lesions develop from insulin deficiency, teeth suffer, atherosclerosis, angina pectoris, hypertension develop, kidneys, nervous system suffer, vision deteriorates.
Etiology and pathogenesis
The pathogenetic basis for diabetes mellitus depends on the type of disease. There are two of its varieties, which are fundamentally different from each other. Although modern endocrinologists call the separation of diabetes very conditional, but still the type of disease is important in determining the therapeutic tactics. Therefore, it is advisable to dwell on each of them separately.
In general, diabetes mellitus refers to those diseases in the essence of which there is a violation of metabolic processes. At the same time, carbohydrate metabolism suffers the most, which is manifested by a persistent and constant increase in glucose in the blood. This indicator is called hyperglycemia. The most basic basis of the problem is the distortion of the interaction of insulin with tissues. It is this hormone that is the only one in the body that contributes to a drop in glucose content, by conducting it into all cells, as the main energy substrate for supporting life processes. If a malfunction occurs in the system of interaction of insulin with tissues, then glucose cannot be included in the normal metabolism, which contributes to its constant accumulation in the blood. These causal relationships are called diabetes.
It is important to understand that not all hyperglycemia is true diabetes, but only that which is caused by a primary violation of the action of insulin!
Why are there two types of illness?
This need is mandatory, since it completely determines the treatment of the patient, which in the initial stages of the disease is radically different. The longer and harder the course of diabetes mellitus, the more its division into types is formal. Indeed, in such cases, the treatment practically coincides with any form and origin of the disease.
Type 1 diabetes
This type is also called insulin-dependent diabetes. Most often, this type of diabetes affects young people, under the age of 40, thin. The disease is quite severe, insulin is required for treatment. Reason: The body produces antibodies that destroy pancreatic cells that produce insulin.
It is almost impossible to completely recover from type 1 diabetes, although there are cases of restoration of pancreatic functions, but this is possible only under special conditions and natural raw nutrition. To maintain the body, it is required to inject insulin into the body with a syringe. Since insulin is destroyed in the gastrointestinal tract, it is not possible to take insulin in the form of tablets. Insulin is administered along with a meal. It is very important to follow a strict diet, completely digestible carbohydrates (sugar, sweets, fruit juices, sugar-containing lemonades) are excluded from the diet.
Type 2 diabetes
This type of diabetes is non-insulin dependent. Most often, type 2 diabetes affects the elderly, after 40 years old, obese. Reason: loss of cell sensitivity to insulin due to an excess of nutrients in them. The use of insulin for treatment is not necessary for every patient. Only a qualified specialist can prescribe treatment and doses.
To begin with, such patients are prescribed a diet.It is very important to fully follow the doctor's recommendations. It is recommended to reduce weight slowly (2-3 kg per month), in order to achieve normal weight, which must be maintained throughout life. In cases where the diet is not enough, sugar-lowering tablets are used, and only in a very extreme case, insulin is prescribed.
Signs and symptoms of diabetes
Clinical signs of the disease in most cases are characterized by a gradual course. Rarely, diabetes manifests itself in a fulminant form with a rise in the glycemic index (glucose content) to critical numbers with the development of various diabetic comas.
With the onset of the disease in patients appear:
Permanent dry mouth
A feeling of thirst with the inability to satisfy her. Sick people drink up to several liters of daily fluid,
Increased urine output - a marked increase in portioned and total urine excreted per day,
Decrease or sharp increase in weight and body fat,
Increased tendency to pustular processes on the skin and soft tissues,
Muscle weakness and excessive sweating,
Bad healing of any wounds
Typically, these complaints are the first call of the disease. Their appearance should be an indispensable reason for an immediate blood test for glycemia (glucose content).
As the disease progresses, symptoms of diabetes complications may appear that affect almost all organs. In critical cases, life-threatening conditions may occur with impaired consciousness, severe intoxication and multiple organ failure.
The main manifestations of complicated diabetes include:
Headaches and neurological abnormalities,
Heart pain, enlarged liver, if not noted before diabetes,
Pain and numbness of the lower extremities with impaired walking function,
Decreased skin sensitivity, especially feet,
The appearance of wounds that do not heal for a long time,
The smell of acetone from the patient,
The appearance of characteristic signs of diabetes or the development of its complications is an alarm signal that indicates the progression of the disease or insufficient medical correction.
Causes of Diabetes
The most significant causes of diabetes are such as:
Heredity. We need other factors that affect the development of diabetes mellitus.
Obesity. Actively fight overweight.
A number of diseases that contribute to the defeat of beta cells responsible for the production of insulin. Such diseases include pancreatic diseases - pancreatitis, pancreatic cancer, diseases of other endocrine glands.
Viral infections (rubella, chickenpox, epidemic hepatitis and other diseases, this includes flu). These infections are the starting point for the development of diabetes. Especially for people who are at risk.
Nervous stress. People at risk should avoid nervous and emotional stress.
Age. With age, for every ten years, the risk of developing diabetes doubles.
The list does not include those diseases in which diabetes mellitus or hyperglycemia are secondary in nature, being only their symptom. In addition, such hyperglycemia cannot be considered true diabetes until developed clinical manifestations or diabetic complications develop. The diseases that cause hyperglycemia (increased sugar) include tumors and adrenal hyperfunction, chronic pancreatitis, and an increase in the level of contra-hormonal hormones.
Blood sugar in diabetes
The first and most informative method of primary diagnosis of diabetes and its dynamic assessment during treatment is the study of blood glucose (sugar) levels.This is a clear indicator from which all subsequent diagnosis and treatment measures should be based.
The experts reviewed the normal and pathological glycemic numbers several times. But today, their clear values are established, which shed true light on the state of carbohydrate metabolism in the body. They should be guided not only by endocrinologists, but also by other specialists and the patients themselves, especially diabetics with a long history of the disease.
2 hours after a carbohydrate load
2 hours after a carbohydrate load
As can be seen from the table, the diagnostic confirmation of diabetes is extremely simple and can be carried out in the walls of any outpatient clinic or even at home with a personal electronic blood glucose meter (a device for determining the level of glucose in the blood). Similarly, criteria have been developed to assess the sufficiency of diabetes mellitus therapy by one or another method. The main one is the same sugar level (glycemia).
According to international standards, a good indicator of the treatment of diabetes is a blood glucose level below 7.0 mmol / L. Unfortunately, in practice this is not always feasible, despite the real efforts and strong desire of doctors and patients.
Degrees of diabetes
A very important section in the classification of diabetes mellitus is its separation by degree of severity. The basis of this distinction is the level of glycemia. Another element with the correct formulation of the diagnosis of diabetes is an indication of the compensation process. This indicator is based on the presence of complications.
But for simplicity of understanding of what happens to a patient with diabetes, looking at the entries in the medical documentation, you can combine the severity with the stage of the process in one section. After all, it is natural that the higher the blood sugar level, the harder the course of diabetes and the higher the number of formidable complications.
Diabetes mellitus 1 degree
It characterizes the most favorable course of the disease to which any treatment should aim. At such a degree of the process, it is fully compensated, the glucose level does not exceed 6-7 mmol / L, there is no glucosuria (excretion of glucose in the urine), and glycosylated hemoglobin and proteinuria do not go beyond the normal range.
There are no signs of diabetes complications in the clinical picture: angiopathy, retinopathy, polyneuropathy, nephropathy, cardiomyopathy. At the same time, it is possible to achieve such results with the help of diet therapy and taking medications.
Diabetes mellitus 2 degrees
This stage of the process indicates partial compensation. Signs of diabetes complications and lesions of typical target organs appear: eyes, kidneys, heart, blood vessels, nerves, lower extremities.
The glucose level is slightly increased and amounts to 7-10 mmol / L. Glucosuria is not determined. Glycosylated hemoglobin values are within normal limits or slightly increased. Severe organ dysfunctions are absent.
Diabetes mellitus 3 degrees
A similar course of the process indicates its constant progression and the impossibility of drug control. At the same time, the glucose level varies from 13-14 mmol / l, persistent glucosuria (excretion of glucose in the urine), high proteinuria (the presence of protein in the urine) are observed, and there are clear unfolded manifestations of target organ damage in diabetes mellitus.
Visual acuity progressively decreases, severe arterial hypertension persists (increase in blood pressure), sensitivity decreases with the appearance of severe pain and numbness of the lower extremities. The level of glycosylated hemoglobin is maintained at a high level.
Diabetes mellitus 4 degrees
This degree characterizes the absolute decompensation of the process and the development of severe complications. At the same time, the level of glycemia rises to critical numbers (15-25 or more mmol / l), is difficult to correct by any means.
Progressive proteinuria with protein loss. The development of renal failure, diabetic ulcers and gangrene of the extremities is characteristic. Another of the criteria for grade 4 diabetes is a tendency to develop frequent diabetic comas: hyperglycemic, hyperosmolar, ketoacidotic.
Main treatment method
To get rid of type 2 diabetes mellitus, you must follow these recommendations:
Go on a low carbohydrate diet.
Refuse to take harmful pills for diabetes.
Start taking an inexpensive and harmless drug for the treatment of diabetes based on metformin.
Start playing sports, increase your physical activity.
Sometimes inulin in small doses may be required to normalize blood sugar levels.
These simple recommendations will help you control your blood sugar and stop taking medications that cause multiple complications. You need to eat right, not from time to time, but every day. The transition to a healthy lifestyle is an indispensable condition for getting rid of diabetes. A more reliable and simple way to treat diabetes at the given time has not yet been invented.
Medicines for diabetes
With type 2 diabetes, sugar-lowering drugs are used:
Drugs to stimulate the pancreas, which causes it to produce more insulin. These are sulfonylurea derivatives (Gliclazide, Glycvidon, Glipizide), as well as meglitinides (Repaglitinid, Nateglitinide).
Drugs that increase the sensitivity of cells to insulin. These are the Biguanides (Siofor, Glucofage, Metformin). Biguanides are not prescribed to people who suffer from pathologies of the heart and kidneys with severe insufficiency of the functioning of these organs. Also, drugs that increase the sensitivity of cells to insulin are Pioglitazone and Avandia. These drugs belong to the group of thiazolidinediones.
Drugs with incretin activity: DPP-4 inhibitors (Vildagliptin and Sitagliptin) and HGP-1 receptor agonists (Liraglutid and Exenatide).
Drugs that prevent glucose from being absorbed in the digestive system. This is a drug called Acarbose from the group of alpha-glucosidase inhibitors.
6 common misconceptions about diabetes
There are common beliefs about diabetes that need to be dispelled.
Diabetes develops in those people who eat a lot of sweets. This statement is not entirely true. In fact, eating sweets can cause weight gain, which is a risk factor for the development of type 2 diabetes. However, a person must have a predisposition to diabetes. That is, two key points are needed: overweight and burdened heredity.
At the beginning of the development of diabetes, insulin continues to be produced, but fat deposits do not allow it to be absorbed normally by the cells of the body. If this situation has been observed for many years, then the pancreas will lose its ability to produce enough insulin.
The use of sweets does not affect the development of type 1 diabetes. In this case, pancreatic cells simply die due to antibody attacks. Moreover, their body produces them. This process is called an autoimmune reaction. To date, science has not found the reasons for this pathological process. It is known that type 1 diabetes is rarely inherited, in about 3-7% of cases.
When I get diabetes, I will immediately understand this. You can find out that a person develops diabetes mellitus right away, if only he has a type 1 disease. This pathology is characterized by a rapid increase in symptoms, which are simply impossible to notice.
Moreover, type 2 diabetes develops for a long time and is often completely asymptomatic. This is the main danger of the disease. People learn about it already at the stage of complications, when the kidneys, heart, and nerve cells were injured.
While the treatment prescribed on time could stop the progression of the disease.
Type 1 diabetes always develops in children, and type 2 diabetes in adults. Regardless of the type of diabetes, it can develop at any age. Although more often children and adolescents get type 1 diabetes. However, this is no reason to believe that the disease cannot begin at an older age.
The main reason that leads to the development of type 2 diabetes is obesity, but it can develop at any age. In recent years, the issue of childhood obesity in the world is quite acute.
However, type 2 diabetes is most often diagnosed in people over 45 years old. Although practitioners are starting to sound the alarm, indicating that the disease has become significantly younger.
With diabetes, you can’t eat sweets, you need to eat special foods for diabetics. Of course, you will have to change your menu, but you should not completely abandon conventional foods. Diabetic foods can replace the usual sweets and favorite desserts, but eating them, you need to remember that they are a source of fat. Therefore, the risk of gaining excess weight remains. Moreover, products for diabetics are very expensive. Therefore, the easiest solution is to switch to a healthy diet. The menu should be enriched with proteins, fruits, complex carbohydrates, vitamins and vegetables.
Recent studies show that an integrated approach to the treatment of diabetes allows significant progress. Therefore, you need not only to take medicines, but also to lead a healthy lifestyle, as well as eat right. Insulin needs to be injected only in extreme cases, it causes dependence.
If a person with type 1 diabetes refuses to give up insulin injections, this will lead to his death. If the patient suffers from type 2 diabetes, then in the early stages of the disease, the pancreas will still produce some insulin. Therefore, patients are prescribed drugs in the form of tablets, as well as injections of sugar-burning drugs. This will allow your insulin to be better absorbed.
As the disease progresses, less and less insulin is produced. As a result, there will come a moment when giving up his injections simply will not succeed.
Many people are wary of insulin injections, and these fears are not always justified. It should be understood that when the tablets are not able to produce the desired effect, then the risk of developing complications of the disease increases. In this case, insulin injections are a mandatory measure.
It is important to control the level of blood pressure and cholesterol, as well as take drugs to normalize these indicators.
Insulin leads to obesity. Often you can observe a situation when a person who is on insulin therapy begins to gain weight. When the blood sugar level is high, the weight begins to decrease, because with the urine excess glucose is excreted, which means excess calories. When the patient begins to receive insulin, these calories with urine cease to be excreted. If a change in lifestyle and diet does not occur, then it is only logical that the weight starts to grow. However, this is not due to insulin.
The first descriptions of this pathological condition highlighted primarily its most striking symptoms - fluid loss (polyuria) and unquenchable thirst (polydipsia).The term "diabetes" (lat. Diabetes mellitus) was first used by the Greek physician Demetrios of Apamania (II century BC. E.), comes from other Greek. διαβαίνω, which means "pass through."
Such at that time was the idea of diabetes - a condition in which a person continuously loses fluid and replenishes it, “like a siphon”, which refers to one of the main symptoms of diabetes - polyuria (excessive urine output). In those days, diabetes was considered a pathological condition in which the body loses its ability to retain fluid.
Glucose incontinence edit |
Why does diabetes arise, and what is it?
Diabetes mellitus is a metabolic disorder that occurs due to insufficient formation of the patient's own insulin (type 1 disease) or due to a violation of the effects of this insulin on the tissue (type 2). Insulin is produced in the pancreas, and therefore patients with diabetes mellitus are often among those who have various disorders in the functioning of this body.
Patients with type 1 diabetes are called “insulin-dependent” - they need regular injections of insulin, and very often the disease is congenital. Typically, a type 1 disease manifests itself already in childhood or adolescence, and this type of disease occurs in 10-15% of cases.
Type 2 diabetes develops gradually and is considered "elderly diabetes." This type is almost never found in children, and is usually characteristic of people over 40 who are overweight. This type of diabetes occurs in 80-90% of cases, and is inherited in almost 90-95% of cases.
Causes of occurrence
Diabetes is one of the most common endocrine disorders with a steady increase in prevalence (especially in developed countries). This is the result of a modern lifestyle and an increase in the number of external etiological factors, among which obesity stands out.
The main causes of diabetes include:
- Overeating (increased appetite) leading to obesity is one of the main factors in the development of type 2 diabetes. If among people with normal body weight the incidence of diabetes is 7.8%, then with an excess of body weight by 20%, the frequency of diabetes is 25%, and with an excess of body weight by 50%, the frequency is 60%.
- Autoimmune diseases (an attack of the body’s immune system on the body’s own tissues) - glomerulonephritis, autoimmune thyroiditis, hepatitis, lupus, etc. can also be complicated by diabetes.
- Hereditary factor. As a rule, diabetes is several times more common in relatives of patients with diabetes. If both parents are ill with diabetes, the risk of developing diabetes for their children is 100% throughout their lives, if one of the parents is sick - 50%, in case of diabetes in a brother or sister - 25%.
- Viral infections that destroy pancreatic cells that produce insulin. Among the viral infections that can cause the development of diabetes are: rubella, mumps (mumps), chicken pox, viral hepatitis, etc.
A person who has a hereditary predisposition to diabetes may not become a diabetic throughout his life if he controls himself and leads a healthy lifestyle: proper nutrition, physical activity, medical supervision, etc. Typically, type 1 diabetes occurs in children and adolescents.
As a result of research, doctors came to the conclusion that the causes of heredity of diabetes mellitus in 5% depend on the mother, 10% on the father, and if both parents have diabetes, the probability of transmitting a predisposition to diabetes increases to almost 70% .
Signs of diabetes in women and men
There are a number of signs of diabetes characteristic of both type 1 and type 2 diseases. These include:
- Feeling of unquenchable thirst and rapid urination, which lead to dehydration,
- Also one of the signs is dry mouth,
- Yawning, drowsiness,
- Wounds and cuts heal very slowly,
- Nausea, possibly vomiting,
- Frequent breathing (possibly with the smell of acetone)
- Genital itching and itching of the skin,
- Weight loss
- Increased urination
- Visual impairment.
If you have the above symptoms of diabetes, you should definitely measure your blood sugar.
A very important section in the classification of diabetes mellitus is its separation by degree of severity.
- It characterizes the most favorable course of the disease to which any treatment should aim. At such a degree of the process, it is fully compensated, the glucose level does not exceed 6-7 mmol / L, there is no glucosuria (excretion of glucose in the urine), and glycosylated hemoglobin and proteinuria do not go beyond the normal range.
- This stage of the process indicates partial compensation. Signs of diabetes complications and lesions of typical target organs appear: eyes, kidneys, heart, blood vessels, nerves, lower extremities. The glucose level is slightly increased and amounts to 7-10 mmol / L.
- A similar course of the process indicates its constant progression and the impossibility of drug control. At the same time, the glucose level varies from 13-14 mmol / l, persistent glucosuria (excretion of glucose in the urine), high proteinuria (the presence of protein in the urine) are observed, and there are clear unfolded manifestations of target organ damage in diabetes mellitus. Visual acuity progressively decreases, severe arterial hypertension persists, sensitivity decreases with the appearance of severe pain and numbness of the lower extremities.
- This degree characterizes the absolute decompensation of the process and the development of severe complications. At the same time, the level of glycemia rises to critical numbers (15-25 or more mmol / l), is difficult to correct by any means. The development of renal failure, diabetic ulcers and gangrene of the extremities is characteristic. Another criterion for grade 4 diabetes is a tendency to develop frequent diabetic coms.
Three states of compensation for carbohydrate metabolism disorders are also distinguished: compensated, subcompensated, and decompensated.
The consequences and complications of diabetes
Acute complications are conditions that develop within days or even hours in the presence of diabetes mellitus.
- Diabetic ketoacidosis is a serious condition that develops due to the accumulation in the blood of products of intermediate fat metabolism (ketone bodies).
- Hypoglycemia - a decrease in blood glucose below the normal value (usually below 3.3 mmol / L), occurs due to an overdose of sugar-lowering drugs, concomitant diseases, unusual physical activity or insufficient nutrition, intake of strong alcohol.
- Hyperosmolar coma. It occurs mainly in elderly patients with type 2 diabetes with or without a history of it and is always associated with severe dehydration.
- Lactacidotic coma in patients with diabetes mellitus is caused by the accumulation of lactic acid in the blood and more often occurs in patients older than 50 years of age against the background of cardiovascular, hepatic and renal failure, decreased tissue oxygen supply and, as a result, accumulation of lactic acid in the tissues.
The late consequences are a group of complications, the development of which takes months, and in most cases years of the course of the disease.
- Diabetic retinopathy - damage to the retina in the form of microaneurysms, pinpoint and spotted hemorrhages, solid exudates, edema, the formation of new vessels. It ends with hemorrhages in the fundus, can lead to retinal detachment.
- Diabetic micro- and macroangiopathy is a violation of vascular permeability, an increase in their fragility, a tendency to thrombosis and the development of atherosclerosis (occurs early, mainly small vessels are affected).
- Diabetic polyneuropathy - most often in the form of bilateral peripheral neuropathy of the type of gloves and stockings, starting in the lower parts of the limbs.
- Diabetic nephropathy - kidney damage, first in the form of microalbuminuria (excretion of albumin protein in the urine), then proteinuria. It leads to the development of chronic renal failure.
- Diabetic arthropathy - joint pain, “crunching”, limited mobility, decreased amount of synovial fluid and increased viscosity.
- Diabetic ophthalmopathy, in addition to retinopathy, includes the early development of cataracts (clouding of the lens).
- Diabetic encephalopathy - changes in the psyche and mood, emotional lability or depression.
- Diabetic foot - damage to the feet of a patient with diabetes mellitus in the form of purulent-necrotic processes, ulcers and osteoarticular lesions that occurs against a background of changes in peripheral nerves, blood vessels, skin and soft tissues, bones and joints. It is the main cause of amputations in patients with diabetes mellitus.
Also, diabetes has an increased risk of developing mental disorders - depression, anxiety disorders, and eating disorders.
How to treat diabetes
Currently, the treatment of diabetes in the vast majority of cases is symptomatic and is aimed at eliminating the existing symptoms without eliminating the cause of the disease, since an effective treatment for diabetes has not yet been developed.
The main tasks of a doctor in the treatment of diabetes are:
- Compensation for carbohydrate metabolism.
- Prevention and treatment of complications.
- Normalization of body weight.
- Patient training.
Depending on the type of diabetes mellitus, patients are prescribed insulin or oral administration of drugs that have a sugar-lowering effect. Patients should follow a diet, the qualitative and quantitative composition of which also depends on the type of diabetes.
- With type 2 diabetes mellitus, a diet and drugs that lower the level of glucose in the blood are prescribed: glibenclamide, glurenorm, glyclazide, glibutide, metformin. They are taken orally after the individual selection of a specific drug and its dosage by a doctor.
- With type 1 diabetes, insulin therapy and a diet are prescribed. The dose and type of insulin (short, medium or long-acting) is selected individually in a hospital, under the control of blood sugar and urine.
Diabetes mellitus must be treated without fail, otherwise it is fraught with very serious consequences, which were listed above. The sooner diabetes is diagnosed, the more likely it is that negative consequences can be completely avoided and a normal and fulfilling life is lived.
Diet for diabetes is a necessary part of treatment, as well as the use of sugar-lowering drugs or insulin. Without a diet, compensation for carbohydrate metabolism is not possible. It should be noted that in some cases with type 2 diabetes, only diets are sufficient to compensate for carbohydrate metabolism, especially in the early stages of the disease. With type 1 diabetes, diet is vital for the patient, a violation of the diet can lead to hypo- or hyperglycemic coma, and in some cases to the death of the patient.
The goal of diet therapy for diabetes is to ensure a uniform and adequate physical activity of the intake of carbohydrates in the patient's body.Diet should be balanced in proteins, fats and calories. Easily digestible carbohydrates should be completely excluded from the diet, with the exception of cases of hypoglycemia. With type 2 diabetes, it is often necessary to correct body weight.
The main concept in the diet therapy of diabetes is a bread unit. A bread unit is a conditional measure equal to 10-12 g of carbohydrates or 20-25 g of bread. There are tables that indicate the number of bread units in various foods. During the day, the number of bread units consumed by the patient should remain constant, on average 12-25 bread units are consumed per day, depending on body weight and physical activity. For one meal it is not recommended to consume more than 7 bread units, it is advisable to organize a meal so that the number of bread units in different meals is approximately the same. It should also be noted that drinking alcohol can lead to distant hypoglycemia, including hypoglycemic coma.
An important condition for the success of diet therapy is to keep a food diary for the patient, add all the food eaten during the day, and calculate the number of bread units consumed in each meal and in general per day. Keeping such a food diary allows in most cases to identify the cause of episodes of hypo- and hyperglycemia, helps to educate the patient, helps the doctor to choose an adequate dose of sugar-lowering drugs or insulin.
Self-monitoring of glycemia is one of the main measures that can achieve effective long-term compensation of carbohydrate metabolism. Due to the fact that it is impossible at the current technological level to completely simulate the secretory activity of the pancreas, fluctuations in blood glucose levels occur during the day. This is influenced by many factors, the main ones include physical and emotional stress, the level of carbohydrates consumed, concomitant diseases and conditions.
Since it is impossible to keep the patient in a hospital all the time, monitoring the condition and insignificant adjustment of doses of short-acting insulin is assigned to the patient. Self-control of glycemia can be carried out in two ways. The first is approximate with the help of test strips, which determine the level of glucose in the urine using a qualitative reaction, in the presence of glucose in the urine, urine should be checked for acetone content. Acetonuria - an indication for hospitalization in a hospital and evidence of ketoacidosis. This method of assessing glycemia is quite approximate and does not allow to fully monitor the state of carbohydrate metabolism.
A more modern and adequate method for assessing the condition is the use of glucometers. A glucometer is a device for measuring the level of glucose in organic liquids (blood, cerebrospinal fluid, etc.). There are several measurement techniques. Recently, portable blood glucose meters for home measurements have become widespread. It is enough to place a drop of blood on a disposable indicator plate connected to the glucose oxidase biosensor apparatus, and after a few seconds the level of glucose in the blood (glycemia) is known.
It should be noted that the readings of two glucometers of different companies may differ, and the level of glycemia displayed by the glucometer is usually 1-2 units higher than the actual one. Therefore, it is advisable to compare the readings of the meter with the data obtained during the examination in the clinic or hospital.
Insulin treatment is aimed at the maximum possible compensation of carbohydrate metabolism, prevention of hypo- and hyperglycemia, and thus prevention of complications of diabetes.Insulin treatment is vital for people with type 1 diabetes and can be used in some situations for people with type 2 diabetes.
Indications for the appointment of insulin therapy:
- Type 1 diabetes
- Ketoacidosis, diabetic hyperosmolar, hyperlacticemic coma.
- Pregnancy and childbirth with diabetes.
- Significant decompensation of type 2 diabetes.
- The lack of effect of treatment with other methods of type 2 diabetes.
- Significant weight loss in diabetes.
- Diabetic nephropathy.
Currently, there are a large number of insulin preparations, differing in duration of action (ultrashort, short, medium, extended), in terms of purification (monopic, monocomponent), species specificity (human, pork, bovine, genetically engineered, etc.)
In the absence of obesity and strong emotional stress, insulin is prescribed in a dose of 0.5-1 unit per 1 kilogram of body weight per day. The introduction of insulin is designed to mimic physiological secretion in connection with this, the following requirements are put forward:
- The dose of insulin should be sufficient for utilization of glucose entering the body.
- The injected insulin should mimic the basal secretion of the pancreas.
- The injected insulin should mimic the postprandial peaks of insulin secretion.
In this regard, there is the so-called intensified insulin therapy. The daily dose of insulin is divided between long and short acting insulins. Extended insulins are usually administered in the morning and evening and mimic the basal secretion of the pancreas. Short-acting insulins are administered after each meal containing carbohydrates, the dose may vary depending on the bread units eaten at a given meal.
Insulin is injected subcutaneously using an insulin syringe, a pen syringe or a special metering pump. Currently, in Russia, the most common method of administering insulin using syringe pens. This is due to greater convenience, less pronounced discomfort and ease of administration compared to conventional insulin syringes. The syringe pen allows you to quickly and almost painlessly enter the required dose of insulin.
Sugar-lowering tablets are prescribed for non-insulin-dependent diabetes mellitus in addition to diet. The following groups of sugar-lowering drugs are distinguished by the mechanism of lowering blood sugar:
- Biguanides (metformin, buformin, etc.) - reduce the absorption of glucose in the intestine and contribute to the saturation of peripheral tissues. Biguanides can increase the level of uric acid in the blood and cause the development of a serious condition - lactic acidosis in patients older than 60 years, as well as people suffering from liver and kidney failure, chronic infections. Biguanides are more commonly prescribed for non-insulin-dependent diabetes mellitus in young obese patients.
- Sulfonylurea preparations (glycidone, glibenclamide, chlorpropamide, carbamide) - stimulate the production of insulin by pancreatic β-cells and promote the penetration of glucose into the tissues. An optimally selected dosage of this group of drugs supports a glucose level of not> 8 mmol / L. With an overdose, the development of hypoglycemia and coma is possible.
- Alpha-glucosidase inhibitors (miglitol, acarbose) - slow down the increase in blood sugar, blocking the enzymes involved in the absorption of starch. Side effects - flatulence and diarrhea.
- Meglitinides (nateglinide, repaglinide) - cause a decrease in sugar levels, stimulating the pancreas to secrete insulin. The effect of these drugs depends on the blood sugar and does not cause hypoglycemia.
- Thiazolidinediones - reduce the amount of sugar released from the liver, increase the sensitivity of fat cells to insulin.Contraindicated in heart failure.
Also, the beneficial therapeutic effect of diabetes has a decrease in excess weight and individual moderate physical activity. Due to muscle efforts, glucose oxidation is increased and its content in the blood decreases.
Currently, the prognosis for all types of diabetes is conditionally favorable, with adequate treatment and adherence to diet, disability remains. The progression of complications is significantly slowed down or completely stopped. However, it should be noted that in most cases, as a result of treatment, the cause of the disease is not eliminated, and therapy is only symptomatic.
There is an opinion that diabetes is an exclusively modern disease, the scourge of our civilization and the reckoning for a high standard of living, leading to widespread availability of foods rich in carbohydrates. However, this is not so, since what diabetes is, it was well known in the ancient world, in ancient Greece and Rome. The term "diabetes" is of Greek origin. Translated from Greek, it means "passing through." This interpretation reflects the main signs of diabetes - irrepressible thirst and profuse urination. Therefore, it seemed that all the fluid consumed by a person passes through his body.
Ancient doctors were able to determine what type of diabetes a patient had, and the first type of disease was considered incurable and leading to an 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 findings have led to the widespread use of insulin in diabetes.
Diabetes mellitus is today one of the most common ailments. Around the world, there are approximately 250 million patients with diabetes (mainly of the second type), and the number of those with it is constantly growing. 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 numbers can be significantly underestimated. Indeed, in those who are sick with the second type of disease, the signs of pathology are very weakly expressed in the early stages. 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 approximately 0.2% of children also suffer from the disease. Forecasts about 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 is much more likely to affect representatives of the Mongoloid and Negroid races than Caucasians.
The prevalence of carbohydrate metabolism diseases in the world
|The percentage of patients from the global population||total amount, million|
|Impaired glucose tolerance||7,5||308|
The disease belongs to the category of endocrine. And 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 a weakening of the effects on the human body of a special substance - insulin. In diabetes mellitus, the tissues feel its lack - either absolute or relative.
So, the onset of diabetes is closely related to insulin. But not everyone knows what kind of substance it is, where it comes from and what functions it performs. Insulin is a special protein. Its synthesis is carried out in a special gland of internal secretion 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 cells of the gland 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" itself comes from the word insula, which in Latin means "islet."
The functions of insulin are closely related to the metabolism of such important substances 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, glucose is the main carbohydrate in the body. Without glucose, the cells of the body will not be able to get the necessary 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. Fructose (fruit sugar), which is found in large quantities in berries and fruits, also belongs to this category. Into the body, fructose 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, while other carbohydrates, such as pectin, hemicellulose and cellulose, do not break down in the intestine at all. Nevertheless, these carbohydrates play an important role in the digestive processes, promoting 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. Organs that cannot exist without insulin are insulin-dependent. Only very few tissues are able to receive 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 the situation when, for some reason, the cells lack insulin? This situation manifests itself in the form of two main negative consequences. First, the 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, go back into the blood), but insulin is also needed for the process of converting glucose to glycogen.
Normal blood glucose levels range from 3.3 to 5.5 mmol / L. The determination of this value is performed when blood is taken on an empty stomach, since eating always causes an increase in sugar level 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 dysfunctions of many body systems. This process is the accumulation of excess glucose in the blood and is called diabetes mellitus.
Causes of diabetes and its varieties
The mechanism of the pathogenesis of the disease is reduced to two main types.In the first case, excess glucose results in a decrease in pancreatic insulin production. This phenomenon can appear due to various pathological processes, for example, due to inflammation of the pancreas - pancreatitis.
Another type of diabetes is observed if the production of insulin is not reduced, but is within normal limits (or even slightly above it). The pathological mechanism for the development of diabetes in this case is different - the loss of tissue sensitivity to insulin.
The first type of diabetes is called - diabetes of the first type, and the second type of disease - diabetes of the second type. Sometimes type 1 diabetes is also called insulin-dependent, and type 2 diabetes is called non-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 name of 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 diseases of the kidneys or pituitary gland.
Despite the fact that diabetes mellitus has characteristics that unite them, the symptoms and treatment of diabetes of 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 old||usually over 40|
|Gender of patients||Mostly men||Mostly women|
|The onset of diabetes||Spicy||gradual|
|Tissue sensitivity to insulin||Normal||Lowered|
|Insulin secretion||at the initial stage - reduced, with severe diabetes - no||at the initial stage - increased or normal, with severe diabetes - reduced|
|Insulin treatment for diabetes||is necessary||at the initial stage is not required, in severe cases - necessary|
|Patient body weight||at the initial stage - normal, then reduced||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, type 1 diabetes 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 can appear due to a large number of reasons, 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 begins to attack pancreatic cells. Also, the first type of diabetes often occurs as a result of cancer. A serious factor favorable to the development of the disease is a hereditary predisposition. In addition, other circumstances play a role in the occurrence of the first form of diabetes:
- the stresses a person has been subjected to
- pancreatic cell hypoxia,
- improper diet (rich in fats and low in protein foods).
Most often, the development of an insulin-dependent occurs at a young age (up to 30 years). However, even older people are not safe from this disease.
How is type 1 diabetes manifested?
The disease is characterized by an acute initial stage, so the first signs of diabetes are usually not difficult to notice.The main symptoms of diabetes are severe thirst, the consumption of large amounts of water. Accordingly, the volume of urine excreted (polyuria) also increases. Patient's urine usually has a sweet taste, which is explained by an increased glucose content in it. This symptom is an increase in the concentration of glucose in the urine, called glucosuria. The development of glucosuria is observed when the concentration of sugar in the blood exceeds 10 mmol / L. In this case, the kidney filters begin to cope with the removal of glucose and it begins to flow into the urine. However, with some renal pathologies, sugar in the urine is often observed at normal blood sugar levels, so this parameter - increased glucose in the urine, is not a determining sign of diabetes mellitus.
Also, diabetes mellitus is manifested by a pathological increase in appetite (polyphagy). This phenomenon is simply explained, because due to the fact that glucose does not enter the cells, the body experiences a constant lack of energy and starving tissues signal this to the brain. With the constant use of food, however, the patient does not gain weight, but loses it. Other signs of the disease are severe fatigue and weakness, itchy skin, persistent headaches, increased blood pressure, and visual impairment. When urine is analyzed, acetone is detected in it, which is a consequence of the use of fat stores by the cells. However, acetone is often excreted along with urine in many other diseases, such as inflammation. Especially often, acetone in the urine appears in children. Therefore, this circumstance should not be considered as a defining sign 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 comas. These conditions often end in the death of the patient.
A common diabetes syndrome is Raynaud's syndrome, including:
- thromboangiitis obliterans,
- cooling and numbness of limbs,
- pain in the hands.
The first form of diabetes is not only incurable, but also a potentially fatal ailment. If the patient does not receive treatment, his insulin-dependent diabetes will turn into complications such as ketoacidosis or diabetic coma, which inevitably result in death. Depending on the concentration of sugar in the blood, the stage of diabetes will be considered mild, severe or moderate.
Stages of insulin-dependent diabetes mellitus
|Stages of diabetes||Values of glucose concentration in the patient’s blood, mmol / l||glucosuria level values, g / l|
Patient education as part of therapy
An important element of diabetes treatment is patient education. The patient should know what he needs to do if a state of hypoglycemia or hyperglycemia appears, how to constantly monitor the level of glucose in the blood, how to change the diet. Similar information should be available to relatives of the patient.
Diabetes is a metabolic disease. Therefore, a diet that is based on the principle of limiting the amount of carbohydrates in food is a vital method of treatment. Without a diet, the patient is at risk of dying as a result of the development of conditions of severe hyper- and hypoglycemia.
The diet for a disease with insulin-dependent diabetes mellitus should be based on strict observance of the norms of carbohydrates entering the patient's body. For the convenience of calculating carbohydrates, a special unit of measurement, the bread unit (XE), has been introduced in the practice of diabetes therapy. One XE contains 10 g of simple carbohydrates, or 20 g of bread. The amount of XE consumed per day is selected by the doctor individually, taking into account physical activity, patient weight and severity of the disease.In case of insulin-dependent diabetes mellitus, alcohol consumption is strictly prohibited.
Non-insulin-dependent diabetes mellitus
This type of diabetes is the most common. According to statistics, it is found in approximately 85% of diabetics. Type 2 diabetes rarely occurs at a young age. It is more characteristic of middle-aged adults and the elderly.
Type 2 disease is caused not by a lack of insulin production, but by a violation of the interaction between insulin and tissues. Cells cease to absorb insulin and glucose begins to accumulate in the blood. The causes of this phenomenon have not been fully clarified, but, as scientists believe, a significant role in the pathogenesis of diabetes is played by:
- a change in the rate of absorption of glucose in the intestine,
- acceleration of the process of destruction of insulin,
- decrease in the number of insulin receptors in the cells.
In particular, in some pathologies, the body's immune cells can perceive insulin receptors as antigens and destroy them.
The main circumstance that affects the likelihood of developing diabetes is obesity. This is evidenced by statistics, since 80% of patients with non-insulin-dependent diabetes are overweight.
Among the factors contributing to the development of the disease, one can also distinguish:
- sedentary lifestyle,
- lack of physical activity,
- wrong diet
- taking certain medications, such as glucocorticosteroids.
A significant role is also played by genetic predisposition and heredity. If at least one of the parents is ill with non-insulin-dependent diabetes, then the likelihood that a child in adulthood will have this ailment is 80%.
There is a misconception that diabetes can lead to excessive consumption of sweets, even one-time. In fact, this is not so, 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 being overweight is already able to cause processes leading to diabetes.
Signs of Diabetes
Non-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, overwork. In the early stages, the symptoms of diabetes are often completely absent. Thus, the first signs of diabetes appear only with a serious increase in blood glucose.
There is a set of symptoms typical of non-insulin-dependent diabetes. The patient begins to worry about intense thirst, frequent urination, insomnia at night, fatigue, weakness and sleepiness during the day.
Also, the first signs of diabetes include the following:
- slow wound healing
- visual impairment
- episodic or persistent dizziness,
- numbness or tingling of the limbs,
On the other hand, similar phenomena often develop with other pathologies, therefore, the diagnosis, and the determination of the type of diabetes should be carried out by the doctor, and not the patient himself.
If untreated, severe forms of complications begin - neuropathy, nephropathy, retinopathy, angiopathy.
The hidden symptoms of changes in carbohydrate metabolism are a slowdown in the synthesis of proteins and fatty acids. With the progression of the disease, signs of pathology develop and become more noticeable. Ultimately, an increased level of glucose in the blood begins to affect the functioning of the pancreas, insulin synthesis processes are disrupted. Ketoacidosis develops, and the loss of water and electrolytes in the urine increases.
Derivatives of sulfonylureas
Another common class of drugs are drugs that are chemically related to sulfonylureas (tolbutamide, glibenclamide, glimepiride). They are used for moderate diabetes, when metformin does not help the patient or its use is impossible for some reason. The principle of action of sulfanilurea 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 disadvantage of these funds is the high likelihood of hypoglycemia with an incorrect 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, this applies to refined sugar, which the body is easiest to digest. It is recommended to increase the use of indigestible fiber, since it prevents the absorption of simple carbohydrates, stabilizes the digestive processes, improves the composition of the intestinal microflora.
In the treatment of non-insulin-dependent diabetes, alcohol should be discontinued. This is due to the fact that alcohol disrupts the natural processes of metabolism, including the processes of insulin production and the absorption of glucose by tissues.
Pregnant diabetes (gestational) is a disease that occurs only in women in the process of bearing the 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 end of pregnancy. However, this does not always happen. It was also found that gestational diabetes increases the risk of non-insulin-dependent diabetes in women. In addition, gestational diabetes can negatively 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 ordinary diabetes mellitus of the first and second variants that appeared before pregnancy.
It is close in characteristics to insulin-dependent diabetes, but it also has some features of non-insulin-dependent 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 ailment. Pathology often manifests as early as adolescence. Compared with typical insulin-dependent diabetes, with the 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 due to which these stages can be distinguished is the concentration of glucose in the blood plasma.
Stages of diabetes and blood glucose
|Stages of Diabetes||fasting sugar from a finger, mmol / l|
|Prediabetes (impaired glucose tolerance)||5,5-6,5|
Another classification criterion is the body's resistance to pathology. Given this parameter, one can distinguish the compensated, subcompensated, and decompensated stages. A feature of the decompensated stage is the presence of acetone in the urine and high levels of glucose in the blood, which respond poorly to drug therapy.
A similar condition, often referred to as impaired glucose tolerance, is characterized by borderline blood glucose concentrations. It is not yet a fully developed pathology or one of its stages, but it can lead to diabetes over time.That is, a normal prognosis of the development of prediabetes is a full-fledged diabetes.
Prognosis for diabetes
The prognosis largely depends on the stage of the pathology and form of diabetes. The prognosis also takes into account concomitant diabetes pathology. Modern methods of therapy can completely normalize the level of sugar in the blood, or, if this is not possible, to maximize the life of the patient. Another factor that affects the prognosis is the presence of certain complications.
Ketoacidosis is a complication in which fat metabolism products - ketone bodies - accumulate in the body. Ketoacidosis most often occurs in a diabetic with concomitant pathologies, 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 condition threatens the cessation of the functioning of many organs, and especially the brain. Typically, the threshold 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 or sugar-lowering drugs. The main method of combating hypoglycemia is the speedy intake of sugar-containing products (sugar, honey). If the patient lost consciousness, then it is necessary to introduce him vitamin B1 subcutaneously and then intravenously 40% glucose solution. Or glucagon preparations are administered intramuscularly.
This condition most often occurs 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 make up for fluid loss due to drinking. Hyperosmolar coma is a vital indication for treatment in a hospital.
Retinopathies are the most common complications of diabetes. The cause of the pathology is a deterioration in the blood supply to the retina. This process often affects other areas of the eye. Often observed the development of cataracts. In patients with diabetes, each year the disease 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 ocular hemorrhage, and 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 healing ulcers. Symptoms of polyneuropathy are numbness of the limbs, or a burning sensation in them. These phenomena are usually amplified at night.
An irrational lifestyle, an improper diet, and insufficient physical activity usually lead to diabetes. Therefore, people in old age, especially those who may suspect a hereditary tendency to diabetes, should constantly monitor their lifestyle and health, regularly take tests and visit a therapist.