Mechanism of occurrence of diabetes mellitus. The mechanism of development of diabetes, symptoms, treatment and complications, diet

For the successful treatment of diabetes mellitus, a prerequisite is the impact on all the components of its pathogenesis. Scientists have been studying the causes and mechanisms of diabetes for many years, and a number of pathophysiological processes and etiological factors have already been established that lead to hyperglycemia as a result.

What triggers diabetes

Diabetes mellitus is a heterogeneous pathology in which a complex of metabolic disorders develops. The main characteristic features of type 2 diabetes are insulin resistance and poor function of beta cells of varying severity.

Modern scientific research has shown that many factors are involved in the development of diabetes mellitus and a significant role in the development this disease played by external, non-genetic factors.

It has now been proven that the following factors play a major role in the pathogenesis of type 2 diabetes:

• hereditary predisposition - diabetes mellitus in parents, close relatives;
• wrong way of life bad habits, low degree of physical activity, chronic fatigue, frequent stress;
• food - high-calorie and leading to obesity;
• insulin resistance - a violation of the metabolic response to insulin;
• violation of insulin production and increased production of glucose by the liver.

The role of individual etiological factors in the pathogenesis of diabetes

The pathogenesis of diabetes mellitus depends on the type. In type 2 diabetes, it includes hereditary and external factors. In fact, genetic factors are more important in type 2 diabetes than in type 1 diabetes. This conclusion is based on a study of twins.

It used to be thought that identical (monozygous) twins had an incidence of type 2 diabetes of about 90-100%.

However, with the use of new approaches and methods, it has been proven that concordance (coincidence in the presence of the disease) in monozygotic twins is slightly lower, although it remains quite high 70-90%. This indicates a significant contribution of heredity in the predisposition to type 2 diabetes.

Genetic predisposition is important in the development of prediabetes (impaired glucose tolerance). Whether a person develops diabetes further depends on their lifestyle, diet, and other external factors.

The role of obesity and hypodynamia

Frequent overeating and a sedentary lifestyle lead to obesity and further exacerbate insulin resistance. This contributes to the implementation of the genes responsible for the development of type 2 diabetes.

Obesity, especially abdominal obesity, plays a special role not only in the pathogenesis of insulin resistance and the resulting metabolic disorders, but also in the pathogenesis of type 2 diabetes.

This is because visceral adipocytes, in contrast to subcutaneous adipose tissue adipocytes, are less sensitive to the anti-lipolytic action of the hormone insulin and more sensitive to the lipolytic action of catecholamines.

This circumstance causes the activation of lipolysis of the visceral fat layer and the entry, first, into the bloodstream of the portal vein, and then into the systemic circulation, of a large amount of free fatty acids. In contrast, the cells of the subcutaneous fat layer to slow down the action of insulin, it promotes the reesterification of free fatty acids to triglycerides.

Insulin resistance of skeletal muscles lies in the fact that they preferentially utilize free fatty acids at rest. This prevents myocytes from utilizing glucose and leads to an increase in blood sugar and a compensatory increase in insulin. Moreover, fatty acids do not allow insulin to bind to hepatocytes, and this exacerbates insulin resistance at the liver level and inhibits the inhibitory effect of the hormone on gluconeogenesis in the liver. Gluconeogenesis leads to a constant increased production of glucose in the liver.

Thus, a vicious circle is created - an increase in the level of fatty acids causes even greater insulin resistance of muscle, adipose and liver tissue. It also leads to the launch of lipolysis, hyperinsulinemia, and hence to an increase in the concentration of fatty acids.

Insufficient physical activity in type 2 diabetics exacerbates existing IR.

At rest, the transfer of glucose transporter substances (GLUT-4) in myocytes is sharply reduced. Muscle contraction during exercise increases glucose delivery to myocytes, this is due to an increase in GLUT-4 translocation to the cell membrane.

Causes of insulin resistance

Insulin resistance in type 2 diabetes mellitus is a condition in which there is an insufficient biological response of tissues to insulin at its normal concentration in the blood. In the study of genetic defects that cause the presence of insulin resistance, it was found that it mainly occurs against the background of the normal functioning of insulin receptors.

Insulin resistance is associated with insulin dysfunction at the receptor, pre-receptor and post-receptor levels. Receptor insulin resistance is associated with an insufficient number of receptors on the cell membrane, as well as a change in their structure. Prereceptor insulin resistance is caused by a disorder in the early stages of insulin secretion and (or) with a pathology of the conversion of proinsulin to C-peptide and insulin. Post-receptor insulin resistance includes a defect in the activity of transducers that signal insulin within the cell, as well as those involved in protein synthesis, glycogen, and glucose transport.

The most important consequences of insulin resistance are hyperinsulinemia, hyperglycemia and dyslipoproteinemia. In violation of insulin production, hyperglycemia plays a leading role and leads to its gradual relative deficiency. In patients with type 2 diabetes, the compensatory capacity of pancreatic beta cells is limited due to the genetic breakdown of glucokinase and the glucose transporter GLUT-2. These substances are responsible for the production of insulin for glucose stimulation.

Insulin production in type 2 diabetics

In patients with type 2 diabetes, insulin secretion is usually impaired. Namely:

• a delayed initial phase of the secretory response to intravenous glucose loading;
• reduced and delayed secretory response to the use of mixed food;
• increased levels of proinsulin and products of its processing;
• the rhythm of fluctuations in insulin secretion is disturbed.

Possible causes of impaired insulin production include both primary genetic defects in beta cells and secondary disorders due to lipo- and glucose toxicity. There are studies aimed at finding out other causes of impaired insulin secretion.

In the study of insulin production in patients with prediabetes, it was found that even before the increase in fasting sugar levels and with normal levels of glycosylated hemoglobin, the rhythm of fluctuations in insulin production is already disturbed. This consists in reducing the ability of pancreatic beta cells to respond with peak insulin secretion to peak fluctuations in blood glucose concentration throughout the day.

Moreover, in obese patients with insulin resistance, in response to the same amount of glucose, more insulin is produced than in healthy people with normal weight and without insulin resistance. This means that in people with prediabetes, insulin secretion is already deficient, and this is important for the development of type 2 diabetes in the future.

Early stages of impaired insulin secretion

Changes in insulin secretion in prediabetes occur due to increased concentrations of free fatty acids. This, in turn, leads to inhibition of pyruvate dehydrogenase, and hence to a slowdown in glycolysis. Inhibition of glycolysis leads in beta cells to a decrease in the formation of ATP, which is the main trigger for insulin secretion. A role for glucose toxicity in a defect in insulin secretion in prediabetic patients (impaired glucose tolerance) is ruled out because hyperglycemia has not yet been observed.

Glucose toxicity is a set of bimolecular processes in which prolonged excessive concentration of glucose in the blood leads to damage to insulin secretion and tissue sensitivity to it. This is another vicious circle in the pathogenesis of type 2 diabetes. It can be concluded that hyperglycemia is not only main symptom, but also a factor in the progression of type 2 diabetes due to the action of the phenomenon of glucose toxicity.

With prolonged hyperglycemia, a decrease in insulin secretion is observed in response to a glucose load. At the same time, the secretory response to stimulation with arginine remains, on the contrary, enhanced for a long time. All of the above problems with insulin production are corrected while maintaining a normal blood sugar concentration. This proves that the phenomenon of glucose toxicity plays an important role in the pathogenesis of defective insulin secretion in type 2 diabetes.

Also, glucose toxicity leads to a decrease in tissue sensitivity to insulin. Thus, achieving and maintaining normal indicators blood glucose will increase the sensitivity of peripheral tissues to the hormone insulin.

The pathogenesis of the main symptom

Hyperglycemia is not only a marker of diabetes, but also the most important link in the pathogenesis of type 2 diabetes.

It disrupts insulin secretion by pancreatic beta cells and glucose uptake by tissues, which aims to correct carbohydrate metabolism disorders in patients with type 2 diabetes mellitus to normoglycemia.

An increase in fasting sugar is an early symptom of type 2 diabetes, which is caused by increased sugar production by the liver. The severity of insulin secretion disorders at night directly depends on the degree of fasting hyperglycemia.

Insulin resistance of hepatocytes is not a primary breakdown, it appears as a result of the influence of metabolic and hormonal disorders, including an increase in glucagon production. In chronic hyperglycemia, beta cells lose their ability to respond to rising blood glucose levels by decreasing glucagon secretion. As a result, hepatic glycogenolysis and gluconeogenesis increase. This is one of the factors of relative insulin deficiency in the portal blood circulation.

An additional reason for the development of insulin resistance at the liver level is the inhibitory effect of fatty acids on the uptake and internalization of insulin by hepatocytes. Excessive intake of free fatty acids into the liver sharply stimulates gluconeogenesis due to an increase in the production of acetyl-CoA in the Krebs cycle.

Moreover, acetyl-CoA, in turn, reduces the activity of the enzyme pyruvate dehydrogenase. The result of this is excess secretion of lactate in the Cori cycle (lactate is one of the main products for gluconeogenesis). Fatty acids also inhibit the activity of the glycogen synthase enzyme.

Role in the pathogenesis of type 2 diabetes mellitus amylin and leptin

Recently, the substances amylin and leptin play a significant role in the mechanism of development of type 2 diabetes. The role of amylin was established only 15 years ago. Amylin is an islet amyloid polypeptide that resides in the secretory granules of beta cells and is normally produced together with insulin in a ratio of approximately 1:100. The content of this substance is increased in patients with insulin resistance and impaired carbohydrate tolerance (prediabetes).

In type 2 diabetes, amylin accumulates in the islets of Langerhans as amyloid. It is involved in the regulation of carbohydrate metabolism by adjusting the rate of absorption of glucose from the intestines, and inhibiting the production of insulin in response to glucose irritation.

In the last 10 years, the role of leptin in the pathology of fat metabolism and the development of type 2 diabetes has been studied. Leptin is a polypeptide produced by white adipose tissue cells and acts on the nucleus of the hypothalamus. Namely, on the ventrolateral nuclei responsible for eating behavior.

Leptin secretion decreases during fasting and increases during obesity, in other words, it is regulated by the adipose tissue itself. A positive energy balance is associated with an increase in the production of leptin and insulin. The latter interact with the hypothalamic centers, most likely through the secretion of the hypothalamic neuropeptide Y.

Fasting leads to a decrease in the amount of adipose tissue and a decrease in the concentration of leptin and insulin, which stimulates the secretion of the hypothalamic neuropeptide Y by the hypothalamus. This neuropeptide controls eating behavior, namely, causes strong appetite, weight gain, accumulation of body fat, and inhibition of the sympathetic nervous system.

Both relative and absolute insufficiency of leptin leads to an increase in the secretion of neuropeptide Y, and hence to the development of obesity. With an absolute deficiency of leptin, its exogenous administration, in parallel with a decrease in appetite and weight, reduces the content of mRNA that encodes neuropeptide Y. Exogenous administration of leptin with its relative deficiency (as a result of a mutation of the gene that encodes its receptor) does not affect weight.

It can be assumed that the absolute or relative deficiency of leptin leads to the loss of inhibitory control over the secretion of the hypothalamic neuropeptide Y. This is accompanied by autonomic and neuroendocrine pathologies that are involved in the development of obesity.

The pathogenesis of type 2 diabetes is a very complex process. It plays a major role in insulin resistance, violation of insulin production and chronic increased secretion of glucose by the liver. When selecting treatment to achieve compensation for type 2 diabetes and prevent complications, this should be taken into account.

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 a hormone called insulin. Insulin is involved in the processing of sugar. And without it, the body cannot convert sugar into glucose. As a result, sugar accumulates in our blood and is excreted in large quantities from the body through urine.

In parallel with this, water exchange is disturbed. Tissues cannot retain water in themselves, and as a result, a lot of defective water is excreted through the kidneys.

If a person's blood sugar (glucose) is higher than normal, then this is the main symptom of the disease - diabetes mellitus. In the human body, pancreatic cells (beta cells) are responsible for producing 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 content of sugar and glucose in the blood is increased, but the cells begin to suffer from a lack of glucose.

This metabolic disease can be hereditary or acquired. Pustular and other skin lesions develop from a lack of insulin, teeth suffer, angina pectoris develops, hypertension, kidneys suffer, nervous system vision deteriorates.

Etiology and pathogenesis

The pathogenetic basis for the occurrence of diabetes mellitus depends on the type of this disease. There are two varieties of it, which are fundamentally different from each other. Although modern endocrinologists call the division of diabetes mellitus very conditional, the type of disease still matters in determining treatment tactics. Therefore, it is advisable to dwell on each of them separately.

In general, diabetes mellitus refers to those diseases, the essence of which 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 blood glucose. This indicator is called hyperglycemia. The most important 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 the drop in glucose content, by carrying it into all cells, as the main energy substrate for maintaining life processes. If there is a failure 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 cause-and-effect relationships are called diabetes mellitus.

It is important to understand that not all hyperglycemia is true diabetes mellitus, but only one that is caused by a primary violation of insulin action!

Why are there two types of disease?

Such a need is mandatory, since it completely determines the treatment of the patient, which is radically different in the initial stages of the disease. The longer and more severe diabetes mellitus proceeds, the more its division into types is formal. Indeed, in such cases, the treatment is practically the same for 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 years, thin. The disease is quite severe, insulin is required for treatment. Reason: The body produces antibodies that destroy the cells in the pancreas 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 food. 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 impossible to take insulin in the form of tablets. Insulin is administered with meals. It is very important to follow a strict diet; easily digestible carbohydrates (sugar, sweets, fruit juices, sugary lemonades) are completely 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, obese. Reason: loss of sensitivity of cells 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 follow the doctor's recommendations completely. It is recommended to reduce weight slowly (2-3 kg per month) to achieve a normal weight that must be maintained throughout life. In cases where the diet is not enough, sugar-lowering tablets are used, and insulin is prescribed only in a very extreme case.

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 glycemia (glucose content) to critical numbers with the development of various diabetic coma.

With the onset of the disease, patients develop:

Persistent dry mouth;

Feeling of thirst with inability to quench it. Sick people drink up to several liters of daily fluid;

Increased diuresis - a noticeable increase in portioned and total urine excreted per day;

Decrease or sharp increase weight and body fat;

The appearance of the smell of acetone from the patient;

Clouding of consciousness.

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.

Most significant causes of diabetes are such as:

Heredity. It is necessary to reduce other factors that influence the development of diabetes mellitus to nothing.

Obesity. Actively deal with excess weight.

A number of diseases that contribute to the defeat of beta cells responsible for the production of insulin. Such diseases include diseases of the pancreas -, pancreas, diseases of other endocrine glands.

Viral infections(, epidemic and other diseases, this includes). These infections are the starting point for the development of diabetes mellitus. Especially for people who are at risk.

Nervous stress. People who are at risk should avoid nervous and emotional stress.

Age. With age, for every ten years, the risk of developing diabetes doubles.

This list does not include those diseases in which diabetes mellitus or hyperglycemia are secondary, being only their symptom. In addition, such hyperglycemia cannot be considered true diabetes until advanced clinical manifestations or diabetic complications develop. Diseases that cause hyperglycemia (increased sugar) include tumors and hyperfunction of the adrenal glands, chronic pancreatitis, and an increase in the level of contra-insular hormones.

The condition that precedes type 2 diabetes is called prediabetes. Diagnosed with prediabetes if the glucose level is above 6.1 mmol / l, but still does not exceed 7.0 mmol / l. The important thing is that with the right approach, pre-diabetes can be reversed and the development of type 2 diabetes can be prevented. Lifestyle changes - regular physical exercise, diet control, and taking certain medications can cause low glucose levels. An effective drug for the prevention of type 2 diabetes is Glucophage Long. It is enough to take the drug once a day, with an evening meal, to ensure a stable decrease in glucose levels to normal values. The drug does not reduce glucose levels below its normal level! slow release active substance significantly reduces the risk of side effects metformin.

In addition, long-term use of metformin has a beneficial effect on fat metabolism, reducing the level of triglycerides and total cholesterol in the blood serum. This was the reason why, in prediabetes, metformin is used to normalize body weight.

Diagnosis of diabetes

If there is a suspicion of diabetes mellitus, this diagnosis must be either confirmed or refuted. For this, there are a number of laboratories and instrumental methods. These include:

Examination of blood glucose - determination of fasting glycemia;

Glucose tolerance test - determination of the ratio of fasting glycemia to this indicator after two hours after taking carbohydrate components (glucose);

Glycemic profile - the study of glycemic numbers several times during the day. Performed to evaluate the effectiveness of treatment;

Urinalysis with the determination of the level of glucose in the urine (glucosuria), protein (proteinuria), leukocytes;

Urinalysis for acetone content - if ketoacidosis is suspected;

A blood test for the concentration of glycosylated hemoglobin - indicates the degree of disorders that are caused by diabetes;

Biochemical blood test - a study of hepatic-renal tests, which indicates the adequacy of the functioning of these organs against the background of diabetes;

The study of the electrolyte composition of the blood - is shown with the development severe forms diabetes

Reberg's test - shows the degree of kidney damage in diabetes;

Determination of the level of endogenous insulin in the blood;

Examination of the fundus;

Ultrasound examination of the abdominal organs, heart and kidneys;

ECG - to assess the degree of diabetic myocardial damage;

Doppler ultrasound, capillaroscopy, vessel rheovasography lower extremities- evaluates the degree of vascular disorders in diabetes;

All patients with diabetes should be consulted by such specialists:

Endocrinologist;

Cardiologist;

neuropathologist;

Ophthalmologist;

Surgeon (vascular or special pediatrician);

The implementation of the whole complex of these diagnostic measures can help to clearly determine the severity of the disease, its degree and the correctness of tactics in relation to the treatment process. It is very important to conduct these studies not once, but to repeat them in dynamics as many times as the specific situation requires.

Blood sugar levels in diabetes

The very first and informative method for the primary diagnosis of diabetes mellitus and its dynamic assessment during treatment is the study of blood glucose (sugar) levels. This is a clear indicator from which all subsequent diagnostics and therapeutic measures should be based.

Specialists reviewed normal and pathological glycemic numbers several times. But today their clear values ​​have been 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 by the patients themselves, especially diabetics with a long history of the disease.

As can be seen from the table above, the diagnostic confirmation of diabetes mellitus is extremely simple and can be carried out within the walls of any outpatient clinic or even at home with a personal electronic glucometer (a device for determining blood glucose). In the same way, criteria for assessing the sufficiency of diabetes therapy by certain methods have been developed. The main one is the same level of sugar (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 aspirations of doctors and patients.

A very important heading in the classification of diabetes mellitus is its division into degrees of severity. This distinction is based on the level of glycemia. Another element in the correct formulation of the diagnosis of diabetes mellitus is an indication of the compensation process. This indicator is based on the presence of complications.

But for ease of understanding what happens to a patient with diabetes, looking at the records in medical records, you can combine the severity with the stage of the process into one rubric. After all, it is natural that the higher the blood sugar level, the more severe the diabetes and the higher the number of its formidable complications.

Diabetes mellitus 1 degree

Characterizes the most favorable course of the disease to which any treatment should strive. With this degree of the process, it is fully compensated, the glucose level does not exceed 6-7 mmol / l, there is no glucosuria (glucose excretion in the urine), the indicators of glycated hemoglobin and proteinuria do not go beyond normal values.

In the clinical picture, there are no signs of complications of diabetes: 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 its partial compensation. There are signs of complications of diabetes and damage to typical target organs: eyes, kidneys, heart, blood vessels, nerves, lower extremities.

The glucose level is slightly increased and is 7-10 mmol / l. Glucosuria is not defined. Indicators of glycosylated hemoglobin are within normal limits or slightly increased. There are no severe organ dysfunctions.

Diabetes mellitus 3 degrees

Such a course of the process indicates its constant progression and the impossibility of drug control. At the same time, the glucose level fluctuates between 13-14 mmol / l, persistent glucosuria (excretion of glucose in the urine), high proteinuria (presence of protein in the urine), and there are obvious detailed manifestations of target organ damage in diabetes mellitus.

Visual acuity progressively decreases, severe (increased 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), it is difficult to correct by any means.

Progressive proteinuria with protein loss. Characterized by the development of renal failure, diabetic ulcers and gangrene of the extremities. Another of the criteria for grade 4 diabetes is the tendency to develop frequent diabetic coma: hyperglycemic, hyperosmolar, ketoacidotic.

Complications and consequences of diabetes

By itself, diabetes mellitus does not pose a threat to human life. Its complications and their consequences are dangerous. It is impossible not to mention some of them, which are either often encountered or pose an immediate danger to the life of the patient.

Coma in diabetes mellitus. The symptoms of this complication increase at lightning speed, regardless of the type of diabetic coma. The most important threatening sign is the clouding of consciousness or extreme lethargy of the patient. Such people should be urgently hospitalized to the nearest medical institution.

The most common diabetic coma is ketoacidotic. It is caused by the accumulation of toxic metabolic products that have a detrimental effect on nerve cells. Its main criterion is the persistent smell of acetone when the patient breathes. In the case of a hypoglycemic coma, consciousness is also clouded, the patient is covered with cold, profuse sweat, but a critical decrease in glucose levels is recorded, which is possible with an overdose of insulin. Other types of com, fortunately, are less common.

Edema in diabetes mellitus. Edema can be both local and widespread, depending on the degree of concomitant heart failure. Actually this symptom is an indicator of renal dysfunction. The more pronounced the swelling, the more severe the diabetic nephropathy ().

If the edema is characterized by an asymmetrical distribution, capturing only one lower leg or foot, then this indicates diabetic microangiopathy of the lower extremities, which is supported by neuropathy.

High/low blood pressure in diabetes. Indicators of systolic and diastolic pressure also act as a criterion for the severity of diabetes. It can be assessed on two levels. In the first case, the level of total arterial pressure on the brachial artery is judged. Its increase indicates progressive diabetic nephropathy (kidney damage), as a result of which they release substances that increase pressure.

The other side of the coin is a decrease in blood pressure in the vessels of the lower extremities, determined by ultrasound dopplerography. This indicator indicates the degree of diabetic angiopathy of the lower extremities ().

Pain in the legs with diabetes. may indicate diabetic angio- or neuropathy. This can be judged by their character. Microangiopathy is characterized by the appearance of pain during any physical activity and walking, which causes patients to stop briefly to reduce their intensity.

The appearance of night and rest pains speaks of diabetic neuropathy. Usually they are accompanied by numbness and decreased sensitivity of the skin. Some patients note a local burning sensation in certain areas of the lower leg or foot.

Trophic ulcers in diabetes mellitus. are the next stage of diabetic angio- and neuropathy after pain. The type of wound surfaces in different forms of diabetic foot is fundamentally different, as well as their treatment. In this situation, it is extremely important to correctly evaluate all the smallest symptoms, since the possibility of saving the limb depends on this.

It is immediately worth noting the relative favorableness of neuropathic ulcers. They are caused by a decrease in the sensitivity of the feet as a result of nerve damage (neuropathy) against the background of foot deformity (diabetic osteoarthropathy). In typical points of friction of the skin in places of bone protrusions, corns appear, which patients do not feel. Under them, hematomas are formed with their further suppuration. Patients pay attention to the foot only when it is already red, swollen and with a massive trophic ulcer on the surface.

Gangrene in diabetes mellitus. most often a consequence of diabetic angiopathy. To do this, there must be a combination of lesions of small and large arterial trunks. Usually the process begins in the region of one of the toes. Due to the lack of blood flow to it, there is severe pain in the foot and its redness. Over time, the skin becomes cyanotic, edematous, cold, and then covered with blisters with cloudy contents and black spots of skin necrosis.

The described changes are irreversible, therefore it is not possible to save the limb under any circumstances, amputation is indicated. Of course, it is desirable to perform it as low as possible, since operations on the foot do not bring any effect in gangrene, the lower leg is considered the optimal level of amputation. After such an intervention, it is possible to restore walking with the help of good functional prostheses.

Prevention of complications of diabetes mellitus. Prevention of complications is early detection disease and its adequate and correct treatment. This requires physicians to have a clear knowledge of all the intricacies of the course of diabetes, and patients to strictly comply with all dietary and medical recommendations. A separate heading in the prevention of diabetic complications is to highlight the correct daily care of the lower extremities in order to prevent damage to them, and if they are detected, immediately seek help from surgeons.

To get rid of type 2 diabetes, you must follow these recommendations:

Go on a low carb diet.

Stop taking harmful diabetes pills.

Start taking an inexpensive and harmless drug for the treatment of diabetes based on metformin.

Start playing sports, increase your physical activity.

Sometimes small doses of inulin may be required to normalize blood sugar levels.

These simple recommendations will allow you to control your blood sugar levels and refuse to take drugs that give multiple complications. You need to eat right not from time to time, but every day. Go to healthy lifestyle life is an indispensable condition for getting rid of diabetes. more reliable and easy way treatment for diabetes has not yet been invented.

Video: Dr. Evdokimenko - how to cure type 2 diabetes: 7 steps. Simple but effective tips:

Medications used in diabetes

In type 2 diabetes, hypoglycemic agents are used medications:

Drugs that stimulate the pancreas to produce more insulin. These are sulfonylurea derivatives (Gliclazide, Gliquidone, Glipizide), as well as meglitinides (Repaglitinide, Nateglitinide).

Drugs that increase the susceptibility of cells to insulin. These are biguanides ( , ). Biguanides are not prescribed to people who suffer from pathology of the heart and kidneys with severe insufficiency in the functioning of these organs. Also medicines that increase the susceptibility 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 GGP-1 receptor agonists (Liraglutide and Exenatide).

Drugs that prevent glucose from being absorbed in the organs of 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 developing type 2 diabetes. However, a person must have a predisposition to diabetes. That is, two key points are necessary: ​​overweight and burdened heredity.

At the beginning of the development of diabetes, insulin continues to be produced, but body fat does not allow it to be properly absorbed by the cells of the body. If this situation is observed for many years, then the pancreas will lose its ability to produce enough insulin.

Eating sweets does not affect the development of type 1 diabetes. In this case, the pancreatic cells simply die due to antibody attacks. Moreover, the body itself produces them. This process is called an autoimmune reaction. To date, science has not found the cause of this pathological process. Type 1 diabetes is known to be inherited rarely, in about 3-7% of cases.

When I have diabetes, I will immediately understand this. You can immediately find out that a person develops diabetes mellitus, if only he manifests a type 1 disease. This pathology is characterized by a rapid increase in symptoms, which are simply impossible to ignore.

At the same time, 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, nerve cells were affected.

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 type 1 diabetes is more common in children and adolescents. However, this is not a 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. AT last years The issue of childhood obesity in the world is quite acute.

However, type 2 diabetes is most commonly diagnosed in people over 45 years of age. Although practitioners are beginning to sound the alarm, indicating that the disease has become much younger.

If you have diabetes, you can not eat sweets, you need to eat special foods for diabetics. Your menu, of course, will have to be changed, but you should not completely abandon ordinary foods. Diabetic products can replace the usual sweets and favorite desserts, but when 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 would be to switch to healthy eating. The menu should be enriched with proteins, fruits, complex carbohydrates, vitamins and vegetables.

As recent studies show, an integrated approach to the treatment of diabetes can make significant progress. Therefore, it is necessary not only to take medicines, but also to lead a healthy lifestyle, as well as eat right. Insulin should be injected only in extreme cases, it is addictive.

If a person with type 1 diabetes refuses insulin injections, this will lead to his death. If the patient suffers from type 2 diabetes, then in the early stages of the development of the disease, the pancreas will still produce some amount of 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 it will simply not be possible to refuse his injections.

Many people are wary of insulin injections, and these fears are not always justified. It should be understood that when the pills are not able to produce the desired effect, the risk of developing complications of the disease increases. In this case, insulin injections are a must.

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. It is often possible to 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 excess glucose is excreted in the urine, which means extra calories. When the patient begins to receive insulin, these calories cease to be excreted in the urine. If there is no change in lifestyle and diet, then it is quite logical that the weight will begin to grow. However, insulin will not be the culprit.

Unfortunately, not in all cases it is possible to influence the inevitability of the appearance of type 1 diabetes. After all, its main causes are the hereditary factor and small viruses that every person encounters. But not everyone develops the disease. And although scientists have found that diabetes is much less common in children and adults who were breastfed and treated respiratory infections antiviral drugs, this cannot be attributed to specific prophylaxis. So really effective methods does not exist.

Today, the question of the possibility of a complete cure for diabetes is considered very ambiguously. The complexity of the situation is that it is very difficult to return what has already been lost. The only exception is those forms of type 2 diabetes that are well controlled under the influence of diet therapy. In this case, normalizing diet and physical activity, you can completely get rid of diabetes. It should be borne in mind that the risk of recurrence of the disease in case of violation of the regimen is extremely high.

According to official medicine Type 1 diabetes and persistent forms of type 2 diabetes cannot be completely cured. But regular medical treatment can prevent or slow down the progression of complications of diabetes. After all, they are dangerous to humans. Therefore, it is extremely important to engage in regular monitoring of blood glycemia, controlling the effectiveness of therapeutic measures. It must be remembered that they must be for life. It is permissible to change only their volumes and varieties depending on the patient's condition.

However, there are many former patients who were able to recover from this incurable disease with the help of curative fasting. But forget about this method if you cannot find a good specialist in your city who could control you and prevent the situation from getting out of control. Because there are many cases when experiments on oneself end up in intensive care!

As for the surgical methods for eliminating diabetes mellitus with the implantation of a kind of artificial pancreas, which is a device that analyzes the level of hyperglycemia and automatically releases the required amount of insulin. The results of such treatment are impressive in their effectiveness, but they are not without significant shortcomings and problems. Therefore, no one has yet been able to replace the natural insulin of a particular person with a synthetic analogue, which may not be suitable for a diabetic patient in everything.

Developments continue in the field of synthesis of those types of insulin that will consist of identical components specific to each patient. And although this is still a distant reality, every person, exhausted by the course of diabetes, believes that a miracle will happen.

Which doctor should I contact?

About the doctor: From 2010 to 2016 practicing physician of the therapeutic hospital of the central medical unit No. 21, the city of Elektrostal. Since 2016, she has been working at the diagnostic center No. 3.

- a chronic metabolic disorder, which is based on a deficiency in the formation of one's own insulin and an increase in blood glucose levels. Manifested by a feeling of thirst, an increase in the amount of urine excreted, increased appetite, weakness, dizziness, slow healing of wounds, etc. The disease is chronic, often with a progressive course. There is a high risk of developing stroke, kidney failure, myocardial infarction, gangrene of the extremities, and blindness. Sharp fluctuations in blood sugar cause life-threatening conditions: hypo- and hyperglycemic coma.

ICD-10

E10-E14

General information

Diabetes mellitus is the second most common metabolic disorder after obesity. In the world, about 10% of the population suffers from diabetes mellitus, however, if we take into account the hidden forms of the disease, this figure can be 3-4 times higher. Diabetes mellitus develops due to chronic deficiency insulin and is accompanied by disorders of carbohydrate, protein and fat metabolism. Insulin is produced in the pancreas by the ß cells of the islets of Langerhans.

Participating in the metabolism of carbohydrates, insulin increases the entry of glucose 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 decay. The effect of insulin on fat metabolism is to activate the entry 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 sodium entering the cell is enhanced. Disorders of metabolic processes controlled by insulin can develop with insufficient synthesis of insulin (type I diabetes mellitus) or with tissue resistance to insulin (type II diabetes mellitus).

Causes and mechanism of development

Type I diabetes mellitus is more often detected in young patients under 30 years of age. Violation of insulin synthesis 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 mellitus develops after a viral infection (mumps, rubella, viral hepatitis) or toxic effects (nitrosamines, pesticides, drugs, etc.), the immune response to which causes the 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 genesis: thyrotoxicosis, diffuse toxic goiter, etc.

There are three degrees of severity of diabetes mellitus: mild (I), moderate (II) and severe (III) and three states of compensation for carbohydrate metabolism disorders: compensated, subcompensated and decompensated.

Symptoms

The development of type I diabetes is rapid, type II - on the contrary, gradually. Often there is a latent, asymptomatic course of diabetes mellitus, and its detection occurs by chance during the study of the fundus or laboratory determination of sugar in the blood and urine. Clinically, type I and type II diabetes manifest themselves in different ways, but the following symptoms are common to them:

• thirst and dry mouth, accompanied by polydipsia (increased fluid intake) up to 8-10 liters per day;
• polyuria (abundant and frequent urination);
• polyphagia (increased appetite);
• dry skin and mucous membranes, accompanied by itching (including perineum), pustular skin infections;
• sleep disturbance, weakness, decreased performance;
• cramps in the calf muscles;
• visual impairment.

Manifestations of type I diabetes are characterized by intense thirst, frequent urination, nausea, weakness, vomiting, increased fatigue, constant hunger, weight loss (with normal or increased nutrition), irritability. A sign of diabetes in children is the appearance of bedwetting, especially if the child has not previously urinated in bed. In type 1 diabetes, hyperglycemic (critically high blood sugar) and hypoglycemic (critically low blood sugar) conditions are more likely to develop, requiring emergency measures.

In type II diabetes mellitus, pruritus, thirst, blurred vision, 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 hair growth on the face, the appearance of xanthomas (small yellowish growths on the body), balanoposthitis in men and vulvovaginitis in women. As diabetes progresses, a violation of all types of metabolism leads to a decrease in immunity and resistance to infections. Long-term diabetes causes damage to the skeletal system, manifested by osteoporosis (bone thinning). There are pains in the lower back, bones, joints, dislocations and subluxations of the vertebrae and joints, fractures and deformation of the bones, leading to disability.

Complications

The course of diabetes mellitus can be complicated by the development of multiple organ disorders:

• diabetic angiopathy - increased vascular permeability, their fragility, thrombosis, atherosclerosis, leading to the development of coronary heart disease, intermittent claudication, diabetic encephalopathy;
• diabetic polyneuropathy peripheral nerves in 75% of patients, resulting in a violation of sensitivity, swelling and chilliness of the extremities, a burning sensation and "crawling" goosebumps. Diabetic neuropathy develops years after the onset of diabetes mellitus, and is more common in the 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 after 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 mellitus after 15-20 years from the onset of the disease;
• diabetic foot - circulatory disorders of the lower extremities, pain in the calf muscles, trophic ulcers, destruction of the bones and joints of the feet.

Critical, acutely emerging conditions in diabetes mellitus are diabetic (hyperglycemic) and hypoglycemic coma.

Hyperglycemia and coma develop as a result of a sharp and significant increase in blood glucose levels. The harbingers of hyperglycemia are the growing general malaise, weakness, headache, depression, loss of appetite. Then there are pains in the abdomen, 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 (accumulation of ketone bodies) in the blood and can lead to loss of consciousness - diabetic coma and death of the patient.

The opposite critical condition in diabetes mellitus - hypoglycemic coma develops with a sharp drop in blood glucose levels, often due to 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, arterial hypertension, the patient's skin is cold, wet, sometimes convulsions develop.

Prevention of complications in diabetes mellitus is possible with constant treatment and careful monitoring of blood glucose levels.

Diagnostics

The presence of diabetes mellitus is evidenced by the content of glucose in capillary blood on an empty stomach, exceeding 6.5 mmol / l. Normally, there is no glucose in the urine, because it is retained in the body by the kidney 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 level of glucose in the blood at which it begins to be determined in the urine is called the “renal threshold”.

Examination for suspected diabetes mellitus includes determining the level of:

• fasting glucose in capillary blood (from a finger);
• glucose and ketone bodies in the urine - their presence indicates diabetes mellitus;
• glycosylated hemoglobin - significantly increased in diabetes mellitus;
• C-peptide and insulin in the blood - in type I diabetes mellitus, both indicators are significantly reduced, in type II they are practically unchanged;
• carrying out a stress test (glucose tolerance test): determination of glucose on an empty stomach and 1 and 2 hours after taking 75 g of sugar dissolved in 1.5 glasses of boiled water. A negative (not confirming diabetes mellitus) test result is considered for tests: on an empty stomach< 6,5 ммоль/л, через 2 часа - < 7,7ммоль/л. Подтверждают наличие сахарного диабета показатели >6.6 mmol/l at the first measurement and >11.1 mmol/l 2 hours after glucose loading.

To diagnose complications of diabetes, additional examinations are carried out: ultrasound of the kidneys, rheovasography of the lower extremities, rheoencephalography, EEG of the brain.

Treatment

Implementation of the recommendations of a diabetologist, self-monitoring and treatment of diabetes mellitus 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 mellitus 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 provided on the principles of calculating the calorie content of the diet, taking into account the content of carbohydrates, fats, proteins, vitamins and microelements. In insulin-dependent diabetes mellitus, it is recommended to consume carbohydrates at the same hours to facilitate control and correction of glucose levels with insulin. With IDDM type I, the 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.

Nutrition should be fractional (at least 4-5 times a day), with an even distribution of carbohydrates, contributing to a stable glucose level and maintaining basal metabolism. Special diabetic products based on sweeteners (aspartame, saccharin, xylitol, sorbitol, fructose, etc.) are recommended. Correction of diabetic disorders with only one diet is used in a mild degree of the disease.

Choice drug treatment diabetes mellitus is determined by the type of disease. Patients with type I diabetes are shown insulin therapy, with type II - a diet and hypoglycemic agents (insulin is prescribed for the ineffectiveness of taking tablet forms, the development of ketoazidosis and precoma, tuberculosis, chronic pyelonephritis, liver and kidney failure).

The introduction of insulin is carried out under the systematic control of glucose levels in the blood and urine. There are three main types of insulin according to the mechanism and duration of action: prolonged (prolonged), intermediate and short-acting. Long-acting insulin is administered once a day, regardless of the meal. More often, injections of prolonged insulin are prescribed together with intermediate and short-acting drugs, allowing compensation for diabetes mellitus.

The use of insulin is dangerous with an overdose, leading to a sharp decrease in sugar, the development of a state 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, the stability of the blood sugar level, the calorie content of the diet, the fragmentation of nutrition, insulin tolerance, etc. Local development is possible with insulin therapy (pain, redness, swelling at the injection site) and general (up to anaphylaxis) allergic reactions. Also, insulin therapy can be complicated by lipodystrophy - "failures" in adipose tissue at the site of insulin injection.

Sugar-reducing tablets are prescribed for non-insulin-dependent diabetes mellitus in addition to the diet. According to the mechanism of lowering blood sugar, the following groups of hypoglycemic agents are distinguished:

• sulfonylurea preparations (gliquidone, glibenclamide, chlorpropamide, carbutamide) - stimulate the production of insulin by pancreatic ß-cells and promote the penetration of glucose into tissues. The optimally selected dosage of drugs in this group maintains a glucose level not > 8 mmol / l. In case of an overdose, hypoglycemia and coma may develop.
• biguanides (metformin, buformin, etc.) - reduce the absorption of glucose in the intestine and contribute to the saturation of peripheral tissues with it. Biguanides can increase the level of uric acid in the blood and cause the development of a serious condition - lactic acidosis in patients over 60 years of age, as well as those suffering from liver and kidney failure, chronic infections. Biguanides are more often prescribed for non-insulin dependent diabetes mellitus in young obese patients.
• meglitinides (nateglinide, repaglinide) - cause a decrease in sugar levels by stimulating the pancreas to secrete insulin. The action of these drugs depends on the content of sugar in the blood and does not cause hypoglycemia.
• alpha-glucosidase inhibitors (miglitol, acarbose) - slow down the rise in blood sugar by blocking the enzymes involved in the absorption of starch. Side effect- flatulence and diarrhea.
• thiazolidinediones - reduce the amount of sugar released from the liver, increase the susceptibility 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 in the development of precomatous and comatose conditions. beneficial therapeutic effect in diabetes mellitus, it has a reduction in excess weight and individual moderate physical activity. Due to muscle efforts, there is an increase in the oxidation of glucose and a decrease in its content in the blood. However, physical exercises should not be started at a glucose level > 15 mmol / l, first you need to wait for it to decrease under the influence of drugs. In diabetes mellitus, physical activity should be evenly distributed to all muscle groups.

Forecast and prevention

Patients with diagnosed diabetes mellitus are registered with an endocrinologist. With the organization of the right lifestyle, nutrition, treatment, the patient can feel satisfactory for many years. Aggravate the prognosis of diabetes mellitus and reduce the life expectancy of patients with acute and chronically developing complications.

Prevention of type I diabetes mellitus is reduced 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 mellitus include preventing the development of obesity, correcting nutrition, especially in people with a burdened hereditary history. Prevention of decompensation and complicated course of diabetes mellitus consists in its correct, systematic treatment.

Diabetes mellitus is an endocrinological pathology accompanied by a syndrome of hyperglycemia (high blood glucose levels) caused by insulin deficiency. This disease is accompanied by carbohydrate imbalance and other metabolic disorders in the body.

At the moment, diabetes is diagnosed in 10-15% of the population of our planet. Increasing incidence of this disease in childhood, as a rule, after unreasonable antibiotic therapy, stress and viral infections. There is an annual increase in the number of patients with diabetes mellitus by 9-10%. Today, the number of patients with this disease exceeds 200 million people. Diabetes is diagnosed in both men and women.

Causes and mechanism of development of diabetes

As a result of a violation of the synthesis and secretion of insulin by the beta cells of the islets of Langerhans, there is a decrease in the level of insulin in the blood, which eventually leads to absolute insulin deficiency. There is also relative insulin deficiency, which may be the result of a decrease in insulin activity as a result of its increased connection with protein, intensive destruction by liver enzymes, the prevalence of the effects of non-hormonal and hormonal insulin antagonists (hormones thyroid gland, adrenal cortex, glucagon, non-esterified fatty acids, growth hormone), changes in insulin resistance of insulin-dependent tissues to insulin.

Insulin deficiency provokes violations of protein, carbohydrate and fat metabolism in the body. The level of glucose permeability of cell membranes in muscle and adipose tissue decreases, gluconeogenesis and glycogenolysis increase, glucosuria, hyperglycemia occur, which are accompanied by polydipsia and polyuria. The breakdown increases and the formation of fats decreases, which causes an increase in the level of ketone bodies in the blood (acetone, a condensation product of acetoacetic acid, beta-hydroxybutyric and acetoacetic acids). These phenomena cause a shift in the acid-base balance towards acidosis, and also affect the increase in the excretion of magnesium, sodium, potassium ions in the urine and lead to renal dysfunction.

There may be a decrease in the alkaline reserve of the blood up to 25% vol. carbon dioxide and a decrease in blood pH to 7.2-7.0.

How Type I Diabetes Develops

The causes of diabetes are somewhat different depending on the type of diabetes. For example, patients with type I diabetes mellitus, due to autoimmune aggression and viral infection, undergo the breakdown of beta cells in the body, as a result of which deficiency develops with all the ensuing consequences.

How Type II Diabetes Develops

Patients with type II diabetes have enough insulin, but the tissues of the body lose the ability to perceive its signal. With the development of obesity, adipose tissue acts as a kind of barrier that blocks the action of insulin. In order to eliminate this barrier, beta cells turn on an intensive mode of operation, which subsequently leads to their depletion and the transition of relative insulin deficiency to absolute. But nevertheless, insulin-dependent diabetes does not transform into insulin-dependent.

Regardless of the etiological factor in the development of diabetes, the same process occurs, which consists in slowing down the conversion of sugar that comes from outside and is present in the blood.

Classification of diabetes

Depending on the clinical features distinguish the following types of diabetes:

1. Type I diabetes mellitus, which in turn has several subspecies:
   • insulin-dependent diabetes mellitus;
   • non-insulin dependent diabetes mellitus:
   • in people with obesity;
   • in persons of normal weight.
   • diabetes mellitus, the cause of which is malnutrition;
   • other verifications of type I diabetes mellitus associated with certain syndromes and conditions of the body:
     • endocrine pathologies;
     • anomalies of insulin or its receptor;
     • diseases of the pancreas;
     • certain genetic syndromes;
     • conditions caused by exposure chemical substances or taking medications;
     • conditions of mixed etiological factors;
2. Type II diabetes mellitus indicates a violation of glucose tolerance and is divided into the following forms:
   • in patients without excess weight;
   • in people with obesity;
   • caused by a particular condition or syndrome.
3. Type III diabetes can develop during pregnancy.

Separate static risk classes of this disease have been identified (patients with normal glucose tolerance, but a significant risk of developing diabetes):

• a condition preceding impaired glucose tolerance;
• potential disorders of glucose tolerance.

Essential (primary) type of diabetes mellitus

Essential (primary) type of diabetes mellitus, which is associated with malnutrition, is singled out as a separate pathology. This disease occurs in people under the age of 30 living in tropical countries. According to statistics, the ratio of men and women is 2:1. The total number of patients with this form of diabetes mellitus is 20 million people.

Most often there are two subtypes of this diabetes. The first of these is fibrocalculous pancreatic diabetes.

Fibrocalculous pancreatic diabetes

Geographically, it mainly covers Indonesia, India, Brazil, Bangladesh, Uganda and Nigeria. This pathology is characterized by the presence of extensive pancreatic fibrosis and stone formation in the main pancreatic duct. Clinical picture presents with dramatic weight loss, recurrent abdominal pain, and other signs of malnutrition. Insulin therapy in this case makes it possible to eliminate moderate and high glucosuria and hyperglycemia. One of the characteristic features of this pathology is the absence of ketoacidosis, which is due to reduced insulin production and the release of glucagon by the islet apparatus of the pancreas. Topographic studies (ultrasound diagnostics, radiography, CT scan) make it possible to determine the presence of stones in the pancreatic ducts.

There is an opinion that one of the factors in the development of fibrocalculous pancreatic diabetes is the inclusion in the diet of cassava roots (cassava, tapioca), which contain cyanogenic glycosides, one of which is linamarin, from which hydrocyanic acid is released during hydrolysis. With the participation of sulfur-containing acids, its harmful effect is eliminated, and insufficient intake of protein foods, often found in the population of the above countries, provokes the accumulation of cyanide in the body, which is the cause of the development of fibrocalculosis.

pancreatic diabetes

The development of pancreatic diabetes (type II diabetes) is associated with protein deficiency in the body, but there are no manifestations of pancreatic fibrosis. It is characterized by moderate insulin resistance and resistance to the development of ketoacidosis. In most cases, patients suffer from exhaustion. Patients have reduced insulin secretion, but not to the same extent as in patients with type I diabetes, this explains the absence of ketoacidosis.

Subtype J

In the classification of diabetes mellitus, according to the WHO data above, there is no mention of the third subtype of pancreatic diabetes that occurs in Jamaica, we are talking about subtype J. Subtype J has much in common with pancreatic diabetes, which occurs due to protein deficiency.

Symptoms of Diabetes

The first symptoms of diabetes occur due to high blood glucose levels. After exceeding the level of 8.9 - 10.0, sugar enters the urine. With continued increase in blood glucose levels, the kidneys additionally remove water, this is clinically manifested by frequent urination (polyuria). Excessive excretion of urine causes constant feeling thirst (polydipsia). With urine, the body loses a large number of calories represented by glucose, so a person loses weight and constantly feels hungry.

Other symptoms of diabetes include drowsiness, decreased visual acuity, fatigue, and nausea. In addition, patients with uncontrolled diabetes are prone to infections. Patients with type 1 diabetes are severely insulin deficient and therefore almost always lose weight before starting therapy. Patients with type II diabetes mellitus do not lose body weight.

Type 1 diabetes develops rapidly and may soon progress to diabetic ketoacidosis. Regardless of the high level of glucose in the blood, the cells are not able to use it without the presence of insulin, so they switch to other sources of energy. The destruction of fat cells begins, which provokes the formation of ketone bodies, which are toxic chemical compounds that “acidify” the blood.

diabetic ketoacidosis

The first symptoms of diabetic ketoacidosis are excessive urination and excessive thirst, nausea, vomiting, fatigue, weight loss, and abdominal pain (especially in childhood). Patients have frequent and deep breathing, which is associated with the body's attempts to neutralize the excess acidity of the blood, this process is accompanied by the appearance of the smell of acetone from the mouth. In the absence of treatment, diabetic ketoacidosis can be complicated by the development of coma, in some cases this process occurs within a few hours.

Type I diabetes can be accompanied by the development of ketoacidosis even after the start of insulin therapy if the patient misses a scheduled injection or is subjected to severe emotional overstrain, in particular in case of injury, severe infection or other serious illness.

Patients with type II diabetes mellitus long time may not feel any signs of this pathology. Such a latent period of the disease can last up to several decades. Clinical manifestations become more active as insulin deficiency worsens.

At first, the volume of urine excreted only slightly exceeds the norm, thirst is mild, but over time, these processes progress. The phenomena of ketoacidosis are rare. With a significant increase in blood glucose levels (in some cases up to 55 mmol / l), this usually occurs with additional stress on the body, for example, under the influence of drugs or with severe infectious diseases, the patient can plunge into a state of confused consciousness provoked by severe dehydration, convulsions, drowsiness and, in the most severe cases, a condition called non-ketone hyperglycemic hyperlsmolar coma are also likely.

How else does diabetes manifest itself?

High blood glucose levels can damage nerves, blood vessels, and other structures over time. Chemical compounds containing glucose in the composition are located on the walls of small blood vessels, as a result of which the walls of the vessels thicken and are damaged. The narrowing of the lumen of the vessels causes a deterioration in blood flow, especially the blood supply to the skin and nerve endings. Without compensation for diabetes in the blood, an increase in the level of fatty substances occurs, which accelerates the development of atherosclerosis. Patients diagnosed with diabetes mellitus, regardless of gender, suffer from atherosclerosis 2-6 times more often than people who do not have this diagnosis. Disturbances in the blood circulation of the vessels cause dysfunctions of the heart, kidneys, eyes, lower extremities, brain, skin and nerves, and also slow down the healing process of wounds.

What is the severity of diabetes

All these factors increase the risk of developing many long-term complications. Patients with diabetes have an increased risk of strokes and heart attacks, damage to the blood vessels in the eyes can cause loss of vision (diabetic retinopathy), and kidney problems cause kidney failure, so dialysis is sometimes necessary. Nerve damage can have many consequences. Mononeuropathy (disruption of the work of one nerve) can manifest itself as a sudden weakness of the upper or lower limb. Diabetic polyneuropathy (damage to the nerves in the legs, feet, or hands) causes sensory disturbances, pain, burning or tingling, and a feeling of weakness in the arms and legs. temperature decreases and pain sensitivity leading to increased trauma. Circulatory disorders can contribute to ulcers and poor wound healing. Ulcers localized on the feet are very deep and poorly healed, which leads to infection and, in some cases, to amputation of the affected limb.

Clinical studies have shown that it is possible to avoid or delay the complications of diabetes by consistently maintaining normal blood sugar levels. The course of this disease is currently not fully understood. There are a number of unexplored factors that cause its development, these factors include genetic ones.

Diagnosis of diabetes

Diagnosis of diabetes mellitus begins with the collection of anamnesis and examination of the patient. During these activities, it is determined whether the patient has hereditary factors, obesity, whether the patient belongs to the number of identical twins (if one of them suffers from diabetes, the second must be examined), in women, the presence of childbirth and whether there was a large fetus.

• blood glucose test - performed twice;
• glucose tolerance test;
• determining the level of glucose in daily urine.

With the diagnosis of diabetes mellitus, it is very important to find out the presence of complications; for this, all organs and systems are diagnosed.

Complications of diabetes

Complications of diabetes can be acute and chronic, and they vary depending on the form of diabetes. Among the acute complications, coma is distinguished, during which loss of consciousness is preceded by disturbances in the functioning of the brain due to a very low or very high concentration of sugar in the blood. These states include:

• diabetic ketoacytosis (the most common complication of an acute nature), manifested by polyuria, polydipsia, lack of appetite, weakness, abdominal pain, nausea and vomiting;
• hypoglycemic coma, is an extreme degree of hypoglycemia, occurs with a sharp decrease in blood glucose levels. Often the result of an incorrect dose of insulin, and sometimes occurs after ingestion of certain foods or sulfa drugs.
• hyperosmolar coma outweighs diabetic coma in severity, occurs predominantly in humans old age, in type II diabetes. In 30% of cases, it causes the death of the patient, and in the presence of severe comorbidities - in 70%.

Chronic (late) complications are combined into a group of pathologies that develop with prolonged exposure to high blood sugar on the patient's organs and systems. First of all, organs that are more sensitive to sugar are subject to damage, they are a kind of “target” for diabetes mellitus. Among the chronic complications of diabetes, the following are known:

• diabetic retinopathy occurs in 90% of diabetic patients. It develops with a long course of diabetes and is manifested by damage to the vessels of the eye retina;
• diabetic nephropathy is a complex lesion of the kidneys (tubules, arteries, glomeruli, arterioles). The prevalence among patients with diabetes is 75%;
• diabetic neuropathy is represented by damage to the peripheral nerves in patients with diabetes. Neuropathy is a predisposing factor for the development of diabetic foot, which can lead to limb amputation;
• diabetic encephalopathy is a progressive brain lesion. Manifested by increased fatigue, decreased performance, impaired concentration, emotional lability, squeezing headaches, anxiety and deterioration of the thought process;
• diabetic skin lesions are structural deformations of the epidermis, follicles, sweat glands due to impaired carbohydrate metabolism and accumulation of metabolic products. In the case of a severe form of diabetes, the skin becomes flaky, rough, with areas of calluses, cracks, the skin becomes yellowish, hair loss occurs;
• diabetic foot and hand syndrome occurs in 30-80% of patients with diabetes mellitus and is a complex of anatomical and functional disorders that manifest themselves as brown spots and ulcerations on the lower leg, foot and phalanges of the fingers, which in severe cases can lead to amputation of the limb.

Treatment of diabetes

Treatment of diabetes depends on the type of disease, but first of all, the patient needs to normalize the level of glucose in the blood. To do this, you need to radically change your lifestyle and diet. Patients with diabetes are recommended a special diet, which is based on the calculation of consumed carbohydrates, proteins and fats, vitamins and microelements. This calculation is taught by specialists in this field.

Choice of tactics drug therapy depends on the type of diabetes. Patients with type I diabetes mellitus need insulin therapy, with type II it is shown to adhere to the strictest diet and use glucose-containing drugs, and if tablet forms of drugs are ineffective, insulin is prescribed.

Insulin intake is carried out under strict control of blood glucose levels. According to the mechanism of action, insulin preparations are divided into three types: prolonged, short and intermediate action. Sugar-containing drugs are indicated in the case of non-insulin dependent diabetes mellitus in combination with a diet. Sugar-containing drugs include: biguanides, sulfonylurea drugs, thiazolidinediones and methiglitinides.

With this insidious disease, it is very important for medical personnel to properly train the patient and his relatives in the skills of monitoring the patient's condition and providing first aid in case of pre-coma and comatose conditions.

Prognosis for diabetes

In the presence of diabetes, the patient becomes registered with the endocrinologist. In conditions of adequate therapy, the patient can be in a satisfactory condition for many years. The development of acute and chronic complications can worsen the prognosis regarding the health status and life expectancy of a patient with diabetes mellitus.

Prevention of diabetes

In type I diabetes, preventive measures are to increase the body's resistance to various infections and eliminate the toxic effects of antibodies on the pancreas. For patients with type II diabetes, it is very important to adjust the diet and prevent the development of obesity. To prevent the development of complications in conditions of diabetes mellitus, it is necessary to correctly and systematically follow the doctor's recommendations and clarify whether one or another food can be consumed.

Diabetes mellitus is a group of diseases of the endocrine system that develop due to a lack or absence of insulin (a hormone) in the body, resulting in a significant increase in the level of glucose (sugar) in the blood (hyperglycemia). It is manifested by a feeling of thirst, an increase in the amount of urine excreted, increased appetite, weakness, dizziness, slow healing of wounds, etc. The disease is chronic, often with a progressive course.

A timely diagnosis gives the patient a chance to delay the onset of severe complications. But it is not always possible to recognize the first signs of diabetes. The reason for this is the lack of elementary knowledge of people about this disease and low level patients seeking medical care.

What is diabetes mellitus?

Diabetes mellitus is a disease of the endocrine system caused by an absolute or relative deficiency in the body of insulin, a pancreatic hormone, resulting in hyperglycemia (a persistent increase in blood glucose).

The meaning of the word "diabetes" from the Greek language is "outflow". Therefore, the concept of "diabetes mellitus" means "losing sugar." In this case, the main symptom of the disease is displayed - the excretion of sugar in the urine.

In the world, about 10% of the population suffers from diabetes mellitus, however, if we take into account the hidden forms of the disease, this figure can be 3-4 times higher. It develops as a result of chronic insulin deficiency and is accompanied by disorders of carbohydrate, protein and fat metabolism.

At least 25% of people with diabetes are unaware of their disease. They calmly go about their business, do not pay attention to the symptoms, and at this time, diabetes gradually destroys their body.

High blood sugar levels can cause dysfunction in almost all organs, up to and including death. The higher the blood sugar level, the more obvious the result of its action, which is expressed in:

• obesity
• glycosylation (saccharification) of cells;
• intoxication of the body with damage to the nervous system;
• damage to blood vessels;
• the development of secondary diseases affecting the brain, heart, liver, lungs, organs
• Gastrointestinal tract, muscles, skin, eyes;
• manifestations of fainting, coma;
• lethal outcome.

Causes

There are a lot of causes of diabetes mellitus, which are based on a general disruption of the functioning of the endocrine system of the body, based either on a deficiency of insulin, a hormone produced by the pancreas, or on the inability of the liver and body tissues to properly process and absorb glucose.

Due to the lack of this hormone in the body, the concentration of glucose in the blood constantly increases, which leads to metabolic disorders, since insulin performs an important function in controlling the processing of glucose in all cells and tissues of the body.

One of the reasons is a predisposition that is inherited. If a person has diabetics in his family, then he has a certain risk of getting this disease, especially if he leads an unhealthy lifestyle. The reasons for the development of diabetes, even in those who do not have a predisposition to it, can be:

• malnutrition and abuse of sweets;
• stress and various psycho-emotional stress; suffered a serious illness;
• disruption of the liver; lifestyle change;
• excess weight;
• hard work, etc.

Many people think that diabetes occurs in sweet tooth. This is largely a myth, but there is also some truth, if only because overconsumption sweetly leads to excess weight, and later obesity, which can be an impetus for type 2 diabetes.

The risk factors contributing to the development of this disease in children, in some respects, are similar to the above factors, however, they also have their own characteristics. Let's highlight the main factors:

• the birth of a child to parents with diabetes mellitus (if one or both of them have this disease);
• frequent occurrence of viral diseases in a child;
• the presence of certain metabolic disorders (obesity, etc.);
• birth weight of 4.5 kg or more;
• reduced immunity.

Important: The older a person becomes, the higher the likelihood of the disease in question. According to statistics, every 10 years the chances of developing diabetes double.

Types

Due to the fact that diabetes mellitus has many different etiologies, signs, complications, and of course, the type of treatment, experts have created a fairly voluminous formula for classifying this disease. Consider the types, types and degrees of diabetes.

Type 1 diabetes

Type 1 diabetes, which is associated with an absolute deficiency of the hormone insulin, usually appears acutely, abruptly, quickly turns into a state of ketoacidosis, which can lead to ketoacidotic coma. Most often manifested in young people: as a rule, most of these patients are under thirty years old. Approximately 10-15% of the total number of diabetic patients suffer from this form of the disease.

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 food.

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 impossible to take insulin in the form of tablets. Insulin is administered with meals.

type 2 diabetes

The second type, previously called non-insulin dependent, but this definition is not accurate, since with the progression of this type, insulin replacement therapy may be required. In this type of disease, insulin levels initially remain normal or even higher than normal.

However, body cells, primarily adipocytes (fat cells), become insensitive to it, which leads to an increase in blood glucose levels.

Degrees

This differentiation helps to quickly understand what happens to the patient at different stages of the disease:

1. 1 degree (mild). Diabetes mellitus of the 1st degree is at the initial stage, that is, the glucose level does not exceed more than 6.0 mol / liter. The patient does not have any complications of diabetes mellitus, it is compensated with the help of diet and special medications.
2. 2nd degree (medium). Type 2 diabetes is more dangerous and severe as glucose levels begin to exceed the normal amount. Also, the normal functioning of organs is disrupted, more precisely: the kidneys, eyes, heart, blood and nerve tissues. Also, the blood sugar level reaches more than 7.0 mol/liter.
3. 3 degree (severe). The disease is at a more acute stage, so it will be difficult to cure it with medical preparations and insulin. Sugar and glucose exceed 10-14 mol / liter, which means that the work of blood circulation deteriorates and blood rings can collapse, causing blood and heart diseases.
4. 4 degree . The most severe course of diabetes mellitus is characterized by a high level of glucose - up to 25 mmol / l, both glucose and protein are excreted in the urine, the condition is not corrected by any drugs. With this degree of the disease in question, it is often diagnosed kidney failure, gangrene of the lower extremities, diabetic ulcers.

The first signs of diabetes

The first signs of diabetes are usually associated with high blood sugar levels. Normally, this indicator in capillary blood on an empty stomach does not exceed 5.5 mM/l, and during the day - 7.8 mM/l. If the average daily sugar level becomes more than 9-13 mM / l, then the patient may experience the first complaints.

According to some signs, it is easy to recognize diabetes mellitus at an early stage. A slight change in the condition, which anyone can notice, often indicates the development of the first or second type of this disease.

Signs to look out for:

• Excessive and frequent urination (about every hour)
• Itching of the skin and genitals.
• Intense thirst or an increased need to drink plenty of fluids.
• Dry mouth.
• Poor wound healing.
• First, a lot of weight, followed by a decrease in it due to a violation of the absorption of food, especially carbohydrates.

If signs of diabetes are detected, the doctor excludes other diseases with similar complaints (sugar insipidus, nephrogenic, hyperparathyroidism, and others). Next, an examination is carried out to determine the cause of diabetes and its type. In some typical cases, this task is not difficult, and sometimes additional examination is required.

Symptoms of Diabetes

The severity of symptoms depends entirely on the following parameters: the level of decrease in insulin secretion, the duration of the disease, the individual characteristics of the patient's body.

There is a complex of symptoms characteristic of both types of diabetes. The severity of symptoms depends on the degree of decrease in insulin secretion, the duration of the disease and individual features patient:

• Constant thirst and frequent urination. The more the patient drinks, the more he wants;
• With increased appetite, weight is quickly lost;
• A “white veil” appears before the eyes, as the blood supply to the retina of the eye is disturbed;
• Disorders of sexual activity and a decrease in potency are common signs of the presence of diabetes mellitus;
• Frequent colds(ARVI, acute respiratory infections) occur in patients due to a decrease in functions immune system. Against this background, there is a slow healing of wounds, dizziness and heaviness in the legs;
• Constant cramps of the calf muscles are the result of a lack of energy during the work of the muscular system.

How does diabetes manifest itself in women?

• Sudden weight loss- a sign that should be alarming if the diet is not followed, the previous appetite remains. Weight loss occurs due to a deficiency of insulin, which is necessary for the delivery of glucose to fat cells.
• Thirst. Diabetic ketoacidosis causes uncontrolled thirst. In this case, even if you drink a large amount of liquid, dry mouth remains.
• Fatigue . Feeling of physical exhaustion, which in some cases has no apparent cause.
• increased appetite(polyphagia). A special behavior in which saturation of the body does not occur even after taking a sufficient amount of food. Polyphagia is the main symptom of impaired glucose metabolism in diabetes mellitus.
• Violation of metabolic processes in the body of a woman leads to a violation of the microflora of the body. The first signs of the development of metabolic disorders are vaginal infections, which are practically not cured.
• Non-healing wounds, turning into ulcers - the characteristic first signs of diabetes in girls and women
• Osteoporosis - accompanies insulin-dependent diabetes mellitus, because the lack of this hormone directly affects the formation of bone tissue.

Signs of diabetes in men

The main signs that diabetes is developing in men are the following:

• the occurrence of general weakness and a significant decrease in performance;
• the appearance of itching on the skin, especially this applies to the skin in the genital area;
• sexual disorders, progression inflammatory processes and development of impotence;
• feelings of thirst, dryness oral cavity and constant feeling of hunger;
• the appearance of ulcerative formations on the skin, which do not heal for a long time;
• frequent urge to urinate;
• tooth decay and hair loss.

Complications

By itself, diabetes mellitus does not pose a threat to human life. Its complications and their consequences are dangerous. It is impossible not to mention some of them, which are either often encountered or pose an immediate danger to the life of the patient.

First of all, it should be noted the most sharp forms complications. For the life of every diabetic, such complications pose the greatest danger, because they can lead to death.

Acute complications include:

• ketoacidosis;
• hyperosmolar coma;
• hypoglycemia;
• lactic acid coma.

Acute complications during diabetes are identical in both children and adults

To chronic complications include the following:

• encephalopathy in diabetic form;
• skin lesions in the form of follicles and structural changes directly in the epidermis;
• diabetic foot or hand syndrome;
• nephropathy;
• retinopathy.

Prevention of complications

Preventive measures include:

• weight control - if the patient feels that he is gaining extra pounds, then you need to contact a nutritionist and get advice on compiling a rational menu;
• constant physical activity - the attending physician will tell you how intense they should be;
• constant monitoring of blood pressure.

Prevention of complications in diabetes mellitus, it is possible with constant treatment and careful monitoring of blood glucose levels.

Diagnostics

Diabetes mellitus manifests itself gradually in a person, therefore, doctors distinguish three periods of its development.

1. In people who are prone to the disease due to the presence of certain risk factors, the so-called pre-diabetes period manifests itself.
2. If glucose is already assimilated with disturbances, but signs of the disease do not yet appear, then the patient is diagnosed with a period of latent diabetes mellitus.
3. The third period is the development of the disease itself.

If there is a suspicion of diabetes mellitus, this diagnosis must be either confirmed or refuted. There are a number of laboratory and instrumental methods for this. These include:

• Determination of the level of glucose in the blood. The normal value is 3.3-5.5 mmol / l.
• The level of glucose in the urine. Normally, sugar in the urine is not detected.
• Blood test for glycosylated hemoglobin. The norm is 4–6%.
• IRI (immunoreactive insulin). The normal value is 86-180 nmol / l. In type 1 diabetes, it is reduced; in type 2 diabetes, it is normal or elevated.
• Urinalysis - to diagnose kidney damage.
• Skin capillaroscopy, Doppler ultrasound - for the diagnosis of vascular damage.
• Inspection eye day- for the diagnosis of retinal lesions.

Blood sugar

What levels of sugar are considered normal?

• 3.3 - 5.5 mmol / l is the norm for blood sugar, regardless of your age.
• 5.5 - 6 mmol / l is prediabetes, impaired glucose tolerance.
• 6. 5 mmol / l and above is already diabetes.

To confirm the diagnosis of diabetes mellitus, remeasurement blood sugar levels at different times of the day. Measurements are best carried out in a medical laboratory and self-monitoring devices should not be trusted, as they have a significant measurement error.

Note: in order to exclude false positive results, it is necessary not only to measure the level of sugar in the blood, but also to conduct a glucose tolerance test (a blood sample with a sugar load).

The norms are given in the table (measurement value - mmol / l):

All patients with diabetes should be consulted by such specialists:

• Endocrinologist;
• Cardiologist;
• neuropathologist;
• Ophthalmologist;
• Surgeon (vascular or special doctor - pediatrician);

How to treat diabetes in adults?

Doctors prescribe complex treatment diabetes mellitus in order to maintain normal blood glucose levels. In this case, it is important to consider that neither hyperglycemia, that is, an increase in sugar levels, nor hypoglycemia, that is, its fall, should be allowed.

Before starting treatment, it is necessary to conduct an accurate diagnosis of the body, because. a positive prognosis of recovery depends on this.

Treatment for diabetes aims to:

• lowering blood sugar levels;
• normalization of metabolism;
• prevention of complications of diabetes.

Treatment with insulin preparations

Insulin drugs for the treatment of diabetes are divided into 4 categories, according to the duration of action:

• Ultrashort-acting (onset of action - after 15 minutes, duration of action - 3-4 hours): insulin LizPro, insulin aspart.
• Rapid action (the onset of action is after 30 minutes–1 hour; the duration of action is 6–8 hours).
• The average duration of action (the onset of action is after 1-2.5 hours, the duration of action is 14-20 hours).
• Long-acting (onset of action - after 4 hours; duration of action up to 28 hours).

Insulin regimens are strictly individual and are selected for each patient by a diabetologist or endocrinologist.

pledge effective treatment diabetes is the careful control of blood sugar levels. However, take several times a day laboratory tests impossible. Portable glucometers come to the rescue, they are compact, easy to take with you and check the glucose level where it is needed.

Makes it easier to check the interface in Russian, marks before and after meals. The devices are extremely easy to use, while they differ in measurement accuracy. Keep your diabetes under control with a portable glucometer

Diet

The main principles of diet therapy include:

• strictly individual selection of daily calorie content, complete exclusion of easily digestible carbohydrates;
• strictly calculated content of physiological amounts of fats, proteins, vitamins and carbohydrates;
• fractional meals with evenly distributed carbohydrates and calories.

In the diet used for diabetes, the ratio of carbohydrates, fats and proteins should be as close to physiological as possible:

• 50-60% of total calories should come from carbohydrates
• 25 - 30% for fats,
• 15 - 20% for proteins.

Also, the diet should contain at least 4 - 4.5 grams of carbohydrates per kilogram of body weight, 1 - 1.5 grams of protein and 0.75 - 1.5 grams of fat in a daily dosage.

The diet in the treatment of diabetes mellitus (table No. 9) is aimed at normalizing carbohydrate metabolism and preventing fat metabolism disorders.

Physical exercise

Regular exercise will help lower your blood sugar levels. In addition, physical activity will help you lose weight.

It is not necessary to make daily runs or go to the gym, it is enough to do at least 30 minutes 3 times a week to do moderate physical activity. Walking daily will be very useful. Even if you work on your garden plot several days a week, this will have a positive effect on your well-being.

Folk remedies

Before use folk methods with diabetes mellitus, it is possible only after consultation with an endocrinologist, because. there are contraindications.

1. Lemon and eggs. Squeeze the juice from 1 lemon and mix 1 raw egg well with it. Drink the resulting remedy 60 minutes before meals, for 3 days.
2. Burdock juice. Juice from crushed burdock root, dug up in May, effectively reduces sugar levels. It is taken three times a day, 15 ml, diluting this amount with 250 ml of cool boiled water.
3. In case of diabetes mellitus, simmer ripe walnuts (40 g) in 0.5 liters of boiling water over low heat for 1 hour; take 3 times a day, 15 ml.
4. Plantain seeds(15 g) is poured into an enamel bowl with a glass of water, boiled over low heat for 5 minutes. The cooled broth is filtered and taken 1 dessert spoon 3 times a day.
5. Baked onion. You can normalize sugar, especially in the initial phase of the disease, with the daily use of a baked onion in the morning on an empty stomach. The result can be tracked after 1-1.5 months.
6. Millet against infection. Against infection and for the prevention of diabetes, you can use the following recipe: take 1 handful of millet, rinse, pour 1 liter of boiling water, leave overnight and drink during the day. Repeat the procedure for 3 days.
7. Lilac buds. Infusion of lilac buds helps to normalize blood glucose levels. At the end of April, the buds are harvested in the swelling stage, dried, stored in a glass jar or paper bag and used all year round. Daily rate infusion: 2 tbsp. spoons of dry raw materials pour 0.4 liters of boiling water, insist 5-6 hours, filter, divide the resulting liquid into 4 times and drink before meals.
8. Helps lower blood sugar and regular bay leaf. You need to take 8 pieces of bay leaf and pour it with 250 grams of "cool" boiling water, the infusion must be infused in a thermos for about a day. The infusion is taken warm, each time you need to strain the infusion from the thermos. Take 1/4 cup twenty minutes before meals.

Lifestyle of a person with diabetes

Basic rules to follow for a diabetic patient:

• Eat foods rich in fiber. These are oats, legumes, vegetables and fruits.
• Reduce your cholesterol intake.
• Use a sweetener instead of sugar.
• Eat often, but in small quantities. The patient's body can cope better with a small dose of food, since it requires less insulin.
• Check your feet several times a day for damage, wash every day with soap and dry.
• If you are overweight, weight loss is the first step in managing diabetes.
• Be sure to take care of your teeth to avoid infection.
• Avoid stress.
• Get your blood tested regularly.
• Do not buy medicines without prescriptions

Forecast

Patients with diagnosed diabetes mellitus are registered with an endocrinologist. With the organization of the right lifestyle, nutrition, treatment, the patient can feel satisfactory for many years. Aggravate the prognosis of diabetes mellitus and reduce the life expectancy of patients with acute and chronically developing complications.

Prevention

To prevent the development of diabetes, the following preventive measures are required:

• healthy eating: diet control, dieting - avoiding sugar and fatty foods reduces the risk of developing diabetes by 10-15%;
• physical activity: normalize blood pressure, immunity and reduce weight;
• control of sugar levels;
• exclusion of stress.

If you have characteristic signs of diabetes, then be sure to go to an appointment with an endocrinologist, because. early treatment is the most effective. Take care of yourself and your health!