Diabetes (diabetes mellitus, DS) is a chronic metabolic disease that manifests itself in the form of an absolute or relative deficiency of the pancreatic protein hormone in the blood called insulin, and is characterized by a violation of dextrose metabolism in the body - persistent hyperglycemia, which subsequently leads to metabolic disorders of fats, proteins, mineral salts and water.
Then you will learn: what is diabetes mellitus, its main types, symptoms and methods of treatment.
Types of diabetes mellitus (classification)
Classification of diabetes mellitus by cause:
Type 1 diabetes- characterized by an absolute deficiency of insulin in the blood:
- Autoimmune - antibodies attack pancreatic β cells and completely destroy them;
- Idiopathic (no known cause);
Type 2 diabetes- relative deficiency of insulin in the blood. This means that the quantitative indicator of the insulin level remains within the normal range, but the number of receptors for the hormone on the membranes of target cells (brain, liver, fatty tissue, muscles) decreases.
Gestational Diabetes- an acute or chronic condition, manifesting as hyperglycaemia during a woman's gestation.
Other (situational) causes of diabetes- impaired glucose tolerance caused by causes unrelated to pathology of the pancreas. They can be temporary and permanent.
Types of diabetes:
medication;
infectious;
genetic defects in the insulin molecule or its receptors;
associated with other endocrine pathologies:
- Itsenko-Cushing's disease;
- adrenal adenoma;
- Graves disease.
Classification of diabetes by severity:
Light form- characterized by hyperglycemia not exceeding 8 mmol / l, slight daily fluctuations in sugar levels, the absence of glucosuria (sugar in the urine). Does not require pharmacological correction with insulin.
Quite often, at this stage, clinical manifestations of the disease may be absent, however, during instrumental diagnosis, the initial forms of typical complications with damage to peripheral nerves, retinal microvessels, kidneys and heart are already detected.
Moderate severity- the glucose level in the peripheral blood reaches 14 mmol/l, glucosuria appears (up to 40 g/l), an entryketoacidosis- a sharp increase in ketone bodies (metabolites of fat breakdown).
Ketone bodies are formed due to lack of energy in cells. Almost all the glucose circulates in the blood and does not enter the cell, and it begins to use fat stores to produce ATP. At this stage, the glucose level is controlled with the help of diet therapy, the use of oral hypoglycemic drugs.
Clinically manifested by impaired functioning of the kidneys, cardiovascular system, vision, neurological symptoms.
Severe course- blood sugar exceeds 14 mmol/l, with fluctuations up to 20-30 mmol, glycosuria above 50 mmol/l. Complete dependence on insulin therapy, severe dysfunction of blood vessels, nerves, organ systems.
Classification according to the level of compensation of hyperglycemia:
Compensation- this is a conditionally normal state of the body in the presence of an incurable chronic disease. The disease has 3 phases:
Compensation- a diet or insulin therapy can achieve normal blood sugar levels. Angiopathy and neuropathy do not progress. The general condition of the patient remains satisfactory for a long time. There is no violation of sugar metabolism in the kidneys, the absence of ketone bodies, acetone. The glycosylated hemoglobin does not exceed the value of "5%";
Undercompensation- the treatment does not completely correct the blood count and the clinical manifestations of the disease. Blood sugar is not higher than 14 mmol / l. Sugar molecules damage erythrocytes and glycosylated hemoglobin appears, damage to microvessels in the kidneys is manifested in the form of a small amount of glucose in the urine (up to 40 g/l). Acetone in the urine is not detected, however, slight manifestations of ketoacidosis are possible;
Decompensation- the most severe phase of diabetic patients. Usually occurs in the later stages of the disease or complete damage to the pancreas, as well as insulin receptors. It is characterized by a severe general state of the patient which can go as far as a coma. The glucose level cannot be corrected using pharmaceuticals. drugs (more than 14 mmol / l). High level of sugar in the urine (more than 50 g/l), acetone. Glycosylated hemoglobin significantly exceeds the norm, hypoxia occurs. With a long course, this condition leads to coma and death.
Causes of Diabetes
Diabetes mellitus (abbreviated as DM) is a polyetiological disease.
There is no single factor that would cause diabetes in all people with this condition.
The most important causes of the development of the disease:
Type I diabetes:
Genetic causes of diabetes:
- congenital pancreatic β-cell insufficiency;
- hereditary mutations in genes responsible for insulin synthesis;
- genetic predisposition to auto-aggression of β-cell immunity (closest relatives are diabetics);
The infectious causes of diabetes mellitus are pancreatic viruses (affecting the pancreas): rubella, herpes type 4, mumps, hepatitis A, B, C. Human immunity begins to destroy pancreatic cells with these viruses, which causes thediabetic sugar.
Type II diabetes has the following causes:
- heredity (presence of diabetes in the immediate family);
- visceral obesity;
- age (usually over 50-60 years);
- low in fiber and high in refined fats and simple carbohydrates;
- hypertonic disease;
- atherosclerosis.
Provoking factors
This group of factors in itself does not cause the disease, but significantly increases the chances of its development, if there is a genetic predisposition.
- physical inactivity (passive lifestyle);
- obesity;
- smoking;
- excessive consumption of alcohol;
- the use of substances that affect the pancreas (for example, drugs);
- excess fats and simple carbohydrates in the diet.
Diabetes symptoms
Diabetes is a chronic disease, so symptoms never appear suddenly. Symptoms in women and symptoms in men are almost the same. With the disease, manifestations of the following clinical signs are possible in varying degrees.
- Constant weakness, declining performance- develops as a result of chronic energy deprivation of brain cells and skeletal muscles;
- Dry and itchy skin- due to constant loss of fluid in the urine;
- Dizziness, headache- signs of diabetes - due to a lack of glucose in the circulating blood of the cerebral vessels;
- Frequent urination- occurs due to damage to the capillaries of the glomeruli of the nephrons of the kidneys;
- Reduced immunity (frequent SARS, prolonged non-healing of wounds on the skin)- the activity of the immunity of the T lymphocytes is altered, the skin fulfills its barrier function less well;
- polyphagia- a constant feeling of hunger - this condition develops due to the rapid loss of glucose in the urine and its insufficient transport into the cells;
- Decreased vision- cause - damage to microscopic retinal vessels;
- Polydipsia- constant thirst due to frequent urination;
- Limb numbness- prolonged hyperglycemia leads to specific polyneuropathy - damage to sensory nerves throughout the body;
- Pain in the region of the heart- the narrowing of the coronary vessels due to atherosclerosis leads to a reduction in the myocardial blood supply and spastic pain;
- Decreased sexual function- is directly linked to poor blood circulation in the organs that produce sex hormones.
Diagnosis of diabetes
The diagnosis of diabetes most often does not cause any difficulties for a qualified specialist. The doctor can suspect the disease based on the following factors:
- A diabetic patient complains of polyuria (increased daily urine quantity), polyphagia (constant hunger), weakness, headache and other clinical symptoms.
- During a preventive blood test for blood sugar, the indicator was above 6. 1 mmol/l on an empty stomach, or 11. 1 mmol/l 2 hours after a meal.
If this symptomatology is detected, a series of tests are carried out to confirm/reject the diagnosis and discover the causes.
Laboratory diagnosis of diabetes
Oral Glucose Tolerance Test (OGTT)
A standard test to determine the functional ability of insulin to bind glucose and maintain normal blood levels.
The essence of the method:in the morning, against the background of an 8-hour fast, blood is taken to assess the level of fasting blood sugar. After 5 minutes, the doctor makes the patient drink 75 g of glucose dissolved in 250 ml of water. After 2 hours, the blood is drawn again and the sugar level is again determined.
During this period, the first symptoms of diabetes usually appear.
OGTT Analysis Endpoints:
| Standard | |
| with an empty stomach | < 5. 6 |
| 2 hours after OGTT | < 7. 8 |
| Diabetes mellitus (requires differential diagnosis for types of diabetes) | |
| with an empty stomach | ≥ 6. 1 |
| 2 hours after OGTT | ≥11. 1 |
| random definition | ≥11. 1 |
Determination of glycosylated hemoglobin level (C - HbA1c)
Glycated hemoglobin or HbA1c- it is the hemoglobin of erythrocytes, undergoing transformation following contact with glucose. Its concentration in the blood has a direct correlation with the level of glucose, which makes it possible to judge the compensation of the state of a diabetic patient.
The norm is up to 6%.
- Doubtful result - 6-6. 4%;
- In diabetes mellitus - more than 6. 4%.
C-peptide level determination
C-peptideis a fragment of the proinsulin molecule. When the C-peptide is cleaved, insulin becomes functionally active. The concentration of this substance in the blood makes it possible to assess the secretion of insulin in the pancreas.
Standard: 0. 79-1. 90 ng/ml (SI: 0. 27-0. 64 mmol/L).
Determination of proinsulin level
This test allows you to differentiate between various diseases of the pancreas and diabetes. An increase in blood proinsulin most often indicates an endocrine tumor - insulinoma (a rather rare pathology). Additionally, high concentrations of proinsulin molecules may indicate type 2 diabetes.
The norm is 3. 3-28 pmol / l.
Determination of the level of antibodies to pancreatic beta cells
One of the most accurate tests for determining the presence and causes of diabetes. The test is carried out in risk groups (people predisposed to diabetes, for example, if relatives have this disease), as well as in patients with impaired glucose tolerance during OGTT.
The higher the titer of specific antibodies, the more likely the autoimmune etiology of the disease, and the faster the beta cells are destroyed and the level of insulin in the blood decreases. In diabetics, it generally exceeds 1h10.
Standard - Titer: less than 1: 5.
If the antibody titer remains within the normal range, but the fasting blood glucose is above 6. 1, the diagnosis is type 2 diabetes mellitus.
Anti-insulin antibody level
Another specific immunological test. It is performed for the differential diagnosis in diabetic patients (type 1 diabetes and type 2 diabetes). If glucose tolerance is impaired, blood is drawn and a serological test is performed. It can also indicate the causes of diabetes.
The insulin AT norm is 0-10 IU / ml.
- If C(AT) is higher than normal, the diagnosis is type 1 diabetes. autoimmune diabetes mellitus;
- If C(AT) is within the reference values, the diagnosis is type 2 diabetes.
GAD (glutamic acid decarboxylase) antibody test
GAD is a specific membrane enzyme of the central nervous system. The logical correlation between the concentration of anti-GAD antibodies and the development of type 1 diabetes is still unclear, however, in 80-90% of patients, these antibodies are detected in the blood. AT GAD analysis is recommended in risk groups to diagnose prediabetes and prescribe a preventive diet and pharmacological therapy.
AT GAD standard - 0-5 IU / ml.
- A positive result with normal blood glucose indicates a high risk of type 1 diabetes;
- A negative result with high blood sugar indicates the development of type 2 diabetes.
Blood insulin test
Insulin- a highly active hormone of the endocrine part of the pancreas, synthesized in the beta cells of the islets of Langerhans. Its main function is to transport glucose into somatic cells. A decrease in insulin levels is the most important link in the pathogenesis of the disease.
The norm of insulin concentration is 2. 6-24. 9 mcU / ml
- Below the norm - the possible development of diabetes and other diseases;
- Above normal - a pancreatic tumor (insulinoma).
Instrumental diagnosis of diabetes
Ultrasound of the pancreas
The ultrasound method allows you to detect morphological changes in the tissues of the gland.
Usually in diabetes mellitus, diffuse lesions are determined (areas of sclerosis - replacement of functionally active cells with connective tissue).
Also, the pancreas may be enlarged, show signs of edema.
Angiography of the vessels of the lower limbs
The arteries of the lower limbs are the target organ of diabetes mellitus. Prolonged hyperglycemia causes increased blood cholesterol and atherosclerosis, which leads to decreased tissue perfusion.
The essence of the method is the introduction of a special contrast agent into the bloodstream with simultaneous control of vascular permeability on a CT scan.
If the blood supply is significantly reduced to the legs of the lower extremities, the so-called "diabetic foot" is formed. The diagnosis of diabetes mellitus is based on this method of research.
Ultrasound of the kidneys and ECHO KG of the heart
Methods of instrumental examination of the kidneys, allowing to assess the damage to these organs in the presence of a diagnosis of diabetes mellitus.
Microangiopathies develop in the heart and kidneys - damage to blood vessels with a significant decrease in their lumen, and therefore a deterioration in functional abilities. The method helps prevent complications of diabetes mellitus.
Retinography or angiography of the retinal vessels
The microscopic vessels of the retina are the most sensitive to hyperglycemia, so the development of lesions begins even before the first clinical signs of diabetes mellitus.
With the help of contrast, the degree of narrowing or complete occlusion of the vessels is determined. In addition, the most important sign of DM will be the presence of microerosions and ulcers at the back of the eye.
Diagnosis of diabetes mellitus is a complex measure based on the history of the disease, an objective examination by a specialist, laboratory tests and instrumental studies. Using only one diagnostic criterion, it is impossible to establish a 100% correct diagnosis.
If you are at risk, be sure to consult your doctor to learn more about what diabetes is and what to do with such a diagnosis.
Treatment
Treatment of diabetes mellitus is a complex of measures aimed at correcting the level of blood sugar, cholesterol, ketone bodies, acetone, lactic acid, preventing the rapid development of complications and improving the quality of human life.
In diabetes, a very important aspect is the use of all treatment methods.
Methods used in the treatment of diabetes:
- Pharmacological therapy (insulin therapy);
- Diet;
- Regular physical activity;
- Preventive measures to prevent disease progression and the development of complications;
- Psychological support.
Type 1 Diabetes Treatment
Pharmacological correction with insulin
The need for insulin injections in patients with diabetes, its type and frequency of administration are strictly individual and are selected by specialists (therapist, endocrinologist, cardiologist, neuropathologist, hepatologist, diabetologist). They always pay attention to the symptoms of diabetes, carry out differential diagnosis, screening and evaluation of the effectiveness of drugs.
Types of insulin:
- fast action(ultra-short acting) - starts working immediately after administration and works within 3-4 hours. Used before or immediately after a meal;
- short action- acts 20-30 minutes after administration. It is necessary to apply strictly 10-15 minutes before eating;
- Average duration- are used for continuous reception and act within 12-18 hours after the injection. Helps prevent diabetes complications;
- Long-acting insulin- requires constant daily use. Valid from 18 to 24 hours. It is not used to lower blood sugar, but only controls its daily concentration and does not allow exceeding normal values;
- Combined insulin- contains in various ratios ultrashort-acting and long-acting insulins. It is mainly used in resuscitation of type 1 diabetes.
Diet therapy for diabetes
Diet - 50% success in controlling blood sugar level in a patient with diabetes mellitus.
What foods should you eat?
- Fruits and vegetables low in sugar and high in vitamins and minerals (apples, carrots, cabbage, beets);
- Meat containing a small amount of animal fat (meat of beef, turkey, quail);
- Grains and cereals (buckwheat, wheat, rice, barley, barley);
- Fish (preferably sea);
- Of the drinks it is better to choose weak tea, fruit decoctions.
What to throw away:
- Candies, pasta, flour;
- juice concentrates;
- fatty meat and dairy products;
- Spicy and smoked foods;
- Alcohol.
Treatment of type 2 diabetes
In the early stages, type 2 diabetes mellitus is well treated with diet therapy, as with type 1 diabetes. If the diet is not followed, as well as with a long course of the disease, pharmacological therapywith hypoglycemic drugs is used. Even more rarely, patients with type 2 diabetes are prescribed insulin.
Hypoglycemic drugs
- a medicine that stimulates the production of insulin in the pancreas.
- stimulates beta cells to produce insulin.
- acts in the intestine, inhibits the activity of enzymes in the small intestine that break down polysaccharides into glucose.
- a drug for the prevention of polyneuropathy, micro- and macroangiopathy of the kidneys, heart and retina.
Folk remedies for the treatment of diabetes
Folk methods include the preparation of various decoctions of herbs, fruits and vegetables, to one degree or another correcting the level of blood sugar.
- kryphea love- ready-to-use moss extract. The use of Criphea causes an increase in the synthesis of pancreatic hormones: lipase, amylase, protease. It also has an anti-allergic and immunomodulatory effect, reduces the main symptoms of diabetes.
- Parsley Root + Lemon Zest + Garlic- these products contain a large amount of vitamin C, E, A, selenium and other trace elements. All this needs to be ground, mixed and infused for about 2 weeks. Use orally 1 teaspoon before meals.
- oak acorns- contain tannin, a very effective remedy against diabetes. This substance stimulates the immune system, has anti-inflammatory and anti-edematous effects, strengthens the wall of blood vessels, relieves pronounced types. Acorns should be ground into powder and taken 1 teaspoon before each meal.
exercise in diabetes
Regular physical activity in diabetes mellitus is a very important aspect in the treatment and prevention of diabetes mellitus complications. Morning exercises, running, swimming help to avoid obesity, improve blood supply to muscles and organs, strengthen blood vessels and stabilize the nervous system.
Disease prevention
With a genetic predisposition, the disease cannot be prevented. However, those at risk should take a number of steps to control blood sugar levels and the rate of development of diabetes complications.
- Children with an unfavorable heredity (parents, grandparents with diabetes) should undergo a blood sugar test once a year, as well as monitor their condition and the appearance of the first symptoms of the disease. Also, an important measure will be annual consultations with an ophthalmologist, neuropathologist, endocrinologist, cardiologist to determine the first symptoms of diabetes, in order to prevent diabetes complications.
- People over 40 should have their blood sugar checked annually to prevent type 2 diabetes;
- All diabetics must use special devices for monitoring blood sugar - glucometers.
You also need to know everything about diabetes - what is possible, what is not, starting with the type and ending with the causes of the disease specifically for you, for this you need a longconversation with the doctor, he will consult, direct to pass the necessary tests and prescribe treatment.
recovery prognosis
Diabetes mellitus is an incurable disease, so the prognosis for recovery is poor. However, modern advances in pharmacological insulin therapy can significantly prolong the life of a diabetic, and regular diagnosis of typical organ system disorders leads to an improvement in the patient's quality of life.