Clinic and Diagnosis of Diabetes

Diagnosis of diabetes mellitus begins with finding out the main signs - symptoms. Despite the similarity of the clinical manifestations of the disease, each diabetes has its own specifics.

Diabetes mellitus was described by the ancient Egyptians about one and a half thousand years ago as an independent nosological unit. Then the diagnosis was established by various methods, which are not used today due to their irrelevance. For example, Hippocrates told his patients that they had diabetes mellitus, the clinic of which was brilliant if the urine tasted sweet when tested. In Chinese medicine, to diagnose this insidious disease, insects were used - flies, wasps, which, in the presence of sugar in the urine, sat on the container where the urine was placed.

Classification

Diabetes itself is a pathology of the endocrine system. With him, the concentration of sugar in the blood constantly increases for various reasons. It is usually an insulin deficiency, which can be absolute or relative. This hormone is produced in the beta cells located in the tail of the pancreas.

The result of this process is always a violation of the metabolism of the human body at all levels, which ultimately leads to serious complications of the cardiovascular and nervous systems to a greater extent, and the remaining functional units of the body suffer a little less.

To date, there are several types of diseases that have completely different treatment approaches. At the same time, regardless of diabetes mellitus, the clinic of this condition is almost always the same.

The most common classification in the literature is as follows:

1. At a young age, as well as in children, diabetes mellitus with absolute insulin deficiency is most common. This is called the first type.
2. Insulin-dependent diabetes occurs more often in adulthood and is characterized by a relative lack of insulin. Type 2 diabetes usually occurs in older people, but there are cases where the pathology also affects young people. It is much more common than the first type, and one of the factors provoking the pathology is overweight.
3. Symptomatic. This type of disease can occur against the background of other pathological processes, therefore it is also called secondary.
4. Gestational diabetes that occurs during pregnancy. It often goes away on its own after childbirth.
5. Along with malnutrition, a pathology such as diabetes mellitus can also develop.

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

By itself, the second type of disease can be characterized by sufficient production of insulin, but the cells of the body are insensitive to it for various reasons: the organelles responsible for this process can be blocked or their number is insufficient for aeffective communication. As a result, cells develop a sugar deficiency, which serves as a signal for increased insulin production, which has little effect. As a result, the amount of insulin produced begins to drop, which leads to an increase in glycemic indicators.

The reasons

The basis of absolute insulin insufficiency, leading to the first type of disease, is an autoimmune process. It is caused by a violation of the immune system, which causes the production of its own antibodies aimed at fighting the beta cells of the islets of Langerhans. This leads to their destruction.

The main factors provoking the disruption of the immune system with the subsequent production of antibodies are often various viral infections, among which the most aggressive can be rubella, chickenpox, mumps. There is a genetic predisposition to pathology.

It should be borne in mind that a substance such as selenium increases the likelihood of a second type of pathology. But this is far from the most important factor in the development of the process. These include the same hereditary predisposition and the presence of excess weight. These factors need to be examined in more detail.

1. The higher the degree of obesity, the higher the risk of diabetes, while in the third degree it increases by 10 times. Abdominal obesity, that is, when fat deposits are located in the abdomen, can be the result of metabolic disorders, that is, prediabetes.
2. Hereditary predisposition suggests a several-fold increase in the risk of diabetes with this pathology in blood relatives. It does not matter whether the older or younger parent suffers from the disease. Sometimes there is a tendency for the disease to be passed on from generation to generation, but this is just a coincidence.

It should be borne in mind that if diabetes mellitus has been detected, the clinic will develop very slowly and gradually, which complicates the diagnosis in time.

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

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

Gestational diabetes and diabetes due to malnutrition are somewhat different because they can be reversible processes.

What happens in the body

For one or more of the above reasons, a process occurs in the body in which excess sugar in the form of glycogen in muscle tissue and the liver ceases to be deposited. The sugar that the body could not process continues to be in the bloodstream, and only a small portion of it is excreted by the kidneys. This has an extremely negative effect on absolutely all organs and systems of the body.

Since glucose does not enter the cells, they begin to actively break down fats in order to obtain energy. This leads to increased formation of nitrogen residues - ketone bodies, which disrupts all metabolic processes.

clinical picture

The most characteristic symptoms of a pathology not yet diagnosed, or with a pronounced increase in sugar, can be:

• excessive thirst, accompanied by excruciating dryness in the mouth;
• increased urination during the day and at night;
• the appearance of general weakness, drowsiness, fatigue and heaviness in the muscles;
• appetite increases significantly;
• skin and genital itching;
• wound surfaces heal for a very long time;
• in type 1 diabetes, patients lose a lot of weight, and in type 2 diabetes, on the contrary, patients gain weight quickly.

Usually, with the development of type 1 diabetes, clinical symptoms develop at lightning speed, and the second type of pathology is characterized by a gradual increase in the clinic, sometimes the symptoms can be undulating (the normal state alternates withthe clinical picture of diabetes).

Complications of the disease

Both types of pathologies are characterized by the development of complications, which usually develop in an elderly person. Diabetes also contributes to the early development of such conditions.

1. Serious diseases of the cardiovascular system: atherosclerosis, ischemic states.
2. Development of microangiopathies in the lower extremities, kidneys, eyes.
3. Damage to the nervous system, which manifests as dry skin, severe pain and leg cramps, decreases pain sensitivity.
4. Reduced vision.
5. Damage to the kidneys with a violation of their function and increased protein excretion.
6. Ulcerative defects develop on the feet, which eventually lead to necrotic and purulent processes. The basis for this is the development of neuropathy and angiopathy of the lower extremities.
7. The development of infectious complications on the skin - abscesses, fungal infections.
8. Due to poor glycemic control, comatose states with high or low sugar can develop. It should be noted that the state of hypoglycemia (low sugar level) is much more difficult to treat than hyperglycemia (high sugar level).

Sometimes with type 1 diabetes there is a deterioration in well-being, which is accompanied by general weakness. It can be accompanied by pain in the abdomen up to vomiting, there is a smell of acetone from the mouth. These changes are explained by the accumulation of ketone bodies, which must be eliminated from the blood as quickly as possible. If this does not happen, a ketoacidotic coma develops.

Possibly coma with incorrect dosage of insulin, when an excessive amount is administered. To prevent the development of any type of diabetic coma, you need to constantly monitor your blood sugar levels and properly select insulin doses.

Diagnostic

Patients who have been diagnosed with diabetes are under the control of an endocrinologist. The diagnosis of pathology involves the following tests:

1. Analysis of the glycemic profile.
2. Glucose tolerance test.
3. Urinalysis for the presence of sugar and acetone, for this there are special test strips.
4. A blood test for glycated hemoglobin, in healthy people it never exceeds the norm.
5. Determination of peptide C, which decreases in the first type of pathology. In the second type, it can remain within the normal range.

Treatment

To treat the process, patients need:

1. Follow dietary recommendations. They mean limiting foods with fast carbs. The diet should be reviewed, preference is given to five meals a day.
2. Insulin therapy is prescribed to patients with the first type or secondary insulin-dependent diabetes. It is injected subcutaneously with a syringe or special syringe pens. Sometimes patients have an insulin pump installed. To date, the development of an artificial pancreas is underway, capable itself of measuring sugar and injecting the right amount of insulin.
3. The second type of disease is taking hypoglycemic drugs in tablets.
4. Special physiotherapy exercises are prescribed, since physical activity helps normalize blood sugar levels and helps fight obesity.

It should be kept in mind that this disease is treated for life. The higher the level of self-control in a patient, the fewer life-threatening complications they will develop and their progression will be significantly slowed.