Diabetes mellitus is one of the most common diseases that tend to increase in incidence and worsen statistics.The symptoms of diabetes mellitus do not appear overnight;the process is chronic, associated with the increase and worsening of endocrine and metabolic disorders.It is true that the development of type 1 diabetes is significantly different from the early stages of type 2 diabetes.
Among all endocrine pathologies, diabetes confidently leads and accounts for more than 60% of cases.In addition, disappointing statistics show that 1/10 of "diabetics" are children.
The probability of acquiring the disease increases with age, so the group size doubles every ten years.This is due to an increase in life expectancy, better methods of early diagnosis, a decrease in physical activity and an increase in the number of overweight people.
Types of diabetes
Many people have heard of a disease like diabetes insipidus.So that the reader does not confuse the diseases called "diabetes", it will probably be useful to explain their differences.
Diabetes insipidus
Diabetes insipidus is an endocrine disease that develops as a result of nerve infections, inflammatory diseases, tumors, poisoning, and develops due to the insufficiency and sometimes complete disappearance of ADH-vasopressin (antidiuretic hormone).
This explains the clinical picture of the disease:
- Constant dryness of the oral mucosa, incredible thirst (a person can drink up to 50 liters of water in 24 hours, stretching the stomach to a large size);
- Isolation of large amounts of unconcentrated light urine with low specific gravity (1000-1003);
- Catastrophic weight loss, weakness, reduced physical activity, digestive disorders;
- Characteristic changes on the skin ("parchment" skin);
- Atrophy of muscle fibers, weakness of the muscular system;
- Development of dehydration syndrome in the absence of fluid intake for more than 4 hours.
In terms of complete recovery, the disease has an unfavorable prognosis;work capacity is significantly reduced.
Brief Anatomy and Physiology
An unusual organ, the pancreas performs a mixed secretory function.Its exogenous part carries out external secretion and produces enzymes involved in the digestive process.The endocrine part, which is entrusted with the task of internal secretion, produces various hormones, including -insulin and glucagon.They are crucial in ensuring the consistency of sugar in the human body.
The endocrine section of the gland is represented by the islets of Langerhans, which consist of:
- A-cells, which occupy a quarter of the total area of the islets and can be considered the site of glucagon production;
- B cells, which occupy 60% of the cell population, synthesize and store insulin, the molecule of which is a double-chain polypeptide that carries 51 amino acids in a certain sequence;
- somatostatin-producing D cells;
- Cells that produce other polypeptides.
Thus, the conclusion suggests itself:In particular, damage to the pancreas and islets of Langerhans is the main mechanism that inhibits insulin production and triggers the development of the pathological process.
Types and special forms of the disease
Lack of insulin leads to reduced sugar stability (3.3-5.5 mmol/l)and contributes to the development of the heterogeneous disease called diabetes mellitus (DM):
- A complete lack of insulin (absolute deficiency) developsinsulin dependentpathological process, which is calledtype 2 diabetes mellitus (IDDM);
- Insulin deficiency (relative deficiency), which in the initial stage causes a disturbance of carbohydrate metabolism, slowly but surely leads to development.not insulin dependentdiabetes mellitus (NIDDM), which is so-calledType II diabetes mellitus.
Due to the disruption of the body's use of glucose and the consequent increase in blood serum (hyperglycemia), which is in principle a manifestation of the disease, the signs of diabetes appear over time, i.e. a complete disruption of metabolic processes at all levels.
In addition to type 1 and type 2 diabetes, there are also special types of this disease:
- Secondary diabetesacute and chronic inflammation of the pancreas (pancreatitis), malignant tumors in the parenchyma of the gland, cirrhosis of the liver.Many endocrine disorders accompanied by excessive production of insulin antagonists (acromegaly, Cushing's disease, pheochromocytoma, thyroid disease) lead to the development of secondary diabetes.Many drugs used for a long time have a diabetogenic effect: diuretics, some antihypertensives and hormones, oral contraceptives, etc.;
- Diabetes in pregnant women (gestational),it is caused by the specific interaction of the hormones of the mother, the child and the placenta.The fetal pancreas, which produces its own insulin, begins to inhibit the insulin production of the mother's gland, as a result of which this special form develops during pregnancy.However, with proper control, gestational diabetes usually resolves after delivery.After that, in some cases (up to 40%) in women with a similar pregnancy, this fact may endanger the development of type II diabetes mellitus (within 6-8 years).
Why does "sweet" disease occur?
The "sweet" disease forms a rather "variegated" group of patients, so it becomes clear that IDDM and its non-insulin-dependent "sibling" have a different genetic origin.There is evidence of an association between insulin-dependent diabetes and the genetic makeup of the HLA (major histocompatibility complex) system, particularly with some genes in the D-region loci.No such association was observed for NIDDM.
Genetic predisposition alone is not sufficient for the development of type I diabetes mellitus;the pathogenetic mechanism is triggered by provoking factors:
- congenital deficiency of the islets of Langerhans;
- adverse effects of the external environment;
- Stress, nervous stress;
- Traumatic brain injuries;
- Pregnancy;
- Viral infectious processes (influenza, mumps, cytomegalovirus infection, Coxsackie);
- The constant tendency to overeat, which leads to excessive fat deposits;
- Abuse of confectionery products (those with a sweet tooth are at greater risk).
Before discussing the causes of type II diabetes mellitus, it would be advisable to dwell on a very controversial question: who suffers more often - men or women?
It was found that today the disease occurs more often in women, although in the 19th century diabetes was not a "prerogative" of men.By the way, now in some countries of Southeast Asia, the presence of this disease is predominant in men.
Predisposing conditions for the development of type II diabetes mellitus are the following:
- Changes in the structure of the pancreas due to inflammatory processes, as well as the appearance of cysts, tumors, and bleeding;
- Age after 40 years;
- Being overweight (the most important risk factor for NIDDM!);
- vascular diseases caused by the atherosclerotic process and arterial hypertension;
- In women, pregnancy and the birth of a child with a large body weight (over 4 kg);
- have relatives with diabetes;
- Strong psycho-emotional stress (adrenal hyperstimulation).
In some cases, the causes of different types of diabetes are the same (stress, obesity, external factors), but the beginning of the process is different in type 1 and type 2 diabetes.IDDM is the domain of children and young people, and non-insulin-dependent people prefer the elderly.
Why do you want to drink so much?
The characteristic symptoms of diabetes mellitus, regardless of its form and type, can be presented as follows:
- dryness of the mucous membrane of the mouth;
- Thirst with dehydration, which is practically impossible to quench;
- Excessive formation and excretion of urine by the kidneys (polyuria), which leads to dehydration;
- An increase in the concentration of glucose in the blood serum (hyperglycemia) due to the suppression of sugar utilization by peripheral tissues due to insulin deficiency;
- The appearance of sugar in the urine (glucosuria) and ketone bodies (ketonuria), which are normally present in negligible amounts, but are intensively produced by the liver in diabetes mellitus and are found in the urine after being excreted from the body;
- Increased content of urea and sodium ions in the blood plasma (in addition to glucose)+);
- Weight loss, which is characteristic of the catabolic syndrome in case of decompensation of the disease, which develops as a result of the breakdown of glycogen, lipolysis (mobilization of fats), catabolism of proteins and gluconeogenesis (transformation into glucose);
- Violation of lipid spectrum indicators, increase in total cholesterol due to the low-density lipoprotein fraction, NEFA (non-esterified fatty acids), triglycerides.The increasing lipid content begins to actively reach the liver, where they are intensively oxidized, which leads to the excessive formation of ketone bodies (acetone + β-hydroxybutyric acid + acetoacetic acid) and their further entry into the blood (hyperketonemia).An excessive concentration of ketone bodies threatens a dangerous condition, the so-calleddiabetic ketoacidosis.
Thus, the general signs of diabetes can be characteristic of any form of the disease, however, in order not to confuse the reader, it is still necessary to note the features inherent in one or another type.
Type I diabetes mellitus is the "privilege" of young people.
IDDM is characterized by an acute onset (weeks or months).The symptoms of type I diabetes mellitus are pronounced and manifest in the clinical symptoms characteristic of the disease:
- Sudden weight loss;
- Unnatural thirst, a person simply cannot get drunk, although he tries to (polydipsia);
- Passing large amounts of urine (polyuria);
- A significant excess of the concentration of glucose and ketone bodies in the blood serum (ketoacidosis).In the initial stage, when the patient is not yet aware of his problems, the development of a diabetic (ketoacidotic, hyperglycemic) coma is very likely - an extremely life-threatening condition, so insulin treatment is prescribed as early as possible (in case of suspicion of diabetes).
In most cases, after the use of insulin, the metabolic processes are compensated,The body's demand for insulin drops sharply and a temporary "healing" occurs.However, this short-term state of remission should not relax either the patient or the doctor, because after a while the disease will remind itself again.The need for insulin may increase as the duration of the disease increases, but usually in the absence of ketoacidosis it does not exceed 0.8-1.0 U/kg.
Signs of late complications of diabetes (retinopathy, nephropathy) may appear after 5-10 years.The main causes of death from IDDM are:
- End-stage renal failure resulting from diabetic glomerulosclerosis;
- Cardiovascular diseases are complications of the underlying disease, which occur somewhat less frequently than kidney diseases.
Disease or age-related changes?(type II diabetes)
NIDDM develops over months or even years.If problems arise, people take them to various specialists (dermatologist, gynecologist, neurologist...).The patient has no idea that, in his opinion, various diseases: furunculosis, skin itching, fungal infections, lower limb pain are signs of type II diabetes mellitus.Patients get used to their condition, and diabetes slowly progresses, affecting all systems, especially blood vessels.
NIDDM is characterized by a stable, slow course, usually not prone to ketoacidosis.
Treatment for type 2 diabetes usually begins with a diet that limits easily digestible (refined) carbohydrates and the use of blood sugar-lowering medications (if needed).Insulin is prescribed when the disease has entered the stage of serious complications or there is resistance to oral drugs.
Cardiovascular pathology resulting from diabetes is the main cause of death in patients with NIDDM.This is usually a heart attack or stroke.
Treatment of diabetes
Therapeutic measures aimed at compensating diabetes mellitus are based on three main principles:
- Compensation of insulin deficiency;
- Regulation of endocrine and metabolic disorders;
- Prevention and timely treatment of diabetes and its complications.
The implementation of these principles is based on 5 main points of view:
- Diabetes mellitus nutrition plays the role of "first violin";
- A suitable and individually selected system of physical exercises follows the diet;
- Blood sugar-lowering drugs are mainly used to treat type 2 diabetes;
- In NIDDM, insulin therapy is prescribed if needed, but is essential in type 1 diabetes;
- Training patients for self-monitoring (taking blood from a finger, using a glucometer, administering insulin without assistance).
The laboratory control over the above positions indicates the degree of compensation after the following biochemical tests:
| Indicators | A good amount of compensation | Satisfying | Bad |
|---|---|---|---|
| Fasting glucose level (mmol/l) | 4.4 – 6.1 | 6.2 - 7.8 | Ø 7.8 |
| Blood sugar content 2 hours after a meal (mmol/l) | 5.5 - 8.0 | 8.1 - 10.0 | Ø 10.0 |
| Percentage of glycosylated hemoglobin (HbA1, %) | < 8.0 | 8.0 - 9.5 | Ø 10.0 |
| Serum total cholesterol (mmol/l) | < 5.2 | 5.2 - 6.5 | Ø 6.5 |
| Triglyceride level (mmol/l) | < 1.7 | 1.7 - 2.2 | Ø 2.2 |
Diet plays an important role in the management of NIDDM
Diabetes-related nutrition is very well known, even for people living far from diabetes mellitus, Table 9.Being in the hospital with any disease, you can sometimes hear about a special diet, which is always in separate pans, different from other diets, and is given out after saying a certain password: "I have the ninth table."What does this all mean?How is this mystery diet different from others?
It should not be mistaken to take care of a diabetic who carries the "porridge" with him, to deprive him of all the joys of life.A diabetes diet is not that different from a healthy person's diet;patients receive the required amount of carbohydrates (60%), fat (24%) and protein (16%).
Diabetes nutrition consists of replacing refined sugars in foods with carbohydrates that break down slowly.The category of prohibited foods includes sugar sold to everyone in stores and confectionery products based on it.
As for nutritional balance, everything here is strict: diabetics must consume the required amount of vitamins and pectin, which must be at least 40 grams.daily.
Strictly individual physical activity
The physical activity of each patient is selected individually by the attending physician, taking into account the following points:
- Age;
- Symptoms of diabetes;
- Severity of the pathological process;
- Presence or absence of complications.
Physical activity prescribed by the doctor and carried out by the "class" should promote the "burning" of carbohydrates and fats without insulin.The dose needed to compensate for metabolic disorders is noticeably reduced, which should not be forgotten, since it can have an undesirable effect by preventing the rise of blood sugar.Adequate physical activity reduces the glucose level, the dose of insulin administered breaks down the remainder, and as a result the sugar level falls below an acceptable value (hypoglycemia).
like thisinsulin administration and physical activity require a lot of attention and careful calculation,so that, complementing each other, we do not exceed the lower limit of normal laboratory parameters.
Maybe try folk remedies?
The treatment of type 2 diabetes mellitus is often accompanied by the patient's search for his own folk remedies, which can slow down the process and, as much as possible, delay the time of taking dosage forms.
Despite the fact that our distant ancestors practically did not know about this disease, there are folk remedies for the treatment of diabetes mellitus, but we must not forget thatinfusions and decoctions made from various plants are helpful.The use of home remedies for diabetes does not exempt the patient from following a diet, controlling blood sugar levels, visiting a doctor and following all his recommendations.
To combat the pathology at home, quite well-known folk remedies are used:
- White mulberry bark and leaves;
- Oat grains and husks;
- Walnut partitions;
- Bay leaf;
- Cinnamon;
- Acorn;
- Nettle;
- Dandelion.
When diet and folk remedies no longer help...
At the end of the last century, the so-called first-generation drugs, which were widely known, became a thing of the past and were replaced by new-generation drugs, which form the 3 main groups of diabetes drugs produced by the pharmaceutical industry.
The endocrinologist decides which remedy is suitable for this or that patient.And so that patients do not self-medicate and do not decide to use these drugs for the treatment of diabetes at their own discretion, we give some illustrative examples.
Sulfonylurea derivatives
Currently, second-generation sulfonylurea derivatives are prescribed, which act from 10 hours to 24 hours.Patients usually take it twice a day, half an hour before meals.
These drugs are absolutely contraindicated in the following cases:
- type 1 diabetes mellitus;
- Diabetic, hyperosmolar, lactic acidotic coma;
- Pregnancy, childbirth, breastfeeding;
- Diabetic nephropathy accompanied by impaired filtration;
- Diseases of the hematopoietic system with a simultaneous decrease in white blood cells - leukocytes (leukocytopenia) and the platelet component of hematopoiesis (thrombocytopenia);
- Severe infectious and inflammatory changes in the liver (hepatitis);
- Diabetes complicated by vascular pathology.
In addition, the use of drugs belonging to this group can endanger the development of allergic reactions, which are manifested in the following:
- Skin itching and hives, sometimes reaching Quincke's edema;
- Disorders of the digestive system;
- Changes in the blood (a decrease in the level of platelets and leukocytes);
- Possible impairment of the functional abilities of the liver (jaundice caused by cholestasis).
Antihyperglycemic agents belonging to the biguanide family
Biguanides (guanidine derivatives) are actively used to treat type 2 diabetes mellitus, often with the addition of sulfonamides.They are very rational for obese patients, however, their use in patients with liver, kidney and cardiovascular pathology is sharply limited, switching to more gentle drugs of the same group or α-glucoside inhibitors, which inhibit the absorption of carbohydrates in the small intestine.
Absolute contraindications to the use of biguanides are:
- IDDM (type 1 diabetes mellitus);
- Significant weight loss;
- Infectious processes, regardless of location;
- Surgical interventions;
- Pregnancy, childbirth, breastfeeding;
- comatose states;
- Liver and kidney pathology;
- Oxygen starvation;
- Microangiopathy (degree 2-4), with impaired vision and kidney function;
- Trophic ulcers and necrotic processes;
- Poor circulation in the lower limbs due to various vascular pathologies.
Treatment with insulin
From the above it becomes clear thatInsulin is the primary treatment for type 1 diabetes, all medical emergencies, and serious complications of diabetes.NIDDM only requires the appointment of this therapy in cases of insulin-requiring forms, when correction by other methods does not give the desired effect.
Modern insulins, the so-called monocompetent insulins, represent two groups:
- Monocompetent pharmacological forms of the human insulin substance (semi-synthetic or DNA recombinant), which undoubtedly have a significant advantage over drugs of pork origin.They have practically no contraindications or side effects;
- Monocompetent insulins obtained from porcine pancreas.These drugs increase the dose of the drug by about 15% compared to human insulins.
Diabetes is dangerous because of complications
Given that diabetes is accompanied by damage to many organs and tissues, its manifestations can be found in almost all body systems.Complications of diabetes mellitus include:
- Pathological changes on the skin: diabetic dermopathy, necrobiosis lipoidica, furunculosis, xanthomatosis, fungal skin infections;
- Osteoarticular diseases:
- Diabetic osteoarthropathy (Charcot joint - change in the ankle joint), which occurs against the background of microcirculation damage and trophic disorders, accompanied by dislocations, subluxations, and spontaneous fractures that preceded its developmentdiabetic foot;
- Diabetic hair treatment, characterized by stiffness of the joints of the hand, which often develops in children with diabetes;
- Respiratory diseases: long-termprolonged bronchitis, pneumonia,increased incidence of tuberculosis;
- Pathological processes affecting the digestive organs:diabetic enteropathy, accompanied by increased peristalsis, diarrhea (30 times a day), weight loss;
- Diabetic retinopathy– one of the most serious complications, characterized by damage to the organs of vision;
- It is considered the most common complication of diabetes mellitusdiabetic neuropathyand its variety -polyneuropathy, which reaches 90% of all forms of pathology.Diabetic polyneuropathy is a common conditiondiabetic foot syndrome;
- A pathological condition of the cardiovascular system, which in most cases is the cause of death caused by diabetes mellitus.Hypercholesterolemia and vascular atherosclerosis that develop in diabetes at a young age inevitably lead to cardiovascular diseases (coronary artery disease, heart attack, heart failure, cerebrovascular accident).
Prevention
Measures to prevent diabetes mellitus are based on the causes that cause it.In this case, it is advisable to talk about the prevention of atherosclerosis and arterial hypertension, including the fight against excess weight, bad habits and food addictions.
The prevention of complications of diabetes mellitus includes the prevention of the development of pathological conditions resulting from diabetes.Correcting the blood serum glucose level, following a diet, adequate physical activity and following the doctor's recommendations will help delay the consequences of this rather terrifying disease.