Diabetes mellitus is one of the most common diseases and disturbs the statistics.Symptoms of diabetes mellitus do not appear overnight;with the increase and worsening of endocrine and metabolic disorders, the process becomes chronic.It is true that the onset of type 1 diabetes is significantly different from the early stage of type 2 diabetes.
Among all endocrine pathologies, diabetes confidently leads and accounts for more than 60% of all cases.In addition, disappointing statistics show that 1/10 of "diabetic patients" are children.
The probability of contracting the disease increases with age, and thus the group size doubles every ten years.This is due to the increase in life expectancy, the improvement of early diagnosis methods, the decrease in physical activity and the increase in the number of people who are overweight.
Types of diabetes
Many people have heard about a disease such as diabetes insipidus.It will probably be useful to explain their differences, so that the reader does not later confuse the diseases called "diabetes".
Diabetes insipidus
Diabetes insipidus is an endocrine disease caused by neuroinfections, inflammatory diseases, tumors, intoxications and caused by deficiency and sometimes complete absence 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, the stomach expands to large sizes);
- Isolation of unconcentrated light urine with a low specific gravity (1000-1003);
- Catastrophic weight loss, weakness, reduced physical activity, disorders of the digestive system;
- Characteristic changes in the skin ("parchment" skin);
- Atrophy of muscle fibers, weakness of the muscular system;
- The development of dehydration syndrome in the absence of liquid intake for more than 4 hours.
In terms of complete treatment, the disease has an unfavorable prognosis;working capacity is significantly reduced.
Brief anatomy and physiology
An unpaired organ, the pancreas performs a mixed secretory function.Its exogenous part carries out external secretion by producing enzymes involved in the digestive process.The endocrine part, entrusted with the mission of internal secretion, produces various hormones, including -insulin and glucagon.They are the basis for 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 are considered the site of glucagon production;
- B cells, which occupy up to 60% of the cell population, synthesize and store insulin, which is a polypeptide consisting of two chains, carrying 51 amino acids in a specific sequence;
- somatostatin-producing D-cells;
- Cells that produce other polypeptides.
Thus, the result is:In particular, damage to the pancreas and islets of Langerhans is the main mechanism that inhibits insulin production and promotes the development of the pathological process.
Types and special forms of the disease
Lack of insulin leads to impaired sugar stability (3.3-5.5 mmol/l)and contributes to the formation of a heterogeneous disease called diabetes mellitus (DM):
- Forms of complete lack of insulin (absolute deficiency).insulin dependentpathological process referred to astype I diabetes mellitus (IDDM);
- Insulin deficiency (relative deficiency), which causes a violation of carbohydrate metabolism in the initial stage, slowly but surely leads to its development.non-insulin dependentcalled diabetes mellitus (NIDDM).Type II diabetes.
Due to the violation of the use of glucose in the body and, as a result, its increase in blood serum (hyperglycemia), in principle, it is a manifestation of the disease, over time, the symptoms of diabetes begin to appear, that is, a general violation of metabolic processes at all levels.
In addition to type 1 and type 2 diabetes, there are special types of this disease:
- Secondary diabetesacute and chronic inflammation of the pancreas (pancreatitis), malignant neoplasms in the parenchyma of the gland, liver cirrhosis.A number of 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 antihypertensive drugs and hormones, oral contraceptives, etc.;
- Diabetes in pregnant women (gestational),it is caused by the unique interaction of the hormones of the mother, the child and the placenta.The fetal pancreas, which produces its own insulin, begins to inhibit the production of insulin by the mother's gland, as a result of which this special form is formed during pregnancy.However, with proper management, gestational diabetes usually resolves after delivery.Later, in some cases (up to 40%), this fact may threaten the development of type II diabetes mellitus (within 6-8 years) in women with a similar history of pregnancy.
Why does "sweet" disease occur?
"Sweet" disease constitutes a rather "colorful" group of patients, so it is clear that IDDM and its non-insulin-dependent "brother" have a genetically different origin.There is evidence of a link between insulin-dependent diabetes and genetic structures of the HLA system (major histocompatibility complex), especially some genes of the D-region loci.No such association was observed for NIDDM.
Genetic predisposition is not enough for the development of type I diabetes mellitus;pathogenetic mechanism is triggered by inciting factors:
- Congenital deficiency of islets of Langerhans;
- Negative influence of the external environment;
- Stress, nervous tension;
- Traumatic brain injuries;
- Pregnancy;
- Infectious processes of viral origin (influenza, mumps, cytomegalovirus infection, Coxsackie);
- Tendency to constant overeating, which leads to excess fat deposits;
- Abuse of sweets (those with a sweet tooth are more at risk).
Before highlighting the causes of type II diabetes, it would be appropriate to dwell on a very controversial issue: who suffers more - men or women?
It has been established that even in the 19th century diabetes was a "privilege" of the male sex, but nowadays this disease is more common in women.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 include:
- As a result of inflammatory processes, changes in the structural structure of the pancreas, as well as the appearance of cysts, tumors, bleeding;
- Age after 40 years;
- Excess weight (the most important risk factor for NIDDM!);
- Vascular diseases caused by atherosclerotic process and arterial hypertension;
- In women, pregnancy and the birth of a child with a high body weight (more than 4 kg);
- Having relatives with diabetes;
- Strong psycho-emotional stress (adrenal hyperstimulation).
The causes of different types of diabetes overlap in some cases (stress, obesity, the influence of external factors), but the beginning of the process in type 1 and type 2 diabetes is different, moreover,IDDM is the province of children and young adults, and insulin-independent people predominate in the elderly.
Why do you want to drink so much?
The characteristic symptoms of diabetes, regardless of the form and type, can be presented as follows:
- Dryness of the mucous membrane of the mouth;
- Thirst associated with dehydration, which is practically impossible to quench;
- Excessive urine production and its excretion by the kidneys (polyuria), which leads to dehydration;
- An increase in the concentration of glucose in the blood serum due to the cessation of the use of sugar by peripheral tissues due to insulin deficiency (hyperglycemia);
- The appearance of sugar in the urine (glucosuria) and the presence of ketone bodies (ketonuria), normally in small quantities, but in diabetes mellitus they are intensively produced by the liver and are detected in the urine when they are excreted from the body;
- Increase of urea and sodium ions (Na) in blood plasma (in addition to glucose).+);
- In case of decompensation of the disease, weight loss is characteristic of the catabolic syndrome, which develops as a result of glycogen breakdown, lipolysis (fat mobilization), protein catabolism and gluconeogenesis (glucose conversion);
- Violation of indicators of the lipid spectrum, increase of total cholesterol due to low-density lipoprotein fraction, NEFA (non-esterified fatty acids), triglycerides.The increased content of lipids begins to be actively sent to 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 situationdiabetic ketoacidosis.
Thus, the general symptoms of diabetes can be characteristic of any form of the disease, but in order not to confuse the reader, it is still necessary to mention the features that are specific to one or another type.
Diabetes mellitus type I is a "privilege" of young people
IDDM is characterized by an acute (weeks or months) onset.The symptoms of type I diabetes mellitus are clearly expressed and are manifested by clinical symptoms characteristic of this disease:
- Sudden weight loss;
- Unnatural thirst, a person simply cannot get drunk, although he tries to do so (polydipsia);
- 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 diabetic (ketoacidotic, hyperglycemic) coma is quite possible - an extremely life-threatening situation, so insulin therapy is prescribed as early as possible (as soon as diabetes is suspected).
In most cases, after using insulin, metabolic processes are compensated,The body's need for insulin is sharply reduced and a temporary "recovery" occurs.However, this short-term state of remission should not relieve the patient or the doctor, because after a while the disease will remind itself again.As the duration of the disease increases, the need for insulin may increase, but in general, in the absence of ketoacidosis, it will not exceed 0.8-1.0 U/kg.
Symptoms indicating the development of late complications of diabetes (retinopathy, nephropathy) may appear after 5-10 years.The leading causes of death from IDDM include:
- terminal renal failure resulting from diabetic glomerulosclerosis;
- Cardiovascular disorders are slightly less common complications of the underlying disease than renal disease.
Disease or age-related changes?(type II diabetes)
NIDDM develops over months or even years.When a problem arises, a person takes them to various specialists (dermatologist, gynecologist, neurologist...).The patient does not even suspect various diseases in his opinion: furunculosis, skin itching, fungal infections, pain in the lower extremities are symptoms of type II diabetes mellitus.Patients get used to their condition, and diabetes continues to develop slowly, affecting all systems and primarily blood vessels.
NIDDM is characterized by a stable, slow course, usually without a tendency toward ketoacidosis.
Treatment of type 2 diabetes usually begins with a diet limiting easily digestible (refined) carbohydrates and limiting the use of sugar-lowering medications (if necessary).If the disease has progressed to the stage of severe complications or there is resistance to oral drugs, insulin is prescribed.
The leading cause of death in patients with NIDDM is known to be cardiovascular disease resulting from diabetes.As a rule, this is a heart attack or stroke.
Treatment of diabetes mellitus
Three main principles form the basis of therapeutic measures aimed at compensation of diabetes mellitus:
- compensation for insulin deficiency;
- Regulation of endocrine and metabolic disorders;
- Prevention of diabetes, its complications and timely treatment.
The implementation of these principles is carried out on the basis of 5 main positions:
- Nutrition plays the role of "first violin" for diabetes mellitus;
- Adequate and individually selected system of physical exercises after the diet;
- Antidiabetic drugs are mainly used in the treatment of type 2 diabetes;
- Insulin therapy is prescribed if necessary for NIDDM, but it is important in type 1 diabetes;
- Training of patients for self-monitoring (taking blood from a finger, using a glucometer, self-administering insulin skills).
Laboratory control above these positions indicates the degree of compensation after the following biochemical studies:
| Indicators | Good compensation rate | Satisfactory | It's bad |
|---|---|---|---|
| Fasting glucose level (mmol/l) | 4.4 – 6.1 | 6.2 - 7.8 | Ø 7.8 |
| Blood sugar level 2 hours after 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 |
The important role of diet in the treatment of NIDDM
Diet for diabetes mellitus is very well known, even to people who are far from diabetes, table 9. When in the hospital for any disease, you can sometimes hear about a special diet that is in separate containers, different from other diets, and given after saying a certain password: "I have a ninth table."What does it all mean?What makes this secret diet different from others?
It cannot be mistaken that by looking at a diabetic patient with his "porridge", they are deprived of all the joys of life.Diet for diabetes is not so different from the diet of healthy people;patients receive adequate amounts of carbohydrates (60%), fats (24%) and proteins (16%).
Diabetes nutrition consists of replacing refined sugars in foods with carbohydrates that break down slowly.Sugar and confectionery made on its basis, which are sold to everyone in stores, belong to the category of prohibited foods.
As for nutritional balance, everything is serious here: a diabetic patient must consume the necessary amount of vitamins and pectin, which is at least 40 grams.per day.
Serious individual physical activity
Physical activity for each patient is selected individually by the attending physician, taking into account the following points:
- Age;
- Symptoms of diabetes;
- The severity of the pathological process;
- The presence or absence of complications.
Physical activity prescribed by the doctor and carried out by the "ward" should promote the "burning" of carbohydrates and fats without involving insulin.The dose needed to compensate for metabolic disorders is significantly reduced, which should not be forgotten, because you can get an unwanted effect by preventing an increase in blood sugar levels.Adequate physical activity reduces glucose, a controlled dose of insulin breaks down the rest, and as a result, the sugar level falls below acceptable values (hypoglycemia).
Thus,insulin dosage 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 together.
Or maybe try folk remedies?
Treatment of type 2 diabetes mellitus is often accompanied by the patient's own search for folk remedies, which can slow down the process and delay the time of taking dosage forms as much as possible.
Despite the fact that our distant ancestors practically did not know about this disease, there are folk remedies for the treatment of diabetes, 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, monitoring blood sugar, visiting a doctor and following all his recommendations.
Quite well-known folk remedies are used to fight this pathology at home:
- White mulberry bark and leaves;
- Oat grains and husks;
- Walnut partitions;
- bay leaf;
- cinnamon;
- acorns;
- nettle;
- Dandelions.
When diet and folk remedies no longer help...
The so-called first-generation drugs, which were widely known at the end of the last century, are in the past, and their place has been replaced by new-generation drugs, which make up the 3 main groups of diabetes drugs produced in the pharmaceutical industry.
The endocrinologist decides which means is suitable for this or that patient.We will give several illustrative examples so that patients do not self-medicate and decide to use these drugs for diabetes at their own discretion.
Sulfonylurea derivatives
Currently, second-generation sulfonylurea derivatives are prescribed, which act for 10 to 24 hours.Patients usually take 2 times a day half an hour before meals.
These drugs are strictly contraindicated in the following cases:
- Type 1 diabetes;
- Diabetic, hyperosmolar, lactic acidotic coma;
- Pregnancy, childbirth, lactation;
- diabetic nephropathy accompanied by impaired filtration;
- Diseases of the hematopoietic system with a simultaneous decrease in white blood cells - leukocytes (leucocytopenia) and the platelet component of hematopoiesis (thrombocytopenia);
- Severe infectious and inflammatory liver lesions (hepatitis);
- Diabetes complicated by vascular pathology.
In addition, the use of drugs in this group may threaten the development of allergic reactions manifested by:
- Skin itching and urticaria, sometimes reaching Quincke's edema;
- Disorders of the digestive system;
- Changes in the blood (decrease in the level of platelets and leukocytes);
- Possible violation of the functional capabilities of the liver (jaundice due to cholestasis).
Antihyperglycemic agents of the biguanide family
Biguanides (guanidine derivatives) are actively used in the treatment of type 2 diabetes, sulfonamides are often added to them.They are very rational for use by obese patients, but for people with liver, kidney and cardiovascular pathology, their use is sharply limited, switching to softer drugs of the same group or α-glucoside inhibitors that inhibit the absorption of carbohydrates in the small intestine.
The following are considered absolute contraindications to the use of biguanides:
- 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 blood circulation in the lower extremities due to various vascular pathologies.
Treatment with insulin
It is clear from the aboveInsulin is the main treatment for type 1 diabetes, all medical emergencies and severe complications of diabetes.NIDDM requires that this therapy be prescribed only in insulin-requiring forms, if correction by other means does not have the desired effect.
Modern insulins, called monocompetent, represent two groups:
- Monocompetent pharmacological forms of human insulin substance (semi-synthetic or DNA recombinant) undoubtedly have a significant advantage over drugs of porcine origin.They have practically no contraindications or side effects;
- Monocompetent insulins from porcine pancreas.These drugs, compared to human insulins, require an increase in the dose of the drug by about 15%.
Diabetes is dangerous due to complications
Since diabetes is accompanied by damage to many organs and tissues, its manifestations can be found in almost all body systems.Complications of diabetes mellitus are as follows:
- Pathological changes in the skin: diabetic dermopathy, lipoid necrobiosis, furunculosis, xanthomatosis, fungal skin infections;
- Osteoarticular diseases:
- Diabetic osteoarthropathy (Charcot joint - a change in the ankle joint), occurring against the background of impaired microcirculation and trophic disorders, is accompanied by dislocations, subluxations, spontaneous fractures before formation.diabetic foot;
- Diabetic sachopathy, characterized by stiffness in the joints of the hands, which often develops in children with diabetes;
- Respiratory diseases: long-termlong-term bronchitis, pneumonia,increased incidence of tuberculosis;
- Pathological processes affecting the digestive organs:diabetic enteropathy, accompanied by an increase in peristalsis, diarrhea (up to 30 times a day), a decrease in body weight;
- 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 diversity -polyneuropathy, reaches 90% of all forms of this 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 from diabetes mellitus.Hypercholesterolemia and atherosclerosis of vessels, which begin to develop in diabetes at a young age, inevitably lead to heart and vascular diseases (coronary artery disease, myocardial infarction, 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 addiction.
Prevention of complications of diabetes mellitus involves preventing the development of pathological conditions caused by diabetes itself.Correcting the level of glucose in the blood serum, following a diet, adequate physical activity and following the doctor's recommendations will help to delay the consequences of this extremely terrible disease.