diabetes (diabetes mellitus, SD) is a chronic metabolic disease that manifests itself in the form of absolute or relative insufficiency of the protein hormone of the pancreas in the blood called insulin and is characterized by a violation of the metabolism of dextrose in the body - persistent hyperglycemia, which subsequently leads to metabolic disorders of fats, proteins, minerals and water.
Next, you will learn: what is diabetes mellitus, its main types, symptoms and treatment methods.
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 level of insulin remains within the normal range, but the number of hormone receptors on the membranes of target cells (brain, liver, adipose tissue, muscles) decreases.
Gestational diabetes- an acute or chronic condition, manifested in the form of hyperglycemia during a woman's pregnancy.
Other (situational) causes of diabetes- impaired glucose tolerance caused by causes unrelated to the pathology of the pancreas. They can be temporary and permanent.
types of diabetes:
medicine;
infectious;
genetic defects in the insulin molecule or its receptors;
associated with other endocrine pathologies:
- Itsenko-Cushing disease;
- adrenal adenoma;
- Graves' disease.
Classification of diabetes by severity:
light shape- characterized by hyperglycemia not exceeding 8 mmol / l, slight daily fluctuations in sugar levels, absence of glycosuria (sugar in the urine). It does not require pharmacological correction with insulin.
Often, at this stage, the clinical manifestations of the disease may be absent, however, during the instrumental diagnosis, the initial forms of typical complications with damage to peripheral nerves, retinal microvessels, kidneys and heart are already detected.
moderate severity- peripheral blood glucose level reaches 14 mmol / l, glycosuria appears (up to 40 g / l), an intakeketoacidosis- a sharp increase in ketone bodies (fat-breaking metabolites).
Ketone bodies are formed due to lack of energy in cells. Most of the glucose circulates in the blood and doesn't enter the cell, and the cell starts using fat stores to produce ATP. At this stage, the glucose level is controlled with the help of diet therapy, the use of oral hypoglycemic agents.
It is 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 stages:
Compensation- diet or insulin therapy allows you to achieve normal blood glucose 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, absence of ketone bodies, acetone. Glycosylated hemoglobin does not exceed the value of "5%";
undercompensation- treatment does not completely correct blood counts and clinical manifestations of the disease. Blood glucose is not more 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). Urine acetone is not detected, however mild manifestations of ketoacidosis are possible;
Decompensation- the most severe phase of diabetic patients. It 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 condition of the patient up to coma. The glucose level cannot be corrected with the help of pharmaceuticals. drugs (more than 14 mmol/l). High urine sugar numbers (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 pathology.
The most important causes for the development of the disease:
Type I diabetes mellitus:
Genetic causes of diabetes:
- congenital insufficiency of pancreatic β cells;
- inherited mutations in genes responsible for insulin synthesis;
- genetic predisposition to self-aggression of β-cell immunity (closest relatives are diabetic);
The infectious causes of diabetes mellitus are pancreatotropic viruses (which affect the pancreas): rubella, herpes type 4, mumps, hepatitis A, B, C. Human immunity begins to destroy pancreatic cells along with these viruses, which causes diabetes mellitus.
Type II diabetes has the following causes:
- heredity (presence of diabetes in the immediate family);
- visceral obesity;
- age (generally over 50-60 years);
- low fiber intake and high intake of refined fats and simple carbohydrates;
- hypertonic disease;
- atherosclerosis.
Provoking factors
This set of factors does not cause the disease by itself, but significantly increases the chances of its development, if there is a genetic predisposition.
- physical inactivity (passive lifestyle);
- obesity;
- smoke;
- excessive alcohol consumption;
- the use of substances that affect the pancreas (eg, drugs);
- excess fat and simple carbohydrates in the diet.
diabetes symptoms
Diabetes is a chronic disease, so symptoms never appear suddenly. The symptoms in women and the symptoms in men are almost the same. With the disease, manifestations of the following clinical signs are possible to varying degrees.
- Constant weakness, diminished performance- develops as a result of chronic lack of energy in brain cells and skeletal muscles;
- Dryness and itching of the skin- due to constant loss of fluid in the urine;
- Dizziness, headaches- signs of diabetes disease - due to the lack of glucose in the blood circulating in the brain vessels;
- frequent urination- occurs due to damage to the capillaries of the glomeruli of the nephrons of the kidneys;
- Reduced immunity (frequent SARS, non-prolonged healing of skin wounds)- the activity of T-cell immunity is impaired, the skin performs a worse barrier function;
- polyphagia- a constant feeling of hunger - this condition develops due to the rapid loss of glucose in the urine and its insufficient transport to the cells;
- decreased vision- causes - damage to the microscopic vessels of the retina;
- 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 heart region- narrowing of the coronary vessels due to atherosclerosis leads to a decrease in the blood supply of the myocardium and spastic pain;
- Decreased sexual function- is directly related to poor blood circulation in the organs that produce sex hormones.
diabetes diagnosis
Diagnosing diabetes most often does not cause difficulties for a qualified specialist. The doctor may suspect the condition based on the following factors:
- A diabetic patient complains of polyuria (increased amount of urine daily), polyphagia (constant hunger), weakness, headache, and other clinical symptoms.
- During a preventive blood test for glucose levels, 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 performed to confirm/refuse 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, in the context of an 8-hour fast, blood is collected to assess the fasting blood glucose level. After 5 minutes, the doctor gives the patient to drink 75 g of glucose dissolved in 250 ml of water. After 2 hours, the blood is collected again and the sugar level is determined again.
During this time, the initial symptoms of diabetes usually appear.
Criteria for evaluating the OGTT analysis:
| Standard | |
| on an empty stomach | < 5, 6 |
| 2 hours after OGTT | < 7, 8 |
| Diabetes mellitus (requires differential diagnosis for types of diabetes) | |
| on an empty stomach | ≥ 6. 1 |
| 2 hours after OGTT | ≥ 11. 1 |
| random definition | ≥ 11. 1 |
Determination of the level of glycosylated hemoglobin (C - HbA1c)
Glycated hemoglobin or HbA1c- this is the hemoglobin of the erythrocytes, undergoing transformation as a result of 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%.
Determination of C-peptide level
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.
Norm: 0. 79-1. 90 ng/ml (SI: 0. 27-0. 64 mmol/l).
Determination of proinsulin level
This test makes it possible to differentiate various diseases of the pancreas and diabetes. An increase in proinsulin in the blood most often indicates an endocrine tumor - insulinoma (a rather rare pathology). In addition, high concentrations of proinsulin molecules may indicate type 2 diabetes.
The norm is 3. 3-28 pmol / l.
Determining the level of antibodies to pancreatic beta cells
One of the most accurate tests to determine the presence and causes of diabetes. The test is performed on risk groups (people with a predisposition to diabetes, for example, if the next of kin has this disease), as well as on patients with impaired glucose tolerance during OGTT.
The higher the titer of specific antibodies, the more likely the autoimmune etiology of the disease is, and the faster the beta cells are destroyed and the level of insulin in the blood decreases. In diabetics, it usually exceeds 1: 10.
Standard - Title: less than 1: 5.
If the antibody titer remains within the normal range but the fasting glucose concentration is above 6. 1, the diagnosis is type 2 diabetes mellitus.
Insulin antibody level
Another specific immunoassay. It is performed for differential diagnosis in patients with diabetes (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 AT norm for insulin is 0-10 IU/ml.
- If C (AT) is greater than normal, the diagnosis is type 1 diabetes. autoimmune diabetes mellitus;
- If C(AT) is within the reference range, 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 antibodies to GAD and the development of type 1 diabetes is still unclear, however, in 80-90% of patients, these antibodies are detected in the blood. Analysis for AT GAD is recommended in risk groups for diagnosing prediabetes and prescribing preventive diet and pharmacological therapy.
Standard AT GAD - 0-5 IU/ml.
- A positive result with normal blood glucose indicates a high risk of type 1 diabetes;
- A negative result with an elevated blood glucose level 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 to somatic cells. Decreased insulin levels are 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 tumor of the pancreas (insulinoma).
Instrumental Diagnosis of Diabetes
pancreas ultrasound
The ultrasound method allows detecting morphological changes in the tissues of the gland.
Usually, in diabetes mellitus, diffuse damage is determined (areas of sclerosis - the replacement of functionally active cells with connective tissue).
In addition, the pancreas may be enlarged, showing signs of edema.
Angiography of the vessels of the lower extremities
The arteries of the lower extremities are the target organ in 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 blood stream with simultaneous control of vascular permeability on a CT scan.
If the blood supply is significantly reduced at the level of the legs of the lower extremities, the so-called "diabetic foot" is formed. The diagnosis of diabetes mellitus is based on this research method.
Kidney ultrasound and heart ECHO KG
Instrumental examination methods of the kidneys, allowing the assessment of 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 of functional abilities. The method makes it possible to prevent complications from diabetes mellitus.
Retinography or angiography of retinal vessels
The microscopic vessels of the retina are the most sensitive to hyperglycemia, so the development of damage to them 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 in the fundus of the eye.
The diagnosis of diabetes mellitus is a complex measure, which is based on the history of the disease, 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 see your doctor to learn more about what diabetes is and what to do with that diagnosis.
Treatment
The treatment of diabetes mellitus is a set of measures to correct the level of blood glucose, cholesterol, ketone bodies, acetone, lactic acid, prevent the rapid development of complications and improve the quality of human life.
In diabetes, a very important aspect is the use of all treatment methods.
Methods that are used in the treatment of diabetes:
- Pharmacological therapy (insulin therapy);
- Diet;
- Regular physical activity;
- Preventive measures to prevent the progression of the disease and the development of complications;
- Psychological support.
Type 1 Diabetes Treatment
Pharmacological correction with insulin
The need for insulin injections in patients with diabetes, their 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, perform differential diagnosis, screening and evaluation of the effectiveness of drugs.
Insulin types:
- fast action(ultra-short acting) - starts to act 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 work within 12-18 hours after 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 glucose levels, but only controls its daily concentration and does not allow excess of normal values;
- combined insulin- contains in various proportions ultra-short and long-acting insulins. It is mainly used in the intensive care of type 1 diabetes.
diet therapy for diabetes
Diet - 50% success in controlling blood glucose level in a patient with diabetes mellitus.
What foods should be consumed?
- Low-sugar fruits and vegetables with high concentrations of vitamins and minerals (apples, carrots, cabbage, beets);
- Low-fat animal meat (beef, turkey, quail);
- Cereals and cereals (buckwheat, wheat, rice, barley, barley);
- Fish (preferably from the sea);
- From drinks it is better to choose weak tea, fruit decoctions.
What should be discarded:
- Sweets, pasta, flour;
- concentrated juices;
- Fatty meats and dairy products;
- Spicy and smoked foods;
- Alcohol.
Type 2 diabetes treatment
In the early stages, type 2 diabetes mellitus is well treated with diet therapy, the same as for type 1 diabetes. If the diet is not followed, as well as with a long course of the disease, pharmacological therapy with hypoglycemic agents is used. Even more rarely, patients with type 2 diabetes receive insulin.
Hypoglycemic drugs
- a drug 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
Popular methods include preparing various decoctions of herbs, fruits and vegetables, correcting the blood glucose level to one degree or another.
- kryphea amur- ready-made 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 Peel + Garlic- these products contain a lot of vitamin C, E, A, selenium and other trace elements. All this must be crushed, mixed and infused for about 2 weeks. Use orally 1 teaspoon before meals.
- oak acorns- contain tannin, a very effective remedy for 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 tsp before each meal.
Physical exercise in diabetes
Regular physical activity in diabetes mellitus is a very important aspect in the treatment and prevention of diabetes mellitus complications. Morning exercise, 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, people who are at risk need to take a number of steps to control their blood sugar and the rate of development of diabetes complications.
- Children with unfavorable heredity (parents, grandparents sick with diabetes) should be tested for blood sugar levels once a year, in addition to monitoring their condition and the appearance of the first symptoms of the disease. In addition, an important measure will be annual consultations with an ophthalmologist, neuropathologist, endocrinologist, cardiologist to determine the first symptoms of diabetes, to prevent complications of diabetes.
- People over 40 need to have their blood glucose levels checked annually to prevent type 2 diabetes;
- All diabetics need to use special devices to monitor blood sugar levels - glucometers.
You also need to find out 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 long conversation with the doctor, he will consult, direct you to pass necessary tests and prescribe treatment.
recovery prognosis
Diabetes mellitus is an incurable disease, therefore, 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.