Diabetes clinic and diagnosis

The diagnosis of diabetes mellitus begins with the discovery of the main signs - symptoms. Despite the similarity of the clinical manifestations of the disease, each diabetes has its own characteristics.

Diabetes mellitus was described by the ancient Egyptians about fifteen hundred 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, whose clinic 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, stayed in the container where the urine was placed.

Classification

Diabetes itself is a pathology of the endocrine system. With it, the concentration of sugar in the blood constantly increases for various reasons. This is usually an insulin deficiency, which can be absolute or relative. This hormone is produced in 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 approaches to treatment. At the same time, whatever the diabetes mellitus, the clinic of this condition is almost always the same.

The most common classification in the literature is:

1. At a young age, as in children, diabetes mellitus with absolute insulin deficiency is more common. It's called the first type.
2. Insulin-dependent diabetes occurs most 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 triggering factors of the pathology is excess weight.
3. Symptomatic. This type of disease can occur against the background of other pathological processes, so it is also called secondary.
4. Gestational diabetes that occurs during pregnancy. It often disappears on its own after childbirth.
5. With malnutrition, a pathology such as diabetes mellitus can also develop.

It should be noted once again that the first and second types of pathology 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 outside. And when pancreatic exhaustion is reached, especially in the case of a long course of type 2 diabetes, that need arises as well.

By itself, the second type of disease can be characterized by the production of sufficient insulin, but the body's cells are insensitive to it for several reasons: the organelles responsible for this process may be blocked or their number is insufficient for effective communication. As a result, the 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 intended to fight the beta cells of the islets of Langerhans. This leads to their destruction.

The main provoking factors in the breakdown 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 the 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 developing the process. These include the same hereditary predisposition and the presence of excess weight. These factors must be considered in more detail.

1. The higher the degree of obesity, the greater the risk of diabetes, while in the third degree it increases 10 times. Abdominal obesity, ie when fat deposits are located in the abdomen, can be a result of metabolic disorders, ie pre-diabetes.
2. Hereditary predisposition suggests an increased risk of diabetes several times with this pathology in blood relatives. It doesn't matter whether the older or younger relative suffers from the disease. Sometimes there is a tendency for the disease to be passed down through the generation, but this is just a coincidence.

It should be borne in mind that if diabetes mellitus is 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 - an 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 in the context of any pathological process.
5. The patient has a genetic disease.

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

what happens in the body

Due to one or more of the above reasons, a process occurs in the body where excess sugar in the form of glycogen in muscle tissue and liver is no longer deposited. The sugar that the body has not been able to process remains in the bloodstream, and only a small part of it is excreted by the kidneys. This has an extremely negative effect on absolutely every organ and system in the body.

As glucose does not enter cells, they begin to actively break down fats for energy. This leads to an increase in the formation of nitrogenous wastes - ketone bodies, which stops all metabolic processes.

Clinical condition

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 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 long time;
• in type 1 diabetes, patients lose a lot of weight, and in type 2 diabetes, on the contrary, patients gain it quickly.

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

Complications of the disease

Both types of pathology are characterized by the development of complications that usually develop in a person in old age. Diabetes also contributes to the early development of such conditions.

1. Serious diseases of the cardiovascular system: atherosclerosis, ischemic conditions.
2. Development of microangiopathies in the lower extremities, kidneys, eyes.
3. Damage to the nervous system, which manifests itself in the form of dry skin, severe pain, and leg cramps, diminishes sensitivity to pain.
4. Reduced vision.
5. Damage to the kidneys with a violation of their function and an increase in the excretion of proteins.
6. Ulcerative defects develop on the feet, which eventually lead to necrotic and purulent processes. The basis for this is the development of lower extremity neuropathy and angiopathy.
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 content can develop. Note that the state of hypoglycemia (low sugar) is much more difficult to treat than hyperglycemia (high sugar).

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 to vomiting, there is a smell of acetone in the mouth. These changes are explained by the accumulation of ketone bodies, which must be removed from the blood as soon as possible. If this does not happen, a ketoacidotic coma develops.

Perhaps a coma with inadequate insulin dosage, when an excessive amount is administered. To prevent the development of any type of diabetic coma, you must constantly monitor your blood sugar levels and properly select your insulin doses.

Diagnosis

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

1. Analysis of the glycemic profile.
2. Glucose tolerance test.
3. Urine analysis for the presence of sugar and acetone, for this there are special test strips.
4. A blood test for glycated hemoglobin, in healthy people, never exceeds the norm.
5. Determination of C-peptide, 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 to:

1. Stick to dietary recommendations. They mean limiting foods that contain fast carbs. The diet should be reviewed, giving preference to five meals a day.
2. Insulin therapy is prescribed for patients with the first type or with secondary insulin-dependent diabetes. It is injected subcutaneously with a syringe or special syringe pens. Sometimes patients have an insulin pump installed. So far, development is underway on an artificial pancreas, which can measure sugar and inject the right amount of insulin.
3. The second type of the disease involves the use of sugar-lowering pills.
4. Special physiotherapy exercises are prescribed, as physical activity helps normalize blood glucose and helps fight obesity.

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