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, mineral salts 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 receptors for the hormone 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 gestation.
Other (situational) causes of diabetes- impaired glucose tolerance caused by causes not related to the pathology of the pancreas. They can be temporary and permanent.
Types of Diabetes:
drug;
infectious;
genetic defects in the insulin molecule or its receptors;
associated with other endocrine pathologies:
- Itsenko-Cushing's disease;
- adrenal adenoma;
- Graves' disease.
Classification of diabetes by severity:
Light form- characterized by hyperglycemia of not more than 8 mmol / l, slight daily fluctuations in sugar levels, the absence of glucosuria (sugar in the urine). Does not require pharmacological correction with insulin.
Quite often, at this stage, the clinical manifestations of the disease may be absent, however, during instrumental diagnostics, the initial forms of typical complications with damage to peripheral nerves, retinal microvessels, kidneys, and heart are already detected.
Moderate severity- the level of glucose in the peripheral blood reaches 14 mmol / l, glucosuria appears (up to 40 g / l), an incomingketoacidosis- a sharp increase in ketone bodies (metabolites of fat breakdown).
Ketone bodies are formed due to energy starvation of cells. Almost all glucose circulates in the blood and does not enter the cell, and it begins to use fat reserves to produce ATP. At this stage, the glucose level is controlled with the help of diet therapy, the use of oral hypoglycemic drugs.
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 over 50 mmol / l. Complete dependence on insulin therapy, serious dysfunction of blood vessels, nerves, organ systems.
Classification according to the level of hyperglycemia compensation:
Compensation- this is a conditionally normal state of the body in the presence of a chronic incurable disease. The disease has 3 phases:
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, the absence of ketone bodies, acetone. Glycosylated hemoglobin does not exceed the value of "5%";
Subcompensation- treatment does not completely correct blood counts and clinical manifestations of the disease. Blood glucose is not higher than 14 mmol / l. Sugar molecules damage erythrocytes and glycosylated hemoglobin appears, damage to micro-vessels in the kidneys manifests itself in the form of a small amount of glucose in the urine (up to 40 g / l). Acetone in the urine is not detected, however, mild manifestations of ketoacidosis are possible;
Decompensation- the most difficult phase of diabetic patients. Usually occurs in the later stages of the disease or total damage to the pancreas, as well as insulin receptors. It is characterized by a general severe condition of the patient up to coma. The glucose level cannot be corrected with the help of pharmaceuticals. drugs (over 14 mmol / l). High numbers of sugar in the urine (over 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 significant causes for the development of the disease:
Type I diabetes mellitus:
Genetic causes of diabetes:
- congenital insufficiency of β-cells of the pancreas;
- hereditary mutations in the genes responsible for insulin synthesis;
- genetic predisposition to autoaggression of immunity to β-cells (closest relatives are diabetic);
Infectious causes of diabetes mellitus are pancreatotropic (affecting the pancreas) viruses: rubella, type 4 herpes, mumps, hepatitis A, B, C. Human immunity begins to destroy pancreatic cells along with these viruses, from which diabetes occurs.
Type II diabetes has the following causes:
- heredity (the presence of diabetes in the immediate family);
- visceral obesity;
- age (usually older than 50-60 years);
- low fiber intake and high intake of refined fats and simple carbohydrates;
- hypertonic disease;
- atherosclerosis.
Provoking factors
This group of factors does not in itself cause the disease, but significantly increases the chances of its development, if there is a genetic predisposition.
- physical inactivity (passive lifestyle);
- obesity;
- smoking;
- excessive alcohol consumption;
- the use of substances that affect the pancreas (for example, drugs);
- excess fat and simple carbohydrates in the diet.
Symptoms of Diabetes
Diabetes is a chronic disease, so the symptoms never appear suddenly. Symptoms in women and symptoms in men are almost the same. With the disease, manifestations of the following clinical signs are possible to varying degrees.
- Constant weakness, decreased performance- develops as a result of chronic energy starvation of 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 a lack of glucose in the circulating blood of the cerebral vessels;
- Frequent urination- occurs due to damage to the capillaries of the glomeruli of the nephrons of the kidneys;
- Reduced immunity (frequent SARS, prolonged non-healing of wounds on the skin)- the activity of T-cell immunity is impaired, the skin performs a barrier function worse;
- Polyphagia- a constant feeling of hunger - this condition develops due to the rapid loss of glucose in the urine and its insufficient transport into the cells;
- Decreased vision- cause - damage to microscopic retinal vessels;
- Polydipsia- constant thirst due to frequent urination;
- Numbness of the limbs- prolonged hyperglycemia leads to specific polyneuropathy - damage to sensory nerves throughout the body;
- Pain in the region of the heart- narrowing of the coronary vessels due to atherosclerosis leads to a decrease in myocardial blood supply and spastic pain;
- Decreased sexual function- is directly related to poor blood circulation in the organs that produce sex hormones.
Diagnosis of diabetes
Diagnosis of diabetes most often does not cause difficulties for a qualified specialist. The doctor may suspect the disease, based on the following factors:
- A diabetic patient complains of polyuria (an increase in the amount of daily urine), 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 is carried out to confirm / refute the diagnosis and to find out 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 levels in the blood.
The essence of the method:in the morning, against the background of an 8-hour fast, blood is taken to assess the level of fasting glucose. After 5 minutes, the doctor gives the patient to drink 75 g of glucose dissolved in 250 ml of water. After 2 hours, blood is taken again and the sugar level is determined again.
During this period, the initial symptoms of diabetes usually appear.
Criteria for evaluating OGTT analysis:
| Norm | |
| 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 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 the level of C-peptide
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 allows you to evaluate the secretion of insulin in the pancreas.
Norm: 0. 79-1. 90 ng / ml (SI: 0. 27-0. 64 mmol / l).
Determination of the level of proinsulin
This test allows you to differentiate various diseases of the pancreas and diabetes. An increase in blood proinsulin most often indicates an endocrine tumor - insulinoma (a rather rare pathology). Also, high concentrations of proinsulin molecules may indicate type 2 diabetes.
The norm is 3. 3-28 pmol / l.
Determination of 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 in risk groups (people with a predisposition to diabetes, for example, if the next of kin have this disease), as well as in patients with impaired glucose tolerance during OGTT.
The higher the titer of specific antibodies, the more likely the autoimmune etiology of the disease, and the faster the beta cells are destroyed and the level of insulin in the blood decreases. In diabetics, it usually exceeds 1: 10.
Norm - Titer: 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 taken and a serological test is performed. It can also indicate the causes of diabetes.
The norm of AT to insulin is 0-10 IU / ml.
- If C (AT) is higher than normal, the diagnosis is type 1 diabetes. autoimmune diabetes mellitus;
- If C (AT) is within the reference values, 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 not clear, 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 a preventive diet and pharmacological therapy.
Norm AT GAD - 0-5 IU / ml.
- A positive result with normal glycemia 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 into somatic cells. A decrease in insulin levels is 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
Ultrasound of the pancreas
The method of ultrasound scanning allows to detect 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).
Also, the pancreas can be enlarged, have signs of edema.
Angiography of vessels of the lower extremities
The arteries of the lower extremities are the target organ in diabetes mellitus. Prolonged hyperglycemia causes an increase in blood cholesterol and atherosclerosis, which leads to a decrease in tissue perfusion.
The essence of the method is the introduction of a special contrast agent into the bloodstream with simultaneous control of vascular patency on a computed tomograph.
If the blood supply is significantly reduced at the level of the legs of the lower extremities, the so-called "diabetic foot" is formed. Diagnosis of diabetes mellitus is based on this research method.
Ultrasound of the kidneys and ECHO KG of the heart
Methods of instrumental examination of the kidneys, allowing to assess the 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 hence a deterioration in functional abilities. The method allows to prevent complications of diabetes mellitus.
Retinography or angiography of retinal vessels
Microscopic vessels of the retina are the most sensitive to hyperglycemia, so the development of damage in 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. Also, the most important sign of DM will be the presence of microerosions and ulcers in the fundus.
Diagnosis of diabetes mellitus is a complex measure, which is based on the history of the disease, an 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 consult your doctor to find out more about what diabetes is and what to do with such a diagnosis.
Treatment
Treatment of diabetes mellitus is a set of measures to correct the level of glycemia, 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 methods of treatment.
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, its 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, conduct a differential diagnosis, screening and evaluation of the effectiveness of drugs.
Types of insulin:
- fast acting(ultra-short action) - begins 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;
- medium duration- are used for continuous reception and act within 12-18 hours after the injection. Helps to prevent complications of diabetes mellitus;
- Long acting insulin- Requires 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 ratios of ultrashort-acting and prolonged-acting insulins. It is used mainly in the intensive care of type 1 diabetes.
Diet therapy for diabetes
Diet - 50% success in controlling the level of glycemia in a patient with diabetes mellitus.
What foods should be consumed?
- Fruits and vegetables with low sugar levels and high concentrations of vitamins and minerals (apples, carrots, cabbage, beets);
- Meat containing a small amount of animal fat (beef, turkey, quail meat);
- Cereals and cereals (buckwheat, wheat, rice, barley, barley);
- Fish (preferably sea);
- From drinks it is better to choose weak tea, fruit decoctions.
What should be discarded:
- Sweets, pasta, flour;
- concentrated juices;
- Fatty meat and dairy products;
- Spicy and smoked foods;
- Alcohol.
Type 2 Diabetes Treatment
In the initial 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 drugs is used. Even more rarely, patients with type 2 diabetes are prescribed insulin.
Hypoglycemic drugs
- a drug that stimulates the production of insulin in the pancreas.
- stimulates beta cells to produce insulin.
- works in the intestine, inhibits the activity of small intestine enzymes that break down polysaccharides to glucose.
- a drug for the prevention of polyneuropathy, micro- and macroangiopathy of the kidneys, heart and retina.
Folk remedies for the treatment of diabetes
Folk methods include the preparation of various decoctions of herbs, fruits and vegetables, to one degree or another correcting the level of glycemia.
- kryphea amur- ready-made extract from moss. 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 large amount 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 must be ground into powder and taken 1 teaspoon before each meal.
Physical exercise in diabetes
Regular physical activity in diabetes mellitus is a very important aspect in the treatment and prevention of complications of diabetes mellitus. Morning exercises, 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 measures to control glycemia and the rate of development of diabetes complications.
- Children with unfavorable heredity (parents, grandparents are sick with diabetes) should be tested for blood sugar levels once a year, as well as monitor their condition and the appearance of the first symptoms of the disease. Also, 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 glycemic levels checked annually to prevent type 2 diabetes;
- All diabetics need to use special devices for monitoring blood sugar levels - glucometers.
You also need to find out everything about diabetes - what is possible, what is not, starting from 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 the necessary tests and prescribe treatment.
recovery prognosis
Diabetes mellitus is an incurable disease, so 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 disorders of organ systems leads to an improvement in the patient's quality of life.