Clinic and diagnosis of diabetes

Diagnosis of diabetes mellitus begins with finding out the main signs - symptoms. Despite the similarity of the clinical manifestations of the disease, each diabetes has its own specific features.

Diabetes mellitus was described by the ancient Egyptians about one and a half thousand 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 bright if the urine tasted sweet when tested. In Chinese medicine, insects were used to diagnose this insidious disease - flies, wasps, which, in the presence of sugar in the urine, sat on 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 rises for various reasons. This is usually an insulin deficiency, which can be absolute or relative. This hormone is produced in the 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 severe complications from the cardiovascular and nervous systems to a greater extent, and the remaining functional units of the body suffer somewhat less.

To date, there are several types of diseases that have completely different approaches to treatment. At the same time, whatever diabetes mellitus is, the clinic of this condition is almost always the same.

The most common classification in the literature is:

1. At a young age, as well as in children, diabetes mellitus with absolute insulin deficiency is most common. It is called the first type.
2. Insulin-dependent diabetes occurs more often in adulthood and is characterized by a relative lack of insulin. Type 2 diabetes usually occurs in older people, but there are cases when the pathology also affects young people. It is much more common than the first type, and one of the provoking factors of pathology is overweight.
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 goes away on its own after delivery.
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 the outside. And when pancreatic exhaustion is reached, especially in the case of a long course of type 2 diabetes, such a need also arises.

By itself, the second type of disease can be characterized by sufficient production of insulin, but the cells of the body are insensitive to it for various 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 production of insulin, which has little effect. As a result, the amount of insulin produced begins to fall, which leads to an increase in glycemic indicators.

The reasons

The basis of the absolute insufficiency of insulin, leading to the first type of disease, is an autoimmune process. It is caused by a violation of the immune system, which provokes the production of its own antibodies aimed at combating the beta cells of the islets of Langerhans. This leads to their destruction.

The main provoking factors of disruption 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 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 the development of the process. These include the same hereditary predisposition and the presence of excess weight. These factors should be considered in more detail.

1. The higher the degree of obesity, the higher the risk of diabetes, while in the third degree it increases 10 times. Abdominal obesity, that is, when fat deposits are located in the abdomen, may be the result of metabolic disorders, that is, prediabetes.
2. Hereditary predisposition suggests an increase in the risk of diabetes by several times with this pathology in blood relatives. It does not matter if the older or younger relative suffers from the disease. Sometimes there is a trend that the disease is transmitted through the generation, but this is just a coincidence.

It should be borne in mind that if diabetes mellitus was 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 against the background of any pathological process.
5. The patient has a genetic disease.

Gestational diabetes and diabetes due to malnutrition are somewhat 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 in which excess sugar in the form of glycogen in the muscle tissue and liver ceases to be deposited. The sugar that the body could not process continues to be in the bloodstream, and only a small part of it is excreted by the kidneys. This has an extremely negative effect on absolutely all organs and systems of the body.

Since glucose does not enter the cells, they begin to actively break down fats in order to obtain energy. This leads to an increased formation of nitrogenous residues - ketone bodies, which disrupts all metabolic processes.

Clinical picture

The most characteristic symptoms of a pathology that has not yet been 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 at 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 very long time;
• in type 1 diabetes, patients lose a lot of weight, and in type 2 diabetes, on the contrary, patients rapidly gain it.

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

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 earlier development of such conditions.

1. Severe 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 cramps in the legs, decreases pain sensitivity.
4. Reduced vision.
5. Damage to the kidneys with a violation of their function and an increase in protein excretion.
6. Ulcerative defects develop on the feet, which ultimately leads to necrotic and purulent processes. The basis for this is the development of neuropathy and angiopathy of the lower extremities.
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 can develop. It is noted 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. She may be accompanied by pain in the abdomen up to vomiting, there is a smell of acetone from the mouth. These changes are explained by the accumulation of ketone bodies, which must be removed from the blood as quickly as possible. If this does not happen, a ketoacidotic coma develops.

A coma is possible with improper dosing of insulin, when an excessive amount is administered. To prevent the development of any type of diabetic coma, you should constantly monitor blood sugar levels and adequately select insulin doses.

Diagnostics

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

1. Glycemic profile analysis.
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, it never exceeds the norm.
5. Determination of the C-peptide, which decreases in the first type of pathology. In the second type, it may remain within the normal range.

Treatment

To treat the process, patients need:

1. Stick to dietary recommendations. They mean limiting foods containing fast carbohydrates. The diet should be reviewed, preference is given 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. To date, the development of an artificial pancreas is underway, which itself can measure sugar and inject the right amount of insulin.
3. The second type of the disease involves taking tableted sugar-lowering drugs.
4. Special physiotherapy exercises are prescribed, since physical activity helps to normalize glycemia and helps fight obesity.

It must 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 slowed down.