diabetes (diabetes mellitus, SD) is a chronic metabolic disease that manifests itself in the form of absolute or relative insufficiency of the pancreatic protein hormone in the blood called insulin and is characterized by a violation of dextrose metabolism in the body - persistent hyperglycemia, which subsequently leads to fat metabolic disorders , proteins, minerals and water.
Next, you will learn: what diabetes mellitus is, its main types, symptoms and methods of treatment.
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 the β cells of the pancreas and destroy them completely;
- idiopathic (no known cause);
Type 2 diabetes- relative deficiency of insulin in the blood. This means that the quantitative indicator of the insulin level remains in 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 the gestation of a woman.
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:
drug;
infectious;
genetic defects in the insulin molecule or its receptors;
associated with other endocrine pathologies:
- Itsenko-Cushing's disease;
- adrenal adenoma;
- Graves disease.
Diabetes classification by severity:
Lightweight 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 drug 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, glycosuria appears (up to 40 g / l), aketoacidosis- a sharp increase in ketone bodies (metabolites of fat breakdown).
Ketone bodies are formed due to the energy starvation of cells. Almost all the glucose circulates in the blood and does not enter the cell and begins to use the 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.
Strict course- blood glucose exceeds 14 mmol / l, with fluctuations up to 20-30 mmol, glycosuria over 50 mmol / l. Complete dependence on insulin therapy, severe dysfunction of blood vessels, nerves, organs.
Classification according to the compensation level 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 reach 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. The glycosylated hemoglobin does not exceed the value of "5%";
Undercompensation- the treatment does not completely correct the blood count and the clinical manifestations of the disease. The blood sugar is not higher than 14 mmol / l. Sugar molecules damage erythrocytes and glycosylated hemoglobin appears, damage to microvessels 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 severe phase of diabetic patients. It usually occurs in the later stages of the disease or in total damage to the pancreas, as well as to the insulin receptors. It is characterized by a severe general condition of the patient up to a coma. The glucose level cannot be corrected with the help of pharmaceuticals. drugs (over 14 mmol / l). High number of sugars 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 to DM) is a polyetiological disease.
There is no single factor that can cause diabetes in all people with this condition.
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 genes responsible for insulin synthesis;
- genetic predisposition to self-attack of immunity to β cells (the closest relatives are diabetic);
Infectious causes of diabetes mellitus are pancreatotropic viruses (affecting the pancreas): rubella, herpes type 4, mumps, hepatitis A, B, C. Human immunity begins to destroy pancreatic cells along with these viruses, causing diabetes mellitus.
Type II diabetes has the following causes:
- heredity (the presence of diabetes in close relatives);
- visceral obesity;
- age (usually greater than 50-60 years);
- low in fiber and high in refined fats and simple carbohydrates;
- hypertonic disease;
- atherosclerosis.
Provocative factors
This group of factors does not cause the disease in itself, but significantly increases the chances of its development, if there is a genetic predisposition.
- physical inactivity (passive lifestyle);
- obesity;
- to smoke;
- 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 symptoms never appear suddenly. Symptoms in women and symptoms in men are almost the same. With the disease, the manifestations of the following clinical signs are possible to varying degrees.
- Constant weakness, reduced performance- develops due to chronic energy starvation of brain cells and skeletal muscles;
- Dry and itchy skin- due to the constant loss of fluid in the urine;
- Vertigo, headache- 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 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 into the cells;
- Reduced 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 heart region- narrowing of the coronary vessels due to atherosclerosis leads to a decrease in the blood supply to the myocardium and spastic pain;
- Decreased sexual function- is directly related to poor blood circulation in the organs that produce sex hormones.
Diabetes Diagnosis
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 (increased daily urine output), 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 / deny the diagnosis and to find out the causes.
Laboratory diagnosis of diabetes
Oral glucose tolerance test (OGTT)
A standard test to determine insulin's functional ability to bind glucose and maintain normal blood levels.
The essence of the method:in the morning, against the background of an 8-hour fast, blood is drawn to assess the fasting glucose level. After 5 minutes, the doctor makes the patient drink 75 g of glucose dissolved in 250 ml of water. After 2 hours, the blood is drawn again and the sugar level is determined again.
During this time, the initial symptoms of diabetes usually appear.
Criteria for the evaluation of the 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, in transformation following 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 C-peptide level
peptide Cit is a fragment of the proinsulin molecule. When the C peptide is cleaved, the insulin becomes functionally active. The concentration of this substance in the blood makes it possible to evaluate the secretion of insulin in the pancreas.
Norm: 0. 79-1. 90 ng / ml (SI: 0. 77-0. 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 proinsulin in the blood most often indicates an endocrine tumor - insulinoma (a rather rare pathology). Additionally, high concentrations of proinsulin molecules can indicate type 2 diabetes.
The norm is 3. 3-28 pmol / l.
Determination of the level of antibodies against pancreatic beta cells
One of the most accurate tests to determine the presence and causes of diabetes. The test is done in risk groups (people with a predisposition to diabetes, for example, if close relatives have this disease), as well as in patients with impaired glucose tolerance during the 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 insulin level in the blood decreases. In diabetics, it usually exceeds 1: 10.
Standard - Titer: less than 1: 5.
If the antibody titer remains in 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 higher 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 antibody test (glutamic acid decarboxylase).
GAD is a specific membrane enzyme of the central nervous system. The logical correlation between the concentration of antibodies against GAD and the development of type 1 diabetes is not yet clear, however, in 80-90% of patients, these antibodies are detected in the blood. The analysis for AT GAD is recommended in the risk groups for the diagnosis of prediabetes and the prescription of a preventive diet and drug therapy.
AT GAD norm - 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. 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 pancreatic tumor (insulinoma).
Instrumental diagnosis of diabetes
Ultrasound of the pancreas
The ultrasound scanning method allows you to detect morphological changes in the tissues of the gland.
Usually, in diabetes mellitus, diffuse damage is determined (areas of sclerosis - 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 of 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 the simultaneous control of vascular patency on a computer tomograph.
If the blood supply is significantly reduced in the legs of the lower limbs, the so-called "diabetic foot" is formed. The 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, which allow to evaluate 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 therefore a deterioration in functional abilities. The method allows you to prevent the complications of diabetes mellitus.
Retinography or angiography of the retinal vessels
The 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. Additionally, the most prominent sign of DM will be the presence of microerosions and ulcers in the fundus.
Diagnosis of diabetes mellitus is a complex measure, based on the history of the disease, a physical 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 with your doctor to learn 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 blood sugar, 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:
- Drug therapy (insulin therapy);
- Diet;
- Regular physical activity;
- Preventive measures to prevent the progression of the disease and the development of complications;
- Psychological support.
Treatment of type 1 diabetes
Pharmacological correction with insulin
The need for insulin injections in patients with diabetes, the 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 differential diagnosis, screening and evaluation of drug effectiveness.
Types of insulin:
- fast acting(ultra-short action) - starts acting 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 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 the normal values to be exceeded;
- Combined insulin- contains in various proportions ultra-short-acting 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 the blood sugar level 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);
- Cereals and cereals (buckwheat, wheat, rice, barley, barley);
- Fish (preferably sea fish);
- 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.
Treatment of type 2 diabetes
In the early stages, type 2 diabetes mellitus is well treated with diet therapy, the same as in type 1 diabetes. If the diet is not followed, as well as with a long course of the disease, drug 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.
- acts in the intestine, inhibits the activity of small intestine enzymes 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
Folk methods include the preparation of various decoctions of herbs, fruits and vegetables, correcting the level of blood sugar in one way or another.
- kryphea amur- ready extract of musk. The use of Criphea causes an increase in the synthesis of pancreatic hormones: lipase, amylase, protease. It also has an antiallergic and immunomodulatory effect, reduces the main symptoms of diabetes.
- Parsley Root + Lemon Zest + Garlic- these products contain a large amount of vitamins C, E, A, selenium and other trace elements. All this must be crushed, mixed and left to infuse 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 a powder and taken 1 teaspoon before each meal.
Exercise in diabetes
Regular physical activity in diabetes mellitus is a very important aspect in the treatment and prevention of the complications of diabetes mellitus. Morning exercises, running, swimming help 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 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 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 and prevent diabetes complications.
- People over 40 need to have their blood sugar checked every year to prevent type 2 diabetes;
- All diabetics must 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 with the type and ending with the causes of the disease specifically for you, for this a long conversation with the doctor is required, he will consult, direct 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 drug insulin therapy can significantly extend the life of a diabetic, and regular diagnosis of organ system disorders leads to an improvement in the patient's quality of life.