Diabetes Clinic and Diagnosis

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

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, the clinic of which was brilliant if the urine tasted sweet during the test. In Chinese medicine, to diagnose this insidious disease, insects were used - flies, wasps, which, in the presence of sugar in the urine, sat on the container in which 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 from the cardiovascular and nervous systems to a greater extent, and the remaining functional units of the body suffer slightly less.

To date, there are several types of diseases that have completely different approaches to treatment. At the same time, whatever 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 well as in children, diabetes mellitus with absolute insulin deficiency is more 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 where the disease also affects young people. It is much more common than the first type, and one of the provoking factors of the pathology is overweight.
3. Symptomatic. This type of disease can occur against the background of other pathological processes, therefore it is also called secondary.
4. Gestational diabetes that occurs during pregnancy. It often disappears on its own after delivery.
5. A pathology such as diabetes mellitus can also develop with malnutrition.

It should be noted once again that the first and second types of pathology are distinguished respectively by the development of absolute and relative insulin deficiency. Therefore, it is the first type of disease that requires the 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, this need also arises.

By itself, the second type of disease can be characterized by a sufficient production of insulin, but the cells of the body are insensitive to it for various reasons: the organelles responsible for this process can be blocked or their number is insufficient for communication effective. 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 decrease, which leads to an increase in glycemic indicators.

The reasons

The basis of the absolute insufficiency of insulin, which leads 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 aimed at fighting 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, chicken pox, mumps. There is a genetic predisposition to the disease.

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 by 10 times. Abdominal obesity, i. e. when fat deposits are found in the abdomen, can be the result of metabolic disorders, i. e. prediabetes.
2. Hereditary predisposition suggests an increased risk of diabetes several times with this pathology in blood relatives. It doesn't matter if the older or younger relative suffers from the disease. Sometimes there is a tendency that the disease is passed on through 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 over time.

Secondary diabetes mellitus usually develops against the background of the following processes:

1. Organic pathologies of the pancreas: 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 muscle tissue and liver ceases to be deposited. The sugar that the body has not been able to 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 all organs and systems of the body.

Since glucose does not enter the cells, they begin to actively break down fats for 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 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, by contrast, patients gain weight rapidly.

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 wavy (the normal state alternates with 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 early development of these conditions.

1. Serious diseases of the cardiovascular system: atherosclerosis, ischemic conditions.
2. Development of microangiopathies in the lower limbs, kidneys, eyes.
3. Damage to the nervous system, which manifests itself in the form of dry skin, severe pain and leg cramps, decreases pain sensitivity.
4. Reduced vision.
5. Damage to the kidneys with violation of their function and increased protein excretion.
6. Ulcerative defects develop on the feet, which ultimately lead to necrotic and purulent processes. The basis of 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. Note that 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 abdominal pain 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 ketoacidosic coma develops.

Perhaps a coma with improper dosing of insulin, when too much is given. To prevent the development of any type of diabetic coma, it is necessary to constantly monitor blood sugar levels and properly select insulin doses.

Diagnostics

Patients diagnosed with diabetes are under the supervision of an endocrinologist. The diagnosis of pathology includes the following tests:

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

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 installed an insulin pump. To date, the development of an artificial pancreas is underway, which in turn can measure the sugar and inject the right amount of insulin.
3. The second type of disease involves taking hypoglycemic drugs in tablets.
4. Special physiotherapy exercises are prescribed, as physical activity helps normalize blood sugar and helps fight obesity.

It should be borne in mind that this disease is cured for life. The higher the level of self-control in a patient, the fewer life-threatening complications the patient will develop and its progression will be significantly slowed.