Diabetes mellitus is one of the most common diseases with a tendency to increase the incidence and spoil the statistics.Symptoms of diabetes mellitus do not appear overnight;the process is chronic, with growth and worsening of endocrine and metabolic disorders.True, the onset of type 1 diabetes differs significantly from the early stage of type 2.
Among all endocrine pathologies, diabetes holds the lead and accounts for more than 60% of all cases.Moreover, disappointing statistics show that 1/10 of "diabetics" are children.
The chance of getting the disease increases with age and, thus, every ten years the size of the group doubles.This is due to the increase in life expectancy, the improvement of early diagnostic methods, the decrease in physical activity and the increase in the number of overweight people.
Types of diabetes
Many people have heard of a disease such as diabetes insipidus.So that the reader does not later confuse the diseases called "diabetes", it will probably be useful to explain their differences.
Diabetes insipidus
Diabetes insipidus is an endocrine disease that appears as a result of neuroinfections, inflammatory diseases, tumors, intoxications and is caused by the insufficiency and sometimes the complete disappearance of ADH-vasopressin (antidiuretic hormone).
This explains the clinical picture of the disease:
- Constant dryness of the oral mucosa, incredible thirst (a person can drink up to 50 liters of water in 24 hours, stretching the stomach to large sizes);
- Isolation of a large amount of light non-concentrated urine with low specific gravity (1000-1003);
- Catastrophic weight loss, weakness, reduced physical activity, disorders of the digestive system;
- Characteristic changes in the skin ("parchment" skin);
- Atrophy of muscle fibers, weakness of the muscular system;
- Development of dehydration syndrome in the absence of fluid intake for more than 4 hours.
In terms of complete recovery, the disease has an unfavorable prognosis;work capacity is significantly reduced.
Brief Anatomy and Physiology
An unpaired organ, the pancreas, performs a mixed secretory function.Its exogenous part carries out external secretion, producing enzymes involved in the digestive process.The endocrine part, which is entrusted with the mission of internal secretion, produces various hormones, including -insulin and glucagon.They are key to ensure the consistency of sugar in the human body.
The endocrine section of the gland is represented by the islets of Langerhans, consisting of:
- A cells, which occupy a quarter of the total space of the islets and are considered the site of glucagon production;
- B cells, occupying up to 60% of the cell population, synthesize and store insulin, whose molecule is a polypeptide of two chains, carrying 51 amino acids in a certain sequence;
- D cells that produce somatostatin;
- Cells that produce other polypeptides.
Thus, the conclusion suggests itself:Damage to the pancreas and islets of Langerhans, in particular, is the main mechanism that inhibits insulin production and promotes the development of the pathological process.
Special types and forms of the disease
Lack of insulin leads to worsening of sugar stability (3.3 – 5.5 mmol/l)and contributes to the formation of a heterogeneous disease called diabetes mellitus (DM):
- A complete lack of insulin (absolute deficiency) is formed.insulin dependentthe pathological process, which is calledtype I diabetes mellitus (IDDM);
- Lack of insulin (relative lack), which causes a disorder of carbohydrate metabolism in the initial phase, slowly but surely leads to the developmentnot insulin dependentdiabetes mellitus (NIDDM), which is calledtype II diabetes mellitus.
Due to the disorder of the use of glucose by the body and consequently its increase in the blood serum (hyperglycemia), which is basically a manifestation of the disease, over time the signs of diabetes mellitus begin to appear, i.e. a total disorder of metabolic processes at all levels.
In addition to type 1 and type 2 diabetes, there are special types of this disease:
- Secondary diabetesresulting from acute and chronic inflammation of the pancreas (pancreatitis), malignant neoplasms in the parenchyma of the gland, cirrhosis of the liver.A number of endocrine disorders accompanied by excessive production of insulin antagonists (acromegaly, Cushing's disease, pheochromocytoma, thyroid disease) lead to the development of secondary diabetes.Many medications used for a long time have a diabetic effect: diuretics, some antihypertensive drugs and hormones, oral contraceptives, etc.;
- Diabetes in pregnant women (gestational),caused by the special mutual influence of the hormones of the mother, the child and the placenta.The pancreas of the fetus, which produces its own insulin, begins to inhibit the production of insulin from the mother's gland, as a result of which this special form is formed during pregnancy.However, with proper control, gestational diabetes usually disappears after delivery.Then, in some cases (up to 40%) in women with a similar history of pregnancy, this fact can threaten the development of diabetes mellitus type II (within 6-8 years).
Why does the "sweet" disease appear?
The "sweet" disease forms a rather "high" group of patients, so it becomes clear that IDDM and its non-insulin-dependent "brother" had a different genetic origin.There is evidence of a relationship between insulin-dependent diabetes and genetic structures of the HLA (major histocompatibility complex) system, in particular, with some genes of the D region loci. For NIDDM, such a relationship was not observed.
For the development of diabetes mellitus type I, genetic predisposition alone is not enough;The pathogenetic mechanism is triggered by provoking factors:
- Congenital lack of islets of Langerhans;
- Adverse impact of the external environment;
- Stress, nervous stress;
- Traumatic brain injuries;
- Pregnancy;
- Infectious processes of viral origin (flu, mumps, cytomegalovirus infection, Coxsackie);
- Tendency to constant overeating, leading to excessive fat deposits;
- Abuse of confectionery products (those with a sweet tooth are at greater risk).
Before addressing the causes of diabetes mellitus type II, it would be advisable to dwell on a very controversial issue: who suffers more often - men or women?
It has been proven that nowadays the disease appears more often in women, although in the 19th century, diabetes was a "privilege" of the male sex.By the way, now in some countries of Southeast Asia the presence of this disease in men is considered predominant.
Predisposing conditions for the development of diabetes mellitus type II include:
- Changes in the structural structure of the pancreas as a result of inflammatory processes, as well as the appearance of cysts, tumors, hemorrhages;
- Age after 40 years;
- Excess weight (the most important risk factor for NIDDM!);
- Vascular diseases caused by the atherosclerotic process and arterial hypertension;
- In women, pregnancy and the birth of a child with high body weight (more than 4 kg);
- Having relatives with diabetes;
- Strong psycho-emotional stress (adrenal hyperstimulation).
The causes of the disease of different types of diabetes in some cases coincide (stress, obesity, the influence of external factors), but the beginning of the process in type 1 and type 2 diabetes is different, moreover.IDDM is the province of children and young people, and non-insulin-dependent people prefer the elderly.
Why do you want to drink so much?
The characteristic symptoms of diabetes mellitus, regardless of the form and type, can be presented as follows:
- Dryness of the oral mucosa;
- Thirst that is practically impossible to quench, accompanied by dehydration;
- Excessive formation of urine and its excretion from the kidneys (poluria), which leads to dehydration;
- Increased concentration of glucose in the blood serum (hyperglycemia), due to the suppression of the use of sugar by peripheral tissues due to the lack of insulin;
- The appearance of sugar in the urine (glucosuria) and ketone bodies (ketonuria), which are normally present in negligible amounts, but in diabetes mellitus are intensively produced by the liver and when excreted from the body are found in the urine;
- Increased blood plasma content (in addition to glucose) of urea and sodium ions (Na+);
- Weight loss, which in the case of decompensation of the disease is characteristic of the catabolic syndrome, which develops due to the breakdown of glycogen, lipolysis (mobilization of fats), catabolism and gluconeogenesis (transformation into glucose) of proteins;
- Violation of indicators of the lipid spectrum, increase in total cholesterol due to the fraction of low-density lipoproteins, NEFA (non-esterified fatty acids), triglycerides.The increased content of lipids begins to be actively sent to the liver and there they are intensively oxidized, which leads to the excessive formation of ketone bodies (acetone + β-hydroxybutyric acid + acetoacetic acid) and their further entry into the blood (hyperketonemia).The excessive concentration of ketone bodies threatens a dangerous condition calleddiabetic ketoacidosis.
Thus, the general signs of diabetes can be characteristic of any form of the disease, however, in order not to confuse the reader, it is still necessary to emphasize the features inherent in one or another type.
Type I diabetes mellitus is a "privilege" of young people
IDDM is characterized by an acute onset (weeks or months).The signs of diabetes mellitus type I are pronounced and manifested by clinical symptoms typical for this disease:
- Sudden weight loss;
- Unnatural thirst, a person simply cannot get drunk, although he tries to do so (polydipsia);
- Large amounts of excreted urine (poluria);
- Significant excess concentration of glucose and ketone bodies in the blood serum (ketoacidosis).In the initial stage, when the patient may not yet be aware of his problems, the development of diabetic coma (ketoacidotic, hyperglycemic) is quite possible - an extremely life-threatening condition, therefore insulin therapy is prescribed as soon as possible (as soon as diabetes is suspected).
In most cases, after using insulin, metabolic processes are compensated,The body's need for insulin drops significantly and a temporary "recovery" occurs.However, this short-term state of remission should not relax either the patient or the doctor, as after a period of time the disease will remind itself again.The need for insulin may increase as the duration of the disease increases, but, in general, in the absence of ketoacidosis, it will not exceed 0.8-1.0 U/kg.
Signs indicating the development of late complications of diabetes (retinopathy, nephropathy) may appear after 5-10 years.The leading causes of death from IDDM include:
- Terminal renal failure, which is a consequence of diabetic glomerulosclerosis;
- Cardiovascular disorders are complications of the underlying disease, which occur somewhat less frequently than renal disorders.
Diseases or age-related changes?(type II diabetes)
NIDDM develops over many months and even years.When problems arise, people take them to different specialists (dermatologist, gynecologist, neurologist...).The patient does not even suspect that various diseases according to him: furunculosis, skin itching, fungal infections, pain in the lower extremities are signs of type II diabetes mellitus.Patients get used to their condition and diabetes continues to develop slowly, affecting all systems, and mainly blood vessels.
NIDDM is characterized by a steady, slow course, usually without a tendency to ketoacidosis.
Treatment of type 2 diabetes usually begins with a diet that limits easily digestible (refined) carbohydrates and the use of sugar-lowering medications (if necessary).Insulin is prescribed if the disease has progressed to the stage of severe complications or there is resistance to oral drugs.
The leading cause of death in patients with NIDDM is known to be cardiovascular pathology resulting from diabetes.As a rule, this is a heart attack or stroke.
Treatments for diabetes mellitus
The basis of therapeutic measures aimed at compensating diabetes mellitus is represented by three main principles:
- Compensation of insulin deficiency;
- Regulation of endocrine and metabolic disorders;
- Prevention of diabetes, its complications and their timely treatment.
The implementation of these principles is carried out based on 5 main positions:
- Nutrition for diabetes mellitus plays the role of "first violin";
- A system of physical exercises, appropriate and individually chosen, follows the diet;
- Sugar-lowering medications are mainly used to treat type 2 diabetes;
- Insulin therapy is prescribed if necessary for NIDDM, but is essential in the case of type 1 diabetes;
- Training patients for self-monitoring (ability to draw blood from a finger, use a glucometer, administer insulin without assistance).
Laboratory control on these positions shows the degree of compensation after the following biochemical studies:
| INDICATORS | Good compensation rate | Satisfying | Bad |
|---|---|---|---|
| Fasting glucose level (mmol/l) | 4.4 – 6.1 | 6.2 – 7.8 | Ø 7.8 |
| Blood sugar content 2 hours after a meal (mmol/l) | 5.5 – 8.0 | 8.1 – 10.0 | Ø 10.0 |
| Percentage of glycosylated hemoglobin (HbA1, %) | < 8.0 | 8.0 – 9.5 | Ø 10.0 |
| Total serum cholesterol (mmol/l) | < 5.2 | 5.2 – 6.5 | Ø 6.5 |
| Triglyceride level (mmol/l) | < 1.7 | 1.7 – 2.2 | Ø 2.2 |
The important role of diet in the treatment of NIDDM
Nutrition for diabetes is very well known, even for people far from diabetes, table number 9. During a stay in the hospital for any disease, you can sometimes hear about a special diet, which is always in special pots, differs from other diets and is given after saying a certain password: "I have the ninth table."What does it all mean?How is this mystery diet different from all the others?
There should be no mistake, caring for a diabetic who takes his "porridge" with him, that they are deprived of all the joys of life.The diet for diabetes is not so different from the diet of healthy people;patients receive the necessary amount of carbohydrates (60%), fats (24%) and proteins (16%).
Nutrition for diabetes consists of replacing refined sugars in food with slowly disintegrating carbohydrates.Sugar sold in stores for everyone and confectionery products based on it fall into the category of prohibited foods.
As for the nutritional balance, here everything is strict: a diabetic must necessarily consume the necessary amount of vitamins and pectins, which must be at least 40 grams.per day.
Strictly individual physical activity
Physical activity for each patient is selected individually by the attending physician, taking into account the following points:
- Age;
- Symptoms of diabetes;
- The severity of the pathological process;
- The presence or absence of complications.
Physical activity prescribed by the doctor and carried out by the "ward" should promote the "burning" of carbohydrates and fats without involving insulin.Its dose, which is necessary to compensate for metabolic disorders, drops significantly, which should not be forgotten, since by preventing the increase in blood sugar, you can get an unwanted effect.Adequate physical activity reduces glucose, the dose of insulin administered breaks down the remaining one, and as a result, the sugar level decreases below acceptable values (hypoglycemia).
Thus,the dose of insulin and physical activity requires attention and careful calculation,so that, complementing each other, together we do not exceed the lower limit of normal laboratory parameters.
Or maybe try folk remedies?
Treatment of diabetes mellitus type 2 is often accompanied by the patient's own search for folk remedies that can slow down the process and delay the time of taking dosage forms as much as possible.
Despite the fact that our distant ancestors practically did not know about this disease, there are folk remedies for the treatment of diabetes mellitus, but we must not forget thatinfusions and decoctions prepared from various plants are helpful.The use of home remedies for diabetes does not release the patient from following a diet, monitoring blood sugar, visiting the doctor and following all his recommendations.
To fight this pathology at home, quite popular folk remedies are used:
- White mulberry bark and leaves;
- Oat grains and husks;
- Nut splitter;
- Bay leaves;
- cinnamon;
- Lisa;
- nettle;
- Dandelion.
When diet and folk remedies no longer help...
The so-called first-generation drugs, widely known at the end of the last century, have become a thing of the past and have been replaced by new-generation drugs, which make up the 3 main groups of diabetes drugs produced by the pharmaceutical industry.
The endocrinologist decides which medicine is suitable for this or that patient.And so that patients do not self-medicate and do not decide to use these drugs for diabetes at their own discretion, we will give some illustrative examples.
Sulphonylurea derivatives
Currently, second-generation sulfonylurea derivatives have been described, which act from 10 hours to 24 hours.Patients usually take them 2 times a day, half an hour before meals.
These drugs are absolutely contraindicated in the following cases:
- Type 1 diabetes mellitus;
- Diabetic, hyperosmolar, lactic acidotic coma;
- Pregnancy, childbirth, lactation;
- Diabetic nephropathy associated with impaired filtration;
- Diseases of the hematopoietic system with a simultaneous decrease in white blood cells - leukocytes (leukocytopenia) and the platelet component of hematopoiesis (thrombocytopenia);
- Severe infectious and inflammatory lesions of the liver (hepatitis);
- Diabetes complicated by vascular pathology.
In addition, the use of drugs in this group can threaten the development of allergic reactions, manifested by:
- Itching of the skin and urticaria, sometimes reaching Quincke's edema;
- Disorders of the digestive system;
- Changes in the blood (decrease in the levels of platelets and leukocytes);
- Possible damage to the functional abilities of the liver (jaundice due to cholestasis).
Antihyperglycemic agents of the biguanide family
Biguanides (guanidine derivatives) are actively used for the treatment of type 2 diabetes mellitus, often adding sulfonamides to them.They are very rational to use by obese patients, however, for people with liver, kidney and cardiovascular pathologies, their use is very limited, switching to milder drugs of the same group or α-glucoside inhibitors, which inhibit the absorption of carbohydrates in the small intestine.
The following are considered absolute contraindications for the use of biguanides:
- IDDM (type 1 diabetes mellitus);
- Significant weight loss;
- Infectious processes, regardless of location;
- Surgical interventions;
- Pregnancy, childbirth, breastfeeding;
- Comatose states;
- Hepatic and renal pathology;
- oxygen starvation;
- Microangiopathy (2-4 degree) with impairment of vision and kidney function;
- Trophic ulcers and necrotic processes;
- Poor circulation in the lower extremities due to various vascular pathologies.
Insulin treatment
From the above, it becomes clear thatInsulin is the primary treatment for type 1 diabetes, all medical emergencies and severe complications of diabetes.NIDDM requires the appointment of this therapy only in cases of forms that require insulin, when correction by other means does not give the desired effect.
Modern insulins, called monocompetent, represent two groups:
- Monocompetent pharmacological forms of the substance of human insulin (semi-synthetic or recombinant DNA), which obviously have a significant advantage over drugs of pig origin.They practically have no contraindications or side effects;
- Monocompetent insulins obtained from porcine pancreas.These drugs, compared to human insulins, require an increase in the dose of the drug by approximately 15%.
Diabetes is dangerous because of complications
Due to the fact that diabetes is associated with damage to many organs and tissues, its manifestations can be found in almost all body systems.Complications of diabetes mellitus are:
- Pathological changes in the skin: diabetic dermopathy, necrobiosis lipoidica, furunculosis, xanthomatosis, fungal skin infections;
- Osteoarticular diseases:
- Diabetic osteoarthropathy (Charcot joint - change in the ankle joint), which occurs against the background of impaired microcirculation and trophic disorders, accompanied by dislocations, subluxations, spontaneous fractures that precede the formationdiabetic foot;
- Diabetic charopathy, characterized by stiffness in the joints of the hands, which often develops in children with diabetes;
- Respiratory diseases: long-termprolonged bronchitis, pneumonia,increased incidence of tuberculosis;
- Pathological processes affecting the digestive organs:diabetic enteropathy, accompanied by increased peristalsis, diarrhea (up to 30 times a day), loss of body weight;
- Diabetic retinopathy- one of the most serious complications, characterized by damage to the organs of vision;
- It is considered the most common complication of diabetes mellitusdiabetic neuropathyand its variety -polyneuropathy, reaching 90% of all forms of this pathology.Diabetic polyneuropathy is a common conditiondiabetic foot syndrome;
- A pathological condition of the cardiovascular system, which in most cases is the cause of death from diabetes mellitus.Hypercholesterolemia and vascular atherosclerosis, which in diabetes begin to develop at a young age, inevitably lead to diseases of the heart and blood vessels (coronary artery disease, myocardial infarction, heart failure, cerebrovascular accident).
Preventing
Measures to prevent diabetes mellitus are based on the causes that cause it.In this case, it is advisable to talk about the prevention of atherosclerosis and arterial hypertension, including the fight against excess weight, bad habits and food addictions.
Prevention of complications of diabetes mellitus includes prevention of the development of pathological conditions arising from diabetes itself.Correcting the glucose in the blood serum, following a diet, adequate physical activity and following the doctor's recommendations will help to delay the consequences of this very scary disease.