Diabetes (diabetes mellitus, DS) 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 methods of treatment.
Types of diabetes mellitus (classification)
Classification of diabetes mellitus by cause:
Diabetes type 1- characterized by an absolute deficiency of insulin in the blood:
- Autoimmune: Antibodies attack pancreatic β cells, destroying 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 within the normal range, but the number of hormone receptors 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 pregnancy.
Other (situational) causes of diabetes- glucose intolerance 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 disease;
- adrenal adenoma;
- Grave's disease.
Classification of diabetes by severity:
light shape- characterized by hyperglycemia of not more than 8 mmol / l, slight daily fluctuations in sugar levels, the absence of glycosuria (sugar in the urine). It does not require pharmacological correction with insulin.
Very often, at this stage, the clinical manifestations of the disease may be absent, however, during instrumental diagnosis, the initial forms of typical complications with damage to peripheral nerves, retinal microvessels, kidneys and heart are already detected.
moderate severity- glucose level in peripheral blood reaches 14 mmol/l, glycosuria appears (up to 40 g/l), an entryketoacidosis- a strong increase in ketone bodies (metabolites from the breakdown of fats).
Ketone bodies are formed due to the energy starvation of cells. Almost all glucose circulates in the blood and does not enter the cell, and it begins to use fat stores to produce ATP. At this stage, the glucose level is controlled with the help of diet therapy, the use of oral hypoglycemic drugs.
Clinically it is manifested by impaired functioning of the kidneys, cardiovascular system, vision, neurological symptoms.
severe course- the level of sugar in the blood exceeds 14 mmol / l, with fluctuations up to 20-30 mmol, glycosuria greater than 50 mmol / l. Complete dependence on insulin therapy, severe 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 an incurable chronic 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%";
Undercompensation- the treatment does not completely correct the blood counts and the clinical manifestations of the disease. Blood glucose 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). No acetone is detected in the urine, 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 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 coma. The glucose level cannot be corrected with the help of pharmaceuticals. drugs (more than 14 mmol / l). High numbers of sugar in the urine (more than 50 g/l), acetone. Glycosylated hemoglobin significantly exceeds the norm, hypoxia occurs. With a prolonged 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 causes diabetes in all people with this pathology.
The most important causes for the development of the disease:
Type I diabetes mellitus:
Genetic causes of diabetes:
- congenital insufficiency of the β cells of the pancreas;
- hereditary mutations in the genes responsible for the synthesis of insulin;
- genetic predisposition to autoaggression of β-cell immunity (closest relatives are diabetics);
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, which causes diabetes mellitus.
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 in itself does not cause the disease, but significantly increases the chances of its development, if there is a genetic predisposition.
- physical inactivity (passive lifestyle);
- obesity;
- of smoking;
- excessive alcohol consumption;
- the use of substances that affect the pancreas (for example, drugs);
- excess fat and simple carbohydrates in the diet.
Diabetes symptoms
Diabetes is a chronic disease, so symptoms never appear suddenly. The symptoms in women and the 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;
- Dry and itchy skin- due to constant loss of fluid in the urine;
- Dizziness, headaches- signs of diabetic 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 lack of 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;
- decreased vision- cause - damage to microscopic retinal vessels;
- polydipsia- constant thirst due to frequent urination;
- Numbness of the extremities- 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 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.
Diagnosis of diabetes
Diagnosis of diabetes in most cases 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 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 these symptoms are detected, a series of tests are carried out to confirm/disprove the diagnosis and 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 to glucose and maintain normal levels in the blood.
The essence of the method:in the morning, in the context of an 8-hour fast, blood is drawn to assess the fasting glucose level. After 5 minutes, the doctor gives the patient 75 g of glucose dissolved in 250 ml of water to drink. After 2 hours, blood is drawn again and the sugar level is determined again.
During this period, the initial symptoms of diabetes usually appear.
Criteria for evaluating the OGTT analysis:
| Rule | |
| on an empty stomach | < 5. 6 |
| 2 hours after OGTT | < 7. 8 |
| Diabetes mellitus (requires differential diagnosis by 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)
Glycosylated Hemoglobin or HbA1c- this is the hemoglobin of erythrocytes, which is transformed 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 C-peptide level
C-peptideIt is a fragment of the proinsulin molecule. When C-peptide is cleaved, insulin becomes functionally active. The concentration of this substance in the blood allows you to assess the secretion of insulin in the pancreas.
Norm: 0. 79-1. 90 ng/ml (SI: 0. 27-0. 64 mmol/l).
Proinsulin level determination
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 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 performed in risk groups (people with a predisposition to diabetes, for example, if relatives have this disease), as well as in patients with glucose intolerance 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 - Title: 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
Other specific immunological assay. 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 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 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 of AT GAD in risk groups is recommended for the diagnosis of prediabetes and the prescription of a preventive diet and pharmacological therapy.
Norm AT GAD - 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 very 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 tumor of the pancreas (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 - the replacement of functionally active cells with connective tissue).
Also, the pancreas may 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 increased blood cholesterol and atherosclerosis, leading to decreased tissue perfusion.
The essence of the method is the introduction of a special contrast agent into the bloodstream with simultaneous monitoring of vascular permeability on a computed tomography.
If the blood supply is significantly reduced at the level of the legs of the lower extremities, the so-called "diabetic foot" is formed. The diagnosis of diabetes mellitus is based on this method of investigation.
Ultrasound of the kidneys and ECHO KG of the heart
Methods of instrumental examination of the kidneys, which allow 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 therefore a deterioration in functional capabilities. The method allows to prevent complications of diabetes mellitus.
Retinography or angiography of retinal vessels
The microscopic vessels of the retina are the most sensitive to hyperglycemia, so the development of damage to 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. Likewise, the most important sign of DM will be the presence of microerosions and ulcers in the fundus.
The 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're at risk, be sure to see your doctor for more information on what diabetes is and what to do about it.
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 treatment methods.
Methods that are used in the treatment of diabetes:
- Drug therapy (insulin therapy);
- Diet;
- Regular physical activity;
- Preventive measures to avoid the progression of the disease and the development of complications;
- The psychological support.
Treatment of type 1 diabetes
Pharmacological correction with insulin
The need for insulin injections in patients with diabetes, their 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, carry out differential diagnosis, screening and evaluation of the effectiveness of drugs.
Types of insulin:
- fast acting(ultra-short-acting): Starts working 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 rigorously 10-15 minutes before eating;
- average 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 excess of normal values;
- combined insulin- Contains ultra-short-acting and long-acting insulins in various proportions. It is mainly used in the intensive care of type 1 diabetes.
Diet therapy for diabetes.
Diet: 50% success in controlling the level of blood glucose 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);
- Of the drinks, it is better to choose weak tea, fruit decoctions.
What should be ruled out:
- Sweets, pasta, flour;
- concentrated juices;
- fatty meats and dairy products;
- Spicy and smoked foods;
- Alcohol.
Treatment of type 2 diabetes
In the initial stages, type 2 diabetes mellitus is well treated with dietary therapy, as is type 1 diabetes. If the diet is not followed, as well as with a prolonged course of the disease, drug therapy with drugs is used. hypoglycemic. 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.
- It works in the intestine, inhibiting the activity of enzymes in the small intestine 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, to one degree or another correcting the glycemic level.
- kryphea amur- prepared extract of moss. 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 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. Take 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.
Physical exercise in diabetes.
Regular physical activity in diabetes mellitus is a very important aspect in the treatment and prevention of diabetes mellitus complications. Morning exercises, running, swimming help to avoid obesity, improve blood supply to muscles and organs, strengthen blood vessels, stabilize the nervous system.
disease prevention
With a genetic predisposition, the disease cannot be prevented. However, people who are at risk should take a number of steps to control blood glucose and the rate of development of diabetic complications.
- Children with unfavorable heredity (parents, grandparents suffering from diabetes) should be tested for blood sugar 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 diabetes complications.
- People over the age of 40 need to check their blood glucose levels annually to prevent type 2 diabetes;
- All diabetics need to use special devices to monitor 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 you need a long conversation with the doctor, he will consult directly. pass the necessary tests and prescribe treatment.
recovery forecast
Diabetes mellitus is an incurable disease, so the prognosis for recovery is poor. However, modern advances in insulin drug therapy can significantly prolong the life of a diabetic, and regular diagnosis of typical organ system disorders leads to an improvement in the patient's quality of life.