Clinic and diagnosis of diabetes.

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

Diabetes mellitus was described by the ancient Egyptians approximately fifteen hundred 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 shone if the urine tasted sweet when tested. In Chinese medicine, to diagnose this insidious disease, insects were used: flies, wasps, which, in the presence of sugar in the urine, settled in 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 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 of 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 treatment approaches. 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's called the first type.
2. Insulin-dependent diabetes occurs most often in adulthood and is characterized by a relative lack of insulin. Type 2 diabetes usually occurs in older people, but there are cases in which the pathology also affects young people. It is much more common than the first type, and one of the factors that cause the pathology is being overweight.
3. Symptomatic. This type of disease can occur against the background of other pathological processes, which is why 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 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, that 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 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 provokes the production of its own antibodies aimed at fighting the beta cells of the islets of Langerhans. This leads to its destruction.

The main factors that provoke the 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 and mumps. There is a genetic predisposition to pathology.

It should be borne in mind that a substance such as selenium increases the probability of a second type of pathology. But this is far from being the most important factor in the development of the process. These include the same hereditary predisposition and the presence of excess weight. These factors need to be considered in more detail.

1. The higher the degree of obesity, the greater 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, can be the result of metabolic disorders, that is, prediabetes.
2. Hereditary predisposition suggests an increased risk of diabetes several times with this pathology in blood relatives. It does not matter if the older or younger relative has the disease. Sometimes there is a tendency for the disease to be passed from generation to generation, but this is just a coincidence.

It should be borne in mind that if diabetes mellitus is detected, the clinic will develop very slowly and gradually, which complicates timely diagnosis.

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 in the context 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 several 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 was unable to process remains in the bloodstream and only a small part 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 for energy. This leads to increased formation of nitrogenous waste - ketone bodies, which disrupt 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 unbearable 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;
• itchy skin and genitals;
• wound surfaces heal for a long time;
• in type 1 diabetes, patients lose a lot of weight, and in type 2 diabetes, on the contrary, patients gain it 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 undulating (the state normal alternates with the clinical picture of diabetes).

disease complications

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 such conditions.

1. Serious 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 as dry skin, severe pain, and leg cramps, decreases sensitivity to pain.
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 can develop with high or low blood sugar levels. It is noted that the state of hypoglycemia (low blood sugar) is much more difficult to treat than hyperglycemia (high blood sugar).

Sometimes with type 1 diabetes there is a deterioration in well-being, which is accompanied by general weakness. It 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 eliminated from the blood as quickly as possible. If this does not happen, a ketoacidotic coma develops.

Perhaps a coma with an inadequate dosage of insulin, when an excessive amount is administered. To prevent the development of any type of diabetic coma, you need to constantly monitor blood sugar levels and properly select insulin doses.

Diagnosis

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

1. Analysis of the glycemic profile.
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, in healthy people, never exceeds the norm.
5. Determination of C-peptide, which decreases in the first type of pathology. In the second type, you can stay within the normal range.

Treatment

To treat the process, patients need:

1. Follow dietary recommendations. They mean limiting foods that contain 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 using a syringe or special syringe pens. Sometimes patients have an insulin pump installed. To date, the development of an artificial pancreas is underway, which in turn can measure sugar and inject the correct amount of insulin.
3. The second type of the disease involves taking medication to reduce sugar tablets.
4. Special physiotherapy exercises are prescribed, since physical activity helps normalize blood glucose and helps fight obesity.

Keep in mind that this disease is treated for life. The higher the level of self-control in a patient, the less life-threatening complications the patient will develop and the progression of it will slow down markedly.