diabetes mellitus (Diabetes mellitus, SD) is a chronic metabolic disease, manifested 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 andWater.
Next you will find out: what is diabetes mellitus, 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 lack of insulin in the blood:
- Autoimmune antibodies attack and completely destroy pancreatic β-cells;
- Idiopathic (no known cause);
Type 2 diabetes- relative lack of insulin in the blood. This means that the quantitative indicator of insulin levels remains within 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 a woman's pregnancy.
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;
contagious;
genetic defects in the insulin molecule or its receptors;
associated with other endocrine pathologies:
- Itsenko-Cushing's disease;
- adrenal adenoma;
- Basedow's disease.
Classification of diabetes according to severity:
Light shape- characterized by hyperglycemia not exceeding 8 mmol / l, slight daily fluctuations in sugar levels, the absence of glucosuria (sugar in the urine). Does not require pharmacological correction with insulin.
Very often at this stage the clinical manifestations of the disease can be absent, however, during instrumental diagnostics, the first forms of typical complications with damage to peripheral nerves, retinal microvessels, kidneys and heart are already detected.
Medium severity- The level of glucose in the peripheral blood reaches 14 mmol / l, glucosuria appears (up to 40 g / l), an incomingketoacidosis- a sharp increase in ketone bodies (metabolites of fat breakdown).
Ketone bodies are formed due to a lack of energy in the cells. Almost all of the glucose circulates in the blood and doesn't get into the cell, and it begins to use fat stores to produce ATP. At this stage, the level of glucose is controlled with the help of diet therapy, the use of oral hypoglycemic drugs.
Clinically manifested by functional disorders of the kidneys, cardiovascular system, vision, neurological symptoms.
Difficult course- Blood sugar exceeds 14 mmol / l, with fluctuations up to 20-30 mmol, glycosuria above 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 a chronic incurable disease. The disease has 3 phases:
compensation- Diet or insulin therapy allows you to achieve normal blood sugar 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. Glycated hemoglobin does not exceed "5%";
undercompensation- The treatment does not fully correct the blood count and clinical manifestations of the disease. Blood sugar is not higher than 14 mmol / l. Sugar molecules damage erythrocytes, and glycated hemoglobin appears, damage to the microvessels in the kidneys is manifested 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, slight manifestations of ketoacidosis are possible;
decompensation- the most severe phase of diabetics. In the later stages of the disease, there is usually total damage to the pancreas and the insulin receptors. It is characterized by a severe general condition of the patient up to and including coma. Glucose levels cannot be corrected with the help of drugs. Medicines (above 14 mmol / l). High level of sugar in the urine (over 50 g/l), acetone. Glycated hemoglobin significantly exceeds the norm, hypoxia occurs. If prolonged, 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 would cause diabetes in all people with this pathology.
The main causes of the development of the disease:
Type I diabetes mellitus:
Genetic causes of diabetes:
- congenital insufficiency of pancreatic β-cells;
- hereditary mutations in the genes responsible for insulin synthesis;
- genetic predisposition to autoaggression of immunity to β-cells (closest relatives are diabetics);
Infectious causes of diabetes mellitus are pancreatotropic (affecting the pancreas) viruses: rubella, herpes type 4, mumps, hepatitis A, B, C. Human immunity along with these viruses begins to destroy pancreatic cells, 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 intake of fiber and high intake of refined fats and simple carbohydrates;
- hypertonic disease;
- atherosclerosis.
provoking factors
This group of factors is not in itself causative of the disease, but in the presence of a genetic predisposition significantly increases the likelihood of its development.
- physical inactivity (passive lifestyle);
- Obesity;
- Smoking;
- 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 come on suddenly. The symptoms in women and men are almost the same. With the disease, manifestations of the following clinical signs are possible to varying degrees.
- Constant weakness, decreased efficiency- develops as a result of a chronic lack of energy of brain cells and skeletal muscles;
- dryness and itching of the skin- due to constant loss of fluid in the urine;
- dizziness, headache- Signs of diabetes - 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 wounds on the skin)- the activity of T-cell immunity is impaired, the skin performs a poorer barrier function;
- polyphagia- a constant feeling of hunger - this condition arises due to the rapid loss of glucose in the urine and its insufficient transport into the cells;
- Decreased eyesight- cause - damage to microscopic retinal vessels;
- polydipsia- constant thirst from frequent urination;
- numbness of the limbs- persistent hyperglycemia leads to specific polyneuropathy - damage to sensory nerves throughout the body;
- pain in the region of the heart- Narrowing of the coronary arteries due to atherosclerosis leads to a decrease in myocardial blood supply and spastic pain;
- Decreased sexual function- is directly related to poor blood flow to the organs that produce sex hormones.
diagnosis of diabetes
The diagnosis of diabetes most often does not cause any difficulties for a qualified specialist. The doctor may suspect the disease based on the following factors:
- A diabetic complains of polyuria (an increase in the 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.
When this symptomatology is detected, a series of tests are performed 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 glucose and maintain normal blood levels.
The essence of the method:In the morning, against the background of an 8-hour fast, blood is taken to determine the level of fasting glucose. After 5 minutes, the doctor gives the patient 75 g of glucose dissolved in 250 ml of water to drink. Blood is taken again after 2 hours and the sugar level is determined again.
During this time, the first symptoms of diabetes usually appear.
Criteria for evaluating the OGTT analysis:
| standard | |
| On an empty stomach | < 5th 6th |
| 2 hours after OGTT | < 7th 8th |
| Diabetes mellitus (differential diagnosis required for types of diabetes) | |
| On an empty stomach | ≥ 6. 1 |
| 2 hours after OGTT | ≥ 11. 1 |
| random definition | ≥ 11. 1 |
Determination of the content of glycosylated hemoglobin (C - HbA1c)
Glycated hemoglobin or HbA1c- This is the hemoglobin of erythrocytes, which is transformed by contact with glucose. Its concentration in the blood is directly related to the level of glucose, which makes it possible to assess the compensation of the condition of a diabetic.
The norm is up to 6%.
- Doubtful result - 6-6, 4%;
- With diabetes mellitus - more than 6. 4%.
Determination of C-peptide content
C-peptideis a fragment of the proinsulin molecule. When the 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).
Determination of the proinsulin level
This test allows you to distinguish 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). High concentrations of proinsulin molecules can also indicate type 2 diabetes.
The norm is 3. 3-28 pmol / l.
Determination of the level of antibodies against beta cells of the pancreas
One of the most accurate tests to determine the presence and causes of diabetes. The test is performed in risk groups (e. g. people with a predisposition to diabetes, if the immediate family has 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 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 - titer: 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 levels
Another specific immunological assay. It is performed for differential diagnosis in patients with diabetes (type 1 diabetes and type 2 diabetes). If the glucose tolerance is disturbed, blood is taken and a serological test is carried out. 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 level of antibodies against GAD and the development of type 1 diabetes is not yet clear, but these antibodies are detected in the blood in 80-90% of patients. Analysis for AT GAD is recommended in risk groups for diagnosing prediabetes and prescribing 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 elevated blood sugar indicates the development of type 2 diabetes.
Insulin test in the blood
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 into body 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 method of ultrasound examination allows you to detect morphological changes in the tissues of the gland.
As a rule, with diabetes mellitus, diffuse damage is noted (areas of sclerosis - the replacement of functionally active cells with connective tissue).
The pancreas can also be enlarged and show signs of edema.
Angiography of the vessels of the lower extremities
The arteries of the lower extremities are the target organ in diabetes mellitus. Persistent hyperglycemia causes an increase in blood cholesterol and atherosclerosis, leading to a decrease in tissue perfusion.
The core of the method is the introduction of a special contrast medium into the bloodstream while at the same time checking the vascular patency on a computer tomograph.
If there is a significant reduction in blood flow at the level of the legs of the lower extremities, the so-called "diabetic foot" develops. 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 assessing 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, as a result, a deterioration in their ability to function. The method allows to prevent complications of diabetes mellitus.
Retinography or angiography of the retinal vessels
Microscopic vessels of the retina are 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 medium, the degree of narrowing or complete occlusion of the vessels is determined. Also, the most important 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, an objective examination by a specialist, laboratory tests and instrumental studies. With only one diagnostic criterion, it is impossible to make a 100% correct diagnosis.
If you are at risk, be sure to consult 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 aimed at correcting the level of blood sugar, cholesterol, ketone bodies, acetone and lactic acid, preventing the rapid development of complications and improving the quality of human life.
In diabetes, a very important aspect is the use of all treatment methods.
Methods used in the treatment of diabetes:
- Pharmacological therapy (insulin therapy);
- Diet;
- Regular physical activity;
- Preventive measures to prevent the progression of the disease and the development of complications;
- psychological support.
Type 1 Diabetes Treatment
Pharmacological correction with insulin
The need for insulin injections in patients with diabetes, their method and frequency of administration are strictly individual and are selected by specialists (therapists, endocrinologists, cardiologists, neuropathologists, hepatologists, diabetologists). They always pay attention to the symptoms of diabetes, conduct differential diagnosis, screening and assessment of the effectiveness of drugs.
Types of Insulin:
- quick reaction(ultra short-term effect) - begins to act immediately after administration and takes effect within 3-4 hours. Used before or immediately after a meal;
- short action- works 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 the injection. Helps prevent complications from diabetes;
- Long-acting insulin- requires constant daily use. Valid from 18 to 24 hours. It is not used to lower blood sugar levels, but only controls its daily concentration and does not allow it to exceed normal values;
- Combined insulin- contains ultra-short-acting and long-acting insulins in various proportions. It is mainly used in intensive care medicine for type 1 diabetes.
Nutritional therapy in diabetes
Diet - 50% success in controlling blood sugar levels in a patient with diabetes mellitus.
Which foods should be consumed?
- Fruits and vegetables with low sugar content and high concentrations of vitamins and minerals (apples, carrots, cabbage, beets);
- meat with a low content of animal fat (beef, turkey, quail);
- Grains and cereals (buckwheat, wheat, rice, barley, barley);
- fish (preferably sea);
- From drinks it is better to choose weak tea and fruit decoctions.
What should be discarded:
- candy, pasta, flour;
- concentrated juices;
- Fatty meat and dairy products;
- Spicy and smoked foods;
- Alcohol.
Type 2 Diabetes Treatment
In the early stages, type 2 diabetes mellitus can be treated well with diet therapy, as can type 1 diabetes mellitus. If the diet is not adhered to and if the disease progresses for a long time, pharmacological therapy with blood sugar-lowering 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 gut, inhibits the activity of small intestinal 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 to correct blood sugar levels to a certain extent.
- crypt amur- ready extract from 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 zest + garlic- these products contain a large amount of vitamins C, E, A, selenium and other trace elements. All of this needs to be crushed, mixed and infused for about 2 weeks. Use orally 1 teaspoon before meals.
- oak acorns- contain tannin, a very effective antidiabetic agent. This substance stimulates the immune system, has anti-inflammatory and anti-edematous effects, strengthens the wall of blood vessels, relieves pronounced types. Acorns must be ground into powder and taken 1 teaspoon before each meal.
Physical activity in diabetes
Regular physical activity in diabetes mellitus is a very important aspect in the treatment and prevention of complications of diabetes mellitus. Morning exercises, running, swimming will help to avoid excess weight, improve blood circulation in muscles and organs, strengthen blood vessels and stabilize the nervous system.
disease prevention
The disease cannot be prevented with a genetic predisposition. However, people at risk need to take a number of measures to control blood sugar levels and the rate of development of diabetes complications.
- Children with unfavorable heredity (parents, grandparents have diabetes) should be tested for blood glucose levels once a year, as well as monitor their condition and the appearance of the first symptoms of the disease. Also, an important measure is annual consultations with an ophthalmologist, neuropathologist, endocrinologist and cardiologist to determine the first symptoms of diabetes and prevent complications from diabetes.
- People over 40 need to have their blood sugar checked annually to prevent type 2 diabetes;
- All diabetics need to use special devices for monitoring blood sugar levels - blood glucose meters.
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 specific to you, for this you need a long conversation with the doctor, he will directly advise you on the necessary testspass and prescribe treatment.
Recovery Forecast
Diabetes mellitus is an incurable disease, so the prognosis for recovery is poor. However, modern advances in pharmacological insulin therapy can significantly prolong the life of a diabetic and the regular diagnosis of typical diseases of the organ systems leads to an improvement in the patient's quality of life.