Clinic and diagnosis of diabetes

Diagnosing diabetes mellitus begins with identifying the main signs - symptoms. Despite the similarity of the clinical manifestations of the disease, each type of diabetes has its own specifics.

Diabetes mellitus was described as a distinct nosological entity by the ancient Egyptians about a thousand and a half years ago. Then the diagnosis was made by various methods that are no longer used today due to their irrelevance. For example, Hippocrates told his patients that they had diabetes mellitus, the clinic of which was bright when 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 on the container into which the urine was placed.

classification

Diabetes itself is a pathology of the endocrine system. The sugar concentration in the blood rises constantly for various reasons. This is usually an insulin deficiency, which can be absolute or relative. This hormone is produced in the beta cells 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 severe complications of the cardiovascular and nervous systems on a larger scale, and the remaining functional units of the body suffer a little less.

To date, there are several types of diseases that have completely different approaches to treatment. Regardless of what diabetes mellitus is, the clinic of this disease is almost always the same.

The most common classification in the literature is:

1. Diabetes mellitus with absolute insulin deficiency is most common at a young age and in children. It is called the first type.
2. Insulin-dependent diabetes occurs more frequently in adulthood and is characterized by a relative lack of insulin. Type 2 diabetes usually occurs in older people, but there are cases when the pathology 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, so it is also called secondary.
4. Gestational diabetes that occurs during pregnancy. It often goes away on its own after birth.
5. With malnutrition, such a pathology as diabetes mellitus can also develop.

It should once again be noted that the first and second types of pathology differ in the development of absolute and relative insulin deficiency, respectively. Therefore, it is the first type of disease that requires constant external administration of insulin. And when the exhaustion of the pancreas is reached, especially with a long course of type 2 diabetes, such a need also arises.

In itself, the second type of disease can be characterized by sufficient insulin production, but the body's cells are insensitive to it for various reasons: the organelles responsible for this process can be blocked or their number is not enough for effective communication. As a result, the cells develop a lack of sugar, 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 insulin insufficiency leading 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 to fight the beta cells of the islets of Langerhans. This leads to their destruction.

Often the main provoking factors for the disruption of the immune system with the subsequent production of antibodies are various viral infections, the most aggressive of which can be rubella, chickenpox and mumps. There is a genetic predisposition to pathology.

It should be borne in mind that a substance like selenium increases the likelihood of a second type of pathology. However, this is far from the most important factor in the development of the process. These include the same hereditary predisposition and the presence of overweight. These factors should be looked at more closely.

1. The higher the degree of obesity, the higher the risk of diabetes, while in the third degree it increases 10 times. Abdominal obesity, ie when there are fat deposits in the abdomen, can be the result of metabolic disorders, ie prediabetes.
2. Hereditary predisposition indicates a several-fold increase in the risk of diabetes with this pathology in blood relatives. It does not matter whether the older or the younger relative suffers from the disease. Sometimes there is a trend that the disease is passed from generation to generation, but this is just a coincidence.

It should be noted that when diabetes mellitus is detected, the clinic develops very slowly and gradually, which makes it difficult to diagnose in a timely manner.

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 by resection.
2. Other hormonal pathologies - diseases of the thyroid gland, adrenal glands, pituitary gland.
3. Toxic effects of drugs and other chemical agents.
4. Change in insulin sensitivity against the background of a pathological process.
5. The patient has a genetic disease.

Gestational diabetes and diabetes due to malnutrition are slightly different as they can be reversible processes.

What is happening in the body

For one or more of the above reasons, a process takes place in the body in which excess sugar is no longer stored in the form of glycogen in the muscle tissue and liver. The sugar that the body couldn't process remains in the bloodstream, and only a small portion of it is excreted through the kidneys. This has an extremely negative effect on absolutely all organs and systems of the body.

Since glucose does not get into the cells, they actively begin to break down fats for energy. This leads to an increased formation of nitrogenous residues - ketone bodies that 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 at 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 very long time;
• With type 1 diabetes, patients lose a lot of weight, while with type 2 diabetes, patients gain weight quickly.

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 changes with the clinical picture of diabetes). ).

complications of the disease

Both types of pathologies are characterized by the development of complications that usually develop in a person in old age. Diabetes also contributes to the earlier 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 itself in the form of dry skin, severe pain and cramps in the legs, reduces sensitivity to pain.
4. Reduced view.
5. Damage to the kidneys with dysfunction and increase in protein excretion.
6. Ulcerative defects develop on the feet, which eventually lead 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. Comatose states with high or low sugar levels can develop due to poor glycemic control. It is noted that the condition of 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 that is accompanied by general weakness. It can be accompanied by abdominal pain and vomiting, and there is a smell of acetone in 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 ketoacidotic coma develops.

Perhaps a coma from improper insulin dosing if an excessive amount is administered. To prevent the development of any type of diabetic coma, you should constantly monitor blood sugar levels and choose insulin doses appropriately.

diagnosis

Patients diagnosed with diabetes are under the control of an endocrinologist. Diagnosis of pathology includes the following tests:

1. Analysis of the glycemic profile.
2. glucose tolerance test.
3. Urine analysis for the presence of sugar and acetone, there are special test strips for this.
4. A blood test for glycated hemoglobin, in healthy people it never exceeds the norm.
5. Determination of the C-peptide that 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. Follow diet recommendations. They mean limiting foods that contain fast carbohydrates. Diet should be reviewed, preferably five meals a day.
2. Patients with the first type or with secondary insulin-dependent diabetes are prescribed insulin therapy. It is injected subcutaneously using a syringe or special syringe pens. Sometimes patients have an insulin pump installed. To this day, work is being done on the development of an artificial pancreas that can measure sugar itself and inject the right amount of insulin.
3. In the second type of the disease, sugar-lowering drugs are taken in tablet form.
4. Special physiotherapeutic exercises are prescribed, since physical activity helps normalize blood sugar levels and fight obesity.

It must be borne in mind that this disease is treated for life. The higher a patient's self-control, the fewer life-threatening complications develop in the patient and their progression is markedly slowed down.