Description of type 2 diabetes mellitus: signs and prevention. Treatment of diabetes mellitus of various types: means and methods of type 2 diabetes mellitus

Development type 2 diabetes can go two ways.

The first way is when the perception of insulin by tissue cells is disrupted, and it is no longer suitable as a “key” that opens the entrance to glucose for cells, where it is processed or stored in reserve (for example, in the form of glycogen in liver cells). This disorder is called insulin resistance.
The second option is when insulin itself loses its ability to perform its actions. That is, glucose cannot enter the cells, not because the cell receptors do not perceive insulin, but because the insulin itself produced is no longer the “key” to the cells.

Type 2 diabetes symptoms

Type 2 diabetes often proceeds without visible manifestations, the person does not even know that he is sick.
Some symptoms may appear for a while and go away again.
Therefore, you need to carefully listen to your body.

Overweight and obese people should regularly donate blood for sugar.

Increased sugar is accompanied by thirst, and, as a result, frequent urination.
Severe dryness of the skin, itching, non-healing wounds may appear.
There is general weakness, fatigue.
Blood sugar levels should also be monitored by people over 40 years of age.

Forms of severity of type 2 diabetes

There are three forms according to severity:

mild form - when diet and exercise or a minimum amount of sugar-lowering drugs is sufficient to achieve compensation;
medium form - to maintain normoglycemia, several tablets of sugar-lowering drugs are required;
severe form - when sugar-lowering drugs do not give the desired result and insulin therapy is connected to the treatment.

Treatment of type 2 diabetes mellitus: sugar-lowering drugs and insulin therapy

Treatment of type 2 diabetes includes several components - sports / physical education, diet therapy, and insulin therapy.

You can not neglect physical activity and diet. Since they help a person to lose weight and, thereby, reduce insulin resistance of cells (one of the causes of diabetes), and thus normalize blood sugar levels.
Of course, not everyone can refuse drugs, but without weight loss, no type of treatment will give good results.
But still, the basis of treatment is sugar-lowering drugs.

According to the mechanism of action, all sugar-lowering drugs are divided into several groups. Check them out below.

- The first group includes two types of drugs - Thiazolidinediones and Biguanides. The drugs of this group increase the sensitivity of cells to insulin, that is, reduce insulin resistance.
In addition, these drugs reduce the absorption of glucose by intestinal cells.

Medicines related to Thiazolidinedionam (Rosiglitazone and pioglitazone), to a greater extent restore the mechanism of action of insulin.

Medicines related to biguanides ( Metformin (Siofor, Avandamet, Bagomet, Glucofage, Metfogamma)), to a greater extent change the absorption of glucose by intestinal cells.
These drugs are often given to overweight people to help them lose weight.

- The second group of sugar-lowering drugs also consists of two types of drugs - Derivatives sulfonylurea and meglitinides.
The drugs of this group stimulate the production of their own insulin by acting on the beta cells of the pancreas.
They also reduce glucose stores in the liver.

Preparations of the group Sulfonylureas ( Maninil , Diabeton , Amaryl , Glurenorm , Glibinez-retard) in addition to the above effects on the body, they also affect insulin itself, thereby increasing its effectiveness.

Meglitinides (Repaglinide) Starlix)) enhance the synthesis of inulin by the pancreas, and also reduce postprandial peaks (increased sugar after eating).
Perhaps a combination of these drugs with Metformin.

- The third group of hypoglycemic drugs includes acarbose (Glukobay). This drug reduces the absorption of glucose by intestinal cells due to the fact that, by binding to enzymes that break down carbohydrates from food, it blocks them. And unsplit carbohydrates cannot be absorbed by cells. And this results in weight loss.

When the use of sugar-lowering drugs does not lead to compensation, it is prescribed insulin therapy.
There are different ways to use insulin. It is possible to use only long-acting insulin in combination with sugar-lowering drugs. Or, with the ineffectiveness of drugs, short-acting and extended-acting insulins are used.

The use of insulin can be permanent, or it can be temporary - with severe decompensation, during pregnancy, during surgery or serious illness.

Nutrition for type 2 diabetes

Diet is one of the key points in the treatment of type 2 diabetes and it is aimed at reducing excess weight and maintaining a normal body weight.

The basis of the diet is the rejection of fast or refined carbohydrates, such as sugar, sweets, jam, many fruits, dried fruits, honey, fruit juices, muffins.

A particularly strict diet at the beginning, when you need to lose weight, then the diet can be somewhat expanded, but fast carbohydrates for the most part are still excluded.

But remember that you should always have some foods containing fast carbohydrates on hand to stop hypoglycemia attacks.
Honey, juice, sugar are well suited for this.

Diet should not be a temporary phenomenon, but a way of life. There are many healthy, tasty and easy-to-make dishes, and desserts are not excluded.
A large selection of calorie- and carbohydrate-calculated diet meals can be found on our partner Dia-Dieta website.

The basis of nutrition should be foods that contain a lot of fiber and slow carbohydrates that slowly raise sugar and do not give such pronounced postprandial hyperglycemia.

It is necessary to reduce the consumption of foods high in fat - meat, dairy products.

It is worth giving up fried foods, steam, boil or bake in the oven.

Food should be taken 5-6 times a day, but in small portions.

Compliance with such a diet will not only help to reduce weight, but also keep it at a normal level, which will have a beneficial effect on the general condition of the body.

Physical activity in type 2 diabetes

Physical exercise is of great importance, but the load should be appropriate for the age and health of the patient.
It is important not to overdo it with the intensity, the load should be smooth and regular.

Sports activities increase the sensitivity of cells to insulin and, as a result, there is a decrease in sugar.

If you have a long load, then before starting it is recommended to eat 10-15g of slow carbohydrates to prevent hypoglycemia. Bread, apple, kefir are suitable as a snack.
But if the sugar has dropped sharply, then you need to take fast carbohydrates in order to quickly raise the glucose level.

Any physical activity should be excluded with sugar above 12-13 mmol / l. With such high sugar, the load on the heart increases, and in combination with the load, this becomes doubly dangerous.
In addition, exercising with such sugar can lead to its further growth.

It is advisable to control the level of sugar before the load, during and after it, in order to avoid unwanted fluctuations.

396 Comments

Hello. Please help me figure out what's wrong with me. Before pregnancy, elevated blood sugar of 6.25 from a vein on an empty stomach was revealed (further, all tests were also from a vein). I passed the GG-4.8%, the glucose tolerance test after two hours was 4.6., Insulin was in the region of 8, i.e. type 1 diabetes definitely cannot be, tk. C-peptide was also normal.
During pregnancy, she had gestational diabetes mellitus and a very strict diet with sugar control using a glucometer and a sensor. After pregnancy, this winter I passed a glucose test of 7.2 in an hour and 4.16 in two hours, the homa index floats from 2.2 to 2.78, and fasting sugar is often in the laboratory in the region of 5.9-6.1, but literally 2 weeks ago I passed and it was already 6.83, but I ate sweets at night (ice cream and an apple), but 8 hours before the fence on an empty stomach definitely passed. The last GG of 4.8% was handed over a week before this high sugar indicator and then sugar also handed over 5.96. Endocrinologists prescribed me Metformin at first 500 and then 850 mg at night, but I did not see a decrease in fasting sugar.
I am on a diet almost all the time (I confess, sometimes I allow too much in the form of ice cream or one cookie) and almost always the sugar in two hours on a glucometer is not higher than 6, but more often 5.2-5.7. I can't understand why my fasting sugar is so high if I'm not fat, but I do have belly fat (67kg and height 173cm)
I am worried about bad symptoms in the form of hunger, severe hair loss, sweating, fatigue, and often dizzy when I eat carbohydrates, although sugar at these moments is absolutely normal (I checked it with a glucometer many times).
I took blood tests and I still have high LDL cholesterol-3.31 (at a rate of up to 2.59) and there is an increase in hemoglobin 158 (normal up to 150), erythrocytes-5.41 (up to 5.1 normal) and hematocrit-47, 60 (norm up to 46). The doctor says that this is nonsense and suggested drinking more fluids, and I'm worried that this may be due to sugar and hypothyroidism. I’m afraid that everything complicates my condition, because cholesterol affects the pancreas, and hypothyroidism and diabetes in general often go together, and then Euthirox is canceled for me, then they are returned.
Tell me, please, what tests should I still pass in order to understand whether my diabetes is starting or is it still a violation of fasting glycemia?

Julia, good afternoon.
Elevated hemoglobin, indeed, can be associated with a small amount of fluid you drink. How much do you drink per day? To be honest, I myself have the same situation, hemoglobin 153-156. I drink very little (less than a liter a day), it is difficult to force myself, although I know that I need more. So pay attention to this fact.
Cholesterol, of course, is above the norm, but not critical to somehow affect the state of health. There is no point in taking cholesterol-lowering drugs. If possible, review your diet - fatty meat, a lot of animal fats. Have you been tested for cholesterol before? Sometimes it happens that high cholesterol is a feature of the body, so it makes no sense to reduce it with drugs.
Fatigue, sweating, dizziness - have you been tested for thyroid function? The symptoms are very similar to a malfunction in the thyroid gland. It may be necessary to increase the dose of euthyrox.
You can check the heart, go to the cardiologist. Small increases in sugar may not cause such symptoms.
While you have such a situation, you can definitely say that you definitely don’t have CD1. SD2 is questionable. How much metformin treatment is necessary, of course, the doctor decides, but so far there is no strict need for taking drugs, in my opinion. Perhaps such a development of the situation that the temporary use of metformin will help to establish the absorption of carbohydrates and then it can be abandoned.
As long as you continue to drink the drug prescribed by your doctor, monitor your sugar levels. If you want to eat more carbohydrates, then it is better to do it in the morning, and not at night.
You don’t need to take any tests yet, you have already passed all the main ones. Retake periodically (3 times a year) glykir.hemoglobin, well, measure sugar yourself.
And one more thing - what kind of glucometer do you have? Does it measure in plasma or whole blood? Look at the ratio of plasma sugar to target blood. Doctors (especially of the old school) often rely on values for whole blood.
1. Thank you for the answer!
  Yes, something very strange is going on with the thyroid gland. After pregnancy on a dose of 50 (before I even alternated between 50 and 75 to keep the TSH around 1.5) fell to 0.08, i.e. the dose was too high. The doctor prescribed an ultrasound (it was good, without any traces of pathology, although there used to be a small nodule) and asked me not to drink Euthyrox for a month, to take an analysis. I did everything and after a month of cancellation I had a TSH of 3.16 at a laboratory norm of 4.2. The doctor again prescribed Etirox at a dose of 25 and my TSH began to decrease again, but pains immediately appeared in the top of the foot. I remembered that I already had this many years ago, when hypothyroidism had not yet been found, so I turned to another doctor and he canceled Euthyrox for 3 months. (legs, by the way, almost immediately passed) + Metformin canceled me too. After 3 months I have to check ttg, glycated and sugar.
  I now have a Contour Plus glucometer (calibrates by plasma), before that I had a Freestyle optium.
  Doctors brought tests only from the laboratory (from a vein).
  My high sugar of 6.83 was from a vein according to the laboratory (((and this scares me, because getting diabetes at the age of 35, when you have a small child in your arms, is very scary.
  1. Julia, your situation is not simple, because thyroid disorders are hormonal disorders, just like diabetes. Everything follows one after the other.
    It's too early to talk about diabetes. Retake periodically tests for GG, sometimes check sugar on an empty stomach at home.
    Sugar 6.8, especially one-time, does not speak in the direction of diabetes.
    It makes no sense to worry about this, severely limit your diet too. It is impossible to protect yourself from diabetes, like, for example, from the flu, by carrying out prevention and vaccinations. With DM2, the situation can be improved by diet, with DM1, the diet does not make sense.
    You have a small child, devote your time to him. Enjoy motherhood. It will be necessary to take measures to treat diabetes only in case of its manifestation, now all this will not bring any positive results. But unrest can do a disservice and cause an increase in sugar, even in the case when there is no diabetes.
    1. Yes, I would like to digress from all this, but the general state of health interferes: dizziness after eating, severe hair loss, sweating, etc. Not much fun, unfortunately.
      Today, tests for hormones have also arrived, and it seems that the abolition of Euthyrox provoked an imbalance, because. this did not happen before, the previous ones were taken in May on Euthyrox. Prolactin jumped strongly to 622 at a rate of up to 496, cortisol at the upper limit of normal, fasting insulin became even higher 11.60, glucose 6.08, and the Hom index is now 3.13, i.e. developed insulin resistance
      Now I don't even know what to do. I could not find a good doctor to deal with all the problems.
      
      Julia, what city are you from? If Moscow, Moscow region, then you can look for doctors. Unfortunately, I don't know about other cities.
      I tend to think that "dizziness after eating, severe hair loss, sweating, etc." not associated with such low sugar. It's more like a thyroid gland.
      These same symptoms can also give malfunctions in the work of the adrenal glands.
      Another question - have you been examined by a gynecologist? What about hormones in this area? Polycystic ovaries can lead to insulin resistance.
      Unfortunately, it is difficult to say right away - you have this and that. In your situation, there are such general symptoms that it is necessary to conduct a systematic examination in order to identify the real cause. This, of course, is not as fast as we would like.
      
      As for insulin resistance, this process has a genetic predisposition. It is impossible to stop it, if it turns out that you do not have polycystic disease, the correct dose of hormones for shields is selected. The glands, and insulin resistance does not go away, you will have to get used to living with it.
      Then treatment with metformin should make a difference.
      
      I couldn't hit the "reply" button on my last comment, so I'll post it here.
      I'm from Minsk and it looks like a good doctor here should be looked for like a treasure)) I signed up for the weekend with the advised endocrinologist ... we'll see.
      It seems to me that my problems with insulin are really hereditary, tk. in our family, all women have an active accumulation of belly fat. My sister is actively involved in sports, but the stomach still has a place to be.
      I don't have PCOS, but after pregnancy there were problems with the cycle and the gynecologist doesn't like my ultrasound with the endometrium. There is a suspicion that the swing with Euthyrox led to such a failure, because. he fell at my dosage of 50 mg to almost 0, but I didn’t know that.
      Today, a detailed analysis of the thyroid gland also came (I have not been drinking Euthyrox since September 12).
      If you can somehow comment, I will be very grateful.
      TSH-2.07
      Т3sv-2.58 (normal 2.6-4.4) reduced
      T3total-0.91 (normal 1.2-2.7) reduced
      T4total-75.90 norm
      T4sv-16.51 norm
      Thyroglobulin-22.80 norm
      Antibodies to TG- 417.70 (norm<115) повышено
      Antibodies to TPO - 12 norm
      I decided to take it in detail so that the doctor could look at all the tests in detail.
      Tell me, please, how can I check the work of the adrenal glands, what tests can I take?
      Thank you for your answers and for spending your time on an essentially stranger :)
      
      Julia, good afternoon.
      Stress and anxiety also affect the hormonal background, can also cause weakness, hair loss, sweating. Hormones such as catecholamines, which are synthesized in the adrenal glands, help us fight stress. They regulate the body's response to stressful situations. You can donate blood or urine for catecholamines - dopamine, adrenaline, norepinephrine and serotonin. I don’t know how it is in district clinics, but in private laboratories they are made everywhere.
      And first of all, you just need to choose the dosage of euthyrox. The thyroid gland has a huge impact on well-being. It is T3 that affects the activity of the cardiovascular system, its lack is manifested by an increase in cholesterol, weakness, and problems with concentration.
      Both the adrenal glands and the thyroid gland should be dealt with by one doctor.
      95% that all your unpleasant symptoms will go away as soon as the work of the thyroid gland improves.
      
      As for diabetes, believe me, life does not end when this diagnosis is made. As people with diabetes, we also live, work, travel, raise families, fly planes, ski, and so on. Well, we just can’t fly into space :). So do not waste time on unnecessary experiences, enjoy life, you have a family, a child - there is something to live and smile for!!!
      
      P.S. A little off topic - it's very nice that you are from Minsk. We love Belarus very much, we also visited Minsk, a very beautiful city. We are planning to come again. In general, we go to Vitebsk 2-3 times a year. Your place is very beautiful!

I am 56 years old, with a pressure of 195-100, I was admitted to the hospital by ambulance. During the research, it turned out that my sugar had risen to 10.5. I never knew about it before. They put DM2 and prescribed Metformin 2 times a day, 500 g, and antihypertensive drugs for pressure. I began to follow a diet to drink medicines, but very often my pancreas began to hurt in my left side. I drink pancreotin, allochol, mezim was prescribed when I was at the gastroenterologist, but the pain does not go away. I drank only water for half a day, I thought it would pass, but the pain does not go away. What do you recommend to drink?

Hello. Dad was recently diagnosed with type 2 diabetes, sugar was 19. And the doctors also cut off the tip of the thumb, because the legs didn’t feel anything at all and apparently the nails began to fall off. According to my father, it started about five years ago, as my feet get cold. When the doctors operated, they did not know that he had sugar. The operation went well, the legs warmed up a little, that is, they began to feel a little. And now, after a while, blisters appeared on my legs, burst and the skin is torn off. It hurts at night. We don't know what to do.
Mom is 60 years old, type 2 diabetes, insulin resistance, they gave insulin injections, her sugar was 14, her eyesight fell.
tell me, is it possible to start physical training or should I wait until the body gets used to insulin and lowers sugar?
Will training help avoid vascular problems?
Thanks for the article, useful information. I am 52 years old, I am overweight, unfortunately, my sugar is slightly elevated. I try to change my eating style, eat less sweets and starchy foods, and regularly measure my sugar at home with a glucometer ts circuit, this is also very important to always be on the alert and control my health

Thanks for the article, it clarified many questions. My sister was recently diagnosed with mild type 2 diabetes, although there really were no symptoms, but she started doing sports more well, she dances, of course she keeps to a diet, we recently bought a circuit for her to control her sugar, she is going to the camp and we will calmer so, especially since it is very simple and she easily manages it.
Hello, my mother's sugar on an empty stomach 8yo eat scales up to 21yo on average from 10 to 14. She refuses insulin. Takes Glyformin. She also has a postoperative hernia above the navel. Maybe you still need to somehow persuade, force him to take insulin?
Hello, my mother, 41 years old, was admitted to the hospital with acute pancreatitis, she passed an analysis for sugar, sugar 14, endocrinology came and said you are insulin dependent and said now they will inject insulin, she refused, she is afraid that she will sit on it all her life, what to do help.
Good afternoon. My mother has had type 2 diabetes for many years. She did not treat herself, she did not follow diets. This fall I had a foot amputation. Gangrene set in. Now she eats semi-finished products - store-bought pancakes and dumplings. Sometimes he cooks a soup with the addition of a batch concentrate. He lives far away and I can’t convince him not to eat this muck. Takes diabetes and drinks pain pills. Sometimes checks (a couple of times a week) sugar. So far, he is holding on to 8. He categorically refuses insulin. The stump heals normally. And yet, it seems to me that this is all “more or less normal”, an apparent calm before another storm. In the discharge from the hospital, concomitant diseases were indicated, such as chronic renal failure, ischemic brain, chronic portable insufficiency. She flatly refuses to change her attitude. The question is, am I right or am I more ignorance escalation? If I'm right, then how long do diabetics live after amputation with such an attitude with such a diagnosis? If I can’t convince, then I can remember the argument exactly.
1. Sveta
  Your situation is not easy - we can always decide for ourselves, but sometimes it is absolutely unrealistic to force or convince another person to change their lifestyle.
  Now on topic - your mom's comorbidities are a consequence of diabetes. Of course, compensation is needed to maintain health to the extent that everything is now.
  With a sugar of 8-9 mmol / l, it is possible to dispense with oral sugar-lowering agents (tablets) and a diet. If such sugars are kept in case of non-compliance with the diet, then if it is observed, everything should be in perfect order. Well, this is if the sugar really does not rise higher. But there are doubts about this, or mom hides, well, 1-2 measurements per week do not give a complete picture, since between these measurements sugar can range from 2 to 20 mmol / l.
  Mom was offered to switch to insulin? If yes, then tell her that with insulin therapy she will not have to follow a diet, there is an opportunity to compensate for all the carbohydrates eaten with a dose of insulin, but sugar will have to be measured more often, especially at first, until suitable doses are determined.
  That is, for a normal future life, there are two options:
  1. Pills and DIET are the basis of treatment for type 2 diabetes.
  2. Insulin and no diet, but more frequent monitoring.
  
  I really don’t want to write disappointing forecasts, but since there was gangrene on one leg - which speaks of the death of the vessels of the lower extremities, the probability of its occurrence on the other leg is very high. How will mom get around then?
  About CKD - mom is not receiving dialysis yet? In many cities it is very difficult to achieve, people stand in long lines to save their lives, but not everyone waits for their turn, unfortunately. And then, finally, having received a place for dialysis, a person becomes attached to the house - since dialysis is done on certain days, at a certain time, this is a matter of five minutes. Therefore, several hours a day, at best once a week, will have to be devoted to trips to the hospital and this procedure. And the procedure itself is not pleasant - there are a lot of additional drugs for the rest of your life, since during dialysis a lot of substances needed by the body are washed out.
  And these are only those problems that are necessarily waiting for a person who does not have normal compensation. Maybe this will still encourage your mother to think about her future life - a more or less active and independent person who is on a diet or bedridden, who will be cared for by loved ones who have the right to their privacy, but measure sugar once a week and eating questionable snacks.
  Your mother - health and prudence, and patience to you!
Mom has type 2 diabetes. Takes metfogamma, metformin (depending on what is on sale). Sometimes in the morning sugar is below normal (according to the glucometer): about 2-3. Usually around 7-8. What is it can be and how much it is harmful? Thanks in advance for your reply.
1. Dmitry
  Reducing sugar to 2-3 mmol is already hypoglycemia. These reductions must be avoided. Especially if the mother herself does not feel low sugar, but only learns about it from a glucometer. Low sugars are dangerous in that measures must be taken immediately, without delay. When sugar levels are low, the brain does not receive enough oxygen, oxygen starvation occurs, which leads to the death of brain cells.
  In order for sugar to be approximately the same every day, you need to do everything at the same time - take drugs, eat a certain amount of carbohydrates. Follow up, perhaps on the eve of those days when sugar is low in the morning, mom eats little carbohydrates (less than usual), this leads to a decrease in sugar. You can't forget to eat.
  If cases of low sugars are regular, then you should consult a doctor. He will either postpone the drug to another time, or, most likely, reduce the dose of the drugs he takes.
  Well, physical activity also reduces sugar. Are there any factors contributing to these decreases on the eve of morning hypoglycemia (trips to the dacha, garden beds, just walking, cleaning around the house, etc.)
Hello. My father has type 2 diabetes. He is 65 years old, weight 125 kg. He doesn’t really want to be treated, but it’s difficult to force him. Since my knowledge is zero, and the patient has no zeal, I am in a stupor.

Question about a specific situation
he vomited yesterday afternoon, felt bad, refused an ambulance. (assumed that just poisoning). Then he slept all evening and all night.
In the morning I asked to measure sugar and pressure, everything turned out to be elevated. 162 to 81, pulse 64, sugar 13.0.
Please tell me what to do. Should I sound the alarm? What exactly to do?
Thank you very much, urgent question.
Hello, all day long sugar is normal from 5 to 6. And on an empty stomach from 6 to 8 !!! How so? I go to bed at 6, and wake up at 7 ((((What happens at night? How to reduce or keep normal night sugar? In the afternoon, after any meal, sugar is always normal from 5 to 6. Please tell me. Thank you
hello, tell me please, I was diagnosed with DM2 4 months ago, i.e. in April, on an empty stomach, I donated blood was 8.6, they prescribed mitformin 850 one tablet in the evening and they kicked me off trying to be treated myself, I drink herbs sugar-reducing teas, I follow a diet sugar when something like 5.6 then 4.8 then 10 .5 I have a height of 168, I weigh 76.800 kg, I am doing exercises, now I was pulling out my teeth, the sugar has risen to 15, the pressure has dropped to 80/76, I feel bad, can I have some more pills to drink, please tell me

is a chronic endocrine disease that develops as a result of insulin resistance and dysfunction of pancreatic beta cells, characterized by a state of hyperglycemia. Manifested by profuse urination (polyuria), increased thirst (polydipsia), itching of the skin and mucous membranes, increased appetite, hot flashes, muscle weakness. The diagnosis is established on the basis of the results of laboratory tests. A blood test is performed for the concentration of glucose, the level of glycosylated hemoglobin, and a glucose tolerance test. Hypoglycemic drugs, a low-carbohydrate diet, and increased physical activity are used in the treatment.

ICD-10

E11 non-insulin dependent diabetes mellitus

General information

Pathogenesis

At the heart of type 2 diabetes is a violation of carbohydrate metabolism due to increased cell resistance to insulin (insulin resistance). The ability of tissues to receive and utilize glucose decreases, a state of hyperglycemia develops - an increased level of plasma sugar, and alternative ways of obtaining energy from free fatty acids and amino acids are activated. To compensate for hyperglycemia, the body intensively removes excess glucose through the kidneys. Its amount in the urine increases, glucosuria develops. A high concentration of sugar in biological fluids causes an increase in osmotic pressure, which provokes polyuria - profuse frequent urination with loss of fluid and salts, leading to dehydration and water-electrolyte imbalance. These mechanisms explain most of the symptoms of diabetes - intense thirst, dry skin, weakness, arrhythmias.

Hyperglycemia alters the processes of peptide and lipid metabolism. Sugar residues attach to protein and fat molecules, disrupting their function, hyperproduction of glucagon occurs in the pancreas, the breakdown of fats as an energy source is activated, glucose reabsorption by the kidneys increases, transmitter transmission in the nervous system is disrupted, and intestinal tissues become inflamed. Thus, the pathogenetic mechanisms of DM provoke pathologies of the vessels (angiopathy), the nervous system (neuropathy), the digestive system, and the endocrine secretion glands. A later pathogenetic mechanism is insulin deficiency. It is formed gradually, over several years, due to depletion and natural programmed death of β-cells. Over time, a moderate deficiency of insulin is replaced by a pronounced one. Secondary insulin dependence develops, patients are prescribed insulin therapy.

Classification

Depending on the severity of carbohydrate metabolism disorders in diabetes mellitus, a compensation phase is distinguished (a state of normoglycemia is reached), a subcompensation phase (with a periodic increase in blood glucose levels) and a decompensation phase (hyperglycemia is stable, difficult to correct). Depending on the severity, there are three forms of the disease:

Light. Compensation is achieved by adjusting nutrition or diet in combination with a minimum dosage of a hypoglycemic drug. The risk of complications is low.
Average. To compensate for metabolic disorders, regular intake of hypoglycemic agents is necessary. The probability of the initial stages of vascular complications is high.
Heavy. Patients need constant use of tableted hypoglycemic drugs and insulin, sometimes only insulin therapy. Serious diabetic complications are formed - angiopathy of small and large vessels, neuropathy, encephalopathy.

Symptoms of type 2 diabetes

The disease develops slowly, at the initial stage, the manifestations are barely noticeable, which greatly complicates the diagnosis. The first symptom is an increased feeling of thirst. Patients feel dry mouth, drink up to 3-5 liters per day. Accordingly, the amount of urine and the frequency of the urge to empty the bladder increase. Children may develop enuresis, especially at night. Due to frequent urination and high sugar content in the excreted urine, the skin of the inguinal region is irritated, itching occurs, and redness appears. Gradually, itching covers the abdomen, armpits, bends of the elbows and knees. Insufficient supply of glucose to the tissues contributes to an increase in appetite, patients experience hunger already 1-2 hours after eating. Despite the increase in the caloric content of the diet, the weight remains the same or decreases, since glucose is not absorbed, but is lost with urine.

Additional symptoms - fatigue, constant feeling of fatigue, daytime sleepiness, weakness. The skin becomes dry, thinner, prone to rashes, fungal infections. The body bruises easily. Wounds and abrasions heal for a long time, often become infected. Girls and women develop genital candidiasis, boys and men develop urinary tract infections. Most patients report a tingling sensation in the fingers, numbness in the feet. After eating, you may experience nausea and even vomiting. High blood pressure, frequent headaches and dizziness.

Complications

The decompensated course of type 2 diabetes is accompanied by the development of acute and chronic complications. Acute conditions include conditions that occur quickly, suddenly and are accompanied by a risk of death - hyperglycemic coma, lactic acid coma and hypoglycemic coma. Chronic complications form gradually, include diabetic micro- and macroangiopathies, manifested by retinopathy, nephropathy, thrombosis, and vascular atherosclerosis. Diabetic polyneuropathies are detected, namely, polyneuritis of peripheral nerves, paresis, paralysis, autonomic disorders in the work of internal organs. There are diabetic arthropathy - joint pain, limited mobility, a decrease in the volume of synovial fluid, as well as diabetic encephalopathy - mental disorders, manifested by depression, emotional instability.

Diagnostics

The difficulty of identifying non-insulin-dependent diabetes mellitus is due to the absence of severe symptoms in the initial stages of the disease. In this regard, people at risk and all persons over 40 years of age are recommended screening plasma tests for sugar levels. Laboratory diagnostics is the most informative, it allows you to detect not only the early stage of diabetes, but also the state of pre-diabetes - a decrease in glucose tolerance, manifested by prolonged hyperglycemia after a carbohydrate load. With signs of diabetes, an examination is carried out by an endocrinologist. Diagnosis begins with clarification of complaints and anamnesis, the specialist clarifies the presence of risk factors (obesity, physical inactivity, hereditary burden), reveals the basic symptoms - polyuria, polydipsia, increased appetite. The diagnosis is confirmed after receiving the results of laboratory diagnostics. Specific tests include:

Fasting glucose. The criterion for the disease is a glucose level above 7 mmol / l (for venous blood). The material is taken after 8-12 hours of fasting.
Glucose tolerance test. To diagnose diabetes at an early stage, the concentration of glucose is examined a couple of hours after eating carbohydrate foods. An indicator above 11.1 mmol / l reveals diabetes, in the range of 7.8-11.0 mmol / l prediabetes is determined.
Glycated hemoglobin. The analysis allows you to evaluate the average value of glucose concentration over the past three months. Diabetes is indicated by a value of 6.5% or more (venous blood). With a result of 6.0-6.4%, prediabetes is diagnosed.

Differential diagnosis includes distinguishing between non-insulin-dependent diabetes mellitus and other forms of the disease, in particular, type 1 diabetes mellitus. Clinical differences are a slow increase in symptoms, a later onset of the disease (although in recent years the disease has also been diagnosed in young people 20-25 years old). Laboratory differential signs - elevated or normal levels of insulin and C-peptide, the absence of antibodies to pancreatic beta cells.

Treatment of type 2 diabetes

In practical endocrinology, a systematic approach to therapy is common. In the early stages of the disease, the focus is on changing the lifestyle of patients and consultations, in which the specialist talks about diabetes, ways to control sugar. With persistent hyperglycemia, the question of the use of drug correction is decided. The full range of therapeutic measures includes:

Diet. The main principle of nutrition is to reduce the amount of food high in fat and carbohydrates. Especially "dangerous" are products with refined sugar - confectionery, sweets, chocolate, sweet carbonated drinks. The diet of patients consists of vegetables, dairy products, meat, eggs, a moderate amount of cereals. We need a fractional diet, small portions, the rejection of alcohol and spices.
Regular physical activity. Patients without severe diabetic complications are shown sports activities that enhance oxidation processes (aerobic exercise). Their frequency, duration and intensity are determined individually. Most patients are allowed walking, swimming and walking. The average time of one lesson is 30-60 minutes, the frequency is 3-6 times a week.
Medical therapy. Medicines of several groups are used. The use of biguanides and thiazolidinediones, drugs that reduce insulin resistance of cells, absorption of glucose in the gastrointestinal tract and its production in the liver, is common. With their insufficient effectiveness, drugs are prescribed that enhance the activity of insulin: DPP-4 inhibitors, sulfonylurea derivatives, meglitinides.

Forecast and prevention

Timely diagnosis and responsible attitude of patients to the treatment of DM make it possible to achieve a state of stable compensation, in which normoglycemia persists for a long time, and the quality of life of patients remains high. To prevent the disease, it is necessary to adhere to a balanced diet high in fiber, limiting sugary and fatty foods, and fractional meals. It is important to avoid hypodynamia, to provide the body with daily physical activity in the form of walking, to play sports 2-3 times a week. Regular glucose monitoring is necessary for people from risk groups (overweight, mature and old age, cases of diabetes among relatives).

Type 2 diabetes mellitus is a common disease that occurs against the background of a violation of carbohydrate metabolism. Due to pathological changes in the body, a hyperglycemic state (high blood sugar) is observed.

In the vast majority of cases, pathology is found in people older than 40 years of age, and, as a rule, is characterized by an unexpressed clinical picture. A person may not suspect for a long time that he has developed a chronic disease.

In type 2 diabetes, the pancreas functions normally, the hormone insulin is produced, but the process of sugar penetration to the cellular level is inhibited, as the soft tissues of the body lose their susceptibility to the hormone.

It is necessary to consider the causes that lead to the second type of diabetes, and to identify the symptoms that characterize the disease. And also find out how type 2 diabetes is treated?

Etiology of occurrence

As you know, there are two types of diabetes - DM1 and DM2, which are more common in medical practice. There are also specific types of pathology, but they are diagnosed in people much less frequently.

If the first type of the disease tends to progress rapidly, then the second type develops gradually in a person, as a result of which a person does not notice negative changes in his body for a long period of time.

From this information, it must be concluded that after the age of 40, careful monitoring of the concentration of glucose in the body is needed in order to be able to recognize the second type of disease at an early stage of development.

At the moment, the exact causes that lead to the development of a chronic disease are unknown. However, there are factors that may accompany the onset of pathology:

Genetic predisposition to the disease. The probability of passing the pathology “by inheritance” ranges from 10% (if one parent is sick) to 50% (if both parents have a history of diabetes).
Excess weight. If the patient has excess adipose tissue, then against the background of such a condition, he has a decrease in the susceptibility of soft tissues to insulin, which in turn contributes to the development of the disease.
Wrong nutrition. Significant absorption of carbohydrates increases the risk of developing pathology.
Stress and nervous tension.
Some medications, due to their toxic effects, can lead to pathological failures in the body, which increases the risk of developing a sugar disease.

The factors that can lead to the occurrence of a chronic disease include a sedentary lifestyle. This circumstance leads not only to excess weight, but also adversely affects the concentration of glucose in the body.

The fair sex, who have been diagnosed with polycystic ovaries, is at risk. As well as those women who gave birth to a child weighing over 4 kilograms.

Type 2 Diabetes: Symptoms and Stages

Sugar level

The second type of diabetes is characterized by a high concentration of glucose in the body, which in turn provokes the occurrence of osmotic diuresis. In other words, through the kidneys, a lot of fluid and salts are excreted from the body.

As a result, the human body is rapidly losing moisture, there is dehydration of the body, a deficiency of minerals in it is revealed - these are potassium, sodium, magnesium, iron, phosphate. Against the background of this pathological process, tissues lose part of their functionality and cannot fully process sugar.

DM2 develops slowly. In the vast majority of cases, there is a latent course of the pathology, which is detected quite by accident when visiting an ophthalmologist or when undergoing a preventive examination in a medical institution.

The clinical picture of the disease is as follows:

Increased fluid intake when the patient is constantly thirsty (a person can drink up to 10 liters per day).
Dryness in the mouth.
Abundant urination up to 20 times a day.
Increased appetite, dry skin.
Frequent infectious diseases.
Sleep disturbance, decreased work capacity.
Chronic fatigue.
Violation of visual perception.

In women after the age of 40, a dermatologist or gynecologist often detects the disease, since the pathology is accompanied by skin itching and other skin problems, as well as itching in the vagina.

As mentioned above, type 2 diabetes mellitus develops slowly, and most often between its occurrence and detection there is a time interval of 2 years. In this regard, when it is diagnosed, patients already have complications.

Depending on the formation process, the second type of ailment can be divided into certain stages:

pre-diabetic condition. There are no signs of deterioration in the patient's condition, laboratory tests are within normal limits.
Latent form of pathology. There are no severe symptoms, laboratory tests may also not reveal abnormalities. However, changes in the body are detected through tests that determine glucose tolerance.
An obvious form of the disease. In this case, the clinical picture is characterized by many symptoms. And type 2 diabetes can be detected through laboratory tests.

In addition to stages, in medical practice, type 2 disease is also divided into certain degrees, which determine the level of severity of a person's condition. There are only three of them. These are mild, moderate and severe.

With a mild degree, the concentration of sugar in the patient's body is not more than 10 units; it is not observed in urine. The patient does not complain of feeling unwell, there are no pronounced abnormalities in the body.

With an average degree, sugar in the body exceeds 10 units, while tests show its presence in the urine. The patient complains of constant apathy and weakness, frequent trips to the toilet, dry mouth. As well as a tendency to skin purulent lesions.

In severe cases, a negative transformation of all metabolic processes in the human body occurs. Sugar in the body and urine goes off scale, the symptoms are pronounced, there are signs of complications of a vascular and neurological nature.

The likelihood of developing a diabetic coma increases several times.

Diagnostic measures

Most people seek medical attention not for the signs and symptoms of diabetes, but for its negative consequences. Since pathology may not indicate its occurrence for a long period of time.

If type 2 diabetes is suspected, the doctor prescribes diagnostic measures that help confirm or refute the disease, determine its stage and severity.

The problem of detecting pathology is that it is not characterized by severe symptoms. In this case, the symptoms of the disease may appear completely irregularly. That is why laboratory tests are of great importance in determining diabetes.

To identify pathology, the doctor prescribes the following studies:

Finger blood sampling (sugar analysis). This analysis allows you to determine the concentration of glucose in the patient's body on an empty stomach. An indicator of up to 5.5 units is the norm. If there is a violation of tolerance, then it may slightly increase or decrease. If the results are more than 6.1 units, a glucose tolerance test is prescribed.
Glucose tolerance study. This test is necessary to find out the degree of carbohydrate metabolism disorder in the patient's body. The amount of hormone and sugar is determined on an empty stomach, as well as after the use of glucose, which is previously dissolved in a liquid (75 dry glucose per 250 ml of liquid).
Analysis for glycated hemoglobin. Through this study, you can determine the degree of the disease. High numbers indicate that the patient has an iron deficiency or type 2 diabetes. If the indicator is more than 7%, diabetes is diagnosed.

Additional diagnostic measures include examination of the skin and lower extremities of the patient, a visit to an ophthalmologist, an ECG.

Type 2 diabetes mellitus: treatment

Treatment of type 2 diabetes mellitus in the early stages is provided by a non-drug method. At the remaining stages, pathologists recommend drug therapy, which may include taking pills to lower blood sugar.

If a patient has a disease of a mild or moderate stage, then therapeutic procedures consist in prescribing a health-improving diet, physical activity, and sports. Medical practice shows that it is enough to devote half an hour every day to sports loads in order to note a positive trend in the fight against pathology.

Proper nutrition is the basis of successful treatment. However, this does not mean that the patient should immediately give up all food, go on a strict diet and quickly get rid of extra pounds.

Weight loss should occur gradually, and the maximum weight loss in seven days should not exceed 500 grams. The diet and menu are always developed on an individual basis for each specific clinical case.

General principles of nutrition for DM2:

It is permissible to eat only permitted foods that do not provoke an increase in sugar in the patient's body.
You need to eat often (5-7 times a day), and in small portions, according to a previously drawn up schedule.
Refuse or limit the use of alcoholic beverages, salt.
If the patient is obese, then a diet that does not exceed 1800 calories per day is recommended.
Food should include a large amount of vitamins, minerals and fiber.

As a rule, upon detection of the second type of diabetes, the doctor always begins therapy with physical activity and proper nutrition. If the therapeutic effect of these measures is not observed, it remains only to proceed to drug treatment.

Derivatives of sulfonylurea. These drugs stimulate the production of the hormone in the body, reduce soft tissue resistance to insulin.
Biguanides. This group of drugs reduces the production of sugar in the liver, reduces its absorption in the gastrointestinal tract, and increases the sensitivity of tissues to the action of the hormone.
Thiazolidinone derivatives contribute to an increase in the activity of hormone receptors, as a result of which the concentration of glucose in the human body decreases.
Alpha-glucosidase inhibitors disrupt the absorption of carbohydrates in the gastrointestinal tract, resulting in a decrease in sugar content.

Drug therapy always begins with the use of a single drug, which must be taken once a day. If the disease is at a severe stage, the ineffectiveness of such treatment is noted, the doctor can combine drugs.

In turn, if the combination of several medicines does not already help, they can be supplemented. We can say that hormone injections are an alternative functioning of the pancreas, which, during full-fledged work, determines the amount of glucose, releases the required amount of the hormone.

Complications of the disease

Type 2 diabetes mellitus does not pose an immediate threat to the life of the patient, in contrast to the probable complications that are diagnosed in patients in 98% of cases of all clinical pictures.

Slowly progressing disease, gradually adversely affects the functionality of all internal organs and body systems, which in turn leads to various serious complications over time.

In patients suffering from the second type of diabetes, the likelihood of pathologies of the cardiovascular system increases several times. At the same time, a violation of the full blood circulation in the body is revealed, hypertension is manifested, the lower limbs lose their sensitivity.

With type 2 diabetes, the following negative complications can develop:

Diabetic microangiopathy, due to which the vascular walls of small blood vessels are affected. Macroangiopathy leads to damage to large blood vessels.
Polyneuropathy is a violation of the functionality of the central nervous system.
Arthropathy leading to severe joint pain. Over time, there are violations of the musculoskeletal system.
Visual disturbances: cataract, glaucoma develops.
Renal failure.
Mental changes, emotional lability.

Is it possible cure diabetes- this is a question that is asked by every person who has felt the signs of it. Every 20th person in the world lives hand in hand with this disease, and on the Internet every now and then you can stumble upon ads about a miraculous method of getting rid of the disease. In this article, we will look at the most effective ways of treatment diabetes mellitus type II.

Basic principles of therapy

The drug has a complex general strengthening effect, restores metabolic processes in the body. Improves the functioning of the endocrine, cardiovascular and digestive systems. To view .

Conclusion

Diabetes This is the disease of the 21st century. it is often said that people quickly recovered from this disease. If type 2 diabetes can be cured, type 1 diabetes is quite difficult to treat. Both medical and folk methods are aimed at maintaining the current state of the patient. To completely cure the patient and normalize his blood sugar level - resort to, in this case, a positive result will not take long.

Let's see what this insidious diagnosis is?

Despite the "sweet" name, this is a serious chronic disease of the endocrine system, as a result of which the patient's tissues lose their sensitivity to insulin.

According to the International Classification of Diseases (ICD 10), type 2 diabetes mellitus (non-insulin-dependent) has the code E11.

This disease is one of the most frequently diagnosed, which encourages scientists around the world to diligently investigate this pathology.

Obesity, malnutrition;
Age: older people are more vulnerable;
Stress, busy lifestyle;
Heredity;

What should the patient do in order not to aggravate the picture?

People with such a diagnosis can live a normal life and be happy! You just have to keep an eye on the slightest changes. It is necessary to visit the doctor frequently to monitor the course of the disease, its progress.

Important Rule- you need to make the right daily routine. To avoid overeating or malnutrition, paint each meal, make the diet moderate - keep a diet.

You should limit yourself to sugar, non-vegetable fats. It is important to bring physical activity into your life, but before that, consultation with a specialist is required!

The doctor will tell you in detail why type 2 diabetes is dangerous, and what will only bring harm and provoke complications. Frequent walks in the fresh air will be a nice bonus!

Useful video

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Conclusion

At the time of 2014 the number of diabetics was 422 million. The figure is growing every minute due to the less active lifestyle of the people.

T2DM is a major global health problem and every person.

If everyone monitors the condition of their relatives and notices any slightest changes, humanity will be able to reduce the number of sick people. And then doctors will be less likely to pronounce confirmation of the disease.