Primary treatment for type 2 diabetes. Treatment of various types of diabetes mellitus: means and methods Modern drugs for the treatment of type 2 diabetes

The main goals of treating diabetes mellitus of any type include maintaining a normal lifestyle; normalization of the metabolism of carbohydrates, proteins and fats; prevention of hypoglycemic reactions; prevention of late complications (consequences) of diabetes; psychological adjustment to life with a chronic illness. These goals can only be partially achieved in diabetic patients, due to the imperfection of modern substitution therapy. At the same time, today it is firmly established that the closer the patient's glycemia is to the normal level, the less likely it is to develop late complications of diabetes.

Despite numerous publications on the treatment of type 2 diabetes mellitus, the vast majority of patients do not achieve compensation for carbohydrate metabolism, although their general health may remain good. Not always a diabetic is aware of the importance of self-control and the study of glycemia is carried out from case to case. The illusion of relative well-being, based on normal well-being, delays the initiation of drug treatment in many patients with type 2 diabetes mellitus. In addition, the presence of morning normoglycemia does not exclude the decompensation of diabetes mellitus in such patients.

The key to successful treatment of patients with type 2 diabetes is education in a diabetic school. Teaching patients how to treat and manage their diabetes at home is extremely important.

Diet to treat type 2 diabetes

90% of people with type 2 diabetes have some degree of obesity, so weight loss through a low-calorie diet and exercise is of paramount importance. It is necessary to motivate the patient to lose weight, since even a moderate weight loss (by 5-10% of the original) can achieve a significant reduction in glycemia, blood lipids and blood pressure. In some cases, the condition of patients improves so much that there is no need for hypoglycemic agents.

Treatment usually begins with the selection of a diet and, if possible, expand the amount of physical activity. Diet therapy is the basis for the treatment of type 2 diabetes mellitus. Diet therapy consists in prescribing a balanced diet containing 50% carbohydrates, 20% proteins and 30% fats and following regular 5–6 meals a day - table number 9. Strict adherence to diet number 8 with fasting days for obesity and increased physical activity can significantly reduce the need in hypoglycemic drugs.

Physical exercise reduces insulin resistance, reduces hyperinsulinemia and improves carbohydrate tolerance. In addition, the lipid profile becomes less atherogenic - total plasma cholesterol and triglycerides decrease and high-density lipoprotein cholesterol increases.

A low-calorie diet can be balanced or unbalanced. With a balanced low-calorie diet, the total calorie content of food is reduced without changing its qualitative composition, in contrast to an unbalanced diet low in carbohydrates and fats. In the diet of patients should be foods high in fiber (cereals, vegetables, fruits, wholemeal bread). The diet is recommended to include fibrous fiber, pectin or guar-guar in the amount of 15 g / day. If it is difficult to restrict dietary fat, you should take orlistat, which prevents the breakdown and absorption of 30% of the fat taken and, according to some reports, reduces insulin resistance. The result of monotherapy with a diet can be expected only with a decrease in weight by 10% or more from the original. This can be achieved by increasing physical activity along with a low-calorie balanced diet.

Of the sweeteners today, aspartame (a chemical compound of aspartic and phenylalanine amino acids), sucrasite, sladeks, saccharin are widely used. Acarbose, an antagonist of amylase and sucrase, which reduces the absorption of complex carbohydrates, can be included in the diet of a diabetic patient.

Exercise for the treatment of type 2 diabetes

Daily exercise is essential for type 2 diabetes. This increases the uptake of glucose by muscles, the sensitivity of peripheral tissues to insulin, improves the blood supply to organs and tissues, which leads to a decrease in hypoxia, an inevitable companion of poorly compensated diabetes at any age, especially the elderly. The amount of exercise in the elderly, hypertensive patients and those with a history of myocardial infarction should be determined by the doctor. If there are no other prescriptions, you can limit yourself to a daily 30-minute walk (3 times for 10 minutes).

With decompensation of diabetes mellitus, physical exercises are ineffective. With heavy physical exertion, hypoglycemia may develop, so the doses of hypoglycemic drugs (and especially insulin) should be reduced by 20%.

If diet and exercise fail to achieve normoglycemia, if this treatment does not normalize the disturbed metabolism, one should resort to drug treatment of type 2 diabetes mellitus. In this case, tableted hypoglycemic agents, sulfonamides or biguanides are prescribed, and if they are ineffective, a combination of sulfonamides with biguanides or hypoglycemic drugs with insulin. New groups of drugs - secretagogues (NovoNorm, Starlix) and insulin sensitizers that reduce insulin resistance (thiazolidinedione derivatives - pioglitazone, Aktos). With complete depletion of residual insulin secretion, they switch to insulin monotherapy.

Medical treatment of type 2 diabetes

More than 60% of patients with type 2 diabetes are treated with oral hypoglycemic drugs. For more than 40 years, sulfonylurea has been the mainstay of oral hypoglycemic therapy for type 2 diabetes mellitus. The main mechanism of action of sulfonylurea drugs is to stimulate the secretion of their own insulin.

Any sulfonylurea preparation, after oral administration, binds to a specific protein on the pancreatic β-cell membrane and stimulates insulin secretion. In addition, some sulfonylurea drugs restore (increase) the sensitivity of β-cells to glucose.

Sulfonylureas are attributed to the action, which consists in increasing the sensitivity of cells of adipose, muscle, liver and some other tissues to the action of insulin, in increasing the transport of glucose in skeletal muscles. For patients with type 2 diabetes mellitus with well-preserved function of insulin secretion, the combination of a sulfonylurea drug with biguanide is effective.

Sulfonamides (sulfonylurea drugs) are derivatives of the urea molecule, in which the nitrogen atom is replaced by various chemical groups, which determines the pharmacokinetic and pharmacodynamic differences of these drugs. But they all stimulate the secretion of insulin.

Sulfonamide preparations are rapidly absorbed, even when taken with food, and therefore can be taken with food.

Suphanilamides for the treatment of type 2 diabetes mellitus

Let us give a brief description of the most common sulfonamides.

Tolbutamide (Butamid, Orabet), tablets of 0.25 and 0.5 g - the least active among sulfonamides, has the shortest duration of action (6-10 hours), and therefore can be prescribed 2-3 times a day. Although it was one of the first sulfonylurea preparations, it is still used today because it has few side effects.

Chlorpropamide (Diabenez), tablets of 0.1 and 0.25 g - has the longest duration of action (more than 24 hours), is taken 1 time per day, in the morning. Causes many side effects, the most serious is long-term and difficult to eliminate hypoglycemia. Severe hyponatremia and antabuse-like reactions were also observed. Currently, chlorpropamide is rarely used.

Glibenclamide (Maninil, Betanaz, Daonil, Euglucon), 5 mg tablets is one of the most commonly used sulfonamides in Europe. It is prescribed, as a rule, 2 times a day, in the morning and in the evening. The modern pharmaceutical form is micronized maninil at 1.75 and 3.5 mg, it is better tolerated and more powerful.

Glipizide (Diabenez, Minidiab), tablets of 5 mg / tab. Like glibenclamide, this drug is 100 times more active than tolbutamide, the duration of action reaches 10 hours, it is usually prescribed 2 times a day.

Gliclazide (Diabeton, Predian, Glidiab, Glizid), tablets of 80 mg - its pharmacokinetic parameters are somewhere between the parameters of glibenclamide and glipizide. Usually given twice a day, modified-release diabeton is now available and taken once a day.

Gliquidone (Glurenorm), tablets of 30 and 60 mg. The drug is completely metabolized by the liver to an inactive form, so it can be used in chronic renal failure. Practically does not cause severe hypoglycemia, therefore it is especially indicated for elderly patients.

Modern sulfonamides of the 3rd generation include glimepiride (Amaryl), tablets of 1, 2, 3, 4 mg. It has a powerful prolonged hypoglycemic effect, close to Maninil. It is used once a day, the maximum daily dose is 6 mg.

Side effects of sulfonamides

Severe hypoglycemia occurs infrequently with sulfonamides, mainly in patients receiving chlorpropamide or glibenclamide. The risk of developing hypoglycemia is especially high in elderly patients with chronic renal failure or against the background of an acute intercurrent disease, when food intake is reduced. In the elderly, hypoglycemia is manifested mainly by mental or neurological symptoms that make it difficult to recognize. In this regard, it is not recommended to prescribe long-acting sulfonamides to the elderly.

Very rarely, in the first weeks of treatment with sulfonamides, dyspepsia, skin hypersensitivity, or a reaction of the hematopoietic system develop.

Since alcohol inhibits gluconeogenesis in the liver, its intake can cause hypoglycemia in a patient receiving sulfonamides.

Reserpine, clonidine and non-selective β-blockers also contribute to the development of hypoglycemia by suppressing the counter-insulin regulatory mechanisms in the body and, in addition, can mask the early symptoms of hypoglycemia.

Diuretics, glucocorticoids, sympathomimetics and nicotinic acid reduce the effect of sulfonamides.

Biguanides (metformin) for the treatment of type 2 diabetes

Biguanides, derivatives of guanidine, enhance glucose uptake by skeletal muscles. Biguanides stimulate the production of lactate in the muscles and/or organs of the abdominal cavity and, therefore, many patients receiving biguanides have elevated lactate levels. However, lactic acidosis develops only in patients with reduced biguanide and lactate elimination or with increased lactate production, in particular, in patients with reduced kidney function (they are contraindicated in elevated serum creatinine), with liver disease, alcoholism and cardiopulmonary insufficiency. Lactic acidosis has been particularly common with phenformin and buformin, which is why they have been discontinued.

For today only metformin (Glucophage, Siofor, Diformin, Dianormet) used in clinical practice for the treatment of type 2 diabetes mellitus. Since metformin reduces appetite and does not stimulate hyperinsulinemia, its use is most justified in obese diabetes mellitus, making it easier for such patients to maintain a diet and promote weight loss. Metformin also improves lipid metabolism by lowering low-density lipoprotein levels.

Interest in metformin has now increased dramatically. This is due to the peculiarities of the mechanism of action of this drug. We can say that basically Metformin increases the sensitivity of tissues to insulin, suppresses the production of glucose by the liver and, naturally, reduces fasting glycemia, slows down the absorption of glucose in the gastrointestinal tract. There are additional effects of this drug that have a positive effect on fat metabolism, blood clotting and blood pressure.

The half-life of metformin, which is completely absorbed in the intestine and metabolized in the liver, is 1.5-3 hours, and therefore it is prescribed 2-3 times a day during or after meals. Treatment is started with minimal doses (0.25–0.5 g in the morning) to prevent adverse reactions in the form of dyspeptic phenomena, which occur in 10% of patients, but in most patients they pass quickly. In the future, if necessary, the dose can be increased to 0.5–0.75 g per dose, prescribing the drug 3 times a day. Maintenance dose - 0.25-0.5 g 3 times a day.

Treatment with biguanides should be immediately discontinued when the patient develops acute kidney disease, liver disease, or manifests cardiopulmonary insufficiency.

Since sulfonamides mainly stimulate insulin secretion, and metformin mainly improves its action, they can complement each other's hypoglycemic effect. The combination of these drugs does not increase the risk of side effects, is not accompanied by their adverse interactions, and therefore they are successfully combined in the treatment of type 2 diabetes mellitus.

Combinations of drugs in the treatment of type 2 diabetes

The expediency of using sulfonylurea drugs is beyond doubt, because the most important link in the pathogenesis of type 2 diabetes is a secretory defect in the β-cell. On the other hand, insulin resistance is an almost constant feature of type 2 diabetes mellitus, which necessitates the use of metformin.

Metformin in combination with sulfonylurea drugs- a component of effective treatment, has been intensively used for many years and allows to achieve a reduction in the dose of sulfonylurea drugs. According to the researchers, combination therapy with metformin and sulfonylurea drugs is as effective as combination therapy with insulin and sulfonylurea drugs.

Confirmation of observations that combination therapy with sulfonylurea and metformin has significant advantages over monotherapy contributed to the creation of the official form of the drug containing both components (Glibomet).

To achieve the main goals of the treatment of diabetes mellitus, it is necessary to change the previously established stereotype of treatment of patients and switch to more aggressive therapy tactics: the early start of combined treatment with oral hypoglycemic drugs, in some patients almost from the moment of diagnosis.

Simplicity, efficiency and relative cheapness explain the fact that secretogens successfully complement metformin. Combined drug Glucovans, containing metformin and micronized form of glibenclamide in one tablet, is the most promising representative of a new form of antidiabetic drugs. It turned out that the creation of Glucovans clearly improves not only patient compliance, but also reduces the total number and intensity of side effects with the same or better efficiency.

Advantages of Glucovans over Glibomet (metformin 400 mg + glibenclamide 2.5 mg): Metformin forms a soluble matrix in which micronized glibenclamide particles are evenly distributed. This allows glibenclamide to act faster than the non-micronized form. The rapid achievement of the peak concentration of glibenclamide allows you to take Glucovans with meals, which, in turn, reduces the frequency of gastrointestinal effects that occur when taking Glibomet. The undoubted advantage of Glucovans is the presence of 2 dosages (metformin 500 + glibenclamide 2.5, metformin 500 + glibenclamide 5), which allows you to quickly select an effective treatment.

Addition of basal insulin (Monotard HM type) at an average dose of 0.2 U per 1 kg of body weight to ongoing combination therapy, it is recommended to start as a single injection at night (22.00), usually the dose is increased by 2 U every 3 days until target glycemic values of 3.9–7.2 mmol are reached / l. In the case of a high initial level of glycemia, it is possible to increase the dose by 4 IU every 3 days.

Secondary resistance to sulfa drugs.

Despite the fact that tissue insulin resistance is the leading mechanism for the development of type 2 diabetes mellitus, insulin secretion in these patients also decreases over the years, and therefore the effectiveness of sulfonamide treatment decreases over time: in 5–10% of patients annually and in most patients after 12 -15 years of therapy. This loss of sensitivity is called secondary resistance to sulfonamides, as opposed to primary, when they are ineffective from the very beginning of treatment.

Resistance to sulfonamides is manifested by progressive weight loss, the development of fasting hyperglycemia, postalimentary hyperglycemia, an increase in glycosuria, and an increase in HbA1c levels.

With secondary resistance to sulfonamides, a combination of insulin (IPD) and sulfonamides is first prescribed. The likelihood of a positive effect of combination therapy is high when it is prescribed at the earliest stages of the development of secondary resistance, i.e. at a fasting glycemia level between 7.5–9 mmol/l.

It is possible to use pioglitazone (Aktos) - a drug that reduces insulin resistance, which makes it possible to reduce the dose of IPD and, in some cases, cancel it. Take actos 30 mg 1 time per day. It can be combined with both metformin and sulfonylurea preparations.

But the most common combination treatment regimen is that the previously prescribed sulfonamide treatment is supplemented with small doses (8-10 IU) of medium-acting drugs (for example, NPH or ready-made "mixes" - mixtures of short-acting and prolonged-acting drugs) 1-2 times a day. day (8.00, 21.00). The dose is increased in steps of 2-4 units every 2-4 days. In this case, the dose of sulfanilamide should be maximum.

Such treatment can be combined with a low-calorie diet (1000-1200 kcal / day) for diabetes in obese people.

If the regimen of a single injection of insulin is ineffective, it is administered 2 times a day, with glycemic control at critical points: on an empty stomach and at 17.00.

The usual dose of IPD is 10–20 IU/day. When the need for insulin is higher, this indicates complete resistance to sulfonamides, and then insulin monotherapy is prescribed, i.e. sulfonamide preparations are completely canceled.

The arsenal of hypoglycemic drugs used in the treatment of type 2 diabetes mellitus is quite large and continues to grow. In addition to sulfonylurea derivatives and biguanides, this includes secretogens, amino acid derivatives, insulin sensitizers (thiazolidinediones), α-glucosidase inhibitors (glucobay), and insulins.

Glycemic regulators for the treatment of type 2 diabetes

Based on the important role of amino acids in the process of insulin secretion by β-cells directly in the process of eating, scientists studied the hypoglycemic activity of phenylalanine analogs, benzoic acid, synthesized nateglinide and repaglinide (NovoNorm).

Novonorm is an oral fast-acting hypoglycemic drug. Rapidly lowers blood glucose levels by stimulating the release of insulin from functioning pancreatic β-cells. The mechanism of action is associated with the ability of the drug to close ATP-dependent channels in the membranes of β-cells by acting on specific receptors, which leads to cell depolarization and the opening of calcium channels. As a result, increased calcium influx induces insulin secretion by β-cells.

After taking the drug, an insulinotropic response to food intake is observed within 30 minutes, which leads to a decrease in blood glucose levels. In the periods between meals, there is no increase in insulin concentration. In patients with non-insulin dependent type 2 diabetes mellitus, when taking the drug in doses of 0.5 to 4 mg, a dose-dependent decrease in blood glucose levels is noted.

Insulin secretion, stimulated by nateglinide and repaglinide, is close to the physiological early phase of hormone secretion in healthy individuals after a meal, which leads to an effective decrease in glucose peaks in the postprandial period. They have a quick and short-term effect on insulin secretion, thereby preventing a sharp increase in glycemia after a meal. When skipping meals, these drugs are not used.

Nateglinide (Starlix) is a derivative of phenylalanine. The drug restores early insulin secretion, which leads to a decrease in postprandial blood glucose concentration and the level of glycosylated hemoglobin (HbA1c).

Under the influence of nateglinide taken before meals, the early (or first) phase of insulin secretion is restored. The mechanism of this phenomenon lies in the rapid and reversible interaction of the drug with K + ATP-dependent channels of pancreatic β-cells.

The selectivity of nateglinide for K + ATP-dependent channels of pancreatic β-cells is 300 times higher than that for the channels of the heart and blood vessels.

Nateglinide, unlike other oral hypoglycemic agents, causes a pronounced secretion of insulin within the first 15 minutes after a meal, thereby smoothing out postprandial fluctuations (“peaks”) in blood glucose concentration. In the next 3–4 hours, the insulin level returns to its original values. Thus, postprandial hyperinsulinemia, which can lead to delayed hypoglycemia, is avoided.

Starlix should be taken before meals. The time interval between taking the drug and eating should not exceed 30 minutes. When using Starlix as monotherapy, the recommended dose is 120 mg 3 times / day (before breakfast, lunch and dinner). If with this dosing regimen it is not possible to achieve the desired effect, a single dose can be increased to 180 mg.

Another prandial regulator of glycemia is acarbose (glucobay). Its action takes place in the upper part of the small intestine, where it reversibly blocks α-glucosidases (glucoamylase, sucrase, maltase) and prevents the enzymatic breakdown of poly- and oligosaccharides. This prevents the absorption of monosaccharides (glucose) and reduces the sharp rise in blood sugar after eating.

Inhibition of α-glucosidase by acarbose occurs according to the principle of competition for the active site of the enzyme located on the surface of the microvilli of the small intestine. Preventing the rise in glycemia after a meal, acarbose significantly reduces the level of insulin in the blood, which improves the quality of metabolic compensation. This is confirmed by a decrease in the level of glycated hemoglobin (HbA1c).

The use of acarbose as the sole oral antidiabetic agent is sufficient to significantly reduce metabolic disturbances in patients with type 2 diabetes mellitus that are not compensated by diet alone. In cases where such tactics do not lead to the desired results, the appointment of acarbose with sulfonylurea drugs (Glurenorm) leads to a significant improvement in metabolic parameters. This is especially important for elderly patients who are not always ready to switch to insulin therapy.

In patients with type 2 diabetes mellitus who received insulin therapy and acarbose, the daily insulin dose decreased by an average of 10 units, while in patients who received placebo, the insulin dose increased by 0.7 units.

The use of acarbose significantly reduces the dose of sulfonylureas. The advantage of acarbose is that it does not cause hypoglycemia when used alone.

Modern conditions dictate the need to create new drugs that allow not only to eliminate metabolic disorders, but also to maintain the functional activity of pancreatic cells, stimulating and activating the physiological mechanisms of regulation of insulin secretion and blood glucose. In recent years, it has been shown that the regulation of glucose levels in the body, in addition to insulin and glucagon, also involves the hormones incretins produced in the intestine in response to food intake. Up to 70% of postprandial insulin secretion in healthy individuals is due precisely to the effect of incretins.

Incretins in the treatment of type 2 diabetes mellitus

The main representatives of incretins are glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (G PP-1).

The entry of food into the digestive tract rapidly stimulates the release of GIP and GLP-1. Incretins can also lower glycemic levels through non-insulin mechanisms by slowing gastric emptying and reducing food intake. In type 2 diabetes, the content of incretins and their effect are reduced, and the level of glucose in the blood is increased.

The ability of GLP-1 to improve glycemic control is of interest in the treatment of type 2 diabetes mellitus (the emergence of a class of incretin mimetics). GLP-1 has multiple effects on the endocrine part of the pancreas, but its principal action is to potentiate glucose-dependent insulin secretion.

Increased intracellular cAMP levels stimulate GLP-1 receptors (rGLP-1), resulting in exocytosis of insulin granules from β-cells. An increase in cAMP levels thus serves as the primary mediator of GLP-1 induced insulin secretion. GLP-1 enhances insulin gene transcription, insulin biosynthesis, and promotes β-cell proliferation through rGLP-1 activation. GLP-1 also potentiates glucose-dependent insulin secretion via intracellular pathways. In the study by C. Orskov et al. GLP-1 has been shown in vivo to cause a decrease in glucagon secretion when acting on α-cells.

Improvement in glycemic indices after administration of GLP-1 may be the result of the restoration of normal β-cell function. An in vitro study indicates that glucose-resistant β-cells become glucose-competent after administration of GLP-1.

The term "glucose competence" is used to describe the functional state of β-cells that are sensitive to glucose and secrete insulin. GLP-1 has an additional hypoglycemic effect that is not associated with an effect on the pancreas and stomach. In the liver, GLP-1 inhibits glucose production and promotes glucose uptake by adipose and muscle tissue, but these effects are secondary to regulation of insulin and glucagon secretion.

An increase in the mass of β-cells and a decrease in their apoptosis is a valuable quality of GLP-1 and is of particular interest for the treatment of type 2 diabetes mellitus, since the main pathophysiological mechanism of this disease is precisely the progressive β-cell dysfunction. Incretinomimetics used in the treatment of type 2 diabetes include 2 classes of drugs: GLP-1 agonists (exenatide, liraglutide) and inhibitors of dipeptidyl peptidase-4 (DPP-4), which destroys GLP-1 (sitagliptin, vildagliptin).

Exenatide (Byetta) isolated from the saliva of the giant lizard Gila monster. The amino acid sequence of exenatide is 50% identical to human GLP-1. When exenatide is administered subcutaneously, its peak plasma concentration occurs after 2-3 hours, and the half-life is 2-6 hours. This allows exenatide therapy in the form of 2 subcutaneous injections per day before breakfast and dinner. Created, but not yet registered in Russia, long-acting exenatide - Exenatide LAR, administered once a week.

Liraglutide is a new drug, an analogue of the human GLP-1, which is 97% similar in structure to the human one. Liraglutide maintains a stable concentration of GLP-1 for 24 hours when administered once a day.

DPP-4 inhibitors for the treatment of type 2 diabetes

GLP-1 preparations developed to date do not have oral forms and require mandatory subcutaneous administration. This drawback is deprived of drugs from the group of DPP-4 inhibitors. By suppressing the action of this enzyme, DPP-4 inhibitors increase the level and lifespan of endogenous GIP and GLP-1, enhancing their physiological insulinotropic action. The drugs are available in tablet form and are prescribed, as a rule, once a day, which significantly increases the adherence of patients to the therapy. DPP-4 is a membrane-binding serine protease from the group of prolyl oligopeptidases, the main substrate for which are short peptides such as GIP and GLP-1. The enzymatic activity of DPP-4 on incretins, especially GLP-1, suggests the possibility of using DPP-4 inhibitors in the treatment of patients with type 2 diabetes mellitus.

The peculiarity of this approach to treatment is to increase the duration of action of endogenous incretins (GLP-1), i.e., the mobilization of the body's own reserves to combat hyperglycemia.

DPP-4 inhibitors include sitagliptin (Januvia) and vildagliptin (Galvus) recommended by the FDA (USA) and the European Union for the treatment of type 2 diabetes mellitus, both as monotherapy and in combination with metformin or thiazolidinediones.

The combination of DPP-4 inhibitors and metformin seems to be the most promising, which makes it possible to influence all the main pathogenetic mechanisms of type 2 diabetes mellitus - insulin resistance, secretory response of β-cells and hyperproduction of glucose by the liver.

The drug GalvusMet was created (50 mg vildagliptin + metformin 500, 850 or 100 mg), which was registered in 2009.

Insulin therapy in type 2 diabetes mellitus.

Despite the definition of type 2 diabetes mellitus as "non-insulin dependent", a large number of patients with this type of diabetes eventually develop absolute insulin deficiency, requiring the administration of insulin (insulin-requiring diabetes mellitus).

Treatment with insulin as monotherapy is indicated primarily for primary resistance to sulfonamides, when treatment with a diet and sulfonamides does not lead to optimal glycemia for 4 weeks, as well as for secondary resistance to sulfonamides against the background of depletion of endogenous insulin reserves, when it is necessary to compensate the exchange dose of insulin prescribed in combination with sulfonamides is high (more than 20 IU / day). The principles of insulin treatment for insulin-requiring diabetes mellitus and type 1 diabetes mellitus are almost the same.

According to the American Diabetes Association, after 15 years, most type 2 diabetics require insulin. However, a direct indication for monoinsulin therapy in type 2 diabetes mellitus is a progressive decrease in insulin secretion by pancreatic β-cells. Experience shows that approximately 40% of patients with type 2 diabetes require insulin therapy, but in fact this percentage is much lower, often due to patient opposition. In the remaining 60% of patients who are not indicated for monoinsulin therapy, unfortunately, treatment with sulfonylurea drugs also does not lead to compensation for diabetes mellitus.

Even if during daylight hours it is possible to reduce glycemia, then almost everyone has morning hyperglycemia, which is caused by nighttime production of glucose by the liver. The use of insulin in this group of patients leads to an increase in body weight, which exacerbates insulin resistance and increases the need for exogenous insulin, in addition, the inconvenience caused to the patient by frequent dosing of insulin and several injections per day should be taken into account. An excess of insulin in the body also causes concern for endocrinologists, because it is associated with the development and progression of atherosclerosis, arterial hypertension.

According to WHO experts, insulin therapy for type 2 diabetes should be started neither too early nor too late. There are at least 2 ways to limit insulin doses in patients not compensated by sulfonylurea drugs: the combination of a sulfonylurea drug with long-acting insulin (especially at night) and the combination of a sulfonylurea drug with metformin.

Combination treatment with sulfonylurea and insulin has significant advantages and is based on complementary mechanisms of action. High blood glucose has a toxic effect on β-cells, in connection with which the secretion of insulin is reduced, and the administration of insulin by lowering glycemia can restore the response of the pancreas to sulfonylurea. Insulin suppresses the formation of glucose in the liver at night, which leads to a decrease in fasting glycemia, and sulfonylurea causes an increase in insulin secretion after meals, controlling the level of glycemia during the day.

A number of studies have compared between 2 groups of type 2 diabetics, of which 1 group received only insulin therapy, and the other - combination therapy with insulin at night with a sulfonylurea. It turned out that after 3 and 6 months, the indicators of glycemia, glycated hemoglobin significantly decreased in both groups, but the average daily dose of insulin in the group of patients receiving combined treatment was 14 IU, and in the group of monoinsulin therapy - 57 IU per day.

The average daily dose of prolonged insulin at bedtime to suppress nocturnal hepatic glucose production is usually 0.16 units/kg/day. With this combination, there was an improvement in glycemia, a significant decrease in the daily dose of insulin and, accordingly, a decrease in insulinemia. Patients noted the convenience of such treatment and expressed a desire to more accurately comply with the prescribed regimen.

Monotherapy with insulin in type 2 diabetes mellitus, i.e., not combined with sulfonamides, is necessarily prescribed for severe metabolic decompensation that has developed during treatment with sulfonamides, as well as for the pain form of peripheral neuropathy, amyotrophy or diabetic foot, gangrene (ICD therapy only or "bolus-basal").

Each patient should strive to achieve a good compensation for diabetes from the first days of the disease, which is facilitated by their training in the “schools for the patient with diabetes”. And where such schools are not organized, patients should be provided with at least special educational materials and diabetic diaries. Self-management and effective treatment also involves providing all diabetic patients with portable means for rapid testing of glycemia, glucosuria and ketonuria at home, as well as glucagon ampoules to eliminate severe hypoglycemia (hypokit kit).

endocrinologist Ph.D.

Diabetes mellitus is a condition in which the level of glucose in the blood rises significantly. There are several types of the disease. With early diagnosis and the right treatment, some types of diabetes can be cured, while others can be successfully controlled throughout life.

Types of Diabetes

There are two main types of the disease - type 1 and type 2 diabetes.

Other types include:

LADA, autoimmune diabetes mellitus in adults;

rare, genetically determined types of diabetes mellitus - MODY;

gestational diabetes - can only develop during pregnancy.

Symptoms of Diabetes

Causes and risk factors for diabetes

Type 1 diabetes

Type 1 diabetes mellitus is characterized by an absolute deficiency of its own insulin. The reason is the autoimmune destruction of pancreatic beta cells that produce insulin. More often the disease occurs in childhood (at 4-6 years and 10-14 years), but can appear at any time in life.

To date, the causes of the development of diabetes mellitus in each individual person are not fully known. At the same time, vaccinations, stress, viral and bacterial diseases are never the cause of type 1 diabetes, they only sometimes coincide in time with the moment of detection of diabetes. Predisposition to autoimmune processes may be related to genetics, but is not 100% determined by it.

Type 2 diabetes

Type 2 diabetes is a striking example of a metabolic disorder, namely, a violation of the absorption of carbohydrates (glucose). In type 2 diabetes, insulin production remains normal for a long time, but the ability of tissues to transport insulin and glucose into cells is impaired, which causes hyperglycemia - an increase in the concentration of glucose in the blood.

Unlike type 1 diabetes, where there is a primary deficiency in insulin production, in type 2 diabetes there is sufficient insulin in the blood. Sometimes insulin can be overproduced as the body tries to fix the problem of a breakdown of the "transport mechanism" by increasing the production of a glucose conductor.

Overweight in combination with a genetic predisposition. As a rule, a combination of these two conditions is necessary. In this case, excess weight can be quite small, but located mainly around the waist. The genetic predisposition for each person is calculated individually, based on their own gene variants and the presence of close relatives with diabetes.

In 2017, the concept of remission and recovery from type 2 diabetes was first introduced in the USA, Europe and Russia. Previously it was thought that this was impossible. Now medical researchers around the world have recognized that in some cases a complete cure for type 2 diabetes is possible. The path to this is the normalization of body weight.

The EMC clinic has developed an individual approach to patients with diabetes and obesity. Against the background of drug normalization of blood sugar, classes are held aimed at correcting eating habits together with nutritionists and psychologists.

As a result of an integrated approach, we manage to achieve a stable result - to normalize the patient's weight and sugar level.

The EMC Genomic Medicine Center conducts a genetic study for predisposition to type 2 diabetes. Often the disease develops due to genetically programmed insufficient insulin synthesis in response to the use of high-carbohydrate foods. Knowing your risk allows you to start prevention even before the first abnormalities in blood tests appear.

It is important for obese patients to know their own biological mechanisms that may influence eating behavior. In most cases, genetic research provides an answer to the reason for the failure of many diets and methods, which allows us to personalize the approach for each of our patients.

LADA – autoimmune diabetes mellitus

This type of diabetes is characterized by a cumulative clinical picture of type 1 and type 2 diabetes. The disease proceeds in a slower form and at the initial stages it can manifest itself as symptoms of type 2 diabetes. Patients with suspected LADA need more precise diagnosis and individualized treatment, which differs from the treatment of type 2 diabetes mellitus.

MODY-juvenile diabetes

It is a monogenic, inherited form of diabetes that usually occurs during adolescence or between the ages of 20 and 40. Patients with MODY usually have a family history of diabetes in almost every generation, that is, such families had diabetes at a young age in their grandfather, mother, and siblings.

Diagnosis of diabetes

The main method for diagnosing diabetes are. Most often, glucose is determined in venous blood. In some cases, to clarify the diagnosis, the doctor may prescribe additional tests, for example, an oral glucose tolerance test, continuous 24-hour blood glucose monitoring (CGMS sensor).

If a hereditary form of diabetes mellitus is suspected, the EMC Center for Genomic Medicine performs molecular genetic diagnostics, which makes it possible to establish an accurate diagnosis and evaluate the prognosis for future children in relation to this disease. Also, patients can always undergo a comprehensive one to understand their genetic predisposition, both to diabetes itself and to its complications (for example, diabetic cataract).

For people with established diabetes, it is especially important to know what genetic risks exist for other diseases, such as kidney or heart disease, because diabetes can trigger the development of many of the increased risks. Thanks to genetic diagnostics, it is possible to plan the volume of regular examinations in time and receive individual recommendations on lifestyle and nutrition.

Diagnosis of diabetes mellitus in EMC clinics is carried out as soon as possible, in accordance with international protocols and under the supervision of an endocrinologist.

Diabetes Treatment at EMC

EMC provides complex treatment of diabetes mellitus, where doctors of various specialties always participate in the management of patients. After the diagnosis is made, the patient may be assigned a consultation of the following specialists: endocrinologist, ophthalmologist, cardiologist. This is necessary because of the different rates of development of the disease and its. First of all, vascular complications in the kidneys and eyes. In addition, additional consultations of related specialists are the international standard for providing medical care for diagnosed diabetes.

Modern treatment of diabetes mellitus is never complete without lifestyle changes, which is often the most difficult for overweight patients. It is necessary to adjust the type of nutrition, start sports training recommended by a specialist. A very important role at this stage is played by the support of doctors: an endocrinologist and a therapist, if necessary, a nutritionist, a cardiologist, a psychotherapist and other specialists. Without lifestyle changes, the effectiveness of therapy may be reduced.

Treatment always involves insulin therapy and constant monitoring of blood glucose levels. According to indications, the doctor may prescribe control with a glucometer or continuous daily monitoring of glucose levels for several days. In the latter case, it is possible to find out and analyze the causes of glucose level deviations under various factors. This is especially important for patients with unstable glucose levels or frequent hypoglycemia, for pregnant women with diabetes. A portable (small size) device measures glucose levels every five minutes for 7 days, wearing it does not affect the patient's usual life activities (you can swim and play sports with it). Detailed data allows the doctor to get the result of the response to therapy and, if necessary, adjust the treatment.

Medical treatment

Treatment also involves drug therapy with hypoglycemic drugs, which should always be under the supervision of a physician.

Insulin in type 2 diabetes is prescribed when the resources of pancreatic beta cells are depleted. This is a necessary measure to prevent various complications. In some cases, insulin therapy is prescribed temporarily, for short periods. For example, before surgery or during periods of decompensation, when the glucose level for some reason becomes high. After passing the “peak”, the person returns to the previous regular drug therapy.

Treatment of gestational diabetes mainly consists of dietary and lifestyle modifications for the expectant mother, as well as strict control of glucose levels. Only in some cases, insulin therapy can be prescribed. EMC doctors and nurses provide training and round-the-clock support for patients on insulin therapy.

Pumps and modern methods for measuring blood glucose

Insulin pumps provide more ways to control diabetes. Pump therapy allows you to administer insulin in doses and regimen as close as possible to the natural work of a healthy pancreas. Glucose monitoring is still needed, but its frequency is decreasing.

Pumps allow you to reduce insulin doses, the number of injections and reduce the dosing step, which is extremely important for children and patients with high insulin sensitivity. Insulin pumps are a small device with a reservoir filled with insulin that is attached to the patient's body. The drug from the pumps is administered painlessly: insulin is delivered through a special micro-catheter. A prerequisite is to teach the patient or parents the rules for calculating insulin doses, self-monitoring of blood glucose levels. The willingness of the patient to learn how to operate the pump and analyze the results is very important.

Diabetes treatment at the EMC clinic in Moscow is carried out according to international protocols under the supervision of experienced doctors from Russia, Germany, and the USA.

One of the most well-known pathologies affecting the endocrine system is diabetes mellitus. The disease occurs as a result of weak activity of the pancreatic hormone. If it is absolutely not produced, the first type is diagnosed, in all other cases - the second. The degrees of diabetes differ in the level of the patient's dependence on insulin.

Why do people get type 2 diabetes?

More recently, as almost every case history shows, type 2 diabetes was a disease of the elderly. Most often it developed in patients whose age exceeded forty years. Today, even teenagers can be diagnosed with type 2 diabetes. Treatment of the disease is always determined individually and depends on the patient's history. However, all people have a persistent violation of carbohydrate metabolism with the development of dysfunction of insulin receptors.

Causes of Diabetes:

Genetic (hereditary) predisposition.
Obesity caused by a sedentary lifestyle and overeating.
Bad habits.
The presence of other ailments of the endocrine system (hypo-, hyperfunction of the thyroid gland, pathology of the pituitary gland, adrenal cortex).
Complication after serious diseases (cancer).
arterial hypertension.
Systematic overeating, unbalanced diet.

At-risk groups

The causes of diabetes that provoke the development of the disease can be expanded by some additional factors. So, the risk group includes people whose age exceeds forty years. In addition, in the presence of a genetic predisposition, conditions such as severe infections, injuries, operations, pregnancy, severe stress, and long-term use of certain medications can “push” the development of the disease.

Diagnosis and insulin dependence

Diabetes mellitus is not manifested by obvious symptoms and is often detected during a laboratory biochemical analysis of blood or urine. The disease progresses very slowly, but can lead to complications, which will be described below.

If a person is already afflicted with a disease such as type 2 diabetes, which has not even been treated and diagnosed, his body still continues to produce insulin. The synthesis of the hormone may be sufficient, the main problem is that the receptor cells do not show sensitivity to it.

The indication for switching to artificial insulin is not the level of sugar in the blood, but other criteria. With the aggressive, long-term development of the disease, complete depletion of beta cells located in the pancreas occurs. When they are almost completely atrophied, a synthesized hormone is introduced into the treatment regimen.

Once type 2 diabetes is diagnosed, treatment with a switch to insulin is often not warranted. The patient must undergo a full range of special studies in order to reliably determine the level of hormone production and the response of beta cells to it.

Insulin, when the second type of diabetes is diagnosed, is prescribed in extreme cases, that is, with complete depletion of cells.

Symptoms of the disease

The body does not give severe symptoms, however, the following conditions help to understand that health is under threat:

almost constant, pronounced thirst;
severe hunger even after eating;
persistent dry mouth;
frequent urination;
fatigue, fatigue, weakness;
headache;
blurred vision;
unexplained weight fluctuations in the direction of decrease or increase.

If a person often feels such conditions, it is better to be screened for type 1 or type 2 diabetes. If the disease is detected at an early stage, it will be possible to avoid the development of complications.

The following symptoms rarely appear:

slow-healing cuts and wounds;
itching, especially in the groin area;
a sharp, unreasonable increase in body weight;
frequent fungal infections;
dark spots in the groin, armpits, on the neck (acanthokeratoderma);
tingling and numbness in the limbs;
decrease in libido.

Treatment

Modern diagnostics, which allows to identify failures in carbohydrate metabolism, helps to establish the causes of non-insulin dependent diabetes. Based on this, an effective treatment is prescribed, which involves the selection of drugs that reduce glucose levels based on the causes that caused the violations. Also, the therapy of diseases that served as a factor in the development of the disease is carried out, the elimination of complications is being carried out. An important role is played by preventive screening and regular visits to the endocrinologist.

Medical treatment

If monotherapy, consisting of a strict diet, is ineffective, it is often necessary to prescribe special drugs that reduce sugar levels. Some modern pharmacological agents (prescribed exclusively by the attending physician after establishing the causes of destabilization of carbohydrate metabolism) do not exclude the consumption of carbohydrates. This helps to prevent the occurrence of hypoglycemic conditions. The choice of a specific medication and the formation of a treatment regimen is carried out taking into account the history and individual characteristics of the patient. You can not take a medicine for diabetes on the advice of another patient whom it has helped, or simply on your own, otherwise you can cause irreparable harm to your body.

Pharmacological agents used for treatment (all groups of these medications are completely contraindicated during pregnancy and if a woman is breastfeeding a baby):

A medicine for diabetes belonging to the sulfonylurea group, for example, Amaryl, Glurenorm, Maninil, Diabeton.
Relatively innovative means that restore cell sensitivity to insulin (drugs "Avandia", "Rosiglitazone", "Aktos", "Pioglitazone").
The drug "Siafor" and its analogues, biguanide metformin.
Combined medicines such as Glibomet, Metaglip, Glucovans.
Drugs that regulate the level of sugar after eating, or, in other words, glinides.
Medications that slow down the absorption of carbohydrates in the intestine and their subsequent digestion, for example, Miglitol, Dibikor, Acarbose preparations.
Dipeptidyl peptidase inhibitors (standard

Innovative drugs and treatment

The drugs of the liraglutide group are the only ones of their kind. The principle of action is based on the imitation of the activity of the natural hormone GPL-1, which provides an innovative approach to the treatment of the disease already in the early stages.

Finally, it is worth noting that the indicator of the level of glycated hemoglobin becomes the international criterion for the effectiveness of the treatment of the disease.

The main goals of therapy

Stimulation of the normal synthesis of natural insulin.
Correction of the amount of lipids contained in the blood.
Reducing the rate of absorption of glucose into the blood from the intestines, reducing its digestibility.
Increased sensitivity of peripheral tissues to the hormone.

Physiotherapy

Patients are often shown the same type of physical activity. It can be easy running, cycling, swimming, walking, walking. The mode and level of complexity of the exercises are set by the physician, based on the individual characteristics of the person.

Treatment and prevention of complications

An important factor in the prevention of complications is the control of blood pressure. The diagnosis automatically places patients at high risk even at low levels. If a person suffers from hypertension, this is comparable to the presence of three additional risk factors. These are disorders of the fatty (lipid) composition of the blood (dyslipidemia), obesity and smoking.

Adequate measures greatly reduce mortality, reduce the risk of developing diseases of the cardiovascular system, and prevent the progression of renal failure at different stages of development. Therapy aimed at lowering blood pressure should be carried out quite aggressively even in those patients who have mild hypertension. This is a must for kidney protection and good general health.

If possible, medications that impair tissue sensitivity to insulin should be avoided. Diabetes adversely affects fat metabolism and blood glucose levels, so these drugs should also be avoided.

People with type 2 diabetes often need to be prescribed a combination of antihypertensive medications. It is advisable to start such treatment at a pressure level of up to 140/90 mm / RT. Art. If the doctor fails to lower the pressure through lifestyle optimization, such therapy begins at a level of 130/80 mm/Hg. Art.

Doctors note that there is often a need to correct violations of fat metabolism. Taking drugs that control blood fat reduces mortality by 37-48%.

Treatment of diabetic neuropathy

A similar complication affects 75% of patients who develop diabetes for several years. As a rule, peripheral nerves suffer and sensitivity to temperature changes decreases, tingling, numbness, and burning of the extremities occur. This lesion is the main risk factor leading to the formation of the "diabetic foot" syndrome. In the absence of therapy, the outcome is

The question of the treatment of neuropathy is separate. In addition to the main ones, drugs are prescribed that act on oxidative damage to cells, protect blood vessels and nerves, and prevent the progression of atherosclerosis. Such drugs have a hepatoprotective effect, that is, they protect the liver.

Tea for diabetics

Official medicine rarely recognizes the effectiveness of traditional methods of treatment. However, tea for diabetes is already recognized in the scientific community as a healthy drink that helps patients achieve healing.

We are talking about a special variety called "Monastic tea". According to official studies, after drinking it, patients feel lightness, a surge of strength, a boost of energy, which is due to the restoration of metabolism and the normalization of body cell functions.

Tea therapy, acting with the help of antioxidants and active ingredients, affects cell receptors, stabilizing their performance and regeneration. Thanks to this effect, diseased cells become healthy and the entire body is involved in the recovery process.

You can find "Monastic tea" only in one place - in the holy monastery in Belarus. The monks were able to create a unique blend of powerful and rare herbs. The drink has already managed to prove its effectiveness in the scientific community, type 2 diabetes, the treatment of which is based on these herbs, goes away in two weeks, which is fully confirmed by studies. A sick person is recommended to follow the instructions that are in the method of tea therapy.

Scientific research and "Monastic tea"

Type 2 diabetes mellitus, which was treated according to the methods of traditional medicine, often progressed, which caused an extremely negative reaction from doctors. However, regarding tea, opinions have changed in a diametrically opposite direction.

To reveal all the properties of the drink, scientists conducted thirty-day studies in which a group of volunteers participated. After 27 people suffering from this ailment underwent a course of therapy, the following results were revealed:

In 89% of patients, a sharp age of the group of subjects ranged from 25 to 69 years.
In 27 volunteers, stable cell regeneration was detected.
A significant improvement in mood and well-being was established.
Metabolic processes in the body have improved significantly.
Tea for diabetes increased libido in men.

Principles of nutrition, or monotherapy

The nutrition of people with a similar diagnosis should follow a fractional scheme. You should organize 5-6 meals daily. The diet for diabetes is predominantly subcaloric food, at the rate of 25 kcal per kg of body weight.

The patient should exclude easily digestible carbohydrates by supplementing the therapeutic diet with foods rich in fiber.

Benefits of fiber for diabetics

Fiber is indicated for use in case of carbohydrate metabolism failures. Vegetable cellulose reduces the absorption of glucose in the intestines, which also reduces its concentration in the blood. Products containing this plant fiber remove accumulated toxins and absorb excess fluid. It will be especially useful for those people who, in addition to diabetes, are obese. Swelling in the digestive tract, fiber causes satiety and helps to reduce the calorie content of food without causing an unbearable feeling of hunger.

The maximum effect can be achieved by taking fiber in food along with complex carbohydrates. The content of potatoes should be limited in the menu; it is better to soak its tubers before heat treatment. Light carbohydrates are found in beets, carrots, peas, which can be taken once a day. Without limitation, dietary nutrition allows you to replenish the diet with squash, cucumbers, zucchini, sorrel, cabbage, eggplant, pumpkin, lettuce, bell pepper, kohlrabi. The use of fruits and berries of unsweetened varieties is shown. Alertness should be shown to bananas, figs, persimmons.

Bakery products should also be presented in small quantities. It is better to give preference to bread with bran. Even cereals and grain products are chosen based on their fiber content. It is permissible to use pearl barley, buckwheat, oatmeal, corn grits. The diet for diabetes always contains these cereals.

Basic principles of monotherapy

Significant restriction of the content of table salt in food.
Half of the fats consumed are vegetable fats.
Products should be rich in minerals and vitamins.
It is permissible to drink 30 ml of alcohol per day, no more.
To give up smoking.
A ban on strong broths, fatty fish, meat, cheeses, pastry, sausage, pickles and marinades, semolina, rice.
The frequent use of ice cream, confectionery, sugar, carbonated drinks, sweet juices, jams is unacceptable.

Bread units

A bread unit is the equivalent of 10 grams of sugar and 25 grams of bread. A similar principle was created specifically to facilitate the formation of the menu for people suffering from this disease. Special tables have been developed that greatly facilitate the calculation of carbohydrates. Most often, the technique is used if diabetes is of the first type, but it is also necessary for overweight patients.

The role of nutrition in the life of a diabetic

The question of what to eat with diabetes worries many patients. It must be borne in mind that even if this disease is detected, carbohydrates are an integral part of the diet. The diet should be complete, consisting of all substances of vital importance. When carbohydrates are digested in the body, energy is synthesized and stored. Therefore, half of the food should consist of complex, slow carbohydrates, which gradually increase the level of glucose.

To correctly compose recipes for type 2 diabetes, you should familiarize yourself with the (glycemic) index of products in comparison with a pure glucose parameter of 100.

About 20% of the diet should be proteins of animal and vegetable origin. However, it is necessary to avoid an excessive amount of animal proteins, which will have a beneficial effect on the functioning of the kidneys and liver. Sufficient levels can be obtained from legumes.

Recipes for diabetes are developed with a limited fat content, but they are not completely excluded. It should be borne in mind that they are found in eggs, nuts, fish, meat. Such a calculation will eventually become a habit and will not be so tiring.

Conclusion

Type 2 diabetes mellitus, which is treated under strict medical supervision, recedes, but is not completely cured. To feel the full quality of life and excellent health, you should adhere to the principles of rational nutrition and monitor the course of the disease with regular visits to the endocrinologist.

People who have been diagnosed with diabetes should prepare for a life that will be under strict control. This primarily concerns eating habits and lifestyle. Although the disease, which belongs to the second type, is not as severe as the first, it requires discipline and will from a person.

According to statistics, a lot of patients with type 2 diabetes are overweight, and they are also elderly people.

Only 8% of patients have normal body weight.

As a rule, a combination of two or more risk factors for the development of the disease is detected in a person.

Consider the factors that increase the risk of debuting the disease:

genetic predisposition. In the presence of type 2 diabetes in one parent, the probability of inheritance is 30%, and if both parents are sick, the risk increases to 60%. An increased sensitivity to a substance that enhances insulin production, which is called enkephalin, is inherited.
Obesity, overweight, abuse of harmful products.
Traumatic lesion of the pancreas.
Pancreatitis causing damage to beta cells.
Frequent stress, depression.
Insufficient physical activity, the predominance of adipose tissue over muscle.
Transferred viruses(chicken pox, mumps, rubella, hepatitis) - provoke the development of the disease in people with a hereditary predisposition.
Chronic diseases.
Old age (over 65 years).
Hypertonic disease and an increased concentration of triglycerides in the blood due to the abuse of fatty foods.

Diagnostic methods

In persons falling under one of the above risk factors, a complex of laboratory tests is carried out, which makes it possible to detect the disease in a timely manner.
If you fall into a risk group, you need to take tests once a year.

If suspected, the following tests are prescribed:

determination of glucose concentration in capillary blood;
glucose tolerance - a test for early detection of the disease;
glycated hemoglobin in the blood.

A blood test for type 2 diabetes is positive if:

the level of glucose in capillary blood exceeds 6.1 mmol/l;
in the study for tolerance, 2 hours after taking glucose, its level is more than 11.1 mmol / l, with a glucose content in the range of 7.8-11.1 mmol / l, a diagnosis is made, which requires further examination under the supervision of a therapist;
with a content of 5.7% glycated hemoglobin, a person is considered healthy, a concentration of more than 6.5% - the diagnosis is confirmed, intermediate values - a high risk of development.

When are injections needed?

In severe cases of the disease, insulin injections are prescribed along with medications. Thus, this form of the disease can become insulin dependent, which will greatly complicate life.

Depending on how the body is able to compensate for carbohydrate metabolism disorders, There are three stages of the disease:

Reversible (compensatory).
Partially reversible (subcompensatory)
Carbohydrate metabolism is irreversibly disturbed - the stage of decompensation.

Symptoms

There are many cases when an ailment is detected by chance, during a routine examination, when taking a blood test for sugar. More often, symptoms appear in people who are overweight and those who have crossed the 40-year milestone.

Associated signs:

frequent bacterial infections due to reduced immunity;
limbs lose their normal sensitivity;
poorly healing ulcers and erosive formations appear on the skin.

Treatment

Is there a cure for type 2 diabetes? This question is asked by every sick patient.
The existing standards for the treatment of type 2 diabetes consider the achievement of the following goals as the main principle:

elimination of symptoms;
lowering blood sugar levels;
metabolic control;
warning ;
ensuring the highest possible standard of living;

Dieting;
Recommended physical activity;
Self-monitoring of the patient's condition;
Teaching the patient life skills with diabetes.

If diet therapy is ineffective, then additional drug therapy is prescribed.

Drug treatment of type 2 diabetes mellitus: drugs that reduce sugar

Modern pharmacotherapy for diabetes mellitus 2 offers many different drugs that reduce sugar. The appointment of drugs is carried out, focusing on laboratory parameters and the general condition of the patient. Consider the severity of the disease and the presence of complications.

Groups of drugs prescribed to a patient with type 2 diabetes to lower the level of sugar (glucose) in the blood:

1.Sulfonylurea derivatives- have a dual effect: they reduce the resistance of cells to insulin and increase its secretion.
In some cases, they can dramatically lower blood sugar levels.
Prescribe drugs: glimeperide, chlorpropamide and glibenclamide, etc.

2. Biagunides. Increase the susceptibility of muscle tissues, liver and fatty tissue to insulin.
Reduce weight, normalize lipid profile and blood viscosity.
Metformin is prescribed, but it causes side effects, stomach and intestinal upsets, as well.

3. Thiazolidinone derivatives reduce glucose levels, increasing the sensitivity of cell receptors and normalize the lipid profile.
Prescribe medications: rosiglitazone and troglitazone.

4. Incretins improve the function of pancreatic beta cells and insulin secretion, inhibit the release of glucagon.
Assign the drug: glucagon-like peptide-1.

5. Dipeptidyl peptidiase inhibitors 4 improve glucose-dependent release of insulin by increasing the susceptibility of pancreatic beta cells to the entry of glucose into the blood.
Prescribe medications - vildagliptin and sitagliptin.

6. Alpha-glucosidase inhibitors disrupt the absorption of carbohydrates in the intestines, reduce the concentration of sugar and the need for injections.
Prescribe medications miglitol and acarbose.

IMPORTANT!

Drugs that lower blood sugar levels are prescribed exclusively by the attending physician, since self-medication in this situation is life-threatening. The list of drugs is for informational purposes only.

Combination therapy involves the appointment of 2 or more drugs at the same time. This type gives fewer side effects than taking a single drug in a large dosage.

Modern methods of treatment of type 2 diabetes mellitus

Modern treatment of type 2 diabetes mellitus involves the achievement of the following goals by doctors:

stimulate the production of insulin;
reduce the immunity (resistance) of tissues to insulin;
reduce the rate of synthesis of carbohydrate compounds and slow down the process of its absorption through the intestinal wall;
correct the imbalance of lipid fractions in the bloodstream.

Initially, only 1 drug is used. Subsequently, the reception of several is combined. With the progression of the disease, the poor condition of the patient and the ineffectiveness of previous drugs, insulin therapy is prescribed.

Physiotherapy and ozone therapy

increases the permeability of cell membranes, which enhances the intake of carbohydrates into tissues and eliminates the lack of energy, while reducing protein breakdown;
activates the exchange of glucose in red blood cells (erythrocytes), which allows you to increase the saturation of tissues with oxygen;
strengthens the vascular wall;
especially effective in ischemic heart disease and atherosclerosis in elderly patients.

But, there are also disadvantages of ozone therapy: it is able to suppress the patient's immunity, which can provoke the development of chronic infections and pustular skin lesions.

The course of treatment is up to 14 procedures, involving the intravenous administration of saline, subjected to ozonation. Enemas are also used with an oxygen-oxygen mixture.

As physiotherapy for diabetes, the following are used:

electrophoresis;
magnetotherapy;
acupuncture;
hydrotherapy;
physiotherapy exercises.

How to treat type 2 diabetes with nutrition?

Treatment regimens for type 2 diabetes mellitus with a diet are based on the following principles:

exclusion from the diet of refined carbohydrates (jam, desserts and honey);
fat intake should correspond to 35% of the daily requirement;
counting the number of bread units and bringing your diet in line with the doctor's recommendations.

A lot of patients have some degree of obesity, and therefore, having achieved weight loss, it is possible to achieve a decrease in glycemia (glucose), which often eliminates the need for drug treatment of the disease.

Diet therapy is the main part of the treatment. The proportion of proteins in the diet should be 20%, fat -30% and carbohydrates 50%. It is recommended to divide the meal into 5 or 6 times.

Fiber in the diet

A prerequisite for a therapeutic diet is the presence of fiber.
Rich in fiber:

The inclusion of guar guar, fibrous fiber and pectin in the diet gives an excellent result. The recommended dosage is 15 grams per day.

What is a bread unit

The practical significance of the bread unit lies in the fact that with its help it is possible to determine the dose of injections for oral administration. The more bread units consumed, the larger the dose is administered to normalize the level of glucose in the body.

For an error-free calculation of XE, many special tables have been compiled containing a list of food products allowed to patients with diabetes and the correspondence of the indicated units to them.

Folk remedies

Folk remedies can be considered as an addition to the main therapy.

A noticeable effect is observed a month after the systematic use.

IMPORTANT!

Before starting to use various herbal preparations, the patient is advised to consult a doctor, since the use of some herbs has contraindications for various conditions.

Useful video

What treatments are considered the most effective? Watch in the video:

Goals of therapy

The main goal of the treatment of type 1 and type 2 diabetes mellitus is to preserve the patient's quality of life and normalize metabolism. It is important to prevent the development of complications, to adapt a person to life, taking into account this complex diagnosis. Proper treatment only delays the onset of serious consequences.