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Many diabetic patients are surprised - why did I have diabetes? Several chronic human endocrine diseases in medicine are combined under one name - diabetes mellitus.

There are a lot of reasons for the occurrence of this disease, which are based on general violation the functioning of the endocrine system of the body, based either on a deficiency of insulin, a hormone produced by the pancreas, or on the inability of the liver and body tissues to properly process and absorb glucose.

Due to the lack of this hormone in the body, the concentration of glucose in the blood constantly increases, which leads to metabolic disorders, since insulin performs important function to control the processing of glucose in all cells and tissues of the body.

When the tissues of the pancreas are destroyed, the cells responsible for the production of insulin are destroyed, which is the cause of diabetes mellitus, and also if, for other reasons, the sensitivity of cells and tissues of the body to insulin contained in human blood changes.

Types of Diabetes

The causes of this disease lie in the violation of metabolism in the body, in particular carbohydrates, as well as fats. Depending on the relative or absolute insufficiency of insulin production or deterioration of tissue sensitivity to insulin, there are two main types of diabetes and other types:

• Insulin dependent diabetes mellitus- Type 1, the causes of occurrence are associated with insulin deficiency. With this type of diabetes, the lack of a hormone leads to the fact that it is not enough even to process a small amount of glucose that has entered the body. As a result, a person's blood sugar level rises. To prevent ketoacidosis - an increase in the number of ketone bodies in the urine, patients are forced to constantly inject insulin into the blood in order to live.
• non-insulin dependent diabetes mellitus- 2 types, the reasons for its appearance lie in the loss of tissue sensitivity to the hormone of the pancreas. In this type, there is both insulin resistance (insensitivity or decreased sensitivity of tissues to insulin), and its relative lack. Therefore, hypoglycemic tablets are often combined with the introduction of insulin.

According to statistics, the number of patients with this type of diabetes is much more than type 1, about 4 times, they do not need additional injections of insulin, and for their treatment drugs are used that stimulate the pancreas to secrete insulin or reduce tissue resistance to this hormone. Type 2 diabetes, in turn, is divided into:

• occurs in people of normal weight
• appears in overweight people.

Gestational diabetes mellitus- This is a rare type of diabetes that occurs in women during pregnancy, it develops due to a decrease in the sensitivity of a woman's own tissues to insulin under the influence of pregnancy hormones.

Diabetes due to malnutrition.

Other types of diabetes, they are secondary, because they occur with the following provoking factors:

• Diseases of the pancreas- hemochromatosis, chronic pancreatitis, cystic fibrosis, pancreatectomy (this)
• malnutrition leading to a mixed state - tropical diabetes
• endocrine, hormonal disorders - glucagonoma, Cushing's syndrome, pheochromocytoma, acromegaly, primary aldosteronism
• chemical diabetes- occurs on the background of the reception hormonal drugs, psychotropic or antihypertensive drugs, thiazide-containing diuretics (glucocorticoids, diazoxide, thiazides, thyroid hormones, dilantin, a nicotinic acid, adrenoblockers, interferon, vacor, pentamidine, etc.)
• Insulin receptor abnormality or genetic syndrome s - muscular dystrophy, hyperlipidemia, Huntington's chorea.

Impaired glucose tolerance, a non-permanent set of symptoms that most often resolve on their own. This is determined by analysis 2 hours after the glucose load, in this case, the patient's sugar level ranges from 7.8 to 11.1 mmol / l. With tolerance, fasting sugar is from 6.8 to 10 mmol / l, and after eating the same from 7.8 to 11.

According to statistics, about 6% of the total population of the country suffers from diabetes, this is only according to official data, but the real number, of course, is much higher, since it is known that type 2 diabetes can develop for years in a latent form and have minor symptoms or go completely unnoticed.

Diabetes enough serious disease, since it is dangerous for those complications that develop in the future. According to diabetes statistics, more than half of diabetics die from angiopathy of the legs, heart attack, nephropathy. Every year, over a million people are left without a leg, and 700,000 people lose their sight.

Causes of type 1 diabetes

Many are interested in whether it is possible to catch diabetes mellitus? Of course, diabetes cannot be contracted, since it is not an infectious disease. It has long been established by experts that diabetes is most often due to the presence of genetic defects, obesity, autoimmune disorders. So why does diabetes occur in humans?

• The causes of type 1 diabetes are most often caused by autoimmune processes in which antibodies are produced in the body against its own cells, the amount of insulin decreases until the hormone production stops completely. This is a genetic predisposition.
• According to many doctors, a viral infection is considered the most likely factor influencing the development of diabetes mellitus from the outside, since often after), infectious mononucleosis, rubella or acute or, diabetes mellitus is recorded in the patient. This is due to the fact that both in healthy people and in patients with pancreatitis, as well as malignant neoplasms In the pancreas, such autoimmune processes (antibodies to beta cells) are found extremely rarely - 0.3% of cases. But the formation of such antibodies appears in patients after damage to pancreatic beta cells against the background of a viral infection. Also, modern endocrinology believes that feeding babies with cow and goat milk leads to an early onset of diabetes, it is not recommended to give fish oil to children.
• responsible for the development of this type of diabetes increased activity T-killer cells, that is, not only violations of the humoral, but also cellular immunity lead to this disease.

It is a viral infection that triggers the development of diabetes in children. For example, as a complication after rubella, every fifth person who has been ill after the disease develops type 1 diabetes mellitus.

Causes of type 2 diabetes

In this type of diabetes, insulin secretion by pancreatic beta cells remains unchanged or decreases, but not significantly. The bulk of patients with non-insulin-dependent type of diabetes are obese people, with a small proportion muscle mass body and big mass fraction fat, as well as the elderly. In such diabetes mellitus, the cause of occurrence is considered to be a decrease in the number of insulin receptors, as well as a lack of intracellular enzymes, leading to impaired glucose metabolism in the cells and tissues of the body. Peripheral tissue resistance to the pancreatic hormone insulin leads to insulinism (increased insulin secretion), which also contributes to

Why does diabetes appear?

hereditary disposition. With diabetes in both parents, the risk of developing this disease in children during their lifetime is guaranteed by almost 60%, if only one parent suffers from diabetes, then the probability is also high and amounts to 30%. This is due to hereditary excessive sensitivity to endogenous enkephalin, which enhances insulin secretion.

In type 2 diabetes, neither autoimmune diseases nor viral infection are the causes of its development.

Frequent overeating, overweight, obesity are the main causes of type 2 diabetes. The receptors of adipose tissue, in contrast to muscle, have an underestimated sensitivity to insulin, so its excess affects the increase in the rate of glucose in the blood. According to statistics, if body weight exceeds the norm by 50%, then the risk of developing diabetes approaches 70%, if the excess weight is 20% of the norm, then the risk is 30%. However, even with normal weight, a person can have diabetes mellitus, and on average 8% of the population without overweight problems suffer from this disease to one degree or another.

With excess weight, if you reduce body weight by even 10% of a person significantly reduces the risk of type 2 diabetes. Sometimes when a patient with diabetes loses weight, glucose metabolism disorders either significantly decrease or disappear completely.

Risk factors for diabetes

• As already mentioned, with a genetic disposition, if the next of kin has diabetes, the risk of developing diabetes is very high.
• With significant trauma, shock, damage to the pancreas, the development of diabetes is also possible.
• Overweight, obesity, sedentary lifestyle, lack of muscle and an abundance of body fat.
• Diseases of the pancreas, accompanied by damage to beta cells.
• chronic stress, nervous breakdowns, aggravating factors that contribute to the progression of the disease and are the trigger for the onset of the disease with hereditary disposition and overweight.
• Viral infections such as chicken pox, rubella, hepatitis, mumps - are provoking factors for people with a genetic predisposition.
• Age also plays a key role in the development of diabetes, the older the person, the more worn out the body, there are many chronic diseases - all this increases the risk of developing diabetes. The probability of developing the disease in people after 45 years is high, and it is even higher after 65 years.
• hypertension, high blood pressure, elevated level fats (triglycerides) in the blood, eating large amounts of fatty foods.
• There is a myth that more people consumes white sugar, the higher the risk of diabetes. This is not entirely true, sweet teeth do not have an increased risk of acquiring this disease just because they eat a lot of sweets. It just makes them more likely to buy. from excess weight, which in turn provokes diabetes, and not vice versa.
• Most often, when diabetes occurs, there are several reasons at once, it can be heredity, age, and overweight.

Even one and a half thousand years before our era, the ancient Egyptians in their medical treatise "Ebers Papyrus" described diabetes mellitus as independent disease. The great physicians of ancient Greece and Rome thought tirelessly about this mysterious disease. The doctor Aretaius coined the name "diabetes" for her - in Greek "I flow, I pass through." The scientist Celsus argued that indigestion was to blame for the occurrence of diabetes, and the great Hippocrates made a diagnosis by tasting the patient's urine. By the way, the ancient Chinese also knew that with diabetes, urine becomes sweet. They came up with an original diagnostic method using flies (and wasps). If flies sit on a saucer with urine, then the urine is sweet, and the patient is sick.

Diabetes- this is endocrine disease, characterized by a chronic increase in blood sugar levels due to an absolute or relative deficiency of insulin, a hormone of the pancreas. The disease leads to a violation of all types of metabolism, damage to blood vessels, the nervous system, as well as other organs and systems.

Classification

Distinguish:

1. Insulin-dependent diabetes (type 1 diabetes) develops mainly in children and young people;
2. Non-insulin-dependent diabetes mellitus (type 2 diabetes) usually develops in people over the age of 40 who have overweight. This is the most common type of disease (occurs in 80-85% of cases);
3. Secondary (or symptomatic) diabetes mellitus;
4. Pregnancy diabetes.

Diabetes due to malnutrition

At type 1 diabetes there is an absolute deficiency of insulin due to a violation of the pancreas.

At type 2 diabetes there is a relative deficiency of insulin. The cells of the pancreas at the same time produce enough insulin (sometimes even an increased amount). However, on the surface of cells, the number of structures that ensure its contact with the cell and help glucose from the blood to enter the cell is blocked or reduced. The lack of glucose in the cells is a signal for even more insulin production, but this has no effect, and over time, insulin production decreases significantly.

The reasons

main reason type 1 diabetes is an autoimmune process caused by a malfunction immune system, in which the body produces antibodies against pancreatic cells that destroy them. The main factor provoking the occurrence of type 1 diabetes is a viral infection (rubella, chickenpox, hepatitis, mumps (mumps), etc.) against the background of a genetic predisposition to this disease.

The main factors provoking the development type 2 diabetes two: obesity and hereditary predisposition:

1. Obesity. In the presence of obesity I st. the risk of developing diabetes mellitus increases by 2 times, with II st. - 5 times, with III Art. - more than 10 times. With the development of the disease, the abdominal form of obesity is more associated - when fat is distributed in the abdomen.
2. hereditary predisposition. In the presence of diabetes in parents or close relatives, the risk of developing the disease increases by 2-6 times.

Non-insulin-dependent diabetes develops gradually and is characterized by mild symptoms.

The reasons for the so-called secondary diabetes can be:

• diseases of the pancreas (pancreatitis, tumor, resection, etc.);
• diseases of a hormonal nature (Itsenko-Cushing's syndrome, acromegaly, diffuse toxic goiter, pheochromocytoma);
• exposure to drugs or chemicals;
• changes in insulin receptors;
• certain genetic syndromes, etc.

Separately, diabetes mellitus of pregnant women and diabetes due to malnutrition are distinguished.

What's happening?

Whatever the cause of diabetes, the consequence is the same: the body cannot fully use the glucose (sugar) from food and store its excess in the liver and muscles. Unused glucose in excess circulates in the blood (partially excreted in the urine), which adversely affects all organs and tissues. Since the supply of glucose to the cells is not enough, fats begin to be used as an energy source. As a result, substances toxic to the body and especially to the brain, called ketone bodies, are formed in an increased amount, fat, protein and mineral metabolism is disturbed.

Symptoms of diabetes:

• thirst (patients can drink 3-5 liters or more of fluid per day);
• frequent urination (both day and night);
• dry mouth;
• general and muscle weakness;
• increased appetite;
• itching of the skin (especially in the genital area in women);
• drowsiness;
• increased fatigue;
• poorly healing wounds;
• sudden weight loss in patients with type 1 diabetes;
• obesity in patients with type 2 diabetes.

As a rule, diabetes mellitus type 1 (insulin-dependent) develops quickly, sometimes suddenly. Non-insulin-dependent diabetes develops gradually and is characterized by mild symptoms.

Complications of diabetes:

• cardiovascular diseases (vascular atherosclerosis, coronary heart disease, myocardial infarction);
• atherosclerosis of peripheral arteries, including arteries of the lower extremities;
• microangiopathy (damage to small vessels) of the lower extremities;
• diabetic retinopathy (decreased vision);
• neuropathy (decrease in sensitivity, dryness and peeling of the skin, pain and cramps in the limbs);
• nephropathy (urine excretion of protein, impaired renal function);
• diabetic foot - foot disease (ulcers, purulent-necrotic processes) against the background of the lesion peripheral nerves, blood vessels, skin, soft tissues;
• various infectious complications(frequent pustular skin lesions, nail fungus, etc.);
• coma (diabetic, hyperosmolar, hypoglycemic).

Type 1 diabetes mellitus is sometimes manifested by a sharp deterioration in the condition with severe weakness, abdominal pain, vomiting, and the smell of acetone from the mouth. This is due to the accumulation of toxic ketone bodies in the blood (ketoacidosis). If this condition is not quickly eliminated, the patient may lose consciousness - a diabetic coma - and die. Coma can also occur with an overdose of insulin and sharp decline blood glucose levels - hypoglycemic coma.

To prevent the development of complications of diabetes requires constant treatment and careful monitoring of blood sugar levels.

Diagnosis and treatment

Patients with diabetes must be registered with an endocrinologist.

For diagnostics diabetes perform the following studies.

• Blood glucose test: on an empty stomach, the glucose content in capillary blood (blood from a finger) is determined.
• Glucose tolerance test: on an empty stomach, take about 75 g of glucose dissolved in 1-1.5 glasses of water, then determine the concentration of glucose in the blood after 0.5, 2 hours.
• Urinalysis for glucose and ketone bodies: The detection of ketone bodies and glucose confirms the diagnosis of diabetes.
• Determination of glycosylated hemoglobin: its amount is significantly increased in patients with diabetes mellitus.
• Determination of insulin and C-peptide in the blood: in the first type of diabetes, the amount of insulin and C-peptide is significantly reduced, and in the second type, values ​​\u200b\u200bare within the normal range.

Treatment for diabetes includes:

• special diet: it is necessary to exclude sugar, alcoholic drinks, syrups, cakes, cookies, sweet fruits. Food should be taken in small portions, preferably 4-5 times a day. Products containing various sweeteners (aspartame, saccharin, xylitol, sorbitol, fructose, etc.) are recommended.
• daily use of insulin (insulin therapy) is necessary for patients with type 1 diabetes mellitus and with the progression of type 2 diabetes. The drug is available in special syringe pens, with which it is easy to make injections. When treating with insulin, it is necessary to independently control the level of glucose in the blood and urine (using special strips).
• the use of tablets that help lower blood sugar levels. As a rule, such drugs begin the treatment of type 2 diabetes. With the progression of the disease, the appointment of insulin is necessary.

People with diabetes benefit from exercise. Weight loss in obese patients also has a therapeutic role.

Treatment for diabetes is lifelong. Self-control and the exact implementation of the doctor's recommendations can avoid or significantly slow down the development of complications of the disease.

is a violation of the metabolism of carbohydrates and water in the body. The consequence of this is a violation of the functions of the pancreas. It is the pancreas that produces a hormone called insulin. Insulin is involved in the processing of sugar. And without it, the body cannot convert sugar into glucose. As a result, sugar accumulates in our blood and is excreted in large quantities from the body through urine.

In parallel with this, water exchange is disturbed. Tissues cannot retain water in themselves, and as a result, a lot of defective water is excreted through the kidneys.

If a person's blood sugar (glucose) is higher than normal, then this main feature disease - diabetes. In the human body, pancreatic cells (beta cells) are responsible for producing insulin. In turn, insulin is a hormone that is responsible for ensuring that glucose is supplied to the cells in the right amount. What happens in the body with diabetes? The body produces insufficient amounts of insulin, while the content of sugar and glucose in the blood is increased, but the cells begin to suffer from a lack of glucose.

This metabolic disease can be hereditary or acquired. Pustular and other skin lesions develop from a lack of insulin, teeth suffer, angina pectoris develops, hypertension, the kidneys, nervous system suffer, and vision deteriorates.

Etiology and pathogenesis

The pathogenetic basis for the occurrence of diabetes mellitus depends on the type of this disease. There are two varieties of it, which are fundamentally different from each other. Although modern endocrinologists call the division of diabetes mellitus very conditional, the type of disease still matters in determining medical tactics. Therefore, it is advisable to dwell on each of them separately.

In general, diabetes mellitus refers to those diseases, the essence of which is a violation metabolic processes. In this case, carbohydrate metabolism suffers the most, which is manifested by a persistent and constant increase in blood glucose. This indicator is called hyperglycemia. The most important basis of the problem is the distortion of the interaction of insulin with tissues. It is this hormone that is the only one in the body that contributes to the drop in glucose content, by carrying it into all cells, as the main energy substrate for maintaining life processes. If there is a failure in the system of interaction of insulin with tissues, then glucose cannot be included in the normal metabolism, which contributes to its constant accumulation in the blood. These cause-and-effect relationships are called diabetes mellitus.

It is important to understand that not all hyperglycemia is true diabetes mellitus, but only one that is caused by a primary violation of insulin action!

Why are there two types of disease?

Such a need is mandatory, since it completely determines the treatment of the patient, which in initial stages disease is fundamentally different. The longer and more severe diabetes mellitus proceeds, the more its division into types is formal. Indeed, in such cases, the treatment is practically the same for any form and origin of the disease.

Type 1 diabetes

This type is also called insulin-dependent diabetes. Most often, this type of diabetes affects young people, under the age of 40 years, thin. The disease is quite severe, insulin is required for treatment. Reason: The body produces antibodies that destroy the cells in the pancreas that produce insulin.

It is almost impossible to completely recover from type 1 diabetes, although there are cases of restoration of pancreatic functions, but this is possible only in special conditions and natural raw food. To maintain the body, it is required to inject insulin into the body with a syringe. Since insulin is destroyed in the gastrointestinal tract, taking insulin in the form of tablets is not possible. Insulin is administered with meals. It is very important to follow a strict diet; easily digestible carbohydrates (sugar, sweets, fruit juices, sugary lemonades) are completely excluded from the diet.

Type 2 diabetes

This type of diabetes is non-insulin dependent. Most often, type 2 diabetes affects the elderly, after 40 years, obese. Cause: loss of cell sensitivity to insulin due to overabundance nutrients in them. The use of insulin for treatment is not necessary for every patient. Only a qualified specialist can prescribe treatment and doses.

To begin with, such patients are prescribed a diet. It is very important to follow the doctor's recommendations completely. It is recommended to reduce weight slowly (2-3 kg per month) to achieve a normal weight that must be maintained throughout life. In cases where the diet is not enough, sugar-lowering tablets are used, and insulin is prescribed only in a very extreme case.

Signs and symptoms of diabetes

Clinical signs of the disease in most cases are characterized by a gradual course. Rarely, diabetes manifests itself in a fulminant form with a rise in glycemia (glucose content) to critical numbers with the development of various diabetic coma.

With the onset of the disease, patients develop:

Constant dryness in the mouth;

Feeling of thirst with inability to quench it. Sick people drink up to several liters of daily fluid;

Increased diuresis - a noticeable increase in portioned and total urine excreted per day;

Decrease or sharp increase weight and body fat;

The appearance of the smell of acetone from the patient;

Clouding of consciousness.

Appearance characteristic features diabetes or the development of its complications is an alarm signal that indicates the progression of the disease or insufficient medical correction.

Most significant causes of diabetes are such as:

Heredity. It is necessary to reduce other factors that influence the development of diabetes mellitus to nothing.

Obesity. Actively deal with excess weight.

A number of diseases that contribute to the defeat of beta cells responsible for the production of insulin. Such diseases include diseases of the pancreas -, pancreas, diseases of other endocrine glands.

Viral infections(, epidemic and other diseases, this includes). These infections are the starting point for the development of diabetes mellitus. Especially for people who are at risk.

Nervous stress. People who are at risk should avoid nervous and emotional stress.

Age. With age, for every ten years, the risk of developing diabetes doubles.

AT this list not included those diseases in which diabetes mellitus or hyperglycemia are secondary, being only their symptom. In addition, such hyperglycemia cannot be considered true diabetes until advanced clinical manifestations or diabetic complications develop. Diseases that cause hyperglycemia (increased sugar levels) include tumors and hyperfunction of the adrenal glands, chronic pancreatitis, and an increase in the level of contrainsular hormones.

Diagnosis of diabetes

If there is a suspicion of diabetes mellitus, this diagnosis must be either confirmed or refuted. For this, there are a number of laboratories and instrumental methods. These include:

Examination of blood glucose - determination of fasting glycemia;

Glucose tolerance test - determination of the ratio of fasting glycemia to this indicator after two hours after taking carbohydrate components (glucose);

Glycemic profile - the study of glycemic numbers several times during the day. Performed to evaluate the effectiveness of treatment;

Urinalysis with the determination of the level of glucose in the urine (glucosuria), protein (proteinuria), leukocytes;

Urinalysis for acetone content - if ketoacidosis is suspected;

A blood test for the concentration of glycosylated hemoglobin - indicates the degree of disorders that are caused by diabetes;

Biochemical blood test - a study of hepatic-renal tests, which indicates the adequacy of the functioning of these organs against the background of diabetes;

The study of the electrolyte composition of the blood - is shown with the development severe forms diabetes

Reberg's test - shows the degree of kidney damage in diabetes;

Determination of the level of endogenous insulin in the blood;

Examination of the fundus;

Ultrasound examination of the abdominal organs, heart and kidneys;

ECG - to assess the degree of diabetic myocardial damage;

Ultrasound dopplerography, capillaroscopy, rheovasography of the vessels of the lower extremities - assesses the degree vascular disorders with diabetes;

All patients with diabetes should be consulted by such specialists:

Endocrinologist;

Cardiologist;

neuropathologist;

Ophthalmologist;

Surgeon (vascular or special pediatrician);

The implementation of the whole complex of these diagnostic measures can help to clearly determine the severity of the disease, its degree and the correctness of tactics in relation to the treatment process. It is very important to conduct these studies not once, but to repeat them in dynamics as many times as the specific situation requires.

Blood sugar levels in diabetes

The very first and informative method primary diagnosis diabetes mellitus and its dynamic assessment during treatment is the study of blood glucose (sugar) levels. This is a clear indicator from which all subsequent diagnostics and therapeutic measures should be based.

Specialists reviewed normal and pathological glycemic numbers several times. But today their clear values ​​​​are established, which shed true light on the state of carbohydrate metabolism in the body. They should be guided not only by endocrinologists, but also by other specialists, and by patients themselves, especially diabetics with a long history of the disease.

Status of carbohydrate metabolism		Glucose indicator
Normal blood sugar		3.3-5.5 mmol/l
		<7,8 ммоль/л
Impaired glucose tolerance		5.5-6.7 mmol/l
	2 hours after carbohydrate loading	7.8-11.1 mmol/l
Diabetes		>6.7 mmol/l
	2 hours after carbohydrate loading	>11.1 mmol/l

As can be seen from the table above, the diagnostic confirmation of diabetes mellitus is extremely simple and can be carried out within the walls of any outpatient clinic or even at home with a personal electronic glucometer (a device for determining blood glucose). In the same way, criteria for assessing the sufficiency of diabetes therapy by certain methods have been developed. The main one is the same level of sugar (glycemia).

According to international standards, a good indicator of the treatment of diabetes is a blood glucose level below 7.0 mmol / l. Unfortunately, in practice this is not always feasible, despite the real efforts and strong aspirations of doctors and patients.

A very important heading in the classification of diabetes mellitus is its division into degrees of severity. This distinction is based on the level of glycemia. Another element in the correct formulation of the diagnosis of diabetes mellitus is an indication of the compensation process. This indicator is based on the presence of complications.

But for ease of understanding what happens to a patient with diabetes, looking at the records in medical records, you can combine the severity with the stage of the process in one rubric. After all, it is natural that the higher the blood sugar level, the more severe the diabetes and the higher the number of its formidable complications.

Diabetes mellitus 1 degree

characterizes the most favorable course disease to which any treatment should strive. With this degree of the process, it is fully compensated, the glucose level does not exceed 6-7 mmol / l, there is no glucosuria (glucose excretion in the urine), the indicators of glycated hemoglobin and proteinuria do not go beyond normal values.

In the clinical picture, there are no signs of complications of diabetes: angiopathy, retinopathy, polyneuropathy, nephropathy, cardiomyopathy. At the same time, it is possible to achieve such results with the help of diet therapy and taking medications.

Diabetes mellitus 2 degrees

This stage of the process indicates its partial compensation. There are signs of complications of diabetes and damage to typical target organs: eyes, kidneys, heart, blood vessels, nerves, lower extremities.

The glucose level is slightly increased and is 7-10 mmol / l. Glucosuria is not defined. Indicators of glycosylated hemoglobin are within normal limits or slightly increased. Severe violations functioning of organs are absent.

Diabetes mellitus 3 degrees

Such a course of the process indicates its constant progression and the impossibility of drug control. At the same time, the glucose level fluctuates between 13-14 mmol / l, persistent glucosuria (excretion of glucose in the urine), high proteinuria (presence of protein in the urine), and there are obvious detailed manifestations of target organ damage in diabetes mellitus.

Visual acuity progressively decreases, severe (increased blood pressure), sensitivity decreases with the appearance of severe pain and numbness of the lower extremities. The level of glycosylated hemoglobin is maintained at a high level.

Diabetes mellitus 4 degrees

This degree characterizes the absolute decompensation of the process and the development of severe complications. At the same time, the level of glycemia rises to critical numbers (15-25 or more mmol / l), it is difficult to correct by any means.

Progressive proteinuria with protein loss. Characterized by the development of renal failure, diabetic ulcers and gangrene of the extremities. Another of the criteria for grade 4 diabetes is the tendency to develop frequent diabetic coma: hyperglycemic, hyperosmolar, ketoacidotic.

Complications and consequences of diabetes

By itself, diabetes mellitus does not pose a threat to human life. Its complications and their consequences are dangerous. It is impossible not to mention some of them, which are either often encountered or pose an immediate danger to the life of the patient.

Coma in diabetes mellitus. The symptoms of this complication increase at lightning speed, regardless of the type of diabetic coma. The most important threatening sign is the clouding of consciousness or extreme lethargy of the patient. Such people should be urgently hospitalized to the nearest medical institution.

The most common diabetic coma is ketoacidotic. It is caused by the accumulation of toxic metabolic products that have a detrimental effect on nerve cells. Its main criterion is the persistent smell of acetone when the patient breathes. In the case of hypoglycemic coma, consciousness is also clouded, the patient is covered with cold profuse sweat, but a critical decrease in glucose levels is recorded, which is possible with an overdose of insulin. Other types of com, fortunately, are less common.

Edema in diabetes mellitus. Edema can be both local and widespread, depending on the degree of concomitant heart failure. Actually this symptom is an indicator of renal dysfunction. The more pronounced the swelling, the more severe the diabetic nephropathy ().

If the edema is characterized by an asymmetrical distribution, capturing only one lower leg or foot, then this indicates diabetic microangiopathy of the lower extremities, which is supported by neuropathy.

High/low blood pressure in diabetes. Indicators of systolic and diastolic pressure also act as a criterion for the severity of diabetes. It can be assessed on two levels. In the first case, the level of total arterial pressure on the brachial artery is judged. Its increase indicates a progressive diabetic nephropathy(kidney damage), as a result of which they release substances that increase pressure.

The other side of the coin is a decrease in blood pressure in the vessels of the lower extremities, determined by ultrasonic dopplerography. This indicator indicates the degree diabetic angiopathy lower limbs ().

Pain in the legs with diabetes. may indicate diabetic angio- or neuropathy. This can be judged by their character. Microangiopathy is characterized by the appearance of pain during any physical activity and walking, which makes patients stop for a short while to reduce their intensity.

The appearance of night and rest pains speaks of diabetic neuropathy. Usually they are accompanied by numbness and decreased sensitivity of the skin. Some patients note a local burning sensation in certain areas of the lower leg or foot.

Trophic ulcers in diabetes mellitus. are the next stage of diabetic angio- and neuropathy after pain. Type of wound surfaces different forms diabetic foot is fundamentally different, as is their treatment. In this situation, it is extremely important to correctly evaluate all the smallest symptoms, since the possibility of saving the limb depends on this.

It is immediately worth noting the relative favorableness of neuropathic ulcers. They are caused by a decrease in the sensitivity of the feet as a result of nerve damage (neuropathy) against the background of foot deformity (diabetic osteoarthropathy). In typical points of friction of the skin in places of bone protrusions, corns appear, which patients do not feel. Under them, hematomas are formed with their further suppuration. Patients pay attention to the foot only when it is already red, swollen and with a massive trophic ulcer on the surface.

Gangrene in diabetes mellitus. most often a consequence of diabetic angiopathy. To do this, there must be a combination of lesions of small and large arterial trunks. Usually the process begins in the region of one of the toes. Due to the lack of blood flow to it, there is severe pain in the foot and its redness. Over time, the skin becomes cyanotic, edematous, cold, and then covered with blisters with cloudy contents and black spots of skin necrosis.

The described changes are irreversible, therefore it is not possible to save the limb under any circumstances, amputation is indicated. Of course, it is desirable to perform it as low as possible, since operations on the foot do not bring any effect in gangrene, the lower leg is considered the optimal level of amputation. After such an intervention, it is possible to restore walking with the help of good functional prostheses.

Prevention of complications of diabetes mellitus. Prevention of complications is early detection disease and its adequate and correct treatment. This requires doctors to have a clear knowledge of all the intricacies of the course of diabetes, and patients must strictly comply with all dietary and medical recommendations. A separate heading in the prevention of diabetic complications is to highlight the correct daily care behind the lower limbs in order to prevent their damage, and if they are found, immediately seek help from surgeons.

To get rid of type 2 diabetes, you need to perform the following recommendations:

Go on a diet with low content carbohydrates.

Stop taking harmful diabetes pills.

Start taking an inexpensive and harmless drug for the treatment of diabetes based on metformin.

Start playing sports, increase your physical activity.

Sometimes small doses of inulin may be required to normalize blood sugar levels.

These simple recommendations will allow you to control your blood sugar levels and refuse to take drugs that give multiple complications. You need to eat right not from time to time, but every day. The transition to a healthy lifestyle is an indispensable condition for getting rid of diabetes. more reliable and easy way diabetes treatment for this moment time has not yet been invented.

Medications used in diabetes

In type 2 diabetes, hypoglycemic agents are used medications:

Drugs that stimulate the pancreas to produce more insulin. These are sulfonylurea derivatives (Gliclazide, Gliquidone, Glipizide), as well as meglitinides (Repaglitinide, Nateglitinide).

Drugs that increase the susceptibility of cells to insulin. These are biguanides ( , ). Biguanides are not prescribed to people who suffer from pathology of the heart and kidneys with severe insufficiency the functioning of these organs. Also drugs that increase the susceptibility of cells to insulin are Pioglitazone and Avandia. These drugs belong to the group of thiazolidinediones.

Drugs with incretin activity: DPP-4 inhibitors (Vildagliptin and Sitagliptin) and GGP-1 receptor agonists (Liraglutide and Exenatide).

Drugs that prevent glucose from being absorbed into the organs digestive system. This is a drug called Acarbose from the group of alpha-glucosidase inhibitors.

6 common misconceptions about diabetes

There are common beliefs about diabetes that need to be dispelled.

Diabetes develops in those people who eat a lot of sweets. This statement is not entirely true. In fact, eating sweets can cause weight gain, which is a risk factor for developing type 2 diabetes. However, a person must have a predisposition to diabetes. That is, two key points are needed: overweight body and burdened heredity.

At the beginning of the development of diabetes, insulin continues to be produced, but body fat does not allow it to be properly absorbed by the cells of the body. If this situation is observed for many years, then the pancreas will lose its ability to produce enough insulin.

Eating sweets does not affect the development of type 1 diabetes. In this case, the pancreatic cells simply die due to antibody attacks. Moreover, the body itself produces them. This process is called an autoimmune reaction. To date, science has not found the cause of this pathological process. Type 1 diabetes is known to be inherited rarely, in about 3-7% of cases.

When I have diabetes, I will immediately understand this. You can immediately find out that a person develops diabetes mellitus, if only he manifests a type 1 disease. This pathology is characterized by a rapid increase in symptoms, which are simply impossible to ignore.

At the same time, type 2 diabetes develops for a long time and is often completely asymptomatic. This is main danger illness. People learn about it already at the stage of complications, when the kidneys, heart, nerve cells were affected.

While the treatment prescribed on time could stop the progression of the disease.

Type 1 diabetes always develops in children, and type 2 diabetes in adults. Regardless of the type of diabetes, it can develop at any age. Although type 1 diabetes is more common in children and adolescents. However, this is not a reason to believe that the disease cannot begin at an older age.

The main reason that leads to the development of type 2 diabetes is obesity, but it can develop at any age. In recent years, the issue of childhood obesity in the world is quite acute.

However, type 2 diabetes is most commonly diagnosed in people over 45 years of age. Although practitioners are beginning to sound the alarm, indicating that the disease has become much younger.

If you have diabetes, you can not eat sweets, you need to eat special foods for diabetics. Your menu, of course, will have to be changed, but you should not completely abandon ordinary foods. Diabetic products can replace the usual sweets and favorite desserts, but when eating them, you need to remember that they are a source of fat. Therefore, the risk of gaining excess weight remains. Moreover, products for diabetics are very expensive. Therefore, the most simple solution there will be a transition to healthy eating. The menu should be enriched with proteins, fruits, complex carbohydrates, vitamins and vegetables.

as show latest research, an integrated approach to the treatment of diabetes can achieve significant progress. Therefore, it is necessary not only to take medicines, but also to lead a healthy lifestyle, as well as eat right. Insulin should be injected only in extreme cases, it is addictive.

If a person with type 1 diabetes refuses insulin injections, this will lead to his death. If the patient suffers from type 2 diabetes, then early stages As the disease progresses, the pancreas will still produce some insulin. Therefore, patients are prescribed drugs in the form of tablets, as well as injections of sugar-burning drugs. This will allow your insulin to be better absorbed.

As the disease progresses, less and less insulin is produced. As a result, there will come a moment when it will simply not be possible to refuse his injections.

Many people are wary of insulin injections, and these fears are not always justified. It should be understood that when the pills are not able to produce the desired effect, the risk of developing complications of the disease increases. In this case, insulin injections are a must.

It is important to control the level of blood pressure and cholesterol, as well as take drugs to normalize these indicators.

Insulin leads to obesity. Often you can observe a situation where a person who is on insulin therapy begins to gain weight. When blood sugar levels are high, the weight begins to decrease, because excess glucose is excreted in the urine, which means extra calories. When the patient begins to receive insulin, these calories cease to be excreted in the urine. If there is no change in lifestyle and diet, then it is quite logical that the weight will begin to grow. However, insulin will not be the culprit.

Unfortunately, not in all cases it is possible to influence the inevitability of the appearance of type 1 diabetes. After all, its main causes are the hereditary factor and small viruses that every person encounters. But not everyone develops the disease. And although scientists have found that diabetes is much less common in children and adults who were breastfed and treated respiratory infections antiviral drugs, this cannot be attributed to specific prevention. So really effective methods does not exist.

The situation is quite different with the prevention of type 2 diabetes. After all, it is very often the result of right image life.

Today, the question of the possibility of a complete cure for diabetes is considered very ambiguously. The complexity of the situation is that it is very difficult to return what has already been lost. The only exception is those forms of type 2 diabetes that are well controlled under the influence of diet therapy. In this case, normalizing diets and physical activity, you can completely get rid of diabetes. It should be borne in mind that the risk of recurrence of the disease in case of violation of the regimen is extremely high.

According to official medicine, type 1 diabetes mellitus and persistent forms of type 2 diabetes cannot be completely cured. But regular medical treatment can prevent or slow down the progression of complications of diabetes. After all, they are dangerous to humans. Therefore, it is extremely important to engage in regular monitoring of blood glycemia, controlling the effectiveness of therapeutic measures. It must be remembered that they must be for life. It is permissible to change only their volumes and varieties depending on the patient's condition.

However, there are many former patients who were able to recover from this incurable disease with help therapeutic fasting. But forget about this method if you cannot find a good specialist in your city who could control you and prevent the situation from getting out of control. Because there are many cases when experiments on oneself end up in intensive care!

As for the surgical methods for eliminating diabetes mellitus with the implantation of a kind of artificial pancreas, which is a device that analyzes the level of hyperglycemia and automatically releases the required amount of insulin. The results of such treatment are impressive in their effectiveness, but they are not without significant shortcomings and problems. Therefore, no one has yet succeeded in replacing the natural insulin of a particular person with a synthetic analogue, which may not be suitable for a diabetic patient in everything.

Developments continue in the field of synthesis of those types of insulin, which will consist of identical components specific to each patient. And although this is still a distant reality, every person, exhausted by the course of diabetes, believes that a miracle will happen.

Which doctor should I contact?

About the doctor:

About the doctor: From 2010 to 2016 practicing physician of the therapeutic hospital of the central medical unit No. 21, the city of Elektrostal. Since 2016, she has been working at the diagnostic center No. 3.

Diabetes mellitus is the second most common metabolic disorder after obesity. In the world, about 10% of the population suffers from diabetes mellitus, however, if we take into account the hidden forms of the disease, this figure can be 3-4 times higher. Diabetes mellitus develops as a result of chronic insulin deficiency and is accompanied by disorders of carbohydrate, protein and fat metabolism. Insulin is produced in the pancreas by the ß cells of the islets of Langerhans.

Participating in the metabolism of carbohydrates, insulin increases the entry of glucose into cells, promotes the synthesis and accumulation of glycogen in the liver, and inhibits the breakdown of carbohydrate compounds. In the process of protein metabolism, insulin enhances the synthesis of nucleic acids, protein and inhibits its decay. The effect of insulin on fat metabolism is to activate the intake of fat cells glucose, energy processes in cells, the synthesis of fatty acids and slowing down the breakdown of fats. With the participation of insulin, the process of sodium entering the cell is enhanced. Disorders of metabolic processes controlled by insulin can develop with insufficient synthesis of insulin (type I diabetes mellitus) or with tissue resistance to insulin (type II diabetes mellitus).

Causes and mechanism of development

Type I diabetes mellitus is more often detected in young patients under 30 years of age. Violation of insulin synthesis develops as a result of damage to the pancreas of an autoimmune nature and the destruction of insulin-producing ß-cells. In most patients, diabetes mellitus develops after a viral infection (mumps, rubella, viral hepatitis) or toxic effects (nitrosamines, pesticides, drugs, etc.), the immune response to which causes the death of pancreatic cells. Diabetes mellitus develops if more than 80% of insulin-producing cells are affected. Being an autoimmune disease, type I diabetes mellitus is often combined with other processes of autoimmune genesis: thyrotoxicosis, diffuse toxic goiter, etc.

There are three degrees of severity of diabetes mellitus: mild (I), moderate (II) and severe (III) and three states of compensation for carbohydrate metabolism disorders: compensated, subcompensated and decompensated.

Symptoms

The development of type I diabetes is rapid, type II - on the contrary, gradually. Often there is a latent, asymptomatic course of diabetes mellitus, and its detection occurs by chance during the study of the fundus or laboratory determination sugar in blood and urine. Clinically, type I and type II diabetes manifest themselves in different ways, but the following symptoms are common to them:

• thirst and dry mouth, accompanied by polydipsia (increased fluid intake) up to 8-10 liters per day;
• polyuria (abundant and frequent urination);
• polyphagia (increased appetite);
• dry skin and mucous membranes, accompanied by itching (including perineum), pustular skin infections;
• sleep disturbance, weakness, decreased performance;
• cramps in the calf muscles;
• visual impairment.

Manifestations of type I diabetes mellitus are characterized by intense thirst, frequent urination, nausea, weakness, vomiting, increased fatigue, constant hunger, weight loss (with normal or increased nutrition), irritability. A sign of diabetes in children is the appearance of bedwetting, especially if the child has not previously urinated in bed. In type 1 diabetes, hyperglycemic (critically high blood sugar) and hypoglycemic (critically low blood sugar) conditions are more likely to develop, requiring emergency measures.

In type II diabetes mellitus, the predominant pruritus, thirst, blurred vision, severe drowsiness and fatigue, skin infections, slow wound healing processes, paresthesia and numbness of the legs. Patients with type II diabetes are often obese.

The course of diabetes is often accompanied by hair loss on the lower extremities and increased hair growth on the face, the appearance of xanthomas (small yellowish growths on the body), balanoposthitis in men and vulvovaginitis in women. As diabetes progresses, a violation of all types of metabolism leads to a decrease in immunity and resistance to infections. The long course of diabetes causes damage to the skeletal system, manifested by osteoporosis (a rarefaction bone tissue). There are pains in the lower back, bones, joints, dislocations and subluxations of the vertebrae and joints, fractures and deformation of the bones, leading to disability.

Complications

The course of diabetes mellitus can be complicated by the development of multiple organ disorders:

• diabetic angiopathy - increased vascular permeability, their fragility, thrombosis, atherosclerosis, leading to the development of coronary heart disease, intermittent claudication, diabetic encephalopathy;
• diabetic polyneuropathy - damage to the peripheral nerves in 75% of patients, resulting in a violation of sensitivity, swelling and chilliness of the limbs, a burning sensation and "crawling" goosebumps. Diabetic neuropathy develops years after the onset of diabetes mellitus, and is more common in the non-insulin dependent type;
• diabetic retinopathy - destruction of the retina, arteries, veins and capillaries of the eye, decreased vision, fraught with retinal detachment and complete blindness. In type I diabetes, it manifests itself after 10-15 years, in type II - earlier, it is detected in 80-95% of patients;
• diabetic nephropathy - damage to the renal vessels with impaired renal function and the development of renal failure. It is noted in 40-45% of patients with diabetes mellitus after 15-20 years from the onset of the disease;
• diabetic foot - circulatory disorders of the lower extremities, pain in the calf muscles, trophic ulcers, destruction of the bones and joints of the feet.

Critical, acutely emerging conditions in diabetes mellitus are diabetic (hyperglycemic) and hypoglycemic coma.

Hyperglycemia and coma develop as a result of a sharp and significant increase in blood glucose levels. The harbingers of hyperglycemia are the increasing general malaise, weakness, headache, depression, loss of appetite. Then there are pains in the abdomen, Kussmaul's noisy breathing, vomiting with the smell of acetone from the mouth, progressive apathy and drowsiness, and a decrease in blood pressure. This condition is caused by ketoacidosis (accumulation of ketone bodies) in the blood and can lead to loss of consciousness - diabetic coma and death of the patient.

The opposite critical condition in diabetes mellitus - hypoglycemic coma develops when plummet blood glucose levels, more often due to an overdose of insulin. The increase in hypoglycemia is sudden, rapid. There is a sharp feeling of hunger, weakness, trembling in the limbs, shallow breathing, arterial hypertension, the patient's skin is cold, wet, sometimes convulsions develop.

Prevention of complications in diabetes mellitus is possible with constant treatment and careful monitoring of blood glucose levels.

Diagnostics

The presence of diabetes mellitus is evidenced by the content of glucose in capillary blood on an empty stomach, exceeding 6.5 mmol / l. Normally, there is no glucose in the urine, because it is retained in the body by the kidney filter. With an increase in blood glucose levels of more than 8.8-9.9 mmol / l (160-180 mg%), the renal barrier fails and passes glucose into the urine. The presence of sugar in the urine is determined by special test strips. The minimum level of glucose in the blood at which it begins to be determined in the urine is called the “renal threshold”.

Examination for suspected diabetes mellitus includes determining the level of:

• fasting glucose in capillary blood (from a finger);
• glucose and ketone bodies in the urine - their presence indicates diabetes mellitus;
• glycosylated hemoglobin - significantly increased in diabetes mellitus;
• C-peptide and insulin in the blood - in type I diabetes mellitus, both indicators are significantly reduced, in type II they are practically unchanged;
• carrying out a stress test (glucose tolerance test): determination of glucose on an empty stomach and 1 and 2 hours after taking 75 g of sugar dissolved in 1.5 glasses boiled water. The test result is considered negative (not confirming diabetes mellitus) with samples: on an empty stomach 6.6 mmol / l at the first measurement and > 11.1 mmol / l 2 hours after the glucose load.

To diagnose complications of diabetes, additional examinations are carried out: ultrasound of the kidneys, rheovasography of the lower extremities, rheoencephalography, EEG of the brain.

Treatment

Implementation of the recommendations of a diabetologist, self-monitoring and treatment of diabetes mellitus are carried out for life and can significantly slow down or avoid complicated variants of the course of the disease. Treatment of any form of diabetes mellitus is aimed at lowering blood glucose levels, normalizing all types of metabolism and preventing complications.

The basis for the treatment of all forms of diabetes is diet therapy, taking into account the gender, age, body weight, physical activity of the patient. Training is provided on the principles of calculating the calorie content of the diet, taking into account the content of carbohydrates, fats, proteins, vitamins and microelements. In insulin-dependent diabetes mellitus, it is recommended to consume carbohydrates at the same hours to facilitate control and correction of glucose levels with insulin. With IDDM type I, the intake of fatty foods that contribute to ketoacidosis is limited. With non-insulin-dependent diabetes mellitus, all types of sugars are excluded and the total calorie content of food is reduced.

Nutrition should be fractional (at least 4-5 times a day), with a uniform distribution of carbohydrates, contributing to a stable glucose level and maintaining basal metabolism. Special diabetic products based on sweeteners (aspartame, saccharin, xylitol, sorbitol, fructose, etc.) are recommended. Correction of diabetic disorders with only one diet is used in a mild degree of the disease.

Choice drug treatment diabetes mellitus is determined by the type of disease. Patients with type I diabetes are shown insulin therapy, with type II - a diet and hypoglycemic agents (insulin is prescribed for the ineffectiveness of taking tablet forms, the development of ketoazidosis and precoma, tuberculosis, chronic pyelonephritis, liver and kidney failure).

The introduction of insulin is carried out under the systematic control of glucose levels in the blood and urine. There are three main types of insulin according to the mechanism and duration of action: prolonged (prolonged), intermediate and short action. Long-acting insulin is administered once a day, regardless of the meal. More often, injections of prolonged insulin are prescribed together with intermediate and short-acting drugs, allowing compensation for diabetes mellitus.

The use of insulin is dangerous with an overdose, leading to a sharp decrease in sugar, the development of a state of hypoglycemia and coma. Selection of drugs and doses of insulin is carried out taking into account changes in the patient's physical activity during the day, stability of blood sugar levels, caloric content diet, fractional nutrition, insulin tolerance, etc. With insulin therapy, the development of local (pain, redness, swelling at the injection site) and general (up to anaphylaxis) is possible allergic reactions. Also, insulin therapy can be complicated by lipodystrophy - "failures" in adipose tissue at the site of insulin injection.

Sugar-reducing tablets are prescribed for non-insulin-dependent diabetes mellitus in addition to the diet. According to the mechanism of lowering blood sugar, the following groups of hypoglycemic agents are distinguished:

• sulfonylurea preparations (gliquidone, glibenclamide, chlorpropamide, carbutamide) - stimulate the production of insulin by pancreatic ß-cells and promote the penetration of glucose into tissues. The optimally selected dosage of drugs in this group maintains a glucose level not > 8 mmol / l. In case of an overdose, hypoglycemia and coma may develop.
• biguanides (metformin, buformin, etc.) - reduce the absorption of glucose in the intestine and contribute to the saturation of peripheral tissues with it. Biguanides can increase the level of uric acid in the blood and cause the development serious condition- lactic acidosis in patients over 60 years of age, as well as those suffering from liver and kidney failure, chronic infections. Biguanides are more often prescribed for non-insulin dependent diabetes mellitus in young obese patients.
• meglitinides (nateglinide, repaglinide) - cause a decrease in sugar levels by stimulating the pancreas to secrete insulin. The action of these drugs depends on the content of sugar in the blood and does not cause hypoglycemia.
• alpha-glucosidase inhibitors (miglitol, acarbose) - slow down the rise in blood sugar by blocking the enzymes involved in the absorption of starch. Side effect- flatulence and diarrhea.
• thiazolidinediones - reduce the amount of sugar released from the liver, increase the susceptibility of fat cells to insulin. Contraindicated in heart failure.

In diabetes mellitus, it is important to teach the patient and his family members the skills to control the well-being and condition of the patient, first aid measures in the development of precomatous and comatose conditions. beneficial therapeutic effect in diabetes mellitus, it has a reduction in excess weight and individual moderate physical activity. Due to muscle efforts, there is an increase in the oxidation of glucose and a decrease in its content in the blood. However, exercise should not be started at glucose levels > 15 mmol/l, but must first be allowed to decrease under the influence of drugs. In diabetes mellitus, physical activity should be evenly distributed to all muscle groups.

Forecast and prevention

Patients with diagnosed diabetes mellitus are registered with an endocrinologist. With the organization of the right lifestyle, nutrition, treatment, the patient can feel satisfactory long years. Aggravate the prognosis of diabetes mellitus and reduce the life expectancy of patients with acute and chronically developing complications.

Prevention of type I diabetes mellitus is reduced to increasing the body's resistance to infections and eliminating the toxic effects of various agents on the pancreas. Preventive measures for type II diabetes mellitus include preventing the development of obesity, correcting nutrition, especially in people with aggravated hereditary history. Prevention of decompensation and complicated course of diabetes mellitus consists in its correct, systematic treatment.

Diabetes mellitus is an endocrinological pathology accompanied by a syndrome of hyperglycemia (high blood glucose levels) caused by insulin deficiency. This disease is accompanied by carbohydrate imbalance and other metabolic disorders in the body.

At the moment, diabetes is diagnosed in 10-15% of the population of our planet. Increasing cases of development this disease in childhood, as a rule, after unreasonable antibiotic therapy, stress and viral infections. There is an annual increase in the number of patients with diabetes mellitus by 9-10%. Today, the number of patients with this disease exceeds 200 million people. Diabetes is diagnosed in both men and women.

Causes and mechanism of development of diabetes

As a result of a violation of the synthesis and secretion of insulin by the beta cells of the islets of Langerhans, there is a decrease in the level of insulin in the blood, which eventually leads to absolute insulin deficiency. There is also relative insulin deficiency, which may be the result of a decrease in insulin activity as a result of its increased connection with protein, intensive destruction by liver enzymes, the prevalence of the effects of non-hormonal and hormonal insulin antagonists (thyroid hormones, adrenal cortex, glucagon, non-esterified fatty acids, growth hormone) , changes in insulin resistance of insulin-dependent tissues to insulin.

Insulin deficiency provokes violations of protein, carbohydrate and fat metabolism in the body. The level of glucose permeability of cell membranes in muscle and adipose tissue decreases, gluconeogenesis and glycogenolysis increase, glucosuria, hyperglycemia occur, which are accompanied by polydipsia and polyuria. The breakdown increases and the formation of fats decreases, which causes an increase in the level of ketone bodies in the blood (acetone, a condensation product of acetoacetic acid, beta-hydroxybutyric and acetoacetic acids). These phenomena cause a shift acid-base balance towards acidosis, and also affect the increase in the excretion of magnesium, sodium, potassium ions in the urine and leads to renal dysfunction.

There may be a decrease in the alkaline reserve of the blood up to 25% vol. carbon dioxide and lowering the blood pH to 7.2-7.0.

How Type I Diabetes Develops

The causes of diabetes are somewhat different depending on the type of diabetes. For example, patients with type I diabetes mellitus, due to autoimmune aggression and viral infection, undergo the breakdown of beta cells in the body, as a result of which deficiency develops with all the ensuing consequences.

How Type II Diabetes Develops

Patients with type II diabetes have enough insulin, but the tissues of the body lose the ability to perceive its signal. With the development of obesity, adipose tissue acts as a kind of barrier that blocks the action of insulin. In order to eliminate this barrier, beta cells turn on an intensive mode of operation, which subsequently leads to their depletion and the transition of relative insulin deficiency to absolute. But nevertheless, insulin-dependent diabetes does not transform into insulin-dependent.

Regardless etiological factor development of diabetes, the same process occurs, which consists in slowing down the conversion of sugar that comes from outside and is present in the blood.

Classification of diabetes

Depending on the clinical features, the following types of diabetes are distinguished:

1. Type I diabetes mellitus, which in turn has several subspecies:
   • insulin-dependent diabetes mellitus;
   • non-insulin dependent diabetes mellitus:
   • in people with obesity;
   • in persons of normal weight.
   • diabetes mellitus, the cause of which is malnutrition;
   • other verifications of type I diabetes mellitus associated with certain syndromes and conditions of the body:
     • endocrine pathologies;
     • anomalies of insulin or its receptor;
     • diseases of the pancreas;
     • certain genetic syndromes;
     • conditions caused by exposure to chemicals or medications;
     • conditions of mixed etiological factors;
2. Type II diabetes mellitus indicates a violation of glucose tolerance and is divided into the following forms:
   • in patients without excess weight;
   • in people with obesity;
   • caused by a particular condition or syndrome.
3. Type III diabetes can develop during pregnancy.

Separate static risk classes of this disease have been identified (patients with normal glucose tolerance, but a significant risk of developing diabetes):

• a condition preceding impaired glucose tolerance;
• potential disorders of glucose tolerance.

Essential (primary) type of diabetes mellitus

Essential (primary) type of diabetes mellitus, which is associated with malnutrition, is singled out as a separate pathology. This disease occurs in people under the age of 30 living in tropical countries. According to statistics, the ratio of men and women is 2:1. The total number of patients with this form of diabetes mellitus is 20 million people.

Most often there are two subtypes of this diabetes. The first of these is fibrocalculous pancreatic diabetes.

Fibrocalculous pancreatic diabetes

Geographically, it mainly covers Indonesia, India, Brazil, Bangladesh, Uganda and Nigeria. This pathology is characterized by the presence of extensive pancreatic fibrosis and stone formation in the main pancreatic duct. Clinical picture presents with dramatic weight loss, recurrent abdominal pain, and other signs of malnutrition. Insulin therapy in this case makes it possible to eliminate moderate and high glucosuria and hyperglycemia. One of the characteristic features of this pathology is the absence of ketoacidosis, which is due to reduced insulin production and the release of glucagon by the islet apparatus of the pancreas. Topographic surveys ( ultrasound diagnostics, radiography, computed tomography) make it possible to determine the presence of stones in the pancreatic ducts.

There is an opinion that one of the factors in the development of fibrocalculous pancreatic diabetes is the inclusion in the diet of cassava roots (cassava, tapioca), which contain cyanogenic glycosides, one of which is linamarin, from which hydrocyanic acid is released during hydrolysis. With the participation of sulfur-containing acids, its pernicious influence is eliminated, and insufficient intake of protein foods, often found in the population of the above countries, provokes the accumulation of cyanide in the body, which is the cause of the development of fibrocalculosis.

pancreatic diabetes

The development of pancreatic diabetes (type II diabetes) is associated with protein deficiency in the body, but there are no manifestations of pancreatic fibrosis. It is characterized by moderate insulin resistance and resistance to the development of ketoacidosis. In most cases, patients suffer from exhaustion. Patients have reduced insulin secretion, but not to the same extent as in patients with type I diabetes, this explains the absence of ketoacidosis.

Subtype J

In the classification of diabetes mellitus, according to the WHO data presented above, there is no mention of the third subtype of pancreatic diabetes, which occurs in Jamaica, we are talking about subtype J. Subtype J has much in common with pancreatic diabetes due to protein deficiency.

Symptoms of Diabetes

The first symptoms of diabetes are due to high content blood glucose. After exceeding the level of 8.9 - 10.0, sugar enters the urine. With continued increase in blood glucose levels, the kidneys additionally remove water, this is clinically manifested by frequent urination (polyuria). Excessive excretion of urine causes a constant feeling of thirst (polydipsia). With urine, the body loses a large number of calories represented by glucose, so a person loses weight and constantly feels hungry.

Other symptoms of diabetes include drowsiness, decreased visual acuity, fatigue, and nausea. In addition, patients with uncontrolled diabetes are prone to infections. Patients with type 1 diabetes are severely insulin deficient and therefore almost always lose weight before starting therapy. Patients with type II diabetes mellitus do not lose body weight.

In type 1 diabetes, there is fast development clinical manifestations and may soon progress to diabetic ketoacidosis. Regardless of the high level of glucose in the blood, the cells are not able to use it without the presence of insulin, so they switch to other sources of energy. The destruction of fat cells begins, which provokes the formation of ketone bodies, which are toxic chemical compounds that “acidify” the blood.

diabetic ketoacidosis

The first symptoms of diabetic ketoacidosis are excessive urination and excessive thirst, nausea, vomiting, fatigue, weight loss, and abdominal pain (especially in childhood). Patients have frequent and deep breathing, which is associated with the body's attempts to neutralize the excess acidity of the blood, this process is accompanied by the appearance of the smell of acetone from the mouth. In the absence of treatment, diabetic ketoacidosis can be complicated by the development of coma, in some cases this process occurs within a few hours.

Type I diabetes can be accompanied by the development of ketoacidosis even after the start of insulin therapy if the patient misses a scheduled injection or is subjected to severe emotional stress, in particular in case of injury, severe infection or other serious illness.

Patients with type II diabetes mellitus long time may not feel any signs of this pathology. Such a latent period of the disease can last up to several decades. Clinical manifestations become more active as insulin deficiency worsens.

At first, the volume of urine excreted only slightly exceeds the norm, thirst is mild, but over time, these processes progress. The phenomena of ketoacidosis are rare. With a significant increase in blood glucose levels (in some cases up to 55 mmol / l), this usually occurs when additional loads on the body, for example, under the influence of drugs or in severe infectious diseases, the patient may plunge into a state of confused consciousness provoked by severe dehydration, convulsions, drowsiness and in the most severe cases- a condition called non-ketone hyperglycemic hyperlsmolar coma.

How else does diabetes manifest itself?

High blood glucose levels can lead to nerve damage over time, blood vessels and other structures. Chemical compounds containing glucose in the composition are located on the walls of small blood vessels, as a result of which the walls of the vessels thicken and are damaged. The narrowing of the lumen of the vessels causes a deterioration in blood flow, especially the blood supply to the skin and nerve endings. Without compensation for diabetes in the blood, an increase in the level of fatty substances occurs, which accelerates the development of atherosclerosis. Patients diagnosed with diabetes mellitus, regardless of gender, suffer from atherosclerosis 2-6 times more often than people who do not have this diagnosis. Disturbances in the blood circulation of the vessels cause dysfunctions in the heart, kidneys, eyes, lower extremities, brain, skin and nerves, and also slow down the healing process of wounds.

What is the severity of diabetes

All of these factors increase the risk of developing many long-term complications. Patients with diabetes have an increased risk of strokes and heart attacks, loss of vision (diabetic retinopathy) can occur as a result of damage to the blood vessels in the eyes, and kidney problems provoke kidney failure therefore dialysis is necessary in some cases. Nerve damage can have many consequences. Mononeuropathy (disruption of the work of one nerve) can manifest itself as a sudden weakness of the upper or lower limb. Diabetic polyneuropathy (damage to the nerves in the legs, feet, or hands) causes sensory disturbances, pain, burning or tingling, and a feeling of weakness in the arms and legs. Reduced temperature and pain sensitivity, which leads to increased trauma. Circulatory disorders can contribute to ulcers and poor wound healing. Ulcers localized on the feet are very deep and poorly healed, which leads to infection and, in some cases, to amputation of the affected limb.

Clinical studies have shown that it is possible to avoid or delay the complications of diabetes if maintained consistently. normal level blood sugar. The course of this disease is currently not fully understood. There are a number of unexplored factors that cause its development, these factors include genetic ones.

Diagnosis of diabetes

Diagnosis of diabetes mellitus begins with the collection of anamnesis and examination of the patient. During these activities, it is determined whether the patient has hereditary factors, obesity, whether the patient belongs to the number of identical twins (if one of them suffers from diabetes, the second must be examined), in women, the presence of childbirth and whether there was a large fetus.

• blood glucose test - performed twice;
• glucose tolerance test;
• determining the level of glucose in daily urine.

With the diagnosis of diabetes mellitus, it is very important to find out the presence of complications; for this, all organs and systems are diagnosed.

Complications of diabetes

Complications of diabetes can be acute and chronic, and they vary depending on the form of diabetes. Among acute complications emit coma, during which loss of consciousness is preceded by disruption of the brain due to very low or very high concentration blood sugar. These states include:

• diabetic ketoacytosis (the most common acute complication), manifested by polyuria, polydipsia, lack of appetite, weakness, abdominal pain, nausea and vomiting;
• hypoglycemic coma, is an extreme degree of hypoglycemia, occurs with a sharp decrease in blood glucose levels. Often the result of an incorrect dose of insulin, and sometimes occurs after ingestion of certain foods or sulfa drugs.
• hyperosmolar coma outweighs diabetic coma in severity, occurs mainly in elderly people, with type II diabetes mellitus. In 30% of cases, it causes the death of the patient, and in the presence of severe comorbidities - in 70%.

Chronic (late) complications are combined into a group of pathologies that develop with prolonged exposure to high blood sugar on the patient's organs and systems. First of all, organs more sensitive to sugar are subject to damage, they are a kind of “target” for diabetes mellitus. Among chronic complications Diabetes is known to:

• diabetic retinopathy occurs in 90% of diabetic patients. It develops with a long course of diabetes and is manifested by damage to the vessels of the eye retina;
• diabetic nephropathy is a complex lesion of the kidneys (tubules, arteries, glomeruli, arterioles). The prevalence among patients with diabetes is 75%;
• diabetic neuropathy is represented by damage to the peripheral nerves in patients with diabetes. Neuropathy is a predisposing factor for the development of diabetic foot, which can lead to limb amputation;
• diabetic encephalopathy is a progressive brain lesion. Manifested by increased fatigue, decreased performance, impaired concentration, emotional lability, clenching headaches, anxiety and deterioration of the thought process;
• diabetic skin lesions are structural deformations of the epidermis, follicles, sweat glands due to impaired carbohydrate metabolism and accumulation of metabolic products. In the case of a severe form of diabetes, the skin becomes flaky, rough, with areas of calluses, cracks, the skin becomes yellowish, hair loss occurs;
• diabetic foot and hand syndrome occurs in 30-80% of patients with diabetes mellitus and is a complex of anatomical and functional disorders that manifest as brown spots and ulcerations on the lower leg, foot and phalanges of the fingers, which in severe cases can lead to limb amputation.

Treatment of diabetes

Treatment of diabetes depends on the type of disease, but first of all, the patient needs to normalize the level of glucose in the blood. To do this, you need to radically change your lifestyle and diet. Recommended for diabetic patients special diet, which is based on the calculation of consumed carbohydrates, proteins and fats, vitamins and trace elements. This calculation is taught by specialists in this field.

Choice of tactics drug therapy depends on the type of diabetes. Patients with type I diabetes mellitus need insulin therapy, with type II it is shown to adhere to the strictest diet and use glucose-containing drugs, if tablet forms of drugs are ineffective, insulin is prescribed.

Insulin intake is carried out under strict control of blood glucose levels. According to the mechanism of action, insulin preparations are divided into three types: prolonged, short and intermediate action. Sugar-containing drugs are indicated in the case of non-insulin dependent diabetes mellitus in combination with a diet. Sugar-containing drugs include: biguanides, sulfonylurea drugs, thiazolidinediones and methiglitinides.

With this insidious disease, it is very important for medical personnel to properly train the patient and his relatives in the skills of monitoring the patient's condition and providing first aid in case of pre-coma and comatose conditions.

Prognosis for diabetes

In the presence of diabetes, the patient becomes registered with the endocrinologist. In conditions adequate therapy, the patient can be in a satisfactory condition for many years. Acute and chronic complications can worsen the prognosis regarding the health status and life expectancy of a patient with diabetes mellitus.

Prevention of diabetes

For type I diabetes preventive measures consist in increasing the body's resistance to various infections and eliminating the toxic effects of antibodies on the pancreas. For patients with type II diabetes, it is very important to adjust the diet and prevent the development of obesity. To prevent the development of complications in conditions of diabetes mellitus, it is necessary to correctly and systematically follow the doctor's recommendations and clarify whether one or another food can be consumed.