The most important principle of treatment of non-insulin dependent. Insulin dependent diabetes mellitus: what is it? The most formidable complications of diabetes

Despite the fact that patients with type II diabetes mellitus are prescribed insulin preparations, insulin-dependent diabetes is still considered to be type I disease. This is due to the fact that with this disease, the body stops producing its own insulin.

The pancreas of people diagnosed with insulin-dependent diabetes is practically devoid of cells that produce this protein hormone.

In type II diabetes, the pancreas produces too little insulin and the cells of the body do not have enough of this hormone to function normally. Often, correct insulin production and metabolism in type II diabetes can be normalized and put in order. physical exercise and well-planned diet.

If this is the case, these patients will not need insulin. For this reason, type I diabetes is also commonly referred to as insulin-dependent. diabetes.

When a patient with type II diabetes has to be prescribed insulin, the disease is said to have entered an insulin-dependent phase. But, fortunately, this does not happen very often.

Type I diabetes mellitus develops very rapidly and usually occurs in childhood and adolescence. This is where another name for this type of diabetes comes from – “juvenile”. Full recovery is possible only with a pancreas transplant. But such an operation entails a lifelong intake of medications that suppress the immune system. This is necessary in order to prevent rejection of the pancreas.

Injection of insulin does not have such a strong effect on the body. negative impact, and with proper insulin therapy, the life of a patient with type 1 diabetes is no different from life healthy people.

How to notice the first symptoms

When type 1 diabetes is just beginning to develop in a child or teenager, it can be difficult to identify right away.

1. If the child constantly asks to drink in summer heat, then, most likely, parents will consider it natural.
2. Visual impairment and high fatigue of students primary school are often attributed to high school loads and the body's unaccustomed to them.
3. There is also an excuse for weight loss, they say, hormonal changes take place in the body of a teenager, fatigue again affects.

But all these signs can be the beginning of developing type I diabetes. And if the first symptoms went unnoticed, then the child may suddenly develop ketoacidosis. By its nature, ketoacidosis resembles poisoning: abdominal pain, nausea, and vomiting occur.

But with ketoacidosis, consciousness gets confused and all the time tends to sleep, which is not the case with food poisoning. The smell of acetone from the mouth is the first sign of illness.

Ketoacidosis can also occur with type II diabetes, but in this case, the patient's relatives already know what it is and how to behave. But the ketoacidosis that appeared for the first time is always unexpected, and this is why it is very dangerous.

Meaning and principles of insulin treatment

The principles of insulin therapy are very simple. After a healthy person has taken food, his pancreas releases the required dose of insulin into the blood, glucose is absorbed by the cells, and its level decreases.

In people with type I and type II diabetes, for various reasons, this mechanism is impaired, so it has to be mimicked manually. To correctly calculate the required dose of insulin, you need to know how much and with what products the body receives carbohydrates and how much insulin is required for their processing.

The amount of carbohydrates in food does not affect its calorie content, so it makes sense to count calories, unless type I and II diabetes is accompanied by overweight.

Type 1 diabetes does not always require a diet, which is not the case with insulin-dependent type 2 diabetes. That's why every type I diabetic needs to measure their blood sugar levels and correctly calculate their insulin doses.

People with type II diabetes who do not use insulin injections should also keep a self-monitoring diary. The longer and more accurate the record is kept, the easier it is for the patient to take into account all the details of his illness.

The diary will provide invaluable assistance in controlling nutrition and lifestyle. In this case, the patient will not miss the moment when type II diabetes turns into an insulin-dependent form of type I.

"Bread unit" - what is it

Diabetes I and II require constant counting of the amount of carbohydrates consumed by the patient with food.

In type I diabetes, this is necessary in order to correctly calculate the dose of insulin. And in type II diabetes, in order to control the treatment and diet food. When calculating, only those carbohydrates are taken into account that affect the level of glucose and the presence of which forces the administration of insulin.

Some of them, such as sugar, are absorbed quickly, others - potatoes and cereals, are absorbed much more slowly. To facilitate their calculation, a conditional value, called a "bread unit" (XE), was adopted, and a peculiar one simplifies the life of patients.

One XE is equal to approximately 10-12 grams of carbohydrates. This is exactly as much as is contained in a 1 cm thick piece of white or black “brick” bread. It does not matter which foods are measured, the amount of carbohydrates will be the same:

• in one tablespoon of starch or flour;
• in two tablespoons of ready-made buckwheat porridge;
• in seven tablespoons of lentils or peas;
• in one medium potato.

Those suffering from type I diabetes and severe type II diabetes should always remember that liquid and boiled foods are absorbed faster, which means that they increase blood glucose levels more than solid and thick foods.

Therefore, when going to eat, the patient is recommended to measure sugar. If it is below the norm, then you can eat semolina porridge for breakfast, but if the sugar level is above the norm, then it is better to have scrambled eggs for breakfast.

On average, one XE requires from 1.5 to 4 units of insulin. True, in the morning it needs more, and in the evening - less. In winter, the dosage increases, and with the onset of summer, it decreases. Between two meals, a type I diabetic can eat one apple, which is equal to 1 XE. If a person controls blood sugar levels, then he will not need an additional injection.

Which insulin is best

In diabetes mellitus I and II, 3 types of pancreatic hormones are used:

1. human;
2. pork;
3. bullish.

It is impossible to say exactly which one is better. The effectiveness of insulin treatment does not depend on the origin of the hormone, but on its correct dosage. But there is a group of patients who are prescribed only human insulin:

1. pregnant women;
2. children with type I diabetes for the first time;
3. people with complicated diabetes.

Insulins are divided into short-acting, intermediate-acting and long-acting insulins according to their duration of action.

Short insulins:

• Actropid;
• Insulrap;
• Iletin P Homorap;

Any of them begins to work 15-30 minutes after the injection, and the duration of the injection is 4-6 hours. The drug is administered before each meal and between them if the sugar level rises above normal. People with type 1 diabetes should always have doses of additional injections with them.

Intermediate acting insulins

• Semilente MS and NM;
• Semilong.

They turn on their activity 1.5 - 2 hours after the injection, and the peak of their action occurs after 4-5 hours. They are convenient for those patients who do not have time or do not want to have breakfast at home, but do it at work, but are embarrassed to administer the drug in front of everyone.

You just need to take into account that if you do not take food on time, then the sugar level can drop sharply, and if there are more than carbohydrates in the diet, you will have to use additional injections.

That's why this group insulin is acceptable only for those who, eating out, know exactly what time they will eat and how much carbohydrates will be in it.

Long acting insulins

1. Monotard MS and NM;
2. Protafan;
3. Iletin PN;
4. Homofan;
5. Humulin N;
6. Tape.

Their action begins 3-4 hours after injection. For some time, their level in the blood remains unchanged, and the duration of action is 14-16 hours. In type I diabetes, these insulins are injected twice a day.

Where and when do insulin injections

Compensation for type I diabetes is carried out by combining insulin different duration. The advantages of such schemes are that with their help you can most closely simulate the work of the pancreas, plus you need to know

A disease such as diabetes mellitus is widespread and occurs in adults and children. Non-insulin-dependent diabetes mellitus (NIDDM) is diagnosed much less frequently and refers to diseases of a heterogeneous type. In non-insulin-dependent patients with diabetes mellitus, there is a deviation in insulin secretion and impaired tissue sensitivity. peripheral type to insulin, this deviation is also known as insulin resistance.

Non-insulin dependent diabetes mellitus requires regular medical supervision and treatment, as severe complications are possible.

Causes and mechanism of development

The main reasons for the development of non-insulin-dependent diabetes mellitus include such unfavorable factors:

• genetic predisposition. The factor is the most common and more likely to cause insulin-independent diabetes in a patient.
• Improper diet leading to obesity. If a person consumes a lot of sweets, fast carbohydrates, while there is a shortage of foods with fiber, then he falls into the risk zone of developing non-insulin-dependent diabetes. The probability increases several times if, with such a diet, an addicted person leads a sedentary lifestyle.
• Decreased sensitivity to insulin. Pathology can occur in three ways:
  • deviation of the pancreas, in which the secretion of insulin is impaired;
  • pathologies of peripheral tissues that become resistant to insulin, which provokes impaired transportation and metabolism of glucose;
  • failures in the functioning of the liver.
• Deviation in carbohydrate metabolism. Insulin-dependent type 2 diabetes mellitus over time activates glucose metabolic pathways that are independent of insulin.
• Disturbed protein and fat metabolism. When protein synthesis decreases and protein metabolism increases, a person has sudden loss weight and muscle wasting.

Non-insulin dependent type of diabetes mellitus develops gradually. First, tissue sensitivity to insulin decreases, which subsequently causes increased lipogenesis and progressive obesity. In non-insulin dependent diabetes mellitus, it often develops arterial hypertension. If the patient is insulin independent, then his symptoms are mild and ketoacidosis rarely develops, unlike a patient who is dependent on insulin injections.

Main symptoms

Non-insulin-dependent diabetes is characterized by a mild clinical picture, but at the same time, several body systems can be affected at once. This type of diabetes mellitus is usually detected by chance, when passing a urine glucose test during a routine examination. The table lists the main symptoms that appear in different systems body in non-insulin dependent diabetes mellitus.

Often, against the background of non-insulin-dependent diabetes mellitus, myocardial infarction occurs, which is manifested by thrombosis. coronary arteries. In most cases, patients with NIDDM do not immediately notice the development of a heart attack, which is explained by impaired autonomic innervation of the heart. In a patient who is independent of insulin, the infarction is more severe and often leads to death.

Features of therapy for non-insulin dependent diabetes mellitus

Treatment with drugs

Resistance in diabetes mellitus is eliminated with the help of medications. The patient is prescribed, which are taken orally. These agents are suitable for patients with mild or medium degree non-insulin dependent diabetes. Medicines can be taken during meals. The exception is Glipizide, which is taken half an hour before a meal. Medicines for non-insulin-dependent diabetes mellitus are divided into 2 types: first and second generation. The table shows the main medications and reception features.

AT complex treatment included insulin, which is administered in an individual dosage. It should be taken by those patients who are constantly under stress. Associated with intercurrent disease or surgery.

Mode Correction

Patients with non-insulin-dependent diabetes should be under constant outpatient medical supervision. This does not apply to patients with emergency conditions who are in the department intensive care. Such patients need to adjust their lifestyle, add more physical activity. A simple set of physical exercises should be performed daily, which can increase glucose tolerance and reduce the need to use hypoglycemic drugs. Patients with non-insulin dependent type of diabetes should observe table number 9. It is extremely important to reduce body weight if there is severe obesity. It is necessary to adhere to such recommendations:

• consume complex carbohydrates;
• reduce the amount of fat in the daily diet;
• reduce the amount of salt intake;
• exclude alcoholic beverages.

insulin dependent diabetes

(Diabetes mellitus type 1)

Type 1 diabetes usually develops in young people aged 18-29 years.

Against the background of growing up, entering an independent life, a person experiences constant stress, acquires and takes root bad habits.

Due to certain pathogenic (disease-causing) factors- viral infection, frequent alcohol consumption, smoking, stress, eating semi-finished products, hereditary predisposition to obesity, pancreatic disease - an autoimmune disease develops.

Its essence lies in the fact that the body's immune system begins to fight with itself, and in the case of diabetes, pancreatic beta cells (islets of Langerhans) that produce insulin are attacked. There comes a time when the pancreas practically ceases to produce the necessary hormone on its own or produces it in insufficient quantities.

The full picture of the reasons for this behavior of the immune system is not clear to scientists. They believe that both viruses and genetic factors influence the development of the disease. Approximately 8% of all patients in Russia have type l diabetes. Type l diabetes is usually a disease of the young, as in most cases it develops during adolescence or adolescence. However, this type of disease can also develop in a mature person. The beta cells in the pancreas begin to break down years before the onset of major symptoms. At the same time, the well-being of a person remains at the level of habitually normal.

The onset of the disease is usually acute, and the person himself can give with certainty the date of the onset of the first symptoms: constant thirst, frequent urination, insatiable hunger and, despite frequent use food, weight loss, fatigue, blurred vision.

This can be explained as follows. The destroyed beta cells of the pancreas are unable to produce enough insulin, the main action of which is to lower the concentration of glucose in the blood. As a result, the body begins to accumulate glucose.

Glucose- a source of energy for the body, however, in order for it to enter the cell (by analogy: gasoline is needed for the engine to work), it needs a conductor - insulin.

If there is no insulin, then the cells of the body begin to starve (hence the fatigue), and glucose that comes from outside with food accumulates in the blood. At the same time, “starving” cells give a signal to the brain about a lack of glucose, and the liver comes into action, which releases an additional portion of glucose into the blood from its own glycogen stores. Fighting with an excess of glucose, the body begins to intensively remove it through the kidneys. Hence frequent urination. The body compensates for the loss of fluid by frequent thirst quenching. However, over time, the kidneys cease to cope with the task, so there is dehydration, vomiting, abdominal pain, and impaired kidney function. Glycogen stores in the liver are limited, so when they come to an end, the body will begin to process its own fat cells for energy production. This explains the weight loss. But the transformation of fat cells to release energy is slower than with glucose, and is accompanied by the appearance of unwanted "waste".

Ketone (that is, acetone) bodies begin to accumulate in the blood, the increased content of which entails conditions that are dangerous for the body - from ketoacidosis and acetone poisoning(acetone dissolves the fatty membranes of cells, preventing the penetration of glucose inside, and sharply inhibits the activity of the central nervous system) up to coma.

It is by the presence of an increased content of ketone bodies in the urine that the diagnosis of "diabetes mellitus type 1" is made, since an acute malaise in a state of ketoacidosis leads a person to a doctor. In addition, people around can often feel the "acetone" breath of the patient.

Since the destruction of pancreatic beta cells occurs gradually, an early and accurate diagnosis can be made, even when there are no obvious symptoms of diabetes yet. This will stop the destruction and save the mass of beta cells that have not yet been destroyed.

There are 6 stages in the development of type 1 diabetes:

1. Genetic predisposition to type 1 diabetes. At this stage, reliable results can be obtained using studies of genetic markers of the disease. The presence of HLA group antigens in a person greatly increases the risk of developing type 1 diabetes.

2. Starting moment. Beta cells are affected by various pathogenic (disease-causing) factors (stress, viruses, genetic predisposition, etc.) and the immune system begins to form antibodies. Violation of insulin secretion does not yet occur, but the presence of antibodies can be determined using an immunological test.

3. stage of prediabetes. The destruction of pancreatic beta cells by autoantibodies of the immune system begins. There are no symptoms, but impaired insulin synthesis and secretion can already be detected using a glucose tolerance test. In most cases, antibodies to pancreatic beta cells, antibodies to insulin, or the presence of both types of antibodies at the same time are detected.

4. Decreased secretion of insulin. Stress tests can reveal violationtolerancetoglucose(NTG) and impaired fasting plasma glucose(NGPN).

5. "Honeymoon. At this stage, the clinical picture of diabetes mellitus is presented with all the listed symptoms. The destruction of pancreatic beta cells reaches 90%. Secretion of insulin is sharply reduced.

6. Complete destruction of beta cells. Insulin is not produced.

It is possible to independently determine the presence of type 1 diabetes in oneself only at the stage when all the symptoms are present. They occur at the same time, so it will be easy to do. The presence of only one symptom or a combination of 3-4, such as fatigue, thirst, headache and itching, does not yet indicate diabetes, although, of course, it indicates another ailment.

To identify if you have diabetes, laboratory tests are needed sugar content in blood and urine, which can be carried out both at home and in the clinic. This is the primary way. However, it should be remembered that an increase in blood sugar in itself does not mean the presence of diabetes. It may be due to other reasons.

Psychologically, not everyone is ready to admit that they have diabetes, and a person often pulls to the last. And yet, if you find yourself having the most alarming symptom - “sweet urine”, it is better to go to the hospital. Even before the advent of laboratory tests, English doctors and ancient Indian and Eastern practices noticed that the urine of diabetic patients attracted insects, and called diabetes "sweet urine disease".

Currently, a wide range of medical devices are being produced aimed at self-monitoring of blood sugar levels by a person - glucometers and test strips to them.

test strips for visual control are sold in pharmacies, are easy to use and available to everyone. When buying a test strip, be sure to pay attention to the expiration date and read the instructions. Wash your hands thoroughly and dry them thoroughly before using the test. Wipe the skin with alcohol is not required.

It is better to take a disposable needle with a round section or use a special lancet, which is attached to many tests. Then the wound heal faster and will be less painful. It is best not to pierce the pad, since this is the working surface of the finger and constant touching does not contribute to the rapid healing of the wound, but the area is closer to the nail. Before the injection, it is better to massage the finger. Then take a test strip and leave a swollen drop of blood on it. It is worth paying attention that you should not dig up the blood or smear it over the strip. One must wait until a sufficient drop swells to capture both halves of the test field. To do this, you need a watch with a second hand. After the time specified in the instructions, wipe the blood from the test strip with a cotton swab. In good light, you need to compare the changed color of the test strip with the scale, which is usually located on the test box.

Such a visual method of determining the level of sugar in the blood may seem inaccurate to many, however, the data turn out to be quite reliable and sufficient to correctly determine whether the sugar is elevated, or to set the dose of insulin needed for the patient.

The advantage of test strips over a glucometer is their relative cheapness. Nonetheless, Glucometers have a number of advantages over test strips. They are portable and lightweight. The result appears faster (from 5 s to 2 min). The drop of blood may be small. It is not necessary to wipe the blood from the strip. In addition, glucometers often have an electronic memory in which the results of previous measurements are entered, so this is a kind of diary of laboratory tests.

Currently, there are two types of glucometers. The former have the same ability as the human eye to visually determine the change in color of the test field.

And the operation of the second, sensory, is based on the electrochemical method, which measures the current that occurs when chemical reaction blood glucose with substances applied to the strip. Some glucometers also measure blood cholesterol, which is important for many diabetics. Thus, if you have the classic hyperglycemic triad: frequent urination, constant thirst and insatiable hunger, as well as a genetic predisposition, anyone can use a glucometer at home or buy test strips at a pharmacy. After that, of course, you need to see a doctor. Even if these symptoms do not indicate diabetes, in any case, they did not arise by chance.

When making a diagnosis, first of all, the type of diabetes is determined, then the severity of the disease (mild, moderate and severe). The clinical picture of type 1 diabetes is often accompanied by various complications.

1. Persistent hyperglycemia- the main symptom of diabetes mellitus, provided that elevated blood sugar levels persist for a long time. In other cases, without being a diabetic characteristic, transient hyperglycemia may develop in a person during infectiousdiseases, in post-stress period or with eating disorders, such as bulimia, when a person does not control the amount of food eaten.

Therefore, if at home with the help of a test strip it was possible to detect an increase in blood glucose, do not rush to conclusions. You need to see a doctor - he will help determine the true cause of hyperglycemia. The level of glucose in many countries of the world is measured in milligrams per deciliter (mg / dl), and in Russia in millimoles per liter (mmol / l). The conversion factor from mmol/l to mg/dl is 18. The table below shows which values ​​are critical.

Glucose level. Content mmol/l and mg/dl

Diabetes is diagnosed with the following indicators: glycemia in capillary blood on an empty stomach is more than 6.1 mmol/l, 2 hours after eating - more than 7.8 mmol/l, or at any time of the day is more than 11.1 mmol/l. Glucose levels can be changed repeatedly throughout the day, before and after meals. The concept of the norm is different, but there is a range of 4-7 mmol / l for healthy adults on an empty stomach. Prolonged hyperglycemia leads to damage to blood vessels and the tissues they supply.

Signs of acute hyperglycemia are ketoacidosis, arrhythmia, disturbed state of consciousness, dehydration. If you have high blood sugar, accompanied by nausea, vomiting, abdominal pain, strong weakness and clouding of consciousness or acetone smell of urine, you must immediately call " ambulance". This is probably most likely a dietary coma, so it is necessary urgent hospitalization!

However, even if there are no signs of diabetic ketoacidosis, but there is thirst, dry mouth, frequent urination, you still need to see a doctor. Dehydration is also dangerous. While waiting for the doctor, you need to drink more water, preferably alkaline, mineral (buy it at a pharmacy and keep a supply at home).

Possible causes of hyperglycemia:

* common error during analysis;

* wrong dosage insulin or hypoglycemic agents;

* violation of the diet (increased consumption of carbohydrates);

* infectious disease, especially accompanied by high fever and fever. Any infection requires an increase in insulin in the patient's body, so you should increase the dose by about 10%, after informing your therapist. When taking tablets for the treatment of diabetes, their dose should also be increased by consulting a doctor (he may advise a temporary transition to insulin);

* hyperglycemia as a consequence of hypoglycemia. A sharp decrease in sugar leads to the release of glucose reserves from the liver into the blood. It is not necessary to reduce this sugar, it will soon normalize itself, on the contrary, the dose of insulin should be reduced. It is also likely that when normal sugar morning and afternoon hypoglycemia may appear at night, so it is important to choose a day and test at 3-4 am.

Symptoms of nocturnal hypoglycemia are nightmares, palpitations, sweating, chills;

* short-term stress(exam, going to the dentist);

* menstrual cycle. Some women experience hyperglycemia during certain phases of the cycle. Therefore, it is important to keep a diary and learn to identify such days in advance and adjust the dose of insulin or diabetes-compensating pills accordingly;

* probable pregnancy;

* myocardial infarction, stroke, trauma. Any operation causes an increase in body temperature. However, since in this case the patient is most likely under the supervision of doctors, it is necessary to inform about the presence of diabetes;

2. Microangiopathy - the general name for lesions of small blood vessels, a violation of their permeability, an increase in fragility, an increase in the tendency to thrombosis. In diabetes, it manifests itself in the form of the following concomitant diseases:

* diabetic retinopathy- damage to the arteries of the retina, accompanied by small hemorrhages in the disc area optic nerve;

* diabetic nephropathy- damage to small blood vessels and arteries of the kidneys in diabetes mellitus. Manifested by the presence of protein and blood enzymes in the urine;

* diabetic arthropathy- damage to the joints, the main symptoms are: "crunching", pain, limited mobility;

* diabetic neuropathy, or diabetic amyotrophy. This is a nerve lesion that develops with prolonged (for several years) hyperglycemia. Neuropathy is based ischemic lesion nerve due to metabolic disorders. Often accompanied by pain of varying intensity. One type of neuropathy is sciatica.

Most often, autonomic neuropathy is detected in type l diabetes. (symptoms: fainting, dry skin, decreased tearing, constipation, blurred vision, impotence, lowering body temperature, sometimes loose stools, sweating, hypertension, tachycardia) or sensory polyneuropathy. Paresis (weakening) of muscles and paralysis are possible. These complications can manifest themselves in type l diabetes before the age of 20-40 years, and in type 2 diabetes - after 50 years;

* diabetic enuephalopathies. Due to ischemic nerve damage, intoxication of the central nervous system often occurs. nervous system, which manifests itself in the form of constant irritability of the patient, states of depression, mood instability and capriciousness.

3. Macroangiopathies - the general name for lesions of large blood vessels - coronary, cerebral and peripheral. This is a common cause of early disability and high mortality in diabetic patients.

Atherosclerosis of the coronary arteries, aorta, cerebral vessels often found in diabetic patients. The main cause of the appearance is associated with elevated insulin levels as a result of treatment for type 1 diabetes mellitus or impaired insulin sensitivity in type 2 diabetes.

Coronary artery disease occurs twice as often in diabetic patients. and leads to myocardial infarction or the development of coronary heart disease. Often a person does not feel any pain, and then a sudden myocardial infarction follows. Almost 50% of diabetic patients die from myocardial infarction, with the risk of developing the same for men and women. Often myocardial infarction is accompanied by this condition, while only one a state of ketoacidosis can cause a heart attack.

Peripheral vascular disease leads to the so-called syndrome diabetic foot. Ischemic lesions of the feet are caused by impaired circulation in the affected blood vessels lower extremities, which leads to trophic ulcers on the skin of the lower leg and foot and the occurrence of gangrene mainly in the area of ​​the first toe. In diabetes, gangrene is dry, with a slight pain syndrome or no pain at all. Left untreated, the limb can be amputated.

After determining the diagnosis and determining the severity of diabetes mellitus you should familiarize yourself with the rules of the new way of life, which from now on will need to be carried out in order to feel better and not aggravate the situation.

The main treatment for type 1 diabetes are regular insulin injections and diet therapy. Severe type l diabetes mellitus requires constant control doctors and symptomatic treatment of complications of the third degree of severity - neuropathy, retinopathy, nephropathy.

Insulin dependent diabetes mellitus

Diabetes- a syndrome, the main diagnostic feature of which is chronic hyperglycemia. Diabetes occurs when various diseases leading to insufficient secretion of insulin or a violation of its biological action.

Type 1 diabetes - endocrine disease, characterized by absolute insufficiency of insulin caused by the destruction of pancreatic beta cells. Type 1 diabetes can develop at any age, but it most commonly affects young people (children, teenagers, adults under 40 years of age. B clinical picture dominated classic symptoms: thirst, polyuria, weight loss, ketoacidotic states.

Etiology and pathogenesis

At the core pathogenetic mechanism development of type 1 diabetes lies in the insufficiency of insulin production endocrine cells pancreas (β-cells of the pancreas), caused by their destruction under the influence of certain pathogenic factors ( viral infection stress, autoimmune diseases, etc.). Type 1 diabetes accounts for 10-15% of all cases of diabetes, and, in most cases, develops in childhood or adolescence. This type of diabetes is characterized by the appearance of basic symptoms that progress rapidly over time. The main method of treatment is insulin injections, which normalize the metabolism of the patient's body. If left untreated, type 1 diabetes progresses rapidly and leads to severe complications such as ketoacidosis and diabetic coma ending in the death of the patient.

Classification

1. According to the severity of the flow:
   1. easy current
   2. moderate severity
   3. severe course
2. By degree of compensation carbohydrate metabolism:
   1. compensation phase
   2. subcompensation phase
   3. decompensation phase
3. For complications:
   1. Diabetic micro- and macroangiopathy
   2. Diabetic polyneuropathy
   3. diabetic arthropathy
   4. Diabetic ophthalmopathy, retinopathy
   5. diabetic nephropathy
   6. Diabetic encephalopathy

Pathogenesis and pathohistology

Insulin deficiency in the body develops due to its insufficient secretion by β-cells of the islets of Langerhans of the pancreas.

Due to insulin deficiency, insulin-dependent tissues (liver, adipose and muscle) lose their ability to utilize blood glucose and, as a result, blood glucose levels increase (hyperglycemia) - cardinal diagnostic sign diabetes mellitus. Due to insulin deficiency in adipose tissue, the breakdown of fats is stimulated, which leads to an increase in their level in the blood, and in muscle tissue- the breakdown of proteins is stimulated, which leads to an increased intake of amino acids into the blood. Substrates of catabolism of fats and proteins are transformed by the liver into ketone bodies, which are used by insulin-independent tissues (mainly the brain) to maintain energy balance against the background of insulin deficiency.

Glycosuria is an adaptive excretion mechanism high content glucose from the blood when the glucose level exceeds the threshold value for the kidneys (about 10 mmol / l). Glucose is an osmoactive substance and an increase in its concentration in the urine stimulates increased excretion of water (polyuria), which can eventually lead to dehydration of the body if the loss of water is not compensated by adequate increased fluid intake (polydipsia). Together with the increased loss of water in the urine are lost and mineral salts- Deficiency of sodium, potassium, calcium and magnesium cations, chloride anions, phosphate and bicarbonate develops.

There are 6 stages in the development of DM1. 1) Genetic predisposition to DM1 associated with the HLA system. 2) Hypothetical starting torque. Damage to β-cells by various diabetogenic factors and triggering of immune processes. In patients, the above listed antibodies are already detected in a small titer, but insulin secretion is not yet affected. 3) Active autoimmune insulinitis. The antibody titer is high, the number of β-cells decreases, insulin secretion decreases. 4) Decreased glucose-stimulated secretion of I.V stressful situations the patient can detect transient IGT (impaired glucose tolerance) and NGPN (impaired fasting plasma glucose). 5) Clinical manifestation of DM, including with a possible episode " honeymoon". Insulin secretion is sharply reduced, as more than 90% of β-cells have died. 6) Complete destruction of β-cells, complete cessation secretion of insulin.

Clinic

• hyperglycemia. Symptoms due to high blood sugar levels: polyuria, polydipsia, weight loss with decreased appetite, dry mouth, weakness
• microangiopathy (diabetic retinopathy, neuropathy, nephropathy),
• macroangiopathy (atherosclerosis of the coronary arteries, aorta, GM vessels, lower extremities), diabetic foot syndrome
• concomitant pathology (furunculosis, colpitis, vaginitis, urinary tract infection)

Mild diabetes - compensated by diet, no complications (only with type 2 diabetes) Medium Diabetes is compensated by PSSP or insulin, diabetic vascular complications of 1-2 degrees of severity are detected. Severe DM - labile course, complications of the 3rd degree of severity (nephropathy, retinopathy, neuropathy).

Diagnostics

In clinical practice, sufficient criteria for diagnosing type 1 diabetes are the presence of typical symptoms hyperglycemia (polyuria and polydipsia) and laboratory-confirmed hyperglycemia - glycemia in capillary blood on an empty stomach more than 7.0 mmol / l and / or at any time of the day more than 11.1 mmol / l;

When establishing a diagnosis, the doctor acts according to the following algorithm.

1. Exclude diseases that present with similar symptoms (thirst, polyuria, weight loss): diabetes insipidus, psychogenic polydipsia, hyperparathyroidism, chronic kidney failure and others. This stage ends with a laboratory statement of the syndrome of hyperglycemia.
2. The nosological form of DM is specified. First of all, diseases that are included in the group "Other specific types of diabetes" are excluded. And only then the issue of DM1 or DM2 is solved. The level of C-peptide is determined on an empty stomach and after exercise. The level of concentration in the blood of GAD-antibodies is also assessed.

Complications

• Ketoacidosis, hyperosmolar coma
• Hypoglycemic coma (in case of insulin overdose)
• Diabetic micro- and macroangiopathy - a violation of vascular permeability, an increase in their fragility, an increase in the tendency to thrombosis, to the development of vascular atherosclerosis;

• Diabetic polyneuropathy - polyneuritis peripheral nerves, pain along the nerve trunks, paresis and paralysis;

• Diabetic arthropathy - joint pain, "crunching", limited mobility, reduced number synovial fluid and increasing its viscosity;

• Diabetic ophthalmopathy - early development cataracts (clouding of the lens), retinopathy (retinal damage);

• Diabetic nephropathy - kidney damage with the appearance of protein and shaped elements blood in the urine, and in severe cases with the development of glomerulonephritis and renal failure;

• Diabetic encephalopathy - mental and mood changes, emotional lability or depression, symptoms of CNS intoxication.

Treatment

The main goals of treatment:

• Elimination of all clinical symptoms of diabetes
• Achieve optimal metabolic control for a long time.
• Prevention of acute and chronic complications of diabetes
• Ensuring a high quality of life for patients.

To achieve these goals, apply:

• diet
• dosed individual physical activity (DIFN)
• teaching patients self-control and the simplest methods of treatment (management of their disease)
• constant self-control

insulin therapy

Insulin therapy is based on the imitation of physiological insulin secretion, which includes:

• basal secretion (BS) of insulin
• stimulated (food) secretion of insulin

Basal secretion provides optimal level glycemia in the interdigestive period and during sleep, promotes the utilization of glucose that enters the body outside meals (gluconeogenesis, glycolysis). Its speed is 0.5-1 units / hour or 0.16-0.2-0.45 units per kg of actual body weight, that is, 12-24 units per day. With physical activity and hunger, BS decreases to 0.5 units / hour. Secretion of stimulated - food insulin corresponds to the level of postprandial glycemia. The level of CC depends on the level of carbohydrates eaten. Approximately 1-1.5 units are produced per 1 bread unit (XE). insulin. Insulin secretion is subject to diurnal fluctuations. In the early morning hours (4-5 o'clock) it is the highest. Depending on the time of day, 1 XE is secreted:

• for breakfast - 1.5-2.5 units. insulin
• for lunch 1.0-1.2 units. insulin
• for dinner 1.1-1.3 units. insulin

1 unit of insulin reduces blood sugar by 2.0 mmol / unit, and 1 XE increases it by 2.2 mmol / l. From the average daily dose (SSD) of insulin, the value of dietary insulin is approximately 50-60% (20-30 units), and basal insulin accounts for 40-50%.

Principles of insulin therapy (IT):

• the mean daily dose (MAD) of insulin should be close to physiological secretion
• when distributing insulin during the day, 2/3 of the SDS should be administered in the morning, afternoon and early evening and 1/3 in the late evening and at night
• using a combination of insulin short action(ICD) and long-acting insulin. Only this allows us to approximately simulate the daily secretion of I.

During the day, the ICD is distributed as follows: before breakfast - 35%, before lunch - 25%, before dinner - 30%, at night - 10% of the SDS insulin. If necessary, at 5-6 o'clock in the morning 4-6 units. ICD. It should not be administered in one injection> 14-16 units. In case it is necessary to administer a large dose, it is better to increase the number of injections by reducing the intervals of administration.

Correction of insulin doses according to the level of glycemia To correct the doses of the administered ICD, Forsh recommended that for every 0.28 mmol / l of blood sugar exceeding 8.25 mmol / l, an additional 1 unit of insulin should be administered. I. Therefore, for each "extra" 1 mmol / l of glucose, an additional 2-3 units are required. And

Correction of insulin doses for glucosuria The patient must be able to carry it out. During the day, between insulin injections, collect 4 portions of urine: 1 portion - between breakfast and lunch (previously, before breakfast, the patient must empty the bladder), 2 - between lunch and dinner, 2 - between dinner and 22 hours, 4 - from 22 hours until breakfast. Diuresis is taken into account in each serving, the % glucose content is determined and the amount of glucose in grams is calculated. If glucosuria is detected, to eliminate it, 1 unit is additionally administered for every 4-5 g of glucose. insulin. The next day after urine collection, the dose of insulin administered is increased. After achieving compensation or approaching it, the patient should be transferred to a combination of ICD and ISD.

Traditional insulin therapy (IT). Allows you to reduce the number of insulin injections to 1-2 times a day. With TIT, ISD and ICD are simultaneously administered 1 or 2 times a day. At the same time, the share of the ISD accounts for 2/3 of the SS, and the ICD - 1/3 of the SS. Advantages:

• ease of administration
• ease of understanding the essence of treatment by patients, their relatives, medical personnel
• no need for frequent glycemic control. It is enough to control glycemia 2-3 times a week, and if self-control is impossible - 1 time per week
• treatment can be carried out under the control of glucosuric profile

Flaws

• the need for strict adherence to a diet in accordance with the selected dose AND
• the need for strict adherence to the daily routine, sleep, rest, physical activity
• obligatory 5-6 meals a day, strictly certain time tied to the introduction and
• inability to maintain glycemia within physiological fluctuations
• persistent hyperinsulinemia accompanying TIT increases the risk of hypokalemia, arterial hypertension, atherosclerosis.

TIT shown

• older people if they cannot master the requirements of IIT
• persons with mental disorders, low educational level
• sick people in need of care
• unruly patients

Calculation of insulin doses for TIT 1. Pre-determine insulin SDS 2. Distribute insulin SDS by time of day: 2/3 before breakfast and 1/3 before dinner. Of these, the ICD should account for 30-40%, ISD - 60-70% of the SDS.

IIT (intensive IT) Basic principles of IIT:

• the need for basal insulin is provided by 2 injections of ISD, which is administered in the morning and evening (the same drugs are used as for TIT). The total dose of the ISD is not > 40-50% of the SDS, 2/3 of the total dose of the ISD is administered before breakfast, 1/3 before dinner.
• food - bolus secretion of insulin is simulated by the introduction of ICD. The required doses of ICD are calculated taking into account the amount of XE planned for breakfast, lunch and dinner and the level of glycemia before meals. IIT provides for mandatory glycemic control before each meal, 2 hours after meals and at night. That is, the patient should carry out glycemic control 7 times a day.

Advantages

• imitation of physiological secretion of I (basal stimulated)
• the possibility of a more free mode of life and daily routine for the patient
• the patient can use a "liberalized" diet by changing the time of meals, a set of products at will
• higher quality of life for the patient
• effective control of metabolic disorders, preventing the development of late complications
• the need to educate patients on the problem of diabetes, the issues of its compensation, the calculation of XE, the ability to select doses and develops motivation, understanding the need for good compensation, prevention of complications of diabetes.

Flaws

• the need for constant self-monitoring of glycemia, up to 7 times a day
• the need to educate patients in schools for patients with diabetes, change their lifestyle.
• additional costs for training and self-control tools
• tendency to hypoglycemia, especially in the first months of IIT

Mandatory conditions for the possibility of using IIT are:

• sufficient intelligence of the patient
• ability to learn and implement acquired skills in practice
• the possibility of acquiring self-control equipment

IIT is shown:

• with DM1 it is desirable for almost all patients, and for newly diagnosed DM it is mandatory
• during pregnancy - transfer to IIT for the entire period of pregnancy, if the patient was treated for TIT before pregnancy
• with gestational diabetes, in case of ineffective diet and DIF

Scheme of patient management when using IIT

• Daily calorie calculation
• Calculation of the amount of carbohydrates planned for consumption per day in XE, proteins and fats - in grams. Although the patient is on a “liberalized” diet, he should not eat more carbohydrates per day than the calculated dose in XE. Not recommended for 1 reception more than 8 XE
• Calculation of SDS I

The calculation of the total dose of basal I is carried out by any of the above methods - the calculation of the total food (stimulated) I is carried out based on the amount of XE that the patient plans to consume during the day

• Distribution of doses of administered And during the day.
• Self-monitoring of glycemia, correction of doses of food I.

More simple modified IIT techniques:

• 25% SDA I administered before dinner or at 22:00 in the form of IDD. The ADI (comprising 75% of the DS) is distributed as follows: 40% before breakfast, 30% before lunch, and 30% before dinner
• 30% SDS And administered in the form of IDD. Of these: 2/3 doses before breakfast, 1/3 before dinner. 70% SSc is administered as an ICD. Of these: 40% of the dose before breakfast, 30% before lunch, 30% before dinner or at night.

In the future - dose adjustment I.

dic.academic.ru

Features of type 2 diabetes mellitus insulin-dependent

Unlike other varieties of the disease, thirst does not torment. Often referred to as the effects of aging. Therefore, even weight loss is accepted as positive result diets. Endocrinologists note that the treatment of type 2 diabetes begins with diets. The therapist or gastroenterologist draws up a list of allowed foods, a nutrition schedule. For the first time there is a consultation on the preparation of the menu for each day. (See also: Insulin-Dependent Diabetes Mellitus— useful information by illness)

In insulin-dependent type 2 diabetes, you always lose weight. At the same time getting rid of fat deposits. This leads to an increase in insulin sensitivity. Insulin, produced by the pancreas, begins to process sugar. The latter rushes to the cells. As a result, there is a decrease in blood sucrose levels.

It is not always possible to regulate glucose levels with diet in type 2 diabetes. Therefore, during the consultation, the endocrinologist prescribes medication. It can be tablets, injections.

Insulin therapy for type 2 diabetes is seen in those who are obese. Even with such a tough restricted diet It's not always easy to lose weight. This is due to the fact that the normalization of sugar indicators did not occur, and the insulin produced is simply not enough to reduce glucose. In such situations, it is important to ensure a decrease in blood levels and insulin injections are prescribed.

Developing, diabetes requires constant injections of a drug that lowers blood sucrose. The endocrinologist is obliged in this case to indicate outpatient card- Type 2 diabetes mellitus, insulin dependent. Distinctive feature diabetics of this type from the first is the dosage for injection. There is nothing critical in this. After all, the pancreas continues to secrete a certain amount of insulin.

How to choose a doctor?

Life expectancy in insulin-dependent diabetes mellitus is difficult to determine. There is a situation when a diabetic ceases to trust the endocrinologist. He believes that insulin therapy was prescribed incorrectly and begins to rush around the clinics.

In other words, you decide to spend finances on obtaining the results of surveys, consulting services. And treatment options may vary. This race forgets the fact that insulin therapy for type 2 diabetes requires instant decisions. After all, with an uncontrolled disease, harm is done quickly and irreversibly. Therefore, before throwing around the offices of endocrinologists, one should decide on the qualifications of a doctor.

This type of diabetes occurs at the age of 40 years and older. In some cases, the development of insulin therapy is not required, because the pancreas secretes the required amount of insulin. Similar situations do not cause diabetic ketoacytosis. However, almost every diabetic has a second enemy, in addition to the disease - obesity.

Genetic predisposition to the disease

In insulin-dependent diabetes mellitus, life expectancy plays a big role. Genetics have a certain chance
cause of diabetes. After all, if a family has a risk of developing an insulin-independent disease, then the chances of children to stay healthy are reduced by 50% (if the father is ill) and only 35% if the mother is ill. Naturally, this reduces life spans.

Endocrinologists say that genes for non-insulin-dependent diabetes mellitus can be found. And at the same time determine the reasons metabolic disorders. In other words, in medical practice, there are 2 types of genetic defects.

• Insulin resistance has a second, more common name, obesity.
• decrease in the secretory activity of beta cells / their insensitivity.

dialekar.ru

The main types of diabetes

Diabetes mellitus (DM) is an autoimmune disease characterized by a complete or partial cessation of the production of a sugar-lowering hormone called insulin. Such a pathogenic process leads to the accumulation of glucose in the blood, which is considered an "energy material" for cellular and tissue structures. In turn, tissues and cells receive less the necessary energy and begin to break down fats and proteins.

Insulin is the only hormone in our body that can regulate blood sugar levels. It is produced by beta cells located on the islets of Langerhans in the pancreas. However, in human body exists a large number of other hormones that increase glucose concentration. These are, for example, adrenaline and norepinephrine, "command" hormones, glucocorticoids and others.

The development of DM is influenced by many factors, which will be discussed below. It is believed that the current lifestyle has big influence for this pathology, because modern people are more likely to be obese and not exercise.

The most common types of the disease are:

• type 1 insulin-dependent diabetes mellitus (IDDM);
• non-insulin-dependent diabetes mellitus type 2 (NIDDM);
• gestational diabetes.

Insulin-dependent type 1 diabetes mellitus (IDDM) is a pathology in which insulin production stops completely. Many scientists and doctors believe that main reason development of IDDM type 1 is heredity. This disease requires constant monitoring and patience, since today there are no drugs that could completely cure the patient. Insulin injections are an integral part of the treatment of insulin-dependent diabetes mellitus.

Non-insulin-dependent type 2 diabetes mellitus (NIDDM) is characterized by impaired perception of target cells to sugar-lowering hormone. Unlike the first type, the pancreas continues to produce insulin, but the cells begin to react incorrectly to it. This type of disease usually affects people older than 40-45 years. Early diagnosis, diet therapy and physical activity avoid drug treatment and insulin therapy.

Gestational diabetes develops during pregnancy. In the body of the expectant mother, hormonal changes occur, as a result of which glucose levels may increase.

At right approach to therapy, the disease disappears after childbirth.

Causes of diabetes

Despite the colossal amount of research done, doctors and scientists cannot give an exact answer to the question of the cause of diabetes.

What exactly exposes immune system to work against the organism itself remains a mystery for the time being.

However, the research and experiments carried out were not in vain.

With the help of research and experiments, it was possible to determine the main factors that increase the likelihood of developing insulin-dependent and non-insulin-dependent diabetes mellitus. These include:

1. Hormonal imbalance in adolescence associated with the action of growth hormone.
2. The gender of the person. It has been scientifically proven that the beautiful half of humanity is twice as likely to have diabetes.
3. Overweight. Overweight lead to the deposition of cholesterol on the vascular walls and to an increase in the concentration of sugar in the blood.
4. Genetics. If insulin-dependent or non-insulin-dependent diabetes mellitus is diagnosed in the mother and father, then the child will also manifest it in 60-70% of cases. Statistics show that twins simultaneously suffer from this pathology with a probability of 58-65%, and twins - 16-30%.
5. The color of a person's skin also affects the development of the disease, since diabetes is 30% more common in blacks.
6. Violation of the pancreas and liver (cirrhosis, hemochromatosis, etc.).
7. Inactive lifestyle, bad habits and malnutrition.
8. Pregnancy, during which there is a violation of the hormonal background.
9. Drug therapy with glucocorticoids, atypical antipsychotics, beta-blockers, thiazides and other drugs.

After analyzing the above, we can identify a risk factor in which a certain group of people are more susceptible to developing diabetes. It includes:

• overweight people;
• people with a genetic predisposition;
• patients suffering from acromegaly and Itsenko-Cushing's syndrome;
• patients with atherosclerosis, hypertension or angina pectoris;
• people suffering from cataracts;
• people prone to allergies (eczema, neurodermatitis);
• patients taking glucocorticoids;
• people who have had a heart attack infectious diseases and stroke;
• women with pathological pregnancy;

The risk group also includes women who have given birth to a child weighing more than 4 kg.

How to recognize hyperglycemia?

The rapid increase in glucose concentration is a consequence of the development of "sweet disease". Insulin dependent diabetes can for a long time not to make themselves felt, slowly destroying vascular walls and nerve endings almost all organs of the human body.

However, with insulin-dependent diabetes mellitus, a lot of signs are manifested. A person who is attentive to his health will be able to recognize the signals of the body, indicating hyperglycemia.

So, what are the symptoms of insulin-dependent diabetes mellitus? Among the two main ones, polyuria (frequent urination), as well as constant thirst, are distinguished. They are associated with the work of the kidneys, which filter our blood, ridding the body of harmful substances. Excess sugar is also a toxin, so it is excreted from the body with urine. The increased load on the kidneys leads to the fact that the paired organ begins to draw the missing fluid from the muscle tissue, causing such symptoms of insulin-dependent diabetes.

Frequent dizziness, migraines, fatigue and poor sleep are other signs that are characteristic of this disease. As mentioned earlier, with a lack of glucose, cells begin to break down fats and proteins to obtain necessary stock energy. As a result of the decay, toxic substances, which are called ketone bodies. Cellular “starvation”, in addition to the toxic effects of ketones, affects the functioning of the brain. Thus, a diabetic patient does not sleep well at night, does not get enough sleep, cannot concentrate, as a result, he complains of dizziness and pain.

It is known that DM (forms 1 and 2) negatively affects nerves and vessel walls. As a result, nerve cells are destroyed, and the vascular walls become thinner. This entails a lot of consequences. The patient may complain of deterioration in visual acuity, which is a consequence of inflammation of the retina. eyeball, which is covered vascular networks. In addition, numbness or tingling in the legs and arms are also signs of diabetes.

Among the symptoms of the “sweet disease”, disorders of the reproductive system, both men and women, deserve special attention. At strong half problems start with erectile function, and in a weak one, the menstrual cycle is disturbed.

Less common are signs such as delayed wound healing, skin rash, increased blood pressure, unreasonable feeling hunger and weight loss.

Consequences of the progression of diabetes

Undoubtedly, insulin-dependent and non-insulin-dependent diabetes, progressing, disables almost all systems of internal organs in the human body. This outcome can be avoided through early diagnosis and effective supportive treatment.

The most dangerous complication of non-insulin-dependent and insulin-dependent diabetes mellitus is diabetic coma. The condition is characterized by symptoms such as dizziness, bouts of vomiting and nausea, clouding of consciousness, fainting. In this case, urgent hospitalization is necessary for resuscitation.

Insulin-dependent or non-insulin-dependent diabetes mellitus with multiple complications is a consequence of a careless attitude to one's health. The manifestations of comorbidities are associated with smoking, alcohol, in a sedentary manner life, non-compliance with proper nutrition, untimely diagnosis and ineffective therapy. What are the complications associated with the progression of the disease?

The main complications of diabetes include:

1. Diabetic retinopathy is a condition in which the retina of the eyes is damaged. As a result, visual acuity decreases, a person cannot see a complete picture in front of him due to the occurrence of various dark dots and other defects.
2. Periodontal disease is a pathology associated with inflammation of the gums due to impaired carbohydrate metabolism and blood circulation.
3. Diabetic foot is a group of diseases covering various pathologies of the lower extremities. Because the legs are the outermost part of the body in circulation, type 1 (insulin-dependent) diabetes mellitus causes trophic ulcers. Over time, with the wrong response, gangrene develops. The only treatment is amputation of the lower limb.
4. Polyneuropathy is another disease associated with the sensitivity of the hands and feet. Insulin-dependent and non-insulin-dependent diabetes mellitus with neurological complications presents a lot of inconvenience to patients.
5. Erectile dysfunction that begins 15 years earlier in men than their non-diabetic peers. The chances of developing impotence are 20-85%, in addition, there is a high probability of childlessness among diabetics.

Additionally, in diabetics, there is a decrease defensive forces organism and frequent occurrence colds.

Diagnosis of diabetes

Knowing that complications this disease enough, patients seek help from their doctor. After examining the patient, the endocrinologist, suspecting an insulin-independent or insulin-dependent type of pathology, directs him for an analysis.

At the present time, there are many methods for diagnosing diabetes. The simplest and fastest is a blood test from a finger. The sampling is carried out on an empty stomach in morning time. The day before the analysis, doctors do not recommend eating a lot of sweets, but you should not deny yourself food either. normal value sugar concentration in healthy people is in the range of 3.9 to 5.5 mmol/L.

Another popular method is the glucose tolerance test. This analysis is carried out for two hours. Before the study, you can not eat anything. First, blood is taken from a vein, then the patient is offered to drink water diluted with sugar in a ratio of 3:1. Next, the health worker begins to take venous blood every half hour. The result obtained above 11.1 mmol / l indicates the development of insulin-dependent or non-insulin-dependent type of diabetes mellitus.

AT rare cases a glycated hemoglobin test is performed. The essence of this study is to measure blood sugar levels for two to three months. Then the average results are displayed. because of long duration the analysis has not gained much popularity, however, it provides an accurate picture for specialists.

Sometimes a urine test for sugar is prescribed in combination. A healthy person should not have glucose in urine, so its presence indicates diabetes mellitus of an insulin-independent or insulin-dependent form.

Based on the results of the tests, the doctor will decide on therapy.

diabetik.guru

Insulin-independent diabetes mellitus

Type 2 disease is associated mainly with the inability of the body to adequately dispose of insulin. The content of glucose in the blood increases significantly, which negatively affects the condition and functioning of blood vessels and organs. Less often, the problem is associated with insufficient production of pancreatic hormone. Non-insulin-dependent type 2 diabetes is diagnosed in middle-aged and older patients. The disease is confirmed by the results of blood and urine tests, in which high content glucose. About 80% of patients are overweight.

Symptoms

Non-insulin-dependent type 2 diabetes develops sequentially, usually over several years. In this case, the patient may not notice the manifestations at all. To more severe symptoms include:

Thirst can be both pronounced and barely perceptible. The same goes for frequent urination. Unfortunately, type 2 diabetes is often discovered incidentally. However, with this disease it is extremely important early diagnosis. To do this, you need to regularly take a blood test for sugar levels.

Insulin-dependent diabetes is manifested by problems with the skin and mucous membranes. Usually this:

With a pronounced thirst, the patient can drink up to 3-5 liters per day. There are frequent nightly trips to the toilet.

With the further progression of diabetes, numbness and tingling appear in the limbs, the legs hurt when walking. In women, intractable candidiasis is observed. In the later stages of the disease develop:

The above severe symptoms in 20-30% of patients are the first obvious signs of diabetes. Therefore, it is extremely important to take tests annually to avoid such conditions.

zdorov.online

• 1. Target fasting and postprandial blood glucose levels and try to maintain them. These levels are planned strictly individually. a. For patients who recognize the approach of hypoglycemia well and in whom it quickly passes on its own or after taking glucose, it is possible to outline a fasting glucose level close to the level in healthy people (3.9-7.2 mmol / l). This category includes adult patients with a short duration of insulin-dependent diabetes mellitus and adolescents. b. Pregnant women should strive for even more low levels fasting glucose. in. Planned fasting glucose levels should be higher in those patients who do not feel the approach of hypoglycemia, as well as in cases where hypoglycemia requires medical treatment or is of particular danger (for example, in patients with coronary artery disease). G. Disciplined patients who frequently measure blood glucose levels and adjust insulin doses manage to maintain target glucose levels for 70-80% of the time of day.
• 2. It is necessary to imitate the physiological fluctuations in insulin levels as best as possible. In healthy people, beta cells continuously secrete small quantities insulin and thus provide it basal level. After eating, the secretion of insulin increases. In order to create a basal level of insulin close to normal in the patient's blood and simulate physiological fluctuations in insulin secretion, one of the following is selected the following schemes insulin therapy: a. Before each meal, short-acting insulin is administered, and to create a basal level of the hormone, medium-acting insulin is injected 1 time per day (before bedtime) or 2 times a day (before breakfast and at bedtime). b. Before each meal, short-acting insulin is administered; insulin is administered to create a basal level of the hormone long-acting 1 or 2 times a day. in. Both short-acting and intermediate-acting insulin are administered simultaneously twice a day, or combination drug insulin. d. Short-acting insulin and intermediate-acting insulin or a combined insulin preparation are administered simultaneously before breakfast. Short-acting insulin is given before dinner and intermediate-acting insulin is given at bedtime. e. A patient with a wearable insulin dispenser should increase the hormone supply before meals. Modern models dispensers equipped with blood glucose meters not only maintain basal insulin levels, but also automatically increase the hormone supply when glucose levels rise after a meal.
• 3. Maintain a balance between insulin doses, nutrition and physical activity. Patients or their relatives are given dietary tables developed by the American Diabetes Association. These tables show the carbohydrate content of various foods, their the energy value and interchangeability. The doctor, together with the patient, develops individual plan nutrition. In addition, the doctor explains how physical activity affects blood glucose levels.
• 4. Self-monitoring of blood glucose levels a. Every day, 4-5 times a day (before each meal and at bedtime), the patient measures the concentration of glucose in capillary blood from a finger using test strips or a glucometer. b. Once every 1-2 weeks, and whenever the dose of insulin administered at bedtime is changed, the patient measures the concentration of glucose between 2:00 and 4:00. With the same frequency determine the level of glucose after meals. in. Always measure the concentration of glucose when the precursors of hypoglycemia appear. d. The results of all measurements, all doses of insulin and subjective sensations (for example, signs of hypoglycemia) are recorded in a diary.
• 5. Self-correction of the insulin therapy regimen and diet, depending on the level of blood glucose and lifestyle. The doctor should give the patient a detailed plan of action, providing for as many situations as possible in which correction of the insulin regimen and diet may be required. a. Correction of the insulin therapy regimen includes changes in insulin doses, changes in the ratio of drugs of different duration of action, and changes in the time of injections. Reasons for adjusting insulin doses and insulin therapy regimens:
• 1) Steady changes in blood glucose levels at certain times of the day, identified by entries in the diary. For example, if your blood glucose levels tend to increase after breakfast, you can slightly increase the dose of short-acting insulin given before breakfast. Conversely, if glucose levels decrease between breakfast and lunch, and especially if signs of hypoglycemia appear at this time, the morning dose of short-acting insulin or the dose of intermediate-acting insulin should be reduced.
• 2) An increase or decrease in the average daily blood glucose level (respectively, you can increase or decrease the total daily dose insulin).
• 3) upcoming additional reception food (for example, if the patient goes to visit).
• 4) upcoming physical activity. 5) Long trip, strong feelings (going to school, divorce of parents, etc.).
• 6) Accompanying illnesses.
• 6. Education of patients. The doctor must teach the patient to act independently in any situation. The main questions that the doctor should discuss with the patient: a. Self-monitoring of blood glucose levels. b. Correction of the scheme of insulin therapy. in. Meal planning. G. Permissible physical activity. d. Recognition, prevention and treatment of hypoglycemia. e. Correction of treatment for concomitant diseases.
• 7. Close contact of the patient with the doctor or with the diabetic team. First, the doctor should as often as possible inquire about the patient's condition. Secondly, the patient should be able to consult a doctor at any time of the day or nurse and get advice on any issue related to your condition.
• 8. Motivation of the patient. The success of intensive insulin therapy largely depends on the discipline of the patient and his desire to fight the disease. Maintaining motivation requires a lot of effort from relatives and friends of the patient and medical staff. Often this task is the most difficult.
• 9. Psychological support. Patients with recently onset insulin-dependent diabetes mellitus and their relatives need psychological support. The patient and his relatives must get used to the thought of the disease and realize the inevitability and necessity of dealing with it. In the United States, special self-help groups are organized for this purpose.

ex-diabetic.com

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    • Milk
    • Cottage cheese
    • Kefir
    • Yogurt
    • Syrniki
    • Sour cream
  • bee products
    • Propolis
    • Perga
    • Podmore
    • bee pollen
    • royal jelly
  • Heat treatment methods
    • In a slow cooker
    • In a double boiler
    • In air grill
    • Drying
    • Cooking
    • Extinguishing
    • frying
    • baking
• DIABETES IN…
  • Among women
    • Vaginal itching
    • Abortion
    • Period
    • Candidiasis
    • Climax
    • Lactation
    • Cystitis
    • Gynecology
    • Hormones
    • Allocations
  • In men
    • Impotence
    • Balanoposthitis
    • Erection
    • Potency
    • Member, viagra
  • In children
    • In newborns
    • Diet
    • Teenagers
    • In infants
    • Complications
    • Signs, symptoms
    • The reasons
    • Diagnostics
    • 1 type
    • 2 types
    • Prevention
    • Treatment
    • Phosphate diabetes
    • Neonatal
  • In pregnant women
    • C-section
    • Is it possible to get pregnant?
    • Diet
    • 1 and 2 types
    • Choosing a maternity hospital
    • non-sugar
    • Symptoms, signs
  • Animals
    • in cats
    • in dogs
    • non-sugar
  • In adults
    • Diet
  • Elderly
• BODIES
  • Legs
    • Shoes
    • Massage
    • heels
    • Numbness
    • Gangrene
    • Edema and swelling
    • diabetic foot
    • Complications, defeat
    • Nails
    • itchy
    • Amputation
    • convulsions
    • Feet care
    • Diseases
  • Eyes
    • Glaucoma
    • Vision
    • retinopathy
    • Ocular fundus
    • Drops
    • Cataract
  • kidneys
    • Pyelonephritis
    • Nephropathy
    • kidney failure
    • Nephrogenic
  • Liver
  • Pancreas
    • Pancreatitis
  • Thyroid gland
  • Sex organs
• TREATMENT
  • Unconventional
    • Ayurveda
    • Acupressure
    • sobbing breath
    • Tibetan medicine
    • Chinese medicine
  • Therapy
    • Magnetotherapy
    • Phytotherapy
    • Pharmacotherapy
    • Ozone therapy
    • Hirudotherapy
    • insulin therapy
    • Psychotherapy
    • Infusion
    • Urinotherapy
    • Physiotherapy
  • Insulin
  • Plasmapheresis
  • Starvation
  • Cold
  • raw food diet
  • Homeopathy
  • hospital
  • Transplantation of the islets of Langerhans
• FOLK
  • Herbs
    • Golden mustache
    • Hellebore
    • Cinnamon
    • Black cumin
    • stevia
    • goat's rue
    • Nettle
    • redhead
    • Chicory
    • Mustard
    • Parsley
    • Dill
    • Cuff
  • Kerosene
  • Mumiyo
  • Apple vinegar
  • Tinctures
  • badger fat
  • Yeast
  • Bay leaf
  • aspen bark
  • Carnation
  • Turmeric
  • Sap
• DRUGS
  • Diuretic
• DISEASES
  • Dermal
    • Itching
    • acne
    • Eczema
    • Dermatitis
    • Furuncles
    • Psoriasis
    • bedsores
    • Wound healing
    • Spots
    • Wound treatment
    • Hair loss
  • Respiratory
    • Breath
    • Pneumonia
    • Asthma
    • Pneumonia
    • Angina
    • Cough
    • Tuberculosis
  • Cardiovascular
    • heart attack
    • Stroke
    • Atherosclerosis
    • Pressure
    • Hypertension
    • Ischemia
    • Vessels
    • Alzheimer's disease
  • Angiopathy
  • Polyuria
  • hyperthyroidism
  • Digestive
    • Vomit
    • Periodontist
    • Dry mouth
    • Diarrhea
    • Dentistry
    • Smell from the mouth
    • constipation
    • Nausea
  • hypoglycemia
  • Ketoacidosis
  • neuropathy
  • Polyneuropathy
  • Bone
    • Gout
    • fractures
    • joints
    • Osteomyelitis
  • Related
    • Hepatitis
    • Flu
    • fainting
    • Epilepsy
    • Temperature
    • Allergy
    • Obesity
    • Dyslipidemia
  • Direct
    • Complications
    • hyperglycemia
• ARTICLES
  • About glucometers
    • How to choose?
    • Principle of operation
    • Comparison of glucometers
    • control solution
    • Accuracy and Verification
    • Batteries for glucometers
    • Glucometers for different ages
    • Laser glucometers
    • Repair and exchange of glucometers
    • Tonometer-glucometer
    • Glucose measurement
    • Cholesterol glucometer
    • The norm of sugar on a glucometer
    • Get a glucometer for free
  • Flow
    • Acetone
    • Development
    • Thirst
    • sweating
    • Urination
    • Rehabilitation
    • Urinary incontinence
    • Clinical examination
    • Recommendations
    • Weight loss
    • Immunity
    • How to live with diabetes?
    • How to gain/lose weight
    • Restrictions, contraindications
    • Control
    • How to fight?
    • Manifestations
    • Injections (injections)
    • How it starts