Diabetes (diabetes, SD) is a chronic metabolic disease manifesting in the form of an absolute or relative deficiency of the pancreatic protein hormone called insulin in the blood, and is characterized by a violation of dextrose metabolism in the body - persistent hyperglycemiapersistent, which then leads to disturbances in the metabolism of fats, proteins, minerals and water.
Next, you'll learn: what diabetes is, the main types, symptoms, and treatments.
Types of diabetes (classification)
Classification of diabetes by cause:
Type 1 diabetes- characterized by an absolute deficiency of insulin in the blood:
- Autoimmune - antibodies attack pancreatic β cells and completely destroy them;
- Idiopathic (unknown cause);
Type 2 diabetes- relative deficiency of insulin in the blood. This means that the quantitative index of insulin levels remains within the normal range, but the number of receptors for the hormone on the membranes of target cells (brain, liver, adipose tissue, muscle) decreases.
Gestational diabetes- an acute or chronic condition, manifesting in the form of hyperglycemia during pregnancy of a woman.
Other causes (situations) of diabetes- impaired glucose tolerance due to causes unrelated to the pathology of the pancreas. They can be temporary and permanent.
Types of diabetes:
medicine;
infection;
genetic defects in the insulin molecule or its receptors;
combined with other endocrine pathologies:
- Itsenko-Cushing disease;
- adrenal gland tumor;
- Grave disease.
Classification of diabetes by severity:
Light form- characterized by hyperglycemia not exceeding 8 mmol/l, mild daily fluctuations in sugar, absence of glucosuria (sugar in the urine). No pharmacological correction of insulin is required.
Usually, at this stage, clinical manifestations of the disease may be absent, however, during instrumental diagnosis, typical early complications with peripheral nerve damage, microscopicRetinal, renal, and cardiac vessels were detected.
Moderate severity- the level of glucose in the peripheral blood reaches 14 mmol / l, the appearance of glucosuria (up to 40 g / l), aketoacidosis- a sharp increase in ketone bodies (metabolites of the breakdown of fats).
Ketone bodies are formed when cells are starved for energy. Almost all of the glucose circulates in the blood and doesn't enter the cells, and it begins to use stored fat to produce ATP. At this stage, the blood glucose level is controlled with the help of diet therapy, the use of oral hypoglycemic drugs.
Clinical manifestations are impaired renal function, cardiovascular system, vision, neurological symptoms.
Serious course- Blood sugar exceeds 14 mmol / l, fluctuates up to 20-30 mmol, urinary sugar is above 50 mmol / l. Total dependence on insulin therapy, severe dysfunction of blood vessels, nerves, organ systems.
Classification according to the degree of blood glucose compensation:
Compensation- this is the normal, conditional state of the body when there is a chronic incurable disease. The disease has 3 stages:
Compensation- a diet or insulin therapy that allows you to achieve normal blood sugar levels. Non-progressive vascular and neurological disease. The patient's general condition remained positive for a long time. There is no violation of sugar metabolism in the kidneys, there are no ketone bodies, acetone. Glycosylated hemoglobin does not exceed the value "5%";
Additional compensation- incomplete treatment of blood count and clinical manifestations of the disease. Blood glucose not higher than 14 mmol/l. Sugar molecules damage erythrocytes and glycosylated hemoglobin, damage to the renal microvasculature manifests as small amounts of glucose in the urine (up to 40 g/l). Acetone in the urine is not detected, however, there may be mild manifestations of ketoacidosis;
Compensation- the most severe stage of patients with diabetes. Usually occurs in the later stages of the disease or damage to the entire pancreas, as well as to the insulin receptors. It is characterized by the patient's general severity up to coma. Glucose levels cannot be regulated with the help of pharmaceuticals. narcotics (above 14 mmol/l). High amount of sugar in the urine (over 50 g/l), acetone. Glycosylation of hemoglobin significantly exceeds the norm, hypoxia occurs. With a long course, this condition leads to coma and death.
Causes of diabetes
Diabetes mellitus (abbreviated as diabetes mellitus) is a multifactorial disease.
There is no single factor that can cause diabetes in all people with this condition.
The most important causes for the development of the disease:
Type I diabetes:
Hereditary causes of diabetes:
- congenital insufficiency of the β-cells of the pancreas;
- genetic mutations in the genes responsible for insulin synthesis;
- genetic predisposition to autoimmunity to β-cells (closest relative is diabetes);
Infectious causes of diabetes mellitus are pancreatotropic viruses (affecting the pancreas): rubella, herpes type 4, mumps, hepatitis A, B, C. Human immunity begins to destroypancreatic cells, together with these viruses, cause diabetes.
Type II diabetes has the following causes:
- heredity (presence of diabetes in the immediate family);
- visceral obesity;
- age (usually older than 50-60 years);
- eat less fiber and eat more refined fats and simple carbohydrates;
- hypertonic disease;
- atherosclerosis.
Stimulating factor
This group of factors themselves do not cause the disease, but greatly increase the chance of developing the disease, if genetic factors are present.
- sedentary (passive lifestyle);
- fat;
- smoke;
- drinking too much alcohol;
- the use of substances that affect the pancreas (eg, drugs);
- excess fat and simple carbohydrates in the diet.
Symptoms of diabetes
Diabetes is a chronic disease, so symptoms never come on suddenly. Symptoms in women and symptoms in men are almost the same. With the disease, the manifestation of the following clinical signs can be of varying degrees.
- Persistent weakness, reduced performance- develop due to chronic lack of energy of brain and skeletal muscle cells;
- Dry and itchy skin- due to constant loss of water in the urine;
- Dizziness, headache- signs of diabetes - due to a lack of glucose in the circulating blood of the cerebral vessels;
- Frequent urination- occurs due to damage to the capillaries of the glomeruli of the nephrons of the kidney;
- Reduced immunity (frequent SARS, persistent skin wounds that do not heal)- the activity of T-cell immunity is impaired, the skin performs a poorer barrier function;
- Polyphagia- a feeling of constant hunger - this condition develops due to the rapid loss of glucose in the urine and insufficient transport into the cells;
- Decreased eyesight- cause - damage to the retinal microvessels;
- Polydipsia- constant thirst due to frequent urination;
- Numbness in limbs- persistent hyperglycemia leading to specific polyneuritis - damage to sensory nerves throughout the body;
- Pain in the heart area- coronary artery narrowing due to atherosclerosis leads to reduced blood supply to the myocardium and causes spastic pain;
- Decreased sexual function- is directly related to poor blood circulation in the sex hormone-producing organs.
Diagnosing diabetes
Diagnosing diabetes is usually not difficult for a qualified specialist. Your doctor may suspect the disease, based on the following factors:
- A diabetic patient complained of polyuria (increased daily urine output), multi-sided pain (persistent hunger), weakness, headache, and other clinical symptoms.
- During a prophylactic blood test for blood glucose levels, readings are above 6. 1 mmol/l on an empty stomach, or 11. 1 mmol/l 2 hours after a meal.
If this symptom is detected, a series of tests are done to confirm/refute the diagnosis and find the cause.
Diabetes Diagnostic Laboratory
Oral glucose tolerance test (OGTT)
A standard test to determine the functional ability of insulin to bind glucose and maintain normal blood levels.
The essence of the method:In the morning, against the background of an 8-hour fast, blood is taken to assess the fasting blood glucose level. After 5 minutes, the doctor gave the patient 75 g of glucose dissolved in 250 ml of water. After 2 hours, the blood is taken again and the sugar level is determined again.
During this stage, the initial symptoms of diabetes often appear.
OGTT analytical evaluation criteria:
| Quota | |
| on an empty stomach | < 5, 6 |
| 2 hours after OGTT | < 7, 8 |
| Diabetes mellitus (need to differentiate from other types of diabetes) | |
| on an empty stomach | 6, 1 |
| 2 hours after OGTT | 11, 1 |
| random definition | 11, 1 |
Determination of glycosylated hemoglobin level (C - HbA1c)
Glycated Hemoglobin or HbA1cThis is the hemoglobin of red blood cells, which undergoes transformation due to exposure to glucose. Its concentration in the blood is directly correlated with the level of glucose, which can assess the compensation of the state of a diabetic patient.
Rated up to 6%.
- Doubtful results - 6-6, 4%;
- In diabetes mellitus - more than 6. 4%.
Determination of C-peptide level
C-peptidepart of the proinsulin molecule. When the C-peptide is cleaved, insulin becomes functionally active. The concentration of this substance in the blood allows you to assess the secretion of insulin in the pancreas.
Norm: 0. 79-1. 90 ng/ml (SI: 0. 27-0. 64 mmol/l).
Determination of proinsulin
This test allows you to distinguish different diseases of the pancreas and diabetes. An increase in proinsulin in the blood often indicates an endocrine tumor - an adenoma (a rather rare pathology). Additionally, high levels of proinsulin molecules can be a sign of type 2 diabetes.
The norm is 3, 3-28 pmol/l.
Determination of antibody levels to pancreatic beta cells
One of the most accurate tests to determine the presence and cause of diabetes. The trial was performed in risk groups (eg, people with a predisposition to diabetes, if a close relative has it), as well as in patients with impaired glucose tolerance during OGTT. .
The higher the titer of specific antibodies, the more likely the autoimmune cause of the disease, and the faster the beta cells are destroyed and the insulin level in the blood decreases. In diabetics, it usually exceeds 1: 10.
Norm - Title: less than 1: 5.
If the antibody titre remains within the normal range, but the fasting blood glucose level is above 6. 1, then type 2 diabetes is diagnosed.
Levels of insulin antibodies
Another specific immunological test. It is performed for differential diagnosis in patients with diabetes (type 1 and type 2 diabetes). If glucose tolerance is impaired, blood will be drawn and serologically tested. It can also indicate the cause of diabetes.
The norm of AT for insulin is 0-10 IU/ml.
- If C (AT) is higher than normal, the diagnosis is type 1 diabetes. autoimmune diabetes;
- If C(AT) is within the reference value, the diagnosis is type 2 diabetes.
GAD (Glutamic Acid Decarboxylase) antibody test
GAD is a central nervous system-specific membrane enzyme. The logical correlation between anti-GAD antibody levels and the development of type 1 diabetes is still unclear, however, in 80-90% of patients, these antibodies are detected in the blood. AT GAD analysis is recommended in risk groups for the diagnosis of prediabetes and the prescription of a prophylactic diet and pharmacological therapy.
AT GAD norm - 0-5 IU/ml.
- A positive result for normal blood sugar indicates a high risk of type 1 diabetes;
- A negative result with elevated blood glucose levels indicates the development of type 2 diabetes.
Blood insulin test
Insulin- a highly active hormone of the endocrine part of the pancreas, synthesized in the beta cells of the islets of Langerhans. Its main function is to transport glucose into somatic cells. The decrease in insulin levels is the most important link in the pathogenesis of the disease.
The norm for insulin levels is 2. 6-24. 9 mcU/ml
- Below normal - possible development of diabetes and other diseases;
- Above normal - a tumor of the pancreas (insulinoma).
Diabetes diagnostic tool
Pancreatic ultrasound
The method of scanning ultrasound allows you to detect morphological changes in the tissues of the gland.
Often, in diabetes mellitus, diffuse lesions are identified (areas of sclerosis - the replacement of functionally active cells by connective tissue).
In addition, the pancreas may be enlarged, showing signs of edema.
Lower extremity angiography
The lower extremity arteries are target organs in diabetes. Prolonged hyperglycemia causes hypercholesterolemia and atherosclerosis leading to tissue hypoperfusion.
The essence of this method is to introduce a special contrast agent into the blood with simultaneous control of the blood vessel on a computed tomography machine.
If the blood supply is significantly reduced at the level of the legs of the lower extremities, the so-called "diabetic foot" is formed. Diagnosing diabetes is based on this research method.
Renal ultrasound and ECHO KG of the heart
The method of examining the kidneys with an instrument, allows to assess the damage of these organs when diagnosing diabetes.
Microscopic pathologies develop in the heart and kidneys - damage to blood vessels with a significant deterioration in their lumen, and thereby impair functional abilities. The method allows to prevent complications of diabetes.
Retinal angiography or retinal angiography
The microvessels of the retina are most sensitive to hyperglycemia, so the development of lesions in them begins even before the first clinical signs of diabetes.
With the help of contrast, the degree of narrowing or complete occlusion of the vessels is determined. Also, the most important sign of DM is the presence of small sores and sores in the background.
The diagnosis of diabetes is a complex one, based on the history of the disease, objective examination by a specialist, laboratory tests, and instrumental studies. Using only one diagnostic criterion, it is not possible to establish a 100% accurate diagnosis.
If you are at risk, consult your doctor to learn more about what diabetes is and what to do with such a diagnosis.
The treatment
Diabetes treatment is a set of measures aimed at regulating the level of blood sugar, cholesterol, ketone bodies, acetone, lactic acid, preventing the rapid development of complications and improving the quality of life of the patient. People.
In diabetes, a very important aspect is the use of all methods of treatment.
Methods used in the treatment of diabetes:
- Pharmacotherapeutic (insulin therapy);
- Diet;
- Regular physical activity;
- Preventive measures to prevent the progression of the disease and the development of complications;
- Psychological support.
Treatment of type 1 diabetes
Pharmacological correction with insulin
The need for insulin injections in patients with diabetes, the type and frequency of insulin injections are completely individual and chosen by the specialists (therapists, endocrinologists, cardiologists, psychiatrists)periodontist, hepatologist, diabetologist). They always pay attention to the symptoms of diabetes, conduct differential diagnosis, screen and evaluate the effectiveness of the drug.
Types of insulin:
- rapid response(ultra-short-acting) - begins to work immediately after administration and works within 3-4 hours. Take before or immediately after a meal;
- short action- Effect 20 - 30 minutes after use. It should be applied strictly before eating 10-15 minutes;
- average duration- used for continuous reception and effect within 12-18 hours after injection. Helps prevent complications of diabetes;
- Long-acting insulin- requires continuous daily use. Valid from 18 to 24 hours. It is not used to lower the blood glucose level, but only to control its daily concentration and not to exceed the normal value;
- Combination insulinContains a wide range of short-acting and long-acting insulin ratios. It is mainly used in the intensive care of type 1 diabetes.
Diet therapy for diabetes
Diet - 50% success in controlling blood glucose levels in patients with diabetes.
What foods should be consumed?
- Fruits and vegetables that are low in sugar and high in vitamins and minerals (apples, carrots, cabbage, beets);
- Meat containing a small amount of animal fat (beef, turkey, quail);
- Cereals and cereals (buckwheat, wheat, rice, barley, barley);
- Fish (preferably sea);
- From drinks, it is better to choose weak tea, sharp fruit.
What should be removed:
- Candy, pasta, flour;
- fruit juice concentrate;
- Fatty meat and dairy products;
- Spicy and smoked foods;
- Wine.
Treatment of type 2 diabetes
In the early stages, type 2 diabetes is well treated with dietary therapy, just as it is for type 1 diabetes. If the diet is not followed, as well as during a prolonged illness, whetherPharmacological measures with hypoglycemic drugs will be used. It's even rare for type 2 diabetics to be prescribed insulin.
Blood sugar lowering drugs
- a drug that stimulates insulin production in the pancreas.
- stimulates beta cells to produce insulin.
- active in the intestine, inhibiting the activity of small intestine enzymes that break down polysaccharides into glucose.
- a drug for the prevention of polyneuropathy, micro- and macro-pathologies of the kidneys, heart and retina.
Folk remedies for the treatment of diabetes
Folk methods include the preparation of various decoctions of herbs, fruits and vegetables, which, to one degree or another, regulate the level of blood sugar.
- kryphea amur- ready-made extract from moss. The use of Criphea causes an increase in the synthesis of pancreatic hormones: lipase, amylase, protease. It also has anti-allergic and immunomodulatory effects, reducing the main symptoms of diabetes.
- Parsley root + lemon peel + garlic- these products contain a large amount of vitamins C, E, A, selenium and other trace elements. All of these must be crushed, mixed and infused for about 2 weeks. Take 1 teaspoon before meals.
- acorns- contains tannin, a very effective remedy for diabetes. This substance stimulates the immune system, has an anti-inflammatory and anti-edema effect, strengthens the walls of blood vessels, visibly reduces types. Acorns must be ground into powder and taken 1 teaspoon before each meal.
Exercise in diabetes
Regular physical activity in patients with diabetes is a very important aspect of the treatment and prevention of diabetes complications. Morning exercises, running, swimming help avoid obesity, increase blood supply to muscles and organs, strengthen blood vessels, stabilize the nervous system.
Disease prevention
With genetic predisposition, this disease cannot be prevented. However, people at risk need to take some steps to control their blood sugar and the rate at which diabetes complications develop.
- Children with unfavorable genetics (parents, grandparents with diabetes) should have their blood sugar checked once a year, as well as monitor the child's condition and the appearance of the first symptoms. of disease. In addition, an important measure will be an annual consultation with an ophthalmologist, neurologist, endocrinologist, cardiologist to identify the first symptoms of diabetes, in order to prevent diabetes. complications of diabetes.
- People over the age of 40 should have their blood glucose levels checked every year to prevent type 2 diabetes;
- All diabetics need to use special devices to monitor blood glucose levels - glucometers.
You also need to learn all about diabetes - what works, what doesn't, starting with which type and ending with your specific cause, which you need to talk to your doctor about at length. Doctor, doctor will advise and guide. You must pass the necessary tests and prescribe treatment.
recovery prognosis
Diabetes is an incurable disease, so the prognosis is poor. However, modern advances in pharmacological insulin therapy can significantly extend the life expectancy of diabetics, and routine diagnosis of typical organ system disorders leads to improved quality of life. patient's life.