Diabetes

It is believed that diabetes develops in those who consume a lot of sweets. In fact, it is a much more complex pathology, which depends only in part on nutrition and can develop in anyone.

Diabetes mellitus: definition of the disease.

Diabetes mellitus (DM) is a group of diseases associated with metabolic disorders. People with diabetes cannot digest carbohydrates properly. As a result, your glucose (blood sugar) concentration increases significantly.

Glucose is a type of sugar that serves as the body's main source of energy.

Excess glucose has a toxic effect and destroys the walls of blood vessels, nerve fibers and internal organs.

Diabetes mellitus develops for several reasons. Some types of disease are genetic in origin, while others are related to lifestyle or environmental factors.

The name of the disease was given by the ancient Greeks. Translated from Greek, διαβαίνω means "to pass", which refers to the main symptom of diabetes mellitus, polyuria or frequent urination. Because of this, a person continually loses fluid and strives to replenish it by drinking as much water as possible.

However, this is not always the case. Some forms of diabetes can develop asymptomatically for a long time or manifest themselves so mildly that a person does not even realize that something has gone wrong. And even with the typical course of the disease, it often takes many years before excess blood glucose causes the development of disease symptoms. Furthermore, during all this time the person is in a state of hyperglycemia and, at the time of diagnosis, already has serious irreversible disorders of the kidneys, blood vessels, brain, peripheral nerves and retina.

The disease causes significant damage to the body. Without treatment, excess glucose can cause impaired kidney, heart, and nerve cell function. But these complications can be prevented. Modern doctors have enough effective medications and techniques to treat diabetes.

Predominance

In 2019, diabetes was the direct cause of 1. 5 million deaths worldwide. Furthermore, in almost half of the cases the disease was fatal in people under 70 years of age. The other half of the patients died from complications of the disease: kidney failure, heart and vascular damage.

In addition to humans, animals also suffer from diabetes. For example, dogs and cats.

From 2000 to 2019, the diabetes mortality rate in developed countries increased by 3% and in lower middle-income countries by 13%. At the same time, the probability of death from complications of the disease in people aged 30 to 70 decreased by 22% worldwide. This is believed to be due to better diagnosis of diabetes and effective methods for early prevention of its complications.

Diabetes classification

In our country we use the classification of diabetes mellitus approved by the World Health Organization in 1999.

Diabetes mellitus type I

In this type of disease, a person's pancreas produces little of the hormone insulin, which is needed to transport glucose to cells. As a result, glucose entering the blood cannot be completely absorbed by cells, remains in the vessels, is transported to tissues and gradually destroys them.

Depending on the cause of pancreatic dysfunction, type I diabetes is divided into two subtypes: immune-mediated and idiopathic.

Immune-mediated diabetes mellitusthe result of autoimmune destruction of pancreatic cells, whereby the immune system mistakenly attacks its own healthy tissue. Diabetes usually begins in childhood or adolescence, but can develop in people of all ages.

Immune-mediated diabetes is often associated with other autoimmune disorders, such as Graves' disease, Hashimoto's thyroiditis, Addison's disease, vitiligo, or pernicious anemia.

Type 1 diabetes mellitus most often develops in children and adolescents, although it can occur at any age.

Idiopathic diabetes mellitus.A rare variant of the disease. These patients do not have laboratory signs of autoimmune damage, but symptoms of absolute insulin deficiency are observed.

Diabetes mellitus type II

In this case, the pancreas produces enough insulin, but the cells are insensitive or resistant to it, so they cannot absorb glucose and it accumulates in the blood.

Depending on the main cause, type II diabetes mellitus is divided into type II diabetes mellitus with predominantly insulin resistance and relative insulin deficiency and type II diabetes mellitus with predominantly impaired insulin secretion with or without insulin resistance.

Other specific types of diabetes

Other specific forms of the disease include pathologies with a pronounced genetic component, associated with infectious diseases or with the intake of certain medications, among others.

Genetic defects in pancreatic β cell function.those types of diseases in the development of which a defective gene is clearly established.

Genetic defects in insulin action.The development of pathology is associated with the peripheral action of insulin, which is impaired due to mutations in the insulin receptor gene.

Diseases of the exocrine pancreas.For example, chronic pancreatitis and other inflammatory pathologies.

Endocrinopathiespathologies associated with excessive secretion of other hormones, such as acromegaly, Cushing's disease, hyperthyroidism.

Diabetes induced by drugs or chemicals, can occur while taking hormonally active substances, α and β adrenergic agonists, psychoactive drugs, diuretics and chemotherapeutics.

Diabetes associated with infectious diseases.As a rule, the disease develops due to viral infections (pathogens: Coxsackie virus, rubella, Epstein Barr virus).

Unusual forms of immunologically mediated diabetes.For example, immobility and rigidity syndrome, systemic lupus erythematosus.

Other genetic syndromes, sometimes combined with diabetes.

Gestational diabetes mellitus

It appears for the first time during pregnancy and is characterized by a decreased sensitivity of cells to glucose. It is believed that the disease develops due to a hormonal imbalance. After childbirth, the condition returns to normal or may develop into type II diabetes.

Causes of diabetes

Diabetes mellitus develops for various reasons, including genetic and autoimmune disorders, chronic pancreatic diseases, and dietary habits.

Common causes of diabetes:

• a malfunction of the immune system, which attacks the pancreatic cells;
• genetic disorders that alter the sensitivity of tissues to glucose, change the functioning of the pancreas and reduce or completely stop the synthesis of insulin necessary for glucose absorption;
• viral infections Coxsackie viruses, rubella, Epstein Barr, and retroviruses can penetrate the cells of the pancreas and destroy the organ;
• chronic diseases affecting the pancreas, cystic fibrosis, pancreatitis, hemochromatosis;
• endocrine diseases Cushing syndrome, acromegaly;
• toxins (e. g. rodenticides, used to kill rodents, heavy metals, nitrates);
• eating habits: excess fat and simple carbohydrates in the diet can cause obesity and decreased sensitivity of cells to insulin;
• medications, some hormonal medications (in particular glucocorticosteroids), certain medications for the treatment of diseases of the heart and nervous system, vitamin B preparations (if consumed in excess).

Risk factors for diabetes

Depending on the type of diabetes, the risk factors for the disease differ.

Risk factors for type I diabetes:

• heredity - the likelihood of getting sick is higher if blood relatives have diabetes;
• Some viral infections (eg, rubella, infectious mononucleosis) can trigger an autoimmune reaction in the body, causing the immune system to attack pancreatic cells.

Excess weight does not cause type I diabetes, but it does increase the risk of developing type II diabetes.

The most common risk factors for type II diabetes mellitus, which are not directly related to an increase in blood glucose levels: excess weight, sedentary lifestyle, pregnancy, etc.

During physical activity, glucose is actively broken down to produce energy; Substances provided by food, as well as the body's own fat reserves, are used as a substrate. With obesity, the volume and, consequently, the area of fat membranes and other cells containing lipid inclusions increases, the relative density of insulin receptors per unit area decreases, as a result, cells become less sensitive to insulin and absorb glucose worsens.

Risk factors for type II diabetes mellitus:

• overweight and obesity;
• a sedentary lifestyle (without physical activity, glucose is broken down more slowly, so cells may become less sensitive to insulin);
• diabetes mellitus in blood relatives;
• age over 45 years;
• Prediabetes is a condition in which the blood glucose level remains at the upper limit of normal for a long time. Prediabetes is said to be present if the analysis shows values of 5. 6 to 6. 9 mmol/l;
• diabetes mellitus during pregnancy (gestational diabetes);
• birth of a child weighing more than 4 kg;
• depression;
• cardiovascular diseases;
• arterial hypertension (pressure greater than 140/90 mm Hg);
• elevated levels of "bad" high-density cholesterol (more than 0. 9 mmol/l) and triglycerides (more than 2. 82 mmol/l);
• polycystic ovary syndrome.

Diabetes symptoms

Type I diabetes mellitus usually manifests itself with pronounced symptoms; Other types of disease can go unnoticed for a long time.

Common symptoms of diabetes:

• be strong;
• weakness;
• frequent urination;
• enuresis in children who have not wet the bed before;
• sudden weight loss for no apparent reason;
• strong and constant feeling of hunger;
• Frequent urinary tract infections or fungal infections.

On the other hand, there are the so-called secondary symptoms of diabetes mellitus, which appear in the later stages of the disease and signal complications.

Secondary symptoms of diabetes:

• skin itch;
• nausea;
• vomit;
• abdominal pain;
• dry mouth;
• muscular weakness;
• blurry vision;
• wounds that heal poorly;
• numbness in your fingers or toes;
• acanthosis nigricans darkening of the skin of the neck, armpits, elbows and knees;
• diabetic dermopathy, pigment spots with atrophy and peeling of the skin, located in the curves of the lower extremities, often appear due to poor healing of wounds on the legs;
• Diabetic pemphigus blisters on the lower extremities ranging in size from a few millimeters to several centimeters. It occurs more frequently in elderly patients with long-term diabetes;
• headache;
• acetone smell from the mouth.

Acanthosis nigricans, or darkening of the skin on the neck, knees, elbows, and armpits, can be a sign of diabetes.

Diabetes complications

Complications usually occur in patients with advanced diabetes mellitus and include retinopathy, nephropathy, and polyneuropathy.

Destruction of large vessels causes atherosclerosis, myocardial infarction, stroke and encephalopathy.

Constant monitoring of blood glucose and taking medications to lower its level can prevent or delay the irreversible complications of diabetes.

In addition, the regeneration of small vessels is impaired. Because of this, wounds on the body do not heal well. Therefore, even a small cut can turn into a deep, purulent ulcer.

Diabetic coma

Diabetic coma is a complication of diabetes associated with too high or, conversely, low blood sugar levels.

Depending on the concentration of glucose in the blood, diabetic coma is divided into two types: hypoglycemic (associated with a decrease in sugar levels) and hyperglycemic (caused by an increase in its level).

hypoglycemic comaIt generally occurs in people with diabetes who are on insulin therapy.

The cause of such a coma is excess insulin, which prevents the body from raising blood glucose levels to normal levels. This often happens when the insulin dose is calculated incorrectly or the diet is altered, in which the amount of insulin administered does not correspond to the carbohydrate portion of the food eaten.

Precursors of hypoglycemic coma:

• trembling in the body,
• shaking chills,
• dizziness,
• nervousness or anxiety
• severe hunger
• nausea,
• blurry vision,
• alteration of heart rhythm.

"Rule 15" to stop hypoglycemia in diabetes:

If your "sugar" level decreases, you should eat 15 g of fast carbohydrates (drink juice, take a glucose tablet) and measure your blood glucose level after 15 minutes. If your level is low, eat another 15 g of fast carbohydrates. Repeat these steps until the sugar rises to at least 3. 9 mmol/l.

In rare cases, low blood sugar can cause a person to faint. In such a situation, you need an urgent injection of the hormone glucagon, which is performed by an ambulance worker.

Some people mistakenly believe that a person in a hypoglycemic coma needs a sweet liquid poured into their mouth. However, this is not the case and he is plagued with suffocation (suffocation).

Hyperglycemic comaaccompanied by an acute lack of insulin, which can be caused by severe stress or an insufficient dose of insulin after meals.

Dangerous hyperglycemia is said to occur if the blood glucose level exceeds 13. 9 mmol/L.

Symptoms of hyperglycemia:

• thirst strong
• frequent urination,
• extreme fatigue
• blurry vision,
• acetone or fruity breath smell,
• nausea and vomiting,
• abdominal pain,
• fast breathing.

If such symptoms appear, you should sit down as soon as possible, ask other people to call an ambulance, or call it yourself.

Diagnosis of diabetes mellitus.

If a person has symptoms of increased blood sugar concentration: constant thirst, frequent urination, general weakness, blurred vision, numbness in the extremities, he or she should consult a family doctor as soon as possible.

But most often, diabetes mellitus develops asymptomatically, so it is recommended that everyone be screened once a year to detect the disease in the early stages and prevent the development of complications. .

Which doctor should I contact if I suspect diabetes mellitus?

As a rule, people first turn to a family doctor. If diabetes is suspected, they are referred to a specialized specialist who treats metabolic pathologies, an endocrinologist.

During the consultation, the doctor will conduct an examination and examination and, to confirm the diagnosis and determine the severity of diabetes, will prescribe instrumental and laboratory tests.

Inspection

If diabetes is suspected, the doctor will clarify the medical history: cases of the disease in blood relatives, chronic pathologies of the pancreas, lifestyle, recent infectious diseases.

There are no specific signs of diabetes that can be detected during the exam.

During the examination, the doctor will also evaluate the condition of the skin: with diabetes mellitus, dark areas of acanthosis nigricans may appear. Additionally, a specialist can perform a rapid glucose test. Exceeding normal values is reason for an in-depth examination.

Laboratory research methods.

For diagnosis, a blood glucose test is prescribed. Its high level along with characteristic symptoms such as constant thirst, frequent urination and frequent infectious diseases is a clear sign of diabetes.

Blood glucose concentration is measured by one of the following tests: fasting and postprandial plasma glucose test, glycated hemoglobin level (HbA1c), which reflects the average blood sugar level over the past 3 months.

An HbA1c level of no more than 6. 0% (42 mmol/L) and a glucose level of no more than 5. 5 mmol/L are considered normal.

To make an accurate diagnosis, the study is performed at least twice on different days. If the results are ambiguous, a glucose tolerance test is performed, which makes it possible to identify altered cellular sensitivity to glucose.

Additionally, your doctor may order additional tests to distinguish type 1 diabetes from type 2 diabetes: an autoantibody test and a urine ketone body test.

Antibodies are usually present in people with type I diabetes and ketone bodies in people with type II diabetes.

To evaluate the sensitivity of cells to insulin, the doctor may order a test to calculate the HOMA-IR index (homeostasis model of insulin resistance assessment), which takes into account the level of glucose and insulin in the blood.

If hereditary forms of diabetes are suspected, experts may recommend genetic testing to identify mutations associated with hereditary forms of diabetes mellitus and glucose intolerance.

Instrumental research methods.

Instrumental examinations help to identify complications of diabetes: damage to the retina, damage to the heart, blood vessels, kidneys, and nerve conduction disorders.

An ultrasound examination of internal organs is prescribed to assess the condition of the kidneys and pancreas. Additionally, the doctor may refer the patient for an ECG to detect abnormalities in the heart.

To diagnose visual disorders, it will be necessary to consult an ophthalmologist. During an ophthalmological examination, the doctor evaluates the condition of the retina and examines the cornea through a slit lamp or ophthalmoscope.

Diabetes treatment

There is not a cure for diabetes. Therapy is aimed at maintaining acceptable blood glucose levels and preventing complications of the disease.

People diagnosed with diabetes need to periodically measure their blood glucose levels, inject insulin for type 1 diabetes or take tablets for type 2 diabetes, or inject insulin to control blood sugar levels.

To prevent complications of the disease, your doctor may recommend other medications. For example, medications to control blood pressure, thin the blood and prevent cardiovascular diseases, as well as medications that lower blood cholesterol.

Monitoring blood glucose levels

Classic glucometers and modern continuous monitoring systems are used to control blood glucose levels.

A glucometer is a device equipped with a fine needle. A person pricks his finger and blood drips onto a special test strip. The glucometer immediately shows the result.

Monitoring systems are sensors that are installed on the shoulder, stomach or leg. These sensors constantly monitor blood glucose levels. Data from the device is automatically downloaded to a special monitor or app on your phone. Such devices can signal blood sugar spikes, plot glucose curves over periods of time, send information to your doctor, and even make recommendations about emergency and routine measures and the need to change diabetes treatment tactics.

Using the monitoring system doesn't hurt; It is not felt in the body.

Diabetes diet

There is no special diet for people with diabetes, but it is important for people with this diagnosis to count the amount of carbohydrates they eat every day and keep a food diary.

carbohydrate counting

Carbohydrates affect blood sugar levels the most, so it is important for people with diabetes not to eliminate them, but to count them.

Carbohydrate counting is the basis of the diet for people with diabetes receiving insulin therapy. To do this, use the universal bread unit (XE) parameter.

1 XE corresponds to approximately 15 g of net carbohydrates or 20 to 25 g of bread and increases blood glucose levels by an average of 2. 77 mmol/l. To absorb such an amount of glucose, an insulin dose of 1. 4 units is required.

The amount of carbohydrates in the diet of a person with type I diabetes on average should not exceed 17 units of bread per day.

The amount of carbohydrates a person with diabetes can typically tolerate varies from person to person and depends on weight, physical activity level, daily caloric needs, and how the body metabolizes carbohydrates.

You can calculate the required amount of carbohydrates per day with a nutritionist or your doctor. After converting the carbohydrates you eat into units of bread, your doctor will help you determine the amount of insulin you will need to absorb the glucose. Over time, a person will learn to calculate this for himself.

In addition, there are other dietary recommendations for people with diabetes:

• limit calorie intake for all overweight patients;
• minimize the content of fats (mainly of animal origin) and sugars in foods;
• consume carbohydrates mainly from vegetables, whole grains and dairy products;
• exclude or limit the consumption of alcoholic beverages (no more than 1 conventional unit for women and 2 conventional units for men per day).

Prognosis and prevention of diabetes mellitus.

Diabetes mellitus is a chronic disease that cannot be completely cured. But medications and healthier lifestyle changes help avoid complications and slow the progression of the disease.

Without treatment, the prognosis of diabetes mellitus is unfavorable: a person can die due to damage to the cardiovascular system.

Ways to prevent diabetes:

• regular physical activity;
• varied diet with enough fiber, protein, fats and carbohydrates;
• healthy weight management;
• reduce alcohol consumption;
• quit alcohol and smoking.

Nutrition for the prevention of type II diabetes mellitus

An important part of preventing type II diabetes is a healthy and varied diet. For this, the principle or method of a healthy dish has been developed.

The Healthy Plate Method divides foods into five main groups: fruits and vegetables, slow-release carbohydrates, dairy, proteins and fats. You can combine these groups using a normal plate. Fruits and vegetables should make up a third or half. Cut carbs by a third or a little more. The remaining part is occupied by dairy products, a little more by protein foods and a small part by fats.

Eat according to the principle of a healthy plate: half is fiber, ⅓ slow carbohydrates and the rest protein foods.

In addition, other important principles of healthy eating must be observed:

• drink according to thirst;
• eat less salt, no more than a teaspoon (5 to 6 g) per day;
• limit the consumption of trans fats (found in many fast food products, prepared and processed cakes and pastries);
• reduce the consumption of saturated fats (found in sweet pastries, fatty meats, sausages, butter and lard);
• Eat less sugar, no more than 7 teaspoons (30 g) per day.