diabetes (diabetes) is a chronic metabolic disease characterized by absolute or relative insufficiency of the pancreatic protein hormone called insulin in the blood and characterized by disruption of glucose metabolism in the body - persistent hyperglycemia, which subsequently leads to the metabolism of fat, protein, mineral salts and waterdisorder.
Next, you will learn: what is diabetes, its main types, symptoms and treatments.
Types of Diabetes (Classification)
Diabetes is classified by cause:
type 1 diabetes- Characterized by an absolute lack of insulin in the blood:
- Autoimmunity - antibodies attack pancreatic beta cells and destroy them completely;
- idiopathic (cause unknown);
type 2 diabetes- A relative lack of insulin in the blood. This means that quantitative measures of insulin levels remain within the normal range, but the number of hormone receptors on the membranes of target cells (brain, liver, adipose tissue, muscle) is reduced.
gestational diabetes- An acute or chronic disease characterized by hyperglycemia during pregnancy in women.
Other (situational) causes of diabetes- Impaired glucose tolerance due to causes unrelated to pancreatic pathology. They can be temporary or permanent.
type of diabetes:
drug;
contagious;
Genetic defects in the insulin molecule or its receptor;
Associated with other endocrine disorders:
- Itsenko-Cushing disease;
- adrenal adenoma;
- Graves disease.
Diabetes is classified by severity:
light shape- Characterized by hyperglycemia of not more than 8 mmol/l, with slight daily fluctuations in sugar levels, without glycosuria (sugar in urine). Pharmacological correction with insulin is not required.
Many times, clinical manifestations of the disease may not be present at this stage, however, during instrumental diagnosis, initial forms of typical complications, including damage to peripheral nerves, retinal microvessels, kidneys, and heart, have been detected.
Moderate- Glucose level in peripheral blood reaches 14 mmol/l, presence of glycosuria (up to 40 g/l), afferentketoacidosis- A dramatic increase in ketone bodies (fat catabolites).
Ketone bodies are formed due to a lack of cellular energy. Almost all glucose circulates in the blood without entering cells, where it begins to use fat reserves to produce ATP. At this stage, blood sugar levels are controlled with the help of dietary therapy, using oral hypoglycemic drugs.
Clinical manifestations are impaired renal function, cardiovascular system, vision, neurological symptoms.
heavy course- Blood sugar over 14 mmol/l, fluctuating up to 20-30 mmol, glucosuria over 50 mmol/l. Completely dependent on insulin therapy, severe dysfunction of blood vessels, nerves, and organ systems.
According to the degree of hyperglycemia compensation:
compensation- This is the conditioned normal state of the body in the presence of chronic incurable diseases. The disease has 3 stages:
compensation- Diet or insulin therapy can bring you to normal blood sugar levels. Vascular disease and neuropathy did not progress. The patient's general condition is long-term satisfactory. There is no violation of glucose metabolism in the kidneys, no ketone bodies, acetone. Glycated hemoglobin does not exceed the "5%" value;
sub compensation- Treatment does not completely correct blood counts and clinical manifestations of disease. Blood sugar is not higher than 14 mmol/L. Sugar molecules damage red blood cells and appear glycosylated hemoglobin, and damage to renal microvasculature manifests as small amounts of glucose (up to 40 g/l) in the urine. Acetone is not detected in urine, but there may be mild manifestations of ketoacidosis;
decompensated- The most severe stage for people with diabetes. It usually occurs later in the disease or with complete damage to the pancreas and insulin receptors. It is characterized by the generally severe condition of the patient up to coma. Glucose levels cannot be corrected with the help of medication. Drugs (over 14 mmol/L). High amounts of sugar (over 50 g/L), acetone in urine. Glycated hemoglobin was significantly exceeded, and hypoxia occurred. If the disease is prolonged, the condition can lead to coma and death.
causes of diabetes
Diabetes mellitus (DM) is a multi-causal disease.
There is no single factor that causes diabetes in all people with this condition.
The most important reasons for the development of the disease:
Type I diabetes:
Genetic causes of diabetes:
- Congenital insufficiency of pancreatic beta cells;
- Inherited mutations in the genes responsible for insulin synthesis;
- Genetic predisposition to immune self-aggression against beta cells (nearest relative with diabetes);
The infectious causes of diabetes are pancreas-stimulating (pancreas-affecting) viruses: rubella, herpes type 4, mumps, hepatitis A, B, and C. Human immunity begins to destroy pancreatic cells as well as these viruses, leading to diabetes.
Type II diabetes has the following causes:
- Genetic (presence of diabetes in an immediate family member);
- Visceral obesity;
- age (usually over 50-60);
- Low intake of fiber and high intake of refined fats and simple carbohydrates;
- Hyperosmolar disease;
- Atherosclerosis.
stimulus
This set of factors does not by itself cause the disease, but if there is a genetic predisposition, it can significantly increase the chances of its development.
- Physical inactivity (passive lifestyle);
- obesity;
- smokes;
- excessive drinking;
- use of substances (such as drugs) that affect the pancreas;
- Too much fat and simple carbohydrates in the diet.
symptoms of diabetes
Diabetes is a chronic disease, so symptoms do not appear suddenly. Symptoms in women are almost the same as those in men. The manifestations of the following clinical symptoms may vary with the disease.
- Continued weakness, performance degradation- develops due to chronic energy deficiency in brain cells and skeletal muscles;
- dry and itchy skin- due to the constant loss of fluid in the urine;
- dizziness, headache- signs of diabetes - due to lack of glucose in the blood circulating in the blood vessels of the brain;
- frequent urination- Occurs due to damage to the glomerular capillaries of the renal nephrons;
- Decreased immunity (SARS is frequent, skin wounds do not heal for a long time)- Impaired T cell immune activity and poor skin barrier function;
- polyphagia- persistent hunger - this condition is caused by the rapid loss of glucose in the urine and its insufficient entry into cells;
- vision loss- causes - damage to the microscopic retinal blood vessels;
- polydipsia- persistent thirst due to frequent urination;
- numbness in the limbs- Long-term hyperglycemia leading to specific polyneuropathy - systemic sensory nerve damage;
- pain in the heart area- Reduced blood supply to the myocardium and spastic pain due to narrowing of coronary vessels due to atherosclerosis;
- decreased sexual function- Directly related to poor blood circulation in organs that produce sex hormones.
Diagnosis of diabetes
Diagnosis of diabetes usually poses no difficulty for a qualified specialist. Doctors may suspect this disorder based on:
- A diabetic patient complained of polyuria (increased daily urine output), polyphagia (persistent hunger), weakness, headache, and other clinical symptoms.
- In a preventive blood test of blood sugar levels, it was higher than 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 performed to confirm/refute the diagnosis and find out the cause.
Laboratory Diagnosis of Diabetes
Oral glucose tolerance test (OGTT)
A standard test used to determine insulin's functional ability to bind glucose and maintain normal levels in the blood.
The essence of the method:In the morning, in the context of an 8-hour fast, blood was drawn to assess fasting blood glucose levels. After 5 minutes, the doctor had the patient drink 75 grams of glucose dissolved in 250 milliliters of water. After 2 hours, blood was drawn again and glucose levels were again determined.
During this time, the first symptoms of diabetes usually appear.
Criteria for evaluating OGTT analysis:
| specification | |
| fasting | < 5. 6 |
| 2 hours after OGTT | < 7. 8 |
| Diabetes (requires differential diagnosis of diabetes type) | |
| fasting | ≥6. 1 |
| 2 hours after OGTT | ≥11. 1 |
| random definition | ≥11. 1 |
Determination of Glycosylated Hemoglobin (C - HbA1c) Levels
Glycated hemoglobin or HbA1c- This is the hemoglobin of red blood cells, which is converted due to contact with glucose. Its concentration in the blood is directly related to the level of glucose, which makes it possible to judge the compensation of the diabetic state.
The norm is up to 6%.
- Doubtful results - 6-6. 4%;
- In diabetes - more than 6. 4%.
Determination of C-peptide levels
C-peptideis a fragment 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.
Standard: 0. 79-1. 90 ng/ml (SI: 0. 27-0. 64 mmol/l).
Determination of proinsulin levels
This test allows you to differentiate between various diseases of the pancreas and diabetes. An increase in proinsulin in the blood usually indicates an endocrine tumor - an insulinoma (a rather rare pathology). In addition, high concentrations of the molecule proinsulin may indicate type 2 diabetes.
The standard is 3. 3-28 pmol/l.
Determination of antibody levels in pancreatic beta cells
One of the most accurate tests to determine the presence and cause of diabetes. This test is performed in at-risk groups (for example, if a close relative has diabetes) and in patients with impaired glucose tolerance during the OGTT.
The higher the titer of the specific antibody, the more likely the autoimmune cause of the disease, the faster the beta cells are destroyed, and the insulin levels in the blood drop. In diabetics, it is usually more than 1: 10.
Standard - Titer: less than 1: 5.
Type 2 diabetes is diagnosed if the antibody titer remains within the normal range, but the fasting blood glucose concentration is above 6. 1.
insulin antibody level
Another specific immunological assay. It is used in the differential diagnosis of diabetic patients (type 1 diabetes and type 2 diabetes). If glucose tolerance is impaired, blood is drawn and serological testing is performed. It can also indicate the cause of diabetes.
The AT standard for insulin is 0-10 IU/ml.
- Type 1 diabetes is diagnosed if C (AT) is higher than normal. autoimmune diabetes;
- Type 2 diabetes was diagnosed if C (AT) was within the reference range.
GAD (glutamate decarboxylase) antibody detection
GAD is a specific membrane enzyme of the central nervous system. The logical correlation between GAD antibody concentrations and the development of type 1 diabetes remains unclear, however, in 80-90% of patients, these antibodies are detectable in the blood. An AT GAD analysis is recommended in at-risk populations to diagnose prediabetes and develop preventive diet and medication.
GAD Standard - 0-5 IU/ml.
- A positive euglycemic result indicates a high risk of developing type 1 diabetes;
- A negative result with elevated blood sugar levels indicates the development of type 2 diabetes.
blood insulin test
insulin- Highly active hormone in 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. Decreased insulin levels are the most important link in disease pathogenesis.
Insulin concentration standard is 2. 6-24. 9 mcU/ml
- Substandard - possible development of diabetes and other diseases;
- Above normal - pancreatic tumor (insulinoma).
Instrumental Diagnosis of Diabetes
Pancreatic ultrasound
The method of ultrasound scanning allows you to detect morphological changes in glandular tissue.
Often, in diabetes, diffuse damage (sclerotic areas - replacement of functionally active cells with connective tissue) is identified.
In addition, the pancreas can be enlarged with signs of edema.
lower extremity angiography
The lower extremity arteries are the target organs of diabetes. Chronic hyperglycemia can lead to elevated blood cholesterol and atherosclerosis, which can lead to reduced tissue perfusion.
The essence of the method is to introduce a special contrast agent into the bloodstream while controlling the patency of the blood vessels on a computed tomography scanner.
If the blood supply to the lower extremities is significantly reduced at the level of the calf, the so-called "diabetic foot" is formed. Diagnosis of diabetes is based on this research method.
Renal Ultrasound and Cardiac ECHO KG
A method of instrumental examination of the kidneys, allowing assessment of damage to these organs in the event of a diagnosis of diabetes.
Microangiopathy develops in the heart and kidneys - the blood vessels are damaged, the lumen of the lumen is significantly reduced, and therefore the ability to function is reduced. This method allows prevention of diabetic complications.
Retinography or angiography of retinal blood vessels
The retina's microscopic blood vessels are most sensitive to hyperglycemia, so the development of their damage begins even before the first clinical symptoms of diabetes.
With the help of contrast, the degree of narrowing or complete occlusion of the blood vessel is determined. In addition, the most important signs of DM are the presence of micro-erosion and ulcers in the fundus.
Diagnosis of diabetes is a complex measure based on the history of the disease, objective examination by experts, laboratory tests and instrumental studies. Using only one diagnostic criterion, it is impossible to establish a 100% correct diagnosis.
If you are at risk, be sure to consult your doctor to learn more about what diabetes is and how to manage such a diagnosis.
treat
The treatment of diabetes is a set of measures to correct the levels of blood sugar, cholesterol, ketone bodies, acetone, and lactic acid, prevent the rapid development of complications, and improve the quality of human life.
In diabetes, a very important aspect is the use of all treatments.
Methods used to treat diabetes:
- drug therapy (insulin therapy);
- diet;
- regular physical exercise;
- preventive measures to prevent disease progression and the development of complications;
- psychological support.
Type 1 diabetes treatment
Pharmacological correction with insulin
The type and frequency of insulin injections required for diabetics are strictly individualized and selected by specialists (therapists, endocrinologists, cardiologists, neuropathologists, hepatologists, diabetologists). They keep an eye on the symptoms of diabetes, make differential diagnoses, screen and evaluate the effectiveness of medications.
Types of insulin:
- act fast(Ultra-short-acting) - Onset of action immediately after administration, within 3-4 hours. Use immediately before or after meals;
- short action- Works 20-30 minutes after administration. It must be applied strictly 10-15 minutes before eating;
- medium duration- For continuous reception and works within 12-18 hours after injection. Helps prevent diabetes complications;
- long-acting insulin- Requires constant daily use. Valid for 18 to 24 hours. It is not used to lower blood sugar levels, but only to control its daily concentration, which is not allowed to exceed normal values;
- combined insulin- Contains different ratios of ultra-short-acting and long-acting insulin. It is mainly used in the intensive care of type 1 diabetes.
diet therapy for diabetes
Diet - 50% successfully control blood sugar levels in people with diabetes.
What food should I eat?
- fruits and vegetables 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);
- The best choice for beverages is light tea, fruit soup.
What should be discarded:
- confectionery, pasta, flour;
- fruit juice concentrate;
- Fatty meat and dairy products;
- spicy and smoked foods;
- Alcohol.
Type 2 Diabetes Treatment
In the early stage of type 2 diabetes, the effect of diet treatment is good, which is the same as that of type 1 diabetes. More rarely, people with type 2 diabetes take insulin.
Hypoglycemic agents
- A drug that stimulates the pancreas to produce insulin.
- Stimulates beta cells to produce insulin.
- Works in the gut, inhibiting the activity of small intestinal enzymes that break down polysaccharides into glucose.
- A drug for the prevention of polyneuropathy, microangiopathy, and macrovascular disease of the kidneys, heart, and retina.
folk remedies for diabetes
Folk methods include preparing decoctions of various herbs, fruits and vegetables to correct blood sugar levels to some extent.
- kriffia amur- Ready-made extracts from moss. The use of Criphea increases 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 zest + garlic- These products contain large amounts of trace elements such as vitamins C, E, A, selenium, etc. All have to be crushed, mixed and infused for about 2 weeks. Take 1 teaspoon orally before meals.
- acorn acorn- Contains tannins, a very effective remedy for diabetes. This substance stimulates the immune system, has anti-inflammatory and anti-edematous effects, strengthens the walls of blood vessels, relieves marked types. Acorns must be ground into powder and 1 teaspoon taken before each meal.
Physical exercise for diabetics
Regular physical activity in people with diabetes is a very important aspect in the treatment and prevention of diabetes complications. Morning exercise, running, and swimming help to avoid obesity, improve blood supply to muscles and organs, strengthen blood vessels, and stabilize the nervous system.
prevent disease
Due to genetic susceptibility, the disease cannot be prevented. However, people at risk need to take some steps to control the rate at which blood sugar and diabetes complications develop.
- Children with poor genetics (parents, grandparents with diabetes) should have their blood glucose levels checked annually and monitored for their condition and the onset of the first symptoms of the disease. In addition, an important measure will be annual consultations with ophthalmologists, neuropathologists, endocrinologists, cardiologists to identify the first symptoms of diabetes to prevent diabetes complications.
- People over 40 need to have their blood sugar levels checked annually to prevent type 2 diabetes;
- All people with diabetes need special equipment to monitor their blood sugar levels - a blood glucose meter.
You also need to know everything you need to know about diabetes - what is possible and what is not possible, starting with the type and ending with the cause of the disease specific to you, for which you need to have a long conversation with your doctor who will consult, Guide you through necessary tests and prescribe treatment.
recovery prognosis
Diabetes is an incurable disease, so the prognosis for recovery is poor. However, modern advances in pharmacological insulin therapy can significantly prolong the lives of people with diabetes, and regular diagnosis of typical organ system diseases can improve patients' quality of life.