Diabetes: types and causes of their development, course and manifestations, how to treat, possible consequences. The main signs of diabetes What are the symptoms in diabetics

Diabetes mellitus is one of the most common diseases that tend to increase in incidence and spoil statistics. Symptoms of diabetes mellitus do not appear in one day, the process flows chronically, with an increase and aggravation of endocrine and metabolic disorders. True, the onset of type I diabetes is significantly different from the early stage of the second.

Among all endocrine pathologies, diabetes confidently holds the lead and accounts for more than 60% of all cases. In addition, disappointing statistics show that 1/10 of the “diabetics” are children.

The probability of acquiring the disease increases with age, and thus the size of the group doubles every decade. This is due to increased life expectancy, improved methods of early diagnosis, reduced physical activity and an increase in the number of people who are overweight.

Types of diabetes

Many have heard of such a disease as diabetes insipidus. So that the reader does not subsequently confuse the diseases that are called "diabetes", it will probably be useful to explain their differences.

diabetes insipidus

Diabetes insipidus is an endocrine disease that occurs as a result of neuroinfections, inflammatory diseases, tumors, intoxications and is caused by deficiency, and sometimes complete disappearance of ADH-vasopressin (antidiuretic hormone).

This explains the clinical picture of the disease:

• Constant dryness of the mucous membranes of the oral cavity, incredible thirst (a person can drink up to 50 liters of water in 24 hours, stretching the stomach to a large size);
• Isolation of a huge amount of non-concentrated light urine with a low specific gravity (1000-1003);
• Catastrophic weight loss, weakness, decreased physical activity, disorders of the digestive system;
• A characteristic change in the skin ("parchment" skin);
• Atrophy of muscle fibers, weakness of the muscular apparatus;
• The development of dehydration syndrome in the absence of fluid intake for more than 4 hours.

The disease in terms of complete cure has an unfavorable prognosis, performance is significantly reduced.

Brief anatomy and physiology

An unpaired organ - the pancreas performs a mixed secretory function. Its exogenous part carries out external secretion, producing enzymes involved in the digestion process. The endocrine part, which is entrusted with the mission of internal secretion, is engaged in the production of various hormones, including - insulin and glucagon. They are key in ensuring the consistency of sugar in the human body.

The endocrine gland is represented by the islets of Langerhans, consisting of:

1. A-cells, which occupy a quarter of the entire space of the islets and are considered the site of glucagon production;
2. B-cells, occupying up to 60% of the cell population, synthesizing and accumulating insulin, the molecule of which is a polypeptide of two chains, carrying 51 amino acids in a specific sequence. The sequence of amino acid residues for each representative of the fauna is different, however, in relation to the structural structure of insulin, pigs are closest to humans, which is why their pancreas is primarily used to produce insulin on an industrial scale;
3. D-cells producing somatostatin;
4. Cells that produce other polypeptides.

Thus, the conclusion is: damage to the pancreas and the islets of Langerhans, in particular, is the main mechanism that inhibits the production of insulin and triggers the development of the pathological process.

Types and special forms of the disease

The lack of insulin leads to a violation of the constancy of sugar (3.3 - 5.5 mmol / l) and contributes to the formation of a heterogeneous disease called diabetes mellitus (DM):

• The complete absence of insulin (absolute deficiency) forms insulin dependent pathological process, which is type I diabetes mellitus (IDDM);
• A lack of insulin (relative deficiency), which triggers a violation of carbohydrate metabolism in the initial stage, slowly but surely leads to the development non-insulin dependent diabetes mellitus (NIDDM), which is called diabetes mellitus type II.

Due to a violation in the body of glucose utilization, and, consequently, its increase in blood serum (hyperglycemia), which, in principle, is a manifestation of the disease, signs of diabetes begin to appear over time, that is, a total disorder of metabolic processes at all levels. Significant changes in the hormonal-metabolic interaction ultimately involve all the functional systems of the human body in the pathological process, which once again indicates the systemic nature of the disease. How quickly the formation of the disease occurs depends on the degree of insulin deficiency, which, as a result, determines the types of diabetes.

In addition to type 1 and type 2 diabetes, there are special types of this disease:

1. secondary diabetes, resulting from acute and chronic inflammation of the pancreas (pancreatitis), malignant neoplasms in the parenchyma of the gland, cirrhosis of the liver. A number of endocrine disorders accompanied by excessive production of insulin antagonists (acromegaly, Cushing's disease, pheochromocytoma, thyroid disease) lead to the development of secondary diabetes. Many drugs used for a long time have a diabetogenic effect: diuretics, some antihypertensive drugs and hormones, oral contraceptives, etc.;
2. Diabetes in pregnancy (gestational), caused by a peculiar mutual influence of the hormones of the mother, child and placenta. The pancreas of the fetus, which produces its own insulin, begins to inhibit the production of insulin by the maternal gland, as a result of which this special form is formed during pregnancy. However, with proper management, gestational diabetes usually disappears after delivery. Subsequently, in some cases (up to 40%) in women with a similar history of pregnancy, this fact may threaten the development of type II diabetes mellitus (within 6-8 years).

Why does the "sweet" disease occur?

"Sweet" disease forms a rather "motley" group of patients, so it becomes obvious that IDDM and its non-insulin-dependent "brother" genetically originated differently. There is evidence of an association of insulin-dependent diabetes with the genetic structures of the HLA system (major histocompatibility complex), in particular, with some genes of the D-region loci. For INDSD, such a relationship was not observed.

For the development of type I diabetes mellitus, one genetic predisposition is not enough, the pathogenetic mechanism is triggered by provoking factors:

• Congenital inferiority of the islets of Langerhans;
• Unfavorable influence of the external environment;
• Stress, nervous stress;
• Traumatic brain injury;
• Pregnancy;
• Infectious processes of viral origin (influenza, mumps, cytomegalovirus infection, Coxsackie);
• Tendency to constant overeating, leading to excess body fat;
• Abuse of confectionery (sweet teeth are more at risk).

Before highlighting the causes of type II diabetes, it would be advisable to dwell on a very controversial issue: who suffers more often - men or women?

It has been established that at present the disease in the territory of the Russian Federation is more often formed in women, although back in the 19th century DM was a "privilege" of the male sex. By the way, now in some countries of Southeast Asia, the presence of this disease in men is considered predominant.

Predisposing conditions for the development of type II diabetes include:

• Changes in the structural structure of the pancreas as a result of inflammatory processes, as well as the appearance of cysts, tumors, hemorrhages;
• Age after 40 years;
• Overweight (the biggest risk factor for NIDDM!);
• Vascular diseases caused by atherosclerotic process and arterial hypertension;
• In women, pregnancy and the birth of a child with a high body weight (more than 4 kg);
• The presence of relatives suffering from diabetes;
• Strong psycho-emotional stress (hyperstimulation of the adrenal glands).

The causes of the disease of different types of diabetes in some cases coincide (stress, obesity, the influence of external factors), but the onset of the process in type 1 and type 2 diabetes is different, moreover, IDDM is the destiny of childhood and young age, and insulin-independent prefers older people.

Why are you so thirsty?

The characteristic symptoms of diabetes mellitus, regardless of form and type, can be represented as follows:

Thus, the general signs of diabetes can be characteristic of any form of the disease, however, in order not to confuse the reader, it should still be noted the features inherent in this or that type.

Type 1 diabetes is a “privilege” for young people

IDDM is characterized by an acute (weeks or months) onset. Signs of type I diabetes are pronounced and manifested by clinical symptoms typical for this disease:

• A sharp drop in weight;
• Unnatural thirst, a person simply cannot get drunk, although he tries to do so (polydipsia);
• Large amounts of urine (polyuria)
• A significant excess of the concentration of glucose and ketone bodies in the blood serum (ketoacidosis). In the initial stage, when the patient may still not be aware of his problems, it is likely that a diabetic (ketoacidotic, hyperglycemic) coma will develop - a condition that is extremely life-threatening, so insulin therapy is prescribed as early as possible (as soon as diabetes is suspected).

In most cases, after the use of insulin, metabolic processes are compensated, the body's need for insulin declines sharply, a temporary "recovery" occurs. However, this short-term state of remission should not relax either the patient or the doctor, because after a certain period of time the disease will again remind of itself. The need for insulin as the duration of the disease increases, may increase, but, basically, in the absence of ketoacidosis, will not exceed 0.8-1.0 U / kg.

Signs indicating the development of late complications of diabetes (retinopathy, nephropathy) may appear in 5-10 years. The main causes of death in IDDM include:

1. Terminal renal failure, which is a consequence of diabetic glomerulosclerosis;
2. Cardiovascular disorders, as complications of the underlying disease, which occur somewhat less frequently than renal ones.

Disease or aging? (type II diabetes)

NIDDM develops over many months and even years. Problems that arise, a person carries to various specialists (dermatologist, gynecologist, neurologist ...). The patient does not even suspect that different diseases in his opinion: furunculosis, pruritus, fungal infections, pain in the lower extremities are signs of type II diabetes mellitus. Often, NIDDM is discovered by pure chance (annual medical examination) or due to disorders that the patients themselves attribute to age-related changes: “vision has fallen”, “something is wrong with the kidneys”, “legs do not obey at all” .... Patients get used to their condition, and diabetes mellitus continues to develop slowly, affecting all systems, and first of all, blood vessels, until a person “falls down” from a stroke or heart attack.

NIDDM is characterized by a stable slow course, as a rule, without showing a tendency to ketoacidosis.

Treatment of type 2 diabetes usually begins with a diet that restricts easily digestible (refined) carbohydrates and, if necessary, the use of sugar-lowering drugs. Insulin is prescribed if the development of the disease has reached the stage of severe complications or there is resistance to oral drugs.

The main cause of death in patients with NIDDM is cardiovascular disease resulting from diabetes. Typically, this is or .

Video: 3 early signs of diabetes

Medications for the treatment of diabetes

The basis of therapeutic measures aimed at compensating for diabetes mellitus is represented by three main principles:

• Compensation for lack of insulin;
• Regulation of endocrine-metabolic disorders;
• Prevention of diabetes mellitus, its complications and their timely treatment.

The implementation of these principles is carried out on the basis of 5 main positions:

1. Nutrition in diabetes mellitus is assigned the party of "first violin";
2. The system of physical exercises, adequate and individually selected, follows the diet;
3. Sugar-lowering drugs are mainly used to treat type 2 diabetes;
4. Insulin therapy is given as needed for NIDDM, but is the mainstay for type 1 diabetes;
5. Teaching patients to exercise self-control (skills of taking blood from a finger, using a glucometer, administering insulin without assistance).

The laboratory control above these positions indicates the degree of compensation after the following:

Indicators	Good degree of compensation	Satisfactory	bad
Fasting glucose (mmol/l)	4,4 – 6,1	6,2 – 7,8	Ø 7.8
The content of sugar in the blood serum 2 hours after a meal (mmol / l)	5,5 – 8,0	8,1-10,0	Ø 10.0
Percentage of glycosylated hemoglobin (HbA1, %)		8,0 – 9,5	Ø 10.0
Serum total cholesterol (mmol/l)		5,2 – 6,5	Ø 6.5
Triglycerides (mmol/L)		1,7 – 2,2	Ø 2.2

The Important Role of Diet in the Treatment of NIDDM

Nutrition for diabetes mellitus is a very well-known table number 9, even for people far from diabetes mellitus. after a certain password is spoken: "I have the ninth table." What does all of this mean? How is this mystery diet different from all the others?

One should not be mistaken, looking after a diabetic who takes away his “porridge”, that they are deprived of all the joys of life. The diet for diabetes is not so different from the diet of healthy people, the right amount of carbohydrates (60%), fats (24%), proteins (16%) patients receive.

Nutrition in diabetes consists in replacing refined sugars in foods with slowly digested carbohydrates. Sugar sold in a store for everyone and confectionery based on it fall into the category of prohibited foods. Meanwhile, the trading network, in addition to diabetic bread, which we often stumble upon when choosing bakery products, provides such people with sweeteners (fructose), sweets, cookies, waffles and many other sweets that contribute to the production of "happiness hormones" (endorphins).

As for the balance of nutrition, everything is strict here: a diabetic must necessarily consume the required amount of vitamins and pectins, which should be at least 40 grams. per day.

Video: doctor about nutrition in diabetes

Strictly individual physical activity

Physical activity for each patient is selected individually by the attending physician, taking into account the following positions:

• Age;
• Symptoms of diabetes;
• The severity of the course of the pathological process;
• Presence or absence of complications.

The physical activity prescribed by the doctor and performed by the "ward" should contribute to the "burning" of carbohydrates and fats, without involving insulin. Its dose, which is necessary to compensate for metabolic disorders, drops noticeably, which should not be forgotten, since by preventing an increase, one can get an undesirable effect. Adequate physical activity reduces glucose, the injected dose of insulin breaks down the rest, and as a result, a decrease in sugar levels below acceptable values ​​(hypoglycemia).

In this way, the dosage of insulin and physical activity requires very close attention and careful calculation, so that complementing each other, together not to step over the lower limit of normal laboratory parameters.

Video: gymnastics complex for diabetes

Or maybe try folk remedies?

Treatment of type 2 diabetes mellitus is often accompanied by a search by the patient for folk remedies that can slow down the process and delay the time of taking dosage forms as far as possible. You can understand a person, because no one wants to feel inferior, dooming himself to dependence on pills or (even worse) on constant injections of insulin.

Despite the fact that our distant ancestors practically did not know about such a disease, folk remedies for the treatment of diabetes exist, but we should not forget that infusions and decoctions prepared from various plants are an adjuvant. The use of home remedies for diabetes does not relieve the patient from following a diet, controlling blood sugar, visiting a doctor and following all his recommendations.

To combat this pathology at home, quite well-known folk remedies are used:

1. Bark and leaves of white mulberry;
2. Oat grains and husks;
3. Partitions walnut;
4. Bay leaf;
5. Cinnamon;
6. acorns;
7. Nettle;
8. Dandelion.

When diet and folk remedies no longer help ...

The so-called first generation drugs, widely known at the end of the last century (bucarban, oranil, butamid, etc.), remained in the memories, and they were replaced by new generation drugs (dionil, maninil, minidiab, glurenorm), which make up 3 main groups drugs for diabetes produced by the pharmaceutical industry.

Which remedy is suitable for this or that patient - the endocrinologist decides, because representatives of each group, in addition to the main indication - diabetes mellitus, have a lot of contraindications and side effects. And so that patients do not self-medicate and do not take it into their heads to use these drugs for diabetes at their own discretion, we will give some illustrative examples.

Sulfonylureas

Currently, second-generation sulfonylurea derivatives are prescribed, acting from 10 hours to a day. Usually patients take them 2 times a day for half an hour before meals.

These drugs are absolutely contraindicated in the following cases:

In addition, the use of drugs in this group may threaten the development of allergic reactions, manifested by:

1. Skin itching and urticaria, sometimes reaching Quincke's edema;
2. Disorders of the function of the digestive system;
3. Changes in the blood (decrease in the level of platelets and leukocytes);
4. Possible violation of the functional abilities of the liver (jaundice due to cholestasis).

Hypoglycemic agents of the biguanide family

Biguanides (guanidine derivatives) are actively used to treat type 2 diabetes mellitus, often adding sulfonamides to them. They are very rational for use by obese patients, however, for people with liver, kidney and cardiovascular pathology, their appointment is sharply limited, switching to more benign drugs of the same group, such as metformin BMS or α-glucoside inhibitors (glucobay), which inhibit absorption carbohydrates in the small intestine.

The use of guanidine derivatives is also very limited in other cases, which is associated with some of their "harmful" abilities (accumulation of lactate in tissues, leading to lactic acidosis).

Absolute contraindications to the use of biguanine are:

• IDDM (type 1 diabetes);
• Significant weight loss;
• Infectious processes, regardless of localization;
• Surgical interventions;
• Pregnancy, childbirth, breastfeeding period;
• Coma states;
• Hepatic and renal pathology;
• oxygen starvation;
• (2-4 degrees) with impaired vision and kidney function;
• and necrotic processes;
• Circulatory disorders in the lower extremities due to various vascular pathologies.

Treatment with insulin

From the above it becomes obvious that the use of insulin is the main treatment for type 1 diabetes, all emergencies and severe complications of diabetes. NIDDM requires the appointment of this therapy only in cases of insulin-requiring forms, when correction by other means does not give the desired effect.

Modern insulins, called monocompetent, represent two groups:

1. Monocompetent pharmacological forms of human insulin substance (semi-synthetic or recombinant DNA), which undoubtedly have a significant advantage over preparations of porcine origin. They practically have no contraindications and side effects;
2. Monocompetent insulins derived from porcine pancreas. These drugs require an approximately 15% increase in drug dose compared to human insulins.

Diabetes is dangerous complications

Due to the fact that diabetes is accompanied by damage to many organs and tissues, its manifestations can be found in almost all body systems. Complications of diabetes are:

Prevention

Measures for the prevention of diabetes are based on the causes of its causes. In this case, it is advisable to talk about the prevention of atherosclerosis, including the fight against excess weight, bad habits and food addictions.

Prevention of complications of diabetes mellitus is to prevent the development of pathological conditions arising from diabetes itself. Correction of glucose in the blood serum, adherence to diet, adequate physical activity, the implementation of the doctor's recommendations will help to postpone the consequences of this rather formidable disease.

Video: TV program about diabetes

Video: lecture on diabetes

The diagnosis of diabetes mellitus is perceived by many as a death sentence.

But this is erroneous, because modern medicine has effective methods of its treatment.

The main thing is to be able to recognize the first signs of diabetes in a timely manner and start appropriate therapy.

How to recognize the first symptoms of diabetes

Relatively soon, you can recognize the disease if you know its first and significant symptoms.

Moreover, it is possible to understand even its type.

Symptoms are based on the following abnormalities and factors:

1. Vomiting, nausea.
2. Slow healing wounds.
3. For the second type, obesity is characteristic, for the first - weight loss with increased appetite.
4. Itching on the skin, namely in the abdomen, on the limbs, genitals, peeling of the skin.
5. The second type is characterized by increased facial hair growth, especially a woman is prone to this manifestation.
6. Frequent urination and swelling associated with this process in men of the foreskin.
7. The development of growths on the human body of a small size with a yellow tint.
8. Dryness of the mouth, thirst even after drinking a large amount of liquid.
9. Convulsive manifestations in the calves.
10. Blurred vision.

It's important to know

Any first signs of diabetes mellitus should be the reason for going to a specialist and further comprehensive examination, this will help prevent possible complications of the disease.

A mature person who has an abnormal excess of sugar in the blood must strictly know how the symptom of diabetes manifests itself. This will help to seek treatment in time and effectively overcome the cause.

Thirst and frequent urination

In the oral cavity at the initial onset of diabetes, a characteristic taste of metal and persistent thirst may be felt. Diabetics drink up to 5 liters of fluid per day. In addition, urination increases, especially at night. These signs are due to the fact that with increased sugar, the latter begins to pass into urine, taking water with it. That is why a person often walks “in a small way”, dehydration begins in the body, dryness of the mucous membranes, and a desire to drink.

Cravings for sweets as a symptom

Some patients may experience an increased appetite, and there is an interest in satiety through the use of carbohydrates, namely sweets. There are 2 explanations for this: an excess of insulin, which leads to an increase in the desire to eat, the second is cell starvation, when glucose does not reach the cells.

Signs of diabetes on the skin

Itching of the skin, in particular the perineum, both in men and women, can also signal a violation. In addition, with a “sweet” disease, a person more often than others suffers from fungal manifestations, furunculosis. Doctors have already named about 30 varieties of dermatoses that appear in the early stages of diabetes.

Most often you can see dermatopathy, the disease spreads to the legs, namely the anterior part, has a size of 5-12 mm and a brownish tint. After it, the course can develop into a pigmented spot, and subsequently disappear. A rare case is a diabetic bladder that occurs on the feet, fingers, hands. Healing occurs on its own in 2-4 weeks.

Manifestations on the dermis have an uncolored liquid inside that is not infected with infection. In the area of ​​\u200b\u200bthe bend of the limbs, on the chest, face, neck, yellowish plaques - xanthoma, the cause of the formation of which are failures in lipid metabolism, may appear. Pink-blue spots develop on the skin of the lower leg with diabetes, which have a sunken central part and an elevated edge. Possible peeling.

No treatment has been developed for the treatment of skin disorders; only ointments aimed at improving lipid metabolism and microcirculation can be used. As for itching, it is also a harbinger of the disease. May begin 2 months to 7 years before the onset of diabetes. It itches mainly in the groin, folds on the abdomen, intergluteal cavity, ulnar fossa.

dental problems

The first and irrefutable signs of diabetes can also appear with problems with the oral cavity: bad teeth, periodontal disease and stomatitis. This is due to the fact that the mucosa is sown with fungi of the genus Candida. Saliva also loses its protective features, as a result, the flora in the oral cavity is disturbed.

Diabetes symptoms and vision

An early symptom is blurred vision. The connection of diseases is that glucose penetrates into the liquid environment of the organs of vision. When the sugar level returns to normal, vision is fully restored.

Change in body weight

Weight gain or weight loss are also the first and main signs of emerging diabetes. Acute unreasonable weight loss can occur with a complete lack of insulin. This is a variant of type 1 diabetes. For the second type, a sufficient amount of insulin is characteristic, therefore, a person gradually gains kilograms, on the contrary, since insulin is a hormone that stimulates the supply of fats.

chronic fatigue syndrome in diabetes

When the metabolism of carbohydrates in the human body is disturbed, he may feel persistent fatigue. Efficiency decreases, drowsiness is observed, the reason for this is the starvation of the cells and the toxic effect on the blood of an excess of sugar.

The first symptoms of diabetes mellitus: characteristic for each type and diagnosis of the disease

The disease proceeds differently in a child, in a female and male body. The first and main signs of diabetes mellitus in males are sexual dysfunction, which is caused by a problem with blood access to the pelvic organs, as well as the presence of ketone bodies that suppress testosterone production. In women, the main reason is the difficulty with the secretion of insulin by the pancreas.

It is also worth saying that the female sex can get diabetes due to pregnancy, vaginal infections, irregular cycles. As for children, the nature of diabetes in their case is based on the increased need of the child's body for sweets, a heightened desire to eat.

Signs of different types of diabetes

The most common types are type 1, type 2 disease and gestational. The first signs that develop from type 1 diabetes are a sharp decrease in body weight, while appetite remains elevated. It often occurs in young people under 30 years of age. You can also determine that a person is sick by the smell of acetone, which is present in the urine and exhaled air. The reason for this is the formation of a large number of ketone bodies.

The onset of the disease will be the brighter, the earlier it manifested itself. Complaints are of a sudden nature, the condition progresses for the worse almost instantly. Consequently, the disease is practically never unrecognized. Type 2 diabetes is a disease of people over 40, more often in overweight women.

The cause of development may be the non-recognition of insulin by their own tissues. Among the early signs is hypoglycemia, that is, the level of sugar decreases. Then begins trembling in the hands, excessive heartbeat, hunger, increased pressure.

What to do at the first sign of diabetes

When signs of diabetes are on the face, it is necessary, firstly, to visit a specialist. Perhaps this is not a “sweet” disease at all, because there are variants of pathologies with similar symptoms, for example, diabetes insipidus or hyperparathyroidism. Only a doctor, prescribing an examination, can accurately diagnose and find out the cause and type of the disease. It is important to understand that the sooner treatment is started, the better.

Should know!

A patient who has discovered signs of diabetes mellitus must definitely monitor the level of sugar in the blood, for this special express testers are used.

Signs of diabetes associated with damage to organs and systems

In particular, type 2 diabetes is difficult to recognize, in this episode the first signs of diabetes mellitus are absent. Patients have no complaints, or they are such that they simply do not pay attention. Then ignoring the problem can cause damage to tissues and organs.

You can suspect the disease by the following formations:

1. Symmetrical debugging of the nerves of the legs, hands, and feet. With this option, a person feels numbness and cold in the fingers, "goosebumps", muscle cramps.
2. Diabetic foot syndrome, which is determined by long-term healing of wounds, ulcers, cracks in the lower extremities. This manifestation can lead to gangrene and subsequent amputation.
3. Reduced vision, namely the development of cataracts, as well as damage to the vessels of the fundus.
4. Decreased immunity. Here you can find long-healing scratches, permanent infectious diseases, complications after illness. For example, a common cold can develop into pneumonia. Also, due to immunodeficiency, fungal diseases of the nail plate, skin, and mucous membranes can occur.

Diagnostic methods

You can diagnose the disease by recognizing the first signs of diabetes. In addition to the standard blood test to detect glucose levels, laboratory tests are carried out in the complex. The first is an anamnesis, 50% of a successful diagnosis depends on its correct collection. The second is the complaints of the patient himself: fatigue, thirst, headaches, appetite, changes in body weight, etc.

Laboratory methods are:

• Blood for glucose detection. An analysis is taken on an empty stomach in the morning. When the indicator is more than 6.1 mmol / l, there is a violation of the body's susceptibility to glucose.
• Blood 2 hours after eating. If the venous blood contains more than 10.0 mmol/l, and the capillary blood contains 11.1 mmol/l or more, then this symptom is considered dangerous.
• Glucose tolerance testing. It should be done after the patient has fasted for 10-14 hours. The patient drinks 75 g of glucose diluted in water, its level is determined after 60-120 minutes. If the indicator is less than 7.8 mmol / l, then everything is in order.
• Urine for detection of glucose and ketone bodies. If ketone bodies are noticed, then ketoacidosis develops, if time and treatment are missed, it can lead to coma, and then to death.
• Determination of hemoglobin in glycated blood. The risk exists when the HbA1c value is above 6.5%.
• Detection of the C-peptide of insulin and blood.

How diabetes manifests itself in adults and children: characteristic signs

The disease itself is a direct violation of metabolic processes. The reason for this is a lack of insulin formation in the body (type 1) or a violation of the effect of insulin on tissues (type 2). Knowing how type 1 and type 2 diabetes manifests itself in adults can stop the course of the disease and get rid of it faster. The main thing is to take care of the pancreas, since it is this organ that is responsible for the production of insulin.

Special signs of diabetes in children

Children also have a susceptibility to illness. Prevention should be carried out from an early age. Knowing how diabetes manifests itself in adults, it is important to know about the childhood course of the disease. So, the child can gain weight, and height can also increase upwards. As for babies, the urine, drying up on the diaper, leaves a white mark behind.

Special signs of diabetes in women

Women should also be aware of how diabetes manifests itself in adults: itching of the organs of the reproductive system, thrush, which is difficult to get rid of. Type 2 diabetes involves long-term treatment for polycystic ovaries. There is also a risk of infertility. Understanding how diabetes in adults manifests itself with special signs, it is worth paying attention to hair growth, it can intensify on the body and face.

Special signs of diabetes in men

The main thing by which you can identify the disease and determine how diabetes manifests itself in adult men is the development of impotence.

Diabetes due to relative or absolute insufficiency of insulin in the human body. With this disease, the metabolism of carbohydrates is disturbed, and the amount of glucose in the blood and urine increases. Diabetes mellitus also causes other metabolic disorders in the body.

Cause Diabetes mellitus is a deficiency of insulin, a pancreatic hormone that controls the processing of glucose at the level of tissues and cells of the body.

Risk factors for developing diabetes

Risk factors for the development of diabetes, that is, conditions or diseases that predispose to its occurrence, are:
hereditary predisposition;
overweight - obesity;
arterial hypertension;
elevated level .

If a person has several facts at the same time, the risk of developing diabetes for him increases up to 30 times.

Causes of diabetes

Destruction of insulin-producing cells in the pancreas as a result of viral infections. A number of viral infections are often complicated by diabetes, as they have a high affinity for pancreatic cells. Mumps (viral mumps), rubella, viral hepatitis, chickenpox, etc. cause the greatest risk of developing diabetes. So, for example, in people who have had rubella, diabetes mellitus develops in 20 % cases. But especially often a viral infection is complicated by diabetes in those who also have a hereditary predisposition to this disease. This is especially true for children and adolescents.
hereditary factor. Relatives of people with diabetes tend to have diabetes several times more often. If both parents have diabetes, the disease manifests itself in children in 100 % cases, if only one of the parents is sick - in 50 % cases, in case of diabetes mellitus in a sister or brother - at 25%.

But when it comes to diabetes 1 type, the disease may not appear, even with hereditary predisposition. In this type of diabetes, the likelihood that a parent will pass on to a child defective gene, is about 4 %. Science also knows cases when only one of the twins fell ill with diabetes. The risk that type 1 diabetes will still develop increases if, in addition to the hereditary factor, there is also a predisposition resulting from a viral infection.
Autoimmune diseases, in other words, those diseases when the body's immune system "attacks" its own tissues. These diseases include autoimmune thyroiditis, glomerulonephritis, lupus, hepatitis, etc. In these diseases, diabetes develops due to the fact that cells of the immune system destroy pancreatic tissue, responsible for insulin production.
Overeating, or increased appetite leading to obesity. In people with normal body weight, diabetes mellitus occurs in 7,8 % cases, when the normal body weight is exceeded by 20 % the incidence of diabetes is 25 %, with an excess of mass 50 % - diabetes appears in 60 % cases. Obesity leads to the development of diabetes 2 type.

You can even reduce the risk of this disease reduced through diet and exercise total body weight 10 %.

Classification of diabetes

The World Health Organization (WHO) classifies diabetes mellitus into 2 type:
insulin-dependent - type 1;
insulin-independent - type 2.

non-insulin dependent diabetes also divided into two varieties: 1) diabetes in persons with normal body weight; 2) diabetes in obese individuals.

In the studies of some scientists, a condition called prediabetes (hidden diabetes). With it, the level of sugar in the blood is already above the norm, but not yet high enough to make a diagnosis of diabetes. For example, the glucose level between 101 mg/dl to 126 mg/dL (slightly higher 5 mmol/l). When there is no right treatment Prediabetes turns into diabetes itself. However, if prediabetes is detected on time and measures are taken to correct this condition, the risk of developing diabetes is reduced.

A form of diabetes mellitus has also been described gestational diabetes. It develops in women during pregnancy, and may disappear after childbirth.

Diabetes mellitus type 1. In insulin-dependent diabetes mellitus ( 1 type) are destroyed more 90 % insulin-secreting pancreatic cells. The reasons for this process can be different: autoimmune or viral diseases, etc.

In patients with diabetes 1 type, the pancreas secretes less insulin than necessary, or does not secrete this hormone at all. Of those people who suffer from diabetes, diabetes 1 type suffer only in 10 % sick. Usually diabetes 1 type manifests itself in people before 30 years. Experts believe that the start to the development of diabetes 1 type gives a viral infection.

The destructive role of an infectious disease is also expressed in the fact that it not only destroys the pancreas, but also causes the immune system of a sick person to destroy the pancreas' own insulin-producing cells. So, in the blood of people suffering from insulin-dependent diabetes mellitus, contains antibodies against insulin-producing b-cells.

Normal absorption of glucose without insulin is impossible, that is, the normal functioning of the organism is also impossible. Those with diabetes 1 type, are in constant dependence on insulin, which they need to receive from the outside, since their own body of these people does not produce it.

Diabetes mellitus type 2. In non-insulin dependent diabetes mellitus ( 2 type) the pancreas secretes insulin in some cases even in larger quantities than necessary. However, the cells of the patient's body as a result of the action of any factors become resistant - their sensitivity to insulin decreases. Because of this, even with a large amount of insulin in the blood, glucose does not enter the cell in the right amount.

diabetes mellitus 2 kind of get sick too 30 years. The risk factors for its occurrence are obesity and heredity. Diabetes 2 type can also result from the misuse of certain drugs, in particular, corticosteroids for Cushing's syndrome, acromegaly, etc.

Symptoms and signs of diabetes

The symptoms of both types of diabetes are very similar. As a rule, the first symptoms of diabetes are caused by high blood glucose levels. When its concentration reaches 160-180 mg/dl (above 6 mmol/l), glucose enters the urine. Over time, when the disease begins to progress, the concentration of glucose in the urine becomes very high. At this point, the first symptom of diabetes appears, which is called polyuria- allocate more 1,5-2 l of urine per day.

Frequent urination leads to polydipsia - constant feeling of thirst to satisfy which you need to consume a large amount of fluid daily.

Calories are also excreted with glucose through the urine, therefore the patient begins to lose weight. Patients with diabetes have an increased appetite.

So there is a classic triad of symptoms characteristic of diabetes mellitus:
polyuria - allocation of more 1,5-2 l of urine per day;
polydipsia - constant feeling of thirst;
polyphagy - increased appetite.

Each type of diabetes has its own characteristics. The first symptoms of diabetes 1 types usually come on suddenly or develop over a very short period of time. Even diabetic ketoacidosis this type of diabetes can develop in a short time.

In patients with diabetes mellitus 2 type, the course of the disease is asymptomatic for a long time. If certain complaints appear, then the manifestation of symptoms is still not pronounced. Blood glucose levels at the onset of diabetes 2 type can even be downgraded. This condition is called "hypoglycemia".

In the body of such patients, a certain amount of insulin is secreted, therefore, in the early stages of diabetes mellitus 2 type of ketoacidosis, as a rule, does not occur.

There are also less characteristic non-specific signs of diabetes mellitus [b]2 type:
frequent occurrence of colds;
weakness and fatigue;
abscesses on the skin, furunculosis, hard-healing ulcers;
severe itching in the groin area.

Patients suffering from diabetes 2 type, often find out that they are sick, by chance, sometimes after several years from the moment the disease appeared. In such cases, the diagnosis is established on the basis of a detected increase in blood glucose levels or when diabetes is already causing complications.

Diagnosis of type 1 diabetes

Diagnosis of diabetes mellitus 1 type is put by the doctor on the basis of an analysis of the symptoms identified in the patient and the analysis data. To diagnose diabetes, you need to perform the following laboratory tests:
a blood test for glucose to detect its elevated content (see table below);
urinalysis for glucose;
glucose tolerance test;
determination of the content of glycosylated hemoglobin in the blood;
determination of C-peptide and insulin in the blood.

Treatment of type 1 diabetes

For the treatment of diabetes 1 type apply the following methods: drugs, diet, exercise.

The insulin treatment regimen for each diabetic patient is individually compiled by the attending physician. In this case, the doctor takes into account the patient's condition, and his age, and weight, and the characteristics of the course of his illness, and the body's sensitivity to insulin, as well as other factors. For this reason, there is no single treatment regimen for insulin-dependent diabetes. Self-medication for diabetes 1 type (both insulin preparations and any folk remedies) strictly prohibited and extremely dangerous to life!

Diagnosis of type 2 diabetes

If there is a suspicion that the patient has diabetes mellitus 2 Type, you need to determine the level of sugar in the blood and urine.

Usually diabetes 2 type, unfortunately, is detected at a time when the patient has already developed complications of the disease, usually this happens through 5-7 years since the onset of the disease.

Type 2 Diabetes Treatment

For the treatment of diabetes 2 type, you need to follow a diet, exercise, take drugs prescribed by a doctor that reduce blood glucose levels.

For those suffering from diabetes 2 type, oral antidiabetic drugs are usually prescribed. Most often they need to be taken once a day. However, in some cases, more frequent medication is required. The combination of drugs helps to increase the effectiveness of therapy.

In a significant number of cases of diabetes mellitus 2 type drugs gradually lose their effectiveness in the process of application. These patients are treated with insulin. In addition, at certain periods, for example, if a patient with diabetes mellitus 2 such as seriously ill with another disease, most often it is required to temporarily change the treatment with tablets to treatment with insulin.

Only the attending physician can determine when taking pills should be replaced with insulin. Purpose of insulin therapy in the treatment of diabetes mellitus 2 type - compensation of the level of glucose in the blood, and consequently, the prevention of complications of the disease. It is worth considering the use of insulin in diabetes mellitus 2 type if:
the patient quickly loses weight;
symptoms of complications of diabetes are revealed;
other methods of treatment do not provide the necessary compensation for the level of glucose in the patient's blood.

People with diabetes have to strictly follow the diet, limiting yourself in many products. Food products for such patients are divided into three categories:
1) products for which there are no restrictions in use for diabetes: cucumbers, tomatoes, cabbage, radishes, radishes, green beans, green peas (no more than three tablespoons), fresh or pickled mushrooms, zucchini, eggplant, carrots, herbs, spinach, sorrel; allowed drinks: mineral water, tea and coffee without sugar and cream (you can add a sugar substitute), drinks with a sweetener;
2) foods that can only be consumed in limited quantities: low-fat chicken and beef meat, eggs, low-fat boiled sausage, low-fat fish, fruits (except those included in the third category, see below), berries, pasta, potatoes, cereals, cottage cheese with a fat content of not more than 4 % (preferably without additives), kefir and milk with a fat content of not more than 2 %, low-fat cheese (less 30 % fat), beans, peas, lentils, bread.
3) Foods to be excluded from the diet: fatty meat (even poultry), fish, lard, sausages, smoked meats, mayonnaise, margarine, cream; fatty varieties of cottage cheese and cheese; canned food in oil, seeds, nuts, sugar, honey, all confectionery, chocolate, jam, ice cream, grapes, bananas, persimmons, dates. It is strictly forbidden to drink sugary drinks, juices, alcoholic drinks.

Diabetes mellitus is a group of diseases of the endocrine system that develop due to a lack or absence of insulin (a hormone) in the body, resulting in a significant increase in the level of glucose (sugar) in the blood (hyperglycemia). It is manifested by a feeling of thirst, an increase in the amount of urine excreted, increased appetite, weakness, dizziness, slow healing of wounds, etc. The disease is chronic, often with a progressive course.

A timely diagnosis gives the patient a chance to delay the onset of severe complications. But it is not always possible to recognize the first signs of diabetes. The reason for this is the lack of basic knowledge about this disease among people and the low level of patients seeking medical help.

What is diabetes mellitus?

Diabetes mellitus is a disease of the endocrine system caused by an absolute or relative deficiency in the body of insulin, a pancreatic hormone, resulting in hyperglycemia (a persistent increase in blood glucose).

The meaning of the word "diabetes" from the Greek language is "outflow". Therefore, the concept of "diabetes mellitus" means "losing sugar." In this case, the main symptom of the disease is displayed - the excretion of sugar in the urine.

In the world, about 10% of the population suffers from diabetes mellitus, however, if we take into account the hidden forms of the disease, this figure can be 3-4 times higher. It develops as a result of chronic insulin deficiency and is accompanied by disorders of carbohydrate, protein and fat metabolism.

At least 25% of people with diabetes are unaware of their disease. They calmly go about their business, do not pay attention to the symptoms, and at this time, diabetes gradually destroys their body.

High blood sugar levels can cause dysfunction in almost all organs, up to and including death. The higher the blood sugar level, the more obvious the result of its action, which is expressed in:

• obesity
• glycosylation (saccharification) of cells;
• intoxication of the body with damage to the nervous system;
• damage to blood vessels;
• the development of secondary diseases affecting the brain, heart, liver, lungs, organs
• Gastrointestinal tract, muscles, skin, eyes;
• manifestations of fainting, coma;
• lethal outcome.

Causes

There are a lot of causes of diabetes mellitus, which are based on a general disruption of the functioning of the endocrine system of the body, based either on a deficiency of insulin, a hormone produced by the pancreas, or on the inability of the liver and body tissues to properly process and absorb glucose.

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

One of the reasons is a predisposition that is inherited. If a person has diabetics in his family, then he has a certain risk of getting this disease, especially if he leads an unhealthy lifestyle. The reasons for the development of diabetes, even in those who do not have a predisposition to it, can be:

• malnutrition and abuse of sweets;
• stress and various psycho-emotional stress; suffered a serious illness;
• disruption of the liver; lifestyle change;
• excess weight;
• hard work, etc.

Many people think that diabetes occurs in sweet tooth. This is more of a myth, but there is also some truth, if only because excessive consumption sweetly leads to excess weight, and later obesity, which can be an impetus for type 2 diabetes.

The risk factors contributing to the development of this disease in children, in some respects, are similar to the above factors, however, they also have their own characteristics. Let's highlight the main factors:

• the birth of a child to parents with diabetes mellitus (if one or both of them have this disease);
• frequent occurrence of viral diseases in a child;
• the presence of certain metabolic disorders (obesity, etc.);
• birth weight of 4.5 kg or more;
• reduced immunity.

Important: The older a person becomes, the higher the likelihood of the disease in question. According to statistics, every 10 years the chances of developing diabetes double.

Types

Due to the fact that diabetes mellitus has many different etiologies, signs, complications, and of course, the type of treatment, experts have created a fairly voluminous formula for classifying this disease. Consider the types, types and degrees of diabetes.

Type 1 diabetes

Type 1 diabetes, which is associated with an absolute deficiency of the hormone insulin, usually appears acutely, abruptly, quickly turns into a state of ketoacidosis, which can lead to ketoacidotic coma. Most often manifested in young people: as a rule, most of these patients are under thirty years old. Approximately 10-15% of the total number of diabetic patients suffer from this form of the disease.

It is almost impossible to completely recover from type 1 diabetes, although there are cases of restoration of pancreatic functions, but this is possible only under special conditions and natural raw food.

To maintain the body, it is required to inject insulin into the body with a syringe. Since insulin is destroyed in the gastrointestinal tract, taking insulin in the form of tablets is not possible. Insulin is administered with meals.

type 2 diabetes

The second type, previously called insulin-independent, but this definition is not accurate, since with the progression of this type, insulin replacement therapy may be required. In this type of disease, insulin levels initially remain normal or even higher than normal.

However, body cells, primarily adipocytes (fat cells), become insensitive to it, which leads to an increase in blood glucose levels.

Degrees

This differentiation helps to quickly understand what happens to the patient at different stages of the disease:

1. 1 degree (mild). Diabetes mellitus of the 1st degree is at the initial stage, that is, the glucose level does not exceed more than 6.0 mol / liter. The patient does not have any complications of diabetes mellitus, it is compensated with the help of diet and special medications.
2. 2nd degree (medium). Type 2 diabetes is more dangerous and severe as glucose levels begin to exceed the normal amount. Also, the normal functioning of organs is disrupted, more precisely: the kidneys, eyes, heart, blood and nerve tissues. Also, the blood sugar level reaches more than 7.0 mol/liter.
3. 3 degree (severe). The disease is at a more acute stage, so it will be difficult to cure it with the help of medications and insulin. Sugar and glucose exceed 10-14 mol / liter, which means that the work of blood circulation deteriorates and blood rings can collapse, causing diseases of the blood and heart.
4. 4 degree . The most severe course of diabetes mellitus is characterized by a high level of glucose - up to 25 mmol / l, both glucose and protein are excreted in the urine, the condition is not corrected by any drugs. With this degree of the disease in question, kidney failure, gangrene of the lower extremities, and diabetic ulcers are often diagnosed.

The first signs of diabetes

The first signs of diabetes are usually associated with high blood sugar levels. Normally, this indicator in capillary blood on an empty stomach does not exceed 5.5 mM/l, and during the day - 7.8 mM/l. If the average daily sugar level becomes more than 9-13 mM / l, then the patient may experience the first complaints.

According to some signs, it is easy to recognize diabetes mellitus at an early stage. A slight change in the condition that anyone can notice often indicates the development of the first or second type of this disease.

Signs to look out for:

• Excessive and frequent urination (about every hour)
• Itching of the skin and genitals.
• Intense thirst or an increased need to drink plenty of fluids.
• Dry mouth.
• Poor wound healing.
• First, a lot of weight, followed by a decrease in it due to a violation of the absorption of food, especially carbohydrates.

If signs of diabetes are detected, the doctor excludes other diseases with similar complaints (sugar insipidus, nephrogenic, hyperparathyroidism, and others). Next, an examination is carried out to determine the cause of diabetes and its type. In some typical cases, this task is not difficult, and sometimes additional examination is required.

Symptoms of Diabetes

The severity of symptoms depends entirely on the following parameters: the level of decrease in insulin secretion, the duration of the disease, the individual characteristics of the patient's body.

There is a complex of symptoms characteristic of both types of diabetes. The severity of the symptoms depends on the degree of decrease in insulin secretion, the duration of the disease and the individual characteristics of the patient:

• Constant thirst and frequent urination. The more the patient drinks, the more he wants;
• With increased appetite, weight is quickly lost;
• A “white veil” appears before the eyes, as the blood supply to the retina of the eye is disturbed;
• Disorders of sexual activity and a decrease in potency are common signs of the presence of diabetes mellitus;
• Frequent colds (ARVI, acute respiratory infections) occur in patients due to a decrease in the functions of the immune system. Against this background, there is a slow healing of wounds, dizziness and heaviness in the legs;
• Constant cramps of the calf muscles are the result of a lack of energy during the work of the muscular system.

Type 1 diabetes

Patients may complain of the following symptoms in type 1 diabetes: feeling of dryness in the mouth; constant unquenchable thirst; a sharp decrease in body weight with normal appetite; increase in the number of urination per day; unpleasant acetone odor from the mouth; irritability, general malaise, fatigue; blurred vision; feeling of heaviness in the lower extremities; convulsions; nausea and vomiting; reduced temperature; dizziness.

type 2 diabetes

Type 2 diabetes is characterized by: common complaints: fatigue, blurred vision, memory problems; problematic skin: itching, frequent fungi, wounds and any damage do not heal well; thirst - up to 3-5 liters of fluid per day; a person often gets up to write at night; ulcers on the legs and feet, numbness or tingling in the legs, pain when walking; in women - thrush, which is difficult to treat; in the later stages of the disease - weight loss without diets; diabetes occurs without symptoms - in 50% of patients; vision loss, kidney disease, sudden heart attack, stroke.

How does diabetes manifest itself in women?

• Sudden weight loss- a sign that should be alarming if the diet is not followed, the previous appetite remains. Weight loss occurs due to a deficiency of insulin, which is necessary for the delivery of glucose to fat cells.
• Thirst. Diabetic ketoacidosis causes uncontrolled thirst. In this case, even if you drink a large amount of liquid, dry mouth remains.
• Fatigue . Feeling of physical exhaustion, which in some cases has no apparent cause.
• increased appetite(polyphagia). A special behavior in which saturation of the body does not occur even after taking a sufficient amount of food. Polyphagia is the main symptom of impaired glucose metabolism in diabetes mellitus.
• Violation of metabolic processes in the body of a woman leads to a violation of the microflora of the body. The first signs of the development of metabolic disorders are vaginal infections, which are practically not cured.
• Non-healing wounds, turning into ulcers - the characteristic first signs of diabetes in girls and women
• Osteoporosis - accompanies insulin-dependent diabetes mellitus, because the lack of this hormone directly affects the formation of bone tissue.

Signs of diabetes in men

The main signs that diabetes is developing in men are the following:

• the occurrence of general weakness and a significant decrease in performance;
• the appearance of itching on the skin, especially this applies to the skin in the genital area;
• sexual disorders, progression of inflammatory processes and development of impotence;
• the occurrence of a feeling of thirst, dryness in the oral cavity and a constant feeling of hunger;
• the appearance of ulcerative formations on the skin, which do not heal for a long time;
• frequent urge to urinate;
• tooth decay and hair loss.

Complications

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

First of all, it should be noted the most acute forms of complications. For the life of every diabetic, such complications pose the greatest danger, because they can lead to death.

Acute complications include:

• ketoacidosis;
• hyperosmolar coma;
• hypoglycemia;
• lactic acid coma.

Acute complications during diabetes are identical in both children and adults

Chronic complications include the following:

• encephalopathy in diabetic form;
• skin lesions in the form of follicles and structural changes directly in the epidermis;
• diabetic foot or hand syndrome;
• nephropathy;
• retinopathy.

Prevention of complications

Preventive measures include:

• weight control - if the patient feels that he is gaining extra pounds, then you need to contact a nutritionist and get advice on compiling a rational menu;
• constant physical activity - the attending physician will tell you how intense they should be;
• constant monitoring of blood pressure.

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

Diagnostics

Diabetes mellitus manifests itself gradually in a person, therefore, doctors distinguish three periods of its development.

1. In people who are prone to the disease due to the presence of certain risk factors, the so-called pre-diabetes period manifests itself.
2. If glucose is already assimilated with disturbances, but signs of the disease do not yet appear, then the patient is diagnosed with a period of latent diabetes mellitus.
3. The third period is the development of the disease itself.

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

• Determination of the level of glucose in the blood. The normal value is 3.3-5.5 mmol / l.
• The level of glucose in the urine. Normally, sugar in the urine is not detected.
• Blood test for glycosylated hemoglobin. The norm is 4–6%.
• IRI (immunoreactive insulin). The normal value is 86-180 nmol / l. In type 1 diabetes, it is reduced; in type 2 diabetes, it is normal or elevated.
• Urinalysis - to diagnose kidney damage.
• Skin capillaroscopy, Doppler ultrasound - for the diagnosis of vascular damage.
• Examination of the fundus - to diagnose retinal lesions.

Blood sugar

What levels of sugar are considered normal?

• 3.3 - 5.5 mmol / l is the norm for blood sugar, regardless of your age.
• 5.5 - 6 mmol / l is prediabetes, impaired glucose tolerance.
• 6. 5 mmol / l and above is already diabetes.

To confirm the diagnosis of diabetes mellitus, repeated measurement of blood sugar at different times of the day is required. Measurements are best carried out in a medical laboratory and self-monitoring devices should not be trusted, as they have a significant measurement error.

Note: in order to exclude false positive results, it is necessary not only to measure the level of sugar in the blood, but also to conduct a glucose tolerance test (a blood sample with a sugar load).

The norms are given in the table (measurement value - mmol / l):

Result evaluation	capillary blood	deoxygenated blood
Norm
Fasting blood glucose test	3,5-5,5	3,5-6,1
After taking glucose (after 2 hours) or after eating	less than 7.8	less than 7.8
prediabetes
on an empty stomach	from 5.6 to 6.1	from 6 to 7.1
After glucose or after meals	7,8-11,1	7,8-11,1
on an empty stomach	over 6.1	over 7
After glucose or after meals	over 11.1	over 11.1

All patients with diabetes should be consulted by such specialists:

• Endocrinologist;
• Cardiologist;
• neuropathologist;
• Ophthalmologist;
• Surgeon (vascular or special doctor - pediatrician);

How to treat diabetes in adults?

Doctors prescribe complex treatment for diabetes mellitus in order to maintain normal blood glucose levels. In this case, it is important to consider that neither hyperglycemia, that is, an increase in sugar levels, nor hypoglycemia, that is, its fall, should be allowed.

Before starting treatment, it is necessary to conduct an accurate diagnosis of the body, because. a positive prognosis of recovery depends on this.

Treatment for diabetes aims to:

• lowering blood sugar levels;
• normalization of metabolism;
• prevention of complications of diabetes.

Treatment with insulin preparations

Insulin drugs for the treatment of diabetes are divided into 4 categories, according to the duration of action:

• Ultrashort-acting (onset of action - after 15 minutes, duration of action - 3-4 hours): insulin LizPro, insulin aspart.
• Rapid action (the onset of action is after 30 minutes–1 hour; the duration of action is 6–8 hours).
• The average duration of action (the onset of action is after 1-2.5 hours, the duration of action is 14-20 hours).
• Long-acting (onset of action - after 4 hours; duration of action up to 28 hours).

Insulin regimens are strictly individual and are selected for each patient by a diabetologist or endocrinologist.

The key to effective diabetes management is careful control of blood sugar levels. However, it is impossible to take laboratory tests several times a day. Portable glucometers come to the rescue, they are compact, easy to take with you and check the glucose level where it is needed.

Makes it easier to check the interface in Russian, marks before and after meals. The devices are extremely easy to use, while they differ in measurement accuracy. Keep your diabetes under control with a portable glucometer

Diet

The main principles of diet therapy include:

• strictly individual selection of daily calorie content, complete exclusion of easily digestible carbohydrates;
• strictly calculated content of physiological amounts of fats, proteins, vitamins and carbohydrates;
• fractional meals with evenly distributed carbohydrates and calories.

In the diet used for diabetes, the ratio of carbohydrates, fats and proteins should be as close to physiological as possible:

• 50-60% of total calories should come from carbohydrates
• 25 - 30% for fats,
• 15 - 20% for proteins.

Also, the diet should contain at least 4 - 4.5 grams of carbohydrates per kilogram of body weight, 1 - 1.5 grams of protein and 0.75 - 1.5 grams of fat in a daily dosage.

The diet in the treatment of diabetes mellitus (table No. 9) is aimed at normalizing carbohydrate metabolism and preventing fat metabolism disorders.

Physical exercise

Regular exercise will help lower your blood sugar levels. In addition, physical activity will help you lose weight.

It is not necessary to do daily jogging or go to the gym, it is enough to do at least 30 minutes 3 times a week to do moderate physical activity. Walking daily will be very useful. Even if you work on your garden plot several days a week, this will have a positive effect on your well-being.

Folk remedies

Before using folk methods for diabetes, it is possible only after consultation with an endocrinologist, because. there are contraindications.

1. Lemon and eggs. Squeeze the juice from 1 lemon and mix 1 raw egg well with it. Drink the resulting remedy 60 minutes before meals, for 3 days.
2. Burdock juice. Juice from crushed burdock root, dug up in May, effectively reduces sugar levels. It is taken three times a day, 15 ml, diluting this amount with 250 ml of cool boiled water.
3. In case of diabetes mellitus, simmer ripe walnuts (40 g) in 0.5 liters of boiling water over low heat for 1 hour; take 3 times a day, 15 ml.
4. psyllium seeds(15 g) is poured into an enamel bowl with a glass of water, boiled over low heat for 5 minutes. The cooled broth is filtered and taken 1 dessert spoon 3 times a day.
5. Baked onion. You can normalize sugar, especially in the initial phase of the disease, with the daily use of a baked onion in the morning on an empty stomach. The result can be tracked after 1-1.5 months.
6. Millet against infection. Against infection and for the prevention of diabetes, you can use the following recipe: take 1 handful of millet, rinse, pour 1 liter of boiling water, leave overnight and drink during the day. Repeat the procedure for 3 days.
7. Lilac buds. Infusion of lilac buds helps to normalize blood glucose levels. At the end of April, the buds are harvested in the swelling stage, dried, stored in a glass jar or paper bag and used all year round. Daily rate of infusion: 2 tbsp. spoons of dry raw materials pour 0.4 liters of boiling water, insist 5-6 hours, filter, divide the resulting liquid into 4 times and drink before meals.
8. Helps lower blood sugar and regular bay leaf. You need to take 8 pieces of bay leaf and pour it with 250 grams of "cool" boiling water, the infusion must be infused in a thermos for about a day. The infusion is taken warm, each time you need to strain the infusion from the thermos. Take 1/4 cup twenty minutes before meals.

Lifestyle of a person with diabetes

Basic rules to follow for a diabetic patient:

• Eat foods rich in fiber. These are oats, legumes, vegetables and fruits.
• Reduce your cholesterol intake.
• Use a sweetener instead of sugar.
• Eat often, but in small quantities. The patient's body can cope better with a small dose of food, since it requires less insulin.
• Check your feet several times a day for damage, wash every day with soap and dry.
• If you are overweight, weight loss is the first step in managing diabetes.
• Be sure to take care of your teeth to avoid infection.
• Avoid stress.
• Get your blood tested regularly.
• Do not buy medicines without prescriptions

Forecast

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

Prevention

To prevent the development of diabetes, the following preventive measures are required:

• healthy eating: diet control, dieting - avoiding sugar and fatty foods reduces the risk of developing diabetes by 10-15%;
• physical activity: normalize blood pressure, immunity and reduce weight;
• control of sugar levels;
• exclusion of stress.

If you have characteristic signs of diabetes, then be sure to go to an appointment with an endocrinologist, because. early treatment is the most effective. Take care of yourself and your health!

Diabetes mellitus (DM) is one of the most common diseases for modern human civilization. No one is immune from this disease - neither men, nor women, nor children. And this disease should not be underestimated, since diabetes in a person can often lead to severe complications, resulting in disability, and sometimes even death.

Spread of disease

There is an opinion that diabetes is an exclusively modern disease, the scourge of our civilization and retribution for a high standard of living, leading to the wide availability of food rich in carbohydrates. However, this is not so, because what diabetes is, it was well known in the ancient world, in ancient Greece and Rome. The term "diabetes" itself is of Greek origin. Translated from Greek, it means "passing through." This interpretation reflects the main signs of diabetes - irrepressible thirst and profuse urination. Therefore, it seemed that all the liquid consumed by a person passes through his body.

Ancient doctors were able to determine what type of diabetes a patient had, with the first type of disease considered incurable and leading to imminent death, and the second was treated with diet and exercise. However, the relationship of DM in humans with the pancreas and the hormone insulin was established only in the 20th century. Then it was possible to obtain insulin from the pancreas of livestock. These discoveries led to the widespread use of insulin in diabetes mellitus.

Diabetes is one of the most common diseases today. Worldwide, there are approximately 250 million people with diabetes (mostly type 2) and the number of those who develop it is constantly growing. This makes diabetes not only a medical but also a social problem. In Russia, the disease is observed in 6% of the population, and in some countries it is recorded in every tenth person. Although doctors believe that these figures can be significantly underestimated. Indeed, in those who are sick with the second type of disease, in the early stages, the signs of pathology are very weakly expressed. The total number of patients with diabetes, taking into account this factor, is estimated at 400 million. Most often, diabetes is diagnosed in adults, but approximately 0.2% of children also suffer from the disease. Forecasts for the spread of diabetes in the future are disappointing - it is expected that in 2030 the number of patients will double.

There are racial differences in the incidence of type 2 diabetes. Diabetes mellitus affects representatives of the Mongoloid and Negroid races much more often than Caucasians.

The prevalence of carbohydrate metabolism diseases in the world

Description

The disease belongs to the category of endocrine. And this means that diabetes mellitus is based on disorders associated with the functioning of the endocrine glands. In the case of diabetes, we are talking about weakening the impact on the human body of a special substance - insulin. In diabetes mellitus, tissues feel its deficiency - either absolute or relative.

Functions of insulin

Thus, the occurrence of diabetes is closely related to insulin. But not everyone knows what kind of substance it is, where it comes from and what functions it performs. Insulin is a special protein. Its synthesis is produced in a special endocrine gland located under the human stomach - the pancreas. Strictly speaking, not all pancreatic tissue is involved in the production of insulin, but only part of it. The cells of the gland that produce insulin are called beta cells and are located in special islets of Langerhans located among the tissues of the gland. The word "insulin" itself comes from the word insula, which in Latin means "island".

The functions of insulin are closely related to the metabolism of such important substances for the body as carbohydrates. A person can get carbohydrates only with food. Since carbohydrates are a source of energy, many physiological processes occurring in cells are impossible without carbohydrates. True, not all carbohydrates are absorbed by the body. In fact, the main carbohydrate in the body is glucose. Without glucose, the cells of the body will not be able to get the required amount of energy. Insulin does more than just absorb glucose. In particular, its function is to synthesize fatty acids.

Glucose belongs to the category of simple carbohydrates. Fructose (fruit sugar), which is found in large quantities in berries and fruits, also belongs to this category. Fructose ingested is metabolized in the liver to glucose. In addition, simple sugars (disaccharides) are sucrose, which is found in foods such as regular sugar, and lactose, which is found in dairy products. These types of carbohydrates are also broken down into glucose. This process takes place in the intestine.

In addition, there are a number of polysaccharides (carbohydrates) with a long molecular chain. Some of them, such as starch, are poorly absorbed by the body, while other carbohydrates, such as pectin, hemicellulose and cellulose, are not digested at all in the intestines. However, these carbohydrates play an important role in the digestive process, promoting the proper absorption of other carbohydrates and maintaining the correct level of intestinal microflora.

Despite the fact that glucose is the main source of energy for cells, most tissues are not able to get it directly. For this purpose cells need insulin. Organs that cannot exist without insulin are insulin dependent. Only very few tissues are able to receive glucose without insulin (these include, for example, brain cells). Such tissues are called insulin-independent. For some organs, glucose is the only source of energy (for example, for the same brain).

What are the consequences of a situation when, for some reason, the cells lack insulin? This situation manifests itself in the form of two main negative consequences. First, the cells will not be able to receive glucose and will experience starvation. Therefore, many organs and tissues will not be able to function properly. On the other hand, unused glucose will accumulate in the body, primarily in the blood. This condition is called hyperglycemia. True, excess glucose is usually stored in the liver as glycogen (from where it can be recycled back into the blood when needed), but insulin is also needed for the process of converting glucose to glycogen.

Normal blood glucose levels range from 3.3 to 5.5 mmol/L. This value is determined when blood is taken on an empty stomach, since eating always causes an increase in sugar levels for a short time. Excess sugar accumulates in the blood, which leads to serious changes in its properties, the deposition of sugar on the walls of blood vessels. This leads to the development of various pathologies of the circulatory system and, ultimately, to dysfunctions of many body systems. It is this process - the accumulation of excess glucose in the blood - that is called diabetes mellitus.

Causes of diabetes and its types

The mechanism of the pathogenesis of the disease is reduced to two main types. In the first case, the occurrence of excess glucose leads to a decrease in insulin production by the pancreas. This phenomenon can appear due to various pathological processes, for example, due to inflammation of the pancreas - pancreatitis.

Another type of diabetes mellitus is observed if insulin production is not reduced, but is within the normal range (or even slightly above it). The pathological mechanism of the development of diabetes in this case is different - the loss of tissue sensitivity to insulin.

The first type of diabetes mellitus is called type 1 diabetes mellitus, and the second type of the disease is type 2 diabetes mellitus. Sometimes also type 1 diabetes is called insulin-dependent, and type 2 diabetes is called non-insulin dependent.

There are also other types of diabetes - gestational, MODY-diabetes, latent autoimmune diabetes, and some others. However, they are much rarer than the two main types.

In addition, diabetes insipidus should be considered separately from diabetes mellitus. This is the name of a type of disease in which there is increased urination (polyuria), but it is not caused by hyperglycemia, but by other types of causes, such as diseases of the kidneys or pituitary gland.

While there are common characteristics between diabetes mellitus, the symptoms and treatment of both major types of diabetes are generally very different.

Two types of diabetes mellitus - distinctive features

sign	type 1 diabetes	type 2 diabetes
Age of patients	usually less than 30 years old	usually older than 40
Gender of patients	Predominantly male	Predominantly female
The onset of diabetes	Acute	gradual
Tissue sensitivity to insulin	Normal	Reduced
secretion of insulin	at the initial stage - reduced, with severe diabetes - absent	at the initial stage - increased or normal, with severe diabetes mellitus - reduced
Treatment of diabetes with insulin	necessary	at the initial stage is not required, in severe cases - it is necessary
The patient's body weight	at the initial stage - normal, then reduced	usually raised

Insulin dependent diabetes mellitus

This diabetes occurs in every tenth patient out of the total number of patients with this disease. However, of the two types of diabetes, type 1 diabetes is considered the most severe and may lead to more life-threatening complications.

The first type of diabetes mellitus, as a rule, is an acquired pathology. It is caused by a malfunction of the pancreas. The malfunction of the gland is followed by a decrease in the amount of insulin produced, which leads to diabetes. Why does the gland cease to function? This phenomenon can appear due to a large number of reasons, but most often it occurs due to inflammation of the gland. Most often, it can be caused by acute systemic viral infections and subsequent autoimmune processes, when the immune system begins to attack the cells of the pancreas. Also, the first type of diabetes often occurs as a result of oncological diseases. A serious factor favoring the development of the disease is hereditary predisposition. In addition, other circumstances also play a role in the occurrence of the first form of DM:

• the stress that the person has been exposed to
• hypoxia of pancreatic cells,
• improper diet (fat-rich and protein-poor food).

Most often, the development of insulin-dependent occurs at a young age (up to 30 years). However, older people are not immune from this disease.

How does type 1 diabetes manifest itself?

The disease is characterized by an acute initial stage, so the first signs of diabetes are usually easy to notice. The main symptoms of diabetes are intense thirst, consumption of large amounts of water. Accordingly, the volume of urine released (polyuria) also increases. The urine of the patient usually has a sweet taste, due to the increased content of glucose in it. This symptom is an increase in the concentration of glucose in the urine, called glucosuria. The development of glucosuria is observed when the concentration of sugar in the blood exceeds 10 mmol / l. At the same time, the kidney filters begin to fail to remove glucose and it begins to flow into the urine. However, in some renal pathologies, sugar in the urine is often observed even with normal blood sugar levels, so this parameter, an increased glucose content in the urine, is not a defining sign of diabetes mellitus.

Also, diabetes mellitus is manifested by a pathological increase in appetite (polyphagia). This phenomenon is explained simply, because due to the fact that glucose does not enter the cells, the body experiences a constant lack of energy and starving tissues signal this to the brain. With the constant use of food, however, the patient does not gain weight, but loses it. Other signs of the disease are severe fatigue and weakness, itching of the skin, persistent headaches, increased blood pressure, visual disturbances. When analyzing urine, acetone is detected in it, which is a consequence of the use of fat reserves by cells. However, acetone is often excreted in the urine and in many other diseases, such as inflammation. Especially often acetone in the urine appears in children. Therefore, this circumstance should not be considered as a defining symptom of diabetes.

Fluctuations in blood glucose levels often lead to its abnormally high or low values, and as a result - to hypoglycemic or hyperglycemic coma. These conditions often end in the death of the patient.

A common diabetes syndrome is Raynaud's syndrome, which includes:

• scleroderma,
• atherosclerosis,
• periarthritis,
• thromboangiitis obliterans,
• coldness and numbness of the extremities,
• pain in the hands.

The first form of diabetes is not only incurable, but also potentially fatal. If the patient does not receive treatment, his insulin-dependent diabetes will turn into complications such as ketoacidosis or diabetic coma, which inevitably end in death. Depending on the concentration of sugar in the blood, the stage of diabetes will be considered mild, severe or moderate.

Stages of insulin-dependent diabetes mellitus

Diagnosis of diabetes

If the first symptoms of the disease appear, then this is a reason for seeking medical help as soon as possible. Only a doctor is able to diagnose the presence of the first form of diabetes, and determine what means can be used to treat it. If the therapy for diabetes is started at the initial stage, then this reduces the likelihood of complications.

However, suspicions of the presence of an ailment alone are not enough; accurate diagnosis is necessary. A number of methods are used to diagnose diabetes. First of all, this is the determination of the level of glucose in the blood on an empty stomach, the level of insulin. In diabetes mellitus, accompanied by high levels of glucose in the body, sugar begins to be excreted in the urine. This is due to the fact that the kidneys can not cope with the filtration of glucose, and it appears in the urine. Thus, using a urine test for glucose, you can determine the presence of diabetes.

How to treat diabetes?

Unfortunately, diabetes mellitus today is one of the incurable pathologies, including at the initial stage, since effective methods of therapy aimed at eliminating pancreatic dysfunctions have not been developed. However, this does not mean that the prognosis of the disease is fatal. Nevertheless, therapy is exclusively symptomatic in nature - stabilization of glucose levels in the body, treatment of concomitant diabetes pathologies.

Insulin therapy for diabetes

With this type of diabetes, treatment consists mainly in the introduction of insulin into the patient's body. Insulin helps tissues absorb glucose and reduces its level in the blood. The introduction of insulin is carried out only by the parenteral (subcutaneous) method, since insulin decomposes when passing through the gastrointestinal tract.

For the introduction of insulin in diabetes of the first variety, conventional syringes are most often used. Although now there are improved compact pen syringes. Injection pumps are also widely used. This type of syringe allows you to accurately control the flow of insulin into the blood, and prevents the occurrence of such dangerous complications as hypoglycemia. The popularity of syringe pumps is growing every year.

There are different types of insulin, which can differ from each other according to various criteria:

• action speed,
• cleaning degree,
• biological origin.

Medical insulin has a concentration of 40 or 100 IU (international units).

Patient education as part of therapy

An important element of diabetes therapy is patient education. The patient should know what he needs to do if a state of hypoglycemia or hyperglycemia appears, how to constantly monitor blood glucose levels, how to change the diet. Relatives of the patient should also have such information.

Diet

Diabetes is a metabolic disease. Therefore, a vital method of its treatment is a diet based on the principle of limiting the amount of carbohydrates in food. Without following the diet, the patient risks dying as a result of the development of conditions of severe hyper- and hypoglycemia.

The diet for insulin-dependent diabetes mellitus should be based on strict adherence to the norms of carbohydrates entering the patient's body. For the convenience of calculating carbohydrates in the practice of treating diabetes, a special unit of measurement has been introduced - a bread unit (XE). One XE contains 10 g of simple carbohydrates, or 20 g of bread. The amount of XE consumed per day is selected by the doctor individually, taking into account physical activity, the patient's weight and the severity of the course of the disease. With diabetes insulin-dependent mellitus, alcohol consumption is strictly prohibited.

non-insulin dependent diabetes mellitus

This type of diabetes is the most common. According to statistics, it is found in about 85% of diabetics. Type 2 diabetes rarely occurs at a young age. It is more typical for middle-aged adults and the elderly.

Type 2 disease is not caused by a lack of insulin production, but by a disruption in the interaction between insulin and tissues. Cells stop absorbing insulin and glucose begins to accumulate in the blood. The causes of this phenomenon have not been fully elucidated, but, according to scientists, an essential role in the pathogenesis of diabetes is played by:

• change in the rate of absorption of glucose in the intestine,
• acceleration of the destruction of insulin,
• decrease in the number of insulin receptors in cells.

In particular, in some pathologies, the immune cells of the body can perceive insulin receptors as antigens and destroy them.

The main circumstance that affects the likelihood of developing diabetes is obesity. This is also evidenced by statistics, since 80% of patients with non-insulin-dependent diabetes are overweight.

Among the factors contributing to the development of the disease, one can also distinguish:

• sedentary lifestyle,
• smoking;
• alcoholism;
• lack of physical activity;
• wrong diet;
• stress;
• taking certain medications, such as glucocorticosteroids.

Genetic predisposition and heredity also play a significant role. If at least one of the parents is sick with non-insulin-dependent diabetes, then the probability that the child will have this disease in adulthood is 80%.

There is a misconception that excessive consumption of sweets, even a single one, can lead to diabetes. In fact, this is not so, a healthy person can eat quite a lot of sweets at a time, and this will not affect his health. Another thing is that the constant consumption of sweets often leads to obesity, but excess weight can already cause processes leading to diabetes.

Signs of diabetes

Non-insulin-dependent diabetes mellitus develops slowly over many years. Therefore, patients often do not pay attention to the first signs of diabetes, attributing them to age-related changes, overwork. In the early stages, there are often no symptoms of diabetes at all. Thus, the first signs of diabetes appear only with a serious increase in blood glucose levels.

There is a set of symptoms typical of non-insulin-dependent diabetes mellitus. The patient begins to be disturbed by intense thirst, frequent urination, insomnia at night, fatigue, weakness and drowsiness during the day.

Also, the first signs of diabetes include the following phenomena:

• slow wound healing
• blurred vision,
• episodic or persistent dizziness,
• numbness or tingling in the limbs,
• dermatitis.

On the other hand, such phenomena often develop in other pathologies, so the diagnosis and determination of the type of diabetes should be made by the doctor, and not by the patient himself.

In the absence of treatment, severe forms of complications begin - neuropathy, nephropathy, retinopathy, angiopathy.

Hidden symptoms of changes in carbohydrate metabolism are a slowdown in the synthesis of proteins and fatty acids. With the progression of the disease, signs of pathology develop and become more and more noticeable. Ultimately, an increased level of glucose in the blood begins to affect the work of the pancreas, the processes of insulin synthesis are disrupted. Ketoacidosis develops, the loss of water and electrolytes in the urine increases.

Diagnostics

The first signs of diabetes are an absolute reason to see a doctor. The main method for diagnosing the disease is a blood test for glucose levels.

The main methods for determining the level of glucose in the blood:

• checking fasting sugar levels
• checking the sugar level 2 hours after eating,
• glucose tolerance test.

The most famous blood test for glucose, taken in the morning on an empty stomach. Blood is taken from a finger or from a vein. Usually, blood sugar values ​​from a vein are slightly higher. The glucose level in a blood test from a finger should not exceed 6 mmol / l, otherwise it is highly likely that the patient has diabetes. However, according to the result of a single blood test, the diagnosis is most often not made, additional studies are needed.

Another way to test when determining the diagnosis is a blood test 2 hours after eating. In this case, the normal sugar level should not exceed 11 mmol / l. If a higher level is obtained during the test, then this is a preliminary confirmation of diabetes.

Also, in diabetes, a glucose tolerance test is done. For this test, the patient is given an empty stomach to drink a glass of water with glucose dissolved in it, and then measure the level of sugar in the blood. The first measurement is taken immediately after drinking a glass, and the second - after two hours. Then the obtained parameters are compared with normal characteristics (less than 11 mmol/l).

Fasting blood sugar and glucose loading test 2 hours later, from finger and vein.

It should be borne in mind that the diagnosis becomes only when all three of the above parameters are outside the normal range. A single test is usually not sufficient to make a diagnosis.

There is another type of analysis - an analysis of glycated hemoglobin. To date, among all the signs, it is considered the most accurate and is recommended for use by WHO when making a diagnosis. Unlike blood sugar, which often fluctuates during the day and fluctuates depending on circumstances (stress, dietary changes, exercise, illness, etc.), glycated hemoglobin levels differ much greater stability. The normal value of glycated hemoglobin is less than 6%. Above 6.5%, the chance of having diabetes approaches 100%.

Compliance between glycated hemoglobin (HbA1c) and mean fasting sugar

Secondary diagnostic signs are the presence of sugar and acetone in the urine (however, these conditions are often observed not only in diabetes mellitus).

Therapy

In the case of a diagnosis of diabetes, the patient should consult an endocrinologist. Many tools and methods have been developed for the treatment of non-insulin dependent diabetes. In general, the methods of therapy for this type of disease are more diverse than the methods for treating insulin-dependent diabetes.

The main method of therapy is the use of drugs. They can be divided into three main categories:

• drugs that do not affect the production of insulin;
• drugs that increase the production of insulin by pancreatic cells, regardless of blood glucose levels;
• drugs that increase insulin production when glucose levels rise.

Also, in severe and decompensated forms of the disease or with resistance to other forms of drug therapy, insulin is often used (usually in combination with other drugs).

Metformin

Non-insulin-dependent diabetes mellitus is most often treated with drugs that do not affect insulin production. Almost all of these drugs belong to the biguanide chemical class. Currently, only one biguanide, .

The mechanism of action of metformin is multifaceted, and the mechanisms of its work are still far from being fully understood. First of all, metformin reduces the intake of glucose from liver stores. Metformin also has a beneficial effect on metabolic processes in the body, in particular, it increases the consumption of glucose by muscle tissue.

Metformin is currently the first-line drug for the treatment of prediabetes and mild-to-moderate diabetes. The drug has gained popularity due to affordability, a small number of side effects and ease of use. When taking metformin, there is almost always no hypoglycemia (low blood glucose), even with an overdose. However, this is true only with monotherapy, that is, with treatment with metformin alone. When some other drugs are taken at the same time, a critically low blood glucose value is often observed.

Diabetes therapy with metformin is usually carried out simultaneously with dietary treatment. Otherwise, the therapeutic effect will be insignificant or completely absent. The diet is designed not only to reduce the amount of carbohydrates entering the body, but also to reduce the patient's body weight, since this factor largely contributes to the development of the disease.

Sulfonylurea derivatives

Another common class of drugs are drugs that are chemically related to sulfonylurea derivatives (tolbutamide, glibenclamide, glimepiride). They are used for moderate diabetes, when metformin does not help the patient or its use is impossible for some reason. The principle of action of sulfonylurea derivatives is based on the stimulation of pancreatic cells, due to which they begin to produce more insulin. Secondary mechanisms are associated with the suppression of glucagon synthesis and the release of glucose from the liver. The disadvantage of these funds is the high likelihood of hypoglycemia with the wrong dosage.

Diet

Diet is one of the most important elements in the treatment of non-insulin-dependent diabetes at any stage of the disease. The main principle of the diet is to reduce the amount of carbohydrates consumed. First of all, it concerns refined sugar, which is the easiest for the body to absorb. An increase in the intake of indigestible fiber is recommended, since it prevents the absorption of simple carbohydrates, stabilizes digestive processes, and improves the composition of the intestinal microflora.

In the treatment of non-insulin-dependent diabetes, alcohol should be avoided. This is due to the fact that alcohol disrupts the natural metabolic processes, including the processes of insulin production and glucose uptake by tissues.

Gestational diabetes

Pregnancy diabetes (gestational) is a disease that occurs only in women in the process of bearing a fetus. The course and symptoms of gestational diabetes are similar to those of non-insulin-dependent diabetes mellitus. This disease occurs in 2-5% of pregnant women. A typical prognosis of pathology is its spontaneous disappearance after the completion of pregnancy. However, this does not always happen. It has also been found that gestational diabetes increases the risk of non-insulin dependent diabetes in women. In addition, gestational diabetes can adversely affect the course of pregnancy, cause various abnormalities in the development of the fetus, and lead to increased weight of the newborn baby. Gestational diabetes should be distinguished from the usual diabetes mellitus of the first and second variants that appeared before the onset of pregnancy.

SD MODY-varieties

It is similar in characteristics to insulin-dependent diabetes, but it also has some features of non-insulin-dependent diabetes. This is an autoimmune pathology, accompanied by a decrease in insulin production. It is believed that among all patients with diabetes, about 5% have this type of disease. Pathology often manifests itself in adolescence. Compared to typical insulin-dependent DM, in MODY DM, the patient's need for insulin is not so high.

DM stages

Diabetes mellitus is a pathology that usually develops gradually. There are three stages of diabetes mellitus. The main parameter by which these stages can be distinguished is the concentration of glucose in the blood plasma.

Stages of diabetes and blood glucose levels

Another classification criterion is the body's resistance to pathology. Given this parameter, it is possible to distinguish compensated, subcompensated and decompensated stages. A feature of the decompensated stage is the presence of acetone in the urine and high levels of glucose in the blood, which respond poorly to drug therapy.

prediabetes

This condition, often referred to as impaired glucose tolerance, is characterized by borderline blood glucose levels. It is not yet a fully developed pathology or one of its stages, but can lead to diabetes over time. That is, the usual prognosis for the development of prediabetes is full-fledged diabetes.

Prognosis for DM

The prognosis largely depends on the stage of pathology and the form of diabetes. The prognosis also takes into account concomitant diabetes pathologies. Modern methods of therapy make it possible to completely normalize the level of sugar in the blood, or, if this is not possible, to prolong the life of the patient as much as possible. Another factor that affects the prognosis is the presence of certain complications.

Complications

SD is not dangerous in itself. First of all, its complications are dangerous and therefore the disease must be treated in a timely manner. Complications in non-insulin-dependent diabetes can be especially dangerous.

There is an opinion that the complications of diabetes are limited only to problems with the legs, their swelling and the appearance of ulcers on them. But in fact, high glucose levels affect the entire circulatory system, and cause a number of related complications. As a result, almost all organs suffer, and in the first place:

• nerves,
• brain,
• kidney,
• vessels,
• a heart,
• eyes,

The consequences of DM can often be the following complications:

• diabetic coma;
• hyperosmolar coma;
• encephalopathy;
• ophthalmopathy;
• nephropathy;
• polyneuropathy;
• dermatitis;
• angiopathy;
• ketoacidosis;
• diabetic foot syndrome caused by impaired blood microcirculation in the lower extremities;
• impotence in men;
• infertility in women;
• depression and psychosis.

Especially dangerous for the patient's life is such a complication as diabetic coma, which leads to either hypoglycemia or hyperglycemia.

Complications of diabetes also include disorders of the immune system, as a result of which the body becomes more vulnerable to various infections, including very dangerous ones, such as tuberculosis.

Ketoacidosis

Ketoacidosis is a complication in which the body accumulates metabolic products of fats - ketone bodies. Ketoacidosis most often occurs in a diabetic with concomitant pathologies, injuries, and malnutrition. Ketoacidosis entails a violation of many vital functions of the body and is an indication for hospitalization.

hypoglycemia

Hypoglycemia is a complication in which the blood contains an abnormally low amount of glucose. Since glucose is the most important source of energy for cells, this condition threatens to stop the functioning of many organs, and first of all, the brain. Typically, the threshold value below which hypoglycemia is recorded is 3.3 mmol / l.

Hypoglycemic crises usually accompany cases of insulin-dependent diabetes mellitus. They can be triggered by stress, alcohol intake or hypoglycemic drugs. The main method of combating hypoglycemia is the early intake of sugar-containing products (sugar, honey). If the patient has lost consciousness, then it is necessary to inject him with vitamin B1 subcutaneously and then intravenously with a 40% glucose solution. Or glucagon preparations are administered intramuscularly.

Hyperosmolar coma

This condition most often occurs in older people with non-insulin-dependent diabetes mellitus and is associated with severe dehydration. Coma is usually preceded by prolonged polyuria. The condition most often appears in older people due to the fact that with age the feeling of thirst is often lost, and the patient does not make up for the loss of fluid by drinking. Hyperosmolar coma is a vital indication for hospital treatment.

Retinopathy

Retinopathy is the most common complication of diabetes. The cause of the pathology is the deterioration of the blood supply to the retina. This process often affects other areas of the eye. The development of cataracts is often observed. In patients with diabetes, each year of illness increases the likelihood of retinopathy by 8%. After 20 years of illness, almost every diabetic suffers from a similar syndrome. The danger of retinopathy lies in the development of blindness, possible eye hemorrhages, retinal detachment.

Polyneuropathy

Polyneuropathy often causes loss of skin sensitivity (pain and temperature), primarily in the limbs. In turn, this leads to the formation of difficult-to-heal ulcers. Symptoms of polyneuropathy are numbness of the extremities, or a burning sensation in them. These phenomena usually intensify at night.

diabetic foot

Circulatory disorders caused by diabetes are most acutely felt in the areas most distant from the heart. In humans, such areas are the feet. Diabetic foot syndrome includes the development of purulent and necrotic processes, ulcers, pathologies of bone tissue in the foot area. In advanced cases of pathology, the only treatment can be only amputation of the foot.

Prevention

Diabetes is usually caused by an unhealthy lifestyle, poor diet, and lack of physical activity. Therefore, older people, especially those who may be suspected of having a hereditary tendency to diabetes, should constantly monitor their lifestyle and health, regularly take tests and visit a therapist.