What is diabetes? Initial and early signs of diabetes mellitus in adults. Signs of diabetes associated with damage to organs and systems

Diabetes ( diabetes mellitus, diabetes) - a chronic metabolic disease, manifested in the form of an absolute or relative deficiency of the pancreatic protein hormone in the blood called insulin, and characterized by a violation of the metabolism of dextrose in the body - persistent hyperglycemia, which subsequently leads to disorders of the metabolism of fats, proteins, mineral salts and water.

Types of diabetes mellitus (classification)

Classification of diabetes mellitus by reason:

  1. Type 1 diabetes mellitus - characterized by an absolute deficiency of insulin in the blood
    1. Autoimmune - antibodies attack β-cells of the pancreas and completely destroy them;
    2. Idiopathic (no known cause);
  2. Type 2 diabetes mellitus is a relative deficiency of insulin in the blood. This means that the quantitative indicator of insulin level remains within normal limits, but the number of receptors for the hormone on the membranes of target cells (brain, liver, adipose tissue, muscles) decreases.
  3. Gestational diabetes is an acute or chronic condition that manifests itself in the form of hyperglycemia during pregnancy.
  4. Other (situational) causes of diabetes mellitus are impaired glucose tolerance caused by causes unrelated to pancreatic pathology. They can be temporary or permanent.

Types of diabetes:

  • drug;
  • infectious;
  • genetic defects in the insulin molecule or its receptors;
  • associated with other endocrine pathologies:
    • adrenal adenoma;
    • Graves' disease.

Classification of diabetes mellitus by severity:

  • Light form - characterized by hyperglycemia of no more than 8 mmol/l, slight daily fluctuations in sugar levels, and the absence of glucosuria (sugar in the urine). Does not require pharmacological correction with insulin.

Quite often, at this stage, clinical manifestations of the disease may be absent, but during instrumental diagnostics are already being discovered initial forms typical complications with damage to peripheral nerves, micro-vessels of the retina, kidneys, and heart.

  • Moderate severity - glucose level in peripheral blood reaches 14 mmol/l, glucosuria appears (up to 40 g/l), incoming - sharp increase ketone bodies(fat breakdown metabolites).

Ketone bodies are formed due to energy starvation of cells. Almost all glucose circulates in the blood and does not penetrate the cell, and it begins to use fat reserves to produce ATP. At this stage, glucose levels are controlled through diet therapy and the use of oral hypoglycemic drugs (metformin, acarbose, etc.).

Clinically manifested by impaired renal function, cardiac vascular system, vision, neurological symptoms.

  • Heavy current - blood sugar exceeds 14 mmol/l, with fluctuations up to 20 – 30 mmol, glucosuria over 50 mmol/l. Complete dependence on insulin therapy, serious dysfunction vessels, nerves, organ systems.

Classification according to the level of compensation for hyperglycemia:

Compensation- this is conditionally the normal state of the body in the presence of a chronic incurable disease. The disease has 3 phases:

  1. Compensation - diet or insulin therapy allows you to achieve normal blood glucose levels. Angiopathy and neuropathies do not progress. General state the patient remains satisfactory for a long time. There is no disturbance of sugar metabolism in the kidneys, no ketone bodies, no acetone. Glycosylated hemoglobin does not exceed the value of “5%”;
  2. WITHsubcompensation - treatment does not completely correct blood counts and clinical manifestations of the disease. Blood glucose is not higher than 14 mmol/l. Sugar molecules damage red blood cells and glycosylated hemoglobin appears, damage to micro-vessels in the kidneys manifests itself in the form of a small amount of glucose in the urine (up to 40 g/l). Acetone is not detected in the urine, but mild manifestations of ketoacidosis are possible;
  3. Decompensation - the most severe phase of diabetic patients. Usually occurs in the late stages of the disease or total damage to the pancreas, as well as insulin receptors. It is characterized by the general severe condition of the patient up to coma. Glucose levels cannot be corrected with pharmaceuticals. drugs (over 14 mmol/l). High levels of sugar in urine (over 50g/l), acetone. Glycosylated hemoglobin significantly exceeds the norm, hypoxia occurs. If prolonged, this condition leads to coma and death.

Causes of diabetes mellitus

Diabetes mellitus (abbreviated as DM) is a polyetiological disease.

There is no single factor that causes diabetes mellitus in all people with this pathology.

The most significant reasons for the development of the disease:

Diabetes mellitus type I:

  • Genetic causes of diabetes:
    • congenital deficiency of β - pancreatic cells;
    • hereditary mutations in genes responsible for insulin synthesis;
    • genetic predisposition to immune autoaggression on β-cells (close relatives have diabetes);
  • Infectious causes of diabetes mellitus:
    • pancreatotropic (affecting the pancreas) viruses: herpes type 4, B, C. The human immune system begins to destroy pancreatic cells along with these viruses, which is what causes diabetes mellitus.

Have type II diabetes following reasons occurrence:

  • heredity (presence of diabetes in close relatives);
  • visceral obesity;
  • Age (usually over 50 – 60 years old);
  • low fiber intake and high intake of refined fats and simple carbohydrates;
  • hypertonic disease;
  • atherosclerosis.

Provoking factors

This group of factors in itself does not cause the disease, but significantly increases the chances of its development, if present. genetic predisposition.

  • physical inactivity (passive lifestyle);
  • obesity;
  • smoking;
  • excessive alcohol consumption;
  • use of substances that damage the pancreas (example: drugs);
  • excess fats and simple carbohydrates in the diet.

Symptoms of diabetes

Diabetes- chronic illness, so symptoms never occur suddenly. Symptoms in women and symptoms in men are almost the same. With the disease, the following manifestations are possible to varying degrees: clinical signs.

  • Constant weakness, decreased performance- develops as a result of chronic energy starvation of brain cells and skeletal muscles;
  • Dry and itchy skin- due to constant loss of fluid in the urine;
  • Dizziness, headaches- signs of diabetes - due to a lack of glucose in the circulating blood of the cerebral vessels;
  • Frequent urination- occurs due to damage to the capillaries of the glomeruli of the nephrons of the kidneys;
  • Decreased immunity (frequent, prolonged non-healing of skin wounds)- the activity of T-cell immunity is impaired, the skin performs a barrier function worse;
  • Polyphagia – constant feeling hunger - this condition develops due to the rapid loss of glucose in the urine and its insufficient transport into cells;
  • Decreased vision - cause - damage to the microscopic vessels of the retina;
  • Polydipsia– constant thirst arising from frequent urination;
  • Numbness of the limbs - prolonged hyperglycemia leads to specific polyneuropathy - damage to sensory nerves throughout the body;
  • Pain in the heart area - narrowing coronary vessels due to atherosclerosis leads to a decrease in blood supply to the myocardium and spastic pain;
  • Decreased sexual function - is directly related to poor blood circulation in the organs that produce sex hormones.

Diagnosis of diabetes

Diabetes diagnosis is most often not difficult for a qualified specialist. A doctor may suspect a disease based on the following factors:

  • A diabetic patient complains of polyuria (increased amount of daily urine), polyphagia (constant hunger), weakness, headache and other clinical symptoms.
  • During a preventive blood test, the level was higher than 6.1 mmol/L on an empty stomach, or 11.1 mmol/L 2 hours after eating.

If these symptoms are detected, a series of tests are performed to confirm/refute the diagnosis and to determine the causes.

Laboratory diagnosis of diabetes

Oral glucose tolerance test(OGTT)

A standard test to determine the functional ability of insulin to bind glucose and maintain its normal levels in the blood.

The essence of the method: In the morning, during an 8-hour fast, blood is drawn to assess fasting glucose levels. After 5 minutes, the doctor gives the patient to drink 75 g of glucose dissolved in 250 ml of water. After 2 hours, blood is taken again and the sugar level is determined again.

During the same period, they usually appear initial symptoms diabetes

Criteria for evaluating the OGTT analysis:

Determination of the level of glycosylated hemoglobin (C - HbA1c)

or HbA1 c- This is the hemoglobin of erythrocytes, which undergoes transformation as a result of contact with glucose. Its concentration in the blood has a direct correlation with glucose levels, which makes it possible to judge the compensation of a diabetic patient’s condition.

Norm – up to 6%

  • Doubtful result – 6 – 6.4%;
  • For diabetes mellitus – more than 6.4%.

Determination of C-peptide level

C – peptide is a fragment of the proinsulin molecule. When the C-peptide is cleaved, insulin becomes functionally active. The concentration of this substance in the blood allows us to evaluate the secretion of insulin in the pancreas.

Normal: 0.79 - 1.90 ng/ml (SI: 0.27-0.64 mmol/l).

Determination of proinsulin levels

This test allows you to differentiate various diseases pancreas and diabetes mellitus. An increase in blood proinsulin most often indicates an endocrine tumor - insulinoma (a rather rare pathology). Also, high concentrations of proinsulin molecules may indicate type 2 diabetes.

The norm is 3.3 – 28 pmol/l.

Determination of the level of antibodies to beta cells of the pancreas

One of the most accurate tests to determine the presence and causes of diabetes. The test is performed in risk groups (people with a predisposition to diabetes, for example, if close relatives have this disease), as well as in patients with impaired glucose tolerance during OGTT.

The higher the titer of specific antibodies, the more likely the autoimmune etiology of the disease, and the faster beta cells are destroyed and the level of insulin in the blood decreases. In diabetics it usually exceeds 1:10.

Normal – Titer: less than 1:5.

  • If the antibody titer remains within the normal range, but the fasting glucose concentration is above 6.1, a diagnosis of type 2 diabetes is made.

Antibody levels to insulin

Another specific immunological analysis. It is carried out for differential diagnosis in patients with diabetes (type 1 diabetes and type 2 diabetes). If glucose tolerance is impaired, blood is taken and a serological test is performed. It may also indicate the causes of diabetes.

The norm of AT to insulin is 0 – 10 U/ml.

  • If C (AT) is higher than normal, the diagnosis is type 1 diabetes. Autoimmune diabetes mellitus;
  • If C (AT) is within the reference values, the diagnosis is type 2 diabetes.

Level testantibodies to GAD (Glutamic acid decarboxylase)

GAD is a specific membrane enzyme of the central nervous system. The logical correlation between the concentration of antibodies to GAD and the development of type 1 diabetes mellitus is still not clear, but in 80% - 90% of patients these antibodies are detected in the blood. Analysis for AT GAD is recommended in risk groups for diagnosing prediabetes and prescribing a preventive diet and pharmacological therapy.

AT GAD norm is 0 – 5 IU/ml.

  • A positive result with normal glycemia indicates a high risk of type 1 diabetes;
  • A negative result with elevated blood glucose levels indicates the development of type 2 diabetes.

Test for blood insulin levels

Insulin- a highly active hormone of the endocrine pancreas, synthesized in the beta cells of the islets of Langerhans. Its main function is the transport of glucose into somatic cells. A decrease in insulin levels is the most important link in the pathogenesis of the disease.

Normal insulin concentration – 2.6 – 24.9 µU/ml

  • Below the norm - possible development of diabetes and other diseases;
  • Above normal - pancreatic tumor (insulinoma).

Instrumental diagnosis of diabetes

Ultrasound of the pancreas

Method ultrasound scanning allows you to detect morphological changes in gland tissues.

Typically, in diabetes mellitus, diffuse damage is determined (areas of sclerosis - replacement of functionally active connective tissue cells).

The pancreas may also be enlarged and have signs of edema.

Angiography of vessels of the lower extremities

The arteries of the lower extremities are a target organ for diabetes mellitus. Prolonged hyperglycemia causes increased blood cholesterol and atherosclerosis, which leads to decreased tissue perfusion.

The essence of the method is to introduce a special contrast agent into the bloodstream while simultaneously monitoring computed tomograph vascular patency.

If the blood supply is significantly reduced at the level of the legs of the lower extremities, the so-called “” is formed. Diagnosis of diabetes mellitus is based on this research method.

Ultrasound of the kidneys and ECHO CG of the heart

Methods for instrumental examination of the kidneys, allowing to assess damage to these organs in the presence of a diagnosis of diabetes mellitus.

Microangiopathies develop in the heart and kidneys - damage to blood vessels with a significant decrease in their lumen, and therefore deterioration functional abilities. The method allows you to prevent complications of diabetes.

Retinography or angiography of retinal vessels

The microscopic vessels of the retina are most sensitive to hyperglycemia, so the development of damage in them begins even before the first clinical signs of diabetes mellitus.

Using contrast, the degree of narrowing or complete occlusion of blood vessels is determined. Also, the most important sign of diabetes will be the presence of microerosions and ulcers in the fundus.

Diagnosis of diabetes mellitus is a complex measure, which is based on data from the medical history, an objective examination by a specialist, laboratory tests and instrumental studies. Using only one diagnostic criterion, it is impossible to establish a 100% correct diagnosis.

If you belong to a risk group, be sure to consult your doctor to learn more about what diabetes mellitus is and what needs to be done with such a diagnosis.

Treatment

Treatment of diabetes mellitus is a set of measures to correct the level of glycemia, cholesterol, ketone bodies, acetone, lactic acid, prevent the rapid development of complications and improve a person’s quality of life.

In diabetes mellitus, a very important aspect is the use of all treatment methods.

Methods used in the treatment of diabetes

  • Pharmacological therapy (insulin therapy);
  • Diet;
  • Regular physical activity;
  • Preventive measures to prevent the progression of the disease and the development of complications;
  • Psychological support.

Treatment of type 1 diabetes

Pharmacological correction with insulin

The need for insulin injections in patients with diabetes, its type and frequency of administration are strictly individual and are selected by specialists (therapist, endocrinologist, cardiologist, neurologist, hepatologist, diabetologist). They always pay attention to the symptoms of diabetes, conduct differential diagnosis, screen and evaluate the effectiveness of medications.

Types of insulin:

  • Fast acting(ultra-short-acting) - begins to act immediately after administration and works for 3 – 4 hours. Used before or immediately after meals. (Insulin – Apidra, Insulin – Humalog);
  • Short acting- acts 20–30 minutes after administration. It must be used strictly 10 - 15 minutes before meals (Insulin - Actrapid, Humulin Regular);
  • Medium duration- are used for continuous use and are effective for 12–18 hours after injection. Allows you to prevent complications of diabetes (Protafan, Humodar br);
  • Long acting insulin- requires constant daily use. Valid from 18 to 24 hours. It is not used to lower blood glucose levels, but only controls its daily concentration and does not allow it to exceed normal values(Tujeo Solostar, Basaglar);
  • Combinedinsulin- contains ultra-short and long-acting insulins in various proportions. Mainly used for intensive care Type 1 diabetes (Insuman Comb, Novomix).

Diet therapy for diabetes mellitus

Diet is 50% successful in controlling the glycemic level of a diabetic patient.

What foods should you eat?

  • Fruits and vegetables that are low in sugar and high concentrations vitamins and minerals (apples, carrots, cabbage, beets
  • Meat containing a small amount of animal fat (beef, turkey, quail meat)
  • Cereals and porridges (buckwheat, wheat, rice, barley, pearl barley)
  • Fish (sea fish is best)
  • Best choice of drinks strong tea, fruit decoctions.

What to give up

  • Sweets, pasta, flour
  • Concentrated juices
  • Fatty meat and dairy products
  • Spicy and smoked products
  • Alcohol

Treatment of type 2 diabetes

In the initial stages, type 2 diabetes mellitus is well treated with diet therapy, the same as for diabetes mellitus 1. In case of non-compliance with the diet, as well as in the long-term course of the disease, pharmacological therapy with glucose-lowering drugs is used. Even less often, patients with type 2 diabetes are prescribed insulin.

Antihyperglycemic drugs

  • Glibenclamide- a drug that stimulates the production of insulin in the pancreas.
  • Repaglinide- stimulates beta cells to synthesize insulin
  • Acarbose- works in the intestines, inhibits the activity of small intestinal enzymes that break down polysaccharides into glucose.
  • Pioglitazone - a drug for the prevention of polyneuropathy, micro-macroangiopathy of the kidneys, heart and retina.

Folk remedies for treating diabetes mellitus

Traditional methods include cooking various decoctions herbs, fruits and vegetables, which to one degree or another correct the level of glycemia.

  • Cryphaea amurica - ready-made moss extract. The use of Krifea causes an increase in the synthesis of pancreatic hormones: lipase, amylase, protease. It also has an antiallergic and immunomodulatory effect, reduces the main symptoms of diabetes.
  • Parsley root + lemon zest + garlic - these products contain a large number of vitamin C, E, A, selenium and other microelements. All This it is necessary to grind, mix and infuse for about 2 weeks. Use 1 teaspoon orally before meals.
  • Oak acorns - contain tannin, a very effective remedy for diabetes. This substance stimulates the immune system, has anti-inflammatory and anti-edematous effects, strengthens the vascular wall, and relieves severe types. Acorns should be ground into powder and taken 1 teaspoon before each meal.

Exercise for diabetes

Regular physical activity for diabetes is a very important aspect in the treatment and prevention of complications of diabetes. Morning exercises, running, swimming help to avoid obesity, improve blood supply to muscles and organs, strengthen blood vessels, and stabilize the functioning of the nervous system.

Disease prevention

If there is a genetic predisposition, the disease cannot be prevented. However, people who are at risk need to take a number of measures to control glycemia and the rate of development of diabetes complications.

  • Children with unfavorable heredity (parents, grandparents have diabetes) need to be tested once a year for blood sugar levels, and also monitor their condition and the appearance of the first symptoms of the disease. Also, an important measure will be annual consultations with an ophthalmologist, neurologist, endocrinologist, cardiologist in order to identify the first symptoms of diabetes and prevent complications of diabetes.
  • People over 40 years of age need to have their glycemic levels checked annually to prevent type 2 diabetes;
  • All diabetics should use special devices to control blood sugar levels - glucometers.

​ You also need to find out everything about diabetes, what is possible and what is not, starting from the type and ending with the causes of the disease specifically for you, for this you need a long conversation with a doctor, he will advise you, refer you to take the necessary tests and prescribe treatment.

Recovery prognosis

Diabetes mellitus is an incurable disease, so the prognosis for recovery is unfavorable. However, modern achievements in pharmacological therapy with insulin can significantly prolong the life of a diabetic, and regular diagnosis of typical disorders of organ systems leads to an improvement in the patient’s quality of life.

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People get diabetes so often that doctors from all over the world are no longer talking about “morbidity”, but about an epidemic. And indeed: in Russia alone, over 10 million people suffer from diabetes. So what is diabetes, and why is it dangerous?

Diabetes: what is happening and who is to blame

Diabetes mellitus is a chronic disease in which there is a constant high level of sugar in the blood. It would seem - so what’s wrong with that?

“Over-sweetened” blood leads to the appearance of free radicals that damage the body’s cells. And the insidious glucose combines with proteins and DNA, turning them into substances that cause the walls of the arteries to thicken. The blood vessels narrow, and this leads to heart disease.

If excess sugar is not removed from the blood in time, the person will gradually lose orientation in space, begin to become delirious and lose consciousness. Without medical care a diabetic with “jumped” sugar may die.

Because the system responsible for moving sugar from the blood into the cells can break down in several different ways, diabetes also comes in different forms and needs to be treated differently.

In this article we will talk about the three types of diabetes, explain where the disease comes from, and what to do about it.

Diabetes mellitus type 1

A person becomes ill if the cells of the pancreas cannot produce insulin, the hormone responsible for transporting nutrient glucose from the blood into the cells. Insulin-dependent diabetes mellitus usually occurs in childhood or adolescence.

Arises type 1 diabetes due to a failure in immune system, in which the immune system begins to attack the β-cells of the pancreas. Less commonly, the disease develops due to viral diseases and stress.

Signs diseases manifest themselves sharply, so it is impossible not to notice them. A person experiences excitement and terrible thirst, and at the same time constantly “runs” to the toilet. His breath smells like acetone, his skin itches, and his head hurts. If a person is not helped, he may fall into a coma and die.

Treat Type 1 diabetes mellitus with regular insulin injections. Unfortunately, there is no other way to help such people: after all, there is no way yet to support and “revive” dead β-cells of the pancreas.

Diabetes mellitus type 2

The disease occurs when the body stops producing enough insulin, or its sensitivity to it decreases. At the same time, everything is in order with the β-cells of the pancreas. Non-insulin-dependent diabetes mellitus usually affects people over 40 years of age.

Arises Type 2 diabetes in people who inherited poor insulin sensitivity from their parents. In addition to them, those at risk are those who like to eat more and move less. To cope with the continuous flow of glucose, pancreatic cells release more and more insulin into the blood every day, “strain” and stop coping with the production of the hormone, which is why diabetes develops over time.

Signs diseases manifest themselves late, so people with diabetes often find out about their disease by accidentally having their blood tested. Because of this, type 2 diabetes is often detected only when excess glucose in the blood has done its dirty work: it has provoked hypertension, atherosclerosis or coronary heart disease.

Therefore, if an adult suddenly begins to experience itching and unusual thirst, if he regularly feels sleepy, gets tired quickly at work, often gets sick or experiences tingling in his legs, he should consult a doctor as soon as possible. The earlier diabetes can be identified, the easier it is to control it later.

Treat Diabetes mellitus is complex: they take medications that lower blood sugar, try to eat as little fatty and sweet foods as possible, and try to move more. It is impossible to completely cure type 2 diabetes, but you can change your life so that diabetes does not interfere with your enjoyment.

Diabetes mellitus type 3

A person develops type 3 diabetes due to serious problems with the pancreas. The disease develops due to inflammation, tumors, or if the pancreas is removed during surgery.

Type 3 diabetes is similar to both type 1 and type 2 diabetes. If you have ever had problems with your pancreas, do not keep it a secret from your doctor to avoid misdiagnosis.

The most important things to know about diabetes

The likelihood of developing type 1 diabetes is very low. If this did not happen in childhood, then most likely it will not happen.

However, the pancreas needs to be protected. To do this, you should give up fast food and smoking, and try to eat more vegetables. Diabetes type 2 and 3 is not only heredity, but also a lifestyle. Even people whose both parents suffered from diabetes can avoid getting sick if they move actively, eat a lot of plant foods and few unhealthy desserts. The best prevention of diabetes is a healthy lifestyle!

Moreover, this rule also applies to those people who are still “unlucky” to get diabetes. It has been proven that if you regularly measure your glucose levels and take prescribed medications, you can successfully control your blood sugar levels and live a full life.

– a chronic metabolic disorder, which is based on a deficiency in the formation of its own insulin and an increase in blood glucose levels. It manifests itself as 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. There is a high risk of stroke, kidney failure, myocardial infarction, gangrene of the limbs, and blindness. Sharp fluctuations in blood sugar cause life-threatening conditions: hypo- and hyperglycemic coma.

ICD-10

E10-E14

General information

Among the common metabolic disorders, diabetes mellitus ranks second after obesity. About 10% of the world's population suffers from diabetes, however, if we take into account the hidden forms of the disease, this figure can be 3-4 times higher. Diabetes mellitus develops as a result of chronic insulin deficiency and is accompanied by disorders of carbohydrate, protein and fat metabolism. Insulin is produced in the pancreas by the β-cells of the islets of Langerhans.

By participating in carbohydrate metabolism, insulin increases the supply of glucose into cells, promotes the synthesis and accumulation of glycogen in the liver, and inhibits the breakdown of carbohydrate compounds. In the process of protein metabolism, insulin enhances the synthesis of nucleic acids and protein and suppresses its breakdown. The effect of insulin on fat metabolism is to activate the entry of glucose into fat cells, energy processes in cells, synthesis fatty acids and slowing down the breakdown of fats. With the participation of insulin, the process of sodium entering the cell is enhanced. Disorders of metabolic processes controlled by insulin can develop with insufficient insulin synthesis (type I diabetes mellitus) or with tissue resistance to insulin (type II diabetes mellitus).

Causes and mechanism of development

Type I diabetes mellitus is more often detected in young patients under 30 years of age. Impaired insulin synthesis develops as a result of autoimmune damage to the pancreas and destruction of insulin-producing ß-cells. In most patients, diabetes mellitus develops after a viral infection (mumps, rubella, viral hepatitis) or toxic exposure (nitrosamines, pesticides, medicinal substances etc.), the immune response to which causes the death of pancreatic cells. Diabetes mellitus develops when more than 80% of insulin-producing cells are affected. Being an autoimmune disease, type I diabetes mellitus is often combined with other processes of autoimmune genesis: thyrotoxicosis, diffuse toxic goiter, etc.

There are three degrees of severity of diabetes mellitus: mild (I), moderate (II) and severe (III) and three states of compensation for carbohydrate metabolism disorders: compensated, subcompensated and decompensated.

Symptoms

The development of type I diabetes mellitus occurs rapidly, while type II diabetes mellitus develops gradually. A latent, asymptomatic course of diabetes mellitus is often observed, and its detection occurs accidentally during examination of the fundus or laboratory determination sugar in blood and urine. Clinically, diabetes mellitus types I and II manifest themselves differently, but the following symptoms are common to them:

  • thirst and dry mouth, accompanied by polydipsia (increased fluid intake) up to 8-10 liters per day;
  • polyuria (copious and frequent urination);
  • polyphagia (increased appetite);
  • dry skin and mucous membranes, accompanied by itching (including the perineum), pustular skin infections;
  • sleep disturbance, weakness, decreased performance;
  • cramps in the calf muscles;
  • visual impairment.

Manifestations of type I diabetes mellitus are characterized by extreme thirst, frequent urination, nausea, weakness, vomiting, increased fatigue, constant feeling hunger, weight loss (with normal or increased nutrition), irritability. A sign of diabetes in children is the occurrence of bedwetting, especially if the child has not wet the bed before. In type I diabetes mellitus, hyperglycemic (with critically high blood sugar levels) and hypoglycemic (with critically high blood sugar) symptoms more often develop. low content blood sugar) conditions requiring emergency measures.

In type II diabetes mellitus, the predominant itchy skin, thirst, blurred vision, severe drowsiness and fatigue, skin infections, slow wound healing, paresthesia and numbness of the legs. Patients with type II diabetes mellitus are often obese.

The course of diabetes mellitus is often accompanied by hair loss on the lower extremities and increased hair growth on the face, the appearance of xanthomas (small yellowish growths on the body), balanoposthitis in men and vulvovaginitis in women. As diabetes progresses, disruption of all types of metabolism leads to decreased immunity and resistance to infections. Long-term diabetes causes damage skeletal system, manifested by osteoporosis (loss of bone tissue). Pain appears in the lower back, bones, joints, dislocations and subluxations of the vertebrae and joints, fractures and bone deformation, leading to disability.

Complications

The course of diabetes mellitus can be complicated by the development of multiple organ disorders:

  • diabetic angiopathy - increased vascular permeability, fragility, thrombosis, atherosclerosis, leading to the development of coronary heart disease, intermittent claudication, diabetic encephalopathy;
  • diabetic polyneuropathy – damage to peripheral nerves in 75% of patients, resulting in impaired sensitivity, swelling and chilliness of the limbs, a burning sensation and “crawling” goosebumps. Diabetic neuropathy develops years after diabetes mellitus and is more common in the non-insulin-dependent type;
  • diabetic retinopathy – destruction of the retina, arteries, veins and capillaries of the eye, decreased vision, fraught with retinal detachment and complete blindness. In type I diabetes, it manifests itself after 10-15 years, in type II – earlier, detected in 80-95% of patients;
  • diabetic nephropathy – lesion renal vessels with impaired renal function and the development of renal failure. It is observed in 40-45% of patients with diabetes mellitus 15-20 years after the onset of the disease;
  • diabetic foot - poor circulation of the lower extremities, pain in the calf muscles, trophic ulcers, destruction of bones and joints of the feet.

Critical, acute conditions in diabetes mellitus are diabetic (hyperglycemic) and hypoglycemic coma.

A hyperglycemic state and coma develop as a result of a sharp and significant increase in blood glucose levels. Harbingers of hyperglycemia are increasing general malaise, weakness, headache, depression, loss of appetite. Then abdominal pain, noisy Kussmaul breathing, vomiting with the smell of acetone from the mouth, progressive apathy and drowsiness, and decreased blood pressure appear. This condition is caused by ketoacidosis (accumulation of ketone bodies) in the blood and can lead to loss of consciousness - diabetic coma and death of the patient.

The opposite critical condition in diabetes mellitus is hypoglycemic coma, which develops when there is a sharp drop in blood glucose levels, often due to an overdose of insulin. The increase in hypoglycemia is sudden and rapid. There is a sudden feeling of hunger, weakness, tremors in the limbs, shallow breathing, arterial hypertension, the patient’s skin is cold, damp, and sometimes convulsions develop.

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

Diagnostics

The presence of diabetes mellitus is indicated by a fasting capillary blood glucose level exceeding 6.5 mmol/l. Normally, there is no glucose in the urine, since it is retained in the body by the kidney filter. When the blood glucose level increases more than 8.8-9.9 mmol/l (160-180 mg%), the renal barrier cannot cope and allows glucose to pass into the urine. The presence of sugar in the urine is determined by special test strips. The minimum level of glucose in the blood at which it begins to be detected in the urine is called the “renal threshold”.

An examination for suspected diabetes mellitus includes determining the level of:

  • fasting glucose in capillary blood (from a finger);
  • glucose and ketone bodies in the urine - their presence indicates diabetes mellitus;
  • glycosylated hemoglobin - increases significantly in diabetes mellitus;
  • C-peptide and insulin in the blood - in type I diabetes, both indicators are significantly reduced, in type II - practically unchanged;
  • conducting a stress test (glucose tolerance test): determination of glucose on an empty stomach and 1 and 2 hours after taking 75 g of sugar dissolved in 1.5 glasses of boiled water. The test result is considered negative (not confirming diabetes mellitus) when tested: on an empty stomach< 6,5 ммоль/л, через 2 часа - < 7,7ммоль/л. Подтверждают наличие сахарного диабета показатели >6.6 mmol/L at first measurement and >11.1 mmol/L 2 hours after glucose load.

To diagnose complications of diabetes mellitus, additional examinations are carried out: ultrasound of the kidneys, rheovasography of the lower extremities, rheoencephalography, EEG of the brain.

Treatment

Following the recommendations of a diabetologist, self-monitoring and treatment for diabetes mellitus are carried out for life and can significantly slow down or avoid complicated variants of the course of the disease. Treatment of any form of diabetes is aimed at lowering blood glucose levels, normalizing metabolic milestones and preventing complications.

The basis of treatment for all forms of diabetes is diet therapy, taking into account the patient’s gender, age, body weight, and physical activity. Training is provided in the principles of calculating the calorie content of a diet, taking into account the content of carbohydrates, fats, proteins, vitamins and microelements. In insulin-dependent diabetes mellitus, it is recommended to consume carbohydrates at the same hours to facilitate control and correction of glucose levels with insulin. In type I IDDM, the intake of fatty foods that contribute to ketoacidosis is limited. In non-insulin-dependent diabetes mellitus, all types of sugars are excluded and the total calorie content of food is reduced.

Meals should be small (at least 4-5 times a day), with an even distribution of carbohydrates, promoting stable glucose levels and maintaining basal metabolism. Special diabetic products based on sweeteners (aspartame, saccharin, xylitol, sorbitol, fructose, etc.) are recommended. Correction of diabetic disorders with diet alone is used in mild degree diseases.

The choice of drug treatment for diabetes depends on the type of disease. For patients with type I diabetes mellitus, insulin therapy is indicated; for type II diabetes mellitus, diet and hypoglycemic agents are indicated (insulin is prescribed in case of ineffectiveness of taking tablet forms, the development of ketoazidosis and precomatosis, tuberculosis, chronic pyelonephritis, liver and kidney failure).

Insulin is administered under systematic monitoring of glucose levels in the blood and urine. There are three main types of insulin based on their mechanism and duration of action: long-acting (long-acting), intermediate-acting and short-acting. Long-acting insulin is administered once a day, regardless of food intake. More often, injections of long-acting insulin are prescribed together with intermediate and short-acting drugs, making it possible to achieve compensation for diabetes mellitus.

The use of insulin is dangerous due to overdose, leading to a sharp decrease in sugar, the development of hypoglycemia and coma. The selection of drugs and insulin doses is carried out taking into account changes in the patient’s physical activity during the day, the stability of blood sugar levels, calorie intake, fractional meals, insulin tolerance, etc. With insulin therapy, local development is possible (pain, redness, swelling at the injection site) and general (up to anaphylaxis) allergic reactions. Also, insulin therapy can be complicated by lipodystrophy - “dips” in adipose tissue at the site of insulin administration.

Antihyperglycemic tablets are prescribed for non-insulin-dependent diabetes mellitus in addition to diet. According to the mechanism of lowering blood sugar, the following groups of hypoglycemic agents are distinguished:

  • sulfonylurea drugs (gliquidone, glibenclamide, chlorpropamide, carbutamide) - stimulate the production of insulin by pancreatic β-cells and promote the penetration of glucose into tissues. The optimally selected dosage of drugs in this group maintains glucose levels not > 8 mmol/l. In case of overdose, hypoglycemia and coma may develop.
  • biguanides (metformin, buformin, etc.) – reduce the absorption of glucose in the intestine and contribute to the saturation of peripheral tissues with it. Biguanides can increase uric acid levels in the blood and cause the development of serious condition- lactic acidosis in patients over 60 years of age, as well as persons suffering from hepatic and renal failure, chronic infections. Biguanides are more often prescribed for non-insulin-dependent diabetes mellitus in young obese patients.
  • meglitinides (nateglinide, repaglinide) - cause a decrease in sugar levels by stimulating the pancreas to secrete insulin. The effect of these drugs depends on blood sugar levels and does not cause hypoglycemia.
  • alpha-glucosidase inhibitors (miglitol, acarbose) - slow down the rise in blood sugar by blocking enzymes involved in the absorption of starch. Side effect- flatulence and diarrhea.
  • thiazolidinediones - reduce the amount of sugar released from the liver and increase the sensitivity of fat cells to insulin. Contraindicated in heart failure.

In case of diabetes mellitus, it is important to teach the patient and his family members the skills to monitor the patient’s well-being and condition, and first aid measures for the development of precomatose and comatose states. A beneficial therapeutic effect in diabetes mellitus is a decrease excess weight and individual moderate physical activity. Due to muscle efforts, glucose oxidation increases and its content in the blood decreases. However, exercise should not be started if the glucose level is > 15 mmol/l; first, it is necessary to wait until it decreases under the influence of drugs. In case of diabetes mellitus, physical activity should be evenly distributed across all muscle groups.

Prognosis and prevention

Patients with diagnosed diabetes mellitus are registered with an endocrinologist. By organizing the right lifestyle, nutrition, and treatment, the patient can feel satisfactory long years. Acutely and chronically developing complications aggravate the prognosis of diabetes mellitus and shorten the life expectancy of patients.

Prevention of type I diabetes mellitus comes down to increasing the body's resistance to infections and eliminating the toxic effects of various agents on the pancreas. Preventive measures Type II diabetes mellitus involves preventing the development of obesity and correcting nutrition, especially in people with a family history. Prevention of decompensation and complicated course of diabetes mellitus consists in its correct, systematic treatment.

Diabetes mellitus is a disease endocrine system, which occurs due to a lack of insulin and is characterized by metabolic disorders and, in particular, carbohydrate metabolism. In diabetes mellitus, the pancreas loses its ability to secrete the required amount of insulin or produce insulin of the required quality.

The name “diabetes mellitus,” according to a 1985 resolution of the World Health Organization, is the name of a whole list of diseases that have common features: due to various factors, the owner of any of these diseases has elevated blood sugar (glucose) levels.

Diabetes is a rarely diagnosed disease.

There are a number factors that predispose to the development of diabetes mellitus. In the first place is hereditary predisposition; the second leading cause of diabetes is obesity; the third reason is some diseases that result in damage to the beta cells that produce insulin (these are diseases of the pancreas - pancreatitis, pancreatic cancer, diseases of other glands internal secretion). The fourth reason is a variety of viral infections (rubella, chicken pox, epidemic hepatitis and some other diseases, including influenza); in fifth place nervous stress as a predisposing factor; In sixth place among the risk factors is age. The older a person is, the more reason he has to fear diabetes. It is believed that with every ten year increase in age, the likelihood of developing diabetes doubles.

In rare cases, certain hormonal disorders lead to diabetes; sometimes diabetes is caused by damage to the pancreas that occurs after the use of certain medications or due to prolonged alcohol abuse.

Depending on the reasons for the rise in blood glucose, diabetes mellitus is divided into two main groups: diabetes mellitus type 1 and diabetes mellitus type 2.

Diabetes mellitus type 1- insulin dependent. It is associated with damage to the pancreas, absolute insufficiency of its own insulin, and requires the administration of insulin. Type 1 diabetes usually occurs at a young age (this form of diabetes mainly affects young people under the age of 30).

Type 2 diabetes- insulin-independent, occurs due to a relative lack of insulin. In the early stages of the disease, insulin administration is usually not required. Type 2 diabetes mellitus is a disease of adulthood (it mainly affects older people). In such patients, insulin is produced, and by following a diet and leading an active lifestyle, these people can ensure that the sugar level remains normal for quite a long time, and complications can be successfully avoided. Treatment of this type of diabetes may be limited to taking tablets only, but in some patients over time there is a need for additional insulin. Is not light form diabetes, as was previously thought, since type 2 diabetes is one of the main risk factors for the development of coronary heart disease (angina, myocardial infarction), hypertension and other cardiovascular diseases.

Symptoms

There is a set of symptoms characteristic of both types of diabetes: frequent urination and a feeling of unquenchable thirst; rapid weight loss, often with a good appetite; feeling weak or tired; fast fatiguability; blurred vision (“white veil” before the eyes); decreased sexual activity, potency; numbness and tingling in the limbs; feeling of heaviness in the legs; dizziness; protracted course of infectious diseases; slow wound healing; a drop in body temperature below average; cramps of the calf muscles.

There are cases when a chronic increase in blood sugar for some time may not have such typical symptoms of diabetes as thirst or a significant increase in the daily amount of urine. And only over time do patients pay attention to general weakness, constantly Bad mood, itching, more frequent pustular skin lesions, progressive weight loss.

The onset of type 1 diabetes is characterized by a rapid deterioration in health or more severe symptoms dehydration of the body. Such patients require urgent prescription of insulin drugs. Without appropriate treatment, it may occur life-threatening condition - diabetic coma. For type 2 diabetes, in almost all cases, weight loss and significant exercise can prevent the progression of diabetes and normalize blood sugar levels.

In order to install diagnosis diabetes, it is necessary to determine the level of sugar in the blood. If the fasting blood sugar level is less than 7.0 mmol/l, but more than 5.6 mmol/l, a glucose tolerance test must be performed to clarify the state of carbohydrate metabolism. The procedure for this test is as follows: after determining the blood sugar level on an empty stomach (fasting period of at least 10 hours), you need to take 75 g of glucose. The next blood sugar measurement is taken after 2 hours. If the blood sugar level is more than 11.1, we can talk about the presence of diabetes. If the blood sugar level is less than 11.1 mmol/l, but more than 7.8 mmol/l, they speak of impaired carbohydrate tolerance. With more low rates The blood sugar test should be repeated after 3-6 months.

Treatment depends on the type of diabetes. Type I diabetes must always be treated with insulin, compensating for its absence in the body. Type II diabetes can first be treated with diet, and if this treatment is insufficient, tablets (oral antidiabetic drugs, i.e. taken orally) are added; as the disease progresses, the person switches to insulin therapy. In most countries modern world Patients’ insulin needs are fully covered by genetically engineered human insulin preparations. This is biosynthetic or recombinant human insulin and that’s it dosage forms, obtained on its basis. According to the International Diabetes Federation, at the end of 2004, in more than 65% of countries in the world, only genetically engineered human insulins were used to treat patients with diabetes.

There are short-acting drugs, intermediate-acting drugs and long-acting drugs. Along with them, insulin analogues with additional properties are also used. These include ultra-short-acting and long-acting (long-acting) insulins. As a rule, such drugs are administered subcutaneously, but if necessary intramuscularly or intravenously.

It is firmly established that diabetes cannot be contracted the same way one can contract influenza or tuberculosis. Diabetes is rightly classified as a disease of civilization, that is, the cause of diabetes in many cases is excess “civilized” food, rich in easily digestible carbohydrates.

Diabetes mellitus is the most common endocrine disease worldwide. According to the World Health Organization (WHO), diabetes is the fourth leading cause of premature death and diabetes deaths are projected to increase by more than 50% in the next 10 years unless urgent action is taken.

Despite all the efforts of healthcare organizations and national programs adopted in many countries around the world to combat this disease, the number of patients with this diagnosis is constantly growing. The incidence of diabetes is increasing not only within the age group over 40 years, but more and more children and adolescents are becoming ill. According to the International Diabetes Federation and WHO, there are currently more than 200 million people with diabetes in all countries of the world.

According to expert estimates, by 2010 this figure will increase to 239.4 million, and by 2030 - to 380 million. More than 90% of cases account for type 2 diabetes.

These values ​​may be greatly underestimated, since up to 50% of patients with diabetes today remain undiagnosed. These people do not receive any glucose-lowering therapy and maintain stable hyperglycemia, which creates favorable conditions for the development of vascular and other complications.

Every 10-15 years total number number of patients doubles. On average, 4-5% of the world's population suffers from diabetes, in Russia - from 3 to 6%, in the USA - from 10 to 20%.

The incidence of diabetes mellitus in Russia today has come close to the epidemiological threshold. More than 2.3 million diabetics are registered in Russia (unofficial statistics indicate figures from 8.4 to 11.2 million people), of which more than 750 thousand require daily insulin intake.

The material was prepared based on information from open sources

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