Diabetes mellitus is a pathology in which the balance of carbohydrates and water in the body is disturbed. The disease is based on dysfunction of the pancreas, the main task of which is to release insulin, which is necessary to deliver glucose to the body’s cells. Glucose is needed for normal cell functioning. Insulin takes part in the process of converting sugar into glucose, which is deposited in the blood and excreted in the urine. When disturbances occur in the functioning of the pancreas, disruptions in water metabolism occur.
Water is no longer retained by the tissues and is excreted by the kidneys. When diabetes mellitus occurs, insulin is produced in insufficient quantities, blood sugar and glucose levels rise, and the body's cells experience glucose deficiency.
Diabetes triggers a chain reaction of disruption of the entire metabolic pattern in the body, and this significantly reduces the quality of life and affects the ability to work.
Pancreas
The pancreas is located in the abdominal cavity behind the stomach at the level of the 1st – 2nd lumbar vertebrae. It has an alveolar-tubular structure and consists of a head (width from 5 cm, thickness - 1.5-3 cm), body (width - 1.75-2.5 cm) and tail (length 3.5 cm, width – 1.5 cm). The head is enclosed by the duodenum, which is curved around it in a horseshoe shape. A groove runs between them and contains the portal vein. The pancreas is supplied with blood by the pancreatic-duodenal arteries, and the outflow of blood is carried out by the portal vein.
The pancreas has anterior, posterior and inferior surfaces. The posterior surface is adjacent to the abdominal aorta and spine, the lower surface is located just below the root of the transverse colon, and the anterior surface is adjacent to the posterior wall of the stomach. The cone-shaped tail is curved up and to the left and approaches the spleen. The gland also has an upper, anterior and lower edge.
The pancreas consists of two types of tissue: endocrine and exocrine. The basis of these tissues are acini, which are separated from each other by connective tissue. Each acini has its own excretory duct. They form a common excretory duct running along the entire gland, and it ends in the duodenum, flowing into the bile duct. Between the acini are the islets of Langerhans, which secrete insulin and glucagon produced by beta cells. The islets do not have their own excretory ducts, but they are abundantly penetrated by blood vessels, so they deliver their secretions directly into the blood.
Two types of disease
There are two types of diabetes:
Diabetes mellitus type 1 (insulin dependent)
Type 1 diabetes occurs more often in young people under the age of forty. Often occurs after a viral illness or severe stress. The course is severe and requires intravenous insulin. The body produces antibodies that destroy pancreatic cells. A complete cure is impossible, but the functioning of the pancreas can be restored with proper nutrition and the creation of favorable conditions.
Diabetes mellitus type 2 (non-insulin dependent)
As a rule, type 2 diabetes occurs in obese people over forty years of age. The cells of the body lose their ability to perceive insulin due to an excess of nutrients in them. The first step is to prescribe a diet. Insulin is prescribed selectively.
Causes of diabetes mellitus:
There are so-called risk group. These are people with diseases that can cause diabetes.
Symptoms of diabetes
- unquenchable thirst;
- frequent urge to urinate;
- weakness, drowsiness;
- smell of acetone from the mouth;
- increased appetite due to sudden weight loss;
- poorly healing wounds;
- the presence of fungus, boils, itchy skin.
Diagnosis of diabetes mellitus
To diagnose diabetes mellitus, both laboratory and instrumental methods are used:
- determination of the presence of fasting glycemia;
- blood electrolyte picture;
- general urinalysis with an indicator of the level of glucose (glucosuria), leukocytes, protein (proteinuria);
- Ultrasound of internal organs;
- sugar tolerance test;
- blood biochemistry;
- Rehberg test (degree of kidney damage);
- ultrasound examination of leg vessels (Dopplerography, rheovasography, capillaroscopy);
- urine test for acetone (ketonuria);
- the presence of glycated hemoglobin in the blood;
- fundus examination;
- glycemic profile (during the day);
- fixing the level of insulin of endogenous etiology in the blood;
- electrocardiogram (picture of myocardial damage).
For a complete diagnosis of diabetes mellitus, the patient should consult the following specialists:
- ophthalmologist;
- surgeon;
- neurologist;
- endocrinologist;
- cardiologist;
At the initial stages of diagnosing diabetes, it is necessary to determine the presence of sugar in the blood. Based on this indicator, all subsequent activities are assigned. Today, after multiple revisions, exact values have been established that characterize the picture of carbohydrate balance in the body.
Degrees of diabetes
Diabetes mellitus has four degrees of severity. All of them are characterized by the level of glycemia.
1st degree diabetes mellitus
The process is compensated, the glucose level is 6-7 mmol/l, glucosuria is not observed. Proteinuria and glycated hemoglobin are normal. General condition is satisfactory.
2nd degree diabetes mellitus
At this stage, the process is partially compensated, and there are signs of associated complications. Damage to the musculoskeletal system, nervous system, cardiovascular system, eyes, and kidneys is observed. There is a slight increase in blood sugar (7-10 mmol/l), glycated hemoglobin is normal or slightly increased. It occurs without severe disturbances in the functioning of internal organs.
Stage 3 diabetes mellitus
The disease progresses inexorably, drug control is impossible. Sugar level is 13-14 mmol/l. Stable proteinuria is recorded (protein is detected in the urine), glucosuria (the presence of glucose is noted in the urine). Severe damage to internal organs is observed.
The level of glycated hemoglobin is high, vision is catastrophically reduced, and significant hypertension is observed. Severe pain in the legs occurs against the background of decreased tactile sensitivity.
Stage 4 diabetes mellitus
Development of very severe complications against the background of complete decompensation of the process. Glycemia reaches high levels (15-25 and above mmol/l) and cannot be corrected.
Severe proteinuria, loss of protein. The presence of acute renal failure, diabetic ulcers appear, and gangrene of the lower extremities begins. There is a risk of developing a diabetic coma.
Complications of diabetes mellitus
Diabetic coma
Coma happens:
- hyperosmolar;
- ketoacidotic;
- hypoglycemic.
Symptoms of coma appear and increase very quickly in all types of diabetes. There is clouding of consciousness and general lethargy. In this condition, emergency hospitalization is indicated.
The most common type is ketoacidotic coma. There is a strong odor of acetone from the mouth, cold pouring sweat, and confusion. There is a deposition of toxic metabolic products in the blood.
In hypoglycemic coma, cold, pouring sweat and confusion are observed. But blood sugar is at the low mark (insulin overdose).
Other types of coma are rarely observed.
Diabetic edema
There are general and local ones. Their picture depends on the severity of damage to the cardiovascular system that occurs with the onset of diabetes mellitus. Edema is a clear sign of impaired renal function. The extent of edema is directly proportional to the severity of nephropathy.
High (low) pressure
Arterial hypertension in the region of the brachial artery indicates the development of nephropathy, which results in excessive production of renin (a hormone that increases blood pressure). At the same time, there is a decrease in blood pressure in the legs, as a result of diabetic angiopathy.
Leg pain
Indicate the appearance of diabetic neuro-or angiopathy. In the case of angiopathy, pain occurs with any type of exercise or when walking. The patient makes forced stops to reduce their intensity.
With neuropathy, night pain and rest pain appear. This reduces tactile sensitivity, accompanied by numbness. In rare cases, a false burning sensation occurs.
Trophic ulcers
Following the pain, trophic ulcers appear. They talk about the occurrence of angio-and neuropathy. Ulcers usually appear on the balls of the feet and big toes (diabetic foot).
In different forms of diabetes mellitus, the characteristics of the wound surface of ulcers also differ. The methods used to combat them are also radically different. The main task is to preserve the limbs, so it is necessary to take into account all the smallest symptoms.
As a rule, the course of trophic ulcers is favorable. Due to decreased sensitivity of the skin (neuropathy), along with foot deformation (osteoarthropathy), corns subsequently appear. Then hematomas and suppuration appear in their place.
Gangrene
Gangrene occurs as a consequence of angiopathy. Damage to both small and large arterial vessels is observed. First, one toe is affected, followed by significant pain and redness. Over time, the skin turns bluish and swelling occurs. Then the foot becomes cold to the touch, islands of necrosis and blisters appear.
This process is irreversible, so amputation is indicated. In some cases, amputation of the lower leg is indicated, since amputation of the foot does not produce results.
Treatment of diabetes
If type 1 diabetes mellitus occurs, the patient is prescribed lifelong insulin injections. Recently, thanks to innovations in the field of medicine, insulin-dependent patients can inject themselves on their own. Syringe pens and insulin pumps for continuous subcutaneous administration appeared.
If the pancreas is still capable of producing insulin, drugs are prescribed that stimulate its production. Some forms of type 2 diabetes can be corrected and even cured through diet therapy and therapeutic fasting. True, the risk of recurrence of the disease is extremely high.
Risk factors
Diabetes mellitus can be caused by:
- sedentary lifestyle;
- hereditary predisposition;
- chronic stress;
- overweight;
- long-term use of certain medications;
- unhealthy diet, overeating.
Prevention of diabetes
The main points on the list of measures to prevent diabetes are normalizing weight, controlling the caloric content of food intake and increasing physical activity. This tactic is effective not only for the risk group, but also against the background of prediabetes, when poor glucose absorption is observed.
Diet plays a particularly important role in preventing diabetes. It is recommended to exclude foods that increase blood sugar from your diet. These are white breads, sweets, sugary drinks, “quick” cereals, white rice, mashed potatoes, fried potatoes, and high-fat foods.
The following foods should be consumed in doses: rye bread, green peas, beets, raisins, apricots, melon, banana, potatoes, kiwi, pineapple, wholemeal products.
Watch the video on how to lower blood sugar using folk remedies:
Watch the video - we can cure diabetes mellitus Yuri Vilunas:
- August 3, 2018
- Endocrinology
- Max Fry
Diabetes mellitus is a disease that affects a large number of people. According to statistics, about 5% of the population of all developed countries have this disease, and every year the number of victims is growing. It is worth noting that this disease in most cases cannot be treated. And mortality from diabetes ranks third after cancer and cardiovascular diseases. The statistics do not inspire peace of mind at all, because no one is immune from this disease. How does diabetes manifest itself? We will answer this question in the article.
Concept
It is necessary to first understand what this term means. Diabetes mellitus according to ICD-10 are assigned codes in the range E10-E14 depending on the type of illness. This disease is a disorder in the body's metabolism. In other words, carbohydrates and water are not processed properly due to problems in the pancreas. This organ is responsible for producing insulin, which in turn must convert sugar into glucose. Due to the fact that this substance is not produced, sugar accumulates in the body and is excreted only through urine, and in large quantities.
How does diabetes manifest itself? The main symptom of the disease is an increased amount of sugar in the blood. In order for this indicator to be normal, it is necessary to produce insulin using the pancreas. However, due to disturbances, the substance is not produced, as a result of which the cells suffer from a lack of glucose.
Types of illness
Most often, there are two forms of the disease: type 1 and type 2 diabetes. The first of them is considered the most dangerous. It is in this case that coma is possible with diabetes. This can happen because the body produces antibodies that destroy pancreatic cells. Type 1 disease is lifelong, and to maintain the normal state of the body it is necessary to regularly inject insulin intramuscularly. Moreover, this substance cannot be taken as tablets, since it is not absorbed. Insulin should be administered during meals. It is worth noting that many people suffering from diabetes crave sweets. However, this is contraindicated; you must adhere to a strict diet. According to the ICD, type 1 diabetes mellitus is assigned code E10.
Type 2 diabetes is characterized by the fact that the body produces insulin, but not in such quantities as needed. Here everything is a little more complicated: the disease behaves secretly. How does type 2 diabetes manifest? It is usually detected during a routine urine or blood test. Symptoms can range from extreme thirst to weight loss. In obese people, weight loss is almost unnoticeable, however, if a disease is detected, it is better not to tempt fate, but to immediately consult a specialist for advice.
Causes of diabetes
Diabetes mellitus is characterized by a lack of such an important substance as insulin in the body. Deficiency may occur due to several factors. Let's look at the main causes of diabetes:
- Heredity. To cope with this, you need to get rid of other factors and hope for the best.
- Obesity. Most often, people who are overweight suffer from diabetes, and this should be combated.
- Diseases of the pancreas. Diseases such as pancreatitis, pancreatic cancer and others contribute to damage to beta cells, which are responsible for producing insulin.
- Viruses. Smallpox, influenza and rubella are especially dangerous. If a person becomes the object of infection, then he is likely to develop insulin-dependent diabetes (mellitus).
- Stress. People who are at risk should avoid nervous disorders, as this can become an activator of the disease.
- Age. According to statistics, older people are at greatest risk of getting sick.
The above reasons do not include secondary diseases, in which diabetes is only a symptom of a serious illness.
Symptoms of the disease
It is worth noting that diabetes develops gradually, slowly. There are practically no cases when the disease takes a critical form at lightning speed. How does diabetes manifest itself? At the initial stage, the patient exhibits the following symptoms:
- Dry mouth.
- A constant feeling of thirst that cannot be quenched. Diabetic patients easily drink several liters a day and cannot get enough water.
- In accordance with the previous point, daily urine output increases.
- Dry skin and persistent itching.
- Chronic fatigue syndrome in diabetes.
All these symptoms directly indicate problems in the body. As soon as you notice the first signs, you should immediately consult a doctor.
But that’s not all, because as soon as the disease begins to progress, complications may appear. Let's look at the main ones:
- Vision problems.
- Headache and nervous breakdowns.
- Numbness of the lower extremities, which leads to disturbances in normal walking.
- The appearance of pustules that do not heal.
- Leg ulcers due to diabetes.
- Impaired consciousness.
If the patient notices these changes, this indicates the insufficiency of treatment and the progression of the disease.
Stages of development of diabetes mellitus
Medical experts distinguish several degrees of severity of diabetes. This depends on the form and progression of the disease. Of course, the higher the blood sugar level, the faster the disease develops.
So, there are currently 4 stages of diabetes progression:
- First degree. It is characterized by a favorable course of the disease. Here the patient is not threatened with complications, the disease proceeds calmly. The blood glucose level is only slightly higher than normal; first-degree diabetes has virtually no effect on health. It is only necessary to maintain this state.
- Second degree. This is a more serious disease, characterized by the appearance of the first complications. The patient may experience problems with vision, kidneys, heart and nervous system. There are no serious disorders, the glucose level exceeds the permissible level slightly.
- Third degree. If the patient has started diabetes, then unpleasant news awaits him. In this case, the disease will constantly progress, and it will be almost impossible to carry out drug control. The glucose level is almost twice the permissible level. The person feels unwell, his vision deteriorates greatly, his blood pressure is constantly high, his lower limbs become numb and very painful, and severe complications are possible.
- Fourth degree. The most recent and, accordingly, severe form of the disease. In this case, correction is not possible. Any means are powerless here, the level of glucose in the blood reaches unrealistic values, gangrene and liver failure develop. Leg ulcers in stage 4 diabetes are common.
Diagnostics
First, you need to understand which doctor to contact if you have such a problem. These issues are mainly dealt with by an endocrinologist, but a therapist can also make a diagnosis. In any case, to determine the disease, you need to conduct an external examination. Based on this, the doctor has his first guesses, which are confirmed or refuted as a result of the patient undergoing various procedures and examinations.
To make a diagnosis of diabetes mellitus, you need to do the following:
- Determine blood glucose levels. It is worth noting that the normal value ranges from 3.3-5.5 mmol/l.
- Determine glucose in urine.
- Take a blood test that will show the content of glycated hemoglobin.
- It is necessary to determine immunoreactive insulin, i.e. find out what its content is in the blood.
- Determine kidney disorders by passing urine for analysis.
- Perform an eye examination to identify problems with the retina.
However, these procedures do not always clearly answer the question of what disease the patient has. In this case, the specialist prescribes additional tests such as a glucose tolerance test. Based on all of the above procedures, the doctor can diagnose diabetes.
Treatment of the disease
Insulin-dependent diabetes is no joke, and this disease should be taken seriously. So, at the first symptoms you can’t wait, you should immediately contact a specialist. The doctor will carry out the necessary medical measures to identify the disease, and then prescribe a course of therapy. It is worth immediately noting that treatment should be comprehensive and cover as many aspects of the disease as possible. You should listen to the recommendations for diabetes given by a specialist. This will help you quickly cope with the unpleasant manifestations of the disease.
If a person is diagnosed with type 1 disease, then insulin cannot be avoided. The doctor prescribes the dose individually.
When a patient has type 2 diabetes, specialists are limited to prescribing medications and diet. We'll talk about proper diet below. If a severe degree of the disease is observed, then insulin administration is also indispensable.
Unfortunately, it is impossible to cure diabetes completely, but if you maintain normal glucose levels, the patient will experience virtually no health problems. Doctors often recommend visiting a sanatorium for diabetes.
Therapy using folk remedies
As already noted, the main ways to maintain glucose levels are diet and medication. However, no one has canceled restoration using folk remedies. It is worth noting that their use can also be harmful, so before using any drugs it is better to consult an endocrinologist. Let's consider the most popular methods of traditional treatment of diabetes:
- Clover infusion. To prepare it, you need to combine a small amount of clover with the same amount of boiling water. After three hours, the drink is ready. It should be taken before meals, 300 ml.
- Blueberry leaves. The cooking method is almost the same, except for the ratio of ingredients. Pour a cup of boiling water over a spoonful of leaves and leave for half an hour. Take one cup orally three times a day.
- Burdock roots. They should be eaten with cheese, both boiled and fried. Sometimes people add this plant to soup instead of potatoes.
Proper diet
There is no universal diet that will suit all patients with diabetes. The diet is compiled individually depending on weight, age, physical development. They also take into account the fact that the patient needs to lose weight or gain weight. What do you eat if you have diabetes? We will try to answer this question. The purpose of the diet is to maintain blood sugar levels so that they do not go beyond acceptable limits. In addition, you should maintain a balance of fats and cholesterol in the body.
The diet is aimed at stabilizing the functioning of the pancreas; food should contain the required amount of proteins, carbohydrates and vitamins. The diet must be designed so that it provides the body with enough energy, which will help a person get closer to his ideal weight.
It is necessary to understand that diet is the basis of diabetes treatment. If you ignore it and still administer insulin, the patient will begin to feel unwell and the treatment will not be effective. To avoid this, you should organize the correct nutritional plan, with which you can normalize blood glucose levels.
So, what do you eat if you have diabetes? Almost every supermarket that sells food has a special section designed for people suffering from this disease. A diabetic's diet should include lean fish, dietary meat, various cereals, vegetables and herbs, soups, and dairy products. Of course, all people want sweets, but you need to understand that with this illness this is prohibited. After all, blood sugar levels increase, which will lead to complications. However, there are special dietary products for diabetics.
Consequences of diabetes
In itself, this disease does not pose a danger to human life and health. But it’s really bad when complications arise. Consider the main consequences of this disease:
- Neuropathy. Diabetes can develop into this disease, which is characterized by burning, severe pain and numbness of the lower extremities. This process develops as a result of metabolic disorders in the nervous system. In this case, doctors recommend using medications containing thioctic acid. If you undergo a proper course of treatment, you can restore nerve tissue and get rid of complications.
- Coma with diabetes mellitus. The symptoms increase at a breakneck speed, and at one point the patient needs to be hospitalized. Usually the patient feels a darkening of consciousness and feels lethargic. There are several types of coma, the most popular is ketoacidotic. It is characterized by the accumulation of toxins that destroy nerve cells.
- Pain and trophic ulcers on the legs with diabetes. As for pain in the lower extremities, this indicates neuropathy. Sometimes patients feel a burning sensation in the foot or lower leg. The appearance of ulcers indicates the next stage of the disease. If you get rid of them in time, no further complications will be observed. However, otherwise, you can significantly complicate your life by fighting hematomas that will fester.
Prevention
It is worth noting that type 1 diabetes is very difficult to predict or predict. It is hereditary in nature, and is also influenced by viruses that “host” the body. Of course, not everyone gets diabetes, but it is impossible to predict whether the disease will affect you.
A completely different conversation about type 2 disease. Here everything depends on the person and his lifestyle. Bad habits, alcohol abuse and a sedentary lifestyle will take their toll. We've talked about how diabetes manifests itself, now it's time to look at preventative measures. Necessary:
- monitor your weight;
- control blood pressure;
- create a diet that includes dietary food with a minimum content of carbohydrates and fats;
- normalize physical activity.
If you follow these recommendations, you can protect yourself from diabetes. A healthy lifestyle and proper nutrition are the key to the normal functioning of human organs. You need to take care of your health, because this is the most important thing in 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, the synthesis of fatty acids and slow 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, drugs, 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 fundus examination or laboratory determination of sugar in the 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 severe thirst, frequent urination, nausea, weakness, vomiting, increased fatigue, constant hunger, weight loss (with normal or increased nutrition), and 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, hyperglycemic (with critically high blood sugar) and hypoglycemic (with critically low blood sugar) conditions that require emergency measures often develop.
In type II diabetes mellitus, skin itching, thirst, blurred vision, severe drowsiness and fatigue, skin infections, slow wound healing, paresthesia and numbness of the legs predominate. 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 to the 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 – damage to the 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, and 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 constant 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 cases of the disease.
The choice of drug treatment for diabetes depends on the type of disease. Insulin therapy is indicated for patients with type I diabetes mellitus, for type II - diet and hypoglycemic agents (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 (including 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 the level of uric acid in the blood and cause the development of a serious condition - lactic acidosis in patients over 60 years of age, as well as in people suffering from liver and kidney 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 effects are 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. Losing excess weight and individual moderate physical activity have a beneficial therapeutic effect on diabetes. 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 for many 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 for type II diabetes mellitus include 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.
The disease called diabetes mellitus implies a serious disorder in the metabolism of water and carbohydrates, which causes malfunctions of the pancreas, which is responsible for the production of a hormone called insulin. Insulin, in turn, is responsible for the absorption of sugar by the body's cells.
Lack or complete absence of the hormone makes it impossible to convert sugars into glucose. For this reason, the body begins to gradually accumulate sugar in the blood plasma, and when it becomes too much, it excretes the excess in the urine.
Violations also negatively affect water metabolism. Most tissues cease to retain water within themselves, so most of the defective fluid is processed by the kidneys.
Hyperglycemia, which is an excess of glucose in the blood, is the main symptom of diabetes. It is worth noting that the disease can be acquired or hereditary.
Signs
Most clinical signs of diabetes mellitus are characterized by a gradual increase in severity.
In rare cases, there is a lightning-fast increase in glucose levels to a critical level, which becomes the cause of diabetic comas.
If the symptoms are left without proper attention, the disease will begin to progress, which can result in serious complications affecting almost any organ of the human body.
What symptoms of the disease do patients complain of in the initial stages:
- Dry mouth, accompanied by intense thirst that is practically impossible to quench. The patient is thirsty immediately after drinking feces.
- Frequent urination with a noticeable increase in urine output.
- Increase or decrease (less frequently) in weight.
- Dryness, thinning and itching of the skin.
- The appearance of pustules on the skin and soft tissues.
- Excessive sweating, muscle weakness even in the absence of physical activity.
- Slow healing of abrasions or wounds.
The listed symptoms of diabetes mellitus in adults are considered the first alarm signal indicating the onset of the development of the disease. The manifestation of such signs should be the reason for a subsequent blood sugar test.
Diabetes in itself is not a threat to human life. The same cannot be said about complications that can cause conditions accompanied by impaired consciousness, multiple organ failure, and serious intoxication.
The most common complications are:
- Neurological abnormalities accompanied by headaches.
- Vision problems.
- Impaired functions of the lower extremities, numbness and pain in the legs.
- Increased liver size, heart pain.
- A noticeable increase in blood pressure.
- Swelling of a local or widespread nature, swelling of the legs and face.
- Prolonged healing of wounds with the addition of fungal and infectious infections.
- Decreased sensitivity of the skin, especially on the feet.
- Smell of acetone from the mouth.
- Blurred consciousness, dizziness, lightheadedness and coma.
Signs of diabetes mellitus or the appearance of complications are considered a signal of the progression of the disease, as well as its incorrect or insufficient correction using medications.
Such symptoms of diabetes should prompt a detailed examination.
Causes
Sugar level
The causes of diabetes in adults are always associated with the inability of the pancreas to fully perform its functions, which is why the cells responsible for the synthesis of a hormone called insulin are destroyed.
In addition, the hormone is involved in carbohydrate metabolism. When the cells of the pancreas fully cope with their functions, glucose is completely absorbed by the human body. Excessive intake of simple carbohydrates is accompanied by increased production of insulin.
If you don't get enough sugar, insulin production also decreases. It turns out that the body of a healthy person always maintains the glucose content in the blood plasma at approximately the same level.
Insufficient insulin secretion causes hyperglycemia because sugar is stored rather than broken down. The main energy source is glucose, but without insulin it cannot enter the cells. Therefore, insulin-dependent cells suffer greatly, despite the excess sugar.
The following causes of the disease can be identified:
Malfunctions of the immune system. Such disorders cause the body to produce antibodies that damage the cells responsible for the synthesis of antibodies. In this case, diabetes may develop due to cell death.
In addition, the disease can be a consequence of autoimmune diseases, including lupus, autoimmune thyroiditis, glomerulonephritis, diseases of the adrenal cortex, and so on.
Predisposition at the genetic level. Heredity is the most serious reason. For example, if a person’s father or mother suffered from diabetes, the risk of developing this disease increases by 30%; if both father and mother were sick, it increases to 70%.
Obesity. Often the onset of the disease is due to excess weight. Excessive amounts of adipose tissue significantly reduces the sensitivity of cells to insulin, which is responsible for the breakdown of glucose. Subsequently, all the symptoms characteristic of diabetes occur.
However, it is worth noting that this process is reversible. Once a person loses excess weight, normalizes his own diet, and exercises regularly, the risk factor will be almost completely eliminated.
Wrong diet. People with a sweet tooth are at the greatest risk of developing diabetes, but those who love other foods with a lot of harmful additives are also at risk. Modern fast food often causes diseases of the gastrointestinal tract, including the pancreas.
Diabetes also often occurs due to the consumption of large amounts of food high in simple carbohydrates, which are easily digestible by the human body. This way of eating leads to obesity, which can also occur due to overeating.
Exposure to frequent stress. Often it is stressful situations that cause the first alarming symptoms of diabetes to appear. When a person experiences stress, his body releases adrenaline, glucocorticoids and norepinephrine. The listed components can cause disruptions in the process of insulin synthesis.
Diseases affecting the cardiovascular system. Long-term disease associated with the heart or blood vessels also increases the risk of diabetes. Dangerous diseases include atherosclerosis, hypertension and other ailments that can reduce sensitivity to insulin.
Use of medications. A certain category of medications can increase the body's tendency to develop diabetes. These include diuretics, synthetic hormonal drugs, drugs that lower blood pressure, and also those with antitumor effects.
Diseases affecting the pancreas. Acute chronic diseases negatively affect the condition of the cells that produce insulin. These also include injuries, tumors and pancreatitis.
Viral diseases. This kind of infection can become a trigger for the development of diabetes mellitus, since viruses also infect pancreatic cells. The risk category includes diseases such as influenza, measles, viral hepatitis, rubella, mumps, and so on. The risk of developing diabetes after an infection increases by 20%.
Age. If a person has a genetic predisposition, the risk of the disease only increases with age, so it’s good to know what it can be like in women, for example.
Pregnancy. Diabetes mellitus can develop during pregnancy. In women in an interesting position, sensitivity to the hormone insulin is significantly reduced, which is explained by increased levels of the pregnancy hormone. Therefore, hyperglycemia may begin. However, after childbirth, the diabetic crisis ends.
People who belong to the risk category must take into account each of the listed causes of the disease. To protect yourself from the disease, you need to monitor the sugar level in your blood plasma.
If there are signs of diabetes, you should consult an endocrinologist.
Causes of the disease in men
Type 1 diabetes does not usually develop in adults. Most often it is diagnosed in adolescence or adolescence. This disease is divided into two types, that is, autoimmune diabetes and idiopathic. The latter species is poorly studied, so the reasons for its occurrence are unknown.
Autoimmune causes among adult men are quite common. All of them are associated with disorders of the immune system. In this case, antibodies negatively affect the functioning of the pancreas, destroying the cells responsible for the production of insulin. In this case, diabetes in adults can be caused by exposure to toxins, as well as infectious diseases.
Type 2 diabetes is most common among men over 45 years of age. However, today the age threshold is regularly lowered, which is caused by excessive weight and obesity. The risk of getting sick is seriously increased by men who regularly drink beer, various types of carbonated sweet drinks, eat dates, and so on.
The abdominal type of men is most prone to diabetes, characterized by the accumulation of fat cells in the abdomen and sides. Usually this problem begins to overtake adults who often eat fast food.
Causes of the disease in women
What are the common causes of diabetes among women? We can talk about the following incentives:
- Non-compliance with diet. Eating at night puts stress on the pancreas.
- Changes in hormonal levels. The fair half of humanity is more susceptible to hormonal imbalances, especially during pregnancy and menopause.
- Women are also more likely to be overweight because they are accustomed to an irregular diet rich in carbohydrates. Sweet and potato lovers are 7 times more likely to develop diabetes.
In addition, representatives of the fairer sex are considered more emotional, and therefore are more susceptible to the influence of stressful situations. Serious nervous and psychological trauma reduces the susceptibility of insulin-dependent cells to the effects of the hormone.
This cause of diabetes may also be associated with women’s love of eating sweets, such as chocolate. To cure diabetes in an adult, it is enough to adhere to medical recommendations, diet, and exercise in moderation.
The listed treatment methods, in addition to drug therapy, can also become measures to prevent the disease. If a person is at risk, they should not be neglected, since in 70% of cases they help avoid diabetes.
In the video in this article, the doctor will continue to cover the topic of the causes of diabetes.
The International Diabetes Federation reports that today about 366 million people in the world suffer from diabetes, and half of them are not even aware of their disease. Diabetes often does not make itself felt until later. Surely you are now wondering what signs of diabetes appear in a patient. In this article we will try to talk about this in as much detail as possible.
Of the total number of people with diabetes, only 5% of them have diabetes, the remaining 95% have type 2 diabetes. These diseases, in essence, are completely different and opposite for the reasons for their development; they are united by their main common disorder - increased blood sugar levels.
The first signs of diabetes
It should be noted that in some cases, diabetes may not manifest itself at all, and its presence is determined, for example, during a fundus examination by an ophthalmologist. However, there are still some manifestations of diabetes mellitus that are characteristic of both types:
- feeling of unquenchable thirst and frequent urination, which causes dehydration;
- rapid weight loss;
- blurred vision (the so-called “white veil” that appears before the eyes);
- feeling tired or constantly weak;
- fast fatiguability;
- difficulties with sexual activity;
- feeling of heaviness in the legs;
- numbness of the limbs and tingling sensation in them;
- frequent cramps of the calf muscles;
- drop in body temperature;
- wounds with diabetes mellitus heal very slowly;
- slow recovery from infectious diseases;
- frequent dizziness.
The severity of these signs depends on the duration of the disease, the level of decrease in insulin secretion and, of course, on the individual characteristics of the patient.
Signs of type 1 diabetes
Among the most common signs of type 1 diabetes, which differ from the symptoms characteristic of both signs of the disease, the following should be highlighted:
- nausea and vomiting;
- irritability;
- constant feeling of hunger.
One of the signs of the disease in children is bedwetting.
During the phase that precedes the manifestation of type 1 diabetes, situations sometimes occur when blood glucose levels rise or fall significantly. These signs of diabetes indicate the need for emergency medical attention, and they may appear even before a person starts injecting insulin.
Signs of type 2 diabetes
How does type 2 diabetes manifest? Let's look at its main symptoms:
- the appearance of skin infections;
- drowsiness;
- paresthesia of the legs.
This disease begins in adulthood and is usually associated with poor nutrition.
Often, with type 2 diabetes, the patient also experiences flu-like symptoms, increased facial hair growth, hair loss on the legs, and the appearance of small yellow growths on the body - xanthomas.
Often the first sign of diabetes is inflammation of the foreskin, associated with frequent urination and poor hygiene.
Complications of diabetes mellitus
First of all, with diabetes, the heart and blood vessels suffer. People who do not take care of their own health are often susceptible to heart and vascular diseases. About 65% of deaths due to diabetes are due to stroke or heart attack. This disease can cause circulatory problems throughout the body, especially in the extremities.
Damage to nerves or damage to blood vessels can cause an acute complication of diabetes, which can ultimately lead to amputation. It should be noted that more than 60% of all amputations occur due to complications of diabetes, and not due to injuries.
Diabetes mellitus often becomes the main cause of blindness. It can cause other eye diseases, including cataracts, glaucoma and diabetic retinopathy.
Diabetes is the leading cause of kidney failure. To reduce the risk of this disease, you should take medications that lower blood pressure, even if the patient does not have high blood pressure.
Diabetes mellitus also leads to various diseases of the nervous system. Most often, the nerves of the extremities are damaged, which leads to loss of sensation in the arms and legs, or to sensations of pain and burning. Also, damage to the nervous system can provoke dysfunction of the gonads and disorders of the gastrointestinal tract.
People with diabetes are at risk of developing periodontitis. To prevent this disease, as well as tooth loss, you need to take very good care of your teeth and visit the dentist regularly.
If diabetes complications are identified in the early stages of their development, there are no particular difficulties in controlling them. Treatment for complications of diabetes focuses on slowing the progression of the disease through medication or surgery. The most important thing for diabetes is to constantly monitor blood sugar levels, maintain blood pressure and prevent cholesterol levels from rising.
If you are interested in the topic of this article, then also watch the video on this topic:
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