Diabetes mellitus - Causes, symptoms and treatment. MF.

Diabetes mellitus is a disease caused by absolute or relative insulin deficiency and characterized by a violation of carbohydrate metabolism with an increase in the amount of glucose in the blood and urine, as well as other metabolic disorders.

Historical information about diabetes

Pro with diabetes mellitus written a lot, the opinions of different authors diverge and to call some dates is really quite difficult. The first information about the disease appeared in the III century BC.The doctors of Ancient Egypt, and, of course, the physicians of Greece, apparently knew him. Rome, medieval Europe and the eastern countries. People could identify the symptoms of diabetes, but the causes of the illness were unknown, they were trying to find any treatment for diabetes, but the results were unsuccessful and those who had detected diabetes were doomed to death.

The term "diabetes" was first introduced by the Roman physician Aretius, who lived in the second century of our era. He described the illness as follows: "Diabetes is a terrible suffering, not very frequent among men, dissolving flesh and limbs in urine. Patients, without ceasing, secrete water in a continuous stream, as through open water pipes. Life is short, unpleasant and painful, thirst is unquenchable, fluid intake is excessive and not commensurate with the huge amount of urine due to even greater diabetes. Nothing can stop them from taking liquids and releasing urine. If they for a short time refuse to take a liquid, they dry out in the mouth, the skin and mucous membranes become dry. Nausea is observed in patients, they are agitated, and die for a short time. "

instagram viewer

In those days, the disease was diagnosed by its appearance, depending on the severity of the disease and the age of the patient. If the patient was a child or a young person with( insulin-dependent diabetes mellitusor type 1) IDDM, he was doomed to rapid death from diabetic coma, but if the disease developed in an adult person in 40-45 years and older( according to modern classification - it is non-insulin-dependent diabetes mellitus( NIDDM) orand type 2 diabetes), then such a patient was treated, or rather supported in it by diet, exercise and phytotherapy

Diabetum in the Greek translation "diabaino" means "to pass through."

In 1776 the English doctor Dobson( 1731)-1784) found out that the sweet taste of the urine of patients is associated with the presence of sugar in it, and from that date diabetes, in fact, became known as diabetes.

Since 1796, doctors have begun to talk about the need for a special diet for diabetics. A special diet for patients was proposed, in which part of carbohydrates was replaced by fats. Physical exercise began to be used as a treatment for diabetes.
In 1841,the method for determining sugar in the urine was first developed. Then they learned to determine the level of sugar in the blood.
In 1921,managed to get the first insulin.
In 1922.Insulin was used to treat a patient with diabetes mellitus.
In 1956,The properties of some sulfanylurea preparations that can stimulate insulin secretion have been studied.
In the 1960s.the chemical structure of human insulin was established.
In 1979,Complete synthesis of human insulin by genetic engineering was carried out.

Classification of diabetes

Non-diabetes mellitus.

The disease is caused by absolute or relative deficiency of antidiuretic hormone( vasopressin) and is characterized by increased urination( polyuria) and thirst( polydipsia).

Diabetes mellitus.

Diabetes mellitus is a chronic disease characterized by a metabolic disorder primarily of carbohydrates( namely glucose) and fats. To a lesser extent, proteins.

1 type( ISDD):

This type of diabetes is associated with insulin deficiency, so it is called insulin-dependent( IDDM).A damaged pancreas can not cope with its duties: it either does not produce insulin at all, or produces it in such poor quantities that it can not process even the minimum volume of incoming glucose, resulting in an increase in the level of glucose in the blood. Patients can have any age, but more often they are up to 30 years old, they are usually thin and, as a rule, notice the sudden appearance of signs and symptoms. People with this type of diabetes have to additionally inject insulin to prevent ketoacidosis( high content of ketone bodies in the urine) and to maintain life.

2 type( NIDDM):

This type of diabetes is called insulin-independent( NIDDM), because it produces enough insulin, sometimes even in large quantities, but it can be completely useless, because the tissues lose sensitivity to it.

This diagnosis is made by the patient usually older than 30 years. They are obese and with relatively few classic symptoms. They have no tendency to ketoacidosis, with the exception of periods of stress. They are not dependent on exogenous insulin. For treatment, tablets are used that reduce the resistance( stability) of cells to insulin or drugs that stimulate the pancreas to secrete insulin.

Gestational with Diabetes mellitus:

Glucose intolerance occurs or is detected during pregnancy.

Other types with of diabetes mellitus and impaired glucose tolerance:

Secondary, after:

pancreatic diseases( chronic pancreatitis, cystic fibrosis, hemochromatosis, pancreaticectomy);
endocrinopathy( acromegaly, Cushing's syndrome, primary aldosteronism, glucagonoma, pheochromocytoma);
use of drugs and chemicals( some antihypertensives, thiazide-containing diuretics, glucocorticoids, estrogen-containing drugs, psychotropic drugs, catecholomines).

Associated with:

anomaly of the insulin receptors;
genetic syndromes( hyperlipidemia, muscular dystrophies, Huntington's chorea);
mixed states( eating disorders - "tropical diabetes."

Symptoms of diabetes

In some cases, diabetes for the time being does not make itself felt. The signs of diabetes are different for diabetes I and diabetes 2. Sometimes, there may not be any signs at all,and diabetics are determined, for example, referring to the oculist when examining the fundus, but there is a complex of symptoms characteristic of of diabetes mellitus of both types. The severity of symptoms depends on the degree of decrease in the secretion of insulin, the duration of the diseaseand individual characteristics of the patient:

frequent urination and a feeling of unquenchable thirst, leading to dehydration of the body;
rapid weight loss, often despite a constant feeling of hunger;
feeling of weakness or fatigue;
blurred vision( "white shroud" before the eyes);
complexitywith sexual activity;
numbness and tingling in numb limbs;
Feeling of heaviness in the legs;
dizziness;
slow healing of infectious diseases;
slow healing of wounds;
drop in body temperature below the mean;
rapid fatigue;
cramps of the calf muscles;
skin itching and itching in the perineum;
furunculosis;
pain in the heart.

Causes of Diabetes

It is established that diabetes is caused by genetic defects, and it is also firmly established that diabetes can not be infected! !!The causes of IDDM are that the production of insulin decreases or completely ceases due to the death of beta-cells under the influence of a number of factors( for example, an autoimmune process, when antibodies are produced to their normal cells and begin to destroy them).With NIDDM, which occurs 4 times more often, beta cells produce insulin with reduced activity, as a rule. Because of the excess fat tissue receptors which have a reduced sensitivity to insulin.

The hereditary predisposition is of primary importance! It is believed that if your father or mother is sick with diabetes, then the likelihood that you, too, will be ill, about 30%.If both parents were ill, then - 60%.
The next most important cause of diabetes is obesity, which is most typical for patients with NIDDM( type 2).If a person knows about his hereditary predisposition to this disease. He must strictly monitor his body weight in order to reduce the risk of disease. At the same time, it is obvious that not everyone who suffers from obesity, even in severe form, develops diabetes.
Some pancreatic diseases that result in the defeat of beta cells. The provoking factor in this case may be trauma.
Nervous stress, which is an aggravating factor. Especially it is necessary to avoid emotional overstrain and stress to people with hereditary predisposition and excessive body weight.
Viral infections( rubella, chickenpox, epidemic hepatitis and other diseases, including influenza), which play a starting role in the development of the disease for people with aggravated heredity.
Risk factors also include age. The older the person, the more reason to fear diabetes .The hereditary factor ceases to be decisive with age. The greatest threat is caused by obesity, which, combined with the old age, the transferred diseases, which usually weakens the immune system, lead to the development of predominantly diabetes mellitus type 2.

Many believe that diabetes occurs in sweet tooth. This is more of a myth, but there is a share of the truth, if only because of excessive consumption, there is an excess weight, and then obesity, which can be a trigger for diabetes mellitus 2 type.

In rare cases, diabetes is caused by some hormonal disorders, sometimes diabetes is caused by a pancreatic lesion that occurs after the administration of certain medications or due to prolonged alcohol abuse. Many experts believe that type 1 diabetes can occur with viral damage to the beta cells of the pancreas that produces insulin. In response, the immune system produces antibodies called insular. Even those reasons that are precisely defined, do not have an absolute character.

An accurate diagnosis can be made based on an analysis of blood glucose.

Diagnosis of diabetes

Diagnosis is based on:

the presence of classical symptoms of diabetes: increased intake and excretion of fluid in the urine, the release of ketone bodies with urine, weight loss, increased blood glucose levels;
increased fasting glucose level after repeated determination( in norm 3.3-5.5 mmol / l.).

There is a certain algorithm for examining a patient with suspected diabetes mellitus. Healthy people with normal body weight and unhealed heredity examine the level of glucose in the blood and urine( on an empty stomach).When obtaining normal values, the analysis for glycated hemoglobin( GG) is additionally required. The percentage of glycated hemoglobin reflects the average level of glucose concentration in the patient's blood for 2-3 months before the study. When controlling the treatment of diabetes, it is recommended to maintain the level of glycated hemoglobin less than 7% and revise therapy at a GH level of 8%.

When obtaining a high level of glycated hemoglobin( screening in a healthy patient), it is recommended to determine the blood glucose level 2 hours after loading with glucose( 75 g).This test is especially necessary if the blood glucose level is higher than normal but not high enough to show signs of diabetes. The test is carried out in the morning, after an overnight fast( not less than 12 hours).Determine the baseline level of glucose and 2 hours after taking 75 g of glucose dissolved in 300 ml of water. In norm( immediately after loading with glucose), its concentration in the blood increases, which stimulates the secretion of insulin. This in turn reduces the concentration of glucose in the blood, after 2 hours its level almost returns to the original in a healthy person and does not return to normal, exceeding the baseline values by half in patients with diabetes mellitus.

Insulin is used to confirm the diagnosis in people with borderline glucose tolerance disorders. Normally, the level of insulin is 15-180 pmol / l( 2-25 mcd / l).

The doctor can also prescribe additional studies - the determination of the C-peptide, antibodies to the beta-cells of the islets of Langerhans, antibodies to insulin, antibodies to GAD, leptin. The determination of these markers allows in 97% of cases to differentiate type 1 diabetes from type 2, when the symptoms of type 1 diabetes mellitus are masked for type 2.

Prophylaxis of diabetes

Diabetes mellitus is primarily a hereditary disease. Identified risk groups allow you to orient people today, to warn them from careless and thoughtless attitude to their health. Diabetes can be both inherited and acquired. The combination of several risk factors increases the likelihood of diabetes: for a patient with obesity, often suffering from viral infections - influenza, etc., this probability is approximately the same as for people with aggravated heredity. So all people at risk must be vigilant. Particular attention should be paid to your condition between November and March, because most cases of diabetes are caused by this period. The situation is complicated by the fact that during this period your condition can be mistaken for a viral infection.

Primary prevention of diabetes

Primary prevention measures aim to prevent of diabetes : lifestyle changes and elimination of risk factors for diabetes mellitus, preventive measures only in individuals or in groups at high risk of diabetes in the future.

The main preventive measures of NIDDM include rational nutrition of the adult population, physical activity, prevention of obesity and its treatment. It is necessary to limit and even completely exclude from food products containing easily digestible carbohydrates( refined sugar, etc.) and foods rich in animal fats. These restrictions apply primarily to people at increased risk of the disease: adverse heredity for diabetes, obesity, especially when combined with diabetic heredity, atherosclerosis, hypertension, as well as to women with diabetes of pregnancy or with impaired glucose tolerance in the pastduring pregnancy, to women who gave birth to a fetus with a body weight of more than 4500g.or had a pathological pregnancy with subsequent death of the fetus.

Unfortunately, the prophylaxis of diabetes in the full sense of the word does not exist, but at present immunological diagnosticums are successfully being developed, with the help of which it is possible to identify the possibility of diabetes development at the earliest stages, while still full of health.

Secondary prevention of diabetes

Secondary prevention includes measures aimed at preventing complications of diabetes - early disease control warning its progression .

Complications of diabetes

Diabetes mellitus must be constantly monitored! !!With poor control and an inappropriate lifestyle, frequent and abrupt fluctuations in blood glucose levels can occur. Which in turn leads to complications. First to acute, such as hypo- and hyperglycemia, and then to chronic complications. The most terrible thing is that they manifest themselves 10-15 years after the onset of the disease, develop imperceptibly and at first do not affect the state of health. Because of the high sugar content in the blood, complications arising from the eyes, kidneys, legs, and also non-specific ones - from the side of the cardiovascular system, gradually develop and very quickly progress. But unfortunately, it is very difficult to cope with complications that have already manifested themselves.

hypoglycemia - lowering of blood sugar, can lead to hypoglycemic coma;
hyperglycemia is an increase in blood sugar, which can result in a hyperglycemic coma.

Hypoglycemia

Hypoglycemia - lowering of blood sugar level below 3.3 mmol / l.

What are the causes of hypoglycemia in diabetes mellitus? For people with diabetes who take sulfonylureas or insulin, hypoglycemia is the "occupational hazard" of treatment. Even a well-designed regimen of insulin treatment can lead to hypoglycemia, when the patient even slightly reduces or pushes the food intake, or the physical load exceeds the usual one. Menstruating women may have hypoglycemia during menstruation due to a sharp drop in the production of estrogen and progesterone. Elderly patients taking sulfonylureas for the first time can respond to it with severe hypoglycemia. In addition to the "accidents" observed in the treatment, hypoglycemia is possible in diabetic patients as a result of a number of other disorders contributing to this.

Symptoms:

1 phase: hunger;weakness, drowsiness, palpitations, headache, impaired coordination of behavior, trembling, sweating.
Phase 2: double vision, pale and damp skin, sometimes numbness of the tongue, inadequate behavior( the patient begins to "piss nonsense"), aggressiveness appears.
3 phase: inhibition, loss of consciousness, coma.

Reasons:

overdose of a hypoglycemic drug;
skipping meal or fewer carbohydrates( cereal units) in eating, a large interval between insulin injection and food;
is large compared to the usual physical activity( especially athletic);
alcohol intake.

Hyperglycemia

Hyperglycemia - increase in blood sugar levels above 5.5-6.7 mmol / l.

Symptoms by which it can be established that blood sugar is elevated:

Polyuria( frequent urination), glucosuria( urine sugar excretion), large loss of water with urine;
Polydipsia( strong permanent thirst);
Drying of the mouth, especially at night.
Weakness, lethargy, fatigue;
Weight Loss;
Nausea, vomiting, headache are possible.

The reason is a lack of insulin, and, as a consequence, increased sugar. High glucose in the blood causes a dangerous acute violation of water-salt metabolism and hyperglycemic( hyperosmolar) coma.

Ketoacidosis

Ketoacidosis - is a clinical disorder caused by the influence of ketone bodies and tissue hypoxia( oxygen starvation) on the cells of the central nervous system, a consequence of hyperglycemia. This condition leads to the formation of ketoacidotic coma.

Symptoms:

The smell of acetone from the mouth( similar to the smell of sour fruit);
Rapid fatigue, weakness;
Headache;
Decreased appetite, and then - lack of appetite, aversion to food;
Abdominal pain;
Possible nausea, vomiting, diarrhea;
Noisy, deep, rapid breathing.

Prolonged hyperglycemic state leads to chronic complications from the eyes, peripheral nerves, cardiovascular system, as well as foot damage - this is one of the most common chronic complications in diabetics.

Diabetic Nephropathy

Nephropathy is a lesion of small vessels in the kidneys.

The leading feature is proteinuria( the appearance of protein in the urine);
Edema;
General weakness;
Thirst, dry mouth;
Reducing the amount of urine;
Unpleasant sensations or heaviness in the lower back;
Loss of appetite;
Rarely nausea, vomiting, bloating, loose stools. Unpleasant taste in mouth.

Diabetic neuropathy

Neuropathy - affection of peripheral nerves.

It is possible to defeat not only the peripheral, but also the central structures of the nervous system. Patients are concerned:

Numbness;
Feeling of running chills;
Cramps in the limbs;
Pain in the legs, worse at rest, at night and decreasing at the pace;
Decrease or absence of knee reflexes;
Decreased tactile and pain sensitivity.

Diabetic foot

Diabetic foot - skin changes, changes in joints and nerve endings on the feet.

The following lesions of the foot are possible:

random cuts, abrasions. Combs, blisters after burns;
combed, cracked, associated with fungal lesions of the skin of the feet;
corns on the joints of the fingers or on the foot caused by uncomfortable shoes or orthopedic causes( one foot shorter than the other, flat feet, etc.).

With loss of sensitivity and angiopathy, any of these lesions can develop into a trophic ulcer, and the ulcer develops into gangrene. The most dangerous thing in this situation is that the patient does not see his foot, and with poor innervation, the sensitivity to pain is lost, resulting in the ulcer can exist for a long time and remain unnoticed. Most often this occurs in the part of the foot, which when walking is the main weight. If they get an infection, all prerequisites for the formation of a purulent ulcer are created. The ulcer can affect the deep tissues of the foot, down to the tendons and bones.

Treatment of complications of diabetes mellitus

Diabetes mellitus is usually incurable. Maintaining a normal blood sugar level, you can only prevent or reduce the complications of this disease. First of all, you need a proper diet.

Treatment procedures for patients with NIDDM

The diet is more severe than with IDDM.The diet can be quite free in time, but you must with all severity avoid foods that contain sugar. Fats and cholesterol.
Moderate physical activity.
Daily intake of hypoglycemic preparations according to the prescriptions of the doctor.
Control of blood sugar several times a week, preferably 1 time per day.

Sequence in the treatment of NIDDM( type 2 diabetes)

Control of blood glucose.
Minimize the dose of medicines.
To suppress hypertension( increase of arterial pressure) and concentration of lipids( fats) with the help of means that do not violate glucose tolerance.

Treatment procedures for patients with IDDM( type 1 diabetes)

Daily insulin injections! !!
The diet is more diverse than with NIDDM, but with some restriction on certain types of products. The amount of food is recalculated into grain units( XE) and must be strictly defined, with the diet regimen determining the insulin injection schedule( ie when and how much to enter).The power mode can be harder or freer.
Universal physical activity - to maintain muscle tone and lower sugar levels.
Control of blood sugar 3-4 times a day, better often.
control of sugar and cholesterol in urine.

Once is found to be hypoglycemic ( blood sugar level is lowered), it can be easily treated by the patient and by himself. In the case of mild hypoglycemia, 15 g is sufficient.a simple carbohydrate, such as 120 g.unsweetened fruit juice or non-diet soft drink. With more severe symptoms of hypoglycemia, you should quickly take 15-20g.simple carbohydrate and later 15-20g. A complex, such as a thin dry biscuit or bread. Patients who are unconscious should never give fluids! In this situation, more viscous sources of sugar( honey, glucose gels, sugar glaze sticks) can be placed gently on the cheek or under the tongue. Alternatively, 1 mg can be administered intramuscularly.glucagon. Glucagon, due to its effect on the liver, indirectly causes an increase in the glucose level in the blood. In a hospital setting, intravenous dextrose( D-50) is probably more affordable than glucagon, and as a result leads to a rapid return of consciousness. Instruct patients and family members to prevent overdose in the treatment of hypoglycemia, especially mild.

What to do if there is hyperglycemia( sugar level is elevated)

It is necessary to introduce an additional dose of insulin or tableted hypoglycemic drugs.

Overview of the information that a diabetic needs to know.

This complex of skills is necessary primarily for patients receiving insulin.

You need to have an idea of the nature of your disease and its possible consequences.
You need to understand the different types of insulin( for type 1), in hypoglycemic preparations( for type 2), drugs that protect against chronic complications, vitamins and minerals.
You should clearly adhere to food, insulin injections or taking pills.
You need to understand the properties of products, to know which ones contain more carbohydrates, and which proteins, fiber, fat. Must know with what speed this or that product raises the level of sugar in the blood.
You must carefully plan for any physical activity.
You need to learn the skills of diabetes self-management with a glucometer and visual test strips for determining blood sugar and urine.
You should have an idea of the acute and chronic complications that develop with diabetes.

Foot care tips for diabetics

Regularly inspect the lower part of the feet.
Timely heal damage to the feet.
Wash feet daily with warm water and wipe dry. Use neutral soap, such as "child".
Cut the nails not too short, not in a semicircle, but straight, not cutting and rounding the corners of the nails, so as not to injure the skin with scissor blades. To smooth the irregularities, use a nail file.
Wear large shoes, very carefully wear new shoes to avoid scuffs. Wear socks or stockings from a fabric that absorbs sweat well. Instead of synthetic products use cotton or woolen. Do not wear socks with a tight band that prevents blood circulation.
Check the shoes so that there are no pebbles, grains of sand, etc.
Protect your feet from damage, cuts, do not walk on rocks, do not walk barefoot.
Do not use hot water bottle, plaster;do not soar your feet, but wash them and soften the corns in warm water.
Daily use a moisturizing foot cream. Apply the cream to the lower surface of the foot, apply talcum powder in interdigital spaces.
Buy shoes in the evening( by the evening of stop a few swells), after having prepared a paper trail - it is necessary to put it into the purchased shoes and check that the edges of the track do not bend.
The heel should not exceed 3-4 cm.
Do not self-medicate.
Visit the office "diabetic foot".

Recommendations on nutrition for diabetics

As you know, people with diabetes must limit themselves in many products. Study detailed lists of permitted, recommended and prohibited products. But this issue can be challenged, since a more stringent diet is necessary when NIDDM is due to the fact that it has excessive body weight, and with IDDM, the amount of carbohydrates consumed is corrected by the introduction of insulin.

The most used products can be divided into 3 categories:

1 category are products that can be consumed without restrictions. These include: tomatoes, cucumbers, cabbage, green peas( no more than 3 tablespoons), radish, radish, fresh or pickled mushrooms, eggplant, courgettes, carrots, greens, green beans, sorrel, spinach. From drinks you can use: drinks on sweetener, mineral water, tea and coffee without sugar and cream( you can add sugar substitute).
Category 2 - these are products that can be consumed in limited quantities. These include: beef and chicken lean meat, low-fat fish, low-fat cooked sausage, fruits( except for fruits belonging to category 3), berries, eggs, potatoes, pasta, cereals, milk and kefir fat content of not more than 2%, cottage cheesefat content not more than 4% and preferably without additives, low-fat cheese( less than 30%), peas, beans, lentils, bread.
3 category - products, which are generally desirable to be excluded from the diet. These include: fatty meat, poultry, lard, fish;smoked meat, sausages, mayonnaise, margarine, cream;fatty sorts of cheese and cottage cheese;canned in oil, nuts, seeds, sugar, honey, all confectionery, ice cream, jam, chocolate,;grapes, bananas, persimmons, dates. From drinks it is strictly forbidden to drink sweet drinks, juices, alcoholic beverages. Details about the diet for different types of diabetes & gt; & gt;

Diabetes insomnia

Frequent and profuse urination( polyuria), thirst( polydipsia), which disturb patients at night, disturbing sleep. The daily amount of urine is 6-15 liters.and more, the urine is light. There is a lack of appetite, weight loss, irritability, insomnia, increased fatigue, dry skin, decreased sweating, impaired function of the gastrointestinal tract. Perhaps the lag of children in physical and sexual development. In women, menstrual irregularities can occur, in men - a decrease in potency.

The cause may be acute and chronic infections, tumors, trauma, vascular lesions of the hypothalamic-pituitary system. In some patients, the cause of the disease remains unknown.

Diagnosis of diabetes insipidus

The diagnosis is based on the presence of polydipsia( thirst) and polyuria( increased urination) in the absence of pathological changes in urine in the sediment. The prognosis for life is favorable. However, complete recovery is rare.

Treatment of diabetes insipidus

Treatment is aimed at eliminating the cause of the disease( tumor removal, elimination of neuroinfections), as well as general restorative therapy. It is necessary to comply with drinking regimen and limit salt intake( not to increase thirst) to prevent complications.

Complications of diabetes insipidus

When limiting the intake of fluid in patients develop symptoms of dehydration: headache, dry skin and mucous membranes, nausea, vomiting, fever, mental disorders, tachycardia( increased heart rate).