Diabetes mellitus has a second name. What causes diabetes mellitus: causes, treatment, prevention, consequences. Causes of the disease in women

Diabetes- a disease caused by insufficiency of insulin in the body, which leads to severe disturbances in carbohydrate metabolism, as well as other metabolic disorders.

Diabetes mellitus is a disease that is manifested by high blood sugar levels due to insufficient insulin. Insulin is a hormone secreted by the pancreas, more precisely by the beta cells of the islets of Langerhans. In diabetes mellitus, it is either absent altogether, or insulin-dependent diabetes), or the body’s cells do not respond sufficiently to it (or non-insulin-dependent diabetes). Insulin regulates metabolism, primarily carbohydrates (sugars), as well as fats and proteins. In diabetes mellitus, due to insufficient exposure to insulin, a complex metabolic disorder occurs, the blood sugar level increases (hyperglycemia), sugar is excreted in the urine (glucosuria), and acidic products of impaired fat combustion—ketone bodies—appear in the blood (ketoacidosis).

The main signs of diabetes are extreme thirst, frequent urination with large amounts of urine, and sometimes dehydration (dehydration). Some signs of type 1 and type 2 diabetes are different.

Diagnosis of diabetes mellitus

The diagnosis of diabetes is made on the basis of a blood test for sugar content (glycemia), in controversial cases - after the administration of glucose. If the patient has problems (thirst, heavy urination, hunger or weight loss), a blood sugar test is sufficient. If its level is elevated, it is diabetes. If the patient does not have typical symptoms of diabetes, but there is only a suspicion of diabetes mellitus, a glucose tolerance test is performed, the principle of which is described above. The body's reaction to this load determines whether it is actually diabetes mellitus or just impaired glucose tolerance.

In order to establish a diagnosis of diabetes mellitus, it is necessary to determine the blood sugar level: if the fasting blood sugar level increases (time of last meal > 8 hours) by more than 7.0 mmol/l on two separate days, the diagnosis of diabetes mellitus is beyond doubt.

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 carrying out 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 75g. glucose. The next blood sugar measurement is taken after 2 hours. If your blood sugar level is more than 11.1, you can say you have diabetes. If the blood sugar level is less than 11.1 mmol/l, but more than 7.8 mmol/l, it is said to be a violation of carbohydrate tolerance. If blood sugar levels are lower, the test should be repeated after 3-6 months.

Normal human blood sugar (normal blood sugar)

For people without diabetes, the blood sugar level is 3.3-5.5 mmol/l After eating, the blood sugar level of a person without diabetes may rise to 7.8 mmol/l
Causes of diabetes

Symptoms of diabetes

Both forms of diabetes are similar in symptoms, but differ in the nature of the course.

Symptoms of diabetes:

If you notice such symptoms, you should immediately consult a doctor. Diabetes mellitus is a very serious and dangerous disease.

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

Spread of the disease

There is an opinion that diabetes is an exclusively modern disease, the scourge of our civilization and the price to pay for a high standard of living, leading to the widespread availability of food rich in carbohydrates. However, this is not so, since what diabetes mellitus is was well known in the ancient world, in Ancient Greece and Rome. The term “diabetes” itself is of Greek origin. Translated from Greek, it means “passing through.” This interpretation reflects the main signs of diabetes mellitus - irrepressible thirst and excessive urination. Therefore, it seemed as if all the liquid consumed by a person passed through his body.

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

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

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

Prevalence of carbohydrate metabolism diseases in the world

Description

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

Functions of insulin

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

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

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

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

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

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

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

Causes of diabetes and its types

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

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

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

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

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

Although diabetes mellitus has common characteristics, the symptoms and treatment of both major types of diabetes are generally very different.

Two types of diabetes mellitus - distinctive features

Insulin-dependent diabetes mellitus

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

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

• stress to which the person was exposed
• hypoxia of pancreatic cells,
• improper diet (food rich in fat and poor in protein).

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

How does type 1 diabetes manifest?

The disease is characterized by an acute initial stage, so the first signs of diabetes are usually not difficult to notice. The main symptoms of diabetes are extreme thirst and consumption of large amounts of water. Accordingly, the volume of urine excreted increases (polyuria). The patient's urine usually has a sweet taste, which is explained by the increased glucose content in it. This symptom is an increase in the concentration of glucose in the urine, called glucosuria. The development of glucosuria is observed when the blood sugar concentration exceeds 10 mmol/l. In this case, the kidney filters begin to fail to remove glucose and it begins to enter the urine. However, in some renal pathologies, sugar in the urine is often observed even with normal blood sugar levels, so this parameter - increased glucose content in the urine - is not a defining sign of diabetes mellitus.

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

Fluctuations in blood glucose levels often lead to abnormally high or low levels, and ultimately to hypoglycemic or hyperglycemic coma. These conditions often end in the death of the patient.

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

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

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

Stages of insulin-dependent diabetes mellitus

Diagnosis of diabetes mellitus

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

However, mere suspicion of the presence of a disease is not enough; accurate diagnosis is necessary. A number of methods are used to diagnose diabetes. First of all, this is the determination of fasting blood glucose levels and insulin levels. In diabetes mellitus, which is accompanied by high levels of glucose in the body, sugar begins to be excreted in the urine. This is due to the fact that the kidneys cannot cope with filtering glucose, and it appears in the urine. Thus, using a urine glucose test, you can determine the presence of diabetes.

How to treat diabetes mellitus?

Unfortunately, diabetes mellitus today is one of the incurable pathologies, including at the initial stage, since no effective methods of therapy have been developed to eliminate pancreatic dysfunction. However, this does not mean that the prognosis of the disease is death. However, therapy is exclusively symptomatic in nature - stabilization of glucose levels in the body, treatment of associated pathologies with diabetes.

Insulin therapy for diabetes mellitus

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

Conventional syringes are most often used to administer insulin in type 1 diabetes. Although improved compact pen syringes have now appeared. Pump syringes are also widely used. This type of syringe allows you to accurately control the flow of insulin into the blood and prevents the occurrence of dangerous complications such as hypoglycemia. The popularity of syringe pumps is growing every year.

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

• speed of action
• degree of purification,
• biological origin.

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

Patient education as part of therapy

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

Diet

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

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

Non-insulin dependent diabetes mellitus

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

Type 2 disease is not caused by a lack of insulin production, but by a disruption in the interaction between insulin and tissues. Cells stop absorbing insulin and glucose begins to accumulate in the blood. The reasons for the occurrence of this phenomenon are not fully understood, but scientists believe that a significant role in the pathogenesis of diabetes mellitus is played by:

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

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

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

Factors contributing to the development of the disease include:

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

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

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

Signs of diabetes

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

A set of symptoms typical of non-insulin-dependent diabetes appears. The patient begins to worry about severe thirst, frequent urination, insomnia at night, fatigue, weakness and drowsiness during the day.

Also, the first signs of diabetes include the following:

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

On the other hand, similar phenomena often develop in other pathologies, so the doctor, and not the patient himself, should make a diagnosis and determine the type of diabetes.

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

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

Diagnostics

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

The main methods for determining blood glucose levels:

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

The best known blood test is for glucose, taken in the morning on an empty stomach. Blood is taken from a finger or from a vein. Typically, vein sugar levels are slightly higher. The glucose level in a finger prick blood test should not exceed 6 mmol/l, otherwise there is a high probability that the patient has diabetes. However, the result of a single blood test most often does not make a diagnosis; additional research is needed.

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

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

Blood sugar levels in the fasting test and in the glucose load test after 2 hours, from a finger and a vein.

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

There is another type of analysis - glycated hemoglobin analysis. Today, among all the signs, it is considered the most accurate and is recommended for use by WHO when making a diagnosis. Unlike blood sugar levels, which often undergo dramatic changes throughout the day and fluctuate depending on circumstances (stress, changes in diet, exercise, illness, etc.), the level of glycated hemoglobin differs much greater stability. The normal value of glycated hemoglobin is less than 6%. Above 6.5%, the likelihood of having diabetes approaches 100%.

Correspondence between the level of glycated hemoglobin (HbA1c) and the average fasting sugar level

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

Therapy

If a diagnosis of diabetes is made, the patient should consult an endocrinologist. Many drugs and methods have been developed for the treatment of non-insulin-dependent diabetes. In general, treatment methods for this type of disease are more varied than methods for treating insulin-dependent diabetes.

The main method of therapy remains taking medications. They can be divided into three main categories:

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

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

Metformin

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

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

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

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

Sulfonylurea derivatives

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

Diet

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

When treating non-insulin-dependent diabetes, you should stop drinking alcohol. This is due to the fact that alcohol disrupts natural metabolic processes, including the production of insulin and the absorption of glucose by tissues.

Gestational diabetes

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

LED MODY varieties

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

Stages of diabetes

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

Stages of diabetes and blood glucose levels

Another classification criterion is the body’s resistance to pathology. Taking into account this parameter, we can distinguish compensated, subcompensated and decompensated stages. A feature of the decompensated stage is the presence of acetone in the urine and high blood glucose concentrations, which respond poorly to drug therapy.

Prediabetes

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

Prognosis for diabetes

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

Complications

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

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

• nerves,
• brain,
• kidneys,
• vessels,
• heart,
• eyes,

The consequences of diabetes can often include the following complications:

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

A complication such as diabetic coma, which is caused by either hypoglycemia or hyperglycemia, is especially dangerous for the patient’s life.

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

Ketoacidosis

Ketoacidosis is a complication in which fat metabolism products, ketone bodies, accumulate in the body. Ketoacidosis most often occurs in diabetics with concomitant pathologies, injuries, or malnutrition. Ketoacidosis entails disruption of many vital functions of the body and is an indication for hospitalization.

Hypoglycemia

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

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

Hyperosmolar coma

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

Retinopathy

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

Polyneuropathy

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

Diabetic foot

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

Prevention

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

This is a chronic endocrine disease. The main metabolic manifestation of diabetes is elevated levels of glucose (sugar) in the blood. Glucose is the source of energy for all cells in the body. But in high concentrations this substance acquires toxic properties. Diabetes mellitus leads to damage to blood vessels, nervous tissue and other body systems. Complications develop - neuropathy, cataracts, nephropathy, retinopathy and a number of other conditions. Manifestations of diabetes are associated with both high blood glucose levels and the development of late complications of the disease.

Early signs of diabetes

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

Appears first copious and frequent urination. The amount of urine in 24 hours is always more than 2 liters. In addition, you have to get up to go to the toilet several times a night. The large volume of urine released is due to the presence of glucose in it. Sugar begins to leave the body through the kidneys when its concentration in the blood is 9-11 mmol/l. Once upon a time, doctors even diagnosed diabetes based on the taste of urine. Sugar “pulls” water from the bloodstream through the wall of the renal capillaries - this is the so-called “osmotic diuresis”. As a result, a diabetic patient produces a lot of urine both day and night.

The body loses fluid and may develop dehydration. The skin on the face and body becomes dry, its elasticity disappears; lips “dry”, the patient feels a lack of saliva, “dryness” in the mouth. Patients usually feel very thirsty. You want to drink constantly, including at night. Sometimes the volume of liquid drunk exceeds 3, 4 or even 5 liters per day. Everyone's taste preferences are different. Unfortunately, many people with diabetes who are unaware of their diagnosis drink fruit juices, sugary drinks, and carbonated water, thereby aggravating their condition. Thirst is a defensive reaction in a given situation. Of course, you cannot refuse to drink in order to reduce the volume of urine. But it is better to drink pure water or unsweetened tea.

Glucose accumulates in the blood, leaves in the urine, but cannot enter the cells. This means that the tissues do not receive the energy they need. Because of this, cells send information to the brain about hunger and lack of nutrients. As a result, a diabetic patient Appetite may increase sharply, he eats and does not get enough of even a large amount of food.

Thus, the first and quite specific signs of diabetes are thirst, dry skin, dry mouth, increased appetite, and a large volume of urine per day.

High blood glucose levels, increased breakdown of fat tissue and dehydration in diabetes have a negative impact on the brain. As a result, another group of early, but not specific, signs of diabetes appears. These are fatigue, fatigue, irritability, frequent mood swings, inability to concentrate, and decreased ability to work. All these symptoms of diabetes occur at the very beginning of the disease, but they can also occur with any other disease. These signs are of little importance for diagnosing diabetes.

Diabetes mellitus is not only characterized by increased blood glucose levels. Another important sign is large amplitude of fluctuations in blood sugar concentration. So, in a healthy person, the minimum and maximum values ​​of blood sugar differ per day by less than 1-2 units. A diabetic patient may have sugar levels of 3 mmol/l and 15 mmol/l on the same day. Sometimes the difference between the values ​​is even greater. An early sign of diabetes associated with a sharp change in blood sugar concentration can be considered temporary blurred vision. The deterioration of vision may last for several minutes, hours or days, then normal visual acuity is restored.

Signs of diabetes associated with damage to organs and systems

Diabetes mellitus, especially type 2, often goes undetected for a long time. Patients have no complaints or do not pay attention to them. Unfortunately, sometimes early signs of diabetes are ignored by medical professionals. As a result, the first obvious signs of the disease may be signs of permanent damage to organs and tissues, that is, late complications of diabetes mellitus.

Who can be suspected of having the disease? Those who have symptoms symmetrical damage to the sensory nerves of the hands or feet, legs. In this situation, the patient will be bothered by numbness and coldness in the fingers, a feeling of “crawling goosebumps,” decreased sensitivity, and muscle cramps. The manifestation of these symptoms is especially typical at rest, at night. The presence of damage to the nervous tissue is associated with the occurrence of another complication - diabetic foot syndrome.

Diabetic foot requiring conservative treatment

This condition is manifested by long-term non-healing wounds, ulcers, and cracks on the legs. Unfortunately, sometimes diabetes is first diagnosed by a surgeon in a patient with such symptoms. The syndrome often causes gangrene and amputations.

Persistent vision loss may also be the first noticed sign of diabetes mellitus due to cataracts or diabetic damage to the vessels of the fundus.

It should be noted that against the background of diabetes mellitus immunity decreases. This means that wounds and scratches take longer to heal, and infectious processes and complications occur more often. Any disease is more severe: cystitis is complicated by inflammation of the renal pelvis, a cold is complicated by bronchitis or pneumonia. Fungal infection of nails, skin, and mucous membranes also often accompanies diabetes due to existing immunodeficiency.

Signs of different types of diabetes

The most common types of diabetes are type 1, type 2 and gestational diabetes. Type 1 diabetes associated with a lack of insulin in the body. It most often occurs in children and young people under 30 years of age. This type of diabetes is characterized by a sharp decrease in body weight against the background of increased appetite. A person eats a lot, but loses more than 10% of weight. In patients with type 1 diabetes, many breakdown products of adipose tissue - ketone bodies - are formed. Exhaled air and urine acquire the characteristic odor of acetone. The earlier the disease debuted, the brighter its onset. All complaints appear suddenly, the condition worsens sharply. Therefore, the disease rarely goes unrecognized.

Sugar diabetes 2 This type usually affects people over 40 years of age, more often women with excess body weight. The disease is hidden. It is caused by tissue insensitivity to its own insulin. One of the early signs of the disease is a periodic sharp decrease in blood sugar - hypoglycemia. The patient feels trembling in the body and fingers, rapid heartbeat, and severe hunger. His blood pressure rises and he breaks out in a cold sweat. Such episodes are possible both on an empty stomach and after eating, especially after eating sweet foods. Diabetes mellitus can also be suspected in those who have signs of tissue insensitivity to insulin. Such symptoms include excess fat deposits around the waist, high blood pressure, high levels of cholesterol, triglycerides and uric acid in the blood. A skin sign of type 2 diabetes mellitus can be considered acanthosis nigricans - rough patches of dark-colored skin in places where the skin rubs.

Acanthosis nigricans in diabetes mellitus

Gestational diabetes appears in a woman during pregnancy. Its signs are the large size of the child, including according to ultrasound, early aging of the placenta, its excessive thickness, miscarriages, stillbirth, and fetal malformations. Gestational diabetes can be expected in women after 25-30 years of age who are overweight and have a family history.

Special signs of diabetes in children

Children with diabetes usually stop gaining weight and height. In infants, urine, when dried on diapers, leaves white marks.

Special signs of diabetes in women

For women with diabetes, an early sign may be itching of the external genitalia and long-term and persistent thrush. Women with latent type 2 diabetes can undergo long-term treatment for polycystic ovary syndrome and infertility. They are also characterized by excess hair growth on the face and body.

Special signs of diabetes in men

In men, the first sign of diabetes may be impotence.

What to do at the first signs of diabetes?

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

If you suspect that you or your relatives have diabetes, you should immediately undergo examination in medical institutions. Remember that the sooner diabetes is diagnosed and treatment is started, the better the patient's health prognosis. For help, you can contact a general practitioner, therapist or endocrinologist. You will have a test to determine your blood sugar levels.

You should not rely on measurements with a self-monitoring device - a glucometer. His readings are not accurate enough to diagnose the disease. To determine the concentration of glucose in the laboratory, more accurate enzymatic methods are used: glucose oxidase and hexokinase. To establish and confirm the diagnosis of diabetes, repeated sugar measurements at different times of the day or an oral glucose tolerance test may be required. This is a stress test using 75 grams of glucose. All over the world, analysis of glycated hemoglobin is becoming increasingly important for diagnosis. This indicator characterizes the blood sugar level not at the moment, but over the past 3-4 months. The diagnosis of diabetes mellitus is established when the value of glycated hemoglobin is more than 6.5%.

Endocrinologist Tsvetkova I.G.

Diabetes mellitus is one of the most common diseases with a tendency to increase in incidence and spoil the statistics. Symptoms of diabetes mellitus do not appear overnight; the process is chronic, with an increase and worsening of endocrine and metabolic disorders. True, the onset of type 1 diabetes differs significantly from the early stage of type 2.

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

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

Types of diabetes

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

Diabetes insipidus

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

This explains the clinical picture of the disease:

• Constant dryness of the oral mucosa, incredible thirst (a person can drink up to 50 liters of water in 24 hours, stretching the stomach to large sizes);
• Isolation of a huge amount of non-concentrated light urine with low specific gravity (1000-1003);
• Catastrophic weight loss, weakness, decreased physical activity, disorders of the digestive system;
• Characteristic changes in the skin (“parchment” skin);
• Atrophy of muscle fibers, weakness of the muscular system;
• Development of dehydration syndrome in the absence of fluid intake for more than 4 hours.

In terms of complete cure, the disease has an unfavorable prognosis; work capacity is significantly reduced.

Brief Anatomy and Physiology

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

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

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

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

Types and special forms of the disease

Lack of insulin leads to impaired sugar constancy (3.3 – 5.5 mmol/l) and contributes to the formation of a heterogeneous disease called diabetes mellitus (DM):

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

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

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

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

Why does the “sweet” disease occur?

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

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

• Congenital deficiency of the islets of Langerhans;
• Unfavorable influence of the external environment;
• Stress, nervous stress;
• Traumatic brain injuries;
• Pregnancy;
• Infectious processes of viral origin (influenza, mumps, cytomegalovirus infection, Coxsackie);
• Tendency to constant overeating, leading to excess fat deposits;
• Abuse of confectionery products (those with a sweet tooth are at greater risk).

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

It has been established that currently the disease in the Russian Federation occurs more often in women, although back in the 19th century, diabetes was a “privilege” of the male sex. By the way, now in some countries of Southeast Asia the presence of this disease in men is considered predominant.

Predisposing conditions for the development of type II diabetes mellitus include:

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

The causes of the disease of different types of diabetes in some cases coincide (stress, obesity, influence of external factors), but the onset of the process in type 1 and type 2 diabetes is different, moreover, IDDM is the province of children and young people, and non-insulin-dependent people prefer older people.

Video: mechanisms of development of type II diabetes

Why do you want to drink so much?

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

Thus, the general signs of diabetes can be characteristic of any form of the disease, however, in order not to confuse the reader, it is still necessary to note the features inherent in one or another type.

Diabetes mellitus type I is a “privilege” of the young

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

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

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

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

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

Illness or age-related changes? (type II diabetes)

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

NIDDM is characterized by a stable, slow course, usually without a tendency to ketoacidosis.

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

The main cause of death in patients with NIDDM is recognized as cardiovascular pathology resulting from diabetes. As a rule, this is or.

Video: 3 early signs of diabetes

Treatments for diabetes mellitus

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

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

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

1. Nutrition for diabetes mellitus plays the role of “first violin”;
2. A system of physical exercises, adequate and individually selected, follows the diet;
3. Sugar-lowering medications are mainly used to treat type 2 diabetes;
4. Insulin therapy is prescribed if necessary for NIDDM, but is essential in the case of type 1 diabetes;
5. Training patients for self-monitoring (skills in drawing blood from a finger, using a glucometer, administering insulin without assistance).

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

The important role of diet in the treatment of NIDDM

Nutrition for diabetes mellitus is very well known, even to people far from diabetes mellitus, table No. 9. While in the hospital for any disease, every now and then you can hear about special food, which is always in separate saucepans, differs from other diets and is given after a certain password is said: “I have the ninth table.” What does all of this mean? How is this mystery diet different from all the others?

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

Nutrition for diabetes consists of replacing refined sugars in foods with slowly broken down carbohydrates. Sugar sold in stores for everyone and confectionery products based on it fall into the category of prohibited foods. Meanwhile, the retail chain, in addition to diabetic bread, which we often come across when choosing bakery products, provides such people with sweeteners (fructose), candies, cookies, waffles and many other sweets that promote the production of “happiness hormones” (endorphins).

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

Video: doctor on nutrition for diabetes

Strictly individual physical activity

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

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

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

Thus, the dosage of insulin and physical activity requires very close attention and careful calculation, so that, complementing each other, together we do not cross the lower limit of normal laboratory parameters.

Video: gymnastics complex for diabetes

Or maybe try folk remedies?

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

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

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

1. White mulberry bark and leaves;
2. Oat grains and husks;
3. Walnut partitions;
4. Bay leaf;
5. Cinnamon;
6. Acorns;
7. Nettle;
8. Dandelion.

When diet and folk remedies no longer help...

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

The endocrinologist decides which remedy is suitable for a particular patient. because representatives of each group, in addition to the main indication – diabetes mellitus, have a lot of contraindications and side effects. And so that patients do not self-medicate and do not decide to use these medications for diabetes at their own discretion, we will give several illustrative examples.

Sulfonylurea derivatives

Currently, second-generation sulfonylurea derivatives are prescribed, which act from 10 hours to 24 hours. Patients usually take them 2 times a day, half an hour before meals.

These drugs are absolutely contraindicated in the following cases:

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

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

Antihyperglycemic agents of the biguanide family

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

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

The following are considered absolute contraindications to the use of biguanines:

• IDDM (type 1 diabetes mellitus);
• Significant weight loss;
• Infectious processes, regardless of location;
• Surgical interventions;
• Pregnancy, childbirth, breastfeeding;
• Comatose states;
• Hepatic and renal pathology;
• Oxygen starvation;
• (2-4 degrees) with impaired vision and renal function;
• and necrotic processes;
• Poor circulation in the lower extremities due to various vascular pathologies.

Treatment with insulin

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

Modern insulins, called monocompetent, represent two groups:

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

Diabetes is dangerous due to complications

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

Prevention

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

Prevention of complications of diabetes mellitus involves preventing the development of pathological conditions arising from diabetes itself. Correcting glucose in the blood serum, following a diet, adequate physical activity, and following the doctor’s recommendations will help delay the consequences of this rather formidable disease.

Video: diabetes in the “Malakhov+” program

Good day, dear friends! In the conditions of our medicine and the availability of the Internet, you have to figure out many issues yourself. So that you do not get confused in the abundance of information, I offer you a reliable and accurate source from a specialist.

Let's talk about the initial symptoms and signs of diabetes mellitus in adults, what are the first manifestations on the skin and in other organs of the incipient disease. I really hope that after reading the article you will receive comprehensive answers to your questions.

How to recognize the first symptoms of diabetes

Early signs of diabetes can appear at any age. It is possible to recognize and begin treatment in time only by knowing the initial manifestations of the disease. I am sure that you know that there are different types of diabetes, for example, diabetes of young people and diabetes of adults or older people. In medicine, they are more often divided into: diabetes mellitus type 1 or 2. But there are many more types than you think.

And although the causes of these types of diabetes are different, the primary manifestations are the same and are associated with the effect of elevated blood glucose levels. There is a difference in the speed of appearance of type 1 or 2 diabetes mellitus, the degree of severity, but the main symptoms will be the same.

Diabetes mellitus type 2, which is often caused by insulin insensitivity, can be virtually asymptomatic for a long time. When in this type, as a result of depletion of pancreatic reserves, a lack of the hormone insulin develops, the manifestations of diabetes become more pronounced, which forces one to seek medical help.

But by this time, unfortunately, major vascular complications, sometimes irreversible, had already developed. Find out to prevent complications in a timely manner.

Initial signs of diabetes

Let's consider the most common and main manifestations of diabetes mellitus in an adult.

Thirst and frequent urination

People begin to complain of dryness and a metallic taste in the mouth, as well as thirst. They can drink 3-5 liters of liquid per day. One of the first signs of diabetes is frequent urination, which may increase at night.

What are these signs of diabetes associated with? The fact is that when the blood sugar level exceeds an average of 10 mmol/l, it (sugar) begins to pass into urine, taking water with it. Therefore, the patient urinates a lot and often, the body becomes dehydrated, and dry mucous membranes and thirst appear. A separate article - I recommend reading it.

Sweet cravings as a symptom

Some people have an increased appetite and often want more carbohydrates. This may be due to two reasons.

• The first reason is excess insulin (type 2 diabetes), which directly affects appetite, increasing it.
• The second reason is “starvation” of cells. Since glucose is the main source of energy for the body, if it does not enter the cell, which is possible both with deficiency and with insensitivity to insulin, hunger occurs at the cellular level.

Signs of diabetes on the skin (photo)

The next sign of diabetes, which is one of the first to appear, is itching of the skin, especially the perineum. A person with diabetes is often susceptible to infectious skin diseases: furunculosis, fungal diseases.

Doctors have described more than 30 types of dermatoses that can occur with diabetes. They can be divided into three groups:

• Primary - resulting from metabolic disorders (xanthomatosis, necrobiosis, diabetic blisters and dermatopathies, etc.)
• Secondary - when attached to a bacterial or fungal infection
• Skin problems during drug treatment, i.e. allergic and adverse reactions

Diabetic dermatopathy - the most common skin manifestation of diabetes mellitus, which manifests itself as papules on the front surface of the lower leg, brownish in color and 5-12 mm in size. Over time, they turn into pigmented atrophic spots that can disappear without a trace. There is no treatment. In the photo below there are signs of diabetes on the skin in the form of dermopathy.

Diabetic bubble or pemphigus occurs quite rarely, as a manifestation of diabetes mellitus on the skin. It occurs spontaneously and without redness on the fingers, hands and feet. The blisters come in different sizes and the fluid is clear and not infected. They usually heal without scarring in 2-4 weeks. The photo shows an example of a diabetic bladder.

Xanthoma occurs when lipid metabolism is disrupted, which often accompanies diabetes. By the way, the main role is played by elevated triglycerides, and not cholesterol, as some believe. Yellowish plaques develop on the flexor surfaces of the limbs; in addition, these plaques can form on the face, neck and chest skin.

Necrobiosis lipoidica rarely occurs as a symptom of diabetes mellitus on the skin. It is characterized by focal lipid degeneration of collagen. More often occurs in type 1 diabetes long before the onset of obvious signs. The disease can occur at any age, but most often between the ages of 15 and 40 years and mainly in women.

Large lesions are observed on the skin of the legs. It begins with bluish-pink spots, which then grow into oval, clearly defined indurative-atrophic plaques. the central part is slightly sunken, and the edge rises above the healthy skin. The surface is smooth, but may peel at the edges. Sometimes there is an ulceration in the center, which can be painful.

There is currently no treatment. Use ointments that improve microcirculation and lipid metabolism. Injecting corticosteroids, insulin, or heparin into the affected area often helps. Sometimes laser therapy is used.

Itchy skin, and also neurodermatitis can occur long before the onset of diabetes. Research shows that it can take anywhere from 2 months to 7 years. Many people believe that skin itching is common in overt diabetes, but it turns out that it is most intense and persistent in latent diabetes.

Most often, the abdominal folds, groin areas, elbow pits and intergluteal cavity itch. It usually only itches on one side.

Fungal skin lesions in diabetes

Candidiasis, commonly known as thrush, is a very common problem in diabetology, one might say a threatening sign. Basically, the skin is affected by fungi of the genus Candidaalbicans It occurs mostly in older people and very obese patients. It is localized in large folds of skin, between the fingers and toes, on the mucous membranes of the mouth and genitals.

First, a white stripe of exfoliating stratum corneum appears in the fold, then cracks and erosions appear. The erosions are smooth in the center, bluish-red in color, and have a white rim around the perimeter. Soon, so-called “dropouts” appear in the form of pustules and vesicles near the main focus. They embed themselves and also turn into erosions, prone to merging the process.

Confirmation of the diagnosis is simple - a positive culture for candidiasis, as well as visual identification of fungi during microscopic examination. Treatment consists of treating the affected areas with alcohol or aqueous solutions of methylene blue, brilliant green, Castellani liquid and ointments containing boric acid.

Antimycotic ointments and oral medications are also prescribed. Treatment continues until the changed areas disappear completely and for another week to consolidate the result.

Dental problems

One of the obvious symptoms of incipient diabetes may be dental problems, as well as frequent stomatitis and periodontal disease. These problems arise against the background of contamination with yeast fungi of the genus Candida, as well as an increase in the population of pathogenic flora in the mouth due to a decrease in the protective properties of saliva.

Diabetes symptoms and vision

Change in body weight

Signs of diabetes can include either weight loss or, conversely, weight gain. A sharp and inexplicable weight loss occurs with an absolute deficiency of insulin, which occurs in type 1 diabetes.

With type 2 diabetes, your own insulin is more than enough and the person only gains weight over time, because insulin plays the role of an anabolic hormone that stimulates fat storage.

Chronic fatigue syndrome in diabetes

Due to impaired carbohydrate metabolism, a person experiences a feeling of constant fatigue. The decrease in performance is associated with both cell starvation and the toxic effects of excess sugar on the body.

These are the initial signs of diabetes, and sometimes it doesn’t matter what type of diabetes it is. The difference will only be in the rate of increase of these symptoms and the degree of severity. How to treat and, read the following articles, stay tuned.

With warmth and care, endocrinologist Lebedeva Dilyara Ilgizovna