Diabetes mellitus first signs how to treat. What causes diabetes mellitus: why it happens in adults and children, causes. Drugs for treatment

Even one and a half thousand years BC, the ancient Egyptians in their medical treatise “Ebers Papyrus” described diabetes mellitus as an independent disease. The great doctors of Ancient Greece and Rome pondered tirelessly about this mysterious disease. The doctor Aretaius came up with the name “diabetes” - in Greek, “I leak, I pass through.” The scientist Celsus argued that indigestion is to blame for the occurrence of diabetes mellitus, and the great Hippocrates made the diagnosis by tasting the patient’s urine. By the way, the ancient Chinese also knew that with diabetes, the urine becomes sweet. They came up with an original diagnostic method using flies (and wasps). If flies land on a saucer of urine, it means the urine is sweet and the patient is sick.

Diabetes is an endocrine disease characterized by a chronic increase in blood sugar levels due to an absolute or relative deficiency of insulin, a pancreatic hormone. The disease leads to disruption of all types of metabolism, damage to blood vessels, the nervous system, and other organs and systems.

Classification

There are:

1. Insulin-dependent diabetes (type 1 diabetes) develops mainly in children and young adults;
2. Non-insulin-dependent diabetes (type 2 diabetes) usually develops in people over 40 years of age who are overweight. This is the most common type of disease (occurs in 80-85% of cases);
3. Secondary (or symptomatic) diabetes mellitus;
4. Pregnancy diabetes.

Diabetes due to malnutrition

At type 1 diabetes mellitus There is an absolute deficiency of insulin due to disruption of the pancreas.

At type 2 diabetes mellitus there is a relative deficiency of insulin. At the same time, pancreatic cells produce enough insulin (sometimes even an increased amount). However, on the surface of cells, the number of structures that ensure its contact with the cell and help glucose from the blood enter the cell is blocked or reduced. The lack of glucose in the cells is a signal for even more insulin production, but this has no effect, and over time, insulin production decreases significantly.

Causes

Main reason type 1 diabetes mellitus is an autoimmune process caused by a malfunction of the immune system, in which the body produces antibodies against pancreatic cells, destroying them. The main factor provoking the occurrence of type 1 diabetes is a viral infection (rubella, chickenpox, hepatitis, mumps, etc.) against the background of a genetic predisposition to this disease.

The main factors provoking the development type 2 diabetes mellitus two: obesity and hereditary predisposition:

1. Obesity. In the presence of obesity I degree. The risk of developing diabetes mellitus increases by 2 times, with stage II. - 5 times, at stage III. - more than 10 times. The development of the disease is more associated with the abdominal form of obesity - when fat is distributed in the abdominal area.
2. Hereditary predisposition. If your parents or immediate relatives have diabetes, the risk of developing the disease increases 2-6 times.

Non-insulin-dependent diabetes develops gradually and is characterized by moderate severity of symptoms.

The reasons for the so-called secondary diabetes can be:

• diseases of the pancreas (pancreatitis, tumor, resection, etc.);
• diseases of a hormonal nature (Itsenko-Cushing syndrome, acromegaly, diffuse toxic goiter, pheochromocytoma);
• exposure to drugs or chemicals;
• changes in insulin receptors;
• certain genetic syndromes, etc.

Separately, diabetes mellitus in pregnant women and diabetes caused by malnutrition are distinguished.

What's happening?

Whatever the cause of diabetes, the consequence is the same: the body cannot fully use the glucose (sugar) supplied with food and store its excess in the liver and muscles. Unused glucose circulates in excess in the blood (partially excreted in the urine), which adversely affects all organs and tissues. Since the supply of glucose to the cells is insufficient, fats begin to be used as an energy source. As a result, substances called ketone bodies, toxic to the body and especially to the brain, are formed in increased quantities, and fat, protein and mineral metabolism is disrupted.

Symptoms of diabetes:

• thirst (patients can drink 3-5 liters or more of liquid per day);
• frequent urination (both day and night);
• dry mouth;
• general and muscle weakness;
• increased appetite;
• itching of the skin (especially in the genital area in women);
• drowsiness;
• increased fatigue;
• poorly healing wounds;
• sudden weight loss in patients with type 1 diabetes mellitus;
• obesity in patients with type 2 diabetes mellitus.

As a rule, type 1 diabetes mellitus (insulin-dependent) develops quickly, sometimes suddenly. Non-insulin-dependent diabetes develops gradually and is characterized by moderate severity of symptoms.

Complications of diabetes:

• cardiovascular diseases (vascular atherosclerosis, coronary heart disease, myocardial infarction);
• atherosclerosis of peripheral arteries, including arteries of the lower extremities;
• microangiopathy (damage to small vessels) of the lower extremities;
• diabetic retinopathy (decreased vision);
• neuropathy (decreased sensitivity, dryness and flaking of the skin, pain and cramps in the limbs);
• nephropathy (excretion of protein in the urine, impaired renal function);
• diabetic foot - disease of the feet (ulcers, purulent-necrotic processes) against the background of damage to peripheral nerves, blood vessels, skin, soft tissues;
• various infectious complications (frequent pustular skin lesions, nail fungi, etc.);
• coma (diabetic, hyperosmolar, hypoglycemic).

Diabetes mellitus of the first type sometimes manifests itself as a sharp deterioration in the condition with severe weakness, abdominal pain, vomiting, and the smell of acetone from the mouth. This is due to the accumulation of toxic ketone bodies in the blood (ketoacidosis). If this condition is not quickly corrected, the patient may lose consciousness - a diabetic coma - and die. A coma can also occur with an overdose of insulin and a sharp decrease in blood glucose levels - hypoglycemic coma.

To prevent the development of complications of diabetes mellitus, constant treatment and careful monitoring of blood sugar levels are necessary.

Diagnosis and treatment

Patients with diabetes must be registered with an endocrinologist.

For diagnostics diabetes mellitus, the following studies are performed.

• Blood test for glucose: on an empty stomach, the glucose content in capillary blood (finger prick) is determined.
• Glucose tolerance test: on an empty stomach, take about 75 g of glucose dissolved in 1-1.5 glasses of water, then determine the concentration of glucose in the blood after 0.5, 2 hours.
• Urinalysis for glucose and ketone bodies: Detection of ketone bodies and glucose confirms the diagnosis of diabetes.
• Determination of glycosylated hemoglobin: its amount increases significantly in patients with diabetes mellitus.
• Determination of insulin and C-peptide in the blood: with the first type of diabetes mellitus, the amount of insulin and C-peptide is significantly reduced, and with the second type, values ​​within the normal range are possible.

Treatment for diabetes includes:

• special diet: it is necessary to exclude sugar, alcoholic drinks, syrups, cakes, cookies, sweet fruits. Food should be taken in small portions, preferably 4-5 times a day. Products containing various sweeteners (aspartame, saccharin, xylitol, sorbitol, fructose, etc.) are recommended.
• daily use of insulin (insulin therapy) is necessary for patients with type 1 diabetes mellitus and with the progression of type 2 diabetes. The drug is available in special syringe pens, which make it easy to give injections. When treating with insulin, it is necessary to independently monitor the level of glucose in the blood and urine (using special strips).
• the use of tablets that help lower blood sugar levels. As a rule, treatment of type 2 diabetes mellitus begins with such drugs. As the disease progresses, insulin administration is necessary.

People suffering from diabetes benefit from exercise. Weight loss in obese patients also has a therapeutic role.

Treatment for diabetes is lifelong. Self-monitoring and strict adherence to doctor’s recommendations can avoid or significantly slow down the development of complications of the disease.

Diabetes mellitus is a chronic disease that develops as a result of an absolute or relative deficiency of the pancreatic hormone insulin. It is necessary to deliver glucose to the body's cells, which enters the blood from food and provides energy to the tissues. When there is a lack of insulin or body tissues are insensitive to it, the level of glucose in the blood rises - this condition is called hyperglycemia. It is dangerous for almost all body systems.

Important

There are two types of diabetes mellitus, which, although similar, have significant differences.

Diabetes mellitus type 1- a condition in which the beta cells of the pancreas die for some reason. It is these cells that produce insulin, so their death leads to an absolute deficiency of this hormone. This type of diabetes is most often discovered in childhood or adolescence. According to modern concepts, the development of the disease is associated with a viral infection, inadequate functioning of the immune system and hereditary causes. But diabetes itself is not inherited, but only a predisposition to it.

Diabetes mellitus type 2, as a rule, develops after 30-40 years in people who are overweight. In this case, the pancreas produces insulin, but the body's cells cannot respond to it correctly and their sensitivity to insulin is reduced. Because of this, glucose cannot penetrate the tissues and accumulates in the blood.

Over time, with type 2 diabetes, insulin production may also decrease, since long-term high blood glucose levels have a detrimental effect on the cells that produce it.

Test yourself

There is a simple test that can help you determine whether you have symptoms of diabetes. Agreeing with even one of the proposed statements is a reason to consult an endocrinologist.

1. No matter how much I quench my thirst, I just can’t get drunk.

2. Due to the frequent urge to urinate, I experience inconvenience when I have to leave home for a long time.

3. Dried drops of urine leave dense white spots on the laundry, reminiscent of starch marks.

4. I am overcome by weakness and drowsiness.

5. I notice a deterioration in my vision: the contours of objects blur, as if I was looking through fog.

6. From time to time, there is a feeling of pins and needles, numbness and tingling in the palms and soles.

7. I just can’t get rid of acne.

8. I have very dry skin, cuts and scratches do not heal well.

9. Skin itching, especially in the perineal area, is bothersome.

10. In recent months I have lost (a) 3-5 kg ​​or more without putting the slightest effort into it;

11. I eat and can’t get enough, I’m constantly feeling very hungry.

However, it is important to note that the classic signs of diabetes described here - thirst, dry mouth, itching, increased urine output, weight loss, blurred vision - do not appear at the onset of the disease, but only when insulin deficiency becomes serious. Therefore, according to experts, for every identified diabetic patient in Russia, there are three to four people who are unaware of the disease they already have.

In order to be able to start treatment in a timely manner, every person over 45 years of age must be tested once a year to determine fasting blood glucose levels. If a person is at risk, this analysis should be performed more often, and in addition to it, a food load test or a glucose tolerance test should be taken.

Another important analysis is the determination of glycated hemoglobin. It is able to show what your average blood glucose level has been over the past three months.

Risk factors

Can lead to the development of diabetes:

• Hereditary predisposition. In a family where the father suffers from type 1 diabetes, the likelihood of the child developing the disease is 5-10%. If the mother has this type of diabetes, the risk is half as much - 2-2.5%. Brother or sister - 5%. When two children are sick, the risk of developing diabetes for the third child increases to 10%.
  If both parents suffer from type 2 diabetes, the risk of developing the same type of disease in their children after 40 years of age increases to 65-70%.
• Overeating and unbalanced nutrition with an abundance of high-calorie, refined foods.
• Overweight.
• Sedentary lifestyle.
• Chronic stress.
• Long-term use of certain medications(diuretics, hormonals, salicylates, cytostatics, etc.).

Treatment

For type 1 diabetes, the most important part of therapy is insulin injections, which the patient must do throughout his life. In recent years, making them has become more convenient thanks to the advent of dosing syringe pens. Another useful development is continuous subcutaneous insulin pumps, the most modern of which have a warning system when the patient’s blood glucose level is too low or too high and are able to automatically adjust the insulin dose.

If pancreatic insufficiency is not complete, drugs can be used that stimulate the patient's body to produce its own insulin.

For type 2 diabetes, medications are prescribed that eliminate insulin resistance - the body's immunity to insulin. If the blood glucose level exceeds the permissible norm during long-term treatment with maximum doses of such drugs, the patient should receive replacement therapy with insulin drugs.

Prevention

To avoid the development of type 2 diabetes, it is important to normalize weight, limit calorie intake, and increase physical activity. This tactic gives good results not only in healthy people with risk factors, but also at the stage of prediabetes, when the disease has not yet set in, but glucose is already poorly absorbed.

If at this time you correctly build tactics of behavior, in 50-60% of cases a person can avoid the development of the disease.

Diet plays an important role in compensating for diabetes. The choice of foods for a person suffering from this disease can be compared to the principle of a traffic light.

Red light- These are foods that lead to a sharp increase in blood glucose levels. These include white bread, buns, sweets, beer, kvass, cola, lemonade, sweet juices, instant cereals, white rice, fried potatoes and mashed potatoes. This group also includes fatty foods. Fat is the highest calorie component of food, so if you abuse it, you risk gaining weight. And animal fats have a bad effect on the heart, and with diabetes it is already under attack.

yellow light- foods that increase blood glucose levels less sharply can be consumed, but in reasonable quantities. These are rye bread and wholemeal products, beets, carrots, green peas, raisins, pineapple, banana, melon, apricot, kiwi, potatoes.

Green light lit for vegetables such as zucchini, cabbage, cucumbers, tomatoes, apple and orange juice, cherries, plums, pears, green salad, dairy products, boiled meat and fish.

SOS!

One of the most dangerous conditions in diabetes mellitus is hypoglycemia - a decrease in blood glucose below 2.8 mmol/l. It can occur if the patient has not accurately calculated the dose of drugs that lower glucose levels.

At the first symptoms (acute hunger, sweating, trembling in the arms or legs, weakness, dizziness), you should immediately take 20-30 g of pure glucose or other quickly digestible carbohydrates.

Therefore, every diabetic, leaving home even for a short time, should have 3-4 lumps of sugar or a small packet of juice with him.

Drugs

Remember, self-medication is life-threatening; consult a doctor for advice on the use of any medications.

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 different 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.

Consult our specialist. It's free!

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

History of diabetes

A lot has been written about diabetes mellitus, the opinions of various authors differ and it is quite difficult to name some dates exactly. The first information about the disease appeared in the 3rd century BC. The doctors of Ancient Egypt, and, of course, the doctors of Greece were apparently familiar with it. Rome, medieval Europe and eastern countries. People could identify the symptoms of diabetes, but the causes of the disease were unknown, they tried to find any treatment for diabetes, but the results were unsuccessful and those who were diagnosed with diabetes were doomed to death.

The term “diabetes” was first introduced by the Roman physician Aretius, who lived in the second century AD. He described the disease as follows: “Diabetes is a terrible suffering, not very common among men, dissolving flesh and limbs into urine. Patients continuously release water in a continuous stream, as if through open water pipes. Life is short, unpleasant and painful, thirst is insatiable, fluid intake is excessive and not commensurate with the huge amount of urine due to even greater diabetes. Nothing can stop them from drinking fluids and passing urine. If they refuse to drink fluids for a short time, their mouth becomes dry, their skin and mucous membranes become dry. Patients become nauseated, agitated, and die within a short period of time."

In those days, the disease was diagnosed by its external signs. Treatment depended on the severity of the disease and the age of the patient. If the patient was a child or young person with (insulin-dependent diabetes mellitus or type 1) IDDM. Then he was doomed to quick death from a diabetic coma. If the disease developed in an adult aged 40-45 years or older (according to the modern classification, it is non-insulin-dependent diabetes mellitus (NIDDM) or type 2 diabetes), then such a patient was treated. Or rather, they kept him alive through diet, exercise and herbal medicine.

Diabetes comes from the Greek "diabaino" meaning "to pass through."

In 1776 The English doctor Dobson (1731-1784) found out that the sweetish taste of patients’ urine is associated with the presence of sugar in it, and from that date diabetes, in fact, began to be called diabetes mellitus.

Since 1796 Doctors began to talk about the need for a special diet for diabetics. A special diet for patients was proposed, in which some carbohydrates were replaced with fats. Physical activity began to be used as a treatment for diabetes.
In 1841 A method for determining sugar in urine was first developed. Then we learned to determine blood sugar levels.
In 1921 managed to obtain the first insulin.
In 1922 insulin was used to treat a patient with diabetes mellitus.
In 1956 The properties of some sulfonylurea drugs that can stimulate insulin secretion have been studied.
In 1960 The chemical structure of human insulin was determined.
In 1979 The complete synthesis of human insulin was carried out using genetic engineering.

Diabetes classification

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

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

• Type 1 (IDDM):

This type of diabetes is associated with a deficiency of insulin, which is why it is called insulin-dependent diabetes (IDDM). A damaged pancreas cannot cope with its responsibilities: it either does not produce insulin at all, or produces it in such meager quantities that it cannot process even the minimum amount of incoming glucose, resulting in an increase in blood glucose levels. Patients can be of any age, but most often are under 30 years of age, are usually thin, and usually experience sudden onset of signs and symptoms. People with this type of diabetes need to take extra insulin to prevent hyperglycemia, ketoacidosis (increased levels of ketone bodies in the urine) and to maintain life.

• Type 2 (INSD):

This type of diabetes is called non-insulin-dependent (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 usually made to patients over 30 years of age. They are obese and with relatively few classic symptoms. They are not prone to ketoacidosis, except during periods of stress. They are not dependent on exogenous insulin. For treatment, tablet drugs are used that reduce the resistance (stability) of cells to insulin or drugs that stimulate the pancreas to secrete insulin.

• Gestational diabetes mellitus:

Glucose intolerance occurs or is discovered during pregnancy.

• Other types of diabetes and impaired glucose tolerance:

Secondary, after:

• diseases of the pancreas (chronic pancreatitis, cystic fibrosis, hemochromatosis, pancreatectomy);
• endocrinopathies (acromegaly, Cushing's syndrome, primary aldosteronism, glucagonoma, pheochromocytoma);
• use of drugs and chemicals (some antihypertensive drugs, thiazide-containing diuretics, glucocorticoids, estrogen-containing drugs, psychotropic drugs, catecholamines).

Connected with:

• abnormality of insulin receptors;
• genetic syndromes (hyperlipidemia, muscular dystrophy, Huntington's chorea);
• mixed conditions (malnutrition - “tropical diabetes”.

Symptoms of diabetes

Causes of diabetes

It has been established that diabetes is caused by genetic defects, and it is also firmly established that diabetes cannot be contracted!!! The causes of IDDM are that insulin production decreases or stops altogether due to the death of beta cells under the influence of a number of factors (for example, an autoimmune process, which is when antibodies are produced to one’s own normal cells and begin to destroy them). In NIDDM, which is 4 times more common, beta cells typically produce insulin with reduced activity. Due to excess adipose tissue, the receptors of which have reduced sensitivity to insulin.

1. Hereditary predisposition is of primary importance! It is believed that if your father or mother had diabetes, then the likelihood that you will also get sick is about 30%. If both parents were sick, then – 60%.
2. The next most important cause of diabetes is obesity, which is most common in patients with NIDDM (type 2). If a person knows about his hereditary predisposition to this disease. Then he needs to strictly monitor his body weight in order to reduce the risk of developing the disease. At the same time, it is obvious that not everyone who is obese, even in severe form, develops diabetes.
3. Some diseases of the pancreas that result in damage to beta cells. The provoking factor in this case may be injury.
4. Nervous stress, which is an aggravating factor. It is especially necessary to avoid emotional stress and stress for people with a hereditary predisposition and excess body weight.
5. Viral infections (rubella, chickenpox, epidemic hepatitis and other diseases, including influenza), which play a trigger role in the development of the disease for persons with aggravated heredity.
6. Age may also be considered risk factors. The older the person, the more reason to fear diabetes mellitus. The hereditary factor ceases to be decisive with age. The greatest threat is posed by obesity, which, in combination with old age and previous diseases, which usually weakens the immune system, leads to the development of predominantly type 2 diabetes.

Many people believe that diabetes occurs in people with a sweet tooth. This is largely a myth, but there is also some truth, if only because excess consumption of sweets results in excess weight, and subsequently obesity, which can be an impetus for type 2 diabetes.

In rare cases, certain hormonal disorders lead to diabetes; sometimes diabetes is caused by damage to the pancreas that occurs after the use of certain medications or due to prolonged alcohol abuse. Many experts believe that type 1 diabetes can occur due to a viral infection of the beta cells of the pancreas, which produces insulin. In response, the immune system produces antibodies called insulin antibodies. Even those reasons that are precisely defined are not absolute.

An accurate diagnosis can be made based on a blood glucose test.

Diagnosis of diabetes mellitus

The diagnosis is based on:

• the presence of classic symptoms of diabetes: increased intake and excretion of fluid in the urine, excretion of ketone bodies in the urine, weight loss, increased blood glucose levels;
• increased fasting glucose levels with repeated determinations (normally 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 no heredity check the level of glucose in the blood and urine (on an empty stomach). When normal values ​​are obtained, an additional test for glycated hemoglobin (GG) is required. The percentage of glycated hemoglobin reflects the average level of glucose concentration in the patient’s blood over the 2-3 months before the study. When monitoring diabetes treatment, it is recommended to maintain glycated hemoglobin levels below 7% and review therapy when the GG level is 8%.

If a high level of glycated hemoglobin is obtained (screening in a healthy patient), it is recommended to determine the blood glucose level 2 hours after a glucose load (75 g). This test is especially necessary if your blood glucose levels, although higher than normal, are not high enough to show signs of diabetes. The test is carried out in the morning, after an overnight fast (at least 12 hours). Determine the initial glucose level and 2 hours after taking 75 g of glucose dissolved in 300 ml of water. Normally (immediately after a glucose load), its concentration in the blood increases, which stimulates insulin secretion. This in turn reduces the concentration of glucose in the blood; after 2 hours, its level practically returns to the original level in a healthy person and does not return to normal, exceeding the initial values ​​twice as much in patients with diabetes.

Insulin testing is done to confirm the diagnosis in people with borderline impaired glucose tolerance. Normal insulin levels are 15-180 pmol/L (2-25 µC/L).

The doctor may prescribe additional tests - determination of C-peptide, antibodies to beta cells of the islets of Langerhans, antibodies to insulin, antibodies to GAD, leptin. Determination of these markers allows in 97% of cases to differentiate type 1 diabetes mellitus from type 2 diabetes mellitus, when the symptoms of type 1 diabetes mellitus are disguised as type 2 diabetes mellitus.

Complications of diabetes

Diabetic neuropathy

Neuropathy is damage to peripheral nerves. Damage to not only peripheral but also central structures of the nervous system is possible. Patients are concerned about:

• Numbness;
• Feeling of goosebumps;
• Cramps in the limbs;
• Pain in the legs, worse at rest, at night and relieved by walking;
• Decreased or absent knee reflexes;
• Reduced tactile and pain sensitivity.

Diabetic foot

Treatment of complications of diabetes mellitus

Diabetes mellitus is usually incurable. By maintaining normal blood sugar levels, you can only prevent or reduce the complications of this disease. First of all, you need an appropriate diet.

Treatment procedures for patients with NIDDM

1. The diet is more strict than for IDDM. The diet can be quite free in time, but you must strictly avoid foods containing sugar. Fats and cholesterol.
2. Moderate physical activity.
3. Take glucose-lowering medications daily as prescribed by your doctor.
4. Monitor blood sugar several times a week, preferably once a day.

Priority order in the treatment of NIDDM (type 2 diabetes)

• Monitoring blood glucose levels.
• Minimize the dose of medications.
• Treat hypertension (high blood pressure) and lipid (fat) concentrations with medications that do not impair glucose tolerance.

Treatment procedures for patients with IDDM (type 1 diabetes)

1. Daily insulin injections!!!
2. The diet is more varied than with NIDDM, but with some restrictions on certain types of foods. The amount of food is converted into bread units (XU) and must be strictly defined, and the diet determines the insulin injection schedule (i.e. when and how much to administer). The diet can be strict or more free.
3. Universal physical activity - to maintain muscle tone and lower sugar levels.
4. Monitor blood sugar 3-4 times a day, more often is better.
5. control of sugar and cholesterol in urine.

Once discovered hypoglycemia(low blood sugar level), it can be easily treated independently by the patient himself. In case of mild hypoglycemia, 15g is sufficient. simple carbohydrate such as 120g. unsweetened fruit juice or non-diet soft drink. For more severe symptoms of hypoglycemia, you should quickly take 15-20g. simple carbohydrate and later 15-20g. complex, such as thin dry cookies or bread. Patients who are unconscious should never be given fluids! In this situation, more viscous sources of sugar (honey, glucose gels, icing sugar sticks) can be gently placed behind the cheek or under the tongue. Alternatively, 1 mg can be administered intramuscularly. glucagon. Glucagon, through its effect on the liver, indirectly causes an increase in blood glucose. In a hospital setting, intravenous dextrose (D-50) is probably more readily available than glucagon and results in rapid return of consciousness. Patients and family members should be instructed not to overdose when treating hypoglycemia, especially mild hypoglycemia.

Herbal medicine is used to help with prescribed medications.

What to do if hyperglycemia occurs (sugar levels are elevated)

It is necessary to administer an additional dose of insulin or tableted glucose-lowering drugs.

Review of information that a diabetic should know.

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

1. You need to have an understanding of the nature of your illness and its possible consequences.
2. You need to understand the different types of insulins (for type 1), glucose-lowering drugs (for type 2), medications that protect against chronic complications, vitamins and minerals.
3. You must strictly adhere to your diet, insulin injections or pills.
4. You must understand the properties of foods, know which ones contain more carbohydrates and which contain more proteins, fiber, and fats. You should know at what rate this or that product increases blood sugar levels.
5. You should plan any physical activity carefully.
6. You will need to learn how to self-monitor your diabetes using a blood glucose meter and visual test strips to measure your blood and urine sugar.
7. You should be aware of the acute and chronic complications that develop with diabetes.

1. Check the bottom of your feet regularly.
2. Treat foot injuries promptly.
3. Wash your feet daily with warm water and wipe dry. Use neutral soap, such as “baby” soap.
4. Trim your nails not too short, not in a semicircle, but straight, without cutting or rounding the corners of the nails, so as not to injure the skin with the blades of the scissors. To smooth out any unevenness, use a nail file.
5. Wear loose-fitting shoes and break in new shoes very carefully to avoid scuffs. Wear socks or stockings made of fabric that absorbs sweat well. Instead of synthetic products, use cotton or wool. Do not wear socks with tight elastic, which impede blood circulation.
6. Check your shoes to make sure there are no pebbles, grains of sand, etc.
7. Protect your feet from damage and cuts, do not walk on rocks, and do not walk barefoot.
8. Do not use a heating pad or band-aid; Do not steam your feet, but wash them and soften calluses in warm water.
9. Use foot moisturizer daily. Apply the cream to the lower surface of the foot and apply talc between the toes.
10. Buy shoes in the evening (the foot swells somewhat in the evening), having previously prepared a paper footprint - you need to put it in the purchased shoes and check that the edges of the footprint are not bent.
11. The heel should not exceed 3-4 cm.
12. Do not self-medicate.
13. Visit the diabetic foot office.

As you know, people suffering from diabetes must limit themselves to many foods. Review detailed lists of permitted, recommended and prohibited products. But this issue can be disputed, since more strict adherence to the diet is necessary in NIDDM due to the fact that there is excess body weight, and in IDDM the amount of carbohydrates consumed is adjusted by administering insulin.

The most commonly consumed products can be divided into 3 categories:

• Category 1 is products that can be consumed without restrictions. These include: tomatoes, cucumbers, cabbage, green peas (no more than 3 tablespoons), radishes, radishes, fresh or pickled mushrooms, eggplant, zucchini, carrots, greens, green beans, sorrel, spinach. Among the drinks you can consume: drinks with sweetener, mineral water, tea and coffee without sugar and cream (you can add sweetener).
• Category 2 are products that can be consumed in limited quantities. These include: lean beef and chicken, lean fish, lean boiled sausage, fruits (except for fruits belonging to category 3), berries, eggs, potatoes, pasta, cereals, milk and kefir with a fat content of no more than 2%, cottage cheese fat content no more than 4% and preferably without additives, low-fat cheeses (less than 30%), peas, beans, lentils, bread.
• Category 3 – products that it is advisable to exclude from the diet altogether. These include: fatty meat, poultry, lard, fish; smoked meats, sausages, mayonnaise, margarine, cream; fatty varieties of cheese and cottage cheese; canned food in oil, nuts, seeds, sugar, honey, all confectionery, ice cream, jam, chocolate; grapes, bananas, persimmons, dates. As for drinks, the consumption of sweet drinks, juices, and alcoholic beverages is strictly prohibited.

Diabetes insipidus

Frequent and copious urination (polyuria), thirst (polydipsia), which bother patients at night, disrupting 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, and dysfunction of the gastrointestinal tract. Children may be delayed in physical and sexual development. Women may experience menstrual irregularities, and men may experience decreased potency.

The cause may be acute and chronic infections, tumors, injuries, 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 urinary 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 (removal of the tumor, elimination of neuroinfection), as well as general restorative therapy. It is necessary to maintain a drinking regime and limit salt intake (so as not to increase thirst) to prevent complications.

Complications of diabetes insipidus

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

Prevention of diabetes

Diabetes mellitus is primarily a hereditary disease. The identified risk groups make it possible today to orient people and warn them against a careless and thoughtless attitude towards their health. Diabetes can be both inherited and acquired. The combination of several risk factors increases the likelihood of developing diabetes: for an obese patient who often suffers from viral infections - influenza, etc., this probability is approximately the same as for people with aggravated heredity. So all people at risk should be vigilant. You should be especially careful about your condition between November and March, because most cases of diabetes occur during this period. The situation is complicated by the fact that during this period your condition may be mistaken for a viral infection.

Primary prevention of diabetes

In primary prevention, interventions are aimed at preventing diabetes mellitus: lifestyle changes and eliminating risk factors for diabetes mellitus, preventive measures only in individuals or in groups at high risk of developing diabetes mellitus in the future.

The main preventive measures for NIDDM include rational nutrition of the adult population, physical activity, prevention of obesity and its treatment. You should limit and even completely exclude from your diet foods containing easily digestible carbohydrates (refined sugar, etc.) and foods rich in animal fats. These restrictions apply primarily to persons with an increased risk of the disease: unfavorable heredity for diabetes mellitus, obesity, especially when combined with diabetic heredity, atherosclerosis, hypertension, as well as women with diabetes during pregnancy or with impaired glucose tolerance in the past during pregnancy, to women who gave birth to a fetus weighing more than 4500 g. or who had a pathological pregnancy with subsequent fetal death.

Unfortunately, there is no prevention of diabetes mellitus in the full sense of the word, but immunological diagnostics are currently being successfully developed, with the help of which it is possible to identify the possibility of developing diabetes mellitus at the earliest stages while still in full health.

Secondary prevention of diabetes

Secondary prevention involves measures aimed at preventing complications of diabetes mellitus - early control of the disease, preventing its progression .