Diabetes mellitus is a disorder of glucose metabolism in the body associated with insulin deficiency. Glucose is the energy material for the cells and insulin is the hormone that helps it enter them. Without insulin, glucose remains in the blood, causing hyperglycemia and risking complications for the kidneys, eyes, nerves, heart and blood vessels. Diabetes is incurable, but can be controlled with proper diet, physical activity and medication. An endocrinologist talks about this in more detail.
Classification of diabetes
Most people only know of two types of diabetes. In fact, there are more of them. Depending on the cause and mechanism of disease development, the following types of pathology are distinguished:
Type 1 diabetes(insulin dependent). In this type, the pancreas is unable to produce insulin due to the destruction of the beta cells that synthesize it. The reasons for this process are not fully known, but it is believed to be influenced by genetic and environmental factors. Type 1 diabetes is usually diagnosed in childhood or adolescence and requires constant insulin administration.
Type 2 diabetes mellitus(non-insulin dependent). In this type of disease, the pancreas produces insulin, but the amount is not enough to maintain normal blood glucose levels, or the cells become insensitive to it. This is due to overweight, obesity, sedentary lifestyle, malnutrition and hereditary predisposition. Type 2 diabetes develops more often in adults.
Diabetes in pregnancy(pregnancy). In this type of disease, elevated blood glucose levels occur during pregnancy and usually disappear after delivery. This is due to changes in hormone levels and metabolism in a woman's body. They can lead to reduced insulin production or poorer insulin action. Women who have had gestational diabetes have an increased risk of developing type 2 diabetes in the future.
Other special types of diabetes. This group includes rare forms of the disease that occur due to genetic defects, pancreatic diseases, endocrine disorders, certain drugs or infections.
Symptoms of diabetes
The classic signs of diabetes are associated with excess blood glucose. These include:
- Polyuria (frequent and abundant urination).
- Polydipsia (increased thirst).
- Binge eating (increased appetite).
- Dry mouth.
- Fatigue, weakness, irritability.
- Weight loss (for type 1 diabetes) or weight gain (for type 2 diabetes).
- Itching of the skin, mucous membranes, genitals.
- Slow wound healing, prone to infection.
- Impaired vision, appearance of spots in front of the eyes.
- Numbness, tingling, pain in extremities.
Causes of diabetes
Diabetes mellitus is a multifactorial disease that can occur for a number of reasons. Some of them:
- Genetic predisposition.The presence of diabetes in relatives increases the risk of developing the disease in offspring. This is especially true for type 1 diabetes, which is associated with inherited defects in the immune system.
- Obesity and overweight.Excess body fat leads to poor insulin action and elevated blood glucose levels. Particularly dangerous is visceral fat, which surrounds internal organs and releases inflammatory mediators that disrupt metabolism.
- Poor nutrition.The consumption of large amounts of simple carbohydrates, fats, salt, alcohol, as well as the lack of complex carbohydrates, proteins, fiber, vitamins and minerals in the diet contribute to metabolic disorders and increased blood glucose levels. The regularity and frequency of meals is also important, as long breaks between meals can lead to hypoglycemia (low blood glucose levels) and frequent snacking can lead to hyperglycemia (elevated blood glucose levels).
- Lack of physical activity.Physical activity helps lower blood glucose levels by increasing energy expenditure and glucose uptake by cells. In addition, physical activity improves blood circulation, strengthens the cardiovascular system, improves immunity, promotes weight loss and prevents the complications of diabetes.
- Stress.Stressful situations cause the release of adrenaline, cortisol and glucagon. They raise blood glucose levels, suppress insulin production, and increase inflammation. Stress can also lead to disturbed eating, sleeping and physical activity.
- Diseases of the pancreas.If the pancreas is damaged due to inflammation, stones, tumors, chronic pancreatitis, this can lead to reduced insulin production and the development of diabetes mellitus. There are also genetic disorders that lead to pancreatic dysfunction, for example, cystic fibrosis, Schwartz-Bartter syndrome, Johanson-Blitzer syndrome and others.
- Endocrine disorders.The endocrine system is a collection of organs that produce hormones that regulate various body functions. Certain hormones, such as glucagon, glucocorticoids, growth hormone, thyroid hormones, catecholamines, counteract the action of insulin and increase blood glucose levels.
- Taking certain medications.Some medications can increase blood glucose levels, suppress insulin production, or decrease insulin sensitivity. These medications include glucocorticoids, thiazide diuretics, beta-blockers, some anticonvulsants, some antivirals, some antipsychotics, and others. Taking these drugs may cause a temporary or permanent increase in blood glucose levels and may require a dose adjustment or drug replacement.
- Infections.Infectious diseases such as viral hepatitis, cytomegalovirus infection, chicken pox, rubella, mumps, meningitis, sepsis and others can damage the pancreas, causing inflammation and reduced insulin production. Infections can also increase the release of stress hormones, which raise blood glucose levels.
Diagnosis of diabetes mellitus
Diagnosis requires a comprehensive examination. Initially, the patient is examined and interviewed by an endocrinologist. It identifies characteristic symptoms, takes into account the conditions of their appearance, accompanying diseases and hereditary factors. A detailed examination is then prescribed:
Laboratory research.The main method for diagnosing diabetes mellitus is the determination of blood glucose levels. To do this, the following tests are performed:
- Fasting glucose.
- Glucose tolerance test.
- Glycated hemoglobin (HbA1c)
Instrumental research.To identify the complications of diabetes mellitus and evaluate the condition of the target organs, the following studies are performed:
Ophthalmoscopy. This is an examination of the eye using a special device - an ophthalmoscope, which allows you to examine the retina, optic nerve and blood vessels of the eye.Kidney ultrasound. This is an ultrasound examination of the kidneys, which allows you to evaluate the size, shape, structure, presence of stones, tumors, cysts and inflammation. Dopplerography of the vessels of the lower extremities. This is an ultrasound examination of the vessels of the lower extremities, which allows you to evaluate the lumen, walls, blood flow, the presence of blood clots, atheromatous plaques, strictures and aneurysms.Electrocardiography (ECG). This is a study of the heart, which allows you to evaluate the rhythm, conduction, contractility, the presence of ischemia, myocardial infarction, arrhythmia and blockade.
Neurological examination.This is an examination of the nervous system, which allows you to evaluate sensitivity, reflexes, coordination, muscle tone, the presence of paresthesia, pain and movement disorders. With diabetes mellitus, nerve changes can develop, such as demyelination, degeneration, inflammation, which can lead to the interruption of the transmission of nerve impulses and the development of polyneuropathy, autonomic neuropathy, mononeuropathy, radiculopathy. This condition is called diabetic neuropathy.
Dermatological examination.This is a skin test that allows you to evaluate color, odor, moisture, the presence of wounds, cracks, ulcers, fungal, bacterial, viral infections, allergic reactions, pigmentation, atrophy, scleroderma, acanthosis.
In diabetes mellitus, skin changes may develop, such as desquamation, diabetic dermatosis, diabetic bullosis, diabetic urticaria, diabetic vasculopathy, diabetic foot, which may lead to disruption of the protective function of the skin and the development of complications.
Consultation with other experts.Depending on the presence of accompanying diseases and complications of diabetes mellitus, consultation with other specialists such as a cardiologist, neurologist, surgeon, dentist, psychologist and others may be required. They will help assess the patient's condition, prescribe the necessary treatment and give recommendations for prevention.
Insulin therapy for diabetes
Insulin therapy for diabetes is a treatment method in which insulin is given externally to the patient. It is necessary for all patients with type 1 diabetes, as well as for some patients with type 2 diabetes, when other treatments do not work.
What types of insulin are there and how to use them
There are several types of insulin, which differ in time of onset of action, peak activity, and duration of action. According to these parameters, insulins are distinguished into extremely short, short and prolonged (prolonged) action.
- Ultra-short and short-acting insulins mimic the normal release of insulin after a meal and are given 15-30 minutes before meals.
- Extended-release insulins provide basal levels of insulin in the blood throughout the day and are given once or twice a day.
- There are also ready-made mixtures of insulins of different duration of action that are convenient to use.
Insulin is injected under the skin using special devices such as pens, pumps or inhalers. The dose of insulin is selected individually for each patient depending on blood sugar levels, volume and composition of food, physical activity and other factors.
To control blood sugar, the patient should measure it regularly using a glucometer or continuous glucose monitor.
What rules and recommendations should be followed during insulin treatment?
Insulin therapy requires strict adherence to diet, physical therapy and doctor's recommendations. With insulin therapy, side effects are possible, such as hypoglycemia (low blood sugar), allergic reactions, lipodystrophy - a violation of the distribution of fat under the skin, which can occur at the site of frequent insulin injections.
To avoid this, it is necessary to change the point of insulin injection and use thin needles. Therefore, patients should learn the basics of insulin therapy and consult a physician if questions or concerns arise.
Diet for diabetes
Diet for diabetes is the most important component of treatment. In mild forms of diabetes, sometimes diet alone is enough to achieve the desired blood glucose level. In more severe cases, drug therapy (oral hypoglycemic agents, insulin) comes to the rescue.
The following general dietary rules for diabetes mellitus must be observed:
Meals should be frequent and small (5-6 times a day), in small portions. This will help you avoid large jumps in glycemic levels.Meals should be taken at the same times . The same goes for taking glucose-lowering drugs and insulin injections.Strict diets and hunger strikes are prohibited , as they can lead to hypoglycemia (low blood sugar), as well as a disturbance in the metabolism of fats and proteins.- These are preferred
cooking methods such as: boiling, boiling, steaming and baking. Fried, smoked, salted and pickled foods should be excluded or minimized. - Must
eliminate easily digestible carbohydrates from food (sugar, honey, confectionery, jam, pastries, white flour). They quickly increase blood sugar and contribute to obesity. Instead, you can use sugar substitutes (xylitol, sorbitol, fructose, stevia, etc. ) in moderation. The food should contain a large amount of fiber, since such carbohydrates are absorbed more slowly and do not increase blood sugar as sharply. Fiber also helps to normalize intestinal function, reduce cholesterol and appetite. Sources of fiber include vegetables, fruits, herbs, whole grain breads and cereals, legumes, nuts and seeds.Limit consumption of animal fats (butter, lard, fatty meats). They contain saturated fatty acids, which increase cholesterol levels and contribute to the development of atherosclerosis and coronary heart disease. Preference should be given to vegetable oils (sunflower, olive, corn, etc. ), which contain unsaturated fatty acids that are beneficial for the heart and blood vessels. Also useful are fish and seafood, which are sources of omega-3 fatty acids, which have anti-inflammatory and anti-sclerotic effects.- This is good
the caloric content of the food and the amount of carbohydrates were about the same on different days, this is especially important when choosing the dose of insulin. To calculate the amount of carbohydrates, you can use special tables that indicate how many grams of carbohydrates are contained in various foods. - Must
control of salt intake , as excess salt can lead to increased blood pressure, edema and deterioration of kidney function. The recommended daily intake of salt does not exceed 5 g (1 teaspoon).
Diet for diabetes should be balanced, varied and tasty. You don't have to give up your favorite dishes, but just learn how to cook them properly, taking into account your situation and needs.
Diabetes mellitus is a serious disease that requires constant medical monitoring and adherence to a lifestyle regimen. If you notice signs of diabetes in yourself or your loved ones, do not delay in going to the doctor. The sooner the diagnosis is made and treatment begins, the fewer the chances of complications occurring and the better the prognosis of the disease.