Diabetes- an insidious disease in which there is an increased level of glucose in the blood. When food is digested, carbohydrates and proteins are decomposed into simple sugars and amino acids. The liver converts all sugar and some of the amino acids into glucose, which is used as an energy source by every cell in the body. Glucose travels from the blood to cells using insulin, a hormone produced by the pancreas (a pear-shaped organ located under the stomach). By attaching to receptors on the surface of the cell membrane, insulin promotes the movement of glucose-transporting proteins from the depths of the cell to its surface, where they combine with glucose and carry it into the cell. In diabetes mellitus, there are several obstacles to this process: the production of insulin by the pancreas may be partially or completely disrupted, or the cells of the body may not be able to effectively respond to normal amounts of insulin.

Diabetes mellitus is a heterogeneous disease and occurs in two forms: diabetes the first type or "insulin-dependent"; and diabetes mellitus of the second type or "non-insulin dependent". In the first type of diabetes mellitus, also known as juvenile diabetes, the pancreas produces little or no insulin.

This type of diabetes develops suddenly and is most common in people under the age of 30; the average age of onset of its development is between 12 and 14 years. However, type 1 diabetes only accounts for about 5 percent of all diabetes cases. Type 2 diabetes mellitus, also known as adult diabetes, is much more common. In this type of diabetes, the production of insulin by the pancreas is only slightly reduced, but the cells are not able to respond effectively to insulin, so this disease is considered insulin resistance. Type 2 diabetes usually begins gradually and affects people in their 40s and especially overweight people, one of the risk factors is age over 50 years. Rarely, adults may have type 1 diabetes.

The main reasons for the development of diabetes mellitus are: hereditary predisposition, diseases of the pancreas, overeating (read - overload of the same pancreas, liver and gastrointestinal tract), excessive consumption of simple carbohydrates (sugar, candy, jam, cakes, chocolate, etc.), animal fats, alcohol. In some cases, diabetes mellitus can occur due to mental trauma, poisoning or intoxication (including medication).

In both types of diabetes, hyperglycemia leads to the release of glucose into the urine, which is accompanied by an increase in urine production. If the wrong amount of insulin is prescribed to a type 1 diabetes patient, the excessive release of fatty acids from adipose tissue will lead to an overproduction of ketone bodies in the liver. The buildup of ketone bodies can cause a life-threatening condition known as diabetic ketocytosis. Diabetic ketocytosis can sometimes occur in people with type 2 diabetes during periods when the body is under intense stress, such as during a severe infectious disease.

People with type 2 diabetes are susceptible to another life-threatening condition known as the hyperosmotic non-ketone condition, characterized by extremely high blood sugar levels. This condition usually occurs in older people with some other serious illness. An attack of diabetic ketocytosis or a hyperosmotic state may be the first sign of diabetes.

People with diabetes can also suffer from low blood sugar (hypoglycemia) if they are given too much insulin during treatment.

After 10 to 20 years of diabetes, patients may develop complications such as blurred vision, kidney damage, and degeneration of the peripheral nervous system (neuropathy). Strict control of blood glucose can delay or prevent these complications from occurring. Loss of sense of touch in the feet can lead to the damage being overlooked and infection.

Symptoms

What are some of the signs that you have diabetes mellitus, or that there is a risk of developing it?

Excessive and frequent urination(approximately every hour). Waking up at night to urinate. The body, in order to get rid of excess sugar, excretes it through the kidneys in the urine.

Intense thirst or an increased need to drink plenty of fluids. It is caused by the fact that the level of glucose in the blood rises, which "takes" fluid from the tissues, the tissues become dehydrated. Therefore, patients are forced to drink a lot: 2-3-5 liters per day or more.

Itching of the skin and genitals.

Dry mouth.

Poor wound healing.

First, a lot of weight, then a decrease in it due to a violation of the absorption of food, especially carbohydrates.

Decreased immunity - frequent infections from commonplace flu and colds to pneumonia.

Sometimes the disease is preceded by "strange" conditions: as a result of short-term forced fasting or after intense physical activity may occur headache, paleness, breaks through sweat, appears general weakness... As soon as a person has eaten, drank at least a cup of sweet tea, all symptoms quickly disappear. Indirectly, this may indicate a malfunction of the pancreas: more insulin entered the blood than usual, and the sugar level dropped below acceptable level- 3-3.5 units.

Increased appetite.

Unintentional weight loss.

Poor eyesight.

Fatigue and weakness.

Frequent or persistent infections Bladder, skin or gums.

Numbness and tingling in the legs and arms.

Signs of hypoglycemia.

Severe symptoms of a hyperosmotic non-ketosis state: extreme thirst, lethargy, weakness, confusion, coma.

Severe symptoms of diabetic ketoacidosis: nausea and vomiting, shortness of breath, confusion, coma.

The described symptoms are observed in 40-90% of patients with diabetes mellitus long before the diagnosis. But there are also "non-diabetic" symptoms that are caused by elevated blood sugar levels:

1. The emergence and progression of vascular disorders - the development of atherosclerosis, hypertension, angina pectoris, memory decreases (brain vessels suffer);

2. Diabetic changes in the vessels of the fundus (retinopathy), decreased vision;

3. Decreased renal function (nephropathy, pyelonephritis);

4. Diabetic foot("Feet burn in the cold, but get cold in the heat" - a violation of the blood supply to the lower extremities);

5. Sometimes the character changes (mental disorders);

6. The skin gradually becomes dry, wrinkled, palms and soles coarse, peeling, nails thicken, hair dry and brittle, thinning and disappearing on the extremities, on the skin, due to a decrease in general immunity, pustular eruptions, boils, carbuncles appear, the relapses of which often push the doctor to check the patient's blood sugar. Often, the skin is affected by fungi, eczema, lichen.

7. One of the signs of diabetes is gum disease - periodontitis, bleeding, gums turn blue, and teeth begin to loosen, sometimes painlessly leaving their rightful places.

8. Diabetes mellitus also affects the endocrine glands. Men lose interest in women, they have decreased not only libido, but also potency. In women it gets confused menstrual cycle, it happens that menstruation disappears completely.

That is why diabetes mellitus is called an endocrine metabolic disease with damage to the pancreas, characterized by an increase in blood sugar levels and a violation of all types of metabolism in the body.

Diabetes mellitus is distinguished: prediabetes, latent diabetes mellitus and actual diabetes mellitus (overt). The latter manifests itself in mild, moderate and severe severity.

With prediabetes, latent diabetes and mild form diabetes nutrition is the only curative factor... And in moderate and severe forms - a prerequisite successful treatment and maintaining an acceptable quality of life.

In addition, people with diabetes are more prone to narrowing coronary arteries and the narrowing of the vessels supplying the brain and legs. The combination of infectious leg diseases and reduced blood supply can lead to gangrene (tissue death), which requires amputation.

Treatment for type 1 diabetes requires one to four daily injections of insulin. (Insulin should not be taken orally, as digestive juices destroy it.) In addition, diet and exercise should be done to keep blood glucose levels not too high or too low. For type 2 diabetes, a combination of diet, exercise, and weight loss can be used, although medications (including insulin) are usually needed as well. Treatment depends a lot on self-control. Although there is no cure for diabetes, nearly all people with diabetes are able to control their symptoms and lead a fulfilling life.

Type 1 diabetes is autoimmune disease resulting from an erroneous attack immune system on the cells of the pancreas that produce insulin.

Genetic factors are important in type 2 diabetes.

Being overweight makes people prone to developing type 2 diabetes.

Certain medications, such as corticosteroids or thiazide diuretics, can increase your risk of type 2 diabetes.

Other diseases such as hemochromatosis chronic pancreatitis, Cushing's syndrome or acromegaly, can lead to diabetes. Surgical removal of the pancreas can also trigger diabetes.

Pregnant women can develop diabetes, which usually disappears after childbirth. These women are at increased risk of developing type 2 diabetes in the future.

Contrary to popular belief, eating a lot of sweets does not contribute to the development of diabetes.

General principles Nutrition for diabetes comes down to simple rules.

The calorie content of the diet should be reduced to 2000-2200 kcal by reducing the consumption of simple carbohydrates: sugar, cakes, ice cream, chocolate, sweets, jams, pasta, rice, honey and similar products. Black bread, legumes, vegetables, fruits are complex carbohydrates (except for bananas, grapes, watermelon), and their consumption is acceptable within normal limits. Seafood is useful because of the well-absorbed high-quality protein and minerals they contain, in particular zinc - an essential component for the production of insulin. Beans are the champion among vegetables in terms of the content of zinc, which is so necessary for patients with diabetes mellitus, and copper. The use of beans reduces thirst, and in the presence of concomitant atherosclerosis with impaired heart rate- restores the normal rhythm!

It is recommended to eat 3-4 times a day. Drink water between meals. It is necessary to limit the daily intake of table salt to 10 g, animal and vegetable fats to 50 g, and also to reduce the consumption of dairy products with a high fat content (cheese, ice cream, cream, sour cream), meat, sausages, smoked meats, sprats, chocolate, cakes , halva, caviar, brains, egg yolks, offal and poultry skin.

Prophylaxis

To prevent the development of type 2 diabetes, you need to lose weight if you are more than 20 percent overweight and maintain a normal weight.

Exercise regularly.

There is no known way to prevent type 1 diabetes.

People with any type of diabetes should have regular eye exams for early detection and treatment of diabetes-related visual impairment.

Diagnostics

The medical history and physical examination can provide a basis for the assumption of the presence of illness.

The diagnosis can be made if an empty stomach blood test shows high glucose levels (126 mg / dL or higher) at least twice.

When test results are inconclusive, a glucose tolerance test may be done. The patient drinks a drink containing 75 g of glucose, and then the blood glucose is measured every 30 minutes for two hours.

A urinalysis may be taken to determine the protein content.

Blood glycohemoglobin is measured; it shows the average blood glucose over the past two to three months.

For type 1 diabetes:

Daily insulin injections are required. It takes one to four daily injections to control blood glucose levels. There are drugs long acting and quick action, and they are often prescribed in combination.

A strict diet and meal schedule are essential to maintain required level blood glucose. Your doctor may recommend foods that are low in fat, salt, and cholesterol, and may advise you to visit a dietitian for meal planning.

Since and physical exercises and insulin lowers glucose levels, exercise and insulin delivery must be timed so that their effects do not overlap and cause a dangerous drop in blood sugar (hypoglycemia).

A strict schedule of injections, food intake, and exercise are essential for proper disease control.

For type 2 diabetes:

Eating low-fat and low-calorie foods in combination with correct execution exercise is necessary to control weight.

Oral medications such as tolbutamide, chlorpropamide, tolazamide, acetohexamide, glyburide, glipizide, glimepiride, repaglinide, or meglitonide may be prescribed to increase the production of insulin by the pancreas if exercise and diet do not sufficiently lower blood glucose levels.

Other oral medications may decrease insulin resistance (metformin, pioglitazone, and rosiglitazone) or slow the absorption of sugar from the intestine (acarbose and miglitol).

Insulin injections may be necessary for severe attacks of type 2 diabetes or if the patient with type 2 diabetes has some other medical condition.

For both types of diabetes:

Blood tests are needed to measure glucose levels, one to four times a day (depending on the doctor's recommendation). Your doctor will advise you on which device you can use at home to measure your blood sugar.

Particular attention should be paid to the possibility of developing atherosclerosis, since it is often combined with diabetes. People with diabetes should not smoke, eat foods that are low in fat, cholesterol, and salt, and take medications for high blood pressure or high level cholesterol.

People with diabetes should drink plenty of water when they get sick with another illness, such as the flu, to replace lost fluids and prevent diabetic coma. During illness, people with type 1 diabetes should have their urine tested for ketone bodies every four to six hours.

People with diabetes should take care of their feet and have them checked every day. Nerve damage in diabetes decreases the sensitivity of the legs, and small injuries can lead to the development of serious infectious diseases.

Laser photocoagulation to prevent tiny tears blood vessels in the eye can help prevent or treat diabetic retinopathy. Most diabetic patients need an eye exam with an ophthalmologist at least once a year to detect the earliest manifestations of retinopathy.

Dialysis, the process of artificially filtering blood, may be necessary when renal failure... In severe cases, a kidney transplant may be required,

To relieve limb pain, amitriptyline, desipramine, or nortriptyline, which are commonly used to treat depression, or gabapentin, used for seizures, may be prescribed.

Close control of blood glucose levels delays or prevents subsequent complications affecting the eyes, kidneys and nervous system.

Kidney damage can be slowed down by controlling blood pressure ..

When a doctor is needed

See your doctor if you notice a sudden or gradual increase in hunger, thirst, or an increased urine output.

See your doctor if you have diabetes and have a runny nose or flu that has made your blood sugar levels out of control. Do not use over-the-counter medications without talking to your doctor.

Attention! Call " ambulance»If a diabetic patient loses consciousness. Tell your doctor that the person has diabetes.

Attention! (For type 2 diabetes.) Call an ambulance immediately if you develop symptoms of a hyperosmotic non-ketogenic state; these include intense thirst, lethargy, weakness, and confusion.

Attention! (For type 1 diabetes.) Call an ambulance immediately if you develop symptoms of diabetic ketocytosis; these include dry mouth, dry and red skin, sweet or fruity odor, difficulty breathing, vomiting, and abdominal pain with or without excessive urination and intense thirst.

Attention! (For type 1 diabetes.) See your doctor immediately if ketone bodies are found in the urine and the measures your doctor prescribed does not help to cope with the problem.

Unfortunately, diabetes has become a very common disease, which can be recognized by the first signs and symptoms of the disease.

Diabetes is the leading disease with a high risk of adverse outcome. Deteriorating environmental conditions, a sedentary lifestyle and poor nutrition are the main catalysts for the growth in the number of insulin-dependent people. Awareness of risks, preventive measures and healthy lifestyles are critical in combating disease. It is important to identify the first signs of diabetes mellitus in time - only in this case it is possible to correct the shape and completely control the disease.

The mechanism of diabetes development

The main cause of the disease is dysfunction of the pancreas, which does not produce enough insulin. Disruption of secretion is a key link in the development of diabetes, since it is the peptide hormone that transfers glucose from the blood to the cells of the body, saturating it with energy. When insulin is not synthesized in sufficient quantities or in the case of immunity of body tissues to it, glucose remains in the blood. Prolonged hyperglycemia causes damage to blood vessels and small capillaries, which in turn leads to dangerous complications, a decrease in the quality of life and disability. The following types of disease are distinguished:

• prediabetes is a borderline condition in which the pancreas produces low levels of insulin. The diagnosis indicates the risks of diabetes, but with proper treatment, the condition stops and is reversible;
• diabetes of the first or second type, characterized by an increase in blood glucose levels.

Most patients consult a doctor at a progressive stage of the disease, when the symptoms are pronounced, so the diagnosis of diabetes is not difficult for a specialist. Urine and blood tests are usually done for glycated hemoglobin, the content of which indicates the form and stage of the disease.

Type 1 diabetes - insulin dependent

The disease affects children and young people under the age of 35. The main causes of the disease are viral infections(rubella, measles, mumps), as well as a decrease or cessation of the production of insulin by the pancreas. The risks are increased if family members have a history of type 2 diabetes. The insidiousness of the disease lies in the spontaneous manifestation of symptoms, which, as a rule, are ignored by the patient. As a result, beta cells are destroyed, which take part in the synthesis of a vital hormone. At critical values, absolute insulin deficiency develops, the disease progresses rapidly, which leads to serious conditions- diabetic coma or metabolic disorders.

Heart palpitations, tremors, increased sweating, pale skin, unexplained restlessness and anxiety are symptoms that indicate the onset of the disease. Do not hesitate to visit a doctor and self-medicate!

Type 2 diabetes - non-insulin dependent

Progressive diabetes mellitus - the symptoms do not give rise to doubt in the diagnosis, is determined in 95% of insulin-dependent patients. The main risk factors are genetic predisposition, age and abdominal obesity - the deposition of adipose tissue in the abdomen and upper body.

If you suspect the onset of the disease or if you are at risk, take a blood sugar test. A proactive strategy and timely therapy will help to avoid formidable complications: heart attack, irreversible visual impairment, kidney function and other organs. The main goal of treatment is to effectively control blood glucose and cholesterol levels, reduce weight and preventive measures aimed at increasing the body's immune forces.

The symptoms of type 2 diabetes are described below, but main feature This form of the disease is relative insulin deficiency, i.e. the pancreas synthesizes a sufficient amount of the hormone, but the receptor sensitivity of the cells is impaired, which leads to a violation of carbohydrate metabolism.

Risk factors and characteristic symptoms

Diabetes mellitus is taking the form of an epidemic, so everyone must keep their health under control and undergo regular medical examinations. First of all, you need to pay attention to risk factors, which include:

• heredity;
• overweight;
• age after 45 years;
• a history of hormone-dependent diseases;
• high levels of cholesterol and triglycerides in the blood.

The first symptoms of diabetes are mild, therefore, most patients miss the early signs, not attaching importance to them. Pathology is detected by chance when passing a medical examination or during an examination for another disease. What symptoms in diabetes mellitus should be paid attention to in detail.

• Sleep disturbance. Elevated level blood glucose indicates hormonal imbalance affecting all systems of the body. Problems with falling asleep and persistent insomnia may begin. In some cases, insufficient tissue nutrition leads to drowsiness and apathy.
• Polyuria and polydipsia. An insatiable feeling of thirst and frequent urination - characteristic symptoms manifested in early stage disease. The body tries to get rid of the high sugar level and excrete it in the urine, which requires a sufficient amount of fluid to form.
• Deterioration of vision. An increased blood sugar level negatively affects the state of blood vessels and small capillaries, which lose elasticity and become fragile. The nutrition of all systems and tissues, including the fundus, is disrupted. The oversaturation of the body with fluid, which is inherent in all diabetics, leads to clouding of the lens and, in the long term, to the development of formidable complications: cataract, glaucoma and diabetic retinopathy.
• Ketonemia. An increase in acetoacetic acids in the blood is a concomitant symptom and is manifested by a specific smell of physiological fluids. A small amount of ketones is always present in human blood, but with metabolic disorders fatty acid do not have time to break down and accumulate in the liver. Increased content ketone bodies indicates insulin hypoglycemia (a critical decrease in blood sugar levels), which can lead to dangerous conditions, up to the occurrence of a diabetic coma.
• Itching, thrush, fungal infections. In diabetes, the hung glucose level is characteristic of all physiological fluids secreted by the body. The warm, humid environment and altered PH of the skin significantly reduce the protective barriers and are an ideal environment for dermatological infections.
• Poor wound healing and migraine headaches. Diabetes mellitus has a negative effect on the state of blood vessels and slows down the regeneration of damaged tissues, which is caused by impaired metabolic processes. Spasmodic vessels lead to headaches and arterial hypertension.
• Hunger. With a lack of insulin, cells do not metabolize glucose and the brain receives a signal of hunger, which leads to increased appetite... The patient ceases to control the amount of food and the feeling of fullness appears only after the production of a sufficient amount of insulin or until the process of breaking down fats begins.

Type 2 diabetes mellitus and its symptoms are caused by impaired insulin production and the body's inability to utilize excess glucose. As the disease progresses, the symptoms increase, but even a slight discomfort should be taken as a signal to visit a doctor!

Diabetes mellitus medication

Diabetes mellitus is an incurable pathology, however, with early detection and adequate therapy, the disease remissions. The main method of treatment is the introduction of insulin preparations into the body, strict adherence to diet and preventive measures.

Most patients self-control their blood glucose levels. Insulin is injected using syringes or pen-shaped devices; insulin pumps are used if indicated. The main factors affecting the dosage of drugs and their effect on the body should be taken into account:

• after a meal, the blood sugar level rises, which means that more insulin is required;
• before intensive physical activity it is recommended to reduce the dosage;
• in the morning, there is a sharp increase in blood glucose.

The selection of the optimal treatment regimen is carried out by the attending physician, taking into account both the indicators of clinical analyzes and risk factors in the history of the disease.

Diet therapy as the main therapeutic factor

It is possible to normalize the condition not only by dose variations medicinal product... It is recommended to keep track of the calories consumed, as well as create a balanced diet with an optimal combination of fats, carbohydrates, proteins and trace elements. Patients with diabetes mellitus should adhere to the following preventive measures:

• exclude smoking and alcoholic beverages;
• getting up from the table with a slight feeling of hunger;
• eat fractionally (at least 5 times a day) and in small portions;
• stick to healthy way life;
• protect yourself from physical and psycho-emotional overload.

What shouldn't be eaten categorically? Potential enemies are simple carbohydrates with high glycemic index... Confectionery, buns, preserves and jams are excluded from the diet, and sugar is forever a prohibited product!

Preference should be given to traditional cereals, baked potatoes, legumes, cruciferous vegetables, herbs, fruits, fish and poultry. It should also be borne in mind that most berries contain increased amount carbohydrates, so they are allowed to eat in remission.

To meet nutritional needs, the diet is diversified with products for insulin-dependent people. In stores, you can buy special varieties of bakery and confectionery products, and there are sugar substitutes in the assortment.

Physical activity

The disease diabetes mellitus, even with pronounced symptoms, is effectively corrected by regular physical activity. Vigorous exercise or brisk walking improves metabolism and circulation, and lowers blood glucose levels. Against the background of regular classes, experts note a positive trend:

• a significant increase in the sensitivity of cells to the hormone insulin;
• stabilization of blood sugar levels;
• reduction of doses of drugs.

You should start exercising with a sufficient insulin content in the blood - at least 5 mmol / l. If you feel unwell and in the stage of exacerbation of the disease, workouts are skipped, you also need to always keep foods with easily digestible carbohydrates with you, for example, a couple of lumps of sugar or caramels.

Exercise is best done under the guidance of a coach and in the company of loved ones who are aware of health problems.

With diabetes of any type, physical activity must be dosed, spontaneous exertion leads to an imbalance in blood glucose levels. Regular anaerobic training is recommended - walking, cycling, skiing. When playing sports, do not forget that shoes must match anatomical structure feet. Particular attention should be paid to foot hygiene after finishing your workout.