diabetes

It is believed that diabetes develops in those who consume a lot of sweets. In fact, this is a more complex pathology, which only partially depends on nutrition and can develop in any person.

Diabetes mellitus: definition of the disease

Diabetes mellitus (DM) is a group of diseases related to metabolic disorders. People with diabetes cannot digest carbohydrates properly. As a result, their glucose (blood sugar) concentration increases significantly.

Glucose is a type of sugar that serves as the body's main source of energy.

Excess glucose has a toxic effect and destroys the walls of blood vessels, nerve fibers and internal organs.

Diabetes mellitus develops for various reasons. Some types of disease are genetic in origin, while others are related to lifestyle or environmental factors.

The name of the disease was given by the ancient Greeks. Translated from Greek, διαβαίνω means "through", which refers to the main symptoms of diabetes mellitus, polyuria, or frequent urination. Because of this, a person constantly loses fluid and tries to replenish it by drinking as much water as possible.

However, this is not always the case. Some forms of diabetes can develop without symptoms for a long time or manifest themselves so lightly that a person does not realize that something is wrong. And even with the typical course of the disease, many years often pass before excess glucose in the blood leads to the development of symptoms of the disease. Moreover, all this time the person was in a state of hyperglycemia, and at the time of diagnosis he already had severe and irreversible damage to the kidneys, blood vessels, brain, peripheral nerves, and retina.

This disease causes significant damage to the body. Without treatment, excess glucose can cause deterioration in kidney, heart, and nerve cell function. But such complications can be avoided. Modern doctors have drugs and techniques that are quite effective in treating diabetes.

Prevalence

In 2019, diabetes was the direct cause of 1. 5 million deaths worldwide. Moreover, in almost half of the cases the disease is fatal in people under the age of 70. Another half of patients died due to complications of the disease: kidney failure, heart and vascular damage.

In addition to humans, animals also suffer from diabetes. For example, dogs and cats.

From 2000 to 2019, the death rate from diabetes in developed countries increased by 3%, and in low-middle income countries by 13%. At the same time, the likelihood of death from complications of the disease in people aged 30 to 70 years decreased by 22% worldwide. This is believed to be due to better diagnosis of diabetes and effective methods for early prevention of its complications.

Classification of diabetes

In our country, we use the diabetes mellitus classification approved by the World Health Organization in 1999.

Type I diabetes mellitus

With this type of disease, a person's pancreas produces less of the hormone insulin, which is needed to transport glucose into cells. As a result, the glucose that enters the blood cannot be fully absorbed by the cells, remains in the vessels, is transported to the tissues and gradually destroys them.

Depending on the cause of pancreatic dysfunction, type I diabetes is divided into two subtypes: immune-mediated and idiopathic.

Immune-mediated diabetes mellitusresults from autoimmune destruction of pancreatic cells, as the immune system mistakenly attacks its own healthy tissue. Diabetes usually begins in childhood or adolescence, but can develop at any age.

Immune-mediated diabetes is often associated with other autoimmune disorders, such as Graves' disease, Hashimoto's thyroiditis, Addison's disease, vitiligo, or pernicious anemia.

Type 1 diabetes mellitus most often develops in children and adolescents, although it can occur at any age.

Idiopathic diabetes mellitus.Rare disease variants. Such patients have no laboratory signs of autoimmune damage, but symptoms of absolute insulin deficiency are observed.

Diabetes mellitus type II

In this case, the pancreas produces enough insulin, but the cells are not sensitive, or resistant, so they cannot absorb glucose and it accumulates in the blood.

Depending on the main cause, type II diabetes mellitus is divided into type II diabetes mellitus with primary insulin resistance and relative insulin deficiency and type II diabetes mellitus with primary impaired insulin secretion with or without insulin resistance.

Other specific types of diabetes

Other specific forms of the disease include pathologies with a clear genetic component, associated with infectious diseases or taking certain drugs, etc.

Genetic defects in pancreatic β-cell functionthe type of disease in which the defective gene is clearly established.

Genetic defects in insulin actionpathological development is associated with the peripheral action of insulin, which is disrupted due to mutations in the insulin receptor gene.

Exocrine pancreatic disease.For example, chronic pancreatitis and other inflammatory pathologies.

Endocrinopathypathologies related to excessive secretion of other hormones, such as acromegaly, Cushing's disease, hyperthyroidism.

Diabetes caused by drugs or chemicals, can occur while taking hormonally active substances, α- and β-adrenergic agonists, psychoactive substances, diuretics and chemotherapy.

Diabetes associated with infectious diseases.As a rule, this disease develops as a result of a viral infection (pathogens: Coxsackie, rubella, Epstein Barr virus).

An unusual form of immunologically mediated diabetes.For example, immobility and rigidity syndrome, systemic lupus erythematosus.

Other genetic syndromes, sometimes combined with diabetes.

Diabetes mellitus during pregnancy

It first appears during pregnancy and is characterized by a decrease in the sensitivity of cells to glucose. It is believed that this disease develops due to hormonal imbalance. After giving birth, the condition returns to normal or may develop into type II diabetes.

Causes of diabetes

Diabetes mellitus develops for a variety of reasons, including genetic and autoimmune disorders, chronic pancreatic disease, and dietary habits.

Common causes of diabetes:

• damage to the immune system, because it attacks pancreatic cells;
• genetic disorders that affect the sensitivity of tissues to glucose, change the function of the pancreas and reduce or completely stop the synthesis of insulin necessary for the absorption of glucose;
• viral infections Coxsackie virus, rubella, Epstein Barr, retrovirus can penetrate pancreatic cells and destroy organs;
• chronic diseases affecting the pancreas, cystic fibrosis, pancreatitis, hemochromatosis;
• endocrine diseases Cushing syndrome, acromegaly;
• toxins (for example, rodenticides, which are used to kill rats, heavy metals, nitrates);
• eating habits of excessive fat and simple carbohydrates in the diet can cause obesity and a decrease in cell sensitivity to insulin;
• drugs, some hormonal drugs (in particular, glucocorticosteroids), certain drugs for the treatment of heart and nervous system diseases, vitamin B preparations (if taken in excess).

Diabetes risk factors

Depending on the type of diabetes, the risk factors for this disease are different.

Risk factors for type I diabetes:

• hereditary - the possibility of getting sick is higher if a blood relative has diabetes;
• Some viral infections (eg, rubella, infectious mononucleosis) can trigger an autoimmune response in the body, causing the immune system to attack pancreatic cells.

Being overweight does not cause type I diabetes, but it does increase the risk of type II diabetes.

The most common risk factors for type II diabetes mellitus, which are not directly related to increased blood glucose levels: overweight, inactive lifestyle, pregnancy, etc.

During physical activity, glucose is actively broken down to produce energy; substances supplied with food, as well as the body's own fat reserves, are used as substrates. With obesity, the volume and, therefore, the area of fat membranes and other cells containing lipid inclusions increases, the relative density of insulin receptors per unit area decreases, as a result, cells become less sensitive to insulin and absorb it. glucose worse.

Risk factors for type II diabetes mellitus:

• overweight and obesity;
• inactive lifestyle (without physical activity, glucose is broken down more slowly, so cells may become less sensitive to insulin);
• diabetes mellitus in blood relatives;
• age over 45 years;
• prediabetes is a condition in which blood glucose levels remain at the upper limit of normal for a long period of time. Prediabetes is said to be present if the analysis shows values from 5. 6 to 6. 9 mmol/l;
• diabetes mellitus during pregnancy (gestational diabetes);
• birth of a child weighing more than 4 kg;
• depression;
• heart disease;
• arterial hypertension (pressure above 140/90 mm Hg);
• high levels of "bad" high-density cholesterol (more than 0. 9 mmol/l) and triglycerides (more than 2. 82 mmol/l);
• polycystic ovary syndrome.

Symptoms of diabetes

Diabetes mellitus type I usually manifests itself as a clear symptom; other types of diseases can develop without being noticed for a long time.

Common symptoms of diabetes:

• strong thirst;
• weakness;
• frequent urination;
• bedwetting in children who did not wet the bed before;
• sudden weight loss for no apparent reason;
• persistent strong hunger;
• frequent urinary tract infections or yeast infections.

Separately, there are so-called secondary symptoms of diabetes mellitus, which appear in the final stages of the disease and signal complications.

Secondary symptoms of diabetes:

• itchy skin;
• nausea;
• vomiting;
• stomachache;
• dry mouth;
• muscle weakness;
• blurred vision;
• poorly healed wounds;
• numbness in fingers or toes;
• acanthosis nigricans darkens the skin on the neck, armpits, elbows and knees;
• pigment spots of diabetic dermopathy with atrophy and peeling of the skin, located on the bend of the lower leg, often appear due to poor wound healing on the leg;
• Diabetic pemphigus blisters on the lower legs range in size from a few millimeters to a few centimeters. Often occurs in elderly patients with long-term diabetes;
• Headache;
• the smell of acetone from the mouth.

Acanthosis nigricans, or darkening of the skin on the neck, knees, elbows, and armpits, may be a sign of diabetes.

Complications of diabetes

Complications usually occur in patients with advanced diabetes mellitus and include retinopathy, nephropathy, and polyneuropathy.

Large vessel destruction leads to atherosclerosis, myocardial infarction, stroke, and encephalopathy.

Continuous monitoring of blood glucose and taking medication to lower its level can prevent or delay the irreversible complications of diabetes.

In addition, the regeneration of small vessels is disrupted. Because of this, wounds on the body do not heal well. So, even a small wound can turn into a deep festering ulcer.

Diabetic coma

Diabetic coma is a complication of diabetes associated with too high or, conversely, low blood sugar levels.

Depending on the concentration of glucose in the blood, diabetic coma is divided into two types: hypoglycemic (related to a decrease in sugar level) and hyperglycemic (due to an increase in its level).

Hypoglycemic comausually occurs in diabetics undergoing insulin therapy.

The cause of such a coma is excess insulin, which prevents the body from raising blood glucose levels to normal levels. This often happens when the insulin dose is calculated incorrectly or the diet is interrupted, where the amount of insulin given does not correspond to the carbohydrate portion of the food eaten.

Precursors of hypoglycemic coma:

• trembling in the body,
• shivering,
• dizziness,
• restlessness or anxiety
• severe hunger
• nausea,
• blurred vision,
• heart rhythm disorders.

"Rule 15" to stop hypoglycemia in diabetes:

If your "sugar" level decreases, you should eat 15 g of fast carbohydrates (drink juice, take glucose tablets) and measure your blood glucose after 15 minutes. If the level is low, eat another 15 g of fast carbohydrates. Repeat this step until the sugar rises to at least 3. 9 mmol/l.

In rare cases, low blood sugar can cause a person to pass out. In such a situation, he needs an immediate injection of the hormone glucagon, which is done by an ambulance worker.

Some people mistakenly believe that a person in a hypoglycemic coma needs to pour a sweet liquid into their mouth. However, this does not happen and is fraught with asphyxia (suffocation).

Hyperglycemic comaaccompanied by an acute lack of insulin, which can be caused by severe stress or an insufficient dose of insulin after a meal.

Dangerous hyperglycemia is said to occur if the blood glucose level exceeds 13. 9 mmol/L.

Symptoms of hyperglycemia:

• strong thirst
• frequent urination,
• extreme fatigue
• blurred vision,
• the smell of acetone or fruity breath,
• dizziness and vomiting,
• stomachache,
• rapid breathing.

If such symptoms appear, you should sit down as soon as possible, ask someone else to call an ambulance, or call an ambulance yourself.

Diagnosis of diabetes mellitus

If a person has symptoms of increased blood sugar concentration: constant thirst, frequent urination, general weakness, blurred vision, numbness in the limbs, you should see a general practitioner as soon as possible.

But often, diabetes mellitus develops without symptoms, so it is recommended that everyone undergo a screening test once a year to detect the disease at an early stage and prevent the development of complications.

Which doctor should I contact if I suspect diabetes mellitus?

As a rule, people first turn to general practitioners. If diabetes is suspected, he refers them to a specialist who treats metabolic pathology, an endocrinologist.

During the consultation, the doctor will conduct a survey and examination, and to confirm the diagnosis and determine the severity of diabetes, he will prescribe laboratory and instrumental tests.

Inspection

If diabetes is suspected, the doctor will explain the medical history: cases of disease in blood relatives, chronic pathology of the pancreas, lifestyle, recent infectious diseases.

No specific signs of diabetes can be detected during the examination.

During the examination, the doctor will also assess the condition of the skin: with diabetes mellitus, dark areas of acanthosis nigricans may appear on it. In addition, the specialist can perform a rapid glucose test. Exceeding normal values is a reason for deep examination.

Laboratory research methods

For diagnosis, a blood glucose test is prescribed. Its high level together with characteristic symptoms such as constant thirst, frequent urination, frequent infectious diseases are clear signs of diabetes.

Blood glucose concentration is measured using one of the following tests: fasting and postprandial plasma glucose test, glycated hemoglobin level (HbA1c), which reflects the average blood sugar level over the past 3 months.

A HbA1c level of no more than 6. 0% (42 mmol/l), a glucose level of no more than 5. 5 mmol/l is considered normal.

To make an accurate diagnosis, the study is performed at least twice on different days. If the results are ambiguous, a glucose tolerance test is performed, which allows identifying the sensitivity of affected cells to glucose.

In addition, your doctor may order additional tests to distinguish type 1 diabetes from type 2 diabetes: an autoantibody test and a urine ketone body test.

Antibodies are usually found in people with type I diabetes, and ketone bodies with type II diabetes.

To assess the sensitivity of cells to insulin, the doctor can order a test to calculate the HOMA-IR index (Homeostasis model assessment of insulin resistance), which takes into account the levels of glucose and insulin in the blood.

If a hereditary form of diabetes is suspected, the specialist may recommend genetic testing to identify mutations associated with the hereditary form of diabetes mellitus and glucose intolerance.

Instrumental research methods

Instrumental examination helps identify complications of diabetes: damage to the retina, damage to the heart, blood vessels, kidneys, and nerve conduction disorders.

An ultrasound examination of internal organs is prescribed to assess the condition of the kidneys and pancreas. In addition, the doctor may refer the patient for an ECG to detect abnormalities in the heart.

To diagnose visual disturbances, you need to consult an ophthalmologist. During an ophthalmological examination, the doctor assesses the condition of the retina and examines the cornea through a slit lamp or using an ophthalmoscope.

Diabetes treatment

There is no cure for diabetes. Therapy aims to maintain acceptable blood glucose levels and prevent disease complications.

People diagnosed with diabetes need to regularly measure their blood glucose levels, inject insulin for type 1 diabetes or take tablets for type 2 diabetes, or inject insulin to control blood sugar levels.

To avoid complications of the disease, your doctor may recommend other drugs. For example, drugs to control blood pressure, thin the blood and prevent cardiovascular disease, as well as drugs that lower blood cholesterol.

Monitor blood glucose levels

To monitor blood glucose levels, classic glucometers and modern continuous monitoring systems are used.

A glucometer is a device equipped with a thin needle. A person pricks his finger with it and drips blood onto a special test strip. The glucometer immediately shows the result.

The monitoring system is a sensor attached to the shoulder, abdomen or leg. This sensor constantly monitors blood glucose levels. Data from the device is automatically downloaded to a special monitor or to an application on the phone. Such devices can signal spikes in blood sugar, plot glucose curves over time, send information to your doctor, and even make recommendations about emergency and routine measures and the need to change diabetes treatment tactics.

Wearing a monitoring system is painless;

Diet for diabetes

There is no special diet for people with diabetes, but it is important for those with this diagnosis to calculate the amount of carbohydrates they eat each day and keep a food diary.

Carb count

Carbohydrates affect the blood sugar level the most, so it is important for people with diabetes not to eliminate them, but to count them.

Carbohydrate counting is the basis of a diet for diabetics undergoing insulin therapy. To do this, use the universal parameter bread unit (XE).

1 XE corresponds to about 15 g of net carbohydrates or 20–25 g of bread and raises blood glucose levels by an average of 2. 77 mmol/l. To absorb such an amount of glucose, an insulin dose of 1. 4 units is required.

The amount of carbohydrates in the diet of a person with type I diabetes on average should not exceed 17 units of bread per day.

The amount of carbohydrates that a person with diabetes can normally tolerate varies from person to person and depends on body weight, level of physical activity, daily caloric needs and how the body metabolizes carbohydrates.

You can calculate the amount of carbohydrates needed each day with your nutritionist or doctor. After converting the carbohydrates you eat into bread units, your doctor will help you determine how much insulin is needed to absorb glucose. Over time, one will learn to calculate this on one's own.

In addition, there are other dietary recommendations for people with diabetes:

• limit the caloric intake of all overweight patients;
• minimize the content of fat (mainly of animal origin) and sugar in food;
• consume carbohydrates mainly from vegetables, whole grains and dairy products;
• exclude or limit the consumption of alcoholic beverages (no more than 1 conventional unit for women and 2 conventional units for men per day).

Prediction and prevention of diabetes mellitus

Diabetes mellitus is a chronic disease that cannot be completely cured. But medications and healthier lifestyle changes help prevent complications and slow the progression of the disease.

Without treatment, the prognosis for diabetes mellitus is not favorable: a person may die from damage to the cardiovascular system.

Ways to prevent diabetes:

• frequent physical activity;
• a varied diet with sufficient fiber, protein, fat and carbohydrates;
• healthy weight control;
• reduce alcohol consumption;
• quit alcohol and smoking.

Nutrition for the prevention of type II diabetes mellitus

An important part of preventing type II diabetes is a healthy and varied diet. The principle, or method, of healthy plates has been developed for this purpose.

The Healthy Plate Method divides foods into five main groups: fruits and vegetables, slow-release carbohydrates, dairy, protein and fat. You can combine these groups using regular plates. Fruits and vegetables should make up a third or half of it. Slow carbs are a third or less. The rest is occupied by dairy products, less protein food, and a small part by fat.

Eat according to the principle of a healthy plate: half is fiber, ⅓ slow carbohydrates, the rest is protein food.

In addition, other important principles of healthy eating should be observed:

• drink according to thirst;
• eat less salt, no more than one teaspoon (5-6 g) per day;
• limit the use of trans fats (found in many prepared and processed fast food products, cakes and pastries);
• reduce consumption of saturated fat (found in sweet pastries, fatty meats, sausages, butter and lard);
• eat less sugar, no more than 7 teaspoons (30 g) a day.