Diabetes

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

Diabetes mellitus: definition of the disease

Diabetes mellitus (DM) is a group of diseases associated with metabolic disorders. People with diabetes cannot properly digest carbohydrates. 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 damages the walls of blood vessels, nerve fibers and internal organs.

Diabetes mellitus develops for various reasons. Some types of the 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 the Greek, diaveino means "to pass", which refers to the main symptom 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 asymptomatically for a long time or manifest so mildly that a person does not even notice that something is wrong. And even with the typical course of the disease, it is often many years before excess blood glucose leads to the development of symptoms of the disease. In addition, all this time the person is in a state of hyperglycemia and at the time of diagnosis already has serious irreversible disorders of the kidneys, blood vessels, brain, peripheral nerves and retina.

The disease causes significant damage to the body. Left untreated, excess glucose can lead to deterioration of kidney, heart and nerve cell function. But such complications can be prevented. Modern doctors have quite effective drugs and techniques to treat diabetes.

Prevalence

In 2019, diabetes was the direct cause of 1. 5 million deaths worldwide. In addition, in almost half of the cases the disease was fatal in people under the age of 70. The other half of the patients died from 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 lower middle-income countries by 13%. At the same time, the probability 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 improved 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.

Diabetes mellitus type I

With this type of disease, a person's pancreas produces too little 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 mellitusthe result of autoimmune destruction of pancreatic cells, due to which the immune system mistakenly attacks its own healthy tissue. Diabetes usually begins in childhood or adolescence, but can develop in people of all ages.

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

Idiopathic diabetes mellitus.A rare variant of the disease. 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 to it, so they cannot absorb the glucose and it accumulates in the blood.

Depending on the underlying cause, type II diabetes mellitus is divided into type II diabetes mellitus with predominant insulin resistance and associated insulin deficiency and type II diabetes mellitus with predominant impaired insulin secretion with or without insulin resistance.

Other special types of diabetes

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

Genetic defects in pancreatic β-cell functionthose types of diseases in the development of which a defective gene is clearly defined.

Genetic defects in insulin actionthe development of the pathology is related to the peripheral action of insulin, which is disturbed due to mutations in the insulin receptor gene.

Diseases of the exocrine pancreas.For example, chronic pancreatitis and other inflammatory pathologies.

Endocrine diseasespathologies associated with excessive secretion of other hormones, such as acromegaly, Cushing's disease, hyperthyroidism.

Diabetes caused by drugs or chemicals, can occur when taking hormonally active substances, α- and β-adrenergic agonists, psychoactive, diuretic and chemotherapeutic drugs.

Diabetes associated with infectious diseases.As a rule, the disease develops due to viral infections (pathogens: Coxsackie, rubella, Epstein Barr viruses).

Unusual forms of immune-mediated diabetes.For example, immobility and rigidity syndrome, systemic lupus erythematosus.

Other genetic syndromes, sometimes in combination with diabetes.

Gestational diabetes mellitus

It appears for the first time during pregnancy and is characterized by a decrease in the sensitivity of cells to glucose. It is believed that the disease develops due to an imbalance of hormones. After delivery, the condition returns to normal or may progress to 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:

• a malfunction of the immune system, due to which it attacks the cells of the pancreas.
• 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 viruses, rubella, Epstein Barr, retroviruses can penetrate the cells of the pancreas and destroy the organ.
• chronic diseases affecting the pancreas, cystic fibrosis, pancreatitis, hemochromatosis.
• endocrine diseases Cushing's syndrome, acromegaly.
• toxins (for example, rodenticides, which are used to kill rodents, heavy metals, nitrates).
• Eating habits Too much fat and simple carbohydrates in the diet can lead to obesity and reduced sensitivity of cells to insulin.
• medicines, some hormonal medicines (especially glucocorticosteroids), some medicines for the treatment of diseases of the heart and nervous system, B vitamin preparations (if consumed in excess).

Risk factors for diabetes

Depending on the type of diabetes, the risk factors for the disease differ.

Risk factors for type I diabetes:

• heredity - the chance of getting sick is higher if blood relatives have diabetes.
• Certain viral infections (eg, rubella, infectious mononucleosis) can trigger an autoimmune reaction in the body, causing the immune system to attack the cells of the pancreas.

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

The most common risk factors for type II diabetes, which are not directly related to the increase in blood glucose levels: overweight, sedentary lifestyle, pregnancy, etc.

During physical activity, glucose is actively broken down to produce energy provided with food, and the body's own fat reserves are used as a substrate. With obesity, the volume and, consequently, the area of fat membranes and other cells containing lipid inclusions increases, the relative density of insulin receptors per unit surface area decreases, as a result, cells become less sensitive to insulin and absorb glucoseworse.

Risk factors for type II diabetes:

• overweight and obesity;
• sedentary 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;
• Prediabetes is a condition in which the blood glucose level remains in the upper normal range for a long time. Prediabetes is said to be present if the analysis shows values from 5. 6 to 6. 9 mmol/l.
• diabetes during pregnancy (gestational diabetes).
• birth of a child weighing more than 4 kg.
• depression;
• cardiovascular diseases;
• arterial hypertension (pressure above 140/90 mm Hg);
• high levels of "bad" high-density cholesterol (above 0. 9 mmol/l) and triglycerides (above 2. 82 mmol/l).
• polycystic ovary syndrome.

Symptoms of diabetes

Type I diabetes usually manifests itself as severe symptoms of the disease that can develop unnoticed for a long time.

Common symptoms of diabetes:

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

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

Secondary symptoms of diabetes:

• itchy skin?
• motion sickness;
• vomit;
• abdominal pain;
• dry mouth?
• muscular weakness;
• blurred vision?
• poor wound healing;
• numbness in fingers or toes;
• acanthosis nigricans dark skin on the neck, armpits, elbows and knees.
• pigmented spots of diabetic dermatosis with atrophy and peeling of the skin, located on the bends of the lower limbs, often appear due to poor healing of leg wounds.
• diabetic pemphigus blisters on the lower extremities ranging in size from a few millimeters to several centimeters. They occur more often in elderly patients with long-standing diabetes.
• headache;
• acetone smell from the mouth.

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

Complications of diabetes

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

The destruction of large vessels 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 disturbed. Because of this, wounds on the body do not heal well. Thus, even a small cut can turn into a deep ulcer.

Diabetic coma

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

Depending on the concentration of glucose in the blood, diabetic coma is divided into two types: hypoglycemic (associated with a decrease in sugar levels) and hyperglycemic (caused by an increase in its level).

Hypoglycemic comausually occurs in people with diabetes who are on 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 dose of insulin is not calculated correctly or the diet is disturbed, in which the amount of insulin administered does not correspond to the portion of carbohydrates from the food consumed.

Precursors of hypoglycemic coma:

• body tremors,
• chills,
• dizziness,
• nervousness or anxiety
• intense hunger
• motion sickness,
• blurred vision,
• heart rhythm disorder.

"Rule 15" to stop hypoglycemia in diabetes:

If your "sugar" level is low, you should eat 15 grams of fast carbohydrates (drink juice, take a glucose tablet) and measure your blood glucose after 15 minutes. If its level is low, eat another 15 grams of fast carbohydrates. Repeat these steps 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, an emergency injection of the hormone glucagon is needed, which is done by an ambulance worker.

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

Hyperglycemic comait is accompanied by an acute lack of insulin, which can be caused by intense stress or an insufficient dose of insulin after meals.

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

Symptoms of hyperglycemia:

• strong thirst
• frequent urination,
• excessive fatigue
• blurred vision,
• acetone or fruity breath odor,
• nausea and vomiting,
• abdominal pain,
• rapid breathing.

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

Diagnosis of diabetes mellitus

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

But most often, diabetes mellitus develops asymptomatically, so it is recommended that all people undergo a preventive test once a year to detect the disease in the early stages and prevent the development of complications.

Which doctor should I contact if I suspect diabetes mellitus?

As a rule, people go to a general practitioner first. If diabetes is suspected, he refers them to a specialist who deals with metabolic pathologies, an endocrinologist.

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

Inspection

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

There are no specific signs of diabetes that 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. In addition, a specialist can perform a quick glucose test. Exceeding normal values is reason for an in-depth examination.

Laboratory research methods

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

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

An 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 carried out at least twice on different days. If the results are ambiguous, a glucose tolerance test is performed, which allows the detection of reduced sensitivity of 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 present in people with type I diabetes and ketone bodies in type II diabetes.

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

If inherited forms of diabetes are suspected, experts may recommend genetic testing to identify mutations associated with inherited forms of diabetes mellitus and glucose intolerance.

Instrumental research methods

Instrumental tests help identify the 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 EKG to detect abnormalities in the heart.

To diagnose vision disorders, you will need to consult an ophthalmologist. During an eye exam, the doctor assesses the condition of the retina and examines the cornea through a slit or using an ophthalmoscope.

Treatment of diabetes

There is no cure for diabetes. Treatment is aimed at maintaining acceptable blood glucose levels and preventing complications of the disease.

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

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

Monitoring 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 fine needle. A person pricks his finger with it and drips blood onto a special test strip. The glucometer shows the result immediately.

Monitoring systems are sensors installed on the shoulder, stomach or leg. These sensors continuously monitor blood glucose levels. Data from the device is automatically uploaded to a special screen or an application on the phone. Such devices can signal spikes in blood sugar, plot glucose curves over time, send information to your doctor, and make recommendations for emergency and routine measures and the need to change regular diabetes treatment.

Wearing the tracking system does not hurt, it is not felt on the body.

Diet for diabetes

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

Carb counting

Carbohydrates have the biggest impact on blood sugar levels, so it's important for people with diabetes not to eliminate them, but to measure them.

Carbohydrate counting is the basis of dieting for people with diabetes who are on insulin therapy. To do this, use the generic parameter bread module (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, a dose of 1. 4 units of insulin 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 weight, level of physical activity, daily calorie needs and how the body metabolizes carbohydrates.

You can calculate the required amount of carbohydrates per day with a nutritionist or your doctor. After converting the carbohydrates you eat into bread units, your doctor will help you determine how much insulin will be needed to absorb the glucose. Over time, a person will learn to calculate it himself.

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

• restrict the caloric intake of all overweight patients.
• minimizing the content of food in fats (mainly of animal origin) and sugars.
• they consume carbohydrates mainly from vegetables, whole grains and dairy products.
• excluding or limiting 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 unfavorable: a person may die due to damage to the cardiovascular system.

Ways to prevent diabetes:

• regular physical activity;
• varied diet with sufficient fiber, protein, fat and carbohydrates.
• healthy weight control;
• reducing alcohol consumption;
• stopping alcohol and smoking.

Nutrition for the prevention of type II diabetes

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

The Healthy Plate method divides foods into five main groups: fruits and vegetables, slow-release carbohydrates, dairy, proteins and fats. You can combine these groups using a normal plate. Fruits and vegetables should make up a third or half of it. Slow carbohydrates a third or a little more. The remaining part is taken up by dairy products, a little more protein foods and a small part by fats.

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

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

• Drink according to thirst.
• eat less salt, no more than a teaspoon (5-6 g) a day.
• limit your consumption of trans fats (found in many prepared and processed fast foods, cakes and pastries).
• reduce your 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.