Diabetes mellitus - symptoms, causes and treatment

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Diabetes mellitus is an endocrine disease caused by a deficiency in the body of the hormone insulin or its low biological activity. It is characterized by a violation of all types of metabolism, damage to large and small blood vessels and manifests itself as hyperglycemia.

The first who gave the name of the disease - "diabetes" was the doctor Arethius, who lived in Rome in the second century AD.e. Much later, in 1776, a Dobson doctor( an Englishman by birth), examining the urine of diabetics, discovered that she had a sweetish taste that spoke of the presence of sugar in her. So, diabetes began to be called "sugar".

With any type of diabetes, monitoring blood sugar becomes one of the primary tasks of the patient and his attending physician. The closer the sugar level to the normal limits, the less symptoms of diabetes appear, and the less the risk of complications.

Why does diabetes occur, and what is it?

Diabetes mellitus is a metabolic disorder that occurs due to the lack of education in the body of a patient's own insulin( type 1 disease) or due to a violation of the effect of this insulin on tissues( 2 types).Insulin is produced in the pancreas, and therefore patients with diabetes often find themselves among those who have various abnormalities in the work of this body.

Patients with type 1 diabetes are called "insulin-dependent" - they need regular injections of insulin, and very often they have a congenital disease. Typically, type 1 disease occurs already in childhood or adolescence, and this type of disease occurs in 10-15% of cases.

Type 2 diabetes develops gradually and is considered "the diabetes of the elderly".This kind of children almost does not occur, and is usually characteristic for people over 40 years old, suffering from excess weight. This type of diabetes occurs in 80-90% of cases, and is inherited in almost 90-95% of cases.

Classification

What is it? Diabetes mellitus can be of two types - insulin-dependent and insulin-independent.

1. Type 1 diabetes occurs on a background of insulin deficiency, so it is called insulin-dependent. With this type of disease, the pancreas is functioning inadequately: it either does not produce insulin at all, or produces it in a volume that is insufficient to process even the minimum amount of incoming glucose. As a result, there is an increase in the level of glucose in the blood. As a rule, type 1 diabetes mellitus is caused by thin people under the age of 30.In such cases, patients are given additional doses of insulin to prevent ketoacidosis and maintain a normal standard of living.
2. Type 2 diabetes affects up to 85% of all patients with diabetes mellitus, mostly people older than 50 years( especially women).For patients with diabetes of this type, excessive body weight is characteristic: more than 70% of such patients are obese. It is accompanied by the production of a sufficient amount of insulin, to which the tissues gradually lose sensitivity.

The causes of the development of diabetes types I and II are fundamentally different. In type 1 diabetics, due to a viral infection or autoimmune aggression, beta cells that produce insulin break down, which is why its deficiency develops with all the dramatic consequences. In patients with type 2 diabetes, beta cells produce enough or even an increased amount of insulin, but tissues lose the ability to perceive its specific signal.

Causes of

Diabetes is one of the most common endocrine disorders with a constant increase in prevalence( especially in developed countries).This is the result of a modern lifestyle and an increase in the number of external etiological factors, among which obesity is recognized.

The main reasons for the development of diabetes are:

1. Overeating ( increased appetite), leading to obesity is one of the main factors in the development of type 2 diabetes. If among people with normal body weight the incidence of diabetes is 7.8%, then with an excess of body weight by 20%, the incidence of diabetes is 25%, and with an excess body weight of 50%, the frequency is 60%.
2. Autoimmune diseases ( immune system attack on body tissues) - glomerulonephritis, autoimmune thyroiditis, hepatitis, lupus, etc., can also be complicated by diabetes mellitus.
3. Hereditary factor .As a rule, diabetes is several times more common in relatives of patients with diabetes mellitus. If both parents are sick with diabetes mellitus, the risk of diabetes for their children throughout life is 100%, if one of the parents is sick, 50%, in the case of diabetes, the brother or sister - 25%.
4. Viral infections of , which destroy pancreatic cells that produce insulin. Among the viral infections that can cause the development of diabetes can be listed: rubella, viral parotitis( mumps), chickenpox, viral hepatitis, and the like.

A person with a genetic predisposition to diabetes can not become a diabetic throughout his life if he controls himself, leading a healthy lifestyle: proper nutrition, physical activity, supervision by a doctor, etc. Typically, the first type of diabetes is manifested in children and adolescents.

As a result of the research, physicians came to the conclusion that the causes of heredity of diabetes mellitus in 5% depend on the mother's line, 10% on the father's line, and in case both parents have diabetes, the probability of transmission of a predisposition to diabetes increases to almost 70%.

Signs of diabetes in women and men

There are a number of signs of diabetes that are typical for both 1 and 2 types of the disease. These include:

1. Feeling of unquenchable thirst and frequent urination, which lead to dehydration of the body;
2. Also one of the signs is dryness in the mouth;
3. Increased fatigue;
4. Yawning, drowsiness;
5. Weakness;
6. Wounds and cuts very slowly heal;
7. Nausea, possibly vomiting;
8. Respiration is frequent( possibly with acetone odor);
9. Rapid heart rate;
10. Genital itching and itching of the skin;
11. Weight loss;
12. Increased urination;
13. Visual impairment.

If you have the above signs of diabetes, then you need to measure blood sugar.

Symptoms of diabetes mellitus

In diabetes, the severity of symptoms depends on the degree of decrease in insulin secretion, the duration of the disease and the individual characteristics of the patient.

Typically, symptoms of type 1 diabetes are acute, the disease begins suddenly. In type 2 diabetes, health deteriorates gradually, in the initial stage, the symptoms are meager.

1. Excessive thirst and frequent urination are classic signs and symptoms of diabetes. When the disease is excessive sugar( glucose) accumulates in the blood. Your kidneys are forced to work intensively in order to filter and absorb excess sugar. If your kidneys do not cope, excess sugar is excreted from the body in the urine with a liquid from the tissues. This causes more frequent urination, which can lead to dehydration. You will want to drink more liquid to quench your thirst, which again leads to frequent urination.
2. Fatigue can be caused by many factors. It can also be caused by dehydration, frequent urination and the inability of the body to function properly, because less sugar can be used to generate energy.
3. The third symptom of diabetes is polyphagia. This is also a thirst, however, no longer to water, but to food. The person eats and thus feels not satiety, and filling of a stomach with food which then quickly enough turns to a new hunger.
4. Intensive weight loss. This symptom is inherent predominantly type I diabetes( insulin-dependent) and often he is at first happy girls. However, their joy passes when they learn the true cause of weight loss. It is worth noting that weight loss occurs against a background of increased appetite and abundant nutrition, which can not but alarm. Quite often, losing weight leads to exhaustion.
5. Symptoms of diabetes can sometimes include problems with eyesight.
6. Slow wound healing or frequent infections.
7. Tingling in the hands and feet.
8. Red, swollen, sensitive gums.

If the first symptoms of diabetes do not take measures, then over time there are complications associated with eating disorders of the tissues - trophic ulcers, vascular disease, changes in sensitivity, decreased vision. A serious complication of diabetes is a diabetic coma that occurs more often with insulin-dependent diabetes in the absence of sufficient insulin treatment.

Degree of severity

A very important rubric in the classification of diabetes is its severity division.

1. Characterizes the most favorable course of the disease to which any treatment should strive. At this stage of the process, it is completely compensated, the glucose level does not exceed 6-7 mmol / l, there is no glucosuria( glucose release in the urine), the glycosylated hemoglobin and proteinuria values ​​do not go beyond the normal range.
2. This stage of the process indicates partial compensation. There are signs of complications of diabetes and the defeat of typical organs of the targets: eyes, kidneys, heart, vessels, nerves, lower limbs. The level of glucose is elevated slightly and is 7-10 mmol / l.
3. A similar course of the process indicates its constant progress and the impossibility of drug control. At the same time, glucose levels range from 13-14 mmol / l, persistent glucosuria( urine glucose release), high proteinuria( presence of protein in the urine), and explicit manifestations of target organ damage in diabetes mellitus. Progressively reduced visual acuity, persists severe arterial hypertension, decreased sensitivity with the appearance of severe pain and numbness of the lower extremities.
4. This degree characterizes the absolute decompensation of the process and the development of severe complications. At the same time, the level of glycemia rises to critical figures( 15-25 and more mmol / l), it is hard to correct by any means. The development of renal insufficiency, diabetic ulcers and gangrene of extremities is characteristic. Another criterion for the 4th degree of diabetes is the tendency to develop frequent diabetic comas.

Three states of compensation for violations of carbohydrate metabolism are also distinguished: compensated, subcompensated and decompensated.

Diagnosis

If the following signs coincide, the diagnosis of "diabetes" is established:

1. The concentration of glucose in the blood( fasting) exceeded the norm of 6.1 millimoles per liter( mol / l).After eating in two hours - above 11.1 mmol / l;
2. If the diagnosis is questionable, a glucose tolerance test is performed in the standard repeat, and it shows an excess of 11.1 mmol / l;
3. Exceeding the level of glycosylated hemoglobin - more than 6.5%;
4. The presence of sugar in the urine;
5. The presence of acetone in the urine, although acetonuria is not always an indicator of diabetes.

What is the norm of sugar?

• 3.3 - 5.5 mmol / l is the norm of blood sugar regardless of your age.
• 5.5 - 6 mmol / l is a prediabetes, a violation of glucose tolerance.

If the sugar level showed a mark of 5.5 - 6 mmol / l is your body's signal that the carbohydrate metabolism has started, all this means that you entered the danger zone. The first thing you need to do is lower the blood sugar level, get rid of excess weight( if you have extra weight).Limit yourself to consumption of 1800 calories per day, include diabetic foods in your diet, give up sweets, cook for a couple.

Consequences and complications of diabetes

Acute complications are conditions that develop for days or even hours, in the presence of diabetes.

1. Diabetic ketoacidosis is a severe condition that develops as a result of the accumulation in the blood of products of intermediate fat metabolism( ketone bodies).
2. Hypoglycemia - lowering the blood glucose level below the normal value( usually below 3.3 mmol / l) is due to an overdose of hypoglycemic drugs, concomitant diseases, unusual physical activity or malnutrition, or taking strong alcohol.
3. Hyperosmolar coma .It occurs mainly in elderly patients with type 2 diabetes in or without an anamnesis and is always associated with severe dehydration.
4. The lactacidotic coma in patients with diabetes mellitus is caused by the accumulation of lactic acid in the blood and more often occurs in patients over 50 years old on the background of cardiovascular, hepatic and renal failure, a lower supply of tissues with oxygen and, as a result, accumulation in lactic acid tissues.

Late consequences represent a group of complications, the development of which requires months, and in most cases years of the course of the disease.

1. Diabetic retinopathy - retinal damage in the form of microaneurysms, spot and spotted hemorrhages, hard exudates, edema, the formation of new vessels. It ends with hemorrhages on the fundus, can lead to detachment of the retina.
2. Diabetic micro- and macroangiopathy - impaired vascular permeability, increased fragility, tendency to thrombosis and development of atherosclerosis( occurs early, mostly small vessels are affected).
3. Diabetic polyneuropathy - most often in the form of bilateral peripheral neuropathy like "gloves and stockings", starting in the lower parts of the limbs.
4. Diabetic nephropathy - renal damage, first in the form of microalbuminuria( excretion of protein albumin in the urine), then proteinuria. It leads to the development of chronic renal failure.
5. Diabetic arthropathy - pain in the joints, "crunching", limiting mobility, reducing the amount of synovial fluid and increasing its viscosity.
6. Diabetic ophthalmopathy , in addition to retinopathy, includes early development of cataracts( opacity of the lens).
7. Diabetic encephalopathy - changes in the psyche and mood, emotional lability or depression.
8. Diabetic foot is a lesion of the foot of a patient with diabetes mellitus in the form of purulent necrotic processes, ulcers and osteoarticular lesions that occurs against the background of changes in peripheral nerves, vessels, skin and soft tissues, bones and joints. It is the main cause of amputation in patients with diabetes mellitus.

Diabetes also increases the risk of developing mental disorders - depression, anxiety disorders and eating disorders.

How to treat diabetes

Currently, the treatment of diabetes in the vast majority of cases is symptomatic and is aimed at eliminating the existing symptoms without eliminating the cause of the disease, since effective treatment of diabetes has not yet been developed.

The main tasks of the doctor in the treatment of diabetes are:

1. Compensation of carbohydrate metabolism.
2. Prophylaxis and treatment of complications.
3. Normalization of body weight.
4. Teaching the patient.

Depending on the type of diabetes mellitus, patients are prescribed insulin administration or ingestion of drugs that have a sugar reducing effect. Patients should follow a diet whose qualitative and quantitative composition also depends on the type of diabetes mellitus.

• With type 2 diabetes, is prescribed a diet and drugs that reduce blood glucose levels: glibenclamide, glenorhorm, glyclazide, glybutide, metformin. They are taken orally after individual selection of a particular drug and its dosage by a doctor.
• With type 1 diabetes, is prescribed insulin therapy and a diet. The dose and type of insulin( short, medium or long-term action) is selected individually in the hospital, under the control of the sugar content in the blood and urine.

Diabetes mellitus must necessarily be treated, otherwise it is fraught with very serious consequences, which were listed above. The earlier diabetes is diagnosed, the greater the chance that negative consequences can be avoided and live a normal and full life.

Diet

Diabetes diet is an essential part of the treatment, as well as the use of hypoglycemic drugs or insulin. Without dieting, carbohydrate metabolism can not be compensated.

There are several diets for diabetics, but practically at home you can use one( diet number 9), which can be easily adapted to the treatment of any patient, excluding or adding separate meals and foods.