Diabetes mellitus is a disorder of glucose metabolism in the body associated with insulin deficiency. Glucose is the energy material for 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 it can be controlled with proper diet, physical activity and medication. The endocrinologist talks about this in more detail.
Classification of diabetes
Most people only know of two types of diabetes. Actually, there are more. Depending on the cause and mechanism of disease development, the following types of pathology are distinguished:
Diabetes mellitus type 1(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 use of insulin.
Diabetes mellitus type 2(insulin independent). In this type of disease, the pancreas produces insulin, but this 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 mellitus most often develops in adults.
Diabetes mellitus in pregnancy(gestational). In this type of disease, elevated blood glucose levels occur during pregnancy and usually disappear after delivery. This is due to changes in the hormonal level and metabolism in the female body. They can lead to reduced insulin production or weaker insulin action. Women who have had gestational diabetes have an increased risk of developing type 2 diabetes in the future.
Other specific types of diabetes. This group includes rare forms of disease caused by genetic defects, pancreatic disease, endocrine disorders, certain drugs or infections.
Symptoms of diabetes
The classic signs of diabetes are associated with excess blood glucose. This includes:
- Polyuria (frequent and copious urination).
- Polydipsia (increased thirst).
- Polyphagia (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 infections.
- Visual impairment, the appearance of spots before the eyes.
- Numbness, tingling, pain in limbs.
Causes of diabetes
Diabetes mellitus is a multifactorial disease that can occur for various 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 linked to inherited defects in the immune system.
- Obesity and overweight.Excess fat in the body leads to poor insulin action and increased blood glucose levels. Visceral fat, which surrounds internal organs and releases inflammatory mediators that disrupt metabolism, is especially dangerous.
- Poor nutrition.The consumption of large amounts of simple carbohydrates, fats, salt, alcohol, as well as the lack of complex carbohydrates, proteins, fibers, vitamins and minerals in the diet contributes to the disruption of metabolism and an increase in blood glucose levels. The regularity and frequency of meals is also important, because long breaks between meals can lead to hypoglycemia (low blood glucose), and frequent snacks can lead to hyperglycemia (high blood glucose).
- Lack of physical activity.Physical activity helps lower blood glucose levels by increasing energy consumption and glucose uptake by cells. In addition, physical activity improves blood circulation, strengthens the cardiovascular system, improves immunity, promotes weight loss and prevents diabetes complications.
- Stress.Stressful situations cause the release of adrenaline, cortisol and glucagon. They increase blood glucose levels, suppress insulin production and increase inflammation. Stress can also lead to disturbances in eating, sleeping and physical activity.
- Diseases of the pancreas.If the pancreas is damaged due to inflammation, stones, tumors, chronic pancreatitis, it 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 set of organs that produce hormones that regulate various bodily functions. Some hormones, such as glucagon, glucocorticoids, growth hormone, thyroid hormones, catecholamines, oppose 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 drugs 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, cause inflammation and impaired insulin production. Infections can also increase the release of stress hormones, which increase blood glucose levels.
Diagnosis of diabetes mellitus
Making a diagnosis requires a comprehensive examination. Initially, the patient is examined and interviewed by an endocrinologist. It identifies characteristic symptoms, takes into account the circumstances of their occurrence, accompanying diseases and hereditary factors. Then a detailed review is prescribed:
Laboratory research.The main method for diagnosing diabetes mellitus is determining the level of glucose in the blood. To do this, the following tests are carried out:
- Fasting glucose.
- Glucose tolerance test.
- Glycated hemoglobin (HbA1c)
Instrumental research.In order to identify the complications of diabetes mellitus and evaluate the state of the target organs, the following studies are carried out:
Ophthalmoscopy. This is an eye examination 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 that allows you to assess their size, shape, structure, presence of stones, tumors, cysts and inflammation. Doppler imaging of the blood vessels of the lower extremities. This is an ultrasound examination of the vessels of the lower extremities, which allows you to evaluate their lumen, walls, blood flow, the presence of blood clots, atherosclerotic plaques, narrowings and aneurysms.Electrocardiography (ECG). This is a study of the heart, which allows you to evaluate its rhythm, conduction, contractility, the presence of ischemia, myocardial infarction, arrhythmia and blockage.
Neurological examination.This is an examination of the nervous system that allows you to assess sensitivity, reflexes, coordination, muscle tone, the presence of paresthesia, pain and movement disorders. In diabetes mellitus, nerve changes such as demyelination, degeneration, inflammation can develop, which can lead to disruption 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 examination that allows you to assess its color, turgor, moisture, the presence of wounds, cracks, ulcers, fungal, bacterial, viral infections, allergic reactions, pigmentation, atrophy, scleroderma, acanthosis.
In diabetes mellitus, skin changes such as xerosis, diabetic dermopathy, diabetic bullous, diabetic urticaria, diabetic angiopathy, diabetic foot can develop, which can lead to disruption of the protective function of the skin and the development of complications.
Consultations with other specialists.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 administered 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 different types of insulin, which differ in the time of onset of action, peak activity and duration of action. According to these parameters, insulins are divided into ultrashort, short and prolonged (prolonged) action.
- Ultrashort and short-acting insulins mimic the physiological release of insulin after a meal and are given 15-30 minutes before a meal.
- Sustained-release insulins provide basal levels of insulin in the blood throughout the day and are administered once or twice a day.
- There are also ready-made mixtures of insulin with different duration of action that are suitable for use.
Insulin is injected under the skin using special devices such as pens, pumps or inhalers. The dose of insulin is chosen individually for each patient, depending on the level of sugar in the blood, the volume and composition of food, physical activity and other factors.
To control blood sugar, the patient should measure it regularly with a glucometer or a continuous glucose meter.
What rules and recommendations should be followed during insulin therapy?
Insulin therapy requires strict adherence to diet, physical therapy and doctor's recommendations. With insulin therapy, side effects such as hypoglycemia (low blood sugar), allergic reactions, lipodystrophy - a disorder of fat distribution under the skin, which can occur at the site of frequent insulin injections, are possible.
To avoid this, it is necessary to change the insulin injection sites and use thin needles. Therefore, patients must learn the basics of insulin therapy and consult a physician if questions or concerns arise.
Nutrition for diabetes
Diet for diabetes is the most important component of treatment. In mild forms of diabetes, diet alone is sometimes sufficient to achieve the target blood glucose level. In more severe cases, drug therapy (oral hypoglycemics, insulin) comes to the rescue.
The following general dietary rules for diabetes mellitus should be followed:
Meals should be frequent and small (5-6 times a day), in small portions. This will help avoid large spikes in glycemic levels.Meals should be taken at the same times . The same applies to taking glucose-lowering drugs and insulin injections.Strict diets and hunger strikes are prohibited , because they can lead to hypoglycemia (low blood sugar), as well as disorders of fat and protein metabolism.- These are preferred
cooking methods such as: stewing, boiling, steaming and baking. Fried, smoked, salted and sour foods should be excluded or reduced to a minimum. - Ought
eliminate easily digestible carbohydrates from food (sugar, honey, sweets, 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 moderate amounts. Food should contain a large amount of fiber, since such carbohydrates are absorbed more slowly and do not raise blood sugar as quickly. Fiber also helps 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, fat, fatty meat). They contain saturated fatty acids that 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.- It is recommended that
the caloric content of the food and the amount of carbohydrates were approximately the same on different days, this is especially important when choosing an insulin dose. To calculate the amount of carbohydrates, you can use special tables that show how many grams of carbohydrates are contained in different foods. - Ought
control salt intake , because excess salt can lead to an increase in blood pressure, edema and deterioration of kidney function. The recommended daily intake of salt is no more than 5 g (1 teaspoon).
Diet for diabetes should be balanced, varied and tasty. You don't have to give up your favorite foods, just learn how to cook them properly, taking into account your condition and needs.
Diabetes mellitus is a serious disease that requires constant medical supervision and adherence to a lifestyle. If you notice signs of diabetes in yourself or your loved ones, do not delay going to the doctor. The sooner the diagnosis is made and the treatment is started, the less likely the development of complications is and the better the prognosis of the disease.