Diabetes

It is believed that diabetes develops in those who consume a lot of sweets. In fact, this is a much more complex pathology that 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 associated with metabolic disorders. Diabetics 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 is toxic and destroys the walls of blood vessels, nerve fibers and internal organs.

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

The name of the disease was given by the ancient Greeks. In the Greek translation, διαβαίνω means "to pass", which refers to the main symptom of diabetes mellitus, polyuria or frequent urination. Because of this, a person is constantly losing fluids and tries to replace 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 they can appear so mild that a person does not even notice that something is wrong. And even with the typical course of the disease, many years often pass before the excess glucose in the blood leads to the development of symptoms of the disease. Moreover, the person is in a hyperglycemic state all the time and at the time of diagnosis already has severe irreversible disorders in the kidneys, blood vessels, brain, peripheral nerves and retina.

The disease causes significant damage to the body. Without treatment, excess glucose can lead to kidney, heart and nerve cell dysfunction. 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. Moreover, in almost half of the cases, the disease was fatal in people under the age of 70. The other half of the patients died due to complications of the disease: kidney failure, damage to the heart and blood vessels.

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

Between 2000 and 2019, the death rate from diabetes increased by 3% in developed countries and by 13% in lower-middle-income countries. At the same time, the probability of death due to complications of the disease among people between the ages of 30 and 70 worldwide decreased by 22%. This is believed to be due to better diagnosis of diabetes and effective methods of early prevention of 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

In the case of this type of disease, the human pancreas produces little of the hormone insulin, which is necessary to transport glucose into the cells. As a result, the glucose entering the blood cannot be completely absorbed by the cells, it remains in the blood 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 mellitusautoimmune destruction of pancreatic cells, as a result of which the immune system mistakenly attacks its own healthy tissues. Diabetes typically 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.A rare variant of the disease. In such patients, there are no laboratory signs of autoimmune damage, but symptoms of absolute insulin deficiency are observed.

Type II diabetes mellitus

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

Depending on the main cause, type II diabetes mellitus can be divided into type II diabetes mellitus with dominant insulin resistance and relative insulin deficiency, and type II diabetes mellitus with predominantly impaired insulin secretion with or without insulin resistance.

Other specific types of diabetes

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

Genetic defects in pancreatic β-cell functiontypes of diseases in which the faulty gene can be clearly identified.

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

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

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

Drug or chemical induced diabetes, may occur while taking hormonally active substances, α- and β-adrenergic agonists, psychoactive, diuretic and chemotherapy drugs.

Diabetes associated with infectious diseases.The disease usually develops due to viral infections (pathogens: Coxsackie, rubella, Epstein Barr viruses).

Unusual forms of immunologically mediated diabetes.For example, immobility and stiffness syndrome, systemic lupus erythematosus.

Other genetic syndromes, sometimes combined with diabetes.

Gestational diabetes mellitus

It first appears 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 childbirth, the condition normalizes, or it can turn into type II diabetes.

Causes of diabetes

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

Common causes of diabetes include:

• malfunction of the immune system, which causes it to attack the cells of the pancreas;
• genetic disorders that impair 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 (such as rodenticides used to kill rodents, heavy metals, nitrates);
• dietary habits excess fats and simple carbohydrates in the diet can lead to obesity and a decrease in the sensitivity of cells to insulin;
• medicines, some hormonal medicines (especially glucocorticosteroids), medicines for the treatment of certain heart and nervous system diseases, B vitamin preparations (in case of excessive consumption).

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 probability of the disease is higher if blood relatives have diabetes;
• Some viral infections (e. g. rubella, infectious mononucleosis) can trigger an autoimmune reaction in the body, as a result of which the immune system attacks the cells of the pancreas.

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

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

During physical activity, glucose is actively broken down to use substances supplied with food as well as the body's own fat reserves as a substrate. With obesity, the volume of the membrane of cells containing fat and other lipid inclusions increases and, accordingly, the area of the membranes, the relative density of insulin receptors per unit area decreases, as a result, the cells are less sensitive to insulin and are absorbed. glucose is worse.

Risk factors for type II diabetes mellitus:

• overweight and obesity;
• sedentary lifestyle (without physical activity, glucose breaks down more slowly, so cells may be less sensitive to insulin);
• diabetes in blood relatives;
• Age over 45 years;
• Prediabetes is a condition in which the blood sugar level remains at the upper limit of the normal value for a long time. We speak of prediabetes if the analysis shows values of 5. 6-6. 9 mmol/l;
• diabetes mellitus 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 "bad" high-density cholesterol (more than 0. 9 mmol/l) and triglycerides (more than 2. 82 mmol/l);
• polycystic ovary syndrome.

Symptoms of diabetes

Type I diabetes mellitus usually manifests itself as pronounced symptoms, other types of the disease can develop unnoticed for a long time.

Common symptoms of diabetes:

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

There are also the so-called secondary symptoms of diabetes mellitus, which appear at a later stage of the disease and indicate complications.

Secondary symptoms of diabetes:

• itchy skin;
• nausea;
• vomit;
• stomach ache;
• dry mouth;
• muscle weakness;
• blurred vision;
• poorly healing wounds;
• numbness in the fingers or toes;
• acanthosis nigricans darkening of the skin on the neck, armpits, elbows and knees;
• diabetic dermopathy pigment spots with atrophy and peeling of the skin, which are located on the bends of the lower limbs, often occur due to poor healing of wounds on the legs;
• diabetic pemphigus blisters on the lower extremities ranging in size from a few millimeters to several centimeters. It occurs most often in elderly patients with long-term diabetes;
• headache;
• acetone smell from the mouth.

Acanthosis nigricans, i. e. the darkening of the skin of the neck, knees, elbows and armpits, can be a sign of diabetes.

Complications of diabetes

Complications typically develop in patients with advanced diabetes mellitus, including retinopathy, nephropathy, and polyneuropathy.

The destruction of large vessels leads to atherosclerosis, heart attack, stroke and encephalopathy.

Continuous monitoring of blood sugar levels and the use of blood sugar-lowering drugs can prevent or delay the irreversible complications of diabetes.

In addition, the regeneration of small blood vessels is interrupted. Because of this, wounds on the body do not heal well. So even a small cut can turn into a deep purulent ulcer.

Diabetic coma

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

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

Hypoglycemic comait usually occurs in diabetics who are treated with insulin.

Such a coma is caused by excess insulin, which prevents the body from raising blood sugar to normal levels. This often happens when the dose of insulin is miscalculated or the diet is disturbed, when the amount of insulin administered does not correspond to the amount of carbohydrates in the food eaten.

Precursors of hypoglycemic coma:

• trembling in the body,
• chills,
• dizziness,
• nervousness or anxiety
• severe hunger
• nausea,
• blurred vision,
• cardiac arrhythmia.

"15. rule" to stop hypoglycemia in diabetes:

If your "sugar level" drops, you need to eat 15 g of fast carbohydrates (juice, glucose tablets) and measure your blood sugar after 15 minutes. If your level is low, eat another 15 g of fast carbohydrates. Repeat these steps until your sugar level is at leastIt does not rise to 3. 9 mmol/l.

In rare cases, low blood sugar can cause fainting. In such a situation, you need an urgent glucagon hormone injection, which is performed by an ambulance.

Some people mistakenly believe that a person in a hypoglycemic coma needs to have a sweet liquid poured into their mouth. However, this is not the case and is full of suffocation (suffocation).

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

Dangerous hyperglycemia occurs when the blood sugar level exceeds 13. 9 mmol/l.

Symptoms of hyperglycemia:

• strong thirst
• frequent urination,
• extreme fatigue
• blurred vision,
• acetone smell or fruity breath,
• nausea and vomiting,
• stomach ache,
• rapid breathing.

If these symptoms occur, 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 high blood sugar: constant thirst, frequent urination, general weakness, blurred vision, numbness in the limbs, consult a family doctor as soon as possible.

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

Which doctor should I see if I suspect diabetes?

Usually people see a general practitioner first. If diabetes is suspected, he is referred to a specialist treating metabolic pathologies, an endocrinologist.

During the consultation, the doctor performs an assessment and examination, prescribes laboratory and instrumental tests to confirm the diagnosis and determine the severity of diabetes.

Control

If diabetes is suspected, the doctor will clarify the medical history: diseases of 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 also assesses the condition of the skin: in the case of diabetes mellitus, dark areas of acanthosis nigricans may appear on it. In addition, the specialist can perform a rapid glucose test. Exceeding the normal values is a reason for a thorough examination.

Laboratory research methods

A blood sugar test is prescribed for diagnosis. Its high level, together with typical symptoms such as constant thirst, frequent urination, frequent infectious diseases, is clearly a sign of diabetes.

The blood sugar level is measured by one of the following tests: fasting and postprandial plasma glucose measurement, glycated hemoglobin (HbA1c) level, which reflects the average blood sugar level of the last 3 months.

An HbA1c level of no more than 6. 0% (42 mmol/l) and a glucose level no higher than 5. 5 mmol/l are considered normal.

In order to make an accurate diagnosis, the examination is performed at least twice, on different days. If the results are not clear, a glucose tolerance test is performed, which allows the identification of impaired sensitivity of the cell to glucose.

In addition, your doctor may order additional tests to distinguish between type 1 diabetes and 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 people with type II diabetes.

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

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

Instrumental research methods

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

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

You should see an ophthalmologist to diagnose vision problems. During the ophthalmological examination, the doctor assesses the condition of the retina and examines the cornea with a slit lamp or ophthalmological examination.

Treatment of diabetes

There is no cure for diabetes. The goal of therapy is to maintain an acceptable blood sugar level and prevent complications of the disease.

Patients diagnosed with diabetes must regularly test their blood sugar levels, inject insulin for type 1 diabetes, or take pills for type 2 diabetes, or inject insulin to control blood sugar levels.

In order to prevent complications of the disease, the doctor may also recommend other medicines. For example, medicines to control blood pressure, thin the blood and prevent cardiovascular disease, and medicines to lower blood cholesterol.

Blood sugar monitoring

Classic glucometers and modern continuous monitoring systems are used to check blood sugar levels.

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

Monitoring systems are sensors that are mounted on the shoulder, stomach or leg. These sensors continuously monitor blood sugar levels. Device data is automatically downloaded to a special monitor or to the application on the phone. Such devices can indicate spikes in blood sugar levels, draw glucose curves for certain periods, send information to your doctor, and even make recommendations for emergency and routine measures, as well as changes in diabetes management tactics.

Wearing the monitoring system does not hurt;

Diet for diabetes

There is no special diet for people with diabetes, but it is important for people with this diagnosis to count their daily carbohydrate intake and keep a food diary.

Carbohydrate counting

Carbohydrates have the greatest influence on blood sugar levels, so it is important for diabetics not to eliminate them, but to count them.

Carbohydrate counting is the basis of the diet of diabetics receiving insulin treatment. To do this, use the universal parametric bread unit (XE).

1 XE is equivalent to about 15 g of net carbohydrates or 20-25 g of bread and raises blood sugar by an average of 2. 77 mmol/l. A dose of 1. 4 units of insulin is required to absorb this amount of glucose.

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

The amount of carbohydrates that people with diabetes can generally tolerate varies from person to person and depends on body weight, level of physical activity, daily caloric needs, and the body's metabolism of carbohydrates.

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

In addition, there are other dietary recommendations for diabetics:

• restrict caloric intake in all overweight patients;
• the fat (primarily of animal origin) and sugar content in food must be minimized;
• eat carbohydrates mainly from vegetables, whole grains and dairy products;
• excluding or limiting the consumption of alcoholic beverages (up to 1 traditional unit for women and 2 traditional 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 healthy lifestyle changes can help avoid complications and slow the progression of the disease.

Without treatment, the prognosis of diabetes mellitus is unfavorable: a person may die due to damage to the cardiovascular system.

Ways to prevent diabetes:

• regular physical activity;
• a varied diet with sufficient fiber, protein, fat and carbohydrates;
• healthy weight control;
• reducing alcohol consumption;
• quitting 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 the healthy plate was developed for this purpose.

The Healthy Plate Method divides foods into five main groups: fruits and vegetables, slow-release carbohydrates, dairy products, proteins and fats. You can combine these groups using a normal plate. Fruits and vegetables account for a third or a half of this. A third of slow carbohydrates or a little more. The remaining part is occupied by dairy products, a little more protein-containing foods, and a small part by fats.

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

In addition, other important principles of a healthy diet must be followed:

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