Diabetes

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

Diabetes: disease definition

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) levels increased 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 develops for many reasons. Some diseases are genetic in origin, while others are related to lifestyle or environmental factors.

The name of this disease was given by the ancient Greeks. Translated from Greek, διαβαίνω means "passing", referring to the main symptom of diabetes, 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 be so mild that a person doesn't even notice something is wrong. And even with the typical course of the disease, years often pass before excess sugar in the blood leads to the development of symptoms of the disease. Furthermore, the person is always in a state of hyperglycemia and at the time of diagnosis, he or she has serious and irreversible disorders in the kidneys, blood vessels, brain, peripheral nerves and retina.

The disease causes serious damage to the body. If left untreated, excess glucose can lead to impaired kidney, heart and nerve cell function. But such complications can be prevented. Modern doctors have enough effective drugs and techniques to treat diabetes.

Prevalence rate

In 2019, diabetes was the direct cause of 1. 5 million deaths worldwide. Furthermore, in almost half of cases, the disease is fatal in people under 70 years of age. The remaining half of patients died from complications of the disease: kidney failure, damage to the heart and blood vessels.

Besides humans, animals also suffer from diabetes. For example dogs and cats.

Between 2000 and 2019, diabetes mortality in developed countries increased by 3% and in lower-middle-income countries by 13%. At the same time, the likelihood of death from complications of the disease in people between 30 and 70 years old worldwide decreased by 22%. This is attributed to improved diabetes diagnosis and effective methods for early prevention of the disease's complications.

Classification of diabetes

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

Type I diabetes

With this type of disease, a person's pancreas produces very little of the hormone insulin needed to transport glucose into cells. As a result, glucose entering the blood is not completely absorbed by the cells, stagnates in the blood vessels, is transported to tissues and is gradually destroyed.

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

Immune-mediated diabetesa result of autoimmune destruction of pancreatic cells, so that the immune system mistakenly attacks its own healthy tissue. Diabetes often 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 often develops in children and adolescents, although it can occur at any age.

Idiopathic diabetes.A rare variant of the disease. These patients have no laboratory signs of autoimmune damage, but have symptoms of absolute insulin deficiency.

Type II diabetes

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

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

Other specific types of diabetes

Other specific disease types include conditions with a clear genetic component, association with infectious diseases or use of certain medications, etc. v.

Genetic defects in pancreatic β-cell functiondevelopmental diseases in which the defective gene is clearly identified.

Genetic defect in insulin actionThe development of the pathology is associated with the peripheral action of insulin, which is disrupted by mutations in the insulin receptor gene.

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

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

Diabetes caused by drugs or chemicals, may occur when taking hormonally active substances, α- and β-adrenergic agonists, psychotropic drugs, diuretics and chemotherapeutic drugs.

Diabetes is related to infectious diseases.As a rule, the disease develops due to viral infection (pathogens: Coxsackie, rubella, Epstein Barr virus).

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

Other genetic syndromes, sometimes associated with diabetes.

Gestational diabetes

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

Causes of diabetes

Diabetes develops for many reasons, including genetic and autoimmune disorders, chronic pancreatic disease, and dietary habits.

Common causes of diabetes:

• malfunction of the immune system, due to which it attacks pancreatic cells;
• genetic disorders that reduce tissue sensitivity to glucose, alter the function of the pancreas, and reduce or completely stop the synthesis of insulin necessary for glucose absorption;
• Viral infection Coxsackie virus, rubella, Epstein Barr, retrovirus can penetrate pancreatic cells and destroy this organ;
• chronic diseases affecting the pancreas, cystic fibrosis, pancreatitis, hemochromatosis;
• endocrine diseases Cushing's syndrome, acromegaly;
• toxins (eg, rat poison, used to kill rodents, heavy metals, nitrates);
• Dietary habits with excess fats and simple carbohydrates in the diet can lead to obesity and reduced cell sensitivity to insulin;
• medications, some hormonal drugs (especially glucocorticosteroids), some drugs to treat diseases of the heart and nervous system, vitamin B preparations (if consumed in excess).

Risk factors for diabetes

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

Risk factors for type I diabetes:

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

Excess weight 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, not directly related to increased blood sugar levels: overweight, sedentary lifestyle, pregnancy, etc. v.

During physical activity, glucose is actively broken down to produce energy; Substances provided by food, as well as the body's fat reserves, are used as a substrate. With obesity, the volume and, accordingly, the area of the adipose membrane and other cells containing fat increases, the relative density of insulin receptors per unit area decreases, as a result, the cells becomeso less sensitive to insulin and absorption. Blood sugar gets worse.

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 in blood relatives;
• age over 45 years old;
• Prediabetes is a condition in which blood sugar levels remain at the upper limit of normal for a long period of time. Prediabetes is said to be present if the analysis shows a value between 5. 6 and 6. 9 mmol/l;
• diabetes during pregnancy (gestational diabetes);
• giving birth to a baby weighing more than 4 kg;
• depression;
• heart-related diseaes;
• 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

Type I diabetes often presents as obvious symptoms; Other diseases can develop unnoticed for a long time.

Common symptoms of diabetes:

• strong thirst;
• weak;
• frequent urination;
• bedwetting in children who have never wet the bed before;
• sudden weight loss for no apparent reason;
• constant feeling of hunger;
• frequent urinary tract infections or fungal infections.

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

Secondary symptoms of diabetes:

• itchy skin;
• nausea;
• vomiting;
• stomach-ache;
• Dry mouth;
• muscle weakness;
• blurred vision;
• poor wound healing;
• numbness in fingers or toes;
• acanthosis nigricans darkens the skin on the neck, armpits, elbows and knees;
• diabetic dermatosis pigmented spots with atrophy and peeling of the skin, located on the bends of the lower limbs, often appearing due to poor healing of leg wounds;
• Diabetic pemphigus blisters on the lower extremities range in size from a few millimeters to several centimeters. Most commonly occurs in elderly patients with long-term diabetes;
• headache;
• smell of acetone from the mouth.

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

Complications of diabetes

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

Destruction of large blood vessels leads to atherosclerosis, myocardial infarction, stroke and encephalopathy.

Continuous monitoring of blood sugar levels and medication to lower blood sugar levels can prevent or delay irreversible complications of diabetes.

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

Diabetes

Diabetic coma is a complication of diabetes that involves blood sugar levels that are too high or vice versa.

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

hypoglycemic comaUsually occurs in people with diabetes who are treated with insulin.

The cause of such a coma is due to excess insulin, which prevents the body from raising blood sugar levels to normal levels. This usually occurs when the insulin dose is miscalculated or the diet is interrupted, where the amount of insulin injected does not correspond to the carbohydrate portion of the food eaten.

Precursors to hypoglycemic coma:

• trembling in the body,
• chills,
• dizzy,
• nervous or worried
• intense hunger
• nausea,
• blurred vision,
• arrhythmia.

"Rule 15" to prevent hypoglycemia in diabetes:

If your "sugar" level drops, you should eat 15 g of fast carbohydrates (drink juice, take a glucose tablet) and measure blood sugar after 15 minutes. If its level is low, eat another 15 g of fast carbohydrates. Repeat these steps until the sugar level increases to at least 3. 9 mmol/l.

In rare cases, low blood sugar can cause a person to lose consciousness. In such a situation, he needs an emergency injection of the hormone glucagon, which is administered by ambulance staff.

Some people mistakenly believe that people in a hypoglycemic coma need to have sweet liquids poured into their mouths. However, this does not happen and causes asphyxiation (suffocation).

coma due to hyperglycemiaaccompanied by acute insulin deficiency, possibly due to severe stress or insufficient postprandial insulin doses.

Dangerous hyperglycemia is said to occur if blood glucose levels exceed 13. 9 mmol/L.

Symptoms of hyperglycemia:

• strong thirst
• frequent urination,
• bar
• blurred vision,
• smell of acetone or fruity breath,
• nausea and vomiting,
• stomach-ache,
• 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

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

But often, diabetes develops without symptoms, so everyone should have a screening test once a year to detect the disease in its early stages and prevent the development of complications. .

Which doctor should I contact if I suspect I have diabetes?

As a rule, people will first go to a general practitioner. If diabetes is suspected, he will refer them to a specialist who specializes in treating metabolic diseases, an endocrinologist.

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

Investigate

If diabetes is suspected, the doctor will clarify the medical history: cases of related diseases, chronic diseases of the pancreas, lifestyle, recent infectious diseases.

No specific signs of diabetes can be detected on examination.

During the examination, the doctor will also evaluate the condition of the skin: with diabetes, dark areas of acanthosis nigricans may appear on it. Additionally, a specialist can perform a quick blood sugar test. Exceeding normal values is reason for in-depth testing.

Research methods in the laboratory

For diagnosis, blood sugar testing is indicated. High levels along with characteristic symptoms such as constant thirst, frequent urination, and frequent infectious diseases are clear signs of diabetes.

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

HbA1c level not more than 6. 0% (42 mmol/l), glucose level not more than 5. 5 mmol/l are considered normal.

For an accurate diagnosis, the study is performed at least twice on different days. If the results are unclear, a glucose tolerance test is performed, which allows determining the impaired sensitivity of cells to glucose.

Additionally, your doctor may order additional tests to distinguish type 1 diabetes from type 2 diabetes: autoantibody testing and urine ketone body testing.

Antibodies are commonly present in people with type I diabetes and ketone bodies with type II diabetes.

To assess cell sensitivity to insulin, your doctor may order a test that calculates the HOMA-IR (Homeostasis Model Assessment of Insulin Resistance) index, which takes into account 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 and glucose intolerance.

Instrumental research methods

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

Ultrasound examination of internal organs is indicated to evaluate the condition of the kidneys and pancreas. In addition, the doctor may refer the patient for an electrocardiogram to detect abnormalities in the heart.

To diagnose visual disorders, you need to consult an ophthalmologist. During an ophthalmological exam, the doctor evaluates 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 is aimed at maintaining acceptable blood sugar levels and preventing complications of the disease.

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

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

Monitor blood sugar levels

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

A blood glucose meter is a device equipped with a thin needle. One person pricked his finger with it and dripped blood onto a special test strip. The blood glucose meter immediately displays the results.

Monitoring systems are sensors installed on the shoulders, abdomen or legs. These sensors continuously monitor blood sugar levels. Data from the device is automatically downloaded to a special screen or application on the phone. Such devices can signal spikes in blood sugar levels, plot glucose curves over time, send information to your doctor, and even make recommendations on emergency and routine measures. regulation as well as the need to change diabetes treatment strategies.

Wearing the monitoring system is painless; it causes no sensation on the body.

Diet for diabetes

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

Count carbohydrates

Carbohydrates have the most impact on blood sugar levels, so it is important for people with diabetes not to eliminate them but to count them.

Carbohydrate counting is the basis of the diet for people with diabetes on insulin therapy. To do this, use the common parametric sandwich unit (XE).

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

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

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

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

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

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

Prediction and prevention of diabetes

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

Without treatment, the prognosis of diabetes is unfavorable: a person can die from damage to the cardiovascular system.

How to prevent diabetes:

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

Nutrition to prevent type II diabetes

An important part of preventing type II diabetes is a healthy and varied diet. The principle or method of a healthy disc 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 regular disks. Fruits and vegetables should make up a third or half of that. Carbohydrates lag by a third or a little more. The remainder is made up of dairy products, a few protein-rich foods, and a small portion of fat.

Eat according to the principle of a healthy meal: half is fiber, ⅓ slow carbohydrates, the rest is protein-rich foods.

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

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