Diabetes

People who consume a lot of sweets are thought to develop diabetes. In fact, this is a more complex pathology that depends only partially 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. People with diabetes cannot digest carbohydrates properly. 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 destroys 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 Greek, διαβαίνω means "to pass" and it refers to the main symptom of diabetes mellitus, polyuria, or frequent urination. For this reason, 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 themselves so mildly that a person does not even notice that something is wrong. And even with the typical course of the disease, it often takes years before excess blood glucose causes symptoms to develop. Moreover, during all this time, a person is in a state of hyperglycemia, and at the time of diagnosis, he already has severe irreversible disorders of the kidneys, blood vessels, brain, peripheral nerves and retina.

The disease causes serious damage to the body. Without treatment, excess glucose can cause deterioration in the functioning of the kidneys, heart and nerve cells. But such complications can be avoided. Modern doctors have quite effective drugs and methods for the treatment of diabetes.

Don't spread

In 2019, diabetes directly caused the death of 1. 5 million people 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 from complications of the disease: kidney failure, damage to the heart and blood vessels.

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

From 2000 to 2019, the death rate from diabetes increased by 3% in developed countries and by 13% in low- and middle-income countries. At the same time, the probability of dying from complications of the disease in people between the ages of 30 and 70 has 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 classification approved by the World Health Organization in 1999.

Type I diabetes

With this type of disease, a person's pancreas produces too much of the hormone insulin, which is needed to transport glucose into the cells. As a result, the glucose entering the blood cannot be fully absorbed by the cells, remains in the blood vessels, is transported to the tissues and gradually destroys them.

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

Immune-related diabetes mellitusit is the result of autoimmune destruction of pancreatic cells, so the immune system mistakenly attacks its own healthy tissue. Diabetes usually begins in childhood or adolescence, but can develop in people of any age.

Immune-mediated diabetes is often associated with other autoimmune diseases 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 there are definitely signs of insulin deficiency.

Type II diabetes

In this case, the pancreas produces enough insulin, but the cells are not sensitive or resistant to it, so glucose cannot be absorbed and accumulates in the blood.

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

Other specific types of diabetes

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

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

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

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

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

Drug or chemically induced diabetes, may 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 immunologically mediated diabetes.For example, immobility and stiffness syndrome, systemic lupus erythematosus.

Other genetic syndromes, sometimes combined with diabetes.

Gestational diabetes mellitus

It appears for the first time during pregnancy and is characterized by a decrease in glucose sensitivity of cells. It is believed that the disease develops due to an imbalance of hormones. After childbirth, the condition normalizes or can become type II diabetes.

Causes of diabetes

Diabetes mellitus develops for a variety of reasons, including genetic and autoimmune disorders, chronic pancreatic diseases, 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 disrupt tissue sensitivity to glucose, change the work of the pancreas and reduce or completely stop the synthesis of insulin necessary for glucose absorption;
• 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 (eg, 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;
• drugs, some hormonal drugs (in particular, glucocorticosteroids), certain drugs for the treatment of heart and nervous system diseases, preparations of B vitamins (in case of excessive consumption).

Risk factors for diabetes

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

Risk factors for type I diabetes:

• heredity - if blood relatives have diabetes, the probability of getting sick is higher;
• Some viral infections (eg, rubella, infectious mononucleosis) can cause an autoimmune reaction in the body, which causes the immune system to attack pancreatic cells.

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

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

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

Risk factors for type II diabetes:

• overweight and obesity;
• sedentary lifestyle (without physical activity, glucose is broken down more slowly, so cells may be less sensitive to insulin);
• diabetes mellitus in blood relatives;
• Age over 45 years;
• prediabetes is a condition in which blood glucose levels remain above normal for a long period of time. Prediabetes is said to exist if the analysis shows values between 5. 6 and 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 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 mellitus can usually develop without other types of the disease being noticed for a long time;

Common symptoms of diabetes:

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

Separately, there are secondary symptoms of diabetes mellitus that 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;
• poorly healed wounds;
• numbness in 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 located in the bends of the lower extremities often appear due to poor healing of leg wounds;
• Diabetic pemphigus blisters ranging in size from a few millimeters to a few centimeters on the lower extremities. It occurs most often in elderly patients with long-term diabetes;
• Headache;
• the 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 usually develop in patients with advanced diabetes and include retinopathy, nephropathy, and polyneuropathy.

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

Constant monitoring of blood glucose and taking drugs that lower its level can prevent or delay irreversible complications of diabetes.

In addition, the regeneration of small vessels is impaired. 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 associated with too high or, conversely, low blood sugar levels.

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

Hypoglycemic comausually occurs in people with diabetes taking insulin therapy.

The cause of such a coma is excessive insulin, which prevents the body from raising blood glucose levels to a normal level. This often happens when the dose of insulin is calculated incorrectly or when the diet is disturbed, when the amount of insulin administered does not correspond to the portion of carbohydrates from the food eaten.

Precursors of hypoglycemic coma:

• body tremors,
• don't catch a cold
• dizziness,
• nervousness or anxiety
• severe hunger
• nausea,
• blurred vision,
• heart rhythm disturbance.

"Rule 15" to stop hypoglycemia in diabetes:

If your "sugar" level has decreased, you need to eat 15 g of fast carbohydrates (drink juice, take a glucose tablet) and measure your blood sugar after 15 minutes. If its level is low, eat another 15 g 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 faint. In such a situation, he needs an emergency injection of glucagon hormone, which is carried out by an emergency worker.

Some people mistakenly believe that it is necessary to pour a sweet liquid into the mouth of a person in a hypoglycemic coma. But this is not so and is full of asphyxia (suffocation).

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

If the blood glucose level exceeds 13. 9 mmol/l, dangerous hyperglycemia is said to occur.

Symptoms of hyperglycemia:

• strong thirst
• don't urinate often
• extreme fatigue
• blurred vision,
• acetone or fruity breath odor,
• nausea and vomiting,
• stomach ache,
• 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 concentration: constant thirst, frequent urination, general weakness, blurred vision, numbness in the limbs, you should consult a general practitioner as soon as possible.

However, diabetes mellitus often develops asymptomatically, so all people are recommended to undergo a screening test once a year to detect the disease at an early stage and prevent the development of complications.

Which doctor should I see if I suspect diabetes?

As a rule, people first consult a general practitioner. If diabetes is suspected, he sends them to an endocrinologist, a specialist who treats metabolic pathologies.

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

Examination

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

There are no specific symptoms 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 on it. In addition, a specialist can perform a rapid glucose test. Exceeding normal values is a reason for deep examination.

Laboratory research methods

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

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

HbA1c level not more than 6. 0% (42 mmol/l), glucose level not 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 inconclusive, a glucose tolerance test is performed, which allows determining the sensitivity of the cell 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 commonly found in people with type I diabetes and ketone bodies in type II diabetes.

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

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

Instrumental research methods

Instrumental examinations help to determine the complications of diabetes: damage to the retina, damage to the heart, blood vessels, kidneys, nerve conduction disorders.

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

You should consult an ophthalmologist to determine vision disorders. During an ophthalmological examination, the doctor assesses the condition of the retina and examines the cornea using a slit lamp or an ophthalmoscope.

Treatment of diabetes

There is no cure for diabetes. Therapy is aimed at maintaining an acceptable blood glucose level 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 their blood sugar levels.

Your doctor may recommend other medications to prevent complications. For example, drugs that regulate blood pressure, thin the blood and prevent cardiovascular diseases, as well as drugs that lower blood cholesterol.

Blood glucose level monitoring

Classic glucometers and modern continuous monitoring systems are used to monitor blood glucose levels.

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

Monitoring systems are shoulder, stomach or foot mounted sensors. These sensors constantly monitor blood glucose levels. The data received from the device is automatically downloaded to a special monitor or an application on the phone. Such devices can show spikes in blood sugar, determine glucose curves over time, send information to your doctor, and even make recommendations about emergency and routine measures and the need to change diabetes treatment tactics.

Wearing the monitoring system 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 calculate the amount of carbohydrates they eat every day and keep a food diary.

Calculation of carbohydrates

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

Carbohydrate counting is the cornerstone of the diet for people with diabetes on insulin therapy. To do this, use the universal parameter bread unit (XE).

1 IU corresponds to approximately 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 a quantity of glucose, a dose of 1. 4 units of insulin is required.

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

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

You can calculate the amount of carbohydrates you need 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, a person will learn to calculate it himself.

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

• restrict caloric intake of all overweight patients;
• to minimize the amount of fat (primarily of animal origin) and sugar in food;
• consume carbohydrates mainly from vegetables, whole grains and dairy products;
• exclude or limit the consumption of alcoholic beverages (no more than 1 standard unit for women and 2 standard units for men per day).

Prediction and prevention of diabetes mellitus

Diabetes mellitus is a chronic disease and cannot be completely cured. But medications and healthier lifestyle changes can 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;
• a diet rich in sufficient fiber, protein, fat and carbohydrates;
• healthy weight control;
• reduce alcohol consumption;
• abstinence from 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. For this purpose, the principle or method of healthy plate has been developed.

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 an ordinary 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 by protein foods, and a small part by fats.

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

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

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