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 the risk of complications for the kidneys, eyes, nerves, heart and blood vessels. Diabetes is incurable, but can be controlled with proper diet, physical activity and medication. An endocrinologist talks about this in more detail.
Classification of diabetes
Most people only know about two types of diabetes. Actually, there are more of them. Depending on the cause and mechanism of disease development, the following types of pathology are distinguished:
Type 1 diabetes mellitus(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 administration of insulin.
Type 2 diabetes mellitus(non-insulin dependent). In this type of disease, the pancreas produces insulin, but the 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 develops more often in adults.
Diabetes mellitus in pregnancy(gestational). In this type of disease, elevated blood glucose levels occur during pregnancy and usually disappear after birth. This is due to changes in hormonal levels and metabolism in a woman's body. They can lead to decreased 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 the disease that occur due to genetic defects, pancreatic diseases, endocrine disorders, certain medications or infections.
Symptoms of diabetes
The classic signs of diabetes are associated with excess glucose in the blood. This includes:
- Polyuria (frequent and abundant urination).
- Polydipsia (increased thirst).
- Polyphagia (increased appetite).
- Dry mouth.
- Fatigue, weakness, nervousness.
- 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 the limbs.
Causes of diabetes
Diabetes mellitus is a multifactorial disease that can appear 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 associated with hereditary defects of the immune system.
- Obesity and overweight.Excess fat in the body leads to poor insulin action and increased blood glucose levels. Particularly dangerous is visceral fat, which surrounds internal organs and releases inflammatory mediators that disrupt metabolism.
- 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 contribute to metabolic disorders and increased blood glucose levels. The regularity and frequency of meals is also important, as long breaks between meals can lead to hypoglycemia (low blood glucose levels), and frequent meals can lead to hyperglycemia (increased blood glucose levels).
- Lack of physical activity.Physical activity helps lower blood glucose levels by increasing energy expenditure 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 raise blood glucose levels, suppress insulin production, and increase inflammation. Stress can also lead to disruptions in diet, sleep and physical activity.
- Diseases of the pancreas.If the pancreas is damaged due to inflammation, stones, tumors, chronic pancreatitis, this can lead to a decrease in 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 group of organs that produce hormones that regulate various body functions. Some hormones, such as glucagon, glucocorticoids, growth hormone, thyroid hormones, catecholamines, counteract the action of insulin and increase blood glucose levels.
- Taking certain medications.Some drugs 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 dose adjustment or replacement of the drug.
- Infections.Infectious diseases such as viral hepatitis, cytomegalovirus infection, chicken pox, rubella, mumps, meningitis, sepsis and others can damage the pancreas, cause inflammation and impair insulin production. Infections can also increase the release of stress hormones, which increase blood glucose levels.
Diagnosis of diabetes mellitus
Establishing a diagnosis requires a comprehensive examination. First, the patient is examined and interviewed by the endocrinologist. It identifies the characteristic symptoms, takes into account the circumstances of their appearance, associated diseases and hereditary factors. Then a detailed examination is described:
Laboratory research.The main method for diagnosing diabetes mellitus is the determination of glucose levels in the blood. To do this, the following tests are performed:
- Fasting glucose.
- Glucose tolerance test.
- Glycated hemoglobin (HbA1c)
Instrumental research.To identify the complications of diabetes mellitus and to assess the state of the target organs, the following studies are performed:
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, which allows you to evaluate their size, shape, structure, the presence of stones, tumors, cysts and inflammation. Dopplerography of 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, strictures and aneurysms.Electrocardiography (ECG). This is a study of the heart, which allows you to evaluate its rhythm, conductivity, contractility, the presence of ischemia, myocardial infarction, arrhythmia and blockade.
Neurological examination.This is an examination of the nervous system, which allows you to assess sensitivity, reflexes, coordination, muscle tone, the presence of paresthesia, pain and movement disorders. With diabetes mellitus, changes in nerves can develop, such as demyelination, degeneration, inflammation, 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 evaluate 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 can develop, such as xerosis, diabetic dermopathy, diabetic bullous, diabetic urticaria, diabetic angiopathy, diabetic foot, which can lead to the breakdown of the protective function of the skin and the development of complications.
Consultation with other specialists.Depending on the presence of concomitant diseases and complications of diabetes mellitus, consultation with other specialists such as cardiologist, neurologist, surgeon, dentist, psychologist, etc. 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 of activity and duration of action. According to these parameters, insulins are divided into ultra-short-acting, short-acting and prolonged (prolonged).
- Ultrashort and short-acting insulins mimic the physiological release of insulin after a meal and are administered 15-30 minutes before meals.
- Extended-release insulins provide basal blood insulin levels throughout the day and are administered once or twice daily.
- There are also ready-made mixtures of insulins with different durations 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 selected 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 must measure it regularly using a glucometer or continuous glucose monitor.
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 are possible, such as hypoglycemia (low blood sugar), allergic reactions, lipodystrophy - a violation of the distribution of fat under the skin, which can occur at the site of frequent insulin injections.
To avoid this, it is necessary to change insulin injection sites and use thin needles. Therefore, patients should learn the basics of insulin therapy and consult a doctor 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 enough to reach the target blood glucose level. In the most severe cases, drug therapy (oral hypoglycemic agents, insulin) comes to the rescue.
The following general rules of diet for diabetes mellitus must be observed:
Food should be frequent and small (5-6 times a day), in small portions. This will help avoid large jumps in blood sugar levels.Food should be taken at the same time . The same goes for taking glucose-lowering medications and insulin injections.Strict diets and hunger strikes are prohibited , as they can lead to hypoglycemia (low blood sugar), as well as breakdown of fat and protein metabolism.- These are favorites
cooking methods such as: boiling, boiling, steaming and baking. Fried, smoked, salty and pickled foods should be excluded or minimized. - MUST
eliminate easily digestible carbohydrates from food (sugar, honey, sweets, jam, baked goods, white flour). They quickly increase blood sugar and contribute to obesity. Instead, you can use sugar substitutes (xylitol, sorbitol, fructose, stevia, etc. ) in moderation. Food should contain a large amount of fiber, since such carbohydrates are absorbed more slowly and do not raise blood sugar as significantly. Fiber also helps normalize bowel function, lower 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, lard, fatty meat). They contain saturated fatty acids, which 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 antisclerotic effects.- It is advisable 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 the dose of insulin. To calculate the amount of carbohydrates, you can use special tables that show how many grams of carbohydrates are contained in different foods. - MUST
control your salt intake , as excess salt can lead to increased blood pressure, edema and deterioration of kidney function. The recommended daily intake of salt is no more than 5 g (1 teaspoon).
Food for diabetes should be balanced, varied and tasty. You don't need to give up your favorite dishes, but just learn how to cook them correctly, taking into account your condition and needs.
Diabetes mellitus is a serious disease that requires constant medical monitoring and adherence to a lifestyle. If you notice signs of diabetes in you or your loved ones, do not delay in going to the doctor. The sooner the diagnosis is established and the treatment is started, the less likely it is to develop complications and the better the prognosis of the disease.