Diabetes mellitus is one of the most common that tends to increase the incidence and statistics of malcriado diseases.The symptoms of diabetes do not appear on the same day, the process flows chronically, with the increase and aggravation of endocrine exchange disorders.It is true that the debut of type I diabetes is significantly different from the early stage of the second.
Among all endocrine pathology, diabetes confidently has the championship and represents more than 60% of all cases.In addition, disappointing statistics indicate that 1/10 of the "diabetics" are children.
The probability of acquiring the disease increases with age and, therefore, every ten years, the group number doubles.This is explained by an increase in life expectancy, improving early diagnosis, a decrease in physical activity and an increase in the number of people with excess weight.
Types of diabetes
Many have heard of a disease like non -alical diabetes.So the reader subsequently does not confuse diseases that have the name of "diabetes", probably, the clarification of their differences will be useful.
Urethra does not see
Non -effective diabetes is an endocrine disease that occurs due to neuroinfections, inflammatory diseases, tumors, poisoning and due to insufficiency, and sometimes the complete disappearance of ADG -Vasopressin (antidihuretic hormone))
This explains the clinical image of the disease:
- The constant dryness of the mucous membranes of the oral cavity, the incredible thirst (a person can drink up to 50 liters of water in 24 hours, stomaging the stomach to large sizes);
- The allocation of a large amount of light urine unconditioned with low specific gravity (1000-1003);
- Catastrophic weight loss, weakness, decrease in physical activity, digestive system disorders;
- A characteristic change in the skin ("parchment");
- Atrophy of muscle fibers, weakness of the muscle apparatus;
- The development of dehydration syndrome in the absence of fluid intake for more than 4 hours.
The disease in terms of complete cure has an adverse forecast, performance is significantly reduced.
Brief Anatomy and Physiology
An organ of Ire: the pancreas performs a mixed secretory function.Its exogenous part of external secretion, producing enzymes involved in the digestion process.The endocrine part, which is trusted with the mission of internal secretion, is dedicated to the development of several hormones, includingInsulin and glucagon.They are key to guaranteeing the constancy of sugar in the human body.
The endocrine section of the gland represents the Langerganes islands, which consists of:
- The cells to which they occupy a quarter of the entire space of the islands and are considered the place of glucagon products;
- B cells that occupy up to 60% of the cell population synthesizing and accumulating insulin, whose molecule is a two -chain polypeptide, which transports in a certain sequence of 51 amino acids;
- Cellas D that produce somatostatin;
- Cells that produce other polypeptides.
Therefore, the conclusion suggests itself:The damage to the pancreas and the Langerganes islands, in particular, is the main mechanism that inhibits the production of insulin and triggers the development of the pathological process.
Special types and forms of the disease
The lack of insulin leads to a violation of sugar constancy (3.3 - 5.5 mmol/l)and contributes to the formation of a heterogeneous disease called diabetes (diabetes):
- The complete absence of insulin form (absolute deficiency)Insulin dependenta pathological process that refers toType I Diabetes (ISD);
- Lack of insulin (relative deficiency), which triggers in the initial stage, a violation of carbohydrate metabolism, slowly but surely leads to developmentinsulin dependentDiabetes (INZSD), which is calledType II diabetes.
Due to violations in the body of the use of glucose and, therefore, its increase in blood serum (hyperglycemia), which, in principle, is a manifestation of the disease, the signs of diabetes mellitus, that is, a total disorder of metabolic processes at all levels, begin to appear over time.
In addition to diabetes of the first and second types, the special types of this disease are distinguished:
- Secondary diabetes,The pancreas that arises from the acute and chronic inflammation of the pancreas (pancreatitis), malignant neoplasms in the parenchyma of the gland, liver cirrhosis.Several endocrine disorders, accompanied by excessive production of insulin antagonists (acromigalia, kushing disease, fochromocytoma, thyroid disease) lead to the development of secondary diabetes.Many medications consumed for a long time have a diabetogenic effect: diuretic, some drugs and antihypertensive, oral contraceptive medications, etc.;
- Diabetes in pregnant women (gestational),Due to the peculiar mutual influence of the hormones of the mother, the child and the placenta.The pancreas of the fetus that produces its own insulin begins to stop insulin products with the mother gland, as a result of which this special form is formed during pregnancy.However, with proper control, gestational diabetes generally disappears after childbirth.Subsequently, in some cases (up to 40%) in women with similar background of pregnancy, this fact can threaten the development of type II diabetes (within 6-8 years).
Why is there a "sweet" disease?
The "sweet" disease forms a quite "heterogeneous" group of patients, therefore, it becomes obvious that the ISSD and its "counterpart" dependent of insulin occurred genetically differently.There is evidence of the connection of insulin -dependent diabetes with the genetic structures of the HLA system (the main histocompatibility complex), in particular, with some gene genes in region D. for InzSD, such a relationship has not been seen.
For the development of diabetes of the type of genetic predisposition, the pathogenetic mechanism is launched by provocative factors:
- Congenital inferiority of Langerganes islets;
- Adverse influence of the external environment;
- Stress, nerve loads;
- Traumatic brain injuries;
- Pregnancy;
- Infectious processes of viral origin (flu, "pork", infection by cytomegalovirus, coksaki);
- A tendency to eating in excess that leads to an excess of fat deposits;
- The abuse of confectionery (the treats risk me more).
Before illuminating the causes of type II diabetes, it would be advisable to stop in a very controversial issue: who suffers more often: men or women?
It has been established that the disease is currently formed more frequently in women, although in the nineteenth century the SD was a "privilege" of men.By the way, now in some countries in Southeast Asia, the presence of this disease in men is considered predominant.
The predisposing conditions for the development of type II diabetes mellitus can be attributed:
- Changes in the structural structure of the pancreas as a result of inflammatory processes, as well as the appearance of cysts, tumors, hemorrhages;
- Age after 40 years;
- Excess weight (the most important risk factor for INZSD!);
- Vascular diseases due to the atherosclerotic process and arterial hypertension;
- In women, pregnancy and the birth of a child with high body weight (more than 4 kg);
- The presence of relatives suffering from diabetes;
- Strong psycho -emotional stress (hypermojía of the adrenal glands).
The causes of the disease of various types of diabetes in some cases coincide (stress, obesity, the influence of external factors), but the beginning of the process in diabetes of the first and second type is different, in addition,ISSD is the large number of children and young people, and insulin dependent prefers people with previous generation.
Why do you want to drink so much?
The characteristic symptoms of diabetes, regardless of form and type, can be represented in the following way:
- Dry oral cavity;
- Thirst, that can hardly be satisfied, associated with dehydration;
- Excessive urine formation and their kidney release (polyuria), which leads to dehydration;
- An increase in glucose concentration in blood serum (hyperglycemia), due to the suppression of sugar elimination with peripheral tissues due to insulin deficiency;
- The appearance of sugar in the urine (glucose) and the bodies of ketone (ketonuria), which are normally present in insignificant quantities, but with diabetes mellitus they are produced intensely by the liver, and when excreting of the body they are detected in the urine;
- Increased blood plasma (in addition to glucose) of urea and sodium ions (na+ +);
- Weight loss, which in the case of the decompensation of the disease is a characteristic feature of a catabolic syndrome, which develops due to the decay of glycogen, lipolysis (fat mobilization), catabolism and glucose (transformation into glucose) of protein;
- Violation of the indicators of the lipid spectrum, an increase in general cholesterol due to the fraction of low density lipoproteins, nezhk (non -cold fatty acids), triglycerides.The growing content of lipids begins to actively go to the liver and oxidizes intensely there, which leads to excessive formation of ketone bodies (acetone + β-oxiélico acid + oletouxus acid) and enters even more to its blood (hyperketoninomia).Excessive concentration of ketone bodies threatens a dangerous state calleddiabetic ketoacidosis.
Therefore, the general signs of diabetes can be characteristic of any form of the disease, however, so as not to confuse the reader, the characteristics inherent to this or that type must still be taken into account.
Type I diabetes - "privilege" of Young
ISD is characterized by acute start (weeks or months).Type I diabetes signs are pronounced and manifested by clinical symptoms typical of this disease:
- A strong weight fall;
- An unnatural thirst, a person simply cannot get drunk, although he tries to do this (polydipsia);
- A large amount of secreted urine (polyuria);
- Significant excess of the concentration of glucose and keton bodies in the blood serum (ketoacidosis).In the initial stage, when the patient still does not know about his problems, he is likely to develop the diabetic coma (ketoacidotic, hyperglycemic), a condition that is extremely threatening, therefore, insulin therapy is prescribed as soon as possible (only diabetes will be accelerated).
In most cases, after the use of insulin, metabolic processes are compensated,The need for the body in insulin to decrease sharply, a temporary "recovery" comes.However, this short state of remission should not relax the patient or the doctor, since after some period of time, the disease will be remembered again.The need for insulin as the duration of the disease increases can increase, but, basically, in the absence of ketoacidosis, it will not exceed 0.8-1.0 units/kg.
Signs that indicate the development of late diabetes complications (retinopathy, nephropathy) may appear in 5-10 years.The main reasons for the fatal result of the ISD include:
- Terminal renal failure, which is a consequence of diabetic glomerulosclerosis;
- Cardiovascular disorders, such as complications of the underlying disease, which occur less renal.
Disease or age -related changes?(Type II diabetes)
Inzsd has been developing for many months or even years.The problems that arise, a person leads several specialists (dermatologist, gynecologist, neurologist ...).The patient does not suspect that diseases are different in their opinion: furununculosis, skin itching, fungal lesions, pain in the lower extremities: type II diabetes signs.Patients get used to their condition, and diabetes continues to develop slowly, affecting all systems and mainly vessels.
Inzsd is characterized by a stable slow course, as a rule, without showing a tendency to ketoacidosis.
The treatment of type 2 diabetes generally begins in accordance with the diet with an easily digestible (refined) carbohydrate limitation and the use (if necessary) to reduce drug drugs.Insulin is prescribed whether the development of the disease has reached the stage of serious complications or there is the immunity of oral medications.
The main cause of death in patients with INZSD was recognized as a cardiovascular pathology that has become a consequence of diabetes.As a rule, this is a heart attack or a stroke.
Diabetes treatment products
The base of medical measures aimed at compensating diabetes are three main principles:
- Compensation due to lack of insulin;
- Regulation of endocrine exchange disorders;
- Prevention of diabetes mellitus, their complications and their timely treatment.
The implementation of these principles is carried out based on 5 main positions:
- Diabetes nutrition is assigned the "first violin" party;
- The system of physical exercises, adequate and selected individually, pursues the diet;
- Medications that reduce sugar are mainly used to treat type 2 diabetes;
- Insulin therapy is prescribed if necessary with INZSD, but it is the main in the case of type 1 diabetes;
- Teach patients for car -control (skills to take blood from a finger, use a glucometer, insulin introduction without external help).
Laboratory control on these positions indicates the degree of compensation after the following biochemical studies:
| Indicators | A good degree of compensation | Satable | Bad |
|---|---|---|---|
| Glucose level with an empty stomach (mmol/L) | 4.4 - 6.1 | 6.2 - 7.8 | Ø 7.8 |
| The sugar content in the blood serum 2 hours after eating (mmol/l) | 5.5 - 8.0 | 8.1 - 10.0 | Ø 10.0 |
| The percentage of glycosilad hemoglobin (HBA1, %) | <8.0 | 8.0 - 9.5 | Ø 10.0 |
| The total serum cholesterol indicator (mmol/l) | <5.2 | 5.2 - 6.5 | Ø 6.5 |
| Triglycerides (mmol/l) | <1.7 | 1.7 - 2.2 | Ø 2.2 |
An important role of a diet in the treatment of Inzsd
Diabetes nutrition is very well known, even far from diabetes for people, table No. 9. Being in a hospital on any disease, from time to time you can listen to special nutrition that is always in separate pots, differs from the rest of the diets and is broadcast after a certain password is spoken: "I have the ninth table."What does all this mean?What is the difference between this mysterious diet of all others?
You should not confuse yourself, taking care of their "porridge" of diabetics that they are deprived of all the joys of life.Diet in diabetes is not so different from the nutrition of healthy people, the correct amount of carbohydrates (60%), fats (24%), proteins (16%) that patients receive.
The energy supply for diabetes consists in replacing refined sugars in products with slowly divided carbohydrates.The sugar sold in a store for all and the confectionery based on it falls into the prohibited food category.
As for the balance of nutrition, everything is strict here: the diabetic must use the required amount of vitamins and pectins, which must be at least 40 g.per day.
Strictly individual physical activity
Physical activity for each patient is individually selected by the treating doctor, while the following positions are taken into account:
- Age;
- Diabetes symptoms;
- Severity of the flow of the pathological process;
- The presence or absence of complications.
The physical activity prescribed by the doctor and carried out by the "Sala" must contribute to the "combustion" of carbohydrates and fats, without attracting insulin to participation.Your dose, which is necessary to compensate for metabolic disorders, is falling significantly, which should not be forgotten, because, preventing the increase in blood sugar, can obtain an undesirable effect.The proper physical activity reduces glucose, the dose introduced of insulin decomposes and, as a result, a decrease in sugar levels below the allowed values (hypoglycemia).
Thus,The dose of insulin and physical activity requires very close attention and an exhaustive calculation,To complement each other, do not jointly pass the lower limit of normal laboratory indicators.
Or maybe try popular remedies?
The treatment of type 2 diabetes is often accompanied by the search for patients with popular remedies that can inhibit the process and, as far as possible, delay the time of taking dosing shapes.
Without observing the fact that our distant ancestors practically did not know about such disease, there are popular remedies for the treatment of diabetes, but we must not forget thatThe prepared infusions and decoctions of several plants are an auxiliary agent.The use of domestic medications for diabetes does not relieve the patient from the fulfillment of the diet, the control of blood sugar, the visit to a doctor and meets all its recommendations.
To combat this pathology at home, quite famous popular remedies are used:
- Bark and white mulberry cortex leaves;
- Grains and peeled oats;
- Walnut partitions;
- Bay leaf;
- Cinnamon;
- Acorns;
- Nettle;
- Dandelion.
When diet and popular remedies no longer help ...
First generation preparations that are widely known at the end of the last century, remained in the memoirs, and were replaced by new generation medications, which constitute 3 main diabetes groups produced by the pharmaceutical industry.
What means is appropriate for one or another patient: the endocrinologist decides.And so that patients do not self -medicate and do not decide to use these diabetes medications to their discretion, we will give several visual examples.
Sulfonylmochevins derivatives
Currently, derivatives of second generation sulfoneme are prescribed, which act from 10 hours to one day.Usually, patients take them twice a day half an hour before meals.
These drugs are absolutely contraindicated in the following cases:
- Type 1 diabetes;
- Diabetic, hyperosmolar, lactacidotic coma;
- Pregnancy, childbirth, breastfeeding;
- Diabetic nephropathy, accompanied by deteriorated filtration;
- Hematopoietic system diseases with a concomitant decrease in white blood cells - leukocytes (leukocytopenia) and a thrombocytic hematopoyesis bond (thrombocytopenia);
- Inflammatory and inflammatory hepatic lesions (hepatitis);
- Diabetes complicated by vascular pathology.
In addition, the use of drugs of this group can threaten the development of allergic reactions that manifest:
- Itching and urticaria, sometimes reaching the edema of Quincke;
- Digestive system disorders;
- Changes from the blood side (reduction in the level of platelets and leukocytes);
- Perhaps a violation of the functional liver skills (jaundice due to cholestasis).
Sahabro winning facilities of the Biguanides family
Biguanidas (guanidine derivatives) are actively used for the treatment of type 2 diabetes, often adding sulfonamides to them.They are very rational for the use of patients with obesity, however, people who have a liver, kidneys and cardiovascular pathology are very limited, changing more saving drugs of the same group or α-glucoside inhibitors that inhibit carbohydrate absorption in the small intestine.
Absolute contraindications are considered to use Biguanides:
- ISD (type 1 diabetes);
- Significant weight loss;
- Infectious processes, regardless of location;
- Surgical interventions;
- Pregnancy, childbirth, breastfeeding period;
- Coma states;
- Liver and renal pathology;
- Oxygen hunger;
- Microangiopathy (2-4 degrees) with visual disabilities and renal function;
- Trophic ulcers and necrotic processes;
- Violation of blood circulation in the lower extremities due to various vascular pathology.
Insulin treatment
From the above, the fact that the above becomesThe use of insulin is the main treatment of type 1 diabetes, all emergency conditions and serious complications of diabetes.INZSD requires the appointment of this therapy only in cases of forms of insulin use, when correction by other means does not give the right effect.
Modern insulins, called monocompetent, represent two groups:
- Monocompetent pharmacological forms of human insulin substance (semi-synthetic or dNA rock), which undoubtedly have a significant advantage over pork preparations.They practically do not have contraindications or side effects;
- Monocompetent insulins obtained from pork pancreas.These medications compared to human insulin require an increase in the dose of medication by approximately 15%.
Diabetes are dangerous complications
Due to the fact that diabetes is accompanied by damage to many organs and tissues, their manifestations can be found in almost all body systems.Diabetes complications are considered:
- Pathological changes in the skin: Diabetic dermopathy, lipoid necrobiosis, furununculosis, xantoma, fungal skin lesions;
- Bone-articular diseases:
- Diabetic osteoarthropathy (joint articulation: a change in the ankle joint), which occurs at the bottom of a microcirculation violation and trophic disorders, accompanied by dislocations, subluxis, spontaneous fractures that precede the formationDiabetic foot;
- Diabetic Hyropathy, characterized by the rigidity in the joints of the hands, which is most frequently formed in children with children's diabetes;
- Respiratory diseases: long -termProlonged bronchitis, pneumonia,Increased frequency of tuberculosis development;
- Pathological processes that affect digestive organs:Diabetic EnteropathyAccompanied by greater peristalsis, diarrhea (up to 30 times a day), a decrease in body weight;
- Diabetic retinopathy- One of the most serious complications characterized by the damage to the vision organs;
- The most common complication of diabetes is consideredDiabetic Neuropathyand its variety -PolyneuropathyReaching 90% of all forms of this pathology.The frequently found diabetic polyneuropathy isDiabetic foot syndrome;
- The pathological state of the cardiovascular system, in most cases, is the cause of the death of diabetes mellitus.Hypercholesterolemia and vascular atherosclerosis, which, with diabetes, begin to develop at an early age, inevitably lead to heart disease and blood vessels (coronary heart disease, myocardial infarction, heart failure, cerebrovascular deterioration).
Prevention
The measures for diabetes prevention are built according to the causes of their challenging.In this case, it is advisable to talk about the prevention of atherosclerosis, arterial hypertension, including struggle with excess weight, bad habits and food addictions.
The prevention of diabetes complications is to prevent the development of pathological conditions derived from diabetes itself.The correction of glucose in the blood serum, the fulfillment of the diet, the adequate physical activity, the implementation of the doctor's recommendations will help to boost the consequences of this fairly formidable disease.