What is insulin-dependent diabetes mellitus? Non-insulin-dependent diabetes mellitus: symptoms, treatment Insulin-dependent diabetes mellitus without complications.
DIABETES MELLITUS NON-INSULIN-INDEPENDENT honey.
Insulin independent diabetes(NIDDM) is a chronic disease caused by a relative deficiency of insulin (reduced sensitivity of insulin-dependent tissue receptors to insulin) and manifested by chronic hyperglycemia with the development of characteristic complications. NIDDM accounts for 80% of all cases of diabetes. Frequency - 300:100,000 population. The predominant age is usually after 40 years. The predominant gender is female. Risk factors. Genetic factors (see below) and obesity. Genetic aspects
Diabetes mellitus, type II (* 138430, 2q24.1, defect in the glycerol-3-phosphate dehydrogenase-2 enzyme gene GPD2)
Mitochondrial glycerol phosphate dehydrogenase (EC 1.1.99.5) is located on the outer surface of the inner mitochondrial membrane and catalyzes the unidirectional conversion of glycerol 3-phosphate to di-hydroxyacetone phosphate
Mitochondrial glycerophosphate dehydrogenase is a key component of glucose sensitivity of pancreatic β-cells. Deficiency of this enzyme contributes to the impairment of glucose-stimulated insulin release in several animal models of NIDDM.
Diabetes mellitus, type II (*138033, 17q25, defect of the glucagon receptor gene GCGR).
Insulin receptor gene defects
Insulin-independent diabetes mellitus with acanthosis of the skin blackening (*147670, 19p13.2, defect of the insulin receptor gene INSR, R). Clinically: leprechaunism, in young women - virilization, polycystic ovary syndrome, clitoral hypertrophy, menstrual irregularities; narrow skull; lipodystrophy; limb hypertrophy; brachydactyly; exophthalmos; generalized hypertrichosis. Laboratory: hyperprolactinemia and hyperglycemia
Robson-Mendenhall syndrome (\#262190, p). NIDDM in combination with pineal hyperplasia and other anomalies (prognathia, dental dysplasia, blackened acanthosis of the skin, etc.)
Non-insulin-dependent diabetes mellitus (*147545, 2q36, IRS1 gene defect)
Diabetes mellitus, rare form (*176730, 11p15.5, INS, R gene).
Juvenile diabetes with onset in adulthood is a heterogeneous form of NIDDM, manifesting before 25 years of age (13% of NIDDM cases in Caucasians)
Juvenile onset diabetes, type 1 (125850, 20ql3, MODY1 gene defect, 90
Juvenile diabetes with onset in adulthood, type 2 (125851, chronicle 7, glucokinase gene defect GCK, 138079, R)
Juvenile diabetes with onset in adulthood, type 3 (\#600496, 12q24.2, TCF1, HNF1A, MODY3, R gene defects).
Pathogenesis
Decreased tissue sensitivity to insulin leads to hyperinsulinemia, increased lipogenesis and progression of obesityThe pathogenesis of arterial hypertension in NIDDM is not entirely clear. It is known that hyperinsulinemia promotes sodium reabsorption in the renal tubules, increases sympathetic activity, causes vascular hypertrophy of SMCs (due to mitogenic action) and increases calcium transport into insulin-sensitive SMCs, but hyperinsulinemia per se (for example, with insulinoma) is not sufficient to increase blood pressure, which suggests a special role of insulin resistance in the development of arterial hypertension.
Features
Gradual onset of the disease
Symptoms are mild (no tendency to ketoacidosis)
Frequently associated with obesity and arterial hypertension
Concordance for identical twins is 100%.
Diagnostics - see.
Treatment:
ModeRegular outpatient monitoring, except in cases of emergency
Regular exercise increases glucose tolerance and reduces the need for hypoglycemic drugs. Diet No. 9 - basic therapy for patients with NIDDM
The main goal is to reduce body weight in obese patients
Basic recommendations - consume complex carbohydrates, reduce fat intake, moderate salt and alcohol intake
Following a diet often leads to normalization of metabolic disorders in NIDDM.
Drug therapy
The drugs of choice are oral hypoglycemic drugs. They are used for mild or moderate severity of the disease, when the level of blood plasma glucose (BG) cannot be controlled by diet alone. The drugs can be taken with meals, except for glipizide, which should be prescribed 30 minutes before meals. Start with a low dose and gradually increase it at intervals of approximately 1 week until a decrease in GPC levels or the maximum dose is achieved.First generation oral antidiabetic drugs (should not be used in elderly patients or with renal failure)
Tolbutamide (butamide) - 500-3,000 mg/day in 2-3 doses
Tolazamide (tolinase) - 100-1,000 mg/day in 1-2 doses
Chlorpropamide - 100-500 mg/day in 1 dose
Second generation oral antidiabetic drugs
Glyburide (glibenclamide) - 1.25-20 mg/day in 1-2 doses (up to 10 mg/day - in one dose in the morning)
Glipizide - 2.5-40 mg/day in 1-2 doses (up to 20 mg/day in one dose in the first half of the day).
Contraindications
Insulin-dependent diabetes mellitus
Ketoacidosis
Pregnancy
History of drug allergy
First generation oral antidiabetic drugs should not be prescribed to elderly patients or those with renal impairment.
Side effects
Hypoglycemia. Reasons: excessive dose, interaction with drugs that potentiate the effect of sulfonylureas, kidney damage, liver damage, diet failure. Prolonged hypoglycemia, especially as a result of treatment with chlorpropamide, requires hospitalization and intravenous glucose infusion for several days
Sometimes, especially when using chlorpropamide, hypersensitivity to alcohol is observed, reminiscent of a reaction to disulfiram
Hyponatremia (more common with chlorpropamide; not caused by glipizide and glyburide) may result from potentiation of the action of ADH on the renal tubules
Rare side effects: skin reactions, gastrointestinal symptoms and bone marrow suppression.
Sometimes the combined use of oral antidiabetic drugs and insulin is effective. If oral medications are ineffective (for example, GPC 180 or HbA,C 1.5% of normal levels), it is recommended to additionally administer one dose of intermediate-acting insulin in the evening. Insulin is also prescribed during times of stress caused by intercurrent illness or surgery.
Drug interactions
The effect of oral antidiabetic drugs is potentiated by salicylates, clofibrate, indirect anticoagulants, chloramphenicol, ethanol
B-blockers mask the symptoms of hypoglycemia (for example, tachycardia), and also cause hypoglycemia themselves and inhibit the restoration of normal blood glucose levels.
Alternative drugs
Metformin - 500-850 mg 2-3 times / day; may be coadministered with sulfonylureas to improve efficacy or overcome insulin resistance. Contraindicated in cases of increased risk of developing lactic acidosis (renal failure, use of radiocontrast agents, surgery, MI, hypoxia, etc.). Should be used with caution in heart failure, alcoholism, elderly patients, in combination with tetracycline
Phenformin (buformin)
Acarbose 25-100 mg 3 times a day orally at the beginning of a meal to prevent hyperglycemia developing after a meal. Contraindicated in renal failure, inflammatory bowel disease, ulcerative colitis or partial intestinal obstruction.
Observation
The frequency of observations depends on the presence of complications and the degree of metabolic disorders. Usually - every 2-4 monthsFasting blood glucose (including HbA1c)
Fundus examination
Study of the functions of the cardiovascular system
Examination of the lower extremities for ulcers, arterial insufficiency, neuropathy
After five years of illness: examination by an ophthalmologist and kidney function testing annually.
Course and prognosis
Maintaining normal glucose levels may delay or prevent the development of complicationsComplications usually appear 10-15 years after the onset of the disease. Concomitant pathology
Arterial hypertension
Hyperlipidemia and obesity
Impotence.
Synonyms
Diabetes mellitus type IISee also , . Obesity, Leprechaunism (p1)
Abbreviations
GPA - blood plasma glucoseNIDDM - insulin-independent diabetes mellitus
ICD
E11 Non-insulin-dependent diabetes mellitusE10.2+ Non-insulin-dependent diabetes mellitus with kidney damage
E10.3+ Non-insulin-dependent diabetes mellitus with eye damage
E10.4+ Non-insulin-dependent diabetes mellitus with neurological complications
E10.5 Non-insulin-dependent diabetes mellitus with impaired peripheral circulation
E10.6 Non-insulin-dependent diabetes mellitus with other specified complications
E10.8 Non-insulin-dependent diabetes mellitus with unspecified complications MIM
125850 Juvenile onset diabetes, type 1
125851 Juvenile onset diabetes, type 2
138033 Diabetes mellitus, type II
138430 Diabetes mellitus, type II
147545 Non-insulin-dependent diabetes mellitus
147670 Non-insulin-dependent diabetes mellitus with blackening acanthosis of the skin
176730 Diabetes mellitus, rare form
262190 Rabso-on-Mendenhom's syndrome
600496 Juvenile onset diabetes, type 3
Literature
Almind K et al: Aminoacid polymorphisms of insulin receptor substrate-1 in non-insulin-dependent diabetes mellitus. Lancet 342: 828-832; 1993; A common ammo acid polymorphism in insulin receptor substrate-1 causes impaired insulin signaling. J. Clin. Invest. 97:2569-2575,1996; Novials A et at: Mutation in the calcium-binding domain of the mitochondrial glycerophosphate dehydrogenase gene in a family of diabetic subjects. Biochem. Biophys. Res. Comm. 231:570-572, 1997; Rabson SM, Mendenhall EN: Familial hypertrophy of pineal body, hyperplasia of adrenal cortex and diabetes mellitus. Am. J. Clin. Path. 26:283-290, 1956
Directory of diseases. 2012 .
See what "NON-INSULIN-INDEPENDENT DIABETES" is in other dictionaries:
Diabetes mellitus- This is an article about diabetes. See also diabetes insipidus. Diabetes. The UN approved symbol for diabetes. ICD 10 E1 ... Wikipedia
Honey. Diabetes mellitus syndrome of chronic hyperglycemia, developing as a result of absolute or relative deficiency of insulin and also manifested by glucosuria, polyuria, polydipsia, lipid disorders (hyperlipidemia, dyslipidemia), ... ... Directory of diseases- Diabetes mellitus type 2. The UN approved symbol for diabetes. ICD 10 E11. Diabetes mellitus type 2 metabolic ... Wikipedia
Honey. Lactic acid coma develops due to the accumulation of excess lactic acid in the blood and tissues. Observed, as a rule, in elderly patients with non-insulin-dependent diabetes mellitus against the background of renal failure and hypoxia. Pathogenesis… Directory of diseases
Honey. Amenorrhea: absence of menstruation for 6 months or more. Amenorrhea is not an independent diagnosis, but a symptom indicating anatomical, biochemical, genetic, physiological or mental disorders. The incidence of secondary amenorrhea is not... ... Directory of diseases
Despite the fact that patients with type II diabetes mellitus are prescribed insulin medications, insulin-dependent diabetes is still considered to be a type I disease. This is due to the fact that with this disease the body stops producing its own insulin.
The pancreas of people diagnosed with insulin-dependent diabetes is virtually devoid of cells that produce this protein hormone.
In type II diabetes, the pancreas produces too little insulin and the body cells do not have enough of this hormone for normal functioning. Often, correct physical activity and a well-designed diet can normalize insulin production and improve metabolism in type II diabetes.
If this is the case, then insulin administration to these patients will not be required. For this reason, type I diabetes is also commonly referred to as insulin-dependent diabetes mellitus.
When a patient with type II diabetes has to be prescribed insulin, the disease is said to have entered the insulin-dependent phase. But, fortunately, this does not happen very often.
Type I diabetes develops very rapidly and usually occurs in childhood and adolescence. This is where another name for this diabetes comes from – “juvenile”. Full recovery is only possible with a pancreas transplant. But such an operation entails lifelong use of medications that suppress the immune system. This is necessary to prevent pancreatic rejection.
Injecting insulin does not have such a strong negative effect on the body, and with proper insulin therapy, the life of a patient with type I diabetes is no different from the life of healthy people.
How to notice the first symptoms
When type I diabetes just begins to develop in the body of a child or teenager, it is difficult to identify immediately.
- If a child constantly asks for a drink in the summer heat, then most likely the parents will consider this natural.
- Visual impairment and high fatigue of primary school students are often attributed to high school loads and the body’s unfamiliarity with them.
- There is also an excuse for weight loss, they say that hormonal changes occur in the teenager’s body, which again affects fatigue.
But all these signs can be the beginning of developing type I diabetes. And if the first symptoms go unnoticed, then the child may suddenly develop ketoacidosis. By its nature, ketoacidosis resembles poisoning: abdominal pain, nausea, and vomiting occur.
But with ketoacidosis, the mind becomes confused and falls asleep all the time, which is not the case with food poisoning. The smell of acetone from the mouth is the first sign of illness.
Ketoacidosis can also occur with type II diabetes, but in this case, the patient’s relatives already know what it is and how to behave. But ketoacidosis that appears for the first time is always unexpected, and this makes it very dangerous.
The meaning and principles of insulin treatment
The principles of insulin therapy are very simple. After a healthy person has eaten, his pancreas releases the required dose of insulin into the blood, glucose is absorbed by the cells, and its level decreases.
In people with diabetes mellitus types I and II, this mechanism is disrupted for various reasons, so it has to be imitated manually. To correctly calculate the required dose of insulin, you need to know how much and with what foods the body receives carbohydrates and how much insulin is needed to process them.
The amount of carbohydrates in food does not affect its calorie content, so counting calories makes sense unless type I and II diabetes is accompanied by excess weight.
Type I diabetes does not always require a diet, which cannot be said about insulin-dependent type II diabetes. This is why every person with type I diabetes should measure their blood sugar levels and calculate their insulin doses correctly.
People with type II diabetes who do not use insulin injections also need to keep a self-monitoring diary. The longer and more clearly the records are kept, the easier it is for the patient to take into account all the details of his disease.
The diary will provide invaluable assistance in monitoring nutrition and lifestyle. In this case, the patient will not miss the moment when type II diabetes turns into the insulin-dependent form of type I.
“Bread unit” - what is it?
Diabetes I and II require constant calculation of the amount of carbohydrates consumed by the patient in food.
For type I diabetes mellitus, this is necessary to correctly calculate the insulin dose. And for type II diabetes - in order to control therapeutic and dietary nutrition. When calculating, only those carbohydrates are taken into account that affect glucose levels and the presence of which forces the administration of insulin.
Some of them, for example, sugar, are absorbed quickly, others - potatoes and cereals, are absorbed much more slowly. To facilitate their calculation, a conventional value called a “bread unit” (XE) has been adopted, and a kind of bread unit calculator makes life easier for patients.
One XE is equal to approximately 10-12 grams of carbohydrates. This is exactly as much as is contained in a 1 cm thick piece of white or black “brick” bread. It doesn’t matter what foods are measured, the amount of carbohydrates will be the same:
- in one tablespoon of starch or flour;
- in two tablespoons of ready-made buckwheat porridge;
- in seven tablespoons of lentils or peas;
- in one medium potato.
Those suffering from type I diabetes and severe type II diabetes should always remember that liquid and cooked foods are absorbed faster, which means they increase blood glucose levels more than solid and thick foods.
Therefore, when preparing to eat, the patient is advised to measure his sugar. If it is below the norm, then you can eat semolina porridge for breakfast, but if the sugar level is above the norm, then it is better to have scrambled eggs for breakfast.
On average, one XE requires from 1.5 to 4 units of insulin. True, in the morning you need more of it, and in the evening – less. In winter, the dosage increases, and with the onset of summer it decreases. Between two meals, a person with type I diabetes can eat one apple, which is equal to 1 XE. If a person controls his blood sugar level, then he will not need an additional injection.
Which insulin is better
For diabetes I and II, 3 types of pancreatic hormones are used:
- human;
- pork;
- bullish.
It is impossible to say exactly which one is better. The effectiveness of insulin treatment depends not on the origin of the hormone, but on its correct dosage. But there is a group of patients who are prescribed only human insulin:
- pregnant women;
- children diagnosed with type 1 diabetes for the first time;
- people with complicated diabetes mellitus.
Based on their duration of action, insulins are divided into short-acting, medium-acting and long-acting insulins.
Short insulins:
- Actropid;
- Insulrap;
- Iletin P Homorap;
- Insulin Humalog.
Any of them begins to work 15-30 minutes after the injection, and the duration of the injection is 4-6 hours. The drug is administered before each meal and between them if the sugar level rises above normal. People with type 1 diabetes should always carry extra injections with them.
Intermediate acting insulins
- Semilente MS and NM;
- Semilong.
They begin their activity 1.5 - 2 hours after the injection, and the peak of their action occurs after 4-5 hours. They are convenient for those patients who do not have time or do not want to have breakfast at home, but do it at work, but are embarrassed to administer the drug in front of everyone.
You just need to take into account that if you don’t eat food on time, your sugar level may drop sharply, and if your diet contains more carbohydrates than it should, you will have to use an additional injection.
Therefore, this group of insulins is acceptable only for those who, when eating out, know exactly what time they will eat and how many carbohydrates it will contain.
Long-acting insulins
- Monotard MS and NM;
- Protafan;
- Iletin PN;
- Homophan;
- Humulin N;
- Lente.
Their action begins 3-4 hours after injection. For some time, their level in the blood remains unchanged, and the duration of action is 14-16 hours. For type I diabetes, these insulins are injected twice a day.
Insulin dependent diabetes
(Type 1 diabetes mellitus)
Type 1 diabetes usually develops in young people aged 18-29 years.
As a person grows up and enters an independent life, he experiences constant stress, and bad habits are acquired and taken root.
Due to certain pathogenic (disease-causing) factors- viral infection, frequent alcohol consumption, smoking, stress, eating processed foods, hereditary predisposition to obesity, pancreatic disease - the development of an autoimmune disease occurs.
Its essence is that the body’s immune system begins to fight itself, and in the case of diabetes, the beta cells of the pancreas (islets of Langerhans) that produce insulin are attacked. There comes a time when the pancreas practically stops producing the necessary hormone on its own or produces it in insufficient quantities.
The full picture of the reasons for this behavior of the immune system is not clear to scientists. They believe that the development of the disease is influenced by both viruses and genetic factors. In Russia, approximately 8% of all patients have type 1 diabetes. Type I diabetes is usually a disease of the young, as in most cases it develops in adolescence or young adulthood. However, this type of disease can also develop in a mature person. Beta cells in the pancreas begin to deteriorate several years before symptoms appear. At the same time, the person’s well-being remains at the usual normal level.
The onset of the disease is usually acute, and the person himself can reliably name the date of the onset of the first symptoms: constant thirst, frequent urination, an insatiable feeling of hunger and, despite frequent eating, weight loss, fatigue, and deterioration of vision.
This can be explained as follows. Destroyed beta cells of the pancreas are unable to produce sufficient amounts of insulin, the main effect of which is to reduce the concentration of glucose in the blood. As a result, the body begins to accumulate glucose.
Glucose- a source of energy for the body, but in order for it to get into the cell (by analogy: gasoline is needed to run an engine), it needs a conductor - insulin.
If there is no insulin, then the body's cells begin to starve (hence fatigue), and glucose coming from outside with food accumulates in the blood. In this case, the “starving” cells give a signal to the brain about the lack of glucose, and the liver comes into action, releasing an additional portion of glucose into the blood from its own glycogen reserves. Struggling with an excess of glucose, the body begins to intensively remove it through the kidneys. Hence the frequent urination. The body replenishes fluid loss by frequently quenching thirst. However, over time, the kidneys cease to cope with the task, so dehydration, vomiting, abdominal pain, and impaired kidney function occur. Glycogen reserves in the liver are limited, so when they run low, the body will begin to process its own fat cells to produce energy. This explains the weight loss. But the transformation of fat cells to release energy occurs more slowly than with glucose, and is accompanied by the appearance of unwanted “waste”.
Ketone (that is, acetone) bodies begin to accumulate in the blood, the increased content of which leads to conditions dangerous to the body - from ketoacidosis And acetone poisoning(acetone dissolves the fatty membranes of cells, preventing the penetration of glucose inside, and sharply inhibits the activity of the central nervous system) up to coma.
It is by the presence of increased levels of ketone bodies in the urine that the diagnosis of “type 1 diabetes mellitus” is made, since acute malaise in a state of ketoacidosis is what brings a person to the doctor. In addition, people around can often feel the patient’s “acetone” breath.
Because the destruction of beta cells in the pancreas occurs gradually, an early and accurate diagnosis can be made even when there are no obvious symptoms of diabetes. This will stop the destruction and preserve the mass of beta cells that have not yet been destroyed.
There are 6 stages of development of type 1 diabetes mellitus:
1. Genetic predisposition to type 1 diabetes mellitus. At this stage reliable results can be obtained through studies of genetic markers of the disease. The presence of HLA group antigens in a person greatly increases the risk of developing type 1 diabetes.
2. Starting moment. Beta cells are influenced by various pathogenic (disease-causing) factors (stress, viruses, genetic predisposition, etc.), and the immune system begins to form antibodies. Impairment of insulin secretion has not yet occurred, but the presence of antibodies can be determined using an immunological test.
3. Prediabetes stage. The destruction of beta cells of the pancreas by autoantibodies of the immune system begins. There are no symptoms, but disorders of insulin synthesis and secretion can already be detected using a glucose tolerance test. In most cases, antibodies to pancreatic beta cells, antibodies to insulin, or the presence of both types of antibodies simultaneously are detected.
4. Decreased insulin secretion. Stress tests can reveal violationtoleranceToglucose(NTG) and abnormal fasting plasma glucose(NGPN).
5. "Honeymoon. At this stage, the clinical picture of diabetes mellitus is presented with all the listed symptoms. Destruction of pancreatic beta cells reaches 90%. Insulin secretion is sharply reduced.
6. Complete destruction of beta cells. Insulin is not produced.
You can independently determine whether you have type 1 diabetes only at the stage when all the symptoms are present. They arise simultaneously, so this will not be difficult to do. The presence of only one symptom or a combination of 3-4, for example, fatigue, thirst, headache and itching, does not yet indicate diabetes, although, of course, it indicates another ailment.
To determine if you have diabetes, laboratory tests are required for sugar content in blood and urine, which can be carried out both at home and in the clinic. This is the primary method. However, it should be remembered that an increase in blood sugar in itself does not mean the presence of diabetes mellitus. It may be caused by other reasons.
Psychologically, not everyone is ready to admit that they have diabetes, and people often wait until the last minute. And yet, if you discover that you have the most alarming symptom - “sweet urine”, it is better to go to the hospital. Even before the advent of laboratory tests, English doctors and ancient Indian and Eastern practitioners noticed that the urine of diabetic patients attracted insects, and called diabetes “sweet urine disease.”
Currently, a wide range of medical devices are produced aimed at self-monitoring of blood sugar levels by a person - glucometers And test strips to them.
Test strips for visual control are sold in pharmacies, are easy to use and accessible to everyone. When purchasing a test strip, be sure to pay attention to the expiration date and read the instructions. Before using the test, you must wash your hands thoroughly and dry them. There is no need to wipe the skin with alcohol.
It is better to take a disposable needle with a round cross-section or use a special lancet, which is included with many tests. Then the wound will heal faster and be less painful. It is best not to pierce the pad, since this is the working surface of the finger and constant touching does not contribute to the rapid healing of the wound, but the area is closer to the nail. It is better to massage your finger before injecting. Then take a test strip and leave a swollen drop of blood on it. It is worth paying attention that you should not add blood or smear it on the strip. You need to wait until the drop swells enough to capture both halves of the test field. To do this you will need a watch with a second hand. After the time specified in the instructions, wipe off the blood from the test strip with a cotton swab. In good lighting, compare the changed color of the test strip with the scale that is usually located on the test box.
This visual method of determining blood sugar levels may seem inaccurate to many, but the data turns out to be quite reliable and sufficient to correctly determine whether sugar is elevated or to set the dose of insulin required for the patient.
The advantage of test strips over a glucometer is their relative cheapness. Nevertheless, Glucometers have a number of advantages over test strips. They are portable and lightweight. The result appears faster (from 5 s to 2 min). The drop of blood may be small. There is no need to wipe the blood off the strip. In addition, glucometers often have an electronic memory into which the results of previous measurements are entered, so this is a kind of diary of laboratory tests.
Currently, two types of glucometers are produced. The former have the same ability as the human eye to visually detect changes in the color of the test field.
And the basis of the work of the second, sensory ones, is the electrochemical method, which is used to measure the current that arises when chemical reaction blood glucose with substances applied to the strip. Some blood glucose meters also measure blood cholesterol levels, which is important for many people with diabetes. Thus, if you have the classic hyperglycemic triad: frequent urination, constant thirst and insatiable hunger, as well as a genetic predisposition, everyone can use a glucometer at home or buy test strips at the pharmacy. After which, of course, you need to consult a doctor. Even if these symptoms do not indicate diabetes, in any case they did not arise by chance.
When making a diagnosis, the type of diabetes is first determined, then the severity of the disease (mild, moderate and severe). The clinical picture of type 1 diabetes is often accompanied by various complications.
1. Persistent hyperglycemia- the main symptom of diabetes mellitus when elevated blood sugar levels persist for a long time. In other cases, not being a diabetic characteristic, temporary hyperglycemia may develop in a person during infectiousdiseases, V post-stress period or with eating disorders, such as bulimia, when a person does not control the amount of food eaten.
Therefore, if at home using a test strip you were able to detect an increase in blood glucose levels, you should not rush to conclusions. You need to see a doctor - he will help determine the real reason hyperglycemia. Glucose levels in many countries around the world are measured in milligrams per deciliter (mg/dL), and in Russia in millimoles per liter (mmol/L). The conversion factor from mmol/l to mg/dl is 18. The table below shows which values are critical.
Glucose level. Content mmol/l and mg/dl
Blood glucose level (mol/l) |
Blood glucose level (mg/dl) |
Severity of hyperglycemia |
6.7 mmol/l |
Mild hyperglycemia |
|
7.8 mmol/l |
||
Moderate hyperglycemia |
||
10 mmol/l |
||
14 mmol/l |
||
Over 14 mmol/l – severe hyperglycemia |
||
Over 16.5 mmol/l – precoma |
||
Over 55.5 mmol/l - coma |
Diabetes is diagnosed with the following indicators: glycemia in capillary blood on an empty stomach is more than 6.1 mmol/l, 2 hours after a meal - more than 7.8 mmol/l, or at any time of the day is more than 11.1 mmol/l. Glucose levels can be changed repeatedly throughout the day, before and after meals. The concept of normal varies, but there is a range of 4-7 mmol/l for healthy adults on an empty stomach. Prolonged hyperglycemia leads to damage to the blood vessels and the tissues they supply.
Signs of acute hyperglycemia are ketoacidosis, arrhythmia, impaired state of consciousness, dehydration. If you notice a high level of sugar in your blood, accompanied by nausea, vomiting, abdominal pain, severe weakness and clouding of consciousness or an acetone smell in your urine, you should immediately call an ambulance. This is probably most likely a diabetic coma, so urgent hospitalization is necessary!
However, even if there are no signs of diabetic ketoacidosis, but there is thirst, dry mouth, and frequent urination, you still need to consult a doctor. Dehydration is also dangerous. While waiting for the doctor, you need to drink more water, preferably alkaline or mineral water (buy it at a pharmacy and keep a supply at home).
Possible causes of hyperglycemia:
* a common mistake when conducting analysis;
* incorrect dosage of insulin or hypoglycemic agents;
* diet violation (increased consumption of carbohydrates);
* infectious disease, especially accompanied high temperature and fever. Any infection requires an increase in insulin in the patient’s body, so you should increase the dose by about 10%, having previously informed your physician. When taking pills to treat diabetes, their dose should also be increased after consulting with your doctor (he may recommend a temporary switch to insulin);
* hyperglycemia as a consequence of hypoglycemia. A sharp decrease in sugar leads to the release of glucose reserves from the liver into the blood. There is no need to reduce this sugar, it will soon return to normal on its own; on the contrary, you should reduce the dose of insulin. It is also likely that with normal sugar in the morning and during the day, hypoglycemia may appear at night, so it is important to choose a day and carry out the analysis at 3-4 am.
Symptoms of nocturnal hypoglycemia are nightmares, rapid heartbeat, sweating, chills;
* short-term stress (exam, going to the dentist);
* menstrual cycle. Some women experience hyperglycemia during certain phases of their cycle. Therefore, it is important to keep a diary and learn to identify such days in advance and adjust the dose of insulin or diabetes pills accordingly;
* probable pregnancy;
* myocardial infarction, stroke, trauma. Any operation causes an increase in body temperature. However, since in this case the patient is most likely under medical supervision, it is necessary to inform him about the presence of diabetes;
2. Microangiopathy - the general name for lesions of small blood vessels, a violation of their permeability, increased fragility, increased susceptibility to thrombosis. Diabetes manifests itself in the form of the following concomitant diseases:
* diabetic retinopathy- damage to the retinal arteries of the eye, accompanied by small hemorrhages in the area of the optic nerve head;
* diabetic nephropathy- damage to small blood vessels and arteries of the kidneys in diabetes mellitus. Manifested by the presence of protein and blood enzymes in the urine;
* diabetic arthropathy- joint damage, the main symptoms are: “crunching”, pain, limited mobility;
* diabetic neuropathy, or diabetic amyotrophy. This is nerve damage that develops during prolonged (several years) hyperglycemia. Neuropathy is based on ischemic nerve damage caused by metabolic disorders. Often accompanied by pain of varying intensity. One type of neuropathy is radiculitis.
Most often, autonomic neuropathy is detected in type 1 diabetes. (symptoms: fainting, dry skin, decreased tear production, constipation, blurred vision, impotence, decreased body temperature, sometimes loose stools, sweating, hypertension, tachycardia) or sensory polyneuropathy. Muscle paresis (weakening) and paralysis are possible. These complications can appear in type 1 diabetes before 20-40 years of age, and in type 2 diabetes - after 50 years;
* diabetic enuephalopathies. Due to ischemic nerve damage, intoxication of the central nervous system often occurs, which manifests itself in the form of constant irritability of the patient, states of depression, mood instability and moodiness.
3. Macroangiopathies - the general name for lesions of large blood vessels - coronary, cerebral and peripheral. This common reason early disability and high mortality in patients with diabetes.
Atherosclerosis of the coronary arteries, aorta, and cerebral vessels often occurs in patients with diabetes. The main reason for its appearance is associated with increased insulin levels as a result of treatment for type 1 diabetes mellitus or impaired insulin sensitivity in type 2 diabetes.
Damage to the coronary arteries occurs 2 times more often in patients with diabetes and leads to myocardial infarction or the development of coronary heart disease. Often a person does not feel any pain, and then a sudden myocardial infarction follows. Almost 50% of people with diabetes die from myocardial infarction, and the risk of development is the same for both men and women. Myocardial infarction is often accompanied by this condition, with only one thing a state of ketoacidosis can cause a heart attack.
Peripheral vascular disease leads to the emergence of the so-called diabetic foot syndrome. Ischemic lesions of the feet are caused by impaired circulation in the affected blood vessels of the lower extremities, which leads to trophic ulcers on the skin of the lower leg and foot and the occurrence of gangrene mainly in the area of the first toe. In diabetes, gangrene is dry, with little or no pain. Lack of treatment can lead to limb amputation.
After determining the diagnosis and identifying the severity of diabetes mellitus you should familiarize yourself with the rules of the new lifestyle, which from now on will need to be led in order to feel better and not aggravate the situation.
The main treatment for type 1 diabetes are regular insulin injections and diet therapy. A severe form of type 1 diabetes mellitus requires constant monitoring by doctors and symptomatic treatment of complications of the third degree of severity - neuropathy, retinopathy, nephropathy.
Etiology and pathogenesis
The pathogenetic mechanism for the development of type 1 diabetes is the insufficiency of insulin production by the endocrine cells of the pancreas (pancreatic β-cells), caused by their destruction under the influence of certain pathogenic factors (viral infection, stress, autoimmune diseases, etc.). Type 1 diabetes accounts for 10-15% of all diabetes cases and, in most cases, develops during childhood or adolescence. This type of diabetes is characterized by the onset of core symptoms that progress rapidly over time. The main method of treatment is insulin injections, which normalize the patient’s metabolism. If left untreated, type 1 diabetes progresses rapidly and leads to severe complications such as ketoacidosis and diabetic coma, ending in the death of the patient.
Classification
According to severity:
- mild course
- moderate severity
- severe course
2.According to the degree of compensation of carbohydrate metabolism:
- compensation phase
- subcompensation phase
- decompensation phase
3. For complications:
- Diabetic micro- and macroangiopathy
- Diabetic polyneuropathy
- Diabetic arthropathy
- Diabetic ophthalmopathy, retinopathy
- Diabetic nephropathy
- Diabetic encephalopathy
Pathogenesis and pathohistology
Insulin deficiency in the body develops due to insufficient secretion of insulin by the β-cells of the islets of Langerhans of the pancreas.
Due to insulin deficiency, insulin-dependent tissues (liver, fat and muscle) lose their ability to utilize blood glucose and, as a result, the level of glucose in the blood increases (hyperglycemia) - a cardinal diagnostic sign of diabetes mellitus. Due to insulin deficiency, the breakdown of fats is stimulated in adipose tissue, which leads to an increase in their levels in the blood, and in muscle tissue, the breakdown of proteins is stimulated, which leads to an increased supply of amino acids into the blood. Substrates for the catabolism of fats and proteins are transformed by the liver into ketone bodies, which are used by non-insulin-dependent tissues (mainly the brain) to maintain energy balance against the background of insulin deficiency.
Glucosuria is an adaptive mechanism for removing high levels of glucose from the blood when the glucose level exceeds the threshold value for the kidneys (about 10 mmol/l). Glucose is an osmoactive substance and an increase in its concentration in the urine stimulates increased excretion of water (polyuria), which can ultimately lead to dehydration of the body if the loss of water is not adequately compensated. increased consumption fluids (polydipsia). Along with the increased loss of water in the urine, mineral salts are also lost - a deficiency of sodium, potassium, calcium and magnesium cations, chlorine anions, phosphate and bicarbonate develops.
There are 6 stages of development of T1DM. 1) Genetic predisposition to T1DM associated with the HLA system. 2) Hypothetical starting moment. Damage to β - cells by various diabetogenic factors and triggering of immune processes. In patients, the above antibodies are already detected in a small titer, but insulin secretion is not yet affected. 3) Active autoimmune insulinitis. The antibody titer is high, the number of β-cells decreases, and insulin secretion decreases. 4) Decrease in glucose-stimulated secretion of I. In stressful situations, transient IGT (impaired glucose tolerance) and NGPG (impaired fasting plasma glucose) can be detected in a patient. 5) Clinical manifestation of diabetes, including a possible “honeymoon” episode. Insulin secretion is sharply reduced, as more than 90% of β-cells have died. 6) Complete destruction of β-cells, complete cessation of insulin secretion.
Clinic
- hyperglycemia. Symptoms caused by increased blood sugar levels: polyuria, polydipsia, weight loss with decreased appetite, dry mouth, weakness
- microangiopathies (diabetic retinopathy, neuropathy, nephropathy),
- macroangiopathy (atherosclerosis of the coronary arteries, aorta, cerebral vessels, lower extremities), diabetic foot syndrome
- concomitant pathology (furunculosis, colpitis, vaginitis, genitourinary tract infection)
Mild diabetes - compensated by diet, no complications (only with diabetes 2) Moderate diabetes - compensated by PSSP or insulin, diabetics are detected vascular complications 1-2 degrees of severity. Severe diabetes - labile course, complications of the 3rd degree of severity (nephropathy, retinopathy, neuropathy).
Diagnostics
In clinical practice, sufficient criteria for the diagnosis of type 1 diabetes mellitus are the presence of typical symptoms of hyperglycemia (polyuria and polydipsia) and laboratory confirmed hyperglycemia - fasting capillary blood glucose more than 7.0 mmol/l and/or at any time of day more than 11.1 mmol/ l;
When making a diagnosis, the doctor acts according to the following algorithm.
- Diseases that manifest themselves with similar symptoms (thirst, polyuria, weight loss) are excluded: diabetes insipidus, psychogenic polydipsia, hyperparathyroidism, chronic renal failure, etc. This stage ends with laboratory confirmation of hyperglycemia syndrome.
- The nosological form of diabetes is being clarified. First of all, diseases that are included in the group “Other specific types of diabetes” are excluded. And only then is the issue of T1DM or whether the patient suffers from T2DM resolved. The level of C-peptide is determined on an empty stomach and after exercise. The level of concentration of GAD antibodies in the blood is also assessed.
Complications
- Ketoacidosis, hyperosmolar coma
- Hypoglycemic coma (in case of insulin overdose)
- Diabetic micro- and macroangiopathy - impaired vascular permeability, increased fragility, increased susceptibility to thrombosis, and the development of vascular atherosclerosis;
- Diabetic polyneuropathy - polyneuritis of peripheral nerves, pain along the nerve trunks, paresis and paralysis;
- Diabetic arthropathy - joint pain, “crunching”, limited mobility, decreased number of synovial fluid and increasing its viscosity;
- Diabetic ophthalmopathy - early development of cataracts (clouding of the lens), retinopathy (retinal damage);
- Diabetic nephropathy - kidney damage with the appearance of protein and blood cells in the urine, and in severe cases with the development of glomerulonephritis and renal failure;
- Diabetic encephalopathy - mental and mood changes, emotional lability or depression, symptoms of central nervous system intoxication.
Treatment
Main goals of treatment:
- Elimination of all clinical symptoms of diabetes
- Achieving optimal metabolic control over the long term.
- Prevention of acute and chronic complications of diabetes
- Ensuring a high quality of life for patients.
To achieve these goals, use:
- diet
- dosed individual physical activity (DIPE)
- teaching patients self-control and simple treatment methods (managing their disease)
- constant self-control
Insulin therapy
Insulin therapy is based on simulating physiological insulin secretion, which includes:
- basal secretion (BS) of insulin
- stimulated (food) insulin secretion
Basal secretion ensures an optimal level of glycemia during the interdigestive period and during sleep, promotes the utilization of glucose entering the body outside meals (gluconeogenesis, glycolysis). Its rate is 0.5-1 units/hour or 0.16-0.2-0.45 units per kg of actual body weight, that is, 12-24 units per day. With physical activity and hunger, BS decreases to 0.5 units/hour. The secretion of stimulated dietary insulin corresponds to the level of postprandial glycemia. The level of CV depends on the level of carbohydrates eaten. For 1 bread unit (XE) approximately 1-1.5 units are produced. insulin. Insulin secretion is subject to daily fluctuations. In the early morning hours (4-5 o'clock) it is highest. Depending on the time of day, 1 XE is secreted:
- for breakfast - 1.5-2.5 units. insulin
- for lunch 1.0-1.2 units. insulin
- for dinner 1.1-1.3 units. insulin
1 unit of insulin reduces blood sugar by 2.0 mmol/unit, and 1 XE increases it by 2.2 mmol/l. Of the average daily dose (ADD) of insulin, the amount of dietary insulin is approximately 50-60% (20-30 units), and the share of basal insulin accounts for 40-50%.
Principles of insulin therapy (IT):
- the average daily dose (ADD) of insulin should be close to physiological secretion
- when distributing insulin throughout the day, 2/3 of the SSD should be administered in the morning, afternoon and early evening and 1/3 in the late evening and at night
- using a combination of short-acting insulin (RAI) and long-acting insulin. Only this allows us to approximately simulate the daily secretion of I.
During the day, the ICD is distributed as follows: before breakfast - 35%, before lunch - 25%, before dinner - 30%, at night - 10% of the insulin SDD. If necessary, at 5-6 o'clock in the morning 4-6 units. ICD. Do not administer > 14-16 units in one injection. If it is necessary to administer a large dose, it is better to increase the number of injections by shortening the administration intervals.
Correction of insulin doses according to glycemic level To adjust the doses of the administered ICD, Forsch recommended that for every 0.28 mmol/L blood sugar exceeding 8.25 mmol/L, an additional unit should be administered. I. Therefore, for every “extra” 1 mmol/l of glucose, an additional 2-3 units are required. AND
Correction of insulin doses for glucosuria The patient must be able to carry it out. During the day, in the intervals between insulin injections, collect 4 portions of urine: 1 portion - between breakfast and lunch (previously, before breakfast, the patient must empty the bladder), 2 - between lunch and dinner, 2 - between dinner and 22 o'clock, 4 - from 22 o'clock until breakfast. In each portion, diuresis is taken into account, the % glucose content is determined and the amount of glucose in grams is calculated. If glucosuria is detected, to eliminate it, an additional 1 unit is administered for every 4-5 g of glucose. insulin. The day after urine collection, the dose of insulin administered is increased. After compensation has been achieved or approached, the patient should be transferred to a combination of ICD and ISD.
Traditional insulin therapy (IT). Allows you to reduce the number of insulin injections to 1-2 times a day. With TIT, ISD and ICD are simultaneously administered 1 or 2 times a day. At the same time, ISD accounts for 2/3 of SSD, and ICD accounts for 1/3 of SSD. Advantages:
- ease of administration
- ease of understanding of the essence of treatment by patients, their relatives, and medical personnel
- no need for frequent glycemic control. It is enough to control glycemia 2-3 times a week, and if self-control is impossible - 1 time a week
- treatment can be carried out under the control of the glucosuric profile
Flaws
- the need for strict adherence to the diet in accordance with the selected dose AND
- the need for strict adherence to the daily routine, sleep, rest, physical activity
- mandatory 5-6 meals a day, at a strictly defined time, tied to the introduction of I
- inability to maintain glycemia within physiological fluctuations
- Constant hyperinsulinemia accompanying TIT increases the risk of developing hypokalemia, arterial hypertension, and atherosclerosis.
TIT shown
- elderly people if they are unable to master the requirements of IIT
- persons with mental disorders, low educational level
- patients in need of outside care
- undisciplined patients
Calculation of insulin doses for TIT 1. Preliminarily determine the insulin SDD 2. Distribute the insulin SDD by time of day: 2/3 before breakfast and 1/3 before dinner. Of these, ICD should account for 30-40%, ISD - 60-70% of SSD.
IIT(IT Intensive) Basic principles of IIT:
- the need for basal insulin is provided by 2 injections of ISD, which is administered in the morning and evening (the same drugs are used as for TIT). The total dose of ISD is not > 40-50% of the SSD, 2/3 of the total dose of ISD is administered before breakfast, 1/3 before dinner.
- food - bolus insulin secretion is simulated by the introduction of an ICD. The required ICD doses are calculated taking into account the amount of XE planned for breakfast, lunch and dinner and the level of glycemia before meals. IIT provides for mandatory glycemic control before each meal, 2 hours after meals and at night. That is, the patient must monitor glycemia 7 times a day.
Advantages
- imitation of physiological secretion I (basal stimulated)
- the possibility of a more free lifestyle and daily routine for the patient
- the patient can use a “liberalized” diet by changing the timing of meals and the set of foods as desired
- higher quality of life for the patient
- effective control of metabolic disorders, preventing the development of late complications
- the need to educate patients on the problem of diabetes, issues of its compensation, calculation of blood cholesterol, the ability to select doses and develops motivation, understanding of the need for good compensation, prevention of complications of diabetes.
Flaws
- the need for constant self-monitoring of glycemia, up to 7 times a day
- the need to educate patients in schools with diabetes, and change their lifestyle.
- additional costs for training and self-control tools
- tendency to hypoglycemia, especially in the first months of IIT
Mandatory conditions for the possibility of using IIT are:
- sufficient intelligence of the patient
- ability to learn and put acquired skills into practice
- possibility of purchasing self-control means
IIT shown:
- in case of type 1 diabetes it is desirable for almost all patients, and in case of newly diagnosed diabetes it is mandatory
- during pregnancy - transfer to IIT for the entire period of pregnancy, if before pregnancy the patient was treated at IIT
- with gestational diabetes, in case of ineffective diet and DIFN
Scheme of patient management when using IIT
- Calculation of daily calories
- Calculation of the amount of carbohydrates in XE, proteins and fats planned for consumption per day - in grams. Although the patient is on a “liberalized” diet, he should not eat more carbohydrates per day than the calculated dose in XE. Not recommended for 1 dose of more than 8 XE
- Calculation of SSD I
The calculation of the total dose of basal I is carried out by any of the above methods - the calculation of the total food (stimulated) I is carried out based on the amount of XE that the patient plans to consume during the day
- Distribution of doses of administered I during the day.
- Self-monitoring of glycemia, correction of food doses.
Simpler modified IIT techniques:
- 25% SSD I is administered before dinner or at 22:00 as an IDD. The ICD (accounting for 75% of the SDI) is distributed as follows: 40% before breakfast, 30% before lunch and 30% before dinner
- 30% SSD I is administered as IDD. Of these: 2/3 doses before breakfast, 1/3 before dinner. 70% of SSDs are administered as ICDs. Of these: 40% of the dose before breakfast, 30% before lunch, 30% before dinner or at night.
In the future - dose adjustment I.
Diabetes- a disease in which the body loses the ability to use glucose for energy as a result of an imbalance in the quantitative level of the hormone insulin or a decrease in sensitivity to its action. It is one of the most common chronic diseases. Sometimes predisposition to the disease is inherited. Risk factors depend on the type of disease.
Diabetes characterized either by insufficient secretion of the hormone insulin by the pancreas, or by the resistance of body cells to its effects. At diabetes mellitus Cells are forced to use other energy sources, which can lead to toxic metabolic byproducts in the body. Unused glucose accumulates in the blood and urine, resulting in symptoms such as increased urination and thirst.
Treatment of the disease is aimed at establishing control over blood sugar levels. Approximately 10% of patients treated for diabetes mellitus, depend on insulin injections that they give themselves throughout their lives. Other patients require a carefully selected diet and often oral glucose-lowering medications. Compliance with these measures allows most patients to lead a normal life. Complications of diabetes include diseases of the eyes, kidneys, cardiovascular and nervous systems. Besides, diabetes weakens the body's immune system, which increases a person's susceptibility to infections such as cystitis. The disease is usually chronic; treatment methods leading to complete recovery are this moment does not exist.
There are two main forms diabetes mellitus: diabetes type I and type II.
Diabetes type II. This is a much more common type of diabetes. In this form, the pancreas continues to produce insulin, but body cells lose sensitivity to its effects. This form of diabetes mainly affects people over the age of 40 and is more common among overweight people. The disease develops slowly and often goes unnoticed for many years. Sometimes the disease can be controlled solely by dietary adjustments, although oral hypoglycemic medications and rarely insulin injections may be necessary.
Diabetes can sometimes develop during pregnancy. This disease, called gestational diabetes, is usually treated with insulin to help keep mother and baby healthy. Diabetes in pregnancy usually goes away after childbirth, but women who have it have an increased risk of developing type II diabetes in the future.
The causes of type II diabetes are less well understood, although genetics and obesity play important roles. Diabetes type II is a problem for society that is becoming more acute due to the widespread prevalence of the disease, as well as due to the increase in the amount of food consumed per share of the population, which leads to an increase in the number of overweight people.
The combination of excess obesity, high blood pressure, diabetes and high cholesterol is called metabolic syndrome.
The main symptoms of both forms of diabetes include:
Frequent urination;
Thirst and dry mouth;
Sleep disturbances caused by the need to frequently go to the toilet;
Decreased performance;
Visual impairment.
Diabetes can lead to the development of both short-term and chronic complications. Short-term complications usually respond well to treatment, but chronic complications are difficult to control and their progression can lead to premature death of the patient.
One of the most common complications in the treatment of both types of diabetes is hypoglycemia, a condition in which blood sugar levels drop to dangerous levels. Hypoglycemia is often caused by a poor balance between food intake and insulin doses. The disease is most often observed in patients with type I diabetes, but can also develop in patients with type II diabetes taking urea derivatives. Left without medical attention, hypoglycemia leads to loss of consciousness and coma.
Chronic complications. Chronic complications diabetes mellitus, which pose the main threat to the health of patients with this disease, eventually occur even in patients with well-compensated disease. Careful monitoring of blood sugar levels reduces the risk of developing such problems, and early detection helps to establish control over their course.
In people suffering diabetes mellitus, increased risk of developing vascular diseases. Large blood vessels can be affected by atherosclerosis, the main cause of coronary heart disease and stroke. Elevated blood cholesterol levels, which contribute to the development of atherosclerosis, are common among patients with diabetes mellitus. In addition, diabetes is often associated with hypertension, another risk factor for cardiovascular disease.
Other chronic complication diabetes mellitus is damage to small blood vessels in all tissues and organs. Diabetes also increases the risk of developing cataracts.
If the blood supply to the nerves is impaired due to diabetes, nerve endings may be damaged. In this case, there may be a gradual loss of sensation, starting in the hands and feet, sometimes moving up the entire limb. Symptoms may also include dizziness when standing and erectile dysfunction in men. Loss of sensation combined with poor blood supply makes the feet more susceptible to ulceration and gangrene.
Damage to the small blood vessels of the kidneys can lead to the development of chronic renal failure or its progression to end-stage failure, which requires lifelong dialysis or a kidney transplant.
First, the doctor will direct the patient to take a urine test to determine the presence of sugar in it. The diagnosis is confirmed by a blood test to check the level of sugar in the blood. If the blood sugar reading is in the borderline range, the patient can repeat the blood test in the morning on an empty stomach. In addition, the patient may have blood tested to determine the level of glycosylated hemoglobin, an altered form of pigment in red blood cells, the concentration of which also appears to be elevated when blood sugar readings are high for several weeks or months.
For every patient suffering diabetes mellitus, the main goal of treatment should be to maintain blood sugar levels within acceptable limits. Treatment usually requires lifelong treatment, and the patient will be forced to make responsible daily decisions about adjusting diet and medication dosage.
Diabetes type II. Many people with this type of disease can manage their blood sugar levels with regular exercise and a healthy diet aimed at achieving their ideal weight.
It is important to keep your fat intake low and also get the energy you need from complex carbohydrates to keep blood sugar fluctuations to a minimum. The diet should provide a fixed daily calorie intake, with constant proportions of protein, carbohydrates and fat.
In addition, the patient should regularly measure their blood sugar levels. If diet alone is not enough to maintain normal sugar levels, the patient may additionally be prescribed one or more glucose-lowering medications. Treatment will likely begin with oral medications, such as sulfonylureas, which stimulate the pancreas to release insulin, or metformin, which helps body tissues absorb glucose. Other newer drugs, such as pioglitazone or rosiglitazone, can lower sugar levels by making cells more responsive to its effects.
Diabetes may cause premature death of the patient, usually due to complications from the cardiovascular system. However, successful blood sugar control in combination with in a healthy way life simplifies the achievement of compensation for the disease, which allows people suffering from it to maintain an almost normal lifestyle.
Type 2 diabetes is called non-insulin dependent. This means that blood sugar rises not due to a lack of insulin, but due to the immunity of the receptors to it. In this regard, this type of pathology has its own characteristics of course and treatment.
Type 2 diabetes mellitus, or non-insulin-dependent diabetes mellitus, is a metabolic disease with the development of chronically elevated blood sugar levels. This occurs either due to decreased synthesis of the pancreatic hormone, or due to decreased sensitivity of cells to it. In the latter case, they say that the person develops insulin resistance. And this despite the fact that in the initial stages of the disease, a sufficient or even increased amount of the hormone is synthesized in the body. In turn, chronic hyperglycemia leads to damage to all organs.
What you need to know about non-insulin-dependent diabetes mellitus
First of all, we note that diabetes mellitus is characterized by an increased level of glucose in the blood. In this case, the person experiences symptoms such as increased urination and increased fatigue. Fungal infections appear on the skin, which cannot be gotten rid of. In addition, diabetes can cause vision problems, weakened memory and attention, and other problems.
If diabetes is not controlled and treated incorrectly, which happens very often, a person can die prematurely. Causes of death: gangrene, cardiovascular pathologies, end-stage renal failure.
Diabetes mellitus of the non-insulin-dependent type mainly develops in middle age - after forty years. However, in Lately This disease is increasingly occurring among young people. The causes of this disease are poor nutrition, excess weight and physical inactivity.
If this type of diabetes is not treated, then over the years it becomes insulin-dependent with a constant deficiency of the hormone insulin in the body and poor compensation for hyperglycemia. In modern conditions, this rarely happens, since many patients die from complications due to lack or improper treatment.
Why does the body need insulin?
This is the most important hormone that controls blood glucose levels. With its help, its content in the blood is regulated. If for some reason the production of insulin stops (and this condition cannot be compensated for by insulin injections), then the person quickly dies.
You need to know that in a healthy body there is a fairly narrow range of blood sugar levels. It is kept within such limits only thanks to insulin. Under its action, liver and muscle cells draw glucose and convert it into glycogen. And for glycogen to turn back into glucose, glucagon is needed, which is also produced in the pancreas. If there is no glycogen in the body, then glucose begins to be produced from protein.
In addition, insulin ensures the conversion of glucose into fat, which is then stored in the body. If you consume a lot of food rich in carbohydrates, then there will be a constantly high level of insulin in the blood. This makes it very difficult to lose weight. Moreover, the more insulin there is in the blood, the more difficult it will be to lose weight. Due to such disturbances in carbohydrate metabolism, diabetes mellitus develops.
Main symptoms of diabetes
The disease develops gradually. Usually a person is not aware of this, and the disease is diagnosed by chance. Non-insulin-dependent diabetes mellitus has the following characteristic symptoms:
- blurred vision;
- poor memory;
- fatigue;
- itchy skin;
- the appearance of fungal skin diseases (and it is very difficult to get rid of them);
- increased thirst (it happens that a person can drink up to five liters of liquid per day);
- frequent urination (note that it also happens at night, several times);
- strange sensations of tingling and numbness in the lower extremities, and pain when walking;
- the development of thrush, which is very difficult to treat;
- In women, the menstrual cycle is disrupted, and in men, potency is disrupted.
In some cases, diabetes mellitus may occur without pronounced symptoms. Sudden myocardial infarction or stroke are also manifestations of non-insulin-dependent diabetes mellitus.
With this disease, a person may experience increased appetite. This occurs because the body's cells do not absorb glucose due to insulin resistance. If there is too much glucose in the body, but the body does not absorb it, then the breakdown of fat cells begins. When fat breaks down, ketone bodies appear in the body. The smell of acetone appears in the air a person exhales.
With a high concentration of ketone bodies, the pH of the blood changes. This condition is very dangerous due to the risk of developing ketoacidotic coma. If a person has diabetes and consumes few carbohydrates, then the pH value does not fall, which does not cause lethargy, drowsiness and vomiting. The appearance of the smell of acetone indicates that the body is gradually getting rid of excess weight.
Complications of the disease
Non-insulin-dependent diabetes mellitus is dangerous due to acute and chronic complications. Among the acute complications, the following should be noted.
- Diabetic ketoacidosis is the most dangerous complication of diabetes mellitus. It is dangerous due to increased blood acidity and the development of ketoacidotic coma. If a patient knows all the intricacies of his disease and knows how to calculate the dose of insulin, the likelihood of developing such a complication is zero.
- Hyperglycemic coma is a disorder and loss of consciousness due to an increase in the amount of glucose in the blood. Often combined with ketoacidosis.
If the patient is not provided with emergency assistance, the patient's death is possible. Doctors need to make a lot of efforts to bring him back to life. Unfortunately, the mortality rate in patients is very high and reaches 25 percent.
However, the vast majority of patients suffer not from acute, but from chronic complications of the disease. If left untreated, they can also be fatal in many cases. However, diabetes mellitus is dangerous because its consequences and complications are insidious, since for the time being they do not let anyone know about themselves. And the most dangerous complications on the kidneys, eyesight and heart appear too late. Here are some of the complications that diabetes can cause.
- Diabetic nephropathy. This is severe kidney damage, causing the development of chronic renal failure. Most patients undergoing dialysis and kidney transplants have diabetes.
- Retinopathy is a disease of the eyes. It is the cause of blindness in middle-aged patients.
- Neuropathy – nerve damage – already occurs in three diabetic patients at the time of diagnosis. Neuropathy causes decreased sensation in the legs, putting patients at high risk for injury, gangrene, and amputation.
- Angiopathy is vascular damage. Because of this, the tissues do not receive enough nutrients. Disease of large vessels leads to atherosclerosis.
- Skin damage.
- Damage to the heart and coronary vessels, leading to myocardial infarction.
- Impaired potency in men and the menstrual cycle in women.
- Progressive impairment of memory and attention.
Nephropathy and retinopathy are the most dangerous. They only appear when they become irreversible. Other disorders can be prevented by effectively controlling blood sugar. The lower it is, the less likely it is to develop such complications and approaches zero.
Features of treatment of the disease
Type 1 diabetes mellitus, or otherwise insulin-dependent diabetes mellitus (IDDM), is a fairly common serious illness associated with disruption of the pancreas. This organ, for some reason, stops producing the required amount of the hormone insulin, which negatively affects the human hormonal background and all systems of the body.
How does this health disorder affect human health and is it possible to cure the insulin-dependent form of the disease?
Why does the disease develop?
If we consider the causes of type 1 diabetes mellitus, then they are based on the pathological effect of the body’s protective functions. In this case, the immune system begins to perceive pancreatic cells as foreign elements and seeks to destroy them.
Type 1 diabetes most often affects children, adolescents and young adults. This disease also affects women during pregnancy, but after the baby is born, the symptoms disappear. However, in such a situation there is a risk that the disease will manifest itself, but in the form of type 2 diabetes mellitus - non-insulin-dependent.
Among the main reasons leading to the development of IDDM, experts note the following phenomena:
- infections caused by viral pathogens;
- autoimmune diseases;
- liver pathologies in severe forms;
- heredity;
- regular consumption of large amounts of sweet foods;
- obesity;
- frequent stressful situations;
- depressive state.
Whatever causes insulin-dependent diabetes, this disease can radically change a person’s life, and in addition to the “diabetic” status, he becomes dependent on insulin for life.
Different stages of the disease
The disease has several stages, and each of them is accompanied by a number of clinical manifestations.
Stage I
At the beginning of development, the disease does not manifest itself in any way, but as a result of genetic tests, defective genes can be detected.
Doctors are confident that preventive measures are extremely important if there is a risk of developing the disease
Stage II
The transition of type 1 diabetes to the next stage is associated with the activation of catalysts. It is still unknown exactly what triggers this process, but if stage 1 is just a genetic predisposition, then we are talking about pathological changes.
Stage III
To determine the disease at this stage, the patient is prescribed tests to identify a specific antigen to b-cell antibodies. During diagnostic studies, specialists detect a decrease in the number of these cells; naturally, such a change leads to a decrease in insulin levels and an increase in the amount of glucose.
IV stage
It is called tolerant diabetes mellitus, the symptoms of which are still absent. But patients may still be bothered by common symptoms: mild malaise, increased inflammation of the conjunctiva and furunculosis, which often recur.
Stage V
During this period, obvious signs that occur with type 1 diabetes mellitus appear.
The symptoms are quite intense and after a few weeks, if the patient does not receive proper treatment, complications may arise in the form of ketoacidosis, a serious metabolic disorder
If insulin replacement therapy is started in a timely manner, the progression of the disease can slow down significantly.
VI stage
We are talking about a severe course of ISD, in which the results of the analysis are disappointing - the production of insulin by the pancreas is completely stopped.
Symptoms of insulin-dependent diabetes
As already noted, insulin-dependent type 1 diabetes mellitus at a certain stage manifests itself in the form of serious symptoms. The signs of the disease are especially pronounced in children:
- if adults experience increased urination, then in children it can manifest itself in the form of urinary incontinence;
- loss of energy leads to weight loss and a similar symptom again often appears in young patients;
- mucous membranes and skin become dry;
- Diabetics experience constant hunger.
As for life-threatening complications - ketoacidosis or ketoacidotic coma, they are often the first signs of the disease in children. This is due to the fact that children are not able to talk about their own well-being.
According to statistics, more than 80% of people seek advice from a specialist no later than 3 weeks after clear signs of the disease appear.
Diagnostic examination
An endocrinologist knows how to identify insulin-dependent diabetes mellitus. First of all, he collects an anamnesis (history) of the disease, based on the patient’s complaints and existing symptoms. Then he establishes a preliminary diagnosis and prescribes a series of laboratory tests to confirm it:
- a blood test that detects sugar levels (taken on an empty stomach and two to three hours after eating);
- blood test for the amount of glycosylated hemoglobin;
- urine tests - for sugar and for the presence of acetone.
Having studied the results obtained, the doctor will be sure whether the patient has type 2 diabetes or type 1 and will be able to determine a therapeutic treatment regimen.
How is insulin-dependent diabetes treated?
Unfortunately, modern medicine cannot offer treatment that can completely relieve the patient of this disease. In addition, with this type of diabetes, the patient needs a constant supply of insulin from outside.
The list of insulins is quite wide, they vary in duration of action and only a doctor can prescribe the appropriate drug and regimen for its administration.
Table No. 1. Insulins used to treat insulin-dependent diabetes
Duration of action of insulins | Name of funds | Nuances of use |
Ultra short acting (three to five hours) | Apidra, Humalog, Novorapid. | They have an effect very quickly - from 1 to 20 minutes. The effect lasts for an average of 4 hours. |
Short acting (6 – 8 hours) | Insuman, Actrapid, Humulinregular. | The effect takes place half an hour after use. The maximum effect is achieved between 2 and 4 hours after injection. |
Medium-long action (from 16 hours to 24 hours) | Insuman basal, Monotard NM, Humulin NPH, Insulatard. | They act an hour after entering the body. The maximum effect occurs after 4-12 hours. |
Prolonged (long) action (average day) | Lantus, Glargine, Levemir, Detemir. | Allows you to forget about insulin fasting even in the absence of food. They have a uniform effect throughout the day. Requires administration once or twice a day. |
Combination drugs containing various insulins (6-18 hours) | InsumanCombi 25, Mixtard 30, Humulin MZ, NovoMix 30. | They take effect within 30–45 minutes. The maximum effect occurs after 1–3 hours. |
In addition to the fact that a diabetic is prescribed medications for constant use, he is faced with another task - monitoring blood sugar levels.
In modern medicine, there are several options for devices that inject insulin and measure sugar levels.
Diet correction
Although insulin is the mainstay of treatment, the role of proper nutrition should not be underestimated. Since the disease is associated with metabolic processes and its manifestations become more intense when the body does not absorb food well enough, it is very important for the patient to know what he needs to eat, when and in what quantities.
For insulin-dependent diabetes mellitus, a low-carbohydrate diet is indicated, in which it is recommended:
- taking protein foods twice a day;
- saturating the diet with foods rich in beneficial minerals and vitamins;
- exclusion from the menu of foods that are a source of fast carbohydrates.
Diabetics should know which foods can aggravate the condition
Eliminating harmful foods will not only eliminate the risk of complications, but will also allow the patient to lose weight, which will also have a positive effect on overall well-being. But it is worth remembering that the ingestion of additional carbohydrates into the body can lead to its excess and the patient should calculate the amount himself.
Physical activity for insulin-dependent diabetes
Experts unanimously say that type 1 diabetes mellitus (insulin-dependent) does not exclude, but even, on the contrary, requires some mobility and activity from the patient. Indeed, this will have a positive effect on blood sugar levels and help avoid hypoglycemia, however, physical activity alone cannot normalize this indicator.
When practicing, you need to consider the following features:
- physical activity leads to an increase in the rate of absorption of insulin from the injection site;
- against their background, glucose consumption increases, but the need for insulin remains the same;
- It is important to make sure you have enough insulin, otherwise the muscle cells will not be able to absorb glucose.
Patients diagnosed with type 1 diabetes should remember that during intense training, the body depletes stored glycogen in the liver, so there is a risk of developing hypoglycemia. However, if a person exercises regularly, then preventing pathological changes becomes not such a difficult task.
If the disease is not treated
Type 1 diabetes is a disease that causes serious changes in the body; without timely treatment, it can lead to serious consequences.
Depending on the degree of development, it can cause a weakening of the immune system and the body will not be able to resist infectious pathogens. In addition to the mentioned ketoacidosis and hypoglycemia, insulin-dependent disease aggravates existing symptoms up to the development of coma and death.
If nutrition and insulin dosage are not balanced, then a critical decrease in blood glucose levels and the manifestation of hypoglycemic syndrome are possible.
But in addition to transient complications, against the background of diabetes mellitus, the development of chronic diseases and conditions is possible:
- atherosclerosis,
- hypertension,
- stroke,
- myocardial infarction, etc.
Unfortunately, today not everything is known about type 1 diabetes, and scientists have not been able to invent a successful cure for it. Yes, the issue of pancreas implantation is being studied, but so far this operation is not justified, since the survival rate of the transplanted organ is too low. Therefore, a diabetic will have to inject insulin daily and take care of his health and active lifestyle.
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