Diabetes

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

Diabetes mellitus: definition of the disease

Diabetes mellitus (DM) is a group of diseases associated with metabolic disorders. People with diabetes cannot digest carbohydrates properly. As a result, their glucose (blood sugar) concentration rises significantly.

Glucose is a type of sugar that serves as the main source of energy for the body.

Excess glucose has a toxic effect and destroys the walls of blood vessels, nerve fibers and internal organs.

Diabetes mellitus develops for various reasons. Some types of disease are genetic in origin, while others are related to lifestyle or environmental factors.

The name of the disease was given by the ancient Greeks. Translated from Greek, διαβαίνω means "to pass", which refers to the main symptom of diabetes mellitus, polyuria or frequent urination. Because of this, a person continuously loses fluid and tries to replace it by drinking as much water as possible.

However, this is not always the case. Some forms of diabetes can develop asymptomatically for a long time or manifest so mildly that a person does not even notice that something has gone wrong. Even with a typical course of the disease, it often takes many years before excess blood glucose leads to the development of symptoms of the disease. Moreover, the whole time the person is in a state of hyperglycemia, and at the time of diagnosis, he already has severe irreversible disorders in the functioning of the kidneys, blood vessels, brain, peripheral nerves and retina.

The disease causes significant damage to the body. Without treatment, excess glucose can lead to deterioration of kidney, heart and nerve cell function. But such complications can be prevented. Modern doctors have enough effective drugs and techniques to treat diabetes.

Prevalence

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

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

From 2000 to 2019, the death rate from diabetes in developed countries increased by 3%, and in lower-middle income countries by 13%. At the same time, the probability of death from complications of the disease in people aged 30 to 70 years decreased by 22% worldwide. This is believed to be due to improved diagnosis of diabetes and effective methods for early prevention of its complications.

Classification of diabetes

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

Diabetes mellitus type I

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

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

Immune-mediated diabetes mellitusthe result of autoimmune destruction of pancreatic cells, causing the immune system to mistakenly attack its own healthy tissue. Diabetes usually begins in childhood or adolescence, but can develop in people of any age.

Immune-mediated diabetes is often associated with other autoimmune disorders, such as Graves' disease, Hashimoto's thyroiditis, Addison's disease, vitiligo, or pernicious anemia.

Type 1 diabetes mellitus most often develops in children and adolescents, although it can occur at any age.

Idiopathic diabetes mellitus.A rare variant of the disease. Such patients do not have laboratory signs of autoimmune damage, but symptoms of absolute insulin deficiency are observed.

Diabetes mellitus type II

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

Depending on the leading cause, type II diabetes mellitus is divided into type II diabetes mellitus with dominant insulin resistance and relative insulin deficiency and type II diabetes mellitus with dominantly impaired insulin secretion with or without insulin resistance.

Other specific types of diabetes

Other specific forms of the disease include pathologies with a pronounced genetic component, associated with infectious diseases or taking certain drugs, etc.

Genetic defects in pancreatic β-cell functionthose types of diseases in the development of which a defective gene is clearly identified.

Genetic defects in the action of insulinthe development of the pathology is associated with the peripheral action of insulin, which is disturbed due to mutations in the insulin receptor gene.

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

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

Diabetes caused by drugs or chemicals, can occur when taking hormonally active substances, α- and β-adrenergic agonists, psychoactive, diuretic and chemotherapeutic drugs.

Diabetes associated with infectious diseases.As a rule, the disease develops due to viral infections (pathogens: Coxsackie viruses, rubella, Epstein Barr).

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

Other genetic syndromes, sometimes in combination with diabetes.

Gestational diabetes mellitus

It appears for the first time in pregnancy and is characterized by a decrease in the sensitivity of cells to glucose. It is believed that the disease develops due to an imbalance of hormones. After delivery, the condition returns to normal or may develop into type II diabetes.

Causes of diabetes

Diabetes mellitus develops for a variety of reasons, including genetic and autoimmune disorders, chronic pancreatic disease, and dietary habits.

Common causes of diabetes:

• malfunction of the immune system, due to which it attacks pancreatic cells;
• genetic disorders that impair tissue sensitivity to glucose, change the work of the pancreas and reduce or completely stop the synthesis of insulin needed for glucose absorption;
• viral infections Coxsackie viruses, rubella, Epstein Barr, retroviruses can penetrate pancreatic cells and destroy the organ;
• chronic diseases affecting the pancreas, cystic fibrosis, pancreatitis, hemochromatosis;
• endocrine diseases Cushing's syndrome, acromegaly;
• toxins (for example, rodenticides, used to kill rodents, heavy metals, nitrates);
• eating habits, an excess of fats and simple carbohydrates in the diet can lead to obesity and reduced sensitivity of cells to insulin;
• drugs, some hormonal drugs (especially glucocorticosteroids), certain drugs for the treatment of diseases of the heart and nervous system, vitamin B preparations (if consumed in excess).

Risk factors for diabetes

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

Risk factors for type I diabetes:

• heredity - you are more likely to get sick if blood relatives have diabetes;
• Some viral infections (eg, rubella, infectious mononucleosis) can trigger an autoimmune reaction in the body, causing the immune system to attack the cells of the pancreas.

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

The most common risk factors for diabetes mellitus type II, which are not directly related to an increase in blood glucose levels: overweight, sedentary lifestyle, pregnancy, etc.

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

Risk factors for type II diabetes mellitus:

• overweight and obesity;
• sedentary lifestyle (without physical activity, glucose is broken down more slowly, so cells may become less sensitive to insulin);
• diabetes mellitus in blood relatives;
• age over 45 years;
• Prediabetes is a condition in which the blood glucose level remains at the upper limit of normal for a long time. Prediabetes is said to be present if the analysis shows values from 5. 6 to 6. 9 mmol/l;
• diabetes mellitus during pregnancy (gestational diabetes);
• birth of a child weighing more than 4 kg;
• depression;
• cardiovascular diseases;
• arterial hypertension (pressure above 140/90 mm Hg);
• high level of "bad" high-density cholesterol (more than 0. 9 mmol/l) and triglycerides (more than 2. 82 mmol/l);
• polycystic ovary syndrome.

Symptoms of diabetes

Type I diabetes usually manifests itself as severe symptoms that can develop unnoticed for a long time.

Common symptoms of diabetes:

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

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

Secondary symptoms of diabetes:

• itchy skin;
• nausea;
• to throw up;
• abdominal pain;
• dry mouth;
• muscle weakness;
• blurred vision;
• poorly healing wounds;
• numbness in fingers or toes;
• acanthosis nigricans darkening of the skin on the neck, armpits, elbows and knees;
• pigment spots of diabetic dermopathy with atrophy and peeling of the skin, located on the folds of the lower extremities, often appear due to poor healing of wounds on the legs;
• blisters of diabetic pemphigus on the lower extremities ranging in size from a few millimeters to a few centimeters. They most often occur in elderly patients with long-term diabetes;
• headache;
• the smell of acetone from the mouth.

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

Complications of diabetes

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

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

Constant monitoring of blood glucose and taking medication to lower blood glucose levels can prevent or delay irreversible complications of diabetes.

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

Diabetic coma

Diabetic coma is a complication of diabetes associated with too high or, conversely, low blood sugar levels.

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

Hypoglycemic comait usually occurs in people with diabetes who are on insulin therapy.

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

Precursors of hypoglycemic coma:

• body tremors,
• chills,
• dizziness,
• nervousness or anxiety
• severe hunger
• nausea,
• blurred vision,
• heart rhythm disorder.

"Rule 15" to stop hypoglycemia in diabetes:

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

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

Some people mistakenly believe that a person in a hypoglycemic coma should have a sweet liquid poured into their mouth. However, this is not the case and it is full of asphyxia (suffocation).

Hyperglycemic comafollowed by an acute lack of insulin, which can be caused by severe stress or an insufficient dose of insulin after a meal.

Dangerous hyperglycemia is said to occur if the blood glucose level exceeds 13. 9 mmol/L.

Symptoms of hyperglycemia:

• strong thirst
• frequent urination,
• extreme fatigue
• blurred vision,
• the smell of acetone or fruity breath,
• nausea and vomiting,
• stomach pain,
• rapid breathing.

If such symptoms appear, you should sit down as soon as possible, ask others to call 911 or call 911 yourself.

Diagnosis of diabetes mellitus

If a person has symptoms of elevated blood sugar concentration: constant thirst, frequent urination, general weakness, blurred vision, numbness of the limbs, they should contact a general practitioner as soon as possible.

But most often, diabetes mellitus develops asymptomatically, so it is recommended that all people undergo a screening test once a year in order to detect the disease in the early stages and prevent the development of complications.

Which doctor should I contact if I suspect diabetes mellitus?

As a rule, people first consult a general practitioner. If diabetes is suspected, they are referred to a specialized specialist who treats metabolic pathologies, an endocrinologist.

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

Inspection

If diabetes is suspected, the doctor will clarify the anamnesis: cases of disease in blood relatives, chronic pancreatic pathologies, lifestyle, recent infectious diseases.

There are no specific signs of diabetes that can be detected during the examination.

During the examination, the doctor will also assess the condition of the skin: in diabetes mellitus, dark areas of black acanthosis may appear on it. In addition, a specialist can perform a rapid glucose test. Exceeding normal values is a reason for in-depth investigation.

Laboratory research methods

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

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

A HbA1c level not higher than 6. 0% (42 mmol/l), and a glucose level not higher than 5. 5 mmol/l is considered normal.

In order to make an accurate diagnosis, the study is performed at least twice on different days. If the results are ambiguous, a glucose tolerance test is performed, which allows the identification of impaired sensitivity of cells to glucose.

In addition, your doctor may order additional tests to distinguish type 1 diabetes from type 2 diabetes: an autoantibody test and a urine ketone body test.

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

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

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

Instrumental research methods

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

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

To diagnose vision disorders, you will need to see an ophthalmologist. During an ophthalmological examination, the doctor assesses the condition of the retina and examines the cornea through a slit lamp or using an ophthalmoscope.

Treatment of diabetes

There is no cure for diabetes. The therapy is aimed at maintaining an acceptable level of glucose in the blood and preventing complications of the disease.

People diagnosed with diabetes must measure their blood glucose levels regularly, inject insulin for type 1 diabetes or take tablets for type 2 diabetes, or inject insulin to control blood sugar levels.

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

Blood glucose monitoring

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

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

Monitoring systems are sensors that are placed on the shoulder, stomach or leg. These sensors constantly monitor the level of glucose in the blood. Data from the device is automatically downloaded to a separate monitor or to an application on the phone. Such devices can signal spikes in blood sugar, draw glucose curves over a certain period of time, send information to your doctor, and even make recommendations about emergency and routine measures and the need to change diabetes treatment tactics.

Wearing a tracking system doesn't hurt; it is not felt on the body.

Diet for diabetes

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

Carbohydrate counting

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

Carbohydrate counting is the basis of nutrition for people with diabetes who are on insulin therapy. To do this, use a bread unit with a universal parameter (XE).

1 XE corresponds to approximately 15 g of net carbohydrates or 20-25 g of bread and increases blood glucose levels by an average of 2. 77 mmol/l. A dose of 1. 4 units of insulin is required for the absorption of such a quantity of glucose.

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

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

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

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

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

Prognosis and prevention of diabetes mellitus

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

Without treatment, the prognosis for diabetes mellitus is unfavorable: a person may die due to damage to the cardiovascular system.

Ways to prevent diabetes:

• regular physical activity;
• a varied diet with sufficient fiber, protein, fat and carbohydrates;
• healthy weight control;
• reducing alcohol consumption;
• giving up alcohol and smoking.

Nutrition for the prevention of type II diabetes mellitus

An important part of the prevention of type II diabetes is a healthy and varied diet. For this purpose, the healthy plate principle or method was developed.

The healthy plate method divides food into five main groups: fruits and vegetables, slow-release carbohydrates, dairy products, proteins and fats. You can combine these groups using a regular plate. Fruits and vegetables should make up a third or a half. Slow carbs a third or a little more. The remaining part is occupied by dairy products, a little more protein food, and a smaller part of fat.

Food according to the principle of a healthy plate: half is fiber, ⅓ slow carbohydrates, the rest protein food.

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

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