Diabetes mellitus is a disorder of glucose metabolism in the body associated with insulin deficiency. Glucose is the energy substance of cells and insulin is the hormone that helps it get there. Without insulin, glucose remains in the blood, causing hyperglycemia and risk of complications in the kidneys, eyes, nerves, heart and blood vessels. Diabetes has no cure, but it can be controlled with proper diet, exercise and medication. An endocrinologist talks about this in more detail.
Diabetes classification
Most people only know about two types of diabetes. In fact, there are more of them. Depending on the cause and mechanism of development of the disease, the following types of pathologies are distinguished:
Type 1 diabetes mellitus(insulin-dependent). In this type, the pancreas is unable to produce insulin due to the destruction of the beta cells that synthesize it. The reasons for this process are not entirely known, but it is believed to be influenced by genetic and environmental factors. Type 1 diabetes is usually diagnosed during childhood or adolescence and requires constant insulin administration.
Type 2 diabetes mellitus(non-insulin dependent). In this type of disease, the pancreas produces insulin, but the amount is not enough to maintain normal blood sugar levels or the cells become insensitive to it. This is due to overweight, obesity, a sedentary lifestyle, malnutrition and hereditary predispositions. Type 2 diabetes mellitus most often develops in adults.
Diabetes mellitus during pregnancy(gestational). In this type of disease, high blood glucose levels occur during pregnancy and usually disappear after delivery. This is due to changes in hormonal levels and metabolism in a woman's body. They can cause decreased insulin production or less insulin action. Women who have had gestational diabetes are at increased risk of developing type 2 diabetes in the future.
Other specific types of diabetes. This group includes rare forms of the disease that occur due to genetic abnormalities, pancreatic diseases, endocrine disorders, certain medications or infections.
Diabetes Symptoms
The classic signs of diabetes are associated with excess glucose in the blood. These include:
- Polyuria (frequent and copious urination).
- Polydipsia (increased feeling of thirst).
- Polyphagia (increased appetite).
- Dry mouth.
- Fatigue, weakness, irritability.
- Weight loss (for type 1 diabetes) or weight gain (for type 2 diabetes).
- Itching of the skin, mucous membranes, genitals.
- Slow healing of wounds, prone to infections.
- Visual impairment, appearance of spots before the eyes.
- Numbness, tingling, pain in the limbs.
Causes of diabetes
Diabetes mellitus is a multifactorial disease that can occur for various reasons. Some of them:
- Genetic predisposition.The presence of diabetes in relatives increases the risk of developing the disease in offspring. This is especially true for type 1 diabetes, which is associated with hereditary defects in the immune system.
- Obesity and overweight.Excess fat in the body leads to poor insulin action and increased blood sugar levels. Visceral fat is particularly dangerous because it surrounds internal organs and releases inflammatory mediators that disrupt metabolism.
- Bad nutrition.Consumption of large amounts of simple carbohydrates, fats, salt, alcohol, as well as the lack of complex carbohydrates, proteins, fiber, vitamins and minerals in the diet contribute to metabolic disorders andincreased blood sugar. Regularity and frequency of meals are also important, as long breaks between meals can lead to hypoglycemia (low blood glucose) and frequent snacking can lead to hyperglycemia (increased blood glucose).
- Lack of physical activity.Physical activity helps reduce blood sugar by increasing energy expenditure and glucose uptake by cells. In addition, physical activity improves blood circulation, strengthens the cardiovascular system, improves immunity, promotes weight loss and prevents complications of diabetes.
- Stress.Stressful situations cause the release of adrenaline, cortisol and glucagon. They raise blood sugar, suppress insulin production, and increase inflammation. Stress can also lead to disruptions in eating, sleeping and physical activity.
- Pancreatic diseases.If the pancreas is damaged due to inflammation, stones, tumors or chronic pancreatitis, this can lead to a decrease in insulin production and the development of diabetes mellitus. There are also genetic disorders leading to pancreatic dysfunction, for example cystic fibrosis, Schwartz-Bartter syndrome, Johanson-Blitzer syndrome and others.
- Endocrine disorders.The endocrine system is a set of organs that produce hormones that regulate various bodily functions. Certain hormones, such as glucagon, glucocorticoids, growth hormone, thyroid hormones, and catecholamines, counteract the action of insulin and increase blood sugar levels.
- Take certain medications.Some medications can increase blood sugar, suppress insulin production, or decrease insulin sensitivity. These medications include glucocorticoids, thiazide diuretics, beta blockers, some anticonvulsants, some antivirals, some antipsychotics, and others. Taking these medications may cause a temporary or permanent increase in blood sugar and may require dose adjustment or replacement of the medication.
- Infections.Infectious diseases such as viral hepatitis, cytomegalovirus infection, chickenpox, rubella, mumps, meningitis, sepsis and others can damage the pancreas, cause inflammation and impair insulin production. Infections can also increase the release of stress hormones, which raise blood sugar levels.
Diagnosis of diabetes mellitus
Making a diagnosis requires a complete examination. First, the patient is examined and interviewed by an endocrinologist. It identifies characteristic symptoms, takes into account the circumstances of their occurrence, concomitant diseases and hereditary factors. Then a detailed examination is prescribed:
Laboratory research.The main method of diagnosing diabetes mellitus is determining blood sugar levels. To do this, the following tests are carried out:
- Fasting blood sugar.
- Glucose tolerance test.
- Glycated hemoglobin (HbA1c)
Instrumental research.To identify complications of diabetes mellitus and assess the condition of target organs, the following studies are carried out:
- Ophthalmoscopy.This is an eye examination using a special device - an ophthalmoscope, which allows you to examine the retina, optic nerve and blood vessels of the eye.
- Ultrasound of the kidneys.This is an ultrasound of the kidneys, which allows you to assess their size, shape, structure, the presence of stones, tumors, cysts and inflammation.
- Dopplerography of the vessels of the lower limbs.This is an ultrasound scan of the vessels of the lower extremities, which allows you to assess their lumen, walls, blood flow, the presence of blood clots, atherosclerotic plaques, narrowings and aneurysms.
- Electrocardiography (ECG).This is a study of the heart, which allows you to assess its rhythm, conductivity, contractility, the presence of ischemia, myocardial infarction, arrhythmia and blockage.
Neurological examination.This is an examination of the nervous system, which makes it possible to assess sensitivity, reflexes, coordination, muscle tone, the presence of paresthesias, pain and movement disorders. With diabetes mellitus, changes in the nerves may develop, such as demyelination, degeneration, inflammation, which can lead to disruption of the transmission of nerve impulses and the development of polyneuropathy, autonomic neuropathy, mononeuropathy, radiculopathy. This condition is called diabetic neuropathy.
Dermatological examination.This is a skin examination which makes it possible to assess its color, turgor, humidity, the presence of wounds, cracks, ulcers, fungal, bacterial, viral infections, allergic reactions, pigmentation, atrophy, scleroderma, acanthosis.
In diabetes mellitus, skin changes may develop, such as xerosis, diabetic dermopathy, diabetic bullosis, diabetic urticaria, diabetic angiopathy, diabetic foot, which can lead to disruption of the protective function of the skin and the development of complications.
Consultation with other specialists.Depending on the presence of concomitant diseases and complications of diabetes mellitus, consultation with other specialists such as a cardiologist, neurologist, surgeon, dentist, psychologist and others may be necessary. They will help assess the patient's condition, prescribe the necessary treatment and give recommendations for prevention.
Insulin therapy for diabetes
Insulin therapy for diabetes is a treatment method in which insulin is administered externally to the patient. It is necessary for all type 1 diabetic patients, but also for some type 2 diabetic patients when other treatments do not work.
What types of insulin exist and how to use them
There are different types of insulin, which differ in the time of onset of action, peak activity and duration of action. According to these parameters, insulins are divided into ultra-short, short and long-acting (prolonged).
- Ultra-short-acting and short-acting insulins mimic the physiological release of insulin after a meal and are administered 15 to 30 minutes before meals.
- Extended-release insulins provide basal levels of insulin in the blood throughout the day and are administered once or twice daily.
- There are also ready-made mixtures of insulins of different duration of action, which are convenient to use.
Insulin is injected under the skin using special devices such as pens, pumps or inhalers. The dose of insulin is selected individually for each patient based on blood sugar levels, volume and composition of food, physical activity and other factors.
To control blood sugar, the patient must measure it regularly using a glucometer or continuous glucose monitor.
What rules and recommendations should be followed during insulin therapy?
Insulin therapy requires strict adherence to diet, physiotherapy and doctor's recommendations. With insulin therapy, side effects are possible, such as hypoglycemia (low blood sugar), allergic reactions, lipodystrophy - a violation of the distribution of fats under the skin, which can occur at the site offrequent insulin injections.
To avoid this, it is necessary to change the insulin injection site and use fine needles. Therefore, patients should learn the basics of insulin therapy and consult a doctor if they have any questions or concerns.
Nutrition for diabetes
Nutrition for diabetes is the most important part of treatment. In mild forms of diabetes, diet alone is sometimes enough to reach the target blood sugar level. In more serious cases, drug treatment (oral hypoglycemic agents, insulin) comes to the rescue.
The following general rules of diet for diabetes mellitus should be followed:
- Meals should be frequent and small(5 to 6 times a day), in small portions. This will help avoid large jumps in blood sugar levels.
- Meals should be taken at the same times. The same goes for taking hypoglycemic medications and insulin injections.
- Strict diets and hunger strikes are prohibited, because they can lead to hypoglycemia (low blood sugar), as well as disruption of fat and protein metabolism.
- These are preferredcooking methodslike: stewing, boiling, steaming and baking. Fried, smoked, salted and marinated foods should be excluded or minimized.
- Shouldeliminate easily digestible carbohydrates from foods(sugar, honey, confectionery, jam, pastry, white flour). They quickly raise blood sugar and contribute to obesity. Instead, you can use sugar substitutes (xylitol, sorbitol, fructose, stevia, etc. ) in moderation.
- Foods should contain a large amount of fiber,because these carbohydrates are absorbed more slowly and do not raise blood sugar levels as much. Fiber also helps normalize intestinal function, reduce cholesterol and appetite. Sources of fiber include vegetables, fruits, herbs, whole grain breads and cereals, legumes, nuts and seeds.
- Limit the consumption of animal fats(butter, lard, fatty meats). They contain saturated fatty acids that increase cholesterol levels and contribute to the development of atherosclerosis and coronary heart disease. You should favor vegetable oils (sunflower, olive, corn, etc. ), which contain unsaturated fatty acids beneficial for the heart and blood vessels. Fish and seafood are also useful, which are sources of omega-3 fatty acids, which have anti-inflammatory and antisclerotic effects.
- It is advised thatthe caloric content of food and the amount of carbohydrates were approximately the sameon different days, this is especially important when choosing the insulin dose. To calculate the amount of carbohydrates, you can use special tables showing how many grams of carbohydrates are contained in various foods.
- Shouldcontrol salt intake, because excess salt can lead to increased blood pressure, edema and worsening kidney function. The recommended daily salt intake is no more than 5 g (1 teaspoon).
Diabetes nutrition should be balanced, varied and tasty. You don't need to give up your favorite dishes, but just learn how to cook them correctly, taking into account your condition and needs.
Diabetes mellitus is a serious disease that requires constant medical supervision and compliance with a lifestyle. If you notice signs of diabetes in yourself or your loved ones, do not delay in seeing a doctor. The earlier the diagnosis is made and treatment started, the less risk of complications and the better the prognosis of the disease.