- a chronic metabolic disorder, which is based on a deficiency in the formation of one's own insulin and an increase in blood glucose levels. It is manifested by a feeling of thirst, an increase in the amount of urine excreted, increased appetite, weakness, dizziness, slow healing of wounds, etc. The disease is chronic, often with a progressive course. There is a high risk of developing stroke, kidney failure, myocardial infarction, gangrene of the extremities, and blindness. Sharp fluctuations in blood sugar cause life-threatening conditions: hypo- and hyperglycemic coma.

ICD-10

E10-E14

General information

Diabetes mellitus is the second most common metabolic disorder after obesity. In the world, about 10% of the population suffers from diabetes mellitus, however, if we take into account the hidden forms of the disease, this figure can be 3-4 times higher. Diabetes mellitus develops as a result of chronic insulin deficiency and is accompanied by disorders of carbohydrate, protein and fat metabolism. Insulin is produced in the pancreas by the ß cells of the islets of Langerhans.

Participating in the metabolism of carbohydrates, insulin increases the entry of glucose into cells, promotes the synthesis and accumulation of glycogen in the liver, and inhibits the breakdown of carbohydrate compounds. In the process of protein metabolism, insulin enhances the synthesis of nucleic acids, protein and inhibits its decay. The effect of insulin on fat metabolism is to activate the entry of glucose into fat cells, energy processes in cells, the synthesis of fatty acids and slow down the breakdown of fats. With the participation of insulin, the process of sodium entering the cell is enhanced. Disorders of metabolic processes controlled by insulin can develop with insufficient synthesis of insulin (type I diabetes mellitus) or with tissue resistance to insulin (type II diabetes mellitus).

Causes and mechanism of development

Type I diabetes mellitus is more often detected in young patients under 30 years of age. Violation of insulin synthesis develops as a result of damage to the pancreas of an autoimmune nature and the destruction of insulin-producing ß-cells. In most patients, diabetes mellitus develops after a viral infection (mumps, rubella, viral hepatitis) or toxic effects (nitrosamines, pesticides, drugs, etc.), the immune response to which causes the death of pancreatic cells. Diabetes mellitus develops if more than 80% of insulin-producing cells are affected. Being an autoimmune disease, type I diabetes mellitus is often combined with other processes of autoimmune genesis: thyrotoxicosis, diffuse toxic goiter, etc.

There are three degrees of severity of diabetes mellitus: mild (I), moderate (II) and severe (III) and three states of compensation for carbohydrate metabolism disorders: compensated, subcompensated and decompensated.

Symptoms

The development of type I diabetes occurs rapidly, type II - on the contrary, gradually. Often there is a latent, asymptomatic course of diabetes mellitus, and its detection occurs by chance during the study of the fundus or laboratory determination of sugar in the blood and urine. Clinically, type I and type II diabetes manifest themselves in different ways, but the following symptoms are common to them:

• thirst and dry mouth, accompanied by polydipsia (increased fluid intake) up to 8-10 liters per day;
• polyuria (abundant and frequent urination);
• polyphagia (increased appetite);
• dry skin and mucous membranes, accompanied by itching (including perineum), pustular skin infections;
• sleep disturbance, weakness, decreased performance;
• cramps in the calf muscles;
• visual impairment.

Manifestations of type I diabetes are characterized by intense thirst, frequent urination, nausea, weakness, vomiting, increased fatigue, constant hunger, weight loss (with normal or increased nutrition), irritability. A sign of diabetes in children is the appearance of bedwetting, especially if the child has not previously urinated in bed. In type 1 diabetes, hyperglycemic (critically high blood sugar) and hypoglycemic (critically low blood sugar) conditions are more likely to develop, requiring emergency measures.

In type II diabetes mellitus, pruritus, thirst, blurred vision, severe drowsiness and fatigue, skin infections, slow wound healing processes, paresthesia and numbness of the legs predominate. Patients with type II diabetes are often obese.

The course of diabetes is often accompanied by hair loss on the lower extremities and increased hair growth on the face, the appearance of xanthomas (small yellowish growths on the body), balanoposthitis in men and vulvovaginitis in women. As diabetes progresses, a violation of all types of metabolism leads to a decrease in immunity and resistance to infections. Long-term diabetes causes damage to the skeletal system, manifested by osteoporosis (bone thinning). There are pains in the lower back, bones, joints, dislocations and subluxations of the vertebrae and joints, fractures and deformation of the bones, leading to disability.

Complications

The course of diabetes mellitus can be complicated by the development of multiple organ disorders:

• diabetic angiopathy - increased vascular permeability, their fragility, thrombosis, atherosclerosis, leading to the development of coronary heart disease, intermittent claudication, diabetic encephalopathy;
• diabetic polyneuropathy - damage to the peripheral nerves in 75% of patients, resulting in a violation of sensitivity, swelling and chilliness of the extremities, a burning sensation and "crawling" goosebumps. Diabetic neuropathy develops years after the onset of diabetes mellitus, and is more common in the non-insulin dependent type;
• diabetic retinopathy - destruction of the retina, arteries, veins and capillaries of the eye, decreased vision, fraught with retinal detachment and complete blindness. With type I diabetes, it manifests itself after 10-15 years, with type II - earlier, it is detected in 80-95% of patients;
• diabetic nephropathy - damage to the renal vessels with impaired renal function and the development of renal failure. It is noted in 40-45% of patients with diabetes mellitus after 15-20 years from the onset of the disease;
• diabetic foot - circulatory disorders of the lower extremities, pain in the calf muscles, trophic ulcers, destruction of the bones and joints of the feet.

Critical, acutely emerging conditions in diabetes mellitus are diabetic (hyperglycemic) and hypoglycemic coma.

Hyperglycemia and coma develop as a result of a sharp and significant increase in blood glucose levels. The harbingers of hyperglycemia are the growing general malaise, weakness, headache, depression, loss of appetite. Then there are pains in the abdomen, Kussmaul's noisy breathing, vomiting with the smell of acetone from the mouth, progressive apathy and drowsiness, and a decrease in blood pressure. This condition is caused by ketoacidosis (accumulation of ketone bodies) in the blood and can lead to loss of consciousness - diabetic coma and death of the patient.

The opposite critical condition in diabetes mellitus - hypoglycemic coma develops with a sharp drop in blood glucose levels, more often due to an overdose of insulin. The increase in hypoglycemia is sudden, rapid. There is a sharp feeling of hunger, weakness, trembling in the limbs, shallow breathing, arterial hypertension, the patient's skin is cold, wet, sometimes convulsions develop.

Prevention of complications in diabetes mellitus is possible with constant treatment and careful monitoring of blood glucose levels.

Diagnostics

The presence of diabetes mellitus is evidenced by the content of glucose in capillary blood on an empty stomach, exceeding 6.5 mmol / l. Normally, there is no glucose in the urine, because it is retained in the body by the kidney filter. With an increase in blood glucose levels of more than 8.8-9.9 mmol / l (160-180 mg%), the renal barrier fails and passes glucose into the urine. The presence of sugar in the urine is determined by special test strips. The minimum level of glucose in the blood at which it begins to be determined in the urine is called the “renal threshold”.

Examination for suspected diabetes mellitus includes determining the level of:

• fasting glucose in capillary blood (from a finger);
• glucose and ketone bodies in the urine - their presence indicates diabetes mellitus;
• glycosylated hemoglobin - significantly increased in diabetes mellitus;
• C-peptide and insulin in the blood - in type I diabetes mellitus, both indicators are significantly reduced, in type II they are practically unchanged;
• carrying out a stress test (glucose tolerance test): determination of glucose on an empty stomach and 1 and 2 hours after taking 75 g of sugar dissolved in 1.5 glasses of boiled water. A negative (not confirming diabetes mellitus) test result is considered for tests: on an empty stomach< 6,5 ммоль/л, через 2 часа - < 7,7ммоль/л. Подтверждают наличие сахарного диабета показатели >6.6 mmol/l at the first measurement and >11.1 mmol/l 2 hours after glucose loading.

To diagnose complications of diabetes, additional examinations are carried out: ultrasound of the kidneys, rheovasography of the lower extremities, rheoencephalography, EEG of the brain.

Treatment

Implementation of the recommendations of a diabetologist, self-monitoring and treatment of diabetes mellitus are carried out for life and can significantly slow down or avoid complicated variants of the course of the disease. Treatment of any form of diabetes mellitus is aimed at lowering blood glucose levels, normalizing all types of metabolism and preventing complications.

The basis for the treatment of all forms of diabetes is diet therapy, taking into account the gender, age, body weight, physical activity of the patient. Training is provided on the principles of calculating the calorie content of the diet, taking into account the content of carbohydrates, fats, proteins, vitamins and microelements. In insulin-dependent diabetes mellitus, it is recommended to consume carbohydrates at the same hours to facilitate control and correction of glucose levels with insulin. With IDDM type I, the intake of fatty foods that contribute to ketoacidosis is limited. With non-insulin-dependent diabetes mellitus, all types of sugars are excluded and the total calorie content of food is reduced.

Nutrition should be fractional (at least 4-5 times a day), with a uniform distribution of carbohydrates, contributing to a stable glucose level and maintaining basal metabolism. Special diabetic products based on sweeteners (aspartame, saccharin, xylitol, sorbitol, fructose, etc.) are recommended. Correction of diabetic disorders with only one diet is used in a mild degree of the disease.

The choice of drug treatment for diabetes depends on the type of disease. Patients with type I diabetes are shown insulin therapy, with type II - a diet and hypoglycemic agents (insulin is prescribed for the ineffectiveness of taking tablet forms, the development of ketoazidosis and precoma, tuberculosis, chronic pyelonephritis, liver and kidney failure).

The introduction of insulin is carried out under the systematic control of glucose levels in the blood and urine. There are three main types of insulin according to the mechanism and duration of action: prolonged (prolonged), intermediate and short-acting. Long-acting insulin is administered once a day, regardless of the meal. More often, injections of prolonged insulin are prescribed together with intermediate and short-acting drugs, allowing compensation for diabetes mellitus.

The use of insulin is dangerous with an overdose, leading to a sharp decrease in sugar, the development of a state of hypoglycemia and coma. The selection of drugs and the dose of insulin is carried out taking into account changes in the patient's physical activity during the day, the stability of the blood sugar level, the calorie content of the diet, the fragmentation of nutrition, insulin tolerance, etc. Local development is possible with insulin therapy (pain, redness, swelling at the injection site) and general (up to anaphylaxis) allergic reactions. Also, insulin therapy can be complicated by lipodystrophy - "failures" in adipose tissue at the site of insulin injection.

Sugar-reducing tablets are prescribed for non-insulin-dependent diabetes mellitus in addition to the diet. According to the mechanism of lowering blood sugar, the following groups of hypoglycemic agents are distinguished:

• sulfonylurea preparations (gliquidone, glibenclamide, chlorpropamide, carbutamide) - stimulate the production of insulin by pancreatic ß-cells and promote the penetration of glucose into tissues. The optimally selected dosage of drugs in this group maintains a glucose level not > 8 mmol / l. In case of an overdose, hypoglycemia and coma may develop.
• biguanides (metformin, buformin, etc.) - reduce the absorption of glucose in the intestine and contribute to the saturation of peripheral tissues with it. Biguanides can increase the level of uric acid in the blood and cause the development of a serious condition - lactic acidosis in patients over 60 years of age, as well as those suffering from liver and kidney failure, chronic infections. Biguanides are more often prescribed for non-insulin dependent diabetes mellitus in young obese patients.
• meglitinides (nateglinide, repaglinide) - cause a decrease in sugar levels by stimulating the pancreas to secrete insulin. The action of these drugs depends on the content of sugar in the blood and does not cause hypoglycemia.
• alpha-glucosidase inhibitors (miglitol, acarbose) - slow down the rise in blood sugar by blocking the enzymes involved in the absorption of starch. Side effects are flatulence and diarrhea.
• thiazolidinediones - reduce the amount of sugar released from the liver, increase the susceptibility of fat cells to insulin. Contraindicated in heart failure.

In diabetes mellitus, it is important to teach the patient and his family members the skills to control the well-being and condition of the patient, first aid measures in the development of precomatous and comatose conditions. A beneficial therapeutic effect in diabetes is the reduction of excess weight and individual moderate physical activity. Due to muscle efforts, there is an increase in the oxidation of glucose and a decrease in its content in the blood. However, exercise should not be started at glucose levels > 15 mmol/l, but must first be allowed to decrease under the influence of drugs. In diabetes mellitus, physical activity should be evenly distributed to all muscle groups.

Forecast and prevention

Patients with diagnosed diabetes mellitus are registered with an endocrinologist. With the organization of the right lifestyle, nutrition, treatment, the patient can feel satisfactory for many years. Aggravate the prognosis of diabetes mellitus and reduce the life expectancy of patients with acute and chronically developing complications.

Prevention of type I diabetes mellitus is reduced to increasing the body's resistance to infections and eliminating the toxic effects of various agents on the pancreas. Preventive measures for type II diabetes mellitus include preventing the development of obesity, correcting nutrition, especially in people with a burdened hereditary history. Prevention of decompensation and complicated course of diabetes mellitus consists in its correct, systematic treatment.

Diabetes mellitus is one of the most common diseases today. Let us consider in more detail the signs of diabetes and the causes of its occurrence.

Diabetes mellitus has been known since the time of medicine BC. The ancient Egyptians described this disease as an independent pathology. The ancient Greek scientist Celsus argued that the main cause of diabetes is not the proper functioning of the stomach, and Hippocrates made a diagnosis by tasting the patient's urine. The doctors of ancient China came up with their own original way of diagnosing diabetes: the patient's urine was poured into a saucer and exposed to the street. If wasps and bees sat on the edge of the saucer, then the doctors knew that sugar was present in the patient's urine.

Diabetes mellitus refers to diseases of the endocrine system and is characterized by an increase in blood sugar levels as a result of a violation of the production of the hormone insulin by the pancreas. The progression of diabetes mellitus leads to disruption of metabolic processes in the body, damage to the nervous system, blood vessels and other organs and systems.

Types and types of diabetes

Depending on the form of the course of the disease, there are:

• Insulin-dependent diabetes mellitus (type 1 diabetes) - most often occurs in children and young people;
• Non-insulin-dependent diabetes (type 2 diabetes) - most often occurs in people over 40 years of age who are overweight. This form of diabetes is observed in 80% of cases;
• Secondary diabetes mellitus - symptomatic;
• Diabetes in pregnant women - blood sugar levels are elevated during pregnancy, and after childbirth everything returns to normal;
• Diabetes resulting from malnutrition and malnutrition.

Diabetes mellitus of the insulin-dependent type is characterized by an absolute deficiency of insulin, which occurs against the background of insufficient production of it by the pancreas.

Diabetes can be caused by lack of insulin

When diagnosing the second type of diabetes mellitus, we are talking about relative insulin deficiency.

Causes of Type 1 Diabetes

Type 1 diabetes begins to manifest itself clinically after the destruction of more than half of the cells of the islets of Langerhans of the pancreas (responsible for the production of insulin). In children and adolescent patients, the progression of the disease is observed much faster, as a result of which the general condition of the patient deteriorates sharply.

Type 1 diabetes is characterized by inadequate production of insulin by the cells of the pancreas. Insulin is either not produced at all, or its quantity is very small. The main function of this hormone is to ensure the delivery of glucose into cells. Glucose is the main source of energy for all tissues and cells of the body. If glucose, for some reason, does not enter the cell, then it begins to accumulate in the blood in high concentrations, and, accordingly, the cells and tissues of the body experience an energy deficit (that is, hunger). To compensate for the lack of nutrients and carbohydrates, the body begins to intensively break down fats and proteins. It is this fact that contributes to the sudden and sharp weight loss of the patient.

Glucose molecules have the property of attracting water to themselves. If the level of sugar in the body rises significantly, then glucose with liquid is intensively excreted from the body along with urine. Thus, a diabetic patient experiences intense thirst and noticeable dehydration.

Due to the active breakdown of fats, fatty acids begin to accumulate in the blood. The liver makes heavy use of these acids to provide the body with energy. As a result, the concentration of ketone bodies in the blood increases sharply. Ketone bodies are products of the breakdown of fats, and their accumulation in the blood leads to the development of ketosis and severe dehydration. If at this stage the patient does not start rehydration (replenishment of fluid deficiency in the body) and insulin therapy, then soon a coma develops and the subsequent shutdown of vital organs.

Predisposing factors provoking the development of this disease are:

• Transferred mumps, rubella virus, chickenpox and hepatitis;
• hereditary predisposition;
• Regular intake of selenium-based supplements.

Causes of Type 2 Diabetes

The main predisposing factors for the development of type 2 diabetes are heredity and overweight.

Obesity

If a person is obese 1 degree, then the risk of developing diseases of the endocrine system is doubled. With obesity of the 2nd degree - 5 times, with obesity of the 3rd degree - more than 10 times!

hereditary factor

If at least one of the parents had and has diabetes, then there is a very high probability that the children will also inherit this disease. Type 2 diabetes mellitus develops gradually with mild clinical symptoms.

Diabetes is hereditary

secondary diabetes mellitus

The secondary form of the disease can develop in humans against the background of such factors:

• Prolonged and uncontrolled intake of certain drugs;
• Changes in cell receptors responsible for delivering insulin to tissues;
• Concomitant diseases of the pancreas (pancreatitis, tumor neoplasms on the gland, partial removal of the pancreas);
• Hormonal diseases (Itsenko-Cushing's disease, acromegaly, thyrotoxicosis, toxic goiter and pheochromocytoma).

How to recognize diabetes? First clinical symptoms

This endocrine disease is characterized by a whole range of clinical symptoms. These include:

• Constant thirst of the patient (a person can drink more than 5 liters of water per day);
• Frequent urination and severe oliguria (up to 10 liters of urine per day);
• Increased appetite, feeling of constant hunger;
• Rapid weight loss, sudden weight loss;
• Rapid fatigue and a feeling of general weakness;
• Sudden deterioration of vision - the appearance of the so-called "white veil" before the eyes;
• Cramps of the calf muscles, disturbing the patient more often at night;
• Dizziness and headaches;
• Decreased libido in women and erectile dysfunction in men;
• Decreased immunity;
• Slow wound healing.

Fatigue is one of the symptoms of diabetes.

In medicine, there have been cases when a constant increase in blood glucose levels was not accompanied in a patient by typical symptoms of diabetes mellitus - thirst and an increase in daily diuresis. Only as the disease progressed, patients noted the presence of dizziness and constant weakness, visual impairment, rapid weight loss and prolonged healing of wounds on the skin. It is these symptoms that often force the patient to consult a doctor.

The onset of the insulin-dependent type of the disease is characterized by the rapid progression of the pathological process and severe dehydration. Such patients should immediately receive medical attention and administer insulin preparations. Without timely medical intervention, the patient rapidly develops ketoacidosis in the blood, and then he falls into a coma.

Complications of diabetes

If people with this disease ignore the doctor's prescriptions and are irresponsible about their state of health, then against the background of the progression of diabetes mellitus, serious complications will soon develop. First of all, the disease affects the cardiovascular system, organs of vision, kidneys and nervous system.

Damage to the heart and blood vessels

With the progression of diabetes in the first place complications affect the cardiovascular system. Approximately 70% of people with diabetes die as a result of a stroke or heart attack. This is due to the fact that diabetes causes severe damage to the large arteries responsible for the blood supply to the heart muscle and great vessels.

In addition, the progression of diabetes and elevated blood sugar levels lead to diseases of the feet, microcracks of the limbs, resulting in gangrene. With the development of gangrene, surgeons carry out amputation of the affected limb to prevent further necrosis of healthy tissues.

Doctors say that timely diagnosis of the disease and the responsible implementation of all medical recommendations can prevent the development of complications.

The effect of diabetes on the organs of vision

Diabetes mellitus, in the absence of timely treatment, leads to a complete loss of vision of the patient. As the disease progresses, the patient may develop other eye conditions such as increased intraocular pressure, cataracts, and diabetic retinopathy. The latter disease is the most common complication of the visual system in diabetes. A timely visit to the ophthalmologist in 90% of cases prevents the development of blindness in diabetics.

Disorders of the excretory system and kidneys

Endocrine disease of the pancreas is one of the main causes of kidney failure. To prevent the development of this complication, it is necessary to take drugs that promote the outflow of urine and normalize blood pressure (diuretics).

Pathologies of the nervous system

Especially often in diabetes mellitus, the nervous system, or rather, the nerve endings of the limbs, is at risk of developing complications. This pathology leads to a decrease in the sensitivity of the limbs and the appearance of numbness and burning of the hands and feet.

In addition, damage to the central nervous system in diabetes can provoke violations of the digestive function and the functioning of the organs of the reproductive system.

How to prevent the development of complications?

If the complications of this disease were diagnosed in a patient at an early stage of their appearance, then they can be easily eliminated with the help of medications. Thus, the patient's lifestyle changes somewhat: for example, with developing nephropathy (damage to the renal tubules), the patient must take daily drugs that will help prevent further progression of the pathology.

Diagnosis of diabetes

To diagnose diabetes in a patient, it is enough to examine a blood test, which determines the level of glucose. If a fasting blood glucose level of less than 7 mmol / l, but more than 5.6 mmol / l is detected in a patient, a glucose tolerance test is additionally prescribed. The test is as follows: the patient donates blood on an empty stomach, doctors determine the level of glucose in the blood, after which the person is offered a piece of sugar. Another blood test is taken from this patient after 2 hours. If the blood glucose levels increased to 11.1 mmol / l, then diabetes mellitus can be diagnosed with confidence. If the blood glucose is less than 11.1 mmol / l, but more than 7.8 mmol / l, then we are talking about a violation of the body's tolerance to carbohydrates. At low glucose levels, but at the same time above the norm, the study is repeated after 3 months, and the patient is registered with an endocrinologist.

Blood glucose levels are used to make a diagnosis

Treatment of diabetes

The method of treatment for diabetes largely depends on the type of disease. When diagnosing type 1 diabetes mellitus (insulin-dependent), the patient is prescribed insulin preparations to compensate for the deficiency of the hormone in the body.

When non-insulin dependent diabetes (type 2 diabetes) is detected, treatment begins with dietary adjustments and antidiabetic medications.

As diabetes progresses, the patient is prescribed insulin therapy. Most often, the body's need for insulin is fully satisfied by preparations of the human hormone. These drugs include recombinant human insulin.

For treatment, short-acting insulins, intermediate-acting insulins and prolonged-acting (long-acting) drugs are used. Most often, insulin preparations are administered subcutaneously, but it can also be administered intramuscularly and into a vein.

Diabetes in women

Manifestations of diabetes mellitus in women has some distinctive feature. Often the patient is unaware of the development of diabetes, and the reason for going to the doctor is severe itching of the external genital organs. This symptom often appears first in the progression of diabetes in women. Patients often take itching of the external genitalia for a venereal infection and rush to see a venereologist. During the examination, the woman found an increased level of glucose in the blood.

The risk of getting diabetes

Many people are very concerned about the question, is it possible to get diabetes from a patient through contact with him? No, it's just a stupid myth. Diabetes is not the flu or an acute respiratory infection. This disease is caused by severe disorders in the islets of Langerhans of the pancreas, as a result of which insulin stops being produced or is produced in insufficient quantities. Diabetes mellitus is not transmitted through handshakes, the use of personal hygiene items of the patient, or airborne droplets.

Diabetes mellitus is also called the "disease of civilization", as the cause of its occurrence is often the abuse of various fast foods, pastries and carbonated sweet drinks.

Nutrition for diabetes

Naturally, diabetes mellitus makes multiple adjustments to a person's lifestyle, and this primarily concerns the patient's diet. If you ignore the instructions of a specialist regarding certain food restrictions, the disease provokes a sharp deterioration in the patient's health. The first thing that people with diabetes need to give up is sugar.

Diabetic patients should take care of their diet

Patients with diabetes mellitus are shown therapeutic diet No. 9. This diet is characterized by a restriction in the diet of a sick person of easily digestible carbohydrates and the prevention of possible disorders of fat metabolism due to the progression of diabetes mellitus.

The patient is recommended to take food 5 times a day in small quantities, preferably at regular intervals. It is absolutely unacceptable for a person with diabetes to skip meals, for whatever reason. This can have a very negative impact on his health.

Diet number 9

The diet of a diabetic patient consists of the following dishes:

First hot meals

Soups and borscht for a diabetic patient are prepared on water, with the addition of boiled lean meat to the plate. Great for eating rabbit meat, turkey breast, chicken fillet and beef. It is very useful to eat soup cooked in vegetable broth for lunch. Thus, the patient not only does not load the pancreas with unnecessary work, but also enriches the body with vitamins.

Main dishes

As a side dish for boiled meat of low-fat varieties, you can cook porridge on the water. Especially useful are buckwheat, barley, oatmeal, wheat and barley. It is very useful as a snack for an afternoon snack to eat wheat bran, pre-filled with warm milk.

Dairy products have a good effect on the digestive system, which is very important for diabetes. Preference should be given to kefir, low-fat cottage cheese, not salty and not spicy hard cheese.

You can also serve the sick porridge with the addition of milk, but always boiled in water. You can add a piece of butter to milk porridge.

Vegetables and fruits

People with diabetes can include vegetables and fruits in their diet: tomatoes, cucumbers, lettuce, zucchini, pumpkin, a little eggplant, green apples, dates and figs. Bananas, grapes and strawberries should not be consumed or tasted in very limited quantities, since these fruits and berries are especially rich in fructose and carbohydrates, and their abuse can dramatically worsen the patient's condition.

Drinks for diabetes

Patients with diabetes need to give up black tea, cocoa and coffee. You can drink a coffee drink with the addition of milk. It is allowed to use rosehip broth, green tea, vegetable and fruit juices (from the list of allowed vegetables and fruits), mineral non-carbonated water.

List of products that are strictly prohibited for people with diabetes:

• Chocolate candies;
• Sausages and smoked sausage;
• Fatty fish (such as mackerel and salmon);
• Red caviar;
• mayonnaise, ketchup, margarine;
• Spices, spices, vinegar;
• Canned food;
• Homemade jam.

How to diversify the menu for diabetes?

People who are diagnosed with diabetes complain that their diet is very monotonous, and the food is all insipid and not tasty. This is an unjustified statement. Possessing desire and culinary skills, you can eat fully, tasty and properly. Below is a sample menu for diabetics. You can take this menu as a basis, changing and adding products from the allowed list daily.

Breakfast: rice milk porridge boiled in water (add milk directly to the plate), bread with butter and tea.

Second breakfast: biscuit cookies and a glass of low-fat natural yogurt.

Lunch: boiled beetroot salad with vegetable oil, vegetable soup with a piece of boiled chicken meat.

Snack: steamed cheesecakes, apple, rosehip broth.

Dinner: boiled fish, vegetable salad with sour cream

At night: a glass of kefir or milk.

As you can see, the diet is quite varied. Of course, at first the patient will experience certain difficulties with permitted and prohibited foods, but he will soon get used to it.

Controlling blood sugar at home

A patient with diabetes cannot be constantly under the control of doctors, and, as you know, the level of glucose in the blood must be constantly maintained at about the same level. It is important to ensure that there are no sudden changes in blood glucose levels - hyperglycemia and hypoglycemia. As a result of such jumps, the patient's blood vessels, organs of vision and nervous system begin to be rapidly affected.

Without insulin, glucose cannot be broken down into the substances needed by the body. The liver begins to intensively produce glucose, believing that the critical state of the body is due precisely to a lack of energy. From an excess of glucose and its accumulation in the body, the accumulation of ketone bodies begins.

If the glucose levels exceed the levels of ketone bodies in the blood, then the patient develops a hyperglycemic coma.

If ketone bodies exceed the amount of glucose in blood, then the patient develops ketoacidotic coma.

It is important to take into account the fact that the development of a coma is not always caused in a patient due to the accumulation of glucose or ketone bodies in the blood. The patient may fall into a coma due to an overdose of insulin. Thus, we are talking about hypoglycemic coma.

Signs of a coma

The first signs of a developing coma include:

• Increased thirst and urination;
• Nervous excitement, subsequently replaced by lethargy;
• Increasing weakness and lethargy;
• Headache;
• Lack of appetite and nausea;

If the patient has such signs within 12-24 hours, it is necessary to urgently seek medical help. Without timely treatment, the patient develops a true coma. Clinical signs of a true diabetic coma are:

• Growing indifference to what is happening around;
• Violation of consciousness (apathy with periods of nervous excitement);
• Lack of response to stimuli.

When examining a patient, the doctor detects severe dryness of the skin, a weakening of the pulse in large arteries, a noticeable smell of acetone from the mouth (with the development of hyperglycemic and ketoacidotic coma), a drop in blood pressure, softening of the eyeballs. The patient's skin is warm to the touch.

With the development of coma due to an overdose of insulin (hypoglycemic), the clinical signs are completely different. When approaching a coma, the patient feels severe hunger, trembling in the limbs and body, increasing weakness, anxiety and sudden sweating.

If, while feeling these signs, the patient is not allowed to drink sweet tea, eat chocolate candy or another “fast” carbohydrate, then the patient experiences loss of consciousness and convulsions. On examination, the doctor notes increased muscle tone, skin moisture and the absence of acetone breath from the mouth.

First aid for the development of coma

As a rule, people with diabetes are well aware of what happens when insulin is administered incorrectly or the level of glucose and ketone bodies in the blood increases. With increasing signs and symptoms of a coma, such patients know what to do. People who are trying to provide first aid to a patient with increasing symptoms of a coma should ask the patient himself what helps him in this case.

It is strictly forbidden, when developing a coma, to prevent the patient from administering insulin to himself (some people regard this as inappropriate behavior), as well as to hesitate to call an ambulance, relying on the patient himself knowing what to do in these situations.

is a violation of the metabolism of carbohydrates and water in the body. The consequence of this is a violation of the functions of the pancreas. It is the pancreas that produces a hormone called insulin. Insulin is involved in the processing of sugar. And without it, the body cannot convert sugar into glucose. As a result, sugar accumulates in our blood and is excreted in large quantities from the body through urine.

In parallel with this, water exchange is disturbed. Tissues cannot retain water in themselves, and as a result, a lot of defective water is excreted through the kidneys.

If a person's blood sugar (glucose) is higher than normal, then this is the main symptom of the disease - diabetes mellitus. In the human body, pancreatic cells (beta cells) are responsible for producing insulin. In turn, insulin is a hormone that is responsible for ensuring that glucose is supplied to the cells in the right amount. What happens in the body with diabetes? The body produces insufficient amounts of insulin, while the content of sugar and glucose in the blood is increased, but the cells begin to suffer from a lack of glucose.

This metabolic disease can be hereditary or acquired. Pustular and other skin lesions develop from a lack of insulin, teeth suffer, angina pectoris develops, hypertension, the kidneys, nervous system suffer, and vision deteriorates.

Etiology and pathogenesis

The pathogenetic basis for the occurrence of diabetes mellitus depends on the type of this disease. There are two varieties of it, which are fundamentally different from each other. Although modern endocrinologists call the division of diabetes mellitus very conditional, the type of disease still matters in determining treatment tactics. Therefore, it is advisable to dwell on each of them separately.

In general, diabetes mellitus refers to those diseases, the essence of which is a violation of metabolic processes. In this case, carbohydrate metabolism suffers the most, which is manifested by a persistent and constant increase in blood glucose. This indicator is called hyperglycemia. The most important basis of the problem is the distortion of the interaction of insulin with tissues. It is this hormone that is the only one in the body that contributes to the drop in glucose content, by carrying it into all cells, as the main energy substrate for maintaining life processes. If there is a failure in the system of interaction of insulin with tissues, then glucose cannot be included in the normal metabolism, which contributes to its constant accumulation in the blood. These cause-and-effect relationships are called diabetes mellitus.

It is important to understand that not all hyperglycemia is true diabetes mellitus, but only one that is caused by a primary violation of insulin action!

Why are there two types of disease?

Such a need is mandatory, since it completely determines the treatment of the patient, which is radically different in the initial stages of the disease. The longer and more severe diabetes mellitus proceeds, the more its division into types is formal. Indeed, in such cases, the treatment is practically the same for any form and origin of the disease.

Type 1 diabetes

This type is also called insulin-dependent diabetes. Most often, this type of diabetes affects young people, under the age of 40 years, thin. The disease is quite severe, insulin is required for treatment. Reason: The body produces antibodies that destroy the cells in the pancreas that produce insulin.

It is almost impossible to completely recover from type 1 diabetes, although there are cases of restoration of pancreatic functions, but this is possible only under special conditions and natural raw food. To maintain the body, it is required to inject insulin into the body with a syringe. Since insulin is destroyed in the gastrointestinal tract, taking insulin in the form of tablets is not possible. Insulin is administered with meals. It is very important to follow a strict diet; easily digestible carbohydrates (sugar, sweets, fruit juices, sugary lemonades) are completely excluded from the diet.

Type 2 diabetes

This type of diabetes is non-insulin dependent. Most often, type 2 diabetes affects the elderly, after 40 years, obese. Reason: loss of sensitivity of cells to insulin due to an excess of nutrients in them. The use of insulin for treatment is not necessary for every patient. Only a qualified specialist can prescribe treatment and doses.

To begin with, such patients are prescribed a diet. It is very important to follow the doctor's recommendations completely. It is recommended to reduce weight slowly (2-3 kg per month) to achieve a normal weight that must be maintained throughout life. In cases where the diet is not enough, sugar-lowering tablets are used, and insulin is prescribed only in a very extreme case.

Signs and symptoms of diabetes

Clinical signs of the disease in most cases are characterized by a gradual course. Rarely, diabetes manifests itself in a fulminant form with a rise in glycemia (glucose content) to critical numbers with the development of various diabetic coma.

With the onset of the disease, patients develop:

Persistent dry mouth;

Feeling of thirst with inability to quench it. Sick people drink up to several liters of daily fluid;

Increased diuresis - a noticeable increase in portioned and total urine excreted per day;

Decrease or sharp increase in weight and body fat;

The appearance of the smell of acetone from the patient;

Clouding of consciousness.

The appearance of characteristic signs of diabetes or the development of its complications is an alarm signal that indicates the progression of the disease or insufficient medical correction.

Most significant causes of diabetes are such as:

Heredity. It is necessary to reduce other factors that influence the development of diabetes mellitus to nothing.

Obesity. Actively deal with excess weight.

A number of diseases that contribute to the defeat of beta cells responsible for the production of insulin. Such diseases include diseases of the pancreas -, pancreas, diseases of other endocrine glands.

Viral infections(, epidemic and other diseases, this includes). These infections are the starting point for the development of diabetes mellitus. Especially for people who are at risk.

Nervous stress. People who are at risk should avoid nervous and emotional stress.

Age. With age, for every ten years, the risk of developing diabetes doubles.

This list does not include those diseases in which diabetes mellitus or hyperglycemia are secondary, being only their symptom. In addition, such hyperglycemia cannot be considered true diabetes until advanced clinical manifestations or diabetic complications develop. Diseases that cause hyperglycemia (increased sugar) include tumors and hyperfunction of the adrenal glands, chronic pancreatitis, and an increase in the level of contra-insular hormones.

Diagnosis of diabetes

If there is a suspicion of diabetes mellitus, this diagnosis must be either confirmed or refuted. There are a number of laboratory and instrumental methods for this. These include:

Examination of blood glucose - determination of fasting glycemia;

Glucose tolerance test - determination of the ratio of fasting glycemia to this indicator after two hours after taking carbohydrate components (glucose);

Glycemic profile - the study of glycemic numbers several times during the day. Performed to evaluate the effectiveness of treatment;

Urinalysis with the determination of the level of glucose in the urine (glucosuria), protein (proteinuria), leukocytes;

Urinalysis for acetone content - if ketoacidosis is suspected;

A blood test for the concentration of glycosylated hemoglobin - indicates the degree of disorders that are caused by diabetes;

Biochemical blood test - a study of hepatic-renal tests, which indicates the adequacy of the functioning of these organs against the background of diabetes;

The study of the electrolyte composition of the blood - is indicated in the development of severe forms of diabetes;

Reberg's test - shows the degree of kidney damage in diabetes;

Determination of the level of endogenous insulin in the blood;

Examination of the fundus;

Ultrasound examination of the abdominal organs, heart and kidneys;

ECG - to assess the degree of diabetic myocardial damage;

Doppler ultrasound, capillaroscopy, rheovasography of the vessels of the lower extremities - assesses the degree of vascular disorders in diabetes;

All patients with diabetes should be consulted by such specialists:

Endocrinologist;

Cardiologist;

neuropathologist;

Ophthalmologist;

Surgeon (vascular or special pediatrician);

The implementation of the whole complex of these diagnostic measures can help to clearly determine the severity of the disease, its degree and the correctness of tactics in relation to the treatment process. It is very important to conduct these studies not once, but to repeat them in dynamics as many times as the specific situation requires.

Blood sugar levels in diabetes

The very first and informative method for the primary diagnosis of diabetes mellitus and its dynamic assessment during treatment is the study of blood glucose (sugar) levels. This is a clear indicator from which all subsequent diagnostics and therapeutic measures should be based.

Specialists reviewed normal and pathological glycemic numbers several times. But today their clear values ​​have been established, which shed true light on the state of carbohydrate metabolism in the body. They should be guided not only by endocrinologists, but also by other specialists, and by the patients themselves, especially diabetics with a long history of the disease.

Status of carbohydrate metabolism		Glucose indicator
Normal blood sugar		3.3-5.5 mmol/l
		<7,8 ммоль/л
Impaired glucose tolerance		5.5-6.7 mmol/l
	2 hours after carbohydrate loading	7.8-11.1 mmol/l
Diabetes		>6.7 mmol/l
	2 hours after carbohydrate loading	>11.1 mmol/l

As can be seen from the table above, the diagnostic confirmation of diabetes mellitus is extremely simple and can be carried out within the walls of any outpatient clinic or even at home with a personal electronic glucometer (a device for determining blood glucose). In the same way, criteria for assessing the sufficiency of diabetes mellitus therapy by certain methods have been developed. The main one is the same level of sugar (glycemia).

According to international standards, a good indicator of the treatment of diabetes is a blood glucose level below 7.0 mmol / l. Unfortunately, in practice this is not always feasible, despite the real efforts and strong aspirations of doctors and patients.

A very important heading in the classification of diabetes mellitus is its division into degrees of severity. This distinction is based on the level of glycemia. Another element in the correct formulation of the diagnosis of diabetes mellitus is an indication of the compensation process. This indicator is based on the presence of complications.

But for ease of understanding what happens to a patient with diabetes, looking at the records in medical records, you can combine the severity with the stage of the process into one rubric. After all, it is natural that the higher the blood sugar level, the more severe the diabetes and the higher the number of its formidable complications.

Diabetes mellitus 1 degree

Characterizes the most favorable course of the disease to which any treatment should strive. With this degree of the process, it is fully compensated, the glucose level does not exceed 6-7 mmol / l, there is no glucosuria (glucose excretion in the urine), the indicators of glycated hemoglobin and proteinuria do not go beyond normal values.

In the clinical picture, there are no signs of complications of diabetes: angiopathy, retinopathy, polyneuropathy, nephropathy, cardiomyopathy. At the same time, it is possible to achieve such results with the help of diet therapy and taking medications.

Diabetes mellitus 2 degrees

This stage of the process indicates its partial compensation. There are signs of complications of diabetes and damage to typical target organs: eyes, kidneys, heart, blood vessels, nerves, lower extremities.

The glucose level is slightly increased and is 7-10 mmol / l. Glucosuria is not defined. Indicators of glycosylated hemoglobin are within normal limits or slightly increased. There are no severe organ dysfunctions.

Diabetes mellitus 3 degrees

Such a course of the process indicates its constant progression and the impossibility of drug control. At the same time, the glucose level fluctuates between 13-14 mmol / l, persistent glucosuria (excretion of glucose in the urine), high proteinuria (presence of protein in the urine), and there are obvious detailed manifestations of target organ damage in diabetes mellitus.

Visual acuity progressively decreases, severe (increased blood pressure) persists, sensitivity decreases with the appearance of severe pain and numbness of the lower extremities. The level of glycosylated hemoglobin is maintained at a high level.

Diabetes mellitus 4 degrees

This degree characterizes the absolute decompensation of the process and the development of severe complications. At the same time, the level of glycemia rises to critical numbers (15-25 or more mmol / l), it is difficult to correct by any means.

Progressive proteinuria with protein loss. Characterized by the development of renal failure, diabetic ulcers and gangrene of the extremities. Another of the criteria for grade 4 diabetes is the tendency to develop frequent diabetic coma: hyperglycemic, hyperosmolar, ketoacidotic.

Complications and consequences of diabetes

By itself, diabetes mellitus does not pose a threat to human life. Its complications and their consequences are dangerous. It is impossible not to mention some of them, which are either often encountered or pose an immediate danger to the life of the patient.

Coma in diabetes mellitus. The symptoms of this complication increase at lightning speed, regardless of the type of diabetic coma. The most important threatening sign is the clouding of consciousness or extreme lethargy of the patient. Such people should be urgently hospitalized to the nearest medical institution.

The most common diabetic coma is ketoacidotic. It is caused by the accumulation of toxic metabolic products that have a detrimental effect on nerve cells. Its main criterion is the persistent smell of acetone when the patient breathes. In the case of hypoglycemic coma, consciousness is also clouded, the patient is covered with cold profuse sweat, but a critical decrease in glucose levels is recorded, which is possible with an overdose of insulin. Other types of com, fortunately, are less common.

Edema in diabetes mellitus. Edema can be both local and widespread, depending on the degree of concomitant heart failure. In fact, this symptom is an indicator of renal dysfunction. The more pronounced the swelling, the more severe the diabetic nephropathy ().

If the edema is characterized by an asymmetrical distribution, capturing only one lower leg or foot, then this indicates diabetic microangiopathy of the lower extremities, which is supported by neuropathy.

High/low blood pressure in diabetes. Indicators of systolic and diastolic pressure also act as a criterion for the severity of diabetes. It can be assessed on two levels. In the first case, the level of total arterial pressure on the brachial artery is judged. Its increase indicates progressive diabetic nephropathy (kidney damage), as a result of which they release substances that increase pressure.

The other side of the coin is a decrease in blood pressure in the vessels of the lower extremities, determined by ultrasound dopplerography. This indicator indicates the degree of diabetic angiopathy of the lower extremities ().

Pain in the legs with diabetes. may indicate diabetic angio- or neuropathy. This can be judged by their character. Microangiopathy is characterized by the appearance of pain during any physical activity and walking, which makes patients stop for a short while to reduce their intensity.

The appearance of night and rest pains speaks of diabetic neuropathy. Usually they are accompanied by numbness and decreased sensitivity of the skin. Some patients note a local burning sensation in certain areas of the lower leg or foot.

Trophic ulcers in diabetes mellitus. are the next stage of diabetic angio- and neuropathy after pain. The type of wound surfaces in different forms of diabetic foot is fundamentally different, as well as their treatment. In this situation, it is extremely important to correctly evaluate all the smallest symptoms, since the possibility of saving the limb depends on this.

It is immediately worth noting the relative favorableness of neuropathic ulcers. They are caused by a decrease in the sensitivity of the feet as a result of nerve damage (neuropathy) against the background of foot deformity (diabetic osteoarthropathy). In typical points of friction of the skin in places of bone protrusions, corns appear, which patients do not feel. Under them, hematomas are formed with their further suppuration. Patients pay attention to the foot only when it is already red, swollen and with a massive trophic ulcer on the surface.

Gangrene in diabetes mellitus. most often a consequence of diabetic angiopathy. To do this, there must be a combination of lesions of small and large arterial trunks. Usually the process begins in the region of one of the toes. Due to the lack of blood flow to it, there is severe pain in the foot and its redness. Over time, the skin becomes cyanotic, edematous, cold, and then covered with blisters with cloudy contents and black spots of skin necrosis.

The described changes are irreversible, therefore it is not possible to save the limb under any circumstances, amputation is indicated. Of course, it is desirable to perform it as low as possible, since operations on the foot do not bring any effect in gangrene, the lower leg is considered the optimal level of amputation. After such an intervention, it is possible to restore walking with the help of good functional prostheses.

Prevention of complications of diabetes mellitus. Prevention of complications consists in the early detection of the disease and its adequate and correct treatment. This requires physicians to have a clear knowledge of all the intricacies of the course of diabetes, and patients to strictly comply with all dietary and medical recommendations. A separate heading in the prevention of diabetic complications is to highlight the correct daily care of the lower extremities in order to prevent damage to them, and if they are detected, immediately seek help from surgeons.

To get rid of type 2 diabetes, you must follow these recommendations:

Go on a low carb diet.

Stop taking harmful diabetes pills.

Start taking an inexpensive and harmless drug for the treatment of diabetes based on metformin.

Start playing sports, increase your physical activity.

Sometimes small doses of inulin may be required to normalize blood sugar levels.

These simple recommendations will allow you to control your blood sugar levels and refuse to take drugs that give multiple complications. You need to eat right not from time to time, but every day. The transition to a healthy lifestyle is an indispensable condition for getting rid of diabetes. A more reliable and simple way to treat diabetes at this point in time has not yet been invented.

Medications used in diabetes

In type 2 diabetes, hypoglycemic drugs are used:

Drugs that stimulate the pancreas to produce more insulin. These are sulfonylurea derivatives (Gliclazide, Gliquidone, Glipizide), as well as meglitinides (Repaglitinide, Nateglitinide).

Drugs that increase the susceptibility of cells to insulin. These are biguanides ( , ). Biguanides are not prescribed to people who suffer from pathology of the heart and kidneys with severe insufficiency in the functioning of these organs. Also drugs that increase the susceptibility of cells to insulin are Pioglitazone and Avandia. These drugs belong to the group of thiazolidinediones.

Drugs with incretin activity: DPP-4 inhibitors (Vildagliptin and Sitagliptin) and GGP-1 receptor agonists (Liraglutide and Exenatide).

Drugs that prevent glucose from being absorbed in the organs of the digestive system. This is a drug called Acarbose from the group of alpha-glucosidase inhibitors.

6 common misconceptions about diabetes

There are common beliefs about diabetes that need to be dispelled.

Diabetes develops in those people who eat a lot of sweets. This statement is not entirely true. In fact, eating sweets can cause weight gain, which is a risk factor for developing type 2 diabetes. However, a person must have a predisposition to diabetes. That is, two key points are necessary: ​​overweight and burdened heredity.

At the beginning of the development of diabetes, insulin continues to be produced, but body fat does not allow it to be properly absorbed by the cells of the body. If this situation is observed for many years, then the pancreas will lose its ability to produce enough insulin.

Eating sweets does not affect the development of type 1 diabetes. In this case, the pancreatic cells simply die due to antibody attacks. Moreover, the body itself produces them. This process is called an autoimmune reaction. To date, science has not found the cause of this pathological process. Type 1 diabetes is known to be inherited rarely, in about 3-7% of cases.

When I have diabetes, I will immediately understand this. You can immediately find out that a person develops diabetes mellitus, if only he manifests a type 1 disease. This pathology is characterized by a rapid increase in symptoms, which are simply impossible to ignore.

At the same time, type 2 diabetes develops for a long time and is often completely asymptomatic. This is the main danger of the disease. People learn about it already at the stage of complications, when the kidneys, heart, nerve cells were affected.

While the treatment prescribed on time could stop the progression of the disease.

Type 1 diabetes always develops in children, and type 2 diabetes in adults. Regardless of the type of diabetes, it can develop at any age. Although type 1 diabetes is more common in children and adolescents. However, this is not a reason to believe that the disease cannot begin at an older age.

The main reason that leads to the development of type 2 diabetes is obesity, but it can develop at any age. In recent years, the issue of childhood obesity in the world is quite acute.

However, type 2 diabetes is most commonly diagnosed in people over 45 years of age. Although practitioners are beginning to sound the alarm, indicating that the disease has become much younger.

If you have diabetes, you can not eat sweets, you need to eat special foods for diabetics. Your menu, of course, will have to be changed, but you should not completely abandon ordinary foods. Diabetic products can replace the usual sweets and favorite desserts, but when eating them, you need to remember that they are a source of fat. Therefore, the risk of gaining excess weight remains. Moreover, products for diabetics are very expensive. Therefore, the easiest solution is to switch to a healthy diet. The menu should be enriched with proteins, fruits, complex carbohydrates, vitamins and vegetables.

As recent studies show, an integrated approach to the treatment of diabetes can make significant progress. Therefore, it is necessary not only to take medicines, but also to lead a healthy lifestyle, as well as eat right. Insulin should be injected only in extreme cases, it is addictive.

If a person with type 1 diabetes refuses insulin injections, this will lead to his death. If the patient suffers from type 2 diabetes, then in the early stages of the development of the disease, the pancreas will still produce some amount of insulin. Therefore, patients are prescribed drugs in the form of tablets, as well as injections of sugar-burning drugs. This will allow your insulin to be better absorbed.

As the disease progresses, less and less insulin is produced. As a result, there will come a moment when it will simply not be possible to refuse his injections.

Many people are wary of insulin injections, and these fears are not always justified. It should be understood that when the pills are not able to produce the desired effect, the risk of developing complications of the disease increases. In this case, insulin injections are a must.

It is important to control the level of blood pressure and cholesterol, as well as take drugs to normalize these indicators.

Insulin leads to obesity. Often you can observe a situation where a person who is on insulin therapy begins to gain weight. When blood sugar levels are high, the weight begins to decrease, because excess glucose is excreted in the urine, which means extra calories. When the patient begins to receive insulin, these calories cease to be excreted in the urine. If there is no change in lifestyle and diet, then it is quite logical that the weight will begin to grow. However, insulin will not be the culprit.

Unfortunately, not in all cases it is possible to influence the inevitability of the appearance of type 1 diabetes. After all, its main causes are the hereditary factor and small viruses that every person encounters. But not everyone develops the disease. And although scientists have found that diabetes occurs much less frequently in children and adults who were breastfed and treated with antiviral drugs for respiratory infections, this cannot be attributed to specific prevention. Therefore, there are no truly effective methods.

The situation is quite different with the prevention of type 2 diabetes. After all, it is very often the result of a wrong lifestyle.

Today, the question of the possibility of a complete cure for diabetes is considered very ambiguously. The complexity of the situation is that it is very difficult to return what has already been lost. The only exception is those forms of type 2 diabetes that are well controlled under the influence of diet therapy. In this case, normalizing diet and physical activity, you can completely get rid of diabetes. It should be borne in mind that the risk of recurrence of the disease in case of violation of the regimen is extremely high.

According to official medicine, type 1 diabetes mellitus and persistent forms of type 2 diabetes cannot be completely cured. But regular medical treatment can prevent or slow down the progression of complications of diabetes. After all, they are dangerous to humans. Therefore, it is extremely important to engage in regular monitoring of blood glycemia, controlling the effectiveness of therapeutic measures. It must be remembered that they must be for life. It is permissible to change only their volumes and varieties depending on the patient's condition.

However, there are many former patients who were able to recover from this incurable disease with the help of curative fasting. But forget about this method if you cannot find a good specialist in your city who could control you and prevent the situation from getting out of hand. Because there are many cases when experiments on oneself end up in intensive care!

As for the surgical methods for eliminating diabetes mellitus with the implantation of a kind of artificial pancreas, which is a device that analyzes the level of hyperglycemia and automatically releases the required amount of insulin. The results of such treatment are impressive in their effectiveness, but they are not without significant shortcomings and problems. Therefore, no one has yet been able to replace the natural insulin of a particular person with a synthetic analogue, which may not be suitable for a diabetic patient in everything.

Developments continue in the field of synthesis of those types of insulin that will consist of identical components specific to each patient. And although this is still a distant reality, every person, exhausted by the course of diabetes, believes that a miracle will happen.

Which doctor should I contact?

About the doctor: From 2010 to 2016 practicing physician of the therapeutic hospital of the central medical unit No. 21, the city of Elektrostal. Since 2016, she has been working at the diagnostic center No. 3.

Good day, dear friends! In the conditions of our medicine and the availability of the Internet, many issues have to be dealt with by yourself. So that you do not get confused in the abundance of information, I offer you a reliable and accurate source from a specialist.

Let's talk about the initial symptoms and signs of diabetes in adults, what are the first manifestations on the skin and in other organs of the onset of the disease. I really hope that after reading the article you will receive comprehensive answers to your questions.

How to recognize the first symptoms of diabetes

Early signs of diabetes can appear at any age. It is possible to recognize and begin treatment in time only by knowing the initial manifestations of the disease. I am sure you are aware of the existence of different types of diabetes, such as diabetes in the young and diabetes in adults or the elderly. In medicine, they are often divided into: type 1 or type 2 diabetes. But there are many more types than you might think.

And although the causes of these types of diabetes are different, the primary manifestations are the same and are associated with the action of elevated blood glucose levels. There is a difference in the rate of appearance of type 1 or 2 diabetes mellitus, the severity, but the main symptoms will be the same.

Type 2 diabetes, which is often caused by insulin insensitivity, can be almost asymptomatic for a long time. When in this type, as a result of the depletion of pancreatic reserves, a lack of the hormone insulin develops, the manifestation of diabetes becomes more pronounced, which forces one to seek medical help.

But by this time, unfortunately, the main vascular complications, sometimes irreversible, had already developed. Learn to prevent complications in a timely manner.

Early signs of diabetes

Let's consider the most frequent and main manifestations of diabetes mellitus in an adult.

Thirst and frequent urination

People begin to complain of dryness and a metallic taste in the mouth, as well as thirst. They can drink 3-5 liters of fluid per day. One of the first signs of diabetes is frequent urination, which can increase at night.

What are these signs of diabetes? The fact is that when the blood sugar level exceeds an average of more than 10 mmol / l, it (sugar) begins to pass into the urine, taking water with it. Therefore, the patient urinates a lot and often, the body becomes dehydrated, and dry mucous membranes and thirst appear. A separate article - I recommend reading it.

Cravings for sweets as a symptom

Some people have an increased appetite and often want more carbohydrates. This may be due to two reasons.

• The first reason is an excess of insulin (type 2 diabetes), which directly affects appetite, increasing it.
• The second reason is the "starvation" of cells. Since glucose is the main source of energy for the body, if it does not enter the cell, which is possible both with a deficiency and with insulin insensitivity, hunger is formed at the cellular level.

Signs of diabetes on the skin (photo)

The next signal of diabetes mellitus, which appears one of the first, is itching of the skin, especially the perineum. A person with diabetes is often prone to infectious skin diseases: furunculosis, fungal diseases.

Doctors have described more than 30 types of dermatoses that can occur with diabetes. They can be divided into three groups:

• Primary - resulting from metabolic disorders (xanthomatosis, necrobiosis, diabetic blisters and dermatopathy, etc.)
• Secondary - when attached to a bacterial or fungal infection
• Skin problems during drug treatment, i.e. allergic and adverse reactions

Diabetic dermatopathy - the most common skin manifestation in diabetes mellitus, which is manifested by papules on the anterior surface of the lower leg, brownish in color and 5-12 mm in size. Over time, they turn into pigmented atrophic spots that can disappear without a trace. Treatment is not carried out. The photo below shows signs of diabetes on the skin in the form of dermopathy.

diabetic bladder or pemphigus occurs quite rarely, as a manifestation of diabetes on the skin. It occurs spontaneously and without redness on the fingers, hands and feet. Bubbles come in different sizes, the liquid is clear, not infected. Usually heal without scarring in 2-4 weeks. The photo shows an example of a diabetic bladder.

xanthoma occurs in violation of lipid metabolism, which often accompanies diabetes. By the way, the main role is played by elevated triglycerides, and not cholesterol, as some believe. Yellowish plaques develop on the flexor surfaces of the limbs, in addition, these plaques can form on the face, neck, and skin of the chest.

Lipoid necrobiosis rarely occurs as a symptom of diabetes on the skin. It is characterized by focal lipid degeneration of collagen. It often occurs in type 1 diabetes long before the onset of obvious signs. The disease can occur at any age, but most often between the ages of 15 and 40 and predominantly in women.

There are large lesions on the skin of the legs. It begins with bluish-pink spots, which then grow into oval, clearly defined indurative-atrophic plaques. the central part slightly sinks, and the edge rises above healthy skin. The surface is smooth, may peel off at the edges. Sometimes there is an ulceration in the center, which can hurt.

There is currently no cure. Apply ointments that improve microcirculation and lipid metabolism. Injection of corticosteroids, insulin, or heparin into the affected area often helps. Sometimes laser therapy is used.

Skin itching, as well as neurodermatitis can occur long before the onset of diabetes. Studies show that it can take from 2 months to 7 years. Many people think that itching of the skin is common in overt diabetes mellitus, but as it turned out, it is most intense and persistent in the latent form of diabetes.

Most often, the folds of the abdomen, inguinal regions, ulnar fossae and intergluteal cavity itch. Itching usually only on one side.

Fungal skin lesions in diabetes

Candidiasis, in the common people thrush, is a very common problem in diabetology, we can say a threatening sign. Basically, the skin is affected by fungi of the genus Candidaalbicans. It occurs mostly in the elderly and very obese patients. It is localized in large folds of the skin, between the fingers and toes, on the mucous membranes of the mouth and genitals.

First, a white stripe of the desquamated stratum corneum appears in the fold, then the appearance of cracks and erosions joins. Erosions are smooth in the center of a bluish-red color, and around the perimeter there is a white rim. Soon, so-called "screenings" appear in the form of pustules and vesicles near the main focus. They embed and also turn into erosions, prone to merging the process.

Confirmation of the diagnosis is simple - a positive culture for candidiasis, as well as visual identification of fungi during microscopic examination. Treatment consists in treating the affected areas with alcohol or aqueous solutions of methylene blue, brilliant green, Castellani liquid and ointments containing boric acid.

Antimycotic ointments and oral preparations are also prescribed. Treatment continues until the complete disappearance of the altered areas and for another week to consolidate the result.

dental problems

One of the obvious symptoms of incipient diabetes can be a problem with the teeth, as well as frequent stomatitis and periodontal disease. These problems arise against the background of contamination with yeast fungi of the genus Candida, as well as an increase in the number of pathogenic flora in the mouth due to a decrease in the protective properties of saliva.

Diabetes symptoms and vision

Change in body weight

Among the signs of diabetes can be either weight loss or, conversely, weight gain. A sharp and inexplicable weight loss occurs with an absolute deficiency of insulin, which occurs in type 1 diabetes.

With type 2 diabetes, one's own insulin is more than enough and a person only gains weight over time, because insulin plays the role of an anabolic hormone that stimulates fat storage.

chronic fatigue syndrome in diabetes

In connection with the violation of carbohydrate metabolism, a person experiences a feeling of constant fatigue. Decreased performance is associated with starvation of cells, and with the toxic effects of excess sugar on the body.

These are the initial signs of diabetes mellitus, and sometimes it does not matter what type of diabetes it is. The difference will only be in the rate of increase of these symptoms and the severity. How to treat and, read the following articles, stay tuned.

With warmth and care, endocrinologist Lebedeva Dilyara Ilgizovna

Diabetes mellitus is a disease, which is based on a lack of the hormone insulin, due to the influence of a number of factors (immune, endocrine, genetic, environmental factors). This disease affects 5% of the population of developed countries, and the number of cases is growing rapidly. Mortality from diabetes is in 3rd place after cardiovascular and oncological diseases.

What is insulin?

Insulin is a hormone produced by the beta cells of the pancreas and is involved in all types of metabolism.

Insulin is a protein hormone produced and stored in the β-cells of the pancreas. This hormone has the ability to influence all types of metabolism - carbohydrate, protein, fat.

Insulin is broken down in the liver, kidneys and adipose tissue.

The main stimulator of its secretion is glucose.

Why does diabetes develop?

- a genetically determined disease.

Type I diabetes occurs when the body produces antibodies that attack the pancreatic cells that produce insulin.

In type II diabetes, the cells of adipose, muscle and many other tissues are insensitive to insulin, since receptors for this hormone are blocked in their membrane.

Provoking factors in type I diabetes are some viral infections (parotitis, rubella, cytomegalovirus infection), while type II diabetes often develops against the background of obesity.

Symptoms and clinical course of the disease

Insulin deficiency can be acute or chronic.

In acute insulin deficiency, there are:

• dry mouth, thirst;
• dry skin;
• weight loss against the background of increased appetite;
• weakness, drowsiness;
• skin itching;
• furunculosis.

With untimely diagnosis and lack of treatment, the patient falls into a hyperglycemic coma.

Chronic deficiency does not differ in severe symptoms, it proceeds for a long time and ends with complications of the disease in the form of:

• retinal lesions (diabetic retinopathy) - manifested by visual impairment, often a veil appears before the eyes;
• kidney damage (diabetic nephropathy) - manifested by the appearance of protein in the urine, the gradual progression of renal failure;
• lesions of peripheral nerves (diabetic neuropathy) - manifested by tingling, pain in the extremities;
• vascular lesions (diabetic angiopathy) - manifested by chilliness, cold extremities, convulsions in them, trophic ulcers.

Features of the course of type I diabetes

• It is characterized by severe clinical manifestations.
• It develops mainly in young people - under the age of 30-35 years.
• Poorly treatable.
• The onset of the disease is often acute, sometimes manifested by coma.
• When receiving insulin therapy, the disease is usually compensated - the so-called diabetic honeymoon occurs, that is, remission occurs, in which the patient does not need insulin.
• After a viral infection or other provoking factors (stress, physical trauma), diabetes develops again - there are signs of its decompensation with the subsequent development of complications.

Clinical features of type II diabetes

• Develops without signs of decompensation, gradually.
• More often people older than 40 years old, more often women get sick.
• Obesity is one of the first manifestations of the disease and a risk factor at the same time.
• Usually, patients are unaware of their disease. An increased level of glucose in the blood is diagnosed when they turn to a neuropathologist - about neuropathies, a gynecologist - due to itching of the perineum, a dermatologist - with fungal skin lesions.
• More often the disease proceeds stably, clinical manifestations are moderately expressed.

Diagnosis of diabetes

The main laboratory sign of diabetes is an increase in fasting blood sugar.

1. Determination of the level of glucose in the blood. The normal value is 3.3-5.5 mmol / l.
2. Determination of the level of glucose in the urine. Normally, sugar in the urine is not detected.
3. Determination of ketone bodies in the blood. Normal - no more than 0.1 mmol / l.
4. Determination of ketone bodies and acetone in urine. Normal - traces of ketone bodies.
5. Blood test for glycosylated hemoglobin. The norm is 4–6%.
6. Determination of IRI (immunoreactive insulin). The normal value is 86-180 nmol / l. In type 1 diabetes, it is reduced; in type 2 diabetes, it is normal or elevated.
7. Urinalysis - to diagnose kidney damage.
8. Skin capillaroscopy, Doppler ultrasound - for the diagnosis of vascular damage.
9. Examination of the fundus - to diagnose retinal lesions.

If the results obtained are doubtful (that is, they do not allow an accurate diagnosis), a glucose tolerance test is performed: the level of fasting glycemia is measured, then the patient is given a carbohydrate load (the so-called trial breakfast), 2 hours after which the glucose level is checked again. With diabetes mellitus, the fasting blood glucose level will be more than 6.1 mmol / l, and 2 hours after the test breakfast - more than 11.1 mmol / l.

Principles of treatment

If the first symptoms of this disease occur, it is recommended to consult a doctor as soon as possible and be examined to confirm the diagnosis, after which it is necessary to immediately begin complex treatment.

Common in the treatment of both types of the disease is a diet, the basis of which is the exclusion from the diet of all easily digestible carbohydrates and fats of animal origin. Food - fractional, small portions.

Insulin is an essential component in the treatment of type 1 diabetics. Its dosage is selected individually depending on the weight of the patient, the level of sugar in his blood and the presence of complications of the disease.

The level of glucose in patients with type II diabetes in some cases can only be normalized by diet. The majority of patients are prescribed hypoglycemic tablets. In the case of a severe course of the disease, people suffering from this type of diabetes are also forced to receive insulin.

Unfortunately, it is impossible to cure diabetes, but maintaining the level of glucose in the blood within normal limits will greatly alleviate the patient's condition and prolong his life for a long time.

Which doctor to contact

Diabetes mellitus type I and II is treated by an endocrinologist, but if the diagnosis has not yet been established, you can also contact a general practitioner / pediatrician for an initial examination. Additionally, the patient is consulted by a neurologist, ophthalmologist, dermatologist, gynecologist, vascular surgeon. It is important for a patient with diabetes to attend special courses - the "School of Diabetes", where he will be taught to live with this disease, while maintaining a satisfactory quality of life.