Diabetes mellitus is a disorder of glucose metabolism in the body that is associated with a lack of insulin. Glucose is the fuel for cells and insulin is the hormone that helps it enter cells. Without insulin, glucose remains in the blood, leading to hyperglycemia and the risk of complications to the kidneys, eyes, nerves, heart and blood vessels. Diabetes is incurable but can be controlled through proper diet, physical activity and medication. An endocrinologist talks about this in more detail.
Diabetes classification
Most people only know of two types of diabetes. In fact, there are more of them. Depending on the cause and mechanism of disease development, the following types of pathologies are distinguished:
Diabetes mellitus type 1(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 fully known, but it is thought to be influenced by genetic and environmental factors. Type 1 diabetes is usually diagnosed in childhood or adolescence and requires constant insulin administration.
Diabetes mellitus type 2(not 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, lack of exercise, malnutrition and hereditary predisposition. Type 2 diabetes mellitus most often develops in adults.
Diabetes mellitus in pregnancy(Pregnancy). With this type of disease, elevated blood sugar levels occur during pregnancy, which usually disappear after delivery. This is due to changes in hormone levels and metabolism in a woman's body. They can lead to reduced insulin production or poorer insulin action. Women with gestational diabetes have an 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 defects, pancreatic diseases, endocrine disorders, certain medications or infections.
Symptoms of diabetes
Classic signs of diabetes are associated with an excess of glucose in the blood. These include:
- Polyuria (frequent and heavy 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 wound healing, prone to infection.
- Visual impairment, appearance of spots in front of 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 particularly true for type 1 diabetes, which is associated with hereditary disorders of the immune system.
- Obesity and overweight.Excess fat in the body leads to poor insulin action and increased blood sugar levels. Visceral fat, which surrounds internal organs and releases inflammatory mediators that disrupt metabolism, is particularly dangerous.
- Poor diet.Consuming large amounts of simple carbohydrates, fats, salt, alcohol, as well as a lack of complex carbohydrates, proteins, fiber, vitamins and minerals in the diet contribute to metabolic disorders and increased blood sugar levels. The regularity and frequency of meals is also important, as long gaps between meals can lead to hypoglycemia (low blood sugar levels) and frequent snacking can lead to hyperglycemia (high blood sugar levels).
- Lack of physical activity.Physical activity helps lower blood sugar levels 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 lead to the release of adrenaline, cortisol and glucagon. They increase blood sugar levels, suppress insulin production and increase inflammation. Stress can also lead to disruptions in diet, sleep and physical activity.
- Diseases of the pancreas.If the pancreas is damaged by inflammation, stones, tumors or chronic pancreatitis, this can lead to reduced insulin production and the development of diabetes mellitus. There are also genetic disorders that lead to pancreatic dysfunction, for example, cystic fibrosis, Schwartz-Bartter syndrome, Johanson-Blitzer syndrome and others.
- Endocrine disorders.The endocrine system is a collection of organs that produce hormones that regulate various body functions. Some hormones such as glucagon, glucocorticoids, growth hormones, thyroid hormones and catecholamines counteract the effects of insulin and increase blood sugar levels.
- Taking certain medications.Some medications can increase blood sugar levels, 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 levels and may require dosage adjustment or medication replacement.
- 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 increase blood sugar levels.
Diagnosis of diabetes mellitus
To make a diagnosis, a comprehensive examination is required. First, the patient is examined and questioned by an endocrinologist. It identifies characteristic symptoms and takes into account the circumstances of their occurrence, concomitant diseases and hereditary factors. Then a detailed examination is prescribed:
Laboratory research.The most important method for diagnosing diabetes mellitus is determining blood sugar levels. For this purpose, the following tests are carried out:
- fasting glucose.
- Glucose tolerance test.
- Glycated hemoglobin (HbA1c)
Instrumental research.To detect complications of diabetes mellitus and assess the condition of target organs, the following studies are carried out:
- Ophthalmoscopy.This is an examination of the eye 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 scan of the kidneys that allows you to assess their size, shape, structure, as well as the presence of stones, tumors, cysts and inflammation.
- Dopplerography of the vessels of the lower extremities.This is an ultrasound examination of the vessels of the lower extremities, which allows you to assess their lumens, walls, blood flow, the presence of blood clots, atherosclerotic plaques, narrowings and aneurysms.
- Electrocardiography (ECG).This is an examination of the heart that 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 that allows you to assess sensitivity, reflexes, coordination, muscle tone, the presence of paresthesias, pain and movement disorders. With diabetes mellitus, changes in the nerves such as demyelination, degeneration, inflammation can develop, which can lead to disruption of the transmission of nerve impulses and the development of polyneuropathy, autonomic neuropathy, mononeuropathy and radiculopathy. This condition is called diabetic neuropathy.
Dermatological examination.This is a skin examination that allows you to assess color, turgor, moisture, the presence of wounds, cracks, ulcers, fungal, bacterial and viral infections, allergic reactions, pigmentation, atrophy, scleroderma and acanthosis.
With diabetes mellitus, skin changes such as xerosis, diabetic dermopathy, diabetic bullosis, diabetic urticaria, diabetic angiopathy and diabetic foot can develop, which can lead to a disruption in 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 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 patients with type 1 diabetes, but also for some patients with type 2 diabetes when other treatments do not work.
What types of insulin are there and how are they used?
There are different types of insulin that 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 prolonged (prolonged) action.
- Ultra-short and short-acting insulins mimic physiological insulin release after a meal and are administered 15-30 minutes before meals.
- Extended-release insulins maintain 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 durations of action that are convenient to use.
Insulin is injected under the skin using special devices such as pens, pumps or inhalers. The insulin dose is selected individually for each patient, depending on blood sugar levels, the amount and composition of food, physical activity and other factors.
To control blood sugar levels, the patient should measure it regularly using a blood glucose meter or continuous glucose monitor.
What rules and recommendations should be followed when using 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 fat under the skin, which can occur at the site of frequent insulin injections.
To avoid this, it is necessary to change the insulin injection site and use thin needles. Therefore, patients must learn the basics of insulin therapy and consult a doctor if they have any questions or concerns.
Diet for diabetes
Diet for diabetes is the most important part of treatment. In mild forms of diabetes, diet alone is sometimes enough to achieve the desired blood sugar level. In more severe cases, drug therapy (oral antidiabetics, insulin) helps.
The following general nutritional rules for diabetes mellitus must be observed:
- Meals should be frequent and small(5-6 times a day), in small portions. This will help avoid large jumps in glycemic value.
- Meals should be taken at the same times. The same applies to taking blood sugar-lowering medications and insulin injections.
- Strict diets and hunger strikes are prohibited, as they can lead to hypoglycemia (low blood sugar) and disruption of fat and protein metabolism.
- These are preferredCooking methodssuch as: steaming, boiling, steaming and baking. Fried, smoked, salted and pickled foods should be excluded or minimized.
- ShouldEliminate easily digestible carbohydrates from the diet(Sugar, honey, confectionery, jam, baked goods, white flour). They quickly increase 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,as such carbohydrates are absorbed more slowly and do not cause blood sugar to rise as much. Fiber also helps normalize intestinal function, lower cholesterol and reduce appetite. Sources of fiber include vegetables, fruits, herbs, whole grain breads and cereals, legumes, nuts and seeds.
- Limit consumption of animal fats(butter, lard, fatty meat). They contain saturated fatty acids, which increase cholesterol levels and contribute to the development of atherosclerosis and coronary heart disease. Vegetable oils (sunflower, olive, corn oil, etc. ) that contain unsaturated fatty acids, which have a positive effect on the heart and blood vessels, are preferred. Fish and seafood are also useful, as they are sources of omega-3 fatty acids, which have anti-inflammatory and anti-sclerotic effects.
- That is advisableThe calorie content of the food and the amount of carbohydrates were approximately the sameB. on different days, this is particularly important when selecting the insulin dose. To calculate the amount of carbohydrates, you can use special tables that indicate how many grams of carbohydrates are contained in various foods.
- ShouldControl salt intake, as 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).
The diet for diabetes should be balanced, varied and tasty. You don't have to give up your favorite dishes, but learn to prepare them correctly, taking into account your condition and needs.
Diabetes mellitus is a serious disease that requires constant medical supervision and lifestyle adherence. If you notice signs of diabetes in yourself or your loved ones, do not hesitate to go to the doctor. The earlier the diagnosis is made and treatment started, the lower the likelihood of complications and the better the prognosis of the disease.