Diabetes mellitus

Diabetes is thought to develop in people who consume a lot of sweets. In fact, it is a much more complex pathology that only partially depends on diet and can occur in any person.

Diabetes mellitus: definition of the disease

Diabetes mellitus (DM) is a group of diseases that are associated with metabolic disorders. People with diabetes cannot digest carbohydrates properly. This causes their glucose concentration (blood sugar) to rise significantly.

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

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

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

The name of the disease was given by the ancient Greeks. Translated from Greek, διαβαίνω means "to go through" and refers to the main symptom of diabetes mellitus, polyuria or frequent urination. For this reason, people constantly lose fluid and try to replenish it with as much water as possible.

However, this is not always the case. Some forms of diabetes can develop asymptomatically over a long period of time or manifest themselves so mildly that the person does not even notice that something has gone wrong. And even with the typical course of the disease, many years often pass before an excess of glucose in the blood leads to the development of symptoms of the disease. In addition, the person is in a state of hyperglycemia all the time and by the time of diagnosis he already has severe irreversible diseases of the kidneys, blood vessels, brain, peripheral nerves and retina.

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

frequency

In 2019, diabetes was the direct cause of 1. 5 million deaths worldwide. In addition, the disease was fatal in almost half of the cases in people under 70 years of age. The other half of the patients died as a result of the disease: kidney failure, heart and vascular damage.

In addition to humans, animals also suffer from diabetes. For example dogs and cats.

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

Classification of diabetes

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

Type I diabetes mellitus

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

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

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

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

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

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

Diabetes mellitus type II

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

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

Other specific types of diabetes

Other specific forms of the disease include pathologies with a pronounced genetic component that are associated with infectious diseases or the use of certain medications.

Genetic defects in the function of pancreatic β-cellsthose types of diseases in which a defective gene is clearly identified.

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

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

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

Drug- or chemical-induced diabetes, can occur while taking hormonally active substances, α- and β-adrenergic agonists, psychoactive, diuretic and chemotherapeutic drugs.

Diabetes related to infectious diseases.As a rule, the disease is caused by viral infections (pathogens: Coxsackie, rubella, Epstein-Barr viruses).

Unusual forms of immunologically mediated diabetes.For example, immobility and rigidity syndrome, systemic lupus erythematosus.

Other genetic syndromes, sometimes combined with diabetes.

Gestational diabetes mellitus

It first appears during pregnancy and is characterized by a decrease in the sensitivity of cells to glucose. The disease is believed to arise due to an imbalance in hormones. After birth, the condition normalizes or it may develop into type II diabetes.

Causes of diabetes

Diabetes mellitus occurs for various reasons, including genetic and autoimmune diseases, chronic pancreatic diseases and dietary habits.

Common causes of diabetes:

• a malfunction of the immune system, due to which it attacks pancreatic cells;
• genetic disorders that affect tissue sensitivity to glucose, alter the functioning of the pancreas and reduce or completely stop insulin synthesis necessary for glucose absorption;
• Viral infections Coxsackie viruses, rubella, Epstein-Barr, retroviruses can penetrate the cells of the pancreas and destroy the organ;
• chronic diseases of the pancreas, cystic fibrosis, pancreatitis, hemochromatosis;
• endocrine disorders Cushing's syndrome, acromegaly;
• Toxins (e. g. rodenticides used to kill rodents, heavy metals, nitrates);
• Dietary habits with an excess of fats and simple carbohydrates in the diet can lead to obesity and reduced sensitivity of cells to insulin;
• Medicines, some hormonal drugs (especially glucocorticosteroids), certain drugs used to treat diseases of the heart and nervous system, preparations of B vitamins (if consumed in excess).

Risk factors for diabetes

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

Risk factors for type I diabetes:

• Heredity – the likelihood of getting sick is higher if blood relatives have diabetes;
• Some viral infections (e. g. , rubella, infectious mononucleosis) can trigger an autoimmune reaction in the body, causing the immune system to attack the cells of the pancreas.

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

The most common risk factors for type II diabetes mellitus that are not directly related to an increase in blood sugar levels: obesity, lack of exercise, pregnancy, etc.

During physical activity, glucose is actively broken down for energy; Substances supplied with food and the body's own fat reserves serve as a substrate. With obesity, the volume and, accordingly, the area of the membranes of fat and other cells containing lipid inclusions increases, the relative density of insulin receptors per unit area decreases, as a result of which the cells become less sensitive to insulin and absorb glucose worse.

Risk factors for diabetes mellitus type II:

• overweight and obesity;
• a sedentary lifestyle (without physical activity, glucose is broken down more slowly, so cells may be less sensitive to insulin);
• Diabetes mellitus in blood relatives;
• age over 45 years;
• Prediabetes is a condition in which blood sugar levels remain at the upper limit of normal for a long period of time. We speak of prediabetes when the analysis shows values of 5. 6 to 6. 9 mmol/l;
• Diabetes mellitus during pregnancy (gestational diabetes);
• Birth of a child weighing more than 4 kg;
• Depression;
• cardiovascular diseases;
• arterial hypertension (pressure above 140/90 mm Hg);
• high levels of "bad" high-density cholesterol (more than 0. 9 mmol/l) and triglycerides (more than 2. 82 mmol/l);
• PCOS syndrome.

Symptoms of diabetes

Type I diabetes mellitus is usually manifested by pronounced symptoms; other forms of the disease can develop unnoticed over a longer period of time.

Common symptoms of diabetes:

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

In addition, there are so-called secondary symptoms of diabetes mellitus that occur in later stages of the disease and indicate complications.

Secondary symptoms of diabetes:

• itchy skin;
• nausea;
• to throw up;
• Stomach pain;
• dry mouth;
• muscle weakness;
• blurred vision;
• poorly healing wounds;
• numbness in fingers or toes;
• Acanthosis nigricans darkening of the skin on the neck, armpits, elbows and knees;
• diabetic dermopathy Pigmented spots with atrophy and peeling of the skin, located on the bends of the lower extremities, often appear due to poor wound healing on the legs;
• Diabetic pemphigus Blisters on the lower extremities ranging in size from a few millimeters to several centimeters. Most commonly occurs in older patients with long-term diabetes;
• Headache;
• Smell of acetone from the mouth.

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

Complications of diabetes

Complications typically occur in patients with advanced diabetes mellitus and include retinopathy, nephropathy and polyneuropathy.

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

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

In addition, the regeneration of small vessels is disrupted. For this reason, wounds on the body do not heal well. Even a small cut can turn into a deep, festering ulcer.

Diabetic coma

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

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

Hypoglycemic comausually occurs in people with diabetes who are receiving insulin therapy.

The cause of such a coma is an excess of insulin, which prevents the body from raising blood sugar levels to normal values. This often happens when the insulin dose is incorrectly calculated or the diet is interrupted, where the amount of insulin administered does not correspond to the carbohydrate content of the food consumed.

Precursors of a hypoglycemic coma:

• trembling in the body,
• Chills,
• Dizziness,
• Nervousness or fear
• severe hunger
• nausea,
• blurred vision,
• Cardiac arrhythmia.

"Rule 15" for stopping hypoglycemia in diabetes:

If your "sugar" level drops, you should eat 15g of fast carbohydrates (drink juice, take a glucose tablet) and measure your blood sugar after 15 minutes. If the level is low, eat another 15g of fast carbohydrates. RepeatThese steps until the sugar content increases to at least 3. 9 mmol/l.

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

Some people mistakenly believe that a sweet liquid needs to be poured into the mouth of a person in a hypoglycemic coma. However, this is not the case and is fraught with asphyxia (suffocation).

Hyperglycemic comaaccompanied by acute insulin deficiency, which can be caused by severe stress or an insufficient dose of insulin after meals.

Dangerous hyperglycemia occurs when blood sugar levels exceed 13. 9 mmol/L.

Symptoms of hyperglycemia:

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

If such symptoms occur, you should sit down as soon as possible, ask others to call an ambulance, or call an ambulance yourself.

Diagnosis of diabetes mellitus

If a person has symptoms of increased blood sugar levels: constant thirst, frequent urination, general weakness, blurred vision, numbness in the limbs, you should consult a family doctor as soon as possible.

However, diabetes mellitus most often develops asymptomatically. Therefore, all people are recommended to undergo a screening test once a year to detect the disease in its early stages and prevent the development of complications.

Which doctor should I contact if I suspect diabetes mellitus?

As a rule, people first turn to a family doctor. If diabetes is suspected, he will refer you to a specialist in the treatment of metabolic diseases, an endocrinologist.

During the consultation, the doctor conducts an interview and examination and prescribes laboratory and instrumental tests to confirm the diagnosis and determine the severity of diabetes.

inspection

If diabetes is suspected, the doctor will clarify the medical history: cases of illness in blood relatives, chronic diseases of the pancreas, lifestyle, recent infectious diseases.

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

During the examination, the doctor also assesses the condition of the skin: with diabetes mellitus, dark areas of acanthosis nigricans can form on it. In addition, a specialist can carry out a rapid glucose test. Exceeding normal values is a reason for a detailed investigation.

Laboratory research methods

A blood sugar test is prescribed for diagnosis. Its high value along with characteristic symptoms such as constant thirst, frequent urination and frequent infectious diseases are a clear sign of diabetes.

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

An HbA1c value of a maximum of 6. 0% (42 mmol/l) and a glucose value of a maximum of 5. 5 mmol/l are considered normal.

To make an accurate diagnosis, the study is carried out at least twice on different days. If the results are unclear, a glucose tolerance test is carried out, which makes it possible to determine impaired cell sensitivity to glucose.

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

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

To assess the sensitivity of cells to insulin, the doctor may order a test to calculate the HOMA-IR index (Homeostasis Model Assessment of Insulin Resistance), which takes into account the level of glucose and insulin in the blood.

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

Instrumental research methods

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

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

To diagnose vision problems, you must consult an ophthalmologist. During an ophthalmological examination, the doctor assesses the condition of the retina and examines the cornea through a slit lamp or with an ophthalmoscope.

Treatment of diabetes

There is no cure for diabetes. Therapy is aimed at maintaining acceptable blood sugar levels and preventing complications of the disease.

People who have been diagnosed with diabetes need to regularly measure their blood sugar levels, inject insulin for type 1 diabetes, take tablets for type 2 diabetes or inject insulin to control blood sugar levels.

To prevent complications of the disease, your doctor may recommend other medications. For example, medications to control blood pressure, thin the blood and prevent cardiovascular disease, as well as medications to lower blood cholesterol levels.

Monitoring blood sugar levels

Classic blood glucose meters and modern systems for continuous monitoring are used to monitor blood sugar levels.

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

Monitoring systems are sensors that are attached to the shoulder, stomach or leg. These sensors constantly monitor blood sugar levels. Data from the device is automatically downloaded to a special monitor or application on the phone. Such devices can report blood sugar spikes, plot glucose curves over time periods, send information to your doctor, and even provide recommendations on emergency and routine measures, as well as the need to change diabetes treatment tactics.

Wearing the monitoring system is not painful and cannot be felt on the body.

Diet for diabetes

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

Carbohydrate counting

Carbohydrates have the greatest impact on blood sugar levels, so it is important for diabetics not to eliminate them, but to count them.

Carbohydrate counting is the basis of the diet of people with diabetes who are receiving insulin therapy. To do this, use the universal parameter Bread Unit (XE).

1 XE is equivalent to approximately 15g of net carbohydrates or 20-25g of bread and increases blood sugar levels by an average of 2. 77mmol/L. To absorb such an amount of glucose, an insulin dose of 1. 4 units is required.

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

The amount of carbohydrates a diabetic can typically tolerate varies from person to person and depends on weight, physical activity, daily calorie needs, and how the body metabolizes carbohydrates.

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

There are also other nutritional recommendations for people with diabetes:

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

Prognosis and prevention of diabetes mellitus

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

Without treatment, the prognosis of diabetes mellitus is unfavorable: a person can die from damage to the cardiovascular system.

Ways to prevent diabetes:

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

Nutrition to prevent type II diabetes mellitus

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

The Healthy Plate method divides foods into five main groups: fruits and vegetables, slow-release carbohydrates, dairy, proteins and fats. You can combine these groups with a regular plate. Fruits and vegetables should make up a third to half of this. Slow down the carbs by a third or a little more. The remaining part is taken up by dairy products, slightly higher protein foods and a small part by fats.

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

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

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