Probably not many people are happy with their medical history. The type 2 diabetes mellitus listed in it can cause even more discouragement. But is it worth it to give up and despair? How dangerous this disease is, and how to deal with it - we will figure it out.
Diabetes mellitus - what is the danger?
People often hear about diabetes, but few know what it is. It should be noted that the concept of "diabetes mellitus" is a collective image. Under this term, several diseases of the endocrine system will be combined. The causes of their occurrence are quite numerous, but, as a rule, the disease is based on endocrine disorders, and in particular, insulin deficiency. Another factor may be the inability to absorb glucose by the liver and body tissues. At the same time, its level in the body rises, which, in turn, is the cause of a number of metabolic disorders.
Sugardiabetes - its types
Modern medicine distinguishes two types of this disease. Gradation occurs depending on what kind of insulin deficiency - relative or absolute - describes the history of the disease. Type 2 diabetes, as a rule, is not associated with a deficiency of the hormone insulin, which is produced by the pancreas. Usually the cause of its development is a decrease in the sensitivity of organs and tissues to this hormone. Insulin-dependent diabetes - the first type - is directly related to insulin deficiency in the body. The lack of this hormone leads to the fact that the glucose that has entered the body is not processed, or it occurs in insufficient quantities, while its level in the blood constantly rises, and in order to save life, such patients are forced to receive additional doses of insulin.
Case history - type 2 diabetes
This diabetes is also called non-insulin dependent. According to statistics, there are much more patients suffering from this particular type of disease than the first. With age, the risk that this disease will manifest itself increases significantly. Very often, its development occurs imperceptibly, and the patient does not know about this pathology for a long time, the data that allow it to be suspected do not reflect the history of the disease. Type 2 diabetes is then discovered as a “chance finding” during a routine examination. The main indicator that allows you to suspect the presence of this pathology is a blood test in which glucose is elevated. In turn, when a medical history is drawn up,type 2 diabetes is subdivided into:
- occurring in normal weight patients;
- identified in overweight patients.
Causes of Diabetes
Even in the process of training, young doctors complete a study history of the disease, type 2 diabetes mellitus in which can be caused by several reasons. The most common ones are:
- consumption of refined carbohydrates (sugar, chocolate, muffins, potatoes) in large quantities and lack of plant fibers in the diet;
- heredity - in the presence of a similar pathology in parents, the risk of developing diabetes exceeds 40%;
- obesity, especially of the visceral type (fat deposits are located mainly in the abdomen);
- hypertension;
- hypodynamia.
What's going on? Pathogenesis
Case history Type 2 diabetes is described as a series of metabolic disorders. It is based on insulin resistance - the inability of tissues to normally perceive insulin, on the one hand, and a violation of the production of this hormone in pancreatic cells, on the other. Normally, with an increase in glucose levels that occurs immediately after a meal, the pancreas begins to diligently produce insulin. In people with type 2 diabetes, this does not happen, and insulin begins to be produced only when the level of glucose concentration is already high. However, despitethe presence of insulin, the decrease in sugar levels in this case does not occur to the desired level. The constant elevated concentration of insulin causes the cells to lose their ability to respond to it, and now, even if the hormone manages to connect to the cell receptor, there is no reaction. Against the background of these changes, liver cells begin to actively synthesize glucose, further increasing its concentration in the blood. All this does not pass without consequences. Over time, under the influence of a high concentration of glucose, glucose toxicity develops, which negatively affects the cells of the pancreas that produce insulin, and, as a result, its deficiency develops. Thus, the history of the disease is aggravated. Type 2 diabetes mellitus insulin-requiring changes form when insulin administration has not yet been required. The patient's condition is deteriorating.
Symptoms
In the classical clinic of diabetes, it is customary to distinguish two groups of signs of the disease - major and minor. The main ones include:
- polyuria - a lot of urine is released (glucose, getting into it, significantly increases osmotic pressure);
- thirst (polydyspepsia) - characterized by a constant, insatiable need to drink;
- hunger (polydysphagia) - due to the inability of cells to absorb glucose with the help of insulin, the body experiences a constant need for energy;
- dramatic weight loss - it occurs against the background of increased appetite.
All these symptoms are more characteristic of the first type of diabetes. The second type may be generally asymptomatic or cause secondary symptoms:
- itching of the skin and mucous membranes - often when examining a patient and suspecting type 2 diabetes mellitus (medical history), a woman may notice unbearable itching in the genitals;
- general weakness and headaches;
- inflammatory skin lesions that are difficult to treat;
- vision decrease.
As a rule, most simply do not pay attention to such symptoms, and the disease can only be detected at the stage of complications.
Children and diabetes
Unfortunately, diabetes is now recognized as the second most common chronic disease. That's what official pediatrics thinks. Diabetes mellitus (type 2) often ranks among the most dangerous diseases in a child's medical history. This is due to the fact that its course differs from the disease of an adult in a more rapid development and often proceeds more malignantly. However, in this case, it all depends on the ability of parents to adjust the child's diet and monitor the timely intake of drugs. In addition, it is very important to detect the disease in time. If the child has the following symptoms, an urgent consultation with an endocrinologist is necessary:
- child is constantly thirsty;
- goes to the toilet much more often (at school or kindergarten he has to take time off from lessons several times);
- weight loss;
- Chronic fatigue is observed.
Diagnosis
Diagnose diabetes based on urine and blood tests. In a he althy individual,urine glucose is not determined, and in the blood its level does not exceed 5, 5. For reliable results, blood is taken from a finger or a vein (the last meal should be taken at least 8 hours before the procedure), sweet tea, coffee or juice should not be drunk before donation. It should be noted that diabetes is diagnosed with indicators above 7. If the indicators range from 4 to 7, then a violation of glucose tolerance is recorded.
Another test that can detect this disease and clarify doubtful values is the glucose tolerance test (GTT). It allows you to get data on the level of glucose on an empty stomach, as well as two hours after he took a glucose solution. Normally, after glucose, its concentration should not be higher than 7.8. This test is not performed when glucose before the test is higher than 6.1, if the patient has a history of acute illness, surgery, myocardial infarction, trauma, and also when taking drugs that increase glucose levels. All these data reflect the medical history.
Type 2 diabetes, subcompensation
Like any disease, diabetes tends to build up and worsen symptoms. There are three stages in its course. The compensation stage is set when the patient's indicators approach the norm. If measures are not taken in time, or they do not bring the expected result, then the disease passes into the stage of subcompensation. At the same time, the patient's condition, of course, is not the best, but also non-critical. On the day the patient loses no more than fifty grams of glucose in the urine, and its blood level is about 13.8,acetone is absent in the urine. The development of hyperglycemic coma at this stage is also impossible. The stage of subcompensation includes an intermediate state between compensation and decompensation, while for the stage of compensation, the upper values take a glucose level of 7.5, the percentage of glycated hemoglobin is 6.5%, and fasting glucose is less than 6.1. The stage of decompensation is set if the indicators exceed the following limits:
- glucose level is over 9;
- glycerated hemoglobin - more than 9%;
- fasting glucose - more than 7.
Changes in these indicators and the effectiveness of the prescribed treatment helps to trace the history of the disease. Type 2 diabetes mellitus, the severe course of which is difficult to treat or provoked by other factors, passes into the stage of decompensation.
Factors causing decompensation
Of course, each organism is individual, and the factors that aggravate the course of the disease may be different, but these are the most common:
- overeating, diet violation;
- mistake in the selection of a drug, its dose or refusal of treatment;
- self-medication or use of dietary supplements instead of prescribed drugs;
- refusing to switch to insulin therapy;
- infections that contribute to dehydration;
- stressful situations.
All these factors, individually or in combination, significantly affect the state of metabolic processes, and, as a result, there is an increaseindicators of glucose levels, which captures the history of the disease. Type 2 diabetes mellitus, the stage of decompensation of which is aggravated by the appearance of various complications from the organs and systems of the body, becomes threatening and, if not treated correctly, can pose a threat to the life of the patient. At the same time, complications can develop both prolonged in time and literally in a matter of hours.
Decompensation stage
As the concentration of glucose increases, and its correction requires more serious measures, the medical history is aggravated. Diabetes mellitus (type 2), the decompensation of which is characterized by a high risk of complications, requires a very careful attitude. This is due to the fact that it can be very difficult to adjust the level of glucose both with the help of diet and the use of drugs. As a result, it is necessary to carefully and constantly monitor the patient's condition, because in the absence of a therapeutic effect when using drugs, pathological changes in various organs very quickly occur. Therefore, these patients need medical supervision, and very often emergency care.
The possibility of self-control over one's condition is of great importance here. Fortunately, modern medicine has a sufficient choice of means for this. Various tests and devices that determine the level of glucose allow a diabetic patient to self-diagnose their condition and, depending on the results, carry out a correction.
Insulin in the treatment of diabetes
As the disease progresses, depletion of those pancreatic cells that produce insulin also develops. This process requires the immediate appointment of hormone therapy. As modern research shows, sometimes this is the only way to maintain glucose levels at the right level. Nevertheless, you should not assume that the appointment of insulin is for life. Often, type 2 diabetes mellitus, insulin-dependent, whose medical history, it would seem, is doomed to record lifelong insulin intake, with some effort on the part of the patient, can move into the category when regular administration of this hormone is not required. In this regard, diabetes mellitus refers to those pathologies where control and efforts on the part of the patient are very important to achieve a therapeutic effect. So, the degree of compensation for the disease will depend on his discipline in relation to diet, self-monitoring of sugar levels and timely intake of medications. However, in some cases, the appointment of insulin is a mandatory measure. This is happening:
- during pregnancy;
- in case of strokes or heart attacks;
- for surgical interventions;
- for infectious diseases of a purulent-septic nature;
- with elevated laboratory diagnostics.
Another important reason for the mandatory appointment of insulin can be a clear lack of this hormone, which confirms the history of the disease. diabetes mellitus 2type, the stage of decompensation of which is characterized by severe progressive weight loss and increasing ketoacidosis, is a prime example of this.
It should be noted that today medicine has greatly expanded the scope of the use of insulin therapy, and it is officially confirmed that the effectiveness of oral monotherapy lasts less than 6 years. Then you have to prescribe several drugs. According to the latest trends in the treatment of diabetes, the use of insulin in such cases is considered to be more effective.
Acute complications
Acute complications of the decompensation stage are conditions in which there is a real threat to the life of the patient. They are usually caused by a significant increase in glucose levels and associated metabolic disorders. When such a condition occurs, it is important to provide timely assistance and, since not only doctors, but also nursing staff should know the signs of these conditions, the nursing history of type 2 diabetes mellitus and its complications is described as follows.
- Hyperglycemic coma (hyperosmolar and ketoacidotic) - their hallmark is a gradual development. The factors provoking them are an insufficient dose or missed insulin intake, a diet disorder (excessive consumption of carbohydrates), physical activity on the background of hyperglycemia, lack of glucose control, alcohol or certain medications. Clinically theymanifested by increasing thirst and polyuria (increase in the amount of urine) over several days, severe dehydration. Arterial pressure is reduced, tachycardia. If the condition worsens, convulsions or depression of consciousness are possible. The skin is dry, scratching is possible, the smell of acetone when exhaling. In this case, the victim needs urgent hospitalization and medical care.
- Hypoglycemic coma - develops as a result of a sharp decrease in blood glucose (less than 3 mmol / l), as a result of which the brain experiences a sharp lack of nutrients. This condition can be provoked by an overdose of insulin, skipping one of the meals or an improperly selected diet, taking alcohol or drugs. Clinically, the attack develops rapidly. Characterized by cold sweat on the forehead, weakness, trembling of the hands, headache, numbness of the lips. The patient is aggressive, poorly coordinates his movements, there is a heartbeat, double vision, confusion. In the later stages, there is a loss of consciousness, convulsions. At the prehospital stage, such patients can be given a sweet drink or something to eat, warm and transport to a medical facility for follow-up care.
Late complications
Such complications develop in decompensated diabetes after several years of illness. Their danger lies in the fact that they gradually and imperceptibly worsen the patient's condition. In addition, often even competent diabetes therapy cannot guarantee that sooner or later they will not appear.
- Retinopathycharacterized by retinal damage. Unfortunately, despite all the achievements of modern medicine, the occurrence of retinopathy in patients with type 2 diabetes, which lasts more than 20 years, tends to 100%. This pathology causes hemorrhages in the fundus and eventually leads to complete loss of vision.
- Angiopathies - are in violation of vascular permeability, which causes the development of thrombosis and atherosclerosis. Can develop in a short time (about a year), unlike other late complications that often aggravate the medical history.
- Type 2 diabetes mellitus, diabetic polyneuropathy, which is also a common complication, registers it in 90% of cases. Clinically, this is expressed by damage to the nerves that control both muscles and internal organs. Polyneuropathy can be manifested by hypersensitivity, sudden sharp (shooting) pains, burning. Also, manifestations of neuropathy can be numbness, decreased sensitivity, which leads to numerous injuries. On the part of the internal organs, there may be diarrhea, urinary incontinence, headaches, dizziness, interruptions in the work of the heart.
- Diabetic foot - is characterized by the appearance of trophic ulcers, abscesses, necrotic areas on the legs and, in particular, on the feet of a diabetic patient. That is why patients suffering from this pathology are recommended to pay special attention to the selection of shoes.
Forecast
Sad as it may seem, butDefinitively defeat diabetes mellitus modern medicine is not able to. However, it may well correct in a timely manner the deviations that are caused in the human body by an increased concentration of glucose, that is, type 2 diabetes mellitus. The history of the disease, the prognosis of this disease in many ways, if not in everything, will depend on the patient's attitude towards it. With careful monitoring on his part of the level of sugar and other indicators, the necessary drug correction, diet and recommendations of doctors, complications can be avoided for many years.
