Diabetes mellitus (DM) is an endocrine pathology with a chronic progressive course. It manifests itself in metabolic disorders of carbohydrate and water metabolism, accompanied by hyperglycemia, that is, an increase in blood sugar. Diabetes itself is not terrible, because sugar levels can be normalized in various ways, but it is dangerous due to its complications.
Women are more likely to get sick, and they also have more complications of diabetes. According to statistics, today 7% of the inhabitants of the Earth are diabetics. Among the leading countries are India, China and the USA, in 4th place is Russia (10 million people - 3.5%). The number of cases is growing so fast that, according to statistics, every 7 seconds, 2 people are diagnosed with this disease. The annual death rate is about 2 million people. Although diabetes is in the lead today, it was known and described as early as the 1st century AD. e. in Ancient Greece and Rome.
General understanding of diabetes
To make a diagnosis"diabetes", the doctor should have the results of a complete examination of the patient, since there are several types and degrees of this disease.
Diabetes is divided into congenital and acquired, primary and secondary, juvenile or juvenile, and adult. The last division allows us to talk about pathology of types 1 and 2. Although the division into stages and types has been abolished since 1999, doctors around the world use the classification, since this is important when choosing treatment tactics and making a diagnosis. The incidence of type 1 diabetes is only 5%, type 2 diabetes develops in 95% of cases. The stages, course and causes are different, but the complications are the same.
Type 1 diabetes is called juvenile or juvenile because it can occur in children, even newborns, and in young people under 30 years of age. In recent years, the age line has grown to 45. This type of diabetes is insulin-dependent - IDDM. This means that the cause of the disease lies in the malfunction of the pancreas, the beta cells of which either do not produce insulin at all, or produce very little of it.
Insulin must be supplied from outside to supply the body. This is its main difference from type 2 diabetes, which is considered a disease of adulthood, develops after 40 and is insulin-independent - NIDDM. The production of insulin in beta cells is normal, but the cells of organs and tissues do not receive it for various reasons, which will be discussed below.
There is a situation when there is a lot of sugar in the blood, and the cells of the body are starving. Glucose does not pass through them. Insulin a lot, but helpHe is not able to "open" the cell to glucose, because the cells themselves are resistant to it. Therefore, the second name of such diabetes is insulin resistance. This type is hereditary most often.
Which one is more dangerous? It is believed that type 1 diabetes develops quickly and is difficult to treat.
Causes of Diabetes
Heredity plays a big role: it does not cause diabetes directly, but is inherited, in 70% of cases predisposition to the disease. Among other factors: viral infections - influenza, rubella, epidemiological hepatitis and chicken pox. They become the impetus for the emergence of the disease. Obesity and physical inactivity are relevant for type 2 diabetes. Some diseases of the pancreas itself - inflammation, tumors, other endocrinopathies - can also cause damage to beta cells. In addition, a significant role belongs to fears and stresses, neuroses - they can also become a trigger.
The chance of getting sick increases with age. There is such a proven fact: every 10 years the possibility of developing diabetes in a person doubles. It has also been observed that formula-fed babies are more likely to develop type 1 diabetes.
The main cause of T2DM is abdominal obesity - a "lifeline" on the stomach. These people are most often hypodynamic, eat junk food with an abundance of simple carbohydrates, fried foods and constantly overeat.
Climate matters in type 1 DM - cold weather favors it. Also juvenile diabetesthreatens those who were heavy at birth, who were weaned early and transferred to artificial feeding.
Pathogenesis of disease
The first type is, in fact, an autoimmune process, when your immune system begins to produce antibodies against pancreatic cells. He mistakes them for aliens, but can evolve for unknown reasons.
With DM1, hyperglycemia cannot be removed by your own insulin, because it is not there. The compensatory reaction of the body in this case is the excretion of excess sugar through urine, and urination becomes more frequent. In parallel, dehydration develops in the body. The breakdown of fats begins due to lack of water and nutrition, and the person loses weight.
The picture in type 2 diabetes is completely different: there is a lot of both insulin and sugar in the blood, but the cells are resistant to insulin. Sugar cannot penetrate. Insulin ceases to play the role of a key in the cells, which used to help sugar pass into the cells.
Insulin goes off scale - hyperinsulinemia occurs. The liver still tries to feed the cells with glucose and produces it from any source. But such products are negative for the pancreas, they hit on it, and its work is disrupted.
Ultimately insulin production stops. Further, in the stage of diabetes, blood sugar transfers its action to the walls of blood vessels, corroding them. Cholesterol fills damaged areas - atherosclerosis starts. First of all, capillaries, nerve endings are affected, and complications of diabetes begin.
Types of diabetes
Except for type 1 and type 2 diabetes:
- gestational - develops during pregnancy, after childbirth it most often disappears;
- DM due to poor nutrition;
- secondary or symptomatic diabetes.
Stages of Type 1 Diabetes
Degrees of SD1:
- The first stage of diabetes has a favorable course. Glycemia is only 7 mmol / l, the blood is without deviations, there is no sugar in the urine. There are no complications, the stage is easily compensated by diet and special pills to reduce sugar. This period, or the initial stage of diabetes, is called premorbid. Many doctors consider it necessary to carry out preventive measures in such cases, especially if a person is at risk for heredity. Pathology can only be detected by identifying defective genes in a hereditary predisposition.
- The second degree, or stage 2 diabetes, becomes partially compensated. The destruction of beta cells begins. Complications begin to appear. A photo of diabetes in the initial stage shows what symptoms await a person: frequent urination, thirst, visual impairment.
- In the third stage, treatment is not limited to diet and pills. Glucose is actively in the urine, glycemia is 14 mmol / l. Less insulin is produced. Signs of complications are already obvious: vision is rapidly decreasing, increased pressure has formed, paresthesia of the limbs.
- At the fourth stage of systematicthere are no symptomatic manifestations, but patients complain of frequent colds, persistent boils, conjunctivitis, weakness and malaise. The aim of the treatment is eye and skin problems.
- At the fifth stage of diabetes, 90% of beta cells are already destroyed. The symptoms are vivid.
- The sixth stage is the hardest. The islets of Langerhans are completely destroyed. The glucose level reaches 25 mmol / l, in the urine - glucosuria, proteinuria, complications in the form of kidney failure, gangrene of the toes, trophic ulcers on them.
Stage type 2 diabetes
Degrees, or stages, of type 2 diabetes also have their own characteristics:
- Mild degree - improvement is achieved by diet and sugar-reducing pills. This compensatory, or initial, stage of diabetes is reversible. Glycemia <7, 7 mmol/l, no glucosuria.
- In the middle stage of diabetes, improvement can be achieved (glycemia<12, 7) by taking sugar-lowering tablets - 2-3 capsules. Insulin is not connected yet. The amount of glucose is more than 10 mmol / l, sugar appears in the urine. Of the symptoms: polydipsia, dry mouth, general weakness, polyuria. On the skin for a long time non-healing pustules. Subcompensatory stage, or stage 2 diabetes mellitus, is partially reversible with proper treatment. In addition to oral glucose-lowering drugs (OSBPs), the use of insulin is required.
- Severe decompensatory stage - complete irreversibility of consequences, many complications and violation of carbohydrate and all types of metabolism for life. Hyperglycemia >12, 7 mmol/l, coma may develop. The clinic is expressed, there are angio-and neuropathy.
Signs and symptoms
The symptoms of early stage diabetes are subtle. In type 1 diabetes, the clinical picture develops rapidly and acutely, within a few weeks. The most accurate sign is literally the hourly onset of the pathology. The state of he alth deteriorates sharply, among the first symptoms of the initial stage of diabetes can be noted:
- increased appetite and constant feeling of hunger;
- thirst;
- weakness and chronic fatigue;
- weight loss;
- attacks of nausea and vomiting;
- nervous excitement and irritability.
The temperature drops to 35.6-36.2 degrees. This is a Type 1 hallmark.
The beginning stage of diabetes IDDM is characterized by thinning of the skin, on which cracks easily appear, scratches that do not heal well. Vision problems are manifested in the veil before the eyes, the growing blurred vision. These are signals from the brain that is not getting enough nutrition. Recognizing the presence of diabetes is simple - donate blood for sugar. Failure to take action in type 1 diabetes, unlike type 2, will quickly lead to coma.
How to identify type 2 diabetes?
There are several first signs of the initial stage of type 2 diabetes, people with these manifestations do not even assume the onset of pathology and do not go to the doctor. These include:
- obesity;
- cravings for sweets and starchy foods;
- chronic hunger;
- permanent fatigue and daytime sleepiness.
Also one of the first calls of early stages of diabetes canmanifest itself in an increase in pressure.
Later joins:
- nausea;
- irritability;
- unreasonable decrease in vision;
- tingling and goosebumps in the legs;
- dry sagging skin - creams do not give effect;
- dry mouth and metallic taste;
- spots and itching on the skin;
- itching vulva;
- cardialgia;
- poor healing of any wounds and abrasions.
Also in women, the symptoms of diabetes at an early stage are manifested in the form of hyperhidrosis and diaper rash, increased urination at night. Nocturia is small in volume - from 100 to 230 ml.
Decreased libido, potency. Symptoms do not occur in droves, singly, over a number of years. The capillaries are dilated, the face is pasty, with a red tint. The skin is flabby and dry, the nails are brittle, uneven. After 50 years, gingivitis, periodontal disease and caries join. Bleeding gums, bad breath. A photo of the initial stage of diabetes (its symptoms) is presented below.
Foot and nail fungus or a trophic ulcer often develops. Heels become dry, with corns. Calluses are easily inflamed and do not heal for a long time. Nails exfoliate, crumble, thicken and emit an unpleasant odor.
Symptomatology can manifest itself even after 10 years. All organs are already worn out. Signs of type 2 diabetes do not appear in a bunch or an avalanche, but even if one symptom appears, you need to be examined.
Diagnosis
Blood and urine tests are mandatory.
Biochemical blood testpoint to hidden pathologies. This type of analysis includes: all types of glycemia determination, lipid spectrum, (cholesterol, triglycerides are increased in type 1 and obesity), lipoproteins (in type 1 they are normal, and in type 2 LDL is elevated), C-peptide.
Mandatory are consultations of narrow specialists - a neuropathologist, an ophthalmologist. The fundus is examined and an ECG is done.
In capillary or venous blood, the amount of insulin, glycated Hg, fructosamine is determined.
Another of the main tests is the study of urine for protein, sugar, acetone, ketone bodies.
Possible complications of sweet sickness
The most dangerous complications include:
- diabetic coma;
- nephropathy;
- retinopathy;
- pressure increase;
- edema;
- polyneuropathy;
- macro- and microangiopathy;
- diabetic foot syndrome;
- trophic ulcers;
- gangrene up to amputation of limbs.
Principles of treatment
Treatment for type 1 diabetes is insulin therapy, for type 2 diabetes is diet and pills.
You can quickly lower your blood sugar with PSP pills. They come in several varieties:
- Sulfonylurea based. The validity period is a day, they gradually reduce the performance and do not allow sudden jumps. Improve the work of beta cells and reduce tissue insulin resistance. This group of drugs: Chlorpropamide, Tolazamide, Glibenclamide, Maninil, etc.
- Biguanides –used as an adjuvant in type 2 diabetics, reducing insulin resistance of cells. These include: "Bagomet", "Metfogamma", "Glucofage", "Siofor" and others.
- Drugs that affect the absorption of carbohydrates and slow it down: Acarbose, Guarem, Bayetta, Glucobay.
Prevention measures
Preventive measures include:
- weight normalization;
- exercise moderation;
- balanced diet - diet is selected only by a doctor;
- exclusion of stress;
- pressure control;
- regular sugar testing to control hyperglycemia;
- Purchasing a glucometer and regularly measuring blood glucose as prescribed by a doctor.
The task of the attending physician and the patient himself is not to reach complications. The real danger comes from them.
