Diabetes mellitus is one of the most common to increase the incidence and corruption statistics.The symptoms of diabetes do not occur on the same day, the process flows chronically with increasing and aggravating disorders of endocrine exchanges.The debut of the type -i diabetes differs significantly from the early phase of the second.
In the entire endocrine pathology, diabetes confidently lasts the championship and accounts for more than 60% of all cases.In addition, disappointing statistics show that 1/10 of the "diabetics" are children.
The likelihood of grasping the disease increases with age and thus doubles the number of group every ten years.This is explained by an increase in life expectancy, the improvement of the early diagnosis, a decrease in physical activity and an increase in the number of people with excess weight.
Types of diabetes
Many have heard of such a disease as not -alicous diabetes.So that the reader does not confuse any diseases that have the name "diabetes", the clarification of their differences will probably be useful.
Not -adalar -urethra
Nonachary diabetes is an endocrine disease that occurs due to neuro -infections, inflammatory diseases, tumors, poisoning and sometimes the full disappearance of ADG vasopress (antihuretic hormone).
This explains the clinical image of the disease:
- Constant drought of the mucous membranes of the oral cavity, incredible thirst (one person can drink up to 50 liters of water in 24 hours and stretch the stomach to large sizes);
- The assignment of a large amount of non-conditional light urine with low specific weight (1000-1003);
- Catastrophic weight loss, weakness, decrease in physical activity, disorders of the digestive system;
- A characteristic change in the skin ("parchment" skin);
- Atrophy of muscle fibers, weakness of the muscle device;
- The development of dehydration syndrome in the absence of fluid intake for more than 4 hours.
The disease in relation to complete healing has a disadvantageous prognosis, the performance is significantly reduced.
Short anatomy and physiology
A non - -organ -the pancreas performs a mixed secretion function.Its exogenous part of the external secretion and generates enzymes that are involved in the digestive process.The endocrine part, which is entrusted with the mission of internal secretion, is with the development of various hormones, including developmentInsulin and glucagon.They are crucial to ensure the consistency of the sugar in the human body.
The endocrine section of the gland represents the islands of Langergans, consisting of:
- A cells that occupy a quarter of the entire island space and are considered the place of glucagon products;
- B cells, which synthesize and accumulate up to 60% of the cell population, the molecule of which is a polypeptide of two chains, which bears a certain sequence of 51 amino acid;
- D cells that produce somatostatin;
- Cells that produce other polypeptides.
So the conclusion is evident:In particular, the damage to the pancreas and islands of Langerganes are the main mechanism that inhibits the production of insulin and triggers the development of the pathological process.
Types and special forms of the disease
The lack of insulin leads to a violation of the sugar constancy (3.3 - 5.5 mmol/l)and contributes to the formation of a heterogeneous disease called diabetes (diabetes):
- The complete absence of insulin (absolute defect) formsInsulin -dependentA pathological process that is onType I diabetes (ISD);
- Lack of insulin (relative defect), which triggers a violation of carbohydrate metabolism in the first stage, slowly but safely leads to developmentInsulin -dependentDiabetes (inzsd), which is calledType -ii -Diabetes.
Due to the violations in the body of using glucose and thus the increase in blood serum (hyperglycemia), which is in principle a manifestation of the disease, there are signs of diabetes mellitus, i.e. a complete disturbance of metabolic processes at all levels, over time.
In addition to diabetes in the first and second types, special types of this disease are differentiated:
- Secondary diabetes,The pancreas, which results from acute and chronic inflammation of the pancreas (pancreatitis), malignant neoplasms in the parenchyma of the gland, cirrhosis of the liver.A number of endocrine disorders, accompanied by excessive production of insulin antagonists (acromigaly, kushing disease, phoOchromocytom, thyroid disease), led to the development of secondary diabetes.Many medications that are consumed for a long time have a diabetogenic effect: diuretics, some blood pressure -lowering medication and hormones, oral contraceptives, etc.;
- Diabetes in pregnant women (pregnancy),Due to the special mutual influence of hormones of the mother, the child and the placenta.The pancreas of the fetus, which produces its own insulin, begins to slow down the products of insulin with the mother gland, with this special shape being formed during pregnancy.With the right control, however, pregnancy diabetes usually disappear after birth.In some cases (up to 40%) in women with a similar pregnancy history, this fact can endanger the development of type II diabetes (within 6 to 8 years).
Why is there a "sweet" illness?
The "sweet" illness forms a rather "colorful" group of patients, so it is obvious that the ISSD and its insulin -dependent "counterpart" have occurred differently.There are indications of the connection between insulin-dependent diabetes with the genetic structures of the HLA system (the main complex of histocompatibility), in particular with some genes in the place of the D region.Such a relationship was not seen for Inzsd.
For the development of diabetes of the type of genetic predisposition, the pathogenetic mechanism is launched by provocative factors:
- Congenital inferiority of the islands of Langerganes;
- Adverse influence of the external environment;
- Stress, nervous loads;
- Traumatic brain injuries;
- Pregnancy;
- Infectious processes of viral origin (flu, "pig", cytomegalovirus infection, Coksaki);
- A tendency towards constant overeating, which leads to excessive fat deposits;
- The abuse of confectionery (sweet tooth risks more).
Before lighting the causes of type -ii diabetes, it would be advisable to deal with a very controversial topic: Who suffers more often -men or women?
It was found that the disease is currently being formed more often in women, although in the 19th century the SD was a "privilege" of the man.Incidentally, in some countries in Southeast Asia, the presence of this disease in men is considered predominant.
The predisposing conditions for the development of the type -II diabetes mellitus can be attributed:
- Changes to the structural structure of the pancreas as a result of inflammatory processes and the occurrence of cysts, tumors, bleeding;
- Age after 40 years;
- Obesity (the most important risk factor for inzsd!);
- Vascular diseases due to the atherosclerotic process and arterial hypertension;
- In women pregnancy and the birth of a child with a high body weight (more than 4 kg);
- The presence of relatives suffering from diabetes;
- Strong psychoemotional stress (hypertostation of the adrenal glands).
The causes of the disease of different types of diabetes in some cases match (stress, obesity, the influence of external factors), but the beginning of the process in the event of diabetes of the first and second type is different, beyond.ISSD is the lot of children and boys, and insulin -dependent, the older generation prefers people.
Why do you want to drink so much?
The characteristic symptoms of diabetes, regardless of shape and type, can be shown in the following form:
- Dry mucus cave;
- Thirst, which can almost not be satisfied, combined with dehydration;
- Excessive urine formation and its release by the kidneys (polyuria), which leads to dehydration;
- An increase in glucose concentration in the blood serum (hyperglycaemia) due to the oppression of sugar disposal with peripheral tissues due to an insulin lack of insulin;
- The appearance of sugar in urine (glucose) and ketone bodies (ketonuria), which are normally present in negligible quantities, but with diabetes mellitus are generated intensively by the liver and when they exit the body, are detected in the urine.
- Increased blood plasma (in addition to glucose) of urea and sodium ions (Na)+);
- Weight loss, which is a characteristic characteristic characteristic of a catabolic syndrome when the disease is decompensation, which is developed due to the decay of glycogen, lipolysis (mobilization of fats), catabolism and glucose (transformation in glucose) of proteins;
- Violation of the indicators of the lipid spectrum, an increase in general cholesterol due to the lipoprotein fraction with low density, NEZHK (rash fatty acids), triglyceride.The increasing content of lipids begins to actively go into the liver, and there is intensively oxidized, which penetrates the excessive formation of ketone bodies (acetone + β-oxieligic acid + acetouxus acid) and continues to penetrate their blood (hyperketoninomy).Excessive concentration of ketone bodies threatens a dangerous state that is mentionedDiabetic ketoacidose.
Therefore, the general signs of diabetes can be characteristic of any form of the disease.In order not to confuse the reader, it should still be noted that the characteristics that are inherent in this or that type.
Type I diabetes - "Privilege" by Young
ISD is characterized by sharp (weeks or months).Signs of type I diabetes are pronounced and manifested by clinical symptoms that are typical for this disease:
- A sharp weight drop;
- An unnatural thirst, a person simply cannot get drunk even though she tries to do this (polydipsia);
- A large amount of urine secreted (polyuria);
- Significant surplus of the concentration of glucose and ketone bodies in the blood serum (ketoacidosis).If the patient still knows nothing about his problems, it probably develops diabetic (ketoacidotic, hyperglycemic) coma - a disease that is extremely life -threatening.Therefore, insulin therapy is prescribed as early as possible (only diabetes are hurried).
In most cases, metabolic processes are compensated for after the use of insulin,The need for the body in insulin decreases greatly, a temporary “recovery” comes.However, this short remission state should not relax the patient or the doctor, since the disease reminds itself again after a certain period of time.The need for insulin with increasing illness can increase, but basically it will not exceed 0.8-1.0 units/kg in the absence of ketoacidosis.
Signs that indicate the development of late complications of diabetes (retinopathy, nephropathy) can occur in 5-10 years.The main reasons for the fatal result of the ISD are:
- Terminal kidney failure, which is a result of diabetic glomerulosclerosis;
- Heart cycle disorders as complications of the underlying disease, which occur somewhat less often.
Diseases or age changes?(Type -ii -Diabetes)
INZSD has been developing for many months or even years.The problems that occur entails a person to various specialists (dermatologist, gynecologist, neurologist ...).In his opinion, the patient does not suspect that the diseases are different: furunculosis, skin itching, mushroom lesions, pain in the lower extremities -signs of type -ii diabetes.The patients get used to their condition, and diabetes continue to develop slowly and affects all systems and mainly vessels.
The INZSD is usually characterized by a stable slow course without showing a tendency towards ketoacidosis.
Treatment of type -2 diabetes usually begins in harmony with a restriction with a restriction of slightly digestible (refined) carbohydrates and use (if necessary) to reduce medicines of medicinal products.Insulin is prescribed when the development of the disease has reached the stage of serious complications or the immunity of oral drugs is present.
The main cause of the main death in patients with INZSD was recognized as a cardiovascular pathology, which has become an episode of diabetes.This is usually a heart attack or stroke.
Diabetes treatment products
The basis for medical measures to compensate for diabetes are three main principles:
- Compensation for a lack of insulin;
- Regulation of endocrine exchange diseases;
- Prevention of diabetes mellitus, its complications and their timely treatment.
The implementation of these principles is based on 5 main positions:
- Diabetes nutrition is assigned to the party of the "first violin".
- The system of physical exercises, adequately and individually selected, is diet;
- Medicines that reduce sugar are mainly used to treat type -2 diabetes.
- Inzsd is prescribed insulin therapy, but is the main reasons for type -1 diabetes.
- Teaching patients for self -control (skills to take blood from a finger, using a glucometer, the introduction of insulin without external help).
The laboratory control via these positions shows the degree of compensation according to the following biochemical studies:
| Indicators | A good measure of compensation | Satellite | Bad |
|---|---|---|---|
| Glucose level on an empty stomach (MMOL/L) | 4.4 - 6.1 | 6.2 - 7.8 | Ø 7.8 |
| The sugar content in the blood serum 2 hours after eating (MMOL/L) | 5.5 - 8.0 | 8.1 - 10.0 | Ø 10.0 |
| The percentage of glycosylated hemoglobin (HBA1, %) | <8.0 | 8.0 - 9.5 | Ø 10.0 |
| The indicator of the entire cholesterol in the serum (mmol/l) | <5.2 | 5.2 - 6.5 | Ø 6.5 |
| Triglyceride mirror (mmol/l) | <1,7 | 1.7 - 2.2 | Ø 2.2 |
An important role of a diet in the treatment of INZSD
The diabetes diet is very well known to be far from diabetes for people, Table No. 9.From time to time you can hear from a special diet that is always in separate pots, differs from the rest of the diets and is pronounced according to a certain password: "I have the ninth table."What does that mean?What is the difference between this mysterious diet of everyone else?
You shouldn't be wrong and take care of his “porridge” of the diabetics that all the joys of life are withdrawn.Diet diet does not differ so much from the diet of healthy people, the right amount of carbohydrates (60%), fats (24%) and proteins (16%) patients.
The power supply for diabetes is to replace refined sugar in products with slowly shared carbohydrates.Sugar was sold in a shop for everyone and confectionery that is based on it falls into the category of prohibited food.
As far as the balance of nutrition is concerned, everything is strict here: the diabetics must use the required amount of vitamins and pectins, which should be at least 40 g.per day.
Strictly individual physical activity
The physical activity for each patient is selected individually by the applicable doctor, while the following positions are taken into account:
- Age;
- Symptoms of diabetes;
- Severe of the river of the pathological process;
- The presence or lack of complications.
The physical activity prescribed by the doctor should contribute to the “combustion” of carbohydrates and fats without gaining insulin to participate.The dose that is necessary to compensate for metabolic disorders is noticeable, which should not be forgotten, since it can achieve an undesirable effect by preventing the increase in blood sugar.A reasonable physical activity reduces glucose, the insulin dose of insulin breaks and consequently a decrease in sugar levels under the permissible values (hypoglycemia).
Therefore,The dosage of insulin and physical activity requires very precisely attention and thorough calculation.In order to complement each other, do not step together across the lower limit of normal laboratory indicators.
Or do you try folk remedies?
Treatment of type -2 diabetes is often accompanied by the search for patients with folk remedies who inhibit the process and can delay the time of taking dosage forms as far as possible.
Without looking at the fact that our distant ancestors knew practically nothing about such a disease, there are folk remedies for the treatment of diabetes, but we should not forget thatInfusions and decocements from different plants are an aid.The use of domestic medication for diabetes does not relieve the patient from compliance with nutrition, control of blood sugar, visiting a doctor and fulfilling all of his recommendations.
In order to combat this pathology at home, quite famous folk remedies are used:
- Bark and white mulberry leaves;
- Körner and peeling oats;
- Walnut partitions;
- Laurel leaf;
- Cinnamon;
- Acorn;
- Nettle;
- Dandelion.
If diet and folk remedies no longer help ...
The preparations of the first generation, which were generally best known at the end of the last century, remained in the memoirs and were replaced by medication from the new generation, from which 3 main groups were made by diabetes from the pharmaceutical industry.
What means is suitable for one or another patient - the endocrinologist decides.So that patients do not mediate themselves and do not opt for diabetes at their own discretion, we will give several visual examples.
Sulfonylmochevins derivatives
Derivatives of the second generation Sulfonema are currently prescribed and 10 hours to take a day.Usually the patients take 2 times a day half an hour before eating.
In the following cases, these drugs are absolutely contraindicated:
- Type -1 -Diabetes;
- Diabetics, hyperosmolar, lactacidotic coma;
- Pregnancy, birth, lactation;
- Diabetic nephropathy, accompanied by an impaired filtration;
- Diseases of the hematopoetic system with a simultaneous decrease in white blood cells - leukocytes (leukocytopenia) and the thrombocytic hematopoese connection (thrombocytopenia);
- Severe infectious and inflammatory liver lesions (hepatitis);
- Diabetes that are complicated by vascular pathology.
In addition, the use of medicinal products of this group can threaten the development of allergic reactions that manifest themselves:
- Itching and urticaria, sometimes reach the edema of Quickke;
- Disruptions of the digestive system;
- Changes from the blood side (reduction of the tile level and leukocytes);
- Perhaps a violation of the functionality of the liver (jaundice due to cholestasis).
Sailbro gain facilities of the Biguanides family
Biguanides (guanid dinders) are actively used for the treatment of type -2 diabetes and often indicate sulfonamides.They are very rational for the use of patients with obesity, people with liver, kidneys and cardiovascular pathology are very limited and switch to more economical drugs in the same group or α-glucoside inhibitors that inhibit the absorption of carbohydrate orpation in the small indarm.
Absolute contraindications for the use of biguanides are taken into account:
- ISD (type -1 -diabetes);
- Significant weight loss;
- Infectious processes, regardless of localization;
- Surgical interventions;
- Pregnancy, birth, lactation;
- Coma states;
- Liver and kidney pathology;
- Oxygen hunger;
- Microangiopathy (2-4 degrees) with visual impairment and kidney function;
- Trophic ulcers and necrotic processes;
- Violation of blood circulation in the lower extremities due to various vascular pathology.
Insulin treatment
From the above becomes the fact that the above is the above, thatThe use of insulin is the main treatment of type -1 diabetes, all emergency conditions and serious complications of diabetes.The INZSD only requires the appointment of this therapy for insulin -use forms if the correction by other means does not have the right effect.
Modern insulins, called monocompetent, represent two groups:
- Monocompetent pharmacological forms of human insulin substance (semi-synthetic or DNA rockombinant), which undoubtedly have a significant advantage over pork preparations.They have practically no contraindications and side effects;
- Monocompetent insulins that were obtained from the pancreas of the pig.These drugs compared to human insulins require an increase in the dose of the drug by approximately 15%.
Diabetes are dangerous complications
Due to the fact that diabetes is accompanied by damage to many organs and tissues, you will find its manifestations in almost all body systems.Complications of diabetes are taken into account:
- Pathological changes in the skin: Diabetic dermopathy, lipoid necrobiosis, furunculose, xanthom, mushroom lesions of the skin;
- Bone-artistic diseases:
- Diabetic osteoarthropathy (joint joint - a change in the ankle joint), which occurs against the background of a violation of microcirculation and trophic disorders, accompanied by transfers, subluxis, spontaneous fractures that proceed before the formationdiabetic;
- Diabetic hyropathy, characterized by stiffness in the hands, joints, which are more often formed in children with diabetes by children;
- Respiratory diseases: long -termExtended bronchitis, pneumoniaPresentIncreasing the frequency of the development of tuberculosis;
- Pathological processes that influence the digestive organs:Diabetics EnteropathyAccompanied by an increased peristalsis, diarrhea (up to 30 -daily), a decrease in body weight;
- Diabetic retinopathy- one of the most serious complications characterized by damage to the organs of seeing;
- The most common complication of diabetes is taken into accountDiabetic neuropathyand its variety -Polyneuropathy90% of all forms of this pathology.The frequently occurring diabetic polyneuropathy isDiabetic foot syndrome;
- In most cases, the pathological state of the heart cycle system is the cause of death of diabetes mellitus.Hypercholesterolemia and vascular atherosclerosis, which begins to develop with diabetes at a young age, inevitably lead to diseases of heart and blood vessels (coronary heart disease, myocardial infarction, heart failure, cerebrovascular impairment).
prevention
Measures to prevent diabetes are created on the basis of the causes of his defiant distance.In this case, it is advisable to talk about the prevention of atheriosclerosis, arterial hypertension, including the struggle with excessive weight, bad habits and food addiction.
The prevention of complications of diabetes is to prevent the development of pathological conditions that result from diabetes.Correction of glucose in the blood serum, compliance with nutrition, appropriate physical activity and the implementation of the doctor's recommendations helps to exceed the consequences of this rather impressive illness.