Diabetes

It is believed that diabetes develops in those who consume a lot of sweets. In fact, this is a much more complex pathology, which only partially depends on nutrition and can develop in anyone.

Diabetes mellitus: definition of the disease

Diabetes mellitus (DM) is a group of diseases associated with metabolic disorders. People with diabetes cannot digest carbohydrates properly. As a result, the concentration of glucose (blood sugar) increases 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 develops for several reasons. Some types of the disease are genetic in origin, 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 pass", which refers to the main symptom of diabetes mellitus, polyuria or frequent urination. Because of this, a person continually loses fluids and strives to replenish them by drinking as much water as possible.

However, this is not always the case. Some forms of diabetes can develop asymptomatically for a long time or manifest itself so mildly that the person does not even realize that something has gone wrong. And even with the typical course of the disease, many years pass before excess blood glucose leads to the development of disease symptoms. Furthermore, throughout this time the person is in a state of hyperglycemia and, at the time of diagnosis, they already have serious irreversible disorders in the kidneys, blood vessels, brain, peripheral nerves and retina.

The disease causes significant damage to the body. Without treatment, excess glucose can lead to deterioration in kidney, heart, and nerve cell function. But such complications can be avoided. Modern doctors have very effective medications and techniques for treating diabetes.

Prevalence

In 2019, diabetes was the direct cause of 1. 5 million deaths worldwide. Furthermore, in almost half of cases the disease was fatal in people under 70 years of age. The other half of the patients died due to complications 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 death rate from diabetes in developed countries increased by 3% and in lower-middle income countries by 13%. At the same time, the probability of death from complications of the disease in people aged between 30 and 70 years decreased by 22% worldwide. This is believed to be due to better 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

With this type of disease, a person's pancreas produces too little of the hormone insulin, which is needed to transport glucose to cells. As a result, glucose entering the blood cannot be completely absorbed by cells, it remains in the vessels, is transported to 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, due to which the immune system mistakenly attacks its own healthy tissue. Diabetes typically begins in childhood or adolescence, but can develop in people of all ages.

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

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

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

Type II diabetes mellitus

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

Depending on the main cause, type II diabetes mellitus is divided into type II diabetes mellitus with predominant insulin resistance and relative insulin deficiency and type II diabetes mellitus with predominant 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, associated with infectious diseases or the use of certain medications, among others.

Genetic defects in pancreatic β-cell functionthose types of diseases in the development of which a defective gene is clearly established.

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.

Exocrine pancreas diseases.For example, chronic pancreatitis and other inflammatory pathologies.

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

Diabetes induced by medications or chemicals, may occur during the use of hormonally active substances, α- and β-adrenergic agonists, psychoactive medications, diuretics and chemotherapy drugs.

Diabetes associated with infectious diseases.As a rule, the disease develops due to viral infections (pathogens: Coxsackie virus, rubella, Epstein Barr virus).

Uncommon forms of immune-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 develop due to a hormonal imbalance. After delivery, the condition returns to normal or may progress to type II diabetes.

Causes of diabetes

Diabetes mellitus develops for a variety of reasons, including genetic and autoimmune disorders, chronic pancreatic diseases, and dietary habits.

Common causes of diabetes:

• malfunction of the immune system, due to which it attacks pancreatic cells;
• genetic disorders that impair tissue sensitivity to glucose, alter the functioning of the pancreas and reduce or completely interrupt the synthesis of insulin 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 affecting the pancreas, cystic fibrosis, pancreatitis, hemochromatosis;
• endocrine diseases, Cushing's syndrome, acromegaly;
• toxins (e. g. rodenticides, which are used to kill rodents, heavy metals, nitrates);
• eating habits excess fats and simple carbohydrates in the diet can lead to obesity and decreased sensitivity of cells to insulin;
• medicines, some hormonal medicines (in particular, glucocorticosteroids), certain medicines for the treatment of diseases of the heart and nervous system, B vitamin preparations (if consumed in excess).

Risk factors for diabetes

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

Risk factors for type I diabetes:

• heredity - the probability of getting sick is greater 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 pancreatic cells.

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

The most common risk factors for type II diabetes mellitus, which are not directly related to increased blood glucose levels: being overweight, sedentary lifestyle, pregnancy, etc.

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

Risk factors for type II diabetes mellitus:

• overweight and obesity;
• sedentary lifestyle (without physical activity, glucose is broken down more slowly, so cells can become less sensitive to insulin);
• diabetes mellitus in blood relatives;
• age over 45 years;
• Prediabetes is a condition in which the blood glucose level remains at the upper limit of normal for a long time. Prediabetes is said to be present if 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);
• polycystic ovary syndrome.

Diabetes symptoms

Type I diabetes mellitus usually manifests itself as pronounced symptoms, other types of the disease can develop unnoticed for a long time;

Common symptoms of diabetes:

• thirst strong;
• weakness;
• frequent urination;
• nocturnal enuresis in children who have never wet the bed;
• sudden weight loss for no apparent reason;
• strong constant feeling of hunger;
• frequent urinary tract infections or fungal infections.

Separately, there are the so-called secondary symptoms of diabetes mellitus, which appear in the more advanced stages of the disease and signal complications.

Secondary symptoms of diabetes:

• itchy skin;
• nausea;
• to vomit;
• abdominal pain;
• dry mouth;
• muscle weakness;
• blurry vision;
• wounds that do not heal;
• 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 in the curves of the lower extremities, often appear due to poor healing of wounds on the legs;
• blisters of diabetic pemphigus on the lower extremities, ranging in size from a few millimeters to several centimeters. It occurs more frequently in elderly patients with long-standing 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 often develop in patients with advanced diabetes mellitus and include retinopathy, nephropathy, and polyneuropathy.

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

Constant monitoring of blood glucose levels and the use of medications to lower their level can prevent or delay irreversible complications of diabetes.

In addition, the regeneration of small vessels is disturbed. Because of this, wounds on the body do not heal well. So, even a small cut can turn into a deep purulent ulcer.

Diabetic coma

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

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

Hypoglycemic comaIt usually occurs in people with diabetes who are on insulin therapy.

The cause of this coma is excess insulin, which prevents the body from increasing blood glucose levels to normal levels. This often happens when the insulin dose is incorrectly calculated or the diet is interrupted, as a result of which the amount of insulin administered does not correspond to the carbohydrate portion of the food eaten.

Precursors of hypoglycemic coma:

• trembling in the body,
• chills,
• dizziness,
• nervousness or anxiety
• severe hunger
• nausea,
• blurry vision,
• heart rhythm disorder.

"Rule 15" to stop hypoglycemia in diabetes:

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

In rare cases, low blood sugar can cause fainting. In this situation, he needs an urgent injection of the hormone glucagon, which is performed by an ambulance worker.

Some people mistakenly believe that a person in a hypoglycemic coma needs a sweet liquid to be placed in the mouth. However, this is not the case and can cause asphyxiation (suffocation).

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

Dangerous hyperglycemia is said to occur if the blood glucose level exceeds 13. 9 mmol/L.

Symptoms of hyperglycemia:

• strong thirst
• frequent urination,
• extreme fatigue
• blurry vision,
• acetone smell or fruity breath,
• nausea and vomiting,
• abdominal pain,
• rapid breathing.

If these symptoms appear, you should sit down as quickly 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 concentrations: constant thirst, frequent urination, general weakness, blurred vision, numbness in the limbs, they should consult a general practitioner as soon as possible.

But most often, diabetes mellitus develops asymptomatically, so it is recommended that everyone undergo a screening test once a year to detect the disease in the 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 general practitioner. If diabetes is suspected, he refers you to a specialized specialist who treats metabolic pathologies, an endocrinologist.

During the consultation, the doctor will carry out a survey and examination and, to confirm the diagnosis and determine the severity of diabetes, will prescribe laboratory and instrumental tests.

Inspection

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

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

During the examination, the doctor will also assess the condition of the skin: in diabetes mellitus, dark areas of acanthosis nigricans may appear. Additionally, a specialist can perform a rapid glucose test. Exceeding normal values is a reason for an in-depth examination.

Laboratory research methods

For diagnosis, a blood glucose test is prescribed. Its high level, along with characteristic symptoms such as constant thirst, frequent urination and frequent infectious diseases, is a clear sign of diabetes.

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

An HbA1c level not exceeding 6. 0% (42 mmol/l), a glucose level not exceeding 5. 5 mmol/l is considered normal.

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

In addition, your doctor may order additional tests to distinguish 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 Assessment Model 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.

An ultrasound examination of internal organs is prescribed to assess the condition of the kidneys and pancreas. Additionally, the doctor may refer the patient for an ECG to detect abnormalities in the heart.

To diagnose visual disorders, you will need to see an ophthalmologist. During an eye exam, the doctor assesses the condition of the retina and examines the cornea using a slit lamp or an ophthalmoscope.

Diabetes treatment

There is no cure for diabetes. Therapy aims to maintain acceptable blood glucose levels and prevent complications of the disease.

People diagnosed with diabetes need to regularly measure their blood glucose levels, inject insulin for type 1 diabetes or take pills for type 2 diabetes, or inject insulin to control blood sugar levels.

To prevent complications from the disease, your doctor may recommend other medications. For example, medicines to control blood pressure, thin the blood and prevent cardiovascular disease, as well as medicines that reduce blood cholesterol.

Monitoring blood glucose levels

To monitor blood glucose levels, classic glucometers and modern continuous monitoring systems are used.

A glucometer is a device equipped with a fine needle. A person pricks their finger and drops blood onto a special test strip. The glucometer immediately shows the result.

Monitoring systems are sensors installed on the shoulder, stomach or leg. These sensors constantly monitor blood glucose levels. Data from the device is automatically downloaded to a special monitor or to an app on the phone. These devices can signal blood sugar spikes, plot glucose curves over periods of time, send information to your doctor, and even make recommendations about emergency and routine measures and the need to change diabetes treatment tactics.

Using the monitoring system doesn't hurt; it is not felt in the body.

Diet for diabetes

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

Carb Count

Carbohydrates are the ones that most affect blood sugar levels, so it is important for people with diabetes not to eliminate them, but rather to contain them.

Carbohydrate counting is the basis of the diet for people with diabetes who are on insulin therapy. To do this, use the universal parameter bread unit (XE).

1 XE corresponds to approximately 15 g of net carbohydrates or 20–25 g of bread and increases blood glucose levels by an average of 2. 77 mmol/l. To absorb this 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, on average, should not exceed 17 units of bread per day.

The amount of carbohydrates that a person with diabetes can typically tolerate varies from person to person and depends on weight, level of 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 doctor. After converting the carbohydrates you eat into bread units, your doctor will help you determine how much insulin you need to absorb glucose. Over time, a person will learn to calculate this on their own.

Additionally, there are other dietary recommendations for people with diabetes:

• limit caloric intake for all overweight patients;
• minimize the content of fats (mainly of animal origin) and sugars in food;
• consume carbohydrates mainly 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).

Forecast and prevention of diabetes mellitus

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

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

Ways to Prevent Diabetes:

• regular physical activity;
• varied diet with sufficient fiber, proteins, fats and carbohydrates;
• healthy weight management;
• reducing alcohol consumption;
• give up alcohol and smoking.

Nutrition for the prevention of type II diabetes mellitus

An important part of preventing type II diabetes is a healthy and varied diet. The principle, or method, of a healthy dish was developed for this purpose.

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 using a regular plate. Fruits and vegetables should make up a third or half of this. Slow carbohydrates a third or a little more. The rest is occupied by dairy products, a little more by protein foods and a small part by fats.

Eat according to the principle of a healthy dish: half is fiber, ⅓ slow carbohydrates, the rest is protein foods.

In addition, other important principles of healthy eating must be observed:

• drink according to thirst;
• eat less salt, no more than a teaspoon (5–6 g) per day;
• limit the consumption of trans fats (found in many prepared and processed fast food products, cakes and sweets);
• reduce the 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.