Diabetes mellitus is a metabolic disorder characterized by an increase in blood sugar.
The disease occurs as a result of defects in insulin production, defect of insulin action or both of these factors. In addition to high blood sugar levels, the disease is manifested by the release of sugar in the urine, abundant urination, increased thirst, violations of fat, protein and mineral metabolism and the development of complications.
1. Type 1 diabetes (autoimmune, idiopathic): destruction of pancreatic beta cells that produce insulin.
2. Type 2 diabetes mellitus-with a predominant insensitivity of tissues to insulin or a predominant defect of insulin production with or without tissue insensitivity.
3. Gestational diabetes occurs during pregnancy.
4. Other type:
-genetic defect;
-diabetes caused by drugs and other chemicals;
-diabetes mellitus caused by infections;
-pancreatitis, trauma, removal of the pancreas, acromegaly, Itsenko –Cushing's syndrome, thyrotoxicosis and others.
Severity
-mild course: no complications.
-moderate severity: there is damage to the eyes, kidneys, nerves.
-severe course: far-reaching complications of diabetes.
The main symptoms of the disease include such manifestations as:
Excessive urination and increased thirst;
Increased appetite;
General weakness;
Lesions of the skin (eg vitiligo), vagina and urinary tract are particularly common in untreated patients as a result of the resulting immunodeficiency;
Blurred vision is caused by changes in the refractive media of the eye.
Type 1 diabetes usually begins at a young age.
Type 2 diabetes is usually diagnosed in people older than 35-40 years.
Diagnosis of the disease is based on blood and urine tests.
For diagnosis, determine the concentration of glucose in the blood (an important circumstance-the repeated determination of elevated sugar levels on other days).
Results analysis in annualized rate (in the absence of sugar diabetes)
On an empty stomach or 2 hours after the test:
venous blood-3,3-5,5 mmol/l;
capillary blood-3,3-5,5 mmol/l;
venous blood plasma-4-6, 1 mmol / l.
The results of the analysis in the presence of diabetes
Prandial:
venous blood more than 6.1 mmol / l;
capillary blood more than 6.1 mmol / l;
venous blood plasma more than 7.0 mmol/l.
At any time of the day, regardless of the time of meal:
venous blood more than 10 mmol / l;
capillary blood more than 11.1 mmol / l;
venous blood plasma more than 11.1 mmol/l.
The level of glycated hemoglobin in the blood of diabetes exceeds 6.7-7.5 %.
The content of C-peptide allows to evaluate the functional state of beta cells. In patients with type 1 diabetes, this level is usually lowered, in patients with type 2 diabetes – normal or elevated, in patients with insulinoma – sharply increased.
The concentration of immunoreactive insulin is reduced in type 1, normal or increased in type 2.
Determination of the concentration of glucose in the blood for the diagnosis of diabetes is not carried out on the background of acute disease, injury or surgery, on the background of short-term administration of drugs that increase the concentration of glucose in the blood (adrenal hormones, thyroid hormones, thiazides, beta-blockers, etc.), in patients with cirrhosis of the liver.
Glucose in the urine of diabetes appears only after exceeding the "renal threshold" (about 180 mg % 9.9 mmol/l). Characterized by significant fluctuations in the threshold and the tendency to increase with age; therefore, glucose determination in urine is considered insensitive and unreliable test. The test serves as a rough guide to the presence or absence of a significant increase in blood sugar (glucose) and in some cases is used for daily monitoring of the dynamics of the disease.
The same symptoms may be signs of different diseases, and the disease may not proceed according to the textbook. Do not try to be treated yourself — consult a doctor.
Physical activity and proper nutrition in the treatment
In a significant part of diabetic patients who comply with dietary recommendations and have achieved a significant reduction in body weight by 5-10% of the original, blood sugar indicators improve up to the norm. One of the main conditions is the regularity of physical activity (for example, walking daily for 30 minutes, swimming for 1 hour 3 times a week). When the concentration of glucose in the blood >13-15 mmol/l exercise is not recommended.
With light and moderate exercise lasting no more than 1 hour requires additional intake of carbohydrates before and after exercise (15 g of digestible carbohydrates for every 40 minutes. loads). With moderate physical activity lasting more than 1 hour and intense sports, it is necessary to reduce the dose of insulin by 20-50%, acting during and in the next 6-12 hours after physical activity.
Diet in the treatment of diabetes mellitus (table 9) aimed at the normalization of carbohydrate metabolism and prevention of disorders of fat metabolism.
Read more about the principles of nutrition in diabetes in our separate article.
Treatment with insulin
Insulin preparations for the treatment of diabetes are divided into 4 categories, according to the duration of action:
Ultrashort action (beginning of action - after 15 minutes, duration of action-3-4 hours): insulin Lispro, insulin aspart.
Fast action (beginning of action-after 30 minutes-1 hour; duration 6-8 hours).
Average duration of action (beginning of action-through 1-2, 5 hours, duration of action 14-20 hours).
Long-acting (beginning of action-after 4 hours; duration up to 28 hours).
Insulin prescribing regimens are strictly individual and are selected for each patient by a diabetologist or endocrinologist.
Methods of insulin administration
When insulin is injected at the injection site, it is necessary to form a skin fold so that the needle enters under the skin, and not into the muscle tissue. The skin fold should be wide, the needle should enter the skin at an angle of 45°, if the thickness of the skin fold is less than the length of the needle.
When choosing the injection site should avoid compacted areas of the skin. Injection sites should not be changed haphazardly. Do not inject under the skin of the shoulder.
Short-acting insulin drugs should be injected into the subcutaneous fat of the anterior abdominal wall 20-30 minutes before meals.
Insulin long-acting drugs are injected into the subcutaneous fat of the thighs or buttocks.
Injections of insulin ultrashort action (Humalog or Novorapid) is carried out immediately before meals, and if necessary – during or immediately after meals.
Heat and exercise increase the rate of insulin absorption, and cold reduces it.