Diabetes mellitus is a disorder of glucose metabolism in the body associated with insulin deficiency. Glucose is the energy material for cells, and insulin is the hormone that helps it penetrate into them. Without insulin, glucose remains in the blood, causing hyperglycemia and the risk of complications for the kidneys, eyes, nerves, heart and blood vessels. Diabetes is incurable, but it can be controlled with proper diet, physical activity and medication. An endocrinologist talks about this in more detail.
Diabetes classification
Most people only know about two types of diabetes. In fact, there are more of them. Depending on the cause and mechanism of development of the disease, the following types of pathology are distinguished:
Diabetes mellitus type 1(insulin dependent). In this type, the pancreas is unable to produce insulin due to the destruction of the beta cells that synthesize it. The reasons for this process are not fully known, but it is believed to be influenced by genetic and environmental factors. Type 1 diabetes is usually diagnosed in childhood or adolescence and requires constant insulin administration.
Diabetes mellitus type 2(non-insulin dependent). In this type of disease, the pancreas produces insulin, but the amount is not enough to maintain normal blood glucose levels or the cells become insensitive to it. This is due to overweight, obesity, sedentary lifestyle, malnutrition, and hereditary predisposition. Type 2 diabetes mellitus most often develops in adults.
Diabetes mellitus in pregnancy(gestational). In this type of disease, elevated blood glucose levels occur during pregnancy and usually disappear after delivery. This is due to changes in hormonal levels and metabolism in a woman’s body. They can lead to decreased insulin production or poorer insulin action. Women who have had gestational diabetes have an increased risk of developing type 2 diabetes in the future.
Other specific types of diabetes. This group includes rare forms of the disease that occur due to genetic defects, pancreatic diseases, endocrine disorders, certain medications, or infections.
Symptoms of diabetes
Classic signs of diabetes are associated with excess glucose in the blood. These include:
- Polyuria (frequent and copious urination).
- Polydipsia (increased feeling of thirst).
- Polyphagia (increased appetite).
- Dry mouth.
- Fatigue, weakness, irritability.
- Weight loss (for type 1 diabetes) or weight gain (for type 2 diabetes).
- Itching of the skin, mucous membranes, genitals.
- Slow wound healing, prone to infections.
- Visual impairment, appearance of spots before the eyes.
- Numbness, tingling, pain in the limbs.
Causes of diabetes
Diabetes mellitus is a multifactorial disease that can occur due to various reasons. Some of them:
- Genetic predisposition.The presence of diabetes in relatives increases the risk of developing the disease in offspring. This is especially true for type 1 diabetes, which is associated with hereditary defects of the immune system.
- Obesity and overweight.Excess fat in the body leads to poor insulin action and increased blood glucose levels. Particularly dangerous is visceral fat, which surrounds internal organs and releases inflammatory mediators that disrupt metabolism.
- Poor nutrition.Consumption of large amounts of simple carbohydrates, fats, salt, alcohol, as well as a lack of complex carbohydrates, proteins, fiber, vitamins and minerals in the diet contribute to metabolic disorders and increased blood glucose levels. The regularity and frequency of meals is also important, since long breaks between meals can lead to hypoglycemia (low blood glucose levels), and frequent snacks can lead to hyperglycemia (increased blood glucose levels).
- Lack of physical activity.Physical activity helps lower blood glucose levels by increasing energy expenditure and glucose uptake by cells. In addition, physical activity improves blood circulation, strengthens the cardiovascular system, improves immunity, promotes weight loss and prevents complications of diabetes.
- Stress.Stressful situations cause the release of adrenaline, cortisol and glucagon. They increase blood glucose levels, suppress insulin production and increase inflammation. Stress can also lead to disruption of diet, sleep, and physical activity.
- Diseases of the pancreas.If the pancreas is damaged due to inflammation, stones, tumors, chronic pancreatitis, this can lead to decreased insulin production and the development of diabetes mellitus. There are also genetic disorders that lead to pancreatic dysfunction, for example, cystic fibrosis, Schwartz-Bartter syndrome, Johanson-Blitzer syndrome and others.
- Endocrine disorders.The endocrine system is a collection of organs that produce hormones that regulate various body functions. Some hormones, such as glucagon, glucocorticoids, growth hormone, thyroid hormones, catecholamines, counteract the action of insulin and increase blood glucose levels.
- Taking certain medications.Some drugs may increase blood glucose levels, suppress insulin production, or decrease insulin sensitivity. These drugs include glucocorticoids, thiazide diuretics, beta blockers, some anticonvulsants, some antivirals, some antipsychotics, and others. Taking these drugs may cause a temporary or permanent increase in blood glucose levels and may require dose adjustment or drug replacement.
- Infections.Infectious diseases such as viral hepatitis, cytomegalovirus infection, chickenpox, rubella, mumps, meningitis, sepsis and others can damage the pancreas, cause inflammation and impaired insulin production. Infections can also increase the release of stress hormones, which increase blood glucose levels.
Diagnosis of diabetes mellitus
Making a diagnosis requires a comprehensive examination. Initially, the patient is examined and interviewed by an endocrinologist. It identifies characteristic symptoms, takes into account the circumstances of their occurrence, concomitant diseases, and hereditary factors. Then a detailed examination is prescribed:
Laboratory research.The main method for diagnosing diabetes mellitus is to determine blood glucose levels. To do this, the following tests are carried out:
- Fasting glucose.
- Glucose tolerance test.
- Glycated hemoglobin (HbA1c)
Instrumental research.To identify complications of diabetes mellitus and assess the condition of target organs, the following studies are carried out:
- Ophthalmoscopy.This is an examination of the eye using a special device - an ophthalmoscope, which allows you to examine the retina, optic nerve, and blood vessels of the eye.
- Ultrasound of the kidneys.This is an ultrasound examination of the kidneys, which allows you to evaluate their size, shape, structure, the presence of stones, tumors, cysts, and inflammation.
- Dopplerography of the vessels of the lower extremities.This is an ultrasound examination of the vessels of the lower extremities, which allows you to evaluate their lumen, walls, blood flow, the presence of blood clots, atherosclerotic plaques, narrowings, and aneurysms.
- Electrocardiography (ECG).This is a study of the heart, which allows you to evaluate its rhythm, conductivity, contractility, the presence of ischemia, myocardial infarction, arrhythmia, and blockade.
Neurological examination.This is an examination of the nervous system, which allows you to evaluate sensitivity, reflexes, coordination, muscle tone, the presence of paresthesia, pain, and movement disorders. With diabetes mellitus, changes in the nerves can develop, such as demyelination, degeneration, inflammation, which can lead to disruption of the transmission of nerve impulses and the development of polyneuropathy, autonomic neuropathy, mononeuropathy, radiculopathy. This condition is called diabetic neuropathy.
Dermatological examination.This is a skin examination that allows you to evaluate its color, turgor, moisture, the presence of wounds, cracks, ulcers, fungal, bacterial, viral infections, allergic reactions, pigmentation, atrophy, scleroderma, acanthosis.
In diabetes mellitus, changes in the skin may develop, such as xerosis, diabetic dermopathy, diabetic bullosis, diabetic urticaria, diabetic angiopathy, diabetic foot, which can lead to disruption of the protective function of the skin and the development of complications.
Consultation with other specialists.Depending on the presence of concomitant diseases and complications of diabetes mellitus, consultation with other specialists such as a cardiologist, neurologist, surgeon, dentist, psychologist and others may be required. They will help assess the patient’s condition, prescribe the necessary treatment and give recommendations for prevention.
Insulin therapy for diabetes
Insulin therapy for diabetes is a treatment method in which insulin is administered externally to the patient. It is necessary for all patients with type 1 diabetes, and also for some patients with type 2 diabetes when other treatments do not work.
What types of insulin exist and how to use them
There are different types of insulin, which differ in the time of onset of action, peak activity and duration of action. According to these parameters, insulins are divided into ultra-short, short and extended (prolonged) action.
- Ultra-short and short-acting insulins imitate the physiological release of insulin after a meal and are administered 15-30 minutes before meals.
- Extended-release insulins provide basal levels of insulin in the blood throughout the day and are administered once or twice a day.
- There are also ready-made mixtures of insulins of different durations of action that are convenient for use.
Insulin is injected under the skin using special devices such as pens, pumps or inhalers. The dose of insulin is selected individually for each patient depending on blood sugar levels, volume and composition of food, physical activity and other factors.
To control blood sugar, the patient should measure it regularly using a glucometer or continuous glucose monitor.
What rules and recommendations should be followed during insulin therapy?
Insulin therapy requires strict adherence to diet, physical therapy and doctor's recommendations. With insulin therapy, side effects are possible, such as hypoglycemia (low blood sugar), allergic reactions, lipodystrophy - a violation of the distribution of fat under the skin, which can occur at the site of frequent insulin injections.
To avoid this, it is necessary to change insulin injection sites and use thin needles. Therefore, patients need to learn the basics of insulin therapy and consult a doctor if questions or concerns arise.
Nutrition for diabetes
Nutrition for diabetes is the most important component of treatment. In mild forms of diabetes, sometimes diet alone is enough to achieve the target blood glucose level. In more severe cases, drug therapy (oral hypoglycemic agents, insulin) comes to the rescue.
The following general rules of diet for diabetes mellitus must be observed:
- Meals should be frequent and small(5-6 times a day), in small portions. This will help avoid large jumps in glycemic levels.
- Meals should be taken at the same hours. The same applies to taking glucose-lowering medications and insulin injections.
- Strict diets and hunger strikes are prohibited, as they can lead to hypoglycemia (low blood sugar), as well as disruption of the metabolism of fats and proteins.
- These are preferredcooking methodslike: stewing, boiling, steaming and baking. Fried, smoked, salted and pickled foods should be excluded or minimized.
- Shouldeliminate easily digestible carbohydrates from food(sugar, honey, confectionery, jam, baked goods, white flour). They quickly increase blood sugar and contribute to obesity. Instead, you can use sugar substitutes (xylitol, sorbitol, fructose, stevia, etc. ) in moderation.
- Food should contain a large amount of fiber,since such carbohydrates are absorbed more slowly and do not increase blood sugar so sharply. Fiber also helps normalize intestinal function, reduce cholesterol and appetite. Sources of fiber include vegetables, fruits, herbs, whole grain breads and cereals, legumes, nuts and seeds.
- Limit consumption of animal fats(butter, lard, fatty meats). They contain saturated fatty acids, which increase cholesterol levels and contribute to the development of atherosclerosis and coronary heart disease. Preference should be given to vegetable oils (sunflower, olive, corn, etc. ), which contain unsaturated fatty acids that are beneficial for the heart and blood vessels. Also useful are fish and seafood, which are sources of omega-3 fatty acids, which have anti-inflammatory and anti-sclerotic effects.
- It is advisable thatthe caloric content of food and the amount of carbohydrates were approximately the sameon different days, this is especially important when selecting the dose of insulin. To calculate the amount of carbohydrates, you can use special tables that indicate how many grams of carbohydrates are contained in various foods.
- Shouldcontrol salt intake, since excess salt can lead to increased blood pressure, edema and deterioration of kidney function. The recommended daily salt intake is no more than 5 g (1 teaspoon).
Nutrition for diabetes should be balanced, varied and tasty. You don’t need to give up your favorite dishes, but just learn how to cook them correctly, taking into account your condition and needs.
Diabetes mellitus is a serious disease that requires constant medical monitoring and adherence to a lifestyle regimen. If you notice signs of diabetes in yourself or your loved ones, do not delay going to the doctor. The sooner the diagnosis is made and treatment is started, the less likely it is to develop complications and the better the prognosis of the disease.