Diabetes mellitus is a group of metabolic diseases characterized by high levels of glucose ("sugar") in the blood.
Why do we need glucose?
The norm of blood glucose (sugar) in the total capillary blood is 3. 3 to 5. 5 mmol/l in the morning on an empty stomach (that is, after 7 to 14 hours of overnight fasting) and up to 7, 8 mmol/l after meals (i. e. 1. 5 -2 hours after the last meal).
Normally, in the human body, the cell uses glucose as a source of energy (in other words, the body's cells "feed" on glucose from the blood). The harder a cell works, the more energy (glucose) it needs.
Glucose (the expression "blood sugar" is more often used, but this is not entirely true) constantly circulates in human blood. There are 2 ways for glucose to enter the human body: - the first is through foods containing carbohydrates, - the second is through the production of glucose by the liver (this is the reason why in diabetesmellitus, even if the patient has not eaten anything, the blood glucose level may increase).
However, to be used for energy, glucose from the blood must go to the muscles (to do work), adipose tissue, or the liver (the body's glucose storage facility). This occurs under the influence of the hormone insulin, which is produced by the beta cells of the pancreas. As soon as the blood glucose level rises after a meal, the pancreas instantly releases insulin into the blood, which, in turn, connects to insulin receptors on muscle, fat or liver cells. Insulin, like a key, "opens" the cells to allow glucose to enter them, causing the blood glucose (sugar) level to return to normal. Between meals and at night, if necessary, glucose enters the blood from the liver's reservoir, so at night insulin controls the liver from releasing too much glucose into the blood.
If a violation occurs at any stage of this process, diabetes mellitus occurs.
Types of diabetes
Diabetes mellitus type 1 (previously used name: insulin-dependent diabetes mellitus) develops mainly at a young age (usually before the age of 30, although type 1 diabetes mellitus can also develop at an older age).
Type 1 diabetes mellitus is caused by the cessation of insulin production by the pancreas due to the death of β cells (responsible for insulin production in the pancreas). The development of type 1 diabetes mellitus occurs against the background of a special genetic predisposition (that is, a person was born with it), which, when exposed to some external factors (for example, viruses), leads to a change in thestate of the body's immune system. The body of a patient with type 1 diabetes begins to perceive their pancreatic β cells as foreign and protects itself from them by producing antibodies (similar to what happens when protecting against infections), leading to the death of the pancreatic β cells, which means severe insulin deficiency.
Diabetes mellitus 1 The type develops when at least 90% of the β cells in the pancreas die. Let's remember the mechanism of action of insulin, its function as a "key" that opens cells to sugar. In type 1 diabetes mellitus, this key disappeared from the blood (see figure).
Lack of insulin in type 1 diabetes mellitus The onset of type 1 diabetes mellitus is acute and is always accompanied by severe symptoms of hyperglycemia (high blood sugar): - weight loss (the patient loses weight involuntarily), -constant feeling of hunger, - thirst, dry mouth (the patient drinks a lot of liquid, including at night), - frequent urination (in regular or large portions, including at night), - weakness.
If you do not consult a doctor in time and do not start treating type 1 diabetes with insulin, the condition worsens and very often diabetic coma develops.
Diabetes mellitus type 2 (previously called insulin-dependent diabetes mellitus) is much more common than type 1 diabetes mellitus. The incidence of type 2 diabetes mellitus is typical for older people: it is detected, as a rule, after the age of 40, although recently, according toWHO experts, the average age of patients with type 2 diabetes mellitus is increasingly younger.
About 80% of people with type 2 diabetes are overweight. In addition, type 2 diabetes is characterized by heredity - a high prevalence among close relatives.
In type 2 diabetes, the pancreas continues to produce insulin, often in larger amounts than usual. Although there are also cases of type 2 diabetes mellitus with reduced insulin secretion.
The main defect of type 2 diabetes is that the cells do not "detect" insulin well, that is, they do not open well in response to interaction with it, so blood sugar cannot fully penetrate inside. (see figure Blood sugar). the level remains high. This state of decreased insulin sensitivity is called insulin resistance.
Low insulin sensitivity in type 2 diabetes mellitus Figuratively speaking, you can imagine that the "keyholes" (scientifically speaking, insulin receptors) in cell doors are deformed and that there is no perfect match with the keys, insulin molecules. It takes more effort (more cues, i. e. more insulin) to overcome the insulin receptor defect. The pancreas cannot supply a sufficient amount of insulin to the blood to overcome insulin resistance and completely normalize blood sugar levels, becauseIn type 2 diabetes mellitus, the capabilities of β cells are still limited.
As a result, with type 2 diabetes, a paradoxical situation arises when there is a lot of insulin and sugar in the blood at the same time.
Type 2 diabetes mellitus, unlike type 1 diabetes mellitus, begins gradually and often goes completely unnoticed by the patient. Therefore, a person can be sick for quite a long time, but not know it. High blood sugar (glucose) levels can be found by chance during a test for some other reason.
At the same time, there are cases with clear manifestations of hyperglycemia:
- weakness, fatigue, thirst, dry mouth (the patient drinks a lot of fluids, even at night),
- frequent urination (regular or in large quantities, even at night),
- itchy skin (especially in the perineal area),
- slow wound healing, - frequent infections, - blurred vision.
Diabetic coma develops much less frequently, usually if type 2 diabetes mellitus is accompanied by some other very serious illness: pneumonia, severe trauma, suppurative processes, heart attack, etc.
Diabetes treatment
Treatment for diabetes differs depending on the type of diabetes.
In type 1 diabetes mellitus, which occurs as a result of absolute failure of insulin secretion by the pancreas itself, constant self-monitoring and insulin treatment are required to preserve life. It should be noted that treatment with topically administered insulin is the only treatment option in this situation. The selection of doses and treatment regimens for diabetes mellitus with insulin is carried out on an individual basis, taking into account age, sex, physical activity and individual insulin sensitivity.
For type 1 diabetes mellitus Sometimes, at the beginning of the disease, after normalization of blood glucose during the treatment of diabetes mellitus with insulin, its need suddenly begins to decrease until it is completely canceled. But this is not recovery. This phenomenon is called the diabetes "honeymoon" or, scientifically, remission. This is explained by the fact that after blood sugar is normalized with the help of insulin, β cells that have not yet died can function for some time. Subsequently, they all die and the person needs lifelong treatment for diabetes mellitus with insulin. Anyone who develops type 1 diabetes for the first time should be warned by their doctor about the possible emergence of such a situation and what to do in this case.
Treatment of diabetes mellitus with insulin can be done using syringes, pens, or an insulin pump.
Insulin pump therapy is an alternative treatment for diabetes for people who heavily use a syringe or pen to inject insulin and regularly measure their blood sugar levels. Insulin pump therapy is used instead of treating diabetes with injections. The pump is worn on the body or on clothing, for example on a belt. Currently, about 250 thousand people around the world use insulin pumps.
The main goal of treating type 2 diabetes is to improve the sensitivity of cells to insulin. The causes of low insulin sensitivity are not yet fully understood. However, it has long been known that the most powerful factor in the formation of insulin resistance is excess weight, that is, excessive accumulation of fat in the body. Numerous scientific studies and long-term observations of patients show that weight loss during type 2 diabetes treatment in most patients can achieve a significant improvement in blood sugar levels.
In type 2 diabetes, weight normalization can lead to complete normalization of blood sugar level for a long time, although this cannot be considered complete recovery.
If diet and exercise aimed at losing weight do not provide sufficient effect in the treatment of type 2 diabetes, medication must be used. They are available in tablets. Some of them act on the pancreas, increasing insulin production, while others improve its action (reduce insulin resistance). Therefore, the drugs themselves used to treat type 2 diabetes mellitus do not lower blood sugar, insulin does, so to obtain the effect of tablets in the treatment of diabetes mellitus, a preserved reserve is necessaryof pancreatic β cells. This makes it clear why there is no point in using tablets in the treatment of type 1 diabetes, because most of the β cells have already died.
Insulin is often used to treat type 2 diabetes. Insulin treatment for type 2 diabetes mellitus may be prescribed as a temporary measure, for example during surgery, severe acute illnesses, or as a permanent treatment. That is why it is currently not recommended to call type 2 diabetes mellitus non-insulin dependent. The type of diabetes treatment does not determine the type of diabetes.
Diet plays the most important role in the treatment of diabetes.
Diabetes diet
Despite the common goals in the treatment of different types of diabetes (elimination of symptoms of high blood sugar, minimization of the risk of hypoglycemia, prevention of complications), dietary patterns for type 1 and type 2 diabetes mellitusdiffer significantly. There is no single diet plan for diabetes mellitus.
In type 1 diabetes mellitus, the onset of which is associated with the death of beta cells of the pancreas and insulin deficiency, the main method of treatment is insulin replacement therapy, and dietary restrictions, according to modern opinions, areof an auxiliary nature and should be administered only to the extent that insulin therapy differs from insulin production in a healthy person.
The fundamental principles of diet prescription for type 1 diabetes mellitus have been the subject of critical review in recent years.
One of the principles of the traditional diabetes diet is the recommendation to consume an identical, strictly defined amount of calories every day. Each patient was prescribed a daily caloric requirement based on "ideal weight. "This is meaningless and impossible for the following reasons:
- In healthy individuals of normal weight, the balance between energy intake and expenditure varies greatly from day to day. Energy expenditure in healthy individuals is variable because their physical activity is variable. Consequently, if a patient with type 1 diabetes is prescribed a specific diet with a daily consumption of a fixed and identical amount of calories, then, to maintain a normal weight, an equally strict physical activity plan would have to be recommended. for every day, which is absolutely unrealistic.
- In patients with type 1 diabetes mellitus with normal weight and an insulin treatment regimen appropriately selected for diabetes mellitus, appetite regulation does not differ from that of healthy people. The fact that they sometimes have to be forced to eat to prevent hypoglycemia, even in the absence of appetite, is usually a consequence of insulin therapy that is not entirely adequate.
Improved treatment regimens for diabetes mellitus using insulin and self-monitoring of metabolism based on blood sugar levels provide the patient with the opportunity to regulate food intake only based on the feeling of hunger and satiety, such as peoplehealthyThus, the diet of a patient with type 1 diabetes mellitus corresponds to a complete healthy diet (balanced in calories and content of essential nutrients). The only difference is that injected insulin does not "know" when or how much you eat. Therefore, you yourself must ensure that the action of insulin corresponds to your diet. Therefore, you need to know which foods increase blood sugar level.
The main method of treatment for type 2 diabetes is the normalization of body weight through a low-calorie diet and increased physical activity. Diet for type 2 diabetes is very important; It is one of the important components that allows you to achieve success.
All food products consist of three components: proteins, fats and carbohydrates. They all contain calories, but not all raise blood sugar.
Only carbohydrates have a pronounced blood sugar-raising effect. What foods contain carbohydrates? It's easy to remember: most products are of plant origin and animal origin, only liquid dairy products. It is important to know if your blood sugar increases after certain foods and, if so, to what extent. There are types of carbohydrate foods after which the blood sugar level does not rise at all or only rises slightly.
All carbohydrates can be roughly divided into two groups: those containing rapidly absorbed carbohydrates ("fast") and slowly absorbed carbohydrates ("slow"). "Fast" carbohydrate products contain refined sugars and include preserves and jams, sweets, sweets, fruits and fruit juices. "Fast" carbohydrates cause a sharp increase in blood sugar (depending on the amount of food eaten) because they are quickly absorbed into the blood, so it is better to exclude them from the diabetes diet. "Slow" carbohydrates are much more beneficial for patients with diabetes, because they take much longer to absorb. Furthermore, the absorption of sugars is slowed down by the fiber contained in foods, so when treating diabetes, the diet should be enriched with foods rich in fiber.
Below are some simple rules to follow in the treatment of diabetes: food should be taken in small portions and frequently (4 to 6 times a day); adhere to the established diet; try not to skip meals; do not overeat: eat as much as your doctor recommends; use bread made with whole wheat flour or bran; vegetables (except potatoes and legumes) should be consumed daily; Avoid eating "fast" carbohydrates.
Exercise for diabetes Physical exercise in the treatment of diabetes is very important: it increases the sensitivity of the body's tissues to insulin and, therefore, helps reduce blood sugar levels.
Housework, walking and jogging can be considered physical activity. Preference should be given to regular and dosed physical exercise: sudden and intense exercise can cause problems in maintaining normal sugar levels.
If you are an athlete, you have no contraindications to playing sports, as long as your blood sugar levels are well controlled and all necessary measures are taken to prevent a significant drop.
Preventing diabetes complications Patients with diabetes are at increased risk of developing complications in the heart and blood vessels (especially the legs and kidneys). Regular physical activity, sometimes simply walking, is enough to prevent circulatory problems in the feet.
If you have diabetes, an untreated wound or abrasion on your foot can become a serious problem. Even minor cuts or scrapes on the feet take longer to heal than in patients without diabetes and require more attention. The key to preventing these problems is to wear well-fitting shoes and check your feet frequently. Use a mirror if you find it difficult to examine all areas of your feet and remember that foot injuries are usually painless at first and can go unnoticed for a long time if you are not careful enough.
Patients with diabetes are at increased risk of kidney dysfunction and heart disease several years after diagnosis. There is good evidence that good blood sugar control reduces this risk. In addition, to prevent complications of diabetes mellitus, it is necessary to undergo preventive treatment 2 times a year.
Blood pressure control is also important. Check your blood pressure regularly. If it is elevated, your doctor will prescribe treatment.