Diabetes mellitus is an endocrinological pathology accompanied by hyperglycemia syndrome (high blood glucose), which occurred due to insulin deficiency.This disease is accompanied by carbohydrate imbalance and other metabolic disorders in the body.
At the moment, diabetes mellitus is diagnosed in 10 to 15 % of the population of our planet.Cases of development of this disease in childhood have become more frequent, as a rule, after irrational antibiotic therapy, stress and viral infections.There is an annual increase in the number of patients with diabetes by 9 to 10%.Today, the number of patients with this disease exceeds 200 million people.Diabetes is diagnosed in men and women.
Causes and mechanism for the development of diabetes
As a result of a violation of insulin synthesis and secretion by the beta cells of Langergannes islets, there is a decrease in blood insulin level, which over time leads to absolute insulin deficiency.Relative Insulin deficiency is also found, Which May Be the Result of A Insulin Activity A A RESULT OF ITS INCREASED CONNECTION WITH PROTEIN, INTENDIVE DESTRATION OF THE LIVER ENZYMES, THE PREVALENCE OF THE Effects of Non -Hormonal and Hormonal Antagonists of Insulin (thyroidHormones, The Adrenal Cortex, Glucagon, and Unustericed Fatty accidents, Growth Hormone), Changes in Insulin Resistance of Insulin insulin -dependent fabrics.
Insulin deficiency causes protein disorders, carbohydrates and fat metabolism in the body.The permeability of cell membranes glucose in the muscle and adipose tissue is reduced, gluconeogenesis and glycogenolysis are increased, glucosie, hyperglycemia occurs, which are accompanied by polydipsia and polyuria.Deciament is intensified and fat formation is reduced, which causes an increase in the level of ketone bodies in the blood (acetone-the product of acid condensation, beta-oxime and acexus acid).These phenomena cause a change in acid-base balance towards acidosis and also affect the increased excretion of magnesium, sodium, potassium in the urine and leads to renal dysfunction.
There may be a decrease in alkaline blood reserve to 25% over.carbon dioxide and a decrease in blood pH level to 7.2-7.0.
How type I diabetes develops
The causes of diabetes development have some differences, depending on the type of diabetes.For example, patients with type of diabetes due to autoimmune aggression and viral infection are expanded by beta cells in the body as a result of which a deficiency develops with all the consequences that followed.
How type II diabetes develops
Patients with type II of diabetes have sufficient insulin, but bodily tissues miss the opportunity to perceive their signal.With the development of obesity, adipose tissue acts as a type of barrier that blocks the effect of insulin.To eliminate this barrier, beta cells include intensive operating mode, which subsequently leads to its exhaustion and transition from relative insulin insufficiency to absolute.However, insulin -dependent diabetes is not transformed into insulin dependent.
Regardless of the etiological factor in the development of diabetes, the same process occurs in the slowdown of sugar transformation from outside and available in the blood.
Diabetes classification
Depending on the clinical characteristics, the following types of diabetes are distinguished:
- I type of diabetes mellitus, which in turn has several subspecies:
- Insulin -dependent diabetes;
- Diabetes Sugar Insulin Dependent:
- in people with obesity;
- In people with normal weight.
- Diabetes, the cause of the development of which is insufficient nutrition;
- Another verification of type I diabetes associated with certain syndromes and body conditions:
- Endocrine pathologies;
- insulin anomalies or their receiver;
- pancreatic diseases;
- certain genetic syndromes;
- Conditions caused by the effects of chemicals or taking drugs;
- state of mixed etiological factors;
- II type of diabetes indicates a violation of glucose tolerance and is divided into such forms:
- in patients without overweight;
- in people with obesity;
- caused by a particular state or syndrome.
- Type III diabetes can develop during pregnancy.
Separate static risk classes of this disease have been identified (patients with normal glucose tolerance, but a significant risk of diabetes):
- a state that precedes a violation of glucose tolerance;
- Potential glucose tolerance disorders.
Essential (primary) type of diabetes
The essential (primary) type of diabetes mellitus, which has a connection with nutritional failure, is highlighted as a separate pathology.This disease occurs in people under 30 who live in tropical countries.According to statistics, the proportion of men and women is 2: 1. The total number of patients with this form of diabetes is 20 million people.
Most of the time, there are two subtypes of this diabetes.The first of these is the fibrocular pancreatic diabetes.
Pancreatic Diabetes Fibrocalculate
Territorially, it covers mainly Indonesia, India, Brazil, Bangladesh, Uganda and Nigeria.This pathology is characterized by the presence of extensive pancreophibrosis and stone formation in the main duct of the pancreas.The clinical picture is represented by marked weight loss, recurrent abdominal pain and other insufficient nutrition signs.In this case, insulin therapy allows you to eliminate moderate and high glucosuria and hyperglycemia.One of the characteristic signs of this pathology is the lack of cetoacidosis, which is due to the reduced production of insulin and the release of glucagon by the pancreas islet apparatus.Topographic studies (ultrasound diagnosis, radiography, computed tomography) allow to determine the presence of stones in the pancreas ducts.
There is an opinion that one of the factors in the development of fibrocorotic diabetes is the inclusion of manioca roots (cassava, tapioka) in the diet, which contain cyanogenic glycosides, one of which is Linamarin, of which the cyanistoric is released during hydrolysis.With the participation of sulfur containing acids, their harmful effects are eliminated and insufficient intake of protein foods, often found in the population of the countries above, causes cyanide accumulation in the body, which is the cause of the development of fibroculosis.
Pancreatic diabetes
The development of pancreatic diabetes (type II diabetes) has a relationship with the insufficiency of protein in the body, but there are no manifestations of pancreatic fibrosis.It is characterized by moderate insulin resistance and resistance to the development of cetoacidosis.In most cases, patients suffer from exhaustion.Patients reduced insulin secretion, but not to one measure as in patients with type I diabetes, this explains the lack of ketatosis.
Subtype j
In the classification of diabetes, according to WHO data, which are presented above, there are no references to the third subtype of pancreatic diabetes found in Jamaica, we are talking about subtype J. Subtype J has a lot in common with pancreatic diabetes that occur due to protein deficiency.
Diabetes symptoms
The first symptoms of diabetes occur due to a high blood glucose content.After exceeding the level of 8.9-10.0, sugar enters the urine.By continuing to increase the blood glucose level, the kidneys additionally remove water, this is clinically manifested by rapid urination (polyuria).Excessive urine isolation causes a constant sensation of thirst (polydipsia).With the urine, the body loses a large number of calories represented by glucose, so a person loses weight and constantly feels hungry.
Among other symptoms of diabetes, such as drowsiness, decreased visual acuity, fatigue and nausea.In addition, patients with unlipped diabetes are prone to infections.Type I diabetes patients have a pronounced insulin deficiency and because of this they almost always lose weight before therapy began.Patients with II type of diabetes do not lose body weight.
With type I diabetes disease, there is rapid development of clinical manifestations and can soon progress in diabetic cetoacidosis.Regardless of the high level of blood glucose, cells do not have the opportunity to use it without insulin, so they change to other sources of energy.The destruction of adipose cells begins, which causes the formation of ketone bodies, which are "acidifying" toxic chemical compounds.
Diabetic Ketoacidosis
The first symptoms of diabetic ketacity manifest themselves in the form of excessive urination and excessive thirst, nausea, vomiting, fatigue, weight loss and abdominal pain (especially in childhood).Patients have frequent and deep breathing, which is associated with attempts by the body to neutralize excessive blood acidity, this process is accompanied by the appearance of the smell of acetone from the mouth.In the absence of treatment, diabetic cetoacidosis may be complicated by the development of a coma, in some cases this process occurs within several hours.
Type I diabetes can be accompanied by the development of cetoacidosis, even after the onset of insulin therapy, if the patient undergoes a planned injection or suffering a severe emotional overload, particularly during injury, severe infection or other serious diseases.
Patients suffering from type II diabetes for a long time may not feel signs of this pathology.Such a hidden period of the disease can last up to several decades.Clinical manifestations are activated as the deficiency of insulin aggravates.
At first, the volume of the dedicated urine exceeds only slightly the norm, thirst is weakly expressed, but over time these processes progress.The phenomena of cetoacidosis are rare.With significant increase in the level of glucose in the blood (in disappells, to 55 mmol/l), this usually happens with additional loads on the body, for example, under the influence of drugs or with severe infectious dissees, the patient can plungal into state of confusedConsciousness, Provored by Severe dehydration, The Phenomena of Seizures, Drowsiness and the Most Severe Cases are also like Hyperglycemic Mate Hyperosmolar.
What another way is manifest diabetes mellitus
The high level of blood glucose over time can lead to damage to the nerves, blood vessels and other structures.Chemical compounds containing glucose are located on the walls of small blood vessels as a result of which the vessel walls are thickened and damaged.The narrowing of blood vessel gaps causes the deterioration of blood flow, especially the blood supply for skin terminations and nerves.With no compensation for blood diabetes, there is an increase in the level of fatty substances, which accelerates the development of atherosclerosis.Patients diagnosed with diabetes, regardless of sex, suffer from atherosclerosis 2-6 times more often compared to people who do not have this diagnosis.The violation of blood vessels in the blood circulation causes heart dysfunctions, kidneys, eyes, lower ends, brain, skin and nerves, and also decreases the process of healing of wounds.
What is the seriousness of diabetes mellitus
All of these factors increase the risk of developing many distant complications.In patients with diabetes, the risk of strokes and heart attacks increases, as a result of damage to blood vessels, loss of visinopathy (diabetic retinopathy) may occur, renal disorders cause renal failure, so in some cases dialysis is required.Nerve damage can lead to many consequences.Mononeuropathy (impaired function of a nerve) can manifest itself by a sudden weakness of the upper or lower limb.Diabetic polyneuropathy (damage to the nerves of the legs, feet or hands) causes disorders of sensitivity, pain, burning or tingling, feeling of weakness in the arms and legs.The temperature and sensitivity to pain decrease, which leads to increased trauma.Circulatory disorders can contribute to the appearance of ulcers and low wound healing.The ulcers located on the feet are very deep and poorly healing, which leads to infection and, in some cases, to the amputation of the affected limb.
Clinical studies have shown that it is possible to avoid or expire diabetes if you constantly keep a normal blood sugar.Currently, the course of this disease is not fully studied.There are several unexplored factors that cause their development, genetics include the number of these factors.
Diagnosis of diabetes
Diabetes diagnosis begins with collecting anamnesis and patient examination.During these measures, the patient has the presence of hereditary factors, obesity, if the patient belongs to the number of unique twins (if one of them suffers from diabetes mellitus, the second should be examined), women specify the presence of delivery and if large fruits have been specified.
Next, various laboratory tests are presented, consisting of:
- Blood tests for glucose levels are performed twice;
- Glucose tolerance test;
- Determining the glucose level in the daily urine.
With the diagnosis of diabetes mellitus, it is very important to discover the presence of complications;For this, all organs and systems are diagnosed.
Diabetes Complications
The complications of diabetes mellitus can be acute and chronic, they are also divided, depending on the form of diabetes.Among acute complications, coma states are distinguished during which the loss of consciousness is preceded by brain disorders due to a very low or very high blood sugar concentration.Such conditions include:
- Diabetic ketatosis (the most common complication of acute nature) is manifested by polyuria, polydipsia, lack of appetite, weakness, abdominal pain, nausea and vomiting;
- A hypoglycemic coma is an extreme degree of hypoglycemia, occurs with a sharp decrease in blood glucose level.It is often the result of introducing an irregular insulin dose and sometimes occurs after taking certain foods or sulfanillamide.
- The hyperosmolar comic in the severity of the state surpasses the diabetic that is found mainly in the elderly, with type II diabetes.In 30% of cases, the cause of the patient's death becomes and in the presence of bass concomitant pathologies - in 70%.
Chronic (late) complications are combined in a group of pathologies that develop prolonged exposure to high blood sugar in the patient's organs and systems.First of all, the most sugar -sensitive organs are subject to damage, they are a kind of "target" for diabetes.Among the chronic complications of diabetes, the following are known:
- Diabetic retinopathy is observed in 90% of patients with diabetes.Develops with a long diabetes course and manifests for damage to the eyes of the eye retina;
- Diabetic nephropathy consists of the damage to the kidneys (tubules, arteries, glomeruli, arteriles).The prevalence among patients with diabetes is 75%;
- Diabetic neuropathy is represented by damage to the peripheral nerves in patients with diabetes.Neuropathy is a predisposing factor in the development of a diabetic foot, which can lead to an amputation of a member;
- Diabetic encephalopathy is a damage to the brain, which is progressive.It is manifested by increased fatigue, a decrease in performance, impaired concentration of attention, emotional lability, squeezing headaches, anxiety and worsening the thought process;
- Diabetic skin lesions are structural deformations of the epidermis, follicles, sweat glands due to a violation of carbohydrate metabolism and the accumulation of metabolism products.In the case of a severe form of diabetes, the skin becomes scaly, rough, with areas of homosepers, cracks, the skin acquire a yellowish hue, hair loss occurs;
- Diabetic foot and brush syndrome occurs in 30-80% of patients with diabetes and is a complex of anatomical and functional disorders that appear in the form of brown spots and fingertips, which in severe cases can lead to limb amputation.
Diabetes treatment
Treatment of diabetes depends on the type of disease, but first and foremost the patient needs to normalize the blood glucose level.To do this, you need to radically change your lifestyle and diet.A special diet is recommended for patients with diabetes, which is based on the calculation of used carbohydrates, proteins and fats, vitamins and trace elements.This calculation is taught by experts in this field.
The choice of drug therapy tactics depends on the type of diabetes.Patients with type of diabetes are needed to perform insulin therapy with type II that is shown to adhere to the most rigorous diet and use agents containing glucose, with the ineffectiveness of drug tablet forms, insulin is prescribed.
Insulin is taken under strict control of blood glucose level.Insulin preparations according to the mechanism of action are divided into three types: prolonged, short and intermediate action.Drugs containing sugar are indicated in the case of insulin -dependent diabetes mellitus in combination with the diet.Sugar -containing medicines include: biguanids, sulfonilmochevine, thiazolidindyons and meglitinids.
With this insidious disease, it is very important that medical staff adequately teach the patient and their relatives the skills of monitoring the condition of the patient and first aid in the case of pre -shattered and coma.
Forecast for diabetes mellitus
In the presence of diabetes mellitus, the patient is registered with the endocrinologist.Under proper therapy conditions, the patient may be satisfactory for a long time.Aggravating the prognosis of health and life expectancy of a patient with diabetes mellitus may develop acute and chronic complications.
Diabetes prevention
With type I diabetes, preventive measures are increasing body resistance to various infections and eliminating toxic antibodies in pancreas.For patients with II, the type of diabetes is very important to adjust nutrition and prevent the development of obesity.To avoid the development of complications under diabetes conditions, it is necessary to correctly and systematically comply with the doctor's recommendations and clarify whether or or that foods can be consumed.