Diabetes mellitus is an endocrinological pathology accompanied by hyperglycemia syndrome (high blood glucose), which occurred due to insulin deficiency.This disease is accompanied by a carbohydrate imbalance and other metabolic disorders in the body.
At this time, diabetes mellitus is diagnosed in 10-15 % of the population of our planet.The cases of development of this disease in childhood have become more frequent, as a rule, after unreasonable antibiotic therapy, stress and viral infections.There is an annual increase in the number of patients with diabetes by 9-10%.Today, the number of patients with this disease exceeds 200 million people.Diabetes is diagnosed both in men and women.
Causes and mechanism for the development of diabetes
As a result of a violation of the synthesis and insulin secretion by the beta cells of the Langerganes islets, there is a decrease in the level of insulin in the blood, which over time leads to an absolute insulin deficiency.There is also a relative insulin deficiency, which can be the result of a decrease in insulin activity as a result of its greater connection with protein, intensive destruction of liver enzymes, the prevalence of the effects of non -hormonal and hormonal antagonists of insulin insulin (thyroid hormones, adrenal glucagon, glucagon and glucagonHormones of hormones, changes in hormone growth, changes in hormone hormones, changes in glucagon, growth hormone hormones, hormones hormones, changes in hormone growth.
Insulin deficiency causes protein disorders, carbohydrates and fat metabolism in the body.The permeability of the glucose of cell membranes in the muscle and adipose tissue is reduced, gluconeogenesis and glycogenolysis are improved, glucoseuria, hyperglycemia are produced, which are accompanied by polydipsia and polyuria.The decomposition intensifies and reduces the formation of fats, which causes an increase in the level of the ketone bodies in the blood (acetone, the product of condensation of acetouxoso acid, beta-oxima and acetouxus acids).These phenomena cause a change in acid-base balance in the direction of acidosis, and also affect the increase in magnesium, sodium, potassium excretion in urine and lead to renal dysfunction.
There may be a decrease in the alkaline blood reserve to 25%.Carbon dioxide and a decrease in the blood pH level to 7.2-7.0.
How type I diabetes develops
The causes of the development of diabetes have some differences, depending on the type of diabetes.For example, patients with diabetes type, due to autoimmune aggression and viral infection, expand through beta cells in the body, as a result of which a deficiency is developed with all subsequent consequences.
How type II diabetes develops
Patients with the type of diabetes II have a sufficient amount of insulin, but body tissues lose the opportunity to perceive their signal.With the development of obesity, adipose tissue acts as a kind of barrier that blocks the effect of insulin.To eliminate this barrier, beta cells include the intensive mode of operation, which subsequently leads to its exhaustion and transition of relative insufficiency of insulin to the absolute.However, insulin -dependent diabetes is not transformed into insulin dependent.
Regardless of the etiological factor in the development of diabetes, the same process takes place in the slowdown in the transformation of sugar from abroad and is 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;
- Insulin dependent diabetes sugar:
- in people with obesity;
- In people with normal weight.
- Diabetes, whose cause of development is insufficient nutrition;
- Another verification of type I diabetes associated with certain syndromes and body conditions:
- endocrine pathologies;
- insulin anomalies or its receiver;
- pancreatic diseases;
- certain genetic syndromes;
- conditions caused by the effects of chemicals or take drugs;
- state of mixed etiological factors;
- II The type of diabetes indicates a violation of glucose tolerance and is divided into such forms:
- in patients without excess weight;
- in people with obesity;
- caused by a certain state or syndrome.
- Type III diabetes can develop during pregnancy.
Static risk classes have been identified separated from this disease (patients with normal glucose tolerance, but a significant risk of diabetes):
- a state that precedes a violation of glucose tolerance;
- Possible glucose tolerance disorders.
ESSENTIAL TYPE (PRIMARY) OF DIABETES
The essential (primary) type of diabetes mellitus, which has a connection with the nutritional failure, stands out 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 fibrocular pancreatic diabetes.
Pancreatic Fibrocalcules Diabetes
Territorially, it covers Indonesia, India, Brazil, Bangladesh, Uganda and Nigeria.This pathology is characterized by the presence of extensive panceofibrosis and stone formation in the main duct of the pancreas.The clinical image is represented by strong weight loss, recurrent abdominal pain and other signs of insufficient nutrition.In this case, insulin therapy allows to eliminate moderate and high glucosuria and hyperglycemia.One of the characteristic signs of this pathology is the lack of ketoacidosis, which is due to the reduced production of insulin and the release of glucagon by the islet apparatus of the pancreas.Topographic studies (ultrasound diagnosis, radiography, computerized tomography) allow determining the presence of stones in the pancreas ducts.
There is an opinion that one of the factors in the development of fibrolystical diabetes is the inclusion of maniac roots (ygre, Tapioka) in the diet, which contain cyanogenic glycosides, one of which is linamarin, from which cyanistoric acid is released during hydrolysis.With the participation of acids that contain sulfur, their harmful effects are eliminated, and insufficient protein food intake, often found in the population of the previous countries, causes the accumulation of cyanide in the body, which is the cause of fibrocalculosis development.
Pancreatic diabetes
The development of pancreatic diabetes (type II diabetes) has a relationship with protein insufficiency in the body, but there are no manifestations of pancreatic fibrosis.It is characterized by moderate insulin resistance and resistance to ketoacidosis.In most cases, patients suffer from exhaustion.Patients have reduced insulin secretion, but not to a measure as in patients with type I diabetes, this explains the lack of ketoacidosis.
J
In the classification of diabetes, according to the WHO data, which are previously presented, there are no references to the third subtype of pancreatic diabetes, which is found in Jamaica, we are talking about the subtype J. Subtype J has much in common with pancreatic diabetes that occurs 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, the sugar enters urine.When the blood glucose level continues to increase, the kidneys eliminate water, this manifests clinically by rapid urination (polyuria).Excessive urine insulation causes a constant thirst sensation (polydipsia).With urine, the body loses a lot of calories represented by glucose, so a person loses weight and constantly feels hungry.
Among other diabetes symptoms, such as drowsiness, the decrease in visual acuity, fatigue and nausea are distinguished.In addition, patients with uncompromising diabetes are prone to infections.Type I diabetes patients have a pronounced insulin deficiency and, because of this, they almost always lose weight before the start of therapy.Patients with type II diabetes do not lose weight of the body.
With type I diabetes disease, the rapid development of clinical manifestations occurs and can soon progress to diabetic ketoacidosis.Regardless of the high level of blood glucose, the cells do not have the opportunity to use it without the presence of insulin, therefore, they change to other energy sources.The destruction of fatty cells begins, which causes the formation of ketone bodies, which are toxic chemical compounds that "acidify" blood.
Diabetic ketoacidosis
The first symptoms of diabetic ketoacidosis are manifested in excessive urine and excessive thirst, nausea, vomiting, fatigue, weight loss and abdominal pain (especially in childhood).Patients have frequent and deep breathing, which is associated with body attempts to neutralize excessive blood acidity, this process is accompanied by the appearance of the acetone smell of the mouth.In the absence of treatment, diabetic ketoacidosis can be complicated by the development of a coma, in some cases this process occurs in several hours.
Type I diabetes can be accompanied by the development of ketoacidosis even after the start of insulin therapy if the patient passes a planned injection or suffers an excess of serious emotional excess, particularly during the lesion, severe infection or other serious illness.
Patients suffering from type II diabetes for a long enough 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 insulin deficiency aggravates.
At first, the volume of the dedicated urine only slightly exceeds the norm, thirst is expressed weakly, but over time, these processes progress.The phenomena of ketoacidosis are rare.With a significant increase in blood glucose level (in some cases, at 55 mmol/l), this generally occurs with additional loads in the body, for example, under the influence of medications or with severe infectious diseases, the patient can immerse himself in a confusing state of consciousness, caused by severe dehydration, the phenomenon of reeds, they come and the severe cases are alsoThey are also hypergects that are also hypergeas.buddy.
How other ways is diabetes mellitus?
The high level of blood glucose over time can cause nerve damage, blood vessels and other structures.The chemical compounds containing glucose are found in the walls of small blood vessels, as a result of which the walls of the vessels are thickened and damaged.The narrowing of the gaps of the blood vessels causes the deterioration of the blood flow, especially the supply of blood to the skin and the nerve endings.Without 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 gender, suffer from atherosclerosis 2-6 times more often compared to people who do not have this diagnosis.The violation of the blood vessels in the blood circulation causes dysfunctions of the heart, the kidneys, the eyes, the lower extremities, the brain, the skin and the nerves, and also slows the process of healing the wounds.
What is the severity of diabetes mellitus?
All these factors increase the risk of developing many distant complications.In patients with diabetes, it increases the risk of strokes and heart attacks, as a result of damage to blood vessels of the eyes, the loss of visionopathy (diabetic retinopathy) may occur, renal disorders cause renal insufficiency, therefore, in some cases, dialysis is required.Nerve damage can lead to many consequences.Mononeuropathy (deteriorated function of a nerve) can manifest itself by sudden weakness of the upper or lower limb.Diabetic polyneuropathy (damage to the nerves of the legs, feet or hands) causes sensitivity, pain, ardor or tingling disorders, feeling of weakness in the arms and legs.Temperature and pain sensitivity decrease, which leads to greater trauma.Circulatory disorders can contribute to the appearance of ulcers and bad wound healing.The ulcers located on the feet are very deep and poorly healing, which leads to the 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 it constantly maintains a normal blood sugar.The course of this disease is currently not completely studied.There are a number of unexplored factors that cause their development, genetics include the number of these factors.
Diabetes diagnosis
The diagnosis of diabetes begins with the collection of an anamnesis and the patient's examination.During these measures, the patient has the presence of hereditary factors, obesity, if the patient belongs to the number of individual twins (if one of them suffers from diabetes mellitus, the second should be examined), women specify the presence of childbirth and if a large fruit was specified.
The following are a series of laboratory tests, which consist of:
- Blood analysis for glucose levels are performed twice;
- glucose tolerance test;
- Determine the level of glucose in 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 loss of consciousness is preceded by brain disorders due to a very low or very high concentration of blood sugar.Such conditions include:
- Diabetic ketoacytosis (the most common complication of an acute nature) is manifested by polyuria, polydipia, lack of appetite, weakness, abdominal pain, nausea and vomiting;
- A hypoglycemic coma is an extreme degree of hypoglycemia, occurs with a strong decrease in blood glucose level.It is often the result of the introduction of an irregular dose of insulin, and sometimes occurs after taking certain foods or sulfanyllamide.
- The hyperosmolar comic in the severity of the State surpasses the diabetic that is mainly found in the elderly, with type II diabetes.In 30% of cases, the cause of the patient's death becomes, and in the presence of severe concomitant pathologies, in 70%.
Chronic (late) complications are combined in a group of pathologies that develop with prolonged exposure to high blood sugar in patient organs and systems.First, the most sugar -sensitive organs are subject to damage, they are a type of "objective" for diabetes.Among the chronic complications of diabetes, the following are known:
- Diabetic retinopathy is observed in 90% of diabetes patients.It develops with a long diabetes course and manifests itself for damage to the vessels of the eye retina;
- Diabetic nephropathy consists of the complex damage of the kidneys (tubules, arteries, glomeruli, arterioles).The prevalence between patients with diabetes is 75%;
- Diabetic neuropathy is represented by damage to 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 limb;
- Diabetic encephalopathy is damage to the brain, which is progressive.It is manifested by an increase in fatigue, a decrease in performance, the concentration of deteriorated attention, emotional lability, tight headaches, anxiety and worsening of 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 scammed, rough, with areas of homos, cracks, the skin acquires a yellowish dye, hair loss occurs;
- Diabetic foot syndrome and brush occurs in 30-80% of diabetes patients and is a complex of anatomical and functional disorders that appear in the form of brown spots and ulcerations at the bottom of the leg, foot and the phalanx of the fingers, which in severe cases can lead to the amputation of the limb.
Diabetes treatment
The treatment of diabetes depends on the type of disease, but in the first place, the patient needs to normalize the level of blood glucose.To do this, you must radically change your lifestyle and diet.A special diet for patients with diabetes is recommended, which is based on the calculation of used carbohydrates, proteins and fats, vitamins and trace elements.This calculation is taught by specialists in this field.
The choice of tactics of pharmacological therapy depends on the type of diabetes.Patients with type of diabetes are necessary to perform insulin therapy, with type II it is demonstrated that it adheres to the strictest diet and uses agents that contain glucose, with the ineffectiveness of the forms of the drug tablets, insulin is prescribed.
Insulin is taken under strict control of the blood glucose level.Insulin preparations according to the mechanism of action are divided into three types: prolonged, short and intermediate action.The medications containing sugar are indicated in the case of insulin -dependent diabetes mellitus in combination with the diet.Drugs containing sugar include: Biguanides, Sulfonylmochevina, Tiazolidios and Meglitinides.
With this insidious ailment, it is very important that medical personnel adequately teach the patient and their families the skills to monitor the patient's condition and first aid in case of predominant and coma.
Prediction for diabetes mellitus
In the presence of diabetes mellitus, the patient is registered with the endocrinologist.Under proper therapy conditions, the patient may be in satisfactory conditions for a long time.Aggravate the prognosis with respect to the state of health and the life expectancy of a patient with diabetes mellitus can develop acute and chronic complications.
Diabetes prevention
With type I diabetes, preventive measures are to increase body resistance to various infections and eliminate the toxic effects of antibodies on the pancreas.For patients with II, the type of diabetes is very important to adjust nutrition and prevent the development of obesity.To prevent the development of complications in diabetes conditions, it is necessary to fulfill correctly and systematically with the doctor's recommendations and clarify whether this or that can be consumed.