Diabetes mellitus is a group of metabolic diseases characterized by high levels of glucose ("sugar") in the blood.
Why do we need glucose?
In complete capillary blood, the norm of blood glucose (sugar) in the morning on an empty stomach (i. e. after 7-14 hours of overnight fasting) is 3. 3-5. 5 mmol/l, and after a meal up to 7. 8 mmol/l (i. e. 1. 5)constitutes. - 2 hours after the last meal).
Normally, in the human body, glucose is used by cells as an energy source (in other words, the cells of the body are "fed" with glucose from the blood). The more the cell works, the more energy (glucose) is required.
Glucose (the term "blood sugar" is more commonly used, but this is not entirely true) is constantly circulating in the human blood. There are 2 ways for glucose to enter the human body: - firstly, through foods containing carbohydrates, - secondly, the production of glucose by the liver (therefore, in diabetes, even if the patient has not eaten, the level of glucose in the blood can rise in any case).
However, to be used as energy, glucose in the blood must go to the muscles (to do work), fat tissue, or the liver (the body's store of glucose). This happens under the influence of the insulin hormone produced by the beta cells of the pancreas. As soon as blood glucose levels rise after a meal, the pancreas immediately releases insulin into the blood, which in turn binds to insulin receptors in muscle, fat, or liver cells. Insulin, like a key, "opens" cells to allow glucose to enter them, resulting in normal blood glucose (sugar) levels. Between meals and at night, if needed, glucose enters the blood from liver storage, so at night, insulin controls the liver so that it does not release 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 (formerly known as: insulin-dependent diabetes mellitus) develops mainly at a young age (usually before the age of 30, type 1 diabetes can also develop at a later 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 occurs against the background of a special genetic predisposition that causes a change in the state of the body when exposed to some external factors (for example, viruses) (that is, a person is born with it). the body's immune system. The body of a person with type 1 diabetes begins to perceive the β-cells of the pancreas as foreign and defends itself against them by producing antibodies (similar to what happens when protecting against infection), which leads to the death of pancreatic β-cells. severe insulin deficiency.
Diabetes 1 type develops when at least 90% of pancreatic β cells die. Let's remember the mechanism of action of insulin, the "key" function that opens cells to sugar. In type 1 diabetes, this key is lost from the blood (see figure).
Insulin deficiency in type 1 diabetes The onset of type 1 diabetes is acute, always accompanied by severe symptoms of hyperglycemia (increased blood sugar): - weight loss (the patient inevitably loses weight), - constant hunger, - thirst, mouthdryness (the patient drinks a lot of liquid, including at night), - frequent urination (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 diabetic coma develops very often.
Diabetes mellitus type 2 (formerly called insulin-dependent diabetes mellitus) is more common than type 1 diabetes mellitus. The frequency of type 2 diabetes is typical for older people: it is usually detected after the age of 40, although recently, according to WHO experts, the average age of patients with type 2 diabetes is getting younger.
About 80% of people with type 2 diabetes are overweight. Also, type 2 diabetes is characterized by heredity - high prevalence among close relatives.
In type 2 diabetes, the pancreas continues to produce insulin, often in greater amounts than usual. Although there are also cases of type 2 diabetes with reduced insulin secretion.
The main defect in type 2 diabetes is that cells do not "feel" insulin well, that is, they do not open well in response to interaction with it, so blood sugar cannot fully penetrate inside (see picture). level remains high. This reduced sensitivity to insulin is called insulin resistance.
Low sensitivity to insulin in type 2 diabetes You can figuratively imagine that the "keyholes" in the cell doors (in scientific terms - insulin receptors) are deformed and there is no perfect match with the keys - insulin molecules. More effort (more switch, ie more insulin) is required to overcome the insulin receptor defect. The pancreas cannot deliver enough insulin to the blood to overcome insulin resistance and completely normalize blood sugar levels, because in Type 2 diabetes mellitus, the capabilities of β cells are still limited.
As a result, with type 2 diabetes, a paradoxical situation occurs when both insulin and sugar are high in the blood at the same time.
Type 2 diabetes mellitus, unlike type 1 diabetes mellitus, begins gradually, often completely unnoticed by the patient. Therefore, a person can be sick for a long time, but not know about it. Elevated blood sugar (glucose) levels may be detected accidentally during an examination for another reason.
At the same time, there are cases with clear manifestations of hyperglycemia:
- weakness, fatigue, thirst, dry mouth (the patient drinks a lot of liquid, including at night),
- frequent urination (regular or copious, including at night),
- itching of the skin (especially in the perineal area),
- slow healing of wounds, - frequent infections, - blurred vision.
Diabetic coma develops less often, usually if type 2 diabetes mellitus is accompanied by another very serious disease: pneumonia, serious injuries, purulent processes, heart attack, etc.
Treatment of diabetes
Treatment of diabetes is different depending on the type of diabetes.
Type 1 diabetes, which is caused by an absolute lack of insulin secretion by the pancreas, requires constant self-monitoring and insulin treatment to maintain life. It should be emphasized that in this case, external insulin treatment is the only treatment option. The selection of doses and treatment regimen for diabetes mellitus with insulin is carried out individually, taking into account age, sex, physical activity and individual sensitivity to insulin.
For type 1 diabetes mellitus sometimes, at the very beginning of the disease, after the blood glucose normalizes during the treatment of diabetes with insulin, the need for it suddenly decreases until it is completely eliminated. But this is not recovery. This phenomenon is called the "honeymoon" of diabetes, or scientifically, remission. This is explained by the fact that β-cells that have not yet died can work for a while after blood sugar is normalized with the help of insulin. Later, they all die, and the person must be treated with insulin for life-long diabetes. Anyone who develops type 1 diabetes for the first time should be warned by their doctor about the possible occurrence of such a condition and what to do in this situation.
Diabetes mellitus can be treated with insulin using insulin syringes, pens or an insulin pump.
Insulin pump therapy is an alternative treatment for diabetes in people who often use a syringe or pen to inject insulin and monitor their blood sugar levels regularly. Instead of treating diabetes with injections, insulin pump therapy is used. The pump is worn on the body or on clothing, such as a belt. Currently, about 250, 000 people in the world use insulin pumps.
The main goal of treatment of type 2 diabetes is to increase the sensitivity of cells to insulin. The causes of poor insulin sensitivity are not yet fully understood. However, it has long been known that the strongest factor in the formation of insulin resistance is excess weight, i. e. excessive fat accumulation in the body. Numerous scientific studies and long-term follow-up of patients show that weight loss during the treatment of type 2 diabetes can achieve a significant improvement in blood sugar levels in most patients.
Normalizing weight in type 2 diabetes can lead to complete normalization of blood sugar for a long time, although this cannot be called complete recovery.
If weight loss diet and exercise are not effective enough to treat type 2 diabetes, you should turn to medication. They are available in tablets. Some of them increase the production of insulin by affecting the pancreas, while others improve its activity (reduce insulin resistance). Thus, the drugs used in the treatment of type 2 diabetes mellitus themselves do not lower blood sugar, but insulin does, so a preserved reserve of pancreatic β-cells is necessary to achieve the effect of tablets in the treatment of diabetes mellitus. This explains why the use of tablets in the treatment of type 1 diabetes is pointless, since most of the β cells are already dead.
Insulin is often used to treat type 2 diabetes. Insulin treatment for type 2 diabetes mellitus can be prescribed as a temporary measure, for example, during surgery, severe acute diseases or as permanent treatment. Therefore, it is currently not recommended to call non-insulin-dependent type 2 diabetes mellitus. The type of diabetes treatment does not determine the type of diabetes.
Diet plays the most important role in the treatment of diabetes.
Diet for diabetes
Despite common goals in the treatment of different types of diabetes (elimination of symptoms of high blood sugar, minimizing the risk of hypoglycemia, prevention of complications), dietary patterns for type 1 and type 2 diabetes mellitus differ significantly. There is no single diet plan for diabetes mellitus.
In type 1 diabetes, which is associated with the death of pancreatic beta cells and insulin deficiency, the main treatment method is insulin replacement therapy, and according to modern ideas, dietary restrictions are adjunctive and should be given only to the extent that insulin therapy differs from insulin production in a healthy person.
The basic principles of prescribing a diet for type 1 diabetes mellitus have been critically revised in recent years.
One of the principles of the traditional diet for diabetes is the recommendation to consume a strictly defined, same amount of calories every day. Each patient was assigned a daily calorie requirement based on their "ideal weight. "This makes no sense and is impossible for the following reasons:
- In healthy individuals of normal weight, the balance between energy intake and expenditure varies greatly from day to day. In healthy individuals, energy expenditure is variable because their physical activity is variable. Consequently, if you prescribe a specific diet that consumes the same amount of calories per day for a person with type 1 diabetes, you should recommend an equally given, rigorous physical activity plan to maintain a normal weight. for every day, this is completely unrealistic.
- In patients with type 1 diabetes mellitus of normal weight and in patients with a properly selected insulin treatment regimen for diabetes, appetite regulation does not differ from healthy people. The fact that they sometimes have to eat to prevent hypoglycemia, even in the absence of appetite, is often the result of completely adequate insulin therapy.
Improved treatment regimens for diabetes using insulin and self-monitoring of metabolism based on blood sugar levels allow the patient to regulate food intake based solely on hunger and satiety, just like healthy people. Thus, the diet of a person with type 1 diabetes corresponds to a completely healthy diet (balanced in calories and essential nutrients). The only difference is that injected insulin does not "know" when and how much you eat. Therefore, you must ensure that the action of insulin is consistent with your diet. Therefore, you should know which foods increase your blood sugar.
The main treatment for type 2 diabetes is to normalize body weight through a low-calorie diet and increased physical activity. Diet is very important for type 2 diabetes, it is one of the important components to achieve success.
All food products consist of three components: proteins, fats and carbohydrates. They all have calories, but not all of them raise blood sugar.
Only carbohydrates have a blood sugar-raising effect. What foods contain carbohydrates? It's easy to remember: most of the products are of vegetable origin, and only liquid dairy products from animals. It is important to know whether and how much your blood sugar rises after certain foods. There are types of carbohydrate foods after which blood sugar either does not rise at all or rises slightly.
All carbohydrates can be roughly divided into two groups: they contain rapidly absorbed ("fast") carbohydrates and slowly absorbed ("slow") carbohydrates. Foods with "fast" carbohydrates are refined sugars and include preserves and jams, candies, sweets, fruits and fruit juices. "Fast" carbohydrates cause a sharp increase in blood sugar (depending on the amount of food eaten), they are quickly absorbed into the blood, so it is better to exclude them from the diet for diabetes. "Slow" carbohydrates are more useful for people with diabetes because they take longer to be absorbed. In addition, the absorption of sugar is slowed down by the fiber in the food, so the diet should be enriched with fiber-rich foods during the treatment of diabetes.
During the treatment of diabetes, several simple rules should be followed: food should be taken in small portions and often (4-6 times a day); follow a prescribed diet - try not to skip meals; do not overeat - eat as much as your doctor recommends; use bran or bread made from bran; vegetables (except potatoes and legumes) should be eaten daily; Avoid eating "fast" carbohydrates.
Exercise for diabetes Physical exercise is very important in the treatment of diabetes: it increases the sensitivity of body tissues to insulin, thus helping to reduce blood sugar levels.
Housework, walking and running can be considered physical activity. Regular and dosed physical exercises should be preferred: sudden and intense exercise can cause problems in maintaining normal sugar levels.
If you are an athlete or athlete, you have no contraindications to exercise, as long as you take all necessary precautions to control your blood sugar levels well and prevent them from dropping significantly.
Prevention of complications of diabetes Patients with diabetes have an increased risk of developing complications from the heart and blood vessels (especially in the legs and kidneys). Regular physical activity, sometimes just walking, is enough to prevent blood circulation problems in the legs.
If you have diabetes, an untreated foot ulcer or abrasion can become a serious problem. Small cuts or scrapes on the feet take longer to heal than in non-diabetic patients and require extra attention. The key to preventing these problems is wearing shoes that fit well and checking your feet often. If you find it difficult to check all areas of your feet, use a mirror and remember that foot injuries are often painless at first and can go unnoticed for a long time if you are not careful enough.
Patients with diabetes have an increased risk of kidney failure and heart disease several years after diagnosis. There is good evidence that good blood sugar control reduces this risk. Also, to prevent complications of diabetes mellitus, it is necessary to undergo preventive treatment twice a year.
Blood pressure control is also important. Check your blood pressure regularly. If it rises, your doctor will prescribe treatment for you.