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 whole capillary blood is 3. 3-5. 5 mmol/l in the morning on an empty stomach (i. e. after 7-14 hours of overnight fasting) and up to 7. 8 mmol/l after a meal (i. e. 1. 5 mmol/l). -2 hours after the last meal).
Normally, in the human body, glucose is used by the cell as a source of energy (in other words, the cells of the body are "fed" glucose from the blood). The more a cell works, the more energy (glucose) it requires.
Glucose (the expression "blood sugar" is more often 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: - the first is through food containing carbohydrates, - the second is throughthe production of glucose by the liver (this is why in diabetes mellitus, even if the patient has not eaten anything, the blood sugar level can rise).
However, to be used as energy, glucose from the blood must go to muscle (to do work), fat tissue, or the liver (the body's glucose storage facility). This happens under the influence of the hormone insulin, which is produced by the beta cells of the pancreas. As soon as the blood sugar level rises after a meal, the pancreas immediately releases insulin into the blood, which in turn binds to insulin receptors on muscle, fat or liver cells. Insulin, like a key, "opens" the cells to allow glucose to enter them, which leads to the normalization of the level of glucose (sugar) in the blood. Between meals and at night, if necessary, glucose enters the blood fromthe liver's depot, so at night insulin controls the liver so it doesn't 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 (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 a later age).
Type 1 diabetes 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 (i. e. a person is born with it), which upon exposure to certain external factors (for example, viruses) leads to a change in the state of the body's immune system. The body of a patient with type 1 diabetes begins to perceive its pancreatic β-cells as foreign and defends itself against them by producing antibodies (similar to what happens in defense against infection), which leads to the death of the β-cells of thepancreas, which means severe insulin deficiency.
Diabetes mellitus 1 type develops when at least 90% of pancreatic β-cells die. Let's recall the mechanism of action of insulin, its function as a "key" that opens the cells to sugar. In type 1 diabetes, this key has disappeared from the blood (see figure).
Lack of insulin in type 1 diabetes The onset of type 1 diabetes is acute, always accompanied by severe symptoms of hyperglycemia (high blood sugar): - weight loss (the patient unintentionally loses weight), - a constant feeling of hunger, - thirst, dry mouth (the patient drinks a lot of liquids, 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 treatment of type 1 diabetes with insulin, the condition worsens and very often a diabetic coma develops.
Diabetes mellitus type 2 (formerly called insulin-dependent diabetes mellitus) is much more common than type 1 diabetes mellitus. The incidence of type 2 diabetes mellitus is characteristic of the elderly: as a rule, it is detected after the age of 40, although recently, according to experts ofWHO, 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 larger 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 the cells do not "sense" insulin well, that is, they do not open well in response to interaction with it, so blood sugar cannot fully penetrate inside (see figure). The level remains elevated. Thisa state of reduced sensitivity to insulin is called insulin resistance.
Low sensitivity to insulin in type 2 diabetes mellitus You can figuratively imagine that the "keyholes" (scientifically speaking - insulin receptors) of the cell doors are deformed and there is no perfect match with the keys - insulin molecules. More effort is needed (more keys, i. e. , more insulin) to overcome the insulin receptor defect. The pancreas cannot deliver enough insulin into the blood to overcome insulin resistance and fully normalize insulin levels. blood sugar, because in type 2 diabetes the capabilities of the β-cells are still limited.
As a result, in type 2 diabetes, a paradoxical situation occurs when there is a lot of insulin and sugar in the blood at the same time.
Type 2 diabetes, unlike type 1 diabetes, begins gradually, often completely unnoticed by the patient. Therefore, a person can be sick for quite a long time, but not know about it. Elevated blood sugar (glucose) levels may be found incidentally during an examination 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, including at night),
- frequent urination (regular or copious, including at night),
- itching of the skin (especially in the perineal area),
- slow wound healing, - frequent infections, - blurred vision.
Diabetic coma develops much less often, usually if type 2 diabetes is accompanied by another very serious illness: pneumonia, severe injury, purulent processes, heart attack, etc.
Treatment of diabetes
Diabetes treatment differs depending on the type of diabetes.
In type 1 diabetes mellitus, which occurs as a result of absolute failure of insulin secretion from the own pancreas, constant self-monitoring and treatment with insulin is necessary to preserve life. It should be emphasized that treatment with externally applied insulin is the only treatment option in this situation. The selection of doses and modes of treatment of diabetes mellitus with insulin is carried out individually, taking into account age, sex, physical activity and individual sensitivity to insulin.
For type 1 diabetes sometimes, at the very beginning of the disease, after normalization of blood sugar during the treatment of diabetes mellitus with insulin, the need for it suddenly begins to decrease until it is completely abolished. But this is not recovery. This phenomenon is called "honeymoon" of diabetes or scientific - 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 work for a while. Subsequently, they all die, and the person needs treatment for diabetes mellitus with insulin for life. Anyone who develops type 1 diabetes for the first time should be warned by their doctor about the possible occurrence of such a situation and what to do in this case.
Treatment of diabetes mellitus with insulin can be done with insulin syringes, pens, or an insulin pump.
Insulin pump therapy is an alternative diabetes treatment for people who often use a syringe or pen to inject insulin and regularly measure their blood sugar levels. Insulin pump therapy is used instead of diabetes treatment with injections. The pump is worn on the body or on clothing, for example on the belt. Currently, about 250, 000 people worldwide use insulin pumps.
The main goal of type 2 diabetes treatment is to improve the cells' sensitivity to insulin. The causes of low insulin sensitivity are still not fully understood. However, it has long been known that the most powerful factor for the formation of insulin resistance is excess weight, i. e. is. excessive accumulation of fat in the body. Numerous scientific studies and long-term observations of patients show that weight loss during the treatment of type 2 diabetes in most patients can achieve a significant improvement in blood sugar levels.
In type 2 diabetes, normalization of weight can lead to complete normalization of blood sugar for a long time, although this cannot be called complete recovery.
If diet and exercise aimed at losing weight do not give sufficient effect in the treatment of type 2 diabetes, you must resort to medication. They are available in tablet form. Some of them act on the pancreas by increasing the production of insulin, while others improve its action (reduce insulin resistance). Thus, the drugs used to treat type 2 diabetes mellitus themselves do not lower blood sugar, insulin does, therefore, to achieve the effect of tablets in the treatment of diabetes mellitus, a preserved reserve of pancreatic β-cells is required. This explains why it is pointless to use tablet drugs in the treatment of type 1 diabetes, since most of the β-cells have already died.
Insulin is often used to treat type 2 diabetes. Insulin treatment for type 2 diabetes may be prescribed as a temporary measure, for example during surgery, severe acute illness, or as permanent treatment. Therefore, it is not currently 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.
Diet for diabetes
Despite the 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 diabetes mellitus type 1 and type 2 differ significantly. There is no single diet for diabetes.
In diabetes mellitus type 1, 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 views, are auxiliary and should be applied only to the extent thatwhich insulin therapy differs from insulin production in a healthy person.
The basic principles of diet prescription for type 1 diabetes mellitus have been subject to critical revision in recent years.
One of the principles of the traditional diabetes diet is the recommendation to consume strictly defined, equal amounts of calories every day. Each patient is prescribed a daily caloric 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 considerably from day to day. Energy expenditure in healthy individuals is variable because their physical activity is variable. Therefore, if you prescribe a type 1 diabetic a given diet with a fixed, uniform amount of calories per day, then in order to maintain a normal weight, you would have to recommend the same specific, strict physical activity plan for each day, which is absolutely unrealistic.
- In patients with type 1 diabetes mellitus of normal weight and a properly selected regimen of insulin treatment of diabetes mellitus, appetite regulation does not differ from that in healthy individuals. The fact that they sometimes have to be forced to eat to prevent hypoglycemia, even in the absence of appetite, is most often a consequence of not quite adequate insulin therapy.
Improved insulin-assisted diabetes treatment regimens and self-monitoring of metabolism based on blood glucose levels allow the patient to regulate food intake based only on feelings of hunger and satiety, like healthy people. Thus, 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 must make sure that the action of insulin matches your diet. Therefore, you need to know which foods raise blood sugar.
The main method of treating type 2 diabetes is to normalize body weight through a low-calorie diet and increased physical activity. Diet in 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-increasing effect. What foods contain carbohydrates? It's easy to remember: most products are plant-based, and animal-based - only liquid dairy products. It's important to know if your blood sugar rises after certain foods, and if so, by how much. 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: those containing quickly digestible ("fast") carbohydrates and slowly digestible ("slow") carbohydrates. Foods with "fast" carbohydrates contain refined sugars and include preserves and jams, candies, sweets, fruits and fruit juices. "Fast" carbohydrates cause a sharp rise in blood sugar (depending on the amount of food eaten) because they are quickly absorbed into the blood, so it is better to themexclude from the diabetes diet. "Slow" carbohydrates are much more useful for patients with diabetes, because they are absorbed much longer. In addition, the absorption of sugars is slowed down by the fiber contained in food, so the diet in the treatment of diabetes should be enriched withfoods rich in fiber.
Here are some simple rules to follow when treating diabetes: food should be taken in small portions and often (4-6 times a day); follow the established diet - try not to miss a meal; do not overeat - eat as much as recommended by the doctor; use wholemeal or bran bread; vegetables (except potatoes and legumes) should be eaten daily; Avoid eating "fast" carbohydrates.
Exercise in diabetes Physical exercise in the treatment of diabetes is very important: it increases the sensitivity of body tissues to insulin and thus helps to reduce blood sugar levels.
Housework, walking and jogging can be considered physical activity. Preference should be given to regular and dosed physical exercises: sudden and intense exercises can cause problems with maintaining normal sugar levels.
If you are an athlete, you have no contraindications to exercise, provided that your blood sugar levels are well controlled and all necessary measures are taken to prevent them from dropping significantly.
Preventing the 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 circulation problems in the legs.
If you have diabetes, an untreated foot wound or callus can become a serious problem. Even minor cuts or scrapes on the feet take longer to heal than in non-diabetic patients and require extra care. The key to preventing these problems is to wear well-fitting shoes and check your feet often. Use a mirror if you find it difficult to examine all areas of your feet 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 dysfunction and heart disease several years after diagnosis. There is strong evidence that good blood sugar control reduces this risk. Also, 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.