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 sugar (sugar) in whole capillary blood is 3. 3-5. 5 mmol/l in the morning on an empty stomach (ie after 7-14 hours of overnight fasting) and up to 7. 8 mmol/l after meals (i. e. 0, 1, 5). -2 hours after last meal).
Normally, in the human body, glucose is used by cells as an energy source (in other words, the body's cells "eat" glucose from the blood). The more active a cell is, the more energy (glucose) it needs.
Glucose (the term "blood sugar" is more commonly used, but this is not entirely correct) constantly circulates in the human blood. Glucose enters the human body in two ways: - First is through foods containing carbohydrates, - Second is by the liver producing glucose (this is the reason that in diabetic patients, even if the patientdon't eat anything, blood sugar level may increase).
However, to be used as energy, glucose from the blood must go to the muscles (to do work), fat tissue, or the liver (where the body stores glucose). This occurs under the influence of the hormone insulin, produced by the beta cells of the pancreas. As soon as blood sugar levels increase after a meal, the pancreas will immediately release insulin into the blood, thereby connecting to insulin receptors on muscle, fat or liver cells. Insulin is like a key, "opening" the cells to let glucose in, causing the amount of glucose (sugar) in the blood to return to normal. During the period between meals and at night, when necessary, glucose will enter the blood from the liver, so at night insulin will control 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 will occur.
Types of diabetes
Type 1 diabetes (formerly known as insulin-dependent diabetes) develops mainly at a young age (usually before age 30, although type 1 diabetes can also develop at a later age).
Type 1 diabetes is caused by the pancreas stopping producing insulin due to the death of β-cells (responsible for insulin production in the pancreas). The development of type 1 diabetes occurs based on a particular genetic factor (i. e. a person is born with the disease), upon exposure to certain external factors (e. g. viruses), will lead to changes in the body's state. the body's immune system. The body of a patient with type 1 diabetes begins to perceive pancreatic β-cells as foreign and protect itself from them by producing antibodies (similar to what happens when protecting against infection). ), leading to the death of pancreatic β cells, meaning severe insulin deficiency.
Diabetes 1 type that develops when at least 90% of the pancreatic β cells die. Let's recall the mechanism of action of insulin, its function as a "key" that opens cells to receive sugar. In patients with type 1 diabetes, this key disappears from the blood (see figure).
Insulin deficiency in type 1 diabetes Onset of type 1 diabetes is acute, always accompanied by symptoms of severe hyperglycemia (high blood sugar): - weight loss (patient loses weight spontaneously)owner), - constant feeling of hunger, - thirst, dry mouth (patient drinks a lot of water, including at night), - frequent urination (frequent or a lot, even at night), - weaknessweakness.
If you do not consult a doctor in time and do not start treating type 1 diabetes with insulin, the condition will worsen and diabetic coma very often develops.
Type 2 diabetes (formerly called insulin-dependent diabetes) is much more common than type 1 diabetes. The incidence of type 2 diabetes is typical in older people: as a rule, the disease is detected later40 years old, although recently, according to WHO experts, the average age of type 2 diabetes patients is getting younger.
About 80% of people with type 2 diabetes are overweight. In addition, type 2 diabetes is also characterized by genetics - the incidence is high in family members.
In type 2 diabetes, the pancreas continues to produce insulin in larger quantities than normal. Although there are also cases of type 2 diabetes with reduced insulin secretion.
The main defect of 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 sugar from the blood cannot fully enter the body. inside (see picture). levels remain high. This reduced sensitivity to insulin is called insulin resistance.
Low sensitivity to insulin in patients with type 2 diabetes You can figuratively imagine that the "keyholes" (scientifically speaking - insulin receptors) on the cell doors are deformed and there is nofits perfectly with the keys - the insulin molecule. It takes more effort (more keys, which means more insulin) to overcome the insulin receptor defect. The pancreas cannot deliver enough insulin into the blood to overcome insulin resistance and completely normalize blood sugar levels, because in patients with type 2 diabetes, the capacity of β cells is still limited.
As a result, with type 2 diabetes, a paradoxical situation arises where 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 have the disease for quite a long time but not know it. Elevated blood sugar (glucose) levels may be discovered incidentally during examination for some other reason.
At the same time, there are cases with obvious signs of hyperglycemia:
- weakness, fatigue, thirst, dry mouth (patient drinks a lot of water, even at night),
- frequent urination (often or a lot, including at night),
- itchy skin (especially in the perineal area),
- slow wound healing, - frequent infections, - blurred vision.
Diabetic coma develops less often, usually if type 2 diabetes is accompanied by some other very serious disease: pneumonia, serious injury, purulent process, heart attack, etc. v.
Diabetes treatment
Diabetes treatment varies depending on the type of diabetes.
In type 1 diabetes, which occurs due to an absolute deficiency of insulin secretion by the pancreas itself, self-monitoring and constant insulin treatment are required to maintain life. It should be emphasized that treatment with topical insulin is the only treatment option in this situation. The choice of dosage and regimen for the treatment of diabetes with insulin is carried out individually, taking into account age, gender, physical activity and individual sensitivity to insulin.
For type 1 diabetes Sometimes, at the very beginning of the disease, after normalization of blood sugar levels during the treatment of diabetes with insulin, the need for insulin suddenly begins to decrease until it is completely canceled. But this is not a recovery. This phenomenon is called the "honeymoon" of diabetes, or scientifically known as remission. This is explained by the fact that after blood sugar levels are normalized with the help of insulin, β-cells that have not died can function for a while. Then they all died and that person had to be treated for diabetes with insulin for life. Anyone suffering from type 1 diabetes for the first time should be warned by their doctor about the possibility of such a situation and what to do in this case.
Treating diabetes with insulin can be done using an insulin syringe, pen, or insulin pump.
Insulin pump therapy is an alternative treatment for diabetes in people who use multiple syringes or pens to inject insulin and regularly measure 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 in the world there are about 250 thousand people using insulin pumps.
The main goal of treating type 2 diabetes is to improve cell sensitivity to insulin. The cause of poor insulin sensitivity is not fully understood. However, it has long been known that the strongest factor in the formation of insulin resistance is being overweight, i. e. Accumulating too much fat in the body. Many scientific studies and long-term observations of patients show that weight loss during the treatment of type 2 diabetes in most patients can significantly improve blood sugar levels.
In type 2 diabetes, normalization of weight can lead to complete normalization of blood sugar levels over a long period of time, although this cannot be called complete recovery.
If diet and exercise for weight loss are not sufficiently effective in treating type 2 diabetes, you may have to resort to medication. They are available in tablets. Some of them act on the pancreas, increasing insulin production, while others improve pancreatic activity (reducing insulin resistance). So, the drugs used to treat type 2 diabetes themselves do not reduce blood sugar levels, insulin does this, therefore, to achieve the effect of pills in the treatment of diabetes, a preserved pancreatic β-cell reserve is required. This clearly shows why it is pointless to use pills in the treatment of type 1 diabetes because most β-cells are dead.
Insulin is commonly 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 orlong-term treatment. This is why type 2 diabetes should now not be called non-insulin dependent. The type of diabetes treatment does not determine the type of diabetes.
Diet plays the most important role in treating diabetes.
Diet for diabetes
Although there are common goals in treating different types of diabetes (eliminating symptoms of high blood sugar, minimizing the risk of hypoglycemia, preventing complications), a diet for the diseaseType 1 and type 2 diabetes have significant differences. There is no single diet plan for diabetes.
In type 1 diabetes, the occurrence of the disease is associated with the death of beta cells of the pancreas and lack of insulin, the main treatment of which is insulin replacement therapy and dietary restriction, according toThe modern view is that it is of an adjunctive nature and should only be used to the extent that insulin therapy differs from insulin production in healthy individuals.
The basic principles of dietary prescription for patients with type 1 diabetes have undergone important revision in recent years.
One of the principles of traditional diabetic diets is the recommendation to consume the same, strictly defined number of calories each day. Each patient is given a daily calorie requirement based on "ideal weight". This makes no sense and cannot be done for the following reasons:
- In healthy people of normal weight, the balance between energy intake and expenditure varies greatly from day to day. Energy expenditure in healthy people may vary as their physical activity changes. Therefore, if you prescribe a patient with type 1 diabetes a certain diet with a fixed daily consumption, the same amount of calories, then to maintain normal weight you will have to recommendan equally rigorous and consistent physical activity plan. every day, which is completely unrealistic.
- In type 1 diabetic patients with normal weight and an appropriately selected insulin regimen for diabetes, appetite regulation does not differ from that in healthy subjects. The fact that they sometimes have to force-feed to prevent hypoglycemia, even when there is no appetite, is often a consequence of incomplete insulin treatment.
Improved diabetes treatment regimens using insulin and self-monitoring of metabolism based on blood sugar levels give patients the opportunity to adjust food intake depending only on hunger andfull, like healthy people. Thus, the diet of patients with type 1 diabetes corresponds to a complete healthy diet (balanced in calories and content of essential nutrients). The only difference is that the injected insulin doesn't "know" when and how much you eat. Therefore, you yourself must ensure that the effects of insulin are consistent with your diet. Therefore, you need to know which foods increase blood sugar levels.
The main treatment for type 2 diabetes is to normalize 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 factors that help you achieve success.
All food products consist of three components: proteins, fats and carbohydrates. All of them contain calories, but not all of them increase blood sugar.
Only carbohydrates have the effect of increasing blood sugar levels significantly. Which foods contain carbohydrates? It's easy to remember: most products are of plant and animal origin - only liquid dairy products. It's important to know whether your blood sugar increases after eating certain foods, and if so, by how much. There are foods containing carbohydrates after which blood sugar levels do not increase at all or only slightly.
All carbohydrates can be roughly divided into two groups: those containing rapidly absorbing ("fast") carbohydrates and slowly absorbing ("slow") carbohydrates. Products with "fast" carbohydrates contain refined sugars and include preserves and jams, candies, 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 exclude them from the diet for people with diabetes. . "Slow" carbohydrates are much more beneficial for diabetics because they take longer to absorb. In addition, the process of sugar absorption is slowed down due to fiber in foods, so the diet when treating diabetes needs to include lots of fiber-rich foods.
Here are some simple rules to follow when treating diabetes: food should be eaten in small portions and often (4-6 times a day); adhere to the established diet - try not to skip meals; do not overeat - eat as much as recommended by your doctor; Use bread made from whole wheat flour or with bran; should eat vegetables (except potatoes and beans) every day; Avoid eating "fast" carbohydrates.
Exercise for diabetes Exercise in the treatment of diabetes is very important: it increases the sensitivity of body tissues to insulin and thus helps reduce blood sugar levels.
Housework, walking and jogging can be considered physical activities. Regular and moderate exercise should be a priority: sudden and intense exercise can cause problems in maintaining normal sugar levels.
If you are an athlete or sportswoman, you have no contraindications to playing sports, as long as your blood sugar level is well controlled and all necessary measures are taken to prevent it. its significant decline.
Preventing complications of diabetes Patients with diabetes are at high risk of complications in 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 feet.
If you have diabetes, untreated foot wounds or scrapes can develop into a serious problem. Even small cuts or scrapes on the feet take longer to heal than in non-diabetic patients and require more attention. The key to preventing these problems is wearing shoes that fit properly and checking your feet regularly. Use a mirror if you find it difficult to examine all areas of your foot, and remember that foot injuries are usually painless initially and can go unnoticed for a long time if you are not careful enough. .
Diabetics are at high risk of developing kidney dysfunction and heart disease several years after diagnosis. There is clear evidence that good blood sugar control reduces this risk. In addition, to prevent complications of diabetes, preventive treatment is required 2 times a year.
Blood pressure control is also important. Check your blood pressure regularly. If it is elevated, your doctor will prescribe treatment for you.