Diabetes: types and causes of their development, course and manifestations, how to treat, possible consequences

Diabetes mellitus is one of the incidence statistics and spoiled diseases.The symptoms of diabetes appear not on the same day, the process flows chronically, with the increase and aggravation of endocrine exchange disorders.It is true that the debut of type I diabetes is significantly different from the early stage of the second.

Among the entire endocrine pathology, Diabetes has the championship and represents more than 60% of all cases.In addition, disappointing statistics indicate that 1/10 of “diabetics” are children.

The likelihood of acquiring the disease increases with age and, therefore, every ten years, the group number folds.This is explained by an increase in life expectancy, improving early diagnoses, a decrease in physical activity and an increase in the number of overweight people.

Types of diabetes

Many have heard of a disease like diabetes do not alic.So that the reader does not later confuse diseases that have the name "diabetes", the clarification of their differences will probably be useful.

URETRA NO -ADOLISE

Diabetes Non -House is an endocrine disease that occurs due to neuroinfections, inflammatory diseases, tumors, poisoning and due to insufficiency and sometimes the complete disappearance of ADG -Vasopressin (antidihuretic hormone)

This explains the clinical image of the disease:

• Constant dryness of the mucous membranes of the oral cavity, incredible thirst (one person can drink up to 50 liters of water within 24 hours, stretching the stomach to large sizes);
• The allocation of a huge amount of unconditional light urine with low severity (1000-1003);
• Catastrophic weight loss, weakness, decreased physical activity, digestive system disorders;
• A characteristic change in the skin (parchment skin);
• Atrophy of muscle fibers, weakness of the muscle tract;
• The development of dehydration syndrome in the absence of fluid intake for more than 4 hours.

Full healing disease has an adverse prognosis, performance is significantly reduced.

Brief Anatomy and Physiology

A non -IRE organ - the pancreas performs a mixed secretory function.Its exogenous part of external secretion, producing enzymes involved in the digestion process.The endocrine part, which is in charge of the internal secretion mission, is involved in the development of various hormones, includingInsulin and glucagon.They are essential to ensure the constancy of sugar in the human body.

The endocrine section of the gland represents the Langergens Islands, consisting of:

1. The cells to which they occupy a quarter of the entire island space and are considered the place of Glucagon products;
2. B cells that occupy up to 60% of the cell population synthesizing and accumulating insulin, whose molecule is a two -chain polypeptide, which carries in a certain sequence of 51 amino acids;
3. D cells that produce somatostatin;
4. Cells that produce other polypeptides.

Thus, the conclusion is suggested:Damage to Pancreas and Langergannes islands, in particular, are the main mechanism that inhibits insulin production and triggers the development of the pathological process.

Special types and forms of the disease

Lack of insulin leads to a violation of sugar constancy (3.3 - 5.5 mmol/L)and contributes to the formation of a heterogeneous disease called diabetes (diabetes):

• The complete absence of insulin forms (absolute deficiency)Insulin -Dependenta pathological process that refers toType I (ISD) diabetes;
• Lack of insulin (relative deficiency), which triggers in the early stage a violation of carbohydrate metabolism, slowly but surely leads to developmentInsulin -Dependentdiabetes (inzsd), which is calledType II diabetes.

Due to violations in the body of glucose use and, therefore, its increase in blood serum (hyperglycemia), which, in principle, is a manifestation of the disease, signs of diabetes mellitus, ie a total disorder of metabolic processes at all levels, begin to appear over time.

In addition to diabetes of the first and second types, the special types of this disease are distinguished:

1. Secondary diabetes,The pancreas resulting from acute and chronic pancreas inflammation (pancreatitis), malignant neoplasms in the gland parenchyma, liver cirrhosis.Several endocrine disorders, accompanied by excessive production of insulin antagonists (acromigalia, kushing disease, focus, thyroid disease) lead to the development of secondary diabetes.Many medicines consumed for a long time have a diurgenic effect: diuretics, some anti -bipertensive drugs and hormones, oral contraceptives, etc.;
2. Diabetes in pregnant women (gestational),Due to the peculiar mutual influence of mother, son and placenta hormones.The fetus pancreas that produces its own insulin begins to slow down insulin products with the mother gland, as a result of which this special form is formed during pregnancy.However, with proper control, gestational diabetes usually disappears after delivery.Subsequently, in some cases (up to 40%) in women with a similar history of pregnancy, this may threaten the development of type II diabetes (within 6 to 8 years).

Why is there a "sweet" disease?

The "sweet" disease forms a very "heterogeneous" group of patients;Therefore, it is obvious that the ISSD and its insulin -dependent "counterpart" occurred differently.There is evidence of insulin -dependent diabetes connection to the genetic structures of the HLA system (the main histocompatibility complex), in particular, with some Locus genes from the D. region for Inzsd, this relationship was not seen.

For the development of diabetes of the type of genetic predisposition, the pathogenetic mechanism is launched by thought -provoking factors:

• Congenital inferiority of Langergannes islets;
• Adverse influence of the external environment;
• Stress, nerve loads;
• Traumatic brain lesions;
• Pregnancy;
• Infectious processes of viral origin (flu, "pig", cytomegalovirus infection, cooksaki);
• A tendency to eat too much constantly, leading to excess fat deposits;
• The confectionery abuse (the sweet tooth runs more).

Before illuminating the causes of type II diabetes, it would be advisable to insist on a very controversial question: who suffers more often - men or women?

It has been established that the disease is most often formed in women today, although in the nineteenth century SD was a "privilege" of man.By the way, now in some countries in southeastern Asia, the presence of this disease in men is considered predominant.

The predisposing conditions for the development of type II diabetes mellitus can be assigned:

• Changes in the structural structure of the pancreas as a result of inflammatory processes, as well as the appearance of cysts, tumors, bleeding;
• Age after 40 years;
• Overweight (the most important risk factor for InzSD!);
• Vascular diseases due to atherosclerotic process and hypertension;
• In women, the pregnancy and the birth of a child with high body weight (over 4 kg);
• The presence of relatives suffering from diabetes;
• Strong psycho -emotional stress (supranal glands hypermation).

The causes of the disease of various types of diabetes, in some cases, coincide (stress, obesity, influence of external factors), but the beginning of the process in the diabetes of the first and second type is different, besides, in addition,The ISSD is many children and young people, and dependent on insulin prefers people from the oldest generation.

Why do you want to drink so much?

The characteristic symptoms of diabetes, regardless of the form and type, can be represented as follows:

1. Dry mucosa oral cavity;
2. Headquarters, which can hardly be satisfied, associated with dehydration;
3. Excessive formation of urine and its release by the kidneys (polyuria), which leads to dehydration;
4. An increase in blood glucose concentration in blood serum (hyperglycemia) due to suppression of sugar disposal with peripheral tissues due to insulin deficiency;
5. The appearance of sugar in the urine (glucose) and ketonia bodies (ketonuria), which are usually present in negligible amounts, but with diabetes mellitus are intensively produced by the liver and when body excretors are detected in the urine;
6. Increased blood plasma (besides glucose) of urea and sodium ions (in⁺);
7. Weight loss, which in the event of decompensation of the disease is a characteristic of a catabolic syndrome, which develops due to glycogen decay, lipolysis (fat mobilization), catabolism and glucose (transformation into glucose) of proteins;
8. In violation of lipid spectrum indicators, an increase in general cholesterol due to the fraction of low density lipoproteins, Nezhk (non -ticket fatty acids), triglycerides.The growing content of lipids begins to actively go to the liver and there is intensely oxidized there, which leads to excessive formation of ketone bodies (acetone + β-oxielic acid + acid acetouxus) and entering the blood further (hypercetoninomy).Excessive concentration of ketone bodies threatens a dangerous state calledDiabetic Ketoacidosis.

Thus, general signs of diabetes can be characteristic of any form of disease;However, in order not to confuse the reader, the characteristics inherent in this or such.

Type I diabetes - "privilege" of young people

ISD is characterized by clear beginners (weeks or months).Signs of type I diabetes are pronounced and manifest by typical clinical symptoms of this disease:

• An accentuated drop in weight;
• A non -natural thirst, a person simply cannot be drunk, although he tries to do this (polydipsia);
• A large amount of secreted urine (polyuria);
• Significant excess of the concentration of glucose and Ceton bodies in blood serum (ketatosis).In the early stage, when the patient does not yet know his problems, it is likely to develop a diabetic (ketacidotic, hyperglycemic) - an extremely threatening condition, so insulin therapy is prescribed as early as possible (only diabetes will be accelerated).

In most cases, after the use of insulin, metabolic processes are compensated,The need for the body in insulin decreases markedly, comes a temporary "recovery".However, this brief state of remission should not relax the patient or doctor, as after some time the disease will remember again.The need for insulin as the duration of the disease increases may increase, but basically, in the absence of cetoacidosis, it will not exceed 0.8-1.0 units/kg.

Signs indicating the development of late diabetes complications (retinopathy, nephropathy) may appear in 5 to 10 years.The main reasons for the fatal result of ISD include:

1. Terminal renal failure, which is a consequence of diabetic glomerulosclerosis;
2. Cardiovascular disorders, such as complications of the underlying disease, which happen slightly less kidney.

Disease or age -related changes?(Type II diabetes)

InzSD has been developing for many months or even years.The problems that arise, a person leads to several experts (dermatologist, gynecologist, neurologist ...).The patient does not suspect that diseases are different in his opinion: cornunculosis, itching on the skin, fungal lesions, lower ends pain - signs of type II diabetes.Patients get used to their condition, and diabetes continues to develop slowly, affecting all systems and especially vessels.

InzSD is characterized by a stable slow path, as a rule, without showing a tendency to ketacity.

Type 2 diabetes treatment usually begins in accordance with the diet with an easily digestible (refined) carbohydrate limitation and use (if necessary) to reduce medications from medicines.Insulin is prescribed if the development of the disease reaches the stage of serious complications or there is the immunity of oral medicines.

The main cause of death in patients with InzSD was recognized as a cardiovascular pathology that became a consequence of diabetes.As a rule, this is a heart attack or stroke.

Treatment products for diabetes

The basis of medical measures designed to compensate for diabetes are three main principles:

• Compensation for the lack of insulin;
• Regulation of endocrine exchange disorders;
• Prevention of diabetes mellitus, their complications and their timely treatment.

The implementation of these principles is performed based on 5 main positions:

1. Diabetes nutrition is attributed to the "first violin" part;
2. The system of exercise, suitable and individually selected, follows the diet;
3. Drugs that reduce sugar are mainly used to treat type 2 diabetes;
4. Insulin therapy is prescribed, if necessary, with INZSD, but is the main one in the case of type 1 diabetes;
5. Teach patients for self -control (blood -taking skills from a finger using a glyrometer, the introduction of insulin without external help).

Laboratory control over these positions indicates the degree of compensation after the following biochemical studies:

Indicators	A good degree of compensation	Skirt	Bad
Level of glucose in the empty stomach (MMOL/L)	4.4 - 6.1	6.2 - 7.8	Ø 7.8
The sugar content in the blood serum 2 hours after eating (mmol/l)	5.5 - 8.0	8.1 - 10.0	Ø 10.0
The percentage of glycosylated hemoglobin (HBA1, %)	<8.0	8.0 - 9.5	Ø 10.0
The total cholesterol indicator in serum (MMOL/L)	<5.2	5.2 - 6.5	Ø 6.5
Triglyceride Level (MMOL/L)	<1.7	1.7 - 2.2	Ø 2.2

An important role of a diet in the treatment of INZSD

Diabetes nutrition is very well known, even far from diabetes for people, Table 9. Being in a hospital on any disease, from time to time you can hear about a special nutrition that is always in separate vessels, differs from the rest of the diets and is emitted after a certain password is spoken: "I have the ninth table."What does all this mean?What is the difference between this mysterious diet of all others?

You should not be mistaken, taking care of your "porridge" of the diabetics that they are deprived of all the joys of life.Diabetes diet is not so different from the nutrition of healthy people, the certain amount of carbohydrates (60%), fats (24%), proteins (16%) that patients receive.

The diabetes power supply is to replace refined sugars in slowly divided carbohydrates.Sugar was sold in a store for everyone and confectionery, based on it, fits the category of prohibited foods.

As for the balance of nutrition, everything is rigorous here: the diabetic should use the necessary amount of vitamins and pectins, which should be at least 40 g.a day.

Physical activity strictly individual

Physical activity for each patient is selected individually by the assistant doctor, while the following positions are taken into consideration:

• Age;
• Diabetes symptoms;
• Gravity of the pathological process flow;
• The presence or absence of complications.

The physical activity prescribed by the doctor and performed by the “wing” should contribute to the “combustion” of carbohydrates and fats, without attracting insulin for participation.Its dose, which is needed to compensate for metabolic disorders, is remarkably falling, which should not be forgotten, because, preventing increased blood sugar, you can have an undesirable effect.Proper physical activity reduces glucose, the introduced dose of insulin breaks and, as a result, a decrease in sugar levels below the permitted values (hypoglycemia).

That's why,The dose of insulin and physical activity requires very close attention and complete calculation,To complement it, do not enter the lower limit of the normal laboratory indicators.

Or maybe experience popular remedies?

Type 2 diabetes treatment is often accompanied by the search for patients with folkloric drugs that can inhibit the process and, to the extent of the possible delay, the time to take forms of dosage.

Without looking at the fact that our distant ancestors practically did not know about this disease, there are popular drugs for the treatment of diabetes, but we should not forget thatInfusions and decoctions prepared from various plants are an auxiliary agent.The use of domestic drugs for diabetes does not relieve the patient from compliance with diet, blood sugar control, visiting a doctor and fulfilling all their recommendations.

To combat this pathology at home, very famous popular remedies are used:

1. White -mulberry bark and leaves;
2. Peeled grains and oats;
3. Nogueira partitions;
4. Bay leaf;
5. Cinnamon;
6. Billotas;
7. Nettle;
8. Dandelion.

When diet and popular medicines no longer help ...

First -generation call preparations, widely known at the end of the last century, remained in memories and were replaced by new generation medicines, which make up three main groups of diabetes produced by the pharmaceutical industry.

What it means is suitable for one patient or another - the endocrinologist decides.And so that patients do not self -fit and do not decide to use these diabetes drugs at their discretion, we will give several visual examples.

Sulfonylmochevines

Currently, the second generation derivatives are prescribed, acting from 10 hours to one day.Generally, patients take them twice a day half an hour before meals.

These medications are absolutely against -indicated in the following cases:

• Type 1 diabetes;
• Coma diabetic, hyperosmolar, lactacidotic;
• Pregnancy, delivery, lactation;

• Diabetic nephropathy, accompanied by impaired filtration;
• Hematopoietic system diseases with a concomitant decrease in white blood cells - leukocytes (leukocytopenia) and binding of thrombocytic hematopoiesis (thrombocytopenia);
• Infectious liver lesions and severe inflammatory (hepatitis);
• Complicated diabetes by vascular pathology.

In addition, the use of medicines in this group may threaten the development of allergic reactions that manifest themselves:

1. Itching and hives, sometimes reaching Quincke's edema;
2. Digestive system disorders;
3. Blood side changes (reduction in platelet and leukocyte level);
4. Perhaps a violation of liver functional skills (jaundice due to cholestasis).

Sahabro winner facilities of the Biguanides family

Biguanides (guanidine derivatives) are actively used to treat type 2 diabetes, usually adding sulfonamides to them.They are very rational for use by obesity patients, however, people who have liver, kidneys and cardiovascular pathology are strongly limited, changing drugs from the same group or inhibitors of α-glucosides that inhibit carbohydrate absorption in the small intestine.

The against absolute indications for the use of biguanides are considered:

• ISD (type 1 diabetes);
• Significant weight loss;
• Infectious processes, regardless of location;
• Surgical interventions;
• Pregnancy, childbirth, breastfeeding period;
• Coma states;
• Liver and renal pathology;
• Oxygen hunger;
• Microangiopathy (2-4 degrees) with visual impairment and renal function;
• Trophic ulcers and necrotic processes;
• Blood circulation violation at the lower ends due to various vascular pathology.

Insulin treatment

Of the above, the fact that the above becomes thatUse of insulin is the main treatment of type 1 diabetes, all emergency conditions and severe diabetes complications.InzSD requires the appointment of this therapy only in cases of forms of use of insulin, when correction by other means does not give the proper effect.

Modern insulin, so -called monocompetent, represent two groups:

1. Monocompetent pharmacological forms of human insulin substance (semi-synthetic or rocombinant of DNA), which undoubtedly have a significant advantage over the preparations for pork.They virtually do not have against -indications and side effects;
2. Monocompetent insulins obtained from the pork pancreas.These drugs compared to human insulins require an increase in the drug dose by approximately 15%.

Diabetes are dangerous complications

Due to the fact that diabetes is accompanied by damage to many organs and tissues, its manifestations can be found in almost all body systems.They are considered complications of diabetes:

• Pathological changes on the skin: Diabetic dermopathy, lipoid necrobiosis, furunculose, xantoma, fungal skin lesions;
• Bone joint diseases:
  1. Diabetic osteoarthropathy (articulation - a change in the ankle joint), which occurs against the backdrop of a microcirculation violation and trophic disorders, accompanied by displacements, subluxis, spontaneous fractures that precede formationDiabetic foot;
  
  2. Diabetic Hyropathy, characterized by hand rigidity, which is most often formed in children with children's diabetes;
• Respiratory Diseases: Long -Prolonged bronchitis, pneumonia, Like this,Increasing the frequency of tuberculosis development;
• Pathological processes that affect digestive organs:Diabetic enteropathyAccompanied by increased peristalsis, diarrhea (up to 30 times a day), a decrease in body weight;
• Diabetic retinopathy- One of the most serious complications characterized by damage to the organs of the vision;
• The most common complication of diabetes is consideredDiabetic neuropathyand its variety -Polyneuropathyreaching 90% of all forms of this pathology.The often found for diabetic polyneuropathy isDiabetic foot syndrome;
• The pathological state of the cardiovascular system, in most cases, is the cause of the death of diabetes mellitus.Hypercholesterolemia and vascular atherosclerosis, which, with diabetes, begin to develop at an early age, inevitably lead to heart and blood vessel disease (coronary heart disease, myocardial infarction, heart failure, cerebrovascular impairment).

Prevention

Diabetes prevention measures are built based on the causes of their challenging.In this case, it is advisable to talk about the prevention of atherosclerosis, hypertension, including overweight struggle, bad habits and food addictions.

Prevention of diabetes complications is to prevent the development of pathological conditions arising from diabetes itself.Correction of glucose in blood serum, compliance with diet, proper physical activity, the implementation of the doctor's recommendations will help promote the consequences of this very formidable disease.