Diabetes mellitus is an endocrinological pathology accompanied by hyperglycaemia syndrome (high blood sugar), which occurred due to the deficiency of insulin.This disease is accompanied by carbohydrate imbalance and other metabolic disorders in the body.
At the moment, diabetes mellitus is diagnosed in 10-15 % of the population of our planet.The cases of development of this disease during 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 9-10%diabetes.Today, the number of patients with this disease exceeds 200 million people.Diabetes is diagnosed in men and women.
Causes and mechanism for the development of diabetes
Due to a violation of the synthesis and the secretion of insulin by the beta cells of the Langganes islands, 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 lack of relative insulin deficiency, which can be the result of a decrease in the activity of insulin following its greater connection with the protein, the intensive destruction of liver enzymes, the prevalence of the effects of fat antagonists and non -hormonal hormones), non -hormonal border), changes in -expiration of invalid fat) of tissues dependent on insulin tissues.to insulin.
The deficiency of insulin causes protein disorders, carbohydrates and fat metabolism in the body.The permeability of the glucose of cell membranes in muscle and adipose tissue is reduced, gluconeogenesis and glycogenolisi have improved, glucoseuria, hyperglycaemia, which are accompanied by polyidipsia and polyuria occurs.The decay is intensified and the formation of fat is reduced, which causes an increase in the level of the blood bodies in the blood (acetone-the condensation of acetouxic acid condensation, beta-ottos and acid acetouxus).These phenomena cause a movement of the acid-base balance in the direction of acidosis and also influence the increase in magnesium, sodium, potassium in the urine excretion and leads to renal dysfunction.
There may be a decrease in the alkaline of blood at about 25%.carbon dioxide and a decrease in the pH level in the blood at 7.2-7.0.
How type I diabetes develop
The causes of diabetes' development have some differences, depending on the type of diabetes.For example, patients with type of diabetes, due to autoimmune aggression and viral infection, are expanded by beta cells in the body, following which a deficiency develops with all the consequences that follow.
They develop how type II diabetes develop
Patients with the type of diabetes II have a sufficient amount of insulin, but body tissues lose the opportunity to perceive its signal.With the development of obesity, the adipose tissue acts as a sort of barrier that blocks the effect of insulin.In order to eliminate this barrier, the beta cells include the intense operating method, which subsequently leads to their exhaustion and transition of the insufficiency of relative insulin ever.However, diabetes dependent on insulin does not turn into insulin dependent.
Regardless of the etiological factor in the development of diabetes, the same process takes place in slowing the transformation of sugar coming from the outside and available in the blood.
Classification of diabetes
Depending on the clinical characteristics, the following types of diabetes are distinguished:
- The type of diabetes mellitus, which in turn has several subspecies:
- diabetes dependent on insulin;
- Sugar diabetes dependent on insulin:
- in people with obesity;
- In people with normal weight.
- Diabetes, the cause of whose development is not insufficient nutrition;
- Another verification of type I diabetes associated with certain syndromes and body conditions:
- endocrine pathologies;
- insulin anomalies or its receptor;
- pancreatic diseases;
- some genetic syndromes;
- conditions caused by the effects of chemicals or by the intake of drugs;
- state of mixed etiological factors;
- 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 separate from this disease have been identified (patients with normal glucose tolerance, but a significant risk of diabetes):
- a state that precedes a violation of glucose tolerance;
- Potential glucose tolerance disorders.
Type of diabetes (primary) essential
The essential type (primary) of diabetes mellitus, which has a connection with nutritional failure, is highlighted as a separate pathology.This disease occurs in people under the age of 30 who live in tropical countries.According to statistics, the ratio between men and women is 2: 1. The total number of patients with this form of diabetes is 20 million people.
Very often there are two subtypes of this diabetes.The first of them is fibrocalcular pancreatic diabetes.
Fibrocalcole pancreatic diabetes
Territorially, it mainly covers Indonesia, India, Brazil, Bangladesh, Uganda and Nigeria.This pathology is characterized by the presence of large pancreofibrosis and stone formation in the main duct of the pancreas.The clinical picture is represented by strong weight loss, recurring abdominal pain and other signs of insufficient nutrition.In this case, insulin therapy allows you to eliminate moderate and high glucosuria and hyperglycaemia.One of the characteristic signs of this pathology is the lack of ketoacidosis, due to the reduced production of insulin and the release of glucagon by the islet of the pancreas.Topographical studies (ultrasound diagnostics, radiography, computerized tomography) allow you to determine the presence of stones in pancreas ducts.
There is an opinion that one of the factors in the development of fibrocalcoretic diabetes is the inclusion of the manufacting roots (cassava, tapoka) in the diet, which contain cyangenic glycosides, one of which is lineamarine, from which cyanistoric acid is released during hydrolysis.With the participation of acids containing sulfur, its harmful effects are eliminated and the insufficient intake of protein food, often present in the population of the above countries, causes the accumulation of cyanide in the body, which is the cause of the development of fibrocalcolosis.
Pancreatic diabetes
The development of pancreatic diabetes (type II diabetes) has a relationship with protein failure in the body, but there are no manifestations of pancreatic fibrosis.It is characterized by moderate insulin resistance and resistance to the development of ketoacidosis.In most cases, patients suffer from tiredness.Patients have a reduced insulin secretion, but not to an extent as in patients with type I diabetes, this explains the lack of ketoacidosis.
Subtype j
In the classification of diabetes, according to the WHO data, which are presented above, there are no references to the third subtype of pancreatic diabetes, which is located in Jamaica, we are talking about the subtype J. The subtype J has a lot in common with the pancreatic diabetes that occurs due to the protein deficit.
Symptoms of diabetes
The first symptoms of diabetes occur due to a high blood sugar content.After exceeding the level of 8.9-10.0, the sugar enters the urine.When they continue to increase the level of glucose in the blood, the kidneys also remove water, this occurs clinically for rapid urination (polyuria).Excessive isolation of urine causes a constant feeling of thirst (Polyidipsia).With urine, the body loses a large number of calories represented by glucose, so a person loses weight and constantly feels hungry.
Other symptoms of diabetes, such as sleepiness, reduction of visual acuity, fatigue and nausea are distinguished.In addition, patients with non -compensated diabetes are subject to infections.Type I diabetes patients have a pronounced deficiency of insulin and, for this reason, almost always lose weight before the start of therapy.Patients with the type of diabetes do not lose body weight.
With type I diabetes disease, the rapid development of clinical manifestations occurs and soon can progress in diabetic ketacidosis.Regardless of the high level of glucose in the blood, the cells do not have the opportunity to use it without the presence of insulin, therefore they move on to other sources of energy.The destruction of fat cells begins, which causes the formation of ketone bodies, which are "acidifying" toxic chemicals.
Diabetic ketoacidosis
The first symptoms of diabetic ketoacidosis manifest themselves in the form of excessive and excessive thirsty urination, nausea, vomiting, fatigue, weight loss and abdominal pain (especially during childhood).Patients have frequent and profound breathing, which is associated with the attempts of the body to neutralize the excessive acidity of the blood, this process is accompanied by the appearance of the smell of acetone from the mouth.In the absence of treatment, diabetic ketoacidosis can be complicated by the development of a coma, in some cases this process occurs within several hours.
Type I diabetes can be accompanied by the development of ketoacidosis even after the start of insulin therapy if the patient moves to a planned injection or suffers serious emotional overstrains, in particular during injuries, serious infections or other serious diseases.
Patients suffering from type II diabetes for a sufficiently long time may not feel any sign of this pathology.Such a hidden period of the disease can last until several decades.Clinical manifestations are activated as the deficiency of insulin aggravates.
Initially, the volume of dedicated urine only slightly exceeds the norm, thirst is weakly expressed, but over time these processes progress.The phenomena of ketoacidosis are rare.With a significant increase in the level of glucose in the blood (in some cases, at 55 mmol/l), this usually happens with additional loads on the body, for example, under the influence of drugs or with serious infectious diseases, the patient can also collapse in a confused state of consciousness, demonstrated for confused consciousness, it has proven to be a little confused consciousness, it has proven to be hypergs.
In what way it is the Diabetes Mellito Manifest
The high level of glucose in the blood over time can cause damage to nerves, blood vessels and other structures.The chemical compounds containing glucose are found on the walls of small blood vessels, due to which the walls of the vessels are thickened and damaged.The narrowing of the gaps of the blood vessels causes the deterioration of the bloodstream, in particular the blood supply to the ending of the skin and nerves.Without compensation for diabetes in the blood, an increase in the level of fatty substances occurs, which accelerates the development of atherosclerosis.Patients with diagnosis of diabetes, regardless of the genre, suffer from atherosclerosis 2-6 times more often than people who do not have this diagnosis.The violation of the blood vessels in the blood circulation causes dysfunctions from the heart, kidneys, eyes, lower ends, brain, skin and nerves and also slows down the healing process of wounds.
What is the seriousness of diabetes mellitus
All these factors increase the risk of developing many distant complications.In patients with diabetes, the risk of stroke and heart attacks increases, due to damage to the blood vessels of the eyes, loss of viscopathy (diabetic retinopathy), renal disorders are therefore necessary, in some cases, dialysis is required.Damage to nerves can lead to many consequences.Mononeuropathy (compromised functionality of a nerve) can manifest itself with a sudden weakness of the upper or lower limb.Diabetic polyninopathy (damage to the nerves of the legs, feet or hands) causes sensitivity, pain, burning or tingling disorders, feeling of weakness in the arms and legs.Sensitivity to temperature and pain decreases, which leads to an increase in trauma.Circulatory disorders can contribute to the appearance of ulcers and poor healing of wounds.The localized ulcers on the feet are very deep and poorly curative, which leads to the infection and, in some cases, to the amputation of the interested limb.
Clinical studies have shown that diabetes can be avoided or expires, if you constantly maintain normal blood sugar.The course of this disease is not currently completely studied.There are numerous unexplored factors that cause its development, genetic ones include the number of these factors.
Diagnosis of diabetes
The diagnosis of diabetes begins with the collection of anamnesis and the patient examination.During these measures, the patient has the presence of hereditary factors, obesity, if the patient belongs to the number of single twins (if one of them suffers from diabetes mellitus, the second must be examined), women specify the presence of childbirth and if a large fruit has been specified.
What follows is a number of laboratory tests, which consist of:
- Blood exams for glucose levels are performed twice;
- Glucose tolerance test;
- Determine the glucose level 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.
Complications of diabetes
The complications of diabetes mellitus can be acute and chronic, they are also divided according to the form of diabetes.Among the acute complications, the states of coma are distinguished, during which the loss of consciousness is preceded by brain disorders due to a very low or very high concentration of blood sugar.These conditions include:
- Diabetic ketacitosis (the most common complication of acute nature) occurs from polyuria, polycids, lack of appetite, weakness, abdominal pain, nausea and vomiting;
- A hypoglycemic coma is an extreme degree of hypoglycaemia, occurs with a strong decrease in the level of glucose in the blood.Often it is the result of the introduction of an irregular dose of insulin and sometimes occurs after taking certain foods or sulfanilamide.
- The hyperosmular comic in the gravity of the state exceeds the diabetic which 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 serious concomitant pathologies - in 70%.
Chronic (late) complications are combined in a group of pathologies that develop with prolonged exposure to high blood sugar on the patient's organs and systems.First of all, the organs most sensitive to sugar are subject to damage, they are a kind of "target" for diabetes.Among the chronic complications of diabetes, they are known:
- Diabetic retinopathy is observed in 90% of patients with diabetes.It develops with a long cycle of diabetes and manifests itself from damage to the ships of the eye retina;
- Diabetic nephropathy consists of complex damage to the kidneys (tubules, arteries, glomeruli, arteriole).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 manifests itself from an increase in fatigue, a decrease in performance, a compromise of the concentration of attention, emotional lability, squeeze headache, anxiety and worsening of the thought process;
- The diabetic lesions of the skin are structural deformations of the epidermis, follicles, sweat glands due to the violation of the metabolism of carbohydrates and the accumulation of metabolism products.In the case of a strong shape of diabetes, the skin becomes rough, rough, with areas of homosopers, cracks, the skin acquires a yellowish tint, a hair loss occurs;
- The diabetic foot and brush syndrome occurs in 30-80% of patients with diabetes and is a complex of anatomical and functional disorders that appear in the form of brown spots and ulcerations on the lower part of the leg, the foot and the phalanx of the fingers, which in serious cases can lead to the amputation of the weapon.
Diabetes treatment
The treatment of diabetes depends on the type of disease, but first of all the patient must normalize the level of glucose in the blood.To do this, you have to radically change your lifestyle and diet.A special diet is recommended for patients with diabetes, 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 the tactics of drug therapy depends on the type of diabetes.Patients with type of diabetes are necessary to conduct insulin therapy, with the type II who adhere to the more severe diet and use glucose agents, with the ineffectiveness of the tablets of forms of drugs, insulin is prescribed.
Insulin is taken under the rigorous control of the blood glucose level.According to the mechanism of action, insulin preparations are divided into three types: prolonged, short and intermediate action.The drugs containing sugar are indicated in the case of diabetes mellitus dependent on the insulin in combination with the diet.The drugs containing sugar include: Biguanidi, Sulfonilmochevine, Tiazolidindyons and Muglitinides.
With this insidious disorder, it is very important for medical personnel to properly teach the patient and his relatives the ability to monitor the conditions of the patient and the emergency room in the event of pre -someno and coma.
Forecast for diabetes mellito
In the presence of diabetes mellitus, the patient is recorded with the endocrinologist.In adequate therapy conditions, the patient can be in satisfactory conditions for a long time.AGRATING the prognosis regarding the state of health and life expectancy of a patient with diabetes mellitus can develop acute and chronic complications.
Diabetes prevention
With type I diabetes, preventive measures must increase the body's 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 regulate nutrition and prevent the development of obesity.To prevent the development of complications in the conditions of diabetes, it is necessary to correctly and systematically respect the doctor's recommendations and clarify whether this or food can be consumed.