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

Diabetes mellitus is one of the most common to increase statistics on incidence and mess diseases.The symptoms of diabetes do not appear on the same day, the process flows chronically, with the increase and worsening of endocrine exchange disorders.Admittedly, the beginnings of type I diabetes are significantly different from the early stage of the second.

Among the entire endocrine pathology, diabetes confidence in the championship and represents more than 60% of all cases.In addition, disappointing statistics indicate that 1/10 of "diabetics" are children.

The probability of acquiring the disease increases with age and, therefore, every ten years, the number of the double group.This is explained by an increase in life expectancy, improving early diagnostics, a decrease in physical activity and an increase in the number of people with excess weight.

Types of diabetes

Many have heard of a disease such as non -food diabetes.So that the reader does not confuse diseases that have the name of "diabetes", probably, the clarification of their differences will be useful.

Non -adalaire urethra

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

This explains the clinical image of the disease:

• Constant dry of the mucous membranes of the oral cavity, incredible thirst (a person can drink up to 50 liters of water in 24 hours, stretching the stomach with large sizes);
• Allocation of a huge amount of unconditioned light urine with a specific low gravity (1000-1003);
• Catastrophic weight loss, weakness, decrease in physical activity, digestive system disorders;
• A characteristic change of skin ("parchment" skin);
• Atrophy of muscle fibers, weakness of the muscle apparatus;
• The development of dehydration syndrome in the absence of cash supply for more than 4 hours.

The disease in terms of complete healing has an unfavorable prognosis, the performance is considerably reduced.

Brief anatomy and physiology

An organ non -ire - The pancreas fulfills a mixed secretory function.Its exogenous part of external secretion, producing enzymes involved in the digestion process.The endocrine part, responsible for the internal secretion mission, is engaged 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 islands of Langerganes, consisting in:

1. Cells A which occupy a quarter of the entire space of the islands and are considered to be the place of glucagon products;
2. B cells occupying up to 60% of the cell population synthesizing and accumulating insulin, whose molecule is a polypeptide of two chains, which has a certain sequence of 51 amino acids;
3. Cells producing somatostatin;
4. Cells producing other polypeptides.

Thus, the conclusion is suggested:Damage to the pancreas and the islands of Langerganes, 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

The absence of insulin leads to a violation of sugar consistency (3.3 - 5.5 mmol / l)and contributes to the formation of a heterogeneous disease called diabetes (diabetes):

• The complete absence of insulin (absolute deficiency) formsInsulina pathological process that refers toType I diabetes (ISD);
• Lack of insulin (relative deficiency), which triggers at the initial stage, a violation of the metabolism of carbohydrates, slowly but surely leads to developmentinsulindiabetes (inzsd), which is calledType II diabetes.

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

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

1. Secondary diabetes,The pancreas resulting from the acute and chronic inflammation of the pancreatitis (pancreatitis), malignant neoplasms in the gland parenchyma, cirrhosis of the liver.A certain number of endocrine disorders, accompanied by excessive production of insulin antagonists (acromigalie, kushing disease, phoochromocytoma, thyroid disease) lead to the development of secondary diabetes.Many drugs consumed for a long time have a diabetogenic effect: diuretics, certain drugs and antihypertensive, oral contraceptives, etc.;
2. Diabetes in pregnant women (gestational),Due to the particular mutual influence of the hormones of the mother, the child and the placenta.The pancreas of the fetus producing its own insulin begins to slow down insulin products with the mother gland, following which this special form forms during pregnancy.However, with appropriate control, gestational diabetes generally disappears after childbirth.Subsequently, in some cases (up to 40%) in women with similar pregnancy history, this fact can threaten the development of type II diabetes (within 6 to 8 years).

Why is there a "sweet" disease?

The "sweet" disease forms a group of rather "homogeneous" patients, it therefore becomes obvious that the ISSD and its "counterpart" dependent on insulin have genetically produced differently.There is evidence of the connection of diabetes dependent on insulin with the genetic structures of the HLA system (the main complex of histocompatibility), in particular, with certain genes of the locus in region D. for Inzsd, such a relationship has not been seen.

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

• Congenital inferiority of the islets of Langerganes;
• Negative influence of the external environment;
• Stress, nerve loads;
• Brain trauma;
• Pregnancy;
• Infectious process of viral origin (flu, "pig", cytomegalovirus infection, coksaki);
• A tendency to constant supercharging leading to excess fat deposits;
• Confectionery abuse (sweet teeth risk more).

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

It has been established that at present, the disease is more often formed in women, although in the 19th century, the SD was a "privilege" of male.By the way, in some countries in Southeast Asia, the presence of this disease in men is considered to be predominant.

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

• Changes in the structural structure of the pancreas following inflammatory processes, as well as the appearance of cysts, tumors, hemorrhages;
• Age after 40 years;
• Excess weight (the most important risk factor for Inzsd!);
• Vascular diseases due to the atherosclerotic process and high blood pressure;
• In women, the pregnancy and the birth of a child with a high body weight (more than 4 kg);
• The presence of parents suffering from diabetes;
• Psycho-emotional emotional stress (adrenal hyper-glands).

The causes of the disease of various types of diabetes in certain cases coincide (stress, obesity, influence of external factors), but the beginning of the process in the diabetes of the first and the second type is also, moreover,The ISSD is the lot of children and young people, and depends on insulin prefers older generation.

Why do you want to drink so much?

The characteristic symptoms of diabetes, regardless of shape and type, can be represented in the following form:

1. Dry mucosa oral cavity;
2. Thirst, which can hardly be satisfied, associated with dehydration;
3. Excessive urine formation and its liberation by the kidneys (polyuria), which leads to dehydration;
4. An increase in the concentration of glucose in blood serum (hyperglycemia), due to the suppression of the elimination of sugar with peripheral tissues due to insulin deficiency;
5. The appearance of sugar in the urine (glucose) and keton bodies (Ketonuria), which are normally present in negligible quantities, but with diabetes mellitus are produced intensively by the liver and when the excrement of the body are detected in the urine;
6. Increase in blood plasma (in addition to glucose) of urea and sodium ions (na⁺));
7. Weight loss, which in the case of decompensation of the disease is a characteristic of a catabolic syndrome, which develops due to the decrease of glycogen, lipolysis (mobilization of fat), catabolism and glucose (transformation into glucose) of proteins;
8. Violation of lipid spectrum indicators, an increase in general cholesterol due to the fraction of low density lipoproteins, Nezhk (unman "fatty acids), triglycerides.The growing lipid content begins to actively go into the liver and there is an intensively oxidized way, which leads to the excessive formation of ketone body (acetone + β-oxielyic acid + acetouxus acid) and more entering their blood (hypercestonic).Excessive concentration of ketone bodies threatens a dangerous condition calledDiabetic ketoacidosis.

Thus, the general signs of diabetes can be characteristic of any form of disease, however, so as not to confuse the reader, it is always necessary to note the characteristics inherent in this type or to this type.

Type I diabetes - "privilege" from Young

The CIO is characterized by a net start (weeks or months).Type I diabetes signs are pronounced and manifest itself in clinical symptoms typical of this disease:

• A sharp drop in weight;
• A thirst -to -nature, a person just can't get drunk, although he tries to do it (polydipsia);
• A large amount of secreted urine (polyuria);
• Significant excess of the concentration of glucose and ketone bodies in blood serum (cretcole).In the initial stage, when the patient may not still know his problems, he is likely to develop a diabetic (ketoacidotic, hyperglycemic) coma - an extremely threatening condition, therefore insulin therapy is prescribed as soon as possible (only diabetes will be accelerated).

In most cases, after the use of insulin, metabolic processes are offset,The need for the body in insulin decreases sharply, a temporary "recovery" occurs.However, this short state of remission should not relax either the patient or the doctor, because after a certain period of time, the disease will remember again.The need for insulin as the duration of the disease increases may increase, but fundamentally, in the absence of ketoacidosis, will not exceed 0.8 to 1.0 units / kg.

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

1. Terminal renal failure, which is a consequence of diabetic glomerulosclerosis;
2. Cardiovascular disorders, as complications from the underlying disease, which occur a little less often renal.

Changes related to disease or age?(type II diabetes)

Inzsd has been developing for several months, even years.The problems arising, a person behaves with various specialists (dermatologist, gynecologist, neurologist ...).The patient does not suspect that diseases are different in his opinion: furunculose, itching skin, fungal lesions, lower limbs - signs of type II diabetes.Patients get used to their condition and diabetes continues to develop slowly, affecting all systems and mainly ships.

Inzsd is characterized by a stable slow course, as a rule, without showing a tendency to ketoacidosis.

Treatment of type 2 diabetes generally starts in line with diet with easily digestible (refined) carbohydrates and use (if necessary) to reduce drugs.Insulin is prescribed if the development of the disease has reached the stage of serious complications or if there is the immunity of oral drugs.

The main cause of death in patients with INZSD has been recognized as a cardiovascular pathology which has become a consequence of diabetes.As a rule, it is a heart attack or a stroke.

Diabetes treatment products

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

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

The implementation of these principles is carried out according to 5 main positions:

1. Nutrition diabetes is assigned the party of the "first violin";
2. The adequate and individually selected physical exercise system goes after the diet;
3. Medicines 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-testimony (skills by taking blood from a finger, using a glueometer, the introduction of insulin without external help).

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

Indicators	A good degree of compensation	Satisfying	Bad
Glucose level on an 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 the serum (MMOL / L)	<5.2	5.2 - 6.5	Ø 6.5
Level of triglycerides (mmol / l)	<1,7	1.7 - 2.2	Ø 2.2

An important role of a diet in the treatment of Inzsd

The nutrition of diabetes is very well known, even far from diabetes for people, table n ° 9. Being in a hospital on any disease, from time to time, you can hear about a particular nutrition which is always in separate pots, differs from the rest of the diets and is published after a certain password is spoken: "I have the ninth table".What does it mean?What is the difference between this mysterious diet of everyone?

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

Diabetes power supply is to replace refined sugars in products with slowly separated carbohydrates.Sugar sold in a store for everyone and confectionery depending on the category of prohibited foods.

As for the balance of nutrition, everything is strict here: diabetics must use compulsory the required quantity of vitamins and pectins, which should be at least 40 g.per day.

Strictly individual physical activity

Physical activity for each patient is individually selected by the attending physician, while the following positions are taken into account:

• Age;
• Symptoms of diabetes;
• Severity of the flow of the pathological process;
• The presence or absence of complications.

The physical activity prescribed by the doctor and carried out by the "district" should contribute to the "combustion" of carbohydrates and fats, without attracting insulin to participation.Its dose, which is necessary to compensate for metabolic disorders, falls significantly, which should not be forgotten, because, by preventing the increase in blood sugar, you can obtain an adverse effect.Adequate physical activity reduces glucose, the dose introduced of insulin is breaking down and, therefore, a decrease in sugar levels lower than authorized values (hypoglycemia).

So,The dosage of insulin and physical activity requires very close attention and in -depth calculation,In order to complement each other, do not pass jointly on the lower limit of normal laboratory indicators.

Or maybe try folk remedies?

Treatment of type 2 diabetes is often accompanied by the search for patients with folk remedies that can inhibit the process and, as far as possible, delay the time to take dose forms.

Without looking at the fact that our distant ancestors practically did not know such a disease, there are popular remedies for the treatment of diabetes, but we must not forget thatPerfusions and decoctions prepared from various plants are an auxiliary agent.The use of domestic drugs for diabetes does not relieve the patient of respect for the diet, the control of blood sugar, the visit of a doctor and the realization of all his recommendations.

To fight against this pathology at home, fairly famous folk remedies are used:

1. Bark and white mulberry leaves;
2. Grains and oat peel;
3. Nut partitions;
4. Bay Leaf;
5. Cinnamon;
6. Acorns;
7. Nettle;
8. Dandelion.

When diet and folk remedies no longer help ...

The first generation SO-appeal preparations, widely known at the end of the last century, remained in the memories, and they were replaced by new generation drugs, which constitute 3 main diabetes groups produced by the pharmaceutical industry.

What way is suitable for any patient - the endocrinologist decides.And so that patients have not been self-medicated and do not decide to use these drugs for diabetes at their discretion, we will give several visual examples.

Sulfonylmochevin derivatives

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

These drugs are absolutely contraindicated in the following cases:

• Type 1 diabetes;
• Diabetic, hyperosmolar, lactacidotic coma;
• Pregnancy, childbirth, lactation;

• Diabetic nephropathy, accompanied by altered filtration;
• Hematopoietic system diseases with a concomitant decrease in white blood cells - leukocytes (leukocytopenia) and the hematopoiete thrombocytic bonds (thrombocytopenia);
• Severe infectious and inflammatory liver damage (hepatitis);
• Diabetes complicated by vascular pathology.

In addition, the use of drugs in this group can threaten the development of allergic reactions that are manifested:

1. Itching and hives, sometimes reaching the edema of quincke;
2. Digestive system disorders;
3. Changes on the blood side (reduction in the level of platelets and leukocytes);
4. Perhaps a violation of the functional capabilities of the liver (jaundice due to cholestasis).

Sahabro installations of the Biguanid family

Biguanides (guanidine derivatives) are actively used for the treatment of type 2 diabetes, often adding sulfonamides.They are very rational for use by patients with obesity, however, people with liver, kidneys and cardiovascular pathology are highly limited, moving to more economical drugs from the same group or α-glucoside inhibitors inhibiting the absorption of carbohydrates in the small intestine.

Absolute contraindications to the use of Biguanids are taken into account:

• ISD (type 1 diabetes);
• Significant weight loss;
• Infectious process, whatever the location;
• Surgical interventions;
• Pregnancy, childbirth, breastfeeding period;
• Coma states;
• Hepatic and renal pathology;
• Oxygen famine;
• Microangiopathy (2-4 degrees) with visual impairment and renal function;
• Trophic ulcers and necrotic processes;
• Violation of blood circulation in the lower limbs due to various vascular pathologies.

Insulin treatment

From the above, the fact that the above becomes thatThe use of insulin is the main treatment of type 1 diabetes, all emergency conditions and serious complications of diabetes.Inzsd only requires the appointment of this therapy in cases of insulin forms of use, when correction by other means does not give the right effect.

Modern insulins, called monocompense, represent two groups:

1. The monocomotic pharmacological forms of substance to human insulin (semi-synthetic orroecanating DNA), which, without any doubt, have a significant advantage over pork preparations.They have practically no contraindication and side effects;
2. The monocomputer insulins obtained from the Pancreas of the pig.These drugs compared to human insulins require an increase in the drug dose by around 15%.

Diabetes is 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 bodily systems.The complications of diabetes are taken into account:

• Pathological changes in the skin: Diabetic dermopathy, lipoid necrobiosis, furunculose, xanthome, fungal lesions of the skin;
• Articular bone diseases::
  1. Osteoarthropathy diabetic (articulation articulation - a change in the ankle joint), which occurs in the context of a violation of microcirculation and trophic disorders, accompanied by dislocations, subluxis, spontaneous fractures preceding the formationdiabetic foot;
  
  2. Diabetic Hyropathy, characterized by stiffness in hand joints, which is more often formed in children with children's diabetes;
• Respiratory diseases: long -termprolonged bronchitis, pneumonia,,Increase the frequency of tuberculosis development;
• Pathological process affecting digestive organs:Diabetic enteropathyAccompanied by an increase in peristalism, diarrhea (up to 30 times a day), a decrease in body weight;
• Diabetic retinopathy- one of the most serious complications characterized by damage to vision organs;
• The most common complication of diabetes is consideredDiabetic neuropathyand its variety -Polyneuropathyreach 90% of all forms of this pathology.Frequently found polyneuropathy isDiabetic feet 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, are starting to develop at a young age, inevitably lead to heart diseases and blood vessels (coronary disease, myocardial infarction, heart failure, cerebrovascular alteration).

Prevention

Diabetes prevention measures are built according to the causes of its challenge.In this case, it is advisable to speak of the prevention of atherosclerosis, high blood pressure, including the fight with excess weight, bad habits and food dependencies.

The prevention of diabetes complications is to prevent the development of pathological conditions resulting from diabetes itself.Correction of glucose in blood serum, compliance with food, adequate physical activity, implementation of doctor's recommendations will help push the consequences of this rather formidable disease.