Diabetes

Diabetes mellitus is a metabolic disorder characterized by an increase in blood sugar.

The disease occurs as a result of defects in the production of insulin, a defect in the action of insulin or both of these factors. In addition to the increased blood sugar level, the disease is manifested by the release of sugar in urine, abundant urination, increased thirst, disorders of fat, protein and mineral metabolism and the development of complications.

Types

1. Type 1 diabetes (autoimmune, idiopathic): destruction of the beta cells of the pancreas, which produce insulin.
2. Type 2 diabetes mellitus - with the predominant insensitivity of tissues to insulin or a predominant defect in insulin production with or without insensitiveness.
3. Diabetes gestational sugar occurs during pregnancy.
4. Other types:
• genetic defects;
• diabetes caused by drugs and other chemicals;
• diabetes caused by infections;
• Pancreatitis, trauma, removal of the pancreas, acromegaly, Izenko - Kushinka, thyrotoxicosis and others.

Severity

• Easy current: There are no complications.
• Average degree of severity: there is damage to the eyes, kidneys, nerves.
• Severe current: far -in complications of diabetes.

Symptoms of diabetes

The main symptoms of the disease include such manifestations as:

• Abundant urination and increased thirst;
• Increased appetite;
• General weakness;
• Lesions of the skin (for example, vitiligo), vagina and urinary tract are especially often observed in non -rusted patients as a result of emerging immunodeficiency;
• The fuzzy of vision is caused by changes in the flipping media of the eye.

Type 1 diabetes usually begins at a young age.

Type 2 diabetes are usually diagnosed in people over 35–40 years.

Diagnosis of diabetes

Diagnosis of the disease is based on blood and urine tests.

To make a diagnosis, the concentration of glucose in the blood is determined (an important circumstance is a repeated determination of an increased level of sugar and on other days).

The results of the analysis are normal (in the absence of diabetes)

On an empty stomach or 2 hours after the test:

• venous blood - 3. 3–5. 5 mmol/l;  
• Capillary blood - 3. 3–5. 5 mmol/l;
• Blood venous plasma - 4–6. 1 mmol/l.

Analysis results in the presence of diabetes mellitus

On an empty stomach:

• venous blood more than 6. 1 mmol/l;  
• capillary blood more than 6. 1 mmol/l;  
• Venous blood plasma is more than 7. 0 mmol/l.

At any time of the day, regardless of the time of eating:

• venous blood more than 10 mmol/l;  
• capillary blood more than 11. 1 mmol/l;  
• Venous blood plasma is more than 11. 1 mmol/l.

The level of glycated blood hemoglobin in diabetes exceeds 6. 7–7. 5 %.

The content of C-peptide allows you to evaluate the functional state of the beta cells. In patients with diabetes of type 1, this level is usually reduced, in patients with diabetes of type 2 - normally or increased, in patients with insulinoma - sharply increased.

The concentration of immunoreactive insulin is reduced with type 1, normally or increased with type 2.

Determining the concentration of glucose in the blood to diagnose diabetes is not carried out against the background of acute disease, injury or surgical intervention, against the background of short-term administration of drugs that increase the concentration of glucose in the blood (adrenal hormones, thyroid hormones, thiazides, beta-blockers, etc. ), in patients with zirrosis. liver.

Glucose in the urine in diabetes appears only after exceeding the "renal threshold" (approximately 180 mg % 9. 9 mmol/l). Significant fluctuations in the threshold and a tendency to increase with age are characteristic; Therefore, the definition of glucose in the urine is considered insensitive and unreliable test. The test serves as a gross reference point for the presence or absence of a significant increase in sugar (glucose) in the blood and in some cases is used for daily observation of the dynamics of the disease.

Treatment of diabetes

Physical activity and proper nutrition in treatment

In a significant part of patients with diabetes mellitus, observing dietary recommendations and reaching a significant decrease in body weight by 5-10 % of the initial, blood sugar indicators improve up to the norm. One of the main conditions is the regularity of physical exertion (for example, walking daily 30 minutes, swimming 1 hour 3 times a week). With the concentration of glucose in the blood> 13–15 mmol/l, physical activity is not recommended.

With light and moderate physical exertion lasting no more than 1 hour, additional use of carbohydrates is required before and after the load (15 g of easily digestible carbohydrates for every 40 minutes). With moderate physical exertion lasting more than 1 hour and intensive sports, it is necessary to reduce by 20-50 % of the dose of insulin, acting during and in the next 6–12 hours after physical activity.

Diet in the treatment of diabetes (table No. 9) is aimed at normalizing carbohydrate metabolism and prevention of fat metabolism.

Treatment with insulin preparations

Insulin preparations for the treatment of diabetes are divided into 4 categories, by the duration of action:

• Ultra -Koro action (the beginning of the action - after 15 minutes, the duration of the action is 3-4 hours).
• Quick action (the beginning of action - after 30 min. - 1 hour; duration of action 6-8 hours).
• The average duration of the action (the beginning of the action is after 1–2. 5 hours, the duration of the action is 14–20 hours).
• Long action (the beginning of the action is after 4 hours; the duration of action is up to 28 hours).

The appointment modes of insulin are strictly individual and are selected for each patient with a dialitologist or endocrinologist.

Methodology for introducing insulin

When the insulin is introduced at the injection site, it is necessary to form a skin fold so that the needle enters under the skin, and not into muscle tissue. The skin fold should be wide, the needle should enter the skin at an angle of 45 ° if the thickness of the skin fold is less than the length of the needle.

When choosing a place for injection, compacted skin areas should be avoided. Places of injection cannot be changed unsystematic. Do not injections under the skin of the shoulder.

• Short -action insulin preparations should be administered into the subcutaneous fat fiber of the front wall of the abdomen 20-30 minutes before eating.
• Long -effect insulin preparations are introduced into the subcutaneous fat fiber of the thighs or buttocks.
• Ultra -short insulin injections are carried out immediately before eating, and if necessary, during or immediately after eating.

Heat and physical activity increase insulin absorption rate, and the cold reduces it.