Diabetes: Types and causes of development, course and their manifestations, how to be treated, possible consequences

Diabetes mellitus is one of the most common tendencies to increase the incidence and disruption of disease statistics.Symptoms of diabetes do not appear on the same day, the process flows chronically, with the increase and deterioration of endocrine exchange disorders.True, type diabetes debut is significantly different from the early phase of the second.

Among all endocrine pathology, diabetes certainly holds the championship and accounts for more than 60% of all cases.Moreover, disappointing statistics show that 1/10 of "diabetics" are children.

The probability of getting the disease increases with age and, thus, every ten years the group number doubles.This is explained by an increase in life expectancy, improving early diagnosis, a decrease in physical activity and an increase in the number of people with overweight.

Types of diabetes

Many have heard of a disease such as non -critical diabetes.So the reader then does not confuse the diseases named "Diabetes", surely, clarifying their differences will be useful.

Non -urethra

Joacked diabetes is an endocrine disease that occurs due to neuro -infections, inflammatory diseases, tumors, intoxications and due to insufficiency, and sometimes complete disappearance of ADG -Vasopressin (antidihretic hormone)

This explains the clinical appearance of the disease:

• The constant dryness of the oral cavity mucosa, the extraordinary thirst (a person can drink up to 50 liters of water in 24 hours, stretching the stomach in large sizes);
• The separation of a large amount of unconditional light urine with low specific gravity (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 muscle apparatus;
• Development of dehydration syndrome in the absence of fluid intake for more than 4 hours.

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

Anatomy and short physiology

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

The endocrine section of the gland represents the islands of Langergan, consisting of:

1. A-cells that 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 population of cells that synthesize and accumulate insulin, the molecule of which is a polypeptide of two chains, which carries a certain sequence of 51 amino acids;
3. D-cells that produce somatostatin;
4. Cells that produce other polypeptides.

Thus, the conclusion suggests itself:Damage to the pancreas and islands of Langergan, in particular, is the main mechanism that inhibits the production of insulin and causes the development of the pathological process.

Special types and forms of illness

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

• Complete lack of insulin forms (absolute absence)Insulin -dependenta pathological process that refers toType I (ISD) diabetes;
• Lack of insulin (relative deficiency), which causes at the initial stage a violation of carbohydrate metabolism, slowly but certainly 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, that is, a total disorder of metabolic processes at all levels, begin to appear over time.

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

1. Secondary diabetes,Pancreas derived from acute and chronic inflammation of the pancreas (pancreatitis), malignant neoplasms in the glandular, liver cirrhosis.A number of endocrine disorders, accompanied by excess production of insulin antagonists (Akromigaly, Kushing, foochromocytoma, thyroid disease) lead to the development of secondary diabetes.Many long -term consumed medicines have a diabetic effect: diuretics, some antihypertensive medicines and hormones, oral contraceptives, etc.;
2. Diabetes in pregnant women (gestational),Due to the particular mutual impact of mother, child and placenta hormones.The fetal pancreas that produces its insulin begins to slow down insulin products with the mother gland, as a result of which this particular form is formed during pregnancy.However, with proper control, gestational diabetes usually disappears after childbirth.Then, in some cases (up to 40%) in women with a similar history of pregnancy, this fact may threaten the development of type II diabetes (within 6-8 years).

Why is there a "sweet" disease?

The "sweet" disease forms a group of very "clumsy" patients, so it becomes clear that the ISSD and "counterpart" dependent on its insulin genetically occurred differently.There are evidence of insulin -dependent diabetes linking to the genetic structures of the HLA system (the main complex of histocompatibility), in particular, with some genes of the region of the region D. For Inzsd, such a relationship is not seen.

For the development of diabetes of the type of type of type of genetic predisposition, the pathogenic mechanism is initiated by provocative factors:

• Congenital inferiority of the Langergan Islands;
• Adverse impact of the external environment;
• Stress, nerve loads;
• Traumatic brain damage;
• Pregnancy;
• Infectious processes of viral origin (flu, "pig", cytomegalovirus infection, coksaki);
• A tendency for continuous overeating leading to excess fat deposits;
• Sweet abuse (sweet tooth risks more).

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

It is proven that the disease is currently most often formed in women, though in the 19th century the SD was a "privilege" of the male.By the way, now in some Southeast Asian countries the presence of this disease in men is considered predominant.

Predisposing conditions for the development of type II diabetes mellitus can be attributed to:

• Changes in the structural structure of the pancreas as a result of 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 arterial hypertension;
• In women, pregnancy and the birth of a baby with a high body weight (more than 4 kg);
• The presence of relatives suffering from diabetes;
• Strong psycho -emotional stress (adrenal gland hyperistration).

Causes of disease of different types of diabetes in some cases coincide (stress, overweight, influence of external factors), but the beginning of the process in first and second type diabetes is different, moreover, more,ISSD is very children and young, and insulin -dependent prefers older generation people.

Why do you want to drink so much?

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

1. Dry oral mucosa cavity;
2. Thirst, which can almost not be satisfied, accompanied by dehydration;
3. Excessive urine formation and its release from the kidneys (polyuria), which leads to dehydration;
4. An increase in glucose concentration in blood serum (hyperglycemia), due to suppression of sugar storage with peripheral tissue due to insulin deficiency;
5. The appearance of sugar in the urine (glucose) and ketone bodies (ketonuria), which are normally present in negligible quantities, but with diabetes mellitus are produced intensely from the liver, and when excreted by the body are detected in the urine;
6. Increased blood plasma (except glucose) of urea and sodium ions (na^{+ +});
7. Weight loss, which in the case of decompensation of the disease is a characteristic feature of a catabolic syndrome, which develops due to the disruption of glycogen, lipolysis (fat mobilization), catabolism and glucose (transformation into glucose);
8. Violation of lipid spectrum indicators, an increase in general cholesterol due to low density lipoproteins fraction, nezhk (unsaturated fatty acids), triglycerides.The growing content of lipids begins to actively go to the liver and there is intensely oxidized, which leads to excessive formation of ketone bodies (Acetone + β-oxielyic + acid acetouxus) and further entering their blood (hyperketonomy).Excessive concentration of ketone bodies threatens a dangerous state calleddiabetic ketoacidosis.

Thus, the general signs of diabetes can be characteristic of any form of the disease, however, in order not to confuse the reader, the natural features in this or that type must still be emphasized.

Type I diabetes - "privilege" of young people

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

• A sharp drop in weight;
• An unnatural thirst, a person simply cannot be drunk, though he tries to do so (polydipsia);
• A large amount of secreted urine (polyuria);
• Significant excess of concentration of glucose and ketone bodies in blood serum (ketoacidosis).In the initial phase, when the patient may still not know about his problems, he is likely to develop diabetic coma (ketoacidic, hyperglycemic) - a condition that is extremely dangerous to life, so insulin therapy is described as soon as possible (diabetes only will be rushed).

In most cases, after the use of insulin, metabolic processes are offset, compensated,The need for body in insulin drops significantly, a temporary "recovery" comes.However, this short state of forgiveness should not rest either the patient or the doctor, as after some time the disease will remember himself again.The need for insulin as the duration of the disease increases may increase, but, in essence, in the absence of ketoacidosis, it will not exceed 0.8-1.0 units/kg.

Signs that indicate the development of delayed complications of diabetes (retinopathy, nephropathy) can occur in 5-10 years.The main reasons for the fatal score of ISD include:

1. Terminal renal failure, which is a consequence of diabetic glomerulosclerosis;
2. Disordishes cardiovascular disorders, as complications of the underlying disease, which occur somewhat less rarely renal.

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

Inzsd has developed for many months or even years.Problems arising, a person goes to different specialists (dermatologist, gynecologist, neurologist ...).The patient does not suspect that the diseases are different in his opinion: furunculosis, itching of the skin, fungal lesions, pain in the lower extremities - signs of type II diabetes.Patients get used to their condition, and diabetes continues to develop slowly, affecting all systems and mainly vessels.

Inzsd is characterized by a slow sustainable course, as a rule, without showing a tendency for ketoacidosis.

Type 2 diabetes treatment usually begins in accordance with the diet with a lightly soluble (refined) and use (if necessary) carbohydrate restriction to reduce medication.Insulin is prescribed whether the development of the disease has reached the stage of severe complications or there is an immunity of oral medication.

The main cause of death in patients with INZSD was recognized as a cardiovascular pathology that has been the result of diabetes.As a rule, this is a heart attack or stroke.

Diabetes treatment products

The basis of medical measures aimed at compensation of diabetes are three main principles:

• Compensation for insulin deficiency;
• Regulation of endocrine exchange disorders;
• Prevention of diabetes mellitus, its complications and their treatment in time.

Implementation of these principles is carried out based on 5 main positions:

1. Diabetes food is assigned to the "first violin" party;
2. The system of physical, adequate and individually selected exercise, goes after the diet;
3. Sugar -reduced medicines are mainly used to treat type 2 diabetes;
4. Insulin therapy is prescribed if necessary with INZSD, but is key in the case of type 1 diabetes;
5. Teaching patients for self -control (ability to get blood from a finger, using a glucometer, introduction of insulin without external help).

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

indicator	A good degree of compensation	Low	Bad
Glucose level on an empty stomach (mmol/l)	4.4 - 6.1	6.2 - 7.8	Ø 7.8
Sugar content in blood serum 2 hours after meals (mmol/l)	5.5 - 8.0	8.1 - 10.0	Ø 10.0
Percentage of glycosilled hemoglobin (HBA1, %)	<8.0	8.0 - 9.5	Ø 10.0
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 food is very popular, even far from diabetes for people, Table no.9.Being in a hospital for any disease, now and then you can hear about a special food that is always in the separate pots, differs from the rest of the diets and released after a certain password is spoken: "I have the ninth table."Mean what all this means?What is the difference between this mysterious diet by everyone else?

You should not be mistaken, looking for his "porridge" of diabetics that they are deprived of all the joys of life.The diet in diabetes is not so different from the food of healthy people, the right amount of carbohydrates (60%), fats (24%), proteins (16%) take patients.

The power supply to diabetes consists of replacing refined sugars in slowly separated carbohydrate products.Sugar sold in a store for everyone and sweets based on it fall into the category of prohibited food.

In terms of nutrition balance, everything is strict here: diabetes should use the required amount of vitamins and pectin, 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;
• The severity of the course of the pathological process;
• The presence or absence of complications.

Physical activity prescribed by the doctor and performed by the "ward" should contribute to "burning" carbohydrates and fats without attracting insulin to participation.Its dose, which is necessary to compensate for metabolic disorders, is falling significantly, which should not be forgotten because, by preventing the growth of blood sugar, you can get an undesirable effect.Adequate physical activity reduces glucose, the presented dose of insulin breaks down, and as a result, a decrease in sugar levels below permissible values (hypoglycemia).

Thus,The dose of insulin and physical activity requires very close attention and complete calculation,In order to fill in each other, do not enter together over the lower limit of normal laboratory indicators.

Or maybe try popular legal remedies?

Type 2 diabetes treatment is often accompanied by the search for patients with folk remedies that can hinder the process and as much as possible to delay the time of obtaining dosage forms.

Without seeing the fact that our distant ancestors practically did not know about such a disease, there are popular remedies for the treatment of diabetes, but we must not forget itInfusions and decoctions prepared by different plants are an auxiliary agent.The use of domestic medicines for diabetes does not facilitate the patient by compliance with diet, blood sugar control, visiting a physician and fulfilling all his recommendations.

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

1. Bark and white mulberry leaves;
2. Grains and oats;
3. Walnut separation;
4. Bay leaves;
5. Cinnamon;
6. Acorns;
7. Nettle;
8. Dandelion.

When diet and folk remedies no longer help ...

The so -called first -generation preparations, widely known at the end of the last century, remained in memories, and they were replaced by new generation drugs, which make up 3 major diabetes groups produced by the pharmaceutical industry.

What does it mean is suitable for one or another patient - the endocrinologist decides.And in order for patients not to self -medicate and do not decide to use these drugs for diabetes at their discretion, we will give some visual examples.

Derivatives of sulfonylmochevins

Currently, second -generation sulfonema derivatives are described, acting from 10 hours to one day.Patients usually take them twice a day half an hour before meals.

These medicines are absolutely contraindicated in the following cases:

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

• Diabetic nephropathy, accompanied by impaired filtration;
• Diseases of the hematopoietic system with a simultaneous decrease in white blood cells - leukocytes (leukocytopenia) and bonding thrombocytic hematopoiesis (thrombocytopenia);
• Severe infectious and inflammatory liver lesions (hepatitis);
• Diabetes complicated by vascular pathology.

Moreover, the use of this group's medicines can threaten the development of allergic reactions that manifest:

1. Itching and urticaria, sometimes reaching Quincke's edema;
2. Disorders of the digestive system;
3. Blood changes (reduction of platelet and leukocyte level);
4. Probably a violation of the functional abilities of the liver (jaundice due to cholestasis).

Biguanides Family Companion Equipment

Biguanides (Guanidine derivatives) are actively used for the treatment of type 2 diabetes, often adding sulfonamide to them.They are very rational to be used by overweight patients, however, people with liver, kidneys and cardiovascular pathology are severely limited, passing on more frugal drugs of the same group or inhibitors that inhibit carbohydrate absorption in the small intestine.

Absolute contraindications to the use of Biguanides are considered:

• ISD (type 1 diabetes);
• Significant weight loss;
• Infectious processes, regardless of localization;
• Surgical intervention;
• Pregnancy, childbirth, breastfeeding period;
• Citizen;
• Pathology of the liver and kidneys;
• Oxygen hunger;
• Microangiopathy (2-4 degrees) with visual impairment and kidney function;
• Trophic ulcers and necrotic processes;
• Violation of blood circulation in the lower extremities due to different vascular pathology.

Treatment with insulin

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

Modern insulin, called monocompetent, represent two groups:

1. The monocompent pharmacological forms of the human insulin substance (semi-synthetic or DNA-Rocombinant), which undoubtedly have an important advantage over pork preparations.They practically have no contraindications and side effects;
2. Monocompetent insulin obtained from pork pancreas.These medicines compared to human insulin require an increase in the dose of the medicine by approximately 15%.

Diabetes is dangerous complications

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

• Pathological changes in the skin: Diabetic dermopathy, lipid necrobiosis, furunculosis, xanthoma, fungal lesions of the skin;
• Bony-articular disease:
  1. Diabetic osteoartropathy (joint fusion - a change in the ankle joint), which occurs against the backdrop of a violation of microcirulation and trophic disorders, accompanied by displacement, subluxis, spontaneous fractures that precede the formationfoot diabetic;
  
  2. Diabetic hiropathy, characterized by stiffness in the wrist joints, which is most often formed in children with children's diabetes;
• Respiratory diseases: Long -termprolonged bronchitis, pneumonia,Increasing the frequency of tuberculosis development;
• Pathological processes affecting digestive organs:Diabetic enteropathyassociated with 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 vision organs;
• The most common complication of diabetes is consideredDiabetic neuropathyand its variety -Polneuropathyreaching 90% of all forms of this pathology.The diabetic polneuropathy often found isDiabetic Leg Syndrome;
• The pathological condition 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 a young age, inevitably lead to heart and blood vessel diseases (coronary heart disease, myocardial infarction, heart failure, cerebrovascular damage).

PREVENTION

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

Preventing diabetes complications consists in preventing the development of pathological conditions arising from diabetes itself.Correction of glucose in the blood serum, compliance with diet, proper physical activity, implementation of the doctor's recommendations will help push the consequences of this very scary disease.