Diabetes mellitus: signs, symptoms and treatment

Diabetes mellitus is a group of metabolic diseases characterized by a constant increase in glucose levels in blood, which is the result of a violation of insulin secretion or its action, or both of these factors.

Currently, on average 1-8% of people have diabetes. Among them, 0.3% are children. The latest data show that the incidence of diabetes mellitus doubles every 10 years.

Type 2 diabetes is the most widespread (90%). It occurs in middle and old age. Type 1 diabetes is common in young people.

Classification of diabetes mellitus

Diabetes mellitus is divided into 2 types:

• type 1 diabetes mellitus - develops as a result of the destruction of the B-cells of the pancreas, which leads to a lack of insulin in the body and impaired glucose processing;
• type 2 diabetes mellitus - due to a violation of insulin secretion. Also, in the development of type 2 diabetes mellitus, tissue immunity to insulin plays a role. That is, the number of insulin receptors in the tissues decreases (insulin resistance).

There are also other types of diabetes mellitus:

• due to a genetic disorder in the cells of the pancreas;
• due to a genetic disorder of the action of insulin;
• in the presence of diseases of the pancreas;
• due to exposure to drugs or chemicals (in the treatment of HIV or AIDS);
• infections;
• gestational (occurring during pregnancy) diabetes mellitus.

Causes

Why does diabetes mellitus occur? Type 1 diabetes can develop after:

• rubella;
• hepatitis A;
• mumps;
• toxic effects of drugs or chemical compounds.

These factors contribute to the damage to the cells of the pancreas. Moreover, there is an autoimmune lesion, then the body itself attacks the tissues of its own pancreas. But the main reason for this type of diabetes is heredity.

The development of type 2 diabetes mellitus is facilitated by:

• hereditary predisposition;
• being overweight (especially excessive belly fat);
• improper nutrition - a lack of plant foods in the diet and the predominance of carbohydrates;
• the presence of diseases of the cardiovascular system (atherosclerosis, arterial hypertension, ischemic heart disease). These conditions decrease the sensitivity of tissues to insulin;
• frequent stress increases the amount of hormones that increase the likelihood of diabetes;
• alcohol intake and smoking;
• taking glucocorticosteroids, diuretics, certain drugs that lower blood pressure;
• chronic adrenal insufficiency.

Due to insufficient insulin secretion or impaired tissue sensitivity to it, glucose is not properly utilized. It does not enter the cells and accumulates in the blood.

This leads to the accumulation of substances that affect the eyes, capillaries, blood vessels, nervous system, joints.

In addition, the body does not receive the required amount of energy, therefore, the breakdown of proteins and fats begins to meet the needs of the body.

When protein is broken down, the patient feels muscle weakness; when fat is broken down, toxic products accumulate - ketone bodies.

To remove excess sugar from the body, excess urine begins to be excreted. This leads to gradual dehydration.

Ultimately, all these processes lead to damage to the lower extremities, eyes, brain, heart, blood vessels, nerves.

Symptoms

How is diabetes mellitus manifested? The symptoms of type 1 diabetes are:

• frequent and profuse urination;
• drowsiness;
• thirst;
• muscle weakness;
• losing weight;
• decreased performance;
• itchy skin;
• decreased skin turgor;
• dyspnea;
• dry skin and mucous membranes;
• blush on the cheeks;
• noisy breathing;
• enlargement of the liver;
• the smell of acetone from the mouth;
• increased appetite;
• cramps in the calf muscles;
• nausea and vomiting;
• bedwetting (in children).

The first type of diabetes begins abruptly, often after an infection. The peak incidence is observed in the autumn-winter period.

For type 2 diabetes mellitus, the following symptoms are characteristic:

• itching of the skin and vagina;
• thirst;
• weakness;
• dry skin and mucous membranes;
• dystrophic changes in the skin (ulcers);
• decreased performance;
• visual impairment;
• increased urination, excretion of large amounts of urine;
• decreased skin turgor;
• apathy;
• enlargement of the liver;
• slow wound healing;
• heat in the feet;
• feeling of "creeping" at night;
• leg cramps.

The disease begins to manifest itself over the age of 40. The patient usually has fullness, increased pressure, accumulation of fat on the abdomen.

Which doctor should I go to?

If you have any symptoms of diabetes, you should see a therapist. He will prescribe the necessary examinations and refer for further treatment to an endocrinologist.

If complications are identified, you will need to consult a neurologist, ophthalmologist, urologist, cardiologist, angiosurgeon.

Diagnostics

Laboratory and instrumental research methods help to identify diabetes mellitus.

Laboratory methods include:

• general blood analysis;
• general urine analysis - detection of glucose and ketone bodies;
• biochemical blood test - an increase in glucose levels of more than 7.0 mmol / l;
• a study of the level of glycated hemoglobin, which allows you to assess the level of glucose in the blood for 3 months;
• the level of C-peptide - a marker of the residual level of insulin. With type 2 diabetes mellitus, its level is normal or increased, with type 2 diabetes, the indicator is reduced;
• stress test with glucose - the patient is given to drink 75 g of glucose (sugar), dissolved in 300 ml of water. On an empty stomach, and then 2 hours after taking glucose, its concentration in the blood is assessed. If the glucose level is more than 6.6 on an empty stomach and more than 11.1 after 2 hours, then this indicates the presence of diabetes.

Instrumental methods include:

• ECG - allows you to identify a violation of the rhythm, insufficient supply of oxygen to the myocardium, signs of an increase in the left ventricle and its overload;
• ultrasound examination of the heart - reveals signs of myocardial depletion, expansion of its cavities, insufficient blood supply, allows to assess the ejection fraction;
• Ultrasound of the abdominal organs - to determine the state of the pancreas and other organs;
• ultrasound dopplerography of the vessels of the lower extremities - allows you to identify violations of the blood supply to the lower extremities;
• Holter ECG monitoring (daily) - to determine the rise in blood pressure and arrhythmias during the day;
• continuous monitoring of glycemia (CMG) - allows you to select the dose of drugs required to lower high glucose levels;
• X-ray of the feet - to identify the depth of skin damage in the presence of a diabetic foot;
• electroneuromyography of the lower extremities - allows early detection of diabetic polyneuropathy.

Treatment

How is diabetes treated? Therapy for this disease depends on the type of disease and the level of glucose in the blood. Treatment is based on adherence to a diet and taking medications for hypoglycemic agents.

Drug-free treatment

All diabetics should follow diet number 9. It provides for the consumption of 2300-2500 kcal / day. If the patient is overweight, then the calorie content should be reduced to 1700 kcal / day.

You need to eat 4-5 times a day. In this case, carbohydrates should be evenly distributed throughout the day. Sweeteners (xylitol, sorbitol, fructose) can be used instead of sugar.

In diabetes, the following foods are prohibited:

• preserves and jams;
• sweet fruits and vegetables;
• pasta;
• white bread;
• confectionery;
• ice cream;
• syrups;
• sugar.

It is necessary to limit consumption:

• a tomato;
• beets;
• potatoes;
• carrots.

It is useful to eat:

• eggplant;
• oatmeal;
• pumpkin;
• zucchini and squash;
• cottage cheese;
• red bell pepper;
• soy.

For patients, classes are held, which describe how to calculate the calorie content of the diet, the amount of necessary carbohydrates, fats and proteins.

In insulin-dependent diabetes, carbohydrates should be consumed at the same time to help control glucose levels.

Drug treatment

Drug therapy depends on the type of diabetes and baseline glucose levels.

Type 1 diabetes mellitus is treated with insulin, the dose of which is selected by an endocrinologist, taking into account the level of glucose in the blood and urine.

With type 2 diabetes, the intake of hypoglycemic drugs is indicated. If they do not reduce the glucose concentration to the required level, then insulin is additionally prescribed.

Insulin is divided into four types:

• extended action;
• medium duration;
• short action;
• ultrashort action.

Long-acting insulin is administered once a day. A combination of short-acting and extended-acting insulins is more commonly used.

At the injection site, redness, swelling, soreness, lipodystrophy (lack of adipose tissue at the injection site) may form. Allergic reactions also occur.

For the treatment of type 2 diabetes mellitus, hypoglycemic drugs are indicated. By the mechanism of action, they are divided into:

• sulfonylurea preparations - their action is based on stimulating the production of insulin in the cells of the pancreas. Also, these drugs promote the penetration of insulin into tissues. The drugs in this group include Gliquidone, Glibenclamide, Carbutamide). The drugs allow you to maintain a blood glucose level of no more than 8 mmol / l;
• alpha-glucosidase inhibitors - prevent glucose from rising by blocking enzymes that aid in starch processing. The drugs in this group include Acarbose, Miglitol. Diarrhea and flatulence in the intestines are possible;
• biguanides - drugs of this group reduce the level of glucose in the blood by reducing its absorption into the intestines. Also, biguanides increase the sensitivity of tissues to glucose. They are prescribed to patients of young age who are overweight. Side effects include an increase in uric acid levels, lactic acidosis in patients over 60 years of age, in the presence of impaired renal or hepatic functions. Examples of drugs in this group are Metformin, Buformin;
• meglitinides - drugs increase the production of insulin by the pancreas, which reduces the level of glucose in the blood (Nateglinide, Repaglinide);
• thiazolidinediones - reduces the amount of glucose produced by the liver, increases the adherence of fat cells to insulin. These medications should not be used if you have heart failure.

If the patient has diabetes mellitus, it is necessary to teach him how to self-control blood glucose levels. The patient's family should also know how to help the patient with a coma.

Weight loss and physical activity (moderate) will help improve the patient's condition. But it is important to remember that you cannot exercise with glucose levels above 15 mmol / L.

Traditional methods

It is impossible to get rid of diabetes mellitus only by folk methods. It is necessary to take medications prescribed by your doctor. Folk recipes can only be used in conjunction with drug therapy.

Recipes:

• 300 g of garlic, 100 g of lemon zest, 300 g of parsley mince, then stir and leave in a dark place for 2 weeks. Take 10 g three times a day before meals;
• collect acorns, peel them, dry the core in the oven. Then grind the cores in a coffee grinder. Take the powder three times a day, 1 teaspoon;
• lettuce, Brussels sprouts, green beans, carrots mince. Take 100 ml in the morning on an empty stomach;
• squeeze lemon juice. Mix one egg with 50 ml lemon juice. Take the mixture half an hour before meals, once a day for three days. Then take a break for 3 days and repeat the courses several times in this way;
• remove the peel from two lemons, place them in a thermos with 400 ml of boiling water and leave for 2 hours. Take 100 ml three times a day;
• remove the partitions from 40 walnuts and pour 200 ml of boiling water over them. Then put in a water bath for an hour. Cool and drain. Take 20 ml three times a day half an hour before meals.

Complications

What does diabetes mellitus lead to? Complications of the disease are possible, such as:

• diabetic polyneuropathy - characterized by damage to the nerves in the limbs. In this case, patients complain of a feeling of "creeping", cold feet, lack of sensitivity, swelling and burning. The condition develops several years after the onset of the disease;
• diabetic angiopathy - vascular damage due to diabetes mellitus. Characterized by atherosclerosis, thrombosis, ischemic heart disease, the appearance of soreness in the lower extremities after walking several meters, encephalopathy;
• diabetic retinopathy - characterized by decreased vision, up to complete blindness. This occurs due to the destruction of arteries, capillaries, eye veins, retinal damage. In type 1 diabetes, such changes appear after 10 years or more. With type 2 - earlier;
• diabetic nephropathy - characterized by damage to the vessels of the kidneys, which leads to the formation of renal failure. The first signs of complications begin to appear 15 years after diagnosis;
• diabetic foot - ulcers appear on the legs, blood circulation is impaired, which can lead to gangrene of the limb. Muscle pains are also common;
• hyperglycemic coma - a sharp increase in blood glucose levels. Patients complain of decreased appetite, headache, weakness, and malaise. Later, soreness in the abdomen joins, breathing is disturbed, the smell of acetone from the mouth, drowsiness appears. Blood pressure drops, loss of consciousness is possible;
• hypoglycemic coma - develops when blood glucose levels drop. This condition is typical for insulin overdose. The patient complains of hunger, tremors of the limbs, increased pressure. Breathing becomes shallow, the skin is moist and cold, cramps are possible.

Prophylaxis

Prevention is based on avoiding infections, stress, maintaining a healthy weight, eating well, avoiding medications (if possible).

To avoid the progression of diabetes mellitus, it is important to detect it in time and prescribe the correct treatment, which must be adhered to.

Conclusion

Diabetes mellitus is a group of metabolic diseases characterized by a constant increase in glucose levels in blood, which is the result of a violation of insulin secretion or its action, or both of these factors.

The disease is divided into two types. Type 1 diabetes often begins in childhood or young age and is associated with damage to the pancreas by cells of its own body.

Type 2 diabetes develops in middle and old age against the background of malnutrition, obesity, chronic diseases, obesity, hereditary predisposition, medication, adrenal failure.

With diabetes mellitus, patients complain of thirst, an increase in the amount of urine excreted, weakness, fatigue, itching of the skin, increased appetite, nausea and vomiting.

Laboratory and instrumental research methods help diagnose pathology.

Laboratory tests include a general blood and urine test, a biochemical blood test, a study of the level of glycated hemoglobin, a glucose tolerance test, a study of the level of C-peptide.

Instrumental methods include ECG, ultrasound of the abdominal organs, kidneys, heart, Holter ECG monitoring, ultrasound Doppler ultrasonography of the vessels of the lower extremities, continuous monitoring of blood glucose levels, radiography of the feet, electroneuromyography of the lower limbs.

Treatment depends on the type of diabetes and baseline blood glucose levels. Type 1 diabetes is treated with insulin, type 2 - with hypoglycemic drugs and insulin if they are ineffective.

It is also important to follow a diet with specific calories and specific levels of proteins, fats and carbohydrates.

To prevent the disease, it is necessary to avoid infections, stress, maintain a normal weight, and exclude taking medications.

If any symptoms of diabetes mellitus appear, you should consult a therapist or endocrinologist as soon as possible, because any delay can lead to the progression of serious complications.