Diabetes mellitus is a group of metabolic diseases characterized by high levels of glucose ("sugar") in the blood.
Why do we need glucose
The norm of blood glucose (sugar) in whole capillary blood is 3. 3-5. 5 mmol/l in the morning on an empty stomach (i. e. after 7-14 hours of night fasting) and up to 7, 8 mmol/l after meals (i. e. 1. 5 -2 hours after the last meal).
Normally, in the human body, glucose is used by the cell as an energy source (in other words, the body's cells "feed" on glucose from the blood). The more a cell functions, the more energy (glucose) it needs.
Glucose (the expression "blood sugar" is used more often, but this is not entirely true) circulates constantly in human blood. There are 2 routes for glucose to enter the human body: - the first via foods containing carbohydrates, - the second via the production of glucose by the liver (this is the reason why in diabetes mellitus, althoughthe patient has not eaten anything, blood sugar may be increased).
However, to be used for energy, glucose from the blood must be transported to the muscles (to do work), fatty tissue, or the liver (the body's glucose storage facility). This occurs under the influence of the hormone insulin, produced by the beta cells of the pancreas. As soon as blood sugar rises after a meal, the pancreas instantly releases insulin into the blood, which in turn connects to insulin receptors on muscle, fat or liver cells. Insulin, like a key, "opens" cells to allow glucose to enter, causing blood glucose (sugar) levels to return to normal. Between meals and at night, if necessary, glucose enters the blood from the liver depot. So, at night, insulin controls the liver so that it doesn't release too much glucose into the blood.
If a violation occurs at any stage of this process, diabetes mellitus occurs.
Types of diabetes
Type 1 diabetes mellitus (formerly called: insulin-dependent diabetes mellitus) mainly develops at a young age (usually before age 30, although type 1 diabetes mellitus can also develop at older ages).
Type 1 diabetes mellitus is caused by the pancreas stopping insulin production due to the death of β cells (responsible for insulin production in the pancreas). The development of type 1 diabetes mellitus occurs against the background of a particular genetic predisposition (that is, a person is born with it), which, when exposed to certain external factors (eg, viruses), leads to a change in the state of the body's immune system. The body of a patient with type 1 diabetes begins to perceive its pancreatic β cells as foreign and protects itself from them by producing antibodies (similar to what occurs when protecting against infection), leading to deathof pancreatic β cells, which means severe insulin deficiency.
Diabetes mellitus 1 This type develops when at least 90% of the β cells in the pancreas die. Let us recall the mechanism of action of insulin, its function as a "key" which opens cells to sugar. In type 1 diabetes mellitus, this key has disappeared from the blood (see figure).
Lack of insulin in type 1 diabetes mellitus The onset of type 1 diabetes mellitus is acute, always accompanied by severe symptoms of high blood sugar (hyperglycemia): - weight loss (the patient involuntarily loses weight), -a constant feeling of hunger, - thirst, dry mouth (the patient drinks a lot of fluids, including at night), - frequent urination (in regular or large portions, including at night), - weakness.
If you do not consult a doctor in time and do not start treating type 1 diabetes with insulin, the condition worsens and very often a diabetic coma develops.
Type 2 diabetes mellitus (formerly called insulin-dependent diabetes mellitus) is much more common than type 1 diabetes mellitus. The incidence of type 2 diabetes mellitus is typical among older people: it is usually detected after 40 years of age, although recently, according toWHO experts, the average age of patients with type 2 diabetes mellitus is getting younger.
About 80% of people with type 2 diabetes are overweight. In addition, type 2 diabetes is characterized by heredity - high prevalence among relatives.
In type 2 diabetes, the pancreas continues to produce insulin, often in greater amounts than usual. Although there are also cases of type 2 diabetes mellitus with reduced insulin secretion.
The main defect of type 2 diabetes is that the cells do not "sense" insulin well, that is, they do not open well in response to interaction with it, so that theBlood sugar cannot fully penetrate inside (see figure Blood sugar). the level remains high. This state of decreased insulin sensitivity is called insulin resistance.
Low insulin sensitivity in type 2 diabetes mellitus You can figuratively imagine that the "keyholes" (scientifically speaking - the insulin receptors) on the cell gates are distorted and it does notThere is no perfect match with the keys - the insulin molecules. It takes more effort (more keys, i. e. more insulin) to overcome the insulin receptor defect. The pancreas cannot provide a sufficient amount of insulin into the blood to overcome insulin resistance and completely normalize blood sugar levels, becauseIn type 2 diabetes mellitus, the capabilities of β cells are still limited.
As a result, with type 2 diabetes, a paradoxical situation arises when there is a lot of insulin and sugar in the blood at the same time.
Type 2 diabetes mellitus, unlike type 1 diabetes mellitus, begins gradually, often completely unnoticed by the patient. Therefore, a person can be sick for quite a long time without knowing it. High blood sugar (glucose) levels may be detected incidentally during an examination for another reason.
At the same time, there are cases with clear manifestations of hyperglycemia:
- weakness, fatigue, thirst, dry mouth (the patient drinks a lot of fluids, including at night),
- frequent urination (in regular or large quantities, including at night),
- itchy skin (especially in the perineum),
- slow healing of wounds, - frequent infections, - blurred vision.
Diabetic coma develops much less frequently, usually if type 2 diabetes mellitus is accompanied by another very serious illness: pneumonia, serious injury, suppurative processes, heart attack, etc.
Diabetes treatment
Treatment for diabetes differs depending on the type of diabetes.
In type 1 diabetes mellitus, which results from absolute insufficiency of insulin secretion by the pancreas's own, constant self-monitoring and insulin treatment are necessary to preserve life. It should be emphasized that treatment with externally administered insulin is the only therapeutic option in this situation. The selection of doses and insulin treatment regimens for diabetes mellitus is carried out individually, taking into account age, gender, physical activity and individual insulin sensitivity.
For type 1 diabetes mellitus sometimes, at the very beginning of the disease, after normalization of blood sugar during treatment of diabetes mellitus with insulin, the need suddenly begins to decrease until it is completely canceled. But this is not a cure. This phenomenon is called the diabetes honeymoon, or scientifically, remission. This is because once blood sugar levels are normalized with the help of insulin, β cells that have not yet died can function for a while. Subsequently, they all die and the person needs treatment for diabetes mellitus with insulin for life. Anyone who develops type 1 diabetes for the first time should be warned by their doctor about the possibility of such a situation and what to do in this case.
Insulin treatment of diabetes mellitus can be carried out using insulin syringes, pens or an insulin pump.
Insulin pump therapy is an alternative treatment for diabetes in people who use a syringe or pen a lot to inject insulin and who measure their blood sugar regularly. Insulin pump therapy is used instead of treating diabetes with injections. The pump is worn on the body or on clothing, for example on the belt. Currently, around 250, 000 people worldwide use insulin pumps.
The main goal of treating type 2 diabetes is to improve the sensitivity of cells to insulin. The causes of poor insulin sensitivity are not yet fully understood. However, it has long been known that the most powerful factor in the formation of insulin resistance is excess weight, i. e. excessive accumulation of fat in the body. Numerous scientific studies and long-term patient observations show that weight loss during treatment of type 2 diabetes in most patients can lead to a significant improvement in blood sugar levels.
In type 2 diabetes, normalization of weight can lead to complete normalization of blood sugar levels for a long time, although this cannot be called a complete cure.
If diet and physical activity aimed at losing weight do not have sufficient effect in the treatment of type 2 diabetes, you must resort to medication. They are available in tablet form. Some of them act on the pancreas by increasing insulin production, while others improve its action (reduce insulin resistance). So the medications themselves used to treat type 2 diabetes mellitus do not lower blood sugar, insulin does. Therefore, to achieve the effect of tablets in the treatment of diabetes mellitus, a preserved reserve of pancreatic β cells is necessary. This clearly shows why it is useless to use tablet medications in the treatment of type 1 diabetes, because most of the β cells are already dead.
Insulin is often used to treat type 2 diabetes. Insulin treatment for type 2 diabetes mellitus may be prescribed temporarily, for example during surgery, serious acute illnesses, or as a permanent treatment. This is why it is currently not recommended to classify type 2 diabetes mellitus as non-insulin dependent. The type of diabetes treatment does not determine the type of diabetes.
Diet plays the most important role in the treatment of diabetes.
Diabetes diet
Despite the common goals in the treatment of different types of diabetes (elimination of symptoms of hyperglycemia, minimizing the risk of hypoglycemia, prevention of complications), diets for type 1 and type 2 diabetes mellitus differ significantly. There is no one-size-fits-all diet for diabetes mellitus.
In type 1 diabetes mellitus, the occurrence of which is associated with the death of beta cells of the pancreas and insulin deficiency, the main method of treatment is insulin replacement therapy, and dietary restrictions, according to modern concepts, areauxiliary in nature and should only be administered to the extent that insulin therapy differs from insulin production in a healthy person.
The fundamentals of diet prescription for type 1 diabetes mellitus have been critically revised in recent years.
One of the principles of the traditional diabetes diet is the recommendation to consume a strictly defined and identical amount of calories every day. Each patient was prescribed a daily calorie requirement based on their "ideal weight. "This makes no sense and is impossible for the following reasons:
- In healthy, normal-weight individuals, the balance between energy intake and expenditure varies considerably from day to day. Energy expenditure in healthy individuals is variable because their physical activity is variable. Therefore, if you prescribe a patient with type 1 diabetes a given diet with daily consumption of a fixed and identical amount of calories, then, to maintain normal weight, you will need to recommend a strict physical activity program to himand just as given. for every day, which is absolutely unrealistic.
- In patients with type 1 diabetes mellitus with normal weight and a correctly selected insulin treatment regimen for diabetes mellitus, appetite regulation does not differ from that of healthy individuals. The fact that they sometimes have to be forced to eat to avoid hypoglycemia, even in the absence of appetite, is most often the consequence of not entirely adequate insulin therapy.
Improved treatment regimens for diabetes mellitus using insulin and self-monitoring of metabolism based on blood sugar give the patient the opportunity to regulate food consumption only based on the feeling of hunger and satiety, like healthy people. Thus, the diet of a patient with type 1 diabetes mellitus corresponds to a healthy and complete diet (balanced in calories and in the content of essential nutrients). The only difference is that the injected insulin does not "know" when or how much you eat. You must therefore ensure yourself that the action of insulin corresponds to your diet. Therefore, you need to know which foods increase your blood sugar.
The main method of treating type 2 diabetes is the normalization of body weight through a low-calorie diet and increased physical activity. Diet for type 2 diabetes is very important; it is one of the important elements that allows you to succeed.
All food products are made up of three components: proteins, fats and carbohydrates. They all contain calories, but not all of them raise blood sugar.
Only carbohydrates have a pronounced effect on raising blood sugar. What foods contain carbohydrates? It's easy to remember: most products are plant and animal based - only liquid dairy products. It is important for you to know if blood sugar rises after certain foods and, if so, by how much. There are types of foods high in carbohydrates after which blood sugar does not increase at all or increases only slightly.
All carbohydrates can be roughly divided into two groups: those containing rapidly absorbing ("fast") carbohydrates and slowly absorbing ("slow") carbohydrates. "Fast" carbohydrate products contain refined sugars and include preserves and jams, candies, sweets, fruits and fruit juices. "Fast" carbohydrates cause a sharp increase in blood sugar levels (depending on the amount of food consumed) because they are quickly absorbed into the blood, so it is better to exclude them from the diet for diabetes. "Slow" carbohydrates are much more beneficial for diabetic patients because they take much longer to be absorbed. In addition, the absorption of sugars is slowed by the fiber contained in food, which is why the diet when treating diabetes must be enriched with foods rich in fiber.
Here are some simple rules to follow when treating diabetes: foods should be taken in small portions and often (4-6 times a day); stick to the established diet - try not to skip meals; don't overeat - eat as much as recommended by your doctor; use bread made from wholemeal flour or with bran; vegetables (except potatoes and legumes) should be eaten daily; Avoid eating "fast" carbohydrates.
Exercise for diabetes Physical exercise in the treatment of diabetes is very important: it increases the sensitivity of body tissues to insulin and thus helps to reduce blood sugar levels.
Housework, walking and jogging can be considered physical activities. Regular and measured physical exercise should be favored: sudden and intense exercise can cause problems maintaining normal sugar levels.
If you are an athlete, you have no contraindication to practicing sport, provided that your blood sugar is well controlled and all necessary measures are taken to avoid a significant drop.
Prevention of diabetes complications Patients with diabetes are at increased risk of developing complications in the heart and blood vessels (particularly in the legs and kidneys). Regular physical activity, sometimes simply walking, is enough to prevent circulatory problems in the feet.
If you have diabetes, an untreated sore or abrasion on your foot can become a serious problem. Even minor cuts or scrapes on the feet take longer to heal than in non-diabetic patients and require increased attention. The key to preventing these problems is to wear well-fitting shoes and check your feet frequently. Use a mirror if you have difficulty examining all areas of your feet, and remember that foot injuries are often painless at first and can go unnoticed for a long time if you don't pay enough attention.
Diabetic patients are at increased risk of kidney dysfunction and heart disease several years after diagnosis. There is good evidence that good blood sugar control reduces this risk. Also, to prevent complications of diabetes mellitus, it is necessary to undergo preventive treatment 2 times a year.
Controlling blood pressure is also important. Check your blood pressure regularly. If it is high, your doctor will prescribe treatment.