Diabetes mellitus is an endocrinological pathology, accompanied by hyperglycaemia syndrome (high blood sugar) that occurred due to an insulin lack.This disease is accompanied by carbohydrate and other metabolic disorders in the body.
Diabetes mellitus is currently being diagnosed in 10-15 % of the population of our planet.Cases to the development of this disease in childhood have usually become more common after inappropriate antibiotic therapy, stress and virus infections.The number of patients with diabetes has increased by 9-10%annually.Today, the number of patients with this disease exceeds 200 million people.Diabetes are diagnosed in both men and women.
Causes and mechanism for the development of diabetes
Due to a violation of the synthesis and the secretion of insulin by the beta cells of the islets of Langerganes, the insulin level in the blood is decreased, which leads to an absolute insulin deficiency over time.Relative insulin deficiency is found, which may be the results of a decreease in insulin activity as a results increased connection with protein, intensive destruction of the Liver enzyme, The Prevalence of Non -Hormonal and Hormonal Antagonists of Insulin (thyroidHormones, The Adrenal Cortex, Glucagon, and Unusterized Fatty Acids, Growth Hormone), Changes in Insulin Resistance from Insulin -dependent tissues to insulin.
Insulin deficiency causes disorders of protein, carbohydrate and fat metabolism in the body.The permeability of the glucose of cell membranes in muscles and adipose tissue is reduced, gluconeogenesis and glycogenolysis are reinforced, glucoseuria, hyperglycemia occurs, which are accompanied by polydipy and polyuria.The decay is reinforced and the formation of fats is reduced, which leads to an increase in the ketone body in the blood (acetone-das condensation product of acetouxix acid, beta-oxyma and acetouxus acids).These phenomena cause a shift in the acid base of equilibrium in the azid seal and also influence the increase in the excretion of magnesium, sodium, potassium in urine and leads to kidney functional disorders.
The alkaline blood reserve can lose 25%.Carbon dioxide and a decrease in the pH of the blood to 7.2-7.0.
How type I diabetes develop
The causes of the development of diabetes have some differences depending on the type of diabetes.For example, patients with diabetes are expanded due to autoimmunaggression and viral infection of beta cells in the body, which develops a defect with all the resulting consequences.
How type II diabetes develop
Patients with the II diabetes type have a sufficient amount of insulin, but the body tissue lose the opportunity to perceive their signal.With the development of obesity, fatty tissue acts as a kind of barrier that blocks the effects of insulin.In order to eliminate this barrier, the beta cells include the intensive operating mode, which then leads to their exhaustion and its transition from relative insulin failure.Nevertheless, the insulin -dependent diabetes is not converted into insulin -dependent.
Regardless of the etiological factor in the development of diabetes, the same process is available when slowing down the transformation of sugar from outside and in the blood.
Classification of diabetes
Depending on the clinical characteristics, the following types are differentiated from diabetes:
- I have diabetes mellitus, which in turn has several subspecies:
- Insulin -dependent diabetes;
- Insulin -dependent diabetes sugar:
- in people with obesity;
- In people with normal weight.
- Diabetes, the cause of the development is inadequate nutrition;
- Other review of the type -i diabetes, which is connected to certain syndromes and body conditions:
- Endocrine pathologies;
- Insulinanomalies or its receptor;
- Seal gland diseases;
- certain genetic syndromes;
- Diseases caused by the effects of chemicals or drugs;
- Condition of mixed etiological factors;
- II type of diabetes indicates a violation of glucose tolerance and is divided into such forms:
- in patients without overweight;
- in people with obesity;
- caused by a certain state or a certain syndrome.
- The type -III diabetes can develop during pregnancy.
Separate static risk classes of this disease have been identified (patients with normal glucose tolerance, but a significant risk of diabetes):
- a state before a violation of glucose tolerance;
- Potential glucose tolerance disorders.
Essential (primary) diabetes type type
The main (primary) type of diabetes mellitus, which has a connection with nutrient failure, is emphasized as a separate pathology.This disease occurs in people under the age of 30 in tropical countries.According to statistics, the ratio of men and women is 2: 1. The total number of patients with this form of diabetes is 20 million people.
Most of the time there are two subtypes of this diabetes.The first of them is fibrocular pancreas diabetes.
Fibrocalcule pankreas diabetes
Territorial, it mainly covers Indonesia, India, Brazil, Bangladesh, Uganda and Nigeria.This pathology is characterized by the presence of extensive pancreofibrosis and stone formation in the main channel of the pancreas.The clinical image is presented by sharp weight loss, recurring abdominal pain and other signs of inadequate nutrition.In this case, insulin therapy, moderate and high glucosuria and hyperglycaemia enables eliminating.One of the characteristic signs of this pathology is the lack of ketoacidosis that is due to the reduced production of insulin and the release of the glucagon by the island apparatus of the pancreas.Topographic studies (ultrasound diagnostics, radiography, computer tomography) make it possible to determine the presence of stones in the channels of the pancreas.
There is an opinion that one of the factors in the development of fibrocoric diabetes is the inclusion of Manioca roots (Manioka, Tapioka) in the diet, which contains cyanogenic glycosides from which a linamarine is released during hydrolysis cyanistoric acid.With the participation of sulfuric acids, its harmful effects are eliminated, and the accumulation of cyanide in the body, which is the cause of the development of fibrocculosis, provokes the accumulation of cyanide in the body, which is the cause of the development of fibrocculosis.
Pancreas diabetes
The development of pancreas diabetes (type -ii -diabetes) has a relationship to protein insufficiency in the body, but there are no manifestations of pancreatic fibrosis.It is characterized by moderate resistance to insulin and resistance to the development of ketoacidosis.In most cases, patients suffer from exhaustion.The patients reduced the secretion of insulin, but not to such a measure as in patients with type -i diabetes, this explains the lack of ketoacidosis.
Subtype J
In the classification of diabetes, there is no evidence of the third subtype of Pankreas -Diabetes, which can be found in Jamaica according to the WHO data shown above.We talk about subtype J. The subtype J has a lot in common with pancreatic diabetes that occur due to deficiency in the protein.
Symptoms of diabetes
The first symptoms of diabetes occur due to a high blood sugar content.After the level of 8.9–10.0, sugar enters the urine.If the kidneys remove water, this is collected clinically by rapid urination (polyuria).Excessive urinisolation causes a constant feeling of thirst (polydipsia).In urine, the body loses a large number of calories that are represented by glucose so that a person loses weight and is constantly hunger.
A distinction is made between other symptoms of diabetes such as sleepiness, reduced visual acuity, tiredness and nausea.In addition, patients with non -compensated diabetes are susceptible to infections.Type I diabetes patients have a pronounced insulin deficiency and therefore almost always lose weight before the start of therapy.Patients with II diabetes do not lose the weight of the body.
In type I diabetes disease, the fast development of clinical manifestations occurs and can soon lead to diabetic ketoacidosis.Regardless of the high level of glucose in the blood, the cells do not have the option of using it without insulin, so switch to other energy sources.The destruction of fat cells begins, which provokes the formation of ketone bodies, which are toxic chemical compounds.
Diabetic ketoacidose
The first symptoms of diabetic ketoacidosis manifest themselves in the form of excessive urination and excessive thirst, nausea, vomiting, fatigue, weight loss and abdominal pain (especially in childhood).Patients have frequently and deeply breathe, which is connected to the body's attempts to neutralize the excessive acid of the blood.This process is accompanied by the appearance of the smell of acetone from the mouth.In the absence of treatment, diabetic ketoacidosis can be complicated by developing a coma, in some cases this process takes place within several hours.
Type -i diabetes can also be accompanied by the development of ketoacidosis after the start of insulin therapy if the patient goes through a planned injection or through a severe emotional overload, especially during violation, serious infection or other serious illnesses.
Patients with type II diabetes for a sufficiently long time may not feel any signs of this pathology.Such a hidden disease period can take up to several decades.Clinical manifestations are activated when the insulin deficiency is worse.
At first, the volume of the dedicated urine exceeds the norm only slightly, the thirst is weakened weakly, but progress over time.The phenomena of ketoacidosis are rare.With a significant increase in the glucose mirror in the blood (in some cases on 55 mmol/l), this usually occurs at additional loads on the body, for example under the influence of drugs or with serious infectious diseases, the patient can immerse themselves in a state of confused consciousness.
How else is diabetes mellitus manifested?
The high glucose level in the blood can lead to nerves, blood vessels and other structures over time.Chemical compounds containing glucose are located on the walls of small blood vessels, with the walls of the vessels thickened and damaged.By narrowing the gaps in the blood vessels, the deterioration of blood flow leads, in particular the blood supply to the skin and nerve endings.Without compensation for diabetes in the blood, there is an increase in fat substances, which accelerates the development of atheriosclerosis.Patients in whom diabetes were diagnosed, regardless of gender, suffer 2-6 times more often from atheriosclerosis compared to people who do not have this diagnosis.The violation of blood vessels in blood circulation leads to disorders from the heart, kidneys, eyes, lower extremities, brain, skin and nerves and also slows down the healing process of wounds.
What is the seriousness of diabetes mellitus
All of these factors increase the risk of developing many distant complications.In patients with diabetes, the risk of strokes and heart attacks increases due to damage to the blood vessels of the eyes, the visual loss loss (diabetic retinopathy) can occur, kidney disorders provoke kidney failure.In some cases, dialysis is required.The nerve damage can lead to many consequences.Mononeuropathy (impaired function of a nerve) can manifest itself with a sudden weakness of the upper or lower extremity.Diabetic polyneuropathy (damage to the nerves of the legs, feet or hands) causes sensitivity, pain, burning or tingling, weakness in the arms and legs.The temperature and pain sensitivity decreases, which leads to increased trauma.Circular disorders can contribute to the occurrence of ulcers and a poor healing of wounds.The ulcers located on the feet are very deep and poorly healing, which leads to infections and in some cases to the amputation of the affected limb.
Clinical studies have shown that it is possible to avoid or out diabetes if they constantly maintain normal blood sugar.The course of this disease is currently not fully examined.There are a number of unexplored factors that cause its development.Genetics include the number of these factors.
Diagnosis of diabetes
The diagnosis of diabetes begins with the collection of an anamnesis and examination of the patient.During these measures, the patient has the presence of hereditary factors, obesity, whether the patient belongs to the number of individual twins (if one of them suffers from diabetes mellitus, the second must be examined), women give the presence of birth and whether a large fruit.
The following are a number of laboratory tests that come from:
- Blood tests for glucose levels are carried out twice.
- Glucose tolerance test;
- Determination of the glucose mirror in daily urine.
With the diagnosis of diabetes mellitus, it is very important to find out the presence of complications.All organs and systems are diagnosed for this.
Complications of diabetes
Complications of diabetes mellitus can be acute and chronic, they are also divided depending on the form of diabetes.The acute complications differentiate between Coma, in which the loss of consciousness is pushed forward due to a very low or very high blood sugar concentration of the brain.Such conditions include:
- The diabetic ketoazitosis (the most common complication of acute nature) shows itself in polyuria, polydipsia, lack of appetite, weakness, abdominal pain, nausea and vomiting;
- A hypoglycemic coma is an extreme degree of hypoglycemia that occurs with a strong decrease in the glucose mirror in the blood.It is often the result of the introduction of an irregular insulin dose and sometimes occurs after taking certain food or sulfanilamide.
- The hyperosmolar comic in the severity of the state predominates the diabetics, which occurs mainly in old people with type -II diabetes.In 30% of cases, the cause of death of the patient and in the presence of more difficult pathologies becomes 70%.
Chronic (late) complications are combined into a group of pathologies that develop with a longer exposure to high blood sugar on the patient's organs and systems.First, the organs that are more sensitive to sugar are more sensitive to damage, they are a kind of “goal” for diabetes.The following are known under the chronic complications of diabetes:
- Diabetic retinopathy is observed in 90% of patients with diabetes.Develops with a long course of diabetes and manifests itself by damage to the vessels of eye help;
- Diabetic nephropathy consists in the complex damage to the kidneys (tubules, arteries, glomeruli, arterioles).The prevalence in patients with diabetes is 75%;
- Diabetic neuropathy is shown by damage to the peripheral nerves in patients with diabetes.Neuropathy is a predisposing factor in the development of a diabetic foot that can lead to an amputation of a limb.
- Diabetic encephalopathy is damage to the brain, which is progressive.It manifests itself through increased tiredness, performance acceptance, the impairment of the attention concentration, the emotional instability, the bruises of headaches, anxiety and deterioration of the thinking process.
- Diabetic lesions of the skin are structural deformations of the epidermis, follicles, sweat glands due to a violation of the carbohydrate metabolism and the accumulation of metabolic products.With a severe form of diabetes, the skin becomes scaly, rough, with areas of homosopers, cracks, the skin captures a yellowish color, hair loss occurs;
- The syndrome of diabetic foot and brush occurs in 30-80% of patients with diabetes and is a complex anatomical and functional disorders that occur in the form of brown spots and ulcers on the lower leg, foot and phalanx of the fingers, which can lead to an amputation of the limbs in severe cases.
Treatment of diabetes
The treatment of diabetes depends on the type of disease, but first the patient has to normalize the glucose level in the blood.To do this, you have to radically change your lifestyle and diet.For patients with diabetes, a special diet is recommended based on the calculation of the carbohydrates, proteins and fats, vitamins and trace elements.This calculation is taught by specialists in this area.
The selection of the tactics of drug therapy depends on the type of diabetes.Patients with diabetes are required to carry out insulin therapy, with type II adheres to the strictest diet and use glucose -containing active ingredients, with the ineffectiveness of tablet forms of medicinal products, insulin.
Insulin is taken in the blood under the strict control of the glucose mirror.Insulin preparations according to the mechanism of action are divided into three species: extended, short and medium effect.In the case of insulin -dependent diabetes mellitus, sugary medication are displayed in combination with nutrition.Sugar -containing medication includes: Biguanides, Sulfonylmochevina, Thiazolidindyons and Meglitinides.
With this insidious illness, it is very important for medical staff to convey the skills to the patient and their relatives to monitor the patient's condition and first aid in the case of before -domestically and in a coma.
Prediction for diabetes mellitus
In the presence of diabetes mellitus, the patient is registered with the endocrinologist.Under the conditions of adequate therapy, the patient can be in a satisfactory state for a long time.The forecast in relation to the condition of the health and life expectancy of a patient with diabetes mellitus can develop acute and chronic complications.
Prevention of diabetes
In type I diabetes, preventive measures must be removed the resistance of the body against various infections and the toxic effect of antibodies on the pancreas.In patients with II, the type of diabetes is very important to adapt the diet and prevent the development of obesity.In order to prevent the development of complications in diabetes conditions, it is necessary to meet the doctor's recommendations correctly and systematically and to clarify whether they can be consumed.