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Diabetes 2 types

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Diabetes 2 types – a chronic endocrine disease which develops owing to insulin resistance and violation of functions of beta cells of a pancreas is characterized by a condition of a hyperglycemia. It is shown by the plentiful urination (polyuria) strengthened by the feeling of thirst (polidipsiya), an itch of integuments and mucous membranes increased by appetite, heat inflows, muscular weakness. The diagnosis is established on the basis of results of laboratory researches. Blood test on concentration of glucose, level of glikozilirovanny hemoglobin, the glyukozotolerantny test is made. In treatment hypoglycemic medicines, a low-carbohydrate diet, increase in physical activity are used.

Diabetes 2 types

The word "diabetes" is translated from Greek as "to expire, follow", actually the name of a disease is meant by the "sugar expiration", "sugar loss" what defines a key symptom – the strengthened removal of glucose with urine. Diabetes 2 types, or insulinnezavisimy diabetes, develops against the background of increase in resistance of fabrics to effect of insulin and the subsequent decrease in functions of cells of islets of Langerhans. Unlike SD of 1 type at which the lack of insulin is primary at the 2nd type of a disease deficiency of hormone is result of long insulin resistance. Epidemiological data are very diverse, depend on ethnic features, social and economic living conditions. In Russia presumable prevalence – 7% that makes 85-90% of all forms of diabetes. Incidence is high among people 40-45 years are more senior.

Diabetes reasons 2 types

Development of a disease is provoked by a combination of hereditary predisposition and the factors influencing an organism throughout life. To mature age adverse exogenous effects reduce sensitivity of cages of an organism to insulin therefore they cease to receive enough glucose. The reasons of SD II of type can become:

  • Obesity. Fatty tissue reduces ability of cages to use insulin. Excess body weight is key risk factor of development of a disease, is defined at 80-90% of patients.
  • Hypodynamia. Deficiency of physical activity negatively affects work of most bodies and promotes delay of exchange processes in cages. The hypodynamic way of life is followed by low consumption of glucose muscles and its accumulation in blood.
  • Improper feeding. The overeating – the excess caloric content of a diet is the main reason for obesity at persons with diabetes. Other negative factor – the use of a large amount of the refined sugar which quickly comes to a blood-groove, provoking insulin secretion "jumps".
  • Endocrine diseases. The demonstration of SD can be provoked by endocrine pathologies. Incidence cases against the background of pancreatitis, tumors of a pancreas, hypophysial insufficiency, hypo - or hyperfunctions of a thyroid gland or adrenal glands are noted.
  • Infectious diseases. At people with a hereditary otyagoshchennost primary manifestation of SD is registered as a complication of a viral disease. Flu, herpes and hepatitis are considered the most dangerous.

Pathogenesis

Violation of metabolism of carbohydrates owing to increase in resistance of cages to insulin (insulin resistance) is the cornerstone of diabetes of the second type. Ability of fabrics to accept and utilize glucose decreases, the condition of a hyperglycemia – the raised plasma sugar level develops, alternative ways of obtaining energy from free fatty acids and amino acids become more active. For compensation of a hyperglycemia the organism strenuously removes excess glucose through kidneys. Its quantity in urine increases, develops a glucosuria. High concentration of sugar in biological liquids causes growth of osmotic pressure that provokes a polyuria – the plentiful speeded-up urination with loss of liquid and salts leading to dehydration and water electrolytically an imbalance. The majority of symptoms of SD – strong thirst, dryness of skin, weakness, arrhythmias is explained by these mechanisms.

The hyperglycemia changes processes of peptide and lipidic exchange. The remains of sugars join molecules of proteins and fats, breaking their functions, there is a hyperproduction of a glucagon in a pancreas, splitting of fats as power source is activated, the glucose reabsorption kidneys amplifies, transmitterny transfer in nervous system is broken, intestines tissues inflame. Thus, the SD pathogenetic mechanisms provoke pathologies of vessels (angiopatiya), nervous system (neuropathy), a gastrointestinal tract, glands of endocrine secretion. Later pathogenetic mechanism – insulin insufficiency. It is formed gradually, within several years, owing to exhaustion and the natural programmed death of β-cages. Over time the moderated deficiency of insulin is replaced by expressed. The secondary insulinozavisimost develops, the patient appoints insulin therapy.

Classification

Depending on expressiveness of violations of carbohydrate exchange at diabetes allocate compensation phase (the condition of a normoglikemiya is reached), subcompensation phase (with periodic increase in level of glucose of blood) and a decompensation phase (the hyperglycemia is steady, hardly gives in to correction). Taking into account severity distinguish three forms of a disease:

  1. Easy. Compensation is reached by correction of food or a diet in combination with the minimum dosage of hypoglycemic medicine. Risk of development of complications low.
  2. Average. Regular reception of antihyperglycemic means is necessary for compensation of metabolic violations. The probability of initial stages of vascular complications is high.
  3. Heavy. Patients need constant use of the tableted hypoglycemic drugs and insulin, sometimes – only insulin therapy. Serious diabetic complications – angiopatiya of small and large vessels, neuropathy, encephalopathy are formed.

Diabetes symptoms 2 types

The disease develops slowly, at an initial stage of manifestation are hardly noticeable, it considerably complicates diagnostics. Strengthening of feeling of thirst becomes the first symptom. Patients feel dryness in a mouth, drink up to 3-5 liters a day. Respectively the amount of urine and frequency of desires to depletion of a bladder increases. At children development of enuresis, is possible especially at night. Because of frequent urinations and high content of sugar in the emitted urine skin of inguinal area is irritated, there is an itch, reddenings appear. Gradually the itch covers area of a stomach, axillary hollows, bends of elbows and knees. Insufficient intake of glucose to fabrics promotes increase in appetite, patients hunger already 1-2 hours later after meal. Despite increase in caloric content of a diet, weight remains the same or decreases as glucose is not acquired, and it is lost with the emitted urine.

Additional symptoms – bystry fatigue, constant feeling of fatigue, day drowsiness, weakness. Skin becomes dry, becomes thinner, is inclined to rashes, fungal defeats. On a body bruises easily develop. Wounds and grazes long heal, are often infected. At girls and women candidiasis of genitals develops, boys and men have infections of urinary tract. Most of patients report about feeling of a pricking in fingers of hands, a sleep a foot. After food there can be a feeling of nausea and even vomiting. The arterial pressure increased headaches and dizzinesses are frequent.

Complications

The Dekompensirovanny current of SD 2 types is followed by development of sharp and chronic complications. The states arising quickly, suddenly and which are followed by risk of a lethal outcome – a hyper glycemic coma, a lactic coma and a hypoglycemic coma belong to sharp. Chronic complications are formed gradually, include diabetic micro and a macrovascular disease, shown a retinopathy, a nephropathy, thromboses, atherosclerosis of vessels. Polyneuritis of peripheral nerves, paresis, paralyzes, autonomous violations in work of internals come to light diabetic polyneuropathy, namely. Diabetic artropatiya – articulate pains, mobility restrictions, reduction of volume of sinovialny liquid, and also diabetic encephalopathies – the frustration of the mental sphere which are shown a depression, emotional instability are observed.

Diagnostics

Complexity of detection of insulinnezavisimy diabetes is explained by lack of the expressed symptomatology initial stages of a disease. In this regard and to all persons after 40 years screening researches of plasma are recommended to people for sugar level from risk group. Laboratory diagnostics is the most informative, allows to find not only an early stage of diabetes, but also a condition of a prediabet – the decrease in tolerance to glucose which is shown a long hyperglycemia after carbohydrate loading. At SD signs examination is conducted by the doctor-endocrinologist. Diagnostics begins with clarification of complaints and collecting the anamnesis, the expert specifies existence of risk factors (obesity, a hypodynamia, a hereditary otyagoshchennost), reveals basic symptoms – a polyuria, a polidipsiya, appetite strengthening. The diagnosis is confirmed after obtaining results of laboratory diagnostics. Treat specific tests:

  • Glucose on an empty stomach. Criterion of a disease is glucose level higher than 7 mmol/l (for blue blood). The intake of material is made after 8-12 hours of hunger.
  • Glyukozotolerantny test. For diagnostics of SD at an early stage concentration of glucose after the use of carbohydrate food is investigated in a couple of hours. The indicator higher than 11,1 mmol/l reveals diabetes, in the range of 7,8-11,0 mmol/l is defined prediabt.
  • Glikirovanny hemoglobin. The analysis allows to estimate average value of concentration of glucose for the last three months. Diabetes is indicated by value of 6,5% and more (blue blood). At result of 6,0-6,4% it is diagnosed prediabt.

Differential diagnostics includes distinction of insulinnezavisimy SD with other forms of a disease, in particular – with diabetes of the first type. Clinical differences are slow increase of symptoms, later starting date of a disease (though in recent years the disease is diagnosed and young people have 20-25 years). Laboratory differential signs – the increased or normal level of insulin and S-peptide, lack of antibodies to beta cells of a pancreas.

Treatment of diabetes 2 types

System approach to therapy is widespread in endocrinology. At early stages of a disease the main attention is paid to change of a way of life of patients and consultations on which the expert tells about diabetes, ways of control of sugar. At a resistant hyperglycemia the issue of application of medicamentous correction is resolved. The full complex of medical actions includes:

  • Diet. The basic principle of food – reduction of amount of food with high content of fats and carbohydrates. Products with the refined sugar – confectionery, candies, chocolate, sweet carbonated drinks are especially "dangerous". The diet of patients consists of vegetables, dairy products, meat, eggs, moderate quantity of cereals. The fractional diet, small volumes of portions, refusal of alcohol and spices is necessary.
  • Regular physical activities. The sports occupations strengthening oxidation processes (aerobic loadings) are shown to patients without heavy diabetic complications. Their frequency, duration and intensity are defined individually. Sports walking, swimming and foot walks is allowed most of patients. The average time of one occupation – 30-60 minutes, frequency is 3-6 times a week.
  • Medicamentous therapy. Medicines of several groups are used. Use of biguanides and tiazolidindion – medicines which reduce insulin resistance of cages, absorption of glucose in a GIT and its production in a liver is widespread. At their insufficient efficiency the drugs increasing activity of insulin are appointed: DPP-4 inhibitors derivative of sulphonylurea, meglitinida.

Forecast and prevention

Timely diagnostics and responsible attitude of patients to treatment of SD allow to reach a condition of steady compensation at which long time remains a normoglikemiya, and quality of life of patients remains high. For prevention of a disease it is necessary to adhere to the balanced food allowance with the high content of cellulose, restriction of sweet and fat products, the fractional mode of meals. It is important to avoid a hypodynamia, to daily provide to an organism physical activity in the form of walking, 2-3 times within a week to play sports. Regular control of glucose is necessary for persons from risk groups (excess weight, mature and advanced age, SD cases among relatives).

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