Diabetes – a chronic metabolic disorder which cornerstone deficiency of formation of own insulin and increase in level of glucose in blood is. It is shown by the feeling of thirst, increase in amount of the emitted urine increased by appetite, weakness, dizziness, slow healing of wounds etc. The disease is chronic, it is frequent with the progressing current. The risk of development of a stroke, renal failure, myocardial infarction, gangrene of extremities, a blindness is high. Sharp fluctuations of sugar in blood cause the states menacing for life: hypo - and hyper glycemic a coma.
Among the found metabolic disorders diabetes is on the second place after obesity. In the world about 10% of the population have diabetes, however, if to consider the latent forms of a disease, then this figure can be 3-4 times more. Diabetes develops owing to chronic deficiency of insulin and is followed by disorders of carbohydrate, proteinaceous and fatty exchange. Production of insulin happens in a pancreas of ß cages of islets of Langerhans.
Participating in exchange of carbohydrates, insulin increases receipt in cells of glucose, promotes synthesis and accumulation of a glycogen in a liver, slows down disintegration of carbohydrate connections. In the course of proteinaceous exchange insulin strengthens synthesis of nucleinic acids, protein and suppresses its disintegration. Influence of insulin on fatty exchange consists in activization of receipt in fatty cells of glucose, power processes in cages, synthesis of fatty acids and delay of disintegration of fats. With the participation of insulin process of receipt in a cell of sodium amplifies. Violations of the exchange processes controlled by insulin can develop at its insufficient synthesis (diabetes of the I type) or at immunity of fabrics to insulin (diabetes of the II type).
Reasons and mechanism of development
Diabetes of the I type comes to light at young patients up to 30 years more often. Violation of synthesis of insulin develops as a result of damage of a pancreas of autoimmune character and destruction insulinprodutsiruyushchy ß cages. At most of patients diabetes develops after a viral infection (epidemic parotitis, a rubella, viral hepatitis) or toxic influence (nitrosamines, pesticides, medicinal substances, etc.), the immune answer to which causes death of cells of a pancreas. Diabetes develops if more than 80% of insulinprodutsiruyushchy cages are struck. Being an autoimmune disease, diabetes of the I type is often combined with other processes of autoimmune genesis: thyrotoxicosis, diffusion toxic craw, etc.
At diabetes of the II type insulin resistance of fabrics, i.e. their tolerance to insulin develops. At the same time the content of insulin in blood can be normal or raised, however cages to it are unreceptive. At most (85%) of patients diabetes of the II type comes to light. If the patient has obesity, the susceptibility of fabrics to insulin is blocked by fatty tissue. Elderly patients who have a decrease in tolerance to glucose with age are more subject to diabetes of the II type.
Influence of the following factors can accompany developing of diabetes of the II type:
- genetic – the risk of development of a disease makes 3-9% if relatives or parents are sick with diabetes;
- obesity – at excess amount of fatty tissue (especially abdominal type of obesity) there is a noticeable decrease in sensitivity of fabrics to insulin promoting development of diabetes;
- violations of food – mainly carbohydrate food at a lack of cellulose increases risk of diabetes;
- cardiovascular diseases – atherosclerosis, an arterial hypertension, IBS reducing insulin resistance of fabrics;
- chronic stressful situations – in a condition of a stress in an organism the quantity of catecholamines (noradrenaline, adrenaline), the glucocorticoids promoting development of diabetes increases;
- diabetogenny action of some drugs - glucocorticoid synthetic hormones, diuretics, some hypotensive medicines, tsitostatik, etc.
- chronic insufficiency of bark of adrenal glands.
At insufficiency or resistance to insulin intake of glucose in cages decreases and its content in blood increases. In an organism activization of alternative ways of processing and digestion of glucose joins that leads to a congestion in fabrics of glikozaminoglikan, a sorbitola, glikilirovanny hemoglobin. Accumulation of a sorbitol leads to development of a cataract, mikroangiopatiya (violations of functions of capillaries and ), neuropathy (to violations in work of nervous system); glikozaminoglikana cause damage of joints. For receiving in an organism the processes of disintegration of protein causing muscular weakness and dystrophy skeletal and warm muscles begin cages of missing energy. Perekisny oxidation of fats becomes more active, there is an accumulation of toxic products of exchange (ketone bodies).
The hyperglycemia in blood at diabetes causes strengthening of a mocheotdeleniye for a conclusion of excess sugar from an organism. Together with glucose through kidneys a significant amount of liquid is lost, leading to dehydration (dehydration). Together with loss of glucose power stocks of an organism therefore at diabetes at patients loss of weight is noted decrease. The increased sugar level, dehydration and accumulation of ketone bodies owing to disintegration of fatty cages causes a dangerous condition of diabetic ketoacidosis. Over time because of the high level of sugar injuries of nerves, small blood vessels of kidneys, eyes, hearts, a brain develop.
On an associativity to other diseases the endocrinology allocates diabetes symptomatic (secondary) and true.
Symptomatic diabetes accompanies diseases of endocrine glands: pancreatic, thyroid, adrenal glands, a hypophysis also serves one of displays of primary pathology.
True diabetes can be two types:
- insulinzavisimy the I type (type ISZD I) if own insulin is not produced in an organism or is developed in insufficient quantity;
- insulinnezavisimy the II type (INZSD II of type) if tolerance of fabrics to insulin at its prosperity and surplus in blood is noted.
Separately allocate diabetes of pregnant women.
Distinguish three severity of diabetes: easy (I), average (II) and heavy (III) and three conditions of compensation of violations of carbohydrate exchange: compensated, subcompensated and dekompensirovanny.
Development of diabetes of the I type happens promptly, the II type - opposite gradually. The hidden, asymptomatic course of diabetes is often noted, and its identification happens incidentally at a research of an eye bottom or laboratory definition of sugar in blood and urine. Clinically diabetes of I and II types prove differently, however the general for them are the following signs:
- the thirst and dryness in a mouth which are followed by a polidipsiya (the increased liquid use) to 8-10 l a day;
- polyuria (the plentiful and speeded-up urination);
- polyphagia (the increased appetite);
- dryness of skin and mucous, followed by an itch (including crotches), pustulous infections of skin;
- sleep disorder, weakness, decrease in working capacity;
- spasms in gastrocnemius muscles;
- sight violations.
Displays of diabetes of the I type are characterized by strong thirst, a frequent urination, nausea, weakness, vomiting, increased fatigue, constant feeling of hunger, loss of weight (at the normal or raised food), irritability. Emergence of bed wetting, especially, is a diabetes sign at children if earlier the child did not urinate in a bed. At diabetes of the I type hyper glycemic (with critically high level of sugar the states demanding holding the emergency actions develop in blood) and hypoglycemic more often (with critically low content of sugar in blood).
At diabetes of the II type the skin itch, thirst, sight violation, the expressed drowsiness and fatigue, skin infections, slow processes of healing of wounds, a paresteziya and a sleep of legs prevail. At patients with diabetes of the II type obesity is often observed.
The course of diabetes quite often is followed by a hair loss on the lower extremities and strengthening of their growth on a face, emergence by a ksant (small yellowish outgrowths on a body), balanopostity at men and vulvovaginity at women. In process of progressing of diabetes violation of all types of exchange leads to decrease in immunity and resilience to infections. The long course of diabetes causes the damage to bone system which is shown osteoporosis (depression of a bone tissue). There are waist, bones, joints pains, dislocations and incomplete dislocations of vertebras and joints, changes and deformation of bones resulting in disability.
The course of diabetes can be complicated by development of polyorgan violations:
- diabetic angiopatiya – strengthening of permeability of vessels, their fragility, thromboses, the aterosklerozirovaniye leading to development of a coronary heart trouble, the alternating lameness, diabetic encephalopathy;
- diabetic polyneuropathy – damage of peripheral nerves at 75% of patients therefore there is a sensitivity violation, hypostasis and a chill of extremities, burning sensation and "crawlings" of goosebumps. Diabetic neuropathy develops years later after a disease of diabetes, meets at insulinonezavisimy type more often;
- diabetic retinopathy – destruction of a retina, the arteries, veins and capillaries of an eye, decrease in sight fraught of an otsloyky retina and a total blindness. At diabetes of the I type it is shown in 10-15 years, at the II type – earlier, comes to light at 80-95% of patients;
- diabetic nephropathy – defeat of kidney vessels with violation of functions of kidneys and development of a renal failure. It is noted at 40-45% of patients with diabetes in 15-20 years from the beginning of a disease;
- diabetic foot – violation of blood circulation of the lower extremities, gastrocnemius muscle pains, trophic ulcers, destruction of bones and joints of feet.
Serve as the critical, sharply arising states at diabetes diabetic (hyper glycemic) and hypoglycemic a coma.
The hyper glycemic state and coma develop as a result of sharp and substantial increase of level of glucose in blood. Serve as harbingers of a hyperglycemia the accruing general malaise, weakness, a headache, depression, appetite loss. Then there are belly-aches, noisy breath of Kussmaul, vomiting with an acetone smell from a mouth, the progressing apathy and drowsiness, decrease HELL. This state is caused by ketoacidosis (accumulation of ketone bodies) in blood and can lead to consciousness loss – a diabetic coma and death of the patient.
Opposite critical condition at diabetes – a hypoglycemic coma develops at sharp falling in glucose level blood, is more often in connection with insulin overdose. Increase of a hypoglycemia sudden, bystry. Sharply there is a feeling of hunger, weakness, a shiver in extremities, superficial breath, arterial hypertension, the patient's skin cold, damp, sometimes develop spasms.
The prevention of complications at diabetes is possible at continuous treatment and careful control of level of glucose in blood.
Existence of diabetes is demonstrated by the content of glucose in capillary blood on an empty stomach exceeding 6,5 mmol/l. Normal glucose in urine is absent since is late in an organism the kidney filter. At increase in level of glucose of blood more than 8,8-9,9 mmol/l (160-180 mg of %) the kidney barrier does not cope and passes glucose in urine. Availability of sugar in urine is defined by special test strips. Minimum content of glucose in blood at which it begins to be defined in urine is called "a kidney threshold".
Inspection at suspicion of diabetes includes determination of level:
- glucose on an empty stomach in capillary blood (from a finger);
- glucose and ketone bodies in urine – their existence testifies to diabetes;
- glikozilirovanny hemoglobin - considerably raises at diabetes;
- S-peptide and insulin in blood – at diabetes of the I type both indicators are considerably lowered, at the II type – are almost not changed;
- carrying out the load test (the test of tolerance to glucose): glucose definition on an empty stomach and in 1 and 2 hours after reception of 75 g of the sugar dissolved in 1,5 glasses of boiled water. Negative (not confirming diabetes) the test result is considered at tests: on an empty stomach 6,6mmol/l at the first measurement and> 11,1 mmol/l in 2 hours after loading glucose.
For diagnostics of complications of diabetes conduct additional examinations: Ultrasonography of kidneys, reovazografiya of the lower extremities, rheoencephalography, brain EEG.
Implementation of recommendations of a diabetolog, self-checking and treatment at diabetes are carried out for life and allow to slow down or avoid the complicated options of a course of a disease significantly. Treatment of any form of diabetes is directed to blood glucose lowering of the level, normalization of milestones of types of exchange and the prevention of complications.
Basis of treatment of all forms of diabetes is the dietotherapy taking into account a sex, age, body weights, physical activities of the patient. Training in the principles of calculation of caloric content of a diet taking into account the content of carbohydrates, fats, proteins, vitamins and minerals is provided. At insulin-dependent diabetes consumption of carbohydrates in the same hours for simplification of control and correction of level of glucose is recommended by insulin. At IZSD I of type reception of the greasy food promoting ketoacidosis is limited. At insulinonezavisimy diabetes all types of sugars are excluded and the general caloric content of food is reduced.
Food has to be fractional (not less than 4-5 times a day), with uniform distribution of carbohydrates, promoting the stable level of glucose and maintenance of the main exchange. Special diabetic products on the basis of sweeteners are recommended (aspartame, saccharin, xylitol, sorbite, fructose, etc.). Correction of diabetic violations only by means of one diet is applied in easy degree of a disease.
The choice of drug treatment of diabetes is caused by disease type. Insulin therapy is shown to patients with diabetes of the I type, at the II type – a diet and antihyperglycemic means (insulin is appointed at inefficiency of reception of the tableted forms, development of a ketoazidoz and prekomatozny state, tuberculosis, chronic pyelonephritis, a liver and renal failure).
Introduction of insulin is carried out under systematic control of level of glucose in blood and urine. Insulin on the mechanism and validity period happens three main types: the prolonged (prolonged), intermediate and short action. Insulin of the prolonged character is entered 1 time a day regardless of meal. More often injections of the prolonged insulin are appointed together with medicines of intermediate and short action, allowing to achieve compensation of diabetes.
Use of insulin is dangerous by the overdose leading to sharp decrease in sugar, development of a condition of a hypoglycemia and coma. Selection of medicines and a dose of insulin is carried out taking into account changes of physical activity of the patient within a day, stability of level of sugar of blood, caloric content of a diet, divisibility of food, tolerance of insulin etc. At insulin therapy development local (pain, reddening, swelled in the place of an injection) and the general (up to an anaphylaxis) allergic reactions is possible. Also insulin therapy can be complicated by lipodistrofiya - "failures" in fatty tissue in the place of introduction of insulin.
The sugar-lowering tableted medicines are appointed at insulinonezavisimy diabetes in addition to a diet. On the mechanism of decrease in sugar in blood allocate the following groups of antihyperglycemic funds:
- sulphonylurea medicines (, glibenclamide, chlorpropamide, carbutamide) – stimulate production of ß cages insulin of a pancreas and promote penetration of glucose into fabrics. Optimum picked up dosage of medicines of this group supports glucose level not> 8 mmol/l. At overdose development of a hypoglycemia and coma is possible.
- biguanides (metformin, , etc.) – reduce digestion of glucose in intestines and promote saturation of peripheral fabrics by it. Biguanides can increase the level of uric acid in blood and cause development of serious condition - a laktatsidoz in patients 60 years, and also the persons having a liver and renal failure, chronic infections are more senior. Biguanides more often are appointed at insulinonezavisimy diabetes at young patients with obesity.
- meglitinida (, ) – cause decrease in level of sugar, stimulating a pancreas to insulin secretion. Effect of these medicines depends on the content of sugar in blood and does not cause a hypoglycemia.
- inhibitors alpha (, acarbose) - slow down increase in sugar in blood, blocking the enzymes participating in digestion of starch. Side effect - a meteorizm and diarrhea.
- tiazolidindiona - reduce amount of the sugar released from a liver, raise a susceptibility of fatty cages to insulin. Are contraindicated at heart failure.
At diabetes training of the patient and members of his family in skills of control of health and a condition of the patient, measures of first aid at development prekomatozny and comas is important. Salutary medical impact at diabetes is made by decrease in excess weight and individual moderate physical activities. Due to muscular efforts there is strengthening of oxidation of glucose and reduction of its content in blood. However, physical exercises cannot be begun at glucose level> 15 mmol/l, at first it is necessary to wait for its decrease under the influence of medicines. At diabetes physical activity has to be distributed evenly on all groups of muscles.
Forecast and prevention
Patients with the revealed diabetes are registered the doctor-endocrinologist. At the organization of the correct way of life, food, treatment the patient can feel well for many years. Burden the forecast of diabetes and reduce life expectancy of patients sharply and chronically developing complications.
Prevention of diabetes of the I type comes down to increase in resilience of an organism to infections and an exception of toxic impact of various agents on a pancreas. Preventive measures of diabetes of the II type provide prevention of development of obesity, correction of food, especially at persons with the burdened hereditary anamnesis. The prevention of a decompensation and the complicated course of diabetes consists in its correct, systematic, treatment.