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 overnight fasting) and up to 7. 8 mmol/l after a meal (i. e. 1. 5 -2 hours after the last meal).
Normally, in the human body, glucose is used by cells as an energy source (in other words, the body's cells "feed" glucose from the blood). The more cells work, the more energy (glucose) they need.
Glucose (the expression "blood sugar" is more often used, but this is not entirely true) is constantly circulating in human blood. There are 2 ways for glucose to enter the human body: - first through food containing carbohydrates, - second is through the production of glucose by the liver (this is the reason that in diabetes mellitus, even if the patient has not eaten anything, the blood glucose level may increase).
However, to be used as energy, glucose from the blood must go to the muscles (to do work), fat tissue, or the liver (the body's glucose storage facility). This happens under the influence of the hormone insulin, which is produced by the beta cells of the pancreas. As soon as blood glucose levels rise after a meal, the pancreas immediately 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 liver depots, so at night insulin controls the liver so that it does not release too much glucose into the blood.
If a violation occurs at any stage of this process, diabetes mellitus occurs.
Type of diabetes
Type 1 diabetes mellitus (previously using the name: insulin-dependent diabetes mellitus) develops mainly at a young age (usually before the age of 30, although type 1 diabetes mellitus can also develop at an older age).
Type 1 diabetes mellitus is caused by the cessation of insulin production by the pancreas 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 special genetic predisposition (that is, a person is born with it), which, when exposed to some external factors (for example, viruses), leads to changes in the state of the body's immune system. The body of a type 1 diabetic begins to regard its pancreatic β-cells as foreign and protects itself from them by producing antibodies (just as it does when protecting against infection), which leads to the death of pancreatic β-cells, which means severe insulin deficiency.
Diabetes mellitus 1 type develops when at least 90% of pancreatic β cells die. Let's remember the mechanism of action of insulin, its function as a "key" that opens cells to sugar. In type 1 diabetes mellitus, this key is lost from the blood (see diagram).
Insulin deficiency in type 1 diabetes mellitus The onset of type 1 diabetes mellitus is acute, always accompanied by symptoms of severe hyperglycemia (high blood sugar): - weight loss (the patient accidentally loses weight), - constant hunger, - thirst, dry mouth (the patient drinks a lot of liquid, including at night), - frequent urination (in normal 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 a diabetic coma often develops.
Type 2 diabetes mellitus (previously called insulin-dependent diabetes mellitus) is more common than type 1 diabetes mellitus. The incidence of type 2 diabetes mellitus is typical for older people: it is detected, as a rule, after the age of 40, although recently, according toWHO experts, the average age of type 2 diabetes mellitus patients is getting younger.
About 80% of people with type 2 diabetes are overweight. Also, type 2 diabetes is characterized by heredity - a high prevalence among close relatives.
In type 2 diabetes, the pancreas continues to produce insulin, often in larger quantities than usual. Although there are also cases of diabetes mellitus type 2 with reduced insulin secretion.
The main defect in type 2 diabetes is that the cells do not "feel" insulin well, that is, they do not open well in response to the interaction with it, so sugar from the blood cannot fully penetrate inside (see diagram). level remains high. This state of decreased sensitivity to insulin is called insulin resistance.
Low sensitivity to insulin in diabetes mellitus type 2 You can figuratively imagine that the "keyhole" (scientifically - the insulin receptor) on the cell door is defective, and there is no perfect match with the key - the insulin molecule. It takes more effort (more key, ie more insulin) to overcome the insulin receptor defect. The pancreas cannot supply sufficient amounts of insulin into the blood to overcome insulin resistance and fully normalize blood sugar levels, because in type 2 diabetes mellitus, the ability of β cells is 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 unnoticed by the patient. Therefore, a person can be sick for a long time, but not know it. High blood sugar (glucose) levels may be detected incidentally during a checkup for other reasons.
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 (normal or large amounts, including at night),
- itching of the skin (especially in the perineal area),
- slow wound healing, - frequent infections, - blurred vision.
Diabetic coma develops less often, usually if diabetes mellitus type 2 is accompanied by some other very serious diseases: pneumonia, serious injury, purulent process, heart attack, etc.
Diabetes treatment
Treatment for diabetes varies depending on the type of diabetes.
In type 1 diabetes mellitus, which occurs due to the absolute insufficiency of insulin secretion by the pancreas itself, constant self-monitoring and insulin treatment are necessary to preserve life. It should be emphasized that treatment with externally administered insulin is the only treatment option in this situation. The choice of dose and treatment regimen for diabetes mellitus with insulin is carried out individually, taking into account age, gender, physical activity, and individual sensitivity to insulin.
For type 1 diabetes mellitus sometimes, at the beginning of the disease, after the normalization of blood glucose during the treatment of diabetes mellitus with insulin, the need for it suddenly begins to decrease until it is completely canceled. But this is not recovery. This phenomenon is called the "honeymoon" of diabetes, or scientifically, remission. This is explained by the fact that after blood sugar is normalized with the help of insulin, β-cells that have not died can function for some time. After that, they all die, and the person needs treatment for diabetes mellitus with insulin for life. Anyone who has 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.
Treatment of diabetes mellitus with insulin can be carried out using insulin syringes, pens or insulin pumps.
Insulin pump therapy is an alternative treatment for diabetes in people who often use syringes or pens to inject insulin and regularly measure their blood sugar levels. Insulin pump therapy is used instead of treating diabetes with injections. Pumps are worn on the body or on clothing, for example, on a belt. Currently, about 250 thousand people around the world use insulin pumps.
The main goal of treating type 2 diabetes is to increase the sensitivity of cells to insulin. The cause of poor insulin sensitivity is still not fully understood. However, it has long been known that the most powerful factor in the formation of insulin resistance is excess body weight, i. e. excessive accumulation of fat in the body. Many scientific studies and long-term observation of patients show that weight loss during the treatment of type 2 diabetes in most patients can achieve a significant increase in blood sugar levels.
In type 2 diabetes, normalizing body weight can lead to normalization of blood sugar for a long time, although this cannot be called complete recovery.
If diet and exercise aimed at losing weight do not provide sufficient effect in the treatment of type 2 diabetes, you need to take medication. They are available in tablets. Some of them act on the pancreas, increasing insulin production, while others increase its action (reduce insulin resistance). Therefore, the drugs themselves used to treat type 2 diabetes mellitus do not lower blood sugar, insulin does this, therefore, to obtain the effect of tablets in the treatment of diabetes mellitus, a preserved reserve of pancreatic β cells is required. This explains why it makes no sense to use tablet drugs in the treatment of type 1 diabetes, because most of the β cells have died.
Insulin is often used to treat type 2 diabetes. Insulin treatment for type 2 diabetes mellitus can be prescribed as a temporary measure, for example, during surgery, severe acute illness, or as permanent treatment. That is why it is not currently recommended to call type 2 diabetes mellitus 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.
Diet for diabetes
Despite the common goals in the treatment of various types of diabetes (elimination of symptoms of high blood sugar, minimizing the risk of hypoglycemia, prevention of complications), the dietary patterns for diabetes mellitus type 1 and type 2 differ significantly. There is no single diet plan for diabetes mellitus.
In type 1 diabetes mellitus, an event associated with the death of pancreatic beta cells and insulin deficiency, the main treatment method is insulin replacement therapy, and dietary restrictions, according to modern views, are of an additional nature and should be given only to the extent that insulin therapy differs from insulin production in peoplewhich is healthy.
The basic principles of prescribing a diet for type 1 diabetes mellitus have been subject to critical review in recent years.
One of the principles of a traditional diet for diabetes is the recommendation to consume the same and strict amount of calories every day. Each patient has been assigned a daily calorie requirement based on "ideal body weight. "This is absurd and impossible for the following reasons:
- In a healthy individual of normal weight, the balance between energy intake and expenditure varies greatly from day to day. Energy expenditure in healthy individuals is variable as their physical activity varies. As a result, if you prescribe a type 1 diabetes patient a certain diet with daily consumption of a constant and equal amount of calories, then to maintain a normal body weight, you need to recommend the same and strict physical activity plan. for every day, which is completely unrealistic.
- In patients with type 1 diabetes mellitus with normal body weight and a correctly selected insulin treatment regimen for diabetes mellitus, appetite regulation does not differ from healthy individuals. The fact that they sometimes have to eat to avoid hypoglycemia, even without appetite, is often the result of completely inadequate insulin therapy.
Better treatment regimens for diabetes mellitus using insulin and self-monitoring of metabolism based on blood sugar levels give patients the opportunity to control food intake only depending on hunger and satiety, like healthy people. Therefore, the diet of patients with type 1 diabetes mellitus corresponds to a complete healthy diet (balanced in calories and content of important nutrients). The only difference is that injected insulin does not "know" when or how much you eat. Therefore, you yourself must ensure that the action of insulin corresponds to your diet. Therefore, you need to know the foods that increase your blood sugar.
The main treatment method for 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 essential components that allow you to achieve success.
All food products consist of three components: protein, fat and carbohydrates. All of them contain calories, but not all of them raise blood sugar.
Only carbohydrates have a significant blood sugar-raising effect. What foods contain carbohydrates? It is easy to remember: most products are plant-based, and from animals - only liquid dairy products. It is important that you know whether blood sugar rises after certain foods, and if so, by how much. There are types of carbohydrate foods after which blood sugar either does not rise at all or rises only slightly.
All carbohydrates can be roughly divided into two groups: those containing carbohydrates that are absorbed quickly ("fast") and carbohydrates that are absorbed slowly ("slow"). Products with "fast" carbohydrates contain refined sugar and include preserves and jams, sweets, candies, fruits and fruit juices. "Fast" carbohydrates cause a sudden increase in blood sugar (depending on the amount of food eaten) 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 diabetics, because they take longer to be absorbed. In addition, the absorption of sugar is slowed down by the fiber contained in the food, so the diet during the treatment of diabetes should be enriched with foods rich in fiber.
Here are some simple rules to follow when treating diabetes: food should be taken in small portions and often (4-6 times a day); adhere to the prescribed diet - try not to skip meals; do not overeat - eat as much as your doctor recommends; use bread made from wheat flour or with bran; vegetables (except potatoes and beans) should be eaten every day; 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 activity. Priority should be given to frequent and dosed physical exercise: sudden and intense exercise can cause problems with maintaining normal sugar levels.
If you are an athlete or sportsman, you have no contraindications to playing sports, provided that your blood sugar level is well controlled and all necessary measures are taken to avoid a significant drop.
Prevention of diabetic complications Diabetic patients have a higher risk of complications from the heart and blood vessels (especially in the legs and kidneys). Regular physical activity, sometimes just walking, is enough to prevent blood circulation problems in the legs.
If you have diabetes, untreated foot sores or abrasions can be a serious problem. Even small cuts or scratches on the feet take longer to heal than in non-diabetic patients and require more attention. The key to preventing this problem is wearing the right shoes and checking your feet regularly. Use a mirror if you find it difficult to check all parts of your feet, and remember that foot injuries are often painless at first and may go unnoticed for a long time if you are not careful enough.
Diabetic patients have an 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 avoid complications of diabetes mellitus, it is necessary to undergo preventive treatment 2 times a year.
Blood pressure control is also important. Check your blood pressure regularly. If it increases, your doctor will prescribe treatment for you.