Diabetes mellitus is a group of metabolic diseases characterized by high levels of glucose ("sugar") in the blood.
Why we need glucose
The normal value of glycaemia (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 aftermeals (i. e. 1, 5 -2 hours after the last meal).
Normally, in the human body, glucose is used by the cell as a source of energy (in other words, the body's cells "feed" on blood glucose). The harder a cell works, the more energy (glucose) it requires.
Glucose (the expression "blood sugar" is more often used, but this is not entirely true) constantly circulates in human blood. There are 2 ways through which glucose enters the human body: - the first occurs through foods containing carbohydrates, - the second occurs through the production of glucose by the liver (this is why in diabetes mellitus, even if the patientyou have not eaten anything, your blood glucose level may increase).
However, to be used as energy, glucose from the blood must reach the muscles (to do work), fat tissue, or the liver (the body's glucose storage structure). This occurs under the influence of the hormone insulin, produced by the beta cells of the pancreas. As soon as the blood glucose level rises after a meal, the pancreas immediately releases insulin into the blood, which in turn connects with insulin receptors on muscle, fat or liver cells. Insulin, like a key, "opens" cells to allow glucose to enter, causing the blood glucose (sugar) level to return to normal. Between meals and at night, if necessary, glucose enters the blood from the liver storage, 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.
Types of diabetes
Type 1 diabetes mellitus (formerly called: insulin-dependent diabetes mellitus) develops mainly at a young age (usually before age 30, although type 1 diabetes mellitus can also develop at a later 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 a change in the state of the immune system of thebody. The body of a patient with type 1 diabetes begins to perceive its own pancreatic β-cells as foreign and protects itself from them by producing antibodies (similar to what happens when it protects itself from infections), leading to the death of the pancreatic β-cells, whichmeans severe insulin insufficiency.
Diabetes mellitus 1 The type develops when at least 90% of the β cells in the pancreas 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 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 hyperglycemia (high blood sugar): - weight loss (the patient loses weight involuntarily), - a constant feeling ofhunger, - thirst, dry mouth (the patient drinks a lot of liquids, even at night), - frequent urination (in regular or large portions, even 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 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 for older people: it is detected, as a rule, after the age of 40, although recently, according to WHO experts, the average age of patients with type 2 diabetes mellitus is becoming younger.
About 80% of people with type 2 diabetes are overweight. In addition, 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 type 2 diabetes mellitus with reduced insulin secretion.
The main defect of type 2 diabetes is that the cells do not "feel" insulin well, that is, they do not open well in response to interaction with it, so blood sugar cannot fully penetrate inside (see figureBlood sugar). the level remains high. This state of reduced insulin sensitivity is called insulin resistance.
Low insulin sensitivity in type 2 diabetes mellitus One can figuratively imagine that the "keyholes" (scientifically speaking - insulin receptors) on the doors of cells are deformed and there is no perfect match with the keys - molecules ofinsulin. 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 occurs 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, but not know it. High blood sugar (glucose) levels may be detected by chance during a test for some other reason.
At the same time, there are cases with clear manifestations of hyperglycemia:
- weakness, fatigue, thirst, dry mouth (the patient drinks a lot of liquids, even at night),
- frequent urination (regular or in large quantities, even at night),
- itchy skin (especially in the perineal area),
- slow wound healing, - frequent infections, - blurred vision.
Diabetic coma develops much less frequently, usually if type 2 diabetes mellitus is accompanied by some other very serious disease: pneumonia, serious injuries, suppurative processes, heart attack, etc.
Diabetes treatment
Treatment for diabetes varies depending on the type of diabetes.
In type 1 diabetes mellitus, which occurs due to an absolute failure of insulin secretion by the pancreas, 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 treatment regimens 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 very beginning of the disease, after the normalization of blood sugar during the treatment of diabetes mellitus with insulin, its requirement suddenly begins to decrease until it is completely canceled. But this is not healing. This phenomenon is called the "honeymoon" of diabetes, or, scientifically, remission. This is explained by the fact that after blood sugar has normalized with the help of insulin, β cells that have not yet died can function for some time. Everyone subsequently dies and the person requires lifelong treatment for diabetes mellitus with insulin. Anyone who develops type 1 diabetes for the first time should be warned by their doctor about the possible onset of such a situation and what to do if it happens.
Treatment of diabetes mellitus with insulin can be done using insulin syringes, pens, or an insulin pump.
Pump therapy is an alternative treatment for diabetes in people who heavily use a syringe or pen to inject insulin and regularly measure blood sugar levels. Insulin pump therapy is used instead of treating diabetes with injections. The pump is worn on the body or on clothing, for example on a belt. Currently, approximately 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. obesity. excessive accumulation of fat in the body. Numerous scientific studies and long-term observations of patients show that weight loss during the treatment of type 2 diabetes in most patients can achieve a significant improvement in blood sugar levels.
In type 2 diabetes, normalization of weight can lead to complete normalization of blood sugar for a long period, although this cannot be called complete recovery.
If diet and exercise aimed at weight loss do not provide a sufficient effect in the treatment of type 2 diabetes, it is necessary to resort to medications. They are available in tablets. Some of them act on the pancreas, increasing insulin production, while others improve its action (reduce insulin resistance). Therefore, the drugs 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 β cells is neededpancreatic. This clarifies why it makes no sense to use tablet drugs 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 as a temporary measure, for example during surgery, severe acute illness, or as a permanent treatment. This is why it is currently not recommended to define 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.
Diet for diabetes
Despite the common goals in the treatment of different types of diabetes (elimination of symptoms of high blood sugar levels, minimization of the risk of hypoglycemia, prevention of complications), dietary patterns for type 1 and type 2 diabetes mellitus differ insignificant way. There is no single diet plan for diabetes mellitus.
In type 1 diabetes mellitus, the onset of which is associated with the death of pancreatic beta cells and insulin deficiency, the main method of treatment is insulin replacement therapy, and dietary restrictions, according to modern views, are auxiliary in natureand should be given only to the extent that insulin therapy differs from insulin production in a healthy person.
The fundamental principles of prescribing a diet for type 1 diabetes mellitus have been subject to critical revisions in recent years.
One of the principles of the traditional diabetes diet is the recommendation to consume an identical and strictly defined amount of calories every day. Each patient was prescribed a daily calorie requirement based on "ideal weight. "This makes no sense and is impossible for the following reasons:
- In healthy individuals of normal weight, the balance between energy intake and expenditure varies greatly from day to day. Energy expenditure in healthy individuals is variable because their physical activity is variable. Consequently, if a certain diet with a daily consumption of a fixed and identical quantity of calories was prescribed to a patient suffering from type 1 diabetes, then to maintain a normal weight an equally rigorous and equally given physical activity program would need to be recommended. for every day, which is absolutely unrealistic.
- In patients with type 1 diabetes mellitus with normal weight and a properly 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 prevent hypoglycemia, even in the absence of appetite, is very often a consequence of not entirely adequate insulin therapy.
Improved treatment regimens for diabetes mellitus using insulin and self-monitoring of metabolism based on blood sugar levels provide the patient with the opportunity to adjust food intake only based on feelings of hunger and satiety, such ashealthy people. Therefore, the diet of a patient with type 1 diabetes mellitus corresponds to a healthy and complete diet (balanced in calories and content of essential nutrients). The only difference is that injected insulin doesn't "know" when or how much you eat. Therefore, you yourself need to make sure that the action of insulin corresponds to your diet. Therefore, you need to know which foods increase your blood sugar level.
The main method of treatment 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 significant components that enables you to achieve success.
All food products are made up of three components: proteins, fats and carbohydrates. They all contain calories, but not all raise blood sugar.
Only carbohydrates have a pronounced blood sugar-raising effect. What foods contain carbohydrates? It's easy to remember: most products are of plant origin, and of animal origin - only liquid dairy products. It is important to know whether blood sugar rises after certain foods and, if so, by how much. There are types of carbohydrate foods after which blood sugar does not increase at all or increases only slightly.
All carbohydrates can be roughly divided into two groups: those containing fast-absorbing ("fast") carbohydrates and slow-absorbing ("slow") carbohydrates. "Fast" carbohydrate products contain refined sugars and include preserves and jams, sweets, sweets, fruit and fruit juices. "Fast" carbohydrates cause a sharp increase in blood sugar (depending on the amount of food consumed) because they are quickly absorbed into the blood, so it is better to exclude them from the diabetes diet. "Slow" carbohydrates are much more useful for patients with diabetes, because they take much longer to be absorbed. Furthermore, the absorption of sugars is slowed down by the fibers contained in foods, so the diet when treating diabetes should be enriched with foods rich in fibre.
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 established diet - try not to skip meals; do not eat too much: eat as much as your doctor recommends; use wholemeal or bran flour bread; vegetables (except potatoes and legumes) should be consumed daily; Avoid eating "fast" carbohydrates.
Exercise for diabetes Exercise in the treatment of diabetes is very important: it increases the sensitivity of body tissues to insulin and, therefore, helps reduce blood sugar levels.
Housework, walking and jogging can be considered physical activity. Preference should be given to regular, dosed physical exercise: sudden and intense exercise can cause problems with maintaining normal sugar levels.
If you are an athlete or sportswoman, you have no contraindications to practicing sports, provided that your blood sugar levels are well controlled and all necessary measures are taken to avoid a significant decrease.
Prevention of diabetes complications Patients with diabetes are at increased risk of developing complications in the heart and blood vessels (especially in the legs and kidneys). Regular physical activity, sometimes even just walking, is enough to prevent circulatory problems in the feet.
If you have diabetes, an untreated wound or abrasion on your foot can turn into a serious problem. Even small cuts or scrapes on the feet take longer to heal than in patients without diabetes and require more attention. The key to preventing these problems is to wear appropriate shoes and check your feet frequently. Use a mirror if you find it difficult to examine all areas of the feet, and remember that foot injuries are often painless at first and can go unnoticed for a long time if you are not careful enough.
Patients with diabetes are at increased risk of kidney dysfunction and heart disease several years after diagnosis. There is clear evidence that good blood sugar control reduces this risk. In addition, to prevent 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 is elevated, your doctor will prescribe treatment.