Diabetes mellitus is a metabolic disorder characterized by an increase in the sugar content of the blood.
The disease results from defects in insulin production, a defect in the action of insulin, or both. In addition to elevated blood sugar, the disease is manifested by the release of sugar in the urine, excessive urination, increased thirst, impaired fat, protein and mineral metabolism and the development of complications.
- Type 1 diabetes mellitus (autoimmune, idiopathic): the destruction of pancreatic beta cells that produce insulin.
- Type 2 diabetes mellitus – with predominant insensitivity of tissues to insulin or a predominant defect of insulin production with insensitivity of tissues or without it.
- Gestational diabetes occurs during pregnancy.
- Other types:
- genetic defects;
- diabetes caused by drugs and other chemicals;
- diabetes caused by infections;
- pancreatitis, trauma, removal of the pancreas, acromegaly, Itsenko-Cushing syndrome, thyrotoxicosis, and others.
mild course: no complications.
moderate severity: there is damage to the eyes, kidneys, nerves.
severe course: advanced complications of diabetes.
The main symptoms of the disease include such manifestations as:
- Excessive urination and increased thirst;
- Increased appetite;
- General weakness;
- Skin lesions (for example, vitiligo), the vagina and urinary tract are especially often observed in untreated patients as a result of the resulting immunodeficiency;
- Blurred vision is caused by changes in the light refractive media of the eye.
Type 1 diabetes usually begins at a young age.
Type 2 diabetes mellitus is usually diagnosed in people over 35–40 years old.
Diagnosis of the disease is carried out on the basis of blood and urine tests.
For diagnosis, determine the concentration of glucose in the blood (an important circumstance – re-determination of elevated sugar levels and on other days).
The results of the analysis are normal (in the absence of diabetes)
On an empty stomach or 2 hours after the test:
- venous blood – 3.3–5.5 mmol / l;
- capillary blood – 3.3–5.5 mmol / l;
- venous blood plasma – 4–6.1 mmol / l.
The results of the analysis in the presence of diabetes
On an empty stomach:
- venous blood more than 6.1 mmol / l;
- capillary blood more than 6.1 mmol / l;
- venous blood plasma is more than 7.0 mmol / l.
At any time of the day, regardless of meal times:
- venous blood more than 10 mmol / l;
- capillary blood more than 11.1 mmol / l;
- venous blood plasma is more than 11.1 mmol / l.
- The level of glycated blood hemoglobin in diabetes exceeds 6.7–7.5%.
The content of C-peptide allows to evaluate the functional state of beta cells. In patients with type 1 diabetes, this level is usually lowered, in patients with type 2 diabetes mellitus – normal or elevated, in patients with insulinoma – dramatically increased.
The concentration of immunoreactive insulin is reduced with type 1, normal or elevated with type 2.
Determination of glucose concentration in the blood for the diagnosis of diabetes mellitus is not performed on the background of an acute illness, injury or surgical intervention, on the background of short-term use of drugs that increase the concentration of glucose in the blood (adrenal hormones, thyroid hormones, thiazides, beta-blockers, etc.), patients with cirrhosis of the liver.
Glucose in the urine in diabetes mellitus appears only after exceeding the “renal threshold” (approximately 180 mg% 9.9 mmol / l). Characterized by significant fluctuations in the threshold and a tendency to increase with age; therefore, the determination of urine glucose is considered an insensitive and unreliable test. The test serves as a rough guide to the presence or absence of a significant increase in the level of sugar (glucose) in the blood and in some cases is used for daily observation of the dynamics of the disease.
Exercise and proper nutrition during treatment
A significant proportion of diabetics who comply with dietary recommendations and have achieved a significant reduction in body weight by 5-10% of the original, improves blood sugar levels up to the norm. One of the main conditions is regular physical activity (for example, walking daily for 30 minutes, swimming for 1 hour 3 times a week). When the concentration of glucose in the blood> 13-15 mmol / l exercise is not recommended.
For mild and moderate physical exertion with a duration of not more than 1 hour, additional carbohydrate intake is required before and after exercise (15 g of easily digestible carbohydrates for every 40 min. Loads). With moderate physical exertion lasting more than 1 hour and intensive sports, it is necessary to reduce by 20–50% the dose of insulin acting during and in the next 6–12 hours after exercise.
Diet in the treatment of diabetes (table number 9) is aimed at the normalization of carbohydrate metabolism and the prevention of disorders of fat metabolism.
Learn more about the principles of nutrition in diabetes in our separate article.
- Insulin preparations for the treatment of diabetes mellitus are divided into 4 categories, according to the duration of action:
- Ultrashort action (onset of action – after 15 minutes, the duration of action – 3-4 hours): insulin LizPro, insulin aspart.
- Quick action (onset of action – after 30 minutes – 1 hour; duration of action is 6–8 hours).
- The average duration of action (onset of action – after 1–2.5 hours, the duration of action is 14–20 hours).
- Long-acting (onset of action – after 4 hours; duration of action up to 28 hours).
- Regimens for prescribing insulin are strictly individual and are selected for each patient by a diabetologist or endocrinologist.
Insulin Injection Technique
When insulin is injected at the injection site, a skin fold must be formed so that the needle goes under the skin and not into the muscle tissue. The skin fold should be wide, the needle should enter the skin at a 45 ° angle if the skin fold thickness is less than the needle length.
When choosing an injection site, avoid tight skin areas. Injection sites can not be changed haphazardly. Do not make injections under the skin of the shoulder.
Preparations of short-acting insulin should be injected into the subcutaneous fatty tissue of the anterior abdominal wall 20-30 minutes before a meal.
Long-acting insulin preparations are injected into the subcutaneous fatty tissue of the thighs or buttocks.
Ultrashort-acting insulin injections (humalog or Novorapid) are injected directly before meals, and, if necessary, during or immediately after a meal.
Heat and exercise increase the rate of insulin absorption, and cold reduces it.