Diabetes

Diabetes mellitus is a metabolic disorder characterized by an increase in blood sugar.

The disease occurs as a result of defects in insulin production, a defect in the action of insulin or both factors. In addition to increasing blood sugar level, the disease manifests itself by the release of sugar in the urine, abundant urination, increased thirst, fat disorders, protein and mineral metabolism and development of complications.

Types

1. Type 1 diabetes (autoimmune, idiopathic): destruction of pancreas beta cells, which produce insulin.
2. Type 2 diabetes mellitus - with the predominant insensitivity of insulin tissues or a predominant defect in insulin production with or without insensitivity.
3. Diabetes gestational sugar occurs during pregnancy.
4. Other types:
• genetic defects;
• Diabetes caused by drugs and other chemicals;
• Diabetes caused by infections;
• Pancreatitis, trauma, pancreas removal, acromegaly, izenko - kushinka, thyrotoxicosis and others.

Gravity

• Easy current: There are no complications.
• Medium degree of gravity: There are damage to the eyes, kidneys, nerves.
• Severe current: complications far from diabetes.

Diabetes symptoms

The main symptoms of the disease include manifestations such as:

• Abundant urination and increased headquarters;
• Increased appetite;
• General weakness;
• Skin lesions (eg vitiligo), vagina and urinary tract are especially observed in patients not restricted as a result of emerging immunodeficiency;
• The confusing vision is caused by changes in eye inversion.

Type 1 diabetes usually starts at an early age.

Type 2 diabetes is usually diagnosed in people over 35 to 40 years old.

Diagnosis of diabetes

The diagnosis of the disease is based on blood and urine tests.

To make a diagnosis, blood glucose concentration is determined (an important circumstance is a repeated determination of an increased level of sugar and other days).

The results of the analysis are normal (in the absence of diabetes)

In 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 Plasma in the Blood - 4-6, 1 mmol/L.

The analysis results in the presence of diabetes mellitus

In an empty stomach:

• venous blood greater than 6, 1 mmol/l;  
• Capillary blood more than 6, 1 mmol/l;  
• Venous blood plasma is greater than 7, 0 mmol/l.

At any time of the day, regardless of the time to eat:

• venous blood greater than 10 mmol/l;  
• Capillary blood greater than 11, 1 mmol/l;  
• Venous blood plasma is greater than 11, 1 mmol/L.

The level of glycated blood hemoglobin in diabetes exceeds 6, 7-7, 5 %.

Peptide C content allows to evaluate the functional state of beta cells. In patients with type 1 diabetes, this level is usually reduced in patients with type 2 diabetes - usually or increased in insulinoma patients - increased markedly.

The concentration of immunoreal insulin is reduced with type 1, usually or increased with type 2.

Determining blood glucose concentration to diagnose diabetes is not performed against the bottom of acute diseases, injury or surgical intervention, against the context of short-term administration of medicines that increase blood glucose concentration (adrenal hormones, thyroid hormones, tiazids, beta-blockers, etc. ), in patients with thiaides. liver.

Urine glucose in diabetes appears only after exceeding the "renal threshold" (approximately 180 mg % 9, 9 mmol/l). Significant threshold fluctuations and a tendency to increase with age are characteristic; Therefore, the definition of glucose in the urine is considered an insensitive and not reliable test. The test serves as a gross reference point for the presence or absence of a significant increase in blood sugar (glucose) and, in some cases, is used for daily observation of disease dynamics.

Diabetes treatment

Physical activity and proper nutrition in treatment

In a significant part of patients with diabetes mellitus, observing eating recommendations and reaching a significant decrease in body weight in 5 to 10 % of the initial blood sugar indicators improve the standard. One of the main conditions is the regularity of physical effort (for example, walking daily 30 minutes, swimming 1 hour 3 times a week). With the concentration of glucose in the blood>13–15 mmol/L, physical activity is not recommended.

With light and moderate physical effort that lasted more than 1 hour, additional carbohydrates are required before and after load (15 g of easily digestible carbohydrates every 40 minutes). With the moderate physical effort that lasted more than 1 hour and intensive sports, it is necessary to reduce by 20 to 50 % of the insulin dose, acting during and next 6 to 12 hours after physical activity.

The diet in the treatment of diabetes (Table 9) aims to normalize carbohydrate metabolism and the prevention of fat metabolism.

Treatment with insulin preparations

Insulin preparations for the treatment of diabetes are divided into 4 categories, by the duration of the action:

• Ultra -koro action (the beginning of the action -after 15 minutes, the duration of the action is 3-4 hours).
• Fast action (the beginning of the action - after 30 min. - 1 hour; action duration 6-8 hours).
• The average duration of the action (the beginning of the action is after 1 to 2, 5 hours, the duration of the action is 14 to 20 hours).
• The long action (the beginning of the action is after 4 hours; the duration of the action is up to 28 hours).

Insulin appointment modes are strictly individual and are selected for each patient with a dialitologist or endocrinologist.

Methodology to introduce insulin

When insulin is introduced at the injection site, it is necessary to form a fold of the skin so that the needle enters the skin and not in muscle tissue. The fold of the skin should be wide, the needle should enter the skin at an angle of 45 ° if the thickness of the skin fold is less than the length of the needle.

When choosing a location for injection, compacted skin areas should be avoided. Injection sites cannot be changed non -systematic. No injections under shoulder skin.

• Short action insulin preparations should be administered in subcutaneous abdomen -wall subcutaneous fat fiber 20 to 30 minutes before eating.
• Long -effect insulin preparations are introduced into the subcutaneous fat fiber of the thighs or buttocks.
• Ultra -Sshort insulin injections are performed immediately before eating and, if necessary, during or immediately after eating.

Heat and physical activity increase the rate of insulin absorption and cold reduces it.