Diabetes - a metabolic disorder characterized by high blood sugar.
The disease results from defects in insulin production, insulin action deficiency or both. In addition to elevated levels of blood sugar, the disease appears the release of sugar in the urine, copious urination, increased thirst, disturbances of lipid, protein and mineral metabolism and the development of complications.
types
1. Diabetes mellitus type 1 (autoimmune idiopathic): destruction of the pancreatic beta cells which produce insulin.
2. Diabetes mellitus type 2 - with advantageous insensitivity to insulin or primary defect in insulin insensitivity with or without tissue.
3. Gestational diabetes It occurs during pregnancy.
4. Other types:
- genetic defects;
- diabetes, induced by drugs and other chemicals;
- diabetes, induced infections;
- pancreatitis, Trauma, excision of the pancreas, acromegaly, Cushing's syndrome - Cushing syndrome, hyperthyroidism and other.
The degree of severity
- mild course: there are no complications.
- the average degree of severity: have eye disease, kidney disease, nerve.
- severe course: an advanced complications of diabetes.
Symptoms of diabetes
The main symptoms of the disease include manifestations such as:
- Copious urination and excessive thirst;
- Increased appetite;
- General weakness;
- skin lesions (e.g. vitiligo), Vaginal and urinary tract is particularly often observed in untreated patients as a result of occurring immunodeficiency;
- Blurred vision caused by changes in photorefractive media eye.
Diabetes mellitus type 1 usually starts at a young age.
Type 2 diabetes is usually diagnosed in people older than 35-40 years.
Diagnosis of diabetes
Diagnosis of the disease is based on blood and urine.
To determine the diagnosis blood glucose concentration (Important point - re-determination of elevated levels of sugar and on other days).
Results of the analysis normally (in the absence of diabetes)
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.
Results of the analysis in the presence of diabetes
fasting:
- venous blood of more than 6.1 mmol / l;
- capillary blood over 6.1 mmol / l;
- Venous blood plasma over 7.0 mmol / l.
At any time of the day regardless of the meal:
- venous blood over 10 mmol / l;
- capillary blood more than 11.1 mmol / l;
- Venous blood plasma over 11.1 mmol / L.
Level glycated hemoglobin blood in diabetes exceed 6.7-7.5%.
Content C-peptide to evaluate the functional state of the beta cells. In patients with diabetes type 1 diabetes, this level is typically reduced in patients with diabetes mellitus type 2 - in normal or elevated in patients with insulinoma - sharply increased.
The concentration of immunoreactive insulin in type 1 reduced, normal or elevated in type 2.
Determination of blood glucose concentrations for the diagnosis of diabetes is not carried out against the background of an acute illness, injury or surgery, against the background of short receiving drugs that increase the concentration of glucose in the blood (adrenal gland hormones, thyroid hormones, thiazides, beta-blockers, etc.), in patients from cirrhosis of the liver.
Glucose in the urine diabetes appears only after exceeding "renal threshold" (approximately 180% mg 9.9 mmol / l). Characterized by significant variations in threshold and a tendency to increase with age; therefore, the determination of glucose in urine is considered insensitive and unreliable test. The test is a rough guide of 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 monitoring of the dynamics of the disease.
Treatment of diabetes
Physical exercise and proper nutrition in the treatment of
A significant portion of patients with diabetes who keep the dietary recommendations and reached a significant reduction in body weight by 5-10% of the original, glycemic control is improved by up to norm. One of the main conditions - regular exercise (such as walking 30 minutes daily swimming for 1 hour 3 times a week). When blood glucose concentration> 13-15 mmol / l sporting not recommended.
In mild and moderate physical stress of not more than 1 chasa requires supplementation of carbohydrates before and after the load (15 g digestible carbohydrates per 40 minutes. loads). At moderate physical exercise longer than 1 hour and vigorous sports must decrease by 20-50% of the dose of insulin acting during and subsequent 6-12 hours. after exercise.
Diet in the treatment of diabetes mellitus (Table №9) is aimed at the normalization of carbohydrate metabolism and prevent fat metabolism disorders.
For more information about the principles of nutrition in diabetes in our separate article.
insulin preparations Treatment
Insulin preparations for the treatment of diabetes are divided into 4 categories, according to the duration:
- Ultrashort action (onset of action - after 15 minutes, duration - 3-4 h..): Insulin lispro, insulin aspart.
- Fast action (onset of action - 30 min.-1 hr.; duration of action of 6-8 hr.).
- Average duration of action (onset of action - after 1-2.5 hours, duration 14-20 hours..).
- Prolonged action (onset of action - after 4 h.; duration of action up to 28 hours.).
Insulin regimen strictly individual and are chosen for each patient-physician diabetologist or endocrinologist.
Method insulin
With the introduction of insulin in the injection site is necessary to form a skin fold, to lower the needle into the skin rather than into muscle tissue. Skinfold should be wide, the needle must be included in the skin at an angle of 45 °, if the thickness of the skin fold less than the needle length.
When selecting the site of injection should be avoided compacted skin. Injection sites should not be changed haphazardly. Should not be made an injection under the skin of the shoulder.
- The preparations of short-acting insulin should be injected into the subcutaneous adipose tissue of the front wall of the abdomen for 20-30 minutes before meals.
- long-acting insulin preparations are administered into the subcutaneous fat of hips and buttocks.
- Injection-acting insulin (Humalog or NovoRapid) is carried out immediately before the meal, and if necessary - during or immediately after eating.
Heat and exercise increase the rate of insulin absorption and reduces its cold.
