Diabetes mellitus is a group of metabolic diseases characterized by high levels of glucose ("sugar") in the blood.
Why do we need glucose?
The rate of glucose (sugar) in capillary whole 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 meals (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 are "fed" glucose from the blood). The more a cell works, the more energy (glucose) it requires.
Glucose (the expression "blood sugar" is used more often, but this is not entirely true) is constantly circulating in the human blood. There are 2 ways for glucose to enter the human body: - the first is through food containing carbohydrates, - the 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, in order 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 facilities). This happens under the influence of the hormone insulin, which is 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, binds to insulin receptors in muscle, fat or liver cells. Insulin, like a switch, "opens" the cells to allow glucose to enter them, resulting in the normalization of the level of glucose (sugar) in the blood. Between meals and at night, if necessary, glucose enters the blood from the liver's store, 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 appears.
Types of diabetes
Type 1 diabetes mellitus (previously used 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 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 the production of insulin in the pancreas). The development of diabetes mellitus type 1 occurs against the background of a special genetic predisposition (i. e. a person is born with it), which, when exposed to some external factors (for example, viruses), leads to a change in the conditionof the body's immune system. The body of a patient with type 1 diabetes begins to perceive the β-cells of the pancreas as foreign and protects itself from them by producing antibodies (similar to what happens when it protects against infection), leading to the death of the β-cells of the pancreas, which means severe insulin deficiency.
Diabetes mellitus 1 The type develops when at least 90% of the pancreatic β cells die. Let's remember the mechanism of action of insulin, its function as a "switch" that opens the cells to sugar. In type 1 diabetes mellitus, this key has disappeared from the blood (see figure).
Lack of insulin in type 1 diabetes The onset of type 1 diabetes mellitus is acute, always accompanied by severe symptoms of hyperglycemia (high blood sugar): - weight loss (unintentionally the patient loses weight), - constant feelinghunger, - thirst, dry mouth (the patient drinks a lot of liquids, including at night), - frequent urination (in regular 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 diabetic coma often 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 usually detected after the age of 40, although the times ofrecently, according to WHO experts, the average age of patients with diabetes mellitus type 2 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 amounts than usual. Although there are also cases of diabetes mellitus type 2 with reduced secretion of insulin.
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 the sugar from the blood cannot fully penetrate inside (see figure). the level remains elevated. This state of decreased insulin sensitivity is called insulin resistance.
Low sensitivity to insulin in diabetes mellitus type 2 You can figuratively imagine that the "keyholes" (scientifically speaking - insulin receptors) in the doors of cells are deformed and there is no perfect match with the keys - insulin molecules. It takes more effort (more switches, i. e. more insulin) to overcome the insulin receptor defect. The pancreas cannot supply a sufficient amount of insulin to the blood to overcome insulin resistance and completely normalize blood sugar levels, because in type 2 diabetes mellitus, the capabilities of β cells are still limited.
As a result, with type 2 diabetes, a paradoxical situation arises when there is too much 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 a long time, but not know about it. Elevated blood sugar (glucose) levels may be discovered incidentally during a test for another 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, including at night),
- frequent urination (in regular or large quantities, including at night),
- itching of the skin (especially in the perineal area),
- slow wound healing, - frequent infections, - blurred vision.
Diabetic coma develops much less often, usually if type 2 diabetes mellitus is accompanied by some other very serious disease: pneumonia, serious injuries, purulent processes, heart attacks, etc.
Treatment of diabetes
Treatment for diabetes varies depending on the type of diabetes.
In diabetes mellitus type 1, which occurs as a result of an absolute insufficiency of insulin secretion by the pancreas itself, constant self-monitoring and insulin treatment are required to preserve life. It should be emphasized that treatment with externally administered insulin is the only treatment option in this situation. The choice of doses and regimen of treatment 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 begins to decrease suddenly until it is completely canceled. But this is not a cure. This phenomenon is called the "honeymoon" of diabetes, or scientifically, remission. This is explained by the fact that after the normalization of blood sugar with the help of insulin, β-cells that have not yet died can function for some time. Then they all die and the person needs treatment for diabetes mellitus with insulin for life. Anyone who develops type 1 diabetes for the first time should be warned by the doctor about the possible occurrence 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 an insulin pump.
Insulin pump therapy is an alternative treatment for diabetes in people who often use a syringe or pen to inject insulin and measure their blood sugar levels regularly. Instead of treating diabetes with injections, insulin pump therapy is used. The pump is worn on the body or on clothing, for example, on a belt. Currently, about 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, d. m. th. 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 time, although this cannot be called a complete recovery.
If diet and exercise aimed at losing weight do not have a sufficient effect in the treatment of type 2 diabetes, you should turn to medication. They are available in tablets. Some of them act on the pancreas, increasing the production of insulin, while others improve its action (reduce insulin resistance). Thus, the drugs themselves used to treat diabetes mellitus type 2 do not lower blood sugar, insulin does, therefore, to obtain the effect of tablets in the treatment of diabetes mellitus, a preserved reserve of pancreatic β cells is necessary. This makes it clear why it is pointless 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 permanent treatment. This is why it is currently not recommended to call it type 2 non-insulin-dependent diabetes mellitus. 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 (eliminating the symptoms of high blood sugar, minimizing the risk of hypoglycemia, preventing complications), the diet patterns for diabetes mellitus type 1 and type 2 differ significantly. There is no single diet plan for diabetes mellitus.
In diabetes mellitus type 1, the appearance of which is associated with the death of beta cells of the pancreas and lack of insulin, the main method of treatment is insulin replacement therapy, and dietary restrictions, according to modern views, are of an auxiliary nature and should begiven only to the extent that insulin therapy differs from insulin production in a healthy person.
The basic principles of prescribing a diet for type 1 diabetes mellitus have been the subject of a critical review in recent years.
One of the principles of the traditional diet for diabetes is the recommendation to consume the same amount of strictly defined calories every day. Each patient was prescribed a daily calorie requirement based on "ideal weight". This does not make 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 you prescribe a certain diet with a daily intake of a fixed, identical amount of calories to a patient with type 1 diabetes, then to maintain a normal weight, you will need to recommend an equally given plan, strict physical activity. for every day, which is absolutely unrealistic.
- In patients with type 1 diabetes mellitus of normal weight and an insulin treatment regimen appropriately selected 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 most often a consequence of not fully adequate insulin therapy.
Improved treatment regimens for diabetes mellitus using insulin and self-monitoring of metabolism based on blood sugar levels give the patient the opportunity to adjust food intake only depending on the feeling of hunger and satiety, like healthy people. Thus, the diet of a patient with diabetes mellitus type 1 corresponds to a complete healthy 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 must ensure that the action of insulin corresponds to your diet. Therefore, you should know which foods increase blood sugar.
The main method of treatment for type 2 diabetes is to normalize 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 allows you to achieve success.
All food products consist of three components: proteins, fats and carbohydrates. All of them contain calories, but not all of them raise blood sugar.
Carbohydrates alone have a pronounced effect of raising blood sugar. What foods contain carbohydrates? It is easy to remember: most products are plant-based, and from animals - only liquid dairy products. It is important for you to know if your 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 quickly absorbed ("fast") carbohydrates and slowly absorbed ("slow") carbohydrates. "Fast" carbohydrate products contain refined sugars and include preserves and jams, candies, sweets, fruit and fruit juices. "Fast" carbohydrates cause a sharp 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 useful for patients with diabetes, because they take much longer to be absorbed. In addition, the absorption of sugars 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 while treating diabetes: food should be taken in small portions and often (4-6 times a day); respect the established diet - try not to skip meals; do not overdo it - eat as much as your doctor recommends; use wholemeal or bran bread; vegetables (except potatoes and legumes) 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 the body's tissues to insulin and, in this way, helps to reduce blood sugar levels.
Housework, walking and running can be considered physical activity. Preference should be given to regular and dosed physical exercise: sudden and intense exercise can cause problems with maintaining normal sugar levels.
If you are a sportsman or sportswoman, you have no contraindications to playing sports, provided that blood sugar levels are well controlled and all necessary measures are taken to prevent their significant decrease.
Prevention of diabetes complications Patients with diabetes have an increased risk of developing 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, an untreated wound or scratch on your foot can turn into a serious problem. Even minor cuts or scrapes on the feet take longer to heal than in non-diabetic patients and require extra attention. The key to preventing these problems is wearing the right shoes and checking your feet frequently. Use a mirror if you find it difficult to examine all areas of your 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 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 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 for you.