Diabetes is a group of metabolic diseases characterized by high levels of glucose ("sugar") in the blood.
Why do we need glucose?
The norm of blood sugar (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 7. 8 mmol/l after a meal (i. e. 1. 5-2 hours afterafter 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 glucose from the blood). The more a cell works, the more energy (glucose) it needs.
Glucose (the term "blood sugar" is more often used, but this is not entirely true) circulates continuously in the human blood. Glucose can enter the human body in two ways: - the first is through food containing carbohydrates, - the second is the production of glucose by the liver (this is the reasonthat in diabetes mellitus, even if the patient has not eaten anything, the blood sugar level can rise).
However, in order for glucose from the blood to be used as energy, it must go to the muscles (for work), adipose tissue, or the liver (the body's glucose store). This occurs under the influence of the hormone insulin, which is produced by the beta cells of the pancreas. As soon as blood sugar levels rise 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 key, "opens" cells to allow glucose to enter, resulting in blood glucose (sugar) levels returning to normal. Between meals and at night, when needed, glucose is released from liver storage into the blood, so at night, insulin regulates the liver so that it does not release too much glucose into the blood.
If there is a violation at any stage of the process, diabetes occurs.
Types of diabetes
Type 1 diabetes mellitus (previous 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 later).
Type 1 diabetes is caused by the cessation of insulin production in the pancreas due to the destruction of β-cells (which are responsible for the production of insulin 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 certain external factors (for example, viruses), leads to a change in the state of the body. 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 defends against them by producing antibodies (similar to the defense against infection), which leads to the destruction of the β-cells of the pancreas. severe insulin deficiency.
Diabetes 1 type is formed when at least 90% of the β-cells of the pancreas are destroyed. Let's recall the mechanism of action of insulin, its function as the "key" that opens the cells to sugar. In type 1 diabetes mellitus, this key has disappeared from the blood (see diagram).
Insulin deficiency in type 1 diabetes mellitus The development of type 1 diabetes mellitus is accompanied by symptoms of acute, always severe hyperglycemia (high blood sugar level): - weight loss (the patient loses weight involuntarily), - a constant feeling of hunger, - thirst, dry mouth (the patient drinks a lot of fluids, also at night), - frequent urination (regular or in large doses, also at night), - weakness.
If you do not consult a doctor in time and start treating type 1 diabetes with insulin, the condition worsens and very often a diabetic coma develops.
Type 2 diabetes mellitus (formerly insulin-dependent diabetes mellitus) is much more common than type 1 diabetes mellitus. The occurrence of type 2 diabetes is characteristic of the elderly: it is usually detected after the age of 40, although recently, according to WHO experts, the average age of patients with type 2 diabetes mellitus is getting younger.
About 80% of people with type 2 diabetes are overweight. Type 2 diabetes is also characterized by heredity, which occurs with a high frequency among close relatives.
In type 2 diabetes, the pancreas continues to produce insulin, often in greater amounts 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 to interact with it, so the sugar from the blood cannot fully penetrate (see the diagram). Its level remains high. The state of reduced sensitivity to insulin is called insulin resistance.
Low insulin sensitivity in type 2 diabetes mellitus It is hypothetically possible that the "keyholes" on the cell doors (scientifically speaking - insulin receptors) are deformed and there is no perfect match with the keys - insulin molecules. More effort (more keys, i. e. more insulin) is needed for the insulin receptorThe pancreas cannot deliver enough insulin to the blood to overcome insulin resistance andfor the complete normalization of blood sugar, because in type 2 diabetes mellitus, the abilities of β-cells are still limited.
As a result, in the case of 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, begins gradually, often completely unnoticed by the patient. Therefore, a person can be sick for quite a long time, but not know about it. Elevated blood sugar (glucose) can also be detected accidentally during a test for another reason.
However, there are cases where there are clear manifestations of hyperglycemia:
- weakness, fatigue, thirst, dry mouth (the patient drinks a lot of fluids, even at night),
- frequent urination (regular or large amounts, including at night),
- skin itching (especially in the perineal area),
- slow wound healing, - frequent infections, - blurred vision.
Diabetic coma develops much less often, usually when type 2 diabetes mellitus is accompanied by other very serious diseases: pneumonia, serious injury, purulent processes, heart attack, etc.
Treatment of diabetes
Treatment for diabetes varies depending on the type of diabetes.
In type 1 diabetes mellitus, which occurs due to the absolute insufficiency of the insulin secretion of one's own pancreas, continuous self-monitoring and insulin treatment are necessary in order to preserve life. It should be emphasized that in this situation, treatment with externally administered insulin is the only treatment option. The selection of insulin doses and regimens for diabetes is made individually, taking into account age, gender, physical activity and individual insulin sensitivity.
In case of type 1 diabetes mellitus sometimes, at the beginning of the disease, after the normalization of the blood sugar level during the insulin treatment of diabetes mellitus, it starts to decrease suddenly until it disappears completely. But this is not recovery. This phenomenon is called the "honeymoon" of diabetes, or scientifically called remission. This can be explained by the fact that after the blood sugar level has been normalized with the help of insulin, the β-cells that have not yet died can function for a while. After that, they all die, and the patient has to be treated with insulin for the rest of his lifeIf you develop type 1 diabetes for the first time, your doctor should warn you about the possible occurrence of this situation and what to do in such cases.
Diabetes mellitus can be treated with insulin using an insulin syringe, pen or insulin pump.
Insulin pump therapy is an alternative treatment for diabetes in people who use a syringe or pen to inject insulin and measure their blood sugar regularly. Insulin pump therapy is used instead of treating diabetes with injections. The pump should be worn on the body or on clothing such as a belt. Currently, around 250, 000 people worldwide use insulin pumps.
The main goal of type 2 diabetes treatment is to improve the cells' insulin sensitivity. The causes of poor insulin sensitivity are not yet fully understood. However, it has long been known that the most powerful factor in the development of insulin resistance is excess weight, i. e. excessive accumulation of fat in the body. Numerous scientific studies and long-term follow-up of patients show that weight loss during the treatment of type 2 diabetes can lead to significant improvements in blood sugar levels in most patients.
In type 2 diabetes, the normalization of body weight can lead to a complete normalization of blood sugar levels for a long time, although this cannot be called a complete recovery.
If diet and exercise aimed at losing weight do not provide an adequate effect in the treatment of type 2 diabetes, then medical treatment must be resorted to. They are available in tablets. Some act on the pancreas, increasing insulin production, while others improve its effect (reduce insulin resistance). Thus, the drugs used to treat type 2 diabetes mellitus themselves do not lower the blood sugar level, insulin does, therefore, in order to achieve the effect of the tablets in the treatment of diabetes, a preserved reserve of β-cells of the pancreas is needed. This makes it clear why it is pointless to use pills to treat type 1 diabetes, because most of the β-cells have already died.
Insulin is often used to treat type 2 diabetes. Insulin treatment for type 2 diabetes mellitus may be prescribed as a temporary measure, such as surgery, for severe acute illnesses, or as permanent treatment. That is why it is currently not recommended to call type 2 diabetes mellitus 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 (eliminating the symptoms of high blood sugar, minimizing the risk of hypoglycemia, preventing complications), the nutritional habits of type 1 and type 2 diabetes mellitus differ significantly. There is no single diet for the treatment of diabetes.
In type 1 diabetes mellitus, the occurrence of which is associated with the destruction of the beta cells of the pancreas and insulin deficiency, the main treatment method is insulin replacement therapy, and dietary restrictions are, according to today's views, auxiliary orit should only be given to the extent that the insulin therapy differs from the insulin production of a healthy person.
The principles of prescribing a diet for patients with type 1 diabetes mellitus have been subjected to critical review in recent years.
One of the basic principles of the traditional diet for diabetes is the daily consumption of a strictly defined, equal amount of calories. All patients were prescribed a daily calorie requirement based on their "ideal body weight". This makes no sense and is impossible for the following reasons:
- In healthy individuals of normal weight, the balance between energy intake and energy expenditure varies greatly from day to day. Energy expenditure in healthy individuals varies as their physical activity varies. Consequently, if you prescribe a specific diet for a patient with type 1 diabetes, with a fixed daily caloric intake, you should prescribe an equally rigorous physical activity plan to maintain a normal body weight. for every day, which is absolutely unrealistic.
- Appetite control of patients with type 1 diabetes mellitus, of normal body weight and with an insulin treatment regimen appropriately selected for diabetes mellitus does not differ from that of healthy individuals. The fact that they are sometimes forced to eat even in the absence of appetite to prevent hypoglycemia is most often the result of inadequate insulin therapy.
The improved treatment regimen for diabetes mellitus using insulin and self-monitoring of metabolism based on blood sugar levels gives the patient the opportunity to regulate food intake only depending on the feeling of hunger and satiety, just like healthy people. Thus, the diet of a patient with type 1 diabetes mellitus corresponds to a full-fledged healthy diet (balanced calorie and essential nutrient content). The only difference is that the injected insulin does not "know" when and how much you eat. Therefore, you yourself must ensure that the effect of the insulin corresponds to your diet. Therefore, you need to know which foods increase your blood sugar.
The main treatment for type 2 diabetes is to normalize body weight through a low-calorie diet and increased physical activity. The type 2 diabetes diet is very important, it is one of the significant components that allow you to achieve success.
All food products consist of three components: proteins, fats and carbohydrates. 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 plant-based and animal-based - only liquid dairy products. It is important to know whether your blood sugar levels rise after certain foods, and if so, by how much. There are carbohydrate-containing foods after which the blood sugar level either does not rise at all or only slightly.
All carbohydrates can be roughly divided into two groups: rapidly absorbed ("fast") and slowly absorbed ("slow") carbohydrates. Products containing "fast" carbohydrates contain refined sugars, including preserves and jams, candies, sweets, fruits and fruit juices. "Fast" carbohydrates cause a sharp rise in blood sugar (depending on the amount of food eaten) because they are quickly absorbed into the blood, thereforeit is better to exclude them from the diabetes diet. "Slow" carbohydrates are much more beneficial for diabetics, as they take much longer to absorb. In addition, the absorption of sugars is slowed down by the fibers in food, so when treating diabetes, the diet should be enriched with fiber-rich foods.
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 overeat - eat as much as your doctor recommends; use bread made from wholemeal flour or bran; vegetables (except potatoes and legumes) must be eaten daily; Avoid eating "fast" carbohydrates.
Exercise in case of diabetes Exercise is very important in the treatment of diabetes: it increases the sensitivity of the body's tissues to insulin, thereby helping to lower blood sugar levels.
Housework, walking and jogging are considered physical activities. Preference should be given to regular and dosed exercise: sudden and intense exercise can cause problems in maintaining normal sugar levels.
If you are an athlete or athlete, there are no contraindications to exercise, provided that your blood sugar level is well controlled and all necessary measures are taken to prevent it from falling significantly.
Prevention of diabetes complications Diabetic patients have an increased risk of developing cardiovascular complications (especially in the legs and kidneys). Regular physical activity, sometimes just walking, is enough to prevent leg circulation problems.
If you have diabetes, an untreated wound or abrasion on your foot can become a serious problem. Even minor cuts or scrapes on the feet take longer to heal than in diabetics and require extra attention. The key to preventing these problems is wearing well-fitting shoes and checking your feet frequently. Use a mirror if you find it difficult to examine all parts of your foot, and remember that foot injuries are often painless at first and can go unnoticed for a long time if you are not careful enough.
Diabetes patients have an increased risk of kidney failure and heart disease several years after diagnosis. There is good evidence that good blood sugar control reduces this risk. In addition, preventive treatment should be carried out twice a year to prevent complications of diabetes mellitus.
Controlling blood pressure is also important. Check your blood pressure regularly. If it is elevated, your doctor will prescribe treatment for you.