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Diabetes. Morphology of diabetes

Introduction

Concept and types

Etiology and pathogenesis

diet therapy

Laboratory research

Risk factors and prognosis

Diagnostics and differential diagnosis

Complications

Symptoms and signs

Prevention

Dispensary observation of patients with diabetes mellitus

Pathological anatomy of diabetes

Diabetic coma and treatment

Conclusion

Literature

Introduction

Diabetes- a disease caused by absolute or relative insufficiency of insulin and characterized by a gross violation of carbohydrate metabolism with hyperglycemia and glycosuria, as well as other metabolic disorders.

In etiology, hereditary predisposition, autoimmune, vascular disorders, obesity, mental and physical trauma, viral infections.

With absolute insulin deficiency, the level of insulin in the blood decreases due to a violation of its synthesis or secretion by beta cells of the islets of Langerhans. Relative insulin deficiency may be the result of a decrease in insulin activity due to its increased protein binding, increased destruction by liver enzymes, the predominance of the effects of hormonal and non-hormonal insulin antagonists (glucagon, adrenal hormones, thyroid gland, growth hormone, unesterified fatty acids), changes in the sensitivity of insulin-dependent tissues to insulin.

Insulin deficiency leads to a violation of carbohydrate, fat and protein metabolism. Decreased permeability to glucose cell membranes in fat and muscle tissue, glycogenolysis and gluconeogenesis increase, hyperglycemia, glycosuria occur, which are accompanied by polyuria and polydipsia. The formation of fats decreases and the breakdown of fats increases, which leads to an increase in the level of ketone bodies in the blood (acetoacetic, beta-hydroxybutyric and the condensation product of acetoacetic acid - acetone). This causes a shift in the acid-base state towards acidosis, promotes increased excretion of potassium, sodium, magnesium ions in the urine, and disrupts kidney function.

Significant fluid loss due to polyuria leads to dehydration. Increased excretion of potassium, chlorides, nitrogen, phosphorus, calcium from the body.

Concept and types.

Diabetes- This endocrine disease, characterized by a chronic increase in blood sugar levels due to an absolute or relative deficiency of insulin, a hormone of the pancreas. The disease leads to a violation of all types of metabolism, damage to blood vessels, the nervous system, as well as other organs and systems.

Classification

Distinguish:

.Insulin-dependent diabetes (type 1 diabetes) develops mainly in children and young people;

.Non-insulin-dependent diabetes (type 2 diabetes) usually develops in people over 40 years of age who have overweight. This is the most common type of disease (occurs in 80-85% of cases);

.Secondary (or symptomatic) diabetes mellitus;

.Pregnancy diabetes.

.Diabetes due to malnutrition

At type 1 diabetesthere is an absolute deficiency of insulin due to a violation of the pancreas.

At type 2 diabetesnoted relative deficiency of insulin. The cells of the pancreas at the same time produce enough insulin (sometimes even an increased amount). However, on the surface of cells, the number of structures that ensure its contact with the cell and help glucose from the blood to enter the cell is blocked or reduced. The lack of glucose in the cells is a signal for even more insulin production, but this has no effect, and over time, insulin production decreases significantly.

Etiology and pathogenesis

Hereditary predisposition, autoimmune, vascular disorders, obesity, mental and physical trauma, and viral infections matter.

Pathogenesis

1.insufficient production of insulin by the endocrine cells of the pancreas;

2. Violation of the interaction of insulin with the cells of body tissues (insulin resistance<#"justify">There is a hereditary predisposition to diabetes. If one of the parents is sick, then the probability of inheriting type 1 diabetes is 10%, and type 2 diabetes is 80%

diet therapy

correct diet food with diabetesIt has essential. By choosing the right diet for mild (and often moderate) form of type 2 diabetes, you can minimize drug treatment, or even do without it.

Recommendeduse in diabetes following products:

· Bread - up to 200 grams per day, mostly black or special diabetic.

· Soups, mostly vegetable. Soups cooked in a weak meat or fish broth can be consumed no more than twice a week.

· Lean meat, poultry (up to 100 grams per day) or fish (up to 150 grams per day) in boiled or aspic form.

· Dishes and side dishes from cereals, legumes, pasta can be afforded occasionally, in small quantities, reducing the consumption of bread these days. Of the cereals, it is better to use oatmeal and buckwheat, millet, barley, rice cereals are also acceptable. But semolina is better to exclude.

· Vegetables and greens. Potatoes, beets, carrots are recommended to consume no more than 200 grams per day. But other vegetables (cabbage, lettuce, radishes, cucumbers, zucchini, tomatoes) and greens (except spicy) can be consumed almost without restrictions in raw and boiled form, occasionally in baked.

· Eggs - no more than 2 pieces per day: soft-boiled, in the form of an omelet or used in the preparation of other dishes.

· Fruits and berries of sour and sweet and sour varieties (Antonovka apples, oranges, lemons, cranberries, red currants ...) - up to 200-300 grams per day.

· Milk - with the permission of a doctor. Sour-milk products (kefir, curdled milk, unsweetened yogurt) - 1-2 glasses a day. Cheese, sour cream, cream - occasionally and a little bit.

· Cottage cheese for diabetes is recommended to be consumed daily, up to 100-200 grams per day in its natural form or in the form of cottage cheese, cheesecakes, puddings, casseroles. Cottage cheese, as well as oatmeal and buckwheat porridge, bran, rose hips improve fat metabolism and normalize liver function, prevent fatty changes in the liver.

· Beverages. Green or black tea is allowed, it is possible with milk, weak coffee, tomato juice, juices from berries and fruits of sour varieties.

Eating with diabetesit is necessary at least 4 times a day, and better - 5-6 times, at the same time. Food should be rich in vitamins, micro and macro elements. Try to diversify your diet as much as possible, because the list of foods allowed for diabetes is not at all small.

Restrictions

§ First of all, and this is unlikely to be a discovery for anyone, with diabetes, it is necessary to limit the intake of easily digestible carbohydrates. These are sugar, honey, jams and jams, sweets, muffins and other sweets, sweet fruits and berries: grapes, bananas, raisins, dates. Often there are even recommendations to completely eliminate these foods from the diet, but this is really necessary only in severe diabetes. With mild and moderate, subject to regular monitoring of blood sugar levels, the use of a small amount of sugar and sweets is quite acceptable.

§ Not so long ago, as a result of a number of studies, it was found that an increased content of fats in the blood contributes greatly to the progression of diabetes. Therefore, limiting the use fatty foods in diabetes, it is no less important than limiting sweets. Total fats used in free form and for cooking (butter and vegetable oil, lard, cooking fats), should not exceed 40 grams per day, it is also necessary to limit the consumption of other foods containing a large amount of fat (fatty meat, sausages, sausages, sausages, cheeses, sour cream, mayonnaise) as much as possible.

§ It is also necessary to seriously limit, and it is better not to use fried, spicy, salty, spicy and smoked dishes, canned food, peppers, mustard, alcoholic beverages at all.

§ And foods that contain a lot of fats and carbohydrates at the same time are absolutely not good for those suffering from diabetes: chocolate, ice cream, cream cakes and cakes ... It is better to completely exclude them from the diet.

Laboratory research

Fasting blood glucose testing<#"justify">Risk factors and prognosis

The risk factors for type 1 diabetes include heredity. If the child has genetic predisposition to the development of diabetes mellitus, it is almost impossible to prevent the course of undesirable events.

Type 2 diabetes risk factors

Unlike type 1 diabetes, type 2 diabetes is due to the characteristics of the life and nutrition of the patient. Therefore, if you know the risk factors for type 2 diabetes, and try to avoid many of them, even with aggravated heredity, you can reduce the risk of developing this disease to a minimum.

Risk factors for type 2 diabetes:

· the risk of developing diabetes increases if the next of kin is diagnosed with this disease;

· age over 45;

Presence of insulin resistance syndrome<#"justify">Risk factors for diabetes include:

· genetic predisposition,

· mental and physical trauma,

· obesity,

· pancreatic duct stone

· pancreas cancer,

· diseases of other endocrine glands,

· increased levels of hypothalamic-pituitary hormones,

· menopause,

· pregnancy,

· various viral infections

· the use of certain drugs,

· alcohol abuse,

· nutritional imbalance.

Forecast

At present, the prognosis for all types of diabetes mellitus is conditionally favorable, with adequate treatment and dietary compliance, working capacity is maintained. The progression of complications slows down significantly or stops completely. However, it should be noted that in most cases, as a result of treatment, the cause of the disease is not eliminated, and therapy is only symptomatic.

Diagnosis and differential diagnosis

Diagnosis of type 1 and type 2 diabetes is facilitated by the presence of the main symptoms: polyuria<#"justify">· the concentration of sugar (glucose) in capillary blood on an empty stomach exceeds 6.1 mmol / l (millimoles per liter), and 2 hours after a meal (postprandial glycemia) exceeds 11.1 mmol / l;

As a result of a glucose tolerance test<#"justify">Differential (DIF) diagnosis of diabetes mellitus

The problem of diabetes in Lately widespread in the world of medicine. It accounts for approximately 40% of all cases of diseases of the endocrine system. This disease often leads to high mortality and early disability.

For differential diagnosis in patients with diabetes mellitus, it is necessary to identify the patient's condition, referring it to one of the classes: neuropathic, angiopathic, combined variant of the course of diabetes.

Patients with a similar fixed number of features are considered to belong to the same class. In this work, diff. diagnosis is presented as a classification task.

As a classification method, cluster analysis and the Kemeny median method are used, which are mathematical formulas.

In the differential diagnosis of diabetes mellitus, in no case should one be guided by the levels of HA. If in doubt, make a preliminary diagnosis and be sure to clarify it.

An explicit or manifest form of diabetes mellitus has a clearly defined clinical picture: polyuria, polydipsia, weight loss. In a laboratory study of blood, an increased content of glucose is noted. In the study of urine - glucosuria and acetouria. If there are no symptoms of hyperclimia, but during the study of blood sugar, an increased glucose content is detected. In this case, to exclude or confirm the diagnosis in the laboratory, special test in response to glucose.

It is necessary to pay attention to specific gravity urine (relative density), which is detected in tests performed in the treatment of other diseases or clinical examination.

For diff. Diagnosis of forms of diabetes, selection of therapy and medicinal product it is imperative to determine the level of insulin concentration in the blood. Insulin determination is possible in patients who have not taken insulin preparations. Elevated insulin with low glucose concentration is an indicator of pathological hyperinsulinemia. A high level of insulin in the blood during fasting with elevated and normal glucose concentrations is an indicator of glucose intolerance and, accordingly, diabetes mellitus.

Required complex diagnostics disease, aimed at a serious examination of the body. Differential diagnosis will prevent the development of diabetes mellitus and will allow timely appointment of the necessary treatment.

Treatment

diabetes mellitus disease insulin

Treatment of diabetes, of course, the doctor prescribes.

Treatment for diabetes includes:

.special diet: it is necessary to exclude sugar, alcoholic drinks, syrups, cakes, cookies, sweet fruits. Food should be taken in small portions, preferably 4-5 times a day. Products containing various sweeteners (aspartame, saccharin, xylitol, sorbitol, fructose, etc.) are recommended.

.daily use of insulin (insulin therapy) is necessary for patients with type 1 diabetes mellitus and with the progression of type 2 diabetes. The drug is available in special syringe pens, with which it is easy to make injections. When treating with insulin, it is necessary to independently control the level of glucose in the blood and urine (using special strips).

.the use of tablets that help lower blood sugar levels. As a rule, such drugs begin the treatment of type 2 diabetes. With the progression of the disease, the appointment of insulin is necessary.

The main tasks of the doctor in the treatment of diabetes are:

· Compensation carbohydrate metabolism.

· Prevention and treatment of complications.

· Normalization of body weight.

Patient education<#"justify">People with diabetes benefit from exercise. Weight loss in obese patients also has a therapeutic role.

Treatment for diabetes is lifelong. Self-control and the exact implementation of the doctor's recommendations can avoid or significantly slow down the development of complications of the disease.

Complications

Diabetes mellitus must be constantly monitored!!! With poor control and inappropriate lifestyle, frequent and sharp fluctuations in blood glucose levels can occur. Which in turn leads to complications. First to acute, such as hypo- and hyperglycemia, and then to chronic complications. The worst thing is that they appear 10-15 years after the onset of the disease, develop imperceptibly and at first do not affect well-being. Due to high blood sugar levels, diabetes-specific complications from the eyes, kidneys, legs, as well as non-specific ones from of cardio-vascular system. But, unfortunately, it can be very difficult to cope with complications that have already manifested themselves.

o hypoglycemia - lowering blood sugar, can lead to hypoglycemic coma;

o hyperglycemia - an increase in blood sugar levels, which may result in hyperglycemic coma.

Symptoms and signs

Both types of diabetes have similar symptoms. The first symptoms of diabetes usually appear due to high level blood glucose. When the concentration of glucose in the blood reaches 160-180 mg / dl (above 6 mmol / l), it begins to penetrate into the urine. Over time, when the patient's condition worsens, the level of glucose in the urine becomes very high. As a result, the kidneys secrete more water in order to dilute the huge amount of glucose excreted in the urine. Thus, the initial symptom of diabetes is polyuria (excretion of more than 1.5-2 liters of urine per day). The next symptom, which is a consequence of frequent urination, is polydipsia (constant feeling of thirst) and drinking large amounts of fluid. Due to the fact that a large number of calories are lost in the urine, people lose weight. As a result, people experience a feeling of hunger (increased appetite). Thus, diabetes is characterized by the classic triad of symptoms:

· Polyuria (more than 2 liters of urine per day).

· Polydipsia (feeling of thirst).

· Polyphagia (increased appetite).

Also, each type of diabetes has its own characteristics.

For people with type 1 diabetes, as a rule, the first symptoms come on suddenly, in a very short period of time. And a condition like diabetic ketoacidosis can develop very quickly. Patients with type 2 diabetes mellitus are asymptomatic for a long time. Even if there are certain complaints, their intensity is insignificant. Sometimes in the early stages of developing type 2 diabetes, blood glucose levels can be low. This condition is called hypoglycemia. Due to the fact that there is a certain amount of insulin in the human body, patients with type 2 diabetes usually do not develop ketoacidosis in the early stages.

Others, less specific features diabetes can be:

· Weakness, fatigue

· Frequent colds

· Purulent disease skin, furunculosis, the appearance of difficult-to-heal ulcers

· severe itching in the genital area

Patients with type 2 diabetes often learn about their disease by accident, several years after its onset. In such cases, the diagnosis of diabetes is established either on the basis of advanced level blood glucose, or based on the presence of complications of diabetes.

Prevention

Diabetes is primarily hereditary disease. The identified risk groups make it possible to orient people today, to warn them against a careless and thoughtless attitude towards their health. Diabetes can be both inherited and acquired. The combination of several risk factors increases the likelihood of diabetes: for an obese patient who often suffers from viral infections - influenza, etc., this probability is approximately the same as for people with aggravated heredity. So all people at risk should be vigilant. You should be especially careful about your condition between November and March, because most cases of diabetes occur during this period. The situation is complicated by the fact that during this period your condition can be mistaken for a viral infection.

At primary prevention measures aimed at preventing diabetes mellitus:

Lifestyle modification and elimination of risk factors for diabetes, preventive measures only in individuals or in groups with a high risk of developing diabetes in the future.

Reducing excess body weight.

Prevention of atherosclerosis.

Prevention of stress.

Reducing the consumption of excess amounts of products containing sugar (use of natural sweetener) and animal fat.

Moderate infant feeding to prevent diabetes in a child.

Secondary prevention of diabetes

Secondary prevention provides measures aimed at preventing the complications of diabetes mellitus - early control of the disease, preventing its progression.

Dispensary observation of patients with diabetes mellitus

Medical examination of patients with diabetes is a system of preventive and medical measures, aimed at early detection disease, prevention of its progression, systematic treatment of all patients, maintaining their good physical and spiritual condition, maintaining their ability to work and preventing complications and concomitant diseases. Well-organized dispensary observation of patients should ensure that they eliminate the clinical symptoms of diabetes - thirst, polyuria, general weakness, and others, restore and maintain working capacity, prevent complications: ketoacidosis, hypoglycemia, diabetic microangiopathies and neuropathy, and others by achieving stable compensation for diabetes mellitus and normalization body weight.

Dispensary group - D-3. Adolescents with IDDM are not removed from dispensary records. The medical examination system should be based on data on the immunopathological nature of diabetes mellitus. It is necessary to register adolescents with IDDM as immunopathological persons. Sensitizing interventions are contraindicated. This is the basis for a medical withdrawal from vaccinations, for limiting the introduction of antigenic preparations. Permanent treatment insulin is a difficult task and requires the patience of a teenager and a doctor. Diabetes mellitus frightens with a mass of restrictions, changes the way of life of a teenager. It is necessary to teach a teenager to overcome the fear of insulin. Almost 95% of adolescents with IDDM do not have a correct idea about the diet, do not know how to change insulin doses when changing nutrition, during physical activity that reduces glycemia. The most optimal - classes in the "Schools of patients with diabetes" or "Universities of health for patients with diabetes." At least once a year, an inpatient examination with correction of insulin doses is necessary. Observation by the endocrinologist of the polyclinic - at least 1 time per month. Permanent consultants should be an ophthalmologist, internist, neuropathologist, and, if necessary, a urologist, gynecologist, nephrologist. Anthropometry is carried out, blood pressure is measured. The levels of glycemia, glucosuria and acetonuria are regularly examined, periodically - blood lipids and kidney function. All adolescents with diabetes need a TB examination. With reduced glucose tolerance - 1 time in 3 months, dynamic observation, examination by an ophthalmologist 1 time in 3 months, ECG - 1 time in six months, and with normal glycemia for 3 years - deregistration.

Pathological anatomy of diabetes

Macroscopically, the pancreas can be reduced in volume, wrinkled. Changes in its excretory section are unstable (atrophy, lipomatosis, cystic degeneration, hemorrhages, etc.) and usually occur in old age. Histologically, in insulin-dependent diabetes mellitus, lymphocytic infiltration of pancreatic islets (insulitis) is found. The latter are found predominantly in those islets that contain p-cells. As the duration of the disease increases, progressive destruction of β-cells, their fibrosis and atrophy, pseudo-atrophic islets without β-cells are found. Diffuse fibrosis of the pancreatic islets is noted (more often with a combination of insulin-dependent diabetes mellitus with other autoimmune diseases). Hyalinosis of islets and accumulation of hyaline masses between cells and around blood vessels are often observed. Foci of regeneration of P-cells are noted (in the early stages of the disease), which completely disappear with an increase in the duration of the disease. In non-insulin-dependent diabetes mellitus, a slight decrease in the number of β-cells is observed. In some cases, changes in the islet apparatus are associated with the nature of the underlying disease (hemochromatosis, acute pancreatitis, etc.).

Those who died from diabetic coma pathological anatomical examination reveals lipomatosis, inflammatory or necrotic changes in the pancreas, fatty degeneration of the liver, glomerulosclerosis, osteomalacia, bleeding in gastrointestinal tract, increase and hyperemia of the kidneys, and in some cases - myocardial infarction, thrombosis of mesenteric vessels, embolism pulmonary artery, pneumonia. Cerebral edema is noted, often without morphological changes in his tissue.

Diabetic coma and treatment

Diabetes mellitus in some patients has a severe course, and this requires careful, accurate treatment with insulin, which in such cases is administered in large quantities. Severe, as well as moderate severity of diabetes mellitus can give a complication in the form of a coma.<#"justify">Conclusion

Diabetic coma occurs in patients with diabetes mellitus with a gross violation of the diet, errors in the use of insulin and the cessation of its use, with intercurrent diseases (pneumonia, myocardial infarction, etc.), injuries and surgical interventions, physical and psychological stress.

Hypoglycemic coma most often develops as a result of an overdose of insulin or other hypoglycemic drugs.

Hypoglycemia can be caused by insufficient intake of carbohydrates with the introduction of the usual dose of insulin or long breaks in food intake, as well as large volume and effort physical labor, alcohol intoxication, the use of blockers of p-adrenergic receptors, salicylates, anticoagulants, a number of anti-tuberculosis drugs. In addition, hypoglycemia (coma) occurs when there is insufficient intake of carbohydrates in the body (starvation, enteritis) or when they are drastically consumed (physical overload), as well as liver failure.

Medical assistance must be provided immediately. The favorable outcome of diabetic and hypoglycemic coma coma depends on the period that has elapsed since the patient fell into unconsciousness before the date of assistance. The sooner action is taken to eradicate coma, topics better outcome. The provision of medical care for diabetic and hypoglycemic coma should be carried out under control laboratory research. This can be done in a hospital setting. Attempts to treat such a patient at home may be unsuccessful.

Literature

Algorithms for the diagnosis and treatment of diseases of the endocrine system, ed. I. I. Dedova. - M., 2005 - 256 p.

Balabolkin M. I. Endocrinology. - M.: Medicine, 2004 - 416 p.

Davlitsarova K.E. Fundamentals of patient care. First health care: Textbook.- M .: Forum: Infa - M, 2004-386s.

Clinical Endocrinology: A Guide for Physicians / Ed. T. Starkova. - M.: Medicine, 1998 - 512 p.

M.I. Balabolkin, E.M. Klebanova, V.M. Kreminskaya. Pathogenesis of angiopathy in diabetes mellitus. 1997

Dreval AV DIABETES MELLITUS AND OTHER PANCREAS ENDOCRINOPATHIES (lectures). Moscow Regional Research Clinical Institute.

Andreeva L.P. and others. Diagnostic value protein in diabetes. // Soviet medicine. 1987. No. 2. S. 22-25.

Balabolkin M. I. Diabetes mellitus. M.: Medicine, 1994. S. 30-33.

Belovalova I.M., Knyazeva A.P. et al. Study of pancreatic hormone secretion in patients with newly diagnosed diabetes mellitus. // Problems of endocrinology. 1988. No. 6. S. 3-6.

With absolute insulin deficiency, the level of insulin in the blood decreases due to a violation of its synthesis or secretion by beta cells of the islets of Langerhans. Insulin deficiency leads to a violation of carbohydrate fat and protein metabolism. The formation of fats decreases and the breakdown of fats increases, which leads to an increase in the blood level of acetoacetic beta-hydroxybutyric ketone bodies and the condensation product of acetoacetic acid - acetone.

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Introduction

Concept and types
Etiology and pathogenesis
diet therapy
Laboratory research
Risk factors and prognosis
Treatment
Complications
Symptoms and signs
Prevention
Diabetic coma and treatment

Conclusion

Literature

Introduction

Diabetes mellitus is a disease caused by absolute or relative deficiency of insulin and characterized by a gross violation of carbohydrate metabolism with hyperglycemia and glycosuria, as well as other metabolic disorders.

In etiology, hereditary predisposition, autoimmune, vascular disorders, obesity, mental and physical trauma, and viral infections matter.

With absolute insulin deficiency, the level of insulin in the blood decreases due to a violation of its synthesis or secretion by beta cells of the islets of Langerhans. Relative insulin deficiency may be the result of a decrease in insulin activity due to its increased protein binding, increased destruction by liver enzymes, the predominance of the effects of hormonal and non-hormonal insulin antagonists (glucagon, adrenal hormones, thyroid, growth hormone, non-esterified fatty acids), changes in the sensitivity of insulin-dependent tissues .

Insulin deficiency leads to a violation of carbohydrate, fat and protein metabolism. The permeability for glucose of cell membranes in adipose and muscle tissue decreases, glycogenolysis and gluconeogenesis increase, hyperglycemia, glycosuria occur, which are accompanied by polyuria and polydipsia. The formation of fats decreases and the breakdown of fats increases, which leads to an increase in the level of ketone bodies in the blood (acetoacetic, beta-hydroxybutyric and the condensation product of acetoacetic acid - acetone). This causes a shift in the acid-base state towards acidosis, promotes increased excretion of potassium, sodium, magnesium ions in the urine, and disrupts kidney function.

Significant fluid loss due to polyuria leads to dehydration. Increased excretion of potassium, chlorides, nitrogen, phosphorus, calcium from the body.

Concept and types.

Diabetes is an endocrine disease characterized by a chronic increase in blood sugar levels due to absolute or relative deficiency of insulin pancreatic hormone. The disease leads to a violation of all types of metabolism, damage to blood vessels, the nervous system, as well as other organs and systems.

Classification

Distinguish:

Insulin-dependent diabetes (type 1 diabetes) develops mainly in children and young people;
Non-insulin-dependent diabetes (type 2 diabetes) usually develops in people over 40 who are overweight. This is the most common type of disease (occurs in 80-85% of cases);
Secondary (or symptomatic) diabetes mellitus;
Pregnancy diabetes.
Diabetes due to malnutrition

At type 1 diabetesthere is an absolute deficiency of insulin due to a violation of the pancreas.

At type 2 diabetes noted relative deficiency of insulin. The cells of the pancreas at the same time produce enough insulin (sometimes even an increased amount). However, on the surface of cells, the number of structures that ensure its contact with the cell and help glucose from the blood to enter the cell is blocked or reduced. The lack of glucose in the cells is a signal for even more insulin production, but this has no effect, and over time, insulin production decreases significantly.

Etiology and pathogenesis

Hereditary predisposition, autoimmune, vascular disorders, obesity, mental and physical trauma, and viral infections matter.

Pathogenesis

insufficient production of insulin by the endocrine cells of the pancreas;
violation of the interaction of insulin with cells of body tissues (insulin resistance) as a result of a change in the structure or a decrease in the number of specific receptors for insulin, changes in the structure of insulin itself, or disruption of intracellular signal transduction mechanisms from receptors cell organelles.

There is a hereditary predisposition to diabetes. If one of the parents is sick, then the probability of inheriting type 1 diabetes is 10%, and type 2 diabetes is 80%

diet therapy

Proper diet for diabetesis of paramount importance. By choosing the right diet for a mild (and often moderate) form of type 2 diabetes, you can minimize drug treatment, or even do without it.

Bread up to 200 grams per day, mostly black or special diabetic.
Soups, mostly vegetable. Soups cooked in a weak meat or fish broth can be consumed no more than twice a week.
Lean meat, poultry (up to 100 grams per day) or fish (up to 150 grams per day) in boiled or aspic form.
Dishes and side dishes from cereals, legumes, pasta can be afforded occasionally, in small quantities, reducing the consumption of bread these days. Of the cereals, it is better to use oatmeal and buckwheat, millet, barley, rice cereals are also acceptable. But semolina is better to exclude.
Vegetables and greens. Potatoes, beets, carrots are recommended to consume no more than 200 grams per day. But other vegetables (cabbage, lettuce, radishes, cucumbers, zucchini, tomatoes) and greens (except spicy) can be consumed almost without restrictions in raw and boiled form, occasionally in baked.
Eggs no more than 2 pieces per day: soft-boiled, in the form of an omelet or used in the preparation of other dishes.
Fruits and berries of sour and sweet and sour varieties (Antonovka apples, oranges, lemons, cranberries, red currants ...) up to 200-300 grams per day.
Milk with the permission of a doctor. Dairy products (kefir, curdled milk, unsweetened yogurt) 1-2 glasses per day. Cheese, sour cream, cream occasionally and a little bit.
Cottage cheese for diabetes is recommended to be consumed daily, up to 100-200 grams per day in its natural form or in the form of cottage cheese, cheesecakes, puddings, casseroles. Cottage cheese, as well as oatmeal and buckwheat porridge, bran, rose hips improve fat metabolism and normalize liver function, prevent fatty changes in the liver.
Beverages. Green or black tea is allowed, it is possible with milk, weak coffee, tomato juice, juices from berries and sour fruits.

Eating with diabetesit is necessary at least 4 times a day, and preferably 5-6 times, at the same time. Food should be rich in vitamins, micro and macro elements. Try to diversify your diet as much as possible, because the list of foods allowed for diabetes is not at all small.

Restrictions

First of all, and it is unlikely that this will be a discovery for anyone,with diabetes, it is necessary to limit the intake of easily digestible carbohydrates.These are sugar, honey, jams and jams, sweets, muffins and other sweets, sweet fruits and berries: grapes, bananas, raisins, dates. Often there are even recommendations to completely eliminate these foods from the diet, but this is really necessary only in severe diabetes. With mild and moderate, subject to regular monitoring of blood sugar levels, the use of a small amount of sugar and sweets is quite acceptable.
Recently, a number of studies have shown thathigh levels of fat in the blood contribute to the progression of diabetes. Therefore, limiting the intake of fatty foods in diabetes is no less important than limiting sweets. The total amount of fat consumed in free form and for cooking (butter and vegetable oil, lard, cooking fats) should not exceed 40 grams per day, it is also necessary to limit the consumption of other products containing a large amount of fat (fatty meat, sausages, sausages, sausages, cheeses, sour cream, mayonnaise).
Also it is necessary to seriously limit, and it is better not to use fried, spicy, salty, spicy and smoked dishes, canned food, peppers, mustard, alcoholic beverages at all.
And foods that contain a lot of fats and carbohydrates at the same time are absolutely not good for those suffering from diabetes:chocolate, creamy ice cream, cream cakes and cakes ... It is better to exclude them from the diet completely.

Laboratory research

Fasting blood glucose test
Testing blood glucose levels after meals
Nighttime blood glucose test
Urinary glucose testing
Glucose tolerance test
Study of glycated hemoglobin
The study of the level of fructosamine in the blood
The study of lipids in the blood
Creatinine and urea test
Determination of protein in urine
Research on ketone bodies

Risk factors and prognosis

TO risk factors for diabetesType 1 is heredity. If a child has a genetic predisposition to develop diabetes, it is almost impossible to prevent the course of undesirable events.

Type 2 diabetes risk factors

Risk factors for type 2 diabetes:

the risk of developing diabetes increases if the next of kin is diagnosed with this disease;
age over 45;
the presence of a syndromeinsulin resistance;
being overweight(BMI);
frequent high arterial pressure;
elevated cholesterol levels;
gestational diabetes.

Risk factors for diabetes include:

genetic predisposition,
mental and physical trauma,
obesity,
pancreatitis,
pancreatic duct stone
pancreas cancer,
diseases of other endocrine glands,
increased levels of hypothalamic-pituitary hormones,
menopause,
pregnancy,
various viral infections
the use of certain drugs,
alcohol abuse,
nutritional imbalance.

Forecast

Diagnosis and differential diagnosis

Diagnosis of type 1 and type 2 diabetes is facilitated by the presence of the main symptoms: polyuria, polyphagia , weight loss. However, the main diagnostic method is to determine the concentration of glucose in the blood. To determine the severity of decompensation of carbohydrate metabolism is usedglucose tolerance test.

The diagnosis of "diabetes" is established if these signs coincide:

the concentration of sugar (glucose) in capillary blood on an empty stomach exceeds 6.1 mmol / l (millimoles per liter), and 2 hours after a meal (postprandial glycemia) exceeds 11.1 mmol / l;
as a result ofglucose tolerance test(in doubtful cases) blood sugar level exceeds 11.1 mmol / l (in a standard repeat);
level glycosylated hemoglobinexceeds 5.9% (5.9-6.5% - doubtful, more than 6.5% more likely to have diabetes);
there is sugar in the urine;
contained in the urine acetone (Acetonuria, (acetone may also be present without diabetes.

Differential (DIF) diagnosis of diabetes mellitus

The problem of diabetes mellitus has recently become widespread in the world of medicine. It accounts for approximately 40% of all cases of diseases of the endocrine system. This disease often leads to high mortality and early disability.

Patients with a similar fixed number of features are considered to belong to the same class. In this work, diff. diagnosis is presented as a classification task.

As a classification method, cluster analysis and the Kemeny median method are used, which are mathematical formulas.

In the differential diagnosis of diabetes mellitus, in no case should one be guided by the levels of HA. If in doubt, make a preliminary diagnosis and be sure to clarify it.

It is necessary to pay attention to the specific gravity of urine (relative density), which is detected in tests performed in the treatment of other diseases or medical examinations.

For diff. diagnosing forms of diabetes, selecting therapy and a therapeutic drug, it is extremely necessary to determine the level of insulin concentration in the blood. Insulin determination is possible in patients who have not taken insulin preparations. Elevated insulin with low glucose concentration is an indicator of pathological hyperinsulinemia. A high level of insulin in the blood during fasting with elevated and normal glucose concentrations is an indicator of glucose intolerance and, accordingly, diabetes mellitus.

A comprehensive diagnosis of the disease is necessary, aimed at a serious examination of the body. Differential diagnosis will prevent the development of diabetes mellitus and will allow timely appointment of the necessary treatment.

Treatment

Treatment of diabetes, of course, the doctor prescribes.

Treatment for diabetes includes:

special diet: it is necessary to exclude sugar, alcoholic drinks, syrups, cakes, cookies, sweet fruits. Food should be taken in small portions, it is better 4-5 once a day. Products containing various sweeteners (aspartame, saccharin, xylitol, sorbitol, fructose, etc.) are recommended.
daily use of insulin (insulin therapy) is necessary for patients with type 1 diabetes mellitus and with the progression of type 2 diabetes. The drug is produced in special syringe pens, with which it is easy to make injections. When treating with insulin, it is necessary to independently control the level of glucose in the blood and urine (using special strips).
the use of tablets that help lower blood sugar levels. As a rule, such drugs begin the treatment of type 2 diabetes. With the progression of the disease, the appointment of insulin is necessary.

The main tasks of the doctor in the treatment of diabetes are:

Compensation of carbohydrate metabolism.
Prevention and treatment of complications.
Normalization of body weight.
Patient education.

People with diabetes benefit from exercise. Weight loss in obese patients also has a therapeutic role.

Treatment for diabetes is lifelong. Self-control and the exact implementation of the doctor's recommendations can avoid or significantly slow down the development of complications of the disease.

Complications

Diabetes must be constantly monitored. With poor control and inappropriate lifestyle, frequent and sharp fluctuations in blood glucose levels can occur. Which in turn leads to complications. First to acute, such as hypo- and hyperglycemia, and then to chronic complications. The worst thing is that they appear 10-15 years after the onset of the disease, develop imperceptibly and at first do not affect well-being. Due to the high blood sugar content, diabetes-specific complications from the eyes, kidneys, legs, as well as non-specific complications from the cardiovascular system gradually occur and progress very quickly. But, unfortunately, it can be very difficult to cope with complications that have already manifested themselves.

hypoglycemia low blood sugar, can lead to hypoglycemic coma;

hyperglycemia an increase in blood sugar levels, which may result in hyperglycemic coma.

Symptoms and signs

Both types of diabetes have similar symptoms. The first symptoms of diabetes usually appear due to high blood glucose levels. When the concentration of glucose in the blood reaches 160-180 mg / dl (above 6 mmol / l), it begins to penetrate into the urine. Over time, when the patient's condition worsens, the level of glucose in the urine becomes very high. As a result, the kidneys excrete more water in order to dilute the huge amount of glucose excreted in the urine. Thus, the initial symptom of diabetes is polyuria (excretion of more than 1.5-2 liters of urine per day).The next symptom, which is a consequence of frequent urination, is polydipsia (constant feeling of thirst) and drinking large amounts of fluid. Due to the fact that a large number of calories are lost in the urine, people lose weight. As a result, people experience a feeling of hunger (increased appetite). Thus, diabetes is characterized by the classic triad of symptoms:

Polyuria (more than 2 liters of urine per day).
Polydipsia (feeling of thirst).
Polyphagia (increased appetite).

Also, each type of diabetes has its own characteristics.

For people with type 1 diabetes, as a rule, the first symptoms come on suddenly, in a very short period of time. And a condition like diabetic ketoacidosis can develop very quickly.Patients with type 2 diabetes mellitus are asymptomatic for a long time. Even if there are certain complaints, their intensity is insignificant. Sometimes in the early stages of developing type 2 diabetes, blood glucose levels can be low. This condition is called hypoglycemia. Due to the fact that there is a certain amount of insulin in the human body, patients with type 2 diabetes usually do not develop ketoacidosis in the early stages.

Other, less specific signs of diabetes may include:

Weakness, fatigue
Frequent colds
Purulent skin diseases, furunculosis, the appearance of difficult-to-heal ulcers
Severe itching in the genital area

Patients with type 2 diabetes often learn about their disease by accident, several years after its onset. In such cases, the diagnosis of diabetes is established either by finding an elevated blood glucose level or by the presence of complications of diabetes.

Prevention

Diabetes is primarily a hereditary disease. The identified risk groups make it possible to orient people today, to warn them against a careless and thoughtless attitude towards their health. Diabetes can be both inherited and acquired. The combination of several risk factors increases the likelihood of diabetes: for an obese patient, often suffering from viral infections influenza, etc., this probability is approximately the same as for people with aggravated heredity. So all people at risk should be vigilant. You should be especially careful about your condition between November and March, because most cases of diabetes occur during this period. The situation is complicated by the fact that during this period your condition can be mistaken for a viral infection.

In primary prevention, measures are aimed at preventingdiabetes:

1. Lifestyle modification and elimination of risk factors for diabetes, preventive measures only in individuals or groups with a high risk of developing diabetes in the future.

2. Reducing excess body weight.

3. Prevention of atherosclerosis.

4. Prevention of stress.

5. Reducing the consumption of excess amounts of products containing sugar (use of natural sweetener) and animal fat.

6. Moderate infant feeding to prevent diabetes in a child.

Secondary prevention of diabetes

Secondary prevention involves measures aimed at preventing complicationsdiabetes- early control of the disease, preventing its progression.

Dispensary observation of patients with diabetes mellitus

Clinical examination of patients with diabetes is a system of preventive and therapeutic measures aimed at early detection of the disease, prevention of its progression, systematic treatment of all patients, maintaining their good physical and spiritual condition, maintaining their ability to work and preventing complications and concomitant diseases.A well-organized dispensary observation of patients should ensure that they eliminate the clinical symptoms of diabetes -thirst, polyuria, general weakness and others, recovery and preservation of working capacity, prevention of complications: ketoacidosis, hypoglycemia, diabetic microangiopathies and neuropathy and others by achieving stable compensation for diabetes mellitus and normalization of body weight.

Dispensary group - D-3. Adolescents with IDDM are not removed from dispensary records. The medical examination system should be based on data on the immunopathological nature of diabetes mellitus. It is necessary to register adolescents with IDDM as immunopathological persons. Sensitizing interventions are contraindicated. This is the basis for a medical withdrawal from vaccinations, for limiting the introduction of antigenic preparations. Constant treatment with insulin is a difficult task and requires the patience of a teenager and a doctor. Diabetes mellitus frightens with a mass of restrictions, changes the way of life of a teenager. It is necessary to teach a teenager to overcome the fear of insulin. Almost 95% of adolescents with IDDM do not have a correct idea about the diet, do not know how to change insulin doses when changing nutrition, during physical activity that reduces glycemia. The most optimal - classes in the "Schools of patients with diabetes" or "Universities of health for patients with diabetes." At least once a year, an inpatient examination with correction of insulin doses is necessary. Observation by the endocrinologist of the polyclinic - at least 1 time per month. Permanent consultants should be an ophthalmologist, internist, neuropathologist, and, if necessary, a urologist, gynecologist, nephrologist. Anthropometry is carried out, blood pressure is measured. The levels of glycemia, glucosuria and acetonuria are regularly examined, periodically - blood lipids and kidney function. All adolescents with diabetes need a TB examination. With reduced glucose tolerance - 1 time in 3 months, dynamic observation, examination by an ophthalmologist 1 time in 3 months, ECG - 1 time in six months, and with normal glycemia for 3 years - deregistration.

Pathological anatomy of diabetes

Morphological changes in other endocrine glands are changeable. The size of the pituitary gland, parathyroid glands can be reduced. Sometimes degenerative changes occur in the pituitary gland with a decrease in the number of eosinophilic, and in some cases, basophilic cells. In the testicles, reduced spermatogenesis is possible, and in the ovaries - atrophy of the follicular apparatus. Micro- and macroangiopathies are often noted. Tuberculous changes are sometimes determined in the lungs. Glycogen infiltration is usually observed renal parenchyma. In some cases, diabetes-specific nodular glomerulosclerosis (intercapillary glomerulosclerosis, Kimmelstiel-Wilson syndrome) and tubular nephrosis are detected. There may be changes in the kidneys, characteristic of diffuse and exudative glomerulosclerosis, arteriosclerosis, pyelonephritis, necrotic papillitis, which are combined with diabetes mellitus more often than with other diseases. Nodular glomerulosclerosis occurs in approximately 25% of patients with diabetes mellitus (more often in insulin-dependent diabetes mellitus) and correlates with its duration. Nodular glomerulosclerosis is characterized by microaneurysms organized into hyaline nodules (Kimmelstiel-Wilson nodules) located at the periphery or in the center of the glomerulus and thickening of the capillary basement membrane. Nodules (with a significant number of mesangial cell nuclei and a hyaline matrix) narrow or completely clog the lumen of the capillaries. With diffuse glomerulosclerosis (intracapillary), a thickening of the basement membrane of the capillaries of all departments of the glomeruli, a decrease in the lumen of the capillaries and their occlusion are observed. Usually find a combination of changes in the kidneys, characteristic of both diffuse and nodular glomerulosclerosis. It is believed that diffuse glomerulosclerosis may precede nodular glomerulosclerosis. With tubular nephrosis, the accumulation of vacuoles containing glycogen in epithelial cells, more often proximal tubules, and the deposition of PAS-positive substances (glycoproteins, neutral mucopolysaccharides) in their cytoplasmic membranes are observed. The severity of tubular nephrosis correlates with hyperglycemia and does not correspond to the nature of tubular dysfunction. The liver is often enlarged, shiny, reddish-yellow (due to infiltration with fat) in color, often with reduced content glycogen. Sometimes there is cirrhosis of the liver. There is glycogen infiltration of the central nervous system and other organs.

Pathoanatomical examination of those who died from diabetic coma reveals lipomatosis, inflammatory or necrotic changes in the pancreas, fatty degeneration of the liver, glomerulosclerosis, osteomalacia, bleeding in the gastrointestinal tract, enlargement and hyperemia of the kidneys, and in some cases myocardial infarction, thrombosis of mesenteric vessels, pulmonary embolism, pneumonia. Brain edema is noted, often without morphological changes in its tissue.

Diabetic coma and treatment

The circumstances under which a diabetic coma can occur are mainly as follows:

1) overeating of carbohydrates, leading to the absorption of large amounts of glucose into the blood, a significant part of which in such cases cannot be bound by insulin;

2) a sudden decrease in the dose of insulin administered;

3) increased energy consumption with an increase in body temperature, during heavy physical work, during pregnancy, etc. The role of strong unrest is also important, in which a large amount of adrenaline is released into the blood, leading to an increase in blood sugar levels.

Cause of diabetic coma. In all these cases, insulin deficiency develops, resulting in an increased consumption of fatty acids with the formation of a very large amount of underoxidized products. The latter circumstance leads to the depletion of blood alkali reserves. As a result, the reaction of the blood becomes acidic, in other words, acidosis (ketosis) develops, which is the direct cause of severe functional disorders. internal organs and especially the central nervous system.

As can be seen from the foregoing, the essence of a diabetic coma is not an excess of sugar (blood sugar enters the nerve cells, where it is used, just freely and in the required amount), but the accumulation in the blood of acid-reactive products of incomplete combustion of fats. Understanding these metabolic disorders is necessary for the rationally constructed treatment of patients with diabetes mellitus who have fallen into a coma.

The development of acidosis (ketosis) due to a lack of insulin in the blood causes inhibition of the central nervous system, primarily the cerebral cortex. The first manifestations of poisoning of the nervous system with under-oxidized products in diabetes mellitus are grouped into pathological phenomena, which are collectively called diabetic precoma.

Signs and symptoms of diabetic precoma are that a patient with diabetes develops a strong general weakness, due to which he is unable to produce physical effort, the patient cannot walk for a long time. The state of stupor gradually increases, the patient loses interest in the environment, gives sluggish answers to questions and with difficulty. The patient lies with his eyes closed and seems to be asleep. Already at this time, you can notice the deepening of breathing. The state of diabetic precoma can last a day or two and then go into a complete coma, that is, into a state with a complete loss of consciousness.

Urgent Care in diabetic comaconsists in vigorous treatment with insulin. The latter is injected under the skin immediately in the amount of 25 units.

Since the blood sugar level in patients with precoma is high, the injected insulin for two to three hours will contribute to the consumption of this sugar. At the same time, the body uses the poisonous products of incomplete breakdown of fats (ketone bodies) accumulated in the blood. 2 hours after the administration of insulin, the patient should be given a glass of sweet tea or coffee (45 teaspoons per glass). The fact is that the action of insulin lasts for a long time - 4 hours or more, and this can lead to such a strong decrease in blood sugar that it can cause a number of disorders (see "Clinic of hypoglycemia"). This is prevented by the intake of sugar, as above.

The treatment carried out leads to a rapid improvement in the patient's condition. However, if 2 hours after the administration of insulin there is no improvement, then you need to re-introduce 25 IU of insulin, and then after 1 hour (note - now after 1 hour!) Give a glass of very sweet tea or coffee.

To combat acidosis, you can do a gastric lavage with a warm soda solution or inject a 1.3% soda solution (100150 ml) intravenously.

Signs and symptoms of diabetic coma appear with a further increase in self-poisoning by products of insufficient oxidation of carbohydrates and fats. Gradually, to those manifestations that are present in precoma, a deepening lesion of the cerebral cortex is added and, finally, an unconscious state appears - a complete coma. When a patient is caught in such a state, one should carefully find out from relatives what circumstances preceded the patient's falling into a coma, how much insulin the patient received.

When examining a patient with a diabetic coma, noisy deep Kusmaul breathing attracts attention. The smell of acetone (the smell of soaked apples) is easily captured. The skin of patients with diabetic coma is dry, flabby, eyeballs soft. It depends on tissue loss tissue fluid passing into the blood due to the high content of sugar in it. The pulse in such patients is quickened, blood pressure decreases.

As can be seen from the foregoing, the difference between diabetic precoma and coma lies in the degree of severity of the same symptoms, but the main thing is reduced to the state of the central nervous system, to the depth of its oppression.

Emergency care for diabetic coma is the introduction of a sufficient amount of insulin. The latter, in the case of a coma, is administered by a paramedic under the skin immediately in the amount of 50 units.

In addition to insulin, 200250 ml of a 5% glucose solution should be injected under the skin. Glucose is injected slowly with a syringe or, even better, through a dropper at a rate of 60-70 drops per minute. If 10% glucose is at hand, then when injected into a vein, it should be diluted in half with saline, and such a solution is injected into the muscle without dilution.

If there is no effect from the injected insulin, 25 IU of insulin should be re-introduced under the skin after 2 hours. After this dose of insulin, the same amount of glucose solution is injected under the skin as the first time. In the absence of glucose, physiological saline is injected under the skin in an amount of 500 ml. In order to reduce acidosis (ketosis), siphon bowel lavage should be done. To do this, take 810 liters of warm water and add drinking soda at the rate of 2 teaspoons for each liter of water.

With a slightly lower chance of success, instead of siphonic bowel lavage soda solution make an enema from a 5% soda solution in 75-100 ml of water. (This solution must be injected into the rectum so that the liquid remains there).

With a frequent pulse, it is necessary to prescribe drugs that stimulate nerve centers, camphor or cordiamine, which are injected 2 ml under the skin. The introduction of one or another drug should be repeated every 3 hours.

It should be considered mandatory to quickly send a patient with diabetic precoma and coma to the hospital. Therefore, the above remedial measures to remove such patients from a serious condition are carried out when there will be any delay in the immediate sending of the patient to the hospital and when it will take a long time to get the patient there, for example 610 hours or more.

Conclusion

Hypoglycemic coma most often develops as a result of an overdose of insulin or other hypoglycemic drugs.

Hypoglycemia can be caused by insufficient intake of carbohydrates with the introduction of a normal dose of insulin or long breaks in food intake, as well as large-scale and effortful physical work, alcohol intoxication, the use of β-adrenergic receptor blockers, salicylates, anticoagulants, and a number of anti-tuberculosis drugs. In addition, hypoglycemia (coma) occurs when there is insufficient intake of carbohydrates in the body (starvation, enteritis) or when they are drastically consumed (physical overload), as well as liver failure.

Medical assistance must be provided immediately. The favorable outcome of diabetic and hypoglycemic coma coma depends on the period elapsed from the moment the patient fell into an unconscious state until the time when assistance will be provided. The earlier measures are taken to eliminate the coma, the more favorable the outcome. The provision of medical care for diabetic and hypoglycemic coma should be carried out under the supervision of laboratory tests. This can be done in a hospital setting. Attempts to treat such a patient at home may be unsuccessful.

Literature

Algorithms for the diagnosis and treatment of diseases of the endocrine system, ed. I. I. Dedova. - M., 2005 256 p.
Balabolkin M. I. Endocrinology. M.: Medicine, 2004 416 p.
Davlitsarova K.E. Fundamentals of patient care. First aid: Textbook.- M.: Forum: Infa M, 2004-386s.
Clinical Endocrinology: A Guide for Physicians / Ed. T. Starkova. - M.: Medicine, 1998 512 p.
M.I. Balabolkin, E.M. Klebanova, V.M. Kreminskaya. Pathogenesis of angiopathy in diabetes mellitus. 1997
Dreval AV DIABETES MELLITUS AND OTHER PANCREAS ENDOCRINOPATHIES (lectures). Moscow Regional Research Clinical Institute.
Andreeva L.P. et al. Diagnostic value of protein in diabetes mellitus. // Soviet medicine. 1987. No. 2. S. 22-25.
Balabolkin M. I. Diabetes mellitus. M.: Medicine, 1994. S. 30-33.
Belovalova I.M., Knyazeva A.P. et al. Study of pancreatic hormone secretion in patients with newly diagnosed diabetes mellitus. // Problems of endocrinology. 1988. No. 6. S. 3-6.
Berger M. et al. The practice of insulin therapy. Springen, 1995, pp. 365-367.
Internal illnesses. / Ed. A. V. Sumarkova. M.: Medicine, 1993. T. 2, S. 374-391.
Vorobyov V. I. Organization of diet therapy in medical institutions. M.: Medicine, 1983. S. 250-254.
Galenok V.A., Zhuk E.A. Immunomodulatory therapy in IDDM: problems and new perspectives. // Ter. archive. 1995. No. 2. S. 80-85.
Golubev M. A., Belyaeva I. F. et al. Potential clinical and laboratory test in diabetology. // Clinical and laboratory diagnostics. 1997. No. 5. S. 27-28.
Goldberg E. D., Yeshchenko V. A., Bovt V. D. Diabetes mellitus. Tomsk, 1993. P. 85-91.
Gryaznova I.M., Vtorova V.G. Diabetes mellitus and pregnancy. M.: Medicine, 1985. S. 156-160.

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Pathological anatomy of diabetes

Morphological changes in other endocrine glands are changeable. The size of the pituitary gland, parathyroid glands can be reduced. Sometimes degenerative changes occur in the pituitary gland with a decrease in the number of eosinophilic, and in some cases, basophilic cells. In the testicles, reduced spermatogenesis is possible, and in the ovaries - atrophy of the follicular apparatus. Micro- and macroangiopathies are often noted. Tuberculous changes are sometimes determined in the lungs. As a rule, glycogen infiltration of the renal parenchyma is observed. In some cases, diabetes-specific nodular glomerulosclerosis (intercapillary glomerulosclerosis, Kimmelstiel-Wilson syndrome) and tubular nephrosis are detected. There may be changes in the kidneys, characteristic of diffuse and exudative glomerulosclerosis, arteriosclerosis, pyelonephritis, necrotic papillitis, which are combined with diabetes mellitus more often than with other diseases. Nodular glomerulosclerosis occurs in approximately 25% of patients with diabetes mellitus (more often in insulin-dependent diabetes mellitus) and correlates with its duration. Nodular glomerulosclerosis is characterized by microaneurysms organized into hyaline nodules (Kimmelstiel-Wilson nodules) located at the periphery or in the center of the glomerulus and thickening of the capillary basement membrane. Nodules (with a significant number of mesangial cell nuclei and a hyaline matrix) narrow or completely clog the lumen of the capillaries. With diffuse glomerulosclerosis (intracapillary), a thickening of the basement membrane of the capillaries of all departments of the glomeruli, a decrease in the lumen of the capillaries and their occlusion are observed. Usually find a combination of changes in the kidneys, characteristic of both diffuse and nodular glomerulosclerosis. It is believed that diffuse glomerulosclerosis may precede nodular glomerulosclerosis. With tubular nephrosis, the accumulation of vacuoles containing glycogen in epithelial cells, more often proximal tubules, and the deposition of PAS-positive substances (glycoproteins, neutral mucopolysaccharides) in their cytoplasmic membranes are observed. The severity of tubular nephrosis correlates with hyperglycemia and does not correspond to the nature of tubular dysfunction. The liver is often enlarged, shiny, reddish-yellow (due to infiltration with fat) in color, often with a low glycogen content. Sometimes there is cirrhosis of the liver. There is glycogen infiltration of the central nervous system and other organs.