Home Tooth pain Type 2 diabetes is insulin dependent. Non-insulin-dependent diabetes mellitus - the basics of pathogenesis and therapy

Tooth pain

Type 2 diabetes is insulin dependent. Non-insulin-dependent diabetes mellitus - the basics of pathogenesis and therapy

Endocrine disorders associated with metabolic disorders and leading to the accumulation of glucose in the blood are characteristic of a disease such as diabetes.

Depending on the reasons for the increase in sugar levels and the need to resort to insulin injections, insulin-dependent and non-insulin-dependent diabetes are distinguished.

Causes of diabetes

Insulin-dependent diabetes has an ICD 10 code - E 10. This type of disease is detected mainly in early childhood, when the first symptoms appear and a diagnosis of type 1 diabetes is made.

In this case, the pancreatic cells, destroyed by the body, stop producing insulin. This is a hormone that controls the absorption of glucose from food into tissues and its conversion into energy.

As a result, sugar accumulates in the blood and can lead to hyperglycemia. Patients with type 1 diabetes need to regularly inject themselves with insulin. Otherwise, an increase in glucose can provoke a coma.

In type 2 diabetes, enough of the hormone is produced, but the cells no longer recognize the hormone, as a result of which glucose is not absorbed and its level increases. This pathology does not require hormonal injections and is called insulin-independent diabetes. This type of diabetes develops more often after 40-45 years.

Both types of disease are incurable and require lifelong correction of blood sugar concentrations for good health and normal functioning. For type 2 diabetes, treatment is carried out with sugar-lowering tablets, increased physical activity and a strict diet.

Type 1 diabetes is considered an indication for disability and is the most dangerous due to its complications. Unstable sugar levels lead to destructive changes in the genitourinary system and the development of kidney failure. This is the main reason for the increased mortality in diabetic patients.

The reasons for the decrease in cell sensitivity to insulin and why the body begins to destroy the pancreas are still being investigated, but the following factors can be identified that contribute to the development of the disease:

Gender and race. It is noted that women and representatives of the Negroid race are more often susceptible to pathology.
Hereditary factors. Most likely, the child of sick parents will also suffer from diabetes.
Changes in hormonal levels. This explains the development of the disease in children and pregnant women.
Cirrhosis of the liver and pathologies of the pancreas.
Low physical activity combined with eating disorders, smoking and alcohol abuse.
Obesity causing atherosclerotic vascular damage.
Taking antipsychotics, glucocorticoids, beta blockers and other drugs.
Cushing's syndrome, hypertension, infectious diseases.

Diabetes often develops in people who have had a stroke and are diagnosed with cataracts and angina.

How to notice the first symptoms?

The first signs of diabetes are the same for all types, only more pronounced in type 1:

inability to quench thirst - diabetics can drink up to 6 liters of water per day;
excessive appetite;
frequent urination and large volume of urine produced.

In the future, with type 1 diabetes, additional symptoms are observed:

smell and taste of acetone;
dry mouth;
decreased ability to regenerate skin damage;
sudden weight loss and increasing weakness;
sleep disturbances and migraine attacks;
susceptibility to fungal infections and colds;
dehydration;
decreased visual function;
unstable blood pressure;
itching and peeling of the skin.

With type 2 of the disease, the same symptoms are observed, with the exception of the smell of acetone. With this type of pathology, ketone bodies, which give the characteristic odor, are not formed.

The meaning and principles of insulin treatment

In diabetes mellitus, the process of sugar absorption into cells is disrupted, since there is little insulin in the body or it is ignored by the cells. In the first case, the hormone must be supplied to the body by injection.

But the dose must correspond to the amount of glucose that is released from the food eaten. Excessive or insufficient amounts of insulin administered can cause hypo- or hyperglycemia.

The source of glucose is carbohydrates, and it is important to know how much of it will enter the blood after each meal in order to select the appropriate dosage of the hormone. It is also necessary to measure blood sugar levels before each meal.

It is more convenient for diabetics to keep a special diary where they can record glucose levels before and after meals, the amount of carbohydrates eaten and insulin doses.

What is a “bread unit”?

The dose of the hormone is calculated depending on the amount of carbohydrates consumed during meals. Diabetics need to count carbohydrates to maintain their diet.

Only fast carbohydrates are counted, which are rapidly absorbed and lead to a jump in glucose. For the convenience of counting, there is such a thing as a “bread unit”.

To eat 1 XE worth of carbohydrates means to consume the same amount of carbohydrates as is contained in half a slice of bread 10 mm thick or 10 g.

For example, 1 XE is contained in:

a glass of milk;
2 tbsp. l. mashed potatoes;
one medium potato;
4 spoons of vermicelli;
1 orange;
a glass of kvass.

It should be taken into account that liquid foods will increase sugar faster than dense foods, and 1 XE contains less raw foods (cereals, pasta, legumes) by weight than boiled foods.

The permissible amount of XE per day varies depending on age, for example:

at 7 years old you need 15 XE;
at 14 – boys 20, girls 17 XE;
at 18 years old - boys 21, girls 18 XE;
adults 21 HE.

You can eat no more than 6-7 XE at a time.

Diabetics should check their glucose levels before each meal. In case of low sugar, you can allow yourself a dish richer in carbohydrates, for example, thin porridge. If the level is elevated, then you need to choose dense and less carbohydrate foods (sandwich, omelet).

For 10 g of carbohydrates or 1 XE, 1.5-4 units are required. hormone insulin. The dose varies depending on the time of year and time of day. So, in the evening the insulin dose should be lower, and in the morning it should be increased. In summer you can administer fewer units of the hormone, but in winter the dose will have to be increased.

By adhering to these principles, you can avoid the need for additional injections.

Which hormone is better?

Treatment of insulin-dependent diabetes mellitus of any type is carried out using hormones of different types of origin:

human pancreatic hormone;
a hormone produced by the gland of a pig;
bovine hormone.

Human hormone is required to correct glucose levels in the following cases:

diabetes during pregnancy;
diabetes with complications;
type 1 diabetes newly diagnosed in a child.

When choosing which hormone to prefer, you should pay attention to the correct calculation of the dose of the drug. The result of treatment depends only on this, and not on the origin.

Short insulins include:

Humalog;
Actrapid;
Insulrap;
Iletin P Homorap.

The effect of such drugs occurs within a quarter of an hour after the injection, but does not last long, 4-5 hours. Such injections will have to be done before eating, and sometimes in between meals if the sugar increases. You will have to keep a supply of insulin with you at all times.

After 90 minutes, intermediate-acting insulins begin to act:

Semilong;
Semilente NM and MS.

After 4 hours, their effectiveness peaks. This type of insulin is convenient if there is not enough time for breakfast and food intake is delayed in time from the injection.

This option can only be used if you know for sure what will be eaten and when and how many carbohydrates this food will contain. After all, if you are late with a meal, your glucose will likely drop below the permissible level, and if you eat more carbohydrates, you will need to take another injection.

Long-acting insulins are more convenient to administer in the morning and evening.

These include:

Protafan;
Lente;
Homophan;
Monotard NM and MS;
Iletin PN.

These hormones work effectively for more than 14 hours and begin to act 3 hours after the injection.

Where and when are injections given?

The standard of treatment for insulin-dependent diabetes is based on a scheme of combinations of insulin injections of different durations of action in order to closely replicate the natural production of the hormone by the pancreas.

Usually, short and long insulin are injected before breakfast, short insulin is injected again before the last meal, and long insulin is injected at night. In another option, long-acting insulin is administered morning and night, and a short-acting hormone is injected before each meal.

For insulin administration, 4 zones are divided.

The most suitable place for injection is the area within 2 fingers from the navel. You should not inject in the same place every time. This can cause a decrease in the layer of fatty tissue under the skin and the accumulation of insulin, which, when it begins to act, provokes hypoglycemia. The injection zones need to be changed; in extreme cases, the injection should be given, moving away from the previous puncture site by at least 3-4 cm.

The following injection scheme is often used: short insulin is injected into the abdominal area, and long insulin is injected into the thigh area. Or mixed hormone preparations are used, for example, Humalog mix.

Video tutorial on insulin administration technique:

Diabetes mellitus is a dangerous and incurable disease that requires strict adherence to all doctor’s recommendations, regular monitoring of blood sugar concentrations and strict adherence to the insulin injection schedule. Only the combination of all these actions will keep the disease under control, prevent the development of complications and increase life expectancy.

Despite the fact that patients with type II diabetes mellitus are prescribed insulin medications, insulin-dependent diabetes is still considered to be a type I disease. This is due to the fact that with this disease the body stops producing its own insulin.

The pancreas of people diagnosed with insulin-dependent diabetes is virtually devoid of cells that produce this protein hormone.

In type II diabetes, the pancreas produces too little insulin and the body cells do not have enough of this hormone for normal functioning. Often, correct physical activity and a well-designed diet can normalize insulin production and improve metabolism in type II diabetes.

If this is the case, then insulin administration to these patients will not be required. For this reason, type I diabetes is also commonly referred to as insulin-dependent diabetes mellitus.

When a patient with type II diabetes has to be prescribed insulin, the disease is said to have entered the insulin-dependent phase. But, fortunately, this does not happen very often.

Type I diabetes develops very rapidly and usually occurs in childhood and adolescence. This is where another name for this diabetes comes from – “juvenile”. Full recovery is only possible with a pancreas transplant. But such an operation entails lifelong use of medications that suppress the immune system. This is necessary to prevent pancreatic rejection.

Injecting insulin does not have such a strong negative effect on the body, and with proper insulin therapy, the life of a patient with type I diabetes is no different from the life of healthy people.

How to notice the first symptoms

When type I diabetes just begins to develop in the body of a child or teenager, it is difficult to identify immediately.

1. If a child constantly asks for a drink in the summer heat, then most likely the parents will consider this natural.
2. Visual impairment and high fatigue of primary school students are often attributed to high school loads and the body’s unfamiliarity with them.
3. There is also an excuse for weight loss, they say that hormonal changes occur in the teenager’s body, which again affects fatigue.

But all these signs can be the beginning of developing type I diabetes. And if the first symptoms go unnoticed, then the child may suddenly develop ketoacidosis. By its nature, ketoacidosis resembles poisoning: abdominal pain, nausea, and vomiting occur.

But with ketoacidosis, the mind becomes confused and falls asleep all the time, which is not the case with food poisoning. The smell of acetone from the mouth is the first sign of illness.

Ketoacidosis can also occur with type II diabetes, but in this case, the patient’s relatives already know what it is and how to behave. But ketoacidosis that appears for the first time is always unexpected, and this makes it very dangerous.

The meaning and principles of insulin treatment

The principles of insulin therapy are very simple. After a healthy person has eaten, his pancreas releases the required dose of insulin into the blood, glucose is absorbed by the cells, and its level decreases.

In people with diabetes mellitus types I and II, this mechanism is disrupted for various reasons, so it has to be imitated manually. To correctly calculate the required dose of insulin, you need to know how much and with what foods the body receives carbohydrates and how much insulin is needed to process them.

The amount of carbohydrates in food does not affect its calorie content, so counting calories makes sense unless type I and II diabetes is accompanied by excess weight.

Type I diabetes does not always require a diet, which cannot be said about insulin-dependent type II diabetes. This is why every person with type I diabetes should measure their blood sugar levels and calculate their insulin doses correctly.

People with type II diabetes who do not use insulin injections also need to keep a self-monitoring diary. The longer and more accurately the records are kept, the easier it is for the patient to take into account all the details of his disease.

The diary will provide invaluable assistance in monitoring nutrition and lifestyle. In this case, the patient will not miss the moment when type II diabetes turns into the insulin-dependent form of type I.

“Bread unit” - what is it?

Diabetes I and II require constant calculation of the amount of carbohydrates consumed by the patient in food.

For type I diabetes mellitus, this is necessary to correctly calculate the insulin dose. And for type II diabetes - in order to control therapeutic and dietary nutrition. When calculating, only those carbohydrates are taken into account that affect glucose levels and the presence of which forces the administration of insulin.

Some of them, for example, sugar, are absorbed quickly, others - potatoes and cereals, are absorbed much more slowly. To facilitate their calculation, a conventional value called a “bread unit” (XE) has been adopted, and a kind of bread unit calculator makes life easier for patients.

One XE is equal to approximately 10-12 grams of carbohydrates. This is exactly as much as is contained in a 1 cm thick piece of white or black “brick” bread. It doesn’t matter what foods are measured, the amount of carbohydrates will be the same:

- in one tablespoon of starch or flour;
- in two tablespoons of ready-made buckwheat porridge;
- in seven tablespoons of lentils or peas;
- in one medium potato.

Those suffering from type I diabetes and severe type II diabetes should always remember that liquid and cooked foods are absorbed faster, which means they increase blood glucose levels more than solid and thick foods.

Therefore, when preparing to eat, the patient is advised to measure his sugar. If it is below the norm, then you can eat semolina porridge for breakfast, but if the sugar level is above the norm, then it is better to have scrambled eggs for breakfast.

On average, one XE requires from 1.5 to 4 units of insulin. True, in the morning you need more of it, and in the evening – less. In winter, the dosage increases, and with the onset of summer it decreases. Between two meals, a person with type I diabetes can eat one apple, which is equal to 1 XE. If a person controls his blood sugar level, then he will not need an additional injection.

Which insulin is better

For diabetes I and II, 3 types of pancreatic hormones are used:

1. human;
2. pork;
3. bullish.

It is impossible to say exactly which one is better. The effectiveness of insulin treatment depends not on the origin of the hormone, but on its correct dosage. But there is a group of patients who are prescribed only human insulin:

1. pregnant women;
2. children diagnosed with type 1 diabetes for the first time;
3. people with complicated diabetes mellitus.

Based on their duration of action, insulins are divided into short-acting, medium-acting and long-acting insulins.

Short insulins:

- Actropid;
- Insulrap;
- Iletin P Homorap;
- Insulin Humalog.

Any of them begins to work 15-30 minutes after the injection, and the duration of the injection is 4-6 hours. The drug is administered before each meal and between them if the sugar level rises above normal. People with type 1 diabetes should always carry extra injections with them.

Intermediate acting insulins

- Semilente MS and NM;
- Semilong.

They begin their activity 1.5 - 2 hours after the injection, and the peak of their action occurs after 4-5 hours. They are convenient for those patients who do not have time or do not want to have breakfast at home, but do it at work, but are embarrassed to administer the drug in front of everyone.

You just need to take into account that if you don’t eat food on time, your sugar level may drop sharply, and if your diet contains more carbohydrates than it should, you will have to use an additional injection.

Therefore, this group of insulins is acceptable only for those who, when eating out, know exactly what time they will eat and how many carbohydrates it will contain.

Long-acting insulins

1. Monotard MS and NM;
2. Protafan;
3. Iletin PN;
4. Homophan;
5. Humulin N;
6. Lente.

Their action begins 3-4 hours after injection. For some time, their level in the blood remains unchanged, and the duration of action is 14-16 hours. For type I diabetes, these insulins are injected twice a day.

Insulin dependent diabetes

(Type 1 diabetes mellitus)

Type 1 diabetes usually develops in young people aged 18-29 years.

As a person grows up and enters an independent life, he experiences constant stress, and bad habits are acquired and taken root.

Due to certain pathogenic (disease-causing) factors- viral infection, frequent alcohol consumption, smoking, stress, eating processed foods, hereditary predisposition to obesity, pancreatic disease - the development of an autoimmune disease occurs.

Its essence is that the body’s immune system begins to fight itself, and in the case of diabetes, the beta cells of the pancreas (islets of Langerhans) that produce insulin are attacked. There comes a time when the pancreas practically stops producing the necessary hormone on its own or produces it in insufficient quantities.

The full picture of the reasons for this behavior of the immune system is not clear to scientists. They believe that the development of the disease is influenced by both viruses and genetic factors. In Russia, approximately 8% of all patients have type 1 diabetes. Type I diabetes is usually a disease of the young, as in most cases it develops in adolescence or young adulthood. However, this type of disease can also develop in a mature person. Beta cells in the pancreas begin to deteriorate several years before symptoms appear. At the same time, the person’s well-being remains at the usual normal level.

The onset of the disease is usually acute, and the person himself can reliably name the date of the onset of the first symptoms: constant thirst, frequent urination, an insatiable feeling of hunger and, despite frequent eating, weight loss, fatigue, and deterioration of vision.

This can be explained as follows. Destroyed beta cells of the pancreas are unable to produce sufficient amounts of insulin, the main effect of which is to reduce the concentration of glucose in the blood. As a result, the body begins to accumulate glucose.

Glucose- a source of energy for the body, but in order for it to get into the cell (by analogy: gasoline is needed to run an engine), it needs a conductor - insulin.

If there is no insulin, then the body's cells begin to starve (hence fatigue), and glucose coming from outside with food accumulates in the blood. In this case, the “starving” cells give a signal to the brain about the lack of glucose, and the liver comes into action, releasing an additional portion of glucose into the blood from its own glycogen reserves. Struggling with an excess of glucose, the body begins to intensively remove it through the kidneys. Hence the frequent urination. The body replenishes fluid loss by frequently quenching thirst. However, over time, the kidneys cease to cope with the task, so dehydration, vomiting, abdominal pain, and impaired kidney function occur. Glycogen reserves in the liver are limited, so when they run low, the body will begin to process its own fat cells to produce energy. This explains the weight loss. But the transformation of fat cells to release energy occurs more slowly than with glucose, and is accompanied by the appearance of unwanted “waste”.

Ketone (that is, acetone) bodies begin to accumulate in the blood, the increased content of which leads to conditions dangerous to the body - from ketoacidosis And acetone poisoning(acetone dissolves the fatty membranes of cells, preventing the penetration of glucose inside, and sharply inhibits the activity of the central nervous system) up to coma.

It is by the presence of increased levels of ketone bodies in the urine that the diagnosis of “type 1 diabetes mellitus” is made, since acute malaise in a state of ketoacidosis is what brings a person to the doctor. In addition, people around can often feel the patient’s “acetone” breath.

Because the destruction of beta cells in the pancreas occurs gradually, an early and accurate diagnosis can be made even when there are no obvious symptoms of diabetes. This will stop the destruction and preserve the mass of beta cells that have not yet been destroyed.

There are 6 stages of development of type 1 diabetes mellitus:

1. Genetic predisposition to type 1 diabetes mellitus. At this stage, reliable results can be obtained through studies of genetic markers of the disease. The presence of HLA group antigens in a person greatly increases the risk of developing type 1 diabetes.

2. Starting moment. Beta cells are influenced by various pathogenic (disease-causing) factors (stress, viruses, genetic predisposition, etc.), and the immune system begins to form antibodies. Impairment of insulin secretion has not yet occurred, but the presence of antibodies can be determined using an immunological test.

3. Prediabetes stage. The destruction of beta cells of the pancreas by autoantibodies of the immune system begins. There are no symptoms, but disorders of insulin synthesis and secretion can already be detected using a glucose tolerance test. In most cases, antibodies to pancreatic beta cells, antibodies to insulin, or the presence of both types of antibodies simultaneously are detected.

4. Decreased insulin secretion. Stress tests can reveal violationtoleranceToglucose(NTG) and abnormal fasting plasma glucose(NGPN).

5. "Honeymoon. At this stage, the clinical picture of diabetes mellitus is presented with all the listed symptoms. Destruction of pancreatic beta cells reaches 90%. Insulin secretion is sharply reduced.

6. Complete destruction of beta cells. Insulin is not produced.

You can independently determine whether you have type 1 diabetes only at the stage when all the symptoms are present. They arise simultaneously, so this will not be difficult to do. The presence of only one symptom or a combination of 3-4, for example, fatigue, thirst, headache and itching, does not yet indicate diabetes, although, of course, it indicates another ailment.

To determine if you have diabetes, laboratory tests are required for sugar content in blood and urine, which can be carried out both at home and in the clinic. This is the primary method. However, it should be remembered that an increase in blood sugar in itself does not mean the presence of diabetes mellitus. It may be caused by other reasons.

Psychologically, not everyone is ready to admit that they have diabetes, and people often wait until the last minute. And yet, if you discover that you have the most alarming symptom - “sweet urine”, it is better to go to the hospital. Even before the advent of laboratory tests, English doctors and ancient Indian and Eastern practitioners noticed that the urine of diabetic patients attracted insects, and called diabetes “sweet urine disease.”

Currently, a wide range of medical devices are produced aimed at self-monitoring of blood sugar levels by a person - glucometers And test strips to them.

Test strips for visual control are sold in pharmacies, are easy to use and accessible to everyone. When purchasing a test strip, be sure to pay attention to the expiration date and read the instructions. Before using the test, you must wash your hands thoroughly and dry them. There is no need to wipe the skin with alcohol.

It is better to take a disposable needle with a round cross-section or use a special lancet, which is included with many tests. Then the wound will heal faster and be less painful. It is best not to pierce the pad, since this is the working surface of the finger and constant touching does not contribute to the rapid healing of the wound, but the area is closer to the nail. It is better to massage your finger before injecting. Then take a test strip and leave a swollen drop of blood on it. It is worth paying attention that you should not add blood or smear it on the strip. You need to wait until the drop swells enough to capture both halves of the test field. To do this you will need a watch with a second hand. After the time specified in the instructions, wipe off the blood from the test strip with a cotton swab. In good lighting, compare the changed color of the test strip with the scale that is usually located on the test box.

This visual method of determining blood sugar levels may seem inaccurate to many, but the data turns out to be quite reliable and sufficient to correctly determine whether sugar is elevated or to set the dose of insulin required for the patient.

The advantage of test strips over a glucometer is their relative cheapness. Nevertheless, Glucometers have a number of advantages over test strips. They are portable and lightweight. The result appears faster (from 5 s to 2 min). The drop of blood may be small. There is no need to wipe the blood off the strip. In addition, glucometers often have an electronic memory into which the results of previous measurements are entered, so this is a kind of diary of laboratory tests.

Currently, two types of glucometers are produced. The former have the same ability as the human eye to visually detect changes in the color of the test field.

And the operation of the second, sensory ones, is based on an electrochemical method, which measures the current generated during the chemical reaction of glucose in the blood with substances applied to the strip. Some blood glucose meters also measure blood cholesterol levels, which is important for many people with diabetes. Thus, if you have the classic hyperglycemic triad: frequent urination, constant thirst and insatiable hunger, as well as a genetic predisposition, everyone can use a glucometer at home or buy test strips at the pharmacy. After which, of course, you need to consult a doctor. Even if these symptoms do not indicate diabetes, in any case they did not arise by chance.

When making a diagnosis, the type of diabetes is first determined, then the severity of the disease (mild, moderate and severe). The clinical picture of type 1 diabetes is often accompanied by various complications.

1. Persistent hyperglycemia- the main symptom of diabetes mellitus when elevated blood sugar levels persist for a long time. In other cases, not being a diabetic characteristic, temporary hyperglycemia may develop in a person during infectiousdiseases, V post-stress period or with eating disorders, such as bulimia, when a person does not control the amount of food eaten.

Therefore, if at home using a test strip you were able to detect an increase in blood glucose levels, you should not rush to conclusions. You need to see a doctor - he will help determine the true cause of hyperglycemia. Glucose levels in many countries around the world are measured in milligrams per deciliter (mg/dL), and in Russia in millimoles per liter (mmol/L). The conversion factor from mmol/l to mg/dl is 18. The table below shows which values are critical.

Glucose level. Content mmol/l and mg/dl

Blood glucose level (mol/l)	Blood glucose level (mg/dl)	Severity of hyperglycemia



6.7 mmol/l		Mild hyperglycemia

7.8 mmol/l
		Moderate hyperglycemia

10 mmol/l
14 mmol/l
Over 14 mmol/l – severe hyperglycemia
Over 16.5 mmol/l – precoma
Over 55.5 mmol/l - coma

Diabetes is diagnosed with the following indicators: glycemia in capillary blood on an empty stomach is more than 6.1 mmol/l, 2 hours after a meal - more than 7.8 mmol/l, or at any time of the day is more than 11.1 mmol/l. Glucose levels can be changed repeatedly throughout the day, before and after meals. The concept of normal varies, but there is a range of 4-7 mmol/l for healthy adults on an empty stomach. Prolonged hyperglycemia leads to damage to the blood vessels and the tissues they supply.

Signs of acute hyperglycemia are ketoacidosis, arrhythmia, impaired state of consciousness, dehydration. If you notice a high level of sugar in your blood, accompanied by nausea, vomiting, abdominal pain, severe weakness and clouding of consciousness or an acetone smell in your urine, you should immediately call an ambulance. This is probably most likely a diabetic coma, so urgent hospitalization is necessary!

However, even if there are no signs of diabetic ketoacidosis, but there is thirst, dry mouth, and frequent urination, you still need to consult a doctor. Dehydration is also dangerous. While waiting for the doctor, you need to drink more water, preferably alkaline or mineral water (buy it at a pharmacy and keep a supply at home).

Possible causes of hyperglycemia:

* a common mistake when conducting analysis;

* incorrect dosage of insulin or hypoglycemic agents;

* diet violation (increased consumption of carbohydrates);

* an infectious disease, especially accompanied by high temperature and fever. Any infection requires an increase in insulin in the patient’s body, so you should increase the dose by about 10%, having previously informed your physician. When taking pills to treat diabetes, their dose should also be increased after consulting with your doctor (he may recommend a temporary switch to insulin);

* hyperglycemia as a consequence of hypoglycemia. A sharp decrease in sugar leads to the release of glucose reserves from the liver into the blood. There is no need to reduce this sugar, it will soon return to normal on its own; on the contrary, you should reduce the dose of insulin. It is also likely that with normal sugar in the morning and during the day, hypoglycemia may appear at night, so it is important to choose a day and carry out the analysis at 3-4 am.

Symptoms of nocturnal hypoglycemia are nightmares, rapid heartbeat, sweating, chills;

* short-term stress (exam, going to the dentist);

* menstrual cycle. Some women experience hyperglycemia during certain phases of their cycle. Therefore, it is important to keep a diary and learn to identify such days in advance and adjust the dose of insulin or diabetes pills accordingly;

* probable pregnancy;

* myocardial infarction, stroke, trauma. Any operation causes an increase in body temperature. However, since in this case the patient is most likely under medical supervision, it is necessary to inform him about the presence of diabetes;

2. Microangiopathy - the general name for lesions of small blood vessels, a violation of their permeability, increased fragility, increased susceptibility to thrombosis. Diabetes manifests itself in the form of the following concomitant diseases:

* diabetic retinopathy- damage to the retinal arteries of the eye, accompanied by small hemorrhages in the area of the optic nerve head;

* diabetic nephropathy- damage to small blood vessels and arteries of the kidneys in diabetes mellitus. Manifested by the presence of protein and blood enzymes in the urine;

* diabetic arthropathy- joint damage, the main symptoms are: “crunching”, pain, limited mobility;

* diabetic neuropathy, or diabetic amyotrophy. This is nerve damage that develops during prolonged (several years) hyperglycemia. Neuropathy is based on ischemic nerve damage caused by metabolic disorders. Often accompanied by pain of varying intensity. One type of neuropathy is radiculitis.

Most often, autonomic neuropathy is detected in type 1 diabetes. (symptoms: fainting, dry skin, decreased tear production, constipation, blurred vision, impotence, decreased body temperature, sometimes loose stools, sweating, hypertension, tachycardia) or sensory polyneuropathy. Muscle paresis (weakening) and paralysis are possible. These complications can appear in type 1 diabetes before 20-40 years of age, and in type 2 diabetes - after 50 years;

* diabetic enuephalopathies. Due to ischemic nerve damage, intoxication of the central nervous system often occurs, which manifests itself in the form of constant irritability of the patient, states of depression, mood instability and moodiness.

3. Macroangiopathies - the general name for lesions of large blood vessels - coronary, cerebral and peripheral. This is a common cause of early disability and high mortality in patients with diabetes.

Atherosclerosis of the coronary arteries, aorta, and cerebral vessels often occurs in patients with diabetes. The main reason for its appearance is associated with increased insulin levels as a result of treatment for type 1 diabetes mellitus or impaired insulin sensitivity in type 2 diabetes.

Damage to the coronary arteries occurs 2 times more often in patients with diabetes and leads to myocardial infarction or the development of coronary heart disease. Often a person does not feel any pain, and then a sudden myocardial infarction follows. Almost 50% of people with diabetes die from myocardial infarction, and the risk of development is the same for both men and women. Myocardial infarction is often accompanied by this condition, with only one thing a state of ketoacidosis can cause a heart attack.

Peripheral vascular disease leads to the emergence of the so-called diabetic foot syndrome. Ischemic lesions of the feet are caused by impaired circulation in the affected blood vessels of the lower extremities, which leads to trophic ulcers on the skin of the lower leg and foot and the occurrence of gangrene mainly in the area of the first toe. In diabetes, gangrene is dry, with little or no pain. Lack of treatment can lead to limb amputation.

After determining the diagnosis and identifying the severity of diabetes mellitus you should familiarize yourself with the rules of the new lifestyle, which from now on will need to be led in order to feel better and not aggravate the situation.

The main treatment for type 1 diabetes are regular insulin injections and diet therapy. A severe form of type 1 diabetes mellitus requires constant monitoring by doctors and symptomatic treatment of complications of the third degree of severity - neuropathy, retinopathy, nephropathy.

Etiology and pathogenesis

The pathogenetic mechanism for the development of type 1 diabetes is the insufficiency of insulin production by the endocrine cells of the pancreas (pancreatic β-cells), caused by their destruction under the influence of certain pathogenic factors (viral infection, stress, autoimmune diseases, etc.). Type 1 diabetes accounts for 10-15% of all diabetes cases and, in most cases, develops during childhood or adolescence. This type of diabetes is characterized by the onset of core symptoms that progress rapidly over time. The main method of treatment is insulin injections, which normalize the patient’s metabolism. If left untreated, type 1 diabetes progresses rapidly and leads to severe complications such as ketoacidosis and diabetic coma, ending in the death of the patient.

Classification

According to severity:

1. mild course
2. moderate severity
3. severe course

2.According to the degree of compensation of carbohydrate metabolism:

1. compensation phase
2. subcompensation phase
3. decompensation phase

3. For complications:

1. Diabetic micro- and macroangiopathy
2. Diabetic polyneuropathy
3. Diabetic arthropathy
4. Diabetic ophthalmopathy, retinopathy
5. Diabetic nephropathy
6. Diabetic encephalopathy

Pathogenesis and pathohistology

Insulin deficiency in the body develops due to insufficient secretion of insulin by the β-cells of the islets of Langerhans of the pancreas.

Due to insulin deficiency, insulin-dependent tissues (liver, fat and muscle) lose their ability to utilize blood glucose and, as a result, the level of glucose in the blood increases (hyperglycemia) - a cardinal diagnostic sign of diabetes mellitus. Due to insulin deficiency, the breakdown of fats is stimulated in adipose tissue, which leads to an increase in their levels in the blood, and in muscle tissue, the breakdown of proteins is stimulated, which leads to an increased supply of amino acids into the blood. Substrates for the catabolism of fats and proteins are transformed by the liver into ketone bodies, which are used by non-insulin-dependent tissues (mainly the brain) to maintain energy balance against the background of insulin deficiency.

Glucosuria is an adaptive mechanism for removing high levels of glucose from the blood when the glucose level exceeds the threshold value for the kidneys (about 10 mmol/l). Glucose is an osmoactive substance and an increase in its concentration in the urine stimulates increased excretion of water (polyuria), which can ultimately lead to dehydration of the body if the loss of water is not compensated by adequately increased fluid intake (polydipsia). Along with the increased loss of water in the urine, mineral salts are also lost - a deficiency of sodium, potassium, calcium and magnesium cations, chlorine anions, phosphate and bicarbonate develops.

There are 6 stages of development of T1DM. 1) Genetic predisposition to T1DM associated with the HLA system. 2) Hypothetical starting moment. Damage to β - cells by various diabetogenic factors and triggering of immune processes. In patients, the above antibodies are already detected in a small titer, but insulin secretion is not yet affected. 3) Active autoimmune insulinitis. The antibody titer is high, the number of β-cells decreases, and insulin secretion decreases. 4) Decrease in glucose-stimulated secretion of I. In stressful situations, transient IGT (impaired glucose tolerance) and NGPG (impaired fasting plasma glucose) can be detected in a patient. 5) Clinical manifestation of diabetes, including a possible “honeymoon” episode. Insulin secretion is sharply reduced, as more than 90% of β-cells have died. 6) Complete destruction of β-cells, complete cessation of insulin secretion.

Clinic

- hyperglycemia. Symptoms caused by increased blood sugar levels: polyuria, polydipsia, weight loss with decreased appetite, dry mouth, weakness
- microangiopathies (diabetic retinopathy, neuropathy, nephropathy),
- macroangiopathy (atherosclerosis of the coronary arteries, aorta, cerebral vessels, lower extremities), diabetic foot syndrome
- concomitant pathology (furunculosis, colpitis, vaginitis, genitourinary tract infection)

Mild diabetes - compensated by diet, no complications (only with diabetes 2) Moderate diabetes - compensated by PSSP or insulin, diabetic vascular complications of 1-2 severity are detected. Severe diabetes - labile course, complications of the 3rd degree of severity (nephropathy, retinopathy, neuropathy).

Diagnostics

In clinical practice, sufficient criteria for the diagnosis of type 1 diabetes mellitus are the presence of typical symptoms of hyperglycemia (polyuria and polydipsia) and laboratory confirmed hyperglycemia - fasting capillary blood glucose more than 7.0 mmol/l and/or at any time of day more than 11.1 mmol/ l;

When making a diagnosis, the doctor acts according to the following algorithm.

1. Diseases that manifest themselves with similar symptoms (thirst, polyuria, weight loss) are excluded: diabetes insipidus, psychogenic polydipsia, hyperparathyroidism, chronic renal failure, etc. This stage ends with laboratory confirmation of hyperglycemia syndrome.
2. The nosological form of diabetes is being clarified. First of all, diseases that are included in the group “Other specific types of diabetes” are excluded. And only then is the issue of T1DM or whether the patient suffers from T2DM resolved. The level of C-peptide is determined on an empty stomach and after exercise. The level of concentration of GAD antibodies in the blood is also assessed.

Complications

- Ketoacidosis, hyperosmolar coma
- Hypoglycemic coma (in case of insulin overdose)
- Diabetic micro- and macroangiopathy - impaired vascular permeability, increased fragility, increased susceptibility to thrombosis, and the development of vascular atherosclerosis;

- Diabetic polyneuropathy - polyneuritis of peripheral nerves, pain along the nerve trunks, paresis and paralysis;

- Diabetic arthropathy - joint pain, “crunching”, limited mobility, decreased amount of synovial fluid and increased viscosity;

- Diabetic ophthalmopathy - early development of cataracts (clouding of the lens), retinopathy (retinal damage);

- Diabetic nephropathy - kidney damage with the appearance of protein and blood cells in the urine, and in severe cases with the development of glomerulonephritis and renal failure;

- Diabetic encephalopathy - mental and mood changes, emotional lability or depression, symptoms of central nervous system intoxication.

Treatment

Main goals of treatment:

- Elimination of all clinical symptoms of diabetes
- Achieving optimal metabolic control over the long term.
- Prevention of acute and chronic complications of diabetes
- Ensuring a high quality of life for patients.

To achieve these goals, use:

- diet
- dosed individual physical activity (DIPE)
- teaching patients self-control and simple treatment methods (managing their disease)
- constant self-control

Insulin therapy

Insulin therapy is based on simulating physiological insulin secretion, which includes:

- basal secretion (BS) of insulin
- stimulated (food) insulin secretion

Basal secretion ensures an optimal level of glycemia during the interdigestive period and during sleep, promotes the utilization of glucose entering the body outside meals (gluconeogenesis, glycolysis). Its rate is 0.5-1 units/hour or 0.16-0.2-0.45 units per kg of actual body weight, that is, 12-24 units per day. With physical activity and hunger, BS decreases to 0.5 units/hour. The secretion of stimulated dietary insulin corresponds to the level of postprandial glycemia. The level of CV depends on the level of carbohydrates eaten. For 1 bread unit (XE) approximately 1-1.5 units are produced. insulin. Insulin secretion is subject to daily fluctuations. In the early morning hours (4-5 o'clock) it is highest. Depending on the time of day, 1 XE is secreted:

- for breakfast - 1.5-2.5 units. insulin
- for lunch 1.0-1.2 units. insulin
- for dinner 1.1-1.3 units. insulin

1 unit of insulin reduces blood sugar by 2.0 mmol/unit, and 1 XE increases it by 2.2 mmol/l. Of the average daily dose (ADD) of insulin, the amount of dietary insulin is approximately 50-60% (20-30 units), and the share of basal insulin accounts for 40-50%.

Principles of insulin therapy (IT):

- the average daily dose (ADD) of insulin should be close to physiological secretion
- when distributing insulin throughout the day, 2/3 of the SSD should be administered in the morning, afternoon and early evening and 1/3 in the late evening and at night
- using a combination of short-acting insulin (RAI) and long-acting insulin. Only this allows us to approximately simulate the daily secretion of I.

During the day, the ICD is distributed as follows: before breakfast - 35%, before lunch - 25%, before dinner - 30%, at night - 10% of the insulin SDD. If necessary, at 5-6 o'clock in the morning 4-6 units. ICD. Do not administer > 14-16 units in one injection. If it is necessary to administer a large dose, it is better to increase the number of injections by shortening the administration intervals.

Correction of insulin doses according to glycemic level To adjust the doses of the administered ICD, Forsch recommended that for every 0.28 mmol/L blood sugar exceeding 8.25 mmol/L, an additional unit should be administered. I. Therefore, for every “extra” 1 mmol/l of glucose, an additional 2-3 units are required. AND

Correction of insulin doses for glucosuria The patient must be able to carry it out. During the day, in the intervals between insulin injections, collect 4 portions of urine: 1 portion - between breakfast and lunch (previously, before breakfast, the patient must empty the bladder), 2 - between lunch and dinner, 2 - between dinner and 22 o'clock, 4 - from 22 o'clock until breakfast. In each portion, diuresis is taken into account, the % glucose content is determined and the amount of glucose in grams is calculated. If glucosuria is detected, to eliminate it, an additional 1 unit is administered for every 4-5 g of glucose. insulin. The day after urine collection, the dose of insulin administered is increased. After compensation has been achieved or approached, the patient should be transferred to a combination of ICD and ISD.

Traditional insulin therapy (IT). Allows you to reduce the number of insulin injections to 1-2 times a day. With TIT, ISD and ICD are simultaneously administered 1 or 2 times a day. At the same time, ISD accounts for 2/3 of SSD, and ICD accounts for 1/3 of SSD. Advantages:

- ease of administration
- ease of understanding of the essence of treatment by patients, their relatives, and medical personnel
- no need for frequent glycemic control. It is enough to control glycemia 2-3 times a week, and if self-control is impossible - 1 time a week
- treatment can be carried out under the control of the glucosuric profile

Flaws

- the need for strict adherence to the diet in accordance with the selected dose AND
- the need for strict adherence to the daily routine, sleep, rest, physical activity
- mandatory 5-6 meals a day, at a strictly defined time, tied to the introduction of I
- inability to maintain glycemia within physiological fluctuations
- Constant hyperinsulinemia accompanying TIT increases the risk of developing hypokalemia, arterial hypertension, and atherosclerosis.

TIT shown

- elderly people if they are unable to master the requirements of IIT
- persons with mental disorders, low educational level
- patients in need of outside care
- undisciplined patients

Calculation of insulin doses for TIT 1. Preliminarily determine the insulin SDD 2. Distribute the insulin SDD by time of day: 2/3 before breakfast and 1/3 before dinner. Of these, ICD should account for 30-40%, ISD - 60-70% of SSD.

IIT(IT Intensive) Basic principles of IIT:

- the need for basal insulin is provided by 2 injections of ISD, which is administered in the morning and evening (the same drugs are used as for TIT). The total dose of ISD is not > 40-50% of the SSD, 2/3 of the total dose of ISD is administered before breakfast, 1/3 before dinner.
- food - bolus insulin secretion is simulated by the introduction of an ICD. The required ICD doses are calculated taking into account the amount of XE planned for breakfast, lunch and dinner and the level of glycemia before meals. IIT provides for mandatory glycemic control before each meal, 2 hours after meals and at night. That is, the patient must monitor glycemia 7 times a day.

Advantages

- imitation of physiological secretion I (basal stimulated)
- the possibility of a more free lifestyle and daily routine for the patient
- the patient can use a “liberalized” diet by changing the timing of meals and the set of foods as desired
- higher quality of life for the patient
- effective control of metabolic disorders, preventing the development of late complications
- the need to educate patients on the problem of diabetes, issues of its compensation, calculation of blood cholesterol, the ability to select doses and develops motivation, understanding of the need for good compensation, prevention of complications of diabetes.

Flaws

- the need for constant self-monitoring of glycemia, up to 7 times a day
- the need to educate patients in schools with diabetes, and change their lifestyle.
- additional costs for training and self-control tools
- tendency to hypoglycemia, especially in the first months of IIT

Mandatory conditions for the possibility of using IIT are:

- sufficient intelligence of the patient
- ability to learn and put acquired skills into practice
- possibility of purchasing self-control means

IIT shown:

- in case of type 1 diabetes it is desirable for almost all patients, and in case of newly diagnosed diabetes it is mandatory
- during pregnancy - transfer to IIT for the entire period of pregnancy, if before pregnancy the patient was treated at IIT
- with gestational diabetes, in case of ineffective diet and DIFN

Scheme of patient management when using IIT

- Calculation of daily calories
- Calculation of the amount of carbohydrates in XE, proteins and fats planned for consumption per day - in grams. Although the patient is on a “liberalized” diet, he should not eat more carbohydrates per day than the calculated dose in XE. Not recommended for 1 dose of more than 8 XE
- Calculation of SSD I

The calculation of the total dose of basal I is carried out by any of the above methods - the calculation of the total food (stimulated) I is carried out based on the amount of XE that the patient plans to consume during the day

- Distribution of doses of administered I during the day.
- Self-monitoring of glycemia, correction of food doses.

Simpler modified IIT techniques:

- 25% SSD I is administered before dinner or at 22:00 as an IDD. The ICD (accounting for 75% of the SDI) is distributed as follows: 40% before breakfast, 30% before lunch and 30% before dinner
- 30% SSD I is administered as IDD. Of these: 2/3 doses before breakfast, 1/3 before dinner. 70% of SSDs are administered as ICDs. Of these: 40% of the dose before breakfast, 30% before lunch, 30% before dinner or at night.

In the future - dose adjustment I.

Type 1 insulin-dependent diabetes is a dangerous endocrine disease of a chronic nature. It is caused by a deficiency of pancreatic hormone synthesis.

As a result, the presence of glucose in the blood increases. Among all the cases of the disease in question, this type is not so common.

As a rule, it is diagnosed in people of young and young age. At the moment, the exact cause of this disease is unknown. But, at the same time, there are several certain factors that contribute to its development.

These include genetic predisposition, viral infectious diseases, exposure to toxins and autoimmune reactions of cellular immunity. The main pathogenetic link of this dangerous and serious disease of the first type is the death of approximately 91% of pancreatic β-cells.

Subsequently, a disease develops that is characterized by insufficient insulin production. So what is insulin-dependent diabetes, and what leads to it?

Insulin-dependent diabetes mellitus: what is it?

This form of the disease accounts for approximately 9% of the incidence, which is associated with increased glucose levels in the blood plasma.

However, the total number of diabetics is increasing every year. It is this type that is considered the most severe and is often diagnosed in people at an early age.

So what should every person know about insulin-dependent diabetes mellitus in order to prevent its development? First, you need to understand the terms. Diabetes mellitus is a disease of autoimmune origin, which is characterized by a complete or partial cessation of the formation of a pancreatic hormone called insulin.

This dangerous and fatal process subsequently leads to an unwanted accumulation of sugar in the blood, which is considered the so-called “energy raw material” necessary for the smooth functioning of many cellular and muscle structures. In turn, they cannot receive the vital energy they need and begin to break down the existing reserves of protein and fat for this.

Insulin production

It is insulin that is considered the only hormone of its kind in the human body that has the ability to regulate. It is produced by certain cells located on the islets of Langerhans of the pancreas.

But, unfortunately, in the body of every person there is a huge number of other hormones that have the ability to increase sugar levels. For example, these include adrenaline and norepinephrine.

The subsequent appearance of this endocrine disease is influenced by many factors, which can be found out later in the article. It is believed that this lifestyle has a tremendous impact on this disease. This is due to the fact that people of the modern generation increasingly suffer from the presence and do not want to lead.

The most popular types of the disease are the following:

insulin-dependent diabetes type 1;
non-insulin dependent type 2;

The first form of the disease is considered a dangerous pathology, in the presence of which insulin production almost completely stops. A large number of modern scientists believe that the main reason for the development of this type of disease is the hereditary factor.

The disease requires constant scrupulous monitoring and remarkable patience, because at the moment there are no medications that could completely cure the patient.

Treatment

As for effective therapy, there are two main tasks: a radical change in the current lifestyle and competent treatment with the help of certain medications.

It is very important to constantly follow a special diet, which involves.

You also shouldn’t forget about sufficient physical activity and self-control. An important stage is individual selection.

Any additional sports activities and meals must be taken into account when calculating the amount of insulin administered.

There is a simple regimen of insulin therapy, a continuous subcutaneous infusion of pancreatic hormone, and multiple subcutaneous injections.

Consequences of disease progression

During subsequent development, the disease has a strong negative impact on all body systems.

This irreversible process can be avoided through timely diagnosis. It is also important to provide specific supportive treatment.

The most devastating complication is.

This condition is characterized by symptoms such as dizziness, attacks of vomiting and nausea, and fainting.

An additional complication in people with diabetes is a decrease in the body's protective functions. It is for this reason that they often suffer from colds.

Video on the topic

All about insulin-dependent diabetes mellitus in:

Type 1 diabetes is not a death sentence. The most important thing is to know everything about this disease. This is what will help you be armed and promptly detect any changes in the performance of your own body. When the first alarming symptoms appear, you should immediately contact a qualified endocrinologist for examination, examination and appropriate treatment.

Diabetes is a disease that people have been suffering from for hundreds of years. It is characterized by increased sugar levels in the body. Diabetes mellitus is a very serious disease that affects not only the blood, but also almost all organs and systems. The following types of disease are distinguished: first and second. The first is characterized by the fact that almost 90% of pancreatic cells stop functioning.

In this case, complete insulin deficiency occurs, that is, the body does not produce insulin at all. This disease mainly occurs before the age of twenty and is called insulin-dependent diabetes mellitus.

The second type is non-insulin-dependent diabetes mellitus. In this case, the body produces insulin in large quantities, however, it does not fulfill its function. The disease is inherited and affects people after forty years of age and those who are overweight.

Diabetes mellitus type 1

They are characterized by the fact that they develop very quickly and occur in children and young people. It is also called “diabetes of the young.” For prevention, insulin injections are used, which are given regularly. The disease usually occurs due to the body's abnormal response to the pancreas (the cells that produce insulin are destroyed through the immune system).

Viral infections greatly increase the risk of type 1 diabetes. If a person has had pancreatic inflammation, then in 80% of cases this disease awaits him. Genetics plays an important role, however, transmission in this way rarely occurs.

Very often, type 1 diabetes mellitus (IDM) occurs suddenly during pregnancy. In this case, insulin injections are administered in order to support the body of the pregnant woman and the fetus. This type of diabetes in pregnant women has the ability to disappear after childbirth. Although women who have had this disease are at risk.

This type is more dangerous than the second and is caused by the following symptoms:

weakness of the body;
insomnia;
rapid weight loss;
increased levels of acetone;
migraine;
aggressiveness;
muscle pain.

For the treatment of this disease use:

insulin;
physical exercise;
diet;
help from a psychologist;
self-control.

The issue of assigning disability is decided upon consideration of the patient’s entire medical history.

Diabetes mellitus type 2

This form of the disease is less dangerous than the first and occurs after 40 years of age. It is characterized by excessive secretion. It is treated with tablets that normalize cells and increase the rate of glucose processing, intestines, liver and muscles.

The disease is manifested by the following symptoms:

scabies;
obesity;
migraine;
dry mouth;
pustular rash on the skin.

Insd is much easier than the insulin-dependent type. Complications of this disease are associated with poor functioning of the organs and systems of the body. If treatment is not carried out, the following complications arise:

atherosclerosis;
neuropathy;
cardiovascular diseases;
diabetic coma.

Treatment is carried out in two interrelated areas:

lifestyle changes;
drug treatment.

The main symptoms of diabetes mellitus type 1 and 2

Diabetes mellitus of both types has the following symptoms:

constant desire to drink liquids (thirst);
poor sleep;
excessive urination;
apathy towards the outside world;
laziness.

In some cases, the patient experiences severe nausea, progressing to vomiting, acetone in the blood increases and clouding of mind occurs. If such symptoms appear, a person should immediately receive qualified help. Otherwise, the likelihood of a diabetic coma increases.

Secondary manifestations of the disease include:

physical exhaustion;
loss of muscle strength;
sudden weight loss;
sudden deterioration of vision;
constant changes in blood pressure;
migraine;
metallic taste in the mouth.

Causes of diabetes

Type 1 diabetes mellitus occurs due to a pathology of the immune system, in which pancreatic cells are perceived as foreign objects and are destroyed.

Diabetes (insulin-dependent) often develops in childhood and in pregnant women. Doctors still cannot find reliable reasons why this happens. But the emphasis is on the following factors:

viral infections;
autoimmune disorders of the body;
liver problems;
genetics;
excessive consumption of sweets;
heavy weight;
mental disorders.

Diagnosis of diabetes mellitus

For diabetes mellitus, it is extremely important to choose the right, high-quality and safe treatment. If the disease is diagnosed at an early stage, it has a high chance of recovery. Persons with this disease should first contact an endocrinologist and register with him. Diagnosis of diabetes mellitus is carried out in the following areas:

examination by an endocrinologist;
echography examination;
cardiogram;
keeping records of blood pressure status (several times a day);
carrying out laboratory tests.

To perform a blood test you need:

donate blood on an empty stomach and 2 hours after eating;
blood for glycosylation of hemoglobin;
blood for glucose tolerance.

A urine test for sugar and acetone is also performed.

Nutrition for insulin-dependent diabetes mellitus is not limited. If the dose of the drug used is calculated correctly, the patient can take almost all products.

However, it should be remembered that sugar levels can fluctuate, and therefore it is still worth sticking to a certain diet. The main rule is to constantly monitor your condition and calculate the dose of medication.

Today this is easy to do because a device such as a glucometer is used. It is also recommended to record all results in a specially designated diary.

This control is necessary not only for the first form of diabetes, but also for the second. And in this case, the patient will always take insulin.

Treatment with insulin

Treatment depends on taking insulin. In order for the disease to make itself felt as little as possible, you need to take into account the amount of sugar that enters the body with food.

A person who has such a diagnosis needs to understand that it will not be possible to completely overcome this disease. You should use not only medications, but also proper nutrition. Treatment of this disease is a new stage in a person’s life, since he will need to constantly monitor his sugar to prevent complications.

Today, insulin therapy is the most effective method of blocking pathology. But the patient must learn to give himself injections (they can be replaced with an insulin pump, since administering the hormone through a catheter is more convenient).

The principle of nutrition is to get the right amount of calories and carbohydrates, but while consuming a small amount of fat. In this case, fluctuations in glucose levels will not be too sharp. It is worth remembering that you need to veto all foods that contain a lot of calories and sugar. If you follow all these rules, diabetes will progress minimally.

Patients with diabetes eat 5-6 times a day the following foods:

vegetable soups;
lean meat;
seafood;

vegetables (except potatoes);
low-fat dairy products;
sweet and sour fruits and honey.

The following folk remedies are very effective:

earthen pear – eat raw;
juice of one lemon and a chicken egg - on an empty stomach;
walnut leaf tea;
ground grain - wash down a spoonful of powder with milk.

Complications of type 1 and type 2 diabetes mellitus

Diabetes mellitus has a very negative effect on the immune system. Therefore, a person becomes easily susceptible to various infections. It becomes acute and chronic. The most severe complications are hypoglycemia and ketoacedosis. With these complications, instead of glucose, fat breakdown occurs and acidity in the blood increases.

If the diet is not followed and the amount of insulin administered is not controlled, glucose sharply decreases and glypoglycemic syndrome develops. In the case of insulin-dependent diabetes mellitus, this prognosis does not at all please the patient and his doctor. The body does not receive enough energy and reacts to this pathologically - if you do not give the body sweets, then a coma will occur. If insulin-dependent diabetes is not treated, chronic diseases occur:

stroke;
heart attack;
hypertension;
atherosclerosis;
ulcers;
cataract;
kidney disorders.

Insulin-dependent diabetes mellitus is a serious disease that is often fatal. It is necessary to undergo regular examinations and blood tests, this will help preserve the health of the body for many years.

Insulin-dependent diabetes mellitus

Diabetes- a syndrome whose main diagnostic feature is chronic hyperglycemia. Diabetes mellitus occurs with various diseases leading to insufficient secretion of insulin or disruption of its biological action.

Diabetes mellitus type 1- an endocrine disease characterized by absolute insulin deficiency caused by the destruction of beta cells of the pancreas. Type 1 diabetes can develop at any age, but most often it affects young people (children, adolescents, adults under 40 years of age. The clinical picture is dominated by classic symptoms: thirst, polyuria, weight loss, ketoacidotic conditions.

Etiology and pathogenesis

Classification

According to severity:
1. mild course
2. moderate severity
3. severe course
According to the degree of compensation of carbohydrate metabolism:
1. compensation phase
2. subcompensation phase
3. decompensation phase
For complications:
1. Diabetic micro- and macroangiopathy
2. Diabetic polyneuropathy
3. Diabetic arthropathy
4. Diabetic ophthalmopathy, retinopathy
5. Diabetic nephropathy
6. Diabetic encephalopathy

Pathogenesis and pathohistology

Insulin deficiency in the body develops due to insufficient secretion of insulin by the β-cells of the islets of Langerhans of the pancreas.

Clinic

hyperglycemia. Symptoms caused by increased blood sugar levels: polyuria, polydipsia, weight loss with decreased appetite, dry mouth, weakness
microangiopathies (diabetic retinopathy, neuropathy, nephropathy),
macroangiopathy (atherosclerosis of the coronary arteries, aorta, cerebral vessels, lower extremities), diabetic foot syndrome
concomitant pathology (furunculosis, colpitis, vaginitis, genitourinary tract infection)

Diagnostics

When making a diagnosis, the doctor acts according to the following algorithm.

Diseases that manifest themselves with similar symptoms (thirst, polyuria, weight loss) are excluded: diabetes insipidus, psychogenic polydipsia, hyperparathyroidism, chronic renal failure, etc. This stage ends with laboratory confirmation of hyperglycemia syndrome.

The nosological form of diabetes is being clarified. First of all, diseases that are included in the group “Other specific types of diabetes” are excluded. And only then is the issue of T1DM or whether the patient suffers from T2DM resolved. The level of C-peptide is determined on an empty stomach and after exercise. The level of concentration of GAD antibodies in the blood is also assessed.

Complications

Ketoacidosis, hyperosmolar coma
Hypoglycemic coma (in case of insulin overdose)
Diabetic micro- and macroangiopathy - impaired vascular permeability, increased fragility, increased susceptibility to thrombosis, and the development of vascular atherosclerosis;

Diabetic polyneuropathy - polyneuritis of peripheral nerves, pain along the nerve trunks, paresis and paralysis;

Diabetic arthropathy - joint pain, “crunching”, limited mobility, decreased amount of synovial fluid and increased viscosity;

Diabetic ophthalmopathy - early development of cataracts (clouding of the lens), retinopathy (retinal damage);

Diabetic nephropathy - kidney damage with the appearance of protein and blood cells in the urine, and in severe cases with the development of glomerulonephritis and renal failure;

Diabetic encephalopathy - mental and mood changes, emotional lability or depression, symptoms of central nervous system intoxication.

Treatment

Main goals of treatment:

Elimination of all clinical symptoms of diabetes
Achieving optimal metabolic control over the long term.
Prevention of acute and chronic complications of diabetes
Ensuring a high quality of life for patients.

To achieve these goals, use:

diet
dosed individual physical activity (DIPE)
teaching patients self-control and simple treatment methods (managing their disease)
constant self-control

Insulin therapy

Insulin therapy is based on simulating physiological insulin secretion, which includes:

basal secretion (BS) of insulin
stimulated (food) insulin secretion

for breakfast - 1.5-2.5 units. insulin
for lunch 1.0-1.2 units. insulin
for dinner 1.1-1.3 units. insulin

Principles of insulin therapy (IT):

the average daily dose (ADD) of insulin should be close to physiological secretion
when distributing insulin throughout the day, 2/3 of the SSD should be administered in the morning, afternoon and early evening and 1/3 in the late evening and at night
using a combination of short-acting insulin (RAI) and long-acting insulin. Only this allows us to approximately simulate the daily secretion of I.

ease of administration
ease of understanding of the essence of treatment by patients, their relatives, and medical personnel
no need for frequent glycemic control. It is enough to control glycemia 2-3 times a week, and if self-control is impossible - 1 time a week
treatment can be carried out under the control of the glucosuric profile

Flaws

the need for strict adherence to the diet in accordance with the selected dose AND
the need for strict adherence to the daily routine, sleep, rest, physical activity
mandatory 5-6 meals a day, at a strictly defined time, tied to the introduction of I
inability to maintain glycemia within physiological fluctuations
Constant hyperinsulinemia accompanying TIT increases the risk of developing hypokalemia, arterial hypertension, and atherosclerosis.

TIT shown

elderly people if they are unable to master the requirements of IIT
persons with mental disorders, low educational level
patients in need of outside care
undisciplined patients

IIT(IT Intensive) Basic principles of IIT:

the need for basal insulin is provided by 2 injections of ISD, which is administered in the morning and evening (the same drugs are used as for TIT). The total dose of ISD is not > 40-50% of the SSD, 2/3 of the total dose of ISD is administered before breakfast, 1/3 before dinner.
food - bolus insulin secretion is simulated by the introduction of an ICD. The required ICD doses are calculated taking into account the amount of XE planned for breakfast, lunch and dinner and the level of glycemia before meals. IIT provides for mandatory glycemic control before each meal, 2 hours after meals and at night. That is, the patient must monitor glycemia 7 times a day.

Advantages

imitation of physiological secretion I (basal stimulated)
the possibility of a more free lifestyle and daily routine for the patient
the patient can use a “liberalized” diet by changing the timing of meals and the set of foods as desired
higher quality of life for the patient
effective control of metabolic disorders, preventing the development of late complications
the need to educate patients on the problem of diabetes, issues of its compensation, calculation of blood cholesterol, the ability to select doses and develops motivation, understanding of the need for good compensation, prevention of complications of diabetes.

Flaws

the need for constant self-monitoring of glycemia, up to 7 times a day
the need to educate patients in schools with diabetes, and change their lifestyle.
additional costs for training and self-control tools
tendency to hypoglycemia, especially in the first months of IIT

Mandatory conditions for the possibility of using IIT are:

sufficient intelligence of the patient
ability to learn and put acquired skills into practice
possibility of purchasing self-control means

IIT shown:

in case of type 1 diabetes it is desirable for almost all patients, and in case of newly diagnosed diabetes it is mandatory
during pregnancy - transfer to IIT for the entire period of pregnancy, if before pregnancy the patient was treated at IIT
with gestational diabetes, in case of ineffective diet and DIFN

Scheme of patient management when using IIT

Calculation of daily calories
Calculation of the amount of carbohydrates in XE, proteins and fats planned for consumption per day - in grams. Although the patient is on a “liberalized” diet, he should not eat more carbohydrates per day than the calculated dose in XE. Not recommended for 1 dose of more than 8 XE
Calculation of SSD I

Distribution of doses of administered I during the day.
Self-monitoring of glycemia, correction of food doses.

Simpler modified IIT techniques:

25% SSD I is administered before dinner or at 22:00 as an IDD. The ICD (accounting for 75% of the SDI) is distributed as follows: 40% before breakfast, 30% before lunch and 30% before dinner
30% SSD I is administered as IDD. Of these: 2/3 doses before breakfast, 1/3 before dinner. 70% of SSDs are administered as ICDs. Of these: 40% of the dose before breakfast, 30% before lunch, 30% before dinner or at night.

In the future - dose adjustment I.

dic.academic.ru

Features of type 2 insulin-dependent diabetes mellitus

Unlike other types of the disease, thirst does not torment. It is often referred to as a consequence of aging. Therefore, even losing weight is accepted as a positive result of dieting. Endocrinologists note that treatment of type 2 diabetes begins with diets. The therapist or gastroenterologist draws up a list of permitted foods and a nutritional schedule. For the first time, consultation is provided on creating a menu for each day. (See also: Insulin-dependent diabetes mellitus - useful information on the disease)

With insulin-dependent type 2 diabetes, you always lose weight. At the same time, getting rid of fat deposits. This leads to an increase in insulin sensitivity. Insulin produced by the pancreas begins to process sugar. The latter rushes towards the cells. As a result, blood sucrose levels decrease.

With type 2 diabetes, it is not always possible to regulate glucose levels with diet. Therefore, during the consultation, the endocrinologist prescribes drug treatment. These can be tablets, injections.

Insulin therapy for type 2 diabetes occurs in those who are obese. Even with such a strictly limited diet, it is not always possible to lose weight. This is explained by the fact that sugar levels have not normalized, and the insulin produced is simply not enough to reduce glucose. In such situations, it is important to ensure a decrease in blood counts and insulin injections are prescribed.

As diabetes develops, it requires constant administration of a drug that lowers blood sucrose. In this case, the endocrinologist is obliged to indicate on the outpatient card “Type 2 insulin-dependent diabetes mellitus.” A distinctive feature of diabetics of this type from the first is the dosage for injections. There is nothing critical about this. After all, the pancreas continues to secrete a certain amount of insulin.

How to choose a doctor?

Life expectancy for insulin-dependent diabetes mellitus is difficult to determine. There is a situation when a diabetic stops trusting the endocrinologist. He believes that insulin therapy was prescribed incorrectly and begins to rush around clinics.

In other words, you decide to spend money on obtaining survey results and consulting services. And treatment options may vary. This race forgets the fact that insulin therapy for type 2 diabetes requires instant decision making. After all, with an uncontrolled disease, the damage is done quickly and irreversibly. Therefore, before rushing around endocrinologists’ offices, you should decide on the doctor’s qualifications.

This type of diabetes occurs in people aged 40 years and older. In some cases, the development of insulin therapy is not required, because the pancreas secretes the required amount of insulin. Such situations do not cause diabetic ketoacytosis. However, almost every diabetic has a second enemy, in addition to the disease - obesity.

Genetic predisposition to the disease

In insulin-dependent diabetes mellitus, life expectancy plays an important role. Genetics gives a certain chance
condition of diabetes. After all, if there is a risk of developing a non-insulin-dependent disease in the family, then the children’s chances of remaining healthy are reduced by 50% (if the father is ill) and only 35% if the mother is ill. Naturally, this reduces life expectancy.

Endocrinologists say that it is possible to find the genes for non-insulin-dependent diabetes mellitus. And at the same time determine the causes of metabolic disorders. In other words, in medical practice there are 2 types of genetic defects.

Insulin resistance has a second, more common name: obesity.
decreased secretory activity of beta cells/their insensitivity.

dialekar.ru

Main types of diabetes

Diabetes mellitus (DM) is a disease of autoimmune origin, which is characterized by a complete or partial cessation of the production of the sugar-lowering hormone called insulin. This pathogenic process leads to the accumulation of glucose in the blood, which is considered an “energy material” for cellular and tissue structures. In turn, tissues and cells do not receive the necessary energy and begin to break down fats and proteins.

Insulin is the only hormone in our body that is able to regulate blood sugar levels. It is produced by beta cells, which are located on the islets of Langerhans of the pancreas. However, there are a large number of other hormones in the human body that increase glucose concentrations. These are, for example, adrenaline and norepinephrine, “command” hormones, glucocorticoids and others.

The development of diabetes is influenced by many factors, which will be discussed below. It is believed that the current lifestyle has a great influence on this pathology, since modern people are more likely to be obese and do not exercise.

The most common types of the disease are:

insulin-dependent diabetes mellitus type 1 (IDDM);
non-insulin-dependent diabetes mellitus type 2 (NIDDM);
gestational diabetes.

Insulin-dependent diabetes mellitus type 1 (IDDM) is a pathology in which insulin production completely stops. Many scientists and doctors believe that the main reason for the development of type 1 IDDM is heredity. This disease requires constant monitoring and patience, since today there are no drugs that could completely cure the patient. Insulin injections are an integral part of the treatment of insulin-dependent diabetes mellitus.

Non-insulin-dependent diabetes mellitus type 2 (NIDDM) is characterized by impaired perception of target cells to glucose-lowering hormone. Unlike the first type, the pancreas continues to produce insulin, but the cells begin to react incorrectly to it. This type of disease usually affects people over 40-45 years of age. Early diagnosis, diet therapy and physical activity can avoid drug treatment and insulin therapy.

Gestational diabetes develops during pregnancy. Hormonal changes occur in the body of the expectant mother, as a result of which glucose levels may increase.

With the right approach to therapy, the disease goes away after childbirth.

Causes of diabetes mellitus

Despite the enormous amount of research conducted, doctors and scientists cannot give an exact answer to the question of the cause of diabetes.

What exactly causes the immune system to work against the body itself remains a mystery.

However, the research and experiments carried out were not in vain.

With the help of research and experiments, it was possible to determine the main factors that increase the likelihood of insulin-dependent and non-insulin-dependent diabetes mellitus. These include:

Hormonal imbalance in adolescence associated with the action of growth hormone.
Gender of a person. It has been scientifically proven that the fair half of humanity is twice as likely to suffer from diabetes.
Excess body weight. Extra pounds lead to the deposition of cholesterol on the vascular walls and increase the concentration of sugar in the blood.
Genetics. If insulin-dependent or non-insulin-dependent diabetes mellitus is diagnosed in the mother and father, then it will also manifest itself in the child in 60-70% of cases. Statistics show that twins simultaneously suffer from this pathology with a probability of 58-65%, and twins - 16-30%.
The color of a person’s skin also affects the development of the disease, since diabetes occurs 30% more often in the Negroid race.
Disorders of the pancreas and liver (cirrhosis, hemochromatosis, etc.).
Inactive lifestyle, bad habits and unhealthy diet.
Pregnancy, during which hormonal imbalance occurs.
Drug therapy with glucocorticoids, atypical neuroleptics, beta blockers, thiazides and other drugs.

Having analyzed the above, we can identify a risk factor in which a certain group of people is more susceptible to developing diabetes mellitus. It includes:

overweight people;
people with a genetic predisposition;
patients suffering from acromegaly and Itsenko-Cushing syndrome;
patients with atherosclerosis, hypertension or angina pectoris;
people suffering from cataracts;
people prone to allergies (eczema, neurodermatitis);
patients taking glucocorticoids;
people who have had a heart attack, infectious diseases and stroke;
women with pathological pregnancy;

The risk group also includes women who gave birth to a child weighing more than 4 kg.

How to recognize hyperglycemia?

A rapid increase in glucose concentration is a consequence of the development of the “sweet disease”. Insulin-dependent diabetes may not make itself felt for a long time, slowly destroying the vascular walls and nerve endings of almost all organs of the human body.

However, insulin-dependent diabetes mellitus exhibits many symptoms. A person who is attentive to their health will be able to recognize the body's signals indicating hyperglycemia.

So, what are the symptoms of insulin-dependent diabetes mellitus? Among the two main ones, polyuria (frequent urination) and constant thirst are distinguished. They are associated with the work of the kidneys, which filter our blood, ridding the body of harmful substances. Excess sugar is also a toxin and is therefore excreted from the body in urine. The increased load on the kidneys leads to the fact that the paired organ begins to draw the missing fluid from the muscle tissue, causing symptoms of insulin-dependent diabetes.

Frequent dizziness, migraines, fatigue and poor sleep are other signs that are characteristic of this disease. As mentioned earlier, with a lack of glucose, cells begin to break down fats and proteins to obtain the necessary energy supply. The breakdown results in toxic substances called ketone bodies. Cellular “starvation”, in addition to the toxic effects of ketones, affects the functioning of the brain. Thus, a diabetic patient sleeps poorly at night, does not get enough sleep, cannot concentrate, and as a result, he complains of dizziness and pain.

It is known that diabetes (forms 1 and 2) negatively affects nerves and vessel walls. As a result, nerve cells are destroyed and vascular walls become thinner. This entails a lot of consequences. The patient may complain of deterioration in visual acuity, which is a consequence of inflammation of the retina of the eyeball, which is covered with vascular networks. Additionally, numbness or tingling in the feet and hands are also signs of diabetes.

Among the symptoms of the “sweet disease”, disorders of the reproductive system, both men and women, deserve special attention. The stronger half begins to have problems with erectile function, and the weaker half begins to have problems with the menstrual cycle.

Less common signs include slow wound healing, skin rashes, increased blood pressure, unreasonable hunger, and weight loss.

Consequences of diabetes progression

Undoubtedly, insulin-dependent and non-insulin-dependent diabetes, as it progresses, disables almost all internal organ systems in the human body. This outcome can be avoided with early diagnosis and effective supportive treatment.

The most dangerous complication of diabetes mellitus, non-insulin-dependent and insulin-dependent forms, is diabetic coma. The condition is characterized by symptoms such as dizziness, attacks of vomiting and nausea, clouding of consciousness, and fainting. In this case, urgent hospitalization is necessary for resuscitation measures.

Insulin-dependent or non-insulin-dependent diabetes mellitus with multiple complications is a consequence of a careless attitude towards one’s health. Manifestations of concomitant pathologies are associated with smoking, alcohol, a sedentary lifestyle, poor nutrition, late diagnosis and ineffective therapy. What complications are typical as the disease progresses?

The main complications of diabetes include:

Diabetic retinopathy is a condition in which the retina of the eyes is damaged. As a result, visual acuity decreases; a person cannot see a full picture in front of him due to the appearance of various dark spots and other defects.
Periodontal disease is a pathology associated with inflammation of the gums due to impaired carbohydrate metabolism and blood circulation.
Diabetic foot is a group of diseases covering various pathologies of the lower extremities. Since the legs are the most distant part of the body during blood circulation, type 1 diabetes mellitus (insulin-dependent) causes the appearance of trophic ulcers. Over time, if the reaction is incorrect, gangrene develops. The only treatment is amputation of the lower limb.
Polyneuropathy is another disease associated with sensitivity in the hands and feet. Insulin-dependent and non-insulin-dependent diabetes mellitus with neurological complications provides a lot of inconvenience to patients.
Erectile dysfunction, which begins in men 15 years earlier than their peers who do not have diabetes. The chances of developing impotence are 20-85%, in addition, the likelihood of childlessness among diabetics is high.

Additionally, diabetics experience a decrease in the body's defenses and a frequent occurrence of colds.

Diagnosis of diabetes mellitus

Knowing that this disease has many complications, patients seek help from their doctor. After examining the patient, the endocrinologist, suspecting an insulin-independent or insulin-dependent type of pathology, refers him for testing.

Nowadays, there are many methods for diagnosing diabetes. The simplest and fastest is a finger prick blood test. The collection is carried out on an empty stomach in the morning. The day before the test, doctors do not recommend eating a lot of sweets, but you shouldn’t deny yourself food either. The normal sugar concentration in healthy people is in the range from 3.9 to 5.5 mmol/l.

Another popular method is the glucose tolerance test. This analysis is carried out over two hours. You should not eat anything before the examination. First, blood is drawn from a vein, then the patient is asked to drink water diluted with sugar in a 3:1 ratio. Next, the health care worker begins to draw venous blood every half hour. The result obtained above 11.1 mmol/l indicates the development of insulin-dependent or non-insulin-dependent diabetes mellitus.

In rare cases, a test for glycated hemoglobin is performed. The essence of this study is to measure blood sugar levels over a period of two to three months. The average results are then displayed. Due to its long duration, the analysis has not gained much popularity, however, it provides an accurate picture to specialists.

Sometimes a urine test for sugar is prescribed in combination. A healthy person should not have glucose in urine, so its presence indicates diabetes mellitus of the non-insulin-dependent or insulin-dependent form.

Based on the test results, the doctor will decide on therapy.

diabetes.guru

Non-insulin dependent diabetes mellitus

Type 2 disease is associated primarily with the body’s inability to adequately manage insulin. The glucose content in the blood increases significantly, which negatively affects the condition and functioning of blood vessels and organs. Less commonly, the problem is associated with insufficient production of the pancreatic hormone. Non-insulin-dependent diabetes type 2 is diagnosed in middle-aged and older patients. The disease is confirmed by the results of blood and urine tests, which contain high glucose levels. About 80% of patients are overweight.

Symptoms

Non-insulin-dependent type 2 diabetes develops sequentially, usually over several years. The patient may not notice the manifestations at all. More severe symptoms include:

Thirst can be either pronounced or barely noticeable. The same applies to frequent urination. Unfortunately, type 2 diabetes is often discovered by chance. However, with this disease, early diagnosis is extremely important. To do this, you need to regularly take blood tests to check your sugar levels.

Insulin-dependent diabetes is manifested by problems with the skin and mucous membranes. Usually this:

With pronounced thirst, the patient can drink up to 3-5 liters per day. There are frequent trips to the toilet at night.

With further progression of diabetes, numbness and tingling appear in the extremities, and the legs hurt when walking. In women, candidiasis is difficult to treat. In the later stages of the disease, the following develop:

The above severe symptoms are the first obvious signs of diabetes in 20-30% of patients. Therefore, it is extremely important to get tested annually to avoid such conditions.

zdorov.online

1. It is necessary to outline the desired fasting and postprandial blood glucose levels and try to maintain them. These levels are outlined strictly individually. A. For patients who well recognize the approach of hypoglycemia and in whom it quickly resolves on its own or after taking glucose, it is possible to target fasting glucose levels close to those in healthy people (3.9-7.2 mmol/l). This category includes adult patients with short duration of insulin-dependent diabetes mellitus and adolescents. b. In pregnant women, you should aim for even lower fasting glucose levels. V. Target fasting glucose levels should be higher in those patients who do not feel hypoglycemia is approaching, as well as in cases where hypoglycemia requires drug treatment or is particularly dangerous (for example, in patients with coronary artery disease). G. Disciplined patients who frequently measure blood glucose levels and adjust insulin doses can maintain target glucose levels 70-80% of the time.
2. It is necessary to imitate physiological fluctuations in insulin levels as best as possible. In healthy people, beta cells continually secrete small amounts of insulin and thus maintain basal insulin levels. After eating, insulin secretion increases. To create a basal level of insulin in the patient’s blood that is close to normal and to simulate physiological fluctuations in insulin secretion, one of the following insulin therapy regimens is selected: A. Before each meal, short-acting insulin is administered, and to create a basal level of the hormone, medium-acting insulin is administered once a day (before bedtime) or 2 times a day (before breakfast and before bedtime). b. Before each meal, short-acting insulin is administered; To create a basal level of the hormone, long-acting insulin is administered 1 or 2 times a day. V. Short-acting and intermediate-acting insulin or a combined insulin preparation are administered simultaneously twice a day. d. Before breakfast, short-acting insulin and intermediate-acting insulin or a combined insulin preparation are administered simultaneously. Before dinner, an injection of short-acting insulin is given and before bed - an injection of intermediate-acting insulin. d. A patient with a wearable insulin dispenser should increase the hormone supply before meals. Modern dispenser models equipped with blood glucose meters not only maintain basal insulin levels, but also automatically increase the supply of the hormone when glucose levels rise after a meal.
3. Maintain a balance between insulin doses, nutrition and physical activity. Patients or their relatives are given dietary tables developed by the American Diabetes Association. These tables indicate the carbohydrate content of different foods, their energy value and interchangeability. The doctor, together with the patient, develops an individual nutrition plan. In addition, the doctor explains how physical activity affects blood glucose levels.
4. Self-monitoring of blood glucose levels A. Every day, 4-5 times a day (before each meal and before bed), the patient measures the concentration of glucose in capillary blood from a finger using test strips or a glucometer. b. Once every 1-2 weeks, and also whenever the dose of insulin administered before bedtime changes, the patient measures the glucose concentration between 2:00 and 4:00. The glucose level is determined at the same frequency after meals. V. Always measure glucose concentration when warning signs of hypoglycemia appear. d. The results of all measurements, all insulin doses and subjective sensations (for example, signs of hypoglycemia) are recorded in a diary.
5. Self-correction of insulin therapy and diet depending on blood glucose levels and lifestyle. The doctor should give the patient a detailed action plan, covering as many situations as possible in which adjustments to the insulin therapy regimen and diet may be required. A. Adjustment of the insulin therapy regimen includes changes in insulin doses, changes in the ratio of drugs of different durations of action, and changes in injection times. Reasons for adjusting insulin doses and insulin therapy regimens:
1) Sustained changes in blood glucose levels at certain times of the day, identified by diary entries. For example, if your blood glucose levels tend to increase after breakfast, you can slightly increase the dose of short-acting insulin administered before breakfast. On the contrary, if the glucose level has decreased between breakfast and lunch, and especially if signs of hypoglycemia appear at this time, the morning dose of short-acting insulin or the dose of intermediate-acting insulin should be reduced.
2) Increase or decrease in the average daily blood glucose level (accordingly, you can increase or decrease the total daily dose of insulin).
3) An upcoming additional meal (for example, if the patient is visiting).
4) Upcoming physical activity. 5) Long trip, strong emotions (entry to school, parents’ divorce, etc.).
6) Accompanying illnesses.
6. Patient education. The doctor must teach the patient to act independently in any environment. The main questions that the doctor should discuss with the patient: A. Self-monitoring of blood glucose levels. b. Correction of insulin therapy regimen. V. Meal planning. G. Permissible physical activity. d. Recognition, prevention and treatment of hypoglycemia. e. Correction of treatment for concomitant diseases.
7. Close contact of the patient with the doctor or diabetes team. First, the doctor should inquire as often as possible about the patient's condition. Secondly, the patient should have the opportunity to consult a doctor or nurse at any time of the day and receive advice on any issue related to his condition.
8. Motivation of the patient. The success of intensive insulin therapy largely depends on the patient’s discipline and his desire to fight the disease. Maintaining motivation requires great effort from relatives and friends of the patient and medical staff. Often this task turns out to be the most difficult.
9. Psychological support. Patients with recent onset insulin-dependent diabetes mellitus and their relatives need psychological support. The patient and his relatives must get used to the idea of illness and realize the inevitability and necessity of fighting it. In the United States, special mutual aid groups are organized for this purpose.

ex-diabetic.com

HOME
GLUCOMETERS
- Accu-Chek
  - Accu-Chek Mobile
  - Accu-Chek Active
  - Accu-Chek Performa Nano
  - Accu-Chek Performa
  - Accu-Chek Go
  - Accu-Chek Aviva
- OneTouch
  - One Touch Select Simple
  - OneTouch Ultra
  - OneTouch UltraEasy
  - One Touch Select
  - OneTouch Horizon
- Satellite
  - Satellite Express
  - Satellite Express Mini
  - Satellite Plus
- Diacont
- Optium
  - Optium Omega
  - Optium Xceed
  - Freestyle Papillon
- Prestige IQ
  - Prestige LX
- Bionime
  - Bionime gm-110
  - Bionime gm-300
  - Bionime gm-550
  - Rightest GM500
- Ascensia
  - Ascensia Elite
  - Ascensia Entrust
- Kontur-TS
- Ime-dc
  - iDia
- Icheck
- Glucocard 2
- CleverChek
  - TD-4209
  - TD-4227
- Laser Doc Plus
- Omelon
- Accutrend GC
  - Accutrend plus
- Clover Check
  - SKS-03
  - SKS-05
- Bluecare
- Glyukofot
  - Glukofot Lux
  - Glukofot Plus
- B.Well
  - WG-70
  - WG-72
- 77 Elektronika
  - Sensocard Plus
  - Autosense
  - SensoCard
  - SensoLite Nova
  - SensoLite Nova Plus
- Wellion Calla Light
- Trueresult
  - Truebalance
  - Trueresulttwist
- GMate
NUTRITION
- Alcohol
  - Vodka and cognac
- Holiday menu
  - Maslenitsa
  - Easter
- Non-alcoholic drinks
  - Mineralka
  - Tea and kombucha
  - Cocoa
  - Kissel
  - Compote
  - Cocktails
- Cereals, porridges, legumes
  - Wheat
  - Buckwheat
  - Corn
  - Pearl barley
  - Millet
  - Peas
  - Bran
  - Beans
  - Lentils
  - Muesli
  - Semolina
- Fruits
  - Grenades
  - Pears
  - Apples
  - Bananas
  - Persimmon
  - A pineapple
  - Unabi
  - Avocado
  - Mango
  - Peaches
  - Apricots
  - Plums
- Oil
  - Linen
  - Stone
  - Creamy
  - Olive
- Vegetables
  - Potato
  - Cabbage
  - Beet
  - Radish and horseradish
  - Celery
  - Carrot
  - Jerusalem artichoke
  - Ginger
  - Pepper
  - Pumpkin
  - Tomatoes
  - Celery
  - cucumbers
  - Garlic
  - Zucchini
  - Sorrel
  - Eggplant
  - Asparagus
  - Radish
  - Cheremsha
- Berries
  - Kalina
  - Grape
  - Blueberry
  - Rose hip
  - Cranberry
  - Watermelon
  - Cowberry
  - Sea buckthorn
  - Mulberry
  - Currant
  - Cherry
  - Strawberry
  - Dogwood
  - Cherries
  - Rowan
  - Strawberries
  - Raspberries
  - Gooseberry
- Citrus
  - Pomelo
  - Tangerines
  - Lemon
  - Grapefruit
  - Oranges
- Nuts
  - Almond
  - Cedar
  - Walnuts
  - Peanut
  - Hazelnut
  - Coconut
  - Seeds
- Dishes
  - Aspic
  - Salads
  - Dish recipes
  - Dumplings
  - Casserole
  - Side dishes
  - Okroshka and botvinya
- Grocery
  - Caviar
  - Fish and fish oil
  - Pasta
  - Sausage
  - Sausages, sausages
  - Liver
  - Olives
  - Mushrooms
  - Starch
  - Salt and salty
  - Gelatin
  - Sauces
- Sweet
  - Cookie
  - Jam
  - Chocolate
  - Marshmallow
  - Candies
  - Fructose
  - Glucose
  - Bakery
  - Cane sugar
  - Sugar
  - Pancakes
  - Dough
  - Dessert
  - Marmalade
  - Ice cream
- Dried fruits
  - Dried apricots
  - Prunes
  - Figs
  - Dates
- Sweeteners
  - Sorbitol
  - Sugar substitutes
  - Stevia
  - Isomalt
  - Fructose
  - Xylitol
  - Aspartame
- Dairy
  - Milk
  - Cottage cheese
  - Kefir
  - Yogurt
  - Syrniki
  - Sour cream
- Bee products
  - Propolis
  - Perga
  - Podmor
  - Bee pollen
  - Royal jelly
- Heat treatment methods
  - In a slow cooker
  - In a steamer
  - In a convection oven
  - Drying
  - Cooking
  - Extinguishing
  - Frying
  - Baking
DIABETES…
- Among women
  - Vaginal itching
  - Abortion
  - Period
  - Candidiasis
  - Climax
  - Lactation
  - Cystitis
  - Gynecology
  - Hormones
  - Discharge
- In men
  - Impotence
  - Balanoposthitis
  - Erection
  - Potency
  - Dick, Viagra
- In children
  - In newborns
  - Diet
  - In teenagers
  - In infants
  - Complications
  - Signs, symptoms
  - Causes
  - Diagnostics
  - 1 type
  - 2 types
  - Prevention
  - Treatment
  - Phosphate diabetes
  - Neonatal
- In pregnant women
  - C-section
  - Is it possible to get pregnant?
  - Diet
  - 1 and 2 types
  - Choosing a maternity hospital
  - Non-sugar
  - Symptoms, signs
- In animals
  - in cats
  - in dogs
  - non-sugar
- In adults
  - Diet
- Elderly
ORGANS
- Legs
  - Shoes
  - Massage
  - Heels
  - Numbness
  - Gangrene
  - Edema and swelling
  - Diabetic foot
  - Complications, defeat
  - Nails
  - Itchy
  - Amputation
  - Convulsions
  - Feet care
  - Diseases
- Eyes
  - Glaucoma
  - Vision
  - Retinopathy
  - Ocular fundus
  - Drops
  - Cataract
- Kidneys
  - Pyelonephritis
  - Nephropathy
  - Kidney failure
  - Nephrogenic
- Liver
- Pancreas
  - Pancreatitis
- Thyroid gland
- Genitals
TREATMENT
- Unconventional
  - Ayurveda
  - Acupressure
  - Sobbing breath
  - Tibetan medicine
  - Chinese medicine
- Therapy
  - Magnetotherapy
  - Phytotherapy
  - Pharmacotherapy
  - Ozone therapy
  - Hirudotherapy
  - Insulin therapy
  - Psychotherapy
  - Infusion
  - Urine therapy
  - Physiotherapy
- Insulin
- Plasmapheresis
- Starvation
- Cold
- Raw food diet
- Homeopathy
- Hospital
- Transplantation of islets of Langerhans
PEOPLE'S
- Herbs
  - Golden mustache
  - Hellebore
  - Cinnamon
  - Black cumin
  - Stevia
  - goat's rue
  - Nettle
  - Redhead
  - Chicory
  - Mustard
  - Parsley
  - Dill
  - Cuff
- Kerosene
- Mumiyo
- Apple vinegar
- Tinctures
- Badger fat
- Yeast
- Bay leaf
- Aspen bark
- Carnation
- Turmeric
- Sap
DRUGS
- Diuretics
DISEASES
- Skin
  - Itching
  - Pimples
  - Eczema
  - Dermatitis
  - Boils
  - Psoriasis
  - Bedsores
  - Wound healing
  - Stains
  - Wound treatment
  - Hair loss
- Respiratory
  - Breath
  - Pneumonia
  - Asthma
  - Pneumonia
  - Angina
  - Cough
  - Tuberculosis
- Cardiovascular
  - Heart attack
  - Stroke
  - Atherosclerosis
  - Pressure
  - Hypertension
  - Ischemia
  - Vessels
  - Alzheimer's disease
- Angiopathy
- Polyuria
- Hyperthyroidism
- Digestive
  - Vomit
  - Periodontium
  - Dry mouth
  - Diarrhea
  - Dentistry
  - Smell from the mouth
  - Constipation
  - Nausea
- Hypoglycemia
- Ketoacidosis
- Neuropathy
- Polyneuropathy
- Bone
  - Gout
  - Fractures
  - Joints
  - Osteomyelitis
- Related
  - Hepatitis
  - Flu
  - Fainting
  - Epilepsy
  - Temperature
  - Allergy
  - Obesity
  - Dyslipidemia
- Direct
  - Complications
  - Hyperglycemia
ARTICLES
- About glucometers
  - How to choose?
  - Principle of operation
  - Comparison of glucometers
  - Control solution
  - Accuracy and Verification
  - Batteries for glucometers
  - Glucometers for different ages
  - Laser glucometers
  - Repair and exchange of glucometers
  - Tonometer-glucometer
  - Glucose level measurement
  - Glucometer-cholesterol meter
  - Sugar level according to glucometer
  - Get a glucometer for free
- Flow
  - Acetone
  - Development
  - Thirst
  - Sweating
  - Urination
  - Rehabilitation
  - Urinary incontinence
  - Clinical examination
  - Recommendations
  - Weight loss
  - Immunity
  - How to live with diabetes?
  - How to gain/lose weight
  - Restrictions, contraindications
  - Control
  - How to fight?
  - Manifestations
  - Pricks (injections)
  - How it begins

Causes of diabetes

How to notice the first symptoms?

The meaning and principles of insulin treatment

What is a “bread unit”?

Which hormone is better?

Where and when are injections given?

How to notice the first symptoms

The meaning and principles of insulin treatment

“Bread unit” - what is it?

Which insulin is better

Short insulins:

Intermediate acting insulins

Long-acting insulins

Etiology and pathogenesis

Classification

Clinic

Diagnostics

Complications

Treatment

Insulin-dependent diabetes mellitus: what is it?

Treatment

Consequences of disease progression

Video on the topic

Diabetes mellitus type 1

Diabetes mellitus type 2

The main symptoms of diabetes mellitus type 1 and 2

Causes of diabetes

Diagnosis of diabetes mellitus

Treatment with insulin

Complications of type 1 and type 2 diabetes mellitus

Etiology and pathogenesis

Classification

Pathogenesis and pathohistology

Clinic

Diagnostics

Complications

Treatment

Features of type 2 insulin-dependent diabetes mellitus

How to choose a doctor?

Genetic predisposition to the disease

Main types of diabetes

Causes of diabetes mellitus

How to recognize hyperglycemia?

Consequences of diabetes progression

Diagnosis of diabetes mellitus

Non-insulin dependent diabetes mellitus

Symptoms

New on the site

Most popular

POPULAR SECTIONS