Diabetes mellitus is a group of metabolic diseases characterized by high levels of glucose ("sugar") in the blood.
Why do we need glucose?
The norm of blood glucose (sugar) in total capillary blood is 3. 3-5. 5 mmol/l in the morning on an empty stomach (i. e. after 7-14 hours of night fasting) and up to 7. 8 mmol/l after meals (i. e. 1, 5). -2 hours after the last meal).
Normally, in the human body, glucose is used by the cell as an energy source (in other words, the body's cells "feed" on glucose from the blood). The harder a cell works, the more energy (glucose) it needs.
Glucose (the expression "blood sugar" is used more often, but this is not entirely correct) constantly circulates in the human blood. Glucose can enter the human body in two ways: - firstly, through carbohydrate-containing food, - secondly, through the production of glucosethrough the liver (this is the reason why, in diabetes mellitus, no food can be consumed).
However, to be used as energy, glucose must travel from the blood to the muscles (for work), fatty tissue, or the liver (the body's glucose storage). This happens under the influence of the hormone insulin, which is produced by beta cells in the pancreas. As soon as blood sugar levels rise after a meal, the pancreas immediately releases insulin into the blood, which in turn connects to insulin receptors on muscle, fat or liver cells. Insulin, like a key, "opens" the cells so that glucose can enter them, which causes the level of glucose (sugar) in the blood to return to normal. Between meals and, if necessary, at night, glucose enters the blood from the liver depot, so thatInsulin controls the liver at night so that it does not release too much glucose into the blood.
If an injury occurs at any stage of this process, diabetes mellitus occurs.
Types of diabetes
Diabetes mellitus type 1 (formerly called insulin-dependent diabetes mellitus) develops primarily at a young age (usually before the age of 30, although type 1 diabetes mellitus can also develop at a later age).
Type 1 diabetes mellitus is caused by the cessation of insulin production by the pancreas due to the death of β-cells (which are responsible for insulin production in the pancreas). The development of type 1 diabetes mellitus occurs against the background of a special genetic predisposition (i. e. a person was born with it), which, when exposed to some external factors (for example, viruses), leads to a change in the state of the body's immune system. The body of a patient with type 1 diabetes begins to perceive his pancreatic β-cells as foreign and protects itself from them by producing antibodies (similar to protection against infections), which leads to the death of the pancreatic β-cellssevere insulin deficiency.
Diabetes mellitus 1 Type develops when at least 90% of pancreatic β-cells die. Let's remember the mechanism of action of insulin, its function as a "key" that opens cells to sugar. In type 1 diabetes mellitus, this key disappeared from the blood (see figure).
Insulin deficiency in type 1 diabetes mellitus Type 1 diabetes mellitus begins acutely and is always accompanied by severe symptoms of hyperglycemia (high blood sugar): - weight loss (the patient loses weight involuntarily), - a constant feeling of hunger, - thirst, dry mouth (the patientdrinks a lot, including at night), - frequent urination (in regular or large portions, including at night), - weakness.
If you do not seek medical attention in a timely manner and do not start treating type 1 diabetes with insulin, the condition worsens and diabetic coma occurs very often.
Diabetes mellitus type 2 (formerly called insulin-dependent diabetes mellitus) is much more common than type 1 diabetes mellitus. The frequency of type 2 diabetes mellitus is typical for older people: it is usually recognized after the age of 40, although the average age of patients with diabetesAccording to WHO experts, type 2 mellitus is getting younger and younger recently.
About 80% of people with type 2 diabetes are overweight. In addition, type 2 diabetes is characterized by heredity - a high prevalence in close relatives.
In type 2 diabetes, the pancreas continues to produce insulin, often in larger amounts than usual. However, there are also cases of type 2 diabetes mellitus with reduced insulin secretion.
The main defect in type 2 diabetes is that the cells do not "sense" insulin well, meaning the level remains elevated. This state of reduced insulin sensitivity is called insulin resistance.
Low sensitivity to insulin in type 2 diabetes mellitus You can imagine that the "keyholes" (scientifically speaking: insulin receptors) on the cell doors are deformed and there is no perfect match with the keys - the insulin molecules. It requires more effort (more key, i. e. more insulin) to overcome the defect in the insulin receptor. The pancreas cannot supply enough insulin to the blood to overcome the insulin resistance and to completely increase the blood sugar levelnormalizeIn type 2 diabetes mellitus, the capabilities of the β cells are still limited.
This creates a paradoxical situation in type 2 diabetes when there is a lot of insulin and sugar in the blood at the same time.
In contrast to type 1 diabetes mellitus, type 2 diabetes mellitus begins gradually, often completely unnoticed by the patient. Therefore, a person can be sick for a long time without being aware of it. Elevated blood sugar levels (glucose levels) can also be discovered accidentally during an examination for other reasons.
At the same time, there are cases with clear manifestations of hyperglycemia:
- Weakness, fatigue, thirst, dry mouth (the patient drinks a lot of fluids, even at night),
- frequent urination (regularly or in large quantities, even at night),
- Itching of the skin (especially in the perineal area),
- slow wound healing, - frequent infections, - blurred vision.
Diabetic coma develops much less often, usually when type 2 diabetes mellitus is accompanied by another very serious disease: pneumonia, serious injury, purulent processes, heart attack, etc.
Treatment of diabetes
Treatment for diabetes varies depending on the type of diabetes.
In type 1 diabetes mellitus, which occurs as a result of absolute insufficiency of insulin secretion by one's own pancreas, constant self-control and insulin treatment are required to maintain life. It should be emphasized that in this situation, treatment with externally administered insulin is the only treatment option. The selection of dosages and treatment regimens for diabetes mellitus with insulin is carried out individually, taking into account age, gender, physical activity and individual insulin sensitivity.
In type 1 diabetes mellitus Sometimes, at the very beginning of the disease, after the normalization of blood sugar during the treatment of diabetes mellitus with insulin, the need suddenly begins to decrease until it is completely eliminated. But that's not recovery. This phenomenon is called the "honeymoon" of diabetes or, scientifically, remission. This is explained by the fact that after the normalization of blood sugar with the help of insulin, the β-cells that have not yet died can continue to work for some time. Then they all die and the person diesMust be treated for life with insulin for diabetes mellitus Anyone who develops type 1 diabetes for the first time should be warned by their doctor about the possible occurrence of such a situation and what to do in this case.
Treating diabetes mellitus with insulin can be done using insulin syringes, pens or an insulin pump.
Insulin pump therapy is an alternative treatment for diabetes in people who frequently use a syringe or pen to inject insulin and regularly measure their blood sugar levels. Instead of treating diabetes with injections, insulin pump therapy is used. The pump is worn on the body or clothing, for example on a belt. Around 250, 000 people worldwide currently use insulin pumps.
The main goal of treating type 2 diabetes is to improve the sensitivity of cells to insulin. The causes of poor insulin sensitivity are not yet fully understood. However, it has long been known that obesity is the strongest factor in the development of insulin resistance, i. e. h. excessive accumulation of fat in the body. Numerous scientific studies and long-term observations of patients show that losing weight during the treatment of type 2 diabetes can achieve a significant improvement in blood sugar levels in most patients.
In type 2 diabetes, normalization of weight can lead to complete normalization of blood sugar over a long period of time, although this cannot be said to be a complete recovery.
If diet and exercise for weight loss do not have sufficient effect in the treatment of type 2 diabetes, medication must be resorted to. They are available in tablet form. Some of them act on the pancreas and increase insulin production, while others improve their action (reduce insulin resistance). Therefore, the drugs themselves that are used to treat type 2 diabetes mellitus do not lower blood sugar, insulin does this. Therefore, to achieve the effect of tablets in the treatment of diabetes mellitus, a preserved reserve of pancreatic β-cells is required. This makes it clear why the use of tablets in the treatment of type 1 diabetes makes no sense, since most of the β-cells have already died.
Insulin is often used to treat type 2 diabetes. Insulin treatment for type 2 diabetes mellitus can be prescribed as a temporary measure, for example during operations, for severe acute illnesses, or as long-term treatment. For this reason, it is currently not recommended to describe type 2 diabetes mellitus as non-insulin dependent. The type of diabetes treatment does not determine the type of diabetes.
Diet plays the most important role in the treatment of diabetes.
Diet for diabetes
Despite the common goals in the treatment of different types of diabetes (elimination of the symptoms of high blood sugar, minimization of the risk of hypoglycemia, prevention of complications), nutritional habits in type 1 and type 2 diabetes mellitus differ significantly. There is no standard diet plan for diabetes mellitus.
In type 1 diabetes mellitus, the occurrence of which is accompanied by the death of beta cells of the pancreas and insulin deficiency, insulin replacement therapy is the main method of treatment, and dietary restrictions, according to modern opinion, are auxiliary in nature and should be administered only to the extent that insulin therapy depends on the production of insulin in onehealthy people differ.
The basic principles of diet prescription for type 1 diabetes mellitus have been critically revised in recent years.
The principles of the traditional diabetes diet include the recommendation to consume a precisely defined, identical amount of calories every day. Each patient was prescribed a daily calorie requirement based on the "ideal weight". This makes no sense and is impossible for the following reasons:
- In healthy, normal-weight people, the ratio between energy intake and consumption fluctuates greatly from day to day. The energy consumption of healthy people is different because their physical activity is different. Therefore, if a patient with type 1 diabetes is prescribed a specific diet with the daily intake of a fixed, identical amount of calories, in order to maintain a normal weight, one would have to recommend an equally prescribed, strict plan of physical activity for every day, which is absolutely unrealistic.
- In patients with type 1 diabetes mellitus with normal weight and a correctly selected insulin treatment regimen for diabetes mellitus, appetite regulation does not differ from that in healthy individuals. The fact that they sometimes have to be forced to eat even when they have a loss of appetite due to hypoglycemia is usually a result of inadequate insulin therapy.
Improved treatment regimens for diabetes mellitus using insulin and self-monitoring of metabolism based on blood sugar levels give patients the opportunity to regulate their food intake, like healthy people, depending on their feelings of hunger and satiety. Thus, the diet of a patient with type 1 diabetes mellitus corresponds to a completely healthy diet (balanced in calories and content of essential nutrients). The only difference is that the injected insulin does not "know" when or how much you eat. Therefore, it is up to you to ensure that the action of the insulin corresponds to your diet. Therefore, you need to know which foods raise your blood sugar.
The main treatment method for type 2 diabetes is to normalize body weight through a low-calorie diet and increased physical activity. Diet for type 2 diabetes is very important; it is one of the essential ingredients that will enable you to succeed.
All foods consist of three components: proteins, fats and carbohydrates. They all contain calories, but not all of them raise blood sugar.
Only carbohydrates have a pronounced blood sugar-increasing effect. Which foods contain carbohydrates? It's easy to remember: most products are plant-based and animal-based - just liquid dairy products. It is important for you to know whether and by how much blood sugar rises after certain foods. There are types of carbohydrate-containing foods after which blood sugar does not rise at all or increases only slightly.
All carbohydrates can be roughly divided into two groups: those that contain quickly absorbed ("fast") carbohydrates and those that contain slowly absorbed ("slow") carbohydrates. "Fast" carbohydrate products contain refined sugar and include jams and marmalades, candies, sweets, fruits and fruit juices. "Fast" carbohydrates cause a sharp increase in blood sugar (depending on the amount of food consumed) because they are quickly absorbed into the blood, which is why if you have diabetes it is better to exclude them from your diet. "Slow" carbohydrates are much more beneficial for diabetics because they take much longer to absorb. In addition, the absorption of sugar is slowed down by the fiber contained in food, which is why the diet should be enriched with foods rich in fiber when treating diabetes.
Here are a few simple rules to follow when treating diabetes: Food should be taken in small portions and frequently (4-6 times a day); stick to the established diet - try not to skip meals; Don't overeat - eat as much as recommended by your doctor; Use bread made from whole wheat flour or with bran. Vegetables (except potatoes and legumes) should be eaten daily; Avoid consuming "fast" carbohydrates.
Exercise in diabetes Physical exercise is very important in the treatment of diabetes: it increases the sensitivity of the body's tissues to insulin and thus helps lower blood sugar levels.
Housework, walking and jogging can be considered physical activity. Regular and measured physical exercise should be preferred: Sudden and intense physical exercise can cause problems in maintaining normal sugar levels.
If you are an athlete, you have no contraindications to exercise, provided that your blood sugar levels are well controlled and all necessary measures are taken to prevent a significant drop.
Preventing Diabetes Complications Patients with diabetes are at increased risk of developing complications of the heart and blood vessels (especially in the legs and kidneys). Regular physical activity, sometimes just walking, is enough to prevent circulatory problems in the feet.
If you have diabetes, an untreated wound or abrasion on your foot can become a serious problem. Even minor cuts or abrasions on the feet take longer to heal than in patients without diabetes and require increased attention. The key to preventing these problems is wearing well-fitting shoes and checking your feet regularly. Use a mirror if you have difficulty examining all areas of your feet, and remember that foot injuries are often painless at first and can go unnoticed for a long time if you are not careful enough.
Patients with diabetes are at increased risk of kidney dysfunction and heart disease several years after diagnosis. There is good evidence that good blood sugar control reduces this risk. In addition, to prevent complications from diabetes mellitus, preventive treatment is necessary twice a year.
Controlling blood pressure is also important. Check your blood pressure regularly. If the level is elevated, your doctor will prescribe treatment.