What causes type 2 diabetes. Treatment of diabetes mellitus of various types: means and methods

Diabetes mellitus is rightly considered around the world as a "genetic and metabolic nightmare". It is difficult to find another such disease, which, based on a violation of the metabolism of one of these simplest substances, and absolutely necessary for the life of any organism, such as glucose, would produce so many disorders.

There are two forms of the disease. In type 1 diabetes, which is detected at an early age and is hereditary (it is also called insulin-dependent), the person is not to blame for what happened to him.

But in type 2 diabetes, insulin is produced in the cells of the islet apparatus of the pancreas enough, or even more than necessary. And partly, and sometimes completely, the fault for the development of this disease lies with the patient himself.

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Type 2 Diabetes - What is it?

Type 2 diabetes is based on the inability of tissues to absorb glucose. Insulin is a hormone, it "requires" glucose to disappear from the blood and be deposited in the cell, but it becomes powerless - its tissues do not "obey". The result is a chronic condition called hyperglycemia.

  • Hyperglycemia is an increased concentration of glucose in the blood.

Type 1 and Type 2 diabetes have a common outcome, but two roads lead to it. In the case of the first type, too little insulin is produced in the pancreas, and no one can "order" the tissues to absorb glucose from the blood. Therefore, it is necessary to constantly replenish the deficiency of endogenous insulin with its artificial forms.

In the case of type 2 diabetes, as it is already becoming clear, there is a lot of "regulator" - insulin, but it knocks on closed doors. According to ICD 10, type 2 diabetes mellitus is coded as E 11, and insulin-dependent as E 10.

Causes of insulin resistance

It is quite possible to put an equal sign between the occurrence of insulin resistance and the occurrence of diabetes mellitus. Until the end, its causes have not yet been studied. For example, if an abnormal form of insulin is synthesized, which is inactive, insulin resistance will develop.

But in this case, it is justified: why should tissues perceive a defective hormone? But, unfortunately, the most common cause of the development of this condition is the usual, alimentary obesity.

Obesity in type 2 diabetes is a vicious circle:

  • Initially, overweight occurs, not associated with the disease. For example, due to physical inactivity and overeating. It is known that with obesity of the 1st degree, the risk of developing diabetes doubles, and with obesity of the 3rd degree - already 10 times. This condition often occurs after the age of 40. It is at this age that type 2 diabetes accounts for 85-90% of all cases;
  • Adipose tissue greatly contributes to a decrease in insulin activity - this causes its compensatory increase. A high level of glucose in the blood causes, among other things, depression, which is "jammed" by fast carbohydrates. This leads to an increase in hyperglycemia, as well as an increase in obesity.

In addition to obesity, type 2 diabetes has many clinical signs and symptoms.

All symptoms of type 2 diabetes are caused by hyperglycemia and its effect on the body:

  1. Thirst, or polydipsia, is a "transient" water designed to dilute the concentration of glucose in the blood plasma;
  2. Dry mouth, almost constant. May occur immediately after the removal of thirst;
  3. Polyuria is profuse urination. Nocturia occurs - patients visit the toilet several times a night;
  4. Weakness general and muscular;
  5. Skin itching. It is especially painful in the perineum and genitals;
  6. Wounds and scratches on the skin do not heal well;
  7. Sleepiness, including daytime.
  8. Despite obesity, patients experience an increase in appetite.

Type 2 diabetes treatment, drugs and nutrition

Type 2 diabetes is one of those diseases that can be treated without drugs - and this is absolutely the right approach.

Unfortunately, many of our compatriots, who are accustomed to "give all of themselves to the Motherland," consider it almost a personal insult when an endocrinologist does not start treatment with pills, but talks about an incomprehensible "healthy lifestyle." He is often listened to indifferently, assenting for decency. Nevertheless, it is necessary to start treatment with him, as well as with a diet.

Lifestyle Modification

It has been said and proved from the highest medical tribunes that the treatment of diabetes without physiotherapy exercises and physical activity is impossible. This is necessary for two reasons:

  • Weight loss breaks the "vicious circle", reduces the risk of heart attacks, strokes, hypercholesterolemia, and thereby significantly reduces the likelihood of complications of diabetes;
  • With increased muscle work, glucose is utilized, which in itself reduces the level of hyperglycemia.

In addition to activating the patient, it is necessary, even before the diet, to reconsider eating behavior and exclude the predominant use of food at night. It should not be so that most of the daily calorie intake falls on the evening.

The third "whale" is a complete cessation of smoking and a sharp restriction of alcohol intake. You can leave only small doses of dry wine. Beer and strong alcohol (vodka, cognac, whiskey) are strictly prohibited.

Diet and glycemic index

correct! nutrition is the key to recovery

Diet is perhaps even more important in the treatment of diabetes than drug therapy.

The diet of a diabetic should not be sophisticated. About 60% should come from carbohydrate foods, a quarter from fats, and the rest from proteins.

At the same time, the calorie content of food should be slightly lower than the daily requirement, which is calculated taking into account height, weight, age and lifestyle using special formulas. This is a sub-calorie diet. On average, this is about 1800 kcal per day.

Meals should be made frequent, but fractional - 5 times a day. Fiber and fibers (bran, fruits, vegetables) must be present. It is important to replace easily digestible carbohydrates with special sweeteners, and half of the resulting fat should be of vegetable origin.

  • Many people ask: what can you eat and what not with type 2 diabetes? There is a special one for this.

For diabetics, understanding the glycemic index is important. It is he who speaks about which carbohydrate foods are “good” and which are “bad”. The “bad” ones are those that quickly break down into sugars and increase the level of hyperglycemia. Of course, first of all, it is glucose itself, which has an index of 100, that is, the maximum value. The groups were distributed as follows:

  1. Mashed potatoes, jacket potatoes, chocolates, jellies, sweet mousses, fried potatoes, muffins, popcorn, sweet watermelons and melons. These products should be banned;
  2. Carbohydrates such as white rice and rye bread have an average glycemic index.
  3. Bananas, grapes, oranges, apples, yogurts, and beans have a low index.

It is clear that preference is given to foods with a low glycemic index.

About products - what is possible and what is not with type 2 diabetes

Forbidden: canned food (meat and fish), smoked meats and semi-finished products (wieners, sausages). You can not fatty meat - pork, goose, duck. You can not eat with type 2 diabetes lard, salted and smoked. Preparations are prohibited: pickles and marinades, salted cheeses. Unfortunately, mayonnaise and other spicy sauces are not allowed.

Sweet dairy products (cottage cheese, glazed curds) are prohibited. You can not eat semolina and all pasta. It is forbidden to eat all sweet desserts. Very sweet fruits (figs, dates, raisins, bananas, melons, watermelons) are prohibited. You can't drink sweet soda.

Permitted and desirable: boiled and baked low-fat types of fish and meat: rabbit, veal, beef, turkey. Of the fish, cod is useful. Fatty varieties such as halibut are best avoided. All seafood is very useful: crabs, shrimps, sea kale, mussels, scallops.

You can eat with type 2 diabetes egg whites, for example, in the form of a protein omelette. Low-fat varieties of milk and dairy products, kefir are allowed. Vegetables should be low glycemic: pumpkin, eggplant, cabbage, tomatoes, cucumbers.

Unsweetened fruits can be eaten all, but only in the form of fruits, since freshly squeezed juice is a “hit” of glucose in the body. We have to put in the work and digest the fruit, not get its "pomace".

From cereals, barley, barley, buckwheat are welcome. Tea, water, mineral water, weak coffee with low-fat milk are allowed.

Egg yolks are limited, no more than 1 time per week, bread should be consumed no more than 300 grams per day, but not white. Beets and potatoes are limited, carrots - no more than 1 time in 2 days.

Medications

Medications for the treatment of type 2 diabetes are very diverse. Here are biguanides (metformin), and drugs that enhance insulin secretion (Maninil, Glibenclamide), and many others.

  • Experience shows that a simple transfer of funds in a popular article for people who do not have a medical education can be not only useless, but also harmful. And doctors use special periodicals and reference literature. Therefore, it is better to talk about current trends in the use of drugs.

Initially, type 2 diabetes is treated with diet and lifestyle changes. In the event that blood sugar does not decrease, then acarbose is added to the patient. This drug reduces the absorption of glucose in the intestines.

In obesity, anorectics, or appetite suppressants, may be prescribed. If the goal is not achieved, then metformin or sulfonylurea drugs are prescribed. In case of ineffectiveness of treatment by all groups of drugs, insulin therapy is indicated.

It is very important that diabetes aggravates the course of all diseases: coronary heart disease, atherosclerosis, heart failure. But in order to slightly improve the patient's condition, it is necessary to compensate for diabetes mellitus first, that is, to achieve a decrease in glucose to acceptable numbers for a long time.

Only in this case it is possible to talk about acceptable therapy for other diseases. Otherwise, the disappointment will be endless, and the effect will be minimal.

Despite the late onset of the disease (after 40 years), with type 2 diabetes, complications such as:

  • Diabetic (decreased sensitivity, impaired gait);
  • Angiopathy (including damage to the vessels of the kidneys and retina);
  • Diabetic and development of retinopathy leading to blindness;
  • Nephropathy of diabetic origin, in which protein, blood begins to penetrate the glomerular membrane, followed by the development of nephrosclerosis, glomerulosclerosis and renal failure;
  • In addition, diabetic encephalopathy develops.

It is often asked if type 2 diabetes gives disability. Yes, they do. But even an endocrinologist, who observes and treats the patient, and is sure of this, cannot resolve this issue. He only submits documents for medical and social examination, which looks mainly at these documents, and on them determines the degree of permanent disability.

In conclusion, it should be said that in middle-aged people with normal body weight, without bad habits, the risk of insulin resistance and diabetes mellitus is several tens of times less than in overweight people. All working and non-working people can determine their blood sugar level, find out the body mass index and draw appropriate conclusions during the medical examination.

Approximately 90% of all cases of diabetes are type 2 diabetes. Unlike type 1 diabetes, which is characterized by a complete cessation of insulin production, in type 2 diabetes, pancreatic hormone is produced, but is not used by the body correctly. The disease affects the ability to process glucose, leads to hyperglycemia and causes a number of complications. We tell you what else you need to know about diabetes, its causes, treatment and prevention.

Type 2 diabetes mellitus (DM) is a metabolic disease characterized by a persistent increase in blood sugar levels (hyperglycemia).

The main mechanism for the development of type 2 diabetes is cell resistance to insulin. That is, muscle and other cells of the body do not bind well with the hormone insulin, which serves as a kind of “key” that opens the cell to allow glucose to enter it. Thus, glucose that does not enter the cells accumulates in the blood. A persistent increase in glucose levels to 7 mmol / l and above is classified as diabetes mellitus.

Who is at high risk?

Consider the main risk factors for type 2 diabetes:

  • Overweight and obesity. This is one of the main factors of the disease. At the same time, the more adipose tissue a person has, the greater the level of cell resistance to insulin. In this case, the greatest danger is abdominal obesity, in which the bulk of fat is located on the abdomen.
  • hereditary predisposition.
  • Age. Previously it was thought that type 2 diabetes is a disease of mature people who are over 45 years old. Indeed, the majority of patients with type 2 diabetes are in this age category. However, analysis of new data suggests that type 2 diabetes also occurs in young people, and even children. At the same time, the incidence of type 2 diabetes among people under 45 years of age is increasing.
  • Prediabetes. This is a condition in which the sugar level is high enough, but not yet high enough to be considered diabetes mellitus.
  • Gestational diabetes. This is diabetes mellitus that occurs in pregnant women, but after childbirth goes away. These women are at an increased risk of developing type 2 diabetes in the future.

Symptoms and complications of diabetes

Symptoms of diabetes include the following:

  • Intense thirst with frequent urination.
  • Strong feeling of hunger.
  • Increased fatigue.
  • Weight loss (not always observed).

It is noteworthy that a high concentration of glucose has a pronounced toxic effect on the cells and tissues of the body. Against this background, a number of complications develop, mainly from the side of blood vessels and nervous tissues. In particular, the vessels of the eyes and kidneys are affected, as a result of which diabetic retinopathy and nephropathy develop. Large vessels are also affected, against the background of which coronary heart disease develops, and the risk of developing heart attacks and strokes also increases.

One of the most serious complications of diabetes is the diabetic foot - a purulent-necrotic process that develops due to a violation of trophic processes in the limbs.

Diagnosis of diabetes

To diagnose type 2 diabetes, it is enough to conduct three simple studies:

  • Fasting glucose level. If the glucose concentration is greater than or equal to 7 mmol/liter, then this may indicate type 2 diabetes. At the same time, the concentration in the range of 5.6-6.9 mmol / l indicates prediabetes.
  • Glucose tolerance test. This is a study of blood sugar levels after a glucose load. The patient is initially measured the level of sugar in the blood on an empty stomach. Then the patient drinks a glucose solution, after which measurements are taken every 30 minutes. Normally, after 2 hours after exercise, the glucose level drops below 7.8 mmol / l. If the sugar concentration is in the range of 7.8-11 mmol / l, then this condition is regarded as prediabetes. In type 2 diabetes, the concentration of glucose in the blood is more than 11 mmol / l 2 hours after exercise.
  • Glycosylated hemoglobin level HbA1c. If a blood glucose test shows a current result, then using a glycosylated hemoglobin test, type 2 diabetes can be established, which has been going on for several months. The thing is that the hemoglobin contained in the red blood cells (erythrocytes) eventually "acquires" glucose (glycosylation). According to the level of glycosylated hemoglobin, it is judged whether or not a patient has type 2 diabetes. The norm is up to 6.5% HbA1c. A level above 6.5% is regarded as diabetes mellitus.

Since there are a number of diseases and conditions in which the life cycle of red blood cells (which normally live for about 120 days) is disrupted, in such cases the HbA1c level does not reflect the true state of affairs regarding diabetes mellitus. For example, these are patients with sickle cell anemia, as well as people who have recently had a serious blood loss or blood transfusion. In such situations, the American Diabetes Association (ADA) recommends using only fasting glucose concentration tests and a glucose tolerance test to make a diagnosis.

Treatment of type 2 diabetes mellitus: modern approaches

The American Diabetes Association and the European Association for the Study of Diabetes (EASD) presented a joint paper in 2018 on the management of type 2 diabetes. Currently, the recommendations set out in the consensus document are used by physicians to manage patients with diabetes. What are these recommendations, and have there been any significant changes in the management of diabetes?

Targets

The first thing that needs to be said is the targets for the treatment of diabetes mellitus. What should patients strive for? ADA/EASD experts indicate that it is advisable to achieve an HbA1c level of 7% or less. This applies to most people with type 2 diabetes. There are more stringent requirements - up to 6.5% HbA1c. Such requirements are provided for patients who suffer from type 2 diabetes mellitus for a short time, and target values ​​​​can be achieved by modifying lifestyle and taking only one hypoglycemic drug (metformin).

ADA/EASD experts are also considering less stringent targets - up to 8% HbA1c. Such requirements are valid for patients with a history of severe hypoglycemia, as well as the presence of severe vascular complications due to diabetes.

As for the level of glucose in the blood, in patients with type 2 diabetes on an empty stomach, this indicator should be in the range of 4.4-7.2 mmol / l. And the concentration of glucose 1-2 hours after a meal (postprandial glucose) should be less than 10.0 mmol / l.

Drugs for the treatment of type 2 diabetes

  • HbA1c ≤ 9%. If the levels of glycosylated hemoglobin do not exceed 9%, then it is recommended to start with type 2 diabetes monotherapy. Metformin is unconditionally recommended as the main drug. Long-term studies on the effectiveness of the use of metformin - DPP and DPPOS (Diabetes Prevention Program Outcomes Study) have shown that metformin is the drug of choice also for patients with prediabetes, especially with a body mass index greater than 35. Control studies are recommended 3-6 months after the start taking metformin. If during this time the patient fails to achieve the goals, then the ADA / EASD experts recommend considering dual therapy.
  • HbA1c > 9%. If the level of glycosylated hemoglobin exceeds 9%, as well as in case of ineffectiveness of metformin monotherapy, it is recommended to add another hypoglycemic drug. At the same time, experts point out that the choice of the second drug is made by the doctor based on the individual characteristics of the patient. In particular, if a patient also has atherosclerotic cardiovascular disease (ASCVD) against the background of type 2 diabetes, then it is recommended to take a drug that significantly reduces the risk of cardiovascular complications. These medicines include empagliflozin, liraglutide, or canagliflozin. As in the previous case, a follow-up study is recommended 3-6 months after. If targets are not achieved, then a triple therapy (plus another antihyperglycemic agent) is recommended.
  • HbA1c ≥ 10%. Combination therapy with insulin injections is recommended for patients who are newly diagnosed with type 2 diabetes with severe symptoms, HbA1c levels ≥ 10% and glucose concentrations above 16.7 mmol/l. As soon as it is possible to achieve a decrease in indicators, the treatment regimen is simplified, leaving only sugar-lowering drugs.

Diabetes mellitus and cardiovascular disease

One of the components of the treatment of type 2 diabetes is to reduce the risk of cardiovascular events, given the fact that type 2 diabetes complicates the course of cardiovascular pathologies.

Patients with type 2 diabetes are advised to measure blood pressure daily and keep it below 140/90 mm Hg. Art. It is noteworthy that a number of reputable cardiology communities have revised such indicators for several years, setting more stringent target values ​​- up to 130/80 mm Hg. Art. However, ADA/EASD experts, having studied the evidence base and the results of clinical observations, concluded that for patients with type 2 diabetes, the achievement of hard targets is not associated with a reduction in risks or an improvement in the general condition.

If a patient with type 2 diabetes has a blood pressure greater than 120/80 mm Hg. Art., in this case, measures are recommended to normalize weight (dietary nutrition and increased physical activity), reduce sodium intake and increase potassium intake.

With blood pressure 140/90 mm Hg. Art. and above, pharmacological therapy is recommended, which is reduced to taking drugs that reduce blood pressure - angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, calcium channel blockers, and thiazide-like diuretics).

Diabetes Mellitus and Lipid Control

For patients with type 2 diabetes, regular monitoring of blood lipid levels is recommended. Triglyceride levels are considered elevated at 150 mg/dL and above. An undesirable phenomenon is also a reduced level of high-density lipoproteins (good cholesterol). The lower mark for men is considered to be 40 mg / dl HDL cholesterol; for women, 50 mg/dl.

To normalize blood lipid levels, ADA/EASD experts recommend prescribing statin therapy. At the same time, the intensity of statin therapy depends on both age and the presence of atherosclerotic diseases.

High-intensity statin therapy is indicated for patients of all ages with type 2 diabetes and cardiovascular diseases of atherosclerotic origin: coronary heart disease, peripheral arterial disease (carotid artery stenosis diagnosed by ultrasound or diagnosed lower extremity artery disease).

Moderate-to-high-intensity statin therapy (eg, atorvastatin 40–80 mg/day or rosuvastatin 20–40 mg/day) is indicated in patients with type 2 diabetes up to 40 years of age with risk factors for cardiovascular disease. As for patients with type 2 diabetes older than 40 years, they are recommended to take statins without the presence of CVD risk factors (the dosage is selected by the doctor).

Attention!

Statin treatment is contraindicated during pregnancy!

Acetylsalicylic acid (aspirin) for diabetes

For patients with type 2 diabetes with a history of atherosclerotic CVD, low-dose aspirin therapy (75–162 mg/day) is recommended. For patients with acute coronary syndromes, experts recommend dual antiplatelet therapy: P2Y12 receptor inhibitors (clopidogrel or ticagrelor) are also added to low-dose aspirin.

The latest ADA/EASD guidelines also consider low-dose aspirin therapy as primary prevention in patients with type 1 and type 2 diabetes mellitus at risk of developing cardiovascular disease. This treatment is recommended for most women and men in the 50+ age group.

Low-dose aspirin therapy may also be considered for the prevention of preeclampsia (late toxicosis) in pregnant women with type 1 or type 2 diabetes.

Non-drug treatment and prevention of type 2 diabetes mellitus

Non-drug treatment is a mandatory component of the treatment of diabetes mellitus, as well as prediabetes. In many ways, non-drug treatment coincides with recommendations for the prevention of type 2 diabetes. Here are the main conditions for non-drug therapy of type 2 diabetes:

Lifestyle change

The modern way of life is such that we all have a high risk of developing type 2 diabetes. If you have been diagnosed with type 2 diabetes, then from now on you should constantly monitor your blood sugar levels. Your number 1 task is to maintain an optimal level of glucose, not allowing both an increase in the concentration of sugar over 7.2 mmol / L, and hypoglycemia.

One of the most important components for non-drug treatment and prevention of diabetes is physical activity. Remember that muscles are the main consumers of glucose. The more physically active you are, the more glucose will be used up. At the same time, remember that the level of physical activity is determined by the doctor.

Diet food

An analysis of numerous studies suggests that there are no general recommendations regarding the ratio of calories, carbohydrates, proteins and fats. In this case, everything is individual and is selected by your doctor. However, there are some general recommendations:

  • In case of violations of carbohydrate metabolism, it is recommended to eat at least 4 times a day, preferably at the same time.
  • Vegetables, except for potatoes, can be eaten without restrictions.
  • Fruits, starchy foods, and dairy products can be eaten in half. This means that a person with diabetes or prediabetes needs to split the normal serving for a healthy person roughly in half.
  • From fruits it is strongly not recommended to use grapes, bananas and dried fruits.
  • Eliminate or minimize the consumption of fatty meat, mayonnaise, butter, smoked meats, canned meat and fish. Naturally, under a complete ban, all types of confectionery products that contain sugar.

Body weight control

Constant control of body weight is necessary for overweight and obese people. Everyone can estimate their weight using the formula by which the body mass index (BMI) is calculated. BMI is a ratio of weight to the square of a person's height. For example, the optimal BMI for a person with a height of 1.80 m and a weight of 84 kg is 84 / 1.80 2 = 25.9. BMI from 18.5 to 24.9 is considered normal; 25-29.9 - overweight; 30-34.9 - obesity of the first degree; 35-39.9 - obesity of the second degree; more than 40 - obesity of the third degree.

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Type 2 diabetes mellitus (non-insulin dependent) is a pathology characterized by a violation of the production of carbohydrates in the body. Normally, the human body produces insulin (a hormone) that converts glucose into nutrient cells for body tissues.

In non-insulin-dependent diabetes mellitus, these cells are secreted more actively, but insulin distributes energy incorrectly. In this regard, the pancreas begins to produce it with a vengeance. The increased excretion depletes the cells of the body, the remaining sugar accumulates in the blood, developing into the main symptom of type 2 diabetes - hyperglycemia.

Causes

The exact cause of type 2 diabetes has not yet been established. Scientists have proven that this disease is more common in women, adolescents during puberty. Representatives of the African American race often suffer from the disease.

Diabetes mellitus type 2 in 40% of cases is a hereditary disease. Patients often note that their closest relatives suffered from the same disease. In addition, type 2 diabetes, together with heredity, can cause an unhealthy lifestyle, as well as negative environmental influences.

Thus, the causes of type 2 diabetes are as follows:

Obesity, especially visceral, when fat cells are located directly in the abdominal cavity and cover all organs. In 90% of cases, the symptoms of type 2 diabetes appear in overweight people. Most often these are patients whose excess weight is due to malnutrition and the use of large amounts of junk food.

Ethnicity is another reason for type 2 diabetes. Such a sign is sharply manifested when the traditional way of life is changed to the exact opposite. Type 2 diabetes, together with obesity, causes a sedentary lifestyle, lack of any physical activity and constant stay in one place.

Non-insulin-dependent diabetes mellitus also occurs due to the peculiarities of a particular diet (for example, therapeutic or professional sports). This happens with the use of a large amount of carbohydrates, but with a minimum content of fiber in the body.

Bad habits are significant causes of type 2 diabetes. Alcohol damages pancreatic tissue, reducing insulin secretion and increasing its sensitivity. This organ in people suffering from this addiction is significantly enlarged, and the special cells that are responsible for the production of insulin completely atrophy. It is noteworthy that a small amount of alcohol per day (48 g) reduces the risk of the disease.

Type 2 diabetes often occurs along with another problem - arterial hypertension. This is a chronic disease in adults, which is associated with a long-term increase in blood pressure. Very often, the causes of diabetes mellitus and arterial hypertension are identical.

Symptoms of the disease

The symptoms of type 2 diabetes are hidden for a long time, and the diagnosis is most often determined by analyzing the level of glycemia. For example, during the annual medical examination. If type 2 diabetes is diagnosed, symptoms may appear mainly in adults over 40 years of age, but even then the sick do not complain of severe fatigue, thirst, or polyuria (increased urination).

The clearest signs of type 2 diabetes are itching of any part of the skin or area of ​​the vagina. But this symptom is very common, so in most cases, patients prefer to seek help from a dermatologist or gynecologist, not even suspecting that they have symptoms of type 2 diabetes.

Many years often pass from the onset of the manifestation of the disease to the exact diagnosis of the diagnosis, at which time the symptoms of type 2 diabetes in many patients already acquire a clinical picture of late complications.

So, patients are hospitalized with leg ulcers, heart attack, stroke. It is not uncommon to seek help from ophthalmologists in connection with a sharp and rapidly developing decrease in vision.

The disease develops in several stages and there are several types of severity:


Stages of type 2 diabetes:

  • Compensatory. The stage is completely reversible and in the future the patient will undergo a complete recovery, since the signs of type 2 diabetes mellitus do not appear here at all or appear slightly.
  • Subcompensatory. More serious treatment will be needed, some symptoms of type 2 diabetes may be present in the patient for the rest of his life.
  • Decompensation. The metabolism of carbohydrates in the body is completely changed and disrupted, it is impossible to return the body to its original “healthy” form.

Diagnosis of the disease

The diagnosis of non-insulin-dependent diabetes mellitus in most cases is based on the detection of a symptom of hyperemia (elevated blood sugar) along with the standard signs of type 2 diabetes mellitus (the above obesity, heredity, etc.).

If these signs are not detected for one reason or another, an absolute deficiency of insulin can be additionally established. With it, the patient dramatically loses weight, experiences constant thirst, develops ketosis (active breakdown of fat to maximize energy conservation due to the low content of carbohydrates in the body).

Since type 2 diabetes is often asymptomatic, screening is indicated to prevent and prevent the spread of the disease. This is a survey of patients without any symptoms of type 2 diabetes.

This procedure for determining the level of glycemia on an empty stomach is shown to people over 40 years old once every 3 years. This study is especially urgent for overweight people.

Young patients should be tested for non-insulin-dependent diabetes in such cases:


To establish an accurate diagnosis, it is necessary to do a blood sugar test. It is determined using special strips, glucometers or auto-analyzers.

Another test is glucose tolerance testing. Before the procedure, the sick person should consume 200 g of carbohydrate-containing food per day for several days, and water without sugar can be drunk in unlimited quantities. Typically, blood counts in diabetes will exceed 7.8 mmol / l.

For a correct diagnosis, a test is performed 10 hours after the last meal. For this, blood can be taken both from a finger and from a vein. Then the subject uses a special glucose solution and donates blood 4 more times: in half an hour, 1 hour, 1.5 and 2 hours.

Additionally, a urine test for sugar may be offered. This diagnosis is not entirely accurate, since sugar in the urine can appear for a number of other reasons not related to diabetes (type 2).

Treatment of the disease

How to treat type 2 diabetes? Treatment will be complex. People diagnosed with obesity will be given a diet first. Its goal is aimed at a smooth weight loss with its further preservation. Such a diet is prescribed to every patient with this problem, even those who have not been diagnosed with type 2 diabetes.

The composition of the products will be selected individually by the attending physician. Often the daily calorie intake will be reduced to 1000-1200 calories for women or 1200-1600 for men. The ratio of BJU (proteins-fats-carbohydrates) in type 2 diabetes is identical to the first: 10-35% -5-35% -65%.

Drinking alcohol is allowed, but in small quantities. Firstly, alcohol, together with certain drugs, can cause hypokleemia, and secondly, it can provide a large amount of extra extra calories.

Type 2 diabetes will be treated by increasing physical activity. You need to start with aerobic exercise like swimming or regular walking for half an hour 3-5 times a day. Over time, the load should increase, in addition, you can start other workouts in the gym.

In addition to accelerated weight loss, the treatment of type 2 diabetes with physical activity will consist of lowering insulin resistance (reducing the response of tissues to insulin) due to increased physical activity.

Treatment for type 2 diabetes will consist of taking medications to lower blood sugar levels.

Antidiabetic agents are divided into several types:


Sensitizers (metamorphine and thiazolidinedione) for the treatment of type 2 diabetes are prescribed to reduce the body's sensitivity to insulin. Metamorphine reduces the production of glucose by the liver. Reception is made inside during meals, and the dosage will be prescribed by the attending physician. Thiazolidinediones are aimed at enhancing the action of insulin, destroy glucose in peripheral tissues.

Insulin injections are prescribed only at advanced stages of the disease, when diet, physical activity and antidiabetic drugs can no longer perform their function or there were no results from previous treatment.

New in treatment

In addition to traditional methods of treating type 2 diabetes, there are a number of other discoveries made by scientists. Most of them have not yet confirmed their effectiveness, so they prefer to use them with caution.

Additional help for losing weight in the treatment of type 2 diabetes will be provided by fiber. Possessing plant cellulose at its core, it will quickly remove harmful substances and toxins from the body, as well as absorb excess water. In addition, increasing in the stomach, fiber causes a feeling of satiety and a full stomach, which will allow a person to be saturated several times faster and not feel hungry.

A fairly effective option (but only as a method of prevention and rehabilitation) of all modern methods of treating type 2 diabetes is the Buraev method, also called “phytotherapy”. It was experimentally conducted on a group of volunteers in 2010 in Sredneuralsk. The average age of patients is 45-60 years, the course of treatment is 21 days.

Every day people consumed products of animal and vegetable origin. Among the ingredients there were such unusual products: aspen bark, bear fat, propolis, fir oil and berry juice. All these products were consumed in conjunction with the prescribed diet No. 9 and 7. In addition, all participants in the experiment underwent a daily medical examination with a number of laboratory tests.

At the end of the experiment, most of the patients significantly lost weight, and 87% noted a decrease in blood pressure.

Recently, a new method of treatment with stem cells has become relevant. The patient in a specialized institution before the operation take the right amount of biological material at the choice of the attending physician. From it, new cells are grown and propagated, which are subsequently introduced into the patient's body.

Biological material immediately starts searching for "empty" tissues, and at the end of the process settles there, making a kind of "patch" on the damaged organ. In this way, not only the pancreas is restored, but also a number of other organs. This method is especially good because it does not require additional medications.

Another new method is autohemotherapy. A certain amount of blood is taken from the patient, mixed with a specially derived chemical solution and cooled. The procedure lasts approximately 2 months through the introduction of prepared chilled vaccines. Trials are still underway, but if such therapy soon comes into use, it will be possible to cure even diabetes in its most advanced stage, stopping the development of other complications.

Disease prevention

Can type 2 diabetes be cured permanently? Yes, it is possible, but without further prevention, the disease will sooner or later make itself felt again.

To prevent this and protect yourself, you must follow a number of simple rules:


You need to constantly check your weight. This is best done using a body mass index table. Even a slight loss of kilograms will dramatically reduce the need for treatment for type 2 diabetes. For prevention, it is advisable to choose a sport or activity that will increase the heart rate.

Every day you need to devote half an hour to a variety of exercises. Experts advise also to include resistive exercises. Exhausting yourself in the gym is not necessary, because physical activity can consist of standard long walks, housework or gardening.

It is necessary to follow a balanced diet, which excludes the volumetric consumption of fatty foods, alcohol, starchy and sweet carbonated drinks. It is not necessary to completely abandon these products, you should reduce their number to a minimum. Eating small meals often will help keep your blood sugar in a normal state.

Nuts, vegetables and grains will significantly reduce the risk of developing type 2 diabetes.

Particular attention should be paid to your legs, because it is this part of the body that suffers most from improper treatment of diabetes mellitus 2. Regular eye examinations will be useful. Taking aspirin will reduce the risk of heart attacks, strokes and various types of heart disease and, as a result, the further development of type 2 diabetes. Be sure to discuss the appropriateness of use and dosage with your doctor.

Scientists have long proven that stress, anxiety and depression directly affect metabolism. The physical state of the body and sharp jumps in weight in the direction of increase or decrease negatively affect human health. Therefore, a calm attitude to life's problems and troubles will positively affect the development of the disease.


Complications after diabetes

If type 2 diabetes is not treated in time, the consequences of the disease can be serious. Main complications:

The first option occurs in patients experiencing serious stress, if they are in a state of constant excitement. The level of sugar in the blood reaches a critical level, as a result of which dehydration develops.

Diabetic coma in most cases affects the elderly.

Before diagnosis, they complain of increased thirst and increased urination. In 50% of cases, these signs of type 2 diabetes cause shock, coma and death. At the first manifestations of symptoms (especially if a person is aware of his diagnosis), it is urgent to consult a doctor who will prescribe the introduction of specialized solutions and additional administration of insulin.

In type 2 diabetes, the legs often swell due to the fact that the blood vessels are injured and the sensitivity of the limbs decreases. The main symptoms are sharp and sharp pains caused by wearing uncomfortable shoes or foot infections or a simple scratch. The sick person may feel "goosebumps" on the skin, his legs swell and turn red, and even minimal scratches heal several times longer. They may lose hair on their legs.

In rare cases, such edema can lead to fatal consequences up to the amputation of the legs. In order to avoid complications, you should carefully monitor them, choose the right shoes and do a variety of massages to relieve them of fatigue.

The most common cause of endocrine disruption is type 2 diabetes mellitus (DM), but you can understand what this is by calling the disease in simple terms, and in medicine it is referred to as an insulin-independent pathology, which has its own characteristic symptoms, diet and treatment. This disease became known 2 thousand years ago, but to this day it is still incurable.

People who suffer from this disease are most concerned about possible complications associated with the legs, vision, cardiovascular system and digestive organs, because without a properly selected diet, exercise and complex treatment, they cannot be avoided. For this reason, in order to prevent these problems, you need to change your lifestyle when an endocrine failure is detected.

At the same time, to understand what type 2 diabetes means and what course of therapy even a child can have, I focus on information found on the Internet, for example, on Wikipedia, where you can find methods for treating legs, insulin administration techniques and a diet compiled by doctors for this disease .

Second-degree diabetes is non-insulin dependent and has its own causes. The development of the disease occurs against the background of a constantly elevated level of glucose in the blood (hyperglycemia), and at the same time the body ceases to perceive the insulin produced by the pancreas, which leads to various complications, including metabolic failures.

Doctors call the first stage an excessive amount of hormone produced, which ultimately leads to the depletion of pancreatic cells. Because of this, an additional injection of insulin is prescribed to compensate for its shortage. These actions provoke disruptions in carbohydrate metabolism and an increase in the amount of glucose that is produced by the liver.

When there is more sugar in the blood and the hormone that is responsible for its transportation does not perform its functions or does not do it completely, this process leads to a constant need to urinate. Due to the strong loss of water and salts, the body begins to dehydrate and there is a deficiency of anions and cations. In addition, excess sugar causes malfunctions in metabolism, which can disrupt the functioning of internal organs.

The reasons that can cause type 2 diabetes are still unclear, but there are risk groups and people in them are much more likely to suffer from this pathology and they are:

  • Hereditary predisposition, especially if the mother had the disease;
  • completeness;
  • Endocrine diseases, for example, problems with the thyroid gland;
  • Transferred viral diseases;
  • With pancreatitis and other inflammatory processes in the pancreas.

Features of Type 2 SD

Type 2 diabetes mellitus is divided into several types and they differ in their course, namely:

  • In a mild form, there are no special deviations and sharp jumps in sugar, and for treatment it is enough to follow a diet, measure glucose levels and take pills for better perception of insulin produced by the body;
  • It is not so easy to treat the moderate form of severity because it is characterized by complications in the vascular system. In the course of therapy, in addition to these methods, you will need to add drugs that lower sugar levels or use short-acting insulin;
  • A severe form means an abundance of complications and comorbidities, and for treatment it will be necessary to use long-acting and fast-acting insulin and constantly measure sugar levels.

In addition, type 2 diabetes should be divided according to the degree to which carbohydrate metabolism is located:

  • compensation phase. It is characterized by good sugar levels, which were achieved by treatment;
  • subcompensation phase. The glucose level will not exceed 13.9 mmol / l and it comes out with urine in an amount of not more than 50 g;
  • phase of decompensation. The disease is difficult to treat and the sugar level remains above 13.9 mmol/l. In addition, it is excreted daily in the urine in the amount of 50 grams or more. It should also be noted that acetone appears in urine and this degree of carbohydrate metabolism can lead to hyperglycemic coma.

You can also note the pathologies caused by diabetes, such as:

  • Angiopathy. Because of it, the walls of blood vessels become brittle, their patency worsens;
  • Polyneuropathy. Manifested in the form of causeless discomfort in the nerve trunks;
  • arthropathy. Signs of this disease are localized in the joints and manifest themselves in the form of pain;
  • Ophthalmopathy. She is characterized by impaired vision and eye pathologies;
  • Nephropathy. Manifested over time in the form of renal failure;
  • encephalopathy. Because of this, mental disorders do not occur.

Symptoms of the disease

With type 2 diabetes, there are clear distinguishing symptoms by which it can be identified and subsequently prescribed treatment. They are caused by an initiated pathological process in the body, due to which fats are used as an energy source, the metabolism of proteins and minerals is disrupted, and toxic substances begin to form.

Of the main signs of a disease such as type 2 diabetes, one can distinguish:

  • Feeling thirsty, dry mouth;
  • Regular urge to go to the toilet;
  • General weakness;
  • Fast fatiguability;
  • A feeling of hunger that cannot be completely appeased;
  • Poor tissue regeneration;
  • Constant desire to sleep;
  • Excess weight.

Unlike the insulin-dependent type, type 2 diabetes mellitus may not appear for years, and only after 50 will the first symptoms become noticeable.

In addition, pathology may not show obvious signs, and be expressed in the form of blurred vision, a skin disease, or resemble a cold.

Diagnostics

Diagnosing the fact that this is type 2 diabetes and starting to treat it should be a doctor such as an endocrinologist. First of all, a blood test is taken for the sugar content in it by the capillary method (from a finger). The material is taken only on an empty stomach and 8 hours before that you can not eat anything, and only boiled water is allowed to drink. After that, the doctor will conduct a test to find out how the body reacts to sugar, and this time the blood will be taken after the patient has consumed a glass of diluted glucose, and then after 1-2 hours.

In addition to blood, you will need to pass urine for analysis to find out whether sugar and ketone bodies (acetone) are excreted from the body during urination. After all, if this is so, then the person will be diagnosed with diabetes.

It is worth noting the need for a blood test for the amount of glucosylated hemoglobin in it. If this indicator is increased, then doctors call it a clear sign of diabetes.

The most important sign of type 2 diabetes is elevated blood sugar and an excess is a number above 120 mg/dL. In addition, a healthy person should not have glucose in urine at all, not to mention acetone, because in a normal state, the kidneys filter the fluid that enters them. Failures in this process occur when the sugar level rises above 160 mg/dL and it gradually seeps into the urine.

The test, designed to find out the reaction of the body to the glucose that has entered it, is considered successfully passed if the indicators at the first blood sampling were less than 120 ml / dl, and after the second they did not increase above 140 ml / dl. Treatment will be required if the concentration was more than 126 ml / dl at 1 time, and more than 200 ml / dl at 2 times.

Diet for diabetes

The most important part of the course of therapy is a properly formulated diet. A properly formulated diet will help overweight people increase the effectiveness of insulin produced by their pancreas. As for the products that are acceptable for this disease, the daily diet can be made up of the following products:

  • Vegetables;
  • Tea, coffee without sugar;
  • Low-fat varieties of meat and fish;
  • dairy products;
  • Potatoes, corn;
  • leguminous crops;
  • Bread;
  • Cereals;
  • Eggs.

At the same time, experts advise limiting to a minimum such products:

  • Fatty or smoked meat and fish;
  • Sausages;
  • Oil;
  • canned meat;
  • Fatty cheeses;
  • sour cream;
  • Various confectionery products, including jam;
  • Walnuts;
  • Alcoholic drinks;
  • Mayonnaise.

You need to try to have fresh vegetables in your daily diet without processing and additional components, such as mayonnaise or vinegar, etc. In addition, instead of frying, it is better to bake food in your own juice, and if it comes to poultry, then you need to remove the skin from it while cooking. Meals should be evenly distributed and carried out at least 3-4 times.

A course of treatment

Type 2 diabetes cannot be completely cured, but it is possible to keep the patient's body in a healthy state by creating the appearance of the pancreas. If the course of the disease is mild, then it is enough to follow a strict diet and exercise, but doctors recommend using medications to improve insulin sensitivity. The average form of the disease is no longer so easy to treat and it will be necessary to control sugar and, if necessary, inject a fast-acting hormone before or after meals. In advanced cases, there are many complications associated with the patient's vision, legs, and the cardiovascular system, and a course of rehabilitation therapy will be required to eliminate them. In addition, it is necessary to measure the sugar level 6-7 times daily and inject insulin.

The course of therapy includes drugs, for example, biguanides, which increase the sensitivity of tissues to insulin so that the body can cope with the transport of sugar on its own. In addition, the doctor will definitely prescribe medications like glycosidase inhibitors to normalize carbohydrate metabolism. Also, with diabetes, drugs to enhance insulin, such as sulfonylurea and gliquidone, will not interfere. In addition to the listed drugs, the course of therapy will also include nuclear receptor activators to improve liver function. All these groups of medicines can be perfectly combined with each other, but only a doctor can prescribe them, focusing on the course of the disease, so their self-administration is prohibited.

Diabetes is not a sentence, but only a difficult test and you need to pull yourself together and start taking care of your health. In addition, thanks to the Internet, anyone can look at the same wikipedia for exercises and diets that are recommended for this disease.

The habit of eating plentifully and sitting comfortably in front of the TV has led to a sharp increase in the number of patients who are diagnosed with type 2 diabetes. 8% of the world's population already suffers from this disease (according to the International Diabetes Federation), the number of cases is steadily growing. If type 2 diabetes treatment is started in time, serious complications can really be avoided. Non-insulin-dependent diabetes can be cured. To do this, sometimes you just need to change your lifestyle. Being slightly hungry and moving is a chance to maintain your health for a long time.

Type 2 diabetes mellitus (non-insulin-dependent diabetes) is caused by overeating and physical inactivity. Do not forget about the genetic predisposition - the presence in the family of relatives who have been diagnosed with type 2 diabetes increases the likelihood of the disease.

The disease affects people of middle and old age, in women it is diagnosed more often than in males. Children with type 2 diabetes may develop if they are overweight.

The development of the disease is associated with insufficient absorption of glucose circulating in the blood by fatty and muscle tissues. This is due to two reasons:

  1. Relative deficiency of produced insulin;
  2. Decreased sensitivity of cells to insulin (insulin resistance).

Age-related changes do not bypass the pancreas. The rhythm of insulin production is disturbed, the hormone is not synthesized in sufficient quantities.

Insulin resistance is the inability of muscle and fat cells to absorb glucose. Insulin resistance can be caused by:

taking certain medications (diuretics, corticosteroids, nicotinic acid, beta-blockers, anticancer drugs);

  • sedentary lifestyle, bed rest;
  • diseases of the cardiovascular system (CVS);
  • obesity.

Tissue sensitivity to insulin decreases in percentage terms in proportion to the excess of the ideal weight. If the weight is exceeded by 40%, insulin sensitivity is reduced by 40%.

The risk group includes people:

  • with obesity;
  • Overweight;
  • After 40 years;
  • Diagnosed with hypertension, atherosclerosis;
  • With a favorable heredity (the closest relatives suffered from hypertension, atherosclerosis and type 2 diabetes);
  • With an addiction to smoking.

Numerous studies conducted by physicians have shown a high likelihood of developing insulin resistance in smokers.

In order not to deal with the complex calculation of indices characterizing the degree of obesity, it is enough to regularly measure your waist. If in men the measurements showed an excess of 1.02 m, and in women 0.88 m, it is worth considering taking immediate measures to combat obesity.

Classification

In the development of the disease, type 2 diabetes mellitus is divided into 3 stages:

  1. Prediabetes can be detected by testing for glycated hemoglobin.
  2. Latent diabetes, symptoms are not observed; It is diagnosed by the results of a glucose tolerance test.
  3. Obvious diabetes, clinical signs are evident. Diagnosed by all relevant tests.

Prediabetes is characterized by a slight excess of glycemia. At this stage of the disease, the pancreas is working to its limits, trying to produce enough insulin to get the cells to react and make them take up glucose. Early detection of prediabetes gives a person a chance to prevent the development of the disease if he thinks about a radical change in his lifestyle.

Type 2 diabetes can occur in 3 forms:

  1. Easy; symptoms are smoothed, there is no sugar in the urine, glycemia slightly exceeds the norm.
  2. Middle; thirst, frequent urination, pustular skin lesions; Glycemia >10 mmol/l, urinalysis revealed the presence of sugar.
  3. heavy; all metabolic processes are disturbed; clear signs of vascular and neurological disorders; high sugar levels in blood and urine tests.

Symptoms

The onset of type 2 diabetes mellitus is characterized by the absence of clear manifestations of the symptoms characteristic of diabetes:

  • Strong thirst;
  • Frequent urination;
  • Constant hunger.

Signs of diabetes should be alerted, such as:

  • Slow healing wounds;
  • Constant fatigue;
  • Numbness/tingling in hands and feet;
  • Itching in the perineum;
  • Dry skin;
  • Furunculosis;
  • floating vision.

In severe forms of insulin resistance, dark hardened spots may appear in the folds of the skin, caused by a violation of metabolic processes in the skin. Sometimes dark rings form around the neck, spots are visible on the elbows and knees.

With the further development of the disease, violations in the genital area are observed:

  • Sexual dysfunction in men;
  • The reluctance of intimacy in women.

If the disease is running, it will manifest itself:

  • Violations in the activity of the CCC (will provoke the development of hypertension, heart attack, stroke);
  • Ulcers (trophic);
  • Diabetic foot syndrome.

Diagnostics

Indolent type 2 diabetes mellitus has an unpleasant feature: it can take about 10 years from its onset to detection. Early detection of the disease will help to start treatment of type 2 diabetes in a timely manner and avoid serious complications. Laboratory tests help diagnose the disease:

  • Blood test for sugar;
  • Urinalysis for sugar and acetone;
  • Glucose tolerance test;
  • Glycohemoglobin analysis.

A blood sugar test is recommended to be done annually. Blood sampling from a finger or vein is done on an empty stomach. This analysis makes it possible to assess glycemia only at the time of the study. Blood sugar levels can be affected by exercise, stress, current acute illnesses. normal glycemia<=5,5 Ммоль/л. Дополнительные исследования назначают, если гликемия превышает 6,1 Ммоль/л. При гликемии в 11 Ммоль/л и явных клинических признаках обычно подозревают сахарный диабет 2 типа.

Glycemia - this is the name of the indicator of the content / level of sugar in the blood (in mmol / l).

If the urinalysis showed the presence of sugar and / or acetone, it is recommended to repeat the analysis to be sure. Sugar and acetone in the urine indicate possible disorders in carbohydrate metabolism. An additional examination is required.