What is insulin-dependent diabetes: a description of the pathology and principles of treatment. What is insulin dependent diabetes mellitus? Non-insulin dependent type 2 diabetes develops

Insulin-dependent diabetes mellitus accounts for only 10% of the incidence associated with an increase in blood glucose levels.

Nevertheless, the number of diabetics is increasing every year, and Russia is among the top five countries in terms of the number of patients suffering from this disease.

It is the most severe form of diabetes and is often diagnosed at an early age.

What should every person know about insulin-dependent diabetes mellitus in order to prevent, diagnose and treat the disease in time? This article will provide an answer to that.

The main types of diabetes

Diabetes mellitus (DM) is a disease of autoimmune origin, which is characterized by complete or partial cessation of the production of sugar-lowering hormone called "insulin". Such a 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.

Causes of diabetes

Sugar level

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

Exactly what makes the immune system 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 developing insulin-dependent and non-insulin-dependent diabetes mellitus. These include:

Hormonal imbalance in adolescence associated with the action of growth hormone.
The gender of the person. It has been scientifically proven that the beautiful half of humanity is twice as likely to have diabetes.
Overweight. Extra pounds lead to the deposition of cholesterol on the vascular walls and to an increase in 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 the child will also manifest it 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 is 30% more common in blacks.
Violation of the pancreas and liver (cirrhosis, hemochromatosis, etc.).
Inactive lifestyle, bad habits and malnutrition.
Pregnancy, during which there is a violation of the hormonal background.
Drug therapy with glucocorticoids, atypical antipsychotics, beta-blockers, thiazides and other drugs.

After analyzing the above, we can identify a risk factor in which a certain group of people are more susceptible to developing diabetes. It includes:

overweight people;
people with a genetic predisposition;
patients suffering from acromegaly and Itsenko-Cushing's 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 have given birth to a child weighing more than 4 kg.

How to recognize hyperglycemia?

The rapid increase in glucose concentration is a consequence of the development of "sweet disease". Insulin-dependent diabetes can 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, with insulin-dependent diabetes mellitus, a lot of signs are manifested. A person who is attentive to his health will be able to recognize the signals of the body, indicating hyperglycemia.

So, what are the symptoms of insulin-dependent diabetes mellitus? Among the two main ones, polyuria (frequent urination), as well as 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, so it is excreted from the body with 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 such symptoms of insulin-dependent diabetes.

Frequent dizziness, migraine, fatigue and bad dream 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. As a result of decomposition, toxic substances are formed, which are called ketone bodies. Cellular “starvation”, in addition to the toxic effects of ketones, affects the functioning of the brain. Thus, a diabetic patient does not sleep well at night, does not get enough sleep, cannot concentrate, as a result, he complains of dizziness and pain.

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

Among the symptoms of the “sweet disease”, disorders of the reproductive system, both men and women, deserve special attention. In the strong half, problems with erectile function begin, and in the weak, the menstrual cycle is disturbed.

Less common are signs such as delayed wound healing, skin rash, increased blood pressure, unreasonable feeling of hunger and weight loss.

Consequences of the progression of diabetes

Undoubtedly, insulin-dependent and non-insulin-dependent diabetes, progressing, disables almost all systems. internal organs in the human body. This outcome can be avoided through early diagnosis and effective supportive treatment.

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

Insulin-dependent or non-insulin-dependent diabetes mellitus with multiple complications is a consequence of a careless attitude to one's health. Manifestations of concomitant pathologies are associated with smoking, alcohol, a sedentary lifestyle, non-compliance with proper nutrition, late diagnosis and ineffective therapy. What are the complications associated with the progression of the disease?

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 complete 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, with the wrong response, gangrene develops. the only way The treatment is amputation of the lower limb.
Polyneuropathy is another disease associated with the sensitivity of the hands and feet. Insulin-dependent and non-insulin-dependent diabetes mellitus with neurological complications presents a lot of inconvenience to patients.
Erectile dysfunction that begins 15 years earlier in men than their non-diabetic peers. The chances of developing impotence are 20-85%, in addition, there is a high probability of childlessness among diabetics.

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

Diagnosis of diabetes

Knowing that there are plenty of complications in this disease, patients seek help from their doctor. After examining the patient, the endocrinologist, suspecting an insulin-independent or insulin-dependent type of pathology, directs him for an analysis.

At the present time, there are many methods for diagnosing diabetes. The simplest and fastest is a blood test from a finger. The fence is carried out on an empty stomach in the morning. The day before the analysis, doctors do not recommend eating a lot of sweets, but you should not deny yourself food either. The normal value of sugar concentration in healthy people is the range from 3.9 to 5.5 mmol/L.

Another popular method is the glucose tolerance test. This analysis is carried out for two hours. Before the study, you can not eat anything. First, blood is taken from a vein, then the patient is offered to drink water diluted with sugar in a ratio of 3:1. Next, the health worker begins to take venous blood every half hour. The result obtained over 11.1 mmol / l indicates the development of insulin-dependent or non-insulin-dependent type of diabetes mellitus.

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

Sometimes it is prescribed in combination. A healthy person should not have glucose in urine, so its presence indicates diabetes mellitus of an insulin-independent or insulin-dependent form.

Based on the results of the tests, the doctor will decide on therapy.

Main aspects of treatment

It should be noted that even insulin-dependent type 2 diabetes occurs. This condition is caused by prolonged and incorrect therapy. To avoid insulin-dependent type 2 diabetes, you should follow the basic rules of effective treatment.

What components of therapy are the key to successful maintenance of glycemic levels and disease control? These are, physical activity, taking medications and regularly checking sugar levels. Each of them needs to be told in more detail.

To maintain normal glucose levels, diabetics must follow a special diet. It eliminates the intake of easily digestible carbohydrates (sweets, sweet fruits), as well as fatty and fried foods. Insulin-dependent and non-insulin-dependent diabetes can be easily controlled by eating fresh vegetables, unsweetened fruits and berries (melon, green apples, pears, blackberries, strawberries), low-fat dairy products, and all kinds of cereals.

As they say, life is in motion. Physical activity is the enemy of excess weight and diabetes. Patients are encouraged to engage in yoga, Pilates, running, swimming, walking and other vigorous activities.

Drug therapy is a necessity when a patient has developed insulin-dependent diabetes mellitus. In this case, insulin administration is indispensable. With an insufficient decrease in glucose levels, doctors prescribe hypoglycemic drugs. Which of them is better suited to the patient, the doctor determines. As a rule, the patient takes medications based on metformin, saxagliptin and some other components.

Patients suffering from type 1 diabetes should measure their sugar levels every time after an insulin injection, and type 2 diabetics at least three times a day.

Also, folk remedies help to treat this disease. Our ancestors have long known about the hypoglycemic effect of decoctions based on bean pods, lingonberry leaves, blackberries and junipers. But one non-traditional treatment will not help, it is used in combination with medication.

Diabetes is not a death sentence. This is the main thing to remember. Knowing what signs are characteristic of the disease, a person can suspect changes in his body in time and come for an examination to the doctor. In such a consequence, you can prevent the adoption of many drugs and ensure a fulfilling life.

Experts will tell about the symptoms and principles of treatment of insulin-dependent diabetes in the video in this article.

Insulin dependent diabetes mellitus

Diabetes- a syndrome, the main diagnostic feature of which is chronic hyperglycemia. Diabetes occurs when various diseases leading to insufficient secretion of insulin or a violation of its biological action.

Type 1 diabetes- an endocrine disease characterized by absolute insufficiency of insulin caused by the destruction of pancreatic beta cells. 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 states.

Etiology and pathogenesis

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

Classification

According to the severity of the flow:
1. easy current
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 its insufficient secretion by β-cells of the islets of Langerhans of the pancreas.

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

Glycosuria is an adaptive mechanism for removing elevated 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 eventually lead to dehydration of the body if the loss of water is not compensated by adequate 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, chloride anions, phosphate and bicarbonate develops.

There are 6 stages in the development of DM1. 1) Genetic predisposition to DM1 associated with the HLA system. 2) Hypothetical starting torque. Damage to β-cells by various diabetogenic factors and triggering of immune processes. In patients, the above listed 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, insulin secretion decreases. 4) Decrease in glucose-stimulated secretion of I. In stressful situations, the patient can detect transient IGT (impaired glucose tolerance) and NGPN (impaired fasting plasma glucose). 5) Clinical manifestation of DM, including with a possible episode of "honeymoon". 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 due to high blood sugar levels: polyuria, polydipsia, weight loss with decreased appetite, dry mouth, weakness
microangiopathy (diabetic retinopathy, neuropathy, nephropathy),
macroangiopathy (atherosclerosis of the coronary arteries, aorta, blood vessels of the brain, lower extremities), diabetic foot syndrome
concomitant pathology (furunculosis, colpitis, vaginitis, urinary tract infection)

Mild DM - compensated by diet, no complications (only with DM 2) Moderate DM - compensated by SSSP or insulin, diabetic vascular complications of 1-2 severity are detected. Severe DM - 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 - glycemia in capillary blood on an empty stomach is more than 7.0 mmol / l and / or at any time of the day more than 11.1 mmol / l;

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

Exclude diseases that are manifested by similar symptoms (thirst, polyuria, weight loss): diabetes insipidus, psychogenic polydipsia, hyperparathyroidism, chronic renal failure, etc. This stage ends with a laboratory statement of hyperglycemia syndrome.

The nosological form of DM is specified. First of all, diseases that are included in the group "Other specific types of diabetes" are excluded. And only then the issue of DM1 or DM2 is solved. The level of C-peptide is determined on an empty stomach and after exercise. The level of concentration in the blood of GAD-antibodies is also assessed.

Complications

Ketoacidosis, hyperosmolar coma
Hypoglycemic coma (in case of insulin overdose)
Diabetic micro- and macroangiopathy - a violation of vascular permeability, an increase in their fragility, an increase in the tendency to thrombosis, to the development of vascular atherosclerosis;

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

Diabetic arthropathy - joint pain, "crunching", limitation of mobility, a decrease in the amount of synovial fluid and an increase in its viscosity;

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

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 CNS intoxication.

Treatment

The main goals of treatment:

Elimination of all clinical symptoms of diabetes
Achieve optimal metabolic control for a long time.
Prevention of acute and chronic complications of diabetes
Ensuring a high quality of life for patients.

To achieve these goals, apply:

diet
dosed individual physical activity (DIFN)
teaching patients self-control and the simplest methods of treatment (management of their disease)
constant self-control

insulin therapy

Insulin therapy is based on the imitation of physiological insulin secretion, which includes:

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

Basal secretion provides an optimal level of glycemia during the interdigestive period and during sleep, promotes the utilization of glucose that enters the body outside meals (gluconeogenesis, glycolysis). Its speed 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. Secretion of stimulated - food insulin corresponds to the level of postprandial glycemia. The level of CC depends on the level of carbohydrates eaten. Approximately 1-1.5 units are produced per 1 bread unit (XE). insulin. Insulin secretion is subject to diurnal fluctuations. In the early morning hours (4-5 o'clock) it is the 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. From the average daily dose (SSD) of insulin, the value of dietary insulin is approximately 50-60% (20-30 units), and basal insulin accounts for 40-50%.

Principles of insulin therapy (IT):

the mean daily dose (MAD) of insulin should be close to physiological secretion
when distributing insulin during the day, 2/3 of the SDS 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 (SDI) 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 SDS insulin. If necessary, at 5-6 o'clock in the morning 4-6 units. ICD. It should not be administered in one injection> 14-16 units. In case it is necessary to administer a large dose, it is better to increase the number of injections by reducing the intervals of administration.

Correction of insulin doses according to the level of glycemia To correct the doses of the administered ICD, Forsh recommended that for every 0.28 mmol / l of blood sugar exceeding 8.25 mmol / l, an additional 1 unit of insulin should be administered. I. Therefore, for each "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, 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 hours, 4 - from 22 hours until breakfast. Diuresis is taken into account in each serving, the % glucose content is determined and the amount of glucose in grams is calculated. If glucosuria is detected, to eliminate it, 1 unit is additionally administered for every 4-5 g of glucose. insulin. The next day after urine collection, the dose of insulin administered is increased. After achieving compensation or approaching it, 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, the share of the ISD accounts for 2/3 of the SS, and the ICD - 1/3 of the SS. Advantages:

ease of administration
ease of understanding the essence of treatment by patients, their relatives, 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 per week
treatment can be carried out under the control of glucosuric profile

Flaws

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

TIT shown

older people if they cannot master the requirements of IIT
persons with mental disorders, low educational level
sick people in need of care
unruly patients

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

IIT (intensive IT) 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 the ISD is not > 40-50% of the SDS, 2/3 of the total dose of the ISD is administered before breakfast, 1/3 before dinner.
food - bolus secretion of insulin is simulated by the introduction of ICD. The required doses of ICD 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 should carry out glycemic control 7 times a day.

Advantages

imitation of physiological secretion of I (basal stimulated)
the possibility of a more free mode of life and daily routine for the patient
the patient can use a "liberalized" diet by changing the time of meals, a set of products at will
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, the issues of its compensation, the calculation of XE, the ability to select doses and develops motivation, understanding 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 for patients with diabetes, 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 implement acquired skills in practice
the possibility of acquiring self-control equipment

IIT is shown:

with DM1 it is desirable for almost all patients, and for newly diagnosed DM it is mandatory
during pregnancy - transfer to IIT for the entire period of pregnancy, if the patient was treated for TIT before pregnancy
with gestational diabetes, in case of ineffective diet and DIF

Scheme of patient management when using IIT

Daily calorie calculation
Calculation of the amount of carbohydrates planned for consumption per day in XE, proteins and fats - 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 reception more than 8 XE
Calculation of SDS 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 And during the day.
Self-monitoring of glycemia, correction of doses of food I.

More simple modified IIT techniques:

25% SDA I administered before dinner or at 22:00 in the form of IDD. The ADI (comprising 75% of the DS) is distributed as follows: 40% before breakfast, 30% before lunch, and 30% before dinner
30% SDS And administered in the form of IDD. Of these: 2/3 doses before breakfast, 1/3 before dinner. 70% SSc is administered as an ICD. Of these: 40% of the dose before breakfast, 30% before lunch, 30% before dinner or at night.

In the future - dose adjustment I.

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Features of type 2 diabetes mellitus insulin-dependent

Unlike other varieties of the disease, thirst does not torment. Often referred to as the effects of aging. Therefore, even weight loss is accepted as a positive result of diets. Endocrinologists note that the treatment of type 2 diabetes begins with diets. The therapist or gastroenterologist draws up a list of allowed foods, a nutrition schedule. For the first time there is a consultation on the preparation of the menu for each day. (See also: Insulin-Dependent Diabetes Mellitus— useful information by disease)

In 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 to the cells. As a result, there is a decrease in blood sucrose levels.

It is not always possible to regulate glucose levels with diet in type 2 diabetes. Therefore, during the consultation, the endocrinologist prescribes medication. It can be tablets, injections.

Insulin therapy for type 2 diabetes is seen in those who are obese. Even with such a strictly limited diet, it is not always possible to lose weight. This is due to the fact that the normalization of sugar indicators did not occur, and the insulin produced is simply not enough to reduce glucose. In such situations, it is important to ensure a decrease in blood levels and insulin injections are prescribed.

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

How to choose a doctor?

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

In other words, you decide to spend finances on obtaining the results of surveys, consulting services. And treatment options may vary. This race forgets the fact that insulin therapy for type 2 diabetes requires instant decisions. After all, with an uncontrolled disease, harm is done quickly and irreversibly. Therefore, before throwing around the offices of endocrinologists, one should decide on the qualifications of a doctor.

This type of diabetes occurs at the age of 40 years and older. In some cases, the development of insulin therapy is not required, because the pancreas secretes the required amount of insulin. These 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 a big role. Genetics have a certain chance
cause of diabetes. After all, if the family has a risk of developing an insulin-independent disease, then the chances of children to stay healthy are reduced by 50% (if the father is ill) and only 35% if the mother is ill. Naturally, this reduces life spans.

Endocrinologists say that genes for non-insulin-dependent diabetes mellitus can be found. And at the same time to 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.
decrease in the secretory activity of beta cells / their insensitivity.

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The main types of diabetes

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

The most common types of the disease are:

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

Insulin-dependent type 1 diabetes mellitus (IDDM) is a pathology in which insulin production stops completely. 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.

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

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

Causes of diabetes

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

Exactly what makes the immune system work against the body itself remains a mystery.

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

Hormonal imbalance in adolescence associated with the action of growth hormone.
The gender of the person. It has been scientifically proven that the beautiful half of humanity is twice as likely to have diabetes.
Overweight. Extra pounds lead to the deposition of cholesterol on the vascular walls and to an increase in 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 the child will also manifest it 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 is 30% more common in blacks.
Violation of the pancreas and liver (cirrhosis, hemochromatosis, etc.).
Inactive lifestyle, bad habits and malnutrition.
Pregnancy, during which there is a violation of the hormonal background.
Drug therapy with glucocorticoids, atypical antipsychotics, beta-blockers, thiazides and other drugs.

After analyzing the above, we can identify a risk factor in which a certain group of people are more susceptible to developing diabetes. It includes:

overweight people;
people with a genetic predisposition;
patients suffering from acromegaly and Itsenko-Cushing's 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 have given birth to a child weighing more than 4 kg.

How to recognize hyperglycemia?

However, with insulin-dependent diabetes mellitus, a lot of signs are manifested. A person who is attentive to his health will be able to recognize the signals of the body, indicating hyperglycemia.

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. As a result of decomposition, toxic substances are formed, which are called ketone bodies. Cellular “starvation”, in addition to the toxic effects of ketones, affects the functioning of the brain. Thus, a diabetic patient does not sleep well at night, does not get enough sleep, cannot concentrate, as a result, he complains of dizziness and pain.

Less common are symptoms such as delayed wound healing, skin rashes, increased blood pressure, unreasonable hunger, and weight loss.

Consequences of the progression of diabetes

Undoubtedly, insulin-dependent and non-insulin-dependent diabetes, progressing, disables almost all systems of internal organs in the human body. This outcome can be avoided through early diagnosis and effective supportive treatment.

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 complete 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, with the wrong response, gangrene develops. The only treatment is amputation of the lower limb.
Polyneuropathy is another disease associated with the sensitivity of the hands and feet. Insulin-dependent and non-insulin-dependent diabetes mellitus with neurological complications presents a lot of inconvenience to patients.
Erectile dysfunction that begins 15 years earlier in men than their non-diabetic peers. The chances of developing impotence are 20-85%, in addition, there is a high probability of childlessness among diabetics.

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

Diagnosis of diabetes

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 an insulin-independent or insulin-dependent form.

Based on the results of the tests, the doctor will decide on therapy.

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Insulin-independent diabetes mellitus

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

Symptoms

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

Thirst can be both pronounced and barely perceptible. The same goes for frequent urination. Unfortunately, type 2 diabetes is often discovered incidentally. However, early diagnosis is essential for this disease. To do this, you need to regularly take a blood test for sugar levels.

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

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

With the further progression of diabetes, numbness and tingling appear in the limbs, the legs hurt when walking. In women, intractable candidiasis is observed. In the later stages of the disease develop:

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

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1. Target fasting and postprandial blood glucose levels and try to maintain them. These levels are planned strictly individually. a. For patients who are well aware of the approach of hypoglycemia and in whom it quickly passes on its own or after taking glucose, it is possible to outline a fasting glucose level close to the level in healthy people (3.9-7.2 mmol / l). This category includes adult patients with a short duration of insulin-dependent diabetes mellitus and adolescents. b. Pregnant women should strive for even more low levels fasting glucose. in. Planned fasting glucose levels should be higher in those patients who do not feel the approach of hypoglycemia, as well as in cases where hypoglycemia requires medical treatment or is of particular danger (for example, in patients with coronary artery disease). G. Disciplined patients who frequently measure blood glucose levels and adjust insulin doses manage to maintain target glucose levels for 70-80% of the time of day.
2. It is necessary to imitate the physiological fluctuations in insulin levels as best as possible. In healthy people, beta cells continuously secrete small amounts of insulin and thus provide its basal level. After eating, the secretion of insulin increases. To create a basal insulin level close to normal in the patient's blood and 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 injected 1 time per day (before bedtime) or 2 times a day (before breakfast and at 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. in. Twice a day, short-acting and intermediate-acting insulin or a combined insulin preparation is administered simultaneously. d. Short-acting insulin and intermediate-acting insulin or a combined insulin preparation are administered simultaneously before breakfast. Short-acting insulin is given before dinner and intermediate-acting insulin is given at bedtime. e. 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 hormone supply 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 list 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 at bedtime), 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 whenever the dose of insulin administered at bedtime is changed, the patient measures the concentration of glucose between 2:00 and 4:00. With the same frequency determine the level of glucose after meals. in. Always measure the concentration of glucose when the precursors of hypoglycemia appear. d. The results of all measurements, all doses of insulin and subjective sensations (for example, signs of hypoglycemia) are recorded in a diary.
5. Self-correction of the insulin therapy regimen and diet, depending on the level of blood glucose and lifestyle. The doctor should give the patient a detailed plan of action, providing for as many situations as possible in which correction of the insulin therapy regimen and diet may be required. a. Correction of the insulin therapy regimen includes changes in insulin doses, changes in the ratio of drugs of different duration of action, and changes in the time of injections. Reasons for adjusting insulin doses and insulin therapy regimens:
1) Steady changes in blood glucose levels at certain times of the day, identified by entries in the diary. For example, if your blood glucose levels tend to increase after breakfast, you can slightly increase the dose of short-acting insulin given before breakfast. Conversely, if glucose levels decrease 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 goes to visit).
4) upcoming physical activity. 5) Long trip, strong feelings (going to school, divorce of parents, etc.).
6) Accompanying illnesses.
6. Education of patients. The doctor must teach the patient to act independently in any situation. The main questions that the doctor should discuss with the patient: a. Self-monitoring of blood glucose levels. b. Correction of the scheme of insulin therapy. in. 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 with the diabetic team. First, the doctor should as often as possible inquire about the patient's condition. Secondly, the patient should be able to contact a doctor or nurse at any time of the day and get advice on any issue related to his condition.
8. Motivation of the patient. The success of intensive insulin therapy largely depends on the discipline of the patient and his desire to fight the disease. Maintaining motivation requires a lot of effort from relatives and friends of the patient and medical staff. Often this task is the most difficult.
9. Psychological support. Patients with recently onset insulin-dependent diabetes mellitus and their relatives need psychological support. The patient and his relatives must get used to the thought of the disease and realize the inevitability and necessity of dealing with it. In the United States, special self-help groups are organized for this purpose.

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DIABETES DIABETES(diabetes mellitus; synonym: sugar disease, diabetes mellitus) - an endocrine disease caused by a lack of the hormone insulin in the body or its low biological activity; characterized by a violation of all types of metabolism and damage to large and small blood vessels.

Diabetessugar is the most common endocrine pathology: in most countries of the world, it affects about 3% of the population. In the development of diabetes mellitus, an essential role is played by hereditary predisposition and adverse environmental effects, however, the nature of hereditary predisposition and the so-called. risk factors are different for different types diabetes mellitus.

One of the most striking manifestations of the numerous effects of insulin, insufficient formation or low biological activity to-rogo underlies the onset of diabetes mellitus, is a decrease in blood glucose as a result of the action of this hormone (the so-called hypoglycemic effect of insulin). The effects of insulin are realized through the interaction of the hormone with specific insulin-binding receptors located on the surface of cells in peripheral tissues. After binding to insulin, these receptors transmit the corresponding signal (information) to the cell, where certain enzymatic systems are activated in response to it.

Insulinis formed in the beta cells of the islets of Langerhans of the pancreas as a precursor, proinsulin, which has practically no hormonal activity. Under the action of a specific proteolytic enzyme, the so-called proinsulin is cleaved off. C-peptide, resulting in the formation of an active insulin molecule. Violation of the process of converting proinsulin to insulin is one of the mechanisms for the development of diabetes mellitus.

Allocate two types of diabetes mellitus - insulin dependent and non-insulin dependent. Type 1 diabetes is relatively rare (children and adolescents are more likely to suffer from it), type 2 diabetes affects up to 85% of all diabetic patients.

insulin dependent diabetes mellitusassociated with autoimmune damage to the insulin-forming cells of the pancreatic islets, leading to degeneration of these cells, wrinkling of the islets themselves and almost complete cessation of insulin production. It is believed that the triggers of such an autoimmune process in people with a hereditary predisposition to diabetes mellitus, i.e. risk factors for insulin-dependent diabetes mellitus, are viral infections (rubella, viral hepatitis, mumps, etc.) or certain intoxications. In insulin-dependent diabetes mellitus, the content of insulin in the blood is sharply reduced (up to its complete absence). Marked metabolic disturbances are noted. Glucose does not enter the cells, accumulating in the blood, which leads to hyperglycemia, a lack of insulin stimulates the formation of glucose from amino acids in the liver, glucose is excreted in the urine (glucosuria). In the body, the breakdown of proteins increases and their synthesis is disturbed. In fat depots, the breakdown of fats increases, which leads to an increase in their content in the blood - lipemia; fatty acids formed during the breakdown of fats enter the liver with blood and participate in the formation of products of incomplete combustion of fats - ketone bodies, to-rye, entering the blood, lead to acidification of the internal environment of the body - acidosis (ketoacidosis).

non-insulin dependent diabetes sugar connect ch. arr. with a decrease in the sensitivity of specific cellular tissue receptors to insulin or with the entry into the bloodstream of an inactive hormone due to the complete absence or decrease in the activity of the enzyme that catalyzes the so-called. limited proteolysis of proinsulin, i.e., cleavage from its C-peptide molecule. Insulin that is not bound to the cell cannot exert its effect, and glucose does not enter the cell. However, insulin-forming cells and the islet tissue itself are not changed in non-insulin-dependent diabetes mellitus, insulin secretion in response to glucose exposure does not change in total, and the hormone content in the blood is normal or slightly lower or higher than normal. In this type of diabetes mellitus, hyperglycemia and glucosuria are also noted, but a high concentration of ketone bodies in the blood is rarely observed. Insulin-dependent diabetes mellitus is more common in people over 50 years of age (especially women). Patients with diabetes mellitus of this type are characterized by overweight: more than 70% of such patients are obese; thus, the main risk factors for non-insulin-dependent diabetes mellitus in people with a hereditary predisposition to diabetes are a sedentary lifestyle and overweight. In non-insulin-dependent diabetes mellitus, hereditary predisposition plays a greater role than in insulin-dependent diabetes mellitus.

In addition to the two types of diabetes mellitus described above, diabetes mellitus is distinguished, which occurs with certain diseases and patol, conditions. So,diabetes mellituscan develop with Itsenko-Cushing's disease (see Itsenko-Cushing's disease), chromaffinoma, diffuse toxic goiter (see Diffuse toxic goiter) and other endocrine pathology. Pancreatitis and nek-ry other diseases of a pancreas can lead to a diabetes mellitus; a number of hereditary diseases are accompanied by diabetes mellitus. Diabetes mellitus can be caused by prolonged and uncontrolled intake of large doses of corticosteroids, hormonal contraceptives, and diuretics.

There is also a group of persons with reliablerisk of developing diabetessugar. These are, for example, people in whom both parents have diabetes mellitus, an identical twin of a patient with diabetes mellitus, women who have impaired glucose tolerance (resistance) during pregnancy or who have given birth to a child weighing (at birth) more than 4500 g. Carry also persons to this group, at to-rykh in the period of acute diseases noted disturbance of tolerance to glucose.

Expressed diabetes precedes the so-called period impaired glucose tolerance, during which there are no wedges, manifestations of diabetes mellitus, the concentration of glucose in the blood on an empty stomach is normal, however, a glucose tolerance test reveals an excessive (compared to the norm) increase in its concentration in the blood 1-2 hours after the so-called. glucose loads. A glucose load test is performed on an empty stomach. Blood is taken from the subject for sugar, then they are allowed to drink a glass of water in which 75 g of glucose is dissolved, after which, after 30 minutes, 1 hour and 2 hours, the glucose content in the blood is determined. Determined thatdiabetes mellitusdevelops in 9-10% of individuals with impaired glucose tolerance.

The clinical manifestations of diabetes mellitus are determined by the degree of insulin deficiency. Characteristic symptoms are thirst, dry mouth, weight loss (or obesity), weakness, and increased urine output (polyuria). The amount of urine excreted per day by patients with diabetes mellitus can reach 6 liters or more. There is a significant decrease in performance.

At easy coursewedge diseases, manifestations of diabetes mellitus are not pronounced, such patients almost never have ketoacidosis; diabetic retinopathy (see Retinitis) can only be detected using sensitive specific methods. Compensation is achieved by diet, without drug treatment.

With diabetes mellitusmoderateketoacidosis is noted very rarely (sometimes it develops after severe stress or a sharp violation of the diet), diabetic retinopathy is diagnosed during examination of the fundus, but it does not affect the function of vision, damage to the small vessels of the kidneys (microangionephropathy) develops, which at this stage of the disease rarely affects on kidney function. Compensation is achieved by prescribing sugar-lowering (antidiabetic) drugs (see Antidiabetic drugs) or insulin, usually at a dose of up to 60 IU per day.

At severe illnessketoacidosis often develops, up to ketoacidotic coma. Severe diabetic retinopathy leads to visual impairment, microangionephropathy - to renal failure. Compensation is often not possible, insulin doses often exceed 60 IU per day.

At decompensation of diabetes mellitusin patients, increased thirst, polyuria, dry skin, slow healing of wounds, a tendency to pustular and fungal skin diseases are noted. Lesions such as lipoid necrobiosis, xanthomatosis, etc. occur. Gingivitis and periodontitis are often observed. Muscular atrophy associated with diabetic polyneuropathy and circulatory disorders develops. Metabolic disorders can contribute to osteoporosis and osteolysis. With a long course of diabetes mellitus, sexual dysfunction often develops: impotence in men and menstrual irregularities in women.

Damage to large blood vessels(macroangiopathy) in decompensated diabetes mellitus is expressed in progressive atherosclerosis of large arteries, chronic coronary heart disease, obliterating atherosclerosis of the vessels of the lower extremities (see Obliterating lesions of the vessels of the extremities), atherosclerosis of the vessels of the brain, etc. Especially often the blood circulation of the lower extremities is disturbed, one of the first The symptom of this is intermittent claudication. The most severe manifestation of atherosclerosis of the arteries of the lower extremities in diabetes mellitus is gangrene. Specific changes in small vessels in diabetes mellitus are manifested by diabetic microangiopathy, which underliesdiabetic retinopathy, (See more - Diabetic retinopathy - stages, course, prevention, symptoms, treatment...) leading to a decrease in visual acuity, sometimes to complete blindness, and microangionephropathy, leading to acute renal failure. In people with diabetes mellitus, cataracts are more common than usual, and glaucoma often occurs. Defeat c. n. With. and autonomic nervous system causes the development of encephalopathy, peripheral and visceralpolyneuropathy, manifested by headache, memory impairment, sensitivity disorder, intestinal motility disorders.

The severe course of diabetes mellitus is characterized by the appearance and progression of diabetic glomerulosclerosis (damage to the glomeruli and capillaries of the glomeruli of the kidneys), up to renal failure with edema and uremia. In the urinary tract, inflammatory processes often develop. Sometimes with diabetes mellitus, the so-called. medullary necrosis is a rare lesion of the kidneys with a wedge, a picture of severe sepsis, hematuria, severe pain such as renal colic (see Urolithiasis), an increase in the concentration of residual nitrogen in the urine (see Residual nitrogen).

Insufficiently adequate, i.e. inappropriate to the severity and degree of development of the disease, treatment, physical and mental overstrain and inf. diseases can quickly worsen the course of diabetes mellitus, lead to its decompensation and severe complications.

Complications of diabetessugar are dangerous, first of all, by the development of coma, in which emergency care is needed. These conditions include ketoacidosis and ketoacidotic diabetic coma, hypoglycemic coma, and hyperosmolar and lactic acid coma. The development of these conditions is associated with acute metabolic disorders. The most common are ketoacidotic diabetic coma and hypoglycemic coma. See details - Coma with diabetes diabetes- ketoacidotic diabetic coma, hypoglycemic coma...

Diagnosisdiabetes mellitus in the presence of hyperglycemia on an empty stomach, glucosuria and the corresponding wedge, symptoms are beyond doubt. However, in practice, there are often situations when, in order to diagnose diabetes mellitus, it is necessary to conduct a test with a load of glucose (with the help of this test, impaired glucose tolerance is also diagnosed). The diagnosis of diabetes mellitus is established on the basis of the following indicators of this test (the concentration of glucose in the blood is given in millimoles per 1 liter and in milligrams per 100 ml, respectively; glucose is determined by the glucose oxidase method): on an empty stomach - more than 6, 7 (more than 120), 2 hours after glucose loads - more than 11.1 (more than 200). Usually such figures coincide with the first wedge, manifestations of a diabetes mellitus.

Diagnosis of Impaired Glucose Toleranceput on the basis of the following indicators of the sample with a glucose load: on an empty stomach - 6, 7 or less (120 or less), 2 hours after the load - 7, 8-11, 1 (140-200). It must be remembered that these figures are 20% lower than those figures, which are obtained when determining blood sugar by the still common method of Hagedorn-Jensen.

Fine blood sugaron an empty stomach, determined by the Hagedorn-Jensen method (ferricyanide method), is 6-7 mmol / l, or 120 mg / 100 ml (fluctuations during day 4, 44-8, 88 mmol / l, or 80-160 mg / 100 ml), and according to the glucose oxidase and orthotoluidine methods - 5.55 mmol / l, or 100 mg / 100 ml (fluctuations during the day from 3.35 to 7.8 mmol / l, or from 60 to 140 mg / 100 ml) . The last two methods are more specific for glucose.

Treatment of diabetesIt is aimed at eliminating metabolic disorders caused by insulin deficiency, and at preventing or eliminating damage to blood vessels. Depending on the type of diabetes mellitus (insulin-dependent or non-insulin dependent), patients are prescribed insulin administration or oral administration of drugs that have a sugar-lowering effect. All patients with diabetes mellitus must follow a diet prescribed by a specialist doctor, the qualitative and quantitative composition of which also depends on the type of diabetes mellitus. Approximately 20% of patients with non-insulin-dependent diabetes mellitus diet is the only and quite sufficient method of treatment to achieve compensation. In patients with non-insulin-dependent diabetes mellitus, especially with obesity, therapeutic nutrition should be aimed at eliminating excess weight. After normalization or reduction of body weight in such patients, the need for the use of sugar-lowering drugs is reduced, and sometimes completely disappears.

The ratio of proteins, fats and carbohydrates in the diet of a diabetic patient should be physiological. It is necessary that the proportion of proteins be 16-20%, carbohydrates - 50-60%, fats - 24-30%. The ration is calculated based on the so-called. ideal, or optimal, body weight. Every diabetic patient must strictly observeindividual diet, compiled by a specialist doctor, taking into account the weight, height and nature of the work performed by the patient, as well as the type of diabetes mellitus. So, if when performing an easy physical work the body needs to receive 30-40 kcal per 1 kg of ideal weight, then with an actual weight of 70 kg, an average of 35 kcal per 1 kg is needed, that is, 2500 kcal. Knowing the content of nutrients in foods, you can calculate the number of kilocalories per unit mass of each of them.

Patients with diabetes mellitus are recommended a regimenfractional nutrition(meals 5-6 times a day). The daily calorie content and nutritional value of the daily diet should be the same, if possible, because this prevents sharp fluctuations in blood glucose concentration. However, it is necessary to take into account the volume of energy consumption, which is different on different days. We must once again emphasize the importance of strict adherence to the diet, which makes it possible to achieve a more complete compensation for the disease. Patients with diabetes mellitus are prohibited from sugar and other sweets, fruits rich in easily digestible carbohydrates (grapes, persimmons, figs, melons), spices. Sugar substitutes (sorbitol, xylitol, etc.) can be included in the diet in an amount of not more than 30 g per day. Depending on the type of diabetes mellitus and the body weight of the patient, the consumption of bread ranges from 100 to 400 g per day, flour products - up to 60-90 g per day. Potatoes are limited to 200-300 g per day, animal fats ( butter, lard, pork fat) up to 30-40 g, they are recommended to be replaced with vegetable oils or margarines. Vegetables - White cabbage, cucumbers, lettuce, tomatoes, zucchini are practically not limited. The consumption of beets, carrots, apples and other unsweetened fruits should not exceed 300-400 g per day. Low-fat meats, fish should be included in the daily diet in an amount of not more than 200 g, milk and dairy products - not more than 500 g, cottage cheese -150 g, eggs - 1-1.5 eggs per day. Moderate (up to 6-10 g) salt restriction is necessary.
The daily diet of patients with diabetes mellitus should contain a sufficient amount of vitamins, in particular vitamins A, C, vitamins of group B. When compiling a diet, it is necessary to take into account the patient's condition, the presence of concomitant diseases and patol, conditions. With ketoacidosis in the patient's diet, the amount of fat is reduced, after the elimination of ketoacidosis, the patient can return to the previous daily set of products. No less important is the nature of the culinary processing of products, which should also be carried out taking into account concomitant diseases, for example, cholecystitis, gastritis, peptic ulcer, etc.

Children's diet, patients with diabetes mellitus, should be as close as possible to the physiological. In a physiologically based diet, the ratio between proteins, fats and carbohydrates is 1: 1: 4. It is very important that the protein content in the diet is within the age norm. Up to 25-50% of the total amount of fat in the daily diet of a child with diabetes mellitus should be vegetable fats (sunflower, olive and other vegetable oils) in the form of seasonings for vegetable and fruit salads. Carbohydrates are limited due to the partial or complete exclusion of sugar and confectionery from the diet. The amount of bread, cereals, potatoes in the diet is controlled. You can give children unsweetened apples and pears, plums, currants, gooseberries, citrus fruits, watermelons. The diet must include products that help reduce blood levels of cholesterol and other metabolites of fat metabolism - low-fat cottage cheese, oatmeal, low-fat varieties of fish and meat. During the period of decompensation of diabetes mellitus (development of ketoacidosis, deterioration of health, enlargement of the liver, hyperglycemia), the fat content in the diet is reduced by 30% (animal fats are completely excluded). At the same time, honey is prescribed for 1 teaspoon. l. 3 times a day. Alkaline drink is necessary (solutions baking soda, alkaline mineral waters).

Experience shows that non-compliance with the patient's diet most often leads to aggravation of the condition, therefore the most important task of health workers is to control the proper nutrition of a patient with diabetes mellitus. Such control is simplified when using rational nutrition counters, for example, the "Ration" counter. This counter can be used by the patient himself.

Treatment with insulinperformed in all patients with insulin-dependent diabetes mellitus. In non-insulin-dependent diabetes mellitus, indications for insulin administration are the lack of effect from the use of sugar-lowering drugs, as well as liver and kidney failure. Insulin therapy is necessary for pregnant women with diabetes mellitus or impaired glucose tolerance.

Insulinprescribed by a doctor, insulin therapy is carried out under the control of glucose in the blood and urine. According to the nature and duration of action, insulin preparations are divided into three main groups: preparations of short, intermediate and prolonged (prolonged) action (see Antidiabetic agents). When a patient receives one injection of insulin per day, it is necessary to combine insulin preparations of different duration of action. However, the use of long-acting insulin preparations does not always make it possible to compensate for diabetes mellitus. Therefore, patients with insulin-dependent diabetes mellitus often need fractional administration of simple insulin 3-4 times a day or two subcutaneous injections of an intermediate-acting insulin preparation before breakfast and dinner in combination with a short-acting insulin preparation. actions.

The most common complications of insulin therapy include hypoglycemic conditions that occur during the period of maximum insulin action in cases where the patient does not follow a diet or with increased physical activity. One of the complications of insulin therapy is an allergy to insulin, while a patient with diabetes mellitus must be hospitalized for treatment in a specialized endocrinology department. Allergic reactions can be local (redness, pain and swelling at the injection sites of insulin) and general, characterized by varying degrees of severity, up to anaphylactic shock (see Anaphylaxis). Lipodystrophies, another complication of insulin therapy, are manifested by the formation of "dips" or "pits" at the injection sites of insulin, which require special treatment.

Treatment of patients with non-insulin-dependent diabetes mellitus mainly consists in strict adherence to the diet and normalization of body weight in obesity. In cases where compensation for diabetes mellitus is not achieved by diet, sugar-lowering drugs are used orally. These include sulfonylurea derivatives, which stimulate the secretion of insulin by the cells of the pancreatic islets and promote the uptake of glucose by tissues, and biguanides, which reduce the absorption of glucose in the intestine and promote its uptake by peripheral tissues. The most widely used sulfonylurea derivatives are bucarban, chlorpropamide, glibenclamide (maninil), etc. Although the mechanism of their action is similar, the sugar-lowering effect of glibenclamide and other so-called sulfonylurea drugs. the second generation is many times higher. The use of these drugs requires constant monitoring of the concentration of glucose in the blood, since they can cause severe hypoglycemic conditions, up to hypoglycemic coma. Biguanides are prescribed less frequently. This is due to the fact that they can cause an increase in the content of lactic acid in the blood and lead to a serious complication - lactic acidosis in patients older than 60 years, in patients with renal and hepatic insufficiency, as well as in hron, infections, etc., that is, in all in cases where there may be a shortage in the supply of oxygen to tissues.

For the treatment of lesions of blood vessels in diabetes mellitus, angioprotectors (prodectin, trental), antiplatelet agents (eg, acetylsalicylic acid), vitamins, and physiotherapeutic methods are used.

Teaching a patient with diabetes the basic, necessary methods of controlling their condition is extremely important. It is necessary that the members of the patient's family also have an idea about this disease, and if necessary (development of a coma or precoma) help the patient. There are various manuals for teaching diabetic patients about self-control of sugar. Middle-level health workers play an important role in teaching patients how to control their condition.

Forecastwith well-organized treatment and monitoring of patients with diabetes mellitus, it is favorable for life. In the presence of vascular lesions of the kidneys and eyes, the prognosis is unfavorable for work and serious for life. All patients with diabetes mellitus are under constant dispensary observation by an endocrinologist. A patient with diabetes mellitus must be annually shown to an ophthalmologist, a neuropathologist, systematically (depending on the severity of the disease) to monitor the concentration of glucose in the blood and urine. Monitoring of patients with diabetes mellitus should be more thorough in acute respiratory diseases, tonsillitis, influenza, etc. (determination of glucose concentration in blood and urine during this period should be carried out daily). It is also necessary to determine the content of acetone in the urine. The issue of childbearing in women with diabetes mellitus is decided in each case individually, depending on the severity of the disease, the presence of complications, the state of health of the husband, etc.

Preventiondiabetes mellitus is one of the most important medical and social problems. Primary prevention - disease prevention - should be based primarily on a healthy lifestyle. To this end, it is necessary to carry out constant work to explain to the population the basics of rational nutrition, prevent obesity, and promote an active lifestyle (moderate physical activity, physical education, and sports significantly reduce the possibility of obesity and, thereby, disorders of carbohydrate metabolism and the development of diabetes mellitus). In persons predisposed to diabetes mellitus, it is important to identify risk factors for the onset of this disease and work to eliminate them. Secondary prevention of diabetes mellitus is the prevention of the development of diabetes mellitus in sick people, for example, in obese people. Tertiary prevention of diabetes mellitus consists in preventing the aggravation of diabetes mellitus and its wedge manifestations. It is based on maintaining a stable compensation for the disease. It is important that a diabetic patient be active, well adapted in society, understand the main tasks in the treatment of his disease and the prevention of complications.

DIABETES INSULIN-INDEPENDENT DIABETES honey.
Non-insulin-dependent diabetes mellitus (NIDDM) is a chronic disease caused by a relative deficiency of insulin (reduced sensitivity of insulin-dependent tissue receptors to insulin) and manifested by chronic hyperglycemia with the development of characteristic complications. NIDDM accounts for 80% of all cases of diabetes. Frequency - 300:100,000 population. The predominant age is usually after 40 years. The predominant gender is female. Risk factors. Genetic factors (see below) and obesity. Genetic Aspects
Diabetes mellitus, type II (*138430, 2q24.1, defect in the gene for the enzyme glycerol-3-phosphate dehydrogenase-2 GPD2)
Mitochondrial glycerol phosphate dehydrogenase (EC 1.1.99.5) is located on the outer surface of the inner mitochondrial membrane and catalyzes the unidirectional conversion of glycerol 3-phosphate to dihydroxyacetone phosphate
Mitochondrial glycerophosphate dehydrogenase is a key component of glucose sensitivity in pancreatic β-cells. Deficiency of this enzyme contributes to the deterioration of glucose-stimulated insulin release in several animal models of NIDDM.
Diabetes mellitus, type II (*138033, 17q25, glucagon receptor gene defect GCGR).
Defects in the insulin receptor gene
Insulin-independent diabetes mellitus with blackening skin acanthosis (*147670, 19p13.2, defect in the insulin receptor gene INSR, R). Clinically: leprechaunism, in young women - virilization, polycystic ovaries, clitoral hypertrophy, menstrual irregularities; narrow skull; lipodystrophy; limb hypertrophy; brachydactyly; exophthalmos; generalized hypertrichosis. Laboratory: hyperprolactinemia and hyperglycemia
Robson-Mendenhall syndrome (\#262190, p). NIDDM in combination with epiphyseal hyperplasia and other anomalies (prognathia, dental dysplasia, blackening skin acanthosis, etc.)
Non-insulin dependent diabetes mellitus (*147545, 2q36, IRS1 gene defect)
Diabetes diabetes, a rare form (*176730, 11р15.5, INS gene, R).
Juvenile diabetes with onset in adulthood is a heterogeneous form of NIDDM that manifests itself before age 25 (13% of NIDDM cases in Caucasians)
Juvenile diabetes with onset in adulthood, type 1 (125850, 20ql3, MODY1 gene defect, 90
Juvenile diabetes with onset in adulthood, type 2 (125851, Chr. 7, GCK glucokinase gene defect, 138079, R)
Juvenile diabetes with onset in adulthood, type 3 (\#600496, 12q24.2, TCF1, HNF1A, MODY3, R gene defects).

Pathogenesis

Decreased sensitivity of tissues to insulin leads to hyperinsulinemia, increased lipogenesis and progression of obesity.
The pathogenesis of arterial hypertension in NIDDM is not entirely clear. It is known that hyperinsulinemia promotes sodium reabsorption in the renal tubules, increases sympathetic activity, causes hypertrophy of SMC vessels (due to mitogenic action) and increases calcium transport to insulin-sensitive SMCs, however, hyperinsulinemia per se (for example, in insulinoma) is insufficient to increase BP, which suggests a special role of insulin resistance in the development of arterial hypertension.
Features
Gradual onset of the disease
Symptoms are mild (no tendency to ketoacidosis)
Frequent association with obesity and arterial hypertension
The concordance for identical twins is 100%.
Diagnostics - see.

Treatment:

Mode
Regular outpatient follow-up except for emergencies
Regular physical exercises increase glucose tolerance and reduce the need for hypoglycemic drugs. Diet number 9 - basic therapy for patients with NIDDM
The main goal is to reduce body weight in patients with obesity
The main recommendations are the use of complex carbohydrates, reduced fat intake, moderate salt and alcohol intake.
Compliance with the diet often leads to the normalization of metabolic disorders in NIDDM.

Drug therapy

The drugs of choice are oral hypoglycemic drugs. They are used for mild or moderate severity of the disease, when the level of blood plasma glucose (GPC) cannot be controlled by diet alone. Drugs can be taken with meals, except for glipizide, which should be given 30 minutes before meals. Start with a low dose and gradually increase it at intervals of approximately 1 week until a decrease in the level of GPA or a maximum dose is reached.
First generation oral antidiabetic drugs (should not be used in elderly patients and in renal failure)
Tolbutamide (butamide) - 500-3,000 mg / day in 2-3 doses
Tolazamide (tolinase) - 100-1000 mg / day in 1-2 doses
Chlorpropamide - 100-500 mg / day in 1 dose
Second generation oral antidiabetic drugs
Glyburide (glibenclamide) - 1.25-20 mg / day in 1-2 doses (up to 10 mg / day - in one dose in the morning)
Glipizide - 2.5-40 mg / day in 1-2 doses (up to 20 mg / day - in one dose in the morning).
Contraindications
insulin dependent diabetes mellitus
Ketoacidosis
Pregnancy
Allergy to the drug in history
First-generation oral antidiabetic drugs should not be given to elderly patients or those with renal insufficiency.
Side effects
Hypoglycemia. Causes: excessive dose, interaction with drugs that potentiate the action of sulfonylurea, damage to the kidneys, liver, diet disruptions. Prolonged hypoglycemia, especially as a result of treatment with chlorpropamide, requires hospitalization and intravenous glucose infusion over several days
Sometimes, especially with the use of chlorpropamide, hypersensitivity to alcohol is observed, reminiscent of a reaction to disulfiram.
Hyponatremia (more common with chlorpropamide; glipizide and glyburide do not cause) may result from potentiation of the action of ADH on the renal tubules
Rare side effects: skin reactions, gastrointestinal symptoms and bone marrow depression.
Sometimes the combined use of oral antidiabetic drugs and insulin is effective. If oral preparations (for example, GPA 180 or HbA, C 1.5% of the normal level) are ineffective, it is recommended to additionally administer one dose of intermediate-acting insulin in the evening. Insulin is also prescribed for times of stress caused by intercurrent illness or surgery.
drug interaction
The action of oral antidiabetic drugs is potentiated by salicylates, clofibrate, indirect anticoagulants, chloramphenicol, ethanol
B-blockers mask the symptoms of hypoglycemia (for example, tachycardia), and also cause hypoglycemia themselves and inhibit the restoration of normal blood glucose levels.
Alternative drugs
Metformin - 500-850 mg 2-3 r / day; may be given concomitantly with sulfonylurea derivatives to improve efficacy or overcome insulin resistance. Contraindicated at an increased risk of developing lactic acidosis (renal failure, the use of radiopaque agents, surgery, myocardial infarction, hypoxia, etc.). Use with caution in heart failure, alcoholism, elderly patients, in combination with tetracycline
Phenformin (buformin)
Acarbose 25-100 mg 3 r / day orally at the beginning of a meal to prevent hyperglycemia developing after a meal. Contraindicated in renal failure, inflammatory bowel disease, ulcerative colitis or partial bowel obstruction.

Observation

The frequency of observations depends on the presence of complications and the degree of metabolic disorders. Usually every 2-4 months
Fasting blood glucose (including HbA1c)
Fundus examination
Study of CCC functions
Examination of the lower extremities for the presence of ulcers, arterial insufficiency, neuropathy
After five years of illness: examination by an ophthalmologist and examination of kidney function annually.

Course and forecast

Maintaining normal glucose levels may delay or prevent complications
Usually complications appear 10-15 years after the onset of the disease. Concomitant pathology
Arterial hypertension
Hyperlipidemia and obesity
Impotence.

Synonyms

Type II diabetes
See also , . Obesity, Leprechaunism (n1)

Abbreviations

GPC - blood plasma glucose
NIDDM - non-insulin dependent diabetes mellitus

ICD

E11 Non-insulin dependent diabetes mellitus
E10.2+ Non-insulin-dependent diabetes mellitus with kidney damage
E10.3+ Non-insulin-dependent diabetes mellitus with eye involvement
E10.4+ Non-insulin-dependent diabetes mellitus with neurological complications
E10.5 Non-insulin-dependent diabetes mellitus with impaired peripheral circulation
E10.6 Non-insulin-dependent diabetes mellitus with other specified complications
E10.8 Non-insulin-dependent diabetes mellitus with unspecified complications MIM
125850 Juvenile diabetes with onset in adulthood, type 1
125851 Juvenile diabetes with onset in adulthood, type 2
138033 Diabetes mellitus type II
138430 Diabetes mellitus type II
147545 Diabetes Insulin-independent mellitus
147670 Sugar diabetes Insulin-independent with blackening skin acanthosis
176730 Diabetes diabetes, a rare form
262190 Rabso-on-Mendenhom Syndrome
600496 Juvenile diabetes with onset in adulthood, type 3

Literature

Almind K et al: Aminoacid polymorphisms of insulin receptor substrate-1 in non-insulin-dependent diabetes mellitus. Lancet 342: 828-832; 1993; A common ammo acid polymorphism in insulin receptor substrate-1 causes impaired insulin signaling. J.Clin. Invest. 97: 2569-2575,1996; Novials A et at: Mutation in the calcium-binding domain of the mitochondrial glycerophosphate dehydrogenase gene in a family of diabetic subjects. Biochem. Biophys. Res. Comm. 231:570-572, 1997; Rabson SM, Mendenhall EN: Familial hypertrophy of pineal body, hyperplasia of adrenal cortex and diabetes mellitus. Am. J.Clin. Path. 26:283-290, 1956

Disease Handbook. 2012 .

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Type 2 diabetes is called non-insulin dependent. This means that blood sugar rises not because of a lack of insulin, but because of the resistance of receptors to it. Concerning this species pathology has its own characteristics of the course and treatment.

Diabetes mellitus of the second type, or non-insulin dependent, is a metabolic disease with the development of chronic advanced level blood sugar. This occurs either due to reduced synthesis of the pancreatic hormone, or due to a decrease in the sensitivity of cells to it. In the latter case, they say that a person develops insulin resistance. And this despite the fact that in the initial stages of the disease, a sufficient or even increased amount of the hormone is synthesized in the body. In turn, chronic hyperglycemia leads to damage to all organs.

What you need to know about non-insulin dependent diabetes mellitus

First of all, we note that diabetes mellitus is characterized by high levels of glucose in the blood. In this case, a person feels symptoms such as frequent urination, increased fatigue. Fungal lesions appear on the skin, from which there is no way to get rid of. In addition, with diabetes, there may be vision, weakening of memory and attention, as well as other problems.

If you do not control diabetes, as well as treat it incorrectly, which happens very often, then a person may die prematurely. The causes of death are gangrene, cardiovascular pathologies, end-stage renal failure.

Diabetes mellitus of the non-insulin-dependent type mainly develops in middle age - after forty years. However, in recent years, this disease is increasingly common among young people. The causes of this disease are malnutrition, excess weight and hypodynamia.

If this type of diabetes mellitus is not treated, then over the years it becomes insulin-dependent with a constant deficiency in the body of the hormone insulin and poor compensation of hyperglycemia. In modern conditions, it rarely comes to this, since many patients die from complications due to lack or improper treatment.

Why does the body need insulin?

It is the most important hormone that controls blood glucose levels. With its help, the regulation of its content in the blood occurs. If for some reason the production of insulin stops (and this condition cannot be compensated by injections of insulin), then the person quickly dies.

You need to know that a healthy body has a fairly narrow range of blood sugar. It is kept within such limits only thanks to insulin. Under its action, liver and muscle cells draw out glucose and convert it into glycogen. And in order for glycogen to turn back into glucose, glucagon is needed, which is also produced in the pancreas. If there is no glycogen in the body, then glucose begins to be produced from protein.

In addition, insulin ensures the conversion of glucose into fat, which is then deposited in the body. If you consume a lot of food rich in carbohydrates, then there will be a constantly high level of insulin in the blood. This makes it very difficult to lose weight. Moreover, the more insulin in the blood, the more difficult it will be to lose weight. Due to such disturbances in the metabolism of carbohydrates, diabetes mellitus develops.

Main symptoms of diabetes

The disease develops gradually. Usually a person does not know about it, and the disease is diagnosed by chance. Insulin-dependent diabetes mellitus has the following characteristic symptoms:

blurred vision;
bad memory;
fatigue;
skin itching;
the appearance of fungal skin diseases (while it is very difficult to get rid of them);
increased thirst (it happens that a person can drink up to five liters of liquid per day);
frequent urination (note that it also happens at night, and several times);
strange sensations of tingling and numbness in lower limbs, and when walking - the occurrence of pain;
the development of thrush, which is very difficult to treat;
in women, the menstrual cycle is disturbed, and in men, potency.

In some cases, diabetes can occur without pronounced symptoms. Sudden myocardial infarction or stroke are also manifestations of non-insulin dependent diabetes mellitus.

With this disease, a person may experience increased appetite. This occurs because the cells of the body do not absorb glucose due to insulin resistance. If there is too much glucose in the body, but the body does not absorb it, then the breakdown of fat cells begins. When fat breaks down, ketone bodies appear in the body. In the air exhaled by a person, the smell of acetone appears.

With a high concentration of ketone bodies, the pH of the blood changes. This condition is very dangerous due to the risk of developing ketoacidotic coma. If a person has diabetes and consumes little carbohydrates, then the pH does not fall, which does not cause lethargy, drowsiness and vomiting. The appearance of the smell of acetone indicates that the body is gradually getting rid of excess weight.

Complications of the disease

Non-insulin-dependent diabetes mellitus is dangerous with acute and chronic complications. Among the acute complications, the following should be noted.

Diabetic ketoacidosis is the most dangerous complication of diabetes. Dangerous by increasing the acidity of the blood and the development of ketoacidotic coma. If the patient knows all the subtleties of his disease and knows how to calculate the dose of insulin, the likelihood of developing such a complication is zero.
Hyperglycemic coma is a violation and loss of consciousness due to an increase in the amount of glucose in the blood. Often associated with ketoacidosis.

If the patient is not provided with emergency assistance, then the death of the patient is possible. Doctors have to make a lot of efforts to bring him back to life. Unfortunately, the percentage of death in patients is very high and reaches 25 percent.

However, the vast majority of patients suffer not from acute, but from chronic complications of the disease. If left untreated, they can also be fatal in many cases. However, diabetes mellitus is also dangerous because its consequences and complications are insidious, since for the time being they do not let anyone know anything about themselves. And the most dangerous complications in the kidneys, vision and heart appear too late. Here are some of the complications that diabetes is dangerous for.

diabetic nephropathy. This is a severe kidney injury that causes the development of chronic renal failure. Most dialysis and kidney transplant patients have diabetes.
Retinopathy is eye damage. It is the cause of blindness in middle-aged patients.
Neuropathy - nerve damage - already occurs in three patients with diabetes at the time of diagnosis. Neuropathy causes reduced sensation in the legs, which puts patients at high risk for injury, gangrene, and amputation.
Angiopathy - damage to blood vessels. As a result, tissues do not receive enough nutrients. Large vessel disease leads to atherosclerosis.
Skin lesion.
Damage to the heart and coronary vessels, leading to myocardial infarction.
Violation of potency in men and the menstrual cycle in women.
Progressive impairment of memory and attention.

Nephropathy and retinopathy are the most dangerous. They appear only when they become irreversible. Other disorders can be prevented by effectively controlling blood sugar. The lower it is, the less likely it is to develop such complications and approaches zero.

What is insulin-dependent diabetes: a description of the pathology and principles of treatment. What is insulin dependent diabetes mellitus? Non-insulin dependent type 2 diabetes develops

The main types of diabetes

Causes of diabetes

How to recognize hyperglycemia?

Consequences of the progression of diabetes

Diagnosis of diabetes

Main aspects of treatment

Etiology and pathogenesis

Classification

Pathogenesis and pathohistology

Clinic

Diagnostics

Complications

Treatment

Features of type 2 diabetes mellitus insulin-dependent

How to choose a doctor?

Genetic predisposition to the disease

The main types of diabetes

Causes of diabetes

How to recognize hyperglycemia?

Consequences of the progression of diabetes

Diagnosis of diabetes

Insulin-independent diabetes mellitus

Symptoms

Pathogenesis

Treatment:

Drug therapy

Observation

Course and forecast

Synonyms

Abbreviations

ICD

Literature

See what "DIABETES INSULIN-INDEPENDENT DIABETES" is in other dictionaries:

What you need to know about non-insulin dependent diabetes mellitus

Why does the body need insulin?

Main symptoms of diabetes

Complications of the disease

Features of the treatment of the disease