Diabetes mellitus is a metabolic disorder characterized by an increase in blood sugar.
The disease occurs as a result of defects in insulin production, a defect in insulin action, or both. In addition to high blood sugar levels, the disease is manifested by the excretion of sugar in the urine, profuse urination, increased thirst, disorders of fat, protein and mineral metabolism and the development of complications.
- Diabetes mellitus type 1 (autoimmune, idiopathic): destruction of the beta cells of the pancreas that produce insulin.
- Diabetes mellitus type 2 – with predominant tissue insensitivity to insulin or a predominant defect in insulin production with or without tissue insensitivity.
- Gestational diabetes occurs during pregnancy.
- Other types:
- genetic defects;
- diabetes mellitus caused by drugs and other chemicals;
- diabetes mellitus caused by infections;
- pancreatitis, trauma, removal of the pancreas, acromegaly, Itsenko-Cushing’s syndrome, thyrotoxicosis and others.
- mild course: no complications.
- moderate severity: there is damage to the eyes, kidneys, nerves.
- severe course: advanced complications of diabetes mellitus.
The main symptoms of the disease include such manifestations as:
Profuse urination and increased thirst;
Lesions of the skin (eg vitiligo), vagina and urinary tract are especially often observed in untreated patients as a result of the resulting immunodeficiency;
Blurred vision is caused by changes in the refractive media of the eye.
Type 1 diabetes usually begins at a young age.
Type 2 diabetes mellitus is usually diagnosed in people over 35-40 years of age.
Diagnosis of the disease is carried out on the basis of blood and urine tests.
To make a diagnosis, the concentration of glucose in the blood is determined (an important circumstance is the repeated determination of the high sugar level on other days).
The test results are normal (in the absence of diabetes mellitus)
On an empty stomach or 2 hours after the test:
venous blood – 3.3–5.5 mmol / l;
capillary blood – 3.3–5.5 mmol / l;
venous blood plasma – 4-6.1 mmol / l.
Analysis results in the presence of diabetes mellitus
On an empty stomach:
venous blood more than 6.1 mmol / l;
capillary blood more than 6.1 mmol / l;
venous blood plasma more than 7.0 mmol / l.
At any time of the day, regardless of mealtime:
venous blood more than 10 mmol / l;
capillary blood over 11.1 mmol / l;
venous blood plasma more than 11.1 mmol / l.
The level of glycated hemoglobin in blood in diabetes mellitus exceeds 6.7–7.5%.
The content of C-peptide makes it possible to assess the functional state of beta cells. In patients with type 1 diabetes mellitus, this level is usually lowered, in patients with type 2 diabetes mellitus, it is normal or increased, in patients with insulinoma, it is sharply increased.
The concentration of immunoreactive insulin is decreased in type 1, normal or increased in type 2.
Determination of the concentration of glucose in the blood for the diagnosis of diabetes mellitus is not carried out against the background of an acute illness, injury or surgery, against the background of a short-term intake of drugs that increase the concentration of glucose in the blood (adrenal hormones, thyroid hormones, thiazides, beta-blockers, etc.), in patients with liver cirrhosis.
Glucose in urine in diabetes mellitus appears only after exceeding the “renal threshold” (approximately 180 mg% 9.9 mmol / l). Characterized by significant fluctuations in the threshold and a tendency to increase with age; therefore, the determination of glucose in urine is considered an insensitive and unreliable test. The test serves as a rough guide to the presence or absence of a significant increase in blood sugar (glucose) levels and in some cases is used to monitor the dynamics of the disease on a daily basis.
Exercise and nutrition during treatment
In a significant part of patients with diabetes mellitus who follow dietary recommendations and have achieved a significant reduction in body weight by 5-10% of the initial, blood sugar indicators improve up to normal. One of the main conditions is the regularity of physical activity (for example, walking daily for 30 minutes, swimming for 1 hour 3 times a week). Exercise is not recommended when blood glucose concentrations are> 13–15 mmol / L.
With light and moderate physical exertion lasting no more than 1 hour, an additional intake of carbohydrates is required before and after exercise (15 g of easily digestible carbohydrates for every 40 minutes of exercise). With moderate physical exertion lasting more than 1 hour and intense sports, it is necessary to reduce the dose of insulin by 20-50%, acting during and in the next 6-12 hours after exercise.
The diet in the treatment of diabetes mellitus (table No. 9) is aimed at normalizing carbohydrate metabolism and preventing fat metabolism disorders.
Read more about the principles of nutrition in diabetes mellitus in our separate article.
Insulin drugs for the treatment of diabetes mellitus are divided into 4 categories, according to the duration of action:
Ultra-short-acting (onset of action – after 15 minutes, duration of action – 3-4 hours): insulin LizPro, insulin aspart.
Rapid action (onset of action – after 30 minutes – 1 hour; duration of action 6–8 hours).
Medium duration of action (onset of action – after 1–2.5 hours, duration of action 14–20 hours).
Long-term action (onset of action – after 4 hours; duration of action up to 28 hours).
Insulin prescription regimens are strictly individual and are selected for each patient by a diabetologist or endocrinologist.
Insulin injection technique
When insulin is injected at the injection site, it is necessary to create a skin fold so that the needle goes under the skin and not into the muscle tissue. The fold of the skin should be wide, the needle should enter the skin at an angle of 45 ° if the thickness of the skin fold is less than the length of the needle.
When choosing an injection site, you should avoid tight skin areas. The injection sites must not be changed haphazardly. Do not inject under the skin of the shoulder.
Short-acting insulin preparations should be injected into the subcutaneous fatty tissue of the anterior abdominal wall 20-30 minutes before meals.
Long-acting insulin preparations are injected into the subcutaneous fatty tissue of the thighs or buttocks.
Ultra-short-acting insulin injections (humalog or novorapid) are carried out immediately before a meal, and, if necessary, during or immediately after a meal.
Heat and exercise increase the rate of insulin absorption, while cold decreases it.