How to live with diabetes: we understand the causes and symptoms together with an endocrinologist

Diabetes mellitus is a disorder of glucose metabolism in the body associated with insulin deficiency. Glucose is the energy material of cells and insulin is the hormone that helps it penetrate them. Without insulin, glucose remains in the blood, causing hyperglycemia and risk of complications for the kidneys, eyes, nerves, heart and blood vessels. Diabetes is incurable but can be controlled with proper diet, physical activity and medication. An endocrinologist talks about this in more detail.

Diabetes classification

Most people are only aware of two types of diabetes. In fact, there are more of them. Depending on the cause and mechanism of development of the disease, the following types of pathology are distinguished:

Type 1 diabetes mellitus(insulin dependent). In this type, the pancreas cannot produce insulin due to the destruction of the beta cells that synthesize it. The reasons for this process are not fully known, but it is believed to be influenced by genetic and environmental factors. Type 1 diabetes is usually diagnosed in childhood or adolescence and requires constant insulin administration.

Type 2 diabetes mellitus(non-insulin dependent). In this type of disease, the pancreas produces insulin, but the amount is not enough to maintain normal blood glucose levels or the cells become insensitive to it. This is due to overweight, obesity, sedentary lifestyle, malnutrition and hereditary predisposition. Type 2 diabetes mellitus develops more often in adults.

Diabetes mellitus in pregnancy(gestational). In this type of disease, high blood glucose levels occur during pregnancy and usually disappear after delivery. This is due to changes in hormonal levels and metabolism in a woman's body. They can lead to decreased insulin production or worse insulin action. Women who have had gestational diabetes have an increased risk of developing type 2 diabetes in the future.

Other specific types of diabetes. This group includes rare forms of the disease that occur due to genetic defects, pancreatic disease, endocrine disorders, certain medications or infections.

Diabetes symptoms

The classic signs of diabetes are associated with excess glucose in the blood. These include:

• Polyuria (frequent and profuse urination).
• Polydipsia (increased sensation of thirst).
• Polyphagia (increased appetite).
• Dry mouth.
• Fatigue, weakness, irritability.
• Weight loss (for type 1 diabetes) or weight gain (for type 2 diabetes).
• Itching of the skin, mucous membranes, genitals.
• Slow healing of wounds, prone to infections.
• Visual impairment, appearance of spots before the eyes.
• Numbness, tingling, pain in limbs.

Causes of diabetes

Diabetes mellitus is a multifactorial disease that can occur for a variety of reasons. Some of them:

• Genetic predisposition.The presence of diabetes in relatives increases the risk of developing the disease in children. This is especially true for type 1 diabetes, which is associated with hereditary immune system defects.
• Obesity and overweight.Excess fat in the body leads to poor insulin action and increased blood glucose levels. Particularly dangerous is visceral fat, which surrounds internal organs and releases inflammatory mediators that disrupt metabolism.
• Poor nutrition.The consumption of large amounts of simple carbohydrates, fats, salt, alcohol, as well as a lack of complex carbohydrates, proteins, fiber, vitamins and minerals in the diet contribute to metabolic disorders and an increase in blood glucose levels. Meal regularity and frequency are also important, as long gaps between meals can lead to hypoglycemia (low blood glucose levels), and frequent snacking can lead to hyperglycemia (increased blood glucose levels).
• Lack of physical activity.Physical activity helps reduce blood glucose levels, increasing energy expenditure and glucose uptake by cells. Furthermore, physical activity improves blood circulation, strengthens the cardiovascular system, improves immunity, promotes weight loss and prevents diabetes complications.
• Stress.Stressful situations cause the release of adrenaline, cortisol and glucagon. They increase blood glucose levels, suppress insulin production and increase inflammation. Stress can also lead to disruption of diet, sleep, and physical activity.
• Pancreas diseases.If the pancreas is damaged due to inflammation, stones, tumors, chronic pancreatitis, this can lead to decreased insulin production and the development of diabetes mellitus. There are also genetic disorders that lead to pancreatic dysfunction, for example, cystic fibrosis, Schwartz-Bartter syndrome, Johanson-Blitzer syndrome and others.
• Endocrine disorders.The endocrine system is a set of organs that produce hormones that regulate various body functions. Some hormones, such as glucagon, glucocorticoids, growth hormone, thyroid hormones, catecholamines, neutralize the action of insulin and increase blood glucose levels.
• Taking certain medications.Some medications can increase blood glucose levels, suppress insulin production, or decrease insulin sensitivity. These medications include glucocorticoids, thiazide diuretics, beta blockers, some anticonvulsants, some antivirals, some antipsychotics, and others. Taking these medications may cause a temporary or permanent increase in blood glucose levels and may require dose adjustment or medication replacement.
• Infections.Infectious diseases such as viral hepatitis, cytomegalovirus infection, chickenpox, rubella, mumps, meningitis, sepsis and others can damage the pancreas, cause inflammation and impair insulin production. Infections can also increase the release of stress hormones, which increase blood glucose levels.

Diagnosis of diabetes mellitus

Making a diagnosis requires a comprehensive examination. Initially, the patient is examined and interviewed by an endocrinologist. Identifies characteristic symptoms, takes into account the circumstances of their occurrence, concomitant diseases and hereditary factors. Then a detailed examination is prescribed:

Laboratory research.The main method for diagnosing diabetes mellitus is to determine blood glucose levels. To achieve this, the following tests are carried out:

• Fasting glucose.
• Glucose tolerance test.
• Glycated hemoglobin (HbA1c)

Instrumental research.To identify complications of diabetes mellitus and assess the state of target organs, the following studies are carried out:

• Ophthalmoscopy.This is an examination of the eye using a special device - an ophthalmoscope, which allows you to examine the retina, optic nerve and blood vessels of the eye.
• Ultrasound of the kidneys.This is an ultrasound examination of the kidneys, which allows evaluating their size, shape, structure, presence of stones, tumors, cysts and inflammation.
• Dopplerography of the vessels of the lower extremities.This is an ultrasound examination of the vessels of the lower extremities, which allows evaluating their lumen, walls, blood flow, presence of blood clots, atherosclerotic plaques, narrowings and aneurysms.
• Electrocardiography (ECG).This is a study of the heart that allows the evaluation of its rhythm, conductivity, contractility, presence of ischemia, myocardial infarction, arrhythmia and blockage.

Neurological examination.This is an examination of the nervous system, which allows the assessment of sensitivity, reflexes, coordination, muscle tone, the presence of paresthesia, pain and motor disorders. In diabetes mellitus, changes in the nerves may occur, such as demyelination, degeneration, inflammation, which can lead to interruption of the transmission of nerve impulses and the development of polyneuropathy, autonomic neuropathy, mononeuropathy, radiculopathy. This condition is called diabetic neuropathy.

Dermatological examination.This is a skin exam that allows you to evaluate its color, turgor, humidity, presence of wounds, fissures, ulcers, fungal, bacterial and viral infections, allergic reactions, pigmentation, atrophy, scleroderma, acanthosis.

Skin changes can occur in diabetes mellitus, such as xerosis, diabetic dermopathy, diabetic bolus, diabetic urticaria, diabetic angiopathy, diabetic foot, which can lead to disruption of the skin's protective function and the development of complications.

Consultation with other specialists.Depending on the presence of concomitant diseases and complications of diabetes mellitus, consultation with other specialists such as a cardiologist, neurologist, surgeon, dentist, psychologist and others may be necessary. They will help assess the patient's condition, prescribe the necessary treatment and give prevention recommendations.

Insulin therapy for diabetes

Insulin therapy for diabetes is a treatment method in which insulin is administered externally to the patient. It is necessary for all patients with type 1 diabetes and also for some patients with type 2 diabetes when other treatments do not work.

What types of insulin are there and how to use them

There are different types of insulin, which differ in the time of onset of action, peak activity and duration of action. According to these parameters, insulins are divided into ultra-short, short and prolonged (prolonged) action.

• Ultrashort-acting and short-acting insulins mimic the physiological release of insulin after a meal and are administered 15 to 30 minutes before meals.
• Extended-release insulins provide basal levels of insulin in the blood throughout the day and are administered once or twice daily.
• There are also ready-made mixtures of insulins of different duration of action that are convenient to use.

Insulin is injected under the skin using special devices such as pens, pumps or inhalers. The dose of insulin is selected individually for each patient, depending on blood sugar levels, volume and composition of food, physical activity and other factors.

To control blood sugar, the patient must measure it regularly using a glucometer or continuous glucose monitor.

What rules and recommendations should be followed during insulin therapy?

Insulin therapy requires strict adherence to diet, physical therapy and medical recommendations. With insulin therapy, side effects are possible, such as hypoglycemia (low blood sugar), allergic reactions, lipodystrophy - a violation of the distribution of fat under the skin, which can occur at the site of frequent insulin injections.

To avoid this, it is necessary to change the insulin injection site and use thin needles. Therefore, patients need to learn the basics of insulin therapy and consult a doctor if any questions or concerns arise.

Nutrition for diabetes

Nutrition for diabetes is the most important component of treatment. In mild forms of diabetes, sometimes diet alone is enough to reach the target blood glucose level. In more severe cases, drug therapy (oral hypoglycemic drugs, insulin) comes to the rescue.

The following general diet rules for diabetes mellitus must be observed:

1. Meals should be frequent and small(5-6 times a day), in small portions. This will help avoid big jumps in blood sugar levels.
2. Meals should be taken at the same times. The same applies to the use of glucose-lowering medications and insulin injections.
3. Strict diets and hunger strikes are prohibited, as they can lead to hypoglycemia (low blood sugar), as well as disruption of fat and protein metabolism.
4. These are preferredcooking methodssuch as: stewing, boiling, steaming and roasting. Fried, smoked, salted and pickled foods should be excluded or minimized.
5. He musteliminate easily digestible carbohydrates from food(sugar, honey, confectionery, jams, baked goods, white flour). They quickly raise blood sugar and contribute to obesity. Instead, you can use sugar substitutes (xylitol, sorbitol, fructose, stevia, etc. ) in moderation.
6. Food should contain a large amount of fiber,since these carbohydrates are absorbed more slowly and do not increase blood sugar as sharply. Fiber also helps normalize intestinal function, reduce cholesterol and appetite. Sources of fiber include vegetables, fruits, herbs, whole grain breads and cereals, legumes, nuts and seeds.
7. Limit your consumption of animal fats(butter, lard, fatty meats). They contain saturated fatty acids, which increase cholesterol levels and contribute to the development of atherosclerosis and coronary heart disease. Preference should be given to vegetable oils (sunflower, olive, corn, etc. ), which contain unsaturated fatty acids that are beneficial to the heart and blood vessels. Also useful are fish and seafood, which are sources of omega-3 fatty acids, which have anti-inflammatory and anti-sclerotic effects.
8. It is advisable thatthe calorie content of food and the amount of carbohydrates were approximately the sameon different days, this is especially important when selecting the insulin dose. To calculate the amount of carbohydrates, you can use special tables that indicate how many grams of carbohydrates are contained in various foods.
9. He mustcontrol salt intake, since excess salt can cause increased blood pressure, edema and deterioration of kidney function. The recommended daily salt intake is no more than 5 g (1 teaspoon).

A diabetes diet should be balanced, varied and tasty. You don't need to give up your favorite dishes, just learn how to cook them correctly, taking into account your condition and needs.

Diabetes mellitus is a serious disease that requires constant medical monitoring and adherence to a lifestyle regimen. If you notice signs of diabetes in yourself or your loved ones, don't delay going to the doctor. The sooner the diagnosis is made and treatment begins, the less likely it is to develop complications and the better the prognosis of the disease.