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 related to insulin deficiency. Glucose is the energy substance for cells, and insulin is the hormone that helps it penetrate into them. Without insulin, glucose remains in the blood, causing hyperglycemia and the risk of complications for the kidneys, eyes, nerves, heart and blood vessels. Diabetes cannot be cured, but it can be controlled with proper diet, physical activity and medication. Endocrinologists talk about this in more detail.

Classification of diabetes

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

Type 1 diabetes mellitus(dependent on insulin). 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(not dependent on insulin). In this type of disease, the pancreas produces insulin, but the amount is insufficient to maintain normal blood glucose levels or the cells become insensitive to it. This is due to overweight, obesity, inactive lifestyle, malnutrition, and hereditary predisposition. Type 2 diabetes mellitus is most common in adults.

Diabetes mellitus during pregnancy(gestational). In this type of disease, blood glucose levels rise during pregnancy and usually disappear after delivery. This is due to changes in hormone levels and metabolism in the female body. They can cause reduced insulin production or weaker insulin action. Women who develop diabetes during pregnancy have a higher 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.

Symptoms of diabetes

The classic signs of diabetes are associated with excess glucose in the blood. This includes:

• Polyuria (frequent urination and a lot).
• Polydipsia (increased thirst).
• Polyphagia (increased appetite).
• Dry mouth.
• Fatigue, weakness, irritability.
• Weight loss (for type 1 diabetes) or weight gain (for type 2 diabetes).
• Itching on the skin, mucous membranes, genitals.
• Wounds are slow to heal, prone to infection.
• Visual impairment, the appearance of spots in front of the eyes.
• Numbness, tingling, pain in the limbs.

Causes of diabetes

Diabetes mellitus is a multifactorial disease that can occur due to various reasons. Some of them:

• Genetic predisposition.The presence of diabetes in relatives increases the risk of developing the disease in offspring. This is especially true for type 1 diabetes, which is associated with hereditary defects of the immune system.
• 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 intake of large amounts of simple carbohydrates, fat, salt, alcohol, as well as the lack of complex carbohydrates, protein, fiber, vitamins and minerals in the diet contribute to metabolic disorders and increased blood glucose levels. Regularity and frequency of meals are also important, as long breaks between meals can cause hypoglycemia (low blood glucose levels), and frequent snacks can cause hyperglycemia (increased blood glucose levels).
• Lack of physical activity.Physical activity helps lower blood glucose levels by increasing energy expenditure and glucose uptake by cells. In addition, physical activity improves blood circulation, strengthens the cardiovascular system, improves immunity, promotes weight loss and prevents diabetes complications.
• Pressure.Stressful situations cause the release of adrenaline, cortisol and glucagon. They raise blood glucose levels, suppress insulin production and increase inflammation. Stress can also cause disturbances in diet, sleep, and physical activity.
• Pancreatic disease.If the pancreas is damaged due to inflammation, stones, tumors, chronic pancreatitis, this can cause a decrease in 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 collection of organs that produce hormones that control various body functions. Some hormones, such as glucagon, glucocorticoids, growth hormone, thyroid hormone, catecholamines, respond to the action of insulin and increase blood glucose levels.
• Taking certain medications.Some medications can increase blood glucose levels, block insulin production, or reduce insulin sensitivity. These drugs include glucocorticoids, thiazide diuretics, beta blockers, some anticonvulsants, some antivirals, some antipsychotics, and others. Taking this medication may cause a temporary or permanent increase in blood glucose levels and may require dose adjustment or medication replacement.
• Infection.Infectious diseases such as viral hepatitis, cytomegalovirus infection, chicken pox, rubella, mumps, meningitis, sepsis and others can damage the pancreas, causing inflammation and impaired insulin production. Infection can also increase the release of stress hormones, which increase blood glucose levels.

Diagnosis of diabetes mellitus

Making a diagnosis requires a thorough examination. Initially, the patient was examined and interviewed by an endocrinologist. It identifies characteristic symptoms, taking 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 the level of glucose in the blood. To do this, the following tests are carried out:

• fasting glucose.
• Glucose tolerance test.
• glycated hemoglobin (HbA1c)

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

• Ophthalmoscopy.This is an eye examination using a special instrument - an ophthalmoscope, which allows you to examine the retina, optic nerve, and blood vessels of the eye.
• Kidney ultrasound.This is an ultrasound examination of the kidneys, which allows you to evaluate the size, shape, structure, presence of stones, tumors, cysts, and inflammation.
• Dopplerography of the vessels of the lower leg.This is an ultrasound examination of the vessels of the lower leg, which allows you to evaluate the lumen, walls, blood flow, the presence of blood clots, atherosclerotic plaques, narrowings, and aneurysms.
• Electrocardiography (ECG).This is a study of the heart, which allows you to evaluate the rhythm, conductivity, contractions, the presence of ischemia, myocardial infarction, arrhythmias, and restrictions.

Neurological examination.This is an examination of the nervous system, which allows you to evaluate sensitivity, reflexes, coordination, muscle tone, the presence of paresthesia, pain, and movement disorders. With diabetes mellitus, changes in the nerves can develop, such as demyelination, degeneration, inflammation, which can cause disruption 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 examination that allows you to evaluate color, turgor, moisture, the presence of wounds, cracks, ulcers, fungi, bacteria, viral infections, allergic reactions, pigmentation, atrophy, scleroderma, acanthosis.

In diabetes mellitus, changes in the skin may develop, such as xerosis, diabetic dermopathy, diabetic bullosis, diabetic urticaria, diabetic angiopathy, diabetic foot, which can cause disruption of the protective function of the skin and the development of complications.

Consultation with other experts.Depending on the presence of concomitant diseases and complications of diabetes mellitus, consultation with other specialists such as cardiologists, neurologists, surgeons, dentists, psychologists and others may be necessary. They will help assess the patient's condition, prescribe the necessary treatment and give recommendations for prevention.

Insulin therapy for diabetes

Insulin therapy for diabetes is a treatment method in which insulin is given 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 are ineffective.

What types of insulin exist and how to use them

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

• Ultra-short-acting, short-acting insulin mimics the physiological release of insulin after a meal and is administered 15-30 minutes before a meal.
• Extended-release insulin provides a baseline level of insulin in the blood throughout the day and is given once or twice a day.
• There are also ready-made mixtures of insulin with different durations of action that are suitable for use.

Insulin is injected under the skin using a special device such as a pen, pump or inhaler. The dose of insulin is selected individually for each patient depending on blood sugar levels, amount and composition of food, physical activity and other factors.

To control blood sugar, patients need to measure it regularly using a glucometer or continuous glucose monitor.

What are the rules and recommendations to follow during insulin therapy?

Insulin therapy requires strict adherence to diet, physical therapy and doctor's 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 a thin needle. Therefore, patients should learn the basics of insulin therapy and consult a doctor if 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 target blood glucose levels. In more severe cases, drug therapy (oral hypoglycemic agents, insulin) comes to the rescue.

The following general rules of diet for diabetes mellitus must be followed:

1. Meals should be frequent and small(5-6 times a day), in small portions. This will help prevent large jumps in glycemic levels.
2. Food should be taken at the same time. The same goes for taking glucose-lowering drugs and insulin injections.
3. Strict diets and hunger strikes are prohibited, because it can cause hypoglycemia (low blood sugar), as well as disorders of fat and protein metabolism.
4. This is preferredcooking methodsuch as: boiling, boiling, steaming and baking. Fried, smoked, salty and pickled foods should be excluded or minimized.
5. Is supposedeliminate easily digestible carbohydrates from food(sugar, honey, sweets, jam, baked goods, white flour). They quickly increase 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,because such carbohydrates are absorbed more slowly and do not raise blood sugar so sharply. Fiber also helps normalize bowel function, reduce cholesterol and appetite. Sources of fiber include vegetables, fruits, herbs, whole grain breads and cereals, legumes, nuts and seeds.
7. Limit consumption of animal fat(butter, lard, fatty meat). It contains 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 for 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 advised thatThe calorie content of food and the amount of carbohydrates are approximately the sameon different days, this is especially important when choosing insulin doses. To calculate the amount of carbohydrates, you can use a special table that shows how many grams of carbohydrates are contained in various foods.
9. Is supposedcontrol salt intake, because excess salt can cause increased blood pressure, edema and deterioration of kidney function. The recommended daily intake of salt is no more than 5 g (1 teaspoon).

Diet for diabetes should be balanced, varied and tasty. You don't have to give up your favorite dishes, but just learn how to cook them properly, taking into account your circumstances and needs.

Diabetes mellitus is a serious disease that requires constant medical monitoring and adherence to a lifestyle regimen. If you see signs of diabetes in yourself or someone you love, do not delay going to the doctor. The sooner the diagnosis is made and the treatment started, the less likely complications are and the better the prognosis of the disease.