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Type 2 diabetes: symptoms, treatment and diet

Beginning with an increase in the glucose concentration of the blood, diabetes acquires an expanded picture of the disease, in which pathological changes affect almost all organs. In diabetes mellitus, the exchange of the most important energy substrate for the cells of the body, glucose (or sugar), suffers.

This substance a person gets from food. Then the blood delivers it to the cells. The main consumers of glucose are the brain, liver, adipose tissue, muscles. To get into the cells, glucose requires insulin - a hormone.

An exception to this rule is the neurons of the brain. In them, sugar enters without the participation of this hormone through special transport channels.

According to ICD-10, type 2 diabetes mellitus belongs to the 4th class - diseases of the endocrine system and metabolic disorders. The disease is encoded with E11.

Content

Type 2 Diabetes - What is it?

Type 2 Diabetes - What is it?

Insulin is produced by special pancreatic cells (endocrine beta cells). In type 1 diabetes , an absolute decrease in insulin is observed, i.e. it is not synthesized at all.

For the 2nd type is characterized by a relative lack of this hormone. This means that at the onset of the disease, beta cells can produce a normal (even elevated) amount of insulin, but then their compensatory reserve decreases.

Therefore, the work of "pumping" sugar into the cell is not fully implemented. Excess sugar remains in the blood. And since the body does not provide anything “extra” in the metabolism, an excess of glucose begins to “sugar” protein structures, such as the inner lining of blood vessels and nervous tissue, which adversely affects their functioning.

This "sugar" (or scientifically - glycation) is the main factor in the development of complications .

At the heart of type 2 diabetes is impaired insulin sensitivity in tissues. Even with its high level observed at the onset of the disease, hyperglycemia is observed. As a rule, it is associated with defects in cellular receptors. Usually, this condition is observed in obesity or genetic defects.

Over time, there is a functional depletion of the pancreas, which can not produce hormones for a long time. At this stage, type 2 diabetes turns into an insulin-dependent subtype, i.e. tableted drugs to reduce the glucose level is no longer possible. In these cases, regular insulin administration is required.

Causes

Diabetes is a disease with complex pathogenesis (the mechanism of the formation of the pathological process). The reason for the "poor quality work" of insulin, as mentioned above, is not in the hormone itself, but in the poor susceptibility to insulin cells. This condition is called insulin resistance.

It is characterized by the presence of insulin, but glucose-consuming cells do not react to it or react unpredictably and insufficiently.

Causes - obesity

obesity

Obesity in type 2 diabetes creates conditions when the usual amount of insulin is simply not enough to "maintain" all the fat cells. In addition, adipocytes (fat cells) independently synthesize contrainsular factors that further increase the glucose level in the blood.

Another pathogenetic factor in the increase of sugar in the second type of disease is the lack of insulin production immediately after eating. This leads to a critical increase in glucose, which damages the blood vessels.

In the future, hyperglycemia is observed even without communication with food. All this creates prerequisites for the gradual extinction of the functional activity of beta cells. As a result, insulin levels drop dramatically, down to complete absence, when insulin demand appears.

Modern medicine identifies the factors of diabetic risk:

  • age over 40 years;
  • obesity;
  • overeating carbohydrates and fats, especially of animal origin;
  • diabetes in relatives, in the presence of which the risk of getting sick is 40%. However, diabetes does not apply to gene diseases. It has only a genetic predisposition, which is realized only in the presence of certain external factors, for example, an excess of carbohydrates in the diet;
  • low physical activity, because normal muscle contractions stimulate the entry of glucose into the cell and its non-insulin-dependent breakdown;
  • pregnancy. In women, gestational diabetes can develop, which after childbirth can disappear on its own or turn into a chronic disease;
  • psychoemotional stress. This condition is accompanied by increased formation of contrinsular hormones (adrenaline, norepinephrine, corticosteroids), which increase the glucose level in the blood.

At the present level of development of medicine, type 2 diabetes is considered not as a hereditary disease, but as a “lifestyle disease”. Even in the presence of burdened heredity, this carbohydrate disorder does not develop if a person:

  • limited the consumption of sweets and other easily digestible carbohydrates;
  • monitors its weight, not allowing its excess;
  • exercise regularly;
  • excludes overeating.

Symptoms of type 2 diabetes

Symptoms of type 2 diabetes are not specific. Their appearance is usually not noticed, because the person does not experience significant discomfort in being.

However, knowing them, you can promptly consult a doctor and determine the glucose concentration in the blood. This will be the key to successful compensation for diabetes and reducing the risk of complications.

The main manifestations of this pathology are:

  1. Increasing the amount of urine that causes a person to visit the toilet even at night.
  2. The desire to constantly drink plenty of water.
  3. Dry mouth.
  4. Itching sensation of the mucous membranes (vagina, urethra).
  5. Increased appetite associated with impaired leptin synthesis.

Poor wound healing ability, furunculosis (pustules on the skin), fungal infections, impotence are frequent and important indicators of the presence of diabetes. The disease is also the first time can be detected only when in the hospital for a heart attack or stroke. This indicates the development of severe complications.

Classic symptoms appear only with an increase in glucose level above the renal threshold (10 mmol / l), i.e. at this level, sugar appears in the urine. Excess of glucose normative values, but less than 10 mmol / l of blood, as a matter of fact, is not felt by man.

Therefore, the accidental diagnosis of type 2 diabetes is a very common phenomenon.

It should be noted that the glycation of proteins begins immediately when the glucose level exceeds the norm. Therefore, early detection of diabetes will avoid the serious complications associated with the deposition of glycated proteins in the vascular wall.

Sugar rate before and after meals

Measurement of blood sugar, photo

Measurement of blood sugar, photo

In type 2 diabetes, the rate of blood sugar before and after meals is different. These indicators should be determined in the morning on an empty stomach and after a 2-hour interval after meals, respectively.

Interpretation of the result depends on the type of material being studied and the time of eating:

  1. On an empty stomach - 5.5 mmol / l or less in the blood from a finger (whole blood).
  2. On an empty stomach - 6.1 mmol / l and less in capillary or venous plasma (the material is obtained in the laboratory by puncturing a vein or scarifying a finger).
  3. After a 2-hour interval after a meal (in any measurement) - 7.8 mmol / l or less, not higher.

Treatment of type 2 diabetes

Treatment of type 2 diabetes Modern treatment of type 2 diabetes affects different parts of the pathological process. It is used as an independent intake of a glucose-lowering drug, as well as a combination. The most optimal choice is determined individually by the endocrinologist.

лечения сахарного диабета 2 типа: Drug treatment of type 2 diabetes mellitus:

1. Biguanides (active substance Metformin, drugs: Siophore, Glucophage). They reduce insulin resistance, glucose production by the liver, increase its utilization, reduce the absorption of excess sugar in the gastrointestinal tract, and also reduce body weight, fighting obesity.

Recently, one more positive property of these drugs has been identified - they are able to slow down the aging processes that occur in diabetic patients ahead of time. This effect is manifested not only in diabetics, but also in healthy people.

2. Thiozolidinedione (glitazones - pioglitazone, rosiglitazone) - effectively reduce insulin resistance, reduce glucose production by the liver, increase its absorption by cells, improve the lipid profile (reduce the amount of triglycerides and fatty acids).

Drugs in this group are preferred with elevated levels of cholesterol in the blood.

3. Production of sulphonyl urea (glibenclamide (Maninil), glimepiride (Amaryl), gliclazide (Dibeton), glykvidon (Glyurenorm). Pancreatic insulin synthesis agents.

Rationally combined with drugs from the biguanide group, which reduce insulin resistance.

Insulin 4. Clays (nateglinide, repaglinide) or prandial regulators - preparations of ultrashort and quick action, aimed at restoring insulin secretion immediately after eating, eliminate the violation of the early phase of secretion of this hormone.

Used when there is postprandial form of hyperglycemia.

5. Incretomimetic (exenatide: Byetta). This is a new class of drugs for diabetics. They enhance the action of incretins - gastrointestinal hormones, which affect the normal secretion of insulin, suppress the sugar-enhancing effect of glucagon (the hormone is produced in the liver).

Additional positive effects are slowing down the passage of food through the intestines, which reduces glucose absorption and weight loss.

6. DPP-IV inhibitor (sitagliptin) . The effect of this drug is similar to the previous one. It is associated with incretins, which increases. This has a positive effect on hyperglycemia.

7. Alpha-glucosidase inhibitors (the only representative is acarbose), which act exclusively in the lumen of the digestive tract. They slow down the absorption of glucose without affecting the secretion of insulin.

The use of acarbose with a preventive purpose reduces the risk of disease by 37% (data from Stopp NIDDM).

8. Combined preparations in one tablet or capsule contain active substances of different groups, for example, metformin glibenclamide (Glibomet, Glucovans), which makes the treatment more convenient and acceptable for the patient.

9. Insulin. With an absolute lack of a hormone that develops over time, subcutaneous insulin injections are used (the insulin-dependent option). Treatment with this hormone begins with a combination of tablet preparations and insulin with prolonged (average) action. In the future, a full transition to hormonal therapy is possible.

Diet for type 2 diabetes

The principle of nutrition in diabetes type 2, photo

The principle of nutrition in diabetes type 2, photo

As a lifestyle disease, type 2 diabetes is effectively treated with a diet, especially at the beginning. Weight reduction helps to reduce insulin resistance and eliminate the relative insulin deficiency caused by obesity.

The essence of the diet in diabetes is to maximally slow the flow of sugar from the intestine into the bloodstream. This will avoid a sharp rise in blood glucose levels immediately after eating. Therefore, all fast-digesting carbohydrates are excluded from the diet (they always have a sweet taste).

The replenishment of the body with energy reserves must occur as a result of the metabolism of complex carbohydrates, whose long molecules cannot be immediately absorbed into the blood and require a longer digestion.

Also in the diet it is important to limit the use of any fats and oils. Therefore, animal fats are excluded and preference is given to unrefined oils in limited quantities.

Type 2 diabetes: what to eat and what not (table)?

Recommended (green) Limited to (yellow) Excluded (red)

All types of vegetables (especially leafy greens) fresh and cooked

Lean meat (chicken, beef, turkey, rabbit)

Dairy products 0-1% fat

Low fat cottage cheese

Lean fish

Whole grain bran bread (in moderation)

Whole fruits, berries (except bananas and grapes) in moderation

All types of cereals, cereals, pasta (use moderately)

Cooking: fresh, boiled, steamed and stews

Fatty fish

Dairy products of average fat content of 1-3%

Dried fruits

Fruit Juices

Oils (prefer unrefined)

Sweeteners (xylitol, sorbitol)

Everything that has a sweet taste due to sugar

Refined flour products

Fat meat (pork, lamb)

Fat

Dairy products above 3.5% fat

Cottage cheese with fat content higher than 5%

Sweet drinks with sugar

Alcohol

Honey jam

Grapes, bananas (low fiber)

Sweet juices

Described in the table "The principle of the traffic light", replaced the more difficult for the patient to perform in everyday life, the well-known diet number 9. However, in inpatient treatment of type 2 diabetes mellitus, the “table 9” diet is used quite actively. The principles of this diet are similar to the "traffic lights".

An important component of treatment is physical activity. Exercise and walking can reduce blood sugar, providing a therapeutic effect. This allows you to reduce the dose of glucose-lowering drug.

Complications

Late complications are due to glycation of protein structures. The latter damage vessels of different diameters, incl. and microvasculature. Late complications are:

  • diabetic polyneuropathy (damage to nerve endings);
  • diabetic angiopathy (atherosclerotic vascular disease);
  • diabetic retinopathy (retinal disease);
  • diabetic nephropathy (kidney damage);
  • diabetic foot syndrome.

Acute complications are different types of lumps. They are based on a sharp fluctuation of metabolites (glucose, ketone bodies). The most frequent acute complication is a sharp decrease in blood sugar (hypoglycemia and the corresponding type of coma).

Elderly patients may develop hyperosmolar coma, the cause of which becomes electrolyte disturbances during dehydration.

Diabetic ketoacidosis occurs with diabetes mellitus rarely.

Interesting
Tanya
2016-10-31 11:20:59
Glucometer is now an extremely urgent thing - at work, many people have diabetes, it turns out. I have prediabetes for now, but I have already studied all the recommendations. Eat only allowed. I also accept Glucophage 500 in the morning and in the evening. Sugar dropped to normal values.
Valeria
2016-11-26 19:45:13
The fact that I have high sugar, I learned by chance. Six months ago she turned to a plastic surgeon - she decided to do a small operation to remove two scars in the neck (the consequences of the accident in the past and the unsuccessful action of the then “Soviet doctors”). The survey found that the level of sugar above normal. The endocrinologist warned that there might be problems with healing and suggested that the operation be postponed for now. I, of course, agreed. The doctor told me to follow a non-carbohydrate diet and drink Forsig's drug for a month. A month later, when re-examining all the tests were satisfactory, the sugar dropped to normal. The operation was successful. Now everything is fine with health, but I still adhere to the diet.
Lucy
2016-12-15 12:04:00
My dad was given sd2 not so long ago, he is suffering from a low-carb diet and dietary restrictions, we bought a blood glucose meter, he uses it regularly, even the diary keeps, and most importantly, he began to drink Forsigu. The pills instantly helped the sugar to return to normal, it’s good that the doctor prescribed them.
Tatyana Ivanovna
2016-12-19 06:17:26
It is better not to make a comment at all, than such primitive ones. It is immediately clear that the drugs are progressing. In general, faith in honest medicine is killing !!!
Stas
2016-12-19 08:06:10
Tatiana, honest medicine is described in the article, and the comments ... are comments. Separate the flies from the chops.
2017-04-27 15:32:25
I suffered a massive heart attack ... And it turned out that I have type 2 diabetes .. I have not yet had an endocrinologist, I just stop after the operation, but diabeton was prescribed, half a pill in the morning ..
Galina
2017-06-06 07:09:20
I have sugar 3 "8 but at night I am tormented by thirst and going to the toilet itch in the groin at the doctor was not yet
Anastasia
2017-06-13 05:59:40
Hello, Galina. You must go to the doctor and be sure to pass a glucose tolerance test. There is such a condition as prediabetes, which can develop into diabetes. You may have this state. It is treated much easier than diabetes, so do not delay the diagnosis. Be healthy!
gulcher
2017-07-04 12:02:35
In my case of type 2 diabetes mellitus, for 6 years already, in February of this year, the oncology of the colon was determined to have been removed, and almost 40 cm were removed. They installed a stoma. Received and radiation ter. and chemistry as a pill Ftorofur-saw 10 days for 2 pieces now break 20 days and then 2 more sessions. Well, it is normal that my veins or muscles very much bother me — veins or muscles began to hurt very much if I lay on my legs then it was very painful to feel that after the convulsions they hurt. And in a state of rest it was not possible to touch them. I went to the doctors; the choroid says that it was not his illness, the endocrinologist prescribed MIDOKALM injections and prolonged leg pain and didn’t sleep at night. ed on the morning of the 14th evening m 5 months 3 months after the operation, the wounds heal well — they are still being treated, but I still cannot sit. To avoid anemia, I try to eat and bread and tongue, or chemistry will be put off. what to do? Who can give advice?

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