Diabetes mellitus treatment

Diabetes mellitus is a group of metabolic diseases characterized by an increased content of glucose (“sugar”) in the blood.

Why do we need glucose

The norm of blood glucose (sugar) in capillary whole blood is 3.3-5.5 mmol / L in the morning on an empty stomach (i.e. after 7-14 hours of night fast) and up to 7.8 mmol / L after meals (i.e. 1.5-2 hours after the last meal).

Normally, in the human body, glucose is used by the cell as an energy source (in other words, the body’s cells “feed” on glucose from the blood). The more the cell works, the correspondingly more energy (glucose) it needs.

Glucose (the expression “blood sugar” is often used, but this is not entirely true) constantly circulates in the human blood. There are 2 ways for glucose to enter the human body: – the first is intake from food containing carbohydrates, – the second is the production of glucose by the liver (this is the reason that in diabetes mellitus, even if the patient did not eat anything, the level of glucose in the blood can be increased).

However, in order to be used as energy, glucose from the blood must travel to muscles (to do work), adipose tissue, or the liver (the body’s store of glucose). This is due to the action of the hormone insulin, which is produced by the beta cells of the pancreas. As soon as the level of glucose in the blood rises after a meal, the pancreas instantly releases insulin into the blood, which, in turn, binds to insulin receptors on the cells of muscle, adipose or liver tissue. Insulin, as a key, “opens” cells for glucose to enter them, as a result of which the level of glucose (sugar) in the blood returns to normal. Between meals and at night, if necessary, glucose enters the bloodstream from the liver depot, so at night insulin controls the liver so that it does not release too much glucose into the bloodstream.

If a violation occurs at any stage of this process, diabetes mellitus occurs.

Types of diabetes

Type 1 diabetes mellitus (previously used the name: insulin-dependent diabetes mellitus) develops mainly at a young age (more often up to 30 years old, although type 1 diabetes can be contracted at a later age). 

Type 1 diabetes is caused by the cessation of insulin production by the pancreas due to the death of β-cells (responsible for the production of insulin in the pancreas). The development of type 1 diabetes mellitus occurs against the background of a special genetic predisposition (i.e., a person was born with it), which, when exposed to some external factors (for example, viruses), leads to a change in the state of the body’s immune system. The body of a patient with type 1 diabetes mellitus begins to perceive its β-cells of the pancreas as foreign and defends itself against them by producing antibodies (in the same way as it happens when protecting against infection), leading to the death of β-cells of the pancreas, which means severe insufficiency insulin.

Type 1 diabetes mellitus develops when at least 90% of pancreatic β cells die. Let us recall the mechanism of action of insulin, its function as a “key” that opens cells for sugar. In type 1 diabetes mellitus, this key disappeared from the blood (see figure). 

Lack of insulin in type 1 diabetes The onset of type 1 diabetes is acute, always accompanied by severe symptoms of hyperglycemia (high blood sugar): – weight loss (the patient involuntarily loses weight), – a constant feeling of hunger, – thirst, dry mouth (the patient drinks a lot fluids, including at night), – frequent urination (in regular or large portions, including at night), – weakness.

If you do not see a doctor in time and do not start treatment for type 1 diabetes mellitus with insulin, the condition worsens, and diabetic coma very often develops.

Type 2 diabetes mellitus (formerly known as insulin-dependent diabetes mellitus) occurs significantly more frequently than type 1 diabetes mellitus. The incidence of type 2 diabetes mellitus is typical for a more mature age: it is detected, as a rule, after 40 years, although recently, as the WHO experts testify, the average age of patients with type 2 diabetes is “younger”. 

About 80% of people with type 2 diabetes are overweight. Also, type 2 diabetes mellitus is characterized by heredity – a high prevalence among close relatives.

In type 2 diabetes, the pancreas continues to produce insulin, often in larger quantities than usual. Although there are also cases of type 2 diabetes mellitus with reduced insulin secretion.

The main defect in type 2 diabetes mellitus is that the cells “feel” insulin poorly, that is, they do not open well in response to interaction with it, so sugar from the blood cannot fully penetrate inside (see figure). remains elevated. This state of decreased insulin sensitivity is called insulin resistance.

Low insulin sensitivity in type 2 diabetes. Figuratively, one can imagine that the “keyholes” (in scientific terms – insulin receptors) on the doors of cells are deformed, and there is no perfect match with the keys – insulin molecules. It takes more effort (more keys, i.e. more insulin) to deal with the defect in insulin receptors. The pancreas cannot supply enough insulin to overcome insulin resistance and completely normalize blood sugar levels. in type 2 diabetes mellitus, the capacity of β-cells is still limited.

As a result, in type 2 diabetes mellitus, a paradoxical situation arises when there is a lot of both insulin and sugar in the blood at the same time.

Diabetes mellitus type 2 begins, in contrast to type 1 diabetes mellitus, gradually, often completely unnoticed by the patient. Therefore, a person can be sick for a long time, but not know about it. Elevated blood sugar (glucose) levels can be detected by chance, during examination for any other reason.

At the same time, there are cases with vivid manifestations of hyperglycemia:

  •  – weakness, fatigue, – thirst, dry mouth (the patient drinks a lot of fluids, including at night), 
  • – frequent urination (regular or large portions, including at night),
  •  – itching of the skin (especially in the perineum), 
  • – slow wound healing, – frequent infections, – blurred vision.
  • Diabetic coma develops much less frequently, usually 
  • – if some other very serious disease joins type 2 diabetes mellitus: pneumonia, serious injury, suppurative processes, heart attack, etc.

Diabetes mellitus treatment

Treatment for diabetes mellitus differs depending on the type of diabetes mellitus.

In type 1 diabetes mellitus, which occurs as a result of an absolute insufficiency of insulin secretion by the own pancreas, constant self-monitoring and insulin treatment are required to save life. It should be emphasized that externally administered insulin treatment is the only treatment in this situation. The selection of doses and treatment regimens for diabetes mellitus with insulin is carried out individually, taking into account age, gender, physical activity, individual insulin sensitivity.

In type 1 diabetes mellitus, sometimes, at the very beginning of the disease, after normalization of blood glucose against the background of insulin treatment for diabetes mellitus, the need for it suddenly begins to decrease until it is completely canceled. But this is not a recovery. This phenomenon is called the “honeymoon” of diabetes, or scientifically, remission. It is explained by the fact that after normalization of blood sugar with the help of insulin, not yet dead? -Cells can work for some time. In the future, they all die, and a person needs for life the treatment of diabetes mellitus with the introduction of insulin. Anyone with type 1 diabetes for the first time should be warned by a doctor about the possible occurrence of such a situation and what to do in this case. 

Insulin treatment for diabetes mellitus can be carried out using insulin syringes, syringe pens, or an insulin pump.

Insulin pump therapy is an alternative treatment for diabetes mellitus in people who use a syringe or pen to deliver insulin intensively and regularly measure their blood sugar. Insulin pump therapy is used instead of injecting diabetes mellitus. The pump is worn on the body or on clothing, such as a belt. Currently, about 250 thousand people around the world use insulin pumps.

The main goal of type 2 diabetes treatment is to improve the sensitivity of cells to insulin. The causes of poor insulin sensitivity are not fully understood yet. However, it has long been known that the most powerful factor in the formation of insulin resistance is overweight, i.e. excessive accumulation of body fat. Numerous scientific studies and long-term observations of patients show that weight loss during the treatment of type 2 diabetes in most patients can achieve a significant improvement in blood sugar levels.

In type 2 diabetes, normalization of weight can lead to complete normalization of blood sugar for a long time, although this cannot be called complete recovery.

If diet and exercise aimed at weight loss do not give a sufficient effect in the treatment of type 2 diabetes mellitus, you have to resort to medication. They are available in tablets. Some of them act on the pancreas, increasing the production of insulin, others improve its action (reduce insulin resistance). Thus, the drugs used to treat type 2 diabetes by themselves do not lower blood sugar; insulin does this, therefore, to obtain the effect of pills in the treatment of diabetes mellitus, a preserved reserve of pancreatic β cells is required. Hence, it becomes clear why it makes no sense to use tablet preparations in the treatment of type 1 diabetes mellitus, because most of the? -Cells have already died.

Insulin is often used to treat type 2 diabetes. Insulin treatment for type 2 diabetes mellitus can be prescribed as a temporary measure, for example, during surgery, severe acute illness, or as a permanent treatment. That is why it is currently not recommended to call type 2 diabetes mellitus non-insulin dependent. The type of diabetes treatment does not yet determine the type of diabetes.

Diet is essential in treating diabetes.

Diabetes diet

Despite common goals in the treatment of different types of diabetes mellitus (eliminating the symptoms of high blood sugar, minimizing the risk of hypoglycemia, preventing complications), diet regimens for type 1 and type 2 diabetes mellitus differ significantly. There is no single diet scheme for diabetes mellitus.

In type 1 diabetes mellitus, the occurrence of which is associated with the death of beta cells of the pancreas and insulin deficiency, the main method of treatment is insulin replacement therapy, and dietary restrictions, according to modern views, are auxiliary and should be given only to the extent that insulin therapy differs from the production of insulin in a healthy person.

The underlying principles of dietary prescription in type 1 diabetes have been undergoing critical revision in recent years.

One of the principles of the traditional diet for diabetes is the recommendation to consume a strictly defined, equal amount of calories every day. Each patient was assigned a daily caloric requirement based on the “ideal weight”. This does not make sense and is impossible for the following reasons:

a) in healthy individuals with normal weight, the balance between energy consumption and energy expenditure varies greatly on different days. Energy expenditure in healthy individuals is variable, since their physical activity is variable. Therefore, if a patient with type 1 diabetes mellitus was prescribed any given diet with a daily consumption of a fixed, equal amount of calories, then in order to maintain a normal weight, he would have to recommend him an equally given, strict plan of physical activity for every day, which is absolutely unrealistic.

b) in patients with type 1 diabetes mellitus with normal weight and a properly selected scheme for treating diabetes mellitus with insulin, the regulation of appetite does not differ from that in healthy individuals. The fact that they sometimes have to eat to prevent hypoglycemia, even in the absence of appetite, is most often the result of inadequate insulin therapy.

Improvements in insulin treatment regimens for diabetes mellitus and self-monitoring of blood sugar metabolism enable the patient to regulate food intake only depending on hunger and satiety, like healthy people. Thus, the diet of a patient with type 1 diabetes mellitus corresponds to a complete healthy diet (balanced in calories and the content of basic nutrients). The only difference is that the injected insulin “does not know” when and how much you are eating. Therefore, it is up to you to ensure that the effect of insulin is appropriate for your diet. Therefore, you need to know which food raises blood sugar.

The main treatment for type 2 diabetes mellitus is to normalize body weight through a low-calorie diet and increase physical activity. Diet in type 2 diabetes is very important, it is one of the essential ingredients to achieve success.

All foods are made up of three components: proteins, fats and carbohydrates. They all have calories, but not all raise blood sugar.

Only carbohydrates have a pronounced blood sugar-increasing effect. What food contains carbohydrates? This is easy to remember: most of the plant foods, and of the animals, only liquid dairy products. It is important for you to know if your blood sugar rises after certain foods, and if so, by how much. There are such types of carbohydrate foods, after which blood sugar either does not rise at all, or rises only slightly.

All carbohydrates can be roughly divided into two groups: fast-absorbing (“fast”) carbohydrates and slow-absorbing (“slow”) carbohydrates. Fast carbohydrate foods contain refined sugars and include jams and jams, candy, sweets, fruits, and fruit juices. “Fast” carbohydrates cause a sharp increase in blood sugar (depending on the amount of food eaten), because they are quickly absorbed into the bloodstream, so it is better to exclude them from the diet for diabetes. “Slow” carbohydrates are much more useful for diabetics, because they take much longer to be absorbed. In addition, the fiber contained in food slows down the absorption of sugars, so the diet for the treatment of diabetes should be enriched with foods rich in fiber.

Here are some simple rules to follow when treating diabetes mellitus: food should be taken in small portions and often (4-6 times a day); adhere to the established diet – try not to skip meals; do not overeat – eat as much as recommended by the doctor; use wholemeal or bran bread; eat vegetables (except potatoes and legumes) daily; avoid eating “fast” carbohydrates.

Exercise for Diabetes Exercise is very important in treating diabetes mellitus: it increases the sensitivity of body tissues to insulin and thus helps to lower blood sugar levels.

Physical activity can include housework, walking, and jogging. Preference should be given to regular and measured physical exercise: sudden and intense exertion can cause problems with maintaining normal sugar levels.

If you are an athlete or an athlete, you have no contraindications to going in for sports, provided that your blood sugar level is well controlled and all necessary measures are taken to prevent a significant decrease in it.

Prevention of complications of diabetes mellitus Patients with diabetes mellitus have an increased risk of developing complications from the heart and blood vessels (especially in the legs and kidneys). Regular physical activity, sometimes just walking, is enough to prevent circulatory disorders in the feet.

In diabetes, an untreated sore or abrasion on the foot can develop into a serious problem. Even small cuts or scrapes on the feet take longer to heal than in non-diabetic patients and require increased attention. The keys to preventing these problems are well-fitting shoes and frequent foot examinations. Use a mirror if you find it difficult to inspect all areas of your feet and remember that at the beginning injuries to the feet are often painless, and they can be ignored for a long time if you are not careful enough.

Patients with diabetes have an increased risk of renal impairment and heart disease several years after diagnosis. There is good evidence that good blood sugar control reduces this risk. Also, to prevent complications of diabetes mellitus, it is necessary to undergo preventive treatment 2 times a year.

Blood pressure control is also important. Measure your blood pressure regularly. If it is elevated, your doctor will prescribe treatment for you.

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