Frequently Asked Questions for Diabetes
Why Rises in blood sugar?
In healthy people, the level of sugar in the blood is regulated by the body. It increases with the ingestion of carbohydrates into the blood, the surplus of which after a while is deposited in the liver in the form of glycogen (a complex carbohydrate compound) and is one of the types of energy reserve of the body. In addition to the liver, glycogen is also deposited in the muscles.
In the process of eating food that contains simple carbohydrates (sucrose, glucose or fructose), carbohydrates of a compound almost instantly enter the blood, sharply raising the level of sugar - this is a natural process. If you measure the sugar level of an absolutely healthy person immediately after eating such a food, it will be greatly overestimated.
If a person needs energy, that is, he experiences a load, the body extracts this energy from carbohydrates, reducing the level of sugar. Energy is expended in all kinds of loads - be it physical work or mental stress. If energy is not needed for the body, or the amount of sugar consumed exceeds what is needed for a given moment, the body stores "extra" carbohydrates for future use when it is needed.
This process takes some time (up to several hours), after which the level of sugar in the blood again normalizes.
In the case when the amount of sugar that has entered the bloodstream is such that the body is not able even to process it into glycogen, then the protective function works and the excess is excreted by the kidneys through the urine. Excess of glucose in the blood is also harmful and is capable of causing damage to the body.
When the blood glucose level reaches 10 mmol / l, the kidneys tend to remove excess sugar with urine (like slag).
When using complex carbohydrates, for example, starch, the sugar level jumps are practically not observed. This is due to the fact that complex carbohydrates are slowly digested and enter the blood in small portions. The organism has time to either spend it or postpone it. In a person who has not had enough energy for a long time (there was no meal for 12 hours or more), the glycogen from the liver is split to glucose, so the body uses the energy reserve.
The increase in sugar in the body can be associated not only with the use of sweet, but also with sharp physical loads. In this case, the following happens: when you load, the muscles urgently need energy, glycogen stored in them, turns into glucose and is released into the blood, resulting in increased sugar levels. In the future, all the glucose obtained will be used for the intended purpose and the sugar will return to normal.
If a person has a constantly elevated sugar level, or sugar rises for other reasons (due to stress, fatigue or for an unknown reason), this may indicate the presence of insulin resistance or other ailments.
Metabolic syndrome, obesity, stress, systemic chronic inflammation are considered the causes of insulin resistance.
The patient has any type of diabetes mellitus elevated blood sugar levels.
And if there is "excess" sugar in the blood, then it means it is missing somewhere. Where?
In the cells of our body, which glucose (sugar) is extremely necessary as energy.
Glucose for cells is like a firewood for a stove or gasoline for a car. But to get into the cell glucose can only with the help of insulin. If insulin is not enough, the sugar, if it gets into the blood from the intestine or from the liver, remains in the blood. But the body's cells are starving at the same time.
It is important to understand that the feeling of hunger in diabetes mellitus does not arise from lack of nutrition, but from the fact that the cells lack glucose due to the lack of insulin in diabetes I or most often because of insulin resistance in diabetes II.
Imagine a man who was planted in a glass aquarium and allowed to swim along the river in hot weather. A person will die of thirst, despite the fact that the area is full of water, as this water can not penetrate into the aquarium. The same happens with the cells of the body: around the blood is full of sugar, and the cells are hungry.
Why is the fasting sugar level higher than after eating?
The main causes of high hyperglycemia on an empty stomach are higher than after eating can be a dawn or dawn syndrome and Somoji syndrome.
With dawn syndrome, usually a sharp increase in sugar occurs in the interval between 4 - 6 hours, although it may occur in some before 9 am. In the pre-weaken hours, the production of counterinsulant hormones (adrenaline, glucagon, cortisol and especially growth hormone-growth hormone) is activated in the body, the level of insulin in the blood decreases, which leads to an increase in glycemia. Early in the morning, cortisol increases insulin resistance, often causing an increase in blood sugar levels. This is a completely physiological phenomenon that is observed in all people, both sick and healthy. But in diabetes mellitus, the syndrome of the "morning dawn" often creates problems, especially in adolescents who grow rapidly (and grow, as is known, at night, when the production of growth hormone is maximum).
This is the same thing that happens to the exercise.
Somogy's syndrome refers to the state of a chronic overdose of insulin.
The organism, trying to cope with hypoglycemia is associated with an overdose of insulin, begins to actively develop counterinsulant hormones, the action of which is opposite to the action of insulin. In the blood, the levels of adrenaline, cortisol, somatotropin, glucagon and other hormones that are capable of increasing blood sugar levels increase.
Somoji syndrome is characterized by low blood glucose levels at 2-4 o'clock in the morning, and with the "dawn" syndrome during these hours, the blood glucose level is normal. In these situations, the correction of therapeutic measures is radically different.
What hormones are responsible for controlling blood glucose?
For the control of the glucose content in the blood, there are four main hormones:
Insulin, produced in beta cells of the pancreas, helps the body use glucose coming from food, by participating in moving it into the cells of the body. People with type 2 diabetes are slowly reducing insulin production and at the same time insulin resistance is increasing.
Amylin, released from beta cells, inhibits the release of glucose into the blood after eating, slowing the emptying of the stomach and enhancing the sense of satiety. In people with type 1 and 2 diabetes, amylin deficiency is observed.
The incretins, a group of hormones released from the intestinal tract, including glucagon-like peptide-1 (GLP-1), promote insulin secretion after eating, which in turn slows the emptying of the stomach, maintains a sense of satiety, delays the release of glucose into the blood and prevents the release glucagon from the pancreas, supplying less glucose to the blood.
Glucagon, produced in the pancreatic alpha cells, cleaves glucose accumulated in the liver and muscle tissues, and releases it to provide the body with energy at a time when glucose from food is not available.
But there are still other hormones that regulate the level of glucose in the blood
- adrenaline and norepinephrine - hormones formed in the adrenal glands;
- glucocorticoids (cortisol, corticosterone), which are synthesized in another layer of the adrenal glands;
- indirectly increase the sugar hormones of the thyroid gland;
- "Command" hormones - are formed in the hypothalamus and pituitary (brain regions), affect both glucocorticoids, and the production of adrenaline and noradrenaline;
- There are also hormone-like substances that also increase blood glucose levels.
As you can see, raises the level of sugar a lot of hormones, and reduces only one - insulin.
Stimulation of certain hormonal processes depends on the autonomic nervous system. So the parasympathetic department of the nervous system reduces the level of glucose, sympathetic - on the contrary, it increases.
What is the normal blood sugar level?
For people without diabetes, the fasting blood sugar level is 3.3 - 5.5 mmol / l. After eating, the blood sugar level in a person without diabetes increases to 6.6 mmol / l.
Sugar in a healthy person never rises above 6.6 mmol / l (120 mg / dL).
Blood from the vein has a slightly different result: 4.0-6.1 mmol / liter, because the sugar content in the capillary blood sample is, on average, 0.56 mmol / l (10 mg%) higher than in the venous sample, independently from methods of research of a glycemia.
The fasting sugar level above 6.6 mmol / liter almost always indicates the presence of diabetes mellitus. In this case, to confirm the diagnosis it is necessary to submit three more analyzes:
- re-blood to glucose level;
- blood for glucose tolerance;
- the level of glycosylated hemoglobin: this is the most accurate indicator in diagnosing "diabetes mellitus."
What is an analysis for glucose tolerance?
In addition to the actual diabetes mellitus, there is a form of latent (latent) diabetes, when clinical manifestations of diabetes are not yet available, but due to various reasons, the sugar content in the blood is inadequate and slowly decreases. This condition is called a "violation of glucose tolerance." The violation of glucose tolerance is a transitory state and can be due to various reasons: taking medications, pregnancy, overweight. The determination of impaired glucose tolerance is of great practical importance for the prevention of clinical diabetes mellitus. If the preventive measures indicated by the doctor are not fulfilled, more than 60% of people with impaired glucose tolerance become diabetic.
For analysis on glucose tolerance, blood is taken on an empty stomach (8-10 hours after the last meal). Then you need to drink 75 grams of glucose, dissolved in warm water. Children are given a load of glucose at a rate of 1.75 g per kilogram of body weight, but not more than 75.0 g.
The glucose concentration in the construction of the sugar curve is less than 7 mmol in 2 hours, not more than 8 mmol - an hour after the sweet drink. With a value higher than 11.1 mmol in any measurement, true diabetes mellitus is diagnosed. Interim results indicate a violation of glucose tolerance.
Why does sugar get into the urine?
With the increase of sugar above the norm, a condition occurs in which a person experiences constant thirst and releases a large amount of urine. Thirst arises because the body takes away a lot of fluid.
Our kidneys work as a filter, the task of which is to remove harmful substances from the body and to detain useful ones. While the level of sugar in the blood remains normal - the kidneys do not excrete it into the urine. When this level exceeds the norm, the kidneys can not keep the "extra" sugar in the blood and it begins to penetrate into the urine, but the sugar can stand out from the body only together with the liquid in which it is dissolved, which is why thirst arises: every gram of glucose, excreted in the urine, "leads" after him a certain amount of water (13-15 g.). Lack of fluid in the body should be replenished, so those patients whose blood sugar level is elevated, feel a strong thirst.
With an increase in blood glucose levels of more than 10 mmol / l, the renal tubules are no longer able to reabsorb so much sugar from the urine back into the blood. As a consequence, glucose - glucosuria appears in the urine.
Blood sugar level 9-10 - a kind of threshold value. This threshold decreases with age, as well as against a background of various kidney diseases.
The level of the renal threshold varies throughout life: low in children, during severe illness or during pregnancy, decreases in the elderly. Each patient with diabetes should know their level of the renal threshold.
Thus, glucosuria can appear with an increase in blood glucose level, as well as with a decrease in the threshold of the kidneys. Proceeding from all of the above, the following forms of glucosuria are distinguished:
You should not allow glucose, which is vital to the cells of your body, leave it with urine. It's like pouring gasoline into a leaky gas tank of a car. How much do not pour - the car will not go.
It is only necessary to lower the blood sugar level, how weight loss will stop, thirst will disappear, the amount of urine released will become normal, the well-being and efficiency will improve.
Why is it necessary to measure glycosylated hemoglobin (HbA1c)?
Glycated hemoglobin is an indicator that shows the average level of sugar in the blood during the last three months. Other names for this indicator are glycosylated hemoglobin, hemoglobin A1C, HbA1C or simply A1C.
Despite the complexity of the name, it's not so difficult to understand what is A1c hemoglobin. To carry out transport and transfer of glucose from one organ (for example, the intestine where glucose enters the body) to another (for example, the liver as the main depot of glucose or actively working organs, for example, brain cells), a transport agent is necessary. In the body, proteins perform this function. The leading transport system is blood and red blood cells, which are called erythrocytes. The composition of these cells is exactly the protein hemoglobin. With normal metabolism, the same amount of glucose is attached to hemoglobin and then the same amount of glucose is added. In diabetes mellitus because of the increase in glucose in the blood, part of the glucose remains attached to hemoglobin and does not split off, and remains in the condition associated with hemoglobin A1c. This condition persists until the erythrocyte circulates in the blood, the average period of its presence in the blood and the period of life is 3 months. The use of modern high-tech research methods allows us to calculate how much hemoglobin associated with glucose can be found in the erythrocyte.
The values of glycated hemoglobin in a healthy person are 4.2-5.0% (corresponding to a sugar level of 4.1-5.4 mmol / l).
In case of improperly selected treatment for diabetes, this level can be 7% or higher.
Why modern medicinal hypoglycemic agents can be more dangerous than diabetes itself?
For the first time, the link between the use of insulin, insulin resistance and the increased mortality of patients with diabetes mellitus was discovered in an article published on 02.07.2008 in one of the most respected and conservative medical journals in the USA-New England Journal of Medicine on pages which in any case are not allowed articles causing doubt!
The main objective of the ACCORD study was to test the hypothesis that a decrease in the level of HbA1c (glycosylated hemoglobin) in patients with CD2 to a normal level of 5.5 mmol / L and lower (HbA1c below 6.0%) would be to reduce the risk of developing cardiovascular complications in comparison with the standard, to date, the goal to reach the level of HbA1c 7.0-7.9% (blood sugar level of 8-9.5 mmol / l). However, despite the successful reduction in the level of sugar in the group of intensive glycemic control (in the "Russian" language - the group treated with higher doses and a wider range of hypoglycemic agents), mortality in it was much higher than in the other two groups treated standardly, those. lower doses and a narrower spectrum of hypoglycemic agents.
So, thanks to the ACCORD study, it became absolutely clear that modern medicinal hypoglycemic agents are more dangerous than the CD2 itself!
It is important to note that in most patients with CD 2 the pancreas produces normal (from 6 to 20 units of insulin per day) or excess (more than 20 units per day) amount of insulin.
Obviously, the main cause of the increased mortality of patients with CD-2 using insulin and stimulants of insulin secretion is an excess of insulin.
In the ACCORD trial, the following antidiabetic agents were used: metformin (syphor, glucophage, metaphamma), insulin, insulin secretion stimulants (MANINIL, GLUENOROM, DIABETONMR, AMARIL, GLIBETIC, GLIMEPIRID, GLYRID, DIAPIRID, MEGHLIMIDE, OLTAR, GLIBOMET, GLUCOVANS, NOVONORM) Thiazolidinediones (ROGLIT, DIAGLITAZONE, PIOC). From this list of suspects, you should immediately exclude metformin, a drug that has been used for more than 20 years and does not stimulate insulin secretion and lowers blood glucose levels by suppressing its synthesis by the liver.
But for all the other groups of drugs that is called "stigma in the gun."
The new class of hypoglycemic drugs presented to date by Baetoi (Exenatide) in injections and tableted Januvia (Sitagliptin) also does not shine with novelty - the main mechanism of action is the same increase in the level of insulin secretion.
Can I drink alcohol with diabetes? And also, how to behave on a visit and the reception of what kind of alcohol is allowed to people with diabetes?
The fact that the use of alcoholic beverages is very dangerous in diabetes mellitus, has been said repeatedly. However, a diabetic patient should not completely deprive himself of all the joys of life. It is only about the moderate and rational use of certain products, including alcohol. In order not to look like an outsider on a "celebration of life" during a family celebration or a friendly party, you should familiarize yourself in advance with those drinks that in a certain quantity and proportion will not do you any harm, but they will allow you to fully enjoy a pleasant evening, a holiday and stay in the company almost on par with the rest. But do not forget that if the text is written moderately, this does not mean 100 grams per kilogram of weight. Such doses are dangerous! Ask why?
Drinking alcohol is a very common cause of hypoglycemia, especially if it is used on an empty stomach, with a small amount of food or improperly selected food.
The fact is that alcohol, on the one hand, enhances the action of insulin and glucose-lowering tablets, and on the other hand it inhibits the formation of glucose in the liver.
Still, alcohol, acting as a fat thinner, increases the permeability of cell membranes, which are partly composed of these fats. Glucose through these dilated pores in the membranes "runs away" from the blood into the cells. Its concentration in the blood drops sharply and there is a feeling of hunger. This hunger is imperative, it is very difficult to manage it. And usually the case ends with abundant excessive food.
In order for diabetes and alcohol to get along well with each other, it is necessary to adhere to the basic rules.
- Do not go on a visit to the hungry, it is better to have a quick bite beforehand, so it will be easier to avoid overeating.
- But we must remember the ability of alcohol, taken in excessive amounts, lead to the development of hypoglycemia.
- After drinking alcohol, you must reduce the dose of insulin or hypoglycemic drugs.
- You can drink with diabetes, not before eating, that is, "on an empty stomach", because the intake of alcohol must necessarily be accompanied by a meal.
- It is not necessary to drink cocktails based on sweet wines, especially with fruit juices or with carbonated drinks. It must be said that very many scientists believe that alcoholism is a definite consequence of chronic hypoglycemia.
This is explained simply - as soon as the sugar level directly in the blood of the alcoholic decreases sharply, he usually begins to feel very bad and also always has a strong desire to drink. And the alcohol itself quickly turns into glucose, and, of course, the blood sugar level increases dramatically, and believe me, the drunkard feels a great deal of relief. But, unfortunately, this blissfully improbable condition disappears, because our insulin always in such cases tries even more actively, than even before, to sharply reduce the level of sugar in its blood. And after a few minutes, literally after the first glass, the alcoholic still feels an even greater need for the same alcohol, so that at least for a short while you can rid your body of hypoglycemia.
Constantly frighten complications of Sugar Diabetes? What it is?
With diabetes, the vascular system suffers first. An increase in the blood glucose level acts toxicly on the walls of the smallest vessels (capillaries) that are present in each organ. Also, larger vessels and nerve cells are affected. Therefore, with diabetes inadequate treatment develop:
- retinal damage (diabetic retinopathy) - the main cause of blindness in patients with diabetes
- damage to the capillaries of the kidneys (diabetic nephropathy) - as a result, kidney failure may develop
- damage to the nerve endings and trunks (diabetic polyneuropathy) - the sensitivity of the most remote parts of the body first (fingers of the feet), then the process goes "closer to the center". Due to loss of sensitivity, the number of microtraumas increases, the burn or frostbite remains unnoticed. Because of the defeat of the nervous tissue, there can also be a "painless" myocardial infarction.
- diabetic angiopathy - vascular damage, which leads to a disruption of nutrition of organs and tissues. First of all, the lower limbs are affected - there is even the term "diabetic foot". If this process is not controlled, gangrene of the limb may develop and it will have to be amputated.
Why is excessive daytime sleepiness associated with the development of diabetes?
In diabetes mellitus, there is an imbalance between the intake of glucose and its utilization by the body. Drowsiness can be a sign of both an excess of glucose in the body, and a lack of it. And the progression of drowsiness may indicate a formidable complication of diabetes - to whom.
The cause of daytime sleepiness may be latent depression, diabetes or obesity. Daytime sleepiness physicians are usually considered a sign of lack of sleep or some kind of disturbance to normal sleep. However, Pennsylvanian researchers who published their work in the journal Clinical Endocrinology and Metabolism concluded that much more often the cause of such drowsiness may be underlying depression, diabetes or obesity. They made such conclusions on the basis of statistical processing of medical data concerning 16,5 thousand men and women at the age from 20 to 100 years. These statistics, the researchers conclude, convincingly show that people suffering from insuperable daytime sleepiness should first of all be examined for the presence of depression and diabetes, regardless of whether they have specific symptoms of sleep disturbance.
Drowsiness after eating is a sign of diabetes
A person who, after eating, tends to sleep, suffers from increased insulin resistance. Therefore, glucose, hitting the body, can not penetrate the cells, does not enter the brain. As a result, the brain does not receive the main nutrient material - glucose - and "falls asleep."
What is "ketosis", "ketoacidosis", "ketone bodies"?
When glucose can not be assimilated by cells, cells begin to produce energy from other substances. As a result of such reactions under conditions of lack of energy and glucose, acetone and a number of acetone derivatives are formed. They all combined the concept of "ketone bodies" ("ketone" - the same as acetone). Ketone bodies lead to acidification of blood and other body fluids (pH is reduced), and the body functions normally only with a certain acidity of the environment. Acidosis (acidosis - from acidum - acid) is manifested by various disorders from almost every system of the body: the brain reacts with inhibition and reflex reflexes; the release of acetone through the stomach and intestinal mucosa causes their irritation - diarrhea and abdominal pain; damage to the tissue of the kidneys, which intensively remove acetone from the body. Acetone appears in the urine - it can be determined by the smell, and by special strips, and in the exhaled air (excreted by the lungs) - the smell of "wet apples", and in feces. The more acidified the blood and other body fluids, the more violated vital functions, and ultimately can damage vital brain centers and develop a stop in breathing and circulation. A condition when there are many ketone bodies in the body is called "ketosis", and "ketoacidosis" is an acidification caused by ketosis. The appearance of any signs of ketoacidosis is a direct indication for calling an ambulance and immediate hospitalization. Remember that this is a life-threatening condition!