Type 2 diabetes mellitus (DM) is a common chronic non-communicable disease. It affects both men and women, most often over the age of 40. The risk of type 2 diabetes is underestimated by many people, and some patients, in fact, are simply not informed that they are susceptible to the disease. And those patients who are aware of their pathology often do not know what it is - diabetes mellitus, what threatens and are not aware of its risk. As a result, type 2 diabetes can become severe and lead to life-threatening conditions. Meanwhile, adequate treatment and proper nutrition in type 2 diabetes can stop the development of the disease.
Causes
When a person develops diabetes, the causes of this fact can be different. The second type of disease often leads to:
- wrong diet;
- lack of physical activity;
- excess weight;
- inheritance;
- stress;
- self-medication with drugs, for example, glucocorticosteroids.
In fact, there is often not a precondition, but a whole complex of reasons.
If we consider the occurrence of the disease from the point of view of pathogenesis, then type 2 diabetes mellitus is caused by a relative lack of insulin in the blood. This is the name of the condition when the insulin protein produced by the pancreas becomes inaccessible to insulin receptors located on cell membranes. As a result, cells are deprived of the ability to absorb sugar (glucose), which leads to a lack of glucose supply to cells, and also, no less dangerous, to the accumulation of glucose in the blood and its storage in tissues. different. According to this criterion, non-insulin dependent diabetes mellitus differs from type 1 diabetes, in which the pancreas produces insufficient insulin.
Symptoms
The symptoms of the disease depend mainly on the stage of the disease. In the early stages, the patient may not feel a serious illness, except for increased fatigue, dry mouth, increased thirst and appetite. This condition is usually attributed to the wrong diet, chronic fatigue syndrome, stress. However, in fact, the cause is a latent pathology. As the disease progresses, symptoms may include:
- poor wound healing
- weakening of the immune system
- pain and swelling in the limbs,
- headache,
- dermatitis.
However, often patients do not correctly interpret even one set of such symptoms and diabetes develops unimpeded until it reaches difficult stages or leads to life-threatening conditions.
Type 2 diabetes mellitus, treatment
In fact, there are no effective enough methods to increase glucose uptake by cells, so the main emphasis in treatment is on lowering blood sugar levels. Furthermore, efforts should be aimed at reducing the patient's excess weight, restoring it to normal, as adipose tissue abundance plays an important role in the pathogenesis of diabetes.
The main factor affecting the possibility of complications in type 2 diabetes is a violation of lipid metabolism. An excessive amount of cholesterol that varies from the norm can lead to the development of angiopathy.
| Risk of developing angiopathy in diabetes | February | Medium | Tall |
|---|---|---|---|
| Total cholesterol, mmol / l | <4. 8 | 4, 8-6, 0 | >6. 0 |
| LDL, mmol / l | <3. 0 | 3, 0-4, 0 | >4. 0 |
| Triglyceride, mmol / l | <1. 7 | 1. 7-2. 2 | >2. 2 |
Treatment Methods
Type 2 diabetes mellitus is a disease that requires long-term and continuous therapy. In fact, all the methods used are divided into three groups:
- taking drugs,
- diet,
- lifestyle change.
Effective treatment of type 2 diabetes involves fighting not only diabetes itself, but also concomitant diseases, such as p. sh.
- obesity,
- hypertension,
- angiopathy,
- neuropathy,
- depression.
Type 2 diabetes is treated on an outpatient basis and at home. Only patients with hyperglycemic and hyperosmolar coma, ketoacidosis, severe neuropathic forms and angiopathy and stroke are subject to hospitalization.
Anti-diabetic drugs
In fact, all medications are divided into two main groups - those that affect insulin production and those that do not.
The main drug of the second group is from the class of biguanides. This medication is most commonly prescribed for type 2 diabetes. Without affecting the pancreatic cells, it maintains blood glucose at normal levels. The drug does not threaten a critically low lower glucose levels. Also, the drug burns fat and reduces appetite, which leads to reducing the patient's excess weight. However, an overdose of the drug can be dangerous, as a serious pathological condition with a high mortality rate can occur - lactic acidosis.
Typical representatives of another group of drugs that affect insulin production are sulfonylurea derivatives. They directly stimulate the beta cells of the pancreas, causing them to produce more insulin. However, an overdose of these drugs threatens the patient with a hypoglycemic crisis. Sulfonylurea derivatives are usually taken together with biguanides.
There are other types of drugs. Incretin mimetics (GLP-1 agonists) and DPP-4 inhibitors belong to the class of drugs that increase insulin production depending on glucose concentration. These are new drugs and so far are quite expensive. They inhibit the synthesis of glucagon, the hormone of growth hormone, improve the action of incretins - gastrointestinal hormones that increase insulin production.
There is also a drug that prevents the absorption of glucose in the gastrointestinal tract - an alpha-glucosidase inhibitor. This tool does not affect insulin production. The drug is often prescribed for prophylactic purposes, to prevent diabetes.
There are also drugs that increase the secretion of glucose in the urine and drugs that increase the sensitivity of cells to glucose.
Medical insulin is rarely used in the treatment of type 2 diabetes. Most often, it is used with the ineffectiveness of therapy with other drugs, with a decompensated form of diabetes mellitus, when the pancreas is depleted and can not produce enough insulin.
Type 2 diabetes is also often associated with comorbidities:
- angiopathy,
- DEPRESSION
- neuropathies,
- hypertension
- disorders of lipid metabolism.
If such diseases are detected, then medications are prescribed for their treatment.
| Business | Mechanism of action |
|---|---|
| Sulfonylureate | stimulation of insulin secretion |
| Glinidet | stimulation of insulin secretion |
| biguanide | decreased glucose production by the liver and tissue resistance to glucose |
| glitazones | decreased glucose production by the liver and tissue resistance to glucose |
| Alpha-glucosidase inhibitors | slow absorption of glucose in the intestine |
| Glucanogon-like peptide receptor agonists | stimulating glucose-dependent insulin secretion and reducing glucagon secretion |
| Gliptinet (dipeptidyl peptidase-4 inhibitors) | stimulating glucose-dependent insulin secretion and reducing glucagon secretion |
| insulin | increased glucose utilization |
diets
The essence of dietary change in DM is the regulation of nutrients entering the gastrointestinal tract. Necessary nutrition should be determined by the endocrinologist individually for each patient, taking into account the severity of diabetes, concomitant diseases, age, lifestyle, etc.
There are several types of diets used for non-insulin dependent diabetes (Table 9, low carb diets, etc. ). All of them have proven themselves well and differ from each other only in a few details. But they agree on the basic principle - the rates of carbohydrate intake in case of illness should be strictly limited. First of all, this applies to products that contain "fast" carbohydrates, ie carbohydrates that are absorbed very quickly by the gastrointestinal tract. Fast carbs are found in refined sugar, jams, sweets, chocolate, ice cream, sweets, baked goods. In addition to reducing the amount of carbohydrates, it is necessary to try to reduce body weight, as the added weight is a factor that worsens the course of the disease.
Other instructions
It is recommended that you increase your water intake to replace fluid loss due to the frequent urination that often accompanies diabetes. Along with this, it is necessary to completely abandon sugary drinks - cola, lemonade, kvass, juices and sugary tea. In fact, you can only drink sugar-free beverages - plain mineral water, tea and coffee without sugar. It should be remembered that drinking alcohol can also be harmful - for the fact that alcohol disrupts glucose metabolism.
Food should be regular - at least 3 times a day, and best of all - 5-6 times a day. You should not sit at the dinner table immediately after exercise.
How to monitor blood glucose levels
The essence of diabetes therapy is self-control by the patient. In type 2 diabetes, the sugar level should be within the normal range, or close to it. Therefore, the patient should control the sugar level himself in order to avoid critical increases. To do this, it is advisable to keep a diary in which the values of blood glucose concentration will be recorded. You can take glucose measurements with special portable glucometers equipped with test strips. It is advisable that the measurement procedure be performed daily. The best time to measure is early in the morning. Before the procedure, it is forbidden to take any food. If possible, the procedure can be repeated several times a day and the sugar level can be determined not only in the morning on an empty stomach, but also after eating, before going to bed, etc. Knowing the graph of changes in blood glucose, the patient will be able to quickly adjust his diet and lifestyle, so that the glucose indicator is in normal condition.
However, the presence of a glucometer does not relieve the patient of the need to regularly check their blood sugar level in the outpatient clinic, as the values obtained in the laboratory are more accurate.
It is not so difficult to control sugar levels when consuming food, as most food items are labeled with their energy value and the amount of carbohydrates they contain. There are diabetic analogues of conventional foods, in which carbohydrates are replaced by low-calorie sweeteners (sorbitol, xylitol, aspartame).
| phase | Glucose level, mmol / l |
|---|---|
| Rate condition | 3. 3-5. 5 |
| Impairment of glucose tolerance | 5, 6-6, 0 |
| Diabetes, early stage | 6. 1-8. 0 |
| Diabetes, middle stage | 8. 1-14. 0 |
| Diabetes, severe stage | >14. 1 |
Fruits and vegetables
Is it possible to eat fruits and berries with type 2 diabetes? Preference should be given to vegetables that contain a large amount of indigestible but beneficial for digestion, fiber and less sugar. However, many vegetables, such as potatoes, beets and carrots, are high in starch and should be limited. Fruits can be consumed in moderation and only those that do not contain very high amounts of carbohydrates. Among fruits, bananas hold the record for carbohydrate content, followed by grapes and melons. Their use is not recommended, as they can increase blood sugar levels.
Folk remedies
Folk remedies include taking decoctions of medicinal herbs. Such therapy can not only lower blood glucose levels, but also reduce appetite, reduce excess weight. However, folk remedies can be taken only in addition to taking medication and in consultation with your doctor.
Physical exercises
An auxiliary method of therapy is physical exercise. During moderate-intensity exercise, the body burns large amounts of glucose. Metabolism returns to normal, the cardiovascular system is strengthened. Exercise is essential every day. However, the exercises should not be exhausting, as this can only achieve the opposite effect. With severe fatigue, appetite increases and a hearty meal can negate all the positive effects of physical activity. Fatigue provokes stress and the release of adrenal hormones, which raises blood glucose levels. Therefore, it is recommended to choose the type of physical activity that will suit the patient's athletic form - simple exercises, dumbbell exercises or walking, running, swimming, cycling.
| Type of activity | Cost, kcal / h | Foods that contain a similar amount of energy |
|---|---|---|
| Rest lying down | 80 | apples, 20 g nuts |
| Rest sitting | one hundred | apples, 20 g nuts |
| Rest on foot | 140 | a glass of milk |
| Housework | 180 | a glass of milk |
| Slow walking, easy work in the field | 220 | 120 g of ice cream |
| Bicycle | 250 | 100 g of white bread |
| Brisk walking, slow swimming, slow dancing, rowing | 300 | 150 g of black bread |
| Volleyball, badminton, table tennis | 350 | 90 g biscuits or cheese |
prediction
In severe cases, when type 2 diabetes mellitus reaches the decompensation stage, then, as a rule, it is already impossible to return the disease and return glucose levels to normal - due to depletion of pancreatic and body resources as well. a whole. Therefore, type 2 diabetes in such a situation is an incurable disease. However, the correct treatment of type 2 diabetes can extend the life of the patient for many years. In the initial stage of type 2 diabetes mellitus, it is possible to control the concentration of glucose in the blood and keep it within acceptable limits only by changing the diet and lifestyle and increasing physical activity. As a result, the patient can live for many decades and not face any complications of diabetes.