Type 2 diabetes mellitus (DM) is a common, non-communicable chronic disease. It affects both men and women, most commonly over the age of 40. The danger of type 2 diabetes is underestimated by many, some patients are simply not informed that they are susceptible to the disease. And those of the patients who are aware of their pathology, often do not know what it is - diabetes mellitus, what threatens it, and are not aware of its danger. As a result, type 2 diabetes can become serious and lead to life-threatening conditions. Meanwhile, proper treatment and proper diet for type 2 diabetes can stop the disease from developing.
causes
When a person develops diabetes, the causes of this fact can be varied. The second type of disease often leads to:
- wrong diet;
- lack of physical activity;
- overweight;
- heredity;
- emphasize;
- Self-medication with drugs, for example glucocorticosteroids.
In fact, there is often not one premise, but a whole complex of reasons.
Looking at the course of the disease from a pathogenetic point of view, type 2 diabetes mellitus is caused by a relative lack of insulin in the blood. This is the name of the condition in which the insulin protein produced by the pancreas becomes inaccessible to insulin receptors on cell membranes. As a result, cells are deprived of the ability to absorb sugar (glucose), which leads to a lack of supply of glucose to cells and, no less dangerous, to the accumulation of glucose in the blood and its deposition in various tissues. This criterion distinguishes non-insulin-dependent diabetes mellitus from type 1 diabetes, in which the pancreas produces too little insulin.
symptoms
The symptoms of the disease largely depend on the stage of the disease. In the early stages, the patient may not feel any serious discomfort, except for increased fatigue, dry mouth, increased thirst and appetite. This condition is usually attributed to improper diet, chronic fatigue syndrome, and stress. However, in fact, the cause is a latent pathology. As the disease progresses, the following symptoms may appear:
- poor wound healing
- weakening of the immune system
- pain and swelling in the limbs,
- Headache,
- Dermatitis.
Often, however, patients do not correctly interpret even a number of such symptoms, and diabetes progresses unchecked until it reaches difficult-to-treat stages or progresses to life-threatening conditions.
Type 2 diabetes mellitus, treatment
In fact, there are no sufficiently effective methods that increase the uptake of glucose by cells, so the focus of treatment is on lowering blood sugar levels. In addition, efforts should be made to reduce and return the patient's excess weight to normal, since the excess of adipose tissue plays an important role in the pathogenesis of diabetes.
The main factor affecting the likelihood of complications of type 2 diabetes is a violation of lipid metabolism. An excess amount of cholesterol, deviating from the norm, can lead to the development of angiopathy.
| The risk of developing angiopathy in diabetes | Short | center | Big |
|---|---|---|---|
| Total cholesterol, mmol/L | <4. 8th | 4. 8-6. 0 | >6, 0 |
| LDL, mmol/L | <3. 0 | 3. 0-4. 0 | >4. 0 |
| Triglycerides, mmol/L | <1. 7 | 1. 7-2. 2 | >2nd 2nd |
treatment methods
Type 2 diabetes mellitus is a disease that requires long-term and persistent therapy. In fact, all the methods used are divided into three groups:
- taking drugs,
- Diet,
- change lifestyle.
Effective treatment of type 2 diabetes involves not only fighting the diabetes itself, but also comorbidities such as:
- Obesity,
- Hypertension,
- angiopathy,
- neuropathy,
- Depression.
Type 2 diabetes is treated in an outpatient setting and at home. Only patients with hyperglycemic and hyperosmolar coma, ketoacidosis, severe forms of neuropathies and angiopathy, and stroke are treated as inpatients.
Medicines for diabetes
In fact, all drugs fall into two main groups - those that affect insulin production and those that don't.
The main active substance of the second group comes from the class of biguanides. This drug is most commonly prescribed for type 2 diabetes. Without affecting the cells of the pancreas, it keeps blood sugar levels at normal levels. The drug does not threaten with a critically low decrease in glucose levels. Also, the drug burns fat and reduces appetite, which leads to a decrease in the patient's excess weight. However, an overdose of the drug can be dangerous, since a serious pathological condition with a high percentage of mortality can occur - lactic acidosis.
Typical representatives of another group of drugs affecting insulin production are sulfonylurea derivatives. They directly stimulate the beta cells in the pancreas, causing them to produce more insulin. However, an overdose of these drugs threatens the patient with a hypoglycemic crisis. Sulfonylurea derivatives are commonly taken 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 as a function of glucose concentration. These are new drugs and so far they are quite expensive. They inhibit the synthesis of the sugar-raising hormone glucagon, enhance 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 excretion of glucose in the urine and drugs that increase the cells' sensitivity 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 exhausted and cannot produce enough insulin.
Type 2 diabetes is also often accompanied by comorbidities:
- angiopathy,
- depression
- neuropathies,
- hypertension
- dyslipidemia.
When such diseases are found, drugs are prescribed for their treatment.
| kind | mechanism of action |
|---|---|
| sulfonylureas | stimulation of insulin secretion |
| glinids | stimulation of insulin secretion |
| biguanides | Decrease in glucose production by the liver and tissue resistance to glucose |
| glitazones | Decrease in 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 | glucose-dependent stimulation of insulin secretion and decrease in glucagon secretion |
| Gliptins (dipeptidyl peptidase 4 inhibitors) | glucose-dependent stimulation of insulin secretion and decrease in glucagon secretion |
| insulins | increased glucose utilization |
diet
The essence of dietary changes in DM is regulation of the nutrients entering the gastrointestinal tract. The 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 different types of diets used in non-insulin dependent diabetes (Table #9, low carbohydrate diet, etc. ). All have proven themselves and differ only in a few details. But they agree on the basic principle - the norms of carbohydrate intake in case of illness should be strictly limited. First of all, this applies to products containing "fast" carbohydrates, that is, carbohydrates that are absorbed very quickly from the gastrointestinal tract. Fast carbohydrates can be found in refined sugar, jams, confectionery, chocolate, ice cream, desserts, baked goodsreduction in carbohydrate intake is aimed at reducing body weight, since weight gain is a factor that aggravates disease progression.
Other Instructions
It is recommended that you increase your water intake to compensate for fluid loss due to the frequent urination that often accompanies diabetes. At the same time, it is necessary to completely abandon sugary drinks - cola, soda, kvass, juices and tea with sugar. In fact, you can only drink drinks that do not contain sugar - mineral and plain water, unsweetened tea and coffee. It must be remembered that alcohol consumption can also be harmful - due to the fact that alcohol disrupts glucose metabolism.
Meals should be regular - at least 3 times a day, and preferably 5-6 times a day. You shouldn't sit down at the dining table right after your workout.
How to monitor blood sugar levels
The essence of diabetes therapy is patient self-control. With type 2 diabetes, the sugar level should be in the normal range or close to it. Therefore, the patient must control his or her own sugar level to avoid critical increases. To do this, it is advisable to keep a diary in which the values \u200b\u200bof the concentration of glucose in the blood are recorded. You can take glucose measurements with special handheld blood glucose meters that are equipped with test strips. It is recommended to perform the measurement process every day. The best time to measure is early in the morning. Before the procedure, it is forbidden to eat. 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 meals, before going to bed, etc. Knowing the graph of changes in blood sugar, the patient can quickly adjust his diet and lifestyle so that the glucose indicator is in the normal state.
However, the presence of a glucometer does not relieve the patient from the need to regularly check the level of glucose in the ambulance, since the values obtained in the laboratory are more accurate.
It's not that difficult to control your sugar levels when eating food since most foods 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 with low-calorie sweeteners (sorbitol, xylitol, aspartame).
| stage | Glucose level, mmol/L |
|---|---|
| state of the norm | 3. 3-5. 5 |
| Limited glucose tolerance | 5, 6-6, 0 |
| Diabetes, early stage | 6. 1-8. 0 |
| Diabetes, intermediate 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 fiber, which is indigestible but useful for digestion, and less sugar. However, many vegetables such as potatoes, beets, and carrots are high in starch and should be limited. Fruit can be consumed in moderation and only those that are not very high in carbohydrates. Among fruits, bananas hold the record for carbohydrate content, followed by grapes and melons. Their use is not recommended because they can increase blood sugar levels.
home remedies
Folk remedies involve taking decoctions of medicinal herbs. Such therapy can not only lower blood sugar levels, but also reduce appetite and reduce excess weight. However, folk remedies may only be taken in addition to medication and in consultation with your doctor.
sports exercise
An auxiliary method of therapy are physical exercises. At moderate intensity, the body burns large amounts of glucose. The metabolism normalizes, the cardiovascular system is strengthened. Physical exercise is essential every day. However, the exercises should not be strenuous, as this can only have the opposite effect. With severe fatigue, appetite increases, and a hearty meal can negate any positive effects of physical activity. Fatigue provokes stress and the release of adrenal hormones that increase blood sugar levels. Therefore, it is recommended to choose the type of physical activity that corresponds to the patient's athletic form - simple exercises, exercises with dumbbells or walking, jogging, swimming, cycling.
| type of activity | Cost, kcal/h | Foods with a similar amount of energy |
|---|---|---|
| Rest lying down | 80 | apple, 20 g nuts |
| sit quietly | one hundred | apple, 20 g nuts |
| standing rest | 140 | a glass of milk |
| House work | 180 | a glass of milk |
| Slow walking, light infield work | 220 | 120g ice cream |
| To go biking | 250 | 100 grams of white bread |
| Fast walking, slow swimming, slow dancing, rowing | 300 | 150 g brown bread |
| Volleyball, badminton, table tennis | 350 | 90 g biscuits or cheese |
forecast
In severe cases, when type 2 diabetes mellitus reaches the stage of decompensation, it is usually already impossible to reverse the disease and return glucose levels to normal - due to the depletion of the resources of the pancreas and the body as a whole. Therefore, in such a situation, type 2 diabetes is an incurable disease. However, proper treatment of type 2 diabetes can add many years to the patient's life. In the initial stages of type 2 diabetes mellitus, it is possible to control the concentration of glucose in the blood and keep it within acceptable limits, just by changing the diet and lifestyle, and increasing physical activity. As a result, the patient can live for many decades and not have complications from diabetes.