How to live with diabetes: we understand the causes and symptoms together with an endocrinologist

Diabetes mellitus is a disorder of glucose metabolism in the body associated with insulin deficiency. Glucose is the energy material for cells, and insulin is the hormone that helps it enter them. Without insulin, glucose remains in the blood, causing hyperglycemia and risking complications for the kidneys, eyes, nerves, heart and blood vessels. Diabetes is incurable but can be controlled with proper diet, physical activity and medication. An endocrinologist talks about this in more detail.

Classification of diabetes

Most people only know of two types of diabetes. In fact, they are more. Depending on the cause and mechanism of disease development, the following types of pathology are distinguished:

Diabetes mellitus type 1(insulin dependent). In this type, the pancreas is unable to produce insulin due to the destruction of the beta cells that synthesize it. The causes of this process are not fully known, but it is believed to be influenced by genetic and environmental factors. Type 1 diabetes is usually diagnosed in childhood or adolescence and requires constant insulin administration.

Diabetes mellitus type 2(non-insulin dependent). In this type of disease, the pancreas produces insulin, but the amount is not sufficient to maintain normal blood sugar levels, or the cells become insensitive to it. This is due to overweight, obesity, sedentary lifestyle, malnutrition and hereditary predisposition. Type 2 diabetes most often develops in adults.

Diabetes during pregnancy(gestational). In this type of disease, elevated blood sugar levels occur during pregnancy and usually disappear after birth. This is due to changes in hormonal levels and metabolism in a woman's body. These can lead to reduced insulin production or poorer insulin action. Women who have had gestational diabetes have an increased risk of developing type 2 diabetes in the future.

Other specific types of diabetes. This group includes rare forms of the disease that occur due to genetic defects, pancreatic diseases, endocrine disorders, certain drugs or infections.

Symptoms of diabetes

The classic signs of diabetes are related to excess glucose in the blood. They include:

• Polyuria (frequent and profuse urination).
• Polydipsia (increased thirst).
• Polyphagia (increased appetite).
• Dry mouth.
• Fatigue, weakness, irritability.
• Weight loss (for type 1 diabetes) or weight gain (for type 2 diabetes).
• Itching of the skin, mucous membranes, genitals.
• Slow wound healing, prone to infections.
• Visual impairment, appearance of spots before the eyes.
• Numbness, tingling, pain in the limbs.

Causes of diabetes

Diabetes mellitus is a multifactorial disease that can occur due to various reasons. Some of them:

• Genetic predisposition.The presence of diabetes in relatives increases the risk of developing the disease in offspring. This is especially true for type 1 diabetes, which is linked to inherited defects in the immune system.
• Obesity and overweight.Excess fat in the body leads to poor insulin action and increased blood sugar levels. Particularly dangerous is visceral fat, which surrounds internal organs and releases inflammatory mediators that disrupt metabolism.
• Bad nutrition.The consumption of large amounts of simple carbohydrates, fats, salt, alcohol, as well as the lack of complex carbohydrates, proteins, fibers, vitamins and minerals in the diet contribute to metabolic disorders and an increase in blood sugar levels. Regularity and frequency of meals are also important, as long breaks between meals can lead to hypoglycemia (low blood sugar levels) and frequent snacking can lead to hyperglycemia (elevated blood sugar levels).
• Lack of physical activity.Physical activity helps lower blood sugar levels by increasing energy expenditure and cellular uptake of glucose. In addition, physical activity improves blood circulation, strengthens the cardiovascular system, improves immunity, promotes weight loss and prevents diabetes complications.
• stress.Stressful situations trigger the release of adrenaline, cortisol and glucagon. They raise blood sugar levels, suppress insulin production, and increase inflammation. Stress can also lead to disruptions in diet, sleep and physical activity.
• Diseases of the pancreas.If the pancreas is damaged due to inflammation, stones, tumors, chronic pancreatitis, this can lead to reduced insulin production and the development of diabetes mellitus. There are also genetic diseases that lead to pancreatic dysfunction, for example, cystic fibrosis, Schwartz-Bartter syndrome, Johanson-Blitzer syndrome, and others.
• Endocrine disorders.The endocrine system is a collection of organs that produce hormones that regulate various body functions. Some hormones, such as glucagon, glucocorticoids, growth hormone, thyroid hormones, catecholamines, counteract the action of insulin and increase blood sugar levels.
• Taking certain medications.Some medications can increase blood sugar levels, suppress insulin production, or decrease insulin sensitivity. These drugs include glucocorticoids, thiazide diuretics, beta-blockers, some anticonvulsants, some antivirals, some antipsychotics, and others. Taking these drugs can cause a temporary or permanent increase in blood sugar levels and may require a dose adjustment or replacement of the drug.
• Infections.Infectious diseases such as viral hepatitis, cytomegalovirus infection, chickenpox, rubella, mumps, meningitis, sepsis and others can damage the pancreas, cause inflammation and disrupt insulin production. Infections can also increase the release of stress hormones that raise blood sugar levels.

Diagnosis of diabetes mellitus

Making a diagnosis requires a comprehensive examination. Initially, the patient is examined and interviewed by an endocrinologist. He identifies the characteristic symptoms, takes into account the circumstances of their occurrence, concomitant diseases and hereditary factors. A detailed review is then prescribed:

Laboratory researches.The main method for diagnosing diabetes mellitus is the determination of blood sugar levels. To do this, the following tests are carried out:

• Fasting glucose.
• Glucose tolerance test.
• Glycated hemoglobin (HbA1c)

Instrumental studies.In order to identify the complications of diabetes mellitus and to assess the condition of the target organs, the following tests are performed:

• Ophthalmoscopy.This is an examination of the eye using a special device - an ophthalmoscope, which allows you to examine the retina, optic nerve and blood vessels of the eye.
• Ultrasound of the kidneys.This is an ultrasound examination of the kidneys, which allows you to evaluate their size, shape, structure, the presence of stones, tumors, cysts and inflammation.
• Doppler imaging of the vessels of the lower extremities.This is an ultrasound examination of the vessels of the lower extremities, which allows you to evaluate their lumen, walls, blood flow, the presence of blood clots, atherosclerotic plaques, narrowings and aneurysms.
• Electrocardiography (ECG).This is a study of the heart that allows you to evaluate its rhythm, conduction, contractility, the presence of ischemia, myocardial infarction, arrhythmia and blockade.

Neurological examination.This is an examination of the nervous system that allows you to assess sensitivity, reflexes, coordination, muscle tone, the presence of paresthesia, pain and movement disorders. In diabetes mellitus, nerve changes such as demyelination, degeneration, inflammation can develop, which can lead to disruption of the transmission of nerve impulses and the development of polyneuropathy, autonomic neuropathy, mononeuropathy, radiculopathy. This condition is called diabetic neuropathy.

Dermatological examination.This is a study of the skin that allows you to evaluate its color, turgor, humidity, presence of wounds, cracks, ulcers, fungal, bacterial, viral infections, allergic reactions, pigmentation, atrophy, scleroderma, acanthosis.

In diabetes mellitus, skin changes can develop, such as xerosis, diabetic dermopathy, diabetic bullous, diabetic urticaria, diabetic angiopathy, diabetic foot, which can lead to a violation of the protective function of the skin and the development of complications.

Consultation with other specialists.Depending on the presence of concomitant diseases and complications of diabetes mellitus, consultation with other specialists such as a cardiologist, neurologist, surgeon, dentist, psychologist, etc. may be necessary. They will help assess the patient's condition, prescribe the necessary treatment and give recommendations for prevention.

Insulin therapy in diabetes

Insulin therapy for diabetes is a treatment method in which insulin is administered externally to the patient. It is needed for all patients with type 1 diabetes, and for some patients with type 2 diabetes when other treatments do not work.

What types of insulin are there and how to use them

There are different types of insulin that differ in time of onset of action, peak activity, and duration of action. According to these parameters, insulins are divided into ultra-short, short and extended (prolonged) actions.

• Ultrashort and short-acting insulins mimic the physiological release of insulin after a meal and are administered 15-30 minutes before a meal.
• Extended-release insulins provide basal levels of insulin in the blood throughout the day and are administered once or twice daily.
• There are also ready-made mixtures of insulins with different durations of action that are convenient to use.

Insulin is injected under the skin using special devices such as pens, pumps or inhalers. The dose of insulin is selected individually for each patient depending on the level of blood sugar, the volume and composition of food, physical activity and other factors.

To control blood sugar, the patient should measure it regularly using a glucometer or continuous glucose monitor.

What rules and recommendations should be followed during insulin therapy?

Insulin therapy requires strict adherence to diet, physical therapy and doctor's recommendations. With insulin therapy, side effects such as hypoglycemia (low blood sugar), allergic reactions, lipodystrophy - a disorder of the distribution of fat under the skin, which can appear at the site of frequent insulin injections, are possible.

To avoid this, it is necessary to change the insulin injection sites and use thin needles. Therefore, patients should learn the basics of insulin therapy and consult a physician if questions or concerns arise.

Nutrition in diabetes

Nutrition in diabetes is the most important component of treatment. In mild forms of diabetes, diet alone is sometimes sufficient to achieve the target blood sugar level. In more severe cases, drug therapy (oral hypoglycemic agents, insulin) comes to the rescue.

The following general rules for a diabetes diet should be followed:

1. Meals should be frequent and small(5-6 times a day), in small portions. This will help avoid large spikes in glycemic levels.
2. Food should be taken at the same times. The same goes for taking glucose-lowering drugs and insulin injections.
3. Strict diets and hunger strikes are prohibited, as they can lead to hypoglycemia (low blood sugar) as well as to disruption of fat and protein metabolism.
4. These are preferablecooking methodssuch as: steaming, boiling, stewing and baking. Fried, smoked, salted and pickled foods should be excluded or minimized.
5. Musteliminate easily digestible carbohydrates from food(sugar, honey, confectionery, sweets, baked goods, white flour). They quickly increase blood sugar and contribute to obesity. Instead, you can use sugar substitutes (xylitol, sorbitol, fructose, stevia, etc. ) in moderation.
6. The food should contain a large amount of fiber,because such carbohydrates are digested more slowly and do not raise blood sugar as sharply. Fiber also helps to normalize intestinal function, reduce cholesterol and appetite. Sources of fiber include vegetables, fruits, herbs, whole grain breads and cereals, legumes, nuts and seeds.
7. Limit consumption of animal fats(butter, lard, fatty meats). They contain saturated fatty acids that increase cholesterol levels and contribute to the development of atherosclerosis and coronary heart disease. Preference should be given to vegetable oils (sunflower, olive, corn, etc. ), which contain unsaturated fatty acids that are good for the heart and blood vessels. Also useful are fish and seafood, which are sources of omega-3 fatty acids, which have anti-inflammatory and anti-sclerotic effects.
8. It is recommended tothe caloric content of the food and the amount of carbohydrates were about the sameon different days, this is especially important when choosing the dose of insulin. To calculate the amount of carbohydrates, you can use special tables that show how many grams of carbohydrates are contained in different foods.
9. Mustcontrol your salt intake, as excess salt can lead to an increase in blood pressure, edema and deterioration of kidney function. The recommended daily intake of salt is no more than 5 g (1 teaspoon).

Diet for diabetes should be balanced, varied and tasty. You don't have to give up your favorite foods, just learn how to prepare them properly, taking into account your condition and needs.

Diabetes mellitus is a serious disease that requires constant medical monitoring and compliance with a lifestyle. If you notice signs of diabetes in yourself or your loved ones, do not delay visiting a doctor. The earlier the diagnosis is made and the treatment begins, the lower the likelihood of complications and the better the prognosis of the disease.