Diabetes mellitus type 2

Type 2 diabetes (T2DM) is a common global disease that is closely related to the obesity epidemic. People with T2DM are highly risk of both microsyuded complications (including retinopathy, nephropathy and neuropathy), as well as macro-vascular complications (such as cardiovascular diseases), which is due to hypergemia and individual components of insulin resistance (metabolic syndrome). The main factors contributing to the development of T2DM include both the environment (for example, obesity, unhealthy nutrition and physical inactivity), as well as genetic factors affecting numerous pathophysiological disorders responsible for violation of glucose homeostasis in T2DM.

Insulin resistance and impaired insulin secretion remain the main defects in T2DM, but at least six other pathophysiological anomalies contribute to the dysregulation of glucose metabolism. Multiple pathogenetic disorders for T2DM dictate the need to use several antidiabetic drugs in combination to maintain normoglycemia. Treatment should be not only effective and safe, but also improve the quality of life. Several new medicines are being developed, however, the greatest need exists for means that improve insulin sensitivity, stop the progressive failure of the pancreatic β-cells, characteristic of T2DM, and prevent or convert the microsyurous complications (Defronzo et al.,,,,,,,, 2015 ).

T2DM is characterized as a heterogeneous disease caused by a combination of two main factors: defective secretion of insulin pancreatic gland and the inability of insulinative tissues to respond to insulin adequately. Since the development and activity of insulin are key processes for glucose homeostasis, molecular mechanisms involved in the synthesis and release of insulin, as well as in its detection, are strictly regulated. Defects in any of the mechanisms involved in these processes can lead to a metabolic imbalance responsible for the development of the disease (Galicia-Garcia et al., 2020title="Pathophysiology of Type 2 Diabetes Mellitus - PMC">).

[1], [2], [3], [4], [5 -]. [7], [8]

Causes of the type 2 diabetes mellitus

1. Insulin resistance: one of the main causes of type 2 diabetes. Body cells become less sensitive to insulin, which helps cells convert glucose into energy. As a result of glucose, it accumulates in the blood, instead of being used by cells.
2. Insufficient production of insulin pancreatic gland: over time, the pancreas can produce an insufficient amount of insulin to maintain the normal level of blood sugar, especially against the background of insulin resistance.
3. Excess weight and obesity: Especially the accumulation of fat in the abdomen enhances insulin resistance and is associated with an increased risk of type 2 diabetes.
4. Physical inactivity: lack of physical exercises helps to increase weight and enhances insulin resistance.
5. Nutrition: a diet rich in high-calorie foods, simple carbohydrates and saturated fats can contribute to the development of insulin resistance and excess weight.
6. Age: the risk of developing type 2 diabetes increases with age, especially after 45 years, although in recent years the disease is increasingly diagnosed in younger people.
7. Genetic predisposition: the presence of close relatives with type 2 diabetes increases the risk of its development.
8. Ethnicity: some ethnic groups, such as African-Americans, Latin American, Asians and indigenous peoples of America, have a higher risk of type 2 diabetes.
9. Gestational diabetes and ovarian polycystosis: women who have undergone gestational diabetes or have polycystosis of the ovary are also undergoing increased risk.

[9], [10], [11], [12]

Alcohol

The use of alcohol in type 2 diabetes requires caution and moderation, since alcohol can have a significant effect on blood sugar and general health.

The effect of alcohol on type 2 diabetes mellitus:

1. Hypoglycemia: alcohol can enhance the effect of insulin and oral hypoglycemic drugs, which increases the risk of hypoglycemia, especially if you consume alcohol on an empty stomach or in abundance. This effect can manifest itself a few hours after consumption.
2. Hyperglycemia: on the other hand, some alcoholic drinks, especially sweet wines and cocktails with sugar or syrups, can increase blood sugar.
3. Investigation: alcohol contains a large number of calories, which can contribute to weight gain, enhancing insulin resistance and complicating control of diabetes.
4. Influence on the liver: excessive alcohol consumption can disrupt the liver function, which plays a key role in the regulation of blood sugar.

Recommendations:

• Moderation: if the doctor is not against drinking alcohol, you should adhere to moderation - no more than one standard alcoholic drink per day for women and no more than two for men. One standard alcoholic drink corresponds to 14 grams of pure alcohol (about 150 ml of wine, 350 ml of beer or 45 ml of strong alcohol).
• Praises: always drink alcohol during food or after eating to reduce the risk of hypoglycemia.
• Monitoring of blood sugar: regularly control the level of glucose in the blood, especially before drinking alcohol and within a few hours after its use.
• Information: It is important to notify the family and friends of the risk of hypoglycemia and how to help in case of its development.

[13], [14], [15], [16]

Symptoms of the type 2 diabetes mellitus

Type 2 diabetes often progress slowly, and in the initial stage it may not show symptoms, which is which it is difficult to diagnose in a timely manner. However, with the deterioration of control over the level of glucose in the blood, the following symptoms may appear:

1. Increased thirst and frequent urination: an excess of blood sugar leads to the fact that your kidneys are forced to work more hard to filter and absorb excess sugar. If your kidneys can not cope, an excess of glucose is excreted in the urine, taking with you fluids from tissues, which can cause dehydration and a sense of thirst.
2. Increased appetite: the insufficient ability of your body to digest glucose can lead to an increased feeling of hunger.
3. Weight loss for no apparent reason: despite an increase in appetite, you can lose weight. Without the ability of insulin, moving sugar to your cells, muscle tissue and fat reserves simply decrease, since energy is obtained from other sources.
4. Fatigue: lack of sugar in your cells can make you unusually tired.
5. Lovetled vision: changes in the level of liquid in your body can lead to the fact that your eyes will swell. This change in form can lead to blurred vision.
6. Slow wound healing and frequent infections: Diabetes mellitus affects your ability to heal wounds and fight infections.
7. A tingling in the arms and legs: an excess of blood sugar can damage the nerves, which can cause a sensation of tingling or numbness in your arms and legs.

These symptoms can develop gradually and do not always clearly indicate the presence of type 2 diabetes, which makes regular medical examination important for the early detection and treatment of the disease.

Stages

Although the classic division into severity and stages may not be so strictly defined for T2DM, as for some other diseases, certain phases can be distinguished in the development and progression of the disease that help in understanding and treatment of the condition.

Type 2 diabetes phases:

1. Prediabet:

   • Disrupted glucose on an empty stomach (NGN) and/or impaired glucose tolerance (NTG) often serve as harbingers of the development of T2DM.
   • At this stage, glucose levels are higher than the norm, but not yet high enough to be classified as diabetes.

2. Early T2DM:

   • In the initial stage of T2DM, the blood glucose level is higher than normal, but the symptoms may be minimal or absent.
   • At this stage, it is still possible to effectively control the disease through changes in the lifestyle and, if necessary, through drug treatment.

3. The installed T2DM:

   • Blood glucose levels remain increased over the course of most of the time.
   • Symptoms can appear, such as increased fatigue, frequent urination and thirst.
   • Medication treatment is necessary to control the level of glucose.

4. T2DM with complications:

   • The long-term presence of a high level of glucose in the blood can lead to the development of complications, including vascular diseases, damage to nerves (neuropathy), kidney problems (nephropathy) and eyes (retinopathy).
   • Complications require additional treatment and can have a significant effect on the quality of life.

Severity:

• Light:
  • A mild degree can be controlled mainly through diet and physical exercises.
• Moderate:
  • A moderate degree may require taking oral hypoglycemic drugs.
• Heavy:
  • A severe degree often requires combined therapy, including insulin and blood glucose monitoring.

[17], [18], [19]

Complications and consequences

The vascular system is most susceptible to complications of type 2 diabetes. In addition to the pathology of blood vessels, a number of other symptoms can develop: hair loss, dry skin, deterioration of nail condition, anemia and thrombocytopenia.

Among the severe complications of diabetes should be distinguished the following:

• Progressive atherosclerosis, provoking a violation of coronary blood supply, as well as limbs and tissues of the brain;
• Stroke;
• Violation of renal functions;
• Lesion of the eye retina;
• Degenerative processes in nerve fibers and tissues;
• Erosive-span damage to the lower extremities;
• Infectious diseases (bacterial and fungal lesions that are difficult to treat);
• Hypoglycemic or hyperglycemic coma.

[20], [21], [22]

Consequences

Due to the fact that therapeutic measures for diabetes are usually aimed at preventing the state of decompensation and retaining the state of compensation, we will get acquainted with these important concepts to assess the consequences.

If the patient’s blood sugar level is slightly higher than the norm, but there is no tendency to complications, then this condition is considered compensated, that is, the body can still cope with a dosage of carbohydrate metabolism.

If the sugar level greatly exceeds the permissible indicators, and the tendency to develop complications is clearly traced, then this condition is indicated as decompensated: the body can no longer cope without drug support.

There is also a third, intermediate version of the course: a state of subcompensation. For a more accurate separation of these concepts, we will use the following scheme.

[23], [24], [--], [26], [27 28

Type 2 diabetes compensation

• Sugar on an empty stomach - up to 6.7 mmol/l;
• Sugar for 2 hours after eating-up to 8.9 mmol/l;
• Cholesterol - up to 5.2 mmol/l;
• The amount of sugar in the urine is 0%;
• Body weight - within normal limits (if we calculate by the formula “growth minus 100”);
• Arterial pressure indicators are not higher than 140/90 mm Hg. Art.

[29], [30], [31], [32], [33]

Sub-compensation of type 2 diabetes

• Sugar level on an empty stomach - up to 7.8 mmol/l;
• Sugar level for 2 hours after eating-up to 10.0 mmol/l;
• Cholesterol indicators - up to 6.5 mmol/l;
• The amount of sugar in the urine is less than 0.5%;
• Body weight-increased by 10-20%;
• Arterial pressure indicators - not more than 160/95 mm Hg. Art.

Decompensation of type 2 diabetes

• Sugar level on an empty stomach - more than 7.8 mmol/l;
• Sugar level after eating - more than 10.0 mmol/l;
• Cholesterol indicators - more than 6.5 mmol/l;
• The amount of sugar in the urine is more than 0.5%;
• Body weight - more than 20% of the norm;
• Arterial pressure indicators - from 160/95 and above.

In order to prevent the transition from a compensated state to a decompensated one, it is important to correctly use the methods and circuits of control. We are talking about regular analyzes, both in home and in the laboratory.

The ideal option is to check the sugar level several times a day: in the morning on an empty stomach, after breakfast, lunch and dinner, as well as shortly before sleep. The minimum number of inspections is in the morning before breakfast and immediately before going to bed.

The presence of sugar and acetone in the analysis of urine is recommended to control at least once every 4 weeks. With a decompensated state - more often.

To prevent the consequences of type 2 diabetes mellitus is possible if you adhere to the doctor’s instructions exactly.

With diabetes, you can live a full life if you adhere to special rules for nutrition and lifestyle, as well as take drugs prescribed by the doctor, accurately following the treatment regimen.

Carefully monitor your condition, regularly check the sugar level in the blood serum and blood pressure, monitor your weight.

[34], [35], [36], [37]

Diagnostics of the type 2 diabetes mellitus

The clinical signs of pathology can already come across the idea of the presence of type 2 diabetes in a person. However, this is not enough to confirm the diagnosis, it is also necessary to carry out laboratory diagnostic procedures.

The main objective of this type of diagnosis is to detect β-cell functionality disorders: it is an increase in sugar level before and after eating, finding acetone in the urine, etc. Sometimes, assessments of laboratory tests can be positive even in the absence of clinical signs of the disease: in such cases they indicate early detection of diabetes.

The sugar level in serum can be determined using autoanizers, test strips or glucometer. By the way, according to the criteria of the World Health Organization, if blood sugar indicators, twice, are more than 7.8 mmol/liter on different days, diagnosis of diabetes can be considered confirmed. For American experts, the norms are slightly different: here a diagnosis is established for indicators of more than 7 mmol/liter.

Carrying out the procedure of 2-hour oral testing tolerance for glucose is used if there is doubt in the accuracy of the diagnosis. How this procedure is carried out:

• For three days before the study, the patient receives about 200 g of carbohydrate food per day, and you can consume liquid (without sugar) without restrictions;
• Testing is carried out on an empty stomach, and should pass at least ten hours from the moment of the last eating of food;
• Blood can be taken both from the vein and from the finger;
• The patient is offered to take a glucose solution (75 g per glass of water);
• Take blood is carried out 5 times: first - before the use of glucose, as well as after half an hour, an hour, an hour and a half, and 2 hours after consumption of the solution.

Sometimes such a study is reduced by conducting a bloodstream of a blood on the vest and 2 hours after the use of glucose, that is, only twice.

Analysis of urine for diagnosis of diabetes is used less often, since the amount of sugar in the urine can not always correspond to the amount of glucose in the blood serum. In addition, sugar in the urine may appear for other reasons.

A certain role can play a study of urine for the presence of ketone bodies.

What should a sick person do without fail, in addition to controlling blood sugar? Track the level of blood pressure and periodically take a blood cholesterol analysis. All indicators in the aggregate may indicate the presence or absence of a disease, as well as the quality of compensation for the pathological condition.

Type 2 diabetes mellitus can be carried out along with additional diagnosis, which provides the opportunity to identify the development of complications. For this purpose, the patient is recommended to relieve ECG, excretory urography, and examination of the fundus.

[38], [39], [40], [41], [42]. [43]

Treatment of the type 2 diabetes mellitus

In the initial stage of the development of the disease, it is sometimes enough to observe the rules of nutrition and engage in special physical exercises, without the use of medications. It is important to bring body weight to normal, this will help restore the exchange of carbohydrates and stabilize the sugar level.

Treatment of subsequent stages of pathology requires the prescription of drugs.

Drugs

Patients with type 2 diabetes are most often prescribed antidiabetic drugs for internal use. The reception of such medications is carried out at least once a day. Depending on the severity of the condition, the doctor can apply not one drug, but a combination of drugs.

The most common antidiabetic drugs:

• Tolbutamide (Pramidex) - is able to affect the pancreas, activating the secretion of insulin. The most suitable for elderly patients with compensatory and subcompensator condition of type 2 diabetes. Among the possible side effects are an allergic reaction and a transient jaundice;
• Glypisis - with caution is used to treat elderly, weakened and exhausted patients with insufficient adrenal gland and pituitary gland;
• Maninyl - enhances the sensitivity of the receptors that perceive insulin. Increases the production of its own insulin pancreas. Take of the drug should begin with one tablet, if necessary, gently increasing the dosage;
• Metformin - does not affect the level of insulin in the body, but is able to change pharmacodynamics by reducing the ratio of associated insulin and free insulin. It is more often prescribed to patients with overweight and obesity. Not used in the treatment of patients with impaired renal function;
• Akarbosa - inhibits the processes of digestion and absorption of carbohydrates in the small intestine and, in connection with this, reduces the increase in the concentration of sugar in the blood after taking carbohydrate food. The medication should not be prescribed for chronic diseases of the intestine, as well as during pregnancy;
• Magnesium preparations - stimulate the production of insulin pancreas, regulate the sugar level in the body.

Also allow the use of combinations of drugs, for example:

• The use of metorphine with glipiside;
• The use of metorphine with insulin;
• The combination of a metorphine with thiazolidindyon or Natheglinide.

Unfortunately, in most type 2 diabetes, the above-mentioned medications are gradually losing their effectiveness. In such situations, you have to switch to the use of insulin agents.

Insulin

Insulin in type 2 diabetes can be prescribed temporarily (in some painful conditions) or constantly, when previous therapy with tablet drugs is ineffective.

Of course, insulin therapy is necessary exclusively when prescribing a doctor by a doctor. He will choose the necessary dosage and plan a treatment regimen.

Insulin can be prescribed in order to facilitate the compensation of blood sugar as much as possible in order to prevent the development of complications of the disease. In what cases the doctor can translate drug therapy for insulin therapy:

• With unmotivated rapid loss of body weight;
• With the development of complicated manifestations of the disease;
• With insufficient compensation for pathology with the usual administration of sugar-playing medications.

The insulin preparation is determined by the attending doctor. This can be insulin of a quick, intermediate or prolonged effect, which is administered by subcutaneous injection in accordance with the treatment regimen proposed by a specialist.

Exercises

The purpose of exercises in type 2 diabetes is to influence the stabilization of blood sugar, activate the effect of insulin, improve the functionality of the cardiovascular and respiratory systems, and stimulate performance. In addition, physical exercises are an excellent prevention of vascular pathologies.

Exercises can be prescribed for all forms of diabetes. With the development of coronary heart disease or heart attack against the background of diabetes, gymnastic exercises are changed, given these diseases.

Contraindications to physical exercises can be:

• Increased blood sugar (more than 16.5 mmol/liter);
• Acetone in the urine;
• Premomatous condition.

Exercise in patients who are on bed mode, but not in the stage of decompensation, are carried out in a lying position. The remaining patients conduct standing or sitting classes.

Classes begin with standard exercises for the muscles of the upper and lower extremities and torso without burden. Next, connect classes using resistance and weights using an expander, dumbbells (up to 2 kg) or fitnessball.

A good effect is observed from breathing exercises. Dosed walking, cycling, rowing, classes in the pool, skiing is also welcome.

It is very important that the patient who is engaged in physical education independently pay attention to his condition. With the development of feelings of hunger, sudden weakness, trembling in the limbs, you should finish physical exercises and be sure to eat. After normalizing the condition on the next day, the resumption of classes is allowed, however, slightly reducing the load.

[44], [45], [46], [47], [48]

Diet

Despite the use of drugs that regulate blood sugar levels, the method of nutrition for diabetes is extremely important. Sometimes light forms of the disease can only be controlled by a diet, without even resorting to the use of medications. Among the known therapeutic tables, diet in type 2 diabetes is defined as diet No. 9. The instructions of this diet are aimed at restoring impaired metabolic processes in the body.

Nutrition in type 2 diabetes should be balanced and taking into account the calorie content of food consumed. The optimal daily calorie intake depends on the weight of the body:

• Normal mass - from 1600 to 2500 kcal;
• Excess weight - from 1300 to 1500 kcal;
• Obesity of the II-III degree-from 1000 to 1200 kcal;
• Obesity of the IV degree - from 600 to 900 kcal.

But you can not always limit yourself in calories. For example, with kidney diseases, severe arrhythmias, mental disorders, gout, serious diseases of the liver, food should be nutritious.

It is recommended to abandon fast carbohydrates, limit the use of fat and salt.

[49], [50], [51], [52]

Prevention

The prevention of type 2 diabetes is based on the compliance with the principles of a healthy diet. The use of “correct” foods serves as a prevention of not only diabetes, but also other all kinds of diseases. After all, the nutrition of many modern people is now difficult to imagine without the use of fast food, semi-finished products, foods with a mass of canned, coloring and other chemicals and quick sugars. Preventive measures should just be aimed at reducing, and better the exclusion of all kinds of harmful food from our diet.

In addition to nutrition, you should pay attention to the degree of physical activity. If classes of fitness or gymnastics are not for you, try to choose other loads for yourself: foot and bicycle walks, swimming, tennis, morning run, dancing, etc. It is useful to go to work on foot, and not go with transport. It is useful to climb the stairs yourself without using the elevator. In a word, win your laziness and move, be active and cheerful.

By the way, an active life position and a stable emotional state are also good methods for the prevention of type 2 diabetes. It has long been known that chronic stresses, experiences, depressive states can lead to metabolic disorders, obesity and, in the end, the development of diabetes. Our emotions and our state are always closely interconnected. Take care of the nervous system, strengthen stress resistance in yourself, do not react to minor reasons to get you out: all this will help you be healthy and happy.

[53], [54], [55], [56]

Forecast

Unfortunately, still type 2 diabetes mellitus is considered an incurable chronic disease. According to statistics, every month this pathology overtakes more than 500 thousand people around the world. Monthly almost 100 thousand patients are carried out by amputation of the limbs to extend their lives and stop vascular complications. We are silent about how many people annually lose their eyesight or gain other complications due to diabetes. Unfortunately, such a disease as diabetes provokes as many deaths as HIV or hepatitis.

That is why it is so important to adhere to the main methods of prevention, to regularly control the blood sugar, not to overeat and not overload the pancreas, not get carried away with sweets, monitor your weight and lead an active lifestyle. Preventive measures must be observed by everyone: both healthy people and those who already have this disease. This will prevent the development of complications and will not allow diabetes to switch to the next, heavier stage.

[57], [58], [59], [60]

Disability

To assign or not a disability in type 2 diabetes, a medical and social expert organization decides to which the patient is sent to his attending physician. That is, you can expect when the doctor decides that you need to arrange a disability, but you can insist on it yourself, and the doctor has no right to refuse you.

Only the fact that you are sick with diabetes sugar does not yet give you the opportunity to get disability. Such a status is provided only in case of violation of certain functions of the body, which can limit the full life of the patient. Consider the criteria for assignment of disability:

• Group III is provided with a mild and moderate course of the disease with the presence of moderate disorders that impede the full movement or the ability to engage in labor activity. If the diabetes is in the stage of compensation, and you do not accept insulin, the disability in this case is not laid;
• Group II is provided to patients with relatively pronounced disorders (retinopathy of the II-III degree, renal failure, neuropathy of the II degree, encephalopathy, etc.);
• The I group can be provided with severe patients with complete blindness, paralysis, pronounced mental disorders, severe cardiionalists, the presence of amputated limbs. Such patients in everyday life cannot do without third-party help.

The disability group is given after examining the patient by experts (the so-called commission) who decide whether to assign whether to assign a group for what time, and also discuss options for the necessary rehabilitation measures.

The standard appeal regarding disability should include:

• The result of a general study of urine and blood;
• The result of the analysis of sugar in the blood serum before and after eating;
• The result of the study of urine for the presence of acetone and sugar;
• Renal and hepatic biochemistry;
• ECG;
• The conclusion of an optometrist, neuropathologist, therapist, surgeon.

From the general documentation may be needed:

• A written statement written on behalf of the patient;
• Passport;
• Dr. Dr.
• Medical card containing the entire history of your disease;
• Certificate of education;
• Photocopy of the work book;
• Description of labor conditions.

If you are applying for a repeated provision of disability, you also need a certificate that you are a disabled person, as well as a rehabilitation program assigned to you earlier.

[61], [62]

Benefits

Regardless of whether you have given a disability or not, you can apply for free insulin preparations and other benefits for type 2 diabetes.

What else do you have the right to:

• Obtaining free syringes and sugar-lowering drugs;
• Preferential order of glucot tests and devices for measuring sugar in the blood;
• Participation in social rehabilitation (relief of working conditions, training of another profession, retraining);
• Sanatorium-resort treatment.

If you are a disabled person, you will receive a cash allowance (pension).

They say that diabetes is not a disease, but a lifestyle. Therefore, patients have to adapt to pathology, attentive to nutrition, control body weight, regularly control their condition and take tests. Well, type 2 diabetes is a really complex disease, and only your caring attitude to yourself can help you live as a full and active life as possible.