Diabetes mellitus type 2

The disease associated with the disorder of metabolic processes inside the body and manifested by an increase in glucose in the blood, is called insulin-independent diabetes, or type 2 diabetes. This pathology develops in response to a disorder of the interaction of tissue cells with insulin.

The difference between this disease and ordinary diabetes is that in our case insulin therapy does not serve as the main method of treatment.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13],

Causes

Specific causes of type 2 diabetes have not yet been established. World scientists who conducted research on this topic explain the appearance of the disease by a violation of the sensitivity and number of receptors of cells to insulin: receptors continue to react to insulin, but a decrease in their number reduces the quality of this reaction. Violations of insulin production do not occur, but the ability of cells to interact with the hormone of the pancreas and to ensure the full absorption of glucose is lost.

Several factors have been identified for the development of type 2 diabetes:

• the risk of developing type 2 diabetes during adolescent puberty, due to changes in hormone levels;
• according to statistics, women are more likely to develop insulin-independent diabetes than men;
• more often the disease is found in representatives of African-American race;
• people with obesity are most likely to develop diabetes.

Sometimes the disease can be observed in close relatives, but there is no clear evidence of inheritance of this pathology at the present time.

[14], [15], [16], [17], [18], [19], [20], [21]

Alcohol

Simultaneously with other factors contributing to the development of type 2 diabetes, a huge role in the aetiology of the disease is played by bad habits: lack of exercise, overeating, smoking, etc. Frequent use of alcoholic beverages is also considered one of the probable causes of pathology. Alcohol can provoke damage to pancreatic tissues, inhibit insulin secretion and increase sensitivity to it, disrupts metabolic processes, leads to disorders of liver and kidney function.

It has been experimentally proved that in persons suffering from a chronic form of alcoholism, the pancreas is significantly reduced in size, and β cells producing hormone insulin are atrophied.

The ability of ethanol to lower the level of glucose in the blood is a great danger for patients who have type 2 diabetes mellitus. According to statistics, 20% of cases of hypoglycemic coma arise as a consequence of drinking alcohol.

It is interesting that the frequency of the development of the disease may depend on the dose of alcohol consumed. So, when you use a small amount of alcohol (6-48 grams per day), the risk of getting sick with diabetes decreases, and when you consume more than 69 g of alcoholic beverages per day - on the contrary, it increases.

Summing up, experts have defined the preventive norm of the use of alcoholic drinks:

• vodka 40 ° - 50 g / day;
• wine dry and semi-dry - 150 ml / day;
• beer - 300 ml / day.

Dessert wines, champagne, liqueurs, cocktails and other drinks containing sugar are prohibited.

Patients receiving insulin should lower their dosage after taking alcohol.

In the decompensated stage, the use of any alcoholic beverages is contraindicated.

It is not recommended to take alcohol on an empty stomach.

Beer is better to choose light varieties with a lower alcoholic degree.

After drinking alcohol, do not go to bed without a snack. From a sharp decrease in the amount of sugar hypoglycemic coma may occur even during sleep.

Alcohol and type 2 diabetes can in some ways be combined, but think about whether there is a need for this?

[22], [23], [24], [25], [26], [27], [28]

Symptoms

The primary manifestations indicating the development of type 2 diabetes are:

• a constant desire to drink;
•  too frequent urge to urinate;
• "Wolfish" appetite;
• pronounced fluctuations in body weight in one direction or another;
• feeling of sluggishness and fatigue.

To secondary signs it is possible to carry:

• weak immunity, frequent bacterial diseases;
• transient sensitivity disorders in the limbs, itchy skin;
• visual impairment;
• the formation of external ulcers and erosions, which are hard to cure.

Stages

Diabetes mellitus type 2 can occur with different severity options:

• light degree - the patient's condition can be improved by changing the principles of nutrition, or by using a maximum of one capsule of sugar reducing agent per day;
• medium degree - improvement of the condition occurs when using two or three capsules of a sugar reducing agent per day;
• heavy form - in addition to sugar reducing agents, you have to resort to the introduction of insulin.

Depending on the ability of the body to compensate for the disorders of carbohydrate metabolism, three stages are distinguished:

1. Compensatory stage (reversible).
2. Subcompensatory stage (partially reversible).
3. The stage of decompensation (irreversible violations of carbohydrate metabolism).

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

Complications and consequences

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

Among the serious complications of diabetes are the following:

• progressive atherosclerosis, which causes the violation of coronary blood supply, as well as limbs and brain tissue;
• stroke;
• impaired renal function;
• damage to the eye retina;
• degenerative processes in nerve fibers and tissues;
• erosive-ulcerative damage of the lower limbs;
• infectious diseases (bacterial and fungal lesions, difficult to treat);
• hypoglycemic or hyperglycemic coma.

[34], [35], [36], [37], [38], [39]

Effects 

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 normal, but there is no propensity to complications, then this condition is considered compensated, that is, the body can still cope with the disorder of carbohydrate metabolism.

If the sugar level is much higher than the permissible levels, and the tendency to complications is clearly traced, then this state is said to be decompensated: the body can no longer cope without medicamental support.

There is also a third, intermediate version of the current: the state of subcompensation. For a more precise separation of these concepts, let us use the following scheme.

[40], [41], [42], [43], [44], [45], [46], [47], [48], [49]

Compensation for Type 2 Diabetes Mellitus

• sugar on an empty stomach - up to 6.7 mmol / l;
• sugar for 2 hours after a meal - up to 8.9 mmol / l;
• cholesterol - up to 5,2 mmol / l;
• the amount of sugar in urine is 0%;
• body weight - within the limits of the norm (if calculated using the formula "growth minus 100");
• indices of arterial pressure - not higher than 140/90 mm Hg. Art.

[50], [51], [52], [53], [54], [55], [56], [57], [58], [59]

Subcompensation of type 2 diabetes mellitus

• sugar level on an empty stomach - up to 7.8 mmol / l;
• the level of sugar for 2 hours after a meal - up to 10.0 mmol / l;
• cholesterol - up to 6.5 mmol / l;
• the amount of sugar in urine is less than 0.5%;
• body weight - increased by 10-20%;
• indicators of blood pressure - no more than 160/95 mm Hg. Art.

Decompensation of type 2 diabetes mellitus

• sugar level on an empty stomach - more than 7.8 mmol / l;
• the level of sugar after meals - more than 10.0 mmol / l;
• cholesterol - 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;
• blood pressure indicators - from 160/95 and above.

To prevent the transition from a compensated state to a decompensated state, it is important to use methods and control schemes correctly. We are talking about regular tests, both in the 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, and also shortly before sleep. The minimum number of checks - in the morning before breakfast and immediately before going to bed.

The presence of sugar and acetone in urinalysis is recommended to be monitored at least once every 4 weeks. At a decompensated condition - more often.

Prevent the consequences of Type 2 diabetes mellitus if you follow the doctor's instructions exactly.

With diabetes, you can live a full life, if you adhere to special rules for nutrition and lifestyle, and take prescribed medications, exactly following the treatment regimen.

Closely monitor your condition, regularly check blood serum levels and blood pressure, watch your weight.

[60], [61], [62], [63], [64], [65], [66], [67], [68]

Diagnostics

Clinical signs of pathology can already lead to the idea of a person having type 2 diabetes. However, to confirm the diagnosis is not enough, it is necessary to conduct also laboratory diagnostic procedures.

The main objective of this type of diagnosis is to detect violations of the functionality of β-cells: this is a rise in the sugar level before and after meals, the presence of acetone in the urine, etc. Sometimes evaluations of laboratory tests can be positive even in the absence of clinical signs of the disease: in such cases, the detection of diabetes mellitus.

The level of sugar in the serum can be determined using auto-analyzers, test strips or a glucometer. By the way, according to the criteria of the World Health Organization, if the blood sugar values are twice, on different days, more than 7.8 mmol / liter, the diagnosis of diabetes mellitus can be considered confirmed. The American specialists have slightly different rates: here they establish a diagnosis at rates of more than 7 mmol / liter.

The procedure for 2-hour oral glucose tolerance testing is used when there is doubt about the accuracy of the diagnosis. How this procedure is carried out:

• for three days before the study, the patient receives about 200 grams of carbohydrate food per day, and you can use the liquid (without sugar) without restrictions;
• testing is carried out on an empty stomach, and must pass at least ten hours after the last meal;
• blood can be taken from both the vein and the finger;
• the patient is offered to take a glucose solution (75 g per glass of water);
• taking blood take 5 times: first - before consumption of glucose, and also in half an hour, an hour, an hour and a half and 2 hours after drinking the solution.

Occasionally, such a study is shortened by blood sampling on an empty stomach and 2 hours after the consumption of glucose, that is, only two times.

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

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

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

Analyzes in type 2 diabetes mellitus can be performed along with additional diagnostics, which provides an opportunity to identify the development of complications. For this purpose, the patient is recommended to remove ECG, excretory urography, examination of the fundus.

[69], [70], [71], [72], [73], [74], [75], [76], [77], [78]

Treatment

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

Treatment of subsequent stages of pathology requires the administration of medications.

Preparations

Patients with type 2 diabetes are usually prescribed antidiabetic drugs for internal use. 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 remedy, but a combination of drugs.

The most common antidiabetic drugs:

• tolbutamide (pramidex) - is able to act on the pancreas, activating the secretion of insulin. It is most suitable for elderly patients with compensatory and subcompensatory state of type 2 diabetes mellitus. Among the possible side effects - allergic reaction and transient jaundice;
• glipizide - with caution used to treat elderly, debilitated and emaciated patients with insufficient adrenal and pituitary function;
• Mannil - enhances the sensitivity of receptors that perceive insulin. Increases the production of their own insulin pancreas. The drug should be taken with one tablet, gently increasing the dosage if necessary;
• metformin - does not affect the level of insulin in the body, but is able to change pharmacodynamics by reducing the ratio of bound insulin and free insulin. It is often prescribed to patients with obesity and obesity. It is not used in the treatment of patients with impaired renal function;
• acarbose - inhibits the processes of digestion and absorption of carbohydrates in the small intestine and, in this connection, reduces the increase in the concentration of sugar in the blood after taking carbohydrate food. The medication should not be prescribed for chronic intestinal diseases, as well as during pregnancy;
• magnesium preparations - stimulate the production of insulin by the pancreas, regulate the level of sugar in the body.

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

• application of metformin with glipizide;
• the use of metformin with insulin;
• The combination of metformin with thiazolidinedione or nateglinide.

Unfortunately, in most people with type 2 diabetes, the medications listed above gradually lose their effectiveness. In such situations it is necessary to switch to the use of insulin products.

Insulin 

Insulin in type 2 diabetes mellitus may be prescribed temporarily (in certain conditions) or permanently when the previous therapy with tableted drugs is ineffective.

Undoubtedly, starting insulin therapy is necessary only with the appointment of a doctor by a doctor. He will choose the necessary dosage and plan a treatment regimen.

Insulin can be prescribed in order to make it as easy as possible to compensate for the level of sugar in the blood in order to prevent the development of complications of the disease. In what cases can a doctor transfer medication to insulin therapy:

• with unmotivated fast loss of body weight;
• with the development of complicated manifestations of the disease;
• with insufficient compensation of pathology with the usual intake of sugar-reducing medications.

The insulin preparation is determined by the treating doctor. This can be a rapid, intermediate or prolonged insulin, which is injected by subcutaneous injection in accordance with the proposed treatment scheme.

Exercises

The goal of the exercises for type 2 diabetes is to influence the stabilization of blood sugar level, to activate the action of insulin, to improve the functionality of the cardiovascular and respiratory system, to stimulate working capacity. In addition, exercise is an excellent prevention of vascular pathologies.

Exercises can be prescribed in all forms of diabetes. With the development of coronary heart disease or a heart attack on a background of diabetes, gymnastic exercises change, taking into account these diseases.

Contraindications to physical activities can be:

• high blood sugar (more than 16.5 mmol / liter);
• acetone in urine;
• precomatous condition.

Physical exercises in patients who are on bed rest, but not in the stage of decompensation, are carried out in a supine position. The rest of the patients spend their time sitting or sitting.

Begin classes with standard exercises for the muscles of the upper and lower extremities and the trunk without burdening. Next, connect classes using resistance and burden, using an expander, dumbbells (up to 2 kg), or a fitness ball.

A good effect is observed from breathing exercises. Dosage walking, cycling, rowing, swimming, skiing are also welcome.

It is very important that the patient, who engages in physical education himself, pay attention to his condition. When developing a feeling of hunger, sudden weakness, shivering in the limbs, you should finish physical exercises and eat. After the normalization of the condition for the next day, resumption of work is allowed, however, slightly reducing the load.

[79], [80], [81], [82], [83], [84], [85], [86], [87]

Diet

Despite the intake of drugs that regulate blood sugar, the dietary way to diabetes is extremely important. Sometimes the mild forms of the disease can be controlled only by diet, even without resorting to the use of medications. Among the well-known therapeutic tables, the diet for type 2 diabetes is defined as diet No. 9. The prescriptions of this diet are aimed at restoring the disturbed metabolic processes in the body.

Nutrition for type 2 diabetes  should be balanced and given the caloric intake of food. The optimal daily intake of calories depends on the body weight:

• normal weight - from 1600 to 2500 kcal;
• excess weight - from 1300 to 1500 kcal;
• Obesity 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, severe liver disease, food should be nutritious.

It is recommended to give up fast carbohydrates, limit the intake of fat and salt.

[88], [89], [90], [91], [92], [93], [94], [95], [96], [97]

Prevention

The prevention of type 2 diabetes is based on the principles of healthy eating. The use of "right" food serves as a preventive maintenance not only of diabetes, but also of all sorts of other diseases. After all, the nutrition of many modern people is now difficult to imagine without eating fast food, semi-finished products, products with a mass of preserving, coloring and other chemicals and fast sugars. Preventive measures should just be aimed at reducing, or rather excluding from our diet of all kinds of harmful food.

In addition to nutrition, you should pay attention to the degree of physical activity. If fitness or gymnastics is not for you, try to choose for yourself other loads: walking and cycling, swimming, tennis, morning jogging, dancing, etc. It is useful to go to work on foot, rather than go by transport. It is useful to climb the stairs yourself, without using an elevator. In a word, overcome your laziness and move, be active and cheerful.

By the way, an active life position and a stable emotional state are also good methods of preventing type 2 diabetes. It has long been known that chronic stress, anxiety, depressive conditions can lead to metabolic disorders, obesity and, eventually, the development of diabetes mellitus. Our emotions and our state are always closely related. Take care of the nervous system, strengthen the stress-resistance, do not react to small reasons to get you out of yourself: all this will help you to be healthy and happy.

[98], [99], [100], [101], [102], [103], [104], [105], [106]

Forecast

Unfortunately, until now, type 2 diabetes is considered an incurable chronic disease. According to statistics, every month this pathology overtakes more than 500 thousand people all over the world. Every month nearly 100,000 patients undergo limb amputation to prolong their life and stop vascular complications. We keep silent about how many people lose their eyesight each year or get other complications due to diabetes. Unfortunately, a disease such as diabetes provokes as many deaths as HIV or hepatitis.

That is why it is so important to adhere to the basic methods of prevention, regularly monitor blood sugar level, not to overeat and not overload the pancreas, not to get involved in sweets, watch your weight and lead an active lifestyle. Preventative measures must be observed by all: both healthy people and those who already have this disease. This will prevent the development of complications and will not allow diabetes to move to the next, more difficult stage.

[107], [108], [109], [110], [111], [112], [113]

Disability 

To assign or not a disability in type 2 diabetes, the medical and social expert organization decides, in which the patient is directed by his attending physician. That is, you can expect when the doctor decides that you need to register 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, does not yet give you the opportunity to get a disability. This status is provided only when certain functions of the body are disturbed, which can limit the full vital activity of the patient. Consider the criteria for disability allocation:

• Group III is provided for mild and moderate disease, with moderate disorders that impede full movement or the opportunity to work. If diabetes is in the stage of compensation, and you do not take insulin, disability is not in that case;
• Group II is given to patients with relatively severe disorders (retinopathy II-III degree, renal insufficiency, grade II neuropathy, encephalopathy, etc.);
• Group I can be provided to a severe patient with complete blindness, paralysis, severe mental disorders, severe cardiac insufficiency, and the presence of amputated limbs. Such patients in their daily life can not do without outside help.

The disability group is given after the examination of the patient by expert specialists (the so-called commission) who decide whether to assign the group for how long, and also discuss options for the necessary rehabilitation measures.

The standard appeal about disability to the expert commission should include:

• the result of a general study of urine and blood;
• the result of an analysis of the sugar content in the blood serum before and after meals;
• the result of a urine test for the presence of acetone and sugar;
• renal and hepatic biochemistry;
• ECG;
• the conclusion of the oculist, the neuropathologist, the therapist, the surgeon.

From the general documentation you may need:

• a written statement written on behalf of the patient;
• passport;
• the direction prescribed by the doctor;
• a medical record containing the entire history of your illness;
• certificate of education;
• a photocopy of the work book;
• description of labor conditions.

If you are applying for a re-grant of a disability, you also need a certificate stating that you are a disabled person, as well as a rehab program assigned to you earlier.

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Privileges 

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

What else do you have the right to:

• obtaining free syringes and sugar reducing drugs;
• preferential order of glucose tests and devices for measuring blood sugar;
• participation in social rehabilitation (facilitating working conditions, training another profession, retraining);
• Spa treatment.

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

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