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

Diabetes is a disorder of glucose metabolism in the body, which is associated with a lack of insulin. Glucose is the energy source of the cells, and insulin is the hormone that helps it enter the cells. Without insulin, glucose remains in the blood, causing hyperglycemia and the risk of complications in the kidneys, eyes, nerves, heart, and blood vessels. Diabetes is incurable, but can be controlled with proper diet, physical activity and medication. An endocrinologist will discuss this in more detail.

Classification of diabetes

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

Type 1 diabetes mellitus(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 understood, but are believed to be influenced by genetic and environmental factors. Type 1 diabetes is usually diagnosed in childhood or adolescence and requires a constant dose of insulin.

Type 2 diabetes mellitus(not insulin dependent). In this type of disease, the pancreas produces insulin, but the amount is insufficient 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 mellitus most often develops in adults.

Diabetes mellitus during pregnancy(pregnancy). In this type of disease, the increase in blood sugar occurs during pregnancy and usually disappears after delivery. This is due to changes in the hormonal level and metabolism of the female body. They can lead to reduced insulin production or a weaker insulin effect. Women with 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 as a result of 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. These include:

• Polyuria (frequent and copious 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 in front of the eyes.
• Numbness, tingling, pain in the limbs.

Causes of diabetes

Diabetes mellitus is a multifactorial disease that can occur for 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.
• Poor nutrition.The consumption of large amounts of simple carbohydrates, fats, salt, and 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. The regularity and frequency of meals is also important, since long breaks between meals can lead to hypoglycemia (low blood sugar), and frequent snacking can lead to hyperglycemia (increased blood sugar).
• Lack of physical activity.Physical activity helps lower blood sugar levels by increasing cellular energy use and glucose uptake. In addition, physical activity improves blood circulation, strengthens the cardiovascular system, improves immunity, promotes weight loss and prevents complications of diabetes.
• Tension.Stressful situations trigger the release of adrenaline, cortisol and glucagon. They increase blood sugar, 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 a decrease in insulin production and the development of diabetes mellitus. There are also genetic disorders that lead to pancreatic dysfunction, such as cystic fibrosis, Schwartz-Bartter syndrome, Johanson-Blitzer syndrome, and others.
• Endocrine disorders.The endocrine system is a set of organs that produce hormones that regulate various body functions. Certain hormones, such as glucagon, glucocorticoids, growth hormone, thyroid hormones, catecholamines, counteract the effects 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 medications 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, chicken pox, rubella, mumps, meningitis, sepsis and others can damage the pancreas, causing inflammation and insulin production. Infections can also increase the release of stress hormones that increase blood sugar levels.

Diagnosis of diabetes mellitus

Establishing a diagnosis requires a comprehensive examination. Initially, the patient is examined and interviewed by an endocrinologist. It defines the characteristic symptoms, takes into account the circumstances of their occurrence, accompanying diseases, and hereditary factors. A detailed examination is then prescribed:

Laboratory research.The main method of diagnosing diabetes mellitus is to determine the blood sugar level. To this end, the following tests are performed:

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

Instrumental research.To identify the complications of diabetes mellitus and to assess the state of the target organs, we perform the following tests:

• Ophthalmoscopy.This is an examination of the eye with a special device - an ophthalmoscope, which allows examination of 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 veins of the lower limbs.This is an ultrasound examination of the vessels of the lower extremities, which allows to evaluate the presence of their lumen, walls, blood flow, blood clots, atherosclerotic plaques, strictures and aneurysms.
• Electrocardiography (ECG).This is an examination of the heart that allows you to evaluate its rhythm, conductivity, contractility, the presence of ischemia, myocardial infarction, arrhythmia and blockade.

Neurological examination.This is a test of the nervous system that allows you to evaluate sensation, reflexes, coordination, muscle tone, paresthesia, pain, and movement disorders. In the case of diabetes, changes in the nerves can develop, such as demyelination, degeneration, inflammation, which can lead to a disturbance in the transmission of nerve impulses and the development of polyneuropathy, autonomic neuropathy, mononeuropathy, and radiculopathy. This condition is called diabetic neuropathy.

Dermatology examination.This is a skin test that allows you to evaluate the color, turgor, moisture content of the skin, the presence of wounds, cracks, ulcers, fungal, bacterial, viral infections, allergic reactions, pigmentation, atrophy, scleroderma, acanthosis.

In case of diabetes, skin changes can develop, such as xerosis, diabetic dermopathy, diabetic bullosis, diabetic urticaria, diabetic angiopathy, diabetic foot, which can lead to disruption of the protective function of the skin and the development of complications.

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

Diabetes insulin therapy

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 ultrashort, short and prolonged (prolonged) acting insulins.

• Ultra-short 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 a basal level of insulin in the blood throughout the day and are given once or twice a day.
• There are also ready-mixed insulins of different strengths that are convenient to use.

Insulin is injected under the skin using special devices such as a pen, pump or inhaler. The dose of insulin is selected individually for each patient, depending on the blood sugar level, the amount and composition of food, physical activity and other factors.

In order to control the blood sugar level, the patient must measure it regularly with a glucometer or a continuous glucose monitor.

What rules and recommendations must be followed during insulin therapy?

Insulin therapy requires strict adherence to diet, physical therapy and doctor's recommendations. During insulin therapy, side effects are possible, such as hypoglycemia (low blood sugar), allergic reactions, lipodystrophy - a violation of subcutaneous fat distribution that can occur at the site of frequent insulin injections.

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

Nutrition for diabetes

Diabetes nutrition is the most important component of treatment. In mild forms of diabetes, diet alone is sometimes sufficient to reach the target blood sugar level. In more severe cases, drug treatment (oral hypoglycemic agents, insulin) helps.

The following general dietary rules should be followed in case of diabetes:

1. Meals should be frequent and small(5-6 times a day), in small doses. This helps avoid large spikes in glycemic levels.
2. Meals should be eaten at the same time. The same applies to taking glucose-lowering drugs and insulin injections.
3. Strict diets and hunger strikes are prohibited, as they can lead to hypoglycemia (low blood sugar) and disturbances in the metabolism of fats and proteins.
4. These are preferredcooking methodssuch as: steaming, boiling, steaming and baking. Fried, smoked, salted and pickled foods should be excluded or minimized.
5. Shouldremove easily digestible carbohydrates from food(sugar, honey, sweets, jam, baked goods, white flour). They quickly increase blood sugar levels and contribute to obesity. Instead, you can use sugar substitutes in moderation (xylitol, sorbitol, fructose, stevia, etc. ).
6. Foods should contain a large amount of fiber,since such carbohydrates are absorbed more slowly and do not raise the blood sugar level as sharply. Fibers help normalize bowel function, reduce cholesterol and appetite. Sources of fiber include vegetables, fruits, herbs, whole grain breads and cereals, legumes, nuts and seeds.
7. Limit the consumption of animal fats(butter, lard, fatty meats). They contain saturated fatty acids, which increase cholesterol levels and contribute to atherosclerosis and coronary heart disease. Preference should be given to vegetable oils (sunflower, olive, corn, etc. ), which contain unsaturated fatty acids, which have a beneficial effect on 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 properties.
8. It is appropriate thatthe calorie content and carbohydrate content of the foods were approximately 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 indicate how many grams of carbohydrates are contained in different foods.
9. Shouldregulates salt intake, as excessive salt content can lead to increased blood pressure, edema and deterioration of kidney function. The recommended daily salt intake should not exceed 5 g (1 teaspoon).

Diabetes nutrition 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 is a serious disease that requires constant medical monitoring and adherence to a lifestyle regimen. If you notice signs of diabetes in yourself or a loved one, do not delay in seeing a doctor. The sooner the diagnosis is made and the treatment started, the less likely complications are and the better the prognosis of the disease.