Type 2 diabetes mellitus (DM) is a common chronic non-communicable disease. It affects both men and women, most often over the age of 40. The danger of type 2 diabetes is underestimated by many, and some patients, in fact, are simply not told that they are susceptible to the disease. And those of patients who are aware of its pathology often do not know what it is - diabetes mellitus, which threatens and are unaware of its danger. As a result, type 2 diabetes can become serious and lead to life-threatening conditions. Meanwhile, proper treatment and proper nutrition in type 2 diabetes can prevent the disease from developing.
Causes
When a person develops diabetes, the causes of this fact can be varied. The second type of disease usually leads to:
- wrong diet;
- lack of physical activity;
- overweight;
- heredity;
- stress;
- self-medication with drugs, eg glucocorticosteroids.
In fact, there is often no prerequisite, but a whole complex of reasons.
If we consider the occurrence of the disease from the point of view of pathogenesis, type 2 diabetes mellitus is caused by a relative lack of insulin in the blood. This is the name of the state in which the insulin protein produced by the pancreas becomes inaccessible to insulin receptors located on cell membranes. As a result, cells are deprived of the ability to absorb sugar (glucose), which leads to a lack of glucose supply to the cells and also, what is no less dangerous, to the accumulation of glucose in the blood and its deposition in various tissues. By this criterion, non-insulin-dependent diabetes mellitus differs from type 1 diabetes, in which the pancreas produces insufficient insulin.
Symptoms
The symptoms of the disease largely depend on the stage of the disease. In the early stages, the patient may not experience a serious illness, with the exception of increased fatigue, dry mouth, increased thirst and appetite. This condition is usually attributed to the wrong diet, chronic fatigue syndrome, stress. However, in fact, the cause is a latent pathology. As the disease progresses, symptoms may include:
- bad healing
- weakening of the immune system
- pain and swelling in the limbs,
- headaches,
- dermatitis.
However, patients often do not correctly interpret even a set of such symptoms, and diabetes develops unhindered until it reaches intractable stages or leads to life-threatening conditions.
Type 2 diabetes mellitus, treatment
In fact, there are no sufficiently effective methods that increase glucose uptake by cells, so the main emphasis in treatment is on reducing blood sugar concentration. Furthermore, efforts should be directed towards reducing the patient's excess weight, bringing him back to normal, since the abundance of adipose tissue plays an important role in the pathogenesis of diabetes.
The main factor influencing the likelihood of complications in type 2 diabetes is a violation of lipid metabolism. An excessive amount of cholesterol that differs from the norm can lead to the development of angiopathy.
| The risk of developing angiopathy in diabetes | Short | Quite | High |
|---|---|---|---|
| Total cholesterol, mmol/l | <4, 8 | 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. two | >2, 2 |
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:
- using drugs,
- diet,
- lifestyle change.
Effective treatment of type 2 diabetes involves fighting not only the diabetes itself, but also concomitant diseases such as:
- obesity,
- hypertension,
- angiopathy,
- neuropathy,
- depression.
Type 2 diabetes is treated on an outpatient basis and at home. Only patients with hyperglycemic and hyperosmolar coma, ketoacidosis, severe forms of neuropathies and angiopathies, and stroke are subject to hospitalization.
Medicines against diabetes
In fact, all medications are divided into two main groups - those that affect insulin production and those that do not.
The main drug of the second group is from the biguanide class. This medication is most often prescribed for type 2 diabetes. Without affecting the cells of the pancreas, it keeps blood glucose at normal levels. The drug does not threaten a critically low decrease in glucose levels. In addition, 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, as a serious pathological condition with a high percentage of mortality - lactic acidosis can occur.
Typical representatives of another group of drugs that affect insulin production are sulfonylurea derivatives. They directly stimulate pancreatic beta cells, causing them to produce more insulin. However, an overdose of these drugs threatens the patient with a hypoglycemic crisis. Sulphonylurea derivatives are generally taken together 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 depending on glucose concentration. These are new drugs and so far they are quite expensive. They inhibit the synthesis of the sugar-raising hormone glucagon, increase 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 sensitivity of cells to glucose.
Medical insulin is rarely used in the treatment of type 2 diabetes. Most often it is used with ineffective 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
- lipid metabolism disorders.
If such diseases are found, drugs are prescribed for their treatment.
| Type | Mechanism of action |
|---|---|
| sulfonylureas | stimulation of insulin secretion |
| Glinides | stimulation of insulin secretion |
| biguanides | decreased production of glucose by the liver and tissue resistance to glucose |
| Glitazones | decreased production of glucose 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 decreased glucagon secretion |
| Gliptins (dipeptidyl peptidase-4 inhibitors) | glucose-dependent stimulation of insulin secretion and decreased glucagon secretion |
| insulins | increased use of glucose |
Diet
The essence of dietary change in DM is the regulation of nutrients entering the gastrointestinal tract. The nutrition needed must be determined by the endocrinologist individually for each patient, taking into account the severity of diabetes, concomitant diseases, age, lifestyle, etc.
There are several types of diets used for non-insulin-dependent diabetes (table number 9, low carbohydrate diet, etc. ). All of them have proved themselves well and differ from each other only in a few details. But they agree with the basic principle - the norms of carbohydrate intake in case of illness should be strictly limited. First of all, this applies to products that contain "fast" carbohydrates, that is, carbohydrates that are absorbed very quickly from the gastrointestinal tract. Fast carbs are found in refined sugar, jellies, confectionery, chocolate, ice cream, desserts, baked goods. In addition to reducing the amount of carbohydrates, it is necessary to strive to reduce body weight, as weight gain is a factor that exacerbates the course of the disease.
Other instructions
It is recommended to increase your water intake to replace fluid loss due to frequent urination that often accompanies diabetes. Along with this, it is necessary to completely abandon sugary drinks - cola, lemonade, kvass, juices and tea with sugar. In fact, you can only drink drinks that do not contain sugar - mineral and pure water, tea and coffee without sugar. It must be remembered that alcohol consumption can also be harmful - due to the fact that alcohol interrupts glucose metabolism.
Meals should be regular - at least 3 times a day, and best of all - 5-6 times a day. You should not sit at the dinner table immediately after exercising.
How to monitor blood glucose levels
The essence of diabetes therapy is self-control on the part of the patient. In type 2 diabetes, the sugar level must be within or close to the normal range. Therefore, the patient needs to control their sugar level on their own to avoid critical increases. To do this, it is advisable to keep a diary in which blood glucose concentration values will be recorded. You can take glucose measurements with special portable glucometers equipped with test strips. It is advisable to carry out the measurement procedure every day. The best time to measure is early in the morning. Before the procedure, it is forbidden to eat any food. 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 bed, etc. Knowing the blood glucose changes graph, the patient can quickly adjust his diet and lifestyle, so that the glucose indicator stays in the normal state.
However, the presence of a glucometer does not relieve the patient of the need to regularly check blood glucose levels in the clinic, as the values obtained in the laboratory are more accurate.
It's not that difficult to control your sugar levels when consuming food, as most grocery items 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 by low-calorie sweeteners (sorbitol, xylitol, aspartame).
| Stage | Glucose level, mmol/l |
|---|---|
| norm status | 3, 3-5, 5 |
| Decreased 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 indigestible, but useful for digestion, fiber and less sugar. However, many vegetables such as potatoes, beets and carrots are high in starch and should be limited. Fruits can be consumed in moderation, and only those that do not contain very high amounts of carbohydrates. Among fruits, bananas hold the record for carbohydrate content, followed by grapes and melons. They are not recommended for use as they can increase blood sugar levels.
Folk remedies
Folk remedies involve taking decoctions of medicinal herbs. Such therapy can not only lower blood glucose levels, but also reduce appetite, reduce excess weight. However, folk remedies can only be taken in addition to taking medication and consulting your doctor.
Physical exercise
An auxiliary method of therapy is physical exercises. During moderate-intensity exercise, the body burns large amounts of glucose. Metabolism returns to normal, the cardiovascular system is strengthened. Physical exercise is essential every day. However, the exercises should not be exhausting as this can only achieve the opposite effect. With severe fatigue, appetite increases and a healthy meal can negate all the positive effects of physical activity. Fatigue causes stress and the release of adrenal hormones, which increases blood glucose levels. Therefore, it is recommended to select the type of physical activity that suits the patient's athletic form - simple exercises, exercises with dumbbells or walking, running, swimming, cycling.
| type of activity | Costs, kcal/h | Foods that contain a similar amount of energy |
|---|---|---|
| rest lying down | 80 | apple, 20 g of walnuts |
| rest seated | hundred | apple, 20 g of walnuts |
| standing rest | 140 | a glass of milk |
| Housework | 180 | a glass of milk |
| Slow walking, light field work | 220 | 120g of ice cream |
| Cycling | 250 | 100 g white bread |
| Fast walking, slow swimming, slow dancing, rowing | 300 | 150 g of black bread |
| Volleyball, badminton, table tennis | 350 | 90 g crackers or cheese |
Forecast
In severe cases, when type 2 diabetes mellitus reaches the stage of decompensation, then, as a rule, it is 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, type 2 diabetes in such a situation is an incurable disease. However, the correct treatment of type 2 diabetes can prolong the patient's life for many years. In the initial phase of type 2 diabetes mellitus, it is possible to control blood glucose concentration and keep it within acceptable limits just by changing diet and lifestyle and increasing physical activity. As a result, the patient can live for many decades and not face any complications from diabetes.