Type 2 diabetes mellitus (DM) is a common noncommunicable chronic 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 informed that they are susceptible to the disease. And those of the patients who are aware of their pathology often do not know what it is - diabetes mellitus, what it threatens, and are unaware of its danger. As a result, type 2 diabetes can become severe and lead to life-threatening conditions. Meanwhile, adequate treatment and proper nutrition in type 2 diabetes can stop the development of the disease.
Causes
When a person develops diabetes, the causes of this fact can be varied. The second type of disease often leads to:
- wrong diet;
- lack of physical activity;
- excess weight;
- heredity;
- stress;
- self-medication with drugs, for example, glucocorticosteroids.
In fact, often there is not one prerequisite, but a whole complex of reasons.
If we consider the occurrence of the disease from the point of view of pathogenesis, then type 2 diabetes mellitus is caused by a relative lack of insulin in the blood. This is the name of the state when 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 supply of glucose to cells, and also, which 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
Symptoms of the disease largely depend on the stage of the disease. In the early stages, the patient may not feel a serious ailment, 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:
- poor wound healing
- weakening of the immune system
- pain and swelling in the limbs,
- headaches,
- dermatitis.
However, often patients 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 the absorption of glucose by cells, so the main emphasis in treatment is on lowering blood sugar levels. In addition, efforts should be aimed at reducing the patient's excess weight, bringing it 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 excess amount of cholesterol that differs from the norm can lead to the development of angiopathy.
| The risk of developing angiopathy in diabetes | Short | Middle | Tall |
|---|---|---|---|
| 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. 2 | >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:
- taking drugs,
- diet,
- lifestyle change.
Effective treatment of type 2 diabetes involves the fight not only with diabetes itself, but also with 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 angiopathy, and strokes are subject to hospitalization.
Drugs against diabetes
In fact, all medications are divided into two main groups - those that affect the production of insulin, and those that do not.
The main drug of the second group is from the class of biguanides. This drug is most often prescribed for type 2 diabetes. Without affecting the cells of the pancreas, it maintains blood glucose at normal levels. The drug does not threaten a critically low decrease in glucose levels. Also, the medicine burns fats 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 can occur - lactic acidosis.
Typical representatives of another group of drugs that affect the production of insulin are sulfonylurea derivatives. They directly stimulate the pancreatic beta cells, causing them to produce more insulin. However, an overdose of these drugs threatens the patient with a hypoglycemic crisis. Sulfonylurea derivatives are usually 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 enhance 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, enhance 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 the production of insulin. The drug is often prescribed for prophylactic purposes, to prevent diabetes.
There are also medicines that enhance 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 the ineffectiveness of therapy with other drugs, with a decompensated form of diabetes mellitus, when the pancreas is depleted 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, then drugs are prescribed for their treatment.
| Type | Mechanism of action |
|---|---|
| Sulfonylureas | stimulation of insulin secretion |
| Glinides | stimulation of insulin secretion |
| biguanides | decrease in glucose production by the liver and tissue resistance to glucose |
| Glitazones | decrease in glucose production 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 decrease in glucagon secretion |
| Gliptins (dipeptidyl peptidase-4 inhibitors) | glucose-dependent stimulation of insulin secretion and decrease in glucagon secretion |
| insulins | increased glucose utilization |
Diet
The essence of changing the diet in DM is the regulation of nutrients entering the gastrointestinal tract. The necessary nutrition should 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 proven themselves well and differ from each other only in some details. But they agree on the basic principle - the norms of carbohydrate intake in case of illness should be strictly limited. First of all, this applies to products containing "fast" carbohydrates, that is, carbohydrates that are very quickly absorbed from the gastrointestinal tract. Fast carbohydrates are found in refined sugar, jams, confectionery, chocolate, ice cream, desserts, baked goods. In addition to reducing the amount of carbohydrates, it is necessary to strive to reduce body weight, since increased weight is a factor that aggravates the course of the disease.
Other instructions
It is recommended that you increase your water intake to replace the fluid lost during frequent urination, which 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 drink only drinks that do not contain sugars - mineral and plain water, unsweetened tea and coffee. It must be remembered that drinking alcohol can also be harmful - due to the fact that alcohol disrupts 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 down at the dinner table immediately after exercise.
How to monitor blood glucose levels
The essence of diabetes therapy is self-control on the part of the patient. With type 2 diabetes, the sugar level should be within the normal range, or close to it. Therefore, the patient needs to control his sugar level on his own in order to avoid critical increases. To do this, it is advisable to keep a diary in which the values \u200b\u200bof the concentration of glucose in the blood will be recorded. You can take glucose measurements with special portable glucometers equipped with test strips. It is advisable to perform the measurement procedure every day. The best time to measure is early morning. Before the procedure, it is forbidden to take 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 going to bed, etc. Knowing the graph of changes in blood glucose, the patient will be able to quickly adjust his diet and lifestyle, so that the glucose indicator would be in the normal state.
However, the presence of a glucometer does not relieve the patient of the need to regularly check blood sugar levels in the outpatient clinic, since the values obtained in the laboratory are more accurate.
It's not that hard 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 |
|---|---|
| State of the norm | 3. 3-5. 5 |
| Impaired glucose tolerance | 5. 6-6. 0 |
| Diabetes, early stage | 6. 1-8. 0 |
| Diabetes, middle 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 to 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 medications and in consultation with your doctor.
Physical exercise
An auxiliary method of therapy is physical exercises. During moderate-intensity exercise, the body burns large amounts of glucose. The 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 hearty meal can negate all the positive effects of physical activity. Fatigue provokes stress and the release of adrenal hormones, which increases blood glucose levels. Therefore, it is recommended to select the type of physical activity that would suit the patient's athletic form - simple exercises, exercises with dumbbells or walking, jogging, swimming, cycling.
| Kind of activity | Costs, kcal/h | Foods containing a similar amount of energy |
|---|---|---|
| Rest lying down | 80 | apple, 20 g nuts |
| Rest sitting | one hundred | apple, 20 g nuts |
| Standing rest | 140 | a glass of milk |
| Household chores | 180 | a glass of milk |
| Slow walking, light infield work | 220 | 120 g ice cream |
| Biking | 250 | 100 g white bread |
| Fast walking, slow swimming, slow dancing, rowing | 300 | 150 g black bread |
| Volleyball, badminton, table tennis | 350 | 90 g biscuits 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. At the initial stage of type 2 diabetes mellitus, it is possible to control the concentration of glucose in the blood and maintain it within acceptable limits only by changing the diet and lifestyle, and increasing physical activity. As a result, the patient can live for many decades and not face any complications of diabetes.