Type 2 diabetes mellitus (DM) is a common chronic non -communicable disease. It affects both men and women, often over 40 years of age. The dangers of type 2 diabetes are underestimated by many, and some patients, in fact, are not informed that they are susceptible to the disease. And patients who are aware of their pathology often do not know what it is - diabetes mellitus, what threatens it, and are unaware of its dangers. 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 progression of the disease.
cause
When a person has diabetes, the cause of this fact can vary. The second type of disease often leads to:
- wrong diet;
- lack of physical activity;
- overweight;
- descent;
- pressure;
- self-medication with medications, for example, glucocorticosteroids.
In fact, often there is not one prerequisite, but complex reasons.
If we consider the incidence 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 the cell membrane. As a result, cells lose the ability to absorb sugar (glucose), which leads to a lack of supply of glucose to the cell, as well as, no less dangerous, to the accumulation of glucose in the blood and its deposition in various tissues. According to these criteria, insulin -independent 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, patients may not feel any serious illness, except for increased fatigue, dry mouth, increased thirst and appetite. This condition is usually associated with incorrect diet, chronic fatigue syndrome, stress. However, in fact, the cause is latent pathology. As the disease progresses, symptoms may include:
- poor wound healing
- weakness of the immune system
- pain and swelling in the limbs,
- Headache,
- dermatitis.
However, often patients do not correctly interpret even a set of such symptoms, and diabetes develops unhindered until it reaches uncontrollable levels or leads to life -threatening conditions.
Type 2 diabetes mellitus, treatment
In fact, there is no sufficiently effective method that increases the absorption of glucose by cells, so the main emphasis in treatment is to lower the concentration of sugar in the blood. In addition, efforts should be aimed at reducing the patient's excess weight, returning it to normal, as the abundance of adipose tissue plays an important role in the pathogenesis of diabetes.
The main factor influencing the possibility of complications in type 2 diabetes is a violation of lipid metabolism. Excessive amounts of cholesterol that differ from the norm can lead to the development of angiopathy.
| The risk of developing angiopathy in diabetes | Short | Middle | height |
|---|---|---|---|
| Total cholesterol, mmol/l | <4. 8 | 4. 8-6. 0 | >6. 0 |
| LDL, mmol/l | <3. 0 | 3. 0-4. 0 | >4. 0 |
| Triglyceride, mmol/l | <1. 7 | 1. 7-2. 2 | >2. 2 |
Methods of Treatment
Type 2 diabetes mellitus is a disease that requires long -term and continuous 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:
- obese
- 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 neuropathy and angiopathy, and stroke were subject to hospitalization.
Drugs against diabetes
In fact, all drugs are divided into two main groups - those that affect insulin production, and those that do not.
The main drugs of the second group are from the class of biguanides. This drug is most often prescribed for type 2 diabetes. Without affecting the pancreatic cells, it keeps blood glucose at normal levels. This drug does not threaten a very low drop in glucose levels. Also, the drug burns fat and reduces appetite, which leads to excessive weight loss of patients. However, drug overdose can be dangerous, because a serious pathological condition with a high percentage of deaths can occur - lactic acidosis.
A common representative of another group of drugs that affect insulin production are sulfonylurea derivatives. They directly stimulate the beta cells of the pancreas, causing them to produce more insulin. However, overdoses of these drugs threaten patients with hypoglycemic crises. Sulfonylurea derivatives are usually taken together with biguanides.
There are other types of medicine. Incretin mimetics (GLP-1 agonists) and DPP-4 inhibitors belong to a class of drugs that increase insulin production depending on glucose concentration. This is a new drug, and so far it is quite expensive. They inhibit the synthesis of the sugar -raising hormone glucagon, enhancing the action of incretins - gastrointestinal hormones that increase insulin production.
There are also drugs that inhibit the absorption of glucose in the gastrointestinal tract - alpha -glucosidase inhibitors. This device does not affect insulin production. These drugs are 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. 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 unable to produce enough insulin.
Type 2 diabetes is also often accompanied by comorbidities:
- angiopathy,
- depression
- neuropathy,
- hypertension
- lipid metabolism disorders.
If such diseases are found, then drugs are prescribed for their treatment.
| yes | Mechanism of action |
|---|---|
| Sulfonilurea | stimulation of insulin secretion |
| Glinides | stimulation of insulin secretion |
| biguanida | reduction of glucose production by the liver and tissue resistance to glucose |
| Glitazones | reduction of glucose production by the liver and tissue resistance to glucose |
| Alpha-glucosidase inhibitors | slow absorption of glucose in the intestine |
| Peptide receptor agonists such as glucanogon | stimulation of glucose -dependent insulin secretion and reduction of glucagon secretion |
| Glyptin (dipeptidyl peptidase-4 inhibitor) | stimulation of glucose -dependent insulin secretion and reduction of glucagon secretion |
| insulin | increased glucose utilization |
Diet
The essence of changing the diet in DM is the regulation of nutrients entering the gastrointestinal tract. The required 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 diabetes that are not insulin dependent (table number 9, low -carbohydrate diets, etc. ). All of them have proven themselves well and differ from each other only in a few details. But they agree on a basic principle - the norm of carbohydrate intake in case of disease should be strictly limited. First of all, this applies to products that contain "fast" carbohydrates, i. e. carbohydrates that are very quickly absorbed from the gastrointestinal tract. Fast carbohydrates are found in refined sugars, jams, cakes, chocolate, ice cream, desserts, baked goods. In addition to reducing the amount of carbohydrates, it is necessary to strive to lose weight, because weight gain is a factor that exacerbates the course of the disease.
Other instructions
It is recommended that you 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 sweet drinks - cola, lemonade, kvass, juice and tea with sugar. In fact, you can drink only beverages that do not contain sugar - minerals and plain water, tea and coffee without sugar. Keep in mind that drinking alcohol can also be harmful - due to the fact that alcohol interferes with glucose metabolism.
Meals should be regular - at least 3 times a day, and the best - 5-6 times a day. You should not sit at the dining 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, sugar levels should be in the normal range, or close to it. Therefore, patients need to control their own sugar levels to avoid a critical increase. To do this, it is advisable to keep a diary in which the value of the concentration of glucose in the blood will be recorded. You can take glucose measurements with a special portable glucometer equipped with a test strip. It is advisable to perform the measurement procedure every day. The best time to measure is early in the morning. Prior to the procedure, it is forbidden to take any food. If possible, the procedure can be repeated several times a day and sugar levels can be determined not only in the morning on an empty stomach, but also after meals, before bedtime, 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 indicators are in a normal state.
However, the presence of a glucometer does not relieve patients of the need to regularly check blood sugar levels in outpatient clinics, as the values obtained in the laboratory are more accurate.
It’s not that hard to control your sugar levels when consuming food, as most groceries are labeled with energy value and the amount of carbohydrates they contain. There are diabetic analogues from conventional foods, in which carbohydrates are replaced by low -calorie sweeteners (sorbitol, xylitol, aspartame).
| Pentas | Glucose level, mmol/l |
|---|---|
| The state of the norm | 3. 3-5. 5 |
| Impaired 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 large amounts of indigestible, but useful for digestion, fiber and less sugar. However, many vegetables, such as potatoes, beets and carrots, contain high levels of starch and should be limited. Fruits can be eaten in moderation, and only fruits 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.
Restoration of the people
Folk remedies involve the intake of 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 the intake of medications and consult your doctor.
Physical training
An additional method of therapy is physical exercise. During moderate intensity exercise, the body burns large amounts of glucose. Metabolism returns to normal, the cardiovascular system is strengthened. Physical exercise is important every day. However, training 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 causes stress and the release of adrenal hormones, which increase blood glucose levels. Therefore, it is recommended to choose the type of physical activity that suits the athletic form of the patient - simple exercises, exercises with dumbbells or walking, jogging, swimming, cycling.
| Type of activity | Kos, kcal/h | Foods that contain the same amount of energy |
|---|---|---|
| Lie down | 80 | apples, 20 g of nuts |
| Sit down | a hundred | apples, 20 g of nuts |
| Stand up to rest | 140 | a glass of milk |
| Homework | 180 | a glass of milk |
| Walk slowly, work lightly in the field | 220 | 120 g ice cream |
| Cycling | 250 | 100 g of white bread |
| Walk fast, swim slow, dance slow, paddle | 300 | 150 g of black bread |
| Volleyball, badminton, table tennis | 350 | 90 g of biscuits or cheese |
Prediction
In severe cases, when type 2 diabetes mellitus reaches a stage of decompensation, then, as a rule, it is impossible to reverse the disease and return glucose levels to normal - due to lack of resources of the pancreas and the body as a whole. Therefore, type 2 diabetes in such circumstances is an incurable disease. However, proper treatment of type 2 diabetes can prolong a patient’s life for many years. In the early stages of type 2 diabetes mellitus, it is possible to control the concentration of glucose in the blood and keep it within acceptable limits only by changing diet and lifestyle, and increasing physical activity. As a result, patients can live for decades and not face any complications of diabetes.