Type 2 diabetes mellitus (DM) is a common, non-communicable chronic disease. It affects both men and women, most often over the age of 40. The risk of type 2 diabetes is underestimated by many, and some patients are actually simply 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, 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, in type 2 diabetes, proper treatment and proper nutrition can stop the disease from developing.
Cause
If someone develops diabetes, the reasons for this fact can be varied. The second type of disease often leads to:
- improper diet;
- lack of physical activity;
- overweight;
- heredity;
- tension;
- self-medication with medications such as glucocorticosteroids.
In fact, it is often not a precondition but a whole complex of causes.
If the incidence of the disease is considered in terms of pathogenesis, the cause of type 2 diabetes mellitus is the relative lack of insulin in the blood. This is the name given to a condition in which the insulin protein produced by the pancreas becomes inaccessible to the insulin receptors on cell membranes. As a result, the cells are deprived of the ability to absorb sugar (glucose), which leads to a lack of glucose supply to the cells, and which is no less dangerous, glucose accumulates in the blood and is deposited in the blood. various fabrics. With this criterion, non-insulin-dependent diabetes mellitus differs from type 1 diabetes, in which the pancreas does not produce enough insulin.
Symptoms
The symptoms of the disease are highly dependent on the stage of the disease. In the early stages, the patient may not feel serious illness except for increased fatigue, dry mouth, increased thirst, and appetite. This condition is usually attributed to malnutrition, chronic fatigue syndrome, stress. In reality, however, 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
- headache,
- dermatitis.
However, patients often do not correctly interpret even such symptoms, and diabetes develops unhindered until it reaches an unattainable stage or leads to life-threatening conditions.
Type 2 diabetes mellitus, treatment
In fact, there are not enough effective methods to increase the absorption of glucose cells, so the main focus during treatment is on lowering blood sugar. In addition, efforts should be made to reduce and restore the patient's excess weight, as abundance of adipose tissue plays an important role in the pathogenesis of diabetes.
The main factor influencing the likelihood of complications of type 2 diabetes is a violation of lipid metabolism. Excessive amounts of cholesterol that are abnormal can lead to the development of angiopathy.
| Risk of developing angiopathy in diabetes | Short | Middle | 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, 2 | >2. 2 |
Treatment methods
Type 2 diabetes mellitus is a disease that requires long-term and long-term treatment. In fact, all the methods used can be divided into three groups:
- to take drugs
- diet,
- lifestyle change.
Effective treatment for type 2 diabetes not only combats diabetes itself, but also comorbidities 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 should be hospitalized.
Medicines for diabetes
In fact, all drugs are divided into two main groups - those that affect insulin production and those that do not.
The main drug in the second group comes from the class of biguanides. This medicine is most commonly prescribed for the treatment of type 2 diabetes. Without affecting the cells in your pancreas, it keeps your blood sugar levels at a normal level. The drug does not threaten a critically low decrease in glucose levels. In addition, the drug burns fats and reduces appetite, leading to a reduction in the patient's overweight. However, overdose can be dangerous, as it can lead to a serious condition and a high mortality rate - lactic acidosis.
Typical members of another class of drugs that affect insulin production are sulfonylureas. They directly stimulate the beta cells of the pancreas, thereby producing more insulin. However, overdose of these drugs threatens the patient with a hypoglycemic crisis. Sulfonylureas are usually taken with biguanides.
There are other types of medications as well. Incretin mimetics (GLP-1 agonists) and DPP-4 inhibitors belong to a group of drugs that increase insulin production depending on glucose concentration. These are new drugs and have been quite expensive so far. They inhibit the synthesis of glucagon, a sugar-lifting hormone, and increase the effects of incretins, hormones that increase the production of insulin in the gastrointestinal tract.
There is also a drug that prevents the absorption of glucose in the gastrointestinal tract - an alpha-glucosidase inhibitor. This device does not affect insulin production. The drug is often prescribed for prophylactic purposes to prevent diabetes.
There are also drugs that increase the urinary excretion of glucose and drugs that increase the glucose sensitivity of cells.
Medical insulin is rarely used to treat type 2 diabetes. It is most commonly used in the ineffective treatment of other drugs, with a decompensated form of diabetes, when the pancreas is exhausted and cannot produce enough insulin.
Diseases often associated with type 2 diabetes are also accompanied by:
- angiopathy,
- depression
- neuropathies,
- hypertension
- lipid metabolism disorders.
If such diseases are found, medications are prescribed to treat them.
| type | Mechanism of action |
|---|---|
| Sulfonylureas | stimulation of insulin secretion |
| Glinides | stimulation of insulin secretion |
| biguanides | decreased hepatic glucose production and tissue glucose resistance |
| Glitazones | decreased hepatic glucose production and tissue glucose resistance |
| Alpha-glucosidase inhibitors | slow absorption of glucose in the gut |
| Glucanogon-like peptide receptor agonists | glucose-dependent stimulation of insulin secretion and reduction of glucagon secretion |
| Gliptins (dipeptidyl peptidase-4 inhibitors) | glucose-dependent stimulation of insulin secretion and reduction of glucagon secretion |
| insulins | increased glucose intake |
Diet
In DM, the essence of dietary change is to regulate the entry of nutrients into the digestive tract. The nutrition required by the endocrinologist should be determined individually for each patient, taking into account the severity of the diabetes, comorbidities, age, lifestyle, and so on.
There are several diets in non-insulin dependent diabetes (Table 9, low carb diet, etc. ). Each is well-proven and differs in only a few details. But they agree in principle - carbohydrate intake standards should be strictly limited in the event of illness. This is especially true for products that contain "fast" carbohydrates, that is, carbohydrates that are absorbed very quickly from the gastrointestinal tract. Fast carbohydrates are found in refined sugar, jams, sweets, chocolate, ice cream, desserts, and baked goods. In addition to reducing the amount of carbohydrates, efforts should also be made to reduce body weight, as weight gain is a factor that exacerbates the course of the disease.
Other instructions
Increased water intake is recommended to compensate for the loss of fluid due to frequent urination, which is often associated with diabetes. At the same time, sugary drinks - cola, lemonade, kvass, juices and tea with sugar - should be completely eliminated. In fact, you can only drink drinks that do not contain sugar - mineral water and plain water, unsweetened tea and coffee. It should be recalled that alcohol consumption can also be harmful - as alcohol disrupts glucose metabolism.
Meals should be regular - at least three times a day and best of all - 5-6 times a day. You should not sit down at a table immediately after a workout.
How to monitor blood sugar levels
The essence of diabetes therapy is patient self-control. In type 2 diabetes, the sugar level should be within or close to the normal range. Therefore, the patient should self-regulate their blood sugar levels to avoid a critical rise. To do this, it is advisable to keep a diary in which your blood glucose levels are recorded. You can measure glucose with special portable glucometers with test strips. It is advisable to perform the measurement procedure every day. The best time to measure is early in the morning. Do not eat food before the procedure. If possible, the procedure can be repeated several times a day and the sugar level should be checked not only in the morning on an empty stomach, but also after a meal, before going to bed, etc. Knowing the graph of changes in blood sugar levels, the patient can quickly adjust their diet and lifestyle to keep the glucose indicator normal.
However, the presence of a glucometer does not relieve the patient from regular blood glucose monitoring at the outpatient clinic, as the values obtained in the laboratory are more accurate.
It is not so difficult to control sugar levels while consuming foods, as most foods are labeled with energy and carbohydrates. There are diabetic analogues of traditional foods in which carbohydrates are replaced by low-calorie sweeteners (sorbitol, xylitol, aspartame).
| Stage | Glucose level, mmol / l |
|---|---|
| The state of the norm | 3, 3-5, 5 |
| Decreased glucose tolerance | 5, 6-6, 0 |
| Diabetes, early stage | 6, 1-8, 0 |
| Diabetes mellitus, middle stage | 8, 1-14, 0 |
| Diabetes, severe stage | >14. 1 |
Fruits and vegetables
Can I Eat Fruit And Berries In 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, are high in starch and should be restricted. Fruits can be consumed in moderation and only those that do not contain too many carbohydrates. Among the fruits, bananas hold the record in terms of carbohydrate content, followed by grapes and melons. Its use is not recommended as they may increase your blood sugar.
Folk remedies
Folk remedies include taking decoctions of herbs. Such therapy can not only lower blood sugar, but also reduce appetite, reduce excess weight. However, folk remedies should only be taken while taking the medication and after consulting a doctor.
Exercise
An additional method of therapy is physical exercises. During a moderate-intensity workout, the body burns large amounts of glucose. Metabolism is normalized and the cardiovascular system is strengthened. Exercise every day is essential. However, the exercises cannot be exhaustive, because only the opposite effect can be achieved. Excessive fatigue increases appetite, and a hearty meal can nullify all the positive effects of physical activity. Fatigue causes stress and the release of adrenal hormones, which increases blood sugar levels. Therefore, it is advisable to choose physical activity appropriate to the patient’s athletic form - simple exercises, weight training or walking, jogging, swimming, cycling.
| A kind of activity | Costs, kcal / h | Foods with similar amounts of energy |
|---|---|---|
| Relax while lying down | 80 | apples, 20 g nuts |
| Relax while sitting | hundred | apples, 20 g nuts |
| Standing rest | 140 | a glass of milk |
| Housework | 180 | a glass of milk |
| Slow walking, easy indoor work | 220 | 120 g of ice cream |
| Cycling | 250 | 100 g of white bread |
| Fast walking, slow swimming, slow dancing, rowing | 300 | 150 g of 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, it is usually already impossible to reverse the disease and normalize glucose levels - due to depletion of pancreatic and body resources. a whole. Therefore, type 2 diabetes is an incurable disease in this situation. However, proper treatment for type 2 diabetes can extend a patient’s life for years. In the early stages of type 2 diabetes mellitus, blood glucose levels can only be controlled and kept within acceptable limits by changing diet and lifestyle and increasing physical activity. As a result, the patient can live for many decades and does not have to face the complications of diabetes.