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

Diabetes mellitus is a disorder of glucose metabolism in the body associated with insulin deficiency. Glucose is an energy source for cells, while insulin is a hormone that helps cells penetrate. Without insulin, glucose remains in the blood, causing hyperglycemia and risking complications for the kidneys, eyes, nerves, heart, and blood vessels. Diabetes is incurable, but it can be managed with proper nutrition, physical activity, and medication. The endocrinologist talks about this in more detail.

Classification of diabetes

Most people only know about two types of diabetes. In fact, their number is more. Depending on the cause of the disease and the mechanism of development, the following types of pathology are distinguished:

Type 1 diabetes(insulin dependent). In this type, the pancreas cannot produce insulin due to the destruction of the beta cells that synthesize it. The reasons for this process are not fully known, but it is believed to be influenced by genetic and environmental factors. Type 1 diabetes is usually diagnosed in childhood or adolescence and requires constant insulin administration.

Diabetes mellitus type 2(non-insulin dependent). In this type of disease, the pancreas produces insulin, but the amount is insufficient to maintain normal blood glucose levels, or the cells become sensitive to it. This is due to overweight, obesity, sedentary lifestyle, poor diet and genetic predisposition. Type 2 diabetes mellitus develops mostly in adults.

Diabetes in pregnancy(pregnancy). In this type of disease, increased blood glucose levels occur during pregnancy and usually disappear after delivery. This is due to changes in hormonal levels and metabolism in a woman's body. They can cause reduced insulin production or poor insulin action. 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 caused by genetic defects, pancreatic diseases, endocrine disorders, certain drugs or infections.

Symptoms of diabetes

The classic symptoms of diabetes are associated with excess glucose in the blood. These include:

• Polyuria (frequent and abundant 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.
• It heals slowly, prone to infections.
• Visual impairment, the appearance of spots in front of the eyes.
• Numbness, tingling, pain in limbs.

Causes of diabetes

Diabetes mellitus is a multifactorial disease that can arise from various causes. Some of them are:

• 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 associated with inherited defects in the immune system.
• Obesity and overweight.Excess fat in the body leads to poor insulin action and increased blood glucose levels. Particularly dangerous is visceral fat, which surrounds internal organs and releases inflammatory mediators that disrupt metabolism.
• Poor nutrition.Consumption of large amounts of simple carbohydrates, fats, salt, alcohol, as well as the lack of complex carbohydrates, proteins, fiber, vitamins and minerals in the diet contribute to metabolic disorders and increased blood glucose levels. Regularity and frequency of meals are also important, as long intervals between meals can lead to hypoglycemia (low blood glucose levels) and frequent snacking can lead to hyperglycemia (high blood glucose levels).
• Lack of physical activity.Physical activity helps lower blood glucose levels by increasing energy expenditure and glucose uptake by cells. In addition, physical activity improves blood circulation, strengthens the cardiovascular system, increases immunity, helps to lose weight and prevents complications of diabetes.
• Stress.Stressful situations cause the release of adrenaline, cortisol and glucagon. They raise blood glucose levels, suppress insulin production, and increase inflammation. Stress can also cause disturbances in diet, sleep and physical activity.
• Diseases of the pancreas.If the pancreas is damaged due to inflammation, stones, tumors, chronic pancreatitis, it can lead to a decrease in insulin production and the development of diabetes. There are also genetic disorders that cause pancreatic dysfunction, such as cystic fibrosis, Schwartz-Bartter syndrome, Johanson-Blitzer syndrome, etc.
• Endocrine disorders.The endocrine system is a collection of organs that produce hormones that regulate various body functions. Some hormones such as glucagon, glucocorticoids, growth hormone, thyroid hormones, catecholamines oppose the effect of insulin and increase blood glucose levels.
• Taking certain medications.Some medications can increase blood glucose levels, inhibit insulin production, or decrease insulin sensitivity. These drugs include glucocorticoids, thiazide diuretics, beta-blockers, some anticonvulsants, some antivirals, some antipsychotics, and others. Taking these drugs may cause a temporary or permanent increase in blood glucose levels and may require dose adjustments or drug changes.
• Infections.Infectious diseases such as viral hepatitis, cytomegalovirus infection, chickenpox, rubella, mumps, meningitis, sepsis and others can damage the pancreas, cause inflammation and impaired insulin production. Infections can also increase the release of stress hormones that increase blood glucose levels.

Diagnosis of diabetes mellitus

Making a diagnosis requires a thorough examination. First, the patient is examined and questioned by an endocrinologist. Determines the characteristic symptoms, takes into account the circumstances of their occurrence, accompanying diseases and hereditary factors. Then a detailed examination is prescribed:

Laboratory research.The main method of diagnosis of diabetes mellitus is to determine the level of glucose in the blood. For this, the following tests are performed:

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

Instrumental research.The following studies are conducted to determine the complications of diabetes mellitus and evaluate the condition of the target organs:

• Ophthalmoscopy.This is an examination of the eye using a special device - an ophthalmoscope - which allows you to examine the retina, optic nerve and blood vessels of the eye.
• Ultrasound of the kidneys.This is an ultrasound examination of the kidneys, which allows us to evaluate their size, shape, structure, the presence of stones, tumors, cysts and inflammation.
• Dopplerography of the veins of the lower extremities.This is an ultrasound examination of the veins of the lower extremities, which allows to evaluate their lumen, walls, blood flow, the presence of blood clots, atherosclerotic plaques, narrowings and aneurysms.
• Electrocardiography (ECG).It is a study of the heart that allows to assess the heart's rhythm, conduction, contractility, ischemia, myocardial infarction, arrhythmia and blockade.

Neurological examination.It is an examination of the nervous system that allows you to assess sensitivity, reflexes, coordination, muscle tone, paresthesia, pain, and the presence of movement disorders. With diabetes mellitus, changes in the nerves such as demyelination, degeneration, and inflammation can develop, which can lead to a violation of the transmission of nerve impulses and the development of polyneuropathy, vegetative neuropathy, mononeuropathy, radiculopathy. This condition is called diabetic neuropathy.

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

During diabetes, skin changes such as xerosis, diabetic dermopathy, diabetic bullous, diabetic urticaria, diabetic angiopathy, diabetic foot may develop, which may lead to disruption of the protective function of the skin and the development of complications.

Consultations 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 required. They will help assess the patient's condition, prescribe the necessary treatment and give recommendations for prevention.

Insulin therapy for diabetes

Insulin therapy for diabetes is a treatment method in which insulin is administered externally to the patient. It is necessary for all patients with type 1 diabetes, as well as for some patients with type 2 diabetes when other treatments do not work.

What types of insulin are available and how they are used

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 ultra-short, short and extended (prolonged) action.

• 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 administered once or twice a day.
• There are also ready-made mixtures of insulins with different duration of action that are convenient for use.

Insulin is injected under the skin using special devices such as pens, pumps or inhalers. The dose of insulin is selected individually for each patient, depending on the level of blood sugar, the volume and composition of food, physical activity and other factors.

To control blood sugar, the patient should measure it regularly using a glucometer or a continuous glucose monitor.

What rules and recommendations should be followed during insulin therapy?

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

To prevent this, it is necessary to change the insulin injection sites 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

Nutrition is the most important component of treatment for diabetes. In mild forms of diabetes, sometimes only diet is enough to reach the target blood glucose level. In more severe cases, drug treatment (oral hypoglycemic agents, insulin) comes to the rescue.

The following general dietary guidelines for diabetes mellitus should be followed:

1. Food should be frequent and small(5-6 times a day), in small portions. This will help prevent large jumps in glycemic levels.
2. Meals should be taken at the same time. The same applies to glucose-lowering drugs and insulin injections.
3. Strict diets and hunger strikes are prohibited, because they can cause hypoglycemia (low blood sugar), as well as disturbances in the metabolism of fats and proteins.
4. These are preferredcooking methodssuch as: cooking, boiling, steaming and baking. Fried, smoked, salty and acidic foods should be excluded or minimized.
5. should beexclude easily digestible carbohydrates from food(sugar, honey, confectionery, jam, baked goods, white flour). They increase blood sugar rapidly and contribute to obesity. Instead, you can use sugar substitutes (xylitol, sorbitol, fructose, stevia, etc. ) in moderation.
6. Food should contain a lot of fiber,because such carbohydrates are absorbed more slowly and do not increase blood sugar so sharply. Fiber also helps to normalize the work of the intestines, reduce cholesterol and appetite. Sources of fiber include vegetables, fruits, greens, whole grain breads and cereals, legumes, nuts and seeds.
7. Limit the consumption of animal fats(butter, fat, fatty meats). They contain saturated fatty acids that increase cholesterol levels and contribute to the development of atherosclerosis and cardiovascular diseases. Preference should be given to vegetable oils (sunflower, olive, corn, etc. ) containing unsaturated fatty acids, which are beneficial for the heart and blood vessels. Fish and seafood are also useful as a source of omega-3 fatty acids, which have anti-inflammatory and anti-sclerotic effects.
8. It is advicethe caloric content of the food and the amount of carbohydrates were about 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 show how many grams of carbohydrates are in different foods.
9. should becontrol your salt intake, because excess salt can cause an increase in blood pressure, edema and deterioration of kidney function. The recommended daily intake of salt is no more than 5 g (1 teaspoon).

Nutrition for diabetes should be balanced, varied and tasty. You don't have to give up your favorite foods, just learn how to cook them properly, taking into account your situation and needs.

Diabetes mellitus is a serious disease that requires constant medical supervision and adherence to a lifestyle regimen. If you feel the symptoms of diabetes in yourself or someone close to you, do not delay going to the doctor. The sooner the diagnosis is made and the treatment is started, the less likely the complications will be and the better the prognosis of the disease.