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, in fact, are simply not informed that they are susceptible to the disease. And those patients who are aware of their pathology often do not know what it is - diabetes mellitus, what threatens, and they are not aware of its danger. As a result, type 2 diabetes can become serious 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 different. The second type of disease often leads to:
- wrong diet;
- lack of physical activity;
- excess weight;
- heredity;
- stress;
- self-medication with, for example, glucocorticosteroids.
In fact, there is often not one precondition, but a whole complex of reasons.
If we look at the appearance 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 condition 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 cells with glucose, and also, no less dangerous, to the accumulation of glucose in the blood and its deposition in various tissues. According to 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 largely depend 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 poor diet, chronic fatigue syndrome, stress. However, in reality, the cause is latent pathology. As the disease progresses, symptoms may include:
- poor wound healing
- weakening the immune system
- limb pain and swelling,
- headaches
- dermatitis.
However, often patients do not interpret correctly even a set of such symptoms, and diabetes develops unhindered until it reaches an incurable phase or leads to a life-threatening condition.
Type 2 diabetes mellitus, treatment
Namely, there are not enough effective methods that increase glucose absorption in cells, so the main emphasis in treatment is on lowering blood sugar levels. In addition, efforts should be focused on reducing the patient's excess weight, returning to normal, because 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. Excessive amounts of cholesterol that differ from the norm can lead to the development of angiopathy.
| Risk of developing angiopathy in diabetes | Short | Medium | 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 |
Methods of treatment
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:
- drug use,
- diet,
- lifestyle changes.
Effective treatment of type 2 diabetes involves combating not only 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 neuropathies and angiopathies, and stroke are subject to hospitalization.
Diabetes medications
In fact, all drugs 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 medicine is most often prescribed for type 2 diabetes. Without affecting the cells of the pancreas, it maintains the level of glucose in the blood at a normal level. The drug does not threaten a critically low reduction in glucose levels. Also, the drug burns fat and reduces appetite, which leads to a reduction in the patient's excess weight. However, drug overdose can be dangerous, because it can lead to a serious pathological condition with a high mortality rate - lactic acidosis.
Typical representatives of the second 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, 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 a class of drugs that promote insulin production depending on glucose concentration. These are new drugs and are quite expensive for now. They inhibit the synthesis of glucagon, a hormone that raises sugar, enhances the action of incretin - 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. It is most commonly used with ineffectiveness of other drug therapy, in the decompensated form of diabetes mellitus, when the pancreas is depleted and unable to produce enough insulin.
Type 2 diabetes is often accompanied by concomitant diseases:
- angiopathy,
- depression
- neuropathy,
- hypertension
- disorders of lipid metabolism.
If such diseases are found, then drugs are prescribed to treat them.
| Tip | Mechanism of action |
|---|---|
| Sulfonylureas | stimulation of insulin secretion |
| Glinides | stimulation of insulin secretion |
| biguanides | reduction in hepatic glucose production and tissue glucose resistance |
| Glitazone | reduction in hepatic glucose production and tissue glucose resistance |
| Alpha-glucosidase inhibitors | slow intestinal glucose absorption |
| Glucanogon-like peptide receptor agonists | stimulation of glucose-dependent insulin secretion and reduction of glucagon secretion |
| Gliptins (dipeptidyl peptidase-4 inhibitors) | stimulation of glucose-dependent insulin secretion and reduction of glucagon secretion |
| insulins | increased glucose utilization |
Diet
The essence of dietary change in DM is the regulation of nutrient intake in the gastrointestinal tract. The necessary diet should be determined by the endocrinologist individually for each patient, taking into account the severity of diabetes, comorbidities, age, lifestyle, etc.
There are several types of diets used for non-insulin independent diabetes (Table 9, low carb diets, etc. ). They have all proven themselves well and differ from each other only in some details. But they agree on a basic principle - the norms of carbohydrate intake in case of illness should be strictly limited. First of all, this refers to products that contain "fast" carbohydrates, or carbohydrates that are very quickly absorbed from the gastrointestinal tract. Fast carbohydrates are found in refined sugar, jams, confectionery, chocolate, ice cream, desserts, bakery products. In addition to reducing the amount of carbohydrates, it is necessary to strive to reduce body weight, because increased weight is a factor that complicates the course of the disease.
Other instructions
It is recommended that you increase your water intake to compensate for fluid loss due to frequent urination that often accompanies diabetes. In addition, it is necessary to completely abandon sweet drinks - cola, lemonade, yeast, juices and tea with sugar. In fact, you can drink only drinks that do not contain sugar - mineral and plain water, unsweetened tea and coffee. It must be borne in mind 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 at the table immediately after exercise.
How to monitor blood glucose levels
The essence of diabetes therapy is self-control by the patient. In type 2 diabetes, the sugar level should be within or close to normal. Therefore, the patient must control the sugar level himself to avoid critical increases. To do this, it is advisable to keep a diary in which blood glucose levels will be recorded. You can measure glucose with special portable glucometers equipped with test strips. It is recommended that the measurement procedure be performed every day. The best time to measure is early morning. It is forbidden to take any food before the procedure. If possible, the procedure can be repeated several times a day and determine the sugar level not only in the morning on an empty stomach, but also after meals, before bedtime, etc. By knowing the chart of changes in blood glucose, the patient will be able to quickly adjust his diet and lifestyle, so that the glucose indicator is in a normal state.
However, the presence of a glucometer does not relieve the patient of the need to regularly check the blood sugar level in the clinic, because the values obtained in the laboratory are more accurate.
It is not so difficult to control the level of sugar when consuming food, because most foods are marked by their energy value and the amount of carbohydrates they contain. There are diabetic analogues of conventional food, 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 |
| 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 a large amount of indigestible, but useful for digestion, fiber and less sugar. However, many vegetables, such as potatoes, beets and carrots, have a high starch content and should be limited. Fruits can be consumed in moderation, and only those that do not contain large amounts of carbohydrates. Among fruits, bananas hold the record for carbohydrate content, followed by grapes and melons. Use is not recommended because they can increase blood sugar levels.
Folk remedies
Folk remedies include taking decoctions of medicinal herbs. Such therapy can not only reduce blood glucose levels, but also reduce appetite, reduce excess weight. However, folk remedies can be taken only with medication and in consultation with your doctor.
Physical exercises
An auxiliary method of therapy is physical exercise. During moderate-intensity exercise, the body burns large amounts of glucose. Metabolism returns to normal, strengthens the cardiovascular system. Physical activity is necessary every day. However, the exercises should not be exhausting, because in that way, only the opposite effect can be achieved. With severe fatigue, appetite increases, and a hearty meal can nullify 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 would suit the patient's athletic form - simple exercises, dumbbell exercises 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 nuts |
| Rest while sitting | a hundred | apple, 20 g of nuts |
| Standing rest | 140 | a glass of milk |
| House works | 180 | a glass of milk |
| Slow walking, light field work | 220 | 120 g 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, then, as a rule, it is impossible to reverse the disease and return the glucose level to normal - due to depletion of resources of the pancreas and the body as a whole. Therefore, type 2 diabetes is an incurable disease in such a situation. However, proper treatment of type 2 diabetes can prolong a patient's life for many years. In the initial phase 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 the diet and lifestyle, and increasing physical activity. As a result, the patient can live for many decades and not face the complications of diabetes.