diabetes

Diabetes mellitus is a metabolic disorder characterized by an increase in blood sugar.

The disease occurs as a result of defects in the production of insulin, a defect in the effect of insulin or both of these factors. In addition to increased blood sugar levels, the disease manifests itself by the release of sugar in the urine, the abundant urination, an increased thirst, faults of fat, protein and mineral metabolism and the development of complications.

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1. Type -1 diabetes (autoimmun, idiopathic): Destruction of the beta cells of the pancreas that produce insulin.
2. Type -2 -Diabetes mellitus -with the prevailing insensitivity of tissues compared to insulin or a prevailing defect in insulin production with or without insensitivity.
3. Diabetes pregnancy sugar occurs during pregnancy.
4. Other types:
• genetic defects;
• Diabetes caused by medicines and other chemicals;
• Diabetes caused by infections;
• Pancreatitis, trauma, removal of the pancreas, acromegaly, Izenko - Kuskinka, thyrotoxicosis and others.

Severity

• Simple electricity: there are no complications.
• Average severity: damage the eyes, kidneys and nerves.
• Heavy electricity: distant complications of diabetes.

Symptoms of diabetes

The main symptoms of the disease are manifestations such as:

• Urinate and increased thirst;
• Increased appetite;
• General weakness;
• Skin lesions (for example vitiligo), vagina and urinary tract are particularly often observed in non -weakened patients due to the emerging immune deficiency.
• The blurring of vision is caused by changes in the flipping media of the eye.

Type -1 -Diabetes usually starts at a young age.

Type -2 diabetes are usually diagnosed in people over 35 to 40 years.

Diagnosis of diabetes

The diagnosis of the disease is based on blood and urine tests.

In order to make a diagnosis, the glucose concentration in the blood is determined (an important fact is a repeated determination of an increased sugar content and on other days).

The results of the analysis are normal (in the absence of diabetes)

On empty stomach or 2 hours after the test:

• Venous blood - 3, 3–5, 5 mmol/l;  
• Capillary blood - 3, 3–5, 5 mmol/l;
• Blood venous plasma - 4–6, 1 mmol/l.

The analysis leads to the presence of diabetes mellitus

On empty stomach:

• Venous blood more than 6, 1 mmol/l;  
• Capillary blood more than 6, 1 mmol/l;  
• The venous blood plasma is more than 7, 0 mmol/l.

At any time of the day, regardless of the time of food:

• Venous blood more than 10 mmol/l;  
• Capillary blood more than 11, 1 mmol/l;  
• The venous blood plasma is more than 11, 1 mmol/l.

6, 7–7, 5 %exceeds the level of glycated blood hemoglobin in diabetes.

With the content of the C-peptide you can evaluate the functional state of the beta cells. In patients with type 1 diabetes, this level is usually greatly increased in patients with diabetes of type 2 - normal or increased in patients with insulinoma.

The concentration of immune -reactive insulin is usually reduced with Type 1 with type 2.

The determination of the glucose concentration in the blood to diagnose diabetes is not carried out against the background of the acute illness, violation or surgical intervention against the background of short-term administration of medicinal products that concentrate in the blood (adrenal hormones, thyroid hormones, thiacides, beta blockers, etc. Cirrose, increase. Liver.

Glucose in urine in diabetes only appears after the "kidney threshold" (approx. 180 mg % 9, 9 mmol/l) appears. Significant fluctuations in the threshold and the tendency to rise with age are characteristic. Therefore, the definition of glucose in urine is regarded as an insensitive and unreliable test. The test serves as a rough reference point for the presence or lack of a significant increase in sugar (glucose) in the blood and is used in some cases to observe the dynamics of the disease.

Treatment of diabetes

Physical activity and correct nutrition in treatment

In a significant part of patients with diabetes mellitus, observes the nutritional recommendations and achieving a significant decrease in body weight by 5-10 % of the initial blood sugar indicators, the standard improve. One of the main conditions is the regularity of physical exertion (e. g. running for 30 minutes a day, swimming three times a week 1 hour). With the glucose concentration in the blood>13–15 mmol/l is not recommended for physical activity.

In the event of light and moderate physical exertion, which does not last longer than 1 hour, an additional use of carbohydrates is required before and after the load (15 g slightly digestible carbohydrates per 40 minutes). With a moderate physical exertion of more than 1 hour and intensive sports, it is necessary to reduce 20-50 % of the insulin dose that act during and in the next 6 to 12 hours after physical activity.

The nutrition in the treatment of diabetes (Table No. 9) aims to normalize carbohydrate metabolism and the prevention of fat metabolism.

Treatment with insulin preparations

Insulin preparations for the treatment of diabetes are divided into 4 categories, according to the duration of action:

• Ultra -Koro campaign (the start of the campaign -after 15 minutes the duration of the campaign is 3-4 hours).
• Fast action (the start of the campaign - after 30 minutes - 1 hour; duration of action 6-8 hours).
• The average duration of the action (the start of the campaign is after 1–2, 5 hours, the duration of the campaign is 14 to 20 hours).
• Long measures (the start of the campaign is after 4 hours; the duration of action is up to 28 hours).

Insulin's appointment modes are only individual and are selected for each patient with a dialitologist or endocrinologist.

Methodology for the introduction of insulin

If the insulin is inserted at the injection site, a skin fold must be formed so that the needle occurs under the skin and not in muscle tissue. The skin fold should be wide, the needle should get into the skin at an angle of 45 ° when the skin thickness is lower than the length of the needle.

When selecting an injection scene, compacted skin areas should be avoided. Injection sites cannot be changed unsystematically. No injections in injections under the skin of the shoulder.

• In the subcutaneous fat fiber of the front wall of the abdomen, the short insulin preparations should be administered in the subcutaneous fiber fiber 20-30 minutes before eating.
• In the subcutaneous fat fiber of the thighs or buttocks, long insulin preparations are inserted into the subcutaneous fat fiber.
• Ultra -short insulin injections are carried out immediately before eating and, if necessary, during or immediately after eating.

Warmth and physical activity increase the insulin absorption rate and the cold reduces them.