Type 2 diabetes mellitus (DM) is a common non-communicable chronic disease. Affects both men and women, up to 40 years. The risk of type 2 diabetes is underestimated by many, and some patients are simply unaware that they are actually susceptible to the disease. Patients who are aware of their pathology often do not know what it is - what diabetes is and what it threatens, and are unaware of its dangers. As a result, type 2 diabetes can be aggravated and life-threatening. Meanwhile, in type 2 diabetes, adequate treatment and proper nutrition can stop the development of the disease.
When a person develops diabetes, the reasons for this fact can be different. The second type of disease often causes the following:
- wrong diet;
- lack of physical activity;
- excess weight;
- self-medication with medications, such as glucocorticosteroids.
In fact, it is often not a condition, but a complex of causes.
If we look at the pathogenesis of the disease, type 2 diabetes is caused by a relative lack of insulin in the blood. This is the name given to a condition in which insulin protein produced by the pancreas becomes inaccessible to insulin receptors located on cell membranes. As a result, the cells lose their ability to absorb sugar (glucose), which leads to a lack of glucose supply to the cells, as well as the accumulation of glucose in the blood, which is less dangerous, and its deposition. different tissues. According to this criterion, non-insulin-dependent diabetes mellitus differs from type 1 diabetes, in which the pancreas produces insufficient insulin.
The symptoms of the disease mainly depend on the stage of the disease. In the early stages, the patient may not feel any serious illness, except for increased fatigue, dry mouth, increased thirst and appetite. This condition is usually associated with poor diet, chronic fatigue syndrome, stress. But in fact the cause is a hidden pathology. Symptoms may include:
- poor wound healing
- weakening of the immune system
- pain and swelling in the limbs,
However, patients often do not even correctly interpret such a set of symptoms, and diabetes progresses unhindered until it reaches difficult stages or leads to life-threatening conditions.
Treatment of type 2 diabetes mellitus
In fact, there are not enough effective methods to increase the absorption of glucose by cells, so the main focus of treatment is to reduce blood sugar concentrations. In addition, efforts should be made to reduce the patient's excess weight, to bring him back 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. Excess cholesterol that is abnormal can lead to the development of angiopathy.
|Risk of developing angiopathy in diabetes||In short||Medium||He is tall|
|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 continuous therapy. In fact, all the methods used are divided into three groups:
- drug intake,
- lifestyle change.
Effective treatment of type 2 diabetes involves not only the fight against diabetes itself, but also the fight against concomitant diseases, for example:
Treatment of type 2 diabetes is carried out in an outpatient setting and at home. Only patients with severe forms and strokes of hyperglycemic and hyperosmolar coma, ketoacidosis, neuropathy and angiopathy are hospitalized.
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 class of biguanides. This drug is most commonly prescribed for type 2 diabetes. Maintains normal blood glucose levels without affecting pancreatic cellsThe drug does not threaten a critical decrease in glucose levels. The drug also burns fats and reduces appetite, which leads to weight loss. However, an overdose of the drug can be dangerous, because it can lead to a serious pathological condition with a high mortality rate - lactic acidosis.
Typical representatives of another group of drugs that affect insulin production are sulfonylureas. They directly stimulate the beta cells of the pancreas and cause them to produce more insulin. However, an overdose of these drugs threatens the patient with a hypoglycemic crisis. Sulfonylureas are usually taken in combination with biguanides.
There are other types of drugs. Incretin mimics (GLP-1 agonists) and DPP-4 inhibitors belong to a class of drugs that increase insulin production depending on glucose concentration. These are new drugs and so far they are quite expensive. They inhibit the synthesis of glucagon, a hormone that increases sugar, and increase the effect of incretins - 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 secretion 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 often used with ineffective therapy with other drugs, with decompensated forms of diabetes, when the pancreas is depleted and unable to produce enough insulin.
Type 2 diabetes is also associated with common diseases:
- Disorders of lipid metabolism.
If such diseases are detected, drugs are prescribed to treat them.
|Type||Mechanism of action|
|Sulfonylurea derivatives||stimulation of insulin secretion|
|Glinids||stimulation of insulin secretion|
|biguanides||Decreased glucose production by the liver and glucose resistance of tissues|
|Glitazones||Decreased glucose production by the liver and glucose resistance of tissues|
|Alpha-glucosidase inhibitors||slow absorption of glucose in the intestine|
|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 utilization|
The essence of dietary change in DM is the regulation of nutrients entering the gastrointestinal tract. Proper nutrition is determined by the endocrinologist to determine the severity of diabetes, concomitant diseases, age, lifestyle, etc. should be determined individually for each patient, taking into account.
Several types of diets are used for insulin-independent diabetes (Table 9, low-carbohydrate diet, etc. ). They have all proven themselves well and differ from each other only in some details. However, they agree with the basic principle - in case of illness, carbohydrate intake should be severely limited. First of all, this applies to products that contain "fast" carbohydrates, ie carbohydrates that are absorbed very quickly 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, you should try to reduce body weight, because increasing weight is a factor that aggravates the course of the disease.
It is recommended to increase water intake to replace fluid loss due to frequent urination, which is often accompanied by diabetes. At the same time, it is necessary to completely give up sugary drinks - cola, lemonade, kvass, juices and sugary tea. In fact, you can drink only sugar-free drinks - mineral and ordinary water, sugar-free tea and coffee. Keep in mind that drinking alcohol can also be harmful - because alcohol disrupts glucose metabolism.
Meals should be regular - at least 3 times a day, preferably 5-6 times a day. You should not sit at the dining table immediately after exercise.
How to monitor blood glucose levels
The essence of diabetes therapy is patient self-management. In type 2 diabetes, blood sugar levels should be at or near normal. Therefore, the patient should monitor their blood sugar levels to prevent critical increases. To do this, it is advisable to keep a diary that will record the values of blood glucose concentration. You can measure glucose with special portable glucometers equipped with test strips. It is recommended to perform the measurement procedure every day. The best time to measure is early in the morning. It is forbidden to take any food before the procedure. If possible, the procedure can be repeated several times a day, and the level of sugar should be checked not only in the morning on an empty stomach, but also after meals, before going to bed, and so on. Knowing the schedule of changes in blood glucose, the patient will be able to quickly adjust their diet and lifestyle so that the glucose level is normal.
However, the presence of a glucometer does not relieve the patient of the need to regularly check blood sugar levels in the outpatient setting, because the values obtained in the laboratory are more accurate.
It is not difficult to control your sugar levels when consuming food, as most foods are labeled with energy value and the amount of carbohydrates they contain. There are diabetic analogues of ordinary foods in which carbohydrates are replaced by low-calorie sweeteners (sorbitol, xylitol, aspartame).
|Stage||Glucose level, mmol / l|
|Norman's condition||3. 3-5. 5|
|Impaired glucose tolerance||5. 6-6. 0|
|Diabetes, early stage||6. 1-8. 0|
|Diabetes, middle 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 are not digested in large quantities, but are good for digestion, contain fiber and less sugar. However, many vegetables, such as potatoes, beets and carrots, are high in starch and should be limited. Fruits can be consumed in moderation and only those that do not contain very high amounts of carbohydrates. Among the fruits, bananas, grapes and melons are in second place in terms of carbohydrate content. Their use is not recommended, as they can raise blood sugar levels.
Folk remedies include taking decoctions of medicinal plants. Such therapy can not only lower blood glucose levels, but also reduce appetite, reduce excess weight. However, folk remedies can be taken only in addition to medication and in consultation with your doctor.
Auxiliary therapy is physical exercise. During moderate-intensity exercise, the body burns large amounts of glucose. Metabolism is normalized, the cardiovascular system is strengthened. Exercise is important every day. However, exercise should not be tiring, because it can only have the opposite effect. With severe fatigue, appetite increases, and a balanced diet can negate all the positive effects of physical activity. Fatigue causes stress and the release of adrenal hormones that increase blood glucose levels. Therefore, it is recommended to choose the type of physical activity that suits the patient's athletic form - simple exercises, exercises with dumbbells or walking, running, swimming, cycling.
|Type of activitie||Costs, kcal / hour||Foods that contain similar amounts of energy|
|Relax by lying down||80||apples, 20 g of nuts|
|Relax while sitting||hundred||apples, 20 g of nuts|
|Rest while standing||140||a glass of milk|
|HomeWork||180||a glass of milk|
|Slow walking, light field work||220||120 g ice cream|
|cycle||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 of biscuits or cheese|
In severe cases, when type 2 diabetes mellitus reaches the stage of decompensation, as a rule, it is no longer possible to return the disease and return glucose levels to normal - due to depletion of the pancreas and the body's reserves. all. Therefore, in such a situation, type 2 diabetes is a disease that cannot be treated. However, proper treatment of type 2 diabetes can prolong a patient's life for many years. In the early stages of type 2 diabetes, it is possible to control the concentration of glucose in the blood and keep it at an acceptable level only by changing your diet and lifestyle, increasing physical activity. As a result, the patient can live for decades and does not face any complications of diabetes.