Probably not many people are happy with their medical history. Type 2 diabetes, indicated in it, can cause even more depression. But is it worth giving up and despairing? What is the danger of this disease, and how to deal with it - we will understand.
Diabetes - what is the danger?
People often hear about diabetes, but few imagine what it is. It should be noted that the concept of diabetes is a collective image. Under this term several diseases of the endocrine system will be combined. The causes of their occurrence are quite numerous, but, as a rule, the underlying disease is endocrine disruption, and in particular insulin deficiency. Another factor may be the inability to absorb glucose by the liver and body tissues. At the same time, its level in the body rises, which, in turn, is the cause of a number of metabolic disorders.
Diabetes - its types
Modern medicine distinguishes two types of this disease. Gradation occurs depending on which insulin deficiency - relative or absolute - is described by the medical history. Type 2 diabetes mellitus, as a rule, is not associated with a deficiency of the hormone insulin, the production of which is the pancreas. Usually, the cause of its development is a decrease in the sensitivity of organs and tissues to this hormone. Insulin-dependent diabetes - the first type - is directly related to insulin deficiency in the body. The lack of this hormone leads to the fact that glucose that is ingested is not processed, or it occurs in insufficient quantities, while its level in the blood is constantly growing, and in order to save life, such patients are forced to receive additional doses of insulin.
Medical history - type 2 diabetes
This diabetes is also called non-insulin-dependent. According to statistics, there are many more patients suffering from this particular type of disease than the first. With age, the risk that this disease will manifest itself increases significantly. Very often, its development occurs imperceptibly, and the patient has not been aware of this pathology for a long time, the history of the disease does not reflect the data allowing her to be suspected. Type 2 diabetes mellitus is then detected as an “accidental find” during a routine examination. The main indicator that allows you to suspect the presence of this pathology is a blood test in which glucose is increased. In turn, when a medical history is made out, type 2 diabetes mellitus is divided into:
- arising in patients with normal weight;
- detected in overweight patients.
Causes of diabetes
Even in the process of training, young doctors draw up a training history of the disease, type 2 diabetes in which can be caused by several reasons. The most common ones are:
- the consumption of refined carbohydrates (sugar, chocolate, pastry, potatoes) in large quantities and the lack of plant fiber in the diet;
- heredity - in the presence of a similar pathology in parents, the risk of diabetes exceeds 40%;
- obesity, especially visceral type (fat deposits are located mainly in the abdomen);
- hypertension;
- lack of exercise.
What's happening? Pathogenesis
The history of the disease describes type 2 diabetes as a number of metabolic disorders. It is based on insulin resistance - the inability of tissues to normally perceive insulin, on the one hand, and the violation of the production of this hormone in pancreatic cells - on the other. Normally, with an increase in glucose that occurs immediately after eating, the pancreas begins to diligently produce insulin. In people with type 2 diabetes, this does not happen, and insulin begins to be produced only when the glucose concentration level already reaches high numbers. However, despite the presence of insulin, a decrease in sugar level in this case to the desired level does not occur. A constant increased concentration of insulin leads to the fact that cells lose their ability to respond to it and now, even if the hormone manages to connect to the cell receptor, there is no reaction. Against the background of these changes, liver cells begin to actively synthesize glucose, further increasing its concentration in the blood. All this does not go without consequences. Over time, under the influence of a high concentration of glucose, glucose toxicity develops, which adversely affects pancreatic cells that produce insulin, and, as a result, its deficiency develops. Thus, the medical history is aggravated. Type 2 diabetes mellitus insulin-demanding changes shape when insulin administration has not yet been required. The patient's condition worsens.
Symptoms
In the classical diabetes clinic, it is customary to distinguish two groups of signs of the disease - primary and secondary. The main ones include:
- polyuria - a lot of urine is released (glucose, getting into it, significantly increases the osmotic pressure);
- thirst (polydyspepsia) - a constant, unquenchable need for drinking is characteristic;
- hunger (polydysphagia) - due to the inability of cells to absorb glucose using insulin, the body experiences a constant need for energy;
- sudden weight loss - it occurs against a background of increased appetite.
All these symptoms are more characteristic of the first type of diabetes. The second type may be asymptomatic or causing secondary symptoms:
- itching of the skin and mucous membranes - often when examining a patient and suspecting type 2 diabetes mellitus (medical history), a woman may notice intolerable itching in the genitals;
- general weakness and headaches;
- inflammatory skin lesions that are difficult to treat;
- decreased vision.
As a rule, most simply do not pay attention to such symptoms, and the disease can be detected only at the stage of complications.
Children and diabetes
Unfortunately, diabetes is now recognized as the second most common chronic disease. That's exactly what official pediatrics thinks. Diabetes mellitus (type 2). The child’s medical history often puts the most dangerous diseases in the category. This is due to the fact that its course differs from adult disease in a more rapid development and often proceeds more malignant. However, in this case, it all depends on the ability of parents to adjust the child’s nutrition and monitor the timely intake of drugs. In addition, it is very important to identify the disease on time. If the child has the following symptoms, an urgent consultation with the endocrinologist is necessary:
- the child is constantly thirsty;
- he goes to the toilet much more often (at school or kindergarten he has to be asked several times for lessons from classes);
- body weight decreases;
- chronic fatigue is observed.
Diagnostics
Diagnose diabetes based on urine and blood tests. In a healthy individual, glucose is not detected in urine, and its level in the blood does not exceed 5.5. For reliable results, blood is taken from a finger or vein (the last meal should be taken at least 8 hours before the procedure), you should not drink sweet tea, coffee or juice before delivery. It should be noted that diabetes mellitus is diagnosed at rates higher than 7. If the indicators range from 4 to 7, then a violation of glucose tolerance is recorded.
Another test to detect this disease and clarify dubious values ​​is the glucose tolerance test (GTT). It allows you to obtain data on fasting glucose levels, as well as two hours after he took a glucose solution. Normally, after glucose, its concentration should not be higher than 7.8. This test is not performed when glucose is higher than 6.1 before the test, if the patient has a history of acute diseases, surgical interventions, myocardial infarction, injuries, and also when taking drugs that increase glucose. All these data reflect the medical history.
Type 2 diabetes mellitus, subcompensation
Like any disease, diabetes is prone to build up and intensify symptoms. In its course, three stages are distinguished. The compensation stage is set when the patient's indicators approach the norm. If measures are not taken in time, or they do not bring the expected result, then the disease goes into the stage of subcompensation. In this case, the patient’s condition, of course, is not the best, but also non-critical. On the day the patient loses with urine no more than fifty grams of glucose, and its level in the blood is about 13.8, there is no acetone in the urine . The development of hyperglycemic coma at this stage is also impossible. The intermediate state between compensation and decompensation is referred to the stage of subcompensation, while for the stage of compensation the glucose level of 7.5, the percentage of glycated hemoglobin is 6.5%, and fasting glucose is less than 6.1. The stage of decompensation is set if the indicators exceed the following limits:
- glucose level - more than 9;
- glycated hemoglobin - more than 9%;
- fasting glucose - more than 7.
Changes in these indicators and the effectiveness of the prescribed treatment helps to trace the medical history. Type 2 diabetes mellitus, the severe course of which is difficult to respond to therapy or provoked by other factors, goes into the stage of decompensation.
Factors causing decompensation
Of course, each organism is individual, and the factors aggravating the course of the disease can be different, but these are most often found:
- overeating, violation of the diet;
- an error in the selection of the drug, its dose or refusal of treatment;
- self-medication or use instead of the prescribed preparations of dietary supplements;
- refusal to switch to insulin therapy;
- infections that promote dehydration;
- stressful situations.
All these factors, individually or in aggregate, significantly affect the state of metabolic processes, and, as a result, there is an increase in glucose levels, which is recorded by the medical history. Type 2 diabetes mellitus, the decompensation stage of which is exacerbated by the appearance of various complications from the organs and systems of the body, becomes threatening and, if not properly treated, can pose a threat to the patient's life. At the same time, complications can develop both in time and literally in a matter of hours.
Decompensation stage
As the concentration of glucose increases, and its correction requires more serious measures, the medical history is aggravated. Diabetes mellitus (type 2), the decompensation of which is characterized by a high risk of complications, requires a very careful attitude. This is due to the fact that it can be very difficult to adjust the glucose level both with the help of a diet and with the use of drugs. As a result, it is necessary to carefully and constantly monitor the patient's condition, because in the absence of a therapeutic effect when using drugs, pathological changes in various organs occur very quickly. Therefore, these patients need medical supervision, and very often in emergency care.
Of great importance here is the ability to independently monitor their condition. Fortunately, modern medicine has a sufficient selection of tools for this. Various tests and devices that determine the level of glucose allow a diabetes patient to independently diagnose his condition and, depending on the results, carry out a correction.
Insulin in diabetes treatment
As the disease progresses, the depletion of those pancreatic cells that are involved in the production of insulin also develops. This process requires the immediate appointment of hormone therapy. As modern studies show, sometimes only this allows you to maintain glucose levels at the right level. Nevertheless, you should not assume that the appointment of insulin is life-long. Often, type 2 diabetes mellitus, insulin-dependent, the medical history of which, it would seem, is doomed to fix a lifelong intake of insulin, with certain efforts on the part of the patient can go into the category when regular administration of this hormone is not required. In this regard, diabetes mellitus refers to those pathologies where, in order to achieve a therapeutic effect, control and efforts on the part of the patient are very important. Thus, the degree of compensation for the disease will depend on his discipline in relation to diet, self-monitoring of sugar levels and the timely administration of drugs. However, in some cases, the administration of insulin is a mandatory measure. It happens:
- during pregnancy;
- in case of strokes or heart attacks;
- during surgical interventions;
- with infectious diseases of a purulent-septic nature;
- with increased laboratory diagnosis.
Another important reason for the mandatory appointment of insulin may be a clear lack of this hormone, which is confirmed by the medical history. Type 2 diabetes mellitus, the decompensation stage of which is characterized by pronounced progressive weight loss and increasing ketoacidosis, is a vivid example of this.
It should be noted that today medicine has greatly expanded the scope of the use of insulin therapy, and it has been officially confirmed that the effectiveness of the use of monotherapy with oral drugs lasts less than 6 years. Then you have to prescribe several drugs. According to recent trends in the treatment of diabetes, the use of insulin in such cases is considered more effective.
Acute complications
Acute complications of the decompensation stage are conditions in which there is a real threat to the patient's life. Usually they are due to a significant increase in glucose levels and the associated metabolic disorders. When such a condition occurs, timely assistance is important and, since not only doctors but also nurses should know the signs of these conditions, the sister history of the disease type 2 diabetes mellitus and its complications are described as follows.
- Hyperglycemic coma (hyperosmolar and ketoacidotic) - their hallmark is the gradual development. The factors provoking them are an insufficient dose or missed intake of insulin, a violation of the diet (excessive consumption of carbohydrates), physical activity against the background of hyperglycemia, lack of control over glucose levels, alcohol or some medications. Clinically, they are manifested by increasing thirst for several days by thirst and polyuria (an increase in the amount of urine), expressed by dehydration. Blood pressure is reduced, tachycardia. If the condition worsens, convulsions or depression of consciousness are possible. The skin is dry, scratching is possible, the smell of acetone during exhalation. In this case, the victim needs urgent hospitalization and medical care.
- Hypoglycemic coma - develops as a result of a sharp decrease in blood glucose (less than 3 mmol / l), as a result of which the brain experiences a sharp lack of nutrients. This condition can be provoked by an overdose of insulin, skipping one of the meals or an improperly selected diet, taking alcohol or drugs. Clinically, an attack develops rapidly. Characterized by cold sweat on the forehead, weakness, trembling hands, headache, numbness of the lips. The patient is aggressive, poorly coordinates his movements, palpitations, double vision, confusion. In the later stages, loss of consciousness, convulsions. At the prehospital stage, such patients can be given a sweet drink or something to eat, warm and transport to a medical facility for subsequent care.
Late complications
Similar complications develop in decompensated diabetes after several years of illness. Their danger lies in the fact that they gradually and imperceptibly worsen the condition of the patient. In addition, often even competent therapy for diabetes cannot guarantee that sooner or later they will not appear.
- Retinopathy is characterized by retinal damage.Unfortunately, despite all the achievements of modern medicine, the occurrence of retinopathy in patients with type 2 diabetes, which lasts more than 20 years, tends to 100%. This pathology causes hemorrhages in the fundus and eventually leads to complete loss of vision.
- Angiopathies - are a violation of vascular permeability, which becomes the cause of thrombosis and atherosclerosis. It can develop in a short time (about a year), unlike other late complications, which often aggravate the medical history.
- Type 2 diabetes mellitus, diabetic polyneuropathy in which is also a common complication, records it in 90% of cases. Clinically, this is expressed in lesions of the nerves that control both the muscles and internal organs. Polyneuropathy can be manifested by increased sensitivity, sudden sharp (shooting) pain, burning. Also, manifestations of neuropathy can be numbness, decreased sensitivity, which leads to numerous injuries. From the side of internal organs there can be diarrhea, urinary incontinence, headaches, dizziness, interruptions in the work of the heart.
- Diabetic foot - characterized by the appearance of trophic ulcers, abscesses, necrotic areas on the feet and, in particular, on the feet of a diabetic patient. That is why patients suffering from this pathology are recommended to pay special attention to the selection of shoes.
Forecast
It is sad, but modern medicine is not able to completely defeat diabetes. However, it can well timely correct deviations caused by an increased concentration of glucose in the human body, that is, type 2 diabetes mellitus. The history of the disease, the prognosis of this disease in many ways, if not in everything, will depend on the attitude of the patient to him. With careful monitoring on his part of the sugar level and other indicators, the necessary drug correction, diet and the recommendations of doctors, you can avoid the development of complications for many years.