Type 2 diabetes mellitus (DM) is a common chronic non-communicable disease. It affects both men and women, most often over the age of 40. The danger of type 2 diabetes is underestimated by many, and some patients are simply not informed that they are susceptible to the disease. And those of patients who are aware of their pathology often do not know what it is: diabetes mellitus, what it threatens and are not aware of its danger. As a result, type 2 diabetes can become severe and lead to life-threatening conditions. Meanwhile, proper treatment and proper nutrition in type 2 diabetes can stop the development of the disease.
When a person develops diabetes, there can be a variety of causes for this. The second type of disease often leads to:
- wrong diet;
- lack of physical activity;
- excess weight;
- self-medication with drugs, for example, glucocorticosteroids.
Indeed, there is often no prerequisite, but a whole complex of reasons.
If we consider the onset of the disease from the point of view of pathogenesis, type 2 diabetes mellitus is caused by a relative lack of insulin in the blood. This is the name of the state in which the insulin protein produced by the pancreas becomes inaccessible to the insulin receptors located on cell membranes. As a result, the cells are deprived of the ability to absorb sugar (glucose), which leads to a lack of glucose supply to the cells and also, no less dangerously, to the accumulation of glucose in the blood and its deposition in various fabrics. According to this criterion, non-insulin-dependent diabetes mellitus differs from type 1 diabetes, in which the pancreas produces insufficient insulin.
Symptoms of the disease largely depend on the stage of the disease. In the early stages, the patient may not experience a serious ailment, with the exception of increased fatigue, dry mouth, increased thirst and appetite. This condition is usually attributed to the wrong diet, chronic fatigue syndrome, stress. However, in reality, the cause is a latent pathology. As the disease progresses, symptoms may include:
- poor wound healing
- weakening of the immune system
- pain and swelling in the limbs,
However, patients often misinterpret even a range of such symptoms and diabetes develops unhindered to intractable stages or lead to life-threatening conditions.
Type 2 diabetes mellitus, treatment
Indeed, there are no sufficiently effective methods that increase the uptake of glucose by cells, so the main emphasis in treatment is on lowering the concentration of sugar in the blood. In addition, efforts should be aimed at reducing the patient's excess weight, bringing him back to normal, since the abundance of adipose tissue plays an important role in the pathogenesis of diabetes.
The main factor affecting the likelihood of complications in type 2 diabetes is a violation of lipid metabolism. An excessive amount of cholesterol that differs from the norm can lead to the development of angiopathy.
|The risk of developing angiopathy in diabetes||Short||Half||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 persistent therapy. In fact, all the methods used are divided into three groups:
- Take drugs,
- lifestyle change.
Effective treatment of type 2 diabetes involves fighting not only the diabetes itself, but also concomitant diseases, such as:
Type 2 diabetes is treated on an outpatient basis and at home. Only patients with hyperglycemic and hyperosmolar coma, ketoacidosis, severe forms of neuropathies and angiopathies and strokes are subject to hospitalization.
Medicines against diabetes
In fact, all drugs are divided into two main groups: those that affect insulin production and those that don't.
The main drug of the second group belongs to the biguanide class. This drug is most often prescribed for type 2 diabetes. Without affecting the cells of the pancreas, it keeps blood sugar at normal levels. The drug does not threaten a critical decrease in glucose levels. In addition, the medicine burns fat and reduces appetite, which leads to a decrease in the patient's excess weight. However, an overdose of the drug can be dangerous, as a serious pathological condition with a high mortality rate can occur - lactic acidosis.
Typical representatives of another 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 hypo. Sulfonylurea derivatives are generally taken together with biguanides.
There are other types of drugs. Incretin mimetics (GLP-1 agonists) and DPP-4 inhibitors belong to the 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 the hormone glucagon, which increases sugar, enhance the action 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 improve 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. Most often, it is used with the ineffectiveness of therapy with other drugs, with a decompensated form of diabetes mellitus, when the pancreas is depleted and cannot produce enough insulin.
Type 2 diabetes is also often accompanied by comorbidities:
- disorders of lipid metabolism.
If such diseases are detected, drugs are prescribed for their treatment.
|Guy||Mechanism of action|
|Sulfonylureas||stimulation of insulin secretion|
|Glinids||stimulation of insulin secretion|
|biguanides||decrease in the production of glucose by the liver and in the resistance of tissues to glucose|
|Glitazones||decrease in the production of glucose by the liver and in the resistance of tissues to glucose|
|Alpha-glucosidase inhibitors||slow absorption of glucose in the intestine|
|Glucanogon-like peptide receptor agonists||glucose-dependent stimulation of insulin secretion and decrease in glucagon secretion|
|Gliptins (dipeptidyl peptidase-4 inhibitors)||glucose-dependent stimulation of insulin secretion and decrease in glucagon secretion|
|insulins||increased use of glucose|
The essence of diet change in DM is the regulation of nutrients that enter the gastrointestinal tract. The necessary nutrition should be determined by the endocrinologist individually for each patient, taking into account the severity of diabetes, concomitant diseases, age, lifestyle, etc.
There are several types of diets used for non-insulin-dependent diabetes (table 9, low-carb diet, etc. ). All of them have proven themselves and differ from each other only in some details. But I agree on the basic principle: the rules on carbohydrate intake in case of illness should be strictly limited. First of all, this applies to products containing "fast" carbohydrates, ie carbohydrates that are absorbed very quickly from the gastrointestinal tract. Fast carbohydrates are found in refined sugar, jams, sweets, chocolate, ice cream, sweets, baked goods. In addition to reducing the amount of carbohydrates, it is necessary to strive to reduce body weight, since weight gain is a factor that aggravates the course of the disease.
Increasing your water intake is recommended to replace the fluid loss due to frequent urination that often accompanies diabetes. Along with this, it is necessary to completely abandon sugary drinks: cola, lemonade, kvass, juices and tea with sugar. In fact, you can only drink drinks that do not contain sugar: mineral and natural water, unsweetened tea and coffee. It should be remembered that drinking alcohol can also be harmful, as alcohol disrupts glucose metabolism.
Meals should be regular - at least 3 times a day and, most importantly, 5-6 times a day. You shouldn't sit down at the table right after exercise.
How to monitor blood glucose levels
The essence of diabetes therapy is patient self-control. In type 2 diabetes, the sugar level should be within the normal range or close to it. Therefore, the patient has to control the sugar level himself to avoid critical rises. To do this, it is advisable to keep a diary in which the values of the concentration of glucose in the blood will be recorded. Glucose measurements can be made with special portable blood glucose meters equipped with test strips. It is recommended to perform the measurement procedure every day. The best time to measure is early in the morning. Before the procedure, it is forbidden to take any food. If possible, the procedure can be repeated several times a day, and the sugar level can be determined not only in the morning on an empty stomach, but also after meals, before bedtime, etc. Knowing the graph of changes in blood glucose, the patient will be able to quickly adjust his diet and lifestyle, so that the glucose indicator is in the normal state.
However, the presence of a glucometer does not relieve the patient of the need to regularly check blood sugar levels in the office, as the values obtained in the laboratory are more accurate.
It is not that difficult to control sugar levels while eating food, as most food products are labeled with their energy value and the amount of carbohydrates they contain. There are diabetic analogues of conventional foods, in which carbohydrates are replaced by low-calorie sweeteners (sorbitol, xylitol, aspartame).
|Phase||Glucose level, mmol / l|
|State of the standard||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 sugars. However, many vegetables, such as potatoes, beets, and carrots, are high in starch and should be limited. Fruit can be eaten in moderation and only fruit that does not contain very high amounts of carbohydrates. Among the fruits, bananas hold the record for carbohydrate content, followed by grapes and melons. It is not recommended to use, as they can increase blood sugar levels.
Folk remedies involve taking decoctions of medicinal herbs. Such therapy can not only lower blood glucose levels, but also reduce appetite, reduce excess weight. However, folk remedies can only be taken in addition to taking medications and in consultation with the doctor.
An auxiliary method of therapy are physical exercises. During moderate-intensity exercise, the body burns large amounts of glucose. The metabolism returns to normal, the cardiovascular system is strengthened. Exercise is essential every day. However, the exercises shouldn't be exhausting, as this can only have the opposite effect. With severe fatigue, appetite increases, and a large meal can negate all the positive effects of physical activity. Fatigue causes stress and the release of adrenal hormones, which increases blood glucose levels. Therefore, it is recommended to select the type of physical activity that suits the patient's athletic form: simple exercises, exercises with dumbbells or walking, jogging, swimming, cycling.
|Kind of activity||Costs, kcal / h||Foods containing a similar amount of energy|
|Rest lying down||80||apple, 20 g of walnuts|
|Rest sitting||one hundred||apple, 20 g of walnuts|
|Rest on your feet||140||a glass of milk|
|Housework||180||a glass of milk|
|Slow walking, light field work||220||120 g of ice cream|
|By bike||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, it is usually already impossible to reverse the disease and bring glucose levels back to normal, due to the depletion of the pancreas and the body's resources. whole. Therefore, type 2 diabetes in such a situation is an incurable disease. However, the correct treatment of type 2 diabetes can extend the 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, lifestyle and increasing physical activity. As a result, the patient can live for many decades and not face any complications of diabetes.