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 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, what threatens, and do not realize the danger of it. As a result, type 2 diabetes can become severe and lead to life-threatening conditions. Meanwhile, adequate treatment and proper nutrition for type 2 diabetes can stop the disease from developing.
Reasons
When a person develops diabetes, the reasons for this fact can be different. The second type of disease often leads to:
- improper diet;
- lack of physical activity;
- Overweight;
- heredity;
- stress;
- self-medication with drugs such as glucocorticosteroids.
In fact, there is often not one prerequisite, but a whole set of reasons.
If we consider the emergence of the disease in terms of pathogenesis, then type 2 diabetes 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 glucose in the cells, and also, no less dangerous, to the accumulation of glucose in the blood and its deposition in varioustissues. 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 improper diet, chronic fatigue syndrome, stress. In fact, the cause is latent pathology. As the disease progresses, symptoms may include:
- poor wound healing
- weakening of the immune system
- pain and swelling of the limbs,
- headache,
- dermatitis.
However, often patients do not correctly interpret even a set of such symptoms and diabetes develops unhindered until it reaches unsolvable stages or leads to life-threatening conditions.
Type 2 diabetes mellitus, treatment
In fact, there are not enough effective methods that increase the absorption of glucose by cells, so the main focus of treatment is on lowering blood sugar levels. In addition, efforts should be made to reduce the patient's overweight, return it to normal, as 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 impaired lipid metabolism. Excess cholesterol, which differs from the norm, can lead to the development of angiopathy.
| The 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 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 change.
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 hyperglycaemic and hyperosmolar coma, ketoacidosis, severe neuropathies and angiopathies and strokes are hospitalized.
Drugs for diabetes
In fact, all drugs are divided into two main groups - those that affect insulin production and those that do not.
The main drug in the second group is the class of biguanides. This drug is most often prescribed for type 2 diabetes. Without affecting the cells of the pancreas, it maintains normal blood sugar levels. 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 overweight. However, drug overdose can be dangerous, as it can cause a serious pathological condition with a high mortality rate - 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 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 increase insulin production depending on glucose concentration. These are new drugs and are quite expensive so far. They inhibit the synthesis of the sugar-boosting hormone glucagon, 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 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 often used in case of ineffectiveness of therapy with other drugs, in decompensated form of diabetes mellitus, when the pancreas is exhausted and can not produce enough insulin.
Type 2 diabetes is also often accompanied by comorbidities:
- angiopathy,
- depression
- neuropathy,
- hypertension
- disorders of lipid metabolism.
If such diseases are found, then drugs are prescribed for their treatment.
| Type | Mechanism of action |
|---|---|
| Sulfonylureas | stimulation of insulin secretion |
| Clays | stimulation of insulin secretion |
| biguanides | reduction of hepatic glucose production and tissue resistance to glucose |
| Glitazones | reduction of hepatic glucose production and tissue resistance to glucose |
| Alpha-glucosidase inhibitors | slow absorption of glucose in the intestine |
| Glucanogon-like peptide receptor agonists | glucose-dependent stimulation of insulin secretion and decreased glucagon secretion |
| Glyptins (dipeptidyl peptidase-4 inhibitors) | glucose-dependent stimulation of insulin secretion and decreased glucagon secretion |
| insulin | increased glucose utilization |
Diet
The essence of the change in diet in DM is the regulation of nutrients entering the gastrointestinal tract. The necessary nutrition should be determined by the endocrinologist individually for each patient, taking into account the severity of diabetes, comorbidities, age, lifestyle and more.
There are several types of diets used in non-insulin dependent diabetes (Table 9, low carb diet, etc. ). All of them have proven themselves well and differ from each other only in some details. But they agree on the basic principle - the norms of carbohydrate intake in case of illness should be strictly limited. In the first place, this applies to products containing "fast" carbohydrates, ie carbohydrates that are very quickly absorbed from the gastrointestinal tract. Fast carbs are found in refined sugar, jams, confectionery, chocolate, ice cream, desserts, baked goods. In addition to reducing the amount of carbohydrates, it is necessary to strive to lose weight, as weight gain is a factor that worsens the course of the disease.
Other instructions
It is recommended that you increase your water intake to replace fluid loss due to frequent urination, which often accompanies diabetes. Along with this, it is necessary to completely abandon sweet drinks - cola, lemonade, yeast, juices and tea with sugar. In fact, you can only drink drinks that do not contain sugars - mineral and plain water, unsweetened tea and coffee. It should be remembered that drinking alcohol can also be harmful - due to the fact that alcohol disrupts glucose metabolism.
Feeding should be regular - at least 3 times a day, and preferably 5-6 times a day. You should not sit at the dinner table immediately after a workout.
How to monitor blood sugar levels
The essence of diabetes therapy is self-control on the part of the patient. In type 2 diabetes, the sugar level should be within or close to normal. Therefore, the patient must control his own sugar level to avoid critical increases. To do this, it is advisable to keep a diary in which the values of blood glucose levels will be recorded. You can measure glucose with special portable meters equipped with test strips. It is recommended that the measurement procedure be performed daily. The best time to measure is early in the morning. It is forbidden to eat any food before the procedure. 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 schedule of changes in blood sugar, the patient will be able to quickly adjustdiet 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 levels in the outpatient clinic, as the values obtained in the laboratory are more accurate.
It is not so difficult to control your sugar levels when you eat food, as most foods 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).
| scene | Glucose level, mmol / l |
|---|---|
| State of the norm | 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 contain large amounts of indigestible but digestive 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 large amounts of carbohydrates. Among fruits, bananas hold the record for carbohydrate content, followed by grapes and melons. They are not recommended for use as they may raise blood sugar levels.
Folk remedies
Folk remedies include taking decoctions of medicinal herbs. Such therapy can not only lower blood sugar levels, but also reduce appetite, reduce overweight. However, folk remedies can be taken only in addition to medication and in consultation with your doctor.
Exercise
Ancillary method of therapy is exercise. During moderate-intensity exercise, the body burns large amounts of glucose. Metabolism is normalized, the cardiovascular system is strengthened. Exercise is essential every day. However, the exercises should not be exhausting, as in this way only the opposite effect can be achieved. With severe fatigue, appetite increases, and a rich diet can cancel all the positive effects of physical activity. Fatigue provokes stress and the release of adrenal hormones, which raises blood sugar levels. Therefore, it is recommended to choose the type of physical activity that corresponds to the athletic form of the patient - simple exercises, exercises with dumbbells or walking, jogging, swimming, cycling.
| Type of activity | Costs, kcal / h | Foods containing a similar amount of energy |
|---|---|---|
| Rest in a supine position | 80 | apple, 20 g nuts |
| Rest sitting | hundred | apple, 20 g nuts |
| Rest in an upright position | 140 | a cup of milk |
| House work | 180 | a cup of milk |
| Slow walking, light work in the field | 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 reaches the stage of decompensation, then, as a rule, it is no longer possible to reverse the disease and return glucose levels to normal - due to depletion of resources of the pancreas and body as a hole. Therefore, type 2 diabetes in such a situation is an incurable disease. However, proper treatment for type 2 diabetes can prolong a patient's life by many years. In the initial stage of type 2 diabetes, 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 any complications from diabetes.