Diabetes mellitus

Description:

The diabetes mellitus is a disease of endocrine system, connected with disbolism, first of all – carbohydrates, as a result of relative or absolute insufficiency of insulin or nonsensitivity of cells of an organism to it.
In terms of the scope of prevalence the diabetes mellitus takes the 3rd place, lagging behind only diseases of cardiovascular system and new growths.
The diabetes mellitus is known to the world long ago. As early as 1500 B.C. ancient Egyptians mentioned diabetes as about an independent disease. The name to a disease diabetes was given by the doctor Aretaius, and ancient Chinese distinguished a disease by means of wasps who sat down on a vessel with urine of the person sick with diabetes.
The medical statistics says about 175 million people suffering from a diabetes mellitus worldwide, and according to forecasts by 2025 this figure will reach  340 million.
Grown for the last decades rates of consumption of the sweet refined products, including aerated water and high-grade flour, caused decrease in average age of the manifesto of a disease. The matter is that the simple carbohydrates which are contained in these products instantly are acquired and turn into glucose for which utilization insulin is necessary. Further the failure of endocrine system leading to development of diabetes develops.
On classification allocate 5 types of diabetes:
1. Diabetes mellitus of 1 type (insulin-dependent); it is diagnosed first of all for children and young people. It three times the name – spontaneous diabetes.
2. Diabetes mellitus 2 types (non-insulin-dependent); develops at people after 40 years.
3. Symptomatic diabetes mellitus.
4. A diabetes mellitus at pregnancy – gestational diabetes.
5. Diabetes at alimentary insufficiency.

Diabetes mellitus reasons:

The diabetes mellitus of 1 type develops as autoimmune process, arises because of failure in work of immune system. At a diabetes mellitus of 1 type in a human body antibodies against pancreas cells begin to be developed. Emergence of a diabetes mellitus is provoked by intercurrent diseases – viral infections (chicken pox, a rubella, a mumps, hepatitis etc.). Genetic predisposition to emergence to a diabetes mellitus is important.
So, 2 main provocative factors – a hereditary factor and obesity are allocated. At obesity of 1 degree the risk of development of a diabetes mellitus increases for 50%, at the 2nd degree – by 5 times, at the 3rd degree – by 10 times. The so-called abdominal form of obesity with a preferential adiposity on a stomach is especially dangerous. Important value plays a hereditary factor. If the parent or other closest relative has diabetes, then the risk to ache increases by 2-6 times.
There are data that the use of dietary supplements with the content of selenium increases risk of development of a diabetes mellitus 2 types.
Secondary (symptomatic) diabetes develops for the following reasons:
1. Existence of diseases of a pancreas – chronic pancreatitis, a tumor of a pankreas, a resection in the anamnesis, etc.);
2. Disturbances of a hormonal background (acromegalia, Icenco-Cushing syndrome, pheochromocytoma, diffusion toxic craw);
3. Influence of medicines or chemicals (hypotensive drugs, thiazide diuretics, etc.);
4. Disturbance of structure of insulin receptors;
5. The accompanying genetic diseases.

Pathogeny:

Glucose is an energy source, the major metabolite in a human body. Glucose comes to our organism with food, then is soaked up in a small intestine, immediately arriving in a liver or skeletal muscles where glucose stocks up in the form of special substance - a glycogen. Level of glucose is controlled by special hormone – insulin. Insulin is produced by beta cells of the endocrine device of a pancreas.
The insulin role in an organism is exclusive. Insulin regulates all power exchange, under its influence glucose and amino acids get in cells. In lipoblasts under the influence of insulin DNA is synthesized, influences growth and a differentiation of other cells, strengthens protein synthesis.
At insufficiency of insulin there is a diabetes mellitus of the 1st type which manifestations are observed at destruction more than 80%  of cells of Langergans of a pancreas.
At disturbance of sensitivity of fabrics to insulin the diabetes mellitus of the 2nd type develops. Insulin resistance is shown even in the conditions of the normal level of insulin. Glucose, without having an opportunity to get into a cell, circulates and collects in blood. Due to the arisen disturbances there is an accumulation of sorbitol, glikozilirovanny hemoglobin and glikozaminoglikan. These substances strike various cells of an organism: sorbitol causes a cataract, a mikroangiopatiya and neuropathy, and damage of joints is promoted by glikozaminglikana. Cardiovascular disturbances, muscular weakness develops because of active disintegration of proteins.
Strengthening of peroxide oxidation of lipids and the subsequent accumulation of toxic substances leads to increase in ketonic bodies.

Diabetes mellitus symptoms:

Symptoms of a diabetes mellitus develop gradually, a long time without having an effect.
The clinical picture differs at diabetes 1 and 2 types a little and depends on expressiveness of insulin deficit.
Main symptoms of diabetes:
- Constant feeling of thirst
- The speeded-up urination, especially at night
- Decrease in body weight
- Xeroderma
- Decrease in sight
- Skin itch
- An itch in a crotch

The diabetes mellitus of 1 type is shown by the expressed thirst, the speeded-up urination, the expressed weakness. Quite often nausea and vomiting joins. Even at normal consumption of food the sick person begins to lose weight. Because of constant feeling of hunger of the patient it is irritable. The manifesto of a disease at children can be shown by enuresis at night.
2 types are characteristic of a diabetes mellitus an itch of integuments, thirst, recurrent skin infectious diseases. The patient notices delay of mending of wounds, emergence of pustulous defeats, numbness or a pricking in legs.

Complications:

Complications of a diabetes mellitus include defeats of vessels, a nervous system, an urinary system, development of a coma, etc.
Will allow to suspect defeat of vessels at diabetes the following symptoms:
- Vision disorder
- Formation of ulcers on the lower extremities
- The increased arterial pressure
- An onychalgia when walking
- Retrosternal pain and other symptoms.
The dangerous complication which is found at a diabetes mellitus is defeat of vessels. The diabetic angiopatiya proceeds in the form of macro - and microvascular disorders. The retinopathy, a nephropathy and an angiopatiya of the lower extremities of diabetic genesis belongs to microvascular complications. To macrovascular complications – aortites, arteriosclerosis of coronary, cerebral vessels, atherosclerosis of peripheral vessels.

Diabetic retinopathy – the defeat of vessels of a retina inherent both at insulin-dependent, and at non-insulin-dependent diabetes. The diabetic retinopathy can be shown not only by misting of sight, but also retinal apoplexies and a vitreous.
Defeat of vessels of a retina at a diabetes mellitus can proceed in 2 forms – a background or proliferative retinopathy. Small hemorrhages are characteristic of a background retinopathy, in a retina exchange products are postponed, retina hypostasis develops. The background retinopathy develops more often at advanced age and conducts with slow decrease in sight.
The proliferative retinopathy develops because of disturbance of blood supply of a retina. Retina amotio is often observed. It is observed preferential at young age.
It is established what at the time of diagnosis of a diabetes mellitus of the 2nd type of 21% of patients already has a retinopathy. The diagnosis of a diabetic retinopathy is made on the basis of survey of an eyeground of oculists, assessment of fields of vision, intraocular pressure, scanning of internal structures of an eye.

Diabetic neuropathy represents damage of various parts of the nervous system against the background of a diabetes mellitus. There is a classification on symmetric generalized polyneuropathy and focal (polyfocal) mononeuropathy. Further progressing of diabetic neuropathy leads to development of trophic ulcers and formation of "diabetic foot". Existence of diabetic neuropathy can be suspected at onychalgias of burning character, especially at night, unpleasant feelings (paresthesias), decrease in painful, temperature and tactile sensitivity. Skin becomes dry, temperature of the struck part of a body decreases or increases. This type of neuropathy develops most often at a diabetes mellitus of the 2nd type, at elderly patients.  The central diabetic neuropathy includes development of encephalopathy and a myelipathy.

Not less widespread complication of a diabetes mellitus is damage of kidneys - a diabetic nephropathy. The mechanism of development of a diabetic nephropathy is connected in defeat of renal vessels. In the conditions of a hyperglycemia and hypertensia of a kidney lose an opportunity to perform the physiological functions – filtering and concentration of urine. It is the most common cause of an invalidism and a lethality among the contingent of patients with a diabetes mellitus. The nephropathy at diabetes develops in 5 stages:
1. In a disease debut a stage of renal hyperfunction. Increase in a glomerular filtration rate is observed, the renal blood stream increases, the renal parenchyma hypertrophies. Protein in urine does not come to light.
2. In 2-5 years from the beginning of a disease there occur initial structural changes of renal fabric. The second stage is characterized by a thickening of a basal membrane, expansion of a mesangium, protein level in urine is still not hung up.
3. The third stage forms in 5-15 years, increase in arterial pressure and a microalbuminuria comes to light.
4. The expressed nephropathy (the 4th stage) develops in 10-25 years, the expressed proteinuria is found, the glomerular filtration rate is moderately lowered.
5. Uraemia develops in 5-7 years after the beginning of a proteinuria. The glomerular filtration rate makes less 10ml/mines, symptoms of intoxication and arterial hypertension are expressed.
The diabetic nephropathy is dangerous that it can not be shown by any clinical signs up to an end-stage. For timely diagnosis of this complication it is necessary to make timely the test of urine where the major role is played by detection of an albuminuria, determination of level of urea and creatinine. It is established that at 20% of sick SD within 20 years the diabetic nephropathy (Kimmelshtilya-Wilson's syndrome) develops. At 50% of patients the course of a disease is complicated by a chronic renal failure.

Diabetic foot is the syndrome at a diabetes mellitus caused angio-and neyropatichesky mechanisms. The first extent of development of diabetic foot includes superficial ulcers on a plantar surface of foot, with callosities under which the ulcer surface is opened.
The deep ulcer defect with accession of an infection which is not reaching a bone tissue develops at the 2nd extent of development of diabetic foot.  Further progressing with involvement of a bone, development of osteomyelitis leads to the 3rd degree. Then limited gangrene (the 4th degree), and extensive gangrene (the 5th degree of diabetic foot) develops.
The syndrome of diabetic foot is shown in a neyropatichesky or ischemic form. Pink color of integuments, sharply reduced pulsation, existence of cracks, painless ulcers, callosities, with a gangrenosis of fingers and Sharko's joints is characteristic of neyropatichesky option. The hyperkeratosis of nails and a neuropathic popedema joins.
The ischemic form is followed by pallor of skin of foot, covers cold to the touch, there is also no pulsation. Ulcers and gangrene of fingers take place painful.

Treatment of the Diabetes mellitus:

It is reasonable to begin treatment of a diabetes mellitus with a dietotherapy. The patient needs an accurate diet with respect for proportionality of the main ingredients: the amount of proteins is necessary makes 15-20%, carbohydrates – 50-60%, fats of 25-30%. The diet has to correspond to a metabolic cost during the day, to age, sex and category of ideal body weight for the specific patient. At diagnosis of obesity it is necessary to take measures for weight reduction. Low - the carbohydrate diet is an alternative method of treatment of diabetes which is used instead of the traditional balanced diet. Learn more here. The carbohydrates consumed patients have to be difficult, their source – not refined products. Digestible carbohydrates (sugar, high-grade flour, etc.) it is necessary to exclude from a diet. Food should be distributed in the small portions proceeding from loading in this or that time of day. Speaking about food at a diabetes mellitus, first of all it is necessary to pay attention to a glycemic index of products. This indicator displays dynamics of level of a glycemia at the use of this or that food stuff. At the use of sugar, honey, Coca-Cola and some other products it reaches 100% that speaks about absolute absorption of carbohydrates. Products with a low glycemic index are recommended to diabetics: fructose, greens, nuts, soy (GI makes up to 30%), lactic products, bean, porridges, bread with bran (30-50%).
Are recommended for the use at a diabetes mellitus the following dishes: low-fat grades of fish (a hake, a pollock, a pike perch), fowl, steam cutlets, boiled eggs or an omelet, fermented milk products, low-fat sour cream, vegetable oil, vegetable and groat soups, low-fat borsch, black bread, bread with bran, vegetables, different types of porridges (especially oat and buckwheat), the apples, sweeteners and products supporting them.
Are undesirable at a diabetes mellitus such products as: smoked products, fat meat and fish, firm cheese, condensed milk, pork and beef fat, pasta soups, flour products, white loaf, sweet fruit and berries – a melon, grapes, plum, an apricot. Also it is not necessary to use sugar, honey and confectionery.

Purpose of replacement therapy at a diabetes mellitus (insulin therapy) pursues such aims:
- decrease in level of sugar of blood
- maintenance of normal body weight
- normalization of lipidic exchange
- social adaptation of the patient, free lifestyle
- reduction of risk of complications of a diabetes mellitus.

Indications to purpose of insulin:
1. Diabetes mellitus of 1 type.
2. Diabetes mellitus 2 types, if
- the hyper glycemic, giperosmolyarny or laktatatsidotichesky coma or a prekoma developed
- accession of a liver or renal failure
- the expressed diabetic neuropathy with a pain syndrome
- progressing of a retinopathy
- macrovascular disorders of acute or chronic character
- ketoacidosis
- progressing of loss of weight
3. A diabetes mellitus at some stages: pregnancy, the lactation period, accession of intercurrent  diseases, including infectious, in need of operative measures and during the postoperative period.
4. A state after removal of a pancreas – a pancreatectomy.

Drugs of insulin are subdivided depending on duration of their action.
Carry to insulin of ultrashort action хумалог, new slow motion. Their action continues 3,5-4 hours.
Drugs of insulin of short action: актропид, хумодар P and P100, monogift, фармасулин N, хумулин регуляр. Their action continues till 8 o'clock.
The following drugs of insulin possess an average term of duration: инсуман bazat, insuman комб, a monogift of B, K15, K30, K50, NANOMETER, фармасулин N of NP, хумодар, K15, K30, K50, хумулин L, NPH and others. They act from 6 to 24 hours.
Drugs of insulin it is long actions exert impact on a glycemia on average for 24 hours (лантус, левемир, фармасулин to HL, хумулин an ultratape, etc.).
Refer simplicity of carrying out, clearness for the patient to advantages of a traditional insulin therapy, his relatives and medical staff. At a traditional insulin therapy control of level of glucose is carried out on a glucosuria. Shortcomings, in principle, too are: need of a priderzhivaniye of a severe diet, attachment to meal in certain hours, high risk of a hypoglycemia, gradual increase in body weight, insufficient efficiency of control of a glycemia.

The average dose of insulin necessary at absolute deficit of endogenous insulin makes 0,7-0,8 PIECES/kg of body weight of the patient a day. However this dose demands correction in certain situations.
It is necessary to reduce an insulin dose at the diet poor in fats and rich with food fibers, at decrease in level of kontrinsulyarny hormones, progressing of a diabetic nephropathy, reduction in the rate of utilization of insulin.
Increase in the entered dose of insulin is necessary at a diet rich with fats, a stress, an immobilization (at changes), intercurrent diseases, increase in level of kontrinsulyarny hormones, tin maturing, the strengthened growth, pregnancy, obesity or emergence of antibodies to insulin.

Treatment of a diabetes mellitus of the 2nd type includes stimulation of insulin secretion (derivative sulfanylurea of 3 generations, derivatives of the benzoic acid, derivatives of insulinopodobny amino acid), reduction of insulin resistance and braking of a gluconeogenesis (tiazolidinediona and guanyl guanidines), delay of absorption of glucose in blood (inhibitors of alpha glucosidases and hyuarovy acid).
From drugs of sulfanylurea drugs of the 2 and 3 generations are most spread: Glibenclamidum, диабетон MR, глипизид, глимепирид.
Guanyl guanidines are presented by such drugs as Metforminum (a siafor, Diforminum) and dianormt (metforat, глюкофаж).
The drugs which are slowing down glucose absorption: inhibitors of alpha glucosidases (drugs acarbose (глюкобай) and миглитол) and hyuarovy pitch (гуар GUM (guary).

Tactics of purpose of therapy at a diabetes mellitus of the 2nd type:
Physical exercises, diet, control of weight => phytodrugs, alpha glucosidase inhibitors => guanyl guanidines and streptocides => a combination of various groups of peroral glucose-lowering drugs => insulin in combination with peroral glucose-lowering drugs => insulin.

Antihyperglycemic phytocollecting is also actively used for correction of level of sugar at a diabetes mellitus of the 2nd type.
The diabetic collecting comprising such vegetable components as a horsetail field, nettle leaves, lime color,  a ninety-knot, a peel of haricot and others has antihyperglycemic properties.