Diabetes mellitus of type 2 (non-insulin-dependent)

Description:

Diabetes mellitus 2 types - the chronic disease which is shown disturbance of carbohydrate metabolism with development of a hyperglycemia vsledsvy insulin resistance and secretory dysfunction of beta cells, and also lipidic exchange with development of atherosclerosis. As the main reason for death and an invalidism of patients are complications of system atherosclerosis, 2 types sometimes call a diabetes mellitus a cardiovascular disease.

Symptoms of the Diabetes mellitus of type 2 (non-insulin-dependent):

In most cases, the expressed clinical manifestations are absent, and the diagnosis is established at routine determination of level of a glycemia. The disease usually demonstrates 40 years are aged more senior, at the same time at the vast majority of patients obesity and other components of a metabolic syndrome takes place. Patients do not show complaints to decrease in working capacity if for this purpose there are no other reasons. Complaints to thirst and a polyuria seldom reach considerable expressiveness. Rather often patients are disturbed by a skin and vulval itch in this connection they address dermatologists and gynecologists. As from real manifestation of a diabetes mellitus 2 types before diagnosis often pass many years (on average about 7 years), at many patients at the time of detection of a disease in a clinical picture symptoms and manifestations of late complications of a diabetes mellitus dominate. Moreover, the first address of the patient 2 types behind medical care very often happens to a diabetes mellitus in connection with late complications. So, patients can be hospitalized in surgical hospitals with a canker of legs (a syndrome of diabetic foot), to address in connection with the progressing decrease in sight ophthalmologists (a diabetic retinopathy), to be hospitalized with heart attacks, strokes, obliterating defeat of vessels of legs in institutions where the hyperglycemia for the first time is found in them.

Reasons of the Diabetes mellitus of type 2 (non-insulin-dependent):

The diabetes mellitus 2 types is a multifactorial disease with genetic predisposition. Most of patients with a diabetes mellitus 2 types indicate existence of a diabetes mellitus 2 types at the immediate family; in the presence of a diabetes mellitus 2 types at one of parents the probability of his development in the descendant throughout life makes 40%. Any one gene which polymorphism defines predisposition to a diabetes mellitus 2 types is not revealed. Great value in implementations of genetic predisposition to a diabetes mellitus 2 types play environment factors, first of all, of feature of a way of life. 2 types are risk factors of development of a diabetes mellitus:

  1.ozhireniye, especially visceral;
  2.etnicheskaya accessory (especially when changing a traditional way of life with western);
  3.sakharny diabetes 2 types at the immediate family;
  4.malopodvizhny way of life;
  5.osobennosti diets (high consumption of the refined carbohydrates and low content of cellulose);
  6.arterialnaya hypertensia.

Treatment of the Diabetes mellitus of type 2 (non-insulin-dependent):

2 types are the main components of treatment of a diabetes mellitus: dietotherapy, expansion of physical activity, antihyperglycemic therapy, prevention and treatment of late complications of a diabetes mellitus. As most of patients with a diabetes mellitus 2 types have obesity, the diet has to be directed to weight reduction (hypocaloric) and prevention of late complications, first of all a macrovascular disease (atherosclerosis). The hypocaloric diet is necessary for all patients a lot of body weight (IMT of 25-29 kg/sq.m) or obesity (IMT> of 30 kg/sq.m). In most cases it is necessary to recommend decrease in a daily kalorazh of food to 1000-1200 kcal for women идо 1200-1600 kcal for men. The recommended ratio of the main food components at a diabetes mellitus 2 types similar to that at a diabetes mellitus of 1 type (carbohydrates - 65%, proteins of 10-35%, fats to 25-35%). Alcohol intake needs to be limited because it is an essential source of additional calories, besides, alcohol intake against the background of therapy by drugs of sulphonylurea and insulin can provoke development of a hypoglycemia.

Recommendations about expansion of physical activity have to be individualized. At the beginning aerobic loadings (walking, swimming) of moderate intensity lasting 30-45 minutes of 3-5 times a day are recommended (about 150 minutes a week). Further gradual increase in exercise stresses is necessary that in an essential measure contributes to decrease and normalization of body weight. Besides, exercise stresses promote decrease in insulin resistance and have gipoglikemiziruyushchy effect.

Drugs for antihyperglycemic therapy at a diabetes mellitus 2 types can be subdivided into four main groups.

I. The drugs promoting decrease in insulin resistance (sensitayzer)

Metforminum and tiazolidindiona concerns to this group. Metforminum is the only drug which is used now from group of guanyl guanidines. The main components of the mechanism of its action are:

  1. Suppression of a gluconeogenesis in a liver (decrease in products of glucose liver) which leads to decrease in level of a glycemia on an empty stomach.
  2. Decrease in insulin resistance (increase in utilization of glucose peripheral fabrics, first of all muscles).
  3. Activation of anaerobic glycolysis and reduction of absorption of glucose in a small bowel.
II. The drugs influencing a beta cell and promoting insulin secretion strengthening.
III. The drugs reducing absorption of glucose in intestines.
IV. Insulin and analogs of insulin.