by e-mail (anytime):
EN | USD
by e-mail (anytime):
Type 2 diabetes mellitus — is often occurring endocrine pathology, associated with decrease of absorption of glucose by tissues. Incidence is steadily increasing in all countries of the world: this disease affects about 5% of the world's population.
The main number of cases falls on people over 40 years old, and almost 80% of them are obese. Type 2 diabetes mellitus is metabolic disorder: in its pathogenesis the leading place is taken by violation of metabolism of not only carbohydrates, but also fats, proteins and microelements.
One of the important metabolic hormones of body is insulin. It is produced by beta cells located in pancreas islets of Langerhans. When insulin interacts with special tissue receptors, glucose transportation is activated inside the cells through the membrane. Thus, normal insulin synthesis is an important condition for nutrition of body tissues.
Unlike type 1 diabetes mellitus, in which insulin secretion is reduced, type 2 diabetes mellitus is characterized by a relative insulin deficiency: at normal or even slightly elevated insulin level, the sensitivity of the insulin to it is sharply reduced. As a result, cells can not metabolize glucose and experience "starvation".
Tissues sensory decrement to insulin (insulin resistance) presumably develops against a background of prolonged hypersecretion of this hormone. Excessive intake of refined carbohydrates in the body requires increased production of insulin, which in this case is necessary for assimilation of excess glucose. Prolonged intake of high volumes of sugar in tissues includes protection mechanisms, one of which is the development of insulin resistance: receptors destined for affinity with insulin, change in such a way that the effectiveness of action of hormone decreases.
Another one outcome of pathological process is deterioration of pancreatic beta cells. After a while there comes a moment when insulin secretion drops sharply, and in some cases stops completely. In this phase of the disease, control over diabetes mellitus is significantly hampered and the only way out of this situation is to use insulin.
Not in every instance wrong "sugar" food ration leads to development of type 2 diabetes mellitus.
To implement the above mechanism of insulin resistance, certain conditions are required - presence of one or more risk factors:
Combination of several of these factors multiplies the risk of developing the disease.
Almost half of cases of disease can detect a hereditary predisposition - an indication of presence of any relative suffering from type 2 diabetes mellitus. Studies of twins show that if one of the identical twins has this form of diabetes mellitus, the risk of disease for another one is close to 100%. In part, such indicators are associated with eating habits and behavioral peculiarities in a given family. Nevertheless, genetic factor in development of disease is very strong, which is confirmed by numerous studies.
All responsible for high risk of type 2 diabetes mellitus genes are conventionally divided into 3 groups:
Genes that cause a decreased secretion of insulin.
Genes that encode hyposensitivity of tissues to insulin.
Genic structures of different orientations: responsible for metabolic processes, appetite, food preferences, etc.
Nowadays there are known more than two dozen important for disease genes. Their detection and demonstration of specific genic polymorphism indicates a genetic predisposition to disease.
Type 2 diabetes mellitus, as a rule, develops gradually.
The following complaints are usually considered to be a reason for contacting an endocrinologist or therapist:
Polydipsia.
High volume of daily urine.
Irregular appetite.
Dry skin.
Mucous membranes itching and burning.
Weakness, decreased functioning.
All these symptoms are a consequence of a high level of glucose in blood with the effect of starvation of tissues.
In many cases timely initiation of therapy allows to effectively control the disease. With progression of pathological process and growth of insulin resistance, there are signs of damage of internal organs:
pathology of organ of vision
— diabetic retinopathy;
neurological disorders
— diabetic polyneuropathy and encephalopathy;
reduced kidney function
— diabetic nephropathy.
Worsening of course of diabetes mellitus provokes emergence of clinically significant atherosclerosis in all its manifestations - coronary heart disease, arterial hypertension, disorder of cerebral circulation, worsening of soft tissue trophism.
The lack of adequate treatment is fraught with a deterioration in the patient's state with the development of coma. The cause of coma may be an increase or a sharp decrease in sugar level in blood, as well as the accumulation of toxic metabolites of glycogen breakdown.
To confirm the diagnosis, the following research methods are used:
Laboratory tests:
determination of glucose level in blood on an empty stomach and after eating, study of glucose tolerance (glucose challenge test), urinalysis, biochemical study including blood lipid analysis.
Determination of endocrine profile:
may be required for differential diagnosis.
U/S, doppler sonography, computerized tomography, magnetic resonance imaging:
are carried out for the main indications with the purpose of revealing of complications.
Consultations of an oculist and neurologist:
are prescribed to all patients suffering from diabetes mellitus. They are necessary for diagnosis of retinopathy, neuropathy and other conditions complicating the course of the disease.
Every year the diagnosis of type 2 diabetes mellitus becomes the cause of dangerous diseases in thousands of people all over the world. Millions of dollars are spent for treatment of complications and control of sugar level, the same amount is considered to be lost as a result of disability.
Do not wait for disease! Take the DNA test on the genetic predisposition to type 2 diabetes mellitus: start preventive measures as soon as possible.
Nutrition for type 2 diabetes mellitus is one of the most important points of disease control. During early diagnosis, dietary nutritional therapy gives a good result: in a number of cases it is possible to manage for a long time without drug correction of blood glucose.
Dietary table - 9 should become the basis of menu for type 2 diabetes mellitus.
Main characteristics of this table are:
Moderately reduced total caloric intake for obese individuals.
Fasting and strict hunger days are categorically contraindicated.
Exclusion of refined carbohydrates, mango, rice and macaroni from menu.
Restriction of salt, animal fats.
Refusal to eat smoked products, spicy spices, marinades.
Diet should contain a physiological amount of protein and an increased amount of fiber.
It is acceptable to include sweeteners (limited) in diet.
Food should be fractional, a little at a time.
Alcohol is in extremely small amounts in the absence of severe damage of heart and blood vessels.
The goal of dietotherapy is reducing excess body weight, normalizing the metabolism of carbohydrates and fats, and maintaining normal blood glucose levels.
Products that are strictly prohibited in type 2 diabetes mellitus are:
sugar;
syrup;
jam;
ice-cream;
cakes, rolls, patty-cakes;
fruits with high sugar content (grapes, banana);
rice;
manna groats;
pasta;
bought-in juice.
It is recommended to limit consumption of the following products:
salt;
smoking and salting products;
alcohol;
fatty fish and fatty meat, lard;
duck, goose meat;
potatoes, carrots, beets.
In addition to diet, patients are prescribed to have exercise therapy or any other moderate physical activity. With severe concomitant cardiovascular pathology, physical activity should be dosed: in this case, the physician puts stress tests and selects an individual training regimen.
Patients, who suffer from type 2 diabetes mellitus, in addition to a special diet, are also prescribed for drug treatment, which is selected individually and periodically adjusted for blood sugar levels.
For type 2 diabetes mellitus treatment, hypoglycemic drugs are prescribed; they stimulate insulin secretion, increase sensitivity of tissues to this hormone and reduce the absorption of glucose in the intestine. The type of drug, its dose and mode of reception are to be selected individually. The most popular hypoglycemic agents are metformin, glibenclamide, nateglinide, pioglitazone, acarbose.
To monitor the effectiveness once in 3 months (or more often - according to the indications) laboratory tests and examination of a doctor-endocrinologist should be conducted.
If the result of treatment by means of hypoglycemic agents is insufficient, prescribe insulin. In this case, the patient should learn the skills of independent dose counting and drug administration. Dietary recommendations remain in force, in addition to caloric content, it is necessary to count the number of "bread units" (according to a special table) characterizing the carbohydrate content in food.
Confirmed increase of cholesterol requires correction of lipid metabolism. Concomitant hypertension and other cardiovascular diseases are subject to regular monitoring and adequate therapy.
Complex treatment allows you to maintain activity and delay the occurrence of severe complications.
Preventive measures do not have a clear specificity. Recommended are:
Indications for screening and its frequency are determined according to the following recommendations:
persons under the age of 45 who are obese and who have at least one of additional risk factors
— laboratory tests are performed every 3 years;
persons with established increased tolerance to glucose (prediabetes)
— once a year;
persons older than age of 45 years, regardless of the presence of risk factors
— every 3 years.
Taking into account great importance of hereditary predisposition in the development of type 2 diabetes mellitus, endocrinologists recommend all patients (especially those ones who have relatives with diabetes mellitus) to be screened for the risk of this disease.
DNA test — is the only way to get information regarding hereditary predisposition. The results of the study will form the basis of an individual program for the prevention and screening of type 2 diabetes mellitus.
Do not wait for disease! Take the DNA test on the genetic predisposition to type 2 diabetes mellitus. Save your health: make preventive measures effective!
