Diabetes mellitus type II (Non-insulin dependent diabetes, Type 2 Diabetes)

It is a chronic disease of the endocrine system, which develops due to a lack of insulin and dysfunction of pancreatic cells. It manifests itself as excessive urination, increased thirst, itchy skin, increased appetite, fever, and muscle weakness. The diagnosis should be confirmed by laboratory tests, namely through a blood test for glucose concentration and the level of glycosylated hemoglobin. Treatment mainly uses a low-carbon diet, increased physical activity and hypoglycemic drugs.

Information about the disease.

In fact, “diabetes mellitus” from Greek means loss of sugar. Thus, the term reflects the main symptom of the disease (lack of sugar) - glucose is not retained in the body and is excreted in the urine. Type 2 diabetes mellitus (non-insulin-dependent) develops against the background of tissue insensitivity to the action of insulin, as well as a subsequent decrease in cell function. Diabetes mellitus type 2 (DM2) is different from diabetes mellitus type 1 (DM1). In diabetes 1, the lack of insulin is primary; in diabetes 2, the lack of the hormone is a consequence of a prolonged lack of insulin. Statistics are very diverse and depend on ethnic characteristics and living standards. In Russia, the prevalence is about 7%, and covers 90% of all forms of diabetes. The group most susceptible to the disease is people over 40-45 years of age.

Why does type 2 diabetes occur: scientists have discovered the cause of the pathological condition

The culprit of the disorder is the hormone adiponectin (GBP-28), produced by adipocytes - cells of adipose tissue of internal organs. The main function of adiponectin is the breakdown of fat deposits into amino acids. It is this process that prevents obesity. In addition, the hormone prevents the formation of atherosclerotic plaques, normalizes cholesterol, and reduces the likelihood of blood clots.

There is a direct relationship between the amount of adiponectin produced and body mass index. The slimmer a person is, the more of this hormone his body produces. And vice versa: high body weight is directly related to a decrease in the amount of GBP-28.

The hormone was discovered only in 1994; until that time, the mechanism of type 2 diabetes was not studied and, accordingly, could not be treated correctly, so the diagnosis of type 2 diabetes was equal to a life sentence. Recent studies have shown that adiponectin directly affects glucose metabolism, influencing the development of diabetes. This discovery provides a new way to treat non-insulin-dependent diabetes.

Adiponectin affects many vital processes, which explains a large number of complications in diabetics who have low levels of the hormone. In particular, GBP-28:

• prevents the formation of fatty deposits in the liver;
• maintains optimal lumen and elasticity of blood vessels;
• prevents visceral fat from depositing on the surface of internal organs;
• helps diagnose atherosclerosis, because hormone cells are deposited in vascular microtraumas;
• increases metabolism and promotes weight loss;
• reduces inflammation of blood vessels and arteries;
• protects the myocardium from necrosis in case of lack of oxygen.

When the level of this hormone decreases, a person becomes ill, and a complex of processes in his body is disrupted.

Causes of type 2 diabetes mellitus.

The disease develops due to a combination of hereditary predisposition and external factors affecting the body throughout life. By adulthood, negative exogenous influences reduce the sensitivity of cells to insulin, as a result of which they cease to receive sufficient amounts of glucose. The main causes of type 2 diabetes:

• • Obesity. Fat tissue reduces the ability of cells to properly perceive insulin. Excess weight is one of the key risk factors for developing the disease. Obesity is present in 80-90% of patients;
• • Poor nutrition. The main cause of obesity is overeating. An increased calorie intake leads to the development of type 2 diabetes. In addition, excessive consumption of large amounts of sugar provokes surges in insulin secretion, which also provokes the development of the disease;
• • Physical inactivity. Lack of physical activity has a bad effect on the functioning of most organs of the body, and also helps to slow down metabolic processes. Physical inactivity is accompanied by low consumption of glucose by muscles, so it accumulates in the blood;
• • Endocrine diseases. Often, the disease occurs against the background of disruption of the endocrine system. Cases have been reported against the background of pancreatic tumors, pancreatitis, hypo- or hyperfunction of the thyroid gland;
• • Infectious diseases. In people with hereditary pathology, the initial appearance of diabetes mellitus can be triggered by an infectious disease - herpes, influenza and hepatitis.

Diabetes mellitus type II (Non-insulin dependent diabetes, Type 2 Diabetes)

Diabetes

Pancreatitis

Hypercholesterolemia

7042 March 22

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Diabetes mellitus type II: causes, symptoms, diagnosis and treatment methods.

Definition

Diabetes mellitus (DM) type II is a metabolic disease characterized by chronic hyperglycemia (high blood glucose), which develops as a result of disruption of the mechanisms of interaction of insulin with tissue cells or its secretion (WHO, 1999). In people with this form of the disease, the pancreas cannot produce enough insulin, or the body does not use it effectively. Type II diabetes is diagnosed in 90% of people with hyperglycemia.

Causes of type II diabetes mellitus

The key mechanism for the development of the disease is insulin resistance - the immunity of body tissue cells to the action of insulin, a decrease in their biological response to one or more effects of insulin at its normal concentration in the blood. Insulin resistance leads to the inability of muscle and fat tissue to absorb glucose and to a disruption in the synthesis of glycogen (one of the main forms of “reserve” energy in the human body) in the liver.

In a healthy person, the insulin molecule binds to a special receptor located on the cell membrane and ensures the passage of glucose (the main source of energy) into the cell. In a patient with type II diabetes, the ability of insulin to transmit a signal for glucose to enter the cell is lost, as a result of which the cell cannot absorb glucose.

The pancreas, reacting to high blood sugar levels, becomes depleted over time and loses its secretory functions. As a result, the blood glucose level increases and glucotoxicity increases, which leads to damage to many organs and systems of the body and serious long-term complications.

Although there is a genetic component to the development of type 2 diabetes, the main risk factors for the disease are a sedentary lifestyle, excess weight and abdominal obesity (accumulation of fat in the abdomen), and a diet containing too much fat and carbohydrates. Often there is not one, but a whole complex of reasons.

The disease most often develops in people over 40 years of age who are overweight or obese, but can also manifest at a younger age, as well as in people with normal body weight. In Russia, at least 9 million people (about 7% of the population) suffer from type II diabetes.

Classification of the disease
According to the severity of glycemia:

• Mild - self-limited by the patient and does not require outside help.
• Severe - with severe symptoms, loss of consciousness, can only be stopped with the help of strangers and in an emergency.

According to the degree of compensation of carbohydrate metabolism:

• compensation phase
• subcompensation phase,
• decompensation phase.

The International Classification of Diseases, 10th revision,
offers the following classification of type II diabetes mellitus:

E11.2 - type II diabetes with kidney damage, E11.3 - type II diabetes with eye lesions, E11.4 - type II diabetes with neurological complications, E11.5 - type II diabetes with peripheral blood supply disorders, E11.6 - diabetes type II with other specified complications, E11.7 - type II diabetes with multiple complications, E11.8 - type II diabetes with unspecified complications, E11.9 - type II diabetes without complications.

Symptoms of type II diabetes mellitus

A distinctive feature of the disease is its long asymptomatic course. The reason for the patient’s initial visit to the doctor may be various manifestations of micro- and macroangiopathies, leg pain, and erectile dysfunction. Symptoms of type II diabetes often occur when hyperglycemia is already persistent.

Patients may complain of weakness, fatigue during physical and mental stress, drowsiness, and memory loss. With chronic hyperglycemia, the following manifestations of the disease may occur: dry mouth, severe thirst, itchy skin, frequent urination (including at night), furunculosis, fungal infections, poor wound healing, blurred vision (blurred before the eyes) due to vascular damage retina of the eye. As diabetes progresses, the symptoms become more pronounced, and disturbances in the functioning of various organs are observed. The cells of the brain and heart, which suffer first, need glucose and oxygen the most. Excess sugar in the blood leads to obliteration of arterial vessels - they lose elasticity and firmness, the lumen of the arteries narrows. As a result, patients' blood pressure increases and their heart rhythm is disrupted.

Diagnosis of type II diabetes mellitus

Detection of the disease most often occurs accidentally or during a clinical examination. The diagnosis of diabetes mellitus is established based on the level of glycated hemoglobin (HbA1C) in the blood plasma. Glucose molecules penetrate into red blood cells and firmly bind to hemoglobin protein receptors - they glycate it. The more glucose in the blood, the more of its molecules “settle” on hemoglobin, preventing it from transporting oxygen and carbon dioxide. The diagnosis of diabetes is established when the HbA1C level is greater than or equal to 6.5%.

Mechanism of disease development.

The basis of the disease is a violation of carbohydrate metabolism due to increased cell resistance to insulin. The ability of tissues to accept and utilize glucose decreases, and a state of hyperglycemia (increased plasma sugar levels) develops. In addition, alternative ways of obtaining energy from amino acids and fatty acids are activated. To compensate for the glucose balance, the body begins to remove it through the kidneys (in the urine). A high concentration of sugar in body fluids causes an increase in osmotic pressure, causing copious and frequent urination. During this process, more fluid and salts are removed from the body, leading to dehydration and electrolyte imbalance. All this provokes the main symptoms of the disease - thirst, dry skin, weakness and arrhythmia.

Classification of the disease:

• • Lightweight. Treatment requires dietary adjustments, as well as a small dosage of a hypoglycemic drug. Low risk of complications;
• • Medium shape. To stabilize the disorders, constant intake of hypoglycemic agents is necessary. There is a possibility of initial stages of vascular complications;
• • Severe form. Patients require a course of tableted hypoglycemic drugs and insulin. Serious diabetic complications arise - angiopathy of small and large vessels, neuropathy, encephalopathy.

Does diabetes really come from sweets?

You should not compare the sweets of your childhood with modern sweets. They are much more high in calories and harmful. In their production, trans fats, preservatives, and dyes are used, and this is an additional burden on the pancreas.

Children's passion for computer games leads to physical inactivity and, as a result, an increase in the amount of visceral fat. And it is precisely the main culprit in the development of type 2 diabetes. Therefore, doctors are no longer surprised that children of primary school age suffer from such an “adult” disease.

Symptoms of the disease.

Type 2 diabetes develops quite slowly. At the initial stage, the symptoms are practically invisible. The first symptom that appears is increased thirst. The mouth feels dry, and patients drink about 3-5 liters per day. With this volume, the amount of urine and frequency of urination increases. Due to the increased sugar content in the urine and frequent urination, itching and redness of the groin area occurs. Over time, itching occurs in the abdomen, armpits, knees and elbows. Since glucose does not reach the tissues in full, appetite increases (after 1-2 hours after eating, the patient feels hungry). Despite the high caloric content of the diet, the patient does not gain weight, since glucose is not absorbed, but is lost in urine.

Additional symptoms include increased fatigue, chronic feeling of tiredness, daytime sleepiness, weakness. The skin becomes drier, rashes and fungal formations appear. Bruises easily appear on the body, and wounds and abrasions take a very long time to heal. Women experience genital candidiasis, and men experience urethral infections. Some patients report tingling in their fingers and numbness in their feet. After eating, a feeling of nausea and even vomiting is also noticeable. Headaches and dizziness are common.

Type 2 diabetes in children

Type 2 diabetes is more common in adults, but young children are also susceptible to the disease. These are mainly kids whose parents did not monitor their diet and allowed them to eat chips, candies and other sweets with dyes and a lot of sugar.

However, type 1 diabetes, which has a high hereditary factor, is most common in childhood. But recently, doctors have noted a sharp increase in the incidence of type 2. If in the 80-90s of the 20th century type 2 diabetes occurred in only 2% of children, today it is diagnosed in almost 45% of diabetic children. Moreover, 85% of them are overweight.

The following factors lead to the development of the disease in children:

• viral infections suffered by the mother during pregnancy;
• stress in the baby, which provokes the release of adrenaline into the blood, disrupting carbohydrate processes;
• the child’s passion for foods rich in sugar (waffles, candies, condensed milk, soda);
• lack of movement, physical inactivity;
• birth weight above 4000 grams.

Serious complications.

The development of type 2 diabetes mellitus may be accompanied by the development of chronic and acute complications. The most dangerous complications can lead to death - hyperglycemic coma, hypoglycemic coma, lactic acid coma. Chronic complications develop gradually and include diabetic microangiopathies and macroangiopathies - manifested by thrombosis and vascular atherosclerosis. Disturbances in the functioning of internal organs, joint pain and mental disorders (depression, emotional instability) are often noticeable.

Where to get tested for diabetes in St. Petersburg

You can get tested for type 2 diabetes at the Diana Clinic in St. Petersburg. Here you can also undergo an ultrasound of the pancreas using a new expert device. After this, you can consult an experienced endocrinologist.

Endocrinologists at the Diana Clinic take a comprehensive approach to the treatment of non-insulin-dependent diabetes mellitus, combining proper nutrition, giving up bad habits and physical activity with rationally selected medications.

Make an appointment with a gynecologist by calling 8-800-707-1560, request a call back or fill out the appointment form on the page!

How to diagnose type 2 diabetes?

The problem of identifying diabetes mellitus is manifested in the absence of obvious symptoms in the initial stages of the disease. Patients with a hereditary predisposition to the disease, or over 40 years of age with suspected diabetes, are recommended to undergo a blood plasma test for sugar levels. Laboratory tests will be the most informative and will detect not only the initial stage of diabetes mellitus, but also the state of prediabetes - decreased susceptibility to glucose. The examination is carried out by an endocrinologist.

To the Endocrinologist

Diagnosis begins with asking the patient about his well-being, symptoms of the disease are identified, and existing risk factors are analyzed. Once results from the laboratory are received, the diagnosis can be confirmed. There are several specific tests to detect type 2 diabetes:

• • Fasting glucose. The material is collected after 8-12 hours of fasting. Glucose levels above 7 mmol/l (venous blood) are a criterion for the disease;
• • Glucose test. To diagnose diabetes at an early stage, glucose concentrations are examined after eating a meal high in carbohydrates. With this test, a reading above 11.1 mmol/l is diabetes, a reading of 7.8-11.0 mmol/l is prediabetes;
• • Glycated hemoglobin. The analysis allows you to estimate the average glucose concentration in the body over the past 3 months. An indicator of 6.5% or more indicates diabetes, 6-6.4% indicates prediabetes.

Diff. diagnosis involves distinguishing between type 1 diabetes and type 2 diabetes. The clinical differences between these diseases are the slow increase in symptoms and the older age of the patients (although recently there have been cases of the disease in people aged 20-25 years).

Evaluation of treatment effectiveness

The effectiveness of the prescribed treatment must be monitored and, if necessary, the treatment program adjusted. In addition, it is important to identify emerging complications at an early stage. To do this, patients are recommended to check glycated hemoglobin every three months, microalbuminuria (MAU) every six months, and undergo a clinical examination once a year.

Patients with diabetes mellitus of the first group are registered with an endocrinologist, and patients with T2DM, after selecting appropriate therapy in the absence of severe cardiovascular diseases, are observed by a therapist or general practitioner. If the patient's condition worsens, the therapist can re-refer him to an endocrinologist to adjust the therapy. If the complications that arise lead to a person’s loss of ability to work, he is assigned a disability, but this is done on the basis of the conclusion of a medical and social examination.

Prevention and treatment of type 2 diabetes

Endocrinology uses a systematic approach to therapy. In the initial stages of the disease, the greatest attention is paid to consultations and changes in the patient’s lifestyle (attempts to control sugar). If such treatment does not help, then a decision is made to use drug treatment. The complex of treatment procedures includes:

• • Diet. The main principle of the diet is to reduce foods high in carbohydrates and fats. The most dangerous are products with refined sugar (confectionery, candy, chocolate, lemonade). The diet should consist of vegetables, milk, meat, eggs and grains. The diet should be fractional (5-6 times a day), portions should be small;
• • Physical exercise. If the patient does not yet have severe complications, then sports activities are indicated for him. The duration and intensity of training is selected individually. Patients are usually recommended to exercise walking, swimming and walking;
• • Drug treatment. Several groups of drugs are used. To reduce insulin resistance of cells, the absorption of glucose in the gastrointestinal tract and its production in the liver, the use of biguanides and thiazolidinediones is allowed. If the use of these drugs is not enough, drugs that enhance insulin activity are prescribed.

Timely diagnosis, an experienced endocrinologist and correctly prescribed treatment (including diet) are the key to successful treatment of the disease. Our multidisciplinary Sante Clinic employs experienced endocrinologists (PhD) who will help you maintain your health with diabetes mellitus type 1 and 2. Without queues, long waits “by appointment” and postponed appointments - we are waiting for you at Sante Clinic!

To the Endocrinologist

Blood sugar levels: norms and violations