Diabetes mellitus (Diabetes, Diabetes mellitus)

Types and symptoms of diabetes

In type 1 (I) diabetes, there is a lack of insulin. This hormone is produced in special areas of the pancreas - the islets of Langerhans. It is produced by beta cells. If a disease occurs, the cells die and are destroyed, so the hormone does not enter the blood. Type 1 diabetes can be immune-mediated or occurs spontaneously, for no apparent reason (idiopathic).

The onset of type 1 diabetes (onset) can be acute and life-threatening. It can be triggered by a recent infection; most often the disease begins in autumn or winter.

In this case, typical clinical symptoms of the disease appear, which are necessarily recorded by a doctor: dry skin, decreased elasticity, blush on the cheeks, shortness of breath, noisy breathing. As a rule, 15-20% of people at the beginning of the disease smell of acetone when exhaling.

At the time of treatment, the doctor must prescribe a comprehensive laboratory examination. It includes a test to determine glucose levels. A concentration above normal is hyperglycemia. A number of other tests can confirm the diagnosis of type 1 diabetes. In this case, lifelong insulin therapy is prescribed.

Diabetes mellitus of the second (II) type is a socially significant disease, the prevention of which is given a lot of attention. Impaired production of insulin secretion due to decreased sensitivity to it occurs for a number of reasons. Often these are metabolic disorders caused by hereditary factors. It is important to understand that the second most common cause of disease is obesity.

In type 2 diabetes, insensitivity to glucose develops; it can be of varying degrees and is also accompanied by varying degrees of impaired insulin production.

With the development of type II diabetes mellitus, general fatigue, apathy, increased amount of urine, thirst, and leg cramps (mainly at night) are often observed. Most often, the disease can “manifest” after 40 years of age against the background of concomitant diseases (arterial hypertension, obesity).

Normal and increased glucose in urine

The process of urine formation in the kidneys is very complex, and the goal is not only to get rid of those substances that the body does not need, but also to preserve useful and valuable substances. That is why the urine of a healthy person contains neither glucose nor protein. Their appearance is a sign of quite serious diseases.

Glucosuria

Glucosuria is the presence of sugar in the urine. As already mentioned, normally it should not be there. When blood passes through the glomeruli of the kidneys, virtually no glucose is filtered into the primary urine and enters the secretions only in small quantities, which are not detected by reagents for urine analysis.

If the level of glucose in the blood is above 10 mmol/ml (the so-called renal threshold for glucose), then it begins to pass the tissue barrier. The indicated value is almost twice the normal level of glucose in the blood, so the appearance of this substance in the urine indicates significant hyperglycemia (excess glucose in the blood).

Hyperglycemia and glycosuria can be physiological - they develop after a heavy meal, especially with a lot of sweets. Normally, physiological hyperglycemia disappears a few hours after eating, and glucosuria disappears earlier without any effort on the part of the patient.

That is why you need to take a urine test on an empty stomach - in this case there will be no physiological glucosuria. For the same reason, a single detection of sugar in the urine is an indication for additional research, and not for making an accurate diagnosis.

Pathological glycosuria

If a repeated study confirms the presence of glucose in urine, then we are talking about pathological glucosuria, i.e. glucose is constantly present in the urine. It can be caused by diseases that increase blood sugar levels or impair glomerular filtration, such as:

• diabetes;
• other diseases of the pancreas;
• kidney pathologies;
• hyperthyroidism (thyroid hormones increase glucose concentrations);
• brain tumors that cause hormonal imbalances;
• infectious kidney diseases;
• poisoning

Differentiation of each of these conditions allows other indicators of urine analysis, as well as data from other laboratory and instrumental studies, and data from the patient’s medical history. Glucosuria may have different features depending on the reasons that caused it.

Glucose content in urine in diabetes

Diabetes mellitus is a pathology of the pancreas in which the production of insulin, the only hormone that lowers blood sugar, is disrupted. The peculiarity of this hormone is that its level in the blood is regulated only by glucose content, and not by the regulating hormones of the thyroid gland or pituitary gland. In addition, hormones that increase sugar, i.e. There are several that counteract insulin (counterinsular), but only insulin increases the uptake of glucose by cells.

Insufficient levels of glucose in the blood lead to the fact that the level of glucose rises; it is no longer absorbed by cells in the required quantities, but remains circulating in the blood. Excess glucose is excreted in the urine. If the disease lasts a long time and the patient does not receive sufficient treatment, then glucose is excreted in the urine constantly, and a paradoxical situation arises - glycosuria with normal or low blood glucose levels.

In addition to the sugar content, the amount of urine also increases, and with a long course of the disease, protein may appear - this indicates the development of a complication of diabetes mellitus - nephropathy. In addition to changes in urine, there will be an increased level of glucose in the blood on an empty stomach, as well as the patient’s characteristic complaints - increased appetite, constant thirst and urge to go to the toilet, weakness, headaches, decreased performance.

Treatment of diabetes mellitus requires a complete revision of lifestyle and nutrition, taking medications that lower sugar, including insulin injections. The disease is chronic, so its treatment lasts a lifetime in close cooperation with an endocrinologist.

Pancreatitis (inflammation of the pancreas) and pancreatic necrosis, tumor or injury of the pancreas, parasitic damage to the organ (for example, opisthorchiasis or ascariasis) can contribute to the development of diabetes mellitus and the accompanying glycosuria. Therefore, for these diseases, monitoring glucose levels in the blood and urine is extremely important.

Glucose and protein in urine in kidney disease

The kidney tubules are formed in such a way as to prevent the passage of substances needed by the body into the urine. Those that pass the renal barrier (for example, albumin) then undergo reabsorption (reabsorption), so they may be present in primary urine, but are completely absent or present in trace amounts in secondary urine.

With kidney diseases, as well as with their injuries and toxic lesions, damage to the kidney tissue occurs, so the renal barrier becomes more permeable, and substances that should remain in the blood, in particular, sugar and protein, enter the urine. The presence of protein in the urine is called proteinuria and is not physiological.

Proteinuria can be a side effect of certain medical procedures - stone crushing, ultrasound, scintigraphy. When prescribing them, the doctor warns the patient about this, and urine tests are rescheduled for 3-4 days after the procedure. During this time, transient proteinuria should completely resolve. Just as in the case of glucosuria, if protein is detected in the urine, a repeat test is prescribed for confirmation.

The combination of glycosuria and proteinuria, confirmed by repeated analysis, indicates that there are kidney lesions, which can be of a different nature:

• infectious;
• parasitic;
• autoimmune;
• toxic.

Proteinuria also develops in diseases of the urinary tract, but in this case it is not accompanied by glucosuria. Signs of kidney disease are the appearance of any foreign substances in the urine (toxins, pus, blood cells), a change in the amount of urine (frequent urge or, conversely, a decrease in the amount of urine), a change in its color.

Severe kidney diseases are manifested by increased blood pressure, changes in skin color (it becomes grayish), deterioration in health, and an unpleasant odor from the skin (sweat takes on the smell of urine). The development of hemodynamic disturbances and a decrease in physical and mental performance are possible.

How to properly collect urine?

Urine for general analysis (the one most often prescribed) must be collected in the morning before breakfast in a special laboratory container. The greatest diagnostic value is the first portion of urine per day. It is allowed to collect urine during the day, but not less than 3 hours after eating.

If the patient cannot urinate, he is allowed to drink a glass of water (still drinking water). Mineral water is not suitable in such cases. Women should not collect urine during menstruation and the next day after it ends - menstrual blood in a urine test distorts the results.

The laboratory container must be clean, but sterility is not required. It is more important to exclude access to foreign substances. Immediately after collection, screw the lid of the container tightly. In a tightly closed laboratory container, the collected urine retains its properties throughout the day, so it is useless to submit “yesterday’s” urine to the laboratory.

Based on the results obtained, the urologist will determine whether there are pathological disorders in the body or not, and, if necessary, prescribe treatment.

Causes of diabetes mellitus

1. Hereditary predisposition, metabolic disorders caused by obesity, sedentary lifestyle (hypodynamia), which to a certain extent is also associated with obesity.
2. Diseases of the pancreas.
3. Infectious diseases that are caused by viruses, for example, rubella, smallpox, influenza.

The chronic course of diabetes is usually accompanied by severe complications and dysfunction of certain organs and systems. Thus, with retinopathy, visual impairment may occur, including cataracts and blindness. Nephropathy leads to kidney damage, angiopathy is fraught with ulcers of the lower extremities (“diabetic foot”). This often leads to tissue necrosis, gangrene and leg amputation. The urogenital system, heart and blood vessels, and teeth (periodontal disease) “suffer” from increased levels of glucose in the blood. That is why, if diabetes is suspected, it is important to diagnose the disease in a timely manner, if it is necessary to begin treatment, and to follow preventive measures.

Analyzes

Before the 20th century, early diagnosis of diabetes would not have had as significant an effect as it does now. After all, even after making a diagnosis, there was simply nothing to treat such a person. Life expectancy was only a few years, and death occurred from ketoacidotic coma.

Today there are both drugs to normalize blood sugar levels and insulin drugs. The administration of insulin compensates for the insufficiency of the pancreas. With the correct use of modern means, life expectancy increases significantly. This is evidenced by the fact that mortality from ketoacidosis in diabetes has decreased and now the main group consists of cardiovascular problems, as developed complications.

The administration of insulin compensates for the insufficiency of the pancreas.

Also, early diagnosis can reduce the likelihood of using insulin and limiting it to pills only. And perhaps, if you don’t have diabetes yet, diet, weight normalization, and physical activity will help. Then it will be possible to normalize the tests and avoid taking medications.

Until 1913, elevated glucose levels were determined by taste in urine. Today, several methods have been developed to determine glucose levels and verify the diagnosis of diabetes mellitus.

Blood glucose level

The level of glucose in the blood is the most important indicator of the constancy of the internal environment of the body. In a healthy person, levels practically do not fall below 2.5 mmol/l during periods of hunger and do not rise above 8 mmol/l even after eating. For diagnosis, both venous blood plasma and whole capillary blood plasma can be used. Venous blood is obtained when taken from a vein, capillary blood is obtained when the skin (finger) is punctured. Typically, laboratory data and portable glucose meter readings do not match because the glucose content in plasma and whole blood from a finger prick is different.

The diagnosis of diabetes mellitus can be made when:

• determining blood glucose levels greater than/equal to 11.1 mmol/l at any time;
• exceeding the level of 6.1 mmol/l in capillary and 7.0 mmol/l in plasma on an empty stomach.

To confirm the diagnosis, measurements are confirmed with a repeat test. Fasting measurements are usually carried out in the morning after sleep; before the test you should not eat or drink anything other than plain water. The fasting period before the study should be within 8-14 hours.

Glucose measurements to diagnose diabetes should only be performed in a laboratory. Glucometers for home use can be used to monitor the condition and determine the dose of medications, but not to establish a diagnosis.

An accurate diagnosis cannot be made based on glucometer data alone.

Oral Glucose Tolerance Test

Sometimes the test data is contradictory, then the blood glucose level is measured under load, the so-called Oral Glucose Tolerance Test. In tests it is designated as OGTT.

Rules for conducting OGTT. Over the previous 3 days there should be no dietary restrictions; the daily portion of carbohydrates should be at least 150 g. The last meal (dinner) should contain 30-50 g of carbohydrates. This is followed by a period of fasting of 8-14 hours (sleep). Upon arrival at the laboratory, fasting blood is first drawn. Then 75 g of anhydrous glucose or 82.5 g of glucose monohydrate diluted in 250 ml of water is given. The solution must be drunk within 5 minutes. Smoking is prohibited during the analysis process. The next blood draw is done after 2 hours.

Diabetes is considered to be an excess of sugar levels greater than or equal to 11.1 mmol/l.

There are situations when the test is not recommended for health reasons:

• there is an acute illness after surgery;
• there was a short course of taking drugs that increase glucose levels (hormonal drugs, beta-blockers, thiazides and others);
• liver cirrhosis, stomach ulcer with diarrhea, acute pancreatitis and exacerbation of chronic pancreatitis, surgery to remove part of the stomach.

Glycated hemoglobin HbA1c

Since 2011, WHO has approved this indicator for diagnosing diabetes mellitus. It shows your average blood sugar level over the last 90-120 days. The diagnosis can be made when HbA1c reaches or exceeds 6.5% or 48 mmol/mol. But it also has limitations. Since he estimates a period of 90 days in children, in case of rapid development of the disease, the level of glycated hemoglobin may be slightly increased, and the symptoms of diabetes may already develop.

WHO has approved the HbA1c indicator for diagnosing diabetes mellitus.

HbA1c levels may be low:

• acute leukemia, hemolytic anemia and other diseases with the destruction of red blood cells;
• large doses of vitamins C and E.

HbA1c levels increase:

• with age after 30 years;
• with alcoholism, smoking;
• iron deficiency anemia;
• taking salicylates, opiates;
• with elevated bilirubin levels.

Laboratory diagnosis of diabetes mellitus

To diagnose diabetes mellitus, the doctor must prescribe laboratory tests of hormones, biochemical tests of blood and urine. So, to diagnose diabetes you need to donate blood for glucose, glycosylated hemoglobin and fructosamine. To differentiate the first type from the second, a glucose tolerance test is used. It includes glucose, insulin, C-peptide. Blood collection is carried out strictly on an empty stomach (at least 8 hours after the last meal), it is repeated after 2 hours, when the patient is given water with glucose dissolved in it (75 g) to drink.

To diagnose glucose insensitivity, insulin resistance is assessed, also calculating the HOMA-IR index. It is calculated based on data on glucose and insulin levels. During an illness, it is recommended to take tests to monitor its course and make adjustments to the therapeutic course.

Blood glucose. The main indicator of blood sugar levels. If a person does not have diabetes and there are no prerequisites for its development, the concentration almost never falls below the established norm and rarely increases.

Insulin is a hormone that regulates blood glucose levels, as well as the metabolism of carbohydrates and fats. If it is not released enough, glucose increases. An increase indicates possible diabetes II. A blood test for this hormone is prescribed to decide on the prescription of insulin drugs, as well as in a complex of studies of metabolic disorders. Proinsulin is a molecule made up of insulin; characterizes the functionality of pancreatic beta cells.

C-peptide is a fragment of proinsulin that circulates in the blood and allows us to evaluate the functioning of pancreatic cells.

Glycosylated hemoglobin (glycated, HBA1c) is a combination of hemoglobin with glucose. The presence of this compound in the blood indicates an increase in sugar levels over the previous 2-3 months, since the lifespan of an erythrocyte is 90 days. Therefore, it can be a laboratory marker of hyperglycemia long before the appearance of other clinical symptoms of diabetes. The analysis is recommended by the World Health Organization, including as a key parameter in monitoring the course of diabetes mellitus.

Fructosamine. Fructosamine readings also reflect changes in glucose levels over the previous two to three months.

Diabetes mellitus (Diabetes, Diabetes mellitus)

Hypercholesterolemia

Pancreatitis

10353 05 March

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: causes, symptoms, diagnosis and treatment methods.

Definition

Diabetes mellitus (DM) is a group of chronic endocrine pathologies associated with impaired glucose absorption resulting from absolute or relative insulin deficiency.

Its main clinical manifestation is prolonged hyperglycemia due to impaired glucose metabolism in the body.

According to scientific research, the prevalence of diabetes is growing everywhere. WHO statistics show that in 2014, 422 million adults worldwide suffered from this disease, with an increase in incidence recorded from year to year. The number of undiagnosed cases of diabetes is about 50% of the officially registered ones. According to WHO documents, the disease is diagnosed in most people only when complications arise. The global prevalence of diabetes among people over 18 years of age increased from 4.7% in 1980 to 8.5% in 2014. Doctors estimate that over the next 20 years the number of people with diabetes will almost double.

Causes of diabetes mellitus

The etiology or pathogenesis of most types of diabetes can be simplistically described as impaired insulin sensitivity or impaired insulin secretion.

Insulin is a hormone that regulates blood sugar levels and is synthesized by β-cells of the pancreas - sequentially, in several stages. In diabetes, the pancreas does not produce enough insulin or the body cannot effectively use the insulin it produces. The physiological and most important stimulator of insulin secretion is glucose. In almost all tissues of the body, insulin affects the metabolism of carbohydrates, fats, proteins and electrolytes, increasing the transport of glucose, protein and other substances across the cell membrane. Endogenous insulin first enters the liver and only then, a smaller part of it, enters the systemic circulation and kidneys.

Insulin controls the utilization of glucose by insulin-dependent tissues and the entry of glucose into the bloodstream.

Insulin-dependent tissues include the liver, muscle and adipose tissue. Glucose can enter the cells of these tissues only with the help of insulin. If there is little insulin in the body or the cells are resistant to it, then glucose remains in the blood. Non-insulin-dependent tissues include vascular endothelium, nervous tissue and the lens of the eye.

Chronic hyperglycemia in diabetes mellitus is accompanied by damage, dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels.

Classification of the disease

According to ICD-10

diabetes mellitus has codes E10-E14, but the classification includes 5 more clarifying diagnoses:

• E10 - type I diabetes mellitus.
• E11 - type II diabetes mellitus.
• E12 - diabetes mellitus associated with malnutrition.
• E13 - other specified forms of diabetes mellitus.
• E14 - diabetes mellitus, unspecified.

The severity of diabetes is determined by the presence of complications, the characteristics of which are indicated in the diagnosis:
1. With diabetic coma:

• with or without ketoacidosis (ketoacidosis);
• hyperosmolar;
• hypoglycemic.

2. Hyperglycemic coma with the following complications:

• ketoacidosis (acidosis without mention of coma, ketoacidosis without mention of coma);
• kidney damage (diabetic nephropathy, intracapillary glomerulonephrosis, Kimmelstiel-Wilson syndrome);
• eye lesions (diabetic: cataracts, retinopathy);
• neurological complications (amyotrophy, autonomic neuropathy, mononeuropathy, polyneuropathy);
• peripheral circulatory disorders (gangrene, ulcer);
• other specified complications (diabetic arthropathy, etc.);
• multiple complications;
• unspecified complications.

Classification of diabetes (WHO, 2019)
WHO experts assumed that classification is necessary for three main purposes:

• to determine treatment tactics;
• to stimulate research into the causes and mechanisms of disease development;
• to provide a basis for epidemiological studies.

Type I diabetes Destruction of β-cells (mainly immune-mediated), leading to the development of absolute insulin deficiency, disruption of carbohydrate, and then other types of metabolism.
The disease develops in childhood and early adulthood. Type II diabetes

The most common type, which is determined by varying degrees of β-cell dysfunction and insulin resistance. Type II diabetes develops in older people. Among the main risk factors for its development are unbalanced nutrition, physical inactivity, excess weight, and family history.

Hybrid forms

1. Slowly developing latent immune-mediated diabetes in adults, in which β-cell function persists longer.
2. Type II diabetes with a tendency to ketosis and insulin deficiency (not immune-mediated). The absolute need for insulin replacement therapy in these patients may come and go.

Other specific types

1. Monogenic diabetes is associated with certain gene mutations and has several clinical manifestations that require different treatments. It occurs in children and young adults and has signs of severe insulin resistance without obesity.
2. Diabetes associated with diseases and injuries of the exocrine pancreas.
3. Diabetes associated with endocrinopathies (acromegaly, Cushing's syndrome, glucagonoma, hyperthyroidism and others).
4. Diabetes induced by drugs or chemicals.
5. Diabetes developing as a result of viral and bacterial infections.
6. Unusual specific forms of immune-mediated diabetes are associated with rare immune diseases. Diabetes diagnosed in the first 6 months of life, in most cases, is not typical autoimmune diabetes, but refers to the so-called neonatal diabetes.
7. Other genetic syndromes sometimes associated with diabetes.
8. Unclassified diabetes - should be used temporarily when there is no clear diagnostic category at the onset of the disease.

Hyperglycemia first discovered during pregnancy

1. Type I diabetes or type II diabetes diagnosed during pregnancy.
2. Gestational diabetes - hyperglycemia below the diagnostic threshold for diabetes.

Symptoms of diabetes
Type I diabetes is insulin dependent. The disease is a consequence of total insulin deficiency in the body and is most often found in young people. Insulin deficiency develops rapidly and has classic clinical manifestations:

• frequent heavy urination;
• constant feeling of thirst;
• weight loss;
• increased appetite;
• weakness;
• frequent dizziness;
• blurred vision;
• poor wound healing, pustules on the skin.

Type II diabetes develops as a result of the body's ineffective use of insulin. Insulin deficiency in this case is relative in nature - insulin is present in the blood (often in elevated concentrations), but the body tissues are insensitive to it. The disease is characterized by a long asymptomatic course and a subsequent gradual increase in symptoms. Symptoms may be similar to those of type 1 diabetes, but are often less severe. As a result, the disease may be diagnosed several years after its onset. As a rule, patients with this disease have obesity as a concomitant diagnosis.

Gestational diabetes is manifested by hyperglycemia with blood glucose levels that exceed normal values, but do not reach diagnostic values ​​for making a diagnosis of diabetes.

Diagnosis of diabetes mellitus

Diagnostics includes establishing the form of the disease, assessing the general condition of the patient’s body, and identifying associated pathologies.

If there are grounds to suspect that a patient has newly diagnosed diabetes mellitus, laboratory examination methods are prescribed.

• First, glycated hemoglobin and/or fasting glucose levels are assessed.

Treatment and prevention of diabetes mellitus

The main thing you need to understand is that life with diabetes is possible. But its quality directly depends on compliance with the set of therapeutic and preventive measures prescribed by the doctor.

It is important to control your glucose levels. Therefore, you should definitely purchase a glucometer with test strips for it. You need to eat a balanced diet. You should not allow an excess of some nutrients and a deficiency of others, for example, monitor the amount of carbohydrate foods in your diet and not exceed the recommended amount.

Physical activity has a significant impact on maintaining the quality of life of a person suffering from diabetes. Many people mistakenly believe that exercise helps control blood sugar. This is not entirely true - you should not train too hard and intensely. It is also important to exclude extreme sports (alpine skiing, diving, surfing).

Remember, self-prescription of drugs and the use of untested traditional methods are not only ineffective, but also life-threatening.

Test results

Only a doctor can interpret test results, since he evaluates them in conjunction with other symptoms, weight, heredity, and condition. So in pregnant women, blood sugar levels may increase and the doctor decides whether adjustments are required or not. If a diagnosis of diabetes has been avoided, many may find themselves with prediabetes, impaired glucose tolerance and metabolic syndrome.

One of the clear ways to correct your diet and physical activity level is to use a Contour Plus glucometer with test strips included. A small drop of blood - an accurate measurement method will allow you to see the results of your efforts on the display and instill new healthy lifestyle habits. This can help avoid many problems in the future.

Diagnostics of diabetes mellitus: cost of tests

Diagnosis, treatment and prevention of diabetes always begins with laboratory tests. At the moment this is the most informative way. The list of necessary studies is in the table. The cost of tests varies for Moscow and regions.

Be healthy!

Bibliography

1. Dedov I.I., Melnichenko G.A. Endocrinology. National leadership. M.: Geotar-Media, 2013.
2. Dedov I.I., Shestakova M.V. Clinical recommendations “Algorithms for specialized medical care for patients with diabetes.” 7th issue. M.: Ministry of Health of the Russian Federation Russian Association of Endocrinologists Federal State Budgetary Institution Endocrinological Research Center, 2015.
3. Kholodova E.A. Clinical endocrinology. Guide for doctors. M.: Medical Information Agency, 2011.

Author:

Baktyshev Alexey Ilyich, General practitioner (family doctor), ultrasound diagnostics doctor, chief physician