What is insulin-dependent diabetes mellitus. E11 insulin and independent diabetes

It turns out insulin-dependent sugar diabetesContrary to the problem, it is not synonymous with 1 type of diabetes. Insulinically dependent patients can be both diabetics 2 types and pregnant women with gestational diabetes. In turn, patients with type 1 diabetes for a certain period of time can cease to be insulin-dependent (during the "honeymoon" of its disease).

Insulino-dependent diabetes

Insulin-dependent diabetes mellitus (as well as juvenile or youth diabetes) - this is outdated titles of type 1 diabetes - This is how this disease is called this disease. It occurs when the pancreas ceases to secrete insulin due to the destruction of beta cells. Insulin is impossible to take orally in the form of tablets, so the patient is forced to make insulin injection. Insulin must be done constantly, throughout life to avoid high blood sugar.

The main function of insulin is the unlocking of the cells to enter them glucose - the source of energy, which is produced from the food received into our organism. Dietary sources of carbohydrates, hitting the body, split on glucose, and insulin delivers glucose into the cells.

In case of insulin-dependent type of diabetes, patients use different insulin treatment schemes. Previously, the so-called traditional insulin therapy was popular, in which insulin injections were made 3 times a day before meals. The insulin doses were the same, patients only recommended to eat the same portions of food every time to meet the prescribed dose of medication.

Over time, a base-bolus (intente) diabetes treatment system was developed, in which patients use two types of insulin - short and long-term action.

Insulino-dependent diabetics are introduced insulin short action (regular or ultra-screw insulin) before eating (to "cover" food), and its dosage may vary depending on the number of cooked carbohydrates.

Insulin of prolonged action provides major assistance to insulin-dependent patients, because It imitates the work of a healthy pancreas that produces natural human insulin. Patients introduce it 1-2 times a day to create a "background" (basal) insulin concentration in the body, which protects against jumps and sugar phases in the blood.

Insulino-dependent diabetes type 2

It is manifested in 3-9% of all pregnancies depending on the studied population. Most often, he arises in the third trimester. This type of diabetes affects only 1% of women under the age of 20, but 13% of those who become pregnant over the age of 44.

Are treated in different ways. Initially, the diet, physical exercises and reception of oral preparations are appointed, and if this is not enough to control blood sugar levels, insulin therapy is appointed. In this way, gestational diabetes patients may also have an insulin-dependent type of diabetesAlthough temporarily.

The difference between the diabetes of pregnant women from 1 and 2 of its types is that after the birth of a child, diabetes is retreating and insulin treatment is stopped.

It can be concluded that the inaccuracy of the term "insulin-dependent diabetes" manifests itself in the fact that the first and second types of diabetes are essentially different diseases, but patients of each of these types can be insulin-dependent. Pregnant women who are detected are also being treated with insulin. Therefore, speaking about insulin-dependent patients, it is impossible to immediately understand, about the patients with which type of diabetes are speech.

Insulino-dependent children

Amazing, above all, children, teenagers and young people. Sometimes diabetes occurs from birth, although such cases are quite rare.

Bring up an insulin-dependent child - heavy test is not only for the patient, but also for his parents. Parents should deeply study this disease in order to teach the child to properly make insulin injections, count carbohydrates and bread units, measure the level of their blood sugar and adapt to ordinary life.

Parents of insulin-dependent children should discuss the following important issues with the endocrinologist:

• How often to measure the child's blood sugar level?
• What insulin therapy is better to carry out: use the bolus system or insulin pump?;
• How to recognize and treat hypoglycemia and high blood sugar levels?
• How to identify the presence of Ketonuria in a child and stop it?
• How do carbohydrates affect blood sugar levels?
• How to count bread units?
• How does physical activity affect the blood sugar level at an insulin-dependent child?
• How to learn to live painlessly with diabetes - learn at school, stop shying the presence of this disease, ride in the summer camps, go hiking, etc.?
• How often attend an endocrinologist and other diabetes treatment professionals?

Honeymoon with type 1 diabetes or transformation of an insulin-dependent patient in insulin-dependent

In type 1 diabetes mellitus, there may be a situation where the remaining pancreatic cells begin to produce insulin strongly, which leads to cancellation or substantial reduction in the designated insulin therapy. Many patients in this period think that they were cured of diabetes, but unfortunately, the period of "honeymoon" of diabetes mellitus is only temporary calm.

Why does the temporary remission of diabetes occur? Developed against the background of destruction by the body of own insulin-producing pancreatic cells. When the patient begins to make insulin injection (becomes insulin-dependent), from the pancreas, part of the load on the production of own insulin is removed. This period of rest, provided by insulin injections, stimulates the pancreas to produce insulin from the remaining beta cells.

However, after a few months, the overwhelming majority of these remaining beta cells will be destroyed. The period of the honeymoon ends when the pancreas ceases to produce a sufficient amount of insulin to maintain the optimal level of glucose in the blood.

A study was conducted "Honeymoon in children with type 1 diabetes mellitus: frequency, duration and impact on it of various factors" (PubMed,PMID: 16629716). It is written that the period of the honeymoon of type 1 diabetes mellitus is characterized by a reduction in insulin need to preserve good glycemic control. The clinical significance of this phase is the potential for pharmacological intervention to slow down or stop the continuing self-destruction of the remaining beta cells.

A group of 103 children with diabetes patients under 12 years of age was examined, as a result of which the frequency, duration and factors affecting partial remission of diabetes were evaluated. According to the results of the study, it was revealed that 71 children had a partial remission of diabetes mellitus, and complete - three. The duration of remission was from 4.8 to 7.2 months.

Insulin-dependent diabetes (the "elderly" or 2 diabetes)

It should be noted that there is also insulin-dependent diabeteswhich today doctors are called type 2 diabetes. At the same time, the type of diabetes pancreas secretes insulin in the normal volume, but the cells cannot be processed correctly.

The main problem of people with the second type of diabetes is the extra weight and (metabolic syndrome), interferes with the cells to interact correctly with insulin.

In contrast to the insulin-dependent type of diabetes mellitus, insulin-dependent can only be patients with 2 types of this disease (except for cases of temporal remission of type 1 sd). There are still unsax diabetes, but this is a completely different disease that has nothing to do with traditional diabetes.

Summary:

The terms "insulin-dependent" and "insulin-dependent" diabetes are radically incorrect and outdated. Insulin dependent on insulin can be not only patients with type 1 diabetes, but also type diabetics, as well as women with gestational diabetes. While insulin-dependent can be not only people who have diabetes 2 types, but also persons who have type 1 diabetes for a while (during the honeymoon period).

Despite the fact that in diabetes mellitus II type II patients prescribe insulin preparations, after all, insulin-dependent diabetes is considered to be type I type I. This is due to the fact that with this disease, the body ceases to produce its own insulin.

Pancreas of people who are diagnosed with insulin-dependent diabetes are practically devoid of cells producing this protein hormone.

With the II type II, the pancreas produces too little insulin and body cells for the normal vital activity of this hormone lacks. Often to normalize the production of insulin and in order to determine the metabolism with type II diabetes can be correct physical exertion and a competent diet.

If things are in this way, then the injection of insulin does not need this patient. For this reason, type I diabetes is taken more and denoted as - insulin-dependent diabetes mellitus.

When the type II patient has to assign insulin, they say that the disease has passed into an insulin-dependent phase. But, fortunately, it is not so common.

The type I diabetes is developing very rapidly and it usually occurs in the children's and adolescent period. Hence the other name of this diabetes - "juvenile". Complete recovery is possible only when transplanting the pancreas. But such an operation entails a lifelong reception of medicines, overwhelming immunity. This is necessary in order to prevent pancreas rejection.

Injection administration of insulin has not such a strong negative impact on the body, and when conducting proper insulin therapy, the life of the patient with diabetes I type I does not differ from the life of healthy people.

How to notice the first symptoms

When type I diabetes is just starting to develop in the body of a child or a teenager, it is difficult to determine it immediately.

1. 1. If the child is constantly asking to drink in the summer heat, then, most likely, parents find it natural.
   2. Violations and high fatigue of primary school students are often written off on high school loads and unusualities of the organism.
   3. Weight loss is also justification, they say, a hormonal restructuring takes place in the body of a teenager, again fatigue.

But all these signs may be the beginning of a developing diabetes according to I type. And if the first symptoms have passed unnoticed, then the child can suddenly develop ketoacidosis. By its nature, ketoacidosis resembles poisoning: abdominal pain arise, nausea, vomiting.

But with ketoacidosis, consciousness is confused and all the time clone in sleep, which is not not in food poisoning. The smell of acetone from the mouth is the first sign of the disease.

Ketoacidosis may occur during type II diabetes, but in this case, close patients already know what it is and how to behave. But the ketoacidosis appeared for the first time, is always unexpected, and this is very dangerous.

The meaning and principles of insulin treatment

The principles of insulin therapy are very simple. After a healthy person took the food, its pancreas throws into the blood the desired dose of insulin, glucose is absorbed by cells, and its level is reduced.

In people having diabetes mellitus I and II type, for various reasons, this mechanism is broken, so it is necessary to simulate it manually. In order to correctly calculate the necessary dose of insulin, you need to know how much and with what products the body gets carbohydrates and how many insulin will need to be recycled.

The amount of carbohydrates in food does not affect its calorie content, so it makes sense to consider calories if only type I and II diabetes is accompanied by overweight.

With type I diabetes mellitus, a diet is not always required, which cannot be said about the insulin-dependent type II diabetes. That is why each patient type I diabetes must independently measure the blood sugar level and correctly calculate the insulin dose.

People with type II diabetes that do not use insulin injections, it is also necessary to keep a self-surveillance diary. The longer and more clear is the case, the easier it is to consider the patient all the details of your disease.

The diary will provide invaluable help in controlling nutrition and lifestyle. In this case, the patient will not miss a moment when diabetes of type Iipputs in an insulin-dependent form of type I.

"Bread Unit" - what it is

Diabetes I and II requires a constant calculation of the amount of carbohydrates consumed by patients with food.

With type I diabetes, it is necessary to correctly calculate the insulin dose. And with type II diabetes - in order to control therapeutic and diet food. When calculating, only those carbohydrates that affect the level of glucose and the presence of which force to the introduction of insulin are taken into account.

Some of them, such as sugar, are absorbed quickly, others - potatoes and cereals, digested much slower. To facilitate their calculation, the conditional value, referred to as the "bread unit" (XE), and a kind of bread unit calculator simplifies life to patients.

One xe is approximately 10-12 grams of carbohydrates. It is exactly as much as it is contained in a piece of white or black bread "bricks" with a thickness of 1 cm. It does not matter which products will be measured, the amount of carbohydrates will be the same:

• • in one tablespoon of starch or flour;
  • in two tablespoons of cereal buckwheat ready;
  • in seven tablespoons of lentils or peas;
  • in one medium potato.

It should always be remembered that liquid and distributed products are always allowed that liquid and strained products are quickly absorbed, which means it increases the level of glucose in the blood than solid and thick products.

Therefore, going to take food, the patient is recommended to measure sugar. If it is lower than the norm, then you can eat for breakfast of the semolina porridge, if the level of sugar is higher than the norm, then it is better to have breakfast scrambled eggs.

One xe on average requires from 1.5 to 4 units of insulin. True, in the morning it needs more, and in the evening - less. In winter, the dosage rises, and with the onset of summer - decreases. Between two meals with patient diabetes in type I can eat one apple, which is 1 x. If a person monitors blood sugar levels, then the additional injection does not need it.

What insulin is better

With SD I and II, 3 types of pancreatic hormones are used:

1. 1. human;
   2. pork;
   3. bullish.

To say exactly which one is better - impossible. The effectiveness of insulin treatment depends not on the origin of the hormone, but from its correct dosage. But there is a group of patients who are prescribed only human insulin:

1. 1. pregnant women;
   2. children, in whom the type I type is for the first time;
   3. people with complicated diabetes mellitus.

Insulines for the duration of action are divided into "short", medium-sized and insulins of a long-term action.

Short insulins:

• • Actropid;
  • Insulrap;
  • Iletin p Homorap;
  • Insulin Humalog.

Any of them begins to work 15-30 minutes after the injection, and the duration of the injection is 4-6 hours. The drug is administered to each meal and between them if the sugar level rises above the norm. People with type I diabetes with you should always have a dose of additional injections.

Medium-action insulins

• • Semilent MS and NM;
  • Semilong.

Includes their activities after 1.5 - 2 hours after injection, and the top of their action occurs after 4-5 hours. They are convenient for those patients who do not have time or do not want to have breakfast at home, but do it in service, but to enter with all the drug are shy.

Only it is necessary to take into account that if you do not take food on time, then the level of sugar can dramatically decrease, and if more than the carbohydrates are in the diet, it will have to use additional injections.

Therefore, this group of insulins is permissible only for those who feed outside the house, it knows exactly what time he will take food and how much carbohydrates will be in it.

Long-term insulins

1. 1. MONOTARD MS and NM;
   2. PROTAFAN;
   3. Iletin Mon;
   4. Homofan;
   5. Humulin H;
   6. Ribe.

Their action begins 3-4 hours after injection. For some time, their level in the blood remains unchanged, and the duration of action is 14-16 hours. In diabetes type I, these insulins are colole twice a day.

Insulino-dependent diabetes

(Sugar diabetes of 1 type)

Type 1 diabetes usually develops in young people aged 18-29 years.

Against the background of growing up, entering an independent life, a person is experiencing constant stress, harmful habits are purchased and rooted.

Due to certain pathogenic (pathogenic) factors- viral infection, frequent use of alcohol, smoking, stress, food with semi-finished products, hereditary predisposition to obesity, pancreatic disease - autoimmune disease occurs.

Its essence is that the body's immune system begins to fight itself, and in the case of diabetes, the beta cells of the pancreas (the islands of Langerhans), producing insulin, are attacked. The moment occurs when the pancreas practically ceases to produce the necessary hormone independently or produces it in insufficient quantity.

A complete picture of the causes of such behavior of the immune system, scientists are not clear. They believe that the development of the disease affects both viruses and genetic factors. In Russia, about 8% of all patients have L-type diabetes. L-type diabetes, as a rule, the disease is young, as in most cases develops in adolescent or youthful age.However, this type of disease can also develop from a mature person. Pancreatic beta cells begin to collapse a few years before the appearance of major symptoms. At the same time, human well-being remains at the level of the usage-normal.

The beginning of the disease is usually acute, and the person himself can, with a reliable certainty, call the date of the appearance of the first symptoms: a constant thirst, frequent urination, an unattricible feeling of hunger and, despite the frequent eating, weight loss, quick fatigue, impairment of vision.

This can be explained as follows. The destroyed beta cells of the pancreas are not able to produce a sufficient amount of insulin, the main action of which is to reduce the concentration of glucose in the blood. As a result, the body begins to accumulate glucose.

Glucose- the source of energy for the body, however, so that it gets into a cage (by analogy: gasoline is needed for engine operation), she needs a conductor - insulin.

If there is no insulin, then the cells of the body begin to starve (hence and fatigue), and glucose coming from the outside with food is accumulated in the blood. At the same time, the "starving" cells give a signal to the brain on the lack of glucose, and the liver is entering, which from its own glycogen reserves ejects an additional portion of glucose into the blood. Fighting with an abrasiveness of glucose, the body begins to intensively remove it through the kidneys. Hence the frequent urination. Loss of fluid The body compensates frequent thorough thirst. However, over time, the kidneys cease to cope with the task, so there are dehydration of the body, vomiting, abdominal pain, disorder of the kidneys. The glycogen reserves in the liver are limited, so when they fit to the end, the body for energy production will begin to process their own fat cells. This explains weight loss. But the transformation of fat cells to isolate energy is slower than with glucose, and is accompanied by the appearance of unwanted "waste".

In the blood of ketone (that is, acetone) body, the increased content of which entails dangerous for the body of the state - from Ketoacidaseand acetone poisoning(Acetone dissolves the fat membranes of cells, preventing the penetration of glucose inside, and the activity of the central nervous system is sharply oppressed) up to coma.

It is according to the presence in the urine of the increased content of ketone bodies and the diagnosis of "type 1 diabetes" is made, since acute malaise in the state of ketoacidosis and leads a person to the doctor. In addition, often surrounding may feel "acetone" sick breathing.

Since the destruction of the beta cells of the pancreas occurs gradually, you can put an early and accurate diagnosis, even when there are no clear symptoms of diabetes. This will allow to stop the destruction and maintain that mass of beta cells that are not yet destroyed.

Select 6 stages of the development of type 1 diabetes mellitus:

1. Genetic predisposition to type 1 diabetes. At this stage, reliable results can be obtained by research of genetic disease markers. The presence of HLA Group antigens has repeatedly increases the risk of type 1 diabetes.

2. Start torque. On beta cells are influenced by various pathogenic (pathogenic) factors (stress, viruses, genetic predisposition, etc.), and the immune system begins to form antibodies. Insulin secretion disorder does not occur yet, but the presence of antibodies can be determined using an immunological test.

3. Prehaletian stage.The destruction of beta cells of the pancreas by autoantales of the immune system begins. There are no symptoms, but disorders of synthesis and secretion of insulin can already be identified using a test for glucose tolerance. In most cases, antibodies to the beta cells of the pancreas are detected, antibodies to insulin or the presence of both types of antibodies at the same time.

4. Reducing the secretion of insulin.Stress tests can reveal violationtolerancetoglucose(NTG) and violation of the content of glucose plasma on an empty stomach(NGPN).

5. "Honeymoon.At this stage, the clinical picture of diabetes is presented with all listed symptoms. The destruction of the beta cells of the pancreas reaches 90%. Insulin secretion is sharply reduced.

6. Full destruction of beta cells. Insulin is not produced.

It is possible to determine the presence of the 1st type diabetes only at the stage when all the symptoms are given. They arise at the same time, so it will make it easy. The presence of only one symptom or a combination of 3-4, such as fatigue, thirst, headaches and itching, does not yet talk about diabetes, although, of course, testifies to another age.

To identify at the presence of diabetes,laboratory tests are needed on sugar content in blood and urine,that can be held at home and in the clinic. This is a primary way. However, it should be remembered that in itself an increase in blood sugar does not mean the presence of diabetes mellitus. It can be caused by other reasons.

Psychologically, not everyone is ready to recognize the presence of diabetes, and the person often pulls to the last.And yet, when detecting the very disturbing symptom - "Sweet urine", it is better to go to the hospital. Even before the appearance of laboratory tests, English doctors and the ancient Indian and oriental practices noticed that the urine of patients with diabetes attracts insects, and called Diabetes "Sweet Urine Disease".

Currently, a wide range of medical devices aimed at independent control of the blood sugar level - glucometersand test stripsto them.

Test stripsfor visual control, sold in pharmacies, easy to use and accessible to everyone. When buying a test strip must necessarily pay attention to the shelf life and read the instructions.Before using the test, you need to carefully wash your hands and wipe them dry. Wipe skin with alcohol is not required.

The needle, one-time, it is better to take with a round cross section or take advantage of a special lanceset, which is attached to many tests. Then the wound will heal faster and will be less painful. Punch is best not a pad, as this work surface of the finger and constant touch does not contribute to the rapid healing of the wound, and the area is closer to the nail. Before the injection, the finger is better to massate. Then take the test strip and leave a swollen blood drop on it. It is worth noting that blood should not be tortured or smear it through the strip. You need to wait until a sufficient drop is shown to capture both halves of the test field. To do this, you will need a clock with a second arrow. Through the time specified in the instruction, the blood should be erased with a test strip. With good lighting it is necessary to compare the changed color of the test strip with a scale that is usually on the test box.

Such a visual way to determine the level of sugar in the blood may seem inaccurate, but the data turn out to be quite reliable and sufficient to correctly determine whether sugar is elevated, or to establish the insulin dose of the patient.

The advantage of test strips in front of the glucometer - in their relative cheapness.However, glucometers have a number of advantages compared to test strips. They are portable, easy. The result appears faster (from 5 seconds to 2 minutes). A drop of blood can be small. Wash blood from the strip is not needed. In addition, there are often electronic memory in glucometters, into which the results of previous measurements are made, so this is a kind of diary of laboratory tests.

Currently, the glucometters of two types are released. The first possesses the same ability as the human eye, to visually determine the change in the coloring of the test field.

And the basis of the operation of the second, sensory, is the electrochemical method, with the help of which the current arising from the chemical glucose reaction in the blood with substances applied to the strip. Some glucometters are also measured by cholesterol levels in the blood, which is important for many diabetes patients. Thus, if there is a classic hyperglycemic triad: rapid urination, constant thirst and unattricible hunger, as well as genetic predisposition - everyone can use a glucometter at home or buy test strips in a pharmacy. After that, of course, you need to consult a doctor. Even if these symptoms do not talk about diabetes, in any case they have no accident.

When diagnosing diagnosis, the type of diabetes is determined, then the severity of the disease (light, moderate gravity and severe). The clinical picture of the 1-type diabetes is often accompanied by various complications.

1. Resistant hyperglycemia- the main symptom of diabetes, subject to the preservation of the increased level of sugar in the blood for a long time. In other cases, not being a diabetic characteristic, temporary hyperglycemia can develop in humans during infectiousdiseases, in poststress periodor with nutritional disorders, for example, with bulimia, when a person does not control the amount of food eaten.

Therefore, if at home with the help of a test strip, it was possible to reveal the increase in blood glucose content, it is not worth a hurry with conclusions. It is necessary to consult a doctor - it will help determine the true cause of hyperglycemia. The level of glucose in many countries of the world is measured in milligrams for decylitr (mg / dl), and in Russia in millimali per liter (mmol / l). The coefficient of recalculation mmol / l in mg / for is 18. From the table below it is clear what values \u200b\u200bare critical.

Glucose level. MMOL / L and MG / DL

Blood glucose (mol / l)	Blood glucose level (mg / dl)	The severity of hyperglycemia
6.7 mmol / l		Easy hyperglycemia
7.8 mmol / l
		Hyperglycemia of medium severity
10 mmol / l
14 mmol / l
Over 14 mmol / l - heavy hyperglycemia
Over 16.5 mmol / l - Prema
Over 55.5 mmol / l - coma

Diabetes is diagnosed with the following indicators: glycemia in capillary blood is equal to more than 6.1 mmol / l, 2 hours after meals - more than 7.8 mmol / l or at any time of the day are more than 11.1 mmol / l. Glucose levels can be repeatedly changed during the day, before meals and after. The concept of the norm is different, however, there is a range of 4-7 mmol / l for adult healthy people on an empty stomach. Long-term hyperglycemia leads to damage to blood vessels and tissues that they supply.

Signs of acute hyperglycemiaare ketoacidosis, arrhythmia, disturbed state of consciousness, dehydration of the body.When a high level of sugar in the blood, accompanied by nausea, vomiting, pain in the abdomen, severe weakness and clouding of consciousness or acetone smell of urine, it is necessary to immediately cause "ambulance". Probably, it is likely to be a Dia6eteismic Coma, so urgent hospitalization is necessary!

However, even if there is no diabetic ketoacidosis signs, but there is thirst, dry mouth, frequent urination, still need to consult a doctor. Dehydration is also dangerous. In anticipation of the doctor, you need to drink more water, better alkaline, mineral (buy it at the pharmacy and keep the reserve of the house).

Possible causes of hyperglycemia:

* normal error when analyzing;

* Incorrect dosage of insulin or sugar-based drugs;

* Diet violation (increased consumption of carbohydrates);

* Infectious disease, especially accompanied by high temperature and fever. Any infection requires an increase in insulin in the patient's body, so that a dose should be increased by about 10%, after informing its therapist. When taking tablets for treating diabetes, their dose should also be increased, consulted with a doctor (perhaps he will advise a temporary transition to insulin);

* hyperglycemia as a result of hypoglycemia. A sharp reduction in sugar with leads to emission to blood glucose reserves from the liver. It is not necessary to reduce this sugar, it will soon be normalized by itself, on the contrary, it is necessary to reduce the dose of insulin. It is also likely that with normal sugar in the morning and the day of hypoglycemia may appear at night, so it is important to choose a day and conduct an analysis of 3-4 hours.

Symptoms of night hypoglycemiaare nightmarish dreams, rapid heartbeat, sweating, chills;

* Short-term stress (exam, hike to the dentist);

* menstrual cycle. Some women in certain cycle phases are experiencing hyperglycemia. Therefore, it is important to start a diary and learn to define such days in advance and accordingly regulate the dose of insulin or tablets compensating for diabetes;

* Probable pregnancy;

* Myocardial infarction, stroke, injury. Any operation causes an increase in body temperature. However, since in this case the patient is most likely under the supervision of doctors, it is necessary to inform about the presence of diabetes;

2. Microangiopathy - the general name of the lesions of small blood vessels, violation of their permeability, increasing fragility, increasing the tendency to thrombose. Diabetes is manifested in the form of the following concomitant diseases:

* Diabetic retinopathy- damage to the arteries of the retina, accompanied by small hemorrhages in the area of \u200b\u200bthe optic nerve disk;

* Diabetic nephropathy- Defeat of small blood vessels and kidney arteries during diabetes mellitus. Manifests the presence of protein and blood enzymes in the urine;

* Diabetic arthropathy- defeat joints, the main symptoms are: "crunch", pain, limited mobility;

* Diabetic neuropathy, or diabetic amyotrophy. This is the defeat of the nerves, developing with long-term (for several years) hyperglycemia. Neuropathy is based on ischemic nerve damage due to disruption of metabolism. It is often accompanied by pain of different intensity. One of the types of neuropathy is radiculitis.

Most often, vegetative neuropathy is detected at diabetes of L-th type (Symptoms: fainting, dry skin, reduce tear, constipation, vision blur, impotence, decrease in body temperature, sometimes liquid chair, sweating, hypertension, tachycardia) or sensory polyneuropathy. Pares are possible (weakening) muscles and paralysis. These complications can manifest themselves with L-th type diabetes up to 20-40 years, and when diabetes of the 2nd type - after 50 years;

* Diabetic enufalopathy. Due to the ischemic damage to nerves, the inxication of the central nervous system is often occurring, which is manifested in the form of a constant irritability of the patient, states of depression, the instability of mood and capriciousness.

3. Macroangiopathy - The general name of the lesions of large blood vessels - coronary, cerebral and peripherals. This is a frequent cause of early disability and high mortality of patients with diabetes.

Atherosclerosis of the coronary arteries, aortic, brain vesselsit is often found in patients with diabetes. The main reason for the appearance is associated with an increased insulin content as a result of the treatment of 1-th type diabetes or insulin sensitivity disorders during type 2 diabetes.

The defeat of the coronary arteries occurs in patients with diabetes 2 times moreand leads to myocardial infarction or the development of coronary heart disease. Often a person does not feel any pain, and then follows a sudden myocardial infarction. Almost 50% of diabetes patients die from myocardial infarction, while the risk of developing the same for men, and for women. Often myocardial infarction is accompanied by this state, at the same time only the state of ketoacidosis can cause a heart attack.

Defeat of peripheral vesselsleads to the emergence of the so-called diabetic foot syndrome. Ischemic lesions of the feet are caused by a circulatory impairment in the affected blood vessels of the lower extremities, which leads to trophic ulcers on the skin of the shin and feet and the occurrence of gangrene mainly in the first finger. With Diabetes, the gangrene is dry, with minor pain syndrome or without pain. Lack of treatment can lead to amputation of the limb.

After determining the diagnosis and detection of the severity of diabetesyou should familiarize yourself with the rules of a new lifestyle, which from now on will need to lead to feel better and not exacerbate the situation.

The main method of treating 1-th type diabetesthere are regular insulin injections and dietherapy. The heavy form of L-type sugar diabetes requires constant control of doctors and symptomatic treatment of complications of the third severity - neuropathy, retinopathy, nephropathy.

Etiology and pathogenesis

At the heart of the pathogenetic mechanism for the development of the type 1 diabetes, there is insulsive insulin production by endocrine cells of the pancreas (β-cells of the pancreas) caused by their destruction under the influence of certain pathogenic factors (viral infection, stress, autoimmune diseases, etc.). Type 1 diabetes is 10-15% of all cases of diabetes, and, in most cases, develops in children's or adolescence. For this type of diabetes, the appearance of basic symptoms, which quickly progress over time. The main method of treatment is insulin injections, normalizing the metabolism of the patient's body. In the absence of treatment, type 1 diabetes is rapidly progressing and leads to severe complications, such as ketoacidosis and diabetic coma, ending with the death of the patient.

Classification

By severity of the flow:

1. 1. easy flow
   2. middle severity
   3. heavy flow

2. At the degree of compensation for carbohydrate exchange:

1. 1. phase compensation
   2. phase subcompensation
   3. phase decompensation

3. At complications:

1. 1. Diabetic micro and macroangiopathy
   2. Diabetic polyneuropathy
   3. Diabetic arthropathy
   4. Diabetic ophthalmopathy, retinopathy
   5. Diabetic nephropathy
   6. Diabetic encephalopathy

Pathogenesis and pathogistology

Insulin deficiency in the body develops due to the insufficient secretion of β-cells of the islands of the pancreatic Langerhans.

Due to insulin deficiency, insulin dependent tissues (liver, fat and muscular) lose the ability to dispose of blood glucose and, as a result, the blood glucose level increases (hyperglycemia) - the cardinal diagnostic sign of diabetes. Due to insulin deficiency in adipose tissue, the disintegration of fat is stimulated, which leads to an increase in their level in the blood, and in muscle tissue - the decay of proteins is stimulated, which leads to an increased flow of amino acids into the blood. The substrates of catabolism of fats and proteins are transformed with the liver in ketone bodies, which are used by insulin-dependent tissues (mainly the brain) to maintain the energy balance against the background of insulin deficiency.

Glucosuria is an adaptive mechanism for removing the increased blood glucose content when the glucose level exceeds the kidney threshold value (about 10 mmol / l). Glucose is an osmoactive substance and an increase in its concentration in the urine stimulates increased removal and water (polyuria), which ultimately can lead to the body's dehydration, if the water loss is not compensated by adequately increased fluid consumption (polydipsy). Along with the increased loss of water with urine, mineral salts are lost - the deficiency of sodium cations, potassium, calcium and magnesium, chlorine anions, phosphate and hydrocarbonate develops.

Eliminate 6 stages of development of SD1. 1) Genetic predisposition to SD1 associated with the HLA system. 2) hypothetical start-up moment. Damage to β - cells by various diabegeneous factors and trigging of immune processes. Patients are already determined above the listed antibodies in a small titer, but the secretion of insulin does not suffer. 3) Active autoimmune insulinitis. The titer of antibodies is high, the amount of β-cells decreases, the secretion of insulin is reduced. 4) a decrease in the stimulated glucose secretion I. In stressful situations in the patient, it is possible to identify the transient NTG (violation of glucose tolerance) and NGPN (violation of the glucose content of an empty stomach plasma). 5) Clinical manifestation of SD, including with a possible episode of the "honeymoon". The secretion of insulin is sharply reduced, since more than 90% of β cells died. 6) Complete destruction of β-cells, complete cessation of insulin secretion.

Clinic

• • hyperglycemia. Symptoms due to increased blood sugar levels: polyuria, polydipsy, weight loss with reduced appetite, dry mouth, weakness
  • microangiopathy (diabetic retinopathy, neuropathy, nephropathy),
  • macroangiopathy (atherosclerosis of the coronary arteries, aortic, vessels of um, lower extremities), diabetic foot syndrome
  • concomitant pathology (furunculese, colpits, vaginites, urinary tract infection)

A light SD is compensated by a diet, there is no complications (only at SD 2) of the moderate SD - compensated for PSEs or insulin, diabetic vascular complications 1-2 degrees of severity are detected. Heavy CD is a labile flow, complications of the 3rd severity (neuropathy, retinopathy, neuropathy).

Diagnostics

In clinical practice, sufficient criteria for diagnosing type 1 diabetes mellitus are the presence of typical symptoms of hyperglycemia (polyuria and polydipsy) and laboratory confirmed hyperglycemia - glycemia in capillary blood on an empty stomach of more than 7.0 mmol / l and / or at any time of the day more than 11.1 mmol / l;

When establishing a diagnosis, the doctor operates according to the following algorithm.

1. 1. Diseases that are manifested by similar symptoms (thirst, polyuria, weight loss) are excluded: unacceptable diabetes, psychogenic polydipsia, hyperparathyroidism, chronic renal failure, etc. This stage ends with the laboratory statement of hyperglycemia syndrome.
   2. The nosological form of the SD is specified. First of all, the diseases that are included in the "Other specific types of diabetes" group are excluded. And only then the question of SD1 or SD 2 suffers from the patient. Determination of the level of C-peptide on an empty stomach and after load. The level of blood concentration in the blood of GAD antibodies is also estimated.

Complications

• • Ketoacidosis, hyperosmolar coma
  • Hypoglycemic Coma (in case of insulin overdose)
  • Diabetic micro- and macroangiopathy - violation of the permeability of vessels, increasing their fragility, increasing the tendency to thrombosis, to the development of atherosclerosis of vessels;

• • Diabetic polyneuropathy - polyneurite peripheral nerves, pains in the course of nervous trunks, paresis and paralysis;

• • Diabetic arthropathy - joint pain, "crunch", restriction of mobility, reducing the number of synovial fluid and increase its viscosity;

• • Diabetic ophthalmopathy - early development of cataracts (crustal turbidity), retinopathy (retina lesions);

• • Diabetic nephropathy - kidney damage with the advent of protein and uniform elements of blood in the urine, and in severe cases with the development of glomerulonephritis and renal failure;

• • Diabetic encephalopathy - changes in psyche and mood, emotional lability or depression, symptoms of CNS intoxication.

Treatment

Main treaties:

• • Elimination of all clinical SD symptoms
  • Achieving optimal metabolic control for a long time.
  • Prevention of sharp and chronic complications of SD
  • Ensuring the high quality of the life of patients.

To achieve his goals, use:

• • diet
  • dosage individual exercise (DIFN)
  • training of patients with self-control and the simplest methods of treatment (managing their disease)
  • permanent self-control

Insulinotherapy

Insulin therapy is based on imitation of physiological secretion of insulin, which includes:

• • basal secretion (BS) insulin
  • stimulated (Food) Insulin Secretion

The basal secretion provides the optimal level of glycemia in an interstability period and during sleep, contributes to the disposal of glucose entering the body outside the meals (glukegenesis, glycolysis). Its speed is 0.5-1 e / hour or 0.16-0.2-0.45 units per kg of actual body weight, that is, 12-24 units per day. In physical load and hunger, the BS decreases to 0.5 units / hour. The secretion of stimulated - food insulin corresponds to the level of postprandial glycemia. The SS level depends on the level of the eaten carbohydrates. On 1 bread unit (xE), approximately 1-1.5 units are produced. insulin. Insulin secretion is subject to daily fluctuations. In the early morning clock (4-5 hours) it is the highest. Depending on the time of day, 1 x is secreted:

• • for breakfast - 1.5-2.5 units. Insulin
  • for lunch 1.0-1.2 units. Insulin
  • for dinner 1.1-1.3 units. Insulin

1 Insulin unit reduces blood sugar by 2.0 mmol / units, and 1 x increases it by 2.2 mmol / l. From the average daily dose (SSD) of insulin, the magnitude of the food insulin is about 50-60% (20-30 units), and the share of basal insulin accounts for 40-50% ..

InsulinTherapy Principles (IT):

• • the average daily dose (CED) insulin must be close to physiological secretion.
  • in the distribution of insulin during the day 2/3 of the CEDD should be administered in the morning, day and early evening and 1/3 - late in the evening and at night
  • using a short-acting insulin combination (ICD) and prolonged insulin. Only this allows approximately imitate the daily secretion of I.

During the day, the ICD is distributed as follows: in front of breakfast - 35%, before dinner - 25%, before dinner - 30%, at night - 10% of SDM insulin. If necessary, 5-6 am 4-6 hours. IKD. Do not enter\u003e 14-16 units in one injection. If it is necessary to introduce a large dose, it is better to increase the amount of injection by reducing the intervals of the introduction.

Correction of insulin doses in terms of glycemia for correction of doses of the ICD Forsh IKD recommended for every 0.28 mmol / l of blood sugar, exceeding 8.25 mmol / l, additionally enter 1 unit. I. Consequently, each "extra" 1 mmol / l glucose is required to additionally introduce 2-3 units. AND

Correction of insulin doses on glucosuria patient should be able to conduct it. During the day between insulin injections, assemble 4 portions of urine: 1 portion - between breakfast and lunch (pre-breakfast, the patient should empty the bladder), 2 - between dinner and dinner, 2 - between dinner and 22 hours, 4 - from 22 hours and to breakfast. Each portion takes into account diuresis, determine% glucose content and calculate the amount of glucose in grams. When removing glucosuria to eliminate it for every 4-5 g of glucose, 1 units are additionally introduced. insulin. The next day after collecting urine, the dose of inserted insulin increases. After reaching compensation or approaching it, the patient should be translated into the CEO and ISD combination.

Traditional insulin therapy (IT). Allows you to reduce the amount of insulin injections up to 1-2 times per day. The titles are simultaneously introduced ISD and ICD 1 or 2 times a day. At the same time, ISD accounts for 2/3 of SSD, and IKD is 1/3 of CDD. Benefits:

• • easy administration
  • ease of understanding the essence of treating patients, their relatives, medical personnel
  • no need for frequent control of glycemia. It is enough to control the glycemia 2-3 times a week, and when self-control - 1 time per week
  • treatment can be carried out under the control of glucosuric profile

disadvantages

• • the need for tough diet compliance in accordance with a selected dose and
  • the need for tough compliance with the schedule of the day, sleep, recreation, physical exertion
  • mandatory 5-6 transparent meals, in a strictly defined time attached to the introduction and
  • inability to maintain glycemia within physiological fluctuations
  • permanent hyperinsulamia, accompanying titles, increases the risk of hypokalemia, arterial hypertension, atherosclerosis.

Tit shows

• • elderly, if they can not assimilate the demands
  • persons with mental disorders, low educational level
  • patients in need of unauthorized care
  • undisciplined patient

Calculation of doses of insulin with tithes 1. Pre-determined the SSD insulin 2. Distribute Insulin SSD by time: 2/3 before breakfast and 1/3 before dinner. Of these, IKD should have 30-40%, ISD is 60-70% of CDS.

IIT (intensive IT) Basic Principles IIT:

• • the need for basal insulin is provided by 2 injections of ISD, which is introduced in the morning and in the evening (they use the same drugs as the titles). The total dose of ISD is not\u003e 40-50% of the SSD, 2/3 from the total dose of ISD is introduced before breakfast, 1/3 - before dinner.
  • food - Bolyuced insulin secretion is mimicified by the introduction of ICD. The necessary doses of the ICD are calculated taking into account the lunch and dinner of the amount of HE and the level of glycemia, which is planned for reception for breakfast, lunch and dinner in front of the food. That is, the patient must carry out the control of glycemia 7 times a day.

Benefits

• • imitation of physiological secretion and (basal stimulated)
  • the possibility of a freer life and routine of the day in the patient
  • the patient can use the "liberalized" diet changing the time of food intake, a set of products at will
  • higher quality of the patient's life
  • effective monitoring of metabolic disorders, providing preventing the development of late complications
  • the need to train patients on the problem of diabetes, questions of its compensation, counting Hehe, the ability to select doses and produces motivation, understanding the need for good compensation, prevention of SD complications.

disadvantages

• • the need for permanent self-control of glycemia, up to 7 times a day
  • the need to teach patients in schools of patients SD, changes in lifestyle.
  • additional costs of training and self-control
  • tendency to hypoglycemias, especially in the first months

Mandatory conditions for the possibility of using IIT are:

• • sufficient Intellect Patient
  • ability to learn and implement acquired skills in practice
  • the possibility of acquiring self-control

IIT is shown:

• • at SD1, it is desirable to almost all patients, and with the first identified diabetes
  • during pregnancy - transfer to the afternoon for the whole period of pregnancy, if the patient was patient before pregnancy
  • in the gestational diabetes, in the event of ineffectiveness diet and dypr

Scheme of patient under the use of yit

• • Calculation of daily calorage
  • The calculation of the carbohydrates planned for consumption on the day of carbohydrates in Hehe, proteins and fats is in grams. Although the patient is on a "liberalized" diet, he should not eat more than the carbohydrate dose in hehe. Not recommended for 1 reception more than 8 hehe
  • Calculation of SSD I.

Calculation of the total dose of basal and is carried out by any of the above methods - the calculation of the total food (stimulated) and is carried out on the basis of the amount of hehe, which the patient plans to use during the day

• • Distribution of doses of introduced and within 24 hours.
  • Glycemia Self Control, Food Dose Correction I.

More simple modified techniques IIT:

• • 25% of SSD and inserted before dinner or at 22 o'clock as IDD. IKD (amounts to 75% of SSD) are distributed as follows: 40% before breakfast, 30% before lunch and 30% before dinner
  • 30% of SSD and administered as IDD. Of these: 2/3 doses before breakfast, 1/3 before dinner. 70% of SSD is introduced as an ICD. Of these: 40% dose before breakfast, 30% before lunch, 30% before dinner or at night.

In the future, the correction of doses I.

Type I diabetes (insulin-dependent) refers to the discharge of chronic diseases associated with metabolic disorders. This disease is mainly striking the younger generation, so it is called juvenile.

Diabetes mellitus 1 type is incurable, but it is possible to "attach" to it - it is only necessary to change your lifestyle in accordance with the recommendations of doctors.

And that the process of adaptation to a new state passed without unnecessary excesses, it is advisable to understand: why the level of glucose in the blood is growing, and which harm can cause the body "Excess sugar".

Where is insulin comes from

For providing the body insulin corresponds to the pancreas. Or rather, its small part is 1-2% of the total organ. These are the so-called Langerhans islands performing an endocrine function.

Each island contains hormonally active cells. Their little - only 80-200 pcs. On the island. Moreover, this small amount of hormonally active cells is divided into 4 types:

1. Alpha;
2. Beta;
3. Delta;

The share of beta cells accounts for 85% of the total. It is they who produce insulin.

How a pair of insulin glucose works

For our body, glucose is the main source of energy necessary for the smooth operation of all its tissues and organs. The blood glucose level should be permanent - this is one of the main conditions for the normal functioning of our body.

But a healthy person does not think about how much glucose he "put" the body during meals. How does the body support its normal level? Here the beta cells come into the game.

If the blood glucose was accepted with food into the blood, there is a sharp insulin emission. As a result:

• Glucose synthesis processes in the body are terminated;
• Surplus from outside are sent to insulin-dependent fabrics - fat, liver, muscles - for assimilation.

Insulin at this moment plays the role of a conductor or key, which opens the glucose path to the cage.

Insulin-dependent fabrics, which can absorb glucose directly from the blood, are also present in our organism. It belongs to both the brain - the head and dorsal. This is good, and bad: on the one hand, the nutrition of our "computer" does not depend on the failures in the pancreas, but it is not protected from the harmful effects of an excess or lack of glucose.

If you have increased need of additional energy (you have experienced stress, we decided to work in the country or run through the park) - the glucose is beginning to be consumed, which is currently contained in the blood. As soon as its level decreases more permissible, the glucose synthesis synthesis process is included in the body:

1. First, glycogen is sent to the processing - its reserves are stored in the liver.
2. If it is not enough - lipids and proteins are going to move.

About the lack of glucose organism signals a sense of hunger. It is worth only to eat, as all the processes of processing strategic reserves stop.

What happens when insulin lack

If your own insulin is not produced, there is no key conducted by glucose into the cells. Any meal leads to the growth of blood sugar, but insulin-independent fabrics cannot assimilate it. The cells are literally floating in the sweet syrup, but they cannot assimilate glucose - and the SOS signal is sent to the brain: "We have no energy for life."

The liver receives a team on the processing of glycogen, and regularly sends synthesized glucose into blood. When this stock is exhausted, the process of glukegenesis will start - proteins and lipids will go into the course.

A man at the physical level is hunger, but no matter how much he eating, his weight will fall, as there are no energy from the body. There are no materials for protein and lipid synthesis.

The situation is trying to fix the kidneys: they begin to pull glucose in urine. The number of urination is growing per day, a person is thirsty, and drinks water to litters - there are no cases when the patient only drank water for the bucket.

If at this stage the body does not assist, will begin to develop sharp complications with a rapid pace.

Where is their own insulin?

Insulin-dependent diabetes mellitus occurs when the beta cells of the pancreas. For some reason, as a result of viral infections (influenza, rubella, parathy, etc.), antibodies appear in the immune system that their own tissues of the body are adopted for alien. They come with them, as strangers - simply destroy.

In addition to viruses, the list of "accused" falls:

• Overly purified drinking water;
• Lack of breastfeeding;
• Too early baby admission to cow's milk.

But all endocrinologists of the world are recognized: the true perpetrator of the appearance of antibodies, aggressively tuned to beta cells, has not yet been found.

These antibodies (autoimmune markers) can be detected by conducting a number of laboratory studies. If they are not, but beta cells are destroyed, type 1 diabetes is assigned the qualifications of idiopathic - that is, which occurred as a result of the destruction of the pancreas cells for an unknown reason.

Actually, when a failure in the exchange of substances has already occurred, the patient is still, for what reason he lost insulin. He has one way left: to introduce an artificial insulin drug and attach to new realities.

Clinical signs of diabetes

Syptians of diabetes are:

• Polyuria is an increase in the daily volume of urine to 3-10 liters at a rate of 1.8-2 liters. This symptom meets most often. Perhaps even night incontinence of urine;
• Polyudipsy is a permanent thirst: for her thickening it takes a large amount of water - from 8 to 10 liters, and sometimes more. Often this feature is accompanied by dry mouth;
• Polyphagia - food intake in large quantities with a constant sensation of hunger and loss of body weight;
• Inexplicable weight change: his loss in 2-3 months can reach 10 kg;
• Drowsiness, fast fatigue, reducing physical endurance and performance;
• Insomnia, dizziness, irritability and increased excitability;
• Leather and mucous membranes constantly get off;
• On the cheeks and chin due to the expansion of small blood vessels, a blush is manifested;
• Pain in legs, muscle cramps.

One of the signs of type 1 diabetes mellitus is often repeated inflammatory and infectious diseases. It is hard to get rid of them: the treatment process is undergoing hard and takes a lot of time.

But all of the above features are not grounds for diagnosis. For its confirmation it is necessary to conduct laboratory studies:

• Carbohydrate exchange: glucose in the blood is determined three times - an empty stomach, 1.5-2 hours after meals and before bedtime;
• Glycated hemoglobin;
• Glucose level in the urine;
• Protear exchange (urea, creatinine, proteins);
• Lipid exchange (cholesterols and ketones);
• Hormonal exchange.

In hormonal surveys, not only the amount of insulin, but the C-peptide, determine. The latter is produced in the same amount as insulin. If the patient already accepts insulin therapy, the amount of own insulin can be determined by the C-peptide, if it is still produced.

How to normalize your life

While you were healthy, you never had to pay attention to the many life moments: you ate what you liked, and how much I wanted, running to workouts or lying on the sofa with a book - in general, did not understand how free you were.

With a diagnosis of type 1 diabetik, you will have to take your way under strict control. By and large, the necessary restrictions will have little to themselves on your freedom, but psychologically suffer hard. Therefore, the young people are rebellious, disturbing the regime, Brabi by their frivolous attitude towards the disease.

Fight in this way with diabetes is useless: the victory will be clearly not on your side. Your loss will be expressed in terrible irreversible complications, therefore it will be more correct with the disease "make friends". And the sooner you do it, the longer the quality of your life will be held at a high level.

Treatment of diabetes in full understanding of this word is absent: there are no such drugs that could start the process of developing insulin. Before the sick is the task of compensation for diabetes

With insulin therapy, preventive preparations, vitamins and diet, it is necessary:

• Compensate carbohydrate exchange;
• Stabilize lipid metabolism;
• Maintain normal blood pressure.

To fulfill the task, diabetics have several "tools":

• Insulin therapy;
• Diet;
• Physical exercise;
• Device for self-control (glucometer).

Be sure to follow the school diabetics: newcomers are always lost by hearing the diagnosis, so they need the help of specialists.

Insulinotherapy

To simulate the physiological secretion of insulin, diabetics should in a certain time to introduce artificial preparations:

• Basal insulin - 1-2 times a day;
• Bolus - before each meal.

Basal insulins are also called extended or prolonged. Their task is to compensate for glucose that the liver produces. Healthy pancreas produces 24-26 insulin units per day. Approximately the same as the prolonged drug will have to be administered. The dose will recommend the doctor.

But you can conduct independent research:

• Do not eat for five hours;
• Each hour measured sugar;
• If his jumps do not exceed 1.5 mmol / l - dose is defined correctly;
• Sugar sharply decreases or rises - it will be necessary to reduce or increase the number of prolonged insulin.

Spend test measurements within a few days:

It is advisable to conduct research and at night. It is only necessary to start them 6 hours after dinner.

In the need for testing, you can make sure that the sugar is on an empty stomach: if it is greater than or less than 6.5 mmol / l - proceed to the study.

• Glucose level in blood before meals;
• The amount of carbohydrates you are going to eat;
• Your plans after the introduction of insulin - will you just relax, engage in intellectual activity or are going to work physically;
• The time of day (for 1 grain unit - we will talk about it below - insulin in the morning will need more than during the day or evening);
• The states of your health (if you are struggling with some kind of infection, you will have to increase the insulin dose by 20-30%)

The correct calculation of insulin doses can be checked in the following indicators:

• On an empty stomach sugar does not exceed 6.5 mmol / l;
• Two hours after eating, it should not rise above 8.0 mmol / l.

The beginner diabetics of the above information generates a lot of questions: what is a cereal unit, as reflected by physical exertion at the level of glucose, and what to do if the calculation failed?

The doctor will calculate the approximate daily need for insulin on the basis of your weight, the experience of diabetes and theoretical indicators of the need for insulin of un / kg.

If diabetes is revealed for the first time, this indicator will be 0.4-0.5 units / kg. With more than 1 year and good compensation in the calculation, the daily need will be 0.6, and in the case of decompensation - 0.8 units / kg.

For example, sick scales of 75 kg in the first year of diabetes disease will be needed in a day of insulin 0.5 x 75 \u003d 37.5. Floor-unit is difficult to catch, so the result is rounded up to 38 units.

Of these, 50% we will assign to the share of extended insulin (10 of them - in the morning, 9- for the night), and the remaining 19 distributed as follows:

Now it remains to make a menu so that it contains bread units sufficient to repay the introduced dose of insulin. And for a start, we'll figure it out, what is he - bread units, and how to express their diet.

What is a "bread unit" (hehe)

The bread unit is called a conditional value corresponding to 10 grams of carbohydrates (excluding nutritional fibers).

Practically in each product contains carbohydrates. In some, their number is so small that when calculating an insulin dose, they can be neglected. The main source of carbohydrates are sugar, flour, cereals, fruits, potatoes and sweets - Sugar-containing drinks, candy, chocolate.

10 grams of carbohydrates are contained in 10 grams of sugar. As much as 20 grams of white and 25 grams of black bread. Experts - diabetics are engaged in the product of carbohydrates in the products sufficiently stocking of the bread units table and learn to use it.

But there is one nuance here: the developers of this important document indicated how many of this or that product falls on one hee in the raw form. For example, one grain unit corresponds to 15 grams of buckwheat.

It remains to find out how to connect all this with the finished porridge? After all, it can be cooked with crumbly or viscous. And they will not define the eyes as the carbohydrates came with the food plate into your body.

At first, you (or your loved ones) will have to hardly work hard and do the following work:

1. Buy kitchen scales;
2. Carefully weigh the cereal, and translate its weight into bread units;
3. Write, in what ratio you take water and cereals;
4. Weigh the saucepan in which porridge will be boiled;
5. Weigh it together with a cooked dish and subtract the weight of the weight empty pan from the resulting figures;
6. The result obtained is divided into the number of bread units (see paragraph 2).

Suppose you cooked porridge in a 1: 4 ratio, and the weight of one bread unit of the finished product was 60 grams. Now put the scales on the scales and fill it with food: Put 120 g - eat 2 x, increase the portion to 180 g - get 3 x.

If all your actions you lock on paper, and you will never change the proportions, in the following times you will need only to weigh the number of cereals and the finished porridge.

Load planning

Note that physical exertion change the sensitivity of insulin-dependent tissues. A healthy body in these moments automatically reduces insulin secretion by half.

Diabetics have to carefully plan any of its own action. If he intends to expose his body to long physical exertion, he will have to first find out the blood glucose level at the initial moment of actions. If he amounted to:

• 4.5 mmol / l, it needs to eat 1-4 x before load;
• 5-9 x - enough to add 1-2 x first, but after every hour it is necessary to eat another bread unit;
• 10-14 mmol / l - no need nothing.

Please note: if you conflict sugar and you have a glucometter showed more than 14 or less than 4.5 mmol / l - refuse physical work.

Complications of type 1 diabetes

Complications of diabetes can be divided into three groups:

• Sharp;
• Late;
• Chronic.

The sharp includes complications that can entail human death. They develop very quickly, and only timely help can save the life of diabetics. These include:

• Ketoacidosis: arises as a result of accumulation in the organism of ketone bodies (acetone);
• Hypoglycemia: rapid decrease in blood glucose levels. The cause of such a fall can be an incorrectly calculated dose of insulin, strong alcohol, a shash through large physical exertion, not compensated by additional carbohydrate intake;
• Hyperglycemia: increased blood sugar content. An empty stomach may occur - with long-term abstinence from meals, or after meals, if the inserted insulin dose does not correspond to the number of eaten bread units.

To late complications include:

• Retinopathy at which the retina is amazed, hemorrhage occurs in the eye day, and, as a result, the loss of vision;
• Ingiopathy - so-called violation of vessel permeability;
• Polynereropathy - which is expressed in the loss of sensitivity of the limbs to warmth, cold and pain. First, there is a feeling of burning in the legs: it is especially clear that it feels at night - this is the first symptom of polyneuropathy;
• The diabetic foot is a complication accompanied by the appearance of purulent injections, open ulcers and necrotic sites on the feet. Feet need to pay special attention: hygiene, selection of proper shoes, wearing socks that do not have comprehensive rubber bands, etc.

The discharge of unpleasant chronic complications include lesions of vessels, skin and kidney. Trophic ulcers, heart attacks, strokes, heart disease and nephropathy - non-discontinued diabetic satellites.

But diabetics should be understood by one very important thing: only in his power to bring closer or remove the moment of manifestation of these terrible complications. If he reaches his disease seriously, it will be softer. But it is only worth waving a hand to mode and control - and you will get a complete set of late complications in just a few years after the occurrence of diabetes.

Type diabetes mellitus is a severe metabolic disease in which there is insulted insulin in the pancreas, due to which the increase occurs.

Type 1 diabetes is also widely known as insulin-dependent diabetes mellitus. In the pancreas of sick people, there are practically no cells that are responsible for the production of protein hormone - insulin, so with this disease in the human body ceases to produce its insulin.

On type 1 diabetes, there are only 2-10% of all cases of diabetes. The risk of developing this disease is only 0.5% for the population of the White race. Most often, this pathology arises in the younger age (10-13 years).

Subject to adequate compensation for the disease (when the glycated hemoglobin is close to a normal level, like in healthy people) and the probability of the development of complications is very low - the lifespan of the patient with an insulin-dependent diabetes for more than 55-50 years is quite possible.

Etiology

Usually, insulin-dependent type 1 diabetes mellitus is evolving due to the pathological reactions of the body, as a result of which the immunity destroys the pancreas cells that are insulin. While the etiology of the disease does not contain accurate causes that cause it.

The reasons

Under the suggestions of specialists, there are several probable reasons for the development of this disease.

These include:

• . If one of the parents is sick of type 1 diabetes, then the chance of developing the disease in the child increases by 4-10%, unlike other people.
• External factors. The prevalence of the disease among European people in different countries is very different. Moreover, in those people who migrated from places with a low incidence of diabetes into a territory with high morbidity, type 1 diabetes occurs more often than those who remained living in the country of birth.
• Viruses. There is a theory that an autoimmune reaction to pancreatic cells occurs due to viruses. It is assumed that the viruses of cokes and rubella have some influence, but there is no accurate evidence to this.
• Medicines and chemicals. Streptozocin used in the treatment of pancreatic cancer, especially toxic for beta cells of the organ. It may be one of the causes of insulin-dependent diabetes mellitus. Pancreatic beta cells are also affected by the rat poison, which is used in some countries to this day.

Symptoms

Classical signs of type 1 diabetes are:

• Polyuria (rapid and abundant urination). Hyperglycemia provokes enhanced sehalation and disposal of sugar from the body, which increases the frequency of urges to the toilet. Little children may have urine incontinence.
• Polydipsy (Strong and constant thirst). Arises due to the abundant loss of moisture.
• Sharp reduction weight. It is a consequence of no sugar digestibility (energy loss) and polyuria. Particularly often observed weight loss in children.

Other manifestations of insulin-dependent diabetes include:

• Fast fatigue, weakness - consequences of a violation of the electrolyte metabolism and disposal of sugar in the body.
• Dry mucous membranes and skin.
• (Permanent feeling of hunger) - caused by the lack of cell food (due to non-improved glucose).
• Frequent infectious lesions.

The first symptoms of the insulin-dependent diabetes mellitus 1 in childhood are diabetic ketoacidosis or ketoacidotic coma.

Most of the diabetics (over 80%) refer to a specialist no later than 3 weeks after the appearance of pronounced symptoms.

Complications

Insulino-dependent diabetes often has consequences. Complications of the disease are short-term and chronic.

Short-term complications

They usually tend to treat. With insufficient or absent treatment of type 1 diabetes mellitus can develop.

Also a common complication with insulin-dependent diabetes is (when the blood sugar is sharply reduced to a dangerous level). If the patient with hypoglycemia does not provide medical care on time, he can lose consciousness and even fall into the state of the coma.

Chronic complications

The course of such complications is more difficult to control, and their progression may cause premature death of diabetics.

Attentive control of blood sugar reduces the risk of such problems, but does not eliminate them completely.

With long-term diabetes, they occur even in patients with a well-compensated disease.

Complications of the insulin-dependent type 1 diabetes mellitus protruding:

• Cardiac and vascular diseases (atherosclerosis, hypertension, ischemia, stroke).
• Damage to small blood vessels of all tissues and organs (et al.).
• The defeat of the nervous system is the loss of the sensitivity of the limbs, dizziness, the disorder of the erectile function in men, the development of ulcers, gangrene.
• Renal failure, etc.

Disability

People suffering from diabetes mellitus, not so easy to get disability. Even the third group of disability can be obtained only when setting moderate disorders in the body. It turns out that type of type 1 diabetes and its complications should be patient to interfere with life fully and it is necessary to prove with doctors.

The first group of disability is given:

Of clearly pronounced violations in the body:

• (blindness of both eyes).
• Neuropathy (ataxia and paralysis).
• In the heavy stage (diabetic stop, gangrene).
• Cardiac insufficiency of the 3rd stage against the background of diabetes.
• Frequent hypoglycemic coma.
• Chronic renal failure in the terminal stage.
• Pronounced psyche disorders (diabetic encephalopathy).
• At the same time, the patient should need constant care and help.

The second group of disability is awarded with diabetics when:

The third group of disability is awarded at:

• Light or moderate severity of diabetes.
• Moderate pathology of organs and systems.
• The disability of 3 groups must be regularly confirmed by the medical commission passing.

Pregnancy

• The presence of insulin-dependent diabetes mellitus in the mother speaks of its children's predisposition to the development of this disease in the future.
• Pregnancy in insulin-dependent diabetes requires at least 2 injunction to a woman in a day. An empty stomach should be no more than 5.0, and 2 hours after meals - no more than 6.6 mmol / liter.
• Pregnancy in diabetes in the first trimester is often accompanied by hypoglycemia, in 2 and 3 trimester increases insulin resistance and hyperglycemia, so the patient must carefully control blood sugar levels.
• Pregnant, suffering type 1 diabetes mellitus, regularly conduct an ultrasound examination, thanks to which you can track the development of the fetus and prevent multi-way.
• Diabetics, carrying a child, need to visit the doctor every 2 weeks, and after 30 weeks of pregnancy - every week.

In addition to the general examination of a pregnant woman with insulin-dependent diabetes mellitus, an ECG is also prescribed and carried out and carried out on creatinine and protein, determine the level of electrolytes and total cholesterol in the blood.

Ischemic heart disease on the background of type 1 diabetes mellitus can perform a medical indication for an abortion, since mortality among mothers with this complication is too high and is about 67%.

Sugar diabetes is a chronic disease, regardless of its variety.

Youth diabetes mellitus occurs most often in children under 15 years old, starting rapidly developing in a growing organism.

There are 2 types of diabetes - the first and second type. A couple of years ago, it was considered an axiom. Nowadays, doctors had to revise the outdated classification, because Scientists have discovered another type of this disease.

LADA is a latent autoimmune diabetes in adults who are inherent in signs of 1 and 2 types of disease.

An autoimmune diabetes mellitus in a non-disciphetic form is a separate version of the first type of diabetes mellitus, which develops in adults.

The diabetes of the second type is called noninsulinically independent. This means that blood sugar is increasing not due to the lack of insulin, but due to the immunity of receptors. In this regard, this type of pathology has its own characteristics of the flow and treatment.

The diabetes mellitus of the second type, or nonnsulino-dependent - is the exchange of disease with the development of a chronically elevated blood sugar level. This occurs because of the reduced synthesis of the hormone of the pancreas, or due to the reduction of cell sensitivity to it. In the latter case, they suggest that a person develops insulin resistance. And this is despite the fact that at the initial stages of the disease in the body, a sufficient or even increased amount of hormone is synthesized. In turn, chronic hyperglycemia leads to the defeat of all organs.

What you need to know about non-insulin-dependent diabetes

First of all, we note that diabetes is characterized by an elevated blood glucose content. At the same time, a person feels symptoms such as stripped urination, increased fatigue. Fungal lesions appear on the skin, from which you can not get rid of. In addition, during diabetes, there may be vicious, weakening memory and attention, as well as other problems.

If you do not control diabetes, and it is also incorrect to treat it, which happens very often, then a person can prematurely die. Causes of death - gangrene, cardiovascular pathologies, terminal stage of renal failure.

Sugar diabetes of nonnsulino-dependent type is mainly developing at middle age - after forty years. However, recently, such a disease is increasingly both in young people. The causes of such a disease are improper nutrition, overweight and hypodynamia.

If not to treat diabetes mellitus of this type, then over the years it goes into an insulin-dependent with a constant deficiency in the body of the insulin hormone and poor hyperglycemia compensation. In modern conditions, it rarely comes to it, since there is a lot of patients from the absence or improper treatment from complications.

What is the body insulin

This is an essential hormone controlling blood glucose levels. With it, it is regulated by its blood content. If for any reason, the generation of insulin is terminated (and such a state does not compensate for insulin injections), then a person dies quickly.

It is necessary to know that in a healthy body a narrower range of blood sugar content. It is held in such a framework only due to insulin. Under its action, the cells of the liver and muscles are pulled out with glucose and turn it into glycogen. And so that glycogen turns out again in glucose, glucagon is needed, which is also produced in the pancreas. If there is no glycogen in the body, then glucose begins to be produced from the protein.

In addition, insulin ensures the conversion of glucose into fat, then deposited in the body. If you consume a lot of food rich in carbohydrates, then in the blood there will be a constantly high level of insulin. Because of this, it is very difficult to lose weight. Moreover, the more insulin it is in the blood, the harder will lose weight. Due to such violations in the exchange of carbohydrates and sugar diabetes develop.

Basic symptoms of diabetes

The disease is developing gradually. Usually a person does not recognize about it, and the disease is diagnosed by chance. Insulin-dependent diabetes mellitus has such characteristic symptoms:

• impairment;
• bad memory;
• fatigue;
• itching skin;
• the appearance of fungal skin diseases (while they are very difficult to get rid of them);
• elevated thirst (it happens that a person can drink up to five liters of fluid per day);
• student urination (note that it happens at night, and several times);
• strange sensations of tingling and numbness in the lower limbs, and when walking - the occurrence of pain;
• the development of thrush, which is very difficult to treat;
• in women, menstrual cycle is broken, and in men - potency.

In some cases, diabetes can flow without pronounced symptoms. Sudden myocardial infarction or stroke is also a manifestation of insulin-dependent diabetes.

In this disease, a person can occur an increased appetite. This occurs because the cells of the body do not absorb glucose due to insulin resistance. If glucose in the body is too much, however, the body does not assimilate it, the disintegration of fat cells begins. When decaying fat in the body, ketone bodies appear. In the exhaled man air appears the smell of acetone.

At high concentration of ketone bodies, blood pH changes. This condition is very dangerous due to the risk of developing a ketoacidotic coma. If a person is sickly diabetes and consumes little carbohydrates, the pH indicator does not fall, which does not cause lethargy, drowsiness and vomiting. The appearance of the smell of acetone suggests that the body is gradually getting rid of excess weight.

Complications of disease

Insulin-dependent diabetes mellitus is dangerous with sharp and chronic complications. Among the acute complications should be noted.

1. Diabetic ketoacidosis is the most dangerous complication of diabetes. It is dangerous with the increase in blood acidity and the development of a ketoacidotic coma. If the patient knows all the subtleties of his disease and knows how to calculate the dose of insulin, the probability of developing such a complication is zero.
2. Hyperglycemic Coma is a violation and loss of consciousness due to increasing the amount of glucose in the blood. Frequently combined with ketoacidosis.

If the patient does not have emergency assistance, then the patient's death is possible. Doctors need to make a lot of effort to bring him back to life. Unfortunately, the percentage of death in patients is very high and reaches 25 percent.

However, yet the overwhelming majority of patients suffer from non-sharp, and chronic complications of the disease. If not to treat them, then in many cases they can also be lethal. However, diabetes mellitus and is dangerous in that its consequences and complications are insidious, as it does not allow to know anything about themselves until time. And the most dangerous complications on the kidneys, vision and heart are manifested too late. Here are some complications that are dangerous sugar diabetes.

1. Diabetic nephropathy. This is a severe kidney damage, which causes the development of chronic renal failure. Most patients who are done by dialysis and kidney transplant suffer from diabetes.
2. Retinopathy - eye defeat. It is the cause of the development of blindness in middle-aged patients.
3. Neuropathy is the defeat of the nerves - it is already found in three patients with diabetes at the time of determining the diagnosis. Neuropathy causes reduced sensitivity in the legs, which is why patients are high risk of injury, gangrene, amputation.
4. Angiopathy is the defeat of the vessels. Because of this fabric, there is no sufficient amount of nutrients. The disease of large vessels leads to atherosclerosis.
5. Skin lesion.
6. Defeat of the heart and coronary vessels leading to myocardial infarction.
7. Violation of potency in men and menstrual cycle in women.
8. Progressive violation of memory and attention.

Nephropathy and retinopathy are most dangerous. They are manifested only when they become irreversible. Other violations can be warned, effectively controlling blood sugar. What it is lower, the probability of developing such complications is less and approaches zero.

Features of the disease

Insulin-dependent type of this ailment is 90 percent of all cases. In four of five such patients there may be overweight.

In the treatment of this disease, it is necessary to accurately and gently perform such steps.

1. Proper diet with a refusal of all products enriched with carbohydrates. At the same time, a person will not remain hungry: it is allowed a lot of naked dishes.
2. Classes of physical education with low loads that bring pleasure, not exhaustion.
3. Receiving tablets to increase tissue sensitivity to pancreatic hormone. Any sacrarizing tablets, especially containing sulfonylurea, are harmful.
4. Injection insulin in cases of necessity. They do not mean that it is necessary to eat products enriched with carbohydrates. Diabetik must keep them further and not have them under any circumstances.

When diabetes insulin-dependent type, the refusal of carbohydrates is extremely important, since their body is poorly tolerated. In incommeced cases, this allows dramatically to reduce the amount of sugar to the level that is in healthy people. People suffering from diabetes mellitus, wellness jogging is very useful.

Adhering to these recommendations, a person, as a rule, do not need to prick insulin. However, if it is obvious that it is not necessary to do without injections (the disease is running), you do not need to postpone the treatment of insulin, and start it as early as possible. Each diabetics is under the power to ensure that its sugar level after meals was not higher than 6, and the best - 5.3 mmol. This is not fantasy, but effective treatment of the disease, which reduces the risk of developing complications to almost zero.