Diagnosis and treatment of type 2 diabetes mellitus. Treatment of diabetes mellitus of various types: means and methods How to treat type 2 diabetes mellitus

The habit of eating plentifully and sitting comfortably in front of the TV has led to a sharp increase in the number of patients who are diagnosed with type 2 diabetes. 8% of the world's population already suffers from this disease (according to the International Diabetes Federation), the number of cases is steadily growing. If type 2 diabetes treatment is started in time, serious complications can really be avoided. Non-insulin-dependent diabetes can be cured. To do this, sometimes you just need to change your lifestyle. Being slightly hungry and moving is a chance to maintain your health for a long time.

Type 2 diabetes mellitus (non-insulin-dependent diabetes) is caused by overeating and physical inactivity. Do not forget about the genetic predisposition - the presence in the family of relatives who have been diagnosed with type 2 diabetes increases the likelihood of the disease.

The disease affects people of middle and old age, in women it is diagnosed more often than in males. Children with type 2 diabetes may develop if they are overweight.

The development of the disease is associated with insufficient absorption of glucose circulating in the blood by fatty and muscle tissues. This is due to two reasons:

1. Relative deficiency of produced insulin;
2. Decreased sensitivity of cells to insulin (insulin resistance).

Age-related changes do not bypass the pancreas. The rhythm of insulin production is disturbed, the hormone is not synthesized in sufficient quantities.

Insulin resistance is the inability of muscle and fat cells to absorb glucose. Insulin resistance can be caused by:

taking certain medications (diuretics, corticosteroids, nicotinic acid, beta-blockers, anticancer drugs);

• sedentary lifestyle, bed rest;
• diseases of the cardiovascular system (CVS);
• obesity.

Tissue sensitivity to insulin decreases in percentage terms in proportion to the excess of the ideal weight. If the weight is exceeded by 40%, insulin sensitivity is reduced by 40%.

The risk group includes people:

• with obesity;
• Overweight;
• After 40 years;
• Diagnosed with hypertension, atherosclerosis;
• With a favorable heredity (the closest relatives suffered from hypertension, atherosclerosis and type 2 diabetes);
• With an addiction to smoking.

Numerous studies conducted by physicians have shown a high likelihood of developing insulin resistance in smokers.

In order not to deal with the complex calculation of indices characterizing the degree of obesity, it is enough to regularly measure your waist. If in men the measurements showed an excess of 1.02 m, and in women 0.88 m, it is worth considering taking immediate measures to combat obesity.

Classification

In the development of the disease, type 2 diabetes mellitus is divided into 3 stages:

1. Prediabetes can be detected by testing for glycated hemoglobin.
2. Latent diabetes, symptoms are not observed; It is diagnosed by the results of a glucose tolerance test.
3. Obvious diabetes, clinical signs are evident. Diagnosed by all relevant tests.

Prediabetes is characterized by a slight excess of glycemia. At this stage of the disease, the pancreas is working to the limit, trying to produce enough insulin to cause the desired reaction of cells and force them to absorb glucose. Early detection of prediabetes gives a person a chance to prevent the development of the disease if he thinks about a radical change in his lifestyle.

Type 2 diabetes can occur in 3 forms:

1. Easy; symptoms are smoothed, there is no sugar in the urine, glycemia slightly exceeds the norm.
2. Middle; thirst, frequent urination, pustular skin lesions; Glycemia >10 mmol/l, urinalysis revealed the presence of sugar.
3. heavy; all metabolic processes are disturbed; clear signs of vascular and neurological disorders; high sugar levels in blood and urine tests.

Symptoms

The onset of type 2 diabetes mellitus is characterized by the absence of clear manifestations of the symptoms characteristic of diabetes:

• Strong thirst;
• Frequent urination;
• Constant hunger.

Signs of diabetes should be alerted, such as:

• Slow healing wounds;
• Constant fatigue;
• Numbness/tingling in hands and feet;
• Itching in the perineum;
• Dry skin;
• Furunculosis;
• floating vision.

In severe forms of insulin resistance, dark hardened spots may appear in the folds of the skin, caused by a violation of metabolic processes in the skin. Sometimes dark rings form around the neck, spots are visible on the elbows and knees.

With the further development of the disease, violations in the genital area are observed:

• Sexual dysfunction in men;
• The reluctance of intimacy in women.

If the disease is running, it will manifest itself:

• Violations in the activity of the CCC (will provoke the development of hypertension, heart attack, stroke);
• Ulcers (trophic);
• Diabetic foot syndrome.

Diagnostics

Indolent type 2 diabetes mellitus has an unpleasant feature: it can take about 10 years from its onset to detection. Early detection of the disease will help to start treatment of type 2 diabetes in a timely manner and avoid serious complications. Laboratory tests help diagnose the disease:

• Blood test for sugar;
• Urinalysis for sugar and acetone;
• Glucose tolerance test;
• Glycohemoglobin analysis.

A blood sugar test is recommended to be done annually. Blood sampling from a finger or vein is done on an empty stomach. This analysis makes it possible to assess glycemia only at the time of the study. Blood sugar levels can be affected by exercise, stress, current acute illnesses. normal glycemia<=5,5 Ммоль/л. Дополнительные исследования назначают, если гликемия превышает 6,1 Ммоль/л. При гликемии в 11 Ммоль/л и явных клинических признаках обычно подозревают сахарный диабет 2 типа.

Glycemia - this is the name of the indicator of the content / level of sugar in the blood (in mmol / l).

If the urinalysis showed the presence of sugar and / or acetone, it is recommended to repeat the analysis to be sure. Sugar and acetone in the urine indicate possible disorders in carbohydrate metabolism. An additional examination is required.

Many people know about diabetes. But far from everyone is aware of the division of the presented disease into two types. They are called like this: type 1 diabetes And type 2 diabetes.

requires mandatory and timely administration of insulin. But type 2 is found today in every fourth person in the world, which the patients themselves do not even know about.

Such ignorance can lead to a series that can be prevented if general supportive therapy is started on time.

Type 2 diabetes - what is it?

Surprisingly, the two types of diabetic disease are quite different.

type 1 diabetes characterized by the absence or shortage of the amount of insulin necessary for normal life, which leads to violations in the conversion of sugar into glucose and the timeliness of its removal.

That is why patients with this disease must take insulin promptly, because the high content of sugar in human blood is fraught with general malaise and the gradual destruction of internal organs.

Type 2 diabetes mellitus is a metabolic disease that is accompanied by persistent hyperglycemia due to a lack of cell sensitivity to insulin produced.

That is type 2 diabetes is not associated with the production of insulin - immunity to the effects of this enzyme is determined here, which also leads to an increased blood sugar level, which means subsequent destruction of vascular cells and internal organs.

Symptoms of type 2 diabetes

Symptoms of the presented disease are often not taken seriously by patients, because they are not so intense at the initial stage of diabetes development.

A person may not be aware of a violation of the insulin receptors of body cells for several years or a lifetime.

As a rule, in such cases, everything ends rather sadly, because it comes before which a person feels severe pain in the head, stomach, suffers from diarrhea and vomiting, drowsiness and lethargy.

If you do not pay attention to the presented symptoms in time, the patient's pressure drops, tachycardia begins, after a while there is a loss of consciousness and a coma.

In order to prevent such unpleasant manifestations, you should consult a doctor at the stage of the initial manifestation for help and for an appropriate examination. Symptoms characteristic of diabetes include:

• dry mouth ;
• unbearable and inexplicable thirst;
• large amount of urine both day and night;
• good appetite, but the patient may lose weight;
• itching of the skin, men have inflammation of the foreskin;
• constant sleepiness and just general malaise.

Women may also pay attention to characteristic white sand on underwear, which appears some time after visiting the toilet. There is also itching in the intimate area and the vagina, which is often mistaken for ordinary candidiasis.

Reasons for the development of the disease

There are three main causes that contribute to the development of diabetes:

1. Age-related changes in the human body. Elderly people should be especially attentive to their condition, because with age the body loses tolerance ( digestibility) to glucose, which can manifest itself as the development of type 2 diabetes mellitus.

Genetic predisposition also plays an important role here, which in most cases leads to the development of the disease, because in some older people, despite violations, blood sugar levels are within normal limits.

2. Obesity and overweight- the presented aspects lead to an increase in cholesterol in human blood. The consequence of this feature is the coating of blood vessels with a cholesterol film and a reduced supply of oxygen.

The walls of blood vessels that have already undergone hypoxia and the development of atherosclerosis cannot fully assimilate the insulin produced in the right quantities and the incoming glucose.

3. Excessive consumption of carbohydrates- these enzymes lead to pancreatic depletion and subsequent damage to insulin receptors in the blood.

The risk group includes people with a genetic predisposition, obesity, the development of atherosclerosis, diseases of the heart and pancreas, and the presence of allergic manifestations.

Under any circumstances, only regular examinations will help to detect the disease in a timely manner.

Type 2 Diabetes: Diet and Treatment

Treatment of diabetes mellitus of the presented type is possible only through diet and taking drugs that will help reduce blood sugar, which has a positive effect on the general condition of the patient.

The diet involves reducing the consumption of foods high in carbohydrates, and vitamins and hypoglycemic drugs are always used as treatment.

Type 2 diabetes: diet and nutrition

The basis of nutrition for type 2 diabetes is a low-carbohydrate diet, where all foods containing a large amount of carbohydrates are banned.

Of course, a complete rejection of buns, bread and other flour products should not follow. They can be replaced by varieties where for cooking used wholemeal flour or durum wheat (e.g. pasta).

Of course, the consumption of even such products should be reduced in significant quantities.

Foods high in sugar are also banned. these are sweets, cakes, cookies and other sweets.

Such use will lead to a sharp increase in blood sugar, which will lead to malaise, because the produced insulin will very slowly convert sugar into glucose ( or not at all).

Many diabetics are deluded eating fruits in unlimited quantities, believing that they contain few carbohydrates. As it turns out in practice, there are plenty of carbohydrates in the pulp of any fruit, just like in vegetables. Therefore, they should be introduced into the diet in small quantities.

There are fruits and vegetables that are fully on the list of prohibited foods. They include grapes, bananas, melons, potatoes.

The list of approved products includes:

all types of meat preferably boiled, stewed or baked);

dairy products in the absence of sugar and artificial flavors in it;

vegetables - beets, carrots, cauliflower and white cabbage, cucumbers, tomatoes, green beans, zucchini and eggplant, celery and other salads;

fruits - apples, pears, plums, apricots and other varieties with a low sugar content;

eggs;

mushrooms of all kinds.

Supplements are used in moderation spices, sunflower and butter, mayonnaise and ketchup.

You should also try to include high-fiber foods in large quantities in your diet. This enzyme contributes to the elimination of incoming carbohydrates, which does not burden the pancreas with work and has a positive effect on the state of the blood.

As for the general principles of nutrition, diabetics should eat small amounts of food every 3 hours. Patients are forbidden any diets and experiments in nutrition.

Benefits of vitamins for type 2 diabetes

As mentioned above, in the presence of the presented disease, patients have increased urination. This leads to the washing out of useful vitamins and trace elements, which also contributes to the destruction of cells and tissues.

To prevent deterioration, experts prescribe a complex of vitamins to patients. For general information, here are some vitamin names for type 2 diabetics:

• General complex of vitamins for the eyes- help prevent the development of diabetic retinopathy, cataracts and glaucoma. Here you can take "Lutein-Complex", "Optics", "Blueberry Forte".
• Vitamin-mineral set "Alphabet Diabetes"- the complex includes 13 vitamins and 9 minerals, various organic acids and plant extracts. The mineral complex includes magnesium, a useful and important microelement for the body, which helps to calm the nerves and improves heart function.
• "Vervag Pharma" - the drug includes 11 vitamins and 2 important minerals - chromium and zinc. Both micronutrients help eliminate cravings for sweets and other unhealthy foods in type 2 diabetes.
• "Doppelgerz Active"– 10 vitamins and 4 minerals. It is taken to prevent damage to the retina and kidney tissue.
• "Complivit Diabetes"- is a dietary supplement that contains 14 vitamins and 4 important minerals. The complex also includes folic, lipoic acid and ginkgo biloba extract, which improves peripheral circulation and acts as a prevention of diseases of the nervous system.
• Complivit Calcium D3- helps to improve the structure of bone tissue and the surface of the teeth, perfectly controls the production of protein.

There are many vitamins for use in diabetes, it is only important to choose them correctly. The attending physician and a comprehensive examination will help to resolve the issue, which will identify the problems that have begun against the background of type 2 diabetes.

Symptoms of diabetes mellitus video:

Treatment of diabetes at home

Considering the question how to treat diabetes at home, you should provide a list of drugs recommended for use.

The impact of the drugs presented in the future helps to improve the general condition and launch the necessary processes for normal life.

All drugs are divided into three groups:

1. Alpha-glucosidase inhibitors- promote the absorption of glucose in the intestine, prevent the rapid breakdown of carbohydrates in the small intestine, which helps to regulate sharp jumps in glycemia.

But the drugs presented cannot be used for a long time - they can lead to complications in the form of dysbacteriosis and inflammation of the intestinal walls. This includes drugs such as Akarbaza and Radio tape recorder.

2. Biguanides - increase the susceptibility of cells to insulin produced in normal amounts. They can be used in the presence of diseases of the liver, kidneys and heart.

Here Metformin is distinguished ( Glucophage and Siofor) and Glyformin. Gliformin in diabetes also contributes to weight loss.

3. Sulfonylureas- affect the production of deficient insulin, so they are consumed depending on the time and number of meals. Such a list of pills for type 2 diabetes looks like Maninil, Glurenorm, Amaryl, Diabeton.

All presented drugs and processes can significantly reduce blood sugar levels, which has a positive effect on the patient's condition.

It should be noted that antidiabetic drugs for type 2 diabetes are determined on the basis of the examination, because doctors should identify the ongoing violations in the patient's body.

Also drugs cannot be used continuously, since some of them have the property of adaptation in the body, and this is fraught with useless use of drugs and deterioration of the patient's condition.

Diabetes mellitus: treatment with folk remedies

Despite the use of traditional medicine, it is possible and recommended. Basically, all methods are based on lowering blood sugar levels. The following recipes are used here:

• Dead bees. Specific bee products can only be used if there is no allergy. Here you can prepare a decoction for which it is used 10-20 dead bees and 2 liters of water. The bees are boiled for 2 hours. The finished broth is filtered and consumed in a glass a day in several doses.
  
• Bay leaf. An infusion of bay leaves helps lower blood sugar, but is approved for use in normal or high blood pressure. 10 dried and crushed bay leaves pour 3 cups of boiling water and infuse for 2 hours. The infusion is applied strained in half a glass at least 3 times a day.
  
• . 4-5 rose hips crush and pour a glass of boiling water. Now the composition is boiled for 5 minutes and left to infuse for 5 hours. Strained broth is used every time half an hour before meals.
  
• Onion. Baked onions as a whole have a sweet taste and help reduce blood sugar in the patient. Just eat a vegetable in the morning on an empty stomach in the amount of one medium head.
  
• Aspen bark. Aspen bark in type 2 diabetes also has a hypoglycemic effect. The presented ingredient can be purchased at a pharmacy, which offers pre-packaged bags for one-time brewing. The sachet contains a tablespoon of chopped aspen bark, which is brewed with a glass of boiling water and infused for 5 minutes. The resulting infusion is used as regular tea.
  
• Flax seeds. Flax seeds in type 2 diabetes contribute to the overall strengthening of the body and lower blood glucose. Here, to prepare a useful drug, you should prepare a decoction using a tablespoon of the main ingredient and a glass of boiling water. Pour boiling water over the seeds and boil for 10 minutes. The slightly cooled broth is filtered and the resulting contents are drunk during the day, divided into 2 or 3 doses.
  

Traditional medicine should be used with caution. It is important to prevent an increase in blood sugar, and not cause more problems, so you should consult your doctor before using traditional medicine.

Benefit or harm from controversial products

There is a whole list of foods that cause controversy among specialists in the use of type 2 diabetes. The debate is to ban or allow their consumption, which is due to the high sugar content of the product, but a slightly lower effect on blood glucose levels.

Persimmon

Persimmon in type 2 diabetes not forbidden to use, although it contains a large amount of sugar. With a high indicator, the glycemic index of the product refers to the average and is concluded in the amount of 45 units.

Of course, excessive consumption of persimmon in the presence of the present disease is prohibited, but one fruit per day will not harm the general condition of the body. You should also choose the right fruit and not eat the unripe fruit, which is expressed in the form of an astringent taste.

Honey

For some reason, many patients forbid themselves to use honey for type 2 diabetes. Such failures are explained by the high content of sugar and glucose.

However, for the presented substances contained in the natural product, the presence of insulin during splitting in the body is not important, and this does not prohibit the use of honey, although in small quantities.

Kiwi

Elevated glucose and protein content leads to a ban on the use kiwi for type 2 diabetes. But such statements of experts can be attributed to erroneous, because the presented fruit contains a lot of fiber, and this has a positive effect on the rapid and efficient breakdown of glucose that has entered the body.

In addition, the calorie content of the product is only 50 kcal per 100 g, and the fruit is recommended for use if you are overweight.

Pomegranate

pomegranate for type 2 diabetes is a controversial product because there are "two sides of the same coin". On the one hand, it contains practically no sugar, which allows its use in case of diabetes.

On the other hand, a high content of acids has a destructive effect on the walls of the stomach and tooth enamel. Therefore, experts recommend not to get carried away with grenades and eat no more than half a fruit a day.

radish

Radish for type 2 diabetes is an indispensable product because it contains a high content of choline - a substance that has a positive effect on the absorption of glucose by the intestines.

In the absence of proper self-release of the substance, and this occurs when there are problems with the pancreas, it is important to replenish it in a timely manner. Therefore, the introduction of radish into the usual diet is recommended.

Beet

Beets for type 2 diabetes is a prohibited product. But some experts talk about its benefits due to the high fiber content in the vegetable.

Here, the glycemic load should also be brought in favor of the vegetable, which, along with the glycemic index ( 64 units), is an indicator of only 5 units, and this can be attributed to the lowest level.

Ginger

The benefits of ginger in the presence of the disease presented are in several aspects.

Firstly, it contains over 400 beneficial vitamins, trace elements, acids and other components that are so necessary in the absence of insulin production.

Secondly, ginger in type 2 diabetes helps to improve the processes of metabolism and digestion of food, and also has a positive effect on liver function.

The most important advantage from the point of view of the issue under consideration is the prevention of the accumulation of cholesterol in the blood vessels of the patient, which provokes the development and further progression of type 2 diabetes mellitus.

Read more about the beneficial properties of ginger.

Alcohol

Most experts do not support the use alcohol in type 2 diabetes. Of course, this is quite justified, because alcoholic beverages contain a large amount of sugar and carbohydrates.

But the use of 50-100 ml of an alcohol-containing product per day will not harm the body and will not lead to the development of complications. Here you can select all drinks, the strength of which is from 40 degrees and above.

Separately, you should consider the use of beer, which can be called a storehouse of carbohydrates. Fans of this drink should be careful, but drinking one glass a day will not lead to dangerous consequences.

Patients often ask doctors a lot of questions, to which there is not always an unambiguous answer. The most interesting and entertaining are the following:

1. Can type 2 diabetes be cured? It sounds terrible, but it is impossible to cure diabetes of any type. The presented disease is a chronic disease and cannot be completely cured.

Therefore, one should not trust dubious drugs and treatments that are offered today by scammers and very unscrupulous sellers and manufacturers.

2. Can type 2 diabetes be treated without medication? It all depends on the degree of neglect of the disease and the characteristics of the violations that have occurred.

Yes, sometimes you can avoid the mandatory consumption of drugs, but for this you should adhere to proper and permitted nutrition, use traditional medicine methods, go in for sports, physical activity contributes to a better absorption of the received portion of glucose.

But such statistics speak of patients with type 1 disease, although representatives with type 2 diseases who do not follow elementary dietary rules and do not use drugs or folk remedies to lower blood glucose levels also fall into the risk group.

Undoubtedly, diabetes is a dangerous disease, but it should not be a death sentence, since there are cases of successful and full survival of patients to old age, in which diabetes was diagnosed in childhood.

Here, first of all, the very attitude of a person to the destruction that has begun is important. If you start treatment in time and follow a diet, then type 2 diabetes mellitus will not entail complications, which become the causes of deaths.

The main goals of treating diabetes mellitus of any type include maintaining a normal lifestyle; normalization of the metabolism of carbohydrates, proteins and fats; prevention of hypoglycemic reactions; prevention of late complications (consequences) of diabetes; psychological adjustment to life with a chronic illness. These goals can only be partially achieved in diabetic patients, due to the imperfection of modern substitution therapy. At the same time, today it is firmly established that the closer the patient's glycemia is to the normal level, the less likely it is to develop late complications of diabetes.

Despite numerous publications on the treatment of type 2 diabetes mellitus, the vast majority of patients do not achieve compensation for carbohydrate metabolism, although their general health may remain good. Not always a diabetic is aware of the importance of self-control and the study of glycemia is carried out from case to case. The illusion of relative well-being, based on normal well-being, delays the initiation of drug treatment in many patients with type 2 diabetes mellitus. In addition, the presence of morning normoglycemia does not exclude the decompensation of diabetes mellitus in such patients.

The key to successful treatment of patients with type 2 diabetes is education in a diabetic school. Teaching patients how to treat and manage their diabetes at home is extremely important.

Diet to treat type 2 diabetes

90% of people with type 2 diabetes have some degree of obesity, so weight loss through a low-calorie diet and exercise is of paramount importance. It is necessary to motivate the patient to lose weight, since even a moderate weight loss (by 5-10% of the original) can achieve a significant reduction in glycemia, blood lipids and blood pressure. In some cases, the condition of patients improves so much that there is no need for hypoglycemic agents.

Treatment usually begins with the selection of a diet and, if possible, expand the amount of physical activity. Diet therapy is the basis for the treatment of type 2 diabetes mellitus. Diet therapy consists in prescribing a balanced diet containing 50% carbohydrates, 20% proteins and 30% fats and following regular 5–6 meals a day - table number 9. Strict adherence to diet number 8 with fasting days for obesity and increased physical activity can significantly reduce the need in hypoglycemic drugs.

Physical exercise reduces insulin resistance, reduces hyperinsulinemia and improves carbohydrate tolerance. In addition, the lipid profile becomes less atherogenic - total plasma cholesterol and triglycerides decrease and high-density lipoprotein cholesterol increases.

A low-calorie diet can be balanced or unbalanced. With a balanced low-calorie diet, the total calorie content of food is reduced without changing its qualitative composition, in contrast to an unbalanced diet low in carbohydrates and fats. In the diet of patients should be foods high in fiber (cereals, vegetables, fruits, wholemeal bread). The diet is recommended to include fibrous fiber, pectin or guar-guar in the amount of 15 g / day. If it is difficult to restrict dietary fat, you should take orlistat, which prevents the breakdown and absorption of 30% of the fat taken and, according to some reports, reduces insulin resistance. The result of monotherapy with a diet can be expected only with a decrease in weight by 10% or more from the original. This can be achieved by increasing physical activity along with a low-calorie balanced diet.

Of the sweeteners today, aspartame (a chemical compound of aspartic and phenylalanine amino acids), sucrasite, sladeks, saccharin are widely used. Acarbose, an antagonist of amylase and sucrase, which reduces the absorption of complex carbohydrates, can be included in the diet of a diabetic patient.

Exercise for the treatment of type 2 diabetes

Daily exercise is essential for type 2 diabetes. At the same time, glucose uptake by muscles increases, the sensitivity of peripheral tissues to insulin increases, blood supply to organs and tissues improves, which leads to a decrease in hypoxia, an inevitable companion of poorly compensated diabetes at any age, especially the elderly. The amount of exercise in the elderly, hypertensive patients and those with a history of myocardial infarction should be determined by the doctor. If there are no other prescriptions, you can limit yourself to a daily 30-minute walk (3 times for 10 minutes).

With decompensation of diabetes mellitus, physical exercises are ineffective. With heavy physical exertion, hypoglycemia may develop, so the doses of hypoglycemic drugs (and especially insulin) should be reduced by 20%.

If diet and exercise fail to achieve normoglycemia, if this treatment does not normalize the disturbed metabolism, one should resort to drug treatment of type 2 diabetes mellitus. In this case, tableted hypoglycemic agents, sulfonamides or biguanides are prescribed, and if they are ineffective, a combination of sulfonamides with biguanides or hypoglycemic drugs with insulin. New groups of drugs - secretagogues (NovoNorm, Starlix) and insulin sensitizers that reduce insulin resistance (thiazolidinedione derivatives - pioglitazone, Aktos). With complete depletion of residual insulin secretion, they switch to insulin monotherapy.

Medical treatment of type 2 diabetes

More than 60% of patients with type 2 diabetes are treated with oral hypoglycemic drugs. For more than 40 years, sulfonylurea has been the mainstay of oral hypoglycemic therapy for type 2 diabetes mellitus. The main mechanism of action of sulfonylurea drugs is to stimulate the secretion of their own insulin.

Any sulfonylurea preparation, after oral administration, binds to a specific protein on the pancreatic β-cell membrane and stimulates insulin secretion. In addition, some sulfonylurea drugs restore (increase) the sensitivity of β-cells to glucose.

Sulfonylureas are attributed to the action, which consists in increasing the sensitivity of cells of adipose, muscle, liver and some other tissues to the action of insulin, in increasing the transport of glucose in skeletal muscles. For patients with type 2 diabetes mellitus with well-preserved function of insulin secretion, the combination of a sulfonylurea drug with biguanide is effective.

Sulfonamides (sulfonylurea drugs) are derivatives of the urea molecule, in which the nitrogen atom is replaced by various chemical groups, which determines the pharmacokinetic and pharmacodynamic differences of these drugs. But they all stimulate the secretion of insulin.

Sulfonamide preparations are rapidly absorbed, even when taken with food, and therefore can be taken with food.

Suphanilamides for the treatment of type 2 diabetes mellitus

Let us give a brief description of the most common sulfonamides.

Tolbutamide (Butamid, Orabet), tablets of 0.25 and 0.5 g - the least active among sulfonamides, has the shortest duration of action (6-10 hours), and therefore can be prescribed 2-3 times a day. Although it was one of the first sulfonylurea preparations, it is still used today because it has few side effects.

Chlorpropamide (Diabenez), tablets of 0.1 and 0.25 g - has the longest duration of action (more than 24 hours), is taken 1 time per day, in the morning. Causes many side effects, the most serious is long-term and difficult to eliminate hypoglycemia. Severe hyponatremia and antabuse-like reactions were also observed. Currently, chlorpropamide is rarely used.

Glibenclamide (Maninil, Betanaz, Daonil, Euglucon), 5 mg tablets is one of the most commonly used sulfonamides in Europe. It is prescribed, as a rule, 2 times a day, in the morning and in the evening. The modern pharmaceutical form is micronized maninil at 1.75 and 3.5 mg, it is better tolerated and more powerful.

Glipizide (Diabenez, Minidiab), tablets of 5 mg / tab. Like glibenclamide, this drug is 100 times more active than tolbutamide, the duration of action reaches 10 hours, it is usually prescribed 2 times a day.

Gliclazide (Diabeton, Predian, Glidiab, Glizid), tablets of 80 mg - its pharmacokinetic parameters are somewhere between the parameters of glibenclamide and glipizide. Usually given twice a day, modified-release diabeton is now available and taken once a day.

Gliquidone (Glurenorm), tablets of 30 and 60 mg. The drug is completely metabolized by the liver to an inactive form, so it can be used in chronic renal failure. Practically does not cause severe hypoglycemia, therefore it is especially indicated for elderly patients.

Modern sulfonamides of the 3rd generation include glimepiride (Amaryl), tablets of 1, 2, 3, 4 mg. It has a powerful prolonged hypoglycemic effect, close to Maninil. It is used once a day, the maximum daily dose is 6 mg.

Side effects of sulfonamides

Severe hypoglycemia occurs infrequently with sulfonamides, mainly in patients receiving chlorpropamide or glibenclamide. The risk of developing hypoglycemia is especially high in elderly patients with chronic renal failure or against the background of an acute intercurrent disease, when food intake is reduced. In the elderly, hypoglycemia is manifested mainly by mental or neurological symptoms that make it difficult to recognize. In this regard, it is not recommended to prescribe long-acting sulfonamides to the elderly.

Very rarely, in the first weeks of treatment with sulfonamides, dyspepsia, skin hypersensitivity, or a reaction of the hematopoietic system develop.

Since alcohol inhibits gluconeogenesis in the liver, its intake can cause hypoglycemia in a patient receiving sulfonamides.

Reserpine, clonidine and non-selective β-blockers also contribute to the development of hypoglycemia by suppressing the counter-insulin regulatory mechanisms in the body and, in addition, can mask the early symptoms of hypoglycemia.

Diuretics, glucocorticoids, sympathomimetics and nicotinic acid reduce the effect of sulfonamides.

Biguanides (metformin) for the treatment of type 2 diabetes

Biguanides, derivatives of guanidine, enhance glucose uptake by skeletal muscles. Biguanides stimulate the production of lactate in the muscles and/or organs of the abdominal cavity and, therefore, many patients receiving biguanides have elevated lactate levels. However, lactic acidosis develops only in patients with reduced biguanide and lactate elimination or with increased lactate production, in particular, in patients with reduced kidney function (they are contraindicated in elevated serum creatinine), with liver disease, alcoholism and cardiopulmonary insufficiency. Lactic acidosis has been particularly common with phenformin and buformin, which is why they have been discontinued.

For today only metformin (Glucophage, Siofor, Diformin, Dianormet) used in clinical practice for the treatment of type 2 diabetes mellitus. Since metformin reduces appetite and does not stimulate hyperinsulinemia, its use is most justified in obese diabetes mellitus, making it easier for such patients to maintain a diet and promote weight loss. Metformin also improves lipid metabolism by lowering low-density lipoprotein levels.

Interest in metformin has now increased dramatically. This is due to the peculiarities of the mechanism of action of this drug. We can say that basically Metformin increases the sensitivity of tissues to insulin, suppresses the production of glucose by the liver and, naturally, reduces fasting glycemia, slows down the absorption of glucose in the gastrointestinal tract. There are additional effects of this drug that have a positive effect on fat metabolism, blood clotting and blood pressure.

The half-life of metformin, which is completely absorbed in the intestine and metabolized in the liver, is 1.5-3 hours, and therefore it is prescribed 2-3 times a day during or after meals. Treatment is started with minimal doses (0.25–0.5 g in the morning) to prevent adverse reactions in the form of dyspeptic phenomena, which occur in 10% of patients, but in most patients they pass quickly. In the future, if necessary, the dose can be increased to 0.5–0.75 g per dose, prescribing the drug 3 times a day. Maintenance dose - 0.25-0.5 g 3 times a day.

Treatment with biguanides should be immediately discontinued when the patient develops acute kidney disease, liver disease, or manifests cardiopulmonary insufficiency.

Since sulfonamides mainly stimulate insulin secretion, and metformin mainly improves its action, they can complement each other's hypoglycemic effect. The combination of these drugs does not increase the risk of side effects, is not accompanied by their adverse interactions, and therefore they are successfully combined in the treatment of type 2 diabetes mellitus.

Combinations of drugs in the treatment of type 2 diabetes

The expediency of using sulfonylurea drugs is beyond doubt, because the most important link in the pathogenesis of type 2 diabetes is a secretory defect in the β-cell. On the other hand, insulin resistance is an almost constant feature of type 2 diabetes mellitus, which necessitates the use of metformin.

Metformin in combination with sulfonylurea drugs- a component of effective treatment, has been intensively used for many years and allows to achieve a reduction in the dose of sulfonylurea drugs. According to the researchers, combination therapy with metformin and sulfonylurea drugs is as effective as combination therapy with insulin and sulfonylurea drugs.

Confirmation of observations that combination therapy with sulfonylurea and metformin has significant advantages over monotherapy contributed to the creation of the official form of the drug containing both components (Glibomet).

To achieve the main goals of the treatment of diabetes mellitus, it is necessary to change the previously established stereotype of the treatment of patients and switch to more aggressive tactics of therapy: the early start of combined treatment with oral hypoglycemic drugs, in some patients almost from the moment of diagnosis.

Simplicity, efficiency and relative cheapness explain the fact that secretogens successfully complement metformin. Combined drug Glucovans, containing metformin and micronized form of glibenclamide in one tablet, is the most promising representative of a new form of antidiabetic drugs. It turned out that the creation of Glucovans clearly improves not only patient compliance, but also reduces the total number and intensity of side effects with the same or better efficiency.

Advantages of Glucovans over Glibomet (Metformin 400 mg + Glibenclamide 2.5 mg): Metformin forms a soluble matrix in which particles of micronized glibenclamide are evenly distributed. This allows glibenclamide to act faster than the non-micronized form. The rapid achievement of the peak concentration of glibenclamide allows you to take Glucovans with meals, this, in turn, reduces the frequency of gastrointestinal effects that occur when taking Glibomet. The undoubted advantage of Glucovans is the presence of 2 dosages (metformin 500 + glibenclamide 2.5, metformin 500 + glibenclamide 5), which allows you to quickly select an effective treatment.

Addition of basal insulin (Monotard HM type) at an average dose of 0.2 units per 1 kg of body weight, it is recommended to start combination therapy as a single injection at night (22.00), usually the dose is increased by 2 units every 3 days until the target values ​​of glycemia of 3.9-7.2 mmol are achieved / l. In the case of a high initial level of glycemia, it is possible to increase the dose by 4 IU every 3 days.

Secondary resistance to sulfa drugs.

Despite the fact that tissue insulin resistance is the leading mechanism for the development of type 2 diabetes mellitus, insulin secretion in these patients also decreases over the years, and therefore the effectiveness of sulfonamide treatment decreases over time: in 5–10% of patients annually and in most patients after 12 -15 years of therapy. This loss of sensitivity is called secondary resistance to sulfonamides, as opposed to primary, when they are ineffective from the very beginning of treatment.

Resistance to sulfonamides is manifested by progressive weight loss, the development of fasting hyperglycemia, postalimentary hyperglycemia, an increase in glycosuria, and an increase in HbA1c levels.

With secondary resistance to sulfonamides, a combination of insulin (IPD) and sulfonamides is first prescribed. The likelihood of a positive effect of combination therapy is high when it is prescribed at the earliest stages of the development of secondary resistance, i.e. at a fasting glycemia level between 7.5–9 mmol/l.

It is possible to use pioglitazone (Aktos) - a drug that reduces insulin resistance, which makes it possible to reduce the dose of IPD and, in some cases, cancel it. Take actos 30 mg 1 time per day. It can be combined with both metformin and sulfonylurea preparations.

But the most common combination treatment regimen is that the previously prescribed sulfonamide treatment is supplemented with small doses (8-10 IU) of medium-acting drugs (for example, NPH or ready-made "mixes" - mixtures of short-acting and prolonged-acting drugs) 1-2 times a day. day (8.00, 21.00). The dose is increased in steps of 2-4 units every 2-4 days. In this case, the dose of sulfanilamide should be maximum.

Such treatment can be combined with a low-calorie diet (1000-1200 kcal / day) for diabetes in obese people.

If the regimen of a single injection of insulin is ineffective, it is administered 2 times a day, with glycemic control at critical points: on an empty stomach and at 17.00.

The usual dose of IPD is 10–20 IU/day. When the need for insulin is higher, this indicates complete resistance to sulfonamides, and then insulin monotherapy is prescribed, i.e. sulfonamide preparations are completely canceled.

The arsenal of hypoglycemic drugs used in the treatment of type 2 diabetes mellitus is quite large and continues to grow. In addition to sulfonylurea derivatives and biguanides, this includes secretogens, amino acid derivatives, insulin sensitizers (thiazolidinediones), α-glucosidase inhibitors (glucobay), and insulins.

Glycemic regulators for the treatment of type 2 diabetes

Based on the important role of amino acids in the process of insulin secretion by β-cells directly in the process of eating, scientists studied the hypoglycemic activity of phenylalanine analogues, benzoic acid, synthesized nateglinide and repaglinide (NovoNorm).

Novonorm is an oral fast-acting hypoglycemic drug. Rapidly lowers blood glucose levels by stimulating the release of insulin from functioning pancreatic β-cells. The mechanism of action is associated with the ability of the drug to close ATP-dependent channels in the membranes of β-cells by acting on specific receptors, which leads to cell depolarization and the opening of calcium channels. As a result, increased calcium influx induces insulin secretion by β-cells.

After taking the drug, an insulinotropic response to food intake is observed within 30 minutes, which leads to a decrease in blood glucose levels. In the periods between meals, there is no increase in insulin concentration. In patients with non-insulin dependent type 2 diabetes mellitus, when taking the drug in doses of 0.5 to 4 mg, a dose-dependent decrease in blood glucose levels is noted.

Insulin secretion, stimulated by nateglinide and repaglinide, is close to the physiological early phase of hormone secretion in healthy individuals after a meal, which leads to an effective decrease in postprandial glucose peaks. They have a quick and short-term effect on insulin secretion, thereby preventing a sharp increase in glycemia after a meal. When skipping meals, these drugs are not used.

Nateglinide (Starlix) is a derivative of phenylalanine. The drug restores early insulin secretion, which leads to a decrease in postprandial blood glucose concentration and the level of glycosylated hemoglobin (HbA1c).

Under the influence of nateglinide taken before meals, the early (or first) phase of insulin secretion is restored. The mechanism of this phenomenon lies in the rapid and reversible interaction of the drug with K + ATP-dependent channels of pancreatic β-cells.

The selectivity of nateglinide for K + ATP-dependent channels of pancreatic β-cells is 300 times higher than that for the channels of the heart and blood vessels.

Nateglinide, unlike other oral hypoglycemic agents, causes a pronounced secretion of insulin within the first 15 minutes after a meal, thereby smoothing out postprandial fluctuations ("peaks") in blood glucose concentration. In the next 3–4 hours, the insulin level returns to its original values. Thus, postprandial hyperinsulinemia, which can lead to delayed hypoglycemia, is avoided.

Starlix should be taken before meals. The time interval between taking the drug and eating should not exceed 30 minutes. When using Starlix as monotherapy, the recommended dose is 120 mg 3 times / day (before breakfast, lunch and dinner). If with this dosing regimen it is not possible to achieve the desired effect, a single dose can be increased to 180 mg.

Another prandial regulator of glycemia is acarbose (glucobay). Its action takes place in the upper part of the small intestine, where it reversibly blocks α-glucosidases (glucoamylase, sucrase, maltase) and prevents the enzymatic breakdown of poly- and oligosaccharides. This prevents the absorption of monosaccharides (glucose) and reduces the sharp rise in blood sugar after eating.

Inhibition of α-glucosidase by acarbose occurs according to the principle of competition for the active site of the enzyme located on the surface of the microvilli of the small intestine. Preventing the rise in glycemia after a meal, acarbose significantly reduces the level of insulin in the blood, which improves the quality of metabolic compensation. This is confirmed by a decrease in the level of glycated hemoglobin (HbA1c).

The use of acarbose as the sole oral antidiabetic agent is sufficient to significantly reduce metabolic disturbances in patients with type 2 diabetes mellitus that are not compensated by diet alone. In cases where such tactics do not lead to the desired results, the appointment of acarbose with sulfonylurea drugs (Glurenorm) leads to a significant improvement in metabolic parameters. This is especially important for elderly patients who are not always ready to switch to insulin therapy.

In patients with type 2 diabetes mellitus who received insulin therapy and acarbose, the daily insulin dose decreased by an average of 10 units, while in patients who received placebo, the insulin dose increased by 0.7 units.

The use of acarbose significantly reduces the dose of sulfonylureas. The advantage of acarbose is that it does not cause hypoglycemia when used alone.

Modern conditions dictate the need to create new drugs that allow not only to eliminate metabolic disorders, but also to maintain the functional activity of pancreatic cells, stimulating and activating the physiological mechanisms of regulation of insulin secretion and blood glucose. In recent years, it has been shown that the regulation of glucose levels in the body, in addition to insulin and glucagon, also involves the hormones incretins produced in the intestine in response to food intake. Up to 70% of postprandial insulin secretion in healthy individuals is due precisely to the effect of incretins.

Incretins in the treatment of type 2 diabetes mellitus

The main representatives of incretins are glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (G PP-1).

The entry of food into the digestive tract rapidly stimulates the release of GIP and GLP-1. Incretins can also lower glycemic levels through non-insulin mechanisms by slowing gastric emptying and reducing food intake. In type 2 diabetes, the content of incretins and their effect are reduced, and the level of glucose in the blood is increased.

The ability of GLP-1 to improve glycemic control is of interest in the treatment of type 2 diabetes mellitus (the emergence of a class of incretin mimetics). GLP-1 has multiple effects on the endocrine pancreas, but its principal action is to potentiate glucose-dependent insulin secretion.

Increased levels of intracellular cAMP stimulate GLP-1 receptors (rGLP-1), resulting in exocytosis of insulin granules from β-cells. An increase in cAMP levels thus serves as the primary mediator of GLP-1 induced insulin secretion. GLP-1 enhances insulin gene transcription, insulin biosynthesis, and promotes β-cell proliferation through rGLP-1 activation. GLP-1 also potentiates glucose-dependent insulin secretion via intracellular pathways. In the study by C. Orskov et al. GLP-1 has been shown in vivo to cause a decrease in glucagon secretion when acting on α-cells.

Improvement in glycemic indices after administration of GLP-1 may be the result of the restoration of normal β-cell function. An in vitro study indicates that glucose-resistant β-cells become glucose-competent after administration of GLP-1.

The term "glucose competence" is used to describe the functional state of β-cells that are sensitive to glucose and secrete insulin. GLP-1 has an additional hypoglycemic effect that is not associated with an effect on the pancreas and stomach. In the liver, GLP-1 inhibits glucose production and promotes glucose uptake by adipose and muscle tissue, but these effects are secondary to regulation of insulin and glucagon secretion.

An increase in the mass of β-cells and a decrease in their apoptosis is a valuable quality of GLP-1 and is of particular interest for the treatment of type 2 diabetes mellitus, since the main pathophysiological mechanism of this disease is precisely the progressive β-cell dysfunction. Incretinomimetics used in the treatment of type 2 diabetes include 2 classes of drugs: GLP-1 agonists (exenatide, liraglutide) and inhibitors of dipeptidyl peptidase-4 (DPP-4), which destroys GLP-1 (sitagliptin, vildagliptin).

Exenatide (Byetta) isolated from the saliva of the giant lizard Gila monster. The amino acid sequence of exenatide is 50% identical to human GLP-1. When exenatide is administered subcutaneously, its peak plasma concentration occurs after 2-3 hours, and the half-life is 2-6 hours. This allows exenatide therapy in the form of 2 subcutaneous injections per day before breakfast and dinner. Created, but not yet registered in Russia, long-acting exenatide - Exenatide LAR, administered once a week.

Liraglutide is a new drug, an analogue of the human GLP-1, which is 97% similar in structure to the human one. Liraglutide maintains a stable concentration of GLP-1 for 24 hours when administered once a day.

DPP-4 inhibitors for the treatment of type 2 diabetes

GLP-1 preparations developed to date do not have oral forms and require mandatory subcutaneous administration. This drawback is deprived of drugs from the group of DPP-4 inhibitors. By suppressing the action of this enzyme, DPP-4 inhibitors increase the level and lifespan of endogenous GIP and GLP-1, enhancing their physiological insulinotropic action. The drugs are available in tablet form and are prescribed, as a rule, once a day, which significantly increases the adherence of patients to the therapy. DPP-4 is a membrane-binding serine protease from the group of prolyl oligopeptidases, the main substrate for which are short peptides such as GIP and GLP-1. The enzymatic activity of DPP-4 on incretins, especially GLP-1, suggests the possibility of using DPP-4 inhibitors in the treatment of patients with type 2 diabetes mellitus.

The peculiarity of this approach to treatment is to increase the duration of action of endogenous incretins (GLP-1), i.e., the mobilization of the body's own reserves to combat hyperglycemia.

DPP-4 inhibitors include sitagliptin (Januvia) and vildagliptin (Galvus) recommended by the FDA (USA) and the European Union for the treatment of type 2 diabetes mellitus, both as monotherapy and in combination with metformin or thiazolidinediones.

The combination of DPP-4 inhibitors and metformin seems to be the most promising, which makes it possible to influence all the main pathogenetic mechanisms of type 2 diabetes mellitus - insulin resistance, secretory response of β-cells, and hyperproduction of glucose by the liver.

The drug GalvusMet was created (50 mg vildagliptin + metformin 500, 850 or 100 mg), which was registered in 2009.

Insulin therapy in type 2 diabetes mellitus.

Despite the definition of type 2 diabetes mellitus as "non-insulin dependent", a large number of patients with this type of diabetes eventually develop absolute insulin deficiency, requiring the administration of insulin (insulin-requiring diabetes mellitus).

Treatment with insulin as monotherapy is indicated primarily for primary resistance to sulfonamides, when treatment with diet and sulfonamides does not lead to optimal glycemia for 4 weeks, as well as for secondary resistance to sulfonamides against the background of depletion of endogenous insulin reserves, when it is necessary to compensate the exchange dose of insulin prescribed in combination with sulfonamides is high (more than 20 IU / day). The principles of insulin treatment for insulin-requiring diabetes mellitus and type 1 diabetes mellitus are almost the same.

According to the American Diabetes Association, after 15 years, most type 2 diabetics require insulin. However, a direct indication for monoinsulin therapy in type 2 diabetes mellitus is a progressive decrease in insulin secretion by pancreatic β-cells. Experience shows that approximately 40% of patients with type 2 diabetes require insulin therapy, but in fact this percentage is much lower, often due to patient opposition. In the remaining 60% of patients who are not indicated for monoinsulin therapy, unfortunately, treatment with sulfonylurea drugs also does not lead to compensation for diabetes mellitus.

Even if during daylight hours it is possible to reduce glycemia, then almost everyone has morning hyperglycemia, which is caused by nighttime production of glucose by the liver. The use of insulin in this group of patients leads to an increase in body weight, which exacerbates insulin resistance and increases the need for exogenous insulin, in addition, the inconvenience caused to the patient by frequent dosing of insulin and several injections per day should be taken into account. An excess of insulin in the body also causes concern for endocrinologists, because it is associated with the development and progression of atherosclerosis, arterial hypertension.

According to WHO experts, insulin therapy for type 2 diabetes should be started neither too early nor too late. There are at least 2 ways to limit insulin doses in patients not compensated by sulfonylurea drugs: the combination of a sulfonylurea drug with long-acting insulin (especially at night) and the combination of a sulfonylurea drug with metformin.

Combination treatment with sulfonylurea and insulin has significant advantages and is based on complementary mechanisms of action. High blood glucose has a toxic effect on β-cells, in connection with which the secretion of insulin is reduced, and the administration of insulin by lowering glycemia can restore the response of the pancreas to sulfonylurea. Insulin suppresses the formation of glucose in the liver at night, which leads to a decrease in fasting glycemia, and sulfonylurea causes an increase in insulin secretion after meals, controlling the level of glycemia during the day.

A number of studies have compared between 2 groups of type 2 diabetics, of which 1 group received only insulin therapy, and the other - combination therapy with insulin at night with a sulfonylurea. It turned out that after 3 and 6 months, the indicators of glycemia, glycated hemoglobin significantly decreased in both groups, but the average daily dose of insulin in the group of patients receiving combined treatment was 14 IU, and in the group of monoinsulin therapy - 57 IU per day.

The average daily dose of prolonged insulin at bedtime to suppress nocturnal hepatic glucose production is usually 0.16 units/kg/day. With this combination, there was an improvement in glycemia, a significant decrease in the daily dose of insulin and, accordingly, a decrease in insulinemia. Patients noted the convenience of such treatment and expressed a desire to more accurately comply with the prescribed regimen.

Monotherapy with insulin in type 2 diabetes mellitus, i.e., not combined with sulfonamides, is necessarily prescribed for severe metabolic decompensation that has developed during treatment with sulfonamides, as well as for the pain form of peripheral neuropathy, amyotrophy or diabetic foot, gangrene (ICD therapy only or "bolus-basal").

Each patient should strive to achieve a good compensation for diabetes from the first days of the disease, which is facilitated by their training in the “schools for the patient with diabetes”. And where such schools are not organized, patients should be provided with at least special educational materials and diabetic diaries. Self-management and effective treatment also involves providing all diabetic patients with portable means for rapid testing of glycemia, glucosuria and ketonuria at home, as well as glucagon ampoules to eliminate severe hypoglycemia (hypokit kit).

Type 2 diabetes is an insulin-independent disease. Nevertheless, today's realities are forcing people to become more and more interested in type 2 diabetes, symptoms and treatment, since about 90% of cases of diabetes fall on the second type.

This is an endocrine disease associated with a decrease in the body's susceptibility to insulin. As a result, the metabolism of carbohydrates is disturbed and the content of glucose in a person's blood increases.

The whole world suffers from this disease, so it is not for nothing that diabetes is recognized as an epidemic of the 21st century.

Causes of the disease and risk groups

Scientists still cannot determine the reason why human cells and tissues do not fully respond to insulin production. However, thanks to many studies, they were able to identify the main factors that increase the chances of developing the disease:

1. Hormonal imbalance during puberty associated with growth hormone.
2. Excess weight, which leads to an increase in blood sugar and the deposition of cholesterol on the walls of blood vessels, which causes the disease atherosclerosis.
3. The gender of the person. Studies have shown that women are more likely to develop type 2 diabetes.
4. Race. Type 2 diabetes has been shown to be 30% more common in blacks.
5. Heredity. If both parents have type 2 diabetes, then there is a 60-70% chance that their child will develop it. In twins, in 58-65% of cases, this disease develops simultaneously, in twins - in 16-30% of cases.
6. Violation of the functioning of the liver with cirrhosis, hemochromatosis, etc.
7. Violations of the beta cells of the pancreas.
8. Drug treatment with beta-blockers, atypical antipsychotics, glucocorticoids, thiazides, etc.
9. Childbearing period. During pregnancy, body tissues are more sensitive to insulin production. This condition is called gestational diabetes, after childbirth it goes away, in rare cases it turns into type 2 diabetes.
10. Bad habits - active and passive smoking, alcohol.
11. Wrong nutrition.
12. Inactive lifestyle.

People at risk for developing this disease include:

• with hereditary predisposition;
• obese;
• taking constantly glucocorticoids;
• with the development of cataracts;
• suffering from diseases - Itsenko-Cushing (tumor of the adrenal gland) and acromegaly (tumor of the pituitary gland);
• suffering from atherosclerosis, angina pectoris, hypertension;
• with allergic diseases, for example, eczema, neurodermatitis, etc.;
• with an increase in blood sugar, in connection with a heart attack, stroke, infections or pregnancy;

The risk group includes women who had a pathological pregnancy or a child weighing more than 4 kg at birth.

Type 2 diabetes symptoms

Sugar level

When type 2 diabetes develops, the symptoms and treatment are very similar to the symptoms and treatment of type 1 diabetes. Often the appearance of the first signs of type 2 diabetes occurs only after a few months, and sometimes after several years (latent form of the disease).

At first glance, the symptoms of type 2 diabetes are no different from those of type 1 diabetes. But still there is a difference. During a person's development of type 2 diabetes, the symptoms are:

1. Strong thirst, constant desire to relieve the need. The manifestation of such symptoms is associated with an increase in the load on the kidneys, which should rid the body of excess sugar. Since they do not have enough water for this process, they begin to take fluid from the tissues.
2. Fatigue, irritation, dizziness. Since glucose is an energy material, its deficiency leads to a lack of energy in the cells and tissues of the body. Dizziness is associated with the work of the brain, which suffers first with an insufficient amount of glucose in the blood.
3. Deterioration of vision, provoking the development of the disease - diabetic retinopathy. There are violations in the functioning of blood vessels in the eyeballs, therefore, if black spots and other defects appear in the picture, you should immediately consult a doctor.
4. Hunger, even when eating large amounts of food.
5. Dryness in the mouth.
6. Decrease in muscle mass.
7. Skin itching and rashes.

With a prolonged course of the disease, aggravation of symptoms is possible.

Patients may complain of symptoms of type 2 diabetes, such as yeast infections, pain and swelling of the legs, numbness of the extremities, and prolonged wound healing.

Possible complications in the development of the disease

Non-compliance with proper nutrition, bad habits, an inactive lifestyle, untimely diagnosis and therapy can cause various complications. The patient may experience such diseases and consequences in type 2 diabetes mellitus:

1. Diabetic (hypersmolar) coma requiring urgent hospitalization and resuscitation.
2. Hypoglycemia is a sharp decrease in blood glucose.
3. Polyneuropathy is a deterioration in the sensitivity of the legs and arms due to impaired functioning of nerve endings and blood vessels.
4. Retinopathy is a disease that affects the retina of the eye and leads to its detachment.
5. Frequent illness with influenza or SARS due to a decrease in the body's defenses.
6. Periodontal disease is a gum disease associated with disruption of blood vessels and carbohydrate metabolism.
7. The presence of trophic ulcers due to the long healing of wounds and scratches.
8. Erectile dysfunction in males, occurring 15 years earlier than in peers. The probability of its occurrence ranges from 20 to 85%.

Based on the foregoing, it becomes clear why type 2 diabetes should be detected as early as possible.

Diagnosing a disease

To check the presence or absence of type 2 diabetes, you need to take one of the tests several times - a glucose tolerance test or a plasma test on an empty stomach. A one-time delivery of the analysis may not always show the correct result. Sometimes a person can eat a lot of sweets or get nervous, so the sugar level will rise. But this has nothing to do with the development of the disease.

A glucose tolerance test measures how much glucose is in the blood. To do this, you need to drink water (300 ml), having previously dissolved sugar (75 g) in it. After 2 hours, an analysis is taken, if a result of more than 11.1 mmol / l is obtained, we can talk about diabetes mellitus.

A study on the content of glucose in plasma shows the development of hyper- and hypoglycemia. Tested on an empty stomach in the morning. Upon receipt of the results, the norm in an adult is considered to be a range of values ​​from 3.9 to 5.5 mmol / l, an intermediate state (prediabetes) - from 5.6 to 6.9 mmol / l, diabetes mellitus - from 7 mmol / l and more.

Many people with type 2 diabetes have a special device for measuring sugar content - a glucometer. Glucose levels should be determined at least three times a day (in the morning, one hour after meals and in the evening).

Please read the enclosed instructions carefully before using it.

Before taking medication, you need to improve your lifestyle.

The attending physician often prescribes a course of therapy, taking into account the individual characteristics of the patient.

A disease such as diabetes mellitus requires 4 mandatory points to be observed during treatment. These items are as follows:

1. Proper nutrition. For diabetics, the doctor prescribes a special diet. Often, it includes vegetables and fruits, foods containing fiber and complex carbohydrates. You will have to give up sweets, pastries, baked goods and red meat.
2. Combination of relaxation and exercise therapy. An active lifestyle is a panacea, in particular, for diabetes. You can do yoga, jogging in the morning or just go for a walk.
3. Taking antidiabetic drugs. Some patients can do without medication, following a special diet and an active lifestyle. Self-administration of the drug is prohibited, only the doctor can prescribe certain drugs, indicating the correct dosage.
4. Constant control of sugar levels, the patient will be able to prevent hypo- or hyperglycemia.

Only by observing these requirements, the use of medicines will be effective, and the patient's condition will improve.

Conducting drug therapy

In type 2 diabetes, most patients are interested in what drugs to take. In modern times, modern medicine has advanced in the treatment of diabetes. It should be borne in mind that self-medication is impossible. The doctor may prescribe:

• Drugs that increase insulin production - Diabeton, Amaryl, Tolbutamide, Novonorm, Glipizide. Mostly young and mature people normally tolerate these drugs, but the reviews of older people are not very positive. In some cases, the drug from this series can cause allergies and disruption of the adrenal glands.
• Means that reduces the absorption of glucose in the intestine. Each tablet of the drug from this series contains the active substance - metformin. These include Gliformin, Insufor, Formin Pliva, Diaformin. The action of the drugs is aimed at stabilizing the synthesis of sugar in the liver and increasing the sensitivity of tissues to insulin.
• Glycosidase inhibitors, which include. The drug affects the enzymes that contribute to the breakdown of complex carbohydrates to glucose, blocking them. As a result, the absorption of glucose is inhibited.
• Fenofibrate is a drug that activates alpha receptors to slow the progression of atherosclerosis. This drug strengthens the walls of blood vessels, improves blood circulation and prevents the occurrence of serious complications such as retinopathy and nephropathy.

Over time, the effectiveness of these drugs decreases. Therefore, the attending physician may prescribe insulin therapy.

Type 2 diabetes can lead to various complications, so insulin is prescribed to compensate for blood sugar.

Folk remedies for type 2 diabetes

Traditional medicine in the treatment of type 2 diabetes can be used in parallel with the main course of therapy.

It strengthens the patient's immunity and has no side effects.

The following folk recipes will help stabilize the sugar content:

1. An infusion of aspen bark is an effective remedy in the initial stage of diabetes. A tablespoon of bark is thrown into boiling water (0.5 l), boiled for about 15 minutes and cooled. This decoction should be taken 50 ml before meals three times a day.
2. A special "drink for diabetics", proven by many generations. For cooking, you will need dry blueberry leaves, bean leaves and burdock root, 15 mg each. Mix all the ingredients and pour boiling water over, leave for about 10 hours. The decoction is drunk three times a day for 0.5 cups. The course of therapy is 1 month, followed by a break for 2 weeks.
3. Cinnamon decoction is an excellent folk remedy for type 2 diabetes, improving cell sensitivity to insulin and eliminating inflammation in the body. To prepare the infusion, you need to pour boiling water over a teaspoon of cinnamon, leave for half an hour, then add 2 teaspoons of honey and mix thoroughly. The medicine should be divided into two doses - in the morning and evening. You can also use

Type 2 diabetes mellitus is the most common disease caused by endocrine disorders. It develops due to a decrease in the sensitivity of cell receptors to a hormone synthesized by the pancreas.

Pathology is not treatable and requires lifelong diet and intake of sugar-lowering drugs to maintain blood sugar levels within acceptable limits.

Classification of type 2 diabetes

There are several forms of sah. diabetes:

1. Latent- the state of prediabetes in people at risk of developing the disease. At this stage, clinical and laboratory signs of pathology are absent.
2. Hidden- slight changes in blood glucose levels are observed. Signs of diabetes do not appear, but the content of glucose in the blood plasma after eating decreases more slowly than normal.
3. Explicit- characteristic symptoms of diabetes mellitus are noted. Indicators of sugar in urine and blood exceed the permissible level.

The disease can occur with varying degrees of severity:

1. At grade 1, the characteristic signs of diabetes are not observed. Blood glucose is slightly elevated, there is no sugar in urine.
2. At grade 2, the manifestations of the disease are already becoming more noticeable. Sugar is detected in the urine, and blood glucose rises above 10 mmol / l.
3. The third degree of diabetes is the most severe. The levels of glucose in blood plasma and urine exceed critical figures, symptoms of the development of a hyperglycemic coma are observed. In this case, hypoglycemic drugs and insulin injections are needed.

Diabetes mellitus of any type is dangerous for its complications.

A high concentration of glucose in the blood plasma causes damage to the vascular system and internal organs, which leads to the development of such pathologies:

Causes of the disease

The pathogenesis of type 2 diabetes mellitus is a decrease in the sensitivity of cell receptors to insulin. The body does not experience a lack of the hormone, but the function of insulin is impaired, the cells simply do not recognize it and do not react. Thus, glucose cannot enter the tissues, and its concentration in the blood increases.

Unlike type 1 diabetes, type 2 disease develops in adults after 35 years of age, but is also incurable. Only in this case, there is no need for insulin therapy, but sugar-lowering drugs and a strict diet are required, so this type of diabetes is called insulin-independent.

The etiology of type 2 diabetes is not yet fully understood.

The risk group includes people who have the following factors:

• different degrees of obesity;
• hereditary predisposition;
• long-term use of certain medications (diuretics, hormonal agents, corticosteroids);
• infectious diseases;
• the period of bearing a child;
• liver pathology;
• endocrine disorders;
• abuse of sweets and foods high in fast carbohydrates;
• tendency to low-calorie diets;
• prolonged stressful situations;
• alcohol and nicotine addiction;
• hypertension;
• race and gender in women, pathology is diagnosed more often than in men, and in representatives of the Negroid race more often than in Europeans.

Symptoms of pathology

The disease develops for a long time without the manifestation of significant symptoms, which prevents diagnosing pathology in the initial stage of formation.

In the future, you can pay attention to the following signs:

Diagnostics

Diagnosis begins with the collection of data about the patient's life. The doctor is interested in the patient's complaints, past and concomitant pathologies, lifestyle and habits, as well as cases of diagnosed diabetes in close relatives. A visual examination of the patient is carried out, the degree of obesity is calculated and pressure is measured.

The next step will be to conduct diagnostic studies:

Treatment Methods

A mild degree of the disease allows maintaining acceptable glucose levels only by dietary nutrition and an increase in the patient's motor activity. In most cases, this is sufficient.

If it is not possible to achieve results or there is a significant increase in plasma sugar, then drug treatment is prescribed.

Preparations

Therapy begins with the use of a single drug, and then combined drug treatment is prescribed using several agents. In some cases, resort to insulin therapy.

In the treatment of diabetes, the most commonly used drugs are:

Changing the principles of nutrition

To achieve a result, patients need to give up the following products:

• dishes containing a large amount of salt, hot and spicy spices;
• smoked meats, fried and pickled foods;
• bakery products made from wheat flour, rich pastries and sweets;
• sausages and pasta from soft wheat varieties;
• fish, meat and dairy products with a high percentage of fat content;
• spicy and fatty sauces;
• white rice, semolina and animal fats;
• sweet soda, packaged juices, strong coffee.

Products that should form the basis of the diet:

• brown rice, pearl barley, buckwheat, durum wheat pasta;
• bread made from whole grain and rye flour;
• fresh herbs, vegetables and unsweetened fruits;
• low-fat dairy and sour-milk products;
• seafood, lean fish and meat products, turkey, chicken and rabbit meat;
• fruit decoctions and tea without added sugar;
• vegetable oil, nuts, legumes and eggs.

The following principles must be observed:

• dishes are mainly steamed, stewed and baked;
• replace sugar with natural sweeteners;
• there should be three main meals and two snacks per day;
• portions should be small - you should not overeat, but you should not feel hungry either;
• take a complex of vitamins;
• exclude alcoholic beverages;
• eat eggs and fruits no more than a couple of times a week;
• measure blood sugar levels before and after meals.

Dietary nutrition will have to be followed for the rest of your life. In combination with regular moderate physical activity, diet is an important point of maintenance therapy.

Thanks to proper nutrition, you can reduce weight, normalize blood pressure and prevent a significant increase in glucose concentration. This will keep the disease under control and prevent complications.

Video lecture on nutrition in DM 2:

Folk remedies

Infusions and decoctions of medicinal plants can help lower blood sugar, but traditional medicine methods can be used only after agreement with the doctor and in combination with the prescribed therapy and diet:

1. Peel 30 g of ginger, soak for an hour in cold water and grind on a grater. Pour into 250 ml of boiled water and stand for two hours. Filter and, diluted with tea, drink in the morning and evening.
2. Mix 0.5 tsp. bay leaf, turmeric and aloe juice. Let stand for an hour and eat 30 minutes before breakfast and dinner.
3. Pour 100 g of chopped dry Jerusalem artichoke into 4 glasses of water. Bring to a boil and then simmer for about an hour over low heat. Take 50 ml daily.
4. Throw 10 pieces of bay leaves into 1.5 cups of boiled water. Boil after boiling for 7 minutes and stand for five hours. Filter and divide into three doses. Everyone drink during the day. Make a rest for two weeks and repeat.
5. Grind buckwheat into flour and mix a tablespoon with 100 ml of kefir. Let stand overnight and drink in the morning. Repeat at night before bed.
6. Grind half a large lemon along with celery root or parsley. Darken for 10 minutes from the moment of boiling and eat before breakfast, lunch and dinner for a large spoon.

DM 2 in children

If earlier type 2 diabetes was a disease of the elderly, now the pathology is increasingly being diagnosed in childhood.

Parents should pay close attention to the well-being of the child and immediately consult a doctor if the following symptoms are noticed:

• frequent desire to drink and frequent trips to the toilet;
• sleep disturbance and moody mood;
• bouts of nausea;
• increased sweating;
• dental disease and visual impairment;
• sudden weight loss or weight gain;
• tingling and numbness in the limbs;
• the appearance of itching;
• general weakness and fatigue.

Causes of diabetes in childhood include:

• artificial feeding;
• eating disorders;
• genetic predisposition;
• low degree of physical activity;
• gestational diabetes in the mother during pregnancy;
• obesity;
• infectious and viral diseases.

Therapy of the disease in children is based on taking sugar-lowering drugs, increasing physical activity and changing the diet with the exception of high-carbohydrate foods and sweets.

From folk methods, you can try the following methods:

• 1 st. l. stir apple cider vinegar in 250 ml of water and let the child drink 50 ml in several doses;
• dissolve a quarter teaspoon of soda in 250 ml of warm milk and give to the child every day;
• squeeze juice from peeled nodules of Jerusalem artichoke and take 100 ml in the morning, afternoon and evening for 4 weeks.

Video from the famous pediatrician Komarovsky about diabetes in children:

Prevention

In most cases, the development of the disease can be prevented by adhering to a healthy lifestyle.

It is worth observing a number of principles:

• set aside time every day for long walks or sports;
• control your weight, preventing the appearance of extra pounds;
• adhere to proper nutrition, eating 5 times a day in small portions, limiting the intake of sugar and foods rich in fast carbohydrates;
• do not forget about clean water - drink at least 6 glasses every day;
• increase immunity by taking vitamin complexes;
• give up alcohol and nicotine addiction;
• do not self-medicate, taking medications only as directed by a doctor;
• once every 6 months to undergo a scheduled examination;
• if you notice any worrying symptoms, consult a doctor without delay.

Preventive measures that can prevent the development of diabetes do not require costs and do not cause difficulties. And as you know, the disease is easier to prevent than to cure. Therefore, you should take your health seriously and prevent the occurrence of a serious illness.