The first serious steps towards the creation of an internationally recognized classification of human diseases were made at the beginning of the twentieth century. It was then that the idea arose International classification diseases (abbreviated - ICD), which as of today already has ten revisions. ICD 10 diabetes mellitus codes belong to the fourth class of this classification and are included in blocks E10-E14.

Basic data

The first descriptions of diabetes mellitus that have come down to our time were compiled in the second century BC. But the doctors of that time had no idea about the mechanism of development, which was first identified back in ancient world diseases. The development of endocrinology made it possible to understand the mechanism of the formation of diabetes mellitus.

Modern medicine distinguishes two types of diabetes:

1. The first type is inherited. Hard to bear. It is insulin dependent.
2. Type 2 diabetes is acquired during life. In most cases, it develops after forty years. Most often, patients do not need insulin injections.

The division of diabetes into two types occurred in the 1930s. Today, each type has an owl designation in the MBK. Although the development of the eleventh revision of the ICD began in 2012, the classification of the tenth revision, adopted in 1989, is still in force.

All diseases associated with diabetes mellitus and its complications belong to the fourth class of ICD.

This is a list of diseases in blocks E10 to E14. Each type of disease and the complications it causes have their own codes.

According to MBK 10, the code of type 1 diabetes mellitus is E10. After the number ten and the dot, there is one more digit (four-digit codes). For example, E10.4. This code denotes insulin-dependent diabetes that has caused neurological complications. If after ten it is zero, this means that the disease is accompanied by a coma. Each type of complication has its own code, so it can be easily classified.

According to ICD 10, the code of the 2nd type of diabetes mellitus is E11. This code designates the non-insulin dependent form of diabetes acquired during life. As in the previous case, each complication is encoded with its own four-digit number. The modern ICD also provides for the assignment of a code to diseases without complications. So, if insulin-dependent diabetes does not cause complications, it is designated by the code E10.9. The number 9 after the dot indicates no complications.

Other forms included in the classifier

As mentioned earlier, today there are basically two main and most common types of diabetes.

But in 1985, this classification was supplemented by another type of disease common among the inhabitants of tropical countries.

This is diabetes mellitus caused by malnutrition. Most people with this disease are between the ages of ten and fifty. The factor that provokes the appearance of the disease is insufficient consumption of food at an early age (that is, in childhood). In the ICD, this type of disease was assigned the code E12. Like the previous types, depending on the complications, the code can be supplemented.

One of the most common complications among diabetics is diabetic foot syndrome. It can lead to the amputation of the affected limb. In most cases (about ninety percent of diagnosed patients), a similar problem occurs in type 2 diabetics. But it is also found among insulin-dependent people (that is, suffering from the first type of the disease).

Since this disease is associated with impaired peripheral circulation, it is entered into the ICD under this definition. The ICD 10 diabetic foot symptom code is designated by the fourth character "5". That is, this syndrome in the first type of disease is coded as E10.5, in the second - E11.5.

Thus, as of today, the ICD revision of the 1989 revision remains relevant. It includes all types of diabetes mellitus. It also includes complications caused by this disease. Such a classification system makes it possible to analyze and investigate diseases, having the ability to carry out their systematic registration.

Expert commentary:

How and what to treat trophic ulcers of the lower extremities in diabetics

Often in diabetes mellitus, the development of concomitant diseases is observed, which are caused by disorders in the body caused by hyperglycemia. If medical prescriptions are not followed, as well as in conditions of severe diabetes, ulcers can form, mainly on the legs. Diabetic or trophic ulcers are common. Treatment of trophic ulcer wounds on the leg at home with diabetes is almost impossible. The victim requires medical and surgical intervention.

Characteristic

A trophic ulcer involves deep damage to the epithelial layer of the skin and all underlying tissues. Often the disease is accompanied by inflammatory processes that develop as a result of the addition of a secondary infection.

Sores are weeping wounds characterized by a large hole diameter, a large area of ​​damage to the tissues surrounding the ulcer, there is constant bleeding and separation of pus with a characteristic odor.

The disease is coded according to ICD-10, it belongs to chronic skin ulcers, not elsewhere classified, and it is assigned the number L98.4.2.

The reasons for the appearance of a trophic ulcer include:

• diabetic neuropathy;
• diabetic angiopathy;
• mechanical damage to the corns;
• destruction of the walls of blood vessels;
• pathology of carbohydrate metabolism;
• tissue hypoxia, which has arisen against the background of diseases associated with impaired blood flow;
• the harmful effects of toxins formed as a result of the breakdown of drugs, the withdrawal of which did not occur due to the peculiarities of the course of diabetes.

Diabetes mellitus is a condition of the body in which there is a constant presence in the blood of a large amount of glucose, due to metabolic disorders. Glucose, when left unbound for a long time, begins to negatively affect nerve endings and blood cells. In the first case, neuropathy develops, in the second - angiopathy. Often, in the absence of proper diabetes treatment, both the first and the second appear at the same time. It is these pathological conditions that are the root causes of disorders that indirectly cause a trophic ulcer.

Wounds on the legs do not form immediately, they are preceded by the initial signs of impaired venous blood flow - heaviness in the legs, cyanosis, edema.

Then eczema, lymphostasis develops, the appearance of the skin of the limb changes and, with minor damage, an ulcer begins to form. First, it destroys the upper layers of the skin and grows in breadth, then the process of destruction of the underlying tissues starts.

Diabetic ulcers are characterized by the following features:

• do not heal on their own;
• when removed by medication or by surgery, deep scars and scars remain at the site of the wounds;
• coldness of the limbs at the initial stages of development due to the death of the nerve endings located in the lower limbs;
• pain that bothers the patient mainly at night;
• lead to gangrene, and then amputation of the limb in the absence of timely treatment.

Ulcers are divided into types depending on the size of the vessels (capillaries, veins, arteries), the degeneration of which was the cause of their occurrence.

Initially, the cause of a trophic ulcer is the patient's negligence towards his health and ignorance of the attending physician's prescriptions about a proper lifestyle and nutritional principles. Only long-term high blood sugar levels have this effect.

Treatment

Treatment of diabetic leg ulcers depends on the severity of the disease, but in most cases it is time consuming and laborious.

Therapeutic measures are carried out in 3 stages, which makes it possible to treat the disease not comprehensively, but sequentially, which is more effective in cases of deep tissue damage.

Initial stage

It is important to ensure that the aggravating factors are neutralized and the establishment of a favorable atmosphere for a positive treatment outcome.

• adhere to the principles of nutrition for diabetics, monitor blood sugar levels, prevent an increase in it;
• to provide the patient with peace and immobility (ulcers located on the soles of the feet are traumatized, as a result of which they heal more slowly);
• stabilize sugar levels with medication, if necessary;
• identify the cause of the disease and start neutralizing therapy;
• restore the activity of the circulatory system.

In addition, it is necessary to apply methods of local therapy:

• washing the wound with antiseptic agents;
• cleansing the wound from pus, blood, scab;
• imposition of wound surfaces;
• preventing dirt or foreign objects from entering the wound.

Second phase

After applying all the above measures, the patient's condition should be stabilized. This is expressed in subsiding pain, as well as in improving appearance wound - it no longer increases in size, the edges become smooth and pink, pus and ichor no longer stand out.

If this happened, then the therapy is my direction and focuses on the use of wound-healing drugs, drugs that contribute to the accelerated regeneration of the skin. It is important to continue to use anti-inflammatory and antiseptic drugs by mouth and topically. In addition, diet therapy must be followed exactly.

If signs of infection are observed, the edges of the wound become swollen, pronounced hyperemia of the skin around the ulcer appears, its size increases and itching and burning are added to the pain, this is a sign that trophic ulcers of the lower extremities appeared due to the addition of infection to the original wound.

At this stage, it is necessary to start taking antibiotics and drugs that stabilize and protect the intestinal microflora and mucous membranes (Linex). The drugs will help get rid of the infection, and if the cause is eliminated, the disease will begin to recede.

If necrotic processes have taken place, then surgical intervention is required. It is important to remove dead tissue in time to avoid the onset of gangrene, which, in turn, can lead to amputation.

The final stage and prevention

At the final stage, it is recommended to continue wound healing therapy, take vitamins and immunomodulators to strengthen the body's natural defenses against viral and bacteriological effects. Physiotherapy can be used to restore elasticity and a healthy color to the skin.

To prevent the disease, you need to follow simple tips:

• timely diagnose an increase in blood sugar and take measures to reduce its level;
• timely subject to the necessary therapy for varicose veins;
• limit active physical activity associated with prolonged static stress on the lower extremities;
• prevent hypothermia or overheating of the lower extremities, the temperature drop will provoke the onset of destructive processes in fragile vessels;
• prevent the formation of microtrauma or minor abrasions on the surface of the skin on the legs, due to the fact that they can become the first stage in the development of a trophic ulcer;
• use orthopedic shoes to ensure the normalization of blood flow in the lower extremities.

With severe hyperglycemia, it is extremely important to monitor your health and follow all the recommendations of an endocrinologist. Such a serious consequence as a trophic ulcer becomes a signal that the form of the course of the disease has become more complex and profound. The attending physician will also tell you how and how to treat a trophic ulcer in diabetes mellitus. Self-treatment of this disease is not allowed, due to the increased risk of developing gangrene. Folk remedies are not prohibited for use, but only in combination with drug therapy.

Diabetes mellitus is a serious disease that changes a person's entire life. And it is very important to recognize this disease in time in order to avoid the development of complications. The signs of diabetes mellitus, or rather their knowledge, will help us with this.

Most diabetics suffer from type 2 diabetes, when the pancreas produces too much insulin, and since the body develops resistance to it, the pancreas cannot produce as much insulin as is necessary to maintain normal levels. sugar in the blood.

And at this stage, the body gives the first signals that are important not to miss:

1 The amount of urination increases sharply, since the kidneys are not able to absorb a large amount of glucose and it is simply excreted in the urine.

2 Constant thirst. To remove excess glucose from urine, you need liquid, so you want to drink more and more.

3 Fatigue appears.

Insulin collects glucose, which the body uses for energy, but with low insulin, energy is not enough, so you get tired.

4 Constant hunger is another symptom. To obtain energy, the body requires carbohydrates, that is, sugar, and in diabetics, the body cannot process carbohydrates.

5 Blurred vision may appear, since excess blood glucose causes fluid to drain from the eyes, which changes their shape and prevents the lenses from focusing.

6 Extremely slow skin healing is characteristic of diabetics.

The fact is that blood filled with glucose is poor in oxygen, which can lead to nerve damage. This means cuts and scrapes are harder and longer to heal.

7 Poor circulation of oxygen in the blood also leads to the fact that a person begins to feel tingling and numbness in the hands and feet, and a burning sensation may occur.

8 High levels of insulin, caused by the body's resistance to its effects, can cause rapid cell reproduction, which leads to darkening of the skin. Typically, such darkening can be seen around the neck and underarms.

9 The body of diabetics has a reduced ability to fight infections, so patients are susceptible to de-sen diseases. Inflamed swollen gums are another unpleasant symptom.

10 Last but not least, diabetics are prone to persistent yeast infections, and their warm and moist skin is an ideal breeding ground for fungi.

The well-being and health of a person is directly related to the indicators of glucose in the body - glycemia. Blood sugar 15 can be considered a critical indicator, since an increase in the content of a substance over 10 units triggers irreversible processes, a malfunction of vital organs occurs, as a result of which a serious disease develops, the name of which is diabetes mellitus.

High glucose levels. Causes

Asking why the glucose level has risen, you should pay attention to the provoking factors:

• overeating, especially those foods that contain fast carbohydrates;
• prolonged stressful state and experiences;
• the consequences of previously transferred infectious diseases;
• hormonal disbalance.

Symptoms How does the disease proceed?

The main signs high content glycemia, over 8 mmol / liter, build up very quickly within a few days. The most common:

• frequent urination;
• intense and constant thirst, especially in the evening;
• weakness and fatigue;
• loss of body weight;
• nausea, vomiting, fever;
• headaches, dizziness;
• deterioration of vision.

In babies 1 year of age, it is not as easy to determine the signs of the disease without a blood test as in adults.

It is more difficult to detect signs of diabetes in a child under 1 year old than in adults and those children who are already 5 or more years old. Therefore, you should pay attention to the appearance of the slightest symptoms. If the readings have reached a mark over 8, but do not exceed a sugar level of 12, a mild degree of hyperglycemia is diagnosed. When the blood sugar is 13, the middle stage is determined. Severe degree, which can provoke irreversible consequences. This happens when the blood sugar is 20 mol / l.

How is the examination carried out?

Diagnosis is carried out by express method. A blood test is taken on an empty stomach using a finger glucometer device. In this case, the result is less accurate and is considered preliminary. In laboratory conditions, tests are passed using special equipment. A blood glucose meter is used at home to constantly monitor blood glucose levels. If the values ​​deviate from the norm, the analyzes should be repeated in the laboratory. Usually blood is taken from a vein. Doctors determine the diagnosis of diabetes mellitus if a repeated test result indicates an excess of the permissible norm.

Effects. Why is a sugar level of 10 or more dangerous?

The more pronounced the nature of diabetes, the more likely it is that complications may arise that are very difficult to treat:

With a diabetic coma, the patient's mouth may smell like acetone.

• Diabetic coma. The result of a spike in glucose levels. It is accompanied by a violation of the respiratory rhythm, the smell of acetone when breathing, frequent urination, which sometimes may be completely absent.
• Hypoglycemic coma. May result from a sharp drop in glucose. The condition is very dangerous, it occurs with alcohol abuse and drugs that lower sugar levels.
• Ketoacidosis It occurs as a result of the accumulation of substances in the blood that appear after metabolism. With this complication, the patient is characterized by loss of consciousness.
• Hyperosmolar coma. Reaction to high blood sugar 16, 17 and 18, which can occur due to a prolonged period of dehydration. In diabetics, the course of the complication is accompanied by a feeling of constant thirst.

The subcompensated form of the disease occurs when glycemia has a sugar level of 10 mmol / L in the blood and above. Already with a blood sugar of 11, you should immediately consult a doctor. The number 13 provokes, in which there is a risk of developing neurological and cardiovascular diseases. Distinguish between a mild form, when blood sugar is 12 mmol / l, medium and severe (a precomatose state occurs).

What to do to lower glucose? General principles

People with the first type of illness must regularly inject insulin to stabilize their condition.

Type 1 diabetes mellitus is life-threatening and requires constant intake of the hormone insulin, when administered, glucose is better absorbed at the cellular level. The drug must be taken throughout life from the moment of diagnosis. The second type of the disease does not oblige a person to live on insulin. The therapy is based on other methods:

• health food;
• optimal physical activity;
• folk remedies;
• taking medications.

Medication treatment

Preparations for a stable value of glycemia in the body are prescribed by the doctor, depending on the test results. At low rates, pills may be prescribed to lower blood sugar levels. There are two types of drugs used:

• Sulfonylurea preparations. When taken, the sugar level drops smoothly without sudden jumps throughout the day. These drugs include: "Gliclazid" and "Glibenclamide", which should be drunk 2 tablets per day.
• Insulins. A complex of sugar-containing medicines. Indications - insulin deficiency. The introduction is carried out subcutaneously with a syringe.

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Diabetes mellitus is one of the most common, with a tendency to an increase in the incidence and spoiling the statistics of diseases. Symptoms of diabetes do not appear in one day, the process proceeds chronically, with an increase and aggravation of endocrine-metabolic disorders. True, the onset of type I diabetes differs significantly from the early stage of the second.

Among all endocrine pathology, diabetes confidently holds the lead and accounts for more than 60% of all cases. In addition, disappointing statistics show that 1/10 of the "diabetics" are children.

The likelihood of acquiring the disease increases with age and, thus, the size of the group doubles every ten years. This is due to an increase in life expectancy, improved methods of early diagnosis, a decrease in physical activity and an increase in the number of people who are overweight.

Types of diabetes

Many have heard of a disease such as diabetes insipidus. In order for the reader not to confuse the diseases with the name "diabetes" later, it will probably be useful to explain their differences.

Diabetes insipidus

Diabetes insipidus is an endocrine disease that occurs as a result of neuroinfections, inflammatory diseases, tumors, intoxications and is caused by a deficiency and sometimes complete disappearance of ADH-vasopressin (antidiuretic hormone).

This explains the clinical picture of the disease:

• Constant dryness of the oral mucosa, incredible thirst (a person can drink up to 50 liters of water in 24 hours, stretching the stomach to a large size);
• Excretion of a huge amount of unconcentrated light urine with a low specific gravity (1000-1003);
• Catastrophic weight loss, weakness, decreased physical activity, disorders of the digestive system;
• A characteristic change in the skin ("parchment" skin);
• Atrophy of muscle fibers, muscle weakness;
• Development of dehydration syndrome in the absence of fluid intake for more than 4 hours.

The disease in terms of complete cure has an unfavorable prognosis, performance is significantly reduced.

Brief Anatomy and Physiology

Unpaired organ - the pancreas performs a mixed secretory function. Its exogenous part carries out external secretion, producing enzymes involved in the digestion process. The endocrine part, which is entrusted with the mission of internal secretion, is engaged in the production of various hormones, including - insulin and glucagon. They are key in ensuring the consistency of sugar in the human body.

The endocrine gland is represented by the islets of Langerhans, consisting of:

1. A-cells, which occupy a quarter of the entire space of the islets and are considered the site of glucagon production;
2. B cells, which occupy up to 60% of the cell population, synthesize and accumulate insulin, the molecule of which is a two-chain polypeptide carrying 51 amino acids in a specific sequence. The sequence of amino acid residues for each representative of the fauna is different, however, with regard to the structural structure of insulins, pigs are the closest to humans, which is why their pancreas is primarily used for the production of insulin on an industrial scale;
3. D cells producing somatostatin;
4. Cells that produce other polypeptides.

Thus, the conclusion suggests itself: damage to the pancreas and islets of Langerhans, in particular, is the main mechanism that inhibits the production of insulin and triggers the development of the pathological process.

Types and special forms of the disease

Lack of insulin leads to a violation of the constancy of sugar (3.3 - 5.5 mmol / l) and contributes to the formation of a heterogeneous disease called diabetes mellitus (DM):

• The complete absence of insulin (absolute deficiency) forms insulin dependent pathological process, which is attributed to type I diabetes mellitus (IDDM);
• Lack of insulin (relative deficiency), triggering in the initial stage a violation of carbohydrate metabolism, slowly but surely leads to the development insulin-independent diabetes mellitus (NIDDM), which is called type II diabetes mellitus.

Due to the violation in the body of glucose utilization, and, consequently, its increase in the blood serum (hyperglycemia), which, in principle, is a manifestation of the disease, signs of diabetes mellitus begin to appear over time, that is, a total disorder of metabolic processes at all levels. Significant changes in the hormonal-metabolic interaction ultimately involve all functional systems of the human body in the pathological process, which once again indicates the systemic nature of the disease. How quickly the disease will develop depends on the degree of insulin deficiency, which as a result determines the types of diabetes.

In addition to diabetes of the first and second types, there are special types of this disease:

1. Secondary diabetes resulting from acute and chronic inflammation of the pancreas (pancreatitis), malignant neoplasms in the parenchyma of the gland, cirrhosis of the liver. A number of endocrine disorders accompanied by excessive production of insulin antagonists (acromegaly, Cushing's disease, pheochromocytoma, thyroid disease) lead to the development of secondary diabetes mellitus. Many medications, used for a long time: diuretics, some antihypertensive drugs and hormones, oral contraceptives, etc.;
2. Diabetes in pregnant women (gestational), due to a kind of mutual influence of the hormones of the mother, child and placenta. The fetal pancreas, which produces its own insulin, begins to inhibit the production of insulin by the maternal gland, as a result of which this special form... However, with proper management, gestational diabetes usually resolves after delivery. Subsequently, in some cases (up to 40%) in women with a similar pregnancy history, given fact may threaten the development of type II diabetes mellitus (within 6-8 years).

Why does "sweet" disease occur?

"Sweet" disease forms a rather "motley" group of patients, so it becomes obvious that IDDM and its non-insulin dependent "brother" genetically occurred differently. There is evidence that insulin-dependent diabetes is associated with the genetic structures of the HLA (major histocompatibility complex) system, in particular, with some genes of the D-region loci. For INZSD, such a relationship was not noticed.

For the development of type I diabetes mellitus, one genetic predisposition is not enough, the pathogenetic mechanism is triggered by provoking factors:

• Congenital inferiority of the islets of Langerhans;
• Unfavorable influence of the external environment;
• Stress, nervous stress;
• Traumatic brain injury;
• Pregnancy;
• Infectious processes of viral origin (flu, "mumps", cytomegalovirus infection, Coxsackie);
• The tendency to constantly overeat, leading to excess body fat;
• Abuse of confectionery (those with a sweet tooth are at greater risk).

Before elucidating the causes of type II diabetes mellitus, it would be advisable to dwell on a very controversial issue: who suffers more often - men or women?

It has been established that at present the disease in the territory Russian Federation more often formed in women, although in the 19th century, diabetes was a “privilege” of the male sex. By the way, now in some countries of Southeast Asia the presence of this disease in men is considered predominant.

The predisposing conditions for the development of type II diabetes mellitus include:

• Changes in the structural structure of the pancreas as a result of inflammatory processes, as well as the appearance of cysts, tumors, hemorrhages;
• Age after 40 years;
• Being overweight (the biggest risk factor for NIDDM!)
• Vascular diseases caused by atherosclerotic process and arterial hypertension;
• In women, pregnancy and childbirth with a high body weight (over 4 kg);
• The presence of relatives with diabetes;
• Strong psycho-emotional stress (hyperstimulation of the adrenal glands).

The causes of the onset of the disease of different types of diabetes in some cases coincide (stress, obesity, the influence of external factors), but the beginning of the process in diabetes of the first and second types is different, moreover, IDDM is the lot of children and young people, and the non-insulin dependent prefers older people.

Why is it so thirsty?

The characteristic symptoms of diabetes mellitus, regardless of the form and type, can be presented as follows:

Thus, the general signs of diabetes can be characteristic of any form of the disease, however, in order not to confuse the reader, it is nevertheless necessary to note the features inherent in this or that type.

Type I diabetes mellitus - the "privilege" of young people

IDDM is characterized by an acute (weeks or months) onset. Signs of type I diabetes mellitus are pronounced and are manifested by clinical symptoms typical of this disease:

• A sharp drop in weight;
• Unnatural thirst, a person simply cannot get drunk, although he tries to do it (polydipsia);
• A large amount of urine excreted (polyuria);
• A significant excess of the concentration of glucose and ketone bodies in the blood serum (ketoacidosis). In the initial stage, when the patient may not yet know about his problems, it is likely that a diabetic (ketoacidotic, hyperglycemic) coma will develop - a condition that is extremely life-threatening, therefore insulin therapy is prescribed as early as possible (as soon as diabetes is suspected).

In most cases, after the use of insulin, metabolic processes are compensated, the body's need for insulin drops sharply, and a temporary "recovery" occurs. However, this short-term state of remission should not relax either the patient or the doctor, since after a certain period of time the disease will again remind of itself. The need for insulin may increase as the duration of the illness increases, but, in general, in the absence of ketoacidosis, it will not exceed 0.8-1.0 U / kg.

Signs indicating the development of late complications of diabetes (retinopathy, nephropathy) may appear in 5-10 years. The main causes of death from IDDM include:

1. Terminal renal failure, which is a consequence of diabetic glomerulosclerosis;
2. Cardiovascular disorders, as complications of the underlying disease, which occur somewhat less frequently than renal.

Disease or age-related changes? (type II diabetes)

INZSD develops over many months and even years. Arising problems, the person brings to various specialists (dermatologist, gynecologist, neurologist ...). The patient does not even suspect that diseases are different in his opinion: furunculosis, itching, fungal lesions, pain in the lower extremities - signs of type II diabetes mellitus. Often, INZSD is detected by pure chance (annual medical examination) or due to disorders that the patients themselves attribute to age-related changes: “vision has fallen”, “something is wrong with the kidneys”, “legs do not obey at all”…. Patients get used to their condition, and diabetes mellitus continues to slowly develop, affecting all systems, and first of all - blood vessels, until the person "falls" from a stroke or heart attack.

NIDDM is characterized by a stable, slow course, as a rule, without showing a tendency to ketoacidosis.

Treatment for type 2 diabetes usually begins with a diet that restricts digestible (refined) carbohydrates and uses (if necessary) sugar-lowering drugs. Insulin is prescribed if the development of the disease has reached the stage of severe complications or there is an immunity to oral medications.

The main cause of death in patients with NIDDM is considered to be cardiovascular pathology resulting from diabetes. As a rule, this is or.

Video: 3 early signs of diabetes

Diabetes mellitus treatment

The basis of treatment measures aimed at compensating for diabetes mellitus is represented by three main principles:

• Compensation for the lack of insulin;
• Regulation of endocrine metabolic disorders;
• Prevention of diabetes mellitus, its complications and their timely treatment.

The implementation of these principles is carried out on the basis of 5 main positions:

1. Diabetes mellitus nutrition is assigned to the “first violin” part;
2. An adequate and individually tailored exercise system follows the diet;
3. Sugar-lowering drugs are mainly used to treat type 2 diabetes;
4. Insulin therapy is prescribed as needed for NIDDM, but is the primary therapy for type 1 diabetes;
5. Patient education for self-monitoring (finger drawing skills, glucometer use, unaided insulin administration).

The laboratory control over these positions indicates the degree of compensation after carrying out the following:

Indicators	Good compensation	Satisfactory	Bad
Fasting glucose (mmol / L)	4,4 – 6,1	6,2 – 7,8	Ø 7.8
Serum sugar content 2 hours after a meal (mmol / L)	5,5 – 8,0	8,1-10,0	Ø 10.0
Percentage of glycated hemoglobin (HbA1,%)		8,0 – 9,5	Ø 10.0
Serum total cholesterol (mmol / L)		5,2 – 6,5	Ø 6.5
Triglyceride level (mmol / L)		1,7 – 2,2	Ø 2.2

The important role of diet in treating NIDDM

Nutrition for diabetes mellitus is a very well-known, even people far from diabetes mellitus, table number 9. Being in the hospital for any disease, every now and then you can hear about special nutrition, which is always in separate saucepans, differs from other diets and is issued after a certain password has been uttered: "I have the ninth table." What does all this mean? How is this mysterious diet different from all the others?

One should not be mistaken, looking after a diabetic who is taking away his "porridge", that they are deprived of all the joys of life. The diet for diabetes is not so different from the diet of healthy people, patients get the right amount of carbohydrates (60%), fats (24%), proteins (16%).

Nutrition for diabetes mellitus consists in replacing refined sugars in foods with slowly digestible carbohydrates. Shop-for-all sugar and sugar-based confectionery are considered prohibited foods. Meanwhile, the distribution network, in addition to diabetic bread, which we often stumble upon when choosing bakery products, provides such people with sweeteners (fructose), sweets, cookies, waffles and many other sweets that contribute to the production of "happiness hormones" (endorphins).

As for the nutritional balance, everything is strict here: a diabetic must necessarily consume the required amount of vitamins and pectins, which must be at least 40 grams. per day.

Video: a doctor about diabetes nutrition

Strictly individual physical activity

Physical activity for each patient is selected individually by the attending physician, taking into account the following positions:

• Age;
• Diabetes symptoms;
• The severity of the pathological process;
• The presence or absence of complications.

The physical activity prescribed by the doctor and performed by the "ward" should promote the "burning" of carbohydrates and fats, without involving insulin. Its dose, which is necessary to compensate for metabolic disturbances, falls noticeably, which should not be forgotten, because, while preventing an increase, you can get an undesirable effect. Adequate physical activity lowers glucose, the injected dose of insulin breaks down the remaining one, and as a result, the sugar level drops below acceptable values(hypoglycemia).

Thus, the dosage of insulin and physical activity requires very close attention and careful calculation, to complement each other, together not to step over the lower limit of normal laboratory parameters.

Video: a complex of gymnastics for diabetes

Or try folk remedies?

Treatment of type 2 diabetes mellitus is often accompanied by the patient's search for folk remedies that can slow down the process and delay the time of taking dosage forms as far as possible. You can understand a person, because no one wants to feel inferior, dooming themselves to dependence on pills or (even worse) from constant injections of insulin.

Despite the fact that our distant ancestors practically did not know about such a disease, folk remedies for the treatment of diabetes mellitus exist, but we should not forget that infusions and decoctions made from various plants are an auxiliary agent. The use of home diabetes medications does not relieve the patient of dieting, blood sugar control, visiting a doctor, and following all of his recommendations.

To combat this pathology at home, fairly well-known folk remedies are used:

1. White mulberry bark and leaves;
2. Oat grains and husks;
3. Walnut partitions;
4. Bay leaf;
5. Cinnamon;
6. Acorns;
7. Nettle;
8. Dandelion.

When diet and folk remedies no longer help ...

The so-called first generation drugs, widely known at the end of the last century (bukarban, oranil, butamide, etc.), remained in memories, and they were replaced by new generation drugs (dionyl, maninil, minidiab, glurenorm), which make up 3 main groups diabetes medications produced by the pharmaceutical industry.

What remedy is suitable for this or that patient - the endocrinologist decides, because representatives of each group, in addition to the main indication - diabetes mellitus, have a lot of contraindications and side effects... And so that patients do not self-medicate and do not decide to use these drugs for diabetes at their own discretion, we will give several illustrative examples.

Sulfonylurea derivatives

Currently, second-generation sulfonylurea derivatives are prescribed, acting from 10 hours to a day. Usually, patients take them 2 times a day, half an hour before meals.

These drugs are absolutely contraindicated in the following cases:

In addition, the use of drugs in this group may threaten the development of allergic reactions, manifested by:

1. Itchy skin and urticaria, sometimes reaching Quincke's edema;
2. Disorders of the digestive system;
3. Changes in the blood (a decrease in the level of platelets and leukocytes);
4. Possible impairment of the functional abilities of the liver (jaundice due to cholestasis).

The biguanide family of sugar-lowering agents

Biguanides (guanidine derivatives) are actively used to treat type 2 diabetes mellitus, often adding sulfonamides to them. They are very rational for use by obese patients, however, for persons with liver, kidney and cardiovascular pathology, their purpose is sharply limited, switching to more sparing drugs of the same group such as metformin BMS or α-glucoside inhibitors (glucobay), which inhibit absorption carbohydrates in the small intestine.

The use of guanidine derivatives is very limited in other cases, which is associated with some of their "harmful" abilities (accumulation of lactate in tissues, leading to lactic acidosis).

Absolute contraindications to the use of biguanines are:

• IDDM (type 1 diabetes mellitus);
• Significant weight loss;
• Infectious processes, regardless of localization;
• Surgical interventions;
• Pregnancy, childbirth, lactation period;
• Coma;
• Hepatic and renal pathology;
• Oxygen starvation;
• (2-4 degrees) with impaired vision and renal function;
• and necrotic processes;
• Violation of blood circulation in the lower extremities due to various vascular pathologies.

Insulin treatment

From the above, it becomes obvious that the use of insulin is the main treatment for type 1 diabetes, all emergency conditions and severe complications of diabetes mellitus. NIDDM requires the appointment of this therapy only in cases of insulin-requiring forms, when correction by other means does not give the desired effect.

Modern insulins, called monocompetent insulins, are of two groups:

1. Monocompetent pharmacological forms human insulin substance (semi-synthetic or DNA-recombinant), which undoubtedly have a significant advantage over porcine preparations. They practically have no contraindications and side effects;
2. Monocompetent insulins derived from porcine pancreas. These drugs, compared to human insulins, require an increase in the dose of the drug by about 15%.

Diabetes is dangerous with complications

Due to the fact that diabetes is accompanied by damage to many organs and tissues, its manifestations can be found in almost all body systems. Complications of diabetes mellitus are:

Prophylaxis

Measures for the prevention of diabetes mellitus are based on the causes of it. In this case, it is advisable to talk about the prevention of atherosclerosis, including the fight against excess weight, bad habits and food addictions.

Prevention of complications of diabetes mellitus is to prevent the development of pathological conditions arising from diabetes itself. Correction of glucose in blood serum, adherence to a diet, adequate physical activity, following a doctor's recommendation will help to postpone the consequences of this rather formidable disease.

Video: TV program about diabetes

Video: lecture on diabetes

Complications of diabetes mellitus include vascular lesions, nervous system, urinary system, development of coma, etc.
The following symptoms will allow you to suspect vascular damage in diabetes:
- Visual impairment.
- Formation of ulcers on the lower extremities.
- High blood pressure.
- Pain in the legs when walking.
- Chest pain and other symptoms.
A dangerous complication that occurs in diabetes mellitus is vascular damage. Diabetic angiopathy occurs in the form of macro- and microvascular disorders. Microvascular complications include retinopathy, nephropathy and angiopathy of the lower extremities of diabetic origin. Macrovascular complications - aortitis, arteriosclerosis of coronary, cerebral vessels, atherosclerosis of peripheral vessels.
Diabetic retinopathy is a lesion of the retinal vessels, characteristic of both insulin-dependent and non-insulin-dependent diabetes. Diabetic retinopathy can manifest itself not only with blurred vision, but also with retinal and vitreous hemorrhages.
Damage to the retinal vessels in diabetes mellitus can occur in 2 forms - background or proliferative retinopathy. For background retinopathy, small hemorrhages are characteristic, metabolic products are deposited in the retina, and retinal edema develops. Background retinopathy develops more often in old age and leads to a sluggish decrease in vision.
Proliferative retinopathy develops due to a violation of the blood supply to the retina. Retinal detachment is common. It is observed mainly at a young age.
It was found that at the time of diagnosis of type 2 diabetes mellitus, 21% of patients already suffer from retinopathy. The diagnosis of diabetic retinopathy is made on the basis of examination of the fundus of the ophthalmologist, assessment of the visual fields, intraocular pressure, scanning of the internal structures of the eye.
Diabetic neuropathy is damage to various parts of the nervous system against the background of diabetes mellitus. There is a classification into symmetric generalized polyneuropathy and focal (polyfocal) mononeuropathy. Further progression of diabetic neuropathy leads to the development of trophic ulcers and the formation of a "diabetic foot". The presence of diabetic neuropathy can be suspected with pain in the legs of a burning nature, especially at night, discomfort (paresthesia), decreased pain, temperature and tactile sensitivity. The skin becomes dry, the temperature of the affected part of the body decreases or rises. This type of neuropathy develops most often in type 2 diabetes mellitus, in elderly patients. Central diabetic neuropathy includes the development of encephalopathy and myelopathy.
An equally common complication of diabetes mellitus is kidney damage - diabetic nephropathy. The mechanism of development of diabetic nephropathy is associated with damage to the renal vessels. In conditions of hyperglycemia and hypertension, the kidneys lose the ability to perform their physiological functions - filtration and concentration of urine. This is the most common cause of disability and mortality among the contingent of patients with diabetes mellitus. Diabetic nephropathy develops in 5 stages:
1. At the onset of the disease, the stage of renal hyperfunction. An increase in glomerular filtration rate is observed, renal blood flow increases, renal parenchyma is hypertrophied. No protein is detected in the urine.
2. After 2-5 years from the onset of the disease, the initial structural changes in the renal tissue occur. The second stage is characterized by a thickening of the basement membrane, expansion of the mesangium, the level of protein in the urine is still not hung.
3. The third stage is formed in 5-15 years, an increase in blood pressure and microalbuminuria are detected.
4. Severe nephropathy (stage 4) develops in 10-25 years, pronounced proteinuria is found, the glomerular filtration rate is moderately reduced.
5. Uremia develops 5-7 years after the onset of proteinuria. The glomerular filtration rate is less than 10 ml / min, symptoms of intoxication and arterial hypertension are expressed.
Diabetic nephropathy is dangerous because it may not show any clinical signs until the terminal stage. For the timely diagnosis of this complication, it is necessary to pass a urinalysis in a timely manner, where the main role is played by the detection of albuminuria, the determination of the level of urea and creatinine. It has been established that 20% of diabetic patients develop diabetic nephropathy (Kimmelstil-Wilson syndrome) within 20 years. In 50% of patients, the course of the disease is complicated by chronic renal failure.
Diabetic foot is a diabetes mellitus syndrome caused by angio- and neuropathic mechanisms. The first stage of development of a diabetic foot includes superficial ulcers on the plantar surface of the foot, with callosities, under which the ulcerative surface is opened.
A deep ulcerative defect with the addition of an infection, which does not reach the bone tissue, develops with the 2nd degree of development of a diabetic foot. Further progression with bone involvement, the development of osteomyelitis leads to grade 3. Then limited gangrene develops (grade 4), and extensive gangrene (grade 5 diabetic foot).
Diabetic foot syndrome manifests itself in a neuropathic or ischemic form. The neuropathic variant is characterized by a pink color of the skin, a sharply reduced pulsation, the presence of cracks, painless ulcers, calluses, with the development of gangrene of the fingers and Charcot's joints. Hyperkeratosis of nails and neuropathic edema of the foot join.
The ischemic form is accompanied by pallor of the skin of the foot, the integument is cold to the touch, and there is also no pulsation. Painful ulcers and gangrene of the fingers occur.