Type 2 diabetes is a chronic endocrine disease that develops due to insulin resistance and dysfunction of beta cells of the pancreas, characterized by a state of hyperglycemia. It is manifested by copious urination (polyuria), increased thirst (polydipsia), itching of the skin and mucous membranes, increased appetite, hot flashes, muscle weakness. The diagnosis is established based on the results of laboratory tests. A blood test is performed for glucose concentration, the level of glycosylated hemoglobin, and a glucose tolerance test. Hypoglycemic drugs, a low-carb diet, and increased physical activity are used in the treatment.
ICD 10
E11 Insulin-dependent diabetes mellitus
Meaning
The word “diabetes” is translated from Greek as “to expire, to flow out”, in fact, the name of the disease means “sugar expiration”, “sugar loss”, which determines the key symptom – increased excretion of glucose in the urine. Type 2 diabetes mellitus, or insulin-independent diabetes mellitus, develops against the background of increased resistance of tissues to the action of insulin and a subsequent decrease in the functions of the cells of the islets of Langerhans. Unlike type 1 diabetes, in which the lack of insulin is primary, in type 2 of the disease, hormone deficiency is the result of prolonged insulin resistance. Epidemiological data are very heterogeneous, depending on ethnic characteristics, socio-economic conditions of life. In the USA, the estimated prevalence is 7%, which is 85-90% of all forms of diabetes. The incidence is high among people over 40-45 years old.
Causes
The development of the disease is provoked by a combination of hereditary predisposition and factors affecting the body throughout life. By adulthood, adverse exogenous effects reduce the sensitivity of the body’s cells to insulin, as a result of which they cease to receive sufficient amounts of glucose. The causes of type II diabetes can be:
- Obesity. Adipose tissue reduces the ability of cells to use insulin. Overweight is a key risk factor for the development of the disease, obesity is determined in 80-90% of patients.
- Physical inactivity. Lack of motor activity negatively affects the work of most organs and contributes to slowing down metabolic processes in cells. A hypodynamic lifestyle is accompanied by low glucose consumption by muscles and its accumulation in the blood.
- Improper nutrition. The main cause of obesity in people with diabetes is overeating – excessive calorie intake. Another negative factor is the use of a large amount of refined sugar, which quickly enters the bloodstream, provoking “jumps” in insulin secretion.
- Endocrine diseases. The manifestation of DM can be triggered by endocrine pathologies. There are cases of morbidity against the background of pancreatitis, pancreatic tumors, pituitary insufficiency, hypo- or hyperfunction of the thyroid gland or adrenal glands.
- Infectious diseases. In people with hereditary burden, the primary manifestation of DM is registered as a complication of a viral disease. The most dangerous are influenza, herpes and hepatitis.
Pathogenesis
Type 2 diabetes mellitus is based on a violation of carbohydrate metabolism due to increased cell resistance to insulin (insulin resistance). The ability of tissues to accept and utilize glucose decreases, a state of hyperglycemia develops – an elevated plasma sugar level, alternative ways of obtaining energy from free fatty acids and amino acids are activated. To compensate for hyperglycemia, the body intensively removes excess glucose through the kidneys. Its amount in the urine increases, glucosuria develops. A high concentration of sugar in biological fluids causes an increase in osmotic pressure, which provokes polyuria – copious frequent urination with loss of fluid and salts, leading to dehydration and water-electrolyte imbalance. These mechanisms explain most of the symptoms of diabetes – severe thirst, dry skin, weakness, arrhythmias.
Hyperglycemia alters the processes of peptide and lipid metabolism. Sugar residues attach to protein and fat molecules, disrupting their functions, there is hyperproduction of glucagon in the pancreas, the breakdown of fats as an energy source is activated, glucose reabsorption by the kidneys increases, the transmission in the nervous system is disrupted, intestinal tissues become inflamed. Thus, the pathogenetic mechanisms of DM provoke vascular pathologies (angiopathy), nervous system (neuropathy), digestive system, endocrine glands. A later pathogenetic mechanism is insulin insufficiency. It is formed gradually, over several years, due to depletion and natural programmed death of β-cells. Over time, moderate insulin deficiency is replaced by severe. Secondary insulin dependence develops, patients are prescribed insulin therapy.
Classification
Depending on the severity of carbohydrate metabolism disorders in diabetes mellitus, there is a compensation phase (a state of normoglycemia has been achieved), a subcompensation phase (with a periodic increase in blood glucose levels) and a decompensation phase (hyperglycemia is stable, difficult to correct). Taking into account the severity , there are three forms of the disease:
- Easy. Compensation is achieved by adjusting the diet or diet in combination with a minimum dosage of a hypoglycemic drug. The risk of complications is low.
- Medium. To compensate for metabolic disorders, regular intake of hypoglycemic agents is necessary. The probability of the initial stages of vascular complications is high.
- Heavy. Patients need constant use of tablet hypoglycemic drugs and insulin, sometimes only in insulin therapy. Serious diabetic complications are formed – angiopathy of small and large vessels, neuropathy, encephalopathy.
Symptoms of type 2 diabetes
The disease develops slowly, at the initial stage the manifestations are barely noticeable, this significantly complicates the diagnosis. The first symptom is an increase in the feeling of thirst. Patients feel dry mouth, drink up to 3-5 liters a day. Accordingly, the amount of urine and the frequency of urge to empty the bladder increases. Children may develop enuresis, especially at night. Due to frequent urination and high sugar content in the excreted urine, the skin of the inguinal region is irritated, itching occurs, redness appears. Gradually, itching covers the abdomen, armpits, elbows and knees. Insufficient glucose intake to the tissues contributes to an increase in appetite, patients experience hunger already 1-2 hours after eating. Despite the increase in the caloric content of the diet, the weight remains the same or decreases, since glucose is not absorbed, but is lost with the excreted urine.
Additional symptoms are rapid fatigue, constant feeling of fatigue, daytime drowsiness, weakness. The skin becomes dry, thinning, prone to rashes, fungal lesions. Bruises easily appear on the body. Wounds and abrasions heal for a long time, often become infected. Girls and women develop candidiasis of the genitals, boys and men develop urinary tract infections. Most patients report a tingling sensation in the fingers, numbness of the feet. After eating, a feeling of nausea and even vomiting may occur. Blood pressure is elevated, headaches and dizziness are not uncommon.
Complications
The decompensated course of type 2 diabetes is accompanied by the development of acute and chronic complications. Acute conditions include conditions that occur quickly, suddenly and are accompanied by a risk of death – hyperglycemic coma, lactic acid coma and hypoglycemic coma. Chronic complications form gradually, including diabetic micro- and macroangiopathies, manifested by retinopathy, nephropathy, thrombosis, atherosclerosis of blood vessels. Diabetic polyneuropathies are detected, namely polyneuritis of peripheral nerves, paresis, paralysis, autonomous disorders in the work of internal organs. Diabetic arthropathies are observed – joint pain, mobility limitations, a decrease in the volume of synovial fluid, as well as diabetic encephalopathy – disorders of the mental sphere, manifested by depression, emotional instability.
Diagnostics
The difficulty of detecting insulin-dependent diabetes mellitus is explained by the absence of pronounced symptoms at the initial stages of the disease. In this regard, plasma screening tests for sugar levels are recommended for people at risk and all persons over 40 years of age. Laboratory diagnostics is the most informative, it allows you to detect not only the early stage of diabetes, but also the state of prediabetes – a decrease in glucose tolerance, manifested by prolonged hyperglycemia after a carbohydrate load. If there are signs of diabetes, an endocrinologist conducts an examination. Diagnosis begins with clarifying complaints and collecting anamnesis, the specialist clarifies the presence of risk factors (obesity, physical inactivity, hereditary burden), identifies the basic symptoms – polyuria, polydipsia, increased appetite. The diagnosis is confirmed after receiving the results of laboratory diagnostics. Specific tests include:
- Fasting glucose. The criterion of the disease is the glucose level above 7 mmol / l (for venous blood). The material is taken after 8-12 hours of hunger.
- Glucose tolerance test. To diagnose diabetes at an early stage, the glucose concentration is examined a couple of hours after eating carbohydrate food. An indicator above 11.1 mmol / l reveals diabetes, in the range of 7.8-11.0 mmol / l, prediabetes is determined.
- Glycated hemoglobin. The analysis allows you to estimate the average glucose concentration over the past three months. Diabetes is indicated by a value of 6.5% or more (venous blood). With a result of 6.0-6.4%, prediabetes is diagnosed.
Differential diagnosis includes the distinction of insulin–independent diabetes with other forms of the disease, in particular, with type I diabetes mellitus. The clinical differences are a slow increase in symptoms, a later onset of the disease (although in recent years the disease has been diagnosed in young people 20-25 years old). Laboratory differential signs are elevated or normal levels of insulin and C–peptide, the absence of antibodies to beta cells of the pancreas.
Type 2 diabetes treatment
In practical endocrinology, a systematic approach to therapy is widespread. In the early stages of the disease, the main focus is on changing the lifestyle of patients and consultations where a specialist talks about diabetes, ways to control sugar. With persistent hyperglycemia, the issue of the use of drug correction is being resolved. The full range of therapeutic measures includes:
- Diet. The basic principle of nutrition is to reduce the amount of food with a high content of fats and carbohydrates. Especially “dangerous” are products with refined sugar – confectionery, sweets, chocolate, sweet carbonated drinks. The diet of patients consists of vegetables, dairy products, meat, eggs, a moderate amount of cereals. A fractional diet, small amounts of portions, refusal of alcohol and spices are necessary.
- Regular physical activity. Patients without severe diabetic complications are shown sports activities that enhance oxidation processes (aerobic exercise). Their frequency, duration and intensity are determined individually. Most patients are allowed to walk, swim and walk. The average time of one lesson is 30-60 minutes, the frequency is 3-6 times a week.
- Drug therapy. Medicines of several groups are used. It is common to use biguanides and thiazolidinediones – drugs that reduce insulin resistance of cells, glucose absorption in the gastrointestinal tract and its production in the liver. If they are insufficiently effective, medications that enhance the activity of insulin are prescribed: DPP-4 inhibitors, sulfonylurea derivatives, meglitinides.
Prognosis and prevention
Timely diagnosis and responsible attitude of patients to the treatment of diabetes allow to achieve a state of stable compensation, in which normoglycemia persists for a long time, and the quality of life of patients remains high. For the prevention of the disease, it is necessary to adhere to a balanced diet with a high fiber content, restriction of sweet and fatty foods, a fractional regime of meals. It is important to avoid physical inactivity, to provide the body with physical activity daily in the form of walking, and to exercise 2-3 times during the week. Regular glucose monitoring is necessary for people from risk groups (overweight, mature and elderly, cases of diabetes among relatives).