Type 2 diabetes mellitus

How is type 2 diabetes diagnosed and treated?

Diabetes mellitus is one of the most widespread diseases of this century. The problem of diabetes mellitus is as relevant as the problems of cancer, as well as diseases of the heart and vascular system. Currently, the number of patients with diabetes mellitus who seek help from medical institutions is more than 360 million people. Based on the data provided by the Russian Endocrinological Research Center, in the course of their screening, it was found that the real number of patients with diabetes mellitus is significantly higher than medical statistics, and is approximately 5% of the total population of the country. Moreover, the lion’s share of all patients – about 90% – suffer from type 2 diabetes.  

Three quarters of patients with diagnosed diabetes mellitus have one or a number of serious complications of this disease, which most often cause mortality in the absence of appropriate corrective measures. One of the most common complications of diabetes mellitus, leading in 80% of cases to death, are pathological processes of the cardiovascular system. 

Type 2 diabetes mellitus is one of the varieties of diabetes mellitus – a metabolic disease resulting from decreased sensitivity of cells to insulin, as well as a relative lack of insulin in the body. 

Factors and mechanisms of development of type 2 diabetes mellitus

The risk group for the incidence of type 2 diabetes mellitus includes people with a family history of cases of this form of diabetes, as well as people with a body weight exceeding the norm, and impaired glucose tolerance, since the disease is based on the resistance of body tissues to the hormone pancreas – insulin and / or its relative deficiency.

Obesity is the most common cause of insulin resistance. However, type 2 diabetes also affects people of normal weight, but with pronounced subcutaneous fat in the abdomen. Unlike type 1 diabetes mellitus, autoimmune destruction of insulin-producing pancreatic cells is not observed in type 2 diabetes mellitus. It is noteworthy that the insulin content in the blood of patients with type 2 diabetes mellitus can be within the normal range, and sometimes be elevated, but there is no full-fledged insulin response to an increase in blood glucose levels, that is, a situation of cell insensitivity to insulin arises. Over time, without appropriate treatment, insulin secretion gradually decreases.

Prevention of type 2 diabetes

To reduce the risk of developing this type of diabetes, it is necessary to monitor your own weight, preventing obesity with a balanced diet and sufficient physical activity. There is a theory of the influence of bad habits (smoking, alcohol consumption) and stress on the development of diabetes. Accordingly, in order to combat this ailment, one should abandon bad habits, observe a full-fledged regime of work and rest, and avoid chronic stress.

A healthy lifestyle and diet can reduce the risk of developing type 2 diabetes, even in people with a hereditary predisposition. In addition, for any suspicious symptoms, you should immediately seek the help of specialists in order to identify a possible disease at the earliest stages of development.

What are the symptoms of type 2 diabetes?

Type 2 diabetes mellitus is characterized by a long course without visible clinical manifestations, so it often remains undiagnosed for a long time. When the level of sugar in the blood rises, reaching alarming levels, and the level of insulin decreases, patients begin to feel dryness in the mouth, a constant feeling of thirst, and decreased visual acuity. In addition, patients complain of frequent urination with an increase in portions of urine discharge, an increase, less often weight loss, increased weakness and rapid fatigue against the background of habitual stress.   

An objective examination of patients reveals obesity (local or total) associated with overeating and hereditary predisposition, increased blood pressure, coronary heart disease, disorders of the peripheral nervous system. Due to the developing destructive processes in small and medium-sized vessels, the body’s immune response decreases, which contributes to the development of furunculosis, fungal lesions of the feet, trophic ulcers. The reason for the first visit of patients to a medical institution may also be pain in the legs, itching of the skin, as well as of the genitals, in men – erectile dysfunction. In rare cases, hyperosmolar coma may be the first manifestation of type 2 diabetes.

Diagnosis of type 2 diabetes mellitus

The diagnosis is made on the basis of patients’ complaints, anamnestic data, an objective examination and the result of laboratory diagnostics. To confirm the diagnosis, an oral glucose tolerance test is performed, which involves determining the concentration of sugar in the blood before ingestion and two hours after ingestion of glucose. The amount of glucose taken by mouth for adults should be 75 grams dissolved in 300 ml of water. Time to consume is 3-5 minutes. In the presence of an obvious clinical picture of the disease and signs of acute metabolic decompensation, a single test is sufficient. In other cases, for a more accurate diagnosis, it is advisable to retest the glucose level at regular intervals, either on an empty stomach, or randomly, or by performing an oral glucose tolerance test.

In the presence of symptoms from the nervous, cardiovascular systems, organs of vision, it is necessary to provide the patient with a consultation with a neurologist, cardiologist and ophthalmologist, which will help early detection and subsequent correction of complications of diabetes mellitus.

Differential diagnosis of type 2 diabetes mellitus is carried out only with type 1 diabetes mellitus, based on laboratory data, excluding the presence of autoantibodies in the blood against the antigens of insulin-secreting cells and confirming the absolute deficiency of insulin.

Type 2 diabetes mellitus – treatments

The scheme of treatment measures to combat type 2 diabetes mellitus includes a number of points.

1. Organization of a healthy lifestyle , providing a balanced diet and a rational increase in physical activity. The patient’s diet should be designed in such a way that against its background there was a decrease in the patient’s weight and it did not contribute to an increase in the concentration of blood sugar after a meal. Physical activity also contributes to weight loss, which normalizes the metabolism of carbohydrates in the body and improves tissue sensitivity to insulin. 

2. Drug therapy to lower blood sugar levels. 

3. Early detection and correction of complications and concomitant diseases that have developed in the course of the pathological process .  

4. Regular monitoring of glucose levels by the patient.  

A conservative method of therapy for patients with type 2 diabetes mellitus consists of a number of stages. At the first stage, along with diet therapy and increased physical activity, patients are prescribed metformin or sulfonylureas. If a patient, upon admission to a medical institution, has a state of severe decompensation, characterized by a fasting blood glucose level exceeding 13.9 mmol / L, insulin injections are immediately prescribed, and after reaching compensation, the patient is transferred to drugs that lower blood sugar. 

If the use of one antihyperglycemic drug does not give the expected results, they proceed to the second stage of treatment, which involves the use of a combination of drugs with a different mechanism for lowering sugar. The dosage of drugs is selected individually, experimentally until the blood glucose level is brought to normal. For treatment, combinations of sulfonylureas, biguanides, glitazones, etc. are used. If necessary, the administration of basal insulin is also included in the treatment regimen.

The third stage of treatment is provided in case of intolerance to hypoglycemic drugs, ineffectiveness of diet therapy within three months from the start of treatment. At this stage, the insulin dosage is included or increased in the treatment regimen. Insulin is also indicated for patients with type 2 diabetes mellitus with the development of ketoacidosis, surgical interventions and exacerbation of chronic diseases, which are accompanied by a failure in carbohydrate metabolism, during pregnancy, etc. The insulin treatment regimen and doses are determined individually, and depend on the degree of increase in blood glucose levels, the required speed of its decrease and the patient’s lifestyle.

People with type 2 diabetes usually receive outpatient treatment. Indications for hospitalization may be complications such as hypoglycemic or hyperosmolar coma, decompensation of carbohydrate metabolism, suggesting a transfer to insulin therapy, and the rapid development of vascular complications.

The effectiveness of the treatment is assessed by the level of glucose in the blood, which is determined daily by the patient himself. Once a quarter, it is necessary to conduct a laboratory test to determine the level of glycated hemoglobin.

Prevention of complications of type 2 diabetes

In patients with type 2 diabetes mellitus, blood vessels of various sizes are involved in the pathological process , as a result of destructive changes in which atherosclerosis develops, disrupting the normal blood circulation in the vascular bed and leading to the development of stroke, heart attack and other pathological conditions. In addition, due to the development of macro and microangiopathies, diabetic nephropathy, ophthalmopathy and neuropathy, as well as trophic ulcers of the legs and feet, can join the underlying disease . The risk of complications and complications can be significantly reduced by carefully and regularly monitoring blood sugar, cholesterol and blood pressure levels.   

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