Type 2 diabetes mellitus (type 2 diabetes) is the most common violation of carbohydrate metabolism. Hyperglycemia in this disease occurs due to 2 factors:
- reducing insulin production by pancreatic beta cells;
- deterioration of the sensitivity of tissues to the action of this hormone.
It is believed that in patients with overweight the leading cause of diabetes is insulin resistance. Due to obesity, the cells lose insulin receptors and stop responding to its presence in the blood. Decreased tissue sensitivity can be compensated for a long time by increased hormone production. But when the reserve capabilities of the pancreas are exhausted, diabetes still manifests.
In a smaller group of patients, the primary disorder is insulin secretion pathology. These patients usually have a normal body weight. They have insulin resistance joined after a while, as the disease progresses.
The incidence is constantly increasing. The World Health Organization (WHO) predicts a long-term increase in the number of diabetics in the world to 300-350 million in 15-25 years. This is explained by the change in the age composition of the population, and the constant urbanization.
Critical numbers for the spread of type 2 diabetes are observed in developed countries. The north of the geographical latitude, the more patients with impaired carbohydrate metabolism.
Identified national characteristics of the incidence. Thus, the incidence is especially high in the Pima Indians and Mexicans. In any populations, older people are more often sick. Among all adults, latent or overt diabetes is detected in 10% of the surveys. In people after 65 years, the prevalence reaches 20%. A critical increase in incidence is observed after 75 years.
In recent years, another dangerous tendency has been observed - a significant “rejuvenation” of the age of manifestation of type 2 diabetes. If earlier the disease was almost never seen in people under 40, now they regularly diagnose cases of illness of adolescents and even children.
In men, type 2 diabetes is detected less frequently than in women.
Several etiological factors play a role in the appearance of a clear metabolic disorder. Diabetes occurs due to:
- genetic predisposition;
- disorders of intrauterine development;
- old age;
- obesity ;
- excess power.
It is proved that heredity determines the incidence of 50-70%. If a patient has diabetes mellitus type 2, one of the parents was ill, then the chance to face the same problem reaches 1: 2. The risk of disease in identical twins reaches 1: 9.
Diabetes is predestined by a combination of different genes. Each of the markers increases the risk of getting sick by 5-15%. Patients may have very different combinations of genetic loci linked to type 2 diabetes.
Potentially, the development of the disease is influenced by the genes:
- determining the synthesis and secretion of insulin;
- responsible for the sensitivity of tissues to insulin.
It is already known that 35-147% increase the risk of diabetes adverse gene markers:
All these loci are primarily responsible for the synthesis and secretion of insulin.
The prenatal period is reflected in human health throughout life. It is known that if a boy was born with a low weight, then the chances of getting sick with type 2 diabetes are quite high. If the birth weight is greater than normal, then the likelihood of carbohydrate metabolism in adulthood is also increasing.
Low weight of the newborn (up to 2.3-2.8 kg) most often indicates malnutrition in the prenatal period. This factor influences the formation of a special “economical” metabolism. Such people initially have higher insulin resistance. Over the years, “economical” metabolism leads to the development of obesity, type 2 diabetes, atherosclerosis, and hypertension.
Being overweight at birth (more than 4.5 kg) indicates a violation of carbohydrate metabolism in his mother. Such women pass on unfavorable genes to their children. The risk of type 2 diabetes in a child is up to 50% (over a lifetime).
The weight and proportions of the body largely influence the development of type 2 diabetes.
Normal body weight corresponds to an index of 18.5 to 24.9 kg / m 2 . If the BMI is 25-29.9 kg / m 2 , then they are talking about overweight.
Next come 3 degrees of obesity:
- 1 degree (30-34.9 kg / m 2 );
- 2 degree (35-39.9 kg / m 2 );
- 3 degree (more than 40 kg / m 2 ).
BMI in men can be applied with minor restrictions. It is not possible to determine obesity in seniors and in athletes with a large mass of muscle tissue. For these categories of patients it is more correct to use the method of calculating the percentage of adipose tissue using caliperimetry.
After 30 years, many men are gaining excess weight. Typically, the representatives of the stronger sex are less focused on calorie foods and even sports. Traditionally, a slight overweight is not considered a disadvantage in an adult male.
For the development of diabetes plays an important role and physique. Most men are prone to abdominal obesity. With this option, fatty tissue is more deposited in the abdomen. If a man has a waist size of more than 96 cm, then he is diagnosed with abdominal obesity. In people with such a physique, the risk of diabetes mellitus is 20 times higher than the average.
Low physical activity
Hypodynamia is one of the characteristic features of the urban lifestyle. Men are most often engaged in mental work.
Physical activity is below the required:
- due to lack of free time;
- low popularity of sports;
- high availability of public and private transport.
On average, a villager requires 3500-4500 kilocalories per day. It is this amount of energy a man spends in the village for everyday work. For the city dweller the need for energy is much less Typically, an office worker spends 2000-3000 kilocalories per day.
Physical activity helps maintain normal metabolism. It is known that within 12 hours after exercise, an increased number of insulin receptors on cell membranes is maintained. Tissues increase their insulin sensitivity as their need for glucose increases.
Pathogenesis of type 2 diabetes
Normally, insulin acts on most body tissues.
At the cell level, he:
- stimulates glucose uptake;
- enhances glycogen synthesis;
- improves amino acid uptake;
- increases DNA synthesis;
- supports ion transport;
- stimulates the synthesis of protein and fatty acids;
- inhibits lipolysis;
- reduces gluconeogenesis;
- inhibits apoptosis.
Insulin resistance and relative insulin deficiency lead primarily to an increase in glycemia. This metabolic disorder is a major symptom of type 2 diabetes. A high level of glucose in the blood leads to the overcoming of the renal threshold and glycosuria. Abundant osmotic diuresis provokes dehydration.
All tissues in conditions of type 2 diabetes do not receive the required amount of energy. The deficit is partially closed due to the breakdown of proteins and fats. But in the body with this form of the disease, at least a small residual insulin secretion is always preserved. Even a minimal hormone level can suppress the synthesis of ketone bodies (ketogenesis). Therefore, ketosis (providing energy to the body due to ketone bodies) and metabolic acidosis (acidification of the body due to the accumulation of acidic products in the tissues) are not characteristic of type 2 diabetes mellitus.
Diabetic coma with high sugar levels in type 2 is a relatively rare occurrence. Usually such a condition arises due to pronounced dehydration while taking diuretics or during cardiovascular accidents (heart attack, stroke).
A more frequent consequence of diabetes is late complications . These organ damage are a direct consequence of chronic hyperglycemia. The longer the blood sugar is elevated, the more massive the damage to the cells.
In type 2, complications can be detected at the very moment when the underlying disease is also detected. This is due to the fact that such diabetes is often hidden for a long time. Asymptomatic course makes it difficult to diagnose early.
Symptoms of the disease
Usually, type 2 diabetes in men is found by chance. A slight deterioration in well-being, which usually accompanies the onset of the disease, can rarely induce patients to consult a doctor. Complaints usually appear during severe hyperglycemia.
Diabetes is characterized by the following symptoms:
- intense thirst;
- dry skin;
- itchy skin;
- dry mouth;
- profuse and frequent urination .
In the early stages of the disease, patients may experience spontaneous hypoglycemia. A drop in blood sugar is associated with hyperinsulinism.
These episodes appear:
- severe hunger;
- trembling hands;
- rapid pulse;
- increased pressure;
Sometimes patients long ignore all the symptoms of the disease. Seek medical attention to them can cause the formation of complications.
For men, one of the significant reasons for consulting with doctors is erectile dysfunction . Initially, the patient may associate a decrease in potency with chronic stress, age, and other causes. When examined in such patients, severe hyperglycemia and insulin resistance can be detected.
Other complications of type 2 diabetes include:
- blurred vision;
- decreased sensitivity in the fingers and toes;
- the appearance of non-healing cracks and ulcers;
- chronic infection.
Diabetes can also be detected for the first time during hospitalization for a heart attack or stroke. These conditions themselves are a consequence of metabolic disorders . Complications could be prevented by early diagnosis of type 2 diabetes.
Diagnosis of type 2 diabetes includes primarily the confirmation of hyperglycemia. To do this, take samples of blood sugar on an empty stomach and 2 hours after eating. In the morning, glucose should be within the limits of 3.3-5.5 mM / l, in the daytime - up to 7.8 mM / l. Diabetes set when hyperglycemia is detected from 6.1 mm / l on an empty stomach or from 11.1 mm / l throughout the day.
If glucose indicators are intermediate, an oral glucose tolerance test (“sugar curve”) is performed.
The patient must come to the clinic on an empty stomach. First, he carries out the first measurement of blood sugar. Then give to drink sweet water (75 g of glucose per glass of water). Further for 2 hours the patient is in a state of physical rest (sitting). During this time, you can not drink or eat, smoke or take medication. Next is the re-measurement of blood sugar.
According to the test results can be diagnosed:
- impaired glucose tolerance;
- hyperglycemia on an empty stomach.
The last two states are attributed to prediabetes. 15% of patients with impaired glucose tolerance develop diabetes within a year.
Table 1 - Criteria for the diagnosis of diabetes and other disorders of carbohydrate metabolism (WHO, 1999).
In recent years, an analysis of glycated hemoglobin has been increasingly used to diagnose hyperglycemia. This indicator shows the average level of glycemia in the last 3-4 months. Normally, glycated hemoglobin is 4-6%. With the manifestation of diabetes, this parameter increases to 6.5% (minimum).
Additional tests are performed to confirm insulin resistance and relative insulin deficiency. It is necessary to investigate blood for insulin, C-peptide, blood and urine for ketone bodies. Sometimes for a differential diagnosis with type 1, it is recommended that patients take specific antibodies (for GAD, etc.).
For type 2 disease is characteristic:
- high or normal insulin levels;
- high or normal levels of C-peptide;
- low or no ketone bodies in the urine and blood;
- lack of high antibody titer.
Insulin resistance indexes (HOMA and CARO) are also calculated. An increase in HOMA values of more than 2.7 indicates an increase in insulin resistance. If the CARO index is less than 0.33, then this indirectly confirms the low sensitivity of the tissues to the hormone beta cells.
Treatment of type 2 diabetes
Diet corresponds to 9 table according to Pevzner. In the diet, the amount of animal fats and simple carbohydrates should be reduced (see Fig. 1). It is desirable to organize meals regularly, in small portions.
Fig. 1 - Principles of dietary recommendations for diabetes 2.
A man needs to know approximately his need for energy during the day and take into account the caloric content of food. Do not overeat. It is especially important to limit food in the evening.
Physical activity is selected in accordance with age and associated diseases.
Table 2 - Physical activity in the treatment of diabetes 2.
|Average||20||Fast walking bike|
|Heavy||ten||Running on the stairs or hills|
Treatment with drugs begins immediately as diabetes is diagnosed. Initially, one drug or combination of pills is usually used. If this is not enough, then insulin is connected to the treatment.
For patients with type 2, the same insulin solutions are recommended as for patients with type 1. Differences therapy:
- sometimes basal insulin is enough;
- no obvious need for pump therapy;
- insulin doses are quite large;
- good effect give miksovye drugs.
Read more "Insulin in the treatment of diabetes."
Table 3 - Therapeutic tasks in diabetes mellitus type 1 and 2.
The treatment of type 2 diabetes is carried out by an endocrinologist. All patients should be at the dispensary. A full examination is required 1 time per year. Inpatient treatment - according to indications.
Endocrinologist Tsvetkova I.G.