Diabetes mellitus

  • Diabetes mellitus in children
  • Diabetes mellitus (synonym: sugar diabetes, diabetes) is a disease characterized by the violation of all types of metabolism as a result of deficiency of insulin in the body and manifesting hyperglycemia and glycosuria.
    Etiology. Significant role is played by heredity. The disease may occur under the influence of psychological trauma, prolonged overstrain of the nervous system, infections (influenza, angina), excess consumption of carbohydrates, traumatic brain injury , etc.
    Pathological anatomy. The main changes detected in the insular apparatus pancreas (see), which synthesized the hormone insulin; they are expressed in the reduction of number of Islands and the number of beta cells in them. In the pancreas are hyalinosis and fibrosis Islands. Diabetes also find common lesions of capillaries (kidney, retina, and others).
    Pathogenesis. Distinguish between relative and absolute lack of insulin (see). The first may occur during normal insulin activity blood and the safety islet, part of the pancreas. These cases of diabetes are associated with the violation of tissue exchange, to compensate for which you want insulin, exceeding the physiological norm. Absolute insulin deficiency is associated with a deficiency of beta-cells of the islets, the origin of which plays the role of pancreatitis, pancreas tumors and other diseases. In the pathogenesis of diabetes is set to overeating that causes stress functions (5-cells of the islets and facilitating the identification of latent deficiency. Diabetes violated carbohydrate, protein, fat, water-salt metabolism and vitamin balance.
    Over and symptoms. The main symptoms of diabetes thirst (polydipsia), the release of a large amount of urine (polyuria), constant hunger, skin itch, hyperglycemia (see) and carbohydraturia (see). Patients drink a lot (up to 6 - 10 l of fluid per day). Often, especially in young patients, it is possible to see the peculiar blush. The back surface of the palms and soles has a yellowish color. The skin is dry, rough, scaly; covered with scratches caused by itching. During examination of the skin is often possible to detect boils, eczema. Language dry. The liver is often increased. According to severity of clinical course there are three forms of diabetes: light, moderate and heavy. When compensation process the patient retains the ability to work and constant weight. The development of diabetes can precede such a state, when clinical symptoms and carbohydraturia no, there is only diabetogenic type of sugar curve, i.e. after load carbohydrates (glucose, galactose , and others) the rise of the curve is much higher and is held on a high digits longer than healthy. Timely detection of this condition is set to prevent the development of diabetes.
    Diabetes is a chronic disease with a tendency to increase insulin deficiency and, consequently, to move in a more severe form. The exacerbation of the disease is favored errors in diet, improper treatment of acute and chronic infection, intoxication, liver disease. The aggravation of diabetes can lead to serious complications coma (see). Usually a few days before coma appear harbingers: increase polyuria and thirst, severe weakness, drowsiness. At this time you can feel the smell of acetone breath of the patient. In urine and blood usually have high sugar content and ketone bodies (see acetone anaemia). The sugar content in the blood usually exceed 300 mg% (or pre-comatose state).
    Diabetes is relatively rare in childhood and adolescence. Over the years, its frequency increases and reaches its maximum at 40 to 60 years. Sick with equal frequency in men and women.
    Complicationsinclude coma, glomerulosclerosis (bilateral diffuse damage to the kidneys, manifested proteinuria, hypertension, edema), pyelonephritis (see), retinopathy (changes in the retina noninflammatory nature), cataract (see), furunkoulez (see), septic processes, polyneuritis (see), amenorea (see below Pregnancy and sexual function in women), lowering potency in men (see below Sexual function in men).
    The diagnosis is based on the patient complaints (thirst, polyuria, weakness, reduced efficiency, skin itch) and data of laboratory tests of blood and urine. Should differentiate with renal diabetes, characterized by normal blood sugar and normal sugar curve. From the bronze diabetes (hemochromatosis) diabetes differs mainly lack of pigmentation of the skin.
    The forecast. With proper systematic treatment favorable. He is deteriorating with the above complications and in neglected, poorly treated cases.
    Treatment. The main treatment means are: diet, insulin, protivodiabeticakih hypoglycemic agents.
    Patient with newly diagnosed diabetes is subject to hospitalization. Treatment of the diet can be applied only in patients with mild form of diabetes mellitus. Appoint a normal physiological diet based on the age, height and weight of the patient and the nature of his work. The daily food ration includes 60% carbohydrates, 24% fat, and 16% protein. In moderate and severe forms of diabetes are prescribed insulin or preparations of prolonged action: Protamine-zinc-insulin suspension zinc-insulin (AIC), suspension zinc-insulin amorphous, suspension zinc-crystalline insulin. In some cases, in the absence of contraindications insulin is prescribed in combination with oral hypoglycemic agents.
    The insulin dose is calculated from the value of the daily glycosuria (1 UNIT of insulin promotes the absorption average 4 g of sugar). The greatest effect with the introduction of insulin occurs within 2-4 hours; the duration of 6-8 h. When insulin is necessary to determine the sugar content in daily urine and blood. The insulin used to treat the following complications: allergic reactions, insulin edema (limit sodium chloride and assign chloride calcium), lipodystrophy.
    When insulin overdose or improper feeding in the period of insulin may cause hypoglycemia (see), the initial signs of a sense of hunger, weakness, tremor, sweating. If time does not take action (the patient should eat a few teaspoons of sugar, sugar or some sweets), can develop hypoglycemic coma (see).
    For the treatment of diabetes applied sulfonamides (Balaban, butamid, aranel and others) and biguanides (debit, debatin, silumin). Contraindications to the appointment of sulfa drugs are: diabetes children and youth, the defeat liver and kidney with a significant violation of their functions, blood diseases, pregnancy, acidosis, prekomatosny and coma condition.
    In non-urgent surgical intervention is necessary preparatory treatment of the patient with diabetes mellitus, insulin and diet (possibly a combination of insulin with sulfonamides or biguanides). For urgent surgery a patient with diabetes need before surgery to enter another dose of insulin. Further dosage insulin determine the level of glycemia and glycosuria.
    Sanatorium-resort treatment is indicated in the forms of diabetes mild and severe in stable without compensation tendency to acidosis (Essentuki, Borjomi, Pyatigorsk, Jermuk, Java, Isti-su, Truskavets, berezivski Mineral Waters and others). In local sanatoria refer patients with severe diabetes.
    Medical and physical culture appointed in forms of diabetes mild and severe. Start with a simple exercise lying down or sitting. Loading increases gradually. If there are no contraindications from internal organs, allow Hiking, light metered sports games. If there are complications to select appropriate physiotherapy.
    Prevention. Consume carbohydrates in families burdened with diabetic heredity. Identification of the state when the only manifestation of the disease is diabetogenic type of sugar curve. Prevention of exacerbations and prevention of complications is reduced to a systematic, correct treatment of diabetes.

    Pregnancy and sexual function in women. Diabetes suffer sexual function in women (amenorea, premature menopause etc). Rational therapy aligns violation. During pregnancy diabetes varies - it gets worse in the second half of pregnancy. Insulin therapy should be strictly individual. Pregnancy diabetes can result in miscarriage or premature birth. In connection with the often observed in pregnant women suffering from diabetes, high fruit is delayed generic act and increases the percentage of postpartum complications. Women, patients with diabetes should from the very beginning of pregnancy to be under systematic observation obstetrician and endocrinologist, which determine the length of hospitalization in the Department of pathology of pregnancy, indications for premature delivery.
    Indications for abortion: a severe form of diabetes, the presence of nephropathy and retinopathy, diabetes mellitus of both spouses.
    Sexual function in men. Sexual dysfunction (decrease sexual desire and the weakening of erection ability) sometimes is the first sign of diabetes mellitus. The degree of reduction of sexual ability is not associated with glycosuria. The systematic treatment of sexual function is restored. In addition to the main treatment, demonstrated appointment testosterone-propionate, vitamins C, E and C.