What Not to Do with Knee Arthritis: Causes of the Disease, Advice and Treatment

Diabetes is a group of metabolic diseases characterized by high levels of glucose ("sugar") in the blood.

Why we need glucose

The normal value of blood glucose (sugar) in total capillary blood is 3. 3-5. 5 mmol/l in the morning on an empty stomach (i. e. after 7-14 hours of overnight fasting), and can reach a maximum of 7. 8 mmol/l after a meal (i. e. 1. 5 - 2 hours after the last meal).Normally, in the human body, glucose is used by cells as an energy source (in other words, the body's cells feed on glucose in the blood). The more a cell works, the more energy (glucose) it requires.Glucose (more commonly known as "blood sugar", but this is not entirely correct) circulates continuously in the human blood. Glucose enters the body in two ways: - The first is through foods containing carbohydrates, - The second is through the production of glucose by the liver (this is why people with diabetes can have elevated blood sugar levels even if they have not eaten). ).However, in order to be used as energy, glucose in the blood must enter muscle (to perform work), adipose tissue, or the liver (the body's glucose storage facility). This occurs under the influence of the hormone insulin produced by the beta cells of the pancreas. Once blood sugar levels rise after a meal, the pancreas immediately releases insulin into the bloodstream, where it connects to insulin receptors on muscle, fat, or liver cells. Insulin acts like a key, "opening" the cells, allowing glucose to enter the cells, causing glucose (sugar) levels in the blood to return to normal. Between meals and at night, if necessary, glucose enters the bloodstream from the liver's storage depots, so at night insulin controls the liver so that it does not release too much glucose into the bloodstream.If a violation occurs at any stage of this process, diabetes will develop.

Types of diabetes

type 1 diabetes(formerly used name: insulin-dependent diabetes mellitus) occurs primarily at a young age (usually before age 30, although type 1 diabetes can also occur at a later age).Type 1 diabetes is caused by the death of beta cells (responsible for the production of insulin in the pancreas), causing the pancreas to stop producing insulin. Type 1 diabetes occurs in the context of a specific genetic predisposition (that is, what a person is born with) that leads to changes in the state of the body when exposed to certain external factors, such as viruses. The body's immune system. The body of a person with type 1 diabetes begins to treat their pancreatic beta cells as foreign material and protects itself from it by producing antibodies (similar to what happens when protecting against infection), causing the pancreatic beta cells to die, which means that insulinSeriously inadequate.Diabetes 1This type develops when at least 90% of the beta cells in the pancreas die. Let's review the mechanism of action of insulin, which functions as the "key" that unlocks cells' access to sugar. In type 1 diabetes, this key is missing from the blood (see picture).Type 1 diabetes is insulin deficient. Type 1 diabetes has an acute onset and is always accompanied by severe symptoms of high blood sugar (hyperglycemia): - weight loss (patient loses weight unconsciously), - persistent hunger, - thirst, dry mouth(patient drinks a lot of fluids, including at night), - Frequent urination (urinates regularly or in large amounts, including at night), - Weakness.If type 1 diabetes is not treated promptly and treatment with insulin is not initiated, the condition worsens and diabetic coma often occurs.type 2 diabetes(formerly called insulin-dependent diabetes) is more common than type 1 diabetes. The incidence of type 2 diabetes is common in older people: it is usually detected after the age of 40, although recently, according to experts from the World Health Organization, the average age of people with type 2 diabetes is becoming younger.About 80 percent of people with type 2 diabetes are overweight. Additionally, type 2 diabetes is hereditary—it occurs more frequently in close relatives. In type 2 diabetes, the pancreas continues to produce insulin, often in greater amounts than usual. Although there are also cases of type 2 diabetes with reduced insulin secretion.The main flaw in type 2 diabetes is that the cells don't "sense" insulin well, that is, they don't respond well to the interaction with insulin, so the sugar in the blood doesn't fully penetrate inside (see picture). levels remain high. This state of reduced sensitivity to insulin is called insulin resistance.Type 2 diabetes has low sensitivity to insulin. You can vividly imagine that the "keyhole" on the cell door (scientifically speaking - the insulin receptor) is deformed and does not perfectly match the key - the insulin molecule. More effort (more keys, i. e. more insulin) is required to overcome the insulin receptor defect. The pancreas is unable to deliver sufficient amounts of insulin to the blood to overcome insulin resistance and completely normalize blood sugar levels because in type 2 diabetes, beta cell function remains limited.So, with type 2 diabetes, a paradoxical situation occurs when there are large amounts of both insulin and sugar in the blood.Unlike type 1 diabetes, type 2 diabetes occurs gradually and is often completely unnoticed by the patient. Therefore, a person can be ill for a long time and not know it. Elevated blood sugar (glucose) levels may be detected incidentally during a test for some other reasons.At the same time, there are also cases of obvious hyperglycemia:

• Weakness, fatigue, thirst, dry mouth (the patient drinks a lot of fluids, including at night),
• Frequent urination (regular or heavy urination, including at night),
• Itchy skin (especially in the perineal area),
• Wounds heal slowly, - Frequent infections, - Blurred vision.

Diabetic coma occurs much less frequently, usually if type 2 diabetes is accompanied by some other very serious illness: pneumonia, severe injury, septic process, heart attack, etc.

diabetes treatment

Treatment for diabetes varies depending on the type of diabetes.Type 1 diabetes is caused by an absolute deficiency of insulin produced by the own pancreas and requires constant self-monitoring and insulin therapy to stay alive. It should be emphasized that in this case, external injection of insulin therapy is the only treatment option. The choice of dosage and treatment regimen of insulin to treat diabetes is made individually, taking into account age, sex, physical activity and individual sensitivity to insulin.for type 1 diabetesSometimes, at the beginning of the disease, after normalization of blood sugar during treatment of diabetes with insulin, the need for insulin suddenly begins to decrease until it is completely eliminated. But this is not recovery. This phenomenon is scientifically known as the diabetes "honeymoon, " or remission. This is because, with the help of insulin, beta cells that have not yet died can work for a period of time after blood sugar returns to normal. Subsequently, they all died, and the person required life-long insulin treatment for diabetes. Anyone developing type 1 diabetes for the first time should be warned by their doctor about this possibility and what to do if it happens.Diabetes can be treated with insulin using an insulin syringe, pen, or insulin pump.Insulin pump therapy is an alternative treatment for people with diabetes who heavily use a syringe or pen to inject insulin and regularly measure their blood sugar levels. Use insulin pump therapy instead of injections to treat diabetes. The pump is worn on the body or clothing, such as on a belt. Currently, approximately 250, 000 people worldwide use insulin pumps. The main goal of treating type 2 diabetes is to increase the sensitivity of cells to insulin. The reasons for poor insulin sensitivity are not fully understood. However, it has long been known that the most powerful factor in the development of insulin resistance is excess body weight, that is, being overweight. Excess fat accumulation in the body. Numerous scientific studies and long-term observations of patients have shown that most patients with type 2 diabetes can achieve significant improvements in blood sugar levels by losing weight during treatment.In type 2 diabetes, weight normalization can lead to long-term complete normalization of blood sugar, although this cannot be called a complete recovery.If diet and exercise aimed at losing weight are not effective enough to treat type 2 diabetes, medication must be resorted to. They are available in tablet form. Some of these act on the pancreas, increasing insulin production, while others improve its action (reduce insulin resistance). Therefore, the drugs used to treat type 2 diabetes do not lower blood sugar per se, whereas insulin has a blood sugar-lowering effect, so in order to obtain the effect of tablets in treating diabetes, pancreatic beta cell reserves need to be preserved. This clearly illustrates why there is no point in using tablet medications to treat type 1 diabetes, as most beta cells are already dead.Insulin is commonly used to treat type 2 diabetes. Insulin therapy for type 2 diabetes can be given as a temporary measure, such as during surgery, severe acute illness, or as a permanent treatment. This is why it is currently not recommended to call type 2 diabetes non-insulin-dependent diabetes. The type of diabetes treatment does not determine the type of diabetes.Diet plays the most important role in the treatment of diabetes.

diabetes diet

Although the goals of treatment for different types of diabetes are the same (eliminate symptoms of hyperglycemia, minimize risk of hypoglycemia, prevent complications), dietary patterns differ significantly between type 1 and type 2 diabetes. There is no single diet plan for diabetes.The occurrence of type 1 diabetes is related to pancreatic beta cell death and insulin deficiency. The main method of treatment is insulin replacement therapy, while dietary restriction is auxiliary according to the modern point of view. Insulin should only be given if insulin therapy differs from insulin production in healthy individuals.The basic principles of dietary prescription for type 1 diabetes have been rigorously revised in recent years.One of the tenets of the traditional diabetes diet is the recommendation to consume the same strictly defined amount of calories every day. Daily calorie requirements are prescribed for each patient based on an "ideal body weight. "This makes no sense and is impossible for the following reasons:

• In healthy individuals of normal weight, the balance between energy intake and expenditure varies significantly from day to day. Energy expenditure in healthy individuals is variable because their physical activity is variable. So if you prescribe a specific diet for a person with type 1 diabetes to consume a fixed, same amount of calories every day, then in order to maintain a normal weight you would have to recommend the same specific, rigorous physical activity program every day, which is absolutely unrealistic.
• Appetite regulation in patients with type 1 diabetes who are of normal weight and correctly selected on their diabetes insulin regimen does not differ from that in healthy individuals. In fact, even in the absence of appetite, it is sometimes necessary to force them to eat to prevent hypoglycemia, which is often the result of incompletely adequate insulin therapy.

Improved diabetes treatment regimens using insulin and self-monitoring of metabolism based on blood glucose levels give patients the opportunity to regulate food intake based solely on feelings of hunger and fullness, like healthy people. Therefore, a person with type 1 diabetes eats a diet equivalent to a complete healthy diet (balanced in calories and essential nutrients). The only difference is that injected insulin doesn't "know" when or how much you've eaten. Therefore, it is up to you to ensure that the effects of insulin are consistent with your diet. Therefore, you need to know which foods increase blood sugar. The main treatment for type 2 diabetes is to normalize weight through a low-calorie diet and increased physical activity. Diet is very important when it comes to type 2 diabetes; it's one of the most important components of your success.All foods are made up of three components: protein, fat and carbohydrates. They all contain calories, but not all increase blood sugar.Only carbohydrates have a significant blood sugar-raising effect. What foods contain carbohydrates? It's easy to remember: most products are plant-based, and animal-based - only liquid dairy. It's important for you to know if and by how much your blood sugar rises after certain foods. Blood sugar either doesn't rise at all or only slightly after some types of carbohydrate foods.All carbohydrates can be roughly divided into two categories: rapidly absorbed ("fast") carbohydrates and slowly absorbed ("slow") carbohydrates. Products containing "fast" carbohydrates contain refined sugar, including preserves and jams, candies, sweets, fruits and juices. "Fast" carbohydrates can cause a sharp spike in blood sugar (depending on the amount of food eaten) because they are quickly absorbed into the bloodstream, so it is best to exclude them from a diabetic diet. "Slow" carbohydrates are more beneficial for diabetics because they take longer to be absorbed. In addition, the fiber contained in food slows down the absorption of sugar, so the diet when treating diabetes should be rich in fiber-rich foods.Here are some simple rules to follow when treating diabetes: Eat food in small portions more often (4-6 times a day); stick to a prescribed diet – try not to skip meals; do not overeat – follow your doctor’s recommendations; use whole foodsBread made from wheat flour or bran; vegetables (except potatoes and beans) should be eaten daily; avoid "fast" carbohydrates.Exercise for Diabetes Exercise is very important in the treatment of diabetes: it increases the sensitivity of body tissues to insulin, thereby helping to lower blood sugar levels.Doing housework, walking, and jogging can all be considered physical activities. Priority should be given to regular and quantitative physical activity: sudden strenuous exercise may cause problems in maintaining normal blood sugar levels.If you are an athlete or sportswoman, you have no contraindications to participating in sports as long as your blood sugar levels are well controlled and you take all necessary steps to prevent them from falling significantly.Preventing Diabetes Complications People with diabetes are at increased risk of heart and blood vessel (especially leg and kidney) complications. Regular physical activity, sometimes just walking, can be enough to prevent foot circulation problems.If you have diabetes, untreated foot cuts or scrapes can develop into serious problems. Even minor cuts or scrapes on the feet take longer to heal and require more attention than non-diabetic patients. The key to preventing these problems is to wear shoes that fit well and check your feet frequently. If you find it difficult to check all areas of your foot, use a mirror, and remember that foot injuries are usually painless at first and can go unnoticed for a long time if you are not careful enough.People with diabetes are at increased risk for kidney dysfunction and heart disease years after diagnosis. There is good evidence that good blood sugar control reduces this risk. In addition, to prevent complications of diabetes, preventive treatment is required twice a year.Blood pressure control is also important. Check your blood pressure regularly. If elevated, your doctor will prescribe a treatment plan for you.