What are Diabetes Mellitus Types Treatment Diagnosis and Prevention?
Basic Information about Diabetes Mellitus Types Treatment Diagnosis and Prevention
Medical Name:Diabetes Mellitus, DM
Related Medical Department:Internal medicine, Endocrinology
Table of Content
1. Generic Symptoms
2. Cause of Diabetes
3. Clinical Manifestations
6. Differential Diagnosis
What are the symptoms of diabetes?
Early symptoms of diabetes (pre-clinical):
1. Weight loss: It is mainly because the the patient’s body cannot be fully utilize glucose, which causes the accelerated decomposition of fat and protein, which consumes a lot. Weight also be severely reduces, so the condition of weight loss occurs.
2. Drinking more water: Because the patient’s urine increases, the water loss is very large. The intracellular dehydration is serious. The hyperglycemia index is aggravated and the thirst center is stimulated, which leads to thirst and drink more. This is one of the symptoms of diabetes.
3. Skin: What are the obvious symptoms of diabetes?
The early symptoms of diabetes are generally more obvious on the skin of patients: lower extremity and foot ulcers may not be curing for a long time. Or may be accompanied by repeated skin and vulvar infections. It is not easy to heal after abrasions or scratches, or repeated episodes of balanitis, vulvitis, and vaginitis appear.
4. Increased diet: Because of polyuria, leading to a lot of sugar in the urine is lost, so they have to be hungry. Energy is very lacking, causing hyper appetite, the phenomenon of polyphagia.
5. Weakness: Because the human body cannot fully use glucose to release its energy, it makes us feel very weak.
What are the causes of diabetes?
1. Genetic factors
There is significant genetic heterogeneity in both type 1 and type 2 diabetes. Diabetes has a family tendency, and 1/4 to 1/2 patients have a family history of diabetes. There are at least 60 genetic syndromes clinically associated with diabetes. Multiple DNA sites are involved in the pathogenesis of type 1 diabetes, among which the DQ site polymorphism in the HLA antigen gene is most closely related. A number of definite genetic mutations have been found in type 2 diabetes, such as insulin genes, insulin receptor genes, glucokinase genes, mitochondrial genes, and so on.
2. Envirnmental factor
Excessive eating and less physical activity causes obesity which is the most important environmental factor in type 2 diabetes, which makes individuals with a genetic susceptibility to type 2 diabetes prone to disease. Patients with type 1 diabetes have abnormal immune systems, which cause autoimmune reactions and destroy insulin beta cells after infection with certain viruses such as coxsackie virus, rubella virus, and mumps virus.
Clinical Diabetic Manifestation
1. Drink more, eat more and lose weight
Symptoms of “three more and one less” are typical in severe hyperglycemia, which is more common in type 1 diabetes. “Three more and one less” symptoms are more pronounced when ketosis or ketoacidosis occurs.
2. Tiredness, obesity
More common in type 2 diabetes: Type 2 diabetes is often evident in obese before the onset of the disease, and if not diagnosis does not take place in time, weight will gradually decrease.
Tests for Diabetes
1. Blood sugar
Is the only criterion for diagnosing diabetes. Those with obvious “three more and one less” symptoms can be diagnosed with only one abnormal blood glucose level. Asymptomatic people need two abnormal blood glucose levels to diagnose diabetes. Suspects need to do a 75g glucose tolerance test.
2. Urine sugar
Often positive. Urine glucose was positive when blood glucose concentration exceeded the renal glucose threshold (160-180 mg / dL). When the renal glucose threshold is increases, the diagnosis of diabetes can be negative even if the blood sugar reaches the diagnosis. Therefore, urine glucose measurement is not a diagnostic criterion.
3．Urinary ketone body
Ketones are positive for ketones or ketoacidosis.
4．Glycosylated hemoglobin (HbA1c)
It is the product of the non-enzymatic reaction of glucose and hemoglobin. The reaction is irreversible, and the level of HbA1c is stable, which can reflect the average blood glucose level 2 months before taking blood. It is the most valuable indicator to judge the state of blood glucose control.
5. Glycated serum protein
It is the product of the combination of blood glucose and serum albumin non-enzymatic reaction, which reflects the average blood glucose level 1 to 3 weeks before blood collection.
6. Serum insulin and C-peptide levels
Reflects the reserve function of islet β cells. Early type 2 diabetes or obese serum insulin is normal or increased. With the development of the disease, islet function gradually decreases and insulin secretion capacity decreases.
7. Blood lipid
Dyslipidemia is common in diabetic patients, especially when blood glucose is poorly controlled. It shows elevated triglycerides, total cholesterol, and low-density lipoprotein cholesterol. Reduced HDL cholesterol levels.
8. Immune indicators
Islet cell antibodies (ICA), insulin autoantibodies (IAA), and glutamate decarboxylase (GAD) antibodies are three important indicators of humoral immune abnormalities in type 1 diabetes. Among them, the positive rate of GAD antibodies is high and the duration is long. The diagnostic value of type 2 diabetes is great. There is also a certain positive rate among first-degree relatives of type 1 diabetes, which has significance in predicting type 1 diabetes.
9. Urinary albumin excretion, radioimmunoassay or enzyme-linked method:
There can be sensitive detection of urinary albumin excretion, and urine albumin is slightly elevates in early diabetic nephropathy.
How we diagnose diabetes?
The diagnosis of diabetes is generally not difficult. A fasting blood glucose greater than or equal to 7.0 mmol / L and / or a blood glucose greater than or equal to 11.1 mmol / L within two hours after a meal can make confirmation. Typing after diabetic diagnosis:
What are the types of Diabetes?
1. Type 1 diabetes
The age of onset is young, mostly <30 years old. Sudden onset, obvious symptoms of weight loss, polydipsia and polydipsia, high blood glucose level, many patients with ketoacidosis as the first symptoms. Low serum insulin and C peptide levels, ICA, IAA Or GAD antibodies can be positive. Oral medication alone is not effective and needs its treatment along with insulin.
2. Type 2 diabetes
Common in the elderly, obese people have a high incidence, often accompanies hypertension, dyslipidemia, arteriosclerosis and other diseases. Insidious onset, no symptoms at early stage, or only mild fatigue, thirst and insignificant increase in blood glucose require glucose tolerance test to confirm the diagnosis. Serum insulin levels are normal or with elevation in the early stages and low in the later stages.
3. Gestational diabetes
Refers to impaired glucose tolerance or diabetes for the first time during pregnancy. Those who have had diabetes and are currently pregnant are not included.
The pathogenesis is that the increase in glycemic hormone secretion during pregnancy makes pregnant women increase insulin resistance, reduce insulin secretion, and increase blood sugar. Elevated blood glucose during pregnancy is inextricably linked to many diseases of the mother and fetus during pregnancy, such as maternal hypertension syndrome and fetal growth restriction, miscarriage and premature birth. Therefore, for pregnant women, currently there is recommendation of diabetes screening for 24-28 weeks to avoid the adverse effects of elevated blood glucose on the mother and fetus. After pregnancy, mothers with diabetics must re-evaluate glucose metabolism and conduct life-long follow-up (specifically separate Chapter introduction).
Differential Diabetic Diagnosis
1. Liver Disease
Patients with liver cirrhosis often have abnormal glucose metabolism. Typical fasting blood glucose is normal or low, and blood glucose rises rapidly after meals. The course of the elderly can also increase fasting blood glucose.
2. Chronic renal insufficiency
Mild glucose metabolism abnormalities may occur.
3． Stress state
Many stress states such as cardiac and cerebrovascular accidents, acute infections, trauma, and surgery may cause transient rises in blood glucose, which can be recovered within 1 to 2 weeks after the stress factors are eliminated.
4． Multiple endocrine diseases
Such as acromegaly, Cushi1ng’s syndrome, hyperthyroidism, pheochromocytoma and glucagonoma can cause secondary diabetes. In addition to elevated blood sugar, there are other characteristic manifestations. It is not difficult to identify.
How can I treat Diabetes?
Diabetes Treatment: There is currently no cure for diabetes, but diabetes can be controlled with a variety of treatments. It mainly includes 5 aspects: education for diabetic patients, self-monitoring blood glucose, diet therapy, exercise therapy and medication.
(A) General Diabetic Treatment
It is necessary to educate people with diabetes to understand the basic knowledge of diabetes, build confidence to overcome the disease, how to control diabetes, and control the health benefits of diabetes. According to the characteristics of each diabetic patient, an appropriate treatment plan formulation takes place.
2. Self-monitoring blood glucose
With the gradual popularization of small and fast blood glucose meters, patients can adjust the dose of hypoglycemic drugs at any time according to blood glucose levels. Monitor blood glucose at least 4 times a day (before meals) during intensive treatment of type 1 diabetes, and 8 times when blood sugar is unstable (before meals, after, before bedtime, and at 3:00 am). During intensive treatment, you should control fasting blood glucose below 7.2 mmol / L, blood glucose less than 10 mmol / L and HbA1c less than 7% two hours after a meal. There can be appropriate reduction in the frequency of self-monitoring blood glucose in patients with type 2 diabetes.
(B) Drug Treatment of Diabetics
1. Oral Medication
(1) Sulfonylureas: After treatment with diet control, exercise and weight reduction in patients with type 2 DM, they can use sulfonylureas. Because the hypoglycemic mechanism is mainly to stimulate insulin secretion, it has a better effect on those with certain islet function. It also has a certain effect on some early-onset, non-obese diabetic patients. However, when using sulfonylurea drugs for obese people, your should pay special attention to diet control to gradually reduce body weight. It is better to combine with biguanide or α-glucosidase inhibitor hypoglycemic agents.
The following conditions are contraindicated:
- Severe liver and kidney dysfunction
- Severe infection, trauma and major surgery, temporarily switch to insulin therapy.
- Diabetic ketosis, ketoacidosis, temporarily switch to insulin therapy.
- Pregnant women with diabetes, pregnancy-induced hyperglycemia has teratogenic effects on the fetus, high incidence of preterm and stillbirth, so you should strictly control blood glucose. You should control fasting blood glucose below 105 mg / dL (5.8 mmol / l), meal. The blood glucose can come under control below 120 mg / dL (6.7 mmol / L) in the next 2 hours, but you should not use oral hypoglycemic drugs to control blood glucose.
- Allergic to sulfonylureas or obvious adverse reactions.
(2) Biguanide hypoglycemic drugs
The main mechanism of lowering blood sugar is to increase the utilization of glucose in peripheral tissues, increase the anaerobic glycolysis of glucose, reduce the absorption of glucose in the gastrointestinal tract and reduce body weight.
i. Indications for obese type 2 diabetes: This is for who have no satisfaction with the effect of diet alone. Type 2 diabetes is not effective with sulfonylurea alone, and can be taken in addition with biguanide. Type 1 diabetes with insulin is unstable, and biguanide is used Drugs can reduce the dose of insulin. When secondary failure of type 2 diabetes is treatment takes place with insulin, you can add biguanide drugs to reduce the amount of insulin.
ii. Contraindications: Severe liver, kidney, heart, lung diseases, wasting diseases, malnutrition, hypoxic diseases, diabetic ketosis, ketoacidosis, suspension of biguanides with severe infection, surgery, trauma and other stress conditions, medication, insulin therapy, pregnancy, etc.
iii. Adverse reactions are gastrointestinal reactions: The most common manifestations are nausea, vomiting, decreased appetite, abdominal pain, and diarrhea. The incidence can reach 20%. To avoid these adverse reactions, you should not take medication with or after meals. The second is headache, dizziness and metallic taste. The third is lactic acidosis, which is more common in long-term and large-scale application of hypoglycemic, accompanied by liver and kidney dysfunction, hypoxic disease, acute infection, gastrointestinal diseases, etc. Hypoglycemic tablets have less chance of causing acidosis.
(3) Alpha glucosidase inhibitors
You can use alpha glucosidase inhibitors for both type 1 and type 2 diabetes, and can be used in combination with sulfonylureas, biguanides or insulin.
i. Voglibose is taken orally immediately before meals.
ii. Acarbose is taken orally immediately before meals.
Main adverse reactions: abdominal pain, flatulence, diarrhea and increased anal exhaust.
(4) Insulin sensitizers have the effect of enhancing insulin and improving glucose metabolism. You can use it alone or in combination with sulfonylureas, biguanides or insulin. Physician should not allow its use in patients with liver disease or cardiac insufficiency.
(5) Glinate insulin secretagogues
i. Reglinide is a fast-acting insulin secretagogue, which is patients take orally, immediately before meals.
ii. Naglinaide works similarly to riglinai.
2. Insulin therapy
Insulin preparations include animal insulin, human insulin and insulin analogs. According to the action time, it is divided into short-acting, medium-acting and long-acting insulin. It is made into mixed preparations such as Novoline 30R and Youbilin 70/30.
(A) Type 1 diabetes needs treatment with insulin. Non-intensive treatments are given 2 to 3 times a day, and intensive treatments are given 3 to 4 times a day, or treated with an insulin pump. You need to adjust the dose often.
(B) Those who fail to take oral hypoglycemic agents for type 2 diabetes should first adopt the combined treatment method. The original oral hypoglycemic agent dose is unchanged. Medium-acting insulin or long-acting insulin analogs are injected at 10:00 the night before bed. Adjust once every 3 days, the purpose is to reduce fasting blood glucose to 4.9 to 8.0 mmol / L. Those who do not respond will stop taking oral hypoglycemic drugs, and instead inject insulin twice a day.
The biggest adverse effect of insulin treatment is hypoglycemia.
(C) Exercise therapy for Diabetics
Increasing physical activity can improve the body’s sensitivity to insulin, reduce weight, reduce body fat, increase physical strength, improve work capacity and quality of life. The intensity and duration of exercise should be determined according to the overall health of the patient, and find the amount of exercise suitable for the patient and the items that the patient is interested in. There are various forms of exercise, such as walking, brisk walking, aerobics, dancing, Yoga, Autophagy, Tai Chi, running, swimming, etc.
(D) Diet Therapy for Diabetics
Diet therapy is the basis of various types of diabetes treatment, and some patients with mild diabetes can control their condition with diet alone.
1. Total calories
The total caloric requirement should be determined according to the patient’s age, gender, height, weight, physical activity, and other comprehensive factors. First of all, to calculate the standard weight of each person, you can refer to the following formula: standard weight (kg) = height (cm)-105 or standard weight (kg) = [height (cm)-100] × 0.9; the standard weight of women should be Subtract 2kg. Can also be obtained according to age, gender, height checklist. After calculating the standard weight, the caloric requirement per kilogram of standard weight is estimated according to the daily physical activity of each person.
After calculating the daily calorie requirement on the basis of standard weight, the patient’s other conditions must be adjusted accordingly. Children, adolescence, lactation, malnutrition, wasting, and chronic wasting diseases should increase total calories as appropriate. Obese people should strictly limit the total calories and fat content, and give a low-calorie diet. The total calories per day should not exceed 1500 kcal.
Generally, it is advisable to reduce 0.5 ～ 1.0kg per month. When the weight is close to the standard weight, calculate the total daily weight according to the method Heat. In addition, older people need less calories than younger ones, and adult women need less calories than men.
Carbohydrates produce 4 kilocalories per gram, which is the main source of calories. It is believed that carbohydrates should account for 55% to 65% of the total calories in the diet, which can be calculated using the following formula:
According to the living habits of our people, you can eat 250 to 400 g of staple food (rice or noodles). You can make a preliminary estimate as follows. The daily staple food for resters is 200 to 250 g, mild manual laborers are 250 to 300 g, and moderate manual laborers are 300 to 400 g. 400g or more for heavy manual workers.
Protein produces 4 kcal per gram. It accounts for 12% to 15% of the total calories. The amount of protein required is about 1 g per kilogram of body weight in an adult. In children, pregnant women, lactating women, malnutrition, weight loss, and those with wasting diseases should increase to 1.5 ~ 2.0g per kilogram of body weight. People with diabetic nephropathy should reduce their protein intake to 0.8g per kilogram of body weight. If they have renal insufficiency, they should consume high-quality protein and their intake should be further reduced to 0.6g per kilogram of body weight.
4. Fat Loquat
Fat has higher energy, producing 9 kcal per gram. About 25% of total calories, generally not more than 30%, 0.8 to 1g per kilogram of body weight per day. Animal fats mainly contain saturated fatty acids, and vegetable oils contain more unsaturated fatty acids. Diabetic patients are susceptible to atherosclerosis, and vegetable oils should be the main factor, which is more conducive to controlling blood cholesterol and low-density lipoprotein cholesterol levels.
What is the pathogenesis of diabetes?
If the body is regarded as a large industrial city, each organ and tissue is a factory and institution with special functions, and each cell is a workshop and department. There are various things to do here, but most of them need energy to complete. This energy is provided by ATP, just like a charged battery; no matter what power is supplied to the battery, the electricity in the battery Will be consumed, ATP will become ADP.
What is the situation of Diabetes in the USA?
Diabetes treatment in the U.S .: 2018 diabetes diagnosis and treatment guidelines (drugs)
Diabetes is a metabolic disorder. It is mainly due to the decline of insulin function, resulting in the inability to break down the sugar in the body and cause the accumulation of sugar. The main manifestation is that the blood is too high in sugar, the amount of food will increase, and the fatigue will increase. Recently, the American Diabetes Association (ADA) issued the 2018 edition of the diabetes diagnosis and treatment guidelines. The ADA guidelines are updated annually and have a wide international influence. Today, Xiaobian brought a cutting-edge version of the guide on drug prevention and treatment, which introduced in more detail the application of drugs for treating diabetes in the United States in various situations, hoping to help the “sugar friends”.
U.S. Treatment of diabetes
American Diabetes Treatment: Prevention of Type 2 Diabetes
➤ For patients with pre-diabetes, especially women with BMI> 35 kg / m2, age <60 years, and history of gestational diabetes, the use of Metformin to prevent type 2 diabetes is considerable.
➤ Long-term use of metformin may cause vitamin B12 deficiency: Diabetes patients taking metformin, especially those with anemia or peripheral neuropathy, should be under regular monitoring for vitamin B12.
US Diabetes Treatment: AIC Target
- A reasonable AIC target for most non-pregnant adults is <7%;
- For diabetic patients with a history of severe hypoglycemia, limited life expectancy, complications of advanced microvascular or macrovascular disease, more concomitant diseases, and the application of a variety of hypoglycemic drugs, including insulin that are still difficult to meet, the AIC target value is <8%.
- For patients who change their treatment plan, AIC is tested every 3 months.
Diabetes in the US: Type 2 Diabetes Drug Therapy
- For those without contraindications, the initial treatment is metformin.
- Newly diagnosed patients with type 2 diabetes, such as AIC ≥ 9%, should consider starting two-drug combination therapy.
- For newly diagnosed type 2 diabetes patients: If they have obvious symptoms of hyperglycemia and / or AIC level ≥10% and / or blood glucose ≥16.7mmol / L, consider starting insulin therapy.
- If monotherapy or combination therapy does not meet or maintain the AIC target within 3 months, add another hypoglycemic agent.
- For patients with type 2 diabetes who do not meet their blood glucose goals, there should be no postponement of intensive drug treatment, including consideration of insulin therapy.
- There is no clear evidence to support dietary supplementation with vitamins, minerals, Chinese herbs or spices for patients who do not lack it, and long-term intake of antioxidants such as vitamin E, vitamin C and carotene may present unthreatening issues.
After reading the above guide, do you know more about the treatment of diabetes in the United States? Diabetes is a kind of “lazy disease”. Many patients are caused by obesity. As long as they are ill, they can only control their diet and keep their condition from worsening.
Why Chinese people are so much diabetic?
Why has China become a diabetes kingdom? Although this statement is certainly not welcome, the fact is that in addition to the genetic factors of the population, there are also some reasons that we blame ourselves. In 2007, Professor Yang Wenying and her research team at the China-Japan Hospital conducted a nationwide survey and published the findings in the New England Journal of Medicine. It says, the prevalence of diabetes in China rose to 9.7% and the number of patients reached 92.
Talking about Diabetes
At least from the perspective of drug development, type 2 diabetes is a more complex disease than type 1 diabetes. The latter is caused by a lack of insulin and can be effectively controlled with the help of insulin injections; the former is caused by the body’s inability to respond to insulin, but how to reawaken our body is a very complicated task. It is this background that highlights the difficult mission of modern medicine and drug development. Metformin, this is still today.
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Stimulating the brain helps treat diabetes
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How to prevent diabetes?
Prevention of diabetes:
(1) Prevent and correct obesity.
(2) Avoid high-fat diets.
(3) The diet should ensure a reasonable weight and the needs of work and life. Eat more vegetable.
(4) Increase physical activity and participate in physical exercise.
(5) Avoid or use drugs that are not good for glucose metabolism.
(6) Actively discover and treat hypertension, hyperlipidemia and coronary heart disease.
(7) Quit smoking and drinking less alcohol, and put an end to all bad living habits. High-risk groups of parents with diabetes who are obese and eaten too much, have high blood sugar, and lack of exercise. Pay particular attention to prevention
(8) Regular health check-ups for middle-aged and elderly people, in addition to routine fasting blood glucose, should pay attention to blood glucose measurement 2 hours after a meal.
(9) It is important to regularly monitor your weight and maintain it at a normal level for a long time. When you gain weight, you should limit your diet in time and increase your exercise volume to return to normal as soon as possible. Make sports an important part of life and a lifelong habit.
What to eat in diabetes?
Sweet, white and tender, containing prostaglandin A and sulfur-containing amino acids, it has the effects of dilating blood vessels, lowering blood pressure, lowering blood lipids, preventing arteriosclerosis, and is beneficial to prevent complications of diabetes.
Crisp and sweet, with a sugar content of only 1.6%, diabetics can eat this instead of fruits and get vitamin C, carotene, cellulose, minerals, etc. from it.
Cucumber also contains glyceric acid, which can inhibit the carbohydrates from turning into fat in the body. Therefore, people with obesity and those with hypertension and hyperlipidemia should eat more cucumbers.
3. Bamboo shoots
Both sugar and fat are very low, and lettuce contains insulin activators, which is beneficial for diabetics. Bamboo shoots are high-fiber foods that can delay the digestion of glucose and glucose absorption in the gut of diabetic patients and help control postprandial blood sugar.
4. Bitter gourd
The meat is soft and tender, and has a bitter cold taste. It is rich in various nutrients, especially the content of vitamin C is the highest among various melons. Pharmacological tests found that the balsam pear saponin contained in balsam pear has a very obvious hypoglycemic effect, not only has an insulin-like effect, can be called plant insulin, but also has the function of stimulating insulin release.
Some people have tested that the total effective rate of bitter melon saponin preparation for oral treatment of type 2 diabetes can reach 78.3%. Therefore, diabetic patients often eat bitter gourds to help control blood sugar.
Healthy life with diabetes through knowledge and action
All about diabetes in short
Symptoms reveal about it so look at them closely.
Through the above introduction, do you have a better understanding of the relevant knowledge of diabetes? Diabetic patients will experience symptoms such as weight loss, increased drinking water and fatigue. If anyone has these symptoms, it is recommended to go to the hospital for a check-up to ensure that you have diabetes.
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