Treatment of diabetes mellitus of various types: means and methods. Treatment of various types of diabetes mellitus: means and methods What does type 2 diabetes mean?

The main goals of treatment for any type of diabetes include maintaining a normal lifestyle; normalization of the metabolism of carbohydrates, proteins and fats; prevention of hypoglycemic reactions; prevention of late complications (consequences) of diabetes; psychological adaptation to life with a chronic disease. These goals can only be partially achieved in diabetic patients, due to the imperfection of modern replacement therapy. At the same time, today it is firmly established that the closer a patient’s glycemia is to normal levels, the less likely it is to develop late complications of diabetes.

Despite numerous publications devoted to the treatment of type 2 diabetes mellitus, the vast majority of patients do not achieve compensation for carbohydrate metabolism, although their overall health may remain good. A diabetic does not always realize the importance of self-control and studies glycemia from time to time. The illusion of relative well-being, based on normal well-being, delays the start of drug treatment in many patients with type 2 diabetes. In addition, the presence of morning normoglycemia does not exclude decompensation of diabetes mellitus in such patients.

The key to successful treatment of patients with type 2 diabetes is training in diabetes school. Educating patients about managing and managing their diabetes at home is extremely important.

Diet for the treatment of type 2 diabetes mellitus

90% of people with type 2 diabetes have some degree of obesity, so weight loss through low-calorie diets and exercise is a priority. It is necessary to motivate the patient to lose weight, since even a moderate weight loss (by 5–10% of the original) can achieve a significant reduction in glycemia, blood lipids and blood pressure. In some cases, the condition of patients improves so much that there is no need for glucose-lowering drugs.

Treatment usually begins with the selection of a diet and, if possible, expanding the amount of physical activity. Diet therapy is the basis for the treatment of type 2 diabetes mellitus. Diet therapy consists of prescribing a balanced diet containing 50% carbohydrates, 20% proteins and 30% fats and observing regular 5-6 meals a day - table No. 9. Strict adherence to diet No. 8 with fasting days for obesity and increasing physical activity can significantly reduce the need in hypoglycemic drugs.

Physical exercise, by reducing insulin resistance, helps reduce hyperinsulinemia and improves carbohydrate tolerance. In addition, the lipid profile becomes less atherogenic - total plasma cholesterol and triglycerides decrease and high-density lipoprotein cholesterol increases.

A low-calorie diet can be balanced or unbalanced. With a balanced low-calorie diet, the total calorie content of food is reduced without changing its qualitative composition, in contrast to an unbalanced diet low in carbohydrates and fats. Patients' diets should include foods high in fiber (cereals, vegetables, fruits, wholemeal bread). It is recommended to include fiber, pectin or guar-guar in the diet in an amount of 15 g/day. If it is difficult to limit fat in food, it is necessary to take orlistat, which prevents the breakdown and absorption of 30% of the taken fat and, according to some data, reduces insulin resistance. Results from diet monotherapy can only be expected if the weight is reduced by 10% or more from the original. This can be achieved by increasing physical activity along with a low-calorie, balanced diet.

Today, aspartame (a chemical compound of aspartic and phenylalanine amino acids), sucrasite, sladex, and saccharin are widely used among sweeteners. Acarbose, an amylase and sucrase antagonist that reduces the absorption of complex carbohydrates, can be included in the diet of a diabetic patient.

Exercise to treat type 2 diabetes

Daily exercise is essential for type 2 diabetes. At the same time, the absorption of glucose by muscles, the sensitivity of peripheral tissues to insulin increases, the blood supply to organs and tissues improves, which leads to a decrease in hypoxia, an inevitable companion of poorly compensated diabetes at any age, especially the elderly. The amount of physical exercise in the elderly, hypertensive patients and those with a history of myocardial infarction should be determined by a doctor. If there are no other instructions, you can limit yourself to a daily 30-minute walk (3 times 10 minutes each).

In case of decompensation of diabetes mellitus, physical exercises are ineffective. With heavy physical exertion, hypoglycemia may develop, so the dose of glucose-lowering drugs (and especially insulin) should be reduced by 20%.

If diet and exercise fail to achieve normoglycemia, if this treatment does not normalize the impaired metabolism, you should resort to drug treatment for type 2 diabetes mellitus. In this case, tableted hypoglycemic drugs, sulfonamides or biguanides are prescribed, and if they are ineffective, a combination of sulfonamides with biguanides or hypoglycemic drugs with insulin. New groups of drugs are secretagogues (NovoNorm, Starlix) and insulin sensitizers that reduce insulin resistance (thiazolidinedione derivatives - pioglitazone, Actos). When residual insulin secretion is completely depleted, they switch to insulin monotherapy.

Drug treatment of type 2 diabetes mellitus

More than 60% of patients with type 2 diabetes are treated with oral glucose-lowering drugs. For more than 40 years, sulfonylureas have remained the mainstay of oral glucose-lowering therapy for type 2 diabetes mellitus. The main mechanism of action of sulfonylurea drugs is stimulation of the secretion of intrinsic insulin.

Any sulfonylurea drug, after oral administration, binds to a specific protein on the membrane of the pancreatic β-cell and stimulates insulin secretion. In addition, some sulfonylurea drugs restore (increase) the sensitivity of β-cells to glucose.

Sulfonylurea drugs are attributed to the effect of increasing the sensitivity of fat, muscle, liver and some other tissue cells to the action of insulin, and enhancing glucose transport in skeletal muscles. For patients with type 2 diabetes mellitus with well-preserved insulin secretion function, a combination of a sulfonylurea drug with a biguanide is effective.

Sulfonamides (sulfonylurea drugs) are derivatives of the urea molecule in which the nitrogen atom is replaced by various chemical groups, which determines the pharmacokinetic and pharmacodynamic differences of these drugs. But they all stimulate insulin secretion.

Sulfonamide medications are rapidly absorbed, even when taken with food, and can therefore be taken with meals.

Suphanilamides for the treatment of type 2 diabetes mellitus

Let us give a brief description of the most common sulfonamides.

Tolbutamide (Butamide, Orabet), tablets of 0.25 and 0.5 g - the least active among sulfonamides, has the shortest duration of action (6-10 hours), and therefore can be prescribed 2-3 times a day. Although this is one of the first sulfonylurea drugs, it is still used today because it has few side effects.

Chlorpropamide (Diabenez), tablets of 0.1 and 0.25 g - have the longest duration of action (more than 24 hours), taken once a day, in the morning. It causes many side effects, the most serious being long-term and difficult to eliminate hypoglycemia. Severe hyponatremia and Antabuse-like reactions were also observed. Currently, chlorpropamide is rarely used.

Glibenclamide (Maninil, Betanaz, Daonil, Euglucon), 5 mg tablets, is one of the sulfonamides commonly used in Europe. It is prescribed, as a rule, 2 times a day, morning and evening. The modern pharmaceutical form is micronized maninil at 1.75 and 3.5 mg, it is better tolerated and more powerful.

Glipizide (Diabenez, Minidiab), tablets 5 mg/tablet. Like glibenclamide, this drug is 100 times more active than tolbutamide, the duration of action reaches 10 hours, and is usually prescribed 2 times a day.

Gliclazide (Diabeton, Predian, Glidiab, Glizide), 80 mg tablets - its pharmacokinetic parameters are somewhere between those of glibenclamide and glipizide. Usually prescribed 2 times a day, now there is modified release diabeton, it is taken 1 time per day.

Gliquidone (Glurenorm), tablets of 30 and 60 mg. The drug is completely metabolized by the liver to an inactive form, so it can be used for chronic renal failure. It practically does not cause severe hypoglycemia, therefore it is especially indicated for elderly patients.

Modern 3rd generation sulfonamides include glimepiride (Amaryl), tablets of 1, 2, 3, 4 mg. It has a powerful, prolonged hypoglycemic effect, similar to Maninil. Used once a day, maximum daily dose 6 mg.

Side effects of sulfonamides

Severe hypoglycemia occurs infrequently during treatment with sulfonamides, mainly in patients receiving chlorpropamide or glibenclamide. The risk of developing hypoglycemia is especially high in elderly patients with chronic renal failure or against the background of an acute intercurrent illness, when food intake is reduced. In the elderly, hypoglycemia is manifested mainly by mental or neurological symptoms, making its recognition difficult. In this regard, it is not recommended to prescribe long-acting sulfonamides to elderly people.

Very rarely, in the first weeks of treatment with sulfonamides, dyspepsia, skin hypersensitivity or a reaction of the hematopoietic system develop.

Since alcohol suppresses gluconeogenesis in the liver, its intake may cause hypoglycemia in a patient receiving sulfonamides.

Reserpine, clonidine and non-selective beta-blockers also contribute to the development of hypoglycemia by suppressing counter-insulin regulatory mechanisms in the body and, in addition, can mask the early symptoms of hypoglycemia.

Diuretics, glucocorticoids, sympathomimetics and nicotinic acid reduce the effect of sulfonamides.

Biguanides (metformin) for the treatment of type 2 diabetes mellitus

Biguanides, derivatives of guanidine, enhance glucose uptake by skeletal muscles. Biguanides stimulate lactate production in the muscles and/or organs of the abdominal cavity and therefore many patients receiving biguanides have elevated lactate levels. However, lactic acidosis develops only in patients with reduced elimination of biguanides and lactate or with increased production of lactate, in particular in patients with reduced renal function (they are contraindicated with elevated serum creatinine levels), liver disease, alcoholism and cardiopulmonary failure. Lactic acidosis was especially common when taking phenformin and buformin, which is why they are discontinued.

For today only metformin (Glucophage, Siofor, Diformin, Dianormet) used in clinical practice for the treatment of type 2 diabetes mellitus. Since metformin reduces appetite and does not stimulate hyperinsulinemia, its use is most justified in obese patients with diabetes, making it easier for such patients to adhere to the diet and promoting weight loss. Metformin also improves lipid metabolism, reducing the level of low-density lipoproteins.

Interest in metformin has now increased dramatically. This is due to the peculiarities of the mechanism of action of this drug. We can say that metformin basically increases tissue sensitivity to insulin, suppresses the production of glucose by the liver and, naturally, reduces fasting glycemia and slows down the absorption of glucose in the gastrointestinal tract. There are additional effects of this drug that have a positive effect on fat metabolism, blood clotting and blood pressure.

The half-life of metformin, which is completely absorbed in the intestine and metabolized in the liver, is 1.5-3 hours, and therefore it is prescribed 2-3 times a day during or after meals. Treatment begins with minimal doses (0.25–0.5 g in the morning) to prevent adverse reactions in the form of dyspeptic symptoms, which are observed in 10% of patients, but disappear quickly in the majority. In the future, if necessary, the dose can be increased to 0.5–0.75 g per dose, prescribing the drug 3 times a day. Maintenance dose – 0.25–0.5 g 3 times a day.

Treatment with biguanides should be discontinued immediately when the patient develops acute kidney disease, liver disease, or cardiopulmonary failure.

Since sulfonamides mainly stimulate insulin secretion, and metformin improves mainly its action, they can complement each other's hypoglycemic effect. The combination of these drugs does not increase the risk of side effects, is not accompanied by adverse interactions, and therefore they are successfully combined in the treatment of type 2 diabetes mellitus.

Combinations of drugs in the treatment of type 2 diabetes mellitus

The advisability of using sulfonylurea drugs is beyond doubt, because the most important link in the pathogenesis of type 2 diabetes mellitus is a secretory defect of the β-cell. On the other hand, insulin resistance is an almost constant feature of type 2 diabetes mellitus, which necessitates the use of metformin.

Metformin in combination with sulfonylureas– a component of effective treatment, has been intensively used for many years and allows for a reduction in the dose of sulfonylurea drugs. According to the researchers, combination therapy with metformin and sulfonylureas is as effective as combination therapy with insulin and sulfonylureas.

Confirmation of the observations that combination therapy with sulfonylurea and metformin has significant advantages over monotherapy contributed to the creation of an official form of the drug containing both components (Glibomet).

To achieve the main goals of treating diabetes mellitus, it is necessary to change the previously established stereotype of treating patients and move to more aggressive treatment tactics: early initiation of combination treatment with oral hypoglycemic drugs, in some patients - almost from the moment of diagnosis.

Simplicity, effectiveness and relative cheapness explain the fact that secretogens successfully complement metformin. The combined drug Glucovance, containing metformin and a micronized form of glibenclamide in one tablet, is the most promising representative of a new form of antidiabetic drugs. It turned out that the creation of Glucovance clearly improves not only patient compliance, but also reduces the total number and intensity of side effects with the same or better effectiveness.

Advantages of Glucovance over Glibomet (metformin 400 mg + glibenclamide 2.5 mg): Metformin forms a soluble matrix in which micronized glibenclamide particles are evenly distributed. This allows glibenclamide to act faster than the non-micronized form. The rapid achievement of peak concentrations of glibenclamide allows you to take Glucovance with food, this, in turn, reduces the frequency of gastrointestinal effects that occur when taking Glibomet. The undoubted advantage of Glucovance is the presence of 2 dosages (metformin 500 + glibenclamide 2.5, metformin 500 + glibenclamide 5), which allows you to quickly select an effective treatment.

Adding basal insulin (Monotard NM type) at an average dose of 0.2 units per 1 kg of body weight, it is recommended to start combination therapy as a single injection at night (22.00), usually the dose is increased by 2 units every 3 days until the target glycemic values of 3.9–7.2 mmol are achieved /l. In case of a high initial level of glycemia, it is possible to increase the dose by 4 units every 3 days.

Secondary resistance to sulfonamide drugs.

Despite the fact that the leading mechanism for the development of type 2 diabetes mellitus is tissue insulin resistance, insulin secretion in these patients also decreases over the years, and therefore the effectiveness of treatment with sulfonamides decreases over time: in 5–10% of patients annually and in the majority - after 12 –15 years of therapy. This loss of sensitivity is called secondary resistance to sulfonamides, as opposed to primary resistance, when they are ineffective from the very beginning of treatment.

Resistance to sulfonamides is manifested by progressive weight loss, the development of fasting hyperglycemia, post-nutrition hyperglycemia, increasing glycosuria and increasing HbA1c levels.

In case of secondary resistance to sulfonamides, a combination of insulin (IPD) and sulfonamides is first prescribed. The likelihood of a positive effect of combination therapy is high when it is prescribed at the earliest stages of the development of secondary resistance, i.e., at a fasting blood glucose level between 7.5–9 mmol/l.

It is possible to use pioglitazone (Actos), a drug that reduces insulin resistance, allowing you to reduce the dose of IPD and, in some cases, cancel it. Take Actos 30 mg once a day. It can be combined with both metformin and sulfonylureas.

But the most common scheme of combination treatment is that previously prescribed treatment with sulfonamides is supplemented with small doses (8-10 units) of drugs with an average duration of action (for example, NPH or ready-made “mixes” - mixtures of short- and long-acting drugs) 1-2 times a day. day (8.00, 21.00). The dose is increased in increments of 2–4 units every 2–4 days. In this case, the dose of sulfonamide should be maximum.

This treatment can be combined with a low-calorie diet (1000–1200 kcal/day) for diabetes mellitus in obese people.

If the single dose insulin regimen is ineffective, it is administered 2 times a day, with glycemic control at critical points: on an empty stomach and at 17.00.

Typically, the required dose of IPD is 10–20 units/day. When the need for insulin is higher, this indicates complete resistance to sulfonamides, and then insulin monotherapy is prescribed, i.e., sulfonamide drugs are completely canceled.

The arsenal of glucose-lowering drugs used in the treatment of type 2 diabetes mellitus is quite large and continues to grow. In addition to sulfonylureas and biguanides, these include secretogens, amino acid derivatives, insulin sensitizers (thiazolidinediones), α-glucosidase inhibitors (Glucobay) and insulins.

Glycemic regulators for the treatment of type 2 diabetes mellitus

Based on the important role of amino acids in the process of insulin secretion by β-cells directly during meals, scientists studied the hypoglycemic activity of phenylalanine and benzoic acid analogues and synthesized nateglinide and repaglinide (NovoNorm).

Novonorm is an oral fast-acting hypoglycemic drug. Quickly reduces blood glucose levels by stimulating the release of insulin from functioning pancreatic β-cells. The mechanism of action is associated with the ability of the drug to close ATP-dependent channels in β-cell membranes due to its effect on specific receptors, which leads to cell depolarization and the opening of calcium channels. The resulting increased calcium influx induces insulin secretion from β cells.

After taking the drug, an insulinotropic response to food intake is observed within 30 minutes, which leads to a decrease in blood glucose levels. During the periods between meals, there is no increase in insulin concentration. In patients with type 2 non-insulin-dependent diabetes mellitus, when taking the drug in doses of 0.5 to 4 mg, a dose-dependent decrease in blood glucose levels is observed.

Insulin secretion stimulated by nateglinide and repaglinide is close to the physiological early phase of postprandial hormone secretion in healthy individuals, resulting in an effective reduction in postprandial glucose peaks. They have a quick and short-term effect on insulin secretion, thereby preventing a sharp increase in glycemia after meals. If you skip a meal, these drugs are not used.

Nateglinide (Starlix)– a derivative of phenylalanine. The drug restores early insulin secretion, which leads to a decrease in postprandial blood glucose concentrations and the level of glycosylated hemoglobin (HbA1c).

Under the influence of nateglinide, taken before meals, the early (or first) phase of insulin secretion is restored. The mechanism of this phenomenon is the rapid and reversible interaction of the drug with K+ATP-dependent channels of pancreatic β-cells.

The selectivity of nateglinide for K+ATP-dependent channels of pancreatic β-cells is 300 times greater than that for channels of the heart and blood vessels.

Nateglinide, unlike other oral hypoglycemic agents, causes pronounced insulin secretion within the first 15 minutes after a meal, thereby smoothing out postprandial fluctuations (“peaks”) in blood glucose concentrations. Over the next 3–4 hours, insulin levels return to their original values. In this way, postprandial hyperinsulinemia, which can lead to delayed hypoglycemia, is avoided.

Starlix should be taken before meals. The time interval between taking the drug and eating should not exceed 30 minutes. When using Starlix as monotherapy, the recommended dose is 120 mg 3 times a day (before breakfast, lunch and dinner). If this dosing regimen fails to achieve the desired effect, the single dose can be increased to 180 mg.

Another prandial glycemic regulator is acarbose (Glucobay). Its action occurs in the upper part of the small intestine, where it reversibly blocks α-glucosidases (glucoamylase, sucrase, maltase) and prevents the enzymatic breakdown of poly- and oligosaccharides. This prevents the absorption of monosaccharides (glucose) and reduces the sharp rise in blood sugar after eating.

Inhibition of α-glucosidase by acarbose occurs on the principle of competition for the active site of the enzyme located on the surface of the microvilli of the small intestine. By preventing a rise in glycemia after a meal, acarbose significantly reduces the level of insulin in the blood, which helps improve the quality of metabolic compensation. This is confirmed by a decrease in the level of glycated hemoglobin (HbA1c).

The use of acarbose as the only oral antidiabetic agent is sufficient to significantly reduce metabolic disorders in patients with type 2 diabetes mellitus that are not compensated by diet alone. In cases where such tactics do not lead to the desired results, the administration of acarbose with sulfonylurea drugs (Glyurenorm) leads to a significant improvement in metabolic parameters. This is especially important for elderly patients who are not always ready to switch to insulin therapy.

In patients with type 2 diabetes mellitus receiving insulin therapy and acarbose, the daily insulin dose decreased by an average of 10 units, while in patients receiving placebo, the insulin dose increased by 0.7 units.

The use of acarbose significantly reduces the dose of sulfonylurea drugs. The advantage of acarbose is that when used alone, it does not cause hypoglycemia.

Modern conditions dictate the need to create new drugs that not only eliminate metabolic disorders, but also maintain the functional activity of pancreatic cells, stimulating and activating the physiological mechanisms regulating insulin secretion and blood glucose levels. In recent years, it has been shown that the regulation of glucose levels in the body, in addition to insulin and glucagon, also involves incretin hormones produced in the intestines in response to food intake. Up to 70% of postprandial insulin secretion in healthy individuals is due to the effect of incretins.

Incretins in the treatment of type 2 diabetes mellitus

The main representatives of incretins are glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GPP-1).

The entry of food into the digestive tract rapidly stimulates the release of GIP and GLP-1. Incretins may also reduce glycemic levels through non-insulin mechanisms by slowing gastric emptying and reducing food intake. In type 2 diabetes, the content of incretins and their effect are reduced, and the level of glucose in the blood is increased.

The ability of GLP-1 to cause improvements in glycemic control is of interest in the treatment of type 2 diabetes mellitus (the emergence of the incretin mimetics class). GLP-1 has multiple effects on the endocrine pancreas, but its principal effect is to potentiate glucose-dependent insulin secretion.

Increased levels of intracellular cAMP stimulate GLP-1 receptors (rGLP-1), leading to exocytosis of insulin granules from β-cells. Increased cAMP levels thus serve as the primary mediator of GLP-1-induced insulin secretion. GLP-1 enhances insulin gene transcription, insulin biosynthesis, and promotes β-cell proliferation through activation of rGLP-1. GLP-1 also potentiates glucose-dependent insulin secretion through intracellular pathways. In a study by C. Orskov et al. It has been shown in vivo that GLP-1, when acting on α-cells, causes a decrease in glucagon secretion.

Improvement in glycemic parameters after GLP-1 administration may result from restoration of normal β-cell function. An in vitro study suggests that glucose-resistant β-cells become glucose competent after GLP-1 administration.

The term “glucose competence” is used to describe the functional state of β-cells that sense glucose and secrete insulin. GLP-1 has an additional hypoglycemic effect that is not associated with the effect on the pancreas and stomach. In the liver, GLP-1 inhibits glucose production and promotes glucose uptake into fat and muscle tissue, but these effects are secondary to the regulation of insulin and glucagon secretion.

An increase in the mass of β-cells and a decrease in their apoptosis is a valuable quality of GLP-1 and is of particular interest for the treatment of type 2 diabetes mellitus, since the main pathophysiological mechanism of this disease is progressive β-cell dysfunction. Incretin mimetics used in the treatment of type 2 diabetes mellitus include 2 classes of drugs: GLP-1 agonists (exenatide, liraglutide) and dipeptidyl peptidase-4 (DPP-4) inhibitors, which destroy GLP-1 (sitagliptin, vildagliptin).

Exenatide (Bayeta) isolated from the saliva of the giant lizard Gila monster. The amino acid sequence of exenatide is 50% identical to human GLP-1. With subcutaneous administration of exenatide, its peak plasma concentration occurs after 2–3 hours, and the half-life is 2–6 hours. This allows exenatide therapy to be administered in the form of 2 subcutaneous injections per day before breakfast and dinner. A long-acting exenatide has been created, but not yet registered in Russia - Exenatide LAR, administered once a week.

Liraglutide is a new drug, an analogue of human GLP-1, its structure is 97% similar to human. Liraglutide maintains a stable concentration of GLP-1 for 24 hours when administered once a day.

DPP-4 inhibitors for the treatment of type 2 diabetes mellitus

The GLP-1 drugs developed to date do not have oral forms and require mandatory subcutaneous administration. Drugs from the group of DPP-4 inhibitors do not have this drawback. By inhibiting the action of this enzyme, DPP-4 inhibitors increase the level and lifespan of endogenous GIP and GLP-1, helping to enhance their physiological insulinotropic effect. The drugs are available in tablet form and are usually prescribed once a day, which significantly increases patient adherence to therapy. DPP-4 is a membrane-binding serine protease from the group of prolyl oligopeptidases; its main substrate is short peptides such as GIP and GLP-1. The enzymatic activity of DPP-4 against incretins, especially GLP-1, suggests the possibility of using DPP-4 inhibitors in the treatment of patients with type 2 diabetes mellitus.

The peculiarity of this approach to treatment is in increasing the duration of action of endogenous incretins (GLP-1), i.e. mobilizing the body’s own reserves to combat hyperglycemia.

DPP-4 inhibitors include sitagliptin (Januvia) and vildagliptin (Galvus), recommended by the FDA (USA) and the European Union for the treatment of type 2 diabetes mellitus, both as monotherapy and in combination with metformin or thiazolidinediones.

The most promising is the combination of DPP-4 inhibitors and metformin, which allows influencing all the main pathogenetic mechanisms of type 2 diabetes mellitus - insulin resistance, the secretory response of β-cells and hyperproduction of glucose by the liver.

The drug GalvusMet (50 mg vildagliptin + metformin 500, 850 or 100 mg) was created, which was registered in 2009.

Insulin therapy for type 2 diabetes mellitus.

Despite the definition of type 2 diabetes mellitus as “non-insulin-dependent,” a large number of patients with this type of diabetes eventually develop absolute insulin deficiency, which requires the prescription of insulin (insulin-dependent diabetes mellitus).

Treatment with insulin in the form of monotherapy is indicated primarily for primary resistance to sulfonamides, when treatment with diet and sulfonamides does not lead to optimal glycemic levels within 4 weeks, as well as for secondary resistance to sulfonamides against the background of depletion of endogenous insulin reserves, when it is necessary to compensate metabolism, the dose of insulin prescribed in combination with sulfonamides is high (more than 20 units/day). The principles of treating insulin-requiring diabetes mellitus and type 1 diabetes mellitus with insulin are almost the same.

According to the American Diabetes Association, after 15 years, most people with type 2 diabetes will require insulin. However, a direct indication for monoinsulin therapy for type 2 diabetes mellitus is a progressive decrease in insulin secretion by pancreatic β-cells. Experience shows that approximately 40% of patients with type 2 diabetes require insulin therapy, but in reality this percentage is much lower, often due to patient resistance. In the remaining 60% of patients for whom monoinsulin therapy is not indicated, unfortunately, treatment with sulfonylurea drugs also does not lead to compensation for diabetes mellitus.

Even if it is possible to reduce glycemia during daylight hours, then almost everyone retains morning hyperglycemia, which is caused by nocturnal glucose production by the liver. The use of insulin in this group of patients leads to an increase in body weight, which aggravates insulin resistance and increases the need for exogenous insulin; in addition, the inconvenience caused to the patient by frequent dosing of insulin and several injections per day should be taken into account. Excess insulin in the body also causes concern among endocrinologists, because it is associated with the development and progression of atherosclerosis and arterial hypertension.

According to WHO experts, insulin therapy for type 2 diabetes mellitus should be started neither too early nor too late. There are at least 2 ways to limit insulin doses in patients who are not compensated by sulfonylureas: a combination of a sulfonylurea with long-acting insulin (especially at night) and a combination of a sulfonylurea with metformin.

Combination treatment with sulfonylureas and insulin has significant advantages and is based on complementary mechanisms of action. High blood glucose levels have a toxic effect on β-cells, thereby reducing insulin secretion, and administering insulin by lowering glycemia can restore the pancreatic response to sulfonylureas. Insulin suppresses the production of glucose in the liver at night, which leads to a decrease in fasting blood glucose levels, and sulfonylurea causes an increase in insulin secretion after meals, controlling blood glucose levels during the day.

A number of studies have compared two groups of patients with type 2 diabetes, one group receiving insulin therapy alone, and the other receiving combination therapy with nightly insulin and a sulfonylurea. It turned out that after 3 and 6 months, the indicators of glycemia and glycated hemoglobin decreased significantly in both groups, but the average daily dose of insulin in the group of patients receiving combination treatment was 14 IU, and in the monoinsulin therapy group - 57 IU per day.

The average daily dose of extended-release insulin at bedtime to suppress nocturnal glucose production by the liver is usually 0.16 U/kg/day. With this combination, there was an improvement in glycemic indicators, a significant reduction in the daily dose of insulin and, accordingly, a decrease in insulinemia. Patients noted the convenience of such treatment and expressed a desire to more accurately comply with the prescribed regimen.

Insulin monotherapy for type 2 diabetes mellitus, i.e. not combined with sulfonamides, is necessarily prescribed for severe metabolic decompensation that has developed during treatment with sulfonamides, as well as for painful peripheral neuropathy, amyotrophy or diabetic foot, gangrene (ICD therapy only or "bolus-basal").

Every patient should strive to achieve good compensation for diabetes from the first days of the disease, which is facilitated by their education in “diabetes schools.” And where schools of this kind are not organized, patients should be provided with at least special educational materials and diabetes diaries. Independent and effective treatment also involves providing all diabetic patients with portable means for rapid testing of glycemia, glucosuria and ketonuria at home, as well as ampoules with glucagon to eliminate severe hypoglycemia (hypokit kit).

Many people know about diabetes. But not everyone is aware of the division of the presented disease into two types. This is what they are called: type 1 diabetes mellitus And diabetes mellitus type 2.

requires mandatory and timely administration of insulin. But type 2 occurs today in every fourth person in the world, which the patients themselves are not even aware of.

Such ignorance can lead to a number of complications that can be prevented if general supportive therapy is started on time.

Type 2 diabetes – what is it?

Surprisingly, the two types of diabetic disease differ significantly.

Type 1 diabetes characterized by the absence or insufficiency of the amount of insulin necessary for normal functioning, which leads to disturbances in the conversion of sugar into glucose and the timeliness of its elimination.

That is why patients with this disease should resort to insulin administration in a timely manner, since high sugar levels in a person’s blood are fraught with general malaise and gradual destruction of internal organs.

Type 2 diabetes mellitus is a metabolic disease that is accompanied by constant hyperglycemia due to the lack of sensitivity of cells to produced insulin.

That is type 2 diabetes is not associated with the production of insulin - here immunity to the effects of this enzyme is determined, which also leads to increased blood sugar, and therefore the subsequent destruction of vascular cells and internal organs.

Symptoms of type 2 diabetes mellitus

The symptoms of this disease are often not taken seriously by patients, because they do not appear so intensely at the initial stage of diabetes development.

A person may not be aware of the disruption of insulin receptors in the body's cells for several years or his entire life.

As a rule, in such cases everything ends quite sadly, since it begins, before which the person feels severe pain in the head, stomach, suffers from diarrhea and vomiting, drowsiness and lethargy.

If you do not pay attention to the presented symptoms in time, the patient’s blood pressure drops, tachycardia begins, and after some time there is loss of consciousness and a coma.

In order to prevent such unpleasant manifestations, you should already at the stage of initial manifestation consult a doctor for help and to undergo an appropriate examination. Symptoms characteristic of diabetes include:

dry mouth;
unbearable and inexplicable thirst;
large amount of urine excreted both day and night;
good appetite, but the patient may lose weight;
itching of the skin, in men there is inflammation of the foreskin;
constant drowsiness and just general malaise.

Women can also pay attention to characteristic white sand on underwear, which appears some time after visiting the toilet. There is also itching in the intimate area and vagina, which is often mistaken for ordinary candidiasis.

Reasons for the development of the disease

There are three main reasons contributing to the development of diabetes:

1. Age-related changes in the human body. Elderly people should be especially attentive to their condition, since with age the body loses tolerance ( absorptive capacity) to glucose, which can manifest itself in the development of type 2 diabetes mellitus.

Genetic predisposition also plays an important role here, which in most cases leads to the development of the disease, because in some older people, despite disorders, blood sugar levels are within normal limits.

2. Obesity and overweight– the presented aspects lead to an increase in cholesterol in human blood. The consequence of this feature is the coating of blood vessels with a cholesterol film and a reduced oxygen supply.

The walls of blood vessels, which have already undergone hypoxia and the development of atherosclerosis, cannot fully absorb insulin produced in the required quantities and incoming glucose.

3. Excessive carbohydrate intake– these enzymes lead to depletion of the pancreas and subsequent damage to insulin receptors in the blood.

The risk group includes people with a genetic predisposition, obesity, the development of atherosclerosis, heart and pancreas diseases, and the presence of allergic manifestations.

Under any circumstances, only regular examination will help to identify the disease in a timely manner.

Diabetes mellitus type 2: diet and treatment

Treatment of diabetes mellitus of this type is possible only by following a diet and taking medications that will help lower blood sugar, which has a positive effect on the general condition of the patient.

The diet involves reducing the consumption of foods high in carbohydrates, and vitamins and hypoglycemic drugs are always used as treatment.

Type 2 diabetes: diet and nutrition

The basis of nutrition for type 2 diabetes is a low-carbohydrate diet, where all foods containing large amounts of carbohydrates are prohibited.

Of course, a complete rejection of buns, bread and other flour products should not follow. They can be replaced with varieties where for cooking wholemeal flour or durum wheat was used (for example, pasta).

Of course, the consumption of even such products should be reduced significantly.

Also prohibited are foods high in sugar - these are sweets, cakes, cookies and other sweets.

Such consumption will lead to a sharp increase in blood sugar, which will lead to malaise, because the insulin produced will very slowly convert sugar into glucose ( or it won't happen at all).

Many diabetic patients are mistaken eating fruits in unlimited quantities, believing that they contain few carbohydrates. As it turns out in reality, there are plenty of carbohydrates in the pulp of any fruit, just like in vegetables. Therefore, they should be introduced into the diet in small quantities.

There are fruits and vegetables that are completely on the list of prohibited consumption. These include grapes, bananas, melons, potatoes.

The list of products allowed for consumption includes:

all types of meat ( preferably boiled, stewed or baked);

fermented milk products in the absence of sugar and artificial flavors;

vegetables - beets, carrots, cauliflower and white cabbage, cucumbers, tomatoes, green beans, zucchini and eggplant, celery and other salads;

fruits - apples, pears, plums, apricots and other varieties with low sugar content;

eggs;

mushrooms of all varieties.

Additives are used in moderation - spices, sunflower and butter, mayonnaise and ketchup.

You should also try to include foods high in fiber in large quantities into your diet. This enzyme helps eliminate incoming carbohydrates, which does not burden the pancreas with work and has a positive effect on the condition of the blood.

As for the general principles of nutrition, diabetics should eat small amounts every 3 hours. Patients are prohibited from any diets or experiments in nutrition.

The benefits of vitamins for type 2 diabetes

As mentioned above, in the presence of this disease, patients experience increased urination. This leads to the leaching of beneficial vitamins and microelements, which also contributes to the destruction of cells and tissues.

To prevent deterioration, experts prescribe patients to take a complex of vitamins. For general information, here are some names of vitamins for type 2 diabetics:

General complex of vitamins for the eyes– help prevent the development of diabetic retinopathy, cataracts and glaucoma. Here you can take Lutein-Complex, Optics, Blueberry Forte.
Vitamin and mineral set “Alphabet Diabetes”– the complex includes 13 vitamins and 9 minerals, various organic acids and plant extracts. The mineral complex includes magnesium, a useful and important microelement for the body that helps calm the nerves and improves heart function.
"Vervag Pharma" - the drug includes 11 vitamins and 2 important minerals - chromium and zinc. Both microelements help eliminate cravings for sweets and other unhealthy foods in type 2 diabetes.
"Doppelhertz Active"– 10 vitamins and 4 minerals. It is taken to prevent damage to the retina and kidney tissue.
"Complivit Diabetes"– is a dietary supplement that contains 14 vitamins and 4 important minerals. The complex also includes folic, lipoic acid and ginkgo biloba extract, which helps improve peripheral circulation and acts as a preventive measure for diseases of the nervous system.
"Complivit Calcium D3"– helps improve the structure of bone tissue and the surface of teeth, perfectly controls protein production.

There are many vitamins for use in diabetes, it is only important to choose them correctly. The attending physician and a comprehensive examination will help in resolving the issue, which will help identify the problems that have begun against the background of type 2 diabetes.

Symptoms of diabetes, video:

Treating diabetes at home

Considering the issue, how to treat diabetes at home, a list of medications recommended for use should be provided.

The influence of the drugs presented below helps to improve the general condition and launch the necessary processes for normal life.

All medications are divided into three groups:

1. Alpha-glucosidase inhibitors– promote the absorption of glucose in the intestine, prevent the rapid breakdown of carbohydrates in the small intestine, which helps regulate sudden jumps in glycemia.

But the presented drugs cannot be used for a long time - they can lead to complications in the form of dysbiosis and inflammation of the intestinal walls. Here we can highlight drugs such as Akarbaza and Magnitol.

2. Biguanides – help increase the sensitivity of cells to insulin produced in normal quantities. They can be used in the presence of liver, kidney and heart diseases.

Metformin is isolated here ( Glucophage and Siofor) and Gliformin. Gliformin for diabetes mellitus also promotes weight loss.

3. Sulfonylureas– affect the production of deficient insulin, so they are consumed depending on the time and number of meals. This list of pills for type 2 diabetes looks like Maninil, Glyurenorm, Amaryl, Diabeton.

All the drugs and processes presented can significantly reduce blood sugar levels, which has a positive effect on the patient’s condition.

It should be noted that glucose-lowering drugs for type 2 diabetes are determined on the basis of the examination, because doctors should identify the occurring disorders in the patient’s body.

Also drugs cannot be used continuously, since some of them have the property of adaptation in the body, and this is fraught with the useless use of medicines and the deterioration of the patient’s condition.

Diabetes mellitus: treatment with folk remedies

Despite the use of traditional medicine, it is possible and recommended. Basically, all methods are based on lowering blood sugar levels. The following recipes are used here:

Dead bees. Specific beekeeping products can only be used if there is no allergy. Here you can prepare a decoction for which it is used 10-20 dead bees and 2 liters of water. The bees are boiled for 2 hours. The finished decoction is filtered and consumed a glass a day in several doses.
Bay leaf. An infusion of bay leaves helps lower blood sugar, but is approved for use with normal or high blood pressure. 10 dried and crushed bay leaves pour 3 cups of boiling water and infuse for 2 hours. The infusion is used strained in half a glass at least 3 times a day.
. 4-5 rose hips crush and pour a glass of boiling water. Now the composition is boiled for 5 minutes and left to infuse for 5 hours. The strained broth is consumed half an hour before meals each time.
Onion. Baked onions in their entirety have a sweet taste and help reduce blood sugar in the patient. You should only eat vegetables in the morning on an empty stomach in the amount of one medium head.
Aspen bark. Aspen bark also has a hypoglycemic effect for type 2 diabetes. The presented ingredient can be purchased at a pharmacy, which offers already packaged bags for one-time brewing. The bag contains a tablespoon of crushed aspen bark, which is brewed with a glass of boiling water and infused for 5 minutes. The resulting infusion is used as regular tea.
Flax seeds. Flax seeds for type 2 diabetes mellitus help to generally strengthen the body and reduce blood glucose. Here, to prepare a useful drug, you should prepare a decoction using tablespoon of the main ingredient and a glass of boiling water. Pour boiling water over the seeds and boil for 10 minutes. The slightly cooled broth is filtered and the resulting contents are drunk during the day, divided into 2 or 3 doses.

Traditional medicine must be used carefully. It is important to prevent an increase in blood sugar, and not lead to even greater problems, so you should consult your doctor before using traditional medicine.

Benefit or harm from controversial products

There is a whole list of products that cause controversy among experts when used for type 2 diabetes. The debate is whether they should be banned or allowed due to the product's high sugar content but slightly less impact on blood glucose levels.

Persimmon

Persimmon for type 2 diabetes It is not prohibited for consumption, although it contains a large amount of sugar. At a high level, the glycemic index of the product is average and is 45 units.

Of course, excessive consumption of persimmons in the presence of this disease is prohibited, but one fruit per day will not harm the general condition of the body. You should also choose the right fruit and avoid eating unripe fruit, which results in an astringent taste.

Honey

For some reason, many patients prohibit themselves from using honey for type 2 diabetes. Such failures are explained by the high content of sugar and glucose.

However, for the substances contained in the natural product, the presence of insulin during breakdown in the body is not important, and this does not prohibit the consumption of honey, albeit in small quantities.

Kiwi

Increased glucose and protein content leads to a ban on consumption kiwi for type 2 diabetes. But such statements by experts can be considered erroneous, because the presented fruit contains a lot of fiber, and this has a positive effect on the rapid and effective breakdown of glucose entering the body.

In addition, the calorie content of the product is only 50 kcal per 100 g, and the fruit is recommended for consumption if you are overweight.

Pomegranate

Pomegranate for type 2 diabetes is a controversial product because there are “two sides of the same coin.” On the one hand, it contains practically no sugar, which allows its use in case of diabetes.

On the other hand, a high acid content has a destructive effect on the walls of the stomach and tooth enamel. Therefore, experts recommend not to get carried away with grenades and eat no more than half a piece of fruit per day.

Radish

Radish for type 2 diabetes is an indispensable product because it contains a high content of choline, a substance that has a positive effect on the absorption of glucose by the intestines.

In the absence of proper independent release of the substance, and this occurs in the presence of problems with the pancreas, its timely replenishment is important. Therefore, it is recommended to introduce radish into your usual diet.

Beet

Beetroot for type 2 diabetes is a prohibited product. But some experts talk about its benefits due to the high fiber content in the vegetable.

Here the glycemic load, which, along with the glycemic index ( 64 units), is only 5 units, and this can be attributed to the lowest level.

Ginger

The benefits of ginger in the presence of this disease lie in several aspects.

Firstly, it contains more than 400 useful vitamins, trace elements, acids and other components that are so necessary in the absence of insulin production.

Secondly, ginger for type 2 diabetes helps improve metabolic processes and digestion of food, and also has a positive effect on liver function.

The most important advantage from the point of view of the issue under consideration is the prevention of cholesterol accumulation in the patient’s blood vessels, which provokes the development and further progression of type 2 diabetes.

Read more about the beneficial properties of ginger.

Alcohol

Most experts do not support the use alcohol for type 2 diabetes. Of course, this is completely justified, because alcoholic drinks contain large amounts of sugar and carbohydrates.

But drinking 50-100 ml of an alcohol-containing product per day will not harm the body and will not lead to the development of complications. Here you can highlight all drinks whose strength is from 40 degrees and above.

Separately, you should consider drinking beer, which can be called a storehouse of carbohydrates. Fans of this drink should be careful, but drinking one glass a day will not lead to dangerous consequences.

Patients often ask doctors many questions, to which there is not always a clear answer. The most interesting and entertaining include the following:

1. Can type 2 diabetes be cured? It sounds terrible, but it is impossible to cure diabetes of any type. The presented disease is a chronic illness and cannot be completely cured.

Therefore, you should not trust dubious drugs and treatment methods that are offered today by scammers and very unscrupulous sellers and manufacturers.

2. Is it possible to treat type 2 diabetes without medication? It all depends on the degree of neglect of the disease and the characteristics of the violations that occurred.

Yes, sometimes you can avoid the mandatory consumption of medications, but to do this you should adhere to proper and permitted nutrition, use traditional medicine methods, play sports, and physical activity contributes to better absorption of the received portion of glucose.

But such statistics speak about patients with type 1 of the disease, although representatives with type 2 of the disease who do not follow basic diet rules and do not use medications or folk remedies to lower blood glucose levels also fall into the risk group.

Undoubtedly, diabetes is a dangerous disease, but it should not be a death sentence, since there are known cases of successful and full survival of patients into old age, in whom diabetes was diagnosed in childhood.

Here, first of all, what is important is the person’s attitude towards the destruction that has begun. If you start treatment in a timely manner and follow a diet, then type 2 diabetes will not lead to complications, which become the causes of deaths.

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When you are diagnosed with diabetes, it is important to immediately understand the characteristics of the type of disease, as well as how to properly treat it. After all, timely compensation is an almost 100% guarantee of the absence of diabetic complications. In this article you will learn what type 2 diabetes mellitus is, how it progresses, and how to treat it correctly.

What is type 2 diabetes

In type 2 diabetes, the interaction of insulin with the cells of the body is disrupted, which leads to constant.

Also developing insulin resistance, that is, tissues lose sensitivity to insulin.

In the initial stages of the disease, insulin continues to be produced in full, which creates its excess in the body. This depletes the beta cells of the pancreas, and over time, diabetics have to take insulin injections.

This type is the most common and accounts for 80% from all cases of the disease.

People suffer more often after 40 who are severely obese, eat poorly and lead an inactive lifestyle. About the reasons in more detail.

Classification of this type of diabetes

The disease is classified according to severity into the following forms:

mild form - diabetes can be compensated for by dietary nutrition (read about), with the rare intake of one tablet of a sugar-lowering drug. The likelihood of complications developing is minimal.
moderate form - diet alone does not help, and you need to take 2-3 glucose-lowering drugs. Vascular complications are possible.
severe form - with this form, the diabetic is already forced to resort to insulin therapy. Severe complications are common.

Symptoms of type 2 diabetes

There are quite a few symptoms of diabetes and they are described in detail in the article. Now let's look at the most common ones for this type.

Weakness

Infections

Extreme thirst accompanied by unhealthy dry mouth
Development of osmotic diuresis (excessive loss of water through the kidneys)
General weakness and malaise
Itching of the skin and mucous membranes
Obesity, especially in the face
Frequent infections

Diagnosis of type 2 diabetes

The diagnosis is made in the presence of hyperglycemia, as well as after laboratory tests.

When testing for sugar in the patient’s blood, there is ≥ 7.0 mmol/l on an empty stomach and/or ≥ 11,1 mmol/l 2 hours after the glucose tolerance test.

Compensation criteria for type 2 diabetes (click on the picture to enlarge)

Diet and treatment for T2DM

To compensate, you should adhere to a diabetic diet and perform moderate exercise. For mild cases this is quite enough. There are many on our website that will help you maintain a healthy diet and effectively control your sugar levels. Also in the section you will find useful tips that will help you create your menu and better understand the usefulness of certain products.

If speak about medicines , then they are classified into:

increasing the sensitivity of body tissues to insulin (metformin, rosiglitazone, pioglitazone)
enhance insulin secretion (glibenclamide, gliclazide, glimepiride, gliquidone, glipizide, repaglinide, nateglinide)
α glycosidase inhibitors (acarbose)
nuclear alpha receptor activator (fenofibrate Traykor 145 mg)

Only your attending physician can prescribe medications, taking into account all examinations and the individual characteristics of the course of the disease.

What are the complications of type 2 diabetes mellitus?

This type is often considered a mild form, and many people do not take its compensation seriously. It is important to remember that a careless attitude towards your body entails serious troubles.

We have a whole section about complications.

If we talk about the second type, the most common complications are:

vascular system
nervous system
on the eyes

Conclusion

It can be concluded that this type of diabetes is more of a dietary disease. If you do not have an advanced form, you can compensate for the disease with the help of a normal healthy diet.

To avoid complications, always monitor your sugar levels.

Remember that a little effort at the beginning of the disease will help avoid serious problems in the future.

Type 2 diabetes mellitus is a chronic disease in which carbohydrate metabolism is impaired and hyperglycemia develops (pathological increase in blood sugar concentration). This process develops as a result of insulin resistance and disruption of the secretory activity of beta cells, as well as disturbances in lipid metabolism with the formation of atherosclerosis.

The second type of diabetes mellitus occurs when tissue sensitivity to the action of insulin decreases, this is called insulin resistance. In the initial stages of the disease, the hormone is produced in normal, and sometimes in increased volume; over time, excess secretion depletes the beta cells of the pancreas, after which the patient requires insulin injections.

Type 2 diabetes mellitus accounts for almost 90% of all types of the disease; the pathology most often develops in people over 40 years of age, in most cases it is associated with obesity. Type 2 diabetes mellitus progresses slowly, it is characterized by secondary symptoms, and ketoacidosis rarely develops. Without timely and adequate treatment, complications appear - microangiopathy and macroangiopathy, neuropathy and nephropathy, retinopathy.

Causes

The first reason why type 2 diabetes develops is the natural aging of the body. With age, the ability to absorb glucose decreases; if in some people the decrease occurs slowly, then in patients with genetic memory of diabetes mellitus it happens faster.

The second reason for the development of pathology is obesity. Excess weight disrupts the composition of the blood, the level of cholesterol in it increases, cholesterol plaques are deposited on the walls of blood vessels, provoking atherosclerosis. Damaged vessels cope with their duties worse - they cannot fully deliver oxygen and nutrients to organs and tissues, and they themselves experience oxygen starvation, as a result of which they absorb glucose and insulin worse.

The third reason is excess consumption of carbohydrates. A high content of carbohydrates in the blood adversely affects the pancreas, depleting its cells; in addition, carbohydrates damage insulin receptors in all organs and tissues.

Risk factors that provoke type 2 diabetes mellitus:

genetic predisposition;
overweight;
pathological pregnancies;
constant use of glucocorticoids;
the presence of Itsenko-Cushing's disease;
presence of acromegaly;
early development of atherosclerosis (in men - up to 40 years, in women - up to 50 years);
hypertonic disease;
angina pectoris;
early development of cataracts;
eczema, neurodermatitis or other allergic diseases;
a one-time increase in glucose against the background of an infectious disease, stroke, heart attack, pregnancy.

Symptoms

Symptoms of type 2 diabetes:

thirst and dry mouth;
increased appetite;
skin itching, inflammation of the foreskin, itchy sensations in the groin;
frequent urination in large volumes;
decreased vision;
tooth loss.

An important difference between the symptoms of type 2 diabetes mellitus and type 1 diabetes is relative rather than absolute insulin deficiency. For this reason, the patient may not be aware of the disease for several years. If you measure your blood sugar level, you will find a slight increase - up to a maximum of 8-9 mmol per liter when measured on an empty stomach.

Diagnostics

The main diagnosis is aimed at identifying hyperglycemia in patients with typical symptoms of the second type of disease. To make a diagnosis, a fasting blood glucose test is performed.

The test is indicated in the following cases:

in all people over 45 years of age;
if overweight - BMI from 25 kg/m2;
sedentary lifestyle;
hereditary predisposition;
women who gave birth to children weighing 4 kg or more;
arterial hypertension - more than 140/90 mm;
HDL level more than 0.9 mmol/l and/or triglyceride level above 2.8 mmol per liter;
impaired ability to metabolize glucose;
cardiovascular diseases;
polycystic ovary syndrome.

Criteria for diagnosing diabetes mellitus:

		Whole blood glucose, mmol/l		Blood plasma glucose, mmol/l
		venous	capillary	venous	capillary
Diabetes
Diabetes
Impaired ability to metabolize glucose
Impaired ability to metabolize glucose	In 2 hours	more than 6.7; less than 10.0	more than 7.8; less than 11.1	more than 7.8; less than 11.1	more than 8.9; less than 12.2
Impaired fasting glycemia		more than 5.6; less than 6.1	more than 5.6; less than 6.1	more than 6.1; less than 7.0	more than 6.1; less than 7.0
Impaired fasting glycemia	In 2 hours

Treatment

Treatment of type 2 diabetes mellitus is complex, it includes therapy to eliminate hyperglycemia, special diet therapy, physical activity, prevention, as well as therapy for late complications of the disease, primarily atherosclerosis.

Drugs to lower blood glucose concentrations:

Drugs that reduce insulin resistance. These are metformin, as well as thiazolidinediones, metformin is the drug of first choice. Such drugs suppress the process of reducing glucose production by the liver, reduce insulin resistance, activate anaerobic glycolysis, and reduce glucose absorption in the small intestine.
Drugs that enhance insulin secretion. The group includes sulfonylurea derivatives and glinides. Used to lower blood glucose levels after meals.
Drugs that reduce glucose absorption. This group includes acarbose and guar gum. Slow down the processes of fermentation and absorption of carbohydrates, reduces the rate of resorption.
Insulins and their analogues. Maintain compensation of carbohydrate metabolism at a normal level or close to a normal level.

Diet for diabetes

The diet for type 2 diabetics is based on limiting the consumption of carbohydrate foods. The patient’s diet divides all carbohydrates into “light” and “heavy”, the first are quickly absorbed in the intestines and quickly increase blood sugar to a high level, these include glucose and fructose. The latter are absorbed slowly and slightly raise blood sugar levels, these include fiber and starch.

The menu for a type 2 diabetic with obesity plays an important role; in this case, nutrition has not only the main goal of reducing the intake of carbohydrates, which will turn into sugar, but is also based on the ability to get rid of excess weight, which provoked the development of the disease.

Diet for type 2 diabetes prohibits the consumption of foods high in glucose:

granulated sugar;
confectionery - sweets, chocolate, cakes, cookies, etc.;
jam and honey;
baked goods made from white flour;
semolina;
pasta;
grapes and bananas.

The sample diet allows you to consume foods that contain starch and fiber in limited quantities:

black bread;
potato;
grain beans;
all cereals except semolina;
green peas.

The following foods are allowed to be eaten with virtually no restrictions:

all types of meat and fish;
eggs;
unsweetened dairy products;
vegetables;
mushrooms;
fruits.

The patient should know not only how to eat with type 2 diabetes, but also about the need for physical activity as one of the components of treatment. The level of physical activity is selected individually; it should be moderate, but at least three times a week for 30-50 minutes. Such measures will reduce the concentration of glucose in the blood and prevent the further development of diabetes.

Development type 2 diabetes can go two ways.

The first way is when the perception of insulin by tissue cells is disrupted, and it is no longer suitable as a “key” that opens glucose into the cells, where it is processed or stored (for example, in the form of glycogen in liver cells). This disorder is called insulin resistance.
The second option is when insulin itself loses its ability to perform its actions. That is, glucose cannot enter the cells not because the cell receptors do not perceive insulin, but because the produced insulin itself is no longer the “key” to the cells.

Symptoms of type 2 diabetes mellitus

Diabetes mellitus type 2 often occurs without visible manifestations, the person does not even know that he is sick.
Some symptoms may appear for a while and then go away.
Therefore, you need to listen carefully to your body.

Overweight and obese people should regularly test their blood sugar levels.

Increased sugar is accompanied by thirst, and, as a result, frequent urination.
Severe dry skin, itching, and non-healing wounds may appear.
There is general weakness and fatigue.
People over 40 years of age should also monitor their blood sugar levels.

Forms of severity of type 2 diabetes mellitus

Depending on the severity, three forms can be distinguished:

mild form - when to achieve compensation it is enough to follow a diet and exercise or a minimum amount of sugar-lowering drugs;
medium form - to maintain normoglycemia, several tablets of sugar-lowering drugs are required;
severe form - when sugar-lowering drugs do not give the required result and insulin therapy is added to treatment.

Treatment of type 2 diabetes mellitus: hypoglycemic drugs and insulin therapy

Treatment of type 2 diabetes mellitus includes several components - sports/physical education, diet therapy, and insulin therapy.

Physical activity and diet should not be neglected. Since they help a person lose weight and thereby reduce insulin resistance of cells (one of the reasons for the development of diabetes), and thus normalize blood sugar levels.
Of course, not everyone can stop taking medications, but without weight loss, no type of treatment will give good results.
But still, the basis of treatment is antihyperglycemic drugs.

According to the mechanism of action, all sugar-lowering drugs are divided into several groups. Check them out below.

- The first group includes two types of drugs - Thiazolidinediones and Biguanides. Drugs in this group increase the sensitivity of cells to insulin, that is, reduce insulin resistance.
In addition, these drugs reduce the absorption of glucose by intestinal cells.

Medicines related to Thiazolidinedionam (Rosiglitazone and Pioglitazone), restore the mechanism of action of insulin to a greater extent.

Medicines related to biguanides ( Metformin (Siofor, Avandamet, Bagomet, Glucophage, Metfogamma)), to a greater extent change the absorption of glucose by intestinal cells.
These drugs are often prescribed to overweight people to help them lose weight.

— The second group of sugar-lowering drugs also consists of two types of drugs — Derivatives sulfonylureas and Meglitinides.
Drugs in this group stimulate the production of your own insulin by acting on the beta cells of the pancreas.
They also reduce glucose reserves in the liver.

Drugs from the group Sulfonylurea derivatives ( Maninil, Diabeton, Amaryl, Glyurenorm, Glibinez-retard) in addition to the above effects on the body, they also affect insulin itself, thereby increasing its effectiveness.

Drugs of the Meglitinide group (Repaglinide ( Starlix)) enhance the synthesis of inulin by the pancreas, and also reduce postprandial peaks (increase in sugar after eating).
It is possible to combine these drugs with Metformin.

— The third group of sugar-lowering drugs includes Acarbose (Glucobay). This drug reduces the absorption of glucose by intestinal cells due to the fact that, by binding to enzymes that break down carbohydrates supplied with food, it blocks them. And unbroken carbohydrates cannot be absorbed by cells. And due to this, weight loss occurs.

When the use of sugar-lowering drugs does not lead to compensation, it is prescribed insulin therapy.
There are different schemes for using insulin. It is possible to use only long-acting insulin in combination with sugar-lowering drugs. Or, if the drugs are ineffective, short- and long-acting insulins are used.

The use of insulin can be permanent, or it can be temporary - in case of severe decompensation, during pregnancy, during surgery or serious illness.

Nutrition for type 2 diabetes mellitus

Diet is one of the key points in the treatment of type 2 diabetes and is aimed at reducing excess weight and maintaining normal body weight.

The basis of the diet is the refusal of fast or refined carbohydrates, such as sugar, sweets, jam, many fruits, dried fruits, honey, fruit juices, and baked goods.

A particularly strict diet at the beginning, when you need to lose weight, then the diet can be expanded somewhat, but fast carbohydrates for the most part are still excluded.

But remember that you should always have some foods containing fast carbohydrates on hand to stop attacks of hypoglycemia.
Honey, juice, and sugar are good for this.

The diet should not become a temporary phenomenon, but a way of life. There are many healthy, tasty and easy-to-make dishes, and desserts are not excluded.
A large selection of dietary dishes with calculated calories and carbohydrates can be found on the website of Dia-Dieta, our partner.

The basis of nutrition should be foods that contain a lot of fiber and slow carbohydrates, which slowly raise sugar and do not cause such pronounced postprandial hyperglycemia.

It is necessary to reduce the consumption of foods with high fat content - meat, dairy products.

You should avoid fried foods; steam, boil or bake in the oven.

Food should be taken 5-6 times a day, but in small portions.

Following such a diet will not only help you lose weight, but also keep it at a normal level, which will have a beneficial effect on the general condition of the body.

Physical activity for type 2 diabetes

Physical exercise is of great importance, but the load must correspond to the age and health of the patient.
It is important not to overdo it with intensity; the load should be smooth and regular.

Sports activities increase the sensitivity of cells to insulin and, as a result, a decrease in sugar occurs.

If you are going to exercise for a long time, it is recommended to eat 10-15 g of slow carbohydrates before starting to prevent hypoglycemia. Bread, apple, kefir are suitable as a snack.
But if your sugar has dropped sharply, then you need to take fast carbohydrates to quickly raise your glucose levels.

Any physical activity should be avoided if sugar levels are above 12-13 mmol/l. With such high sugar, the load on the heart increases, and combined with the load, this becomes doubly dangerous.
In addition, exercising with such sugar can lead to its further increase.

It is advisable to monitor your sugar levels before, during and after exercise to avoid unwanted fluctuations.

396 Comments

Hello. Please help me figure out what's wrong with me. Before pregnancy, high blood sugar was detected 6.25 from a vein on an empty stomach (further all tests were also from a vein). I passed the GG - 4.8%, glucose tolerance test two hours later was 4.6., insulin was around 8, i.e. Type 1 diabetes definitely cannot be, because... C-peptide was also normal.
During pregnancy, I had gestational diabetes mellitus and a very strict diet with sugar monitoring using a glucometer and sensor. After pregnancy, this winter I had a glucose test of 7.2 in an hour and 4.16 in two hours, the Homa index floats from 2.2 to 2.78, and fasting sugar is often in the laboratory in the region of 5.9-6.1, but literally 2 weeks ago I took the test and it was already 6.83, but I ate sweets at night (ice cream and an apple), but the 8 hours before the test on an empty stomach definitely passed. The last GG was 4.8%, the test was taken a week before this high sugar level and the sugar test then was also 5.96. Endocrinologists prescribed me Metformin, first 500 and then 850 mg at night, but I did not see a decrease in fasting sugar.
I’m on a diet almost all the time (I confess, sometimes I allow too much in the form of ice cream or one cookie) and almost always the sugar after two hours on the glucometer is no higher than 6, and more often 5.2-5.7. I can’t understand why my fasting sugar is so high if I’m not fat, although I do have belly fat (67kg and height 173cm)
I am worried about bad symptoms in the form of hunger, severe hair loss, sweating, fatigue, and often feel dizzy when I eat carbohydrates, although my sugar is absolutely normal at these moments (I checked it with a glucometer many times).
I took blood tests and my LDL cholesterol is still elevated - 3.31 (with the norm being up to 2.59) and there is an increase in hemoglobin 158 (the norm is up to 150), red blood cells - 5.41 (up to 5.1 norm) and hematocrit - 47, 60 (norm up to 46). The doctor says that this is nonsense and suggested drinking more fluids, but I’m worried that it might be due to sugar and hypothyroidism. I’m afraid that my condition is complicating everything because cholesterol affects the pancreas, and hypothyroidism and diabetes often occur together, and Eutirox is either canceled or returned to me.
Please tell me what other tests I should take to understand if I’m starting to have diabetes or is it still a disorder of fasting blood glucose?

Julia, good afternoon.
Increased hemoglobin, indeed, can be associated with a small amount of fluid drunk. How much do you drink per day? Honestly, I have the same situation, hemoglobin 153-156. I drink very little (less than a liter a day), it’s difficult to force myself, although I know that I need more. Therefore, pay attention to this fact.
Cholesterol, of course, is higher than normal, but not critical enough to somehow affect health. There is no point in taking cholesterol-lowering drugs. If possible, reconsider your diet - fatty meat, a lot of animal fats. Have you been tested for cholesterol before? Sometimes it happens that high cholesterol is a feature of the body, so it makes no sense to reduce it with drugs.
Fatigue, sweating, dizziness - have you been tested for thyroid function? The symptoms are very similar to a malfunction of the thyroid gland. It may be necessary to increase the dose of eutirox.
You can check your heart, go to a cardiologist. Small increases in sugar may not cause such symptoms.
For now, your situation is such that you can say for sure that you definitely do not have T1DM. T2DM is questionable. Of course, the doctor decides how much treatment with metformin is necessary, but so far there is no strict need to take the drugs, in my opinion. It is possible that the situation will develop in such a way that temporary use of metformin will help improve the absorption of carbohydrates and after that it will be possible to stop taking it.
For now, continue to take the medication prescribed by your doctor and monitor your sugar levels. If you want to eat more carbohydrates, it is better to do it in the morning rather than at night.
You don’t need to take any tests yet; you’ve already passed all the main ones. Retest glycerin and hemoglobin periodically (3 times a year), and measure your sugar yourself.
And one more thing - what kind of glucometer do you have? Does it measure in plasma or whole blood? Look at the ratio of plasma and goal blood sugar levels. Doctors (especially old-school ones) often rely on whole blood values.
1. Thank you for the answer!
  Yes, something very strange is happening with the thyroid gland. After pregnancy at a dose of 50 (previously I even alternated between 50 and 75 to keep TSH around 1.5) it dropped to 0.08, i.e. The dose turned out to be too high. The doctor ordered an ultrasound (it was good, without any traces of pathology, although there was a small nodule before) and asked me not to drink Eutirox for a month and get tested. I did everything and after a month of withdrawal I had a TSH of 3.16, while the laboratory norm was 4.2. The doctor prescribed Ethirox again at a dose of 25 and my TSH began to decrease again, but pain immediately appeared in the top of the foot. I remembered that I had already had this many years ago, when hypothyroidism had not yet been discovered, so I turned to another doctor and he canceled Eutirox for 3 months. (my legs, by the way, went away almost immediately) + I stopped Metformin too. After 3 months I have to check TSH, glycated and sugar.
  I now have a Contour Plus glucometer (calibrated by plasma), before that I had a Freestyle Optium.
  I brought tests to the doctors only from the laboratory (from a vein).
  My high sugar of 6.83 was from a vein in the laboratory (((and this scares me, because developing diabetes at 35 years old, when you have a small child in your arms, is very scary.
  1. Julia, your situation is not simple, since thyroid disorders are hormonal disorders, just like diabetes mellitus. Everything goes one after another.
    It's too early to talk about diabetes. Periodically retake blood glucose tests, and sometimes check your fasting sugar at home.
    Sugar 6.8, especially once, does not in any way indicate diabetes.
    There is no point in worrying about this, nor do you greatly limit your diet. It is impossible to protect yourself from diabetes, like, for example, from the flu, by carrying out prevention and vaccinations. With T2DM, it is possible to improve the situation with diet; with T1DM, diet does not make sense.
    You have a small child, devote your time to him. Enjoy motherhood. It will be necessary to take measures to treat diabetes only if it manifests itself; now all this will not bring any positive results. But worries can do a disservice and cause an increase in sugar, even if there is no diabetes.
    1. Yes, I would like to take my mind off all this, but my overall health is interfering: dizziness after eating, severe hair loss, sweating, etc. It's not very pleasant, unfortunately.
      Hormone tests came back today and it looks like the cancellation of Eutirox provoked an imbalance, because... This has never happened before; I took the previous ones in May on Eutirox. Prolactin jumped significantly to 622 when the norm was 496, cortisol was at the upper limit of normal, fasting insulin became even higher than 11.60, glucose 6.08, and the Khoma index is now 3.13, i.e. insulin resistance appeared ((
      Now I don’t even know what to do. I was never able to find a good doctor to sort out all my problems.
      
      Julia, what city are you from? If Moscow, Moscow region, then you can look for doctors. In other cities, I don’t know, unfortunately.
      I am inclined to believe that “dizziness after eating, severe hair loss, sweating, etc.” are not associated with such low sugar. This is most likely caused by the thyroid gland.
      The same symptoms can also result from malfunctions of the adrenal glands.
      Another question: have you been examined by a gynecologist? What about hormones in this regard? Polycystic ovary syndrome can lead to insulin resistance.
      Unfortunately, it’s difficult to say right away whether you have this or that. In your situation, the symptoms are so common that it is necessary to carry out a systematic examination to identify the real cause. This, of course, is not as fast as we would like.
      
      Regarding insulin resistance, this process has a genetic predisposition. It is impossible to stop it, if it turns out that you do not have polycystic disease, the correct dose of hormones for the thyroid glands is selected, and insulin resistance does not go away, then you will have to get used to living with it.
      Then treatment with metformin should change the situation.
      
      I couldn’t click the “reply” button on my last comment, so I’ll write it here.
      I’m from Minsk and it seems like a good doctor here needs to be sought out like a treasure)) I made an appointment with the recommended endocrinologist over the weekend... we’ll see.
      It seems to me that my problems with insulin are really hereditary, because... In our family, all women are actively accumulating fat on their belly. My sister is actively involved in sports, but the stomach still has a place to be.
      I don’t have PCOS, but after pregnancy I started having problems with my cycle and the gynecologist doesn’t like my ultrasound with the endometrium. There is a suspicion that the swing with Eutirox led to such a failure, because... At my dosage of 50 mg it dropped to almost 0, but I didn’t know it.
      Today I also received a detailed analysis of the thyroid gland (I have not taken Eutirox since September 12).
      If you can comment in any way, I would be very grateful.
      TSH-2.07
      T3sv-2.58 (normal 2.6-4.4) reduced
      T3total-0.91 (norm 1.2-2.7) reduced
      T4total-75.90 norm
      T4sv-16.51 norm
      Thyroglobulin is 22.80 normal
      Antibodies to TG - 417.70 (normal<115) повышено
      Antibodies to TPO - 12 norm
      I decided to take the test in detail so that the doctor could look at all the tests in detail.
      Tell me, please, how can I check the functioning of the adrenal glands, what tests can I take?
      Thank you for your answers and for devoting your time to essentially a stranger :)
      
      Julia, good afternoon.
      Stress and anxiety also affect hormonal levels and can also cause weakness, hair loss, and sweating. Hormones such as catecholamines, which are synthesized in the adrenal glands, help us fight stress. They regulate the body's reactions to stressful situations. You can donate blood or urine for catecholamines - dopamine, adrenaline, norepinephrine and serotonin. I don’t know how it is in district clinics, but in private laboratories they are done everywhere.
      And first of all, you just need to choose the dosage of eutirox. The thyroid gland has a huge impact on your well-being. It is T3 that affects the activity of the cardiovascular system; its deficiency is manifested by increased cholesterol, weakness, and problems with concentration.
      Both the adrenal glands and the thyroid gland should be dealt with by one doctor.
      There is a 95% chance that all your unpleasant symptoms will go away as soon as the functioning of the thyroid gland improves.
      
      Regarding diabetes, believe me, life does not end when this diagnosis is made. We, people with diabetes, live, work, travel, create families, fly on airplanes, ski, etc. in the same way. Well, we just can’t fly into space :). So don’t waste time on unnecessary worries, enjoy life, you have a family, a child - there is something to live and smile for!!!
      
      P.S. A little off topic - it’s very nice that you are from Minsk. We love Belarus very much, we’ve been to Minsk too, it’s a very beautiful city. We plan to come again. In general, we go to Vitebsk 2-3 times a year. Your place is very beautiful everywhere!

I am 56 years old, with a blood pressure of 195-100, I was taken to the hospital by ambulance. During the research, it turned out that my sugar rose to 10.5. I never knew about this before. I was diagnosed with T2DM and prescribed Metformin 2 times a day, 500 g, and antihypertensive drugs for blood pressure. I began to follow a diet and take medications, but the pancreas on the left side began to hurt very often. I take pancreatin, allohol, mezim was prescribed when I visited a gastroenterologist, but the pain does not go away. For half a day I drank only water, I thought it would go away, but the pain did not go away. What do you recommend to drink?

Hello. My dad was recently diagnosed with type 2 diabetes, his sugar level was 19. And the doctors also cut off the tip of his big toe because his legs didn’t feel anything at all and apparently his nails began to fall off. According to dad, it started about five years ago, when his feet were freezing. When the doctors operated, they didn’t know that he had sugar. The operation was successful, my legs warmed up a little, that is, they began to feel a little. And now, after a while, blisters appeared on my legs, they burst and the skin peeled off. It hurts at night. We don't know what to do.
My mother is 60 years old, type 2 diabetes, insulin resistance, she was given insulin injections, her sugar level was 14, her eyesight had decreased.
Tell me, is it possible to start physical training or should I wait until the body gets used to insulin and lowers sugar?
Will exercise help avoid vascular problems?
Thanks for the article, useful information. I am 52 years old, unfortunately I am overweight and my sugar levels are slightly elevated. I’m trying to change my eating style, eat less sweets and starchy foods, and regularly measure my sugar at home with a TC contour glucometer, this is also very important to always be on guard and monitor my health.

Thanks for the article, many questions were explained. My sister was recently diagnosed with mild type 2 diabetes, although she really didn’t have any symptoms, but she behaved well, began to play more sports, dances, of course follows a diet, we recently bought her a tc circuit so that she can control her sugar, she is going to camp and we will It’s calmer this way, especially since it’s very simple and she can easily handle it.
Hello, My mother’s fasting sugar level is 8, the scale goes up to 21, on average from 10 to 14. She refuses insulin. Takes Gliformin. She also has a postoperative hernia above her navel. Maybe we still need to somehow persuade him, force him to take insulin?
Hello, my 41-year-old mother was admitted to the hospital with acute pancreatitis, she was tested for sugar, sugar 14 endocrinology came and said you are insulin dependent and they said now they will inject insulin, she refused, she is afraid that she will sit on it for the rest of her life, what should I do, help.
Good afternoon. My mother has type 2 diabetes for many years. She did not do any treatment for herself and did not follow any diets. This fall I had a foot amputation. Gangrene began. Now she eats semi-finished products - store-bought pancakes and dumplings. Sometimes she prepares soup with the addition of packet concentrate. He lives far away and I can’t convince him not to eat this crap. He is diabetic and takes painkillers. Sometimes checks (a couple of times a week) sugar. For now it stays at 8. He categorically refuses insulin. The stump is healing normally. And yet it seems to me that this is all “more or less normal”, a seeming calm before the next storm. The hospital extract indicated concomitant diseases such as chronic renal failure, ischemic brain disease, and chronic transfer failure. She flatly refuses to change her attitude. The question is, am I right or am I pushing more out of ignorance? If I’m right, then how long do diabetics live after amputation with such an attitude and such a diagnosis? If I can’t convince you, then maybe I can remember the argument exactly.
1. Sveta
  Your situation is not simple - we can always decide for ourselves, but sometimes forcing or convincing another person to change their lifestyle is absolutely unrealistic.
  Now on topic - your mother’s concomitant diseases are a consequence of diabetes. Of course, compensation is necessary to maintain health to the extent that things are now.
  With a sugar level of 8-9 mmol/l, it is possible to manage with oral hypoglycemic drugs (tablets) and diet. If such sugars persist if you do not follow the diet, then if you follow it everything should be in perfect order. Well, this is if the sugar really doesn’t rise higher. But there are doubts about this, or the mother is hiding it, and 1-2 measurements per week do not give a complete picture, since between these measurements sugar can fluctuate from 2 to 20 mmol/l.
  Was your mom suggested to switch to insulin? If yes, then tell her that with insulin therapy she will not have to follow a diet, there is an opportunity to compensate for all the carbohydrates eaten with a dose of insulin, but she will have to measure her sugar more often, especially at first, until the appropriate doses are determined.
  That is, for a normal future life there are two options:
  1. Pills and DIET are the basis of treatment for T2DM.
  2. Insulin and no diet, but more frequent monitoring.
  
  I really don’t want to write disappointing forecasts, but since there was gangrene on one leg, which indicates the death of the vessels of the lower extremities, the probability of its occurrence on the other leg is very high. How will mom move then?
  About chronic renal failure - mom is not receiving dialysis yet? In many cities it is very difficult to achieve, people stand in long lines to save their lives, but not everyone waits their turn, unfortunately. And then, finally, having received a place for dialysis, a person becomes tied to the house - since dialysis is done on certain days, at certain times, it is a matter of five minutes. Therefore, several hours a day, or at best once a week, will have to be devoted to trips to the hospital and this procedure. And the procedure itself is not pleasant - there are a lot of additional medications for the rest of your life, since during dialysis many substances needed by the body are washed away.
  And these are just the problems that necessarily await a person who does not have normal compensation. Maybe this will still encourage your mother to think about her future life - a more or less active and independent person, on a diet or bedridden, who will be looked after by loved ones who have the right to their privacy, but who measures her sugar once a week and eating dubious delicacies.
  To your mother - health and prudence, and to you, patience!
Mom has type 2 diabetes. Takes metfogamma, metformin (depending on what is on sale). Sometimes in the morning the sugar is below normal (according to the glucometer): about 2-3. Usually around 7-8. What could it be and how harmful is it? Thanks in advance for your answer.
1. Dmitriy
  A decrease in sugar to 2-3 mmol is already hypoglycemia. These declines must be avoided. Moreover, if the mother herself does not feel low sugar, but only learns about it from the glucometer. Low sugar levels are dangerous because measures must be taken immediately, without delay. When sugar levels are low, the brain does not receive enough oxygen and oxygen starvation occurs, which leads to the death of brain cells.
  In order for your sugar level to be approximately the same every day, you need to do everything at the same time - take medications, eat a certain amount of carbohydrates. Make sure, perhaps on the eve of those days when sugar is low in the morning, that mother eats little carbohydrates (less than usual), this leads to a decrease in sugar. You can't forget to eat at all.
  If cases of low sugar occur regularly, you should consult a doctor. He will either reschedule the drug for another time, or, most likely, reduce the dose of the drugs taken.
  Well, physical activity also reduces sugar. Are there any factors on the eve of morning hypoglycemia that contribute to these decreases (trips to the country, garden beds, just walks, cleaning around the house, etc.)
Hello. My father has type 2 diabetes. He is 65 years old, weight 125 kg. He doesn’t really want treatment, but it’s hard to force him. Since I have zero knowledge, and the patient has no zeal, I am in a stupor.

Question about a specific situation
he vomited yesterday afternoon, felt unwell, and refused to go to the ambulance. (they assumed it was just poisoning). Then I slept all evening and all night.
In the morning I asked to measure my sugar and blood pressure, everything turned out to be elevated. 162 over 81, pulse 64, sugar 13.0.
Please tell me what to do. Should we sound the alarm? What exactly should I do?
Thank you very much, the question is URGENT.
Hello, the normal sugar level all day is from 5 to 6. And on an empty stomach from 6 to 8!!! How so? I go to bed at 6 and wake up at 7 ((((What happens at night? How to reduce or keep night sugar normal? During the day after any meal, sugar is always normal from 5 to 6. Please tell me. Thank you
hello, please tell me, I was diagnosed with T2DM 4 months ago, i.e. in April, I donated blood on an empty stomach, it was 8.6, they prescribed Mitformin 850, one tablet in the evening and they kicked me off, I’m trying to treat myself, I drink herbs, sugar-lowering teas, I follow a diet, sugar when it’s like 5.6, then 4.8, then 10 .5 I’m 168 tall, I weigh 76,800 kg, I’m doing exercises, now I’m pulling out my teeth, my sugar has risen to 15, my blood pressure has dropped to 80/76, I feel bad, maybe I should take some other pills, please tell me

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