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 treating diabetes mellitus of any type 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 adjustment to life with a chronic illness. These goals can only be partially achieved in diabetic patients, due to the imperfection of modern substitution therapy. At the same time, today it is firmly established that the closer the patient's glycemia is to the normal level, the less likely it is to develop late complications of diabetes.

Despite numerous publications on the treatment of type 2 diabetes mellitus, the vast majority of patients do not achieve compensation for carbohydrate metabolism, although their general health may remain good. Not always a diabetic is aware of the importance of self-control and the study of glycemia is carried out from case to case. The illusion of relative well-being, based on normal well-being, delays the initiation of drug treatment in many patients with type 2 diabetes mellitus. In addition, the presence of morning normoglycemia does not exclude the decompensation of diabetes mellitus in such patients.

The key to successful treatment of patients with type 2 diabetes is education in a diabetic school. Teaching patients how to treat and manage their diabetes at home is extremely important.

Diet to treat type 2 diabetes

90% of people with type 2 diabetes have some degree of obesity, so weight loss through a low-calorie diet and exercise is of paramount importance. 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 hypoglycemic agents.

Treatment usually begins with the selection of a diet and, if possible, expand the amount of physical activity. Diet therapy is the basis for the treatment of type 2 diabetes mellitus. Diet therapy consists in prescribing a balanced diet containing 50% carbohydrates, 20% proteins and 30% fats and following regular 5–6 meals a day - table number 9. Strict adherence to diet number 8 with fasting days for obesity and increased physical activity can significantly reduce the need in hypoglycemic drugs.

Physical exercise reduces insulin resistance, reduces 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. In the diet of patients should be foods high in fiber (cereals, vegetables, fruits, wholemeal bread). The diet is recommended to include fibrous fiber, pectin or guar-guar in the amount of 15 g / day. If it is difficult to restrict dietary fat, you should take orlistat, which prevents the breakdown and absorption of 30% of the fat taken and, according to some reports, reduces insulin resistance. The result of monotherapy with a diet can be expected only with a decrease in weight by 10% or more from the original. This can be achieved by increasing physical activity along with a low-calorie balanced diet.

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

Exercise for the treatment of type 2 diabetes

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

With decompensation of diabetes mellitus, physical exercises are ineffective. With heavy physical exertion, hypoglycemia may develop, so the doses of hypoglycemic drugs (and especially insulin) should be reduced by 20%.

If diet and exercise fail to achieve normoglycemia, if this treatment does not normalize impaired metabolism, one should resort to drug treatment of type 2 diabetes mellitus. In this case, tableted hypoglycemic agents, 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, Aktos). With complete depletion of residual insulin secretion, they switch to insulin monotherapy.

Medical treatment of type 2 diabetes

More than 60% of patients with type 2 diabetes are treated with oral hypoglycemic drugs. For more than 40 years, sulfonylurea has been the mainstay of oral hypoglycemic therapy for type 2 diabetes mellitus. The main mechanism of action of sulfonylurea drugs is to stimulate the secretion of their own insulin.

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

Sulfonylureas are attributed to the action, which consists in increasing the sensitivity of cells of adipose, muscle, liver and some other tissues to the action of insulin, in increasing the transport of glucose in skeletal muscles. For patients with type 2 diabetes mellitus with well-preserved function of insulin secretion, the combination of a sulfonylurea drug with 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 the secretion of insulin.

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

Suphanilamides for the treatment of type 2 diabetes mellitus

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

Tolbutamide (Butamid, 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 administered 2-3 times a day. Although it was one of the first sulfonylurea preparations, it is still used today because it has few side effects.

Chlorpropamide (Diabenez), tablets of 0.1 and 0.25 g - has the longest duration of action (more than 24 hours), is taken 1 time per day, in the morning. Causes many side effects, the most serious is 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 most commonly used sulfonamides in Europe. It is prescribed, as a rule, 2 times a day, in the morning and in the 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 of 5 mg / tab. Like glibenclamide, this drug is 100 times more active than tolbutamide, the duration of action reaches 10 hours, it is usually prescribed 2 times a day.

Gliclazide (Diabeton, Predian, Glidiab, Glizid), tablets of 80 mg - its pharmacokinetic parameters are somewhere between the parameters of glibenclamide and glipizide. Usually given twice a day, modified-release diabeton is now available and taken once a 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 in chronic renal failure. Practically does not cause severe hypoglycemia, therefore it is especially indicated for elderly patients.

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

Side effects of sulfonamides

Severe hypoglycemia occurs infrequently 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 disease, when food intake is reduced. In the elderly, hypoglycemia is manifested mainly by mental or neurological symptoms that make it difficult to recognize. In this regard, it is not recommended to prescribe long-acting sulfonamides to the elderly.

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

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

Reserpine, clonidine and non-selective β-blockers also contribute to the development of hypoglycemia by suppressing the 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

Biguanides, derivatives of guanidine, enhance glucose uptake by skeletal muscles. Biguanides stimulate the production of lactate 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 biguanide and lactate elimination or with increased lactate production, in particular, in patients with reduced kidney function (they are contraindicated in elevated serum creatinine), with liver disease, alcoholism and cardiopulmonary insufficiency. Lactic acidosis has been particularly common with phenformin and buformin, which is why they have been 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 diabetes mellitus, making it easier for such patients to maintain a diet and promote weight loss. Metformin also improves lipid metabolism by lowering low-density lipoprotein levels.

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 basically Metformin increases the sensitivity of tissues to insulin, suppresses the production of glucose by the liver and, naturally, reduces fasting glycemia, 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 is started with minimal doses (0.25-0.5 g in the morning) to prevent adverse reactions in the form of dyspeptic phenomena, which occur in 10% of patients, but most pass quickly. 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 immediately discontinued when the patient develops acute kidney disease, liver disease, or manifests cardiopulmonary insufficiency.

Since sulfonamides mainly stimulate insulin secretion, and metformin mainly improves 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 their 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

The expediency of using sulfonylurea drugs is beyond doubt, because the most important link in the pathogenesis of type 2 diabetes mellitus is a secretory defect in 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 sulfonylurea drugs- a component of effective treatment, has been intensively used for many years and allows to achieve a reduction in the dose of sulfonylurea drugs. According to the researchers, combination therapy with metformin and sulfonylurea drugs is as effective as combination therapy with insulin and sulfonylurea drugs.

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

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

Simplicity, efficiency and relative cheapness explain the fact that secretogens successfully complement metformin. Combined drug Glucovans, containing metformin and 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 Glucovans clearly improves not only patient compliance, but also reduces the total number and intensity of side effects with the same or better efficiency.

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

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

Secondary resistance to sulfa drugs.

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

Resistance to sulfonamides is manifested by progressive weight loss, the development of fasting hyperglycemia, postalimentary hyperglycemia, an increase in glycosuria, and an increase in HbA1c levels.

With 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 glycemia level between 7.5–9 mmol/l.

It is possible to use pioglitazone (Aktos) - a drug that reduces insulin resistance, which makes it possible to reduce the dose of IPD and, in some cases, cancel it. Take actos 30 mg 1 time per day. It can be combined with both metformin and sulfonylurea preparations.

But the most common combination treatment regimen is that the previously prescribed sulfonamide treatment is supplemented with small doses (8-10 IU) of medium-acting drugs (for example, NPH or ready-made "mixes" - mixtures of short-acting and prolonged-acting drugs) 1-2 times a day. day (8.00, 21.00). The dose is increased in steps of 2-4 units every 2-4 days. In this case, the dose of sulfanilamide should be maximum.

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

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

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

The arsenal of hypoglycemic drugs used in the treatment of type 2 diabetes mellitus is quite large and continues to grow. In addition to sulfonylurea derivatives and biguanides, this includes secretogens, amino acid derivatives, insulin sensitizers (thiazolidinediones), α-glucosidase inhibitors (glucobay), and insulins.

Glycemic regulators for the treatment of type 2 diabetes

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

Novonorm is an oral fast-acting hypoglycemic drug. Rapidly lowers 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 the membranes of β-cells by acting on specific receptors, which leads to cell depolarization and the opening of calcium channels. As a result, increased calcium influx induces insulin secretion by 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. In the periods between meals, there is no increase in insulin concentration. In patients with non-insulin dependent type 2 diabetes mellitus, when taking the drug in doses of 0.5 to 4 mg, a dose-dependent decrease in blood glucose levels is noted.

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

Nateglinide (Starlix) is a derivative of phenylalanine. The drug restores early insulin secretion, which leads to a decrease in postprandial blood glucose concentration 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 lies in 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 higher than that for the channels of the heart and blood vessels.

Nateglinide, unlike other oral hypoglycemic agents, causes a pronounced secretion of insulin within the first 15 minutes after a meal, thereby smoothing out postprandial fluctuations (“peaks”) in blood glucose concentration. In the next 3–4 hours, the insulin level returns to its original values. This avoids postprandial hyperinsulinemia, which can lead to delayed hypoglycemia.

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 / day (before breakfast, lunch and dinner). If with this dosing regimen it is not possible to achieve the desired effect, a single dose can be increased to 180 mg.

Another prandial regulator of glycemia is acarbose (glucobay). Its action takes place 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 according to the principle of competition for the active site of the enzyme located on the surface of the microvilli of the small intestine. Preventing the rise in glycemia after a meal, acarbose significantly reduces the level of insulin in the blood, which improves the quality of metabolic compensation. This is confirmed by a decrease in the level of glycated hemoglobin (HbA1c).

The use of acarbose as the sole oral antidiabetic agent is sufficient to significantly reduce metabolic disturbances 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 appointment of acarbose with sulfonylurea drugs (Glurenorm) 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 who received insulin therapy and acarbose, the daily insulin dose decreased by an average of 10 units, while in patients who received placebo, the insulin dose increased by 0.7 units.

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

Modern conditions dictate the need to create new drugs that allow not only to eliminate metabolic disorders, but also to maintain the functional activity of pancreatic cells, stimulating and activating the physiological mechanisms of regulation of insulin secretion and blood glucose. In recent years, it has been shown that the regulation of glucose levels in the body, in addition to insulin and glucagon, also involves the hormones incretins produced in the intestine in response to food intake. Up to 70% of postprandial insulin secretion in healthy individuals is due precisely 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 (G PP-1).

The entry of food into the digestive tract rapidly stimulates the release of GIP and GLP-1. Incretins can also lower 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 improve glycemic control is of interest in the treatment of type 2 diabetes mellitus (the emergence of a class of incretin mimetics). GLP-1 has multiple effects on the endocrine part of the pancreas, but its principal action is to potentiate glucose-dependent insulin secretion.

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

Improvement in glycemic indices after administration of GLP-1 may be the result of the restoration of normal β-cell function. An in vitro study indicates that glucose-resistant β-cells become glucose-competent after administration of GLP-1.

The term "glucose competence" is used to describe the functional state of β-cells that are sensitive to glucose and secrete insulin. GLP-1 has an additional hypoglycemic effect that is not associated with an effect on the pancreas and stomach. In the liver, GLP-1 inhibits glucose production and promotes glucose uptake by adipose and muscle tissue, but these effects are secondary to 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 precisely the progressive β-cell dysfunction. Incretinomimetics used in the treatment of type 2 diabetes include 2 classes of drugs: GLP-1 agonists (exenatide, liraglutide) and inhibitors of dipeptidyl peptidase-4 (DPP-4), which destroys GLP-1 (sitagliptin, vildagliptin).

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

Liraglutide is a new drug, an analogue of the human GLP-1, which is 97% similar in structure to the human one. 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

GLP-1 preparations developed to date do not have oral forms and require mandatory subcutaneous administration. This drawback is deprived of drugs from the group of DPP-4 inhibitors. By suppressing the action of this enzyme, DPP-4 inhibitors increase the level and lifespan of endogenous GIP and GLP-1, enhancing their physiological insulinotropic action. The drugs are available in tablet form and are prescribed, as a rule, once a day, which significantly increases the adherence of patients to the therapy. DPP-4 is a membrane-binding serine protease from the group of prolyl oligopeptidases, the main substrate for which are short peptides such as GIP and GLP-1. The enzymatic activity of DPP-4 on 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 to increase the duration of action of endogenous incretins (GLP-1), i.e., the mobilization of 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 combination of DPP-4 inhibitors and metformin seems to be the most promising, which makes it possible to influence all the main pathogenetic mechanisms of type 2 diabetes mellitus - insulin resistance, secretory response of β-cells and hyperproduction of glucose by the liver.

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

Insulin therapy in 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, requiring the administration of insulin (insulin-requiring diabetes mellitus).

Treatment with insulin as monotherapy is indicated primarily for primary resistance to sulfonamides, when treatment with a diet and sulfonamides does not lead to optimal glycemia for 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 the exchange dose of insulin prescribed in combination with sulfonamides is high (more than 20 IU / day). The principles of insulin treatment for insulin-requiring diabetes mellitus and type 1 diabetes mellitus are almost the same.

According to the American Diabetes Association, after 15 years, most type 2 diabetics require insulin. However, a direct indication for monoinsulin therapy in 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 fact this percentage is much lower, often due to patient opposition. In the remaining 60% of patients who are not indicated for monoinsulin therapy, unfortunately, treatment with sulfonylurea drugs also does not lead to compensation for diabetes mellitus.

Even if during daylight hours it is possible to reduce glycemia, then almost everyone has morning hyperglycemia, which is caused by nighttime production of glucose by the liver. The use of insulin in this group of patients leads to an increase in body weight, which exacerbates 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. An excess of insulin in the body also causes concern for endocrinologists, because it is associated with the development and progression of atherosclerosis, arterial hypertension.

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

Combination treatment with sulfonylurea and insulin has significant advantages and is based on complementary mechanisms of action. High blood glucose has a toxic effect on β-cells, in connection with which the secretion of insulin is reduced, and the administration of insulin by lowering glycemia can restore the response of the pancreas to sulfonylurea. Insulin suppresses the formation of glucose in the liver at night, which leads to a decrease in fasting glycemia, and sulfonylurea causes an increase in insulin secretion after meals, controlling the level of glycemia during the day.

A number of studies have compared between 2 groups of type 2 diabetics, of which 1 group received only insulin therapy, and the other - combination therapy with insulin at night with a sulfonylurea. It turned out that after 3 and 6 months, the indicators of glycemia, glycated hemoglobin significantly decreased in both groups, but the average daily dose of insulin in the group of patients receiving combined treatment was 14 IU, and in the group of monoinsulin therapy - 57 IU per day.

The average daily dose of prolonged insulin at bedtime to suppress nocturnal hepatic glucose production is usually 0.16 units/kg/day. With this combination, there was an improvement in glycemia, a significant decrease 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.

Monotherapy with insulin in 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 the pain form of peripheral neuropathy, amyotrophy or diabetic foot, gangrene (ICD therapy only or "bolus-basal").

Each patient should strive to achieve a good compensation for diabetes from the first days of the disease, which is facilitated by their training in the “schools for the patient with diabetes”. And where such schools are not organized, patients should be provided with at least special educational materials and diabetic diaries. Self-management 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 glucagon ampoules to eliminate severe hypoglycemia (hypokit kit).

Many people know about diabetes. But far from everyone is aware of the division of the presented disease into two types. They are called like this: type 1 diabetes and type 2 diabetes.

requires mandatory and timely administration of insulin. But type 2 is found today in every fourth person in the world, which the patients themselves do not even know about.

Such ignorance can lead to a series 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 are quite different.

type 1 diabetes characterized by the absence or shortage of the amount of insulin necessary for normal life, which leads to violations in the conversion of sugar into glucose and the timeliness of its removal.

That is why patients with this disease must take insulin promptly, because the high content of sugar in human blood is fraught with general malaise and the gradual destruction of internal organs.

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

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

Symptoms of type 2 diabetes

Symptoms of the presented disease are often not taken seriously by patients, because they are not so intense at the initial stage of diabetes development.

A person may not be aware of a violation of the insulin receptors of body cells for several years or a lifetime.

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

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

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

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

Women may 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 the vagina, which is often mistaken for ordinary candidiasis.

Reasons for the development of the disease

There are three main causes that contribute to the development of diabetes:

1. Age-related changes in the human body. Elderly people should be especially attentive to their condition, because with age the body loses tolerance ( digestibility) to glucose, which can manifest itself as 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 violations, 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 supply of oxygen.

The walls of blood vessels that have already undergone hypoxia and the development of atherosclerosis cannot fully assimilate the insulin produced in the right quantities and the incoming glucose.

3. Excessive consumption of carbohydrates- these enzymes lead to pancreatic depletion and subsequent damage to insulin receptors in the blood.

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

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

Type 2 Diabetes: Diet and Treatment

Treatment of diabetes mellitus of the presented type is possible only through diet and taking drugs that will help reduce 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 a large amount of carbohydrates are banned.

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

Of course, the consumption of even such products should be reduced in significant quantities.

Foods high in sugar are also banned. these are sweets, cakes, cookies and other sweets.

Such use will lead to a sharp increase in blood sugar, which will lead to malaise, because the produced insulin will very slowly convert sugar into glucose ( or not at all).

Many diabetics are deluded eating fruits in unlimited quantities, believing that they contain few carbohydrates. As it turns out in practice, 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 fully on the list of prohibited foods. They include grapes, bananas, melons, potatoes.

The list of approved products includes:

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

dairy products in the absence of sugar and artificial flavors in it;

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 a low sugar content;

eggs;

mushrooms of all varieties.

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

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

As for the general principles of nutrition, diabetics should eat small amounts of food every 3 hours. Patients are forbidden any diets and experiments in nutrition.

Benefits of vitamins for type 2 diabetes

As mentioned above, in the presence of the presented disease, patients have increased urination. This leads to the washing out of useful vitamins and trace elements, which also contributes to the destruction of cells and tissues.

To prevent deterioration, experts prescribe a complex of vitamins to patients. For general information, here are some vitamin names 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-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, which helps to calm the nerves and improves heart function.
• "Vervag Pharma" - the drug includes 11 vitamins and 2 important minerals - chromium and zinc. Both micronutrients help eliminate cravings for sweets and other unhealthy foods in type 2 diabetes.
• "Doppelgerz 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 improves peripheral circulation and acts as a prevention of diseases of the nervous system.
• Complivit Calcium D3- helps to improve the structure of bone tissue and the surface of the teeth, perfectly controls the production of protein.

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 to resolve the issue, which will identify the problems that have begun against the background of type 2 diabetes.

Symptoms of diabetes mellitus video:

Treatment of diabetes at home

Considering the question how to treat diabetes at home, you should provide a list of drugs recommended for use.

The impact of the drugs presented in the future helps to improve the general condition and launch the necessary processes for normal life.

All drugs 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 to regulate sharp jumps in glycemia.

But the drugs presented cannot be used for a long time - they can lead to complications in the form of dysbacteriosis and inflammation of the intestinal walls. This includes drugs such as Akarbaza and Radio tape recorder.

2. Biguanides - increase the susceptibility of cells to insulin produced in normal amounts. They can be used in the presence of diseases of the liver, kidneys and heart.

Here Metformin is distinguished ( Glucophage and Siofor) and Glyformin. Gliformin in diabetes also contributes to weight loss.

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

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

It should be noted that antidiabetic drugs for type 2 diabetes are determined on the basis of the examination, because doctors should identify the ongoing violations 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 useless use of drugs and 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 bee 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 broth is filtered and consumed in a glass a day in several doses.
  
• Bay leaf. An infusion of bay leaves helps lower blood sugar, but is approved for use in 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 applied 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. Strained broth is used every time half an hour before meals.
  
• Onion. Baked onions as a whole have a sweet taste and help reduce blood sugar in the patient. Just eat a vegetable in the morning on an empty stomach in the amount of one medium head.
  
• Aspen bark. Aspen bark in type 2 diabetes also has a hypoglycemic effect. The presented ingredient can be purchased at a pharmacy, which offers pre-packaged bags for one-time brewing. The sachet contains a tablespoon of chopped 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 in type 2 diabetes contribute to the overall strengthening of the body and lower blood glucose. Here, to prepare a useful drug, you should prepare a decoction using a 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 should be used with caution. It is important to prevent an increase in blood sugar, and not cause more problems, so you should consult your doctor before using traditional medicine.

Benefit or harm from controversial products

There is a whole list of foods that cause controversy among specialists in the use of type 2 diabetes. The debate is to ban or allow their consumption, which is due to the high sugar content of the product, but a slightly lower effect on blood glucose levels.

Persimmon

Persimmon in type 2 diabetes not forbidden to use, although it contains a large amount of sugar. With a high indicator, the glycemic index of the product refers to the average and is concluded in the amount of 45 units.

Of course, excessive consumption of persimmon in the presence of the present 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 not eat the unripe fruit, which is expressed in the form of an astringent taste.

Honey

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

However, for the presented substances contained in the natural product, the presence of insulin during splitting in the body is not important, and this does not prohibit the use of honey, although in small quantities.

Kiwi

Elevated glucose and protein content leads to a ban on the use kiwi for type 2 diabetes. But such statements of experts can be attributed to erroneous, because the presented fruit contains a lot of fiber, and this has a positive effect on the rapid and efficient breakdown of glucose that has entered the body.

In addition, the calorie content of the product is only 50 kcal per 100 g, and the fruit is recommended for use 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 content of acids 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 fruit a 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 self-release of the substance, and this occurs when there are problems with the pancreas, it is important to replenish it in a timely manner. Therefore, the introduction of radish into the usual diet is recommended.

Beet

Beets 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 should also be brought in favor of the vegetable, which, along with the glycemic index ( 64 units), is an indicator of only 5 units, and this can be attributed to the lowest level.

Ginger

The benefits of ginger in the presence of the disease presented are in several aspects.

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

Secondly, ginger in type 2 diabetes helps to improve the processes of metabolism 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 the accumulation of cholesterol in the blood vessels of the patient, which provokes the development and further progression of type 2 diabetes mellitus.

Read more about the beneficial properties of ginger.

Alcohol

Most experts do not support the use alcohol in type 2 diabetes. Of course, this is quite justified, because alcoholic beverages contain a large amount of sugar and carbohydrates.

But the use of 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 select all drinks, the strength of which is from 40 degrees and above.

Separately, you should consider the use of 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 a lot of questions, to which there is not always an unambiguous answer. The most interesting and entertaining are 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 disease and cannot be completely cured.

Therefore, one should not trust dubious drugs and treatments that are offered today by scammers and very unscrupulous sellers and manufacturers.

2. Can type 2 diabetes be treated without medication? It all depends on the degree of neglect of the disease and the characteristics of the violations that have occurred.

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

But such statistics speak of patients with type 1 disease, although representatives with type 2 diseases who do not follow elementary dietary rules and do not use drugs 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 cases of successful and full survival of patients to old age, in which diabetes was diagnosed in childhood.

Here, first of all, the very attitude of a person to the destruction that has begun is important. If you start treatment in time and follow a diet, then type 2 diabetes mellitus will not entail complications, which become the causes of deaths.

You need to enable JavaScript to vote

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, compensation started on time is almost a 100% guarantee of the absence of diabetic complications. In this article, you will learn what type 2 diabetes is, how it occurs, and how to properly treat it.

What is type 2 diabetes

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

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 redundancy in the body. This depletes the β-cells of the pancreas, and over time, diabetics have to take insulin injections.

This type is the most common and is 80% from all cases of illness.

More people suffer after 40 who have severe obesity, who do not eat well 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 by dietary nutrition (read about), with a rare intake of one tablet of a sugar-lowering drug. The likelihood of developing complications is minimal.
• moderate form - the diet itself does not help, and you need to take 2-3 hypoglycemic drugs. Vascular complications are possible.
• severe form - with this form, the diabetic is already forced to resort to insulin therapy. Severe complications are frequent.

Type 2 diabetes symptoms

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 with this type.

Weakness

infections

• Intense thirst accompanied by an 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 analyzing 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 type 2 diabetes

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

If speak about medicines , then they are classified into:

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

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

What are the complications of type 2 diabetes?

Often this type is considered a mild form, and many 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, then 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, with the help of a regular healthy diet, you can compensate for the disease.

To avoid complications, always control your sugar levels.

Remember that small efforts at the beginning of the disease will help to avoid serious problems in the future.

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

The second type of diabetes mellitus occurs when there is a decrease in the sensitivity of tissues to the action of insulin, this is called insulin resistance. In the initial stages of the disease, the hormone is produced in a normal, and sometimes in an increased volume, over time, excess secretion is depleted by pancreatic beta cells, after which the patient needs insulin injections.

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

The reasons

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 is slow, then in patients with a genetic memory for diabetes, this happens faster.

The second reason for the development of pathology is obesity. Excess weight violates 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 excessive consumption of carbohydrates. The high content of carbohydrates in the blood adversely affects the pancreas, depleting its cells, in addition, carbohydrates damage the insulin receptors of all organs and tissues.

Risk factors that provoke type 2 diabetes mellitus:

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

Symptoms

Type 2 diabetes symptoms:

• 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 is the relative rather than absolute deficiency of insulin. For this reason, the patient may not be aware of the disease for several years. If you measure the level of sugar in the blood, its slight increase will be found - up to a maximum of 8-9 mmol per liter when measured on an empty stomach.

Diagnostics

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

The test is indicated in the following cases:

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

Diagnosis criteria for diabetes mellitus:

		Whole blood glucose, mmol/l		Blood plasma glucose, mmol/l
		venous	capillary	venous	capillary
Diabetes
Impaired ability to absorb 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	over 8.9; less than 12.2
Impaired fasting glucose		more than 5.6; less than 6.1	more than 5.6; less than 6.1	over 6.1; less than 7.0	over 6.1; less than 7.0
	In 2 hours

Treatment

The 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 the concentration of glucose in the blood:

• Drugs that reduce insulin resistance. This is metformin, as well as thiazolidinediones, metformin is the drug of first choice. Such drugs inhibit 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 increase insulin secretion. The group includes sulfonylurea derivatives and glinides. Used to lower blood glucose levels after meals.
• Drugs that reduce the absorption of glucose. 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 normal levels.

Diet for diabetes

The diet for type 2 diabetics is based on limiting carbohydrate intake. The patient's diet divides all carbohydrates into "light" and "heavy", the former are quickly absorbed in the intestines and quickly increase blood sugar to a high level, these include glucose and fructose. The latter are digested slowly and slightly raise blood sugar levels, these include fiber and starch.

An important role is played by the menu for a type 2 diabetic with obesity, in which case nutrition pursues not only the main goal - a reduced intake of carbohydrates that turn into sugar, but is also based on the ability to get rid of excess weight, which provoked the development of the disease.

Nutrition in type 2 diabetes prohibits the use of foods high in glucose:

• granulated sugar;
• confectionery - sweets, chocolate, cakes, cookies and so on;
• jam and honey;
• bakery products made from white flour;
• semolina;
• pasta;
• grapes and bananas.

An exemplary diet allows you to consume foods that contain starch and fiber in a limited amount:

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

With virtually no restrictions, you can eat the following foods:

• all kinds of meat and fish;
• eggs;
• unsweetened dairy products;
• vegetables;
• mushrooms;
• fruit.

Menu

Table No. 8 becomes the basis of the diet for patients with type 2 diabetes after treatment with medications, it is stricter than the usual diet, but it is not necessary to adhere to it constantly, only in order to prevent the worsening of the disease.

Sample menu for the day with diet number 8:

• Breakfast - cottage cheese and an apple or boiled eggs, or baked champignons.
• Second breakfast - fruit or yogurt.
• Lunch - vegetarian borscht or borscht with chicken, beetroot salad.
• Snack - a glass of kefir.
• Dinner - stewed zucchini with liver.

In fact, the diet for type 2 diabetes can be quite varied and include delicious meals, but food is only allowed to be boiled, steamed, stewed, fried foods are prohibited. It is also not recommended to eat fatty, spicy, canned and overly salty foods.

The patient should know not only how to eat in 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.

1. 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 the entrance to glucose for cells, where it is processed or stored in reserve (for example, in the form of glycogen in liver cells). This disorder is called insulin resistance.
2. 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 insulin itself produced is no longer the “key” to the cells.

Type 2 diabetes symptoms

Type 2 diabetes often proceeds without visible manifestations, the person does not even know that he is sick.
Some symptoms may appear for a while and go away again.
Therefore, you need to carefully listen to your body.

Overweight and obese people should regularly donate blood for sugar.

• Increased sugar is accompanied by thirst, and, as a result, frequent urination.
• Severe dryness of the skin, itching, non-healing wounds may appear.
• There is general weakness, fatigue.
• Blood sugar levels should also be monitored by people over 40 years of age.

Forms of severity of type 2 diabetes

There are three forms according to severity:

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

Treatment of type 2 diabetes mellitus: sugar-lowering drugs and insulin therapy

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

You can not neglect physical activity and diet. Since they help a person to lose weight and, thereby, reduce insulin resistance of cells (one of the causes of diabetes), and thus normalize blood sugar levels.
Of course, not everyone can refuse drugs, but without weight loss, no type of treatment will give good results.
But still, the basis of treatment is sugar-lowering 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. The drugs of 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), to a greater extent restore the mechanism of action of insulin.

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

- The second group of sugar-lowering drugs also consists of two types of drugs - Derivatives sulfonylurea and meglitinides.
The drugs of this group stimulate the production of their own insulin by acting on the beta cells of the pancreas.
They also reduce glucose stores in the liver.

Preparations of the group Sulfonylureas ( Maninil , Diabeton , Amaryl , Glurenorm , Glibinez-retard) in addition to the above effects on the body, they also affect insulin itself, thereby increasing its effectiveness.

Meglitinides (Repaglinide) Starlix)) enhance the synthesis of inulin by the pancreas, and also reduce postprandial peaks (increased sugar after eating).
Perhaps a combination of these drugs with Metformin.

- The third group of hypoglycemic drugs includes acarbose (Glukobay). This drug reduces the absorption of glucose by intestinal cells due to the fact that, by binding to enzymes that break down carbohydrates from food, it blocks them. And unsplit carbohydrates cannot be absorbed by cells. And this results in weight loss.

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

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

Nutrition for type 2 diabetes

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

The basis of the diet is the rejection of fast or refined carbohydrates, such as sugar, sweets, jam, many fruits, dried fruits, honey, fruit juices, muffins.

A particularly strict diet at the beginning, when you need to lose weight, then the diet can be somewhat expanded, 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 hypoglycemia attacks.
Honey, juice, sugar are well suited for this.

Diet should not be 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 calorie- and carbohydrate-calculated diet meals can be found on our partner Dia-Dieta website.

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

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

It is worth giving up fried foods, steam, boil or bake in the oven.

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

Compliance with such a diet will not only help to reduce weight, but also keep it at a normal level, which will have a beneficial effect on the general condition of the body.

Physical activity in type 2 diabetes

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

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

If you have a long load, then before starting it is recommended to eat 10-15g of slow carbohydrates to prevent hypoglycemia. Bread, apple, kefir are suitable as a snack.
But if the sugar has dropped sharply, then you need to take fast carbohydrates in order to quickly raise the glucose level.

Any physical activity should be excluded with sugar above 12-13 mmol / l. With such high sugar, the load on the heart increases, and in combination with the load, this becomes doubly dangerous.
In addition, exercising with such sugar can lead to its further growth.

It is advisable to control the level of sugar before the load, during and after it, in order to avoid unwanted fluctuations.

396 Comments

Hello. Please help me figure out what's wrong with me. Before pregnancy, elevated blood sugar of 6.25 from a vein on an empty stomach was revealed (further, all tests were also from a vein). I passed the GG-4.8%, the glucose tolerance test after two hours was 4.6., Insulin was in the region of 8, i.e. type 1 diabetes definitely cannot be, tk. C-peptide was also normal.
During pregnancy, she had gestational diabetes mellitus and a very strict diet with sugar control using a glucometer and a sensor. After pregnancy, this winter I passed 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 passed and it was already 6.83, but I ate sweets at night (ice cream and an apple), but 8 hours before the fence on an empty stomach definitely passed. The last GG of 4.8% was handed over a week before this high sugar indicator and then sugar also handed over 5.96. Endocrinologists prescribed me Metformin at first 500 and then 850 mg at night, but I did not see a decrease in fasting sugar.
I am 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 in two hours on a glucometer is not higher than 6, but more often 5.2-5.7. I can't understand why my fasting sugar is so high if I'm not fat, but 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 I often feel dizzy when I eat carbohydrates, although sugar at these moments is absolutely normal (I checked it with a glucometer many times).
I took blood tests and I still have high LDL cholesterol-3.31 (at a rate of up to 2.59) and there is an increase in hemoglobin 158 (normal up to 150), erythrocytes-5.41 (up to 5.1 normal) and hematocrit-47, 60 (norm up to 46). The doctor says that this is nonsense and suggested drinking more fluids, and I'm worried that this may be due to sugar and hypothyroidism. I’m afraid that everything complicates my condition, because cholesterol affects the pancreas, and hypothyroidism and diabetes often go together, and then Euthirox is canceled for me, then they are returned.
Tell me, please, what tests should I still pass in order to understand whether my diabetes is starting or is it still a violation of fasting glycemia?

1. Julia, good afternoon.
   Elevated hemoglobin, indeed, can be associated with a small amount of fluid you drink. How much do you drink per day? To be honest, I myself have the same situation, hemoglobin 153-156. I drink very little (less than a liter a day), it is difficult to force myself, although I know that I need more. So pay attention to this fact.
   Cholesterol, of course, is above the norm, but not critical to somehow affect the state of health. There is no point in taking cholesterol-lowering drugs. If possible, review 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 in the thyroid gland. It may be necessary to increase the dose of euthyrox.
   You can check the heart, go to the cardiologist. Small increases in sugar may not cause such symptoms.
   While you have such a situation, you can definitely say that you definitely don’t have CD1. SD2 is questionable. How much metformin treatment is necessary, of course, the doctor decides, but so far there is no strict need for taking drugs, in my opinion. Perhaps such a development of the situation that the temporary use of metformin will help to establish the absorption of carbohydrates and then it can be abandoned.
   As long as you continue to drink the drug prescribed by your doctor, monitor your sugar levels. If you want to eat more carbohydrates, then it is better to do it in the morning, and not at night.
   You don’t need to take any tests yet, you have already passed all the main ones. Retake periodically (3 times a year) glykir.hemoglobin, well, measure 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 sugar to target blood. Doctors (especially of the old school) often rely on values ​​for whole blood.

   1. Thank you for the answer!
      Yes, something very strange is going on with the thyroid gland. After pregnancy on a dose of 50 (before I even alternated between 50 and 75 to keep the TSH around 1.5) fell to 0.08, i.e. the dose was too high. The doctor prescribed an ultrasound (it was good, without any traces of pathology, although there used to be a small nodule) and asked me not to drink Euthyrox for a month, to take an analysis. I did everything and after a month of cancellation I had a TSH of 3.16 at a laboratory norm of 4.2. The doctor again prescribed Etirox at a dose of 25 and my TSH began to decrease again, but pains immediately appeared in the top of the foot. I remembered that I already had this many years ago, when hypothyroidism had not yet been found, so I turned to another doctor and he canceled Euthyrox for 3 months. (legs, by the way, almost immediately passed) + Metformin canceled me too. After 3 months I have to check ttg, glycated and sugar.
      I now have a Contour Plus glucometer (calibrates by plasma), before that I had a Freestyle optium.
      Doctors brought tests only from the laboratory (from a vein).
      My high sugar of 6.83 was from a vein according to the laboratory (((and this scares me, because getting diabetes at the age of 35, when you have a small child in your arms, is very scary.

      1. Julia, your situation is not simple, because thyroid disorders are hormonal disorders, just like diabetes. Everything follows one after the other.
         It's too early to talk about diabetes. Retake periodically tests for GG, sometimes check sugar on an empty stomach at home.
         Sugar 6.8, especially one-time, does not speak in the direction of diabetes.
         It makes no sense to worry about this, severely limit your diet too. It is impossible to protect yourself from diabetes, like, for example, from the flu, by carrying out prevention and vaccinations. With DM2, the situation can be improved by diet, with DM1, the 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 in case of its manifestation, now all this will not bring any positive results. But unrest can do a disservice and cause an increase in sugar, even in the case when there is no diabetes.

         1. Yes, I would like to digress from all this, but the general state of health interferes: dizziness after eating, severe hair loss, sweating, etc. Not much fun, unfortunately.
            Today, tests for hormones have also arrived, and it seems that the abolition of Euthyrox provoked an imbalance, because. this did not happen before, the previous ones were taken in May on Euthyrox. Prolactin jumped strongly to 622 at a rate of up to 496, cortisol at the upper limit of normal, fasting insulin became even higher 11.60, glucose 6.08, and the Hom index is now 3.13, i.e. developed insulin resistance
            Now I don't even know what to do. I could not find a good doctor to deal with all the problems.

            Julia, what city are you from? If Moscow, Moscow region, then you can look for doctors. Unfortunately, I don't know about other cities.
            I tend to think that "dizziness after eating, severe hair loss, sweating, etc." not associated with such low sugar. It's more like a thyroid gland.
            These same symptoms can also give malfunctions in the work of the adrenal glands.
            Another question - have you been examined by a gynecologist? What about hormones in this area? Polycystic ovaries can lead to insulin resistance.
            Unfortunately, it is difficult to say right away - you have this and that. In your situation, there are such general symptoms that it is necessary to conduct a systematic examination in order to identify the real cause. This, of course, is not as fast as we would like.

            As for 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 shields is selected. The glands, and insulin resistance does not go away, you will have to get used to living with it.
            Then treatment with metformin should make a difference.

            I couldn't hit the "reply" button on my last comment, so I'll post it here.
            I'm from Minsk and it looks like a good doctor here should be looked for like a treasure)) I signed up for the weekend with the advised endocrinologist ... we'll see.
            It seems to me that my problems with insulin are really hereditary, tk. in our family, all women have an active accumulation of belly fat. My sister is actively involved in sports, but the stomach still has a place to be.
            I don't have PCOS, but after pregnancy there were problems with the cycle and the gynecologist doesn't like my ultrasound with the endometrium. There is a suspicion that the swing with Euthyrox led to such a failure, because. he fell at my dosage of 50 mg to almost 0, but I didn’t know that.
            Today, a detailed analysis of the thyroid gland also came (I have not been drinking Euthyrox since September 12).
            If you can somehow comment, I will be very grateful.
            TSH-2.07
            Т3sv-2.58 (normal 2.6-4.4) reduced
            T3total-0.91 (normal 1.2-2.7) reduced
            T4total-75.90 norm
            T4sv-16.51 norm
            Thyroglobulin-22.80 norm
            Antibodies to TG- 417.70 (norm<115) повышено
            Antibodies to TPO - 12 norm
            I decided to take it in detail so that the doctor could look at all the tests in detail.
            Tell me, please, how can I check the work of the adrenal glands, what tests can I take?
            Thank you for your answers and for spending your time on an essentially stranger :)

            Julia, good afternoon.
            Stress and anxiety also affect the hormonal background, can also cause weakness, hair loss, sweating. Hormones such as catecholamines, which are synthesized in the adrenal glands, help us fight stress. They regulate the body's response 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 made everywhere.
            And first of all, you just need to choose the dosage of euthyrox. The thyroid gland has a huge impact on well-being. It is T3 that affects the activity of the cardiovascular system, its lack is manifested by an increase in cholesterol, weakness, and problems with concentration.
            Both the adrenal glands and the thyroid gland should be dealt with by one doctor.
            95% that all your unpleasant symptoms will go away as soon as the work of the thyroid gland improves.

            As for diabetes, believe me, life does not end when this diagnosis is made. As people with diabetes, we also live, work, travel, raise families, fly planes, ski, and so on. Well, we just can’t fly into space :). So do not waste time on unnecessary experiences, 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 also visited Minsk, a very beautiful city. We are planning to come again. In general, we go to Vitebsk 2-3 times a year. Your place is very beautiful!

I am 56 years old, with a pressure of 195-100, I was admitted to the hospital by ambulance. During the research, it turned out that my sugar had risen to 10.5. I never knew about it before. They put DM2 and prescribed Metformin 2 times a day, 500 g, and antihypertensive drugs for pressure. I began to follow a diet to drink medicines, but very often my pancreas began to hurt in my left side. I drink pancreotin, allochol, mezim was prescribed when I was at the gastroenterologist, but the pain does not go away. I drank only water for half a day, I thought it would pass, but the pain does not go away. What do you recommend to drink?

1. Hello. Dad was recently diagnosed with type 2 diabetes, sugar was 19. And the doctors also cut off the tip of the thumb, because the legs didn’t feel anything at all and apparently the nails began to fall off. According to my father, it started about five years ago, as my feet get cold. When the doctors operated, they did not know that he had sugar. The operation went well, the legs warmed up a little, that is, they began to feel a little. And now, after a while, blisters appeared on my legs, burst and the skin is torn off. It hurts at night. We don't know what to do.

2. Mom is 60 years old, type 2 diabetes, insulin resistance, they gave insulin injections, her sugar was 14, her eyesight fell.
   tell me, is it possible to start physical training or should I wait until the body gets used to insulin and lowers sugar?
   Will training help avoid vascular problems?

3. Thanks for the article, useful information. I am 52 years old, I am overweight, unfortunately, my sugar is slightly elevated. I try to change my eating style, eat less sweets and starchy foods, and regularly measure my sugar at home with a glucometer TS circuit, this is also very important to always be on the alert and control my health

   Thanks for the article, it clarified many questions. My sister was recently diagnosed with mild type 2 diabetes, although there really were no symptoms, but she started to do more sports, dances, of course she keeps to a diet, we recently bought her a tc circuit so that she can control her sugar, she is going to the camp and we will calmer so, especially since it is very simple and she easily manages it.

4. Hello, my mother's sugar on an empty stomach 8yo eat scales up to 21yo on average from 10 to 14. She refuses insulin. Takes Glyformin. She also has a postoperative hernia above the navel. Maybe you still need to somehow persuade, force him to take insulin?

5. Hello, my mother, 41 years old, was admitted to the hospital with acute pancreatitis, she passed an analysis for sugar sugar 14 endocrinology came and said you are insulin dependent and said now they will inject insulin, she refused, she is afraid that she will sit on it all her life, what to do help.

6. Good afternoon. My mother has had type 2 diabetes for many years. She did not treat herself, she did not follow diets. This fall I had a foot amputation. Gangrene set in. Now she eats semi-finished products - store-bought pancakes and dumplings. Sometimes he cooks a soup with the addition of a batch concentrate. He lives far away and I can’t convince him not to eat this muck. Takes diabetes and drinks pain pills. Sometimes checks (a couple of times a week) sugar. So far, he is holding on to 8. He categorically refuses insulin. The stump heals normally. And yet, it seems to me that this is all “more or less normal”, an apparent calm before another storm. In the discharge from the hospital, concomitant diseases such as chronic renal failure, ischemic brain, chronic portable insufficiency were indicated. She flatly refuses to change her attitude. The question is, am I right or am I more ignorance escalation? If I'm right, then how long do diabetics live after amputation with such an attitude with such a diagnosis? If I can’t convince, then I can remember the argument exactly.

   1. Sveta
      Your situation is not easy - we can always decide for ourselves, but sometimes it is absolutely unrealistic to force or convince another person to change their lifestyle.
      Now on topic - your mom's comorbidities are a consequence of diabetes. Of course, compensation is needed to maintain health to the extent that everything is now.
      With a sugar of 8-9 mmol / l, it is possible to dispense with oral sugar-lowering agents (tablets) and a diet. If such sugars are kept in case of non-compliance with the diet, then if it is observed, everything should be in perfect order. Well, this is if the sugar really does not rise higher. But there are doubts about this, or mom hides, well, 1-2 measurements per week do not give a complete picture, since between these measurements sugar can range from 2 to 20 mmol / l.
      Mom was offered 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 sugar will have to be measured more often, especially at first, until suitable doses are determined.
      That is, for a normal future life, there are two options:
      1. Pills and DIET are the basis of treatment for type 2 diabetes.
      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 speaks of the death of the vessels of the lower extremities, the probability of its occurrence on the other leg is very high. How will mom get around then?
      About CKD - ​​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 for their turn, unfortunately. And then, finally, having received a place for dialysis, a person becomes attached to the house - since dialysis is done on certain days, at a certain time, this is a matter of five minutes. Therefore, several hours a day, 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 drugs for the rest of your life, since during dialysis a lot of substances needed by the body are washed out.
      And these are only those problems that are necessarily waiting for a person who does not have normal compensation. Maybe this will still encourage your mother to think about the future - a more or less active and independent person who is on a diet or bedridden, who will be cared for by loved ones who have the right to their privacy, but measure sugar once a week and eating questionable snacks.
      Your mother - health and prudence, and patience to you!

7. Mom has type 2 diabetes. Takes metfogamma, metformin (depending on what is on sale). Sometimes in the morning sugar is below normal (according to the glucometer): about 2-3. Usually around 7-8. What is it can be and how much it is harmful? Thanks in advance for your reply.

   1. Dmitry
      Reducing sugar to 2-3 mmol is already hypoglycemia. These reductions must be avoided. Especially if the mother herself does not feel low sugar, but only learns about it from a glucometer. Low sugars are dangerous in that measures must be taken immediately, without delay. When sugar levels are low, the brain does not receive enough oxygen, oxygen starvation occurs, which leads to the death of brain cells.
      In order for sugar to be approximately the same every day, you need to do everything at the same time - take drugs, eat a certain amount of carbohydrates. Follow up, perhaps on the eve of those days when sugar is low in the morning, mom eats little carbohydrates (less than usual), this leads to a decrease in sugar. You can't forget to eat.
      If cases of low sugars are regular, then you should consult a doctor. He will either postpone the drug to another time, or, most likely, reduce the dose of the drugs he takes.
      Well, physical activity also reduces sugar. Are there any factors contributing to these decreases on the eve of morning hypoglycemia (trips to the dacha, garden beds, just walking, cleaning around the house, etc.)

8. Hello. My father has type 2 diabetes. He is 65 years old, weight 125 kg. He doesn’t really want to be treated, but it’s difficult to force him. Since my knowledge is zero, and the patient has no zeal, I am in a stupor.

   Question about a specific situation
   he vomited yesterday afternoon, felt bad, refused an ambulance. (assumed that just poisoning). Then he slept all evening and all night.
   In the morning I asked to measure sugar and pressure, everything turned out to be elevated. 162 to 81, pulse 64, sugar 13.0.
   Please tell me what to do. Should I sound the alarm? What exactly to do?
   Thank you very much, urgent question.

9. Hello, all day long sugar is normal 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 normal night sugar? In the afternoon, after any meal, sugar is always normal from 5 to 6. Please tell me. Thank you

10. hello, tell me please, I was diagnosed with DM2 4 months ago, i.e. in April, on an empty stomach, I donated blood was 8.6, they prescribed mitformin 850 one tablet in the evening and they kicked me off trying to be treated 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 have a height of 168, I weigh 76.800 kg, I am doing exercises, now I was pulling out my teeth, the sugar has risen to 15, the pressure has dropped to 80/76, I feel bad, can I have some more pills to drink, please tell me