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Diabetes mellitus
Definition
Diabetes mellitus (DM) - a group of
metabolic (metabolic)
diseases characterized by hyperglycemia,
which is
result of a lack of insulin secretion and / or
violation of the
insulin, which leads to a violation of all
kinds of metabolic
primarily of carbohydrate, the defeat of
vessels (angiopathy), nervous
system (neuropathy) and other organs and
systems.
Epidemiology
The prevalence of diabetes among people of
different stran
is 2-6%. In recent years, the prevalence of
the disease
increases rapidly.
Classification
1 Diabetes mellitus type I (insulindependent).
2. Diabetes mellitus Type II (insulinindependent).
Etiology
The reason for diabetes to date is not known.
Possible etiofactors for diabetes type I:
1) viral infection (rubella virus,Coxsackie B,
hepatitis B, mumps, infectious
mononucleosis, Phippen, etc.), and
2) a genetic predisposition, autoimmune
disorders, structural disease of the pancreas
(Pancreatic necrosis, sclerosing pancreatitis,
pancreatic resection cancer), toxic
substances that damage the E-cells
(nitrozaminy. cyanide compounds).
Possible etiofactors for diabetes type II:
genetic factors (nature of the dominant mode
of inheritance) overeating, excessive
carbohydrates, obesity, prolongeduse of
drugs diabetogenic action (corticosteroids
and etc.).
Pathogenesis
Pathogenesis of DM I type. The main
pathogenetic mechanism of diabetic
(hepatomegaly, tenderness
liver). The defeat of the cardiovascular
system .. Arterial
hypertension, diabetes or heart disease,
"diabetes
the heart. " (Manifested apnea, various types
of arrhythmias and
heart block, ECG changes, cardiomegaly,
heart
failure), CHD (see. diabetic
macroangiopathy)
metabolic syndrome X (a combination of
features such as CD 11,
obesity, hyperlipidemia, and arterial
giperteizii). Defeat
respiratory system. Most pulmonary
tuberculosis. It is also often develop
lobular pneumonia, acute exacerbation of
chronic bronchitis and
bronchitis. The defeat of urine. Often,
cystitis,
exacerbation of chronic pyelonephritis,
sometimes acute renal abscess
(Carbuncle, abscess). Almost all patients
have an asymptomatic
urinary infection in the form of bacteriuria,
leukocyturia.
It should be noted that the classic types of
long-term complications
Diabetes are diabetic angiopathy, which are
generalized vascular lesions. Diabetic
angiopathy
divided into two categories:
macroangiopathy and microangiopathy.
1.3.1. Diabetic macroangiopathy
Definition
This defeat of the arteries of large and
medium-sized patients
diabetes is characterized by rapid
development
atherosclerotic narrowing of the arteries.
Classification
There are diabetic macroangiopathy
associated with the development of
atherosclerosis-1) of the aorta and coronary
arteries, 2) cerebral
correction of diabetes
diabetes, the treatment of atherosclerosis and
emergency treatment of stroke.
Diabetic macroangiopathy of the lower
extremities is manifested
symptoms such as sensitivity to cold feet,
weakness in the legs during walking and
prolonged standing, the syndrome of
intermittent claudication (pain - in the
gastrocnemius muscle, emerging or
aggravated by walking and
decreasing at rest), dry skin of feet and legs,
cold
foot, muscle atrophy legs, loss of hair on the
legs, cyanosis
fingers, the weakening or absence of pulse
in large arteries
legs and feet, trophic changes (up to the
trophic ulcers)
skin of feet and legs, in severe cases it may
be the development of gangrene
the toes of this form of treatment
complications of diabetes include
timely treatment of atherosclerosis and
diabetes, the use of
vasodilators, and thrombolytic drugs,
surgical
treatment (see treatment of diabetic foot).
1.3.2. Diabetic microangiopathy
Definition
"This is generalized loss of small vessels
(capillaries,
precapillaries, arterioles, venules) in patients
with diabetes, characterized by
the development of thickening of the
basement membrane of blood vessels,
proliferation of endothelial mikrotrombozov
and microaneurysms, which in
Ultimately, accompanied by impaired
patency of the
vessels.
Diabetic microangiopathy is a classic view
complications of diabetes and occurs in 5090% of patients with diabetes.
Classification
Depending on the vascular bed
microcircular
of a body distinguished the following types
of
Diabetic microangiopathy: 1. Retinopathy,
2. Nephropathy 3.
Microangiopathy of the lower extremities. 4.
Neuropathy. Five. Syndrome
diabetic foot.
1.3.2.1. Diabetic retinopathy
Definition
This defeat of the retina in diabetes,
characterized by
narrowing of the capillaries, increasing the
aggregation of formed elements
blood, swelling of the retina, progressive
obliteration of the retinal
capillaries.
Diabetic retinopathy is the leading cause of
Blindness and visual impairment. When
diabetes develops blindness is 25 times more
likely
than the general population.
The clinical picture
Flickering before the eyes of flies and
patches of fog and a sense of
odd items, a progressive decrease of visual
acuity
including blindness. But the more specific
signs of diabetic
retinopathy, detected during the
ophthalmologic examination. These
signs depend on the stage of retinopathy,
and so we list these
signs depending on the stage of diabetic
retinopathy. /.
Nonproliferative retinopathy,
microaneurysms (hemorrhage,
edema, exudative lesions in the retina.
Hemorrhages are of the form
small dots, lines or dark spots rounded,
localized in the center of the fundus or along
the large veins in the
deep layers of the retina. Hard and soft
exudates, as a rule,
located in the central part of the fundus and
have yellow or
months). 4.3.
Antiplatelet agents and anticoagulants
(aspirin 375 mg per day, five thousand
heparin
IU 2 times n / a in the abdomen).
1.3.2.2. Diabetic nephropathy
Definition
This particular kidney disease in diabetic
patients,
morphological basis of which is
nefroangioskleroz
renal glomeruli, clinically manifested by
proteinuria and
progressive renal insufficiency.
The incidence of diabetic nephropathy is 4050%
with type I diabetes and 15-30% for type II
diabetes. Diabetic nephropathy
is the leading cause of disability and
disability in patients
SD.
Clinical and laboratory data
The earliest sign of diabetic nephropathy is
moderate proteinuria (albuminuria exact)
from 50 to 300 mg per day.
Over time, as the disease progresses,
proteinuria
increases and can reach up to 1.0-3.5 grams
per day or more. In 30% of patients
developed nephrotic syndrome. In later
stages
appears. hypertension with a sharp increase
diastolic blood pressure. In the final, has
been steadily growing
progressive chronic renal failure.
Treatment
A. Treatment of diabetes mellitus. Two.
Angioprotectors, antiplatelet agents, and
anticoagulants (see the treatment of diabetic
retinopathy). Three. Diuretics
(With the appearance of edema and
hypertension): furosemide 40-120 mg or
more in the morning
an empty stomach. 4. ACE inhibitors (for
hypertension): znalapril 5-20 mg per day.
Five.
Autonomous
(Visceral) neuropathy. Clinical
manifestations depend on the
destruction of an organ or system. Heart
disease:
tachycardia rest, orthostatic hypotension and
syncope
status, respiratory arrhythmia. The defeat of
the gastrointestinal tract: with gastroparesis
delayed or, conversely, a very rapid gastric
emptying,
atony of the esophagus, reflux esophagitis,
dysphagia, change in the aqueous
diarrhea, constipation, excessive salivation,
diskinezyi biliary tract with
propensity to stone formation, reactive
pancreatitis. Defeat
urinary system: atony of the ureters and
bladder,
violation of the separation of urine and a
tendency to develop urinary infections
Erectile dysfunction (about 50% of diabetic
patients), retrograde
ejaculation and testicular innervation
violation of pain, impaired
moistening the vagina. Violation of the pupil
function: violation
adaptation to darkness. Violation of the
function of sweat glands: the skin
becomes doughy, atrophic and dry
(anhidrosis).
Treatment
A. Treatment of type 2 diabetes.
Angioprotectors, antiplatelet agents and
anticoagulants
(See treatment "for diabetic retinopathy). 3.
Symptomatic
treatment.
1.3.2.5. Diabetic foot syndrome (SDS)
Definition
This is a pathological condition in the
diabetic foot that occurs in the
background lesions of peripheral nerves,
skin, soft tissues, bones and
joints, manifested by acute and chronic
ulcers, osteo-