Diabetes mellitus is such a disease or fiction. Interesting facts about diabetes and the whole truth

Candidate of Medical Sciences, Associate Professor of the Department of Endocrinology of the Federal University of Higher Education, Senior Researcher of the Department of Therapeutic Endocrinology of MONIKI - spoke about this disease and the misconceptions associated with it.

"AiF": - They say that with regular consumption of fruit juices, the risk of developing diabetes after 5-6 years is very high. It's true?

Redkin Yuri: - Drinking fruit juice does not increase the risk of developing diabetes. At least, there is no such data in the scientific literature available to me.

"AiF": - With diabetes, vision deteriorates. Is it really impossible for diabetics to deal with this side effect?

Redkin Yuri: - Any (including those from the eyes) arise due to constantly elevated blood glucose levels. For an elderly person with complications of diabetes mellitus, fasting blood glucose targets are less than 8 mmol / l, 2 hours after eating - less than 11 mmol / l, which corresponds to the level of glycated hemoglobin, that is, reflects the average blood glucose level over the past 2 -3 months, less than 8%.

However, if the patient has proliferative retinopathy or so-called macular edema, then lowering the blood glucose level below 8 mmol / l is dangerous. In order to understand what changes in the eyes the patient has - diabetic or age-related, it is necessary to consult an ophthalmologist with a mandatory examination of the fundus with dilated pupils.

AiF: Is diabetes inherited?

Redkin Yuri: - Familial or family recurrence rates are determined by a number of factors:

1) the frequency of diabetes in the population;

2) the number of sick and healthy relatives, the degree of their relationship;

3) the age of onset of diabetes in the patient, in some cases, his gender;

4) the age of the examined relatives, in some cases, their gender;

5) the type of diabetes mellitus in the patient.

When conducting medical genetic counseling, it must be remembered that types 1 and 2 diabetes mellitus are pathogenetically different, genetically independent diseases and are inherited independently of each other. In general, the risk of developing type 1 diabetes is 3–3.5% when the mother has diabetes and 4.5–5% when the father has diabetes.

A more accurate determination of the genetically mediated risk of developing type 1 and type 2 diabetes mellitus is possible using genetic analysis - identifying polymorphisms in genes, for example, TCF7L2, PPARG, KCNJ11 (for type 2 diabetes mellitus), PTPN22, DQA1 and DQB1 (for type 1 diabetes mellitus ). However, the study of genetic markers has only prognostic, but not diagnostic value. Immunological examination also allows to clarify the risk of developing type 1 diabetes: the determination of antibodies to pancreatic islet cells, antibodies to insulin, antibodies to GAD.

"AiF": - At what stage of the development of the disease can one independently determine diabetes? What are the symptoms for which you should see a doctor?

Redkin Yuri: - Unfortunately, it is more often detected when the level of glucose in the blood is already elevated. However, the symptoms of diabetes are very simple, and they cannot be overlooked: frequent copious urination, thirst, dry mouth, change in appetite, itching of the skin and mucous membranes, weight loss, weakness. This is especially important for people who are predisposed to diabetes: overweight, relatives with diabetes.

"AiF": - Is it possible to determine the ideal indicators for calculating insulin doses on the pump? Or all these parameters can and should change depending on age, season, activity mode?

Redkin Yuri: - is one of modern ways administration of insulin for diabetes. According to studies, when insulin is administered using a pump, the need for insulin is reduced, and compensation for the disease improves. However, this method of administering insulin imposes special requirements on a person, which must be met in order to achieve the desired results. In particular, it is necessary to know the insulin sensitivity coefficient (i.e., the coefficient that reflects how much 1 unit of injected insulin lowers blood glucose levels), the “per meal” coefficient (i.e., the coefficient that reflects how much blood glucose will increase if a person eats 10– 12 grams of carbohydrates).

Moreover, it is possible to choose a "basal profile" in such a way that blood glucose is maintained within the target values. All these parameters are individual for each person and depend on his lifestyle, activity, age, weight and even the season.

MOSCOW, November 14 - RIA Novosti. World Diabetes Day is observed annually on November 14th. On this day, Frederick Banting was born, who, along with Charles Best, played a decisive role in the discovery in 1922 of insulin, which saves the lives of people with diabetes.

Diabetes is of two types. In type I diabetes, the level of insulin in the blood is critically reduced, and patients are forced to constantly inject this hormone to stabilize the metabolic processes in the body. In type II diabetes, insulin is produced in normal or even increased amounts, but the mechanism of its interaction with the cells of the body is disrupted. In this case, patients are prescribed a diet and hypoglycemic drugs.

About 3.7 million Russians, according to official statistics, suffer from diabetes. The International Diabetes Federation estimates that there are actually 12.7 million such people, since only those patients who seek treatment are taken into account in official statistics. Candidate of Medical Sciences, endocrinologist of the State Research Center for Preventive Medicine Ekaterina Dudinskaya named 12 common myths about this disease.

Myth 1: Diabetes only affects overweight people.

Indeed, the vast majority of cases of type II diabetes mellitus are diagnosed in people who are overweight or obese. But diabetes mellitus is also detected in adults with normal or even low body weight. And in people with type 1 diabetes, weight is usually normal.

Myth 2. If you have type 1 diabetes, you can not eat sweet, fatty and fried foods.

In fact, the diet of a patient with type 1 diabetes is practically no different from the diet healthy person provided that the patient is familiar with the rules of insulin therapy and can apply them in practice.

For people with diabetes, it is enough to follow a balanced diet, which includes, among other things, foods containing glucose. It is important to remember that the main feature of nutrition in diabetes is a reasonable restriction of foods containing easily digestible carbohydrates (sugar), and the use of sucrose (sugar) in its pure form is really not recommended.

Myth 3: People with diabetes should only eat diabetic foods.

Specialized "diabetic" products that replace sucrose with artificial sweeteners may be high in fat. Consequently, these products bring no less harm and are fraught with a number of complications. The diet of a person with diabetes, like any person leading a healthy lifestyle, should not be oversaturated with fats, sugar, salt. At the same time, vegetables, fruits, durum cereals, complex carbohydrates (polysaccharides), proteins, vitamins should be present in sufficient quantities.

Myth 4. Diabetes sooner or later leads to loss of vision and amputation of limbs.

Unfortunately, vision loss and limb amputation are unfortunate consequences of some of the complications caused by diabetes. However, patients who do not smoke and control their blood glucose, blood pressure and cholesterol levels have every chance of avoiding the negative development of the disease. Moreover, modern medications and new approaches to diabetes therapy can effectively prevent complications.

Myth 5. Patients with diabetes mellitus are contraindicated in sports.

This myth is clearly refuted by numerous examples of athletes suffering from diabetes. In fact, people with this condition even need to exercise to improve their health. Of course, a number of contraindications in the choice of physical activity should be taken into account, however, there are no absolute contraindications to exercise in patients with diabetes.

Myth 6. Eating too much sugar causes diabetes.

Type I diabetes is a genetic disease. Type II diabetes is also caused by genetic factors and poor lifestyle habits. Being overweight, of course, increases the risk of developing the disease. A high-calorie diet high in fats and simple carbohydrates contributes to obesity. If you have a history of diabetes in your family, you should opt for a healthy, balanced diet to avoid excess weight and reduce the risk of developing the disease. So far, there is no evidence that the consumption of easily digestible carbohydrates (sugars) alone can cause diabetes.

Myth 7. If a doctor prescribed insulin for type II diabetes, then the disease has become critical

In most cases, type II diabetes is a progressive disease. At first, it can only be treated with oral (taken by mouth) medicines. However, over time, the body produces less and less insulin, which causes the need to take insulin-containing drugs. Nevertheless, the transition to insulin should not cause panic, as this is an obligatory part of complex treatment.

Myth 8. Honey can be a sweetener, and black bread raises blood sugar less than white bread.

Honey consists of fructose and glucose in approximately equal proportions. The food sugar (sucrose) molecule also consists of a fructose residue and a glucose residue. The sugar-boosting effect of honey is the same as that of sugar.

The sugar-increasing effect of all types of bread is the same. However, rich bread raises sugar more, and bread with the addition of bran or whole grains - a little less. The sugar-increasing effect depends on the amount of bread. Three slices of black bread will increase sugar more than a slice of white.

Myth 9. Insulin administration is associated with pain.

Modern thin needles make the injection almost painless. For patients with fear of injections, there are needleless injectors and special means insertions in which the needle is hidden.

Myth 10. Insulin causes weight gain.

In the absence of an overdose, insulin therapy does not cause weight gain more than the amount to which the appetite regulation system is "tuned". Often, insulin therapy begins after a sufficiently long period of decompensation (a condition in which blood sugar levels cannot be corrected by other drugs). In such cases, a spike in sugar levels dramatically reduces weight due to the loss of part of the food consumed in the form of glucose in the urine.

Myth 11. Patients with diabetes get fat from hormonal disorders and insulin intake.

Extra pounds can not be gained from the air. If the weight increases - the body needs to take it from somewhere " construction material"to build a body. Excess body weight occurs when we consume more energy than we expend. Losing weight is a long and difficult process. This task must be constantly worked on - limiting calorie intake, expanding the amount of physical activity, and sometimes with the help of medications and surgical methods.

Myth 12. Children with diabetes are doomed to diabetes.

This question usually arises in type 1 diabetes. In reality, the risk of type I diabetes in a child is 2-3% if the father has type I diabetes, and 5-6% if the mother has type I diabetes. With this type of disease in both parents, this risk is significantly higher (15-30%). In relation to type II diabetes, the probability of the disease of the patient's children is much higher and exceeds 50%.

This is both true and myth at the same time.

The fact is that diabetes is an incurable disease For the rest of their lives, people with diabetes need to perform actions aimed at achieving normoglycemia (normal blood glucose levels). Such manipulations include taking oral hypoglycemic agents, administering insulin, dieting, etc.

Only in this case it is worth dividing and. With diabetes mellitus of the first, there are no alternative methods of treatment, except for insulin therapy - correctly selected doses, periodic measurements of sugar - this is the way to normal sugars and a long healthy life.

No decoctions of herbs, buckwheat in kefir, bean leaves, physiotherapy, carbohydrate-restricted diets, insane physical activity, etc. Only insulin and the desire to achieve good sugars.

But with type 2 diabetes, it is possible to refuse to take sugar-lowering oral drugs (pills). This is only possible, provided that a person follows a diet, performs physical activity (to the extent permitted by the doctor), and brings his weight back to normal. In this case, due to disappearing fat reserves, tissue sensitivity to insulin increases, in some it is completely restored, which makes it possible to refuse to take drugs. But you need to follow a diet and maintain normal weight for life.

Myth 2
Doctors put on insulin

Get hooked on insulin- such a phrase sounds more than strange, because all healthy people are excreted in full, and as soon as it ceases to be synthesized in the right amount, diabetes mellitus develops. Therefore, in order for a person with diabetes to be no different from a healthy person, he needs to inject the missing insulin.

You can “get off insulin” at any second ... and die from hyperglycemic coma or numerous complications of diabetes.

Therefore, doctors do not “put anyone on” insulin, but give a person a chance to live for many more years by injecting the insulin he lacks.

Myth 3
Switching to insulin in type 2 diabetes is the extreme severity of diabetes and there will be no turning back.

At first, people with type 2 diabetes produce enough or even more insulin than they need. But the very effect of insulin is disrupted, it no longer regulates sugar levels. Often this happens due to excess body weight of a person, when fat reduces the sensitivity of cells, and they do not perceive insulin, as if they do not see it. Therefore, more and more of it is secreted, as a result, the pancreas overstrains and stops working, it does not produce more insulin. This happens not in a day or two, but in several months or years (depending on the degree of decompensation).

Therefore, in the case when oral preparations are powerless, insulin is prescribed. About the fact that they put you on insulin - see myth 2.

Myth 4
Diabetes requires a strict diet

You often hear from people that if you have diabetes, then you can’t have sweets. This is not entirely true.

With type 2 diabetes, indeed, you need to constantly follow a diet. Of course, in no case should you completely refuse to take carbohydrates, since carbohydrates are the main source of energy for the body. You should stop taking fast carbohydrates - sweets, some fruits, juices, sugar, jams, some vegetables, and some cereals. It is worth eating foods with low, slowly digestible and not drastically raising sugar.

Type 1 diabetes does not require a diet. The main task of people with the first type of diabetes is to choose the right dose of insulin. It must be remembered that insulin doses fluctuate depending on the time of day, on the day of the cycle (for women), on the glycemic index of the foods consumed, and much more. Frequent measurement of sugar, checking the action of insulin in different situations - and in a while you will collect the information you need, which will help you draw conclusions about the doses you need when eating a particular product. With type 1 diabetes, a person has much more freedom in terms of choosing dishes, he is limited only by the ability to correctly calculate the dose.

Myth 5
Get fat from insulin

Another common myth is that when prescribing insulin therapy, a person gets fat. This is not true. They get fat from the wrong lifestyle, from incorrectly selected doses of insulin, with poor compensation.

When insulin doses are too high, a person may go into a state of hypoglycemia several times a day. Accordingly, he eats sweets several times a day, often overeating heavily. Thus, he eats much more than a person needs per day. After overeating, as well as in case of severe hypoglycemia (as a result of a sharp decrease in sugar, the body ejects glycogen from the liver), as well as in the case of missed hypoglycemia (a person may not feel “hypo” and the liver itself corrects the situation by ejecting glycogen and thereby increasing sugar) sugar naturally rises. A person increases the dose of insulin, thereby worsening the situation. The next time he gets more severe hypoglycemia, eats sweets, then lowers the sugar again with insulin. This process is called "swing" - sugar is up, then down, and so on ad infinitum.

This is the behavior that leads to weight gain - a person eats almost constantly and overeats a lot of calories.

By taking on compensation, in a couple of months you can bring everything back to normal, then the weight will not be gained.

Myth 6
Diabetic sweets can be eaten without restrictions

One of the most common myths. Sweets on fructose, glucose, pastries on artificial sweeteners are sold in any store.

People eat them in large quantities (they are diabetic!), and sugar is rising higher and higher. What's the matter?

And the fact that both glucose and fructose increase sugar in almost the same way as sugar. Look at how many carbohydrates are listed on the package of waffles/cookies/chocolate made with fructose and regular sugar. There is no difference.

These products, like regular sweets and pastries, increase sugar, they require the same amount of insulin for their absorption.

Therefore, in type 2 diabetes, they can be consumed in very small quantities, considering them as ordinary foods with a high glycemic index. And with type 1 diabetes, they must be counted as ordinary sweets and insulin should be injected under them.

Today, the diagnosis of "diabetes mellitus" no longer sounds like a sentence, but the insidiousness of this disease cannot be underestimated. And since the vast majority of diabetics are at least 90%— suffer from type 2 diabetes, it is about him that we decided to talk with a specialist.

Our expert: Elmira B. SALIMZHANOVA endocrinologist of the highest category, head of the endocrinology department of the Hospital of the Ministry of Foreign Affairs of the Russian Federation

What is the difference between types 1 and 2 diabetes?

- If we talk about the risk of developing the disease, then who has it increased?

“Mostly in people with prediabetes, a borderline condition in which blood sugar levels are higher than normal but not high enough to be diabetic. Obesity, the presence of diabetes in relatives, gestational diabetes during pregnancy, age over 60 years are risk factors.

- Are there any characteristic signs by which diabetes can be suspected?

- The signs and symptoms of the disease can be so mild that the patient simply does not notice them. These include:

• increased thirst
• increased hunger
• fatigue
• increased urination, especially at night
• unexplained weight loss
• blurry vision
• numbness or tingling of the hands and feet
• non-healing wounds.

How is type 2 diabetes diagnosed?

This disease is characterized by a gradual onset and a slow rise in blood sugar levels. In some cases, a laboratory test is required for insulin level or C-peptide in the blood. However, these indicators are not reliable enough, and the interpretation of the results of the analysis is ambiguous.

- What is the therapy?

- The most widely used today are drugs that stimulate the production of their own insulin. There are other pills that enhance the absorption of sugar by cells; they are usually given to obese patients who are not very successful in losing weight. Tablet preparations are effective as long as the pancreas produces enough insulin. In many patients, they gradually stop working, and then insulin treatment becomes the only alternative. In addition, in some cases (for example, during serious illnesses), even successful treatment with tablets is temporarily canceled, and the patient is transferred to insulin.

Insulin treatment should replace the work of the pancreas, which normally detects and secretes an adequate amount of insulin. The only way to administer it is by injection, since when taken “inside”, it is destroyed by gastric juice. Subcutaneous insulin works just as well as our own. It is more difficult to determine when it should be entered. A healthy pancreas "feels" the increase in blood sugar and regulates the amount of insulin released. The doctor's task is to teach the patient to constantly maintain a normal glucose level in order to avoid both its high content (hyperglycemia) and low (hypoglycemia).

- Is the use of herbs as part of complex therapy justified?

- There is an opinion that only plants with insulin-like action are effective. This is not true; With diabetes, you can - and you should! - use different medicinal herbs. According to their impact, they are divided into several groups.

Plants with a tonic effect - ginseng, eleutherococcus, golden root, zamaniha and leuzea.

Plants that contain hormone-like, including insulin-like substances, -,.

Plants that can improve and regulate metabolism, as well as cleanse the body, -, cudweed marsh, blueberries,.

Plants that contain easily digestible substances that reduce the body's need for insulin are blackberries, pears, dogwoods, pomegranates, chicory, grapes.

Plants rich in vitamins and organic acids that increase the body's defenses -,. This group also includes brewer's yeast, although it is not a plant. Cereals and horticultural crops—beans, garlic, lettuce, beets, cabbage, spinach, celery, potatoes, and barley—also have cleansing properties.

Of course, such a classification is very arbitrary, but it helps to understand which plants are which. useful properties possess.

What foods should be excluded? Is physical activity important?

- In type 2 diabetes, getting rid of overweight is an important part of therapy. This can only be achieved by following low calorie diet. It is not necessary to count calories, it is enough to divide all products into three groups:

1. Products that can be consumed without restriction. This group includes all vegetables, with the exception of potatoes and corn (but cooked with a minimum of fat), as well as tea and coffee without the addition of cream and sugar.

2. Foods that can be consumed in moderation (that is, eat half as much as usual). These are lean meat, fish, dairy products, cheese less than 30% fat, eggs, potatoes, corn, legumes, bread, cereals, fruits.

3. Products that should be excluded from the daily diet. These include:

• butter, fatty meat and fish, smoked meats, sausages, poultry skin, canned food, cheese with a fat content of more than 30%, cream, sour cream, mayonnaise, nuts, seeds;
• sugar and sweets (confectionery, sweets, chocolate, jam, jam, honey, sweet drinks, ice cream);
• alcoholic drinks.

Regular exercise stress very important. It helps to reduce weight, maintains blood sugar and blood pressure, keeps cholesterol levels under control, allowing the body to effectively use insulin. But the load should be increased gradually! First, discuss with your doctor what kind of physical activity you prefer, and then slowly and carefully increase its duration to at least 30 minutes a day.

What are the most common complications for people with type 2 diabetes?

- Diabetes mellitus must be constantly monitored - measure glucose levels several times a week, and preferably once a day, and take medications prescribed by a doctor. Frequent and sharp fluctuations in blood glucose levels lead to chronic complications. The most dangerous thing is that they develop imperceptibly, at first without affecting the state of health, and appear only 10-15 years after the onset of the disease.

Is it possible to hope that type 2 diabetes will be defeated?

- Diabetes mellitus is incurable, but a significant weight loss allows in some cases to normalize sugar to long years. When sugar levels remain consistently normal without medication, the patient has the feeling that the diabetes has “disappeared”. In fact, in such cases, we are talking about adequate control of the disease with the help of the right diet.

In the future, we can expect the appearance of more radical methods of treating diabetes mellitus - transplantation of the pancreas or its cells. Perhaps an artificial pancreas will be created.

But even today, with timely diagnosis, proper treatment and constant monitoring of glucose levels, a person with diabetes can live a full life.

Mr. "Stoletnik" No. 12, 2015

Diet for diabetes is an important part of treatment. Scientists around the world have conducted many studies, during which they managed to prove the role of diet in stabilizing the patient's condition and controlling sugar levels. The treatment of diabetes is always multifaceted, its goals are varied and are achieved by taking medications, giving up bad habits, playing sports, but nutrition is still the main value.

Perhaps for these reasons, there are so many myths and misconceptions circulating around diabetes nutrition, and some of them can be potentially dangerous. We debunk common myths and provide useful recommendations.

Myth #1. There is no universal diet

Some recommended diets for diabetes are too strict and difficult to follow. A significant restriction of products, an insufficient number of calories can cause breakdowns. The consequences of these breakdowns are not formed at lightning speed, and sometimes have long-term consequences. Perhaps for these reasons, rumors circulate among patients with diabetes that there is no specific diet for diabetes, you can eat anything you like, most importantly, in small quantities.

In fact, there is a rational grain in this delusion. You can not limit yourself in nutrition only when there is no risk of developing complications of diabetes. Which is extremely rare. Therefore, if the patient has a goal to live happily ever after without the complications of diabetes, then the diet will have to be followed - to limit carbohydrates. Today, this is not only the only way to avoid blood sugar spikes, it is also the safest and most enjoyable option if done right.

Myth #2. Food is free - we correct errors with pills

In continuation of the first myth, patients often do not limit their diet, carbohydrate intake, and blood glucose surges prefer to control insulin or drugs.

Diabetes is a rather serious disease that is fraught with the development of serious complications, just remember neuropathy, diabetic foot, gangrene and amputation. And insulin pills or injections alone will not help to avoid an increase in blood glucose levels after eating. Patients who neglect the elementary rules of diabetes control may develop vascular complications. Moreover, at high doses of insulin, a condition such as hypoglycemia can develop - a decrease in blood sugar levels. This is an acute condition that can threaten the life of the patient.

Myth #3. Can diabetics eat sugar?

Sometimes you really want to drink tea or coffee with sugar, but diabetes prohibits such a luxury. But, meanwhile, there are those who believe that one cannot deny oneself pleasure, the main thing is a small amount of sugar.

Any table sugar and any fast carbohydrates banned from all acceptable diets. It is also necessary to exclude from the diet all products with its content. Even small doses of sugar can significantly increase blood glucose levels with all the ensuing consequences.

Instead of sugar, you can use its substitutes, before buying which you need to consult with a specialist.

Myth number 4. Bread, pasta and potatoes are the head of everything, nutrition is impossible without them

The food culture of many nations, especially in the post-Soviet space, cannot exist without bread and potatoes. It is difficult for many to imagine how one can eat without bread and be full, and potatoes, the product that is present in all soups, are often used as a side dish and appear on the tables of many every day. Perhaps it is for these reasons that one can hear the opinion that bread, pasta, potatoes can be eaten with diabetes.

In fact, these foods, including some grains, are loaded with carbohydrates and can quickly and significantly raise blood glucose levels. It is necessary to strictly follow the principles and rules of the recommended diet.

Myth number 5. Confusion about carbs

Diabetes forces patients not only to understand what is happening in their body, but also to understand the complex structure of carbohydrates. For a better understanding, all carbohydrates can be divided into fast and slow. All sweets are among the fast carbohydrates, since when they are consumed, a large amount of sugar is immediately released into the blood. Slow carbohydrates require careful digestion, and sugar levels rise gradually. According to some patients, only fast carbohydrates are dangerous, but slow ones should not be limited.

In fact, any carbohydrates in diabetes must be limited and eliminated, while focusing on those foods that are allowed by the diet.

Myth number 6. Let's talk about fructose and special nutrition for diabetes

Proper and safe nutrition in diabetes is always associated with the absence of sugar. Many patients believe that fructose (fruit sugar) is safe. And when it is used, there are no jumps in blood glucose. But still fructose is also excluded. It is able to reduce the sensitivity of tissues to insulin, increase the level of bad cholesterol in the blood. In addition, its use will disrupt the regulation of appetite, and the feeling of satiety in this case comes much later and more slowly.

By the way, in specialized products for diabetics, fructose is used instead of a sweetener, and their uncontrolled use can cause the above-described consequences. In type 2 diabetes, it is generally better not to use any sweeteners, because they can interfere with weight loss, which is extremely important in treatment.

Myth number 7. Diabetic diets can cause hypoglycemia

Usually, such consequences are predicted by a low-carbohydrate diet. Indeed, the use of such a diet can provoke a decrease in blood sugar levels, but only if the dosages of drugs and insulin have not been revised.

Therefore, any diet, its principles, a list of products and sample menu must be discussed with the doctor. The dosage of drugs, insulin directly depends on nutrition. Therefore, often with type 2 diabetes, drugs are completely canceled, a low-carbohydrate diet is enough to control the disease and maintain normal blood sugar levels. In type 1 diabetes, the insulin dosage is reduced several times. Only under these conditions can one not be afraid of the development of hypoglycemia.

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