Case history: type 2 diabetes mellitus, decompensation stage, subcompensation, severe course, insulin-dependent, insulin-dependent, diabetic polyneuropathy. Forecast

Probably, not many people are happy with their medical history. Diabetes mellitus type 2, indicated in it, can cause even more despondency. But is it worth to give up and despair? How dangerous this disease is, and how to deal with it - we will understand.

Diabetes mellitus - what is the danger?

People often hear about diabetes, but only a few know what it is. It should be noted that the concept of "diabetes" is a collective image. Under this term, several diseases of the endocrine system will unite. The reasons for their occurrence are quite numerous, but, as a rule, endocrine disorders, and in particular insulin deficiency, are at the heart of the disease. Another factor can be the inability to absorb glucose by the liver and tissues of the body. At the same time in the body its level rises, which, in turn, is the cause of a number of disorders in the metabolism.

Diabetes mellitus - its types

Modern medicine distinguishes two types of this disease. Gradation occurs depending on what insulin insufficiency - relative or absolute - describes the medical history. Diabetes mellitus type 2, as a rule, is not associated with insulin deficiency, the development of which is involved in the pancreas. Usually, the cause of its development is a decrease in the sensitivity of organs and tissues to this hormone. Diabetes insulin-dependent - the first type - is directly related to insulin deficiency in the body. The lack of this hormone leads to the fact that glucose, which has entered the body, is not processed, or it occurs in insufficient quantities, while its blood level is constantly growing, and in order to save life, such patients are forced to receive additional doses of insulin.

Case history - type 2 diabetes mellitus

This diabetes is also called insulin-independent. According to statistical data, patients suffering from this type of disease are much more numerous than the first. With age, the risk that this disease will manifest itself significantly increases. Very often its development occurs unnoticed, and the patient for a long time does not know about this pathology, the data that allow her to suspect does not reflect the history of the disease. Diabetes mellitus type 2 in this case is detected as a "random finding" during a routine examination. The main indicator, which allows you to suspect the presence of this pathology, is a blood test in which glucose is increased. In turn, when the medical history is made out, type 2 diabetes is divided into:

• Arising in patients with normal weight;
• Revealed in patients with obesity.

Causes of diabetes

Even in the process of training young doctors formulate a medical history of the disease, type 2 diabetes mellitus in which can be caused by several reasons. The most common of these are:

• Consumption of refined carbohydrates (sugar, chocolate, buns, potatoes) in large quantities and insufficiency of plant fibers in the diet;
• Heredity - in the presence of a similar pathology in parents, the risk of diabetes is greater than 40%;
• Obesity, especially visceral type (fat deposits are located mainly in the abdominal region);
• hypertension;
• Physical inactivity.

What's happening? Pathogenesis

The history of the disease type 2 diabetes mellitus describes as a number of disorders in the metabolism process. At its core is insulin resistance - the inability of tissues to normally perceive insulin, on the one hand, and the disruption of the production of this hormone in pancreatic cells - on the other. Normally, with an increase in the glucose level, which occurs immediately after eating, the pancreas begins to diligently produce insulin. In people with type 2 diabetes, this does not happen, and insulin begins to be produced only when the level of glucose concentration has already reached high figures. However, despite the presence of insulin, a decrease in the level of sugar in this case to the desired level does not occur. A constant elevated insulin concentration results in the cells losing the ability to react to it and now, even if the hormone can connect to the cell receptor, there is no reaction. Against the backdrop of these changes, liver cells begin to actively synthesize glucose, further increasing its concentration in the blood. All this does not pass without consequences. Over time, under the influence of a high concentration of glucose, glucose toxicity develops, which adversely affects pancreatic cells that produce insulin, and as a result, its deficiency develops. Thus, the history of the disease is aggravated. Type 2 diabetes mellitus replaces the form when insulin administration has not yet been required. The patient's condition worsens.

Symptoms

In the classical clinic of diabetes, it is common to distinguish two groups of symptoms of the disease - basic and secondary. The main include:

• Polyuria - a lot of urine is released (glucose, getting into it, significantly increases osmotic pressure);
• Thirst (polydispepsy) - characterized by a constant, unquenchable need for drinking;
• Hunger (polydisfagy) - due to the inability of cells to metabolize glucose with insulin, the body experiences a constant need for energy;
• A sharp loss of weight - it occurs against a background of increased appetite.

All these symptoms are more typical for the first type of diabetes. The second type can be generally asymptomatic or causing secondary symptoms:

• Itching of the skin and mucous membranes - often when examining a patient and suspected of type 2 diabetes mellitus (a medical history), a woman can mark intolerable itching in the genitals;
• General weakness and headaches;
• Inflammatory skin lesions, which are difficult to treat;
• Decreased vision.

As a rule, most simply do not pay attention to such symptoms, and the disease can be detected only at the stage of complications.

Children and diabetes

Unfortunately, diabetes is now recognized as the second most frequent chronic disease. This is what official pediatrics consider. Diabetes mellitus (type 2) the child's medical history often puts in the category of the most dangerous diseases. This is due to the fact that its course differs from that of an adult by a more rapid development and often proceeds more malignantly. However, in this case, everything depends on the ability of parents to adjust the nutrition of the child and to monitor the timely use of drugs. In addition, it is very important to identify the disease in time. If the child has the following symptoms, urgent consultation of the endocrinologist is necessary:

• The child experiences constant thirst;
• Much more often goes to the toilet (at school or kindergarten forced to several times to ask for lessons);
• Decreased body weight;
• Chronic fatigue is observed.

Diagnostics

Diagnose diabetes on the basis of urine and blood tests. In a healthy individual, glucose is not detected in the urine, but in the blood its level does not exceed 5.5. For reliable results, blood is taken from the finger or vein (the last meal should be taken at least 8 hours before the procedure), before surrender, you can not drink sweet tea, coffee or juice. It should be noted that diabetes mellitus is diagnosed at rates above 7. In case if the indices fluctuate from 4 to 7, then a violation of glucose tolerance is recorded.

Another test that allows to identify this disease and clarify the doubtful values is the glucose tolerance test (GTT). It allows you to obtain data on the level of glucose on an empty stomach, and also two hours after he took a glucose solution. Normally, after glucose, its concentration should not be higher than 7.8. This test is not performed when the glucose before the test is higher than 6.1 if the patient has a history of acute illnesses, surgical interventions, myocardial infarction, trauma, and when taking drugs that increase glucose. All this data reflects the medical history.

Diabetes mellitus type 2, subcompensation

Like any disease, diabetes is prone to build up and increase symptoms. In its current three stages are distinguished. The compensation stage is set when the patient's indicators approach the norm. If the time is not taken, or they do not bring the expected result, then the disease goes to the stage of subcompensation. In this case, the patient's condition, of course, is not the best, but also uncritical. On the day the patient loses not more than fifty grams of glucose in the urine , and her blood level is about 13.8, acetone in the urine is absent. At this stage, the development of hyperglycemic coma is also impossible. The intermediate state between compensation and decompensation is referred to the subcomputation stage, with the glucose level 7.5, the percentage of glycated hemoglobin 6.5%, and the fasting glucose less than 6.1. The decompensation stage is set if the indicators exceed the following limits:

• The glucose level is more than 9;
• Glycerized hemoglobin - more than 9%;
• Fasting glucose - more than 7.

Changes in these indicators and the effectiveness of the prescribed treatment helps to track the history of the disease. Diabetes mellitus type 2, the severe course of which is difficult to treat or provoked by other factors, goes into the stage of decompensation.

Factors causing decompensation

Of course, each organism is individual, and the factors aggravating the course of the disease may be different, but these are the most common:

• Overeating, a violation of diet;
• An error in the selection of a medicinal product, its dose or the refusal of treatment;
• Self-medication or use in place of the prescribed dietary supplements;
• Refusal to switch to insulin therapy;
• Infections that promote dehydration of the body;
• Stressful situations.

All these factors individually or in combination significantly affect the state of metabolic processes, and as a result, there is an increase in glucose levels, which records the history of the disease. Diabetes mellitus type 2, the stage of decompensation of which is further aggravated by the appearance of various complications from the organs and systems of the body, acquires a threatening character and, if improperly treated, may pose a threat to the patient's life. In this case, complications can develop as prolonged over time, and literally in a matter of hours.

The stage of decompensation

As the concentration of glucose increases, and its correction requires more serious measures, the history of the disease is aggravated. Diabetes mellitus (type 2), whose decompensation is characterized by a high risk of complications, requires a very careful attitude. This is due to the fact that it can be very difficult to adjust the glucose level both with the help of a diet and with the use of medicines. Because of this, it is necessary to carefully and constantly monitor the patient's condition, because in the absence of a therapeutic effect with the use of drugs, pathological changes in various organs very quickly occur. Therefore, these patients need medical supervision, and very often in urgent care.

The possibility of independent control over one's own condition is of great importance here. Fortunately, modern medicine has a sufficient choice of means for this. Various tests and devices that determine the level of glucose, allow a diabetic patient to independently diagnose their condition and, depending on the results, carry out a correction.

Insulin in Diabetes Therapy

As the disease progresses, the depletion of those pancreatic cells that develop insulin also develops. This process requires immediate administration of hormone therapy. As modern research shows, sometimes this alone helps maintain glucose levels at the right level. Nevertheless, it is not necessary to consider that the purpose of insulin is for life. Often type 2 diabetes mellitus, insulin dependent, whose medical history seems to be doomed to fix lifelong insulin intake, under certain efforts on the part of the patient can go into that category when regular administration of this hormone is not required. Diabetes mellitus in this regard refers to those pathologies where, in order to achieve a therapeutic effect, control and effort on the part of the patient is very important. So, it is from his discipline regarding diet, self-monitoring of sugar level and timely intake of medications that the degree of compensation of the disease will depend. However, in some cases, the appointment of insulin is a mandatory measure. It happens:

• During pregnancy;
• In case of strokes or heart attacks;
• With surgical interventions;
• With infectious diseases of purulent-septic character;
• With increased indicators of laboratory diagnosis.

Another important reason for the mandatory appointment of insulin may be a clear drawback of this hormone, which confirms the medical history. Type 2 diabetes mellitus, whose decompensation stage is characterized by pronounced progressive weight loss and growing ketoacidosis, is a vivid example of this.

It should be noted that today the medicine has greatly expanded the scope of the use of insulin therapy, and it is officially confirmed that the effectiveness of oral therapy with monotherapy remains less than 6 years. Then I have to prescribe several medicines. According to the latest trends in the treatment of diabetes, the use of insulin in such cases is considered more effective.

Acute complications

Acute complications of the stage of decompensation are the conditions under which there is a real threat to the life of the patient. They are usually caused by a significant increase in the level of glucose and the related metabolic disorders. When such a situation occurs, timely assistance is important, and since the symptoms of these conditions need to be known not only to doctors but also to the average medical staff, the nursing history of the disease, type 2 diabetes and its complications, is described as follows.

1. Hyperglycemic coma (hyperosmolar and ketoacidotic) - their distinctive feature is the gradual development. Factors provoking them are insufficient dose or missed insulin intake, a violation of diet (excessive consumption of carbohydrates), physical stress on the background of hyperglycemia, lack of control over the level of glucose, the intake of alcohol or certain medications. Clinically, they are manifested by thirst and polyuria growing for several days (increase in the amount of urine), expressed by dehydration. Arterial pressure is reduced, tachycardia. If the condition worsens, convulsions or depression of consciousness are possible. Skin covers are dry, rasches are possible, the smell of acetone upon exhalation. In this case, the victim needs urgent hospitalization and medical care.
2. Hypoglycemic coma - develops as a result of a sharp decrease in blood glucose (less than 3 mmol / l), which causes the brain to have a sharp lack of nutrients. Provoke this condition may be an overdose of insulin, skipping one of the meals or an improperly chosen diet, taking alcohol or medicines. Clinically, the attack develops quickly. Characterized by cold sweat on the forehead, weakness, trembling of the hands, headache, numbness of the lips. The patient is aggressive, poorly co-ordinates his movements, palpitations, double vision, confusion. In the late stages there is a loss of consciousness, convulsions. At the pre-hospital stage, such patients can be given a sweet drink or something to eat, warmed up and transported to a medical institution for further assistance.

Late complications

Similar complications develop with decompensated diabetes after several years of the disease. The danger is that they gradually and imperceptibly worsen the patient's condition. In addition, often even literate diabetes therapy can not guarantee that sooner or later they will not appear.

1. Retinopathy is characterized by retinal damage. Unfortunately, despite all the achievements of modern medicine, the emergence of retinopathy in patients of the second type of diabetes, which lasts more than 20 years, tends to 100%. This pathology causes hemorrhages on the fundus and eventually leads to a complete loss of vision.
2. Angiopathy - is the violation of the permeability of blood vessels, which causes the development of thrombosis and atherosclerosis. It can develop in a short time (about a year), in contrast to other late complications, which often burdens the medical history.
3. Diabetes mellitus type 2, diabetic polyneuropathy in which also is a common complication, registers it in 90% of cases. Clinically, this is expressed by the defeat of nerves that control both the muscles and internal organs. Polyneuropathy can be manifested by hypersensitivity, sudden acute (sweeping) pain, burning. Also, manifestations of neuropathy can become numbness, decreased sensitivity, which leads to numerous injuries. From the internal organs can be diarrhea, urinary incontinence, headaches, dizziness, interruptions in the work of the heart.
4. Diabetic foot - characterized by the appearance on the feet and, in particular, on the feet of a diabetic patient with trophic ulcers, abscesses, necrotic areas. That is why patients suffering from this pathology are recommended to pay special attention to the selection of shoes.

Forecast

It is sad, but modern medicine can not completely defeat diabetes. However, it can quite well timely correct the deviations that cause an increased concentration of glucose in the human body, that is, type 2 diabetes mellitus. The history of the disease, the prognosis of this disease in many respects, if not in everything, will depend on the attitude of the patient himself to him. With careful monitoring from his side for the level of sugar and other indicators, the necessary drug correction, compliance with the diet and recommendations of doctors, you can avoid complications for many years.