Black plaque between teeth. Reasons for the appearance of Priestley's plaque in children, depending on its color

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

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

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

Diet for the treatment of type 2 diabetes mellitus

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

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

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

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

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

Exercise to treat type 2 diabetes

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

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

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

Drug treatment of type 2 diabetes mellitus

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

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

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

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

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

Suphanilamides for the treatment of type 2 diabetes mellitus

Let's give brief description the most common sulfonamides.

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

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

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

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

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

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

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

Side effects of sulfonamides

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

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

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

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

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

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

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

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

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

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

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

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

Combinations of drugs in the treatment of type 2 diabetes mellitus

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

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

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

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

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

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

Adding basal insulin (Monotard NM type) at an average dose of 0.2 units per 1 kg of body weight, it is recommended to begin combination therapy as a single injection at night (10 p.m.), usually the dose is increased by 2 units every 3 days until the target glycemic values ​​of 3.9–7.2 mmol are achieved /l. In case of high baseline glycemia, it is possible to increase the dose by 4 units every 3 days.

Secondary resistance to sulfonamide drugs.

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

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

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

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

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

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

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

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

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

Glycemic regulators for the treatment of type 2 diabetes mellitus

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Incretins in the treatment of type 2 diabetes mellitus

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

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

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

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

Improvement in glycemic parameters after GLP-1 administration may be the result of recovery normal functionβ-cells. An in vitro study suggests that glucose-resistant β-cells become glucose competent after GLP-1 administration.

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

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

Exenatide (Bayeta) isolated from the saliva of the giant lizard Gila monster. The amino acid sequence of exenatide is 50% identical to human GLP-1. 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 to be administered in the form of 2 subcutaneous injections per day before breakfast and dinner. A long-acting exenatide has been created, but not yet registered in Russia - Exenatide LAR, administered once a week.

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

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

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

The peculiarity of this approach to treatment is to increase the duration of action of endogenous incretins (GLP-1), i.e. 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 most promising is the combination of DPP-4 inhibitors and metformin, which allows influencing all the main pathogenetic mechanisms of type 2 diabetes mellitus - insulin resistance, the secretory response of β-cells and hyperproduction of glucose by the liver.

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

Insulin therapy for type 2 diabetes mellitus.

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

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

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

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

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

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

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

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

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

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

Type 2 diabetes mellitus is a common disease that occurs against the background of impaired carbohydrate metabolism. Due to pathological changes the body experiences a hyperglycemic state ( high sugar in blood).

In the vast majority of cases, the pathology is detected in people over 40 years of age, and, as a rule, is characterized by a mild clinical picture. Human can long time not suspect that he has developed a chronic disease.

In type 2 diabetes, the pancreas functions normally, the hormone insulin is produced, but the process of sugar penetration to the cellular level is inhibited, since soft fabrics The body loses sensitivity to the hormone.

It is necessary to consider the causes that lead to type 2 diabetes and identify the symptoms that characterize the disease. And also find out how type 2 diabetes is treated?

Etiology of occurrence

As you know, there are two types of diabetes – T1DM and T2DM, which are more common in medical practice. There are also specific types of pathology, but they are diagnosed in people much less frequently.

If the first type of disease tends to progress quickly, then the second type develops in a person gradually, as a result of which the person does not notice negative changes in his body for a long period of time.

From this information it must be concluded that after 40 years of age, careful monitoring of glucose concentrations in the body is necessary in order to be able to recognize the second type of disease in early stage development.

At the moment, the exact reasons that lead to the development of a chronic disease are unknown. However, there are factors that may accompany the occurrence of pathology:

• Genetic predisposition to the disease. The probability of transmitting the pathology “by inheritance” ranges from 10% (if one parent is sick) to 50% (if both parents have a history of diabetes).
• Excess weight. If a patient has excess adipose tissue, then against the background of this condition he experiences a decrease in the sensitivity of soft tissues to insulin, which in turn contributes to the development of the disease.
• Poor nutrition. Significant absorption of carbohydrates increases the risk of developing pathology.
• Stress and nervous tension.
• Some medications, due to their toxic effects, can lead to pathological disruptions in the body, which increases the risk of developing diabetes.

Factors that can lead to chronic illness include a sedentary lifestyle. This circumstance leads not only to excess weight, but also has a detrimental effect on the concentration of glucose in the body.

Representatives of the fair sex who have been diagnosed with polycystic ovary syndrome are at risk. And also those women who gave birth to a child weighing over 4 kilograms.

Type 2 diabetes: symptoms and stages

Sugar level

The second type of diabetes is characterized by a high concentration of glucose in the body, which in turn provokes the occurrence of osmotic diuresis. In other words, a lot of fluid and salts are removed from the body through the kidneys.

As a result, the human body rapidly loses moisture, dehydration is observed, and a deficiency is detected. minerals it contains potassium, sodium, magnesium, iron, phosphate. Against this background pathological process, tissues lose some of their functionality and cannot fully process sugar.

T2DM develops slowly. In the vast majority of cases, there is a hidden course of pathology, which is discovered completely by chance when visiting an ophthalmologist or during a preventive examination in a medical institution.

The clinical picture of the disease is as follows:

1. Increased fluid intake when the patient is constantly thirsty (a person can drink up to 10 liters per day).
2. Dryness in oral cavity.
3. Copious urination up to 20 times a day.
4. Increased appetite, dry skin.
5. Frequent infectious diseases.
6. Sleep disorder, decreased ability to work.
7. Chronic fatigue.
8. Violation visual perception.

In women after 40 years of age, the disease is often detected by a dermatologist or gynecologist, since the pathology is accompanied skin itching and other skin problems, as well as vaginal itching.

As mentioned above, type 2 diabetes develops slowly, and most often there is a time interval of 2 years between its occurrence and detection. Due to this, when it is diagnosed, patients already have complications.

Depending on the formation process, the second type of disease can be divided into certain stages:

• Prediabetic condition. There are no signs of deterioration of the patient's condition; laboratory tests are within normal limits.
• Hidden form of pathology. There are no pronounced symptoms, laboratory tests may also not reveal abnormalities. However, changes in the body are detected through tests that determine glucose tolerance.
• An obvious form of the disease. In this case, the clinical picture is characterized by many symptoms. And type 2 diabetes can be detected through laboratory tests.

In addition to stages, in medical practice, type 2 illness is also divided into certain degrees, which determine the level of severity of a person’s condition. There are only three of them. These are mild, moderate and severe.

In mild cases, the concentration of sugar in the patient’s body is no more than 10 units; it is not observed in urine. The patient does not complain of feeling unwell, there are no pronounced abnormalities in the body.

At medium degree sugar in the body exceeds 10 units, and tests show its presence in the urine. The patient complains of constant apathy and weakness, frequent trips to the toilet, dry mouth. As well as a tendency to purulent skin lesions.

In severe cases, a negative transformation of all metabolic processes in the human body occurs. Sugar in the body and urine goes through the roof, the symptoms are pronounced, and there are signs of complications of a vascular and neurological nature.

The likelihood of developing a diabetic coma increases several times.

Diagnostic measures

Most people apply for medical care not with the signs and symptoms of diabetes, but with its negative consequences. Since pathology can a long period time does not testify to its occurrence.

If type 2 diabetes is suspected, the doctor prescribes diagnostic measures that help confirm or refute the disease, determine its stage and severity.

The problem with detecting pathology is that it is not characterized by severe symptoms. In this case, signs of the disease may appear completely irregularly. That is why laboratory tests are of great importance in determining diabetes.

To identify pathology, the doctor prescribes the following tests:

1. Taking blood from a finger (sugar test). This analysis allows you to determine the concentration of glucose in the patient’s body on an empty stomach. An indicator of up to 5.5 units is the norm. If there is a violation of tolerance, then it may slightly increase or decrease. If the results are more than 6.1 units, a glucose tolerance test is prescribed.
2. Glucose tolerance study. This test is necessary to find out the degree of carbohydrate metabolism disorder in the patient’s body. The amount of hormone and sugar is determined on an empty stomach, as well as after consuming glucose, which is pre-dissolved in liquid (75 dry glucose per 250 ml of liquid).
3. Analysis for glycated hemoglobin. Through this study, the degree of the disease can be determined. High performance they say that the patient has a lack of iron or type 2 diabetes. If the rate is more than 7%, diabetes is diagnosed.

Additional diagnostic measures include examination of the patient’s skin and lower extremities, a visit to an ophthalmologist, and an ECG.

Diabetes mellitus type 2: treatment

Treatment of type 2 diabetes mellitus in the early stages is provided by non-drug methods. At other stages, pathologists recommend drug therapy, which may involve taking pills to lower blood sugar.

If a patient is diagnosed with a mild or middle stage, then therapeutic procedures consist of prescribing a healthy diet, physical activity, and sports. Medical practice shows that it is enough to devote half an hour every day to sports activities to notice positive dynamics in the fight against pathology.

Proper nutrition is the basis successful treatment. However, this does not mean that the patient should immediately give up all food, go on a strict diet and quickly get rid of extra pounds.

Body weight loss should occur gradually, and the maximum weight loss in seven days is no more than 500 grams. The diet and menu are always developed individually for each specific clinical case.

General principles of nutrition for T2DM:

• It is permissible to eat only approved foods that do not provoke an increase in sugar in the patient’s body.
• You need to eat often (5-7 times a day), and in small portions, according to a previously drawn up schedule.
• Refuse or limit the consumption of alcoholic beverages and salt.
• If the patient is obese, then a diet that does not exceed 1800 calories per day is recommended.
• Food products must include a large number of vitamin substances, mineral components and fiber.

As a rule, when type 2 diabetes is detected, the doctor always begins therapy with physical activity and proper nutrition. If therapeutic effect these measures are not observed, all that remains is to move on to drug treatment.

1. Sulfonylurea derivatives. These medications stimulate the production of the hormone in the body and reduce the resistance of soft tissues to insulin.
2. Biguanides. This group medications reduces the production of sugar in the liver, reduces its absorption in the gastrointestinal tract, and increases the sensitivity of tissues to the action of the hormone.
3. Thiazolidinone derivatives help increase the activity of hormone receptors, as a result of which the concentration of glucose in the human body decreases.
4. Alpha-glucosidase inhibitors impair the absorption of carbohydrates in the gastrointestinal tract, resulting in a decrease in sugar content.

Drug therapy always begins with the use of one single drug, which must be taken once a day. If the disease is at a severe stage and such treatment is ineffective, the doctor may combine medications.

In turn, if a combination of several medications no longer helps, they can be supplemented. We can say that hormone injections are an alternative functioning of the pancreas, which, when fully functioning, determines the amount of glucose and releases the required amount of hormone.

Complications of the disease

Type 2 diabetes mellitus does not pose an immediate threat to the patient’s life, in contrast to the probable complications that are diagnosed in patients in 98% of all clinical cases.

A slowly progressing disease, it gradually has a detrimental effect on the functionality of all internal organs and systems of the body, which in turn leads to various serious complications over time.

In patients suffering from type 2 diabetes, the likelihood of pathologies of the cardiovascular system increases several times. In this case, a violation of the full circulation of blood in the body is revealed, and hypertonic disease, the lower limbs lose their sensitivity.

In type 2 diabetes, the following negative complications may develop:

• Diabetic microangiopathy, which affects the vascular walls of small blood vessels. Macroangiopathy leads to damage to large blood vessels.
• Polyneuropathy is a dysfunction of the central nervous system.
• Arthropathy leading to severe joint pain. Over time, disorders of the musculoskeletal system are observed.
• Visual disturbances: cataracts and glaucoma develop.
• Kidney failure.
• Mental changes, emotional lability.

Type 2 diabetes mellitus is a chronic disease that reduces the sensitivity of body tissues to insulin. The main symptom characterizing this disease is a violation of carbohydrate metabolism and an increase in blood glucose levels.

Today, type 2 diabetes is considered one of the most common diseases. endocrine system. In developed countries, the percentage of people with type 2 diabetes mellitus is more than 5% of the total population of the country. This is a fairly large number and therefore experts have been studying this disease and the causes of its occurrence for several decades.

Causes of type 2 diabetes

With this type of disease, the body's cells do not absorb glucose, which is necessary for their vital activity and normal functioning. Unlike type 1 diabetes, the pancreas produces insulin, but it does not react with the body at the cellular level.

Currently, doctors and scientists cannot pinpoint the exact cause of this reaction to insulin. In the course of research, they identified a number of factors that increase the risk of developing type 2 diabetes. Among them are:

• change hormonal levels during puberty. Sharp changes in hormone levels in 30% of people are accompanied by an increase in blood sugar levels. Experts believe that this increase is due to growth hormone;
• obesity or body weight several times higher than normal. Sometimes it is enough to lose weight in order for blood sugar to drop to normal levels;
• person's gender. Women are more likely to suffer from type 2 diabetes;
• race. It has been observed that African-Americans are 30% more likely to have diabetes;
• genetic predisposition;
• liver dysfunction;
• pregnancy;
• low physical activity.

Symptoms

Detecting the disease in its early stages will help avoid long-term treatment and taking large amounts of medications. However, recognizing type 2 diabetes is initial stage quite problematic. For several years, diabetes mellitus may not manifest itself in any way, this is. In most cases, patients notice its signs after several years of illness, when it begins to progress. The main symptoms of the disease are:

1. strong thirst;
2. increased urine volume and frequent urge to urination;
3. increased appetite;
4. a sharp increase or decrease in body weight;
5. weakness of the body.
6. To more rare signs type 2 diabetes mellitus include:
7. the body's susceptibility to infectious diseases;
8. numbness of the limbs and tingling in them;
9. the occurrence of ulcers on skin;
10. decreased visual acuity.

Diagnosis and degree of diabetes mellitus

Very often a person may not suspect that he has such a disease. In most cases, elevated blood sugar levels are detected during treatment for other diseases or through blood and urine tests. If you suspect elevated blood glucose levels, you should consult an endocrinologist and check your insulin levels. It is he who, based on the diagnostic results, will determine the presence of the disease and its severity.

Availability higher level Sugar in the body is determined by the following tests:

1. Blood analysis. Blood is taken from a finger. The analysis is carried out in the morning, on an empty stomach. A sugar level above 5.5 mmol/l is considered to be above the norm for an adult. At this level, the endocrinologist prescribes appropriate treatment. If the sugar level is more than 6.1 mmol/l, a glucose tolerance test is prescribed.
2. Glucose tolerance test. The essence of this analysis method is that a person drinks a glucose solution of a certain concentration on an empty stomach. After 2 hours, the blood sugar level is measured again. The norm is 7.8 mmol/l, in case of diabetes - more than 11 mmol/l.
3. Blood test for glycohemoglobin. This test allows you to determine the severity of diabetes. With this type of disease, the level of iron in the body decreases. The severity of the disease is determined by the ratio of glucose and iron in the blood.
4. Urine analysis for sugar and acetone content.

There are three degrees of development of type 2 diabetes:

• prediabetes. A person does not feel any disturbances in the functioning of the body or deviations in its functioning. Test results do not show deviations in glucose levels from normal;
• hidden diabetes. The person doesn't have obvious symptoms of this disease. Blood sugar levels are within normal limits. This disease can only be determined by testing for glucose tolerance;
• obvious diabetes. One or more symptoms of the disease are present. Sugar levels are determined based on the results of blood and urine tests.

Depending on the severity, diabetes mellitus is divided into three stages: mild, moderate, severe, and each is treated individually.

At a mild stage of the disease, it does not exceed 10 mmol/l. There is no sugar in the urine at all. There are no obvious symptoms of diabetes, the use of insulin is not indicated.

The middle stage of the disease is characterized by the appearance of symptoms of diabetes mellitus in a person: dry mouth, extreme thirst, constant feeling hunger, weight loss or weight gain. Glucose level is more than 10 mmol/l. A urine test reveals sugar.

In the severe stage of the disease, all processes in the human body are disrupted. Sugar is determined both in the blood and urine, and insulin cannot be avoided; treatment is long-term. The main signs of diabetes mellitus include disturbances in the functioning of the vascular and neurological systems. The patient may fall into a diabetic coma from type 2 diabetes.

Treatment of diabetes

After consultation and diagnosis of sugar levels, the endocrinologist prescribes appropriate treatment. If this mild treatment and the middle stage of the disease, then moderate physical exercise, diet and increased activity.

Treatment for type 2 diabetes as an effect of sports activities is to increase the level of sensitivity to glucose, reduce body weight and reduce the risk of possible complications. It is enough to exercise daily for 30 minutes to notice positive dynamics in the fight against the signs of diabetes, and this can be done without insulin. This could be swimming, aerobic exercise or cycling.

Diet is an integral part of the treatment of type 2 diabetes. The patient should not give up all foods and urgently lose weight. Losing body weight should occur gradually. Weight loss should be about 500 grams per week. The menu for each person is developed individually, based on the severity of diabetes, body weight and concomitant diseases. However, there are several rules that all patients must adhere to.

Completely eliminate sweets, white bread and fruits high in sugar from your diet if you have type 2 diabetes.

Meals should be taken in small portions 4-6 times a day.

Eat plenty of vegetables and herbs throughout the day. The exception is potatoes. Its daily norm is no more than 200 grams.

Drinks allowed are green and black tea, natural juices with low sugar content, and not strong coffee.

At the initial stage of the disease, the doctor may not prescribe drug treatment. Diet and exercise can reduce sugar levels in the body, normalize carbon metabolism and improve liver function, plus the use of insulin is necessary.

If the disease is at a more severe stage, then treatment involves prescribing appropriate medications. To achieve the effect, it is enough to take 1 tablet during the day. Often, your doctor may combine different antidiabetic medications and the use of insulin to achieve the best results.

In some patients, constant use of medications and insulin becomes addictive and their effectiveness decreases. Only in such cases is it possible to transfer patients with type 2 diabetes mellitus to the use of insulin. This can be a temporary measure during a period of exacerbation of the disease, or used as the main medicine to regulate glucose levels in the body.

Like all diseases, type 2 diabetes is easier to prevent than to cure. Even when using insulin, treatment is long-term. To do this, it is enough to maintain a normal weight, avoid excessive consumption of sweets and alcohol, devote more time to sports, as well as a mandatory consultation with a doctor if you suspect this disease.

Unlike the first type of the disease, type 2 diabetes mellitus is detected in every fourth patient, and often the person is not even aware of the presence of pathological disorders in the body. Due to such ignorance, all sorts of serious complications arise.

But if you start therapy in time in men and women, when the first signs appear and diabetes develops, you can prevent serious consequences. In type 2 diabetes, there is constant hyperglycemia due to the fact that the cells lack sensitivity to the insulin produced.

Thus, this type of disease is not associated with insulin synthesis. Due to decreased sensitivity, blood glucose levels usually increase, resulting in developing disease cells of blood vessels and internal organs are destroyed. To choose correct treatment, you need to know what type 2 diabetes mellitus is and how to deal with it.

Causes of type 2 diabetes

In 90 percent of cases, patients are diagnosed with type 2 diabetes, the causes of which can be very different. In this case, the pancreas continues to produce insulin, but the body cannot properly dispose of the available hormone, which causes sugar to accumulate in the blood and cause a number of complications.

Despite the fact that the pancreas is not damaged, the body is not able to fully absorb incoming insulin due to the presence of damaged insulin receptors on the cells, which results in type 2 diabetes.

First of all, this means that a person needs to follow a strict therapeutic diet and limit the consumption of foods rich in carbohydrates as much as possible.

1. The most common causes of type 2 diabetes are the natural aging of the body. In old age, a person may develop glucose tolerance, that is, the body gradually loses the ability to fully absorb sugar.
2. With age, such changes occur in almost everyone, but in healthy people sensitivity decreases at a slow rate. But if the patient has a genetic predisposition, this process occurs much faster, and as a result the person may develop type 2 diabetes.
3. Also, the causes of diabetes are often associated with obesity. Because of overweight There is a disturbance in the composition of the blood, an increase in cholesterol levels, which settles on the walls of blood vessels and leads to the development of atherosclerosis. If we talk in simple language, when cholesterol plaques appear, nutrients and oxygen cannot reach the tissues and internal organs, as a result oxygen starvation the absorption of insulin and glucose decreases.
4. The third main reason why type II diabetes occurs is the excessive consumption of foods rich in fast carbohydrates. Carbohydrates in increased quantities lead to depletion of the pancreas and damage to insulin receptors in the cells of tissues and internal organs.

As shown Scientific research, if one of the parents has type 2 diabetes, the risk of the disease developing in a child along the hereditary line is 35-40 percent. If the disease is spread between two parents, the risk increases to 60-70 percent. Monozygous twins can simultaneously have type 2 diabetes in 60-65 percent of cases, and heterozygous twins in 12-30 percent of cases.

When type 2 diabetes is diagnosed in men or women, it is most often associated with excess weight; this metabolic disorder occurs in 60-80 percent of diabetics. The risk of morbidity is especially high with abdominal obesity, when fat accumulates in the abdomen and waist.

With an excess of fatty tissue in the body, the level of free fatty acids increases. fatty acids. This is the main source of energy in humans, but with an increased content of these types of acids, hyperinsulinemia and insulin resistance develop.

This condition also provokes a decrease in the secretory activity of the pancreas. For this reason, type 2 diabetes mellitus is early stage Diagnosed by plasma analysis of free fatty acids. With an excess of these substances, glucose tolerance is detected, even if fasting hyperglycemia has not yet been identified.

• Many tissues require a constant supply of glucose. But when you fast for more than 10 hours, your blood sugar levels become depleted. In this case, the liver begins to synthesize glucose from substances that are non-carbohydrate in nature.
• After eating, sugar levels rise, the liver suspends its activity and stores glucose for the future. However, in the presence of cirrhosis, hemochromatosis and other serious illnesses the liver does not stop its work and continues to actively synthesize sugar, which ultimately provokes type 2 diabetes.
• Weight gain due to metabolic syndrome or insulin resistance syndrome visceral fat, carbohydrate, lipid and purine metabolism is disrupted, and arterial hypertension develops.
• Such causes of diabetes lie in the presence of menopause, polycystic ovary syndrome, hypertension, coronary disease heart, hormonal changes, uric acid metabolism disorders.

Often, the causes of type 2 diabetes mellitus can be associated with organic and functional damage to the beta cells of the pancreas. The disease can also develop due to certain medications - glucocorticoids, thiazides, beta blockers, atypical antipsychotics, statins.

Thus, the second type of diabetes mellitus most often develops in the following cases:

1. In the presence of a hereditary predisposition;
2. In people with increased body weight and obesity;
3. In women who have previously given birth to a child weighing more than 4 kg, or with a pathological pregnancy;
4. With frequent use of glucocorticoids - analogues of the hormone of the adrenal cortex;
5. When diagnosed with Itsenko-Cushing's disease or an adrenal tumor, as well as acromegaly - a pituitary tumor;
6. In men and women aged 40-50 years at an early stage of development of atherosclerosis, angina pectoris or hypertension;
7. In people at an early stage of cataract development;
8. When diagnosed with eczema, neurodermatitis and other allergic diseases;
9. After a stroke, heart attack, infectious disease, as well as during pregnancy.

Symptoms and treatment of type 2 diabetes

Sugar level

If a person is diagnosed with type 2 diabetes, the symptoms are similar to those of type 1 disease. The patient experiences increased urination during the day and at night, thirst, dry mouth, increased appetite, unexplained weakness, and poor health. Often itching appears on the skin, burning in the perineal area, and the foreskin becomes inflamed.

However, in the second type of disease, the difference lies not in absolute, but in relative insulin deficiency. A small amount of the hormone can still interact with the receptors; metabolic disorders occur at a slow pace, which is why the patient may not be aware of the development of the disease.

A diabetic feels slight dryness in the mouth and thirst, in some cases itching appears on the skin and mucous membranes, and develops inflammatory process, women often experience thrush.

A person’s gums also become very sore, teeth fall out, and vision noticeably decreases. This is due to the release of accumulated glucose through the skin to the outside or into the blood vessels; in turn, fungi and bacteria begin to actively multiply on sugar.

If a doctor diagnoses diabetes mellitus type 2, treatment begins after full examination and passing all necessary tests.

With advanced disease, sugar can be found in the urine, which leads to the development of glucosuria.

Therapy for type 2 diabetes mellitus

When the disease is detected in men or women, the doctor explains what type 2 diabetes mellitus is and selects suitable treatment. First of all, a diabetic is prescribed a special therapeutic diet, which limits the consumption of carbohydrates and high-calorie foods. Such measures help to lose weight and restore cell sensitivity to the hormone insulin.

If the diet does not help and the disease becomes more active, the patient takes glucose-lowering pills, this remedy allows you to restore insulin synthesis and normalizes the functioning of the pancreas. Medicine to lower glucose levels is taken every day at least two to three times a day, 30 minutes before meals.

The dosage is selected strictly as prescribed by the doctor; changing the dose is also allowed only after agreement with doctors. If the patient has cirrhosis of the liver or kidney failure, taking glucose-lowering drugs is contraindicated, so insulin therapy is prescribed for this group of diabetics.

• Treatment with insulin may be prescribed if a therapeutic diet has not been followed for a long time and prescribed medications have not been taken. In the absence of necessary therapy, the pancreas becomes depleted, and only injections can help.
• Various traditional methods of treatment with herbs are often used, which restore the sensitivity of cells to the hormone. Herbal decoctions are also useful for type 1 diabetes mellitus, as they promote better interaction insulin with cells of internal organs.
• But it is important to understand that similar method can only be auxiliary and used in combination with the main treatment. During herbal medicine, the therapeutic diet should not stop; you need to continue taking pills or injecting insulin.

In addition, a diabetic should lead an active lifestyle and not forget about physical exercise, this allows you to normalize the general condition of the diabetic and lower blood sugar levels. If you regularly engage in physical activity and eat right, you may not need pills, and your sugar levels will normalize in just two days.

Nutrition for type 2 diabetes

As mentioned above, the therapeutic diet acts as the main and effective method therapy, which means maximum refusal of foods high in carbohydrates. Carbohydrates are “light”; they have small molecules, so they can be instantly absorbed into the intestines. These substances include glucose and fructose.

As a result, this causes a rapid increase in blood glucose levels in both men and women. There are also so-called “heavy” carbohydrates that slightly increase sugar levels - these are fiber and starch.

If you have type 2 diabetes, you should avoid eating granulated sugar, honey, jam, chocolate, sweets, ice cream and other sweets. Should be excluded from the diet bakery products made from white flour, pasta, cookies, cakes; bananas and grapes are also not recommended. These types of foods contribute to a sharp increase in blood sugar, and if left untreated, a diabetic may develop.

1. Fiber and starch can be consumed, but in limited quantities. The patient is allowed to eat potatoes, coarse rye bread, various cereals, green peas, and beans. If your glucose levels increase, you should temporarily avoid these types of foods.
2. However, a therapeutic diet allows for the consumption of many foods that can be beneficial for a diabetic. In particular, the patient can eat lean meats and fish, fermented milk products without sugar and dyes, cheese, and cottage cheese.
3. Vegetables you should include in your menu are beets, carrots, turnips, rutabaga, radishes, radishes, cabbage, cauliflower, tomatoes, cucumbers, pumpkin, green beans, eggplants, zucchini, celery. Also, do not forget about unsweetened apples, pears, plums, cherries, and wild berries.

• The largest amount of fiber is found in bran, raspberries, strawberries, black, red and white currants, fresh mushrooms, blueberries, cranberries, gooseberries, and prunes.
• Slightly less fiber is found in carrots, white cabbage, green peas, eggplants, sweet peppers, pumpkin, quince, sorrel, oranges, lemons, and lingonberries.
• Moderate fiber content is found in rye bread, green onions, cucumbers, beets, tomatoes, radishes, cauliflower, melon, apricots, pears, peaches, and apples. Bananas, tangerines.
• The least amount of fiber is in rice, zucchini, lettuce, watermelon, cherries, plums, and cherries.

A special therapeutic diet is selected based on the type and severity of the disease.

Choosing a therapeutic diet

The therapeutic diet “Table No. 8” is used if diabetes mellitus has recently appeared. Typically, such a diet is prescribed to older people and children in order to quickly normalize the patient’s blood glucose levels. But they do not adhere to this treatment regimen constantly, but periodically.

The oral cavity is a complex area of ​​the body, which primarily encounters various microorganisms (bacteria, fungi, viruses). This feature causes the development of a wide range of diseases, accompanied not only by an unpleasant set of symptoms (pain, bad odor, bleeding, etc.), but also by a change in the aesthetic appearance of teeth (enamel staining black, yellow, brown or green shades). One of these pathologies is Priestley’s plaque; in children it occurs 8–10 times more often than in adults. Treatment for deviation has many specific features depending on the cause of occurrence.

What it is

Priestley's plaque is the result of the active development and activity of pigment-forming bacteria. It is the appearance of many black or brownish-brown spots on the teeth. Usually all exposed enamel surfaces are affected. The condition is accompanied by an unpleasant odor with a sweetish tint emanating from the oral cavity.

External signs of black plaque

It is important! In 95% of cases, only baby teeth are involved in the process. After they fall out and are gradually replaced by permanent manifestations of the disease, they disappear due to changes in the microflora of the oral cavity (complete death of pathogenic microorganisms).

Causes

Normally, there are over 160 in the oral cavity various types microorganisms. This anatomical segment is the most contaminated.

Single-celled life forms arrive in various ways:

• With food;
• With water;
• From the surrounding air;
• When in contact with various surfaces (bringing toys and other objects to the mouth).

Thanks to optimal living conditions (favorable temperature, high level humidity, alkaline environment, sufficient oxygen, abundance of nutrients supplied with food) microorganisms are able to maintain the growth of their colonies for a long time.

An additional advantage for the life of bacteria, viruses and fungi are multiple folds of the mucous membrane, spaces between teeth and gum pockets, which are teeming with desquamated epithelial cells and rotting food debris. All the described features create a constantly replenished “storehouse of nutrients” that are essential for the reproduction and active growth of pathogenic flora.

It is important! 1 gram of plaque on teeth contains over 300,000,000,000 microbes, 1 ml of saliva - about 900,000,000.

Under certain conditions, the qualitative and quantitative composition of the microflora of the oral cavity undergoes changes, and pigment-forming representatives begin to actively reproduce. These include:

• Gram-positive rods of the genera Prevotella and Porphyromonas;
• N. flavescens and pha-ryngis;
• Staphylococcus;
• Representatives of the family Actinomycetaceae (including corynobacteria).

It is important! Colonies of individual species or all together determine the formation dark coating, which can have a whole range of shades: from yellowish or greenish to dark brown or black.

However, such phenomena are not typical for every child. There are a number of predisposing factors that significantly increase the risk of developing adverse events:

1. Hereditary predisposition. Several large randomized studies conducted in the United States have demonstrated the involvement of individual genes in creating optimal conditions for bacterial growth.
2. Features of oral hygiene. Lack of regular brushing of teeth and tongue, consumption of low-quality or spoiled food, abuse bad habits significantly increase the incidence of the disease.
3. Dysbacteriosis due to inadequate functioning of the gastrointestinal tract (incompetence of the esophagogastric sphincter, severe liver disease with the development of failure) or uncontrolled reception antibacterial drugs.
4. Course of caries. The destruction of tooth enamel by bacteria disrupts all physiological and metabolic processes at the site of the lesion.
5. Congenital anomalies and malformations of teeth. Most common cause is enamel hypoplasia (underdevelopment of the outer layer).
6. Insufficient intake or defects in absorption of the most important macro- and microelements (calcium, magnesium, phosphorus, iron). It has been proven that in persons born to women with anemia during pregnancy, in the absence of appropriate therapy, pathology is detected 2.5–3 times more often.
7. Defects immune system. Failure can occur at any level, involving both local and general protective factors.
8. Excessive consumption of sugar-containing foods. Sweet environment creates ideal conditions for the propagation of staphylococci and neisseria.
9. Pathologies of occlusion and formation of the facial skeleton. As a result, individual parts of the tooth enamel are in the zone increased load and are destroyed, areas of destruction are quickly populated by pathogenic flora.

Manifestations of dysbiosis caused by inadequate functioning of the gastrointestinal tract

It is important! In any case, the basis of the pathology is a violation of the normal microflora of the oral cavity with excessive development of pigment-producing microorganisms and a decrease in the number of opportunistic and beneficial bacteria.

The appearance of black plaque on teeth in adults may be associated with the influence of specific factors. These include:

1. Smoking. More than 900 resins included in the composition tobacco products, not only form dark areas of pigmentation, but also reduce the reactivity of the immune system.
2. Abuse of coffee and alcoholic beverages.
3. Systematic contact with heavy metals in the process of carrying out production activities.
4. Drug use.
5. Long-term course of chronic somatic diseases.

Harmful substances contained in cigarettes

Treatment

There are many traditional methods of treatment, but their use is not recommended, since the pathology is serious and threatening to dental health. It is also strictly forbidden to get rid of deposits using rude means, which are extremely common among the population:

• Scraping plaque with a knife, blade and other objects;
• Using toothbrushes with hard bristles;
• Use of abrasive cleaning products with large elements.

It is important! Such methods create the illusion of healing for a while, but in the future the problem returns, as areas of tooth enamel are damaged even more.

At the dentist

Depending on the factors that lead to the appearance of areas of darkening on the tooth enamel, appropriate treatment is prescribed:

1. Caries. In case of minor damage, the pathological areas of enamel are removed and fillings are applied; in case of massive damage, the tooth is removed.
2. Lack of biologically valuable active substances. Calcium preparations (Kalcemin), magnesium, iron (Maltofer, Sorbifer), and fluoride toothpastes (Elgidium) are prescribed.
3. Malformations maxillofacial area. A consultation with a plastic surgeon is indicated, during which a decision is made on further treatment tactics.

It is important! If there are diseases of the gastrointestinal tract or immune system, appropriate treatment is carried out by a gastroenterologist, allergist-immunologist and other specialists.

In the absence of contraindications and the patient is over 14 years of age, non-invasive methods of therapy can be used:

1. Laser enamel cleaning. After preliminary hygienic treatment of teeth, the laser is applied, then the remaining plaque is washed away with an airborne jet. For complete removal Black microparticles are polished with low-abrasive nozzles.
2. Impact of ultrasound. Due to vibrations created by a special device, the plaque cracks and is easily removed from the surface of the chewing elements.

Laser cleaning of tooth enamel

Traditional methods

Home methods can only be used with complex therapy and in no case as a separate method of treatment. The following options for removing plaque have proven themselves to be excellent:

1. Active solution prepared on the basis of hydrogen peroxide (200 ml) and activated carbon (5-6 tablets). It is necessary to apply the composition to all teeth for 10–15 minutes 1–2 times a week.
2. A mixture of grated radish and lemon zest at a rate of 1 to 1. The substance should be of uniform consistency. The resulting pulp should be chewed for several minutes 1-2 times a day and then spat out.
3. Rinsing the mouth with a solution of natural honey (1 tsp of bee products per 250 ml of boiled or distilled water).
4. Rubbing in oil tea tree into the gums. This method allows not only to reduce the strength of dark plaque with an unpleasant odor, but also helps prevent inflammatory diseases gums.

It is important! The maximum duration of treatment is 7 days. For the purpose of prevention, it is allowed to carry out traditional methods of therapy once every 2 weeks.

Consequences

Adverse events in the absence of timely contact with a specialist or inadequate therapy include:

1. Appearance unpleasant odor from the mouth, which is a factor of social maladjustment.
2. The formation of tartar is a hardened plaque that is extremely difficult to remove.
3. Decay of enamel and progression of any carious processes followed by complete loss of teeth.
4. Periodontitis. Caused by the involvement of the gum mucosa and the transition of the infectious-inflammatory process to periodontal tissue (alveolar process of the jaw).
5. Increased sensitivity of teeth to sudden temperature changes (hot-cold and vice versa) and certain food irritants (sweet, sour, salty).
6. Development of chronic gingivitis, bleeding gums.

Consequences of the disease and their symptoms

Prevention

The best way to prevent any disease is prevention. It is strictly forbidden to use any tooth powders, which not only are a source of bacteriological contamination of the oral cavity, but also destroy exposed areas of tooth enamel.

Preference should be given to hygienic pastes containing many pharmacological additives. Highlight:

1. Anti-carious pastes;
2. Pastes affecting soft tissues (gums, mucous membranes);
3. Pastes that help eliminate unpleasant plaque and tartar;
4. Whitening cleaning products.

It is important! The greatest demand is for combined (multiple approaches to treating one pathology) or complex (effective against a whole range of diseases) toothpastes.

The highest quality representatives of this group of funds are:

• "President"
• "Splat"
• "SATO";
• "Dentavit".

Other methods hygiene care are selected individually during a visit to the dentist and include:

1. Teaching a child to brush his teeth independently at the age of 12 months. In the first 2-3 years of life, parents can help with cleaning, but they should use a brush with a thin head and only a flat working area. All movements must be progressive and sweeping. Electronic toothbrushes that have a safety certificate are allowed (for example, Oral-B Vitality CrossAction). Be sure to teach your baby to spit out the remaining toothpaste. Brush hardness level – soft or medium.
2. Rinse your mouth with liquid products. Such methods are recommended to be used from the age of 10 due to the large number of local disorders: burning, discomfort, tingling on the mucous membrane, etc. Solutions such as Listerine and Eludril have proven themselves to be excellent.
3. Do not eat after the last brushing of your teeth.

A child must be taught from childhood to proper care for teeth and oral cavity

1. Seeds and nuts. Natural abrasive substances effectively remove plaque and other pathological stains from teeth. The products also contain many useful vitamins that help strengthen the immune system.
2. Apples and pears. The fruit contains water with dissolved acids, which destroy almost all pathogenic microorganisms.
3. Strawberry. Improves enamel color due to malic acid.
4. Broccoli. The vegetable is effective specifically against Priestley’s plaque.

It is important! You should avoid drinking coffee, strong tea, carbonated drinks, and concentrated juices. The described products affect tooth enamel and contribute to its destruction.

Adults should avoid the following foods or try to limit them as much as possible because high risk development of pathological plaque and dysbiosis of the oral cavity:

Name	Characteristics of the adverse effect
Spices, sauces	Deposition of pigments in the pores of the enamel with its subsequent softening.
Bright berries (blueberries, blackberries)	Changing the color of the filling material, improving the conditions for the existence of staphylococci and streptococci.
Solid sweet products	The formation of a sticky film on teeth, reducing the resistance of enamel to external stimuli of any nature.
Red wines	Changes in enamel color, increased incidence of calcifications in the gum tissue.

Video: Priestley's raid

The appearance of any deposits on teeth, including Priestley plaque, is a problem that anyone can face. You cannot try to get rid of the disease on your own; you need to promptly contact a dentist. Only a doctor can identify the causes and provide adequate therapy. The specialist will also prescribe a set of measures to prevent the condition in the future.