Insulin Resistance Syndrome

Fairly common condition that destroys the health of the age of 45 years - the so-called metabolic syndrome.

Metabolic syndrome (syndrome X, insulin resistance syndrome) - a sum of a large number of interrelated pathological factors that create conditions for the emergence and development of cardiovascular disease and insulin-dependent diabetes.

This syndrome first identified an American scientist Gerald Riven. In the late 80s of last century D. Riven proved the existence of insulin resistance syndrome (syndrome Rivena later called), which defines the concomitant development of hypertension, diabetes mellitus type 2, hyperlipidemia and atherosclerosis.

Namely insulin resistance and hypoglycemia are at the root factors of metabolic syndrome.

The loss of cell sensitivity to insulin - insulin resistance develops against the background of obesity, which violates the distribution of glucose and hypoglycemia develops. Scientists have proved that the degree of insulin resistance is directly proportional to the amount of excess fat. With the accumulation of fat in the body fat cells gradually grow in size. The greater the fat cell in size, the less it responds to the hormone insulin. Thus, insulin inhibits the process is less breakdown of fat into fatty acids. As a result, accumulate in the blood free fatty acids.

In accordance with the laws of interaction products of metabolism - glucose and aliphatic acids - the muscle cells of the liver and stimulates the oxidation of free fatty acids, and thus prevent the normal transport of glucose - insulin resistance occurs. In this situation, starting the pancreas to secrete insulin in an even larger quantities, resulting in hypoglycemic disease.

As a result, we have the following chain: physical inactivity, obesity, and abundance in the diet of fatty foods lead to insulin resistance of body tissues. Insulin resistance leads to hyperinsulinism (hypoglycemia). A hyperinsulinism is a cause of hypertension, dyslipidemia, atherosclerosis, coronary heart disease and diabetes type 2. Thus developing metabolic syndrome.

World medical practice suggests that metabolic syndrome is a major factor in the extreme aggravation of these pathologies, raising their overall risk. Metabolic syndrome, sick almost every fifth person aged and elderly vozrasta.Poetomu today so it is important to diagnose early and effective treatment.

Markers of metabolic syndrome: abdominal obesity, hypertension, dyslipidemia. All these markers typically originate from the tissue to insulin resistance and hypoglycemia.

Metabolic syndrome consists of the following abnormalities:
- High blood pressure - more than 170/100 mm Hg. Art.
- Hyperlipidemia: increased concentration of fat in the blood (more than 1.72 millimoles / liter) and decreased concentration of HDL cholesterol - less than 0.9 millimoles / liter for men and less than 1 mmol / liter for women.
- Overweight: BMI - over 30 kg/m2, or the ratio of waist circumference to hip circumference greater than 0.9 in men and 0.86 in women.
- Hyper Albuminuria (concentration of albumin in the urine - a 0.02mg/ml).
- Insulin-dependent diabetes.

According to generally accepted rules of medical suffering from metabolic syndrome are at high risk of serious heart disease and circulatory system, as well as renal pathology.

Patients with metabolic syndrome to lead healthy lives, to establish a healthy food system with effective dietary supplements.

It should be noted that pharmacological drugs that are often used to control blockers in this situation are not welcome, because they exacerbate the imbalance of metabolism and provoke damage the glomerular apparatus of the kidneys and increase resistance to insulin.

Medicine today has detailed data on metabolism at the intracellular level, and allows you to regulate it in various diseases. Therefore, in recent years people are increasingly interested in various biologically active supplements containing active ingredients: fermentarnye substrates, amino acids, enzymes, cell membrane stabilizers, antioxidants, catalysts education RNA, DNA and other nucleic acids.

So now gaining popularity dietary supplements Tianshi Corporation, which are composed of vitamins, macro-and micronutrients, dietary flavonoids (fat eel Biotsink, Holikan, Biocalcium). Receiving the substance, the body is able to synthesize the most important structures that support health and normal activity (enzymes, peptides, neurotransmitters, nucleic acids, etc.).

Diabetes and Anemia

Diabetes mellitus is a chronic endocrine disorder characterized by disturbance of all types of metabolism on the background of an absolute or relative insulin deficiency. Metabolic disorders that occur with diabetes, negatively affect the state of internal organs, which is why diabetes mellitus often develops in such a state as diabetic nephropathy. One of the consequences of diabetic kidney disease is anemia that occurs in most patients with this disease. In this article we would like to tell about the causes, the importance and principles of treatment of anemia in patients with diabetes mellitus.

What is diabetes?
Diabetes is an endocrine disorder that is caused by absolute or relative deficiency of insulin. What does this mean?

Insulin - a hormone in our body, which regulates the exchange of carbohydrates (glucose) lipids and proteins. Insulin is produced by the pancreas in response to raise blood glucose levels (eg after a meal). Once in the blood, insulin is spread throughout the body, reacts with the cells and enables you to capture and process glucose. Thus, insulin lowers blood glucose and tissue nutrition (some tissues of the body is not able to capture in the absence of glucose, insulin). The cause of diabetes is insulin deficiency. Insulin deficiency may be

absolute - that is, the pancreas produces too little insulin (or not produce it). Absolute insulin deficiency occurs in diabetes mellitus type I.

relative - when produced in normal amounts of insulin can not provide adequate glucose metabolism. This situation is observed in type II diabetes, when physiological amounts of insulin can not provide the decrease in blood glucose levels due to reduced tissue sensitivity to insulin itself (this phenomenon is called insulin resistance).

Why diabetes leads to kidney impairment?
With inadequate treatment and long-term increase in blood glucose levels, diabetes leads to significant damage of internal organs. The first of diabetes affects the small blood vessels of arterioles and capillaries that feed blood, all organs and tissues of the body. In patients with diabetes (long-term preservation of high blood glucose levels) the walls of the arterioles are saturated fat and carbohydrate complexes, which in turn leads to cell death in the walls of these vessels is the widening of the connective tissue in them. The affected arterioles are closed, and fed their body begins to suffer from lack of oxygen and nutrients. Renal disease in diabetes (diabetic nephropathy) is developing by this mechanism. Massive destruction of the renal vessels with diabetes leads to the death of a working kidney tissue and replacing it inactive connective tissue. With the development of nephropathy, the kidneys gradually lose the ability to filter blood and form urine - with chronic renal failure. Today, more than half of all cases of chronic renal failure caused by the problem of diabetes.

What relation to diabetes has anemia?
Anemia is a condition in which blood is reduced red blood cells and hemoglobin.

As you know, in our body blood cells are formed in the bone marrow. However, for the red marrow was working, he should get a definite signal in the form of the hormone erythropoietin. Erythropoietin is produced by special cells in the kidneys. In diabetic nephropathy (see above) not only kills kidney cells involved in blood filtration, but also the cells that produce erythropoietin, so in conjunction with chronic renal failure in diabetic patients develop anemia (lack of erythropoietin leads to the termination of the bone marrow).

In addition to lack of erythropoietin in the pathogenesis (development) of anemia in patients with diabetes is the role of iron deficiency and chronic protein loss accompanying renal failure.

What is the impact on the state of anemia in patients with diabetes? According to recent research, for chronic renal failure that developed against the background of diabetic nephropathy complicated by anemia in more than half the cases.

Anemia significantly reduces the quality of life in patients with diabetes mellitus. Against the background of anemia a decrease in appetite, physical abilities, intellectual, and sexual function of patients. People with diabetes with anemia are at greater risk of developing cardiovascular disease, as is likely, anemia is an independent factor contributing to the malfunction of the heart and blood vessels.

How to carry out the treatment of anemia in patients with diabetes? Unlike the cases of anemia caused by iron deficiency or vitamin (iron deficiency anemia, anemia with a deficit of vitamin B12 and folic acid), and anemia that occurred against the background of renal failure in patients with diabetes, not only to treat vitamin and mineral preparations and without adequate treatment can take a very severe form.

How to carry out the treatment of anemia in patients with diabetes?
Given that the main factor in the development of anemia in patients with diabetes is a lack of erythropoietin in its treatment used medications containing erythropoietin.

Erythropoietin - a complex organic compound of the carbohydrate-protein nature. Carbohydrate component of the molecule of erythropoietin may be of two types: alpha and beta (hence the name drug erythropoietin). Erythropoietin for anemia treatment with recombinant get it, that is to synthesize a bacteria, which were introduced human genes that encode the structure of erythropoietin. During the preparation of drugs erythropoietin treatment is repeated, which allows to minimize the incidence of adverse reactions.

Diabetics with diabetic nephropathy should enter with a decrease in erythropoietin hemoglobin level below 120 g / l (ie, early anemia), the ineffectiveness of other treatments (eg, iron). Early treatment with erythropoietin can slow the development of angiopathy (damage small blood vessels), and, consequently, renal disease, which improves the prognosis of the disease and facilitate its flow.

Patients with diabetes, erythropoietin is administered in two ways: intravenously and subcutaneously. Standard injection frequency - 3 times a week. Recent studies in the treatment of anemia in patients with diabetes showed that subcutaneous injections of erythropoietin is not as effective as intravenous, which greatly simplifies the process of treatment (patients can self-perform the injection), and the frequency of injections can be reduced to 1 time per week, subject to the introduction of triple dose.

To increase the effectiveness of treatment of anemia in patients with diabetes, injections of erythropoietin supplement with iron.

Prevention of anemia in patients with diabetes mellitus
We have already mentioned that the diabetic nephropathy, chronic renal failure and, consequently, anemia, most often develop in diabetic patients not taking medication or in patients whose treatment does not ensure the maintenance of normal blood glucose levels. Therefore, the main measures to prevent anemia in patients with diabetes are:
• Earlier access to a doctor at the first symptoms of diabetes, or immediately after the detection of diabetes through a blood test;
• Strict adherence to prescribed treatment (antidiabetic drugs, insulin) and diet in the first days of illness;
• Regular self-monitoring: checking blood glucose levels, the correction of the treatment regimen with your doctor.
• Avoid bad habits - can significantly reduce the risk of cardiovascular disease and diabetes makes it easier for;
• Weight loss (for obese people) - can not only relieve for diabetes, but also to remove it. In addition, weight loss has a positive effect on the course of other diseases related diabetes (hypertension, coronary heart disease, etc.);

In Western countries, diabetes has long ceased to be considered "incurable disease" or "sentence". Thanks to modern possibilities of control of blood glucose (insulin preparations, antidiabetic drugs) diabetes was seen as a "special way of life", not a disease. Indeed, compliance with treatment regimens and streamlined diet can compensate for a lack of insulin for decades, without causing any complications of diabetes.

Treatment of anemia in patients with diabetes should be mandatory, since anemia is not only lowers the quality of life in patients with diabetes but also accelerates the development of the disease and its complications. At the moment the main problem of drug use erythropoietin to treat anemia in patients with diabetes is a high cost of drugs themselves.

Diabetic Foot Treatment

1. Normalization of carbohydrate metabolism.

The majority of patients with ulcerative lesions stop marked hyperglycemia, and one of the conditions conducive to healing, is to normalize blood glucose levels. Keep in mind that in infectious inflammation and fever in patients with diabetes type 1 require higher doses of insulin.

Diabetes type 2 in inadequate compensation for the background diet and taking tablets recommended transfer to insulin therapy in non-healing ulcers of the foot.

2. Treatment of diabetic neuropathy and angiopathy.

Apply non-pharmacological (diet, etc.) and drug therapies, as set out in the thematic sections of diabetic neuropathy, treatment of diabetic neuropathy, atherosclerosis and coronary heart disease, coronary heart disease, clinical nutrition and atherosclerosis.

Of great importance is the normalization of blood pressure with concomitant hypertension and slow progression of the complications of diabetes like nephropathy.

These areas of treatment are interrelated, although each has its own peculiarities. Thus, it is a difficult task effects on different mechanisms for development, but, in some degree, interdependent co-morbidities and complications of diabetes. Particularly difficult choice of only those necessary and demonstrably effective drugs, which would preclude excessive medical treatment, leading to drug overload the body and excessive material costs.

Therefore, patients should not self-medicate based on information received from the media - popular magazines, newspapers, and radio and television.

3. Unloading of the affected limb.

In the past, patients recommended increasing physical activity in relation to the concept of leadership in the development of vascular diabetic foot.

Currently, discharge of the affected limb or part of it is considered a prerequisite of treatment of purulent-necrotic lesions in all forms of diabetic foot problems of any severity. Lack of, or at least limit load reduces inflammation and swelling, slows the growth of corns around the ulcer, increasing the regenerative processes in tissues. Unloading of the affected limb is particularly effective for neuropathic ulcer of the foot.

Increased physical activity is shown for ischemic, and partly neuroischemic form of diabetic foot (with no necrotic effects). In this case, dosed walking in combination with aspirin can reduce the pain of movement.

Enforcement of unloading is not always easy to be done. Preferred almost complete abandonment of walking and maintaining an elevated position of the limbs. However, bed rest is applicable only for a short period of time and only in some patients. A simple method of unloading is the use of crutches, but for many patients, this method is difficult and affects the quality of life. More convenient for some patients is a wheelchair.

Permissible to use a special shoe that provides unloading of fingers or toes.

At home, like orthopedic device can be made out of old sneakers. Specialists of the St. Petersburg Diabetes Center are among the most effective ways to discharge under the application of bandages of ulcers from synthetic materials during solidification acquiring greater strength than plaster casts, but with less weight. An example of such material is tsellokast, which can be purchased at pharmacies. Studies conducted in several countries indicate a decrease in the duration of treatment of diabetic foot ulcers (4-8 weeks) when using this method. However, in the form of ischemic lesions of the lower extremities, this method of treatment should not be used.

After healing, the ulcer treatment discharge, or at least limiting distance shall be maintained for 2 - 4 weeks. It is necessary to create conditions for the restoration of full tissue in place of the former ulcer.

4. Local treatment of ulcers involves the removal of (most often with a scalpel), hyperkeratosis and corns around the ulcer in order to reduce pressure on the affected area. Another method of local treatment is the removal of necrotic, nonviable tissue as a source of infections and toxins, and the healing is stimulated.

For moist ulcers using moisturizing dressings, dry - dry.

In the first phase of wound healing dressings are used for dampening solutions furatsilina, yodovidona, yodopirona, chlorhexidine, dioksidina, lavasepta or other antiseptic.

Do not use this alcohol solutions, including cologne, iodine tincture, "manganese", "green fodder," hydrogen peroxide

The frequency of dressings depends on the amount of discharge from the ulcer - usually 1 - 2 times a day. In the second phase of wound healing (after cleansing ulcers) use a variety of wound coverage (based on collagen), oil (sea buckthorn, shipovnikovoe oil) and hydrogel dressings. The patient and his household should learn how to make dressings for ulcers.

5. Antimicrobial drug treatment. Used mainly antibiotics, type, route of administration, dose and duration of which is determined only by a physician, based on the severity of the process and speed healing of ulcers.
However, patients should have some understanding of the principles of antimicrobial therapy of diabetic foot syndrome, namely:

Prophylactic antibiotics is not appropriate for long-existing ulcers, and even I II degree (see table diagnostic criteria for different forms of diabetic foot syndrome in the thematic section neuroischemic form on an information portal on vital diabetunet.ru) in providing local care, discharge in the absence of foot and signs of intoxication of the infectious process;

Antibiotics should have a broad spectrum of antimicrobial action, since the majority of infections in ulcers associated with several types of microbes. For a correct choice of antibiotic is desirable laboratory to determine the sensitivity to it of microbes isolated from affected tissues;

For ulcerative lesions without involvement of bone or joint and marked signs of intoxication acquitted of infectious oral antibiotics for 7 - 14 days. In a severe infectious process antibiotics administered intramuscularly or intravenously. From the set used for diabetic foot ulcers, antibiotics to select-amoksiklav, azithromycin (sumamed), moxifloxacin (aveloks) tsiprofloksvtsin (tsifran), ertapenem (invanz).

At the same time we note once more - the choice of antibiotic in each case decides physician.

Nor can we ignore the financial side of choice due to the cost of new imports of antibiotics;

Complications of antimicrobial therapy is most common intestinal bacteria overgrowth - the disruption of its micro-organisms.

For the prevention and treatment of intestinal dysbiosis probiotics and prebiotics are used relating to the biologically active additives to food or drugs.

Another complication of treatment with antibiotics are fungal infections of the mucous membranes of the mouth, intestines, vagina. As antifungal agents used for systemic effects of fluconazole (Diflucan, diflazon), which suppresses the most common cause of fungal infections - yeast-like fungi Candida genus.

If the vaginal fungal infection in women using natamycin (pimafutsin) - topically in the form of suppositories and oral.

6. Surgical treatment.

In severe lesions of the lower extremities, which are not disposed of the above therapeutic methods of treatment, surgical intervention is necessary - removal (amputation) of non-viable limb to save the remaining part of it and / or the patient's life.

Surgical techniques used for the restoration of blood flow in severe limb ischemia, as well as for the closing of large tissue defects with the use of plastics at the expense of their own or artificial skin.

To surgery also includes excision and vaporization of the affected tissue with a laser beam further grafting the wound with local tissues.

Diabetes Mellitus as a Cause of Blindness

Diabetes - a disease characterized by impaired endocrine metabolic processes of the body. One of its complications - is diabetic retinopathy (damage of the retina).

The prevalence of diabetic retinopathy is 90% of those with diabetes type I and 38.9% of those with diabetes type II.

The cause eye damage in diabetes
With prolonged and uncompensated (when higher than normal sugar), diabetes, retinal damage occurs - diabetic retinopathy.

What are the causes of this disease?
In diabetes disturbed metabolism of carbohydrates (sugars) and fats (triglycerides and cholesterol). These substances are not absorbed by the body for a long time and remain in the blood, damaging the lining of blood vessels (endothelium). As a result of microvascular damage - in the past formed clots, narrowing their clearance and as a result, there is a lack of oxygen to tissues and organs (called ischemia). If ischemia persists for a long time, irreversible changes in the affected organs - they atrophy (if there was a gradual decrease in blood flow) or infarction (with a sharp decrease in blood supply to any part or organ). In the body there is a compensation mechanism of ischemia - education about the blockage of new blood vessels. But the problem is that the newly formed vessels are not full - their walls thin, endothelial lining with defects that lead to undesirable consequences:

- Swelling of tissue due to passage through the vascular wall of blood plasma
- Bleeding in the retina (even with a slight increase in blood pressure)
- The deposition in the tissues of organic matter (formation of hard exudates)
- Retinal detachment
- Bleeding into the vitreous

The manifestations of diabetic retinopathy:
- Gradual reduction of vision is not improving after spectacle correction

- The appearance of dark spots in the field of view

- A sharp sudden decrease of
Diagnosis of Diabetic Retinopathy:
- Ophthalmoscopy (fundus examination) can detect retinal edema, exudates, microbleeds on the retina, vitreous hemorrhage, the newly formed blood vessels.

Fluorescence angiography (study of blood flow to the retina) reveals the ischemic zone, the newly formed blood vessels, retinal vascular occlusion.
- Optical coherence tomography - at the cellular level defines the retinal lesions.
Treatment of diabetic retinopathy:
Drug treatment is carried out ophthalmologist in an outpatient or inpatient setting and has the following objectives:

1. compensate for diabetes - when blood sugar levels will be kept at a high level, there is no long-term effect of treatment should be expected. For this purpose, appointed by the consulting endocrinologist.
2. Improve blood flow through the vessels of the retina
vasodilators Pentoxifylline (Pentoxifylline)
Antiplatelet Acidum acetylsalicylicum (Aspirin)
3. Antioxidant therapy:
Vitamin E
Methylethylpiridinol (emoksipin)
4. Angioprotective therapy (medicines strengthen the vascular wall)
Acidum Ascorbicum (Vitamin C)
Etamsylate (etamzilata)
5. Improvement of metabolic processes of the retina (retinal preparations containing the necessary trace elements and vitamins)
Retinalamin
Trimethylhydrazinium propionate (Mildronate)
Wobenzym

Surgical treatment is performed in a hospital:
Laser coagulation of the retina - is to reduce the swelling of the retina. Is to apply laser-coagulants on the retina - formed through the pores of the liquid, creating a swelling of the retina, an additional outflow of preretinalnoe space.

- Injection drug (Avastin, Lucentis) in the vitreous. These drugs at the molecular level, blocking the vascular growth factor, preventing the appearance of newly formed blood vessels, contribute to the disappearance of already appeared.
- Surgery on the retina - vitrectomy is used when the long-term absorbable hemorrhages into the vitreous.

Diabetic retinopathy is a terrible complication, potentially leading to complete blindness. For the treatment of this disease requires constant monitoring of blood sugar and blood cholesterol, maintaining blood pressure within normal limits and timely assistance ophthalmologist. If exposed to diagnose diabetic retinopathy, the ophthalmologist inspections should be carried out at least 2 times a year.

Diabetic and Sweetener

Sweeteners are very similar in substance to the purpose, but belonging to different groups. Such a separation due to the fact that sweeteners have some nutritional value as a source of energy for the body, such as sweeteners do not have.

Sweeteners are used patients with diabetes mellitus, as well as the combination of diabetes with obesity to sweeten food because many people find it very difficult to limit myself of the habit is sweet. If there is no craving for sweets, you need a sweetener or sweeteners disappears.

Sweeteners

To substitute sugar include fructose and sugar alcohols different (polyols), mainly xylitol and sorbitol. Fructose is the same nutrients as glucose and sucrose (ie, sugar) but, unlike them, requires for its absorption of smaller amounts of insulin. Fructose is absorbed from the intestine more slowly than glucose, but more rapidly undergoes oxidation in the liver, which leads to a smaller increase in blood glucose levels after meals.

However, fructose absorption from the intestine is significantly increased when it is consumed along with other sugars or starches, such as fructose in the honey, or drink with fruit along with the bread. The consumption of one of its fructose glycemic index, which characterizes the increase in blood glucose levels, approximately 4 times lower than the glycemic index after ingestion of glucose. However, the glycemic index of honey, in which fructose is nearly 40%, only slightly inferior to the glycemic index of glucose.

For the same caloric and sugar fructose is sweeter than a factor of 1.7 and therefore used in smaller doses, thus reducing caloric different foods and dishes, as well as the need for insulin. The sweetness of fructose is especially noticeable in cold and acidic drinks and expressed little if added to hot dishes. Fructose in an amount not to exceed 30 - 40 grams per day is used for patients with diabetes, and 20% fructose adopted must be considered in the carbohydrate composition of the diet. When consumption of 30 grams of fructose per day it will be half the "bread of unity" (6 g carbohydrates). Excessive consumption of fructose (40 g) can cause flatulence, diarrhea, as well as disrupt fat and purine metabolism - increase blood levels of triglycerides and uric acid. Recent side effects limit its use of fructose in the diet of diabetics, especially type 2, as well as the presence of metabolic syndrome.
 

In the diet therapy of diabetes, coupled with obesity, fructose is not recommended because of its caloric: 1 g of fructose yields about 4 calories. However, when choosing between sugar and fructose preference should be given to the latter. If you can not replace hypoglycemic states receiving glucose or sugar fructose, as it is slowly absorbed from the intestine. Thus, the question of the use of fructose in diabetes mellitus is ambiguous, since it has both positive and negative sides.

"Fruit" - a mixture of fructose and vitamin C, which makes it more useful - it is used in the same doses and under the same conditions as conventional fructose, but 20 g fruktovita provides almost daily rate of demand for vitamin C. Xylitol (ksilisorb) and sorbitol - natural sugar alcohols are solid, well- soluble in water.
They have a caloric close to that of glucose or fructose, 1 g of xylitol yields about 4 calories, 1 g sorbitol 3.4 calories. For sweets xylitol is sugar, sorbitol, almost half as sweet. They can be used for hot food handling.
Xylitol and sorbitol are used in diabetes, at least - in obesity, and in connection with a light and choleretic laxative action (30 g PCP) - chronic cholecystitis with bile stasis and constipation. Preferred method of xylitol - up to 30-40 grams per day, for 2 - reception (drinks and desserts).

When excess consumption (40 g), xylitol and sorbitol have an adverse effect on the gastrointestinal tract, causing a rumbling, bloating, heaviness in the stomach, diarrhea. Currently, many countries in the production of dietary products for patients with diabetes, at least - for immediate consumption, use of new sweeteners from the group of sugar-alcohols: maltitol, isomalt, lactitol, erythritol.

If the sweetness of sugar to take the unit (1.0), the sweetness of maltitol (maltisorba) and izomaltita (palantinita) is equal to 0.65 and 0.45. Caloric 1 g maltitol or izomaltita 2 kcal, that is 2 times less than sugar or xylitol, which enhances their use in diabetes mellitus type 2 with obesity. Daily consumption of sweeteners is limited to 30 grams in order to avoid disorders of the intestine. Lactitol 2.5 times less sweet than sugar. Caloric 1 g lactitol is 2 kcal.

After receiving lactitol blood glucose level is almost not increased. If the glycemic index of glucose taken as 100, the glycemic index of maltitol is equal to 35 Xylitol - 13, and lactitol - 6. In addition, lactitol has the properties of prebiotic - it stimulates the growth of beneficial bacteria in the colon. Daily consumption of lactitol can be up to '20 By caloric, and the effect on blood glucose levels and prebiotic properties of erythritol is close to lactitol, but it is sweeter.

Erythritol is intended mainly for the production of low-calorie diet products.

Prevention of Secondary Diabetes

Secondary prevention is aimed at preserving the functions of the remaining beta-cells in patients with clinical manifestation of diabetes, its prevention of acute and late complications.

Such prevention is reduced to the proper lifestyle, diet, timely medical treatment (taking tablets lowering drugs or insulin injections), the wise use of exercise as an adjunct to primary therapy using physiotherapy, herbal medicine, spa treatment.

Maintenance of compensation of diabetes mellitus as the 1st and 2nd type - the main way to prevent diabetic complications.

The following rules, following which, it is possible to avoid decompensation, complications of diabetes, or to stop their development:

1. Normalize blood glucose levels. To do this diet, it is reasonable to use the exercise, lead a normal life, to comply with all recommendations of the treating physician must conduct self-control.

Every patient should strive to have a fasting blood glucose level less than 5.5 mmol / L, after eating no more than 7.8 mmol / l, glycated hemoglobin level of 6-7%.

It is important to remember that the value of glycated hemoglobin (or HbA1c) reflects the value of the blood glucose level over the past 3-4 months.

Thus, the level of HbA1c 6-7% in patients with diabetes means that his blood glucose level over the past 90 days was between 4.4 - 6.3 mmol / l during the day. Therefore, achieving normalization of blood glucose, normalizes the level of patient HbA1c!

In one of the reputable international study under the acronym DCCT in the prevention of diabetic complications proved that the desire to normalize the patient's HbA1c levels in diabetes mellitus type 1 reduces the likelihood:

- eye damage by 76%;
- renal disease by 50%;
- nerve damage by 60%;
- damage the cardiovascular system (heart and blood vessels) to 35%.

Another international study by the acronym UKPDS in the prevention of diabetic complications proved that the desire to normalize the patient's HbA1c levels in diabetes type 2 can reduce the risk:

-  any complications associated with diabetes by 12%;
-  microvascular complications (damage small blood vessels) to 25%;
-  myocardial infarction by 16%.

In order to better understand what life to lead, it is recommended to be trained in the "school of diabetes."

These schools are organized at hospitals (specialized endocrine units) and specialized diabetes centers and dispensaries. The school should be trained not only to children with diabetes mellitus type 1, but also adult patients with diabetes mellitus type 2.

2. Need regular medical checkups to detect decompensation and complications begin.

For the prevention of nephropathy (kidney damage) to: 

- Normalize blood glucose levels;
- Regular urine for microalbuminuria (small protein) - at least once a year during the first 5 years of disease onset diabetes;
- Conduct urinalysis for proteinuria (large protein) at least 1 time in 3 months;
- Determine the glomerular filtration rate (sample Rehberg) at least 1 time in 6 months;
- Daily to control blood pressure;
- Investigate the level of creatinine and urea in serum (blood chemistry), 1 per 6 months;
- In the presence of elevated levels of albumin or proteinuria should have more control over the carbohydrate metabolism (to normalize blood glucose levels);

Time to begin treatment, that is to see a doctor appointment for medical treatment and normalization of intrahepatic pressure (drugs: Captopril, Capoten, Enalapril, Enap, Renitek, etc.) and treatment of high blood pressure with antihypertensive drugs);
 

For the treatment of nephropathy (by appointment doctor!) Angioprotectors used (drugs, "defenders" of blood vessels) - Trental, Pentoxifylline, Actovegin, Sulodexide (Lively Du F), a new drug that is based on nanotechnology (microscopic particle of the drug has the size - 400 nm when comparing the diameter of a human hair is 100 000 nm, red blood cell - red blood cell 1,000 nm) - Traykor (Fenofibrate);

With the appearance of proteinuria is also recommended to limit consumption of animal protein intake (up to 0.6-0.8 g / kg body weight per day) and the number of salt.

For the prevention of retinopathy (eye damage) that

- Normalize blood glucose levels;
- Regular urine for microalbuminuria (small proteins);
- Eye doctor check-ups once in a year in the absence of retinopathy;
- Eye doctor check-ups 2 times a year when there are changes in the fundus;
- Held fundus examination with dilated pupils (eyes buried atropine), which gives a complete picture of the fundus. In this case, considered contraindications to the use of atropine (eg, glaucoma);
- Time to begin treatment.

For the prevention of neuropathy (nervous system) must be:

- Normalize blood glucose levels;
- Conduct regular surveys by a neurologist (sensitivity, reflexes) 2-4 times per year;
- Observe the rules of foot care and regular exercises for the legs.

Rules for the care of their feet. It should be:

- Wash their feet daily with warm soapy water (not steam out feet!)
-  After washing, dry with a towel to wipe his feet (especially between the toes carefully);
-  Lubricated regularly stops fat cream - it will help prevent cracking and dryness of the skin (but the cream should not fall into the interdigital spaces). Currently, pharmacies appeared in a series of special creams DiaVord (Diaword):
- Diaderm soothing, protective Diaderm, Diaderm regenerating;
- Regularly inspect the feet (including using a pocket mirror);
- Properly and timely treat the nails with nail file 1 - 2 times a week, do not use sharp objects - scissors and forceps, and never round off the corners of the nails;
- Rough skin on heels and corns are regularly removed with pumice stone or nail file special cosmetic;
- Do not cut corns, use special tools to remove them;
- Check the inner surface of the shoe for the presence of foreign bodies, fractures, folds insoles;
-  Do not go barefoot and wear no shoes on bare feet;
-  Wear warm socks if feet are cold, made from natural fibers with no tight elastic band;
-  Not warm feet heaters, a fireplace, batteries;
-  Be correct clamping shoes (do not buy a hard, narrow shoes, with a decrease in the sensitivity of the legs to go for buying shoes with cardboard footprints), to avoid open shoes, shoes with heels, narrow nose;
-  Properly lace shoes (lace should be parallel);
-  Detection of cracks, abrasions, cuts, abrasions, burns, ulcers, discoloration of the skin. Changes in temperature and swelling of the extremities should be immediately consult a doctor;
-  When to see a doctor urgently given the opportunity to use to process colorless antiseptic solutions (Miramistin, Aioksidin) not to use iodine as well as handling them can cause irritation.

 The following is a special gymnastics for the prevention of lower limb neuropathy and diabetic foot.

- Exercising the legs.
- Every night is very important to take 15 minutes to perform the exercises for the legs. If you experience pain doing the exercises should be stopped and subsequently consulted on this matter with your doctor. Each exercise should be performed 10 times.

Starting position: sit down, keeping your back straight in a chair or stool.

1. Prim toes and straighten again.

2. Then alternately raise socks, then the heel.

3. Feet up and make circular movements toes.

4. Based on the socks, to perform circular motions with your heels.

5. Straighten the leg at the knee. Pick it up parallel to the floor. Toe delay. Bend the leg at the knee. Put your foot on the floor. (Each foot to perform the exercise 10 times.)

6. Raise the leg, straightening it in the knee, parallel to the floor. Pull the sock itself. Lower the leg to the floor, leaning on his heel. (Each foot to perform the exercise 10 times.)

7. Repeat the previous exercise by doing it with both legs simultaneously.

8. Lift, straightening your knees, both legs. Flexion and extension of the foot at the ankle joint.

9. Raise the foot, straightening her knee. Make a circular motion foot (10-fold from right to left, left to right 10 times each leg).

10. Fingers of both feet to crush a single page of the newspaper lying on the floor, then flatten it and break into pieces. Pieces of paper seized, fingers and move to the second page of the newspaper. Then this page to spread out her pieces of paper rolled up into a ball with your toes. (Run 1 times.).

Exercises Ratshou:

These exercises are known to exercise, improves blood circulation in the feet and legs, and are recommended for the prevention of angiopathies of the lower extremities.

1. Lie on your back on the bed or the gym mat.

2. The legs lift up as much as possible straightening of the knees. Hands to support your feet under your knees.

3. Make a circular motion stops at 1 revolution in 2 seconds

4. Perform a circular motion for 2 minutes.

5. Sit on the edge of the bed and sit in this position, his legs dangling, 2 minutes.

6. Alternately repeating these steps within 20 minutes.

7. At the end of exercise a little walk around the room.

8. On the day of repeating this exercise several times.



A few tips for preventing lower limb neuropathy, diabetic foot.

1. Daily walking at a higher pace of 30 minutes to 1 hour is the best exercise for your feet. We must try to increase the distance each day.

2. Also recommends the following exercises you can do at home:

 Wuickly up the stairs, using only the rise of the foot; Bend your knees, holding the chair. Squat as deeply as possible 10 times. Back while keeping a straight; Knead calf muscles: in a standing position with his hands rest against a suitable wall. Set legs so that the trunk was tilted forward in some situation. The feet should be fully in contact with the floor surface. Bend your elbows 10 times, while holding his back and legs fully extended position. This exercise helps prevent muscle cramps legs; Rise and fall on your toes to the heel 20. At the same time trying to shift the weight from one foot to another;  Sit on a chair and get up with him 10 times. Hands at the same time must be crossed in front of the abdomen;

Exercise for the toes: holding on to the back of the chair in turn stand on the fingertips of each leg; Stand with one foot on the platform, such as a large book. Holding onto a chair or table to make 10 swings back and forth with one foot. Change the position of the feet and repeat the exercise;  Sit on the floor, lean back slightly and press against the floor with his hands behind him. Shake a few times before the feet of a sense of warmth and relaxation; Time to begin treatment (using medications that contain vitamins A, B, C, E, Su, minerals zinc and chromium, for example, "Vitamins for people with diabetes," products containing only vitamins B "Multi-Tubbs B-complex," "Neyromultivit "but the most effective drugs is a derivative of alpha-lipoic acid or thioctic" Tiogamma, "" Valium, "" Tioktatsid ").

For the prevention of angiopathies (micro-and macroangiopathy - vascular lesions of the lower limbs, heart attacks, strokes), you must:

Normalize blood glucose levels; Regularly carry out surveys in the vascular surgeon, cardiologist, neurologist 2-4 times a year (on the testimony and more); Struggle with excess weight, obesity, physical inactivity;
Observe antiholesterinovuyu diet (described in detail in the thematic section of the vital information portal diabetunet.ru, dedicated to diabetes care); Follow the recommendations of the attending physician (not to oppose the appointment of insulin in patients with diabetes mellitus type 2).

Very often patients with diabetes mellitus type 2 for a long time are treated just as diet and physical activity or diet, physical activity and sugar-reducing pills.

There comes a time when these treatments become scarce and there are initial manifestations of complications of hypertension.

These circumstances are required to transfer patients to insulin.



Patients strongly resist insulin, believe that they were "carefully tended, planted" on the insulin that they can be a life-long dependency on medication. This is a mistake.

Insulin can not be used! Inclusion of insulin therapy when complications appeared only delay their progression and prolong life.

It is therefore very important time to begin treatment (on prescription medications are used - and Angioprotectors antihypoxants - eliminating the lack of oxygen in the brain and heart: Meksidol, Mildronate, Coenzyme Q and vitamin antioxidants: vitamin E, A, C, trace element selenium). Antioxidant rich herbs (parsley, onion, dill, etc.), green pepper.

For the prevention of osteoarthropathy (bone and joint destruction) that

Normalize blood glucose levels; Conduct regular surveys by an endocrinologist, surgeon, podiatrist. Independently examine the joints, on a monthly basis to test for hayropatiyu (damage of joints of the hands) to do this, lay your hands in prayer position (palm to palm) is normal, in the absence of joint damage, the fingers and palms are closed tightly to each other, without gaps; Struggle with excess weight, obesity, physical inactivity; About driving articular exercises (described in detail in the thematic section of the vital information portal diabetunet.ru, devoted to physical activities); To avoid situations in which possible fractures obstruction of the house, injuring exercise, limit the movement of heavy ice, etc.); In the diet (if no contraindications) include daily milk and dairy products rich in calcium; Time to begin treatment if there are signs osteoarthropathy.

Diabetes Mellitus and Toxicants

We have already talked about how important proper nutrition in diabetes mellitus.

We talk about how some foods can be dangerous because of the presence of toxic substances. We all know that in the present environment is poor. Environmental pollution affects the food. This should be considered absolutely all healthy people, especially in patients with diabetes mellitus.

If you have any serious chronic disease, including such as diabetes mellitus, to food should be treated with special caution. The disease weakens the body, making it even more vulnerable. Therefore, it is desirable to avoid any negative factors.


Nitrate, nitrite, pesticides

Where did come from harmful substances in products. The answer to this question is very simple. Toxic substances accumulate in the water, air and soil. It could be pesticides, heavy metals, nitrates, nitrites and many, many others

When growing vegetables, fruits, vegetables, various chemical fertilizers - the salt of nitric acid, which include nitrates, potassium, sodium, ammonium, calcium. When different nitrate applied to land, they accumulate in plants.

By themselves, these substances are less harmful to the human body, that is, are relatively low-toxic.

But it can turn into nitrates, N-nitroso compounds, which have a carcinogenic effect, that is, capable of causing cancer. In addition, nitrates can cause poisoning.

Increased ambient humidity leads to that in plants there is a restoration of nitrate to nitrite. That same is observed in the gastrointestinal tract as a result of influence of the microflora. Nitrites enter the bloodstream, forming a methemoglobin.

Methemoglobin differs from hemoglobin that can not tolerate, oxygen. If blood appears certain concentration of methemoglobin, it can cause poisoning. Person feels fatigue, weakness. Symptoms can appear within an hour or several hours later.

In acute poisoning, nausea, diarrhea, vomiting, decreased blood pressure. In this case the hands and feet become cold, breathing quickens, there is noise in the ears, headache. There may be convulsions, loss of consciousness. In some cases, people can fall into a coma.

You can simply protect themselves from poisoning.

Nitrates are in the plant through the roots and accumulate in the leaves. Especially a lot of them in the following plants: watermelon, melon, fennel, celery, radish, spinach, lettuce, beets, radish, parsley, cabbage, cucumbers, sorrel, carrots. In cabbage nitrates contained mainly in the stalk and leaf veins. Sorrel, cucumbers, dill harmful substances accumulate in the stem. Can significantly reduce the amount of nitrates from sort of  plants.

Greens need to handle as follows: the leaves are pre-cleaned of streaks, and then pour water and leave for 2 hours. After that, the water should be drained, and add a new one. Soaking should be continued for 1-2 hours. For the third time in the water to greens

leave for 5-7 hours

This method of getting rid of nitrates is perfect for parsley, sorrel, kale and other leafy plants.

To root it does not work, here you need to use a decoction.

After boiling roots is important to immediately drain the water. If it cools down, a significant part of harmful substances back into the vegetables.

It is important to remember that most of the nitrates and nitrites in the water passes in the first 15 minutes. Therefore, you first need to cook vegetables until soft, drain the broth. Then pour boiling water over vegetables, season them and cook until fully cooked. The broth must then immediately drain.

When cooking carrots is desirable from both sides cut to 1-1.5 cm and discard. In these parts of the highest concentration of harmful substances. In cabbage harmful substances contained in the stalk and upper leaves.

If you have doubts as to the security purchased cabbage, fresh is better not to use it. Boil the cabbage can ferment or. When fermentation most of the harmful substances goes into the brine, which must be drained.

If you doubt cause cucumbers to remove them from the peel, and cut off the part that is closest to the stem. It is in these parts of the most hazardous substances.

If doubtful dill, parsley and celery, it is necessary to cut off their stems, using only the leaves (the leaves can be pre-soaked in water).

Of course, if there is a possibility to use vegetables and herbs from his garden, where no chemical fertilizers. But the possibility is not all urban residents.

No need to over-dramatize the situation by refusing to vegetables and herbs because of fear of nitrates. In fact, plants without nitrate does not happen. Even those that are grown on their own garden, to some extent contain nitrates, getting them out of the soil. When nitrates and nitrites enter the body in small amounts, it does not bring any harm to man. Moreover, some scholars have argued that small doses of nitrates and nitrites as trace elements necessary for normal functioning of the human body.

Sometimes the stores indicated that the products without nitrates and nitrites. In this case, means that they have been grown in compliance with all technological norms, in the absence of violations of the technology to make nitrogen fertilizers, and therefore contain very low, safe for the person the amount of nitrates and nitrites. Allowable rate is 0.3-0.4 g nitrate and nitrite per kilogram of food.

When buying fruits and vegetables, you can use a special indicator paper or devices that can help you determine the level of nitrates and nitrites.

It is useful to adopt a rule inspect fruits and vegetables - if the fruits are very large, then most likely they have been grown using large amounts of fertilizer. Often these fruits and vegetables are much cheaper than usual. It is best to abandon their use.

Plants such as tomatoes, onions, grapes, eggplants, relatively little accumulated harmful substances. Therefore, they can buy without any worries.

When buying a watermelon should pay attention to the veins. If a slice of watermelon yellow streaks and yellowish flesh visible condensation, it means that a high content of nitrites and nitrates. The acquisition of watermelon in this case should be abandoned. When buying carrots should pay attention to the core. If a slice of carrot core whitish color, do not buy it.

If plants were gathered in close proximity to a busy highway, they will inevitably contain various toxic substances such as dioxin, lead, and many others These toxic substances emit machinery engines with the exhaust gases. If a field or garden, which had grown fruits and vegetables, is closer than 70 meters to the highway, they are very dangerous to use.

It must be remembered and that nitrites as preservatives used in the manufacture of canned meat and sausages. That is why one should, as you can rarely buy ready-made canned meat, frankfurters, sausages.

In the cultivation of various plants used in agriculture pesticides. These substances help to protect plants from pests, weeds and diseases. Pesticides inevitably accumulate in plants, so they can get into the human body. This is highly undesirable.

There organophosphate, organochlorine, organomercury pesticides.

Already from the title, it is clear what lies at their base. All these substances are toxic to the human body, and even more so for the body, weakened by diabetes. Pesticides can cause acute poisoning, which causes such symptoms as weakness, fatigue, dizziness, headache.

Pesticide poisoning can be chronic, which will inevitably lead to inflammation of the stomach lining, inflammation of the liver, inflammation of the respiratory system, the development of allergies. To protect yourself from pesticides, not to buy vegetables, fruits and herbs to unauthorized markets where there is no control over the products.

Gives good results and a simple tap water. Berries, herbs, fruits should be washed thoroughly under running water. Thus, it is possible to remove up to 60% of the pesticides.

Very good results are obtained by removing the skin, leaves, remove the veins from fruits and vegetables. If you use apples, pears, bananas, melons, peaches, oranges, lemons and other citrus fruits is desirable to remove the peel. It - the highest concentration of harmful substances.

Any heat treatment reduces the content of pesticides in several times. This may be a decoction, stewing, roasting. You can also use the soaking water, which we discussed above. Of course, fruits, berries, vegetables and herbs grown in their own garden, it is preferable, because it is absolutely safe for humans.