Diabetic Cure - The No Glucose, No Insulin Diabetic Remedy

Diabetes is in no way an infectious disease, yet the growing trend in statistics manifests that diabetes is spreading out globally as if it is an infectious disease.

The next decade's projection is that statistics will grow even bigger because those who are currently afflicted will be passing on the disease to their descendants as genetic deficiency. Diabetic cure if any is urgently needed to stop the increasing growth of these statistics.

The root causes have been previously established as mainly due to the inability of the insulin hormones to help in the absorption of glucose as a body nutrient. The pancreas works doubly hard to give out fresh supply of insulin as an automatic response to the rising blood sugar level.

However, the insulin hormones cannot keep up with the rate by which the pancreas produces and the resiliency by which the cells deflect the glucose substance. Diabetes type 1 takes place and finding a diabetic cure is surely a matter of urgency.

Social and environmental factors are now great contributors especially in the cases of children who have developed insulin-resistant cells due to improper diet and a sedentary lifestyle, leading to obesity.

However, majority of these children acquired their diabetes from at least one parent who was passed down with this affliction coming from several generations. Causes have been established but the diabetic cure remains elusive.

There are records however to prove that diabetes has been cured but not as a result of the $51 million worth of research granted to the American Diabetes Association.

The Proven Natural Diabetes Cure

As early as 1999, a 52-year old family doctor in Lawrence, Kansas, treated type 2 diabetic patients with an approach already popular during the depression era and with proven track record of success. The doctor's patients didn't stay sick with diabetes affliction.

The doctor's first line of cure was by totally eliminating carbohydrates from her patient's diet. In a general context, the doctor's diabetic cure bordered on reversing all the symptoms of type 2 diabetes. As one believer described it, it was only a matter of clearing out the refrigerator of all possible sources of glucose.

This may be an exaggeration but the point of the matter is that the pancreas is instigated to produce great amounts of insulin in response to the amounts of glucose present in the body.

This being the case, cells that are insulin resistant will not produce much significance in as much as there isn't a great amount of glucose to contend with. A little infusion is all that will be needed to raise the blood sugar level to normal.

The good doctor's treatment has not gained support from the American Diabetes Association despite the $51M research they have conducted since 2005. The treatment is so pure and simple, the diabetes sufferer who can't seem to find the right diabetic cure, can consider this as a way of managing his diabetes with the help of his physician and/or dietitian.

Hence, if this natural diabetic cure works, you're as good as cured.

Organic Diabetic Cure - A To Do List For Curing Diabetes

Many people are looking for a natural diabetic cure but are frustrated with the oodles of information on the internet. One website tells you to eat carbohydrates and another website tells you to stay away from carbohydrates. Who should you believe for curing diabetes?

Only recently has natural health research discovered some interesting studies about curing diabetes. If you suffer from diabetes, this may be the most important information you read all year.

By the end of this article, you will know 7 ways to start curing diabetes.

1. Watch the show "Biggest Loser" which encourages severely obese people to become healthy again! After recently watching the final episode, I was encouraged to see that one of the contestants cured diabetes naturally by eating healthy and losing weight. Start your alternative treatment by eating lean foods that are not processed. Foods that are whole (fruits, vegetables, and nuts) are a great option.

2. Exercising is so important in our 21st century lifestyle. Most of us have jobs where we sit on a chair all day. You should aim for at least 30-45 minutes of exercise daily. Did you know that 80% of people who combine dieting and exercising will almost immediately lose weight? This will help normalize blood sugar levels and eventually reverse diabetes.

3. Avoid carbohydrates which can be in many of the grains, breads and cereals you eat. You should drastically decrease you carbohydrate intake. Carbs turn into sugars after the body processes them.

4. Dark green leafy vegetables, nuts, avocados and whole grains are an excellent source of magnesium. Magnesium is known to lower blood pressure, relax the heart muscles, and control homocysteine which is known to trigger heart disease and diabetes.

5. Eating protein is important to repair cells' membranes. The cell membrane is extremely important to repair because it is responsible to eventually accepting insulin into the cell. Thus, diabetes will eventually be cured. Protein can be found in lean meats, dairy, nuts and supplementing shakes.

6. New studies also show that using cinnamon in your diet can also be beneficial. Cinnamon reduces blood glucose levels, triglycerides and LDL cholesterol which can all add up to a great natural diabetic cure. You should supplement 500 mg of cinnamon extract daily.

7. Finally, drinking water throughout the day can benefit your body in numerous ways. Water helps the body run more efficiently and also helps regenerate healthier cells which are not pre-diabetic. Men should drink about 125 ounces of water daily and women should get 100 ounces daily.

Techniques to Cure Diabetes Naturally Without Injecting Insulin

We can easily get rid of diabetes by following a balanced diet. The importance of healthy diet is very essential to control the blood sugar level in our body. We mostly see obese people suffering from this problem. The excess fats in their body causes this ailment and in order to prevent themselves from this disease. They should go for diabetic cure which includes shedding those extra pounds of weight . It can be only possible with a proper food intake and a regular exercise. Reducing extra pounds from body can be the effective tips to cure diabetes without injecting Insulin.

Regular exercise will keep high metabolism in their body hence they will lose lots of calories. Eating low fat diet will keep them healthy and sugar free can be one of the best diabetic cure.

There are three types of diabetes. They are Type 1, Type 2 and Gestational. Among them, the most common form is type 2. Surveys say that around 95 percent people in US suffers from this disease. It's very common due to excess intake of junk food and their irregular habits. Avoiding junk food can be the best diabetic cure. There are numerous effective tips to cure diabetes without injecting insulin.

Tips To Cure Diabetes Naturally Without Injecting Insulin

Exercise and diet is the best tips to cure diabetes without injecting Insulin. The change in your lifestyle for good can help you a lot as it can prove to be the best diabetic cure. A diabetic should usually take 1500-1800 calories in order to lose weight and maintain the sugar level in the body. The dynamics of carbohydrates counting plays a vital role in controlling the blood sugar level. It can prove to be the best tips to treat diabetes.

One should eat lots of green vegetables and fruits as they contain high fibers, which helps in the reduction of glucose level from the body. One should totally avoid red meat from their diet.It can be the best tips to help diabetes naturally. Injecting insulin is not a safe diabetic cure as it can lead to certain side effects in the body.

It is always advisable to make a diet list according to calories from a doctor or a dietitian. It will make your work much easier. You can have fishes, soy and poultry meat. While in fruits, you can have apples, which can be considered as best diabetic treatment .These can be the best tips to diabetes naturally without injecting insulin.

An Effective Diabetic Meal Plan Can Help Fight Diabetes

It is unquestionable that a person having blood sugar problems (high blood sugar or low blood sugar) depends on several factors. To beat a destructive thing, it is essential to draft a constructive plan. Thinking in this angle, it is reiterated that a good diabetic meal plan can convincingly work well to beat diabetes. Such a plan designed by a professional dietitian is highly recommended. Lifestyle is another thing which finds a significant place in any diabetic meal plan. It is important that the meal plan for diabetes should not be prepared on a run through discussion. Drafting such a plan needs a thorough diagnosis of the body's condition. It is the main concern of the physician to appraise the percentage of the damage caused to the body with diabetes.

Plan of diabetes foods

When we get into the discussion of a diabetic food list, there are many things to consider and understand well. But many people have a short notion about a meal plan to beat diabetes. Some people prone to diabetes claim in a short sense that they are strictly following diabetic meal plan. They are having a false confidence of overcoming hyperglycemia or hypoglycemia just with restricted foods. There are many things to take into positive consideration. Since a meal plan is broader in sense, a diabetic should avail the guidance properly to fight diabetes.

Plus points of a quality meal plan:

• It is positively self guiding. There are the descriptions of what causes diabetes and what are the various symptoms of diabetes.

• A diabetic meal plan is benefiting not only people who have diabetes but also those who have not been affected with diabetes. It is claimed so because the plan includes an additional focus on cautionary prevention of diabetes at any stage.

• A good meal plan is not with a bare list of foods to eat for diabetics. A parallel list of foods to avoid for diabetics also finds place in the content of the plan. In addition to these two lists of foods, various food habits will also be discussed in detail.

• In medical terminology, diabetes is not a disease to cure completely. It is indeed a disorder in the functioning of the internal parts of the body. It can also be recognized as malfunctioning of the metabolism. However, diabetes can be managed with medication and lifestyle. It is believed that a good diabetic meal plan is designed with tips for managing diabetes.

Be sure, a diabetic will be highly benefitted with a diabetes foods list on hand to fight diabetes. Without proper guidance on what to eat and what to avoid eating, the affected person with abnormal blood sugar cannot save him from life risks.

Diabetes Meals Plans - What Should You Eat If You Suffer From Diabetes?

A diabetes meal plans is a guide that tells you how much and what categories of food you can choose to eat at meals and break times. A meal plan for diabetes is supposed to fit into your schedule and eating habits to help you keep your blood sugar levels on an even keel during the day.

The idea that you must completely avoid sugar in your diabetes meal plans is one of the most important misapprehensions in diabetes management. Though the meal plan for diabetes is designed to help you manage your diabetes, the professionals say the plan should be flexible, rather than rigid, to keep your blood glucose in good control and also fit your way of life.

The diabetes meal plans is intended to be healthy for diabetics and is reduced carbohydrate, reduced fat, and reduced sodium. A crucial part of the well working diabetic meal plans is to follow a healthy diabetic diet, reducing any farther issues like stroke or heart problems.

The diabetes meal plans isn't much different to the way everybody should eat. The focus of the meal plan for diabetes is healthy meals targeted on whole foods like grains, lean proteins and healthy fats with the inclusion of herbs and spices like cinnamon, to provide delectable taste and added health benefits.

Which diabetes meal plans is right for you? There's no one meal plan for diabetes that works for everyone ; much of it really is primarily based on age, sex, activity level, weight, and food preferences. There are several methods to help to keep a meal plan for diabetes ; some are food pyramids, food classification, exchange lists and carbohydrate counting. With planning, you can follow your guide for diabetes when you eat at cafes.

If you are showing signs of diabetes and experiencing signs of this disease, then you should follow a meal plan for diabetes. A structured diabetes meal plans is a vital part of your diabetes control as is spotting when you need to drink or eat in order to balance the effects of tablets or insulin on your blood glucose level.

Diabetes - A Modern Therapy!

When a doctor diagnosed diabetes, it usually needs to comfort the patient. But there is no reason for pessimism. Diabetes is a dangerous disease, but they can be treated in most cases very well.

First, it is important to know exactly which disease is present. A type-1 diabetics must be prepared to rely on the rest of life to be insulin preparations. This is for many patients, a dramatic turning point. But after a while, the victims used to it.

A type-2 diabetes is much more difficult to treat because the patient must often change his entire life. In a diabetes treatment in the early stages only in exceptional cases medications used. It is much more effective when the patient reduces the existing usually overweight. Therefore it is necessary for sports and nutrition switch.

A diabetes treatment requires patient cooperation. She is otherwise unsuccessful. But it is a fallacy, if an interested party believes that modern medicine would be sufficient alone. A diabetes can with the current medical knowledge can not be cured.

If people have cultivated many years or decades an unhealthy lifestyle, this can not be changed in a few weeks. It takes months, sometimes years, to a sustainable conversion succeeded. This requires the absolute will of the patient. Therefore, it can also be a part of a psychological support diabetes treatment.

What's new in the treatment of type 1 diabetes

If one considers that the treatment of type 1 diabetes became possible in 1922 with the discovery of insulin, one must admit that for many new features have greatly increased the quality of life of these patients ( eg 1 meter in 1969, portable pumps late 70s, the insulin analogues and continuous measurement of blood glucose in the late 90s ...
 

New level of insulin.

The first inhalable insulin appeared on the market in 2005, intended primarily for people with type and type 1 diabetic adults. Because of its high price, lack of long-term studies on possible effects on the airways, difficulty of a precise dosage, this insulin has been very little interest and was withdrawn in in 2008. In late November 2007, the first oral insulin spray form has been marketed in Equador. Probably intended for people with type 2 diabetes or prediabetes, it has not yet been approved in Europe and long-term studies are not yet available. United States, a study began in 2006 trying to treat patients at high risk of diabetes with insulin capsules. The goal is to see if we can delay or prevent the onset of disease by administering insulin by the digestive tract to create a kind of tolerance and thus calm the immune system. Prevention of type 1 diabetes is not so far, the results of this study (in a few years) are eagerly awaited. However, it has already been proven that these insulin capsules will not be used to treat diabetes already said.

Vaccination

A hot topic in diabetes research for GAD65 vaccination. The GAD65 protein is beta cells. Diabetic type 1 there are antibodies that destroy certain proteins, often also GAD65. The idea of this vaccine is to keep as long as possible the production of insulin by beta cells by deflecting action of immune antibodies to the injected proteins. First results seem promising in Sweden and large-scale studies are planned in Europe in 2008. The Swedish study suggests that most are vaccinated sooner a person in whom diabetes has just been declared, the more we come to preserve beta cell.

Prevention (of disease onset)

These measures include also studies of oral insulin (see "insulin") In Europe, several countries are currently involved in "the study pre Point", in which we try to prevent the formation of destructive beta-cell antibodies by administration of insulin as a spray or powder in the diet of children at high risk of diabetes (which could have a hypoglycemic effect in those already diabetic). The hypothesis is that insulin may stimulate the immune system by inducing an immune response designed to protect cells against beta-destruction. The study has just begun, but similar studies in the U.S. seem promising.

Transplants

We are in the hot topic of stem cell therapy. The goal of research in the field of transplantation is a cure for diabetes by transplanting functional beta cells, the major problem is however the lack of organ donors. In recent years, a new method was developed: the culture of Beta cells from stem cells (= cells that can renew themselves indefinitely and give specialized cells by cell differentiation). We distinguish embryonic stem cells and adult stem cells. Studies in mice have allowed to grow insulin-producing cells from embryonic or adult stem cells which, transplanted into diabetic mice, have improved even normalization of blood glucose. Unfortunately, these experiences are only a stage animal and research on human embryonic cells still raises many ethical issues well justified. Similarly, studies of autologous stem cells (in Germany, Brazil) are very interesting. In this case, is transplanted to the patient's own stem cells that will be responsible for insulin production and replace insulin injections. The initial results seem positive, but research is still needed.

Measurement of continuous glucose

In 2006, the techniques of continuous glucose measurement have become increasingly efficient and allow the patient to directly read glucose values measured
in the subcutaneous tissue that appear on the device using a transmitter without cable, whose size has also fallen sharply, which enhances comfort, especially in children. The sensors can remain in place 3-6 days. Recently, the RealTime Paradigm insulin pump was also placed on the market in Luxembourg, (not yet repaid). This pump is combined with a continuous glucose monitor, the patient must wear two subcutaneous catheters (one for the administration of insulin to a glucose sensor). He can see glucose values on the pump which also warns if glucose is trying to climb or fall and emits alarm signals in case of hypo-or hyperglycemia. All these study results and progress in research lead us slowly towards the dream of a cure diabetes, but the road is still long! However, we can also see that all these small steps since the discovery of insulin allows diabetics to continuously improve their quality of life.

Therapeutic Diet for Diabetes

Purpose of the diet: the creation of conditions conducive to the normalization of carbohydrate metabolism, determination of patient tolerance to carbohydrates.

General characteristics of the diet: a diet with reduced fat (mostly animal), and carbohydrates from the physiological norm of vitamins and minerals. In the diet include a variety of foods. Eliminate sugar, jam, confectionery and other foods containing a lot of sugar. Sugar substitute xylitol, sorbitol, aspartame. Main dishes are prepared in boiled or baked form. Eating 5-6 times.

The chemical composition of the diet: protein, 100 g, 70-80 g fat (of which 25 g of plant), 300 g carbohydrates mainly due to the complex and simple carbohydrates exclude or severely limit, calories 2300 kcal, 0.3 mg of retinol, carotene, 12 mg, 1.5 mg of thiamine, riboflavin 2.1 mg, 18 mg nicotinic acid, ascorbic acid, 100 mg sodium 3.7 g, 4 g of potassium, calcium, 0.8 g, 1.3 g of phosphorus, iron, 15 mg. Free liquid 1.5 liters.

Featured products and dishes:
- Predominantly black bread 300 g;
- Mostly vegetarian soups;
- Meat and poultry, beef, veal, chicken, turkey boiled;
- Fish, lean boiled in;
- Vegetables as a side dish and leaf greens, cabbage, cauliflower, lettuce, cucumbers, tomatoes, zucchini, potatoes, raw, boiled and baked;
- Cereals and pasta limit;
- Milk and dairy products - milk, cheese, yogurt, buttermilk, cheese, sour cream are limited;
- Fruits, berries - sour and sweet and sour varieties, Antonov apples, cranberries, red currants - 200 grams per day;
- Drinks - tea, coffee, rather weak, the juice of sour grapes varieties.

In diabetes mellitus in obese patients with clinical nutrition coincides with the treatment of obese patients. Patients with insulin-dependent diabetes mellitus who are receiving large doses of insulin prescribed diet, which is close in chemical composition to the management table.

The basic amount of carbohydrate should be given to the first breakfast and lunch. Before these meals administered insulin. With the introduction of insulin before dinner, a meal should be left for the night to prevent the possible hypoglycemic reactions.

With the threat of diabetic coma, the amount of fat in the diet should be reduced to 30 g, protein content to 50 g carbohydrates should not exceed 300 g at the same time increasing the dose of insulin.

What You Should Know About Hemorrhoids Diabetes?

Hemorrhoids - it's painful and embarrassing, in the head immediately comes to terrible words medicine and proctology. Such a stereotype popular in society, if you are sick with diabetes, in addition to the above problems, there is another - treatment of hemorrhoids complicated by the fact that conventional medicine may be contraindicated.

As a rule, hemorrhoids in diabetics is caused by sedentary lifestyles. Develop complications of the disease, the body breaks down the blood circulation, loss of sensitivity, tissue regeneration is difficult - this is the person the clinical picture, which often results in anal fissures and hemorrhoids.

But do not despair, any problem should be solved. And if you do not try and put up with pain and discomfort - you are a penny price.

So, to begin, let us remember the following tips to prevent and treat hemorrhoids:

Eat plenty of fiber and vegetables. As you know, the diet in diabetes suggests the presence of these products in their diet, so consider the first step to recovery you've already done.

Avoid strain during bowel movements and do not sit on the toilet for a long time. The emerging strain could remove the cold pack, be sure to try it.

A warm (not hot!) Bath for 15 minutes removes unpleasant symptoms. Add the water a little bitter salt (magnesium sulfate). Such sitting baths several times a day, a positive impact on your feelings.

Avoid any food that causes discomfort and aggravates hemorrhoids.

In diabetes very carefully think about and increasing the sugar drugs such as ephedrine, phenylephrine, adrenaline or hydrocortisone.

Drugs that will help with hemorrhoids in patients with diabetes:

Anesthetics. They relieve burning and pain, are applied topically to the prianalnoy area where the nerve endings are concentrated. For the active ingredients of these drugs include benzocaine, lidocaine, pramoxine, tetracaine.

Astringent preparations dried hemorrhoids and soothe burning, but no easier pain. Gammamelis recommended for outdoor use, it is well eliminates discomfort, relieves irritation and itching. A good astringent is zinc oxide and calamine.

Disinfectants (protective agent). They form a physical barrier on the skin and mucosa, thereby relieving inflammation and slowing down the process of dehydration. A good tool is cocoa butter, aluminum hydroxide, an aqueous solution of glycerin, lanolin, mineral oil and calamine.

In any case, consult your doctor for advice. Gemmoroy in diabetes, as well as any other disease, can lead to irreversible consequences, do not risk!

Know the correct treatment of haemorrhoids win drugs, do not delay with this!

Tooth and Gum Disease in Diabetes - Do Not Run your Mouth!

Very often the complications of diabetes develop in the mouth. There is a risk of diseases of the teeth and gums because of the high concentration of glucose in the blood, and as you know, sweet Wednesday is ideal for infection.

The body is weakened, and the fight against these infections is difficult. Let us remember and about frequent dry mouth, which usually leads to problems with the gums, and then to decay.

As a result, suffers from the mouth, you can not normally eat and sleep, and a terrible smell of infection kills the natural need - communicating with people.

How do I determine if I have gum disease?

    The constant bleeding gums, especially when brushing your teeth.
    The teeth become loose and begin to crumble.
    Degeneration of the gums bares his teeth, they look longer than they were before.
    Bad taste in your mouth.
    Bad breath.

How to fight tooth and gum disease to the patient with diabetes?

    Constantly monitor the normal level of glucose in the blood.
    The dentist should be your friend - visit it as often as possible, at least 4 times a year.
    Brush your teeth at least 2 times a day
    Use the paste to antigingivitnym effect, it will get rid of gum disease.
    Use a paste with triclosan, which has antibacterial and anti-inflammatory properties.
    Use interdental device (toothpicks and dental floss).
    Brush your tongue at least once a day.
    If you are using medications that cause dry mouth - drink water, suck on ice, use sugar-free gum.
    Patients in the prevention of tooth in need of 3-day treatment with antibiotics.

If you have lost your teeth, be sure to enjoy a prosthesis. When there is nothing to chew food, neither of which health can be no question. Find special clinics dealing with prosthetics.

Before you choose a medical facility, pay attention to reviews of prosthetics - if people speak out positively and advise, so good people working here, and they will help you. Just do not forget to notify the dentist of their disease before treatment.

Stay healthy, keep the diet in diabetes, keep gums and teeth, because a beautiful smile - a pledge of confidence. And confidence, trust, so necessary in diabetes mellitus.

By the way! Now the alignment of the teeth without braces became available to all. Advice and guidance on this procedure, you can always get in the dental clinic.

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.

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.

Physiotherapy for Patients With Diabetes

Physical Therapy (from the Greek. Physis - in kind and therapy) is a branch of medicine that uses the physiological effects of natural (water, air, solar heat and light) and artificial (electric current, magnetic field, etc.) of physical factors in the treatment of certain diseases .

In the treatment of diabetes using a number of physiotherapy techniques. Very often, patients are electrophoresis. This method is based on the exposure of the body by direct current and medicinal materials. With the current medicines into the body through mucous membranes or skin. When diabetes is used electrophoresis of zinc, copper electrophoresis, electrophoresis of potassium. Electrophoresis of zinc has beneficial effects on the state of the islets of Langerhans which produce insulin. Electrophoresis of copper improves the reduction-oxidation, reduces blood sugar levels. Diabetes is often accompanied by polyuria, that is, the increased amount of urine separation. In this regard, the body loses potassium. That is why diabetes often prescribe electrophoresis of potassium to make up for the missing trace mineral.

In addition, the use of magnesium electrophoresis in the general procedure for the neck area or on Shcherbak, as well as on the liver area. Magnesium is very important for the organism of the patient with diabetes mellitus. This trace mineral is involved in redox processes, lowers cholesterol. Electrophoresis of the neck of calcium reduces blood glucose levels. Electrophoresis of nicotinic acid on the epigastrium improves the function of the pancreas. In diabetes often occur microangiopathy of the lower extremities, which are accompanied by pain. In this case, patients administered iodine-novocaine-electrophoresis.
 

This method is also used in the treatment of hypertonicity of the vessels. When angiopathies of the lower limbs with peripheral neuropathy are often assigned electrophoresis of 5% sodium thiosulfate. He entered with a negative pole to the region of gastrocnemius muscle. When angiopathies of the lower extremities is also assigned to electrophoresis with novocaine lumbar krestuovuyu area. It promotes the expansion of lower extremities, thereby decreasing pain. In the treatment of diabetic retinopathy is widely used medicinal electrophoresis. It has a resolving, anti-inflammatory, anti-sclerotic action. If you are experiencing bleeding, the use of heparin electrophoresis. If a patient suffers from multiple sclerosis retinal vessels, using electrophoresis, a solution of potassium iodide. When angiospasm, degenerative changes of the retina using electrophoresis of nicotinic acid, a mixture of aloe with vitamin E, S. In the complex treatment of diabetes used a beneficial effect of magnetic field on the metabolic processes in the body. That is why diabetics assigned to the magnet projection area of the pancreas. Usually the course of treatment is 12 sessions. At the same after the first 3-5 sessions a decrease in blood sugar.

Magnetic therapy is used in diabetic neuropathy and diabetic foot. The magnetic field has angioprotective, analgesic, immunomodulating, trophico-regulatory effects. After an increase in the magneto speed of about nerve impulse along the nerve fibers and peripheral blood flow. Markedly reduced pain in the extremities, less concerned about patients cramps and paresthesia, increased muscular activity, there are beneficial changes in the sensitivity of the foot.
 

For the treatment of neuropathies, used inductothermy angiopathies of the lower extremities. Inductothermy - a method of electrotherapy, which uses a magnetic field of high frequency. The duration of a procedure - 15 - 20 min. Sessions are held either every day or every other day. The course of treatment consists of 10-12 procedures. The impact of an alternating magnetic field significantly improves blood and lymph circulation, therefore, is a very effective method of treatment. Also effective in hyperbaric oxygen therapy. This treatment with oxygen under high pressure. This method is capable of eliminating all forms of hypoxia that occur in diabetes. That is why the hyperbaric oxygen therapy is a medical complex with various forms of diabetes. Observations show that after the second session, patients feel much better. The general course of treatment consists of 10-12 sessions. Each session lasts 40-60 minutes. After about their management of patients are able to significantly reduce the dose of insulin and other medications. When diabetes is usually oxygen-reduced function of the blood. Therefore, there is oxygen starvation of tissues and organs.
Oxygen treatment reduces hypoxia in various organs and tissues, thus improving vision and hearing, as well as blood circulation in the limbs. It is also important that as a result of the procedures activated the activity of cells of the pancreas. Keep in mind that hyperbaric oxygen therapy is contraindicated in those suffering from claustrophobia (fear of closed spaces), and epilepsy.
 

Hyperbaric oxygen therapy as a form of oxygen treatment includes the use of oxygen inside the foam. This procedure is very useful for obesity, combined with diabetes mellitus. Ingestion of oxygen foam helps to reduce body weight. This is based on the fact that the foam expands the stomach, making the patient feel satiety and eating less. Foam take 2 - 3 times a day for 1 hour before meals. Oxygen has beneficial effects on oxidative processes in the body. Oxygen foam is made from infusions and decoctions of herbs with the addition of whipped egg whites. The finished foam should foam, passing through her oxygen. This is done through a special apparatus. The course of treatment varies from 3 to 6 months. During treatment, patients must be under medical supervision.
 

When using acupuncture neuropathy. Special needles are inserted into the biologically active points. Usually carried out 2 - 3 courses of treatment, each of which includes several sessions. The result of treatment is improvement of general condition. And most importantly, significantly improved nerve conduction, increases the sensitivity of the lower limbs, decrease pain. In addition to using acupressure, electroacupuncture and laser acupuncture.
 

In the treatment of diabetes is used and plasmapheresis. The essence of this method is that the plasma is removed and replaced with the patient's blood plasma substitutes. Such treatment is usually given in renal failure and in septic complications. Very effective in treatment of diabetes is ozone therapy. The use of medical ozone increases the permeability of cell membranes to glucose. Can achieve this effect by stimulating the pentose phosphate shunt, and aerobic glycolysis.

As a result, glucose enters the tissue better, decreases hyperglycemia. Carried out the oxidation of glucose to the final products. Ozone affects the exchange of glucose in erythrocytes. Tissues receive more oxygen, hypoxia is eliminated. Ozone therapy can prevent development of pathological processes such as neuropathy, arthropathy, angiopathy. In addition, ozone has immunomodulatory effects. It is very important to diabetes type 1, because it increases the tendency to chronic infections and inflammation of the skin against the backdrop of a weakened immune system. The basis of ozone therapy - intravenous administration of OS (ozonized physiological solution). Procedures are carried out through the day. Total course of treatment is 10-14 procedures. Can also be rectal administration of ozone.
 

During treatment, necessarily exercise control over blood glucose levels. If necessary, adjusted dose glucose-lowering drugs, the ozone-oxygen mixture because it has a hypoglycemic effect. Often in the course of therapy decreases the amount of glucose-lowering drugs.

Ozone treatment significantly improves performance, normalizes sleep. The general condition of the patient improves. There was also a reduction in blood sugar levels, increases immunity. Repeated treatments are necessary after 3 - 6 months.

In severe forms of diabetes treatment is carried out with great care. Can suddenly worsen, because the antioxidant defense system is broken.

For physiotherapy and hydrotherapy methods include, or hydrotherapy. The essence of this method - in the external application of water. It could be pouring, wraps, shower, bath, wiping, etc. Various water treatment stimulates blood flow and lymph flow.

As a result, water treatment increases lymph and blood flow to a particular area, improved nutrition and respiration of cells in this area. This is beneficial for tissue repair and for the whole body.

Therapeutic effects of water based on the fact that by warming or cooling. Hot water dilates blood vessels, thus increasing blood flow and lymph flow in a certain place. Cold water, however, leads to a narrowing of veins and arteries. On this site reduces the amount of blood and lymph. The alternation of hot and cold water can bring fresh portions of oxygen and nutrients in a particular area of the body. Hydrotherapy is used in the complex sanatorium treatment, as well as in everyday life. Every patient with diabetes may use a contrast shower, alternating hot and cold water. It has beneficial effects on the nervous system, blood circulation, has a tonic and invigorating action.
 

Some caution should be exercised in a decreased sensitivity of limbs, which often occurs in patients with diabetes mellitus. Using excessively hot water can cause burns because the patient does not always feel right temperature. It is undesirable to use and extremely cold water, so as not to catch cold. And the rest of hydrotherapy - an effective, affordable and secure method. However, preliminary medical consultation is still necessary.

Balneotherapy (from Latin. Balnem - bath, bathing) for at least an effective treatment for patients with diabetes. This method is based on the treatment of natural or artificially prepared mineral waters. Balneotherapy is used in complex sanatorium treatment. For more information on it is written in the thematic section of the sanitary-health resort treatment on an information portal on vital diabetunet.ru.

Modern Principles of Treatment of Type 2 Diabetes

The term "diabetes" refers to metabolic disorders of different etiology, characterized by the development of chronic hyperglycemia, accompanied by changes in carbohydrate, fat and protein metabolism that is the result of a defect in insulin action and secretion. Diabetes leads to defeat, dysfunction and the development of failure of various organs and systems, especially the eyes, kidneys, nerves, heart and blood vessels.

Type 2 diabetes - the most widespread form of the disease, which is characterized by impaired insulin action (insulin resistance) and insulin secretion. Type 2 diabetes can develop at any age but most often after age 40. Start gradually, often against a background of excess body weight. Symptoms of diabetes are absent or weakly expressed. This may be due to slow disease progression and as a result of adaptation of patients to long-existing hyperglycemia. Determined sufficient level of C-peptide, autoantibodies to b-cells producing insulin are lacking. Morphologically in the debut of type 2 diabetes revealed normal dimensions of the pancreas, can be marked hypertrophy of the b-cells. b-cells contain a large number of secretory granules. In contrast, type I diabetes is an autoimmune disease where there is an absolute insulin deficiency due to destruction of b-cells. Leave a comment

Figure 1. Pathogenesis of type 2 diabetes

According to modern concepts in the pathogenesis of type 2 diabetes plays a key role in insulin secretion violation of b-cells. Revealed signs of peripheral glucose utilization. Schematically, the pathogenesis of type 2 diabetes is presented in Fig. 1. Leave a comment

Violation of insulin synthesis may occur out of sequence of amino acids in the molecule of insulin and proinsulin conversion to insulin. In both cases, the hormone produced will have low biological activity, leading to the development of hyperglycemia. Insulin secretion may be impaired due to diseases of b-cells with inadequate prenatal and postnatal nutrition, and long existing glyukozotoksichnosti, which supports the secretory defect in insulin secretion, as well as a result of genetic defects in the mechanism of secretion. Leave a comment

Peripheral insulin resistance appears a violation of glucose uptake in peripheral tissues, primarily the liver tissue, muscle and adipose tissue. Most important in her development are defective insulin receptors (decrease in the number and affinity or affinity to insulin) and glucose transporter pathology. Leave a comment

The number of insulin receptors is reduced in obesity, type 2 diabetes mellitus, acromegaly, disease ItsenkoKushinga, glucocorticoid, taking birth control pills. Leave a comment

For the penetration of glucose into the cell is a necessary condition normal functioning of glucose transporters. Fig. Figure 2 shows glucose transport in adipocyte under the influence of insulin. Insulin binds to a-subunit of the receptor on the cell membrane, which leads to autophosphorylation b-subunit. As a result of momentum transfer within the cell system is activated kinase and glucose transporter translocation occurs GLUT-4 in the cell membrane. This ensures the penetration of glucose into the cell. Glucose moves along the concentration gradient by diffusion, which requires no additional energy. In the kidney inflow of glucose occurs against a concentration gradient and requires energy. It is now known glucose transporter 8. The main isoform of the family are shown in Table 1. Leave a comment

Fig. 2. Insulin action on glucose transport in adipocyte

In recent years, there is enough experimental and clinical evidence that the defects in insulin secretion and the development of peripheral insulin resistance is largely due to violations of genetic control. These data are summarized in Table 2. Leave a comment

Non-drug therapies

The most important goals in the treatment of diabetes are: elimination of symptoms, optimal metabolic control, prevention of acute and chronic complications, achieving the highest possible quality of life and accessibility for patients.

Goals are achieved with the basic principles of treatment are crucial for patients with diabetes of both types: diabetic diet, dosed exercise, training and self-control.

If in type 2 diabetes as monotherapy diet is ineffective, requires the appointment of saharoponizhayuschih oral medications. In diabetes type 1 is always assigned to insulin.

Diet therapy for type 2 diabetes must meet the following requirements: the exclusion of refined carbohydrates (sugar, honey, jam, etc.), low intake of saturated fats and total fat content should not exceed 30-35% of daily energy needs; carbohydrates should provide 50-60% protein to 15% calorie daily diet, we recommend the preemptive use of complex carbohydrates and foods rich in soluble fiber, to produce menus use special tables, in which all foods are divided into groups: food,


that can not be limited, the products that must be considered, and products that should be deleted; meals preferably distributed evenly throughout the day, allowed to use beskaloriynyh sweeteners, if not contraindicated, is recommended not to restrict fluid intake, to limit or eliminate alcohol intake.

Very relevant is the question of compensation criteria for type 2 diabetes. According to the recommendations of the European Group Policy diabetes [2], the risk of complications is estimated, as shown in Table 3.

In addition to the state of carbohydrate metabolism, one must also consider the degree of lipid metabolism and blood pressure levels, because hyperglycemia after these factors are essential in the development of cardiovascular complications of diabetes. Leave a comment

Tableted products saharoponizhayuschie

Treatment of type 2 diabetes always begin with the appointment of diet and dosed physical load. It should also explain to the patient the need to conduct self-monitoring and teach it at home using test strips (glucose in the blood and urine). In those cases where it proves to be ineffective, prescribe tablets saharoponi distorting drugs. Use three groups of drugs: inhibitors of a-glucosidase sulfonilamidy and biguanides. Leave a comment

Inhibitors of a-glucosidases (acarbose) reduce glucose absorption in the intestine and are effective in the early stages of the disease. Leave a comment

More commonly used sulfonylureas, which are divided into samples for 1 st and 2 nd generation. Samples for 1 st generation are less effective and is now in our country are not used. Drugs 2 nd generation is active sekretogeny their saharoponizhayuschy effect appears at a daily dose of 50,100 times smaller than that of drugs a second generation. The most commonly used now are gliclazide, glibenclamide, glipizide, glikvidon.

Sulfonylureas stimulate insulin secretion b-cells in the pancreas. Initially, the drug is binding to receptors on the surface of b-cells is closely associated with the ATP-dependent K + channels. Then, the closing of these channels and depolymerization of the membrane. The discovery followed by calcium channel provides a flow of calcium ions inside the b-cells and stimulation of insulin secretion. It should be borne in mind that the appointment of a number of drugs can be marked as a strengthening and weakening of the sulfonylureas. Drugs to lower their operation are as follows: thiazide diuretics, b-blockers, corticosteroids, indomethacin, isoniazid, niacin, calcium antagonists.

Potentiate the action of these drugs: salicylates, sulfonamides, pyrazolone derivatives,

clofibrate, monoamine oxidase inhibitors, anticoagulants, alcohol. Leave a comment

Treatment of derivatives of sulfonylurea is contraindicated in: type 1 diabetes or secondary (pancreatic) diabetes mellitus, pregnancy and lactation (because of teratogenicity), surgery (larger operations), severe infections, trauma, allergy to sulfonylurea drugs or similar drugs history, there is a risk of severe hypoglycemia. Leave a comment

Group tablets saharoponizhayuschih biguanide drugs are now presented with metformin. In contrast to the above-mentioned drugs biguanides do not increase insulin secretion. Saharoponizhayuschee biguanide effect is seen only in the event that the blood has enough insulin. Biguanides enhance its action on peripheral tissues, reducing insulin resistance. Biguanides increase glucose uptake by muscles and adipose tissue by increasing insulin binding to receptors and increase the activity of GLUT-4. They reduce production of glucose by the liver, glucose absorption in the intestine, increase its utilization, reduce appetite. Their purpose is contraindicated in: renal impairment, hypoxic conditions of any cause (cardiovascular disease, lung disease, anemia, infectious disease), acute complications of diabetes, alcohol abuse, laktatatsidoze history.

Insulinotherapy

In patients with a prolonged course of disease often develop secondary resistance to peroral saharoponizhayuschim drugs. At the onset of type 2 diabetes require insulin 2-3% of patients, and 10-15 years from the onset of the disease in half of patients previous treatment is ineffective and there are indications for insulin therapy. On average, 10-15% of patients with type 2 diabetes each year go on insulin therapy.

Indications for use of insulin in type 2 diabetes are: a temporary increase in insulin requirements, a sharp decrease in insulin secretion, cases of hyperglycemia does not respond to other forms of therapy. Insulin therapy in type 2 diabetes may be temporary or lifelong. Temporary insulin therapy is indicated for: stress, acute illness, the need for surgery, acute infections, stroke, myocardial infarction, pregnancy and lactation. Lifelong insulin therapy is indicated for diabetes mellitus with late autoimmune origin and secondary resistance to saharoponizhayuschim tableted drugs. Leave a comment

Secondary resistance to the tableted product is the result of reducing the weight of b-cells and / or increase insulin resistance. Side effects of insulin therapy in type 2 diabetes are: weight gain, frequent hunger, fluid retention and sodium, the risk of hypoglycemia. In this case, may use different modes of insulin therapy: long-acting insulin at bedtime in combination with diet and daily intake of tablets of drugs; twofold insulin short-and long-acting before breakfast and dinner; tablet combination therapy drugs and insulin, intensive insulin therapy in the basal-bolus regime for Persons younger.

Leave a comment

Intensive insulin therapy involves the introduction of long-acting insulin twice a day (usually before breakfast and before bedtime) and short-acting insulin before each meal. To maintain the compensation of the disease at the level of normoglycemia and glycosuria should be learning and self-control patient. Leave a comment

To facilitate injections use a semi-automatic injectors, syringe pens, which use heat-stable insulin. Have ready a mixture of insulin in which insulin short-and long-acting mixed in factory conditions, which is convenient for patients and reduces the error rate when mixed insulin by the patient. Leave a comment

The most difficult question remains about when to start insulin therapy in type 2 diabetes. It should be addressed individually in each case by analyzing the indications, contraindications, the goals of therapy. Achieving and maintaining a stable compensation of the disease is essential for the prevention and timely treatment of chronic complications of diabetes.

In addition to traditional drugs in recent years in clinical practice is being introduced more and more effective new drugs, many of which have unique properties. Thus, the use of new drugs sulfonylureas daily glimepiride and glipizide steps you can take 1 every day. Proposed and a short-acting drug that restores insulin secretion after a meal, repaglinide. Studied drugs that affect peripheral insulin resistance (group glitazones).

Development of diabetology ensures a high metabolic control of patients with type 2 diabetes, because Doctors have in the arsenal of modern tablet preparations and preparations of insulin, the means of their introduction, the means of self-control training system patients. All of this in clinical practice makes it possible to provide a high quality of life and delay the development of chronic complications of the disease.

Educating Patients with Diabetes Mellitus

In diabetes mellitus (especially type 1 diabetes), the patient must spend life rather complicated treatment, right to expect the necessary amount of insulin which is necessary to introduce to balance effect of food (which is evaluated using a system of "bread units), taking into account the level of blood glucose before meal, the effect of physical activity, comorbidities, etc.

In order to successfully manage their own blood glucose levels, the patient must undergo a special training program "Diabetes School". Usually it is held in the form of group sessions, total duration of at least 20-25 hours of study in type 1 diabetes and at least 15-20 hours of type 2 diabetes.

Such training has been called a structured and fundamentally different from simple conversations with patients (or read them lectures) for those or other topics related to diabetes. For structured learning characteristically follow a specially prepared program, divided into topics and learning steps within these themes. Teaching the next block of the material begins only after the group had learned the previous one. The level of knowledge of patients is monitored by means of questionnaire at the beginning and end of the course. Sufficient attention should be given the practical activity of patients: problem solving ("how to act in a particular case"), development of skills of self-control blood glucose, insulin injection techniques, etc.).

Not every endocrinologist (capable of competently treat patients with diabetes) is capable of without the proper training to conduct group training. In this regard, there are special methods of preparation "educator" (which may include doctors (mostly in Russia) or nurses (often overseas)).

When type 2 diabetes, such training is no less important than in type 1 diabetes. Courses for patients with type 2 diabetes not receiving insulin and receiving, are distinct. Education in these categories should always be carried out separately. For patients without insulin emphasis is on nutrition, weight loss. The program also includes a self-blood glucose, proper docking of hypoglycaemia, prevention of complications of diabetes. The result of well-conducted study is to reduce weight, the actual inclusion of glucose-lowering effect of dieting, which reduces the dosage of OSSP. It is shown that the frequency of self-control is correlated with the quality of diabet.

When type 2 diabetes on insulin therapy, in addition to the above, training is needed to the rules of insulin, as well as the fact that the carbohydrate content in foods should be distinguished from the caloric content. The degree of self-correction of insulin varies depending on the abilities and motivation of the patient: the increase / decrease the dose of ICDs for 2-4 units with a high / low blood sugar before eating (this patient is recommended to maintain approximately the same carbohydrate content in meals each day) to intensive diabetes management c calculated required dose of insulin before a meal on the "bread units" as in type 1 diabetes.

The problem, which often takes place in Russia lies in the fact that education in the School of diabetes, "runs the majority of patients, but very often it is formal in nature, conducted in violation of principles of group patient education. As a result, many patients retain the state of decompensation of diabetes and can not really control your blood sugar in spite of the training.

The most frequent errors in training:

Combining the classroom in patients with type 2 diabetes receiving and not receiving insulin (and even more so - with type 1 and type 2) Education in too large groups (more than 8-10 patients), which makes it impossible to work individually with each of them, control the assimilation of material and adjust therapy during the course.

Continuous reading of a series of lectures at the hospital in which hospitalized patients begin studying from 1 st class, but with what is currently Insufficient duration of the course. Lack of proper training and certification of "educator" (eg, conducting classes alternately all doctors belonging to the staff offices).

Lack of interactive learning and its integration with the treatment process. Complete the School of diabetes - is not just a series of lectures (and even more so - not videokurs demonstrated by patients), but detailed answers to questions from the audience, evaluation and self-correction therapy for each participant group. This provides not only the transfer of educational material, but also the creation of the listeners of motivation to adopt the new behaviors required for successful management of diabetes.

In the "Patients" were surveyed site visitors on how quality education they occurred.

Drug-Free Treatment for Type 2 Diabetes

Drug-free treatment - an important part of the patient with diabetes, especially when it comes to treatment and prevention of type 2 diabetes mellitus.

 Key measures of non-drug treatment of diabetes can be characterized as "healthy way of life" - the normalization and maintenance of normal body weight, nutritional therapy (individual meal plan), not smoking and excessive alcohol consumption and regular exercise.

    Treatment of food (nutritional therapy) occupies an important place on the stage of prevention, treatment of diabetes, as well as prevention / slowing the progression of diabetic complications.

    Goal of nutritional therapy - to achieve and maintain target blood glucose, cholesterol, blood pressure, normal body weight with regard to the specifics needs and preferences of individual patients. All dietary restrictions should be based on scientific evidence.

    Clinical studies of the effectiveness of nutritional therapy have shown that adequate nutrition leads to a reduction in HbA1c by 1% in patients with type 1 diabetes and 1.2% in patients with type 2 diabetes, and the effectiveness of individual food plan depends on the length of diabetes - the earlier intervention started, so it efficiently. Meta-analysis of studies of NT in people without diabetes, indicating a decrease in LDL cholesterol by 15-25 mg / dl.

Meta-analysis of clinical trials and expert opinion also confirmed the important role of lifestyle changes in the treatment of hypertension.

Is very important to support physician or other, so our advice on lifestyle changes and / or food should be specific and consistent, and support - regular.

• Patients who are overweight (particularly in patients with type 2 diabetes) to assist in lifestyle modifications - reducing daily caloric intake, primarily - at the expense of fat (no more than 30% of daily calories), the development plan for regular physical activity. Goal - a persistent reduction in body weight by 5-7%. Additional possible gives medical therapy of obesity, while a BMI over 35 kg/m2 is recommended the use of bariatric surgery, which also has a positive effect on diabetes control. Available data do not allow us to recommend a diet for patients with severely restricting carbohydrates, starvation or drastic reduction of daily calories (less than 800 kcal / day).

• As a foundation food (50-60% of daily calories) in patients with diabetes are recommended to complex carbohydrates with plenty of fiber (vegetables, fruits, legumes, whole grains, dairy products low in fat). The key point in achieving normoglycemia, especially in patients treated with insulin injections, is the allowance of carbohydrates in the diet (perhaps use different systems of counting). Restriction of foods with a high glycemic index may bring additional benefits compared with simple light carbohydrate, but not necessarily demand it. If the patient uses the simple carbohydrates, this should be taken into account in treatment. Instead of table sugar and may safely use nekaloriynyh sweeteners, but is not recommended to use fructose in large amounts.

• We recommend limiting consumption of saturated fats (less than 7% of daily calories), particularly in patients with dyslipidemia, and the introduction of the diet of fish dishes (2 or more times per week).

• In the absence of proteinuria, the recommended protein content in food - 15-20% of daily calories.

• If a patient with diabetes, drinking alcohol, it is considered safe moderate drinking (no more than 15 g in terms of pure alcohol per day for women and no more than 30 grams - for men).

• Patients are often asked to advise the "vegetable" for the treatment of diabetes, many of our patients take a variety of dietary supplements and surcharges. Patients should be informed that the scientific evidence on the usefulness of certain herbs and nutritional supplements in people with diabetes do not exist. In addition, their possible side effects and interactions with other drugs are not known.

• A mandatory moment is training in proper behavior during hypoglycemia, as well as measures to prevent it (if you exercise, concomitant diseases, changes in the usual mode of day, etc.).

• Physical activity is especially important for overweight and obesity. It should be regular, with a gradual increase of the intensity of the load and taking into account patient preference and existing comorbidities.

Insulin Therapy in Diabetes Mellitus Type 1

   Basic principles:

    • Intensified insulin therapy (mode "basal bolus"). Such a mode of insulin administration most closely matches the daily profile of insulin in humans without diabetes. Short-acting insulin (ICD) is inserted before each meal, insulin is longer-acting (SDI) introduced 1 or 2 times a day, creating a background concentration of insulin between meals (including at night).

    • The patient can and should be independently change the dose of insulin (in the first place, ICD), depending on blood glucose before meals and the amount of carbohydrates eaten (counting on the "bread units (XE), as well as taking into account physical activity, comorbidities, etc.

    • To successfully manage diabetes, the patient must undergo special training (usually a group) on a structured program "Diabetes School" (at least 20-25 hours of training, with the program, divided into training steps, with sufficient attention to the practical activity of patients, etc.).

    • Diet for type 1 diabetes is a "liberalized". Almost any dish can be estimated action with the help of bread units and balance it correctly calculated the short-acting insulin dose. Saved only minor limitations: (1) not more than 7-10 XE for eating, (2) avoid much carbohydrates (fruit juices, lemonade), because increase blood glucose after taking "ahead of" the action of insulin, (3) avoid foods in which it is difficult to calculate the XE and determine the rate of assimilation.

    • Role of the endocrinologist: monitoring the success of diabetes management (blood glucose measurement results, the patient recorded in the diary of self-control, glycated hemoglobin), assistance in making the right decisions on the calculation of doses of insulin (discussion blog), regular screening for early detection or exclusion of diabetic complications (assessment of the "target organs" DM).
    Means of insulin

    • Insulin syringes (with graduation not in ml, and in units of insulin, and a short (6-13 mm) needle for subcutaneous injection)

    • Syringe-pen (automatic syringe with a cartridge of insulin for several days). Injections and the addition of antimicrobial agents in the insulin eliminates the risk of inflammation and infection at the injection site, even if its holding through a thin layer of clothing. Treatment of skin with alcohol when insulin injections are required.

    • Bezigolny injector for insulin (sold in Russia, but has no great advantages over the syringe-pen)

    • dosing of insulin (insulin pump): portable and small device on his belt, which continuously delivers insulin short-acting subcutaneously injected through the catheter. Background (basal) of insulin similar to longer-acting insulin, and served during the meal boluses - short-acting drug. Dose of insulin (as in the background flow, and during the meal) is determined by the patient on the basis of the doctor's recommendations and the results of self-control (ie, pump does not regulate blood sugar automatically, on the basis of feedback). The pump is not removed at night, but can be switched off for a short time (up to 1-2 hours - on the shower, swimming, etc.).

The advantages of the pump before injection with a pen or a syringe - insulin in the lung at any number of carbohydrates taken even in small "bite" (the usual treatment of ICD is introduced, usually 2-4 times a day) and the ability to fine tune the speed of the background flow insulin at different times of day (important when the phenomenon of "dawn"). Disadvantages - the need for a permanent location on the pump body (even during sleep) and the high cost of equipment and consumables. Insulin pump to fully disclose its advantages in well-trained patients are able to successfully manage their glucose levels with conventional insulin. In this case, the transition to pump therapy treatment leads to some improvement in the diabet (reduction of glycated hemoglobin HbA1c by an average of 1%). 

Technology insulin

The correctness of insulin (both patients and medical staff) is very important, because if not properly introduce undesirable effect of insulin is attenuated or amplified, as is often unpredictable, ie, the strength of insulin action may not completely match the number of input units. If unexpectedly weak effect of insulin or "chaotic behavior" of glycemia during the day checking equipment injections - the first and necessary step in finding the causes of decompensation. This can be done with a special leaflet