Diabetes, an increasingly common chronic disease in modern society, is bringing serious challenges to the health of countless people. It not only affects the quality of life of patients, but may also cause a series of serious complications. Understanding the pathogenesis of diabetes and effective disease management methods is of great significance for the prevention, control and treatment of diabetes.
1、 Historical origin of diabetes
diabetes is not the product of modern society, and its history can be traced back to ancient times. As early as 1500 BC, the medical literature in ancient Egypt described the symptoms of diabetes, such as polyuria and emaciation. In China, there are also records of symptoms similar to diabetes in the Yellow Emperor's Canon of Internal Medicine, a classic of traditional medicine. Until the end of the 17th century, British doctor Thomas Willis first proposed the term "diabetes" to describe this disease characterized by polyuria, thirst and emaciation. With the progress of medical science, people's understanding of diabetes has gradually deepened.
2、 Classification and pathogenesis of diabetes
diabetes can be divided into type 1 diabetes and type 2 diabetes. The pathogenesis is complex and diverse, but generally it can be divided into two categories: insufficient insulin secretion or dysfunction.
1.1 Type diabetes: type 1 diabetes, also known as insulin dependent diabetes, whose pathogenesis is mainly due to the destruction of islet β cells by autoimmune attacks or other reasons, resulting in absolute insufficient insulin secretion. Type 1 diabetes patients often get sick in childhood or adolescence, with acute onset and obvious symptoms, and need lifelong insulin dependence treatment.
2.2 Type diabetes: Type 2 diabetes is the most common type of diabetes, accounting for more than 90% of the total number of diabetes patients. Its pathogenesis is relatively complex, mainly related to insulin resistance and relatively insufficient insulin secretion.
① Insulin resistance: Insulin resistance refers to the body's insensitivity to insulin, resulting in a decrease in the efficiency of insulin in promoting glucose uptake and utilization. This may be related to various factors such as genetic factors, obesity, long-term high calorie diets, and lack of exercise.
② Relatively insufficient insulin secretion: As the condition progresses, the function of pancreatic beta cells gradually decreases, and insulin secretion cannot meet the body's needs, leading to an increase in blood sugar.
3. Special type of diabetes: including diabetes caused by genetic defects, endocrine diseases, drugs or chemicals, infections, etc.
4. Gestational diabetes: refers to the hyperglycemia found for the first time during pregnancy. Its onset is related to the changes of hormones during pregnancy, genetic factors, lifestyle, etc.
3、 Symptoms and diagnosis of diabetes
1. Common symptoms: The typical symptoms of diabetes are "more than three and less", that is, drinking more, eating more, urinating more and losing weight. However, in the early stage of diabetes, the symptoms may not be obvious, and many patients are found to have elevated blood sugar during physical examination or examination due to other diseases.
2. Diagnostic criteria: At present, the diagnosis of diabetes is mainly based on the blood glucose test results. Common diagnostic indicators include fasting blood glucose, 2-hour postprandial blood glucose, and glycated hemoglobin.
Fasting blood glucose (FPG): ≥ 7.0mmol/L.
Oral glucose tolerance test (OGTT) 2-hour blood glucose: ≥ 11.1mmol/L.
- Glycated hemoglobin (HbA1c): ≥ 6.5% (using NGSP/DCCT standardized detection method).
In addition, a comprehensive judgment should be made based on the patient's clinical symptoms, signs, and past medical history.
4、 Hazards of diabetes
1. Acute complications:
① diabetes ketoacidosis: It is common in type 1 diabetes patients. Due to the serious lack of insulin, fat decomposition is accelerated, a large number of ketones are produced, causing acidosis. Patients may experience symptoms such as nausea, vomiting, abdominal pain, deep and rapid breathing, and impaired consciousness.
② Hypertonic hyperglycemic syndrome: It is mostly seen in elderly patients with type 2 diabetes. Under the inducements of infection, stress, etc., blood sugar significantly rises, causing severe hyperosmolar state. Patients may have dehydration, neuropsychiatric symptoms, or even coma.
2. Chronic complications
① Cardiovascular disease: diabetes is an independent risk factor of cardiovascular disease, and patients are prone to coronary heart disease, myocardial infarction and stroke.
② Renal disease: Long term hyperglycemia can lead to glomerulosclerosis, renal interstitial fibrosis, and ultimately develop into renal failure.
③ Retinopathy: diabetes can cause retinal microvascular disease, resulting in decreased vision and blindness.
④ Neuropathy: including peripheral neuropathy, autonomic neuropathy, etc. Patients may experience symptoms such as limb numbness, pain, sensory abnormalities, gastrointestinal dysfunction, urinary incontinence, etc.
⑤ Diabetes foot: due to neuropathy and vascular disease, patients' feet are prone to infection, ulcer, gangrene, and may need amputation in serious cases.
5、 Disease management of diabetes
diabetes management is a comprehensive process, involving lifestyle intervention, drug treatment, blood glucose monitoring, education and psychological support.
1. Lifestyle intervention:
- Dietary management: Balanced diet, control total calorie intake, reduce high sugar and high-fat foods, and increase dietary fiber intake.
- Exercise: Regular aerobic exercise, such as brisk walking, swimming, cycling, etc., can improve insulin sensitivity and reduce weight.
- Quit smoking and limit alcohol consumption: Avoid smoking and excessive drinking to reduce damage to blood vessels and pancreatic function.
2. Drug therapy
- Oral hypoglycemic drugs: including sulfonylureas, biguanides, alpha glucosidase inhibitors, thiazolidinediones (glitazones), DPP-4 inhibitors, SGLT2 inhibitors, etc. Choose appropriate drugs according to the patient's condition.
- Insulin treatment: For type 1 diabetes and some late diabetes patients, insulin treatment is the key to control blood sugar.
3. Blood glucose monitoring: Regularly monitor blood glucose levels, including fasting blood glucose, postprandial blood glucose, and glycated hemoglobin, to evaluate blood glucose control and adjust treatment plans in a timely manner.
4. Education and psychological support: strengthen diabetes health education and improve patients' self-management ability; Pay attention to the psychological health of patients, provide necessary psychological support and intervention, and alleviate the impact of negative emotions such as anxiety and depression on the condition.
5. Prevention and treatment of complications: diabetes complications are an important factor threatening patients' health and quality of life. Therefore, it is necessary to actively prevent and treat complications such as diabetes related microvascular diseases (such as diabetes nephropathy, diabetes retinopathy), macrovascular diseases (such as coronary heart disease, stroke), and neuropathy.
In conclusion, diabetes is a chronic disease that seriously threatens human health. But through in-depth understanding of its pathogenesis and taking scientific and effective treatment and management measures, patients can effectively control blood sugar, prevent complications and improve their quality of life. At the same time, the whole society should also strengthen the publicity and education of diabetes, improve the public's awareness level, and jointly respond to this public health challenge. Let's work together to overcome diabetes and embrace a healthy and beautiful life.