Metformin or Januvia? Choosing the best treatment for diabetes

A few words about diabetes

Diabetes mellitus is a chronic disease characterized by elevated fasting blood glucose and after eating. In addition to hyperglycemia - elevated sugar, an essential symptom of uncompensated diabetes is glycosuria - the release of glucose in the urine.

Translated from the Greek language, diabetes mellitus means "to pass through", that is, the water does not linger in the body at all, but the whole goes.

Diabetes mellitus is not a disease of our time, as many believe, but goes deep in history.

For the first time, diabetes mellitus is mentioned in Ancient Roman documents, dating from the third millennium BC.

And for many hundreds of years, scientists and doctors tried to find out the causes of the development of diabetes mellitus, to prevent the development of this disease in subsequent generations and to find a cure to help those who are already sick, but for now all the diseased were doomed.

At the very beginning of the 20th century, scientists Langergans discovered special cells of the pancreas - beta cells responsible for the synthesis of insulin. These cells are located in groups that are named after the scientist who discovered them, they were called the islets of Langerhans.

After the discovery of these cells, a series of experiments followed, which in 1921 made it possible to isolate a substance from beta cells, called insulin (the name is derived from the word "island").

The discovery of insulin marked the beginning of a new era in endocrinology, and diabetics got the chance to live a fuller life than it was before the discovery of insulin.

Subsequently, scientists were able to provide patients with a wide range of insulins of different action (short or extended) and origin (beef, pork, human).

The task of modern endocrinology is to select the appropriate type of insulin for the patient and enable him to live a full life.

What happens with diabetes in the body?

In diabetes, carbohydrate and lipid metabolism is disturbed in the body, that is, the compensation is disturbed when carbohydrates and fats are absorbed. To compensate for diabetes used to proc eed important absorption of carbohydrates.

Carbohydrates, fats and proteins contained in foods, entering the body, are absorbed under the influence of digestive enzymes.

Carbohydrates, turning into glucose molecules, are the main source of energy, which is necessary for all processes in cells.

Glucose accumulates in the blood so that it is used by the cells, it is necessary that it falls into the cell itself. It is for this that insulin is needed, it plays the role of the so-called key, which opens the door to the glucose molecules inside the cell.

Also, insulin is needed to create an energy reserve, which is formed as follows - part of the glucose molecules is not used immediately, but is processed into glycogen, which is stored in the liver and used by the body as needed (during fasting, with hypoglycemia).

A healthy body immediately responds to the intake of carbohydrates into it, producing so much insulin, which is necessary for the assimilation of carbohydrate intake.

But in case of diabetes mellitus, insulin synthesis is disturbed (it is produced in an insufficient amount or is not produced at all, or its action is impaired). In this case, glucose cannot pass into the cells, it accumulates in the blood, due to which there is an increase in the glucose content in the blood above the norm, whereas the cells and the whole-body lack energy.

For the normal functioning of the body, it is necessary to allow glucose molecules to pass into the cells and be absorbed there, and this is possible with the introduction of insulin injections (for the first type of diabetes) or taking medications that normalize the effect or structure of insulin (for the second type of diabetes).

How is diabetes mellitus diagnosed?

There are standards for normal levels of sugar. Measurements of sugar on an empty stomach and after meals.

It is possible to test for glucose in whole blood and in blood plasma. Note that the testimony in whole blood is 12% lower than that in plasma. To facilitate the translation, there is the following rule - the value in whole blood multiplied by 1.12 - this is how the value in the blood plasma is obtained. Conversely, the value in plasma is divided by 1.12 to get the value in whole blood.

Glucose is measured in several units - in mol / L and in mg / dL.

A normal fasting blood sugar level is 3.3–5.5 mmol / L (59.4–99 mg / dL).

After 1.5-2 hours after a meal, the sugar should be no higher than 7.8 mmol / l. There should be no traces of sugar in the urine.

If glucose values are higher than normal, then we can talk about impaired glucose tolerance.

For the diagnosis of "diabetes mellitus" it is necessary to pass another series of blood tests, such as:

• GG (glycated / glycosylated hemoglobin);
• Insulin antibodies;
• C-peptide.

And already, based on the results of these tests, we can talk about the presence or absence of diabetes.

At present, many different laboratories carry out these analyzes, and the technique for their implementation may differ, so when getting a result, it is necessary that the norm should be next to the result so that you can compare whether your results exceed the established norm.

If the result of the blood glucose test is above the norm, then the doctor will prescribe a further examination, including a "sugar curve" or a "test with a load".

With this type of examination, blood for sugar is surrendered on an empty stomach, then the patient drinks 75 g of glucose and gives blood again after a while.

In a healthy person, sugar does not rise above 7–8 mmol / l, and when sugar increases to 11 mmol / l and above, it is said about diabetes.

When blood sugar exceeds 7-9 mmol / l, it begins to be excreted in the urine. Therefore, during the examination prescribed to pass a urine test for sugar. The higher the blood sugar, the more, respectively, in the urine.

The appearance of sugar in the urine can be a sign of newly diagnosed diabetes mellitus or decompensated diabetes mellitus with a poorly chosen treatment regimen.

Signs of Diabetes

The main signs of diabetes are intense thirst, a constant feeling of hunger, frequent urination, excretion of sugar in the urine, the smell of acetone.

Often the development of diabetes is accompanied by severe dryness and peeling of the skin, itching of the skin and mucous membranes. In women, diabetes can be detected after visiting a gynecologist with complaints of itching in the vagina, not passing thrush. Since decompensated or not yet established diabetes mellitus provide fertile ground for the development of fungal infections.

The patient may also experience severe weakness, cramps and pain in the calf muscles, severe weight loss (with type 1 diabetes) and weight gain (with type 2 diabetes).

Increased sugar can cause nausea and vomiting, poor wound healing and scratching.

If you find in yourself some signs that may suggest the development of diabetes, it is better to immediately consult a doctor and undergo the necessary examination.

Types of diabetes

There are several types of diabetes: type 1 diabetes and type 2 diabetes. Gestational diabetes or pregnant women with diabetes are also identified.

Diabetes mellitus of the first type is characterized by the fact that pancreatic cells cease to produce insulin.

First, insulin can be produced, but in insufficient quantities. Over time, the beta cells die, and insulin ceases to be produced completely.

In this type, insulin delivery from the outside is required.

Diabetes of the first type is also called, though not quite right, young diabetes, as it most often develops in children, adolescents and people under 30-35 years old. But there are exceptions everywhere, so it can be detected in older people.

This type is not as common as type 2 diabetes.

Diabetes mellitus type one is incurable! Neither pills nor any other means will help restore dead beta cells that produce insulin.

But the main thing to remember is that with properly selected therapy, people with diabetes live a long full life without indulging in anything.

Only have to spend some time and effort to achieve compensation.

Type 2 diabetes is more common than type 1 diabetes. Also, it is called obese diabetes, as it develops in people suffering from overweight and elderly diabetes. Although the latter is not quite true, although it is mainly people who suffer after 40 years and older, but recently it is also diagnosed in children and young people.

In diabetes of the second type, insulin is produced in sufficient and sometimes in excess. But there is a violation of its structure or the mechanism of its effects on cells. That is, insulin is produced, but it cannot carry out glucose into the cells, therefore, glucose molecules accumulate in the blood, which explains the high content of sugar in the blood.

Diabetes of the second type is characterized by gradual development. Often, a person finds out that he has diabetes only after being examined for a completely different reason.

Diabetes of the second type requires medicinal treatment (with special sugar - lowering drugs), insulin therapy may be treated (according to test results, if normoglycemia cannot be achieved through diet and sugar - lowering drugs).

In some cases, it is possible to maintain a normal sugar level by following a strict diet and exercising. Since diet and sports contribute to weight loss, and achieving a normal body weight reduces tissue insulin resistance, which leads to a normal effect of insulin on cells and the return of normal blood sugar levels.

It is wrong to call the diabetes of the first type "insulin-dependent", and the second type " insulin-independent."

Since insulin-dependent can be not only diabetes of the first type, but also of the second; as well as the second type of diabetes can be not only insulin-independent, but insulin-dependent.

Another form of diabetes is gestational diabetes, or, as it is also called, pregnant diabetes.

It occurs in some women at different stages of pregnancy. Its manifestations are the same - high blood sugar levels.

Often, to achieve normal compensation for gestational diabetes requires a diet, with the exception of fast carbohydrates.

But sometimes this is not enough, then during pregnancy connect insulin therapy. It is possible to use only prolonged insulin or a combination of short and prolonged.

This diabetes can completely go away after giving birth and no longer remind you of yourself. But often, after a while (sometimes after several years), it turns into diabetes of the second type, and more rarely it manifests itself in the form of diabetes of the first type.

Causes of diabetes

To date, scientists and doctors can not identify the causes that contribute to the development of diabetes.

There are several theories. One of which says that a person is already born with a predisposition to diabetes, and external conditions only contribute to its development.

The conditions that provoke the development of diabetes mellitus are:

1. stressful situations
2. severe infections
3. taking certain medications
4. severe injuries
5. operational interventions
6. pregnancy

Risk groups

Although the causes of diabetes are not exactly known, but doctors identify several risk groups in which diabetes can develop with the greatest likelihood.

The risk groups for the development of diabetes include people who can note the following points:

• overweight and obesity (characteristic of type 2 diabetes);
• the presence of relatives with diabetes;
• postponed severe infections;
• previous surgical interventions;
• age over 40

How to store insulin

Insulin is essentially a hormone, so abrupt changes in storage temperature are contraindicated. Insulin needs strictly adhered storage rules. He does not tolerate freezing, but the heat also does not suit him.

In all pharmacies, insulin is stored in special refrigerators. That is why it is recommended to obtain or purchase insulin in regular pharmacies, and not in online stores, in order to prevent its incorrect storage during transportation.

It is also not recommended to send insulin by mail, precisely because of the inconsistency of the conditions of shipment to the recommended storage temperature.

Insulin, which you received in a pharmacy, should be stored in a refrigerator at home. The best place for this is a box for storing vegetables and fruits. The average temperature recommended for storing insulin ranges from plus 2 to plus 6. It is good to keep a thermometer in such a box so that from time to time you can check if the refrigerator keeps the right temperature.

In no case do not allow the freezing and overheating of insulin, it can affect its properties. And that is why it is not necessary to buy insulin from the hands of strangers, since you cannot verify whether they stored insulin correctly.

If the entire stock of insulin should be stored in a cool place, then the insulin that you are currently using should be at room temperature. Therefore, do not put the bottle or pen in the refrigerator, but keep it at room temperature.

If you notice that you do not have enough insulin for the next injection, then in advance remove the insulin cartridge or vial from the refrigerator so that the insulin has time to warm up before the injection. Cool insulin that has just been pulled out of the refrigerator will work slower than room temperature insulin. This is important to take into account, especially in the morning hours, when insulin itself is more slowly unfolding.

Of course, diabetes is not a sentence and people with diabetes live a full active life, go on holidays, go hiking and play sports.

For such cases in our time offers a lot of devices that help maintain the optimum temperature for insulin, not allowing it to spoil.

Your attention in almost any pharmacy presents various thermo - covers or thermo - canisters. They can be of different sizes - some are designed for carrying one or two syringe pens, while others can carry several packages of insulin.

To these cases it is necessary to buy special thermo - bags, which keep the required temperature inside the case.

In such cases, insulin is protected from temperature extremes, from excessively low or excessively high temperatures.

Small cases can easily fit even in a small handbag, so they will not cause any inconvenience.

These covers art of IT to pay attention to those who are going on vacation. No matter how you get to a place of rest - by plane, on a train or by car, a bag will reliably protect your insulin.

A few words about the transport of insulin in the plane - check with your airline in advance if you can carry insulin in your carry-on baggage or have to take it in your luggage. The latter, of course, is not desirable, since the temperature of the luggage compartment can be very far from the ideal storage temperature of insulin.

Speaking of rest, make sure that there is a refrigerator in the room where you are going to spend your vacation time. Since the southern heat does not benefit insulin at all, and staying somewhere in an unfamiliar place without the necessary supply of medication will not add pleasant sensations.

If you follow all the rules for storage of insulin, then you will always have on hand a fresh drug that works at full capacity. And these rules are very simple:

1. Do not allow insulin to freeze.
2. Do not overheat insulin.
3. Keep spare insulin in the refrigerator.
4. Periodically check the temperature on the shelf of the refrigerator.
5. Store insulin filled with the syringe pen you use at room temperature.
6. Use thermo covers to carry and transport insulin over short and long distances.
7. Always buy insulin only in licensed pharmacies, do not buy it from the hands of strangers.

Hypoglycemia

With diabetes mellitus, not only glucose rises, but also falls. For sure, every person with diabetes has experienced at least once in their life what hypoglycemia is. Hypoglycemia refers to a condition caused by low blood sugar. Usually, hypoglycemia is considered a decrease in sugar below 3.5 mmol / l, but each person may experience unpleasant symptoms at higher or lower rates.

Hypoglycemia is a very unpleasant and dangerous condition. Most often, it develops suddenly and requires immediate action to eliminate it. Particular attention should be paid to cases of hypoglycemia in children, when they themselves can not understand what is happening to them.Frequent hypoglycemia suggests the need to revise therapy. In this article we will take a closer look at what hypoglycemia is, what its causes are and how to act correctly so that hypoglycemia does not take you by surprise.

Causes of hypoglycemia

One of the main reasons for the development of hypoglycemia is the incorrect dose matching of the sugar lowering drug. The following errors can be noted, leading to a decrease in blood sugar levels:

• improper dose of insulin or oral hypoglycemic agents;
• skipped meals or insufficient portions of carbohydrates with a full dose of sugar - reducing drugs;
• mismatch of insulin profile and glycemic index of food intake (when insulin acts faster than food starts to digest);
• great physical exertion - hypoglycemia may develop during the exercise itself or several hours after it;
• illness, poisoning, accompanied by nausea, vomiting, and refusal to eat;
• taking certain drugs that slow down the digestion and reduce the speed of absorption of carbohydrates;
• taking strong alcohol, slowing down the absorption of carbohydrates

Manifestations of hypoglycemia

Usually the sensations of hypoglycemia are quite pronounced. At this time, a person feels strong weakness, fatigue, hunger. The body often shakes, sweating increases. Often there is a tremor of the hands.

During a low sugar, your eyesight may deteriorate, confusion appears, a person does not always adequately answer questions or acts.

When hypoglycemia occurs in a dream, the first signs of this condition are excessive sweating - clothes can get wet through, nightmares, often a person dreams about food. If a person wakes up during hypoglycemia, then he feels a strong heartbeat.

It often happens that a person does not wake up during hypoglycemia. Or it can happen in real life, that is, a person is busy with ordinary activities and does not feel signs of hypoglycemia.

In general, signs of hypoglycemia are more acutely felt at the onset of the disease, with the experience of diabetes, the perception of hypoglycemia can be blurred and this is a big risk to health and life.

What to do during hypoglycemia?

At the first sign of low sugar or suspicion that glucose levels may fall below normal, you need to measure sugar. Then take measures to raise the level of sugar - drink a glass of juice, dissolve 1-2 teaspoons of sugar, eat a few spoons of jam.

With mild hypoglycemia, it is usually enough to consume 10-12 g of carbohydrates (1ХЕ). In more severe cases, you need more carbohydrates, about 2-3 XE or 24-36g of carbohydrates.

But there may not always be something on hand that raises sugar. Yes, and carry food when leaving the house is also not always convenient. Therefore, pharmaceutical companies are developing different versions of drugs that raise sugar. Especially they are needed in those moments when a person loses consciousness from low sugar and cannot swallow juice or suck sugar. There are cases when a person begins to vomit with a low level of sugar, in this case it is useless to give something to drink, there is still little to digest. It is at such moments that drugs that increase sugar are not just necessary, but they are necessary. They save a person's life.

What happens if you do not take fast carbohydrates in time during hypoglycemia?

If a person does not feel the symptoms of hypoglycemia or ignores them, then there are two ways of development of events.

With a reduced level of sugar, the body itself can increase it. For an organism, hypoglycemia is an extreme situation, during which all forces go to restore normal functioning. During hypoglycemia, glycogen stores are released, which is converted into glucose by the action of enzymes. Usually after that the sugar level rises very much. Measuring sugar, after missing hypoglycemia, you can see 15-20mmol / l and above. This body reaction saves lives, but the body’s abilities are not limited. If the person was hungry the day before, he had food poisoning, accompanied by diarrhea and vomiting, or hypoglycemia goes unnoticed not for the first time in a short time, glycogen stores may be very small and the body will not be able to ensure that glucose levels rise to a normal level.

And the second possible path of development is hypoglycemic coma. Sugar level drops so much that a person loses consciousness, the brain does not receive nourishment and oxygen. Hypoglycemic coma is a very dangerous condition. If time does not take action, it is possible fatal. In the case when a person loses consciousness, immediately call an "First Aid" and be sure to report that the victim has diabetes.

Why is hypoglycemia dangerous?

Not only are the manifestations of hypoglycemia very unpleasant, the most important thing is that hypoglycemia causes irreversible damage to the body and can be fatal.

The main danger from hypoglycemia is that the brain experiences oxygen starvation during low sugar levels.

In the absence of actions to relieve hypoglycemia, a person may fall into a hypoglycemic coma, which often leads to death. In the case when it is impossible to raise the level of sugar by yourself, it is necessary to call an ambulance. This must be done without waiting for the person to faint.

With severe hypoglycemia, the brain suffers. The consequences of hypoglycemia can adversely affect memory, impair vision, worsen the functioning of the heart and cause other disruptions in the work of various systems and organs.

Drugs that increase the level of glucose

There are not many such funds, but still they exist. Consider some of them.

First, it is worth mentioning the glucose solution. It is already 40% ready - ny solution, sold in capsules. When hypoglycemia is recommended to take 40-60 ml of this solution. It can simply be taken inside. If necessary, a medical professional can administer it intravenously.

This solution acts quickly and efficiently, but is not convenient to carry around. Yes, and open the ampoule during hypoglycemia is quite difficult if there is no one around who could help.

There are glucose tablets. The package always indicates how much glucose is in a single pill. Glucose in this form is convenient to carry, but it has one drawback. 1-2 XE will have to eat quite a lot of pills, not everyone will like it.

In pharmacies, you can find the means to eliminate hypoglycemia in the form of special jams. Usually they are packaged in small tubes with a lid like toothpaste. These tubes are comfortable to carry. They have different fruit flavors. Usually each tube contains 0.5-1XE. Some people like them to taste, some do not have due to their sweetness.

All of the above means are good when the person himself feels hypoglycemia, comes to consciousness and is able to take measures to raise the level of sugar.

But what if a person cannot drink glucose or eat a piece of refined sugar? If he loses consciousness, he is tormented by vomiting, or he refuses to eat because of inappropriate behavior. In such cases, the best solution is to give a glucose injection. There are more convenient injection options than a vial of glucose.

The most famous is Glukagen from Novo Nordisk. It is a solution and dry matter, which must be mixed immediately before injection. This drug is based on human genetically engineered glucagon, which is a hormone involved in carbohydrate metabolism. The drug can be administered intravenously and intramuscularly. Naturally, when administered intravenously, the effect of the drug appears faster. It starts working 1 minute after intravenous administration. The effect of the drug lasts for 15-20 minutes.

Glukagen acts regardless of what causes hypoglycemia - an overdose of insulin or oral sugar - lowering drugs.

What will help avoid hypoglycemia?

In order not to get into a dangerous situation related to hypoglycemia, you should try to follow some rules that to some extent can save lives:

• Correctly calculate the dose of sugar - lowering drugs, whether oral agents or insulin;
• When changing the dose of drugs, illness, increasing physical exertion, stress, and other situations that cause a change in the established life schedule, you should more often measure the level of glucose;
• Before exercise, it is worth measuring the sugar level, take 1-2 XE in the form of bread, apple, banana. After loading, measure the sugar again;
• Remember that the load can cause a decrease in sugar not immediately, but after a few hours. Therefore, we must be careful and take measurements of sugar more often within 10-12 hours after exertion;
• When leaving the house, be sure to take a blood glucose meter and something sweet with you - a 0.2l package of juice, a few pieces of refined sugar, caramel, or drugs for hypoglycemia in tubes.

Diabetic foot syndrome

Diabetic foot syndrome is a late complication of diabetes. It is one of the most common complications of diabetes.

It is expressed in the form of necrotic processes, lesions of bone tissue, skin and soft tissues. Causes deformation of the joints, damage to peripheral nerves and blood vessels.

Skin lesions have the appearance of ulcers, of varying degrees of severity, the last stage is gangrene.

Such lesions develop in 20–40% of patients with diabetes mellitus, and more often they develop in patients with type 2 diabetes.

With increasing levels of glycosylated ( glycated ) hemoglobin by 1.5% of normal increases the risk of lower limb lesions by 20%.

Of the one hundred people suffering from foot ulcers, 15-20 have to have their legs amputated.

The causes of the development of skin and joint lesions are in decompensation of diabetes mellitus, namely, in constantly elevated blood sugar levels and frequent jumps in sugar levels from very low to very high. This is due to the fact that high sugar negatively affects the blood vessels, which leads to impaired innervation and blood supply. Due to poor sensitivity, it is easy to get injuries of the foot - burn, cut, chop or rub the leg, etc. Any minor injury to the foot can lead to serious consequences. The healing process is extremely slow, and due to the weakening of the protective functions of the body, infection, getting into the wound, causes inflammation.

Depending on which leg lesions prevail - blood flow disorders or innervation disorders, there are three forms of diabetic foot syndrome manifestation: neuropathic, ischemic and mixed.

Neuropathic form of diabetic foot

Neuropathic form - develops with the defeat of the nervous system of the lower extremities. This is the most common form of diabetic foot.

Due to the long-term effects of neuropathy, there are disturbances in the structure of the foot, that is, deformation of the foot occurs, and this redistributes pressure to different parts of the foot in a different way, which leads to the occurrence of the neuropathic form of diabetic foot: the formation of mozoro, edema. This form occurs most often on the foot or between the toes.

The consequences of such a lesion can be: the development of "Charcot's feet", to neuropathic edema, or to the formation of a neuropathic ulcer.

One of the reasons for the development of neuropathic changes is wearing uncomfortable shoes - too narrow or dense.

Symptoms of neuropathic lesions:

1. The absence of pain in the affected area;
2. The preservation of normal pulsation;
3. The ulcer has smooth edges;
4. There is deformity of the foot;
5. There is increased blood flow;
6. The skin of the foot is dry and warm;
7. Usually there are corns on the foot.

Treatment with neyropatichekoy form

We must not forget that any violations associated with the manifestation of diabetic foot, are associated primarily with decompensation of diabetes.

Therefore, in order to successfully treat the manifestations of the neuropathic form of the diabetic foot, compensation must be adjusted. Sugar should be normalized. Since inflammation often increases the body's need for insulin, the usual dose will need to be increased.

Often, neuropathic damage is manifested in people suffering from insulin-independent diabetes in the decompensation stage, who cannot achieve normoglycemia with the help of diets and sugar - reducing drugs. In such cases, it is advisable to switch to insulin therapy and bring your sugar back to normal.

The skin of the foot with neuropathic lesions has weak protective properties, and any microorganisms easily penetrate inside and cause inflammation. Therefore, it is necessary to carry out antibacterial treatment.

Drugs and doses should be prescribed by a doctor.

Also, under the supervision of a physician should be regular treatment of wounds (treatment of edges, removal of dead skin layers).

For a speedy cure, reduce the load on the sore spot to a minimum. In this case, help crutches, wheelchair and orthopedic shoes.

Ischemic form

Ischemic diabetic foot is less common than neuropathic or mixed. It develops as a result of disturbed blood supply to the legs.

This form of disturbance usually occurs on the toes. Severe deformity of the foot does not occur.

Occurs when wearing uncomfortable shoes, due to constant swelling of the feet.

Symptoms of ischemic lesions:

• Pain at the site of skin lesions, including pain at rest, that is, without a load on the leg;
• The ulcer has rough, torn edges;
• Pulsation is absent or greatly weakened;
• Blood flow is significantly reduced;
• The skin of the foot is cold;
• Corns are usually absent or very few.

Treatment of the ischemic form

As with the neurotic form, it is important to maintain a normal blood sugar level.

If there are swelling, then conduct dehydration therapy.

Antibiotic therapy and wound treatment are performed.

If supportive measures fail, surgical intervention is required. Depending on the extent of the lesion, it is carried out through cutaneous transluminal angioplasty (restoration of blood flow in the vessels without a skin incision); thrombarteriectomy or distal vein shunting in situ (a large saphenous vein circulates blood flow to the small vessels of the foot).

Mixed form

A mixed form of diabetic foot is in second place after neuropathic prevalence.

The patient has symptoms of both a neuropathic and ischemic form of the diabetic foot.

Diabetic gangrene

With strong and extensive purulent lesions, gangrene develops.

It is important to identify this condition in time and carry out amputation in order to avoid the death of the patient.

Diagnosis of lesions

It is important to regularly conduct the inspection of the feet in order to identify the slightest changes in the initial stages.

Attention should be paid to discoloration of the feet (redness, pallor); for pain; the presence of edema; fungal skin and nails; deformities of the toes; to maintain normal pulsation; on dry skin of the feet.

In case of any changes, you should immediately consult a doctor for further examination.

It is necessary to conduct a neurological examination, which the examination of the legs with the help of a tuning fork includes a study of vibration sensitivity (carried out with the help of a tuning fork); temperature sensitivity study; determination of tactile sensitivity.

Definition of ankle- shoulder index. This is an important indicator for determining the state of blood flow.

To do this, measure the systolic pressure in the brachial artery and in the arteries of the legs. The ratio of these indicators and shows the ankle- shoulder index. Normally, it is 1.0 and above. If the blood flow of the lower extremities is affected, the index will be lower than 1.0.

Important information provides such an examination, as angiography angiography of the vessels of the legs. It shows the presence and extent of thrombosis.

Prevention of diabetic foot lesions

First, it is important to continuously monitor the condition of the feet of patients who are at risk of diabetic foot.

The risk group includes people who are overweight, who consume alcohol, smokers, aged people who have initial lesions of the legs and who suffer from nephropathy.

It is necessary to choose the right shoes. You can not wear too tight, narrow shoes. It is advisable, especially in the presence of initial lesions of the feet, to wear special orthopedic shoes.

Glycemic index

The concept of the Glycemic Index (GI) was introduced in 1981 by an Australian scientist who decided to test how various foods affect fluctuations in blood glucose levels. Researches were conducted many years; numerous volunteers took part in them.

The studies themselves were as follows: the volunteers consumed the product under study in an amount containing 50g of carbohydrates. Then every 15-30 minutes they measured blood sugar. All data were compared and tables of the glycemic index (GI) were compiled.

The basis was the body's reaction to the use of 50g of pure glucose. Her glycemic index is 100. All other products were compared with GI glucose and received their GI values.

Thus, the glycemic index is a feature of a food product to raise blood sugar levels. It reflects how quickly and how high the sugar rises, if you eat any food product.

The glycemic index of different foods depends on many points, such as the content of carbohydrates, proteins and fats in the product, the type of carbohydrates (fast or slow), the type of processing the product (for example, the glycemic index of raw carrots is lower than the glycemic index of boiled).

The glycemic index of all products is divided into three groups:

1. low - from 10 to 40
2. medium - from 40 to 70
3. high - from 70 to 100

The glycemic index of a product does not reflect the amount of carbohydrates contained in this product. For example, in a piece of bread there are less carbohydrates than in a plombira But the glycemic index of bread is higher than that of ice cream. Because ice cream contains a lot of fats, which slow down the absorption of carbohydrates, which means that sugar will not rise so sharply.

Information about the glycemic index is reflected in the tables. It may be useful for people with diabetes. For example, when calculating the dose of insulin, it is helpful to know what the glycemic index is for the foods eaten. This will help decide what dose of insulin should be done, whether to do it all at once or in parts, and maybe it is worthwhile to inject insulin after eating.

For people taking oral sugar - lowering drugs, information about the glycemic index can be important. In diabetes of the second type, it is important not to use products that dramatically raise blood sugar. But if at the moment the sugar is low, then you should take something that contains fast carbohydrates.

Knowledge of the glycemic index will benefit those who want to lose weight. Choosing foods with a low or medium glycemic index, a person will lose weight faster, but at the same time will not feel constant hunger. It is important to choose the right foods that you eat.

It should be noted that it is not necessary to compare the concept of "glycemic index" with the concept of "insulin index." These are different things. And, if in most cases the glycemic index and insulin index are not very different, then, for example, in dairy products the difference is simply huge. Having a low and medium glycemic index, dairy products have a high insulin index.

Insulin index

This concept appeared in the 90s of the 20th century, when research showed that products containing little or no carbohydrates at all cause a surge in the synthesis of endogenous insulin. For example, meat or cottage cheese almost do not contain carbohydrates, but at the same time the body reacts to their reception as follows - the pancreas produces a significant amount of insulin.

This is due to the fact that insulin is a "broad profile" hormone. He takes part not only in the "processing" of carbohydrates, but also participates in the synthesis of fats and amino acids - the constituent proteins.

Jeannette Brand-Miller, a Harvard scientist, conducted research in which volunteers were given different foods and then watched the body's response — measured changes in insulin levels in response to a particular product and blood sugar levels. The basis was taken the level of insulin index portions of white bread calorie in 240 calories. The insulin index of such a portion of bread equals 100 points.

Long-term studies have shown that almost all products cause an increase in insulin synthesis to one degree or another. To the surprise of scientists and nutritionists, as well as experts in the field of endocrinology, dairy products such as cottage cheese, kefir, milk, as well as protein products and fats of plant origin, such as meat, poultry, fish, have a very high insulin index. But it is precisely these products that are recommended to include in your diet for people with diabetes and people suffering from overweight.

Thus, the insulin index is a value that reflects the level of insulin synthesis when using different products. It is measured for a portion of a product containing 240 kilocalories. Insulin index values are rated on a scale from 1 to 100.

Consider the effect of the insulin index on the example of a healthy person who does not have diabetes. The man ate a serving of food with a low insulin index. The pancreas responded with a small release of insulin, which helped to "process" the incoming proteins - fats - carbohydrates.

If a person eats a product with a high insulin index (AI), then the pancreas produces a lot of insulin. The result is a so-called insulin wave.

Such insulin waves with proper nutrition should occur 3-4 times a day. Then the person will not have problems with excess weight.

And if a person constantly snacks on fast carbohydrates, fast food or other foods with a high insulin index, then insulin waves occur too often, with every meal. And here the side effect of insulin begins to manifest itself, which is that an excess amount of insulin leads to an accumulation of fat. That is, the existing fat reserves are not consumed, but, on the contrary, the body begins to postpone the new fat. The more insulin is secreted, the more fat the body stores.

That is why all diets that are based on counting calories and urge to eat more meat - fish - cottage cheese, etc., do not lead to the desired results. People who want to lose weight, you must consider not only calories, but also the insulin index products.

There is another interesting point. The insulin index of foods may increase when they are combined with each other.

For example, take the cottage cheese with a spoon of honey or jam. Separately, both honey, and jam and cottage cheese have high insulin indices. But their combination gives a stunning effect - the insulin index of such a dish will be very high.

The same is observed with a combination of carbohydrates and animal fat and protein. A completely dietary dish, such as boiled chicken breast, in combination with vegetables (salad, stewed cabbage, cucumber) will have an average AI and is perfect for a dietary dinner. But, in combination with the same dietary boiled buckwheat will have a completely different effect. The insulin index of such a dish will be very large and will provoke a huge insulin surge.

Therefore, it is important to learn how to properly combine products, even dietary ones, in order not to worsen their condition and not to place a heavy load on the pancreas.

It is also not recommended to use a product with a high insulin index at night. Since at night, with insulin wave, more fat is deposited than during the day.

Only animal fats have a high insulin index, whereas vegetable fats have a less pronounced insulin index and do not increase it as much in combination with carbohydrates as animals. Therefore, it is preferable to fill the porridge with vegetable oil, rather than cream.

It is impossible to calculate the insulin index by yourself. Therefore, it is recommended to use ready-made tables with an Insulin Index of different products. The only thing at the moment not so many products listed in these tables. Perhaps in the future such tables will be supplemented with indications for many other products.

This information is more necessary for people with type 2 diabetes than people with type 1 diabetes. But people with the first type of diabetes should keep in mind that if they are going to eat a large amount of protein (meat, cottage cheese, chicken), then they should monitor their blood sugar and, if necessary, poke insulin.

Do not confuse and compare the insulin index and glycemic index. These are different concepts, there is no connection between them and it is impossible to calculate the Insulin Index based on the data of the glycemic index!

New methods in the treatment of diabetes

Studies on the treatment of type 1 diabetes mellitus performed on mice have shown that a treatment regimen has been found that really helps to cure diabetes, and not just improve blood glucose compensation.

Therapy consists of several drugs, namely - granulocyte colony-stimulating factor, an inhibitor of dipeptidyl peptidase-4, a proton pump inhibitor and antithymocyte globulin. These drugs are already used to treat other diseases. Their action has been fully studied, and they are allowed for use.

And in the aggregate, they give an amazing effect - almost 90% of mice with initially diagnosed diabetes were cured of it. Moreover, 50% of mice that have long suffered from diabetes, also cured. The fact that the drug treats not only newly diagnosed cases of diabetes, but also affects patients with diabetes with great experience, speaks about the prospects of this treatment.

Basic mechanisms of action

Metformin has a peripheral hypoglycemic effect, which means that it does not stimulate insulin secretion by the pancreas. This drug has many peripheral effects and I will list the most important of them:

• decrease in the release of glycogen from the liver, thereby reducing the basal increase in blood sugar
• inhibits glucose synthesis from proteins and fats
• stimulates the deposition of glucose in the liver
• increases the sensitivity of peripheral insulin receptors, thereby reducing insulin resistance
• reduces the absorption of glucose from the intestines
• increasing the conversion of glucose to lactate in the digestive tract
• has a beneficial effect on blood lipids, increases high-density lipoproteins (HDL), reduces total cholesterol, triglycerides and low-density lipoproteins (LDL)
• increased glucose transfer through the membrane into the muscles, i.e., it increases glucose uptake by muscles

Since metformin does not have a stimulating effect on the pancreas, it does not have such side effects as hypoglycemia (a sharp decrease in blood sugar levels).

Indications for appointment Metformin

The drugs of the metformin-online.com group are not only antidiabetic drugs. This medicine can be used:

1. In case of impaired glucose tolerance and impaired fasting glucose. I have already written about these conditions in my article "Signs and symptoms of prediabetes", so you can already read it.
2. In the treatment of obesity, which is accompanied by insulin resistance.
3. In the treatment of ovarian clelerosis (PCOS) in gynecology.
4. With metabolic syndrome.
5. For the prevention of aging.
6. In sports.

As you can see, metformin has a very wide range of uses, and I will talk a lot more about it in my future articles. Recently, there is information that the drug is permitted to children from 10 years for the treatment of diabetes mellitus type MODY and obesity.

Contraindications to the appointment of the drug

This drug is contraindicated in the following cases:

• pregnancy and lactation
• major surgery and trauma
• liver disorders
• children up to 10 years
• low-calorie diet (less than 1000 kcal per day), since it causes acidification of the body, i.e., metabolic acidosis develops
• renal failure (creatinine level is greater than 0.132 mmol / l in men and 0.123 mmol / l in women)
• lactic acidosis in the past
• the presence of conditions leading to lactataciosis

About the last I want to stop more. A particularly dangerous complication of the drug is the development of lactic acidosis (accumulation of lactic acid), but this is a very rare phenomenon, and it occurs with comorbidities, which can aggravate lactic acidosis. With this complication, previous generations of thebiguanide drugs were sinful, and metformin preparations were the third, safest generation of the drug.

Conditions that may contribute to the accumulation of lactic acid and aggravation of lactic acidosis:

1. impaired kidney function that prevents the removal of this acid from the body
2. chronic alcoholism and acute ethanol poisoning
3. chronic and acute diseases that lead to deterioration of tissue respiration (respiratory and heart failure, acute myocardial infarction, obstructive pulmonary diseases)
4. diabetic ketoacidosis
5. acute infectious diseases that occur with dehydration (vomiting, diarrhea, high fever)

In such cases, it is necessary to cancel the drug, possibly only temporarily, until the homeostasis of the body is restored. I write about manifestations of lactic acidosis in the overdose section.

Side Effects and Phenomena

In any synthetic drug, in addition to positive qualities, there are side effects. Metformin is no exception. His most frequent side effect is an upset digestive tract. A very large percentage of people who take metformin complain about:

• diarrhea
• abdominal distention
• nausea
• vomiting
• taste disturbance (metallic taste in mouth)
• loss of appetite

As a rule, all these symptoms occur at the very beginning of therapy and disappear after 2 weeks of administration. All this is due to the blocking of the absorption of intestinal glucose, resulting in the fermentation of carbohydrates with the formation of carbon dioxide, which causes diarrhea and bloating when takingmetformin, and after a few weeks there is an addiction of the human body.

What should I do if I get irritable bowel syndrome and diarrhea after taking Metformin?

The only thing that can help is a temporary decrease / cancellation of the medication or taking it during a meal. If this does not help and the symptoms do not go away, then you need to completely give up this drug. You can also try to change the drug to a drug from another company. Judging by the reviews,Glucophage is less capable of causing such unpleasant symptoms.

Rarely, there is an allergy to metformin, which also requires immediate discontinuation of the drug. It may be a rash, erythema or itchy skin.

Dosage and method of administration of metformin

As a rule, the drug is prescribed already at the first symptoms of diabetes mellitus and this justifies the prescription because the treatment is prescribed on time, and this is already 50% of success. To begin, I will tell you in what form metformin hydrochloride is produced. Today, there are two forms of medication that differ in time of action: the extended form and the usual form.

Both forms are available in tablets, but differ in dosage.

Regular metformin is available in a dose of 1000, 850 and 500 mg.

Prolonged metformin available in a dose of 750 and 500 mg

In combination medications, metformin may be at a dose of 400 mg. For example, in glibomet.

The initial dose of the drug is only 500 mg per day. The drug is taken strictly after or during meals 2-3 times a day. In the future, after 1-2 weeks, it is possible to increase the dose of the drug, depending on the level of glucose. The maximum dose of metformin per day is 2000 mg.

If you take the medicine before a meal, then the effectiveness of metformin is sharply reduced. It must be remembered that this type of glucose - lowering agent is intended to normalize the glucose level on an empty stomach, and not after a meal. You also need to remember that without limiting carbohydrate foods, the effectiveness of the drug is much lower. So, eat when taking metformin need according to the general principles of nutrition for diabetes and obesity.

Metformin intake can be combined with other hypoglycemic agents and insulin to achieve the maximum effect of the latter. To evaluate the effect of this drug, no need to rush and immediately wait for the decline in glucose levels. It is necessary to wait for 1-2 weeks until the drug expands its maximum effect.

After that, it is recommended to estimate the level of blood sugar on an empty stomach (in the morning before breakfast) using a glucometer, as well as immediately before eating and before going to bed. But you need to make sure that the break between meals is no more than 4-5 hours. If during these periods the target value of blood sugar is not reached, then the dose can be increased, but not more than the maximum allowed.

How long can you take metformin?

In fact, there is no clear answer to this question. The duration of use depends on the goals and indications in the appointment of metformin. If short-term goals are pursued, such as losing weight, then metformin is canceled immediately after they are achieved. In diabetes, the carbohydrate metabolism is seriouslyimpaired and the drug may be prescribed for a long time. In any case, the question of the cancellation of the medication, you must decide together with your doctor.

Help with overdose of metformin

With an overdose of metformin hypoglycemia does not happen, but often lactic acidosis or lactic acidosis develops. This is a very dangerous complication that can end fatally. May occur with a combination of factors leading to hypoxia and metformin intake. Above, I told you what kind of conditions these could be.

The clinical signs of lactic acidosis are:

• nausea and vomiting
• diarrhea
• severe abdominal pain
• decrease in body temperature
• muscle pain
• increased breathing
• dizziness
• loss of consciousness

If a person is not helped, he will fall into a coma, and then biological death will occur.

What is the help with lactic acidosis? First of all, the abolition of metformin and urgent hospitalization. Previously, this condition was treated with sodium bicarbonate (soda) infusion, but this treatment does more harm than good, so it was abandoned or done in exceptional cases.

The drug januvia-sitagliptin.net is intended for the treatment of type 2 diabetes. The active active ingredient - sitagliptin - is different from other substances for the treatment of the disease, increases the concentration of two hormones incretin. The drug promotes the secretion of these hormones in the intestine, increasing production with food intake, synthesizes insulin production in the pancreas and suppresses the production of glucagon. This helps to reduce the production of glucose in the liver and leads to a decrease in glycemia.

The drug can be used both independently and in the complex therapy of diabetes. The drug significantly reduces the risk of occurrence and development of side effects and effects on the cardiovascular system.

Januia is almost completely absorbed by the body, the absorption efficiency does not depend on food intake.

Januvia is one of the most effective and safest drugs used in medical practice for the treatment of diabetes.

The drug in its structure is a synthetic drug from the group of incretins.

By themselves, incretins are hormones that are directly involved in the process of insulin synthesis and utilization of glucose in the blood.

Preparations from this group have the following effects on the human body:

1. stimulate the production of insulin hormone beta cells of the pancreas;
2. inhibit glucagon production by pancreatic alpha cells;
3. slow down the process of gastric emptying;
4. help reduce appetite;
5. in addition, a beneficial effect on the functioning of the cardiovascular and nervous systems.

Januvia is a cure for diabetes is gaining its popularity among medical professionals and patients with this diagnosis.

Tableted drug has a pronounced hypoglycemic effect and belongs to the group of DPP-4 inhibitors.

The use of drugs promotes the growth of active incretins and stimulates their action. During normal functioning of the body, increkins are produced in the intestine, and their level significantly increases after eating.

As a result of the development of diabetes mellitus, there is a failure in the mechanism of this process, and as a result, medical specialists are seeking to restore it, prescribing to patients, the drug Januvia.

Increins are responsible for stimulating insulin production by the pancreas.

Among the main therapeutic features of a medical product are:

• Decreased concentration of glycated hemoglobin.
• Elimination of signs of hyperglycemia (including reducing fasting blood sugar).
• Normalization of body weight.

The drug is available in tablet form in the form of rounded tablets beige color coated.

The main active ingredient is sitagliptin (mnn), as the auxiliary components are calcium phosphate, microcrystalline cellulose, magnesium stearate, croscarmellose and sodium fumarate, which are also part of the drug.

Tablets with the active component sitagliptin, as a rule, are used in cases of:

• in case of complex therapeutic treatment of a disease such as diabetes mellitus of the second type, in order to increase the hypoglycemic effect together with antagonists or metformin hydrochloride;
• as monotherapy in the development of an insulin-independent form of diabetes mellitus in combination with non-drug treatment regimens - diet therapy and physical exertion.

It should be noted that complex therapy is the use of medical drugs in the following groups:

1. Sitagliptin is often used in conjunction with metformin (Ciafor, Glucophage, Formetin).
2. With drug-derived sulfonylureas (Diabeton or Amaryl).
3. With medicines from the group of thiazolidinediones (Pioglitazol, Rosiglitazone).

The tablets of Januvia, which contain sitagliptin, after they are taken are rapidly absorbed and reach their maximum concentration in the blood plasma after four hours.

Side effects and possible negative effects

Drug Janow has far fewer negative effects unlike other sugar-reducing drugs.

The active component is easily transferred by the body, almost without causing adverse reactions.

However, in some cases, there may be minor negative effects from different organs and body systems.

As a rule, such negative effects disappear after discontinuation of the drug.

Adverse reactions may occur from the organs of the respiratory system in the form of nasopharyngitis or infectious diseases of the respiratory tract.

In addition, the patient may complain about the development of such processes:

• Severe headaches.
• Pain in the abdomen, accompanied by nausea, vomiting, or diarrhea.
• The manifestation of hypoglycemia.

According to the test results, the following deviations can occur - the level of uric acid and neutrophils increases, the concentration of alkaline phosphatase decreases.

Also, among the negative manifestations may be an increase in sleepiness, as a result of which it is not recommended to drive vehicles or carry out activities with mechanisms that require increased concentration of attention.

Reviews of consumers and medical professionals

Among the many patients who used the drug, reviews of it in most cases are positive.

Negative reviews are most often associated with violations of the instructions for use of the drug.

About Januvia reviews indicate that the drug has several advantages.

The most significant benefits of a hypoglycemic agent, compared with other sugar-reducing medicines, are the following:

there is a normalization of morning blood glucose values, compensation becomes less pronounced;

after a meal, the drug acts quickly, normalizing blood glucose levels;

blood sugar ceases to be “spasmodic” in nature, no sharp drops or increases are observed.

It should be noted that according to the instructions for use of the medicine, tablets can be taken at any time of the day, regardless of the meal.

At the same time, patients prefer the morning medication, arguing that a more stable and pronounced result is thus observed, because the drug must compensate for food that comes in during the day.

The opinion of doctors is that there is no difference when medication is taking place and the main rule is to follow the regimen and not skip the next application. Such a scheme will allow therapy to have a positive impact.

In some cases, diabetics report that after a certain time, the therapeutic effect of the drug begins to decrease and glucose spikes resume. This situation is explained by the further development of the pathological process.

The main disadvantage of Januvia, according to patients, is the pricing policy of the drug.

The price of the drug with the maximum dosage varies from 1,500 to 1,700 rubles per pack (28 tablets).

For many diabetics, the cost becomes unaffordable, given that the drug should be taken regularly, and this package will last for less than a month.