Diabetes mellitus fat and skinny. Dermal pruritus

Allocate diabetes ” obese ” and ” skinny ” (Lanceraux and others). Clinically, diabetes in overweight patients proceeds favorably. Compensation of diabetes mellitus is achieved by limiting the diet and small doses of insulin or sugar-lowering sulfonamide drugs.
The course of diabetes can be characterized as labile (unstable) or stable (calm). 

The main complaints of patients with diabetes are: dry mouth, increased thirst, diabetes, increased appetite. Patients note weight loss, general weakness, fatigue. When compensated, thirst disappears. Daily diuresis is normal.  

When examining urine for sugar in patients with diabetes mellitus, glucosuria is determined from 1 to 6% and above. High blood sugar exceeds the ability of the renal tubules to reabsorb glucose. A high concentration of sugar in the urine is accompanied by an increase in urine output. 

The clinical picture of diabetes is manifested by significant changes in organs and systems. The appearance of small symptoms is often ahead of the main symptoms of diabetes. Patients are concerned about itchy skin , as well as itching in the genital area. Abscesses, boils are observed, wounds heal slowly. Teeth fall out, nails break. Itching of the skin is explained by the effect of glucose on nerve endings. Violation of carbohydrate metabolism and the balance of vitamins leads to the appearance of skin diseases (dermatitis, eczema, etc.). Violation of the metabolism of provitamin A – carotene is manifested by the yellowness of the palms. High cholesterol in the blood causes xanthomas on the skin and xanthelasm on the eyelids. 
   

With significant dehydration, the skin becomes dry, turgor decreases, the muscles of the limbs become flabby, atrophic. Reduced muscle tone. Tendon and muscle reflexes are lowered. Violation of electrolyte and protein metabolism leads to a decrease in muscle excitability. Joint damage, metabolic arthritis is possible. There is osteoporosis of the bones of the extremities, vertebrae. Insulin deficiency promotes protein catabolism, resulting in a delay in growth processes in childhood and adolescence.  

Patients with diabetes mellitus in combination with obesity have a tendency to exchange polyarthritis, gout (uric acid diathesis). With diabetic nephropathy, swelling or pasty tissue occurs. In severe forms of diabetes at a young age, exhaustion and an increase in ketoacidosis progresses. 

There are also forms of obese lipoplethoric diabetes , especially in the elderly (P. M. Draznin and M. F. Merezhinsky). Changes in the cardiovascular system are due to a shift in all types of metabolism in patients with severe diabetes mellitus and in patients with moderate diabetes. The vascular pathology is most intensively manifested in the elderly and in women in the menopause, however, in children and adolescents, vascular damage by the type of microangiopathy is also observed.