draculalespectacle.com Open in urlscan Pro
2606:4700:3032::ac43:86f4  Public Scan

Form analysis
0 forms found in the DOM

Text Content

Top


METFORMIN OR JANUVIA? CHOOSING THE BEST TREATMENT FOR DIABETES

Diabetes mellitus is a serious disease that kills more than a million people
every year, and everyone can get sick. Diabetes
occurs when our body cannot cope
with the level of sugar (glucose)
in the blood.

 * Home
 * Diabetes treatment
 * How to control diabetes
 * Living with diabetes
 * Modern views on diabetes
 * Type 1 diabetes
 * Type 2 diabetes
 * Blog


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.

 * Home
 * Diabetes treatment
 * How to control diabetes
 * Living with diabetes
 * Modern views on diabetes
 * Type 1 diabetes
 * Type 2 diabetes
 * Blog

Copyright (c) 2019 Approved Pharmacy Online | All rights reserved.
draculalespectacle.com