Type 2 diabetes is a chronic disease characterized by a persistent increase in blood glucose. The development of diabetes is associated with a violation of the interaction of insulin and cells of organs and tissues. With the type 2, diabetes develops relative insulin deficiency (unlike type 1 diabetes, in which insulin deficiency is absolute and treatment consists only in the lifelong administration of insulin from the outside).
In older people, the frequency of type 2 diabetes is much higher than in people of younger age. This is due to the fact that with age, the risk of insulin resistance increases, i.e. reducing the sensitivity of body cells to insulin. With type 2 diabetes, the production of insulin for the pancreas can be preserved or even excessive, but its sugar -free effect is weakened. This is especially expressed in people with an excess body mass or obesity, a sedentary lifestyle. Insulin resistance at the beginning leads to a violation of glucose tolerance (pre -Aibet), and then, if you do not take measures to correct lifestyle, to the development of type 2 diabetes.
Timely detection of diabetes in elderly patients is accompanied by some difficulties. Symptoms of the onset of diabetes at this age are lubricated, can be non -specific: weakness, fatigue, memory decrease, dizziness, etc. All known symptoms, like dry mouth, thirst, abundant urination may be absent. At the time of the detection of diabetes, there are often diabetic complications from the vessels, nervous tissue. In addition, age -related patients have concomitant chronic diseases: coronary heart disease, arterial hypertension, renal pathology, diseases of bones and joints, etc. All this imposes symptoms, weights the possibilities of diagnosis and treatment of diabetes.
For timely diagnosis of diabetes, it is necessary to regularly check the level of blood glucose. Remember, if two blood glucose studies on different days noted the level of glucose of the blood on the cost of a hop above 6.1 mmol/l (when examining capillary blood) and higher than 7.0 mmol/l (when examining venous blood) is likely diabetes. The peculiarity of the elderly people - at the beginning, increases blood glucose after eating, and over time, glycemia on an empty stomach. Therefore, it is useful to check the glucose level 2 hours after eating. With randomly detected blood glucose at any time of the day, more than 11.1 mmol/l (on laboratory equipment) immediately establish a diagnosis of diabetes.
Type 2 diabetes are also called insulin -dependent. At the beginning of the disease, this is so. Therefore, the basis of treatment is based:
- change in lifestyle, increased physical activity. In the elderly with a concomitant pathology, a consultation of a specialist, therapist, and a physiotherapist to determine the recommended individual physical exertion is always necessary. More often it is walking at a moderate pace daily, swimming, physiotherapy exercises;
- rational nutrition with a limitation of simple carbohydrates, animal fats, an increase in the amount of fiber consumed (vegetables);
- tablet drugs are widely used in the treatment of type 2 diabetes.
Specific drugs will be prescribed by the doctor based on the level of glucose in the blood and taking into account the accompanying chronic diseases;
- Insulin therapy in treatment is used at a certain stage of the course of the disease, when the effect of tablet drugs is exhausted.
A very important point in treatment is a decrease in blood glucose. Therapy of diabetes is primarily aimed at this. But sometimes with improperly selected treatment, an overdose of the drug, an irregular nutrition, a dangerous state develops- hypoglycemia (low blood sugar levels). At the same time, sharply increasing symptoms appear: weakness, sweating, feeling of hunger, anxiety, heartbeat, trembling in the body, fainting. Loss of consciousness is possible. In age -related patients, hypoglycemia symptoms can be lubricated or disguised as other conditions. Therefore, it is important not to adjust the use of drugs, the administration of insulin, to regularly conduct self -control of blood glucose with a glucometer and, if such states appear to consult a doctor.
Treatment of diabetes, the necessary daily self -control has difficulties in old age, since many patients develop age -related memory reduction, attention, and ability to learning.
For patients with elderly and senile age, the target values of glycemic control are not as stiff as for young ones. Not strict compensation for diabetes sugar, but risk correction of cardiovascular disasters, providing them with the necessary care and general-medical assistance (table No. 1) comes to the forefront
Table No. 1.
Target indicators of carbohydrate metabolism depending on the general state of health
Indicator | Group 1 Good health | Group 2 Intermediate Health | Group 3 Fragile patients | |
Characterization of patients | There is no comorbid pathology or 1-2 non-aabatic chronic diseases and there is no violation of activity in life or <1 restrictions in self-care | 3 or more non-human chronic diseases or something of the following: moderate cognitive dysfunction or dementia; >2 restrictions in self -service | One of: The final stage of the disease (cancer, chronic obstructive lung disease with oxygenotherapy. Chronic kidney disease, chronic heart failure, etc.) Pronounced dementia >2 restrictions on self -service, the need for a nurse | |
Determination of glycemic goals | ||||
Usage medicinal funds, Calling | No | Tocial glucose 5.0-7.2 Before bedtime 5.0-8.3 Ny1s <7.5% | 5.0-8.3 5.5-10.0 <8% | 5.5-7.2 7.2-10.0 |
Yes | Tocial glucose 5.0-8.3 Before bedtime 5.5-10.0 ny1s> 7.0 and <7.5% | 5.5-7.2 7.2-10.0 > 7.5 and <8.0 % | 5.5-10.0 8.3-13.8 > 8.0 and <8.5 | |
In hospitals or nursing houses, the target values of glycemia are on an empty stomach 5.55 - 7.77 mmol/l
Endocrinologist of the Minsk City Clinical Endocrinological Center L.V. Silvanovich
