Zuhra Pavlova, WHC, endocrinologist MSU University Hospital, scientific director of the Clinic for Systems Medicine https://t.me/doctorpavlova
The World Health Organization recognized obesity is not infectious epidemic of the 21st century. What is more, the disease progresses at the same rate? Type 2 diabetes mellitus (DM).
This is the American statistics, but this trend throughout the world. In 2010, when patients with type 2 diabetes numbered 285 million people have assumed that they will be 438 million by 2030, but already in 2011, when patients became 366 million forecast for 2030 have changed and suggested that such patients will be 552 million people (the image number 2-3).
And exactly it is clear that a mistake, because according to the WHO in 2016 422 million people are diagnosed with type 2 diabetes type was recorded. Unfortunately, this growth continues to this day.
So, on the basis of the statistical data that we have, each unit of BMI after 25 (this is the line, after which the excess begins body weight) increases the risk of type 2 diabetes by 12.1% and increasing waist circumference from 81 cm to 86 increases this risk disubstituted (picture number 4 and 5).
According to others, scientists have noted a 9-fold increase in the risk of developing diabetes type 2 in men with increasing BMI over 30 kg / m2.
BMI - a measure of the overweight and obesity. Author - Belgian scientist Quetelet. This criterion was introduced in the mid-19th century and does not reflect the true proportionality of different tissues in the body. In other words, BMI can be increased at the expense of fat or muscle mass. In the first case it is bad and good in the second.
From 18 to 25 kg / m 2 - normal body weight
from 25 to 29.4- overweight,
from 30 to 35 - 1 st. obesity
from 35 to 40 - 2 tbsp. obesity
from 40 to 45-3 Art. obesity
45 and the above 4-v., morbid obesity.
Based on statistics it is evident that Diabetes is the basis of accumulation of adipose tissue and the processes occurring in it.
What else contributes to the development of the disease:
1) Heredity - if your immediate family suffered from type 2 diabetes, there is a high probability of developing the disease you have.
2) malnutrition - irregular, unbalanced diet, high energy intake.
3) a sedentary lifestyle.
4) elevated levels of triglycerides and cholesterol, reduced level of HDL or a combination of both. It is necessary to look analyzes.
5) cardiovascular diseases.
6) polycystic ovaries in women.
7) birthweight over 4 kg
According to some studies 50% of patients, to determine the accidental, we did not know that suffer from type 2 diabetes type.
Is it so difficult to diagnose this disease?
Not really. The picture below reflects very well what has caused that diabetes is detected only when it is already not only developed, but also brings with it a lot of complications that develop in full within a few years.
If on prophylactic examinations or at most except for fasting blood glucose examination (which for many years will be the norm, despite the fact that developing prediabetes 10-15 years before the fasting glucose go beyond the norm), and would look more insulin, much earlier discovered that developed insulin resistance.
Insulin resistance - this is the pre-diabetes (a formula for calculating the index HOMA-insulin resistance: insulin glucose multiply and divide by 22.5 Anything less than 2.7 - the norm.. There is also a criterion that helps to suspect that all is not well - it's insulin levels above 10.4).
So, all that time, when fasting glucose more normal and the insulin is already growing, and with it, and insulin resistance, the following events occur:
- developing self-sustaining and systemic inflammation of adipose tissue,
- decreasing intestinal synthesis of incretin hormones, which provide for 80% insulin response during a meal,
- dying of pancreatic beta cells (the ones that produce insulin)
- deteriorating vascular inner shell (endothelial dysfunction),
- deteriorating liver and its fatty degeneration,
can be such a violation,
- as peripheral neuropathy,
renal failure,
retinopathy,
gout,
erectile disfunction,
violation of reproductive functions in both men and women,
changes substantially balance the steroid hormones, and more.
The higher the weight, the smaller man becomes mobile. The less it moves, the less it spends its energy resources, and consequently, more saves them, because background of insulin resistance people tend to want to eat constantly, with persuasion and force of will is not very effective.
The mechanism of this phenomenon is that - insulin can not take its receptor, in order to start a cascade of reactions that provide entry of glucose into the cell. Cell without receiving energy substrate, indicating that there was a shortage of energy resources.
The brain perceives it literally, and stimulates the hunger for a person to eat, and added resources, and increases the synthesis of insulin to "recycle" these resources come.
The result - a lot of blood, and insulin and glucose, and glucose in the cells of all well enough. Developing glucose toxicity.
Glucose, figuratively speaking, "prosaharivaet" nerve endings and blood vessels, disrupting blood flow at the periphery and nerve conduction.
This will continue until the exhaustion of the pancreas to synthesize insulin opportunities.
And then, an endocrinologist should assign the patient insulin replacement therapy to replace the lost function.
Diabetes is not a death sentence, but you have to obey the things that complicate your life. Therefore, guard your health, try to maintain your BMI is in the normal range, and if it is high, it is only at the expense of muscle mass, eat properly (all centenarians were maloeshkami) (and fructose and the products based on it is not something that can be used in patients with type 2 diabetes without limitations and consequences), be physically active and follow mode day! And remember, that heredity is only a need for more attention to their health!
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