Decompensated diabetes mellitus has been identified: what is it?

Compensated and decompensated diabetes mellitus: what is the difference?

To begin with, it’s worth understanding the basic information. Today, many people are faced with such a problem as decompensated diabetes mellitus. What it is?

If we are talking about a compensated form of the disease, this means that the patient’s blood glucose level is completely normal. This indicator can be maintained with the help of medications (including insulin), proper diet, rest and sleep.

But for one reason or another, the disease can become more complicated. Most often, decompensated diabetes mellitus type 2 is recorded, although a similar course is possible in the insulin-dependent form of the disease (type 1).

What indicators are important to determine the degree of compensation?

In the process of diagnosing this disease, several factors are taken into account.

• Blood sugar level is the most important indicator. Blood for testing is taken on an empty stomach. Normally, the result should range from 3.3 to 3.5 mmol/l.
• A blood test for glucotolerance is also performed. Two hours before donating blood, the patient takes a glucose solution. Normally, this figure should not exceed 7.7 mmol/l.
• It is important to determine the amount of glycated hemoglobin. During the analysis, it is possible to determine the ratio of hemoglobin molecules that have already combined with glucose to the total amount of hemoglobin. In healthy people, this figure ranges from 3-6%.
• A urine test is performed to check blood sugar levels. Normally, glucose is not excreted in the urine. The permissible limit for diabetics is 8.9 mmol/l.
• It is important to determine the amount of low-density cholesterol. In healthy people, this figure does not exceed 4 mmol/l.
• During the diagnostic process, blood pressure is also measured, because diabetes primarily affects the condition of blood vessels. As decompensation processes worsen, blood pressure rises. It is worth recalling that normally this figure should not exceed 140/90 mmHg. Art.
• By determining the level of triglycerides in the blood, you can calculate the likelihood of developing vascular complications in a patient.
• An important part of the diagnosis is determining the mass index, which normally should not exceed 24-25. Patients with diabetes (especially if we are talking about type 2 disease) often suffer from varying degrees of obesity.

Treatment methods

Therapeutic measures for decompensated heart failure are aimed at slowing down further progression of the disease, protecting target organs, and improving the patient’s quality of life.

These goals are achieved by carrying out the following activities:

• diet;
• establishing a physical activity regime;
• psychologist consultations;
• taking medications;
• electrophysiological correction of heart function;
• surgical intervention.

The greatest effectiveness of treatment is achieved by combining all of the above methods.

Diet

Therapeutic nutrition for decompensated heart failure helps normalize blood pressure, reduce the load on the heart, and provide the body with the necessary nutrients.

The diet is based on the following principles:

• reducing salt intake to 1 g per day;
• reducing fluid intake to one and a half liters per day;
• providing the necessary calorie content, sufficient protein content in food;
• enriching the diet with vitamins.

Body weight should be measured regularly. A weight gain of more than 2 kg in 3 days indicates an accumulation of fluid in the body.

An unfavorable sign is a decrease in body weight. A progressive decrease in the volume of fat and muscle tissue is called cardiac cachexia. This condition requires the introduction of specialized nutritional mixtures into the diet.

Physical activity

Physical activity is indicated for patients with decompensated heart failure, but with certain restrictions.

Contraindications to physical activity are:

• acute myocarditis;
• stenotic defects;
• severe arrhythmias;
• frequent attacks of angina pectoris.

For other patients, the degree of physical activity is determined by a six-minute test. Physical activity begins with breathing exercises, after 3-4 weeks the person moves on to light gymnastics. Simple and Nordic walking is considered the most optimal option for physical activity.

Recommendations for the regimen

Patients with decompensated heart failure are subject to some lifestyle restrictions:

• Abrupt climate change is not recommended;
• air travel is limited to no more than 2.5 hours without a break;
• smoking is excluded;
• sexual activity is limited;
• It is recommended to avoid emotional stress;
• it is necessary to get a full night's sleep;
• It is recommended to take short breaks from studying during the day.

Instructions on daily routine, nutrition, and lifestyle are given to the patient in special cardiology schools, which are organized at some medical institutions.

Drug therapy

Drugs used to treat CHF are divided into three groups according to their effectiveness:

• the main ones have proven effectiveness;
• additional - the effect is not present in all patients;
• auxiliary - used symptomatically.

The main group includes 6 classes of drugs.

Table. Drugs for the treatment of heart failure.

Additional drugs are prescribed in the presence of atherosclerosis, hypertension, and blood clotting disorders. They do not have a direct effect on the course of heart failure, but they reduce the severity of risk factors.

1. Statins - Atorvastatin, Rosuvastatin. Indicated in the presence of severe atherosclerosis. Helps normalize cholesterol levels.
2. Anticoagulants - Warfarin. Indicated for high risk of thrombosis in elderly patients.

These medications are prescribed by the attending physician if indicated. Auxiliary drugs are prescribed according to strict indications, as they do not have a positive effect on the course of heart failure.

The following groups are used:

• nitrates;
• calcium channel blockers;
• antiarrhythmics;
• antiplatelet agents;
• non-glycoside inotropes;
• cytoprotectors.

Patients with CHF are not recommended to take NSAIDs, glucocorticoids, or antidepressants. These drugs have a negative effect on the course of the disease.

Electrophysiological methods

Three main procedures are used:

• placement of a pacemaker;
• placement of ventricular electrodes;
• installation of a cardioverter-defibrillator.

Methods are used only after intensive drug therapy if its effectiveness is insufficient.

Surgery

Indicated when conservative therapy is unsuccessful. Several types of surgical interventions are performed.

1. Coronary artery bypass grafting. The operation is aimed at restoring the vascular network of the myocardium and improving its blood circulation.
2. Correction of mitral regurgitation. Performed in the presence of mitral prolapse.
3. Heart transplantation. The most effective method for terminal heart failure, but the possibility of its use is limited.

Contraindications to surgical treatment are severe bleeding disorders, liver cirrhosis, and renal failure.

Decompensated heart failure is a serious condition, often resulting in death. It develops as a result of a breakdown in the compensatory capabilities of the myocardium.

The clinical picture consists of symptoms of circulatory disorders of internal organs. Treatment is carried out comprehensively, using medicinal and non-medicinal methods, and surgical intervention.

Main causes of decompensation

You already know what factors are paid attention to when diagnosing decompensated diabetes mellitus and what it is. But what can trigger the onset of decompensation?

As reviews indicate, the reasons are individual in each case. Doctors identify the following risk factors:

• unhealthy diet, overeating, eating foods prohibited for diabetes;
• incorrectly drawn up treatment plan, unauthorized use of dietary supplements by the patient instead of prescribed medications;
• choosing the wrong dose of insulin;
• refusal of insulin treatment;
• infectious diseases that are accompanied by dehydration;
• constant stress, emotional overstrain.

Decompensated diabetes mellitus: symptoms

Unfortunately, many people face a similar diagnosis. What does “decompensated diabetes mellitus” mean? What symptoms accompany this pathological process? The clinical picture has a number of features:

• there is a sharp weight loss;
• patients complain of fatigue, constant weakness and drowsiness;
• the urge to urinate becomes more frequent;
• a characteristic sign of diabetes mellitus is dry mouth and severe thirst;
• sometimes it is possible to disrupt the functions of the visual analyzers.

If such symptoms occur, do not hesitate - you need to consult an endocrinologist. Constant monitoring of blood glucose levels is extremely important in this situation.

Symptoms

What is decompensated heart failure? If we consider the symptoms of the disease, we can see that it is characterized by the same manifestations as the initial stages of heart failure, but they are more pronounced.

A patient with heart failure in the stage of decompensation will present the following complaints:

• shortness of breath on exertion, fatigue - in 98% of patients;
• palpitations - in 80% of patients;
• coughing, asthma attacks are observed quite rarely.

The objective symptoms include the following:

• Almost every patient has high blood pressure;
• increased heart rate;
• the presence of swelling in the legs, in the abdominal cavity;
• swelling of the neck veins;
• increase in liver size;
• cyanosis of the face, lips, fingertips;
• changes in the terminal phalanges of the fingers like drumsticks;
• percussion enlarged the borders of the heart;
• wheezing in the lungs indicates stagnation of venous blood.

The classic triad of signs for CHF is a combination of edema, shortness of breath and wheezing in the lungs. However, these symptoms can also be observed in other diseases of the cardiac and respiratory systems, so they cannot be considered fundamental for making a diagnosis.

Almost every patient with HF has shortness of breath

Characteristic signs of cardiac dysfunction

Possible complications in the acute development of decompensation

How dangerous is decompensated diabetes mellitus? Complications are possible, and the list of them is quite large. The acute form of decompensation is dangerous, as it develops at lightning speed - complications develop within several hours, and sometimes even minutes.

• Hypoglycemia. This condition is accompanied by a sharp decrease in blood sugar levels. Patients feel severe weakness. There is a feeling of extreme hunger.
• Hyperglycemia. A sharp increase in glucose levels, which is very dangerous, as it can lead to the development of a coma.
• Ketoacidosis. This condition is accompanied by a sharp increase in sugar concentration. Metabolic disorders lead to the formation of ketone bodies, which are toxic to the body.
• Glucosuria. Glucose begins to be excreted along with the urine.
• Diabetic coma. During diabetes, insulin levels decrease along with an increase in sugar levels. However, tissues, in particular the structures of the nervous system, are not able to utilize glucose. The result of this is coma.

Stage of decompensation [edit | edit code ]

Any compensatory mechanism has certain limitations on the severity of the disorder that it is able to compensate for. Mild disorders are easily compensated, while more severe ones may not be fully compensated and with various side effects. Starting from a certain level of severity, the compensatory mechanism either completely exhausts its capabilities or itself fails, as a result of which further counteraction to the violation becomes impossible. This condition is called decompensation

.

A disease state in which disruption of the activity of an organ, system or organism as a whole can no longer be compensated by adaptive mechanisms is called in medicine the “stage of decompensation”. Reaching the stage of decompensation is a sign that the body can no longer repair the damage on its own. In the absence of radical treatments, a potentially fatal disease in the decompensation stage inevitably leads to death. For example, cirrhosis of the liver in the stage of decompensation can only be cured by a transplant - the liver cannot recover on its own.

Cardiac decompensation is the last stage of cardiac failure, manifested by many symptoms. At the first signs, you need to start treatment so that there is no need for a heart transplant.

Consequences of chronic decompensated diabetes

Chronic decompensated diabetes mellitus is extremely dangerous. A constant increase in blood glucose levels negatively affects the condition of blood vessels, nerve endings and organs of vision. There are a number of dangerous complications that the chronic process of decompensation can lead to.

• Nephropathy is a pathological damage to the kidneys, which is associated with increased pressure inside the organs and constant hyperglycemia. According to reviews, in most cases this disease leads to disability.
• Microangiopathy - accompanied by damage to small blood vessels.
• Diabetic retinopathy is a severe form of microangiopathy. The disease is associated with damage to the small vessels of the retina, which often leads to complete loss of vision.
• Disorders of the heart and blood vessels, including atherosclerosis, myocardial infarction and coronary heart disease.

What is hypothyroidism?

Hypothyroidism is a disease characterized by insufficient production of thyroid hormones.

In other words, hypofunction of the endocrine system organ develops. The thyroid gland produces thyroid hormones, the main ones being: triiodothyronine (T3) and thyroxine (T4).

The synthesis of these hormones occurs under the control of thyroid-stimulating hormone (TSH), produced by the pituitary gland. If the level of T3 and T4 in the blood is below normal, the pituitary gland begins to intensively produce the hormone TSH, which stimulates the hormonal function of the thyroid gland. When the amount of thyroid hormones exceeds the norm, the synthesis of TSH decreases, and thereby the production of T3 and T4 is inhibited.

Depending on the level at which disorders occur that lead to a deficiency of thyroid hormones, hypothyroidism is divided into the following types:

1. Primary – provoked by the occurrence of organic or functional changes in the tissues of the thyroid gland.
2. Secondary - appears due to disturbances in the activity of the pituitary gland, which is responsible for the production of thyroid hormones by the thyroid gland.
3. Tertiary - develops in case of damage to the centers of the hypothalamus, which synthesize the hormone thyrotropin-releasing hormone (TRH), which stimulates the production of TSH by the pituitary gland.
4. Peripheral - occurs after the appearance of disturbances in the processes of converting the hormone T4 into T3, as well as their movement throughout the body. This pathology is caused by metabolic failures; insufficient amounts of liver and kidney enzymes involved in the transformation of hormones, as well as other autoimmune processes. Pathology is very rare. It is also called transport or fabric.

The patient may develop manifest hypothyroidism, which has clear symptoms. A subclinical form of pathology with vague symptoms is possible.

Preventive actions

You already know why decompensated diabetes mellitus develops, what it is and what complications it can lead to. Of course, such a condition is dangerous and cannot always be corrected with medication. That is why it is much easier to prevent the development of the decompensation stage. You just need to follow a few simple rules.

• Patients with diabetes are advised to avoid spicy, starchy and salty foods, as well as foods containing glucose.
• You should not include fried foods in your diet. Doctors advise cooking food by steaming or in the oven - it is much healthier this way.
• It is worth paying attention to your diet - it is better to eat often, but in small portions.
• You need to monitor the balance of calories consumed and burned.
• Physical activity is an important part of a person's life with diabetes. Of course, we are talking about feasible activities, be it morning jogging, swimming or just a walk in the park.
• Experts recommend maintaining the correct work and rest schedule, as overwork affects hormonal levels and blood sugar levels.
• It is worth considering yoga and meditation, as this can help you cope with stress more easily.

Of course, diabetics should monitor their blood sugar levels themselves. If any changes or deterioration in your health occur, you should consult your doctor. The earlier the stage of decompensation is noticed, the greater the chance of preventing the development of certain complications.