Types of Diabetes, diabetes type 1 – diabetes type 2

Question: Dear doctor. My mother 60 years (1947 pp.). Already for 16 years or more it suffers from diabetes, insulin never promulgated. Over the past 4 years her eyesight deteriorated. She was diagnosed – diabetic retinopathy. No surgery, laser correction was not. The last 2-3 days eyesight dramatically weakened. Doctors, to whom we spoke recommend surgery on the eye. I would like to know how effective can the operation and what are the chances of restoring vision. Can you recommend a clinic where you can make an operation with the greatest chance of recovery. (Is there some kind of statistics of the operations on the eye with a diagnosis of diabetic retinopathy? ") Thanks for the information.

Answer: Indeed, in diabetic retinopathy operation – the only method that improves eyesight. Other methods (such as laser coagulation of the retina) are needed for inhibition progressirvoaniya, but what is lost, they do not return. The operation is called vitrektomiya (removal of darkened vitreous, a sharp decline in eyesight is often associated with new hemorrhage (hemophthalmus). The best place I know in Moscow – Center for diagnosis and surgery, posterior eye (www. retina. Ru). And, of course, in all major ophthalmic clinics in Russia (IRTC "Eye Microsurgery", Institute of Ophthalmology, etc.) such operations are conducted. IRTC "Eye Microsurgery, it seems, has a branch in Irkutsk (if you're close). The more difficult problem to treat (a very intractable treatment) – retinal detachment due to diabetic retinopathy. In addition, the vision for the SD can be violated due to cataracts. In this case, surgery to replace the lens with an artificial darkened considerably improve vision. In the past 20 years, diabetes is not a contraindication for surgery in cataract.

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Question: My mother is sick with diabetes, more than that she, too, several other serious diseases, but recently I ktoto said that patients with diabetes do not live more than 30 years, it's true or not

Answer: This is not true – it all depends on how well the management of diabetes is carried out, how close is supported by the sugar to normal. You can read other questions in the "Diabetes" to look into this and see what assistance may be required to Mama.

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Question: Oleg! In my godmother SD type 2 for 15 years, she was 57 years, 3 years on insulin. In February, were strong swelling of legs, creatinine 280, made by computer-tomography, kidney, without significant changes. The hospital swelling removed, creatinine decreased to 180. But at home in 2 months it got worse again, swelling, hemoglobin 60, admitted to the hospital, creatinine was 350, with each week increasing to 100, edema does not subside, Laziksa dropper 2 times a day and 20 the effect does not give a urea is 40, urinated on 500 grams a day, from his leg was oozing fluid from 300-500 grams per day, to refuse to hemodialysis, kidney transplant, too, do they say it makes no sense, is it really all that can be our medicine? How can it help? And whether it was before all this warning

Answer: This is – manifestations of diabetic nephropathy (diabetic kidney disease). Now it is necessary that the patient saw a nephrologist (or will find themselves in the city, or in Moscow – www. Endocrincentr. Ru), he must appear quite frequently (every 1-3 months). In this situation, treatment is prescribed, inhibiting the degradation of the kidney (but this can not be done in absentia), you must also delete the administration of drugs that can damage the kidneys in these patients – anti-inflammatory drugs (NSAIDs – such as diclofenac, indomethacin, нурофена, etc.), antibiotics -aminoglycosides (gentamicin, amikacin), etc. Further, since the state of the kidneys can deteriorate with age – to look for a place where to hemodialysis (artificial kidney). In some cities, people with diabetes are denied dialysis, but this is disingenuous. Treatment of this situation is really a kidney transplant. Older (10-15 years ago) thought that the CD kidney transplant should not do (because if the SD generally more health problems than without DM), but has long been understood that it is not, in the transplant SD DO. The problem – the cost of drugs for preventing rejection, and the availability of donor organ (the most realistic to date in Russia – kidney transplant from a relative).

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Question: Doctor! Experience the SD type 1 uzhe23 year in recent years, the participation problems with the feet, everything starts from the rubbed sore shoes, and any shoes left at various places damaged skin. What

Answer: Probably due to long-term diabetes, you have decreased sensitivity of the feet (neuropathy), and your legs do not feel if the shoe rubs a little, a little cramped, etc. First, in this situation be very strictly and scrupulously abide by the rules to protect the feet of patients with diabetes (see below – is a detailed version of the rules. The leaflets, which are usually handed out, he often "pinched"). Secondly, the possible selection of special ( "poluortopedicheskoy or orthopedic) footwear, in which the risk of damage to lower due to a number of features of this shoe. In Russia, available in German footwear company "Schein", learn how to get it in Ukraine, and try to get into a good cabinet "Diabetic Foot" to give you advice on what type of shoe you need. Terms foot care: 1. Slight inflammation of the legs due to diabetes can develop into a major problem. Even with a small inflammation should consult your doctor. 2. Every day, wash your feet and gently (no rubbing), wipe them. Do not forget the interdigital intervals! After showering or swimming legs to dry thoroughly. 3. Inspect feet daily, in time to discover blisters, cuts, scratches and other damage, which may let the infection. Do not forget to examine the gaps between your fingers! Underside of the foot can easily look through the mirror. If you yourself can not do this, ask someone from the family members to see your feet. 4. Do not expose your feet Effects of very high and very low temperatures. The water in the bathroom at first hand, check to make sure that it is not very hot. If feet are freezing at night, wear warm socks Do not use heaters or other hot items! 5. Daily inspect their shoes – have not got it in her foreign objects, if not torn lining. All this can injure the skin or rubbing the legs. 6. It is important every day to change socks or stockings. Wear only suitable for the size of stockings or socks. You can not wear darned socks or socks with tight elastic. 7. Buy only the shoes, which from the outset is sitting comfortably on the leg, do not buy shoes that you want to break in (or stretch). Do not wear shoes with narrow toes, or one that squeezes the toes. Never wear shoes on his bare feet. Never wear sandals or sandals with a strap that goes between the toes. Never go barefoot, and, especially, on a hot surface. 8. For injuries: iodine, "permanganic acid, alcohol and" brilliant green "are contraindicated because of the tanning action. Bruises, cuts, etc., treat with hydrogen peroxide (3% solution) and better – special means (dioxidine, miramistin, chlorhexidine) and apply a sterile bandage. 9. Never use chemicals or drugs to soften calluses (like plaster "Salipod"). Never remove calluses cutting tools (razor, knife, etc.). For this purpose, use a pumice stone and similar special attachments. 10. Toenails should be cut straight, not rounded corners (short corners "grows"). 11. You should not smoke. (Smoking increases the risk of amputation in 2,5 times) 12. Dry skin lubricate their feet (but not the interdigital spaces) fatty cream (contains peach, sea buckthorn and other similar oils, cream "Children," "Effect"), and do not contain alcohol, or by special means (Balzamed, Kallyuzan).

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Question: Good day! In my acquaintance diabetes and sugar is jumping to 20 and above! But recently ill big toe – has appeared under the blue nogtemObyasnite please, what can help and how to avoid further such problems. I thank you, Docto

Answer: High blood sugar over time can cause complications of diabetes, in particular – to damage the nerve endings in the feet, because of which decreases the sensitivity. In this situation, if the shoe a little cramped and presses on the nail (the reason may be bent shank, thickened nails, etc.) – the foot does not feel. As a result, there hyponychial hemorrhage (nail "turning blue"). Some patients they suppurate (then the doctor will make a small hole in the nail to release the pus / accumulated liquid). If suppuration is not – it does not require treatment does not in itself but is a signal that can no longer wear shoes, which has created this bleeding, you should check footwear to the presence of foreign objects (they can not feel at SD). If the pressure on the finger will continue – probably increase bleeding, suppuration, formation of diabetic ulcers. In any case, should apply to the cabinet "Diabetic Foot" (for podiatry). This is a fairly common problem, especially in spring (when all the transitions from winter shoes demi, which is usually less spacious).

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Question: I am 55 years old, the first type of diabetes for 20 years. Since January this year, three times the general was taking a urine analysis: ketone bodies in urine up to 5 mmol / l (at a rate up to 0.49 mmol / l). The last two weeks very carefully controlling blood sugar levels (4 measurements per day glucometer), sugar, mainly within 3,4 – 8,6 mmol / l, over the past 13 days by days: 4,5, 5,8 , 1,9, 11,2 / 5,6, 8,6, 2,1, 8,1 / 3,8, 2,1, 2,1, 14,8 / 9,7, 4,7, 8 , 2, 2,8 / 10,9, 2,5 -, 4,8 / 7,7, 5,9, 1,9, 4,1 / 9,8, 5,1, 4,7 — / 5,8, 3,6, 3,7 – / 3,7, 1,8, 2,8, 5,2 / 5,3, 2,2, 8,6, 6,6 / 7,7 , 3,4, 2,3, 4,7 / 6,1, 3,7, 3,3, 7,1 / 4,4, -, -, 2,6 /. Glucometer seemingly normal (One touch II), compared with the testimony of another new Accu-chek, the latter testimony at 1,5-2 units above. In addition, Merya several times a day, the level of ketones in the urine test strips: in the morning is always about 5 mmol / liter. Day – less. Took Essenciale and Pancreatin, yesterday did not take, just in case. Today ketones in the urine again about 5 mmol / liter. I eat normally, do not eat meat, eat low fat (20 g of butter, cheese, 20-30 g, 10-20 g sunflower oil per day). Thirst, dry mouth, do not feel. What? In general, whether such a dangerous ketoacidosis

Answer: In diabetes, acetone, or speaks of decompensation (but the high blood sugar), or the so-called "hungry acetone (as a result of very limited quantity of carbohydrates in the diet). If blood glucose meter is not defective – it is "hungry acetone, it is not dangerous (but should increase the amount of carbohydrates – it must be for you at least 10 (but usually 12-15) XE / day). In general, acetone – a byproduct of splitting fats, and can occur when the metabolism switches from carbohydrates to fat.

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Question: My boyfriend (he is 30 years old) insulinozavimy diabetes. I am concerned the question: would not it be problems with conceiving a child? I heard that men with diabetes and erectile difficulties in conceiving, with the age-all strongly exacerbated. Is there a critical age for conception? How to support sexual activity maksimalnot long? Thank you.

Answer: Do any men over time, problems may occur in the sexual sphere, diabetes actually increases the risk (although certainly not at 100% of the men, and this reduces the risk of keeping sugar close to normal). But it usually manifests erectile disturbances. That is, if you are currently with erection and ejaculation are no problems – then everything is OK. Another common recommendation – close to normal sugar at least several weeks before conception to prevent problems associated with the violation of maturation of sperm.

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Question: I have for you this is the question. My mother is ill with diabetes, how much I do not know, but it uses insulin. it was so. Five years ago, and then maybe more, my mother clipped mazol on foot, not long after the wound heals within + – five years. Our doctors have argued that the need to smear ointment Kuriozin, drip into the wound dioksedin, and even advised to impose Vishnevsky ointment. but no changes were, we called the herbalist and he ordered the mother tincture, which she took in half a year and posavetoval wound lubricated Krasin and thank God wound practically dragged on, but not before they delayed there two, like it. doctors told what to do ligation more frequently, and rarely do they say something that's got it. we have to do in the dressing several times a day and now about a month ago, she opened a third wound, and they are all located on the foot. my mother took a dislike to doctors for such an attitude to diabetchikam and thus decided to continue in the same spirit. But time passed, the foot bothered, but the wound grew deeper and gnoilis. the courage my mother calls emergency doctors and taken to hospital. there once done cleaning her feet, walked across the foot pus and almost did not rise above. she was offered amputation of his leg, but she disagreed saying that she will fight for it, though, and we, the family did not consent. now mom make dressing once in 2.3 days, referring to the fact that the wound can not be disturbed. they kolyat her vitamins, and leg obrabaotyvayut potassium permanganate and sea salt, but I think that the results nikakh not, though I hope for the best. diagnose ostemelit, but how strange they do, walk around and nothing intelligible to say they can not. talk about the expansion of tissue. and I beg you to help me, or rather my mom. you need to ensure that it cured. where to go, what medicines are needed and what clinic you very good, maybe I'll send it to you. and tell me honestly whether you can do is heal and avoid amputation of his legs. So my mom with childhood luck with his health. she was born with a sick leg, after she broke her several times and even her doctors themselves broke inserting apparatus elizarova, but now more and wounds pootkryvat. Help me! please answer

Answer: When trophic ulcers on the background of SD should be: * the correct local treatment: application of modern dressings (non-adherent to the wound, unlike gauze), * protection from stress ulcers in walking (there are special handling devices ), * competent application of antibiotics for infection. * Approximation of blood sugar to normal (compensated diabetes). If the Alma-Ata is the office or branch "Diabetic Foot" – should seek advice there. In this case, treatment is usually more successful than in non-surgical department. Approximately 30% of diabetic ulcers – ischemic (ie, caused by violation of blood flow to the foot). If confirmed this diagnosis – medical treatment is much less effective. make a difference helping some of the "cardiovascular" drugs (vazaprostan (analog – alprostan), but it is expensive and they need the experience of its application by the treating physicians. The other "vascular" drugs virtually useless in the treatment of ischemic ulcers). The most effective way to restore blood flow – the operation of vessels (bypass surgery or balloon angioplasty). In order to reliably assess the state of the vessels should duplex ultrasound scanning arteries (or angiography). A significant narrowing of the arteries is more than 60-70%. For osteomyelitis (suppurative process involving the bone): its treatment is really very difficult. Previously, the main treatment was the removal of bone (usually amputation) – amputation of the finger with a good blood flow and a high amputation – in ischemic form (because in her lower amputation is usually not heal unless you restore the patency of vascular surgery). Now the alternative is sufficiently powerful and long-term (at least 6-8 weeks) course of antibiotics. If antibiotics are assigned based on seeding of microbes from a purulent focus, if modern drugs, and they really take no breaks and that all contained at the beginning of treatment as in trophic ulcer – the probability of cure without amputation 70%.

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Question: My grandfather, he was 74 years old, diabetes. Recently transferred to insulin, previously treated tablets. The problem is that much burning feet. Lay in the hospital, where he made a dropper, like easier. I was told they should go, but after discharge has not passed, burning even more. He is very boitsya possible amputations. What should I do to help him

Answer: Usually burning feet is a sign of diabetic polyneuropathy (nerve damage in his legs at the level of sugar above normal), although other possible causes (fungus and other diseases of the skin). Treatment of polyneuropathy is the maintenance of glucose as close to normal (you can help by providing it with glucometer and test strips to monitor glucose before meals, which allows to adjust the insulin dose on the instructions of the attending physician) + preparations tioktovoy acid (tioktatsid, berlition , tiogamma) intravenously, then – vnurtr 2-3 months (probably, they were assigned) + when expressed pain – painkillers (tablets or ointments). This in itself is burning does not lead to amputation or the formation of wounds on the legs, etc. (you can calm him down). But it is usually accompanied by a decreased sensitivity stop, because of what may occur unnoticed damage to the skin, and this – the way to diabetic ulcers. To prevent this, we must comply with special rules for foot care in diabetes (inspect on a daily basis, do not walk without shoes, etc. – you can look at www. Primamedica. Ru, or on other websites), it is desirable – to visit the clinic "Diabetic Foot" ( if there is in the city), to obtain more detailed recommendations, which are possible after the examination and some simple surveys.

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Question: Good morning doctor. 1. ODS corner nail toe, gives a lot of trouble (pain, a small abscess). How do we fix that, and how to do, what resources to use (at home)? If you are not hard to describe step by step all the steps. 2. Sometimes a feeling that some inner shaking while visually normal, what is it? Special diets do not hold, the level of sugar in the average from 5 to 9. Thank you very muc

Answer: Yes, it will be difficult to explain this on his fingers. . . . 1. Normally, the corners of the nail should lie on top of the skin. If they cut too short, plunge deep into the corners (grow into), and in the end sooner or later becomes inflamed. This inflammation is practically impossible to cure until the nail in the process of growth rests on the soft tissue (ie, the problem is in fact – mechanical). If the angle of the nail sunk deeply – must be removed plastingi edge of the nail surgically. If you are not very deep – you can try (in a medical office, but in your situation – possibly your own) put under the corner nail lump of cotton wool, twisted "the flagellum. Inflammation can be reduced to drip under the corner of the nail solution of povidone-iodine (Betadine =, akvazan), and put a gauze bandage with this solution – it reduces inflammation and slightly dried. Strong dry a little (burn Zelenkov, etc.) it makes no sense. 2. At the time of this internal shaking necessary to measure sugar. If it is below 3. 5 or so – it is hypoglycemia (see FAQ), but it is possible only if you get hypoglycemic tablets or insulin (from your question is not clear). If the sugar above 4-4. 5 – this internal shaking is not related to diabetes (possibly "nervous"). > Special diets do not hold, the level of sugar in the average from 5 to 9. Make an analysis of glycated hemoglobin (HbA1c), if it is above 7-7. 5% – means you live at the level of sugar, which quickly leads to complications, and treatment of diabetes should be reviewed.

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