The goal of diabetes treatment is to keep glucose at a level close to normal for a long time. If this fails, they say that the patient has decompensated diabetes. To achieve long-term compensation is possible only with the help of strict discipline. The treatment regimen includes: adherence to the mode and composition of nutrition, active, but not excessive exercise, timely taking of hypoglycemic drugs, the correct calculation and the introduction of insulin.
The results of the treatment are monitored daily with a glucometer. If a diabetic was able to achieve lasting long-term compensation, his risk of acute and chronic complications is significantly reduced, and his life expectancy increases.
Degree of Diabetes Compensation
According to Russian standards, diabetes is divided into 3 degrees:
Diabetes and pressure surges will be a thing of the past.
- Sugar normalization -95%
- Elimination of vein thrombosis - 70%
- Elimination of palpitations -90%
- Excessive Blood Pressure - 92%
- Increased vigor during the day, improved sleep at night -97%
- Compensation - Sugar indicators in a patient are close to normal. In type 2 diabetes, the blood lipid profile and blood pressure are also evaluated. When compensation is achieved, the risk of complications is minimal.
- Decompensation - glucose is constantly increased, or its level changes dramatically during the day. The patient's quality of life is seriously deteriorating, weakness is constantly felt, sleep is disturbed. Decompensation is dangerous high risk of acute complications, the rapid development of angiopathy and neuropathy. The patient requires correction treatment, additional examinations.
- Subcompensation - occupies an intermediate position between compensation and decompensation of diabetes. Sugar level is slightly higher than normal, so the risk of complications is higher. If the subcompensation is not eliminated in time, the carbohydrate metabolism disturbances will inevitably pass into the decompensation stage.
This classification is used to assess the effectiveness of treatment. For example, upon admission to a hospital, in the diagnosis, in addition to the type of diabetes, it is indicated “in the phase of decompensation”. If the patient is discharged with subcompensation, this indicates a properly selected therapy.
A quick transition from high to normal sugar is undesirable, as it leads to temporary neuropathy, blurred vision and edema.
In international practice, the degree of compensation is not used. Diabetes mellitus is estimated in terms of the risk of complications (low, high likelihood of angiopathy and microangiopathy).
Thanks to the development of medicine, with each decade, diabetics are getting more and more opportunities to bring their blood counts to normal, due to which their life expectancy has increased significantly, the number of complications has decreased. Along with the advent of new drugs and self-diagnostics, the requirements for diabetes are becoming tougher.
The WHO and the Federation of Diabetes mellitus established the following criteria for type 1 disease:
|Criterion||Norm||Good control||Insufficient control, decompensated diabetes|
|Glucose, mmol / l||Before meals||4-5||up to 6.5||> 6,5|
|Maximum after meals||4-7,5||up to 9||> 9|
|Before sleep||4-5||up to 7.5||> 7,5|
|Glycated hemoglobin, GG,%||up to 6.1||up to 7.5||> 7,5|
Type 2 diabetes is always accompanied by a deterioration of fat metabolism, so the lipid profile of blood is included in the compensation criteria:
|Criteria mmol / l||Complications|
|YY%||≤ 6,5||above 6.5||above 7.5|
|Fasting glucose, laboratory analysis||≤ 6,1||higher than 6.1||above 7|
|Glucose, measuring glucometer||before meals||≤ 5,5||above 5.5||higher than 6.1|
|maximum after meals||≤ 7,5||above 7.5||above 9|
|Cholesterol||common||≤ 4,8||above 4.8||above 6|
|low density||≤ 3||above 3||above 4|
|high density||≥ 1,2||below 1.2||below 1|
|Triglycerides||≤ 1,7||above 1.7||higher than 2.2|
Additional compensation criteria for type 2 diabetes:
|the good||insufficient (subcompensation)||bad (decompensation)|
|BMI||women||up to 24||24-26||more than 26|
|men||up to 25||25-27||more than 27|
|Arterial pressure||up to 130/85||130/85-160/95||more than 160/95|
The compensation criteria are not the same for all groups of patients. Adults of working age should tend to the "norm" column, if this does not increase the number of hypoglycemia. For children, diabetics of old age, patients with reduced sensitivity to hypoglycemia, target sugar levels may be slightly higher.
Target values are determined by the attending physician. In any case, they are within the limits of compensation or subcompensation. Decompensation is not justified for any patient.
The ability to control at home
To avoid diabetes decompensation, not enough laboratory tests before visiting a doctor. We need daily monitoring of blood parameters and pressure. The minimum set required for diabetics: blood glucose meter, blood pressure monitor, urine test strips with the ability to determine the level of ketones. Patients with obesity will also need floor scales. Dates, time and results of all home measurements should be recorded in a special notebook - a diabetic diary. The accumulated data will allow analyzing the course of the disease and changing the treatment in time to prevent decompensation.
To control sugar, the simplest blood glucose meter, lancets and test strips to it are sufficient. It is not necessary to buy expensive devices with a multitude of additional functions; it is enough to choose a trusted manufacturer and make sure that the meter is always on sale.
Sugar should be measured in the morning on an empty stomach, after any meal, before sleep. Decompensated diabetes needs even more frequent measurements: at night and with every deterioration in well-being. Only diabetics with mild type 2 disease can afford to measure sugar less often.
Acetone and sugar in the urine
Sugar in the urine appears most often with decompensation of diabetes, when its level in the blood is more than the renal threshold (about 9 mmol / l). It can also indicate kidney problems, including diabetic nephropathy. Measure urine sugar once a month.
During decompensation of diabetes, the risk of ketoacidosis and coma is high. In time to identify these complications can be using urine analysis on ketones. It should be done whenever sugar approaches a threshold of 13 mmol / l.
For home measurement of ketones and sugar in the urine, you need to purchase test strips, for example, Ketoglyuk or Bioscan. The analysis is extremely simple and takes only a couple of minutes. Be sure to read our article on acetone in the urine.
This indicator most accurately reflects the degree of compensation of diabetes and allows you to determine the average sugar in recent times. The analysis reveals the percentage of hemoglobin exposed to glucose for 3 months. The higher it is, the diabetes is closer to decompensation. Glycated (also used glycosylated variant) hemoglobin at home can be measured using special diagadgets or portable analyzers. These devices are expensive and have a high measurement error; therefore, it is more rational to take an analysis in the laboratory on a quarterly basis.
Decompensated diabetes is accompanied by pathological changes in the vessels and an increase in blood pressure. Hypertension leads to the rapid progression of angiopathy and neuropathy, therefore, for patients with diabetes, the criteria for normal pressure are stricter than for healthy people - up to 130/85. Repeatedly exceeding this level requires the appointment of treatment. Measure pressure preferably daily, as well as with dizziness and headache.
Factors of decompensation
To provoke the transition of diabetes into decompensated form can:
- wrong dosage of pills and insulin;
- failure to comply with the diet, incorrect calculation of carbohydrates in food, abuse of fast sugars;
- lack of treatment or self-treatment of folk remedies;
- incorrect insulin injection technique - more on this;
- untimely transition from pills to insulin therapy for type 2 diabetes;
- severe stress;
- serious injuries, surgery;
- catarrhal diseases, chronic infections;
- weight gain to the stage of obesity.
Decompensated diabetes leads to complications of 2 types: acute and chronic. Acute develops quickly, in a few hours or days, without treatment lead to coma and death. These include severe hypoglycemia, ketoacidosis, lactic acidosis, and hyperosmolarity.
Hypoglycemia is more dangerous than other complications, as it leads to irreversible changes in the shortest possible time. The first symptoms are hunger, inner tremors, weakness, anxiety. At the initial stage, it is stopped by fast carbohydrates. Patients in the state of precoma and coma is required fast hospitalization and intravenous glucose.
Very high sugar leads to a shift in blood parameters of several types. Depending on the changes, the hyperglycemic coma is divided into ketoacidotic, lactic acidotic and hyperosmolar. Patients need urgent medical care, insulin therapy is necessarily part of the treatment.
Chronic complications can develop over the years, their main cause is long-term decompensation of diabetes. Because of the high sugar, large (angiopathy) and small (microangiopathy) vessels are damaged, which is why the organs are disrupted. The most vulnerable of them are retina (diabetic retinopathy), kidneys (nephropathy), brain (encephalopathy). Also, decompensated type diabetes leads to the destruction of nerve fibers (neuropathy). The complex changes in the vessels and nerves - the cause of the formation of diabetic foot, tissue death, osteoarthropathy, trophic ulcers.