The hardest losses in recent years were related to oncology – Dmitry Khvorostovsky, Mikhail Zadornov, Zhanna Friske, Iosif Kobzon. Cancer is always scared, seems to be a deadly disease. (why is it really not the case, what kind of breakthroughs occurred in the fight against cancer – read in Health section on the site kp.ru). And suddenly – shock: the death of 38-year-old singer Juliaof diabetes. Why is the & # 39; diabetes & # 39; Started so early and developed so quickly as diabetes is traditionally considered a disease of the elderly? How can diabetes mellitus start even if Yulia did not have a major risk factor – obesity, her parents were not sick with diabetes and did she lead an active lifestyle?
– Valentin Viktorovich, for you, an endocrinologist with a lot of experience, is this case unique, a rare exception?
– Diabetes is much more common in old age, after 55 – 60 years. But this case, as a doctor, does not shock and amaze me. In the past 20-30 years, the disease is really younger. And now the diagnosis of type 2 diabetes at 30-40 years and even among adolescents is not surprising.
– All because modern people have a lot of fast food, & # 39; fast & # 39; started to eat carbohydrates, to get obese, and from him to diabetes to give way?
– This is the simplest and only partially correct explanation, which is very useful to use for a wide audience. Not to go into details and … don't get to the bottom of the true reasons. In fact, both the style of eating and the lifestyle of humanity have not changed so much in recent decades that this could explain the current scale of diabetes. We can even talk about the epidemic. And by 2030, according to the World Health Organization, the number of people with type 2 diabetes will reach 310 million people worldwide.
More knowledge – more questions
– Scientists studying aging say that the development of diabetes in the elderly is due to a general weakening, deterioration of the body and the accumulation of errors in various organs and systems. Do diabetes lead to other factors among young people?
– Maybe yes. The more we study, the more mysterious we find in this disease. People used to use one name – "diabetes mellitus", but now the realization is that type 2 diabetes itself is heterogeneous, meaning that it is different. For example, 30-40 percent of patients require insulin administration, others do not (this is not about the different stages of the same disease.) Car.).
– Do you know what causes diabetes most often?
– In most cases, this violation of insulin production is combined with a violation of the effects, which in turn is combined with obesity in a significant proportion of cases.
– You said diabetes raises questions for scientists and doctors. What, for example?
– One of the most important is the connection between diabetes and cardiovascular disease.. It used to be enough for a patient to normalize the leveland everything will be okay. But it turned out that that wasn't enough. It was found that there are also serious lipid disorders in diabetes (that is, in the metabolism of fats in the body.) author) .. This causes atherosclerosis. And even after the normalization of sugar in patients, a high death rate from cardiovascular disease, heart attacks and strokes. That is why modern treatment standards are not only responsible for monitoring sugar, but also for adjusting it exchange.
But in general it's all about high sugar being just the tip of the iceberg. Diabetes itself is a very complex, multifactorial disorder in the body. And it not only manifests itself by all known increases in blood glucose levels.
What is dangerous overweight?
– Why is obesity often the precursor to diabetes?
– In short, obesity is accompanied by a decrease in the sensitivity of our tissues to insulin. This increases the blood sugar level.
In general, when we talk about the causes of diabetes, the so-called beta cell theory is now considered important (pancreatic beta cells produce the hormone insulin, which promotes the penetration of glucose into the cells of the body.) Car.). With diabetes, insulin production is weakened. A healthy person has insulin spikes and troughs, thanks to such fluctuations the normal sensitivity to this hormone is maintained. And when the level of insulin remains consistently high, the cells of the body lower the sensitivity to it. As a result, the blood sugar level rises.
But remember, we were talking about riddles? Obesity is now found in around 20% of the population of developed countries, which is one in five. And diabetes mellitus is only about 20-30% of them. That is, the vast majority of people with obesity do not have diabetes. This means that obesity alone is not enough for the development of diabetes.
Evolution versus fast food
– Not everyone understands why fast food helps to start diabetes.
– When we eat refined food, we are in conditions of excessive abundance of food, for our body it is unnatural. Thirty thousand years ago food had to be obtained with great difficulty. There is no such thing to reach out and you will receive everything. Our genome and the body have hardly changed at this time and the metabolism is "not attuned" to the fact that it is surrounded by a multitude of foods consisting of refined calories.
"Could our body not develop over these 30 thousand years to adapt to more frequent nutrition?"
– Firstly, this is an insignificant short period for evolution. And second, what kind of human evolution can we discuss if we have artificially eliminated its main driver – natural selection? For us, as humans, it is a blessing, we treat sick patients who would die in the wild. Then they have children. For this, including, artificial reproduction techniques can be used, in vitro fertilization. Medications make it possible to save prematurely born babies.
– Biologists say that as a result, unfavorable genetic changes accumulate, so in the future humanity will have to adapt the genome to survive. But it will still be. Or maybe young people who are overweight get sick of diabetes just because of genetic lesions that are invisible to the eye, that were not critical to the parents individually, but "shot" of the child?
– Yes, this is possible.
About genetic testing and stress
– Then it might be useful to perform genetic tests to determine your susceptibility to diabetes?
– The difficulty is that diabetes can occur as a result of a "breakdown", not in one, not in five or even in ten genes. Dozens of genes are known, some of which may be related to the development of diabetes. But today you don't change your genes. And in any case there are so-called influenceable risk factors. Simply put – the rules that everyone must follow to reduce the risk of not only diabetes, but also a number of other dangerous diseases (see "Be warned").
– What role does stress play?
– In general, someone who is less stressful usually lives longer. At the same time, in the modern world with an abundance of food under chronic stress, obesity often develops – people seize the experience.
– They also say that when stress increases blood sugar levels. That is, will he stay high with frequent stress?
– If a person is healthy, there is no violation of insulin, then such a sugar increase is not dangerous due to stress. They are very short-lived, sugar quickly returns to normal. The most striking example is war periods. Stress was catastrophic, but people had no increase in the number of cases of diabetes.
How long can you live with diabetes?
– Doctors who treat another illness of the century, HIV, ensure that it is possible to live with it as if without HIV – if you strictly follow the treatment rules, lead a correct lifestyle, etc. Can you also say about diabetes?
– I can say more. According to some data, the life expectancy of officially registered diabetics in our country is on average higher than that of people without diabetes. She is more than 70 years old. The explanation is simple: if someone has diabetes, he often goes to the clinic, passes tests, and is simply under medical supervision. In the absence of diabetes, our fellow citizens considerablyappear in the field of vision of doctors. The essential part is located between the TV and the refrigerator and rinses the chips with beer or vodka until a heart attack or stroke catches up. If we compare patients with diabetes and people who pay attention to their health, while actually paying, the mortality rate among diabetics is of course much higher.
What do people with diabetes suffer from?
– 75% of patients with diabetes die from cardiovascular complications, which are now considered to be independent diseases.
– Malignant tumors are diagnosed much more often in patients with diabetes. The researchers suggest that this may play the role of so-called growth factors that circulate excessively in the body with diabetes. Excessive growth factors increase the risk of uncontrolled cell division and the occurrence of a tumor.
– The death directly from diabetes itself is a diabetic coma. fromUnits die today. In most cases – if a person has lost self-control and does not take the necessary measures to correct the sugar content and the associated diseases, Valentin notes .
BE IN THE COURSE
Five rules for reducing the risk of diabetes
1. Remove excess weight.
2. Move more. "Physical activity increases insulin sensitivity, making the body healthier – reducing both the risk of diabetes and cancer," says Professor Fadeev.
3. Try to avoid fast food, refined food, ie fully processed food.
4. Ensure adequate sleep. The less a person sleeps, the more he eats, the risk of obesity increases.
5. Try to control the level of stress. The easiest and safest way to reduce stress is a reasonable physical activity.
Valentin Fadeev – Endocrinologist, corresponding member of the Russian Academy of Sciences, professor, doctor of medicine, head of the endocrinology clinic, head of the endocrinology department no. 1 of the medical faculty of the University of Sechenov.
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