E10-E14 Diabetes mellitus. Diabetes: types and causes of their development, course and manifestations, how to treat, possible consequences Causes of hyperglycemia in healthy people

Complications of diabetes mellitus include vascular damage, nervous system, urinary system, development of coma, etc.
The following symptoms will allow you to suspect vascular damage in diabetes:
- Visual impairment.
- Formation of ulcers on the lower extremities.
- High blood pressure.
- Pain in legs when walking.
- Substernal pain and other symptoms.
A dangerous complication that occurs with diabetes is vascular damage. Diabetic angiopathy occurs in the form of macro- and microvascular disorders. Microvascular complications include retinopathy, nephropathy and angiopathy lower limbs diabetic origin. Macrovascular complications include aortitis, arteriosclerosis of coronary and cerebral vessels, atherosclerosis of peripheral vessels.
Diabetic retinopathy is a lesion of the retinal vessels, characteristic of both insulin-dependent and non-insulin-dependent diabetes. Diabetic retinopathy can manifest itself not only with blurred vision, but also with hemorrhages in the retina and vitreous body.
Damage to retinal vessels in diabetes mellitus can occur in 2 forms - background or proliferative retinopathy. Background retinopathy is characterized by small hemorrhages, metabolic products are deposited in the retina, and retinal edema develops. Background retinopathy develops more often in old age and leads to a sluggish decrease in vision.
Proliferative retinopathy develops due to impaired blood supply to the retina. Retinal detachment is often observed. It is observed mainly at a young age.
It has been established that at the time of diagnosis of type 2 diabetes mellitus, 21% of patients already suffer from retinopathy. The diagnosis of diabetic retinopathy is made based on an examination of the fundus by an ophthalmologist, assessment of visual fields, intraocular pressure, scanning the internal structures of the eye.
Diabetic neuropathy is a lesion of various parts of the nervous system due to diabetes mellitus. There is a classification into symmetric generalized polyneuropathy and focal (polyfocal) mononeuropathy. Further progression of diabetic neuropathy leads to the development of trophic ulcers and the formation of a “diabetic foot”. The presence of diabetic neuropathy can be suspected if there is burning pain in the legs, especially at night, discomfort(paresthesia), decreased pain, temperature and tactile sensitivity. The skin becomes dry, the temperature of the affected part of the body decreases or increases. This type of neuropathy develops most often in type 2 diabetes mellitus, in elderly patients. Central diabetic neuropathy includes the development of encephalopathy and myelopathy.
An equally common complication of diabetes is kidney damage - diabetic nephropathy. The mechanism of development of diabetic nephropathy is associated with damage to the renal vessels. In conditions of hyperglycemia and hypertension, the kidneys lose the ability to perform their physiological functions - filtering and concentrating urine. This is the most common cause of disability and mortality among patients with diabetes. Nephropathy in diabetes develops in 5 stages:
1. At the onset of the disease, the stage of renal hyperfunction. An increase in glomerular filtration rate is observed, renal blood flow increases, and the renal parenchyma hypertrophies. Protein is not detected in the urine.
2. After 2-5 years from the onset of the disease, initial structural changes in the renal tissue occur. The second stage is characterized by thickening of the basement membrane, expansion of the mesangium, and the level of protein in the urine is still not elevated.
3. The third stage is formed after 5-15 years, increased blood pressure and microalbuminuria are detected.
4. Severe nephropathy (4th stage) develops after 10-25 years, pronounced proteinuria is detected, and the glomerular filtration rate is moderately reduced.
5. Uremia develops 5-7 years after the onset of proteinuria. The glomerular filtration rate is less than 10 ml/min, symptoms of intoxication and arterial hypertension.
Diabetic nephropathy is dangerous because it may not manifest any clinical signs until the terminal stage. For timely diagnosis of this complication, it is necessary to promptly submit a urine test, where the main role is played by the detection of albuminuria, determination of urea and creatinine levels. It has been established that 20% of patients with diabetes develop diabetic nephropathy (Kimmelstiel-Wilson syndrome) within 20 years. In 50% of patients the course of the disease is complicated by chronic renal failure.
Diabetic foot is a syndrome in diabetes mellitus caused by angio- and neuropathic mechanisms. The first stage of diabetic foot development includes superficial ulcers on the plantar surface of the foot, with calluses under which the ulcerative surface opens.
A deep ulcerative defect accompanied by infection, which does not reach the bone tissue, develops with the 2nd degree of development of the diabetic foot. Further progression with bone involvement and the development of osteomyelitis leads to grade 3. Then limited gangrene develops (grade 4), and extensive gangrene (grade 5 of diabetic foot).
Diabetic foot syndrome manifests itself in a neuropathic or ischemic form. The neuropathic variant is characterized by pink color skin, sharply reduced pulsation, the presence of cracks, painless ulcers, calluses, with the development of gangrene of the fingers and Charcot joints. Hyperkeratosis of the nails and neuropathic edema of the foot are added.
The ischemic form is accompanied by pallor of the skin of the foot, the integument is cold to the touch, and there is also no pulsation. Painful ulcers and gangrene of the fingers occur.

Blood sugar levels are not always a constant value and can change depending on age, time of day, diet, physical activity, and the presence of stressful situations.

Blood glucose levels can rise or fall based on the body's needs. This complex system is controlled by pancreatic insulin and, to some extent, adrenaline.

When there is a lack of insulin in the body, regulation fails, which causes metabolic disorders. After a certain time, an irreversible pathology of internal organs is formed.

To assess the patient’s health status and prevent the development of complications, it is necessary.

Sugar 5.0 - 6.0

Blood sugar levels within 5.0-6.0 units are considered acceptable. Meanwhile, the doctor may be wary if the tests vary from 5.6 to 6.0 mmol/liter, as this may symbolize the development of so-called prediabetes

Acceptable levels in healthy adults can range from 3.89 to 5.83 mmol/liter.
For children, the norm is considered to be between 3.33 and 5.55 mmol/liter.
The age of children is also important to consider: in newborns up to a month old, the levels can range from 2.8 to 4.4 mmol/liter; up to 14 years of age, the values range from 3.3 to 5.6 mmol/liter.
It is important to consider that with age these data become higher, so for older people over 60 years of age, blood sugar levels may be above 5.0-6.0 mmol/liter, which is considered normal.
During pregnancy in women, due to hormonal changes, data may increase. For pregnant women, test results from 3.33 to 6.6 mmol/liter are considered normal.

When testing venous blood glucose, the norm automatically increases by 12 percent. Thus, if you do an analysis from a vein, the data can vary from 3.5 to 6.1 mmol/liter.

Also, indicators may vary if you take whole blood from a finger, vein or blood plasma. In healthy people, the average plasma concentration is 6.1 mmol/liter.

If a pregnant woman has blood taken from her finger on an empty stomach, the average data can vary from 3.3 to 5.8 mmol/liter. When examining venous blood, values can range from 4.0 to 6.1 mmol/liter.

It is important to consider that in some cases, under the influence of certain factors, sugar may temporarily increase.

Thus, glucose data can increase:

Physical labor or training;
Prolonged mental work;
Fright, fear or acute stressful situation.

Also, in addition to diabetes, diseases such as:

The presence of pain and pain shock;
Acute myocardial infarction;
Brain stroke;
Presence of burn diseases;
Brain injury;
Carrying out a surgical operation;
Epilepsy attack;
Presence of liver pathology;
Fractures and injuries.

Some time after the influence of the provoking factor is stopped, the patient’s condition returns to normal.

An increase in glucose in the body is often associated not only with the fact that the patient consumed a lot of fast carbohydrates, but also with sudden physical activity. When muscles are stressed, they need energy.

Glycogen in muscles is converted to glucose and released into the blood, causing blood sugar levels to rise. Next, glucose is used for its intended purpose, and sugar returns to normal after a while.

Sugar 6.1 - 7.0

It is important to understand that in healthy people, capillary blood glucose levels never increase above 6.6 mmol/liter. Since the concentration of glucose in blood from a finger is higher than from a vein, venous blood has different indicators - from 4.0 to 6.1 mmol/liter for any type of study.

If the blood sugar data on an empty stomach is above 6.6 mmol/liter, the doctor usually diagnoses it, which represents a serious metabolic failure. If every effort is not made to normalize the health status, the patient may develop type 2 diabetes.

With prediabetes, the blood glucose level on an empty stomach ranges from 5.5 to 7.0 mmol/liter, glycated hemoglobin levels range from 5.7 to 6.4 percent. One or two hours after eating, blood sugar test data range from 7.8 to 11.1 mmol/liter. At least one of the signs is enough to diagnose the disease.

To confirm the diagnosis, the patient must:

take a repeat blood sugar test;
take a glucose tolerance test;
examine blood for glycosylated hemoglobin levels, since this method is considered the most accurate for detecting diabetes mellitus.

The age of the patient must also be taken into account, since in old age data from 4.6 to 6.4 mmol/liter are considered normal.

In general, an increase in blood sugar in pregnant women does not indicate obvious disorders, but it is also a reason to worry about your own health and the health of the unborn child.

If during pregnancy the sugar concentration increases sharply, this may indicate the development of latent diabetes. If a pregnant woman falls into a risk group, she is registered, after which she is assigned to undergo a blood test for glucose and a load test for glucose tolerance.

If the concentration of glucose in the blood of pregnant women is above 6.7 mmol/liter, the woman most likely has diabetes mellitus. For this reason, you should immediately consult a doctor if a woman experiences symptoms such as:

Feeling of dry mouth;
Constant thirst;
Frequent urination;
Constant feeling of hunger;
Appearance unpleasant odor from mouth;
Formation of a sour metallic taste in the mouth;
Appearance general weakness and frequent fatigue;
Blood pressure rises.

To prevent the onset of gestational diabetes, you need to regularly see your doctor and take all necessary tests. It is also important not to forget about a healthy lifestyle, and, if possible, avoid frequent consumption of foods with a high glycemic index, high content of simple carbohydrates, and starches.

If you take all the necessary measures in a timely manner, the pregnancy will pass without problems, and a healthy and strong baby will be born.

Sugar 7.1 - 8.0

If the indicators are morning hours on an empty stomach in an adult are 7.0 mmol/liter or higher, the doctor can confirm the development of diabetes mellitus.

In this case, blood sugar data, regardless of food intake and time, can reach 11.0 mmol/liter or higher.

In the case when the data is in the range from 7.0 to 8.0 mmol/liter, while there are no obvious signs of the disease, and the doctor doubts the diagnosis, the patient is prescribed a test.

To do this, a blood test is taken from the patient on an empty stomach.
75 grams of pure glucose is diluted with water in a glass, and the patient must drink the resulting solution.
The patient must be at rest for two hours; he must not eat, drink, smoke or move actively. After which a repeat blood sugar test is taken.

Pregnant women are required to take a similar test for glucose tolerance at midterm. If, according to the results of the analysis, the indicators are from 7.8 to 11.1 mmol / liter, it is considered that tolerance is impaired, that is, sensitivity to sugar is increased.

When the analysis shows a result above 11.1 mmol/liter, diabetes mellitus is preliminarily diagnosed.

The risk group for developing type 2 diabetes mellitus includes:

People who are overweight;
Patients with constant blood pressure of 140/90 mmHg or higher;
People whose blood cholesterol levels are higher than normal;
Women who were diagnosed with gestational diabetes during pregnancy, as well as those whose child weighed 4.5 kg or more at birth;
Patients with polycystic ovary syndrome;
People who have a hereditary predisposition to developing diabetes.

For any risk factor, it is necessary to take a blood sugar test at least once every three years, starting from the age of 45.

Overweight children over 10 years of age should also be tested regularly for sugar.

Sugar 8.1 - 9.0

If three times in a row the sugar test shows inflated results, the doctor diagnoses type 1 or type 2 diabetes mellitus. If the disease is advanced, high levels of glucose will also be found in the urine.

Besides hypoglycemic drugs, the patient is prescribed a strict therapeutic diet. If it turns out that your sugar rises sharply after dinner and these results persist until bedtime, you need to reconsider your diet. Most likely, high-carbohydrate dishes are consumed, which are contraindicated for diabetes.

A similar situation can occur if a person has not eaten properly throughout the day, and when he comes home in the evening, he pounces on food and eats an excess portion.

In this case, in order to prevent sugar spikes, doctors recommend eating small portions evenly throughout the day. Fasting should not be allowed, and carbohydrate-rich foods should be excluded from the evening menu.

Sugar 9.1 – 10

Blood glucose levels of 9.0 to 10.0 units are considered the threshold value. When the data increases above 10 mmol/liter, the kidneys of a diabetic are not able to perceive such a large concentration of glucose. As a result, sugar begins to accumulate in the urine, which causes the development of glucosuria.

Due to a lack of carbohydrates or insulin, the diabetic’s body does not receive the required amount of energy from glucose, and therefore fat reserves are used instead of the required “fuel”. As you know, ketone bodies are substances that are formed as a result of the breakdown of fat cells. When blood glucose levels reach 10 units, the kidneys try to remove excess sugar from the body as waste along with urine.

Thus, diabetics whose blood sugar levels are above 10 mmol/liter in several blood measurements need to undergo a urine test for the presence of ketone substances. For this purpose, special test strips are used to determine the presence of acetone in the urine.

Also, a similar study is carried out if a person, in addition to high data of more than 10 mmol/liter, suddenly feels unwell, the body temperature has increased, and the patient feels nausea and vomiting. Such symptoms allow timely detection of decompensation of diabetes mellitus and prevent diabetic coma.

When lowering blood sugar with the help of antihyperglycemic drugs, physical exercise or insulin, the amount of acetone in the urine decreases, the patient’s performance and general well-being improves.

Sugar 10.1 – 20

If a mild degree of hyperglycemia is diagnosed when blood sugar levels are from 8 to 10 mmol/liter, then when the data increases from 10.1 to 16 mmol/liter, the average degree is determined, above 16-20 mmol/liter is a severe degree of the disease.

This relative classification exists to guide doctors when they suspect the presence of hyperglycemia. Moderate and severe degrees indicate decompensation of diabetes mellitus, resulting in all sorts of chronic complications.

There are the main symptoms that indicate high blood sugar levels from 10 to 20 mmol/liter:

The patient experiences frequent urination, sugar is found in the urine. Due to the increased concentration of glucose in the urine, the underwear in the genital area becomes as if starched.
At the same time, due to the large loss of fluid through urine, the diabetic feels intense and constant thirst.
The mouth feels constantly dry, especially at night.
The patient is often lethargic, weak and gets tired quickly.
A diabetic suddenly loses weight.
Sometimes a person feels nausea, vomiting, headache, the temperature rises.

The reason for this condition is due to an acute lack of insulin in the body or the inability of cells to act on insulin in order to utilize sugar.

At this moment, the renal threshold is exceeded above 10 mmol/liter, it can reach 20 mmol/liter, glucose is excreted in the urine, which causes frequent urge to urinate.

This condition leads to loss of moisture and dehydration, which is what causes the unquenchable thirst of a diabetic. Along with the fluid, not only sugar leaves the body, but also all kinds of vital elements, such as potassium, sodium, chlorides, as a result a person feels severe weakness and loses weight.

The higher the blood sugar level, the faster the above processes occur.

Blood sugar above 20

With such indicators, the patient experiences strong signs of hypoglycemia, which often leads to loss of consciousness. The presence of acetone at 20 mmol/liter and above is most easily detected by smell. This is a clear sign that diabetes is not being compensated for and the person is on the verge.

You can identify dangerous disorders in the body using the following symptoms.

Blood sugar is 10, what does this mean? This indicator indicates elevated level glucose dissolved in the blood. There are many ways to lower the rate. To find out your blood sugar level, you should have your blood tested early in the morning before or after meals. Older people should perform this test about 3 times a year. When diabetes is detected, a home device is used to measure the indicator daily: it is convenient and inexpensive.

Increased sugar

Elevated blood sugar is called hyperglycemia. An increased rate may be normal, but will only be an adaptive action of the body to restore energy metabolism.

Glucose consumption increases:

fear;

excitement;

severe pain.

Diseases of the endocrine system with an increase in glucose provoke an increase in the release of sugar into the internal environment of the body, which it does not have time to process into energy.

With hyperglycemia, metabolism is disrupted, therefore:

Performance immune system decreases.
Abscesses and dysfunction of the genital organs and innervation occur.
Usually the consequences are expressed in damage to the pancreas and the presence of sugar in the urine.
Also, increased sugar can cause metabolic disorders and the release of toxic metabolic products, which will negatively affect the body.

Mild hyperglycemia has almost no negative effect on the body, but if sugar is very high, then the person suffers from thirst and drinks a lot of liquid, resulting in a frequent urge to urinate. In this case, the body removes sugar along with urine, and the mucous membranes become too dry.

In extreme cases of the disease, the following appear:

Nausea with vomiting.
Drowsiness.
General weakness.
Sometimes loss of consciousness occurs, which is a sign of hyperglycemic coma, which in some cases ends in death.

Blood must be donated for testing on an empty stomach. If the indicator increases above 5.5 mmol/l, the doctor makes a diagnosis of hyperglycemia.

The main symptoms of the disease are:

thirst;
dry mouth;
frequent urination;
dry skin;
vision as if in a fog;
state constant fatigue and drowsiness;
losing weight for no apparent reason;
poor wound regeneration;
tingling in the legs;
infectious and fungal diseases that are difficult to treat;
rapid breathing;
smell of acetone from the mouth;
emotional instability.

How to determine the indicator, what is the norm in human blood?

To determine your glucose level, you need to take a fasting blood test.

This method has certain disadvantages:

With the help of such a study, you can determine your glucose level only at the moment. The numbers may vary from week to week.
The road to the clinic, especially on foot, can cause a decrease in the indicator. This is because fresh air lowers blood sugar. Water drunk in the morning before leaving the house has the same effect: it dilutes the sugar.
The indicator may have been elevated for a long time, but random physical activity may lower it, and the result of the study will be incorrect.

The sugar level for a healthy person ranges from 3.3 to 5.5 mmol/l. An increase in sugar occurs when the glucose received with food is not completely absorbed. Diabetes can also be insulin-dependent, that is, the pancreas does not produce enough insulin (type 1). The second type is characterized by improper functioning of insulin.

A sufficiently prolonged increase in the indicator leads to serious complications. One of them is blood thickening due to excess glucose. This makes it difficult for blood to pass through the capillaries and can lead to thrombosis.

A sick person has fairly large limits: from 4 to 10 mmol/l. It is quite rare to get close to the normal value, but the above limits are a kind of norm for diabetics. With such limits, a person will be able to protect himself from various complications for about 10 years. To constantly monitor your blood sugar levels, you need to buy a glucometer and take measurements daily.

To reduce the rate, you should combine several methods. First of all, you must strictly follow all the doctor’s instructions and correctly build your own diet. A correctly composed daily diet can lower blood sugar levels and maintain it in this state for quite a long time.

Diet

What to do if your glucose is high? Elevated glucose is a reason to consult a qualified doctor. Sometimes diabetes mellitus is not accompanied by specific symptoms, but it is still better to get certain recommendations. It is especially important to adjust your diet to reduce carbohydrate processing.

An overweight person requires a low-calorie diet that includes many foods that contain vitamins, minerals and other important trace elements. The daily menu includes the intake of both proteins and fats with carbohydrates. Carbohydrates consumed in food should be broken down slowly. In the glycemic index table, such carbohydrates should be in the last positions.

When creating a healthy diet, you need to pay great attention to the frequency of meals and their portions:

The food supply should be sufficiently voluminous in total throughout the day, but it must be supplied in small portions.
Breaks between meals should be approximately three hours.
It is best to have about 6 meals a day: snacks and main meals. This means that you can’t indulge in chips, fast food and soda for snacks.
It is very useful to eat fruits.

The amount of calories consumed will depend on the person’s constitution and the degree of physical activity. The diet should include the consumption of vegetable dishes, protein foods and fruits. It is also important to drink enough fluids to lower your blood sugar levels.

If you have high sugar levels, you should avoid the following foods:

pure sugar;
carbonated drinks;
flour and other confectionery products;
fat;
smoked;
alcohol;
grapes with figs and raisins;
butter and sour cream with cream.

It is imperative to eat boiled and stewed, baked and steamed food. At the same time, ready-made dishes should contain a minimum amount of salt and fats of vegetable origin. You need to eat 2 hours before bedtime. It is recommended to drink water and tea, black coffee without sugar and herbal infusions with freshly squeezed juices.

First of all, if you detect high sugar levels, you should visit a specialist. He will help you adjust your diet, prescribe all the necessary studies and tell you how to avoid this in the future. At the same time, it is important to monitor your glucose levels yourself at home so as not to provoke unpleasant complications that can interfere with everyday life.

Diabetes- a serious disease that changes a person’s entire life. And it is very important to recognize this disease in time to avoid the development of complications. The signs of diabetes mellitus, or more precisely, knowing them, will help us with this.

Most diabetics suffer from type 2 diabetes, when the pancreas produces too much insulin, and because the body develops resistance to it, the pancreas cannot produce as much insulin as is necessary to maintain normal levels blood sugar.

And at this stage the body gives the first signals that it is important not to miss:

1 The number of urinations sharply increases, since the kidneys are not able to absorb large amounts of glucose and it is simply excreted in the urine.

2 Constant thirst. To remove excess glucose with urine, you need liquid, so you want to drink more and more.

3 Fatigue appears.

Insulin collects glucose, which the body uses for energy, and with low insulin there is not enough energy, so you get tired.

4 A constant feeling of hunger is another symptom. To obtain energy, the body requires carbohydrates, that is, sugar, and in diabetics the body cannot process carbohydrates.

5 Blurred vision may occur because excess glucose in the blood causes fluid to drain from the eyes, changing their shape and preventing the lenses from focusing.

6 Diabetics are characterized by extremely slow skin healing.

The fact is that blood, filled with glucose, is poor in oxygen, which can lead to nerve damage. This means that cuts and scratches are more difficult to heal and take longer to heal.

7 Poor circulation of oxygen in the blood also leads to the fact that a person begins to feel tingling and numbness in the arms and legs, and a burning sensation may occur.

8 High levels of insulin, caused by the body's resistance to its effects, can cause rapid cell reproduction, which leads to darkening of the skin. Typically, such darkening can be noticed around the neck and armpit area.

9 The body of diabetics has a reduced ability to fight infections, so patients are susceptible to gum diseases. Inflamed, swollen gums are another unpleasant symptom.

10 One last thing: Diabetics are prone to constant yeast infections; their warm, moist skin is an ideal environment for fungi to multiply.

The first serious steps towards the creation of an internationally recognized classification of human diseases were made at the beginning of the twentieth century. That's when the idea came up International classification diseases (abbreviated as ICD), which as of today already has ten revisions. Diabetes mellitus codes according to ICD 10 belong to the fourth class of this classification and are included in blocks E10-E14.

Basic data

The first descriptions of diabetes mellitus that have reached our time were compiled in the second century BC. But the doctors of that time had no idea about the mechanism of development first identified back in ancient world diseases. The development of endocrinology has made it possible to understand the mechanism of diabetes mellitus formation.

Modern medicine distinguishes two types of diabetes:

The first type is inherited. It's hard to bear. Is insulin dependent.
Type 2 diabetes is acquired during life. In most cases it develops after forty years. Most often, patients do not require insulin injections.

The division of diabetes into two types occurred in the 1930s. Today, each type has its own designation in the IBC. Although the development of the eleventh revision of the ICD began in 2012, the classification of the tenth revision, adopted in 1989, is still in effect.

All diseases associated with diabetes mellitus and its complications belong to the fourth class of the ICD.

This is a list of diseases in blocks E10 to E14. Each type of disease and the complications it causes have their own codes.

According to IBC 10, the code for type 1 diabetes mellitus is E10. After the number ten and the dot there is another digit (four-digit codes). For example, E10.4. This code indicates insulin-dependent diabetes that has caused neurological complications. If there is a zero after ten, this means that the disease is accompanied by coma. Each type of complication has its own code, so it can be easily classified.

According to ICD 10, the code for type 2 diabetes mellitus is E11. This code designates the non-insulin-dependent form of diabetes acquired during life. As in the previous case, each complication is coded with its own four-digit number. The modern ICD also provides for assigning a code to diseases without complications. So, if insulin-requiring diabetes does not cause complications, it is designated by code E10.9. The number 9 after the dot indicates the absence of complications.

Other forms included in the classifier

As mentioned earlier, today there are mainly two main and most common types of diabetes.

But in 1985, this classification was supplemented by another type of disease, common among residents of tropical countries.

This is diabetes mellitus caused by malnutrition. Most people suffering from this disease are between ten and fifty years of age. The factor that provokes the onset of the disease is insufficient food consumption at an early age (that is, in childhood). In the ICD, this type of disease was assigned code E12. Like previous types, depending on complications, the code can be supplemented.

One of the quite common complications among diabetics is diabetic foot syndrome. It can lead to amputation of the affected limb. In most cases (about ninety percent of diagnosed patients), a similar problem occurs in type 2 diabetics. But it also occurs among insulin-dependent people (that is, those suffering from the first type of disease).

Since this disease is associated with impaired peripheral circulation, it is included in the ICD under this definition. The ICD 10 symptom code for diabetic foot is indicated by the fourth character “5”. That is, this syndrome in the first type of disease is coded as E10.5, in the second - E11.5.

Thus, as of today, the ICD revision of the 1989 revision remains relevant. It includes all types of diabetes. It also includes complications caused by this disease. This classification system makes it possible to analyze and study diseases, being able to carry out their systematic registration.

Expert comment:

How and with what to treat trophic ulcers of the lower extremities in diabetics

Often, with diabetes mellitus, there is the development of concomitant diseases, the cause of which is disturbances in the body caused by hyperglycemia. If medical prescriptions are not followed, as well as in conditions of severe diabetes, ulcers can form, mainly on the legs. Diabetic or trophic ulcers are quite common. Treatment of trophic ulcer wounds on the leg at home with diabetes is almost impossible. The victim requires medical and surgical intervention.

Characteristic

A trophic ulcer involves deep damage to the epithelial layer of the skin and all underlying tissues. The disease is often accompanied inflammatory processes, developed as a result of the addition of a secondary infection.

The sores are weeping wounds characterized by a large hole diameter, a large area of damage to the tissues surrounding the ulcer, constant bleeding and discharge of pus with a characteristic odor.

The disease was assigned a code according to ICD-10, it refers to chronic skin ulcers not classified in other sections and was assigned the number L98.4.2.

The causes of trophic ulcers include:

diabetic neuropathy;
diabetic angiopathy;
mechanical damage to corns;
destruction of the walls of blood vessels;
pathology of carbohydrate metabolism;
tissue hypoxia that occurs against the background of diseases associated with impaired blood flow;
harmful effects of toxins formed as a result of breakdown medicines, the withdrawal of which did not occur due to the characteristics of the course of diabetes.

Diabetes mellitus is a condition of the body in which there is a constant presence of large amounts of glucose in the blood due to metabolic disorders. Glucose, when left in an unbound state for a long time, begins to negatively affect nerve endings and blood cells. In the first case, neuropathy develops, in the second, angiopathy. Often, in the absence of proper treatment for diabetes, both the first and second symptoms appear simultaneously. It is these pathological conditions that are the root causes of disorders that indirectly cause trophic ulcers.

Wounds on the legs do not form immediately; they are preceded by initial signs of impaired venous blood flow - heaviness in the legs, cyanosis, swelling.

Then eczema and lymphostasis develop, the appearance of the skin of the limb changes, and with minor damage, an ulcer begins to form. First, it destroys the upper layers of the skin and grows in width, then the process of destruction of the underlying tissue begins.

Diabetic ulcers are characterized by the following symptoms:

do not heal on their own;
when deleting medications or surgically, deep scars remain at the site of the wounds;
coldness of the extremities in the initial stages of development due to the death of nerve endings located in the lower extremities;
pain that bothers the patient mainly at night;
lead to gangrene, and then amputation of the limb in the absence of timely treatment.

Ulcers are divided into types depending on the size of the vessels (capillaries, veins, arteries), the degeneration of which caused their occurrence.

Initially, the cause of a trophic ulcer is the patient’s negligent attitude towards his health and ignoring the instructions of the attending physician about proper lifestyle and nutritional principles. Only long-term high blood sugar levels lead to such consequences.

Treatment

Treatment for diabetic leg ulcers depends on the severity of the disease, but in most cases it takes a long time and is quite labor-intensive.

Therapeutic measures are carried out in 3 stages, which makes it possible to treat the disease not comprehensively, but sequentially, which is more effective in cases of deep tissue damage.

Initial stage

It is important to ensure that aggravating factors are neutralized and a favorable atmosphere is established for a positive treatment outcome.

adhere to the principles of nutrition for diabetics, monitor blood sugar levels, and prevent its increase;
provide the patient with peace and immobility (ulcers located on the soles of the feet are subject to trauma, as a result of which they heal more slowly);
stabilize sugar levels with medications, if necessary;
identify the cause of the disease and begin neutralizing therapy;
restore the activity of the circulatory system.

In addition, it is necessary to apply local therapy methods:

washing the wound with antiseptic agents;
cleansing the wound from pus, blood, scab;
application of wound surfaces;
preventing dirt or foreign objects from entering the wound.

Second phase

After applying all of the above measures, the patient's condition should stabilize. This is expressed in the subsidence of pain, as well as in improvement appearance the wound - it no longer increases in size, the edges become smooth and pink, pus and ichor cease to be released.

If this happens, then the therapy is directed towards me and focuses on the use of wound-healing drugs, drugs that promote accelerated skin regeneration. It is important to continue to use anti-inflammatory and antiseptic drugs orally and topically. In addition, dietary therapy must be followed exactly.

If signs of infection are observed, the edges of the wound become swollen, pronounced hyperemia of the skin around the ulcer appears, its size increases, and itching and burning are added to the pain, this is a sign that trophic ulcers of the lower extremities appeared as a result of infection joining the original wound.

At this stage, it is necessary to start taking antibiotics and drugs that stabilize and protect the microflora of the intestines and mucous membranes (Linex). The drugs will help get rid of the infection, and when the cause is eliminated, the disease will begin to recede.

If necrotic processes have occurred, surgical intervention is required. It is important to remove dead tissue in a timely manner to avoid the onset of gangrene, which, in turn, can lead to amputation.

The final stage and prevention

At the final stage, it is recommended to continue wound healing therapy, take vitamins and immunomodulators to strengthen the body’s natural defenses against viral and bacteriological effects. Physiotherapy can be used to restore the skin's elasticity and healthy color.

To prevent the disease, you need to follow simple tips:

diagnose increased blood sugar in a timely manner and take measures to reduce its level;
promptly subject varicose veins to the necessary therapy;
limit active physical exercise associated with prolonged static stress on the lower limbs;
avoid hypothermia or overheating of the lower extremities; temperature changes will provoke the onset of destructive processes in fragile vessels;
avoid the formation of microtraumas or minor abrasions on the surface of the skin on the legs, due to the fact that they can become the first stage in the development of a trophic ulcer;
use orthopedic shoes to ensure normalization of blood flow in the lower extremities.

In case of severe hyperglycemia, it is extremely important to monitor your health and follow all recommendations of the endocrinologist. Such a serious consequence as a trophic ulcer becomes a signal that the form of the disease has become more complex and profound. The attending physician will also tell you how and how to treat a trophic ulcer in diabetes mellitus. Self-treatment of this disease is not allowed, due to the increased risk of developing gangrene. Folk remedies are not prohibited for use, but only in combination with drug therapy.