Plenum of the Russian Scientific Medical Society of Physicians (N. Novgorod, October 12-13, 1993)

A regular visiting plenum of the Russian Scientific Medical Society of Physicians with the agenda "Actual problems of internal medicine" took place. The report "Errors and difficulties in the diagnosis of diabetes mellitus" was made by the chairman of the local society of physicians prof. E.P. Kamysheva. The speaker noted that today diabetes mellitus (DM) is considered as an exchange-vascular pathology with an endocrine component, that is, completely differently than it seemed for many years. In the pathogenesis of the disease, insulin deficiency (absolute and relative) is isolated, and a perverse reaction to insulin is of certain importance, then - syndromes of vascular permeability and thromboembolic complications. Causal multifactoriality leads to multiple symptoms, which complicates the timely diagnosis of diabetes (lack of knowledge of the clinic, haste or carelessness of the doctor). Hyperglycemia can occur for various reasons and is completely unnecessary only with diabetes: it depends on age, gender, body weight. Therefore, it is necessary to carry out not glucose, but the usual food load, and this will be the first stage in the timely diagnosis of diabetes. In the tactics of treatment, the following points are important: one should not strive for a rapid decrease in hyperglycemia, one should reduce sugar-like substances that cause the formation of angiopathies, carry out detoxification and disaggregation therapy, improve microcirculation, use blood substitutes and hepatoprotectors (Essentiale). The role of physical activity in reducing the complications of diabetes was highlighted. If physical activity does not help, hypoglycemic drugs should be used, while it should be remembered that hyperglycemia is a dangerous complication that causes cardiac (rhythm) disturbances. Attention was also drawn to the features of diabetes therapy in concomitant pathology: long-term use of nicotinic acid promotes hyperglycemia, beta-blockers, nitrates reduce glucose tolerance, diuretics increase blood sugar levels. Therefore, the course of treatment with these drugs should be short.