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Russian
00:00:01
[music]00:00:11
may ping 2 top protect us from ourselves,00:00:17
what is the threat of ignorance of the history of astronomy00:00:21
or paleontology, may we not be able to00:00:24
distinguish an exoplanet from a candida gamma or00:00:27
deny evolution, it is unlikely that this00:00:29
will greatly affect our well-being, but00:00:33
medical ignorance can greatly00:00:35
shorten the life of those who frivolously00:00:38
turned away from science00:00:40
when ignorance kills00:00:48
Alexander c birkin doctor endocrinologist00:00:52
blog author entertaining endocrinology00:00:58
[music]00:01:01
Alexander hello now I00:01:04
invite viewers to00:01:06
vote, dear friends,00:01:08
please tell me will there be less00:01:11
diabetes if sugar is gone from stores,00:01:14
that is, either it will be less or00:01:17
nothing will change or diabetes and it will00:01:19
only get worse, please follow the00:01:21
link in the chat and vote, but I have a00:01:24
personal question: how many Snickers do I need to eat before00:01:27
I get diabetes? Well,00:01:32
Alexander, I can say that if you do00:01:34
n’t have diabetes yet, then judging by your00:01:36
build, we still have a certain a00:01:38
supply of chocolates before the onset of diabetes,00:01:40
but of course how much can we say based on the external00:01:42
data of Snickers until the X hour is left for you?00:01:44
We, of course, based on reliable data, we00:01:45
cannot, or rather, based on visual data, this00:01:48
requires insiders, so to speak, a view from the inside,00:01:50
but this is rather the subject of such a more00:01:52
personal conversation, we’ll talk separately,00:01:54
we’ll talk separately a little later,00:01:56
yes, that’s why today we00:01:58
will talk more publicly directly about the problem of00:01:59
diabetes mellitus. Diabetes mellitus00:02:01
often occurs much more often than you00:02:03
think. In principle, smart people from00:02:05
various specialized organizations00:02:07
have given this figure at 10 percent in recent years,00:02:09
that is, if you see day 10 in front of00:02:10
you. adult people, then one00:02:12
of them most likely has diabetes, the figure00:02:14
I give exclusively for drinking00:02:16
was listed and represented an approximate00:02:17
niche and client base for00:02:20
endocrinologists and, accordingly, on the Internet with00:02:22
such a high prevalence of00:02:24
diabetes, it has acquired a large00:02:26
number of myths which I think you00:02:28
have heard one way or another yes, for example, since00:02:29
diabetes is diabetes, then obviously it comes from00:02:32
because of sugar that diabetics, so to00:02:35
speak, if they live not h-well,00:02:37
then at least a long life and should00:02:39
eat only buckwheat, how insidious00:02:41
doctors only sleep and see, as it were00:02:43
transfer patients to insulin needles00:02:45
and never use them again so that people do00:02:47
n’t get off we, in principle, that after the flood the00:02:50
establishment of a diagnosis of diabetes00:02:52
mellitus and very sad depressive00:02:53
sad, so rather than today let’s00:02:55
go through all this myth and figure out00:02:57
what is true and what is not so00:02:59
we’ll start with so that by the end of00:03:02
my speech everyone will be at approximately the same00:03:03
level, then we’ll start a little from afar00:03:06
or talk in principle about carbohydrate00:03:07
metabolism, let’s talk about who this00:03:09
diabetes mellitus is, what it comes from, where it comes from,00:03:12
and of course we’ll go through the myths that the00:03:13
organizers instructed me to do00:03:15
to comment on this in view of00:03:18
some time limitations and the fact00:03:19
that I am, first of all, a modest00:03:20
practicing doctor, yes, I want to note00:03:22
that we will, one way or00:03:24
another, examine theoretical issues quite00:03:26
superficially,00:03:27
so a disclaimer right away, that is,00:03:29
of course, the topic of diabetes is very00:03:31
socially significant and very interesting, a00:03:33
huge number and doctors and scientists00:03:35
are engaged in this and we00:03:37
know very deep down there a lot of interesting things00:03:39
there, right down to which electrons00:03:44
are exchanged between which subunits of which molecules in all these00:03:46
processes, this is all very interesting to someone,00:03:49
but this will not happen today and therefore00:03:51
dear friends, if you wanted to listen, it00:03:53
will be about heat shock proteins, the00:03:55
process of achromatic00:03:57
electron transfer, or where the Krebs cycle00:03:58
takes a wrong turn in the development of diabetes,00:04:00
this won’t happen today because I was00:04:03
giving the lecture, I’m a fairly down-to-earth person,00:04:06
everyone at one time00:04:07
called me a doctor we are a craftsman00:04:09
who does not have time for art, that00:04:11
is, science, so I will00:04:12
correspond to this, therefore we are speaking at a00:04:14
rather primitive level,00:04:16
first of all I say yes, for respected00:04:18
commentators on the Internet, remember that00:04:19
much of what I say I say not00:04:22
because I swear an oath there for eternity the00:04:23
radiance of pure knowledge about the fact that00:04:26
we are limited in time, we have a00:04:28
popular science lecture and, in principle,00:04:30
not everything that is written in biochemistry textbooks00:04:32
has its significance00:04:34
in the real world, and so that means if we are00:04:36
talking in general about carbohydrate metabolism00:04:37
at home, I think everyone knows that when we00:04:39
eat a date, in addition to the feeling of satiety,00:04:41
the feeling of guilt,00:04:43
various substances often enter our body, which00:04:45
very roughly very roughly can be divided00:04:48
into the well-known macronutrients to00:04:50
proteins, fats, carbohydrates, but today we are00:04:51
talking more about carbohydrates, that is,00:04:53
carbohydrates are basically what they are there are a00:04:55
lot of complex molecules, we00:04:57
have all seen life-and-death battles00:04:58
recently in the news feeds, for example, for00:05:01
sucrose, before this there was a complex carbohydrate there with a00:05:03
bowl of fructose and glucose, and so00:05:06
carbohydrates are in the process of transformation in00:05:08
our body, in addition to the one I mentioned, the00:05:10
release of guilt also well,00:05:12
they are broken down into their fragments, in particular00:05:15
to glucose, glucose is accordingly00:05:17
absorbed into the bloodstream in the intestines,00:05:19
where its content increases and it00:05:21
is further distributed throughout the body,00:05:22
and then the problem arises that00:05:24
most of the cells of our body,00:05:26
glucose itself, cannot penetrate00:05:29
there and will be closed to them no, they00:05:30
don’t pass the control and I need00:05:32
help and help comes from the00:05:34
pancreas, in principle there are00:05:36
a lot of interesting things in it today we are00:05:38
globally interested in beta cells00:05:40
that produce probably the most00:05:41
popular hormone on the Internet, insulin,00:05:43
so this very insulin helps00:05:45
pass glucose in the clip, most of the00:05:48
cells of our body, that is, but it00:05:50
promotes the integration of00:05:51
special transport proteins into the cell wall,00:05:53
which plays such a gate role and00:05:55
launches glucose itself in the cell where00:05:57
it is already there doing its glucose my00:05:59
business, and accordingly the level of00:06:01
glucose in the blood decreases beta cells00:06:03
this feels it produces less00:06:04
insulin and a balance arises until the00:06:07
next meal, which sometimes00:06:08
occurs more often than it should be. This is00:06:12
what it’s worth to think00:06:13
about carbohydrate metabolism and remember00:06:15
the words before glucose and insulin, and now00:06:17
what is diabetes mellitus if you open, in00:06:19
principle, there are terrible medical river of00:06:21
definition tons the definition is quite00:06:23
cumbersome yes, well, every word in it00:06:25
has a very deep biological meaning,00:06:27
however, let’s not be scared and00:06:28
let’s focus on five words that this is a00:06:30
group of diseases characterized by00:06:33
chronic hyperglycemia hyper a lot00:06:35
for chemistry I think you understand that is,00:06:37
diabetes is a group of diseases with00:06:39
which rack increased00:06:40
glucose level elevated glucose level at the00:06:43
level of diabetes we consider the indicators00:06:44
on an empty stomach more than seven miles and moles per liter and00:06:46
not on an empty stomach more than 11 1 the key00:06:49
word here is group00:06:52
group that is, that there are a lot of00:06:55
reasons why a person can have an00:06:57
increased glucose level so00:06:59
say it’s just that a person has00:07:00
diabetes, but this is not an abstraction, that00:07:02
is, but it’s the same as saying that there is a00:07:04
vehicle waiting for you outside,00:07:06
or that it could be a00:07:08
helicopter, a car or a cart, which is more00:07:10
realistic in our near future,00:07:12
so if we are talking about the presence of00:07:14
diabetes then this is some abstraction,00:07:16
you need to clarify what type of types of diabetes there are00:07:18
many, much more than you00:07:20
think, much more likely than I00:07:22
know, but in general, the well-known00:07:25
type 1 diabetes, type 2 diabetes, these are the00:07:28
main types, and they also separately00:07:29
distinguish gestational diabetes mellitus,00:07:31
which occurs during pregnancy00:07:33
in most cases ends 10000:07:35
pregnancy ear although anything can happen and the00:07:37
so-called specific safin types of00:07:40
diabetes there are a lot of them we won’t even00:07:42
read into them yes I’m just00:07:43
showing this so that you can, so to speak, given to00:07:46
gain expertise to increase the sense of00:07:48
self-importance winter taxes that00:07:49
they are like this00:07:51
they deal with complex things, but let’s talk globally about the00:07:53
first and second types of diabetes, that is, a00:07:55
nice picture on the Internet means00:07:57
this yellow organ is the00:07:59
pancreas, which normally00:08:01
produces insulin, which00:08:02
contributes to the formation of it, or rather, the00:08:04
entry of glucose into the cell, so in00:08:07
type 1 diabetes the fundamental point is that00:08:09
insulin is not produced00:08:11
at all, so no insulin,00:08:13
glucose cannot enter the cell, the00:08:15
level of glucose in the blood increases,00:08:16
diabetes occurs in type 2 diabetes,00:08:19
this fundamental point is that the00:08:21
living beta cells produce their own insulin,00:08:23
but something prevents00:08:26
it from working and accordingly, the cells00:08:28
also do not respond to insulin, glucose00:08:30
cannot enter the cell and the00:08:32
level of glucose in the blood increases if, as it were, we00:08:34
draw further analogies, so00:08:35
once again I simply emphasized that once again00:08:37
with the first type there is no insulin at all and the00:08:39
fundamental conclusion from this is that,00:08:41
accordingly, everything is unfortunately what We00:08:43
can help patients in this situation by00:08:45
only prescribing insulin, no00:08:47
other options, well, so to speak, to00:08:49
reduce the glucose level, for the most00:08:51
part we don’t have our own insulin in type 2 diabetes,00:08:53
but something prevents it from00:08:55
working, and the main conclusion from this is that we,00:08:58
of course In this situation, we can, as it were,00:09:00
add some water to 0 because00:09:02
we add insulin and lower the00:09:04
glucose level, but we have other options, and00:09:06
lately there seem to be00:09:08
more and more of them. Svir and type 2 diabetes,00:09:10
this is the principle of the fundamental differences between them,00:09:12
where do these diabetes come from?00:09:15
Well, as and as I already said,00:09:17
type 1 diabetes does not produce its own00:09:18
insulin, so there are quite00:09:20
obvious reasons for this, let’s say if you, that00:09:22
is, the patient may not have a00:09:23
pancreas there, for example, they00:09:26
cut it out there for the00:09:28
ontologies of trauma or alcoholism, but in00:09:31
general like a bull, in the classic version,00:09:32
type 1 diabetes is considered, as it is00:09:35
written in medical textbooks, to be an00:09:37
indirect disease, that is, its00:09:38
own immune system begins to00:09:40
perceive its00:09:42
own beta cells as something foreign00:09:44
and destroys them and, accordingly, insulin00:09:46
becomes less and less until00:09:48
diabetes develops like this and with any autoimmune00:09:50
disease, it is believed that there is a00:09:52
certain back inheritance on the00:09:53
predisposition to this, which was00:09:55
influenced by something, that is, that something00:09:56
caused the immune system to fight,00:09:58
so I found it on my own beta cells,00:10:00
it is believed that most often it is a viral00:10:02
infection, but unfortunately to say00:10:04
we can’t always know exactly what this is in a particular patient,00:10:06
so it’s a fact that to some00:10:08
extent, the development of type 1 diabetes is of00:10:09
such an ephemeral nature, that is,00:10:11
well, that’s how to meet a dinosaur on the street,00:10:13
it will either arise or not with00:10:16
type 2 diabetes, the reason for it is much00:10:18
less exemplary in nature, you can often00:10:20
see it and sometimes even touch it,00:10:22
that is, in most cases it is hidden in00:10:24
adipose tissue, since adipose00:10:26
tissue is not just some kind of storage of00:10:28
substances or a cosmetic defect, adipose00:10:30
tissue is a very active tissue, a huge00:10:32
number of all sorts of interesting cells.00:10:34
but the main one is for the sake of adding the00:10:36
so-called main cells of00:10:38
adipose tissue and adipocytes that produce a00:10:40
huge amount of the most terrible00:10:42
molecules, the reading of which, in principle, is the00:10:44
height of oratorical medical00:10:48
skill, and even there doctors go to00:10:49
special courses to reprimand them,00:10:51
I did not go to these courses therefore, we will not00:10:53
mention them, but the point is that there are a00:10:54
lot of substances through which these00:10:56
adipocytes influence absolutely every00:10:58
organ, every tissue, every cell of00:11:00
our body, in principle, everything, but00:11:02
the main thing in our current story is that they00:11:05
affect the sensitivity of tissues to00:11:06
insulin,00:11:07
that is, reducing I call it the00:11:09
popular Internet word00:11:11
insulin resistance, that is, that the00:11:12
body’s own tissue begins to00:11:14
take insulin worse than you, to some00:11:17
extent, this can last quite a long time00:11:18
until the adaptive reserves of our00:11:20
body are00:11:21
very, very large, but not indefinitely,00:11:24
and over time, well, as if everything I’m00:11:26
progressing, that is,00:11:27
adipose tissue and grass are increasing,00:11:29
insulin resistance is progressing, then after it00:11:31
builds up, a certain hour x until what happens,00:11:33
if you still eat a00:11:34
certain amount of Snickers and the00:11:36
glucose level begins to rise and00:11:37
diabetes develops00:11:39
accordingly, so let’s remember00:11:41
until that as if for normal absorption00:11:43
glucose needs insulin before that diabetes is a00:11:45
group of different diseases in which the00:11:47
level of glucose is increased, type 1 diabetes00:11:50
is associated with a deficiency of insulin against the background most00:11:52
often of the destruction of beta cells and fortunately00:11:54
this occurs more and type 2 diabetes00:11:57
in which insulin is produced,00:11:59
but what prevents it and yes and most often00:12:01
it is precisely the excess of adipose tissue and00:12:03
this accounts for the majority of cases,00:12:05
now let’s move on to our legends00:12:07
and myths about diabetes mellitus, there are a00:12:09
lot of them, a vote was held, so to00:12:11
speak, and the voice of the people chose specific00:12:13
specific myths, so let’s go through them00:12:15
in general I’ll be separate, well,00:12:17
if you haven’t specified the condition of the myth that00:12:19
it’s divided into type 1 diabetes and00:12:22
type 2 diabetes, well, of course, yes, I’m somehow00:12:24
a collector, I’m tempted to just don’t00:12:26
make a gag, well, in principle, yes,00:12:28
we’re in a decent place on a decent forum00:12:29
therefore, of course, about everything I’m00:12:32
saying, but it has an evidence00:12:33
base, I will provide links given to00:12:36
fashionable research, the00:12:39
presence of links to research is one of the00:12:42
criteria for professionalism and a00:12:44
popularizer of science and, for example, a doctor, but it’s00:12:47
unpleasant00:12:48
to encounter unprofessionalism in any field, we really00:12:51
value the quality of the broadcast when we00:12:54
were actually looking for and conducting streams, it00:12:56
turned out that there are a lot of products on the market,00:12:58
but the interface is very user-friendly, there are some00:13:01
glitches, there are not enough necessary functions,00:13:03
choose nothing, what is this connected with, it may00:13:07
be due to the lack of qualified programmers on the market,00:13:10
including front-end developers who00:13:12
do the programs are convenient for us00:13:14
users, it’s good that frontend00:13:18
developers are trained by our friends online00:13:20
programming school hacksmith and if00:13:23
you are thinking about changing your profession,00:13:25
listen to what I say,00:13:27
Huxley students are immersed in practice00:13:30
from the first days by solving more than 400 problems in an00:13:33
online simulator under the guidance of00:13:35
mentors, you learn to think as a00:13:37
developer, learn to translate business00:13:40
tasks into Kona language, but is it possible to sit in by the way,00:13:43
listen to get a body, but00:13:46
you won’t learn anything, it’s unlikely that the00:13:50
learning process is designed so that in 1000:13:52
months you will have to write 4 real00:13:55
applications, these applications will be included in your00:13:57
portfolio and will help you go through the career00:13:59
track job search program login00:14:02
resume letters interview internships in00:14:05
good companies friends will help you with all this,00:14:08
find time to00:14:10
study by the way, I know this really00:14:13
becomes frontend developers, the00:14:15
entry threshold is not so high and00:14:18
finally write to us a decent application for00:14:20
online broadcasting all links in the description00:14:23
of the video and also pay attention to the bonus of00:14:26
5 free introductory courses00:14:35
in the first up to what if there is a lot of sugar00:14:37
to what time diabetes mellitus then it comes00:14:39
from sugar and, accordingly, to what, as it00:14:40
were, all the evil comes from it and, accordingly,00:14:43
perhaps diabetes will become less and00:14:45
diabetes will no longer exist sugar, well, not sugar,00:14:47
of course, it won’t become from a completely different00:14:48
disease that has nothing to00:14:50
do with carbohydrates but is not the point in general, that’s why, well,00:14:53
if you, in principle,00:14:55
listened to me carefully, they already know00:14:57
what type 1 diabetes is, then I’m there before that00:14:59
in principle yes visual and audio answer00:15:01
yes that this does not affect the risk of developing type 1 diabetes in00:15:03
any way yes it is00:15:05
based on autoimmune00:15:07
aggression against one’s own beta cells00:15:09
if it were caused by sugar date00:15:11
humanity would not have survived but in general it would be as00:15:13
if there are very meticulous00:15:14
there are some works that00:15:16
show a relationship, or rather an association of the00:15:19
development of type 1 diabetes there with the00:15:20
consumption of whole grain products and there00:15:22
was some kind of cow's milk in00:15:23
certain periods of children's lives, but this is00:15:25
there and we are there in general globally has00:15:28
nothing to do with the matter it is not00:15:30
associated with sugar in type 2 diabetes, as we remember,00:15:33
as we remember, it is for the most part associated00:15:35
precisely with the dysfunction of adipose tissue, and00:15:38
that I become very much more, in principle,00:15:39
if you look, yes, here the00:15:42
body mass index is more than 30,00:15:43
which, in principle, is the border obesity00:15:45
tourist diabetes increases absolutely00:15:47
linearly, well, as if if we don’t00:15:49
deceive anyone, then in general, where00:15:51
does body weight come from00:15:52
and not from thin air to from00:15:54
calories eaten, and again00:15:56
enough in a linear amount there in00:15:58
general and per 10,000 the excess00:16:00
kilocalories eaten account for one and a half to00:16:03
two kilograms of body weight, and here we seem to have the00:16:05
main question: if the calories are00:16:06
gained specifically from soho from sugar00:16:09
or from others to macronutrients, that is,00:16:11
fats and proteins, then does the risk of00:16:14
diabetes vary unconditionally, as it would be very00:16:16
logical the question is that a huge number of00:16:18
studies have been conducted on this matter, in00:16:21
particular, just an example of one of them is00:16:23
given, that is, because here in the00:16:24
study they took thousands of people and00:16:28
assessed for several years how it00:16:29
affects what they ate after eating a00:16:32
Mediterranean diet, that is, such a00:16:33
balanced diet others are00:16:35
low-carbohydrate and the third is low-00:16:37
fat and in fact how their00:16:39
glucose level changed while00:16:41
following these diets, as you can see, no matter how much it did00:16:44
n’t change in any way, it didn’t00:16:46
change, that is, there is a huge00:16:48
amount of work that I actually00:16:51
confirm and reproduce these00:16:53
data in the opera there is a huge number of00:16:55
meta-analyses meta-analysis is a special type of00:16:57
research where the00:16:58
data of many studies are merged there, with the help of a00:17:01
certain mathematical analysis,00:17:03
extensive conclusions are drawn00:17:04
based on these studies, this is the00:17:06
same example of one of the largest00:17:07
meta-analyses on this topic yes, how00:17:09
different diets affect the risk of developing00:17:11
diabetes, let's look here at the00:17:13
fearless graphics, don't be afraid, let's go00:17:15
through them in place, yes, that is, as if00:17:17
you see there all sorts of horizontal stripes00:17:18
and a vertical stripe, in short, if a00:17:21
horizontal line intersects a00:17:23
vertical stripe, then00:17:24
there are no differences if doesn’t cross, it00:17:26
means there are some differences, well, for00:17:28
example, yes, something is here, on00:17:30
the sign, not there, healthy eating was studied,00:17:33
that is, this is what00:17:34
doctors usually recommend to tourists,00:17:35
balanced there in terms of macronutrients,00:17:37
that is, half there are carbohydrates, there are00:17:39
30 percent, well, proteins 20 fats there are00:17:42
optimal calories less00:17:43
processed red meats00:17:45
more fruits vegetables well, that is, this is00:17:46
what doctors usually recommend in general,00:17:48
if you follow this, then the risk of diabetes00:17:50
at least the reason for the results of this00:17:51
analysis is less, if not, a healthy00:17:54
diet, accordingly, that is what is more00:17:56
common to all of us, yes then eat something00:17:58
we throw for breakfast we run to work there00:18:00
and who isn’t birthdays donuts pizza here00:18:02
then we work we run home there 1 200:18:04
3 dinners soon and breakfast here and this is00:18:07
associated with high risks of00:18:09
developing diabetes vegetarian food00:18:11
before the diet you give this is special the diet is00:18:13
designed for a patient with high00:18:14
blood pressure, the Mediterranean diet, in00:18:16
which the risk of diabetes is shown to be lower, and00:18:19
if you consume foods with a higher00:18:22
glycemic index, which would00:18:23
normally be more calorie-dense, then the risk of diabetes is00:18:25
higher, just like when you skip breakfast, so00:18:28
what exactly for the sake of00:18:31
Why did I show all this with a00:18:32
low-carb diet, and if you00:18:34
limit sugar intake, in principle, the00:18:36
risks of diabetes are significantly different, and in the00:18:39
same meta-analysis, as in fact, and00:18:41
in many others, they also assessed00:18:42
not individual diets, individual types of00:18:44
products, if you look here00:18:45
directly given, so to speak,00:18:47
carbohydrates there are different types of sugars00:18:49
everywhere,00:18:51
no significant differences were obtained, that00:18:53
is, as if limiting00:18:54
sugar consumption did not change much, if there was a00:18:57
change from what, then when you00:18:58
consumed more00:18:59
whole grain fiber products and00:19:01
all this why because when,00:19:04
in most00:19:07
cases, type 2 diabetes is based on dysfunction of00:19:09
adipose tissue, respectively,00:19:10
insulin resistance of adipose tissue, it doesn’t00:19:12
matter where you get 356 calories from00:19:15
candy or from more so to speak ppm00:19:17
products, everything will still go into it, here’s the00:19:20
following myth: Is diabetes00:19:22
inherited, yes, that is, is it00:19:24
to blame or is it genes? Well, let me00:19:26
figure it out, that is, but because here00:19:28
you can basically look at the statistics00:19:29
and that in general, in the general population,00:19:31
type 1 diabetes occurs somewhere around 0 4 percent,00:19:34
but if diabetes and If both parents have a mother and a father, then the00:19:37
chances are higher, but if both parents have the same00:19:39
chances, then the chances are quite high. This, by the way,00:19:41
is quite important00:19:43
because, from experience, it often00:19:45
happens that it’s like in a couple, but00:19:47
where there’s a man and a woman for both00:19:49
maybe type 1 diabetes, well, because we00:19:51
get to know each other where we spend a lot of00:19:53
time, that is, at work, at study, in00:19:55
hobby groups, in line at the doctors,00:19:56
so to speak, the disease is united by a00:19:59
new thing, to some extent, it’s possible, it’s00:20:00
convenient, you can always shoot, given there00:20:02
insulin syringes, a pen or a test00:20:04
strip, measure your sugar or something00:20:06
like that, but it seems to have00:20:08
practical significance that, unfortunately,00:20:09
the laptop and the risk of diabetes in such a situation are00:20:11
slightly higher in children; the same thing with00:20:14
brothers and, like, sisters, like00:20:15
twins, that is there00:20:17
is, of course, some kind of predisposition, well,00:20:19
that is, we are, in principle, transmitted by a00:20:21
certain readiness of the immune system of someone00:20:23
to implement this this immune00:20:25
aggression against one’s own body,00:20:27
but unfortunately it is clear to predict what00:20:29
this child will have and this one will not,00:20:31
we are in what -we can’t, so in00:20:33
any case, it’s like I already made an00:20:35
analogy, how to meet a dinosaur on00:20:36
the street, it will either happen or not with00:20:39
type 2 diabetes, again, statistical00:20:41
data in principle is what we00:20:44
can glean from a conversation with a00:20:46
person Well, I kind of confirm this, yes, that00:20:48
is, if a person has diabetes,00:20:51
then the chance that his relatives have type 2 diabetes is00:20:53
higher, and vice versa,00:20:55
that if they have diabetes, then his00:20:56
person’s risks are higher, but on the other hand,00:20:59
again the same situation there is, if, in00:21:01
principle, the partner or the person with whom the00:21:03
person lives has diabetes mellitus00:21:05
because well, one way or another, here00:21:07
we impose our everyday life, our00:21:09
stereotypes, nutrition, eating habits and00:21:10
so on, but again, many00:21:12
have encountered this, so what? everyone00:21:14
has friends who got married there,00:21:17
their body weight, usually after that,00:21:19
land rover pauses in general, but if00:21:21
we talk in general about the genetics of diabetes, a00:21:23
problem arises here00:21:25
because, of course, our eating00:21:27
behavior yes it is, as it were, different00:21:30
metabolic indicators the function of beta00:21:31
cells, the function of adipose tissue, they are00:21:33
certainly regulated by a huge00:21:35
number of genes, a00:21:37
huge number of them have been identified, mutations that in00:21:38
one way or another affect all these00:21:40
processes, well, there are tens00:21:42
of thousands of them, and even millions are on the way,00:21:44
but the problem is that the individual00:21:47
contribution each of these genes, but it is very00:21:49
doubtful, that is, of course, there are00:21:50
separate types of diabetes where we know there is a00:21:52
specific gene that causes a00:21:54
specific breakdown in a specific protein that00:21:56
causes a specific type of diabetes,00:21:58
this happens, it is rare, well, in00:22:00
principle, and is not considered type 2 diabetes00:22:02
in diabetes Type 2 is that it kind of00:22:04
exists in real life, and for example,00:22:06
these are genetic passports that you00:22:08
can kind of ask to see and where they00:22:10
look like some dozens of genes00:22:12
mutations in which they kind of increase or00:22:14
decrease the risks by some00:22:17
thousandths percent, well, it’s possible at home, for the00:22:19
most part it’s of a00:22:20
commercial nature, that is, but in00:22:22
real life it doesn’t seem to play a special role, no matter00:22:23
what mutations you have here,00:22:25
well, you’ll still have to eat less00:22:28
as part of type 2 diabetes, that’s00:22:31
accordingly, that’s why about Type 2 diabetes is00:22:33
certainly a trend for00:22:35
inheritance on predisposition, it00:22:37
exists, but we are as far as you know, that is, outside of00:22:39
strict laboratory studies and not00:22:43
mice or something like that to say00:22:44
exactly what we pass on,00:22:46
especially metabolism or00:22:48
eating behavior, just when to our00:22:50
relatives Well, it’s quite difficult to say unequivocally00:22:51
ok, the next myth and yes,00:22:55
such a fatalistic one, is00:22:58
insulin therapy forever and is00:23:00
type 2 diabetes mellitus in particular forever, but00:23:02
if we talk about the first type of diabetes,00:23:04
how how, again, we have already said00:23:06
that it arises due to a deficiency and for00:23:08
the destruction of beta cells and, unfortunately, by the00:23:10
time glucose begins to00:23:12
rise at the level of diabetes, this00:23:15
means that most of the beta cells have00:23:16
already been destroyed, that is, there is00:23:18
nowhere to go and therefore, unfortunately, all we00:23:20
can do in this situation is00:23:22
only prescribe a stroke, so yes,00:23:24
not yet at the moment,00:23:25
insulin therapy is all that we can00:23:28
offer patients with type 100:23:29
diabetes with type 2 diabetes, let me00:23:32
introduce for a second the principles of00:23:34
evidence-based medicine and [ __ ] on00:23:35
meta-analysis before we try storytelling, I’ll00:23:37
just show you an example, yes, here you go00:23:39
I recently had a patient at my appointment00:23:41
when, as if don’t scare me, now I’ll00:23:43
explain everything, she’s been there for many years, over00:23:45
ten years, she’s been injecting herself with insulin for00:23:48
diabetes, and that’s how her story didn’t convince me00:23:50
that this is type 1 diabetes and00:23:52
she really needs insulin, so her00:23:54
own, well, look at something00:23:57
on herself, she injected 28 units of insulin,00:23:59
I actually prescribed certain pills in the summer,00:24:02
let’s do it without and without00:24:04
product placement, I shaded it, and00:24:07
accordingly, within a couple of weeks, we’ll be00:24:09
with her, as it were we completely moved away from00:24:11
insulin itself and we completely00:24:13
removed it, and the glucose remained at the same00:24:16
level,00:24:17
I see thank you and the glucose remained at the00:24:20
same level, well, how could we manage to00:24:23
completely get away from00:24:25
insulin therapy, well, just imagine how00:24:26
completely different the quality00:24:28
of life is, yes that is, that a person injects00:24:31
himself with insulin every day before measuring his00:24:33
sugar and just takes a pill, a completely00:24:35
different quality of life, and in fact,00:24:36
such stories are quite00:24:38
common, that is, examples in00:24:39
outpatient practice, diabetes I insulin, I00:24:42
more often than not, three are canceled in the second type are00:24:44
prescribed here and accordingly are they00:24:47
forever similar to the question of type 2 diabetes00:24:51
here is also like a minute of storytelling00:24:53
yes that is yes here the boys00:24:54
here have a terrible word glycated00:24:57
hemoglobin don’t be afraid of the people’s thoughts00:24:59
the word hemoglobin everyone knows before this00:25:01
what is contained in red blood cells yes here in00:25:03
red blood cells that look like dried apricots,00:25:05
yes, this is the one that carries oxygen, so there00:25:07
is such a trick here that00:25:09
this hemoglobin is to some00:25:11
extent associated with glucose in the bloodstream, but the00:25:13
percentage of its binding00:25:15
is, well, roughly speaking, clearly00:25:16
proportional to the glucose content in00:25:18
blood, that is, this is the degree of00:25:20
contamination, and that is, glycosylation,00:25:22
and therefore, these red blood cells live for00:25:25
about three months, so based on00:25:27
this percentage of healing and glucose00:25:29
with hemoglobin, we can indirectly judge the00:25:31
average glucose level over the last 300:25:33
months in a person so here the00:25:35
patient had an average level of glucose and00:25:37
from 17 millimoles per liter, that is, as if00:25:39
he had such obvious diabetes and00:25:41
of course he was told that here is insulin for you, here are00:25:43
buckwheat tablets, no sugar,00:25:45
here you go, this is how you will live, he00:25:48
was scared insulin but he didn’t start00:25:50
drinking and didn’t take pills, but he00:25:52
restructured his eating behavior and accordingly he00:25:54
called, he lost weight and best at without insulin without00:25:57
there a pilot without registration without SMS, it’s00:25:59
like his glucose, as you can see, has already returned00:26:01
to normal, that is, it’s00:26:03
no longer diabetic level, that is, we are00:26:05
essentially water, that it is an illustration of an00:26:07
example of the fact that diabetes is forever or not,00:26:09
that is, cabaret it is possible to carry it00:26:11
because it is based precisely on00:26:13
insulin resistance against the background, like a tongue, of00:26:15
excess adipose tissue in the body, and00:26:17
adipose tissue, but still to some00:26:19
extent, the indicator varies, it is00:26:21
again in our power, well, in principle,00:26:24
because there is already a large number in the world,00:26:26
give it a consensus, as if00:26:27
the experts are coming to the conclusion that there00:26:29
is such a concept of diabetes renicia and it00:26:31
can be achieved, and this is the00:26:33
last the myth about which I00:26:35
wanted to comment today is that the main thing in the00:26:37
treatment of diabetes mellitus is00:26:39
glucose level control, well, in principle, it seems00:26:40
logical that diabetes mellitus and the00:26:42
actual definition of the disease is that00:26:44
it is an elevated sugar level, so it00:26:46
is logical that we need to reduce it, we00:26:48
again certainly seem to this is00:26:49
completely logical in the context of00:26:51
statistical data, well, that is, a huge00:26:52
number of studies have shown that the00:26:54
higher the glucose level, the higher the risk of00:26:57
complications of diabetes and mortality in this00:26:58
disease, but we still have to00:27:03
check the evidence-based medicine of the house elf during00:27:04
controlled studies such00:27:06
studies, of course, there are particular ones, for00:27:07
example, in type 1 diabetes, well, that00:27:10
is, as if00:27:11
studies were conducted where patients were actually treated for them,00:27:12
well, as necessary, that00:27:14
is, they can inject insulin and00:27:16
hurt others in such a way and no more00:27:19
intensely we treated them, that is, and tried to00:27:20
achieve their glucose levels close to00:27:22
normal and assessed the risks and00:27:24
complications, and of course, those on the00:27:26
side button were treated normally, yes, their00:27:28
risks were lower, this is absolutely00:27:30
intuitively logical, but as you remember,00:27:32
type 1 diabetes accounts for a smaller00:27:34
number cases and, accordingly, it’s00:27:39
interesting what happens in type 2 diabetes,00:27:41
and when we transferred a similar00:27:43
study design to type 2 diabetics,00:27:45
we got such somewhat counter-00:27:47
intuitive results because in00:27:50
studies similar in design, where00:27:52
some were treated more intensively before others00:27:54
and others tried to achieve the same results00:27:56
glucose close to normal, there was no special00:27:58
difference, yes, that is, these00:28:00
mortality curves as a general and00:28:03
heart disease, they practically00:28:05
did not differ, but there are separate00:28:07
studies in which, on the contrary,00:28:08
patients who were treated more intensively00:28:12
began to die more often and such studies00:28:14
seemed to be closed yes yes yes yes yes yes yes00:28:16
urgently for ethical reasons00:28:17
so well, how would we, in principle,00:28:19
almost all the works confirm this up to what00:28:21
type 2 diabetics certainly have, but there is a00:28:23
very high level of glucose and the00:28:25
mortality rate increases if, as it were,00:28:27
low from of course not very good00:28:28
because we are re-treating them, but00:28:30
if glucose is, as it were, moderately increased,00:28:32
and then we will lower simple ones, but we do not00:28:35
greatly influence the outcomes of our00:28:37
patients, which is why, as it were,00:28:40
other fundamental00:28:43
drugs for the treatment of type 2 diabetes are already being developed.00:28:44
not only reduce00:28:46
glucose levels, but they also have other effects that00:28:48
affect the outcomes, and also, well, how does this00:28:51
play out? Well, if, in principle, the00:28:53
main question that00:28:54
arises here is how to improve the outcome of00:28:56
patients with type 2 diabetes, well, let me remind you00:28:58
that first of all, they die from00:29:00
cardiovascular diseases,00:29:02
respectively, here is your control of00:29:03
other factors that increase the risk of00:29:06
these very diseases which, as it is00:29:08
logical to assume, are also00:29:09
associated with excess body weight, first of all,00:29:12
this is the level of pressure and00:29:14
cholesterol level, which is the garden,00:29:16
respectively, and here, when controlling both00:29:19
high blood pressure and and by increasing it and00:29:21
elevated cholesterol levels, the00:29:22
mortality rate in diabetes is like a bull's head in a00:29:24
large number of studies, it00:29:26
has clearly been shown that it00:29:27
decreases significantly, so it cannot be00:29:29
said that of course with in the00:29:31
second type of diabetes there is no need to00:29:33
control the glucose level of course it is00:29:35
necessary but simply but if not more but no00:29:37
less important is the control of other00:29:39
risk factors, first of all, this is the00:29:40
level of blood pressure and cholesterol level,00:29:42
we again have this type of experience that, at00:29:44
least for the time being, on an outpatient basis,00:29:47
I prescribe medications for blood pressure and cholesterol more00:29:49
often in Aktobe for the second00:29:51
type than insulin, for example, dense00:29:53
in principle, because all this has long been00:29:55
off the table routine for00:29:57
modern endocrinologists, well,00:29:59
it’s all reflected in the00:30:01
outcomes so far in civilized countries, that00:30:03
is, if you look at the approximate00:30:05
trend of what patients with00:30:06
type 2 diabetes die from, you need fresh ones data00:30:08
from the UK, for example, there, in00:30:11
principle, the trend is towards a00:30:13
decrease in00:30:15
death from cardiovascular00:30:17
diseases and against the background it increases00:30:19
until the death rate from oncology,00:30:21
since everyone will have oncology if00:30:23
they live to see it, and so we give a chance to00:30:26
our patients with diabetes mellitus00:30:28
type 2 in Denmark, live accordingly,00:30:31
plus or minus the staples, the whole information00:30:32
part, so let's00:30:34
go through the myths of Das once again, as if the first one is00:30:36
that if you eat a lot of sugar, will there be00:30:37
diabetes with the first type no, this is not so00:30:40
with the second type, well, formally yes but as00:30:42
if diabetes is not just sugar, you can00:30:45
eat food and all other00:30:47
macronutrients, but in relation to00:30:49
whether it is inherited in general00:30:51
and to whom there is this tendency to00:30:53
inherit, but exactly its00:30:55
significance is, as it were, all very00:30:57
conditional because with the first type, diabetes,00:30:59
well, roughly speaking, it either00:31:00
occurs or not, but with the second type, the00:31:02
ladies pass it on to this, but00:31:05
essentially all that we the patient can do, knowing it, is to00:31:07
kind of control it, but here’s00:31:09
your lifestyle and your body weight and you00:31:11
need control regardless of00:31:13
whether you have a hereditary history of00:31:15
diabetes or not regarding the fact that00:31:18
insulin therapy is permanent in the first type,00:31:19
unfortunately, in the second type, in00:31:22
many cases there is no, there are individual00:31:24
situations, for example, in patients00:31:26
whose kidneys do not work or00:31:28
there are very severe concomitant the situation there and00:31:30
of course we don’t have many00:31:31
options, but for the vast majority of00:31:34
patients we have options, part of them is00:31:36
becoming more and more type 2 diabetes00:31:38
forever, that is, this is a00:31:40
fundamental point, and that it is00:31:42
possible to achieve remission in the00:31:44
vast majority of patients and in fact00:31:46
In fact, very few patients seem to hear00:31:48
this from doctors and, accordingly, do00:31:50
not receive the proper motivation to00:31:51
change their lifestyle. Well, the00:31:54
main thing in the treatment of diabetes mellitus is00:31:56
only monitoring glucose levels in00:31:58
patients with the first type, since00:31:59
they actually do not have insulin and the main thing the00:32:01
same problem that arises for them is this00:32:03
increased level of glucose, rather yes,00:32:04
although they still have until because they still00:32:07
live no longer like they did00:32:09
a hundred years ago, much longer over time,00:32:12
as it were, the need also arises to00:32:14
control other risk factors for the00:32:15
development of cardiovascular diseases00:32:17
in the first place the turn of blood pressure00:32:19
on elevated and elevated00:32:21
cholesterol levels, and this is clearly applicable to00:32:24
patients with type 2 diabetes in which,00:32:26
well, most likely, well, that is, not if not00:32:29
more, then00:32:31
other risk factors play the same importance thousands of times for an00:32:34
increased level of pressure on and00:32:35
cholesterol, well, and accordingly, there are,00:32:38
of course, a huge number of other00:32:39
myths about which we and we haven’t00:32:41
told, well, maybe00:32:43
we’ll talk a lot today, but my answer to00:32:45
most of them is yes, don’t consider it a00:32:46
fudge of names to us that we will still have to eat less00:32:51
This is where my informational part of the ladies00:32:55
ends,00:32:57
now let’s see the voting results,00:33:00
how our viewers voted, and as00:33:03
we can see, the majority and it was leaked that nothing00:33:06
will change in vain, I gave a lecture and it seems like everyone00:33:09
knows everything, well, probably you00:33:12
had something else meaningful, but00:33:14
I’m afraid what now give and cool00:33:17
memes tails memes but now they wo00:33:20
n’t help you because are00:33:24
you ready to answer for your words on00:33:28
stage harmful opponent Olga Derevianko00:33:33
Candidate of Medical Sciences chief00:33:35
endocrinologist of a network of clinics their names00:33:37
head of the department of endocrinology and00:33:39
metabolic disorders you have ten00:33:41
minutes,00:33:43
thank you Alexander Ivanovich there were a lot of00:33:46
simplifications, of course, you made00:33:49
a disclaimer, but there are things that00:33:52
hurt my endocrinological suffocation to the point of00:33:54
impossibility, let's get back to this,00:33:57
first of all, we are at the event, scientists00:33:59
against myths, and speaking about diabetes mellitus,00:34:03
you mentioned that most often and most of00:34:05
all we have a cohort of patients with00:34:08
type 2 diabetes mellitus and from the very beginning speaking about the00:34:11
criteria, the blood sugar level is all00:34:14
millimoles per liter and higher, but00:34:16
type 2 diabetes mellitus does not occur00:34:19
at lightning speed and it is usually preceded by00:34:22
several years of hyperglycemia, that is, an00:34:25
increase in blood sugar levels to00:34:26
certain limits and an important myth that00:34:30
many people think that diabetes mellitus is00:34:32
necessarily accompanied by00:34:34
certain complaints, yes, this thirst,00:34:37
urination at night is so debilitating, and00:34:40
I would like to draw the attention of our00:34:42
listeners to the fact that firstly,00:34:45
type 2 diabetes mellitus begins to develop00:34:48
long before the moment00:34:50
blood sugar begins to rise to more than 700:34:53
millimoles per liter and the norm is the00:34:55
sugar level in the region according to the00:34:58
World Health Organization00:34:59
clinical recommendations yes yes 6 and00:35:02
millimoles inclusive and in some00:35:04
countries even lower values up to00:35:06
five or six even then doctors recommend00:35:09
examination for hidden00:35:11
diabetes for impaired00:35:13
tolerance to glucose,00:35:15
that is, in diabetic conditions,00:35:17
why did this excite me so much, yes,00:35:19
because with diabetes and such a situation00:35:21
when we can return the blood sugar level completely to00:35:24
normal by giving the normal limits to the blood sugar level00:35:27
and really save00:35:29
the patient from the diagnosis of00:35:31
type 2 diabetes mellitus, as for the myths that type00:35:33
2 diabetes mellitus like forever and00:35:36
this is still a myth, but we will talk about the fact00:35:39
that the diagnosis remains and perhaps00:35:41
impurities, but again not for all00:35:44
patients, and00:35:45
here I would like to move on to the second00:35:48
important point, this is heredity for00:35:50
patients with type 2 diabetes mellitus,00:35:53
you made a lot of00:35:54
such emphasis on the fact that this is still a00:35:57
way of life, this is the00:35:58
body mass index, have you encountered00:36:01
patients with type 2 diabetes mellitus in your practice00:36:04
without excess body weight,00:36:06
thank you very much Olga Sergeevna, well,00:36:08
your previous comment went through00:36:11
and I will also answer, that is, I00:36:13
certainly agree that as if an important00:36:14
problem is both latent forms of00:36:15
diabetes and 3rd lunch, but I indirectly00:36:18
mentioned this there, saying that the00:36:20
adaptive reserves of our body are00:36:21
quite extensive in China and a00:36:24
person can walk for a very long time with such a00:36:27
subclinical to immortal condition,00:36:29
and certainly yes in this the big00:36:30
problem is that sugars don’t hurt, that is, by00:36:33
the time all00:36:36
these symptoms already appear about which they write on00:36:37
the Internet, that’s what Olga00:36:39
Sergeevna said, well, of course, this is already with00:36:40
severe hyperglycemia, so your00:36:44
second question in relation to the fact that00:36:46
how have I met on certainly00:36:48
met certainly met not only on00:36:50
the side of course there are cases of type 2 diabetes00:36:52
without the premium of obesity00:36:54
because we classify it around it here the00:36:57
body mass index is more than 30 but on the other00:36:59
hand well it’s just like there well like of00:37:01
course I am that’s all, take cumin,00:37:05
there are other components that affect the00:37:07
decrease in the function of beta cells, perhaps00:37:09
before it is there and something else, but the point is that00:37:12
from a practical point00:37:13
of view, everything that we can influence, well, one00:37:15
way or another it namely the00:37:17
patient’s diet, lifestyle, and everything00:37:19
else, in fact, a couple of weeks00:37:20
ago, a study was published00:37:22
that even in patients00:37:24
who are not obese, that is, they00:37:25
just have excess body weight, their00:37:28
body weight still decreased. rice,00:37:29
well, that is, contributed to Rene's environment in00:37:31
achieving diabetes, one cannot help but say00:37:34
that there is virgin soil resistance in00:37:36
people with an ideal body mass index in00:37:38
athletes in people who do not have00:37:41
any deviations according to the strictest00:37:43
bio impedance and they, unfortunately, have a00:37:45
diagnosis of diabetes mellitus of the second like,00:37:47
despite the fact that they eat like you and I00:37:51
never dreamed of, and by all rights,00:37:53
something in between even the00:37:54
Mediterranean and Harvard plates,00:37:57
that is, this is absolutely not a hundred percent of00:37:59
cases, far from it, this is an excellent motivation00:38:03
for our patients, but I wouldn’t want00:38:05
to create the illusion that this is00:38:08
possible for everyone because such00:38:10
patients are often very motivated00:38:12
who do not have excess and, indeed, an00:38:14
increased body mass index, they are very00:38:16
motivated and they try very hard to00:38:18
do everything regarding lifestyle and00:38:20
say that remission is possible00:38:23
for everyone if we we follow00:38:24
certain recommendations, but this is00:38:27
deliberately misleading, I00:38:28
would like to differentiate these points to00:38:30
say that of course for people with00:38:32
mobile obesity with a body mass index00:38:34
in general greater than thirty up to a00:38:36
diagnosis of obesity,00:38:38
glycemic control will certainly improve if00:38:40
weight loss occurs and better00:38:43
or pi to the gram and all this is true, but00:38:44
unfortunately here simplifications in the pathogenesis of00:38:48
type 2 diabetes mellitus can simply00:38:50
mislead a large number of00:38:52
our patients and lead them to00:38:54
eating disorders; there is no00:38:56
completely different plan; I myself00:38:58
certainly agree that, well, so to speak,00:39:01
absolutization everything in medicine is, of00:39:03
course, unacceptable, but I didn’t say that00:39:05
every type 2 diabetic can00:39:07
achieve mission 3, yes, if you limit the00:39:09
consumption of sweets, that is, but it00:39:10
can simply be achieved, they don’t00:39:12
need to say about this, well, as if00:39:14
because I, well, actually In fact, I very00:39:16
often come across in practice that the very00:39:18
idea that, again, diabetes could00:39:20
go into remission and not require insulin00:39:22
or drug therapy, as if00:39:24
patients don’t know this and in fact,00:39:26
many doctors,00:39:28
not endocrinologists, don’t know this yes, yes, even00:39:29
endocrinologists sometimes persist in this, that00:39:32
is, at stake, as it were, that’s why the very00:39:33
idea that something can be done about this,00:39:35
how could he and and00:39:37
this can be such a powerful00:39:39
motivating factor, as if it should be00:39:41
conveyed,00:39:42
they persist in relation to what we00:39:45
cannot say is that00:39:47
type 2 diabetes is forever, it is a myth, in this00:39:49
case it is forever, but it may be a00:39:51
mission and the person should be00:39:53
informed that he is at extremely00:39:54
high risk upon the return of this00:39:57
disease, yes, because hyperglycemia00:39:59
will progress we will see00:40:01
an improvement in 1 year 2 but you and I know very well00:40:04
that the function of beta cells00:40:05
still decreases over the years and sooner00:40:08
or later, unfortunately, no matter how our00:40:11
patient follows all the recommendations, the00:40:14
likelihood that hyperglycemia and00:40:16
high blood sugar will return and00:40:18
we will need to intensify00:40:20
our intervention, it is great, so in general I am a00:40:23
very big optimist in life, and00:40:24
today my role is a harmful opponent and00:40:27
I want to emphasize this for00:40:29
people, this is such a socially significant00:40:31
disease, type 2 diabetes,00:40:33
probably each of us has, well at00:40:35
least relatives with this disease,00:40:37
therefore, until remission is achieved, it is possible,00:40:39
but to say that we remove this diagnosis and00:40:42
forget about it forever, remission is00:40:44
an emission that requires constant00:40:45
monitoring, knowledge of risk factors, the00:40:48
frequency of these observations of certain00:40:50
examinations, and00:40:52
well, what we told you is not right, but00:40:55
can you then counter question Olga00:40:57
Sergey no no I completely agree with you00:40:58
and I said about this that it is00:41:00
possible to achieve remission of the00:41:02
disease yes that is unconditional if a00:41:04
person is already well it seems to me that00:41:06
this is a myth that diabetes is forever00:41:08
and and it you came across the site that this is a myth,00:41:10
I would not want this to be imprinted00:41:13
in the heads of our viewers, that it00:41:15
always interferes, but the onset of00:41:16
long-term emission is possible, the question of how00:41:19
persistent we are here can probably be discussed for a00:41:22
long time, but it definitely requires00:41:24
observation of such patients throughout their00:41:25
lives, and quite regular00:41:28
and returning to the fact that there are some00:41:30
clinical manifestations here, too, we00:41:32
cannot do this operation, of course, I00:41:34
agree with you in Kobi and on the final00:41:36
slide, as if where I summed up and rhizomes,00:41:38
I was told that it can be00:41:39
achieved rimi Sep, that is, of course,00:41:41
if remission is an absence, or rather,00:41:44
it is maintaining the proper level of glucose00:41:46
without insulin and00:41:48
medications no, I wanted you if I can00:41:52
meet him then the question is no, I00:41:53
certainly agree that if the fact itself and00:41:55
deduced where type 2 diabetes arose in a person00:41:58
and how would he achieve remixed is an00:42:00
absolutely different situation00:42:02
compared to a person who has never00:42:03
had diabetes, because the system00:42:05
was already compromised, so to speak,00:42:07
and so in such a00:42:09
situation, for example, we write a00:42:11
diagnosis that diabetes is in remission, and if the00:42:13
patient had more, it turns out that00:42:15
diabetes mellitus with this patient00:42:16
forever mine can be imprisoned I will ask00:42:20
a question accordingly no no I’m just00:42:21
interested in your position that is, but if the00:42:23
patient was obese and he lost weight you00:42:25
leave in the diagnosis obesity in the00:42:28
anamnesis 1 zenith but we have00:42:30
certain rules that relate to00:42:32
diabetes mellitus like diffuse00:42:33
toxic goiter, yes, most00:42:35
patients will leave this in the diagnosis,00:42:38
we also understand that antibodies to the TSH receptor00:42:40
will persist and the likelihood that, for00:42:43
example, the occurrence of endocrine00:42:44
ophthalmopathy in such a patient during his00:42:46
life is, although less after00:42:48
radical treatment, these are different things,00:42:50
what we are talking about we are talking in the context of00:42:52
Sandra’s disease and type 2 diabetes00:42:54
no, but I mean that,00:42:56
well, how can we talk about a00:42:57
history of the army, and a history of gastritis00:43:00
that was treated, no, but I don’t, I00:43:03
mean here that we are formally speaking00:43:04
here if a person was obese and00:43:07
lost weight, that is, obesity, the diagnosis of00:43:10
obesity is made on the basis of00:43:12
body mass index, the diagnosis of diabetes00:43:13
is made on the basis of a glucose level of00:43:15
more than seven millimoles per liter or before the00:43:18
hemoglobin level or a random00:43:19
determination, yes, but if there is, it turns out00:43:21
we have a hint and I have there was another00:43:23
important question00:43:25
answering the question that the diagnosis of obesity,00:43:27
of course, yes, we remove it as soon as the00:43:29
body mass index is normalized for00:43:31
type 2 diabetes mellitus, as well as00:43:32
diffuse toxic goiter, we leave the diagnosis00:43:33
precisely because we must00:43:35
pay attention to both the patient himself00:43:37
and colleagues who will see our00:43:39
conclusions are that this is a00:43:41
high-risk patient whom we must00:43:43
definitely follow up with, please one00:43:45
short question,00:43:49
how do you explain you showed that00:43:51
skipping breakfast increases the likelihood of00:43:54
type 2 diabetes mellitus, what do you00:43:57
think, or in terms of obesity, what was the slide00:43:59
that this directly fell into also such a scale00:44:03
that this is such a serious00:44:05
risk factor, as you yourself explain it,00:44:07
do you think so in fact, it’s more magnificent,00:44:09
I would again like to00:44:10
mislead our viewers, let’s00:44:13
discuss this briefly, well, if very briefly,00:44:15
I think that of course there is no deep00:44:17
biological meaning in skipping00:44:19
breakfast that it increases the risk of00:44:20
diabetes is not necessary, as it were, and a special00:44:22
breakfast in the name of00:44:25
fighting diabetes is not necessary until 0 and I00:44:27
think that rather this is more of00:44:29
such organizational issues that most00:44:30
likely those who are people who skip00:44:32
breakfast are in general less organized00:44:34
approach to their eating behavior00:44:37
and simply eat more in each other00:44:39
at other times of the day, thank you very much, I00:44:42
would not like it, but it’s just that the00:44:43
additional meal of food does not get used to it at first,00:44:45
and we seem to recommend00:44:47
introducing an extra meal in order to00:44:50
improve diabetes control00:44:52
thank you very much thank you viewers I00:44:55
will now ask you to rate our harmful00:44:58
opponent please follow the link00:45:00
and vote vote how do you00:45:02
assess the harmfulness of Olga was she a00:45:05
good friend Alexander may be an00:45:07
interesting conversationalist a00:45:08
master of tricky questions or maybe a00:45:10
real thunderstorm00:45:12
vote there should be another option that00:45:14
everything at once and lost, well, it won’t work right away,00:45:17
we’ll see because00:45:19
today at the end of the day we will choose the00:45:20
most harmful opponent00:45:23
by voting and only at the end we will find out not00:45:24
from the results we will know now, but then00:45:26
we will evaluate other opponents and they00:45:28
may be more harmful than you have00:45:31
here thank you now for gifts from00:45:33
the forum duck against myths friends00:45:35
vote and we move on to questions from the00:45:38
audience and we have a question that is00:45:43
visually asked using video00:45:45
please turn on00:45:53
hello my name is Sergey and I have a00:45:56
question for Lexan today the wide sale00:45:59
has already spread very inexpensive00:46:01
commercial genetic tests that00:46:04
can tell a lot about a person,00:46:06
from origin to the00:46:10
location of a serious disease,00:46:11
including diabetes, how much to trust the00:46:14
interpretation of the results that are00:46:16
published in these reports and whether00:46:19
these reports in this form will be useful to00:46:21
non-genetic practitioners whom00:46:24
the patient is seeking with our complaints, well,00:46:29
we answer00:46:32
Sergei’s questions, of course, such genetic00:46:34
passports are now extremely00:46:37
common, and perhaps, based on00:46:39
their results, you can00:46:40
find out whether you had00:46:41
relatives and Egyptians there, or whether there were00:46:43
followers of the penguin htb, but in00:46:45
relation to exactly how real00:46:46
practical medicine and type 2 diabetes00:46:48
in particular, well, I even showed us an00:46:51
example of such genetic tests,00:46:54
well, they have a special and direct clinical00:46:56
meaning at the moment, but in00:46:58
real practice this does not have any00:46:59
more such a commercial component, I00:47:00
repeat, there are certain types of diabetes for00:47:03
which individual ones are known Here genes00:47:05
and00:47:06
here and there it plays a role, but this is a very00:47:09
rare story, that is, well, I’m00:47:10
not usually included in those genetic00:47:12
passports, so for the most part it doesn’t00:47:14
make sense and is of such a commercial00:47:15
nature, well, or inquisitive, thanks00:47:18
Alexander because you agreed to the00:47:21
blitz, now we will have such a00:47:23
story for three minutes, I will00:47:25
ask you questions and ask you to00:47:27
answer as succinctly as possible, our00:47:28
previous record was full of 13 minutes,00:47:31
let's see, let's start with00:47:33
questions, internet questions in00:47:36
three minutes, that is, in one word,00:47:39
if this will be exhaustive of the feature00:47:42
then the expenses can be gestures dance as you00:47:46
wish in the form of persons to be I just00:47:48
went00:47:50
a question from Alina Glushko can diabetes00:47:53
appear and disappear during the course of life00:47:55
for example during the first pregnancy a glucose00:47:57
tolerance test showed a positive00:47:58
result increased glucose level with00:48:00
2 negative yes of course it can well that00:48:04
is, this is in the context of approximately what00:48:05
we were talking about, that is, that all the same, at the00:48:07
basis of both type 2 diabetes and00:48:10
gestational diabetes, although there are other00:48:12
factors, the game or for lies00:48:14
insulin resistance,00:48:15
insulin resistance is proportional to the00:48:17
content of adipose tissue in the body and,00:48:18
accordingly, as it were if, well, roughly00:48:21
speaking, you vary, that is, you and00:48:22
each person has a nukaba conditional00:48:24
here on their threshold value when00:48:25
reaching a certain body weight,00:48:28
can diabetes occur and,00:48:30
accordingly, if how to reduce it,00:48:31
who can look at00:48:33
glucose levels at the level of diabetes leave so00:48:35
there is of course possible to flash a romance cable00:48:38
what happens to the glucose level00:48:39
in T1 diabetes on the strength heroes koch on00:48:43
the Internet there is a lot of conflicting00:48:45
information oh well, in general, well, not that within the00:48:47
framework of, in principle, the strength00:48:49
training cabin, glucose most often00:48:52
increases, but how would it be everything varies,00:48:53
there was one interesting00:48:56
individual study on patients00:48:58
with type 1 diabetes, how strength00:49:00
training affected their glucose levels00:49:02
and during three workouts during the00:49:05
day, there seemed to be something that if00:49:07
training is carried out there in the morning, then00:49:09
this is Sparta and then an00:49:12
increased level of glucose occurs more often, if in the00:49:14
second half of the day, then hypoglycemia occurs more often,00:49:15
so the authors there00:49:17
recommend that if patients have a00:49:18
tendency to hypoglycemia, then it is better to do it00:49:20
in the morning and vice versa, as if in the second00:49:22
half of the day, but this is all very,00:49:24
very empirical a question is being picked up00:49:27
from Ekaterina Samoilova, if there is harm00:49:30
from synthetic sweeteners, when will00:49:34
low-calorie sweets and baked goods become available to the masses? Well,00:49:35
to some extent, Tanya is available,00:49:38
yes, in various health00:49:41
food stores there is no, but these artificial00:49:43
sweeteners mikhael globally are00:49:45
quite often frightening that they don’t00:49:46
have all sorts of toxic effects there, that00:49:48
they have a bad effect on the micro on the00:49:50
intestinal microbiota and all that, that00:49:52
is, well, to some extent, this is possible00:49:54
and so we under their potential benefits for00:49:55
reducing body weight, it outweighs the risks,00:49:58
so it’s like, well if you really00:50:00
can’t live without it, but you can switch to it,00:50:01
that is, well, laser will be00:50:04
healthier than regular cola and you have a00:50:06
large number of studies00:50:07
confirming that switching to00:50:09
artificial sweeteners improves the00:50:11
situation with body weight and diabetes with00:50:13
other parameters Anna Petrakova00:50:16
do we need sweets as such or can we00:50:18
wean ourselves off them without harm to00:50:20
health, well, just like a biological need00:50:23
other than a psychological one, of course it’s00:50:25
not special, therefore, that is, but if a00:50:27
person simply doesn’t eat sweets, but00:50:29
he definitely doesn’t will die therefore, that if00:50:32
you can afford it, it00:50:35
will be very good; for example, I00:50:37
can’t. Vyacheslav Kuznetsov, tell00:50:39
the seller what you know about Russian00:50:40
insulins, if there are prospects for imports00:50:42
to replace kumalak and lantus,00:50:46
if not that they are prospects to00:50:49
some extent yes, hu hu milk00:50:51
lantus is replaced,00:50:53
we must continue, because we00:50:56
have it, that is, well, as if they often00:50:58
criticize our insulin, but as if they are there,00:51:00
and it’s as if it’s definitely not a saline solution, they00:51:02
work and she, as it were, to he had a00:51:04
pretty close relationship, so to speak,00:51:07
at the stage of Adam Booth testing them,00:51:11
here, of course, there are a large00:51:13
number of other problems, as if in addition to the00:51:15
development itself, therefore, because we00:51:18
understand that it is one thing to create a molecule00:51:19
to prove that it is equivalent, another00:51:21
matter and and to scale it up to a huge00:51:23
production up to millions of people and,00:51:25
accordingly, there are further00:51:27
problems with logistics with transport00:51:28
preservation and other things, that is, these00:51:30
may be problems that can00:51:32
reduce the quality of insulin at the00:51:34
stage of its consumption, but globally there is00:51:37
such a prospect, and these00:51:39
drugs are available, that is, but how to00:51:41
absorb the doses no one will fall into00:51:43
the tables we have run out of four and a00:51:45
half questions approximately now it’s already00:51:47
just blitz but nevertheless they are calling00:51:51
to take the laconic old questions a lot of ok00:51:54
ask the great designer is it possible to00:51:57
maintain sugar in a type 1 diabetic00:51:59
at the level of 33 at night without insulin or00:52:03
this is fraught with consequences without insulin,00:52:04
but since type 1 diabetics00:52:07
do not produce their own insulin,00:52:09
they will not drive at all, as if00:52:11
new ones they will have hyperglycemia00:52:14
Karl-August avanti asks00:52:16
whether attempts have been made to00:52:17
control type 1 diabetes mellitus00:52:19
with the help of selective00:52:21
immunosuppressants,00:52:23
yes of course they have been made and they00:52:26
continue to be undertaken, that is, there are00:52:27
actually two types of work in00:52:29
relation to this, that is, the first thing that will00:52:31
catch people who, well, will already00:52:34
have autoantibodies to their own beta00:52:36
cells and to other structures that00:52:38
cause their destruction, that is, to catch00:52:40
when there are still some antibodies, we have beta00:52:42
cells still alive and will prescribe00:52:44
immunosuppressive therapy for this, or well, we are00:52:46
talking about00:52:48
using stem cells for us00:52:50
like an artificial00:52:51
pancreas and subsequent00:52:54
immunosuppression so that these tissues00:52:56
function, there is such work, but how00:52:59
would it all be like so far at the level of00:53:00
theory, that is, there are some more00:53:02
successful molecules, less successful ones,00:53:04
but it is in routine practice, yes, that00:53:07
is, how we treat00:53:08
patients now, this is not used in00:53:10
relation to type 1 diabetes, much more00:53:12
promising and most likely how would00:53:14
this happen earlier than an artificial00:53:15
pancreas is an artificial00:53:17
pancreas, that is, it is00:53:19
a system where they use insulin00:53:21
pumps and a system for determining00:53:23
glucose levels and the ladies kind of form00:53:25
that feedback loop between them,00:53:28
that is, they simultaneously combine a00:53:30
pump and a sensor device to00:53:32
determine glucose, as it were, and which00:53:34
itself imitates the action of the pancreas, a00:53:37
question from Nikolai Tuzhilina, which00:53:40
crystal has won today in00:53:41
the production of insulin, natural pork00:53:43
or synthesized by genetic engineering, well, of00:53:47
course, genetically engineered, since00:53:49
almost all insulin and which we00:53:51
now use are analogs of insulin00:53:52
then there is, as it were, an already modified00:53:54
molecule of our native insulin, which00:53:57
we have given some additional properties so that,00:53:58
on the contrary, it works faster or00:54:01
works slower, that is, so of00:54:02
course, well, I’m interested in00:54:04
bacteria and fungi, mushrooms,00:54:07
it’s from Tomsk, what infectious00:54:11
diseases suffered in early00:54:13
childhood leads to diabetes and how often does this00:54:15
happen,00:54:16
well, how often is it 0 4 percent in the00:54:20
general population, that’s how specific it is,00:54:22
that is, there is a huge number of viruses,00:54:24
that is, the flu, like parvovirus sake,00:54:26
intones not only there was a very large00:54:27
number of viruses, but to say that this00:54:29
particular one was in this00:54:31
specific pupa person something this00:54:32
child at the age of seven developed00:54:35
diabetes because he was ill on00:54:37
October 15, 2015 and therefore he has00:54:39
diabetes, we unfortunately cannot00:54:41
question from Denis told from Novy00:54:44
Urengoy I correctly understood that00:54:45
normalizing weight this00:54:47
minimizes the risk of getting diabetes what00:54:50
weight parameters are considered minimally00:54:52
dangerous from the point of view of developing diabetes,00:54:54
but in general, in most studies it is believed00:54:57
that a decrease in body weight by 5 7 dash 1000:55:00
percent of consumables is already00:55:02
accompanied by a significant change in a00:55:04
significant change in the level of glucose to whom,00:55:07
as it were, that is, not only the maximum00:55:09
reduction, but simply from what an00:55:10
ordinary person can do in his life00:55:13
to reduce the risks of diabetes or to00:55:15
try to overcome the existing one is to00:55:17
reduce body weight, as it were,00:55:20
some specific cut-off point there is a00:55:22
ratio of body weight in kilograms00:55:24
to waist circumference as more so that00:55:27
exactly that as a threshold value00:55:28
that needs to be reached conditionally00:55:30
there is no such thing, well, that is, in general, as if00:55:32
the less the better, Daria from Moscow00:55:34
asks what sources are worth00:55:36
getting acquainted with for educational purposes and on the topic of00:55:39
diabetes00:55:41
must, I think there00:55:45
are quite a lot of such sources on the Internet a large00:55:46
number of diabetes schools, both in00:55:48
large diabetic centers and00:55:50
in large hospitals, in00:55:52
some private centers where you00:55:53
can get adequate00:55:55
consultations, that is, they00:55:58
have a large number of video manuals on00:56:00
YouTube, and these schools00:56:03
lack information about diabetes principle00:56:05
this is a special no00:56:07
question from Denis to tell again00:56:11
how often00:56:13
old diabetes mellitus is mistakenly diagnosed, what a doctor should00:56:15
check to make sure the00:56:16
diagnosis is correct, well, as we already looked at in the00:56:19
definition of diabetes, this is a persistent increase in the00:56:22
level of glycemia to, respectively, more than a00:56:25
family of millimoles on an empty stomach more than 11 1 in00:56:28
random point or in a test of more than six00:56:29
and a half percent privileged00:56:31
hemoglobin, it is very often a mistake to diagnose00:56:34
diabetes by looking at one point before, that is, because00:56:37
having received one value and00:56:40
immediately diagnosing diabetes and, as it were,00:56:42
prescribing the appropriate therapy or00:56:44
in the wrong conditions or else00:56:46
Quite often in our practice00:56:49
we encounter erroneous diagnoses of diabetes,00:56:51
for example, what if patients are given a00:56:53
special test with a glucose load where00:56:55
they give 75 grams of glucose to drink and then00:56:58
normally they should check the glucose level00:56:59
after two hours, but more often they look at00:57:02
it again after an hour after 30 minutes an00:57:04
hour and a half if there is anything there that00:57:06
exceeds the conditional made-up00:57:08
norms, this is diagnosed as diabetes, or for example,00:57:10
diabetes can be diagnosed based on an00:57:12
increased insulin level with00:57:14
normal glucose levels, and to intimidate00:57:16
a person is to prescribe a shock00:57:17
battery of dietary supplements like this occurs00:57:19
quite often, therefore, in general, once again, there00:57:21
are clear criteria for diabetes and00:57:22
such values should be obtained00:57:24
repeatedly, that is, as if at00:57:26
least 2 and better with an interval of some00:57:29
time if there are no acute signs of diabetes,00:57:32
that is, this is what we’re talking about they write on00:57:34
the Internet a sharp decrease in body weight is00:57:36
born, and00:57:38
frequent urination and so on00:57:41
Daria from Moscow asks if possible00:57:44
briefly the opinion of an endocrinologist Akita diet00:57:48
briefly well, for weight loss it00:57:51
works the same way as any other diet, well,00:57:53
that is, as if specifically for00:57:55
weight loss with the same caloric intake,00:57:57
plus or minus k, you would also reduce it, but it’s00:57:59
just quite problematic to00:58:02
stick to it in the long00:58:03
term, and so it’s like, in general,00:58:06
well, no, not a single study has shown the00:58:07
advantage of the chum diet00:58:09
compared to any other00:58:11
forest, but he asks, I heard that if a00:58:15
large baby is born weighing more than00:58:16
four and a half g, then this is a consequence of the00:58:19
mother’s gestational diabetes, is this true, yes,00:58:22
well, in many cases this is00:58:24
really true, something is born, a00:58:26
large fetus is born, everyone is happy that she gave birth00:58:29
to a hero, but in reality, yes, that’s that, that’s00:58:31
that cleverly called00:58:33
macros, that is, macros are one00:58:35
of the possible consequences of gestational00:58:37
diabetes00:58:39
Daria Korzukhin A.I. diabetes occurs00:58:42
only in mammals, a00:58:46
good question, well, I think that there are some00:58:51
analogues and it has ucoz, but today00:58:53
there will be a report from the spouses, let's00:58:55
ask, we will hold a consultation of blood with the00:58:58
involvement of several specialists00:58:59
Elena Malinkina received information about00:59:02
studies showing that rotavirus00:59:04
can include diabetes 1 like, first of00:59:06
all, in children, is such a connection really00:59:08
possible or is it a fake?00:59:10
Well, just specific work with a00:59:14
specific rotavirus of mine and a specific00:59:16
strain,00:59:17
it’s difficult to say this, in principle, it00:59:19
can be given simply as if all such00:59:21
work is simply due to the limited number of cases00:59:24
and a small number of cases. the00:59:26
bottleneck effect,00:59:28
therefore, in a specific work, a00:59:29
different relationship could have been completely shown00:59:31
and there might not have been, well, a trend that in00:59:33
general, a global viral infection00:59:35
can trigger a story like this, but this does00:59:38
not mean that if you are your child,00:59:40
you have acquired a viral infection and00:59:42
he will have diabetes00:59:44
zlotnik darena asks whether00:59:46
diabetes mellitus is a provocateur of diseases00:59:48
not directly related to the disease valerie00:59:51
research on this topic of children00:59:54
whose mothers had gestational diabetes mellitus00:59:56
but in my opinion these are two different questions, I00:59:58
answer the first ones, but as if01:00:00
unconditionally, if not directly then01:00:03
Diabetes mellitus indirectly affects, but about01:00:05
practically any disease, and01:00:09
it’s absolutely not even connected with01:00:13
heart disease, even for example with01:00:16
gynecological pathology, with01:00:17
endometriosis or something like that, so well,01:00:20
one way or another, yes, unfortunately there are 2 answers01:00:23
Yes, this and that, it was also01:00:25
shown that children of mothers who had01:00:28
gestational diabetes, they have, well,01:00:30
more of a trend for here again, the01:00:32
disease is like this at the risk of developing01:00:35
metabolic diseases of the same01:00:38
diabetes, in particular, they01:00:40
ask Eugene, highly what are the01:00:44
biotechnological prospects for the desire for01:00:46
insulin and dependent diabetes,01:00:49
well, he said indirectly about this, that is, of course,01:00:51
that in some way, given the excellent01:00:55
medicine of the future, we can, as it were,01:00:57
achieve01:00:58
technologies that allow us to create01:01:00
artificial analogues of the01:01:02
pancreas and, as it were, so that it takes root01:01:05
and its work is supported with the help of01:01:06
seemingly adequate drugs01:01:09
that provide immunosuppression or to01:01:11
intervene it is01:01:13
more expensive to destroy beta cells with01:01:16
existing immunosuppression with the help of01:01:18
drugs, but so far this is the domain of01:01:20
research in real life there is no such thing,01:01:22
I have already said that in my opinion01:01:23
adequate and more advanced ones will appear much sooner,01:01:26
the main thing is that they are available to a01:01:28
wide circle circle of users, here are01:01:31
artificial pancreases, that01:01:32
is, this is a mixture of a pump and a sensor, a01:01:35
question from Maria Polyakova, how01:01:38
promising is pancreas transplantation effectively01:01:40
if the data are01:01:42
pancreatic regeneration and therapy for01:01:45
beliar pancreatitis, but here immediately yes01:01:48
no, well, indirectly, I have already01:01:51
answered this that as if there were attempts at01:01:53
transplantation with the help of01:01:54
stem cells, they seem to have a01:01:57
lot of such studies on mice01:02:00
walking pigs, if I’m not mistaken, there01:02:02
are some in humans, well, that is,01:02:04
because such work exists and there, well, they01:02:05
sort of achieved that they01:02:07
produce insulin there, but over01:02:08
time it’s still there, it’s as if its01:02:11
own products are fading away, but you01:02:13
still need to understand that01:02:15
immunosuppressive drugs are01:02:17
not vitamins and they have their own side01:02:19
effects, it’s not a fact that at least for now At01:02:20
least I think their potential benefit is that01:02:23
they will allow you to maintain a01:02:25
functioning state of beta cells01:02:27
outweighs the risks, so that’s why01:02:29
this is all so controversial01:02:31
about biliary pancreatitis, but there is a sense there that due to01:02:37
diseases that are somehow related with a pathetic01:02:40
current, the pancreas is destroyed,01:02:42
including beta cells, well, that is, in01:02:44
essence, it’s the same type 1 diabetes, well, that’s why it’s01:02:46
about the01:02:48
same logic and there are01:02:50
many more questions at work, but now there’s01:02:54
only time left to choose the best one01:02:55
question, maybe you noted one01:02:57
of the questions that deserves to be the best right away,01:03:00
or I can remind you that there are01:03:02
many questions, but they seemed to be quite01:03:05
similar, I still remember about01:03:07
mammals because I will give an answer to it,01:03:09
they also liked Dori’s question answered01:03:12
and Korzukhina his diabetes in mammals01:03:14
Daria Korzukhina gets the book everything01:03:17
possible how doctors save our lives01:03:19
from the Alpina non-fiction publishing house now01:03:22
let's look at the results of the assessment of a01:03:24
harmful opponent let's see let's see01:03:27
show please well, the majority01:03:30
rated Olga as a master of tricky01:03:33
questions not bad not bad01:03:36
we just have to hand it to you gifts means these are01:03:40
such wonderful wooden01:03:42
diplomas, this is a figure of ping ping 2 t,01:03:45
printed by paul red my studio01:03:46
artifact on including lowers01:03:49
blood sugar I will be applying arruda here is a01:03:52
patient wooden notebook and from our01:03:56
partner from shelter volunteers printers represented by01:03:58
grandfather’s company color and01:04:01
souvenirs from the store of prints and gadgets01:04:04
gen dotka ru that's all for you now a01:04:06
sketch of Yulia Rodina based on your speech will appear on the screen, by01:04:10
the way it01:04:12
will be on the last page of the notebook01:04:15
which you give as a gift, you can then look at the01:04:18
money and with the ears of the crippled cable I remember01:04:21
helping many roles not blown away with the wind01:04:23
first of all, from Rama out of desire,01:04:25
crush Williams, he also had01:04:28
bipolar disorder, but listen,01:04:30
you’re definitely a man if you’re like this,01:04:33
not dangerous for you; of course, it’s dangerous for you in01:04:35
August to take your family away, but nothing more01:04:38
[music]Description:
Фронтенд-разработчик от Хекслет — https://clc.to/XSlHEQ, переходите и осваивайте новую профессию! Если есть много сахара - будет диабет? Сахарный диабет передается по наследству? Диабет второго типа и инсулинотерапия - это навсегда? ================ Научно-просветительский Форум «Ученые против мифов. Пробуждение Пингвохотепа» 09-10 апреля 2022 г. Рубрика: #Когда_невежество_убивает Эпизод-9. «Мифы о сахарном диабете: сахар, инсулин, гены и фатализм» Спикер: Александр Циберкин — врач-эндокринолог, автор блога «Занимательная эндокринология», https://t.me/funwithmedicine Вредный оппонент: Ольга Деревянко — врач-эндокринолог, к.м.н., зав. отделением эндокринологии Клиники Фомина. ❤ Понравился ролик? Подпишитесь на новые эпизоды ► https://www.youtube.com/antropogenezru?sub_confirmation=1 ❓ Есть вопросы? Пишите вопросы в комментариях - и спикер ответит на них в "Постскриптуме" на канале @ScienceVideoLab 💥 Поддержите наш проект ► https://sponsr.ru/antropogenezru ► https://www.patreon.com/antropogenez 0:00 Начало 1:12 Голосование зрителей «Станет ли меньше сахарного диабета, если из магазинов пропадет сахар?» 3:02 План лекции 4:40 Углеводный обмен на минималках 6:22 Сахарный диабет на минималках 08:46 Сахарный диабет тип 1 vs тип 2 11:48 Что запомнить? 14:45 Миф 1: «Если есть много сахара — будет сахарный диабет» 19:27 Миф 2: «Сахарный диабет передается по наследству» 23:01 Миф 3: «Если посадят на инсулин — навсегда» и Миф 4: «Сахарный диабет второго типа — навсегда» 26:40 Миф 5: «Главное в лечении сахарного диабета —контроль уровня глюкозы» 30:31 Выводы 33:07 Результаты голосования зрителей «Станет ли меньше сахарного диабета, если из магазинов пропадет сахар?» 33:30 Дискуссия с «вредным» оппонентом — врачом-эндокринологом Ольгой Деревянко 45:04 Голосование зрителей «Как вы оцениваете “вредность” оппонента (Ольга Деревянко)?» 45:45 Ответы на вопросы зрителей 47:56 Блиц-опрос 1:03:01 Выбор лучшего вопроса 1:03:30 Результаты голосования «Как вы оцениваете “вредность” оппонента (Ольга Деревянко)?» 1:04:28 Анонс доклада: «Биполярное расстройство: неверные представления и рациональные решения» 📖 Стенограмма доклада: https://vk.com/@antropogenez_ru-mify-o-saharnom-diabete 🎧 Подкасты (Apple, Google и др.): https://antropogenez.mave.digital/ 📚 Источники: https://docs.google.com/document/d/1Ln8U_scLad0BCgreaEBbM2gcc_EdMufsRyxvnTSgpbo/edit ================ Организатор форума: @AntropogenezRu Запись, монтаж: "Лаборатория Научных Видео" @ScienceVideoLab Площадка в Москве предоставлена НИТУ "МИСиС" Юридическая поддержка: адвокатское бюро CTL https://abctl.ru/ 🦈 GEN.RU: поставщик уникальных принтов и гаджетов для форума https://gen.ru/collection/uchyonie-protiv-mifov%E2%80%8B Ведущий: Александр Соколов, редактор АНТРОПОГЕНЕЗ.РУ Музыка: Константин Устинович, Дмитрий Денисов https://vk.com/alt_sound Дизайн: Ирина Фролова, Ирина Галенкова, Евгения Беляева Стенограмма: Анастасия Карцева, Екатерина Тигры Диктор: Евгений Прохоров Видео-заставка: Тимур Низов, Виталий Краусс Анимация: Тимур Низов Скетч: Юлия Родина Видеорежиссер: Виталий Краусс Звукорежиссер: Ксения Аблез Оператор-постановщик: Пётр Стерликов Продюсер: Георгий Соколов Координатор: Мариша Эрина ======================== 🗿 Хотите поддержать проект и получить доступ к эксклюзивным видео? В России ► https://sponsr.ru/antropogenezru/ За рубежом ► https://www.patreon.com/antropogenez Наши Правила комментирования видео: https://antropogenez.ru/youtube-rules/ ANTROPOGENEZ.RU https://vk.com/antropogenez_ru https://t.me/antropogenez_ru https://dzen.ru/antropogenez https://rutube.ru/u/science/
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