Diabetes mellitus is a disease of the endocrine system associated with pathological changes in the hormonal background and metabolic failures.
To date, the disease is not amenable to eradication (complete elimination). The destructive process in the body can be slowed down through medication and diet therapy, but it is impossible to stop it and start it in the opposite direction.
Types of diabetes mellitus (DM) are defined by the World Health Organization and do not have fundamental differences across the medical world. Diabetes mellitus of any type is not a contagious disease.
Diabetes mellitus can be of different types as well as different types. As the treatment for each species and type is different, it is necessary to know which specific variant of the disease has arisen.
typification of pathology
There are several types of the disease, united by one main symptom - an increase in the concentration of glucose in the blood. The typification of diabetes mellitus is due to the causes of its occurrence. There are also applied methods of therapy, gender and age of the patient.
Medically accepted types of diabetes:
- the first type is insulin dependent (IDDM 1), or juvenile;
- the second is insulin independent (INZDM 2), or insulin resistant;
- gestational diabetes mellitus (GDM) in the perinatal period in women;
- other specific types of diabetes, including:
- damage to pancreatic β cells at the genetic level (varieties of MODY-diabetes);
- pathology of the exocrine function of the pancreas;
- hereditary and acquired pathologies of the external secretion glands and their functions (endocrinopathy);
- pharmacologically determined diabetes;
- diabetes as a consequence of congenital infections;
- DM associated with genomic pathologies and hereditary defects;
- Decreased blood glucose (blood sugar) on an empty stomach and impaired glucose tolerance.
Pre-diabetes is a borderline state of the body, when the blood glucose level is changed upwards (glucose tolerance is impaired), however, blood sugar indicators "do not reach" the generally accepted digital values corresponding to the true diabetes. According to the World Health Organization (WHO 2014), more than 90% of endocrinologist patients suffer from the second type of disease.
According to medical statistics, there is a clear trend of increasing number of cases worldwide. In the last 20 years, the number of type 2 diabetics has doubled. GDM accounts for about 5% of pregnancies. Specific types of diabetes are extremely rare and occupy a small percentage of medical statistics.
By sex, NIDDM 2 is more common in premenopausal and menopausal women. This is due to a change in hormonal status and a set of extra pounds. In men, the most common factor in the development of type 2 diabetes is chronic inflammation of the pancreas due to the toxic effects of ethanol.
Insulin-dependent diabetes (type 1)
Type 1 diabetes is characterized by pancreatic cell failure. The organ does not fulfill its endocrine (intrasecretory) function of producing insulin, a hormone responsible for supplying the body with glucose. As a result of the accumulation of glucose in the blood, the organs do not receive adequate nutrition, including the pancreas itself.
To mimic the natural production of the endocrine hormone, the patient is given lifelong injections of medical insulin with different durations of action (short and long), in addition to diet therapy. The classification of type 1 diabetes mellitus is dictated by the various etiologies of the disease. The insulin-dependent type of the disease has two causes: genetic and autoimmune.
genetic cause
The formation of pathology is associated with the biological characteristic of the human body to transmit its characteristics and pathological abnormalities to subsequent generations. In relation to diabetes, a child inherits a predisposition to the disease from parents or close relatives who suffer from diabetes.
Important! The predisposition is inherited, but not the disease itself. There is no 100% guarantee that a child will develop diabetes.
autoimmune cause
The onset of the disease is due to a functional failure of the immune system, when, under the influence of negative factors, it actively produces autoimmune antibodies that have a destructive effect on the cells of the body. The triggers (push) to start autoimmune processes are:
- unhealthy eating behavior combined with physical inactivity;
- failure of metabolic processes (carbohydrates, lipids and proteins);
- critical deficiency in the body of cholecalciferol and ergocalciferol (vitamins of group D);
- pathology of the pancreas of a chronic nature;
- hx of mumps (mumps), measles, Coxsackie herpes virus, Epstein-Barr virus, cytomegalovirus, viral hepatitis A, B, C;
- distress (prolonged stay in a state of neuropsychological stress);
- chronic alcoholism;
- incorrect treatment with hormone-containing drugs.
IDDM is formed in children, adolescents and adults under thirty years of age. The infantile developmental variant of type 1a diabetes is associated with complicated viral infections. Form 1b occurs in young people and children in the context of autoimmune processes and hereditary predisposition. The disease usually develops rapidly within a few weeks or months.
Insulin resistant diabetes (type 2)
The difference between type 2 and type 1 diabetes is that the pancreas does not stop producing insulin. Glucose is concentrated in the blood and is not delivered to the body's cells and tissues due to lack of insulin sensitivity - insulin resistance. To some extent, treatment is carried out through hypoglycemic (sugar-reducing) drugs and diet therapy.
To compensate for the imbalance in the body, the pancreas activates the production of the hormone. Working in emergency mode, the organ wears out over time and loses its intrasecretory function. Type 2 diabetes becomes insulin dependent. The decrease or loss of cellular susceptibility to the endogenous hormone is mainly associated with obesity, in which the metabolism of fats and carbohydrates is disturbed.
This is especially true for visceral obesity (fat deposition around internal organs). In addition, with excess body weight, blood flow becomes difficult due to the numerous cholesterol plaques inside the vessels, which form during hypercholesterolemia, which always accompanies obesity. The body's cells are therefore deficient in nutrition and energy resources. Other factors that influence the development of NIDDM include:
- alcohol abuse;
- gastronomic addiction to sweet dishes;
- chronic diseases of the pancreas;
- pathology of the heart and vascular system;
- overeating in the context of a sedentary lifestyle;
- incorrect hormone therapy;
- complicated pregnancy;
- dysfunctional heredity (diabetes in parents);
- Suffering.
Most of the time, the disease develops in women and men in the age group 40+. At the same time, type 2 diabetes is latent and may not show severe symptoms for several years. Timely tests for blood glucose levels can detect prediabetes. With proper therapy, the prediabetic state is reversible. If time is lost, it progresses and subsequently NIDDM is diagnosed.
Lada diabetes
In medicine, the term "Diabetes 1. 5" or the name Lada diabetes is found. This is an autoimmune disorder in the production of hormones and the failure of metabolic processes that occurs in adults (over 25 years old). The disease combines the first and second types of diabetes. The mechanism of development corresponds to IDDM, the latent course and the manifestation of symptoms are similar to NIDDM.
Triggers for the development of pathology are autoimmune diseases in the patient's history:
- non-infectious inflammation of the intervertebral joints (ankylosing spondylitis);
- irreversible disease of the central nervous system - multiple sclerosis;
- granulomatous inflammatory pathology of the gastrointestinal tract (Crohn's disease);
- chronic inflammation of the thyroid gland (Hashimoto's thyroiditis);
- juvenile and rheumatoid arthritis;
- discoloration (loss of pigment) of the skin (vitiligo);
- inflammatory pathology of the colonic mucosa (ulcerative colitis);
- chronic damage to connective tissue and external secretion glands (Sjogren's syndrome).
In combination with hereditary predisposition, autoimmune disorders lead to the progression of Lada diabetes. To detect the disease, basic diagnostic methods are used, in addition to blood microscopy, which determines the concentration of immunoglobulins of the IgG class for antigens - ELISA (enzymatic immunoassay). Therapy is carried out through regular insulin injections and nutritional correction.
Gestational form of the disease
GDM is a specific type of diabetes that develops in women in the second half of the perinatal period. The disease is most often detected during the second routine screening, when the pregnant woman undergoes a complete examination. The main feature of GDM that is similar to type 2 diabetes is insulin resistance. Cells in a pregnant woman's body lose sensitivity (sensitivity) to insulin due to the correlation of three main reasons:
- Hormonal reorganization. During the period of pregnancy, the synthesis of progesterone (a steroid sex hormone) increases, blocking the production of insulin. In addition, placental endocrine hormones, which tend to inhibit insulin production, are gaining traction.
- Double burden on the female body. To provide adequate nutrition to the fetus, the body requires an increased amount of glucose. A woman starts consuming more monosaccharides, which causes the pancreas to synthesize more insulin.
- An increase in body weight against the background of a decrease in physical activity. Glucose, abundantly supplied to the body, builds up in the blood as cells refuse to take insulin due to obesity and physical inactivity. The pregnant woman and the fetus in this situation have nutritional deficiencies and energy hunger.
Unlike type 1 and 2 diabetes, gestational diabetes is a reversible process because insulin molecules and pancreatic functionality are preserved.
Properly selected therapeutic tactics guarantee the elimination of the pathology after childbirth in 85% of cases. The main method of treating GDM is the "Table No. 9" diabetic diet. In difficult cases, injections of medical insulin are used. Hypoglycemic agents are not used because of their teratogenic effects on the fetus.
Additionally
Specific types of diabetes are genetically determined (MODY-diabetes, some types of endocrinopathies) or caused by other chronic pathologies:
- pancreas diseases: pancreatitis, hemochromatosis, tumor, cystic fibrosis, mechanical trauma and gland surgery;
- functional failure of the anterior pituitary gland (acromegaly);
- increased synthesis of thyroid hormones (thyrotoxicosis);
- hypothalamic-pituitary-adrenal pathology (Itsenko-Cushing syndrome);
- adrenal cortex tumors (aldosteroma, pheochromocytoma, etc. ).
A separate diabetic pathology - diabetes insipidus is characterized by a decrease in the production of the hypothalamic hormone vasopressin, which regulates fluid balance in the body.
diagnostic measures
The diagnosis of diabetes mellitus (of any type) is only possible based on the results of laboratory blood microscopy. The diagnosis consists of several consecutive studies:
- General clinical blood test to detect hidden inflammatory processes in the body.
- Blood test (capillary or venous) for glucose content. Produced strictly on an empty stomach.
- GTT (Glucose Tolerance Test). It is performed to determine the body's ability to absorb glucose. The tolerance test is a double collection of blood: on an empty stomach and two hours after the "glucose load", which is an aqueous glucose solution prepared in the proportion of 200 ml of water per 75 g. substances.
- HbA1C analysis for the level of glycosylated (glycated) hemoglobin. Based on the results of the study, a retrospective of blood sugar levels over the past three months is evaluated.
- Blood biochemistry. Indicators of liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (AP), bilirubin (bile pigment), cholesterol levels are evaluated.
- A blood test for the concentration of antibodies to glutamate decarboxylase (GAD antibodies) determines the type of diabetes mellitus.
Blood sugar reference values and disease indicators
| Analyze | for sugar | glucose tolerance test | glycated hemoglobin |
|---|---|---|---|
| standard | 3, 3 - 5, 5 | < 7, 8 | ⩽ 6% |
| prediabetes | 5, 6 - 6, 9 | 7. 8 - 11. 0 | from 6 to 6, 4% |
| diabetes | >7, 1 | >11, 1 | More than 6. 5% |
In addition to blood microscopy, a general urinalysis is examined for the presence of glucose in the urine (glycosuria). In healthy people, there is no sugar in the urine (for diabetics, 0. 061 - 0. 083 mmol/l is considered an acceptable norm). A Reberg test is also performed to detect the protein albumin and a protein metabolism product of creatinine in the urine. In addition, hardware diagnosis is prescribed, including an ECG (electrocardiogram) and ultrasound of the abdominal cavity (with kidneys).
Results
Modern medicine classifies diabetes into four main types, depending on the pathogenesis (origin and development) of the disease: insulin-dependent (IDDM type 1), non-insulin-dependent (NIDDM type 2), gestational (pregnant GDM), specific (DM includes several types of diabetes). diseases caused by genetic defects or chronic pathologies). Gestational diabetes, formed in the perinatal period, is curable. Prediabetes (impaired glucose tolerance) is considered reversible if diagnosed early.