Diabetes mellitus is a disease of the endocrine system associated with pathological changes in hormonal levels and metabolic failures.
To date, the disease cannot be eradicated (completely eliminated).The destructive process in the body can be slowed down by medication and diet therapy, but it is impossible to stop it and start it in the opposite direction.
The main symptom of the disease is a chronic increase in blood sugar levels.The causes and nature of the course of the disease differ, therefore it is divided into several types.
Types of diabetes mellitus (DM) are defined by the World Health Organization and do not have fundamental differences in the medical world.Diabetes mellitus, regardless of its type, is not a contagious disease.
Pathology typing
There are several types of disease, united by one main symptom: increased blood glucose concentration.The classification of diabetes mellitus is determined by the causes of its occurrence.The treatment methods used, gender and age of the patient are also taken into account.
Types of diabetes accepted in medicine:
- the first type is insulin-dependent (IDDM 1) or juvenile;
- the second is non-insulin dependent (NIDDM 2) or insulin resistant;
- gestational diabetes mellitus (GDM) during the perinatal period in women;
- other specific types of diabetes, including:
- damage to pancreatic β cells at the genetic level (MODY diabetes varieties);
- pathologies of the exocrine function of the pancreas;
- hereditary and acquired pathologies of the exocrine glands and their functions (endocrinopathies);
- diabetes of pharmacological origin;
- diabetes due to congenital infections;
- Diabetes associated with genomic pathologies and hereditary abnormalities;
- Impaired fasting blood sugar (FBG) and impaired glucose tolerance.
Prediabetes is a borderline state of the body when the glycemic level is increased (impaired glucose tolerance), but blood sugar “does not reach” the generally accepted numerical values corresponding to true diabetes.According to the World Health Organization (WHO 2014), more than 90% of endocrinology patients suffer from the second type of disease.
According to medical statistics, there is a clear trend of increasing cases worldwide.Over the past 20 years, the number of people with type 2 diabetes has doubled.GDM represents approximately 5% of pregnancies.Specific types of diabetes are extremely rare and occupy a small percentage in medical statistics.
Depending on gender, NIDDM 2 is more common in women during the premenopausal period and during menopause.This is due to changes in hormonal status and gaining extra pounds.In men, the most common factor in the development of type 2 diabetes is chronic inflammation of the pancreas caused by the toxic effects of ethanol.
Insulin-dependent diabetes (type 1)
Type 1 diabetes is characterized by the incapacity of pancreatic cells.The organ does not fulfill its endocrine (intrasecretory) function of producing insulin, the hormone responsible for supplying glucose to the body.Due to the buildup of glucose in the blood, organs do not receive adequate nutrition, including the pancreas itself.
To imitate the natural production of the endocrine hormone, the patient is prescribed injections of medical insulins with different durations of action (short and long), as well as dietary therapy, for life.The classification of type 1 diabetes mellitus is dictated by the different etiologies of the disease.The insulin-dependent type of disease has two causes: genetic and autoimmune.
Genetic cause
The formation of pathology is associated with the biological ability of the human body to transmit its characteristic signs and pathological deviations to subsequent generations.When it comes to diabetes, a child inherits a predisposition to the disease from diabetic parents or relatives.
Important!The predisposition is hereditary, but not the disease itself.There is no 100% guarantee that a child will develop diabetes.
Autoimmune cause
The onset of the disease is caused by a malfunction of the immune system when, under the influence of negative factors, it actively produces autoimmune antibodies that have a destructive effect on the body's cells.Triggers (impulses) for launching autoimmune processes are:
- unhealthy eating behavior combined with physical inactivity;
- failure of metabolic processes (carbohydrates, lipids and proteins);
- critical deficiency of cholecalciferol and ergocalciferol (vitamins D) in the body;
- pancreatic pathologies of a chronic nature;
- a history 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 drugs containing hormones.
IDDM develops in children, adolescents and adults under the age of thirty.The childhood variant of form 1a diabetes is associated with complicated viral infections.Form 1b appears in young people and children against the background of autoimmune processes and hereditary predispositions.The disease usually develops rapidly over several weeks or months.
Insulin-resistant diabetes (type 2)
The difference between the second type of diabetes and the first 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 their lack of sensitivity to insulin - insulin resistance.To some extent, treatment relies on hypoglycemic (sugar lowering) medications and dietary 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.A decrease or loss of cellular sensitivity to endogenous hormone is mainly associated with obesity, which disrupts fat and carbohydrate metabolism.
This is particularly true for visceral obesity (deposition of fat around internal organs).In addition, with excess weight, blood circulation is hampered due to numerous cholesterol plaques inside the vessels, which are formed during high cholesterol, which always accompanies obesity.The body's cells thus experience a lack of nutritional and energy resources.Other factors influencing the development of NIDDM include:
- alcohol abuse;
- gastronomic addiction to sweet dishes;
- chronic diseases of the pancreas;
- pathologies of the heart and vascular system;
- excess food in the context of a sedentary lifestyle;
- incorrect hormonal treatment;
- complicated pregnancy;
- Unfavorable heredity (diabetes in parents);
- distress.
The disease most often develops in women and men aged 40 and over.At the same time, type 2 diabetes is latent and may not show pronounced symptoms for several years.Testing your blood sugar early can reveal prediabetes.With adequate treatment, the prediabetic state is reversible.If time is lost, it progresses and NIDDM is then diagnosed.
Diabetes Lada
In medicine, we use the term “diabetes 1.5”, or the name Lada diabetes.It is an autoimmune disorder of hormone production and metabolic failure that occurs in adults (ages 25 and older).The disease combines the first and second types of diabetes.The mechanism of development corresponds to DID, the latent course and manifestation of symptoms are similar to NIDDM.
The 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;
- change in color (loss of pigment) of the skin (vitiligo);
- inflammatory pathology of the colon mucosa (ulcerative colitis);
- chronic damage to connective tissue and exocrine glands (Gougerot-Sjögren syndrome).
In combination with a hereditary predisposition, autoimmune diseases lead to the progression of Lada's diabetes.To identify the disease, basic diagnostic methods are used, as well as blood microscopy, which determines the concentration of immunoglobulins of the IgG class to antigens - ELISA (enzyme-linked immunosorbent assay).Treatment is carried out by regular insulin injections and nutritional correction.
Gestational form of the disease
Gestational diabetes 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 scheduled screening, when the expectant mother undergoes a comprehensive examination.The main characteristic of GDM coincides with type 2 diabetes: insulin resistance.Cells in a pregnant woman's body lose sensitivity (sensitivity) to insulin due to the correlation of three main reasons:
- Hormonal changes.During gestation, the synthesis of progesterone (a steroid sex hormone) increases, blocking insulin production.Additionally, endocrine hormones in the placenta, which tend to inhibit insulin production, gain strength.
- Double the load on the female body.To provide adequate nutrition to the unborn child, the body requires an increased amount of glucose.A woman begins to consume more monosaccharides, which causes the pancreas to synthesize more insulin.
- Increased body weight due to decreased physical activity.Glucose, which enters the body in abundance, accumulates in the blood because cells refuse to accept insulin due to obesity and physical inactivity.The future mother and the fetus in such a situation suffer from nutritional deficiencies and energy starvation.
Unlike type 1 and type 2 diabetes, gestational diabetes is a reversible process, since insulin molecules and the functionality of the pancreas are preserved.
Correctly selected therapeutic tactics guarantee the elimination of pathology after childbirth in 85% of cases.The main method of treating GDM is the “Table No. 9” diet for diabetics.In difficult cases, medical insulin injections are used.Antihyperglycemic drugs are not used due to their teratogenic effects on the fetus.
What's more
Certain types of diabetes are genetically determined (MODY diabetes, certain types of endocrinopathies) or caused by other chronic pathologies:
- diseases of the pancreas: pancreatitis, hemochromatosis, tumor, cystic fibrosis, mechanical injuries and operations on the gland;
- functional failure of the anterior pituitary gland (acromegaly);
- increased synthesis of thyroid hormones (thyrotoxicosis);
- hypothalamic-pituitary-adrenal pathology (Itsenko-Cushing syndrome);
- tumors of the adrenal cortex (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
A diagnosis of diabetes mellitus (of any type) is possible only based on the results of laboratory blood microscopy.The diagnosis includes several sequential studies:
- General clinical blood test to identify hidden inflammatory processes in the body.
- Blood test (capillary or venous) for glucose content.This is done strictly on an empty stomach.
- GTT (glucose tolerance test).It is performed to determine the body's ability to absorb glucose.The tolerance test consists of two blood samples: on an empty stomach and two hours after a “glucose load”, which is an aqueous solution of glucose prepared at a rate of 200 ml of water for 75 g.substances.
- HbA1C analysis for glycosylated (glycated) hemoglobin level.Based on the results of the study, a retrospective of blood sugar levels over the last three months is evaluated.
- Biochemistry of blood.Liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (ALP), bilirubin (bile pigment), and cholesterol levels are assessed.
- 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
| Analysis | For the 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 the blood microscopic examination, a general urine test is performed to determine the presence of glucose in the urine (glycosuria).In healthy people, there is no sugar in the urine (for diabetics, the acceptable norm is 0.061-0.083 mmol/l).A Rehberg test is also performed to detect the protein albumin and creatinine, a product of protein metabolism, in the urine.Additionally, hardware diagnostics are prescribed, including an ECG (electrocardiogram) and an 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 (GDM in pregnant women), specific (DM includes several types of diseases caused by genetic abnormalities or chronic pathologies).Gestational diabetes that develops during the perinatal period is curable.The state of prediabetes (impaired glucose tolerance) is considered reversible if diagnosed early.