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 through 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 the chronic increase in blood glucose levels.The causes and nature of the course of the disease are different, which is why it is divided into several types.
The types of diabetes mellitus (DM) are defined by the World Health Organization and do not present fundamental differences throughout the medical world.Diabetes mellitus of any type is not a contagious disease.
Pathology Typing
There are several types of the 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 varieties of diabetes);
- pathologies of the exocrine function of the pancreas;
- hereditary and acquired pathologies of exocrine glands and their functions (endocrinopathies);
- pharmacologically caused diabetes;
- diabetes as a result of congenital infections;
- Diabetes associated with genomic pathologies and hereditary defects;
- impaired fasting glycemia (blood sugar) and impaired glucose tolerance.
Prediabetes is a borderline state of the body when the glycemic level is increased (impaired glucose tolerance), but blood sugar levels “do not reach” the generally accepted digital 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 towards an increase in the number of cases around the world.In the last 20 years, the number of type 2 diabetics has doubled.GDM is responsible 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 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.As a result of the accumulation of glucose in the blood, organs do not receive adequate nutrition, including the pancreas itself.
To imitate the natural production of endocrine hormone, the patient is prescribed injections of medicinal insulins with different durations of action (short and long), in addition to diet therapy, for the rest of their 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 their parents or close relatives with diabetes.
Important!The predisposition is hereditary, but not the disease itself.There is no 100% guarantee that a child will develop diabetes.
Autoimmune cause
The occurrence of the disease is caused by 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 body's cells.The triggers (impetus) for the launch of autoimmune processes are:
- unhealthy eating behavior combined with physical inactivity;
- failure in metabolic processes (carbohydrates, lipids and proteins);
- critical deficiency of cholecalciferol and ergocalciferol (vitamins D) in the body;
- pancreas pathologies of a chronic nature;
- history of mumps (mumps), measles, Coxsackie herpes virus, Epstein-Barr virus, cytomegalovirus, viral hepatitis A, B, C;
- anguish (prolonged stay in a state of neuropsychological stress);
- chronic alcoholism;
- incorrect treatment with hormone-containing drugs.
IDDM develops in children, adolescents, and adults under thirty years of age.The childhood variant of form 1a diabetes is associated with complicated viral infections.Form 1b occurs in young people and children against the background of autoimmune processes and hereditary predisposition.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 a lack of insulin sensitivity - insulin resistance.To a certain extent, treatment involves hypoglycemic (sugar-reducing) medications and diet therapy.
To compensate for the body's imbalance, the pancreas activates hormone production.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 susceptibility to endogenous hormone is mainly associated with obesity, which disrupts fat and carbohydrate metabolism.
This is especially true for visceral obesity (fat deposition around internal organs).In addition, with excess body weight, blood flow is impaired due to numerous cholesterol plaques inside the vessels, which form during hypercholesterolemia, which always accompanies obesity.The body's cells thus suffer from a shortage of nutritional and energy resources.Other factors that influence the development of NIDDM include:
- alcohol abuse;
- gastronomic addiction to sweet dishes;
- chronic diseases of the pancreas;
- pathologies of the heart and vascular system;
- excessive eating in a sedentary lifestyle;
- incorrect hormone therapy;
- complicated pregnancy;
- Unfavorable heredity (diabetes in parents);
- Suffering.
The disease develops more often in women and men over 40 years of age.At the same time, type 2 diabetes is latent and may not show pronounced symptoms for several years.Testing blood glucose levels early can reveal prediabetes.With proper treatment, the pre-diabetic condition is reversible.If time is missed, it progresses and NIDDM is later diagnosed.
diabetes
In medicine, the term “Diabetes 1.5” is used, or the name Lada diabetes.This is an autoimmune disorder of hormone production and metabolic failure that occurs in adults (over 25 years of age).The disease combines the first and second types of diabetes.The development mechanism corresponds to IDDM, 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 (Sjögren's syndrome).
In combination with a hereditary predisposition, autoimmune disorders lead to the progression of Lada diabetes.To identify the disease, basic diagnostic methods are used, in addition to blood microscopy, which determines the concentration of immunoglobulins of the IgG class to antigens - ELISA (enzyme-linked immunosorbent assay).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 scheduled screening, when the pregnant woman undergoes a complete examination.The main characteristic of GDM coincides with type 2 diabetes – insulin resistance.The cells of a pregnant woman's body lose sensitivity (sensitivity) to insulin due to the correlation of three main reasons:
- Hormonal changes.During pregnancy, the synthesis of progesterone (steroid sex hormone) increases, blocking the production of insulin.Additionally, placental endocrine hormones, which tend to inhibit insulin production, are gaining strength.
- Double the load on the female body.To ensure adequate nutrition for the fetus, the body needs a greater amount of glucose.The woman begins to consume more monosaccharides, which causes the pancreas to synthesize more insulin.
- Increase in 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 a sedentary lifestyle.The expectant mother and fetus in such a situation experience nutritional deficiency and lack of energy.
Unlike type 1 and type 2 diabetes, gestational diabetes is a reversible process, as 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 medications are not used due to their teratogenic effects on the fetus.
Furthermore
Specific types of diabetes are genetically determined (MODY diabetes, some 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 insufficiency 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
Diagnosis of diabetes mellitus (of any type) is only possible based on the results of laboratory blood microscopy.Diagnosis consists of several sequential studies:
- General clinical blood test to identify hidden inflammatory processes in the body.
- Blood test (capillary or venous) to check 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 collections: on an empty stomach and two hours after a “glucose load”, which is an aqueous glucose solution prepared in a proportion of 200 ml of water to 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.Liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (ALP), bilirubin (bile pigment) and cholesterol levels are evaluated.
- A blood test to check the concentration of antibodies against glutamate decarboxylase (GAD antibodies) determines the type of diabetes mellitus.
Blood sugar reference values and disease indicators
| Analysis | 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 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 urine.Additionally, hardware diagnostics are prescribed, including 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 (type 1 NIDDM), non-insulin dependent (type 2 NIDDM), gestational (GDM in pregnant women), specific (DM includes several types of diseases caused by genetic defects or chronic pathologies).Gestational diabetes that develops during the perinatal period is curable.The condition of prediabetes (impaired glucose tolerance) is considered reversible if diagnosed early.