Diabetes mellitus is a disease of the endocrine system associated with pathological changes in the hormonal background and metabolic disorders.
To date, the disease is not subject to eradication (complete elimination). The destructive process in the body can be slowed down with medication and diet therapy, but it is impossible to stop and let go in the opposite direction.
Types of diabetes mellitus (DM) are determined by the World Health Organization and there are no fundamental differences throughout the world of medicine. Diabetes mellitus of any kind is not a contagious disease.
Diabetes mellitus can be of several types or different. As the treatment for each species is different, it is necessary to know which specific variant of the disease has arisen.
Typing the pathology
There are several types of the disease, united by one main symptom - elevated blood glucose. The typing of diabetes is due to the reasons for its occurrence. Therapeutic methods, sex and age of the patient are also applied.
Types of diabetes accepted by medicine:
- the first type is insulin-dependent (IDDM 1) or juvenile;
- the second is non-insulin dependent (INZDM 2) or non-insulin resistant;
- gestational diabetes mellitus (GDM) in the perinatal period in women;
- other specific types of diabetes, including:
- damage to β-cells of the pancreas at the genetic level (varieties of MODY-diabetes);
- pathology of the exocrine function of the pancreas;
- hereditary and acquired pathologies of the glands with external secretion and their functions (endocrinopathy);
- pharmacologically determined diabetes;
- diabetes as a consequence of congenital infections;
- Diabetes related to genomic pathologies and hereditary defects;
- impaired glycemia (blood sugar) on an empty stomach and impaired glucose tolerance.
Pre-diabetes is a borderline condition in which the blood glucose level changes (glucose tolerance is impaired), but blood sugar levels "do not reach" the generally accepted figures corresponding to true diabetes. According to the World Health Organization (WHO 2014) more90% of endocrinologists suffer from the second type of disease.
According to medical statistics, there is a clear trend of increasing the number of cases worldwide. The number of type 2 diabetics has doubled in the last 20 years. GDM accounts for about 5% of pregnancies. Types of specific diabetes are extremely rare and occupy a small percentage in medical statistics.
By gender 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 a lack of pancreatic cells. The body does not perform its endocrine (intrasecretory) function to produce insulin, the 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 endocrine hormone, the patient is given lifelong injections of medical insulin with different durations of action (short and long), as well as dietary therapy. The classification of type 1 diabetes is dictated by the different etiologies of the disease. Insulin-dependent type of disease has two causes: genetic and autoimmune.
genetic cause
The formation of pathology is related to the biological feature of the human body to transmit its characteristic features and pathological anomalies to future generations. In connection with diabetes, the child inherits a predisposition to the disease from parents or close relatives suffering from diabetes.
Important! The predisposition is inherited, but not the disease itself. There is no 100% guarantee that the child will develop diabetes.
autoimmune cause
The onset of the disease is due to functional insufficiency 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. Triggers (pressing) to start autoimmune processes are:
- unhealthy diet combined with lack of physical activity;
- violation of metabolic processes (carbohydrates, lipids and proteins);
- critical deficiency in the body of cholecalciferol and ergocalciferol (vitamins of group D);
- chronic pathology of the pancreas;
- history of mumps (mumps), measles, herpes virus Coxsackie, Epstein-Barr virus, cytomegalovirus, viral hepatitis A, B, C;
- distress (prolonged stay in a state of neuropsychological stress);
- chronic alcoholism;
- improper treatment with hormone-containing drugs.
IDDM is formed in children, adolescents and adults under the age of thirty. The pediatric variant of developing type 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 in an accelerated mode 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 cells and tissues of the body due to their lack of sensitivity to insulin - insulin resistance. Until a certain point, the treatment is performed with hypoglycemic (sugar-lowering) drugs and diet therapy.
To compensate for the imbalance in the body, the pancreas activates the production of the hormone. Operating in an emergency mode, the organ wears out over time and loses its intrasecretory function. Type 2 diabetes becomes insulin dependent. Decreased or lost cellular sensitivity to endogenous hormone is associated primarily with obesity, which disrupts the metabolism of fats and carbohydrates.
This is especially true for visceral obesity (deposition of fat around internal organs). In addition, when you are overweight, blood flow becomes difficult due to the numerous cholesterol plaques inside the vessels that form during hypercholesterolemia, which always accompanies obesity. In this way, the body's cells are deficient in food 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;
- food surpluses against the background of a sedentary lifestyle;
- improper hormone therapy;
- complicated pregnancy;
- dysfunctional heredity (parental diabetes);
- distress.
The disease most often 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 testing for blood sugar levels can detect prediabetes. With adequate therapy, the pre-diabetic condition is reversible. If time is lost, it progresses and NIDDM is subsequently diagnosed.
Lada diabetes
In medicine, the term "Diabetes 1, 5" or the name Lada diabetes. This is an autoimmune disorder in the production of hormones and a violation of metabolic processes that occurs in adults (aged 25+). 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.
The reasons for the development of the pathology are autoimmune diseases in the patient's anamnesis:
- 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 glands with external secretion (Sjogren's syndrome).
Combined with a hereditary predisposition, autoimmune disorders lead to the progression of Lada diabetes. Basic diagnostic methods are used to detect the disease, as well as blood microscopy, which determines the concentration of immunoglobulins of the IgG class to antigens - ELISA (enzyme immunoassay). The therapy is carried out through regular insulin injections and dietary adjustments.
Gestational form of the disease
GDM is a specific type of diabetes that develops in women in the second half of the perinatal period. Most often, the disease is detected during the second routine screening, when the expectant mother undergoes a full examination. The main feature of GDM, which is similar to type 2 diabetes, is insulin resistance. The cells of a pregnant woman's body lose sensitivity (sensitivity) to insulin due to the correlation of three main reasons:
- Hormonal reorganization. During pregnancy, the synthesis of progesterone (steroid sex hormone) increases, blocking insulin production. In addition, placental endocrine hormones, which tend to inhibit insulin production, are gaining strength.
- Double load on the female body. To ensure adequate nutrition for the unborn child, the body needs an increased amount of glucose. One woman begins to consume more monosaccharides, which causes the pancreas to synthesize more insulin.
- Weight gain against the background of reduced physical activity. Glucose, which is abundant in the body, accumulates in the blood as cells refuse to take insulin due to obesity and lack of physical activity. The mother-to-be and the fetus in this situation experience nutritional deficiencies and energy starvation.
Unlike type 1 and 2 diabetes, gestational diabetes is a reversible process, as insulin molecules and pancreatic function are preserved.
Properly selected therapeutic tactics guarantee the elimination of pathology after birth in 85% of cases. The main method of treating GDM is the diet for diabetics "Table No. 9". In difficult cases, injections of medical insulin are used. Hypoglycaemic agents are not used due to their teratogenic effect on the fetus.
Furthermore
Specific types of diabetes are genetically determined (MODY-diabetes, some types of endocrinopathies) or are provoked by other chronic pathologies:
- diseases of the pancreas: pancreatitis, hemochromatosis, tumor, cystic fibrosis, mechanical trauma and gland surgery;
- anterior pituitary insufficiency (acromegaly);
- increased synthesis of thyroid hormones (thyrotoxicosis);
- hypothalamic-pituitary-adrenal pathology (Itsenko-Cushing syndrome);
- tumors of the adrenal cortex (aldosterone, pheochromocytoma, etc. ).
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 kind) is possible only on the basis of the results of laboratory microscopy of the blood. The diagnosis consists of several consecutive tests:
- General clinical blood test to detect hidden inflammatory processes in the body.
- Blood test (capillary or venous) for glucose content. It is 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 blood test: on an empty stomach and two hours after "loading with glucose", which is an aqueous solution of glucose prepared in a ratio of 200 ml of water per 75 g of substance.
- Analysis of HbA1C for the level of glycosylated (glycated) hemoglobin. Based on the results of the study, a retrospective review of blood sugar levels over the past three months is performed.
- Blood chemistry. The indicators of the liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (AP), bilirubin (bile pigment), cholesterol levels were evaluated.
- A blood test for the concentration of antibodies against glutamate decarboxylase (GAD antibodies) determines the type of diabetes.
Blood sugar reference values and disease indicators
> zxtable border = "1" cellpadding = "0" >In addition to blood microscopy, a general urinalysis is tested 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 albumin protein and a product of the protein metabolism creatinine in the 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 (IDDM type 1), non-insulin-dependent (NIDDM type 2), gestational (GDM pregnant), specific (DM). includes several types of diseases caused by genetic defects or chronic pathologies). Gestational diabetes, which is formed in the perinatal period, is treatable. Prediabetes (impaired glucose tolerance) is considered reversible if diagnosed early.