Diabetes: types and causes of their development, course and manifestations, how to treat, possible consequences

Diabetes mellitus is one of the most common diseases with a tendency towards increasing incidence and disfiguring statistics.The symptoms of diabetes mellitus do not appear overnight;the process is chronic, with increasing and worsening endocrine and metabolic disorders.It is true that the onset of type 1 diabetes differs significantly from the early stage of type 2.

Among all endocrine pathologies, diabetes confidently occupies a leading position and accounts for more than 60% of all cases.In addition, the disappointing statistics show that 1/10 of "diabetics" are children.

The probability of acquiring the disease increases with age, and thus every ten years the size of the group doubles.This is due to an increase in life expectancy, improved methods of early diagnosis, a decrease in physical activity and an increase in the number of overweight people.

Types of diabetes

Many people have heard of such a disease as diabetes insipidus.So that the reader does not subsequently confuse the diseases called "diabetes", it will probably be useful to explain their differences.

Diabetes insipidus

Diabetes insipidus is an endocrine disease that occurs as a result of neuroinfections, inflammatory diseases, tumors, intoxications and is caused by a deficiency, and sometimes a complete disappearance of ADH-vasopressin (antidiuretic hormone).

This explains the clinical picture of the disease:

• Constant dryness of the oral mucosa, incredible thirst (a person can drink up to 50 liters of water in 24 hours, stretching the stomach to large sizes);
• Isolation of a huge amount of unconcentrated light urine with a low specific gravity (1000-1003);
• Catastrophic weight loss, weakness, reduced physical activity, disorders of the digestive system;
• Characteristic changes in the skin ("parchment" skin);
• Atrophy of muscle fibers, weakness of the muscular system;
• Development of dehydration syndrome in the absence of fluid intake for more than 4 hours.

In terms of complete cure, the disease has an unfavorable prognosis;performance is significantly reduced.

Brief Anatomy and Physiology

An unpaired organ, the pancreas, performs a mixed secretory function.Its exogenous part carries out external secretion, producing enzymes involved in the digestion process.The endocrine part, entrusted with the mission of internal secretion, produces various hormones, including -insulin and glucagon.They are key to ensuring the consistency of sugar in the human body.

The endocrine part of the gland is represented by the islets of Langerhans, consisting of:

1. A-cells, which occupy a quarter of the total space of the islets and are considered the site of glucagon production;
2. In cells occupying up to 60% of the cell population, synthesizing and storing insulin, whose molecule is a polypeptide of two chains carrying 51 amino acids in a certain sequence;
3. somatostatin-producing D cells;
4. Cells that produce other polypeptides.

So the conclusion is self-evident:Damage to the pancreas and the islets of Langerhans, in particular, is the main mechanism that inhibits insulin production and triggers the development of the pathological process.

Types and special forms of the disease

The lack of insulin leads to impaired constancy of sugar (3.3 – 5.5 mmol/l)and contributes to the formation of a heterogeneous disease called diabetes mellitus (DM):

• A complete lack of insulin (absolute deficiency) is formed.insulin dependentpathological process, which is referred to astype I diabetes mellitus (IDDM);
• The lack of insulin (relative deficiency), which causes a violation of carbohydrate metabolism in the initial stage, slowly but surely leads to the development ofnon-insulin dependentdiabetes mellitus (NIDDM), which is calleddiabetes mellitus type II.

Due to the violation in the absorption of glucose by the body and therefore its increase in the blood serum (hyperglycemia), which is basically a manifestation of the disease, over time signs of diabetes mellitus begin to appear, that is, a complete violation of metabolic processes at all levels.

In addition to type 1 and type 2 diabetes, there are special types of this disease:

1. Secondary diabetesas a result of acute and chronic inflammation of the pancreas (pancreatitis), malignant neoplasms in the parenchyma of the gland, cirrhosis of the liver.A number of endocrine disorders accompanied by excessive production of insulin antagonists (acromegaly, Cushing's disease, pheochromocytoma, thyroid disease) lead to the development of secondary diabetes.Many drugs that are used for a long time have a diabetogenic effect: diuretics, some antihypertensive drugs and hormones, oral contraceptives, etc.;
2. Diabetes in pregnant women (gestational),caused by the specific mutual influence of the hormones of the mother, the child and the placenta.The pancreas of the fetus, which produces its own insulin, begins to inhibit the production of insulin by the mother's gland, as a result of which this special form is formed during pregnancy.However, with appropriate control, gestational diabetes usually resolves after birth.Subsequently, in some cases (up to 40%) in women with a similar history of pregnancy, this fact may threaten the development of diabetes mellitus type II (within 6-8 years).

Why does the "sweet" disease occur?

The "sweet" disease forms a rather "motley" group of patients, so it becomes obvious that IDDM and its non-insulin-dependent "brother" genetically originate in a different way.There is evidence of an association between insulin-dependent diabetes and genetic structures of the HLA (major histocompatibility complex) system, in particular with some genes of the D-region loci.For NIDDM, no such relationship was observed.

For the development of type I diabetes mellitus, genetic predisposition alone is not enough;the pathogenetic mechanism is triggered by provoking factors:

• Congenital deficiency of the islets of Langerhans;
• Adverse influence of the external environment;
• Stress, nervous stress;
• Traumatic brain injuries;
• Pregnancy;
• Infectious processes of viral origin (influenza, mumps, cytomegalovirus infection, Coxsackie);
• Tendency to constant overeating, which leads to excess fat accumulation;
• Abuse of confectionery (those who love sweets are at greater risk).

Before looking at the causes of diabetes mellitus type II, it would be advisable to dwell on a very controversial question: who suffers more often - men or women?

It has been established that nowadays the disease occurs more often in women, although even in the 19th century diabetes was a "privilege" of the male sex.By the way, now in some countries of Southeast Asia, the presence of this disease in men is considered predominant.

Predisposing conditions for the development of type II diabetes include:

• Changes in the structural structure of the pancreas as a result of inflammatory processes, as well as the appearance of cysts, tumors, hemorrhages;
• Age after 40 years;
• Being overweight (the most important risk factor for NIDDM!);
• Vascular diseases caused by atherosclerotic process and arterial hypertension;
• In women, pregnancy and childbirth with a high body weight (more than 4 kg);
• Having relatives with diabetes;
• Strong psycho-emotional stress (adrenal hyperstimulation).

The causes of the disease of different types of diabetes in some cases coincide (stress, obesity, influence of external factors), but the beginning of the process in type 1 and type 2 diabetes is different, in addition,IDDM is the province of children and young people, and non-insulin-dependent people prefer the elderly.

Why do you want to drink so much?

The characteristic symptoms of diabetes mellitus, regardless of the form and type, can be presented as follows:

1. Dryness of the oral mucosa;
2. Thirst that is practically impossible to quench, associated with dehydration;
3. Excessive formation of urine and its release from the kidneys (polyuria), which leads to dehydration;
4. An increase in the concentration of glucose in the blood serum (hyperglycemia), due to suppression of the absorption of sugar by peripheral tissues due to insulin deficiency;
5. The appearance of sugar in the urine (glucosuria) and ketone bodies (ketonuria), which are usually present in insignificant amounts, but in diabetes mellitus are intensively produced by the liver and, when they are excreted from the body, are found in the urine;
6. Increased content in the blood plasma (in addition to glucose) of urea and sodium ions (Na⁺);
7. Weight loss, which in the case of decompensation of the disease is a characteristic feature of the catabolic syndrome, which develops due to the breakdown of glycogen, lipolysis (mobilization of fats), catabolism and gluconeogenesis (transformation into glucose) of proteins;
8. Violation of indicators of the lipid spectrum, increase in total cholesterol due to the fraction of low-density lipoproteins, NEFA (non-esterified fatty acids), triglycerides.The increasing content of lipids begins to be actively sent to the liver, where they are intensively oxidized, which leads to the excessive formation of ketone bodies (acetone + β-hydroxybutyric acid + acetoacetic acid) and their further entry into the blood (hyperketonemia).An excessive concentration of ketone bodies threatens a dangerous condition calleddiabetic ketoacidosis.

Thus, the general signs of diabetes can be characteristic of any form of the disease, but in order not to confuse the reader, it is still necessary to note the characteristics inherent in one or another type.

Type I diabetes is a "privilege" of the young

IDDM is characterized by an acute (weeks or months) onset.The signs of diabetes mellitus type I are expressed and manifested by clinical symptoms typical of this disease:

• Sudden weight loss;
• Unnatural thirst, a person simply cannot get drunk, although he tries to do so (polydipsia);
• Passing large amounts of urine (polyuria);
• Significant excess of the concentration of glucose and ketone bodies in the blood serum (ketoacidosis).In the initial stage, when the patient may still be unaware of his problems, the development of a diabetic (ketoacidotic, hyperglycemic) coma is quite likely - a condition that is extremely life-threatening, which is why insulin therapy is prescribed as early as possible (as soon as diabetes is suspected).

In most cases, after using insulin, the metabolic processes are compensated,The body's need for insulin sharply decreases and a temporary "recovery" occurs.However, this short-term state of remission should not relax either the patient or the doctor, because after some time the disease will remind itself again.The need for insulin may increase with increasing duration of the disease, but in general, in the absence of ketoacidosis, it will not exceed 0.8-1.0 U/kg.

Signs indicating the development of late complications of diabetes (retinopathy, nephropathy) may appear after 5-10 years.The leading causes of death from IDDM include:

1. End-stage renal failure, which is a consequence of diabetic glomerulosclerosis;
2. Cardiovascular disorders are complications of the underlying disease that occur somewhat less frequently than renal disorders.

Disease or age-related changes?(type II diabetes)

NIDDM develops over many months and even years.When problems arise, a person takes them to various specialists (dermatologist, gynecologist, neurologist...).The patient does not even suspect that various diseases in his opinion: furunculosis, skin itching, fungal infections, pain in the lower extremities are signs of type II diabetes mellitus.Patients get used to their condition and diabetes continues to slowly develop, affecting all systems and especially blood vessels.

NIDDM is characterized by a stable, slow course, usually without a tendency towards ketoacidosis.

Treatment of type 2 diabetes usually begins with a diet that limits easily digestible (refined) carbohydrates and the use of sugar-lowering medications (if necessary).Insulin is prescribed if the disease has progressed to the stage of severe complications or there is resistance to oral drugs.

The main cause of death in patients with NIDDM is recognized as cardiovascular pathology resulting from diabetes.As a rule, this is a heart attack or stroke.

Treatments for diabetes mellitus

The basis of therapeutic measures aimed at compensating diabetes mellitus is represented by three main principles:

• Compensation of insulin deficiency;
• Regulation of endocrine and metabolic disorders;
• Prevention of diabetes, its complications and their timely treatment.

The application of these principles is based on 5 main positions:

1. Nutrition in diabetes mellitus plays the role of "first violin";
2. The diet follows a system of adequate and individually selected physical exercises;
3. Sugar-lowering drugs are mainly used to treat type 2 diabetes;
4. Insulin therapy is prescribed if necessary for NIDDM, but is essential in the case of type 1 diabetes;
5. Training patients for self-monitoring (skills for taking blood from a finger, using a glucometer, administering insulin without assistance).

Laboratory control over these positions shows the degree of compensation after the following biochemical tests:

Indicators	Good compensation rate	Satisfactory	bad
Fasting glucose level (mmol/l)	4.4 – 6.1	6.2 – 7.8	Ø 7.8
Blood sugar content 2 hours after a meal (mmol/l)	5.5 – 8.0	8.1 – 10.0	Ø 10.0
Percentage of glycosylated hemoglobin (HbA1, %)	< 8.0	8.0 – 9.5	Ø 10.0
Serum total cholesterol (mmol/l)	< 5.2	5.2 – 6.5	Ø 6.5
Triglyceride level (mmol/l)	< 1.7	1.7 – 2.2	Ø 2.2

The important role of diet in the treatment of NIDDM

Diet for diabetes mellitus is very well known, even to people far from diabetes mellitus, table number 9. While in the hospital for any disease, from time to time you can hear about a special diet, which is always in separate pots, differs from other diets and is given after a certain password: "I have the ninth table."What does it all mean?How is this mystery diet different from all the others?

One should not be fooled by caring for a diabetic carrying his "mess" into thinking that he is deprived of all the joys of life.A diabetic diet is not that different from a healthy person's diet;patients receive the required amount of carbohydrates (60%), fat (24%) and protein (16%).

Diabetes nutrition consists of replacing refined sugars in foods with slow-degrading carbohydrates.Sugar sold in general stores and confectionery products based on it fall into the category of prohibited foods.

As for the nutritional balance, everything is strict here: a diabetic must necessarily consume the required amount of vitamins and pectins, which must be at least 40 grams.per day.

Strictly individual physical activity

Physical activity for each patient is selected individually by the attending physician, taking into account the following points:

• age;
• Symptoms of diabetes;
• The severity of the pathological process;
• The presence or absence of complications.

Physical activity prescribed by the doctor and performed by the "ward" should promote the "burning" of carbohydrates and fats without involving insulin.Its dose, which is necessary to compensate for metabolic disorders, is significantly reduced, which should not be forgotten, because preventing an increase in blood sugar levels, you can get an unwanted effect.Adequate physical activity reduces glucose, the administered dose of insulin breaks down the rest and, as a result, sugar levels fall below acceptable values (hypoglycemia).

in this waythe dosage of insulin and physical activity requires a lot of attention and careful calculation,so that, complementing each other, together we do not cross the lower limit of normal laboratory indicators.

Or maybe try folk remedies?

Treatment of diabetes mellitus type 2 is often accompanied by the search for folk remedies by the patient himself, which can slow down the process and delay the time of taking medicinal forms as much as possible.

Despite the fact that our distant ancestors practically did not know about this disease, there are folk remedies for the treatment of diabetes mellitus, but we must not forget thatauxiliary means are tinctures and decoctions prepared from various plants.The use of home remedies for diabetes does not exempt the patient from following a diet, monitoring blood sugar, visiting a doctor and following all his recommendations.

To combat this pathology at home, quite well-known folk remedies are used:

1. Bark and leaves of white mulberry;
2. Oat grains and flakes;
3. Nut partitions;
4. Bay leaf;
5. cinnamon;
6. acorns;
7. Nettles;
8. Dandelion.

When diet and folk remedies no longer help...

The so-called first-generation drugs, widely known at the end of the last century, remained in the past and were replaced by new-generation drugs that make up the 3 main groups of diabetes drugs produced by the pharmaceutical industry.

The endocrinologist decides which drug is suitable for this or that patient.And so that patients do not self-medicate and do not decide to use these drugs for diabetes at their own discretion, we will give a few illustrative examples.

Sulfonylureas

Currently, second-generation sulfonylureas are prescribed, which last from 10 hours to 24 hours.Patients usually take them 2 times a day, half an hour before meals.

These drugs are absolutely contraindicated in the following cases:

• Diabetes mellitus type 1;
• Diabetic, hyperosmolar, lactic acidotic coma;
• Pregnancy, childbirth, breastfeeding;

• Diabetic nephropathy accompanied by impaired filtration;
• Diseases of the hematopoietic system with a concomitant decrease in white blood cells - leukocytes (leukocytopenia) and the platelet component of hematopoiesis (thrombocytopenia);
• Severe infectious and inflammatory liver lesions (hepatitis);
• Diabetes complicated by vascular pathology.

In addition, the use of drugs from this group can threaten the development of allergic reactions manifested by:

1. Skin itching and urticaria, sometimes reaching Quincke's edema;
2. Disorders of the digestive system;
3. Changes in the blood (reduced levels of platelets and leukocytes);
4. Possible damage to the functional abilities of the liver (jaundice due to cholestasis).

Antihyperglycemic agents from the biguanide family

Biguanides (guanidine derivatives) are actively used for the treatment of type 2 diabetes mellitus, and sulfonamides are often added to them.They are very rational for use by obese patients, but for people with liver, kidney and cardiovascular pathology, their use is sharply limited, switching to gentler drugs of the same group or α-glucoside inhibitors, which inhibit the absorption of carbohydrates in the small intestine.

The following are considered absolute contraindications to the use of biguanides:

• IDDM (type 1 diabetes mellitus);
• Significant weight loss;
• Infectious processes, regardless of localization;
• Surgical interventions;
• Pregnancy, childbirth, breastfeeding;
• Comatose states;
• Liver and kidney pathology;
• Oxygen starvation;
• Microangiopathy (2-4 degrees) with impaired vision and kidney function;
• Trophic ulcers and necrotic processes;
• Poor circulation in the lower limbs due to various vascular pathologies.

Insulin treatment

From the above it is obvious thatInsulin is the main treatment for type 1 diabetes, all medical emergencies and severe complications of diabetes.NIDDM requires the appointment of this therapy only in cases of forms requiring insulin, when correction with other means does not give the desired effect.

Modern insulins, called monocompetent, represent two groups:

1. Monocompetent pharmacological forms of human insulin substance (semi-synthetic or DNA recombinant), which undoubtedly have a significant advantage over drugs of pig origin.They practically have no contraindications and side effects;
2. Monocompetent insulins derived from porcine pancreas.These drugs, compared to human insulins, require an increase in the dose of the drug by approximately 15%.

Diabetes is dangerous because of complications

Due to the fact that diabetes is accompanied by damage to many organs and tissues, its manifestations can be found in almost all body systems.Complications of diabetes mellitus are:

• Pathological changes in the skin: diabetic dermopathy, lipoid necrobiosis, furunculosis, xanthomatosis, fungal skin infections;
• Osteo-articular diseases:
  1. Diabetic osteoarthropathy (Charcot's joint - a change in the ankle joint), occurring against the background of impaired microcirculation and trophic disorders, accompanied by dislocations, subluxations, spontaneous fractures preceding the formationdiabetic foot;
  
  2. Diabetic cosomopathy, characterized by stiffness in the joints of the hands, which often develops in children with diabetes;
• Respiratory diseases: long-termprolonged bronchitis, pneumonia,increased incidence of tuberculosis;
• Pathological processes affecting the digestive organs:diabetic enteropathy, accompanied by increased peristalsis, diarrhea (up to 30 times a day), loss of body weight;
• Diabetic retinopathy– one of the most serious complications, characterized by damage to the visual organs;
• The most common complication of diabetes mellitus is considereddiabetic neuropathyand its variety -polyneuropathy, reaching 90% of all forms of this pathology.Diabetic polyneuropathy is a common conditiondiabetic foot syndrome;
• Pathological condition of the cardiovascular system, which in most cases is the cause of death from diabetes mellitus.Hypercholesterolemia and vascular atherosclerosis, which in diabetes begin to develop at an early age, inevitably lead to heart and vascular diseases (coronary artery disease, myocardial infarction, heart failure, cerebrovascular accident).

Prevention

Measures to prevent diabetes mellitus are based on the causes that cause it.In this case, it is advisable to talk about the prevention of atherosclerosis and arterial hypertension, including the fight against excess weight, bad habits and food addictions.

Prevention of the complications of diabetes mellitus includes preventing the development of pathological conditions resulting from diabetes itself.Correcting the glucose in the blood serum, following a diet, adequate physical activity and following the doctor's recommendations will help to slow down the consequences of this rather dangerous disease.