Diabetes mellitus is a disease of the endocrine system associated with pathological changes in the hormonal background and metabolic failures.
To date, this disease cannot be cured (completely eliminated). The process of destruction in the body can be slowed down with drugs and dietary therapy, but it is not possible to stop it and start it in the opposite direction.
Types of diabetes mellitus (DM) are defined by the World Health Organization and there is no fundamental difference throughout the medical world. Diabetes of any kind is not contagious.
Diabetes can be of many types, as well as many different types. Since the treatment for each species and type is different, it is important to know what specific disease has arisen.
Pathology classification
There are several types of diseases, united by one main symptom - an increase in the concentration of glucose in the blood. The classification of diabetes mellitus is by the cause of its occurrence. In addition, treatment methods, gender, and age of the patient were also applied.
Medically accepted types of diabetes:
- the first type is insulin dependent (IDDM 1), or juvenile;
- the second is non-insulin dependent (INZDM 2), or insulin resistant;
- gestational diabetes mellitus (GDM) in the perinatal period in women;
- other specific types of diabetes, including:
- pancreatic β-cell injury at the genetic level (MODY-diabetes-like);
- pathology of the exocrine function of the pancreas;
- hereditary and acquired pathologies of the external excretory glands and their function (endocrine diseases);
- pharmacologically defined diabetes;
- diabetes as a result of congenital infections;
- DM is associated with genomic pathology and genetic defects;
- hypoglycemia (blood sugar) on an empty stomach and impaired glucose tolerance.
Prediabetes is a borderline state of the body, where blood glucose levels are altered in an upward direction (impaired glucose tolerance), however, blood glucose readings "fail" the technical values. generally accepted number corresponding to true diabetes. According to the World Health Organization (WHO 2014), more than 90% of endocrinology patients have the latter type of disease.
According to medical statistics, the number of cases worldwide is on an increasing trend. Over the past 20 years, the number of people with type 2 diabetes has doubled. GDM accounts for about 5% of pregnancies. Specific types of diabetes are extremely rare and make up a small percentage of medical statistics.
By sex, NIDDM 2 is more common in premenopausal and postmenopausal women. This is due to changes in hormonal status and extra weight gain. In men, the most common factor in the development of type 2 diabetes is chronic pancreatitis due to the toxic effects of ethanol.
Insulin-dependent diabetes (type 1)
Type 1 diabetes is characterized by the failure of pancreatic cells. This organ that does not fulfill its endocrine (endocrine) function produces insulin, the hormone responsible for delivering glucose to the body. As a result of the accumulation of glucose in the blood, the organs do not receive adequate nutrition, including the pancreas.
To mimic the natural production of endocrine hormones, patients receive lifelong medical insulin injections with varying durations of action (short and long), as well as dietary therapy. The classification of type 1 diabetes is determined by the different causes of the disease. This type of insulin-dependent disease has two causes: genetic and autoimmune.
genetic cause
Pathogenesis is associated with the biological characteristics of the human body to pass on the characteristic features and pathological abnormalities to the next generations. With regard to diabetes, a child inherits a predisposition to the disease from a parent or relative with diabetes.
Important! Genetic predisposition, but not the disease itself. There is no 100% guarantee that a child will develop diabetes.
autoimmune causes
The disease is triggered by a weakened immune system, when under the influence of negative factors, it will actively produce autoimmune antibodies that destroy the body's cells. Triggers (promoters) to initiate autoimmune processes are:
- unhealthy eating behavior combined with little physical activity;
- failure of metabolism (carbohydrates, lipids and proteins);
- severe deficiency in the body of cholecalciferol and ergocalciferol (vitamin D);
- pathology of the pancreas of a chronic nature;
- history of mumps (mumps), measles, Coxsackie herpes virus, Epstein-Barr virus, cytomegalovirus, hepatitis A, B, C viruses;
- anxiety (long stay in a state of nervous tension);
- chronic alcoholism;
- Improper treatment with hormone-containing drugs.
IDDM is formed in children, adolescents, and adults under the age of thirty. Childhood variant of the development of type 1a diabetes is associated with complex viral infections. Type 1b occurs in young adults and children against the background of autoimmune processes and genetic predisposition. The disease usually develops in an accelerated fashion over weeks or months.
Insulin resistant diabetes (type 2)
The difference between type 2 and type 1 diabetes is that the pancreas doesn't stop producing insulin. Glucose accumulates in the blood and is not carried to the body's cells and tissues because they are insensitive to insulin - insulin resistant. Until a certain point, treatment is done through blood sugar-lowering (sugar-lowering) medications and dietary therapy.
To compensate for the imbalance in the body, the pancreas activates the production of hormones. Working in emergency mode, this organ wears out over time and loses its excretory function. Type 2 diabetes becomes insulin dependent. The reduction or loss of cellular susceptibility to endogenous hormones is mainly associated with obesity, in which fat and carbohydrate metabolism is disturbed.
This is especially true of visceral obesity (the deposition of fat around the internal organs). In addition, with excess body weight, blood flow becomes difficult due to the many cholesterol plaques inside the vessels, which are formed during hypercholesterolemia, which always accompanies obesity. As a result, the body's cells are deprived of nutrients and energy sources. Other factors influencing the development of NIDDM include:
- alcohol abuse;
- foodies addicted to sweet dishes;
- chronic diseases of the pancreas;
- pathology of the heart and vascular system;
- food excess against the background of a sedentary lifestyle;
- incorrect hormone therapy;
- complicated pregnancy;
- hereditary dysfunction (parental diabetes);
- depression.
Usually, the disease develops in women and men aged 40+. At the same time, type 2 diabetes is latent and may not show serious symptoms for several years. Timely testing of blood glucose levels can detect prediabetes. With adequate therapy, prediabetes can be reversed. If it takes time, it will progress and then NIDDM is diagnosed.
Diabetes Lada
In medicine, people find out the term Diabetes 1. 5, also known as Lada diabetes. It is an autoimmune disorder of hormone production and metabolic failure that occurs in adults (age 25 and older). A combination of the first and second types of diabetes. The mechanism of development corresponds to IDDM, the latent course and manifestation of symptoms is similar to NIDDM.
Factors that provoke the development of pathology are autoimmune diseases in the patient's history:
- noninfectious inflammation of the disc joints (ankylosing spondylitis);
- irreversible diseases 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 pigmentation) of the skin (vitiligo);
- inflammatory pathologies of the colonic mucosa (ulcerative colitis);
- Chronic damage to connective tissue and external excretory glands (Sjogren's syndrome).
Combined with a genetic predisposition, autoimmune disorders lead to the progression of Lada diabetes. To detect the disease, basic diagnostic methods are used, as well as blood smear, determination of the concentration of immunoglobulins of the class IgG for antigens - ELISA (enzyme immunoassay). Therapy is accomplished through regular insulin injections and nutritional adjustments.
Gestational form of the disease
GDM is a specific type of diabetes that develops in women during the second half of the perinatal period. The disease is most often discovered during the second routine examination, when the expectant mother undergoes a comprehensive examination. The main feature of GDM similar to type 2 diabetes is insulin resistance. The cells of a pregnant woman's body lose their sensitivity (sensitivity) to insulin due to a correlation of three main reasons:
- Hormonal reorganization. During pregnancy, the synthesis of progesterone (a steroid sex hormone) increases, blocking the production of insulin. Plus, the endocrine hormones of the placenta, which tend to inhibit insulin production, are gaining strength.
- Double the load on the female body. To provide adequate nutrition to the fetus, the body needs an increased amount of glucose. A woman begins to consume more monosaccharides, causing the pancreas to synthesize more insulin.
- An increase in body weight on the background of a decrease in physical activity. Glucose, which is abundantly supplied to the body, accumulates in the blood, because the cells refuse to accept insulin due to obesity and inactivity. The expectant mother and fetus in this case suffer from nutritional deficiencies and energy starvation.
Unlike type 1 and 2 diabetes, gestational diabetes is a reversible process because insulin molecules and pancreatic function are preserved.
Appropriately selected treatment strategies ensure elimination of the pathology after birth in 85% of cases. The main treatment for GDM is the "Table 9" diabetic diet. In difficult cases, medical insulin injections are used. Antidiabetic drugs should not be used because of their teratogenic effects on the fetus.
Besides
Specific types of diabetes are genetically determined (MODY-diabetes, certain types of endocrine disease) or caused by other chronic conditions:
- diseases of the pancreas: pancreatitis, hemoglobinopathies, tumors, cystic fibrosis, mechanical trauma and gland surgery;
- dysfunction of the anterior pituitary gland (massive);
- increased synthesis of thyroid hormones (thyrotoxicosis);
- pathology of the hypothalamus-pituitary-adrenal region (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 the balance of fluids in the body.
Diagnostic measures
The diagnosis of diabetes mellitus (of any type) can be based solely on the results of a blood microscopy in the laboratory. Diagnosis involves several consecutive studies:
- General clinical blood test to detect hidden inflammatory processes in the body.
- Blood tests (capillary or venous) to look for glucose levels. Strict production on an empty stomach.
- GTT (glucose tolerance test). It is done to determine the body's ability to absorb glucose. The tolerance test is a blood sample taken twice: fasting and two hours after "glucose loading", which is an aqueous glucose solution prepared at a ratio of 200 ml of water per 75 g. building materials.
- 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 was evaluated.
- Biochemistry of blood. The liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (AP), bilirubin (bile pigment), cholesterol levels were assessed.
- A blood test to look for levels of antibodies to glutamate decarboxylase (GAD antibodies) determines the type of diabetes.
Blood glucose reference value and disease index
| Analysis | For the road | Glucose tolerance test | Glycated Hemoglobin |
|---|---|---|---|
| quota | 3, 3 - 5, 5 | <7. 8 | 6% |
| pre-diabetes | 5, 6 - 6, 9 | 7, 8 - 11, 0 | from 6 to 6. 4% |
| Diabetes | >7, 1 | >11, 1 | Over 6. 5% |
In addition to a blood microscopy, a general urinalysis is to check for the presence of glucose in the urine (urinary tract). In healthy people, there is no sugar in the urine (for diabetics, 0. 061 - 0. 083 mmol/l is considered an acceptable norm). The Reberg test is also performed to detect the protein albumin and a protein metabolite of creatinine in the urine. In addition, hardware diagnostics are prescribed, including ECG (electrocardiogram) and abdominal ultrasound (with kidneys).
Results
Modern medicine classifies diabetes into 4 main types, depending on the pathogenesis (source and course) of the disease: insulin dependent (IDDM type 1), non-insulin dependent (NIDDM type 2), fetalpregnancy (pregnant GDM), specific (CAD). including certain types of diseases caused by genetic defects or chronic diseases). Gestational diabetes that develops during the perinatal period can be cured. Prediabetes (impaired glucose tolerance) is considered reversible if diagnosed early.