Diabetes: types and causes of development, progression and manifestations, treatment, possible consequences

Diabetes mellitus is one of the most common diseases with a tendency to increase in incidence and confounding statistics.Symptoms of diabetes do not appear overnight;This process is chronic, with increasing and worsening of endocrine and metabolic disorders.It's true that the onset of type 1 diabetes is significantly different from the early stages of type 2 diabetes.

Among all endocrine pathologies, diabetes confidently ranks first and accounts for more than 60% of all cases.Additionally, disappointing statistics show that one in ten “diabetics” are children.

The likelihood of developing the disease increases with age and therefore, every ten years, the group size doubles.This is due to increased life expectancy, improved early diagnosis methods, reduced physical activity and increased numbers of overweight people.

Types of diabetes

Many people have heard about a disease such as diabetes insipidus.So that the reader is not subsequently confused with the diseases called “diabetes”, it would perhaps be helpful to explain their differences.

diabetes insipidus

Diabetes insipidus is an endocrine disease that occurs due to neurological infections, inflammatory diseases, tumors, toxins and is caused by a deficiency and sometimes complete disappearance of ADH-vasopressin (antidiuretic hormone).

This explains the clinical picture of the disease:

• Constantly dry oral mucosa, terrible thirst (a person can drink up to 50 liters of water in 24 hours, stretching the stomach to a large size);
• Isolate large amounts of light unconcentrated urine with low specific gravity (1000-1003);
• Catastrophic weight loss, weakness, decreased physical activity, digestive system disorders;
• Characteristic changes in the skin (“skin”);
• Muscle fiber atrophy, muscle weakness;
• Develop dehydration syndrome when not drinking water for more than 4 hours.

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

Summary of anatomy and physiology

A single organ, the pancreas, performs a mixed secretory function.Its exogenous part performs external secretion, produces enzymes that participate in the digestive process.The endocrine part, tasked with internal secretion, produces various hormones, including -insulin and glucagon.They are key in ensuring sugar consistency in the human body.

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

1. A cells, which occupy a quarter of the total area of the islets and are considered to be the site of glucagon production;
2. B cells, which make up up to 60% of the cell population, synthesize and store insulin, the molecule of which is a polypeptide of two chains, carrying 51 amino acids in a certain sequence;
3. D cells produce somatostatin;
4. Cells produce other polypeptides.

So the conclusion itself suggests:In particular, damage to the pancreas and islets of Langerhans is the main mechanism that inhibits insulin production and stimulates the development of the pathological process.

Special types and forms of the disease

Insulin deficiency leads to disturbances in stable sugar levels (3.3 - 5.5 mmol/l)and contribute to the formation of a heterogeneous disease called diabetes mellitus (DM):

• Complete absence of insulin (absolute deficiency)insulin dependentpathological process, calledtype I diabetes mellitus (IDDM);
• Insulin deficiency (relative deficiency), causes carbohydrate metabolism disorders in the early stages, slowly but surely leading to the developmentnot insulin dependentdiabetes mellitus (NIDDM), calledtype II diabetes.

Due to disorders in the body's use of glucose, and, as a result, an increase in serum (hyperglycemia), which, in principle, is a manifestation of the disease, over time, signs of diabetes mellitus begin to appear, that is, a disorder of the entire metabolic process at all levels.

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

1. Secondary diabetesdue to acute and chronic pancreatitis (pancreatitis), malignant tumors in the glandular parenchyma, cirrhosis.Some endocrine disorders accompanied by excessive production of insulin antagonists (acromegaly, Cushing's disease, pheochromocytoma, thyroid disease) lead to the development of secondary diabetes.Many long-term medications have the effect of causing diabetes: diuretics, some antihypertensive drugs and hormones, oral contraceptives, etc.;
2. Diabetes in pregnant women (gestation),caused by the special interaction of hormones of mother, child and placenta.The fetal pancreas, which itself produces insulin, begins to inhibit the production of insulin by the maternal gland, as a result of which this special form is formed during pregnancy.However, if properly controlled, gestational diabetes usually goes away after giving birth.Then, in some cases (up to 40%) in women with a similar pregnancy history, this fact can threaten the development of type II diabetes (within 6-8 years).

Why does "sweet" disease occur?

The “sweet” disease constitutes a rather “diverse” patient group, so it is clear that IDDM and its non-insulin-dependent “cousin” have different genetic origins.There is evidence of a link between insulin-dependent diabetes and the genetic makeup of the HLA (major histocompatibility complex) system, in particular, with some genes belonging to the D region locus. For NIDDM, such a relationship was not observed.

For the development of type I diabetes, genetic factors alone are not enough;The pathogenesis is triggered by stimulating factors:

• Congenital deficiency of the islets of Langerhans;
• Adverse effects of the external environment;
• Stress, nervous tension;
• Traumatic brain injury;
• Pregnant;
• Infectious processes of viral origin (influenza, mumps, cytomegalovirus infection, Coxsackie);
• Tendency to continuously overeat, leading to excess fat accumulation;
• Abuse of confectionery products (people with a sweet tooth are at higher risk).

Before mentioning the causes of type II diabetes, it is worth focusing on a very controversial issue: who gets the disease more often - men or women?

It has been established that today this disease occurs more often in women, although in the 19th century diabetes was a "privilege" of the male sex.By the way, currently in some Southeast Asian countries, the presence of this disease in men is considered to prevail.

Conditions favorable to the development of type II diabetes include:

• Changes in the structure of the pancreas due to inflammatory processes, as well as the appearance of cysts, tumors, hemorrhages;
• Age after 40 years;
• Excess weight (the most important risk factor for NIDDM!);
• Vascular disease due to atherosclerotic processes and arterial hypertension;
• In women, pregnancy and childbirth with high body weight (over 4 kg);
• Have a relative with diabetes;
• Strong psycho-emotional stress (increased adrenal stimulation).

The causes of the disease of different types of diabetes in some cases coincide (stress, obesity, influence of external factors), but the process of onset in type 1 and type 2 diabetes is different, moreover,IDDM is the domain of children and adolescents, and those who are not insulin-dependent prefer the elderly.

Why do you want to drink so much?

Characteristic symptoms of diabetes, regardless of form and type, can be presented as follows:

1. dry oral mucosa;
2. Thirst that is nearly impossible to quench, associated with dehydration;
3. Excessive urine formation and excretion by the kidneys (polyuria), leading to dehydration;
4. Increased serum glucose concentration (hyperglycemia), due to inhibition of sugar utilization by peripheral tissues due to lack of insulin;
5. The appearance of sugar in urine (glucosuria) and ketone bodies (ketonuria), usually appear in insignificant amounts, but in diabetes, this amount of sugar is produced in large amounts by the liver and when excreted from the body will be found in the urine;
6. Increased plasma content (in addition to glucose) of urea and sodium ions (Na⁺);
7. Weight loss, in the case of decompensation is a characteristic feature of the catabolic syndrome, which develops due to glycogenolysis, lipolysis (fat mobilization), catabolism and gluconeogenesis (conversion to glucose) of proteins;
8. Violation of lipid spectrum indicators, increase in total cholesterol due to low-density lipoprotein components, NEFA (non-esterified fatty acids), triglycerides.Increasing lipid content begins to be actively transported to the liver and there they are strongly oxidized, which leads to the formation of too many ketone bodies (acetone + β-hydroxybutyric acid + acetoacetic acid) and they continue to enter the blood (hyperketonemia).Excessive concentrations of ketone bodies threaten a dangerous condition calleddiabetic ketoacidosis.

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

Type I diabetes is a "privilege" of young people

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

• sudden weight loss;
• Abnormal thirst, a person simply cannot get drunk, although he tries to do so (polyphora);
• Excretion of large amounts of urine (polyuria);
• Significant excesses of serum glucose and ketone bodies (ketogenic ketoacidosis).In the early stages, when the patient may not be aware of his problem, diabetic coma (ketoacids, hyperglycemia) is very likely to occur - an extremely life-threatening condition, therefore insulin therapy is prescribed as soon as possible (as soon as diabetes is suspected).

In most cases, after using insulin, metabolic processes are compensated,The body's need for insulin drops sharply and a temporary "recovery" occurs.However, this short-term state of remission should not relax either the patient or the doctor, because after a while the disease will remind itself again.Insulin requirements may increase as the duration of illness increases, but in general, in the absence of ketoacidosis, insulin levels 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 main causes of death from IDDM include:

1. End-stage renal failure, a consequence of diabetic glomerulosclerosis;
2. Cardiovascular disorders are complications of underlying disease, occurring less frequently than kidney disorders.

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

NIDDM develops over months and even years.When problems arise, one takes them to various specialists (dermatologists, gynecologists, neurologists...).In his opinion, the patient does not even suspect that various diseases: pimples, itchy skin, fungal infections, pain in the lower extremities are signs of type II diabetes.The patient gets used to his condition and diabetes continues to develop slowly, affecting all systems and mainly the blood vessels.

NIDDM is characterized by a slow, steady course, often without a tendency to ketoacidosis.

Treatment for type 2 diabetes usually begins with a diet that limits digestible (refined) carbohydrates and the use of glucose-lowering medications (if needed).Insulin is prescribed if the disease has progressed to a stage of severe complications or is resistant to oral medications.

The main cause of death in NIDDM patients is determined to be cardiovascular disease due to diabetes.As a rule, this is a heart attack or stroke.

Methods of treating diabetes

The basis of compensatory treatment measures for diabetes is expressed in three main principles:

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

The implementation of these principles is based on 5 main viewpoints:

1. Nutrition for diabetes plays the role of “first violin”;
2. Complete system of physical exercises, selected for each individual, following the diet;
3. Hypoglycemic drugs are mainly used to treat type 2 diabetes;
4. Insulin therapy is indicated if necessary for NIDDM, but is necessary in cases of type 1 diabetes;
5. Train the patient how to self-monitor (skills to take blood from a finger, use a blood glucose meter, inject insulin without assistance).

Laboratory controls on these sites revealed compensatory levels following the following biochemical studies:

Indicators	Good level of compensation	meet the requirements	Bad
Fasting blood sugar level (mmol/l)	4.4 – 6.1	6.2 – 7.8	Ø 7.8
Blood sugar 2 hours after eating (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
Total serum 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

Nutrition for diabetes is very well known, even among people who do not have diabetes, table number 9. When hospitalized for any disease, you can occasionally hear about a special diet, always in separate pans, different from other diets and given after a certain password is said: “I have the ninth table”.What does all this mean?How is this mysterious diet different from all the others?

There should be no mistake when caring for a diabetic patient who brings their own “porridge” that they are deprived of all the joys in life.The diet for people with diabetes is not too different from the diet of healthy people;Patients receive the required amount of carbohydrates (60%), fats (24%) and proteins (16%).

Nutrition for diabetes involves replacing refined sugars in foods with slowly broken down carbohydrates.Sugar is sold in stores to everyone, and confectionery products made from this sugar fall under the category of prohibited foods.

As for nutritional balance, everything is strict here: diabetics must necessarily consume the necessary amount of vitamins and pectin, which must be at least 40 grams.everyday.

Strict individual physical activity

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

• Year old;
• Symptoms of diabetes;
• Severity of the pathological process;
• Presence or absence of complications.

Physical activity prescribed by a doctor and performed by a "guardian" will promote the process of "burning" carbohydrates and fats without the need for insulin.The dosage required to compensate for metabolic disorders will be significantly reduced, which should not be forgotten, because by blocking the increase in blood sugar, you can get unwanted effects.Adequate physical activity reduces the amount of glucose, the administered dose of insulin breaks down the remainder and as a result, the amount of sugar drops below the acceptable value (hypoglycemia).

So,Insulin dosage and physical activity require extreme attention and careful calculation,To complement each other, we together do not exceed the lower limit of common laboratory parameters.

Or maybe try folk remedies?

Treatment of type 2 diabetes is often accompanied by the patient's own search for folk remedies that can slow down the process and delay the time of taking dosage forms as much as possible.

Despite the fact that our distant ancestors practically did not know about this disease, there were still folk remedies for the treatment of diabetes, but we should not forget thatInfusions and decoctions prepared from many different plants have a supportive effect.Using home remedies for diabetes does not help the patient to stick to the diet, monitor blood sugar levels, see a doctor and follow all the doctor's recommendations.

To combat this pathology at home, quite famous folk remedies are used:

1. Mulberry bark and leaves are white;
2. Oat seeds and hulls;
3. Walnut partition;
4. Bay leaves;
5. cinnamon;
6. Acorns;
7. nettle;
8. Dandelion.

When diets and folk remedies no longer help...

The so-called first generation drugs, widely known at the end of the last century, have become a thing of the past and have been replaced by new generation drugs, which constitute 3 main groups of diabetes drugs produced by the pharmaceutical industry.

The endocrinologist decides which treatment is suitable for this or that patient.And so that the patient does not self-medicate and does not decide to use these diabetes drugs on his own, we will give some illustrative examples.

Sulfonylurea derivatives

Currently, second-generation sulfonylurea derivatives are prescribed, which have an effect from 10 hours to 24 hours.Patients usually take it twice a day, half an hour before meals.

This medicine is absolutely contraindicated in the following cases:

• Type 1 diabetes;
• Diabetic coma, hyperosmolar, lactic acid;
• Pregnancy, childbirth, breastfeeding;

• Diabetic kidney disease with impaired filtration;
• Diseases of the hematopoietic system with a simultaneous decrease in the number of leukocytes - leukocytes (leukopenia) and the platelet component of hematopoiesis (thrombocytopenia);
• Severe infectious and inflammatory liver damage (hepatitis);
• Diabetes is complicated by vascular disease.

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

1. Skin itching and hives, sometimes reaching Quincke's edema;
2. Digestive system disorders;
3. Changes in the blood (thrombocytopenia and leukopenia);
4. Possible impairment of liver function (cholestatic jaundice).

Biguanide hypoglycemic drugs

Biguanides (guanidine derivatives) are actively used to treat type 2 diabetes, often adding sulfonamides to them.They are very reasonable for use in obese patients, however, for people with liver, kidney and cardiovascular pathologies, their use is significantly limited, switching to more gentle 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 biguanide use:

• IDDM (type 1 diabetes mellitus);
• Significant weight loss;
• Infectious process, regardless of location;
• Surgical intervention;
• Pregnancy, childbirth, breastfeeding;
• Lethargy;
• liver and kidney diseases;
• Lack of oxygen;
• Microangiopathy (2-4 degrees) with impaired vision and kidney function;
• Nutritional ulcers and necrotic processes;
• Poor circulation in the lower limbs due to various vascular pathologies.

Insulin treatment

From the above, it is clear thatInsulin is the main treatment for type 1 diabetes, all medical emergencies, and serious complications of diabetes.NIDDM only requires that this therapy be prescribed in the case of insulin-requiring forms, when correction by other means does not bring the desired effect.

Modern types of insulin, called monofunctional, represent two groups:

1. Single-potency pharmacological forms of human insulin (semi-synthetic or recombinant DNA), certainly have significant advantages over drugs derived from pork.They have virtually no contraindications or side effects;
2. Monofunctional insulin is obtained from the pancreas of pigs.These drugs, compared to human insulin, require an approximately 15% increase in drug dosage.

Diabetes is dangerous due to complications

Because diabetes is accompanied by damage to many organs and tissues, its manifestations can be seen in almost every body system.Complications of diabetes are:

• Pathological changes in the skin: diabetic dermatosis, necrotizing lipoidica, boils, xanthomatosis, fungal skin infections;
• Bone and joint disease:
  1. Diabetic osteoarthritis (Charcot arthrosis - changes in the ankle joint), occurring against the background of impaired microcirculation and nutritional disorders, accompanied by dislocation, subluxation, spontaneous fractures before their formationdiabetic feet;
  
  2. Diabetic trichotillomania, characterized by stiffness in the hands, often develops in children with diabetes;
• Respiratory disease: long-termProlonged bronchitis, pneumonia,tuberculosis incidence increased;
• Pathological processes affecting the digestive organs:diabetic intestinal disease, accompanied by increased intestinal motility, diarrhea (up to 30 times a day), weight loss;
• Diabetic retinopathy– one of the most serious complications, characterized by damage to the visual organs;
• The most common complication of diabetes is considereddiabetic neuropathyand its diversity -polyneuropathy, reaching 90% of all forms of this pathology.Diabetic polyneuropathy is a common diseasediabetic foot syndrome;
• A pathological condition of the cardiovascular system, which in most cases is the cause of death from diabetes.Hypercholesterolemia and atherosclerosis of blood vessels, which in diabetes begin to develop at a young age, inevitably lead to diseases of the heart and blood vessels (coronary artery disease, myocardial infarction, heart failure, stroke).

prevent

Diabetes prevention measures are based on the cause of the disease.In this case, it should be said about the prevention of atherosclerosis and arterial hypertension, including the fight against overweight, bad habits and addiction to food.

Preventing complications of diabetes involves preventing the development of pathological conditions that arise from the diabetes itself.Regulation of serum glucose levels, adherence to diet, adequate physical activity and following the doctor's recommendations will help delay the consequences of this rather formidable disease.