Diabetes mellitus is a disease of the endocrine system associated with pathological changes in the hormonal background and metabolic failures.
To date, the disease is not likely to be eradicated (complete elimination). The destructive process in the body can be slowed down by medication and diet therapy, but it is impossible to stop it and start it in the opposite direction.
The types of diabetes mellitus (DM) are defined by the World Health Organization and have no fundamental differences in the medical world. Diabetes mellitus of any type is not a contagious disease.
Diabetes mellitus can be of several types, as well as different types. Since the treatment for each species and type is different, it is necessary to know which particular variant of the disease has arisen.
Type of pathology
There are several types of the disease, united by one main symptom - an increased concentration of glucose in the blood. The typification of diabetes mellitus is due to the causes of its occurrence. There are also applied methods of therapy, gender and age of the patient.
Medically accepted types of diabetes:
- the first type is insulin-dependent (IDDM 1), or juvenile;
- the second is insulin-independent (INZDM 2) or insulin-resistant;
- gestational diabetes mellitus (GDM) in the perinatal period in women;
- other specific types of diabetes, including:
- damage to the 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 external secretory glands and their functions (endocrinopathy);
- pharmacologically determined diabetes;
- diabetes as a result of congenital infections;
- DM associated with genomic pathologies and hereditary defects;
- impaired fasting blood glucose (glycaemia) and impaired glucose tolerance.
Prediabetes is a borderline state of the body, when the level of blood sugar is changed upwards (glucose tolerance is impaired), however, blood sugar indicators "do not reach" the generally accepted numerical values corresponding to real diabetes. According to the World Health Organization (WHO 2014), more than 90% of endocrinologist patients suffer from the second type of disease.
According to medical statistics, there is a clear trend of increasing cases all over the world. Over the past 20 years, the number of type 2 diabetics has doubled. DG accounts for approximately 5% of pregnancies. Specific types of diabetes are extremely rare and occupy a small percentage in medical statistics.
By gender, NIDDM 2 is more common in premenopausal and postmenopausal women. This is due to a change in hormonal status and a set of extra pounds. In humans, 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 the failure of pancreatic cells. The organ does not fulfill its endocrine (intrasecretory) function of producing insulin, the hormone responsible for supplying the body with glucose. Due to the accumulation of glucose in the blood, the organs do not receive adequate nutrition, including the pancreas itself.
To mimic natural endocrine hormone production, the patient receives lifelong injections of medical insulin with different durations of action (short and long), along with diet therapy. The classification of type 1 diabetes mellitus is dictated by the different etiologies of the disease. The insulin-dependent type of the disease has two causes: genetic and autoimmune.
genetic cause
The formation of pathology is associated with the biological feature of the human body to transmit its characteristics and pathological abnormalities to subsequent generations. When it comes to diabetes, a child inherits a predisposition to the disease from parents or 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 onset of the disease is due to 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 cells of the body. The (push) triggers to start autoimmune processes are:
- unhealthy eating behaviors combined with physical inactivity;
- failure of metabolic processes (carbohydrates, lipids and proteins);
- critical deficiency in the body of cholecalciferol and ergocalciferol (vitamins of group D);
- pathology of the pancreas of a chronic nature;
- a history of mumps (mumps), measles, herpes Coxsackievirus, Epstein-Barr virus, cytomegalovirus, viral hepatitis A, B, C;
- distress (prolonged stay in a state of neuropsychological stress);
- chronic alcoholism;
- incorrect treatment with drugs containing hormones.
IDDM forms in children, adolescents and adults under the age of thirty. The infantile variant of the development of 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 manner over a few weeks or months.
Insulin resistant diabetes (type 2)
The difference between type 2 diabetes 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 insulin sensitivity - insulin resistance. To some extent, treatment is carried out by hypoglycemic (hypoglycemic) drugs and diet therapy.
To compensate for the body's imbalance, the pancreas activates the production of the hormone. Working in emergency mode, the organ wears out over time and loses its intrasecretory function. Type 2 diabetes becomes insulin dependent. The decrease or loss of cellular sensitivity to the endogenous hormone is mainly associated with obesity, in which the metabolism of fats and carbohydrates is disturbed.
This is especially true of visceral obesity (deposition of fat around internal organs). In addition, with excess weight, blood circulation becomes difficult due to numerous cholesterol plaques inside the vessels, which are formed during hypercholesterolemia, which always accompanies obesity. The cells of the body are therefore deficient in 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;
- pathology of the heart and vascular system;
- overeating against the background of a sedentary lifestyle;
- incorrect hormone therapy;
- complicated pregnancy;
- dysfunctional heredity (diabetes in parents);
- distress.
Most often the disease develops in women and men of the 40+ age category. At the same time, type 2 diabetes is latent and may not show serious symptoms for several years. Rapid blood sugar tests can detect prediabetes. With adequate therapy, the pre-diabetic state is reversible. If time is lost, it progresses and subsequently NIDDM is diagnosed.
Diabetes Lada
In medicine, we find the term "Diabetes 1. 5", or the name Lada diabetes. It is an autoimmune disorder of hormone production and failure of metabolic processes that occurs in adults (aged 25 and older). 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 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;
- discoloration (loss of pigment) of the skin (vitiligo);
- inflammatory pathology of the colon mucosa (ulcerative colitis);
- chronic lesions of connective tissue and external secretory glands (Sjogren's syndrome).
In combination with a hereditary predisposition, autoimmune disorders lead to the progression of Lada diabetes. To detect the disease, basic diagnostic methods are used, as well as blood microscopy, which determines the concentration of immunoglobulins of the IgG class in relation to antigens - ELISA (enzyme immunoassay). Therapy is carried out by regular insulin injections and nutritional correction.
Gestational form of the disease
DG 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 routine screening, when the expectant mother undergoes a full examination. The main feature of DG similar to type 2 diabetes is insulin resistance. Cells in a pregnant woman's body lose sensitivity (sensitivity) to insulin due to the interrelation of three main reasons:
- Hormonal reorganization. During the gestation period, the synthesis of progesterone (a steroid sex hormone) increases, blocking the production of insulin. In addition, the endocrine hormones of the placenta, which tend to inhibit the production of insulin, gain strength.
- Double load on the female body. To provide adequate nutrition to the unborn child, the body needs an increased amount of glucose. A woman begins to consume more monosaccharides, which causes the pancreas to synthesize more insulin.
- An increase in body weight against the background of a decrease in physical activity. Glucose, abundantly supplied to the body, accumulates in the blood, as cells refuse to take insulin due to obesity and physical inactivity. The future mother and the fetus in this situation experience nutritional deficiencies and a thirst for energy.
Unlike type 1 and 2 diabetes, gestational diabetes is a reversible process because insulin molecules and pancreatic functionality are preserved.
Properly selected therapeutic tactics guarantee the elimination of pathology after childbirth in 85% of cases. The main method of treating DG is the diabetic diet "Table No. 9". In difficult cases, medical insulin injections are used. Hypoglycemic drugs are not used because of their teratogenic effects on the fetus.
Besides
Some types of diabetes are genetically determined (MODY-diabetes, certain types of endocrinopathies) or caused by other chronic pathologies:
- pancreatic diseases: pancreatitis, hemochromatosis, tumor, cystic fibrosis, mechanical trauma and surgery of the gland;
- functional failure of the anterior pituitary (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 the balance of fluids in the body.
Diagnostic measures
The diagnosis of diabetes mellitus (of any type) is possible only on the basis of the results of blood microscopy in the laboratory. The diagnosis consists of several consecutive studies:
- General clinical blood test to detect hidden inflammatory processes in the body.
- Blood test (capillary or venous) for glucose content. 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 sample: on an empty stomach and two hours after the "glucose load", which is an aqueous solution of glucose prepared in a ratio 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 assessed.
- Blood biochemistry. Indicators of liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (AP), bilirubin (bile pigment), cholesterol level are evaluated.
- A blood test for the concentration of antibodies to glutamate decarboxylase (GAD antibodies) determines the type of diabetes mellitus.
Blood Glucose Reference Values and Disease Indicators
| Analysis | For the 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 urinalysis is examined 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's test is also performed to detect albumin protein and a product of protein metabolism of creatinine in urine. In addition, hardware diagnostics are prescribed, including an ECG (electrocardiogram) and an 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 (pregnant GDM), specific (DM includes several typesdiseases caused by genetic defects or chronic pathologies). Gestational diabetes, formed during the perinatal period, is curable. Prediabetes (glucose intolerance) is considered reversible if diagnosed early.