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

Diabetes mellitus is one of the most common diseases whose incidence tends to increase and spoil the statistics.The symptoms of diabetes mellitus do not appear overnight;the process is chronic, with increasing and worsening endocrine and metabolic disorders.Certainly, the onset of type 1 diabetes differs significantly from the early stage of type 2 diabetes.

Among all endocrine pathologies, diabetes undoubtedly takes the lead and represents more than 60% of all cases.Furthermore, disappointing statistics show that 1/10 of “diabetics” are children.

The likelihood of contracting the disease increases with age and so, 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 a disease such 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 insufficiency and sometimes 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, thereby stretching the stomach);
• Isolation of a huge amount of light, unconcentrated urine with low density (1000-1003);
• Catastrophic weight loss, weakness, decreased physical activity, digestive system disorders;
• 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 recovery, the disease has an unfavorable prognosis;work capacity 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, which is entrusted with the mission of internal secretion, produces various hormones, including -insulin and glucagon.They are essential for ensuring the consistency of sugar in the human body.

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

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

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

Types and particular forms of the disease

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

• The complete absence of insulin (absolute deficit) is formedinsulin dependentpathological process, calledtype I diabetes mellitus (IDDM);
• Lack of insulin (relative deficiency), which triggers a carbohydrate metabolism disorder at the initial stage, slowly but surely leads to the developmentnon-insulin dependentdiabetes mellitus (NIDDM), calleddiabetes mellitus type II.

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

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

1. Secondary diabetesresulting from acute and chronic inflammation of the pancreas (pancreatitis), malignant neoplasms of 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 medications used for a long time have a diabetogenic effect: diuretics, certain antihypertensives and hormones, oral contraceptives, etc.;
2. Diabetes in pregnant women (gestational),caused by the special mutual influence of the hormones of the mother, child and placenta.The fetal pancreas, which produces its own insulin, begins to inhibit the production of insulin by the maternal gland, resulting in the formation of this particular form during pregnancy.However, with proper control, gestational diabetes usually goes away after delivery.Subsequently, in some cases (up to 40%) in women with a similar pregnancy history, this fact can threaten the development of type II diabetes mellitus (within 6-8 years).

Why does “mild” disease appear?

The “mild” disease forms a rather “motley” group of patients, so it becomes obvious that diabetes mellitus and its non-insulin-dependent “brother” have a different genetic origin.There is evidence of a link between insulin-dependent diabetes and genetic structures of the HLA (major histocompatibility complex) system, particularly with some genes in the D region loci. For NIDDM, such a relationship has not been observed.

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

• Congenital islet deficiency of Langerhans;
• Unfavorable influence of the external environment;
• Stress, nervous stress;
• Traumatic brain injuries;
• Pregnancy;
• Infectious processes of viral origin (flu, mumps, cytomegalovirus infection, Coxsackie);
• Tendency to constantly overeat, leading to excess fat;
• Abuse of confectionery products (those with a sweet tooth are more at risk).

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

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

Conditions predisposing to the development of type II diabetes mellitus 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;
• Excess weight (the biggest risk factor for NIDDM!);
• Vascular diseases caused by the atherosclerotic process and arterial hypertension;
• In women, pregnancy and birth of a child of high body weight (more than 4 kg);
• Having loved ones with diabetes;
• Strong psycho-emotional stress (adrenal hyperstimulation).

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

Why do you want to drink so much?

Symptoms characteristic of diabetes mellitus, regardless of form and type, can be presented as follows:

1. Dryness of the oral mucous membranes;
2. Thirst almost impossible to quench, associated with dehydration;
3. Excessive formation of urine and its excretion through the kidneys (polyuria), leading to dehydration;
4. An increase in the concentration of glucose in the blood serum (hyperglycemia), due to suppression of sugar utilization by peripheral tissues due to insulin deficiency;
5. The appearance of sugar in urine (glucosuria) and ketone bodies (ketonuria), which are normally present in negligible quantities, but in diabetes mellitus, are intensively produced by the liver and, when excreted from the body, are found in urine;
6. Increased content in blood plasma (in addition to glucose) of urea and sodium ions (Na⁺);
7. Weight loss, which in case of decompensation of the disease is a characteristic feature of 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 lipid spectrum indicators, increase in total cholesterol due to low-density lipoprotein fraction, NEFA (non-esterified fatty acids), triglycerides.The increasing content of lipids begins to be actively sent to the liver and there they are intensively oxidized, which leads to the excessive formation of ketone bodies (acetone + β-hydroxybutyric acid + acetoacetic acid) and their subsequent entry into the blood (hyperketonemia).Excessive concentration of ketone bodies threatens a dangerous condition calleddiabetic ketoacidosis.

So, 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 features inherent in one or another type.

Type I diabetes mellitus is a “privilege” of young people

IDDM is characterized by an acute onset (weeks to months).Signs of type I diabetes mellitus are pronounced and are manifested by clinical symptoms typical of this disease:

• Sudden weight loss;
• Unnatural thirst, a person simply cannot get drunk, even if he tries to do so (polydipsia);
• Large amounts of urine excreted (polyuria);
• Significant excess of the concentration of glucose and ketone bodies in the blood serum (ketacidosis).At the initial stage, when the patient may not yet be aware of his problems, the development of diabetic (acidotic, hyperglycemic) coma is very likely - an extremely life-threatening condition, therefore insulin therapy is prescribed as early as possible (as soon as diabetes is suspected).

In most cases, after using insulin, metabolic processes are compensated,The body's need for insulin sharply decreases and a temporary "recovery" occurs.However, this state of short-term remission should not relax either the patient or the doctor, because after a while the disease will remind itself again.The need for insulin may increase as the illness lasts, but, generally, in the absence of ketoacidosis, it will not exceed 0.8 to 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, a consequence of diabetic glomerulosclerosis;
2. Cardiovascular disorders are complications of the underlying disease, which occur somewhat less frequently than kidney disorders.

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

NIDDM develops over several months, even several years.When problems arise, a person takes them to different specialists (dermatologist, gynecologist, neurologist, etc.).The patient does not even suspect that different diseases according to him: furunculosis, itchy skin, fungal infections, pain in the lower extremities are signs of type II diabetes mellitus.Patients become accustomed to their condition and diabetes continues to develop slowly, affecting all systems, mainly blood vessels.

NIDDM is characterized by a stable and slow course, generally without a tendency to ketoacidosis.

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

The leading cause of death in patients with NIDDM is recognized as cardiovascular pathology resulting from diabetes.Typically, 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 for insulin deficiency;
• Regulation of endocrine and metabolic disorders;
• Prevention of diabetes, its complications and their prompt treatment.

The implementation of these principles is carried out from 5 main positions:

1. Nutrition for diabetes mellitus plays the role of “first violin”;
2. A system of physical exercises, adequate and individually selected, follows the diet;
3. Hypoglycemic medications are primarily used to treat type 2 diabetes;
4. Insulin therapy is prescribed if necessary in cases of NIDDM, but is essential in cases of type 1 diabetes;
5. Train patients in self-monitoring (ability to draw blood from a finger, use a glucometer, administer insulin without assistance).

Laboratory monitoring above these positions indicates the degree of compensation after the following biochemical studies:

Indicators	Good level of remuneration	Satisfying	Bad
Fasting blood sugar (mmol/l)	4.4 – 6.1	6.2 – 7.8	Ø7.8
Blood sugar content 2 hours after a meal (mmol/l)	5.5 – 8.0	8.1 – 10.0	Ø10.0
Percentage of glycosylated hemoglobin (HbA1, %)	< 8.0	8.0 – 9.5	Ø10.0
Serum total cholesterol (mmol/l)	<5.2	5.2 – 6.5	Ø6.5
Triglyceride level (mmol/l)	<1.7	1.7 – 2.2	Ø2.2

The important role of diet in the treatment of NIDDM

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

It should not be mistaken, caring for a diabetic by taking away his "porridge", that he is deprived of all the joys of life.The diabetes diet is not that 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 breaking down carbohydrates.Sugar sold in stores for everyone and sugar-based confectionery products 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 ;
• Diabetes Symptoms;
• The severity of the pathological process;
• The presence or absence of complications.

The physical activity prescribed by the doctor and carried out by the “service” must promote the “burning” of carbohydrates and fats without using insulin.Its dose, necessary to compensate for metabolic disorders, noticeably decreases, which should not be forgotten, because by preventing an increase in blood sugar levels, an undesirable effect can be achieved.Adequate physical activity reduces glucose, the dose of insulin administered breaks down the remaining dose and, as a result, a decrease in sugar levels below acceptable values (hypoglycemia).

So,insulin dosage and physical activity require very special attention and careful calculation,so that, by complementing each other, we do not together cross the lower limit of normal laboratory parameters.

Or maybe try folk remedies?

Treatment of type 2 diabetes mellitus is often accompanied by the patient's 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 are folk remedies for the treatment of diabetes mellitus, but we should not forget thatinfusions and decoctions prepared from various plants help.The use of home remedies for diabetes does not exempt the patient from following a diet, monitoring blood sugar levels, consulting a doctor and following all his recommendations.

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

1. Bark and leaves of white mulberry;
2. Oat grains and hulls;
3. Walnut partitions;
4. Bay leaf;
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, are a thing of the past and have been replaced by new generation drugs, which constitute the 3 main groups of diabetes drugs produced by the pharmaceutical industry.

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

Sulphonylurea derivatives

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

These medications are absolutely contraindicated in the following cases:

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

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

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

1. Itchy skin and hives, sometimes reaching angioedema;
2. Digestive system disorders;
3. Blood changes (decrease in platelet and leukocyte levels);
4. Possible alteration of the functional capacities of the liver (jaundice due to cholestasis).

Antihyperglycemic agents of the biguanide family

Biguanides (guanidine derivatives) are actively used to treat type 2 diabetes mellitus, often adding sulfonamides to them.They are very rational for obese patients, however, for people suffering from liver, kidney and cardiovascular pathologies, their use is sharply limited, switching to softer drugs of the same group or to 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 process, regardless of location;
• Surgical interventions;
• Pregnancy, childbirth, breastfeeding;
• Comatose states;
• Liver and kidney pathology;
• Lack of oxygen;
• Microangiopathy (2-4 degrees) with impaired vision and renal function;
• Trophic ulcers and necrotic processes;
• Poor circulation in the lower limbs due to various vascular pathologies.

Insulin treatment

From the above, it becomes evident thatInsulin is the primary treatment for type 1 diabetes, all medical emergencies, and serious complications of diabetes.NIDDM requires the appointment of this therapy only in cases of forms requiring insulin, when correction by 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 recombinant DNA), which undoubtedly have a significant advantage over drugs of porcine origin.They have practically no contraindications or side effects;
2. Monocompetent insulins obtained from porcine pancreas.These drugs, compared to human insulins, require an increase in the dose of the drug by approximately 15%.

Diabetes is dangerous due to complications

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

• Pathological changes in the skin: diabetic dermopathy, lipoid necrobiosis, furunculosis, xanthomatosis, fungal infections of the skin;
• Osteoarticular diseases:
  1. Diabetic osteoarthritis (Charcot joint - 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 hairopathy, characterized by stiffness in the joints of the hands, which often develops in diabetic children;
• 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 diseasediabetic foot syndrome;
• A 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 a young age, inevitably lead to heart and vascular diseases (coronary heart disease, myocardial infarction, heart failure, stroke).

Prevention

Measures to prevent diabetes mellitus are based on the causes that provoke it.In this case, it is appropriate to talk about the prevention of atherosclerosis and high blood pressure, in particular the fight against excess weight, bad habits and food addictions.

Prevention of complications of diabetes mellitus involves preventing the development of pathological conditions resulting from diabetes itself.Correcting blood sugar levels, following a diet, adequate physical activity and following the doctor's recommendations will help delay the consequences of this rather formidable disease.