Diabetes mellitus is a disease of the endocrine system associated with pathological changes in the hormonal background and metabolic disorders.
To date, the disease is not susceptible to eradication (complete elimination). The destructive process in the body can be slowed down by medication and diet, but it is impossible to stop and start in the opposite direction.
Types of diabetes mellitus (DM) are defined by the World Health Organization and have no fundamental differences throughout the medical world. Diabetes of any kind is not a contagious disease.
Diabetes mellitus can be of several types, as well as different types. Since the treatment is different for each species, it is necessary to know which variant of the disease has arisen.
Pathology typing
There are several types of disease, united by one main symptom - increased blood glucose levels. The typification of diabetes mellitus is caused by the causes of its occurrence. Methods of therapy, sex and age of the patient are also applied.
Medically acceptable types of diabetes:
- the first type is insulin-dependent (IDDM 1), or juvenile;
- the other 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 pancreatic β-cells at the genetic level (variants of MODY-diabetes);
- pathology of exocrine function of the pancreas;
- hereditary and acquired pathologies of the glands of external secretion and their functions (endocrinopathy);
- pharmacologically determined diabetes;
- diabetes as a consequence of congenital infections;
- DM associated with genomic pathologies and hereditary defects;
- impaired glycemia (blood sugar) on an empty stomach and impaired glucose tolerance.
Prediabetes is a borderline condition of the body, when the level of glycemia changes upwards (impaired glucose tolerance), however, blood sugar indicators "do not reach" the generally accepted digital values corresponding to true diabetes. According to the World Health Organization (WHO 2014), more than 90% of endocrinologist patients suffer from other types of diseases.
According to medical statistics, there is a clear trend of increasing the number of cases worldwide. In the past 20 years, the number of type 2 diabetics has doubled. GDM accounts for about 5% of pregnancies. Types of specific diabetes are extremely rare and occupy a small percentage in medical statistics.
By gender, NIDDM 2 is more common in premenopausal and menopausal women. This is due to a change in hormonal status and a set of extra pounds. In men, 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 pancreatic cell failure. The organ does not fulfill its endocrine (intrasecretory) function of producing insulin, the hormone responsible for supplying the body with glucose. As a result of the accumulation of glucose in the blood, the organs do not receive adequate nutrition, including the pancreas itself.
To mimic the natural production of endocrine hormone, the patient is given lifelong injections of medical insulin of varying duration (short and long), as well as dietary therapy. The classification of type 1 diabetes mellitus is dictated by different etiologies of the disease. Insulin-dependent type of disease has two causes: genetic and autoimmune.
genetic cause
The formation of pathology is associated with the biological properties of the human body to pass on its characteristic features and pathological abnormalities to future generations. With regard to diabetes, a child inherits a predisposition to the disease from parents or close relatives who suffer from diabetes.
Bitan! The predisposition is inherited, 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 functional failure of the immune system, when under the influence of negative factors it actively produces autoimmune antibodies that have a destructive effect on body cells. Triggers (push) to start autoimmune processes are:
- unhealthy eating habits combined with physical inactivity;
- failure of metabolic processes (carbohydrates, lipids and proteins);
- critical deficiency in the body of cholecalciferol and ergocalciferol (vitamin D group);
- pancreatic pathology of chronic nature;
- history of mumps (smallpox), smallpox, Coxsackie herpes virus, Epstein-Barr virus, cytomegalovirus, viral hepatitis A, B, C;
- distress (prolonged stay in a state of neuropsychological stress);
- chronic alcoholism;
- improper treatment with hormone-containing drugs.
IDDM is formed in children, adolescents and adults under the age of thirty. A variant of the development of type 1a diabetes in childhood is associated with complicated viral infections. Form 1b occurs in young people and children in the background of autoimmune processes and hereditary predisposition. The disease usually develops rapidly within a few weeks or months.
Insulin resistant diabetes (type 2)
The difference between type 2 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 insensitivity to insulin - insulin resistance. Until a certain point, treatment is carried out through hypoglycemia (sugar-lowering drugs) and diet therapy.
To compensate for the imbalance in the body, the pancreas activates hormone production. Working in the emergency mode, the organ wears out over time and loses its intrasecretory function. Type 2 diabetes becomes insulin dependent. Decreased or lost cell sensitivity to endogenous hormone is primarily associated with obesity, in which fat and carbohydrate metabolism is impaired.
This is especially true for visceral obesity (deposition of fat around internal organs). In addition, with being overweight, blood flow is impaired due to the numerous cholesterol plaques within the blood vessels, which occur during hypercholesterolemia, which always accompanies obesity. The cells of the body, therefore, lack in nutrition and energy resources. Other factors influencing the development of NIDDM include:
- alcohol abuse;
- gastronomic addiction to sweet foods;
- chronic diseases of the pancreas;
- pathology of the heart and vascular system;
- food excesses on the background of a sedentary lifestyle;
- improper hormone therapy;
- complicated pregnancy;
- dysfunctional heredity (parental diabetes);
- trouble.
The disease most often develops in women and men aged 40+. At the same time, type 2 diabetes is latent and may not show severe symptoms for several years. Timely testing of blood glucose levels can detect prediabetes. With adequate therapy, the prediabetic condition is reversible. If time is lost, it progresses and NIDDM is then diagnosed.
Lada diabetes
In medicine, the term "diabetes 1, 5", or the name Lada diabetes. This is an autoimmune disorder in hormone production and metabolic failure that occurs in adults (25+). The disease combines the first and second types of diabetes. The mechanism of development corresponds to IDDM-u, latent course and manifestation of symptoms are similar to NIDDM.
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 mucous membrane of the colon (ulcerative colitis);
- chronic damage to connective tissue and glands of external secretion (Sjögren's syndrome).
Combined with a hereditary predisposition, autoimmune disorders lead to the progression of Lada diabetes. Basic diagnostic methods are used to detect the disease, as well as blood microscopy which determines the concentration of IgG class immunoglobulins on antigens - ELISA (enzyme immunoassay). Therapy is carried out through regular insulin injections and dietary correction.
Gestational form of the disease
GDM 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 future mother undergoes a complete examination. The main feature of GDM that is similar to type 2 diabetes is insulin resistance. Pregnant body cells lose sensitivity (sensitivity) to insulin due to the correlation of three main reasons:
- Hormonal reorganization. During the period of gestation, the synthesis of progesterone (steroid sex hormone) increases, blocking the production of insulin. In addition, placental endocrine hormones, which tend to inhibit insulin production, are becoming stronger.
- Double the load on a woman's body. In order to ensure adequate nutrition for the unborn child, the body needs an increased amount of glucose. A woman begins to ingest more monosaccharides, which causes the pancreas to synthesize more insulin.
- Weight gain on the background of reduced physical activity. Glucose, which is abundantly supplied in the body, accumulates in the blood because the cells refuse to take insulin due to obesity and physical inactivity. The future mother and fetus in this situation experience nutritional deficiencies and energy hunger.
Unlike type 1 and 2 diabetes, gestational diabetes is a reversible process because insulin molecules and pancreatic function are preserved.
Properly chosen therapeutic tactics guarantee the elimination of pathology after childbirth in 85% of cases. The main method of treating GDM is the "Table No. 9" diet for diabetics. In severe cases, medical insulin injections are used. Hypoglycaemic drugs are not used due to their teratogenic effects on the fetus.
Additionally
Specific types of diabetes are genetically determined (MODY-diabetes, some types of endocrinopathy) or are caused by other chronic pathologies:
- pancreatic diseases: pancreatitis, hemochromatosis, tumor, cystic fibrosis, mechanical trauma and glandular surgery;
- functional anterior pituitary failure (acromegaly);
- increased synthesis of thyroid hormones (thyrotoxicosis);
- hypothalamus-pituitary-adrenal pathology (Itsenko-Cushing syndrome);
- tumors of the adrenal cortex (aldosterone, pheochromocytoma, etc. ).
Separate diabetic pathology - diabetes insipidus is characterized by a decrease in the production of the hypothalamic hormone vasopressin, which regulates fluid balance in the body.
Diagnostic measures
The diagnosis of diabetes mellitus (of any type) is possible only on the basis of the results of laboratory microscopy of blood. 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. Produced strictly on an empty stomach.
- GTT (glucose tolerance testing). It is performed to determine the body’s ability to absorb glucose. The tolerance test is a double blood test: 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 per 75 g of substance.
- HbA1C analysis for glycosylated (glycated) hemoglobin levels. Based on the results of the study, a retrospective of blood sugar levels in the past three months is estimated.
- Blood biochemistry. Indicators of liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (AP), bilirubin (bile pigment), cholesterol levels are assessed.
- A blood test for the concentration of antibodies to glutamate decarboxylase (GAD antibody) determines the type of diabetes mellitus.
Blood sugar reference values and disease indicators
> zxtable border = "1" cellpadding = "0" >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). Reberg's test is also performed to detect albumin protein and the product of creatinine protein metabolism in urine. Additionally, hardware diagnostics are prescribed, including ECG (electrocardiogram) and 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), insulin-independent (NIDDM type 2), gestational (GDM pregnant), specific (DM includes several typesdiseases caused by genetic defects or chronic pathologies). Gestational diabetes, which occurs in the perinatal period, is curable. Prediabetes (impaired glucose tolerance) is considered reversible if diagnosed early.