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

Diabetes mellitus is one of the most common diseases with a tendency to increase in incidence and distort statistics.Symptoms of diabetes mellitus do not appear overnight;the process is chronic, with the increase and worsening of endocrine and metabolic disorders.In truth, the onset of type 1 diabetes is significantly different from the early stages of type 2 diabetes.

Among all endocrine pathologies, diabetes holds the leading position and accounts for more than 60% of all cases.In addition, the disappointing statistics show that 1/10 of "diabetics" are children.

The probability of getting the disease increases with age and therefore every ten years the size of the group doubles.This is due to the increase in life expectancy, the improvement of early diagnosis methods, the decrease in physical activity and the increase in the number of people who are overweight.

Types of diabetes

Many people have heard of such a disease 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 the insufficiency and sometimes the 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, stretching the stomach to large sizes);
• Isolation of a huge amount of unconcentrated light urine of low specific gravity (1000-1003);
• Catastrophic weight loss, weakness, reduced physical activity, disorders of the digestive system;
• 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 cure, the disease has an unfavorable prognosis;working capacity is significantly reduced.

Brief anatomy and physiology

The 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, entrusted with the mission of internal secretion, produces various hormones, including -insulin and glucagon.They are crucial in ensuring the consistency of sugar in the human body.

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

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

So, the conclusion is self-evident:Damage to the pancreas and islets of Langerhans is the main mechanism that inhibits insulin production and triggers the development of the pathological process.

Types and special forms of the disease

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

• There is a complete lack of insulin (absolute deficiency).insulin dependentpathological process, which is calledtype I diabetes mellitus (IDDM);
• Lack of insulin (relative lack), which in the initial phase causes a disorder of carbohydrate metabolism, slowly but surely leads to developmentindependent of insulindiabetes mellitus (NIDDM), which is calleddiabetes mellitus type II.

Due to disturbances in the utilization of glucose in the body, and therefore its increase in the blood serum (hyperglycemia), which is, in principle, a manifestation of the disease, signs of diabetes mellitus, i.e. a total disturbance of metabolic processes at all levels, begin to appear over time.

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

1. Secondary diabeteswhich arise as a result of acute and chronic inflammation of the pancreas (pancreatitis), malignant neoplasms in the parenchyma of the gland, cirrhosis of the liver.Numerous endocrine disorders accompanied by excessive production of insulin antagonists (acromegaly, Cushing's disease, pheochromocytoma, thyroid disease) lead to the development of secondary diabetes.Many drugs that are used for a long time have a diabetogenic effect: diuretics, some antihypertensives and hormones, oral contraceptives, etc.;
2. Diabetes in pregnant women (gestational),caused by the special mutual influence of the hormones of the mother, the child and the placenta.The fetal pancreas, which produces its own 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, with proper management, gestational diabetes usually resolves after delivery.Subsequently, in some cases (up to 40%) in women with a similar history of pregnancy, this fact can threaten the development of type II diabetes mellitus (within 6-8 years).

Why does "sweet" disease occur?

The "sweet" disease forms a rather "motley" group of patients, so it becomes obvious that IDDM and its non-insulin-dependent "brother" genetically originated differently.There is evidence of a connection between insulin-dependent diabetes and the genetic structures of the HLA system (major histocompatibility complex), in particular, with some genes of the D-region loci.No such relationship was observed for NIDDM.

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

• Congenital deficiency of islets 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 constant overeating, which leads to excess fat deposits;
• Abuse of confectionery products (those with a sweet tooth are at greater risk).

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

It was found that today the disease occurs more often in women, although back in the 19th century diabetes was a "privilege" of the male sex.By the way, now in some countries of Southeast Asia, the presence of this disease in men is considered dominant.

Predisposing conditions for 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, bleeding;
• Age after 40 years;
• Being overweight (the most important risk factor for NIDDM!);
• Vascular diseases caused by the atherosclerotic process and arterial hypertension;
• In women, pregnancy and the birth of a child with a high body weight (more than 4 kg);
• Having relatives with diabetes;
• Strong psycho-emotional stress (hyperstimulation of the adrenal gland).

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

Why do you want to drink so much?

The characteristic symptoms of diabetes mellitus, regardless of the form and type, can be presented as follows:

1. Dryness of the oral mucosa;
2. Thirst that is practically impossible to quench, associated with dehydration;
3. Excessive production of urine and its excretion through the kidneys (polyuria), which leads to dehydration;
4. An increase in the concentration of glucose in the blood serum (hyperglycemia), due to the suppression of the use of sugar in peripheral tissues due to a lack of insulin;
5. The appearance of sugar in the urine (glucosuria) and ketone bodies (ketonuria), which are normally present in negligible amounts, but in diabetes mellitus are intensively produced in the liver, and when they are excreted from the body, they are found in the urine;
6. Increased content in blood plasma (in addition to glucose) of urea and sodium ions (Na⁺);
7. Weight loss, which in the case of decompensation of the disease is characteristic of the catabolic syndrome, which occurs due to the breakdown of glycogen, lipolysis (mobilization of fat), catabolism and gluconeogenesis (transformation into glucose) of proteins;
8. Violation of indicators of the lipid spectrum, increase in total cholesterol due to the low-density lipoprotein fraction, NEFA (non-esterified fatty acids), triglycerides.The increased content of lipids begins to be actively sent to the liver, where they are intensively oxidized, which leads to the excessive formation of ketone bodies (acetone + β-hydroxybutyric acid + acetoacetic acid) and their further entry into the blood (hyperketonemia).An excessive concentration of ketone bodies threatens the dangerous condition of the so-calleddiabetic ketoacidosis.

Thus, the 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 characteristic of one or another type.

Diabetes mellitus type I is a "privilege" of the young

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

• Sudden weight loss;
• Unnatural thirst, the person simply cannot get drunk, although he tries (polydipsia);
• Large amounts of excreted urine (polyuria);
• Significant excess concentration of glucose and ketone bodies in the blood serum (ketoacidosis).In the initial phase, when the patient may not yet be aware of his problems, the development of diabetic (ketoacidotic, hyperglycemic) coma is very likely - a condition that is extremely life-threatening, so 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 some time the disease will remind itself again.Insulin requirements may increase as the duration of the disease increases, but generally, in the absence of ketoacidosis, 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 leading causes of death from IDDM include:

1. Terminal kidney failure, which is a consequence of diabetic glomerulosclerosis;
2. Cardiovascular disorders are complications of the underlying disease, which occur somewhat less frequently than kidney disorders.

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

NIDDM develops over many months and even years.When problems arise, the person takes them to various specialists (dermatologist, gynecologist, neurologist...).The patient does not even suspect that various diseases in his opinion: furunculosis, skin itching, fungal infections, pain in the lower extremities are signs of type II diabetes mellitus.Patients get used to their condition, and diabetes continues to develop slowly, affecting all systems, primarily blood vessels.

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

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

The main cause of death in patients with NIDDM is recognized as cardiovascular pathology resulting from diabetes.As a rule, it is a heart attack or a stroke.

Treatments for diabetes mellitus

The basis of therapeutic measures aimed at compensating diabetes mellitus is represented by three main principles:

• Compensation for lack of insulin;
• Regulation of endocrine and metabolic disorders;
• Prevention of diabetes, its complications and their timely treatment.

The implementation of these principles is carried out on the basis of 5 main positions:

1. Nutrition for diabetes mellitus plays the role of "first violin";
2. A system of physical exercises, adequate and individually selected, accompanies the diet;
3. Sugar-lowering drugs are mainly used to treat type 2 diabetes;
4. Insulin therapy is prescribed if necessary for NIDDM, but is necessary in case of type 1 diabetes;
5. Training patients for self-monitoring (skills for drawing blood from a finger, using a glucometer, administering insulin without assistance).

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

Indicators	A good degree of compensation	Satisfying	Bad
Fasting glucose level (mmol/l)	4.4 – 6.1	6.2 – 7.8	Ø 7.8
Blood sugar content 2 hours after a meal (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
Serum total 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 nutrition in the treatment of NIDDM

The diet for diabetes mellitus is very well known, even to people who are far from diabetes, table number 9. While in the hospital for any disease, from time to time you can hear about a special diet, which is always in special pots, differs from other diets and is issued after saying a certain password: "I have the ninth hundred".What does all this mean?What makes this mystery diet different from all the others?

It should not be mistaken, looking at a diabetic carrying his "porridge", that they are deprived of all the joys of life.A diet for diabetes is not that different from a diet for healthy people;patients receive the required amount of carbohydrates (60%), fat (24%) and protein (16%).

Diet for diabetes consists of replacing refined sugars in food with slowly broken down carbohydrates.Sugar that is sold in general stores and confectionery products based on it belong to the category of prohibited foods.

As for the nutritional balance, everything here is strict: a diabetic must necessarily consume the necessary amount of vitamins and pectin, 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:

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

Physical activity prescribed by the doctor and performed by the "department" should stimulate the "burning" of carbohydrates and fats without involving insulin.Its dose, which is necessary to compensate for metabolic disorders, drops significantly, which should not be forgotten, because by preventing an increase in blood sugar levels, you can get an unwanted effect.Adequate physical activity reduces glucose, the administered dose of insulin breaks down the remaining, and as a result, the sugar level drops below acceptable values (hypoglycemia).

therefore,insulin dose and physical activity require a lot of attention and careful calculation,so, complementing each other, together we do not exceed 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 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 are folk remedies for the treatment of diabetes mellitus, but we should not forget thatInfusions and decoctions prepared from various plants are an aid.The use of home remedies for diabetes does not exempt the patient from following a diet, monitoring blood sugar, visiting a doctor and following all his recommendations.

Quite well-known folk remedies are used to fight this pathology at home:

1. Bark and leaves of white mulberry;
2. Oat grains and husks;
3. Partitions of walnut;
4. Bay leaf;
5. Cinnamon;
6. Acorn;
7. Nettles;
8. Dandelion.

When diet 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 they have been replaced by new-generation drugs, which make up the 3 main groups of diabetes drugs produced by the pharmaceutical industry.

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

Sulfonylurea derivatives

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

These drugs are absolutely contraindicated in the following cases:

• Diabetes mellitus type 1;
• Diabetic, hyperosmolar, lactic acidotic coma;
• Pregnancy, childbirth, breastfeeding;

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

In addition, the use of drugs of this group can threaten the development of allergic reactions, which manifest themselves as:

1. Skin itching and urticaria, sometimes reaching Quincke's edema;
2. Disorders of the digestive system;
3. Changes in the blood (decrease in the level of platelets and leukocytes);
4. Possible damage to the functional abilities of the liver (jaundice due to cholestasis).

Antihyperglycemic agents from the biguanide family

Biguanides (guanidine derivatives) are actively used for the treatment of type 2 diabetes mellitus, and sulfonamides are often added to them.They are very rational for use in obese patients, however, for people with liver, kidney and cardiovascular pathology, their use is sharply limited, switching to milder 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 for the use of biguanide:

• IDDM (type 1 diabetes mellitus);
• Significant weight loss;
• Infectious processes, regardless of location;
• Surgical interventions;
• Pregnancy, childbirth, breastfeeding;
• Comatose states;
• Liver and kidney pathology;
• oxygen starvation;
• Microangiopathy (2-4 degrees) with impairment of vision and renal function;
• Trophic ulcers and necrotic processes;
• Poor circulation in the lower extremities due to various vascular pathologies.

Insulin treatment

From the above it becomes obvious thatInsulin is the primary treatment for type 1 diabetes, all medical emergencies and severe complications of diabetes.NIDDM requires the appointment of this therapy only in cases of forms that require insulin, when correction by other means does not give the desired effect.

Modern insulins, called monocompetent, represent two groups:

1. Monocompetent pharmacological forms of the human insulin substance (semi-synthetic or DNA recombinant), which undoubtedly have a significant advantage over drugs of pig origin.They practically have no contraindications or side effects;
2. Monocompetent insulins derived from porcine pancreas.These drugs, compared to human insulins, require an increase in the dose of the drug by approximately 15%.

Diabetes is dangerous because of complications

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

• Pathological changes on the skin: diabetic dermopathy, lipoid necrobiosis, furunculosis, xanthomatosis, fungal skin infections;
• Osteoarticular diseases:
  1. Diabetic osteoarthropathy (Charcot's joint - a change in the ankle joint), which occurs against the background of disturbed microcirculation and trophic disorders, accompanied by dislocations, subluxations, spontaneous fractures that precede the formationdiabetic foot;
  
  2. Diabetic frisopathy, characterized by stiffness of the joints of the hands, which often develops in children with diabetes;
• 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), weight loss;
• 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 diversity -polyneuropathy, reaching 90% of all forms of this pathology.Diabetic polyneuropathy is a common conditiondiabetic 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 artery disease, myocardial infarction, heart failure, cerebrovascular accidents).

Prevention

Measures to prevent diabetes mellitus are based on the causes that cause it.In this case, it is advisable to discuss the prevention of atherosclerosis and arterial hypertension, including the fight against excess weight, bad habits and food addiction.

Prevention of complications of diabetes mellitus means preventing the development of pathological conditions arising from diabetes itself.Correction of glucose in the blood serum, adherence to a diet, adequate physical activity and adherence to the doctor's recommendations will help delay the consequences of this rather terrible disease.