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 suitable for eradication (complete elimination). The destructive process in the body can be slowed down with medication and dietary therapy, but it is impossible to stop it and start in the opposite direction.
Types of diabetes mellitus (DM) are defined by the World Health Organization and do not have fundamental differences across the entire medical world. Not all types of diabetes are contagious.
Diabetes mellitus can be of several types, as well as different types. Because treatment is different for each type and species, it is important to know which specific variant of the disease occurs.
Typology of pathology
There are several types of disease associated with one major symptom - an increase in blood glucose levels. The typification of diabetes mellitus is related to the causes of its occurrence. The methods of therapy used are the sex and age of the patient.
Types of diabetes accepted by medicine:
- the first type is insulin dependent (IDDM 1) or young;
- the latter is insulin-independent (INZDM 2) or insulin-resistant;
- gestational diabetes mellitus (GDM) in the perinatal period in women;
- including other specific types of diabetes:
- genetic damage to β-cells of the pancreas (MODY-diabetes types);
- pathology of exocrine function of the pancreas;
- hereditary and acquired pathologies of the exocrine glands and their functions (endocrinopathy);
- pharmacologically prescribed diabetes;
- diabetes as a result of congenital infections;
- DM associated with genomic pathologies and hereditary defects;
- impaired glycemia (blood sugar) and impaired glucose tolerance on an empty stomach.
Prediabetes is a borderline condition in which the glycemic level fluctuates upward (impaired glucose tolerance), but the blood sugar levels "do not reach" the generally accepted numerical values corresponding to true diabetes. According to the World Health Organization (WHO 2014), more than 90% of endocrinologists suffer from type 2 disease.
According to medical statistics, the number of patients is increasing all over the world. The number of people with type 2 diabetes has doubled in the last 20 years. GDM accounts for about 5% of pregnancies. Specific types of diabetes are extremely rare and account for a small percentage of medical statistics.
By gender, NIDDM 2 is more common in premenopausal and menopausal women. This is due to changes in hormonal status and a number of extra pounds. The most common factor in the development of type 2 diabetes in men is chronic inflammation of the pancreas due to the toxic effects of ethanol.
Insulin-dependent diabetes (type 1)
Type 1 diabetes is characterized by a lack of pancreatic cells. The body does not perform the 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 medical insulin injections with different duration of action (short and long), as well as diet therapy. The classification of type 1 diabetes mellitus is dictated by the different etiologies of the disease. Insulin-dependent disease has two causes: genetic and autoimmune.
genetic cause
The formation of pathology is associated with the biological characteristics of the human body to pass on the characteristics and pathological abnormalities to future generations. In connection with diabetes, a child inherits a predisposition to the disease from parents or close relatives who suffer from diabetes.
It is important! Predisposition is hereditary, but not the disease itself. There is no 100% guarantee that a child will have diabetes.
autoimmune cause
The onset of the disease is associated with functional failure of the immune system, when under the influence of adverse factors, the body actively produces autoimmune antibodies that have a destructive effect on the cells. The triggers for starting autoimmune processes are:
- unhealthy eating behavior accompanied by physical inactivity;
- failure of metabolic processes (carbohydrate, lipid and protein);
- critical deficiency of cholecalciferol and ergocalciferol (vitamins of group D) in the body;
- chronic pancreatic pathology;
- history of mumps, measles, 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 up to thirty years of age. The childhood variant of the development of type 1a diabetes is associated with complex 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 mode within a few weeks or months.
Insulin-resistant diabetes (type 2)
The difference between type 2 diabetes and type 1 is that the pancreas does not stop producing insulin. Glucose accumulates in the blood and is not delivered to the body's cells and tissues due to lack of sensitivity to insulin - insulin resistance. Up to a certain point, treatment is carried out with hypoglycemic (sugar-lowering) drugs and diet therapy.
To compensate for the imbalance in the body, the pancreas activates hormone production. An organ that works in an emergency mode wears out over time and loses its intrasecretory function. Type 2 diabetes is insulin dependent. Decreased or lost sensitivity of cells to endogenous hormones is primarily associated with obesity, which disrupts fat and carbohydrate metabolism.
This is especially true of visceral obesity (the deposition of fat around the internal organs). In addition, being overweight complicates blood flow due to the large number of cholesterol plaques inside the arteries that form during hypercholesterolemia, which is always accompanied by obesity. The body's cells are deficient in nutrients and energy. Other factors influencing the development of NIDDM include:
- alcohol abuse;
- gastronomic dependence on sweet foods;
- chronic diseases of the pancreas;
- pathology of the cardiovascular system;
- overeating against the background of a sedentary lifestyle;
- wrong hormone therapy;
- complicated pregnancy;
- dysfunctional heredity (diabetes in parents);
- boredom.
The disease most often develops in women and men over 40 years. At the same time, type 2 diabetes is latent and may not show serious symptoms for several years. Timely examination for blood glucose levels can detect prediabetes. With adequate therapy, the pre-diabetes condition can be reversed. If time is lost, it progresses and then NIDDM is diagnosed.
Lada diabetes
In medicine, the term "Diabetes 1. 5" is the name of Lada diabetes. It is an autoimmune disease that occurs in adults (25+ years) in the production of hormones and the failure of metabolic processes. The disease combines type 1 and type 2 diabetes. The mechanism of development is consistent with IDDM, the latent course and manifestation of symptoms is 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);
- adolescence and rheumatoid arthritis;
- skin discoloration (loss of pigment) (vitiligo);
- inflammatory pathology of the colonic mucosa (ulcerative colitis);
- chronic damage to connective tissue and exocrine glands (Sjogren's syndrome).
Along with hereditary predisposition, autoimmune disorders lead to the development of Lada diabetes. The main diagnostic methods used to detect the disease, as well as blood microscopy, which determines the concentration of IgG class immunoglobulins on antigens - ELISA (enzymatic immunoassay). Treatment is carried out with regular insulin injections and nutritional 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 regular screening, when the expectant mother undergoes a complete examination. The main feature of GDM, similar to type 2 diabetes, is insulin resistance. Cells in a pregnant woman's body lose their insulin sensitivity due to three main reasons:
- Hormonal reconstruction. During pregnancy, the synthesis of progesterone (steroid sex hormone) increases, inhibiting insulin production. In addition, the endocrine hormones of the placenta, which tend to inhibit insulin production, are strengthened.
- Double load on the female body. The body requires an increasing amount of glucose to ensure adequate nutrition for the unborn child. A woman begins to consume more monosaccharides, which causes the pancreas to synthesize more insulin.
- Weight gain against the background of decreased physical activity. Glucose, which is given to the body in large quantities, accumulates in the blood because the cells refuse to take insulin due to obesity and physical inactivity. In this case, the future mother and fetus are experiencing malnutrition and energy starvation.
Unlike type 1 and type 2 diabetes, gestational diabetes is a reversible process because insulin molecules and pancreatic function are preserved.
Properly selected therapeutic tactics guarantee the elimination of pathology after birth in 85% of cases. The main method of treatment of GDM is a diet for diabetics "Table No. 9". In difficult cases, medical insulin injections are used. Hypoglycemic drugs are not used because they have a teratogenic effect on the fetus.
In addition to
Specific types of diabetes are genetically determined (MODY-diabetes, some types of endocrinopathy) or are triggered by other chronic pathologies:
- pancreatic diseases: pancreatitis, hemochromatosis, tumors, cystic fibrosis, mechanical trauma and gland surgery;
- functional insufficiency of the anterior pituitary gland (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 vasopressin, a hypothalamic hormone that regulates fluid balance in the body.
Diagnostic measures
Diagnosis of diabetes mellitus (any type) is possible only on the basis of the results of laboratory blood microscopy. Diagnosis consists of several consecutive studies:
- A general clinical blood test to detect latent inflammatory processes in the body.
- Blood test for glucose content (capillary or venous). 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: two hours after an "glucose load" on an empty stomach and an aqueous glucose solution prepared at a rate of 200 ml of water per 75 g. items.
- HbA1C assay for glycosylated (glycosylated) hemoglobin levels. According to the results of the study, the retrospective of blood sugar levels in the last three months is assessed.
- Blood biochemistry. Liver enzyme levels are assessed for aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (AP), bilirubin (bile pigment), and cholesterol.
- A blood test for the concentration of antibodies to glutamate decarboxylase (GAD antibodies) determines the type of diabetes mellitus.
Reference values of blood sugar and disease indicators
| Analysis | For sugar | Glucose tolerance test | Glyated hemoglobin |
|---|---|---|---|
| norm | 3. 3 - 5. 5 | < 7. 8 | ⩽ 6% |
| prediabetes | 5, 6 - 6, 9 | 7, 8 - 11, 0 | Between 6 and 6, 4% |
| diabetes | >7. 1 | >11. 1 | More than 6, 5% |
In addition to blood microscopy, a general urine test is performed to see if there is glucose (glycosuria) in the urine. Healthy people do not have sugar in the urine (0, 061 - 0, 083 mmol / l is the acceptable norm for diabetics). Reberg test is also performed to detect albumin protein and creatinine protein metabolism product in urine. In addition, hardware diagnostics, including ECG (electrocardiogram) and abdominal ultrasound (with kidneys), are prescribed.
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), pregnancy (GDM pregnant), specific (DM). include several types of diseases caused by genetic defects or chronic pathologies). Gestational diabetes formed in the perinatal period can be treated. Prediabetes (impaired glucose tolerance) is considered reversible when diagnosed early.