Type 1 and 2 diabetes mellitus

Diabetes mellitus(DM) is an endocrine disorder that occurs due to insufficient synthesis/action of insulin.Against this background, chronic hyperglycemia develops, a condition accompanied by a constantly high level of sugar (glucose) in the blood plasma.Hyperglycemia is the main cause of the symptoms and complications of diabetes: metabolic disorders, damage to blood vessels and nerve fibers, kidney failure and blindness.

Over the past forty years, the number of diabetes cases worldwide has nearly quadrupled.The disease spreads more rapidly in underdeveloped countries and countries with weak economies.Doctors note a trend of increased incidence in the age group over 40 years.In terms of social significance, this pathology ranks third after cardiovascular diseases and cancer.

Diabetes mellitus is divided into two main types:

1. insulin-dependent (juvenile, youth, children),
2. insulin-independent (insulin-resistant).

They have different causes, symptoms, treatment tactics and different prognoses.Therefore, in the future we will consider them separately from each other.

Causes

Insulin is a protein hormone synthesized in the beta cells of the pancreas.Its effects are achieved through insulin receptors in various organs and tissues.Diabetes occurs when beta cells are destroyed or when the sensitivity of receptors decreases.

Type 1 diabetes develops in the presence of a genetic predisposition.The impetus for the emergence of pathology is given by toxins and viral infections, such as rubella, influenza, hepatitis B virus, cytomegalovirus and retroviruses.The provoking factor causes acute damage to β-cells or leads to the persistence of the infectious agent in pancreatic tissues with the further development of an autoimmune reaction.The probability of the disease increases if a person has other autoimmune diseases: thyroiditis, adrenal insufficiency, etc.

Important!Diet plays a certain role in the onset of the disease in children.So, this is facilitated by too early contact with gluten: it is optimal to introduce cereal porridge into complementary foods no earlier than 6-7 months.The risk increases when feeding a child cow's milk, with vitamin D deficiency and with a high concentration of nitrates in drinking water.

Thanks to the adaptive capabilities of our body, type 1 diabetes can remain silent for many years.The first signs appear when the number of β cells (and, consequently, insulin) becomes insufficient to regulate glucose levels.Type 1 represents approximately 10% of all cases of the disease.It mainly affects children, adolescents and people under 30.Less commonly, it can be found in elderly patients in a latent form, often confused with the non-insulin-dependent form.

Type 2 diabetes accompanied by reduced insulin secretion and reduced sensitivity of insulin receptors, otherwise “insulin resistance”.The most important risk factors:

1. Hereditary predisposition is noted in almost all cases.If close relatives have the disease, the risk of developing the pathology increases 6 times.
2. Obesity is often an abdominal and visceral form, when excess fat is deposited mainly in the waist area and/or on internal organs.With class I obesity, the risk of developing the disease increases by 2 times, class II - by 5 times, class III - by 10 times.

Important!High-calorie foods, in which simple, quickly digestible carbohydrates predominate, are considered diabetogenic.These are sweets, alcohol, flour products, sausages, fast food, fried potatoes, soft wheat pasta.In combination with a sedentary lifestyle and a deficiency of plant fiber, such food, if consumed regularly, can cause irreparable harm to the body.

The second type usually occurs in adulthood.A trend has been noticed: the older a person is, the higher the blood glucose concentration after eating a carbohydrate meal.The speed with which glucose returns to normal depends largely on muscle mass and the degree of obesity.Since childhood obesity is now an epidemic, type 2 is increasingly found in children.

As in the previous case, the disease develops when the amount of insulin synthesized cannot completely compensate for the decrease in sensitivity of insulin receptors.A vicious circle is thus created: excess glucose in the blood has a toxic effect on beta cells, causing their dysfunction.

Diabetes mellitus: symptoms of an insidious disease

We consider the clinic of diabetes depending on the disorders it causes, the stage of the disease and the type of pathology.

Symptoms associated with metabolic disorders

Insulin is involved in all types of metabolism:

1. Carbohydrates: Regulate plasma glucose levels, as well as glycogen degradation, gluconeogenesis, and other reactions involving sugars.
2. Fat: increases the synthesis of fatty acids and reduces their entry into the blood.
3. Proteins: improves protein synthesis and suppresses its degradation, activates DNA and RNA replication.
4. Electrolyte: activates the flow of potassium and inhibits the flow of sodium in the cells.

With so many physiological effects, changes in insulin concentration do not pass without a trace in the body.The main symptoms are associated with impaired carbohydrate metabolism, in particular, hyperglycemia.Increased glucose levels lead to the following symptoms:

• thirst, dehydration, polyuria - urine production greater than three liters per day;
• polyphagia: constant need for food, gluttony, develops in response to energy deficiency;
• nausea, vomiting;
• accumulation of sorbitol (a product of glucose conversion) in the nerve fibers, retina, lens resulting in damage;
• predisposition to bacterial and fungal infections.

Due to the disorder of protein metabolism, the following signs of diabetes mellitus develop::

• muscular dystrophy - appears due to reduced synthesis and increased breakdown of proteins;
• hypoxia - lack of oxygen in the tissues - causes lethargy, decreased concentration and drowsiness;
• generalized vascular damage due to protein glycosylation.

Impaired fat metabolism manifests itself in:

• increase the concentration of cholesterol in the blood;
• fatty liver infiltration;
• ketonuria, ketonemia - accumulation of ketones in the blood and urine;at high concentrations, without treatment, coma and death develop.

Due to the loss of electrolytes (potassium, magnesium, sodium, phosphorus), general and muscle weakness occurs.

Clinic depending on the stage of the disease

The initial phase is characterized by an almost complete absence of symptoms.Diagnosis sometimes takes years, especially without a proper examination.In diabetes, symptoms come and go based on fluctuations in blood glucose levels.General manifestations prevail, since damage to internal organs is still far away.

Patients complain:

• severe weakness, fatigue;
• thirst: patients are able to drink approximately 3-5 liters of fluids per day, of which a significant amount is drunk at night;
• characteristic dry mouth (due to dehydration);
• frequent and abundant urination;children may develop enuresis;
• skin itching, in women especially in the genital area.

Important!Progressive tooth decay and periodontal disease are often found among the first symptoms of diabetes.Loose teeth and deep carious lesions in the roots of the teeth indicate a pre-diabetic condition.A biochemical analysis of blood glucose concentration shows no visible changes.Therefore, if such symptoms are detected, the patient is advised to visit a therapist and take a glucose tolerance test.

Without treatment, the patient's condition gradually worsens.Dry skin appears, skin infections are common: hidradenitis, furunculosis, fungal infections of the foot.From the gastrointestinal tract, gastrointestinal dysfunction, gallbladder dyskinesia, chronic gastritis and duodenitis are observed.Due to damage to the vascular system and increased cholesterol levels, atherosclerosis and coronary heart disease develop.The latter is usually difficult and often leads to serious complications.The cause of death in 38-50% of patients is myocardial infarction.

Diabetic patients are more likely to develop bronchitis, pneumonia and are predisposed to tuberculosis.Men with prostate adenoma and women over the age of 50 are 4 times more likely than ordinary people to suffer from cystitis and pyelonephritis.In advanced stages, blindness and other complications due to vascular damage may occur.

Signs of type 1 and type 2 diabetes

With the first type, people often don't notice or ignore the initial symptoms.A common situation is when the diagnosis is made only after the first “attack” of ketoacidosis.The disease occurs in response to stress, viral infection and simple carbohydrate overload.Since sugars are extremely poorly absorbed, tissues and organs lack energy.In an attempt to compensate for the energy deficiency, the body begins to actively burn fat.This process is accompanied by the release of ketone bodies.

In large quantities, ketone bodies are toxic to humans.The patient feels thirst, dizziness, lethargy, drowsiness and rapid heartbeat.Characterized by frequent urination, abdominal pain, nausea, vomiting, and acetone odor from the mouth.Without proper treatment, ketoacidosis leads to coma, brain swelling, and death.

Important!If you have already been diagnosed with diabetes, you can prevent ketoacidosis yourself.

To do this you should:

• in case of acute respiratory infections, acute respiratory viral infections, monitor plasma sugar levels more often and administer insulin in the appropriate amount;
• when using other drugs, notify your doctor about the presence of diabetes (for example, glucocorticoids increase the need for insulin);
• even during remission, do not stop administering the drug, just reduce the dose and consult a doctor to correct the therapy;
• do not skip injections and strictly monitor glucose levels;
• administer insulin using the correct tools and in the correct place;
• monitor the expiry date and storage conditions of the medicine.

The other three main signs of type 1 diabetes are fatigue, weight loss, and constant hunger.- arise in response to the inability to use sugars as an energy source.And to eliminate excess glucose, the body actively removes it in the urine, causing polyuria.As a result of dehydration, the patient feels severe weakness.

The second type is characterized by a slower flow.The patient notices the problem when hyperglycemia becomes a chronic condition.Sometimes the disease is discovered by chance, during a routine examination.There are situations when a patient turns to an endocrinologist at an advanced stage of the disease, with complications.The most common disorders linked to this type of pathology are drowsiness, weakness, lethargy, difficulty concentrating and nausea.

Classification and types

The World Health Organization offers a fairly complete classification of the pathology.So, in addition to the already known first and second types, other specific types of disease are distinguished.They all belong to category III and are collected, depending on the reason for their development, in classes A, B, C, D, E, F, G and H.

1. This class includes genetic defects of beta cell function: mitochondrial mutations, damage to individual sections of some chromosomes.
2. Also genetic defects, but not in the cells of the pancreas, but at the level of insulin receptors.These include Donohue syndrome, Rabson-Mendenhall syndrome, some lipodystrophies, and type A insulin resistance.
3. Diseases of the exocrine pancreas (fibrosis, pancreatitis, neoplasms, trauma, etc.).
4. Endocrinopathies.The disease can develop against the background of Cushing's syndrome, pheochromocytoma, thyrotoxicosis and other endocrine pathologies.
5. Diabetes induced by chemicals and drugs: nicotinic acid, thyroid hormones, glucocorticoids, alpha interferon, etc.
6. Viral infections: cytomegalovirus, congenital rubella and others.
7. Atypical forms of immune-mediated diabetes.
8. Genetic defects, part of the clinical picture of which are often diabetic symptoms (myodystrophy, Turner syndrome, Down syndrome, porphyria).

Separately, in category IV, gestational diabetes is assigned, which is a hidden disorder of carbohydrate metabolism in pregnant women.

Important!Treatment tactics for diabetes mellitus largely depend on its type.Therefore, it is recommended to consult a doctor as soon as possible to determine the exact cause of unpleasant symptoms.An experienced endocrinologist will prescribe the necessary examination and find the source of the disease.

Diagnostics and screening

The diagnosis is made based on the following criteria.

1. Patient history, symptoms, complaints.
2. Examination of the patient to identify potential complications.
3. Biochemical blood test: determination of fasting plasma glucose (FPG) concentration.It is taken on an empty stomach, with the last meal no later than 8-12 hours before the test.
4. Determination of glycosylated hemoglobin (HbA1C) level.Rent the same way.Avoid smoking, alcohol and strenuous physical activity the day before.
5. Glucose tolerance test (OGTT).More sensitive analysis, but at the same time more complex.Primarily used to diagnose prediabetic conditions, including during pregnancy.If the FPG is greater than 7.0 mmol/l, the OGTT is not performed.

In reality, pathology is often detected by random analysis, for example during regular screening.The patient is then sent for further examination.

Diagnostic criteria for diabetes and prediabetic conditions

Analyses	Norm, mmol/l	Impaired carbohydrate metabolism (prediabetes), mmol/l	DM, mmol/l
GPN	less than 5.6	from 5.6 to 6.9	more than 7.0
HbA1C	less than 5.7%	from 5.7 to 6.4%	greater than or equal to 6.5%
OGTT	less than 7.8	from 7.8 to 11.0	more than 11.1
Random	less than 11.1	-	more than 11.1 with symptoms

Important!The urine glucose test, very widespread in the recent past, is no longer used due to its non-specificity and low sensitivity.

People in a high-risk group are recommended to undergo regular testing for FPG and HbA1C (or OGTT) once every three years.If FPG is already elevated, such monitoring should be done annually.Risk factors include:

• physical inactivity;
• obesity;
• age > 35 years;
• Family history of diabetes;
• prediabetes, gestational diabetes, PCOS, personal history of cardiovascular disease;
• birth of a child weighing more than 4.1 kg;
• hypertension;
• fatty liver hepatosis;
• high levels of cholesterol, “harmful” lipids - low-density lipoproteins;
• HIV infection.

All diabetic patients are regularly monitored for complications after diagnosis.Standard screening includes ophthalmoscopy, foot examination, urine test for proteinuria, lipid test, and creatinine level.Most endocrinologists consider it important to record a baseline ECG and lipid profile during initial treatment to study the dynamics of the disease and predict the risk of cardiovascular disease.If necessary, consultations with specialized specialists are prescribed: ophthalmologist, gynecologist, cardiologist, neurologist.

The most dangerous complications

All complications that develop with this disease can be divided into acute and chronic conditions.Acute ones usually occur when:

• skip an insulin injection or take a hypoglycemic drug;
• the use of other drugs that affect carbohydrate metabolism;
• severe stress;
• alcohol abuse;
• self-cancellation of therapy;
• against the background of severe trauma, surgical interventions, infections;
• during pregnancy.

This includesketoacidotic statewhich was described in detail above, ehypoglycemic coma.Ketoacidosis and hypoglycemia often develop suddenly and may take only a few hours from the first symptoms to complete coma.Both complications should be stopped as quickly as possible, if necessary, by consulting a doctor.

Hypoglycemia- decrease in blood sugar levels, characterized by increased sweating, chills, severe weakness and feeling of intense hunger.Some patients notice numbness and tingling in certain areas of the body.If the necessary actions are not taken, hypoglycemia turns into a coma: the patient loses consciousness.In this situation, you need to call an ambulance.

Important!To eliminate hypoglycemia, a person urgently needs to take simple carbohydrates.Lemonade, sugar cubes (to be placed under the tongue), juice - anything that is easy to swallow and absorbed quickly will do.To avoid such cases, a patient taking hypoglycemic drugs should always carry any of the above products with him.

Other complications are a consequence of metabolic disorders and damage to small and large vessels.

1. Diabetic heart disease, or “diabetic heart”.Myocardial dystrophy develops in people over 40 years of age without pronounced signs of coronary atherosclerosis.It manifests as left ventricular dysfunction and leads to heart failure.The main symptoms are shortness of breath, arrhythmia and reduced tolerance to physical activity.
2. Metabolic syndrome X, or the “deadly quartet”.The combination of hyperglycemia, obesity, hypertension, and atherosclerosis causes early onset of angina pectoris and damage to peripheral arteries.Frequent complications are heart attack, stroke, transient ischemic attacks.The main problem is that each element of the quartet enhances the manifestations of the others, creating a vicious circle.
3. Diabetic nephropathy.The main factor of disability and mortality among patients with diabetes.It develops in 40-50% of cases, leading to chronic and end-stage renal failure.The main reason is damage to the capillaries of the kidneys, increased pressure inside the renal glomeruli.The presence of hypertension accelerates pathological processes.This complication is considered one of the most insidious, since in the initial stages it does not give any noticeable symptoms.The patient usually does not associate swelling, dyspepsia, and weakness with kidney damage.Pain and urinary discomfort appear in the later stages, when the problem is already difficult to treat.
4. Diabetic retinopathy.Subjectively it looks like fog before the eyes, a characteristic “flickering of flies”.Surrounding objects become blurry and blurry.The decrease in vision progresses to complete blindness.The cause is damage to the retinal vessels resulting in the appearance of microaneurysms, hemorrhages and edema.To prevent vision loss, patients should undergo an ophthalmoscopy once a year and, if problems occur, receive treatment.
5. Neuropathies.The functioning of neurons is disrupted due to the toxic effects of glucose, lack of oxygen, and electrolyte shifts.Diabetics suffer from a large number of neuropathies, but the most common is symmetric polyneuropathy.Its main symptoms are numbness, discomfort, pain, loss of sensation in the hands and feet, "like gloves and socks".Such processes in the lower extremities can lead to inadequate loads with further trauma or infections of the feet and degeneration of the joints.Neuropathies affect not only peripheral nerve fibers, but also cranial nerves and the brain tissue itself.The result of this is acute neuropsychic disorders, neurosis-like conditions, dysfunction of innervated areas - decreased hearing, vision, smell, etc.
6. Diabetic foot.Against the background of damage to blood vessels, nerves, skin and joints, a syndrome occurs accompanied by soft tissue ulceration and purulent-necrotic processes.Necrosis of the foot ends with amputation of the affected area.The syndrome occurs in 20-25% of patients.

Therapy: diet and medications

Diabetes treatmentIt starts with lifestyle changes.This includes a properly structured diet, sufficient physical activity and regular monitoring of plasma sugar concentrations.All this, combined with basic therapy, helps prevent the rapid progression of the disease and the development of complications.

Type 1 diabetes is also treated with insulin.Regular subcutaneous injections mimic the function of beta cells.The number of units and the scheme are selected individually.It is important to observe the timing and dosage of drug administration.

Patients with type 2, in the event that diet and physical activity are not sufficient,antihyperglycemic agents are prescribed.These drugs differ in their mechanism of action:

• stimulate the secretion of one's own insulin (sulfonylurea, meglitinides);
• increase the sensitivity of insulin receptors (thiazolidinediones);
• inhibit further pathways for glucose production (biguanides);
• prevent the absorption of sugars in the intestinal wall, slowing down digestion (alpha-glucosidase inhibitors);
• increase the excretion of glucose in the urine (NGLT-2 inhibitors).

These drugs can work together, enhancing each other's effects.Therapeutic and prophylactic agents are also widely used.Statins and acetylsalicylic acid help reduce damage resulting from damage to the vascular bed, ACE inhibitors help fight nephropathy in the initial stages.

The prediction is up to you

Every year approximately four million people die from this insidious disease.In children and adolescents, the leading cause of death is ketoacidosis, which progresses to coma.In adults, the presence of complications and alcohol consumption are critical.The average life expectancy of each patient with diabetes is reduced by 6-15 years.In the second type, the prognosis is largely related to lifestyle.Smokers, alcoholics and people with high cholesterol levels can prolong their lives simply by quitting bad habits and changing their diet.

The disease is the leading cause of blindness, increases the risk of stroke and heart attack by two times, chronic renal failure by 17 times and foot necrosis by 20 times.Despite the terrible numbers,the prognosis depends on the timeliness of the diagnosis and the personal attitude towards the disease.The earlier the disease is detected and the more carefully the patient approaches treatment, the higher the survival rate.

Prevention

Preventive measures boil down to:

1. Regular and adequate physical activity.The latter normalizes metabolism and increases the sensitivity of tissue receptors to insulin molecules.
2. Diet.Meals are fractional, 4-5 times a day, in small portions.Consumption of simple carbohydrates and saturated fats should be minimized.Avoid mayonnaise, pastries, jams, sausages and starchy foods.Avoid fried, fatty, overly salty foods, fast food, smoked foods and canned food.The basis should be made up of complex carbohydrates, fiber and pectins.Lean fish, poultry, vegetables, herbal infusions, unsweetened compotes, durum wheat pasta are preferable.Follow the BJU report 20:20:60.
3. Prevention of infections.The first type of diabetes mellitus often occurs under the influence of a viral infection.Therefore, if risk factors are present, it is recommended to strengthen the immune system, prevent a prolonged course of ARVI, wear a mask and use antiseptics during epidemics and in proximity to sick people.