Diabetes mellitus is a pathological condition characterized by a violation of metabolic processes (metabolism). This happens due to insufficient production of its own hormonal substance insulin, as in the case of type 1 diabetes mellitus or a violation of its effect on the cells and tissues of the body (type 2 pathology).
The article discusses in detail the main types of diabetes mellitus, the differences in their causes and mechanisms of development, as well as a description of the characteristics of the treatment of patients.
A little about insulin and its role in the human body
Insulin is a hormone produced by the pancreas. The organ is located behind the stomach, surrounded by the spleen and a loop of the duodenum. The weight of the pancreas is approximately 80 g.
In addition to hormones, the gland produces pancreatic juice, which is necessary for the digestion of lipids, carbohydrates and proteins. The insulin hormone is synthesized by β cells. They are located almost on the entire surface of the pancreas in the form of small clusters called islets of Langerhans. The islets also contain α cells that synthesize the hormonal active ingredient glucagon. This hormone has the opposite action to insulin.
A healthy adult person has around one million of these islets with a total weight of several grams.
Insulin is a protein molecule made up of several amino acid chains. Its job is to assimilate glucose (sugar) from the body's cells. Sugar is necessary for a person to receive energy. Without it, cells and tissues are unable to cope with their functions.
Parallel to the sugar intake, insulin also regulates the penetration of amino acids into cells. Amino acids are considered to be one of the main building materials. Another function of insulin is the accumulation of lipids in the body.
Diabetes classification
According to the generally accepted classification of diabetes mellitus and used in modern endocrinology, the pathology is divided into the following types:
- Type 1 - insulin dependent (IDDM);
- type 2 - non insulin dependent (NIDDM);
- gestational form;
- specific types of diabetes.
The latter option is a group of pathological conditions that differ from each other in their pathogenesis and causes of development. These include hereditary defects at the genetic level by the hormone insulin or insulin secretory cells, a disease caused by the action of chemicals and drugs, diabetes as a result of infectious processes, etc.
All types of diabetes have hyperglycemia in common. This is a condition that occurs with high blood glucose levels. It is against the background of the diagnosis of blood glucose numbers that the confirmation or refutation of the diagnosis of diabetes is based.
1 type
Type 1 pathology (code ICD-10 - E10) is considered an autoimmune process, which causes the death of insulin secretory cells. Put simply, these processes are initiated in the human body, during which time one's own immune cells consider pancreatic cells to be foreign and destroy them.
As a rule, the insulin-dependent type arises from a hereditary predisposition, but concomitant provoking factors also play an important role. Statistics show that the presence of pathology in a child is possible in the following cases:
- if the mother is sick - with a frequency of 2%;
- sick father - 5%;
- sick brother or sister - 6%.
If one of the relatives has the disease, the rest of the family may be healthy, although they are at high risk.
The presence of an autoimmune process, that is, antibodies in the body against the cells of the pancreas, occurs in more than 80% of insulin-dependent patients. Often, along with type 1 disease, diabetics suffer from other autoimmune diseases, for example, chronic adrenal insufficiency, diseases of the pancreas, vitiligo, rheumatism.
How is it developing?
Typically, clinical signs of the disease appear when more than 85% of insulin secretory cells have already died, but depending on the individual characteristics of the organism, this period can vary in its duration. It often occurs in childhood and adolescence. It happens that young patients become aware of the presence of the disease already in the period of acute complications, for example, in the ketoacidotic state.
Energy deficiency and insulin deficiency lead to massive breakdown of fat and protein, which explains the patient's weight loss. The high blood sugar level causes hyperosmolarity, which is manifested by massive urine output and the development of symptoms of dehydration. Since there is not enough insulin, the body suffers from energy starvation, as a result, excessive synthesis of counterinsular hormones occurs, that is, those that have the opposite effect from the work of insulin.
These hormones include cortisol, glucagon, and somatotropin. They cause the stimulation of glucose formation in the body, despite the fact that the blood sugar level is already skyrocketing.
The massive breakdown of fats leads to an increase in the number of free fatty acids in the blood. This is a trigger for the formation and accumulation of ketone bodies (acetone), which become provocateurs of a ketoacidotic state. If such a pathology, dehydration and a shift in blood pH to the acid side continue to progress, the patient can fall into a coma, even death is possible.
Symptoms
Type 1 diabetes is characterized by the development of bright symptoms, which are gaining severity over several weeks. Diabetic patients complain:
- for the formation of a large amount of urine;
- excessive thirst;
- constant itching of the skin;
- weight loss.
Manifestations of the disease are considered to be quite specific, but still require a differential diagnosis.
Weight loss, which is accompanied by a normal or increased appetite, is one of the symptoms that distinguish type 1 from other types of diabetes mellitus. The patient is worried about severe weakness, cannot do his usual work, drowsiness occurs.
The progression of the clinical picture is accompanied by the appearance of an acetone odor in the exhaled air, abdominal pain, nausea and vomiting and symptoms of severe dehydration. If the disease appears at a later age (about 40 years), the symptoms are not so pronounced and, as a rule, the presence of the disease is determined during clinical examination.
type 2
Non-insulin-dependent diabetes mellitus (code ICD-10 - E11) is a chronic disease in which high blood sugar levels occur due to insulin resistance. Subsequently, the work of the β cells of the islets of Langerhans is also interrupted. Parallel to the metabolism of carbohydrates, the pathology also affects the metabolic process of fats.
Hereditary predisposition is one of the main causes of type 2 diabetes. If one of the parents has a disease, children get sick in 40% of cases. However, inheritance alone is not enough, the provoking factors are:
- high body weight;
- low physical activity;
- high blood pressure numbers;
- high levels of triglycerides in the blood;
- the presence of a child born weighing more than 4 kg in the past;
- the presence of gestational diabetes in the past;
- polycystic ovaries.
Currently, the number of patients with type 2 diabetes is growing. This form of pathology accounts for over 85% of all clinical cases. Middle-aged and older men and women are more often ill.
How is it developing?
The mechanism of development is based on the fact that insulin resistance appears, that is, the pancreas produces a sufficient amount of the hormone necessary to transport sugar molecules into the cells, but the cells themselves lose sensitivity to this substance. The result is hyperglycemia.
In order to reduce blood sugar levels, the gland begins to work at the limit of its capabilities. This results in the depletion of insulin secretory cells.
For the second type of pathological condition, the appearance of ketoacidosis is unusual, as even a small amount of the hormone is synthesized by the islets of Langerhans.
Symptoms
The disease usually occurs in patients over the age of 40. In most cases, the clinical picture is combined with the appearance of pathological body weight, changes in fat metabolism in blood tests. Associated symptoms:
- performance is slightly reduced, but not as pronounced as in the first type of disease;
- pathological thirst;
- excretion of a large amount of urine;
- women can be bothered by itching of the skin in the genital area and perineum;
- rashes appear on the skin, which do not heal for a long time;
- discomfort, feeling of numbness and goosebumps in the lower limbs.
Gestational type
The WHO classification of diabetes mellitus includes the gestational form of the disease (code ICD-10 - O24). It is typical of pregnant women. 5-7% of patients who give birth suffer from diabetes. The WHO classification of diabetes and its types includes another name for this type of pathology - diabetes in pregnant women.
If the disease appeared in a woman before the moment of conception of a child, it is considered pregestational, during the period of pregnancy, gestational. At the moment, the mechanism of development and the causes of the disease are not fully understood. There are data on the role of hereditary predisposition. Risk factors can be:
- physical and mental trauma;
- infectious diseases;
- diseases of the pancreas;
- inclusion in the menu in large quantities of foods rich in carbohydrates.
Obstetricians and gynecologists agree that adequate physical activity can reduce the risk of developing pathologies.
The gestational form can manifest itself as a manifestation, that is, a vivid clinical picture or as a violation of glucose tolerance. Pathology, as a rule, disappears by itself after the birth of the child.
The woman joins a group of patients with a high risk of developing non-insulin-dependent type of diabetes mellitus in the next 10-15 years.
During the period of pregnancy, a woman's body undergoes some changes associated with the hormonal sphere. This is due to the functioning of the placenta, which secretes the following hormones:
- chorionic gonadotropin;
- progesterone;
- estrogen;
- corticosteroids, etc.
All these hormonally active substances cause the appearance of insulin resistance. At this stage, hyperplasia of insulin secretory cells and the release of a large amount of insulin into the blood from the pancreas are observed. The appearance of insulin resistance leads to the fact that the woman's body begins to actively use the metabolic products of fats, while sugar is stored for feeding the fetus. Under conditions of a combination of hereditary predisposition to diabetes and the above factors, the disease develops.
Symptoms
The gestational type of the disease manifests itself in the same way as other types of diabetes, but the symptoms are slightly less pronounced. A woman may not pay attention to symptoms, associating her appearance with her "interesting" position about her. If the clinical picture is pronounced, the pregnant woman can make the following complaints to the attending physician:
- dry mouth;
- constant desire to drink;
- excretion of a large amount of urine;
- increased appetite;
- decreased performance and weakness;
- the appearance of itching and burning in the genital area.
Important! The disease usually develops in the late second or early third trimester.
The impact of the disease on the mother and fetus
Chronic hyperglycemia negatively affects both the mother's body and the baby himself. Pregnancy can be complicated:
- polyhydramnios;
- late gestosis;
- termination of pregnancy in different periods of gestation;
- the birth of a child with a high body weight (over 4-4, 5 kg).
Babies born to a sick mother have a characteristic appearance. Their shoulders are wide enough, the subcutaneous fat is pronounced, the face has a round moon shape. There is significant swelling of the skin and hypertrichosis. The most serious complications of the disease are fetal death during fetal development and death of the newborn. As a rule, such conditions occur in the presence of a pregestational form of the disease.
Babies born to a sick mother differ from their peers in their large body weight and characteristic appearance.
Specific types
We are talking about secondary forms of the pathological condition that develop under the influence of chemicals, drugs, infectious processes and other diseases of the endocrine and extra-endocrine sphere.
Diabetes can be caused by the following pancreatic diseases and conditions:
- inflammation of the organs;
- mechanical damage;
- removal of the gland;
- neoplasms;
- cystic fibrosis;
- pigmentary cirrhosis, etc.
Among chemicals and drugs, nicotinic acid, hormones of the adrenal cortex, interferons, thyroid hormones, and diuretics can contribute to the development of the disease. The list goes on with opiates, poisons intended for the destruction of rodents, antidepressants, drugs used for antiretroviral therapy.
Among the causative agents of infectious diseases, the provoking factors are the rubella virus and cytomegalovirus.
Characteristics of the treatment
The therapy of the pathological condition is selected individually for each clinical case. The scheme and methods of treatment used depend on the degree of diabetes, its type, the brightness of the clinical picture and the presence of complications. How to determine and confirm the presence of the disease, a qualified endocrinologist will tell you. He will give indications on the following diagnostic methods:
- general blood and urine tests;
- capillary blood test for glucose from a finger on an empty stomach;
- blood biochemistry;
- urinalysis for sugar;
- glucose tolerance test - it is mandatory for all expectant mothers in the period from 22 to 26 weeks of pregnancy;
- determination of glycosylated hemoglobin indicators.
Therapeutic measures include not only taking medications, but also physiotherapy exercises, nutritional correction, teaching the patient self-control.
It is important for relatives to support in a sick person the desire to reduce the aggressiveness of the pathological condition and obtain compensation.
self control
Patients with diabetes should keep records of their feelings, blood sugar, urine sugar levels, as well as record data on individual menus and physical activity throughout the day. The totality of these indicators and their accounting is self-control. The purpose of such events is not only to control the sugar level, but also to interpret the results and plan their actions if the numbers exceed the acceptable range.
With normal health, it is important to measure the sugar level at home and record these indicators at least once a day. Any changes in well-being require clarification of the amount of glucose in the blood several times a day:
- before each main meal;
- some time after food has entered the body;
- before the evening rest;
- in some cases, a morning measurement on an empty stomach may be required.
Glucose in the urine is also measured at home. This requires the presence of express strips. You can buy them at the pharmacy. The presence of sugar in the urine will indicate that the blood glucose level exceeds 10 mmol / l, since it is this figure that is the renal threshold at which glucose molecules enter the urine.
If the patient is traveling, actively involved in sports or has comorbidities, more rigorous self-monitoring will be required.
For the comfortable daily life of a person with diabetes, it is necessary to purchase the following individual devices and devices:
- blood glucose meter with lancets, test strips and necessary accessories included;
- strips of expressed urine, which measure the level of acetone and sugar bodies;
- tonometers to clarify blood pressure numbers;
- self-control diary, where all the necessary data will be recorded.
Food
Correction of individual nutrition is the basis for the treatment of any type of diabetes mellitus. With type 1, changing the personal menu allows you to reduce the load on the pancreas, reduce the amount of carbohydrates supplied to the body. In type 2 diabetes, a low-calorie diet can not only achieve the above goals, but also reduce pathological body weight.
Patients are advised to look at table number 9, which can have several options (a, b, c).
Patients must strictly observe the daily calorie intake. It is calculated individually for each patient, based on his weight, age, sex, energy expenditure, physical activity, drug therapy used. In the diet of patients it is necessary to limit the intake of carbohydrates and high-calorie foods. Protein is not only possible, but also necessary, fats should be limited a little, especially with type 2 pathology.
Patients should understand the bread unit system, the glycemic and insulin indices of the products, the calories. Features of the principles of nutrition:
- do not eat more than 8 units of bread in one meal;
- sweet liquids (lemonade, tea with sugar, store-bought juices) are prohibited;
- sweeteners are used instead of sugar, and homemade compotes and fruit drinks are used instead of store-bought juices;
- the number of units of bread must be planned in advance, since insulin is administered before the products enter the body;
- meals should be in small portions, but frequent;
- patients should receive a sufficient amount of fluids - restrictions may be in the presence of renal failure or other complications accompanied by edema.
You can read more about forbidden foods, as well as those to be eaten without fear, on the table.
| The most high-calorie ones to limit | Permitted products | Permitted amount of alcohol (in the conditions of use - below) |
|---|---|---|
|
|
|
The possibility of drinking alcohol is discussed individually. A small amount is allowed if there is compensation for diabetes mellitus, there are no complications, the patient feels normal. Beer and sweet cocktails are prohibited.
Medical treatment
Treatment of IDDM and gestational form is based on insulin therapy. This is the process of introducing hormonal preparations based on insulin in order to replace the lack of its own substance in the body. There are several groups of drugs that differ in the duration of action and the speed of onset of effect: ultrashort preparations, short, medium-lasting hormones and prolonged insulins.
Usually, doctors combine two drugs with different duration of action at the same time. This is necessary to create the most physiological conditions for the pancreas.
Medicines are administered with insulin syringes, syringe pens or by using an insulin pump in automatic mode.
Type 2 disease requires the use of hypoglycemic tablets. The main groups are biguanides, sulfonylurea preparations, thiazolidinediones, glinides, etc.
Differential diagnosis between types of diabetes mellitus should only be performed by a qualified specialist. It will also help you choose a treatment regimen, an optimal lifestyle and provide recommendations that will allow the patient to obtain compensation as quickly as possible.