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 amenable to eradication (complete elimination). The destructive process in the body can be slowed down by means of medications and diet therapy, but it is impossible to stop it and start it in the opposite direction.
Types of diabetes mellitus (DM) are defined by the World Health Organization and do not have fundamental differences throughout the medical world. Diabetes mellitus of any type is not a contagious disease.
Diabetes mellitus can be of several types, as well as different types. Since the treatment for each species and type is different, it is necessary to know which particular variant of the disease has arisen.
Typification of pathology
There are several types of the disease, united by one main symptom - an increased concentration of glucose in the blood. Typification of diabetes mellitus is due to the causes of its occurrence. There are also applied methods of therapy, sex and age of the patient.
Medically accepted types of diabetes:
- the first type is insulin-dependent (IDDM 1), or juvenile;
- the second 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 β-cells of the pancreas at the genetic level (varieties of MODY-diabetes);
- pathology of the exocrine function of the pancreas;
- hereditary and acquired pathologies of the external secretion glands 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 state of the body, when the level of glycemia is changed upward (glucose tolerance is impaired), 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 the second type of disease.
According to medical statistics, there is a clear trend of increasing the number of cases all over the world. Over 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 the failure of pancreatic cells. 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 imitate the natural production of endocrine hormone, the patient is given lifelong injections of medical insulin with different durations of action (short and long), as well as diet therapy. The classification of type 1 diabetes mellitus is dictated by the various etiologies of the disease. The insulin-dependent type of the disease has two causes: genetic and autoimmune.
genetic cause
The formation of pathology is associated with the biological feature of the human body to pass on its characteristic features and pathological abnormalities to subsequent generations. In relation to diabetes, a child inherits a predisposition to the disease from parents or close relatives suffering from diabetes.
Important! 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 a functional failure of the immune system, when, under the influence of negative factors, it actively produces autoimmune antibodies that have a destructive effect on the cells of the body. Triggers (push) to start autoimmune processes are:
- unhealthy eating behavior combined with physical inactivity;
- failure of metabolic processes (carbohydrate, lipid and protein);
- critical deficiency in the body of cholecalciferol and ergocalciferol (group D vitamins);
- pathology of the pancreas of a chronic nature;
- a history of mumps (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;
- incorrect treatment with hormone-containing medications.
IDDM is formed in children, adolescents and adults under the age of thirty. The childhood variant of the development of type 1a diabetes is associated with complicated 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 is concentrated in the blood and is not delivered to the cells and tissues of the body due to their lack of sensitivity to insulin - insulin resistance. Up to a certain point, treatment is carried out through hypoglycemic (sugar-lowering) medications and diet therapy.
To compensate for the imbalance in the body, the pancreas activates the production of the hormone. Working in emergency mode, the organ wears out over time and loses its intrasecretory function. Type 2 diabetes becomes insulin dependent. The decrease or loss of cell susceptibility to the endogenous hormone is primarily associated with obesity, in which fat and carbohydrate metabolism is disturbed.
This is especially true of visceral obesity (deposition of fat around the internal organs). In addition, with excess body weight, blood flow becomes difficult due to numerous cholesterol plaques inside the vessels, which are formed during hypercholesterolemia, which always accompanies obesity. The cells of the body, thus, are deficient in nutrition and energy resources. Other factors that influence the development of NIDDM include:
- alcohol abuse;
- gastronomic addiction to sweet dishes;
- chronic diseases of the pancreas;
- pathology of the heart and vascular system;
- excesses in food against the background of a sedentary lifestyle;
- incorrect hormone therapy;
- complicated pregnancy;
- dysfunctional heredity (diabetes in parents);
- distress.
Most often, the disease develops in women and men of the age category 40+. At the same time, type 2 diabetes is latent in nature and may not show pronounced symptoms for several years. Timely testing for blood glucose levels can detect prediabetes. With adequate therapy, the pre-diabetic state is reversible. If time is lost, it progresses and subsequently NIDDM is diagnosed.
Lada diabetes
In medicine, the term "Diabetes 1. 5" is found, or the name Lada diabetes. This is an autoimmune disorder in the production of hormones and the failure of metabolic processes that occurs in adults (aged 25+). The disease combines the first and second types of diabetes. The mechanism of development corresponds to IDDM, the latent course and manifestation of symptoms are similar to NIDDM.
The 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 colon mucosa (ulcerative colitis);
- chronic damage to the connective tissue and glands of external secretion (Sjogren's syndrome).
In combination with hereditary predisposition, autoimmune disorders lead to the progression of Lada diabetes. To detect the disease, basic diagnostic methods are used, as well as blood microscopy, which determines the concentration of IgG class immunoglobulins to antigens - ELISA (enzymatic immunoassay). Therapy is carried out through 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 routine screening, when the expectant mother undergoes a complete examination. The main characteristic of GDM that is similar to type 2 diabetes is insulin resistance. The cells of the body of a pregnant woman lose sensitivity (sensitivity) to insulin due to the correlation of three main reasons:
- Hormonal reorganization. During the gestation period, the synthesis of progesterone (a steroid sex hormone) increases, blocking the production of insulin. Plus, the endocrine hormones of the placenta, which tend to inhibit the production of insulin, are gaining strength.
- Double load on the female body. To provide adequate nutrition for the unborn child, the body requires an increased amount of glucose. A woman begins to consume more monosaccharides, which causes the pancreas to synthesize more insulin.
- An increase in body weight against the background of a decrease in physical activity. Glucose, abundantly supplied to the body, accumulates in the blood, as cells refuse to take insulin due to obesity and physical inactivity. The expectant 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 functionality are preserved.
Properly selected therapeutic tactics guarantee the elimination of pathology after delivery in 85% of cases. The main method of treating GDM is the diet for diabetics "Table No. 9". In difficult cases, injections of medical insulin are used. Hypoglycemic drugs are not used because of their teratogenic effects on the fetus.
Additionally
Specific types of diabetes are genetically determined (MODY-diabetes, some types of endocrinopathies) or provoked by other chronic pathologies:
- diseases of the pancreas: pancreatitis, hemochromatosis, tumor, cystic fibrosis, mechanical trauma and surgery on the gland;
- functional failure of the anterior pituitary gland (acromegaly);
- increased synthesis of thyroid hormones (thyrotoxicosis);
- hypothalamic-pituitary-adrenal pathology (Itsenko-Cushing's syndrome);
- tumors of the adrenal cortex (aldosteroma, pheochromocytoma, etc. ).
A separate diabetic pathology - diabetes insipidus is characterized by a decrease in the production of the hypothalamic hormone vasopressin, which regulates the balance of fluid in the body.
Diagnostic measures
The diagnosis of diabetes mellitus (of any type) is possible only on the basis of the results of laboratory blood microscopy. Diagnostics consists of several consecutive studies:
- General clinical blood test to detect hidden inflammatory processes in the body.
- Blood test (capillary or venous) for glucose content. Produced strictly on an empty stomach.
- GTT (glucose tolerance testing). It is carried out to determine the body's ability to absorb glucose. The tolerance test is a double blood sampling: on an empty stomach and two hours after the "glucose load", which is an aqueous glucose solution prepared in a ratio of 200 ml of water per 75 g. substances.
- HbA1C analysis for the level of glycosylated (glycated) hemoglobin. Based on the results of the study, a retrospective of blood sugar levels over the past three months is evaluated.
- Biochemistry of blood. The indicators of liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (AP), bilirubin (bile pigment), cholesterol levels are evaluated.
- A blood test for the concentration of antibodies to glutamate decarboxylase (GAD antibodies) determines the type of diabetes mellitus.
Blood sugar reference values and disease indicators
| Analysis | For sugar | Glucose tolerance test | Glycated hemoglobin |
|---|---|---|---|
| norm | 3. 3 - 5. 5 | < 7. 8 | ⩽ 6% |
| prediabetes | 5. 6 - 6. 9 | 7. 8 - 11. 0 | from 6 to 6. 4% |
| diabetes | > 7. 1 | > 11. 1 | Over 6. 5% |
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). A Reberg test is also performed to detect albumin protein and a product of protein metabolism of creatinine in the urine. Additionally, hardware diagnostics is prescribed, including an 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), non-insulin dependent (NIDDM type 2), gestational (GDM pregnant), specific (DM includes several types of diseases caused by geneticdefects or chronic pathologies). Gestational diabetes, formed in the perinatal period, is curable. Pre-diabetes (impaired glucose tolerance) is considered reversible if diagnosed early.