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 spoil the statistics.Symptoms of diabetes mellitus do not appear overnight; the process is chronic, with an increase and worsening of endocrine and metabolic disorders.True, the onset of type 1 diabetes differs significantly from the early stage of type 2.

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

The likelihood of acquiring the disease increases with age and, thus, every ten years the group size doubles.This is due to an increase in life expectancy, improved methods of early diagnosis, a decrease in physical activity and an increase in the number of people who are overweight.

Types of diabetes

Many people have heard about such a disease as diabetes insipidus.So that the reader does not subsequently confuse 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 insufficiency and sometimes 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 non-concentrated light urine with low specific gravity (1000-1003);
• Catastrophic weight loss, weakness, decreased 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; work capacity is significantly reduced.

Brief Anatomy and Physiology

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

The endocrine section of the gland is represented by the islets of Langerhans, consisting of:

1. A-cells, which occupy a quarter of the total space of the islets and are considered the site of glucagon production;
2. B cells, occupying up to 60% of the cell population, synthesizing and storing insulin, the molecule of which is a polypeptide of two chains, carrying 51 amino acids in a certain sequence;
3. D-cells producing somatostatin;
4. Cells that produce other polypeptides.

Thus, the conclusion suggests itself:Damage to the pancreas and islets of Langerhans, in particular, 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 impaired sugar constancy (3.3 – 5.5 mmol/l)and contributes to the formation of a heterogeneous disease called diabetes mellitus (DM):

• The complete absence of insulin (absolute deficiency) formsinsulin dependentpathological process, which is referred to astype I diabetes mellitus (IDDM);
• Lack of insulin (relative deficiency), which triggers a disorder of carbohydrate metabolism in the initial stage, slowly but surely leads to the developmentnon-insulin dependentdiabetes mellitus (NIDDM), which is calleddiabetes mellitus type II.

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

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

1. Secondary diabetesresulting from acute and chronic inflammation of the pancreas (pancreatitis), malignant neoplasms in the parenchyma of the gland, cirrhosis of the liver.A number of endocrine disorders accompanied by excessive production of insulin antagonists (acromegaly, Cushing's disease, pheochromocytoma, thyroid disease) lead to the development of secondary diabetes.Many medications used for a long time have a diabetogenic effect: diuretics, some antihypertensive drugs and hormones, oral contraceptives, etc.;
2. Diabetes in pregnant women (gestational),caused by the peculiar mutual influence of hormones of the mother, child and 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 control, gestational diabetes usually disappears after childbirth.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 the “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.For NIDDM, such a relationship was not observed.

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

• Congenital deficiency of the islets of Langerhans;
• Unfavorable influence of the external environment;
• Stress, nervous stress;
• Traumatic brain injuries;
• Pregnancy;
• Infectious processes of viral origin (influenza, mumps, cytomegalovirus infection, Coxsackie);
• Tendency to constant overeating, leading to excess fat deposits;
• Abuse of confectionery products (those with a sweet tooth are at greater risk).

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

It has been established that nowadays 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 predominant.

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, hemorrhages;
• Age after 40 years;
• Excess weight (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 high body weight (more than 4 kg);
• Having relatives with diabetes;
• Strong psycho-emotional stress (adrenal hyperstimulation).

The causes of the disease of different types of diabetes in some cases coincide (stress, obesity, influence of external factors), but the onset of the process in type 1 and type 2 diabetes is different, moreover,IDDM is the province of children and young people, and non-insulin-dependent people 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 mucous membranes;
2. Thirst that is practically impossible to quench, associated with dehydration;
3. Excessive formation of urine and its excretion by 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 sugar utilization by peripheral tissues due to insulin deficiency;
5. The appearance of sugar in the urine (glucosuria) and ketone bodies (ketonuria), which are normally present in negligible quantities, but in diabetes mellitus are intensively produced by the liver, and when excreted from the body are found in the urine;
6. Increased content in the 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 a characteristic feature of the catabolic syndrome, which develops due to the breakdown of glycogen, lipolysis (mobilization of fats), catabolism and gluconeogenesis (transformation into glucose) of proteins;
8. Violation of lipid spectrum indicators, increase in total cholesterol due to the low-density lipoprotein fraction, NEFA (non-esterified fatty acids), triglycerides.The increasing content of lipids begins to be actively sent to the liver and there they are intensively oxidized, which leads to excessive formation of ketone bodies (acetone + β-hydroxybutyric acid + acetoacetic acid) and their further entry into the blood (hyperketonemia).Excessive concentration of ketone bodies threatens a dangerous condition 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 inherent in 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 type I diabetes mellitus are pronounced and are manifested by clinical symptoms typical for this disease:

• Sudden weight loss;
• Unnatural thirst, a person simply cannot get drunk, although he tries to do so (polydipsia);
• Large amounts of urine excreted (polyuria);
• Significant excess of the concentration of glucose and ketone bodies in the blood serum (ketoacidosis).In the initial stage, when the patient may not yet be aware of his problems, the development of diabetic (ketoacidotic, hyperglycemic) coma is quite likely - a condition that is extremely life-threatening, therefore insulin therapy is prescribed as early as possible (as soon as diabetes is suspected).

In most cases, after using insulin, metabolic processes are compensated,The body's need for insulin sharply declines, and a temporary “recovery” occurs.However, this short-term state of remission should not relax either the patient or the doctor, since after some period of time the disease will remind itself again.The need for insulin may increase as the duration of the disease increases, but, generally, in the absence of ketoacidosis, it 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 main causes of death from IDDM include:

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

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

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

NIDDM is characterized by a stable, 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 progressed to the stage of severe complications or there is resistance to oral medications.

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

Treatments for diabetes mellitus

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

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

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

1. Nutrition for diabetes mellitus plays the role of “first violin”;
2. A system of physical exercises, adequate and individually selected, follows the diet;
3. Sugar-lowering medications are mainly used to treat type 2 diabetes;
4. Insulin therapy is prescribed if necessary for NIDDM, but is essential in the case of type 1 diabetes;
5. Training patients for self-monitoring (skills in 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	Good degree of compensation	Satisfactory	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 diet in the treatment of NIDDM

Nutrition for diabetes mellitus is very well known, even to people far from diabetes mellitus, table number 9. While in the hospital for any disease, every now and then you can hear about a special diet, which is always in separate saucepans, differs from other diets and is given out after a certain password is said: “I have the ninth table.”What does this all mean?How is this mystery diet different from all the others?

One should not be mistaken, looking after a diabetic carrying away his “porridge,” that they are deprived of all the joys of life.The diet for diabetes is not so different from the diet of healthy people; patients receive the required amount of carbohydrates (60%), fats (24%), and proteins (16%).

Nutrition for diabetes consists of replacing refined sugars in foods with slowly broken down carbohydrates.Sugar sold in stores for everyone and confectionery products based on it fall into the category of prohibited foods.

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

• Age;
• Symptoms of diabetes;
• The severity of the pathological process;
• The presence or absence of complications.

Physical activity prescribed by the doctor and performed by the “ward” should promote the “burning” of carbohydrates and fats without involving insulin.Its dose, which is necessary to compensate for metabolic disorders, drops noticeably, which should not be forgotten, since by preventing an increase in blood sugar levels, you can get an undesirable effect.Adequate physical activity reduces glucose, the administered dose of insulin breaks down the remaining one, and as a result, a decrease in sugar levels below acceptable values (hypoglycemia).

Thus,the dosage of insulin and physical activity requires very close attention and careful calculation,so that, complementing each other, together we do not cross 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 far as possible.

Despite the fact that our distant ancestors practically did not know about this disease, folk remedies for the treatment of diabetes mellitus exist, but we should not forget thatinfusions and decoctions prepared from various plants are an aid.The use of home remedies for diabetes does not relieve the patient from following a diet, monitoring blood sugar, visiting a doctor and following all his recommendations.

To combat this pathology at home, fairly well-known folk remedies are used:

1. White mulberry bark and leaves;
2. Oat grains and husks;
3. Walnut partitions;
4. Bay leaf;
5. Cinnamon;
6. Acorns;
7. Nettle;
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 remedy is suitable for this or that patient.And so that patients do not self-medicate and do not decide to use these medications for diabetes at their own discretion, we will give several illustrative examples.

Sulfonylurea derivatives

Currently, second-generation sulfonylurea derivatives are prescribed, which act from 10 hours 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, lactation;

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

In addition, the use of drugs in this group may threaten the development of allergic reactions, manifested by:

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

Antihyperglycemic agents of the biguanide family

Biguanides (guanidine derivatives) are actively used to treat type 2 diabetes mellitus, often adding sulfonamides to them.They are very rational for use by obese patients, however, for persons with liver, kidney and cardiovascular pathology, their use is sharply limited, switching to more gentle 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 to the use of biguanides:

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

Treatment with insulin

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 insulin-requiring forms, when correction by other means does not give the desired effect.

Modern insulins, called monocompetent, represent two groups:

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

Diabetes is dangerous due to 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 in the skin: diabetic dermopathy, necrobiosis lipoidica, furunculosis, xanthomatosis, fungal infections of the skin;
• Osteoarticular diseases:
  1. Diabetic osteoarthropathy (Charcot joint - change in the ankle joint), occurring against the background of impaired microcirculation and trophic disorders, accompanied by dislocations, subluxations, spontaneous fractures preceding the formationdiabetic foot;
  
  2. Diabetic hairopathy, characterized by stiffness in 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), loss of body weight;
• 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 variety -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 accident).

Prevention

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

Prevention of complications of diabetes mellitus involves preventing the development of pathological conditions arising from diabetes itself.Correcting glucose in the blood serum, following a diet, adequate physical activity, and following the doctor’s recommendations will help delay the consequences of this rather formidable disease.