Diabetes mellitus type 1 and 2

diabetes mellitus(DM) is an endocrine pathology that occurs due to insufficient synthesis/action of insulin.Against this background, chronic hyperglycemia develops - a condition accompanied by a constantly elevated 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.

In the past forty years, the number of people suffering from diabetes worldwide has almost quadrupled.The disease spreads the fastest in underdeveloped countries and in countries with a weak economy.Doctors notice a tendency to increase the incidence in the age group over 40 years.In terms of social importance, this pathology is in third place after cardiovascular diseases and cancer.

Diabetes mellitus is divided into two main types:

1. dependent on insulin (minors, young people, children),
2. non-insulin dependent (insulin resistant).

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

Causes

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

Type 1 diabetes it develops in the presence of a genetic predisposition.Toxins and viral infections, such as rubella, influenza, hepatitis B virus, cytomegalovirus and retroviruses, give impetus to the development of pathology.The provoking factor causes acute damage to β-cells or leads to the persistence of the infectious agent in the tissues of the pancreas 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 development of diseases in children.Therefore, it is facilitated by premature contact with gluten - it is optimal to introduce cereal porridge into complementary food no earlier than 6-7 months.The risk increases when feeding a child with cow's milk, with a lack of vitamin D and a high concentration of nitrates in drinking water.

Thanks to our body's adaptive abilities, type 1 diabetes can remain dormant for many years.The first signs appear when the number of β-cells (and, consequently, insulin) becomes insufficient to regulate glucose levels.Type 1 accounts for about 10% of all cases of pathology.It mainly affects children, adolescents and people under 30 years of age.Less often, it can be found in elderly patients in a latent form, which is often confused with insulin-independent.

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

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

Important!High-calorie foods, dominated by simple, quickly digestible carbohydrates, are considered diabetogenic.These are sweets, alcohol, flour products, sausages, fast food, fried potatoes, soft wheat pasta.Combined with a sedentary lifestyle and a lack of plant fiber, such food, if consumed regularly, can cause irreparable damage to the body.

The second type usually occurs in adulthood.A trend was observed: the older the person, the higher the concentration of glucose in the blood after a carbohydrate meal.The speed at which glucose is reduced to normal largely depends on muscle mass and the degree of obesity.Because 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 synthesized insulin cannot fully compensate for the decrease in sensitivity of insulin receptors.This creates a vicious cycle: excess glucose in the blood has a toxic effect on the beta cells, causing their dysfunction.

Diabetes mellitus: symptoms of an insidious disease

Let's consider the clinic of diabetes depending on the disorder 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 breakdown, gluconeogenesis and other reactions involving sugars.
2. Fat - increases the synthesis of fatty acids and reduces their entry into the blood.
3. Protein - enhances protein synthesis and suppresses its degradation, activates DNA and RNA replication.
4. Electrolyte - activates the flow of potassium and inhibits the flow of sodium into the cells.

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

• thirst, dehydration, polyuria - excretion of urine more than three liters per day;
• polyphagia - constant need for food, gluttony, develops as a response to lack of energy;
• nausea, vomiting;
• accumulation of sorbitol (glucose conversion product) in nerve fibers, retina, lens with subsequent damage;
• tendency to bacterial and fungal infections.

The following signs of diabetes mellitus develop due to protein metabolism disorders::

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

A disorder of fat metabolism is manifested in:

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

Loss of electrolytes (potassium, magnesium, sodium, phosphorus) leads to general and muscle weakness.

Clinic depending on the stage of the disease

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

Patients complain of:

• severe weakness, fatigue;
• thirst - patients can drink about 3-5 liters of liquid per day, and a significant amount occurs at night;
• characteristic dry mouth (due to dehydration);
• frequent and copious urination;children may develop enuresis;
• itching of the skin, in women especially in the genital area.

Important!Progressive caries and periodontal disease can often be found among the first symptoms of diabetes.Loose teeth and deep carious lesions in the roots of the teeth indicate a prediabetic condition.Biochemical analysis of blood glucose concentration shows no visible changes.Therefore, if such symptoms are detected, the patient is recommended to visit a therapist and do 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 feet.From the gastrointestinal tract, gastrointestinal dysfunction, gallbladder dyskinesia, chronic gastritis and duodenitis are observed.As a result of damage to the vascular system and an increase in 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.

Diabetics are more likely to suffer from bronchitis, pneumonia and have a predisposition 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 can occur due to vascular damage.

Signs of type 1 and type 2 diabetes

In the first type, people often do not notice or ignore the initial symptoms.A frequent situation is when the diagnosis is made only after the first "attack" of ketoacidosis.The disease manifests itself as a 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 lack of energy, the body begins to actively burn fat.This process is accompanied by the release of ketone bodies.

In large amounts, ketone bodies are toxic to humans.The patient feels thirsty, dizzy, lethargic, sleepy and has a rapid heartbeat.It is characterized by frequent urination, abdominal pain, nausea, vomiting and the smell of acetone 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 on your own.

To do this you need to:

• in the case of acute respiratory infections, acute respiratory viral infections, more often monitor the level of sugar in the plasma and give insulin in the appropriate amount;
• when using other drugs, warn your doctor about the presence of diabetes (for example, glucocorticoids increase the need for insulin);
• even during remission, do not stop giving the drug - just reduce the dose and consult a doctor for correction of therapy;
• do not skip injections and strictly monitor glucose levels;
• administer insulin using the correct instruments and in the correct place;
• monitor the shelf life and storage conditions of the drug.

The other three main signs of type 1 diabetes are fatigue, weight loss, and constant hunger.- arise as a response to the impossibility of using sugar as an energy source.And in order to get rid of excess glucose, the body actively removes it in the urine, which causes polyuria.As a result of dehydration, the patient feels very weak.

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

Classification and types

The World Health Organization offers a fairly comprehensive classification of pathology.So, in addition to the already known first and second types, there are also other specific types of diseases.All of them belong to category III and are grouped, according to the reason for their development, into classes A, B, C, D, E, F, G and H.

1. This class includes genetic defects of beta-cell function - mitochondrial mutations, damage to certain sections of certain chromosomes.
2. Also genetic defects, but not in pancreatic cells, 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, neoplasia, trauma, etc.).
4. Endocrinopathies.The disease can develop against the background of Cushing's syndrome, pheochromocytoma, thyrotoxicosis and other endocrine pathologies.
5. Diabetes caused 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 whose clinical picture are often symptoms of diabetes (myodystrophy, Turner's syndrome, Down's syndrome, porphyria).

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

Important!The tactics of treatment of diabetes mellitus largely depends on its type.Therefore, it is recommended that you consult a doctor as soon as possible in order to determine the exact cause of the 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. Anamnesis, symptoms, complaints of the patient.
2. Examination of the patient to determine possible complications.
3. Biochemical blood test - determination of glucose concentration in fasting plasma (FPG).It is taken on an empty stomach, with the last meal no later than 8-12 hours before the test.
4. Determination of the level of glycosylated hemoglobin (HbA1C).Rent the same way.Avoid smoking, alcohol and intense physical activity the day before.
5. Glucose tolerance test (OGTT).More sensitive, but at the same time more complex analysis.It is used mainly to diagnose prediabetic conditions, including during pregnancy.If the FPG is greater than 7.0 mmol/l, then 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 an additional examination.

Diagnostic criteria for diabetes and prediabetic condition

Analysis	Norm, mmol/l	Disorder of 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
Coincidentally	less than 11.1	-	more than 11.1 with symptoms

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

People who belong to the high-risk group are recommended to be tested regularly, once every three years, for FPG and HbA1C (or OGTT).If FPG is already elevated, such monitoring should be carried out once a year.Risk factors include:

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

After diagnosis, all diabetics are regularly monitored for possible complications.Standard screening includes ophthalmoscopy, foot examination, urine test for proteinuria, lipid test and creatinine level.Most endocrinologists consider it important to record an initial ECG and lipid profile during initial treatment in order 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 arising from this disease can be divided into acute and chronic conditions.Acute usually occurs when:

• skipping an insulin injection or taking a glucose-lowering drug;
• use of other drugs that affect carbohydrate metabolism;
• severe stress;
• alcohol abuse;
• self-cancellation of therapy;
• in the background of severe trauma, surgery, infection;
• during pregnancy.

This includesketoacidotic statewhich is described in detail above, ihypoglycemic coma.Ketoacidosis and hypoglycemia often develop suddenly, and it can take only a few hours from the first symptoms to full coma.Both complications should be stopped as soon as possible, if necessary, by consulting a doctor.

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

Important!To eliminate hypoglycemia, a person must urgently take simple carbohydrates.Lemonade, a piece of sugar (put under the tongue), juice - anything that is easy to swallow and quickly absorbed will do.To avoid such cases, a patient taking glucose-lowering drugs should always carry any of the above-mentioned products with them.

Other complications are the result of metabolic disorders and damage to small and large blood vessels.

1. Diabetic cardiopathy or "diabetic heart".Myocardial dystrophy develops in people older than 40 years without pronounced signs of coronary atherosclerosis.It manifests as left ventricular dysfunction and leads to heart failure.The main symptoms are difficulty breathing, 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 amplifies the manifestations of the others, creating a vicious circle.
3. Diabetic nephropathy.Leading factor of disability and mortality in 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 kidney capillaries, increased pressure inside the kidney glomeruli.The presence of hypertension accelerates pathological processes.This complication is considered one of the most insidious, because in the early stages it does not give any noticeable symptoms.The patient usually does not associate swelling, dyspepsia and weakness with kidney damage.Pain and urination disorders appear in the later stages, when the problem is already difficult to treat.
4. Diabetic retinopathy.Subjectively, it is like a fog before the eyes, a characteristic "blinking of flies".Surrounding objects become blurry and blurry.Vision loss progresses to the point of total blindness.The cause is damage to the blood vessels of the retina with the subsequent occurrence of microaneurysms, bleeding and edema.To prevent vision loss, patients should undergo an ophthalmoscopy once a year and, if problems arise, receive treatment.
5. Neuropathies.The functioning of neurons is disturbed due to the toxic effect of glucose, lack of oxygen and electrolytes.Diabetics have a large number of neuropathies, but the most common of them is symmetrical polyneuropathy.Its main symptoms are numbness, discomfort, pain, loss of sensation in hands and feet, "like gloves and socks".Such processes in the lower extremities can lead to inadequate loads with further trauma or infection of the feet and degeneration of the joints.Neuropathies affect not only peripheral nerve fibers, but also cranial nerves and brain tissue itself.The result is acute neuropsychiatric disorders, neurosis-like conditions, dysfunction of innervated areas - reduced hearing, sight, smell, etc.
6. Diabetic foot.In the background of damage to blood vessels, nerves, skin and joints, a syndrome appears, followed by ulceration of soft tissues and purulent-necrotic processes.Foot necrosis ends with amputation of the affected area.The syndrome occurs in 20-25% of patients.

Treatment: diet and medication

Treatment of diabetesit starts with lifestyle changes.This includes a properly structured diet, sufficient physical activity and regular monitoring of plasma sugar concentration.All this, together with the basic therapy, helps to prevent the rapid progression of the pathology and the development of complications.

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

Patients with type 2, in case nutrition and physical activity are not enough,antihyperglycemic agents are prescribed.These drugs differ in their mechanism of action:

• stimulate the secretion of own insulin (sulfonylurea, meglitinides);
• increase the sensitivity of insulin receptors (thiazolidinediones);
• inhibit additional pathways for glucose production (biguanides);
• they prevent the absorption of sugar in the intestinal wall, slowing down their 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 from damage to the vascular bed, ACE inhibitors help fight nephropathy in the early stages.

The forecast is up to you

Every year about four million people die from this insidious disease.In children and adolescents, the main 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 extend their lives simply by giving up bad habits and adjusting their diet.

The disease ranks first among the causes of blindness, it increases the risk of stroke and heart attack twice, chronic kidney failure 17 times, foot necrosis 20 times.Despite the dire numbers,the prognosis depends on the timeliness of the diagnosis and your 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 are reduced 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.The consumption of simple carbohydrates and saturated fats should be minimized.Avoid mayonnaise, pastries, jams, sausages and starchy foods.Avoid fried, fatty, over-salted food, fast food, smoked food and canned food.The basis should be complex carbohydrates, fibers and pectins.Lean fish, poultry, vegetables, herbal infusions, unsweetened compotes, durum wheat pasta are preferred.Follow the BJU ratio of 20:20:60.
3. Prevention of infections.The first type of diabetes mellitus is often manifested under the influence of a viral infection.Therefore, if there are risk factors, it is recommended to strengthen the immune system, prevent the long-term course of ARVI, wear a mask and use antiseptics during epidemics and near sick people.