Diabetes mellitus is a pathological condition characterized by a violation of metabolic processes (metabolism). This happens due to insufficient production of the 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 patient treatment.
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 the loop of the duodenum. The weight of the pancreas is about 80 g.
In addition to hormones, the gland produces pancreatic juice, which is necessary for the digestion of lipids, carbohydrates and proteins. The hormone insulin is synthesized by β-cells. They are located almost all over the surface of the pancreas in the form of small groups called islets of Langerhans. The islets also contain α-cells that synthesize the hormonally active substance glucagon. This hormone has the opposite effect of insulin.
Insulin is a protein molecule consisting of several chains of amino acids. Its task is to assimilate glucose (sugar) into the cells of the body. Sugar is necessary for a person to get energy. Without it, cells and tissues are unable to cope with their functions.
In parallel with the intake of sugar, insulin also regulates the penetration of amino acids into the cells. Amino acids are considered one of the main building materials. Another function of insulin is the accumulation of lipids in the body.
Classification of diabetes
According to the generally accepted and used in modern endocrinology classification of diabetes mellitus, 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 last 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 on the part of the insulin hormone or insulin secretory cells, diseases caused by the action of chemicals and drugs, diabetes as a result of infectious processes, etc.
All types of diabetes are united by hyperglycemia. This is a condition manifested by elevated blood glucose levels. Confirmation or refutation of the diagnosis of diabetes is based on the background of diagnosing glycemic numbers.
1 type
Type 1 pathology (ICD-10 code - E10) is considered an autoimmune process, which results in the death of insulin-secreting cells. In simple language, such processes are triggered in the human body, during which their own immune cells consider pancreatic cells to be foreign and destroy them.
As a rule, the insulin-dependent type arises as a result of a hereditary predisposition, but accompanying provocative 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%.
The presence of an autoimmune process, that is, antibodies in the body against the pancreas' own cells, occurs in more than 80% of insulin-dependent patients. Often, in addition to type 1 disease, diabetics also suffer from other autoimmune diseases, for example, chronic adrenal insufficiency, pancreatic disease, vitiligo, rheumatism.
How does it develop?
Usually, clinical signs of the disease appear when more than 85% of the cells secreting insulin have already died, but depending on the individual characteristics of the organism, this period can vary in duration. It often occurs in childhood and adolescence. It happens that young patients find out about the presence of the disease already in the period of acute complications, for example, in a ketoacidotic state.
The lack of energy and insulin lead to a massive breakdown of fat and protein, which explains the patient's weight loss. Elevated blood sugar causes hyperosmolarity, which is manifested by the massive formation of urine and the development of symptoms of dehydration. Since there is not enough insulin, the body suffers from energy starvation, as a result of which there is an excessive synthesis of counterinsular hormones, that is, those that have the opposite effect in relation to the work of insulin.
These hormones include cortisol, glucagon, and somatotropin. They cause the stimulation of glucose production in the body, despite the fact that the blood sugar level is already going through the roof.
The massive breakdown of fat leads to an increase in the number of free fatty acids in the blood. This is the trigger for the creation and accumulation of ketone (acetone) bodies, which become provocateurs of the ketoacidotic state. If such pathology, dehydration and the shift of blood pH to the acidic side continue to progress, the patient may fall into a coma, and even death is possible.
Symptoms
Type 1 diabetes is characterized by the development of bright symptoms, which gain weight over several weeks. Diabetics complain:
- to produce a large amount of urine;
- excessive thirst;
- constant itching of the skin;
- weight loss.
Weight loss, which is accompanied by normal or increased appetite, is one of the symptoms that distinguish type 1 pathology from other types of diabetes mellitus. The patient is worried about severe weakness, he cannot do his usual work, drowsiness appears.
The progression of the clinical picture is accompanied by the appearance of the smell of acetone in 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 by a clinical examination.
type 2
Non-insulin-dependent diabetes mellitus (ICD-10 code - E11) is a chronic pathology in which high blood sugar levels occur due to insulin resistance. Later, the work of the β-cells of the islets of Langerhans was also disrupted. In parallel with 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 the disease, children get it in 40% of cases. However, inheritance alone is not enough, provocative factors are:
- high body weight;
- low physical activity;
- elevated blood pressure numbers;
- high level of triglycerides in the blood;
- the presence of a baby born weighing more than 4 kg in the past;
- presence of gestational diabetes in the past;
- polycystic ovaries.
Currently, the number of patients with type 2 diabetes is increasing. This form of pathology accounts for more than 85% of all clinical cases. Middle-aged and older men and women get sick more often.
How does it develop?
The mechanism of development is based on the fact that insulin resistance occurs, that is, the pancreas produces a sufficient amount of the hormone needed to transport sugar molecules into the cells, but the cells themselves lose sensitivity to this substance. The result is hyperglycemia.
In order to reduce the level of sugar in the blood, the gland begins to work to the limit of its capabilities. This provokes the depletion of insulin-secreting cells.
For another type of pathological condition, the occurrence of ketoacidosis is uncharacteristic, because even a small amount of hormones is synthesized by the islets of Langerhans.
Symptoms
The disease usually manifests itself in patients older than 40 years. 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 it is not as pronounced as in the first type of disease;
- pathological thirst;
- passing large amounts of urine;
- women may be disturbed by itching of the skin in the area of the genitals and perineum;
- rashes appear on the skin that do not heal for a long time;
- discomfort, numbness and tingling in the lower extremities.
Gestational type
The WHO classification of diabetes mellitus includes the gestational form of the disease (ICD-10 code - O24). It is typical for 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, it is considered pregestational, during the period of childbirth - 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 psychological trauma;
- infectious diseases;
- diseases of the pancreas;
- inclusion in the menu of large amounts of foods rich in carbohydrates.
The gestational form can manifest itself as a manifestation, that is, a vivid clinical picture, or as a violation of glucose tolerance. The pathology, as a rule, disappears by itself after the birth of the baby.
The woman becomes a member of the group of patients with a high risk of developing insulin-dependent diabetes mellitus in the next 10-15 years.
During the period of childbirth, a woman's body goes through certain changes that are related to the hormonal sphere. This is due to the functioning of the placenta, which secretes the following hormones:
- chorionic gonadotropin;
- progesterone;
- estrogens;
- corticosteroids etc.
All these hormonally active substances cause the appearance of insulin resistance. In this phase, hyperplasia of insulin-secreting cells and the release of a large amount of insulin into the blood are observed from the pancreas. The appearance of insulin resistance leads to the fact that the female body begins to actively use the metabolic products of fat, while sugar is stored to feed the fetus. In conditions of a combination of hereditary predisposition to diabetes and the above-mentioned 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 somewhat less pronounced. A woman may not pay attention to the symptoms, associating their appearance with her "interesting" position. If the clinical picture is accentuated, the pregnant woman may present the following complaints to the attending physician:
- dry mouth;
- constant desire to drink;
- passing large amounts of urine;
- increased appetite;
- reduced performance and weakness;
- the appearance of itching and burning in the genital area.
Important! Usually the disease develops at the end of the second or the beginning of the third trimester.
The impact of the pathology on the mother and fetus
Chronic hyperglycemia negatively affects both the mother's body and the child itself. Pregnancy can be complicated:
- polyhydramnios;
- late gestosis;
- termination of pregnancy in different periods of pregnancy;
- the birth of a child with a large body weight (more than 4-4. 5 kg).
Babies born to sick mothers have a characteristic appearance. Their shoulders are quite broad, 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 the death of the fetus during fetal development and the death of the newborn. As a rule, such conditions occur in the presence of the pregestational form of the disease.
Specific species
These are secondary forms of the pathological condition that develop under the influence of chemicals, drugs, infectious processes and other diseases of the endocrine and extraendocrine sphere.
Diabetes can be caused by the following diseases and conditions of the pancreas:
- organ inflammation;
- mechanical damage;
- gland removal;
- neoplasms;
- cystic fibrosis;
- pigmentary cirrhosis etc.
Of the chemicals and drugs, nicotinic acid, adrenal cortex hormones, interferons, thyroid hormones and diuretics can contribute to the development of the disease. The list continues with opiates, poisons intended to destroy rodents, antidepressants, drugs used for antiretroviral therapy.
Features of treatment
The therapy of the pathological condition is selected individually for each clinical case. The treatment scheme and methods used depend on the degree of diabetes, its type, the brightness of the clinical picture and the presence of complications. A qualified endocrinologist will tell you how to determine and confirm the presence of the disease. He will provide instructions for the following diagnostic methods:
- general blood and urine tests;
- analysis of capillary blood for glucose from a fingertip on an empty stomach;
- blood biochemistry;
- urine analysis 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 medication, but also physiotherapy exercises, diet correction, teaching the patient self-control.
Self control
Patients with diabetes should keep records of their feelings, glycemia, sugar level in urine, as well as record data on individual menus and physical activity throughout the day. The totality of such 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, as well as to plan their actions if the numbers exceed acceptable limits.
With normal health, it is important to measure your sugar level at home and record these indicators at least once a day. All 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 enters the body;
- before evening rest;
- in some cases, you may need to measure in the morning on an empty stomach.
Urine glucose is also measured at home. This requires the presence of express lanes. They can be bought in pharmacies. The presence of sugar in the urine will indicate that the level of glucose in the blood exceeds 10 mmol / l, because this figure is the renal threshold at which glucose molecules penetrate into the urine.
If the patient travels, actively engages in sports or has any comorbidities, stricter self-monitoring will be required.
For the daily comfortable life of a person with diabetes, it is necessary to acquire the following individual devices and devices:
- glucometer with lancets, test strips and necessary accessories included;
- express urine strips, which measure the level of acetone and sugar;
- tonometers for clarifying blood pressure numbers;
- self-control diary, in which all necessary data will be recorded.
Food
Correction of individual diet is the basis for treatment of any type of diabetes mellitus. With type 1, changing your personal menu allows you to reduce the load on the pancreas, reduce the amount of carbohydrates delivered 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 must strictly adhere to daily calorie intake. It is calculated individually for each patient, depending on their weight, age, gender, energy consumption, physical activity, drug therapy used. In the diet of patients, it is necessary to limit the intake of carbohydrates and high-calorie foods. Proteins are not only possible, but also necessary, fats should be slightly limited, especially in type 2 pathology.
Patients will need to understand the system of bread units, glycemic and insulin indices of products, calories. Characteristics of the principles of nutrition:
- not to eat more than 8 units of bread in one meal;
- sweet liquids (lemonade, tea with sugar, juice from the store) are prohibited;
- sweeteners are used instead of sugar, and home-made compotes and fruit drinks are used instead of store-bought juices;
- the number of bread units must be planned in advance, because insulin is given before the products enter the body;
- meals should be in small portions, but frequent;
- patients should receive a sufficient amount of fluid - restrictions may be in the presence of kidney failure or other complications that are accompanied by edema.
You can read more about prohibited foods, as well as those that should be consumed without fear, in the table.
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The possibility of consuming alcohol is agreed upon 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.
Treatment
Treatment of IDDM and the gestational form is based on insulin therapy. This is the process of introducing hormone preparations based on insulin in order to compensate for the lack of its own substance in the body. There are several groups of drugs that differ in duration of action and speed of onset of action: ultra-short-acting preparations, short-acting hormones of medium duration and prolonged insulins.
Usually, doctors combine two drugs with different durations of action at the same time. It is necessary to create the most physiological conditions for the pancreas.
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 be performed only by a qualified specialist. It will also help you choose a therapeutic regimen, an optimal lifestyle and give recommendations that allow the patient to achieve compensation as quickly as possible.