Type 1 and 2 diabetes mellitus

Diabetes mellitus(DM) is an endocrine pathology that occurs due to insufficient insulin synthesis/action.Against this background, chronic hyperglycemia develops - a condition accompanied by a constantly elevated level of sugar (glucose) in the blood plasma.It is hyperglycemia that is the main cause of the symptoms and complications of diabetes: metabolic disorders, damage to blood vessels and nerve fibers, renal failure and blindness.

Over the past forty years, the number of diabetes cases worldwide has almost quadrupled.The disease spreads faster in underdeveloped countries and in countries with weak economies.Doctors notice a tendency towards increased incidence in the age group over 40 years old.In terms of social importance, this pathology ranks third after cardiovascular diseases and cancer.

Diabetes mellitus is divided into two main types:

1. insulin-dependent (minors, young people, children),
2. independent of insulin (insulin resistant).

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

Causes

Insulin is a protein hormone that is synthesized in the beta cells of the pancreas.Its effects are realized through insulin receptors in different organs and tissues.Diabetes occurs either when the beta cells are destroyed or when the sensitivity to the receptors decreases.

Type 1 diabetes 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 appearance of pathology.The provocative factor causes acute damage to β-cells or leads to the persistence of the infectious agent in the pancreatic tissue with the further development of an autoimmune reaction.The possibility of increasing the disease if a person has other autoimmune diseases - thyroiditis, kidney failure, etc.

Important!Diet plays a certain role in the appearance of the disease in children.So, this is facilitated by very early contact with gluten - it is optimal to introduce cereal porridge into complementary foods no earlier than 6-7 months.The risk increases when a child is fed cow's milk, deficient in vitamin D and with a high concentration of nitrates in drinking water.

Thanks to our body's adaptive abilities, type 1 diabetes can remain silent for many years.The first signs appear when the number of β cells (and, accordingly, insulin) becomes insufficient to regulate glucose levels.Type 1 accounts for about 10% of all cases of pathology.It mainly affects children, teenagers 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 non-insulin-dependent.

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

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

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

The second type usually appears in adulthood.A trend has been observed: the older a person is, the higher the concentration of glucose in the blood after eating a carbohydrate meal.The speed with which glucose decreases to normal depends mainly on muscle mass and the degree of obesity.Since childhood obesity is already an epidemic, type 2 is increasingly being found in children.

As in the previous case, the disease develops when the amount of insulin synthesized cannot fully compensate for the decreased sensitivity of insulin receptors.This creates a vicious circle: excess glucose in the blood has a toxic effect on beta cells, causing them to malfunction.

Diabetes mellitus: symptoms of an insidious disease

Let's consider the clinic of diabetes depending on the disorders it causes, the stage of the disease and the type of pathology.

Symptoms related to 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. Fatty - increases the synthesis of fatty acids and reduces their entry into the blood.
3. Protein - increases protein synthesis and suppresses its breakdown, activates DNA and RNA replication.
4. Electrolyte - activates the flow of potassium and prevents the flow of sodium into the cells.

With so many physiological effects, changes in insulin concentration do not go unnoticed by the body.The main symptoms are related to impaired carbohydrate metabolism, in particular hyperglycemia.Increased glucose levels lead to the following symptoms:

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

Due to the disorder of protein metabolism, the following signs of diabetes mellitus appear::

• muscular dystrophy - appears due to a decrease in the synthesis and increase in the breakdown of proteins;
• hypoxia - lack of oxygen in tissues - causes lethargy, decreased concentration and sleepiness;
• general vascular damage due to protein glycosylation.

Impaired fat metabolism is manifested in:

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

Due to the loss of electrolytes (potassium, magnesium, sodium, phosphorus), general and muscle weakness appears..

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 proper screening.In diabetes, symptoms come and go according to fluctuations in blood glucose levels.General manifestations predominate, as damage to internal organs is still far away.

Patients complain of:

• severe weakness, fatigue;
• thirst - patients are able to drink about 3-5 liters of fluid per day, with a significant amount occurring at night;
• characteristic dry mouth (due to dehydration);
• frequent and abundant 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 on the roots of the teeth indicate a prediabetic condition.A biochemical analysis of blood glucose concentration shows no obvious 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 foot.From the gastrointestinal tract, gastrointestinal dysfunction, gallbladder dyskinesia, chronic gastritis and duodenitis are observed.As a result of damage to the vascular system and increased 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.

Patients with diabetes are more likely to develop bronchitis, pneumonia and are predisposed to tuberculosis.Men with prostate adenoma and women over 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 damage to blood vessels.

Signs of type 1 and type 2 diabetes

With the first type, people often do not notice or ignore the initial symptoms.A common situation is when the diagnosis is made only after the first "attack" of ketoacidosis.The disease manifests as a response to stress, viral infection and simple carbohydrate overload.Since sugars are extremely poorly absorbed, tissues and organs lack energy.In an effort 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 fast 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 independently prevent ketoacidosis.

To do this you need:

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

The other three main signs of type 1 diabetes are fatigue, weight loss, and constant hunger.- arise as a response to the inability to use sugars as an energy source.And to get rid of excess glucose, the body actively removes it in the urine, which provokes polyuria.As a result of dehydration, the patient feels severe weakness.

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

Classification and types

The World Health Organization provides a fairly complete classification of pathology.So, in addition to the already known first and second types, other specific types of the disease are distinguished.All belong to category III and are collected, according to the reason for their development, in classes A, B, C, D, E, F, G and H.

1. This class includes genetic defects of beta cell function - mitochondrial mutations, damage to individual sections of certain chromosomes.
2. Also genetic defects, but not in the cells of the pancreas, 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 the clinical picture of which are often diabetic symptoms (myodystrophy, Turner syndrome, Down syndrome, porphyria).

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

Important!Treatment tactics for diabetes mellitus mainly depend on its type.Therefore, it is recommended to consult a doctor as soon as possible to determine the exact cause of the unpleasant symptoms.An experienced endocrinologist will prescribe the necessary examination and find the source of the disease.

Diagnosis and screening

The diagnosis is made based on the following criteria.

1. History, symptoms, complaints of the patient.
2. Examination of the patient to identify possible complications.
3. Biochemical blood test - determination of fasting plasma glucose concentration (FPG).It is taken on an empty stomach, with the last meal no later than 8-12 hours before the analysis.
4. Determination of the level of glycosylated hemoglobin (HbA1C).It is rented in the same way.Avoid smoking, alcohol and intense physical activity the day before.
5. Glucose tolerance test (OGTT).The most sensitive analysis, but at the same time more complex.It is mainly used for the diagnosis of prediabetic conditions, including during pregnancy.If the FPG is more than 7.0 mmol/l, then the OGTT is not performed.

In reality, the pathology is often discovered by a random analysis, for example, during regular screening.The patient is then sent for additional examination.

Diagnostic criteria for diabetes and prediabetic condition

ANALYSIS	Rate, mmol/l	Defective 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
Random	less than 11.1	-	more than 11.1 with symptoms

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

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

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

All patients with diabetes are regularly monitored for complications after diagnosis.Standard examination includes ophthalmoscopy, foot examination, urine test for proteinuria, lipid test and creatinine level.Most endocrinologists consider it important to record a basic ECG and lipid profile during the initial treatment to study the dynamics of the disease and to predict the risk of cardiovascular diseases.If necessary, consultations with specialized specialists are prescribed - ophthalmologist, gynecologist, cardiologist, neurologist.

The most dangerous complications

All complications that develop with this disease can be divided into acute and chronic conditions.Acute ones usually occur when:

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

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

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

Important!To eliminate hypoglycemia, a person must urgently take simple carbohydrates.Lemonade, granulated 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 medications should always have any of the above products with them.

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

1. Diabetic cardiopathy, or "diabetic heart".Myocardial dystrophy develops in people over 40 years of age without significant signs of coronary atherosclerosis.It manifests as left ventricular dysfunction and leads to heart failure.The main symptoms are shortness of breath, arrhythmia and decreased tolerance to physical activity.
2. Metabolic syndrome X, or the "deadly four".The combination of hyperglycemia, obesity, hypertension and atherosclerosis provokes the 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 increases the manifestations of the others, creating a vicious circle.
3. Diabetic nephropathy.The main 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 renal glomeruli.The presence of hypertension accelerates pathological processes.This complication is considered one of the most hidden, since in the early stages it does not give any visible symptoms.The patient usually does not associate swelling, dyspepsia and weakness with kidney damage.Pain and urinary disorders appear in the later stages, when the problem is already difficult to treat.
4. Diabetic retinopathy.Subjectively, it feels like fog before the eyes, a characteristic "flicker".Surrounding objects become blurred and blurry.Decreased vision progresses to complete blindness.The cause is damage to retinal vessels with the subsequent appearance of microaneurysms, hemorrhages and edema.To prevent vision loss, patients should undergo an ophthalmoscopy once a year and, if problems arise, receive treatment.
5. Neuropathies.Neuronal function is disrupted due to the toxic effects of glucose, lack of oxygen, and electrolyte shifts.Diabetics experience a large number of neuropathies, but the most common of them is symmetrical polyneuropathy.Its main symptoms are numbness, restlessness, pain, loss of sensation in the hands and feet, "like gloves and socks".Such processes in the lower extremities can lead to inadequate loads with trauma or further infection of the feet and degeneration of the joints.Neuropathies affect not only the peripheral nerve fibers, but also the cranial nerves and the brain tissue itself.The result of this is acute neuropsychic disorders, neurosis-like conditions, dysfunction of innervated areas - decreased hearing, vision, smell, etc.
6. Diabetic foot.Against the background of damage to blood vessels, nerves, skin and joints, a syndrome appears, accompanied by ulceration of soft tissues and purulent-necrotic processes.Leg necrosis ends with amputation of the affected area.The syndrome occurs in 20-25% of patients.

Treatment: diet and medications

Treatment of diabetesit starts with lifestyle changes.This includes a properly structured diet, sufficient physical activity and regular monitoring of plasma sugar concentrations.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 the function of beta cells.The number of units and the scheme are selected individually.It is important to observe the time and dose of drug administration.

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

• stimulate your insulin secretion (sulfonylureas, meglitinides);
• increased sensitivity of insulin receptors (thiazolidinediones);
• inhibit additional pathways for glucose production (biguanides);
• preventing the absorption of sugars in the intestinal walls, 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.Both therapeutic and prophylactic agents are 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 prediction 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 leads 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 mainly 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, increases the risk of stroke and heart attack by two times, chronic renal failure by 17 times and leg necrosis by 20 times.Despite the dire numbers,the prognosis depends on the time of diagnosis and your personal attitude towards the disease.The earlier the disease is detected and the more carefully the patient approaches the treatment, the higher the survival rate.

Preventing

Preventive measures consist of:

1. Regular and adequate physical activity.The latter normalizes metabolism and increases the sensitivity of tissue receptors to insulin molecules.
2. diets.Meals are partial, 4-5 times a day, in small portions.The consumption of simple carbohydrates and saturated fats should be kept to a minimum.Avoid mayonnaise, pastries, jams, sausages and starchy foods.Avoid fried, fatty, highly salty, fast foods, smoked foods and canned foods.The basis should be complex carbohydrates, fiber and pectin.Lean fish, poultry, vegetables, herbal infusions, sugar-free compote, durum wheat pasta are preferred.Follow the BJU report 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 a prolonged course of ARVI, wear a mask and use antiseptics during epidemics and near sick people.