Diabetes mellitus is a pathological condition characterized by a violation of metabolic processes (metabolism). This happens due to insufficient production of its 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 features of the treatment of patients.
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, it is surrounded by the spleen and a 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 on the entire surface of the pancreas in the form of small groups called islets of Langerhans. The islets also contain α cells that synthesize the active hormonal substance glucagon. This hormone has the opposite effect to insulin.
Insulin is a protein molecule that consists of several chains of amino acids. Its job is to assimilate glucose (sugar) from the body's cells. 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 classification of diabetes mellitus generally accepted and used in modern endocrinology, the pathology is divided into the following types:
- Type 1 - insulin dependent (IDDM);
- type 2 - non-insulin dependent (NIDDM);
- gestational form;
- special types of diabetes.
The last option is a group of pathological conditions that differ from each other in their pathogenesis and causes of development. This includes hereditary defects at the genetic level on the part of the insulin hormone or insulin-secreting cells, disease 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 that manifests itself with high blood glucose levels. It is on the background of the diagnosis of glycemia numbers that the confirmation or refutation of the diagnosis of diabetes is based.
1 type
Type 1 pathology (ICD-10 code - E10) is considered an autoimmune process, which results in the death of insulin-secreting cells. Speaking in simple language, such processes start in the human body, during which their immune cells consider pancreatic cells as foreign and destroy them.
As a rule, the insulin-dependent type arises as a result of a hereditary predisposition, but an important role is also played by accompanying provocative factors. 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 pancreatic cells, occurs in more than 80% of insulin-dependent patients. Often, along with type 1 disease, diabetics suffer from other autoimmune diseases, for example, chronic kidney failure, pancreatic diseases, vitiligo, rheumatism.
How is it developing?
Typically, the clinical signs of the disease appear when more than 85% of the insulin-secreting cells have already died, but depending on the individual characteristics of the organism, this period can vary in its duration. It often appears in childhood and adolescence. It happens that young patients learn about the presence of the disease already in the period of acute complications, for example, in the ketoacidotic state.
Lack of energy and lack of insulin lead to a massive breakdown of fats and proteins, which explains the patient's weight loss. High blood sugar causes hyperosmolarity, which is manifested by the massive production of urine and the development of symptoms of dehydration. Since there is not enough insulin, the body suffers from energy starvation, as a result, 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 stimulation of the formation of glucose in the body, despite the fact that the blood sugar level is already going through the roof.
The massive breakdown of fats leads to an increase in the number of free fatty acids in the blood. This is a trigger for the formation and accumulation of ketone bodies (acetone), which become provocateurs of the ketoacidotic state. If such a pathology, dehydration and a 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 are taking their severity over several weeks. Patients with diabetes complain:
- for the formation of 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 a sharp 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 old), the symptoms are not so pronounced and, as a rule, the presence of the disease is determined during the 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 β-cells of the islets of Langerhans also stop working. In parallel with the metabolism of carbohydrates, the pathology also affects the process of fat metabolism.
Hereditary predisposition is one of the main causes of type 2 diabetes. If one of the parents has a disease, children get sick in 40% of cases. However, only heredity is not enough, the provoking factors are:
- high body weight;
- low physical activity;
- elevated blood pressure numbers;
- high levels of triglycerides in the blood;
- the presence of a baby born weighing more than 4 kg in the past;
- the 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 old men and women are more often ill.
How is it developing?
The mechanism of development is based on the fact that insulin resistance appears, that is, the pancreas produces a sufficient amount of the hormone necessary to transport sugar molecules to the cells, but the cells themselves lose sensitivity to this substance. The result is hyperglycemia.
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 the second type of pathological condition, the appearance of ketoacidosis is not characteristic, since even a small amount of the hormone is synthesized by the islets of Langerhans.
Symptoms
The disease usually occurs in patients over 40 years old. In most cases, the clinical framework is combined with the appearance of pathological body weight, changes in fat metabolism in blood tests. Associated symptoms:
- performance is slightly reduced, but this is not as pronounced as in the first type of the disease;
- pathological thirst;
- passing a large amount of urine;
- women may be bothered by itching of the skin in the genital area and perineum;
- rashes appear on the skin, which do not heal for a long time;
- discomfort, numbness and lumps 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 of a child, it is considered pregestational, during the period of birth of a baby - 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 mental trauma;
- infectious diseases;
- pancreatic diseases;
- inclusion in the menu in large quantities of foods rich in carbohydrates.
The form of pregnancy can appear 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 a group of patients at high risk of developing a type of non-insulin-dependent diabetes mellitus during the next 10-15 years.
During the period of childbirth, a woman's body undergoes certain changes related to the hormonal sphere. This is due to the functioning of the placenta, which secretes the following hormones:
- chorionic gonadotropin;
- progesterone;
- estrogen;
- corticosteroids etc.
All these hormonally active substances cause insulin resistance to appear. At this stage, there is hyperplasia of insulin-secreting cells and the release of a large amount of insulin into the blood from the pancreas. The appearance of insulin resistance leads to the fact that the woman's body begins to actively use the metabolic products of fats, while sugar is stored to feed the fetus. Under conditions of a combination of hereditary predisposition to diabetes and the above 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 pronounced, the pregnant woman may present the following complaints to the attending physician:
- dry mouth;
- constant desire to drink;
- passing a large amount of urine;
- increased appetite;
- decreased performance and weakness;
- the appearance of itching and burning in the genital area.
Important! Usually the disease develops at the end of the second trimester or at 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 at different periods of pregnancy;
- the birth of a child with a large body weight (more than 4-4, 5 kg).
Babies born to a sick mother 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 the development of the fetus and the death of the newborn. As a rule, such conditions occur in the presence of a pregestational form of the disease.
Specific types
It is about secondary forms of the pathological condition that develop under the influence of chemicals, drugs, infectious processes and other diseases of the endocrine and extra-endocrine sphere.
Diabetes can be caused by the following diseases and conditions of the pancreas:
- inflammation of organs;
- mechanical damage;
- removal of the gland;
- neoplasms;
- cystic fibrosis;
- pigmentary cirrhosis etc.
From chemicals and drugs, nicotinic acid, hormones of the adrenal cortex, interferons, thyroid hormones and diuretics can contribute to the development of the disease. The list goes on with opiates, rodenticides, 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;
- capillary blood test for glucose from a finger on an empty stomach;
- blood biochemistry;
- urine analysis for sugar;
- glucose tolerance test - is mandatory for all future mothers in the period from 22 to 26 weeks of pregnancy;
- determination of glycosylated hemoglobin indicators.
Therapeutic measures include not only taking medications, but also physical therapy exercises, correcting nutrition, teaching the patient self-control.
self control
Patients with diabetes should keep a record of their feelings, glycemia, sugar levels in the urine, as well as record data on individual menus and physical activity throughout the day. The totality of such indicators and their calculation 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 go beyond acceptable limits.
With normal health, it is important to measure the sugar level at home and record these indicators at least once a day. Any change in well-being requires 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 the evening break;
- in some cases, you may need a measurement in the morning on an empty stomach.
Glucose in the urine is also measured at home. This requires the presence of express strips. They can be bought at the pharmacy. The presence of sugar in the urine will indicate that the level of glucose in the blood exceeds 10 mmol / l, since it is this figure that is the threshold of the kidneys at which glucose molecules penetrate into the urine.
If the patient is traveling, actively involved in sports or has any concomitant diseases, a stricter self-monitoring will be needed.
For a comfortable daily life of a person with diabetes, it is necessary to purchase the following individual devices and equipment:
- glucometer with lancets, test strips and necessary accessories included;
- expressed urine strips, which measure the level of acetone and sugar bodies;
- tonometers to clarify blood pressure numbers;
- self-control diary, where all the necessary data will be recorded.
Food
Correction of individual nutrition is the basis for the treatment of any type of diabetes mellitus. With type 1, changing the personal menu allows you to reduce the load on the pancreas, reduce the amount of carbohydrates supplied 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 observe the daily intake of calories. It is calculated individually for each patient, depending on his weight, age, gender, energy expenditure, 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 limited a little, especially with type 2 pathology.
Patients will need to understand the system of bread units, glycemic and insulin indices of products, calories. Features of the principles of nutrition:
- do not eat more than 8 units of bread in one meal;
- Sweet liquids (lemonade, tea with sugar, store-bought juices) are prohibited;
- sweeteners are used instead of sugar, and homemade compotes and fruit drinks are used instead of store-bought juices;
- the number of bread units must be planned in advance, since insulin is administered before the products enter the body;
- meals should be in small portions, but frequent;
- patients should receive a sufficient amount of fluids - restrictions may be in the presence of kidney failure or other complications associated with 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 drinking alcohol is discussed 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.
Medical treatment
Treatment of IDDM and the pregnancy form is based on insulin therapy. This is the process of introducing hormonal preparations based on insulin to replace the lack of its substance in the body. There are several groups of drugs that differ in the duration of action and the speed of the onset of effect: ultrashort preparations, short-term, medium-term hormones and long-acting insulins.
Usually, doctors combine two drugs with different duration of action at the same time. This 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. He will also help you choose a therapy regimen, an optimal lifestyle and give recommendations that allow the patient to achieve compensation as soon as possible.