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 high level of sugar (glucose) in the blood plasma.It is hyperglycemia that is the main cause of diabetes symptoms and complications: metabolic disorders, damage to blood vessels and nerve fibers, kidney failure and blindness.

In the last forty years, the number of diabetes cases worldwide has almost quadrupled.The disease spreads more quickly in underdeveloped countries and countries with weak economies.Doctors observe a tendency for the incidence to increase in the age group over 40 years.In terms of social significance, this pathology ranks third, after cardiovascular diseases and cancer.

Diabetes mellitus is divided into two main types:

1. insulin dependent (juveniles, young people, children),
2. insulin independent (insulin resistant).

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

Causes

Insulin is a protein hormone synthesized in the beta cells of the pancreas.Its effects are carried out through insulin receptors in various organs and tissues.Diabetes occurs when beta cells are destroyed or when receptor sensitivity decreases.

Type 1 diabetes develops in the presence of a genetic predisposition.The impetus for the emergence of pathology is given by toxins and viral infections, such as rubella, influenza, hepatitis B virus, cytomegalovirus and retrovirus.The provoking factor causes acute damage to β-cells or leads to the persistence of the infectious agent in pancreatic tissues with the subsequent development of an autoimmune reaction.The likelihood of the disease increases if a person has other autoimmune diseases - thyroiditis, adrenal insufficiency, etc.

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

Thanks to our body's adaptive capabilities, type 1 diabetes can remain silent 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 around 10% of all pathology cases.It mainly affects children, teenagers and people under 30.Less commonly, it can be found in elderly patients in a latent form, often confused with non-insulin dependence.

Type 2 diabetes accompanied by impaired insulin secretion 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 tends to be an abdominal and visceral form, when excess fat is deposited mainly in the waist area and/or internal organs.With class I obesity, the risk of developing the disease increases 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, alcoholic drinks, flour products, sausages, fast food, French fries, soft wheat pasta.Combined with a sedentary lifestyle and a deficiency of vegetable fibers, these foods, if consumed regularly, can cause irreparable damage to the body.

The second type usually occurs in adulthood.A trend has been noticed: the older the person, the higher the concentration of glucose in the blood after eating a meal with carbohydrates.The rate at which glucose decreases to normal depends largely on muscle mass and the degree of obesity.As 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 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 their dysfunction.

Diabetes mellitus: symptoms of an insidious disease

Let us consider the diabetes clinic depending on the disorders 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. Carbohydrate – regulates plasma glucose levels, as well as glycogen degradation, 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 their degradation, activates DNA and RNA replication.
4. Electrolyte - activates the flow of potassium and inhibits the flow of sodium into cells.

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

• thirst, dehydration, polyuria - urine production exceeding three liters per day;
• polyphagia - constant need for food, gluttony, develops in response to energy deficiency;
• 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 develop::

• muscular dystrophy - appears due to a decrease in synthesis and increased degradation of proteins;
• hypoxia – oxygen deficiency in tissues – causes lethargy, decreased concentration and drowsiness;
• widespread vascular damage due to protein glycosylation.

Impaired fat metabolism manifests itself in:

• increasing 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 occur.

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

Clinic depending on the stage of the disease

The initial phase is characterized by an almost complete absence of symptoms.Diagnosis sometimes takes years, especially without a proper examination.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 around 3 to 5 liters of liquid per day, with a significant amount occurring at night;
• characteristic dry mouth (due to dehydration);
• frequent and profuse urination;children may develop enuresis;
• itchy skin in women, especially in the genital area.

Important!Progressive tooth decay 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 pre-diabetic condition.A biochemical analysis of blood glucose concentration shows no visible changes.Therefore, if such symptoms are detected, the patient is recommended to consult a therapist and undergo 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 dysfunctions, 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 generally difficult and often leads to serious complications.The cause of death in 38-50% of patients is myocardial infarction.

Diabetic patients are more likely to develop bronchitis, pneumonia and a predisposition 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 may occur due to vascular damage.

Signs of type 1 and type 2 diabetes

With the first type, people often don't 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 itself in response to stress, viral infection and simple carbohydrate overload.As sugars are very poorly absorbed, tissues and organs lack energy.In an attempt to compensate for the energy deficiency, the body begins to actively burn fat.This process is accompanied by the release of ketone bodies.

In large quantities, ketone bodies are toxic to humans.The patient feels thirsty, dizzy, lethargic, drowsy and tachycardia.Characterized by frequent urination, abdominal pain, nausea, vomiting and the smell of acetone in 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 independently.

To do this you must:

• in case of acute respiratory infections, acute respiratory viral infections, monitor plasma sugar levels more frequently 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 taking the medicine - just reduce the dose and consult a doctor to correct the therapy;
• do not skip injections and strictly monitor glucose levels;
• administer insulin using the correct instruments and in the correct location;
• monitor the expiration date and storage conditions of the medicine.

The other three main signs of type 1 diabetes are fatigue, weight loss and constant hunger.- arise in response to the inability to use sugars as a source of energy.And 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 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 in which a patient comes to the endocrinologist at an advanced stage of the disease, with complications.The most common complaints 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.Thus, in addition to the already known first and second types, other specific types of the disease can be distinguished.They all belong to category III and are grouped, depending on the reason for their development, into classes A, B, C, D, E, F, G and H.

1. This class includes genetic defects in 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 induced by chemicals and medications – 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, the clinical pictures of which are often diabetic symptoms (myodystrophy, Turner syndrome, Down syndrome, porphyria).

Separately, in category IV, gestational diabetes stands out, which is a latent disorder of carbohydrate metabolism in pregnant women.

Important!Diabetes mellitus treatment tactics largely 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

Diagnosis is made based on the following criteria.

1. History, symptoms, patient complaints.
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 being no later than 8 to 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 analysis, but at the same time more complex.Mainly used to diagnose pre-diabetic conditions, including during pregnancy.If FPG is greater than 7.0 mmol/l, OGTT will not be performed.

In reality, pathology is often detected by a random analysis, for example during regular screening.The patient is then referred for additional tests.

Diagnostic criteria for diabetes and prediabetic condition

Analysis	Norm, mmol/l	Impaired carbohydrate metabolism (prediabetes), mmol/l	MD, mmol/l
GP	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 urinary glucose test, popular in the recent past, is no longer used due to its nonspecificity and low sensitivity.

It is recommended that people belonging to a high-risk group regularly, once every three years, test for FPG and HbA1C (or OGTT).If the GPJ is already elevated, this monitoring must be carried out annually.Risk factors include:

• physical inactivity;
• obesity;
• age > 35 years;
• Family history of diabetes;
• pre-diabetes, gestational diabetes, PCOS, personal history of cardiovascular disease;
• 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 diabetic patients are regularly monitored for complications after diagnosis.Standard screening includes ophthalmoscopy, foot examination, urine test for proteinuria, lipid test, and creatinine level.Most endocrinologists consider it important to record a baseline ECG and lipid profile during initial treatment to study disease dynamics 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 that develop with this disease can be divided into acute and chronic conditions.Trebles usually occur when:

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

This includesketoacidotic statewhich was described in detail above, andhypoglycemic coma.Ketoacidosis and hypoglycemia often develop suddenly and may take just 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- decreased blood sugar - characterized by increased sweating, chills, intense weakness and a feeling of intense hunger.Some patients notice numbness and tingling in certain areas of the body.If the necessary actions are not taken, hypoglycemia turns into a coma - the patient loses consciousness.In this situation, it is necessary to call an ambulance.

Important!To eliminate hypoglycemia, a person urgently needs to eat simple carbohydrates.Lemonade, lump 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 medications should always carry one of the above products with them.

Other complications are a consequence of metabolic disorders and damage to small and large vessels.

1. Diabetic heart disease or “diabetic heart”.Myocardial dystrophy develops in people over 40 years of age without pronounced 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 quartet”.The combination of hyperglycemia, obesity, hypertension and atherosclerosis causes 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 enhances the manifestations of the others, creating a vicious circle.
3. diabetic nephropathy.The main factor of disability and mortality among patients with diabetes.It develops in 40-50% of cases, leading to chronic and terminal renal failure.The main reason is damage to the renal capillaries, increased pressure inside the renal glomeruli.The presence of hypertension accelerates pathological processes.This complication is considered one of the most insidious, as in the initial stages it does not present noticeable symptoms.The patient does not usually associate swelling, dyspepsia, and weakness with kidney damage.Pain and urinary disorders appear in later stages, when the problem is already difficult to treat.
4. diabetic retinopathy.Subjectively, it looks like a fog before the eyes, a characteristic “flickering of flies”.Surrounding objects become confused and blurry.Decreased vision progresses to complete blindness.The cause is damage to the retinal vessels with the subsequent appearance of microaneurysms, hemorrhages and edema.To prevent vision loss, patients should have an ophthalmoscopy once a year and, if problems occur, receive treatment.
5. Neuropathies.The functioning of neurons is disrupted due to the toxic effects of glucose, lack of oxygen and electrolyte changes.Diabetics have a large number of neuropathies, but the most common of them is symmetric polyneuropathy.Its main symptoms are numbness, discomfort, pain, loss of sensitivity in the hands and feet, “like gloves and socks”.Such processes in the lower extremities can lead to inappropriate 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 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 occurs, accompanied 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 medications

Diabetes treatmentIt starts with lifestyle changes.This includes a properly structured diet, sufficient physical activity and regular monitoring of plasma sugar concentrations.All this, combined with basic therapy, helps prevent the rapid progression of 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 timing and dosage of medication administration.

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

• stimulate the secretion of your own insulin (sulfonylurea, meglitinides);
• increase the sensitivity of insulin receptors (thiazolidinediones);
• inhibit additional pathways for glucose production (biguanides);
• prevent the absorption of sugars in the intestinal wall, slowing down their digestion (alpha-glucosidase inhibitors);
• increase glucose excretion in 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 caused 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 progresses to coma.In adults, the presence of complications and alcohol consumption are critical.The average life expectancy of each diabetes patient is reduced by 6 to 15 years.In the second type, the prognosis is largely correlated with lifestyle.Smokers, alcoholics and people with high cholesterol levels can prolong their lives simply by giving up bad habits and adjusting their diet.

The disease ranks first among the causes of blindness, increasing the risk of stroke and heart attack by two times, chronic kidney failure by 17 times and the risk of necrosis in the feet by 20 times.Despite the terrible numbers,the prognosis depends on the timeliness of 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 boil down 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 divided into 4 to 5 times a day, in small portions.The consumption of simple carbohydrates and saturated fats should be kept to a minimum.Avoid mayonnaise, sweets, jellies, sausages and starchy foods.Avoid fried, fatty, highly salty foods, fast food, smoked foods and canned foods.The basis should be complex carbohydrates, fiber and pectins.Lean fish, poultry, vegetables, herbal infusions, sugar-free jams and durum wheat pasta are preferred.Follow the BJU ratio 20:20:60.
3. Infection prevention.The first type of diabetes mellitus often manifests itself under the influence of a viral infection.Therefore, in the presence of 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.