Diabetes mellitus is a pathological condition characterized by a violation of metabolic processes (metabolism). This happens due to insufficient production of its 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 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 on almost 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 substance of the hormone glucagon. This hormone has the opposite action to insulin.
A healthy adult person has about a million of these islets with a total weight of several grams.
Insulin is a protein molecule that consists of several chains of amino acids. Its task is to assimilate glucose (sugar) by the body's cells. Sugar is necessary for a person to obtain energy. Without it, cells and tissues are not able to handle their functions.
In parallel with sugar intake, insulin also regulates the penetration of amino acids into cells. Amino acids are considered one of the main building materials. Another function of insulin is the accumulation of lipids in the body.
diabetes classification
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;
- 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 hormone insulin or insulin-secreting cells, a disease caused by the action of chemicals and drugs, diabetes as a result of infectious processes, etc.
All types of diabetes are linked by hyperglycemia. This is a condition that is manifested by high blood glucose levels. It is in the context of diagnosing blood glucose numbers that 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 are launched in the human body, during which your own immune cells regard the pancreatic cells as foreign and destroy them.
As a rule, the insulin-dependent type arises as a result of an inherited predisposition, but concomitant provoking 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%.
If one of the relatives has the disease, the rest of the family may be healthy, although at high risk.
The presence of an autoimmune process, that is, antibodies in the body against the pancreas cells itself, occurs in more than 80% of insulin-dependent patients. Often, along with type 1 disease, diabetics suffer from other autoimmune diseases, for example, chronic adrenal insufficiency, pancreatic diseases, vitiligo, rheumatism.
How is it developing?
Normally, 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 occurs 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.
Energy deficiency and insulin deficiency lead to massive breakdown of fats and proteins, which explains the patient's weight loss. High blood sugar causes hyperosmolarity, which is manifested by massive production of urine and the development of symptoms of dehydration. As 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 on the work of insulin.
These hormones include cortisol, glucagon and somatotropin. They cause the stimulation of glucose formation in the body even though the blood sugar level is already past the ceiling.
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 triggers of a ketoacidotic state. If such pathology, dehydration and a shift in blood pH to the acidic side continue to progress, the patient may fall into a coma, even death is possible.
Symptoms
Type 1 diabetes is characterized by the development of bright symptoms, which gain in severity over several weeks. Diabetic patients complain:
- for the formation of a large amount of urine;
- excessive thirst;
- constant itching of the skin;
- weight loss.
The manifestations of the disease are considered quite specific, but still require differential diagnosis.
Weight loss, 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 an acute weakness, he cannot do his usual work, drowsiness occurs.
The progression of the clinical picture is accompanied by the appearance of acetone odor in the 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 during the clinical examination.
type 2
Non-insulin-dependent diabetes mellitus (ICD-10 code - E11) is a chronic pathology against which high blood sugar levels occur due to insulin resistance. Later, the work of the β cells of the islets of Langerhans is also stopped. In parallel with carbohydrate metabolism, the pathology also affects the metabolic process of fat.
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, heredity alone is not enough, the provoking factors are:
- high body weight;
- low physical activity;
- high 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 ovary.
Currently, the number of patients with type 2 diabetes is growing. This form of pathology accounts for more than 85% of all clinical cases. Middle-aged and older men and women are more often sick.
How is it developing?
The developmental mechanism is based on the fact that insulin resistance appears, 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.
To reduce blood sugar levels, the gland starts working at the limit of its capabilities. This causes the depletion of insulin-secreting cells.
For the second type of pathological condition, the appearance of ketoacidosis is uncharacteristic, as even a small amount of the hormone is synthesized by the islets of Langerhans.
Symptoms
The disease usually manifests itself in patients over 40 years of age. 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 this is not as pronounced as in the first type of illness;
- pathological thirst;
- excretion of a large amount of urine;
- women can be troubled by itchy skin in the genital area and perineum;
- rashes appear on the skin, which do not heal for a long time;
- discomfort, feeling of numbness and chills in the lower extremities.
gestational type
The WHO classification for diabetes mellitus includes the gestational form of the disease (ICD-10 code - O24). It is typical for pregnant women. 5-7% of patients who have babies 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 time of conception of a child, then it is considered pre-gestational, during the period of birth of a baby - gestational. At the moment, the mechanism of development and 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;
- pancreas diseases;
- inclusion in the menu of large amounts of foods rich in carbohydrates.
Obstetricians and gynecologists agree that adequate physical activity can reduce the risk of developing pathology.
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 on its own after the birth of the baby.
The woman becomes part of a group of patients at high risk of developing non-insulin-dependent diabetes mellitus in the next 10-15 years.
During the period of having a child, a woman's body undergoes certain changes that are associated with 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 onset of insulin resistance. In this phase, hyperplasia of insulin-secreting cells and the release of a large amount of insulin into the blood of the pancreas are observed. 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 nourish the fetus. In conditions of a combination of hereditary predisposition to diabetes and the above factors, the disease develops.
Symptoms
The gestational type of the disease manifests in the same way as other types of diabetes, but the symptoms are slightly less pronounced. A woman may not pay attention to symptoms, associating their occurrence with her "interesting" position. If the clinical picture is accentuated, the pregnant woman can present the following complaints to the attending physician:
- dry mouth;
- constant desire to drink;
- excretion of a large amount of urine;
- increased appetite;
- decreased performance and weakness;
- the appearance of itching and burning in the genital area.
Important! Typically, the disease develops in the late second or early third trimester.
The impact of 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 a sick mother have a characteristic appearance. His 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 a pregestational form of the disease.
Children born to a sick mother differ from their peers in their large body weight and characteristic appearance.
specific types
We are talking 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:
- 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 all contribute to the development of the disease. The list goes on with opiates, poisons intended for the destruction of rodents, antidepressants, drugs used for antiretroviral therapy.
Of the causative agents of infectious diseases, the triggering factors are rubella virus and cytomegalovirus.
Treatment features
Therapy of the pathological condition is selected individually for each clinical case. The regimen and treatment methods used depend on the degree of diabetes, its type, the brightness of the clinical picture and the presence of complications. How to determine and confirm the presence of the disease, a qualified endocrinologist will tell you. It will give instructions for the following diagnostic methods:
- general blood and urine tests;
- capillary blood analysis for glucose from a finger on an empty stomach;
- blood biochemistry;
- urinalysis for sugar;
- glucose tolerance test - it is mandatory for all pregnant women in the period from 22 to 26 weeks of pregnancy;
- determination of indicators of glycosylated hemoglobin.
Therapeutic measures include not only the use of medication, but also physical therapy exercises, nutritional correction, teaching self-control to the patient.
It is important that family members support a sick person's desire to reduce the aggressiveness of the pathological condition and obtain compensation.
self control
Patients with diabetes should keep a record of their feelings, blood glucose, urine sugar levels, in addition to recording data about individual menus and physical activity throughout the day. All of these indicators and their accounting are self-controlled. The purpose of such events is not only to control the level of sugar, but also to interpret the results, as well as to plan your actions if the numbers exceed the acceptable range.
With normal health, it is important to measure your sugar level at home and record these indicators at least once a day. Any 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 night rest;
- in some cases, you may need a morning measurement on an empty stomach.
Urine glucose is also measured at home. This requires the presence of express strips. They can be purchased at pharmacies. The presence of sugar in the urine will indicate that the blood glucose level exceeds 10 mmol/l, as it is this value that is the renal threshold at which glucose molecules enter the urine.
If the patient is traveling, actively involved in sports, or has any comorbidities, more rigorous self-monitoring is warranted.
For the comfortable daily life of a person with diabetes, it is necessary to purchase the following devices and individual devices:
- 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 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 are advised to look at table number 9, which may have several options (a, b, c).
Patients should strictly observe their daily caloric intake. It is calculated individually for each patient, depending on their weight, age, sex, 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 bit, especially with type 2 pathology.
Patients will have to understand the bread unit system, glycemic and insulin indices of the products, calories. Features of the principles of nutrition:
- do not eat more than 8 pieces of bread in one meal;
- sweet liquids (lemonade, tea with sugar, store-bought juice) are prohibited;
- instead of sugar, sweeteners are used, and instead of store-bought juices, homemade jams and fruit drinks are used;
- the number of units of bread must be planned in advance, as insulin is administered before the products enter the body;
- meals should be in small but frequent portions;
- patients should receive a sufficient amount of fluids - restrictions may occur in the presence of renal failure or other complications accompanied by edema.
You can read more about prohibited foods, as well as those that should be consumed without fear, in the table.
| The most calories to limit | allowed products | Allowed amount of alcohol (under conditions of use - below) |
|---|---|---|
|
|
|
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
The treatment of IDDM and the gestational form is based on insulin therapy. This is the process of introducing insulin-based hormonal preparations to replace the body's lack of its own substance. There are several groups of drugs that differ in duration of action and speed of onset of effect: ultra-short preparations, short- and medium-acting hormones, and prolonged insulins.
Doctors usually combine two drugs with different duration of action at the same time. This is necessary to create the most physiological conditions for the pancreas.
Medications are administered with insulin syringes, syringe pens, or using an insulin pump in automatic mode.
Type 2 disease requires the use of hypoglycemic pills. The main groups are biguanides, sulfonylurea preparations, thiazolidinediones, glinides, etc.
Differential diagnosis between types of diabetes mellitus should only be performed by a qualified specialist. He will also help you choose a therapy regimen, an optimal lifestyle, and provide recommendations that will allow the patient to obtain compensation as quickly as possible.