Diabetes mellitus is a pathological condition that is characterized by a violation of metabolic processes (metabolism). This occurs due to insufficient production of its own hormonal substance, insulin, as in type 1 diabetes mellitus or a violation of its effect on the cells and tissues of the body (type pathology2).
The article deals in detail with the main types of diabetes mellitus, 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 fats, 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 which synthesize the hormonally active substance glucagon. This hormone has the opposite action of insulin.
A healthy adult person has about a million of these islets with a total weight of several grams.
Insulin is a protein molecule made up of several chains of amino acids. Its task is to assimilate glucose (sugar) by the cells of the body. Sugar is necessary for a person to get energy. Without it, cells and tissues are not able to cope with their functions.
Along 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.
Classification of diabetes
According to the generally accepted classification of diabetes mellitus 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;
- certain types of diabetes.
This 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 in the hormone insulin or insulin-secreting cells, disease caused by the action of chemicals and drugs, diabetes resulting from infectious processes, etc.
All types of diabetes are united by hyperglycemia. It is a condition that is manifested by high levels of glucose in the blood. It is in the context of the diagnosis of the blood sugar figures that the confirmation or invalidation of the diagnosis of diabetes is based.
1 type
Type 1 pathology (code ICD-10 - E10) is considered an autoimmune process, which leads to the death of insulin-secreting cells. Clearly, such processes are initiated in the human body, during which their own immune cells consider pancreatic cells as foreign and destroy them.
As a rule, the insulin-dependent type results from a hereditary predisposition, but concomitant 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%.
If one family member has the disease, the rest of the family may be healthy, even if they are at high risk.
The presence of an autoimmune process, that is, antibodies in the body against the own cells of the pancreas, occurs in more than 80% of insulin-dependent patients. Often, in addition to type 1 disease, diabetics suffer from other autoimmune diseases, such as chronic adrenal insufficiency, pancreatic diseases, vitiligo, rheumatism.
How is it evolving?
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. 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 state ketoacidosis.
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. Since there is not enough insulin, the body suffers from energy starvation, which leads to an excessive synthesis of contrasular hormones, that is, those that have the opposite effect with respect to workinsulin.
These hormones include cortisol, glucagon and somatotropin. They cause the stimulation of the formation of glucose in the body, despite the fact that the level of sugar in the blood is already exploding.
The massive breakdown of fat leads to an increase in the number of free fatty acids in the blood. It is a trigger for the formation and accumulation of ketone bodies (acetone), which become provocateurs of a ketoacidotic state. If such a pathology, dehydration and a shift in the pH of the blood to the acid 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 worsen over several weeks. Diabetic patients complain:
- for the formation of a large amount of urine;
- excessive thirst;
- constant itching of the skin;
- weightloss.
Manifestations of the disease are considered quite specific, but still require differential diagnosis.
Weight loss, which is accompanied by normal or increased appetite, is one of the symptoms that distinguishes type 1 pathology from other types of diabetes mellitus. The patient is worried about acute weakness, he cannot do his usual job, drowsiness occurs.
The progression of the clinical picture is accompanied by the appearance of the smell of acetone in the exhaled air, abdominal pain, nausea and vomiting, and symptoms of severe dehydration. If the disease appears at an older age (about 40 years), the symptoms are not so pronounced, and, as a rule, the presence of the disease is determined during clinical examination.
type 2
Non-insulin-dependent diabetes mellitus (code ICD-10 - 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 disturbed. Along 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 is sick, the 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 ovaries.
Currently, the number of patients with type 2 diabetes is increasing. This form of pathology represents more than 85% of all clinical cases. Men and women of middle and old age are more often ill.
How is it evolving?
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 into cells, but cellsthemselves lose their sensitivity to this substance. The result is hyperglycemia.
In order to reduce the blood sugar level, the gland begins to work at the limit of its capacity. This causes 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 manifests in patients over the age of 40. In most cases, the clinical picture is associated 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;
- excretion of a large amount of urine;
- women may be disturbed by itchy skin in the genital area and perineum;
- rashes appear on the skin, which do not heal for a long time;
- discomfort, numbness and goosebumps in the lower extremities.
Gestational type
The WHO classification of diabetes mellitus includes the gestational form of the disease (code ICD-10 - O24). It is typical of pregnant women. Suffer from diabetes 5-7% of patients who carry babies. 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, then it is considered pregestational, during the period of carriage - gestational. At present, 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 a large amount of foods rich in carbohydrates.
Obstetricians and gynecologists agree that adequate physical activity can reduce the risk of developing a pathology.
The gestational form can manifest itself as a manifestation, that is, a vivid clinical picture, or as a violation of glucose tolerance. Pathology, as a rule, disappears on its own after the birth of the baby.
The woman becomes a member of a group of patients with a high risk of developing a non-insulin-dependent type of diabetes mellitus in the next 10-15 years.
During the period of childbirth, the body of a woman undergoes certain changes 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 of these hormonally active substances cause the appearance of insulin resistance. 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 female body begins to actively use fat metabolic products, while sugar is stored to nourish 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 her 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;
- excretion of 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 or the beginning of the third trimester.
The impact of pathology on the mother and fetus
Chronic hyperglycemia negatively affects both the mother's body and the child himself. Pregnancy can be complicated:
- polyhydramnios;
- late gestosis;
- termination of pregnancy at different periods of gestation;
- 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 wide, 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 are distinguished from their peers by 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:
- inflammation of organs;
- mechanical damage;
- removal of the gland;
- neoplasms;
- cystic fibrosis;
- pigmentary cirrhosis, etc.
Among 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, poisons intended for the destruction of rodents, antidepressants, drugs used for antiretroviral therapy.
Among the causative agents of infectious diseases, the provoking factors are rubella virus and cytomegalovirus.
Treatment characteristics
Therapy for the disease state is selected individually for each clinical case. The scheme and methods of treatment 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 guidance on 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 taking medications, but also physiotherapy exercises, nutritional correction, teaching the patient self-control.
It is important that relatives support a sick person's desire to reduce the aggressiveness of the pathological condition and obtain compensation.
self control
Diabetic patients should keep a record of their feelings, blood sugar levels, urine sugar levels, as well as data on individual menus and physical activity throughout the day. All of these indicators and their accounting are subject to self-monitoring. 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 figures exceed the acceptable range.
With normal health, it is important to measure the level of sugar 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 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 bands. They can be purchased at pharmacies. The presence of sugar in the urine will indicate that the blood sugar level exceeds 10 mmol/l, since this figure is the renal threshold at which glucose molecules enter the urine.
If the patient travels, actively participates in sports, or has comorbidities, more stringent self-monitoring will be required.
For comfortable everyday life of a person with diabetes, it is necessary to purchase the following individual devices and devices:
- glucometer with lancets, test strips and necessary accessories included;
- express urine strips, which measure the level of acetone bodies and sugar;
- tonometers to clarify blood pressure figures;
- self-check log, where all the necessary data will be recorded.
Food
The correction of individual nutrition is the basis of 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 observe table number 9, which may have several options (a, b, c).
Patients should strictly observe the daily calorie intake. It is calculated individually for each patient, depending on their weight, age, sex, energy expenditure, physical activity, drug treatment used. In the diet of patients, it is necessary to limit the consumption of carbohydrates and high-calorie foods. Proteins are not only possible, but also necessary, fats should be somewhat limited, especially with type 2 pathology.
Patients will need to understand the bread unit system, glycemic and insulin indices of products, calories. Characteristics of Nutrition Principles:
- do not eat more than 8 units of bread at one meal;
- sweet liquids (lemonade, sweet tea, commercial juice) are prohibited;
- instead of sugar, sweeteners are used, and instead of store-bought juices, homemade compotes and fruit drinks are used;
- the number of bread units must be planned in advance, as insulin is administered before the products enter the body;
- meals should be in small portions, but frequent;
- patients should be given a sufficient amount of fluid - restrictions may be 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 eaten without fear, in the table.
| The most caloric to limit | Authorized products | Amount of alcohol allowed (on the conditions of use - below) |
|---|---|---|
|
|
|
The possibility of drinking alcohol is discussed individually. A small amount is allowed if there is compensation for diabetes mellitus, if there are no complications, the patient feels normal. Beer and sugary cocktails are prohibited.
Medical treatment
The treatment of DSID and the gestational form is based on insulin therapy. This is the process of introducing hormonal preparations based on insulin in order to replace 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 effect: ultrashort preparations, short- and medium-acting 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.
Drugs are administered with insulin syringes, syringe pens or using an insulin pump in automatic mode.
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 only be carried out by a qualified specialist. He will also help you choose a treatment regimen, an optimal way of life, and give recommendations for the patient to get compensation as soon as possible.