Diabetes mellitus type 1 and 2

Diabetes mellitus(DM) is an endocrine pathology that occurs due to insufficient synthesis/action of insulin.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 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 most quickly in undeveloped countries and in countries with weak economies.Doctors note a tendency towards an increase in incidence 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 (juvenile, youthful, children),
2. insulin-independent (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 various organs and tissues.Diabetes occurs either 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 retroviruses.The provoking factor causes acute damage to β-cells or leads to the persistence of the infectious agent in the pancreatic tissues with the further development of an autoimmune reaction.The likelihood of the disease increasing 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.So, this is facilitated by too early contact with gluten - it is optimal to introduce cereal porridge into complementary foods no earlier than 6-7 months.The risk increases when feeding a child with cow's milk, with a deficiency of vitamin D and with a high concentration of nitrates in drinking water.

Thanks to the adaptive capabilities of our body, 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, adolescents, and people under 30 years of age.Less commonly, it can be found in older patients in a latent form, which is often confused with non-insulin dependent.

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 noted 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 on internal organs.With class I obesity, the risk of developing the disease increases by 2 times, class II - by 5 times, class III - by 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, fried potatoes, soft wheat pasta.In combination with a sedentary lifestyle and a deficiency of plant fiber, such food, if consumed regularly, can cause irreparable harm to the body.

The second type usually occurs in adulthood.A trend has been noticed: the older a person is, the higher the concentration of glucose in the blood after eating a carbohydrate meal.The rate at which glucose decreases to normal largely depends on muscle mass and the degree of obesity.Since childhood obesity is now 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 decrease in the 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 clinic of diabetes 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 breakdown, gluconeogenesis and other reactions involving sugars.
2. Fatty - increases the synthesis of fatty acids and reduces their entry into the blood.
3. Protein - enhances protein synthesis and suppresses its breakdown, 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 for the body.The main symptoms are associated with impaired carbohydrate metabolism, in particular, hyperglycemia.Increased glucose levels lead to the following symptoms:

• thirst, dehydration, polyuria - urine output more than 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 protein metabolism disorder, the following signs of diabetes mellitus develop::

• muscular dystrophy - appears due to decreased synthesis and increased breakdown of protein;
• hypoxia - oxygen deficiency in tissues - causes lethargy, decreased concentration, and drowsiness;
• generalized 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; at high concentrations, without treatment, coma and death develop.

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 stage is characterized by an almost complete absence of symptoms.Diagnosis sometimes takes years, especially without proper examination.In diabetes, symptoms come and go according to fluctuations in blood glucose levels.General manifestations predominate, since 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 liquid per day, with a significant amount occurring at night;
• characteristic dry mouth (due to dehydration);
• frequent and copious urination; children may develop enuresis;
• skin itching, 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 in the tooth roots indicate a pre-diabetic condition.A biochemical analysis of the concentration of glucose in the blood does not show visible changes.Therefore, if such symptoms are detected, the patient is recommended to visit a therapist and take 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.

Diabetic patients are more likely to develop bronchitis, pneumonia, and are predisposed to tuberculosis.Men with prostate adenoma and women over the age of 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 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 itself in response to stress, viral infection, and overload of simple carbohydrates.Since sugars are absorbed extremely poorly, tissues and organs lack energy.In an attempt to compensate for 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 thirst, dizziness, lethargy, drowsiness, and rapid heartbeat.Characterized by frequent urination, abdominal pain, nausea, vomiting, and the smell of acetone from the mouth.Without appropriate 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 should:

• in case of acute respiratory infections, acute respiratory viral infections, monitor 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 administering the drug - just reduce the dose and consult a doctor for correction of therapy;
• do not skip injections and strictly monitor glucose levels;
• administer insulin using the correct instruments and in the correct 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 in response to the inability to use sugars as a source of energy.And in order 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 an 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 nausea.

Classification and types

The World Health Organization offers a fairly comprehensive classification of pathology.So, in addition to the already known first and second types, other specific types of the disease are distinguished.All of them belong to category III and are collected, according to the reason for their development, into 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 induced 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 allocated, which is a hidden disorder of carbohydrate metabolism in pregnant women.

Important!Treatment tactics for diabetes mellitus 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.

Diagnostics 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 potential 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 test.
4. Determination of the level of glycosylated hemoglobin (HbA1C).Rent in the same way.Avoid smoking, alcohol, and intense physical activity the day before.
5. Glucose tolerance test (OGTT).More sensitive, but at the same time more complex analysis.Used mainly for diagnosing prediabetic conditions, including during pregnancy.If FPG is more than 7.0 mmol/l, then OGTT is not performed.

In reality, pathology is often detected 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	Norm, mmol/l	Impaired 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%	more 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 urine glucose test, which was popular in the recent past, is no longer used due to its nonspecificity and low sensitivity.

Persons belonging to a high-risk group are recommended to regularly, once every three years, be tested for FPG and HbA1C (or OGTT).If FPG is already elevated, 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 diseases;
• birth of a child weighing more than 4.1 kg;
• hypertension;
• fatty liver hepatosis;
• high levels of cholesterol, “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 the dynamics of the disease and 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 medications 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 can take only a few hours from the first symptoms to full-blown coma.Both complications should be stopped as quickly as possible, if necessary, by consulting a doctor.

Hypoglycemia- decreased blood sugar - characterized by increased sweating, chills, severe weakness, and a feeling of severe hunger.Some patients note 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 need to call an ambulance.

Important!To eliminate hypoglycemia, a person urgently needs to take simple carbohydrates.Lemonade, lump 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 any of the above products with him.

Other complications are a consequence 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 pronounced signs of coronary atherosclerosis.It manifests itself 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 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 enhances the manifestations of others, creating a vicious circle.
3. Diabetic nephropathy.The leading factor of disability and mortality among patients with diabetes.Develops in 40-50% of cases, leading to chronic and end-stage renal failure.The main reason is damage to the capillaries of the kidneys, increased pressure inside the renal glomeruli.The presence of hypertension accelerates pathological processes.This complication is considered one of the most insidious, since in the early stages it does not give any noticeable 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 “flickering of flies”.Surrounding objects become fuzzy and blurry.Decreased vision progresses to the point of 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 undergo 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 shifts.Diabetics experience a huge number of neuropathies, but the most common of them is symmetrical polyneuropathy.Its main symptoms are numbness, discomfort, 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 further trauma or infection of the feet and degeneration of the joints.Neuropathies affect not only peripheral nerve fibers, but also 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 occurs, accompanied by ulceration of soft tissues and purulent-necrotic processes.Necrosis of the foot ends with amputation of the affected area.The syndrome occurs in 20-25% of patients.

Treatment: diet and medications

Treatment of diabetesstarts with lifestyle changes.This includes a properly structured diet, sufficient physical activity, and regular monitoring of plasma sugar concentrations.All this, coupled 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 drug administration.

Patients with type 2, in the event that diet and physical activity are not enough,antihyperglycemic agents are prescribed.These medications 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 the excretion of glucose in the 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 from damage to the vascular bed, ACE inhibitors help fight nephropathy in the early stages.

The forecast 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 patient with diabetes is reduced by 6-15 years.In the second type, the prognosis largely correlates with lifestyle.Smokers, alcoholics, and people with high cholesterol levels can extend their lives by simply 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 foot necrosis 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 fractional, 4-5 times a day, in small portions.Consumption of simple carbohydrates and saturated fats should be kept to a minimum.Avoid mayonnaise, pastries, jams, sausages, and starchy foods.Avoid fried, fatty, too salty foods, fast food, smoked foods, and canned food.The base should be complex carbohydrates, fiber, and pectins.Lean fish, poultry, vegetables, herbal infusions, unsweetened compotes, durum wheat pasta are preferred.Follow the BJU ratio 20:20:60.
3. Prevention of infections.The first type of diabetes mellitus often manifests itself under the influence of a viral infection.Therefore, if there are risk factors, it is recommended to strengthen the immune system, prevent a protracted course of ARVI, wear a mask and use antiseptics during epidemics and near sick people.