Diabetes mellitus is a pathological condition that is 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 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 localized almost over the entire surface of the pancreas in the form of small groups called the islets of Langerhans. The islets also contain α-cells that synthesize the hormone-active substance glucagon. This hormone has the opposite action to insulin.
An adult healthy 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 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.
In parallel with the intake of sugar, 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 classification of diabetes mellitus generally accepted and used in modern endocrinology, 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 latter 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 secretory cells, a 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 is manifested by elevated levels of glucose in the blood. It is against the background of diagnosing glycemia 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 secretory cells. Speaking in plain language, such processes are launched in the human body, during which their own immune cells consider pancreatic cells to be foreign and destroy them.
As a rule, the insulin-dependent type arises as a result of 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 of the relatives has the disease, the rest of the family may be healthy, although they are at high risk.
The presence of an autoimmune process, that is, antibodies in the body to the pancreas' own 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 adrenal insufficiency, pancreatic diseases, vitiligo, rheumatism.
How is it developing?
Typically, clinical signs of the disease appear when more than 85% of insulin secretory cells have already died, but depending on the individual characteristics of the organism, this period may 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 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 urine production and the development of symptoms of dehydration. Since there is not enough insulin, the body suffers from energy hunger, as a result, an excessive synthesis of contrainsular hormones occurs, that is, those that have the opposite effect in relation to the work of insulin.
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 going through the roof.
Massive breakdown of fats leads to an increase in the numbers of free fatty acids in the blood. This is a trigger for the formation and accumulation of ketone (acetone) bodies, 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, even death is possible.
Symptoms
Type 1 diabetes is characterized by the development of bright symptoms, which are gaining their severity within a few weeks. Diabetic patients complain:
- for the formation of a large amount of urine;
- excessive thirst;
- constant itching of the skin;
- weight loss.
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 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 occurs.
The progression of the clinical picture is accompanied by the appearance of an 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 β-cells of the islets of Langerhans is also disrupted. In parallel with carbohydrate metabolism, pathology also affects the fat metabolic process.
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, provocative factors are:
- high body weight;
- low physical activity;
- elevated blood pressure numbers;
- high levels of triglycerides in the blood;
- the presence of a born baby weighing more than 4 kg in the past;
- the presence of gestational diabetes in the past;
- polycystic ovaries.
At the moment, the number of patients with type 2 diabetes is growing. This form of pathology accounts for more than 85% of all clinical cases. Men and women of middle and older age 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 into the cells, but the cells themselves lose sensitivity to this substance. The result is hyperglycemia.
In order to reduce blood sugar levels, the gland begins to work to the limit of its capabilities. This provokes the depletion of insulin secretory cells.
For the second type of pathological condition, the appearance of ketoacidosis is uncharacteristic, since even a small amount of the hormone is synthesized by the islets of Langerhans.
Symptoms
The disease usually manifests itself in patients older than 40 years. 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 disease;
- pathological thirst;
- excretion of a large amount of urine;
- women may be disturbed 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, feeling of numbness and goosebumps on 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. Suffer from diabetes 5-7% of patients who bear 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, it is considered pregestational, during the period of bearing 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 may be:
- physical and mental trauma;
- infectious diseases;
- diseases of the pancreas;
- inclusion in the menu in large quantities 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. Pathology, as a rule, disappears on its own after the baby is born.
The woman becomes a member of a group of patients with a high risk of developing non-insulin-dependent type of diabetes mellitus over the next 10-15 years.
During the period of bearing 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 of these hormonally active substances cause the appearance of insulin resistance. At this stage, hyperplasia of insulin secretory cells and the release of a large amount of insulin into the blood are observed 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 in order 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 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 its occurrence 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 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 gestation periods;
- the birth of a child with a large body weight (more than 4-4. 5 kg).
Babies born from 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 severe 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 from 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;
- removal of the gland;
- neoplasms;
- cystic fibrosis;
- pigmentary cirrhosis, etc.
Of the chemicals and drugs, nicotinic acid, adrenal cortex hormones, interferons, thyroid hormones, and diuretics can contribute to the development of the disease. The list continues with opiates, poisons intended for the destruction of rodents, antidepressants, drugs used for antiretroviral therapy.
Of the causative agents of infectious diseases, provoking factors are the rubella virus and cytomegalovirus.
Features of treatment
Therapy of the pathological condition 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. He will give directions to the following diagnostic methods:
- general blood and urine tests;
- analysis of capillary blood for glucose from a finger on an empty stomach;
- blood biochemistry;
- urinalysis for sugar;
- glucose tolerance test - it is mandatory for all expectant mothers 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, nutrition correction, teaching the patient self-control.
It is important that relatives support in a sick person the desire to reduce the aggressiveness of the pathological condition and achieve compensation.
self control
Patients with diabetes should keep a record of their feelings, glycemia, urine sugar levels, as well as record data on individual menus and physical activity throughout the day. The totality of such indicators and their accounting is self-control. The purpose of such events is not only to control the level of sugar, but also to interpret the results, as well as plan their actions if the numbers go beyond 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 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 evening rest;
- in some cases, you may need a morning measurement on an empty stomach.
Glucose in urine 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, since it is this figure that is the renal threshold at which glucose molecules penetrate the urine.
If the patient is traveling, actively involved in sports or has any comorbidities, more stringent self-monitoring will be needed.
For the daily comfortable living 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 the numbers of blood pressure;
- 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 are advised to observe table number 9, which may have several options (a, b, c).
Patients must strictly observe the daily calorie intake. 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 have to understand the system of bread units, glycemic and insulin indices of products, calories. Characteristics of the principles of nutrition:
- do not eat more than 8 bread units at 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 compotes and fruit drinks are used;
- 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 fluid - restrictions may be in the presence of renal failure or other complications that are 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 high-calorie ones to limit | Allowed Products | Allowed amount of alcohol (on the conditions of use - below) |
|---|---|---|
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|
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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 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 the duration of action and the speed of the onset of the effect: ultrashort preparations, short, medium-lasting hormones and prolonged 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.
The 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 therapy regimen, an optimal lifestyle, and give recommendations that allow the patient to achieve compensation as quickly as possible.