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.Hyperglycemia is the main cause of the symptoms and complications of diabetes: metabolic disorders, damage to blood vessels and nerve fibers, kidney failure and blindness.

In the last forty years, the number of diabetes cases in the world has increased almost fourfold.The disease spreads fastest in underdeveloped countries and in countries with weak economies.Doctors note a trend towards an increase in morbidity in the over 40 age group.In terms of social importance, this pathology ranks third after cardiovascular and oncological diseases.

Diabetes mellitus is divided into two main types:

1. insulin dependent (youth, youth, children),
2. non-insulin dependent (insulin resistant).

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

reasons

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 the beta cells are destroyed or when the sensitivity of the receptor decreases.

Type 1 diabetes develops in the presence of a genetic predisposition.The impetus for the appearance 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 persistence of the infectious agent in pancreatic tissues with further development of an autoimmune reaction.The probability of disease increases if a person has other autoimmune diseases - thyroiditis, adrenal insufficiency, etc.

important!Diet plays a certain role in the onset of the disease in children.So this is facilitated by too early contact with gluten - it is optimal to introduce cereal porridge in complementary foods no earlier than 6-7 months.The risk increases when feeding a child with cow's milk, with vitamin D deficiency and with a high concentration of nitrates in drinking water.

Thanks to our body's adaptive abilities, type 1 diabetes can remain silent for many years.The first signs appear when the number of β-cells (and therefore 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 often, 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 reduced 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 abdominal and visceral, where excess fat is deposited mainly in the waist area and/or on the 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, in which simple, quickly digestible carbohydrates predominate, are considered diabetogenic.These are sweets, alcohol, flour products, sausages, fast food, French fries, soft wheat pasta.In combination with a sedentary lifestyle and a deficiency of vegetable fiber, such food, if consumed regularly, can cause irreparable harm to the body.

The second type usually occurs in adulthood.A trend is observed: the older a person is, the higher the concentration of glucose in the blood after taking a carbohydrate meal.The rate at which glucose decreases to normal is largely dependent on muscle mass and degree of obesity.As childhood obesity is now an epidemic, type 2 is becoming more common in children.

As in the previous case, the disease develops when the amount of synthesized insulin cannot fully compensate for the decrease in 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's look at 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. Carbohydrates - regulate 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 degradation, activates DNA and RNA replication.
4. Electrolyte - activates the flow of potassium and inhibits the flow of sodium in the cells.

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

• thirst, dehydration, polyuria - excretion of urine more than three liters per day;
• polyphagia - constant need for food, gluttony, develops in response to energy deficit;
• nausea, vomiting;
• accumulation of sorbitol (glucose conversion product) in nerve fibers, retina, lens with subsequent damage;
• susceptibility to bacterial and fungal infections.

Due to a violation of protein metabolism, the following signs of diabetes mellitus develop::

• muscular dystrophy - occurs due to reduced synthesis and increased degradation of proteins;
• hypoxia - lack of oxygen in the tissues - causes lethargy, reduced concentration and drowsiness;
• generalized vascular damage due to protein glycosylation.

Disrupted fat metabolism is manifested in:

• increase in 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 appears.

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 a proper examination.In diabetes, symptoms come and go with fluctuations in blood sugar levels.General manifestations prevail, since the damage to the internal organs is still far away.

Patients complain of:

• severe weakness, fatigue;
• thirst - patients can drink about 3-5 liters of liquid per day, with a significant amount appearing at night;
• characteristic dry mouth (due to dehydration);
• frequent and profuse urination;children may develop enuresis;
• itching of the skin, in women, especially in the genital area.

important!Progressive tooth decay and periodontal disease can often be detected among the first symptoms of diabetes.Loose teeth and deep carious lesions in the roots of the teeth indicate a prediabetic condition.Biochemical analysis of blood glucose concentration showed no 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 feet.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 ischemic 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.

Diabetics are more likely to develop bronchitis, pneumonia and are prone to tuberculosis.Men with prostate adenoma and women over 50 years of age suffer from cystitis and pyelonephritis 4 times more often than ordinary people.In an advanced stage, blindness and other complications can occur due to vascular damage.

Signs of type 1 and type 2 diabetes

In 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 an overload of simple carbohydrates.Because sugars are absorbed extremely poorly, tissues and organs lack energy.In an attempt to compensate for the energy deficit, the body begins to actively burn fat.This process is accompanied by the release of ketone bodies.

In large amounts, ketone bodies are toxic to humans.The patient experiences thirst, dizziness, lethargy, drowsiness, and rapid heart rate.It is characterized by frequent urination, abdominal pain, nausea, vomiting and the smell of acetone from the mouth.Without proper 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 must:

• in acute respiratory infections, acute respiratory viral infections, monitor the plasma sugar level more often and administer insulin in an appropriate amount;
• when using other drugs, warn your doctor about the presence of diabetes (for example, glucocorticoids increase the need for insulin);
• even during remission, do not stop taking the drug - just reduce the dose and consult a doctor for correction of therapy;
• do not miss injections and strictly monitor glucose levels;
• administer insulin with the right tools and in the right place;
• monitor the shelf life and storage conditions of the medicinal product.

The other three main symptoms of type 1 diabetes are fatigue, weight loss, and constant hunger.- arise in response to the inability to use sugars as an energy source.And to get rid of excess glucose, the body actively removes it with urine, which provokes polyuria.As a result of dehydration, the patient feels very weak.

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 accidentally, during a routine examination.There are situations when the patient comes to an endocrinologist at an advanced stage of the disease, with complications.The most common complaints in 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.They all belong to category III and are grouped, 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, certain 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 caused by chemicals and drugs - nicotinic acid, thyroid hormones, glucocorticoids, alpha-interferon, etc.
6. Viral infections - cytomegalovirus, congenital rubella, etc.
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).

Gestational diabetes, which is a hidden disorder of carbohydrate metabolism in pregnant women, is allocated separately in category IV.

important!The tactics of treating 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.

Diagnosis 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 possible 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 examination.
4. Determination of the level of glycosylated hemoglobin (HbA1C).Hire 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.It is mainly used to diagnose pre-diabetic conditions, including during pregnancy.If the FPG is more than 7.0 mmol/l, then the OGTT is not performed.

In fact, the pathology is often detected by random analysis, for example, during regular screening.The patient is then sent for further examination.

Diagnostic criteria for diabetes and prediabetes

Analysis	Norm, mmol/l	Disturbed 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%	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 urine glucose test popular in the recent past is no longer used due to its non-specificity and low sensitivity.

Individuals belonging to the high-risk group are recommended to be tested regularly, once every three years, for FPG and HbA1C (or OGTT).If FPG is already elevated, such monitoring should be done annually.Risk factors include:

• lack of physical activity;
• obesity;
• age > 35 years;
• A family history of diabetes;
• prediabetes, 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 patients with diabetes are regularly monitored for complications after diagnosis.Standard screening includes ophthalmoscopy, foot examination, urine test for proteinuria, lipid test, and creatinine level.Most endocrinologists believe that it is 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 disease.If necessary, consultations with specialized specialists are appointed - ophthalmologist, gynecologist, cardiologist, neurologist.

The most dangerous complications

All complications that develop with this disease can be divided into acute and chronic conditions.Acutes usually occur when:

• missing an insulin injection or taking a glucose-lowering drug;
• the use of other drugs 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 detailed above, andhypoglycemic coma.Ketoacidosis and hypoglycemia often develop suddenly, and it may take only a few hours from the first symptoms to complete coma.Both complications should be stopped as quickly as possible, if necessary, by consulting a doctor.

Hypoglycemia- low blood sugar - characterized by increased sweating, chills, severe weakness and a feeling of intense 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 should call an ambulance.

important!To eliminate hypoglycemia, a person urgently needs to take simple carbohydrates.Lemonade, sugar cubes (place under the tongue), juice - anything that is easy to swallow and digests quickly will do.To avoid such cases, a patient taking glucose-lowering drugs 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 cardiopathy or "diabetic heart".Myocardial dystrophy develops in people over the age of 40 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 reduced tolerance to physical activity.
2. Metabolic syndrome X or the "deadly quartet".The combination of hyperglycemia, obesity, hypertension, and atherosclerosis provokes early onset of angina pectoris and damage to peripheral arteries.Common complications are heart attack, stroke, transient ischemic attacks.The main problem is that each element of the quartet amplifies the manifestations of the others, creating a vicious circle.
3. Diabetic nephropathy.The leading factor in disability and mortality among patients with diabetes.It 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, because in the early stages it does not give noticeable symptoms.The patient usually does not associate swelling, dyspepsia and weakness with kidney damage.Pain and urination disorders appear in the later stages, when the problem is already difficult to treat.
4. Diabetic retinopathy.Subjectively, it feels like a fog before the eyes, a characteristic "fluttering of flies".Surrounding objects become fuzzy and blurry.Reduced vision progresses to complete blindness.The cause is damage to the vessels of the retina with the subsequent appearance of microaneurysms, hemorrhages and edema.To prevent vision loss, patients should undergo an ophthalmoscopy once a year and, if problems arise, receive treatment.
5. neuropathies.Neuronal functioning is impaired due to the toxic effects of glucose, lack of oxygen, and electrolyte changes.Diabetics suffer from a huge number of neuropathies, but the most common of them is symmetrical polyneuropathy.Its main symptoms are numbness, discomfort, pain, loss of feeling in the hands and feet, "like gloves and socks."Such processes in the lower limbs can lead to inadequate loads with additional trauma or infection of the legs and degeneration of the joints.Neuropathies affect not only the peripheral nerve fibers, but also the cranial nerves and the brain tissue itself.The result of this is acute neuropsychiatric disorders, neurosis-like conditions, dysfunction of innervated areas - reduced hearing, vision, sense of 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 medication

Treatment of diabetesit starts with lifestyle changes.This includes a properly structured diet, sufficient physical activity and regular monitoring of plasma sugar concentrations.All this, combined with the main therapy, helps to prevent the rapid progression of the 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 time and dosage of drug administration.

Patients with type 2, in case diet and physical activity are not sufficient,antihyperglycemic agents are prescribed.These drugs differ in their mechanism of action:

• stimulate the secretion of own insulin (sulfonylurea, meglitinides);
• increasing the sensitivity of insulin receptors (thiazolidinediones);
• inhibit additional glucose production pathways (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 person with diabetes is reduced by 6-15 years.In the second type, the prognosis is largely correlated 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 is the leading cause of blindness, doubles the risk of stroke and heart attack, 17 times the risk of chronic kidney failure and 20 times the risk of leg necrosis.Despite the dire numbers,the prognosis depends on the timeliness of the diagnosis and your personal attitude to the disease.The earlier the disease is detected and the more carefully the patient approaches the treatment, the higher the survival rate.

Prevention

Preventive measures are reduced to:

1. Regular and adequate physical activity.The latter normalizes metabolism and increases the sensitivity of tissue receptors to insulin molecules.
2. diet.Eating is partial, 4-5 times a day, in small portions.The consumption of simple carbohydrates and saturated fats should be kept to a minimum.Avoid mayonnaise, sweets, jams, sausages and starchy foods.Avoid fried, fatty, overly salty foods, fast food, smoked foods, and canned foods.The basis should be complex carbohydrates, fiber and pectins.Lean fish, poultry, vegetables, herbal decoctions, unsweetened compotes, durum wheat pasta are preferred.Follow the BJU 20:20:60 ratio.
3. Prevention of infections.The first type of diabetes mellitus often occurs under the influence of a viral infection.Therefore, if there are 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.