Diabetes mellitus is a pathological condition characterized by a violation of metabolic processes (metabolism). This happens due to insufficient production of the own hormonal substance insulin, as in type 1 diabetes mellitus or a violation of its effect on the cells and tissues of the body (pathology type 2).
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, surrounded by the spleen and duodenal loop. 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 on 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 hormonally active substance glucagon. This hormone has the opposite effect of insulin.
Insulin is a protein molecule that consists of several chains of amino acids. Its job is to assimilate glucose (sugar) from the body's cells. A person needs sugar to get energy. Without it, cells and tissues cannot cope with their functions.
Along with the intake of sugar, insulin also regulates the penetration of amino acids into the 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, 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 are hereditary defects at the genetic level on the part of the insulin hormone or insulin-secreting cells, 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 manifests itself with elevated levels of glucose in the blood. Confirmation or refutation of the diagnosis of diabetes is based on the diagnosis of glycemia values.
1 species
Type 1 pathology (ICD-10 code - E10) is considered an autoimmune process that leads to the death of insulin-secreting cells. Speaking in simple language, such processes are started in the human body, in which the own immune cells consider the cells of the pancreas to be foreign and destroy them.
As a rule, the insulin-dependent type occurs as a result of a hereditary 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%.
The presence of an autoimmune process, i. e. antibodies in the body against 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?
Usually, 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 length. It is common 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 a ketoacidotic state.
The energy deficit and insulin deficiency lead to massive fat and protein breakdown, 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, as a result of which there is an excessive synthesis of counterinsular hormones, i. e. those that have the opposite effect in relation to the work of insulin.
These hormones include cortisol, glucagon, and somatotropin. They cause 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.
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 (acetone) bodies, which become provocateurs of a ketoacidotic state. If such pathology, dehydration and shifting of 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 that gain their weight over several weeks. Patients with diabetes complain of:
- to form a large amount of urine;
- excessive thirst;
- constant itching of the skin;
- weight loss
Weight loss, accompanied by normal or increased appetite, is one of the symptoms that distinguish type 1 pathology from other types of diabetes. The patient is worried about acute weakness, cannot do his usual work, drowsiness appears.
The progression of the clinical picture is accompanied by the appearance of the smell of acetone in 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 established during the clinical examination.
type 2
Non-insulin-dependent diabetes mellitus (ICD-10 code - E11) is a chronic pathology, against the background of which high blood sugar levels occur due to insulin resistance. Later, the β-cell function of the islets of Langerhans is also impaired. Along with carbohydrate metabolism, the pathology also affects the process of fat metabolism.
Hereditary predisposition is one of the main causes of type 2 diabetes. If one of the parents has the disease, children get sick in 40% of cases. Heredity alone is not enough, provoking factors are:
- high body weight;
- low physical activity;
- increased blood pressure values;
- 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 accounts for more than 85% of all clinical cases. Middle-aged and older men and women are more often affected.
How is it developing?
The mechanism of development is based on the fact that insulin resistance occurs, i. e. 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 begins to work at the limit of its capabilities. This provokes the depletion of insulin-secreting 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 occurs in patients over 40 years of age. In most cases, the clinical picture is combined with the appearance of abnormal body weight, changes in fat metabolism during blood tests. Associated symptoms:
- efficiency 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 bothered by itching of the skin in the genital area and perineum;
- rashes appear on the skin that do not heal for a long time;
- discomfort, tingling and goosebumps in the lower limbs.
Gestational type
The WHO classification of diabetes mellitus includes the gestational form of the disease (ICD-10 code - O24). It is characteristic of pregnant women. 5-7% of patients who carry 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 appears in a woman before the moment of conception of a child, it is considered pregestational, during the period of childbirth - gestational. Currently, 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;
- diseases of the pancreas;
- inclusion in the menu in large quantities of foods rich in carbohydrates.
The gestational form can manifest itself as a manifestation, i. e. a bright 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 with a high risk of developing non-insulin-dependent diabetes mellitus in the next 10-15 years.
During the period of carrying a child, a woman's body undergoes certain changes that are related to the hormonal sphere. This is due to the functioning of the placenta, which releases the following hormones:
- chorionic gonadotropin;
- progesterone;
- estrogens;
- corticosteroids, etc.
All these hormonally active substances cause the appearance of insulin resistance. At this stage, hyperplasia of the insulin-secreting cells and the release of a large amount of insulin into the blood from 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 fat, while sugar is stored to nourish the fetus. In the 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 slightly less pronounced. A woman may not pay attention to the symptoms, associating their appearance with her "interesting" position. If the clinical picture is expressed, 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;
- reduced performance and weakness;
- the appearance of itching and burning in the genital area.
important! The disease usually develops at the end of the second or beginning of the third trimester.
The impact of the pathology on the mother and the fetus
Chronic hyperglycemia negatively affects both the mother's body and the child itself. Pregnancy can be complicated:
- polyhydramnios;
- late gestosis;
- termination of pregnancy at 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. Their 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 intrauterine development and the death of the newborn. As a rule, such conditions occur in the presence of a pregestational form of the disease.
Specific species
We are talking about secondary forms of a pathological condition that develop under the influence of chemicals, drugs, infectious processes and other diseases of the endocrine and extraendocrine 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.
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 goes on with opiates, poisons designed to kill rodents, antidepressants, drugs used for antiretroviral therapy.
Features of treatment
The 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. A qualified endocrinologist will tell you how to determine and confirm the presence of the disease. He will give instructions for the following diagnostic methods:
- general blood and urine tests;
- capillary blood glucose analysis from a fingertip on an empty stomach;
- blood biochemistry;
- urine test 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 drugs, but also physical therapy exercises, correction of nutrition, teaching the patient to self-control.
self control
Patients with diabetes should keep a record of their feelings, glycemia, sugar levels in the urine, as well as record data about individual menus and physical activity throughout the day. The set of such indicators and their reporting is self-control. 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 numbers exceed the permissible range.
In 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 evening rest;
- in some cases, a morning measurement on an empty stomach may be necessary.
Urine glucose is also measured at home. This requires the availability of express lanes. 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 penetrate into the urine.
If the patient travels, actively sports or has concomitant diseases, stricter self-control is necessary.
For the daily comfortable life of a person with diabetes, it is necessary to purchase the following individual devices and devices:
- glucometer with included lancets, test strips and necessary accessories;
- express urine strips that measure the level of acetone bodies and sugar;
- tonometers to clarify blood pressure numbers;
- a self-monitoring diary, 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. In 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 must strictly observe the daily calorie intake. It is calculated individually for each patient depending on their weight, age, gender, energy consumption, physical activity, applied drug therapy. In the diet of patients, it is necessary to limit the intake of carbohydrates and high-calorie foods. Proteins are not only possible, but necessary, fats should be somewhat limited, especially in type 2 pathology.
Patients will need to understand the system of bread units, glycemic and insulin indices of products, calories. Features of the principles of nutrition:
- do not eat more than 8 bread units at one meal;
- sweet liquids (lemonade, tea with sugar, store juice) are prohibited;
- sweeteners are used instead of sugar, and homemade compotes and fruit drinks are used instead of store juices;
- 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 often;
- patients must receive a sufficient amount of fluid - restrictions may be in the presence of kidney failure or other complications that are accompanied by edema.
You can read more about prohibited foods, as well as those that should be eaten without fear, in the table.
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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 the gestational form is based on insulin therapy. This is the process of introducing hormone preparations based on insulin 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-acting hormones and prolonged insulins.
Doctors usually combine two drugs with different durations of action at the same time. This is necessary to create the most physiological conditions for the pancreas.
Type 2 disease requires the use of hypoglycemic tablets. The main groups are biguanides, sulfonylureas, thiazolidinediones, glinides, etc.
The differential diagnosis between the types of diabetes mellitus should be performed only by a qualified specialist. He will also help you choose a treatment regimen, an optimal lifestyle and give recommendations that allow the patient to achieve compensation as quickly as possible.