Diabetes is an endocrine disease associated with pathological changes in the hormonal background and metabolic failure.
To date, the disease cannot be eradicated (completely eliminated). The destructive process in the body can be slowed down with medication and dietary therapy, but it is impossible to stop it and start it in the opposite direction.
Types of diabetes mellitus (DM) are defined by the World Health Organization and do not differ fundamentally across the medical community. Diabetes of any kind is not an infectious disease.
There can be several types of diabetes, and different types. Since each species and type of treatment is different, it is necessary to know which specific variant of the disease is present.
pathological type
There are several types of disease, combined by one main symptom - an increase in the concentration of glucose in the blood. The typification of diabetes is due to the cause of its occurrence. There are also treatments applied, gender and age of the patient.
Medically Accepted Types of Diabetes:
- The first is insulin-dependent (IDDM 1), or juvenile;
- The second is insulin-independent (INZDM 2), or insulin resistance;
- perinatal gestational diabetes mellitus (GDM) in women;
- Other specific types of diabetes, including:
- Damage to pancreatic beta cells at the genetic level (MODY - variety of diabetes);
- Pathology of the exocrine function of the pancreas;
- Inherited and acquired disorders of the exocrine glands and their function (endocrine disorders);
- Pharmacologically established diabetes;
- Diabetes caused by congenital infection;
- Diabetes associated with genomic pathology and genetic defects;
- Impaired fasting glucose and impaired glucose tolerance.
Prediabetes is a borderline state of the body in which blood sugar levels change upwards (impaired glucose tolerance) and blood sugar levels "do not reach" the generally accepted numerical values that correspond to true diabetes. According to the World Health Organization (WHO 2014), more than 90% of endocrinology patients suffer from category II diseases.
According to medical statistics, the number of global cases is showing a clear upward trend. The number of people with type 2 diabetes has doubled over the past 20 years. GDM accounts for about 5% of pregnancies. Certain types of diabetes are extremely rare and account for only a small percentage of medical statistics.
By sex, NIDDM 2 was more common in premenopausal and postmenopausal women. This is due to changes in hormonal status and a set of extra pounds. In men, the most common factor in the development of type 2 diabetes is chronic inflammation of the pancreas due to the toxic effects of ethanol.
Insulin-dependent diabetes (type 1)
Type 1 diabetes is characterized by pancreatic cell failure. This organ does not perform its endocrine (endocrine) function of producing insulin, the hormone responsible for supplying the body with glucose. Due to the accumulation of glucose in the blood, organs cannot get enough nutrients, including the pancreas itself.
To mimic the natural production of endocrine hormones, patients are given life-long injections of medical insulin with different durations of action (short and long), as well as dietary therapy. The classification of type 1 diabetes depends on the various causes of the disease. The insulin-dependent form of the disease has two causes: genetic and autoimmune.
genetic causes
The formation of pathology is related to the biological characteristics of the human body, and its characteristics and pathological abnormalities are passed on to offspring. With regard to diabetes, children inherit a susceptibility to the disease from a parent or close relative who has diabetes.
important! Susceptibility is inherited, but not the disease itself. There is no 100% guarantee that a child will develop diabetes.
autoimmune causes
The onset of the disease is due to the failure of the immune system, which, when under the influence of negative factors, actively produces autoimmune antibodies that have a damaging effect on the body's cells. The triggers (nudges) that start the autoimmune process are:
- Unhealthy eating behaviors coupled with lack of exercise;
- failure of metabolic processes (carbohydrates, lipids and proteins);
- Severe deficiency of cholecalciferol and ergocalciferol (group D vitamins) in the body;
- chronic pancreatic pathology;
- History of mumps (mumps), measles, coxsackie virus, Epstein-Barr virus, cytomegalovirus, viral hepatitis A, B, and C;
- distress (prolonged periods of neuropsychological stress);
- chronic alcoholism;
- Incorrect treatment with hormone-containing drugs.
IDDM forms in children, teens, and adults under the age of 30. Childhood variants of type 1a diabetes are associated with complex viral infections. Type 1b occurs in young adults and children in the context of autoimmune processes and genetic predispositions. The disease usually develops in an accelerated pattern over weeks or months.
Insulin Resistant Diabetes (Type 2)
The difference between type 2 diabetes and type 1 diabetes is that the pancreas does not stop producing insulin. Glucose is concentrated in the blood and is not transported to the cells and tissues of the body due to a lack of sensitivity to insulin - insulin resistance. To some extent, it is treated with blood sugar-lowering (glycemic) medications and dietary therapy.
To compensate for the imbalance in the body, the pancreas activates the production of hormones. Working in emergency mode, the organ wears out over time and loses its secretory function. Type 2 diabetes becomes insulin dependent. Decreased or lost cellular sensitivity to endogenous hormones is primarily associated with obesity, in which the metabolism of fat and carbohydrates is disturbed.
This is especially true of visceral obesity (fat deposits around the internal organs). In addition, with excess weight, blood flow becomes difficult due to the large number of cholesterol plaques in the blood vessels, which are formed during the hypercholesterolemia that always accompanies obesity. As a result, the cells of the body lack nutrient and energy resources. Other factors influencing the development of NIDDM include:
- Abuse of alcohol;
- Gourmet addiction to sweets;
- Chronic diseases of the pancreas;
- Pathology of the heart and vascular system;
- overeating in the context of a sedentary lifestyle;
- Incorrect hormone therapy;
- complicated pregnancy;
- Dysfunctional inheritance (parents with diabetes);
- distressed.
Mostly, the disease occurs in women and men over the age of 40. Meanwhile, type 2 diabetes is latent and may not develop severe symptoms for several years. Timely testing of blood sugar levels can detect prediabetes. With proper treatment, the prediabetic state is reversible. If time is lost, it continues to develop and NIDDM is subsequently diagnosed.
Lada Diabetes
In medicine, the term "diabetes 1. 5" was discovered, or named Lada diabetes. This is an autoimmune disease that occurs in adults (over the age of 25) in which hormone production and metabolic processes fail. The disease combines the first and second types of diabetes. The development mechanism corresponds to IDDM, and the latent disease course and symptoms are similar to NIDDM.
The trigger for the development of the pathology is the autoimmune disease in the patient's medical history:
- Noninfectious inflammation of the intervertebral joints (ankylosing spondylitis);
- Irreversible diseases of the central nervous system - multiple sclerosis;
- Gastrointestinal granulomatous inflammatory pathology (Crohn's disease);
- Chronic inflammation of the thyroid gland (Hashimoto's thyroiditis);
- juvenile and rheumatoid arthritis;
- Skin discoloration (pigment loss) (Vitiligo);
- Inflammation of the colonic mucosa (ulcerative colitis);
- Chronic damage to connective tissue and exocrine glands (Sjögren's syndrome).
Combined with genetic predisposition, autoimmune disease contributes to the progression of Lada diabetes. To detect this disease, basic diagnostic methods are used along with blood microscopy to determine the concentration of IgG class immunoglobulins in antigens - ELISA (enzyme immunoassay). Treatment is provided by regular insulin injections and nutritional corrections.
Pregnancy form of the disease
GDM is a specific type of diabetes that occurs in women during the second half of the perinatal period. The disease is most often detected during the second routine screening, when expectant mothers undergo a comprehensive examination. The main feature of GDM, which is similar to type 2 diabetes, is insulin resistance. The cells of a pregnant woman's body lose their sensitivity (sensitivity) to insulin due to the correlation of three main reasons:
- Hormonal restructuring. During pregnancy, the synthesis of progesterone, a steroid sex hormone, increases, which blocks the production of insulin. In addition, the placenta's endocrine hormones, which tend to suppress insulin production, are increasing.
- Double load on the female body. In order to provide adequate nutrition to the unborn child, the body needs more glucose. Women start consuming more simple sugars, which causes the pancreas to synthesize more insulin.
- Weight gain in the context of decreased physical activity. The large supply of glucose to the body can build up in the blood as cells refuse insulin due to obesity and physical inactivity. In this case, the expectant mother and fetus experience nutritional deficiencies and energy starvation.
Unlike type 1 and type 2 diabetes, gestational diabetes is a reversible process because insulin molecules and pancreatic function are preserved.
Properly selected treatment strategies ensure that the pathology is eliminated after delivery in 85% of cases. The main way to treat GDM is the diet "No. 9" of diabetic patients. In difficult cases, injectable medical insulin is used. Hypoglycemic drugs are not used because of their teratogenic effects on the fetus.
also
Certain types of diabetes are genetically determined (MODY-diabetes, certain types of endocrinopathy) or caused by other chronic diseases:
- Pancreatic diseases: pancreatitis, hemochromatosis, tumors, cystic fibrosis, mechanical injury and gland surgery;
- failure of the anterior pituitary gland (acromegaly);
- Increased synthesis of thyroid hormones (thyrotoxicosis);
- Hypothalamic-pituitary-adrenal pathology (Itsenko-Cushing syndrome);
- Adrenal cortical tumors (aldosteronoma, pheochromocytoma, etc. ).
Another diabetes pathology, diabetes insipidus, is characterized by reduced production of the hypothalamic hormone vasopressin, which regulates fluid balance in the body.
Diagnostic measures
Diagnosis of diabetes (of any type) can only be based on the results of laboratory blood microscopy. Diagnosis consists of several consecutive studies:
- General clinical blood test to detect hidden inflammatory processes in the body.
- Blood tests (capillaries or veins) for blood sugar levels. Strictly fasting production.
- GTT (Glucose Tolerance Test). Do it to determine the body's ability to absorb glucose. Tolerance testing is a double blood draw: fasting and two hours after a "glucose load", an aqueous solution of glucose prepared at a ratio of 200 ml of water per 75 grams. substance.
- HbA1C analysis of glycated (glycated) hemoglobin levels. Based on the study results, blood glucose levels over the past three months were assessed retrospectively.
- Biochemistry of blood. Indicators to assess the levels of liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (AP), bilirubin (bilirubin), and cholesterol.
- A blood test for the concentration of glutamate decarboxylase antibodies (GAD antibodies) can determine the type of diabetes.
Blood Glucose Reference Values and Disease Indicators
| analyze | for sugar | Glucose tolerance test | Glycated hemoglobin |
|---|---|---|---|
| specification | 3. 3 - 5. 5 | < 7. 8 | ⩽ 6% |
| prediabetes | 5. 6 - 6. 9 | 7. 8 - 11. 0 | From 6% to 6. 4% |
| diabetes | >7. 1 | >11. 1 | more than 6. 5% |
In addition to blood microscopy, the urine is also checked for the presence of glucose (glycosuria). In healthy people, there is no sugar in the urine (for diabetics, 0. 061 - 0. 083 mmol/l is considered an acceptable standard). The Reberg test was also performed to detect protein metabolites of albumin and creatinine in urine. In addition, hardware diagnostics are prescribed, including electrocardiogram (ECG) and abdominal ultrasound (with kidneys).
result
Modern medicine divides diabetes into four main types according to the pathogenesis (origin and development) of the disease: insulin-dependent (IDDM type 1), non-insulin-dependent (NIDDM type 2), gestational (GDM pregnancy), specific (DM includes several diseases caused by genetic defects or chronic diseases). Gestational diabetes that develops in the perinatal period is curable. Prediabetes (impaired glucose tolerance) is considered reversible if diagnosed early.