Diabetes: types and causes of its development, course and manifestations, treatment, possible consequences

Diabetes is one of the most common diseases whose incidence is on the rise and busting statistics.Symptoms of diabetes do not appear overnight; the process is chronic, with increasing and worsening endocrine and metabolic disturbances.It is true that the onset of type 1 diabetes is very different from the early stages of type 2 diabetes.

Among all endocrine diseases, diabetes undoubtedly occupies the leading position, accounting for more than 60% of all cases.Furthermore, disappointing statistics show that 1 in 10 "diabetics" are children.

The likelihood of developing the disease increases with age, so the group size doubles every decade.This is due to increased life expectancy, improved early diagnosis methods, reduced physical activity and an increase in the number of people who are overweight.

type of diabetes

Many people have heard of diseases like diabetes insipidus.To avoid subsequent confusion among readers about the disease called "diabetes," it may be helpful to explain their differences.

diabetes insipidus

Diabetes insipidus is an endocrine disease caused by neuroinfections, inflammatory diseases, tumors, intoxications and is caused by insufficient and sometimes complete absence of ADH-vasopressin (antidiuretic hormone)

This explains the clinical manifestations of the disease:

• Persistent dryness of the oral mucosa, incredible thirst (a person can drink up to 50 liters of water in 24 hours, and the stomach is very full);
• Separate large amounts of low specific gravity (1000-1003) non-concentrated light urine;
• Catastrophic weight loss, weakness, reduced physical activity, digestive disorders;
• Characteristic changes in skin ("parchment" skin);
• Muscle fiber atrophy, muscle system weakness;
• Dehydration syndrome can occur if fluids are not taken for more than 4 hours.

In terms of complete cure, the prognosis of the disease is poor; work ability is significantly reduced.

Brief Anatomy and Physiology

The pancreas is an unpaired organ with mixed secretory functions.Its exogenous part undergoes external secretion, producing enzymes involved in the digestive process.The endocrine part is responsible for the endocrine mission and produces various hormones, including——Insulin and glucagon.They are key to ensuring the consistency of sugar in the body.

The endocrine part of the gland is represented by the islands of Langerhans and includes:

1. A cells, occupying one-quarter of the total islet space, are thought to be the sites of glucagon production;
2. B cells, accounting for 60% of the cell population, synthesize and store insulin. Its molecule is a two-chain polypeptide that carries 51 amino acids in a certain order;
3. D-cells produce somatostatin;
4. Cells that produce other polypeptides.

Therefore, the conclusion is self-evident:Damage to the pancreas and islets in particular is the main mechanism that inhibits insulin production and triggers the development of pathological processes.

Types and specific forms of the disease

Lack of insulin leads to impaired blood glucose stability (3.3 – 5.5 mmol/l)and leads to the development of a heterogeneous disease called diabetes mellitus (DM):

• Complete insulin deficiency (absolute deficiency) forminsulin dependencepathological process, calledType I diabetes mellitus (IDDM);
• Insulin deficiency (relative deficiency) triggers an initial disturbance in carbohydrate metabolism, which slowly but surely leads to developmentalnon-insulin dependentdiabetes mellitus (NIDDM), known asType II diabetes.

As the body's use of glucose is disturbed, resulting in an increase in glucose in the serum (hyperglycemia), which is in principle a manifestation of the disease, over time the signs of diabetes begin to appear, that is, a complete disturbance of metabolic processes at all levels.

In addition to type 1 and type 2 diabetes, there are special types of this disease:

1. secondary diabetesCaused by acute and chronic pancreatic inflammation (pancreatitis), glandular parenchymal malignancies, and cirrhosis of the liver.Many endocrine disorders associated with overproduction of insulin antagonists (acromegaly, Cushing's disease, pheochromocytoma, thyroid disease) can lead to secondary diabetes.Many long-term drugs have diabetic effects: diuretics, some antihypertensive drugs and hormones, oral contraceptives, etc.;
2. Maternal Diabetes (During Pregnancy),It is caused by the special interaction of maternal, fetal and placental hormones.This particular form develops during pregnancy as the fetal pancreas, which itself produces insulin, begins to inhibit the maternal glands from producing insulin.However, if managed properly, gestational diabetes usually goes away after delivery.Subsequently, this fact may threaten the development of type II diabetes (within 6-8 years) in some cases (up to 40%) in women with a similar pregnancy history.

Why does “sweetness” disease occur?

This "sweet" disease forms a rather "messy" patient population, so it is clear that IDDM and its non-insulin-dependent "brothers" have different genetic origins.There is evidence of a link between insulin-dependent diabetes and the genetic architecture of the HLA system (major histocompatibility complex), particularly with certain genes in the D-region locus.For NIDDM, this relationship was not observed.

Genetic predisposition alone is not sufficient for the development of type I diabetes.Pathogenesis is triggered by predisposing factors:

• Congenital islet defects;
• adverse effects of the external environment;
• stress, nervousness;
• Traumatic brain injury;
• Pregnant;
• Infectious processes of viral origin (influenza, mumps, cytomegalovirus infection, coxsackievirus);
• Frequent overeating, leading to excessive fat accumulation;
• Abuse of confectionery products (people with a sweet tooth are at greater risk).

Before discussing the causes of type II diabetes, it is recommended to discuss a very controversial question: who is more likely to develop diabetes, men or women?

It has now been established that the disease is more common in women today, although back in the 19th century, diabetes was a male “privilege.”By the way, now in some countries of Southeast Asia this disease is predominant in men.

Predisposing conditions for the development of type 2 diabetes include:

• Changes in the structure of the pancreas due to inflammatory processes and the appearance of cysts, tumors, hemorrhages;
• Age after 40 years old;
• Being overweight (the most important risk factor for NIDDM!);
• Vascular diseases caused by atherosclerotic processes and arterial hypertension;
• For women, pregnancy and giving birth to a child with a higher weight (more than 4 kg);
• Have a relative with diabetes;
• Intense psycho-emotional stress (adrenal overstimulation).

The causes of different types of diabetes are the same in some cases (stress, obesity, influence of external factors), but the pathogenesis of type 1 and type 2 diabetes is different, and,IDDM is the domain of children and young adults, with non-insulin dependent individuals preferring the elderly.

Why do you drink so much?

Characteristic symptoms of diabetes, regardless of form and type, can present as follows:

1. Dry oral mucosa;
2. Thirst associated with dehydration is rarely relieved;
3. Too much urine is formed and excreted through the kidneys (polyuria), leading to dehydration;
4. Increased serum glucose concentration (hyperglycemia) due to inhibition of glucose utilization by peripheral tissues due to insulin deficiency;
5. The presence of sugar (glucosuria) and ketone bodies (ketonuria) in the urine, usually in negligible amounts but in diabetes, produced in large amounts by the liver and found in the urine when excreted from the body;
6. Urea and sodium ions (Na⁺);
7. Weight loss, in the setting of decompensated disease, is characteristic of the catabolic syndrome, which occurs due to glycogenolysis, lipolysis (fat mobilization), protein catabolism, and gluconeogenesis (conversion to glucose);
8. Violation of lipid profile indicators, increase in total cholesterol due to LDL fraction, NEFA (non-esterified fatty acids), triglycerides.The increased lipid content begins to be actively transported to the liver, where it is strongly oxidized, leading to the excessive formation of ketone bodies (acetone + beta-hydroxybutyrate + acetoacetate) and their further entry into the blood (hyperketonemia).High levels of ketones can lead to a dangerous condition called ketosis.diabetic ketoacidosis.

Therefore, the general signs of diabetes can be characteristic of any form of the disease, however, in order not to confuse the reader, it is still necessary to pay attention to the characteristics inherent to one or another type.

Type I diabetes is a 'privilege' for young people

IDDM is characterized by an acute (weeks or months) onset.The signs of type I diabetes are obvious and present with the typical clinical symptoms of the disease:

• Sudden weight loss;
• Unnatural thirst, where a person is unable to get drunk despite trying to do so (polydipsia);
• Passing large amounts of urine (polyuria);
• Significant excess of glucose and ketone body concentrations in the serum (ketoacidosis).In the initial stages, when the patient may not be aware of their problem, a diabetic (ketoacidosis, hyperglycemia) coma is likely to occur, which is extremely life-threatening and therefore insulin therapy should be initiated as early as possible (as soon as diabetes is suspected).

In most cases, with the use of insulin, metabolic processes are compensated,The body's need for insulin drops sharply and a temporary "recovery" occurs.However, neither the patient nor the doctor should relax in this short-term state of remission, because after a while the disease will remind itself again.As the disease progresses, the need for insulin may increase, but generally it will not exceed 0.8-1.0 U/kg in the absence of ketoacidosis.

Signs of late complications of diabetes (retinopathy, nephropathy) may appear after 5-10 years.The leading causes of death in IDDM include:

1. End-stage renal failure, a result of diabetic glomerulosclerosis;
2. Cardiovascular disease is a complication of underlying disease and occurs less frequently than kidney disease.

Illness or age-related changes?(Type II diabetes)

The development of NIDDM takes months or even years.When a problem arises, people take them to various specialists (dermatologists, gynecologists, neurologists…).The patient did not even suspect that what he considered to be different illnesses: boils, itchy skin, fungal infections, and leg pain were signs of type II diabetes.The patient gets used to his condition, while the diabetes continues to progress slowly, affecting all systems, mainly the blood vessels.

NIDDM is characterized by a stable, slow course, usually without a tendency toward ketoacidosis.

Treatment of type 2 diabetes usually begins with a diet that limits digestible (refined) carbohydrates and the use of antidiabetic medications (if necessary).Insulin is required if the disease has progressed to the stage of severe complications or is resistant to oral medications.

The leading cause of death in patients with NIDDM is considered to be cardiovascular pathology due to diabetes.Usually, this is a heart attack or stroke.

diabetes treatment

The basis of therapeutic measures aimed at compensating diabetes is represented by three main principles:

• compensate for insulin deficiency;
• Regulate endocrine and metabolic disorders;
• Prevent diabetes and its complications and treat them promptly.

The implementation of these principles is based on 5 main positions:

1. Nutrition plays the “first violin” role in diabetes;
2. Follow dietary habits and engage in an appropriate and personally chosen system of physical exercise;
3. Antidiabetic drugs are mainly used to treat type 2 diabetes;
4. Insulin therapy is prescribed if necessary for NIDDM but is essential for type 1 diabetes;
5. Train patients in self-monitoring (skills in drawing blood from finger, using glucometer, injecting insulin without assistance).

Laboratory controls above these locations indicate the degree of compensation following biochemical studies:

index	Good level of compensation	satisfy	not good
Fasting blood glucose level (mmol/l)	4.4 – 6.1	6.2 – 7.8	Ø7.8
Blood glucose level 2 hours after meal (mmol/l)	5.5 – 8.0	8.1 – 10.0	Ø 10.0
Glycated hemoglobin percentage (HbA1, %)	< 8.0	8.0 – 9.5	Ø 10.0
Serum total cholesterol (mmol/l)	< 5.2	5.2 – 6.5	Ø6.5
Triglyceride level (mmol/L)	< 1.7	1.7 – 2.2	Ø2.2

The important role of diet in the treatment of NIDDM

Nutrition for diabetes is well known and Table No. 9 is well known even to people who are far away from diabetes.When hospitalized for any disease, from time to time you will hear about a special diet, which is always served in a separate pan, different from other diets, and given after saying a certain password: "I have the ninth table." What does it all mean?How is this mystery diet different from other diets?

One should not make the mistake of thinking that caring for a diabetic takes away his "porridge" and that they are deprived of all the joys of life.The diet of a diabetic patient is not much different from that of a healthy person; patients consume the required amounts of carbohydrates (60%), fats (24%), and protein (16%).

Diabetes nutrition involves replacing refined sugars in foods with slowly broken down carbohydrates.Sugar and sugar-based confectionery products sold in stores to everyone fall under the prohibited food category.

As for nutritional balance, everything is strict here: diabetics must consume the required amount of vitamins and pectin, at least 40 grams.every day.

Rigorous personal physical activity

Physical activity for each patient is chosen individually by the attending physician, taking into account the following:

• age;
• Diabetes Symptoms;
• severity of the pathological process;
• Are there any complications?

Physical activity prescribed by a doctor and performed by the "ward" should promote the "burning" of carbohydrates and fat without involving insulin.Its dosage is necessary to compensate for metabolic disorders, but its dosage is significantly reduced, which should not be forgotten, since by preventing an increase in blood sugar levels, you can have adverse effects.Adequate physical activity lowers blood sugar, and the dose of insulin administered breaks down the remaining blood sugar, thereby lowering blood sugar levels below acceptable values (hypoglycemia).

therefore,Insulin dosage and physical activity require very close attention and careful calculation,This way, by complementing each other, we do not cross the lower limits of normal laboratory parameters.

Or try folk remedies?

Treatment of type 2 diabetes is often accompanied by the patient's own search for folk remedies to slow down the process and delay taking dosage forms as long as possible.

Although our distant ancestors were actually unaware of this disease, folk remedies for treating diabetes exist, but we should not forgetInfusions and decoctions made from various plants are an aid.Using home remedies to treat diabetes does not relieve the patient from the obligation to follow a diet, monitor blood sugar, visit a doctor and follow all his recommendations.

To combat this condition at home, quite famous folk remedies can be used:

1. white mulberry bark and leaves;
2. oat groats and husks;
3. walnut partitions;
4. bay leaves;
5. Cinnamon;
6. acorn;
7. nettle;
8. Dandelions.

When diet and folk remedies no longer help…

The so-called first-generation drugs that were widely known at the end of the last century are a thing of the past, replaced by newer generations of drugs that make up the three major classes of diabetes drugs produced by the pharmaceutical industry.

The endocrinologist decides which treatment is appropriate for the patient or patients.In order to prevent patients from self-medicating and from making their own decisions about using these medications to treat diabetes, we will give several illustrative examples.

Sulfonylurea derivatives

Currently, second-generation sulfonylurea derivatives are prescribed, which have an action time of 10 to 24 hours.Patients usually take it twice daily, half an hour before meals.

These drugs are absolutely contraindicated in the following cases:

• type 1 diabetes;
• Diabetic, hyperosmolar, lactic acidosis coma;
• Pregnancy, childbirth, lactation;

• Diabetic nephropathy is associated with impaired filtration;
• Diseases of the hematopoietic system accompanied by a decrease in white blood cells - white blood cells (leukopenia) and the platelet component of hematopoiesis (thrombocytopenia);
• Severe infectious and inflammatory liver disease (hepatitis);
• Diabetes mellitus complicated by vascular pathology.

In addition, use of drugs from this group may cause allergic reactions, which may manifest as:

1. Skin itching and urticaria, sometimes reaching Kunque's edema;
2. Digestive system diseases;
3. blood changes (lower levels of platelets and white blood cells);
4. Liver function may be impaired (cholestasis leading to jaundice).

Biguanide antihyperglycemic drugs

Biguanides (guanidine derivatives) are actively used to treat type 2 diabetes, often with the addition of sulfonamides.In obese patients, their use is very reasonable, but in people with liver, kidney, and cardiovascular disease, their use is extremely limited and requires switching to milder drugs of the same group or alpha-glucoside inhibitors, which inhibit the absorption of carbohydrates in the small intestine.

The following are considered absolute contraindications to the use of biguanides:

• IDDM (type 1 diabetes);
• Significant weight loss;
• Infectious process, regardless of location;
• surgical intervention;
• Pregnancy, childbirth, breastfeeding;
• comatose state;
• Hepatic and renal pathology;
• hypoxia;
• Microvascular disease (grade 2-4) with impaired vision and renal function;
• trophic ulcers and necrotic processes;
• Poor blood circulation in the lower limbs due to various vascular lesions.

Insulin treatment

It can be seen from the above thatInsulin is the main treatment for type 1 diabetes, all medical emergencies, and serious complications of diabetes.NIDDM requires the prescription of this therapy only if insulin is required and correction by other methods does not achieve the desired effect.

Modern insulins, called single-acting insulins, represent two categories:

1. Single-acting pharmacological forms of human insulin substances (semi-synthetic or DNA recombinant) undoubtedly have significant advantages over pork-derived drugs.They have few contraindications or side effects;
2. Single-acting insulin obtained from porcine pancreas.These drugs require approximately a 15% increase in drug dosage compared to human insulin.

Diabetes Dangerous with Complications

Because diabetes is accompanied by damage to a variety of organs and tissues, its manifestations can occur in almost every system of the body.Complications of diabetes include:

• Skin pathological changes: Diabetic dermatosis, lipoid necrosis, furuncle, xanthoma, skin fungal infection;
• Bone and joint diseases:
  1. Diabetic osteoarthropathy (Charcot joint - changes in the ankle joint), which occurs on the background of impaired microcirculation and nutritional disorders, with dislocations, subluxations, spontaneous fractures before the formationdiabetic foot;
  
  2. Diabetic trichosis, which is characterized by stiffness of the hand joints and usually occurs in children with diabetes;
• Respiratory disorders: long termLong-term bronchitis, pneumonia,Increased incidence of tuberculosis;
• Pathological processes affecting the digestive organs:diabetic enteropathy, accompanied by increased intestinal motility, diarrhea (up to 30 times a day), and weight loss;
• diabetic retinopathy– One of the most serious complications, characterized by damage to the visual organs;
• The most common complications of diabetes are considered to bediabetic neuropathyand its diversity—polyneuropathy, reaching 90% of all forms of this pathology.Diabetic polyneuropathy is a common diseasediabetic foot syndrome;
• A pathological condition of the cardiovascular system that is the cause of death in diabetes in most cases.Hypercholesterolemia and vascular atherosclerosis begin in diabetic patients at a young age, inevitably leading to cardiac and vascular diseases (coronary artery disease, myocardial infarction, heart failure, cerebrovascular accidents).

prevention

Measures to prevent diabetes are based on what causes diabetes.In this case, it is recommended to talk about the prevention of atherosclerosis and arterial hypertension, including the fight against excess weight, bad habits and food addiction.

Prevention of diabetic complications involves preventing the development of pathological conditions caused by diabetes itself.Correcting glucose in the serum, following a diet, adequate physical activity and following the advice of a doctor will help to delay the consequences of this rather terrible disease.