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 worldwide has almost quadrupled.The disease spreads more rapidly in underdeveloped countries and countries with weak economies.Doctors note a trend towards an increase in incidence in the age group over 40 years.In terms of social importance, this pathology ranks third after cardiovascular diseases and cancer.

Diabetes mellitus is divided into two main types:

1. insulin dependent (young, young, children),
2. insulin independent (insulin resistant).

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

Causes

Insulin is a protein hormone that is synthesized in the beta cells of the pancreas.Its effects are carried out through insulin receptors in various organs and tissues.Diabetes occurs when beta cells are destroyed or when receptor sensitivity decreases.

type 1 diabetes It 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 the persistence of the infectious agent in the pancreatic tissues with the subsequent development of an autoimmune reaction.The likelihood of the disease increases if a person has other autoimmune diseases: thyroiditis, adrenal insufficiency, etc.

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

Thanks to our body's adaptive capabilities, type 1 diabetes can remain silent for many years.The first signs appear when the number of β cells (and, consequently, insulin) becomes insufficient to regulate glucose levels.Type 1 represents approximately 10% of all cases of pathology.It mainly affects children, adolescents and people under 30 years of age.Less commonly, 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 decreased sensitivity of insulin receptors, otherwise “insulin resistance”.The most important risk factors:

1. Hereditary predisposition is observed in almost all cases.If close relatives suffer from the disease, the risk of developing the pathology increases 6 times.
2. Obesity is usually an abdominal and visceral form, when excess fat is deposited mainly in the waist area and/or in the internal organs.With class I obesity, the risk of developing the disease increases by 2 times, class II - by 5 times, class III - by 10 times.

Important!High-calorie foods, in which simple and 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 plant fiber, these foods, if consumed regularly, can cause irreparable damage to the body.

The second type usually appears in adulthood.A trend has been observed: the older a person is, the higher the concentration of glucose in the blood after eating a carbohydrate meal.The rate at which glucose decreases to normal depends largely on muscle mass and the degree of obesity.Since childhood obesity is currently an epidemic, type 2 is increasingly found in children.

As in the previous case, the disease develops when the amount of insulin synthesized cannot fully compensate for the decreased sensitivity of insulin receptors.This creates a vicious circle: excess blood glucose has a toxic effect on beta cells, causing their dysfunction.

Diabetes mellitus: symptoms of an insidious disease

Let's consider the symptoms of diabetes based on the disorders it causes, the stage of the disease and the type of pathology.

Symptoms associated with metabolic disorders.

Insulin participates in all types of metabolism:

1. Carbohydrates: regulates plasma glucose levels, as well as glycogen degradation, gluconeogenesis and other reactions that involve sugars.
2. Fatty: increases the synthesis of fatty acids and reduces their entry into the blood.
3. Protein: improves protein synthesis and suppresses its breakdown, activates DNA and RNA replication.
4. Electrolyte: activates the flow of potassium and inhibits the flow of sodium into cells.

With so many physiological effects, changes in insulin concentration do not pass without a trace in the body.The main symptoms are associated with a disturbance in carbohydrate metabolism., in particular, hyperglycemia.High glucose levels cause the following symptoms:

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

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

• muscular dystrophy - appears due to a decrease in the synthesis and increased degradation of proteins;
• hypoxia (deficiency of oxygen in the tissues) causes lethargy, decreased concentration and drowsiness;
• Widespread vascular damage due to protein glycosylation.

Altered fat metabolism manifests itself in:

• increase the concentration of cholesterol in the blood;
• fatty liver infiltration;
• ketonuria, ketonemia: accumulation of ketones in the blood and urine;in high concentrations, without treatment, coma and death develop.

Due to the loss of electrolytes (potassium, magnesium, sodium, phosphorus), general and muscle weakness occurs..

Clinic according to the stage of the disease.

The initial stage is characterized by an almost complete absence of symptoms.Diagnosis sometimes takes years, especially without proper examination.In diabetes, symptoms come and go based on fluctuations in blood glucose levels.General manifestations predominate, since damage to internal organs is still far away.

Patients complain of:

• severe weakness, fatigue;
• thirst: patients can drink 3 to 5 liters of fluid per day, and a significant amount at night;
• characteristic dry mouth (due to dehydration);
• frequent and copious urination;children can develop enuresis;
• Itchy skin, in women especially in the genital area.

Important!Progressive tooth decay and periodontal disease are often among the first symptoms of diabetes.Loose teeth and deep decay lesions on the roots of the teeth indicate a prediabetic condition.A biochemical analysis of blood glucose concentration shows no visible changes.Therefore, if such symptoms are detected, the patient is recommended to visit a therapist and undergo 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 coronary heart disease develop.The latter is usually difficult and usually causes serious complications.The cause of death in 38-50% of patients is myocardial infarction.

Diabetic patients are more likely to develop bronchitis, pneumonia and are predisposed to tuberculosis.Men with prostate adenoma and women over 50 years old are 4 times more likely than ordinary people to suffer from cystitis and pyelonephritis.In advanced stages, blindness and other complications may 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 simple carbohydrate overload.Since sugars are very poorly absorbed, tissues and organs lack energy.In an attempt to compensate for the energy deficiency, the body begins to actively burn fat.This process is accompanied by the release of ketone bodies.

In large quantities, ketone bodies are toxic to humans.The patient feels thirst, dizziness, lethargy, drowsiness and tachycardia.It is characterized by frequent urination, abdominal pain, nausea, vomiting, and the smell of acetone in the mouth.Without proper treatment, ketoacidosis causes coma, swelling of the brain, and death.

Important!If you have already been diagnosed with diabetes, you can prevent ketoacidosis yourself.

To do this you must:

• in case of acute respiratory infections, acute respiratory viral infections, monitor plasma sugar levels more frequently and administer insulin in appropriate amount;
• when using other medications, warn your doctor about the presence of diabetes (for example, glucocorticoids increase the need for insulin);
• even during remission, do not stop taking the medication;just reduce the dose and consult a doctor to correct the therapy;
• do not skip injections and strictly monitor glucose levels;
• administer insulin using the right instruments and in the right place;
• control the expiration date and storage conditions of the medicine.

The other three main signs of type 1 diabetes are fatigue, weight loss, and constant hunger.- arise in response to the inability to use sugars as a source of energy.And to eliminate excess glucose, the body actively eliminates it with urine, which causes polyuria.As a result of dehydration, the patient feels severe weakness.

The second type is characterized by a slower flow..The patient notices the problem when hyperglycemia becomes chronic.Sometimes the disease is discovered by chance, during a routine examination.There are situations in which a patient goes to the endocrinologist in an advanced stage of the disease, with complications.The most common complaints of this type of pathology are drowsiness, weakness, lethargy, difficulty concentrating and nausea.

Classification and types

The World Health Organization offers a fairly complete classification of pathology.So, in addition to the already known first and second types, other specific types of the disease are distinguished.All of them belong to category III and are included, depending on the reason for their development, in 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 pancreas cells, but at the level of the insulin receptors.These include Donohue syndrome, Rabson-Mendenhall syndrome, some lipodystrophies, and insulin resistance type A.
3. Diseases of the exocrine pancreas (fibrosis, pancreatitis, neoplasms, trauma, etc.).
4. Endocrinopathies.The disease can develop against the background of Cushing's syndrome, pheochromocytoma, thyrotoxicosis and other endocrine pathologies.
5. Diabetes induced by chemicals and drugs: nicotinic acid, thyroid hormones, glucocorticoids, alpha interferon, etc.
6. Viral infections: cytomegalovirus, congenital rubella and others.
7. Atypical forms of immune-mediated diabetes.
8. Genetic defects, the clinical picture of which usually includes diabetic symptoms (myodystrophy, Turner syndrome, Down syndrome, porphyria).

Separately, category IV includes gestational diabetes, which is a latent disorder of carbohydrate metabolism in pregnant women.

Important!Diabetes mellitus treatment tactics 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 origin of the disease.

Diagnosis and detection

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 (FPG) concentration.It is taken on an empty stomach and the last meal is eaten no later than 8 to 12 hours before the test.
4. Determination of the level of glycosylated hemoglobin (HbA1C).Rent the same way.Avoid smoking, alcohol, and intense physical activity the day before.
5. Glucose tolerance test (OGTT).More sensitive analysis, but at the same time more complex.It is primarily used to diagnose prediabetic conditions, including during pregnancy.If FPG is greater than 7.0 mmol/L, OGTT is not performed.

In reality, pathology is often detected by random analysis, for example, during a periodic examination.The patient is then sent for further examination.

Diagnostic criteria for diabetes and prediabetic condition.

Analysis	Norm, mmol/l	Impaired carbohydrate metabolism (prediabetes), mmol/l	MS, 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, which was popular in the recent past, is no longer used due to its nonspecificity and low sensitivity.

It is recommended that people who belong to a high-risk group undergo regular testing, once every three years, for FPG and HbA1C (or OGTT).If FPG is already elevated, such monitoring should be performed annually.Risk factors include:

• physical inactivity;
• obesity;
• age > 35 years;
• family history of diabetes;
• prediabetes, gestational diabetes, PCOS, personal history of cardiovascular diseases;
• 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 diabetic patients are periodically monitored for complications after diagnosis.The standard examination includes ophthalmoscopy, foot examination, urinalysis for proteinuria, lipid analysis and creatinine level.Most endocrinologists consider it important to record a baseline ECG and lipid profile during initial treatment to study disease dynamics and predict the risk of cardiovascular diseases.If necessary, consultations with specialized specialists are prescribed: ophthalmologist, gynecologist, cardiologist, neurologist.

The most dangerous complications

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

• skipping an insulin injection or taking a glucose-lowering medication;
• the use of other medications 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 described in detail 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- decrease in blood sugar, characterized by increased sweating, chills, severe weakness and a feeling of intense hunger.Some patients notice numbness and tingling in certain areas of the body.If the necessary measures are not taken, hypoglycemia goes into a coma and the patient loses consciousness.In this situation, it is necessary to call an ambulance.

Important!To eliminate hypoglycemia, a person urgently needs to take simple carbohydrates.Lemonade, lump sugar (put under the tongue), juice - anything that is easy to swallow and quickly absorbed will do.To avoid these cases, a patient taking glucose-lowering medications should always carry any of the above products with them.

Other complications result from metabolic disorders and damage to small and large vessels.

1. Diabetic heart disease or “diabetic heart”.Myocardial dystrophy develops in people over 40 years of age without pronounced signs of coronary atherosclerosis.It manifests as left ventricular dysfunction and leads to heart failure.The main symptoms are difficulty breathing, arrhythmia and decreased tolerance to physical activity.
2. Metabolic syndrome X, or the “deadly quartet”.The combination of hyperglycemia, obesity, hypertension and atherosclerosis causes the early onset of angina and damage to peripheral arteries.Common complications are heart attacks, strokes, and transient ischemic attacks.The main problem is that each element of the quartet enhances the manifestations of the others, creating a vicious circle.
3. diabetic nephropathy.The main factor of disability and mortality among patients with diabetes.It develops in 40-50% of cases and leads to chronic and terminal kidney failure.The main reason is damage to the capillaries of the kidneys, increased pressure inside the kidney glomeruli.The presence of hypertension accelerates pathological processes.This complication is considered one of the most insidious, since in the early stages it does not present any noticeable symptoms.The patient does not usually associate swelling, dyspepsia, and weakness with kidney damage.Pain and urinary disorders appear in the later stages, when the problem is already difficult to treat.
4. diabetic retinopathy.Subjectively, before the eyes it feels like fog, a characteristic “fluttering of flies”.Surrounding objects become blurry and blurry.Decreased vision progresses to the point of total blindness.The cause is damage to the retinal vessels with the subsequent appearance of microaneurysms, hemorrhages and edema.To prevent vision loss, patients should undergo ophthalmoscopy once a year and, if problems arise, receive treatment.
5. Neuropathies.The functioning of neurons is altered due to the toxic effects of glucose, lack of oxygen, and electrolyte changes.Diabetics experience a large number of neuropathies, but the most common of these is symmetrical polyneuropathy.Its main symptoms are numbness, discomfort, pain, loss of sensation in hands and feet, “like gloves and socks.”These processes in the lower extremities can lead to inadequate loading, with further foot trauma or infection and joint degeneration.Neuropathies affect not only the peripheral nerve fibers, but also the cranial nerves and the brain tissue itself.The result of this is acute neuropsychic disorders, neurosis-like conditions, dysfunction of innervated areas: decreased hearing, vision, 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 medications.

Diabetes treatmentIt starts with lifestyle changes.This includes a properly structured diet, sufficient physical activity and regular monitoring of plasma sugar concentrations.All this, together with basic therapy, helps prevent the rapid progression of pathology and the development of complications.

Type 1 diabetes is also treated with insulin.Regular subcutaneous injections mimic beta cell function.The number of units and the scheme are selected individually.It is important to observe the timing and dosage of drug administration.

Patients with type 2, in the event that diet and physical activity are not enough,Antihyperglycemic agents are prescribed..These drugs differ in their mechanism of action:

• stimulate the secretion of your own insulin (sulfonylurea, meglitinides);
• increase the sensitivity of insulin receptors (thiazolidinediones);
• inhibit additional pathways for glucose production (biguanides);
• prevent the absorption of sugars in the intestinal wall, slowing down its digestion (alpha-glucosidase inhibitors);
• increase glucose excretion in the urine (NGLT-2 inhibitors).

These medications can work together, enhancing the effects of each other.Therapeutic and prophylactic agents are also widely used.Statins and acetylsalicylic acid help reduce the damage caused to the vascular bed, ACE inhibitors help combat nephropathy in the early stages.

The prognosis depends on you.

Every year, around 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 patient with diabetes is reduced by between 6 and 15 years.In the second type, the prognosis is highly correlated with lifestyle.Smokers, alcoholics and people with high cholesterol levels can prolong their lives simply by giving up bad habits and adjusting their diet.

The disease ranks first among the causes of blindness, increases the risk of stroke and heart attack by two times, the risk of chronic kidney failure by 17 times, and the risk of foot necrosis by 20 times.Despite the terrible numbers,The prognosis depends on the timeliness of the diagnosis and your personal attitude towards the disease..The earlier the disease is detected and the more careful the patient is with 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.Meals are divided, 4-5 times a day, in small portions.The consumption of simple carbohydrates and saturated fats should be kept to a minimum.Avoid mayonnaise, pastries, jams, sausages and starchy foods.Avoid fried, fatty, overly salty foods, fast food, smoked foods and canned foods.The base should be complex carbohydrates, fiber and pectins.Lean fish, poultry, vegetables, herbal infusions, unsweetened compotes and durum wheat pasta are preferred.Follow the BJU ratio 20:20:60.
3. Infection prevention.The first type of diabetes mellitus often manifests itself under the influence of a viral infection.Therefore, if there are risk factors, it is recommended to strengthen the immune system, prevent a long course of ARVI, wear a mask and use antiseptics during epidemics and near sick people.