Diabetes mellitus types 1 and 2

Diabetes mellitus(DM) is an endocrine pathology that occurs due to inadequate 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.

Over the last forty years, the number of diabetes cases worldwide has almost quadrupled.The disease spreads most rapidly in underdeveloped countries and those with weak economies.Doctors note a tendency towards an increase in the 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 (adolescent, adolescent, children),
2. insulin independent (insulin resistant).

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

Causes

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

Type 1 diabetes develops in the presence of a genetic predisposition.The impetus for the development of pathologies is provided by toxins and viral infections such as rubella, influenza, hepatitis B virus, cytomegalovirus and retroviruses.The triggering factor causes acute damage to β-cells or leads to the persistence of the infectious agent in the pancreatic tissue with the further development of an autoimmune reaction.The likelihood of disease increases if a person suffers from other autoimmune diseases - thyroiditis, adrenal insufficiency, etc.

Important!Diet plays a certain role in the development of the disease in children.This is encouraged by contact with gluten too early - it is optimal to introduce cereal porridge into complementary foods in the 6th to 7th month at the earliest.The risk increases if a child is fed cow's milk, lacks vitamin D, and has a high concentration of nitrates in the drinking water.

Thanks to our body's ability to adapt, type 1 diabetes can remain silent for many years.The first signs appear when the number of β-cells (and therefore insulin) is no longer sufficient to regulate glucose levels.Type 1 accounts for about 10% of all pathology cases.Children, young people and people under 30 are particularly affected.Less commonly, it occurs in older patients in a latent form, which is often confused with a non-insulin-dependent form.

Type 2 diabetes accompanied by impaired insulin secretion and reduced sensitivity of insulin receptors, otherwise “insulin resistance”.The most important risk factors:

1. In almost all cases, a hereditary predisposition is identified.If close relatives suffer from the disease, the risk of developing the pathology increases six times.
2. Obesity is often an abdominal and visceral form in which excess fat is deposited primarily in the waist area and/or internal organs.In class I obesity, the risk of developing the disease increases 2 times, in class II - 5 times, and in class III - 10 times.

Important!High-calorie foods dominated by simple, quickly digestible carbohydrates are considered diabetogenic.These are sweets, alcohol, flour products, sausages, fast food, fried potatoes, soft wheat noodles.Combined with a sedentary lifestyle and a lack of plant fiber, such foods can cause irreparable harm to the body if consumed regularly.

The second type usually occurs in adulthood.A trend can be observed: the older a person is, the higher the glucose concentration in the blood after eating a meal containing carbohydrates.The speed at which glucose falls to normal depends largely on muscle mass and the degree of obesity.With childhood obesity now an epidemic, type 2 is increasingly being found in children.

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

Diabetes mellitus: symptoms of an insidious disease

Let's consider the diabetes clinic 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 sugar.
2. Fat – increases the synthesis of fatty acids and reduces their entry into the blood.
3. Protein – increases 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 go unnoticed in the body.The main symptoms are associated with impaired carbohydrate metabolism, especially hyperglycemia.Elevated glucose levels lead to the following symptoms:

• Thirst, dehydration, polyuria – urine output of more than three liters per day;
• Polyphagia – constant need for food, gluttony, develops in response to lack of energy;
• nausea, vomiting;
• Accumulation of sorbitol (a product of glucose conversion) 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 – occurs due to decreased synthesis and increased protein breakdown;
• Hypoxia – lack of oxygen in tissues – leads to lethargy, reduced concentration and sleepiness;
• generalized vascular damage due to protein glycosylation.

A disturbed fat metabolism manifests itself in:

• increase in cholesterol concentration in the blood;
• fatty liver infiltration;
• Ketonuria, ketonemia – accumulation of ketones in the blood and urine;At high concentrations, coma and death can occur without treatment.

The loss of electrolytes (potassium, magnesium, sodium, phosphorus) leads to general and muscle weakness.

Clinic depending on the stage of the disease

The initial stage is characterized by almost complete freedom from symptoms.Diagnosis sometimes takes years, especially without proper examination.With diabetes, symptoms come and go according to fluctuations in blood sugar levels.General manifestations predominate because damage to the internal organs is still a long way off.

Patients complain about:

• severe weakness, fatigue;
• Thirst – Patients may drink approximately 3-5 liters of fluid per day, with a significant amount occurring at night;
• characteristic dry mouth (due to dehydration);
• frequent and copious urination;Children can develop enuresis;
• Itching of the skin, especially in the genital area in women.

Important!Progressive tooth decay and periodontitis are often among the first symptoms of diabetes.Loose teeth and deep carious lesions on the roots of teeth indicate prediabetic disease.A biochemical analysis of glucose concentration in the blood shows no visible changes.Therefore, if such symptoms are detected, the patient is recommended to consult a therapist and undergo a glucose tolerance test.

Without treatment, the patient's condition gradually worsens.Dry skin occurs, skin infections are common – hidradenitis, furunculosis, fungal infections of the foot.In 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, arteriosclerosis and coronary heart disease occur.The latter is usually difficult and often leads to serious complications.The cause of death in 38-50% of patients is a heart attack.

Diabetics are more likely to develop bronchitis and pneumonia and are more susceptible to tuberculosis.Men with prostate adenoma and women over 50 are four times more likely to suffer from cystitis and pyelonephritis than normal people.In advanced stages, blindness and other complications can occur due to vascular damage.

Signs of type 1 and type 2 diabetes

With the first type, people often do not notice the initial symptoms or ignore them.A common situation is that the diagnosis is only made after the first “attack” of ketoacidosis.The disease manifests itself in response to stress, viral infections and an excess of simple carbohydrates.Since sugar is extremely poorly absorbed, the tissues and organs lack energy.To compensate for the lack of energy, 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, sleepiness and palpitations.Characterized by frequent urination, abdominal pain, nausea, vomiting and smell of acetone from the mouth.Without appropriate treatment, ketoacidosis leads to coma, brain swelling, and death.

Important!If you have already been diagnosed with diabetes, you can prevent ketoacidosis on your own.

To do this you should:

• in acute respiratory infections, acute respiratory viral infections, monitor plasma glucose levels more often and administer insulin in the appropriate amount;
• If you are taking other medications, tell your doctor about the presence of diabetes (e.g. glucocorticoids increase insulin requirements);
• Do not stop administering the drug even during remission.Simply reduce the dose and consult a doctor for correction of therapy.
• Do not skip injections and closely monitor glucose levels.
• Administer insulin with the right instruments and in the right place;
• Monitor the expiration date and storage conditions of the drug.

The other three main symptoms of type 1 diabetes are fatigue, weight loss and constant hunger.- arise in response to the inability to use sugar as an energy source.And to get rid of excess glucose, the body actively removes it with urine, which leads to 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 a chronic disease.Sometimes the disease is discovered accidentally during a routine examination.There are situations when a patient comes to the endocrinologist in an advanced stage of the disease with complications.The most common complaints with 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.In addition to the already known first and second types, other specific disease types are distinguished.They all belong to category III and are divided into classes A, B, C, D, E, F, G and H depending on the reason for their development.

1. This class includes genetic defects in beta cell function - mitochondrial mutations, damage to individual sections of certain chromosomes.
2. Also genetic defects, although not in the cells of the pancreas, 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, 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 and others.
7. Atypical forms of immune-mediated diabetes.
8. Genetic defects, the clinical picture of which often includes diabetic symptoms (myodystrophy, Turner syndrome, Down syndrome, porphyria).

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

Important!Treatment tactics for diabetes mellitus largely depend on the type.Therefore, it is recommended to see 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 cause of the disease.

Diagnostics 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 should be taken on an empty stomach; the last meal should be taken at least 8-12 hours before the test.
4. Determination of glycosylated hemoglobin (HbA1C) content.Rent in 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.Used primarily to diagnose prediabetic conditions, including during pregnancy.If FPG is more than 7.0 mmol/L, OGTT is not performed.

In reality, the pathology is often discovered through a random analysis, for example as part of regular preventive examinations.The patient is then sent for further examination.

Diagnostic criteria for diabetes and prediabetic conditions

analysis	Norm, mmol/l	Impaired carbohydrate metabolism (prediabetes), mmol/l	TS, 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%	more than or equal to 6.5%
OGTT	less than 7.8	from 7.8 to 11.0	more than 11.1
Randomly	less than 11.1	-	more than 11.1 with symptoms

Important!The urine glucose test, which has been popular in the recent past, is no longer used due to its non-specificity and low sensitivity.

People who belong to a high-risk group are recommended to be tested for FPG and HbA1C (or OGTT) regularly every three years.If the FPG is already elevated, such monitoring should be carried out annually.Risk factors include:

• physical inactivity;
• Obesity;
• age > 35 years;
• 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, “harmful” lipids – low density lipoproteins;
• HIV infection.

All diabetics are regularly monitored for complications after diagnosis.Standard screening includes ophthalmoscopy, foot examination, urine test for proteinuria, lipid test, and creatinine levels.Most endocrinologists consider it 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 prescribed - ophthalmologist, gynecologist, cardiologist, neurologist.

The most dangerous complications

All complications that arise with this disease can be divided into acute and chronic conditions.Acute ones usually occur when:

• Skipping an insulin injection or taking a blood sugar-lowering drug;
• taking other medications that affect carbohydrate metabolism;
• severe stress;
• alcohol abuse;
• self-termination of therapy;
• against the background of severe trauma, operations, infections;
• during pregnancy.

This includesketoacidotic statewhich was described in detail above, andhypoglycemic coma.Ketoacidosis and hypoglycemia often develop suddenly and only a few hours can pass from the first symptoms to complete coma.Both complications should be stopped as quickly as possible, if necessary by consulting a doctor.

Hypoglycemia- decreased blood sugar – characterized by increased sweating, chills, severe weakness and a strong feeling of hunger.Some patients notice numbness and tingling in certain areas of the body.If the necessary measures are not taken, hypoglycemia leads to coma - the patient loses consciousness.In this situation you need to call an ambulance.

Important!To eliminate hypoglycemia, a person urgently needs to consume simple carbohydrates.Lemonade, sugar cubes (place under the tongue), juice - anything that is easy to swallow and quickly absorbed will do.To avoid such cases, a patient taking blood sugar-lowering medications should always have one of the above products with them.

Further complications are a result of metabolic disorders and damage to small and large vessels.

1. Diabetic cardiopathy or “diabetic heart”.Myocardial dystrophy develops in people over 40 years old without pronounced signs of coronary atherosclerosis.It manifests itself in left ventricular dysfunction and leads to heart failure.The main symptoms are shortness of breath, cardiac arrhythmias and reduced tolerance to physical activity.
2. Metabolic Syndrome X or the “deadly quartet”.The combination of hyperglycemia, obesity, hypertension, and atherosclerosis leads to the early onset of angina and damage to peripheral arteries.Common complications include heart attack, stroke and transient ischemic attacks.The main problem is that each element of the quartet amplifies the manifestations of others, creating a vicious circle.
3. Diabetic nephropathy.The main factor for disability and mortality in patients with diabetes.Develops in 40-50% of cases and leads to chronic renal failure and end-stage renal failure.The main reason is damage to the renal capillaries and increased pressure in the renal glomeruli.The presence of hypertension accelerates pathological processes.This complication is considered one of the most insidious because it does not cause any noticeable symptoms in the early stages.Typically, the patient does not associate swelling, dyspepsia, and weakness with kidney damage.Pain and urinary tract discomfort occur in later stages when the problem is already difficult to treat.
4. Diabetic retinopathy.Subjectively, it feels like fog in front of the eyes, a characteristic “flickering of flies”.Surrounding objects become out of focus and blurry.The reduced vision progresses to complete 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 an ophthalmoscopy once a year and receive treatment if problems arise.
5. Neuropathies.The function of neurons is disrupted by the toxic effects of glucose, oxygen deficiency and electrolyte shifts.Diabetics suffer from a variety of neuropathies, but the most common is symmetrical polyneuropathy.The main symptoms are numbness, discomfort, pain and loss of feeling in the hands and feet, “like gloves and socks”.Such processes in the lower extremities can lead to inadequate loading with further trauma or infection of the feet and degeneration of the joints.Neuropathies affect not only peripheral nerve fibers, but also cranial nerves and the brain tissue itself. The consequences of this are acute neuropsychic disorders, neurosis-like conditions, dysfunction of innervated areas - reduced sense of hearing, vision, smell, etc.
6. Diabetic foot.Against the background of damage to blood vessels, nerves, skin and joints, a syndrome occurs, which is accompanied by ulcers in 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 diabetesstarts with lifestyle changes.This includes a properly structured diet, sufficient physical activity and regular monitoring of plasma sugar concentrations.All this, coupled 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 the function of beta cells.The number of units and the scheme are selected individually.It is important to pay attention to the timing and dosage of drug administration.

Patients with type 2, in case diet and physical activity are not enough,Antihyperglycemic drugs 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 sugar into the intestinal wall and slow down its digestion (alpha-glucosidase inhibitors);
• increase the excretion of glucose in the urine (NGLT-2 inhibitors).

These medications can work together and enhance each other's effects.Therapeutic and prophylactic agents are also widely used.Statins and acetylsalicylic acid help reduce damage caused by damage to the vascular bed, ACE inhibitors help fight early-stage nephropathy.

The prognosis is yours

Every year around four million people die from this insidious disease.In children and adolescents, ketoacidosis is the main cause of death, progressing to coma.In adults, complications and alcohol consumption are critical.The average life expectancy of every patient with diabetes is reduced by 6-15 years.In the second type, the prognosis largely correlates with lifestyle.Smokers, alcoholics and people with high cholesterol can prolong their lives simply by giving up bad habits and changing their diet.

The disease ranks first among the causes of blindness, increases the risk of stroke and heart attack by two times, of chronic kidney failure by 17 times and of foot necrosis by 20 times.Despite the terrible 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 treatment, the higher the survival rate.

Prevention

Preventive measures boil down to the following:

1. Regular and sufficient physical activity.The latter normalizes metabolism and increases the sensitivity of tissue receptors to insulin molecules.
2. diet.Meals are served 4-5 times a day in small portions.Consumption of simple carbohydrates and saturated fats should be kept to a minimum.Avoid mayonnaise, pastries, jam, 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 teas, unsweetened compotes and durum wheat pasta are preferred.Follow the BJU ratio 20:20:60.
3. Prevention of infections.The first type of diabetes mellitus often manifests itself under the influence of a viral infection.Therefore, in the presence of risk factors, it is recommended to strengthen the immune system, prevent a prolonged course of ARVI, wear a mask during epidemics and near sick people, and use antiseptics.