Diabetes is a disease of the endocrine system that is associated with abnormal changes in the hormonal background and metabolic failures.
To date, the disease is not treatable (complete elimination). The destructive process in the body can be slowed down with medication and diet therapy, but it is impossible to stop it and start it in the opposite direction.
The types of diabetes mellitus (DM) are defined by the World Health Organization and there are no fundamental differences in the medical world. Any type of diabetes mellitus is not a contagious disease.
There can be several but different types of diabetes. Because each species and type is treated differently, it is important to know which variant of the disease has developed.
Typing of pathology
There are several types of the disease, which are united by a single main symptom - increased blood glucose. The typification of diabetes mellitus can be traced back to the causes of its occurrence. There are also therapeutic methods used, the gender and age of the patient.
Medically acceptable types of diabetes:
- the first type is insulin-dependent (IDDM 1) or juvenile;
- the second is insulin-independent (INZDM 2) or insulin-resistant;
- gestational diabetes mellitus (GDM) in women in the perinatal period;
- other specific types of diabetes, including:
- genetic damage to pancreatic β-cells (types of MODY diabetes);
- pathology of exocrine function of the pancreas;
- hereditary and acquired pathologies of the endocrine glands and their functions (endocrinopathy);
- pharmacologically defined diabetes;
- diabetes mellitus due to congenital infections;
- DM associated with genomic pathologies and hereditary defects;
- decreased glycemia (blood sugar levels) on an empty stomach and decreased glucose tolerance.
Prediabetes is a borderline condition in which the body's glycemic levels change (glucose tolerance worsens), but blood glucose levels "do not reach" generally accepted digital values for true diabetes. According to the World Health Organization (WHO 2014), more than 90 patients with endocrinology% suffer from the second type of disease.
According to medical statistics, the increase in the number of diseases is showing a clear trend worldwide. The number of people with type 2 diabetes has doubled in the last 20 years. GDM accounts for about 5% of pregnancies. Types of specific diabetes are extremely rare and occupy a small percentage in medical statistics.
Gender suggests that NIDDM 2 is more common in premenopausal and menopausal women. This is due to a change in hormonal status and a range 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 mellitus (type 1)
Type 1 diabetes is characterized by insufficiency of pancreatic cells. The body does not perform its endocrine (intrasecretory) function, which is insulin, the hormone responsible for supplying the body with glucose. Due to the accumulation of glucose in the blood, the organs do not receive adequate food, including the pancreas itself.
To mimic the natural production of endocrine hormone, the patient receives a lifetime injection of medical insulin in various treatments (short and long) as well as diet. The classification of type 1 diabetes mellitus is determined by the different etiologies of the disease. There are two causes of the insulin-dependent type of the disease: genetic and autoimmune.
genetic cause
The development of pathology is related to the biological characteristics of the human body, to pass on its characteristic features and pathological differences to the next generations. In relation to diabetes, a child inherits a predisposition to the disease from the parents or close relatives of the diabetic.
Important! The predisposition is inherited, but not the disease itself. There is no 100% guarantee that a child will develop diabetes.
autoimmune ok
The development of the disease is due to the functional failure of the immune system, when it actively produces autoimmune antibodies under the influence of negative factors, which have a devastating effect on the cells of the body. The triggers that trigger autoimmune processes are:
- unhealthy eating behavior combined with physical inactivity;
- failure of metabolic processes (carbohydrate, lipid and protein);
- critical deficiency of colecalciferol and ergocalciferol (group D vitamins) in the body;
- chronic pathology of the pancreas;
- history of mumps, measles, Coxsackie herpes virus, Epstein-Barr virus, cytomegalovirus, viral hepatitis A, B, C;
- distress (prolonged stay in a state of neuropsychological stress);
- chronic alcoholism;
- improper treatment with hormone-containing drugs.
IDDM develops in children, adolescents, and adults under the age of thirty. The childhood version of type 1a diabetes is associated with complicated viral infections. Form 1b occurs in adolescents and children in the background of autoimmune processes and hereditary predisposition. The disease usually develops in an accelerated state within a few weeks or months.
Insulin-resistant diabetes (type 2)
The difference between type 2 and type 1 diabetes is that the pancreas does not stop producing insulin. Glucose is concentrated in the blood and does not reach the cells and tissues of the body because they are not sensitive to insulin - insulin resistance. Up to a certain point, treatment is with hypoglycaemic (low blood sugar) medicines and diet therapy.
To compensate for the imbalance in the body, the pancreas activates hormone production. When working in an emergency, the organ wears out over time and loses its intrasecretory function. Type 2 diabetes becomes insulin dependent. Decreased or lost sensitivity of cells to endogenous hormones is primarily associated with obesity, in which fat and carbohydrate metabolism are disrupted.
This is especially true for visceral obesity (fat deposits around the internal organs). In addition, being overweight makes blood flow more difficult due to the many cholesterol plaques in the blood vessels that are formed during hypercholesterolemia, which is always associated with obesity. The cells of the body are thus deficient in nutrition and energy sources. Other factors influencing the development of NIDDM include:
- alcohol abuse;
- gastronomic dependence on sweet foods;
- chronic diseases of the pancreas;
- cardiovascular pathology;
- exaggeration in food in the background of a sedentary lifestyle;
- improper hormone therapy;
- complicated pregnancy;
- dysfunctional inheritance (diabetes in parents);
- anxiety.
The disease is most common in women and men over the age of 40. However, type 2 diabetes is latent and may not show severe symptoms for several years. Prediabetes can be detected by monitoring blood sugar levels over time. With appropriate therapy, the prediabetic condition can be reversed. If time is lost, it will progress and NIDDM will then be diagnosed.
Lada diabetes
The term "Diabetes 1, 5" or the name Lada diabetes can be found in medicine. It is an autoimmune disorder in hormone production and failure of metabolic processes that occurs in adults (over 25 years of age). The disease combines the first and second types of diabetes. The mechanism of development is consistent with IDDM, and the latent course and manifestation of symptoms is similar to NIDDM.
Causes of the pathology are autoimmune diseases in the patient's history:
- non-infectious inflammation of the intervertebral joints (ankylosing spondylitis);
- irreversible disease of the central nervous system - multiple sclerosis;
- granulomatous inflammatory pathology of the gastrointestinal tract (Crohn's disease);
- chronic inflammation of the thyroid gland (Hashimoto's inflammation of the thyroid gland);
- juvenile and rheumatoid arthritis;
- skin discolouration (loss of pigment) (vitiligo);
- inflammatory pathology of the colonic mucosa (ulcerative colitis);
- chronic damage to the connective tissue and glands of external secretion (Sjogren syndrome).
In addition to hereditary predisposition, autoimmune disorders lead to progression of Lada diabetes. Basic diagnostic methods are used to detect the disease, as well as a blood microscopic test to determine the concentration of IgG class immunoglobulins in antigens - ELISA (enzymatic immunoassay). Therapy is with regular insulin injections and nutritional adjustments.
The pregnancy form of the disease
GDM is a specific type of diabetes that develops in the second half of the perinatal period in women. The disease is most often discovered during the second routine screening, when the expectant mother undergoes a full examination. The main feature of GDM similar to type 2 diabetes is insulin resistance. The cells in a pregnant woman's body lose their sensitivity (sensitivity) to insulin due to a combination of three main reasons:
- Hormonal reorganization. During pregnancy, the synthesis of progesterone (a steroid sex hormone) is increased, which inhibits insulin production. In addition, placental endocrine hormones, which tend to inhibit insulin production, are potentiated.
- Double load on the female body. The body needs an increased amount of glucose to properly feed the unborn baby. A woman begins to consume more monosaccharides, as a result of which the pancreas synthesizes more insulin.
- Increase in body weight against a background of decrease in physical activity. Glucose, which is abundant in the body, builds up in the blood as the cells refuse to take up insulin due to obesity and physical inactivity. The expectant mother and fetus in this situation experience nutritional deficiencies and energy hunger.
Unlike type 1 and type 2 diabetes, gestational diabetes is a reversible process because insulin molecules and pancreatic function are retained.
Properly selected therapeutic tactics guarantee the elimination of pathology after childbirth in 85% of cases. The main way to treat GDM in the diet of diabetics is "Table 9". In severe cases, medical insulin injections are used. Hypoglycaemic agents are not used due to their teratogenic effects on the fetus.
Also
Certain types of diabetes are genetically determined (MODY diabetes, certain types of endocrinopathies) or are provoked by other chronic pathologies:
- pancreatic diseases: inflammation of the pancreas, hemochromatosis, tumor, cystic fibrosis, mechanical trauma and surgery on the gland;
- functional insufficiency of the anterior pituitary gland (acromegaly);
- increased synthesis of thyroid hormones (thyrotoxicosis);
- hypothalamic-pituitary-adrenal pathology (Itsenko-Cushing's syndrome);
- tumors of the adrenal cortex (aldosteroma, pheochromocytoma, etc. ).
A distinct diabetic pathology — diabetes insipidus — is characterized by a decrease in the production of the hormone vasopressin by the hypothalamus, which regulates the body’s fluid balance.
Diagnostic measures
Diagnosis of diabetes mellitus (of any type) is only possible based on the results of a laboratory blood microscopic examination. The diagnosis consists of several consecutive tests:
- General clinical blood test to detect latent inflammatory processes in the body.
- Blood test (capillary or venous) to determine glucose content. Manufactured on a strictly empty stomach.
- GTT (glucose tolerance test). This is done to determine the body's ability to absorb glucose. The tolerance test is a double blood sample: on an empty stomach and two hours after the "glucose load", which is a solution of 200 ml of water / 75 g of aqueous glucose.
- HbA1C analysis for glycosylated (glycated) hemoglobin levels. Based on the results of the study, a review of blood sugar levels over the past three months will be evaluated.
- Biochemistry of blood. Liver enzymes evaluate indicators of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (AP), bilirubin (bile pigment), and cholesterol levels.
- Blood tests for antibodies to glutamate decarboxylase (GAD antibodies) determine the type of diabetes mellitus.
Blood glucose benchmarks and indicators
| Analysis | For the sugar | Glucose tolerance test | Glycated hemoglobin |
|---|---|---|---|
| norm | 3, 3 - 5, 5 | < 7. 8 | ⩽ 6% |
| prediabetes | 5, 6 - 6, 9 | 7, 8 - 11, 0 | 6-6, 4% |
| diabetes | >7. 1 | >11. 1 | more than 6, 5% |
In addition to blood microscopy, a general urine test is performed for the presence of glucose in the urine (glycosuria). There is no urine sugar in healthy people (0. 061-0. 083 mmol / l is considered acceptable in diabetics). A Reberg test is also performed to detect the product of albumin protein and creatinine protein metabolism in the urine. In addition, hardware diagnostics are prescribed, including an ECG (electrocardiogram) and abdominal ultrasound (with the kidneys).
Results
Modern medicine classifies diabetes into four main types depending on the pathogenesis (origin and development) of the disease: insulin-dependent (IDDM type 1), non-insulin-dependent (NIDDM type 2), pregnancy (GDM pregnant), specific (DM). includes several types of diseases caused by genetic defects or chronic pathologies). Gestational diabetes that develops in the perinatal period can be cured. Prediabetes (decreased glucose tolerance) is considered reversible if diagnosed early.