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 constant high level of sugar (glucose) in the blood plasma.Hyperglycemia, which is the main cause of symptoms and complications of diabetes: metabolic disorders, damage to blood vessels and nerve fibers, kidney failure and blindness.

In the past forty years, the number of diabetes cases worldwide has almost quadrupled.The disease is spreading fastest in underdeveloped countries and countries with weak economies.Doctors tend to increase in the age group of more than 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 (minor, young, 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.

To be the cause

Insulin is a protein hormone synthesized in the beta cells of the pancreas.Its effect is carried out through insulin receptors in various organs and tissues.Diabetes occurs when the beta cells are either destroyed or the receptor becomes desensitized.

Type 1 Diabetes develops with the presence of a genetic predisposition.The impetus for the emergence of pathology was given by viral infections and viral infections, such as rubella, influenza, hepatitis b virus, cytomegalovirus and retoviruses.The contributing factor causes acute damage to β-cells or causes persistence of the infectious agent in pancreatic tissues with further development of an autoimmune reaction.If a person has other autoimmune diseases, the probability of the disease increases - thyroiditis, adrenal insufficiency, etc.

It is important!Diet plays a role in the development of the disease in children.Thus, it is facilitated by very early contact with gluten - it is optimal to introduce cereal porridge to complementary foods before 6-7 months.A child who has a child with cow's milk grows with the milk of a child with vitamin D deficiency and a high concentration of drinking water.

Thanks to our body's adaptive capabilities, type 1 diabetes can remain silent for years.The first signs appear when the number of β cells (and, accordingly, insulin) is insufficient to regulate glucose levels.Type 1 accounts for about 10% of all pathological cases.It mainly affects children, teenagers and people under 30 years of age.Less published, in elderly patients, it can often be found in a non-insulin-dependent latent form.

Type 2 diabetes accompanied by uncontrolled insulin secretion and a decrease in the sensitivity of insulin receptors, otherwise "insulin resistance".The most important risk factors:

1. In almost all cases, a hereditary tendency is noted.If close relatives have the disease, the risk of developing the pathology increases 6 times.
2. Obesity is often an abdominal and visceral form, when excess fat is stored mainly in the waist area and / or internal organs.With obesity class I, the risk of developing the disease increases 2 times, class II, class II, class III - 10 times.

It is 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 pasta.With a sedentary lifestyle and a lack of plant fiber, such food can cause irreparable damage to the body if it is consumed regularly.

The second type usually occurs during puberty.A trend was seen: The older the person, the higher the glucose concentration after eating a carbohydrate meal.The rate at which glucose returns to normal is highly dependent on muscle mass and adiposity.Since childhood obesity is now an epidemic, type 2 is found in children.

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

Diabetes Mellitus: Symptoms of an insidious disease

Let's consider the clinic of diabetes depending on the disease, the stage of the disease and the type of pathology.

Symptoms associated with metabolic disorders

Insulin is involved in all types of metabolism:

1. Carbohydrate - regulates plasma glucose levels, as well as glycogen breakdown, gluconeogenesis and other sugar-related reactions.
2. Fat - increases the synthesis of fatty acids and reduces their entry into the blood.
3. Protein - Increases protein synthesis and suppresses degradation, activates DNA and RNA replication.
4. Electrolyte - activates the flow of potassium and prevents the flow of sodium into the cells.

With such a physiological effect, changes in insulin concentration do not leave a trace for the body.The main symptoms are associated with impaired carbohydrate metabolism, in particular, hyperglycemia.An increased glucose level causes the following symptoms:

• thirst, dehydration, polyuria - more than three liters of urine per day;
• Polifogia - constant need for food, greed, develops in response to lack of energy;
• Nausea, vomiting;
• sorbitol (a product of glucose conversion) in nerve fibers, retina, and subsequently damaged lenses;
• prone to bacterial and fungal infections.

Due to the violation of protein metabolism, the following symptoms of diabetes Mellitus develop::

• Muscular dystrophy - appears due to increased synthesis and breakdown of protein;
• Hypoxia - lack of oxygen in tissues - lethargy, reduced concentration and sleepiness;
• Generalized vascular damage due to protein glycosylation.

Disabled fatty metabolism manifests itself:

• increase the concentration of cholesterol in the blood;
• fatty liver infiltration;
• Ketonuria, Ketonemia - Accumulation of ketones in blood and urine;At high concentrations, without treatment, coma and death develop.

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

The clinic depends on the stage of the disease

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

Patients complain:

• Severe weakness, fatigue;
• Thirst - patients are able to drink about 3-5 liters of liquid per day, a significant amount of which occurs at night;
• Characteristic dry mouth (due to dehydration);
• frequent and copious urination;children may develop enures;
• Skin itching in women, especially in the genital area.

It is important!Progressive caries and periodontal disease can often be found among the first signs of diabetes.Loose teeth and a deep dwarf lesion on the roots of the teeth indicate a pre-diabetic condition.Biochemical analysis of blood glucose concentration does not show visible changes.Therefore, if such symptoms are detected, the patient is recommended to visit a therapist and get a glucose tolerance test.

Without treatment, the patient's condition gradually worsens.Dry skin appears, skin infections are common - hidradenitis, furunculosis, fungal infection of the foot.From the gastrointestinal tract, gastrointestinal dysfunction, gallbladder dyskinesia, chronic gastritis and duodenal ulcers are observed.As a result of damage to the vascular system and increased cholesterol levels, atherosclerosis and coronary heart disease develop.The latter is generally difficult and often causes serious complications.Myocardial infarction is the cause of death in 38-50% of patients.

Diabetic patients are prone to bronchitis, pneumonia and tuberculosis.Men with prostate adenoma and women over 50 are 4 times more likely to suffer from cystitis and pyelonephritis than ordinary people.In advanced stages, blindness and other complications may occur due to vascular damage.

Symptoms of type 1 and type 2 diabetes

With the first type, people often do not notice or ignore the initial symptoms.A common condition, 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.Because sugars are too weak, tissues and organs lack energy.In an attempt to compensate for the lack of energy, the body begins to actively burn.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 rapid heartbeat.It is often characterized by urine, abdominal pain, nausea, vomiting and the smell of acetone from the mouth.Without proper treatment, ketoacidosis can lead to coma, brain swelling, and death.

It is important!If you have already been diagnosed with diabetes, you can independently prevent ketoacidosis.

To do this:

• Acute respiratory infections, in case of acute respiratory viral infection, monitor plasma sugar levels more often and administer the appropriate amount of insulin;
• Inform your doctor about the presence of diabetes when using other drugs (for example, glucocorticoids increase the need for insulin);
• Even during remission, do not stop administering the drug - just reduce the dose and consult a doctor to adjust the therapy;
• Do not skip injections and strictly monitor glucose levels;
• administer insulin using the right tools and in the right place;
• Follow the shelf life and storage conditions of the medicinal product.

The three main symptoms of the other three types of diabetes are fatigue, weight loss, and constant hunger.- It arises in response to the inability to use sugars as an energy source.To get rid of excess glucose, the body actively eliminates it in the urine, which provokes polyuria.As a result of dehydration, the patient feels severe weakness.

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

Classification and types

The World Health Organization offers a fairly broad classification of pathology.Thus, in addition to the already known first and second types, other special types of the disease are distinguished.All of them belong to category III and, according to the reason for their development, they are collected according to classes A, B, C, D, E, F, G and H.

1. Genetic defects of beta cell function of this class - mitochondrial mutations, damage to individual parts of certain chromosomes.
2. Genetic defects, but not in pancreatic cells, but at the level of insulin receptors.These include Donohue syndrome, Rabson-Mendenhall syndrome, some lipodessoshies and insulin resistance.
3. Ecocrine pancreatic diseases (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 diabetes.
8. Genetic defects, often part of the clinical picture with diabetic symptoms (myotrophy, turner's syndrome, low syndrome, porphyria).

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

It is important!Treatment tactics for diabetes mellitus mainly depends on its type.Therefore, it is recommended to consult a doctor as soon as possible to determine the exact cause of unpleasant symptoms.An experienced endocrinologist will do the necessary examination and find the source of the disease.

Diagnosis and selection

The diagnosis is made based on the following criteria.

1. History, symptoms, complaints of the patient.
2. Examination of the patient to identify potential complications.
3. Biochemical blood test - determination of fasting plasma glucose concentration (FPG).It is carried out on an empty stomach with the last meal 8-12 hours before the test.
4. Determination of glycosylated hemoglobin (HBA1C) level.Rent the same.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.It is mainly used to diagnose priagiabetic conditions, including during pregnancy.If FPG is more than 7.0 mmol / l, ogtt is not performed.

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

Diagnostic criteria for diabetes and priadiabetic condition

Analysis	Norm, mmol / l	Disabled carbohydrate metabolism (prediabetes), mmol / l	Dm, mmol / l
Gop	Less than 5.6	Between 5.6 and 6.9	More than 7.0
HBA1C	Less than 5.7%	Between 5.7 and 6.4%	Greater than or equal to 6.5%
August	Less than 7.8	Between 7.8 and 11.0	More than 11.1
Casual	Less than 11.1	-	With more than 11.1 symptoms

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

Individuals belonging to a high-risk group are regularly recommended to be tested for FPG and HBA1C (or Ogtt) every three years.If the FPG is already elevated, such monitoring should be done annually.Risk factors include:

• physical inactivity;
• obesity;
• Age > 35 years;
• Family history of diabetes;
• Personal history of prediabetes, gestational diabetes, pcos, cardiovascular diseases;
• Birth of a child weighing more than 4.1 kg;
• hypertension;
• fatty liver hepatosis;
• High level of cholesterol, "harmful" lipids - low-density lipoproteins;
• HIV infection.

All diabetic patients are regularly monitored for complications after diagnosis.A standard screen includes ophthalmoscopy, foot examination, proteinuria, lipid testing, and urinalysis for creatinine levels.Most endocrinologists, to study the dynamics of the disease and predict the risk of cardiovascular diseases, it is important to record the initial ecg and lipid profile during the initial treatment.If necessary, consultations with specialized specialists are appointed - ophthalmologist, gynecologist, cardiologist, neurologist.

The most dangerous complications

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

• taking insulin injections or a glucose-lowering drug;
• the use of other drugs affecting carbohydrate metabolism;
• severe stress;
• Alcohol abuse;
• self-cancellation of therapy;
• Against the background of severe trauma, surgery, infection;
• during pregnancy.

It includesketoacidotic statedescribed in detail above andhypoglycemic coma.Ketoacidosis and hypoglycemia often develop suddenly, and only a few hours from the first symptoms can lead to a full-blown coma.Both complications should be stopped as soon as possible by consulting a doctor if necessary.

Hypoglycemia- Decreased blood sugar - characterized by increased sweating, tremors, severe weakness and severe hunger.Some patients report numbness and tingling in certain areas of the body.If the necessary actions are not taken, hypoglycemia turns into a coma - the patient loses consciousness.In this case, you should call an ambulance.

It is important!To eliminate hypoglycemia, you need to eat simple carbohydrates urgently.Lemonade, disposable sugar (put under the tongue), water - anything that is easy to swallow and swallow quickly will do.To avoid such situations, a patient taking glucose-lowering drugs should take any of the above products with him.

Other complications are the result of metabolic diseases and damage the small and large vessels.

1. Diabetic cardiopathy or "diabetic heart".Myocardial dystrophy develops in people older than 40 years without symptoms of coronary atherosclerosis.It manifests as left ventricular dysfunction and causes heart failure.The main symptoms are shortness of breath, arrhythmia and reduced tolerance to physical activity.
2. Metabolic syndrome X or the "deadly four".A combination of hyperglycemia, obesity, hypertension, and arteriosclerosis predisposes to early onset of angina pectoris and damage to peripheral vessels.Frequent complications are heart attack, stroke, transient ischemic attacks.The main problem is that each element of the quad reinforces the manifestations of the others, creating a vicious circle.
3. Diabetic nephropathy.A leading cause of disability and death among patients with diabetes.It develops in 40-50% of cases that cause chronic and end-stage renal failure.The main reason is damage to the capillaries of the kidneys, increased pressure in the kidney glomeruli.The presence of hypertension accelerates pathological processes.This complication is considered one of the most insidious, as it does not cause any noticeable symptoms in the early stages.The patient usually does not associate weakness with bloating, dyspepsia and kidney damage.Pain and urinary disorders appear in later stages when the problem is difficult to treat.
4. Diabetic retinopathy.Subjectively, before the eyes, a characteristic "fluttering of flies" is felt.Surrounding objects become fuzzy and blurry.Decreased vision progresses to the point of complete blindness.The reason is the damage of retinal vessels with the subsequent appearance of vanes, hemorrhage and edema.To prevent vision loss, patients should undergo an opthalmoscopy once a year and receive treatment if there are problems.
5. Neuropathies.The functioning of neurons is disturbed due to the toxic effects of glucose, lack of oxygen and electrolyte shifts.Diabetics experience many types of neuropathy, but the most common is symmetrical polyneuropathy.Its main symptoms are loss of sensation in the hands and feet, "like gloves and socks", anxiety, restlessness, pain, pain and loss of sensation in the feet.In the lower extremities, such processes can lead to further trauma or infection of the degeneration of the feet and joints.Neuropathies affect not only peripheral nerve fibers, but also cranial nerves and brain tissue.The result of this is acute neuropsychiatric diseases, neurosis-like conditions, dysfunction of innervated areas - hearing, vision, smell, etc.
6. Diabetic foot.Against the background of damage to blood vessels, nerves, skin and joints, a syndrome occurs with the suppuration of soft tissues and the suppuration of purulent-necrotic processes.Leg necrosis ends with amputation of the affected area.The syndrome occurs in 20-25% of patients.

Treatment: Diet and drugs

Treatment of diabetesit starts with lifestyle changes.This includes a properly structured diet, sufficient physical activity and regular monitoring of plasma sugar concentrations.All this, combined with basic therapy, helps to prevent the rapid progression of the 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 observe the time and dosage of drug administration.

Patients with type 2, in the presence of diet and physical activity,antihyperglycemic agents are prescribed.These drugs differ in their mechanism of action:

• Stimulate the secretion of your own insulin (sulfonylureas, meglitinides);
• increase the sensitivity of insulin receptors (thiazoliditiones);
• inhibits additional pathways (biguanides) for glucose production;
• slows down digestion and prevents the absorption of sugar in the intestinal wall (alpha-glucosidase inhibitors);
• Increase urinary glucose excretion (NGLT-2 inhibitors).

These drugs can work together by enhancing each other's effects.Therapeutic and preventive substances are also widely used.Statins and acetylsalicylic acid help reduce damage to the vascular bed, Ace inhibitors help fight nephropathy in the early stages.

The forecast is up to you

About four million people die from this insidious disease every year.The main cause of death in children and adolescents is ketoacidosis, which progresses to coma.It is important to have complications and alcohol consumption in adults.The average life expectancy of each patient with diabetes is reduced by 6-15 years.In the second type, the forecast is mainly related to 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 is the number one cause of blindness, doubles the risk of stroke and heart attack, 17 times with chronic kidney failure, and 20 times monthly necrosis.Despite the dire numbers,The prognosis depends on the time of diagnosis and your personal attitude to the disease.If the disease is detected earlier and the patient approaches treatment more carefully, the survival rate is higher.

Prevention

Preventive measures are reduced:

1. Regular and adequate physical activity.The latter normalizes metabolism and increases the sensitivity of tissue receptors to insulin molecules.
2. Diet.Meals 4-5 times a day, fractional 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, highly salty foods, fast food, smoked foods and canned foods.The basis should be complex carbohydrates, fiber and pectins.Lean fish, poultry, vegetables, herbal infusions, silent compotes, durum wheat rolls are preferred.Watch 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, if there are risk factors, it is recommended to strengthen the immune system, prevent a prolonged course of Arvi, wear a mask and use antiseptics during epidemics and sick people.