Diabetes mellitus type 1 and 2

Diabetes mellitus(DM) is an endocrine pathology that occurs due to insufficient insulin synthesis/action.In this context, chronic hyperglycemia develops - a condition accompanied by constantly increased levels of sugar (glucose) in the blood plasma.It is hyperglycemia that 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 faster in underdeveloped countries and countries with weak economies.Doctors note a trend towards an increase in incidence in the over 40 age group.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 (adolescents, young people, 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 from each other.

Reasons

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

Type 1 diabetes develops in the presence of genetic predisposition.The trigger for the appearance of pathology is given by toxins and viral infections, such as rubella, influenza, hepatitis B virus, cytomegalovirus and retroviruses.The causative agent causes acute damage to β-cells or leads to the persistence of the infectious agent in the pancreatic tissues with the further development of an autoimmune reaction.The probability of the disease increases if a person has other autoimmune diseases - thyroiditis, adrenal insufficiency, etc.

Important!Diet plays a specific role in the onset of the disease in children.Thus, this is facilitated by very early contact with gluten - it is optimal to introduce cereal porridge into complementary foods no earlier than 6-7 months.The risk increases when you feed a child with cow's milk, with vitamin D deficiency and with a high concentration of nitrates in the drinking water.

Thanks to our body's adaptive abilities, 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 accounts for about 10% of all cases of pathology.It mainly affects children, teenagers and people under 30 years of age.Less often, it can be found in elderly patients in a latent form, which is often confused with non-insulin-dependent.

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

1. Hereditary predisposition is observed in almost all cases.If close relatives have the disease, the risk of developing the pathology increases 6 times.
2. Obesity is often an abdominal and visceral form, where excess fat is deposited mainly in the waist area and/or 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.

Great!High-calorie foods dominated by simple, quickly digestible carbohydrates are considered diabetogenic.These are sweets, alcohol, flour products, sausages, fast food, French fries, soft wheat pasta.Combined with a sedentary lifestyle and a lack of fiber, such food, 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 blood glucose concentration after eating a carbohydrate meal.The rate at which glucose decreases to normal is highly dependent on muscle mass and degree of obesity.Since childhood obesity is now an epidemic, type 2 is occurring more and more in children.

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

Diabetes mellitus: symptoms of an insidious disease

Let's examine the clinic of diabetes depending on the disorders it causes, the stage of the disease and the type of pathology.

Symptoms related to metabolic disorders

Insulin is involved in all types of metabolism:

1. Carbohydrates - regulates plasma glucose levels, as well as glycogen breakdown, gluconeogenesis, and other reactions involving sugars.
2. Fats - increases the synthesis of fatty acids and reduces their entry into the blood.
3. Protein - enhances 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 related to carbohydrate metabolism disorder, in particular, hyperglycemia.Elevated 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 (glucose conversion product) in nerve fibers, retina, lens with subsequent damage.
• predisposition to bacterial and fungal infections.

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

• muscular dystrophy - occurs due to reduced synthesis and increased breakdown of protein.
• hypoxia - lack of oxygen in the tissues - causes lethargy, reduced concentration and sleepiness.
• generalized vascular damage due to protein glycosylation.

Disturbed fat metabolism is manifested in:

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

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

Clinic depending on the stage of the disease

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

Patients complain of:

• severe weakness, fatigue.
• thirst - patients can drink about 3-5 liters of fluid per day, with a significant amount occurring at night.
• characteristic dry mouth (due to dehydration).
• frequent and profuse urination.children may develop enuresis.
• skin itching, in women especially in the genital area.

Great!Progressive tooth decay and periodontal disease can often be found among the first symptoms of diabetes.Loose teeth and deep carious 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 advised to visit a therapist and take a glucose tolerance test.

Without treatment, the patient's condition gradually worsens.Dry skin appears, skin infections are common - hidradenitis, furculitis, fungal infections of the foot.From the gastrointestinal system, gastrointestinal dysfunctions, 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 often leads to 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 are 4 times more likely than ordinary people to suffer from cystitis and pyelonephritis.In advanced stages, blindness and other complications due to vascular damage may occur.

Signs of type 1 and type 2 diabetes

With 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 extremely poorly absorbed, tissues and organs are deprived of energy.In an attempt 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 amounts, ketone bodies are toxic to humans.The patient feels thirsty, dizzy, lethargic, sleepy and has a fast heartbeat.It is characterized by frequent urination, abdominal pain, nausea, vomiting and the smell of acetone from the mouth.Without proper treatment, ketoacidosis leads to coma, brain swelling and death.

Great!If you have already been diagnosed with diabetes, you can independently prevent ketoacidosis.

To do this you should:

• in case of acute respiratory infections, acute respiratory viral infections, monitor blood sugar levels more often and administer insulin in the appropriate amount.
• when using other drugs, warn your doctor about the presence of diabetes (for example, glucocorticoids increase the need for insulin);
• even during remission, do not stop giving the drug - just reduce the dose and consult a doctor to correct the treatment.
• Do not skip injections and strictly monitor glucose levels.
• administer insulin using the right instruments and in the right place.
• monitors the expiry date and storage conditions of the medicinal product.

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 an energy source.And to get rid of excess glucose, the body actively removes 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 a chronic condition.Sometimes the disease is discovered accidentally, during a routine examination.There are cases when a patient comes to an endocrinologist at 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.Thus, in addition to the already known first and second types, other specific types of the disease can be distinguished.All belong to category III and are collected, depending on the reason for their growth, in classes A, B, C, D, E, F, Z and H.

1. This category includes genetic defects of β-cell function - mitochondrial mutations, damage to individual parts of certain chromosomes.
2. Also genetic defects, but not in the cells of the pancreas, but at the level of insulin receptors.These include Donohue syndrome, Rabson-Mendenhall syndrome, certain lipodystrophies, and type A insulin resistance.
3. Diseases of the exocrine pancreas (fibrosis, pancreatitis, neoplasia, trauma, etc.).
4. Endocrine diseases.The disease can develop in the context 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 diabetes caused by the immune system.
8. Genetic defects, part of the clinical picture of which are often diabetic symptoms (myodystrophy, Turner syndrome, Down syndrome, porphyria).

Separately, category IV is allocated to gestational diabetes, which is a hidden disorder of carbohydrate metabolism in pregnant women.

Great!Treatment tactics for diabetes mellitus 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 source of the disease.

Diagnostics and preventive control

The diagnosis is made based on the following criteria.

1. History, symptoms, complaints of the patient.
2. Examining the patient to identify possible complications.
3. Biochemical blood test - determination of fasting plasma glucose (FPG) concentration.It is taken on an empty stomach, with the last meal no later than 8-12 hours before the examination.
4. Determination of the level of glycated hemoglobin (HbA1C).Rent in the same way.Avoid smoking, alcohol and vigorous 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 prediabetic conditions, including pregnancy.If the FPG is greater than 7.0 mmol/l, then the OGTT is not performed.

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

Diagnostic criteria for diabetes and prediabetes

Analysis	Norm, mmol/l	Disorder of carbohydrate metabolism (prediabetes), mmol/l	DM, mmol/l
GPN	less than 5.6	from 5.6 to 6.9	above 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
Random	less than 11.1	-	over 11.1 with 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 in a high-risk group are advised to undergo regular, once every three years, testing for FPG and HbA1C (or OGTT).If FPG is already elevated, this monitoring should be done annually.Risk factors include:

• physical inactivity;
• portliness;
• 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 hepatitis;
• high cholesterol levels, "harmful" lipids - low-density lipoproteins.
• HIV infection.

All diabetic patients are regularly monitored for complications after diagnosis.Standard testing includes ophthalmoscopy, foot exam, urine test for proteinuria, lipid test 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 cardiovascular risk.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.Acutes usually occur when:

• missing an insulin injection or taking glucose-lowering medicine.
• the use of other drugs that affect carbohydrate metabolism.
• intense stress;
• alcohol abuse;
• self-cancellation of treatment.
• in the context of severe trauma, surgery, infection.
• during pregnancy.

This includesketoacidic statedetailed 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 soon as possible, if necessary, consult a doctor.

Hypoglycemia- low blood sugar - characterized by increased sweating, chills, severe weakness and a feeling of intense hunger.Some patients experience numbness and tingling in certain areas of the body.If the necessary actions are not taken, then hypoglycemia turns into a coma - the patient loses consciousness.In this case, you need to call an ambulance.

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

Other complications are a consequence of 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 strong signs of atherosclerosis of the coronary vessels.It manifests as left ventricular dysfunction and leads to heart failure.The main symptoms are shortness of breath, arrhythmia and reduced 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 peripheral arterial damage.Frequent complications are heart attack, stroke, transient ischemic attacks.The main problem is that each element of the quartet amplifies the manifestations of the others, creating a vicious circle.
3. Diabetic nephropathy.The main factor of disability and mortality in patients with diabetes.It develops in 40-50% of cases, leading to chronic and end-stage renal failure.The main reason is the damage to the capillaries of the kidneys, the increased pressure inside the renal glomeruli.The presence of hypertension accelerates pathological processes.This complication is considered one of the most insidious, since in the initial stages it does not give any noticeable symptoms.The patient usually does not associate edema, indigestion, and weakness with kidney damage.Pain and urinary disorders appear in the last stages, when the problem is already difficult to treat.
4. Diabetic retinopathy.Subjectively, it feels like a mist before the eyes, a characteristic "flickering of flies".Surrounding objects become blurred and blurry.Reduced vision progresses to the point of 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 have an ophthalmoscopy once a year and, if problems occur, receive treatment.
5. Neuropathies.Neuronal function is disrupted due to the toxic effects of glucose, lack of oxygen, and electrolyte changes.Diabetics experience a huge number of neuropathies, but the most common of them is symmetrical polyneuropathy.Its main symptoms are numbness, discomfort, pain, loss of sensation in hands and feet, "like gloves and socks".Such processes in the lower extremities can lead to insufficient loads with further trauma or infection of the feet and joint degeneration.Neuropathies affect not only the peripheral nerve fibers, but also the cranial nerves and the brain tissue itself.This results in acute neuropsychic disorders, neurosis-like conditions, dysfunction of innervated areas - impaired 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 leg 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, adequate physical activity and regular monitoring of plasma sugar concentrations.All this, combined with the basic treatment, 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 shape are selected individually.It is important to observe the time and dosage of the drug.

Patients with type 2, in case diet and physical activity are not sufficient,antihyperglycemic agents are prescribed.These drugs differ in their mechanism of action:

• stimulate the secretion of your own insulin (sulphonylureas, meglitinides).
• increasing the sensitivity of insulin receptors (thiazolidinediones).
• inhibit additional glucose production pathways (diguanides).
• they prevent the absorption of sugars in the intestinal wall, slowing down their digestion (alpha-glucosidase inhibitors).
• increase urinary glucose excretion (NGLT-2 inhibitors).

These drugs can work together, enhancing each other's effects.Therapeutic and prophylactic agents are also widely used.Statins and acetylsalicylic acid help reduce damage from damage to the vascular layer, ACE inhibitors help fight kidney disease in the early stages.

The prediction is up to you

Every year, about 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 of each patient with diabetes is reduced by 6-15 years.In the second type, prognosis is highly correlated with lifestyle.Smokers, alcoholics and people with high cholesterol levels can extend 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, chronic kidney failure by 17 times and leg necrosis by 20 times.Despite the dire numbers,the prognosis depends on early diagnosis and your personal attitude towards the disease.The earlier the disease is detected and the more carefully the patient approaches the treatment, the higher the survival rate.

Prevention

The preventive measures are summarized in:

1. Regular and adequate physical activity.The latter normalizes metabolism and increases the sensitivity of tissue receptors to insulin molecules.
2. Diet.Meals are fractional, 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, very salty food, fast food, smoked and canned food.The basis should be complex carbohydrates, plant fibers and pectins.Lean fish, poultry, vegetables, herbal teas, sugar-free compotes, durum wheat pasta are preferred.Follow the BJU 20:20:60 ratio.
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 near sick people.