Diabetes mellitus Type 1 and 2

Diabetes mellitus(DM) is an endocrine pathology that occurs due to insufficient insulin synthesis/action.Against this background, chronic hyperglycemia develops - a condition accompanied by a constantly high level 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.

Over the past forty years, the number of diabetes cases worldwide has nearly quadrupled.This disease spreads fastest in undeveloped countries and in countries with weak economies.Doctors noted a tendency towards increased incidence in the over 40 age group.In terms of social importance, this pathology ranks third after cardiovascular disease and cancer.

Diabetes mellitus is divided into two main types:

1. insulin dependent (adolescent, young, child),
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.

Cause

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

Type 1 diabetes develop in the presence of 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 retrovirus.Provocative factors cause acute damage to β-cells or lead to persistence of infectious agents in pancreatic tissue with further development of autoimmune reactions.The possibility of this disease increases if a person has other autoimmune diseases - thyroiditis, adrenal insufficiency, etc.

Important!Diet plays a certain role in the occurrence of diseases in children.Therefore, this is facilitated by early contact with gluten - it is optimal to introduce cereal porridge into complementary food no earlier than 6-7 months.The risk increases when feeding children with cow's milk, with vitamin D deficiency and with high nitrate concentrations in drinking water.

Thanks to our body's adaptive capacity, type 1 diabetes can be dormant for years.The first signs appear when the number of β cells (and, therefore, insulin) becomes insufficient to control glucose levels.Type 1 accounts for about 10% of all pathological cases.It mainly affects children, teenagers, and people under the age of 30.Less commonly, it can be found in older patients in a latent form, which is often confused with insulin dependence.

Type 2 diabetes accompanied by impaired insulin secretion and decreased insulin receptor sensitivity, otherwise "insulin resistance".The most important risk factors:

1. Hereditary predisposition is noted in almost all cases.If close relatives have this disease, the risk of developing pathology increases 6 times.
2. Obesity is often a form of abdominal pain and suffering, when excess fat is deposited mainly in the waist area and/or on internal organs.With Obesity Class I, the risk of developing this disease increases by 2 times, class II - by 5 times, class III - by 10 times.

Important!High-calorie foods, dominated by simple carbohydrates, quickly digested, are considered diabetogenic.These are sweets, alcohol, flour products, sausages, fast food, French fries, soft wheat pasta.In combination with a sedentary lifestyle and lack of plant fiber, such food, if eaten regularly, can cause irreparable harm to the body.

The second type usually occurs 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 is largely dependent on muscle mass and degree of obesity.As childhood obesity is 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 insulin receptor sensitivity.This creates a vicious circle: Excess glucose in the blood has a toxic effect on beta cells, causing their dysfunction.

Diabetes mellitus: Symptoms of a dangerous disease

Let us consider the clinic of diabetes depending on the disorder that causes it, the level 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 prevents the flow of sodium into the cell.

With so many physiological effects, changes in insulin concentration do not pass without leaving a trace for the body.The main symptoms are associated with impaired carbohydrate metabolism, In particular, hyperglycemia.Elevated glucose levels lead to the following symptoms:

• thirst, dehydration, polyuria - urine output more than three liters per day;
• Polyphagia - constant need for food, crowding, develops in response to lack of energy;
• 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 - appears due to decreased synthesis and increased breakdown of proteins;
• Hypoxia - lack of oxygen in the tissues - causes lethargy, decreased concentration, and drowsiness;
• General vascular damage is caused by protein glycosylation.

Impaired fat metabolism manifests itself:

• increase 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.

The clinic depends 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 examination.In diabetes, symptoms come and go according to fluctuations in blood glucose levels.General manifestations predominate, as damage to internal organs is far from over.

The patient complains:

• severe weakness, fatigue;
• Thirst - The patient can drink about 3-5 liters of liquid a day, with a large amount occurring at night;
• characteristic dry mouth (due to dehydration);
• frequent and abundant urination;Children can develop enuresis;
• Itchy skin, in women, especially in the genital area.

Important!Progressive caries and periodontal disease are often found among the first symptoms of diabetes.Loose teeth and deep lesions in the roots of the teeth indicate a pre-diabetic condition.Biochemical analysis of glucose concentration in the blood showed no visible changes.Therefore, if such symptoms are detected, the patient is recommended 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, 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 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 prone to tuberculosis.Men with prostate adenoma and women over 50 years old are 4 times more likely than the average person to suffer from cystitis and pyelonephritis.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 early symptoms.The same situation is when the diagnosis is made only after the first "attack" of ketoacidosis.This disease manifests itself as a response to stress, viral infections, and simple carbohydrate overload.Since sugar is absorbed very poorly, tissues and organs lack energy.In an effort 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.Patients feel thirsty, dizzy, lethargic, sleepy, and have a fast heartbeat.Characterized by frequent urination, abdominal pain, nausea, vomiting, and the smell of acetone from the mouth.Without appropriate treatment, ketoacidosis leads to coma, brain swelling and death.

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

To do this you should:

• In case of acute respiratory infection, acute respiratory viral infection, monitor plasma sugar levels more often and administer insulin in appropriate amounts;
• 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 administering the drug - just reduce the dose and consult a doctor for correction of therapy;
• Do not skip injections and monitor glucose levels strictly;
• administer insulin using the right instrument and in the right place;
• Monitor the expiration date and storage conditions of medical products.

The other three main signs 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 in the urine, which causes polyuria.As a result of dehydration, the patient feels severe weakness.

The second type is characterized by a slower flow.Patients see problems when hyperglycemia becomes a chronic condition.Sometimes this 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 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 pathologies.Therefore, in addition to the already known first and second types, other types of diseases are distinguished.All of them belong to Category III and are grouped, according to the reason for their development, into 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 parts of certain chromosomes.
2. Also a genetic defect, but not in pancreatic cells, but at the level of insulin receptors.These include Donohue syndrome, Rabson-Mendenhall syndrome, some lipodystrophies, and type insulin resistance.
3. Exocrine pancreatic diseases (fibrosis, pancreatitis, neoplasia, trauma, etc.).
4. Endocrinopathies.This 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. An atypical form of immune-mediated diabetes.
8. Genetic defects, part of the clinical picture are often symptoms of diabetes (myodystrophy, Turner syndrome, Down syndrome, porphyria).

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

Important!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 true cause of the unpleasant symptoms.An experienced endocrinologist will prescribe the necessary examinations and find the source of the disease.

Diagnostics and inspections

Diagnosis is made based on the following criteria.

1. History, symptoms, patient complaints.
2. Examination of patients to identify potential 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 test.
4. Determination of glycosylated hemoglobin (HbA1c) levels.Rent 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 mainly to diagnose prediabetic conditions, including during pregnancy.If FPG is more than 7.0 mmol/L, then OGTT is not performed.

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

Diagnostic criteria for diabetic and prediabetic conditions

Analysis	Norm, mmol/l	Carbohydrate metabolism (prediabetes), mmol/l	DM, 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!Urine glucose tests, which were popular in the past, are no longer used due to uncertainty and low sensitivity.

People belonging to high-risk groups are recommended to be tested regularly, once every three years, for FPG and HbA1c (or OGTT).If the FPG has been increased, the monitoring should be done every year.Risk factors include:

• physical inactivity;
• obesity;
• Age > 35 years;
• Family History of Diabetes;
• prediabetes, gestational diabetes, PCOS, personal history of cardiovascular disease;
• the birth of a child weighing more than 4.1 kg;
• hypertension;
• Fatty liver hepatosis;
• high cholesterol levels, "dangerous" lipids - low-density lipoproteins;
• HIV infection.

All diabetic patients are constantly monitored for complications after diagnosis.Standard examinations include ophthalmoscopy, foot examination, urine test for proteinuria, lipid test, and creatinine level.Most endocrinologists consider it important to record ECG and baseline lipid profiles during initial treatment to study disease dynamics and predict the risk of cardiovascular disease.If necessary, a consultation with a specialist is prescribed - an ophthalmologist, a gynecologist, a cardiologist, a neurologist.

The most dangerous complication

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

• skip insulin injections or take glucose-lowering medications;
• the use of other drugs that affect carbohydrate metabolism;
• severe stress;
• alcohol abuse;
• self cancel therapy;
• against the background of severe trauma, surgery, infection;
• during pregnancy.

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

Hypoglycemia- Decreased blood sugar - characterized by increased sweating, chills, severe weakness, and severe hunger.Some patients note numbness and tingling in certain areas.If the necessary action is not taken, then hypoglycemia becomes a coma - the patient loses consciousness.In this situation, you need to call an ambulance.

Important!To eliminate hypoglycemia, a person immediately needs to consume simple carbohydrates.Lemonade, lump sugar (placed under the tongue), juice - anything easy to swallow and quickly absorbed will do.To avoid such cases, patients taking glucose-lowering medications should always carry the above products with them.

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

1. Diabetic cardiopathy, or "diabetic heart".Myocardial dystrophy develops in people older than 40 years without signs of coronary atherosclerosis.It manifests itself as left ventricular dysfunction and leads to heart failure.The main symptoms are shortness of breath, arrhythmia, and decreased tolerance to physical activity.
2. Metabolic syndrome x, or the "deadly quartet".The combination of hyperglycemia, obesity, hypertension and atherosclerosis causes early onset of angina pectoris and damage to peripheral arteries.Frequent complications are heart attacks, strokes, transient ischemic attacks.The main problem is that each element of the quartet increases the manifestation of others, creating a vicious circle.
3. Diabetic nephropathy.A major factor in disability and death among diabetic patients.Develops in 40-50% of cases, which leads to chronic and end-stage renal failure.The main reason is damage to the kidney capillaries, increased pressure in the kidney glomeruli.The presence of hypertension accelerates the pathological process.This complication is considered one of the most dangerous, because in the early stages it does not give significant symptoms.Patients usually do not associate swelling, dyspepsia, and weakness with kidney damage.Pain and urinary disturbances appear at a later stage, when the problem is already difficult to treat.
4. Diabetic retinopathy.Subjectively, it feels like fog in front of the eyes, characteristic of "flickering".Surrounding objects become blurred and blurry.Reduced vision progresses to the point of complete blindness.The cause is damage to retinal vessels with the subsequent appearance of microaneurysms, bleeding, and edema.To prevent vision loss, patients should undergo ophthalmoscopy once a year and, if problems occur, receive treatment.
5. Neuropathy.Neuronal function is disrupted due to the toxic effects of glucose, oxygen deprivation, and electrolyte shifts.Diabetics suffer from a large number of neuropathies, but the most common of them is symmetrical polyneuropathy.The main symptoms are numbness, discomfort, pain, loss of sensation in the hands and feet, "like gloves and socks."Such a process in the lower part of the foot can cause insufficient load with trauma or foot infection and joint degeneration.Neuropathy affects not only peripheral nerve fibers, but also cranial nerves and brain tissue itself.The result is acute neuropsychic disorders, neurosis-like conditions, dysfunction of isolated areas - decreased hearing, vision, smell, etc.
6. Diabetic feet.Against the background of damage to blood vessels, nerves, skin, and joints, the syndrome occurs, accompanied by soft tissue ulcers and purulent-necrotic processes.Leg necrosis ends with amputation of the affected area.This syndrome occurs in 20-25% of patients.

Treatment: diet and medication

Diabetes treatmentstarting with lifestyle changes.This includes a properly structured diet, adequate physical activity, and regular monitoring of plasma sugar concentrations.All this, plus basic therapy, helps to prevent the rapid development of pathology and the development of complications.

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

Patients with Type 2, if diet and physical activity are insufficient,Antihyperglycemic agents are prescribed.These drugs differ in their mechanism of action:

• stimulate your own insulin secretion (sulfonylureas, meglitinides);
• increase the sensitivity of insulin receptors (thiazolidinediones);
• inhibits additional pathways for glucose production (biguanides);
• preventing the absorption of sugar in the intestinal wall, delaying their digestion (alpha-glucosidase inhibitor);
• Increases the excretion of glucose in the urine (NGLT-2 inhibitor).

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 bed, ACE inhibitors help fight nephropathy in the early stages.

The prediction is up to you

Every year, about four million people die from this dangerous disease.In children and adolescents, the main cause of death is ketoacidosis, which develops into coma.In adults, the presence of complications and alcohol use is critical.The average life expectancy of each patient with diabetes is reduced by 6-15 years.In the second type, prognosis is largely correlated with lifestyle.Smokers, alcoholics, and people with high cholesterol levels can prolong their lives by simply giving up bad habits and adjusting their diet.

This 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 the timeliness of the diagnosis and your personal attitude towards the disease.Previously, the disease was detected and the more carefully the patient approached treatment, the higher the survival rate.

Prevention

Boil prevention measures to:

1. Regular and adequate physical activity.The latter normalizes metabolism and increases the sensitivity of tissue receptors to insulin molecules.
2. Diet.Food is 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, overly salty foods, fast foods, smoked foods, and canned foods.The basis should be complex carbohydrates, fiber, and pectin.Lean Fish, chicken, vegetables, herbal infusions, unsweetened compote, durum wheat pasta is preferred.Follow the BJU ratio of 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 protracted course of ARVI, wear a mask and use antiseptics during epidemics and sick people.