Diabetes mellitus is a disease of the endocrine system that is associated with pathological changes in the hormonal background and metabolic failures.
To date, the disease is not suitable for eradication (complete elimination). The destructive process in the body can be slowed down through medication and diet therapy, but it is impossible to stop and start in the opposite direction.
The types of diabetes mellitus (DM) are defined by the World Health Organization and have no substantial differences across the medical world. Diabetes mellitus of any kind is not a contagious disease.
Diabetes mellitus can be of several types as well as different types. Since the treatment for each species and species is different, it is necessary to know which particular variant of the disease was born.
Pathology typing
There are several types of the disease, combined with one main symptom - an increased concentration of glucose in the blood. The typification of diabetes mellitus is due to the causes of its occurrence. Methods of therapy, gender and age of the patient are also applied.
Medically Accepted 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 the perinatal period in women;
- Other specific types of diabetes, including:
- damage to pancreatic β cells at the genetic level (MODY-diabetes varieties);
- pathology of exocrine function of the pancreas;
- hereditary and acquired pathologies of the external secretory glands and their functions (endocrinopathy);
- pharmacologically defined diabetes;
- diabetes due to congenital infections;
- DM associated with genomic pathology and hereditary defects;
- impaired glycemia (blood sugar) on an empty stomach and impaired glucose tolerance.
Prediabetes is a borderline condition of the body, when glycemic levels fluctuate upwards (glucose tolerance is impaired), however, blood sugar indicators "do not reach" the generally accepted digital values corresponding to true diabetes. According to the World Health Organization (WHO 2014), more than 90% of endocrinologists patients suffer from the second type of disease.
According to medical statistics, there is a clear trend of increasing number of cases worldwide. Over the past 20 years, the number of type 2 diabetics has doubled. GDM accounts for about 5% of pregnancies. Specific types of diabetes are extremely rare and occupy a small percentage in medical statistics.
By gender, NIDDM 2 is most common in premenopausal and postmenopausal women. This is due to a change in hormonal status and an extra set of 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 (type 1)
Type 1 diabetes is characterized by pancreatic cell failure. The body does not fulfill its endocrine (intrasecretory) function of producing insulin, the hormone responsible for supplying the body with glucose. As a result of the accumulation of glucose in the blood, the organs do not receive proper nutrition, including the pancreas itself.
To mimic the natural production of endocrine hormone, the patient is given lifelong injections of medical insulin with different durations of action (short and long), as well as diet therapy. The classification of type 1 diabetes mellitus is dictated by the various etiologies of the disease. The type of insulin-dependent disease has two causes: genetic and autoimmune.
genetic cause
The formation of pathology is associated with the biological feature of the human body to convey its characteristic features and pathological abnormalities in subsequent generations. In relation to diabetes, a child inherits a predisposition to the disease from parents or close relatives suffering from diabetes.
Important! Predisposition is inherited, but not the disease itself. There is no 100% guarantee that a child will develop diabetes.
autoimmune cause
The onset of the disease is due to a functional failure of the immune system, when, under the influence of negative factors, it actively produces autoimmune antibodies that have a destructive effect on the cells of the body. Triggers (push) to start autoimmune processes are:
- unhealthy eating behavior combined with physical inactivity;
- failure of metabolic processes (carbohydrates, lipids and proteins);
- critical deficiency in the body of cholecalciferol and ergocalciferol (group D vitamins);
- pancreatic pathology of a chronic nature;
- a history of mumps (measles), measles, herpes Coxsackie virus, Epstein-Barr virus, cytomegalovirus, viral hepatitis A, B, C;
- anxiety (prolonged stay in a state of neuropsychological stress);
- chronic alcoholism;
- incorrect treatment with hormone-containing medications.
IDDM is formed in children, adolescents, and adults under the age of thirty. The childhood variant of developing type 1a diabetes is associated with complicated viral infections. Form 1b appears in adolescents and children against the background of autoimmune processes and hereditary predisposition. The disease usually develops in an accelerated manner 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 is not distributed to the cells and tissues of the body due to their lack of insulin sensitivity - insulin resistance. Up to a certain point, treatment is carried out through hypoglycemic (sugar lowering) medications and dietary therapy.
To compensate for the imbalance in the body, the pancreas activates hormone production. Working in emergency mode, the organ is consumed over time and loses its intrasecretory function. Type 2 diabetes becomes insulin dependent. Decreased or lost cell sensitivity to endogenous hormone is mainly associated with obesity, in which fat and carbohydrate metabolism is disturbed.
This is especially true for visceral obesity (the deposition of fat around the internal organs). In addition, with excess body weight, blood flow is impeded due to the numerous cholesterol plaques within the vessels, which are created during hypercholesterolemia, which always accompanies obesity. Thus, the body's cells are deficient in food and energy sources. Other factors influencing the development of NIDDM include:
- alcohol abuse;
- gastronomic addiction to sweet dishes;
- chronic diseases of the pancreas;
- pathology of the heart and vascular system;
- overeating in the background of a sedentary lifestyle;
- wrong hormonal therapy;
- complicated pregnancy;
- dysfunctional inheritance (diabetes in parents);
- concern.
Most often, the disease develops in women and men in the age group 40+. At the same time, type 2 diabetes is latent and may not show severe symptoms for several years. Timely testing for blood glucose levels can detect prediabetes. With adequate therapy, the prediabetic condition is reversible. If time is lost, it progresses and then NIDDM is diagnosed.
Diabetes Lada
In medicine there is the term "Diabetes 1. 5", or the name Lada diabetes. This is an autoimmune disorder in hormone production and metabolic failure that occurs in adults (25+). The disease combines the first and second type of diabetes. The mechanism of development corresponds to IDDM, the latent course and manifestation of symptoms are similar to NIDDM.
Causes for the development of 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 thyroiditis);
- juvenile and rheumatoid arthritis;
- discoloration (loss of pigment) of the skin (vitiligo);
- inflammatory pathology of the colon mucosa (ulcerative colitis);
- chronic damage to connective tissue and external secretory glands (Sjogren's syndrome).
In combination with hereditary predisposition, autoimmune disorders lead to the progression of Lada diabetes. Basic diagnostic methods are used to detect the disease, as well as blood microscopy, which determines the concentration of IgG class immunoglobulins against antigens - ELISA (enzymatic immunoassay). Therapy is performed through regular insulin injections and food correction.
Gestational form of the disease
GDM is a specific type of diabetes that develops in women in the second half of the perinatal period. The disease is most often detected during the second routine examination, when the expectant mother undergoes a thorough examination. The main feature of GDM that is similar to type 2 diabetes is insulin resistance. The cells of a pregnant woman's body lose their sensitivity (sensitivity) to insulin due to the correlation of three main reasons:
- Hormonal reorganization. During pregnancy, the synthesis of progesterone (a steroid sex hormone) increases, blocking insulin production. Plus, placental endocrine hormones, which tend to inhibit insulin production, are gaining strength.
- Double load on the female body. To provide adequate nutrition for the unborn baby, the body requires an increased amount of glucose. A woman starts consuming more monosaccharides, which causes the pancreas to synthesize more insulin.
- An increase in body weight against the background of a decrease in physical activity. Glucose, supplied in abundance in the body, accumulates in the blood as the cells refuse to take insulin due to obesity and lack of physical activity. The expectant mother and fetus in this situation experience nutritional deficiencies and hunger for energy.
Unlike type 1 and type 2 diabetes, gestational diabetes is a reversible process because insulin molecules and pancreatic function are preserved.
Properly selected therapeutic tactics guarantee the elimination of postpartum pathology in 85% of cases. The main method of treating GDM is the diet for diabetics "Table No. 9". In severe cases, medical insulin injections are used. Hypoglycemic drugs are not used because of their teratogenic effects on the fetus.
For more
Specific types of diabetes are genetically determined (MODY-diabetes, some types of endocrinopathies) or provoked by other chronic pathologies:
- diseases of the pancreas: pancreatitis, hemochromatosis, tumor, cystic fibrosis, mechanical trauma and surgery on the gland;
- functional failure of the anterior pituitary gland (acromegaly);
- increased thyroid hormone synthesis (thyrotoxicosis);
- Hypothalamic-pituitary-adrenal pathology (Itsenko-Cushing syndrome);
- tumors of the adrenal cortex (aldosteroma, pheochromocytoma, etc. ).
A special diabetic pathology - diabetes insipidus is characterized by a decrease in the production of vasopressin hormone hypothalamic, which regulates the balance of fluids in the body.
Diagnostic measures
Diagnosis of diabetes mellitus (of any type) is possible only on the basis of the results of laboratory blood microscopy. Diagnosis consists of several consecutive studies:
- General clinical blood test for the detection of inflammatory processes hidden in the body.
- Blood test (capillary or venous) for glucose content. Produced strictly on an empty stomach.
- GTT (glucose tolerance testing). It is performed 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 "glucose loading", which is an aqueous glucose solution prepared in a ratio of 200 ml of water per 75 g. substances.
- HbA1C analysis for glycosylated (glycated) hemoglobin level. Based on the results of the study, a retrospective of blood sugar levels over the past three months was assessed.
- Blood biochemistry. Indicators of liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (AP), bilirubin (bile pigment), cholesterol levels.
- A blood test for the concentration of antibodies to glutamate decarboxylase (GAD antibodies) determines the type of diabetes mellitus.
Blood sugar reference values and disease indicators
| analysis | For sugar | Glucose tolerance test | Glycated hemoglobin |
|---|---|---|---|
| rate | 3. 3 - 5. 5 | < 7. 8 | ⩽ 6% |
| paradiabetes | 5, 6 - 6, 9 | 7. 8 - 11. 0 | from 6 to 6. 4% |
| diabetes | >7. 1 | >11. 1 | Over 6. 5% |
In addition to blood microscopy, a general urine test for the presence of glucose in the urine (glucosuria) is also examined. In healthy people, there is no sugar in the urine (for diabetics, 0, 061 - 0, 083 mmol / l is considered an acceptable rate). A Reberg test is also performed to detect albumin protein and a product of creatinine protein metabolism in urine. Furthermore, hardware diagnostics are described, including an ECG (electrocardiogram) and ultrasound of the abdominal cavity (with 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), gestational (pregnant GDM), specific(DM). includes several types of diseases caused by genetic defects or chronic pathology). Gestational diabetes, formed in the perinatal period, is curable. Prediabetes (impaired glucose tolerance) is considered reversible if diagnosed early.