Type 1 and 2 diabetes

Diabetes(DM) is an endocrine disease that occurs due to inadequate insulin synthesis/action.Against this background, chronic hyperglycemia develops - a condition that is accompanied by persistently elevated levels of sugar (glucose) in the blood plasma.Hyperglycemia is the main cause of 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.The disease spreads fastest in undeveloped countries and countries with weak economies.Doctors note a tendency to increase the incidence of the disease in the age group over 40 years old.In terms of social significance, this disease ranks third after cardiovascular diseases and cancer.

Diabetes is divided into 2 main types:

1. insulin-dependent (adolescents, infants, children),
2. independent of insulin (insulin resistance).

They have different causes, different symptoms, treatment strategies and prognosis.So in the future we will consider them separately from each other.

reason

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 when beta cells are destroyed or when receptor sensitivity is reduced.

Type 1 diabetes develop in the presence of genetic predisposition.The driving force for the appearance of pathology is toxins and viral infections, such as rubella, influenza, hepatitis B virus, cytomegalovirus and retrovirus.The irritant causes acute damage to β-cells or leads to persistence of the infectious agent in pancreatic tissues with further development of the autoimmune reaction.The likelihood of getting sick increases if a person suffers from other autoimmune diseases - thyroiditis, adrenal insufficiency, etc.

Important!Diet plays a certain role in the occurrence of diseases in children.So, this will be facilitated by too early exposure to gluten - it is best to introduce cereal porridge into complementary foods no earlier than 6-7 months.The risk increases with feeding cow's milk, vitamin D deficiency and high nitrate levels in drinking water.

Thanks to our body's ability to adapt, type 1 diabetes can go on silently for many years.The first signs appear when the number of β-cells (and therefore insulin) is insufficient to regulate glucose levels.Type 1 accounts for about 10% of all pathological cases.It mainly affects children, adolescents and people under 30 years of age.Less commonly, it can be found in older patients in a latent form, often confused with non-insulin-dependent disease.

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

1. Genetic predisposition is noted in most cases.If a relative has the disease, the risk of developing the pathology increases 6 times.
2. Obesity is usually an abdominal and visceral form, when excess fat accumulates mainly in the waist area and/or internal organs.With grade I obesity, the risk of developing the disease increases 2 times, grade II - 5 times, grade III - 10 times.

Important!High-calorie foods, mainly simple, fast-digesting carbohydrates, are considered diabetic.These are sweets, alcohol, flour products, sausages, fast food, chips, soft pasta.Combined with a sedentary lifestyle and lack of vegetable fiber, such foods, if consumed regularly, can cause irreparable harm to the body.

The second type usually occurs in adulthood.A trend has been noticed: the older a person is, the higher their blood glucose concentration after eating a carbohydrate meal.The rate of glucose reduction to normal levels largely depends on muscle mass and the degree of obesity.Because childhood obesity is now an epidemic, type 2 obesity is increasingly being detected in children.

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

Diabetes: a sign of a dangerous disease

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

Symptoms related to metabolic disorders

Insulin participates in all types of metabolism:

1. Carbohydrates - regulate plasma glucose concentration, as well as glycogenolysis, gluconeogenesis and other sugar-related reactions.
2. Fat - increases the synthesis of fatty acids and reduces their penetration into the blood.
3. Protein - enhances protein synthesis and prevents its breakdown, activates DNA and RNA replication.
4. Electrolytes - activate the influx of potassium and inhibit the influx of sodium into cells.

With so many physiological effects, changes in insulin levels do not pass without leaving their mark on the body.The main symptoms are related to impaired carbohydrate metabolism, especially hyperglycemia.Increased glucose levels lead to the following symptoms:

• thirst, dehydration, polyuria - urine output more than three liters per day;
• polyphagia - a constant, gluttonous need to eat, developing in response to energy deficiency;
• nausea, vomiting;
• accumulation of sorbitol (glucose metabolism product) in nerve fibers, retina, lens and subsequent damage;
• predisposition to bacterial and fungal infections.

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

• muscular dystrophy - appears due to reduced synthesis and increased breakdown of proteins;
• hypoxia - lack of oxygen in the tissues - causes coma, decreased ability to concentrate and drowsiness;
• Systemic vascular damage due to protein glycosylation.

Impaired fat metabolism manifests itself in:

• increased cholesterol levels in the blood;
• fatty liver infiltration;
• ketonuria, ketonemia - accumulation of ketones in the blood and urine;At high, untreated concentrations, coma and death will develop.

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

Clinic depends on the stage of the disease

The first stage is characterized by the almost complete absence of symptoms.Diagnosis sometimes takes years, especially if proper testing is not performed.In diabetes, symptoms come and go according to fluctuations in blood sugar levels.General manifestations prevail, since damage to internal organs is still very far away.

Patients complain about:

• severe weakness, fatigue;
• thirst - the patient 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 frequent urination;Children may experience bedwetting;
• itchy skin, in women especially in the genital area.

Important!Progressive tooth decay and periodontal disease can often be found among the first symptoms of diabetes.Loose teeth and deep caries lesions at the roots indicate prediabetes.Biochemical analysis of blood glucose concentration did not show obvious changes.Therefore, if such symptoms are detected, the patient should see a therapist and take a glucose tolerance test.

Without treatment, the patient's condition will gradually worsen.Dry skin appears, skin infections are common - hidradenitis, boils, fungal infections of the feet.From the digestive tract, gastrointestinal dysfunction, gallbladder disorders, chronic gastritis and duodenitis are observed.Due to damage to the vascular system and increased cholesterol levels, atherosclerosis and coronary heart disease will develop.The latter is often difficult and often leads to serious complications.The cause of death in 38-50% of patients is myocardial infarction.

Diabetics are more likely to get bronchitis, pneumonia and tuberculosis.Men with prostate tumors and women over 50 years old are four times more likely to develop cystitis and pyelonephritis than the general population.In advanced stages, blindness and other complications can occur due to damage to blood vessels.

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 as a reaction to stress, viral infections and simple carbohydrate overload.Because sugar is extremely poorly absorbed, tissues and organs lack 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 quantities, ketone bodies are toxic to humans.The patient feels thirsty, dizzy, lethargic, sleepy and has a fast heart rate.Characterized by frequent urination, abdominal pain, nausea, vomiting and an acetone odor from the mouth.Without proper treatment, ketoacidosis will lead to coma, brain swelling, and death.

Important!If you have 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 plasma sugar levels more often and inject insulin in appropriate amounts;
• when using other drugs, warn the doctor about the presence of diabetes (for example, glucocorticoids increase the need for insulin);
• even in remission, do not stop taking the drug - just reduce the dose and consult your doctor to adjust the therapy;
• do not skip injections and closely monitor blood sugar levels;
• administer insulin using the correct device and location;
• Monitor the expiration date and storage conditions of the medicine.

The other three main signs of type 1 diabetes are fatigue, weight loss and constant hunger.- arose in response to the inability to use sugar as an energy source.And to get rid of excess glucose, the body will actively eliminate it through urine, which causes polyuria.Due to dehydration, the patient feels severely weak.

The second type is characterized by a slower flow.Patients notice problems when hyperglycemia becomes a chronic condition.Sometimes the disease is discovered accidentally during a routine check-up.There are situations when patients come to see 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 the disease.So, in addition to the already known first and second types, other specific types of diseases are also distinguished.They all belong to type III and are grouped, according to the reasons for their development, into types 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. There is also a genetic defect, but not in the pancreatic cells but at the insulin receptor level.These include Donohue syndrome, Rabson-Mendenhall syndrome, some lipodystrophy, and type A insulin resistance.
3. Diseases of the exocrine pancreas (fibrosis, pancreatitis, neoplasms, trauma, etc.).
4. Endocrine disease.The disease can develop against the background of Cushing's syndrome, pheochromocytoma, thyrotoxicosis and other endocrine diseases.
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-mediated diabetes.
8. Genetic defects, part of the clinical picture are often symptoms of diabetes (muscular dystrophy, Turner syndrome, Down syndrome, porphyria).

Type IV alone is classified as gestational diabetes, which is a potential disorder of carbohydrate metabolism in pregnant women.

Important!Tactics for treating diabetes largely depend on the type of disease.Therefore, it is advisable to consult a doctor as soon as possible to determine the exact cause of unpleasant symptoms.An experienced endocrinologist will prescribe the necessary examination and find the origin of the disease.

Diagnosis and screening

The diagnosis is made based on the following criteria.

1. Patient history, symptoms, complaints.
2. Examine the patient to determine possible complications.
3. Biochemical blood test - determination of fasting plasma glucose (FPG) concentration.It is taken on an empty stomach, the last meal is no later than 8-12 hours before the test.
4. Determine the level of glycosylated hemoglobin (HbA1C).Rent in the same way.Avoid smoking, drinking alcohol, and intense physical activity the day before.
5. Glucose tolerance test (OGTT).More sensitive, but at the same time more complex analysis.Used primarily to diagnose prediabetes, including during pregnancy.If FPG is greater than 7.0 mmol/l, OGTT is not performed.

In practice, pathology is often detected by random analysis, such as during routine screening.The patient will then be sent for additional examination.

Diagnostic criteria for diabetes and prediabetes

Analysis	Norm, mmol/l	Impaired 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 have symptoms

Important!Urine glucose testing, which was common in the past, is no longer used due to its nonspecificity and low sensitivity.

People in high-risk groups are recommended to have their FPG and HbA1C (or OGTT) tested every three years.If FPG has become elevated, such monitoring should be performed annually.Risk factors include:

• physical inactivity;
• obesity;
• age > 35 years old;
• Family history of diabetes;
• prediabetes, gestational diabetes, PCOS, history of cardiovascular disease;
• giving birth to a baby weighing more than 4.1 kg;
• increased blood pressure;
• fatty liver;
• high levels of cholesterol, “bad” lipids - low-density lipoprotein;
• HIV infection.

All diabetics are regularly monitored for complications after diagnosis.Standard screening includes ophthalmoscopy, foot examination, urinalysis for proteinuria, lipid testing, and creatinine levels.Most endocrinologists consider it important to obtain baseline ECG and lipid profiles during initial treatment to study the course of the disease and predict the risk of cardiovascular diseases.If necessary, consultation with designated specialists - ophthalmologist, gynecologist, cardiologist, neurologist.

The most dangerous complications

All complications that develop with this disease can be divided into acute and chronic conditions..Acute illness often occurs when:

• quit injecting insulin or taking blood sugar-lowering medications;
• the use of other drugs that affect carbohydrate metabolism;
• severe stress;
• alcohol abuse;
• self-cancellation of therapy;
• in the setting of severe trauma, surgery, infection;
• during pregnancy.

This includesketoacidosis statehas been described in detail above andhypoglycemic coma.Ketoacidosis and hypoglycemia often develop suddenly and it may take only a few hours from the first symptoms to general coma.Both complications should be stopped as quickly as possible, if necessary, by consulting a doctor.

Hypoglycemia- decreased blood sugar levels - characterized by increased sweating, chills, severe weakness and feelings of intense hunger.Some patients feel numbness and tingling in certain areas of the body.If the necessary actions are not taken, hypoglycemia passes into a coma - the patient loses consciousness.In this situation, you need to call an ambulance.

Important!To eliminate hypoglycemia, a person urgently needs to replenish simple carbohydrates.Lemon juice, sugar cubes (placed under the tongue), fruit juice - anything that's easy to swallow and absorbs quickly will do.To avoid such situations, patients taking hypoglycemic medications should always carry any of the above products with them.

Other complications are a consequence of metabolic disorders and damage to small and large blood vessels.

1. Diabetic cardiomyopathy, also known as “diabetic heart”.Myocardial dystrophy develops in people over 40 years of age without obvious signs of coronary atherosclerosis.It manifests as left ventricular dysfunction and leads to heart failure.The main symptoms are difficulty breathing, arrhythmia, and reduced tolerance to physical activity.
2. Metabolic syndrome X, or the “deadly four”.The combination of hyperglycemia, obesity, hypertension, and atherosclerosis causes premature angina and peripheral arterial damage.Common complications are heart attack, stroke, and transient ischemic attack.The main problem is that each element of the tetrad enhances the manifestation of the others, creating a vicious cycle.
3. diabetic nephropathy.Leading factor causing disability and death in diabetics.Develops in 40-50% of cases, leading to chronic and end-stage renal failure.The main cause is damage to kidney capillaries and increased pressure inside the glomerulus.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 cause any noticeable symptoms.Patients typically do not associate swelling, indigestion, and weakness with kidney damage.Pain and urinary disorders appear in the later stages, when the problem is already difficult to treat.
4. Diabetic retinopathy.Subjectively, there is a feeling of fog in front of the eyes, characterized by "buzzing flies".Surrounding objects become blurred.Reduced vision progresses to complete blindness.The cause is damage to retinal blood vessels leading to the appearance of microaneurysms, hemorrhage and edema.To prevent vision loss, patients should have an ophthalmoscopy once a year and if problems occur, they must be treated.
5. Neurological disease.Neuronal function is disrupted by the toxic effects of glucose, hypoxia, and electrolyte changes.Diabetics experience many neurological diseases, but the most common of them is symmetric polyneuropathy.Its main symptoms are numbness, discomfort, pain, loss of feeling in the hands and feet, “like gloves and socks”.Such processes in the lower extremities can lead to insufficient loading, leading to further injury or infection of the foot and osteoarthritis.Neuropathy affects not only peripheral nerve fibers but also cranial nerves and brain tissue itself.The result of this is acute neuropsychiatric disorders, neurosis-like conditions, dysfunction of nervous areas - loss of hearing, vision, smell, etc.
6. Diabetic feet.Against the background of damage to blood vessels, nerves, skin and joints, a syndrome occurs, accompanied by soft tissue ulceration and purulent necrotic processes.Gangrene of the foot ends with amputation of the affected area.The syndrome occurs in 20-25% of patients.

Treatment: diet and medication

Diabetes treatmentStart with a lifestyle change.This includes a properly structured diet, adequate physical activity and regular monitoring of plasma glucose levels.All this, along with basic therapy, helps prevent rapid progression of pathology and the development of complications.

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

Type 2 patients, in cases where diet and physical activity are not enough,Antihyperglycemic medication is prescribed.These drugs differ in their mechanism of action:

• Stimulates your own insulin secretion (sulfonylureas, meglitinides);
• increased sensitivity of insulin receptors (thiazolidinediones);
• Inhibits additional pathways for glucose production (biguanide);
• prevents the absorption of sugars in the intestinal wall, slowing down their digestion (alpha-glucosidase inhibitor);
• increased urinary glucose excretion (NGLT-2 inhibitors).

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

Forecasting is up to you

Every year about four million people die from this terrible 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 important.The average life expectancy of each diabetic patient 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 giving up bad habits and adjusting their diet.

The disease is the leading cause of blindness, increasing the risk of stroke and heart attack by 2 times, chronic kidney failure by 17 times and foot necrosis by 20 times.Despite the terrible numbers,Prognosis depends on the timeliness of diagnosis and your personal attitude towards the disease.The earlier the disease is detected and the more carefully the patient approaches treatment, the higher the survival rate.

prevent

Preventive measures can be shortened to:

1. Get regular and adequate physical activity.The latter normalizes metabolism and increases the sensitivity of tissue receptors to insulin molecules.
2. Diet.Meals are small, 4-5 times a day, divided into small portions.Consumption of simple carbohydrates and saturated fats should be kept to a minimum.Avoid mayonnaise, cakes, 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.Prioritize lean fish, poultry, vegetables, herbal infusions, unsweetened fruit juices, and durum wheat pasta.Follow the BJU ratio 20:20:60.
3. Prevent infection.The first type of diabetes often manifests itself under the influence of viral infections.Therefore, if there are risk factors, you should strengthen the immune system, prevent a prolonged ARVI episode, wear a mask and use antiseptics when there is an epidemic and near sick people.