Types of diabetes

Diabetes mellitus is a disease of the endocrine system associated with pathological changes in the hormonal background and metabolic failure.

To date, the disease has not been eradicated (complete elimination). The process of destruction in the body can be slowed down by means of medications and dietary therapies, but it is impossible to stop it and start it in the opposite direction.

The type of diabetes mellitus (DM) is defined by the World Health Organization and has no fundamental 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 type is different, it is necessary to know the specific disease variants that have arisen.

Type of pathology

There are several types of diseases, united by one main symptom - an increase in the concentration of glucose in the blood. This type of diabetes mellitus is due to its cause. There are also the method of therapy used, the gender and age of the patient.

Medically accepted types of diabetes:

• the first type is insulin -dependent (IDDM 1), or juvenile;
• the second is insulin -free (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-diabetic variety);
• pathology of pancreatic exocrine function;
• hereditary and acquired pathology of the external secretory glands and their function (endocrinopathy);
• pharmacologically determined 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 are altered upwards (glucose tolerance is impaired), however, blood sugar indicators "do not reach" generally accepted digital values corresponding to actual diabetes. According to the World Health Organization (WHO 2014), more than 90% of endocrinology patients suffer from the second type of disease.

According to medical statistics, there is a clear trend of increasing the number of cases worldwide. Over the past 20 years, the number of patients with type 2 diabetes 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 more common in premenopausal and menopausal women. This is due to changes in hormonal status and a set of extra 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. Organs do not fulfill the endocrine (intrasecretory) function to produce 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 adequate nutrition, including the pancreas itself.

To mimic the natural production of endocrine hormones, patients are given lifelong medical insulin injections with different durations of action (short and long), as well as dietary therapy. The classification of type 1 diabetes mellitus is determined by the various etiologies of the disease. This type of insulin -dependent disease has two causes: genetic and autoimmune.

genetic cause

The formation of pathology is associated with the biological characteristics of the human body to pass on the characteristic features and pathological abnormalities to the next generation. In relation to diabetes, children inherit a predisposition to the disease from a parent or close relative who has diabetes.

Important! The tendency is inherited, but not the disease itself. There is no 100% guarantee that a child will have diabetes.

autoimmune causes

The onset of the disease is due to the failure of the function of the immune system, when, under the influence of negative factors, it actively produces autoimmune antibodies that have a damaging effect on the cells of the body. The triggers (minus) to initiate the autoimmune process are:

• unhealthy eating behaviors combined with physical inactivity;
• failure of metabolic processes (carbohydrates, lipids and proteins);
• critical deficiency in the body of cholecalciferol and ergocalciferol (group D vitamins);
• chronic pancreatic pathology;
• history of mumps (mumps), measles, Coxsackie herpes virus, Epstein-Barr virus, cytomegalovirus, viral hepatitis A, B, C;
• distress (prolonged stay in a state of neuropsychological stress);
• chronic alcoholism;
• improper treatment with hormone -containing medications.

IDDM is formed in children, adolescents and adults under the age of thirty years. The childhood variant of the development of type 1a diabetes is associated with a complicated viral infection. Form 1b occurs in young people and children against the background of autoimmune processes and hereditary predispositions. The disease usually develops in an accelerated mode in 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 delivered to the cells and tissues of the body due to their lack of sensitivity to insulin - insulin resistance. To a certain extent, treatment is carried out through hypoglycemic (lowering sugar) medications and dietary therapy.

To balance the imbalance in the body, the pancreas activates the production of hormones. Working in emergency mode, the organ becomes worn out over time and loses its intrasecretory function. Type 2 diabetes becomes insulin dependent. Reduction or loss of cell susceptibility to endogenous hormones is primarily associated with obesity, in which fat and carbohydrate metabolism is disrupted.

This is especially true for visceral obesity (deposition of fat around internal organs). In addition, with excess weight, blood flow becomes difficult due to the many cholesterol plaques in the ducts, which are formed during hypercholesterolemia, which always accompanies obesity. The body's cells, therefore, lack nutrients and energy sources. Other factors that affect the development of NIDDM include:

• alcohol abuse;
• gastronomic addiction to sweet dishes;
• chronic diseases of the pancreas;
• pathology of the heart and vascular system;
• excess in food against the background of an inactive lifestyle;
• improper hormone therapy;
• complicated pregnancy;
• dysfunctional offspring (diabetes in parents);
• trouble.

Most often, the disease develops in women and men in the age category of 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 pre-diabetic condition can be reversed. If time is lost, it develops and subsequently NIDDM is diagnosed.

Diabetes Pepper

In medicine, the term "Diabetes 1. 5" is found, or the name of Lada diabetes. These are autoimmune disorders in hormone production and failure of metabolic processes that occur in adults (aged 25+). The disease combines the first and second types of diabetes. The developmental mechanisms corresponding to IDDM, latent travel and symptom manifestations are similar to those of NIDDM.

The trigger for the development of pathology is an autoimmune disease in the patient's history:

• non -infectious inflammation of the intervertebral joints (ankylosing spondylitis);
• irreversible diseases 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 colonic 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 development of diabetes Pepper. To detect the disease, basic diagnostic methods are used, as well as a blood microscope, which determines the concentration of IgG class immunoglobulins to the antigen - ELISA (enzyme immuoassay). Therapy is carried out through regular insulin injections and dietary correction.

Pregnancy forms of the disease

GDM is a specific type of diabetes that develops in women in the second half of the reproductive period. The disease is most often detected during the second routine examination, when the pregnant mother undergoes a complete examination. The main feature of GDM similar to type 2 diabetes is insulin resistance. Pregnant women's body cells lose sensitivity (sensitivity) to insulin due to the correlation of three main reasons:

• Hormonal rearrangements. During pregnancy, the synthesis of progesterone (steroid sex hormone) increases, blocking insulin production. Furthermore, the placental endocrine hormones, which tend to inhibit insulin production, are getting stronger.
• Double load on the female body. To provide adequate nutrition for the unborn baby, the body needs an increase in the amount of glucose. A woman begins to take in more monosaccharides, which causes the pancreas to synthesize more insulin.
• Weight gain against the background of a decrease in physical activity. Glucose, supplied in abundance to the body, accumulates in the blood, as cells refuse to take insulin due to obesity and physical inactivity. Expectant mothers and fetuses in this situation suffer from nutritional deficiencies and energy starvation.

Unlike type 1 and 2 diabetes, gestational diabetes is a reversible process because insulin molecules and pancreatic function are preserved.

Properly selected therapeutic tactics guarantee the elimination of pathology after delivery in 85% of cases. The main method of treatment of GDM is a diet for diabetics "Table No. 9". In difficult cases, medical insulin injections are used. Hypoglycemic drugs are not used because of their teratogenic effects on the fetus.

Besides

Certain types of diabetes are genetically determined (MODY-diabetes, some types of endocrinopathy) or provoked by other chronic pathologies:

• pancreatic diseases: pancreatitis, hemochromatosis, tumors, cystic fibrosis, mechanical trauma and surgery on the gland;
• anterior pituitary gland dysfunction (acromegaly);
• increased synthesis of thyroid hormones (thyrotoxicosis);
• hypothalamic-pituitary-adrenal pathology (Itsenko-Cushing syndrome);
• adrenal cortex tumors (aldosteroma, pheochromocytoma, etc. ).

A separate pathology of diabetes - diabetes insipidus is characterized by a decrease in the production of the hypothalamic hormone vasopressin, which regulates fluid balance in the body.

Diagnostic measures

The diagnosis of diabetes mellitus (of any type) is possible only based on the results of a laboratory blood microscope. Diagnostics consists of several consecutive studies:

• General clinical blood tests to detect hidden inflammatory processes in the body.
• Blood test (capillary or venous) for glucose content. Produced strictly on an empty stomach.
• GTT (glucose tolerance test). It is performed to determine the body’s ability to absorb glucose. The tolerance test was a double blood sampling: on an empty stomach and two hours after the "glucose load", which was an aqueous glucose solution prepared in a ratio of 200 ml of water per 75 g. ingredients.
• HbA1C analysis for glycosylated (glycation) hemoglobin levels. Based on the results of the study, retrospectively blood sugar levels over the past three months were assessed.
• Blood biochemistry. Liver enzyme indicators aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (AP), bilirubin (bile pigment), cholesterol levels were assessed.
• Blood tests for the concentration of antibodies to glutamate decarboxylase (GAD antibodies) determine the type of diabetes mellitus.

Blood sugar reference values and disease indicators

Analysis	For sugar	Glucose tolerance test	Hemoglobin is glycated
norm	3. 3 - 5. 5	< 7. 8	6%
prediabetes	5. 6 - 6. 9	7. 8 - 11. 0	from 6 to 6. 4%
diabetes	>7. 1	>11. 1	Over 6. 5%

In addition to a blood microscope, general urinalysis is checked for the presence of glucose in the urine (glycosuria). In healthy people, there is no sugar in the urine (for diabetics, 0. 061 - 0. 083 mmol / l is considered the acceptable norm). The Reberg test is also performed to detect albumin proteins and creatinine protein metabolism products in urine. In addition, hardware diagnostics are prescribed, including 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 (type IDDM 1), insulin -independent (type NIDDM 2), pregnancy (containing GDM), specific (DM). including some types of diseases caused by genetic defects or chronic pathology). Gestational diabetes, which forms in the perinatal period, can be cured. Prediabetes (impaired glucose tolerance) is considered reversible if diagnosed early.