Diabetes: types and causes of their development, course and manifestations, how to treat, possible consequences

Diabetes mellitus is one of the most common diseases with a tendency to increase incidence and damage statistics.Symptoms of diabetes mellitus do not appear overnight;the process is chronic, with improvement and deterioration of endocrine and metabolic disorders.True, the onset of type 1 diabetes is significantly different from the early stages of type 2.

Among all endocrine pathologies, diabetes confidently holds the lead and accounts for more than 60% of all cases.In addition, disappointing statistics show that 1/10 of "diabetic patients" are children.

The probability of getting the disease increases with age and, therefore, every ten years the size of the group doubles.This is due to an increase in life expectancy, better early diagnosis methods, a decrease in physical activity and an increase in the number of overweight people.

Type of diabetes

Many people have heard of a disease like diabetes insipidus.So that readers do not confuse the disease called "diabetes," it may be useful to clarify their differences.

Diabetes insipidus

Diabetes insipidus is an endocrine disease that occurs as a result of nerve infections, inflammatory diseases, tumors, intoxication and is caused by a deficiency and sometimes a complete loss of ADH-vasopressin (antidiuretic hormone).

This explains the clinical picture of the disease:

• Constant dryness of the oral mucosa, unusual thirst (a person can drink up to 50 liters of water in 24 hours, stretching the stomach to a large size);
• Isolation of large amounts of light unconcentrated urine with low specific gravity (1000-1003);
• Severe weight loss, weakness, decreased physical activity, digestive system disorders;
• Characteristic changes in the skin ("parchment" skin);
• Atrophy of muscle fibers, weakness of the muscular system;
• The development of dehydration syndrome if there is no fluid intake for more than 4 hours.

In terms of complete healing, this disease has an unfavorable prognosis;work capacity is significantly reduced.

Brief Anatomy and Physiology

An unpaired organ, the pancreas, performs mixed secretory functions.Its exogenous part conducts external secretions, producing enzymes involved in the digestive process.The endocrine division, entrusted with the mission of internal secretion, produces various hormones, including -insulin and glucagon.They are key in ensuring the consistency of sugar in the human body.

The endocrine part of the gland is represented by the islets of Langerhans, which consist of:

1. A-cells, which occupy a quarter of the total islet space and are considered the site of glucagon production;
2. B cells, occupying up to 60% of the cell population, synthesize and store insulin, a molecule that is a two-chain polypeptide, carrying 51 amino acids in a specific sequence;
3. D-cells that produce somatostatin;
4. Cells that produce other polypeptides.

Therefore, the conclusion suggests itself:Damage to the pancreas and the islets of Langerhans, in particular, is the main mechanism that inhibits insulin production and triggers the development of the pathological process.

Special types and forms of the disease

Lack of insulin causes impaired sugar stability (3.3 - 5.5 mmol/l)and contribute to the formation of a heterogeneous disease called diabetes mellitus (DM):

• Complete absence of insulin (absolute deficiency) is formeddependent on insulinpathological process, referred to astype I diabetes mellitus (IDDM);
• Insulin deficiency (relative deficiency), which triggers carbohydrate metabolism disorders in the early stages, slowly but surely leads to developmentnot dependent on insulindiabetes mellitus (NIDDM), which is calleddiabetes mellitus type II.

Due to the disruption in the use of glucose by the body, and, as a result, an increase in the blood serum (hyperglycemia), which, in principle, is a manifestation of the disease, over time, the signs of diabetes mellitus begin to appear, that is, a total disruption of the metabolic process at all levels.

In addition to type 1 and type 2 diabetes, there are special types of this disease:

1. Secondary diabetesas a result of acute and chronic inflammation of the pancreas (pancreatitis), malignant neoplasms in the parenchyma of the gland, cirrhosis of the liver.A number of endocrine disorders accompanied by excessive production of insulin antagonists (acromegaly, Cushing's disease, pheochromocytoma, thyroid disease) lead to the development of secondary diabetes.Many drugs used for a long time have a diabetogenic effect: diuretics, some antihypertensive drugs and hormones, oral contraceptives, etc.;
2. Diabetes in pregnant women (gestational),caused by the special joint influence of mother, child and placenta hormones.The fetal pancreas, which produces its own insulin, begins to inhibit the production of insulin by the mother's gland, as a result of which this special form is formed during pregnancy.However, with proper control, gestational diabetes usually disappears after delivery.After that, in some cases (up to 40%) in women with the same pregnancy history, this fact can threaten the development of type II diabetes mellitus (within 6-8 years).

Why does "sweet" disease occur?

"Sweet" disease forms a rather "colored" group of patients, so it becomes clear that IDDM and non-insulin-dependent "relatives" genetically originate differently.There is evidence of a link between insulin-dependent diabetes and the genetic structure of the HLA (major histocompatibility complex) system, in particular, with some D-region locus genes.For NIDDM, such a relationship was not observed.

For the development of diabetes mellitus type I, genetic predisposition alone is not enough;The pathogenetic mechanism is triggered by provoking factors:

• Congenital deficiency of the islets of Langerhans;
• Unfavorable external environmental influences;
• Stress, nervous tension;
• Traumatic brain injury;
• Pregnancy;
• Infectious processes of viral origin (influenza, mumps, cytomegalovirus infection, Coxsackie);
• The tendency to overeat continues, leading to excessive fat deposits;
• Abuse of confectionery products (those with a sweet tooth are more at risk).

Before discussing the causes of diabetes mellitus type II, it is advisable to discuss a very controversial issue: who suffers more often - men or women?

It has been established that nowadays this disease occurs more often in women, although in the 19th century, diabetes was a "privilege" of the male sex.By the way, now in some Southeast Asian countries the presence of this disease in men is considered the main one.

Predisposing conditions for the development of type II diabetes mellitus include:

• Changes in the structure of the structure of the pancreas due to the inflammatory process, as well as the appearance of cysts, tumors, bleeding;
• Age after 40 years;
• Being overweight (the most important risk factor for NIDDM!);
• Vascular diseases caused by atherosclerotic processes and arterial hypertension;
• In women, pregnancy and the birth of a child with a high body weight (more than 4 kg);
• Having a relative with diabetes;
• Strong psycho-emotional stress (adrenal hyperstimulation).

The causes of the disease of various types of diabetes in some cases coincide (stress, obesity, the influence of external factors), but the beginning of the process in type 1 and type 2 diabetes is different, moreover,IDDM is the province of children and young people, and non-insulin-dependent people prefer older people.

Why do you want to drink so much?

The characteristic symptoms of diabetes mellitus, regardless of the form and type, can be presented as follows:

1. Dryness of the mucous membrane of the mouth;
2. Thirst that is almost impossible to quench, associated with dehydration;
3. Excessive formation of urine and its excretion by the kidneys (polyuria), which leads to dehydration;
4. An increase in the concentration of glucose in the blood serum (hyperglycemia), due to the suppression of the use of sugar by peripheral tissues due to a lack of insulin;
5. The appearance of sugar in the urine (glucosuria) and ketone bodies (ketonuria), which are usually present in negligible quantities, but in diabetes mellitus are intensively produced by the liver, and when removed from the body are found in the urine;
6. Increased content in blood plasma (in addition to glucose) of urea and sodium ions (Na⁺);
7. Weight loss, which in the case of disease decompensation is a characteristic feature of the catabolic syndrome, which develops due to the breakdown of glycogen, lipolysis (fat mobiliser), catabolism and gluconeogenesis (transformation into glucose) of proteins;
8. Violation of indicators of the spectrum of lipids, an increase in the amount of cholesterol due to the breakdown of low-density lipoproteins, NEFA (non-diester fatty acids), triglycerides.The increasing content of lipids begins to be actively sent to the liver and there it is intensively oxidized, which leads to the formation of excessive ketone bodies (acetone + β-hydroxybutyric acid + acetoacetic acid) and further entry into the blood (hyperketonemia).An excessive concentration of ketone bodies threatens the so-called dangerous conditiondiabetic ketoacidosis.

Therefore, the general signs of diabetes can be characteristic of any form of the disease, however, in order not to confuse the reader, it is still necessary to note the characteristics that exist in one or another type.

Diabetes mellitus type I is the "privilege" of young people

IDDM is characterized by an acute onset (weeks or months).Signs of diabetes mellitus type I are expressed and shown by clinical symptoms typical for this disease:

• Sudden weight loss;
• Unreasonable thirst, a person cannot get drunk, even if he tries to do so (polydipsia);
• A large amount of urine is excreted (polyuria);
• Significant excess concentration of glucose and ketone bodies in the blood serum (ketoacidosis).In the early stages, when the patient may not be aware of the problem, the development of a diabetic coma (ketoacidotic, hyperglycemic) is quite possible - a very life-threatening condition, therefore insulin therapy is prescribed as early as possible (as soon as diabetes is suspected).

In most cases, after using insulin, metabolic processes are compensated,The body's need for insulin declines dramatically, and a temporary "recovery" occurs.However, this state of short-term remission should not relieve either the patient or the doctor, because after some time the disease will remind itself again.The need for insulin may increase as the duration of the disease increases, but, in general, in the absence of ketoacidosis, it will not exceed 0.8-1.0 U/kg.

Signs that indicate the development of late complications of diabetes (retinopathy, nephropathy) may appear after 5-10 years.The leading causes of death from IDDM include:

1. Terminal kidney failure, which is a consequence of diabetic glomerulosclerosis;
2. Cardiovascular disorders are complications of the underlying disease, which occur somewhat less frequently than renal disorders.

Diseases or age-related changes?(type II diabetes)

NIDDM develops over several months and even years.When a problem arises, one takes it to various specialists (dermatologists, gynecologists, neurologists...).The patient does not suspect that different diseases in his opinion: furunculosis, itchy skin, fungal infection, pain in the lower part of the leg are signs of type II diabetes mellitus.Patients get used to their condition, and diabetes continues to develop slowly, affecting all systems, and especially blood vessels.

NIDDM is characterized by a stable and slow course, usually without a tendency to ketoacidosis.

Treatment of type 2 diabetes usually begins with a diet that limits easily digestible (refined) carbohydrates and the use of sugar-lowering drugs (if necessary).Insulin is prescribed if the disease has progressed to the stage of severe complications or there is resistance to oral drugs.

The main cause of death in patients with NIDDM is recognized as cardiovascular pathology due to diabetes.As a rule, this is a heart attack or stroke.

Treatment for diabetes mellitus

The basis of therapeutic measures aimed at balancing diabetes mellitus is represented by three main principles:

• Compensation for insulin deficiency;
• Regulation of endocrine and metabolic disorders;
• Prevention of diabetes, its complications and timely treatment.

The implementation of this principle is carried out based on 5 main positions:

1. Nutrition for diabetes mellitus plays the role of "first violin";
2. Physical exercise system, sufficient and individually selected, according to diet;
3. Sugar-lowering drugs are mainly used to treat type 2 diabetes;
4. Insulin therapy is prescribed if necessary for NIDDM, but important in the case of type 1 diabetes;
5. Train the patient for self-monitoring (skills in taking blood from the finger, using a glucometer, administering insulin without assistance).

Laboratory control above this position shows the level of compensation after the following biochemical studies:

Pointer	Good level of compensation	Satisfying	bad
Fasting glucose level (mmol/l)	4.4 – 6.1	6.2 – 7.8	Ø 7.8
Blood sugar content 2 hours after eating (mmol/l)	5.5 – 8.0	8.1 – 10.0	Ø 10.0
Percentage of glycosylated hemoglobin (HbA1, %)	< 8.0	8.0 – 9.5	Ø 10.0
Total serum cholesterol (mmol/l)	< 5.2	5.2 – 6.5	Ø 6.5
Triglyceride level (mmol/l)	< 1.7	1.7 – 2.2	Ø 2.2

The important role of diet in the treatment of NIDDM

Diet for diabetes mellitus is very well known, even to people who are far from diabetes mellitus, table number 9. While in the hospital for any disease, at every moment you can hear about a special diet, which is always in a separate pot, different from other diets and is given after a certain password is said: "I have a ninth table."What does all this mean?How is this mystery diet different from others?

One cannot be mistaken, taking care of a diabetic brings his "porridge", that they lose all the joy of life.A diet for diabetes is not that different from a healthy person's diet;patients receive the required amount of carbohydrates (60%), fat (24%), and protein (16%).

Nutrition for diabetes consists of replacing refined sugar in food with carbohydrates that are broken down slowly.Sugar sold in stores for everyone and confectionery products based on it are included in the category of prohibited foods.

As for nutritional balance, everything is strict here: diabetics must necessarily take the required amount of vitamins and pectin, which is at least 40 grams.every day.

Strict individual physical activity

Physical activity for each patient is selected individually by the attending physician, taking into account the following:

• age;
• Symptoms of diabetes;
• The severity of the pathological process;
• Presence or absence of complications.

Physical activity prescribed by the doctor and performed by the "wards" should promote the "burning" of carbohydrates and fats without involving insulin.The dose, which is needed to compensate for metabolic disorders, drops significantly, which should not be forgotten, because by preventing the increase in blood sugar levels, you can get unwanted effects.Sufficient physical activity reduces glucose, the dose of insulin administered breaks down the rest, and as a result, a decrease in sugar levels below an acceptable value (hypoglycemia).

Therefore,insulin dose and physical activity require very careful attention and careful calculation,so that, complementing each other, together we do not exceed the lower limit of normal laboratory parameters.

Or maybe try folk remedies?

Treatment of diabetes mellitus type 2 is often accompanied by the patient's own search for folk remedies that can slow down the process and delay the time of taking the dosage form as much as possible.

Despite the fact that our distant ancestors practically did not know about this disease, folk remedies for the treatment of diabetes mellitus exist, but we must not forget thatinfusions and decoctions prepared from various plants are helpful.The use of home remedies for diabetes does not relieve the patient from following a diet, monitoring blood sugar, visiting a doctor and following all his recommendations.

To combat this pathology at home, quite well-known folk remedies are used:

1. White mulberry skin and leaves;
2. Cereals and oat bran;
3. Walnut division;
4. bay leaves;
5. Cinnamon;
6. Acorns;
7. Nettle;
8. Dandelions.

When diet and folk remedies no longer help...

The so-called first-generation drugs, which were widely known at the end of the last century, have become a thing of the past, and they have been replaced by new-generation drugs, which form the 3 main groups of diabetes drugs produced by the pharmaceutical industry.

The endocrinologist decides which drug is suitable for this or that patient.And so that patients do not self-medicate and do not decide to use these drugs for diabetes at their own discretion, we will give some illustrative examples.

Sulfonylurea derivatives

Currently, second-generation sulfonylurea derivatives are prescribed, which act from 10 hours to 24 hours.Patients usually take it 2 times a day, half an hour before meals.

These drugs are absolutely contraindicated in the following cases:

• Diabetes mellitus type 1;
• Diabetes, hyperosmolar, lactic acidotic coma;
• Pregnancy, childbirth, lactation;

• Diabetic nephropathy is accompanied by impaired filtration;
• Diseases of the hematopoietic system with a simultaneous decrease in white blood cells - leukocytes (leukocytopenia) and platelet components of hematopoiesis (thrombocytopenia);
• Severe infectious and inflammatory liver lesions (hepatitis);
• Diabetes is complicated by vascular pathology.

In addition, the use of drugs in this group can threaten the development of allergic reactions, which are indicated by:

1. Skin itching and urticaria, sometimes reaching Quincke's edema;
2. Disorders of the digestive system;
3. Changes in the blood (decrease in the level of platelets and leukocytes);
4. Possible impairment of liver function (jaundice due to cholestasis).

Antihyperglycemic agents from the biguanide family

Biguanides (guanidine derivatives) are actively used to treat type 2 diabetes mellitus, often adding sulfonamides to them.They are very rational for use by obese patients, however, for people with liver, kidney and cardiovascular pathologies, their use is very limited, switching to softer drugs of the same group or α-glucoside inhibitors, which prevent the absorption of carbohydrates in the small intestine.

The following are absolute contraindications to the use of biguanides:

• IDDM (diabetes mellitus type 1);
• Significant weight loss;
• Infectious process, regardless of location;
• surgical intervention;
• Pregnancy, childbirth, breastfeeding;
• Coma state;
• Hepatic and kidney pathology;
• Oxygen starvation;
• Microangiopathy (2-4 degrees) with impaired vision and kidney function;
• Trophic ulcers and necrotic processes;
• Poor circulation in the lower leg is caused by various vascular pathologies.

Treatment with insulin

From the above, it becomes clear thatInsulin is the main treatment for type 1 diabetes, all medical emergencies, and severe complications of diabetes.NIDDM requires the appointment of this therapy only in the case of forms that require insulin, when correction by other means does not give the desired effect.

Modern insulin, called monocompetent, represents two groups:

1. A monocompetent pharmacological form of the human insulin substance (semi-synthetic or recombinant DNA), which undoubtedly has significant advantages over drugs of pork origin.They have almost no contraindications or side effects;
2. Monocompetent insulin obtained from porcine pancreas.These drugs, compared to human insulin, require an increase in the drug dose by about 15%.

Diabetes is dangerous because of complications

Due to the fact that diabetes is accompanied by damage to many organs and tissues, its manifestations can be found in almost all body systems.Complications of diabetes mellitus are:

• Pathological changes in the skin: diabetic dermopathy, necrobiosis lipoidica, furunculosis, xanthomatosis, fungal infections of the skin;
• Osteoarticular disease:
  1. Diabetic osteoarthropathy (Charcot joint - changes in the ankle joint), occurs against the background of impaired microcirculation and trophic disorders, accompanied by dislocations, subluxations, spontaneous fractures before the formationdiabetic foot;
  
  2. Diabetic hairopathy, characterized by stiffness in the joints of the hands, which often develops in children with diabetes;
• Respiratory disease: long-termprolonged bronchitis, pneumonia,increased incidence of tuberculosis;
• Pathological processes affecting the digestive organs:diabetic enteropathy, accompanied by increased peristalsis, diarrhea (up to 30 times a day), weight loss;
• Diabetic retinopathy– one of the most serious complications, characterized by damage to the visual organ;
• The most common complications of diabetes mellitus are considereddiabetic neuropathyand its diversity -polyneuropathy, reaching 90% of all forms of this pathology.Diabetic polyneuropathy is a common conditiondiabetic foot syndrome;
• Pathological condition of the cardiovascular system, which in most cases is the cause of death due to diabetes mellitus.Hypercholesterolemia and vascular atherosclerosis, which in diabetes begin to develop at a young age, inevitably lead to heart and vascular diseases (coronary artery disease, myocardial infarction, heart failure, cerebrovascular accidents).

Prevention

Measures to prevent diabetes mellitus are based on the causes that cause it.In this case, it is advisable to talk about the prevention of atherosclerosis and arterial hypertension, including the fight against excess weight, bad habits and food addiction.

Prevention of complications of diabetes mellitus involves prevention of the development of pathological conditions arising from diabetes itself.Correcting the glucose in the blood serum, following a diet, adequate physical activity, and following the doctor's recommendations will help delay the consequences of this rather formidable disease.