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

Diabetes mellitus is one of the most common diseases and tends to increase in incidence and ruin the statistics.The symptoms of diabetes mellitus do not appear overnight;The process is chronic, with increase and worsening of endocrine and metabolic disorders.It is true that the onset of type 1 diabetes differs significantly from the initial stage of type 2 diabetes.

Among all endocrine pathologies, diabetes safely occupies the leadership and accounts for more than 60% of all cases.Furthermore, disappointing statistics show that one tenth of “diabetics” are children.

The probability of acquiring 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.

Types of diabetes

Many people have heard of a disease like diabetes insipidus.So that the reader does not later confuse the diseases called “diabetes”, it will probably be useful to explain their differences.

Diabetes insipidus

Diabetes insipidus is an endocrine disease that occurs as a result of neuroinfections, inflammatory diseases, tumors, poisoning and is caused by insufficiency and sometimes complete disappearance of ADH-vasopressin (antidiuretic hormone).

This explains the clinical picture of the disease:

• Constant dryness of the oral mucosa, incredible thirst (a person can drink up to 50 liters of water in 24 hours, stretching the stomach to large sizes);
• Isolation of a large amount of light unconcentrated urine with a low specific gravity (1000-1003);
• Catastrophic 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;
• Development of dehydration syndrome in the absence of fluid intake for more than 4 hours.

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

Brief anatomy and physiology

An unpaired organ, the pancreas, performs a mixed secretory function.Its exogenous part carries out external secretion, producing enzymes involved in the digestion process.The endocrine part, which has been entrusted with the mission of internal secretion, produces several hormones, including:insulin and glucagon.They are key to ensuring the consistency of sugar in the human body.

The endocrine section 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, which occupy up to 60% of the cell population, synthesize and store insulin, whose molecule is a two-chain polypeptide, which transports 51 amino acids in a certain sequence;
3. D cells that produce somatostatin;
4. Cells that produce other polypeptides.

Thus, 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.

Types and special forms of the disease.

Lack of insulin causes an alteration in sugar consistency (3.3 – 5.5 mmol/l)and contributes to the formation of a heterogeneous disease called diabetes mellitus (DM):

• The complete absence of insulin is formed (absolute deficiency).insulin dependentpathological process, which is known asdiabetes mellitus type I (IDDM);
• Lack of insulin (relative deficiency), which triggers a disorder of carbohydrate metabolism at the initial stage, slowly but surely leads to the developmentnot insulin dependentdiabetes mellitus (NIDDM), which is calleddiabetes mellitus type II.

Due to the alteration in the use of glucose by the body and, consequently, its increase in the blood serum (hyperglycemia), which, in principle, is a manifestation of the disease, over time signs of diabetes mellitus begin to appear, that is, a total disorder of metabolic processes at all levels.

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

1. secondary diabetesresulting from 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 medications 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 peculiar mutual influence of the hormones of the mother, child and placenta.The fetal pancreas, which produces its own insulin, begins to inhibit the production of insulin by the maternal gland, as a result of which this special form is formed during pregnancy.However, with proper control, gestational diabetes usually disappears after delivery.Subsequently, in some cases (up to 40%) in women with a similar pregnancy history, this fact may threaten the development of type II diabetes mellitus (within 6-8 years).

Why does “sweet” disease occur?

The "sweet" disease forms a rather "varied" group of patients, so it is obvious that IDDM and its non-insulin-dependent "brother" have a different genetic origin.There is evidence of a connection between insulin-dependent diabetes and the genetic structures of the HLA (major histocompatibility complex) system, in particular, with some genes of the D region loci. For NIDDM, no such relationship was observed.

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

• Congenital deficiency of the islets of Langerhans;
• Unfavorable influence of the external environment;
• Stress, nervous stress;
• Traumatic brain injuries;
• Pregnancy;
• Infectious processes of viral origin (influenza, mumps, cytomegalovirus infection, Coxsackie);
• Tendency to constantly overeat, which causes excess fat deposits;
• Abuse of confectionery products (those with a sweet tooth are at greater risk).

Before addressing the causes of type II diabetes mellitus, it would be appropriate to dwell on a very controversial question: who suffers from it more frequently, men or women?

It has been established that today the disease occurs more frequently in women, although back 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 predominant.

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

• Changes in the structural structure of the pancreas as a result of inflammatory processes, as well as the appearance of cysts, tumors, hemorrhages;
• Age after 40 years;
• Excess weight (the most important risk factor for NIDDM!);
• Vascular diseases caused by the atherosclerotic process and high blood pressure;
• In women, pregnancy and birth of a child with high body weight (more than 4 kg);
• Have family members with diabetes;
• Strong psycho-emotional stress (adrenal hyperstimulation).

The causes of the disease of different types of diabetes in some cases coincide (stress, obesity, influence of external factors), but the beginning of the process in type 1 and 2 diabetes is different, in addition,IDDM is the territory of children and young people, and people who are not insulin dependent prefer older people.

Why do you want to drink so much?

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

1. Dryness of the oral mucous membranes;
2. Thirst that is practically impossible to quench, associated with dehydration;
3. Excessive formation of urine and its excretion by the kidneys (polyuria), which causes dehydration;
4. An increase in the concentration of glucose in the blood serum (hyperglycemia), due to suppression of sugar utilization by peripheral tissues due to insulin deficiency;
5. The appearance of sugar in the urine (glycosuria) and ketone bodies (ketonuria), which are normally present in insignificant quantities, but in diabetes mellitus are intensively produced by the liver and, when excreted 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 case of decompensation of the disease is a characteristic feature of the catabolic syndrome, which develops due to the breakdown of glycogen, lipolysis (mobilization of fats), catabolism and gluconeogenesis (transformation into glucose) of proteins;
8. Violation of lipid spectrum indicators, increase in total cholesterol due to the low-density lipoprotein fraction, NEFA (non-esterified fatty acids), triglycerides.The increasing content of lipids begins to be actively sent to the liver and there they are intensively oxidized, which leads to excessive formation of ketone bodies (acetone + β-hydroxybutyric acid + acetoacetic acid) and their subsequent entry into the blood (hyperketonemia).Excessive concentration of ketone bodies threatens a dangerous condition calleddiabetic 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 necessary to take into account the characteristics inherent in one or another type.

Diabetes mellitus type I is a “privilege” of young people

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

• Sudden weight loss;
• Unnatural thirst, a person simply cannot get drunk, even if he tries (polydipsia);
• Large amounts of urine are excreted (polyuria);
• Significant excess concentration of glucose and ketone bodies in the blood serum (ketoacidosis).At the initial stage, when the patient is not yet aware of his problems, diabetic coma (ketoacidotic, hyperglycemic) is very likely to develop - a life-threatening condition, therefore insulin therapy is prescribed as soon as possible (as soon as diabetes is suspected).

In most cases, after the use of insulin, metabolic processes are compensated.The body's need for insulin decreases sharply and a temporary "recovery" occurs.However, this brief state of remission should not relax either the patient or the doctor, since after a while the disease will be remembered again.The need for insulin may increase as the duration of the disease increases, but generally, in the absence of ketoacidosis, it will not exceed 0.8 to 1.0 U/kg.

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

1. End-stage renal failure, which is a consequence of diabetic glomerulosclerosis;
2. Cardiovascular disorders are complications of the underlying disease, occurring less frequently than kidney disorders.

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

NIDDM develops over many months and even years.When problems arise, a person takes them to various specialists (dermatologist, gynecologist, neurologist...).The patient does not even suspect that, in his opinion, different diseases: furunculosis, itchy skin, fungal infections, pain in the lower extremities are signs of type II diabetes mellitus.Patients become accustomed to their condition and diabetes continues to develop slowly, affecting all systems and mainly the blood vessels.

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

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

It is recognized that the main cause of death in patients with NIDDM is cardiovascular pathology resulting from diabetes.As a rule, this is a heart attack or stroke.

Treatments for diabetes mellitus

The basis of therapeutic measures aimed at compensating for diabetes mellitus is represented by three fundamental principles:

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

The implementation of these principles is carried out based on 5 main positions:

1. Nutrition for diabetes mellitus plays the role of “first violin”;
2. A system of physical exercises, suitable and individually selected, accompanies the diet;
3. Sugar-lowering medications are primarily used to treat type 2 diabetes;
4. Insulin therapy is prescribed if necessary for NIDDM, but is essential for type 1 diabetes;
5. Train patients in self-management (skills in drawing blood from a finger, using a glucometer, administering insulin without assistance).

The laboratory control above these positions indicates the degree of compensation after the following biochemical studies:

Indicators	Good degree of compensation.	Satisfying	bad
Fasting glucose level (mmol/l)	4.4 – 6.1	6.2 – 7.8	7.8
Blood sugar content 2 hours after a meal (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	2.2

The important role of diet in the treatment of NIDDM.

Nutrition for diabetes mellitus is well known, even to people far from diabetes mellitus, table number 9. While you are in the hospital for any illness, from time to time you hear about a special diet, which is always in separate pans, differs from other diets and is distributed after saying a certain password: "I have the ninth table."What does all this mean?How is this mystery diet different from all the others?

There is no mistake when caring for a diabetic by bringing him his “porridge”, which deprives him of all the joys of life.The diabetes diet is not that different from the diet of healthy people;Patients receive the necessary amount of carbohydrates (60%), fats (24%) and proteins (16%).

Nutrition for diabetes involves replacing refined sugars in foods with slowly broken down carbohydrates.Sugar sold in stores for everyone and confectionery products based on it fall into the category of prohibited foods.

As for nutritional balance, everything is strict here: a diabetic must necessarily consume the necessary amount of vitamins and pectins, which should be at least 40 grams.per day.

Strictly individual physical activity

The physical activity of each patient is selected individually by the treating doctor, taking into account the following points:

• Age;
• Diabetes symptoms;
• The severity of the pathological process;
• The presence or absence of complications.

The physical activity prescribed by the doctor and carried out by the “room” should promote the “burning” of carbohydrates and fats without insulin intervening.Its dose, necessary to compensate for metabolic disorders, decreases significantly, which must not be forgotten, since preventing an increase in blood sugar levels can lead to an undesirable effect.Adequate physical activity reduces glucose, the administered dose of insulin breaks down the remaining one and, as a result, a decrease in sugar levels below acceptable values (hypoglycemia).

So,Insulin dosage and physical activity require close attention and careful calculation,so that, by complementing each other, together we do not cross the lower limit of normal laboratory parameters.

Or maybe try home remedies?

The treatment of type 2 diabetes mellitus is usually accompanied by the patient's search for home remedies that can slow down the process and delay as much as possible the moment of taking the pharmaceutical forms.

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

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

1. Bark and leaves of white mulberry;
2. Oat grains and hulls;
3. Walnut partitions;
4. bay leaf;
5. Cinnamon;
6. Acorns;
7. Nettle;
8. Dandelion.

When diet and home remedies no longer help...

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

The endocrinologist decides which remedy is suitable for this or that patient..And so that patients do not self-medicate and do not decide to use these diabetes medications on their own, we will give several illustrative examples.

Sulfonylurea derivatives

Second generation sulfonylurea derivatives are currently prescribed, which act for 10 to 24 hours.Patients usually take them 2 times a day, half an hour before meals.

These medications are absolutely contraindicated in the following cases:

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

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

Also, the use of drugs from this group can threaten the development of allergic reactions, which are manifested by:

1. Skin itching and urticaria, sometimes leading to Quincke's edema;
2. Digestive system disorders;
3. Changes in the blood (decreased levels of platelets and leukocytes);
4. Possible deterioration of the functional abilities of the liver (jaundice due to cholestasis).

Antihyperglycemic agents of the biguanide family.

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

The following are considered absolute contraindications for the use of biguanides:

• IDDM (type 1 diabetes mellitus);
• Significant weight loss;
• Infectious processes, regardless of their location;
• surgical interventions;
• Pregnancy, childbirth, breastfeeding;
• Comatose states;
• Liver and kidney pathology;
• Lack of oxygen;
• Microangiopathy (2-4 degrees) with vision and kidney function problems;
• Trophic ulcers and necrotic processes;
• Poor circulation in the lower extremities due to various vascular pathologies.

insulin treatment

From the above it follows thatInsulin is the main treatment for type 1 diabetes, all medical emergencies, and serious complications of diabetes.NIDDM requires the appointment of this therapy only in cases of insulin-requiring forms, when correction by other means does not bring the desired effect.

Modern insulins, called monocompetent, represent two groups:

1. Monocompetent pharmacological forms of the substance human insulin (semi-synthetic or recombinant DNA), which undoubtedly have a significant advantage over drugs of porcine origin.They have practically no contraindications or side effects;
2. Monocompetent insulins obtained from the porcine pancreas.These drugs, compared to human insulins, require an increase in the drug dose by approximately 15%.

Diabetes is dangerous because of complications.

Because diabetes is accompanied by damage to many organs and tissues, its manifestations can be found in almost all body systems.The complications of diabetes mellitus are:

• Pathological changes in the skin.: diabetic dermopathy, lipoid necrobiosis, furunculosis, xanthomatosis, fungal skin infections;
• Osteoarticular diseases:
  1. Diabetic osteoarthropathy (Charcot joint - change in the ankle joint), occurring against the background of microcirculation disturbances and trophic disorders, accompanied by dislocations, subluxations and spontaneous fractures preceding the formation.diabetic foot;
  
  2. Diabetic hairopathy, characterized by stiffness in the joints of the hands, which often develops in children with diabetes;
• Respiratory diseases: long termprolonged bronchitis, pneumonia,increased incidence of tuberculosis;
• Pathological processes that affect the digestive organs:diabetic enteropathy, accompanied by increased peristalsis, diarrhea (up to 30 times a day), loss of body weight;
• diabetic retinopathy– one of the most serious complications, characterized by damage to the visual organs;
• It is considered the most common complication of diabetes mellitus.diabetic neuropathyand its variety -polyneuropathy, reaching 90% of all forms of this pathology.Diabetic polyneuropathy is a common condition.diabetic foot syndrome;
• A pathological condition of the cardiovascular system, which in most cases is the cause of death from diabetes mellitus..Hypercholesterolemia and vascular atherosclerosis, which in diabetes begin to develop at an early age, inevitably lead to heart and vascular diseases (coronary artery disease, myocardial infarction, heart failure, stroke).

Prevention

Measures to prevent diabetes mellitus are based on the causes that cause it.In this case, it is worth talking about the prevention of atherosclerosis and high blood pressure, including the fight against excess weight, bad habits and food addictions.

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