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types of diabetes

diabetes mellitus

Diabetes mellitus is a disease of the endocrine system, which is accompanied by pathological changes in the hormonal background and metabolic failure.

To date, the disease has not been eradicated (completely eliminated). The destructive process in the body can be slowed down by medication and diet therapy, but not stopped and started in the opposite direction.

The types of diabetes mellitus (DM) are defined by the World Health Organization and do not differ fundamentally in 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 is different for each species and type, it is necessary to know which specific variant of the disease has occurred.

Typing of pathology

There are several types of the disease, united by one main symptom - an increased concentration of glucose in the blood. Diabetes mellitus is classified according to the causes of its occurrence. There are also applied methods of therapy, sex and age of the patient.

Medically recognized forms of diabetes:

  • the first type is insulin dependent (IDDM 1) or juvenile;
  • the second is insulin independent (INZDM 2) or insulin resistant;
  • gestational diabetes (GDM) in the perinatal period in women;
  • other specific types of diabetes, including:
  • Damage to the β-cells of the pancreas at the genetic level (varieties of MODY diabetes);
  • pathology of the exocrine function of the pancreas;
  • hereditary and acquired pathologies of the external secretory glands and their functions (endocrinopathy);
  • pharmacological diabetes;
  • diabetes as a result of congenital infections;
  • DM associated with genomic pathologies 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 shifted upwards (glucose tolerance is impaired), but blood glucose indicators "do not reach" the generally accepted digital values that correspond to real diabetes. According to the World Health Organization (WHO 2014), more than 90 suffer% of endocrinological patients with the second type of disease.

According to medical statistics, there is a clear trend towards increasing case numbers worldwide. In the last 20 years, the number of type 2 diabetics has doubled. GDM accounts for about 5% of pregnancies. Types of specific diabetes are extremely rare and occupy only a small percentage in medical statistics.

By gender, NIDDM 2 is more common in premenopausal and menopausal women. This is due to a change in hormonal status and a bunch 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 the failure of pancreatic cells. The organ is not performing 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, including the pancreas itself, do not receive enough nutrition.

To mimic the natural production of the endocrine hormone, the patient receives lifelong injections of medical grade insulin of varying durations of action (short and long) and diet therapy. The classification of type 1 diabetes mellitus is dictated by the various etiologies of the disease. The insulin-dependent form of the disease has two causes: genetic and autoimmune diseases.

genetic cause

The emergence of pathology is associated with the biological feature of the human body in order to transmit its characteristic features and pathological abnormalities to subsequent generations. Regarding diabetes, a child inherits a predisposition to the disease from parents or close relatives who have diabetes.

Important! The predisposition is inherited, but not the disease itself. There is no 100 percent guarantee that a child will develop diabetes.

autoimmune cause

The onset of the disease is due to a failure of the immune system to function, 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 habits combined with physical inactivity;
  • failure of metabolic processes (carbohydrates, lipids and proteins);
  • critical deficiency of cholecalciferol and ergocalciferol (group D vitamins) in the body;
  • pathology of the pancreas of a chronic nature;
  • a history of mumps (mumps), measles, Coxsackie herpesvirus, Epstein-Barr virus, cytomegalovirus, viral hepatitis A, B, C;
  • distress (prolonged stay in a state of neuropsychological stress);
  • chronic alcoholism;
  • incorrect treatment with hormone-containing drugs.

IDDM is formed in children, adolescents and adults under the age of thirty. The childhood variant of the development of type 1a diabetes is associated with complicated viral infections. Form 1b occurs in adolescents and children against the background of autoimmune processes and hereditary predisposition. The disease usually develops at an accelerated rate over a few weeks or months.

Insulin Resistant Diabetes (Type 2)

The difference between type 2 diabetes 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 body's cells and tissues because they are not sensitive to insulin - insulin resistance. Treatment is, up to a point, with hypoglycemic (sugar-lowering) drugs and diet therapy.

To compensate for the imbalance in the body, the pancreas activates the production of the hormone. In emergency mode, the organ wears out over time and loses its intrasecretory function. Type 2 diabetes becomes insulin dependent. The decrease or loss of cellular responsiveness to the body's hormone 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 obesity, blood flow is complicated by numerous cholesterol plaques in the vessels, which are formed during hypercholesterolemia, which always accompanies obesity. So, the cells of the body lack food and energy resources. Other factors affecting the development of NIDDM include:

  • alcohol abuse;
  • gastronomic addiction to sweets;
  • chronic diseases of the pancreas;
  • pathology of the heart and vascular system;
  • overeating against the background of a sedentary lifestyle;
  • incorrect hormone therapy;
  • complicated pregnancy;
  • dysfunctional heredity (diabetes in parents);
  • distress.

The disease most commonly develops in women and men aged 40+. At the same time, type 2 diabetes is latent and may not show severe symptoms for several years. Timely testing of blood sugar levels can detect prediabetes. With adequate therapy, the prediabetic condition is reversible. If time is lost, it progresses and NIDDM is subsequently diagnosed.

Lada diabetes

In medicine, one finds the term "diabetes 1. 5" or the name Lada diabetes. This is an autoimmune disease in the production of hormones and the failure of metabolic processes that occurs in adults (from the age of 25). The diseasecombines 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.

Triggers 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 glands of external secretion (Sjögren's syndrome).

Autoimmune diseases, in combination with hereditary predisposition, lead to the progression of Lada diabetes. To detect the disease, basic diagnostic methods are used, as well as blood microscopy, which determines the concentration of immunoglobulins of the IgG class to antigens - ELISA (enzymatic immunoassay). Therapy is through regular insulin injections and dietary 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 full examination. The main feature of GDM, which is similar to type 2 diabetes, is insulin resistance. The body cells of a pregnant woman lose 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 and blocks the production of insulin. Also, placental endocrine hormones, which tend to inhibit insulin production, increase in strength.
  • Double burden on the female body. In order to feed the unborn child adequately, the body needs an increased amount of glucose. A woman begins to consume more monosaccharides, which causes the pancreas to synthesize more insulin.
  • An increase in body weight against a background of a decrease in physical activity. Glucose, supplied to the body in abundance, accumulates in the blood as cells refuse to absorb insulin due to obesity and physical inactivity. The expectant mother and the fetus in this situation suffer from 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 the pathology after delivery in 85% of cases. The main method of treating GDM is the diet for diabetics "Table No. 9". In difficult cases, injections with medicinal insulin are used. Hypoglycemic drugs are not used because of their teratogenic effect on the fetus.

Additionally

Certain types of diabetes are genetic (MODY diabetes, some types of endocrinopathies) or caused by other chronic pathologies:

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

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

diagnostic measures

Diagnosis of diabetes mellitus (of any kind) is possible only on the basis of the results of laboratory blood microscopy. The diagnosis consists of several consecutive studies:

  • General clinical blood test to detect hidden inflammatory processes in the body.
  • Blood test (capillary or venous) for glucose levels. Produced exclusively on an empty stomach.
  • GTT (glucose tolerance test). It is performed to determine the body's ability to absorb glucose. The tolerance test is a double blood draw: on an empty stomach and two hours after the "glucose load", which is an aqueous solution of glucose prepared in the ratio of 200 ml of water per 75 g of substances.
  • HbA1C analysis for the level of glycosylated (glycated) hemoglobin. Based on the results of the study, a retrospective of the blood sugar values of the last three months will be evaluated.
  • blood biochemistry. Indicators of liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (AP), bilirubin (bile pigment), cholesterol levels are evaluated.
  • A blood test for the level of antibodies to glutamate decarboxylase (GAD antibodies) determines the type of diabetes mellitus.

Blood glucose reference values and disease indicators

analysis For sugar glucose tolerance test Glycated Hemoglobin
standard 3rd 3 - 5th 5th < 7th 8th ⩽ 6%
prediabetes 5th 6th - 6th 9th 7. 8 - 11. 0 from 6 to 6. 4%
diabetes >7. 1 >11. 1 Over 6. 5%

In addition to blood microscopy, a general urinalysis is examined 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 an acceptable norm). A Reberg test is also performed to detect albumin protein and a protein metabolite of creatinine in urine. Additionally, hardware diagnostics are prescribed, including ECG (electrocardiogram) and ultrasound of the abdominal cavity (with kidneys).

Results

Modern medicine divides 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 (GDM pregnant), specific (DM includes several types of diseases, caused by genetic defects or chronic pathologies). Gestational diabetes formed in the perinatal period is curable. Prediabetes (impaired glucose tolerance) is considered reversible if diagnosed early.