Diabetes: types and causes of its development, course and manifestations, treatment, possible consequences

Diabetes mellitus is one of the most common diseases, the frequency of which tends to increase and distorts the statistics.The symptoms of diabetes mellitus do not appear overnight;The process is chronic, with an increase and worsening of endocrine and metabolic disorders.The onset of type 1 diabetes differs significantly from the early stages of type 2 diabetes.

Among all endocrine pathologies, diabetes is certainly at the top, accounting for more than 60% of all cases.Furthermore, disappointing statistics show that 1/10 of “diabetics” are children.

The likelihood of developing the disease increases with age and so the group size doubles every ten years.This is due to increasing life expectancy, improved methods of early detection, a decrease in physical activity and an increase in the number of overweight people.

Types of diabetes

Many people have heard of a disease such as diabetes insipidus.So that the reader does not later confuse 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 and poisoning and is caused by a deficiency 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, causing the stomach to expand to large sizes);
• Isolation of a large amount of unconcentrated light urine with low specific gravity (1000-1003);
• Catastrophic weight loss, weakness, reduced physical activity, digestive system disorders;
• Characteristic changes in the skin (“parchment skin”);
• Atrophy of muscle fibers, weakness of muscles;
• 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;The ability to work is significantly restricted.

Brief anatomy and physiology

An unpaired organ, the pancreas, performs a mixed secretory function.Its exogenous part carries out external secretion and produces enzymes involved in the digestive process.The endocrine part, which is entrusted with the task of internal secretion, produces various hormones including –Insulin and glucagon.They are crucial for the consistency of sugar in the human body.

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

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

So the conclusion is obvious:In particular, damage to the pancreas and islets of Langerhans is the main mechanism that inhibits insulin production and triggers the development of the pathological process.

Types and special forms of the disease

Insulin deficiency leads to impaired sugar stability (3.3 – 5.5 mmol/l)and contributes to the development of a heterogeneous disease called diabetes mellitus (DM):

• There is a complete lack of insulin (absolute deficiency).insulin dependentpathological process, which is calledType I diabetes mellitus (IDDM);
• A lack of insulin (relative deficiency), which in the initial stages triggers a disorder of carbohydrate metabolism, slowly but surely leads to the developmentnot insulin dependentDiabetes mellitus (NIDDM), the so-calledDiabetes mellitus type II.

Due to the disruption of the body's use of glucose and the associated increase in blood serum (hyperglycemia), which is in principle a manifestation of the disease, signs of diabetes mellitus appear over time, i.e. a complete disruption of metabolic processes at all levels.

In addition to type 1 and type 2 diabetes, there are special forms 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 associated with excessive production of insulin antagonists (acromegaly, Cushing's disease, pheochromocytoma, thyroid disease) lead to the development of secondary diabetes.Many drugs taken for a long time have a diabetogenic effect: diuretics, some antihypertensive drugs and hormones, oral contraceptives, etc.;
2. Diabetes in pregnant women (gestational diabetes),caused by the special mutual influence of the hormones of mother, child and placenta.The fetal pancreas, which produces its own insulin, begins to inhibit the production of insulin by the mother's gland, resulting in this special form during pregnancy.However, if properly controlled, gestational diabetes usually disappears after birth.As a result, in some cases (up to 40%) in women with a similar pregnancy history, this circumstance can threaten the development of type II diabetes mellitus (within 6-8 years).

Why does the “sweet” disease appear?

The “sweet” disease forms a rather “motley” group of patients, so it is obvious that IDDM and its non-insulin-dependent “brother” have genetically different origins.There is evidence of a connection between insulin-dependent diabetes and the genetic structures of the HLA (major histocompatibility complex) system, particularly with some genes of the D region loci.No such relationship was observed for NIDDM.

A genetic predisposition alone is not sufficient for the development of type I diabetes mellitus;The pathogenetic mechanism is triggered by provoking factors:

• Congenital deficiency of 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 leads to excessive fat deposits;
• Abuse of confectionery (those with a sweet tooth are at higher risk).

Before we delve into the causes of type II diabetes mellitus, it would be advisable to address a very controversial question: who suffers from it more often - men or women?

It has been noted that the disease is now more common in women, although diabetes was a “privilege” of the male gender in the 19th century.By the way, in some countries in Southeast Asia the incidence of this disease in men is now considered predominant.

The 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, bleeding;
• age after 40 years;
• Obesity (the most important risk factor for NIDDM!);
• Vascular diseases caused by the atherosclerotic process and arterial hypertension;
• In women, pregnancy and birth of a child with high body weight (more than 4 kg);
• have relatives with diabetes;
• Severe psycho-emotional stress (adrenal hyperstimulation).

The causes of the disease of different types of diabetes are partly the same (stress, obesity, influence of external factors), but the beginning of the process is different for type 1 and type 2 diabetes, moreoverIDDM is the domain of children and adolescents, and non-insulin dependent people prefer older people.

Why do you want to drink so much?

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

1. dryness of the oral mucous membranes;
2. Virtually impossible to quench thirst, associated with dehydration;
3. Excessive production of urine and its excretion by the kidneys (polyuria), leading to dehydration;
4. An increase in glucose concentration in blood serum (hyperglycemia) due to suppression of sugar utilization by peripheral tissues due to insulin deficiency;
5. The appearance of sugar in the urine (glucosuria) and ketone bodies (ketonuria), which are normally present in negligible quantities, but in diabetes mellitus they are intensively produced by the liver and are found in the urine when excreted from the body;
6. Increased content in blood plasma (in addition to glucose) of urea and sodium ions (Na).⁺);
7. Weight loss, which, in the 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 (conversion into glucose) of proteins;
8. Violation of lipid spectrum indicators, increase in total cholesterol due to low density lipoprotein fraction, NEFA (non-esterified fatty acids), triglycerides.The increasing content of lipids begins to actively enter the liver and be intensively oxidized there, which leads to excessive formation of ketone bodies (acetone + β-hydroxybutyric acid + acetoacetic acid) and their further entry into the blood (hyperketonemia).An excessive concentration of ketone bodies threatens a dangerous condition calleddiabetic ketoacidosis.

Thus, 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 features inherent in this or that species.

Type I diabetes mellitus is a “privilege” of young people

IDDM is characterized by an acute onset (weeks or months).The signs of type I diabetes mellitus are pronounced and are expressed in the clinical symptoms typical of this disease:

• Sudden weight loss;
• Unnatural thirst, a person simply cannot get drunk even though he tries (polydipsia);
• Excessive urine output (polyuria);
• Significant excess of glucose and ketone body concentration in the blood serum (ketoacidosis).In the early stages, when the patient may not yet be aware of his problems, the development of a diabetic (ketoacidotic, hyperglycemic) coma is very likely - a condition that is extremely life-threatening.Therefore, insulin therapy is prescribed as early as possible (as soon as diabetes is suspected).

In most cases, after using insulin, metabolic processes are balanced,The body's need for insulin drops sharply and a temporary "recovery" occurs.However, this short-term state of remission should not relax either the patient or the doctor, since the disease becomes noticeable again after a while.Insulin requirements may increase with disease duration, but generally will not exceed 0.8-1.0 U/kg in the absence of ketoacidosis.

Signs of 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 as a result of diabetic glomerulosclerosis;
2. Cardiovascular diseases are complications of the underlying disease that occur somewhat less frequently than kidney diseases.

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

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

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

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

The main cause of death in patients with NIDDM is considered to be cardiovascular pathology due to diabetes.This is usually a heart attack or stroke.

Treatments for diabetes mellitus

The basis of therapeutic measures to compensate for diabetes mellitus are three main principles:

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

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

1. Diet in diabetes mellitus plays the role of “first fiddle”;
2. The diet is followed by a system of adequate and individually selected physical exercises;
3. Sugar-lowering medications are primarily used to treat type 2 diabetes;
4. In NIDDM, insulin therapy is prescribed if necessary, but in type 1 diabetes it is essential;
5. Training patients in self-control (skills in taking blood from a finger, using a blood glucose meter, administering insulin independently).

Laboratory control over these positions indicates the degree of compensation according to the following biochemical studies:

Indicators	Good compensation	Satisfactory	Bad
Fasting glucose level (mmol/l)	4.4 – 6.1	6.2 – 7.8	Ø 7.8
Blood sugar level 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 cholesterol in serum (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

The diet for diabetes mellitus is very well known even among people who are far from diabetes mellitus, table No. 9. While being in the hospital for an illness, you now and then hear about a special diet, which is always in separate pots, different from other diets and is issued according to a certain password: “I have the ninth table.”What does it all mean?How is this mystery diet different from all others?

One should not be mistaken when caring for a diabetic who carries away his “porridge” that he is deprived of all the joys of life.The diet for diabetes is not that different from the diet of healthy people;Patients receive the required amount of carbohydrates (60%), fats (24%) and proteins (16%).

Diet for diabetes consists of replacing refined sugar in foods with slowly broken down carbohydrates.Sugar, which is sold in stores for everyone, and confectionery based on it falls into the category of prohibited foods.

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

Strictly individual physical activity

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

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

The physical activity prescribed by the doctor and carried out by the “ward” is intended to promote the “burning” of carbohydrates and fats without the effect of insulin.Its dose, which is necessary to compensate for metabolic disorders, drops noticeably, which should not be forgotten, because 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, and as a result, sugar levels fall below acceptable levels (hypoglycemia).

So,The dosage of insulin and physical activity requires the utmost attention and careful calculation.So that we complement each other and together do not exceed the lower limit of normal laboratory parameters.

Or maybe try folk remedies?

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

Although our distant ancestors practically did not know about this disease, there are folk remedies for the treatment of diabetes mellitus, but we should not forget about thisInfusions and decoctions from various plants are helpful.The use of home remedies for diabetes does not exempt the patient from following a diet, monitoring blood sugar levels, visiting a doctor and following all his recommendations.

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

1. White mulberry bark and leaves;
2. oat grains and husks;
3. Walnut partitions;
4. bay leaf;
5. Cinnamon;
6. acorns;
7. Nettle;
8. Dandelion.

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, are becoming a thing of the past and have been replaced by new generation drugs, which make up the three 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 drugs for diabetes at their own discretion, we give some illustrative examples.

Sulfonylurea derivatives

Currently, second-generation sulfonylurea derivatives are prescribed that last between 10 and 24 hours.Patients usually take them twice a day half an hour before meals.

These drugs are absolutely contraindicated in the following cases:

• diabetes mellitus type 1;
• Diabetic, hyperosmolar, lactic acid coma;
• pregnancy, birth, breastfeeding;

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

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

1. Itchy skin and urticaria, sometimes leading to Quincke's edema;
2. Disorders of the digestive system;
3. Changes in the blood (decreased platelet and leukocyte levels);
4. Possible impairment of liver functionality (jaundice due to cholestasis).

Antihyperglycemic active ingredients from the biguanide family

Biguanides (guanidine derivatives) are actively used to treat type 2 diabetes mellitus, often adding sulfonamides to them.They are very useful for use in obese patients, but in people with liver, kidney and cardiovascular diseases their use is greatly limited and is switched to gentler drugs of the same group or α-glucoside inhibitors, which inhibit 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 processes, regardless of location;
• Surgical procedures;
• pregnancy, birth, breastfeeding;
• coma states;
• liver and kidney pathology;
• lack of oxygen;
• Microangiopathy (2-4 degrees) with impaired vision and kidney function;
• Trophic ulcers and necrotic processes;
• Poor blood circulation in the lower extremities due to various vascular diseases.

Treatment with insulin

From what has been said above it is clearInsulin is the primary treatment for type 1 diabetes, all medical emergencies and serious complications of diabetes.NIDDM requires the appointment of this therapy only for insulin-dependent forms, when correction with other means does not bring the desired effect.

Modern insulins, so-called monocompetent insulins, represent two groups:

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

Diabetes is dangerous due to complications

Since diabetes is associated with 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 skin infections;
• Osteoarticular diseases:
  1. Diabetic osteoarthropathy (Charcot joint - change in the ankle joint), which occurs against the background of impaired microcirculation and trophic disorders, accompanied by dislocations, subluxations and spontaneous fractures before formationdiabetic foot;
  
  2. Diabetic hairopathy, characterized by stiffness of the wrists, which often occurs in children with diabetes;
• Respiratory diseases: long-termpersistent 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 organs of vision;
• The most common complication of diabetes mellitus is considereddiabetic neuropathyand its diversity -Polyneuropathy, which affects 90% of all forms of this pathology.Diabetic polyneuropathy is a common diseaseDiabetic 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 develop at an early age in diabetes, inevitably lead to heart and vascular diseases (coronary heart disease, myocardial infarction, heart failure, stroke).

Prevention

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

Prevention of complications of diabetes mellitus includes preventing the development of pathological conditions caused by diabetes itself.Correction of glucose levels in the blood serum, adherence to a diet, sufficient physical activity and following the doctor's recommendations can help delay the consequences of this rather serious disease.