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Type of diabetes

diabetes mellitus and its types

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

Until now, this disease cannot be eradicated (completely eliminated).The process of destruction in the body can be slowed down through drugs and diet therapy, but it is impossible to stop it and start it in the opposite direction.

The main symptom of this disease is a chronic increase in blood glucose levels.The causes and nature of the course of the disease are different, so they are divided into several types.

The type of diabetes mellitus (DM) is defined by the World Health Organization and has no fundamental differences throughout the medical world.Diabetes mellitus of any type is not a contagious disease.

Typing pathology

There are several types of diseases, united by one main symptom - an increase in the concentration of glucose in the blood.The classification of diabetes mellitus is determined by the causes of its occurrence.The treatment method used, gender and age of the patient also take into account.

Types of diabetes accepted in medicine:

  • the first type is insulin dependent (IDDM 1), or juvenile;
  • the second is non-insulin dependent (NIDDM 2), or insulin resistant;
  • gestational diabetes mellitus (GDM) during the perinatal period in women;
  • other specific types of diabetes, including:
  • damage to pancreatic β-cells at the genetic level (MODY diabetes variety);
  • pathology of pancreatic exocrine function;
  • hereditary and acquired pathology of exocrine glands and their functions (endocrinopathy);
  • pharmacologically induced diabetes;
  • diabetes due to congenital infection;
  • Diabetes associated with genomic pathology and hereditary defects;
  • impaired fasting glucose (blood sugar) and impaired glucose tolerance.

Prediabetes is a borderline state of the body when the glycemic level is elevated (glucose tolerance is impaired), but the blood sugar level "does not reach" the generally accepted digital value corresponding to true 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 towards an increase in the number of cases worldwide.Over the past 20 years, the number of people with type 2 diabetes has doubled.GDM accounts for about 5% of pregnancies.This specific type of diabetes is very rare and occupies a small percentage in medical statistics.

According to gender, NIDDM 2 occurs more often in women during the premenopausal period and during menopause.This is due to changes in hormonal status and weight gain.In men, the most common factor in the development of type 2 diabetes is chronic inflammation of the pancreas caused by the toxic effects of ethanol.

Insulin-dependent diabetes (type 1)

Type 1 diabetes is characterized by pancreatic cell dysfunction.The organ does not fulfill the endocrine function (intrasecretory) to produce insulin, the hormone responsible for supplying the body with glucose.Due to the accumulation of glucose in the blood, the organs do not receive sufficient nutrition, including the pancreas itself.

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

Genetic causes

The formation of pathology is associated with the biological ability of the human body to transmit characteristic signs and pathological deviations to the next generation.With regard to diabetes, a child inherits a tendency to this 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 develop diabetes.

Autoimmune causes

The occurrence of this disease is caused by the failure of the immune system, when, under the influence of negative factors, it actively produces autoimmune antibodies that have a damaging effect on the body's cells.Triggers (motivation) for the launch of the autoimmune process are:

  • unhealthy eating behavior combined with physical inactivity;
  • failure of metabolic processes (carbohydrates, lipids and proteins);
  • critical shortage of cholecalciferol and ergocalciferol (vitamin D) in the body;
  • 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 drugs containing hormones.

IDDM develops in children, adolescents and adults under the age of thirty.The juvenile variant of type 1a diabetes is associated with complicated viral infections.Form 1b occurs in young people and children against the background of autoimmune processes and hereditary predisposition.The disease usually develops rapidly over several 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 drugs (lowering sugar) and diet therapy.

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

This is especially true for visceral obesity (deposition of fat around internal organs).In addition, with excess body weight, blood flow is obstructed due to many cholesterol plaques in the vessels, which are formed during hypercholesterolemia, which always accompanies obesity.Therefore, body cells experience a lack of nutrition and energy sources.Other factors that influence the development of NIDDM include:

  • alcohol abuse;
  • gastronomic addiction to sweet dishes;
  • chronic pancreatic disease;
  • pathology of the heart and vascular system;
  • excessive eating against the background of an inactive lifestyle;
  • incorrect hormone therapy;
  • complicated pregnancy;
  • Unfavorable heredity (diabetes in parents);
  • trouble

This disease most often develops in women and men aged 40+.At the same time, type 2 diabetes is latent and may not show obvious symptoms for several years.Testing your blood glucose levels early can reveal prediabetes.With adequate treatment, prediabetes can be reversed.If time is lost, it develops and NIDDM is then diagnosed.

Pepper diabetes

In the medical field, the term "Diabetes 1.5" is used, or the name Pepper diabetes.This is an autoimmune disorder of hormone production and metabolic failure that occurs in adults (aged 25+).This disease combines type 1 and type 2 diabetes.The developmental mechanism corresponds to IDDM, the latent course and symptom manifestations are similar to NIDDM.

The trigger for the development of the pathology is an autoimmune disease 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 colonic mucosa (ulcerative colitis);
  • chronic damage to connective tissue and exocrine glands (Sjögren's syndrome).

In combination with a hereditary predisposition, autoimmune disorders lead to the development of Lada diabetes.To identify the disease, basic diagnostic methods are used, as well as blood microscopy, which determines the concentration of IgG class immunoglobulins to antigens - ELISA (enzyme-linked immunosorbent assay).Therapy is carried out through regular insulin injections and dietary correction.

The pregnancy form of this disease

GDM is a specific type of diabetes that develops in women in the second half of the postpartum period.This disease is most often detected during the second scheduled examination, when the expectant mother undergoes a full examination.The main feature of GDM coincides with type 2 diabetes - insulin resistance.The cells of a pregnant woman's body lose sensitivity (sensitivity) to insulin due to the correlation of three main reasons:

  • Hormonal changes.During pregnancy, the synthesis of progesterone (steroid sex hormone) increases, blocking the production of insulin.Furthermore, the placenta's endocrine hormones, which tend to inhibit insulin production, are getting stronger.
  • Double the load on the female body.To ensure adequate nutrition for the unborn baby, the body needs an increased amount of glucose.A woman begins to consume more monosaccharides, which causes the pancreas to synthesize more insulin.
  • Weight gain due to decreased physical activity.Glucose, which enters the body in abundance, accumulates in the blood because cells refuse to accept insulin due to obesity and physical inactivity.Expectant mothers and fetuses in such conditions suffer from nutritional deficiencies and energy starvation.

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

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

Besides that

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

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

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

Diagnostic steps

Diagnosis of diabetes mellitus (of any type) is only possible based on laboratory blood microscopy results.Diagnostics consists of several sequential studies:

  • General clinical blood tests to identify hidden inflammatory processes in the body.
  • Blood test (capillary or venous) for glucose content.It is done strictly on an empty stomach.
  • GTT (glucose tolerance test).It is carried out to determine the body's ability to absorb glucose.The tolerance test is a two-time blood draw: on an empty stomach and two hours after a "glucose load", which is an aqueous solution of glucose prepared in a ratio of 200 ml of water per 75 g.material.
  • HbA1C analysis for the level of glycosylated hemoglobin (glycation).Based on the results of the study, blood sugar levels in the past three months were retrospectively assessed.
  • Blood biochemistry.Liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), Alpha-Amylase, alkaline phosphatase (ALP), bilirubin (bile pigment), and cholesterol levels were evaluated.
  • A blood test for the concentration of antibodies to glutamate decarboxylase (GAD antibodies) determines the type of diabetes mellitus.

Blood sugar reference values and disease indicators

Analysis For sugar Glucose tolerance test Glycated hemoglobin
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 More than 6.5%

In addition to blood microscopy, a general urine test is checked to determine the presence of glucose in the urine (glycosuria).In healthy people, there is no sugar in the urine (for diabetics, the acceptable norm is 0.061 - 0.083 mmol/l).The Rehberg test is also performed to detect the protein albumin and creatinine, a product of protein metabolism in the urine.In addition, hardware diagnostics are prescribed, including ECG (electrocardiogram) and ultrasound of the abdominal cavity (with kidneys).

Decision

Modern medicine classifies diabetes into four main types, depending on the pathogenesis (origin and development) of the disease: insulin-dependent (type 1 IDDM), non-insulin-dependent (type 2 NIDDM), pregnancy (GDM in pregnant women), specific (DM includes several types of diseases caused by genetic defects or chronic pathology).Gestational diabetes that develops during the perinatal period can be cured.Prediabetes (impaired glucose tolerance) is considered reversible if diagnosed early.