Diabetes mellitus (DM) is an endocrine pathology that has a chronic progressive course. It manifests itself in metabolic disorders of carbohydrate and water metabolism, accompanied by hyperglycemia, that is, an increase in blood sugar. Diabetes itself is not terrible, because sugar can be normalized in various ways, but it is dangerous for its complications.
Women get sick more often, and they often have complications of diabetes. According to statistics, today 7% of the world's inhabitants are diabetics. Among the leading countries are India, China and the United States, Russia is in 4th place (10 million people - 3.5%). The number of cases is growing so fast that, according to statistics, every 7 seconds in 2 people this diagnosis is revealed. The annual mortality rate is about 2 million people. Although diabetes is leading today, it was known and described in the 1st century AD. e. in ancient Greece and Rome.
Diabetes Overview
To make a diagnosis of diabetes, the doctor must have the results of a full examination of the patient, since there are several types and degrees of this disease.
Diabetes is distinguished by congenital and acquired, primary and secondary, juvenile, or juvenile, and adult. The last division allows us to talk about pathologies of type 1 and 2. Although the division into stages and types has been abolished since 1999, doctors all over the world use the classification, since this is important when choosing treatment tactics and diagnosing. The frequency of type 1 diabetes is only 5%, type 2 diabetes develops in 95% of cases. The stages, course and causes are different, but the complications are the same.
Type 1 diabetes is called juvenile, or juvenile, because it can occur in children, even newborns, and in young people under 30 years old. In recent years, the age line has grown to 45. This type of diabetes is insulin-dependent - IDDM. This means that the cause of the disease lies in the disruption of the pancreas, whose beta cells either do not produce insulin at all, or produce very little of it.
To ensure the body, insulin must be administered from the outside. This is its main difference from type 2 diabetes, which is considered a disease of adulthood, develops after 40 and is non-insulin-dependent - NIDDM. The production of insulin in beta cells is in normal quantities, but the cells of organs and tissues do not receive it for various reasons, which will be discussed below.
A situation arises when there is a lot of sugar in the blood, and the body's cells are starving. Glucose does not pass in them. There is a lot of insulin, but it is not able to help “open” the cell to glucose, because the cells themselves are resistant to it. Therefore, the second name for such diabetes is insulin-resistant. This type is hereditary in nature most often.
Which one is more dangerous? It is believed that type 1 diabetes develops quickly and is difficult to treat.
Causes of diabetes
An important role is played by heredity: it does not cause diabetes directly, but is inherited, in 70% of cases a predisposition to the disease. Among other factors: viral infections - influenza, rubella, epidhepatitis and chickenpox. They become the impetus for the onset of the disease. Obesity and physical inactivity are important for type 2 diabetes. Some diseases of the pancreas itself - inflammation, tumors, other endocrinopathies - can also cause damage to beta cells. In addition, fears and stresses, neurosises play a significant role - they can also become a trigger.
The chance of getting sick increases with age. There is such a proven fact: every 10 years, the possibility of diabetes in a person doubles. It has also been observed that breast-fed children are more likely to develop type 1 diabetes.
The main cause of T2DM is abdominal obesity - a lifebuoy on the stomach. These people are most often hypodynamic, eat junk food with an abundance of simple carbohydrates, fried and constantly overeat.
The climate matters with type 1 diabetes - cold weather has it. Juvenile diabetes also threatens those who were heavy at birth, who were weaned early and transferred to artificial feeding.
Pathogenesis of the disease
The first type is, in fact, an autoimmune process, when your immunity begins to produce antibodies against pancreatic cells. He takes them for an alien, but can develop for unknown reasons.
With type 1 diabetes, hyperglycemia cannot be removed with insulin, because it is not there. The compensatory reaction of the body in this case is the elimination of excess sugar through urine, and urination becomes more frequent. In parallel, dehydration develops in the body. The breakdown of fats begins due to lack of water and nutrition, and a person loses weight.
The picture for type 2 diabetes is completely different: there is a lot of insulin and sugar in the blood, but the cells are resistant to insulin. Sugar cannot penetrate. Insulin ceases to play the role of a key in the cells, which used to help sugar pass into the cells.
Insulin goes off scale - hyperinsulinemia occurs. The liver still tries to feed the cell with glucose and produces it from any sources. But such products are negative for the pancreas, they hit her, and her work is disrupted.
Ultimately, insulin production stops. Further, in the stage of diabetes, blood sugar transfers its action to the walls of blood vessels, corroding them. Damaged places are filled with cholesterol - atherosclerosis starts. First of all, capillaries, nerve endings are affected, and complications of diabetes begin.
Types of Diabetes
In addition to type 1 and type 2 diabetes, there are:
- gestational - develops during pregnancy, after childbirth it most often passes;
- Diabetes provoked by poor nutrition;
- secondary or symptomatic diabetes.
Stage 1 Type 1 Diabetes
Degrees of T1DM:
- The first stage of diabetes has a favorable course. Glycemia is only 7 mmol / l, blood without deviations, there is no sugar in the urine. There are no complications, the stage is easily compensated by a diet and special pills to reduce sugar. This period, or the initial stage of diabetes, is called pre-painful. Many doctors consider it necessary to carry out preventive measures in such cases, especially if a person is at risk for heredity. Pathology can only be detected by identifying defective genes with a hereditary predisposition.
- The second degree, or stage 2 diabetes mellitus, becomes partially compensated. The destruction of beta cells begins. Signs of complications begin to appear. A photo of diabetes at the initial stage shows what symptoms await the person: frequent urination, thirst, impaired vision.
- In the third stage, treatment is not limited to diet and pills. Glucose is actively found in urine, glycemia is 14 mmol / L. Insulin is produced less. Signs of complications are already obvious: vision is rapidly declining, an increase in pressure, limb paresthesia are formed.
- At the fourth stage, there are no systematic symptomatic manifestations, but patients complain of frequent colds, persistent boils, conjunctivitis, weakness and malaise. The task of treatment is eye and skin problems.
- In the fifth stage of diabetes, 90% of beta cells are already destroyed. The symptoms are bright.
- The sixth stage is the hardest. The islands of Langerhans are completely destroyed. The glucose level reaches 25 mmol / l, in the urine - glucosuria, proteinuria, complications in the form of renal failure, gangrene of the toes, trophic ulcers on them.
Stage 2 type 2 diabetes
The degrees, or stages, of type 2 diabetes also have their own characteristics:
- Mild - improvement is achieved by diet and sugar-lowering tablets. This compensatory, or initial, stage of diabetes is reversible. Glycemia <7.7 mmol / L, no glucosuria.
- In the middle stage of diabetes, improvement can be achieved (glycemia <12.7) by taking sugar-lowering tablets - 2-3 capsules. Insulin is not connected yet. The amount of glucose is more than 10 mmol / l, sugar appears in the urine. Of the symptoms: polydipsia, dry mouth, general weakness, polyuria. There are long non-healing abscesses on the skin. The subcompensatory stage, or stage 2 diabetes mellitus , is partially reversible with proper treatment. In addition to oral hypoglycemic agents (PRA), the use of insulin is required.
- The severe decompensatory stage is the complete irreversibility of the consequences, many complications and a violation of the carbohydrate and all types of metabolism for life. Hyperglycemia> 12.7 mmol / L, coma may develop. The clinic is expressed, angio-and neuropathies occur.
Signs and Symptoms
Symptoms of diabetes of the initial stage proceed unnoticed. In type 1 diabetes, the clinical picture develops rapidly and acutely, in a few weeks. The most accurate sign is the literally hourly beginning of the pathology. The state of health sharply worsens, among the first symptoms of the initial stage of diabetes mellitus it can be noted:
- increased appetite and a constant feeling of hunger;
- thirst;
- weakness and chronic fatigue;
- weight loss;
- bouts of nausea and vomiting;
- nervous agitation and irritability.
There is a decrease in temperature to 35.6-36.2 degrees. This is a hallmark of type 1.
The onset of diabetes, IDDM, is characterized by thinning of the skin, on which cracks easily develop, poorly healing scratches. Vision problems appear in the veil before the eyes, increasing blurred vision. These are brain signals that lack nutrition. Recognizing the presence of diabetes is simple - donate blood for sugar. Missed measures for diabetes of the first type, unlike the second, will quickly lead to a coma.
How to determine type 2 diabetes?
There are several first signs of the initial stage of type 2 diabetes mellitus, people with these manifestations do not even suggest the onset of pathology and do not consult a doctor. These include:
- obesity;
- craving for sweets and starchy foods;
- chronic hunger;
- permanent fatigue and daytime sleepiness.
Also, one of the first calls of the early stages of diabetes can manifest itself in increased pressure.
Later joins:
- nausea;
- irritability;
- causeless vision loss;
- feeling of tingling and goosebumps in the legs;
- dry saggy skin - creams do not give an effect;
- dry mouth and metallic taste;
- spots and itching on the skin;
- itching of the vulva;
- cardialgia;
- poor healing of any wounds and abrasions.
Also, in women, the symptoms of diabetes at an early stage are manifested in the form of hyperhidrosis and diaper rash, increased urination at night. Nocturia is small in volume - from 100 to 230 ml.
Decreases libido, potency. Symptoms do not occur in a crowd, singly, over a number of years. The capillaries are dilated, the face is pasty, with a red tint. The skin is flabby and dry, brittle nails, uneven. After 50 years, gingivitis, periodontal disease and caries join. Gums bleed, bad breath. A photo of initial stage diabetes (its symptoms) is presented below.
Often a foot and nail fungus or trophic ulcer develops. Heels become dry, with corns. Corns are easily inflamed and do not heal for a long time. Nails exfoliate, crumble, thicken and emit an unpleasant odor.
Symptoms can manifest itself even after 10 years. All organs are already worn out. Signs of type 2 diabetes do not appear in a whole bunch or avalanche, but even if one symptom appears, you need to be examined.
Diagnostics
Blood and urine tests are mandatory.
A biochemical blood test will indicate hidden pathologies. This type of analysis includes: all types of determination of glycemia, lipid spectrum (cholesterol, triglycerides are elevated for type 1 and obesity), lipoproteins (for type 1 they are normal, and for type 2 they are high in LDL), C-peptide.
Mandatory are consultations of narrow specialists - a neuropathologist, an ophthalmologist. The fundus is examined and an ECG is done.
In the capillary or venous blood, the amount of insulin, glycated Hg, fructosamine is determined.
Another of the main tests is urine testing for protein, sugar, acetone, and ketone bodies.
Possible complications of a sweet illness
The most dangerous complications include:
- diabetic coma;
- nephropathy;
- retinopathy
- increase in pressure;
- swelling
- polyneuropathy;
- macro- and microangiopathy;
- diabetic foot syndrome;
- trophic ulcers;
- gangrene up to amputation of limbs.
Treatment principles
Treatment for type 1 diabetes is insulin therapy, and for type 2 diabetes, diet and pill administration.
You can quickly lower blood sugar with PSSP tablets. They come in several forms:
- Based on sulfonylurea. Validity - 24 hours, they gradually reduce performance and do not allow sudden jumps. Improve the functioning of beta cells and reduce tissue insulin resistance. This group of drugs: Chlorpropamide, Tolazamide, Glibenclamide, Maninil, etc.
- Biguanides - used as an adjunct in type 2 diabetics, reducing insulin resistance of cells. These include: "Bagomet", "Metfogamma", "Glucophage", "Siofor" and others.
- Drugs that affect and slow down the absorption of carbohydrates: Acarbose, Guarem, Bayetta, Glucobay.
Preventive actions
Preventive measures include:
- normalization of weight;
- moderate exercise;
- balanced nutrition - the diet is selected only by a doctor;
- stress elimination;
- pressure control;
- regular sugar tests to control hyperglycemia;
- acquisition of a glucometer and regular measurement of blood glucose as prescribed by a doctor.
The task of the attending physician and the patient himself is not to get to the complications. The real danger comes precisely from them.