Diabetes mellitus is an endocrinological pathology accompanied by hyperglycemia syndrome (high blood glucose), which occurred due to insulin deficiency.This disease is accompanied by carbohydrate imbalance and other metabolic disorders in the body.
At the moment, diabetes mellitus is diagnosed in 10-15 % of the population of our planet.Cases of development of this disease in childhood have become more frequent, as a rule, after unreasonable antibiotic therapy, stress and viral infections.There is an annual increase in the number of patients with diabetes by 9-10%.Today, the number of patients with this disease exceeds 200 million people.Diabetes are diagnosed in both men and women.
Causes and mechanism for the development of diabetes
As a result of a violation of the synthesis and secretion of insulin by the beta-cells of the islets of Langerganes, there is a decrease in the level of insulin in the blood, which over time leads to absolute insulin deficiency.Relative insulin deficiency is also found, which may be the result of a decrease in insulin activity as a result of its increased connection with protein, intensive destruction of the liver enzymes, the prevalence of the effects of non -hormonal and hormonal antagonists of insulin (thyroid hormones, the adrenal cortex, glucagon, and unustericed fatty acids,Growth hormone), changes in insulin resistance of insulin -dependent tissues to insulin.
Insulin deficiency provokes disorders of protein, carbohydrate and fat metabolism in the body.The permeability of the glucose of cell membranes in muscle and adipose tissue is reduced, gluconeogenesis and glycogenolysis are enhanced, glucoseuria, hyperglycemia occurs, which are accompanied by polydipsy and polyuria.The decay is intensified and the formation of fats is reduced, which causes an increase in the level of ketone bodies in the blood (acetone-the condensation product of acetouxic acid, beta-oxyma and acetouxus acids).These phenomena cause a shift of the acid-base balance in the direction of acidosis, and also affect the increase in excretion of magnesium, sodium, potassium in urine and leads to renal dysfunction.
There may be a decrease in the alkaline reserve of blood to 25% about.carbon dioxide and a decrease in blood pH level to 7.2-7.0.
How type I diabetes develop
The causes of the development of diabetes have some differences, depending on the type of diabetes.For example, patients with type of diabetes, due to autoimmune aggression and viral infection, are expanded by beta cells in the body, as a result of which a deficiency develops with all the ensuing consequences.
How type II diabetes develop
Patients with the II type of diabetes have a sufficient amount of insulin, but the body tissues lose the opportunity to perceive its signal.With the development of obesity, adipose tissue acts as a kind of barrier that blocks the effect of insulin.In order to eliminate this barrier, the beta cells include the intensive mode of operation, which subsequently leads to their depletion and transition of relative insulin insufficiency to absolute.Nevertheless, insulin -dependent diabetes is not transformed into insulin -dependent.
Regardless of the etiological factor in the development of diabetes, the same process takes place in the slowdown of the transformation of sugar coming from the outside and available in the blood.
Classification of diabetes
Depending on the clinical features, the following types of diabetes are distinguished:
- I type of diabetes mellitus, which in turn has several subspecies:
- insulin -dependent diabetes;
- Insulin -dependent diabetes sugar:
- in people with obesity;
- In people with normal weight.
- diabetes, the cause of the development of which is insufficient nutrition;
- Other verification of type I diabetes associated with certain syndromes and body conditions:
- endocrine pathologies;
- insulin anomalies or its receptor;
- pancreatic diseases;
- certain genetic syndromes;
- conditions caused by the effects of chemicals or taking drugs;
- state of mixed etiological factors;
- II type of diabetes indicates a violation of glucose tolerance and is divided into such forms:
- in patients without excess weight;
- in people with obesity;
- caused by a certain state or syndrome.
- Type III diabetes can develop during pregnancy.
Separate static risk classes of this disease have been identified (patients with normal glucose tolerance, but a significant risk of diabetes):
- a state preceding a violation of glucose tolerance;
- Potential glucose tolerance disorders.
Essential (primary) type of diabetes
The essential (primary) type of diabetes mellitus, which has a connection with nutrition failure, is highlighted as a separate pathology.This disease occurs in people under the age of 30 years living in tropical countries.According to statistics, the ratio of men and women is 2: 1.The total number of patients with this form of diabetes is 20 million people.
Most often there are two subtypes of this diabetes.The first of them is fibrocalcular pancreatic diabetes.
Fibrocalcule pancreatic diabetes
Territorially, it mainly covers Indonesia, India, Brazil, Bangladesh, Uganda and Nigeria.This pathology is characterized by the presence of extensive pancreofibrosis and stone formation in the main duct of the pancreas.The clinical picture is represented by sharp weight loss, recurrent abdominal pain and other signs of insufficient nutrition.In this case, insulin therapy makes it possible to eliminate moderate and high glucosuria and hyperglycemia.One of the characteristic signs of this pathology is the lack of ketoacidosis, which is due to reduced production of insulin and the release of the glucagon by the islet apparatus of the pancreas.Topographic studies (ultrasound diagnostics, radiography, computed tomography) make it possible to determine the presence of stones in the ducts of the pancreas.
There is an opinion that one of the factors in the development of fibrocalcoretic diabetes is the inclusion of manioca roots (cassava, tapioka) in the diet, which contain cyanogenic glycosides, one of which is linamarin, from which cyanistoric acid is released during the hydrolysis.With the participation of sulfur -containing acids, its detrimental effects are eliminated, and insufficient intake of protein food, often found in the population of the above countries, provokes the accumulation of cyanide in the body, which is the cause of the development of fibrocalculosis.
Pancreatic diabetes
The development of pancreatic diabetes (type II diabetes) has a relationship with protein insufficiency in the body, but there are no manifestations of pancreatic fibrosis.It is characterized by moderate resistance to insulin and resistance to the development of ketoacidosis.In most cases, patients suffer from exhaustion.Patients have reduced secretion of insulin, but not to such a measure as in patients with type I diabetes, this explains the lack of ketoacidosis.
Subtype j
In the classification of diabetes, according to WHO data, which are presented above, there are no references to the third subtype of pancreatic diabetes, which is found on Jamaica, we are talking about the subtype J. The subtype J has much in common with pancreatic diabetes that occurs due to protein deficiency.
Symptoms of diabetes
The first symptoms of diabetes occur due to a high blood glucose content.After exceeding the level of 8.9–10.0, sugar enters urine.When continuing to increase the level of glucose in the blood, the kidneys additionally remove water, this is clinically manifested by rapid urination (polyuria).Excessive urine isolation causes a constant feeling of thirst (polydipsy).With urine, the body loses a large number of calories represented by glucose, so a person loses weight and constantly feels hunger.
Among other symptoms of diabetes, such as drowsiness, decreased visual acuity, fatigue and nausea are distinguished.In addition, patients with uncompensated diabetes are prone to infections.Patients of type I diabetes have a pronounced insulin deficiency and, because of this, almost always lose weight before the start of therapy.Patients with II type of diabetes do not lose weight of the body.
With type I diabetes disease, the rapid development of clinical manifestations occurs and soon it can progress to diabetic ketoacidosis.Regardless of the high level of glucose in the blood, the cells do not have the opportunity to use it without the presence of insulin, therefore they switch to other sources of energy.The destruction of fat cells begins, which provokes the formation of ketone bodies, which are toxic chemical compounds "acidifying" blood.
Diabetic ketoacidosis
The first symptoms of diabetic ketoacidosis are manifested in the form of excessive urination and excessive thirst, nausea, vomiting, fatigue, weight loss and abdominal pain (especially in childhood).Patients have frequent and deep breathing, which is associated with attempts by the body to neutralize the excessive acidity of the blood, this process is accompanied by the appearance of the smell of acetone from the mouth.In the absence of treatment, diabetic ketoacidosis can be complicated by the development of a coma, in some cases this process occurs within several hours.
Type I diabetes may be accompanied by the development of ketoacidosis even after the start of insulin therapy if the patient passes a planned injection or undergoes severe emotional overstrain, in particular during injury, severe infection or other serious illness.
Patients suffering from type II diabetes for a sufficiently long time may not feel any signs of this pathology.Such a hidden period of the disease can last up to several decades.Clinical manifestations are activated as insulin deficiency aggravates.
At first, the volume of the dedicated urine only slightly exceeds the norm, the thirst is weakly expressed, but over time, these processes progress.The phenomena of ketoacidosis are rare.With a significant increase in the level of glucose in the blood (in some cases, to 55 mmol/l), this usually happens with additional loads on the body, for example, under the influence of drugs or with severe infectious diseases, the patient can plunge into a state of confused consciousness, provoked by severe dehydration, the phenomena of seizures, drowsiness and the most severe cases are also likelyHyperglycemic hyperosmolar mate.
How else is diabetes mellitus manifest
The high level of glucose in the blood over time can lead to damage to nerves, blood vessels and other structures.Chemical compounds containing glucose are located on the walls of small blood vessels, as a result of which the walls of the vessels are thickened and damaged.The narrowing of the gaps of blood vessels causes the deterioration of blood flow, especially the blood supply to the skin and nerve endings.Without compensation for diabetes in the blood, an increase in the level of fatty substances occurs, which accelerates the development of atherosclerosis.Patients diagnosed with diabetes, regardless of gender, suffer from atherosclerosis 2-6 times more often compared to people who do not have this diagnosis.Violation of blood vessels in the blood circulation causes dysfunctions from the heart, kidneys, eyes, lower extremities, brain, skin and nerves, and also slows down the healing process of wounds.
What is the seriousness of diabetes mellitus
All these factors increase the risk of developing many distant complications.In patients with diabetes, the risk of strokes and heart attacks increases, as a result of damage to the blood vessels of the eyes, visinopathy loss (diabetic retinopathy) can occur, kidney disorders provoke renal failure, therefore, in some cases, dialysis is required.Damage to nerves can lead to many consequences.Mononeuropathy (impaired function of one nerve) can manifest itself by a sudden weakness of the upper or lower limb.Diabetic polyneuropathy (damage to the nerves of the legs, feet, or hands) causes sensitivity disorders, pain, burning or tingling, sensation of weakness in the arms and legs.The temperature and pain sensitivity decreases, which leads to increased trauma.Circulatory disorders can contribute to the appearance of ulcers and poor healing of wounds.The ulcers localized on the feet are very deep and poorly healing, which leads to infection and, in some cases, to amputation of the affected limb.
Clinical studies have shown that it is possible to avoid or expire of diabetes, if you constantly maintain a normal blood sugar.The course of this disease is currently not fully studied.There are a number of unexplored factors that cause its development, genetic ones include the number of these factors.
Diagnosis of diabetes
Diagnosis of diabetes begins with the collection of an anamnesis and examination of the patient.During these measures, the patient has the presence of hereditary factors, obesity, whether the patient belongs to the number of single -tie twins (if one of them suffers from diabetes mellitus, the second must be examined), women specify the presence of childbirth and whether a large fruit was specified.
The following is a number of laboratory tests, which consists of:
- blood tests for glucose levels are performed twice;
- glucose tolerance test;
- Determining the level of glucose in the daily urine.
With the diagnosis of diabetes mellitus, it is very important to find out the presence of complications; for this, all organs and systems are diagnosed.
Complications of diabetes
Complications of diabetes mellitus can be acute and chronic, they are also split depending on the form of diabetes.Among acute complications, coma states are distinguished, during which the loss of consciousness is preceded by disorders of the brain due to a very low or very high concentration of blood sugar.Such conditions include:
- diabetic ketoacitosis (the most common complication of an acute nature) is manifested by polyuria, polydipsy, lack of appetite, weakness, abdominal pain, nausea and vomiting;
- A hypoglycemic coma, is an extreme degree of hypoglycemia, occurs with a sharp decrease in the level of glucose in the blood.Often it is the result of the introduction of an irregular dose of insulin, and sometimes occurs after taking certain food or sulfanilamide.
- The hyperosmolar comic in the severity of the state outweighs the diabetic who, is mainly found in old people, with type II diabetes.In 30% of cases, the cause of the death of the patient becomes, and in the presence of severe concomitant pathologies - in 70%.
Chronic (late) complications are combined into a group of pathologies that develop with prolonged exposure to the high blood sugar on the organs and systems of the patient.First of all, the organs more sensitive to sugar are subject to damage, they are a kind of “target” for diabetes.Among the chronic complications of diabetes, the following are known:
- Diabetic retinopathy is observed in 90% of patients with diabetes.Develops with a long course of diabetes and is manifested by damage to the vessels of the eye retina;
- Diabetic nephropathy consists in the complex damage to the kidneys (tubules, arteries, glomeruli, arterioles).The prevalence among patients with diabetes is 75%;
- Diabetic neuropathy is represented by damage to the peripheral nerves in patients with diabetes.Neuropathy is a predisposing factor in the development of a diabetic foot, which can lead to an amputation of a limb;
- Diabetic encephalopathy is a damage to the brain, which is progressive.It is manifested by increased fatigue, a decrease in performance, impaired concentration of attention, emotional lability, squeezing headaches, anxiety and worsening of the thought process;
- Diabetic lesions of the skin are structural deformations of the epidermis, follicles, sweat glands due to a violation of carbohydrate metabolism and the accumulation of metabolism products.In the case of a severe form of diabetes, the skin becomes flaky, rough, with areas of homosopers, cracks, the skin acquire a yellowish tint, hair loss occurs;
- The syndrome of diabetic foot and brush occurs in 30-80% of patients with diabetes and is a complex of anatomical and functional disorders that appear in the form of brown spots and ulcerations on the lower leg, foot and phalanx of the fingers, which in severe cases can lead to amputation of the limb.
Treatment of diabetes
The treatment of diabetes depends on the type of disease, but first of all, the patient needs to normalize the level of glucose in the blood.To do this, you need to radically change your lifestyle and diet.A special diet is recommended for patients with diabetes, which is based on the calculation of the used carbohydrates, proteins and fats, vitamins and trace elements.This calculation is taught by specialists in this field.
The choice of tactics of drug therapy depends on the type of diabetes.Patients with type of diabetes are necessary to conduct insulin therapy, with type II it is shown to adhere to the strictest diet and use glucose -containing agents, with the ineffectiveness of tablet forms of drugs, insulin is prescribed.
Insulin is taken under strict control of the level of glucose in the blood.Insulin preparations according to the mechanism of action are divided into three types: prolonged, short and intermediate action.Sugar -containing drugs are indicated in the case of insulin -dependent diabetes mellitus in combination with diet.Sugar -containing drugs include: Biguanides, sulfonylmochevina, thiazolidindyons and meglitinides.
With this insidious ailment, it is very important for medical personnel to properly teach the patient and his relatives the skills of monitoring the condition of the patient and first aid in the case of pre -domestic and coma.
Prediction for diabetes mellitus
In the presence of diabetes mellitus, the patient is registered with the endocrinologist.In conditions of adequate therapy, the patient can be in satisfactory condition for a long time.To aggravate the prognosis regarding the state of health and life expectancy of a patient with diabetes mellitus can develop acute and chronic complications.
Prevention of diabetes
With type I diabetes, preventive measures are to increase the body's resistance to various infections and eliminate the toxic effects of antibodies on the pancreas.For patients with II, the type of diabetes is very important to adjust nutrition and prevent the development of obesity.To prevent the development of complications in conditions of diabetes, it is necessary to correctly and systematically comply with the doctor’s recommendations and clarify whether this or that food can be consumed.