Diabetes is the general name for a group of chronic endocrine diseases. All ailments of this group have a common symptom – polyuria (increased urine production). But only diabetes is associated with an increase in the concentration of glucose in the blood.
Types of diabetes
The most common is diabetes mellitus – an endocrine disease caused by a violation of metabolic processes in the body. Its main symptom is hyperglycemia (high blood sugar) due to insulin deficiency. But there are other types:
- Central non-sugar. It is caused by a lack or resistance of the body to vasopressin, a peptide hormone of the hypothalamus responsible for maintaining fluid in the body.
- Nephrogenic non-sugar. It is characterized by a loss of the ability to concentrate urine. Hereditary is caused by genetic mutations, acquired – by kidney diseases or pathologies in the brain.
All these diseases are accompanied by a large loss of fluid and, as a result, a violation of mineral metabolism. Non-sugar species do not pose a threat to life, provided that the patient quenches thirst in a timely manner and in sufficient quantity.
What is diabetes
Diabetes is one of the most pressing global health problems. According to the World Health Organization (WHO), about 500 million people worldwide suffer from it.
This disease is characterized by multiple metabolic disorders:
- glucose regulation ;
- protein metabolism;
- carbohydrate metabolism;
- lipid metabolism;
- water-salt balance;
- mineral metabolism.
The main role in the development of pathology is played by insulin, a protein-peptide hormone of the pancreas. It is responsible for maintaining a normal level of glucose in the blood, ensuring its entry into tissue cells for their nutrition.
With diabetes, metabolic processes fail. Depending on the type of disease, either the pancreas does not produce enough insulin, or the body becomes unresponsive to it. As a result, glucose does not reach the cells, but accumulates in the blood. Tissues experience energy starvation.
Symptoms of Diabetes
Both types of the disease are characterized by frequent bouts of hunger, a constant feeling of thirst and frequent urination. These are all signs of hyperglycemia. This means that there is a lot of sugar in the patient’s blood. It should not be restricted in liquids to avoid dehydration.
Also, diabetes is accompanied by such symptoms:
- blurred vision;
- numbness of the limbs;
- increased sweating;
- increased fatigue;
- muscle weakness;
- long wound healing;
- skin itching.
In type 1 diabetes, bedwetting is possible. The second type is often manifested by black acanthosis – dark skin seals on the neck, armpits, groin, elbows.
Insulin inhibits the breakdown of adipose tissue. Therefore, patients with type 2 diabetes suffer from excess weight against the background of insulin resistance. The first type, on the contrary, can provoke rapid weight loss against the background of cellular starvation.
Types of Diabetes
Depending on the reason for which glucose transport is disturbed, the following types of diabetes are distinguished:
- SD of the first type. It is caused by a deficiency of insulin. The pancreas can not cope, so the patient must take drugs containing this hormone.
- SD of the second type. Its cause is insulin resistance. The hormone itself is sufficient in the body, but the cells are insensitive to it, so the transportation of glucose does not occur.
- Gestational diabetes. It develops during pregnancy in the absence of diabetes and threatens the health of the mother and child.
Separately, consider the pre-diabetic state, characterized by reduced glucose tolerance. On an empty stomach, sugar remains within the normal range, but after a load of glucose, a deviation is detected.
The mechanism of development of diabetes mellitus type 1
It is characterized by an absolute deficiency of insulin, that is, it is not enough to perform its function. This disease is diagnosed in children and adolescents, but not necessarily from birth. The main causes of such pancreatic dysfunction are the destruction of beta cells by the immune system. It happens gradually – before the first signs of the disease appear, it can take from several months to several years. In rare cases, type 1 diabetes develops by the age of 30. Because of this, it can be confused with the second type.
The reason for the destruction of beta cells lies in the genetic predisposition and the presence of autoantigens in the body. In rare cases, the destruction process is triggered by viruses (Coxsackie enterovirus, rubella or HIV).
Causes of type 2 diabetes
This type of disease is caused by insulin resistance that occurs in adulthood. The pancreas continues to produce the necessary hormone, but it does not work. In this case, one speaks of its relative deficit.
The body may perceive this as a lack of insulin (although in fact it is not) and produce it in excess of the norm. Then there is hyperinsulinemia and metabolic syndrome. Causes of insulin resistance can be:
- excess fat cells in the abdominal cavity;
- hypertonic disease;
- polycystic ovary syndrome (in women);
- other endocrine pathologies;
- taking certain medications, including combined oral contraceptives ( Diana and others)..
Insulin resistance is also physiological. This is common in teenagers, pregnant women and the elderly. Its short-term manifestations are in the second phase of the menstrual cycle and during sleep.
Diabetes and obesity
Scientists have identified a relationship between diabetes and overweight. On the one hand, insulin prevents the breakdown of fat, which makes losing weight almost impossible for a diabetic. On the other hand, obesity complicates the course of the disease:
- fat is deposited in the abdomen;
- the pancreas and liver are compressed;
- carbohydrate-lipid metabolism is disturbed;
- insulin production is activated;
- insulin sensitivity decreases.
Visceral (intra-abdominal) obesity can be the result of a sedentary lifestyle, an excess of androgens (male hormones), and can also be inherited. According to the standards of the World Organization of Gastroenterology, it is diagnosed with a waist circumference of more than 80 cm in women and more than 94 cm in men. The US National Cholesterol Education Program also focuses on the waist-to-hip ratio – more than 0.85 for women and more than 0.9 for men.
Diabetes mellitus and polycystic ovary syndrome
PCOS is the formation of multiple follicular cysts in the ovaries. Ovulation occurs rarely or stops altogether. Women with this diagnosis always have a history of hyperandrogenism (excess testosterone) and often insulin resistance.
Diabetes mellitus and polycystic ovary syndrome are interdependent. On the one hand, androgen excess contributes to visceral obesity, which ultimately leads to the development of insulin resistance and type 2 diabetes. On the other hand, hyperinsulinemia promotes an increase in the number of follicles and subsequently formed cysts. At the same time, excess insulin suppresses ovulation. It also inhibits the production of sex hormone-binding globulin, which is necessary for the “neutralization” of testosterone.
Who is at risk
Patients with overweight or polycystic ovary syndrome have a higher chance of developing diabetes. Also at risk are people:
- over 45 years old;
- having diabetic parents;
- suffering from arterial hypertension;
- leading a sedentary lifestyle;
- deprived of breastfeeding in childhood;
- eating a lot of simple carbohydrates and fats;
- smokers.
Reduced glucose tolerance is also a reason to closely monitor health. Diabetes may appear more than ten years after the diagnosis of prediabetes. In this case, the disease at the initial stage may not attract attention due to mild symptoms.
A blood glucose test should be taken at least once a year, more often for people at risk. According to WHO standards, the upper limit of normal is 6.1 mmol / l, the American Diabetes Association – 5.6 mmol / l.
Diagnosis
Higher than normal blood glucose results suggest diabetes. But to clarify the diagnosis, the endocrinologist will also prescribe:
- fasting glucose test;
- oral glucose tolerance test;
- blood chemistry;
- analysis for glycated hemoglobin (norm – no more than 6%);
- analysis for cholesterol (total, high density and low density lipoproteins);
- determination of the index of insulin resistance.
In addition to blood tests, urinalysis may be required. Doctors are interested in indicators of urea, uric acid, creatinine.
If there are indications, the patient should visit narrow specialists to prevent complications. Usually it is a cardiologist and an ophthalmologist.
Treatment of diabetes
Treatment methods depend on the type of disease. Although it is impossible to completely get rid of diabetes, it is quite possible to relieve symptoms and prevent complications.
According to WHO forecasts, in 10 years diabetes will become the seventh leading cause of death in the world’s population. Therefore, it is important to treat the disease in a timely manner and ensure the availability of medicines for patients.
For patients with type 1 diabetes, insulin is vital. Its analogues ( Humulin and others) should replenish the functions of beta cells. There are 3 types of drugs:
Type of drugs Peak action after administration How long does the effect last ?
Patients with type 2 diabetes rarely need insulin. They usually have more than they need. Treatment is reduced to taking drugs that lower blood sugar levels (for example, Siofor y), and lifestyle changes.
Possible Complications
Violation of carbohydrate metabolism, hyperglycemia and hyperinsulinemia are reflected in different organs. The main danger of diabetes is damage to micro- and macrovessels, many of which significantly reduce the quality of life and can even lead to death:
- diabetic retinopathy – aneurysms of the retinal capillaries, leading to its detachment;
- diabetic nephropathy – damage to the renal glomeruli, a complication of which is renal failure;
- diabetic neuropathy – damage to neurons, leading to dysfunction of the nerves (from pain to atrophy of the limbs);
- atherosclerosis leading to angina pectoris, myocardial infarction, stroke, or peripheral arterial disease.
The disease also suppresses the immune system, causes skin ulceration up to gangrene, deformity of the fingers, and numerous joint pathologies. Lack of treatment for lesions of peripheral arteries often results in amputation of the lower extremities and sepsis.
diabetic coma
20% of the causes of death in diabetic patients are due to diabetic coma. In this case, an emergency can cause both high blood sugar and low blood sugar.
There are 3 types of diabetic coma:
Type of coma Causes Characteristic features Ketoacidotic Acute need for insulin (including due to missed medication)
- Hyperglycemia
- Acidity
- Elevated levels of ketone bodies in the urine
Hyperosmolar ketoacidotic Insulin deficiency associated with dehydration
- Hyperglycemia
- Increased plasma osmolarity
- Increased sodium concentration without changing the acid-base balance
Hypoglycemic Insulin overdose or skipping meals
- Hypoglycemia
- Cell starvation
In all cases, patients require prompt medical attention. Most often it is provided in intensive care.