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Types of diabetes

diabetes mellitus and its types

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

To date, it is impossible to eliminate the disease (completely eliminated).The destructive process in the body can be slowed down with drugs and dietary therapy, but it cannot be stopped and reversed.

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

The types of diabetes mellitus (DM) are defined by the World Health Organization and there are no major differences in the medical world.All types of diabetes are not contagious.

Types of pathology

There are several types of the disease combined with 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.Treatment methods used, gender and age of the patient are also taken into account.

Types of diabetes accepted in medicine:

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

Prediabetes is a borderline state of the body in which the glycemic level is increased (glucose tolerance is impaired), but the blood sugar level does not "reach" the generally accepted digital values that correspond 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, the trend of increasing the number of infection cases is clearly observed all over the world.In the last 20 years, the number of patients with type 2 diabetes has doubled.GDM accounts for about 5% of pregnancies.Specific types of diabetes are extremely rare and account for a small percentage in medical statistics.

By gender, NIDDM 2 is more common in premenopausal and menopausal women.This is due to the change in hormonal status and gaining extra pounds.The most common factor in the development of type 2 diabetes in men is chronic inflammation of the pancreas caused by the toxic effect of ethanol.

Insulin-dependent diabetes (type 1)

Type 1 diabetes is characterized by insufficient pancreatic cells.The body does not perform the endocrine (intrasecretory) function of producing insulin, the hormone responsible for supplying the body with glucose.Due to the accumulation of glucose in the blood, the organs, including the pancreas itself, do not receive adequate nutrition.

In order to imitate the natural production of the endocrine hormone, the patient is prescribed lifelong injections of medical insulins with different duration of action (short and long), as well as dietary therapy.Classification of type 1 diabetes mellitus is dictated by different etiologies of the disease.The insulin-dependent type of the disease has two causes: genetic and autoimmune.

Genetic cause

The formation of pathology is associated with the biological ability of the human body to transmit the characteristic signs and pathological deviations to subsequent generations.As for diabetes, a child inherits a predisposition to the disease from diabetic parents or close relatives.

It is important!The predisposition is hereditary, but not the disease itself.There is no 100% guarantee that a child will develop diabetes.

Autoimmune cause

The occurrence of the disease is caused by a functional deficiency of the immune system, which actively produces autoimmune antibodies that have a destructive effect on the cells of the body under the influence of negative factors.Triggers (impulse) for the initiation of autoimmune processes are:

  • unhealthy eating behavior combined with physical inactivity;
  • failure of metabolic processes (carbohydrate, lipid and protein);
  • critical lack of cholecalciferol and ergocalciferol (vitamin D) in the body;
  • chronic pancreatic pathologies;
  • history of parotitis (mumps), measles, Coxsackie herpes virus, Epstein-Barr virus, cytomegalovirus, viral hepatitis A, B, C;
  • distress (staying in a state of neuropsychological stress for a long time);
  • chronic alcoholism;
  • incorrect treatment with hormone-containing drugs.

IDDM develops in children, adolescents and adults under the age of thirty.The childhood variant of diabetes type 1a 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 progresses rapidly over several weeks or months.

Insulin resistant diabetes (type 2)

The difference between the second type of diabetes and the first 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 the lack of sensitivity to insulin - insulin resistance.Up to a certain point, treatment is carried out through hypoglycemic (sugar-lowering) drugs and dietary therapy.

To compensate for the imbalance in the body, the pancreas activates hormone production.The organ working in emergency mode wears out over time and loses its intrasecretory function.Type 2 diabetes is insulin dependent.Decreased or lost sensitivity of cells to endogenous hormones is primarily associated with obesity, which disrupts fat and carbohydrate metabolism.

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

  • alcohol abuse;
  • gastronomic addiction to sweet foods;
  • chronic diseases of the pancreas;
  • pathologies of the heart and vascular system;
  • overeating against the background of a sedentary lifestyle;
  • incorrect hormone therapy;
  • complicated pregnancy;
  • Unfavorable heredity (diabetes in parents);
  • distress.

The disease develops mostly in women and men over 40 years of age.At the same time, type 2 diabetes is latent and may not show obvious symptoms for several years.Checking your blood glucose levels early can detect prediabetes.With adequate treatment, the prediabetic condition can be reversed.If time is lost, it progresses and NIDDM is diagnosed later.

Lada diabetes

In medicine, the term "Diabetes 1.5" or Lada diabetes is used.It is an autoimmune disease of hormone production and metabolic deficiency that occurs in adults (age 25+).The disease combines the first and second type of diabetes.The mechanism of development corresponds to IDDM, the latent course and manifestation of symptoms are similar to NIDDM.

Triggers for the development of pathology are autoimmune diseases in the patient's history:

  • non-infectious inflammation of 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;
  • skin discoloration (loss of pigment) (vitiligo);
  • inflammatory pathology of the colon mucosa (ulcerative colitis);
  • chronic damage to connective tissue and exocrine glands (Sjögren's syndrome).

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

Gestational form of the disease

GDM is a specific type of diabetes that develops in women in the second half of the perinatal period.The disease is most often detected during the second scheduled screening, when the expectant mother undergoes a complete examination.The main characteristic 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 connection of three main reasons:

  • Hormonal changes.During pregnancy, the synthesis of progesterone (steroid sex hormone) increases, inhibiting insulin production.Moreover, the endocrine hormones of the placenta, which inhibit the production of insulin, are strengthened.
  • Double the load on the female body.The body requires an increased amount of glucose to provide adequate nutrition for the unborn child.A woman begins to consume more monosaccharides, which causes the pancreas to synthesize more insulin.
  • An increase in body weight due to a decrease in physical activity.Because the cells refuse to accept insulin due to obesity and physical inactivity, glucose, which enters the body in large quantities, accumulates in the blood.In such a situation, the future mother and fetus experience nutritional deficiency and energy starvation.

Unlike type 1 and type 2 diabetes, gestational diabetes is a reversible process, because insulin molecules and the functionality of the pancreas are preserved.

Correctly selected therapeutic tactics guarantee the elimination of pathology after childbirth in 85% of cases.The main method of treatment of GDM is "Table No. 9" diet for diabetic patients.In difficult cases, medical insulin injections are used.Antihyperglycemic drugs are not used because they have a teratogenic effect on the fetus.

Additionally

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

  • pancreatic diseases: pancreatitis, hemochromatosis, tumor, cystic fibrosis, mechanical injuries and operations on the gland;
  • functional deficiency of the anterior pituitary gland (acromegaly);
  • increased synthesis of thyroid hormones (thyrotoxicosis);
  • hypothalamo-pituitary-adrenal pathology (Itsenko-Cushing syndrome);
  • tumors of the adrenal cortex (aldosteroma, pheochromocytoma, etc.).

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

Diagnostic measures

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

  • A general clinical blood test to identify latent inflammatory processes in the body.
  • Blood test for glucose content (capillary or venous).This is strictly done on an empty stomach.
  • GTT (glucose tolerance test).It is performed 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 at the rate of 200 ml of water per 75 g.ingredients.
  • HbA1C analysis for the level of glycosylated (glycosylated) hemoglobin.Based on the results of the study, the blood sugar levels in the last three months are evaluated retrospectively.
  • Biochemistry of blood.Liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (ALP), bilirubin (bile pigment) and cholesterol levels are 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 Between 6 and 6.4%
diabetes >7.1 >11.1 More than 6.5%

In addition to blood microscopy, a general urine test is also examined to determine the presence of glucose in the urine (glycosuria).In healthy people, there is no sugar in the urine (the acceptable norm for diabetics is 0.061 - 0.083 mmol/l).A Rehberg test is also performed to detect 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).

Results

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), gestational (GDM in pregnant women), specific (DM includes several types of diseases caused by genetic defects or chronic pathologies).Gestational diabetes that develops in the perinatal period can be treated.The condition of prediabetes (impaired glucose tolerance) is considered reversible if diagnosed early.