Types of diabetes

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

To date, the disease is not amenable to eradication (complete elimination). The destructive process in the body can be slowed down by drugs and diet therapy, but it is impossible to stop and start it in the opposite direction.

Types of diabetes mellitus (DM) are defined by the World Health Organization and have no fundamental differences throughout the medical world. Diabetes mellitus of any kind is not a contagious disease.

Diabetes mellitus can be of several types, as well as several types. Since the treatment for each species and type is different, it is necessary to know which particular variant of the disease has manifested itself.

Pathology typing

There are several types of the disease, united by one main symptom - an increased concentration of glucose in the blood. The typing of diabetes mellitus is due to the causes of its onset. There are also applied methods of therapy, gender and age of the patient.

Medically accepted types of diabetes:

• the first type is insulin dependent (IDDM 1) or juvenile;
• the second is insulin-independent (INZDM 2) or insulin-resistant;
• gestational diabetes mellitus (GDM) in the perinatal period in women;
• other specific types of diabetes, including:
• damage to β cells of the pancreas at the genetic level (MODY-diabetes variety);
• pathology of the exocrine function of the pancreas;
• hereditary and acquired pathologies of the glands of external secretion and their functions (endocrinopathy);
• pharmacologically determined diabetes;
• diabetes as a result of congenital infections;
• DM associated with genomic diseases and hereditary defects;
• altered blood sugar (blood sugar) on an empty stomach and impaired glucose tolerance.

Prediabetes is a borderline state of the body, when the blood sugar level is changed upwards (glucose tolerance is reduced), however, blood sugar indicators "do not reach" the generally accepted digital values corresponding to true diabetes . According to the World Health Organization (WHO 2014), over 90% of endocrinological patients suffer from the second type of disease.

According to medical statistics, there is a clear trend of increasing the number of cases around the world. Over the past 20 years, the number of type 2 diabetics has doubled. GDM accounts for about 5% of pregnancies. Specific types of diabetes are extremely rare and occupy a small percentage of medical statistics.

By gender, NIDDM 2 is more common in premenopausal and postmenopausal women. This is due to a change in hormonal status and a number of extra pounds. In men, the most common factor in the development of type 2 diabetes is chronic inflammation of the pancreas due to the toxic effects of ethanol.

Insulin dependent diabetes (type 1)

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

To mimic the natural production of endocrine hormone, the patient is given lifelong injections of medical insulin with different durations of action (short and long), as well as diet therapy. The classification of type 1 diabetes mellitus is dictated by the various 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 characteristic of the human body to transmit its pathological characteristics and anomalies to subsequent generations. In connection with diabetes, a child inherits a predisposition to the disease from parents or close relatives with diabetes.

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

autoimmune cause

The onset of the disease is due to a functional failure of the immune system, when, under the influence of negative factors, it actively produces autoimmune antibodies that have a destructive effect on the cells of the body. The (push) triggers for initiating autoimmune processes are:

• unhealthy eating behavior combined with physical inactivity;
• failure of metabolic processes (carbohydrates, lipids and proteins);
• critical deficiency in the body of cholecalciferol and ergocalciferol (vitamins of group D);
• pathology of the pancreas of a chronic nature;
• a history of mumps (mumps), measles, Coxsackie's herpes virus, Epstein-Barr virus, cytomegalovirus, viral hepatitis A, B, C;
• distress (prolonged stay in a state of neuropsychological stress);
• chronic alcoholism;
• incorrect treatment with hormone-containing drugs.

IDDM occurs in children, adolescents, and adults under the age of thirty. The childhood variant of the development 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 in an accelerated fashion within a few weeks or months.

Insulin resistant diabetes (type 2)

The difference between type 2 and type 1 diabetes is that the pancreas doesn't 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 insulin sensitivity - insulin resistance. To a certain extent, treatment is done through hypoglycemic (sugar-lowering) drugs and diet therapy.

To compensate for the imbalance in the body, the pancreas activates the production of the hormone. Working in emergency mode, the organ wears out over time and loses its intrasecretory function. Type 2 diabetes becomes insulin dependent. The decrease or loss of cellular susceptibility to the endogenous hormone is mainly associated with obesity, in which the metabolism of fats and carbohydrates is disturbed.

This is especially true of visceral obesity (deposition of fat around internal organs). In addition, with excess body weight, blood flow becomes difficult due to the numerous cholesterol plaques within the vessels, which are formed during hypercholesterolemia, which always accompanies obesity. The cells of the body, therefore, are deficient in nutritional and energy resources. Other factors that influence the development of NIDDM include:

• alcohol abuse;
• gastronomic dependence on sweet dishes;
• chronic diseases of the pancreas;
• pathology of the heart and vascular system;
• excesses in food against the background of a sedentary lifestyle;
• incorrect hormone therapy;
• complicated pregnancy;
• dysfunctional inheritance (diabetes in parents);
• distress.

Most often, the disease develops in women and men over the age of 40. At the same time, type 2 diabetes is latent and may not show severe symptoms for several years. Timely tests for blood glucose levels can detect prediabetes. With adequate therapy, the pre-diabetic state is reversible. If time is wasted, it advances and NIDDM is subsequently diagnosed.

Lada's diabetes

In medicine we find the term "Diabetes 1. 5", or the name Lada diabetes. This is an autoimmune disease in the production of hormones and the failure of metabolic processes that occurs in adults (over the age of 25). The disease combines the first and second types of diabetes. The development mechanism corresponds to the IDDM, the latent course and the manifestation of symptoms are similar to the NIDDM.

Triggers for the development of pathology are autoimmune diseases 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 colon mucosa (ulcerative colitis);
• chronic damage to connective tissue and external secretion glands (Sjogren's syndrome).

Combined with hereditary predisposition, autoimmune disorders lead to the progression of Lada's diabetes. To detect the disease, basic diagnostic methods and blood microscopy are used, which determines the concentration of IgG class immunoglobulins on antigens - ELISA (enzyme immunoassay). Therapy is done through 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 routine screening, when the expectant mother is undergoing a comprehensive examination. The main feature of GDM that is similar to type 2 diabetes is insulin resistance. The cells of the body of a pregnant woman lose sensitivity (sensitivity) to insulin due to the correlation of three main reasons:

• Hormonal reorganization. During the gestation period, the synthesis of progesterone (a steroid sex hormone) increases, blocking the production of insulin. Additionally, the placenta's endocrine hormones, which tend to inhibit insulin production, are gaining strength.
• Double load on the female body. To provide adequate nutrition for the unborn child, the body requires an increased amount of glucose. A woman begins to consume more monosaccharides, which causes the pancreas to synthesize more insulin.
• An increase in body weight against the background of a decrease in physical activity. Glucose, abundantly supplied to the body, accumulates in the blood, as cells refuse to take insulin due to obesity and physical inactivity. The expectant mother and fetus in this situation experience nutritional deficiencies and energy hunger.

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

Appropriately selected therapeutic tactics guarantee the elimination of the pathology after childbirth in 85% of cases. The main method of treatment of GDM is the diabetic diet "Table No. 9". In difficult cases, medical insulin injections are used. Hypoglycemic drugs are not used due to their teratogenic effects on the fetus.

Furthermore

Specific types of diabetes are genetically determined (MODY-diabetes, some types of endocrinopathies) or caused by other chronic diseases:

• diseases of the pancreas: pancreatitis, hemochromatosis, tumor, cystic fibrosis, mechanical trauma and gland surgery;
• functional insufficiency of the anterior pituitary gland (acromegaly);
• increased synthesis of thyroid hormones (thyrotoxicosis);
• hypothalamic-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 the hypothalamic hormone vasopressin, which regulates the fluid balance in the body.

Diagnostic measures

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

• General clinical blood test to detect hidden inflammatory processes in the body.
• Blood test (capillary or venous) for glucose content. Strictly produced 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 double blood sampling: on an empty stomach and two hours after the "glucose load", which is an aqueous solution of glucose prepared in a ratio of 200 ml of water per 75 g. substances.
• HbA1C analysis for the level of glycosylated (glycated) hemoglobin. Based on the study results, a retrospective of blood sugar levels over the past three months is evaluated.
• Blood biochemistry. Indicators of liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (AP), bilirubin (bile pigment), cholesterol levels are evaluated.
• A blood test for the concentration of antibodies against glutamate decarboxylase (GAD antibodies) determines the type of diabetes mellitus.

Glycemic reference values and disease indicators

Analyses	For the sugar	Glucose tolerance test	Glycated hemoglobin
norm	3. 3 - 5. 5	< 7. 8	⩽ 6%
prediabetes	5. 6 - 6. 9	7. 8 - 11. 0	6 to 6, 4%
diabetes	>7. 1	>11. 1	Over 6. 5%

In addition to blood microscopy, a general urinalysis is examined for the presence of glucose in the urine (glycosuria). In healthy people, there is no sugar in the urine (for diabetics, 0. 06 - 0. 083 mmol / l is considered an acceptable norm). A Reberg test is also done to detect albumin protein and a protein metabolism product of creatinine in the urine. In addition, hardware diagnostics are prescribed, including an ECG (electrocardiogram) and an 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 (IDDM type 1), non-insulin-dependent (NIDDM type 2), gestational (GDM gravida), specific ( DM includes several types of diseases caused by genetic defects or chronic diseases). Gestational diabetes, formed in the perinatal period, is treatable. Prediabetes (impaired glucose tolerance) is considered reversible if diagnosed early.