Diabetes mellitus

Diabetes mellitus is a chronic endocrine disease in which the level of glucose (sugar) in the blood increases significantly.

Glucose is the main source of energy for humans, it comes from food and is necessary for the proper functioning of tissues and organs. Insulin, a hormone produced by the pancreas, helps glucose enter the cells and acts as a "key" that opens the cell "door". Diabetes develops when the pancreas does not produce enough hormones or when the body cannot use them effectively.

There is no cure for the disease, but it can be managed with medication. Uncontrolled or poorly controlled diabetes is associated with serious health consequences - complications: damage to tissues and organs, including the heart, kidneys (nephropathy), eyes (retinopathy), ears (hearing loss) and nerves (diabetic neuropathy); limb amputation (diabetic foot), Alzheimer's disease, depression, dental diseases.

The diabetes mellitus group includes several endocrine diseases (or metabolic disorders): type I diabetes, type II diabetes, gestational diabetes (develops only during pregnancy). Prediabetes is an early disorder of carbohydrate metabolism (blood sugar levels are higher than normal, but not high enough to be classified as diabetes) and, if left unchecked, can eventually develop into type II diabetes. Prediabetes and gestational diabetes are considered potentially reversible conditions.

Less common types of diabetes include:

• monogenic diabetes (MODY, Maturity-Onset Diabetes of Young) is a genetically determined diabetes caused by mutations in different genes. MODY accounts for up to 4% of all diabetes cases;
• diabetes associated with cystic fibrosis (cystic fibrosis), a form of diabetes that is common in people with this disease;
• drug or chemical diabetes - occurs after organ transplantation, during the treatment of HIV/AIDS or during therapy with glucocorticosteroids.

Diabetes insipidus is a rare (treatable) disease in which the body produces too much urine (polyuria). It is caused by insufficient secretion of antidiuretic hormone (ADH) or insufficient sensitivity of the kidneys to it.

As of 2019, the worldwide prevalence of diabetes is 463 million cases. The number of patients with this disease is expected to increase to 578 million by 2030 and 700 million by 2045 (25% and 51% increase, respectively). Also in 2019, diabetes was the ninth leading cause of death, with 1. 5 million deaths directly attributable.

Reasons

Type I diabetes is an autoimmune disease in which the body's immune system attacks the cells of the pancreas that produce insulin, resulting in an absolute deficiency. The disease occurs most often in children, but it can develop at any age. The exact cause is unknown, but a combination of factors: genetic predisposition and environmental factors (not fully defined) are thought to play a major role. Type 1 diabetes patients must compensate for the lack of insulin on a daily basis, so it is called insulin-dependent diabetes.

Type II diabetes - the most common type of disease, "insulin resistant" - is associated with impaired glucose absorption: the transport of insulin and glucose into cells is impaired, which leads to hyperglycemia (increased blood glucose levels). Strictly speaking, type II diabetes occurs for two related reasons: the pancreas does not produce the normal amount of insulin to regulate blood sugar levels, and the cells (fat, muscles, liver) become resistant to it and do not take in enough glucose. It is not entirely clear why this happens, but it is known that the main role in the occurrence of the disease is played by genetic predisposition (a person's own gene variants, type II diabetes in the family), excess weight and a sedentary lifestyle. (However, not all people with type II diabetes are overweight). The disease can develop at any age (even in childhood), but most often occurs in middle-aged and elderly people.

Gestational diabetes occurs in women during pregnancy (diabetes insipidus) due to insulin resistance or a decrease in the production of this hormone. It is also characterized by hyperglycemia. The symptoms of the disease may be minor, but with HD, the mother is at increased risk of preeclampsia, depression, and cesarean section, and the baby is at increased risk of hypoglycemia (low blood sugar), jaundice, and high birth weight. In addition, the child has a higher risk of developing overweight and type II diabetes in the long term.

Risk factors

Factors that increase your risk of developing diabetes vary depending on the type of diabetes.

Risk factors for type I diabetes include:

• Family history of type I diabetes (close relatives have the disease - parents, brothers, sisters);
• damage to the pancreas (infections, tumors, surgical interventions);
• the presence of autoantibodies;
• physical stress (illness, surgery);
• diseases caused by viruses.

Risk factors for type II diabetes (and prediabetes) include:

• family history of type II diabetes;
• ethnicity (African Americans, Hispanics, and other ethnic groups have a higher risk);
• overweight;
• high blood pressure;
• low HDL, high triglycerides;
• sedentary lifestyle;
• gestational diabetes;
• polycystic ovary syndrome;
• history of heart disease, stroke;
• cigarettes.

Risk factors for gestational diabetes include:

• family history of prediabetes or type II diabetes;
• overweight;
• ethnicity (African Americans, Hispanics, and other ethnic groups have a higher risk);
• GD's personal history;
• age above 25 years.

Symptoms

Symptoms of type I diabetes:

• strong thirst;
• frequent urination;
• blurred vision;
• fatigue;
• unexplained weight loss.

Symptoms appear quite quickly - within a few days / weeks from the onset of the disease. Sometimes they talk about the development of a life-threatening condition - diabetic ketoacidosis, which requires emergency care. Its symptoms: breath acetone smell, dry skin, redness, nausea, vomiting, abdominal pain, difficulty breathing, impaired concentration and attention.

Symptoms of type II diabetes:

• strong thirst;
• frequent urination;
• fatigue;
• blurred vision;
• numbness in areas of the body, tingling in the arms or legs;
• slow-healing or non-healing ulcers;
• frequent infections (gums, skin, vaginal);
• unexplained weight loss.

Symptoms develop slowly, over several years, and can be mild, so a person does not pay attention to them. Many people do not have symptoms characteristic of diabetes and do not seek medical attention immediately.

With gestational diabetes, the signs and symptoms typical of diabetes are often absent. It is worth paying attention to increased thirst and frequent urination.

Diagnostics

The main method of diagnosis of type I and II diabetes is to determine the level of glucose in the blood. Your doctor may suggest one of these tests:

• analysis of fasting glucose level - after 8-12 hours of fasting;
• analysis for glycated hemoglobin - at any time, shows the average level of blood sugar over the past two to three months, measures the percentage of blood sugar associated with hemoglobin;
• random glucose test - a blood sugar level of 200 mg/dL - 11. 1 mmol/L or higher at any time, regardless of food intake, indicates diabetes;
• oral glucose tolerance test - the measurement is performed on an empty stomach, then you are asked to drink a glass of water with glucose dissolved in it, the measurement is repeated after 1 and 2 hours.

If type I diabetes is suspected, the blood is additionally checked for the presence of autoantibodies. To diagnose gestational diabetes, a fasting blood glucose test is performed, and the diagnosis is confirmed by an oral glucose tolerance test.

A patient diagnosed with diabetes may require consultation with doctors of relevant specialties: ophthalmologist, cardiologist, urologist, nephrologist, psychotherapist and others.

Treatment of diabetes

Treatment - blood sugar level monitoring, insulin therapy, drug treatment with glucose-lowering drugs - depends on the type of diabetes. This is complemented by proper nutrition, maintaining a normal weight and regular physical activity.

Treatment of type 1 diabetes includes insulin therapy (insulin injections or use of an insulin pump), frequent blood glucose testing, and carbohydrate counting; Type II diabetes - primarily lifestyle changes (weight loss, physical activity, healthy eating), control of blood sugar, cholesterol and blood pressure, hypoglycemic drugs, insulin therapy.

Treatment of gestational diabetes mainly involves adjusting the diet, ensuring regular physical activity and careful monitoring of blood sugar levels; Insulin therapy is prescribed only in some cases.

If prediabetes is diagnosed, it is very important to follow a healthy lifestyle, eat right and normalize weight. Exercising (at least 150 minutes per week) and losing just 7% of your body weight can help prevent or at least delay the development of type 2 diabetes. If you are still at high risk of transitioning from prediabetes to diabetes, have chronic diseases (cardiovascular, non-alcoholic fatty liver disease, polycystic ovary syndrome), your doctor may prescribe glucose-lowering drugs, cholesterol-controlling drugs, and antihypertensive drugs. .