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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 the hormonal level and metabolic disorders.

To this day, the disease cannot be eradicated (completely eliminated).The destructive process in the body can be slowed down with drugs and dietary therapy, but it is impossible to stop it and start it in the opposite direction.

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

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

Typing of pathology

There are several types of diseases, which are united by one main symptom - an increased concentration of glucose in the blood.The classification of diabetes mellitus is determined by the causes of its occurrence.The treatment methods used, gender and age of the patient are also taken into account.

Types of diabetes accepted in medicine:

  • the first type is insulin-dependent (IDDM 1), or juvenile;
  • the second is non-insulin dependent (NIDDM 2) or insulin resistant;
  • gestational diabetes mellitus (GDM) during the perinatal period in women;
  • other specific types of diabetes, including:
  • damage to the β-cells of the pancreas at the genetic level (variants of MODY diabetes);
  • pathologies of the exocrine function of the pancreas;
  • hereditary and acquired pathologies of exocrine glands and their functions (endocrinopathy);
  • pharmacologically induced diabetes;
  • diabetes as a consequence of 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 when the level of glycemia is increased (impaired glucose tolerance), 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 endocrinologists' patients suffer from another type of disease.

According to medical statistics, there is a clear trend of an increase in the number of cases worldwide.In the past 20 years, the number of type 2 diabetics has doubled.GDM accounts for about 5% of pregnancies.Types of specific diabetes are extremely rare and occupy a small percentage in medical statistics.

According to gender, NIDDM 2 is more common in premenopausal and menopausal women.This is due to changes in hormonal status and weight gain.In men, the most common factor in the development of type 2 diabetes is chronic inflammation of the pancreas caused by the toxic effects of ethanol.

Insulin-dependent diabetes (type 1)

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

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

Genetic cause

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

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

Autoimmune cause

The appearance of the disease is caused by the 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 body's cells.Triggers (stimulus) for starting autoimmune processes are:

  • unhealthy eating behavior combined with physical inactivity;
  • failure of metabolic processes (carbohydrates, lipids and proteins);
  • critical lack of cholecalciferol and ergocalciferol (vitamin D) in the body;
  • pancreatic pathologies of a chronic nature;
  • history of mumps (mumps), measles, Coxsackie herpes virus, Epstein-Barr virus, cytomegalovirus, viral hepatitis A, B, C;
  • distress (long-term stay in a state of neuropsychological stress);
  • chronic alcoholism;
  • improper treatment with drugs containing hormones.

IDDM develops in children, adolescents and adults under the age of thirty.Childhood variant 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 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 their insensitivity to insulin - insulin resistance.Up to a certain point, treatment is carried out through hypoglycemia (sugar-lowering drugs) and diet therapy.

In order to compensate for the imbalance in the body, the pancreas activates the production of hormones.Working in emergency mode, the organ wears out over time and loses its intrasecretory function.Type 2 diabetes becomes insulin dependent.Decrease or loss of cell sensitivity to endogenous hormone is primarily associated with obesity, which disrupts fat and carbohydrate metabolism.

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

  • alcohol abuse;
  • gastronomic addiction to sweet dishes;
  • chronic pancreatic diseases;
  • pathologies of the heart and vascular system;
  • excess in nutrition against the background of a sedentary lifestyle;
  • improper hormone therapy;
  • complicated pregnancy;
  • Unfavorable heredity (diabetes in parents);
  • distress.

The disease most often develops in women and men older than 40 years.At the same time, type 2 diabetes is latent and may not show pronounced symptoms for several years.Early testing of blood glucose levels can detect prediabetes.With adequate therapy, the prediabetic condition is reversible.If time is lost, it progresses and NIDDM is subsequently diagnosed.

Lada diabetes

In medicine, the term "diabetes 1.5" or the name Lada diabetes is used.This is an autoimmune disorder of hormone production and metabolic failure that occurs in adults (aged 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;
  • discoloration (loss of pigment) of the skin (vitiligo);
  • inflammatory pathology of the colon mucosa (ulcerative colitis);
  • chronic damage to connective tissue and exocrine glands (Sjögren's syndrome).

In combination with a hereditary predisposition, autoimmune disorders lead to the progression of Lada diabetes.To identify the disease, basic diagnostic methods are used, as well as blood microscopy, which determines the concentration of immunoglobulin class IgG to antigens - ELISA (enzyme immunosorbent assay).Therapy is carried out through regular insulin injections and dietary 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 feature 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 correlation of three main reasons:

  • Hormonal changes.During pregnancy, the synthesis of progesterone (steroid sex hormone) increases, blocking the production of insulin.In addition, the endocrine hormones of the placenta, which tend to inhibit insulin production, become stronger.
  • Double the load on the female body.In order to ensure adequate nutrition of the unborn child, the body needs an increased amount of glucose.A woman begins to consume more monosaccharides, which causes the pancreas to synthesize more insulin.
  • Weight gain due to reduced physical activity.Glucose, which enters the body in abundance, accumulates in the blood because cells refuse to accept insulin due to obesity and physical inactivity.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 the insulin molecules and the functionality of the pancreas are preserved.

Correctly selected therapeutic tactics guarantee the removal of pathology after childbirth in 85% of cases.The main method of treating GDM is the "Table No. 9" diet for diabetics.In severe cases, medical insulin injections are used.Antihyperglycemic drugs are not used because of their teratogenic effects on the fetus.

Additionally

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

  • diseases of the pancreas: pancreatitis, hemochromatosis, tumor, cystic fibrosis, mechanical injuries and operations on the gland;
  • functional failure of the anterior pituitary gland (acromegaly);
  • increased synthesis of thyroid hormones (thyrotoxicosis);
  • hypothalamic-pituitary-adrenal pathology (Itsenko-Cushing's syndrome);
  • adrenal cortex tumors (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

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

  • A general clinical blood test to identify hidden inflammatory processes in the body.
  • Blood test (capillary or venous) for glucose content.It is done strictly on an empty stomach.
  • GTT (glucose tolerance testing).It is performed to determine the body's ability to absorb glucose.The tolerance test is a double blood draw: on an empty stomach and two hours after a "glucose load", which is an aqueous solution of glucose prepared in a ratio of 200 ml of water to 75 g.substances.
  • HbA1C analysis for the level of glycosylated (glycated) hemoglobin.Based on the results of the study, retrospective blood sugar levels over the past three months are evaluated.
  • Blood biochemistry.Liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (ALP), bilirubin (bile pigment) and cholesterol levels are assessed.
  • 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
the norm 3.3 - 5.5 < 7.8 ⩽ 6%
prediabetes 5.6 – 6.9 7.8 – 11.0 from 6 to 6.4%
diabetes >7.1 >11.1 More than 6.5%

In addition to blood microscopy, a general urine test is performed to determine the presence of glucose in the urine (glycosuria).In healthy people, there is no sugar in the urine (for diabetics, the acceptable norm is 0.061 - 0.083 mmol/l).The Rehberg test is also performed to detect protein albumin and creatinine, a product of protein metabolism in the urine.In addition, hardware diagnostics are also prescribed, including ECG (electrocardiogram) and ultrasound of the abdominal cavity (with kidneys).

The 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-independent (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 is curable.The condition of prediabetes (impaired glucose tolerance) is considered reversible if diagnosed early.