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 tissues and organs to function properly. Insulin, a hormone produced by the pancreas, helps glucose enter cells and acts as a "key" that opens the cellular "door. "When the pancreas does not produce enough of the hormone, or the body cannot use it effectively, diabetes develops.

The disease has no cure, but it can be controlled with medications. 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 amputations (diabetic foot), Alzheimer's disease, depression, dental diseases.

The group of diabetes mellitus 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), which, if left unchecked, can eventually transform 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 the Young, adult-type diabetes in the young) is a genetically determined diabetes caused by mutations in various genes. MODY accounts for up to 4% of all diabetes cases;
• diabetes associated with cystic fibrosis (cystic fibrosis), a form of diabetes 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 a lot of urine (polyuria). It is caused by insufficient secretion of antidiuretic hormone (ADH) or insufficient susceptibility of the kidneys to it.

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

Reasons

Type I diabetes is an autoimmune disease in which the body's immune system attacks and destroys the cells of the pancreas that produce insulin, resulting in an absolute deficiency. The disease most often occurs in children, but can develop at any age. The exact cause is unknown, but a combination of factors: genetic predisposition and environmental factors (not fully determined) are thought to play a key role. Patients with type 1 diabetes need to make up for insulin deficiency daily, which is why 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 disrupted, which causes hyperglycemia (increased blood glucose levels). Strictly speaking, type II diabetes occurs for two interrelated reasons: the pancreas does not produce the normal amount of insulin to regulate blood sugar levels, and cells (fat, muscles, liver) become resistant to it and do not receive enough glucose. Why this happens is not entirely clear, but it is known that a key role in the occurrence of the disease is played by genetic predisposition (a person’s own gene variants, family history of type II diabetes), excess weight, and a sedentary lifestyle (however, not all people with type II diabetes are overweight). weight). The disease can develop at any age (even in childhood), but most often it occurs in middle-aged and elderly people.

Gestational diabetes occurs in women (without diabetes) during pregnancy due to insulin resistance or decreased production of this hormone. It is also characterized by hyperglycemia. Symptoms of the disease may be minor, but with HD, the mother increases the risk of preeclampsia, depression and cesarean section, and the baby increases the risk of hypoglycemia (low blood sugar), jaundice, and high birth weight. In addition, in the long term, the child is at higher risk of being overweight and developing type II diabetes.

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);
• 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;
• heart disease, history of stroke;
• smoking.

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);
• personal history of GD;
• age over 25 years.

Symptoms

Symptoms of type I diabetes:

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

Symptoms appear fairly 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 signs: the smell of acetone from the mouth, dry skin, flushing, 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 may be mild, so a person does not pay attention to them. Many people do not have symptoms characteristic of diabetes and do not consult a doctor promptly.

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

Diagnostics

The main method for diagnosing type I and II diabetes is to determine blood glucose levels. Your doctor may suggest one of these tests:

• analysis of fasting glucose levels - after 8-12 hours of fasting;
• analysis for glycated hemoglobin - at any time, shows the average blood sugar level over the past two to three months, measures the percentage of blood sugar associated with hemoglobin;
• random glucose test - at any time, regardless of food intake, a blood sugar level of 200 mg/dL - 11. 1 mmol/L or higher indicates diabetes;
• oral glucose tolerance test - the measurement is carried out 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 tested for the presence of autoantibodies. To diagnose gestational diabetes, a fasting blood glucose test is performed, and the diagnosis is confirmed using an oral glucose tolerance test.

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

Treatment of diabetes

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

Treatment for 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 modification (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 carefully monitoring blood sugar levels; Insulin therapy is prescribed only in some cases.

If prediabetes is diagnosed, it is very important to adhere to 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 still have a high risk of transition from prediabetes to diabetes, have chronic diseases (cardiovascular, non-alcoholic fatty liver disease, polycystic ovary syndrome), your doctor may prescribe glucose-lowering drugs, drugs to control cholesterol levels, and antihypertensive drugs.