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 needed 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 hormones, or the body cannot use them effectively, diabetes develops.
This disease has no cure, but it can be controlled with medicines. 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 disease.
The group of diabetes mellitus includes several endocrine diseases (or metabolic disorders): type I diabetes, type II diabetes, gestational diabetes (only develops 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 untreated, can eventually turn 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 of the young) is a genetically determined diabetes caused by mutations in multiple 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 HIV/AIDS treatment 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 antidiuretic hormone (ADH) secretion or insufficient kidney sensitivity to it.
As of 2019, the prevalence of diabetes mellitus worldwide 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 attributable to the disease.
The 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 absolute deficiency. This 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 an important role. Patients with type 1 diabetes need to compensate for the lack of insulin every day, 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 interconnected reasons: the pancreas does not produce the normal amount of insulin to control blood sugar levels, and cells (fat, muscle, liver) become resistant to it and do not receive enough glucose. Why this happens is not very clear, but it is known that the main role in the occurrence of this disease is played by genetic predisposition (one's own gene variants, family history of type II diabetes), excess weight, and an inactive lifestyle ( however, not all suffererstype II diabetes is overweight). 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. The symptoms of this 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 becoming 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 (infection, tumor, surgical intervention);
- 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;
- diabetes during pregnancy;
- 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);
- GD's personal history;
- age over 25 years.
symptoms
Symptoms of type I diabetes:
- strong thirst;
- frequent urination;
- blurred vision;
- tiredness;
- unexplained weight loss.
Symptoms appear relatively quickly - within a few days/weeks of the onset of the disease. Sometimes they talk about the development of a life-threatening condition - diabetic ketoacidosis, which requires emergency care. The signs: the smell of acetone from the mouth, dry skin, redness, nausea, vomiting, stomach pain, difficulty breathing, impaired concentration and attention.
Symptoms of type II diabetes:
- strong thirst;
- frequent urination;
- tiredness;
- blurred vision;
- numbness in an area of the body, tingling in the arms or legs;
- slow-healing or non-healing ulcers;
- frequent infections (gums, skin, vagina);
- unexplained weight loss.
Symptoms develop slowly, over several years, and may be mild, so a person does not pay attention to it. Many people do not have the characteristic symptoms of diabetes and do not immediately see a doctor.
With gestational diabetes, the characteristic signs and symptoms 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 type II diabetes is to determine blood glucose levels. Your doctor may recommend one of these tests:
- fasting glucose level analysis - after 8-12 hours of fasting;
- analysis for glycated hemoglobin - at any time, shows the average blood sugar level in 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 also tested for the presence of autoantibodies. To diagnose diabetes during pregnancy, a fasting blood glucose test is performed, and the diagnosis is confirmed using an oral glucose tolerance test.
Patients diagnosed with diabetes may need consultation with doctors of related specialties: ophthalmologists, cardiologists, urologists, nephrologists, psychotherapists and others.
Diabetes treatment
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 body 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 - mainly lifestyle modifications (weight loss, physical activity, healthy diet), control of blood sugar, cholesterol and blood pressure, hypoglycemic drugs, insulin therapy.
Treatment of gestational diabetes mainly involves dietary adjustments, ensuring regular physical activity, and closely monitoring 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 a 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, drugs to control cholesterol levels and antihypertensive drugs.