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Types of diabetes

diabetes mellitus and its types

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

To date, the disease cannot be eradicated (completely eliminated).The destructive process in the body can be slowed down through medication 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 vary, so it is divided into several types.

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

Type of pathology

There are several types of the disease, united by one main symptom - an increase in the 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:
  • pancreatic β-cell damage at the genetic level (MODY diabetes varieties);
  • 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 result of congenital infections;
  • Diabetes associated with genomic pathology and hereditary defects;
  • impaired fasting glucose (blood sugar) and impaired glucose tolerance.

Prediabetes is a borderline condition of the body when the level of glycemia increases (impairment of glucose tolerance), but the blood sugar levels "do not reach" the generally accepted digital values that correspond to true diabetes.According to the World Health Organization (WHO 2014), more than 90% of endocrinology patients suffer from the second type of disease.

According to medical statistics, there is a clear trend towards an increase in the number of cases worldwide.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 account for a small percentage of medical statistics.

By gender, NIDDM 2 is more common in premenopausal and postmenopausal 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 failure 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, organs do not receive proper nutrition, including the pancreas itself.

To imitate the natural production of the endocrine hormone, the patient is prescribed medical insulin injections with different durations of action (short and long), as well as diet therapy, throughout life.The classification of diabetes mellitus type 1 is dictated by the various etiologies of the disease.The type of insulin-dependent disease has two causes: genetic and autoimmune.

Genetic cause

The formation of pathology is associated with the biological ability of the human body to transmit its characteristic signs and pathological deviations to subsequent generations.Regarding 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 appearance of the disease is caused by 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 body cells.The causes (incitement) for the initiation of 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;
  • a history of mumps (mumps), measles, herpes Coxsackie virus, Epstein-Barr virus, cytomegalovirus, viral hepatitis A, B, C;
  • restlessness (prolonged stay in a state of neuropsychological stress);
  • chronic alcoholism;
  • wrong treatment with medications containing hormones.

IDDM develops in children, adolescents and adults under the age of thirty.The childhood variant of type 1a diabetes is associated with complicated viral infections.Form 1b appears 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 type 2 and type 1 diabetes is that the pancreas does not stop producing insulin.Glucose is concentrated in the blood and is not distributed to the cells and tissues of the body due to their lack of sensitivity to insulin - insulin resistance.Up to a certain point, treatment is carried out through hypoglycemic (sugar-lowering) medications and dietary 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 sensitivity of cells to the endogenous hormone is mainly related to obesity, which disrupts the metabolism of fat and carbohydrates.

This is especially true of visceral obesity (fat deposition around the internal organs).In addition, with excess body weight, blood flow is impeded due to numerous cholesterol plaques inside the vessels, which are created during hypercholesterolemia, which always accompanies obesity.Thus, the cells of the body experience a lack of food and energy sources.Other factors that influence the development of NIDDM include:

  • alcohol abuse;
  • gastronomic addiction to sweet dishes;
  • chronic diseases of the pancreas;
  • pathologies of the heart and vascular system;
  • overeating against the background of a sedentary lifestyle;
  • incorrect hormonal therapy;
  • complicated pregnancy;
  • Unfavorable inheritance (diabetes in parents);
  • worry

The disease develops more often in women and men aged 40+.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 treatment, the prediabetic condition is reversible.If time is lost, it progresses and NIDDM is then diagnosed.

Diabetes Lada

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 (25+).The disease combines the first and second type of diabetes.The mechanism of development corresponds to IDDM, the latent course and the manifestation of symptoms are similar to NIDDM.

The causes 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 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 IgG class immunoglobulins to antigens - ELISA (enzyme-linked immunosorbent assay).Therapy is carried out through regular insulin injections and food 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 discovered during the second scheduled examination, 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 (a steroid sex hormone) increases, blocking the production of insulin.Plus, the placenta's endocrine hormones, which tend to inhibit insulin production, are gaining strength.
  • Double the 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.
  • Increased body weight 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 lack of physical activity.The expectant mother and the fetus in such a situation experience nutritional deficiencies and energy starvation.

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

Correctly chosen therapeutic tactics guarantee the elimination of postnatal pathology in 85% of cases.The main method of treatment of GDM is the "Table No. 9" diet for diabetics.In difficult cases, medical insulin injections are used.Antihyperglycemic drugs are not used due to teratogenic effects on the fetus.

Moreover

Specific types of diabetes are genetically determined (MODY diabetes, some types of endocrinopathies) or provoked 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 syndrome);
  • tumors of the adrenal cortex (aldosteroma, pheochromocytoma, etc.).

A special diabetic pathology, diabetes insipidus, is characterized by a decrease in the production of the hypothalamic hormone vasopressin, which regulates the balance of fluids 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.Diagnosis consists of several following studies:

  • General clinical blood test to identify hidden inflammatory processes in the body.
  • Blood test (capillary or venous) for glucose content.It is strictly done 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 blood draw twice: 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 per 75 g.substances.
  • HbA1C analysis for the level of glycosylated (glycated) hemoglobin.Based on the results of the study, a retrospective review of blood sugar levels over the past three months was assessed.
  • 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 indicators of disease

ANALYSIS For sugar Glucose tolerance test Glycated hemoglobin
RATE 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 the blood microscope, a general urine test is examined to determine the presence of glucose in the urine (glycosuria).In healthy people, there is no sugar in the urine (for diabetics, the acceptable rate is 0.061 - 0.083 mmol/l).A Rehberg test is also performed to detect protein albumin and protein metabolism product creatinine in the urine.In addition, hardware diagnostics are prescribed, including an EKG (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-dependent (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 during the perinatal period is curable.The condition of prediabetes (impaired glucose tolerance) is considered reversible if diagnosed early.