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 cells and acts as a "key" that opens the cell's "door. "When the pancreas does not produce enough hormones or the body cannot use them effectively, diabetes develops.

There is no cure for the disease, but it can be controlled 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 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 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, mature-onset diabetes of the young, adult-onset diabetes of 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;
• diabetes or diabetes - occurs after organ transplantation, during HIV/AIDS treatment or during glucocorticosteroid therapy.

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 sensitivity of the kidneys 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.

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 it can develop at any age. The exact cause is unknown, but a combination of factors: genetic predisposition and environmental factors (which have not been fully determined) are thought to play a key role. Patients with type 1 diabetes must compensate for the lack of insulin on a daily basis, 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 impaired, which causes hyperglycemia (increased blood glucose level). 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 the 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 onset of the disease is played by genetic predisposition (a person's own gene variants, a family history of type II diabetes), excess weight and a sedentary lifestyle (however, not all people with type II diabetes have excessiveweight). The disease can develop at any age (even in childhood), but it most often occurs in middle-aged and elderly people.

Gestational diabetes occurs in women (without diabetes) during pregnancy due to insulin resistance or reduced production of this hormone. It is also characterized by hyperglycemia. The symptoms of the disease may be less, but with HD, the mother increases the risk of preeclampsia, depression and caesarean 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 has a higher risk of being overweight and developing type II diabetes.

Risk factors

Factors that increase the 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;
• aged over 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 of 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, redness, nausea, vomiting, abdominal pain, difficulty breathing, reduced concentration and attention.

Symptoms of type II diabetes:

• strong thirst;
• frequent urination;
• fatigue;
• blurred vision;
• numbness in parts of the body, tingling in the hands or feet;
• 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 the person does not pay attention to them. Many people do not have symptoms characteristic of diabetes and do not immediately consult a doctor.

In 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 type II diabetes is determining the level of glucose in the blood. Your doctor may suggest one of these tests:

• fasting glucose analysis - after 8-12 hours of fasting;
• glycated hemoglobin analysis - at any time, shows the average level of blood sugar 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 more indicates diabetes;
• Oral glucose tolerance test - the measurement is performed on an empty stomach, then you are asked to drink a glass of water in which glucose has been dissolved, 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 by 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 – blood sugar monitoring, insulin therapy, glucose-lowering drug therapy – depends on the type of diabetes. It is supplemented 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 measurements, and carbohydrate counting; Type II diabetes - primarily lifestyle modification (weight loss, physical activity, healthy diet), 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 properly and normalize your 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 pre-diabetes to diabetes, you have chronic diseases (cardiovascular, non-alcoholic fatty liver disease, polycystic ovary syndrome), your doctor may prescribe glucose-lowering drugs, cholesterol-lowering drugs, and antihypertensive drugs.