Diabetes mellitus

Diabetes mellitus is a chronic endocrine disease in which blood glucose (sugar) levels rise 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. "If 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 has 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 considered diabetes) that, if left untreated, can eventually progress to 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) is a genetically determined diabetes caused by mutations in different genes. MODY accounts for 4% of all diabetes;
• diabetes associated with cystic fibrosis (cystic fibrosis), a form of diabetes that is common in people with this disease;
• medicinal or chemical diabetes - occurs after organ transplantation, HIV/AIDS treatment or glucocorticosteroid therapy.

Diabetes insipidus is a rare (treatable) disease in which the body produces a lot of urine (polyuria). This is due to insufficient secretion of antidiuretic hormone (ADH) or insufficient sensitivity of the kidneys to it.

In 2019, the worldwide prevalence of diabetes mellitus was estimated at 463 million. The number of patients with this disease is expected to increase to 578 million by 2030 and to 700 million by 2045 (25% and 51% growth, respectively). In 2019, diabetes was also 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 insulin-producing cells in the pancreas, 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 it is a combination of several factors: genetic predisposition and environmental factors (not fully defined) play a key role. Patients with type 1 diabetes must make up 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 the disease, "insulin resistant" - involves impaired glucose absorption: the transport of insulin and glucose into the cells is interrupted, causing hyperglycemia (elevated blood sugar). Strictly speaking, type II diabetes is twoit develops for a related reason: the pancreas does not produce the normal amount of insulin to regulate blood sugar levels, the cells (fat, muscle, liver) become resistant to it and do not receive enough glucose. Why this happens is not entirely clear, but it is known that genetic predisposition plays a key role in the development of the disease (a person's own gene variants, type II diabetes occurring in the family), overweight and a sedentary lifestyle (however, not all type II diabetes patients are overweight). occurs in the elderly.

Gestational diabetes in women (without diabetes) occurs during pregnancy due to insulin resistance or reduced production of this hormone. It is also characterized by hyperglycemia. Symptoms of the disease may be mild, but with HD, the mother is at increased risk of preeclampsia, depression, and caesarean section, and the baby is at risk of hypoglycemia (low blood sugar), jaundice, and high birth weight. In addition, in the long term, the child is at greater 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:

• type I diabetes in the family (close relatives of 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:

• type II diabetes in the family;
• ethnicity (African-Americans, Hispanics, and other ethnic groups are at higher risk);
• overweight;
• hypertension;
• low HDL, high triglycerides;
• sedentary lifestyle;
• gestational diabetes;
• polycystic ovary syndrome;
• history of heart disease, stroke;
• smoking.

Risk factors for gestational diabetes include:

• prediabetes or type II diabetes in the family;
• overweight;
• ethnicity (African-Americans, Hispanics, and other ethnic groups are at higher risk);
• GD's personal story;
• age 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. Symptoms: acetone smell from the mouth, dry skin, flushing, nausea, vomiting, abdominal pain, breathing difficulties, concentration and attention disorders.

Symptoms of type II diabetes:

• strong thirst;
• frequent urination;
• fatigue;
• blurred vision;
• numbness in some parts of the body, tingling in the arms or legs;
• slow-healing or non-healing ulcers;
• frequent infections (gums, skin, vagina);
• unexplained weight loss.

The symptoms develop slowly, over several years, and can be mild, so people don't pay attention to them. Many people do not have diabetes symptoms and do not seek medical attention immediately.

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

Diagnostics

The main method of diagnosing type I and type II diabetes is to determine the blood sugar level. Your doctor may recommend one of the following tests:

• analysis of fasting glucose level - after 8-12 hours of fasting;
• analysis of glycated hemoglobin - shows the average blood sugar level for the past two to three months at any time, 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 must be performed on an empty stomach, then you will be asked to drink a glass of water in which glucose has been dissolved, the measurement will be repeated after 1 and 2 hours.

If type I diabetes is suspected, the presence of autoantibodies in the blood is also examined. A fasting blood glucose test is used to diagnose gestational diabetes, and the diagnosis is confirmed with an oral glucose tolerance test.

A patient diagnosed with diabetes can request a consultation with doctors in related fields: ophthalmologist, cardiologist, urologist, nephrologist, psychotherapist and others.

Treatment of diabetes

Treatment – blood glucose monitoring, insulin therapy, medication with glucose-lowering drugs – depends on the type of diabetes. This is complemented by proper nutrition, maintaining a normal body weight and regular physical activity.

Treatment for type 1 diabetes includes insulin therapy (using insulin injections or an insulin pump), frequent blood glucose testing, and carbohydrate counting; Type II diabetes - mainly lifestyle changes (weight loss, physical activity, healthy diet), control of blood sugar, cholesterol and blood pressure, hypoglycemic agents, insulin therapy.

Management 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 certain cases.

If you are diagnosed with prediabetes, it is very important to follow a healthy lifestyle, eat right, 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 onset of type 2 diabetes. If there is still a risk of transitioning from prediabetes to diabetes, if you have a chronic disease (cardiovascular system, non-alcoholic fatty liver disease, polycystic ovary syndrome), your doctor may prescribe blood sugar-lowering, cholesterol-regulating and blood-pressure-lowering drugs. .