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 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 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), andthe nerves (diabetic neuropathy); limb amputations (diabetic foot), Alzheimer's disease, depression, dental diseases.

The diabetes mellitus group 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) that, if left uncontrolled, can eventually develop 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 several 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;
• Pharmacological or chemical diabetes: occurs after organ transplant, 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 susceptibility of the kidneys to it.

In 2019, the global prevalence of diabetes mellitus is estimated at 463 million cases. The number of patients with this disease is expected to increase to 578 million in 2030 and 700 million in 2045 (an increase of 25% and 51%, respectively). Also in 2019, diabetes was the ninth leading cause of death, with 1. 5 million deaths caused directly 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 absolute deficiency. The disease occurs most often in children, but can develop at any age. The exact cause is unknown, but a combination of factors: genetic predisposition and environmental factors (not completely determined) are thought to play a key role. Patients with type 1 diabetes need to compensate for the insulin deficiency daily, which is why it is called insulin-dependent diabetes.

Type II diabetes, the most common type of "insulin-resistant" disease, is associated with poor glucose absorption: the transport of insulin and glucose to cells is impaired, causing hyperglycemia (increased blood levels). of blood glucose). 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 enoughglucose. It is not entirely clear why this happens, but it is known that a key role in the onset of the disease is played by genetic predisposition (a person's own genetic variants, family history of type II diabetes), excess weight and asedentary lifestyle (however, not all people with type II diabetes are overweight). The disease can develop at any age (even in childhood), but most often 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. Additionally, 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:

• 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 are at higher risk);
• overweight;
• hypertension;
• 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 are at higher risk);
• EG's personal history;
• age over 25 years.

Symptoms

Symptoms of type I diabetes:

• be strong;
• frequent urination;
• blurred vision;
• fatigue;
• Unexplained weight loss.

Symptoms appear quite quickly, within a few days or 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: acetone smell in the mouth, dry skin, redness, nausea, vomiting, abdominal pain, difficulty breathing, impaired concentration and attention.

Symptoms of type II diabetes:

• be strong;
• frequent urination;
• fatigue;
• blurred vision;
• numbness in areas of the body, tingling in arms or legs;
• slow-healing or non-healing ulcers;
• frequent infections (gums, skin, vaginal);
• Unexplained weight loss.

The symptoms develop slowly, over several years, and may be mild, so the person does not pay attention to them. Many people do not have characteristic symptoms of diabetes and do not consult a doctor immediately.

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

Diagnosis

The main method to diagnose 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 to 12 hours of fasting;
• glycated hemoglobin analysis: at any time, shows the average blood sugar level over the last two to three months, measures the percentage of blood sugar associated with hemoglobin;
• random glucose testing: 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 carried out on an empty stomach, then you are asked to drink a glass of water with dissolved glucose, 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.

Diabetes treatment

Treatment (monitoring blood sugar levels, insulin therapy, glucose-lowering drug therapy) 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: mainly lifestyle modification (weight loss, physical activity, healthy eating), control of blood sugar, cholesterol and blood pressure, hypoglycemic drugs, insulin therapy.

The 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 you are diagnosed with prediabetes, it is very important to follow a healthy lifestyle, eat well 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 prediabetes to diabetes, you havechronic diseases (cardiovascular, non-alcoholic fatty liver disease, polycystic ovary syndrome), your doctor may prescribe glucose-lowering medications, medications to control cholesterol levels, and antihypertensive medications. .