Diabetes mellitus

Diabetes mellitus is a chronic endocrine disease in which glucose (sugar) levels in the blood 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 cellular "door. "When the pancreas does not produce enough hormone or the body cannot use it effectively, diabetes occurs.

The disease is not curable, but 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 disease.

The group of diabetes mellitus includes several endocrine diseases (or metabolic disorders): type I diabetes, type II diabetes, gestational diabetes (only occurs 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 untreated, can eventually turn into type II diabetes. Prediabetes and gestational diabetes are considered potentially reversible diseases.

The rarer types of diabetes include:

• Monogenic diabetes (MODY, Maturity-Onset Diabetes of the Young) is a genetic diabetes caused by mutations in various genes. MODY accounts for up to 4% of all diabetes cases;
• diabetes related to cystic fibrosis (cystic fibrosis), a form of diabetes common in people with the disease;
• drug or chemical diabetes - occurs after an organ transplant, during treatment of HIV/AIDS 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 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 by 2030 and 700 million by 2045 (an increase of 25% and 51%, respectively). Diabetes was also the ninth leading cause of death in 2019, 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 cells of the pancreas that produce insulin, resulting in absolute deficiency. The disease is most common in children, but can develop at any age. The exact cause is unknown, but a combination of factors: genetics and environmental factors (not fully understood) are thought to play a key role. Patients with type 1 diabetes have to compensate for their insulin deficiency every day, which is why they are referred to as insulin-dependent diabetes.

Type II diabetes - the most common type of the disease, "insulin resistant" - is associated with impaired glucose absorption: the transport of insulin and glucose into cells is disrupted, which leads to hyperglycemia (increased blood sugar levels). Strictly speaking, type II occurs-Diabetes for two interrelated reasons: the pancreas does not produce the normal amount of insulin to regulate blood sugar levels, and cells (fat, muscle, liver) do notresistant and do not receive enough glucose. Why this happens is not entirely clear, but it is known that a key role in the development of the disease is a genetic predisposition (own gene variants, family history of type II diabetes), obesity and a sedentary lifestylePlay lifestyle ( However, not all people with type II diabetes are overweight. The disease can occur at any age (including 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 reduced production of this hormone. It is also characterized by hyperglycemia. Symptoms of the disease may be minor, but Huntington's disease increases the mother's risk of preeclampsia, depression, and cesarean section, and the baby's increased risk of hypoglycemia (low blood sugar), jaundice, and high birth weight. In addition, the child has a higher long-term risk of being overweight and developing type II diabetes.

Risk factors

The 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 (infections, tumors, surgical procedures);
• 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);
• obesity;
• high blood pressure;
• low HDL, high triglycerides;
• sedentary lifestyle;
• gestational diabetes;
• polycystic ovary syndrome;
• heart disease, history of stroke;
• Smoke.

Risk factors for gestational diabetes include:

• family history of prediabetes or type II diabetes;
• obesity;
• ethnicity (African Americans, Hispanics, and other ethnic groups are at higher risk);
• personal story of GD;
• Age over 25 years.

Symptoms

Symptoms of Type I Diabetes:

• intense thirst;
• frequent urination;
• blurred vision;
• Fatigue;
• unexplained weight loss.

Symptoms appear relatively quickly - within a few days/weeks after the onset of the disease. Sometimes they talk about the development of a life-threatening disease - diabetic ketoacidosis, which requires emergency care. Its signs: smell of acetone from the mouth, dry skin, feeling of heat, nausea, vomiting, abdominal pain, difficulty breathing, difficulty concentrating and paying attention.

Symptoms of Type II Diabetes:

• intense thirst;
• frequent urination;
• Fatigue;
• blurred vision;
• Numbness in certain areas of the body, tingling in arms or legs;
• slow-healing or non-healing ulcers;
• frequent infections (gums, skin, vaginal);
• unexplained weight loss.

Symptoms develop slowly, over several years, and may be mild, so the person does not pay attention to them. Many people do not have any symptoms typical of diabetes and do not seek medical attention immediately.

Gestational diabetes often lacks the signs and symptoms characteristic of diabetes. It is worth paying attention to increased thirst and frequent urination.

diagnosis

The most important method for diagnosing type I and II diabetes is to measure blood sugar levels. Your doctor may suggest one of these tests:

• Analysis of fasting glucose levels - after 8-12 hours of fasting;
• Glycated hemoglobin analysis – displays average blood sugar levels over the last two to three months at any time and measures the percentage of blood sugar associated with hemoglobin;
• Random glucose test - at any time, regardless of food intake, a blood glucose level of 200 mg/dL - 11. 1 mmol/L or higher indicates diabetes;
• oral glucose tolerance test – the measurement is taken 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 examined 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 need consultation with doctors of related specialties: ophthalmologist, cardiologist, urologist, nephrologist, psychotherapist and others.

Treatment of diabetes

Treatment - monitoring blood sugar levels, insulin therapy, drug therapy with blood sugar-lowering drugs - 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 monitoring and carbohydrate counting; Type II diabetes – mainly lifestyle changes (weight loss, physical activity, healthy diet), control of blood sugar, cholesterol and blood pressure, blood sugar lowering medications, insulin therapy.

Treatment of gestational diabetes essentially involves adjustment of diet, regular physical activity and careful monitoring of blood sugar levels; Insulin therapy is only prescribed in some cases.

If prediabetes is diagnosed, it is very important to maintain a healthy lifestyle, eat right and normalize weight. Exercising (at least 150 minutes per week) and losing just 7% of body weight can help prevent or at least delay the development of type 2 diabetes. If you are still at high risk of progressing from prediabetes to diabetes, have chronic diseases (cardiovascular disease, non-alcoholic fatty liver disease, polycystic ovary syndrome), your doctor may prescribe blood sugar-lowering medications, cholesterol control medications, and antihypertensive medicationsPrescribe medication.