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 doesn't produce enough of the hormone or the body can't 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) andnerves (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 onset disorder of carbohydrate metabolism (blood sugar levels are higher than normal, but not high enough to be classified as diabetes), which, if left uncontrolled, can eventually develop intotype 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 genetic 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;
• drug-induced or chemical diabetes - occurs after organ transplantation, during treatment for HIV/AIDS, or during treatment 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 sensitivity 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 reach 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 caused by the disease.

Reasons

Type I diabetes is an autoimmune disease in which the immune system attacks and destroys the cells in the pancreas that produce insulin, resulting in an absolute deficiency. The disease most often occurs in children, but can develop at any age. The exact cause is unknown, but a combination of factors: genetic predisposition and environmental factors (not fully determined) are thought to play a key role. Patients with type 1 diabetes must make up their insulin deficit daily, which is why we speak of 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 disrupted, which causeshyperglycemia (increase in blood sugar). Strictly speaking, type II diabetes occurs for two interrelated reasons: the pancreas does not produce the normal amount of insulin to regulate blood sugar, and the cells (fat, muscle, liver) become resistant to it and do not receive enoughglucose. Why this happens is not entirely clear, but it is known that genetic predisposition (genetic variants unique to a person, family history of type II diabetes), excess weight and lifestylesedentary lifestyle play a key role in the onset of the disease (however, not all people with type II diabetes are overweight). The disease can develop at any age (even during childhood), but most often occurs in middle-aged and elderly people.

Gestational diabetes occurs in (non-diabetic) women 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 andhigh birth weight. In addition, in the long term, the child is at higher 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 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;
• 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 are at higher risk);
• personal history of DG;
• age over 25 years.

Symptoms

Symptoms of Type I Diabetes:

• strong thirst;
• frequent urination;
• blurred vision;
• fatigue;
• unexplained weight loss.

Symptoms appear quite quickly, a few days/weeks after the onset of the illness. 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, flushing, nausea, vomiting, abdominal pain, breathing difficulties, difficulty concentrating and paying attention.

Symptoms of Type II Diabetes:

• strong thirst;
• frequent urination;
• fatigue;
• blurred vision;
• numbness in certain areas of the body, tingling in the 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 a person does not pay attention to them. Many people do not have symptoms characteristic of diabetes and do not seek medical attention promptly.

In gestational diabetes, the characteristic signs and symptoms of diabetes are often absent. Attention should be paid to increased thirst and frequent urination.

Diagnosis

The main method of diagnosing type I and II diabetes is determining 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 - at any time, shows the average blood sugar level over the past two to three months, measures the percentage of blood sugar associated with hemoglobin;
• random blood sugar test – at any time, regardless of food intake, a blood sugar level between 200 mg/dL and 11. 1 mmol/L or more 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 dissolved glucose, the measurement is repeated after 1 and 2 hours.

If type I diabetes is suspected, the blood is also tested for the presence of autoantibodies. To diagnose gestational diabetes, a fasting blood sugar test is performed and the diagnosis is confirmed using 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 – blood sugar monitoring, insulin therapy, drug treatment with hypoglycemic agents – depends on the type of diabetes. It is supplemented by a good diet, 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 sugar testing, and carbohydrate counting; Type II diabetes – mainly lifestyle modification (weight loss, physical activity, healthy diet), control of blood sugar, cholesterol and blood pressure, hypoglycemic medications, insulin therapy.

Treatment of gestational diabetes mainly consists of adjusting the diet, ensuring regular physical activity and carefully monitoring blood sugar levels; Insulin therapy is only prescribed in certain cases.

If prediabetes is diagnosed, it is very important to adhere to 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 development of type 2 diabetes. If you are still at high risk of transitioning from prediabetes todiabetes, if you suffer from chronic diseases (cardiovascular, non-alcoholic fatty liver disease, polycystic ovarian syndrome), your doctor may prescribe hypoglycemic drugs, drugs to control cholesterol levelsand antihypertensives. .