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Types of diabetes

diabetes mellitus and its types

Diabetes mellitus is a disease of the endocrine system associated with pathological changes in hormonal levels and metabolic failures.

To date, the disease cannot be eradicated (completely eliminated).The destructive process in the body can be slowed down by drugs and dietary therapy, but it is impossible to stop and reverse it.

The main symptom of the disease is a chronic increase in blood sugar levels.The causes and nature of the course of the disease are different, so it is divided into several types.

The types of diabetes mellitus (DM) are defined by the World Health Organization and have no fundamental differences throughout the medical world.Diabetes mellitus of any kind is not a contagious disease.

Pathology typing

There are several types of the disease, united by one main symptom - an increased concentration of glucose in the blood.The classification of diabetes mellitus is determined by the causes of its occurrence.Treatment methods used, gender and age of the patient also take into account.

Types of diabetes accepted in medicine:

  • the first type is insulin-dependent (IDDM 1) or juvenile;
  • the second is non-insulin dependent (NIDDM 2) or insulin resistant;
  • gestational diabetes mellitus (GDM) during the perinatal period in women;
  • other specific types of diabetes, including:
  • damage to the β-cells of the pancreas at the genetic level (types of diabetes MODY);
  • pathologies of the exocrine function of the pancreas;
  • hereditary and acquired pathologies of the exocrine glands and their functions (endocrinopathies);
  • pharmacologically induced diabetes;
  • diabetes as a result of congenital infections;
  • Diabetes associated with genomic pathologies and hereditary defects;
  • impaired fasting glucose (blood sugar) and impaired glucose tolerance.

Prediabetes is a borderline state of the body when the level of glycemia is elevated (impaired glucose tolerance), but blood sugar levels "do not reach" the generally accepted numerical values corresponding to true diabetes.According to the World Health Organization (WHO 2014), more than 90% of endocrinologists' patients suffer from a second type of disease.

According to medical statistics, there is a clear trend towards an increase in the number of cases worldwide.In the last 20 years, the number of type 2 diabetics has doubled.GDM accounts for about 5% of pregnancies.Types of specific diabetes are extremely rare and occupy a small percentage in medical statistics.

According to gender, NIDDM 2 is more common in women during the premenopausal period and during menopause.This is due to changes in the hormonal status and accumulation of extra pounds.In men, the most common factor in the development of type 2 diabetes is chronic inflammation of the pancreas caused by the toxic effects of ethanol.

Insulin-dependent diabetes (type 1)

Type 1 diabetes is characterized by the failure of pancreatic cells.The organ does not perform its endocrine (intrasecretory) function to produce insulin, the hormone responsible for supplying the body with glucose.As a result of the accumulation of glucose in the blood, the organs do not receive adequate nutrition, including the pancreas itself.

In order to imitate the natural production of the endocrine hormone, the patient is prescribed injections of medical insulins of different duration of action (short and long), as well as dietary therapy for life.The classification of diabetes mellitus type 1 is dictated by the different etiology of the disease.The insulin-dependent type of disease has two causes: genetic and autoimmune.

Genetic cause

The formation of pathology is related to the biological ability of the human body to transmit its characteristic signs and pathological deviations to subsequent generations.As for diabetes, a child inherits a predisposition to the disease from parents or close relatives with diabetes.

important!The predisposition is inherited, but not the disease itself.There is no 100% guarantee that a child will develop diabetes.

Autoimmune cause

The appearance of the disease is due to a functional failure of the immune system, when under the influence of negative factors it actively produces autoimmune antibodies that have a destructive effect on the cells of the body.Triggers (impulses) for starting autoimmune processes are:

  • unhealthy eating behavior combined with lack of physical activity;
  • failure of metabolic processes (carbohydrates, lipids and proteins);
  • critical deficiency of cholecalciferol and ergocalciferol (vitamins D) in the body;
  • pathologies of the pancreas of a chronic nature;
  • history of mumps (mumps), measles, herpes virus Coxsackie, Epstein-Barr virus, cytomegalovirus, viral hepatitis A, B, C;
  • distress (prolonged stay in a state of neuropsychological stress);
  • chronic alcoholism;
  • incorrect treatment with drugs containing hormones.

IDDM develops in children, adolescents and adults under the age of thirty.The childhood variant of type 1a diabetes is associated with complicated viral infections.Form 1b occurs in young people and children against the background of autoimmune processes and hereditary predisposition.The disease usually develops rapidly over several weeks or months.

Insulin-resistant diabetes (type 2)

The difference between the second type of diabetes and the first is that the pancreas does not stop producing insulin.Glucose is concentrated in the blood and is not delivered to the cells and tissues of the body due to their lack of sensitivity to insulin - insulin resistance.Until a certain point, treatment is carried out by hypoglycemic (sugar-lowering) drugs and dietary therapy.

To compensate for the imbalance in the body, the pancreas activates the production of the hormone.Working in emergency mode, the organ wears out over time and loses its intrasecretory function.Type 2 diabetes becomes insulin dependent.The reduction or loss of sensitivity of cells to the endogenous hormone is mainly associated with obesity, which disrupts the metabolism of fats and carbohydrates.

This is especially true for visceral obesity (deposition of fat around the internal organs).In addition, with excess body weight, blood flow becomes difficult due to the many cholesterol plaques inside the vessels that form during the hypercholesterolemia that always accompanies obesity.In this way, the cells of the body experience a shortage of food and energy resources.Other factors influencing the development of NIDDM include:

  • alcohol abuse;
  • gastronomic addiction to sweet dishes;
  • chronic diseases of the pancreas;
  • pathologies of the heart and vascular system;
  • excess in nutrition against the background of a sedentary lifestyle;
  • incorrect hormone therapy;
  • complicated pregnancy;
  • Unfavorable heredity (diabetes in parents);
  • distress.

Most often, the disease develops in women and men aged 40+.At the same time, type 2 diabetes is latent and may not show pronounced symptoms for several years.Testing your blood sugar levels early can reveal prediabetes.With adequate treatment, the prediabetic condition is reversible.If time is lost, it progresses and NIDDM is subsequently diagnosed.

Lada diabetes

In medicine, the term "Diabetes 1.5" or the name Lada diabetes is used.It is an autoimmune disorder of hormone production and metabolic failure that occurs in adults (aged 25+).The disease combines type 1 and type 2 diabetes.The mechanism of development corresponds to IDDM, the latent course and the manifestation of symptoms are similar to NIDDM.

Triggering factors for the development of the pathology are autoimmune diseases in the patient's history:

  • non-infectious inflammation of the intervertebral joints (ankylosing spondylitis);
  • irreversible disease of the central nervous system - multiple sclerosis;
  • granulomatous inflammatory pathology of the gastrointestinal tract (Crohn's disease);
  • chronic inflammation of the thyroid gland (Hashimoto's thyroiditis);
  • juvenile and rheumatoid arthritis;
  • discoloration (loss of pigment) of the skin (vitiligo);
  • inflammatory pathology of the mucous membrane of the large intestine (ulcerative colitis);
  • chronic damage to connective tissue and exocrine glands (Sjögren's syndrome).

In combination with a hereditary predisposition, autoimmune disorders lead to the progression of Lada diabetes.To identify the disease, basic diagnostic methods are used, as well as blood microscopy, which determines the concentration of IgG class immunoglobulins to antigens - ELISA (enzyme-linked immunosorbent assay).Therapy is carried out through regular insulin injections and correction of nutrition.

Gestational form of the disease

GDM is a specific type of diabetes that develops in women during the second half of the perinatal period.Most often, the disease is detected during the second scheduled screening, when the expectant mother undergoes a complete examination.The main characteristic of GDM coincides with type 2 diabetes - insulin resistance.The cells of a pregnant woman's body lose sensitivity (sensitivity) to insulin due to the connection of three main reasons:

  • Hormonal changes.During pregnancy, the synthesis of progesterone (steroid sex hormone) increases, blocking the production of insulin.Plus, the endocrine hormones of the placenta, which tend to inhibit insulin production, gain strength.
  • Double the load on the female body.In order to provide adequate nutrition to the unborn child, the body needs an increased amount of glucose.The woman begins to consume more monosaccharides, which causes the pancreas to synthesize more insulin.
  • Weight gain due to reduced physical activity.Glucose, which enters the body in abundance, accumulates in the blood because the cells refuse to accept insulin due to obesity and lack of physical activity.The expectant mother and the fetus in such a situation experience nutritional deficiency and energy starvation.

Unlike type 1 and type 2 diabetes, gestational diabetes is a reversible process because insulin molecules and pancreatic functionality are preserved.

Correctly selected therapeutic tactics ensure the elimination of the pathology after birth in 85% of cases.The main method of treatment of GDM is the diet "Table No. 9" for diabetics.In difficult cases, medical insulin injections are used.Antihyperglycemic drugs are not used because of their teratogenic effect on the fetus.

Additionally

Specific types of diabetes are genetically determined (MODY diabetes, some types of endocrinopathies) or provoked by other chronic pathologies:

  • diseases of the pancreas: pancreatitis, hemochromatosis, tumor, cystic fibrosis, mechanical injuries and operations of the gland;
  • functional failure of the anterior lobe of the pituitary gland (acromegaly);
  • increased synthesis of thyroid hormones (thyrotoxicosis);
  • hypothalamic-pituitary-adrenal pathology (Itsenko-Cushing syndrome);
  • tumors of the adrenal cortex (aldosteroma, pheochromocytoma, etc.).

A separate diabetic pathology, diabetes insipidus, is characterized by a decrease in the production of the hypothalamic hormone vasopressin, which regulates the balance of fluids in the body.

Diagnostic measures

The diagnosis of diabetes mellitus (of any type) is possible only on the basis of the results of laboratory microscopy of blood.The diagnosis consists of several consecutive studies:

  • General clinical blood test to identify hidden inflammatory processes in the body.
  • Blood test (capillary or venous) for glucose content.It is done strictly on an empty stomach.
  • GTT (glucose tolerance test).It is conducted to determine the body's ability to absorb glucose.The tolerance test consists of two blood draws: fasting and two hours after a "glucose load", which is an aqueous solution of glucose prepared in a ratio of 200 ml of water per 75 g.substances.
  • Analysis of HbA1C for the level of glycosylated (glycated) hemoglobin.Based on the test results, a retrospective review of blood sugar levels over the past three months is assessed.
  • Blood biochemistry.Liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (ALP), bilirubin (bile pigment) and cholesterol levels are assessed.
  • A blood test for the concentration of antibodies against glutamate decarboxylase (GAD antibodies) determines the type of diabetes mellitus.

Blood glucose reference values and indicators of disease

Analysis For sugar Glucose tolerance test Glycated hemoglobin
norm 3.3 - 5.5 < 7.8 ⩽ 6%
prediabetes 5.6 – 6.9 7.8 – 11.0 from 6 to 6.4%
diabetes >7.1 >11.1 More than 6.5%

In addition to blood microscopy, a general urine test is examined to determine the presence of glucose in the urine (glycosuria).In healthy people, there is no sugar in the urine (for diabetics, the acceptable norm is 0.061 - 0.083 mmol/l).A Rehberg test is also performed to detect protein albumin and protein metabolism product creatinine in the urine.In addition, hardware diagnostics are prescribed, including ECG (electrocardiogram) and ultrasound of the abdominal cavity (with kidneys).

Results

Modern medicine classifies diabetes into four main types depending on the pathogenesis (origin and development) of the disease: insulin-dependent (type 1 IDDM), non-insulin-dependent (type 2 NIDDM), gestational (GDM in pregnant women), specific (DM includes several types of diseases caused by genetic defects or chronic pathologies).Gestational diabetes, which develops in the perinatal period, is treatable.The condition of prediabetes (impaired glucose tolerance) is considered reversible if diagnosed in time.