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 correct functioning of tissues and organs. Insulin, a hormone produced by the pancreas, helps glucose enter cells and acts like 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 can be controlled with medications. 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 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), which, 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) is a genetically determined 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;
- Pharmacological or chemical diabetes: occurs after an organ transplant, during treatment for HIV/AIDS, 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 suffering from this disease is expected to increase to 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 insulin-producing cells of the pancreas, causing an 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 fully determined) are believed to play a key role. Patients with type 1 diabetes must compensate for the insulin deficiency daily, which is why it is called insulin-dependent diabetes.
Type II diabetes - the most common form of the disease, "insulin resistant" - is associated with reduced glucose absorption: the transport of insulin and glucose into cells is interrupted, causing hyperglycemia (increased blood glucose levels). Strictly speaking, type II diabetes occurs for two related reasons: the pancreas does not produce the normal amount of insulin to regulate blood sugar levels, and the cells (fat, muscle, liver) become resistant and do not receive enoughglucose. The reason why this happens is not entirely clear, but it is known that a key role in the onset of the disease is played by genetic predisposition (genetic variants of a person, family history of type II diabetes), excess weightand a sedentary 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 reduced 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 becoming 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 affected by the disease: parents, brothers, sisters);
- damage to the pancreas (infections, tumors, surgery);
- 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 have a 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 have a higher risk);
- GD's personal history;
- aged 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 treatment. Its signs: smell of acetone from the mouth, dry skin, hot flashes, nausea, vomiting, abdominal pain, difficulty breathing, reduced concentration and attention.
Symptoms of type II diabetes:
- strong thirst;
- frequent urination;
- fatigue;
- blurred vision;
- numbness in some 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 the person does not pay attention to them. Many people do not have the characteristic symptoms of diabetes and do not consult a doctor promptly.
In gestational diabetes, the characteristic signs and symptoms of diabetes are often absent. It is worth paying attention to increased thirst and frequent urination.
Diagnostics
The main method for diagnosing 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 8-12 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 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 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 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 (monitoring blood sugar levels, insulin therapy, drug therapy with hypoglycemic 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 sugar checks, and carbohydrate counting; Type II diabetes - mainly lifestyle modification (weight loss, physical activity, healthy eating), blood sugar, cholesterol and blood pressure control, hypoglycemic drugs, insulin therapy.
Treatment of gestational diabetes primarily involves adjusting your diet, ensuring regular physical activity, and carefully monitoring your blood sugar levels; Insulin therapy is prescribed only in some cases.
If prediabetes is diagnosed, it is very important to adhere to a healthy lifestyle, eat well and normalize weight. Exercising (at least 150 minutes a week) and losing just 7% of your body weight can help prevent or at least delay the development of type 2 diabetes. If you still have a high risk of switching from prediabetes to diabetes, you have chronic diseases(cardiovascular, non-alcoholic fatty liver disease, polycystic ovary syndrome), your doctor may prescribe hypoglycemic drugs, drugs to control cholesterol levels, and antihypertensive drugs.