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 cell's "door. "When the pancreas does not produce enough of the hormone or the body cannot use it effectively, diabetes develops.

There is no cure for the disease, 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) 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 (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 not controlled, can eventually transform into type II diabetes. Prediabetes and gestational diabetes are considered potentially reversible conditions.

Less common types of diabetes include:

• monogenic diabetes (MODY, Diabetes-Onset of the Young) is a genetically determined diabetes caused by mutations in different genes. MODY accounts for up to 4% of all diabetes cases;
• diabetes associated with cystic fibrosis (cystic fibrosis), a form of diabetes that is common in people with this disease;
• drug or chemical diabetes - occurs after organ transplantation, 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 sensitivity of the kidneys to it.

As of 2019the worldwide 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. (25% and 51% increase respectively). Also in 2019diabetes was the ninth leading cause of death, with 1. 5 million deaths directly attributable to 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 an absolute deficiency. The disease most often occurs in children, but it can develop at any age. The exact cause is unknown, but a combination of factors: genetic predisposition and environmental factors (not fully defined) are thought to play a key role. Patients with type 1 diabetes must compensate for the insulin deficiency on a daily basis, which is why it is called insulin-dependent diabetes.

Type II diabetes - the most common type of disease, "insulin-resistant" - is associated with impaired absorption of glucose: the transport of insulin and glucose in cells is impaired, which causes hyperglycemia (increased blood sugar levels). 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, muscle, liver) become resistant to it and do not receive enough glucose. Why this happens is not entirely clear, but it is known that a key role in the appearance of the disease is played by genetic predisposition (a person's own gene variants, family history of type II diabetes), overweight and a sedentary lifestyle (however, not all peoplewith 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. The symptoms of the disease may be subtle, but HD puts the mother at increased risk of pre-eclampsia, depression and caesarean section, and the baby at increased risk of hypoglycemia (low blood sugar), jaundice and high birth weight. In addition, in the long term, the child is at a higher 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 have a 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 have a higher risk);
• personal history of GD;
• age over 25 years.

Symptoms

Symptoms of type I diabetes:

• strong thirst;
• frequent urination;
• blurred vision;
• tiredness;
• 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 care. Its signs: smell of acetone from the mouth, dry skin, redness, nausea, vomiting, abdominal pain, difficulty breathing, impaired concentration and attention.

Symptoms of type II diabetes:

• strong thirst;
• frequent urination;
• tiredness;
• blurred vision;
• numbness of parts of the body, numbness of the hands or feet;
• slow-healing or non-healing ulcers;
• frequent infections (gums, skin, vaginal);
• unexplained weight loss.

Symptoms develop slowly, over several years, and can be mild, so one does not pay attention to them. Many people do not have symptoms characteristic of diabetes and do not consult a doctor in a timely manner.

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

Diagnosis

The main method for diagnosing type I and type II diabetes is the determination of blood sugar levels. Your doctor may suggest one of these tests:

• analysis of fasting glucose levels - after 8-12 hours of fasting;
• analysis for glycated hemoglobin - at any time shows the average level of blood sugar over the past 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 glucose level of 200 mg/dL - 11. 1 mmol/L or higher indicates diabetes;
• oral glucose tolerance test - the measurement is performed on an empty stomach, after which you are required 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 further 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 need consultation with doctors from related specialties: ophthalmologist, cardiologist, urologist, nephrologist, psychotherapist, etc.

Treatment of diabetes

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

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

If prediabetes is diagnosed, it is very important to stick 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 to diabetes, you have chronicdiseases (cardiovascular, non-alcoholic fatty liver disease, polycystic ovary syndrome), your doctor may prescribe medicines to lower glucose, medicines to control cholesterol levels andantihypertensive drugs.