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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 hormone levels and metabolic failures.

To date, the disease cannot be eradicated (completely eliminated).The destructive process in the body can be slowed down through medications and diet therapy, but it is impossible to stop it and start it in the opposite direction.

The main symptom of the disease is a chronic increase in blood glucose levels.The causes and nature of the course of the disease differ, therefore it is divided into several types.

The types of diabetes mellitus (DM) are defined by the World Health Organization and do not have fundamental differences in the medical world.Diabetes mellitus of any type is not a contagious disease.

Typification of the pathology

There are different types of disease, which share a main symptom: the increase in glucose concentration in the blood.The classification of diabetes mellitus is determined by the causes of its onset.The treatment methods used, the sex and age of the patient are also taken 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), i.e. insulin-resistant;
  • gestational diabetes mellitus (GDM) during the perinatal period in women;
  • other specific types of diabetes, including:
  • damage to pancreatic β cells at the genetic level (MODY variety of diabetes);
  • pathologies of the exocrine function of the pancreas;
  • hereditary and acquired pathologies of the exocrine glands and their functions (endocrinopathies);
  • pharmacologically caused diabetes;
  • diabetes due to congenital infections;
  • Diabetes associated with genomic pathologies and hereditary defects;
  • impaired fasting glycemia (blood sugar) and reduced glucose tolerance.

Prediabetes is a borderline state of the body in which the glycemic level increases (reduced glucose tolerance), but blood sugar levels “do not reach” the generally accepted digital values corresponding to true diabetes.According to the World Health Organization (WHO 2014), more than 90% of endocrinology patients suffer from the second type of disease.

According to medical statistics, there is a clear trend towards an increase in the number of cases around the world.Over the last 20 years the number of type 2 diabetics has doubled.GDM accounts for approximately 5% of pregnancies.Specific types of diabetes are extremely rare and occupy a small percentage in medical statistics.

By gender, NIDDM 2 is more common in women during the premenopausal period and during menopause.This is due to changes in hormonal status and gaining 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 fulfill its endocrine (intrasecretory) function of producing insulin, the hormone responsible for supplying glucose to the body.Due to the accumulation of glucose in the blood, the organs do not receive adequate nutrition, including the pancreas itself.

To mimic the natural production of the endocrine hormone, the patient is prescribed injections of medical insulins with different durations of action (short and long), as well as diet therapy, throughout his life.The classification of type 1 diabetes mellitus is dictated by the different etiologies of the disease.The insulin-dependent type of disease has two causes: genetic and autoimmune.

Genetic cause

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

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

Autoimmune cause

The onset of the disease is caused by 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 body's cells.The triggers (impulse) for starting autoimmune processes are:

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

IDDM develops in children, adolescents, and adults under thirty years of age.The childhood variant of diabetes form 1a 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 supplied to the cells and tissues of the body due to their lack of sensitivity to insulin - insulin resistance.Up to a certain point, treatment is carried out with hypoglycemic (sugar-lowering) drugs and diet 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.A decrease or loss of cellular sensitivity to endogenous hormone is primarily associated with obesity, which disrupts fat and carbohydrate metabolism.

This is especially true for visceral obesity (fat deposition around the internal organs).In addition, with excess body weight, blood flow is hindered due to numerous cholesterol plaques inside the vessels, which are formed during hypercholesterolemia, which always accompanies obesity.The body's cells then experience a shortage of nutritional and energy resources.Other factors that influence the development of NIDDM include:

  • alcohol abuse;
  • gastronomic dependence on sweet dishes;
  • chronic pancreatic diseases;
  • pathologies of the heart and vascular system;
  • overeating against the background of a sedentary lifestyle;
  • incorrect hormone therapy;
  • complicated pregnancy;
  • Unfavorable heredity (diabetes in parents);
  • anguish.

The disease develops more often in women and men over 40 years of age.At the same time, type 2 diabetes is latent and may not show pronounced symptoms for several years.Testing blood glucose levels early can reveal prediabetes.With appropriate treatment, the prediabetic condition is reversible.If time is missed, it progresses and NIDDM is subsequently diagnosed.

Diabetes Lada

In medicine the term “Diabetes 1.5” or the name Lada diabetes is used.It is an autoimmune disease of hormone production and metabolic failure that occurs in adults (over the age of 25).The disease combines the first and second types of diabetes.The mechanism of development corresponds to IDDM, the latent course and 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 (Hashimoto's thyroiditis);
  • juvenile and rheumatoid arthritis;
  • discoloration (loss of pigment) of the skin (vitiligo);
  • inflammatory pathology of the colon mucosa (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 immunoglobulins of the IgG class on antigens - ELISA (enzyme-linked immunosorbent assay).Therapy is carried out through regular insulin injections and nutritional correction.

Gestational form of the disease

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

  • Hormonal changes.During gestation, the synthesis of progesterone (a steroid sex hormone) increases, blocking the production of insulin.In addition, the endocrine hormones of the placenta, which tend to inhibit insulin production, are gaining strength.
  • Doubles the load on the female body.To ensure adequate nutrition for the unborn child, the body requires a greater amount of glucose.A woman begins to consume more monosaccharides, which causes the pancreas to synthesize more insulin.
  • Increase in body weight due to decrease in physical activity.Glucose, which enters the body in abundance, accumulates in the blood because cells refuse to accept insulin due to obesity and physical inactivity.The future mother and fetus in such a situation experience nutritional deficiency and energy starvation.

Unlike type 1 and type 2 diabetes, gestational diabetes is a reversible process, as insulin molecules and pancreas function are preserved.

Correctly selected therapeutic tactics guarantee the elimination of pathology after childbirth in 85% of cases.The main method of treating GDM is the “Table No. 9” diet for diabetics.In difficult cases, medical insulin injections are used.Antihyperglycemic drugs are not used due to their teratogenic effects on the fetus.

Furthermore

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

  • diseases of the pancreas: pancreatitis, hemochromatosis, tumor, cystic fibrosis, mechanical injuries and interventions on the gland;
  • functional failure of the anterior 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 fluid balance in the body.

Diagnostic measures

A diagnosis of diabetes mellitus (of any type) is possible only on the basis of the results of microscopic laboratory blood examination.Diagnostics consists of several sequential studies:

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

Blood glucose reference values and disease indicators

Analyses For the 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 the microscopic examination of the blood, a general urinalysis 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 value is 0.061 - 0.083 mmol/l).A Rehberg test is also performed to detect the protein albumin and creatinine, a product of protein metabolism, in the urine.Additionally, hardware diagnostics is prescribed, including an ECG (electrocardiogram) and an 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 (IDDM type 1), non-insulin-dependent (NIDDM type 2), gestational (GDM in pregnant women), specific (DM includes several types of diseases caused by genetic defects or chronic pathologies).Gestational diabetes that develops during the perinatal period is treatable.The condition of prediabetes (impaired glucose tolerance) is considered reversible if diagnosed early.