Depending on the causes of the metabolic disorder diabetes mellitus is of three types diabetes mellitus of the first type, diabetes type II diabetes and gestational diabetes, or gestational diabetes.
Until recently, the predominant form of diabetes was type one diabetes, but in recent decades, patients with type II diabetes was significantly greater due to the prevailing food culture and the modern sedentary lifestyle.
This statement is confirmed by statistics, according to estimates by the who, in 2011, worldwide there were about 347 million people with diabetes, 90% of which are holders of type II diabetes.
Diabetes mellitus type I, until now, remains a disease with unclear cause of development. It is known that the leading role in the course of the disease is the destruction of pancreatic cells, insulin-secreting -cells of the islets of Langerhans by the immune system. As a result of this process is an absolute deficiency of insulin in the body and there is a need for its artificial replacement. Because of this, diabetes of the 1st type is also called insulin-dependent diabetes.
In the case of insulin-dependent diabetes in humans do not detect antibodies to insulin, the mechanism of the disease is called idiopathic, that is not installed.
Factors predisposing to diabetes mellitus of the first type
- genetic predisposition
- intrauterine viral infection, viral infection among adolescents, such as rubella, measles, chicken pox, etc.
- infant feeding nutrition mixtures based on cow’s milk or having in its composition gluten
- eating foods excessive nitratsoderzhaschie dyes and preservatives.
Diabetes type II is a consequence of overeating and overweight, and this form of diabetes develops not only by the apparent obesity, but also in the hidden abdominal, when adipose tissue is concentrated in the abdomen and surrounds the internal organs.
Factors predisposing to diabetes mellitus of the second type
- unhealthy food full of sweets and fats
- the absence or lack of physical activity
- overweight and obesity
- violation of glucose tolerance.
Under gestational diabetes mean any disorders of carbohydrate metabolism in the organism, first discovered during pregnancy. At normal current of pregnancy observed increase in the rate of glucose utilization caused by the fact that glucose is absorbed by cells not only women but also the fetus. Also normal in pregnant women is the development of minor insulinrezistentnost reduce the sensitivity of cells to insulin. Significant insulinrezistentnost and the level of blood glucose more than 7,8 Mall are the signs of gestational diabetes.
Risk factors predisposing to the development of gestational diabetes
- overweight and obesity
- weight gain more than 10 kg after 18 years
- violation of glucose tolerance
- glycosuria (sugar in urine) during this or previous pregnancies
- hydramnion or the birth of a baby weighing over 4500 g or stillbirth history
- rapid weight gain during current pregnancy
- age pregnant more than 30 years
- the presence of T2DM in close relatives
- the presence of GDM during previous pregnancy.
The beginning of diabetes of the first type, that is, its symptoms, characterized by the rapid development of adverse symptoms with symptoms of ketoacidosis (offset acid-base balance to the acid side because of excessive amounts of ketone bodies) or even diabetic coma.
The main symptoms of diabetes of the 1st type
- dry mouth and throat, strong thirst, polyuria (increase urine output)
- increased appetite accompanied by weight loss
- itchy skin together with the enhanced susceptibility to skin and other infections (furunculosis, fungal nail and skin, tuberculosis, pneumonia)
- hypoactive sexual desire and potency
- the decrease in visual acuity
- the growing phenomenon of mucosal lesions of the mouth and tooth structure (caries, gingivitis, stomatitis, periodontal disease, etc.)
The increase in hyperglycemia is accompanied by dryness of the skin and mucous membranes, redness of the cheeks, forehead and chin.
Complications insufficient or even non-compensated diabetes of the 1st type are
- trophic ulcers of the lower extremities
- osteoporosis and diabetic Charcot osteoarthropathy
- the occurrence of diabetic neuropathy
- diabetic retinopathy
- the impaired fertility (ability to conception and childbirth) young women
- violation of mental and physical development in children with type 1 diabetes (Mauriac syndrome)
- ischemic heart disease and myocardial infarction which caused the death of more than 50% of patients with type 1 diabetes.
The most unfavorable complications of diabetes of the first type is diabetic coma (ketoatsidoticheskaya, lactate-acidotic and hyperosmolar).
Is characterized by a relatively long period of asymptomatic course of the disease. The first signs of diabetes of the 2nd type, are gradual. Patients concerned about the same symptoms as in type 1 diabetes, but less pronounced dry mouth, thirst, itching, pain in the legs, infection of skin and mucous membranes. Also, often there is hypertension, vision disorders, various neuropathies, and erectile dysfunction.
Does not have any specific symptoms that would allow to suspect its presence without laboratory diagnosis. Therefore, all pregnant women, regardless of the indicators previous pregnancy, conducted a laboratory test to determine the level of glucose with and without load.
Diabetes mellitus of the 1st type is detected using the blood test on sugar on an empty stomach and with a load. The level of glucose in venous blood on an empty stomach over a 6.1 mmoll, and the load above 10 mmoll are the basis for diagnosis.
The degree of compensation of diabetes-type 1 is estimated with the help of such analyses and tests
- a blood test for glycated hemoglobin (Hbalc)
- determination of glucose in blood plasma fasting and 2 hours after a meal
- the General analysis of urine and blood
- urine test for ketone bodies
- the serum bilirubin, the amount of lipoproteins of low and high density (LDL, HDL), cholesterol, triglycerides, ketone bodies, liver enzymes (ALT, AST), trace elements (potassium, calcium, phosphorus, sodium), urea and creatinine
- ECG (electrocardiogram)
- photo x-rays
- ophthalmoscopy with dilated pupils.
In cases where diagnosis is difficult, resort to the tests for C-peptide level, and is carried out to determine immunological and genetic markers of type 1 diabetes type.
Diagnosis of type 2 diabetes mellitus and gestational diabetes mellitus did not significantly differ, the differentiation of the diagnosis is carried out based on examination of the patient and medical history.
Diabetes of any type is characterized by the fact that his treatment should be for life.
Treatment of diabetes of the 1st type
- lifelong insulin (recombinant human insulin (Actrapid, protafan) and genetically engineered insulins (Apidra, Lantus and Novo-rapid)
- diet (limit consumption of glucose)
- normalized physical activity
- patient education daily self-monitoring of glucose level in plasma
- prevention and treatment of late complications.
Treatment of diabetes of the 2nd type
- The 1st stage of the therapy aimed at reducing the consumption of fat and sugar, weight gain, normalized physical activity a daily dose of Metformin, or (if hypersensitive) sulfonylureas
- 2nd stage (with the ineffectiveness of monotherapy) appointment of two – or three-component of pharmacotherapy (Metformin with glibenclamide, Metformin with glipizide, etc.), perhaps the appointment of insulin (Actrapid, Humulin na)
- 3rd stage in addition to pharmacotherapy is assigned to daily administration of insulin.
Treatment of gestational diabetes
- diet (3 main meals and 3 snacks a day, daily calorie intake 25-30 kcalkg, the amount of carbohydrates 50-40% of the total ration, protein 20-25%)
- physical exercise (20 minutes 3 times a week)
- insulin therapy (insulin middle of the action, combined with short-acting insulin).