Diabetes

Diabetes mellitus is a chronic endocrine disease in which blood glucose (sugar) levels are significantly increased.

Glucose is the main source of energy for humans; it is derived from food and is needed for tissues and organs to function properly. Insulin, a hormone produced by the pancreas, helps glucose enter cells and acts as a "key" to open the cell's "door". When the pancreas does not produce enough hormone or the body cannot use it effectively, diabetes develops.

The disease has no cure but can be controlled with medication. Uncontrolled or poorly controlled diabetes is linked to serious health consequences—complications: damage to tissues and organs, including the heart, kidneys (nephropathy), eyes (retinopathymembranes), ears (hearing loss) and nerves (diabetic neuropathy); amputation (diabetic foot), Alzheimer's disease, depression, dental disease.

The diabetes group includes a number of 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) that, if not controlled, can eventually develop into diabetes. type II road. Prediabetes and gestational diabetes are considered reversible conditions.

Less common types of diabetes include:

• monogenic diabetes (MODY, maturity-onset diabetes of the young, adult-onset diabetes in the young) is a genetically determined diabetes caused by mutations in many other geneseach other. 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 condition;
• Drug- or chemical-induced 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 2019, the worldwide prevalence of diabetes is estimated at 463 million cases. The number of patients with this disease is expected to increase to 578 million in 2030 and 700 million in 2045 (an increase of 25% and 51%, respectively). Also in 2019, diabetes was the 9th leading cause of death, with 1. 5 million deaths directly caused by this disease.

Reason

Type I diabetes is an autoimmune disease in which the body's immune system attacks and destroys insulin-producing pancreatic cells, leading to absolute deficiency. The disease usually occurs in children, but can develop at any age. The exact cause is unknown, but a combination of factors: genetic predisposition and environmental factors (not yet fully determined) are thought to play a major role. Patients with type 1 diabetes need to compensate for insulin deficiency on a daily basis, which is why the disease is called insulin-dependent diabetes.

Type II diabetes - the most common type of the disease, "insulin resistance" - is associated with impaired glucose absorption: the transport of insulin and glucose into cells is disrupted, causing hyperglycemia (increased sugar levels). in the blood). 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 cells (fat, muscle, liver) becomeinsulin resistance and not getting enough glucose. Why this happens is not entirely clear, but it is known that the main role in the occurrence of the disease is played by genetic factors (a person's own gene variations, family history of diabetestype II), overweight and a sedentary lifestyle (however, not all people with type II diabetes are overweight). The disease can develop at any age (even in childhood), but occurs most often in middle-aged and elderly people.

Gestational diabetes occurs in women (who do not have 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 mild, but with HD, the mother will have an increased risk of pre-eclampsia, depression and cesarean section, and the baby will have an increased risk of hypoglycemia (low blood sugar) and jaundice. , high birth weight. In addition, in the long term, children have a high risk of becoming overweight and developing type II diabetes.

Risk factors

Factors that increase the risk of diabetes vary depending on the type of diabetes.

Risk factors for type I diabetes include:

• family history of type I diabetes (relatives with the disease - parents, siblings);
• damage to the pancreas (infection, tumor, surgical intervention);
• presence of autoantibodies;
• physical stress (illness, surgery);
• disease 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 are at higher risk);
• overweight;
• high blood pressure;
• Low HDL, high triglycerides;
• sedentary lifestyle;
• gestational diabetes;
• polycystic ovary syndrome;
• heart disease, history of stroke;
• smoke.

Risk factors for gestational diabetes include:

• family history of diabetes or type II diabetes;
• overweight;
• ethnicity (African Americans, Hispanics, and other ethnic groups are at higher risk);
• GD's personal history;
• age over 25 years old.

Symptom

Symptoms of type I diabetes:

• strong thirst;
• frequent urination;
• blurred vision;
• Tired;
• unexplained weight loss.

Symptoms appear quite quickly - within a few days/weeks of illness onset. Sometimes they talk about the development of a life-threatening condition - diabetic ketoacidosis, which requires urgent care. Its signs: the smell of acetone in the mouth, dry skin, flushing, nausea, vomiting, abdominal pain, difficulty breathing, impaired concentration and attention.

Symptoms of type II diabetes:

• strong thirst;
• frequent urination;
• Tired;
• blurred vision;
• numbness in areas of the body, tingling in the arms or legs;
• ulcers heal slowly or not at all;
• frequent infections (gums, skin, vagina);
• unexplained weight loss.

Symptoms develop slowly, over several years, and may be so mild that the person does not notice them. Many people do not have typical symptoms of diabetes and do not consult a doctor promptly.

With gestational diabetes, the characteristic signs and symptoms of diabetes are often absent. It is worth noting increased thirst and frequent urination.

Diagnose

The main method for diagnosing type I and II diabetes is to determine blood glucose levels. Your doctor may recommend one of the following tests:

• analysis of fasting blood sugar levels - after 8-12 hours of fasting;
• glycated hemoglobin analysis - at any time, shows the average blood sugar level over the past two to three months, measures the percentage of blood sugar relative to 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 performed 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 will be additionally tested for the presence of autoantibodies. To diagnose gestational diabetes, a fasting blood sugar test is performed and the diagnosis is confirmed with an oral glucose tolerance test.

A patient diagnosed with diabetes may require consultation with doctors of related specialties: ophthalmologist, cardiologist, urologist, nephrologist, psychotherapistly et al.

Diabetes treatment

Treatment—blood sugar monitoring, insulin treatment, hypoglycemic drug treatment—depends on the type of diabetes. It is supplemented by proper nutrition, maintaining a normal weight and regular physical activity.

Treatment of type 1 diabetes includes insulin therapy (insulin injections or use of an insulin pump), regular blood sugar testing, and carbohydrate counting; Type II diabetes - mainly lifestyle modifications (weight loss, physical activity, healthy eating), blood sugar, cholesterol and blood pressure control, hypoglycemic drugs, insulin therapy.

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

If prediabetes is diagnosed, it is very important to adhere to a healthy lifestyle, eat properly and normalize 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 moving fromprediabetes to diabetes, chronic diseases (cardiovascular disease, nonalcoholic fatty liver disease, polycystic ovary syndrome), your doctor may prescribe hypoglycemic drugs, drugs to control cholesterol levels, and medicationslower blood pressure. .