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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 hormonal 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, so it is divided into several types.

The types of diabetes mellitus (DM) are defined by the World Health Organization and have no fundamental differences throughout the medical world.Diabetes mellitus of any type is not a contagious disease.

Typing of pathology

There are several types of the disease, united by one main symptom – increased concentration of glucose in the blood.The classification of diabetes mellitus is determined by the causes of its occurrence.The treatment methods used, the gender and age of the patient also take 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), or 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 (varieties of MODY 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 as a result of congenital infections;
  • Diabetes associated with genomic pathologies and hereditary defects;
  • impaired fasting glucose (blood sugar) and impaired glucose tolerance.

Prediabetes is a borderline state of the body when the glycemic level is increased (impaired 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 endocrinologist 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 throughout the world.Over the past 20 years, the number of type 2 diabetics has doubled.GDM accounts for about 5% of pregnancies.Types of specific 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 the gain of 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 inability of pancreatic cells.The organ does not fulfill its endocrine (intrasecretory) function of producing insulin, the hormone responsible for supplying the body with glucose.As a result of the accumulation of glucose in the blood, the organs do not receive adequate nutrition, including the pancreas itself.

To imitate 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, for 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.With regard to diabetes, a child inherits a predisposition to the disease from parents or close relatives with diabetes.

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

Autoimmune cause

The occurrence 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.Triggers (impetus) for the launch of autoimmune processes are:

  • unhealthy eating behavior combined with physical inactivity;
  • failure of metabolic processes (carbohydrate, lipid and protein);
  • critical deficiency of cholecalciferol and ergocalciferol (vitamins D) in the body;
  • pathologies of the pancreas of a chronic nature;
  • 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 medications.

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 delivered 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 through hypoglycemic (sugar-lowering) medications 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 cell susceptibility to the endogenous hormone is primarily associated with obesity, which disrupts fat and carbohydrate metabolism.

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

  • alcohol abuse;
  • gastronomic addiction to sweet dishes;
  • chronic diseases of the pancreas;
  • pathologies of the heart and vascular system;
  • excess in eating against the backdrop of a sedentary lifestyle;
  • incorrect hormone therapy;
  • complicated pregnancy;
  • Unfavorable heredity (diabetes in parents);
  • distress.

The disease most often develops in women and men aged 40+.At the same time, type 2 diabetes is latent and may not show pronounced symptoms for several years.Testing your blood glucose levels early can reveal prediabetes.With adequate treatment, the prediabetic condition is reversible.If time is lost, it progresses and NIDDM is subsequently diagnosed.

Lada diabetes

In medicine, the term “Diabetes 1.5” is used, or the name Lada diabetes.This is an autoimmune disorder of hormone production and metabolic failure that occurs in adults (aged 25+).The disease combines the first and second types of diabetes.The development mechanism corresponds to IDDM, the latent course and manifestation of symptoms are similar to NIDDM.

Triggers for the development of 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 gland (Hashimoto's thyroiditis);
  • juvenile and rheumatoid arthritis;
  • change in color (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 IgG class immunoglobulins to 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 most often detected during the second scheduled screening, when the expectant mother undergoes a full examination.The main characteristic of GDM coincides with type 2 diabetes – insulin resistance.The cells of a pregnant woman’s body 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.Plus, the endocrine hormones of the placenta, which tend to inhibit the production of insulin, are gaining strength.
  • Double the load on the female body.To ensure adequate nutrition for the unborn child, the body requires an increased amount of glucose.A woman begins to consume more monosaccharides, which causes the pancreas to synthesize more insulin.
  • Increase in body weight due to decreased physical activity.Glucose, which enters the body in abundance, accumulates in the blood because the cells refuse to accept insulin due to obesity and physical inactivity.The expectant 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, since insulin molecules and the functionality of the pancreas are preserved.

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

Additionally

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

  • diseases of the pancreas: pancreatitis, hemochromatosis, tumor, cystic fibrosis, mechanical injuries and operations 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 fluid balance in the body.

Diagnostic measures

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

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

Blood sugar reference values and disease indicators

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