Type 1 diabetes mellitus

Type 1 diabetes mellitus

In the modern world, diabetes mellitus is one of the diseases that belong to the category of serious medical and social problems of a global scale, since it has a high prevalence rate, severe complications, and also requires significant financial costs for diagnostic and therapeutic procedures, which will be necessary. sick all his life. That is why the mass of forces and resources of the entire healthcare sector is aimed at a deeper study of the causes and mechanisms of the development of diabetes mellitus, as well as at finding new effective methods for preventing and combating it.

What is type 1 diabetes?

Diabetes mellitus is a chronic disease, a characteristic feature of which is a violation of metabolic processes, accompanied by hyperglycemia (an increase in blood glucose), which occurs as a result of a violation of the production of insulin by the endocrine gland (pancreas), or a violation of its action. Statistics show that the total number of patients with diabetes mellitus of all forms in the world currently exceeds 160 million people. New cases of morbidity are recorded so often that the number of patients doubles every decade. The most severe form of diabetes mellitus in terms of correction and possible complications is considered type 1 diabetes mellitus, the incidence of which ranges from 8-10% of all cases of the disease.

Type 1 diabetes mellitus is a disease of the endocrine system, which is characterized by an increased concentration of glucose in the blood, which develops due to destructive processes in specific cells of the pancreas that secrete the hormone insulin, as a result of which there is an absolute lack of insulin in the body. A high incidence of type 1 diabetes mellitus is noted in adolescent and adolescent children – 40 cases per 100,000 people. Previously, this form of diabetes mellitus was called insulin-dependent and juvenile diabetes mellitus. 

There are two forms of type 1 diabetes mellitus : autoimmune and idiopathic. 

Causes contributing to the development of type 1 diabetes mellitus

The development of the autoimmune form of type 1 diabetes mellitus often begins in childhood, but it can also be diagnosed in the elderly. This reveals autoantibodies (antibodies produced against the human body’s own antigens) to the structural components of β-cells – specific cells of the pancreas that produce insulin, namely, to their surface antigens, insulin, glutamate decarboxylase, etc. They are formed due to congenital or acquired loss of tolerance (insensitivity) to the own antigens of β-cells. As a result of this process, autoimmune decay of β-cells develops. In children, the process of decay of these cells is rapid, therefore, within a year after the onset of the pathological process, the secretion of insulin in the pancreas completely stops. In the body of adults, the process of cell destruction takes longer, so β-cells can secrete enough insulin for a long time to prevent the development of such a complication of diabetes mellitus as ketoacidosis. However, a decrease in insulin secretion is inevitable, and after a certain time its absolute deficiency develops.   

Predisposes to autoimmune breakdown of insulin-producing cells in the pancreas and a number of genetic factors. Type 1 diabetes mellitus is often diagnosed in combination with such autoimmune diseases as diffuse toxic goiter, autoimmune thyroiditis, Addison’s disease, vitiligo, and autoimmune syndrome complex. 

Idiopathic type 1 diabetes is rare. At the same time, patients have no immunological and genetic factors for type 1 diabetes mellitus, but there are symptoms confirming the absolute deficiency of insulin. 

The course of type 1 diabetes mellitus

Type 1 diabetes mellitus is characterized by a latency period, the duration of which can range from one year to several years. The development of the disease goes through several stages:

Stage 1. The presence of a genetic predisposition. If specific antigens of the HLA system are found in the blood , then the likelihood of developing type 1 diabetes mellitus increases significantly.  

Stage 2. Estimated triggering factor. It can be agents of an infectious nature – enteroviruses, retroviruses, togaviruses, as well as non-infectious reasons – dietary features, psychoemotional stresses, exposure to chemicals, toxins and poisons, insolation (sun exposure), radiation, etc. 

Stage 3. Violations of the immune system are noted – the appearance of autoantibodies to antigens of β-cells, insulin, tyrosine phosphatase – with a normal level of insulin in the blood. In this case, the first phase of insulin production is absent.   

Stage 4. It is characterized by serious immune failures, namely, insulin secretion rapidly decreases due to the development of insulitis (inflammation in the islets of Langerhans pancreas containing cells that produce insulin), glucose resistance is impaired, while the blood sugar level remains within normal limits. 

Stage 5. Severe clinical manifestations are typical for it, since three quarters of the β-cells are destroyed by this time. Only the residual secretion of C-peptide is preserved.  

6 stage. Total death of β-cells. C-peptide is not detected, antibody titers are reduced. This stage is otherwise called total diabetes. The course of diabetes mellitus becomes uncontrollable, which threatens the development of severe complications – disseminated intravascular coagulation, edema of the cerebral cortex and the development of diabetic coma. 

How does type 1 diabetes manifest?

Since clinical signs appear at a time when most of the β-cells of the pancreas are destroyed, the onset of the disease is always acute and may first manifest itself as a severe form of acidosis or diabetic coma . In children and adolescents, the onset of the disease is characterized by signs of ketoacidosis. Sometimes patients can clearly name the day when they noted the signs of the disease that appeared. Sometimes the onset of the disease may be preceded by a severe viral infection (influenza, mumps, rubella).     

Patients may complain of dry mouth and thirst, caused by excessive excretion of fluid from the body by the kidneys, frequent urination, increased appetite along with an impressive loss of body weight (up to 10-15 kg per month), general weakness, and rapid fatigue. In addition, patients may complain of itching, pustular processes on the skin and nails, and blurred vision. On the part of the genital area, patients note a decrease in libido and potency. In the oral cavity, signs of periodontal disease, alveolar pyorrhea, gingivitis, stomatitis can be detected. carious damage to the teeth.

When examining patients with type 1 diabetes mellitus, an increase in the concentration of sugar in the blood and its presence in the urine are revealed. In the stage of decompensation, experts note dryness of the skin of patients, their mucous membranes, tongue, a decrease in the turgor of the subcutaneous fat, redness of the cheeks, forehead and chin due to the expansion of the skin capillaries of the face. If the decompensation process is delayed, patients may develop complications such as diabetic ophthalmopathy, nephropathy, peripheral neuropathy, diabetic osteoarthropathy, etc. Girls may develop infertility, and children may develop a noticeable impairment and retardation in growth and physical development.

Diagnostic criteria for type 1 diabetes mellitus

If, along with clinical signs, there is an increased concentration of glucose in the blood (more than 11.1 mmol / l) at any time of the day, then we can talk about diabetes mellitus.

The World Health Organization has developed a number of criteria that are used to diagnose diabetes mellitus. First of all, this is the determination of the level of glucose in the blood on an empty stomach, that is, when at least 8 hours have passed since the last meal. It is also obligatory to determine the blood glucose level in a random way, namely, at any time during 24 hours, regardless of the time of eating.

In order to assess the stage of diabetes mellitus the patient is in, it is necessary to conduct the following laboratory tests:

– general analysis of urine and blood;

– the concentration of glucose in the blood on an empty stomach, and then a couple of hours after eating food;

– determination of the level of glycated hemoglobin;

– the level of ketone bodies and glucose in daily urine;

– blood chemistry;

– urine analysis according to Nechiporenko.

For the purpose of differential diagnosis of type 1 diabetes mellitus, an analysis is carried out for the content of immunological and genetic markers and the level of C-peptide.

In addition, patients undergo a number of mandatory instrumental examinations – electrocardiography, chest x-ray and ophthalmoscopy.

Despite the fact that the clinical picture of insulin-dependent and non-insulin-dependent diabetes mellitus has many similar features, the differential diagnosis between them is based on a number of differences. If type 1 diabetes mellitus is characterized by a decrease in the body weight of patients, then for type 2, weight gain is more typical. Type 1 diabetes begins acutely, in contrast to type 2 diabetes, which is characterized by a slow onset of symptoms. Diabetes mellitus type 2 is more often diagnosed in adults and the elderly (over 45 years old), and type 1 – in children and young people. In laboratory studies, antibodies to antigens of β-cells are detected only in insulin-dependent diabetes.

If a patient has type 1 diabetes mellitus for the first time, he must be hospitalized in order to select an insulin treatment regimen, learn how to self-control blood glucose levels, and develop a diet and work regimen. In addition, patients in a precomatose and comatose state, with diabetic ketoacidosis, with an increase in angiopathies, with the addition of infections, as well as if it is necessary to carry out any surgical intervention, are subject to hospitalization.

Treatment for type 1 diabetes

The main goal of treatment of patients with type 1 diabetes mellitus is to preserve their life, as well as improve its quality. For this purpose, preventive measures are taken to prevent the development of acute and chronic complications, and to correct concomitant pathology.

Treatment of type 1 diabetes mellitus involves a set of measures, including insulin therapy, which is currently the only method for correcting absolute insulin deficiency . For these purposes, human insulin analogs or genetically engineered insulin are used in our country. Insulin replacement therapy can be carried out according to the traditional scheme, when a certain level of insulin is injected subcutaneously without constant adjustment of the dose to the level of glycemia. Intensified insulin therapy, which includes repeated injections of insulin, dietary adjustments by counting bread units, and monitoring glucose levels throughout the day, have great benefits. 

The next point of the diabetes treatment regimen is the development of a special nutrition program that will normalize body weight and help maintain blood glucose levels within normal limits. The food of patients with diabetes mellitus should be low-calorie, not contain refined carbohydrates (confectionery, sugary drinks, jams), and meal times should be strictly observed. It is necessary to exclude canned food, smoked meats, foods high in fat (sour cream, mayonnaise, nuts) from the diet. The ratio of the main energy components in the diet is usually equated to physiological, and it is 3: 1: 1.

Physical activity for patients with type 1 diabetes mellitus should be moderate and selected individually, based on the severity of the disease. The best form of physical activity is walking. However, it should be remembered that shoes should be selected so as to exclude the formation of corns and calluses, which can become the beginning of a formidable complication of diabetes mellitus – diabetic foot.

The outcome of diabetes mellitus treatment is directly related to the active participation of the patient himself, who should be trained by medical personnel in the methods of self-monitoring of blood glucose levels using glucometers and test strips, because he needs to carry out this manipulation at least 3-4 times a day. In addition, the patient must assess his condition, control the diet and the amount of physical activity, and also regularly visit the attending physician, who, in addition to talking with the patient, must examine the legs and measure blood pressure. Once a year, a patient with type 1 diabetes must undergo all the necessary tests (biochemical blood test, general blood and urine analysis, determination of the level of glycated hemoglobin), undergo an examination by an ophthalmologist and a neuropathologist, and make a chest X-ray. 

Prevention of type 1 diabetes mellitus

It is possible to prevent the development of type 1 diabetes mellitus in persons with a high genetic predisposition in the case of prevention of intrauterine viral infections, as well as infection with viral infections in childhood and adolescence. Should not include in the diet of children susceptible to the disease, nutritional formula containing gluten, foods with preservatives and dyes that can cause an autoimmune reaction against insulin-producing cells in the pancreas.

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