Currently, the main causes of morbidity, disability and mortality of the population are diseases of a non-infectious nature: cardiovascular, oncological, neuropsychic and others. The problem of endocrine diseases, and in particular diabetes mellitus, is becoming increasingly important among them.
Diabetes mellitus (sugar disease) was known for thousands of years BC. The word “diabetes” literally translated from Greek means “leaking”, which reflects one of the main signs of sugar disease – the consumption and subsequent release of a huge amount of fluid by a sick person.
With this disease, which can occur at any age and continue throughout life, the pancreas does not produce enough insulin. As a result, disorders of carbohydrate metabolism are formed in the body, and then (if the disease is not treated) and fat metabolism. This, in turn, has a detrimental effect on the quality of human life and life.
The role of the pancreas in the body and the relationship with diabetes mellitus
In order to have a good idea of the mechanism of development of diabetes mellitus and the associated changes in the body, one should clearly understand what role the pancreas plays.
As the name implies, it is located under the stomach. Its mass in an adult is 65–80 grams; length – 12-15 centimeters, width – 5-7 centimeters, thickness – 2-3 centimeters. It is abundantly supplied with blood vessels and nerves. This endocrine gland is involved in the digestion process, since it secretes into the gastrointestinal tract a secretion containing enzymes necessary for the digestion of food. Along with this, it constantly produces a very important hormone insulin, which is involved in glucose metabolism and in the formation of a complex polysaccharide – glycogen, which is deposited in the liver and plays a huge role in energy balance.
Due to the violation of the basic functions of insulin in the body in diabetes mellitus, the following deviations occur:
- the cells of the body cannot sufficiently use glucose for their vital activity;
- glucose not used for energy production is not sufficiently converted into glycogen and fats;
- glucose is additionally formed from proteins.
Disorders of carbohydrate metabolism
Due to the lack of insulin in the body, sugar burns very slowly and is not deposited in tissues at all, the cells of the body cannot use glucose in sufficient volume for their vital functions, as a result, the blood sugar level also decreases extremely slowly. Each subsequent meal causes a new increase in sugar concentration, as a result of which the rise in blood sugar levels is constantly increasing.
Molecular model of fat
Fats obtained from food or mobilized from places of deposition can normally be used by the body only with sufficient combustion of carbohydrates, which is impossible in diabetes due to a lack of insulin production. Incomplete breakdown of fats occurs, and extremely toxic decomposition products are formed in the body – ketone bodies (acetone, acetoacetic acid, beta- hydroxybutyl acid). Due to the increased content of ketone bodies in the blood and, as a consequence, their excessive excretion in the urine, water-salt metabolism is disturbed, which in turn leads to dehydration (dehydration).
Protein metabolism disorders
Along with disorders of carbohydrate and fat metabolism, insulin deficiency also causes disturbances in protein metabolism. This is mainly manifested in the weakening of the formation of protein and its greater use as a source of energy. Inhibition of protein synthesis from amino acids is a prerequisite for the formation of carbohydrates from them. In diabetes mellitus, the formation of carbohydrates from protein ( glyconeogenesis ) increases significantly. The protein composition of blood plasma also changes.
Classification of diabetes
There are several stages of diabetes, depending on the severity of the manifestations and the nature of the deviations of laboratory parameters.
Prediabetes is the earliest (latent) stage, a state of predisposition to the disease. This stage is not characterized by an increase in blood sugar, but everyone needs to know if they are at risk.
Risk factors are:
- the presence of diabetes mellitus in parents;
- identification of diabetes mellitus in one of the identical twins;
- the birth of a child weighing 4 kilograms or more, as well as a complication during pregnancy (toxicosis, fetal death).
In many cases, diabetes prevention and detection at this stage will prevent the development of the disease.
Impaired glucose tolerance (latent diabetes) is another latent stage of diabetes. It is asymptomatic, determined by laboratory tests with glucose load. At this stage, pregnant women at various times may experience a large body weight (or even death) of the fetus, less often neuroderma , changes in the vessels of the kidneys and retina of the eyes, dental diseases, boils, carbuncles and more are found.
Explicit diabetes mellitus is characterized by an increase in blood sugar levels on an empty stomach or during the day, as well as its appearance in the urine; with a more severe course of the disease – an increase in the level of ketone bodies in the blood, their excretion in the urine. This stage can also be asymptomatic , but most patients have:
- losing weight;
- general weakness;
- periodontal disease;
- increased volume of excreted urine;
- skin changes;
- slow wound healing;
- boils, carbuncles.
More often, in comparison with the stages described above, the following are observed:
- changes in the vessels of the eyes and kidneys;
- atherosclerosis of large vessels;
- inflammatory kidney disease;
- fatty liver;
- growth retardation (with diabetes in children).
Diabetes mellitus, in turn, is subdivided into insulin-dependent (type I) and insulin-independent (type II): a) in persons without obesity , b) in persons with obesity .
Diabetes is distinguished, the occurrence of which is due to certain conditions or syndromes:
- diseases of the pancreas (congenital absence of islets of Langerhans or their functional insufficiency);
- endocrine diseases (Itsenko- Cushing’s syndrome , acromegaly, pheochromocytoma and others); the use of certain drugs or chemicals (adrenocorticotropic hormone, glucocorticoids , analgesics, diuretics, catecholamines, and others);
- genetic syndromes (congenital metabolic disorders, genetic diseases and others);
- insulin receptor pathologies;
- mixed reasons.
Diabetes is conventionally divided into three degrees of severity according to the following positions:
- blood sugar levels;
- the amount of sugar excreted in the urine;
- the nature of the clinical course and treatment used;
- the duration of the disease;
- the severity of the existing complications.
With a mild degree of the disease, the blood sugar content does not exceed 11.1 mmol / l, its daily loss in urine is no more than 20 grams. Wellness and performance are supported by strict adherence to diet. However, in case of infectious diseases, intoxications of various kinds, surgical interventions and in some other cases, the administration of small doses of insulin (up to 20 units per day) is required for several days.
Diabetes of moderate severity includes forms in which an increase in ketone bodies is absent or is quickly eliminated under the influence of treatment. The blood sugar level does not exceed 16.7 Mmol / l. Its daily loss in urine is no more than 100 grams. In addition to the diet, to eliminate these manifestations and preserve the ability to work, it is necessary to administer moderate doses of insulin (no more than 60 units per day) or oral administration of drugs that reduce sugar (sulfonamides or biguanides ). Under some unfavorable conditions, patients may experience hypo – and hyperglycemia, ketoacidosis . Then the daily dose of insulin increases (sometimes doubles).
By heavy degree includes all forms of the disease, for which repeatedly found to have elevated blood levels of ketone bodies repeatedly encountered prekomatosnoe condition or diabetic coma. The fasting blood sugar before the start of treatment is fixed at over 16.7 mmol / l, there is a labile course, a tendency to ketoacidosis . To compensate for carbohydrate metabolism, high doses of insulin (more than 60 units per day) or oral sugar-lowering drugs are required. This degree is accompanied by various complications that determine the nature of the course of diabetes. Such diabetes most often develops at a young age, it is characterized by a complete lack of insulin resources, a tendency to ketosis and hypoglycemic reactions in case of insulin overdose.
Depending on the characteristics of the course of the disease, the following types of diabetes are distinguished:
The division is conditional, but it largely determines the nature of the treatment.
Juvenile type diabetes
Juvenile diabetes usually occurs in children younger than 15 years of age. It is characterized by a rapid onset, high severity of symptoms, and a tendency to ketosis . To normalize metabolic processes and alleviate the condition, most patients require diet and insulin therapy.
Adult type diabetes
Adult-onset diabetes is more common in people over 40. Their onset of the disease is often latent, gradual, has a stable course, is well compensated by a diet that restricts carbohydrates, or a diet in combination with antihyperglycemic drugs (in a third of patients, a diet in combination with the administration of insulin).
Depending on the severity and duration of diabetes mellitus, its manifestations are very different (from general weakness, severe thirst – the use of 8-10 liters or more of liquid per day, sharp weight loss – a loss of 10-12 kilograms in 2-3 months against the background of increased appetite, dryness in the mouth, fatigue to pustular diseases, long non-healing wounds and even vulvitis (inflammation of the external genital organs) in women and balanitis (inflammation of the skin of the glans penis) in men.
Attention to your condition and timely access to a doctor will help prevent many life-threatening consequences.