Types of diabetes mellitus: types 1 and 2, gestational , insipidus and others

The term “diabetes mellitus” refers to a group of endocrine disorders that result in a persistent rise in blood glucose concentration (hyperglycemia). Initially, only types of diabetes such as type 1 and type 2 diabetes were diagnosed. As research has grown, other types have begun to be distinguished, such as gestational , latent, sugarless, and labile. Their differences are due to etiology and pathogenesis.

Type 1 diabetes mellitus

Type 1 diabetes mellitus is diagnosed in childhood and adolescence. The cause of the disease is considered to be insufficient production of insulin due to the destruction (destruction) of the cells of the pancreas that produce this hormone. An autoimmune variant (or immune- mediated diabetes) and an idiopathic variant ( occurring spontaneously, for no apparent reason) are distinguished. It is possible that diseases are provoked by viruses ( Coxsackie , meningovirus type 2, rubella, mumps, cytomegalovirus , encephalomyocarditis virus ). It is believed that they damage the cells that produce insulin in people who are genetically predisposed to this. There is usually a certain amount of time between a viral infection and the onset of diabetes. A number of signs indicate an autoimmune etiology:

• quite often other autoimmune disorders are simultaneously detected (for example, thyroidin, Addison’s disease);
• detection of antibodies to their own cells that produce insulin;
• insulitis – infiltration of islets of pancreatic tissue by lymphocytes, subsequently leading to cell destruction. Revealed by histological examination.

In children, in the case of an autoimmune etiology of the process, cells are destroyed quite rapidly. Often, within a year after the onset of the disease, the production of its own insulin completely stops. The onset of the disease has a latent (latent) period lasting from one year to several years. When specific antigens are detected in the blood, indicating a genetic predisposition, the risk of the onset of the disease increases several times. The trigger mechanism is most often a past viral infection, as well as stress, unbalanced diets, radiation, toxic or intense sun exposure. The body begins to produce antibodies against the cells of the pancreas, which are gradually destroyed and do not produce insulin. This type of diabetes is usually diagnosed when coma or severe acidosis develops. They occur suddenly and lead to conditions that threaten human life. If the diagnosis is confirmed, insulin replacement therapy begins immediately.

Type 1 diabetes requires lifelong treatment.

Type 2 diabetes mellitus

Type 2 diabetes mellitus is mainly diagnosed in adults or the elderly. The reason for its appearance is a decrease in the sensitivity of cells to their own insulin and its relative insufficiency. The main provoking moment is obesity. It also occurs in people of normal weight who have excessive fat deposits on the abdomen. In this case, the cells that produce insulin are not damaged. The level of this hormone in the blood is normal, often even increased. As a result of the lack of an adequate response, cells become insensitive to insulin. Over time, the production of the hormone in the body decreases. The onset of the disease can be triggered by diseases of the pancreas, infections, certain chemicals and even medications. Often, at the same time, an increased level of cholesterol is detected, eventually leading to atherosclerosis and massive damage to the vessels of the circulatory system. There is an increase in blood pressure, requiring medication. As a preventive measure, it is recommended to prevent the development of obesity, proper nutrition and physical activity. You should get rid of smoking and excess alcohol consumption, avoid stress, and maintain a balance between stress and rest. Often this is enough to avoid the appearance of the disease, even with a genetic predisposition.

Type 2 diabetes is treated with pills , but in difficult cases, insulin is required.

Gestational diabetes

It is detected during pregnancy, therefore its other name is pregnancy diabetes. A decrease in the sensitivity of tissue and cells to glucose causes a violation of carbohydrate metabolism. This is due to changes in hormonal levels in pregnant women and a sharp decrease in sugar levels that are required by the fetus and the placenta. In a normal state, the pancreas compensatory increases the production of insulin. If this does not happen, then gestational diabetes develops . The risk of developing diabetes in pregnant women is at risk for women who have a genetic predisposition and also have diabetes in their relatives. Other factors are:

• obesity;
• age over 30;
• the birth of a child weighing over 4 kg;
• miscarriages;
• stillbirth;
• diseases of the cardiovascular system;
• severe toxicosis and gestosis ;
• already diagnosed gestational diabetes.

Elevated blood glucose levels interfere with the normal development of the fetus. In the first trimester of pregnancy, miscarriages are possible, malformations of the brain and heart appear. At later stages, the fetus becomes large, hyperinsulinemia (increased insulin in the blood) is detected . Diabetic fetopathy may develop , in which the weight of the newborn exceeds 4 kg, his subcutaneous fat is increased. The body can be formed disproportionately. There may also be breathing problems. In addition, in the characteristics of blood, an increased viscosity is noted, and the risk of developing blood clots increases.

Most often, sugar levels return to normal on their own after the baby is born. In 10% of women, diabetes symptoms continue after childbirth. After 10-15 years, half of women diagnosed with gestational diabetes develop type 2 diabetes.

Latent diabetes

Another name is latent diabetes, prediabetes . For a long time, it does not manifest itself in anything, and disorders of carbohydrate metabolism are detected only during special laboratory tests. The provoking factors include:

• genetic predisposition;
• drops in blood pressure;
• obesity;
• inactive lifestyle;
• unbalanced diet;
• alcohol consumption;
• stress;
• hormonal problems.

Often, the disease is detected late, as a result, serious changes occur in the vessels, the threat of myocardial infarction and strokes increases.

Therapy for prediabetes is complex and consists of diet and regular physical activity, and medications are prescribed.

Subcompensated diabetes

This is not a separate type of disease, but a phase in the treatment of type 1 and type 2 diabetes, which occupies an intermediate position between decompensation and compensation (stabilization). There is no risk of coma. Together with urine, up to 50 g of sugar is lost during the day, and the level of glucose in the blood can rise to 7-13.8 mmol / l (normal values ​​are 3.3-5.6). All existing symptoms intensify at the same time. The following factors provoke subcompensation :

• irregular medication;
• diet disorders;
• stress;
• excessive physical and mental stress;
• chronic diseases affecting carbohydrate metabolism.

For stabilization, drug doses are usually adjusted and the factors that provoked subcompensation are eliminated . Untimely treatment leads to the fact that this condition becomes chronic.

Labile diabetes

Labile diabetes is most common in type 1 diabetes (about 10% of all cases). The risk group is mainly young patients and women, although the disease is detected in the elderly. It is characterized by changes in sugar levels for no apparent reason during the day against the background of selected therapy and without dietary disturbances. Sugar is often reduced to levels that cause hypoglycemia. At risk are also patients who incorrectly measure with a glucometer . The patient discovers sugar drops during self-measurement and begins to take additional medications, although in this case they are not needed. Sharp fluctuations in blood sugar levels can be accompanied by the development of ketoacidosis and hypoglycemic coma, which require urgent hospital treatment. In such patients, various complications are more common: damage to blood vessels, nerve fibers, blurred vision, which causes severe disability. To correct the condition, regular measurement of glucose levels is necessary. For treatment, short-acting insulin is used, the dose of which is easier to adjust taking into account the testimony of the glucometer . You also need regular physical activity and a healthy diet.

Diabetes insipidus

A rare diabetes that can be attributed to endocrinological diseases. It manifests itself after brain surgery. It is based on impaired absorption of fluid in the kidneys. Urine does not reach the required concentration and is excreted in large quantities from the body. The volume of released fluid varies between 4-7 liters per day. Another name for this disease is diabetes. At the same time, intense thirst arises. If the patient does not compensate for the excreted fluid, then signs of dehydration appear. Causes:

• Violation of the production of the antidiuretic hormone vasopressin in the hypothalamus (central, or hypothalamic variant). The cause may be a hereditary predisposition to low hormone production. Another option is the consequences of trauma, tumors and other brain damage that reduce hormonal secretion.
• Decreased sensitivity to the hormone of the kidney cells (renal, or nephrogenic ). It is much less common. Associated with a renal defect at the cellular level or insensitivity to vasopressin. It may appear after toxic effects (including medicinal) or be congenital.

Treatment is based on eliminating the cause. Tumors are removed, chronic diseases are treated, etc. Drugs that increase the production of vasopressin are used, and its synthetic analogue is introduced. Special attention is paid to the stabilization of water-salt metabolism. A kidney-friendly diet is selected.

Proper treatment can lead to a cure. However, an idiopathic illness requires lifelong medication.