Diabetes mellitus type 1

Diabetes mellitus type 1is an endocrine disease characterized by insufficient insulin production and elevated blood glucose levels. Due to long-term hyperglycemia, patients suffer from thirst, lose weight and get tired quickly. It is characterized by muscle and headaches, cramps, itchy skin, increased appetite, frequent urination, insomnia, hot flashes. Diagnosis includes a clinical interview, blood and urine laboratory tests that reveal hyperglycemia, insulin deficiency, and metabolic disorders. Treatment is carried out with insulin therapy, diet and physical activity are prescribed.

General information

The term "diabetes" comes from the Greek and means "flowing, running away", so the name of the disease describes one of its key symptoms - polyuria, the excretion of large amounts of urine. Type 1 diabetes is also called autoimmune, insulin-dependent, and juvenile diabetes. The disease can manifest itself at any age, but it manifests itself more often in children and adolescents. In recent decades, there has been an increase in epidemiological indicators. The prevalence of all forms of diabetes mellitus is 1-9%, and the insulin-dependent variant of the pathology accounts for 5-10% of cases. The incidence depends on the ethnicity of the patients, and is highest among the Scandinavian peoples.

Causes of type 1 diabetes

Factors that contribute to the development of the disease continue to be studied. It is now established that type 1 diabetes mellitus arises from a combination of biological predisposition and external harmful influences. The most likely causes of pancreatic damage and reduced insulin production include:

• Heredity.The tendency to insulin-dependent diabetes is transmitted in a direct line - from parents to children. Several combinations of genes that predispose to this disease have been identified. They are most common among residents of Europe and North America. Having an affected parent increases the child's risk by 4-10% compared to the general population.
• Unknown external factors.There are certain environmental influences that cause type 1 diabetes. This fact is confirmed by the fact that identical twins, who have exactly the same set of genes, get the disease together only in 30-50% of cases. People who migrated from low-incidence areas to areas with higher epidemiology were also found to be more likely to develop diabetes than those who refused to migrate.
• Viral infection.An autoimmune response to pancreatic cells can be triggered by a viral infection. Coxsackie and rubella viruses are the most likely to affect.
• Chemicals, medicines.The beta cells of the insulin-producing gland can be damaged by certain chemicals. Examples of such compounds are rat poison and cancer medicine.

Pathogenesis

The pathology is based on the insufficient production of the insulin hormone in the beta cells of the islets of Langerhans of the pancreas. Insulin-dependent tissues include liver, fat, and muscle. When the secretion of insulin decreases, they stop taking glucose from the blood. A state of hyperglycemia occurs - a key sign of diabetes mellitus. The blood thickens, the blood flow in the vessels is disturbed, which is manifested by deterioration of vision and trophic lesions of the extremities.

Lack of insulin stimulates the breakdown of fats and proteins. They enter the bloodstream and are then metabolized by the liver into ketones, which become energy sources for non-insulin-dependent tissues, including brain tissue. When the concentration of sugar in the blood exceeds 7-10 mmol/l, an alternative pathway for glucose excretion is activated - through the kidneys. Glucosuria and polyuria develop, leading to an increased risk of body dehydration and electrolyte deficiency. To compensate for water loss, the feeling of thirst increases (polydipsia).

Classification

According to the recommendations of the World Health Organization, type I diabetes mellitus is divided into autoimmune (provoked by the formation of antibodies against gland cells) and idiopathic (there are no organic changes in the gland, the causes of the pathology remain unknown). The development of the disease takes place in several stages:

1. Identification of predisposition.Preventive examinations are carried out, genetic load is determined. Taking into account the average statistical indicators for the country, the level of risk of developing the disease in the future is calculated.
2. Initial initial moment.Autoimmune processes are activated and damage β-cells. Antibodies are already produced, but insulin production remains normal.
3. Active chronic autoimmune insulitis.The antibody titer becomes high, and the number of insulin-producing cells decreases. A high risk of developing diabetes in the next 5 years was determined.
4. Hyperglycemia after carbohydrate loading.A significant part of the cells that produce insulin is destroyed. Hormone production decreases. Normal fasting glucose levels are maintained, but hyperglycemia is detected within 2 hours after eating.
5. Clinical manifestation of the disease.Symptoms characteristic of diabetes mellitus appear. Hormone secretion is sharply reduced, 80-90% of gland cells are subject to destruction.
6. Absolute lack of insulin.All cells responsible for insulin synthesis die. The hormone enters the body only in the form of medicine.

Symptoms of type 1 diabetes

The main clinical signs of the disease are polyuria, polydipsia and weight loss. The urge to urinate becomes more frequent, the amount of daily urine reaches 3-4 liters, and sometimes bedwetting occurs. Patients feel thirsty, dry mouth and drink up to 8-10 liters of water per day. Appetite increases, but body weight decreases by 5-12 kg in 2-3 months. In addition, you may experience insomnia at night and sleepiness during the day, dizziness, irritability and fatigue. Patients feel constant fatigue and find it difficult to perform their usual work.

Itching of the skin and mucous membranes, rashes and ulcerations occur. The condition of hair and nails worsens, wounds and other lesions on the skin do not heal for a long time. Disturbance of blood flow in capillaries and vessels is called diabetic angiopathy. Capillary damage is manifested by reduced vision (diabetic retinopathy), reduced kidney function with edema, arterial hypertension (diabetic nephropathy), uneven redness on the cheeks and chin. With macroangiopathy, when veins and arteries are involved in the pathological process, atherosclerosis of blood vessels of the heart and lower extremities begins to progress and gangrene develops.

Half of patients develop symptoms of diabetic neuropathy, which is the result of electrolyte imbalance, insufficient blood supply and swelling of nerve tissue. Conductivity of nerve fibers deteriorates, convulsions occur. With peripheral neuropathy, patients complain of burning and pain in the legs, especially at night, a feeling of "pins and needles", numbness and increased sensitivity to touch. Autonomic neuropathy is characterized by disturbances in the functions of internal organs - symptoms of digestive disorders, bladder paresis, genitourinary infections, erectile dysfunction and angina In focal neuropathy, pain of different localization and intensity occurs.

Complications

Prolonged disturbance of carbohydrate metabolism can lead to diabetic ketoacidosis, a condition characterized by the accumulation of ketones and glucose in the plasma and increased acidity of the blood. It occurs acutely: appetite disappears, nausea and vomiting appear, abdominal pain and the smell of acetone in exhaled air. In the absence of medical help, confusion, coma and death occur. Patients with signs of ketoacidosis require immediate treatment. Other dangerous complications of diabetes include hyperosmolar coma, hypoglycemic coma (with improper use of insulin), "diabetic foot" with the risk of limb amputation, severe retinopathy with complete loss of vision.

Diagnostics

Patients are examined by an endocrinologist. Sufficient clinical criteria for the disease are polydipsia, polyuria, changes in body weight and appetite - signs of hyperglycemia. During the survey, the doctor also clarifies the presence of hereditary burden. Doubts about the diagnosis are confirmed by the results of blood and urine laboratory tests. Detection of hyperglycemia makes it possible to distinguish diabetes mellitus from psychogenic polydipsia, hyperparathyroidism, chronic renal failure and diabetes insipidus. In the second stage of diagnosis, differentiation of different forms of diabetes is carried out. A comprehensive laboratory examination includes the following tests:

• Glucose (blood).Determination of sugar is performed three times: in the morning on an empty stomach, 2 hours after the carbohydrate load and before going to bed. Hyperglycemia is indicated by a reading of 7 mmol/l on an empty stomach and 11. 1 mmol/l after consuming food with carbohydrates.
• Glucose (urine).Glucosuria indicates persistent and severe hyperglycemia. Normal values for this test (in mmol/l) are up to 1. 7, borderline - 1. 8-2. 7, pathological - more than 2. 8.
• Glycated hemoglobin.Unlike free glucose that is not bound to proteins, the amount of glycosylated hemoglobin in the blood remains relatively constant throughout the day. The diagnosis of diabetes is confirmed at rates of 6. 5% and more.
• Hormonal tests.Insulin and C-peptide tests are performed. The normal concentration of immunoreactive insulin in fasting blood ranges from 6 to 12. 5 µU/ml. The C-peptide indicator allows you to assess the activity of beta cells and the volume of insulin production. The normal result is 0. 78-1. 89 μg/l, and in diabetes mellitus the marker concentration is reduced.
• Protein metabolism.Creatinine and urea tests are done. The final data make it possible to clarify the functionality of the kidneys and the degree of change in protein metabolism. If the kidneys are damaged, the levels are higher than normal.
• Lipid metabolism.For early detection of ketoacidosis, the content of ketone bodies in the bloodstream and urine is examined. To assess the risk of atherosclerosis, the level of cholesterol in the blood (total cholesterol, LDL, HDL) is determined.

Treatment of type 1 diabetes

The efforts of doctors are aimed at eliminating the clinical manifestations of diabetes, as well as at preventing complications, teaching patients to independently maintain normoglycemia. Patients are monitored by a multiprofessional team of specialists that includes endocrinologists, nutritionists and exercise instructors. Treatment includes consultations, medication and educational sessions. The main methods include:

• Insulin therapy.The use of insulin preparations is necessary for maximally achievable compensation of metabolic disorders and prevention of hyperglycemia. Injections are vital. The application regimen is made individually.
• Diet.Patients are prescribed a low-carbohydrate diet, including a ketogenic one (ketones serve as an energy source instead of glucose). The basis of the diet consists of vegetables, meat, fish and dairy products. Sources of complex carbohydrates - whole grain bread, cereals - are allowed in moderate amounts.
• Dosed individual physical activity.Physical activity is beneficial for most patients who do not have severe complications. The classes are individually selected by the physical therapy instructor and conducted systematically. The specialist determines the duration and intensity of training taking into account the general health of the patient and the level of diabetes compensation. Regular walking, athletics and sports games are prescribed. Strength sports and marathon running are contraindicated.
• Self-control training.The success of diabetes treatment largely depends on the patient's level of motivation. In special classes, they are told about the mechanisms of the disease, possible ways of compensation, complications, and the importance of regular monitoring of the amount of sugar and the use of insulin is emphasized. Patients learn the skills of self-administration of injections, selection of food products and creation of menus.
• Prevention of complications.Medicines are used to improve the enzymatic function of glandular cells. These include agents that promote tissue oxygenation and immunomodulatory drugs. Timely treatment of infections, hemodialysis and antidote therapy are carried out to remove compounds that accelerate the development of pathology (thiazides, corticosteroids).

Among the experimental methods of treatment, it is worth highlighting the development of special DNA vaccines for the treatment of diabetes mellitus in the early stages of development. In patients who received intramuscular injections for 12 weeks, the level of C-peptide, a marker of pancreatic islet cell activity, increased. Another line of research is the transformation of stem cells into insulin-producing gland cells. Experiments conducted on rats gave positive results, but for the application of the method in clinical practice, evidence of the safety of the procedure is needed.

Prognosis and prevention

The insulin-dependent form of diabetes mellitus is a chronic disease, but proper maintenance therapy allows patients to maintain a high quality of life. Preventive measures have not yet been developed, because the exact causes of the disease have not been clarified. Currently, all people at risk are recommended to undergo annual examinations in order to detect the disease at an early stage and start treatment as soon as possible. This measure allows you to slow down the process of creating permanent hyperglycemia and minimize the likelihood of complications.