Diabetes mellitus type 1

Diabetes mellitus type 1is an endocrine disease characterized by insufficient insulin production and increased 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, and hot flashes. Diagnosis includes a clinical interview, blood and urine laboratory tests that detect hyperglycemia, insulin deficiency, and metabolic disorders. Treatment is carried out with insulin therapy, diet and physical exercises 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 main symptoms - polyuria, the passage of large amounts of urine. Type 1 diabetes is also called autoimmune, insulin-dependent and juvenile. The disease can appear at any age, but it is more common in children and adolescents. An increase in epidemiological indicators has been observed in recent decades. The prevalence of all forms of diabetes is 1-9%, and the insulin-dependent variant of the pathology is found in 5-10% of cases. The incidence depends on the ethnicity of the patients and is highest among Scandinavian peoples.

Causes of type 1 diabetes

The study of factors contributing to the development of the disease continues. It has now been established that type 1 diabetes mellitus occurs based on a combination of biological predisposition and external negative influences. The most likely causes of pancreatic damage and decreased insulin production are:

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

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 - the main symptom of diabetes mellitus. Blood thickens, blood flow in the vessels is disturbed, this is manifested by deterioration of vision and trophic lesions of the extremities.

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

Classification

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

1. Determination of inclination.Preventive examinations are carried out, genetic load is determined. Taking into account the average statistical indicators for the country, the level of the risk of developing the disease in the future is calculated.
2. Initial start time.Autoimmune processes are activated and β-cells are damaged. Antibodies are already produced, but insulin production remains normal.
3. Active chronic autoimmune insulitis.The antibody titer increases and the number of insulin-producing cells decreases. It was determined that the risk of developing diabetes in the next 5 years is high.
4. Hyperglycemia after carbohydrate loading.A significant part of the insulin-producing cells is destroyed. Hormone production decreases. Normal fasting glucose levels are maintained, but hyperglycemia is detected within 2 hours after a meal.
5. Clinical manifestation of the disease.Symptoms characteristic of diabetes mellitus appear. Hormone secretion decreases sharply, 80-90% of gland cells are destroyed.
6. Absolute insulin deficiency.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 is frequent, the daily volume of urine reaches 3-4 liters, sometimes bedwetting occurs. Patients feel thirsty, dry mouth, 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 drowsiness, dizziness, irritability and fatigue during the day. Patients feel constant fatigue and find it difficult to perform their usual tasks.

Itching of the skin and mucous membranes, rashes and ulcers occur. The condition of hair and nails deteriorates, wounds and other skin injuries do not heal for a long time. Disruption of blood flow in capillaries and veins 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 vessels and arteries are involved in the pathological process, atherosclerosis of the vessels of the heart and lower extremities begins to progress and gangrene develops.

Half of patients develop symptoms of diabetic neuropathy caused by electrolyte imbalance, insufficient blood supply, and swelling of nerve tissue. The permeability of nerve fibers deteriorates, convulsions are provoked. Patients with peripheral neuropathy complain of burning and pain in the legs, especially at night, "pins and needles", numbness and increased sensitivity to touch. Autonomic neuropathy is characterized by dysfunction of internal organs - symptoms of digestive disorders, bladder paresis, genitourinary infections, erectile dysfunction and angina. With focal neuropathy, pain of different localization and intensity occurs.

Complications

Long-term disturbance of carbohydrate metabolism can lead to diabetic ketoacidosis, a condition characterized by the accumulation of ketones and glucose in the plasma and an increase in blood acidity. It happens acutely: appetite disappears, nausea and vomiting, abdominal pain and the smell of acetone appear in the exhaled air. In the absence of medical assistance, confusion, coma, and death occur. Patients with symptoms of ketoacidosis require urgent treatment. Other dangerous complications of diabetes include hyperosmolar coma, hypoglycemic coma (with improper use of insulin), "diabetic foot" with a 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 weight and appetite - symptoms of hyperglycemia. During the examination, the doctor also clarifies the presence of hereditary burden. The suspected diagnosis is confirmed by the results of blood and urine laboratory tests. Detection of hyperglycemia allows to distinguish diabetes from psychogenic polydipsia, hyperparathyroidism, chronic renal failure and diabetes insipidus. In the second stage of diagnosis, different forms of diabetes are differentiated. A comprehensive laboratory examination includes the following tests:

• Glucose (blood).Sugar is determined three times: in the morning on an empty stomach, 2 hours after a carbohydrate load and before going to bed. Hyperglycemia is indicated by indicators of 7 mmol/l on an empty stomach and 11. 1 mmol/l after taking carbohydrate foods.
• 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, which is not bound to protein, the amount of glycosylated hemoglobin in the blood remains relatively constant throughout the day. The diagnosis of diabetes is confirmed at a rate of 6. 5% or higher.
• Hormonal tests.Insulin and C-peptide tests are performed. Normal fasting blood concentration of immunoreactive insulin ranges from 6 to 12. 5 µU/ml. The C-peptide indicator allows to assess the activity of beta cells and the volume of insulin production. The normal result is 0. 78-1. 89 μg/l, the concentration of the marker decreases in diabetes.
• Protein metabolism.Tests for creatinine and urea are carried out. The latest data allow 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 blood 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

Doctors' efforts are aimed at eliminating the clinical manifestations of diabetes, as well as preventing complications, teaching patients to independently maintain normoglycemia. Patients are accompanied by a multi-professional team of endocrinologists, nutritionists and exercise therapy instructors. Treatment consists of counseling, medication, and educational sessions. The main methods include:

• Insulin therapy.The use of insulin preparations is necessary for the maximum compensation of metabolic disorders and prevention of hyperglycemia. Injections are vital. Management mode is designed 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 is vegetables, meat, fish and dairy products. Sources of complex carbohydrates - whole grain bread, cereals - are allowed in moderation.
• Dosed individual physical activity.Physical activity is beneficial for most patients without severe complications. Lessons are selected individually 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 training and marathon running are contraindicated.
• Self-control training.The success of maintenance treatment for diabetes largely depends on the motivation level of the patients. During special trainings, they are told about the mechanisms of the disease, possible compensation methods, complications, and the importance of regular monitoring of the amount of sugar and the use of insulin is emphasized. Patients learn the ability to independently inject, choose food products, create a menu.
• Prevention of complications.Medicines are used to improve the enzyme function of gland cells. These include agents that promote tissue oxygenation and immunomodulators. In order to eliminate compounds that accelerate the development of pathology (thiazides, corticosteroids), timely treatment of infections, hemodialysis and antidote therapy are carried out.

Among experimental treatments, it is worth noting the development of specific DNA vaccines for the treatment of diabetes mellitus at an early stage of development. C-peptide, a marker of pancreatic islet cell activity, increased in patients who received intramuscular injections for 12 weeks. Another area of research is the transformation of stem cells into insulin-producing glandular cells. Experiments on rats gave positive results, but to use the method in clinical practice, proof of the safety of the procedure is required.

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. Since the exact causes of the disease have not been clarified, preventive measures have not yet been developed. Currently, all people in the risk group are recommended to undergo annual examinations in order to detect the disease at an early stage and start timely treatment. This measure allows to slow down the process of formation of persistent hyperglycemia and minimizes the possibility of complications.