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Insulin-independent diabetes mellitus - the basis of pathogenesis and therapy. What is insulin dependent diabetes mellitus? Insulin dependent diabetes mellitus 1

Insulin-independent diabetes mellitus - the basis of pathogenesis and therapy. What is insulin dependent diabetes mellitus? Insulin dependent diabetes mellitus 1

is an endocrine disease characterized by insufficient production of insulin and an increase in blood glucose levels. Due to prolonged hyperglycemia, patients suffer from thirst, lose weight, and quickly get tired. Characterized by muscle and headaches, convulsions, itching, increased appetite, frequent urination, insomnia, hot flashes. Diagnosis includes a clinical survey, laboratory blood and urine tests that reveal hyperglycemia, lack of insulin, and metabolic disorders. The treatment is carried out by the method of insulin therapy, a diet, physical education is prescribed.

ICD-10

E10 insulin dependent diabetes mellitus

General information

The term "diabetes" comes from the Greek language and means "flows, flows out", thus 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. The disease can manifest itself at any age, but more often manifests itself 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%, the insulin-dependent variant of the pathology accounts for 5-10% of cases. The incidence depends on the ethnicity of the patients, being highest among the Scandinavian peoples.

Causes of type 1 diabetes

Factors contributing to the development of the disease continue to be investigated. To date, it has been established that type 1 diabetes mellitus arises on the basis of a combination of biological predisposition and external adverse influences. The most likely causes of damage to the pancreas, a decrease in insulin production include:

Heredity. The tendency to insulin-dependent diabetes is transmitted in a straight line - from parents to children. Several combinations of genes predisposing to the disease have been identified. They are most common among residents of Europe and North America. In the presence of a sick parent, the risk for the child increases by 4-10% compared with the general population.
unknown external factors. There are certain environmental influences that provoke type 1 diabetes. This fact is confirmed by the fact that identical twins, who have exactly the same set of genes, fall ill together only in 30-50% of cases. It was also found that people who migrated from an area with a low incidence to an area with a higher epidemiology are 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. The most likely influence of Coxsackie and rubella viruses.
Chemicals, drugs. The beta cells of the insulin-producing gland can be affected by certain chemicals. Examples of such compounds are rat poison and streptozocin, a drug for cancer patients.

Pathogenesis

The pathology is based on the insufficiency of the production of the hormone insulin in the beta cells of the islets of Langerhans of the pancreas. Insulin-dependent tissues include liver, fat and muscle. With a decrease in insulin secretion, they stop taking glucose from the blood. There is a state of hyperglycemia - a key symptom of diabetes. The blood thickens, the blood flow in the vessels is disturbed, which is manifested by visual impairment, trophic lesions of the limbs.

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 insulin-independent tissues, including brain tissue. When the blood sugar concentration exceeds 7-10 mmol / l, the secondary pathway for glucose excretion is activated - through the kidneys. Glucosuria and polyuria develop, as a result of which the risk of dehydration of the body and electrolyte deficiency increases. To compensate for the loss of water, 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 production of antibodies to gland cells) and idiopathic (organic changes in the gland are absent, the causes of the pathology remain unknown). The development of the disease occurs in several stages:

Identification of predisposition. Preventive examinations are carried out, genetic burden 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.
Initial starting moment. Autoimmune processes are turned on, β-cells are damaged. Antibodies are already being produced, but insulin production remains normal.
Active chronic autoimmune insulitis. The antibody titer becomes high, the number of insulin-producing cells decreases. A high risk of DM manifestation in the next 5 years is determined.
Hyperglycemia after carbohydrate loading. A significant part of the insulin-producing cells undergoes destruction. Hormone production is reduced. Normal fasting glucose levels are maintained, but hyperglycemia is determined within 2 hours after eating.
Clinical manifestation of the disease. Symptoms characteristic of diabetes mellitus appear. The secretion of the hormone is sharply reduced, 80-90% of the cells of the gland are subject to destruction.
Absolute insulin deficiency. All cells responsible for insulin synthesis die. The hormone enters the body only in the form of a drug.

Type 1 diabetes symptoms

The main clinical signs of disease manifestation are polyuria, polydipsia and weight loss. The urge to urinate becomes more frequent, the volume of daily urine reaches 3-4 liters, sometimes nighttime incontinence appears. Patients feel thirsty, feel 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. Additionally, there may be insomnia at night and drowsiness during the day, dizziness, irritability, fatigue. Patients feel constant fatigue, with difficulty doing their usual work.

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

Half of the patients have symptoms of diabetic neuropathy, which is the result of electrolyte imbalance, insufficient blood supply and swelling of the nervous tissue. The conductivity of nerve fibers worsens, convulsions are provoked. With peripheral neuropathy, patients complain of burning and painful phenomena in the legs, especially at night, a feeling of "goosebumps", numbness, increased sensitivity to touch. Autonomic neuropathy is characterized by failures in the functions of internal organs - there are symptoms of digestive disorders, paresis of the bladder, urogenital infections, erectile dysfunction, angina pectoris. With focal neuropathy, pains of various localization and intensity are formed.

Complications

Prolonged violation of carbohydrate metabolism can lead to diabetic ketoacidosis - a condition characterized by the accumulation of ketones and glucose in the plasma, an increase in blood acidity. It proceeds acutely: appetite disappears, nausea and vomiting appear, abdominal pain, the smell of acetone in the exhaled air. In the absence of medical care, confusion, coma and death occur. Patients with signs of ketoacidosis require urgent 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

Examination of patients is carried out by an endocrinologist. Sufficient clinical criteria of the disease are polydipsia, polyuria, changes in weight and appetite - signs of hyperglycemia. During the survey, the doctor also clarifies the presence of hereditary burden. The alleged diagnosis is confirmed by the results of laboratory tests of blood and urine. Detection of hyperglycemia makes it possible to distinguish between diabetes mellitus with psychogenic polydipsia, hyperparathyroidism, chronic renal failure, diabetes insipidus. At the second stage of diagnosis, differentiation of various forms of DM is carried out. A comprehensive laboratory examination includes the following tests:

Glucose (blood). The determination of sugar is performed three times: in the morning on an empty stomach, 2 hours after a load of carbohydrates and before bedtime. Hyperglycemia is indicated by indicators from 7 mmol / l on an empty stomach and from 11.1 mmol / l after eating carbohydrate foods.
Glucose (urine). Glycosuria indicates persistent and severe hyperglycemia. Normal values for this test (in mmol / l) - up to 1.7, borderline - 1.8-2.7, pathological - more than 2.8.
Glycated hemoglobin. Unlike free, unbound glucose, the amount of glycated hemoglobin in the blood remains relatively constant throughout the day. The diagnosis of diabetes is confirmed at rates of 6.5% and above.
Hormonal tests. Tests for insulin and C-peptide are carried out. The normal concentration of immunoreactive insulin in the blood on an empty stomach is from 6 to 12.5 mcU / ml. The C-peptide indicator allows you to evaluate the activity of beta cells, the volume of insulin production. The normal result is 0.78-1.89 µg/l; in diabetes mellitus, the concentration of the marker is reduced.
Protein metabolism. Creatinine and urea tests are performed. The final data make it possible to clarify the functionality of the kidneys, the degree of change in protein metabolism. With kidney damage, the indicators are above the norm.
lipid metabolism. For early detection of ketoacidosis, the content of ketone bodies in the bloodstream and urine is examined. In order to assess the risk of atherosclerosis, the level of blood cholesterol (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 self-maintain normoglycemia. Patients are accompanied by a multiprofessional team of specialists, which includes endocrinologists, nutritionists, exercise therapy instructors. Treatment includes consultations, the use of medicines, training sessions. The main methods include:

insulin therapy. The use of insulin preparations is necessary for the maximum achievable compensation of metabolic disorders, prevention of hyperglycemia. Injections are vital. The scheme of administration is compiled individually.
Diet. Patients are shown a low-carb, including a ketogenic diet (ketones serve as an energy source instead of glucose). The basis of the diet is vegetables, meat, fish, dairy products. In moderation, sources of complex carbohydrates are allowed - whole grain bread, cereals.
Dosed individual physical activity. Physical activity is useful for most patients who do not have severe complications. Classes are selected individually by the exercise therapy instructor and are conducted systematically. The specialist determines the duration and intensity of training, taking into account the general health of the patient, the level of diabetes compensation. Regular walking, athletics, sports games are prescribed. Power sports, marathon running are contraindicated.
Self-control training. The success of maintenance treatment in diabetes largely depends on the level of motivation of patients. In special classes, they are told about the mechanisms of the disease, about possible ways of compensation, complications, they emphasize the importance of regular control of the amount of sugar and the use of insulin. Patients learn the skill of self-administration of injections, food selection, and menu preparation.
Prevention of complications. Drugs are used that improve the enzymatic function of glandular cells. These include agents that promote tissue oxygenation, immunomodulatory drugs. Timely treatment of infections, hemodialysis, antidote therapy is carried out to remove compounds that accelerate the development of pathology (thiazides, corticosteroids).

Among the experimental methods of treatment, it is worth noting the development of the BHT-3021 DNA vaccine. In patients who received intramuscular injections for 12 weeks, the level of C-peptide, a marker of activity of pancreatic islet cells, increased. Another area of research is the transformation of stem cells into glandular cells that produce insulin. Experiments conducted on rats gave a positive result, but to use the method in clinical practice, evidence of the safety of the procedure is needed.

Forecast and prevention

Insulin-dependent form of diabetes mellitus is a chronic disease, but proper maintenance therapy helps to maintain a high quality of life for patients. Preventive measures have not yet been developed, since the exact causes of the disease have not been clarified. Currently, all people at risk are recommended to undergo annual examinations to detect the disease at an early stage and start treatment in a timely manner. This measure allows you to slow down the process of formation of persistent hyperglycemia, minimizes the likelihood of complications.

The insulin-dependent form of diabetes is characterized by the cessation of the production of its own hormone. As a result, to maintain the viability of the body, patients need daily injections of insulin.

Insulin-dependent diabetes mellitus (DM) develops as a result of the activation of an autoimmune process that inhibits beta cells that produce insulin. The reasons for this reaction of the body have not yet been elucidated.

Fundamental factors in the development of DM:

genetic predisposition;
diseases of the pancreas;
metabolic disorders and obesity;
intoxication of the body;
viral diseases.

Genetic predisposition, today, is a controversial factor. Indeed, the genes that provoke the development of pathology are inherited, but this does not mean one hundred percent probability of developing the disease. If two parents are diagnosed with insulin-dependent diabetes mellitus, the probability of developing pathology in a child does not exceed 17-20%. If only one parent is sick, this probability is reduced to 4-5%.

There are types 1 and 2 diabetes, and the second type of the disease is also insulin-dependent.

A characteristic difference between the two forms is the cause of the development of pathology. The insulin-dependent form of type 1 develops due to inhibition of insulin-producing cells, as a result, hormone production is reduced by 95%, and the substance produced by the body is not enough to normalize sugar levels.

Type 2 diabetes is an acquired form of the disease that develops against the background of impaired carbohydrate metabolism and obesity. The disease is characterized by cell resistance to insulin and glucose, as a result, glucose is not consumed and accumulates in the body.

Clinical picture

The disease is characterized by a violation of all metabolic processes in the body. In this case, first of all, protein and carbohydrate metabolism, immunity and water metabolism suffer. As a rule, this form of pathology develops at a young age. The following symptoms are typical for SD:

increased water intake due to ever-increasing thirst;
fast fatiguability;
rapid weight loss, which is accompanied by an increase in appetite;
symptoms of intoxication of the body;
skin irritations and rashes;
increased frequency of urination;
nervous disorders - irritability, insomnia, apathy.

The disease affects all body systems. Often there is a decrease in visual acuity. Patients complain of convulsions and numbness of the lower extremities. Diabetes is characterized by a deterioration in immunity and an increase in the frequency of infectious diseases.

A characteristic symptom is the smell of acetone in the exhaled air, which characterizes the development of ketoacidosis.

The insulin-dependent type of the disease is fraught with serious complications. If the necessary measures are not taken immediately upon detection of the first symptoms, the risk of diabetic coma is high.

Insulin dependent type 2 diabetes

Type 2 diabetes is more common than type 1 diabetes. Usually, the acquired form of the disease does not require insulin injections, and compensation is achieved by reducing the patient's weight, diet and exercise.

However, in some cases, type 2 diabetes (acquired with age), but insulin-dependent, occurs. Features of pathology are the immunity of cells to the hormone. As a result, insulin does not lower glucose levels, so hormone secretion increases. Due to the increase in insulin secretion, the pancreas malfunctions and, over time, its cells are depleted and destroyed.

In this case, the therapy of the disease completely repeats the therapy of type 1 diabetes.

Diagnosis of the disease

The disease has characteristic symptoms, but this is not enough to determine the severity and type of diabetes. Diagnosis is carried out using the following tests:

determination of the amount of glucose in the blood;
analysis for glycated hemoglobin;
urinalysis for the determination of ketone bodies;
determination of insulin levels.

These studies help to get a complete picture of the patient's health, determine the form of the disease and further treatment methods.

Treatment of the insulin-dependent form of the disease

DM is a chronic disease that cannot be cured. All treatment is aimed at compensating for the disease. One can talk about compensated diabetes only when the glucose level is normalized, and sharp jumps and deviations from the norm are not observed for a long time.

The danger of the disease lies in the development of complications of varying severity, some of them significantly reduce life expectancy and lead to death. Compensation of the disease can significantly reduce the risk of complications, so it is a priority for each patient.

Treatment includes:

daily injections;
diet therapy;
physical activity;
sugar control.

The scheme of hormone administration is selected by the attending physician. At the beginning of the development of the disease, the patient adheres to the insulin therapy regimen recommended by the doctor, however, as the disease progresses, the control over the number of injections and dosage is carried out by the patient independently.

The diet is selected taking into account the amount of carbohydrates in different products. In diabetes, a low-carbohydrate, properly balanced diet is indicated. You should follow the rules of a healthy diet, take into account the glycemic index of products. Patients eat small meals, but often, at least five times a day.

To adjust the menu and determine the effectiveness of insulin therapy, it is necessary to measure blood sugar levels several times a day.

The patient should without fail purchase an accurate portable glucometer.

Insulin-dependent type 2 diabetes is characterized by metabolic disorders, which affects the patient's lifestyle. Often these patients are obese. In this case, therapy necessarily includes exercise and a reduction in the calorie content of the menu.

During physical exercise, the susceptibility of muscle fibers to glucose increases, which always goes into consumption with a strong load. The more developed the muscles, the more they require glucose, which means that its level in the blood is reduced and it is better absorbed. Therefore, exercise is necessary to compensate for the disease.

Daily Injections

Insulin-dependent diabetes mellitus (diabetes mellitus) type 1 requires daily administration of the hormone. As a rule, the insulin therapy regimen is selected individually for each patient and adjusted if necessary.

The purpose of the administered hormone is to effectively lower the sugar level over a certain period of time. There are several types of drugs, depending on the duration of action.

The patient needs to learn to listen to his own body. Features of therapy with an administered drug are that the glucose level can sometimes drop to a critical value, which is fraught with the development of coma. Therefore, the patient must distinguish between the signals of his own body in order to respond in time to a critical level of sugar in the blood and take the necessary measures.

As a rule, injections of a short-acting drug are given before meals. Such drugs help to cope with the amount of glucose that increases immediately after eating. Also, twice a day, injections of a hormone of prolonged action are made, which effectively controls sugar levels throughout the day.

How to learn to live with a diagnosis?

Type 2 diabetes, like the insulin-dependent type of the disease, leaves a certain imprint on lifestyle, but you can learn to live with this diagnosis.

The patient should always listen to his own body and learn to distinguish the slightest hint of an increase or decrease in blood glucose levels. Patients eat according to the schedule. This is necessary in order to make an injection on time and control glucose levels. Foods high in simple carbohydrates are taboo.

Diet therapy and timely injections will avoid the development of complications. Physical activity becomes an important part of life, especially in type 2 pathology. It is impossible to allow excess weight gain, so diet and sports are constant companions of patients.

It should be remembered that a sudden sharp change in the concentration of sugar in the blood can cause negative consequences - confusion, fainting. The impetus for a decrease or increase in sugar is not only nutrition, but also occasional colds, stress, and the day of the menstrual cycle. This somewhat limits the patient's performance, so patients with diabetes should not choose professions that require the utmost concentration of attention. For extreme patients, night shifts and shift work are undesirable, as this leads to metabolic disorders and can cause complications.

However, if you carefully monitor your own health and adhere to the treatment regimen, the diagnosis will not become an obstacle to a fulfilling life.

Diabetes is a disease that people have been suffering from for hundreds of years. It is characterized by an increased level of sugar in the body. Diabetes mellitus is a very serious disease that affects not only the blood, but also almost all organs and systems. The following types of disease are distinguished: the first and second. The first is characterized by the fact that almost 90% of the cells of the pancreas cease to function.

In this case, complete insulin deficiency occurs, that is, the body does not produce insulin at all. This disease mainly occurs before the age of twenty and is called insulin-dependent diabetes mellitus.

The second type is non-insulin-dependent diabetes mellitus. In this case, the body produces insulin in large quantities, however, it does not perform its function. The disease is inherited and affects people after forty years of age, and those who are overweight.

Type 1 diabetes

They are characterized by the fact that they develop very quickly and occur in children and young people. It is also called "juvenile diabetes". For prevention, insulin injections are used, which are done regularly. Usually, the disease occurs due to the body's improper response to the pancreas (the cells that produce insulin are destroyed by the immune system).

Viral infections greatly increase the risk of type 1 diabetes. If a person has been ill with inflammation of the pancreas, then in 80% of cases this disease awaits him. Genetics play an important role, however, transmission in this way is rare.

Very often, type 1 diabetes mellitus (IDD) occurs suddenly during pregnancy. In this case, insulin injections are administered in order to support the body of the pregnant woman and the fetus. This type of diabetes in pregnant women has the ability to disappear after childbirth. Although women who have had this disease are at risk.

This type is more dangerous than the second and is caused by the following symptoms:

weakness of the body;
insomnia;
rapid weight loss;
elevated levels of acetone;
migraine;
aggressiveness;
muscle pain.

For the treatment of this disease use:

insulin;
physical exercise;
diet
help of a psychologist;
self-control.

The issue of assigning disability is decided by considering the entire medical history of the patient.

Type 2 diabetes

This form of the disease is less dangerous than the first, and occurs after 40 years. It is characterized by excessive secretion. It is treated with pills that normalize cells and increase the rate of glucose processing, intestines, liver and muscles.

The disease is manifested by the following symptoms:

scabies;
obesity;
migraine;
dry mouth;
pustular rash on the skin.

Insd is much easier than the insulin-dependent type. Complications of this disease are associated with poor functioning of the organs and systems of the body. If treatment is not carried out, then the following complications arise:

atherosclerosis;
neuropathy;
cardiovascular diseases;
diabetic coma.

Treatment is carried out in two interrelated areas:

lifestyle changes;
medical treatment.

The main symptoms of type 1 and type 2 diabetes

Diabetes mellitus of both types has the following symptoms:

constant desire to drink liquids (thirst);
bad sleep;
excessive urination;
apathy towards the outside world;
laziness.

In some cases, the patient experiences severe nausea, turning into vomiting, acetone in the blood rises and clouding of mind occurs. If such symptoms appear, a person should immediately receive qualified help. Otherwise, the likelihood of diabetic coma increases.

Secondary manifestations of the disease include:

physical exhaustion;
loss of strength in the muscles;
sudden weight loss;
sudden deterioration of vision;
constant drops in blood pressure;
migraine;
metallic taste in the mouth.

Causes of diabetes

Type 1 diabetes occurs as a result of the pathology of the immune system, in which pancreatic cells are perceived as foreign objects and destroyed.

Diabetes (insulin-dependent) often develops in childhood and in pregnant women. Reliable reasons why this happens, doctors can not find until now. But the emphasis is on the following factors:

viral infections;
autoimmune disorders of the body;
liver problems;
genetics;
excessive abuse of sweets;
big weight;
mental disorders.

Diagnosis of diabetes

In diabetes mellitus, it is extremely important to choose the right, high-quality and safe treatment. If the disease is diagnosed at an early stage, then it has a high chance of recovery. Persons with this disease should first of all contact an endocrinologist and register with him. Diagnosis of diabetes mellitus is carried out in the following areas:

examination by an endocrinologist;
study by echography;
cardiogram;
keeping records of the state of blood pressure (several times a day);
conducting laboratory tests.

For a blood test you need:

donate blood on an empty stomach and 2 hours after eating;
blood for hemoglobin glycosylation;
blood for glucose tolerance.

A urine test for sugar and acetone is also carried out.

Nutrition in insulin-dependent diabetes mellitus is not limited. If the dose of the drug used is calculated correctly, then the patient can take almost all products.

However, it should be remembered that sugar levels can fluctuate, and therefore it is still worth sticking to a certain diet. The main rule is to constantly monitor your condition and calculate the dose of the medicine.

Today, this is easy to do, since a device such as a glucometer is used. It is also recommended to record all the results in a diary specially designated for this.

This control is necessary not only in the first form of diabetes, but also in the second. And in this case, the patient will always take insulin.

Treatment with insulin

Treatment depends on insulin intake. In order for the disease to make itself felt as little as possible, you need to take into account the amount of sugar that enters the body with food.

A person who has such a diagnosis needs to understand that it will not be possible to completely overcome this disease. It is necessary to use not only medications, but also proper nutrition. The treatment of this disease is a new stage in a person's life, as he will need to constantly monitor sugar in order to prevent complications.

To date, insulin therapy is the most effective method of blocking pathology. But the patient must learn how to independently inject himself (they can be replaced with an insulin pump, since the introduction of the hormone through a catheter is more convenient).

The principle of nutrition is to get the right amount of calories and carbohydrates, but with a small amount of fat. In this case, fluctuations in glucose levels will not be too sharp. It is worth remembering that you need to veto all foods that contain a lot of calories and sugar. If all these rules are observed, diabetes mellitus will progress minimally.

Patients with diabetes eat 5-6 times a day the following foods:

vegetable soups;
lean meat;
seafood;

vegetables (except potatoes);
low-fat dairy products;
sweet and sour fruits and honey.

Such folk remedies are very effective:

ground pear - eat raw;
juice of one lemon and a chicken egg - on an empty stomach;
walnut leaf tea;
ground grain - drink a spoonful of powder with milk.

Complications of type 1 and type 2 diabetes

Diabetes has a very negative effect on the immune system. Therefore, a person becomes easily susceptible to various infections. Passes into an acute and chronic form. The most severe complications are hypoglycemia and ketoacidosis. With these complications, instead of glucose, the breakdown of fats occurs and the acidity in the blood increases.

If the diet is not followed and the amount of insulin administered is controlled, glucose decreases sharply and a glypoglycemic syndrome develops. In the case of insulin-dependent diabetes mellitus, this prognosis does not at all please the patient and his doctor. The body does not receive enough energy and reacts pathologically to this - if you do not give the body sweet, then a coma will come. If insulin-dependent diabetes is not treated, chronic diseases occur:

stroke;
heart attack;
hypertension;
atherosclerosis;
ulcers;
cataract;
kidney disorders.

Insulin-dependent diabetes mellitus is a serious disease that often leads to death. It is necessary to undergo regular examinations and take blood tests, this will help preserve the health of the body for many years.

Type 1 diabetes mellitus, or insulin-dependent diabetes mellitus (IDDM), is a fairly common serious illness associated with a malfunction of the pancreas. For some reason, this organ stops producing the required amount of the hormone insulin, which negatively affects the human hormonal background and all body systems.

How does this health disorder affect human health and is it possible to cure the insulin-dependent form of the disease?

Why does the disease develop?

If we consider the causes of type 1 diabetes, then they are based on the pathological effect of the protective functions of the body. In this case, the immune system begins to perceive pancreatic cells as foreign elements and seeks to destroy them.

Type 1 diabetes is more common in children, adolescents, and young adults. This ailment also does not bypass women during the bearing of a child, but, after the appearance of the baby, the symptoms disappear. However, in such a situation there is a risk that the disease will manifest itself, but already in the form of type 2 diabetes mellitus - non-insulin dependent.

Among the main reasons leading to the development of IDDM, experts note the following phenomena:

infections caused by viral pathogens;
autoimmune diseases;
liver pathology in severe forms;
heredity;
regular consumption of large amounts of sugary foods;
obesity;
frequent stressful situations;
depressive state.

In order not to cause insulin-dependent diabetes, this disease can radically change a person's life, and in addition to the status of "diabetic", he receives a lifelong dependence on insulin.

different stages of the disease

The disease has several stages, and each of them is accompanied by a number of clinical manifestations.

I stage

At the beginning of development, the disease does not manifest itself in any way, but as a result of genetic analyzes, defective genes can be detected.

Doctors are sure that preventive measures are extremely important if there are risks of developing the disease.

II stage

The transition of type 1 diabetes mellitus to the next stage is associated with the activation of catalysts. It is still not known exactly what becomes the impetus for this process, but if stage 1 is only a genetic predisposition, then here we are talking about pathological changes.

III stage

To determine the disease at this stage, the patient is prescribed tests to detect a specific antigen to b-cell antibodies. During diagnostic studies, specialists detect a decrease in the number of these cells, naturally, such a change leads to a decrease in insulin levels and an increase in glucose.

IV stage

It is called tolerant diabetes mellitus, the pronounced symptoms of which are still absent. But patients can still be bothered by common signs: mild malaise, increased inflammation of the conjunctiva and furunculosis, which often recur.

V stage

During this period, there are clear signs that occur with type 1 diabetes.

Symptoms are quite intense and after a few weeks, if the patient does not receive proper treatment, complications may occur in the form of ketoacidosis, a serious metabolic disorder.

If insulin replacement therapy is started in a timely manner, the progression of the disease can slow down significantly.

VI stage

We are talking about a severe course of ISD, in which the results of the analysis are disappointing - the production of insulin by the pancreas is completely stopped.

Symptoms of insulin dependent diabetes

As already noted, type 1 insulin-dependent diabetes mellitus at a certain stage manifests itself in the form of serious symptoms. Especially bright signs of the disease are manifested in children:

if in adults there is an increase in urination, then in babies it can manifest itself in the form of urinary incontinence;
energy loss leads to weight loss and a similar symptom is again more often manifested in young patients;
mucous membranes and skin become dry;
Diabetics are constantly hungry.

As for life-threatening complications - ketoacidosis or ketoacidotic coma, they are often the first signs of illness in children. This is due to the fact that babies are not able to talk about their own well-being.

According to statistics, more than 80% of people seek advice from a specialist no later than 3 weeks after they show clear signs of the disease.

Diagnostic examination

An endocrinologist knows how to detect insulin-dependent diabetes mellitus. First of all, he collects an anamnesis (history) of the disease, based on the patient's complaints, the symptoms present. Then he establishes a preliminary diagnosis and, in order to confirm it, appoints a series of laboratory tests:

a blood test that detects sugar levels (taken on an empty stomach and two to three hours after eating);
a blood test for the amount of glycated hemoglobin;
urine tests - for sugar and for the presence of acetone.

Having studied the results, the doctor will be sure whether the patient has type 2 diabetes or type 1 and will be able to determine the therapeutic treatment regimen.

How is insulin dependent diabetes treated?

Unfortunately, modern medicine cannot offer a treatment that can completely rid the patient of this disease. In addition, with this type of diabetes, the patient needs a constant supply of insulin from the outside.

The list of insulins is quite wide, they differ in duration of action and only a doctor can prescribe the appropriate drug and its regimen.

Table number 1. Insulins used to treat insulin-dependent diabetes

Duration of insulin action	Name of funds	Nuances of use
Ultra-short action (three to five hours)	Apidra, Humalog, Novorapid.	Very soon they have an effect - from 1 to 20 minutes. The action lasts an average of 4 hours.
short action (6 – 8 hours)	insuman, Actrapid, Humulin regular.	The effect is exerted half an hour after use. The maximum effect is achieved in the period from 2 to 4 hours after the injection.
medium long action (from 16 hours to a day)	insuman basal, Monotard NM, Humulin NPH, Insulatard.	They act an hour after penetration into the body. The maximum effect occurs after 4-12 hours.
Prolonged (long) action (average day)	lantus, glargin, Levemir, Detemir.	Allows you to forget about insulin starvation even in the absence of food. They work evenly throughout the day. It is required to enter once or twice a day.
Combined preparations, which include various insulins (6-18 hours)	InsumanCombi 25, Mixtard 30, Humulin MZ, NovoMix 30.	They take effect in 30-45 minutes. The maximum effect is after 1-3 hours.

In addition to the fact that the diabetic is prescribed drugs for continuous use, he faces another task - control of blood sugar levels.

In modern medicine, there are several options for devices that inject insulin and measure sugar levels.

Diet correction

Although insulin is the mainstay of treatment, the role of proper nutrition should not be underestimated. Since the disease is associated with metabolic processes and its manifestations become more intense when the body does not absorb food well enough, it is very important for the patient to know what he needs to eat, when and in what quantities.

In insulin-dependent diabetes mellitus, a low-carbohydrate diet is indicated, in which it is recommended:

twice a day intake of protein products;
saturation of the diet with foods rich in useful minerals and vitamins;
exclusion from the menu of food that is a source of fast carbohydrates.

Diabetics need to know which foods can aggravate the condition

The exclusion of harmful products will not only eliminate the risks of complications, but also allow the patient to lose weight, which will also have a positive effect on overall well-being. But it is worth remembering that the ingestion of additional carbohydrates into the body can lead to its excess and the patient should calculate its amount himself.

Physical activity in insulin-dependent diabetes

Experts unanimously repeat that type 1 diabetes mellitus (insulin-dependent) does not exclude, but even, on the contrary, requires some mobility and activity from the patient. Indeed, this will have a positive effect on blood sugar levels and help avoid hypoglycemia, however, by itself, physical activity cannot normalize this indicator.

When doing this, you need to take into account the following features:

physical activity leads to an increase in the rate of insulin absorption from the injection site;
against their background, glucose consumption increases, but the need for insulin remains the same;
it is important to take care of a sufficient amount of insulin, otherwise the muscle cells will not be able to absorb glucose.

Patients diagnosed with type 1 diabetes should remember that during intensive training the body depletes stored glycogen in the liver, so there is a risk of developing hypoglycemia. However, if a person is engaged regularly, then preventing pathological changes becomes not such a difficult task.

If the disease is not treated

Type 1 diabetes is a disease that causes serious changes in the body, without timely treatment can lead to serious consequences.

Depending on the degree of development, it can cause a weakening of the immune system and the body will not be able to resist infectious pathogens. In addition to the mentioned ketoacidosis and hypoglycemia, insulin-dependent disease exacerbates the existing symptoms up to the development of a coma and death.

If nutrition and insulin dosage are not balanced, then a critical decrease in blood glucose levels and the manifestation of a hypoglycemic syndrome are possible.

But in addition to transient complications, against the background of diabetes, the development of chronic diseases and conditions is also possible:

atherosclerosis,
hypertension,
stroke,
myocardial infarction, etc.

Unfortunately, today far from everything is known about type 1 diabetes mellitus, and scientists have not been able to invent a successful variant of its cure. Yes, the question of implantation of the pancreas is being studied, but so far this operation has not justified itself, since the survival rate of the transplanted organ is too low. Therefore, a diabetic will have to inject daily with insulin, take care of health and an active lifestyle.

Type 2 diabetes is called non-insulin dependent. This means that blood sugar rises not because of a lack of insulin, but because of the resistance of receptors to it. In this regard, this type of pathology has its own characteristics of the course and treatment.

Type 2 diabetes mellitus, or non-insulin dependent, is a metabolic disease with the development of chronically elevated blood sugar levels. This occurs either due to reduced synthesis of the pancreatic hormone, or due to a decrease in the sensitivity of cells to it. In the latter case, they say that a person develops insulin resistance. And this despite the fact that in the initial stages of the disease, a sufficient or even increased amount of the hormone is synthesized in the body. In turn, chronic hyperglycemia leads to damage to all organs.

What you need to know about non-insulin dependent diabetes mellitus

First of all, we note that diabetes mellitus is characterized by high levels of glucose in the blood. In this case, a person feels symptoms such as frequent urination, increased fatigue. Fungal lesions appear on the skin, from which there is no way to get rid of. In addition, with diabetes, there may be vision, weakening of memory and attention, as well as other problems.

If you do not control diabetes, as well as treat it incorrectly, which happens very often, then a person may die prematurely. The causes of death are gangrene, cardiovascular pathologies, end-stage renal failure.

Diabetes mellitus of the non-insulin-dependent type mainly develops in middle age - after forty years. However, in recent years, this disease is increasingly common among young people. The causes of this disease are malnutrition, excess weight and physical inactivity.

If this type of diabetes mellitus is not treated, then over the years it becomes insulin-dependent with a constant deficiency in the body of the hormone insulin and poor compensation of hyperglycemia. In modern conditions, it rarely comes to this, since many patients die from complications due to lack or improper treatment.

Why does the body need insulin?

It is the most important hormone that controls blood glucose levels. With its help, the regulation of its content in the blood occurs. If for some reason the production of insulin stops (and this condition cannot be compensated by injections of insulin), then the person quickly dies.

You need to know that a healthy body has a fairly narrow range of blood sugar. It is kept within such limits only thanks to insulin. Under its action, liver and muscle cells draw out glucose and convert it into glycogen. And in order for glycogen to turn back into glucose, glucagon is needed, which is also produced in the pancreas. If there is no glycogen in the body, then glucose begins to be produced from protein.

In addition, insulin ensures the conversion of glucose into fat, which is then deposited in the body. If you consume a lot of food rich in carbohydrates, then there will be a constantly high level of insulin in the blood. This makes it very difficult to lose weight. Moreover, the more insulin in the blood, the more difficult it will be to lose weight. Due to such disturbances in the metabolism of carbohydrates, diabetes mellitus develops.

Main symptoms of diabetes

The disease develops gradually. Usually a person does not know about it, and the disease is diagnosed by chance. Insulin-dependent diabetes mellitus has the following characteristic symptoms:

blurred vision;
bad memory;
fatigue;
skin itching;
the appearance of fungal skin diseases (while it is very difficult to get rid of them);
increased thirst (it happens that a person can drink up to five liters of liquid per day);
frequent urination (note that it also happens at night, and several times);
strange sensations of tingling and numbness in the lower extremities, and when walking - the onset of pain;
the development of thrush, which is very difficult to treat;
in women, the menstrual cycle is disturbed, and in men, potency.

In some cases, diabetes can occur without pronounced symptoms. Sudden myocardial infarction or stroke are also manifestations of non-insulin dependent diabetes mellitus.

With this disease, a person may experience increased appetite. This occurs because the cells of the body do not absorb glucose due to insulin resistance. If there is too much glucose in the body, but the body does not absorb it, then the breakdown of fat cells begins. When fat breaks down, ketone bodies appear in the body. In the air exhaled by a person, the smell of acetone appears.

With a high concentration of ketone bodies, the pH of the blood changes. This condition is very dangerous due to the risk of developing ketoacidotic coma. If a person has diabetes and consumes little carbohydrates, then the pH does not fall, which does not cause lethargy, drowsiness and vomiting. The appearance of the smell of acetone indicates that the body is gradually getting rid of excess weight.

Complications of the disease

Non-insulin-dependent diabetes mellitus is dangerous with acute and chronic complications. Among the acute complications, the following should be noted.

Diabetic ketoacidosis is the most dangerous complication of diabetes. Dangerous by increasing the acidity of the blood and the development of ketoacidotic coma. If the patient knows all the subtleties of his disease and knows how to calculate the dose of insulin, the likelihood of developing such a complication is zero.
Hyperglycemic coma is a violation and loss of consciousness due to an increase in the amount of glucose in the blood. Often associated with ketoacidosis.

If the patient is not provided with emergency assistance, then the death of the patient is possible. Doctors have to make a lot of efforts to bring him back to life. Unfortunately, the percentage of death in patients is very high and reaches 25 percent.

However, the vast majority of patients suffer not from acute, but from chronic complications of the disease. If left untreated, they can also be fatal in many cases. However, diabetes mellitus is also dangerous because its consequences and complications are insidious, since for the time being they do not let anyone know anything about themselves. And the most dangerous complications in the kidneys, vision and heart appear too late. Here are some of the complications that diabetes is dangerous for.

diabetic nephropathy. This is a severe kidney injury that causes the development of chronic renal failure. Most dialysis and kidney transplant patients have diabetes.
Retinopathy is eye damage. It is the cause of blindness in middle-aged patients.
Neuropathy - nerve damage - already occurs in three patients with diabetes at the time of diagnosis. Neuropathy causes reduced sensation in the legs, which puts patients at high risk for injury, gangrene, and amputation.
Angiopathy - damage to blood vessels. Because of this, tissues do not receive enough nutrients. Large vessel disease leads to atherosclerosis.
Skin lesion.
Damage to the heart and coronary vessels, leading to myocardial infarction.
Violation of potency in men and the menstrual cycle in women.
Progressive impairment of memory and attention.

Nephropathy and retinopathy are the most dangerous. They appear only when they become irreversible. Other disorders can be prevented by effectively controlling blood sugar. The lower it is, the less likely it is to develop such complications and approaches zero.

Features of the treatment of the disease

The insulin-independent type of this disease occurs in 90 percent of all cases. Four out of five of these patients may be overweight.

In the treatment of this disease, it is necessary to accurately and accurately follow these steps.

Proper diet with the rejection of all foods rich in carbohydrates. At the same time, a person will not remain hungry: he is allowed a lot of hearty meals.
Low-impact exercise that brings pleasure, not exhaustion.
Taking pills to increase the sensitivity of tissues to the pancreatic hormone. Any hypoglycemic tablets, especially those containing sulfonylurea, are harmful.
Insulin injections as needed. They do not mean that you need to eat foods rich in carbohydrates. A diabetic should stay away from them and not eat them under any circumstances.

In non-insulin-dependent diabetes, the rejection of carbohydrates is extremely important, as the body does not tolerate them well. In unopened cases, this allows you to drastically reduce the amount of sugar to the level that occurs in healthy people. For people with diabetes, jogging is very useful.

By adhering to these recommendations, a person usually does not need to inject insulin. However, if it is obvious that injections are indispensable (the disease is advanced), there is no need to postpone insulin treatment, but start it as early as possible. Each diabetic is able to achieve that his post-meal sugar level is no higher than 6, and best of all - 5.3 mmol. This is not a fantasy, but an effective treatment of the disease, reducing the risk of complications to almost zero.