Diabetes is a chronic metabolic disorder, which is based on the formation of insulin deficiency and an increase in blood glucose levels. Among metabolic disorders the diabetes occupies a second place after obesity. In the world about 10% of the population suffer from diabetes, however, when one considers hidden form of the disease, this figure can be 3-4 times higher. Diabetes develops due to chronic deficiency of insulin and it is accompanied by disorders of carbohydrate, protein and fat metabolism. By interfacing with other diseases endocrinology highlights symptomatic (secondary) and true diabetes. Symptomatic diabetes accompanies diseases of the endocrine glands: pancreas, thyroid, adrenal, pituitary, and serves as one of the primary manifestations of the disease. The true diabetes can be two types: insulin-dependent of type I if insulin is not produced in the body or produced in insufficient quantities; non-insulin dependent type II if the insensitivity of tissues to insulin by its abundance and excess in the blood is marked.
Type I diabetes is usually diagnosed in young adults up to 30 years. Violation of insulin synthesis develops as a result of the pancreas destruction of an autoimmune nature and the destruction of insulin-producing ß-cells. In most patients, diabetes develops after viral infection (epidemic parotitis, rubella, hepatitis B virus) or toxic effects (nitrosamines, pesticides, drugs and other substances), the immune response on which causes the death of cells in the pancreas. In type II diabetes develops insulin resistance of tissues, i. e. their insensitivity to insulin. In this case insulin level in blood may be normal or increased, but the cells are immune to it. In the majority (85%) of the patients is revealed the diabetes type II. If the patient is obese, susceptibility of tissues to insulin is blocked by adipose tissue. The elderly patients are more prone to type II diabetes, in whom with the age occurs a decrease in glucose tolerance. The emergence of diabetes type II may be accompanied by the impact of the following factors: genetic - the risk of developing the disease is 3-9%, if the relatives or parents have diabetes; obesity - with excess adipose tissue (especially abdominal obesity type) there is decrease in sensitivity of tissues to insulin, contributing to the development of diabetes; eating disorders - mainly carbohydrate food with a lack of fiber increases the risk of diabetes; cardiovascular disease - atherosclerosis, hypertension; chronic stress - in a state of stress in the body increases the amount of catecholamines (norepinephrine, epinephrine), glucocorticoids, contributing to the development of diabetes; diabetogenic effects of some medications - synthetic glucocorticoid hormones, diuretics, some antihypertensive drugs, cytostatics, and others; chronic adrenal insufficiency. The development of type I diabetes occurs rapidly, II type - on the contrary gradually. Often there is latent, asymptomatic diabetes and its identification happens by accident in the study of the fundus or by laboratory determination of sugar in blood and urine. Clinically, diabetes type I and II manifest themselves in different ways, but the following symptoms are common to them: thirst, dry mouth, accompanied by polydipsia (increased fluid intake) to 8-10 liters per day; polyuria (excessive and frequent urination); polyphagia (increased appetite); dry skin and mucous membranes, accompanied by itching, pustular skin infections; sleep disturbance, fatigue, decreased performance; cramps in the calf muscles; visual impairment. Manifestations of diabetes type I are characterized by strong thirst, frequent urination, nausea, weakness, vomiting, increased fatigue, constant hunger, weight loss (at normal or high nutrition), irritability. In diabetes type II is dominated by itchy skin, thirst, blurred vision, drowsiness, and fatigue, skin infections, slow wound healing processes, paresthesia and numbness in the legs. In patients with type II diabetes is often observed the obesity. Long duration of diabetes causes bone system damage, manifested by osteoporosis (bone density loss). There are pains in bones, joints, dislocations and subluxations of the vertebrae and joints, fractures and bone deformation, leading to disability (Ozougwu et al, 2013).
Implementation of the diabetologist’s recommendations, self-control and treatment of diabetes are carried out lifelong and can significantly slow or prevent complications of the disease. The treatment of any form of diabetes is aimed at lowering the level of blood glucose, normalization of metabolism all kinds and prevention of complications. The mainstay of treatment of all forms of diabetes is diet therapy, taking into account gender, age, body weight, physical loads of the patient. Training for calculating caloric intake based on the content of carbohydrates, fats, proteins, vitamins and minerals is conducted. The choice of drug treatment of diabetes is caused by the type of disease. For patients with type I diabetes is prescribed the insulin therapy, with type II - diet and diabetes medications (insulin is assigned in case of the ineffectiveness of the tablet form reception, development of pre-comatose state, tuberculosis, chronic pyelonephritis, hepatic and kidney failure). The administration of insulin is carried out under systematic control of the glucose levels in blood and urine. The use of an insulin is dangerous by overdose, leading to a sharp decline in sugar, the development of hypoglycemia and coma. In diabetes it is important to educate patient and members of his family how to control the state of a patient’s health, first aid measures in the development of pre-comatose and comatose states. Patients with revealed diabetes shall be registered by an endocrinologist. In organizing the proper lifestyle, diet, treatment, the patient may feel satisfactorily for many years. Acute and chronic developing complications burden prognosis of diabetes and reduce the life expectancy of patients. Prevention of type I diabetes is reduced to improvement of the body's resistance to infections and elimination of the toxic effects of various agents on the pancreas. Preventive measures of type II diabetes include obesity prevention, nutrition correction, especially in individuals with hereditary anamnesis (Kaku, 2010).
References
Ozougwu, J. C, Obimba, K. C., Belonwu, C. D., Unakalamba, C. B. (2013). The pathogenesis and pathophysiology of type 1 and type 2 diabetes mellitus. Journal of Physiology and Pathophysiology, p. 47-54.
Kaku, K. (2010). Pathophysiology of Type 2 Diabetes and Its Treatment Policy. Japan Medical Association Journal, p. 44-46.
