Carbohydrate metabolism disorders constitute a significant proportion of general metabolic disorders. A part of them is symptomatic and secondary by occurrence, but some are separate diseases. Among endocrine pathology, diabetes ranks the first place with the frequency up to 50% of all endocrine glands diseases. Along with cardiovascular and oncological illnesses, diabetes belongs to the most common diseases that impairs the quality of life, leads to disability, and death. 50% of diabetic patients are persons aged 30-50 years, but a non-rare disease begins in childhood and young age.
A sophisticated understanding of clinical and pathogenesis aspects of diabetes mellitus provides a selection of adequate treatment algorithm taking into consideration the type difference and causative aspects of the disease.
Etiology and Pathogenesis of Diabetes
Physiologically, pancreas is responsible for controlling glucose level in blood. This function based on influence of insulin level by means of the inverse relationship.
Diabetes mellitus is a polyetiological disease, which develops under the influence of endogenous and exogenous factors with the background of genetic predisposition. The pathogenesis of the disease is based on absolute or relative lack of insulin in the human body (Loghmani, 2005).
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Absolute insulin deficit is associated with damage of Langerhans islets ?-cells. Relative insulin deficiency is the result of overproduction of antiinsulin hormones, increased destruction of insulin, reduced number of insulin receptors in peripheral tissues, or decreased sensitivity of insulin receptors. Hyperglycemia that is an eventual result of insulin deficiency leads to pathogenic consequences (Ozougwu, Obimba, Belonwu, & Unakalamba, 2013). The first effect is inability of glucose to passage through the cell membrane. The process of glycogen synthesis develops very slowly, but decay of glycogen accelerates (Loghmani, 2005). The formation of glucose from lactate, amino acids, and other non-carbohydrate products activates. This phenomenon is called gluconeogenesis.
Risk factors for type 1 diabetes are viruses or toxic substances that affect the genetically determined antigens of HLA system and cause autoimmune destruction of Langerhans ?-cells. Risk factors of type 2 diabetes include obesity, improper diet, lack of exercise, stress, old age (Ozougwu et al., 2013).
In addition, there is a diabetic gene in 5% of the population that causes diabetes in homozygous persons.
Different Types of Diabetes
There are two consequential types of diabetes mellitus based on features of pathological development mechanism.
Type 1 is characterized by ?-cells destruction, which leads to absolute insulin deficiency. It is also called autoimmune or idiopathic diabetes (Ozougwu et al., 2013). Type I diabetes primarily develops by progressing lesions of pancreatic islet cells with a gradual decrease in insulin secretion. Type 2 occurs mainly from insulin tissue resistance (Loghmani, 2005).
1 type diabetes type starts at young age (under 30 years) and has specific antigens HLA phenotype. Autoimmune reactions to ?-cells develop during vitality of ?-cells. Patients need replacement therapy with insulin or pancreas transplantation in combination with immune corrective therapy (Loghmani, 2005).
2 type diabetes is marked by innate tolerance of muscle cells, liver cells, adipose tissue receptors to insulin. As the result, high level of insulin stimulates weight gain. Usually, this type of pathology initiates after 30 years and does not require insulin replacement therapy, except for the decompensation stage and coma. Decompensation cases occur frequently in the form of hyperosmolar coma (Maureen, n.d.).
Also, there are some other types of diabetes mellitus caused by genetic defects with dysfunction of ?-cells or other genetic syndromes associated with the disease. Gestational diabetes is also classified as a unique pathology (Ozougwu et al., 2013).
Clinical Aspects of Diabetes
The severity of the signs of diabetes depends on the duration of the disease, the degree of reduction of insulin, and individual characteristics of the human body. Key symptoms include polydipsia (unquenchable continuous thirst), polyuria (enhanced urine), and polyphagia (irrepressible constant hunger) (Ozougwu et al., 2013).
Non-specific clinical symptoms develop very slowly (usually 6-12 months or more) and include dry mouth, itchy skin, headache, general muscular weakness, inflammatory skin lesions that are very difficult to treat, blurred vision (the typical appearance of the so-called white veil in front of the eyes), occurrence of acetone in the urine (typical for type 1 diabetes) (Loghmani, 2005).
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The major symptoms are more distinctive for 1 type diabetes and their development has a changed character. Secondary symptoms may also take place during diabetes of the first and second types (Maureen, n.d.).
Type 1 has obvious symptoms, which also develops very quickly (sometimes even for just a few days). Typically, patients begin to feel fatigue and note weight loss. If the patient does not pay attention to them, ketoacidosis develops very quickly. Weight loss is an intermittent symptom that often characterizes 1 type of diabetes. Weight loss is caused by usage of the body's own protein and fat stores instead of glucose for biological processes (Ozougwu et al., 2013).
Clinic of 2 type diabetes develops slowly. In the case of an accidental detection of this disease in patients, they do not complain and after the corresponding treatment report significant improvement in health. Most cases of 2 type diabetes are diagnosed in people with obesity and those whose work is related to sedentary lifestyle (Diabetes UK, 2005).
Doctors use diagnostics criteria of diabetes that were installed by America Diabetes Association in 1997 and in 1999 by World Health Organization (Maureen, n.d.).
Then laboratory diagnostics of the diabetes is the most valid method for disease registration. Determining the level of glucose in the blood can figure above meaning of glucose amount and violation of glucose metabolism. This probe should be done at least in two consecutive measurements on different days (Loghmani, 2005).
Also, glucose stress tests and sensitivity to glucose tests can be provided. Determination of glycated hemoglobin depends on the concentration of glucose in the blood. Exceeding of the norm states that for the last three months glucose concentration in blood has raised (Maureen, n.d.).
Determination of glucose in the urine depends on the stage of the disease, when glucose transports through the kidney barrier and into the urine. This method is optional in the diagnosis. Determination of acetone in the urine is used to assess the patient's condition. If urine ketone bodies are found, this indicates severe ketoacidosis (Ozougwu et al., 2013).
Current diagnostic criteria for diabetes are based on presence of clinical signs plus elevated levels of glucose in a random sample of blood (above 11.1 mmol/L). It is also important to determine whether concentration of glucose in plasma exceeds the point 7 mmol/L and whether its concentration in plasma taken to study tolerance to the substance of the body two hours after drinking glucose reaches above 11.1 mmol/L (Maureen, n.d.).
Treatment of Diabetes
A treatment tactic depends on the type of diabetes, clinical features, and possible complications accompanied by the disease.
In patients with type 1 diabetes, insulin is not secreted by own pancreas cells and, therefore, the need for insulin injection is reinforced. It is important to comprehend the duration of insulin action and the level of sugar levels throughout the day while appointing the insulin injection schedule (Loghmani, 2005).
In type 2 diabetes, insulin is produced but has low-level activity. Treatment of such patients is carried out mainly through diet and hypoglycemic drugs. However, the normalization of body weight, mode graduated exercise, and prevention of acute and chronic complications are also essential factors of recovery (Ozougwu et al., 2013).
Complications of diabetes determine prognosis and quality of life. The group of chronic complications include vascular, kidney, retina, and lower extremities vessels malfunctions that develop slowly and lead organ failure . Acute complications usually are presented by different types of coma and require the provision of immediate medical attention. Thus, diagnosis of diabetes should be comprehensive, aimed at examination of all systems of the body for prevention of serious complications, and accompanied with an adequate timely treatment.
Early diagnosis of diabetes is a key factor in the selection and correction treatment algorithm. This endocrine pathology requires a systematic approach to the treatment and consideration of pathogenic features. Combinations of medications, exercise, and diet can help to achieve a compensation of the disease and reduce the risk of possible complications. The results of experimental and early clinical studies should contribute to further refinement capacity of pathogenetically substantiated treatments to prevent and eliminate aggravation of diabetes.