Diabetes of 1 type
Diabetes of 1 type – the endocrinological disease which is characterized by insufficient production of insulin and increase in level of glucose in blood. Because of a long hyperglycemia patients suffer from thirst, lose weight, quickly get tired. Also headaches, spasms, a skin itch, appetite strengthening, frequent urinations, sleeplessness, heat inflows are characteristic muscular. Diagnostics includes the clinical poll, laboratory blood tests and urine revealing a hyperglycemia, a lack of insulin, metabolic violations. Treatment is carried out by an insulin therapy method, the diet, occupations physical culture is appointed.
Diabetes of 1 type
The term "diabetes" comes from Greek and means "flows, follows", thus, the name of a disease describes one of its key symptoms – a polyuria, allocation of a large amount of urine. Diabetes of 1 type call also autoimmune, insulin-dependent and juvenile. The disease can be shown at any age, but to a thicket demonstrates at children and teenagers. In the last decades growth of epidemiological indicators is noted. Prevalence of all forms of diabetes makes 1-9%, 5-10% of cases fall to the share of insulin-dependent option of pathology. Incidence depends on an ethnic origin of patients, is highest among the Scandinavian people.
Reasons of diabetes of 1 type
The factors promoting development of a disease continue to be investigated. It is so far established that diabetes of the first type evolves from a combination of biological predisposition and external adverse effects. Carry to the most probable causes of damage of a pancreas, decrease in production of insulin:
- Heredity. Tendency to insulin-dependent diabetes is transferred in a straight line – from parents to children. Several combinations of the genes contributing to a disease are revealed. They are most widespread among inhabitants of Europe and North America. In the presence of the sick parent the risk for the child increases by 4-10% in comparison with the general population.
- Unknown external factors. There are certain influences of the environment provoking SD of 1 type. This fact is confirmed by the fact that the monoovular twins having absolutely identical set of genes get sick together only in 30-50% of cases. It is also established that the people migrating from the territory with low incidence on the territory with higher epidemiology have diabetes more often, than those who refused migration.
- Viral infection. The autoimmune answer to cells of a pancreas can be started by a viral infection. Influence of viruses of Koksaki and a rubella is the most probable.
- Chemicals, drugs. Beta cells of gland producing insulin can be struck with some chemical means. Examples of such connections are rat poison and – medicine for oncological patients.
Insufficiency of production of hormone of insulin in beta cells of islets of Langerhans of a pancreas is the cornerstone of pathology. Treat insulin-dependent fabrics hepatic, fatty and muscular. At insulin secretion reduction they cease to accept glucose from blood. There is a condition of a hyperglycemia – a key symptom of diabetes. Blood is condensed, the blood-groove in vessels is broken that is shown by deterioration in sight, trophic damages of extremities.
Insufficiency of insulin stimulates disintegration of fats and proteins. They come to blood, and then are metabolized by a liver in ketones which become power sources for insulinnezavisimy fabrics, including brain tissues. When concentration of sugar of blood exceeds 7-10 mmol/l, the glucose removal side-track – through kidneys becomes more active. The glucosuria and a polyuria develops owing to what the risk of dehydration of an organism and deficiency of electrolytes increases. For compensation of loss of water the feeling of thirst amplifies (polidipsiya).
According to recommendations of World Health Organization, diabetes of the I type is subdivided on autoimmune (provoked by development of antibodies to cells of gland) and idiopathic (organic changes in iron are absent, the reasons of pathology remain unknown). Development of a disease happens in several stages:
- Detection of predisposition. Preventive examinations are conducted, the genetic otyagoshchennost is defined. Risk level of development of a disease in the future calculates taking into account average statistics over the country.
- Initial starting moment. Autoimmune processes join, β-cages are damaged. Antibodies are already developed, but production of insulin remains normal.
- Active chronic autoimmune insulit. The caption of antibodies becomes high, the quantity of the cages producing insulin is reduced. The high risk of a demonstration of SD in the next 5 years is defined.
- Hyperglycemia after carbohydrate loading. A considerable part of the cages producing insulin is exposed to destruction. Production of hormone decreases. Normal level of glucose on an empty stomach remains, but after meal within 2 hours the hyperglycemia is defined.
- Clinical demonstration of a disease. The symptoms characteristic of diabetes are shown. Secretion of hormone is sharply reduced, 80-90% of cells of gland are subject to destruction.
- Absolute insulin insufficiency. All cages responsible for insulin synthesis perish. Hormone comes to an organism only in the form of medicine.
Symptoms of diabetes of 1 type
The main clinical signs of a demonstration of a disease – a polyuria, a polidipsiya and loss of weight. Desires to an urination become frequent, the volume of daily urine reaches 3-4 liters, the night incontience sometimes appears. Patients thirst, feel dryness in a mouth, drink up to 8-10 liters of water per day. Appetite amplifies, but body weight decreases by 5-12 kg in 2-3 months. In addition sleeplessness at night and drowsiness in the afternoon, dizzinesses, irritability, bystry fatigue can be noted. Patients feel constant fatigue, hardly perform habitual work.
There is an itch of skin and mucous membranes, rashes, ulcerations. The condition of hair and nails worsens, wounds and other skin defeats long do not heal. Violation of a blood-groove in capillaries and vessels is called a diabetic angiopatiya. Defeat of capillaries is shown by decrease in sight (a diabetic retinopathy), oppression of functions of kidneys with hypostases, arterial hypertension (a diabetic nephropathy), an uneven flush on cheeks and a chin. At a macrovascular disease when veins and arteries are involved in pathological process, atherosclerosis of vessels of heart and the lower extremities begins to progress, gangrene develops.
At a half of patients symptoms of diabetic neuropathy which is result of an electrolytic imbalance, insufficient blood supply and hypostasis of nervous tissue are defined. Conductivity of nervous fibers worsens, spasms are provoked. At peripheral neuropathy patients complain of burning and the painful phenomena in legs, especially at night, on feeling of "goosebumps", a sleep, hypersensibility to touches. Failures from functions of internals are characteristic of autonomous neuropathy – there are symptoms of disorders of digestion, paresis of a bladder, urinogenital infections, erectile dysfunction, stenocardia. At focal neuropathy pains of various localization and intensity are formed.
Long violation of carbohydrate exchange can lead to diabetic ketoacidosis – the state which is characterized by accumulation in plasma of ketones and glucose, increase in acidity of blood. Proceeds sharply: appetite disappears, there is nausea and vomiting, belly-ache, an acetone smell in the exhaled air. In the absence of medical care there occurs obscuring of consciousness, a lump and death. Patients with symptoms of ketoacidosis need urgent treatment. Among other dangerous complications of diabetes there is a giperosmolyarny coma, a hypoglycemic coma (at the wrong use of insulin), "diabetic foot" with risk of amputation of an extremity, a heavy retinopathy with total loss of sight.
Inspection of patients is carried out by the doctor-endocrinologist. Sufficient clinical criteria of a disease are the polidipsiya, a polyuria, changes of weight and appetite – hyperglycemia signs. During the poll the doctor also specifies existence of a hereditary otyagoshchennost. The estimated diagnosis is confirmed by results of laboratory blood tests, urine. Detection of a hyperglycemia allows to distinguish diabetes with a psychogenic polidipsiya, giperparatireozy, a chronic renal failure, not diabetes. At the second stage of diagnostics differentiation of the SD various forms is carried out. Comprehensive laboratory examination includes the following analyses:
- Glucose (blood). Definition of sugar is carried out is triple: since morning on an empty stomach, in 2 hours after loading carbohydrates and before going to bed. Indicators from 7 mmol/l on an empty stomach and from 11,1 mmol/l after the use of carbohydrate food testify to a hyperglycemia.
- Glucose (urine). The glucosuria indicates the resistant and expressed hyperglycemia. Normal values for this test (in mmol/l) – to 1,7, boundary – 1,8-2,7, pathological – more than 2,8.
- Glikirovanny hemoglobin. Unlike glucose, free, untied with protein, the amount of glikozilirovanny hemoglobin of blood remains rather constant for days. The diagnosis of diabetes is confirmed at indicators of 6,5% and above.
- Hormonal tests. Insulin and S-peptide tests are carried out. Normal concentration of immunoreactive insulin of blood on an empty stomach makes from 6 to 12,5 ¼¬àä/ml. The indicator of S-peptide allows to estimate activity of beta cages, the insulin output. Normal result – 0,78-1,89 mkg/l, at diabetes concentration of a marker is reduced.
- Proteinaceous metabolism. Analyses on creatinine and urea are made. A total gives the chance to specify functionality of kidneys, extent of change of proteinaceous exchange. At damage of kidneys indicators are higher than norm.
- Lipidic metabolism. For early detection of ketoacidosis the maintenance of ketone bodies in a blood-groove, urine is investigated. For the purpose of assessment of risk of atherosclerosis the level of holesterin of blood (the general cholesterol, LPNP, LPVP) is defined.
Treatment of diabetes of 1 type
Efforts of doctors are aimed at elimination of clinical displays of diabetes, and also at the prevention of complications, training of patients in independent maintenance of a normoglikemiya. Patients are accompanied by polyprofessional team of experts into which endocrinologists, nutritionists, the instructor of LFK enter. Treatment includes the consultations, use of medicines training occupations. Treat the main methods:
- Insulin therapy. Use of medicines of insulin is necessary for the most achievable compensation of metabolic violations, prevention of a condition of a hyperglycemia. Injections are vital. The scheme of introduction is formed individually.
- Diet. The low-carbohydrate, including ketogene diet is shown to patients (ketones are a power source instead of glucose). The basis of a diet is made by vegetables, meat, fish, dairy products. In moderate quantities sources of complex carbohydrates – whole-grain bread, grain are allowed.
- The dosed individual physical activities. Physical activity is useful to most of the patients who do not have heavy complications. Occupations are selected LFK instructor individually, are held systematically. The expert determines duration and intensity of trainings taking into account the general state of health of the patient, level of compensation of SD. Regular walking, track and field athletics, sports is appointed. The strength sport, marathon race is contraindicated.
- Training in self-checking. Success of the supporting treatment at diabetes in many respects depends on the level of motivation of patients. On special occupations they are told about disease mechanisms, about possible ways of compensation, complications, emphasize importance of regular control of amount of sugar and use of insulin. Patients master skill of independent performance of an injection, the choice of food, drawing up the menu.
- Prevention of complications. The drugs improving fermental function of ferruterous cages are applied. The means promoting oxygenation of fabrics, immunomodulatory medicines concern to them. Timely treatment of infections, a hemodialysis, antidote therapy for removal of the connections accelerating development of pathology (tiazid, corticosteroids) is carried out.
Among experimental methods of treatment It should be noted development of the DNA vaccine BHT-3021. At the patients receiving intramuscular injections within 12 weeks C-peptide level – a marker of activity of insular cells of a pancreas increased. Other direction of researches – transformation of stem cells into the ferruterous cages producing insulin. The made experiments on rats yielded positive result, but proofs of safety of the procedure are necessary for use of a method in clinical practice.
Forecast and prevention
The insulin-dependent form of diabetes is a chronic disease, but the correct supporting therapy allows to keep high quality of life of patients. Preventive measures are still not developed as exact etiologies are not found out. Now from risk groups it is recommended to all people to undergo annual inspections for detection of a disease at an early stage and a timely initiation of treatment. Such measure allows to slow down process of formation of a resistant hyperglycemia, minimizes probability of complications.