Type 1 diabetes mellitus: signs, complications, treatment

What is type 1 diabetes and why is it dangerous?

The content of the article

Juvenile type 1 diabetes (T1DM) is a disease associated with metabolic disorders, namely a deficiency of the hormone insulin and increased concentrations of glucose in the blood. It is an autoimmune disease in which the immune system mistakenly destroys the body's own cells, making it difficult to treat. The disease affects both adults and children. A baby can become insulin dependent after suffering a virus or infection. If we compare statistics on type 1 and type 2 diabetes, type 1 diabetes occurs in approximately one in 10 cases.

Type 1 diabetes is dangerous due to severe complications - it gradually destroys the entire vascular system. For example, T1DM significantly increases the risk of developing cardiovascular diseases: people suffering from hyperglycemia are more likely to suffer strokes and heart attacks. The life expectancy of a woman suffering from type 1 diabetes is 15 years less than that of a healthy woman of the same age. Men with hyperglycemia live on average to 50-60 years and die 15-20 years earlier than their peers.

Diabetics must follow a diet and daily routine throughout their lives, take insulin and monitor their blood sugar levels. If you follow all the recommendations of the endocrinologist, and it is this doctor who treats type 1 and type 2 diabetes mellitus, you can avoid dangerous complications and live a normal life.

Causes of diabetes

Type 1 diabetes develops due to a defect in the immune system, which begins to attack pancreatic cells that produce insulin (beta cells of the islets of Langerhans) with antibodies. The immune system can be triggered by:

Who's at risk

The risk factors for type 1 diabetes are not as clear as those for type 2 diabetes. Among the people most susceptible to this disease:

People whose close relatives (parents, brothers or sisters) have type 1 diabetes.
Children and teenagers. Type 1 diabetes most often appears at a young age.
People of white race (in the United States, whites are more likely to develop type 1 diabetes than African Americans and Hispanics).

Type 2 diabetes most often develops in overweight adults and women who have had gestational diabetes.

How does type 1 diabetes develop?

What is the trigger for the development of type 1 diabetes, like all autoimmune diseases, there is still no exact answer. But the main cause of the disease is known - a lack of insulin occurs due to the death of cells in the islets of Langerhans. The islets of Langerhans are areas on the tail of the pancreas that produce endocrine cells that participate in various life processes.

The role of endocrine cells is extensive, to be convinced of this, it is enough to consider a few examples:

Alpha cells produce glycogen, which stores energy in the liver. This polysaccharide is the main form of glucose storage: glycogen reserves in the liver in a healthy person can reach 6% of the total body weight. Glycogen from the liver is available to all organs and can quickly replenish glucose deficiency in the body.
Beta cells produce insulin, which converts glucose from the blood into energy. If the number of beta cells is insufficient or their work is poor, there is not enough insulin, so glucose remains unchanged in the blood.
Delta cells are responsible for the production of somatostatin, which is involved in the functioning of the glands. Somatostatin limits the secretion of somatotropin - growth hormone.
PP cells stimulate the production of gastric juice, without which complete digestion of food is impossible.
Epsilon cells secrete a secretion that stimulates appetite.

The islets of Langerhans are equipped with capillaries, innervated by the vagus and peripheral nerves, and have a mosaic structure. The islets that produce certain cells are interconnected. Beta cells that produce insulin inhibit the production of glucogen. Alpha cells suppress the production of beta cells. Both islets reduce the amount of somatostatin produced.

Failure of immune mechanisms leads to the body's immune cells attacking the cells of the islets of Langerhans. Due to the fact that 80% of the surface of the islets is occupied by beta cells, they are the ones that are destroyed the most.

Dead cells cannot be restored; the remaining cells produce too little insulin. It is not enough to process the glucose entering the body. All that remains is to take insulin artificially in the form of injections. Diabetes mellitus becomes a lifelong death sentence; it cannot be cured and leads to the development of concomitant diseases.

2.What is insulin and why is it needed?

Typically, the hormone insulin is produced in small quantities in the pancreas. When you eat, the sugar (glucose) in the food stimulates the pancreas to produce insulin. Its amount is proportional to the amount of food taken. Insulin's main role is to help move certain nutrients, especially sugar, into the body's tissues and cells. Cells use sugar and other nutrients as an energy source to function.

The amount of sugar in the blood decreases when it enters the cells. This usually signals the beta cells to reduce the amount of insulin they secrete to avoid hypoglycemia (low blood sugar), and the amount of insulin they secrete also decreases. But the destruction of beta cells disrupts the functioning of the entire system.

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Causes of type 1 diabetes mellitus

The development of type 1 diabetes is provoked by the following diseases:

Severe viral infections
(rubella, chickenpox, cytomegalovirus, hepatitis, mumps). In response to infection, the body produces antibodies that, simultaneously with the virus cells, destroy beta cells, which are in many ways similar to the infection cells. In 25% of cases, after suffering from rubella, a person is diagnosed with diabetes mellitus.
Autoimmune diseases of the thyroid gland and adrenal glands
that produce hormones: autoimmune thyroiditis, chronic adrenal insufficiency.
Hormonal diseases
: Itsenko-Cushing syndrome, diffuse toxic goiter, pheochromocytoma.
Long-term use of a number of medications
. Antibiotics, tablets against rheumatism, dietary supplements with selenium are dangerous - they all provoke hyperglycemia - increased levels of glucose in the blood.
Pregnancy
. Hormones produced by the placenta increase blood sugar levels. The pancreas is under increased stress and cannot cope with the production of insulin. This is how gestational diabetes develops. This disease requires observation and may disappear without a trace after childbirth.
Stress.
When a person is very nervous, a large amount of adrenaline and glucocorticosteroids are released into the blood, which destroy beta cells. In patients with a genetic predisposition, it is after stress that a diagnosis of type 1 diabetes is made.

Prognosis and complications

The main cause of death and severe morbidity in patients with diabetes is cardiovascular disease. Advanced type 1 diabetes often ends in death due to diabetic ketoacidosis. Inadequate treatment greatly increases the risk of diabetes complications: blindness, kidney failure, and heart attacks. 15% of people with diabetes develop diabetic foot syndrome, which can lead to leg amputation.

Careful monitoring of blood sugar levels helps reduce the risk of vascular diseases and slow their progression by 30 years or more in patients with type 1 diabetes.

Is type 1 diabetes completely curable?

Unfortunately, at the moment there is no radical treatment for type 1 diabetes, but scientists hope to create an artificial pancreas in the foreseeable future, and the problem will be solved.

Causes of type 1 diabetes in children and adolescents

Many parents are mistaken in thinking that diabetics got sick because they ate a lot of chocolate and sugar. If you limit your child’s sweets, he can be protected from diathesis rather than from diabetes. Children get diabetes at an early age not because of poor diet. This is evidenced by the findings of scientists studying this problem.

The authoritative scientist Andreas Beyerlein from the Munich Helmholtz Center conducted a study, upon completion of which the following conclusions were made:

A severe viral infection suffered at the age of 0-3 years leads to the development of type 1 diabetes mellitus in 84%, and the pathology is more often diagnosed when the child reaches the age of 8.
Acute acute respiratory viral infection suffered by infants under 3 months causes diabetes in 97% of cases.
In children with a hereditary predisposition to hyperglycemia, the risk of developing the disease increases depending on nutritional factors (nutrition): artificial feeding, early consumption of cow's milk, high birth weight (above 4.5 kg).

There are two peak ages for detecting diabetes in children - 5-8 years and adolescence (13-16 years). Unlike adults, childhood diabetes develops very quickly and rapidly. The disease manifests itself as an acute form of ketoacidosis (poisoning by ketone bodies formed in the liver) or diabetic coma.

As for heredity, the likelihood of transmitting T1DM is low. If the father has type 1 diabetes, the risk of transmission to children is 10%. If the mother, then the risks are reduced to 10%, and in late births (after 25 years) to 1%.

Identical twins have different risks of getting the disease. If one child is sick, the disease occurs in the second no more than 30-50%.

Complications of type 1 diabetes

In addition to diabetes itself, its complications are no less dangerous. Even with a slight deviation from the norm (5.5 mmol/liter on an empty stomach), the blood thickens and becomes viscous. Vessels lose their elasticity, and deposits in the form of blood clots (atherosclerosis) form on their walls. The internal lumen of arteries and vessels narrows, organs do not receive sufficient nutrition, and the removal of toxins from cells is slowed down. For this reason, places of necrosis and suppuration appear on the human body. Gangrene, inflammation, rash occurs, and blood supply to the extremities deteriorates.

High blood sugar disrupts the functioning of all organs:

Kidneys
. The purpose of the paired organs is to filter the blood from harmful substances and toxins. When the sugar level is more than 10 mmol/liter, the kidneys stop doing their job efficiently and pass sugar into the urine. A sweet environment becomes an excellent base for the development of pathogenic microflora. Therefore, hyperglycemia is usually accompanied by inflammatory diseases of the genitourinary system - cystitis (inflammation of the bladder) and nephritis (inflammation of the kidneys).
The cardiovascular system.
Atherosclerotic plaques, formed due to increased blood viscosity, line the walls of blood vessels and reduce their capacity. The cardiac muscle myocardium ceases to receive adequate nutrition. This is how a heart attack occurs - necrosis of the heart muscle. If a sick person does not suffer from diabetes, he will feel discomfort and a burning sensation in the chest during a heart attack. A diabetic suffers from decreased sensitivity of the heart muscle and may die unexpectedly. The same goes for blood vessels. They become brittle, increasing the risk of stroke.
Eyes
. Diabetes damages small vessels and capillaries. If a blood clot blocks a large vessel of the eye, partial death of the retina occurs, and detachment or glaucoma develops. These pathologies are incurable and lead to blindness.
Nervous system.
Poor nutrition, associated with serious restrictions in type 1 diabetes, leads to the death of nerve endings. A person stops reacting to external stimuli, he does not notice the cold and freezes his skin, does not feel the heat and burns his hands.
Teeth and gums.
Diabetes is accompanied by diseases of the oral cavity. The gums soften, tooth mobility increases, gingivitis (inflammation of the gums) or periodontitis (inflammation of the inner surface of the gums) develops, which leads to tooth loss. The effect of insulin-dependent diabetes on the teeth of children and adolescents is especially noticeable - they rarely have a beautiful smile: even their front teeth deteriorate.
Gastrointestinal tract
. In diabetes, beta cells are destroyed, and along with them the PP cells responsible for the production of gastric juice. Patients with diabetes often complain of gastritis (inflammation of the stomach lining), diarrhea (diarrhea due to poor digestion of food), and the formation of gallstones.
Problems with bones and joints
. Frequent urination leads to the leaching of calcium, resulting in damage to the joints and skeletal system, and an increased risk of fractures.
Leather
_ Increased blood sugar leads to the loss of protective functions of the skin. Small capillaries become clogged with sugar crystals, causing itching. Dehydration makes the skin wrinkled and very dry. In some cases, patients develop vitiligo - the breakdown of skin cells that produce pigment. In this case, the body becomes covered with white spots.
Female reproductive system
. A sweet environment creates favorable soil for the development of opportunistic microflora. In type 1 diabetes, frequent relapses of thrush are typical. Women have poor vaginal lubrication, which makes sexual intercourse difficult. Hyperglycemia negatively affects fetal development in the first 6 weeks of pregnancy. Diabetes also leads to premature menopause. Early menopause occurs at 42-43 years.

Symptoms of type 1 diabetes

External signs help determine diabetes, because the disease affects the functioning of the entire body. In young people under 18 years of age, diabetes develops very quickly and rapidly. It often happens that 2-3 months after a stressful event (ARVI, moving to another country), a diabetic coma occurs. In adults, symptoms may be milder and gradually worsen.

The following signs are cause for concern:

Frequent urination, a person goes to the toilet several times a night.
Weight loss (dieting and the desire to lose weight in adolescence is fraught with the rapid development of hyperglycemia).
The appearance of age-appropriate wrinkles, dry skin.
Increased feeling of hunger with lack of weight.
Lethargy, apathy, the teenager quickly gets tired, he begins to have painful thoughts.
Fainting, severe headache, vision problems.
Constant thirst, dry mouth.
A specific smell of acetone from the mouth, and in severe cases from the body.
Night sweats.

If at least a few symptoms are noticed, the patient should be immediately sent to an endocrinologist.

The younger the body, the faster the coma sets in.

Diagnosis of diabetes mellitus

The endocrinologist will definitely prescribe the following tests for diabetes:

Test for blood glucose levels
. Blood is taken on an empty stomach; the last meal should be no earlier than 8 hours before. A reading below 5.5 mmol/liter is considered normal. An indicator of up to 7 mmol/liter indicates a high predisposition; 10 mmol/liter and above indicates hyperglycemia.
Oral glucose tolerance test
. This test is done for those who are at risk of developing diabetes. The patient takes a glucose solution on an empty stomach. Then, 2 hours later, blood is taken for sugar. Normally, the reading should be below 140 mg/dL. A blood sugar level above 200 mg/dL confirms diabetes mellitus.
Test for glycosylated hemoglobin A1C
. Excess sugar in the blood reacts with hemoglobin, so the A1C test shows how long the body's sugar levels have been above normal. Monitoring is carried out every 3 months, the level of glycosylated hemoglobin should not exceed 7%.
Blood test for antibodies
. Type 1 diabetes is characterized by an abundance of antibodies to the cells of the islets of Langerhans. They destroy body cells, which is why they are called autoimmune. By identifying these cells, the presence and type of diabetes is determined.
Urinalysis - microalbuminuria
. Detects protein in urine. It appears not only with kidney problems, but also with vascular damage. High levels of albumin protein lead to heart attack or stroke.
Screening for retinopathy
. High glucose levels lead to blockage of small vessels and capillaries. The retina of the eye does not receive nourishment; it peels off over time and leads to blindness. Special digital equipment allows you to take pictures of the back surface of the eye and see the location of damage.
Test for thyroid hormones.
An overactive thyroid gland leads to hyperthyroidism—excessive production of hormones. Hyperthyroidism is dangerous because the breakdown products of thyroid hormones increase the level of glucose in the blood; diabetes is accompanied by acidosis (high levels of acetone in the urine), osteoporosis (leaching of calcium from the bones), and arrhythmia (failure of heart rhythm).

Possible complications

In the absence of treatment or non-compliance with medical instructions, dangerous complications develop:

diabetic ketoacidosis – accumulation of ketone bodies in the blood;
hypoglycemia – a decrease in sugar concentration below normal (3.3 mmol/l);
hyperosmolar coma – accompanied by severe dehydration;
lactic acidotic coma - lactic acid accumulates in the blood and tissues;
diabetic retinopathy – damage to the retina of the eye, leading to hemorrhages, possibly retinal detachment;
diabetic macro- and microangiopathy – impaired permeability of blood vessels, increased fragility, tendency to thrombosis and atherosclerosis;
diabetic polyneuropathy – damage to both parts of the nervous system (somatic and autonomic), which leads to pain in various parts of the body, deterioration of sensitivity and numbness of the lower extremities;
diabetic nephropathy – kidney damage, eventually leading to kidney failure;
diabetic arthropathy – pain and “crunching” in the joints, limited mobility of the limbs;
diabetic ophthalmopathy - eye damage that contributes to the development of cataracts;
diabetic encephalopathy – instability and sudden mood swings;
diabetic foot – purulent-necrotic lesions of the foot, often leading to amputation.

It should be noted that the higher the blood glucose level and the longer the disease develops, the greater the risk of complications. Diabetics are 4-6 times more likely to develop malignant tumors. More than half of all amputations are caused by complications of diabetes mellitus.

Treatment of type 1 diabetes

Type 1 diabetes is not curable because beta cells cannot be restored. The only way to maintain normal blood sugar levels in a sick person is to take insulin, a hormone produced by the beta cells of the islets of Langerhans.

Based on the speed of action and duration of effect, medications containing insulin are divided into categories:

Short-acting (Insuman Rapid, Actrapid)
. They begin to act 30 minutes after administration, so they should be taken half an hour before meals. When the drug is administered intravenously, it is activated after a minute. The duration of the effect is 6-7 hours.
Ultra-short-acting (Lispro, Aspart).
They begin to work 15 minutes after the injection. The action lasts only 4 hours, so the drug is used for pump administration.
Medium duration (Insuman Bazal, Protafan).
The effect occurs an hour after administration and lasts 8-12 hours.
Long-term exposure (Tresiba).
The drug is administered once a day, it does not have a peak effect.

Medicines are selected individually for the patient in combination with other drugs that prevent the negative effects of high blood glucose.

Classification of pathology

Depending on the cause of the disease, there are 2 main types of diabetes mellitus: insulin-dependent (type 1) and non-insulin-dependent (type 2). In insulin-dependent diabetes, the pancreas does not synthesize insulin or produces it in insufficient quantities, and in non-insulin-dependent diabetes, tissue sensitivity to insulin decreases.

Additionally, a distinction is made between secondary diabetes (develops against the background of other diseases) and gestational diabetes (occurs in pregnant women).

Depending on compensation, diabetes mellitus is:

compensated - carbohydrate metabolism is normalized, and glucose concentration approaches normal;
subcompensated – blood sugar levels periodically increase or decrease;
decompensated - neither diet nor medications can lower glucose, which is why diabetics often develop precoma or coma, which can lead to death.

To successfully compensate for diabetes, it is important to regularly measure blood sugar levels and make timely adjustments to treatment.

Exercise for diabetes

Physical activity for type 1 diabetes is simply necessary, although there are restrictions regarding the type of sport. Exercise normalizes blood pressure, improves well-being, and normalizes weight. But in some cases, physical activity causes spikes in blood glucose levels.

If you have type 1 diabetes, you cannot overload yourself, so training should not exceed 40 minutes a day. The following sports are acceptable:

walking, cycling;
swimming, aerobics, yoga;
table tennis, football;
exercises in the gym.

Any exercise is contraindicated if ketones, protein breakdown products, are found in the urine, and if blood pressure has increased or problems with blood vessels have appeared.

References

Clinical recommendations. Diabetes mellitus type 1 in adults, 2019. - 167 p.
Guide to laboratory diagnostic methods. - M.: GEOTAR Media, 2007. - 800 p.
Guyton, A.K., Hall, J.E. Medical physiology / ed. IN AND. Kobrina. - M.: Logosphere, 2008. - 1296 p.
Regnell, S., Lernmark, Å. Early prediction of autoimmune (type 1) diabetes. Diabetologia, 2021. - Vol. 60(8). - P. 1370-1381.
Nazarenko, G.I., Kishkun, A.A. Clinical evaluation of laboratory results. - M.: Medicine, 2000. - 544 p.
Kishkun, A.A. Guide to laboratory diagnostic methods. - M.: GEOTAR-Media, 2007. - 800 p.

Where type 1 diabetes is diagnosed and treated in St. Petersburg, prices

If you suspect diabetes, be sure to get tested; this can be done at the Diana Clinic in St. Petersburg. Here you can get advice from an experienced endocrinologist, undergo expert ultrasound of the pancreas and other types of diagnostics. The cost of an ultrasound is 1000 rubles, the cost of an appointment with an endocrinologist is 1000 rubles.

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