Diabetes Mellitus – Type 1, Type 2, and Gestational Diabetes

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Last Medical Review: March 27, 2020
Medically Reviewed by Dr. David Costa Navarro
Diabetes (March 27, 2020)
Classification of Diabetes Mellitus (March 27, 2020)

What is that

Diabetes mellitus is a disease of metabolism, that is, of the process that the body uses to obtain the energy and substances it needs from food – characterized by an increase in the concentration of a sugar, glucose, in the blood.

The simple and complex sugars (starches) present in food (e.g. bread, pasta, sweets, fruit, milk) during digestion are transformed into glucose (a simple sugar) which is the main source of energy in the body. Glucose enters the blood and then passes inside the cells to provide energy or to be further transformed into other substances. In order for glucose to enter cells, the presence of insulin is indispensable. Insulin is a hormone produced by particular cells, called beta cells, present in the pancreas, a large gland located behind the stomach.

Hormone:
Substance, produced by a gland, which is introduced directly into the blood and affects the activity of one or more organs of the body.

Gland:
Organ equipped with cells capable of producing secretions. It can be by internal secretion, when the substances produced (hormones) are introduced into the blood or by external secretion
if secretions pour out of the body (e.g. sweat glands) or into body cavities that communicate with the outside, such as the intestine.

When we eat, the pancreas produces the right amount of insulin to allow glucose to enter the cells. In people with diabetes, however, the pancreas produces insufficient insulin, or does not produce it at all, or the cells do not respond to insulin produced by the pancreas.
As a consequence, the concentration of glucose in the blood increases above normal levels, passes into the urine and is thus eliminated from the body. In this way the body loses its main source of energy, although there is paradoxically an excess of glucose in the blood.

What are the different types of diabetes mellitus

There are 3 different types of diabetes mellitus:

  • type 1 diabetes
  • type 2 diabetes
  • pregnancy diabetes

Type 1 diabetes

Type 1 diabetes (once known as insulin-dependent diabetes or juvenile diabetes) is considered an autoimmune disease.

Autoimmune disease:
Disease due to an abnormal immune system reaction. The immune system, normally used to fight infections, reacts against parts of the body to which it belongs.

In diabetes, the immune system attacks and destroys the beta cells of the pancreas that produce insulin. The pancreas only manages to produce small amounts of insulin or does not even produce insulin at all. The patient therefore needs to receive, through daily injections, the insulin he needs to survive. At present, it is not known why the immune system attacks beta cells, but both genetic factors and viruses are believed to be involved.
Type 1 diabetes develops most frequently in children and young adults, but the disease can occur at all ages. About %10 of people with diabetes have type 1 diabetes.
The symptoms of this type of diabetes manifest themselves in a short span of time, although the destruction of the beta cell may have started long before.
They include intense thirst and increased urine production, hunger, weight loss, blurred vision and deep tiredness. If diabetes is not diagnosed and treated with insulin, the affected person can experience coma and death

Type 2 diabetes

The most frequent (about 90%90) form of diabetes is type 2 (formerly known as non-insulin-dependent diabetes mellitus). In Italy it is estimated that about %6 of the population suffers from type 2 diabetes but only half of the cases are diagnosed. This form of diabetes normally develops in adults over the age of 40 and is more frequent over the age of 55. About %80 of people with type 2 diabetes are overweight.
In type 2 diabetes, the pancreas generally produces insulin but, for several reasons, cells are unable to use it efficiently. The end result is the same as that of type 1 diabetes, i.e. an increase in blood glucose above normal values ​​and the body’s inability to efficiently use its main energy source.
The symptoms of type 2 diabetes develop gradually and are not as evident as in type 1 diabetes. They mainly consist of feeling tired or unwell, frequent need to urinate (especially at night), unusual thirst, weight loss, vision blurred, frequent infections and slow wound healing.

Gestational diabetes

Gestational diabetes is a form of diabetes that develops or is discovered during pregnancy. It generally disappears at the end of pregnancy, but women who have had gestational diabetes are more likely to develop type 2 diabetes at an older age.

What are the damages induced by diabetes?

Diabetes is a major cause of death and disability.
It is associated with long-term complications of important organs. It can lead to blindness, heart disease, stroke, kidney failure, serious damage to the nerves and the vascular system of the legs (with pain in walking up to the gangrene). Properly controlled diabetes can complicate a pregnancy, and babies born to diabetic mothers have birth defects more frequently than other babies.
Social and economic costs are very high, due to the lower life expectancy of diabetic patients, the necessary treatment and the loss of working hours.

Who is at risk of getting diabetes?

Some factors can increase the risk of developing diabetes. The people most at risk are those who have other family members with diabetes (especially type 2), those who are overweight or those who belong to particular ethnic groups.
Type 1 diabetes occurs with the same frequency in males and females, and is more common in the white breed.
Type 2 diabetes is more common in older people, especially women, and in overweight people.

Objective of diabetes treatment

The goal of diabetes treatment is to keep the blood glucose concentration as close to normal as possible. Studies conducted over many years and involving thousands of diabetics have shown that if this is achieved, the risks of developing serious complications of diabetes in organs such as the eyes, kidney and nerves are reduced.
People with diabetes must therefore be followed by a doctor who specializes in the treatment of diabetes, who is able to keep the disease and its complications under control. Diabetic patients must often visit an ophthalmologist, refer regularly to a dietician, who can help set up a personalized diet, and to a podiatrist, to have the assistance of an expert in foot care.

The drugs used in the treatment of diabetes

Although insulin is not considered a cure for diabetes, its discovery was the first big step in the treatment of diabetes. Before its discovery in 1921, all people with diabetes died within a few years of the onset of the disease. Currently, daily insulin injections are the basic therapy of type 1 diabetes. The amount of insulin to be injected should take into account individual nutrition and physical activity carried out by each patient, and blood glucose levels must be constantly checked during the day.
Diet, physical activity and glycemic control are also the cornerstones in the treatment of type 2 diabetes. Some of these patients may also need drug treatment with oral hypoglycaemic agents (eg Diabemide, Daonil, Minidiab) or insulin.
People with diabetes need to take responsibility for managing their particular disease condition day after day. The goal is always to ensure that the amount of glucose in the blood does not drop too low or increase too much. In the first case we encounter a situation called “hypoglycemia” characterized by the appearance of agitation, tremors and mental confusion, up to impaired judgment and even loss of consciousness.
The treatment of hypoglycaemia is very simple because it is enough to eat or drink a food that contains sugars or starches.

If, on the other hand, there is an increase in the concentration of glucose in the blood “a defined condition of hyperglycaemia”, the disturbances can be very serious. In any case, both hypo and hyperglycaemia in a diabetic patient can endanger their lives if they are not taken promptly.

The state of diabetes research

In recent years, the results of diabetes research have improved the chances of managing the disease and treating its complications.
Major advances include:

  • The availability of new forms of purified insulin, such as human insulin produced by genetic engineering methods.
  • The availability on the market of very precise instruments for the control of blood glucose levels, which can be used both by doctors and by patients at home.
  • The development of external or implantable insulin infusion pumps that release the appropriate amount of hormone, thus replacing the need for repeated daily injections.
  • Laser treatment of eye complications, thus reducing the risk of blindness.
  • The possibility of successfully carrying out kidney transplants in patients whose kidneys have been damaged by diabetes.
  • Improvements in the management of diabetes in pregnancy, increasing the chances of a happy outcome of many pregnancies.
  • The availability of new drugs to treat type 2 diabetes and improved ability to manage this form of diabetes by controlling body weight.
  • Acquisition of data demonstrating that constant blood glucose control reduces and can prevent the development of complications affecting the microcirculation.
  • The demonstration that particular drugs used to lower blood pressure – called ACE inhibitors – are able to reduce and prevent the development of kidney failure in diabetic people.

What will the future bring us?

In the future, it may be possible to administer insulin in the form of a nasal spray or in the form of a pill or patch. Tools are also being developed that will measure blood glucose concentration without needing to prick your finger to get a blood sample.
Research continues to find out the cause (or causes) of diabetes and ways to prevent it. One of the directions is the search for genes that can be involved in type 1 and 2 diabetes. Some genetic indicators for type 1 diabetes have been identified, and it is now possible to check those who are at risk of getting sick among relatives of diabetic subjects. Studies underway in different countries will tell us if it is useful to treat these people with low doses of insulin preventively to avoid the development of the disease.

Transplantation of the pancreas, or the beta cells of the pancreas that produce insulin, offers the best hope for a definitive cure for people with type 1 diabetes. Some pancreas transplants have been successful, but transplanted people have to take a lot of drugs. powerful to avoid rejection of the transplanted organ. These drugs can eventually cause serious health problems to the people who take them and are expensive.
Researchers are working to develop less dangerous drugs and better methods of pancreatic tissue transplantation, to prevent organism rejection reactions. Using bioengineering techniques, efforts are even being made to create artificial cells that secrete insulin in response to increases in blood glucose concentration.

For type 2 diabetes, the focus is more on prevention. An approach of this type is based on identifying people at risk to encourage them to reduce their body weight, to exercise more and to follow a correct diet.

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