Diabetes mellitus classification etiology pathogenesis diagnosis of diabetes

Diabetes mellitus: classification, etiology, pathogenesis, diagnosis of diabetes type 1 and 2.

Diabetes mellitus n Syndrome of chronic hyperglycemia and glycosuria due to absolute or relative insulin deficiency, which leads to a violation of all kinds of metabolism, the affected vessels (various angiopathy), neuropathy, and pathological changes in various organs and tissues.

Classification of a diabetes (1999) Diabetes mellitus type 1, Autoimmune Idiopathic Diabetes mellitus type 2 Destruction of the β-cells of the pancreas, leading to insulin deficiency With predominantly insulin resistance and relative insulin deficiency or with a primary defect in insulin secretion, insulin resistance with or without

Others - genetic defects of function β-клеток spetsifigenetic defects in operation insulin chesky types illnesses of exocrine part of a pancreas of a diabetes endocrinopathies mellitus Diabetum induced by drugs or chemicals infections other genetic syndromes which are combining with a diabetes mellitus

Gestational Arises during pregnancy diabetes mellitus Genetic defects of function β cells МОДУ – 1 МОДУ – 2 МОДУ – 3 МОДУ – 4 Genetic defects in operation insulin Resistance to insulin of type A Leprechaunizm Rabson's syndrome – Mendelkholla Lipoatrofichesky Diabetum

Illnesses of exocrine part of a pancreas Pancreatitis Trauma / pancreatectomy Neoplasias Cystic fibrosis Hemochromatosis Fibrokalkulezny pancreatopathy Endocrinopathies Acromegalia Syndrome of Kushinga Glucagonoma Pheochromocytoma Thyrotoxicosis Somatostatinoma Aldosteroma

Diabetum induced by drugs or chemicals Nicotinic acid Glucocorticoids Thyroid hormones Diazoxide Tiazida ά – an interferon β – adrenoblockers Infections Congenital rubella Cytomegalovirus Unusual forms of "Stiff – man" an obezdvizhennost immunomediate syndrome d Diabetum Antibodies to insulin receptors Antibodies to insulin

Other genetic syndromes being combined with a diabetes mellitus Down syndrome Klaynfelter's syndrome Turner's syndrome Tungsten syndrome Fridreykh's ataxy Chorea of Gentington Lawrence's syndrome – Moon – Bidlya Miotonichesky dystrophia Porphyria Prader's syndrome - Willie

Gestational diabetes mellitus n n n Tolerance disturbance to a glucose, for the first time taped during pregnancy. In 6 weeks and more after the end of pregnancy the woman has to be surveyed repeatedly, and is carried to one of категорий: 1) Diabetum; 2) the broken glycemia on an empty stomach; 3) the broken tolerance to a glucose; 4) Normoglicemy. More often level of a glucose comes back to norm after a delivery. The diagnosis is specified on the basis of a peroral glucose loading with 75 гр. glucoses

n n It is offered to lower the names "insulinzavisimy" and "non-insulin-dependent", "Diabetum of type 1 or 2" respectively remains DM 1 and DM of 2 types represent two different nosological forms – etiologically, pathogenetically, clinically, and also concerning medical approaches. Key pathogenetic link which unites to them, development is at both types of a syndrome of a chronic hyperglycemia

n Diabetes mellitus 6, 6% of the population everyone of 10 - 15 years number of sick SD on the average suffer increases twice. Annually at 1 – 5% from the diabetes mellitus 2 types develops

Comparative characteristic of the DM main types DM type 1 synonym age Genetic data Juvenile DM, Insulinzavisimy of DM, (IZSD) DM type 2 DM - adults, D M– corpulent, noninsulin-dependent DM (INSD) Usually till 30 years, Usually after 40 years peaks of a case rate of 14 and 25 years Association with гаплотипами HLA, concordance at unioval twins – 40% The association with гаплотипами HLA is absent, concordance at unioval twins of 95 100%

Body mass Лечение инсулином Obesity in 80% of cases current Often sudden beginning, in 5 – 15% of cases demonstrates ketoacidos Obesity in 80% of cases Develops gradually, often subclinically Late complications are often taped already at diagnosis statement Treatment by insulin It is vital Usually it isn't required

DM symptomatology 1 type Demonstrates acutely. Signs: thirst, polyuria, dermal itch, predilection to infectious processes. Specific complaints to the weight loss, the expressed delicacy, working capacity depression, sleepiness. 2 type Softer current is characteristic. The diagnosis often is established casually. For many years proceeds subclinically. Patients suffer an obesity. As a rule the working capacity, the increased appetite remains.

1 type Often the ana-reksiya against a keto-acidosis develops. Its signs: acetone smell, nausea, vomiting, abdominal pains, serious deaquation. All this leads to development of a ketoatsido-tichesky coma. 2 type Often SD is established by dermatologists, urologists, oculists, gynecologists. Against a decompensation the transient ketosis can develop. Late complications are often taped at the time of diagnosis establishment

n n n DM 1 – an autoimmune disease which can be induced by a virus infection and as other acute or chronic factors of environment against a certain genetic predisposition The death about 75% β-клеток leads to tolerance depression to a glucose. Destruction of 80 - 90% β-клеток leads to a clinical manifestation of SD-1. The greatest significance is attached to a virus infection (a virus of a rubella, parotitis), influence of genetic factors and environment and delivery factors. DM 1 – is characterized by an acute debut of a disease, fast development of metabolic disturbances, the manifestation of a diabetic coma or a serious acidosis is possible.

n n At persons of suffering DM 2 the course of a disease often soft, symptoms are expressed moderately, often in general are absent. The diagnosis of Diabetum is established casually, good working capacity, appetite often raised becomes perceptible. In the majority patients have excess mass of a body or an obesity. DM 2 develops gradually at persons is more senior than 40 years, often isn't diagnosed for a long time. The first symptoms of a disease – moderately expressed polydipsia, a polyuria, increased fatigue, weight change.

At DM allocate 2 groups of complications: acute and chronic Acute complications are more specific to DM of 1 type, in particular, development of a ketoatsidotichesky coma. At the DM insulinpotrebny form 2 types can develop a transient ketosis, but the ketoatsidotichesky coma, as a rule, doesn't develop. n Giperosmolyarny coma - infrequent, but specific complication of DM 2 types. n

n n n n n Laboratory diagnostics of DM 1. Saccharum definition in a blood. a) on an empty stomach in norm: - in a capillary blood from 3, 33 to 5, 55 mmol/l - in a blue blood is 0, 28 - 0, 83 mmol/l less than in arterial and capillary At obvious Diabetum on an empty stomach it is higher than 6, 1 mmol/l b) in 2 hours after food in norm lower than 7, 8 mmol/l 2. Saccharum definition in daily urine, in norm – abs. 3. Glikirovanny hemoglobin – Hb. A 1 c (information on a glycemia in 2 – 3 months) in norm makes 4 -6% from the general hemoglobin.

n n 4. Fruktozamina – information on a glycemia for the last 1 – 3 weeks, at healthy faces of 2 - 2, 8 mmol/l 5. The S-peptide and IRI reflect endogenic secretion of insulin (at 1 type it is lowered, at 2 – normal or it is raised). 6. Glikirovanny keratin of hair (information on the beginning and duration of the obvious and occult diabetes). 7. Glikirovanny fibrinogen (information on a glycemia for the last 4 days)

Diabetes mellitus diagnostics The glycemia on an empty stomach – means glucose level in the morning before a breakfast, after starvation within 8 hours n The Postprandialny glycemia – means level of a glucose of a blood in 2 hours after meal n

At DM allocate 2 groups of complications: acute and chronic Acute complications are more specific to DM of 1 type, in particular, development of a ketoatsidotichesky coma. At the DM insulinpotrebny form 2 types can develop a transient ketosis, but the ketoatsidotichesky coma, as a rule, doesn't develop. n Giperosmolyarny coma - infrequent, but specific complication of DM 2 types. n

It is important to note, at the time of a manifestation of DM of 1 type late complications practically never meet, they develop in years. n At DM 2 types late complications are often taped already at the time of diagnosis statement. It is bound, often that before establishment of the diagnosis of DM 2 types, the disease proceeds subclinically. n

Kliniko-laboratornaya the characteristic of DM of 2 type at the time of diagnosis establishment n n n n Hyperglycemia, rising of level of free fatty acids in blood serum – 100%. Obesity – 80%. Giperinsulinemiya on an empty stomach – 80%. Essential AG - 50%. Dislipidemiya – 50%. Cardiovascular diseases of-30%. Diabetic retinopathy, neyropatiya – 15%. Diabetic nephropathy – 5%.

Shorting of expected life expectancy at DM of 2 type depending on age of a debut of a disease Age of a debut: n 30 - 45 years a shorting of expected life expectancy twice. n 45 - 64 years by 1, 5 times. n 65 – 74 years by 1, 3 times. n More than 75 years by 1, 1 times. n