What is diabetes mellitus?
Diabetes mellitus is when there’s too much glucose, a type of sugar, in the blood. Diabetes mellitus can be split into type 1, type 2, as well as a couple other sub-types, including gestational diabetes and drug-induced diabetes.
How does glucose increase in body?
Learning medicine is difficult. In diabetes, the body has a problem in moving glucose (which is a type of sugar) From the blood to the cells. This leads to high levels of glucose in the blood and insufficient levels of it inside the cells. And remember, cells need glucose as an energy source. So, not being allowed to enter means that the cells will starve for energy despite the presence of glucose on its doorstep. In general, the body controls the level of glucose in the blood depending on the intake of glucose cells according to two hormones: insulin and glucagon.
What do Insulin and Glucagon do?
Insulin is used to lower blood glucose, and glucagon is used to raise the level of blood glucose. Both of these hormones are produced from clusters of cells located in the pancreas called Langerhans Islands. Insulin is secreted from beta cells in the center of these islands, and glucagon is excreted from Alpha cells around the islands. Insulin reduces the amount of glucose in the blood by binding to existing insulin receptors in the cell wall in many tissues that respond to insulin, such as muscle cells and adipose tissue.
When insulin receptors are activated, they push vesicles inside the cell containing glucose transporters fusion from the cellular membrane, allowing glucose to be transported into the cell.
Glucagon works exactly the opposite, as it raises blood glucose levels by pushing Liver to generate new molecules of glucose starting from other molecules and also by breaking down glycogen into glucose, thereby throwing them all into the blood. Diabetes is diagnosed when glucose concentrations rise dramatically, and it is seen in 10% of the global population.
Types of Diabetes
There are two types of diabetes: the first and second types, and the main difference between them is the mechanism that causes high blood glucose levels. Almost 10% of patients with diabetes have type 1 diabetes, and the remaining 90% of those with diabetes have diabetes type 2.
Type 1 diabetes
Sometimes diabetes is called type 1. In this case, the body does not make enough insulin. The reason for this thing in type 1 diabetes is an allergic response. A fourth pattern or cell-mediated immune response (that is, when T cells attack the pancreas cells for the same person).
What are T cells?
For a quick review, remember that your immune system has T cells that interact with all types Antigens, which are often small peptides, multiple sugars, or fats. And this kind one of the antigens is part of the cells of the body itself.
It is illogical to let the T cells that attack the auto cells to mess around, so there is a process of privatization called “self-tolerance.” In type 1 diabetes, there is a genetic defect that causes a deficiency in the process of self-tolerance of T cells, which specifically attack T cell antigens. A loss of self-tolerance means that these T cells can recruit other immune cells. It coordinates an attack on beta cells. Beta cell loss means that there is insulin deficiency, and insulin deficiency means that glucose will accumulate in blood because it cannot enter the cells.
What is leukocyte antigen system?
One really important gene involved in regulating immune response is the leukocyte antigen system Human or what is known as the HLA system. Although it is called a system, it is essentially that group of genes on the sixth chromosome, which denotes histocompatibility complex or MHC, which is a protein important in helping the immune system to identify foreign molecules in addition to maintenance of self-tolerance.
What is MHC?
MHC is like a large dish through which antigens are introduced into the immune system. Interestingly, people with type 1 diabetes have a common, specific HLA gene with each other, one is called HLA-DR3 and the other is called HLA-DR4. But this is only genetic evidence, right? Yes, because not everyone with HLA-DR3 and HLA-DR4 develops diabetes.
Beta cell destruction
In type 1 diabetes, beta cell destruction often begins early in life, however sometimes 90% of our home cells are destroyed before suddenly showing symptoms. There are four clinical symptoms of uncontrolled diabetes that all look similar and that is bulimia, urine intoxication, urination and thirst. Let’s talk about it one by one. Although there is a lot of blood glucose, it cannot enter cells. This leads to a severe lack of energy, so on the other hand, the adipose tissue breaks down the fat and this is called (Lipolysis), and muscle tissue also begins to break down proteins.
Both of the above two processes lead to low weight of the patient due to uncontrolled sugar. This state of demolition makes the person feel hungry, which is what is known as voracity. Phagia means eating, Ploy means a lot. With these high levels of glucose, the blood when filtered into the kidneys, some glucose molecules are released to the urine, which is called urine glycation. Glycos means uria sugar means urine.
Since glucose is an active solution, water tends to follow, causing an increase in urination, which is called polyuria. We repeat that Poly means a lot of uria, again it means urine. Finally, because there is a lot of urination, diabetics are dehydrated and thirsty which is called thirst. Poly means a lot dipsia which means thirst. Although people with diabetes here do not produce insulin on their own, they remain able to respond to insulin, so treatment includes lifelong insulin to regulate their blood glucose levels and enable the cells to use it.
There is a serious complication in diabetes mellitus, the first type is diabetic ketoacidosis Or DKA. To understand it, let’s return to the lipolysis process, where the fats are segmented into Free fatty acids. After this happens, the liver converts the fatty acids into ketone bodies such as acetoacetic acid and Beta hydroxybutyrate. Acetoacetic acid is keto acid because it contains Ketone group and carboxyl group in it.
Beta hydroxybutyrate despite being one of the ketogenic bodies, it is technically not a keto acid, because its ketogenic group has been returned to a group Hydroxyl. These keto bodies are very important, because they can be used by cells as a source of energy, but they are The acidity of the blood increases, so this condition is called ketoacidosis. The transformation of blood into an acidic medium has major effects throughout the body. It is possible that Cosmawl’s respiration can develop, which is a deep effort in my body. It tries to move carbon dioxide out of the body to reduce acidity.
Cells also have a vector that exchanges hydrogen ions (or protons) with potassium. When the blood becomes acidic, this means by definition that the blood is loaded with protons which are sent to the cells while potassium is excreted from the cells to the extracellular fluid. Another important thing is that in addition to helping glucose enter cells, insulin stimulates the sodium-potassium-atypase pump that helps keep potassium inside the cells, so without insulin more potassium will remain outside, that is, in the extracellular fluid.
Both of these mechanisms lead to increased potassium levels in the extracellular fluid, which soon moves to the blood, causing high blood potassium. Potassium is then secreted with urine, so over time even though potassium levels remain high. The total stores of it in the body that are inside the cells begin Depletion. The patient will also have a large ascending gap, which reflects the big difference between non-measured negative electrolytes the positive in serum, which is largely caused by ketoacidosis.
Diabetic ketoacidosis can affect newly diagnosed people with diabetes and also those who get some insulin treatment. In severe cases such as sepsis, the body releases epinephrine, which in turn built by the release of glucagon. Too much glucagon can displace the delicate hormonal balance between insulin and glucagon in favor. Raising blood sugar levels can lead to a cascade of events we just explained: high glucose in the blood, loss of glucose with urine, loss of water, dehydration, and parallel the emergence of a need for another source of energy, the generation of ketone bodies and the occurrence of diabetic ketoacidosis.
Interestingly, both types of ketone bodies shatter into acetone and escape as a gas. The breath is taken out of the lungs, which gives a sweet scent of fruit coming out of the person’s breath. In general, this is the only sweet thing in this disease that also causes Nausea, vomiting, and if severe, mental disorder and severe edema. Treating an attack of diabetic ketoacidosis involves giving a lot of fluids that help repair dehydration, Insulin, which helps lower blood glucose and correct electrolytes, such as potassium. All of the above helps to correct acidosis.
Type 2 diabetes
Type 2 diabetes, in which the body makes Insulin, but the tissues do not respond well to it. The exact cause of cell failure not being fully understood is mainly incomplete. The body provides enough insulin, but the cells do not carry glucose transporters to its membranes. In response, remember that the receptor is essential for glucose entering the cell, thus, these cells have insulin resistance.
Some of the risk factors for insulin resistance are: obesity, lack of exercise, high pressure. The mechanisms are still under consideration? For example, it is believed that increased fat tissue – lipids – causes release Free fatty acids called “adipokines” are signal molecules that can cause inflammation, which appears to be related to insulin resistance. However, many people who are obese are not glycemic. Genetic factors are more likely to play a major role as well. We see this when we look at twin studies as well, since having twins has type 2 diabetes. The risk of developing type 2 diabetes is completely independent of any risk factors.
In type 2 diabetes, since the tissues do not respond properly to normal levels of insulin, the body produces more insulin to have the same effect in removing sugar from blood. This is done by increasing the synthesis of beta cells, increasing the number of beta cells, and increasing the size of cells, where they grow by size, all in an effort to pump more insulin. This works for a while, and by keeping the amount of insulin higher than normal, the levels of glucose remain normal – whether sugar – in addition to insulin, beta cells also secrete amyloid polypeptide (amylin).
So beta cells release insulin and an excess of amylin. Over time, amylin accumulates and accumulates within islands. However, this compensation made by beta cells is not sustainable, and over time the beta cells have reached their maximum energy. You will suffer from fatigue, become functional and subject to deficiency They get smaller, decrease in size and die. As beta cells are lost and insulin levels decrease, glucose levels begin to rise and patients develop hyperglycemia, leading to similar clinical signs When I mentioned above, such as drinking too much water, glucoseuria, polyuria, and thirst.
But unlike pattern 1, type 2 usually has some circulating insulin Of beta cells that try to compensate for insulin resistance. This means that insulin / glucagon balance is such that diabetic ketoacidosis does not happen. By the way, there is a mixture called HHS hyper state which is much more common. In type 1, it causes an increase in plasma precursors. As a result of severe dehydration and increased blood concentration. To understand this: remember that glucose is a polar compound that the cell membrane passes through passively, which means that it acts as a solute.
So when glucose levels are very high in the blood (that is, they are hyper-alcoholic), water begins to leave the cells of the body and enter the blood vessels, leaving the cells relatively dry and wilted, instead of being full and supple. Water-filled blood vessels increase urination and dehydration. This is a very serious condition due to the dehydration of the body cells especially the brain, which can cause a number of symptoms, including mental state changes.
In HHS, we may occasionally see a mild and sour blood abandonment, but not to a degree seen in diabetic acetic acidosis (DKA), and in DKA we can see mild hyperacidity, so there is definitely some overlap between these two syndromes. Apart from type 1 and 2, there are also two subtypes of the disease diabetes.
Gestational diabetes is when the blood sugar of a pregnant woman rises during the last trimester of pregnancy. The exact cause is unknown, but it is believed to be related to pregnancy hormones that interferes with insulin action on its receptors. Also, some people may develop drug diabetes, which is where it causes drug side effects increase in blood sugar levels.
The mechanism in both is believed to be related to insulin resistance (e.g. Type 2 diabetes, rather than an autoimmune sabotage process (such as type 1) Types 1 or 2 are diagnosed with glucose blood-thinners, which have specific criteria used by the World Health Organization Globalism. Commonly, fasting blood sugar is taken where the patient neither eats nor drinks water for 8 hours, we analyze their blood for glucose levels. Levels between 100 and 125 mg / dl indicate pre-diabetes And 126 mg / dl or more indicate diabetes. Non-fast or random sugar testing can be done at any time, indicating 200 mg / d or more to a red flag for diabetes.
Oral Diabetes Tolerance Test
There is another test called the oral diabetes tolerance test, in which a person is given glucose. Blood samples are then taken at intervals to see the extent of the removal sugar from blood, the most important period is after two hours. Levels from 140 to 199 mg / dl indicate pre-diabetes. 200 or more refers to diabetes. Another thing to know: is that when blood sugar levels are high, glucose can bind with circulating proteins in cycles or intracellular.
This brings us to another test, HbA1c. It tests the hemoglobin level in the red blood cells to which glucose is bound. It is called diabetic hemoglobin. HbA1c levels between 5.7% and 6.4% indicate pre-diabetes, and 6.5% and higher indicate diabetes. This percentage of diabetic hemoglobin does not change from day to day, so it gives an idea whether glucose levels are high during the past 2-3 months.
Finally, we have the C-peptide test, which results from the production of insulin-origin. In the event of a decrease or absence of peptide levels C. Insulin is produced, and glucose cannot enter cells.
Treatment of Different Types of Diabetes
For type 1 diabetes the only treatment option is insulin. For type 2 diabetes, change the lifestyle and adjust weight and exercises along with a healthy diet and oral hypoglycemia, such as metformin and many others varieties. It may be sufficient to reverse and maintain some insulin resistance, sugar levels are controlled.
However, if oral hypoglycemia fails, it is possible to treat type 2 diabetes via Insulin. Another thing to consider is that insulin therapy is accompanied by a risk of low blood sugar especially if insulin is taken without a meal. Symptoms of low blood sugar may be mild, such as weakness, hunger and fibrillation, but they may develop unconsciousness and convulsions in severe cases.
In mild cases, eating juice, candy or sugar may raise your blood sugar levels to normal. But in severe cases, intravenous administration of glucose should be given as soon as possible. The World Food Organization (FDA) recently approved trans-nasal glucagon as a treatment for low blood sugar concentration. Well, over time, high levels of glucose cause damage to the vessels fine bloody in arterioles, a process called hyaline degeneration occurs where the hyaline builds up in the arterial walls.
These clusters of protein make them stiff and inflexible. In capillaries, the basement membrane can harden oxygen crossing from the vessel to the tissue, causing hypoxia. One of the most important effects is that diabetes increases the risk of damage to the walls of medium and large arteries and later atherosclerosis, which leads to heart attacks and strokes, which are the leading cause of disease and death in diabetics. In the eyes, diabetes can lead to retinopathy, and evidence for this can be seen.
With a test, we see a tease of cotton or a bleeding flame, and ultimately it causes blindness. In the kidneys, the arterioles and the fore can be damaged in addition to the glomerulus itself, which leads to a nephrotic syndrome that slowly reduces capacity. On clearing the blood over time, in the end, it may lead to transformation.
Diabetes may affect the functioning of nerves, causing symptoms such as a sensory deficiency in the abakhs and the fingers, it is sometimes called the distribution of gloves and socks too. It leads to dysfunction of the autonomic nerves and the systems that control several processes in the body everything from getting to knowing the wind. In the end, both a lack of blood contained and nerve damage may lead to ulcers (Typically on the feet). It does not heal quickly and may become rather severe, requiring amputation.
These are some complications of uncontrolled diabetes, and for this it is necessary prevention, diagnosis, and control of diabetes through a healthy lifestyle, medication that reduces insulin resistance and even insulin compensation if the beta cells are spilled. While type 1 diabetes cannot be prevented, the second type is preventable. In fact, many diabetics are able to control their blood sugar effectively And live a full active life without any complications.