Director of the Nursing Home in Kalisz
TYPES OF DIABETES
Diabetes is a result of lack of insulin (a hormone produced by the pancreas) in the body. The role of insulin is comparable to the role of the key – thanks to it we get into the apartment, and thanks to insulin sugar (glucose) can get into the body’s cells where it is converted among other things into energy. If there is lack of insulin in the body, sugar builds up in the bloodstream.
Currently, there are two prevalent types of diabetes: type 1 and type 2. The causes of this condition are different depending on the type of the disease.
Type 1 diabetes, formerly insulin dependent diabetes or juvenile diabetes, is caused by a complete lack of insulin due to the damage of appropriate cells of the pancreas. It occurs mainly in children and adolescents, hence its name. The emergence of the disease is not fully known. We only know that it is genetically determined, resulting in impaired immune mechanism and further in damage to the beta cells of the pancreas.
Type 2 diabetes, formerly noninsulin-dependent diabetes, is the most common form of the disease. The cause is usually impaired insulin secretion by pancreatic beta cells or the use of insulin by tissues. This diabetes occurs most often in the elderly people, obese, or with other metabolic disorders. In the early stage of the disease insulin is secreted in increased amounts, but at the same time the amount is insufficient for the increased needs of the body (insulin resistance).
In the literature there are many definitions of diabetes, and one of them says that it is a group of various genetically determined and acquired metabolic disorders that are characterised by glucose intolerance and hyperglycaemia, and over time the emergence in the vascular system, nervous system and other organs of changes referred to as chronic complications of diabetes. The cause of impaired glucose tolerance is the lack of insulin or its inappropriate tissue action. The name “diabetes” according to the new classification means a disease with a complete clinical picture, and mild carbohydrate metabolism disorders are called impaired glucose tolerance. 1
However, according to J. Tatoń diabetes is “a large group of diseases and metabolic disorders of various etiology, characterised by a constant, pathological fasting hyperglycaemia, between meals or just after a meal, resulting from the failure of insulin secretion by pancreatic beta cells or impaired response of cells, tissues and peripheral organs”. 2
In 1997 the American Diabetes Association developed a new division of diabetes, which was modified in 2003 and is now it looks as follows:
- type 1 diabetes – the destruction of beta cells leading to absolute insulin deficiency
- type 2 diabetes – a progressive disorder of insulin secretion and insulin resistance
- other specific types of diabetes – caused by genetic defects of beta cell function and insulin action, by exocrine pancreatic diseases, certain drugs or chemicals
- gestational diabetes – diagnosed during pregnancy
Classification of type 2 diabetes by Tatoń:
1. Genetic conditioning:
- occurring within a family
- with the occurrence of erythema after chlorpropamide and alcohol
- associated with syndromes caused by genetic disorders
- type 2 diabetes syndrome in young people
2. Nutrition conditioning:
- hyperplastic obesity
- hypertrophic obesity
- without obesity
3. Determinants of disturbed cell reactivity to insulin:
- with an excess of hormonal “anti-insulin” factors
- with impaired insulin receptor function
Each of these subtypes can be divided into type 2 diabetes treated with:
- diet alone
- oral hypoglycaemic medicines
- insulin 3
Type 2 diabetes has often latent asymptomatic course, so it cannot give characteristic symptoms. This disease is like a “mask” and as a result it is often diagnosed only when symptoms get worse or when another illness appears. The “mask” symptoms characteristic for type 2 diabetes include:
- skin symptoms – itchy skin, especially in the genital area, boils, thrush, fungal nail infections, poor wound healing, xanthomas, hair loss
- gynaecological symptoms – vaginal bacterial infection, vaginal thrush, menstrual disorders, impotence
- nervous system symptoms – numbness, stinging, burning, loss of sensation – especially in fingers and toes, nocturnal leg cramps, weakness of one of the nerves
- fatigue, weakness
- blurred vision
The typical symptoms of type 2 diabetes include:
- general weakness
- increased thirst
- increased appetite
- skin inflammation and itching 4
Every cell in our body need glucose i.e. sugar, which is the source of energy and affects the normal functioning of the brain, muscles, liver, kidney and heart. The glucose to penetrate into the cells requires insulin. When cells become resistant to the hormone, the sugar cannot get into them, but circulates in the bloodstream. This causes an excessive amount of glucose in the blood (hyperglycaemia) and so-called cell hunger. The body in defending itself from the lack of sugar triggers the mechanisms of increased appetite, but due to the lack of insulin the glucose from food cannot get into the tissues – is excreted in the urine. Undiagnosed type 2 diabetes leads to severe complications. Can cause atherosclerosis, heart attack or stroke i.e. conditions associated with the damage to large blood vessels. The second type of complications results from the damage to small blood vessels. These include, inter alia, retinopathy (eye disease), which can lead to blindness. Patients may also suffer from kidney failure and circulatory disorders and innervation of the lower limbs. They lead to the development of so-called diabetic foot ulcers – wounds and ulcers occurring on the leg. If this condition is not healed in time it may lead to amputation.
HOW TO LIVE WITH DIABETES
It is possible to live a normal life with diabetes provided that a few basic rules are obeyed:
- education i.e. consciousness – in diabetes, as in any other disease, the patients are responsible for their own health
- nutrition – drug therapy with appropriate diet does not differ from the one recommended for healthy people
- physical exercise – walking, playing sports should become a habit, because it provides good physical form of every human being
- medicines – modern treatment consists of therapy that allows to restore similar processes that take place in the body of a healthy man
1. A. Czyżyk, Encyklopedia chorego na cukrzycę, PWN, Warszawa 1992.
2. J. Tatoń, Poradnik dla osób z cukrzycą typu 2, PZWL, Warszawa 2002.
3. J. Tatoń, Diabetologia kliniczna, PZWL , Warszawa 1986.
4. P. Hien, Cukrzyca, krótki kurs diabetologii, Sprinter, PWN, Warszawa, 1997.