Diabetes mellitus of type 1 (insulin-dependent)

Description:

Diabetes mellitus of 1 type - the organospetsifichesky autoimmune disease leading to destruction of insulinprodutsiruyushchy beta cells of islands of a pancreas, which is shown absolute deficit of insulin. In some cases patients with an explicit diabetes mellitus of 1 type have no markers of autoimmune defeat of beta cells (an idiopathic diabetes mellitus of 1 type).

Symptoms of the Diabetes mellitus of type 1 (insulin-dependent):

In typical cases, especially at children and young people, the diabetes mellitus of 1 type debuts a bright clinical picture which develops for several months or even weeks. Infectious and other associated diseases can provoke manifestation of a diabetes mellitus of 1 type. The general are characteristic of all types of a diabetes mellitus the symptoms connected with a hyperglycemia: the polydipsia, a polyuria, a skin itch, but at a diabetes mellitus of 1 type they are very brightly expressed. So, for day patients can drink and allocate up to 5-10 liters of liquid. A symptom, specific to a diabetes mellitus of 1 type, which is caused by absolute deficit of insulin is the weight loss reaching 10-15 kg for 1-2 months. The expressed general and muscular weakness, decrease in working capacity, drowsiness is characteristic. In the beginning diseases at some patients increase in appetite which is replaced by anorexia in process of development of ketoacidosis can be noted. The last is characterized by emergence of a smell of acetone (or a fruit smell) from a mouth, nausea, vomiting, frequent abdominal pains (pseudoperitonitis), heavy dehydration and comes to an end with coma development. In some cases the first manifestation of a diabetes mellitus of 1 type at children is the progressing disturbance of consciousness up to a coma against the background of associated diseases, as a rule, infectious or acute surgical pathology.

In rare instances development of a diabetes mellitus of 1 type in persons is more senior than 35-40 years (latent autoimmune diabetes of adults) a disease can demonstrate not so brightly (a moderate polydipsia and a polyuria, lack of loss of body weight) and even to come to light accidentally at routine determination of level of a glycemia. In these cases to the patient quite often the diagnosis of a diabetes mellitus 2 types is established in the beginning and the tableted glucose-lowering drugs which some time provide acceptable compensation of a diabetes mellitus are appointed. Nevertheless for several years (it is frequent within a year) the patient has symptoms caused by the increasing absolute deficit of insulin: weight loss, impossibility of maintenance of a normal glycemia against the background of the tableted glucose-lowering drugs, ketoses, ketoacidosis.

Reasons of the Diabetes mellitus of type 1 (insulin-dependent):

The diabetes mellitus of 1 type is a disease with genetic predisposition, but its contribution to development of a disease is small (defines its development approximately on 1/3). The probability of development of a diabetes mellitus of 1 type in the child at sick mother makes 1-2%, the father - 3-6%, the brother or the sister - 6%. One or several humoral markers of autoimmune defeat of beta cells to which antibodies belong to islands of a pancreas, antibodies to a glutamate decarboxylase (GAD65) and antibodies to tyrosine-phosphatase (IA-2 and IA-2beta) are found in 85-90% of patients. Nevertheless major importance in destruction of beta cells is attached to factors of cellular immunity. The diabetes mellitus of 1 type is associated with such haplotypes of HLA as DQA and DQB. With the increased frequency the diabetes mellitus of 1 type is combined with others autoimmune endocrine (an autoimmune thyroiditis, Addison's disease) and not endocrine diseases, such as an alopecia, vitiligo, a disease Krone, rheumatic diseases.

Treatment of the Diabetes mellitus of type 1 (insulin-dependent):

Treatment  of any type of a diabetes mellitus is based on three basic principles: antihyperglycemic therapy (at a diabetes mellitus of 1 type - an insulin therapy), a diet and training of patients. An insulin therapy at a diabetes mellitus of 1 type has replaceable character and its purpose is the maximum imitation of physiological products of hormone for the purpose of achievement of the accepted criteria of compensation. An intensive insulin therapy is brought most closer to physiological secretion of insulin. The need for insulin corresponding to its basal secretion is provided with two injections of insulin of average duration of action (in the morning and in the evening) or one injection of insulin of long action (гларгин). The total dose of basal insulin should not exceed half of all daily need for drug.

Food or bolyusny secretion of insulin is replaced with injections of insulin of short or ultrashort action before each meal, at the same time its dose is calculated, proceeding from amount of carbohydrates which is supposed to be accepted during the forthcoming meal, and the available level of a glycemia determined by the patient by the glucose meter before each injection of insulin.

After manifestation of a diabetes mellitus of 1 type and the beginning of an insulin therapy throughout rather long time the need for insulin can be small and make less than 0,3-0,4 Pieces/kg. This period is designated as a remission phase, or "honeymoon". After the period of a hyperglycemia and ketoacidosis which suppress secretion of insulin of 10-15% the remained beta cells compensation of hormonal and metabolic disturbances by administration of insulin recovers function of these cells which then undertake providing an organism with insulin at the minimum level. This period can proceed from several weeks to several years, but eventually, owing to autoimmune destruction of the remained beta cells, "honeymoon" comes to an end.
At a diabetes mellitus of 1 type the trained patients who own skills of self-checking and selection of a dose of insulin can have a liberalized diet, i.e. approaching to free. If the patient has no surplus or deficit of body weight, the diet has to be isocaloric. The main component of food at a diabetes mellitus of 1 type are carbohydrates on which about 65% of a daily kalorazh have to fall. Preference should be given to the products containing the complex, slowly soaking up carbohydrates and also the products rich with food cellulose. The products containing legkousvayemy carbohydrates (farinaceous food, sweet), it is necessary to avoid. The share of proteins has to be lowered to 10-35% that it promotes decrease in risk of development of a mikroangiopatiya, and a share of fats - to 25-35%, at the same time has to fall on limit fats about 7% of a kalorazh that reduces risk of development of atherosclerosis. Besides, it is necessary to avoid reception of alcoholic beverages, especially strong.