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Diabetes mellitus

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Diabetes mellitus (DM) is a group of chronic diseases described by an increased level of sugar in blood.

The most common types of DM are type 1 diabetes (without proper insulin therapy a person may die), type 2 diabetes (more frequently diagnosed) and gestational diabetes (diabetes developing during pregnancy).

Today we are discussing type 2 diabetes in details. The disease is associated with hyperglycaemia (increased sugar (glucose) in blood) in terms of insulin resistance.

Insulin resistance (IR) – insensitivity of tissues such as liver, muscles, fat tissue, etc. to insulin. To handle it the pancreas starts producing insulin more intensely. But it cannot last forever and results in deterioration of pancreatic cells responsible for insulin secretion.

What is insulin and what role does it play in human body? The term has a Latin origin and derived from the word “insula” meaning island. Insulin is a hormone produced by beta cells of the islets of Langerhans in the pancreas. These cells are extremely sensitive to change of blood glucose level. Meals but not only including glucose or sugar and carbohydrates are of great importance for insulin secretion.

Insulin secretion can also be intensified by some substances – amino-acids (especially leucine and arginine), hormones (especially estrogens – female sex hormones – and hormones of gastro-pancreatic system – cholecystokinin, etc.).

Some intensifying influence on insulin secretion is attributed to potassium, calcium and free fatty acids (especially increased number thereof). Glucagon reduces insulin secretion. Autonomous nervous system also has significant influence on pancreatic beta-cells:

  • parasympathetic part stimulates insulin production in some ways;
  • sympathetic part, on the contrary, suppresses insulin secretion.
Insulin as a complex effect on the metabolism almost in all tissues. However, the metabolism of carbohydrates has a priority effect. Primary effect of insulin is associated with intensified transportation of glucose through cellular membranes.

The only ones insensitive to insulin are nervous tissue and red blood cells which can dispose of glucose even with no insulin. At the same time target-organ cells (liver – hepatocytes, fat tissue, etc.) can contain between 40 to 300 thousand of insulin receptors. There are some factors affecting the number and binding capacity of these receptors. For example, the number of these receptors reduces in case of obesity and high blood pressure.

  • Insulin oppresses endogenous glucose production: suppresses glycogenolysis (disintegration of glycogen to glucose) and gluconeogenesis (synthesis of glucose from non-carbohydrate sources – for example, from amino-acids, fatty acids), increases glucose transportation through cellular membranes and disposal thereof by tissues, facilitates conversion of glucose into glycogen (this is main reserve for endogenous glucose synthesis). All these factors have hypoglycaemic effect
  • Insulin increases bio synthesis of proteins in muscular tissues, prevents production of ketone bodies, decreases consumption of protein by tissues
  • Insulin oppresses lipolysis and increases lipogenesis in fat cells

We have talked about sugar or glucose in blood. Every person always has some glucose in his blood. This is a main source of energy production. Food consumed is digested in human gastrointestinal tract. Glucose from food is absorbed into bloodstream and distributed among organs for further energy production which is necessary for most life processes.

E. V. Doskina

Candidate of Medical Sciences, Assistant Professor at the Department of Endocrinology and Diabetology of the Russian Medical Academy of

Post-Graduate Education under the Russian Ministry of Health

Risk factors and prevention of diabetes mellitus

Risk factors are an aggregate of predisposing factors. Knowledge thereof helps make a prognosis of clinical course and development of the disease in some cases and sometimes it helps delay or prevent diabetes mellitus or/and complications. Let’s talk about risk factors of diabetes mellitus of different types.

Risk factors of type 1 diabetes mellitus (T1D)

One of the main risk factors of type 1 diabetes is genetic predisposition. This type of diabetes mellitus has a strong genetic component, its development depends on genetic factors for more than 50 %.

Currently, they do research to identify additional genes responsible for T1D. It is hard to identify genetic predisposition to T1D because there is no single gene responsible for the disease. There are a few versions of genes associated with T1D in Russians identified. But not a singe gene is an absolute 100 % genetic marker of type 1 diabetes.

It is important to understand that only predisposition to the disease is inherited and it may evolve into the disease or it may not. Theoretical risk of type 1 diabetes for the relatives of those having type 1 diabetes is the highest in the following cases:

  • identical twins – 30–50 %;
  • descendants of two parents with diabetes – 30 % (in other words, 3 children out of 10 can have the disease and 7 will stay healthy).
It is interesting that:
  • descendants of men with T1D are more likely to have the disease (6 %) than descendants of women with T1D (1,1 %). It is especially true for cases when a woman gives birth at the age of over 25;
  • the earlier a person in a family gets type 1 diabetes, the higher is the risk for his close relatives.

Despite many years of studying, there is still no single point of view at launch mechanisms of T1D, but obvious role is attributed to the following factors:

  • virus infections (rubella viruses, Coxsackie B virus, parotitis). The most important are virus infections suffered by a baby in utero (there is a connection between T1D and congenital rubella – this is the only one external factor clearly associated with type 1 diabetes). Besides, it should be mentioned that despite earlier opinion vaccination does not increase risk of T1D as well as the time of standard vaccinations in childhood has no effect on type 1 diabetes;
  • toxic substances destructing beta-cells, for example, nitrosamines, food nitrates;
  • nutrition factor (for example, early introduction of a baby with cow’s milk). According to the recent studies early introduction (before 3 months old) of a baby with grains is supposed to increase risk of T1D.

One more predisposing factor is stress. Its role in the development of type 1 diabetes is not so obvious. There is a phenomenon of transient (i.e. temporary) hyperglycaemia (increased blood glucose level) in children affected by severe stress.

Later when the stress is handled blood glucose level comes to normal and additional examination (identification of specific antibodies level) do not show any abnormalities. But it is important to remember that at the start of T1D stress can reveal the disease so the clarifying examination is necessary.

Risk factors of type 2 diabetes

One of the main risk factors of type 2 diabetes is inheritance. If close relatives (parents, siblings) have type 2 diabetes, risk of the disease is higher. If one of the parents has T2D, there is 40 % probability that a child inherits the disease.

A person acquires many other risk factors of the disease during life. They include:

  • age of over 45;
  • increased fasting glucose level in blood identified at any time;
  • arterial hypertension;
  • overweight and obesity (Body Mass Index more than 25 kg/m2);
  • increased levels of atherogenic lipid blood fractions – triglycerides, cholesterol, low-density lipoproteins, etc.;
  • previous gestational diabetes or giving birth to a baby weighing more than 4 kg;
  • habitually low physical activity;
  • polycystic ovarian syndrome;
  • cardio-vascular diseases.

The factors mentioned above should be a reason for regular examinations to control blood glucose level:

  • people at the age of over 45 and overweight and obese people having one more risk factor should be examined once in three years;
  • people with previous prediabetes should be examined once a year.
Some risk factors of type 2 diabetes can be prevented and thus the likelihood of the disease diminishes.

Risk factors of gestational diabetes

Risk factors of gestational diabetes (diabetes mellitus first time occurred during pregnancy) can be divided into high risk factors and average risk factors.

High risk factors include:

  • obesity (Body Mass Index ≥ 25 kg/m2);
  • inheritance (first-degree relatives with type 2 diabetes);
  • gestational diabetes or other previous carbohydrate metabolic disorders;
  • gucosuria (glucose in blood) during this pregnancy.
Average risk factors include:
  • woman’s age of over 30;
  • giving birth to a baby weighing more than 4 kg or stillbirth in the past;
  • giving birth to a baby with birth defects in the past;
  • recurrent pregnancy lost (two or more spontaneous abortions in 1 and 2 trimesters);
  • fast weight gain during this pregnancy;
  • polyhydramnios during this pregnancy.

E. V. Doskina

Candidate of Medical Sciences, Assistant Professor at the Department of Endocrinology and Diabetology of the Russian Medical Academy of

Post-Graduate Education under the Russian Ministry of Health

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