Types of diabetes
There are different types of diabetes in diabetes mellitus. All forms have one thing in common: blood sugar that is permanently too high, also…
Forms of diabetes
There are different types of diabetes in diabetes mellitus. All forms have one thing in common: blood sugar that is permanently too high, also known as hyperglycaemia. Diabetes mellitus types 1 and 2 and the so-called pregnancy or gestational diabetes are important. There are also other, rarer forms of diabetes. Diabetes is the most common metabolic disorder in children.
Type 1 diabetes
This form of diabetes accounts for about 3-5% of all diabetes cases and occurs particularly in childhood and adolescence, but can also occur later in adulthood. Type 1 diabetes used to be known as adolescent or juvenile diabetes.
The cause is a destruction of the insulin-producing beta cells in the Langerhans’ islet cells of the pancreas by an autoimmune process. Hereditary predisposition, external factors (e.g. certain viral infections) and a malfunctioning of the immune system are probably responsible for the development of type 1 diabetes. The body’s own defense cells (antibodies) are directed against the insulin-producing cells (beta cells) of the pancreas and destroy them. The most important antibodies in type 1 diabetes are cytoplasmic islet cell antibodies (ICA), insulin autoantibodies (IAA), antibodies against the enzyme glutamate decarboxylase (GADA) and antibodies against the tyrosine kinase IA-2 (IA-2A). These antibodies can be detected in the blood months to years before the onset of diabetes.
The consequence of the destroyed beta cells is a lack of insulin, so that glucose can no longer be absorbed into the body’s cells and the blood sugar level rises. Because there is an absolute lack of insulin, insulin must be supplied from outside.
Type 1 diabetes has a 3-5% chance of being passed from parent to child. If both parents have type 1 diabetes, the risk increases to 10-25%. In addition to this predisposition, external factors must be present for the disease to come to light. Viral infections and nutritional factors presumably play a role here.
Type 2 diabetes
At over 90%, this is by far the most common form of diabetes. It used to be referred to as adult-onset diabetes because older people are particularly affected. Nowadays, however, younger people are increasingly becoming a part of it, because the risk factors of being overweight and lack of exercise are increasingly present at a young age. Both risk factors lead to reduced insulin sensitivity (insulin resistance) and increased blood sugar levels. In addition, the beta cells release insulin too slowly after a meal. These disorders mean that the hormone insulin can no longer properly fulfill its tasks in the body. In most cases, however, these processes are insidious, so that the disease is often only recognized late, when secondary diseases have already occurred.
Heredity plays an important role in type 2 diabetes. The disease risk for identical twins from type 2 diabetics is 50-90%. Today, however, we know that in addition to hereditary predisposition, external factors such as malnutrition, obesity or lack of exercise must also be present for type 2 diabetes to develop.
Type 2 diabetes and its preliminary stages often occur together with other risk factors for cardiovascular diseases. One speaks of a “metabolic syndrome” when the following factors are present:
- Waist circumference ≥94 cm (men) or ≥80 cm (women)
- plus two of the following factors:
- Triglycerides ≥150 mg/dl or equivalent therapy
- HDL cholesterol <40 mg/dl (men) or <50 mg/dl (women) or equivalent therapy
- Blood pressure systolic ≥130 mmHg or diastolic ≥85 mmHg or antihypertensive therapy
- Fasting glucose ≥100 mg/dl or 5.6 mmol/l or known type 2 diabetes
Gestational diabetes is defined as a permanently elevated blood sugar level in the mother that first occurs during pregnancy. It is possible that the diabetes was already undetected before the pregnancy. About 4% of all pregnant women are affected by gestational diabetes, which, if left untreated, entails significant health risks for mother and child. Gestational diabetes usually occurs in the 24th to 28th week of pregnancy. During this time, the insulin sensitivity of the cells decreases due to hormones and blood sugar can rise slightly. However, in women with gestational diabetes, blood sugar rises well above normal levels during pregnancy. Blood sugar levels return to normal after childbirth, but 30-50% of women will develop type 2 or type 1 diabetes in the years that follow. Gestational diabetes also appears to increase the risk for the child of later becoming overweight and developing type 2 diabetes.
The following risk factors for the development of gestational diabetes are known:
- Age over 30 years
- diabetes in the family
- high blood pressure
- Pre-existing gestational diabetes or the birth of a child weighing more than 4 kg in the past
Other forms of diabetes
In addition to the above, there are other, rather rare forms of diabetes. Diabetes can be triggered, for example, by diseases such as pancreatitis, hormone imbalances or medication. Two other special shapes are LADA and MODY. LADA stands for “late autoimmune diabetes in adults” and means that there is type 1 diabetes that occurs late in adulthood.
MODY means “maturity onset diabetes in the young”. This form is based on genetic disorders of glucose metabolism, which are associated with diabetes mellitus and are inherited in families.
Diabetes in children
Diabetes is the most common metabolic disease in childhood. It is usually type 1 diabetes, but type 2 diabetes is also observed. Experts have found that the number of childhood type 1 diabetics is increasing worldwide, especially among young children. The causes of this increase are not yet known. According to current estimates, there are around 17,500 children and young people aged 0 to 14 with type 1 diabetes in Germany. Around 30,500 children and adolescents in the 0 to 19 age group are affected by type 1 diabetes. The number of young people who are overweight at an early age and subsequently develop type 2 diabetes is also worrying: there are around 200 new cases every year. Experts are therefore calling for a glucose tolerance test to be carried out in adolescents with obesity in order to avoid serious complications.
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