Diabetes mellitus distinguishes between different types of diabetes. Common to all forms is a permanently high blood sugar, it is also called hyperglycemia. Important are diabetes mellitus type 1 and 2 and the so-called gestational or gestational diabetes. There are also other, rarer forms of diabetes. In children, diabetes is the most common metabolic disorder.
Type 1 Diabetes
This form of diabetes accounts for about 3-5% of all diabetes cases and occurs especially in children and adolescents, but can also occur later in adulthood. Previously, type 1 diabetes was also referred to as adolescent or juvenile diabetes.
The cause is a destruction of the insulin-producing beta cells in the islets of the Langerhans pancreas (pancreas) by an autoimmune process. Hereditary predisposition, external factors (eg certain viral infections) and a malfunction 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 to type 1 diabetes are cytoplasmic islet cell antibodies (ICA), insulin autoantibodies (IAA), antibodies to the enzyme glutamate decarboxylase (GADA) and antibodies to tyrosine kinase IA-2 (IA-2A). These antibodies are detectable in the blood months to years before the onset of diabetes.
The result 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 insulin deficiency, insulin must be supplied from the outside.
Type 1 diabetes is inherited from a parent to a child with a 3-5% chance. 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. Probably viral infections and nutritional factors play a role here.
Type 2 Diabetes
At over 90%, this is by far the most common type of diabetes. It used to be called adult-onset diabetes because it mainly affects older people. However, younger people are becoming more and more popular today, because the risk factors obesity and physical inactivity are becoming increasingly common at an early age. Both risk factors lead to decreased insulin sensitivity (insulin resistance) and increased blood sugar levels. In addition, the beta cells give off the insulin too slowly after a meal. These disorders mean that the hormone insulin can no longer properly fulfill its tasks in the body. Most of these processes, however, are gradual, so that the disease is often recognized late, when complications have already occurred.
Inheritance plays an important role in type 2 diabetes. The disease risk for identical twins of type 2 diabetics is 50-90%. Today, however, it is known that in addition to hereditary predisposition additional external factors such as malnutrition, obesity or lack of exercise must be added in order for a Type 2 diabetes to develop.
Type 2 diabetes and its precursors are often associated with other risk factors for cardiovascular disease. One speaks of a “metabolic syndrome” if the following factors are present:
- Waist circumference ≥94 cm (men) or ≥80 cm (women)
- additionally two of the following factors:
- Triglycerides ≥150 mg / dl or equivalent
- HDL cholesterol <40 mg / dl (men) or <50 mg / dl (women) or equivalent
- Blood pressure systolic ≥130 mmHg or diastolic ≥85 mmHg or hypotensive therapy
- Fasting glucose ≥100 mg / dl or 5.6 mmol / l or known type 2 diabetes
Gestational diabetes means a permanently elevated blood sugar level of the mother, which occurs for the first time during pregnancy. Maybe the diabetes was already unrecognized before the pregnancy. About 4% of all pregnant women are affected by gestational diabetes, which, if left untreated, can pose significant health risks for both mother and child. In most cases, gestational diabetes occurs in the 24th to 28th week of pregnancy. During this time the insulin sensitivity of the cells decreases due to hormones and the blood sugar can rise slightly. However, in women with gestational diabetes, blood sugar rises significantly above normal levels during pregnancy. After delivery, the blood sugar normalizes again.
The following risk factors for the development of gestational diabetes are known:
- Age over 30 years.
- Diabetes in the family.
- high blood pressure.
- Previous gestational diabetes or the birth of more than 4 kilograms of a child in the past.
Other Forms Of Diabetes
In addition to the mentioned, there are other, more rare forms of diabetes. For example, diabetes can be triggered by conditions such as pancreatitis, hormonal imbalances, or medications. Two other special forms are LADA and MODY. LADA stands for “late autoimmune diabetes in adults” and means that type 1 diabetes occurs late in adulthood.
MODY means “maturity onset diabetes in the young“. This form is based on genetic disorders of the glucose metabolism, which are associated with diabetes mellitus and inherited as a family.
Diabetes In Children
Diabetes is the most common metabolic disease in childhood. It is mostly type 1 diabetes, but diabetes type 2 is also observed. Experts have found that the number of pediatric type 1 diabetics is increasing worldwide, especially in infants. The causes of this increase are unknown.
According to current estimates, approximately 17,500 children and adolescents aged 0 to 14 years in Germany live with type 1 diabetes. In the age group of 0 to 19 years, about 30,500 children and adolescents are affected by type 1 diabetes. Another worrying factor is the number of adolescents who are overweight at a young age and subsequently develop type 2 diabetes: Every year there are around 200 new cases. Experts therefore demand.