The cardiovascular risk factors

THE INSULIN-DEPENDENT DIABETES

- Definition, A few explanations
- Circumstances of discovery, Positive diagnosis
- The complications, Prognosis
- Treatment, Conclusion

DEFINITION

The insulin-dependent diabetes corresponds to an insulin deficiency, the consequence of the destruction of some pancreas cells by an immunological process. The consequence of this insulin deficiency results in an elevation of the sugar rate in blood.

A FEW EXPLANATIONS

The insulin-dependent diabetes does not usually put a diagnosis problem but rather the problem of a long-run treatment including a demanding specific surveillance and the detection of the complications at the eye level (retinal complications), at the kidney level, and nervous and cardiovascular system.

The insulin-dependent diabetes is called type I diabetes mellitus. It can occur at any age but its frequency peak is located toward 10-15 years. It composes 10 to 15% of the diabetes.

From a genetic point of view, some genes have been put in evidence as capable of being responsible for the occurrence of a diabetes. These genetic factors do not explain everything because they only give account of about maximum 40% of the development of the illness.

Diabetes also corresponds to a disorder of the protective system of the body (the immune system), as testified by the anomalies often put in evidence:

• presence of anti-cells antibodies of the pancreas in 80% of the cases, presence of anti-insulin antibodies before a treatment by insulin;
• underlining an inflammation of the pancreas;
• efficacy of the medicines decreasing the immune system activity in the animal experimental models;
• association to other illnesses responsible for a disorder of the immune system.

The factors causing diabetes are badly known but we currently lean toward viral, toxic or nutritional factors. Their underlining is difficult because the illness only appears when 80 to 90% of the beta cells of the pancreas are destroyed.

The metabolic anomalies of the insulin-dependent diabetes consist in an elevation of the sugar rate in blood (hyperglycaemia) due to a sugar hyperproduction by the liver and a reduction of its use at the muscles level (and of course a decrease of the insulin production).

This state provokes an increase of the consumption of fat and a reduction of their production.

The attack of the nerves and small blood vessels has in common the evolution duration of the insulin-dependent diabetes, the chronic hyperglycaemia and its importance.

The attack of the big blood vessels, more frequent in the insulin-dependent diabetes than in the general population, is less bound to the hyperglycaemia. The lipid disorders, the high blood pressure (HBP), and the coagulation disorders are responsible for it.

The secondary diabetes (<5%) are the sugar regulation disorders, met in other pathological contexts:

• they can be pancreatic affections as the acute pancreatitis, chronic pancreatitis or a pancreas cancer,
• in the endocrine illnesses (illnesses of the glands) secreting a hyperglycaemic hormone, the anomaly is an intolerance to glucose capable of leading to the insulin-dependent diabetes: hyperthyroidism, acromegaly, Cushing’s syndrome, pheochromocytoma, Cohn’s adenomas, glucagonoma,
• finally in the haemochromatosis, the insulin-dependent diabetes can occur.