1. Pathogenic factors
The exact etiology and pathogenesis of diabetes are still not very clear, the cause of which is the joint participation of genetic and environmental factors. It is mainly due to the selective destruction of the immune mediated islet B cells.
(I) type 1 diabetes
1. genetic factors
Type 1 diabetes has a certain familial aggregation. There are reports that the parents have diabetes history. The incidence of type 1 diabetes in their children is 4% to 11%. The incidence of familial aggregation of type 1 diabetes among brothers and sisters is 6% to 11%, and the incidence of type 2 diabetes in the identical twins is less than 50%.
2. environmental factors
The occurrence of type 1 diabetes is often associated with or after infection. The common infection of the original mumps virus, rubella virus, cytomegalovirus, measles virus, influenza virus, encephalitis virus, poliovirus, Coxsackie virus and Epstein-Barr virus, but the virus after infection, diabetes susceptibility or resistance may be determined by the first day.
(two) type 2 diabetes
The etiology of type 2 diabetes is not very clear. It is generally believed that it is strongly inherited or polygenic, and the environmental factors are obesity, lack of activity and aging. The main reason is insulin resistance and insulin secretion. Insulin resistance usually precede insulin secretion, or insulin secretion is mainly accompanied by or without insulin resistance. Although type 2 diabetes has genetic heterogeneity, most patients with type 2 diabetes and fasting hyperglycemia are characterized by insulin resistance, insulin secretion disorders and liver glucose production.
Two. Pathophysiology of diabetes
(1) the natural pathogenesis of type 1 diabetes
The first phase (genetic susceptibility: related to some HLA loci)
Phase second (initiating autoimmune reaction, islet B cell damage)
Phase third (immunological abnormalities: there are a variety of autoantibodies against B cells in the circulation, and the insulin secretion is still normal).
The fourth phase (the number of B cells in the islets is reduced, the function is decreasing, the blood sugar is raised, so that diabetes occurs).
Phase fifth (clinical diabetes: islet B cell remnants less than 10%, significant hyperglycemia with clinical symptoms)
The sixth phase (after several years or years of clinical diabetes mellitus, B cells were completely destroyed, insulin levels were extremely low, and the response to stimulation was lost. Many patients had various chronic complications.
(two) islet pathology of type 1 diabetes
(1) early pathological changes
As early as 1910, an acute islet inflammatory disease with lymphocytes and macrophages infiltrated in type 1 diabetic patients was recorded. Subsequently, it was reported that individuals with type 1 diabetes died 6 months later. The autopsy showed that the 2/3 of islet had such damage, and the survival of B cells was less than 10% of the total. But the patients with long course of disease had no lymphocytic infiltration. The local regeneration of islet B cells can be seen in patients with short course of type 1 diabetes. However, with the development of disease, local regeneration of B cells is more and more rare, and the regenerated B cells are also destroyed.
(2) late pathology
The autopsy of 1.5 to 34 years after diagnosis of type 1 diabetes showed that the weight of the pancreas decreased because of the atrophy of the exocrine tissue that accounted for 98% of the normal pancreas. Atrophy of exocrine glands may be due to the lack of high concentration of insulin through the perfusion of blood vessels to the pancreas itself. The high insulin concentration in the pancreas has its own nutritional function, which is not achieved by subcutaneous exogenous insulin therapy. The islets of type 1 diabetic patients are small and small, and the weight is less than normal or type 2 diabetic patients with 1/3, and B cells are almost completely deficient. Islets contain almost only alpha and sigma cells and PP cells located at the distal end of the pancreatic head. The number of alpha and sigma cells in each islet was normal or increased, and the total amount of alpha and sigma cells in the pancreas was in the normal range.
(three) pathophysiology of type 2 diabetes
(the following 1-4 are the core causes)
Reduction of insulin secretion in 1. islet beta cells
The 2. generation of hepatic glycogen increased
3. decrease of glucose uptake in muscle
The 4. increase in lipolysis
The decrease of intestinal trypsin action in 5. gastrointestinal tract
Increase of pancreatic glucagon secretion in 6. islet alpha cells
Increased glucose reabsorption in 7. kidneys
8. brain neurotransmitter dysfunction
Three. Syndrome differentiation of traditional Chinese Medicine
The etiology and pathogenesis of this disease are discussed in more detail in Chinese medicine. That was mainly due to the ferrite deficiency, weakness of five viscera, complex due to improper diet, overeatingfeigan, emotional disorders, resulting in excessive labor, kidney yin deficiency, lung and stomach heat; pathogenesis key Yin hot and yin deficiency, hot as the standard; the extension of disease course, sinister and Yang. Yin and yang asthenia; Yin deficiency, consumption of Tianjin burning liquid so that the blood viscosity, blood stagnation and blood stasis; sinister and Yang, Yang deficiency, blood stasis can also lead to yang.
(1) the deficiency of the body of the body
The cause of ferrite Yin are maternal fetal nutrient deficiency, excessive consumption, acquired metaplasia Yin viscera damage, Yin Conghua, imbalance between yin and yang relationship between the internal organs, and ultimately caused excessive hyperactivity, Yang Ying, the gasterexcessiveheat and polyorexia.
(two) diet, body fat, long overeating
Sweet taste, the transport function damage of spleen, stomach stagnation, Yin Yun heat dryness, consumption of Tianjin, the stomach Zaore, polyorexia aggravated. Because of the fat people phlegm, phlegm heat, can also wear the Yin, yin deficiency and metaplasia hot, hot will hurt the Yin fu. Such a vicious cycle has a disease of thirst.
(three) emotional disorders, liver qi stagnation
Because of the long-term emotional discomfort, stagnation of heat, dry Yin; or because of rage, resulting in the failure of the liver; blockage of Qi, can also heat dryness and tb-12 lung stomach yin, lead to lung and stomach heat, and thirsty to drink, polyorexia. The excessive heat and heat of the yin deficiency will inevitably lead to