There is no need to talk about the gradual development of type 1 diabetes – in this regard, doctors do not distinguish any stages. This is because the disease comes on abruptly, always unexpectedly.
— There are 3 stages of type 1 diabetes: compensation, subcompensation and decompensation. It is important to understand that they do not correspond to the development of the disease, but reflect its course. These stages are always included in the diagnosis, – explains endocrinologist Anton Kudryavtsev. – To assess the compensation of diabetes mellitus, 2 analyzes are used – a glucose tolerance test and glycosylated hemoglobin. The first involves taking blood on an empty stomach, and then an hour and 2 after a carbohydrate load (75 grams of glucose). The second displays the average sugar for the last three months, which is related to the lifespan of red blood cells.
Stage of compensation
The first stage of type 1 diabetes is when blood sugar is slightly higher than it should be, but less than in the further course of the disease.
– The compensation stage corresponds to fasting blood sugar less than 6,5 mmol / l, after 2 hours – less than 8 mmol / l, and glycosylated hemoglobin – less than 7%. In healthy patients, these figures are not higher than 5,5 mmol / l and 6,1%, respectively, – says Dr. Kudryavtsev.
It is logical: it is this stage of type 1 diabetes that is asymptomatic.
Subcompensation stage
The next stage: blood glucose is moving away from the norm.
– Blood sugar on an empty stomach ranges from 6,5 to 7,5 mmol / l, 2 hours after exercise – 8-10 mmol / l, and glycosylated hemoglobin – 7-7,5%, – our expert cites the numbers. – The vast majority of patients with diabetes live with this stage of the disease, which is associated with many factors, but usually it is non-compliance with medical recommendations regarding nutrition, inadequate insulin therapy.
Decompensation stage
Most often, this stage is prescribed in the medical history when the patient first comes to the doctor. Because this is where the typical symptoms of type 1 diabetes begin: severe thirst, dry mouth, frequent urination, weight loss.
— Patients are often referred already when very high blood sugars are noted, which corresponds to the stage of decompensation of the disease: fasting blood sugar is above 7,5 mmol/l, after a carbohydrate load it is above 10 mmol/l, and glycosylated hemoglobin is above 7,5, XNUMX%, says Dr. Kudryavtsev. – The stage of decompensation of the disease is fraught with a high risk of ketosis (acetone rises in the blood and urine – approx. Auth), the development of vascular and neurological complications of the disease. Sometimes the debut of the disease is accompanied by a coma.
It is not surprising that here you need to be as careful as possible and almost every step you take is to consult a doctor. So, for example, at the stage of decompensation, patients, as a rule, are not recommended to undergo elective surgeries, since many of them negatively affect the course of diabetes mellitus.
“Therefore, very often patients turn to an endocrinological hospital or for a consultation in order to adjust hypoglycemic therapy (and in the first type of diabetes it is always insulin injections), in order to compensate for the course of diabetes,” notes Anton Kudryavtsev. — It is important to take into account that in international recommendations there is no clear gradation between the stages, but there are only target levels for all these indicators.
Popular questions and answers
We asked questions about the stages of diabetes endocrinologist Anton Kudryavtsev.