Diabetes

8 August 2016

Diabetes, a worldwide scourge

And yes, talking about diabetes today is already thinking about tomorrow. The number of people with diabetes in the world already amounted to more than 150 million people about twenty years ago. The figures are alarming, that number will have doubled in 10 years. This disease must not be taken lightly as it can affect each of us!

How can we exactly define diabetes?

Diabetes is a disorder in the blood sugar levels and specifically in its assimilation, use and storage during feeding, this occurring at all ages. In fact, adults are not the only ones affected by this chronic disease that is treated to avoid any complications. There is no cure for diabetes but you can manage the condition!
We must understand that sugar is not confined to pastries and other sweets that by definition are saturated with sugar. In fact, the food you eat can be divided into 3 groups: fats, proteins and carbohydrates, carbohydrates composed of the famous sugar that is of most interest in this case, sugar that provides energy to the body, to all its organs and to all the cells of the body in order for it to work properly.

Therefore when you eat, this sugar is found in the blood, after having passed through the intestinal wall. The immediate effect after a meal is the increased sugar level in the blood, which is called glucose. So far, nothing unusual for a non-diabetic person. A non-diabetic person then sees the cells of the pancreas (also called beta cells of islets of Langerhans) taking over by secreting the famous insulin allowing glucose to enter the body cells. The chain reaction continues, the insulin being detected by the liver cells, the muscle cells and adipose tissue cells… for immediate consumption of the sugar or glucose or for its future consumption by storing it.

In a non-diabetic person, even if the blood sugar level increases for all the reasons I have just explained to you, the body starts a process that will in fact restore the balance by transforming this sugar surplus to meet the needs of the organism. The return to normality is therefore automatically.

If it happens in the diabetic person it means that all this mechanism is not working or is working wrong, the sugar remains in the blood without any possibility of a “purge” in quotes of this surplus that should then be consumed by the body cells. Consequently, this leads to hyperglycemia (too high blood sugar level).

THERE ARE TWO TYPES OF DIABETES:

  • Type 1 diabetes (insulin-dependent diabetes mellitus or IDDM) where cells of the pancreas do not produce insulin any more, the beta cells of the islets of Langerhans are completely destroyed.
  • Type 2 diabetes (non-insulin dependent diabetes or NIDDM) occurs either when the glucose cannot enter the cells to be stored or consumed, the insulin is not recognized by the cells receptors, which is called insulin resistance or when the insulin is produced in insufficient quantities (also called insulinopenia).

In any case, glucose cannot enter the cells, this is the core problem, the sugar levels remaining well above normal after meals, the body not being able to play its regulator role.

Aside from blood tests: I am diabetic (type 1 or 2) or not? How do I get tested?

The best test remains the blood test we perform on an empty stomach (fasting glucose), tests performed by our medical laboratories. Reference data in a normal non-diabetic patient are: blood glucose less than 1.10 g / l on an empty stomach (fasting glucose) and less than 1.40 g / l after meals. The diagnosis of diabetes is confirmed when the fasting blood sugar level is greater than or equal to 1.26 g / l (tests carried out twice) or at any time of the day when the blood sugar level is equal to or greater than 2 g / l .

Diagnosis can also be made through research of glucose in urine, which is called glycosuria. In a non-diabetic patient, glucose is absent.

The different types of diabetes:

TYPE 1 DIABETES (INSULIN-DEPENDENT DIABETES OR DID)
AND TYPE 2 DIABETES (NON INSULIN-DEPENDENT DIABETES OR NIDDM)

The type 1 diabetes or insulin-dependent diabetes

DEFINITION OF TYPE 1 DIABETES

This is the diabetes that affects a young population (under 30 years), approximately 15% of diabetes case, therefore it is a rare form of diabetes. Type 1 diabetes or insulin-dependent diabetes is also known as diabetes mellitus. As we have seen, this diabetes is due to the destruction of the beta cells of the islets of Langerhans by the body. Glucose thus stagnates in the blood and it is no more distributed to cells which therefore need it, as it is the case in a healthy subject. This is known as an autoimmune disease, the body mistakenly attacking its own cells which it now considers foreign bodies.

FURTHER DETAILS: DIABETES AND THE FETUS, RISKS DURING PREGNANCY

Ladies, a small piece of advice, the screening for diabetes (blood sugar test) is essential because the risks to the fetus (malformations …) are really important and this is particularly true for women who are unaware of their diabetes!
Note that type 3 diabetes, also known as gestational diabetes is a particular type of diabetes that occurs during pregnancy, usually during the 2nd or 3rd quarter, the pancreas being unable to insure the need for increasing insulin resulting from pregnancy.

Once again, ladies, monitoring and control are required before and during pregnancy to ensure the health of both the mother and the baby.

THE CAUSES OF THIS DIABETES

The causes of type 1 diabetes have not been identified with certainty; we speak about multifactorial causes even if we can tilt the balance towards the genetic and hereditary factors. Indeed, parents with type 2 diabetes worsen significantly the risk of diabetes transmission to their children (as type 1 or type 2 diabetes). The track of the environmental factor (high nitrate levels in drinking water in particular) but also of the dietary factor (cow milk consumption during childhood) is also mentioned.

CLINICAL SIGNS

Clinical signs of type 1 diabetes in the patient are indicative and unambiguous, the brutality of their occurrence is the number one sign par excellence: a patient with profound fatigue (asthenia), a patient with an insatiable desire to drink (polydipsia), a patient with abundant urine (polyuria), a patient undergoing unexplained weight loss, a patient with abdominal pain, a patient with recurrent infections. Go to the doctor if you have any doubts. Better safe than sorry (Prevention is better than cure).

A LIFE-LONG TREATMENT

The only possible treatment is therefore to overcome this lack of insulin to regulate glucose levels in the blood. It is not a treatment to cure type 1 diabetes, but a treatment to supplement the body disorders. Like any treatment, the patient’s seriousness and responsibility to follow the advice of the doctor remain the key to success for a life quality similar to that of a non-diabetic person.

The medical advances allow the patient to be treated in a simple way without need for external assistance either by manual injection of insulin through a syringe or by an insulin pump that injects insulin continuously, system that has been implemented or not in the patient. The patient’s life quality is then improved!

Note that the pancreas or the islets of Langerhans transplants are to be reserved for the most serious cases with all the risks of rejection generated by this type of operation. Much hope is now pinned on the current research on artificial pancreas.

POST DIAGNOSIS PREVENTION

The diabetic diet is to be measured and well calculated. This does not prevent the diabetic person from eating in a normal way but, in order to keep the blood sugar at a not critical rate, (s)he must control his/her carbohydrate intake in order to manage his/her insulin intake on his/her own. Therefore, it is important not to become overwhelmed, the patient’s investment in controlling the disease is essential. A low-carbohydrate diet is the basis of everything. Opt for cooking without animal fats. Choose rather vegetable fats, lean meats, fish, fruits and vegetables rich in fiber. You should absolutely avoid sugary drinks, all foods rich in hyper-caloric fat. Choose good carbs (rice, split peas, dried beans, pasta, lentils, chick peas …)

A healthy lifestyle also involves regular exercises (walking, jogging, cycling …), giving up smoking, moderate alcohol consumption and eating meals at regular times.

The patient will of course perform full and regular tests but also self glucose monitoring before and after the meals using strips, medical lancing devices or electronic glucose meters in order to change the dosage of insulin to inject himself/herself.

Type 2 diabetes or non-insulin-dependent diabetes

DEFINITION OF TYPE 2 DIABETES

Type 2 diabetes appears mainly among patients over 50 years old. More pernicious than type 1 diabetes, this type of diabetes can take years or decades to set in, that diabetes is often discovered when the complications of the disease begin to occur (visual disturbances, infarction …) so often much too late. This is the most subtle but unfortunately also the most common type of diabetes.

I remind you that this type of diabetes occurs either when insulin is not playing its role, the glucose is no longer used or stored by the body cells, it is called insulin resistance or when the insulin is produced by the pancreas in insufficient quantity (it is called insulinopenia), the pancreas gets tired over time especially because of this insulin resistance.

CAUSES OF THIS TYPE OF DIABETES

Genetics is an aggravating factor but it is not enough especially in this specific type of diabetes. In fact, a sedentary lifestyle because of the lack of physical activity, a poor lifestyle with what is now called junk food (fast food …), a high fat diet (delicatessen …) overweight, a lack of medical supervision which includes allowing the bad cholesterol to set in the blood or ignoring arterial hypertension … are a set of factors that gradually lead to type 2 diabetes.
A blood test starting from the age of 40 should be systematic, which is a must if the family history in terms of diabetes or if the risks such as those detailed above are present.

EARLY-WARNING SINGS

Silent disease, symptoms may still occur like the type 1 diabetes (fatigue, polydipsia …) but often the complications are the ones that your doctor should consider as warnings.

TREATMENTS

Of course, the first treatment to be administered will be to stick to a healthy lifestyle in addition to regular physical activity and adherence to a strict diet program on the advice of a dietician.

The doctor will monitor the progress of the disease through a rigorous blood testing (monitoring period is of 2 to 3 months). According to the results of the blood glucose level, the doctor will determine if oral treatment is necessary or not through oral antidiabetic drugs (OAD) grouped into 5 classes: biguanides, incretins, sulfonylureas and glinides, inhibitors of alpha -glucosidase, the SGLT2 inhibitors). Without significant improvement, the patient should use insulin shots (injections).

Type 1 and type 2 diabetes: complications often very serious!

Untreated, type 1 as type 2 diabetes may indeed lead to very serious complications, unregulated hyperglycemia in a patient who ignores this disease may have, in time, extremely serious repercussions on the nerves and blood vessels with irrecoverable consequences on the key organs of the human body. Diabetes can indeed cause blindness, amputations, kidney complications, stroke but also coma in the most severe cases. Hypoglycemia (too low glucose levels in the blood) in case of effort, for example, but also ketoacidosis caused by a decrease of the amount of insulin therefore a low sugar level in the blood are also frequent complications which can be very severe.

One piece of advice: monitor your blood glucose level!

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