In this informative article, you will read about Type-1, Diabetes Type-II, Gestational Diabetes, Treatment of Diabetes, and at last Conclusion.
Diabetes is a chronic disease that occurs because the pancreas does not synthesize the amount of insulin that the human body needs, produces it of inferior quality, or is not able to use it effectively.
What is Diabetes?
Insulin is a hormone produced by the pancreas. Its main function is the maintenance of adequate blood glucose values.
It allows glucose to enter the body and be transported into cells, where it is transformed into energy for muscles and tissues to function.
Besides, it helps cells store glucose until its use is needed.
In people with Diabetes, there is an excess of glucose in the blood (hyperglycemia), since it is not distributed properly.
Noemi González, secretary of the Spanish Diabetes Society (SED) and specialist in Endocrinology and Nutrition at Hospital La Paz, Madrid, explains that high glucose can be harmful,
“for the whole organism, but mainly for the heart, kidney, and arteries, so people who have Diabetes and do not know it or do not treat it are at higher risk of kidney problems, heart attacks, loss of vision, and lower-limb amputations. “
According to the Diabetes study, the incidence of Diabetes in Spain is 11.58 cases per 1,000 people per year. In other words, 1,057 new cases occur every day.
The current percentage of people with Diabetes (prevalence) according to this same study is 13.8 percent. “What is more important is that 6 percent of them do not know (undiagnosed Diabetes)”, highlights González.
Luis Ávila, a member of the SED Board of Directors, points out that ” the exact cause of Diabetes is not known, among other things because there are many different types.”
The time of onset of the disease, the causes, and symptoms that patients present depends on the type of Diabetes:
Now we discuss the types of diabetes.
(1) Diabetes type I.
It generally appears in children, although it can also begin in adolescents and adults.
It usually occurs abruptly and many times regardless of the existence of family history.
The cells that produce insulin in the pancreas (beta cells) are destroyed by autoantibodies.
“That is, the organism attacks its cells as if they were foreign (as occurs in celiac disease, and other autoimmune diseases)”, clarifies González.
The initial mechanism that induces the appearance of these antibodies is not fully identified and is very complex.
It is being investigated whether the origin is, according to Ávila, in “a genetic predisposition that, due to different environmental factors, produces that autoimmune response that destroys those cells.”
(2) Diabetes Type II.
It arises in adulthood; its incidence increases in elderly people and is about ten times more frequent than type 1.
In it there is a decrease in the action of insulin, so that, although there is a lot, it cannot act.
González indicates that there is “a mixed component: on the one hand, there is less insulin in the pancreas and, on the other, this insulin works worse in the tissues (the so-called insulin resistance)”.
“Its main cause is obesity because fatty tissue produces certain substances that decrease the sensitivity of insulin receptors,” adds Ávila. Since obesity has grown very significantly in Spain, so has this type of Diabetes.
(3) Gestational Diabetes.
During pregnancy, insulin increases to increase energy reserves. Sometimes this increase does not occur, which can lead to gestational diabetes.
It usually disappears after delivery, but these women have a high risk of developing type 2 diabetes throughout their lives.
(4)Other Types of Diabetes.
Diabetes mellitus is the complete name for Diabetes but mostly refers to it as only Diabetes. Diabetic ketoacidosis (abbreviated to DKA) is a really serious illness.
It happens when there isn’t any insulin to help the body use sugar for energy.
Glucose builds up in the bloodstream, and the body turns to fat for energy.
Another less well-known type of Diabetes is that which appears due to injury to the pancreas, either due to surgical removal of inflammation.
It is called pancreatic deprivation Diabetes. Other types of Diabetes appear due to genetic causes or due to the consumption of certain drugs.
Possible symptoms of elevated glucose include the following:
- Very thirsty (polydipsia).
- Feeling very hungry (polyphagia).
- Need to urinate continuously, even at night (polyuria).
- Weight loss, despite eating a lot.
- Blurred vision.
- Tingling or numbness in the hands and feet.
- Recurrent fungal skin infections.
If glucose rises slowly, progressively (generally in type 2 diabetes), it can take years for symptoms to begin, and therefore the disease may go unnoticed.
“That it does not hurt does not mean that it does not hurt, and hence the importance of early diagnosis to prevent the appearance of complications”, emphasizes González.
Currently, it is not possible to prevent type 1 diabetes, despite the many attempts that have been made. Type 2 Diabetes, which is the most common, can be prevented.
Since the most important cause is obesity, “all the actions that have to do with the prevention of obesity -avoiding a sedentary lifestyle, junk food, sugary drinks …- will have a positive result”, underlines González, who states that it is known “that a healthy lifestyle reduces the chances of having type 2 diabetes by 80 percent.”
Once the disease has been diagnosed, the occurrence of micro and macrovascular complications must be prevented.
Following the prescribed treatment, as well as the dietary and physical activity recommendations, is essential to avoid complications such as cardiovascular, kidney, diabetic retinopathy, or diabetic foot.
Also, it is advisable to carry out periodic reviews, among which the following stand out:
- Eye fundus.
- Analysis of kidney function.
- Reviews of feet.
- Measurement of blood pressure.
People with Diabetes should also be on the lookout for hypoglycemia (low blood glucose).
A person is currently considered to have hypoglycemia when their blood sugar level is less than 70 mg/dl.
It is the most common acute complication of Diabetes and can appear in many circumstances:
- Excessive insulin dose.
- Insufficient carbohydrates in meals.
- Meals delayed in time.
- Extra exercise for the insulin dose administered.
- Some oral antidiabetics can also cause hypoglycemia.
- Administration of insulin to muscle rather than subcutaneous tissue.
- Errors in the administration of insulin (giving rapid instead of delayed insulin or dose errors).
- Bathing or showering with very hot water shortly after taking your insulin.
Measures to prevent hypoglycemia include carrying out a greater number of blood glucose controls during the day.
Especially if physical exercise has been done, as well as planning of the physical exercise to be carried out to adjust the insulin to be administered and carbohydrates to be eaten.
In this sense, experts emphasize that insulin should never be administered without having blood glucose control.
How to measure glucose levels?
There are several ways to measure glucose. Implantable continuous glucose meters (CGM), which consist of a small sensor that is implanted in the forearm and a transmitter that sends the data to an application that the patient installs on their mobile phone, can be especially useful for sports.
These devices provide results in real-time, which can also be downloaded to other mobiles.
They also allow you to program alarms that are activated when the patient has levels close to hypoglycemia and offer the possibility of keeping a record of blood glucose levels and analyzing how diet or physical activity affects them.
Diagnosis of diabetes is made by measuring glucose levels in the blood. These are tests that the primary care physician can perform. Ávila explains that there are only 4 ways to diagnose Diabetes:
- Basal blood glucose (fasting) greater than 126 mg/dl
- Glycated hemoglobin greater than 6.5 percent
- Blood glucose curve with 75 g of glucose greater than 200 mg/dl
- Random blood glucose (at any time of day) greater than 200 mg/dl with typical symptoms
All of them must be confirmed on a second occasion except the last one, which is confirmed by the symptoms.
The treatment of Diabetes is based on three pillars: diet, physical exercise and medication. It aims to keep blood glucose levels within normality to minimize the risk of complications associated with the disease.
Insulin is the only treatment for type 1 Diabetes today single day can be administered injected with either insulin pens or continuous infusion systems (insulin pumps).
As per González,
“It is necessary to adjust the administration of insulin to what the person eats, the activity they carry out and their glucose figures, so the patient must measure glucose frequently, by using glucometers (pricking their fingers) or with interstitial glucose sensors (some are already funded in several autonomous communities), more simply and less painfully, “
Type 2 Diabetes has a wider therapeutic range. In this case, unlike patients with type 1 diabetes, insulin administration will not always be necessary.
By adopting a healthy lifestyle and losing weight, glucose levels can return to normal.
Along with this, adds the endocrinologist, “the use of one or more drugs that help insulin work better will be the best treatment option.”
According to Ávila, the drug that is prescribed “will fundamentally depend on the clinical characteristics of the patient.” The therapeutic groups available are the following:
- Biguanides, of which only metformin is used.
- Alpha decarboxylase inhibitors.
- DPP-4 enzyme inhibitors.
- SGLT-2 antagonists.
- GLP-1 agonists.
Although there is no specific diet established as such for Diabetes, diet is an essential element of treatment to improve glycemic control, whose efficacy is similar and even superior to that of many medications.
“Besides, it is also effective in controlling lipids and blood pressure, and in preventing complications of Diabetes”. Therefore, it is worth taking the time to explain to patients the benefits of diet and to carry out an adequate prescription of the same.
In the future, I will discuss more regarding unknown facts for diabetes, causes, other symptoms, and advanced treatment.
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