Diabetes

Diabetes (Diabetes mellitus) is a chronic and metabolic disease characterized by an excess of glucose (sugar) in the blood. The level increases because the body is unable to metabolize it correctly.

Glucose comes from the food we eat. Insulin is a hormone made by the pancreas, the function of which is to supply glucose to the blood cells, which will act as a source of energy to carry out different life processes. Diabetes is caused by a deficit or malfunction of insulin. An organism must be able to maintain glycaemias between 100 mg/ml (fasting) and 140 mg/ml (after ingestion). In diabetes, the sustained increase in blood glucose can cause injuries in different organs, mainly in the cardiovascular system.

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Typology

Diabetes mellitus type 1 - Diabetes mellitus insulin-dependent

It usually appears during childhood, adolescence and youth and tends to be congenital. It represents 10% of diabetes cases. It appears abruptly and if the proper treatment is not applied, it can quickly complicate.

It presents a loss of the ability of the pancreas to produce insulin very quickly and progressively, and for this reason, it is necessary to treat it from the moment it is diagnosed.

Diabetes mellitus type 2 - Diabetes mellitus non-insulin-dependent

This type of diabetes is characterized by its late appearance, since it usually manifests after the age of 40. It can go unnoticed for a long time, which makes early diagnosis and treatment difficult.

It represents 80% of diabetes cases.

It is conditioned by hereditary factors, is linked to a poor use of insulin and frequently associated with a sedentary lifestyle, obesity, high blood pressure and alterations of fats in the blood.

The pancreas produces insulin, but it is unable to introduce the glucose from the blood into the cells.

Although, in principle, insulin administration is not necessary, it may be necessary depending on the evolution of the disease.

It is becoming more frequent, and according to the WHO, it is one of the epidemics of the 21st century.

Gestational diabetes

It is an alteration of the control of glycaemia that occurs during pregnancy and that ends after delivery. It can cause a tendency to diabetes after childbirth in the mother.

It may also have implications for the baby but with intensive controls and an immediate application of corrective measures, they are practically non-existent today.

These cases are usually controlled through diet.

Secondary diabetes mellitus

The cause is a disease or treatment capable of improperly raising the amount of glucose in the blood. It returns to normal when the cause disappears.

Causes

In the case of type 1 diabetes, a combination of environmental factors, together with genetic predisposition, are involved. What happens inside the organism is that there is an autoimmune reaction in which the defence system damages the cells that produce insulin in the pancreas. Consequently, the body does not produce the insulin it needs.

In the case of type 2 diabetes, resistance can be found in the use of insulin. Thus, whether the pancreas does not produce insulin or there are problems to take advantage of it, the result is that the glucose stays in the blood instead of entering the cells, and therefore; elevates the normal level (hyperglycaemia).

It is a multi-causal process, since it has not been possible to determine a single cause that explains these anomalies.

The most influential risk factors are:

Obesity and being overweight
Sedentarism
Family history
History of gestational diabetes
Hypertension and hyperlipidaemia
Women from 40 with polycystic ovaries

Symptoms

Diabetes is a silent disease but there are signs that make it possible to suspect the onset of the disease.

Some of the symptoms are the following:

Constant need to urinate
Extreme fatigue
Unusual thirst (excessive)
Weight loss
Irritability and changes in mood
Excessive hunger
Digestive discomfort
Coagulation problems
Vision problems

Diagnosis

Diabetes is diagnosed via three different types of blood tests.

Blood glucose test

It consists of extracting a blood sample to measure its glucose levels. The test can be done after not eating for eight hours or randomly at any time of the day. The results will vary depending on what the person has eaten or drunk before the test.

Oral glucose tolerance test

It consists of two blood extractions. The first one requires fasting for eight hours and the second one is done after the person ingests a sugary liquid. This test gives information about whether the normal increase in blood glucose as a result of the intake is normalized in the appropriate period of time. The health professional assesses whether the results obtained are correct or are above a certain level that would be considered a diagnosis of diabetes.

Haemoglobin A1c test

It is a simple blood test. The person can drink and eat before extracting the sample. Haemoglobin A1c is formed when excess blood glucose binds to molecules that carry oxygen in red blood cells. This test reports the average glucose level in recent months.

Treatment

The main objective of the correct treatment of diabetes is to avoid, delay or mitigate the possible complications of the disease. Treatment is based on three basic points that must be in balance.

Diet

A professional will prepare a personalized plan considering different factors such as the type of diabetes, age, weight, etc.
Some characteristic features of the diet are:

Restrict added sugars
Properly calculate and distribute foods rich in carbohydrates
Prioritize foods rich in fibres such as vegetables, legumes, etc.
Restrict consumption of foods rich in saturated fats such as sausages, butters and creams, fatty meats, etc.
Follow the number of proposed meals (4/5) and schedules.

Medication

DM1
It always requires the administration of insulin, which is not active orally and therefore must be injected.
The doctor determines the need, quantity and frequency of administration.
DM2
It involves oral drugs or insulin depending on how it progresses and when diet and physical exercise are not enough.

Physical exercise

It is recommended to exercise regularly.

Tobacco is incompatible with diabetes because it contributes to the onset of chronic complications of the disease.

Complications of the diabetes

Chronic complications

Tendency of premature aging of the large arteries, which may involve an increased risk of cerebral vascular accidents, myocardial infarctions and the defective arrival of blood to the lower extremities.
Specific eye involvement (diabetic retinopathy) with risk of vision loss.
Specific kidney affectation (diabetic nephropathy) with risk of suffering from chronic renal insufficiency and, sometimes, final need of dialysis or kidney transplant.
Specific involvement of the nervous system (diabetic neuropathy) with the possible appearance of disorders of sensitivity (especially legs and feet) and sexual potency in the case of man.
Little capacity to fight against infections. Skin lesions.
Poorly treated diabetes can affect a woman's fertility.

Acute complications

Ketoacidosis
Clinical manifestation of an excess of glucose in the blood, with the corresponding intensification of the need to urinate and drink to try to avoid dehydration.
Hypoglycaemia
Excessive drop in the level of glucose in the blood.

Prevention

Prevention consists of measures aimed at avoiding an event before it happens.

Diabetes mellitus type 1

In this case, prevention is quite difficult to establish, since the onset of this diabetes is related to hereditary and environmental factors. Preventing it is a challenge for investigators.

Diabetes mellitus type 2

We will talk about primary prevention focused on a series of preventable factors such as: Obesity, Sedentarism, Hormone medication, Stress.

Recommendations

Perform exercise on a regular basis
Maintain a balanced diet
Refrain from using drugs and tobacco
Periodic reviews