Diabetes Causes, Preventions And Treatments

 

DIABETES CAUSES, PREVENTIONS AND TREATMENTS

Diabetes is a chronic disease that arises because the pancreas does not synthesize the amount of insulin that the human body needs, produces it of an inferior quality or is not able to use it effectively.

The insulin is a hormone produced for 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 converted into energy for muscles and tissues to function. In addition, 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 in the proper way. Noemí González, secretary of the Spanish Diabetes Society (SED) and specialist in Endocrinology and Nutrition at the 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.”

Incidence

According to the di@bet.es 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.

Causes

Luis Ávila, member of the Board of Directors of the SED, points out that "the exact cause of diabetes is not known, among other things because there are many different types." In fact, the time of onset of the disease, the causes and symptoms that patients present depend on the type of diabetes:

Diabetes type 1

It generally appears in children, although it can also begin in adolescents and adults. It usually appears abruptly and many times regardless of the existence of a family history.

The cells that produce insulin in the pancreas (beta cells) are destroyed by autoantibodies. "In other words, the organism attacks its own 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 has not been fully identified and is very complex. According to Ávila, it is being investigated whether the origin lies in "a genetic predisposition that, due to different environmental factors, produces that autoimmune response that destroys those cells."

Type 2 diabetes

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.

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.

Assess your symptoms

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.
• Fatigue.
• Blurry vision.
• Tingling or numbness in the hands and feet.

 

Recurring 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.

Prevention

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. In addition, it is advisable to carry out periodic reviews, among which the following stand out:

 

• Eye fundus.
• Analysis of kidney function.
• Foot checks.
• Electrocardiogram.
• 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 you have done physical exercise, as well as planning ahead of the physical exercise to be performed in order 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 a 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 her 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 food or physical activity affects them.

Types

Type 1 Diabetes Mellitus

It is caused by the destruction of insulin-producing cells. It usually appears in childhood.

Type 2 Diabetes mellitus

It is the most frequent and preventable and is produced by a deficit of insulin, which is added to a reduced action of this hormone in the tissues.

Gestational diabetes

It appears in between 2 and 5 percent of pregnancies. It is associated with maternal-fetal complications if it is not treated properly.

Other types of diabetes

Another less well-known type of diabetes is that which appears due to an injury to the pancreas, either due to surgical removal or inflammation. It is called pancreatic deprivation diabetes. Other types of diabetes appear due to genetic causes or due to the consumption of certain drugs.

Diagnosis

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 (fasting) blood glucose 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, which is confirmed by the symptoms.

 

Treatments

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 it can only be given by injection, either with insulin pens or with continuous infusion systems (insulin pumps). "It is necessary to adjust the administration of insulin to what the person eats, the activity they carry out and their glucose levels, so the patient must measure glucose frequently, by using glucometers (pricking their fingers) or with intertitial glucose sensors (some are already funded in several autonomous communities), in a simpler and less painful way ", comments González.

Type 2 diabetes has a broader therapeutic spectrum. 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 normalize.

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.

Sulfonylureas.

DPP-4 enzyme inhibitors.

SGLT-2 antagonists.

GLP-1 agnoists.

Insulins.

 

Complications

There is a direct relationship between compliance with treatment and adequate glycemic control, which in turn is related to the risk of developing chronic complications associated with diabetes.

According to the member of the SED board of directors, "diabetes is currently the leading cause of dialysis and non-traumatic amputations, as well as being a very important cause of blindness." Likewise, "it has a great influence on the development of circulatory problems, such as angina pectoris and heart attack".

Along the same lines, González highlights that "diabetes can go unnoticed for years, in which it already produces complications. Therefore, it is important to go to the primary care doctor in case of a family history of diabetes or risk factors (obesity, hypertension, gestational diabetes) for a glucose test. "