By Dra. Lourdes Alcantara
Diabetes is a chronic disease that is due to 3 things 1- the pancreas does not synthesize the amount of insulin that the human body needs, 2-it produces it of a lower quality 3-it is not able to use it effectively.
Insulin is the hormone produced by the pancreas, which allows sugar from food to be used by our body
Its main function is to maintain adequate blood glucose values. It allows glucose to enter the body and be transported to the interior of cells, where it is transformed into energy for muscles and tissues to function. In addition, it helps cells store glucose until its use is necessary.
In people with diabetes there is an excess of glucose in the blood (hyperglycemia), since it is not distributed properly. Noemí 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 don’t know it or don’t treat it have a higher risk of kidney problems, heart attacks, vision loss and lower limb amputations. ”
According to Luis Ávila, member of the Board of Directors of the SED, notes that “the exact cause of diabetes is not known, diabetes is classified as type 1 and type 2.
Diabetes type 1
It generally appears in children, although it can also start in adolescents and adults. There is a destruction of the cells that produce insulin in the pancreas because the organism attacks its own cells as if they were foreign ‘’, it is believed to be due to different environmental factors, it produces that autoimmune response that destroys those cells. ”
Type 2 diabetes
It arises in adulthood, a decrease in the action of insulin occurs,
“Its main cause is obesity because fatty tissue produces certain substances that decrease the sensitivity of insulin receptors,” adds Ávila.
During pregnancy insulin increases to increase energy reserves. Sometimes this increase does not occur, which can cause gestational diabetes, if it does not subside postpartum, the woman develops type 2 diabetes.
- Very thirsty (polydipsia).
- Feeling very hungry (polyphagy).
- Need to urinate continuously, even at night (polyuria).
- Weight loss, despite eating a lot.
- Blurry vision.
- Tingling or numbness in the hands and feet.
- Recurrent fungal skin infections.
If glucose rises slowly, progressively (usually in type 2 diabetes), it can take years for symptoms to begin, and the disease can therefore go unnoticed.
It is not possible to prevent type 1 diabetes, type 2 diabetes can be prevented. Because obesity is the most important cause, a healthy lifestyle reduces the chances of having type 2 diabetes by 80 percent. ”
We must prevent the appearance of micro and microvascular complications. Dietary recommendations and physical activity are essential to avoid complications such as cardiovascular, kidney, diabetic retinopathy or diabetic foot. Periodic reviews are recommended, among which the following stand out:
- Analysis of kidney function.
- Foot checks.
- Measurement of blood pressure.
People with diabetes should also be aware of the appearance of hypoglycemia (low blood glucose level), It is blood sugar level is less than 70 mg / dl. It is the most frequent acute complication of diabetes and can appear when:
- Excessive insulin dose.
- Insufficient carbohydrates in meals.
- Meals delayed in time.
- Extra exercise for the dose of insulin administered.
- Some oral antidiabetics can also cause hypoglycemia.
- Administration of insulin in muscle instead of subcutaneous tissue.
- Errors in insulin administration (administer fast rather than delayed insulin or dose errors).
- Bathing or showering with very hot water shortly after you have been on insulin.
Among the measures to prevent hypoglycemia, the experts emphasize that insulin should never be administered without checking blood glucose.
There are several ways to measure glucose. Implantable continuous glucose meters (GCMs) can be especially useful for sports, 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 his cell phone.
These devices provide real-time results, which can also be downloaded to other mobiles. They also allow programming alarms that are activated when the patient has levels close to hypoglycemia and offer the possibility
to keep a record of blood glucose levels and analyze how diet or physical activity affect them.
Type 1 diabetes mellitus
It is caused by the destruction of insulin-producing cells.
Diabetes mellitus type 2
It is the most frequent and preventable and is caused by an insulin deficit
It appears in between 2 and 5 percent of pregnancies.
Other types of diabetes
Another type of less well-known diabetes is the one that appears due to injury to the pancreas, either due to surgical removal or inflammation. It is called pancreatic-private diabetes, due to genetic causes or due to the consumption of certain drugs.
The diagnosis of diabetes is made by measuring glucose levels in the blood. These are tests that the primary care physician can perform. The parameters to take into account are:
- 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 the 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.
Diabetes treatment is based on three pillars: diet, physical exercise and medication. The goal is to keep blood glucose levels within normal limits to minimize the risk of complications associated with the disease.
Insulin is the only treatment for type 1 diabetes. It can be administered by injection, or with continuous infusion systems (intravenously). “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 his glucose frequently, by using glucometers (finger pricking) or with interstitial glucose sensors
Type 2 diabetes. In this case, 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 are going to be the best treatment option.” According to Ávila, the drug that is prescribed. Other available therapeutic groups are the following:
- Biguanides, of which only metformin is used.
- Alpha decarboxylase inhibitors.
- DPP-4 enzyme inhibitors.
- SGLT-2 antagonists.
- GLP-1 agnoists.
It is the leading cause of dialysis, amputations, blindness, circulatory problems, angina and heart attack.
It is important to inform the doctor in case of a family history of diabetes or risk factors (obesity, hypertension, gestational diabetes.