Diabetes (diabetes mellitus) is a chronic disease in which the body can not use the carbohydrates from the food or drinks we ingest.
Glucose is the body’s main source of energy, but in order to be used, it must enter the cells. Glucose enters the cells using insulin, a hormone produced by the pancreas. Diabetes occurs when the body does not produce enough insulin or does not use it properly.
In people that suffer from diabetes, glucose instead of being used as a nutrient by cells, remains in the blood (increases blood sugar) and can be eliminated in the urine (glycosuria).
Diabetes is the most common disease of the endocrine system.
What is the cause of diabetes ?
The pancreas, an abdominal gland, produces through its endocrine part, a hormone called insulin.
Insulin is the only hormone that allows the cells to absorb glucose and use it as the main source of energy. In this way, the blood glucose level decreases. So insulin is the only hypoglycemic hormone.
The absence or decrease in the level of insulin leads to an increase in blood sugar (ie blood glucose concentration, which is normally 70-110 mg/dl). If your blood sugar exceeds 180 mg/dl, it will appear in the urine, a phenomenon called glucosuria.
Diabetes (diabetes mellitus) is mainly of two types:
1. Juvenile or insulin-dependent type 1 diabetes, which occurs in children and young people. It is considered an autoimmune disease, meaning that the immune system attacks insulin-secreting cells and destroys them. As a result, insulin is no longer produced and in this case patients will need to receive insulin injections throughout their lifetime.
2. Mature, type 2 diabetes, which usually occurs in people over the age of 40 and is the most common form of diabetes. In these patients, the pancreas does not produce enough insulin or the insulin produced can not be used effectively. The result is the deposit of glucose in the blood, ie hyperglycemia. Type 2 diabetes occurs predominantly in overweight or obese people.
The evolution of diabetes lead towards many complications, the appearance of which can be delayed and sometimes stopped by properly controlling blood sugar and maintaining a healthy lifestyle.
Complications of diabetes occur sooner if the blood sugar level is not well controlled. Complications occur at the level of:
- heart and blood vessels (atherosclerosis, hypertension, ischemic heart disease, arteriopathy);
- nerves (diabetic neuropathy);
- kidney (diabetic nephropathy);
- eyes (diabetic retinopathy);
- gums, teeth, genitals and other organs.
A very important thing is to discover the complications early and to apply treatment to reduce the negative effects.
Many patients wonder if diabetes can be prevented. The answer is yes, but only in case of type 2 diabetes. Type 2 diabetes can be prevented by:
- avoid obesity, loose weight
- physical exercises
- healthy diet
- lifestyle improvement
- careful use of diabetic drugs (such as cortisone).
More than half of the patients have no symptoms, especially in type 2 diabetes. The diagnosis being established only in the presence of chronic complications of diabetes or as a result of laboratory tests performed on other diseases.
Hence the importance of at least annual laboratory investigations, especially in people who have risk factors for diabetes (the leading place being occupied by obesity, disorders of fat metabolism, diet rich in fats and sweets, stress, sedentary lifestyle).
Diabetes may be suggested by the following symptoms:
- frequent and large urination volume;
- exaggerated thirst;
- permanent feeling of hunger;
- delayed wound healing;
- stings or tingling in the limbs;
- frequent infections;
- visual disturbances;
These disorders occur over time and persist for many years, during which time type 2 diabetes can go undiagnosed. In these cases the diagnosis is made late, when the complications of the disease have appeared.
It is very important that in the presence of these symptoms the patient should see a doctor in order to adopt the appropriate therapeutic approach for the situation and to be followed and advised by him.
Diabetes does not show worrying symptoms in the initial stages, so the visit to the doctor is frequently delayed and the disease continues to progress.
In some situations, diabetes is discovered by chance, during routine medical tests.
For early detection of the disease, accurate diagnosis of diabetes and monitoring of glycemic control, doctors recommend having regular blood tests.
The determination of fasting blood glucose is the first choice of doctors for diagnosing prediabetes and diabetes. It consists of taking blood, in the morning on an empty stomach (you should not eat or drink anything, except water, at least 8 hours before the test), to observe the blood glucose values. If in three different days the blood glucose values exceed 126 mg / dl, doctors can diagnose diabetes. In the case of a healthy person, blood glucose levels should not exceed 100 mg / dl.
If the values are between 100-125 mg / dl, there is a suspicion of prediabetes, a reversible medical condition that favors the onset of type 2 diabetes, but which can be treated with diet, maintaining body weight and exercise.
The oral glucose tolerance test (TTGO) is a “challenge test” used primarily to diagnose people with low glucose tolerance (such as women who have high blood sugar levels during pregnancy) and diabetes. Specifically, if there is a suspicion of prediabetes or diabetes:
● The patient should not eat or drink 8-14 hours before the blood collection, which takes place in the early hours of the morning;
● After collecting the blood, he must consume a sweet drink (300 ml of water mixed with 1.75 grams of glucose per kilogram / body)
● Two hours later, the doctor takes a blood sample again to check your blood sugar.
● If it exceeds 200 mg / dl, the diagnosis of diabetes is supported.
Values between 140 and below 200 mg / dl raise the suspicion of prediabetes and at a blood glucose value of less than 140 mg / dl the person is healthy. The oral glucose tolerance test is not recommended in case of a recent history of surgery, heart attack, labor or previously diagnosed diabetes.
The routine plasma glucose test is done only in specialized laboratories and involves collecting a blood sample at some point in the day, regardless of the interval at the last meal.
The diagnosis of diabetes is confirmed if you have symptoms of diabetes and your blood sugar level is equal to or greater than 200 mg / dl.
Screening tests and testing criteria for asymptomatic adults
Analysis of the average glycemia for the last 3 months – A1c test. This test involves taking a small amount of blood and measuring how high your blood sugar (glucose) level has been in the last 2-3 months. Excess glucose attaches to the hemoglobin in red blood cells and stays there for the rest of their lives.
The glycated hemoglobin test is frequently required in newly diagnosed patients with diabetes to assess how high their previous blood glucose levels were. This is a good way to track blood sugar in people known to have diabetes, but it is not an ideal test for diagnosis.
In healthy individuals, the A1c test should be below 5.7%. At values above 6.5%, the person suffers from prediabetes and has an increased risk of diabetes and cardiovascular disease. The use of the A1c test in the diagnosis of diabetes is not recommended, as its sensitivity is low compared to the glucose tolerance test. Determination of A1c is therefore an appropriate test for long-term monitoring of glycemic control in patients with diabetes and has a predictive role on the risk of progression of diabetes complications.
What can we do at home? Diet and exercise
To be effective, the diet for diabetes must be individualized according to age, sex, physical activity, food preferences, but also any associated diseases (high blood pressure, obesity, kidney disease). The diabetic patient must follow the principles of the healthy eating pyramid in the diet.
The following rules must also be observed:
- small amounts of food in 5-6 meals
- keep to the meal schedule
- dinner should be 2 hours before bedtime
- avoiding sugar and sweet foods
- the use of artificial sweeteners in non-alcoholic beverages
- cereals, bread, pasta or potatoes are restricted
- grilled meat will be preferred to fried
- dairy products should not be missing at every meal
- fruits (grapefruit, lemons) and vegetables will be used in abundance.
- Vegetable fiber will be consumed which improves cholesterol levels and gives a feeling of satiety
- alcohol should be consumed in moderation, never on an empty stomach, because there is a risk of a sudden drop in blood sugar (hypoglycemia)
- salt consumption should be avoided in case of associated hypertension.
Exercise in diabetes
Exercise increases the body’s sensitivity to insulin, helps lower blood sugar and stimulates blood circulation. They have the role of reducing stress and improving the mental state. The diabetic must know that sedentary lifestyle must be fought through walks, moderate efforts and any activity that involves walking and mobilizing the entire muscles in a balanced way.
If a great physical effort has been made, quick sweets will be administered, 10-15 g (jam, chocolate, candy, fruit juices).
The exercise should include a warm-up period of 10 minutes, followed by a stretch of skeletal muscles for another 10 minutes. The exercise itself follows: walking, running, cycling, swimming, which lasts on average 30 minutes. It ends with exercises to “cool” the muscles, similar to warm-up. These exercises are done at least 5 times a week.
Before 2 hours of practicing exercises and during them, the diabetic will consume water to compensate for losses through perspiration. Clothing and especially footwear should be light and comfortable. The drug treatment in case of diabetes will be administered according to the indications and in the rhythm established by the diabetologist and followed together with medical team.
Complications of diabetes
These complications occur faster and more frequently in those who neglect their disease and who have long episodes of hyperglycemia in the course of the disease.
It is good to remember that it is not just the glucose that causes damage to the body, but the products of abnormal processes that include glucose and increased presence in the blood.
Severe complications of diabetes are:
- Cardiovascular diseases – People with diabetes have a 2 times higher risk of atherosclerosis, expressed by major cardiovascular events: acute myocardial infarction, stroke, sudden death. Diabetes accelerates the deposition of fat deposits in large vessels and especially in small ones, increasing the risk of cardiovascular disease. The diabetic patient should periodically check his blood pressure, which should be kept below 130/80 mmHg. Abnormalities in blood fats (dyslipidemia) are common in diabetes. They further increase the risk of cardiovascular disease.
- Eye disorders – Diabetic retinopathy is a chronic complication of diabetes that means the disease of small vessels in the retina, the covering of the eye responsible for vision. The appearance of retinopathy is reported by the patient as a decrease in vision. This can go as far as total vision loss (blindness). That is why an ophthalmological control is required annually.
- Kidney disease – Diabetic nephropathy means kidney disease due to diabetes. Failure to treat in time leads to kidney failure when a significant part of the kidney is destroyed. The final stage of kidney failure is uremia, a situation in which the patient must undergo dialysis or kidney transplantation to survive. Diabetic nephropathy has no symptoms, so early detection of albuminuria is required for early detection. To prevent the rapid evolution of nephropathy, a very good glycemic balance is required.
- Diabetic foot – Diabetic foot refers to all the changes produced due to diabetes in the foot. In the most advanced stages, diabetic gangrene is reached, most frequently located at the level of one or more toes and which can extend to the entire foot.
- Diabetic arteriopathy is manifested at first by the sensation of cold feet, then as a sensation of “bite” in the thigh, which appears on movement and which yields at rest. The pain will appear at shorter intervals and finally at rest, being stronger. When the blood vessel is completely “clogged”, some areas of the leg die and gangrene appears.
- Peripheral diabetic neuropathy – pain in the legs (more intense at night and at rest, decreasing in movement), tingling and numbness of the feet, the feeling of “restless legs”. Sometimes the foot becomes insensitive to stinging, cutting or burning. Diabetic foot care thus becomes a keystone in treatment. The diabetic foot patient will have to follow the “ten commandments” of care: daily washing of the foot with warm water and soap and drying by dabbing, especially the area between the toes, with a clean towel; the nails will be cut straight, without corners and files properly; daily change of socks and use of cotton socks in summer, over which wool socks are put in winter; use of comfortable, suitable shoes, the new ones being worn for 30 minutes. on the first day; any leg injury is treated immediately and if necessary consult a surgeon; avoidance of extreme temperatures (heat-cold); electric pillows, hot water bottles, ice packs at the foot will not be used; avoid garters or any other tight clothing on the leg or calf;
Definitely NO to smoking, it decreases blood flow to the legs; examine your feet daily, using the mirror.
Emergencies in diabetes:
Ketoacidosis that occurs when there is not enough insulin in the blood and the body begins to use fats instead of carbohydrates (sugars) to produce energy. The symptoms of ketoacidosis are: nausea, vomiting, altered general condition; epigastric pain, breathing with the smell of acetone or “rotten apples”; increasing the frequency and amplitude of respiratory movements. IN THIS SITUATION PRESENT YOURSELF URGENTLY TO THE DOCTOR!
Hypoglycemia – a marked drop in blood glucose.
Symptoms of hypoglycemia: sweating, tremors, fatigue, feeling cold, irritability, hunger, headache, vision problems. Symptoms usually appear before meals or after intense physical activity. IN THIS CASE YOU HAVE TO TAKE SUGAR CUBES FROM WHICH YOU CONSUME 3 AND PRESENT YOURSELF TO THE DOCTOR!
Any disease you might have as well as diabetes can greatly increase blood sugar. Your health is a problem in which the responsibility belongs to you! The decision to take care of the condition is made by you in full knowledge of the facts! The doctor will only help and advise you!