Diabetes

WHAT IS THE DIABETES?

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

Insulin is a hormone produced by the pancreas. Its main function is to maintain adequate blood glucose values. Allows glucose to enter the body and be transported into cells, where it is transformed into energy to operate the muscles and tissues. It also helps the cells to store glucose until its use is necessary.

In people with diabetes there is an excess blood glucose (hyperglycemia) as it is not distributed properly. Specialists warn that, if patients do not follow the right treatment can end up damaged tissue and can cause serious complications in the body.

INCIDENCE

The di@bet.es study published in 2012 placed the prevalence of diabetes in Spain around 13.8 percent of the population.

"The study results also confirm the association between diabetes, obesity and hypertension and the importance of physical activity as a prevention method," explains DMedicina, Rebecca Reyes, Unit of Endocrinology, University Hospital Rafael Mendez, in Lorca (Murcia) and coordinator of the Working Group of Diabetes Mellitus of the Spanish Society of Endocrinology and Nutrition (SEEN). "In addition, the study shows that 6 percent of people with type 2 diabetes are unaware that suffers this disease."

On the other hand, Reyes said that the prevalence is higher with increasing patient age. In fact, it is estimated that may affect up to 25-30 percent of the elderly population. "It also increases with increasing prevalence of obesity," he says.

CAUSES

The time of onset of the disease, and the causes and symptoms presented by patients, depending on the type of diabetes:

TYPE 1 DIABETES

The most common ages are appearing in childhood, adolescence and early adulthood. He usually occur abruptly and often regardless of a family history.

The causes of type 1 diabetes are mainly the progressive destruction of the pancreatic cells that produce insulin. This has to artificially administered from the beginning of the disease. His particular symptoms are increasing the need for increased drinking and urination, feeling tired and weight loss despite increased appetite.

DIABETES TYPE 2

Usually emerges later in life and is about ten times more frequent than before. Generally, type 2 diabetes is also diagnosed or have had other people in the family.

It arises due to low insulin production, along with the insufficient use of the substance by the cells. Depending on which of the two predominant defect, the patient will be dealing with diabetes pills or insulin (or a combination of both). In these cases the patient is not presenting any hassle, nor specific symptoms, so it may go unnoticed for long affected person.

GESTATIONAL DIABETES

An occasional diabetes that can be controlled like the other types of diabetes is considered. During pregnancy increases insulin to increase energy reserves. Sometimes, this increase does not occur and can cause diabetes during pregnancy. Nor it has symptoms and detection is almost always performed after routine testing to all pregnant women undergo after 24 weeks of gestation. What it greatly increases the risk of developing diabetes within a few years.

SYMPTOMS

The main symptoms of diabetes include:

Frequent urination (phenomenon of wet bed in children).

 Unusual feeling of hunger.

 Excessive thirst.

 Weakness and fatigue.

 Weightloss.

 Irritability and mood changes.

 Feeling sick in the stomach and vomiting.

 Blurred vision.

 Cuts and scratches that do not heal or heal slowly.

 Tingling or numbness in the hands or feet.

 Recurrent infections of the skin, gum or bladder (cystitis).

 High levels of glucose in the blood and urine.

PREVENTION

For type 1 diabetes there is no effective prevention method for now. Instead, there is evidence that type 2, which is what appears most often, being related to obesity can be treated largely avoided by adopting a healthy lifestyle.

"Studies have shown that physical activity and weight loss prevent the development of diabetes in people predisposed to it, even those who already have some degree of impaired glucose tolerance (or prediabetes)," said Rebeca Reyes, coordinator of the Working Group of Diabetes Mellitus SEEN. "Moreover, in the recently published Predimed study it shows that the Mediterranean diet prevents cardiovascular disease, so it should be the diet of choice."

Tips to prevent hypoglycemia in diabetics

Adjust dose of drug to the real needs.

Maintain a regular eating schedule as far as possible.

Drinking moderate amounts of carbohydrates before exercise.

Always carry sugar.

As the first signs of hypoglycemia should take sugar (2 or 3 lumps), biscuits (of 3-5 units) or drink a glass (150 ml) of any drink containing carbohydrates rapidly absorbed (fruit juices appear , cola, etc.).

Symptoms usually happen in 5 or 10 minutes. If hypoglycemia is severe or the person may lose consciousness, it is necessary to inject a vial of glucagon subcutaneously (like insulin) or intramuscular (buttock). Glucagon mobilizes glucose reserves in the body and takes effect in about 10 minutes. If no recovery, the affected should receive immediate medical attention.

Types of Diabetes

Diabetes mellitus type 1 mediated autoimmune processes:

It is caused by autoimmune destruction of the pancreatic cells.

It represents the most cases of type 1 diabetes mellitus.

Typically appears in children or young adults, but can also occur in other ages.

It usually begins abruptly.

Risk factors are not well defined, but is known to be involved in its onset genetic, autoimmune and environmental factors.

Usually the weight is normal or below normal, although the presence of obesity is not incompatible with the diagnosis.

Patients are prone to deterioration of the immune system.

A minority of patients with type 1 diabetes develop type 1 diabetes mellitus idiopathic, which cause that triggers this subtype that mainly affects people of African and Asian origin is unknown.

In idiopathic, hereditary factor is very important and there are no alterations of the immune system. In addition, the need for insulin may appear or disappear.

According to the International Diabetes Federation, each year the number of people with type 1 diabetes Although the causes for this increase are unclear increases, consider that it may be due to changes in environmental risk factors, to circumstances during development in utero, food during the early stages of life or viral infections.

Moreover, since the Federation they insist that these patients may have a normal life if they follow the treatment combining the daily administration of insulin with close monitoring, regular exercise and healthy diet.

Diabetes mellitus type 2:

Although it can occur at any age, it is customary to begin in adulthood, after 40 years, but today is producing an increase in young children.

It is characterized by insulin resistance and usually is associated with a relative deficiency of this hormone production by the pancreas.

Obesity is present in 80 percent of patients.

The risk of developing this form of diabetes increases with age, weight and physical inactivity. It is more common in women with a history of gestational diabetes and in individuals with hypertension or disorders in the metabolism of fats.

It represents 90-95 percent of all cases of diabetes mellitus.

Patients do not require insulin, although they may require it for controlling the level of glucose.

It is often associated with a strong genetic predisposition, although this factor is complex and not clearly defined.

Unlike patients with type 1 diabetes, people with type 2 diabetes do not usually need daily doses of insulin to survive. However, in some cases it might require insulin bound to an oral medication, a healthy diet and increased physical activity.

As in type 1 diabetes, type 2 diabetes cases are increasing worldwide. The causes are related to lifestyle changes as a result of economic development. Other causes may be aging population, increasing urbanization, dietary changes and decreased activity.

Gestational diabetes:

Begins or is diagnosed for the first time during pregnancy.

It appears between 2 and 5 percent of gestation processes.

Usually, the patient regains normal state after delivery.

Women with gestational diabetes are the short, medium or long term, increased risk of developing type 2 diabetes.

Risk factors for gestational diabetes include obesity and family history.

 Other types of diabetes:

There are other types of diabetes caused by a malfunction of the cells of the pancreas or the insulin they produce, for metabolism problems and so on. Often these disorders are caused by genetic defects, drugs, infections or other diseases.

DIAGNOSIS

The diagnosis of diabetes occurs when the patient has abnormally elevated levels of blood glucose. This analysis is usually controlled and measured during an annual routine examination or clinical examination that takes place prior to incorporation into a new employment or practice a sport.

Analysis can also be performed to determine the possible cause of symptoms such as increased thirst, urination, hunger, or if there are factors characteristic risk, such as family history of diabetes, obesity, frequent infections or other complications associated with diabetes .

As Rebecca Reyes, coordinator of the Working Group of Diabetes Mellitus SEEN said the diagnosis of diabetes is made through a blood test. "The current diagnostic criteria, according to the American Diabetes Association in its recommendations of 2015, are:

Glycosylated hemoglobin greater than or equal to 6.5 percent.

Fasting glucose fasting greater than or equal to 126 mg / dl or blood glucose 2 hours of an oral glucose tolerance with 75 g of greater than or equal to 200 mg / dl glucose.

All of them must be repeated twice, unless there are unmistakable signs of diabetes, in which case a random blood glucose> = 200 mg / dl is enough, "he specified.

Testing

To measure the concentration of glucose in the blood sample of a patient's blood, who must be fasting for at least 8 hours before the test is obtained.

It is normal that there is some degree of elevated values ​​of blood glucose after eating, but even then, the values ​​should not be very high. In people over 65 is better testing fasting because older people have a greater increase in the concentrations of glucose in the blood after eating.

There is another kind of blood test, oral test called glucose, which is carried out in certain cases, such as when it is suspected that a pregnant woman has gestational diabetes tolerance.

In this test, a blood sample was obtained to measure fasting glucose value and is supplied to the patient to drink a special solution, which contains a standard amount of glucose. For the next two or three hours several blood samples are obtained.

TREATMENTS

The treatment of diabetes mellitus is based on three pillars: diet, exercise and medication. It aims to keep blood glucose levels within the normal range to minimize the risk of complications associated with the disease. In many patients with type 2 diabetes medication it would not be necessary if the excess weight would control and a program of regular exercise would be carried out. However, it is often necessary to insulin replacement therapy or taking oral hypoglycemic agents.

Oral hypoglycemic agents: are prescribed to people with type 2 diabetes who fail to lower the blood sugar through diet and physical activity, but are not effective in people with type 1 diabetes.

 Insulin therapy: In patients with type 1 diabetes exogenous insulin administration is necessary because the pancreas is unable to produce this hormone. It is also required in type 2 diabetes if diet, exercise and oral medications fail to control blood glucose levels. Insulin is administered through injections into the existing fat under the skin of the arm, as if taken orally would be destroyed in the digestive tract before passing into the bloodstream. Insulin requirements vary depending on the foods eaten and physical activity performed. People who follow a steady diet and regular physical activity vary little insulin doses. However, any change in the diet or making any sport requiring changes to patterns of insulin. Insulin can be injected through different devices:

Traditional syringes: They are single use, graded in International Units (0 to 40).

Insulin injection pens: they are pen-shaped device having inside a cartridge containing insulin. The cartridge is changed when insulin is over, but the pen is still used.

Prefilled syringes: They are similar to feathers devices, but preloaded insulin. Once all ends insulin syringe is pulled. The blood glucose level depends on the area of ​​the body where insulin is injected. It is advisable to enter the abdomen, arms or thighs. Penetrates faster if injected in the abdomen. It is recommended to always inject in the same area, but about two centimeters displacing the injection point after another. Avoid injections in the skin folds, the midline of the abdomen and groin area and the navel.

OTHER DATA

Complications

"There is a direct relationship between compliance and adequate glycemic control, which in turn is related to the risk of developing chronic complications associated with diabetes. Therefore, poor compliance increases the risk of complications, "says Rebecca Reyes, coordinator of the Working Group of Diabetes Mellitus of the Spanish Society of Endocrinology and Nutrition (SEEN).

From the International Diabetes Federation stress that the major complications are cardiovascular, kidney, eye, nerve diseases and diabetic foot that occurs. In addition, diabetes can be a threat to oral health and increase the likelihood of sleep apnea is triggered.

When does the patient should see a specialist?

According to Reyes, when patients have symptoms such as constant urination, unusual thirst, extreme hunger, unusual weight loss, extreme fatigue and irritability, frequent infections and / or blurred vision, you need to go to the doctor for them make a determination of glucose.

FORECAST

As specified by the coordinator of the Working Group of Diabetes Mellitus of the Spanish Society of Endocrinology and Nutrition, diabetes research currently pursuing several lines. "The first is research in artificial pancreas systems and replacement stem cells producing insulin cells," says Reyes. "This therapy would be applicable to patients with type 1 diabetes."

The second is aimed at developing better and better insulin, longer and with a lower risk of hypoglycemia. "Finally, the treatments currently available for the treatment of type 2 diabetes increasingly have fewer side effects and also help to reduce weight, which is a problem that often coexists with type 2 diabetes," says Reyes.