Diabetes

Its scientific name is diabetes mellitus. Diabetes is a very common chronic disease throughout the world and especially in industrialized countries.

In diabetes it is a general metabolism disorder, so that:

• On the one hand, there is a decrease in the secretion of “insulin” and / or its action, which leads to a permanent increase in blood glucose.
• On the other hand, diabetes produces a large number of injuries and long-term complications that affect almost all the organs of the body, but especially the kidneys, eyes, heart, etc.

Why is it produced?

The American Diabetes Association, with the support of the World Health Organization (WHO), has proposed the following classification, which replaces the one approved in 1985 by the WHO:

• Type 1 Diabetes Mellitus
• Diabetes mellitus type 2
• Pregnancy diabetes. It is necessary to know other concepts and situations that increase the risk of suffering from diabetes mellitus: These are called glucose regulation disorders.
  These include:
  → Glucose intolerance (blood glucose two hours after the oral tolerance test, greater than 140 mg / dl and less than 200 mg / dl).
  → Altered basal glucose (basal blood glucose greater than 110 mg / dl and less than 126 mg / dl).

Type 1 diabetes mellitus

It is produced by the destruction of the insulin-producing cells located in the pancreas, which causes a lack of insulin, so the administration of this hormone is essential for the survival of these patients.

It can occur at any age, but it is more common in young people, usually before the age of 30. The maximum incidence occurs between 10-12 years in women and 12-14 years in men.

It usually occurs abruptly and gets worse quickly if the proper measures are not taken. There is significant weight loss.

Diabetes mellitus type 2

It is the most common form of diabetes in developed countries.

In this type of diabetes, insulin secretion does occur, but this secretion is little or does not produce the proper effects. At some point in the course of the disease, the administration of insulin may be necessary.

Its diagnosis is more frequent after the age of 40.

It is associated with obesity in a large percentage of cases. Obesity is the risk factor most frequently associated with diabetes mellitus. Losing weight considerably reduces your risk. Diets with excess calories and lack of exercise contribute to its development. It is also associated with high blood pressure and dyslipidemia. It is closely related to heredity.

Pregnancy diabetes

It is that alteration in the regulation of blood glucose that is detected for the first time during pregnancy, without there having previously been any type of alteration of it.
It presents a very high risk of complications for both the woman and the fetus.

After delivery, blood glucose should be closely monitored to see if it has normalized or is still altered.

Symptoms of diabetes

There are a series of signs that make us suspect diabetes, but it must be a doctor who accurately diagnoses whether or not the disease exists.

These signs are:

• Excess urine production.
• General feeling of tiredness.
• Excessive thirst.
• Weight loss without losing your appetite.

Acute complications

The acute complications that we can find are:

• Diabetic cetoacidosis.
• Nonketotic hyperosmolar syndrome.
• Hypoglycemia .

Chronic complications

The chronic complications of diabetes mellitus are:

• Diabetic retinopathy .
• Diabetic nephropathy.
• Diabetic neuropathy.
• Diabetic macroangiopathy.
• Others (diabetic foot,…).

Causes of mortality

In type 1 diabetes mellitus, the most common cause of mortality is nephropathy. In the case of type 2 diabetes mellitus, the most frequent cause of mortality is cardiovascular complications.

Diabetic cetoacidosis

It is an acute metabolic complication that requires urgent hospital treatment. Diabetic ketoacidosis is the clinical manifestation of excess glucose in the blood. Severe hyperglycemia (more than 300 mg / dl), ketosis, osmotic diuresis , and dehydration occur .

Symptoms: thirst, polyuria (abundant urine discharge), asthenia, anorexia, abdominal pain, nausea, vomiting, hyperventilation, ketone-smelling breath, dry skin and mucous membranes, tachycardia, hypotension. It can end in a diabetic coma.

Nonketotic hyperosmolar syndrome

It is characterized by severe hyperglycemia (generally greater than 500 mg / dl) without ketoacidosis leading to dehydration and decreased level of consciousness and even coma. It must be treated in the hospital. It occurs mainly in patients with type 2 diabetes mellitus. It manifests with symptoms derived from dehydration and neurological symptoms, such as decreased level of consciousness, seizures, and coma.

Hypoglycemia

It is an excessive drop in the level of glucose in the blood. It is manifested by dizziness, sweating, trembling, weakness, disorientation and can even cause loss of consciousness.

Diabetic retinopathy

Diabetes is the second leading cause of blindness in industrialized countries and the leading cause in the population under 40 years of age. Diabetic retinopathy is the most common chronic complication in diabetes. There is a close relationship between the presence and severity of retinopathy and glucose control. Other risk factors that influence its evolution are high blood pressure and tobacco abuse. An annual fundus check should be performed by the ophthalmologist.

Treatment

• Strict glucose control.
• Control of arterial hypertension and smoking cessation.
• Photocoagulation (reduces the incidence of blindness).

Diabetic nephropathy

It is the main cause of mortality in patients with type 1 diabetes mellitus. It is detected by the determination of albumin in a urine sample.

Treatment

• Strict glucose control.
• Strict control of arterial hypertension.

Diabetic neufropathy

It can occur for different causes: ischemia, hypoxia , etc. At 25 years after diagnosis, approximately 500% of diabetics present neuropathy.

Treatment

• Treatment of pain and sensitivity disorders.
• Adequate glucose control. Strict control reduces the appearance of neuropathy as well as its progression and severity. Abstention from tobacco and alcohol.

Diabetic macroangiopathy

It is the arteriosclerotic involvement of the vessels of medium and large caliber. Diabetes is the most important cardiovascular risk factor after high blood pressure, dyslipidemia and tobacco.
The fundamental clinical manifestations of diabetic macroangiopathy are:

• Ischemic heart disease: main cause of death in type 2 diabetes mellitus.
• Peripheral vascular disease: the most common symptom is intermittent claudication. It usually manifests as a syndrome of chronic ischemia of the lower limbs.
• Cerebrovascular disease: strokes in Diabetes are usually caused by thrombi.
• However excesiva.
• Weight loss without losing your appetite.

Diagnosis of diabetes

When one of the following assumptions occurs, the diagnosis of diabetes is subject to the confirmation of the elevation of glucose above the values ​​indicated in each case, at least on one more occasion.

There are typical symptoms of diabetes and a random elevation of blood glucose in venous plasma greater than or equal to 200 mg / dl.
Fasting blood glucose in venous plasma is greater than or equal to 126 mg / dl.
Blood glucose at two hours after oral glucose overload (75 g) is greater than or equal to 200 mg / dl.

For the diagnosis of diabetes, a series of tests are used to help us determine glucose levels in the body.

The most used tests are:

• Basal blood glucose.
• Blood glucose curve (oral glucose tolerance test).
• O’sullivan’s test (gestational diabetes).

Other tests are:

Intravenous glucose tolerance test: used when there is doubt about glucose absorption or when oral glucose is vomited. It is outstanding.
Tolbutamide tolerance test: stimulates insulin secretion and is used to diagnose small alterations in glucose tolerance.
Glucosuria: can be used to control the disease. Not for diagnosis.
Ketonuria: used in the prevention of diabetic ketoacidosis.
Glycated Hemoglobin
Fructosamine
Peptide C

How is it treated?

The treatment of diabetes is based on four pillars: diet, physical exercise, diabetes education and pharmacological treatment.

Diet

Diet is the basic pillar of treatment, so in many cases it is the only intervention necessary. The diet should be adapted to the diabetic and never the diabetic to a standard diet. It must be a balanced, varied and attractive diet. Let’s see the key points:

Physical exercise

Improves insulin sensitivity and can reduce drug needs.
It favors weight loss and / or contributes to its maintenance.
Reduces cardiovascular risk: lowers cholesterol and triglycerides, and lowers blood pressure.
It should be done on a regular basis. Moderate intensity aerobic exercise is especially indicated.

Diabetes education

Its purpose is to enhance the self-care and autonomy of the diabetic. It is a measure that reduces the incidence of diabetic comas, amputations and days of hospitalization.

Pharmacotherapy

Insulin

The doctor is the one who must indicate its need, the amount and frequency at which it should be administered. It is indicated in:

All patients with type 1 diabetes.
Some type 2 diabetics due to failure in diet and oral drugs, adverse effects or contraindications to oral antidiabetics, ketonuria and / or significant weight loss, temporarily in pregnancy, surgery, trauma and serious diseases, acute myocardial infarction, etc.
Existence of diabetic ketoacidosis.
The hyperosmolar syndrome.

Oral
antidiabetics : – Sulfonylureas (Chlorpropamide, Glibenclamide, Tolbutamide, Tolazamide, …)
It seems that they act primarily by stimulating the release of insulin from pancreatic cells.
– Biguanides (Metformin)
Increases glucose uptake by the muscle. Decreases intestinal glucose absorption.
It has an anorectic effect. Decrease in LDL-cholesterol and triglyceride levels.
– Inhibitors of alpha-glucosidases (Acarbose)
Reduces the absorption of complex carbohydrates at the level of the small intestine.
When this medicine is taken alone, it does not cause hypoglycemia.
– Thiazolidinediones (Troglitazone)
It is a new group of hypoglycemic drugs that reduce glucose levels by increasing the action of insulin without increasing its secretion.
– Repaglinide
It acts on the beta cells of the pancreas by stimulating the secretion of insulin after taking food.

Avoiding diabetes

To try not to appear or delay the onset of diabetes complications, we must perform:

A strict glycemic control.
Adequate treatment of associated risk factors:
– Arterial hypertension.
– Dyslipidemia.
– Obesity.
– Smoking.

BASIC RECOMMENDATIONS FOR A GOOD SELF-CONTROL GUIDELINE

The basic objective is to promote the responsibility and autonomy of patients in the control of their disease.

Weight control by the patient himself.
Self-examination of the feet.
Self-analysis:

The method of choice is capillary blood glucose. It is an essential method in patients treated with insulin and oral antidiabetics and recommended in patients receiving diet. It is the only method that allows detecting hypoglycemia and decompensation.
Control of ketones: the patient must know this method and perform it in the event of intercurrent illnesses and / or severe hyperglycemia.