By Georgia Argyrakopoulou – Internist, Diabetologist, Director of the Diabetes Unit, Athens Medical Center
What is diabetes mellitus?
Diabetes mellitus is a chronic condition, characterized by a metabolic disorder of carbohydrates, fats and proteins. The main and common disorder in all forms of diabetes is hyperglycemia, that is, increased blood sugar levels.
It is distinguished in type I diabetes, type II diabetes, pregnancy diabetes and other particular and rare types.
Type I diabetes mellitus is caused by the destruction of pancreatic B cells, which, under normal conditions, produce the hormone insulin. Thus, in this type, absolute insulin deficiency is observed and for its treatment the external administration of insulin is necessary.
Type II diabetes mellitus is caused by a combination of disorder in the secretion and action of insulin (tissue resistance to insulin).
More than 350 million people today suffer from diabetes worldwide, and it is worth noting that almost half of them are undiagnosed.
What are the risk factors for developing diabetes mellitus?
Risk factors for developing diabetes mellitus are obesity, lack of exercise, heredity, women with a history of giving birth to an overweight baby or who suffer from polycystic ovarian syndrome, hypertension, history of cardiovascular problems etc.
Why is it important to regulate sugar prices?
An important step in the treatment and regulation of blood sugars is the proper education of diabetic patients in order to comply in principle with the hygienic-dietary guidelines given by the specialist. Good regulation of blood sugar can reduce the incidence of complications of diabetes mellitus.
How is diabetes diagnosed?
Diagnosis of the diabetic patient is provided by measuring the morning blood sugar or sugar values during the glucose curve. The diagnosis also includes the measurement of glycosylated hemoglobin (HbA1c), which reflects the average sugars of the last three-month.
What is pre-diabetes?
Pre-diabetic are those individuals who have sugar values higher than normal, but not so high to be considered diabetic.
We use the term "pre-diabetes" to indicate the relatively high risk for future development of diabetes and cardiovascular disease.
Which individuals should be tested for diabetes?
Individuals asymptomatic, non-obese and without risk factors should be screened at the age of 45 years. People who are overweight or obese and have some additional risk factors, such as lack of exercise, first degree relatives with diagnosed diabetes, or who suffer from hypertension, dyslipidemia or cardiovascular disease should be screened at an earlier age. Also, overweight / obese mothers diagnosed with pregnancy diabetes or overweight babies at birth should be regularly screened.
Is there a way to prevent the onset of diabetes?
People with pre-diabetes should be monitored for diabetes by specialists, at least once a year. Changing lifestyle can reduce the rate of progression to diabetes and, indeed, it is more effective even than administering antidiabetic drugs. Patients with pre-diabetes should follow closely the guidelines they will receive from their doctor in order to lose weight and increase their physical activity.
Generally, mild to moderate exercise intensity is recommended for at least 150 minutes, weekly. Walking relatively fast, for just 30 minutes a day, covers the needs for physical exercise. At the same time, other concomitant cardiovascular risk factors, such as hypertension and dyslipidemia, should be addressed.
What are the treatment goals for diabetes?
Fasting glucose values should be between 70 and 130 mg / dl, while post-meal sugar regulation is important (measuring two hours after meals). The goals, however, must be personalized, depending on the patient and depending on other factors, such as the duration of diabetes, age, patient survival, and so on.
The diabetic patient's ability to understand hypoglycemia plays an important role. Unrecognized hypoglycemia, that is, when the patient does not perceive low blood sugar levels, is an important limiting factor in regulating sugars and in these patients our treatment goals are usually less stringent.
At the same time, with the regulation of blood sugars, we must pay close attention to other coexisting disorders such as hypertension and dyslipidemia.
How is diabetes treated?
The first and most important step in the treatment of diabetes is diet and exercise. Even when it is necessary to add medication, we should never omit the hygienic-dietary guidelines. Moreover, sometimes, even small weight loss combined with exercise is sufficient to regulate sugars in individuals suffering from type II diabetes mellitus.
While type I diabetes requires insulin administration, initiation of treatment in patients with type II diabetes is with antidiabetic tablets. Thus, when the change in the lifestyle (diet and exercise) is not enough, antidiabetic tablets are gradually added until the glycemic goals are achieved.
Insulin administration in patients with type II diabetes mellitus is necessary when sugar levels are still high despite dietary guidelines and antidiabetic tablets. The usual practice involves maintaining antidiabetic tablets and adding a single dose of insulin (administration of basic insulin). As the duration of diabetes increases and the capacity of pancreatic b-cells to secrete insulin is reduced, multiple insulin injections may be required to maintain euglycemia.
What are the chronic complications of diabetes mellitus?
Chronic complications of diabetes mellitus can be reduced by the proper regulation of blood sugar. The target organs affected by diabetes are the eyes, the kidneys, the nervous system and the vessels of the heart, brain and peripheral arteries.
With regard to the eyes, so-called diabetic retinopathy is the damage of the small vessels of the eyes and without treatment it can even lead to blindness. Check up with an ophthalmologist should begin early, with the diagnosis of diabetes, well before the patient becomes symptomatic. It must be repeated at least once a year.
Inflammation of the kidneys is called diabetic kidney disease (or nephropathy) and is one of the most important causes of hemodialysis worldwide. It is asymptomatic in the early stages of the disease and for this reason diabetic patients should undergo at least a yearly urine examination for the excretion of albumin.
Diabetic neuropathy is distinguished in peripheral neuropathy, which usually manifests with symptoms from the lower extremities such as numbness, pain and a burning sensation, and neuropathy of the autonomic nervous system, with symptoms in the stomach (gastroparesis), urinary tract disorder (diarrhea or constipation), orthostatic (postural) hypotension, erectile dysfunction, etc.
The infestation of large vessels mainly affects coronary heart vessels, carotid arteries, and lower limb vessels, also known as macroangiopathy, and may be manifested as angina pectoris or even acute myocardial infarction, stroke or intermittent claudication (pain in the lower extremities while walking).
Finally, the "infamous" diabetic foot is due to peripheral neuropathy and / or peripheral arterial disease, and sometimes there is a leg injury that has not been realized, since peripheral neuropathy eliminates / reduces the pain sensation in these patients; if there is no timely intervention, it can even lead to amputation.
