Diabetes Mellitus

Diabetes mellitus is a systemic disease, that is, it affects many organs of the human body. It is characterized by the elevation of the glucose (sugar) level in the blood, above normal values. A glucose value of up to 100 mg/dl is considered normal. If a person has a blood sugar level equal to or above 200 mg/dl, taken at any time of the day, and if this value is repeated in a new intake on another day, he/she can be considered to have diabetes.

Patients with diabetes have an increased risk of suffering alterations in the microcirculation (small vessels), such as damage to the retina and kidneys; in the macrocirculation (large vessels), such as the lower limbs, which generally manifests as neuropathy and damage to the heart (infarction). type 2 diabetes is accompanied by hypertension in approximately 75% of cases and hyperlipidemia (elevated cholesterol and triglycerides), which is considered a cardiovascular risk factor.

In Ecuador, diabetes is the second leading cause of death after ischemic heart disease. In 2016, 2628 women and 2278 men died from diabetes. According to the ENSANUT survey, the prevalence of diabetes in the population of Ecuador is 10 to 59 years is 1.7%.

Metabolic disorders prediabetes

Glucose levels greater than 100 mg/dL but less than 125 mg/dL are considered to be impaired fasting plasma glucose.

Fasting glucose levels between 140 and 199 mg/dl after ingesting 75 g of glucose during an OGTT (glucose tolerance test) are considered carbohydrate intolerance.

People who present either of these two types of alterations in blood glucose levels are considered to be prediabetic and are at high risk of developing the disease in the future.

Metabolic syndrome

People with abdominal obesity and insulin resistance present metabolic alterations called metabolic syndrome. In these patients, elevated glucose is associated with high blood insulin levels, elevated fats and hypertension leading to coronary artery (heart) disease and embolisms.

Risk Factors

There are some risk factors for the development of diabetes:

-Familial inheritance.
-Overweight and obesity.
-Diabetes during pregnancy.
-Metabolic syndrome.
Arterial hypertension.
-Polycystic ovary syndrome.
-Lipid disorders (cholesterol and triglycerides).

Causes of diabetes

Diabetes has always been considered a disease of unknown cause. But many triggers for this disorder are now recognized; among these are genetic factors, certain types of viruses that have been implicated in the destruction of the cells of the pancreas that produce insulin, which is the hormone that keeps blood sugar levels within the normal range.

In addition to the predisposition that a person has for diabetes, there may be triggering factors that precipitate the onset of the disease, such as overweight and obesity and an inadequate diet.

Symptoms

They are nonspecific and in many occasions it is silent and the patient does not know that he/she suffers from the disease. It is only discovered when high blood sugar values are detected in a routine examination or for other reasons.Some patients may initially present: abundant thirst, weight loss, increased appetite and frequent urination.

Diagnosis

A blood test is performed to detect the sugar levels mentioned above. Some patients will require special tests such as the Oral Glucose Tolerance Test to rule out or confirm that they have diabetes.

Types of Diabetes

In general it is considered that there are 2 types of diabetes; Type 1 or insulin-dependent, that is to say that there is no insulin in the pancreas, so the patient requires insulin injections, it is more frequent in children.

Type 2 or non-insulin-dependent diabetes, also called adult-onset diabetes. In this case the pancreas does produce insulin, but in small quantities, or there is an inadequate utilization of insulin, in which case what is called resistance to the utilization of insulin is produced, due to certain conditions such as obesity and overweight.

Treatment of diabetes

For type 1 diabetes, insulin injections and proper supplemental nutrition, not just diet, are needed. In type 2 diabetes, oral medications are used to normalize glucose. It is important to note that a balanced diet is vital along with medication to prevent or delay long-term complications, which are those that deteriorate the patient’s quality of life.

The introduction of insulin to the treatment of type 2 diabetes will depend on the sugar levels and the control of the disease. Patients who, despite good nutrition and oral antidiabetic control, maintain elevated blood glucose levels should receive insulin-based regimens.

Complications

Diabetes can affect organs and body systems that perform vital functions for the human being. Complications appear when there is poor control or inadequate medical treatment.

Kidney: Terminal renal failure and consequently the need for dialysis to maintain life.
Heart: The most important is the infarction that in many occasions due to the evolution of diabetes itself does not usually cause symptoms and leads to the patient not being attended in a timely manner. If the heart attack is massive, it can trigger sudden death.
Retina: Damage to the microcirculation that can lead to permanent blindness.
Nervous System: Sensitivity disorders causing numbness and tingling in both feet and lower legs.

Digestive system: dyspepsia, abdominal swelling, intestinal motility disorders (diarrhea and constipation).
Metabolism: Ketoacidosis which is a complication characterized by acidification of the blood that triggers respiratory disorders such as shortness of breath (dyspnea), disorientation and may lead to coma, usually occurs in type 1 diabetic patients. Non-ketotic hyperosmolar syndrome, especially in older adults, characterized by dyspnea, drowsiness, weakness, decreased vision, excessive thirst, hallucinations that may lead to coma. Both metabolic complications are caused by elevated blood sugar levels (400 mg or more).

Skin and scalp: At skin level bacterial infections such as stye, abscesses, boils (accumulation of several abscesses), folliculitis (inflammation of hair follicles). Infection by fungi and bacteria in the nails.
Genitourinary system: In women recurrent and difficult to control urinary tract infections, pruritus (itching) in the vulva due to vaginal candidiasis. In men erectile dysfunction, itching of the glans penis due to balanopreputial candidiasis.

General recommendations

-Maintain the appropriate weight for your age, size and sex.
-Eat a variety of foods.
-Fractionate your meals.
-Eat enough calories to cover your daily energy needs.
-Eat complex carbohydrates rich in vegetable fiber, such as whole grain bread, cereals, dry grains, legumes, vegetables and fruits.
-Avoid consuming fats and fried foods.
-Eat little salt.
-Alcohol is not recommended.
-Consume enough vitamins, minerals and antioxidants as nutritional supplements.
-Drink water without any type of restriction unless your doctor tells you otherwise.
-Avoid fasting and do not skip any of your meals.
-Eliminate the consumption of sugar and its derivatives.
-In particular, eat your meals with pleasure and tranquility.

Glucose targets in the diabetic patient

-Glycated hemoglobin (HbA1c) <70%.
-Glucose before meals 80-130 mg/dl
-Glucose after meals <180 mg/dl

Myths and facts about Diabetes

1. Myth: A diabetic patient cannot eat fruits.
Truth: Fruits contain fiber, vitamins and minerals, therefore, fruits should be consumed within a proper nutritional regimen.

2. Myth: Diabetics tend to get sick more frequently.
Truth: Diabetic patients are no more prone to illness than other people if they maintain good glucose control, therefore, quality of life will not deteriorate.

3. Myth: Using insulin means end-stage disease.
Truth: Insulin can be used in the early stages of diabetes to ensure better control. Later the patient can use oral medication. In addition, the use of insulin can even delay the onset of complications, which in the end is what deteriorates the quality of life of patients and causes death.

4. Myth: Obesity and overweight eventually lead to diabetes.
Truth: Not all obese or overweight people will become diabetic. Many factors influence, of which we have already commented, logically their risk will be much higher. That is why it is essential to have a healthy diet and enough physical activity to maintain a weight according to your height.

5. Myth: Diabetic patients cannot eat sweets or desserts.
Truth: If they are within an adequate and optimal nutritional regimen for the patient, these foods can be eaten without problems, only abuse and carelessness lead to an imbalance and deterioration of the condition.

6. Myth: Consuming too much sugar will make us diabetic.
Truth: Eating a lot of sugar and sweet foods leads to the risk of diabetes, but other factors such as heredity, overweight and physical inactivity also play a role.

The American Diabetes Association recommends limiting consumption of sugary drinks to prevent the development of this condition such as: regular soft drinks, fruit juice, sweetened juices, energy drinks, sports drinks, sweet tea.

7. Myth: Diabetes can be emotional.
Truth: Emotions or alterations in the psychic sphere do not cause diabetes, because this disease is a complicated metabolic disorder in which many hormonal alterations are involved that together will trigger the disease.

8. Myth: Insulin causes blindness.
Truth: It is a widespread myth, but in reality insulin can prevent a patient from reaching such a serious complication as blindness.

References

 

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Diabetes Mellitus
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Diabetes Mellitus
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Patients with diabetes have an increased risk of suffering alterations in the microcirculation (small vessels), such as damage to the retina and kidneys; in the macrocirculation (large vessels), such as the lower limbs, which generally manifests as neuropathy and damage to the heart (infarction).
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