Diabetes
What is it?
Diabetes is an emerging public health problem characterised by a fasting blood sugar level above 1.26g/l or a postprandial level above 2 g/l.
In 2019, 1 in 11 people worldwide suffers from diabetes. The figure released by the International Diabetes Federation (IDF) in the 9th edition of its Diabetes Atlas (2019) shows a precise figure of 463 million people worldwide.
Hyperglycaemia results from insulin deficiency, the main hypoglycaemic hormone. In this case, two mechanisms may be involved:
– Destruction of pancreatic beta cells that no longer produce the secretion of insulin (type 1 diabetes)
– Relative deficiency in insulin-resistant patients in whom a necessary compensating hypersecretion is not produced (type 2 diabetes).
Hyperglycaemia is dangerous in itself in the short term (polyuria, ketosis, direct toxicity for the nephron and arterioles), but also in the long term leading to microangiopathic lesions and increasing the risk of atherosclerosis lesions which shorten suffers’ lifespans.
What can be done to prevent it?
Good lifestyle habits reduce the risk or at least delay the onset of diabetes, namely:
- Monitoring one’s weight
Being overweight is one of the major factors in type 2 diabetes. In order to stay healthy, it is therefore important to maintain a normal body weight (according to the WHO, the BMI (body mass index), for a normal weight, should be between 18.5 kg/m² and 25 kg/m²).
- Exercise regularly
Studies have found that the more physical exercise a person does, the lower their risk of developing diabetes. Indeed, the “Finnish Diabetes Prevention Study” and the “Diabetes Prevention Program” have shown that after 4 years of a regular sporting activity, the risk of developing type 2 diabetes decreased by 58%.
- Adopting a healthy diet
Avoid foods that are too high in saturated fats (fried foods, pastries, chocolate, etc.) and give priority to a diet rich in various fruits and vegetables. Eating 6 servings of fruits and vegetables a day has been shown to reduce the risk of type 2 diabetes by 21%! And there is a good reason for this, since plant foods are rich in antioxidants and fibre that capture some of the sugars and fats found in food.
Also, give priority to slow carbohydrates (pasta, potatoes, rice, etc.) over fast sugars (cakes, chocolate, ice cream, etc.) which cause the blood sugar level to increase rapidly.
- Limiting stress
Stress leads to the secretion of two hormones: adrenaline and cortisol. These promote the release of sugars through the liver and thus increase blood sugar levels. There are different methods that can help manage stress (contemplation of nature, yoga, music, etc.)
- Stopping smoking and consuming alcohol in moderation
An American study published in the British Medical Journal in 2006 showed that being exposed to tobacco, even passively, multiplies by 1.4 the risk of developing type 2 diabetes. As for alcohol, excessive consumption influences the regulation of blood sugar, in the sense that the liver concentrates all its action on removing alcohol from the blood and no longer deals with controlling the blood sugar.
Which treatments ?
And if, in the end, a person has not been able to protect themselves against this nasty condition, they are affected, pharmacological treatments can supplement the hygiene-dietary measures taken. The type of hypoglycaemic treatment to be adopted will in this case depend on the pathophysiology of each type of diabetes.
Type 1 diabetes: insulin substitution from the outset, since insulin deficiency is the main issue.
Type 2 diabetes:
- Initially (insulin resistance), biguanides (metformine) should be used.
- If metformine alone can no longer control the diabetes, other oral anti-diabetic agents (hypoglycaemic sulfonamides, “glinides”, intestinal glucose absorption inhibitors, DPP4 inhibitors, GLP1 analogues, tubular glucose reabsorption inhibitors) are used with metformine.
- When bi or tri oral therapy is insufficient, insulin becomes necessary, which can still be used with metformine or another oral hypoglycaemic agent.
It should be noted that, since diabetes is a chronic disease, the affected patient will have to take their treatment for life.
Also, the phenomenon which, according to the IDF, is a real pandemic with often disabling complications (retinopathy responsible eventually for blindness, kidney disease which may lead to renal failure, diabetic foot ulcers which may lead to amputation, etc.), prevention is better than all curative measures, by adopting a healthy lifestyle, especially in relation to hygiene and diet.