The fourth leading cause of death in developed countries, diabetes is expected, according to an estimate by the World Health Organization (WHO), to affect more than 360 million people worldwide in 2030. Yet many are unaware of the signs and complications of disease.
- What is diabetes ?
- What are the treatments for diabetes?
- Insulin pumps
- Incretins: a promising new treatment
- Screening and living with diabetes
- Diabetes: talking about it to accept the disease
- Diabetes: no need for an injection to measure your blood sugar
- A summer camp to learn how to live better with diabetes
What is diabetes ?
The diabetes is a chronic illness constantly increasing in the world and in 2016. In France, 3.7 million people were taking treatment for diabetes and it is estimated that 600,000 are living with the disease without knowing it (source: French Diabetes Federation ). If you don’t get a cure for diabetes, you can learn to live better with the disease and reduce the risk of complications.
Diabetes is characterized by the presence of excess sugar in the blood , glucose. When the blood glucose level exceeds 1.26 g on an empty stomach twice (or at any time of the day if the glucose is more than 2 g /) l, in the presence of the above symptoms., we are talking about diabetes. The body of people with diabetes cannot properly regulate this excess sugar in the blood.
There are two main forms of diabetes: type 1 diabetes and type 2 diabetes . Type 1 diabetes is most often detected in childhood, but it can be detected in adults up to 35 years of age. It concerns 10% of diabetics. This form occurs when the pancreas does not make enough insulin , a hormone that regulates blood sugar levels. Symptoms are increased thirst and hungry, increased urination (the diabetic urinates more), fatigue, weight loss despite retained appetite, and muscle wasting.
Nine times out of ten, diabetes is type 2. It mainly affects adults over 40, sedentary and overweight, but it affects younger and younger people. It concerns more men than women, the risk increases in the event of a large waist circumference (due to the accumulation of fat in the abdomen). When insulin is produced, the body’s cells fail to use it properly. There is a kind of resistance on the part of the cells, which limits the absorption of glucose, so it remains in excess in the blood.
This form remains symptom-free for a long time, it can cause the same symptoms as type 1 diabetes, but in an attenuated manner.
Late diagnosis can lead to serious complications: blindness , amputation … Diabetes multiplies by 2 or 3 the risk of heart attack and stroke. It is one of the main causes of kidney failure.
What are the treatments for diabetes?
Type 1 diabetes is mainly treated by insulin therapy, in other words by injections of insulin which allow the patient to regulate his level, or by insulin pump (see next paragraph). The diabetic child can eat a normal diet, similar to that of his brothers and sisters but it must obviously be balanced and varied. The insulin dose is always adapted to food intake and physical activity.
The first treatment for type 2 diabetes is a diet that should avoid fatty foods and favor those rich in fiber such as fruits and vegetables. Starchy foods should be chosen whole, dried vegetables and alcohol should be limited because it is rich in sugars. If after 6 months the glucose level has not fallen, then anti-diabetic tablets can be prescribed and many families of drugs are possible. It can be metformin (from the biguanide family, which increase insulin sensitivity) alone or combined with another medicine if it is not sufficient. It can then be sulfonamides, glinides which stimulate the production of insulin. Another class, the incretins, is also prescribed (see paragraph below). Of other drugs decrease the absorption of sugars (aplphaglucosidase inhibitors) but they are used very little. Some promote their elimination through the urine, these are SGLT2 or glifozins; authorized since April 2020, they have a beneficial effect on blood sugar, weight, blood pressure and kidney function. Another class is interesting, the inhibitors of DPP4 “because they cause less hypoglycemia.
Finally, the administration of insulin is sometimes necessary.Regular physical activity is strongly recommended and is part of the management.
It should be remembered that it is the “hyperglycaemic spurts” which are dangerous for the arteries : those of the heart (the risk of heart disease is multiplied by fifteen in diabetics), of the kidneys (10% of dialysis patients are untreated diabetics. ), legs (8,000 amputations each year are also linked to untreated diabetes) and eyes (diabetes is the leading cause of blindness in adults). Since type 2 diabetes is diagnosed late, it is often diagnosed at the time of complications, while type 1 diabetes is diagnosed earlier, complications are rarer at diagnosis.
As long as there are no complications , diabetics do not feel sick and therefore often find it difficult to accept the necessary follow-up and treatment. Even when the disease is advanced, follow-up remains difficult.
For type 1 diabetics, that is, those whose pancreas no longer makes insulin, improving treatment requires insulin pumps that are easier to use. They allow you to inject the necessary amount of insulin throughout the day and night.
The insulin pump provides improved quality of life for nearly 25,000 patients. But 70,000 could potentially benefit.
Incretins: a promising new treatment
A new family of drugs arrived around 2007, the incretins . These are gastrointestinal hormones that indirectly stimulate the production of insulin . There are several classes. Some even have the advantage of making type 2 diabetics , those with serious nutritional problems, lose weight . This is a very interesting tool for diabetologists.
Screening and living with diabetes
Screening is essential. It is simple and reliable: a blood test is sufficient, which measures the glycemia (the level of sugar in the blood) on an empty stomach, twice.
The following must be screened from the age of 40 in particular: people who have diabetic parents, hypertension , too much cholesterol or too much triglyceride, and therefore overweight. Women who have given birth to babies weighing more than 4 kg should also be tested.
In addition, due to the obesity “epidemic”, type 2 diabetes affects younger and younger people. Diabetologists would therefore like to see tests developed for young people.
It should be remembered that the rate of overweight children rose from 3% forty years ago to more than 16% in 2004.
Regarding genetic factors , we know that when a parent has type 2 diabetes, the risk for offspring is 30%, while it is only 6% in the general population. If both parents are diabetic, this rate rises to 50% and the disease appears earlier, from 30-40 years old. As for identical twins, if one is diabetic, the risk for the other is 90%.
For many diabetics, the days are punctuated by pricks on the fingertip to check their blood sugar . An often heavy constraint for these patients. Today, there are alternatives to measure your blood sugar without pricking yourself, like the new glucose sensors . In addition, the measurement of glycated emoglobin is part of the monitoring and it gives an idea of blood sugar levels over two or three months; it is supposed to be 6% at the onset of the disease and then 6.5 and 7% as the disease progresses.
Diabetes: talking about it to accept the disease
Medical appointments, injections, diet … Diabetes disrupts the lives of patients and can cause anxiety. In Marseille, an association offers diabetes support groups to learn how to live with their disease .
Learning to live with diabetes is not easy. Patients need to change their eating habits and deal with the new anxieties that the treatment can cause. By discussing their illness, participants create links and above all feel understood. For those who are more anxious, it is important to get psychological support because stress can have a negative impact on blood sugar .