Diabetes is an incurable disease that occurs when the body cannot properly process sugar (glucose), which is an essential “fuel” for its function. Glucose, which is poorly absorbed by cells, accumulates in the blood and is then released into the urine. This abnormally high concentration of glucose in the blood is called hyperglycemia. Over time, it can cause complications in the eyes, kidneys, heart and blood vessels.

Diabetes can result from a partial or total inability of the pancreas to make insulin, which is a hormone that is essential for cells to absorb glucose. It can also arise from an inability of the cells themselves to use insulin to take up glucose. In both cases — the cells being deprived of their main source of energy — the condition result in significant physiological consequences, such as extreme fatigue or healing problems for example.

Glucose comes from 2 sources: foods rich in carbohydrates that we ingest and the liver (which stores glucose after a meal and releases it into the blood as needed). Once extracted from food by the digestive system, glucose passes into the blood. In order for the body’s cells to use this vital source of energy, they need the intervention of insulin.

The main types of diabetes

• Type 1 diabetes

Also known as “insulin-dependent diabetes” (IDD) or “juvenile diabetes,” type 1 diabetes occurs when the pancreas either stops producing or is not making enough insulin. This can be caused by a viral or toxic attack, or by an autoimmune reaction that destroys the beta cells in the pancreas, which are responsible for the synthesis of insulin. This type of diabetes mostly affects children and young adults, although the incidence in adults appears to be increasing. It affects about 10% of diabetics.

• Type 2 diabetes

Often referred to as “non-insulin dependent diabetes” or “adult diabetes,” type 2 diabetes is when the body becomes resistant to insulin. This problem usually occurs in people over the age of 45, but the incidence is growing strongly in younger people. This type of diabetes, by far the most common, affects nearly 90% of diabetics.

• Gestational Diabetes

Defined as any diabetes or glucose intolerance that manifests itself during pregnancy, most often in the 2nd or 3rd trimester. Often gestational diabetes is only temporary and goes away soon after childbirth.

• Diabetes insipidus

Another form of diabetes is diabetes insipidus. This is a fairly rare disease caused by insufficient production of the antidiuretic hormone by the pituitary gland called “vasopressin”. Diabetes insipidus is accompanied by an increase in urine output, while blood sugar levels remain completely normal. So, it has nothing to do with diabetes mellitus. It is called “diabetes” insipidus because, as in diabetes mellitus, urine output is abundant. However, urine is tasteless rather than sweet.

Diabetes on the rise

Although heredity plays a role in its onset, the growing prevalence of diabetes is associated with the diet and lifestyle that prevails in the West: abundance of refined sugars, saturated fat and meat, poverty in dietary fiber, excess weight, lack of physical activity. The more these characteristics increase in a given population, the greater the incidence of diabetes.

According to the Centers for Disease Control and Prevention (CDC), 34.2 million people in the United States, or about 10% of the population, suffer from diabetes and about 88 million are pre-diabetic.

The pattern seems to hold true when studying the incidence of the disease in developing countries: as large segments of the population adopt a diet and lifestyle similar to ours, the incidence of diabetes, both type 1 and type 2, has been increasing in the developed world.

Possible complications of diabetes

In the long term, people with diabetes who have inadequate control of their disease are at risk of a variety of complications, primarily because prolonged hyperglycemia causes tissue damage in blood capillaries and nerves, as well as narrowing of the arteries. These complications do not affect all diabetics, and when they do, it is to varying degrees.

In addition to these chronic complications, poorly controlled diabetes (for example due to forgetfulness, incorrectly calculated insulin doses, suddenly altered insulin requirements following illness or stress, etc. ) can cause the following acute complications:

• Diabetic ketoacidosis

This is a condition that can be fatal. In people with type 1 diabetes who are untreated or who receive inadequate treatment (eg lack of insulin), glucose remains in the blood and is no longer available for use as a source of energy. (This can also happen in people with type 2 diabetes treated with insulin.) The body must therefore replace glucose with another fuel: fatty acids. However, the use of fatty acids produces ketone bodies which, in turn, increase the acidity of the body.

Symptoms include fruity breath, dehydration, nausea, vomiting and abdominal pain. Difficult breathing, confusion, coma, and death can also occur.

• Diabetic Hyperosmolar Syndrome

When type 2 diabetes is left untreated, hyperglycemic hyperosmolar syndrome can develop. This is a real medical emergency which is fatal in more than 50% of cases. This condition is caused by the accumulation of glucose in the blood, exceeding 33 mmol/l (600 mg / dl).

Symptoms include increased excessive urination, intense thirst, and other symptoms of dehydration (weight loss, loss of skin elasticity, dry mucous membranes, increased heart rate and low blood pressure).

Symptoms of Diabetes

Regardless of the type of diabetes, the symptoms are the same. They are often more insidious in type 2 diabetes.

• Excessive urination
• An increase in thirst and hunger.
• Weight loss.
• Excessive weakness and fatigue.
• Blurry vision.
• An increase in the occurrence and recurrence of infections of the skin, gums, bladder, vulva or foreskin.
• A slowing down of the healing process.
• Numbness or tingling in the hands and feet.

P.S.: Untreated or poorly controlled diabetes causes serious symptoms that are important to recognize. Consult the Complications of diabetes sheet.

Risk factors of diabetes

• Family history

The familial character of diabetes has long been known for type 2 diabetes. It is indeed a genetically determined disease. It is also estimated that, when one of the two parents has type 2 diabetes, the risk of transmission is of the order of 40% and, if both parents are affected, the risk rises to 70%.

The genes predisposing to diabetes are starting to be identified. France, very active in this field, has at the Institut Pasteur in Lille the world’s largest bank of DNA samples from families of diabetics. The first results are promising and several genes have been found involved in the disease. These discoveries should soon make it possible to screen people at risk and offer them preventive measures.

However, this disease will only appear in the presence of favorable environmental factors, such as diet or a sedentary lifestyle.

• Age

Type 2 diabetes usually starts after the age of 40 years and is diagnosed at an average age of 65. However, in recent years, we have observed more and more cases in adolescents, and even in children.

• Lifestyle

Lifestyle is the main risk factor for type 2 diabetes today. A diet that is too fatty and too sweet, combined with a lack of physical activity, promotes obesity. However, the more fat in the body, the more insulin the body needs. And a sedentary lifestyle does not allow enough glucose consumption to compensate for overeating.

In addition, excess weight in the abdominal belt is also a risk factor since the fat is then located in the organs of the abdomen and in particular in the liver, which can affect the function of insulin. .

A person is considered to be at risk of developing diabetes when:

• His or her body mass index or BMI is greater than 28;
• His or her HDL-cholesterol level is less than 0.35g / L;
• His or her triglyceride level is over 2g / L.

• Blood pressure

Hypertension and diabetes often go hand in hand. In fact, people with high blood pressure have a greater risk of developing diabetes and vice versa. It is estimated that people with high blood pressure have a 50% increased risk of developing diabetes.

• Pregnancy

During pregnancy, the action of insulin is very regularly disturbed. The result: many women develop gestational diabetes. However, if for many of them the blood sugar level returns to normal after childbirth, the risk of developing type 2 diabetes is multiplied by 7. In addition, the fact of having given birth to a child of more than 4 kg is also considered to be at risk.

• Stress

Stress hormones have a hyperglycemic effect. When faced with a stressful situation, our body produces high amounts of adrenaline and norepinephrine, cortisol, glucagon and somatotropin. In response, an increased production of blood sugar will occur in the body to give it the strength to act in the face of danger. These repeated changes in blood sugar can lead to diabetes.

• Ethnic origin

Some populations are said to be “at risk”: Africans, Latin Americans, Asians and indigenous peoples of North America (Indians). In fact, type 2 diabetes is statistically less frequent in Caucasian (European) populations than in these populations.

There is also an increase in the prevalence of diabetes among people who have emigrated to a country where the diet is different from the country of origin, especially if the food there is very “westernized”.

Regular tobacco consumption

Smoking, whether active or passive, can also play a role in the onset of type 2 diabetes. The nicotine in cigarettes increases the level of catecholamines in the body. However, these hormones tend to alter our sensitivity to insulin but also the secretion of insulin. One of these molecules, adrenaline, increases blood sugar.

Although little is known about the risk factors for type 1 diabetes, it is now clear that a sedentary lifestyle, a Western-style diet (rich in saturated fat and animal products, poor in vegetable fibers), weight (especially when the fat collects in the abdomen) and high blood pressure increase the risk of type 2 diabetes.

Treatment of Diabetes

To date, no cure has yet been found to cure diabetes. The proposed treatment aims to restore normal blood sugar levels. However, compliance with treatment and medical follow-up is crucial to avoid acute and chronic complications.

A doctor usually make a treatment plan based on the results of the blood tests, checkup, and symptoms. With the right medication, a good diet, and some lifestyle changes, people with diabetes can lead almost normal lives.

Medicines

• Type 1 diabetes

The usual medication is insulin, given with daily injections or continuously with a small pump connected to a catheter placed under the skin.

• Type 2 diabetes

There are 3 types of medication (in tablets), each with their own mode of action: stimulate the production of insulin by the pancreas; help tissues use insulin to absorb glucose; or slow down the intestinal absorption of sugars. These different drugs can be used alone or in combination to improve their effectiveness. People with type 2 diabetes sometimes need insulin therapy.

• Gestational Diabetes

Studies indicate the treatment is effective in preventing certain complications for the mother and the fetus. Usually, changes in diet and weight control are enough to keep blood sugar levels within normal range. If needed, insulin or, more rarely, certain hypoglycemic drugs are offered.

When and how to measure blood sugar?

Blood sugar is a measure of the concentration of glucose (sugar) in the blood. People with diabetes must monitor their blood sugar closely in order to adjust their medication (depending on diet, exercise, stress, etc.) and to maintain blood sugar levels as close as possible to normal at all times. . Blood sugar control is all the more important as it helps reduce or prevent complications of diabetes.

Normally, people with type 1 diabetes measure their blood sugar 4 times a day (before each meal and before bedtime), while those with type 2 diabetes can usually get by with a daily measurement or in some cases with 3 readings per week.

Hyperglycemia

Hyperglycemia refers to an increase in the concentration of glucose in the blood: when, on an empty stomach, the glycemia is greater than or equal to 7 mmol/l (130 mg / dl) or rises to 11 mmol / l (200 mg / dl) or more 1 or 2 hours after a meal. The symptoms are those of diabetes: excessive excretion of urine, increased thirst and hunger, fatigue, etc.

Causes of hyperglycemia

• Consumption of more sugary foods than is permitted.
• Decrease of physical activities.
• Incorrect dosage of drugs: lack of insulin or hypoglycemic drugs.
• Live stress.
• A serious infection, such as pneumonia or pyelonephritis (infection of the kidney), as this increases the need for insulin.
• Taking of certain medications (glucocorticoids like cortisone, for example, increase blood sugar).

What to do

• Measure your blood sugar.
• If the blood glucose exceeds 15 mmol / l (270 mg / dl) and if you have type 1 diabetes, measure the level of ketone bodies in the urine
• Drink plenty of water to avoid dehydration.
• Trying to find the cause of the hyperglycemia.
• See your doctor if the condition persists

Hypoglycemia

Hypoglycemia refers to a decrease in the concentration of glucose in the blood: when the blood sugar drops below 4 mmol/l (70 mg/dl). Shaking, sweating, dizziness, palpitations, fatigue, yawning and pallor are signs of low blood sugar. Left untreated, hypoglycemia can cause unconsciousness, with or without seizures.

Causes of hypoglycemia

• Making a drug dosage error (too much insulin or hypoglycemic agents).
• Skipping a meal or snack, or catching it late.
• Eat sugary foods in insufficient quantities.
• Increase in physical activities.
• Alcohol consumption.

What to do

• Measure your blood sugar.
• Eat a food that provides about 15 g of carbohydrates (which are absorbed quickly), such as 125 ml of fruit juice or regular soft drink; 3 tbsp. of sugar dissolved in water; 3 tbsp. of honey or jam; or 1 cup of milk, and wait 20 minutes for the blood sugar to stabilize.
• Measure blood sugar again and take 15 g of carbohydrate again if the hypoglycemia persists.
• Trying to find the cause of hypoglycemia
• See your doctor if the condition persists

Diabetic lifestyle

Apart from medication, diabetics have a great interest in establishing a diet plan and adopting a good exercise program. Indeed, these non-drug interventions can reduce the dosage of the medication and prevent certain complications. Overweight and lack of physical exercise are real health risks for diabetics.

• Diet

A person suffering from diabetes would greatly benefit from a tailor-made diet developed by a nutrition specialist. These specialized dietary recommendations can better control blood sugar, maintain or move the patient towards a healthy weight, improve the lipid profile in the blood, control blood pressure and reduce the risk of complications.

A person suffering from diabetes should:

• Control the amount and type of carbohydrates consumed, and the frequency of their consumption.
• Eat more dietary fibers as they slow down the absorption of carbohydrates.
• Favor good fats to improve the lipid profile and prevent complications.
• Drink alcohol moderately.
• Adjust diet according to exercise.

• Physical exercise

It is particularly important for diabetics to practice cardiovascular exercises of moderate intensity, according to taste: walking, tennis, cycling, swimming, etc.

Benefits of exercising regularly:

• Decrease in blood glucose levels, in particular by allowing the body to make better use of insulin.
• Lower blood pressure and strengthening of the heart muscle, which is a definite advantage given that diabetics are particularly at risk of suffering from cardiovascular diseases.
• Achieving or maintaining a healthy weight, which is especially important in type 2 diabetes.
• Increased feeling of well-being (self-esteem, etc.) as well as muscle tone and strength.
• Decrease in the dosage of the antidiabetic medication in some people.

Precautions to take

• Diabetes must be brought under control before starting any exercise program;
• Talk to your doctor about your exercise program (the frequency and volume of doses of insulin or hypoglycemic drugs may change).
• Check blood sugar before and after exercise.
• Start with moderate intensity activities.
• Keep foods rich in carbohydrates close at hand in case hypoglycemia develops.
• The periods of physical activity and the insulin injection sessions must be far enough apart to avoid a too sharp drop in blood sugar.

Warning. Exercise should be avoided during a hyperglycemic attack. For any type of diabetes, if blood sugar exceeds 16 mmol / l (290 mg / dl), refrain from exercise since blood sugar temporarily rises during physical exertion. People with type 1 diabetes and whose blood sugar exceeds 13.8 mmol / L (248 mg / dL) should measure the level of ketone bodies in their urine. Do not exercise if there are ketones present.

Mutual aid and social support

The diagnosis of diabetes comes as a shock to many people. At first, it often causes stress related to many concerns. Will I be able to control my disease and maintain a lifestyle that’s right for me? How will I live with the possible consequences of the disease, both short and long term? If necessary, several resources (relatives, the doctor or other health workers, support groups) can offer moral support. Do not hesitate to find help in case of stress.

Stress and blood sugar

Good management of daily stress promotes better disease control, for 2 reasons.

• Under the effect of stress, you may be tempted to take less care of your health. You might stop planning your meals or exercising. You might even start monitoring your blood sugar less often or consuming alcohol, etc.
• Stress acts directly on blood sugar, but its effects vary from person to person. In some people, stress hormones (such as cortisol and adrenaline) increase the release of glucose stored in the liver into the bloodstream, causing high blood sugar. In others, stress slows digestion and instead causes hypoglycemia (it can be compared to a delay in eating a meal or snack).

Deep breathing exercises and meditation, as well as getting enough sleep can help reduce the swings in blood sugar caused by stress. You will also need to make the appropriate changes in your life to deal with the sources of stress. These practices are not a substitute for medication (a type 1 diabetic who stops taking insulin can die). See you your doctor in case of stress.