Diabete

Diabetes mellitus, a chronic disease caused by a disorder of carbohydrate metabolism and characterized by an abnormally high level of sugar in the blood and urine. Its frequency continues to grow in the world, along with the aging of populations and living conditions related to diets high in fat and glucose and sedentary lifestyle. Diabetes mellitus can severely damage the eyes, kidneys, heart, limbs, and is a risk in pregnancy.

TYPES OF DIABETES

There are usually two types of diabetes mellitus.

Type I or insulin-dependent diabetes (IDDM)

Type I or insulin-dependent diabetes (IDDM), formerly known as juvenile diabetes. It mainly affects children and adolescents and would be part of autoimmune diseases. It represents 10 to 15 percent. 100 of the cases of diabetes and its evolution is very fast.

Type II, or non-insulin-dependent diabetes mellitus (NIDDM)

Type II, or non-insulin-dependent diabetes mellitus (NIDDM), also known as diabetes mellitus, is usually found in people over the age of 40 and its progression is slow. Clinical symptoms are often not observed and only high levels of glucose in the blood and urine can detect the disease.

CAUSES AND EVOLUTION

Diabetes is considered a disorder whose origins are multiple. In a healthy subject, the pancreas secretes a hormone, insulin, which facilitates the penetration of glucose into the tissues. In diabetics, glucose penetration does not occur properly, either because the amount of insulin is insufficient or because the cellular glucose receptors are not effective. The sugar accumulates in the blood and is evacuated in the urine.

Type I diabetes is almost always due to a significant decrease or cessation of insulin production. In the second type, the pancreas produces a considerable amount of insulin, which is not enough to satisfy the needs of the body, because the tissues are resistant to the action of this hormone. In some cases, this resistance is due to old obesity: high blood sugar inactivates the target tissue components of insulin.

In the absence of treatment, type I diabetes can quickly become fatal. It is accompanied by a feeling of intense thirst, weight loss and significant fatigue. Because tissue glucose does not provide enough energy to the body, it begins to use fat. This phenomenon helps to increase the level of ketones in the blood and the increase in blood acidity affects the breathing. Before the discovery of insulin therapy in the 1920s, patients usually died of diabetic coma. In both types of diabetes, the persistence of high blood sugar can lead to disorders whose consequences are difficult to control.

In pregnancy, untreated diabetes increases the risk of fetal death or congenital abnormality. In the absence of treatment, the longevity of a person with diabetes is reduced by one third.
In the absence of any symptoms, screening for type II diabetes is done by determining the level of glucose in the urine. When this level is high, the fasting glucose is determined, then the subject undergoes a glucose tolerance test in which blood glucose is determined after absorption of a large amount of sugar.

TREATMENT

The treatment aims to maintain normal blood glucose. People with diabetes can live a normal life and escape potential long-term complications. In cases where there is little or no insulin production, treatment consists of injecting insulin and following a proper diet. It is necessary to take meals and snacks throughout the day so as not to "drown" insulin and eat foods containing polysaccharides (which increase blood glucose more slowly) rather than simple sugars such as sucrose, fructose and lactose, small molecules quickly available to the body, which rapidly increase blood sugar.

In type II diabetes, where the majority of patients are at least moderately overweight, treatment consists primarily of dieting, weight loss and sports. Weight loss appears to partially decrease tissue resistance to insulin. If the blood glucose level remains high, the treatment may also include insulin injections or the prescription of hypoglycemic or antidiabetic drugs such as biguanides and sulphonylureas to lower the sugar level.

Some diabetic patients are provided with an insulin pump that delivers insulin quantities appropriate to the needs of the body. These pumps allow better control of blood glucose, but sometimes serious complications such as ketoacidosis or infection at the injection site.

COMPLICATIONS

Diabetes is responsible for many complications. Diabetes is responsible for retinopathies and is the leading cause of blindness before age 50. It can cause damage to the arteries (arthériopathie) and nerves (neuropathy) of the lower limbs, because of poor irrigation and podiatry problems. These can be corrected by wearing thermo-molded soles. Some necrosis leads to amputation of toe, foot, or leg.

PREVENTION

Diabetes prevention includes primary prevention to prevent the onset of the disease in healthy subjects, and secondary prevention for diabetics aimed at delaying or preventing the worsening of the disease and its complications.

In all cases, physical activity promotes a stable glycemic equilibrium and prevents cardio-vascular complications. Weight loss in overweight subjects improves blood sugar levels. This makes necessary a low calorie diet with reduced intake of carbohydrates and lipids but rather rich in fiber.