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Diabetes: a chronic disease with serious consequences

Diabetes, or diabetes mellitus, currently affects 200 million people and is the 5th cause of death throughout the world. This chronic disease, in constant increase, is characterized by an excess of glucose in the blood (hyperglycemia), which causes abundant urination and intense thirst. A distinction is made between type 1 and type 2 diabetes, which do not have the same cause, but can result in the same complications. These result from attacks on the blood vessels caused by the excess sugar: infarction, cerebrovascular accident, ulcer, gangrene, diabetic retinopathy, kidney failure, sensory problems, etc.

The normal regulation of glycemia

Glycemia is the level of glucose in the blood. It is primarily regulated by two hormones produced by the pancreas, insulin and glucagon. These two hormones have antagonist effects: insulin lowers glycemia by promoting the use and the storage of glucose, while the glucagon causes its release into the blood by the liver.The blood glucose level, which is normally approximately 5 millimoles per liter (or 1 gram per liter), may be measured by blood analysis.

Normal regulation of glycemia

Hyperglycemia and hyperglycemia

Hyperglycemia is an increase in the blood glucose level, considered pathological beyond 7 mmol/l or 1.2 g/l. Significant and sustained hyperglycemia causes fatigue, increased appetite, and intense thirst. It is treated by an adapted diet, by hypoglycemic drugs, or by insulin injection. Hypoglycemia is a reduction in the blood glucose level (less than 3.5 mmol/l or 0.6 g/l), capable of causing a loss of consciousness. In diabetics, hypoglycemia can occur following an overdose of insulin, in case of hypoglycemic treatment, after a physical activity, or an insufficient meal. It is then treated through the administration of sugar.

Type 1 diabetes

Type 1, or insulin-dependent diabetes, is an autoimmune disease that causes the destruction of the pancreatic cells producing the insulin, resulting in hyperglycemia. It accounts for 10% of cases of diabetes and generally appears before the age of 20, most often around the age of 12. Since the pancreas is unable to produce insulin in a quantity sufficient to prevent hyperglycemia, the treatment of type 1 diabetes requires the regular administration of insulin. It also requires an adapted diet and frequent self-testing of glycemia by capillary sampling. Left untreated, the disease can result in a coma, or even death. At the onset of the disease, the patient often does not feel any symptoms. When glycemia reaches very high values, the body tries to eliminate the excess glucose by increasing the frequency and abundance of urination, and by producing urine with a high sugar content. Dehydration follows, which causes intense thirst. Appetite increases, but this generally does not prevent weight loss. Type 1 diabetes also causes fatigue and headaches, and may promote repeated infections.

Type 2 diabetes

Type 2, or non-insulin-dependent diabetes, is a chronic disease characterized by the resistance of the body's cells to the action of the insulin produced by the pancreas. The cells assimilate glucose poorly and it accumulates in the blood (hyperglycemia). As a result, the pancreas provides more and more insulin to lower glycemia, without effect. It becomes progressively exhausted, resulting in a decrease in insulin production that must be compensated for through injections. Type 2 diabetes is connected with aging, obesity, a sedentary lifestyle, as well as genetic factors that are poorly understood. It is increasing in industrialized countries and generally appears around age 50, but it is more and more common in younger people. It may remain asymptomatic for several years before revealing itself through a complication. Its treatment is based on reducing sugar and fats in the diet, increasing physical activity, and the administration of hypoglycemic drugs or insulin.

Gestational diabetes

Gestational diabetes, or pregnancy diabetes, is an intolerance to glucose that occurs during pregnancy, generally during the 6th month. It may cause premature childbirth, as well as complications for the fetus (excess weight, heart malformation) and for the pregnant woman (gravidic hypertension). It generally disappears after childbirth. Women having suffered from gestational diabetes present an elevated risk for developing type 2 diabetes later. Many injection areas are possible and must be chosen on an alternating basis in the same day. Within the same area, each injection must be 1.2 inches (3 cm) away from the previous one.

Insulin injection

Insulin injections are given from one to four times per day according to the individuals, by means of a single-use syringe, or with a reloadable insulin pen. They may also be given automatically and continuously using an insulin pump, a device worn at the waist and equipped with a catheter fixed under the skin. Insulin injections must be given in the subcutaneous tissue (hypodermis). An intra-muscular injection would cause the insulin to act too quickly, risking hypoglycemia, while too superficial an injection would cause the insulin to act too slowly, resulting in hyperglycemia.

Living with diabetes

If you have diabetes, you must take a number of daily precautions in order to prevent the complications connected with the disease. The main recommendations consist in properly controlling your glycemia and adopting a healthy lifestyle.

  • Scrupulously follow your treatments

    Regularly monitor your glycemia and respect your medication by adapting it to different situations: sports, travel, diet, etc.

  • Adopt a healthy diet

    Have your meals and snacks at regular hours and maintain a healthy weight by eating in a balanced and diversified manner. Give preference to foods rich in fiber (vegetables, whole grains, legumes) and foods low in fats, salt and sugar.

  • Engage in a regular physical activity

    By engaging in a physical activity, particularly an endurance activity, you will be able to better control your glycemia. It is important, however, to pay particular attention to your feet by wearing the appropriate shoes. Also make sure to eat enough before and after the sport, to adapt your glycemic monitoring and your injections, and to have sugar on hand to counter hypoglycemia.

  • Adopt proper oral hygiene

    Diabetes promotes the production of dental plaque and thus the destruction of the support tissues of the teeth (periodontitis), specifically when glycemia is poorly controlled. In addition, a dental infection may, in turn, interfere with the regulation of glycemia. It is therefore important that you adopt good oral hygiene, in addition to controlling your glycemia.

  • Take care of your feet

    Diabetes promotes the development of ulcers. Clean and moisturize your feet regularly. Pumice callouses, file your nails. Avoid walking with bare feet. Wear clean and dry socks as well as comfortable shoes, being careful that they do not contain any harmful object (pebbles, twigs, etc.). Examine your feet daily and meticulously. In case of a minor lesion, wash, bandage and monitor it. If there is an infection (redness, swelling, presence of pus) or in case of a more serious injury, consult a doctor immediately.

  • Plan ahead when traveling

    Travel only if your diabetes is under control and if you are not suffering from any disabling complication. Prepare for your trip carefully, specifically by consulting your doctor and informing yourself about the health conditions and medical resources in your destination country. Be vigilant about your treatment, your diet, etc.

  • Have eye, blood and urine tests annually and monitor your blood pressure

    Regular tests permit the immediate treatment of any damage.

  • Limit your alcohol consumption to one glass per day, at meal time.

  • Stop smoking

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