The number of diabetics is growing rapidly. In 1980, there were 153 million diabetics worldwide. Currently, there are already 371 million of them. It is predicted that 550 million diabetics will live on the globe in 2030. Therefore, the rapid spread of this disease was called an epidemic.

Diabetesismetabolic disease , which develops as a result of a lack of insulin - absolute or relative (not enough of this hormone in relation to the needs) . It is insulin that enables cells to use glucose as an energy source. If sugar can't get inside them, it circulates in the blood. This condition is called hyperglycemia. It is a hallmark of diabetes.

Currently, people with diabetes constitute approx. 8% of world population. However, the projected rapid increase in the number of diabetics will not be the same in all parts of our globe. The largest is observed at the time of the civilization leap, which is associated with a change in lifestyle and nutrition, but also with the aging of the society (the peak incidence of type 2 diabetes occurs after the age of 65). The United States and Western Europe are behind them. It is therefore expected that the number of diabetics will increase the fastest in the countries of Asia, South America and Africa.

Diabetes mellitus type I and diabetes mellitus type II

There are two main forms of this disease. Type 1 diabetes mellitus is an autoimmune disease in which the immune system destroys the insulin-producing cells in the pancreas. Type 1 diabetes develops very quickly at a young age (usually before the age of 30). People who suffer from it constitute approx. 10 percent. all diabetics. Their number grows relatively slowly.

On the other hand, the number of people suffering fromdiabetes type 2(they constitute approx. 90 percent of diabetics), which is classified as a civilization disease, is rapidly growing. It is based on overweight and obesity (especially abdominal) and related metabolic disorders. In this form of diabetes, the pancreas produces insulin, but the amount (albeit large) is insufficient for the amount needed because the cells are not very sensitive to its effects (this is called insulin resistance). The disease mainly affects people over 45 years of age. It develops slowly and is asymptomatic for a long time.We can prevent type 2 diabetes because it is favored by an excessively caloric diet rich in simple carbohydrates, highly processed food, and low physical activity. Type 2 diabetes is spreading rapidly in highly developed or rapidly developing countries. It is rare in poor societies. This is evidenced by the fact that in Europe the inhabitants of the Republic of Moldova are the he althiest in this respect - only 2.73 percent suffer from the disease. population. In Poland, diabetics constitute 9.03 percent. and more and more of them.

In 2001, there were 800,000 people under the care of diabetes clinics and primary he alth care doctors (POZ). people with diabetes, but in 2012 this number increased to approx. 2 million (according to the National He alth Fund data, in 2012, prescriptions for diabetes medications were issued for 2 million 100 thousand people).

Important

Diabetes: risk factors

These include, among others: age over 45, overweight or obesity, diabetes in parents or siblings, lack of physical activity, pre-diabetes in a previous study, history of gestational diabetes or having a child weighing more than 4 kg, hypertension, hyperlipidemia.

Diabetes - an interdisciplinary disease

Diabetes is a disease that is treated not only by diabetologists, but also by doctors of other speci alties: ophthalmologists, cardiologists, vascular surgeons, and nephrologists. It causes changes in small and large blood vessels, resulting in diseases of various organs. Complications of diabetes include: retinopathy (damages the retina), nephropathy (leads to kidney failure), neuropathy (nerve damage), coronary heart disease, heart attack, stroke, diabetic foot.

The most common complications are related to the cardiovascular system. They are responsible for 2/3 of deaths related to diabetes. In the world, someone dies every 6 seconds because of the complications of this disease. Therefore, it is extremely important to diagnose it early and treat it effectively. Type 1 diabetes is quickly detected due to the sudden onset of disturbing symptoms (e.g. excessive thirst, frequent urination, weight loss).

On the other hand, type 2 diabetes does not signal its presence for a long time, and because we test ourselves too rarely, it is sometimes diagnosed at an advanced stage. In extreme cases, a diabetic learns about it at the time of a heart attack or stroke. It is often diagnosed early, incl. thanks to periodic examinations at work. However, not everyone is covered by them, so people exposed to it should be screened.

Important

Pre-diabetes

It is a state of decreased ability of the body to metabolize glucose and is an announcementtype 2 diabetes (it should be emphasized that this term has not been accepted by the World He alth Organization (WHO)). Since pre-diabetes is not a full-blown disease, it is sometimes neglected by patients and sometimes by doctors. Currently, it is treated as a major he alth risk and both non-pharmacological (lifestyle change) and pharmacological treatment (in Poland, it is the administration of metformin, which has been reimbursed by the National He alth Fund for pre-diabetes since last year) is implemented. This type of therapy reduces the risk of conversion of prediabetes to type 2 diabetes, although American and British researchers in a work published in the British Medical Journal question the sense of medicating pre-diabetes. In their opinion, changing the lifestyle is sufficient.

Diabetes treatment - diet, exercise and new medications

Treating type 2 diabetes, the biggest problem today, begins with lifestyle changes. It is necessary to limit the caloric content of meals and to properly compose them in terms of carbohydrates, and to increase physical activity in order to reduce body weight. Because with each loss of kilogram, the level of sugar in the blood decreases. Such actions are often insufficient, because it is not easy to lose weight, therefore oral hypoglycaemic drugs with a different mechanism of action are included in the therapy. For example, they increase the sensitivity of tissues to insulin, stimulate the pancreas to produce this hormone, and limit the absorption of glucose from food in the intestines. Insulin is introduced into pharmacological treatment only when lifestyle changes and oral specifics have no effect.

However, after starting therapy with this hormone, it becomes almost impossible to lose weight, because it stimulates the appetite and increases the risk of hypoglycaemia if the patient eats too little. The time of insulin administration, however, can be delayed thanks to incretin drugs, which not only lower sugar levels, but also cause weight loss (therefore some of them are tested as slimming preparations).

Important

Test Your Glucose

Do this every 3 years if the previous result was correct. Before the age of 45, do the test when you are at increased risk of developing diabetes, and after the age of 45 - also when you are not one of them. The correct result is 70-99 mg / dl (3.3-5.5 mmol / l). However, the result of 100-125 mg / dl (5.6-6.9 mmol / l) indicates pre-diabetes, and values ​​≥ 126 mg / dl (7 mmol / l) diabetes.

One group of specifics are agonists of the GLP-1 receptor. They act as the natural hormone GLP-1, produced in the gut, which increases insulin secretion by the pancreas and suppresses the appetite at the same time.They are given by injection. The second group consists of oral drugs that inhibit the secretion of the DPP-4 enzyme, which breaks down the natural GLP-1 hormone, which increases the concentration of the latter in the blood (and its effect). They are weaker than GLP-1 receptor agonists, but they also lower blood sugar and body weight. Both types of pharmaceuticals are available in Polish pharmacies, but the National He alth Fund does not refund them. They are expensive, so few patients can fill the prescription.

Diabetologists have one more group of new pharmaceuticals at their disposal. They increase the excretion of sugar in the urine. They are useful, for example, in patients who, despite the use of other drugs, including insulin, still have uncontrolled diabetes. They can also postpone the start of insulin treatment.

Increasingly better insulin

For people with type 1 diabetes, insulin is the main drug because their pancreas does not make it at all. The patient may be treated with human insulins or with insulin analogues obtained synthetically. The latter, due to modifications in the molecule, can act for a very short or very long time, which improves the quality of life of diabetics and allows better control of diabetes. Fast-acting analogs can be given just before, during or after a meal because they take 10-20 minutes to work. They mimic the pancreas 'ejection' of insulin when you eat it. Long-acting, for which reimbursement has long been fought by diabetologists, they mimic the natural slight secretion of insulin by the pancreas around the clock. Until recently, the available analogues had the longest effect for 24 hours, but another insulin appeared (degludec), which will be absorbed from the subcutaneous tissue for even longer.

Pharmaceutical companies do not spare money for research into new drugs. Work is underway on the so-called smart insulins that will only be activated after an injection when there is excess sugar in the blood. If its concentration is correct, the molecules of this insulin will not work.

Compensated diabetes

This is the goal of the therapy for this disease. The term means that the value of the so-called glycosylated hemoglobin (HbA1c) remains below 7%. (in pregnant women, patients with newly diagnosed diabetes and type 1 diabetes, it should be lower, in the elderly, the sick it may be higher). In a he althy person, the value of this parameter is between 4 and 5.6%. It reflects the average blood glucose level over the past few months.

Dangerous hypoglycemia

The goal of treating diabetes is not only to avoid hyperglycaemia and thus lower blood glucose to a normal level, but also to avoid hypoglycaemia (hypoglycaemia). It is recognized by valueless than 55 mg / dL (3.0 mmol / L). Severe hypoglycaemia causes the death of nerve cells in the brain that cannot function without glucose, and can be fatal. People treated with insulin are mainly at risk of hypoglycaemia.

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Diabetes