Diabetes is generally defined as the presence of high levels of sugar in blood. However, this is just a symptom that indicates a high probability of having diabetes, while the real cause is due to low or null levels of the hormone insulin. Normal glycemic levels (glucose in blood) should oscillate in 80-100 mg/dL. There are several types of diabetes, and knowing which type an individual suffers is vital for a proper treatment. The most common forms are type 1 and type 2 diabetes. Type 1 diabetes, also called autoimmune diabetes, is a disorder where the immune system selectively destroys the cells responsible for the production of insulin. This hormone controls glycemia levels as well as important nutrient metabolism routes such as the processing of fats and proteins. The individuals affected with this disease have almost no insulin production. Onset generally occurs in young children and comprises approximately 10% of the total cases of diabetes in the world. On the other hand, type 2 diabetes generally appears in the elderly and is very difficult to define, since it is usually accompanied by other pathologies such as obesity, hyperlipidemias, hypercholesterolemia and cardiovascular alterations. There is a certain genetic predisposition to present this disease, although the main causes are defects in the diet and an unhealthy lifestyle. This means that if the disease is detected early, it is possible to halt or prevent its progression, by adopting healthy habits such as a proper diet and more physical activity. Patients with type 2 diabetes generally consume excess amounts of fat and cholesterol, and have a sedentary lifestyle. This type of diabetes is characterized by a dysfunction at the cellular level, resulting in an inadequate production of insulin. In its early stages, known as insulin resistance, hormone production is excessive. At this moment it is possible to treat the disorder with a high level of success, with the help of sanitary professionals. For insulin to exert its effect, muscle and adipose tissues have receptors where the hormone binds to. This binding helps glucose to enter the tissues, as well as other nutrients, activating its metabolism. Insulin resistance is when the tissues are not capable of recognizing the hormone, what is known as a “lack of dialogue” between the tissues and the hormone. This mainly affects glucose, which remains in the blood at high levels. Type 2 diabetes can progress and ultimately affect the insulin-producing cells, located in the pancreas. At the end, these cells die, resulting in decreased insulin production, becoming similar to that observed in type 1 diabetes. In this later stage, type 2 diabetic patients must inject insulin into their organism.
Diabetes is one of the most prevalent diseases in our industrialized society, along with obesity, cardiovascular disease and neoplasic processes (cancer). Currently in Spain there are approximately 2 million people with diabetes. However, this number is probably much higher considering that many people are unaware of having diabetes, or are in the pre-diabetic processes and have not been diagnosed. The number of affected individuals around the world is alarming. There are currently 180 million people with diabetes, increasing in such a manner that in a decade (2025) this number could reach 300 million. Therefore, this is a disease that continues expanding around the world at an alarming rate, with its subsequent enormous social and sanitary cost. Fortunately, compared to other diseases, diabetes can be controlled and the individuals live an almost-normal lifestyle, if properly detected and adopting certain habits. Furthermore, in the case of pre-diabetes type 2 (the insulin resistance stage), it is even possible to revert the disease. However, once the disorder progresses to type 2 diabetes, this is irreversible and the individual must learn how to control it. Unlike other diseases, the patient can regulate the disease and must make adequate choices on a daily basis, with the support and advice of sanitary professionals. Therefore, diabetes education is essential, and there are many manuals and associations where the patient can obtain the necessary formation and instruction. This is crucial, as an inadequately-controlled diabetes can become one of the most serious metabolic alterations that an individual can suffer, with many secondary pathologies that, once they have appeared, are very difficult to treat.
Pathologies associated with diabetes
- Retinopathy: alteration of the microcirculation in the eye due to high levels of sugar in the blood and/or sustained hypertension, causing damage to the retina. This disease can progress towards blindness if not detected on time, therefore it is very important for diabetic patients to check their eyesight regularly.
- Nephropathy: affects the nephrons (structural units in the kidneys that filters the blood, eliminating residues from the organism and controlling liquid balance). This pathology is very frequent in type 1 and 2 diabetes, and is accompanied by hypertension. The damage can cause kidney failure, which can be either acute or chronic depending on the severity and time.
- Neuropathy: a high level of glucose in blood can damage peripheral nerves. The most commonly affected nerves are those found in the feet, causing tingling, heat or deep pain, as well as ulcerations. It is very important for a diabetic patient that presents these symptoms to go to a medical specialist.
- Cardiopathy: High glucose and/or triglyceride levels in blood, as well as arterial hypertension (all related to type 2 diabetes) can cause cardiovascular damage. These include high cardiac frequency (tachycardia) that increases the risk for heart attacks or failure (unbalance between the ability of the heart to pump blood and the body´s needs).
Knowing all this, and as many studies related to sanitary and social interventions such as the DPP (Diabetes Prevention Program) have shown, the quality of life of diabetic patients and their families depends on the control both by the patients as well as a group of multidisciplinary sanitary specialists. The latter includes doctors, sanitary personnel, pharmacists, psychologists, nutritionists, educators, physical therapists, researchers, politicians, etc. It is necessary to overtake all fronts in order to stop the frenetic advancement of this epidemic, which has such an enormous impact on society.