The records on diabetes are old, but it was around the 2nd century AD that the pathology was called diabetes.
The term refers to “passing through a siphon”. That’s because, at the time, the most common symptom in patients was excess urine (polyuria), which was compared to the passage of water through a siphon.
A few years later, a series of events and research led scholars to note that, in addition to the increased urinary volume, some patients had sweet urine, showing that they eliminated sugar through the urine.
It was only in 1769 that the two clinical conditions in which there was an excess of urine production were named: Diabetes Insipidus and Diabetes Mellitus. The term “Mellitus” means honey in Latin, making reference to the sweetness of the urine. “Insipidus”, on the other hand, characterizes clear urine with no sweet taste, like water.
There are currently several types of diabetes. The most frequent can be identified in the ICD-10 under the codes:
- E10 : Insulin-dependent diabetes mellitus;
- E11 : Non-insulin-dependent diabetes mellitus;
- E13 : Other specified types of diabetes mellitus;
- E23.2 : Diabetes tasteless;
- O24 : Diabetes mellitus in pregnancy.
How does the pancreas regulate blood glucose
The pancreas is an organ located in the abdominal region, which is approximately 15cm to 25cm.
This organ is responsible for producing enzymes that participate in the digestion of fats, proteins and carbohydrates (exocrine function), in addition to secreting hormones that regulate blood sugar (endocrine function).
It is by hormonal secretion that the organ regulates blood sugar and, therefore, is directly related to diabetes.
Every time we eat, the digestive system activates a number of cellular functions and mechanisms to digest food, take advantage of nutrients and, of course, maintain the body’s balance.
Among the nutrients that make up food is carbohydrate.
Generally feared in diets, he gained a reputation for being responsible for weight gain and for causing health problems, but we must remember that this only occurs when it is consumed in excessive amounts.
Today we know that the choice of the type of carbohydrate that is consumed (poor or rich in fiber and other nutrients) makes all the difference.
An important source of energy, carbohydrate is essential for maintaining body functions – whether it be the heartbeat, concentration during a game of chess or the explosion required for a hurdle race.
Some foods are low in carbohydrates, others are high in carbohydrates. But, regardless of the quantity, the healthy pancreas is capable of dealing with everyone.
This is because when food starts to be digested, the pancreas is signaled and responds by secreting insulin, a regulatory hormone that facilitates the entry of glucose into cells, allowing it to be stored or transformed into energy.
But the pancreas is not only responsible for the release of insulin. There is also another hormone called glucagon.
When the body goes many hours without receiving food or needs to spend a lot of energy for intense physical activity, for example, glucose stores start to be consumed, maintaining the body’s functioning.
As an alert, the pancreas produces and releases glucagon, which works by transforming stocks (glycogen) into glucose, which is released to supply the needs of the moment.
People with diabetes usually have flaws in the production, secretion and / or action of glycemic regulating hormones.
As a result, they may experience hyperglycemia, which is an increase in blood sugar, or hypoglycemia, which is a drop in blood glucose levels.
The discovery of insulin
In 1889 doctors and researchers already knew that patients diagnosed with Diabetes Mellitus, or excess blood sugar, had a disorder in the pancreas. Therefore, they believed that it would be in this body that the solution would be found.
The problem is that until the 1921 years, treatment for diabetes was ineffective and resulted only in an extension of the patients’ suffering.
At the time, patients diagnosed with diabetes were told to follow an extremely strict diet. Because, until then, it was the only available resource to try to avoid blood sugar spikes and the consequent ketoacidosis (increased concentration of ketones that make blood acidic).
However, despite preventing the patient from entering a diabetic coma for some time, the diet, in addition to not being very effective in keeping blood glucose regulated, made the patient suffer from malnutrition until death.
It was only in 1921 that Canadian doctor Frederick Banting and medical student Charles Best were able to isolate the hormone insulin through studies in a dog’s pancreas.
From there, the substance started to be synthesized on a large scale. The team of researchers received the Nobel Prize.
What types of diabetes?
Diabetes Mellitus can be subdivided into some types, the most common of which are type 1 and type 2 diabetes. Type 2 diabetes is the most common form of the disease worldwide.
According to the Brazilian Diabetes Society, there is also Adult Latent Autoimmune diabetes (LADA), a less frequent condition, in addition to gestational diabetes, which implies a greater risk of developing diabetes over the years, both for the mother and the baby. .
Learn more about each type:
Diabetes Mellitus
Diabetes Mellitus is characterized by dysfunction in the production and / or action of insulin – a hormone secreted by the pancreas that regulates blood sugar (glycemia).
Metabolic dysfunction means that after the patient ingests food, the body is unable to properly metabolize glucose, leading to increased blood sugar levels.
People with undiagnosed diabetes have high blood sugar.
In the long term, this alteration can affect several organs by impairing circulation and damaging the nerves, which can lead to irreversible damage such as amputations and blindness.
Diabetes can be classified into some types, mainly according to the mechanism that led to the disease. The most common are type 1 and type 2.
Popularly, people call type 1 diabetes infant or juvenile, as it mostly affects children, adolescents and young adults, but it can also occur at older ages.
Type 2, on the other hand, is more common in older patients, and comprises about 90% of all cases diagnosed around the world. Despite these age differences, it is the way in which the disease manifests itself that characterizes each type.
While type 1 diabetes is an autoimmune disease, in which antibodies attack cells of the pancreas itself, impairing insulin production, type 2 is due to defects in the action and / or insufficient production of insulin, a hormone that regulates blood glucose levels.
Type 2 diabetes is commonly associated with obesity, physical inactivity and poor diet. So the story that eating too much candy causes diabetes is not quite like that.
Gestational diabetes
Between 2% and 4% of pregnant women suffer from gestational diabetes, which can be a temporary condition.
However, after delivery, these women should be monitored, as they are at greater risk of progressing to type 2 diabetes over time.
Diabetes can occur during pregnancy due to major changes in the woman’s body, which can result in loss of metabolic balance.
The placenta can release hormones that reduce the action of insulin, causing the pancreas to increase insulin production and release.
Some pregnant women may not have this mechanism as effective, causing the elevation of the glycemic rate to occur.
Although it does not always show signs and symptoms, especially in milder cases, gestational diabetes can increase the risk of maternal and fetal complications.
Therefore, all pregnant women are instructed to maintain a routine of exams, such as the glycemic curve, when performing prenatal care.
Read more: Pregnancy symptoms may arise before menstrual delay
Excessive weight gain during pregnancy, family history of diabetes (of any type), previous pregnancies with glycemic changes, hypertension, overweight or obesity, and polycystic ovary syndrome, are some of the conditions that can favor the onset of the condition.
Type 1 Diabetes
Type 1 diabetes is an autoimmune disease. For reasons not yet fully understood, the body causes antibodies to attack healthy cells in the body.
With the destruction of cells in the pancreas, insulin production is affected, causing secretion of the hormone to be insufficient or completely absent.
This type is usually called childhood or juvenile diabetes, but it is important to remember that although it manifests itself predominantly in childhood, it can also occur in adulthood or in old age.
The destruction of pancreatic cells, when it becomes clinically evident, evolves rapidly, causing symptoms to be aggressive.
Type 1 diabetes accounts for about 5% to 10% of all cases of diabetes, being treated with daily insulin applications.
But diet, physical activity and health care in general is also a fundamental part of treatment.
Type 2 diabetes
Type 2 is the most frequent, affecting about 90% of patients with diabetes. It stems from conditions in which the body is unable to produce enough insulin or is unable to properly use the released hormone.
It is more frequent in adults, but it can be present in children, especially in those with obesity, because – unlike type 1 – type 2 has a great relationship with lifestyle and eating habits.
Most patients suffering from type 2 are obese or overweight.
Although it is not so frequent, the patient may need insulin applications. In general, treatment is initially done with oral medications, diet, physical activity and other behavioral care.
LADA
In LADA type diabetes, or Adult Autoimmune Latent, an autoimmune change similar to type 1 occurs, in which the body attacks its own insulin-producing cells.
However, the evolution is slowly progressive. Thus, under less attentive eyes, it can be confused with type 2 diabetes.
Other types of Diabetes
There are other types of diabetes that are far less common.
These cases are associated with genetic defects, the use of drugs capable of affecting the normal glycemic cycle, problems in the pancreas or endocrinopathies (diseases that affect the endocrine system).
Diabetes insipidus
A rare type of diabetes that, despite the same name, carries an important difference: there is no need to worry about blood glucose levels! Despite this, the condition is serious and needs treatment.
The main characteristic of diabetes insipidus is polyuria, that is, the excessive release of urine, in addition to excessive thirst. The patient has a clear urine, similar to water.
The condition is caused by a change in the functioning or production of the antidiuretic hormone (ADH) , also called vasopressin.
It works by controlling the amount of water in the body, through the renal control of urine.
ADH also acts by signaling that the body needs to be hydrated. Therefore, when water is lacking, it sends signals to the kidneys to reduce the elimination of urine, and stimulates the feeling of thirst.
If there is too much water in the body, the secretion of the hormone is reduced, causing the body to produce and eliminate more urine.
When there are changes in the production or action of ADH, the body misses its effects, at risk of dehydration.
These dysfunctions are known as diabetes insipidus, which can present themselves in different forms, such as central DI (origin in the central nervous system) or nephrogenic (renal origin).
In this case, there is ADH circulating, but the kidneys do not respond properly.
Treatment is done with specific supplementation. But, unlike Diabetes Mellitus, it does not need insulin and the patient does not have significant glycemic changes.
What is prediabetes?
The diagnosis of pre-diabetes is a warning sign. It is as if the body has a mechanism to warn that things are not going well, but there is still time to reverse.
The condition works as an indication that the body is not able to correctly balance blood glucose levels , but the lack of control is still not enough to characterize type 2 diabetes.
It is worth mentioning that type 1 diabetes does not have this intermediary system of the disease.
With the diagnosis, the patient needs to take care of the food, invest in physical activities and take care of the emotional.
Each year, about 3.5 to 7% of patients who have the problem become diabetic (35 to 70% risk in 10 years). The more risk factors for developing diabetes and the more abnormal the tests, the greater the risk.
However, for many of these people at risk, a 5% to 10% weight reduction, associated with regular physical exercise, would be enough for insulin to be sufficient again.
What is insulin dependent diabetes?
Insulin is the hormone that is missing or is not acting properly in the patient with diabetes.
Unlike type 1, which is always treated with applications of the hormone, most of those diagnosed with type 2 of the disease are able to perform glycemic control with diet, physical activities and oral medications, which are called antidiabetics.
Even so, most of the patients need to resort to injectable medications or insulin with the progression of the disease, which is progressive.
Therefore, regardless of the type of diabetes, if the condition requires the use of insulin, the condition is considered insulin dependent.
What causes diabetes?
The causes of diabetes depend on the etiology of the disease, that is, the type. Among the main ones are:
Autoimmune condition
Type 1 diabetes is an autoimmune disease, in which the immune system changes and attacks healthy cells in the body. In that case, the pancreas is affected.
Type 1 diabetes patients are more likely to develop autoimmune diseases, which are seen more frequently in patients with type 1 diabetes as well as in their closest relatives.
Celiac disease, hypothyroidism, hyperthyroidism, Addison’s disease (adrenal insufficiency) and pernicious anemia are some of the most prominent associated diseases.
For example, one in 20 patients with type 1 diabetes has celiac disease, the majority of whom are asymptomatic.
But it is not known for sure what determines the predisposition. However, it is known that people who already have conditions in the family or who have other autoimmune diseases are more susceptible to type 1 diabetes.
Insulin resistance
Conditions that make the body more resistant to the action of insulin may be the cause of type 2 diabetes.
In these cases, the body produces the hormone in increased amounts in an attempt to overcome the difficulty of insulin exerting its action.
Obesity and a sedentary lifestyle are strongly associated with the condition.
Gestation
Gestational diabetes mellitus is defined when glucose intolerance is first recognized during pregnancy. In most cases the disorder starts in the third trimester.
Amid the various changes and alterations in the body, there is a decrease in glucose tolerance, causing the mother’s body to need to produce more insulin.
However, there is not always a sufficient increase in production, causing the metabolic disorder to manifest.
The condition affects about 8 to 9% of all pregnancies, although the rates may double in women at high risk for type 2 diabetes.
It is important to remember that 6 weeks after the end of the pregnancy, the woman must be reassessed to determine whether there was normalization of the condition or persistence of the metabolic disorder, with a possible diagnosis of pre-diabetes or even diabetes.
Other causes
There are also special cases that can cause diabetes, such as:
- Genetic changes interfering with the production or action of insulin;
- Endocrine diseases (endocrinopathies);
- Infections;
- Genetic syndromes;
- Severe diseases of the exocrine pancreas (pancreatitis, trauma or carcinoma);
- Effect of substances or drugs.
Risk factors
Risk factors are associated with types of diabetes. Between them:
Genetics
Genetics play a big role in type 1 diabetes.
Several genes strongly influence the development of the disease, however, although genes may predispose to type 1 diabetes, environmental factors also play a significant role in its pathogenesis.
Having close relatives with the disease or having other autoimmune diseases increases the chances of diabetes.
But genetics is also related to type 2 of the disease. Having a close relative diagnosed, such as parents or siblings, increases the risks.
Diagnosis of pre-diabetes
Pre-diabetes is any condition that does not fit either normal blood glucose levels or high levels (diabetes).
Pre diabetes is considered a risk factor for the development of diabetes, however, if it receives due attention, the condition can be reversed.
High cholesterol or triglycerides, high blood pressure, physical inactivity and a history of heart problems may also be associated with pre-diabetes.
The more associated risk factors, the greater the chance of becoming diabetes or having long-term complications.
Overweight or obesity
Weight is closely related to glycemic changes, and a high percentage of body fat, especially in a central location (abdomen and trunk), results in greater resistance to the action of insulin.
Therefore, in addition to observing body weight, it is important to check if there is an accumulation of the most harmful fat: the one around the waist.
Read more: Thinness and obesity: genetic factors are to blame for this
It is not exactly the pnequinho, the one we manage to tighten, but visceral fat, which is between the organs.
For this reason, even thin people, but who have a high waist circumference (men over 102cm and women over 88cm) are in the risk group.
Women who gain a lot of weight during pregnancy or who start pregnancy already overweight are also at increased risk of developing gestational diabetes.
Sedentary lifestyle
The lack of physical activities is related to diabetes, especially if it is associated with poor eating habits, overweight and other changes in the body, such as hypertension.
Age
Type 2 diabetes is more likely to manifest with aging. From the age of 45, the body may naturally become more resistant to insulin.
Gestational diabetes also has a higher incidence with age, that is, women who become pregnant in old age have a higher risk of developing the condition.
Diseases or conditions associated with diabetes
Among the conditions that can favor diabetes are:
- Low HDL-c or high triglycerides;
- Arterial hypertension;
- Coronary disease;
- Gestational diabetes;
- Polycystic ovary syndrome.
Gestational diabetes
Pregnant women who have suffered from gestational diabetes should maintain endocrine monitoring after childbirth by assessing glycemic rates, as there may be greater risks of developing type 2 diabetes in the future.
Use of medicines
Some medications can affect glucose metabolism, among them are corticosteroids, thiazides and beta-blockers.
What are the symptoms of diabetes?
In type 1 diabetes, symptoms usually manifest more quickly and more aggressively, causing marked weight loss, severe malaise and excessive thirst.
In type 2, even before the diagnosis, some signs may indicate insulin resistance.
An example is acanthosis nigricans, which makes the skin darker in regions such as the neck, armpits and groin.
As for general symptoms, they are similar, but as some patients still continue to produce insulin, even if in an insufficient way, they tend to be milder.
There are also other types, such as gestational diabetes or pre-diabetes, in which the patient does not always notice the symptoms, or, when they occur, they can be quite mild.
Among the most common manifestations of uncontrolled diabetes are:
Weight loss
When food is digested and sugar falls into the bloodstream, it is the role of insulin to take it into cells to be used for energy.
However, in the absence of the hormone, glucose is free in the blood causing hyperglycemia. If it is not possible to obtain energy through glucose, the body must resort to other ways of maintaining its functions.
At that moment, the use of fat sources begins, which generates an abnormal burning of stocks.
This change in metabolism, associated with the loss of glucose in the urine, leads to rapid weight loss, even if the patient continues to eat even more than normal.
Exaggerated appetite
The symptoms of diabetes are interrelated. Hunger, for example, is a mechanism that the body uses to warn of a lack of energy.
As there is no glucose entering the cells, the body understands that the lack of energy is due to lack of food.
Thus, hunger is activated and, often, it is foods rich in carbohydrates that arouse the most appetite, creating a vicious cycle.
Read more: Foods rich in carbohydrates: what to eat and what to avoid?
Excess urine ( polyuria)
With the high concentration of glucose circulating in the blood, the kidneys start to produce more urine, because the inadequate components of the blood are eliminated by it, taking more water with them. As there is a high production of urine, dehydration can occur.
Excessive thirst ( polydipsia)
To compensate for the great elimination of fluids and rehydrate the organism, the patient feels excessive thirst.
It is not difficult to notice the change in water intake, because even someone who rarely drank a bottle of water a day starts to drink a few liters of water. And yet, the thirst does not pass.
Tiredness and drowsiness
The body needs energy for all activities, ranging from walking to maintaining the body’s functions.
As the cells are unable to produce energy due to the lack of insulin, it is common for tiredness, drowsiness and slowness to manifest.
Bearing in mind that the organism also starts to degrade proteins in order to obtain energy, it is possible that there will also be a decrease in muscular strength and resistance.
The tendency is for the patient to get tired very easily, especially at times when blood glucose is quite high, which can get worse after a meal, for example.
Dry skin
There are several mechanisms involved in the skin changes of the patient with diabetes. In general, it is possible to notice the dryness of the tissue, which is sensitive.
The lack of hydration due to excessive urine, associated with other mechanisms, favors the appearance of itching, irritation and flaking of the skin.
Spots on the skin
It is common that, between skin changes, spots or darkened regions appear in the skin folds.
The condition, known as acanthosis nigricans, is often a marker of insulin resistance. Treatment involves lifestyle changes and the management of diabetes.
Tingling and pain
Blood circulation is greatly affected by the high levels of circulating sugar. When the blood vessels in the legs and feet suffer from contraction and stiffness, poor circulation sets in, also affecting the peripheral nerves.
As a consequence, it is common to experience pain, the sensation of heavy legs, cramps and tingling for no apparent reason.
Mood swings and irritability
Changes in mood can be quite intense when blood glucose is not controlled, and this includes sudden changes in a few hours.
For example, a sharp drop in blood glucose can generate a very characteristic irritability.
Another situation is when blood glucose rises a lot after a meal – due to lack of proper treatment – causing tiredness and discouragement.
Smell of acetone
In general, ketone breath is perceived more by people close than by the patient. The condition is more common in cases of decompensated type 1 diabetes, where there are high blood sugar levels for long periods.
In diabetic ketoacidosis, a severe condition of uncontrolled disease, breath is very similar to the odor of acetone, generally perceived when the patient speaks or breathes.
Lesions that do not heal
Noticing small wounds, cuts or even scratches that don’t heal can be a sign of high blood sugar.
With a weakened defense system, even small injuries can take weeks to improve and, in some cases, can act as a gateway to infection.
Other symptoms
In addition to the most characteristic symptoms and signs of diabetes – weight loss, excessive hunger, extreme thirst and excess urine – there are a number of other signs that can indicate pancreas failure.
For example:
- Headache;
- Vomiting;
- Vision change;
- Frequent inflammations.
Hyperglycemia and hypoglycemia
Hyperglycemia and hypoglycemia are terms that refer to high blood sugar and low blood sugar, respectively.
It is important to note that, even when diabetes treatment is started, the patient needs to maintain constant control of blood glucose and medication dosages , especially if insulin is used.
Even so – even with regulated diet, physical activities and medication – episodes of glycemic decompensation can occur.
In general, infections, stress, changes in diet, menstrual cycle, anxiety and other factors can impact control.
The ideal value of blood glucose levels should be individualized according, for example, to the age group and associated clinical problem.
In general, it is recommended that blood glucose be between 70mg / dL and 100mg / dL on an empty stomach, or up to 140mg / dL 2 hours after a meal.
Within this average, the patient feels well. But just skipping one meal or exaggerating another – without proper insulin correction, when necessary – for symptoms to manifest.
Below 70mg / dl, in general, patients already start to have characteristic symptoms, such as:
- Cold sweat;
- Tremors;
- Sensations of fainting;
- Irritability;
- Difficulty concentrating;
- Difficulty speaking;
- Hunger;
- Heat;
- Pallor.
Bearing in mind that, if it is not corrected, the tendency is for blood glucose to continue to fall, which represents risks of seizure and death.
In such cases, one should preferably drink some sweet drink followed by a more complete snack. Or, when available in more severe cases, give the glucagon injection, so that the levels are restored and the symptoms pass.
Hyperglycemia, especially above 180mg / dl, usually manifests classic signs of diabetes, such as:
- Headache;
- Sleep;
- Tiredness;
- Thirst;
- Excessive urine;
- Blurry vision.
In such cases, it is necessary to correct the rates with appropriate medication, according to the type of diabetes and medical advice.
How is the diagnosis made?
The diagnosis of diabetes can be made by the general practitioner or by the endocrinologist .
It is not always simple to raise suspicion of the disease, as many patients have very mild signs and symptoms – and this is one of the reasons why up to half of people with diabetes still do not know they have the disease.
According to the Brazilian Diabetes Society, there are 3 tests used to diagnose the disease. Even if there are no symptoms, the diagnosis is defined by specific changes in the exams.
Fasting blood glucose
Fasting blood glucose consists of a regular blood test that will measure the blood sugar level at the time of collection.
The patient must collect a blood sample, usually with an 8 to 12 hour fast.
For the Brazilian Diabetes Society, values above 126mg / dL confirm the diagnosis of diabetes. If the patient is asymptomatic, the diagnosis must be confirmed with the collection of a second sample.
Glycated hemoglobin (HbA1c)
The test is done by collecting common blood, fasting for at least 8 hours. But, unlike fasting blood glucose, glycated hemoglobin makes a glycemic average over the past few months (between 2 and 3 months).
Hemoglobin is a protein located in red blood cells (blood cells), which binds to glucose.
On average, these blood cells, called red blood cells, live for about 90 days, and in that time, hemoglobin binds to sugar. If there is an increase in blood sugar, there will be an increase in the levels of glycated hemoglobin.
It is important that both fasting blood glucose and glycated hemoglobin be measured, mainly for monitoring the disease, as they are complementary.
To close the diagnosis of diabetes, the result must be equal to or greater than 6.5%. If the test is altered and the patient is asymptomatic, a new collection must be performed for confirmation.
Glycemic curve (TOTG)
Typically, TOTG is requested when blood tests show variations indicating the possibility of diabetes. It is indicated when fasting blood glucose is greater than 99mg / dl, but less than 126mg / dl.
The glycemic curve test consists of fasting blood collection, followed by the ingestion of 75g of liquid glucose.
The test is, in general, simple, but it is mainly the glucose ingestion that makes it more complicated. It is necessary to ingest a small bottle of an extremely sweet liquid on an empty stomach.
After 120 minutes of ingestion (2 hours), the patient needs to perform another blood collection. Therefore, it is necessary that he remains at rest in the laboratory.
The new collection will assess what was the change in glycemia generated by the controlled amount of glucose ingested.
Above 200mg / dL, the result closes the diagnosis of the disease, according to the Brazilian Diabetes Society.
Reference values
The reference values are the same for the diagnosis of any type of diabetes, and it is always recommended to perform the glycemic curve test if the fasting glucose levels are between 99 and 126mg / dl.
Having any examination altered along with a symptomatic condition, the patient is already considered diagnosed . If there are no symptoms, confirmation by repeated tests is required.
According to the Brazilian Diabetes Society, the reference values are:
Fasting blood glucose
- Without diabetes: below 100mg / dL;
- Pre-diabetes or increased risk: between 100mg / dL and 126mg / dL;
- Type 1 or 2 diabetes: above 126mg / dL.
Glycemic curve (or glycemia 2 hours after glucose overload)
- Without diabetes: up to 140mg / dL;
- Pre-diabetes or increased risks: between 140mg / dL and 200mg / dL;
- Type 1 or 2 diabetes: above 200mg / dL.
Glycated hemoglobin
- Without diabetes: below 5.7%;
- Pre-diabetes or increased risks: between 5.7% and 6.5%;
- Type 1 or 2 diabetes: 6.5% or more.
Read more: Why does blood glucose rise after a meal?
Is there a cure?
No . There are several forms of treatment and follow-up, but from a clinical point of view, diabetes cannot be cured.
In general, patients with type 1 will need daily insulin applications for life.
Type 2 is the one that most generates doubts regarding the cure. Some patients are able to stabilize glycemic rates only with diet and exercise, reaching normal values.
In such cases it can be said that the disease is in remission.
However, the disease can reoccur at any time, and therefore, even in these cases, long-term monitoring is essential.
But it is worth mentioning that, even if there is no need to use medications, the condition is not considered cured.
What is the treatment?
Diabetes treatment consists of a series of dietary and behavioral changes. Type 1, predominantly, requires daily insulin, whereas type 2 can, in some cases, be regulated only with strict diet control, at least in the early stages.
The treatment of diabetes is considered multidisciplinary, as it involves monitoring not only by the endocrinologist, but also by the ophthalmologist, cardiologist and nephrologist, as needed. Behavioral changes are critical, including:
Food control
Caring for food should be part of everyone’s life. It is important to know that food control is not a restrictive diet, but to be aware of what is part of the routine.
Every patient who begins treatment for diabetes should be accompanied by nutritionists who will indicate healthier food choices and exchanges.
Many people think that those who have diabetes cannot eat anything sweet anymore. But it is possible to have a diversified diet if it is done in a balanced way.
In addition, there is a lot of salty food that generates glycemic changes greater than that sweetie.
It is important to know what carbohydrates and simple sugars are, but also what proteins and fats are, which directly affect the absorption of sugars.
In general, those simple exchanges are recommended, such as replacing coffee sugar with a sweetener, prefer less sweet foods on a daily basis and opt for whole grains.
Type 2 patients, in general, are advised to plan their diet to reduce weight.
Even though it is not always possible to enter the ideal BMI, the Brazilian Diabetes Society indicates that reducing between 10% and 15% of weight already represents a major change in quality of life and reduces insulin resistance.
For type 1, carbohydrate counting is essential and has been shown to be a very safe and effective method for glycemic control.
In addition to providing better results in insulin adjustment, counting ensures that the patient’s diet can be more pleasurable and varied.
Physical exercises
Activities are fundamental to health in general and are especially important for those who have diabetes.
Exercising helps to maintain weight, glycemic control, blood circulation and is good for the whole body.
It is important that activities are part of the routine and always accompanied by a physical education professional.
In addition, patients who are going to start activities should always be aware of changes in blood glucose, as both during practice and even many hours later, hypoglycemia can occur.
It is also always important to talk to the doctor and find activities that fit the needs of each patient.
Read more: Functional Training (at home, circuit): what is it, benefits, lose weight?
In addition to helping to control blood glucose, activities help to reduce body fat. In general, losing a few pounds in a healthy way decreases insulin resistance (also in type 1, but especially in type 2).
Blood glucose control and measurement
The glucometer is a small, portable and essential device for those who have diabetes, whether type 1 or 2.
This is because it allows the patient to measure blood sugar at any time of the day, facilitating medication control and correction.
Only one drop of blood is needed and the blood glucose value is shown in up to 20 seconds, and there are devices that take only 5.
Usually the doctor requests a schedule of measurements that, especially in type 1, must be done before feeding (to assist in insulin counting), and 2 hours after meals.
By making notes, the doctor is able to assess the need to adjust doses or change medications.
The glucometer is also essential to confirm cases of hypoglycemia or other malaise, which can also be an episode of hyperglycemia.
In addition, there are currently continuous blood glucose meters. They are like small stickers placed on the skin, usually on the arm, and you only need to bring the meter closer to this sensor for the blood glucose value to be measured.
The advantage is to avoid constant finger bites, facilitating control and improving quality of life.
Medicines
Some patients with type 2 diabetes may need to use medications that, most of the time, are oral (tablets). However, type 2 may also, in some cases, require applications of insulin or other injectable medications.
Type 1 patients, on the other hand, are considered insulin dependent, as in these cases, oral medications have no effect and the option to control the disease is only by means of subcutaneous insulin.
Read more: High-tech pill can replace insulin injections
Insulin infusion pump
The insulin infusion pump is an enhancement to injectable insulin. It is just another way to perform the injections, avoiding the constant bites in the patient.
The device is considerably small, but quite effective in controlling and quality of life.
With a size similar to that of a cell phone, the pump is connected to the body and releases microdoses of insulin throughout the day.
As the device is able to deliver the medication constantly, blood glucose changes are reduced, hypoglycemia is reduced, and the bites are also reduced, getting closer to what happens when the pancreas functions normally.
In relation to syringes and application pens, the pump still offers advantages when it comes to releasing doses. While the lowest dose of a pen is 0.5 (half a unit), the pump is capable of releasing 0.1 unit, which is quite effective for optimizing control.
Pen or needle?
Needles and syringes are used for insulin delivery. Over time, new options that facilitate application and storage have reached patients.
Pens are accessories for injecting insulin. They resemble a pen and can be disposable or permanent.
Disposable ones are used until the end of the insulin and then thrown away, as they cannot be reused. The permanent ones work with insulin refills and do not discard the equipment.
The advantage, compared to syringes, is that it is easier to adjust the dosage and load the medicine.
Regardless of the application equipment, it doesn’t take long for the patient to start making their own applications.
This is because insulin is injected into the subcutaneous tissue – located just below the skin and comprises a layer of fat -, which means that it is a superficial application.
The needles are quite thin and there are varying lengths . Therefore, children and very thin people may use shorter needles .
As several applications are made (usually more than 1 per day), it is recommended that the patient change the site and avoid applying it frequently in the same region, as this can lead to lipohypertrophy .
The condition occurs when small nodules form as a result of the accumulation of fat in places of frequent application and can affect the absorption of insulin.
Therefore, it is important to make the so-called rotation application, avoiding repeating the site for a few days.
It is not possible to determine which region hurts less, as the sensitivity depends on the patient, but the application can be made in those fatter parts of the body, such as:
- Abdomen (about 2 to 3 fingers away from the navel);
- Thigh (external side);
- Waist (part close to the hip bone);
- Buttocks (external upper part);
- Arm (upper outer region).
Antidiabetic drugs
Antidiabetics are, according to the Brazilian Diabetes Society, substances that aim to lower blood glucose and keep it at levels considered normal – that is, below 100mg / dL on an empty stomach and up to 140mg / dL after eating.
Oral medications (tablets) can be divided according to the mechanism of action, which are:
Increase insulin secretion
The substances act by stimulating the secretion of insulin by the cells of the pancreas and are, in general, indicated for patients who are not obese, or, in the obese, when blood glucose has not been well controlled with other medications and diet.
In general, the most common are:
- Glibenclamide ;
- Glipizide ;
- Gliclazide ;
- Glimepiride ;
- Repaglinide ;
- Nateglinide .
Alpha-glycosidase inhibitors
The inhibitory drugs d the alpha-glucosidase interfere in the process of digestion of carbohydrates and make this nutrient is absorbed more slowly, which results in better glycemic control.
One of the most common is Acarbose .
Insulin sensitizers
The substances act by decreasing insulin resistance and, therefore, improve its action.
The metformin
it is one of the best known treatments today, being considered quite effective and with good results, reducing the production of glucose in the liver and improving the muscular uptake of glucose.
However, there is caution in the use and contraindication in cases of pregnancy, renal, hepatic, cardiac and pulmonary failure.
The thiazolidinediones , or glitazones, are considered a class of newer antidiabetic drugs. The mechanism of action is by increasing the sensitivity to insulin in muscle and fat, in addition to decreasing the production of glucose in the liver.
SGLT-2 inhibitors, or glyphozins
They act by reducing reabsorption and increasing glucose loss through the kidneys, in addition to other vascular effects. They usually promote associated weight loss.
DPP-4 inhibitors, or glyptins
They favor the action of the hormone GLP-1, which stimulates the release of insulin after meals, reducing blood glucose levels.
Analogs of GLP-1
They mimic the action of the natural hormone, GLP-1. They reduce blood glucose by stimulating the release of insulin when blood glucose levels rise.
Use is injectable, subcutaneous. Weight loss is common in the use of this therapeutic class.
Insulin
There are currently several insulins available for treatment. Normally, they are differentiated by the time of action on the body.
Remembering that, in general, it is quite common for more than one type of insulin to be used daily.
There are so-called human insulins , which are NPH and Regular. Both are produced using recombinant DNA techniques.
These are older substances, but no less effective when compared to new drugs, called insulin analogues .
The differences between them are the duration of action and the risk of hypoglycemia, for example.
Analogues are produced from human insulin, but are modified to have a longer or shorter effect.
Among the options of fast action (effect between 5 and 20 minutes after the application, with action for up to 2 hours) are: Lispro ( Humalog ), Asparte (like Novomix and Novorapid ), Glulisina ( Aprida ).
Among those with slow or prolonged action are Glargina (like Lantus and Basaglar ), Detemir ( Levemir ) and Degludeca ( Trebisa ).
Attention!
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Diabetes in SUS: free treatment
According to Law No. 11,347, in force since 2006, patients with diabetes are entitled to receive, free of charge, through SUS, the drugs and supplies for the treatment .
That is, insulin, needles, lancets, meters (glucometer), test strips are provided, according to the medical indication, to patients.
The list of drugs offered by SUS includes NPH and Regular insulins.
Patients who use other medications, such as Glargine or Asparte, and need treatment assistance, can appeal directly to the Health Department of each state.
To start the process, the prescription, specific exams and copies of documents must be included, according to the doctor’s guidance.
It is worth remembering that it is the patient’s right to have access to adequate medication and to promote a better treatment condition.
All procedures – by SUS or by the State – must be indicated by the responsible body and by the doctor who accompanies the patient.
Living together: tips to control diabetes
With proper treatment and constant medical monitoring, it is possible to have a good quality of life after the diagnosis of diabetes.
Unlike some diseases with timely treatment, diabetes is a daily condition that requires long-term maintenance.
This means that it is not enough to adjust the dose of the medicine and do not forget to take it – be it the pill or the insulin.
The tips for living well with the disease include paying attention to health in general, valuing physical activities, keeping the focus on food, finding ways to cope well with the routine and taking care of mental health.
In addition, doubts are frequent, especially when the diagnosis is recent. Therefore, having professional assistance is essential.
Below, some important doubts are clarified and can help patients to have a more harmonious coexistence with diabetes:
Stay tuned to the nutritional tables
There are a number of foods and products called Diet, which are, in general, reduced in sugars or other nutrients. However, it is more important to look at the packaging and evaluate the benefits of the exchange.
That sweet diet doesn’t always have much less carbohydrate compared to the traditional version. In addition, even with no added sugars, you need to moderate the intake of the product.
In general, the ideal is to reduce the sources of carbohydrates and sugars. Switching from sugar to a sweetener, for example, is an option indicated for most patients.
Load the glucometer and insulin
Yes. No matter how regulated blood glucose is, unforeseen events happen and, every day, the body reacts in a different way.
This means that even keeping the food at the right times and making the right use of medication, episodes of hypo or hyperglycemia can occur.
So, it is necessary to always have the meter close by and the insulins too.
Log in
Notifying relatives, friends and colleagues about diabetes is the safest way so that, in an emergency, the right measures are taken quickly.
It is important that those closest to you know how to act in cases of hyperglycemia or hypoglycemia.
But there are not always people close by. Therefore, carrying ID cards with emergency phones can be a simple and effective measure.
Read more: Tattooing good warns of diseases and hides scars
Young children may wear wristbands, especially during physical activity or in the school environment.
Do physical activities
Choosing a pleasant exercise is essential to help control diabetes.
It doesn’t matter exactly if you are going to ride a bicycle or invest in pilates, the important thing is to move your body.
In addition to being essential for regulating blood glucose levels, activities help to reduce weight (which improves glycemic control) and promote improvements in emotional well-being.
Know the way your body reacts to each activity. For example, weight training, basketball or that dance class can cause different reactions in blood glucose.
This is especially important in insulin-dependent diabetes, where each individual has a variable glycemic response to exercise.
This variability must be taken into account when recommending the type and duration of exercise for each patient.
In the absence of restrictions, patients with type 2 diabetes should be encouraged to do at least two weekly sessions of resistance exercise (weight training), alternating with aerobic exercise on other days, as this will achieve the best results.
Aerobic activities such as running or swimming can cause your blood sugar to drop during class. Therefore, it is sometimes necessary to adjust the doses of the medication and reinforce the diet.
With correct control and constant monitoring, exercises only bring benefits.
Carry a sweetie
There is no time or place for your blood glucose to drop, so having something sweet around is always essential.
The best thing is that, during the glycemic drop, sweet liquids of rapid absorption, such as juices, soda or water with sugar, are ingested.
However, if you can’t always carry a drink, there are glucose sachets sold in pharmacies and supplement stores, which are practical to consume and store.
Reduce stress
Glycemic changes can be closely related to stress and anxiety. Therefore, giving attention to emotional health is fundamental.
Diabetes patients are more likely to suffer from depression and eating disorders, according to the Brazilian Diabetes Society.
Therefore, in addition to thinking about disease control, giving attention to health is also taking care of mental well-being.
Read more: The mental (and physical) benefits of deep breathing
Do not smoke
The tip is for everyone, but staying away from cigarettes is extremely important for those who have diabetes.
It is important to remember that the disease can impair circulation and, with cigarettes, damage to blood vessels is even more severe.
In addition, smoking increases the risk of patients suffering from hypertension, a common condition in patients with type 2 diabetes.
Take care of oral health
Diabetes patients tend to have dental problems more easily. This is because the high rate of blood sugar makes the mouth a place of easy proliferation of bacteria harmful to the tooth structure.
The ideal is, therefore, to maintain adequate hygiene habits and to consult a dentist regularly.
Pay attention to wounds and bruises
Small cuts, wounds and even scratches can be a problem for the patient who does not have well-controlled blood glucose levels.
As blood circulation is impaired in patients with diabetes, healing is slow and any possible entry of bacteria can become an infection.
Therefore, aesthetic treatments that require applications, cuts or shared use of accessories (for example, making cuticles) should always be medically authorized.
It is important to always notify professionals about the condition. You can, for example, take your cuticle accessories. This reduces the risk of infection if there is a minor injury.
Diabetic Diet and Feeding Tips
Being diagnosed with diabetes, whether type 1 or type 2, is not a food sentence. The patient needs to review habits and pay more attention to meals , but that does not mean abandoning all delicious foods.
It is necessary, first of all, to go through a nutritionist who, together with the endocrinologist, will adapt the routine to the needs and well-being of the patient.
In general, there are some tips that can facilitate planning and adapting to treatment, but that are suitable for everyone.
Include natural foods
Preferring the consumption of raw, cooked or grilled foods, and avoiding fried foods ensures that the products retain their nutritional properties and are not added to calories or fats.
Consuming less carbohydrates or investing in whole grains and cereals causes blood glucose levels to change less, whether it is type 1 or type 2 diabetes.
Beware of fruits and juices
Including fruits is important, but you need to be aware of their glycemic level. The ideal is to opt for the consumption of whole fruits, preferably with peel (as it contains a lot of fiber, helping to reduce blood sugar spikes).
Read more: Why should we eat fiber and what is the ideal daily amount
Natural juices are good ways to eat fruit, but you need to pay attention.
For example, 3 oranges or more are needed for a glass of juice. What may seem healthy then becomes a high source of carbohydrates.
As only fruit juice is used, the fibers contained in the bagasse or peel of the fruit are lost, causing the nutritional value to be reduced as well.
In addition, drinks are digested quickly, causing blood glucose to rise immediately.
But for those who like the natural drink, you can consume it in moderation. Some tips may be to include the peels of the fruit and add leaves (such as cabbage), which help to reduce the speed of absorption.
It is also indicated to prefer those fruits with less carbohydrates, such as strawberries and lemon.
Set times to eat
Each person has a dietary rhythm and diabetes treatments seek to make the patient more and more comfortable with the routine of care.
The ideal is not to spend long hours without eating, as the risk of hypoglycemia is reduced and it becomes easier to keep track of the action of insulin.
The most important tip is to respect the feeding times so that the use of medications can be adjusted according to needs.
Count carbohydrates
Among the nutritional notes for diabetes, the carbohydrate count is one of the most relevant and with the best results – both in glycemic control and in food satisfaction.
Counting carbohydrates is very simple and resembles the calorie count, made in weight loss diets, for example.
The best thing is to talk to a nutritionist or diabetes educator so that, together with the patient and the endocrinologist, the patient’s routine is observed and the diet adjusted.
It is worth mentioning that the main aspect of counting is precisely to allow the person to diversify their food, making exchanges or even including an extra sweet on special occasions, without affecting the control of blood glucose.
The patient can consult the food tables, on the back of the packages, consult online food lists or, also, have applications that assist in counting and conversion.
Prognosis
After diagnosis, if the treatment is carried out correctly, the prognosis is good, although there is no cure for the disease.
However, inadequate control of glycemic rates can result in irreversible complications.
In general, cardiovascular disease is the leading cause of death for patients with diabetes.
Research shows that among type 1 patients who were diagnosed before age 15, acute complications from diabetes were the leading cause of death up to age 30.
After 30 years of age, cardiovascular disease is prevalent, although mortality attributable to acute complications is still important in this age group.
Studies point out that a more rigorous control of blood glucose at any stage of the disease, regardless of the time of diagnosis, usually has beneficial effects.
That is, patients who take more care of the treatment have, in the coming years, a lower risk of suffering complications from the disease.
It is important to remember that intensive treatment can bring more risks than benefits, for example, for older patients. Therefore, the objectives of treatment must be assessed on a case-by-case basis.
Other factors associated with type 2 diabetes also deserve attention, since the presence of other risk factors, such as obesity, hypertension and physical inactivity, increases the chances of complications and premature death.
The lack of correct treatment can result in severe damage to the health and integrity of the organism.
Complications
The most common and most associated with loss of quality of life are:
Kidney disease
Poorly controlled diabetes can lead to kidney damage and complications.
These organs are responsible for cleaning the blood, acting as a filter that removes waste from the body and leads it to be eliminated by urine.
However, when blood glucose is poorly controlled, the kidneys end up undergoing significant changes. This overloads them and causes important substances to be eliminated incorrectly, as can be the case with proteins.
When this happens, the initial condition is called microalbuminuria, which can worsen and progress to proteinuria, considered a more advanced stage of the disease.
Without the correct treatment, the kidneys will gradually lose their ability to act, causing blood residues to accumulate, which may lead to the need for hemodialysis.
Dryness and corns
The skin is very affected by diabetes. This is due to damage to microvessels and nerves responsible for skin hydration and oiliness, causing tissue to dry out, facilitating the appearance of cracks and wounds.
The Brazilian Diabetes Society also warns of the ease of the appearance of foot injuries, often without causing pain, which makes them go unnoticed.
In addition to poor healing, small lesions can become ulcers, which are open wounds. In such cases there may be secondary infection and serious complications.
Amputation of limbs
Diabetes is a condition that favors the reduction of blood flow to the feet. Gradually, the lack of attention to treatment, and the progressive evolution of the disease itself, can cause a reduction in sensitivity in the limbs.
Together, these factors favor small injuries or bruises to become wounds that take time to heal.
Cases of intense lack of control, especially if associated with smoking, can lead to the need for amputation of varying length due to injury complications.
Glaucoma
Diabetes sufferers are up to 40% more likely to develop high blood pressure in their eyes, called glaucoma.
The time of diagnosis of diabetes is directly related to the possibility of the disease, which gradually causes a gradual loss of vision due to damage to the optic nerve.
Cataract
Diabetes patients have up to a 60% greater chance of developing cataracts, which are characterized by the alteration of a layer of the eyeball, called the crystalline lens.
The alteration generates a kind of opacity, causing the light to fail to penetrate the ocular structure, which, consequently, impairs vision.
Diabetic retinopathy
The term is used to refer to all conditions and changes that compromise the retina, caused by diabetes. In such cases, capillary vessels (small blood vessels) swell, leak or close completely.
The most common are of the nonproliferative type. Macular edema can be present in all stages of diabetic retinopathy, being the most common cause of vision loss in nonproliferative diabetic retinopathy.
But there is also the proliferative type, which is considered a more advanced degree of retinopathy. In these cases, blood vessels are unable to deliver oxygen to the retina due to complete obstruction.
The body tries to resume oxygenation of the retina through new vessels, but they are fragile and can sometimes rupture.
In that case, vitreous hemorrhage occurs. Scars may appear in the region, causing the vision to be greatly affected and distorted, which can also result in glaucoma.
Diabetic neuropathy
Poorly controlled diabetes can cause serious damage to nerves and circulation, especially in the feet and legs.
According to the Brazilian Diabetes Society, diabetes is the most common cause of peripheral neuropathy, being a highly disabling condition.
When it occurs, the condition can generate continuous pain, altered perception (such as burning, burning or tingling), exaggerated pain to stimuli (for example, when tapping a part of the body or just touching it, intense pain appears).
In addition, the reduction in sensitivity can have another aggravating factor: the difficulty in perceiving injuries.
Thus, the patient may step on a shard of glass or injure his foot without noticing. Due to the difficulty of healing, small injuries can become serious infections.
Diabetic ketoacidosis
Ketoacidosis is a serious condition of glycemic control. Without the correct use of insulin or due to incorrect adjustment of doses, the body cannot properly use glucose for energy.
To try to reverse the situation, the body uses stored fat, converting it into an energy source.
What may at first seem like a good alternative, generates an accumulation of ketone bodies – substances that affect the pH of the blood, leaving it acidic and severely affecting the normal functions of the body.
If not treated on an emergency basis, ketoacidosis can lead to death.
How to prevent?
Type 1 diabetes is an autoimmune condition, which means that, so far, there are no ways to effectively prevent it.
But a healthy routine is the best way to promote more health for the whole body and avoid complications from the disease.
In type 2, these same healthy measures serve as prevention for those who are not yet at risk, or for those who already have pre-diabetes.
Take care of the food
Reducing your intake of processed and processed foods is a good way to improve your diet.
Whenever possible, opt for raw, cooked or grilled fruits and vegetables. Also, avoid using ready-made spices.
Paying attention to meals is a way to bring more health to the whole body, in addition to helping with weight reduction – which can reverse cases of pre-diabetes.
Do activities
Exercising the body, whether in the gym or in the park, improves blood circulation, gives more physical and mental disposition, improves physical conditioning, helps muscles and facilitates weight reduction.
According to the World Health Organization, 20 minutes of light or moderate physical activity per day, or 10 minutes of intense activity, is enough to achieve the ideal exercise goal. And if there is no time, that amount can be distributed throughout the week.
Therefore, anyone who wants to run or take intensive aerobic classes, can invest in 75 minutes (1h15min) per week, but the ideal is to maintain regular sessions of physical activity, within the routine of daily life.
Those who prefer to leave their car or bus aside, can walk for 150 minutes (2h30min) throughout the week.
Take care of mental health
Paying attention to mental and emotional health is fundamental to the well-being and integrity of the body.
Although it may not seem like it, there is a very close relationship between the mind and type 2 diabetes.
Some people may develop inappropriate eating habits when they are anxious or tense, which can result in weight gain and, consequently, increased risks of diabetes.
But paying attention to mental health does not mean, just or necessarily, therapy.
Adopting a lighter routine, doing pleasurable activities, maintaining healthy habits in general and finding relaxing techniques can be options to promote well-being.
Lose weight
Losing between 5% and 10% of your weight is enough to reduce your risk of developing type 2 diabetes.
So what can seem difficult – losing weight – can be a gradual and attainable process. For example, an 80kg woman needs to reduce between 4kg and 8kg to halve the risk of the disease.
So, the best way to take care of your health is to invest in a balanced diet, physical activities and specialized monitoring.
