It is also important to understand the role of the liver in this process. The organ is responsible for storing glucose in the form of glycogen, so that it releases it as the body needs it.
If your glucose level is low (hypoglycemia), the liver will kick in and release more glucose to maintain your normal sugar level. In situations of type 2 diabetes, this process is hampered, causing an excess of glucose in the bloodstream (hyperglycemia).
Understand the difference between type 1 and 2 diabetes
The types of diabetes differ especially in relation to insulin secretion in the body. In the case of type 1 diabetes, an autoimmune disease, the malfunction of the pancreas means that there is no production of insulin. In type 2 diabetes, which represents the vast majority of cases, there is insufficient production and resistance to the hormone.
Risk factors can also interfere with types of diabetes. In type 1, there is a genetic relationship and the diagnosis usually occurs during childhood or adolescence. In type 2, the disease is commonly related to other factors, such as physical inactivity and obesity .
Causes
In people with type 2 diabetes, the body has insufficient levels of insulin produced by the pancreas, in addition to poor assimilation of the hormone by the body’s cells (insulin resistance). This causes glucose levels, or blood sugar, to be elevated.
The various imbalances in the body are due to the fat cells in the muscles and liver not responding correctly to insulin.
The main causes of the disease are related to the patient’s lifestyle, such as poor diet, physical inactivity and smoking. In some cases, the hereditary factor may have an influence.
Epidemiology
Currently, type 2 diabetes accounts for about 90% of diabetes cases worldwide. The disease, previously considered an adult, is increasingly common in young people and children. In Brazil alone, more than 2 million cases are registered every year.
The disease is quite common in countries that have high rates of obesity and populations with less healthy lifestyles. Another contributing factor is age. Adults aged 40 and over are more likely to develop type 2 diabetes, in addition to the fact that the prevalence of the disease increases with advancing age.
Transmission: Is diabetes contagious?
This is a myth that must be clarified: diabetes is not a contagious disease! There is no possibility of contracting the disease through direct or indirect contact with a diabetic. It is important to note, however, that the disease may be a recurrence of genetic inheritance, especially in type 1 cases.
Risk factors
Type 2 diabetes can affect anyone, but certain factors increase the risk of the disease.
Overweight
Obesity and overweight are primary risk factors. The excess of adipose tissue increases the resistance of cells to insulin.
Sedentary lifestyle
In addition to helping with weight control, regular exercise makes cells more sensitive to insulin and uses glucose as an energy source.
Fat distribution
Excess fat located in the abdomen increases the risk of developing the disease.
Family history
The risk is greater if there are cases of type 2 diabetes in first-degree relatives. The chances increase by 75% if both parents have the disease (British Medical Journal).
Age
Adults over 40 are the most affected by type 2 diabetes. This can occur due to physical inactivity, loss of muscle mass and weight gain resulting from aging.
Pre-diabetes
These are the patients who have the potential to develop diabetes. As the blood sugar level is higher than normal in these cases, it is possible that the condition will progress to type 2 diabetes.
Gestational diabetes
If you develop gestational diabetes during a previous pregnancy, the chances of developing type 2 of the disease are increased.
Hypertension, poor eating habits, high cholesterol levels and smoking also contribute to the onset of the disease.
Symptoms of type 2 diabetes
Symptoms of the disease may appear after years, as the signs of type 2 diabetes develop slowly. Be aware if you have the following conditions:
- Increased thirst and frequent urge to urinate;
- Constant hunger;
- Weight loss;
- Extreme tiredness;
- Blurry vision;
- Slow healing wounds;
- Frequent fungal infections;
- Dark spots on the skin, especially on the neck, armpit and groin;
- Tingling in the feet and boils;
- Headache;
- Erectile dysfunction (impotence).
When should I see a doctor?
As signs of the disease usually take time to appear, seek medical help as soon as you notice any of the above symptoms. People who are part of the risk groups should be more attentive.
How is the diagnosis made?
The diagnosis of the disease is made by an endocrinologist and can be confirmed through tests that will detect possible changes in the patient’s blood glucose rate. Are they:
Glycated hemoglobin (HbA1c)
This blood test measures the average concentration of glucose linked to hemoglobin for two or three months. Hemoglobin is a protein that acts in the transport of oxygen in red blood cells. The test dispenses with fasting and has the advantage of not taking into account the fluctuations in blood glucose that occur from one day to the next.
The rule is simple: the higher the blood sugar levels, the higher the percentage of glycated hemoglobin .
Reference values:
- Between 5.7 and 6.4%: pre-diabetes.
- Above 6.5%: diabetes (with later confirmation).
Fasting blood glucose
The most common method for diagnosing diabetes, the test measures the blood glucose rate after a minimum period of 8 hours of fasting. It is even used in conjunction with the treatment of the disease, to monitor sugar levels.
Reference values:
- Less than 100 mg / dl: normal.
- Between 100 to 125 m / dl: pre-diabetes.
- 126 mg / dl or greater: diabetes (with later confirmation).
Glycemic curve (oral glucose tolerance test)
This test is performed in stages and is used to periodically measure the glucose rate in the body. A fast of at least 8 hours is necessary for the first blood collection to be carried out. Then, the patient will be asked to ingest the glucose syrup (75g) to take samples over 2 hours.
Reference values:
- Less than 140 mg / dl: considered normal.
- Between 140 and 199 mg / dl: pre-diabetes.
- Value equal to or greater than 200 mg / dl: diabetes (with later confirmation).
Random plasma glucose test
A blood collection will be performed at a random time in order to measure the concentration of glucose in the blood. In this case, the result does not take into account what was consumed during the last meal. The disease will be confirmed in conjunction with the patient’s symptom analysis.
Reference values:
Can Type 2 Diabetes Affect Children?
As stated earlier, it is increasingly common for children to have cases of the disease. And the main cause of this is related to the increase in childhood obesity rates . When overweight, the chances of having diabetes are twice as high in children.
Does type 2 diabetes have a cure? What is the treatment?
Diabetes is a disease that still has no definitive cure . Its treatment requires multidisciplinary follow-up and includes measures to maintain blood glucose levels at normal rates and to avoid any complications.
Controlled diet
Many patients who suffer from the disease often wonder what they can eat, but contrary to what they think, there is no specific diet for diabetes. All food is allowed. However, strict care is needed in food, especially in relation to the glycemic index (GI) of foods. Those with low GI are absorbed more slowly into the body and help to control the blood sugar level. For this reason, they should be included in greater quantities in meals.
Diabetes patients should prioritize high-fiber, low-fat foods, such as fruits and vegetables. In addition, it is important to limit the sugars present in sweets and simple carbohydrates as much as possible . An important tip is to count carbohydrates using notes or cell phone apps.
A nutritionist or nutritionist will be able to assist the patient in the process of food reeducation and devise a specific diet according to the needs, preferences and lifestyle of each one.
Regular exercise
Regular physical exercise helps to reduce blood glucose levels, in addition to promoting weight loss. However, before starting any activity, the patient should consult a doctor to check which option is most appropriate. The minimum recommendation is 30 minutes of moderate activity, three times a week. Small changes in habit, such as replacing the elevator with the stairs, can be a good way to start.
It is worth mentioning that physical activity lowers blood sugar. Therefore, it is important to check the blood glucose level and have a snack before exercising to prevent hypoglycemia.
Blood glucose control and verification
This procedure is essential in the treatment of the disease. By monitoring blood glucose, it will be possible to understand how the blood sugar level responds to food, exercise, medications and symptoms. The measurement can be done at home using glucometers, portable glucose monitoring systems, which provide the exact concentration of sugar in the patient’s blood. The device must be purchased and used with medical advice.
Another important factor to be considered is the glycemic goal. It will be determined during a doctor’s appointment and will serve as a reference to identify high and low blood glucose levels before causing problems. This value is individual and varies according to the physiological characteristics, lifestyle and health status of each patient.
With each measurement, it is important to write down the results to take them to the doctor during regular consultations. There are also some situations that should be reported to the health professional:
- Blood glucose levels above 300 mg / dl for more than two days;
- Blood glucose rates between 70 and 80 mg / dl more than twice a day;
- Hypoglycemic conditions in which help from another person was needed;
- Recurrence of unexplained hypoglycemia in the same week;
- Emergence of any disease accompanied by nausea, vomiting, diarrhea or fever.
How to check with the meter?
- Clean your finger, or the chosen location for the measurement, with 70% alcohol. Let it dry before drilling the area.
- To insert the test strip in the indicated location, follow the instructions on the device.
- Place the lancet on the lancet and drill the measurement location.
- Place a small drop of blood on a test strip.
- Wait as long as necessary for the meter to read the blood glucose level.
Avoid doing saunas and scalding feet
Because it is a disease that affects metabolism, the patient who suffers from diabetes has circulation problems and has compromised blood vessels. For this reason, people with diabetes should avoid saunas and scalding, as the possible damage from exposure to high temperatures and thermal shocks can aggravate or cause angiopathies and other heart problems.
Stop smoking
In patients with diabetes, smoking is even more harmful. Cigarette use in patients with the disease is associated with an increased risk of stroke, kidney failure, heart attack, diabetic retinopathy and lung cancer . In addition, nicotine impairs the effectiveness of insulin and can generate resistance to the hormone, which can make it difficult to control diabetes.
Take care of oral hygiene
Diabetes patients are more likely to develop gingivitis and, later, periodontitis , due to the ease of the appearance of bacteria caused by high blood sugar levels. Taking care of oral hygiene is important to avoid the accumulation of these bacteria in the mouth region. In the event of periodontal disease, there may be a need for surgery and even removal of the teeth.
Bariatric surgery
If the patient with type 2 diabetes has a body mass index ( BMI ) greater than 35, it is possible that bariatric surgery will be considered. Studies show that blood sugar levels return to normal in 55 to 95% of cases, depending on the procedure performed.
The main types of this surgery are:
- Gastric Bypass: Promotes stomach shrinkage and shortens the path that food travels in the small intestine, limiting the number of calories absorbed. This change is permanent.
- Laparoscopic Gastric Band (Lap-Band): By means of a band placed around a small region of the stomach, the patient will be satisfied after a reduced food intake. This change can be adjusted or reversed later.
Both procedures include risks, changes in lifestyle and possible long-term complications. It is important to emphasize that, like other treatment methods, bariatric surgery does not promote the definitive cure of the disease. Even if glucose levels are normalized, care must remain, along with medical monitoring.
Insulin treatment
Unlike type 1 diabetes, the application of insulin will not always be indicated for type 2. This type of treatment may be necessary for a short-term correction or because the drugs are not being sufficient to control the disease. The application of the hormone is done through injections, with the aid of a needle and syringe or with a device called an “insulin pen”.
The doctor may order a combination of hormones based on the patient’s needs. The medical prescription will also indicate specific times and dosages. There are several types of insulin available on the market, which are classified according to the time of action and effect. Among the main options are:
- Insulin Glulisine ( Apidra );
- Lispro insulin ( Humalog );
- Insulin Aspart (Novolog);
- Insulin Glargine ( Lantus );
- Insulin Detemir ( Levemir );
- Isophane Insulin ( Humulin N , Novolin N ).
How to apply insulin
Diabetes patients need to self-apply insulin and, for that, it is necessary to follow some recommendations.
One of them concerns the application technique, the injection must be applied to the subcutaneous tissue, a layer of fat located just below the skin. If applied to the muscle, the process will be more painful and the insulin will be absorbed more quickly.
The ideal angle and location of application can be determined with the help of a healthcare professional, who will consider the patient’s profile.
Insulin overdose: what to do?
An overdose of insulin can cause hypoglycemia in diabetic patients. Symptoms include shaking hands, chills, anxiety , nervousness, nausea, dizziness and mental confusion. If you have these signs, follow these recommendations:
- Check the blood sugar level.
- Ingest (small portion) of a food / drink with a high concentration of sugar and fast action, such as soft drinks, industrial juices or glucose tablets.
- If you skipped a meal, eat a source of 15 to 20 grams of carbohydrate.
- After 15 or 20 minutes, check your blood sugar again.
If after 2 hours the levels remain low and the symptoms do not improve, seek medical help.
And in situations where the patient has unconsciousness, immediate help is needed through the administration of glucagon , a hormone that stimulates the release of glucose by the liver. Glucagon is injectable and must be prescribed by the doctor, if necessary. In such cases, it is important to always guide family members on how to act in episodes like this.
Medicines
In some cases, it is possible that the doctor requests the use of medications to control the disease. However, medication does not dispense with the need for diet and regular exercise.
The remedies will be indicated according to the needs and profile of each patient. In Brazil, the following antidiabetics are available:
Insulin secretagogues
They serve to increase the secretion of insulin by the beta cells of the pancreas.
- DPP-4 inhibitors (Vidagliptin, Sitagliptin, Saxagliptin and Linagliptin ): Increase the action of incretins (GLP-1), hormones that stimulate insulin secretion. Administered orally, they do not cause weight gain and are usually associated with other medications.
- Sulphonylureas ( Glipizida , Glimepirida , Glicazida , Glibenclamida ): They assist in the production of insulin and help the body to use it. Possible side effects are hypoglycemia, itching, stomach pain and weight gain.
- Metiglinides ( Repaglinide and Nateglinide ): Stimulate the secretion of insulin by the pancreas after meals. They have a rapid onset of action and short duration of effect on the body. The use of these drugs can cause weight gain and hypoglycemia.
Insulin sensitizers
They act on glucose metabolism, decreasing the resistance of cells to insulin.
- Biguanides ( Metformin ): Improve tissue sensitivity to insulin, making the body use it more effectively. These drugs alone do not stimulate insulin secretion, so they do not cause hypoglycemia. Effects such as nausea and diarrhea are common at the beginning of use.
- Thiazolidinediones ( Pioglitazone ): They act similarly to Metformin, facilitating the transport of glucose into cells. Its possible effects include weight gain and an increased risk of heart failure. Its use can also reduce the effectiveness of the contraceptive pill.
Modulators of nutrient absorption in the gastrointestinal tract
They help to decrease glucose levels, delaying the absorption of carbohydrates in the intestine.
Alpha-glucosidase inhibitors ( Acarbose ): They promote the blocking of enzymes that digest starches. Especially after meals, these drugs slow down the absorption of glucose from food. Side effects include diarrhea, gas and bloating.
Injectables
For the treatment of type 2 diabetes, there are also injectable medications that decrease the speed with which the food leaves the stomach and promote a feeling of satiety. Some also help the pancreas to produce insulin, like GLP-1 analogues.
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 in this website 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.
Living together
Being a diabetes patient requires constant care, such as:
- Maintain a healthy and balanced diet;
- Practice physical exercises on a regular basis;
- Control the weight;
- Use the prescribed drugs correctly;
- Control blood glucose according to the goals stipulated by the responsible physician;
- Carry out a daily self-examination of the feet in order to avoid the appearance of injuries and infections.
Travel and Diabetes: Tips and Care
Like anyone, the diabetic patient needs to plan before traveling. In the case of people with the disease, special attention is needed to details, such as food, duration of the trip and even the time zone.
Check out some specific tips and care:
- Before traveling, take a test to see if your diabetes is under control.
- If you are traveling by car, make stops to stretch your legs and take your blood glucose test. Perform this procedure also whenever you suspect hypoglycemia.
- Take a prescription and a medical report with you, containing all the medicines and supplies you use, as well as explanations about the treatment. In case of travel abroad, be aware of the country’s prescription laws and take the translated documents.
- Make an estimate of the medications and supplies you will need and always take an amount sufficient for two days more than the total estimated time. Remember to take them in your hand luggage.
- Never forget to take the glucose meter (glucometer) with enough reagent strips, backup batteries, puncture device and lancets.
- When traveling alone, especially to other countries, wear a medical identification bracelet or necklace.
- To avoid hypoglycemia, always have a supply of snacks on hand (cookies, cereal bars, box juices, glucose tablets). Consume these foods whenever there is an unexpected delay in meals.
- If you use insulin, keep it at 2 to 8 ºC and avoid freezing. If traveling by plane, do not board the hormone in the cargo hold.
- If you are facing different time zones, talk to your doctor about the entire travel schedule. It will help you with the right moments to apply insulin.
- If the schedule includes different activities and you are more active than usual, bring snacks during the tours and check your blood sugar in small intervals.
- When hiking, wear comfortable shoes and never go barefoot. Check your feet every day for blisters, cuts, redness, swelling and scratches. At the sign of infection or inflammation, perform the necessary medical care.
- Avoid sitting too long. Seek aisle seats so that you can stretch your legs and, if possible, walk a little. If you are driving, make stops along the route.
Common questions
Does insulin application cause addiction?
Insulin does not cause chemical or psychological dependence. What happens is that the patient with diabetes needs this hormone to survive, since it is through it that the entry of glucose into the cell is allowed.
How many times a day do I need to monitor blood glucose?
The correct frequency and times will be determined by the doctor. Only in some cases should the check be done daily. Generally, patients who use insulin need to perform this process several times in the same day.
Does eating too much sugar cause diabetes?
In the case of type 2 diabetes, it is known that one of its causes is related to the patient’s lifestyle. Studies point to a relationship between the development of the disease and the consumption of sugary drinks, such as soft drinks. Therefore, it is important to reduce the intake of these drinks, since they have a high concentration of sugar in the composition and favor weight gain.
Can I eat fruit at will?
Even though they are considered healthy foods, fruits should be consumed with caution. This is because blood glucose rates vary from one to the other, in addition to all being sources of carbohydrates. It is important to talk to your multidisciplinary team to check the ideal amount, frequency and types of fruits allowed for your diet.
Can I consume honey, brown sugar and cane juice?
The sucrose present in these foods is highly harmful to patients with diabetes. The consumption can even be done, but it is important that the patient does not abuse and compensates with balance in the diet.
Can I avoid insulin if I don’t eat carbohydrates?
In people with diabetes, carbohydrate intake must be controlled, as it raises blood glucose more quickly. In the case of type 2 diabetes, if the blood glucose level is controlled, the use of insulin can be stopped. But it is worth mentioning that only a doctor can make this assessment .
Can people with diabetes drink alcohol?
Alcoholic beverages are allowed, as long as care is taken. Moderate consumption is advisable and always with a meal, isolated intake can cause a picture of hypoglycemia or make it difficult to recover from a hypoglycemic crisis.
Blood glucose monitoring before and after consumption is also important. Fermented beverages, such as wine and beer, have a high glycemic index and are more dangerous compared to distilled spirits.
Does stress harm diabetes?
Regardless of whether you are diabetic or not, a condition of stress raises the blood glucose rate. And in the case of diabetes, this can cause problems.
Complications
As with other chronic diseases, early diagnosis favors treatment and can prevent serious problems resulting from diabetes. Although there are different types of the disease, most complications are similar in both.
Effects include microvascular (affect small blood vessels), macrovascular (affect large arteries) and neuropathic (affect nerves) problems. In most cases, these complications have hyperglycemia as a determining factor.
Cardiovascular diseases
The risk of developing cardiovascular disease, including angina , heart attack, stroke (stroke), myocardial infarction, atherosclerosis (hardening of the arteries) and hypertension is much higher in patients with type 2 diabetes.
High blood glucose levels can favor the deposition of fat on the walls of blood vessels and cause partial or total obstruction of the arteries.
Nephropathy (kidney disease)
Diabetes can damage the blood vessels in the kidneys, leading to kidney failure or total organ paralysis. A diabetic who has a urinary tract infection should seek immediate treatment, as the condition can also cause kidney damage.
Retinopathy (eye disease)
Blood vessels in the retina can also be affected, causing difficulty in vision or even blindness. Other eye problems, such as cataracts and glaucoma , can also arise.
Neuropathy (nerve damage)
The accumulation of sugar in the blood can also cause damage to the small blood vessels in the nerves. These nerve injuries usually reach the feet and hands and can cause loss of sensation or tingling, numbness, burning and pain.
Neuropathy can also affect the digestive system, eyes, bladder, heart, sweat glands and bladder. Upon reaching sexual functions, there may be erectile dysfunction (impotence).
Caused by a wound on the feet that does not heal and generates infection, the diabetic foot is caused by circulatory problems and poor glycemic control. This condition forms an ulcer in the region and, in severe cases, can lead to the need for amputation.
Infections
High levels of glucose in the blood favor the growth of bacteria and fungi in the body and increase the chances of infections.
In the case of infections that affect the skin, the cause is related to hyperglycemia, which causes greater chances of the appearance of cracks in the skin. This can facilitate the entry of fungi and bacteria in the region. Circulatory problems resulting from diabetes can also be decisive, since the action of defense cells at the site of an injury is impaired.
Acanthosis nigricans
This condition that affects the skin usually affects people who are very overweight. It is the appearance of dark spots with a velvety texture in regions such as the armpits, groin, neck, elbows and knees.
Diabetic skin disease
By reaching small blood vessels, diabetes can cause a condition of dermopathy. This condition causes light and scaly patches on the skin, which usually appear in an oval or circular shape.
Lipoid necrobiosis
This is a rare condition that can also occur due to changes in blood vessels. Lipoid necrobiosis causes spots similar to those of dermopathy, but larger and more profoundly. The condition can be painful and generate open wounds that require treatment.
Eruptive xanthomatosis
Out-of-control diabetes can cause yellowish-looking bumps on the skin, which usually appear on the hands, feet, arms and legs. Eruptive xanthomatosis is more common in men with type 1 diabetes, but it can also occur in type 2.
Disseminated annular granuloma
Related to diabetes, disseminated annular granuloma generates ring or arc shaped rashes on the skin. They may appear in reddish tones or skin color and usually appear on the fingers and ears.
Osteoporosis
People who have type 2 diabetes are at increased risk of fractures. The disease affects bone remodeling and the formation of collagen matrix, making the bone structure more fragile and compromised. Such bone health problems can increase the risk of osteoporosis .
Diabetic ketoacidosis
High levels of glucose for long periods can cause ketoacidosis. This condition happens when the body starts producing ketones in order to provide an alternative source of energy for glucose (since there is no insulin in the blood).
The condition can cause nausea and vomiting. In the absence of treatment, there is a risk of coma, which can lead to death.
Ketoacidosis is more common in cases of type 1 diabetes, but in rare cases, it can affect patients with type 2 diabetes.
Depression
People who have diabetes are twice as likely to become depressed. This is because the treatment of diabetes control is time-consuming and often stressful. Limitations in diet and lifestyle can also favor depression .
It is worth remembering that this is a complex disease, the result of countless other factors, which go beyond the emotional.
Periodontal disease
This disease is characterized by inflammation of the gums. Its appearance may be related to high blood glucose levels, since hyperglycemia favors the manifestation of bacteria.
If not treated properly, periodontal disease can result in the loss of teeth.
Sleep disorders
Diabetes patients can have a variety of sleep-related problems, including difficulty sleeping, drowsiness and sleep apnea . These complications can be developed from other consequences and symptoms of diabetes, such as peripheral neuropathy and hyperglycemia.
Obesity or excess body fat, two risk factors for diabetes, are also directly associated with sleep disorders. People in this situation are at greater risk of developing most complications of the disease.
How to prevent?
The main preventive measures to prevent type 2 diabetes refer to changes in lifestyle. You must:
- Control the weight;
- Adopt good eating habits, avoiding excessive consumption of sugar and fat;
- Consume grains and fibers, since these types of foods help to control weight and blood glucose;
- Practice physical exercises regularly;
- Keep away from cigarettes;
- Avoid alcohol consumption;
- Control levels of triglycerides and HDL cholesterol.
