Diabetes, everything you need to know

By Cristiano Antonino On Apr 8, 2023

Diabetes, more properly called “diabetes mellitus” is a metabolic disease whose manifestation is related to insulin, the hormone that controls blood sugar and which is produced by the pancreas

In particular, diabetes can be linked to:

a reduced availability of insulin (whose production does not meet the body’s need)
to a poor sensitivity to the hormone by the target tissues
to a combined action of these factors

A clinical feature of diabetes is hyperglycemia, resulting from the changes in insulin levels just mentioned.

Types of diabetes

Compared to the past, the classification of types by the scientific community appears more simplified and includes three main groups:

type 1 diabetes
type 2 diabetes
gestational diabetes.

Type 1 and type 2 diabetes

Also called juvenile diabetes, type 1, due to its characteristic tendency to develop during childhood and adolescence, is an autoimmune disease: the immune system, identifying the cells in the pancreas that produce insulin (Beta cells) as foreign and harmful, he tends to attack and then destroy them.

Type 2 diabetes is characterized by a condition in which the pancreas is able to produce insulin but this is insufficient or is not used optimally by the body.

In both cases, this circumstance leads to an excess of glucose in the blood.

Gestational diabetes

It is a form that affects women during pregnancy. During pregnancy, some hormones produced by the placenta counteract the action of insulin: usually the woman’s body reacts by generating insulin in greater quantities.

If the pancreas, on the other hand, fails to respond to this need, blood sugar rises, causing this particular form of diabetes. About 4% of pregnant women are affected by this condition, which however tends to resolve itself at the end of pregnancy.

Triggering factors

The growth trend that characterizes Western countries is due to various factors such as:

the aging of the population
the sedentary lifestyle
obesity
lack of attention to a healthy lifestyle

Symptoms

Very frequently this pathology remains silent for some time: the presence of hyperglycemia does not generate symptoms, which rather appear when the pathology has already been going on for years.

Typical clinical manifestations in acute cases are:

exhaustion
polydipsia, i.e. increased thirst
polyuria, i.e. unwanted weight loss (sometimes even in the presence of increased appetite)
pains in the abdominal area
mental confusion and loss of consciousness in the most compromised situations

The constant presence of blood sugar values above normal generates an increased risk of macrovascular and microvascular complications (damage affecting blood vessels).

Damage caused by diabetes

The primary complications can be classified into:

neurological (neuropathy), through the anatomical and functional alteration of the central, peripheral and voluntary nervous system, sensory, motor, visual and acoustic deficits
kidneys (nephropathy), i.e. damage to the filtering structures of the kidney (glomeruli and renal tubules) which can lead in extreme cases to dialysis, a procedure designed to remove the waste products from the body and the excess fluid from the blood when the kidney function of the patient has a degree of impairment over 85-90%. In Italy, 30% of patients undergoing dialysis therapy are affected by diabetes
ocular (retinopathy), generated by chronic hyperglycemia and hypertension that lead to alteration of blood vessels with consequent progressive worsening of vision up to blindness
cardio-cerebrovascular, through myocardial infarction or ischemic heart disease, stroke.

Causes of diabetes

From an etiological and pathogenetic point of view, type 1 diabetes and type 2 diabetes present relevant distinctions.

Type 1 diabetes, as seen, is an autoimmune disease and is the consequence of a relatively rapid destruction of the pancreatic cells responsible for the production of insulin.

For this type of diabetes, therapy with insulin injections is necessary because in a short time the body does not produce it (absolute lack of insulin).

Type 1 diabetes occurs mainly in children, adolescents, young adults and rarely occurs after the age of 40.

In a variant of type 1 diabetes, called LADA (Latent Autoimmune Diabetes of the Adult) in which the autoimmune attack on the cells that produce insulin is slow and more contained, the disease develops over years, appearing at a more advanced age than to classic type 1 diabetes, and in which some clinical characteristics of type 2 diabetes are present (such as, for example, the possibility of treatment with oral drugs for a long time).

As for type 1 diabetes, today the causes that determine its manifestation have not yet been identified.

However, there are factors that can play an important role in its onset.

In this case we are talking about:

genetic factors; in fact, a greater predisposition to the disease has been observed in individuals with parents or relatives affected by type 1 diabetes
environmental factors; it is hypothesized that some viral infections, even common ones, can trigger the disease in subjects already predisposed from a genetic point of view

Type 2 diabetes develops, over many years, due to a deficit in insulin production which, however, is never as serious as that found in type 1 diabetes and does not depend on an autoimmune process.

It is an insulin deficiency which is generally also associated with a lower efficacy of the same. These two conditions are both attributable to multiple genetic alterations that interact with acquired (environmental) factors.

In this type of diabetes, there is not enough insulin to meet the body’s needs (relative insulin deficiency).

Type 2 diabetes occurs mainly after the age of 40 but the age of onset is progressively decreasing due to the ever-increasing diffusion of obesity even in the younger age group.

The various predisposing factors identified are:

obesity
unbalanced diet, high in sugar
sedentary lifestyle
age over 40 years
genetic factors.

Treatment and prevention

Insulin therapy. It consists of subcutaneous injections and is necessary to treat type 1 diabetes.

This therapy combined with a correct lifestyle allows most patients to lead a normal life and is able to prevent the onset of long-term complications of the disease.

Treatment for type 2 diabetes. Type 2 diabetes involves different approaches to insulin therapy.

Currently there is no valid drug for all patients affected by type 2 diabetes, which is why it is essential to build a personalized therapy on the specific needs of each patient, in relation to the different clinical situation and different individual characteristics.

Only 10% of patients with type 2 diabetes maintain good control of the metabolic pathology without treatment.

International diabetes societies recommend the following therapeutic objectives, aimed not only at correcting the symptoms and signs of the disease and at preventing serious complications, but also at improving the quality and life expectancy of the diabetic patient:

fasting and pre-prandial blood sugar between 90-130 mg/dl;
post-prandial blood sugar (about 2 hours after meals) lower (<) 180 mg/dl;
lower glycated hemoglobin (<) 7%.

Diabetes treatment also includes:

diastolic blood pressure (minimum pressure) <80 mmHg and systolic blood pressure (maximum pressure) <130 mmHg;
LDL cholesterol values <100 mg/dl, HDL levels >40 mg/dl in men and >50 mg/dl in women.

For preventive purposes, actions aimed at affecting a better lifestyle are also of great importance, such as regular moderate-intensity physical exercise (for example 20/30 minutes a day) and weight reduction equal to 10%. It is estimated that similar interventions can reduce the incidence of type 2 diabetes by 60%.

A diet rich in saturated fatty acids (animal fats) increases the risk of developing diabetes, while the partial replacement of the latter with unsaturated fatty acids reduces it (the so-called omega 3).

A screening, aimed at identifying the disease even in asymptomatic subjects, is generally recommended for the entire population, as it takes the form of a simple blood test (fasting blood sugar).

In particular, there are also subjects considered to be more at risk, who must constantly monitor the value of their blood sugar.

These are those who:

have reported a fasting blood glucose value between 100 and 126 mg/dl (impaired fasting blood glucose),
have a BMI (body mass index, i.e. ratio of weight in kilos/height in m2) with a value >25 kg/m2
have a first-degree family history of type 2 diabetes.

Treatment for gestational diabetes. Gestational diabetes, a form which, as we have seen, can affect women during pregnancy, is usually transient, i.e. it ends at the end of the gestation.

Already in physiological pregnancy the antagonist hormones of insulin, produced by the placenta and the adrenal cortex, decrease the entry of glucose into the maternal tissues with more lasting hyperglycemia after meals.

This mechanism, together with the placental activity, is aimed at supplying the developing fetus with the energy necessary for its growth, a real diversion of resources which protects and favors the interests of the unborn child.

In the case of gestational diabetes this mechanism of insulin resistance finds its maximum expression and therefore a state of hyperglycemia occurs.

The treatments recommended in the prenatal phase are:

physical activity (increase calorie consumption)
diet (reduce unnecessary intake)
fasting and post-meal glucose monitoring
monitoring of fetal development to avoid macrosomia and related problems.

After childbirth, with the consequent elimination of the placenta, insulin is no longer antagonized by hormonal substances: the maternal metabolism can thus return to its previous mode, with recovery of the correct glycemic levels.

However, it is advisable to reevaluate the metabolism some time after delivery, as a percentage of women with gestational diabetes will develop clinically evident diabetes over time.

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