DIABETES

DIABETES

WHAT IS IT?

Diabetes is a chronic disease that is characterized by an excess of sugar (glucose) in the blood.

This condition, known as hyperglycemia, can have several causes:

• an insufficient production of insulin, that is the hormone, produced by the pancreas, that controls and regulates the levels of glucose in the blood.
• an inadequate action of insulin itself.

CLASSIFICATION

Diabetes is a very complex disease, as it is a “container” of multiple clinical syndromes.

In fact, these are different diseases that are linked by the fact that the blood sugar is high.

The main varieties of diabetes are:

• type 1 diabetes, also called insulin-dependent.
• type 2 diabetes, also called non-insulin-dependent.
• gestational diabetes.
• monogenic diabetes, for example MODY or maturity-onset diabetes of the young.
• diabetes secondary to other pathology (such as a disease of the pancreas) or drugs (such as cortisone).

Type 1 diabetes and type 2 diabetes are the most known and the most frequent varieties; however, they are two completely different diseases from the etiological and pathogenetic point of view.

• TYPE 1 DIABETES

Type 1 diabetes is a pathology of autoimmune origin: it is the result of the destruction of the cells of the pancreas that produce insulin.

The destruction is carried out by substances, such as antibodies and cytokines, produced by the cells of the body’s immune system probably in response to a virus or to one or more toxic substances present in the environment.

In a short time, the body ceases to produce insulin: an absolute insulin deficiency develops, so therapy with insulin injections itself is absolutely necessary.

Type 1 diabetes mainly appears in children, adolescents, young adults and rarely begins after 40 years.

However, there is a variant of diabetes type 1, called LADA, or Latent Autoimmune Diabetes of the Adult, in which the autoimmune attack on insulin-producing cells is slow and less massive: the disease develops over years, appearing at a later age than classic type 1 diabetes, and presents with some clinical features of type 2 diabetes.

• TYPE 2 DIABETES

Type 2 diabetes develops over many years due to a deficit in insulin production, which, however, never reaches the levels and severity of that present in type 1 diabetes and which does not depend on autoimmunity. The deficit of insulin production depends on multiple genetic alterations and acquired (environmental) factors and, in general, it is associated with a lower efficacy of insulin itself.

This last condition, also called insulin resistance, is caused by multiple genetic alterations that interact with acquired factors.

In type 2 diabetes there is not enough insulin to meet the needs of the body: in this case, we talk about a relative shortage of insulin.

Type 2 diabetes appears especially after the age of 40.

In this type of diabetes an important role is exerted by excessive body weight, which on the one hand determines insulin resistance and on the other negatively affects the secretion of the hormone itself: this is the reason why most people with type 2 diabetes are overweight or obese.

• GESTATIONAL DIABETES

Gestational diabetes occurs during pregnancy and it usually disappears after childbirth.

However, women who have suffered from it during pregnancy are at risk of still developing gestational diabetes in later pregnancies or even developing type 2 diabetes during their life.

• MONOGENIC DIABETES

Monogenic diabetes is a variety of diabetes in which there is a single genetic defect that can determine hyperglycemia.

Monogenic diabetes is transmitted from one generation to another: it appears earlier than type 2 diabetes and shares many characteristics with it.

The typical example is MODY, or Maturity Onset Diabetes of the Young, of which there are many variations depending on the gene involved.

Neonatal diabetes also belongs to this category.

• DIABETES SECONDARY TO OTHER DISEASES OR DRUGSù

In secondary diabetes and drug-induced diabetes, changes in insulin secretion or efficacy are secondary to other diseases or medications.

Among the diseases, we have:

• chronic pancreatitis.
• cirrhosis of the liver.
• chronic renal failure.
• the acromegaly.
• Cushing’s syndrome.

Among the drugs, above all a prolonged therapy based on cortisone appears .

This diabetes can also develop when the pancreas is surgically removed.

DIAGNOSIS

It is possible to diagnose diabetes in each of the following cases:

• glycated hemoglobin (HbA1c), measured by a method aligned to the DCCT standard in two circumstances, is equal to or greater than 6.5%.
• blood sugar, measured in the laboratory, in the morning, after 8 hours of fasting, in two circumstances, is equal to or greater than 126 mg/dl.
• blood sugar, measured in two circumstances, is equal to or greater than 200 mg/dl at the second hour after an oral glucose load.
• blood sugar, measured even in only one condition, is equal to or greater than 200 mg/dl at any time of the day and in the presence of symptoms typical of the disease.

SYMPTOMATOLOGY

Often the presence of hyperglycemia does not give any symptoms or signs or, sometimes, symptoms appear when the disease has already been present for years.

The classic symptomatology of diabetes involves:

• fatigue.
• polydipsia, that is, increased thirst.
• polyuria, that is, increased diuresis.
• unwanted weight loss, sometimes even concomitant with increased appetite.
• sickness.
• abdominal pain.
• mental confusion and loss of consciousness, in the most severe cases.

Obviously, the constant presence of higher than normal blood sugar values increases the risk of macrovascular and microvascular complications, as blood vessels are damaged.
The major complications caused by diabetes can cause the patient several damages, which are divided into:

• Neurological (neuropathy).
• Renal (nephropathy).
• Ocular (retinopathy).
• Cardio-cerebrovascular.

EPIDEMIOLOGY

in Italy, about 3 million people have had a sure diagnosis of diabetes and it is estimated that another million and a half have the disease without knowing it.

About 95% of known diabetes cases and all cases of unknown diabetes are classified as type 2 diabetes, of which about 5%, if properly evaluated, would be classified as a variety of monogenic diabetes or diabetes secondary to another pathology.

About 5% of known diabetes cases are classified as type 1, in some cases as late-onset ones (LADA or latent autoimmune diabetes of the adult).

THERAPHY

The treatment of diabetes includes:

• therapeutic education.
• diet.
• physical activity.
• drugs.

 

• THERAPEUTIC EDUCATION

Therapeutic education covers all the knowledge that makes the diabetic patient able to manage the disease.

• DIET

Diet control is essential in diabetes, because:

• the glycemic level in part depends on the sugars introduced with the daily diet.
• excessive fat intake can lead to dyslipidemia, which is a very common condition in type 2 diabetes.
• excessive body weight contributes to the onset of type 2 diabetes.

• PHYSICAL ACTIVITY

Physical activity, performed correctly and regularly, allows to:

• determine a weight loss.
• reduce blood sugar, thanks to the consumption of glucose in the muscles.
• increase insulin sensitivity.
• increase HDL cholesterol, called “good”, and reduce blood pressure, resulting in an improvement in the risk factors of chronic complications of diabetes.

• DRUGS

Insulin is used as a drug when a deficiency occurs, especially in type 1 diabetes.

Alternatively, some oral or injectable drugs are also able to increase secretion and/or insulin sensitivity.

DIABETIC FRIENDLY PRODUCTS

NUTRA-BE is a young Italian company that, with competence and passion, has formulated a line of nutraceutical products with formulations called “Diabetic Friendly”.

All NUTRA-BE food supplements are made without added sugar, that means that the amount of sugar is less than 0.5 grams per 100 grams of product: this allows the different formulations to adapt adequately even to patients suffering from diabetes.