For the treatment of diabetes it is important to be able to know if you are at risk of suffering from this disease, as well as to be able to see if it is necessary to analyze a person’s family history. In order to obtain an optimal clinical diagnosis of a health problem of these characteristics, it is also important to know the treatments that exist both for prevention and for when the diagnosis of diabetes is confirmed. Dr. Prof. Francisco José Rodríguez Rodrigo, cardiologist, expert in Preventive Cardiology, Cardiovascular Risk, Congenital Heart Disease and Ischemic Heart Disease, explains how the study of diabetes or prediabetes should be carried out.
In which cases it is necessary to analyze blood glucose levels.
A prediabetes screening is recommended for all overweight adults with a body mass index greater than 25 k/m2 and who also have any of these additional risk factors:
- Sedentary lifestyle.
- First-degree relatives with diabetes.
- Women with a previous diagnosis of gestational diabetes or who had a child born with a high birth weight (more than 4 kg).
- Hypertensive, i.e., with blood pressure above 140/90 mmHg or treated with antihypertensive drugs.
- Cholesterol alterations: HDL less than 35 mg/dl and/or triglycerides above 250 mg/dl.
- Women diagnosed with polycystic ovary.
- Alterations in fasting glucose or glucose intolerance in a previous determination.
- Other clinical conditions associated with insulin resistance.
- History of cardiovascular disease.
Control of cardiovascular risk among patients with diabetes.
You must control the other cardiovascular risk factors, especially hypertension, smoking and cholesterol, especially if you are obese, you must lose weight. You should practice physical activity on a continuous basis. In order to prevent further problems with diabetes, it is recommended to control blood glucose levels. The correct levels that should be given are: glycosylated hemoglobin (HbA1C):
Early identification of diabetics with cardiovascular disease, especially when they are still asymptomatic, is the best tactic to reduce complications and mortality from this cause. In the same way, a good blood pressure level should be maintained: BP
What are the different forms of treatment for diabetes?
In the case of type 1 diabetes, the treatment is always lifelong insulin administration. In type 2 diabetes, you can usually start by working with a heart-healthy diet and exercise program. If this is not enough, the physician may recommend taking oral antidiabetic drugs. When drugs are also not sufficient, insulin will need to be added.
Heart-healthy diet
In order to treat diabetes, it is important to reduce the intake of saturated fats, which must be less than 7 percent of total calories. Olive oil has to be the predominant fat in a change of diet. It is important to reduce or eliminate animal fats: butter, cream, bacon, etc. It is preferable to replace them with fish.
Meat, fish and eggs are rich in proteins and also contain fats, but not carbohydrates. Eat little and several times a day, avoiding large meals and rapidly absorbed sugars that sharply raise blood glucose levels.
Heart-healthy exercise
Physical activity controls blood glucose levels, reduces overweight, improves the patient’s quality of life and avoids possible complications that may arise from the development of the diabetes disease. The ideal physical exercise for most diabetics is walking, running or cycling. In case of neuropathy or diabetic foot, avoid exercises with risk of trauma.
Oral antidiabetics
They are only useful in type 2 diabetes. When diet and exercise are not enough to control this type of diabetes, different drugs are used to help the pancreas produce more insulin or to make the insulin it produces itself work better.
Insulin
This hormone, which is produced in the pancreas, is the mainstay of treatment for type 1 diabetes, but it is also part of the treatment for type 2 diabetes. Insulin must be administered by subcutaneous injection.
There are different types of insulin that differ fundamentally in the time they take to take effect and their duration, which can be: ultra-fast, fast, intermediate and slow.
The different patterns and types of insulin try to imitate what the pancreas of a person without diabetes does. Rapid and ultra-rapid assimilation insulins are used at each meal to mimic the insulin peak produced by the pancreas in order to assimilate the nutrients ingested.
Slow and ultralow insulins try to mimic the basal secretion of the pancreas, this is the type of insulin that is produced between meals or at night, to maintain stable blood glucose levels.
Diabetes and pregnancy
Gestational diabetes is the inadequate elevation of glucose detected in the pregnancy of non-diabetic women. In this type of case, the following should be taken into account:
- As it has no symptoms, a blood test is performed around 24 weeks of pregnancy to detect it.
- It affects 5 percent of pregnant women. It has been proven that gestational diabetes appears more frequently in older or overweight women. Of this percentage, only 1 percent corresponds to cases of pregestational diabetes (type 1 or infantile-juvenile diabetes).
- Depending on the degree of danger, frequent obstetric and glycemic controls should be followed. It is also necessary for the patient to be monitored by the endocrinologist.
- The basic treatment consists of dietary recommendations and exercise. If this is not sufficient, insulin treatment should be initiated.
- Although most gestational diabetes disappears after delivery, a follow-up is recommended to rule out the possibility that it has become chronic.
- Women who have suffered gestational diabetes should be monitored when they reach menopause, since at this stage it could reappear and become type 2 diabetes.
What is the process by which diabetes is diagnosed?
The first symptoms of diabetes are hyperglycemia or elevated blood sugar levels, which is directly responsible for the typical symptoms of diabetes. Therefore, it is important to know them in order to facilitate their diagnosis:
- Need to urinate very frequently, also called polyuria.
- Being very thirsty: polydipsia.
- Being very hungry: polyphagia.
- Weakness, weight loss and digestive discomfort are also common.
However, type 2 diabetes mellitus may not present symptoms for years and may be diagnosed by a test by chance.
How the clinical diagnosis of diabetes develops
There are currently four clinical ways of diagnosing diabetes mellitus:
- The appearance of symptoms of hyperglycemia and a blood test can confirm glucose levels equal to or greater than 200 mg/dl.
- A fasting blood test detects blood glucose levels equal to or greater than 126 mg/dl. For the measurement to be correct, no caloric food should be ingested 8 hours before the analysis.
- Performing an oral glucose overload test, which consists of taking 75 grams of glucose diluted in water and remaining at rest for the following two hours. Glucose levels are then measured and compared with those taken before the test. Figures equal to or above 200 mg/dl would confirm the diagnosis of diabetes.
- By means of a special analysis that tells us how the glucose levels in the blood have been in the last three months, which is called Glycosylated Hemoglobin (Hb1Ac), and which if it is equal or higher than 6.5% the diagnosis of diabetes is established.
How can the normal glucose level be known?
We speak of prediabetes when there is an elevation of glucose levels in the blood, but it does not reach the minimum to be considered diabetes. This occurs in two situations, both of which are risk factors for diabetes and cardiovascular disease:
- When fasting glucose levels are between 100 and 125 mg/dl.
- When two hours after the oral glucose overload test, blood glucose levels are between 140 and 199 mg/dl.
- When Hb1c levels are between 5.5 and 6.4%.
Below these levels, there is no diabetes.
Affect of family history on the diagnosis of diabetes
Numerous studies have shown a genetic component in cases of hypertension, familial hypercholesterolemia and type 2 diabetes, all factors related to the development of cardiovascular disease.
The risk of cardiovascular problems is higher in the following cases:
- If a first-degree male relative (father or brother) has suffered a heart attack before the age of 55.
- If a first-degree female relative (mother or sister) has suffered a heart attack before the age of 65.
- If the father and mother have suffered cardiovascular problems before the age of 55, the child’s risk increases by 50 percent. It is important to have a family history.
- Hypertension problems: there is a certain family predisposition to suffer from hypertension. In addition, it has been shown that hypertension is a very important risk factor for myocardial infarction, coronary insufficiency, angina pectoris and arrhythmias.
- Familial hypercholesterolemia: one of the hereditary factors of greatest cardiovascular risk. If we have a family history of high cholesterol, we should undergo blood tests from an early age so that an early diagnosis can be made.
- Type 2 diabetes: also has a genetic component. If one of the parents has diabetes, the child has a high risk of developing it. Therefore, it is advisable to control risk factors.
Apart from the unquestionable importance of family history in the diagnosis and possible development of cardiovascular disease, it is important to bear in mind that maintaining a heart-healthy lifestyle, not smoking, following a balanced diet and regular physical exercise greatly minimizes the percentage of risk.
Since family history is a non-modifiable risk factor, people with a family predisposition to cardiovascular disease should concentrate their efforts on controlling the factors on which it is possible to act.