Diabetes is a clinical metabolic entity produced by an increase in blood glucose. Glucose is the fundamental metabolite of carbohydrates and diabetes can also be defined as an alteration of carbohydrate metabolism. It is a pathology that has been known for centuries. In the modern and ancient ages there were clinical pictures described in books and in autopsies of cases of diabetes. But above all it is an entity that has had a development in terms of research, knowledge and treatment in the last hundred years, a part of the twentieth century, especially after the Second World War, and also at the same time that had a spectacular growth in the world population in the last 30, 20, 40 years.
Basically it is a disease that nowadays has taken an epidemic category and appears in almost all countries, and its causes are diverse. It is produced by a basically metabolic alteration, but this is due to two basic reasons: a genetic component and an acquired component. As in almost all pathologies these two factors are directly interrelated and have a more or less important role in the appearance of the pathology and the way in which the pathology is expressed.
Differences between type 1 diabetes and type 2 diabetes
In a very general way I can say that diabetes is classified into 2 basic types although this is a generalization and exists in all intermediate situations, type 1 diabetes and type 2 diabetes.
Type 1 diabetes is very genetic and also has a component basically of autoimmune disease, that is to say, this results in a deficit of insulin production by the pancreas produced by a destruction of the pancreas itself of the insulin-secreting cells of the pancreas and then there is no insulin so there is no control of the level of glucose in the blood.
In general terms, this is the key point, on the other hand, the other types of diabetes are much more important in terms of quantity and also in terms of pathologies, for example, it can be said that if there are 100 cases, then 7-8 at the most, 10 at the most, and it does not usually reach a hundred anywhere, of these ten cases correspond to the first type and the rest in one way or another, with all of the situations interspersed with the other type of diabetes, which is type 2 diabetes. This type 2 diabetes is basically produced by different situations.
In a very basic way by poor utilization of peripheral glucose, that is, the body’s insulin production may be completely normal but it is not used because it is destroyed or does not act properly, that is, and perhaps in the medium term also comes the other mechanism that the pancreas itself becomes insufficient and does not produce the necessary amount of insulin due to exhaustion. And in the end it also becomes an insulin type diabetes, which needs insulin in the treatment.
It is already clear that to say what I have done before about type 1 diabetes because type 2 diabetes, type 1 diabetes is basically insulin treatment and the other one has many other actions. From the point of view of symptomatology it is a very insidious disease that only when it appears is when the levels are already very, especially type 2, also type 1 in part, are very developed.
The key point is very high blood glucose which leads to metabolic alterations of all kinds and this produces symptomatic metabolic problems in a large part of the organic pathology and leads to a series of alterations known as diabetic complications. Basically I can point out diabetic neuropathy, diabetic nephropathy, diabetic heart disease, diabetic vasculopathy and, finally, diabetic ophthalmopathy. All of them can be mild or very serious depending on the evolution and will require specific treatment.
Incidence of diabetes
A lot can be said about this but they are not very difficult things to explain by which I mean that what has to be achieved in a very general way is to prevent the problem of diabetes. It is not simply a question of medical treatment, which I will comment on a little later, but simply to comment that the basic thing here is to prevent diabetes, because this is a worldwide epidemic, which is the consequence, not so much of a strange situation of the organism, but the response to a situation of a general type of way of life that undoubtedly produces and encourages the appearance of these types of problems.
That is to say, as examples we can say, or as information, that in the world at this moment there may be approximately more than 350 million people with diabetes. Of these a huge promotion corresponds for example to the United States, in the USA there may be some 90 million inhabitants with diabetes problems. And then a fundamental point, in Europe also Europe has produced a tremendous boom of diabetics and in Spain itself there is a very large proportion of diabetics that can reach three million, which is a very high population and higher than in countries similar to ours, such as France and England, which are below, that is to say, it is at a very high level.
And finally, regarding the epidemiology of diabetes, I can say that a very important point is to relate these pictures with what is also happening in countries that used to be called developing countries, they can still be called emerging countries, where they have gone in a much shorter time than what has happened in other Western countries, from having a much lower number of cases of diabetes to, as a result of a change of life, that is, introduction of Western habits, societies that would have many problems but the dietary point was relatively correct and there were not these problems.
China, India, for example two key points, Brazil, South America, Central America, have literally changed their habits and have introduced into their diets substances that lead to an increase in diabetes, such as foods rich in sugars and finally, there are saturated fats and other types of absolutely harmful things, together with a huge increase in obesity cases. Concretely it can be said perhaps, he commented a hair at the end of this a little bit, it can be said that this is a consequence of a way of life. If we do not change vital situations such as physical activity, the dietary issue and then another key point, the stress of society, which generates all this, it is also very difficult to solve these problems.
Symptoms of diabetes: hypoglycemia and hyperglycemia
The symptomatology of diabetes is very anodyne as I have commented previously when referring to generalities. What must be said without a doubt is that it has two key points which is when diabetes is detected or can be detected.
Here there are two situations, hyperglycemia and hypoglycemia. When glycemia increases a lot, as is evident from the name, it is called hyperglycemia and when it is very high, the metabolic systems are very altered and then give rise to a variety of symptoms. This is what has been commonly known as the 3 or 4 p.s., that is, polyuria, polydipsia, polyphagia and weight loss. Translated into more understandable language it can be said:
- Polyuria, urinating a lot and also dicturia, urinating at night;
- Polydipsia, to be very thirsty, to drink a lot of water;
- Polyphagia, to eat a lot
- Finally, in spite of running a lot of all this, there is also weight loss.
These data are basic, and also perhaps fatigue as key points.
That is the symptomatology of uncontrolled hyperglycemia, which is when blood glucose is very high. And then the other extreme is hypoglycemia, which are the most important symptoms, the most important ways of manifesting, which is simply a drop in the glucose level.
This is a very intense and very rapid situation that occurs because there is no sugar, so the body is off center, the nervous system is activated, a situation of anxiety is produced, tachycardia can occur, nervousness, in a situation of dizziness and a situation in which the body asks for sweets in an immense way and it is fixed simply by taking something that has sugar. Those are the two basic symptoms that can be said in diabetes.
Treatment to combat diabetes
The treatment of diabetes, the pharmacological pathway has advanced tremendously in the last 50-70 years. The key point of progress was the introduction of human insulin in the treatment, which occurred after the Second World War. This has come a long way and in recent years, progressively, insulin preparations have been appearing with different actions, long, slow, delayed, mixed, very fast acting, less fast acting, lasting more than 12 hours, 24 hours.
Playing with all that well and knowing how to do it, it is a decisive advance, of course in type 1 diabetes, where there is no or little insulin of its own, and also in type 2 diabetes that needs it. On the other hand, there are oral antidiabetic drugs that have been used for many years, first of all we could talk about the oldest drugs used, sulfeminureas, metformin, which was a drug that was used, then abandoned and then reused for the last 30 years as a first level medication in diabetes.
And finally, the most modern ones are called syncretins, which are drugs that regulate or modify the balance of insulin release, glycemia and anti-insulin hormones. These are, for example, the DPPA, which are the dpp-4 inhibitors that work well, they do not cause problems and also those of the other medication, which are the glp-1 inhibitors. Well, there are other newer ones that have also recently come out that work at the renal level and are very important.
Finally, to conclude, I can say that apart from all that, we have to prevent diabetes and that means changing our lifestyle habits, losing weight and being physically active and reducing stress. If we don’t change that we can have a very bad result no matter how much we use other lines of treatment.