What are the appropriate blood sugar values?
In the general population, i.e., in non-diabetics, blood sugar levels are considered normal when, in the fasting state, after eight hours without food, they are less than 110 mg/dL.
In people with diabetes, blood sugar control is considered to be adequate when blood glucose levels are less than 130 mg/dL before meals and 180 mg/dL two hours after eating. However, these control targets are not generalized and should be individualized according to each person’s circumstances; the control target for an 80-year-old is different from that for a 45-year-old.
In the elderly, less strict glucose control is recommended, due to the presence of other complications that could worsen, while in the younger population we should try to achieve practically normal blood glucose levels, if possible.
What advances have there been in recent years in this disease?
The advances have been mainly therapeutic, since there has been a great deal of progress in the knowledge of the factors involved in the development of type 2 diabetes, also known as adult-onset diabetes.
In this regard, drugs with different mechanisms of action to the classic ones have appeared with which highly satisfactory results are being obtained, both because of their greater efficacy in controlling blood glucose and because of the presence of fewer severe side effects and, fundamentally, because some of them have been shown to have protective effects on the cardiovascular complications of diabetes.
In addition, in recent years insulins have been developed that are easier and more convenient to use and have a more physiological action profile, i.e., more similar to normal insulin production by the pancreas. Insulin treatment, unjustly considered the “bête noire” in the treatment of diabetes, has been significantly improved. The possibility of injecting insulin only once a day and the reduction in the number of glucose drops or hypoglycemia are just a few examples of the advantages offered by this new type of insulin.
In type 1 diabetes, more frequent in children and young people, where the only possible treatment so far is the administration of insulin, research has been mainly oriented towards the production of insulin-producing cells from stem cells (with poor initial results) and the development of intelligent insulin infusion systems, through the combination of insulin pumps and highly technical interstitial glycemia sensors. In this respect, progress can be considered very satisfactory. High technology is finally at the service of diabetes.
What is the trend in recent years in the incidence of diabetes?
The incidence of diabetes, i.e. the number of new cases, is increasing exponentially. According to the latest data published by the International Diabetes Federation (IDF), it is estimated that there are currently 415 million people with diabetes worldwide and by 2040 the number will rise to 642 million (one in ten people). What is most shocking is that only half of the people with diabetes know that they have diabetes, the other half do not.
This increase is most evident in type 2 or adult-onset diabetes. However, the increase in the incidence of type 1 diabetes over the last two decades is striking.
In the case of type 2 diabetes, there is a clear and direct relationship between this increase and the obesity epidemic we are suffering worldwide. However, the reasons why cases of type 1 diabetes are increasing are unknown, although they are being investigated.
What is the link between diabetes and the development of other pathologies?
It is well known that diabetes, especially when it is not well controlled, either due to inadequate treatment or lack of diagnosis, leads to complications in all organs.
Classically, it is known that diabetes is the main cause of blindness and amputations not caused by lower extremity trauma. In addition, chronic renal failure (leading to the need for dialysis and renal transplantation) is another frequent complication. Nor should we forget the lesser known complications, but with a high health impact, such as periodontal and neurological complications.
However, the main cause for concern are cardiovascular complications, such as myocardial infarction, which are four times more frequent among people with diabetes and constitute their main cause of mortality.
In recent years, the relationship that is being observed between Alzheimer’s disease and diabetes has been the subject of attention. We will have more data on this in the near future.
Can it be prevented by any measures?
It is not possible to prevent type 1 diabetes, given its mechanism of onset by immunological processes that are practically impossible to predict. However, type 2 diabetes is more predictable in most cases. The way? Maintaining an adequate weight and regular physical activity, i.e. leading a healthy life.
What influence does diet have?
The relationship between any specific food and the onset of diabetes has not been clearly established. In other words, dietary patterns do not increase the probability of becoming diabetic, as long as the appropriate weight is maintained through a combination of a healthy diet and physical exercise.
However, it should be noted that excessive consumption of sugary drinks leads to a significant increase in the incidence of obesity and, consequently, diabetes, mainly among the younger population.
However, once diabetes has been diagnosed by an Endocrinology specialist, diet is one of the basic pillars of its treatment. There are no “special rules” in the nutritional approach to people with diabetes (mainly type 2) and the advice is to maintain the principles of a healthy and balanced diet in the proportion of its components.
If you are pregnant, what should you do?
Pregnancy constitutes a physiological situation in which the risk of suffering from diabetes increases, which is generally transitory, but can negatively affect the development of the fetus. It is called Gestational Diabetes.
The key lies in proper pregnancy planning. To avoid developing gestational diabetes, it is essential to start the pregnancy with an adequate weight, especially if there is a history of diabetes in the family.
On the other hand, diabetic women can become pregnant without any problem, as long as they have an adequate control of their blood glucose levels and the pregnancy is planned with their doctor with enough time to make a complete evaluation and the pertinent modifications in the treatment.
In most hospitals there are Diabetes and Pregnancy Units, which allow to manage this circumstance in an adequate way and without complications.
Is diabetes a hereditary pathology?
Although it may be believed to the contrary, the most genetically charged diabetes is type 2 or adult-onset diabetes. There is a high probability of developing it if some of the first-degree relatives already suffer from it. This is a good thing to know, as it allows prevention to be initiated at an early age, trying to avoid the onset of obesity.
However, type 1 diabetes requires other internal and environmental factors (not well known), apart from genetic factors, for its development.