Type 2 diabetes is also known as diabetes mellitus or diabetes mellitus. It is the most common diabetes: it affects especially people over 50 who have an unbalanced diet. Type 2 diabetes requires regular monitoring and appropriate treatment to avoid complications.
Type 2 Diabetes: What is it?
Also known as diabetes mellitus or maturity, the diabetes non-insulin dependent (NIDDM) is a metabolic disease characterized by a chronic excess of sugar in the blood (hyperglycemia).
The regulation of the sugar level ( glycemia ) in the body involves:
- Sugar intake(mainly through the diet);
- “In-house” manufacturing of sugar(mainly through the liver)
- Peripheral use of sugar in cells: insulin, a hormone made by the pancreas, allows cells to capture and use glucose.
In DNID, there is a poor regulation of this system, most often a state of insulin resistance: to maintain a constant sugar level, the body needs more insulin, because it becomes less effective. Ultimately, even large amounts of insulin are no longer sufficient to use circulating glucose that accumulates in the blood: it is hyperglycemia. Finally, the pancreas gets tired of this permanent stimulation and can no longer make enough insulin: it is insulin-necessity.
These mechanisms of insulin resistance are particularly relevant to people who are overweight.
Causes and risk factors of type 2 diabetes
NIDD is a very common disease that affects more than a million and a half people in France, and continues to grow. It accounts for about 85% of all diabetes , and affects as many men as women.
The diagnosis of NIDD is usually made at around 40-50 years , but the age of onset of the disease is earlier.
There is no single causal factor of the disease but several risk factors :
- Genetics and heredity: a hereditary factor is very often found (“many family members have diabetes”). In addition, some populations are particularly affected by NIDDM confirming its genetic origin;
- Overweight and obesity: between 60 and 90% of patients with NIDDM are significantly overweight;
- Physical inactivity;
- Tobacco consumption;
- Arterial hypertension;
- For women, the birth of babies weighing more than 4 kilos.
The secondary diabetes are less frequent. They can be found in people who have or have had certain diseases such as:
- Inflammatory disorders of the pancreas (alcohol, overload or malnutrition diseases …);
- Pancreas operations;
- Liver diseases;
- Endocrine disruption …
Some medications may also develop diabetes, temporarily or permanently (medicines to treat hypertension, hypothyroidism or hypercholesterolemia , antiepileptic drugs, etc.).
All of these risk factors should motivate increased regular surveillance.
Symptoms of type 2 diabetes
Chronic hyperglycemia is most often asymptomatic.
If the diabetes is very unbalanced, symptoms can appear and will be the signs of insulin-necessitance, imposing a fast medical check-up:
- Want to urinate very often(it is polyuro-polydipsic syndrome );
- Fatigue(asthenia) major;
Certain health problems are frequently associated with diabetes: repeated urinary infections , mycosis, furunculosis, visual disturbances , leg pain or cramps, impotence, cardiac or vascular pathology …
Diagnosis of type 2 diabetes
A blood test in the laboratory makes it possible to measure blood glucose in the blood.
A fasting blood glucose level greater than or equal to 1.26 g / l, twice , diagnoses diabetes. Other dosages may be performed: postprandial glucose (2 hours after a meal), glycosuria (presence of sugar in the urine), glycosylated hemoglobin , are only rarely used for the diagnosis of diabetes, but may help with follow-up.
The complete medical examination will look for signs that can guide the origin of diabetes , and may guide the existence of complications : assessment of overweight (weight, height, fat distribution), blood pressure , auscultation of the heart and the vessels, examination of the reflexes and the sensitivity of the legs and the feet in particular …
Once the diagnosis is established, examinations are systematic and repeated regularly:
- Biological: lipid balance (cholesterol, triglycerides), albumin or protein in urines (micro albuminuria, proteinuria ), renal function by serum creatinine determination;
- Paraclinics: fundus (even retinal angiography), cardiovascular examination with an electrocardiogram (or cardiac ultrasound, exercise test, cardiac scintigraphy, Doppler of the arteries of the legs and neck …).
Other examinations may be performed later depending on the results of previous examinations, and depending on the patient’s symptoms.
Evolution of type 2 diabetes
NIDDM is a chronic disease . It is possible that it causes acute complications such as diabetic comas of ketoacidosis type, hyperosmolarity, lactic acidosis … In cause: poorly adapted treatments, a context of particular diseases associated, old age, brutal events (severe infection, shock …).
But the main feature of diabetes is to have long-term adverse consequences(chronic complications) on certain target organs . These are the specific complications of diabetes :
- On the eye: damage to the retina (retinopathy ) can be responsible for blindness if it is not managed. It requires an annual ophthalmological examination, even in the absence of visual disturbances ; laser treatment can be performed on the first lesions;
- On the nerves: it is the neuropathy which affects mainly the legs and the feet, causing pains, cramps, a decrease of the sensitivity, and wounds of the feet or toes (poor perforating plantar). Neuropathy can affect the nerves of organs such as the stomach, intestines, heart … and lead to digestive disorders, diarrhea, accelerated heart rate, etc.
- On the kidney: it is the nephropathy , which will begin by a decrease in the quality of the filter of the kidneys, and which can lead to the renal insufficiency .
It is particularly important to fight against other cardiovascular risk factorsapart from diabetes, in particular by tracking them: high blood pressure , excess blood lipids (dyslipidemia), tobacco, obesity, inheritance of heart disease …
Given diabetes and other frequently associated risk factors, patients with NIDDM are more likely to have angina pectoris, myocardial infarction , stroke, etc.
Treatment of type 2 diabetes
Diabetes must be managed early to slow down its progression and limit complications. There are medications or not.
RESPECT THE RULES OF HYGIENE AND DIETETICS
The first treatment is not in a pill: it is simply the respect of hygiene and dietary rules:
- The diet must be balanced(include carbohydrates, lipids, proteins while respecting a good proportion of each group);
- The eating behavior is relatively strict: 3 meals a day minimum ;
- The snacks should be avoided. Sometimes snacks can be put in place.
The food program will be established at best by a nutritionist or a dietician , in order to take into account each particular situation, and according to possibly associated pathologies.
Some food tips
- Carbohydrates should not be totally removed, only fast sugarsshould be (sugar, sugary drinks, jam, sweets, ice cream …);
- Each meal must include bread or starchy foods in limited intake depending on the existence of overweight, physical activity, age …;
- The fats will be limited, with use of fats rather of vegetable origin;
- Privilege the consumption of fish;
- A low calorie dietis most often recommended to reduce overweight.
A very regular physical activity is essential : walking, cycling, swimming, gymnastics are recommended with a multi-weekly practice. Stopping smoking is desirable, even with moderate smoking.
If the dietary and hygiene rules are not effective after 3 months , then it will be necessary to combine a drug treatment .
They are oral antidiabetic drugs (ADO) and insulin. Four families of drugs make up the ODA:
- The biguanide;
- The sulfonylureas;
- The inhibitors of alpha-glucosidase;
- The Glinides.
They are represented by Metformine . They promote the action of insulin in the body , decrease the production of sugar by the liver and the intestinal absorption of glucose . They have no direct action on the secretion of insulin by the pancreas. They are usually prescribed as first-line treatment for people who are overweight.
The side effects of biguanides are represented by digestive disorders (diarrhea, flatulence, bloating ), quite common at the beginning of treatment, not imposing their judgment except major disorders. These disorders will be limited in case of absorption during meals.
This treatment is contraindicated in the elderly, renal insufficiency, hepatic insufficiency, in case of ischemic cardiac disorders, respiratory disorders , pregnancy … It must be interrupted before an injection of iodine (for a radiological examination) and avoided before surgery .
Many drugs exist and they have a duration of action more or less long , according to the compound: carbutamide , glipizide , glibenclamide , gliclazide , glibornuride , glimepiride . They act directly on the pancreas by stimulating the secretion of insulin . They are always started in small doses because of the risk of hypoglycaemia.
These drugs are more effective in people without or with little overweight .
The contraindications are elderly (depending on the drug), advanced renal failure, liver failure , pregnancy, sulphonamide allergy. They are likely to have many interactions with other drugs, which expose them to the risk of hypoglycaemia .
INHIBITORS OF ALPHA-GLUCOSIDASE
They act mainly on the increase of the postprandial glucose (after the meal) because they slow down the absorption of the carbohydrates contained in the food. Side effects are especially digestive ( bloating , flatulence).
The cons-indications are the renal failure severe, sub-occlusive disease (progressive or sudden stop intestinal transit), malabsorption disorders …
This class acts, like sulphonamides, on the pancreatic secretion of insulin . The side effects of these medications are mostly digestive disorders . They are always started in small doses because of the risk of hypoglycaemia .
The contraindications are children under 12, advanced renal failure, liver failure , pregnancy and allergy .
The four types of drugs mentioned above can be combined , but attention to the increased risk of hypoglycemia when used in combination.
The insulin may be involved in the treatment of NIDDM in several cases:
- Maximum oral treatment and not sufficient for the balance of diabetes. In this case, an injection of insulin can be associated, especially in “bed-time” form : ADO + insulin at bedtime. ADO can also be replaced by 2 injections of insulin (morning and evening);
- Transient or definitive contraindications to OADs: usually 2 insulin injections per day;
- Insulin-necessity, that is, pancreas depletion and insulin deficiency.
Depending on the situation, 3 or 4 injections or a small external insulin pumpare necessary to balance diabetes (pregnancy, pre- or post-operative surgery, severe infectious problems …).
Of course, the treatment of diabetes, the management of arterial hypertension, dyslipidemia (cholesterol, triglycerides …), and specific complications will be associated. The ultimate goal is to achieve normoglycemia (normal blood sugar) and to manage all cardiovascular risk factors .
To note: the medical treatments of the diabetes do not dispense in any case the continuation of the rules dietary and hygiene.
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Living with type 2 diabetes
Diabetes requires regular medical monitoring to verify the effectiveness of treatment. Glycated hemoglobin or HbA1c should be checked every three months with a blood test . Other examinations must be done every year:
- It is advisable to see an ophthalmologist to detect any ocular complications;
- A dental checkup is important because there is a significant risk of abscess;
- A lipid assessment will also be requested to evaluate the cardiovascular risks;
- A renal bioassay can detect kidney failure;
- The patient will be asked to perform an electrocardiogramand an examination of the feet to verify that there are no lesions.
It is also advisable to eat a balanced diet and to practice a gentle sporting activity .