Diabetes is a chronic disease that originates because the pancreas does not synthesize the amount of insulin the human body needs, produces it at an inferior quality, or is unable to use it effectively.
Insulin is a hormone produced by the pancreas. Its main function is to maintain adequate blood glucose levels. It allows glucose to enter the body and be transported inside cells, where it is transformed into energy for muscles and tissues to function. It also helps cells store glucose until its use is necessary.
In people with diabetes, there is an excess of glucose in the blood (hyperglycemia), as it is not properly distributed. Noemí González, secretary of the Spanish Diabetes Society (SED) and specialist in Endocrinology and Nutrition at La Paz Hospital in Madrid, explains that elevated glucose can be harmful "to the entire body, but mainly to the heart, kidneys, and arteries, so people who have diabetes and do not know it or do not treat it are at higher risk of kidney problems, heart attacks, vision loss, and amputations of lower limbs."
Types of Diabetes
Type 1 Diabetes: Generally appears in children, though it can also start in adolescents and adults. It usually presents suddenly and often independently of family history. It results from the destruction of insulin-producing cells in the pancreas (beta cells) by autoantibodies. "That is, the body attacks its own cells as if they were foreign (as happens in celiac disease and other autoimmune diseases)."
Type 2 Diabetes: Appears in adulthood, its incidence increases with age, and it is about ten times more common than type 1. It involves decreased insulin action, so even if there is plenty of insulin, it cannot act effectively. González indicates there is "a mixed component: on one hand, there is less insulin in the pancreas, and on the other, this insulin works worse in tissues (called insulin resistance)."
"Its main cause is obesity because fatty tissue produces certain substances that decrease insulin receptor sensitivity," adds Ávila. Since obesity has increased significantly in Spain, this type of diabetes has also increased.
Gestational Diabetes
During pregnancy, insulin increases to boost energy reserves. Sometimes, this increase does not occur, which can cause gestational diabetes. It usually disappears after delivery, but these women have a high risk of developing type 2 diabetes later in life.
Symptoms
Possible symptoms of elevated glucose include:
- Excessive thirst (polydipsia).
- Strong hunger sensation (polyphagia).
- Frequent urination, even at night (polyuria).
- Weight loss despite eating a lot.
- Fatigue.
- Blurred vision.
- Tingling or numbness in hands and feet.
- Recurrent fungal skin infections.
Diabetic Foot
80% of patients with diabetic foot have sensory alteration, and these are the most prone to develop ulcers.
A very characteristic lesion in people with diabetes is the diabetic foot, resulting from sensitivity alterations (peripheral neuropathy) and arterial circulation problems (peripheral arteriopathy). The risk of this lesion increases as diabetes progresses, with an incidence of amputations around 4 per 1,000 patients per year. It is estimated that 15% of diabetics will have lesions compatible with diabetic foot at some point in their lives.
The most important factors for its development are poor diabetes control, neuropathy, foot deformities (Charcot arthropathy), arteriopathy, and smoking. 80% of patients with diabetic foot have sensory alterations, making them more prone to ulcers.
These alterations facilitate that minor trauma or wounds cause ulcers or wounds that are difficult to heal, leading to serious infections, pain, and in advanced situations, even amputations.
Warning Signs of Diabetic Foot
Early signs indicating the start of diabetic foot are redness in some foot areas, increased temperature, callused areas that do not improve and eventually ulcerate. These initial lesions can progress to deep ulcers reaching the bone, causing osteomyelitis, and in very advanced cases, gangrene. With good follow-up and control, these lesions are preventable.
Basic Care for Diabetic Foot
Strict control of diabetes and other mentioned risk factors significantly reduce the incidence of these complications. Diabetic patients should be regularly examined by their primary care doctors and educated on proper foot hygiene and care. Some recommendations are:
- Do not cut nails excessively.
- Do not walk barefoot.
- Check water temperature before soaking feet.
- Use moisturizing creams.
Frequent inspection of foot areas by doctors or nurses is necessary, along with sensitivity testing (superficial and vibratory using monofilament and tuning fork, respectively) to detect early neuropathy signs, ankle-brachial index measurement to assess arteriopathy, and close monitoring of apparently harmless wounds.
Prevention
Currently, type 1 diabetes cannot be prevented despite multiple attempts.
Type 2 diabetes, the most common type, can be prevented. Since obesity is the most important cause, all actions related to obesity prevention (avoiding sedentary lifestyle, junk food, sugary drinks) will have positive results. A healthy lifestyle reduces the chances of type 2 diabetes by 80%.
Treatments
Diabetes treatment is based on three pillars: diet, physical exercise, and medication. Its goal is to maintain blood glucose levels within normal range to minimize the risk of complications associated with the disease.
Insulin is the only treatment for type 1 diabetes. Today, it can only be administered by injection, either via insulin pens or continuous infusion systems (insulin pumps). Insulin administration must be adjusted according to what the person eats, their activity, and glucose levels. Patients must frequently measure glucose using glucometers (finger pricks) or interstitial glucose sensors (some are funded in several autonomous communities), which are easier and less painful.
Type 2 diabetes has a broader therapeutic range. Unlike type 1 patients, insulin administration is not always necessary. By adopting a healthy lifestyle and losing weight, glucose levels can normalize.
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