Diabetul (Diabetes)

Diabetul –de ce prea mult zahar in sange e rau pentru memorie

„Diabetul este manifestarea metabolica a unei scaderi in producerea insulinei de catre pancreas si/sau a unei rezistente la efectele insulinei in tesuturile periferice”. Aceasta este definitia stiintifica pe care o veti gasi in cartile medicale la categoria diabetes mellitus. In traducere libera, corpul unui diabetic nu poate utiliza toate glucidele pe care le ia din alimentatie. Efectul advers al acestei proaste utilizari: nivel crescut de glucide in sange (hiperglicemie), glucoza in urina (glicozurie), probleme renale, problem de vedere, problem de circulatie.

Exista 2 tipuri de diabet, dupa cum sunt sigur ca ati auzit/citit deja.

Tipul 1, se mai numeste juvenil pentru ca efectele si simptomele pot aparea de la o varsta frageda, avand un important factor genetic in compozitie. Diabetul de tip 1 (DT1) este o boala ce se datoreaza unui defect al pancreasului. Mai exact, unui deficit de productie de catre celulele beta din pancreas a unui hormon (un tip de proteina) denumit insulina. Acest defect de productie apare datorita distrugerii celulelor beta de catre celulele imunitare proprii (DT1 este o boala auto-imuna). Insulina este o proteina care ajuta la utilizarea glucidelor in scopul obtinerii energiei necesare functionarii celulelor. Fara insulina nu putem utiliza glucidele din alimente. Persoanele cu DT1 sunt, in majoritatea cazurilor, insulino-dependente.  Au nevoie de un aport de insulina din exterior pentru a-si ajuta organismul sa utilizeze glucidele.

Celalalt tip, diabetul de tip 2 (DT2) are o alta cauza pentru aparitie. De aceasta data, desi pancreasul poate functiona normal si poate produce o cantitate echivalenta de insulina cu a unei persoane sanatoase, tesuturile periferice unde insulina isi face efectul (muschi, ficat si tesut adipos) devin rezistente la actiunea acesteia. In consecinta, aceste tesuturi, care sunt metabolic active in mod normal, nu mai pot capta glucidele si, astfel nu mai pot produce energie. Se instaleaza o stare de „rezistenta la insulina”, rezistenta caractestica pacientilor cu acest tip de diabet. In unele cazuri, pacientii pot avea un DT2, unde, pe langa faptul ca sunt rezistenti la actiunea insulinei, pancreasul lor nu mai produce insulina. Se poate ajunge, asadar, la un diabet de tip 2 insulino-dependent, unde tratamentul cu insulina este obligatoriu.

Hypodermic needle

Fig. 1 Seringa speciala pentru injectarea insulinei (ac hipodermic) cu unitati de insulina marcate

          Special syringe for injecting insulin (hypodermic needle) with special units for insulin

Sunt multi factori de risc care pot duce la aparitia diabetului:

  • Varsta (peste 45 de ani)
  • Factori genetici
  • Tensiunea arteriala crescuta, nivelul colesterolului/trigliceridelor marit
  • Lipsa activitatii fizice
  • Sindrom de ovar polichistic
  • Sarcina, etc.

S-a dovedit ca obezitatea si diabetul sunt interdependente. Persoanele obeze cu un indice de masa corporala (IMC) de peste 30 kg/m2 (persoanele normo-ponderale au un IMC intre 20-25) au un risc foarte ridicat sa dobandeasca un DT2. Mai exact, o persoana cu un IMC de peste 30 are de 80 de ori mai mari sanse sa dezvolte un DT2 decat o persoana cu un IMC intre 22-23.

In ultimele 2 decenii, ne-am modificat drastic stilul de viata si alimentatia. Am devenit mai sedentari si, in acelasi timp, mancam mai mult, mai gras si ne miscam mai putin. Acesti factori au crescut incidenta diabetului in populatia generala in ultimii 30 de ani. Si, daca nu eliminam riscurile, va creste si mai mult in viitor.

Diabetul si functionarea creierului

Un studiu recent publicat in Diabetes Care arata ca, in cazul unui diabet necontrolat, nivelul crescut de zahar in sange poate duce la consecinte nefaste asupra memoriei si capacitatii de concentrare. Pacientii cu nivele crescute de HbA1c  au o putere de momorare si de concentrare mai scazuta comparat cu pacientii care au nivele normale de HbA1c. Acest efect este explicat prin faptul ca nivelele crescute de zahar in sange pot afecta micile artere din creier, producand mini-atacuri cerebrale si moarte a tesutului cerebral. Consecinta este pierderea graduala a capacitatii de memorare. Pe langa acest efect, rezistenta la insulina la acesti pacienti poate duce la o comunicare deficitara in caile de semnalizare din creier. Un alt efect secundar al pacientilor cu un diabet necontralat, hipoglicemia (nivele scazute de glucoza in sange), poate conduce la pierderi de cunostinta cu impact puternic asupra capacitatii cerebrale. Aceasta ultima cauza este mai ales importanta la pacientii varstnici care sunt iau ca tratament pentru diabet medicamente din clasa sulfamidelor. Acestea au ca principal efect secundar o hipoglicemie rapida si pot cauza o revenire mai dificila.

Hemoglobina glicozilata explicata (HbA1c) – Este hemoglobina care reflecta nivelele glicemiei din ultimele 2 sau 3 luni. Pentru diabetici, un nivel ridicat al HbA1c este legat de un diabet cu risc crescut de complicatii:

–         Valori normale: sub 5.7%

–          Prediabet: 5.7-6.4%

–          Diabet: peste 6.5%

insulin-pump-pros-and-cons

Fig. 2 Pompa de insulina care poate doza glicemia si ajusta doza de insulina administrata automat

Insulin pump that doses the blood glucose level and adjusts automatically the administered insulin dose

Acum ca intelegem cauzele si efectele diabetului, cum putem trata boala?

In primul rand, cel mai important de inteles este ca, chiar daca ne simtim bine si credem ca putem controla prin dieta si printr-un stil de viata sanatos un diabet, este absolut necesar sa ne facem periodic analize si sa avem un medic care sa ne supravegheze. DT1 sunt obisnuiti cu aceasta ideologie. Pacientii cu DT2 pot neglija aceasta problema.

Ce trebuie sa intelegem este ca DT1 poate fi tratat, nu reversat!

  1. Nemedicamentos:

Dieta: Exista mai multe diete speciale care limiteaza consumul de hidrocarburi (glucide). Trebuie evitate alimentele cu hidrocarburi imediat disponibile (dulciuri cu zahar rafinat, anumite tipuri de ciocolata, etc). De retinut ca hidrocarburile cu eliberare intarziata (cele din anumite tipuri de fructe ca de exemplu merele) pot fi buna sursa de glucide, dar, in acelasi timp trebuie avut grija pentru ca pot produce o crestere a glicemiei dupa un consum ridicat. Vezi Fig. 3, piramida alimentatiei diabeticului!

Miscarea/slabitul: Cum am mentionat mai devreme, o persoana cu un IMC peste 30 are de 80 de ori mai mare riscul sa dezvolte un diabet decat o persoana cu un IMC normal. Legatura dintre diabet si greutate este clar stabilita. Este absolut necesar sa facem miscare pentru a ne creste masa musculara pentru o mai buna captare a glucozei. S-a demonstrat, de asemenea, o reversie a rezistentei la insulina la pacientii cu pierdere in greutate, reversie care poate duce la normalizarea nivelului glicemiei.

Renuntarea la fumat: Una dintre consecintele nefaste ale diabetului este afectarea vaselor de sange. Fumatul produce cresterea placii de aterom in vasele de sange, cu efect asupra circulatiei si vascozitatii sangelui. Pacientii diabetici fumatori au risc crescut de boli cardiovasculare datorita dublei lovituri asupra sistemului circulator

      2. Medicamentos exista mai multe optiuni:

A. Pentru diabeticii de tip 1 si unii de tip 2 insulino-dependenti : Insulina (injectabil, doza in functie de glicemie si de cat am mancat/vom manca)

B. Pentru diabeticii de tip 2 in functie de efect medicamentele se impart in mai multe clase:

a. Care cresc utilizarea glucozei in periferie (muschi, tesut adipos, ficat): Biguanide (ex Metformin) ; Glitazone (ex Pioglitazona)

b. Care cresc secretia insulinei de catre pancreas: Sulfaminde (ex Gliclazid)

c. Inhibitori de alfa-glucozidaza – alfa-glucozidaza este enzima care produce degradarea amidonului in sistemul digestiv. Amidonul este o sursa           importanta de glucide alimentare. Inhiband enzima, intarziem absorbtia glucidelor din intestin si dam mai mult timp pancreasului sa secrete                 cantitatea suficienta de insulina – ex Acarboza.

d. Agonisti („care are acelasi efect cu”) ai glucagonului (peptida care stimuleaza secretia insulinei) – ex Exenatide

***Este foarte important sa retinem regula de aur a metabolismului: balata energetica este cea mai importanta. Daca vreau sa slabesc trebuie sa consum mai mult decat introduc. Dieta e foarte importanta pentru slabit, dar fara efort fizic care sa miste balanta inspre un consum consistent de energie, risc sa nu produc efecte vizibile.

Concluzii:

  • Diabetul este o boala metabolica datorata unui dezechilibru intre productia de insulina si efectele acesteia la nivel periferic
  • Nivele marite de glucide in sange, probleme vasculare, probleme de vedere, cerebrale si renale sunt printre principalele consecinte ale diabetului
  • Trebuie avut grija la balanta energetica si la greutate
  • In toate cazurile, este absolut necesar un control medical periodic, un consult medical la medicul de familie sau medicul specialist diabetolog si o discutie cu farmacistul referitoare la tratament si efectele adverse.

Orice incepe de la un sfat bun. Sanatatea trebuie personalizata! Pentru mai multe detalii legate de cum poti avea o viata sanatoasa intreaba farmacistul! 🙂


Diabetes – why too much sugar in your blood is bad for your memory

„Diabetes is the metabolic manifestation of a decrease in insulin production and/or a peripheral insulin resistance”. This is the text-book definition that you will find in most medicine books when you search for diabetes mellitus. This means that a diabetic patient cannot use all the sugars that he takes from his alimentation. The adverse effect of this manifestation is an increased glucose level in the blood (hyperglycaemia), glucose in the urine (glycosuria), kidney problems, eye problems, circulation problems.

There are two different kinds of diabetes, as you might already know.

Type 1 diabetes (T1D) is also called juvenile diabetes because of the fact that the symptoms may occur at an early age. It has an important genetic factor in its onset. In the case of T1D, the pancreas is not working efficiently anymore. The beta-cells of the pancreas, responsible for the production and secretion of insulin are attacked by the body’s immune cells. We can say that T1D is an auto-immune disorder. Insulin is a protein that makes the peripheral tissues (muscles, liver, adipose tissue) take in the glucose and utilise it to produce energy. Without insulin, we would not be able to use the sugars that we eat. Because of this loss-of-function, T1D patients are, in most cases, insulin-dependent. They need exogenous insulin to metabolize the sugars.

The other type of diabetes, type 2 (T2D), has another cause. This time, although the pancreas can be working fine and producing the equivalent quantity of insulin of a healthy person, the peripheral tissues stop responding to the action of insulin. That means that the muscles, adipose tissue and liver stop using the glucose as a source of energy. Not because they don’t want to, because they can’t! They become insulin-resistant. In some cases, a supplementary loss-of-function of insulin secretion can occur, thus rendering the patient insulin-dependent, as in the case of T1D.

Risks for developing a T2D:

  • Age (over 45)
  • Genetic factors
  • High blood pressure, high cholesterol/triglycerides levels
  • Lack of physical activity
  • Polychistic ovaries syndrome
  • Pregnancy, etc.

It has been shown that diabetes and obesity are inter-dependent. Obese patients which have a body –mass index (BMI) of over 30 kg/m2 (normal person BMI is between 20 and 25) have an increased risk of developing a T2D. For example, a person with a BMI of 30 has an 80 fold risk of developing a T2D compared with a person with a BMI between 22 and 23.

In the last 2 decades we have drastically modified our lifestyle and diet habits. We have become more sedentary and, at the same time, we eat more. All these changes have contributed to the increase in the incidence of T2D in the general population. And, if we do not take any measures, it will increase even more.

Diabetes Diet Coupon

Fig. 3 Piramida alimentatiei pentru un pacient diabetic. La baza piramidei se regasesc alimentele ce trebuie consumate in cantitatile cele mai mari, apoi pe masura ce ne apropiem de varf scade procentul alimentelor reprezentate

        The diet pyramid for a diabetic patient. At the base of the pyramid you can find the foods that have to be in the biggest proportion in the alimentation of the diabetic patient and, as you work your way up the pyramid, the proportion decreases

Diabetes and brain function

A recent study published in Diabetes Care shows that, in the case of uncontrolled diabetes, the high level of glucose in the blood can lead to severe consequences on memory function and on the capacity to focus. Patients with high levels of HbA1c have a lower memory capacity and decreased ability to focus compared to patients with normal levels of HbA1c. This is explained by the fact that high blood levels of glucose can affect the small arteries in the brain, producing mini-strokes and cerebral tissue cell death. The immediate consequence is a gradual loss of the brain function for memory and focus. Apart from this, the insulin resistance that these patients have can lead to a bad communication in the signalling pathways of the brain. Another side-effect of T2D patients is hypoglycaemia (low glucose levels in the blood). Hypoglycaemia can lead to loss of conscience with a great impact on the overall function of the brain. The patients that fall in this category are the elderly. Since sulphonamides are the most prescribed antidiabetics for these patients and one of the side-effects of these drugs is hypoglycaemia, there is an increased risk for brain damage in this group of patients.

Explained glycosylated haemoglobin (HbA1c) – It’s the haemoglobin that shows the glucose levels in the blood in the last 2 or 3 months. It is used as a diagnostic tool to asses weather the diabetes is controlled or not. For diabetic patients, a high value of HbA1c is correlated with an increased risk of complications due to the disease:

–          Normal values: lower than 5.7%

–          Prediabetes: 5.7-6.4%

–          Diabetes: over 6.5%

Now that we understand the causes and effects of diabetes, how can we treat it?

First of all, it is extremely important to understand that, even though we might be feeling OK and even if we think we can control the diabetes through diet and a healthy life-style, it is crucial to do a medical examination periodically and to have a physician that knows about our illnesses. T1D patients are used to this way of living. For T2D patients it’s not as clear.

What needs to be understood is that, for the moment, T1D can be treated, but not cured.

  1. Lifestyle and diet:

Diet: There are special diets that limit the use of carbohydrates (sugars). Some foods have to be avoided, for example processed sugars and foods have a big concentration of immediately available sugars (sweets, some types of chocolates, etc). It is important to know that slow-acting carbohydrates (such as the ones from fruits) can be a source of good sugars, but, in the same time they can also raise your glycaemia if you do not pay attention to the quantity. See Fig. 3, the diet pyramid for a diabetic patient!

Loosing weight/exercise: As mentioned earlier, a person with a BMI of 30 has an 80 fold increased risk to develop a diabetes compared to a person with a normal BMI. Thus, the link between diabetes and obesity is clearly established. It is crucial to move, to do exercise, to increase our muscle mass. Increasing our muscle mass will lead to a higher use of glucose. It has been shown that obese patients which lost weight had a reverse in the insulin resistance status. They became more insulin sensitive and normalised they blood glucose concentration.

Quit smoking: One of the consequences of diabetes is the fact that it affects the function of the blood vessels. Smoking leads to an increase in the atheromatous plaque of the vessels, decreasing the blood flow. Diabetic patients which smoke have an increased risk of developing cardiovascular disease.

Healthcare

Fig. 4 Diabetul inseamna ingrijire medicala continua si personalizata. Mereu discuta cu medicul si farmacistul problemele tale de sanatate pentru a-ti imbunatati calitatea vietii

       Diabetes is all about continuous and personalised healthcare. Always talk to your physician and pharmacist about your health problems to improve your quality of life

          2. Using medication:

A. T1D and T2D which are insulin-dependent: Insulin (injectable, the dose depending on their blood glucose and what they eat)

B. For T2D, in accordance to the mechanism of action:

     a. Drugs that increase the peripheral use of glucose (in muscles, liver, adipose tissue): Biguanides (Metformin); Glitozones (Pioglitazone for ex)

     b. Drugs that increase pancreatic insulin secretion: Sulphonamides (ex Gliclazide)

     c. Inhibitors of alpha-glucosidase: aplha-glucosidase in the enzyme that produces the degradation of starch in the digestive system. Starch is a          polycarbohydrate that, when lysed, releases glucose. Inhibiting the enzyme you inhibit the fast release of glucose, giving the pancreas time to                  secrete the necessary quantity of insulin. ex Acarbose

     d. Agonists of glucagon: Glucagon is the peptide that stimulates the secretion of insulin. Exenatide for example.

*** It is very important to know the golden rule of metabolism: the energetic balance is extremely important! If you want to lose weight, you have to burn more that you take in. Diet is an important step in this direction, but without exercise to push the balance towards consumption you risk to not produce visible effects.

Conclusions:

  • Diabetes is a metabolic disorder due to the lack of insulin production and/or insulin resistance in peripheral tissues
  • High levels of blood glucose, vascular problems, eye problems, cerebral and kidney problems are among the most important consequences of diabetes
  • It is crucial to watch your weight and your energetic balance
  • It is absolutely necessary to have a medical examination periodically either with you family physician or your diabetologist, and to discuss you treatment, doses and potential side-effects with your pharmacist!

Everythings in health start from a good advice. It’s time to personalise healthcare! For more details on how to have a healthy life ask you pharmacist! 🙂

7 thoughts on “Diabetul (Diabetes)

  1. As mai preciza si diabetul gestational, care poate fi tranzitoriu, atunci cand e controlat (regim alimentar, exercitii fizice si terapie medicamentoasa, cand e nevoie), sau poate avea repercusiuni atunci cand nu e controlat atat pentru mama, cat si pentru fat. Complicatiile se refera la dobandirea diabetului zaharat de tip 2 post-sarcina, obezitatea la copil, complicatii la nastere, etc.

    1. Foarte buna precizare Ana. Intr-adevar, exista acest tip de diabet tranzitoriu (de cele mai multe ori), indus de sarcina. Cum am spus in articol, printre riscurile aparitiei diabetului se numara si sarcina. Multumim pentru precizare si te invitam sa participi la discutiile noastre in continuare 🙂
      Farmacistii

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