Type 2 diabetes

type 2 diabetes
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Type 2 diabetes

Type 2 diabetes is also called fatty diabetes or mature diabetes. It is the most frequent diabetes: it mainly affects 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 called fatty or mature diabetes, non-insulin-dependent diabetes (DNID) is a metabolic disease characterized by a chronic excess of blood sugar (hyperglycemia).

The regulation of the sugar level (glycemia) in the body involves:

  • Sugar intake (mainly through food);
  • The “internal” manufacture of sugar (mainly by the liver);
  • The peripheral use of sugar at the level of cells: insulin, a hormone produced by the pancreas, then allows cells to capture and use glucose.
  • In the DNID, there is a poor regulation of this system, with 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 enough to use the circulating glucose that accumulates in the blood: this is hyperglycemia. Finally, the pancreas gets tired of this permanent stimulation and can then no longer make enough insulin: this is insulin-need.

These insulin resistance mechanisms particularly concern people who are overweight.

Causes and risk factors of type 2 diabetes


DNID is a very common disease which affects more than a million and a half people in France, and is constantly increasing. It represents around 85% of all diabetics, and concerns as many men as women.

The diagnosis of DNID is generally made around 40-50 years, but the age of onset of the disease is earlier.

There is not a single causative factor for the disease, but several risk factors:

  • Genetics and heredity: a hereditary factor is very often found (“several members of the family have diabetes”). In addition, certain populations are particularly affected by DNID thus confirming its genetic origin;
  • Overweight and obesity: between 60 and 90% of patients with DNID are significantly overweight;
  • Physical inactivity ;
  • Tobacco consumption;
  • High blood pressure ;
  • For women, the birth of babies weighing more than 4 kilos.


SECONDARY DIABETES
Secondary diabetes is less common. They can be found in people with or having suffered from certain diseases such as:

Inflammatory disorders of the pancreas (alcohol, overload or malnutrition diseases …);
Pancreas operations;
Liver diseases;
Endocrine disorders …
Certain medicines can also cause diabetes, temporarily or permanently (medicines to treat hypertension, hypothyroidism or hypercholesterolemia, antiepileptic medicine, etc.)

All of these risk factors should motivate regular increased surveillance.

Symptoms of type 2 diabetes
Chronic hyperglycemia is most often asymptomatic.

If the diabetes is very unbalanced, symptoms may appear and will be the signs of insulin-need, requiring a rapid medical check-up:

Significant thirst;
Very frequent urge to urinate (this is polyurea-polydipsic syndrome);
Major fatigue (asthenia);
Weight loss.
Certain health problems are frequently associated with diabetes: repeated urinary tract infections, yeast infections, furunculosis, visual disturbances, leg pain or cramps, impotence, cardiac or vascular pathology …

Diagnosis of type 2 diabetes

A blood test in the laboratory allows you to measure the blood sugar level.

A fasting blood sugar level greater than or equal to 1.26 g / l, twice, diagnoses diabetes.

Other assays can be performed: postprandial blood sugar (2 hours after a meal), glycosuria (presence of sugar in the urine), glycosylated hemoglobin, are only rarely used for the diagnosis of diabetes, but can help monitoring.

The full medical examination will be looking for signs that can guide the origin of diabetes, and that can guide the existence of complications: assessment of overweight (weight, height, distribution of fat), blood pressure measurement , auscultation of the heart and vessels, examination of reflexes and sensitivity of the legs and feet in particular …

Once the diagnosis has been established, examinations are systematic and to be repeated regularly:

Biological: lipid balance (cholesterol, triglycerides), search for albumin or proteins in the urine (micro albuminuria, proteinuria), renal function by assay of creatininaemia;
Paraclinical: fundus (even retinal angiography), cardiovascular examination with an electrocardiogram (even 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


DNID is a chronic disease. It is possible that it leads to acute complications such as diabetic comas of ketoacidosis, hyperosmolarity, lactic acidosis … The cause: ill-adapted treatments, a context of specific associated diseases, advanced age, brutal events (severe infection, shock …).

But the main characteristic of diabetes is to have long-term harmful 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 mainly affects the legs and feet, causing pain, cramps, a decrease in sensitivity, and wounds on the feet or toes (poor plantar perforation). Neuropathy can affect the nerves of organs such as the stomach, intestines, heart … and cause digestive problems, diarrhea, an accelerated heart rate, etc. ;


On the kidney: this is nephropathy, which will start with a reduction in the quality of the kidney filter, and which can lead to renal failure.
It is particularly important to fight against the other cardiovascular risk factors apart from diabetes, in particular by detecting them: high blood pressure, excess blood lipids (dyslipidemia), tobacco, obesity, heredity of heart disease …

Given diabetes and other frequently associated risk factors, patients with DNID are more often affected by angina pectoris, myocardial infarction, strokes …

Treatment of type 2 diabetes


Diabetes must be managed early in order to slow down its progression and limit complications. There are medicated means or not.

RESPECT THE HYGIENE-DIETETIC RULES


The first treatment is not in a pill, it is simply a matter of respecting the hygieno-dietetic rules:

  • The diet must be balanced (include carbohydrates, fats, proteins while respecting a good proportion of each group);
  • The eating behavior is relatively strict: 3 meals a day minimum;
  • Snacks are to be avoided. Sometimes snacks can be put in place.
  • The food program will be established at best by a nutritionist doctor, or by a dietician, in order to take account of each particular situation, and according to possibly associated pathologies.

Some dietary advice

  • Carbohydrates should not be completely eliminated, only fast sugars should be removed (sugar, sugary drinks, jam, candy, ice cream …);
  • Each meal must include bread or starchy foods in limited amounts depending on the existence of overweight, physical activity, age …;
  • The fats will be limited, with the use of fats rather of vegetable origin;
  • Favor the consumption of fish;
  • A low-calorie diet is most often advised to reduce overweight. The diagnosis of type 2 diabetes
  • A blood test in the laboratory allows you to measure the blood sugar level.

DRUG TREATMENTS
They consist of oral antidiabetics (ADO) and insulin. Four families of drugs make up the ADOs:

The biguanides;
Sulfonylureas;
Alpha-glucosidase inhibitors;
Glinids.
THE BIGUANIDES
They are represented by Metformin. They promote the action of insulin in the body, decrease the production of sugar by the liver as well as the intestinal absorption of glucose. They have no direct action on the secretion of insulin by the pancreas. They are generally prescribed as a first line for people who are overweight.

The side effects of biguanides are represented by digestive disorders (diarrhea, flatulence, bloating), quite frequent at the start of treatment, not requiring their discontinuation 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 iodine injection (for a radiological examination) and avoided before surgery.

HYPOGLYCEMIC SULFAMIDS
Many drugs exist and they have a longer or shorter duration of action, depending on 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 hypoglycemia.

These drugs are most effective in people with little or no overweight.

Contraindications are age (contraindicated in the elderly depending on the drug), advanced renal failure, liver failure, pregnancy, allergy to sulfa drugs. They are likely to have many interactions with other drugs, which put them at risk of hypoglycemia.

ALPHA-GLUCOSIDASE INHIBITORS
They act especially on the increase in post-meal blood sugar (after the meal) because they slow down the absorption of the carbohydrates contained in the food. The side effects are mainly digestive (bloating, flatulence).

Contraindications are severe renal failure, sub-occlusive syndromes (gradual or abrupt cessation of intestinal transit), malabsorption disorders …

GLINIDES
This class acts, like sulfonamides, on the pancreatic secretion of insulin. The side effects of these drugs are mainly digestive disorders. They are always started in small doses because of the risk of hypoglycemia.

Contraindications are age (avoid in children under 12), advanced renal failure, liver failure, pregnancy and allergy.

The four types of drugs mentioned above can be combined, but beware of the increased risks of hypoglycemia in the event of association.

INSULIN
Insulin therapy can intervene in the treatment of DNID in several cases:

Maximum oral treatment and not sufficient for the balance of diabetes. In this case, an injection of insulin can be associated, in particular in “bed-time” form: ADO + insulin made at bedtime. ADOs can also be replaced by 2 insulin injections (morning and evening);
Transient or definitive contraindications to ADO: generally 2 injections of insulin per day;
Insulin-need, that is, exhaustion of the pancreas and insulin deficiency.
Depending on the situation, 3 or 4 injections or even a small external insulin pump are necessary to balance the diabetes (pregnancy, pre- or post-operative surgical intervention, severe infectious problems …).

Will of course be associated with the treatment of diabetes, the management of high blood pressure, dyslipidemia (cholesterol, triglycerides …), and specific complications. The final objective is to obtain normoglycemia (normal blood sugar level) and to take charge of all cardiovascular risk factors.

THE BITE-FREE GLYCEMIA READER
No need for finger pricks to determine the doses of insulin to inject! This is the big step forward that the FreeStyle Libre blood glucose meter does not allow. The system uses a filament attached to a sensor on the skin on the back of the arm to continuously read the glucose level. A box passed over the sensor “scans” the measurements. Two years after it was taken over by Health Insurance (in June 2017), this new system could be used by several hundred thousand patients on insulin.

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 by a blood test. Other examinations must be carried out every year:

It is advisable to see an ophthalmologist to screen for a possible ocular complication;
A dental check-up is important because there is a significant risk of abscess;
A lipid assessment will also be requested to assess the cardiovascular risks;
A renal biological assessment can detect renal failure;
The patient will be asked to perform an electrocardiogram and a foot exam to check for lesions.
It is also advisable to adopt a balanced diet and to practice a gentle sporting activity.

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