Types of diabetes

The diabetes is a chronic disease characterized because the body loses its ability to produce insulin, or, in any case, so that it effectively fulfills its function: allow glucose contained in food reaches all body cells to become energy in the tissues need to function. People with diabetes not properly metabolize glucose, so that it remains in the bloodstream, while tissues do not receive the amount they need.

However, there are different types of diabetes:

  

• Type 1 diabetes in 13% of cases inherited a predisposition to develop this condition characterized by an autoimmune reaction of the body, so that it attacks the cells in the pancreas which produce insulin, but not it even knows why it happens. It usually begins during childhood and adolescence, but can affect people of any age. The usual symptoms relate to an abnormal thirst with dry mouth, frequent urination, tiredness or fatigue, hunger, sudden weight loss, wounds heal slowly, recurrent infectious diseases occur and sometimes blurred vision. Patients with this type of diabetes must inject insulin daily and require continued monitoring.Treatment should be complemented with a specific diet and regular physical exercise. However, they can lead a normal life.
    
• Type 2 Diabetes is also known as adult-onset diabetes, although today there has been a significant increase in its incidence among children. Besides age, other risk factors that predispose to this type of diabetes are obesity, physical inactivity, poor nutrition and family history (may be genetic in 20% of cases). In this case, the body itself can produce insulin, but their action does not have the necessary (insulin resistance) and efficacy entails the accumulation of glucose in the blood. This type of diabetes can remain asymptomatic for a long time before it is diagnosed, usually after a routine blood analytics. If not treated properly, which involves the control of blood glucose levels in normal numbers, you can have significant health consequences: cardiovascular and cerebrovascular accidents, peripheral neuropathy, amputation of one or both feet, etc.           

• Gestational diabetes occurs in advanced stages of labor and generally usually disappears after it occurs. It arises because the body can not produce the amount of insulin or use it properly to provide enough energy to body tissues. This diabetes must be treated, but generally may be sufficient to proper diet, but sometimes the use of insulin or oral medications that peritan control blood glucose levels is necessary. Importantly, women who have suffered this type of diabetes have a higher risk than others of developing type 2 diabetes over time. Also, the children of women who have had this type of diabetes during pregnancy have a higher risk of becoming obese and developing type 2 diabetes.
    
• Cystic fibrosis-related diabetes: Cystic fibrosis affects, among other organs, the pancreas, which carry a higher risk of developing the disease, which usually occurs in the second decade of life.
    
• MODY diabetes: is due to the existence of genetic abnormalities of beta cells (there are seven genes involved), which are responsible for producing insulin. It's hereditary, so it is common to find three generations of one family affected. It is characterized by the diagnosis occurs before 25 years of age and patients do not need insulin at least during the first five years.
    
• Secondary diabetes medications: some medicines may alter the functionality or production of insulin, such as glucocorticoids or immunosuppressants.

Treatment of type 1 diabetes

The type 1 diabetes is characterized by the body's inability to produce insulin it needs to move glucose into cells of all tissues and transform it into energy. The immediate consequence is that either the glucose produced by the body itself or coming from the food you eat, accumulates in the blood.

Assuming that a person with diabetes will remain the rest of his life, the treatment oftype 1 diabetes , therefore, it is to maintain the presence of glucose in the blood at normal levels. To do this you must see different aspects:

1) Provide the body the insulin it needs

Insulin can not be administered orally because it would be destroyed by gastric juices around the stomach and therefore could not fulfill its function of reducing the concentration of blood glucose by facilitating transport to the cells. That is why all patients with type 1 diabetes must inject insulin at least once a day and may reach up to four.

The type (different types differ in how quickly they begin to have effect) and the amount of insulin to be injected will depend on the characteristics of each patient (considering food and the amount of exercise you do).

  

• Syringes for single use: are traditional, with very fine needles, which are loaded with insulin dose prescribed by your doctor. It is advisable to puncture in the abdomen, arms or thighs, avoiding skin folds and abdominal midline, where the navel is included. It is also recommended that the injection is always in the same area, changing the puncture point about two centimeters of above.
• Prefilled syringes: syringes are come already loaded with the required doses.
• Insulin injection pens: devices are pen-shaped, in which a cartridge containing insulin dose required is introduced, so they are reusable.
• Insulin Pump: small portable devices are fast acting insulin administered 24 hours a day, through a tube that is implanted under the skin. The amount of insulin administered by the apparatus is adjusted according to the needs of each patient.

2) Follow a specific diet for diabetics

diet of a person with type 1 diabetes is closely related to the dose of insulin you take and your level of physical activity. Carbohydrates, proteins and fats are three main types of nutrients found in foods are the main food groups that should be present in a diet to provide the energy needed, but keep in mind that those are carbohydrates more help to raise the presence of glucose in the blood. However, insulin and exercise let reduce.

Hence diet plan of a diabetic will be designed to provide the necessary nutrients but balancing the supply of sugar to the dose of insulin and exercise being performed. You can eat almost anything, but in the indicated amounts and at the times determined for a total of five daily meals. The diabetic must learn how and what to eat, in order to establish a certain flexibility in the diet that allows even enjoy special occasions (parties, weddings, etc.), provided that the blood glucose levels are kept figures normal.

3) Practice regular exercise

Physical activity helps to reduce levels of blood glucose, which is an essential part of the treatment of type 1 diabetes . Any kind of exercise is good, but should avoid strenuous exercise, as is the If the weights. Only keep in mind that sometimes can occur hypoglycaemia (rapid drop in blood sugar) or hyperglycaemia (rapid rise in blood glucose), so you must know how to avoid them and how to act in the event that occur.

4) Check several times a day blood glucose levels

in a diabetic, the blood glucose levels must be maintained in normal numbers and the best way to ensure this happens is to do a control test several times a day (up to four), which will be determined by the physician based on the characteristics of each patient.

  

Compliance with the treatment plan will allow the patient to stay healthy and avoid long-term complications of the disease. You should never forget that there is not just this insulin, but food and exercise are important part of it. It is ultimately define and establish a way of life in which continuous monitoring of blood glucose determine the possible need to modify the overall treatment plan.

Type 2 diabetes and fat intake

In relation to the healthy population, people with diabetes have an increased risk of atherosclerosis and cardiovascular diseases or accidents, which will be even higher if other cardiovascular risk factors are associated, such as obesity, high cholesterol or high blood pressure. In addition, the accumulation of abdominal fat is especially dangerous for these patients. Consequently, in addition to losing the extra kilos and stay at a normal weight, you will need special attention to the type of food that is done, especially as regards the fat of it.

Gauze are energy reserves of the organism, which he uses when stocks are depleted carbohydrate. But each gram of fat ingested amounts to 9 calories, twice what they provide proteins or carbohydrates. We also have to differentiate between the different types of fat (saturated or unsaturated), as some of them, inadequate amounts are harmful to health by providing cholesterol; while others, such as content olive oil oleic acid, protect against the development of atherosclerosis.

With this in mind, fat should not exceed 30% of the calories provided by the diet, taking into account that saturated must be less than 10% and not to be exceeded 300 grams of cholesterol.

Therefore, the diabetic patient must have accurate information on the content and type of fat in different foods in order to balance healthy food.

Don'ts

Know the foods that provide saturated, polyunsaturated or hydrogenated fats are essential to define a balanced diet:

  

• Foods rich in it visible or animal fat; high-fat red meat, poultry skin, guts, sausage, bacon or pork fat parts.
• Whole milk and derivatives full fat milk: cream, butter, margarine, fatty cheeses.
• Fatty sauces.
• Battered and breaded.
• Fried appetizers (nachos and the like).
• Excess egg yolk (never more than 4 per week).
• Palm oil, palm kernel and coconut, with which is usually made bakery products. In packaged foods, often masked behind the term "vegetable oils".
    

The recommended

Recommendations to cover that 30% of the daily diet fat focus on the following foods:

  

• Olive oil. Should be used for cooking and frying, but for the right amount (10-30 cc.). Ideally, cook meat on the grill and salad dressing minimally.
• Fish, especially blue (sardines, mackerel, sea bass) and rich in essential fatty acids (salmon).
• Eggs, no more than 3 per week (one egg contains 250 mg. Cholesterol).
• The milk must preferably be skimmed or low, like the dairy products.
• Some nuts (sparingly): almonds, hazelnuts or walnuts.

Diabetes Christmas

Food is an essential part of the treatment of diabetes and these celebrations are characterized by excesses in meals with a significant presence of sweets and fats. But the diet control is a standard that should not prevent people with diabetes enjoy as others, because it should be some flexibility in the application of nutritional criteria which allow them not to give up eating the same as the rest.

Until it must at all times be aware of their diabetic condition, follow a few basic guidelines will help them enjoy:

  

• Control glucose levels: should be more picky than ever, because the smaller rise in blood sugar should take the necessary corrective measures: exercise, diet control, etc.
• Do not neglect the medication: taking specific medication for diabetes in the doses prescribed by the doctor is more important than ever; and so is adherence to treatment for other diseases.
• Planning nutritional food: to eat everything must be balanced diet these days.You must check the presence of carbohydrates each meal and counter festive foods with healthy foods. The important thing is the daily nutrient bottom line and if planned properly should not be necessary to modify the dose of insulin ( diabetestype 1) or medication to control glucose ( diabetes type 2). However, it is important to remember that today many of the traditional Christmas sweets suitable for diabetics are marketed, it would be important to eat these instead of those with a high sugar content.

• Portion control: lunches and dinners great celebrations are characterized by abundance. Diabetics can eat everything, but in perspective and according to their overall nutritional content. In any case, excess as to the amount of food must be counteracted by increased number and intensity of exercise. To avoid high blood sugar, people with diabetes type 1 must be clear what additional dose of insulin should be used if rapid increase the amount of food eaten.
• Moderate alcohol consumption: alcohol provide calories and carbohydrates, so you have to avoid or minimize the high alcohol (gin, rum, brandy, whiskey brandy, etc.) and no more than two drinks per day the consumption of wine, champagne or beer.
• Exercise: it is important to maintain physical activity throughout Christmas. It is advisable to prolong the rides to enable excess burn and therefore the blood glucose levels remain normal in figures. Dancing is also a great option to increase exercise.
• Weight: maintain unchanged the weight is a good indicator that they have committed excesses, or that they are duly offset.

  

 These few precautions will help diabetics to fully enjoy Christmas with their families and friends without losing control of diabetes . 

Diabetic Eye Disease

The diabetes has been identified as a major risk factor when suffer a number of eye diseases, receiving the generic name of diabetic eye disease and some of which can lead to blindness. In fact, the eyes are after the kidneys, the organs most affectsdiabetes . Hence adherence to treatment and proper control of blood glucose levels is the best way to prevent them.

The most common are:

  

• Diabetic retinopathy is the most serious eye disease that can cause diabetesand is characterized by inflammation of the retina as a result of the weakening of blood vessels that irrigate because of the presence of high levels of blood glucose.It was situation can cause blood to leak fluid or blood vessels forming such a fibrous tissue that makes the image sent to the brain blurred image. The existence of hypertension benefits their development. Sometimes this disease can cause retinal detachment and consequently cause blindness.
    
• Macular edema: It usually occurs in advanced stages of diabetic retinopathy and involves swelling of the macula. It affects the central vision.

  

• Optic neuropathy: the optic nerve is damaged by the death of nerve cells, for example, because of the blockage of blood vessels. Depending on the damage, vision loss that occurs is unrecoverable.
    
• Cataract: although it is a very eye disease of the aging process, the existence ofdiabetes can significantly advance its appearance. The cataract is characterized by the formation of a gray film on the lens due to protein accumulation, so that obstructs the passage of light blurred vision.
   
• Glaucoma: the diabetes doubles the risk of a person to suffer an increase in intraocular pressure (IOP) and therefore, for developing glaucoma. In the United States, for example, two-thirds of glaucoma have their origin in a diabetes poorly controlled, one of the major causes of blindness in the world.
    

It is important to note that some of these eye diseases caused by diabetes start without symptoms and are progressively developed, so it is advisable to perform a complete eye examination every so often to detect them as soon as possible, before the damage is irreversible. 

Treatment of diabetic retinopathy

Prevention should always be the initial treatment of diabetic retinopathy , by appropriate control of diabetes strict compliance with the treatment prescribed by the doctor and daily control of blood glucose levels to ensure they are within normal . Also, this control should extend to high blood pressure and high cholesterol. Only this will significantly reduce the risk of becoming develop diabetic retinopathy .

However, in cases in which diabetes has existed for at least ten years this risk is significant to the extent that the disease develops in 80-84% of cases, as in the case of diabetes type 1 or Type 2, respectively. When this occurs, it is usual to wait until the disease progresses and becomes a diabetic retinopathy proliferative to decide the most appropriate treatment, usually surgical. In this way you can use two different surgical techniques:

  

• Laser surgery: the laser is used to reduce the vessels which are formed with neovascularization and reduce an eventual macular edema. In this case the laser is used to cauterize the blood vessels on the retina and prevent their growth, while preserving the macula, thereby leakages of liquid reaching it and causing blurred vision is reduced. It can produce some recovery of vision, but usually this problem is not reversed. This type of surgery does not cure diabetic retinopathy , but it does help prevent complications such as vitreous hemorrhage or traction retinal detachment. Over time, several interventions of this type, always ambulatory may be necessary.

    

• Vitrectomy: this intervention should be performed in a hospital, it needs local anesthesia may require a short hospital stay, although usually it is done on an outpatient basis. Its objective is the removal of blood and scar tissue may have formed in the blood vessels, so that once again opens the way for the light to focus on the retina. Sometimes surgery involves filling the eye cavity with a special gas or serum in order to fix the retina of the eye walls and facilitate recovery, avoiding at the same time a possible traction retinal detachment.
    

Injected drugs

currently available drugs that are injected into the eye that can contribute to the treatment of diabetic retinopathy . Its function is to block what is called endothelial growth factor (VEGF) favoring the abnormal growth of blood vessels some cases, drugs may be used to aid in treatment of diabetic retinopathy .

Occasionally, steroid medications can be prescribed. In other cases, you may develop an anti-vascular endothelial growth factor (VEGF English). This treatment can help reduce macular swelling, leakage of fluid to the macula and the proliferation of abnormal blood vessels, thus helping to improve vision. Periodic (every four to six weeks) injection may be necessary. 

What is diabetic retinopathy

The diabetic retinopathy is a serious complication of diabetes that affects the blood vessels that supply the retina and is causing serious harm to the accompanying loss of vision, to the extent that this disease is a major cause of blindness in developed countries.

Although diabetes is the origin of this eye condition, diabetic retinopathy can be aggravated or have a faster evolution to the influence of other factors:

  

• Poorly controlled hypertension, since it affects bloodflow.
• Hypercholesterolemia: facilitates the formation of exudates and protein deposits that leak into the retina.
• Ethnicity: African Americans, Latinos and Americans have a higher propensity to develop this disease.
    

With regard to diabetes, the two factors that influence decisively the appearance and development of the disease is the one hand, which is not adequately controlled and, secondly, that takes many years suffering from diabetes, although is controlled. In fact, 80% of patients with type 1 diabetes and 84% of those with type 2 diabetes will developdiabetic retinopathy of varying severity.

Symptoms of diabetic retinopathy

is common for diabetic retinopathy has no symptoms in its early stages, so it is very important that diabetics undergo a routine examination periodically. When they appear, symptoms may include the following:

  

• Blurred vision and gradual loss of vision.
• Shadows vision or loss of vision zones.
• Floaters.
• Difficulty seeing at night or in poorly lit places.

Nonproliferative diabetic retinopathy

is the name given to the initial stage of this eye disease and during different alterations different eye disorders may occur in the eye:

  

• Microaneurysms: small bumps are the vessels that carry blood to the retina and may cause some leakage of fluid form.
• Bleeding retinal.
• Swelling of the macula: macular edema is the most common cause of vision loss in people with diabetes.
• Macular ischemia: the macula does not receive enough blood because they are closed or clogged blood vessels that irrigate, which makes the vision becomes blurred.
    

However, at this stage of diabetic retinopathy it is not often that vision disturbances occur, except in cases where a macular edema or ischemia occurs. Sometimes it is not necessary to begin treatment, but continuous monitoring of the patient to act when necessary.

Proliferative diabetic retinopathy

is when it comes to diabetic retinopathy nonproliferative evolves and affects numerous blood vessels, which become clogged and significantly reduce the blood supply of the retina, so that it reacts to form new blood vessels (neovascularization) that does not solve anything, as they are also affected by the disease, and sometimes produce scarring that may eventually cause a retinal detachment.

In this case, it can cause a significant loss of central and peripheral vision, for various reasons, among which must be mentioned in the vitreous hemorrhage, traction retinal detachment or glaucoma caused by neovascularization. The moment when the first symptoms of visual impairment occurs is necessary to start the treatment, surgery is usually, but can also be drug. 

Exercise and Diabetes

Although generally run regularly it can be said to be very beneficial for people with diabetes reduce rates by allowing blood glucose and consequently control the disease this statement must be undertaken with caution and providing all the necessary nuances, and physical exercise, if not done properly and not proper precautions are taken may have significant adverse effects for the metabolism of glucose.

Keep in mind that the energy needed by muscles during any sport is obtained from glucose, so it is released in greater numbers than when at rest. In this situation it is raised two different scenarios.

In the first, if the agency does not provide the amount of insulin to use glucose that is released with exercise, it remains in the bloodstream and cause a significant increase of the same. This also means that the muscles have to rely on fat stores for energy, resulting in a significant elevation of ketone bodies, which is no good either.

The other scenario is opposed to it, because if there is too much insulin and glucose it metabolized all released with exercise, and does not have the necessary reserves or not replaced, a situation of hypoglycemia may occur.    

This leads to fundamental conclusions regarding the practice of physical exercise by people with diabetes, whether the diabetes is type 1 or type 2:

  

• They should take the initiative to run or perform any other type of exercise without consulting your doctor. This will determine whether you can practice or exercise of a certain intensity and what is the most appropriate to the clinical situation of each person, and if necessary modify treatment to control diabetes .
• They should know how to prepare for the exercise safely and what precautions should be taken while doing so.
    

In any case, there are a number of recommendations that all diabetics should follow when they decide to exercise:

  

• Controlling blood glucose levels before and after exercise.
• Comply with drug treatment, be it with insulin or other medications and consult your doctor if you need to modify the dosage depending on the intensity of exercise to be performed. The latter is especially important for people using insulin pumps.
• Before undertaking the practice of exercise you have to wait the necessary time for the drug or insulin have been metabolized properly.
• As for food, we should not be run without having eaten before, even a snack and, if exercise is intense and prolonged, you should eat something and drink water during the course of it. Of course, after you've done. The doctor will adapt diet plan to exercise.
• You also have to know when to stop to recognize the symptoms that occur in situations of hypoglycemia (excessive sweating, dizziness, weakness, tremors, anxiety, headache, hunger, state of confusion or loss of concentration) and hyperglycemia (thirsty , urination, fatigue or blurred vision.
       

Another problem of people with diabetes when sport refers to the possible complications of the disease, especially with regard to wounds or blisters, as have higher susceptibility of infected and inflamed. Apart from using proper shoes to prevent blisters, should properly wash and dry your feet at least three times a day and keep nails short. 

Complications of diabetes mellitus or type 2

The better control glucose levels in blood and healthier habits are balanced life -food and exercise remain, especially-take longer to emerge the possible complications of diabetes mellitus, which may affect different parts of the body:

   

• Cardiovascular disease: this type of diabetes enhances the development of arteriosclerosis and can eventually cause calcification of arterial walls. Moreover, its coexistence with other cardiovascular risk factors -Obesity, hypertension, high cholesterol and tabaquismo- significantly increases the chances of suffering a heart attack, stroke, coronary heart disease or peripheral arterial occlusive disease (problems with blood supply in the legs).
     
• Microvascular complications: the smaller caliber vessels are those who suffer most from the effects of type 2 diabetes, causing what is known as diabetic microangiopathy and can eventually cause clogging them and causing major damage especially in the retina and the kidneys.
     
• Diabetic nephropathy: the involvement of the blood vessels supplying the kidneys can lead to kidney failure and, therefore, the need for entering a dialysis program. Moreover, this may be the cause of high blood pressure may appear.

• Diabetic retinopathy is one of the most common complications of microvascular origin and is caused by lack of blood supply to the retina, which can lead to total loss of vision in the affected eye or even blindness if it affects both.
    
• Diabetic neuropathy: particularly affects the lower limbs and manifests with the feeling of having cold feet and even pain.
    
• Diabetic foot is a consequence of diabetic neuropathy in combination with blood flow problems, which favors the appearance of skin lesions and wounds that do not heal, appearing ulcerations can become infected and cause gangrene, leading the need to amputate the foot. When this happens often the same thing happen on the other foot in a period not exceeding two years, reducing life expectancy drastically.
    
• Erectile dysfunction is a disorder that can affect men but in most cases reversed with treatment.

Treatment of diabetes mellitus or type 2

Being a chronic disease, diabetes mellitus or Type 2 is not a disorder that can be cured, but they control; and how much greater is detected before you will be your chances of success and that no serious complications in the medium and long term occurrence.

Keep in mind that when detected in its early stages glucose levels in the blood can reach easily controlled without drugs, by adopting certain habits, such as a balanced eating plan that will eliminate excess weight, regular physical exercise and cessation of snuff if you are a smoker. Only by this way in order to normalize the presence of blood sugars have to adopt pharmacological measures is not achieved.

Currently there are available numerous drugs (oral agents) that maintain controlled diabetes mellitus, by using one or combining. One of the last to have been approved, metformin, even helps with overweight. But in any case, there are two factors that are essential to ward off type 2 diabetes The first is strict compliance with the treatment prescribed by the doctor.

The other measured daily at the same hour glucose levels in blood, in order to detect its elevation. In this case you must consult your doctor to adjust or modify the treatment. The importance of this lies in the fact that oral agents can fail to work and lead to a situation in which the pancreas can not produce more insulin, so that oversight be exogenously (with injections or insulin pumps ) and at this point the risk of serious complications is much higher.

Surgery for the treatment of diabetes mellitus

A recent development in the treatment of diabetes mellitus is that it has come to understand even better the mechanisms that trigger and where the small intestine seems to play an important role.

And it has been able to control the presence of glucose in the blood without drugs in 37.5% of patients treated with oral antidiabetic agents and more than 90% of those requiring insulin administration.