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Diabetes (overview) symptoms causes and treatment

The diabetes is an incurable disease that occurs when the body fails to properly use sugar (glucose), which is a “fuel” essential to its operation. The glucose, poorly absorbed by the cells, then accumulates in the blood and is then poured into the urine. This abnormally high concentration of glucose in the blood is called hyperglycemia . In the long run, it can cause complications to the eyes, kidneys, heart and blood vessels.

Diabetes can come from a partial or complete inability of the pancreas to make insulin , which is an essential hormone for glucose uptake by cells. It can also come from an inability of the cells themselves to use insulin to absorb glucose. In both cases, the cells being deprived of their main source of energy , it follows inevitably important physiological consequences, such as extreme fatigue or healing problems for example.

Diagram of glucose uptake

Click to see the interactive diagram

The glucose comes from 2 sources: foods rich in carbohydrates that we ingest and liver (which stores glucose after a meal and pour the blood as needed). Once extracted from food by the digestive system, glucose passes into the bloodstream. For the cells of the body to be able to use this indispensable source of energy, they need the intervention of the insulin .

The main types of diabetes

For a detailed description of the types of diabetes (symptoms, prevention, medical treatments, etc.), consult each of the cards that are devoted to them.

  • Type 1 diabetes. Also known as “insulin- dependent diabetes mellitus  ” (IDDM) or ” juvenile diabetes “, type 1 diabetes occurs when the pancreas no longer produces insulin or does not produce enough insulin. This can be caused by a viral or toxic attack, or by an autoimmune reaction that causes the destruction of pancreatic beta cells, which are responsible for the synthesis of insulin. This type of diabetes mostly affects children and young adults, although the incidence in adults appears to be increasing. It affects about 10% of diabetics.
  • Type 2 Diabetes Often referred to as “non-insulin-dependent diabetes” or ” adult  diabetes”, type 2 diabetes is characterized by the fact that the body becomes insulin resistant. This problem usually occurs in people over the age of 45, but the incidence is growing rapidly among younger people. This type of diabetes, by far the most common, affects nearly 90% of people with diabetes.
  • Gestational Diabetes. Is any diabetes or glucose intolerance that occurs during pregnancy , usually during the 2 or 3 quarter. Often, gestational diabetes is only temporary and disappears shortly after delivery.

There is another form of diabetes, diabetes insipidus . It is a fairly rare disease, caused by an insufficient production of antidiuretic hormone by the pituitary, called “vasopressin”. Diabetes insipidus is accompanied by an increase in urine output, while blood glucose remains quite normal. So, it has nothing to do with diabetes mellitus . It is called “diabetes” tasteless, because as in diabetes mellitus, the flow of urine is abundant. However, urine is tasteless rather than sweet. (The term comes from the ancient methods of diagnosis: the tasting of urine!)

Diabetics, more and more numerous

Although heredity plays a role in its emergence, the increasing prevalence of diabetes in the diet and lifestyle of the West is associated with an abundance of refined sugars, saturated fats and meat, and a lack of dietary fiber. , overweight, lack of physical activity. As these characteristics increase in a given population, the incidence of diabetes increases.

According to the Public Health Agency of Canada , in a report published in 2008-09, 2.4 million Canadians were diagnosed with diabetes (6.8%), including 1.2 million between 25 and 64 years of age.

The pattern seems to be confirmed when studying the incidence of the disease in developing countries: as large segments of the population adopt a diet and a lifestyle similar to ours, the incidence of diabetes, both type 1 and type 2, increases.

Possible complications of diabetes

In the long term, people with diabetes who have inadequate control of their disease are at risk for a variety of complications, mainly because prolonged hyperglycaemia causes deterioration of blood capillary and nerve tissue , as well as narrowing of the arteries. These complications do not affect all diabetics, and when they do, it is at very different levels. For more information, see our Complications of Diabetes fact sheet.

In addition to these chronic complications , poorly controlled diabetes (eg, forgetfulness, poor calculation of insulin doses, insulin requirements suddenly changed as a result of illness or stress, etc.) can lead to the following acute complications :

Diabetic ketoacidosis
This is a condition that can be fatal . In untreated or inadequately treated type 1 diabetic patients (eg lack of insulin), glucose remains in the blood and is no longer available for use as a source of energy. (This can also happen in people with type 2 diabetes treated with insulin.) The body must replace glucose with another fuel: fatty acids. However, the use of fatty acids produces ketone bodies which, in turn, increase the acidity of the body.
Symptoms:fruity breath, dehydration, nausea, vomiting and abdominal pain. If no one intervenes, a difficult breathing, a state of confusion, coma and death can occur.
How to detect: a blood sugar high, usually around 20 mmol / l (360 mg / dl) and sometimes more.
What to do: If ketoacidosis is detected, go to the emergency department of a hospital and contact your doctor later to adjust the medication.

Testing ketone bodies
Some diabetics, when advised by the doctor, use an additional test to screen for ketoacidosis. It is a question of determining the quantity of ketone bodies present in the body. The rate can be measured in the urine or in the blood. The urine test , called ketonuria test, requires the use of small strips that are procured in pharmacies. First, put a few drops of urine on a strip. Then compare the color of the strip with the reference colors provided by the manufacturer. The color indicates the approximate amount of ketone bodies in the urine. It is also possible to measure the rate of ketone bodies in the blood. Some blood glucose machines offer this option.

Hyperosmolar state
When type 2 diabetes is not treated, hyperglycemic hyperosmolar syndrome may occur. This is a real medical emergency that is fatal in more than 50% of cases. This condition is caused by the accumulation of glucose in the blood, exceeding 33 mmol / l (600 mg / dl).
Symptoms: increased urination , intense thirst and other symptoms of dehydration (weight loss, loss of skin elasticity, dryness of the mucous membranes, increased heart rate and low blood pressure).
How to detect it: A blood glucose level that exceeds 33 mmol / l (600 mg / dl).
What to do :If a hyperosmolar condition is detected, go to the emergency department of a hospital and contact your doctor later to adjust the medication.

The symptoms of diabetes

Regardless of the type of diabetes , the symptoms are the same. They are often more insidious in the case of type 2 diabetes.

  • An excessive elimination of urine (it is frequent to get up at night to urinate).
  • An increase in thirst and hunger .
  • A loss of weight .
  • Weakness and fatigue, excessive.
  • A blurred vision .
  • An increase in the occurrence and recurrence of infections of the skin, gums, bladder, vulva or foreskin.
  • A slowdown in the process of healing .
  • numbness or tingling in the hands and feet.

Note. Untreated or poorly controlled diabetes causes severe symptoms that are important to recognize. Consult Diabetes Complications.

People at risk

People who have a genetic predisposition . For both type 1 and type 2 diabetes, it seems that genetic predisposition is a determining factor for the onset of the disease.

Risk factors for diabetes

Although there is little knowledge of the risk factors for type 1 diabetes, it is now clear that a sedentary lifestyle , Western diet (high in saturated fats and animal products, low in plant fiber), surplus weight(especially when fat is concentrated in the abdomen) and hypertension increases the risk of type 2 diabetes.

For more details, see our Diabetes Type 1 and Diabetes Type 2 charts.

Medical treatments for diabetes

To date, we have not yet found a cure to cure diabetes . The proposed treatment is intended to restore normal blood glucose levels . However, adherence to treatment and medical follow-up is crucial to avoid acute and chronic complications.

The doctor establishes a treatment plan based on the results of the blood tests, the checkup and the symptoms. Consulting a nurse, a nutritionist and, if possible, a kinesiologist helps to better direct efforts and properly control the disease.

With proper medication , a good diet and some lifestyle changes , people with diabetes can lead a near- normal life.

pharmaceuticals

Type 1 diabetes . The usual medication is always insulin , administered with daily injections or continuously using a small pump connected to a catheter placed under the skin.

Type 2 diabetes . There are 3 types of drugs (in tablets ), each with their own mode of action: to stimulate insulin production by the pancreas; help tissues use insulin to absorb glucose or slow down the intestinal absorption of sugars. These different drugs can be used alone or combined to improve their effectiveness. Type 2 diabetics sometimes need insulin therapy .

Gestational diabetes . Studies indicate that the treatment effectively prevents certain complications for the mother and the fetus . Usually, dietary changes and weight control are enough to keep blood glucose within normal range. If necessary, insulin or more rarely some hypoglycemic drugs are offered.

Refer to the Diabetes Fact Sheets for more information on medical treatments .

To find out how to prevent and treat diabetes-related conditions in the long term, see our Complications of Diabetes fact sheet.

When and how to measure your blood sugar?

The blood glucose is a measure of the concentration of glucose (sugar) in the blood. People with diabetes should monitor their blood glucose levels closely to adjust their medication (based on diet, exercise, stress, etc.) and to maintain blood glucose levels as close to normal as possible. . The control of blood glucose is all the more important as it can reduce or prevent the complications of diabetes.

Normally, people with type 1 diabetes measure their blood glucose 4 times a day (before each meal and before bedtime), while those who have type 2 diabetes can generally be content with a daily measurement or, in some cases case of 3 readings per week (see our new home blood glucose tests are useful for diabetics not treated with insulin? ).

Reading blood sugar

With a finger pricker, the subject takes a drop of blood on the tip of his finger and submits it to the analysis of a blood glucose meter which, in a few seconds, will display the blood glucose level. The results of these analyzes will be stored in a notebook or software designed for this purpose (for example, OneTouch or Accu-Chek 360º). A recent reader model comes in the form of a USB key with integrated software (Contour USB), which can facilitate the tracking of the results. A blood glucose meter can be purchased at most pharmacies. The models are many and varied, it is advisable to consult your doctor or other diabetes specialist to obtain the model best suited to your needs.

 

Glycemic values ​​for adolescents and adults with diabetes

Time of the day Optimum blood sugar Inadequate blood glucose
(intervention required)
Fasting or before the meal Between 4 and 7 mmol / l
or
between 70 and 130 mg / dl
Equal to or greater than 7 mmol / l
or
130 mg / dl
Two hours after the meal (postprandial) Between 5 and 10 mmol / l
or
between 90 and 180 mg / dl
Equal to or greater than 11 mmol / l
or
200 mg / dl

The unit mmol / l represents a unit of molar mass of glucose per liter of blood.
Source: 2008 Canadian Diabetes Association Clinical Practice Guide.

 

In case of hyperglycemia or hypoglycaemia
People with diabetes are more likely to experience extreme variations in blood glucose levels. It is therefore important to know how to react if the situation arises.

Hyperglycemia.

An increase in the concentration of glucose in the blood: when, on an empty stomach, blood sugar is greater than or equal to 7 mmol / l (130 mg / dl) or 1 or 2 hours after a meal, it is 11 mmol / l (200 mg / dl) or more. The symptoms are those of diabetes: excessive elimination of urine, increased hunger and thirst, fatigue, etc.

causes

  • Consume sugary foods in excess of what is allowed.
  • Decrease your physical activities.
  • Make a wrong dosage of medicines: lack of insulin or hypoglycemic drugs.
  • Live a stress.
  • A serious infection, such as pneumonia or pyelonephritis (kidney infection), as this increases the need for insulin.
  • Take certain medications (glucocorticoids such as cortisone, for example, increase blood sugar).

What to do

  • Measure your blood sugar.
  • If the blood glucose exceeds 15 mmol / l (270 mg / dl) and if you are diabetic type 1, measure the level of ketone bodies in the urine (ketonuria test: see above).
  • Drink plenty of water to avoid dehydration.
  • Attempt to discover the cause of hyperglycemia.
Important. If the blood glucose is above 20 mmol / l (360 mg / dl) or if the ketonuria test (ketone bodies in the urine) reveals ketoacidosis, you should see a doctor urgently . If it is not possible to contact your family doctor or Diabetes Center quickly, you must go to the emergency department of a hospital.

Hypoglycemia.

A decrease in blood glucose concentration: when blood glucose falls below 4 mmol / l (70 mg / dl). Tremors, sweating, dizziness, palpitations, fatigue, yawning and pallor are signs of hypoglycemia. Untreated hypoglycaemia may cause unconsciousness with or without convulsions .

causes

  • Make an error in the dosage of medications (too much insulin or hypoglycemic agents).
  • Skip a meal or snack, or take them late.
  • Consume sugary foods in insufficient quantity.
  • Increase your physical activities.
  • Consume alcohol.

What to do

  • Measure your blood sugar.
  • Eat a food that provides 15 grams of carbohydrate (which absorbs quickly), such as 125 ml of fruit juice or regular pop; 3 c. sugar dissolved in water; 3 c. honey or jam; or 1 cup of milk, and wait 20 minutes until the blood glucose level is stable.
  • Measure the blood glucose again and take 15 g of carbohydrate if hypoglycaemia persists.
  • Attempt to discover the cause of hypoglycemia.
I mportant. Always have a sweet food with you . If necessary, inform people around you and at work of your condition and the symptoms of hypoglycaemia.

Lifestyle of the diabetic

In addition to medication , diabetics have a great interest in establishing a diet plan and adopting a good exercise program . In fact, these non-drug interventions can lead to a decrease in the dosage of the medication and prevent certain complications. Overweight and lack of exercise are real health risks for people with diabetes.

Diet plan

tailored diet is developed by a nutrition specialist. The proposed dietary changes provide better control of blood glucose , maintain or tend to a healthy weight, improve the blood lipid profile, control blood pressure and reduce the risk of complications.

In the special diet card Diabetes , nutritionist Hélène Baribeau gives an overview of a food program designed for people with diabetes. Here are the highlights :

  • Control the amount and type of carbohydrates , and the frequency of their consumption.
  • Eat more dietary fiber because they slow down the absorption of carbohydrates.
  • Focus on good fats to improve the lipid profile and prevent complications.
  • Consume alcohol moderately.
  • Adjust the diet according to the physical exercise .

See the special diet sheet : Diabetes for more details. You will also find an example of a typical menu .

Physical exercise

It is particularly important to exercise moderate intensity cardiovascular exercises , according to taste: walking, tennis, cycling, swimming, etc.

Experts from the Mayo Clinic recommend a daily session at least 30 minutes , and added to its program of exercises of stretching and strength training with weights.

Benefits of regular exercise
– Lower blood glucose levels , including allowing the body to better use insulin.
– Lowering blood pressure and strengthening the heart muscle , which is a definite advantage since diabetics are particularly at risk for cardiovascular disease.
– Achievement or maintenance of a healthy weight , which is particularly important in the case of type 2 diabetes.
– Increased sense of well-being (self-esteem, etc.) as well as muscle tone and strength.
– Decrease in the dosage of the medication antidiabetic drugs, in some people.

Precautions
– Diabetes must be controlled before undertaking any exercise program;
– Talk to your doctor about your exercise program (the frequency and volume of insulin or hypoglycemic medications may change).
– Check blood glucose before and after exercise.
– Start with activities of moderate intensity .
– Keep carbohydrate-rich foods close at hand should hypoglycaemia occur.
– Periods of physical activity and insulin injection sessions must be sufficiently far apart from each other to avoid a sharp drop in blood sugar.

Warning. Exercise should be avoided during a hyperglycemia crisis . For any type of diabetes, if the blood glucose exceeds 16 mmol / l (290 mg / dl), abstain from exercise since the blood sugar increases temporarily during physical exertion. People with type 1 diabetes whose blood glucose level exceeds 13.8 mmol / l (248 mg / dl) should measure the level of ketone bodies in their urine (ketonuria test: see above). Do not exercise if ketones are present .

Mutual support and social support

The diagnosis of diabetes is a shock for many people. At first, it often causes stress related to many concerns. Will I be able to control my illness and maintain a lifestyle that suits me? How am I going to live with the possible consequences of the disease, both in the short and long term? If necessary, several resources (family, doctor or other health care providers, self-help groups) can offer moral support.

Stress and blood sugar

Good management of daily stress promotes better control of the disease for two reasons.
Under the influence of stress, one may be tempted to take less care of one’s health (stop planning meals, suspend exercise, monitor blood sugar less often, consume alcohol, etc.).
Stress acts directly on blood sugar, but its effects vary from person to person. In some, stress hormones (such as cortisol and adrenaline) increase the release of glucose stored in the liver into the bloodstream, causing hyperglycemia . In others, stress slows digestion and causes hypoglycaemia (It can be compared to a delay in taking a meal or a snack).

Deep breathing exercises and meditation, as well as adequate sleep can help reduce blood glucose changes caused by stress. It will also be necessary to make the appropriate changes in one’s life in order to act on the sources of stress. These practices do not replace medications (a type 1 diabetic who stops taking his insulin may die).

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