Diabetes is a growing disease worldwide due to several factors, especially in Western countries. On the one hand, the progressive aging of the population, improper eating habits, and the resulting increase in obese people; on the other hand, the increase in early diagnosis and, conversely, the decrease in the mortality rate of diabetic patients.
What is Diabetes, and What Causes It?
Diabetes is a chronic disease associated with increased blood glucose due to defective secretion or malfunction of insulin, the hormone produced by the pancreas cells responsible for controlling sugar levels.
There are two types of diabetes mellitus: type 1 diabetes, affecting between 5 percent and 10 percent of diabetics, and the more common type 2 diabetes, affecting more than 90 percent of patients with diabetes. These are two very different diseases in terms of their onset and treatment and their impact on patients’ lives.
Although diabetes mellitus is an insidious disease, which can arise without overt symptoms and remain silent for quite some time, in acute cases, some symptoms we can recognize are:
- Fatigue;
- Increased urinary volume (polyuria), resulting in increased thirst (polydipsia);
- Decrease in body weight;
- Abdominal pain;
- Increased hunger (polyphagia);
- Nausea and vomiting;
- Blurred vision;
- Acetonemic breath (smell of ripe fruit).
The long-term consequences of hyperglycemia lead to the appearance of the dreaded complications of diabetes: retinopathy, nephropathy, neuropathy, and cardiovascular disease (coronary artery disease, stroke, lower limb arteriopathy).
To diagnose diabetes mellitus, a simple blood glucose test with a standard blood draw is sufficient.
What Is Type 1 Diabetes?
Type 1 diabetes occurs during childhood and adolescence (more rarely in patients who are already adults). It is caused by a total absence of insulin after the destruction of pancreatic beta cells due to the presence of autoantibodies.
We do not yet know the actual causes of this abnormal immune response. Still, it is associated with hereditary factors on which environmental elements (e.g., certain viral infections) act.
Type 2 Diabetes: What Is It
Type 2 diabetes is a multifactorial disease that tends to occur after the age of 30-40.
Several mechanisms are involved in this metabolic disorder. However, the initial defect is usually insulin resistance, which refers to reduced insulin action on target organs. As a result, the hepatic production of glucose increases, and its utilization by muscles decreases.
The most relevant risk factors for the onset of type 2 diabetes include family history, a sedentary lifestyle, a diet too high in fat and sugar, and being overweight.
Hyperglycemia in type 2 diabetes can have a gradual onset, which is why the disease may be silent for several years before developing symptoms, when complications of the disease may already be present.
How to Prevent Diabetes?
Unfortunately, it is not currently possible to prevent the onset of type 1 diabetes, although studies are exploring the possibility of intervening in the earliest stages of the disease.
Instead, type 2 diabetes can be prevented by adopting a healthy, low-fat, low-calorie diet, engaging in regular physical activity, and avoiding being overweight. These actions are particularly effective: studies confirm that a proper lifestyle is more effective than pharmacological intervention in lowering blood sugar.
Insulin: The Cure for Type 1 Diabetes
Type 1 diabetes can only be cured with insulin. Insulin can be administered via subcutaneous injections or continuous infusion systems (micro pumps). Patients can lead a normal daily routine with this treatment, which must be uninterrupted and lasts a lifetime. It is essential, however, to refer to specialized and multidisciplinary centers, both for the treatment of diabetes and complications that may arise in association with this disease.
How to Treat Type 2 Diabetes?
For the treatment of type 2 diabetes, we have several therapeutic options available. Indeed, recent years have seen the marketing of several new “innovative” drugs that are now widely recommended by major guidelines. They have proven to reduce cardiovascular risk significantly, the primary cause of mortality in type 2 diabetes.
Specifically, the reference is to analogs of GLP-1 (Glucagon-like peptide-1), a hormone responsible for facilitating insulin secretion, produced by intestinal cells following food ingestion, and to gliflozins, or sodium-glucose co-transporter 2 (SGLT2) inhibitors, which promote glucose elimination through the urine through action on a renal receptor.
Research never stops: promising new drugs, such as the dual GLP-1/GIP agonist, are already being studied.
However, it must be underlined that no single drug therapy is valid for all patients with type 2 diabetes: treatments must be tailored to the needs of the individual patient based on their characteristics and medical history.