Diabetes, which untreated can have dramatic consequences, is not inevitable: simple hygienic and dietary measures can help contain it.
In France, the rate of growth of type 2 diabetes continues to increase (1). This insidious disease currently affects more than 3.7 million French people (representing 5.4% of the population) (2). Globally, it is a true epidemic partly linked to sedentary lifestyles and poor diet. If all diabetic individuals formed a country, it would be the 3rd largest country in the world (3).
However, diabetes, which untreated can have dramatic consequences, is not inevitable, and simple hygienic and dietary measures can help contain it.
Let's try to better understand its mechanism and the means we have to prevent it.
What is type 2 diabetes?
The mechanisms of diabetes
Diabetes is "a disorder of the assimilation, utilization, and storage of sugars provided by diet" (4). This results in a high blood glucose level (glycemia): this is called hyperglycemia.
When we eat, blood glucose levels increase and carbohydrates are mainly converted into glucose. The role of the pancreas is then to detect this increase; beta cells secrete insulin. This hormone's function is to allow glucose to enter the body's cells: in muscles, adipose tissues, and the liver where it can be transformed and stored. When it performs its role correctly, blood glucose levels decrease.
Another hormone, called glucagon, allows the release of stored glucose in the liver, outside of meals, during efforts, for example.
The balance of these hormones should normally maintain stable blood glucose levels in the body. In the case of diabetes, blood glucose regulation does not work.
Type 2 diabetes (formerly called non-insulin-dependent) is an acquired disease and manifests later in life, although first cases are observed in adolescents. It is characterized by insulin resistance and a relative deficiency in insulin production. It can result from two phenomena:
Either the pancreas still produces insulin, but not in sufficient quantity (referred to as insulinopenia),
Or this insulin does not properly fulfill its role as a regulator (referred to as insulin resistance), which exhausts the pancreas.
These two mechanisms can combine to varying degrees.
Symptoms of diabetes
- Diabetes often advances insidiously and without symptoms. However, some signs of hyperglycemia can give a clue:
- Fatigue, drowsiness,
- Increase in urine volume and frequency,
- Intense thirst,
- Excessive hunger,
- Unexplained weight loss,
- Blurry vision,
- Slow healing,
- Infection of the genital organs and bladder,
- Tingling in the fingers or feet,
- Irritability.
- These should prompt consultation and blood glucose testing.
Diabetes diagnosis
To diagnose type 2 diabetes, a fasting blood glucose measurement is performed. This test measures the glucose level in the blood. After a 12-hour fast, the body draws on its glucose reserves to meet its needs. In a non-diabetic person, insulin is produced and used to lower blood glucose levels. In a diabetic person, this mechanism does not occur, and the blood glucose level remains high.
Prediabetes or abnormal glucose regulation is diagnosed when fasting blood glucose is between 1.10 g/l (6.1 mmol/l) and 1.26 g/l (7.0 mmol/l), and diabetes is diagnosed when fasting blood glucose is equal to or higher than 1.26 g/l (or 7 mmol/l). Sometimes, a second blood test is necessary to confirm the results.
Causes of type 2 diabetes
If there is no precise cause explaining the development of type 2 diabetes, it is a combination of factors that triggers the disease. These include:
- Gender: men are more vulnerable than women;
- Age: the risk increases with age;
- Excess weight;
- High waist circumference, indicating accumulated abdominal fat;
- Sedentary lifestyle;
- Unbalanced diet, high in simple sugars, fat, and salt;
- High blood pressure;
- Abnormally high blood glucose levels in the past;
- For women, giving birth to a baby weighing more than 4.1 kg;
- Heredity (5);
- Poor oral health (7);
- Lack of sleep (7);
- Inflammatory conditions (8).
Complications of type 2 diabetes
Poorly managed diabetes can have dramatic consequences. Amputations of the lower limbs (diabetes is responsible for 50% of non-traumatic amputations) are often thought of. But repeated and prolonged hyperglycemia leads to serious complications throughout the body, including:
Nerve damage in the limbs, digestive system, and urinary system.
Cardiac, vascular, or arterial disorders.
Glycation phenomenon leading to premature cell aging, as well as rheumatoid arthritis and Alzheimer's disease (9).
Eye and retinal damage (diabetic retinopathy): Diabetes is the leading cause of blindness in adults under 65 (10).
Numbness and pain in the hands.
Nerve ending damage in the feet leading to injuries that may result in amputation.
Renal complications (diabetic nephropathy). Diabetes is responsible for 40% of kidney failures (11).
Dental problems (gingivitis, periodontitis), cavities.
Sexual disorders.
Sleep disorders (insomnia, hypersomnia, restless legs syndrome, or sleep apnea) (12).
Depression(13).
Prediabetes and diabetes, how to react?
As a general rule, once the diagnosis of diabetes is established, medications are not immediately prescribed, with priority given to following hygienic and dietary rules to limit the progression of the disease. Whether at risk, prediabetic, or diabetic, it is crucial to follow advice that helps regulate blood glucose levels.
Nutrition
Eating well is essential for good blood glucose control. For this, it is recommended to:
- Have 3 balanced meals a day and not skip meals.
- Maintain regular meal times.
- Consume fiber-rich foods.
- Eat slow sugars at each meal.
- Limit the consumption of sugary and low-nutrient foods.
Reduce intake of saturated fats and prefer anti-atherogenic, anti-thrombogenic, and anti-oxidative stress mono-unsaturated fats (14).
The Mediterranean diet is a good model to follow for type 2 diabetics. It mainly consists of fresh fruits and vegetables, whole grain products, legumes, nuts, seeds, and olive oil. Fish, poultry, eggs, and dairy products are consumed moderately, and red meat is only occasionally on the menu. Pastries and other sweets are reserved for rare occasions.
Weight management
Since overweight significantly increases the risk of complications, it is recommended to lose about 10% of one's weight and return to a body mass index (weight divided by height squared) between 18.5 and 25.
A balanced diet with calorie reduction and regular exercise should help achieve this goal.
Physical exercise
Regular physical activity should complement the diet and plays a significant role in preventive and curative measures. Cycling, walking, swimming, yoga, Qi Gong... it is recommended to engage in 150 minutes of cardiovascular activities per week and 2 to 3 sessions of muscle-strengthening exercises.
The benefits of physical activity are well established:
Healthy weight management;
Improved heart health;
Reduced blood pressure and blood cholesterol levels;
Stress and anxiety management;
Prevention or slowing down the development of diabetes and its complications;
Sense of well-being, improved self-confidence, and quality of life.
Tob
acco and alcohol
Not only does tobacco increase the risk of developing type 2 diabetes, but it is also partly responsible for complications (14)(15). It is therefore important to bid farewell to cigarettes. It is best to seek help to limit weight gain, which is equally harmful for patients.
Regarding alcohol, while one glass of wine per day is allowed, it is important not to consume it on an empty stomach as it significantly disrupts blood glucose levels. Therefore, limit alcohol to one glass at lunch or dinner, but avoid aperitifs.
Dietary supplements
In addition to hygienic and dietary rules, nutritional supplementation may be interesting to better control blood glucose levels and fight against the harmful effects of frequent and prolonged hyperglycemia:
Zinc: it regulates blood glucose by stimulating insulin synthesis. It has also been shown that in combination with magnesium, it improves kidney function and lowers blood pressure (17).
Chromium picolinate: it also affects blood glucose control, allows better sugar assimilation, and helps reduce cholesterol and triglyceride levels. It contributes to reducing fat mass and increasing muscle mass (18).
Carnosine: it plays a protective role against diabetic nephritis (19), may play a role in blood glucose regulation (20), and helps fight against the harmful effects of glycation (21).
Omega-3: they tend to improve insulin sensitivity (22) and prevent metabolic syndrome (23).
There is no such thing as "small" or "big" diabetes, but rather diabetes under control or not. Knowing the risks of this disease, it is important to take control of it.
Sources:
Le nombre de personnes diabétiques en France est passé de 1,6 à 2,9 millions. À cela s'ajoute les presque 700 000 diabétiques qui s'ignorent. (Source : BEH Invs, 42-43, novembre 2010)
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