Diabetes

1. What is diabetes?

Diabetes is a chronic disease characterized by increased levels of sugar (glucose) in the blood. Blood glucose is called glycaemia – when it is increased it is called hyperglycemia and when it is decreased it is called hypoglycemia.

The disease affects more increasingly young people around the world. Currently, this disease affects both sexes and has a high prevalence among the Portuguese population.

Diabetes is a disease that results from the human body’s incapacity to use its main source of energy (glucose), which requires insulin. Hyperglycemia occurs due to insufficient production or insufficient insulin action or both, which is most often the case.

2. What types of diabetes are there?

The disease is classified into three types:

Type 1
This type of Diabetes, rarer than Type 2, is more common in children and young people, although it can affect any age group, and it used to be called Insulin-Dependent Diabetes Mellitus. It is not usually related to weight, so most of the affected patients have normal body weight. It is caused by problems in pancreases that have a deficit in insulin production or cannot produce it in sufficient amounts. People with Type 1 Diabetes need daily insulin shots to control this condition.

Type 2
This is the most common type, it is responsible for 90 to 95% of the cases of diabetes, and was previously called Non-Insulin-Dependent Diabetes Mellitus. It usually affects people in adulthood and is closely associated with excess weight, due to poor diet and sedentary lifestyle.

It is caused by resistance to the actions of insulin, leading to insufficient compensatory insulin secretion, i.e., the pancreas secretes insulin in normal amounts early in the disease but said insulin is unable to exert its effect as it should, which makes the pancreas produce more and more insulin in an attempt to compensate for this shortcoming. Over the years, the pancreas becomes “tired” and is no longer able to compensate for the insulin resistance, which is when the hyperglycaemia emerges and is then diagnosed as Type 2 Diabetes.

Gestational
This type of diabetes occurs during pregnancy, in pregnant women who did not have Diabetes beforehand and it usually ends with the delivery. However, about half of the people who suffer from this type of disease later end up suffering from Type 2 Diabetes, if they are not properly monitored.

3. What are the diabetes risk factors?

Even though diabetes can affect anyone, there are some cases with a higher risk:

• People who have direct family members with the disease;

• Obese men and women;

• People with particularly sedentary lifestyles

• People with high blood pressure or high blood cholesterol levels;

• Women who contracted gestational diabetes during pregnancy;

• Children weighing four kilograms or more at birth;

• Patients with pancreatic issues or endocrine diseases;

• The elderly are more likely to develop the disease.

4. What are the symptoms of diabetes?

Since diabetes can cause serious complications, it is important that people pay attention to the appearance of signs suggestive of diabetes. Symptoms associated with diabetes are usually discrete and slow, which leads to late diagnosis.

Symptoms in children:

• Frequent Urination;

• Thirst;

• Tiredness;

• Headaches;

• Nausea and Vomiting;

• Rapid Weight Loss.

Symptoms in adults:

• Frequent Urination;

• Thirst;

• Tiredness;

• Headaches;

• Possible Weight Loss;

• Blurred Vision.

It is important to remember that while the symptoms in children and adolescents are quite clear, the same cannot be said for adults, especially early on in the disease, hence why it can go undetected for some time. With Type 1 Diabetes, the symptoms usually surface faster and can be more severe and bothersome. With Type 2 Diabetes, it is very common for patients to not show any symptoms, especially at an early stage.

If faced with these symptoms, you should seek your doctor immediately, to test for the presence or absence of diabetes.

5. Can eating too much sugar cause diabetes?

Contrary to popular belief, eating too much sugar, in and of itself, does not cause diabetes. However, eating too much sugar can lead to excessive weight gain, and obesity is one of the most common causes of diabetes.

6. Should the patient manage the disease?

Yes, diabetes should be managed daily by the patient through a good diet, exercise and blood tests – by measuring capillary blood glucose (fingerstick) daily and more than once a day. It is important that measurements are made, preferably, at the same times every day and before eating, so that you can compare the data.

A patient who is not controlled can have serious complications, while a patient who takes the proper precautions and keeps up the daily monitoring can have a perfectly normal life.

7. Is there a cure for diabetes?

Diabetes is a chronic disease for which there is currently no cure. However, like many other diseases, it can be treated and controlled. Most people with diabetes can lead a completely healthy and normal life, so long as they maintain their treatment and a proper diet.

8. How is it diagnosed?

Diabetes is diagnosed using the following parameters:

• Fasting blood glucose ≥ 126 mg/dl;

• Classical symptoms plus random blood glucose ≥ 200mg/dl;

• Glycemia ≥ 200 mg/dl in the 2 hours OGTT with 75g; 

• Glycated hemoglobin A1c ≥6.5%

The diagnosis should always be confirmed after 1 to 2 weeks with the same test. Fasting blood glucose levels between 110 and 126 mg/dl and/or figures between 140 and 200 mg/dl after the 2 hours Oral Glucose Tolerance Test indicates an increased risk of Diabetes.

9. What are the normal levels of blood glucose?

Currently, the following blood glucose levels are considered normal:

a) Fasting Glycemia:

• Normal between 70 and 110mg/dl  

• Altered between 110 and 126mg/dl  

• Probable Diabetes – above 126mg/dl

b) OGTT (after glucose overload of 75g)

• After 2 hours

• Probable Diabetes – 200mg/dl or above 

• Low glucose tolerance- between 140 and 200mg/dl

10. If my mother and/or father have diabetes, will I be diabetic as well?

Diabetes can be inherited. This means that an individual with diabetic parents has a higher probability of becoming diabetic. However, that is not certain, provided you lead a healthy lifestyle (balanced diet, regular exercise, normal body weight) you may never develop this disease.

In other words, having diabetic parents does not mean you will have diabetes, but it is more likely to happen than to an individual who does not have diabetics in the family.

11. Can diabetes cause infertility?

Diabetic women who do not control their blood glucose levels are associated with a higher risk of miscarriage in the first three months of pregnancy. In addition, Type 2 diabetic women are often obese or suffering from polycystic ovary syndrome, which hinders conception.

12. What is gestational diabetes?

Gestational Diabetes is the hyperglycemia that occurs exclusively in pregnant women who have not previously had diabetes. It usually disappears after the baby is born.

During pregnancy (approximately around the 24th gestational week) the body produces large amounts of hormones that help the baby to grow and the organism has a greater need for insulin. If the pancreas does not produce the amount of insulin required or if it does not perform its function properly, blood glucose increases (hyperglycemia), leading to gestational diabetes.

Hyperglycemia causes the baby to grow in size and produce insulin. But do not worry – most women with gestational diabetes have healthy babies.

Gestational diabetes must, however, be monitored until the baby is born. Maintaining your blood glucose levels as normal as possible prevents complications, for you and your baby.

Pregnant women who are now faced with diabetes should accept this step without alarmism or unfounded concerns, as most women with gestational diabetes have healthy babies. Simply check your blood sugar levels regularly and follow the directions given by your health care team.

13. Is it important to control gestational diabetes? Why?

It is important to control it so that there are no complications at birth. Currently, the oral glucose tolerance test is mandatory for pregnant women and, fortunately, in most cases of gestational diabetes, a high-quality glycemic control can prevent complications for both the baby and the mother.