Gulf Diabetes Week

 

A Call to Action: Conquer Diabetes Before It Conquers You!

#GulfDiabetesWeek

As the World Health Organization (WHO) states, about 422 million people worldwide have diabetes, the majority living in low-and middle-income countries. Around 1.5 million deaths are directly attributed to diabetes each year. And the prevalence of diabetes have been steadily increasing over the past few decades.

The GCC region is suffering extraordinary. The rapid socioeconomic development of the GCC has resulted in major demographic and epidemiological transitions, with obesity and a high prevalence of diabetes. In the MENA region one out of six adults has diabetes, this accounts for 73 million people. In addition, one out three people living with diabetes in the region is undiagnosed. By 2045, there will be 136 million people with diabetes, an 86% increase if the current trend is not halted or reversed.

Over time, diabetes may lead to serious damage to the heart, blood vessels, eyes, kidneys and nerves. If left untreated, diabetes results in poor life quality and premature death. The GCC has the highest rate of diabetes-related deaths among people of working age worldwide.

Let´s fight diabetes — with the know how to prevent, detect and treat.

What is Diabetes?

Diabetes is a metabolic disease that causes high blood sugar (glucose) levels and has a wide range of effects on the body. Today’s blog provides an overview of the several types of diabetes, their causes, potential preventive strategies, and treatment.

Depending on the type of diabetes, the body either is unable to produce insulin (type 1), or it is unable to properly use the insulin it produces (type 2). Insulin is a hormone, or chemical messenger. Insulin is produced in the pancreas after a meal and as blood glucose levels rise. Insulin is released into the bloodstream and delivered to all bodily cells. It allows glucose from our food and drinks to be carried into our cells and transformed into energy. Without insulin, our body is unable to use the glucose in our blood. While our cells are starving and lack the energy to function correctly, glucose accumulates in the bloodstream. This condition is known as diabetes.

Type 1 Diabetes: Causes and Risk Factors

Insulin is produced in special cells in the pancreas known as beta cells. n persons with type 1 diabetes, their own immune system attacks the beta cells. This process typically begins in children, teenagers, or young adults, but only rarely in older persons. Type 1 diabetes is often known as “juvenile” or “young” diabetes. Over time, more and more beta cells become destroyed. The surviving cells may compensate for a period. However, if approximately 80–90 percent of beta cells are gone, the pancreas produces very little insulin, if any at all. By then, diabetic symptoms become obvious frequently sudden and severe.

Type 1 diabetes is more common in particular families. This suggests that some people are more likely to develop diabetes due to genetics. Other factors are thought to play a role, such as special viral infections in early life or environmental circumstances. However, it is unclear what specific role they serve.

Type 2 Diabetes: Causes and Risk Factors

Things are different in type 2 diabetes, where enough insulin is made by the pancreas but the body’s cells gradually lose their ability to use it. Insulin helps cells to absorb sugar (glucose) from the blood, such as those in the liver and muscles. If insulin loses its effectiveness, the body will be unable to adequately use glucose in the blood. This causes an increase in blood glucose levels. This induces the pancreas’ beta cells to make more insulin to compensate for its limited efficacy. As a result, people with type 2 diabetes usually have high blood insulin levels, whereas type 1 diabetics have very little insulin levels.

Type 2 diabetes was previously known as “adult-onset” diabetes due to its prevalent diagnosis later in life. However, with obesity being a rising risk factor already in children, type 2 diabetes is a growing health concern at a younger age. Other associated risks for developing type 2 diabetes include low physical activity and sedentary lifestyle, smoking, a low-fiber, high-fat, and sugary diet, and a family history of diabetes.

Type 2 diabetes is much more common than type 1 diabetes. About 90% of people who have diabetes have type 2 diabetes.

Gestational Diabetes

Gestational diabetes occurs during pregnancy when blood glucose levels are higher than usual but lower than those required to diagnose diabetes. Women with gestational diabetes have a higher risk of complications during pregnancy and delivery. These women, and maybe their children, are at a higher risk of developing type 2 diabetes in the future. Statistically, approximately one out of every two women who had gestational diabetes would subsequently acquire type 2 diabetes.

Gestational diabetes is detected by prenatal screening rather than reported symptoms.

What Are Signs of Diabetes?

An elevated blood sugar level isn´t always immediately noticeable. But very high blood sugar (hyperglycemia) can cause the following problems:

• Frequent urination
• Extreme thirst
• Tiredness and exhaustion
• Trouble concentrating
• Nausea
• Dizziness
• Confusion, drowsiness, or even lose consciousness (diabetic coma).

These symptoms may appear rapidly in type 1 diabetes due to a shortage of insulin. Because they impact children, adolescents, or young adults, they are usually immediately recognized.

In type 2 diabetes, the process is substantially slower. Insulin overproduction may compensate for poor function for a period of time. Blood glucose levels often rise slowly. Because type 2 diabetes affects the elderly, the increased need to urinate is occasionally misconstrued as bladder or prostate problems. Tiredness, lack of strength and energy, and attention issues are incorrectly attributed to aging. As a result, type 2 diabetes can develop gradually over several years, making the diagnosis sometimes unexpected. Having high blood sugar levels for years eventually results in additional symptoms of the organ damage caused by chronically high blood glucose levels, such as

• problems with erections.
• diabetic retinopathy leading to worsened vision.
• peripheral neuropathy (damage of nerves) leading to decreased foot sensitivity.
• slow or poor wound healing
• atherosclerosis resulting in diminished blood flow to the legs and feet (PAD), coronary arteries (CVD), or brain (stroke).

How is Diabetes Diagnosed?

If diabetes is suspected, doctors will first inquire about any symptoms or other diseases before doing a physical examination.

Then, blood sugar (glucose) levels will be measured. Diabetes is diagnosed when blood sugar levels exceed specified internationally agreed-upon levels (“thresholds”). The diagnosis is typically only established if at least two separate blood glucose levels are abnormally high. However, if a person also exhibits typical symptoms (see above), a single too-high value is sufficient to diagnose diabetes.

Fasting blood sugar test

This test is often done in the morning before breakfast. Diabetes is diagnosed if the fasting blood sugar level is over 126 milligrams per deciliter (mg/dL). That’s 7 millimoles per liter (mmol/L).

HbA1c

Sugar molecules can bind permanently to the red pigment in our red blood cells known as hemoglobin (Hb). The HbA1c value shows how much of the hemoglobin has been changed (“sugared”, technical term is “saccharified”) in this way. As red blood cells live for around 2–3 months, and there is a constant turnover of these cells, HbA1c is a measure of the average blood sugar level over the last 8 to 12 weeks. People with an HbA1c over 6.5% are considered to have diabetes.

Random glucose test

Blood sugar levels are also often tested when blood is taken for another reason. In these random tests, levels above 200 mg/dL (11.1 mmol/L) are a sign of diabetes. Then doctors usually recommend a fasting blood sugar test or a glucose tolerance test to find out for sure.

Glucose tolerance test

The oral glucose tolerance test (OGTT) measures how well our body can process sugar. It is done if the results of other tests aren’t clear or if a person has a high risk of developing diabetes. First, you drink a glass of water with 75 grams of sugar (glucose) dissolved in it. This makes your blood sugar levels rise, but they should go back down quite quickly after that. If they’re still above 200 mg/dL (11.1 mmol/L) after two hours, you’re diagnosed with diabetes.

If blood sugar levels are high enough to be causing typical diabetes symptoms, sugar can usually also be detected by urine test strips. However, this test can be positive also under other conditions such as bladder infection. In addition, the test is not useful for an early detection of diabetes and is therefore not used as a diagnostic criteria any more.

Diabetes Treatment

Depending on the type of diabetes, blood sugar monitoring, insulin and oral drugs may be part of your treatment. Eating a healthy diet, staying at a healthy weight and getting regular physical activity also are important parts of managing diabetes.

Treatments for all Types of Diabetes

An important part of managing diabetes — as well as overall health — is keeping a healthy weight through a healthy diet and exercise plan.

Healthy eating: A diabetes diet is simply a healthy-eating plan beneficial for the whole family. Vegetables, lean proteins and whole grains are high in nutrition and fiber and low in fat and calories. The fibers slow down the extraction of glucose from the food in the bowel. Therefore, the glucose supply is more steady, peak values of glucose are avoided. Saturated fats, refined carbohydrates and sweets should be cut down on and eaten only occasionally.

Understanding what and how much to eat can be a challenge. A registered dietitian can help creating a meal plan that fits the individual health goals, food preferences and lifestyle. This may include carbohydrate counting in type 1 diabetes or when using insulin as part of the treatment.

Physical activity: Everyone needs regular aerobic activity, including people who have diabetes. Physical activity lowers the blood glucose level by moving glucose into the body cells, where it’s used for energy. Physical activity also results in strengthening our muscles which are full of insulin receptors and therefore an important tissue for glucose regulation. Used muscles make our body more sensitive to insulin, glucose is transported into cells more easily.

Some sport activities, however, are not recommended if diabetes complications in the eyes or at the feet are already present. Therefore, diabetes patients should consult their doctor before starting new or more intense physical activities. Then it is important to choose activities which are enjoyable and may be easily integrated as part of the daily routine.

For every person, healthy or diabetic, at least 30 minutes of moderate physical activity most days of the week are recommended. Also avoid sitting for too long. Try to get up and move if you’ve been sitting for more than 30 minutes.

Well-being: In addition, supporting mental health is crucial because diabetic persons may experience significant stress due to the demands of daily life and the diagnosis itself. We will dedicate our next blog on the interaction between diabetes and well-being.

Treatments for Type 1 Diabetes

In type 1 diabetes, the focus of treatment is to monitor blood sugar levels every day and regularly use insulin. The aim of insulin therapy in diabetes is to make up for the lack of insulin in the body, to lower blood sugar levels, and prevent long-term complications as much as possible. There are different types of insulin therapy. All of them aim to regulate blood sugar levels in order to stop them from getting too high or too low.

Blood glucose levels are not only affected by the amount of injected insulin, but also by food and drinks, as well as how much energy is used during physical activity. The time of day, inflammatory diseases, other medications and hormonal changes can influence blood glucose levels too. The know how about glucose regulation is the only way to adjust insulin therapy optimally.

There are various types of insulin medicines which mainly differ in how long their effect lasts. Some types of insulin cover the body’s basic needs: they work slowly and constantly over half a day or a whole day (intermediate-acting or long-acting insulin). “Short-acting” insulin is used at mealtimes to provide the insulin needed right after eating.

Nowadays, people with diabetes can generally choose one of the various types of insulin therapy themselves in order to fit it into their daily routine as well as possible.

Conventional insulin therapy: involves injecting insulin twice a day. This approach is often chosen by people who have a fairly regular daily routine and prefer to inject their insulin at the same times every day.

The medication used in conventional insulin therapy is intermediate-acting or long-acting insulin that works for at least half a day. This type of insulin can either be used alone or together with short-acting insulin. Most people use a standard mixture of short-acting and longer-acting insulin. They inject this mixture once before breakfast and once before their evening meal. In order to compensate for the effect of insulin, they have to eat fixed amounts of food regularly over the course of the day. People who do a lot of physical exercise balance their blood sugar out by eating extra snacks between meals. So, with conventional insulin therapy, meals and physical exercise are planned around the insulin.

Choosing conventional insulin therapy can mean leading a fairly regimented lifestyle. And, compared with intensive insulin therapy, conventional insulin therapy is much less effective at preventing complications associated with type 1 diabetes. So it’s usually only considered as a treatment option for people with type 1 diabetes who can’t deal with intensive insulin therapy.

In Intensive insulin therapy, the amount of insulin can be adjusted flexibly and spontaneously based on a person’s blood sugar levels, how much they eat and how physically active they are. Regular blood sugar monitoring is essential. Insulin can either be inject by the patient several times a day or using an insulin pump. To cover basic insulin needs, longer-acting insulin is injected once or twice a day. This is often referred to as “basal insulin.” Short-acting insulin is also injected before each meal in order to allow the body to process the carbohydrates in the food. This is known as a “bolus dose” or “mealtime insulin.”

People who have an insulin pump only use short-acting insulin. The pump regularly delivers small amounts of insulin to continuously cover the body’s basic needs.

One goal of intensive insulin therapy is to keep blood sugar at almost normal levels. It also aims to allow greater flexibility in the daily life, as there is no need to eat meals at fixed times or make sure eating always the same amount of carbohydrates. Instead, insulin is injected according to the need at the time. The amount of insulin needed will also depend on blood glucose levels, the time of day and whether physical activity is planned.

Intensive insulin therapy has been shown to have health benefits compared to conventional insulin therapy. It can lower the risk of developing diabetes-related complications, particularly those affecting the eyes, kidneys, and nervous system.

Additional treatment with tablets: The medication dapagliflozin has been approved for the treatment of type 1 diabetes for patients with a body mass index (BMI) of 27 kg/m² or more if treatment with insulin doesn’t lower their blood sugar levels enough. Research suggests that this can help to keep blood sugar levels under control better. But the medication often has side effects such as genital infections and gastrointestinal (stomach and bowel) problems.

Treatments for Type 2 Diabetes

A number of factors influence which treatment approach for type 2 diabetes is suitable. They include other health problems, age, individual life circumstances and personal goals.

Lifestyle changes: Losing weight and getting more exercise can lower blood glucose levels. Quitting smoking helps to reduce insulin insensitivity and the risk of cardiovascular (heart and blood vessel) disease. Some people manage to get their diabetes under control simply by changing these kinds of habits.

Medication: Many people need medication to regulate their blood sugar levels. Some take tablets, others inject insulin. It is also possible to use a combination of tablets and injections.

Surgery: If highly obese diabetic people (BMI ❤5) find it hard to lose weight, surgical approaches such as stomach stapling may be an option.

Treating other health problems: A lot of people who have type 2 diabetes also have other health problems, such as high blood pressure or high cholesterol. These conditions also need treatment to reduce the risk of cardiovascular disease.

Choosing the Right Type 2 Diabetes Treatment

The aim of medical treatment of type 2 diabetes is to prevent the diabetes from leading to complications. Constantly high blood sugar levels can cause damage to blood vessels and nerves resulting in medical problems affecting the kidneys, feet and eye. The risk of stroke or heart attack may also increase. Blood-sugar-lowering drugs are used with the aim of preventing or delaying these health problems as much as possible.

Medications for type 2 diabetes (antidiabetics) include:

Metformin: This drug reduces the amount of glucose produced by the body, and has been used for a long time. It is the best studied diabetes medication, as well as one of the best tolerated. For this reason, doctors usually recommend trying metformin first. The most frequent possible side effects include diarrhea and feeling unwell, especially if metformin isn’t taken together with a meal. People with decreased kidney function, heart failure or an alcohol dependence have an increased risk of more serious metabolic side effects. For this reason, they aren’t usually allowed to take metformin.

Sulfonylureas: These drugs help the body to produce more insulin. Like metformin, they have also been in use for quite a while. Episodes of hypoglycemia are a bit more common when using sulfonylureas than when using metformin. Some people also gain weight when they start the treatment.

Glitazones: aim to strengthen the effect of the insulin made in your body. Pioglitazone is the only glitazone that is still on the market. Compared to sulfonylureas, pioglitazone is less likely to cause hypoglycemia. Possible side effects include weight gain, bone fractures, water retention and heart failure. Pioglitazone may slightly increase the risk of bladder cancer. Due to pioglitazone’s potential side effects, it is not the drug of first choice.

Glinides: include the drugs nateglinide and repaglinide. They increase insulin production in the body. Compared to metformin, glinides are more likely to lead to mild and moderate hypoglycemia. Glinides can cause weight gain.

Gliptins (dipeptidyl peptidase-4 inhibitors): also stimulate the production of insulin. They include the drugs linagliptin, saxagliptin, vildagliptin and sitagliptin.

Gliflozins (SGLT2 inhibitors): include the drugs dapagliflozin, empagliflozin, ertugliflozin and canagliflozin. Their name Sodium-GLucose coTransporter-2 describes their mode of action: They block a transporter in the kidneys which makes sure, glucose does not leave the body through the urine. By inhibiting the SGLT-2, glucose is released with the urine, thereby blood glucose levels are lowered. The constant glucose content in the urine may rise the risk of urogenital infections, as glucose is “food” not only for our body cells, but also for bacteria.

Incretin mimetics (GLP-1 agonists): are hormone-like drugs that are injected under the skin with a pre-filled pen. Research is ongoing to provide them also as pills. They aim to have the same effect (“mimic”) as the hormone glucagon-like-peptide-1 (GLP-1). This hormone is produced in the bowel and signals that carbohydrates have been eaten and glucose will soon arrive in the blood. GLP-1 then stimulates the pancreas to make more insulin. Examples of these drugs include liraglutide, dulaglutide, lixisenatide, exenatide, semaglutide and albiglutide.

In several scientific studies, Gliflozines (SGLT2 inhibitors) and Incretin mimetics (GLP-1 agonists) have demonstrated robust and significant reductions of major adverse cardiovascular events and additional cardiovascular outcomes, such as hospitalizations for heart failure. This evidence has changed the landscape for treatment of patients with type 2 diabetes. Both diabetes and cardiology guidelines and professional societies have responded to this paradigm shift by including strong recommendations to use SGLT2 antagonists and/or GLP-1 agonists to reduce cardiovascular risk in high-risk type 2 diabetes patients, independent of the need for additional glucose control. In addition, GLP-1 agonists induce satiety and lead to weight loss — a frequent goal for type 2 diabetics.

Insulin therapy in type 2 diabetes: People with type 2 diabetes usually only need insulin if treatment with tablets doesn’t reduce their blood sugar levels enough. That is rarely the case, though. Two different types of insulin are available: human insulin and insulin analogues. Both are genetically engineered, but have different chemical structures. Short-acting insulin analogues can lower blood sugar a bit faster than human insulin can. But there is no clear scientific proof that this has added health benefits. Human insulin and insulin analogues work equally well in the treatment of type 2 diabetes.

Which Medication is the Most Suitable for Me?

Diabetes treatment is not a “one-size-fits-all” situation. Whether or not a person has to take antidiabetic medication at all, and which drugs are best suitable, depends on a number of various criteria, including:

• the person’s treatment goal
• their age
• their general health
• whether they have other medical conditions
• whether they are taking other medications
• how well a drug works and how well it is tolerated

Doctors and patients must choose from a wide range of medications and pharmacological classes to treat type 2 diabetes. Most diabetes drugs efficiently reduce blood glucose in persons who have a minimal risk of heart disease or no history of diabetic kidney damage. Before selecting a medication, it is vital to ask certain pertinent questions: Is my blood glucose level within the recommended range? Do I have renal or heart disease? What are the side effects of suggested medicines? Is it a pill or an injection, and how frequently is it taken?

Regardless of which treatment is selected, reassessment of diabetes control is recommended every three to six months, followed by modifications to treatment if needed.

It is essential to have an open and honest conversation with your doctor about what is most important to you and what aligns with your goals and preferences. Management of a complex disease like diabetes takes an entire team, with you being the key team member.

TheKnowHow Independent Second Opinion Service

Are you or a loved one suffering from diabetes? You are unsure about your current treatment, or not satisfied with its effect?

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