Diabetes mellitus

Diabetes mellitus (type I or juvenile or insulin-dependent or type II or adult type or gestational diabetes etc. commonly called "sugar") is a disease with a global distribution and serious complications for sufferers.
Prevention and intensive monitoring are useful weapons in its treatment.

What is Diabetes Mellitus?

Diabetes mellitus (DM) is a condition characterised by impaired carbohydrate metabolism or, more simply, the body's inability to use carbohydrates, resulting in an increase in blood glucose levels. Despite its name, this disorder does not only affect the metabolism of carbohydrates but also of other essential components of food, fats and proteins. At the basis of this problem is a deficiency of a pancreatic hormone, insulin. This deficiency involves either reduced production of the hormone or increased needs of the body to which the pancreas cannot respond.

Diabetes mellitus classification

Depending on the insulin disorder, DM is classified into the following types:

• Type I DM or juvenile or insulin-dependent DM. In this type, the pancreatic cells that produce insulin are destroyed by an autoimmune mechanism (i.e. by antibodies produced by the body itself). It mainly affects young people, insulin is completely absent and the patient needs insulin treatment from the beginning.
• Type II or adult-type DM. It is characterized by increased resistance of the body to insulin so that the insulin produced is not sufficient to meet the metabolic needs of the body. Insulin levels may be normal or even elevated in the early stages of the disease and the patient is treated with antidiabetic tablets. In advanced stages, however, pancreatic cells become insufficient and insulin administration becomes necessary as a treatment. This type of diabetes is characterised by heredity. Type II DM is the vast majority encountered in everyday medical practice.
• Diabetes of pregnancy. It is DM that first appears during pregnancy. It is treated with diet and insulin.
• Other specific types of DM. There are different types of DM due to drugs, hormonal disorders, pancreatic diseases, genetic syndromes. We will not mention more about these types.

Epidemiological data on Diabetes mellitus

Around 285 million people around the world were affected by DM in 2010. This is expected to double by 2030, with a greater increase in developing countries in Asia and Africa. Of these, 90% of patients are affected by type II DM. This type is mainly associated with sedentary lifestyles and obesity and is characteristic of societies that have adopted a 'western lifestyle'.

Studies have shown that diabetes increases the risk of coronary heart disease (2-4 times) and the risk of vascular stroke (about 2 times) and is the leading cause of kidney failure. Finally, diabetes is the leading cause of blindness in people aged 20-74 years.

Symptoms of Diabetes Mellitus

In its early stages the disease may be completely asymptomatic and therefore the patient may not know that he or she has the disease. However, the complications of diabetes (listed below) progress from these stages and often these are the first manifestations of the disease. The symptoms of DM involving elevated blood sugar levels are:

• Polyuria
• Polydipsia
• Dry mouth
• Polyphagia
• Weight Loss
• Blurred vision
• Fatigue

Complications of Diabetes Mellitus

The complications of DM are divided into immediate and distant complications. The immediate complications are diabetic coma and hypoglycaemia and can pose an immediate risk to the patient's life. On the other hand, the more distant complications have a slower progression but are serious factors of morbidity and mortality of diabetic patients, affecting their quality of life. The ultimate complications are:

• Diseases of the heart and large vessels such as coronary heart disease, myocardial infarction, stroke are more common in people with diabetes mellitus. These complications are the leading cause of death and hospitalisation of people with type II DM. All patients with diabetes should be screened with a cardiogram every year, and if they have symptoms suggestive of heart disease (chest or epigastric pain, shortness of breath, lower limb swelling) they should undergo more specific tests and have regular cardiac monitoring.
• Kidney diseases. As mentioned above, diabetes is the main cause of kidney failure. All patients should undergo regular monitoring of renal function as part of diabetes monitoring. Simple blood tests (urea, creatinine) as well as 24-hour urine collection for albumin determination are sufficient.
• Eye disorders. Patients suffering from diabetes mellitus should undergo an annual preventive eye examination to check for complications such as retinopathy, cataracts and glaucoma. The presence of DM increases the risk of blindness by 25 times.
• Peripheral vasculopathy and neuropathy. Diabetes damages peripheral vessels and nerves causing burning pain in the legs (especially at night), decreased sensation, intermittent claudication (pain in the calves when walking that improves with rest), and ulcers that are difficult to heal. The result of the above is a reduced quality of life and possible amputations of the lower limbs. The value of regular inspection and foot care as directed by the attending physician should be emphasized.
• Predisposition to infections. It has been shown that diabetes reduces the body's defense against viruses and microbes. In these people, preventive vaccination (flu, pneumococcal) is necessary to prevent serious infections such as pneumonia and meningitis.

For these reasons, patients suffering from diabetes need regular monitoring by a specialist both to achieve glycemic control and to prevent and treat the complications of the disease.

Diagnosis of Diabetes Mellitus

In addition to regular monitoring, early diagnosis of diabetes is important. Early interventions have been shown to reduce the risk of developing complications and improve patients' quality of life.

The diagnosis of DM is made when:

• The patient has symptoms (polyuria, polydipsia, weight loss) and a blood sugar value equal to or higher than 200 mg/dl
• Blood sugar after 8 hours of fasting equal to or greater than 126 mg/dl; or
• Blood sugar 2 hours after taking 75g of glucose (blood sugar curve) equal to or greater than 200 mg/dl
• In recent years, the measurement of glycosylated haemoglobin has been used abroad in the diagnosis of DM. Thus values greater than 6.5 are considered diagnostic of the disease. In the guidelines of the Greek diabetological society, this test is not included in the diagnostic criteria for diabetes and can therefore only be used as an indication.

Pre-symptomatic screening of patients with Diabetes Mellitus

Some people have an increased chance of developing diabetes and should undergo screening which includes fasting glucose measurement.

These individuals are:

• People over 45 years old
• Central type obesity, i.e. men with a waist circumference greater than 102 cm or women with a waist circumference greater than 88 cm
• People with a body mass index greater than 30
• History of diabetes in the immediate family
• gestational diabetes or giving birth to children weighing more than 4 kg
• Hypertension or cardiovascular disease
• Polycystic ovaries
• Taking medicines that cause diabetes (e.g. cortisone).

Prevention of Diabetes Mellitus

Just as important as diagnosis and treatment is the prevention of DM with early interventions on risk factors such as poor diet, obesity and sedentary lifestyle.
Nutrition and maintaining body weight at normal levels

Poor diet is an important risk factor for developing DM. A high-fat diet predisposes to obesity which is associated with insulin resistance and the development of type II DM.

The Mediterranean diet is the recommended diet for the prevention of cardiovascular events (vascular strokes, coronary heart disease, peripheral vascular disease), obesity and type II DM. This diet is based on olive oil, and consists of low-fat, high-fibre foods such as fresh fruit, vegetables and whole grains. Instead, foods containing saturated fatty acids such as red meats, cold cuts, butters and margarines, yellow cheeses and ready-made foods such as hamburgers, ready-made puff pastry products, precooked foods and foods fried in palm oil should be avoided.
The distribution of calories evenly throughout the day in meals and snacks (breakfast, brunch, lunch, afternoon, dinner) is also important and should be emphasised over a hearty meal a day suggested by modern lifestyles.

Exercise
The combination of a healthy diet and exercise is a cornerstone in maintaining good physical health and protecting against obesity and diabetes. Moderate aerobic exercise (cycling, brisk walking, swimming) is recommended for 20-30 minutes, 4 or 5 times a week. It is helpful to consult a personal physician about the intensity and duration of exercise for people over 40 years of age and those with a medical condition.

Treatment of Diabetes mellitus

After the diagnosis of diabetes, diet and exercise continue to be the cornerstone of treatment, which together with hypoglycaemic treatment, preventive interventions (e.g. flu vaccination) and regular screening for complications (cardiogram, funduscopy, etc.) ensure a good quality of life for people with diabetes.) Regular glucose and glycosylated haemoglobin measurements are necessary to monitor treatment. Desirable values for excellent control are fasting (8-hour fasting) sugar less than 120 mg/dl and postprandial (2 hours after a meal) below 160 mg/dl. For glycosylated haemoglobin the desirable values are below 7%. These values are individualised for each patient and are determined by the treating physician.