Diabetes is a chronic disease that is on the rise around the world. In France, 3.5 million people are concerned, and it is estimated that 600,000 people live with the disease without knowing it. If there is no cure for diabetes, we can learn to live better with the disease and reduce the risk of complications.
Diabetes is characterized by the presence of excess sugar in the blood, called glucose. When the blood glucose level exceeds 1.26 g on an empty stomach twice (or at any time of the day if the glucose is above 2 gr/)l, in the presence of the above symptoms, it is called diabetes. The body of people with diabetes is unable to regulate this excess blood sugar properly.
In Which Forms Come Diabetes
There are two primary forms of diabetes: type 1 diabetes and type 2 diabetes. Type 1 diabetes is most often diagnosed in childhood but can be detected in adults up to 35. It affects 10% of people with diabetes. This form appears when the pancreas does not produce enough insulin, which regulates blood sugar levels. Symptoms are increased thirst and faintness, increased urination (the person with diabetes urinates more), fatigue, weight loss despite a preserved appetite, and muscle wasting.
Nine times out of ten, diabetes is type 2. It mainly affects sedentary and overweight adults over 40 years of age, affecting younger and younger people. It affects men more than women, the risk increases in case of high waist circumference (due to the accumulation of fat in the abdomen). When insulin is produced, the body’s cells are unable to use it properly. There is a kind of resistance on the part of the cells, limiting the absorption of glucose, so it remains in excess in the blood.
This form remains without symptoms for a long time, and the late diagnosis can lead to severe complications: blindness, kidney failure, amputation, etc.
What Are the Treatments for Diabetes?
Type 1 diabetes is mainly treated by insulin therapy, i.e., insulin injections that allow the patient to regulate his or her level, or by insulin pump (see next paragraph). The diabetic child can have a regular diet, similar to that of his brothers and sisters, but it must be balanced and varied. The dose of insulin is always adapted to the food intake.
The first treatment for type 2 diabetes is a diet that should avoid fatty foods and favor those rich in fiber, such as fruits and vegetables. Starchy foods should be chosen wholemeal or pulses, and alcohol should be limited because it is rich in sugars. If the glucose level has not fallen after six months, antidiabetic tablets can be prescribed, and many families of medicines are possible. These can be metformin (from the biguanide family, which increases insulin sensitivity) or sulfonamides, glinides that stimulate insulin production. Another class, incretins, is also prescribed (see paragraph below). Other drugs reduce the absorption of sugars (alpha-glucosidase inhibitors). Still, they are very little used, or they promote their elimination through the urine (SGLT2), but they are not yet marketed in France. Another exciting class is the DPP4 inhibitors “because they provoke less hypoglycemia.
Finally, insulin administration is sometimes necessary, and regular physical activity is strongly recommended as part of the management.
It should be remembered that it is the “hyperglycemic jolts” that are dangerous for the arteries: those of the heart (the risk of heart disease is multiplied by fifteen in people with diabetes), kidneys (10% of dialysis patients are untreated diabetics), legs (5,000 amputations each year are also linked to untreated diabetes) and eyes (diabetes is the leading cause of blindness in adults). Because type 2 diabetes is diagnosed late, it is often diagnosed at the time of complications, while type 1 diabetes is diagnosed earlier, complications are rarer at the time of diagnosis.
As long as there are no complications, people with diabetes do not feel sick and therefore often find it difficult to accept the necessary follow-up and treatment. Even when the disease has progressed, follow-up remains difficult.
The Challenges of Good Glycemic Control: Blood Glucose Monitoring
Diabetes is a chronic disease for which there is no cure. However, it can be well-balanced with appropriate treatment and daily blood glucose monitoring.
To control their diabetes, people need to monitor their blood glucose levels very regularly to make sure that they are neither too high (hyperglycemia) nor too low (hypoglycemia).
Hyperglycemia is the cause of future complications. High blood glucose levels damage tissues and cells. Conversely, hypoglycemia is associated with a risk of malaise and coma.
Measuring your blood glucose and maintaining a right blood glucose balance allows you to :
- Limit the frequency and severity of hypoglycemia in everyday life.
- Reduce hyperglycemia and, therefore, the risk of medium and long-term complications.
Blood Glucose Controls and Measurements
For people with type 1 diabetes, blood glucose testing should be done by patients several times a day. This component of treatment is one of the main constraints.
Conventional blood glucose control is achieved with capillary blood glucose. A fingertip is pricked with a lancet, and a drop of blood is placed on a strip that has been inserted into a blood glucose meter. It takes a few seconds for the meter to display the glucose level. The daily number of blood glucose measurements is usually between 3 and 6 per day.
In severe hyperglycemia, a ketone test should also be done to check for acetone in the blood.
To Go Further… Continuous Glucose Testing
Many fluctuations take place without being detected by capillary blood glucose levels alone.
Continuous glucose measurement is the level of glucose in the fluid between the cells (interstitial fluid).
When we eat, carbohydrates are converted into glucose (sugar). This glucose passes from your digestive tract to your blood. The blood then carries it throughout the body. Finally, glucose moves from the blood to the interstitial fluid to nourish cells and muscles.
The glucose sensor measures the sugar level in the interstitial fluid.
It is essential to know that you will not get the same value on your glucose sensor as you will on your blood glucose meter; this is entirely normal.
What Does Continuous Glucose Testing Do for You?
Your meter measures blood glucose in the capillary vessels while the sensor measures glucose in the interstitial fluid.
There is a difference between the two: your blood glucose meter displays a point value, while your glucose sensor displays the average of the last 5 minutes. This gives you a curve based on the glucose level in the interstitial fluid. The more glucose you have, the higher the angle and the lower the curve.
Continuous glucose monitors (glucose sensors) allow you to monitor the glucose level throughout the day and night continuously. This system brings more security in daily life because you can know the direction and speed of the glucose level evolution. Some systems can also be equipped with alerts to warn the patient in the event of rapid blood glucose levels and thus enable the patient to anticipate hypos/hyperglycemia.
Examples of The Use of Continuous Glucose Monitoring :
During the day: It is 11:30 in the morning, and you have a blood glucose level of 0.90 g/l. It is likely, with a meal approaching, that you decide to do nothing. It turns out that your blood sugar level is dropping sharply, and within 30 minutes, you will be hypoglycemic. With continuous glucose testing, you would have been able to visualize your glucose curve and see that your blood glucose was dropping sharply.
During a sports session: When you do sports, visualizing the variations of your glucose level allows you to avoid hypoglycemia and therefore to take sugar for nothing: for example, you are at 1g/l, and your glucose level is rising. Therefore, continuous glucose measurement allows you to see how your glucose level behaves at any time and thus anticipate hypo- and hyperglycemia. Rather than acting only when you are hypo- or hyperglycemic, continuous glucose monitoring allows you to anticipate and react quickly.
During the night: At night, unless you wake up for multiple capillary blood glucose tests, you cannot know how your blood glucose is behaving. With continuous glucose monitors, you can :
- View your morning glucose curve in the morning
- Set alarms so that the device will warn you when you reach/exceed your hypo/hyperglycemia limit.
The data download also allows you to view glucose changes for each day the sensor was worn.
Diabetes: Talking About It to Accept the Disease
With the stress of medical appointments, injections, and diet, diabetes is life-altering and can cause anxiety. There are associations who offer people with diabetes talking groups to learn how to live with their disease.
Learning to live with diabetes is not easy. Patients have to change their eating habits and face the new anxieties that treatment can cause. By talking about their disease, participants create bonds and, above all, feel understood. It is essential for those who are more anxious to receive psychological support because stress can hurt blood sugar levels.