notes by dr Claudio Italiano
You have performed clinical analyzes. Looking at the results, you
noticed that the blood glucose values were high, around 130 mg% fasting. No
problem, you thought! I will put on a diet and eat less, in these times you have
been very stressed at work and family problems. Nothing could be more wrong!
Having a blood glucose of 130 mg% is considered a condition related to diabetes
mellitus, especially if it is the second time that the glycaemia values have
risen.
The problem is very serious, however, if we talk about your child, who is still a child, in this case if there are high blood
sugar levels, you must immediately go to the pediatrician.
Speak about it, therefore, with your doctor, now!
Who can we define diabetic (cf definition of diabetes)? The diabetic is a
patient with impaired carbohydrate metabolism, which has a tendency to fasting
hyperglycemia and dangerous glycemic spikes in the post-prandium. Glucose, as we
know, is the main fuel for the cells of our body, fuel that the body uses using
the process of glycolysis and the cycle of Krebs, with the intent to produce
energy from the bonds of carbohydrates.
But the problem of a person with
diabetes lies in the fact that he can not get a good use of carbohydrates
because he lacks or lacks the key that allows them to be used. This key, which
opens the mechanisms of the use of glucose and which makes glucose enter the
cell, is a hormone produced by the pancreas and exactly by the pancreatic islets
(beta-cells). The diabetic, in the final analysis, is as if he were rich (of
glucose) but did not possess the key (insulin) that allows him to open the
access door of the glucose in the cell, because, precisely, this key or does not
work as it should and is jammed inside the mechanism of the patch (peripheral
alteration of the receptor), or completely missing (type 1 diabetes mellitus) or
has multiple copies but all malfunctioning (type 2 diabetes).
So far it would seem very simple to give a definition to diabetes, but when it is necessary to
be precise on the subject and, even worse, when you have to choose a good therapy for diabetes, then here is a dispute on the new criteria for the
diagnosis and classification of diabetic disease, from which the guidelines of
the cure arise. Today, 2018, we tend to "sew the treatment on the patient", that
is to say depending on the phenotype of the person with diabetes, whether it is
obese or lean, if it is in beta-cellular depletion or if the function is left,
if necessary keep the blood sugar levels in the morning level or rather those of
the post-prandium level. Insomuch the cure for diabetes is such a beautiful art,
as difficult: there are many weapons available to the diabetologist, but how
many are suitable diabetes warriors?
Still counts and numbers.
But the problem of diabetes is not easy if we take into account the fact that
the disease is growing enormously and that a great contribution to its surge is
given to us by the emerging countries, first of all China, India and the South
of the World. It is estimated that diabetes will increase from 30 million cases
in 1985 to 370 million in 2030. In Italy the prevalence stands at 7.1% and we
are in 10th place among the nations of the world.
Another problem is that diabetes is the 6th cause of death in general and the 1st cause of blindness for the complications that it determines (diabetic retinopathy) and reason for amputation of the lower limbs for peripheral neuropathy and the chronic obliterative arteriopathy that it determines. Finally, let us remember that the cardiovascular risk in diabetic rears from 2 to 4 times. Even a study conducted in the USA shows that diabetes in recent years has been a cause of death soaring, more than the cardiovascular cause or neoplasia itself. Compare the table in bleu, where they represent in number of deaths per year and pathology (in green the neoplasies, in red the diabetes, in violet the cardiovascular disease and in blue the stroke.Therefore it is easy to affirm when asserting the my professor at the University of Messina, namely that diabetes is not "high blood sugar, but vascular disease with hyperglycemia".
Diabetic disease is a disease to be treated at 360 °, taking into account its complications. It is not only a question of controlling glycometabolic compensation, but it is necessary to treat macroangiopathic alterations (cf. ateromasia) and microangiopathic complications (eg diabetic neuropathy, retinopathy, etc.). There are studies that correlate, in the elderly diabetic, complications with the risk of death due to vascular causes. The type 2 diabetic, without proper care, dies in 40% of cases due to complications of ischemic heart disease, in 15% for heart disease in general, in 13% for tumors, given the obesity of the diabetic, in 10% of cases, finally, for stroke cerebri. For these reasons, on the whole, he says that life expectancy in a type 2 diabetic is on average 8 years: we are obviously referring to the patient who does not undergo the appropriate follow-up and is already suffering from macroangiopathies. The risk of infarction of the myocardium is in men increased 2-fold, in women 4 to 5 times, see Framingham Study and Joslin patients. In 20% of cases the patient dies from cardiovascular disease in 10 years.
| Classification of diabetes mellitus due to its complications | Annual expenditure in Italy in euros per patient |
| Uncomplicated diabetes | 2.301 |
| Complicated by macroangiopathies | 6.043 |
| Complicated by Macro and microangiopathies | 10.792 |
If, then, other risk factors such as hypertension and dyslipidemia and
smoking are added to diabetes (see also diabetes and smoking), then the risk is
prone and from a study of evince that cardiovascular disease grows to the tip of
120 people per 10,000 / year. In essence it is not the high blood sugar that
worries us in the diabetic but the vascular complications that it goes to. Hence
the importance of therapeutic targets. (eg good control of cholesterol,
triglycerides, blood pressure, lifestyle, diet, etc.).
Healthcare spending in Italy is increasing due to the overall management of the
diabetic patient (6.5% of global expenditure), both for expenses resulting from
hospitalizations, outpatient costs and drug costs.
It can be divided as follows:
The individual expense per patient increases, obviously, to the growing
complications, for ex. microangiopathic, ie for costs related to treatment, for
example of nephropathy. The CODE-2 study, which concluded how to spend on
prevention means to save money, was taken care of. Certain subjects at risk must,
therefore, undergo prevention and screening, as widely explained in this my
website. There is always a test on my site to know immediately if you are a
candidate for diabetes!