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Diabetes. What are we talking about?

  1. Gastroepato
  2. Diabetology
  3. Diabetes. What are we talking about?
  4. The cardiometabolic risk in type 1 diabetes mellitus
  5. Recommendations for screening
    and diagnosis of gestational diabetes
  6. Pregnancy and risk of diabetes during pregnancy

We are talking about the epidemic of the third millennium, at least until we live seated, at work, stressed, without ever moving, proceeding with cars and eating fast and bad. Only the robots, which will work for us, can solve the problem of our diabetes. In the past time, when the work was carried out by hand, people ate little food, many country foods, many vegetables and healthy foods, without fats and fried oils; they moved on foot, they hoed the earth, they always worked with the strength of their arms, they tune in with nature and creation and respected the environment; diabetes did not exist among the poor who ate only one poor meal a day. Only the well-to-do classes suffered from diabetes, gout and vascular diseases; the women suffered from scoliosis, because fashion required them to dress with tight clothes that covered the whole body, up to the neck. Then someone understood that the sun was important for the calcification of the bones and the life in the open air reinforces the body and the spirit. Hence the motto that says: "where the sun comes in, do not enter the doctor!".

Over the last century the picture of the most common diseases in the developed world has changed significantly. Until the middle of the last century, the most widespread, fearsome diseases were those caused by infectious agents: tuberculosis, pneumonia, intestinal typhus, polio. Acute illnesses that the discovery of penicillin, and then other large antibiotics, and vaccines have in fact solved with a consequent lengthening of the average life. In the 50s-70s, heart attacks and tumors have become the leading causes of death for both men and women, and they are still, even if in ways and in quantities very different from before. In this case too, the progress of medical science has changed the lives of patients. New drugs, increasingly advanced surgical procedures and increasingly sophisticated diagnostic and organizational tools have significantly reduced mortality for acute cardiovascular diseases and cancer.
The history of medical and scientific progress, however, should not mislead us: all these improvements have led us today to know how to treat a great number of diseases better and better. But treating does not mean healing. And this is the main reason why today we are facing a growing number of chronic diseases. Chronic means that they do not heal, that they last for a lifetime, that accompany the person every day. And, as we now know, that can cause the episodes of sharpness that we fight so well, but that it would be even better to be able to prevent.


Diabetes which means?

The disease called "diabetes" is a defect of our engine to burn its gasoline. "I'm glad that this concept of" the engine and the gasoline "I listened to it in a conference, when a speaker, who liked this My observation, took up this my practical concept that I, in my turn, had learned from my great Prof. Macaione of biochemistry It may seem a paradoxical concept but if we assume that our organism works like a car, that in order to move it needs fuel, or rather glucose instead of burnt gas, and produces energy.

Our fuel is the food and the engine  are the cells of the whole body, where the glucose enters and it's burned.
The foods that we eat contain basically three elements that can produce energy: proteins, fats and carbohydrates. But the body considers the carbohydrates as "a super petrol"  and in particular the glucose such as the only fuel,  which is absorbed through the intestine and carried  in the blood. From the blood, the glucose to be "burned" and produce energy must enter every cell and it burns according to highly energetic chemical processes,  with production of heat and energy for our body.

The process, of course, is not as explosive as in the case of the petrol engine! When the glucose is lowered in the blood, the body also tends to turn off and there are some people who suffer from the decline in sugar, late in the morning, especially if they have made a poor and hurried breakfast.
The entry of glucose into cells is not a simple mechanism: there is a kind of obligatory "door" through which it must pass, a door that also has a name, is called Glut 4, and which has a sort of "lock" which can only be opened in the presence of a substance, a hormone, insulin, which functions as an "access key" to open the Glut 4 port. Insulin is a large protein produced by a special gland, the pancreas, made of specific cells that "feel" the amount of glucose that runs in the blood and, in the presence of increased quantities, as after a meal, increase their ability to produce the hormone.
Diabetes is precisely the condition in which this mechanism does not work: the patient becomes like the rich man who has lost the key to his strongboxt. He has too much glucose available and inability to assimilate it into the cells.

To get some ideas on treatment of diabetes

Diabetes care consists, in fact, in making this access key work inside the keyhole, that is the insulin, to trigger the mechanism that conducts the fuel (glucose) inside the cells. Sometimes we lost the key due to the exhaustion of the beta cell that does not produce the insulin key and we have to introduce it from the outside with insulin injections; at other times the lock works poorly (insulin resistance phenomenon) and it is necessary to unblock the keyhole (to use insulin-sensitizing drugs, eg metformin and pioglitazone).
Now there is a new class that eliminates excess blood glucose (SGLT2 receptor inhibitor drugs) in urine. It has been demonstrated by all the clinical and scientific research that the presence of chronic hyperglycemia over time causes damage to circulation: in fact, diabetes is considered the "vascular disease with elevated blood sugar". The walls of the blood vessels, in particular of the arteries, small or large, and of the capillaries are damaged. The damage consists in a slow and progressive hardening of the vessel walls, further increased by hypertension (high blood pressure) and by the excess of circulating fats (cholesterol, triglycerides). They form on the walls of the "plaques", whose scientific name is "atheroma", which not only reduce the possibility of passing through the blood, but which often create real internal "wounds", which can be subject to inflammation and to " thrombosis ", ie complete occlusion. A thrombosis in a coronary artery causes a stroke, in a brain artery causes a stroke, in an artery of the legs can also lead to amputation of a limb.

Two types of diabetes, diabetes during pregnancy

Type 1 diabetes is the condition in which an important inflammation of the pancreas cells occurs, which progressively die as they fail to produce more insulin. In type 1 diabetes, the only treatment option is to replace the hormone deficiency with the insulin injections needed to maintain the vital function of the body's cells from the outside. This form of diabetes that in fact creates an "insulin-addiction" is also known as "juvenile diabetes", because it is much more frequent in the developmental, or even infantile, even if today we know that it can present itself, although to a much lesser extent , even in adulthood. From a scientific point of view, the cause of the severe pancreatic inflammation that causes the death of insulin-producing cells is singular: it is a genetically determined "mistake" of the organism, which does not recognize those cells as its own and implements a species of "rejection" against them. It is what in medicine is called "autoimmunity process" and that, in reality, is the mechanism of many other diseases. The inheritance of this form of diabetes consists precisely in the genetic predisposition to develop autoimmunity: the disease is not inherited, but the tendency to form antibodies against oneself.

Type 1 diabetes accounts for around 10% of all diabetes cases. Type 2 diabetes is the most widespread form in the world, in developed countries but also in developing countries, and it is progressively growing everywhere. In this case insulin is produced by the pancreas, to a slightly lower extent than normal.
The insulin produced in these people, however, fails to perform all its tasks giving rise to what is called: "insulin resistance". In this case, a particular genetic condition, inherited, tends to accumulate a lot of fat in the abdomen and this excess of fat causes the insulin does not work as it should. The result is once again the difficulty of the glucose to pass inside the cells to be burned and an excessive amount of glucose that stagnates inside the bloodstream. The body then tries to produce more insulin, and for a while it succeeds, but at a certain point the capacity of the "pancreatic insula" is no longer able to respond to the needs. This type of diabetes, also called "adult diabetes" or "non-insulin-dependent", does not require the replacement of the missing hormone from the outside and usually appears only after age 40, or very often only in the last years decades of life of people. In countries where there has been a growing presence of obesity for an incongruous diet even in childhood or adolescence for many years, type 2 diabetes is starting to show up even in the younger age groups, with significant health problems importance. Gestational diabetes is a form that appears during pregnancy, almost always without any symptoms on the part of the woman, but that is discovered during the normal examinations that are performed during the gestation. It is very important that a diabe diagnosis test is performed

Diabetology