Type 2 diabetes

What is it about ?

Diabetes is a chronic disease characterized by high levels of sugar (glucose) in the blood, called hyperglycemia. Diabetes can lead to a large number of acute and chronic complications (including eye damage, from kidneys and nerves). It also comes with a higher cardiovascular risk.

Insulin is the hormone that regulates the level of sugar in the blood (blood sugar). Normally, insulin causes cells to get enough sugar from the blood. In type 2 diabetes, the body still produces insulin, but in insufficient amounts. In addition, cells become less sensitive to the effects of insulin. As a result, they “consume” less sugar and too much is left in the blood.

Heredity plays a role in the disease, but being overweight and not being physically active also increases the risk of developing it. Up to 80% of people with type 2 diabetes are overweight. The main steps are therefore to eat a healthy diet and exercise a lot.

What is its frequency?

It is estimated that around 8 out of 100 adults in the Belgian population suffer from diabetes (type 1 and type 2 combined). This number is thought to rise to almost 10 in 100 by 2030. Type 2 diabetes is the main culprit behind the rise in diabetes numbers.

Each year, there are 23,500 new cases of type 2 diabetes in Belgium. It is estimated that one in three diabetics is unaware that they have the disease and therefore receives no treatment. On top of that, between 6 and 7 in every 100 adults are in what is known as the “gray zone” – where they are at risk of developing diabetes in the short term. In total, our country has 1 million people with diabetes or at increased risk of developing the disease.

How to recognize it?

Unlike type 1 diabetes, type 2 diabetes causes few, if any, symptoms. You can live with the disease for years without knowing it. Often, the diagnosis is made rather by chance, for example during a routine examination or a complication such as a foot wound that does not heal well. Infections of the penis or vagina can be an early sign of the disease. The more recognizable symptoms, such as thirst, having to urinate often, and fatigue, appear later in the disease.

The following people are at greater risk of developing diabetes than others:

• people who have had high blood sugar in the past, for example during pregnancy;
• people who use certain medicines (eg corticosteroids) for a long time;
• people over the age of 45 who have a first degree relative with diabetes;
• people over the age of 45 who suffer from what is called a metabolic syndrome, i.e. a combination of increased blood sugar (hyperglycemia), excess weight, high blood pressure (hypertension) and increased fat in the blood (hyperlipidaemia);
• all persons over 65 years of age.

See a doctor if you suspect diabetes. If you are in a risk group, a fasting blood sugar test may be recommended whether or not you have symptoms (screening test).

How is the diagnosis made?

The level of sugar in the blood (blood sugar) is measured on a sample of blood taken on an empty stomach. Being on an empty stomach means that you haven’t eaten anything for at least 8 hours. A value less than 100 mg / dl is normal, a value between 100 and 125 mg / dl is disturbed, and a value greater than or equal to 126 mg / dl may indicate diabetes. The diagnosis is always confirmed by a second fasting control measurement. A blood glucose greater than 126 mg / dl in a non-fasting person will be monitored on an empty stomach. A value above 200 mg / dl associated with classic symptoms of hyperglycemia (excessive thirst, urinating often) points directly in the direction of diabetes.

To assess the sensitivity of cells to insulin, a glucose tolerance test (or oral hyperglycemia) can be performed. This is done by first measuring fasting blood sugar. Then the person should drink 75 g of pure glucose in solution. After 2 hours, a new blood test is taken. A value between 125 and 200 mg / dl indicates abnormal tolerance; a value greater than 200 mg / dl, diabetes.

At the same time, the doctor will also assess the cardiovascular risk.

What can you do ?

The adoption of a healthy lifestyle is crucial.

Food

A balanced diet is essential in order to maintain the greatest possible stability in terms of weight and blood sugar levels, and to avoid complications due to blood sugar spikes. The advice of a dietitian or a nutritionist is very important. If you benefit from a “diabetes” treatment path, you have the right to consult a dietitian free of charge.

Preferably eat your meals at set times and at regular intervals. Try to eat more or less the same amount of food. Preferably eat foods containing low glycemic index carbohydrates. The glycemic index refers to the rate at which carbohydrates are digested in the intestine and absorbed into the blood in the form of glucose. Sugar (jam, sweets, honey, etc.) thus has a high glycemic index, it is absorbed there faster than bread or potatoes.

Physical activity

Physical activity has many positive effects on diabetes. It helps stabilize blood sugar levels, improve the sensitivity of cells to the effects of insulin, keep fat in the blood under control, improve heart and lung function, control weight and improve muscle strength. .

Get around 150 minutes per week, spreading your activities over at least 3 days. Focus on endurance sports, such as walking, swimming, cycling or jogging. You can be accompanied by a coach from the Sport program on prescription. Sometimes, a specific exercise and / or rehabilitation program established by a physiotherapist may be indicated.

Tobacco and alcohol

It is important to quit smoking because tobacco significantly increases your cardiovascular risk. Your doctor or a tobacco specialist can help you with this.

When it comes to alcohol consumption, the recommended maximum is 10 standard units per week, for both men and women. Alcohol contains a lot of calories. So the less you drink, the better.

Weight

Most people with type 2 diabetes are overweight. A dietitian or nutritionist can help you adjust your diet. Getting enough physical activity can also help you lose weight.

As a last resort, obesity surgery (bariatric surgery (intervention in the digestive tract)) may be considered in people with diabetes who have a BMI greater than 35. Especially if diabetes or the associated complications are difficult to control in the patient. through lifestyle and medication adjustment advice.

What can the doctor do?

In the management of type 2 diabetes, we usually start with an adaptation of the lifestyle (diet and physical activity). If these measures are not sufficient, the doctor will prescribe medication. If these are no longer sufficient to control blood sugar levels, we will switch to insulin injections.

Medications

It exists different drugs to treat type 2 diabetes:

• the oral antidiabetics are drugs that lower blood sugar; they stimulate the pancreas to secrete insulin or improve the sensitivity of cells to insulin. There are different types, which can optionally be combined to achieve a more potent effect. Among oral antidiabetics, metformin is the first choice;
• the incretinomimetics are anti-diabetics that act like incretins, hormones secreted by the intestine when food is passed; they stimulate the production of insulin by the pancreas and reduce the feeling of hunger. They are available as tablets or injections;
• the’insulin : there are different types of insulin, they are classified according to their duration of action. Short-acting insulin starts working in 5 to 15 minutes, peaks after 1 hour, and continues to work for 2 to 5 hours. Long-acting insulin peaks after about 2 hours and can work for up to 24 hours. There are also mixed forms, which combine a rapid effect and a prolonged effect.

Insulin is given by injections under the skin (subcutaneous injections), using an insulin pen or an insulin pump. It is extremely important to use these devices correctly. For more information on the subject, please read the patient guide corresponding.

Find out more

• Diabetes: the keys to treatment – Solidaris – Mutualité Socialiste

• Eat better – Christian mutuality
• Nutri-Score – SPF Public health, food chain safety and the environment

• Physical activity – Eat Move – Health question
• Prescription Sports – Eat Move – Health Question

• Stop smoking. It’s possible – Tabacstop – Foundation against cancer
• Alcohol, the point on your consumption – Stop or else?

• Diabetes: mobile applications – mHealthBelgium

• Metformin – CBIP – Belgian Center for Pharmacotherapeutic Information
• Incretinomimetics – CBIP – Belgian Center for Pharmacotherapeutic Information
• Insulin – CBIP – Belgian Center for Pharmacotherapeutic Information
• Insulin pump to control diabetes – CHU Montreal

Are you looking for more specialized help?

• Care Pathways – How to Improve Management of Your Type 2 Diabetes
• Smoking Assistance Center (CAF®) – FARES – Respiratory Affections Fund
• Tobacco specialists – FARES – Respiratory Affections Fund
• Find a registered dietitian – Professional Union of French-speaking dieticians
• Find a nutritionist doctor – Belgian Society of Nutritionist Doctors
• Alcohol aid – Le Pélican & Le center ALFA

Source

www.ebpnet.be