Diabetes (overview)

Diabetes is an incurable disease that occurs when the body fails to properly use sugar (glucose), which is an essential 'fuel' for its function. Glucose, poorly absorbed by cells, then accumulates in the blood and is then released into the urine. This abnormally high concentration of glucose in the blood is called hyperglycemia. Over time, it can cause complications in the eyes, kidneys, heart and blood vessels.

Diabetes can result from a partial or total inability of the pancreas to make insulin, which is a hormone essential for the absorption of glucose by cells. It can also arise from an inability of the cells themselves to use insulin to take up glucose. In both cases, the cells being deprived of their main source of energy, there necessarily follow significant physiological consequences, such as extreme fatigue or healing problems for example.

Glucose comes from 2 sources: foods rich in carbohydrates that are ingested and the liver (which stores glucose after a meal and pours it into the blood as needed). Once extracted from food by the digestive system, glucose passes into the bloodstream. In order for the body’s cells to be able to use this indispensable source of energy, they need the intervention of insulin.

The main types of diabetes

For a detailed description of the types of diabetes (symptoms, prevention, medical treatment, etc.), consult each of the sheets devoted to them.

Type 1 diabetes.

Also known as “insulin-dependent diabetes” (IDD) or “juvenile diabetes,” type 1 diabetes occurs when the pancreas either no longer produces or does not make enough insulin. This can be caused by a viral or toxic attack, or by an autoimmune reaction that destroys the beta cells in the pancreas, which are responsible for the synthesis of insulin. This type of diabetes mostly affects children and young adults, although the incidence in adults appears to be increasing. It affects about 10% of diabetics.

Type 2 diabetes.

Often referred to as “non-insulin-dependent diabetes” or “adult diabetes,” type 2 diabetes is when the body becomes resistant to insulin. This problem usually occurs in people over 45, but the incidence is growing sharply in younger people. This type of diabetes, by far the most common, affects nearly 90% of diabetics.

Gestational Diabetes.

Defined as any diabetes or glucose intolerance that manifests itself during pregnancy, most often in the 2nd or 3rd trimester. Often, gestational diabetes is only temporary and goes away soon after childbirth.

Another form of diabetes is diabetes insipidus.

This is a fairly rare disease caused by insufficient production of the antidiuretic hormone by the pituitary gland called 'vasopressin'. Diabetes insipidus is accompanied by an increase in urine output, while blood sugar levels remain completely normal. So, it has nothing to do with diabetes mellitus. It is called 'diabetes' insipidus because, like in diabetes mellitus, urine output is abundant. However, urine is tasteless rather than sweet. (The term comes from ancient diagnostic methods: urine tasting!)

Diabetics, more and more numerous

Although heredity plays a role in its onset, the increasing prevalence of diabetes is associated with the diet and lifestyle that prevails in the West: an abundance of refined sugars, saturated fat and meat, poor dietary fiber. , excess weight, lack of physical activity. The more these characteristics increase in a given population, the greater the incidence of diabetes.

According to the Public Health Agency of Canada, in a report published in 2008-09, 2.4 million Canadians were diagnosed with diabetes (6.8%), including 1.2 million between the ages of 25 and 64.

The pattern seems to be confirmed when studying the incidence of the disease in developing countries: as large sections of the population adopt a diet and lifestyle similar to ours, the incidence of diabetes, Both type 1 and type 2, increases1.

Possible complications of diabetes

In the long term, people with diabetes who have inadequate control of their disease risk a variety of complications, primarily because prolonged hyperglycemia causes tissue damage in the blood capillaries and nerves, as well as narrowing of the arteries. These complications do not affect all diabetics, and when they do, it is to varying degrees. For more information, see our Complications of Diabetes sheet.

In addition to these chronic complications, poorly controlled diabetes (for example due to forgetfulness, incorrectly calculated insulin doses, suddenly altered insulin requirements as a result of illness or stress, etc. ) can cause the following acute complications:

Diabetic ketoacidosis

This is a condition that can be fatal. In people with type 1 diabetes who are untreated or who receive inadequate treatment (eg lack of insulin), glucose remains in the blood and is no longer available for use as a source of energy. (This can also happen in people with type 2 diabetes taking insulin.) The body must therefore replace glucose with another fuel: fatty acids. However, the use of fatty acids produces ketone bodies which, in turn, increase the acidity of the body.

Symptoms:

fruity breath, dehydration, nausea, vomiting and abdominal pain. If no one intervenes, difficult breathing, confusion, coma, and death can occur.

How to detect it: high blood sugar, most often around 20 mmol / l (360 mg/dl) and sometimes more.

What to do:

If ketoacidosis is detected, go to a hospital emergency department and contact your doctor afterwards to adjust the medication.

Hyperosmolar state

When type 2 diabetes is left untreated, the hyperglycemic hyperosmolar syndrome can develop. This is a real medical emergency that is fatal in more than 50% of cases. This condition is caused by the accumulation of glucose in the blood, exceeding 33 mmol / l (600 mg/dl).

Symptoms:

increased urination, intense thirst and other symptoms of dehydration (weight loss, loss of skin elasticity, dry mucous membranes, increased heart rate and low blood pressure).