What is diabetes?


The different types of diabetes




Diabetes mellitus is a dysfunction of the sugar metabolism in the body, leading to an excessive accumulation of glucose in the blood. During digestion, food is broken down into small molecules, particularly glucose (sugar) that passes into the bloodstream and increases the glycaemia (blood sugar level). This is the signal for the pancreas to secrete a hormone called insulin, which allows cells to either use glucose for immediate energy needs or to store it in the body’s reserves. Blood glucose then returns to a normal level. In the case of diabetes, the pancreas produces insufficient or no insulin at all. There is also a situation in type 2 when the pancreas secretes normal insulin but the insulin action at the tissue level (liver and muscles) is inadequate.  There is therefore “insulin resistance”, no key allowing the passage of sugar from blood to muscle. Sugar accumulates in the blood causing hyperglycaemia.


There are 2 main types of diabetes mellitus. In the case of Type 1 diabetes, the pancreas produces no insulin at all. This type of diabetes represents 10% of diabetics. It particularly affects young children, adolescents, or young adults, and obliges them to inject insulin daily.


In the case of Type 2 diabetes, the pancreas does produces insulin but in inadequate quantities to which the body is unresponsive. Part of the sugar carried in the blood does not reach the muscle, but stays in the blood and builds up, causing disorders that will gradually appear. This type of diabetes, representing 90% of diabetics, particularly affects adults over the age of 45, who lack exercise and are overweight. Moreover, these subjects often suffer from high blood pressure and too much fat in the blood (cholesterol). Added to diabetes, these patients’ disorders can lead to a very high risk of complications for the heart, brain, arteries and liver.


There is also a third form of diabetes called “gestational diabetes”, which can affect pregnant women. It is transitory and linked to the pregnancy.




Finally, there are other forms of diabetes called “secondary diabetes” caused by another illness, such as pancreatic cancer or by certain drugs.



Risk factors



facteurs de risque


We talk about diabetes risk factors in the case of Type 2 diabetes because the origins of or predisposition to Type 1 diabetes cannot be anticipated or prevented.


The main risk factor for Type 2 diabetes primarily relates to an unbalanced diet, rich in refined sugars, vegetable and animal fat (above all saturated), and poor in dietary fibres (roughage). This unbalanced diet often results in overweight and obesity as aggravating factors. This goes together with another phenomenon in full acceleration: the sedentary lifestyle associated with urbanization.


An unbalanced diet, obesity and lack of exercise are all the more factors that can bring on diabetes if there is a predisposition to the disease. In over 50% of cases, there is already a history of Type 2 diabetes in the family. We can therefore consider Type 2 diabetes as a hereditary disease as much as an environmental one. However, it is environmental changes that are responsible for the present epidemic.



Diabetes Symptoms





The classic symptom for both Type 1 and Type 2 diabetes is feeling very thirsty, linked to the need to urinate frequently, especially at night.


In Type 1 diabetes, the symptoms are acute and expressed by a great feeling of hunger, weight loss and excessive fatigue.


In Type 2 diabetes, the illness is often insidious, settling in the body without marked symptoms. We say that Type 2 diabetes is “asymptomatic” at the start. Indeed, the symptoms are only noticed when sugar is noticed in a urine sample, when the glycaemia level is over 1.80 g/l. Contrary to Type 1 diabetes, Type 2 diabetes is often discovered by chance, during a routine check-up or when complications set in.






On a daily basis, the mismanagement of medical treatment, nutrition, physical activity and the onset of other illnesses can cause a decrease or an increase in the blood sugar level. This leads to disorders that create diabetic complications, which are often very serious and debilitating.



Acute complications


There are three main acute diabetic complications, resulting from a very fast and sudden decrease or increase of blood sugar, which can all lead to coma and eventually death:


  • diabetic ketoacidosis, found almost exclusively in Type 1 diabetes, occurs when the body can no longer use sugar as fuel because of the total absence of insulin.
  • hypoglycaemia, concerning both Type 1 and Type 2 diabetes, occurs when the blood sugar level falls below a certain threshold. This is always caused by an excessive effect of the treatment. It may occur following an insulin injection that does not correspond to food intake, or an overdose of certain oral diabetes pills. The risk is accentuated by the lack of adequate food intake due to various reasons: lack of information or errors of the patient, socio-economic or infectious causes.
  • non-ketotic hyperosmolar coma, concerns exclusively Type 2 diabetes, above all in the elderly, may occur for various reasons including severe dehydration during infections or treatment with diuretics.



Chronic complications


Blood sugar imbalance progressively damages the small blood vessels leading to chronic complications, which can seriously harm many organs. In this way, diabetes can cause diabetic retinopathy, due to the damage of small blood vessels that supply the retina with blood, causing reduced visual acuity, which may lead to blindness. Diabetes is also one of the main causes of chronic renal failure that can lead to total kidney failure.


One of the most common complications is diabetic neuropathy. The nerve fibres are affected, causing numbness and loss of sensation especially in the legs and feet. Neuropathy associated with poor blood circulation in the legs contributes to the development of ulcers on the feet. If “diabetic foot” is not treated properly, patients run the risk of gangrene and amputation. Diabetes also contributes to impotence in men.


Diabetes also affects the large blood vessels thereby affecting the heart, brain and lower limbs. When the largest arteries are affected, serious damage is inflicted on the cardiovascular system. People with diabetes run a far higher risk of developing atherosclerosis, which is when small atheromatous plaques (cholesterol) build up on the walls of large arteries. The long-term danger is that the artery may become completely blocked which may cause a coronary thrombosis (heart attack). Peripheral arteries are also affected, greatly increasing the risk of stroke or CVA.


Different studies have shown that, today, diabetes multiplies the risk of dying from a cardiovascular accident by 2 or 3 for men and by 3 to 5 for women.







In contrast with an illness that evolves quickly, but lasts a short time, diabetes mellitus is a chronic disease that sets in, will evolve over time and cannot be cured. On the other hand, with appropriate treatment right from screening and diagnosis, the disease can be effectively controlled and complications avoided. This implies that the blood sugar level (glycaemia) be maintained as much as possible at a near normal level.


The first condition for effective treatment is the patients’ acceptance of the changes in their lifestyle. The diabetic, particularly if overweight, should especially ensure that his diet is regular, balanced, and lower in calories than it was before. At the same time, physical activity (several times a week, or even daily) is encouraged.


For Type 2 diabetes, a good balanced diet coupled with physical activity can postpone the taking of medication for a long time.




When this is no longer sufficient, pills are added called oral diabetes pills, which help normalise patients’ glycaemia.


People with Type 1 diabetes must inject insulin several times per day with a syringe or an injection pen. Insulin injections are also necessary for some Type 2 diabetics when oral diabetic pills are no longer sufficient. With the right treatment and self-monitoring of glycaemia, life expectancy for Type 1 diabetics, as well as for Type 2 diabetics when diagnosed early, can almost become equivalent to that of non-diabetics.



Diabetes education




Education of the patient about his illness is the watchword for the successful management of a person with diabetes. It will focus on explaining the key concepts of diabetes, especially the chronic nature of the disease and therefore the inevitability of treatment for life, and on understanding its interactions within the social context, which is vital to effectively fighting the disease. It will also help to explain the management of diet and physical activity, and warn of the risks of complications. Education should be thorough and permanent so that the various stages of the treatment are understood and effectively applied.


In summary, the education sessions provide valuable assistance in the daily management of diabetes as well as a place of emotional and social support. These may include individual sessions between a patient and a healthcare professional or group sessions involving one or more healthcare professionals and a group of patients (focus group).A third option is to involve very well trained patients, competent peer educators, who share their knowledge with other patients.


Finally, we should not forget the highly important function of patient associations. They play a crucial role in demanding adequate education about the disease and in defending patients’ rights to access medicines at affordable prices.


Last update: 14/05/14