Diabetes
Diabetes is a disease defined by permanently high blood sugar levels. 537 million adults worldwide live with diabetes. By 2021, it will have killed 6.7 million people, and is progressing very rapidly in Africa.
What are the different types of diabetes?
Diabetes is a disease that is defined by a high blood sugar (the blood sugar is permanently high).
The blood sugar level must not exceed 1,26 g/L fasting. Diabetes is a chronic disease which cannot be cured,, but can be treated with appropriate medication.
The main types of diabetes are: type 1 diabetes and type 2 diabetes. There is also a third type of diabetes called gestational diabetes, which can affect pregnant women.
TYPE 1 DIABETES
The pancreas is not producing insulin at all or not in a sufficient amount. This hormone helps regulate blood sugar levels. Patients need to inject insulin every day to regulate their blood sugar.
This type of diabetes affects 10% of people with diabetes. It more specifically affects young children, adolescents or young adults.
TYPE 2 DIABETES
The pancreas produces insulin, but in inadequate quantities and the body has difficulty using it. Some of the sugar carried by the blood no longer passes into the muscle, accumulates in the blood and can cause complications.
This type of diabetes affects 90% of people with the condition. It particularly affects adults over 45, sedentary and overweight people.
GESTATIONAL DIABETES
In many countries this type of diabetes affects more than 15% of pregnant women. It manifests itself by an abnormal rise in blood sugar at the end of the 2nd trimester of pregnancy or during the 3rd trimester.
In the majority of cases, it disappears after childbirth. However, it is important to know that a woman with gestational diabetes has a greater risk of developing type 2 diabetes in the future.
What are
THE RISK FACTORS FOR DIABETES?
We talk about "diabetes risk factors" only for type 2 diabetes.
With type 1 diabetes, the onset of the condition is sudden and cannot be anticipated or prevented.
TYPE 2 DIABETES HAS 3 RISK FACTORS:
- An unbalanced diet with a high consumption of refined sugars, vegetable or animal fats (especially saturated) and a lack of fruits, vegetables and therefore dietary fibers
- Lack of physical activity leading to a sedentary lifestyle
- Overweight and obesity which are the consequence of a lifestyle that combines unbalanced diet and a sedentary lifestyle.
An unbalanced diet, a sedentary lifestyle, overweight or obesity are risk factors that can trigger the disease but this will happen, in the majority of cases, in a field of family predispositions.
In fact, in more than half of the cases, type 2 diabetes occurs in families where there is already a history of the disease.
What are the symptoms of diabetes ?
The main symptoms of diabetes are: a very frequent need to urinate (especially at night), be very thirsty, hunger and fatigue.
FOR TYPE 1 DIABETES
The symptoms are acute and appear very quickly.
FOR TYPE 2 DIABETES
The disease is often insidious and can be in the body without visible symptoms for several years. Type 2 diabetes is said to be asymptomatic in its early stages.
Unlike type 1 diabetes, type 2 diabetes is often discovered by chance, during a routine check-up or when complications appear.
WHAT ARE THE COMPLICATIONS OF DIABETES?
ACUTE COMPLICATIONS:
There are 3 main acute complications of diabetes, caused by a sudden drop or rise in blood sugar, which can lead to coma :
- Diabetic ketoacidosis: which mainly affects type 1 diabetes and occurs when the body can no longer use sugar for fuel due to the complete lack of insulin;
- Hypoglycemia: This can affect both type 1 and type 2 diabetes, and occurs when blood sugar levels drop below a certain threshold. It always occurs following an overdose of the treatment (for example, too much insulin in relation to the food ingested or an overdose of certain oral antidiabetic drugs). This risk increases if the food intake is not adequate. This happens if the patient is not sufficiently informed or if the patient has economic difficulties in accessing sufficient food.
- Non-ketotic hyperosmolar coma: only affects people with type 2 diabetes and occurs mainly in the elderly. It is often linked to severe dehydration caused by infections or diuretic medication.
Chronic complications :
Unbalanced blood sugar levels can progressively damage small blood vessels, which can cause serious damage to many organs. Diabetes can cause :
- Diabetic retinopathy: characterized by damage to the small vessels that supply blood to the retina, resulting in reduced visual acuity which can lead to blindness.
- Diabetic nephropathy: which will lead to the destruction of the kidneys and which is one of the main causes of chronic kidney disease.
- Diabetic neuropathy: nerve fibres are affected, causing loss of sensation, mainly in the legs and feet. Neuropathy associated with poor blood circulation in the legs encourages the development of ulcers on the feet, known as "diabetic feet". If these "diabetic feet" are poorly treated, people living with diabetes risk gangrene and amputation.
- Sexual disorders: Diabetes can affect sexuality in both men and women (infections, fungal infections, vaginal dryness, prostatitis, erectile dysfunction, reduced libido, etc.).
In addition, diabetes also affects the large vessels and thus damages the heart, brain and lower limbs. When large arteries are affected, serious damage occurs to the cardiovascular system. People with diabetes have a much higher risk of developing atherosclerosis, which is small plaques of atheroma (cholesterol) on the lining of large arteries.
Ultimately, the danger is that the artery becomes completely blocked, causing a myocardial infarction. Peripheral arteries are also affected, increasing the risk of a vascular accident. Various studies show that the presence of diabetes increases the risk of cardiovascular mortality. The risk is 2 to 3 times higher for men, and 3 to 5 times higher for women.
HOW TO TREAT DIABETES?
Diabetes cannot be cured but, by adopting an appropriate treatment as soon as it is diagnosed, it is possible to manage the disease, that is to say to keep the level of sugar in the blood (blood sugar) as close as possible to normal, in order to avoid the occurrence of complications.
For people with type 1 diabetes, drug treatment is unavoidable and involves injecting insulin several times a day.
For people with type 2 diabetes, a good diet /physical activity balance can delay taking medication for a long time.
When these measures, called "hygieno-dietary" measures, are no longer sufficient, we add the taking of tablets called "oral antidiabetics" which help to normalize the blood sugar of the patients. The use of insulin may also be necessary for some patients with type 2 diabetes when oral antidiabetics are no longer sufficient.
It is important to remember that with appropriate treatment and monitoring, the life expectancy of a person with type 1 or type 2 diabetes, diagnosed early, can almost be the same as that of people who do not have diabetes.
What is therapeutic education?
The World Health Organization (WHO) defines therapeutic education as "a continuous process which is part of medical care aimed at training the patient so that he can acquire adequate know-how, in order to achieve a balance between his life and the optimal control of his disease".
In practice, educating patients about their disease is the essential step for a successful management of diabetes for the person living with this disease.
It is a place where key diabetes-related concepts can be explained, in particular its chronicity and therefore the obligation to take lifelong treatment, but also to allow the understanding of the interactions of diabetes with the social context, which is essential for a proper response to the disease.
This education helps in the management of diet, physical activity and alert on the risk of complications. For the patient, it will also be a valuable tool to assist in the daily management of diabetes as well as a space for mental and social support.
« Cancer, diabetes and heart disease are no longer diseases of the rich. Today, they affect the populations and economies of the poorest countries even more than infectious diseases. They represent an underestimated public health emergency. »
BAN KI-MOON, Former Secretary-General of the United Nations
Non-Communicable Diseases (NCDs)
Diabetes, cardiovascular diseases, cancer and chronic respiratory diseases are the 4 Non-Communicable Diseases (NCDs) prioritary for the World Health Organization (WHO).
NCDs kill 41 million people every year, accounting for 74% of deaths worldwide (out of a total of 56.9 million deaths).
More than 80% of these premature deaths are attributed to these 4 diseases (1). Indeed :
disease kills
Respiratory diseases kill
Cancers kill
Diabetes kills
Low- and middle-income countries pay the heaviest toll with more than 85% of annual deaths due to NCDs
(i.e. 34.8 million deaths per year), making NCDs a major cause of poverty and a central development issue for countries.
By 2025, Non-communicable Diseases will be the leading cause of disability worldwide and will cause 30% of deaths in Africa.
Diabetes : global data
Diabetes of all types is a chronic disease that currently affects more than 537 million people worldwide (2).
It affects 1 in 11 people and gestational diabetes 1 in 6 births.
In 2021, diabetes killed 6.7 million people, or 18,000 a day, and 1 death every 4.8 seconds.
In comparison, tuberculosis is estimated to have killed 1.6 million people in 2021.
Diabetes will affect 783 million people by 2045, becoming one of the leading causes of disability and death worldwide.
diabetes killed
Diabetes :
an "epidemic"
in Africa
Diabetes is no longer a disease of rich countries. In fact, 81% of people with diabetes live in low- and middle-income countries.
These alarming figures explain the statement of the former Director General of WHO, Gro Harlem Brundtland:
"This is further scientific proof of the world's transition from communicable and non-communicable diseases. In the 21st century, it is in developing countries that the impact of this transition will be the strongest".
Africa will experience the highest increase in the prevalence of diabetes in the world during the period 2015 - 2045.
The number of people with diabetes in Africa will increase by 134% by 2045, from 24 million in 2021 to 55 million in 2045. By this date, the prevalence of this disease will exceed 5% of the population of the continent.
If we take as an example Mali, Burkina Faso and the Union of Comoros, these 3 countries in West Africa and the Indian Ocean already had in 2021 a prevalence of diabetes of 2.1% of the general adult population in Burkina Faso, 11.7% for the Comoros, and 2.1% for Mali. For comparison, the prevalence of diabetes in France in 2021 is estimated at 5.3% of the adult population.
NUTRITIONAL TRANSITION,
URBANIZATION AND SEDENTARITY
Bringing food problems in Africa brings us back to these images of adults with hollow faces, aged before age, and emaciated children with bloated bellies. This all-too-familiar images of famine resurfaces again in some excessively drought-stricken regions or in areas of conflict.
However, what has been observed most of the time, on the African continent in recent years has been a transition in the forms of malnutrition, from undernutrition to overnutrition. The problems of overweight today far exceed the problems of underweight.
This phenomenon mainly hits cities where overweight already affects one in four women and one in six men. This explosion in obesity, involving both the wealthy and the working classes, is mainly linked to the onset of a nutritional transition.
It is defined as a gradual modification of diets with the transition from a monotonous diet, rich in starch and fiber, low in fat, to a more diversified diet but rich in sugars, saturated animal fats and processed foods, while being low in fruits, vegetables and fiber.
Indeed, fatty products such as oil, mayonnaise, fried dishes, salty products such as food cubes, tomato concentrates, edible salt and sweet products such as simple sugar and cookies invade the shops in African markets. These modern stalls are very far from traditional rural markets.
These changes in eating patterns are also very often accompanied by a shift from a physically active lifestyle to a sedentary lifestyle. Indeed, the evolution of lifestyles linked to the very fast growth of urbanization (generalization of office work, use of motorized means of transport, proliferation of television screens and video games for children) reinforces a sedentary lifestyle.
Finally, we must not forget that :
- "In 2009, Africa surpassed one billion inhabitants, of which 395 million (or nearly 40 percent) lived in urban areas"
- « In 2050, the total population of African cities will rise to 1.23 billion, i.e. 60% of the total population and as much as the entire population of the continent today » (3).
OVERWEIGHT AND OBESITY
To this is added a social atavism. Indeed, in Africa, overweight and obesity represent positive external signs of wealth and good health. This is even more true for women whose overweight is supposed to reflect the kind attentions lavished on her by her husband. In contrast, a relatively thin adult person who is not gaining weight will be suspected of being ill or having financial difficulties.
If we take the example of Mali, international statistics show that the risk factors for diabetes linked to lifestyle already have a very strong impact on the prevalence:
- overweight and obesity of 21% in people over 20 years old (with a prevalence exceeding 25% in women)
- a sedentary lifestyle of 19.5% in people aged over 15 (4)
References:
(1) WHO : WHO Global NCD Action Plan, 2013-2020
(2) International Diabetes Federation Diabetes Atlas, 2021
(3) L’état des villes africaines 2010, ONU Habitat, rapport global 2010.
(4) World Health Organization. Noncommunicable Diseases Country Profiles 2011
How to cure diabetes?
We cannot cure diabetes but good diabetes control allows people with diabetes to live well with their diabetes.
What are the symptoms of hyperglycemia?
Symptoms of diabetes:
- An abundance of urine with several night awakenings
- Excessive thirst: the person can drink several liters of water a day even when it is cold
- High fatigability: with the least effort the person can feel tired
- Unexplained weight loss, despite the fact that the person eats normally even a little more than usual.
What kind of bread to eat when you are diabetic?
A person with diabetes can eat any type of bread even if "wholemeal bread" is better than "white bread". It is strongly advised to consume white bread in a moderate way because it quickly releases its sugar in the blood and can quickly raise the sugar level.
What can a diabetic eat?
A person with diabetes can eat any food, but there are foods that they should eat in moderation. His diet will depend on his blood sugar level and his treatment.
What is the normal blood sugar level?
Blood sugar level is considered as normal when it is between 0.7 g / l (i.e. 4 mmol / l) to 1.1 g / l (i.e. 5.5 mmol / l)
What is the normal level of glycated hemoglobin?
Glycated hemoglobin is considered as normal when it is between 4 and 6%. The goal for people with diabetes is to have a rate below 7% in most cases.
What are the risks when you have type 2 diabetes?
In the short term: acute complications such as hypo and hyperglycaemia can lead to coma.
In the medium and long term: damage to the nerves and muscles can affect all parts of the body, causing a risk of blindness, dialysis, amputations, heart and brain attacks.
What are the side effects of metformin?
Main side effects:
- Digestive problems (diarrhea)
- Risk: lactic acidosis (1 / 40,000 patient-years)
What is type 1 diabetes?
One of the less common forms of diabetes is type 1 diabetes. It represents around 10% of diabetics and generally affects children, adolescents and young adults under the age of 30. It is due to a total defect in insulin production and its treatment requires lifelong insulin treatment.
How to lower blood sugar levels?
To permanently lower blood sugar levels, the following measures must be observed:
- Practice regular physical activity that must adapt to each patient (the general recommendation of the World Health Organization is to practice physical activity 30 minutes a day)
- Adopt a balanced and diversified diet,
- Take your medication as prescribed without interruption.
What are the carbs to avoid?
Quick sugars like "ordinary" sugar are not recommended outside of hypoglycaemia. The sugars in cereals and bread pass more slowly through the blood and can be consumed during the main meals.
What is the normal level of glycated hemoglobin?
Glycated hemoglobin is considered normal between 4 and 6%. The goal for people with diabetes is to have a rate of less than 7% in most cases, sometimes as high as 6.5%.
What is the blood sugar level not to be exceeded?
Objectives must be individualized. In general, the sugar level should not exceed 1.1 g / l on an empty stomach and 1.8 g / l two hours after meals.
What is the difference between type 1 diabetes and type 2 diabetes?
Type 1 diabetes:
- It occurs in younger people (usually before the age of 30)
- The concept of diabetes is often overlooked in the family (in only one in 10 cases we find a parent with diabetes)
- the person often has a normal weight or is even a little bit lean
- In general, there are no chronic complications in the discovery of diabetes
Treatment is based on administration of INSULIN for life.
Type 2 diabetes :
- It occurs most often in people over 40 years old but can occur at any age
- The notion of diabetes in the family is found in 1 in 2 cases, the whole family is sometimes even affected by the disease
- The person is overweight and sedentary in most cases
- The onset is insidious and can progress for several years without the person being aware of their diabetes
- The discovery of diabetes often comes with the appearance of chronic complications (this is even stronger for some continents such as Africa or Southeast Asia)
- Women who have given birth to children over 4 kg or who have suffered from gestational diabetes have a higher risk of developing type 2 diabetes
The treatment is based on a change in lifestyle (better diet and physical activity), taking tablets and in some cases the administration of INSULIN.
What foods are prohibited in case of diabetes?
There is no formally prohibited food for diabetes. It is imperative to tailor the treatment of diabetes to each patient. The needs are different according to the type of diabetes, the type of treatment, the type of physical activity practiced and according to the age.
In general, as in the non-diabetic population, it is advisable to limit the consumption of foods rich in fat (reduce fried foods and cooking oil), rich in sugar (especially sugars added to food, jams, honey ….), To encourage the consumption of fruits (1 to 3 per day) and vegetables.
What can cause diabetes?
Diabetes is caused by a manufacturing defect or the action of a substance called INSULIN. This substance is made by the pancreas and allows sugar to enter the muscle, which then converts it into energy, which gives us the strength necessary to carry out most of our activities.
What are the first signs / symptoms of diabetes?
Diabetes manifests as:
- An abundance of urine with several night awakenings
- Excessive thirst: the person can drink several liters of water a day even when it is cold
- High fatigability: with the least effort the person can feel tired
- Unexplained weight loss, despite the fact that the person eats normally even a little more than usual.
- In some cases in older people, diabetes can develop for years without symptoms and be revealed during certain complications including damage to the eyes, nerves, recurrent wounds.
How do you know if you have diabetes?
A blood sample quantifies the blood sugar level, called blood sugar. This is the only way to say whether a person has diabetes or not. Diabetes is diagnosed if:
- The fasting sugar level reaches or exceeds 1.26g / l (7mmol / l) twice
- The sugar level, measured at any time of the day, reaches or exceeds 2 g / l (11.1 mmol / l)
- In some countries, you can also measure the average blood sugar level in the past three months called glycated hemoglobin. If its value reaches or exceeds 6.5%, we also diagnose diabetes.
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