Diabetes

Diabetes is a disease that is defined by a permanent high blood sugar level. 425 million people live with diabetes in the world. It kills 5 millions of people per year et is spreading very quickly in Africa.

What is diabetes ?

What are the different types of diabetes?

Diabetes is a disease that is defined by hyperglycemia (that is, a permanently high blood sugar level).

Blood sugar level must not exceed 1.26 G / L with an empty stomach. Diabetes is a chronic illness that cannot be cured, but which is controlled by an adapted treatment.

There are 2 main types of diabetes: type 1 diabetes and type 2 diabetes. There is also a third form of diabetes called "gestational diabetes" which can affect pregnant women.

TYPE 1 DIABETES

The pancreas no longer produces enough insulin. This hormone helps regulate blood sugar (blood sugar). Patients must inject insulin daily to regulate their blood sugar.

This type of diabetes affects 10% of people with diabetes. It particularly affects young children, adolescents and young adults.

TYPE 2 DIABETES

The pancreas produces insulin, but in the wrong quantity and the body has difficulty using it. Some of the sugar carried in 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 disease. It particularly affects adults over 45 years old, sedentary and overweight.

GESTATIONAL DIABETES

It is important to know that this indicates a risk of developing type 2 diabetes later.

In many countries this diabetes affects more than 15% of pregnant women. It manifests as an abnormal increase in blood sugar at the end of the 2nd trimester or during the 3rd trimester of pregnancy.

In most cases, it disappears after childbirth. However, it is important to know that the mother becomes at risk of developing type 2 diabetes in the years that follow.

What are
the risk factors?

We are talking about risk factors for diabetes only for type 2 diabetes.

In fact, for type 1 diabetes, the onset of the disease is sudden and cannot be anticipated or prevented.

TYPE 2 DIABETES HAS 3 RISK FACTORS:

  • An unbalanced diet with a significant consumption of refined sugars, vegetable or animal fats (especially saturated) and a poverty in fruits, vegetables and therefore in dietary fiber
  • Lack of physical activity which leads to a sedentary lifestyle
  • Overweight and obesity which are the result of a lifestyle that combines unbalanced diet and sedentary lifestyle.

An unbalanced diet, a sedentary lifestyle, overweight or obesity are risk factors that can trigger the disease, but this will, in most cases, be done on the basis 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: very frequent need to urinate (especially at night), thirst, hunger and fatigue.

FOR TYPE 1 DIABETES

Symptoms are acute and manifest very quickly.

IN THE CASE OF TYPE 2 DIABETES

The disease is often insidious, it can settle 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 arise.

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 cause coma:

  • Diabetic ketoacidosis: which mainly concerns type 1 diabetes and which occurs when the body can no longer use sugar as fuel due to the total lack of insulin;
  • Hypoglycemia: which can affect both type 1 and type 2 diabetes, and occurs when the blood sugar level drops below a certain threshold. It always occurs due to an excessive effect of the treatment (for example an excessive dose of insulin compared 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: concerns only type 2 diabetes and occurs mainly in the elderly. It is often linked to severe dehydration during infections or taking diuretic drugs.

Chronic complications:

A poor blood sugar balance can gradually damage small blood vessels which can severely damage many organs. Thus, diabetes can cause:

  • Diabetic retinopathy: which is 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 represents one of the main causes of chronic renal failure.
  • Diabetic neuropathy:  the nerve fibers are affected and cause loss of sensation which mainly affects the legs and feet. A neuropathy associated with a deficient blood circulation in the legs promotes the development of ulcers on the feet which we will call "diabetic foot". If these "diabetic feet" are poorly treated, the patients risk gangrene and amputation.
  • Erectile dysfunction: diabetes also promotes impotence in humans.

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.

The danger, eventually, is that the artery becomes completely blocked, causing a myocardial infarction. The peripheral arteries are also affected, increasing the risk of stroke. Different studies show that the presence of diabetes increases the risk of cardiovascular mortality by a factor of 2 to 3 for men and 3 to 5 for women.

HOW TO TREAT DIABETES?

Diabetes cannot be cured but, by adopting an appropriate treatment as soon as the diagnosis is made, it is possible to control the disease, that is to keep the blood sugar level (glycemia) as close as possible to normal , in order to avoid the occurrence of complications.

For people with type 1 diabetes, drug treatment is compulsory and involves injecting insulin several times a day.

For people with type 2 diabetes, a good balance between diet and physical activity can permanently delay taking medication.

When these measures, called "hygieno-dietetic" measures, are no longer sufficient, we take the use of tablets called oral anti-diabetics which help normalize the blood sugar levels of patients. Insulin may also be necessary for some patients with type 2 diabetes when oral anti-diabetic drugs are no longer sufficient.

It is important to remember that, with appropriate treatment and monitoring, the life expectancy of a person diagnosed with type 1 or type 2 diabetes, diagnosed early, can almost become equivalent to that of people who are 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 intended to train the patient so that he can acquire adequate know-how, in order to arrive at a balance between his life and optimal control of his illness. "

In practice, educating the patient about their illness represents the central stage in the successful management of a person with diabetes.

It allows the explanation of the key concepts of diabetes, in particular its character of chronicity and therefore the obligation of treatment for life, but also the understanding of its interactions with the social context, essential to effectively fight against the disease.

This education helps explain the management of diet, physical activity and warns of the risks 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 emotional and social support.

Diabetes in numbers

“Cancer, diabetes and heart disease are no longer diseases of the wealthy. 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 disease, cancer and chronic respiratory diseases are the 4 priority non-communicable diseases (NCDs) for the World Health Organization (WHO).

NCDs kill 41 million people each year, which represents 71% of deaths worldwide (out of 56.9 million deaths worldwide).

More than 80% of these “premature” deaths are attributed to the 4 priority diseases (1). Indeed :

Cardiovascular disease kills
millions
people per year

Respiratory diseases kill
millions
people per year

Cancers kill
millions
people per year

Diabetes kills
million
people per year

Low- and middle-income countries pay the highest price with more than 85% of annual deaths from Noncommunicable Diseases
(34.8 million deaths per year) making NCDs a major cause of poverty and a central development problem for countries.

In 2025, Noncommunicable Diseases will be the leading cause of disability worldwide and will cause 30% of deaths in the Africa region.

Diabetes: global data

Diabetes is a chronic disease which affects more than 425 million people worldwide today.

It already affects one in 11 people and gestational diabetes one in 7 births (2).

Diabetes kills more than 5.1 million people a year, 14,000 deaths per day and 1 death every 7 seconds.

In comparison, in 2012, 1.6 million deaths were due to HIV (1.4- 1.9 million) (3). According to the International Diabetes Federation (IDF), in 2045, diabetes will affect 650 million people, making it one of the leading causes of disability and death worldwide.



millions
of diabetics around the world

dead
per day

Diabetes kills
millions
people per year
1 dead every
seconds

Diabetes :
an "epidemic"
in Africa

%
people with diabetes live in low- and middle-income countries
The number of people with diabetes in Africa will increase by
%
over the next 30 years
The prevalence of this disease will exceed
%
of the population of the African continent in 2040

Diabetes is no longer a disease of rich countries. In fact, 80% of people with diabetes live in low- and middle-income countries.

These alarming figures explain the statement of former WHO Director-General Gro Harlem Brundtland:

"This is new scientific evidence of the transition the world is experiencing between communicable and noncommunicable diseases. In the 21st century, the impact of this transition will be greatest in developing countries. "

Africa will experience the largest 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 140% over the next 30 years, from 14.2 million in 2015 to 34.2 million in 2040. By this date, the prevalence of this disease will exceed 5% the population of the continent.

If we take Mali, Burkina Faso or the Union of the Comoros as an example, these 3 countries in West Africa and the Indian Ocean already have a prevalence of diabetes between 3 and 6% of the adult population. For comparison, the prevalence of diabetes in France in 2013 is estimated at 5.4% of the adult population (3).

WHY DIABETES is advancing so much in Africa?

Nutritional transition, urbanization and sedentary lifestyle 

Talking about food problems in Africa refers to these images of adults with sunken faces, aged before age, and skinny children with bloated stomachs. This all too familiar imagery of famine still resurfaces in certain regions hit by excessive drought or in conflict zones.

However, what has been observed for the most part on the African continent in recent years has been a transition from forms of malnutrition, from undernutrition to over-nutrition. The problems of overweight today go far beyond the problems of underweight.

This phenomenon mainly affects cities where overweight already affects one in four women and one in six men. This explosion of obesity, involving both the wealthy and the working classes, is essentially linked to the appearance of a nutritional transition.

It is defined as a progressive 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 like oil, mayonnaise, fried dishes, salty products like food cubes, tomato concentrates, food salt and sweet products like simple sugar and cookies invade the shops of African markets. These modern stalls are very far from traditional rural markets.

These changes in eating habits are also very often accompanied by the transition from a physically active lifestyle to a sedentary lifestyle. Indeed, the evolution of lifestyles linked to the very strong growth of urbanization (generalization of office work, use of motorized means of transport, proliferation of television screens and video games for children) reinforces sedentary lifestyle .

Finally, it should not be forgotten that in :

  • "2009, Africa exceeded one billion people, 395 million (nearly 40 percent) of whom lived in urban areas"
  • "2050, the total population of African cities will increase to 1.23 billion inhabitants or 60% of the total population and as much as the entire population of the continent today" (4)

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 the woman whose overweight reflects the good attentions lavished on her by her husband. On the other hand, a relatively thin and underweight adult will be suspected of being ill or having financial difficulties.

If we take the example of Mali, international statistics show that lifestyle risk factors for diabetes already have a very strong impact with a prevalence:

  • 21% overweight and obesity in people over 20 (with a prevalence exceeding 25% in women)
  • sedentary lifestyle of 19.5% in people over the age of 15 (5)

Sources :

(1) OMS : WHO Global NCD Action Plan, 2013-2020
(2) International Diabetes Federation : Diabetes Atlas 8th edition. 2017
(3) Unaids : Rapport ONUSIDA sur l’épidémie mondiale de sida 2013
(4) L’état des villes africaines 2010, ONU Habitat, rapport global 2010.
(5) World Health Organization. Noncommunicable Diseases Country Profiles 2011

Frequently Asked Questions

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 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.

How to cure diabetes?

We cannot cure diabetes but good diabetes control allows people with diabetes to live well with their diabetes.

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 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 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 are the side effects of metformin?

Main side effects:

  • Digestive problems (diarrhea)
  • Risk: lactic acidosis (1 / 40,000 patient-years)

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.

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 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.

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 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 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 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 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 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.

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.

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.