Diabetes without myths: a conversation with an endocrinologist MCSC

It all depends on the type of diabetes.

Type 1 diabetes mellitus develops rapidly. It is important to pay attention to extreme thirst, frequent urination, weight loss, fatigue and slowly healing wounds.

Type 2 diabetes mellitus is often asymptomatic and develops gradually. Elevated blood glucose levels are often detected accidentally — for example, during medical examinations.

Type 2 diabetes can be prevented in many cases. It is important to modify the lifestyle: adhere to a rational diet, observe a drinking regime, regularly perform aerobic exercise and prevent the development of obesity.

Stress and lack of sleep increase blood sugar levels.

During stress, hormones (cortisol, adrenaline) are released, which increase glucose levels to mobilize the body. The balance of ghrelin and leptin is disturbed.

Lack of sleep exacerbates the problem: insulin resistance increases, cells use insulin worse, appetite increases and the risk of overeating increases. Over time, this increases the risk of developing type 2 diabetes.

Modern glucose monitoring devices include:

• traditional electrochemical glucose meters (e.g. Accu-Chek Instant, OneTouch Verio Reflect);
• continuous glucose monitoring (CGM) systems such as FreeStyle Libre, Medtronic systems, etc.

CGM measures the level of glucose in the interstitial fluid under the skin and allows you to obtain a daily glycemic profile.

For a healthy person, the maximum daily rate of added sugar is up to 10% of the daily calorie content. This is about 50 g (about 12 teaspoons) with a diet of 2000 kcal.

For additional benefits, it is recommended to reduce consumption to 5% — about 25 g (about 6 teaspoons) per day.

Yes, slim people can also get diabetes.

Type 1 diabetes mellitus is more often diagnosed in people with normal or low body weight and is associated with autoimmune destruction of pancreatic beta cells.

Type 2 diabetes mellitus is usually associated with overweight and insulin resistance, but it can also develop with normal body weight, especially in the presence of visceral (abdominal) fat.

LADA-diabetes — latent autoimmune diabetes of adults: slowly progressing autoimmune diabetes in people with normal body weight. It is similar in mechanism to type 1 diabetes, but clinically resembles type 2 diabetes.

MODY-diabetes is a monogenic form of diabetes with an autosomal dominant type of inheritance found in children, adolescents and young adults, often with normal body weight.

Heredity is important, but not a verdict, especially in type 2 diabetes, where lifestyle and metabolic factors play a big role.

The risk of developing type 1 diabetes in offspring is approximately 3-7% on the maternal side and about 10% on the paternal side.

With type 2 diabetes, the risk increases by about 1.7 times if one parent is ill, and can reach 70-100% if both parents are diagnosed with diabetes.

With type 2 diabetes mellitus, the use of sweets should be limited as much as possible and coordinated with the attending physician.

With type 1 diabetes mellitus, sweets in moderation are possible with careful monitoring of glucose levels and adjustment of insulin doses, taking into account bread units or grams of carbohydrates. Some types of sweets, especially in liquid form, are undesirable.

To maintain normal blood sugar levels, it is recommended to include in the diet:

• Low-carb vegetables (leafy greens, broccoli, cucumbers);
• protein products (fish, poultry, eggs);
• whole grain products;
• foods rich in fiber and healthy fats.

Dangerous myths that lead to ignoring the disease or refusing treatment, for example:

• "Type 2 diabetes is not dangerous";
• "if there are no pronounced symptoms, you do not need to be treated";
• "insulin is addictive";
• "you can't exercise with diabetes."

Such misconceptions increase the risk of serious complications: vascular and nerve damage, visual disturbances up to blindness, amputations, damage to internal organs.

For early diagnosis of diabetes are used:

• determination of fasting blood glucose;
• glycated hemoglobin (HbA1c).

It is enough for people without risk factors to be screened once every 3 years.

In the presence of risk factors (age over 45 years, obesity, heredity, etc.) — at least once a year.

In case of prediabetes, an examination is recommended every 6 months.