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All about Diabetes | Diseases and conditions
Table of contents:1. What is Diabetes
2. What is hypoglycemia and causes?
3. gestational diabetes
4. diabetes insipidus
5 nutrition and diabetes
6. oral care for diabetics
1. What is Diabetes
Diabetes is a disease that is characterized by an elevation of blood glucose (sugar) levels in the blood. If those levels are very low or very high can lead to acute complications that we must try to resolve quickly.
Blood glucose levels high and maintained for a long time cause damage in the arteries of the body, and long run impair and alter various organs, especially eyes, kidneys, nerves, heart and other blood vessels.
Types of diabetesThere are basically two types: type 1 and type 2, although it is also common to see it in pregnant women:
• Diabetes type 1: typical in early ages of life, usually before the age of 30-40. In its treatment usually almost always need insulin.
• Diabetes type 2: is the most common, usually occurs in obese people and older. You do not always need insulin, especially in the early stages of the disease, and it can be controlled with diet and antidiabetic drugs.
• Gestational diabetes: pregnancy is a situation that favors the poor control of blood sugar and that can lead to gestational diabetes. For this reason, approximately in week 28 of pregnancy is a special test to all pregnant women, to assess whether there is diabetes.
Causes of diabetesThe ageing of the population and changes in lifestyles are the two factors that most influence the progressive increase in diabetes. Thus, the change in eating habits and increasing sedentary lifestyles and increase of physical inactivity, which cause obesity, have as a direct consequence that disease is increasing all over the world.
There are factors that increase the likelihood of developing diabetes: the elderly and the presence of other diseases such as obesity and high blood pressure, as well as the family history of diabetes, are factors that significantly influence the development of this disease.
In some cases diabetes can be secondary to concrete circumstances: consumption of alcohol (especially in males), some drugs (corticosteroids, anti-inflammatory, contraceptive) in women, kidney disease, and others.
Symptoms of diabetesIn the early stages of the disease may not have symptoms of diabetes.
Alert symptoms, and more frequent when the disease is fully developed, are: polyuria (urinating much), weight loss, polydipsia (be very thirsty and drink plenty of water), reduction of visual acuity, tiredness and drowsiness.
Risks associated with diabetes
Diabetic always has a much higher than that of the non-diabetic population mortality (more than double). Therefore, in the diabetic patient acquires a special importance control of all the risk factors associated, such as high blood pressure, cholesterol and obesity, and not just the sugar control; Although it is clear that a worse risk of death and complications greater glycemic control.
Complications of diabetes
80% of patients with diabetes will develop cardiovascular disease. The risk of cardiovascular disease occurs 15 years earlier in diabetic patients in the rest of the people, by which diabetes mellitus greatly reduces the life expectancy of both men and women. The costs of health care that generates are very high, and are conditioned by these cardiovascular complications. Complications of diabetes include:
• Myocardial infarction, stroke and cerebral thrombosis.
• Peripheral vascular disease; diabetes is the most common cause of non-traumatic limb amputation.
• Diabetic nephropathy, which may progress to renal failure.
• Retinopathy, which can lead to blindness.
• Peripheral diabetic neuropathy
Diagnosis of diabetesThe normal limit of blood sugar has been changing in the course of the years. Currently those who have, at least on two occasions, a blood glucose are diagnosed as diabetic in fasting greater than or equal to 126 mg/dl.
Those with blood glucose between 100 and 125 mg/dl is considered that they are in a situation of pre-diabetes and at greater risk of becoming diabetic in the future.
For the general population, the programme of preventive activities and health promotion (PAPPS) recommends screening for diabetes with the determination of the basal glucose in some specific situations. They match almost in its entirety the recommendations from the American Diabetes Association, and are:
• All those older than 45 years. If it is normal, repeat every three years.
• For ages earlier or more frequently (annual):
or the presence of other risk factors: obesity, altered cholesterol or high blood pressure.
or if there is a previous diagnosis of impaired glucose in fasting or intolerance to glucose, without criteria of diabetes.
or when the patient has or has had gestational diabetes or obstetric history of interest: births of children of over 4.5 kg.
or if there is a history of diabetes in first-degree relatives.
or in the case that there are other characteristics that might influence the development of the disease as: PCOS, belonging to certain ethnic groups (African American, Hispanic American), etc.
Complementary tests for the diagnosis of diabetesA late diabetes diagnosis carries a higher risk of complications, so it is very important to consider strategies for early diagnosis in population groups that have a higher risk.
The study of all diabetic patient must be completed with an analysis of blood and urine, the realization of an electrocardiogram, and the evaluation of the retina by scanning the bottom of eye.
It is essential to discard that they may exist other added risk factors, especially high blood pressure and high cholesterol.
If there is enough evidence on the possibility of preventing or delaying the onset of diabetes mellitus type 2:
• Weight loss (if obesity): 7-10% in 1 year.
• Exercise: 30 minutes a day of physical activity moderated (ride fast).
Treatment of diabetesThe goal of diabetes treatment is not so much control blood sugar, but decrease the mortality rate.
If the diabetes is out of control, in the initial phase is very important to get the disappearance of the symptoms of hyperglycemia: polyuria, polydipsia and fatigue.
You should avoid acute decompensation of the disease, and delay the onset or progression of chronic complications: in large arteries and heart (reperfusion), as well as in small arteries in kidney, retina and nerves (microangiopathy).
We must identify objectives; Although there are some general and common measures for all patients, each diabetic need individualized treatment.
Non-pharmacological treatment of diabetesWeight loss is the key factor to reduce the risk of diabetes in people at high risk and overweight. No need to reach an ideal weight, a modest reduction in 5-10% can be very beneficial for the control of diabetes.
Dietary control, avoiding refined sugars ("sweet" and derivatives), smoking abstinence if you are smoking, and physical activity, are other key steps to reduce the risks of complications.
Pharmacological treatment of diabetesPharmacological treatment of diabetes is based on the use of 'pills', sometimes associated with insulin.
The reference for the treatment of diabetes antidiabetic medicine is metformin. There are other groups of drugs which will be valued by your doctor in each case; It's the sulfonylureas, such as gliclazide, glyburide, glinidas, and the tiazolindionas or glitazones.
Two new groups of drugs belonging to a new class of diabetes treatments are also available. Some are inhibitors of DPP-4, such as sitagliptin, vidagliptina; and others, the so-called analogues of GLP-1, such as exenatide.
InsulinsWhen it is not possible to control diabetes with the measures referred to above, the use of insulin is essential.
Basically, the insulins are classified by their action in modo-duracion:
• Regular insulin (fast-acting): Home 30 to 60 minutes - maximum 2-4 hours - 5 to 7 hours.
• Intermediate (slow-acting): Home 1-2 hours - maximum 5-7 - 12 to 13 hours.
• Mixtures, sharing characteristics of the former.
All are subject to variability inter and intraindividual, so the titration must be carried out specifically for each patient, as measured by the levels of glucose in blood.
Lately new types of insulin by genetic recombination techniques, have developed the so-called insulin analogues. They can also be fast-acting, mixes, or slow-acting. The latter produce an insulin sustained, slow release and without spikes, so their risk of hypoglycemia is low, and are currently more on the rise. The representatives of the latter group are insulin glargine and insulin detemir.
Other aspects to be considered in the treatment of diabetesIn addition to specific measures to control the sugar, you always have to keep under control other risk factors such as high blood pressure and cholesterol. In the majority of cases, it is also necessary to use medications to treat these problems.
The benefit of treatment is maximum in high-risk patients, i.e. those who have worse controlled diabetes and other risk factors present partners, such as smoking, high blood pressure, obesity, cholesterol...
It is imperative to meet well the treatment prescribed by the physician and be scrupulous monitoring of the dietary measures. It should know the side effects and learn to recognize the hypoglycemia and how to treat them.
Recommendations for diabetesIn the early stages of the disease may be no symptoms or these very mild. The overall prevalence in Spain is highly variable, depending on the region and studies, but round about 10% of the population. As is the case with other chronic diseases, it is important to understand the disease and know what we can do to try to better control. If the power supply is neglected or is in breach of the treatment, the risk of complications greatly increases.
In those smoking patients is a priority the permanent abandonment of the smoking habit.
Exercise for diabeticsModerate exercise, and adapted to the possibilities of each individual, is an excellent way to improve diabetes control. If it is not a very good education diabetes and a broad knowledge of the illness, and especially in patients using insulin, it is advisable to not perform strenuous exercise, since it may cause hypoglycemia.
It is considered that an exercise is effective when all or almost all days of the week, at least for 30 minutes with moderate intensity. Most recommended exercises for diabetic patients are walking, smooth trot, dance, swimming, bicycling...
Food for diabetesThey have to avoid foods with high carbohydrate content, especially if they are sugars of rapid absorption (sugar, cakes and pastries, pastry creams, jams, cakes, ice creams...).
We recommend the Mediterranean diet, which is characterized by the abundance of fresh products of plant origin (fruit, vegetables, cereals, potatoes, nuts, etc.), the scarcity of products rich in refined sugar and red meat, the presence of olive oil as the principal source of fat, and intake of cheese, yogurt, chicken and fish in moderate amounts, which is considered an ideal food for the prevention of cardiovascular diseases.
Caloric intake must be adequate to maintain your ideal weight and avoid sugar-rich foods (sweets, cakes, tarts, pastry creams, jams, ice creams...). It should also limit much or avoid alcohol consumption, since it favors the hypoglycemia.
Ocular complications associated with diabetesDiabetes is associated with a group of eye problems that can result in loss of vision or even blindness. In particular, people with diabetes have an increased risk of:
• Diabetic retinopathy: is damage to the retina, the layer more internal eye, caused by an inadequate control of glucose for an extended period. Although the majority of people with type 1 diabetes and many patients with type 2 diabetes will finally experience some degree of retinopathy, early diagnosis and proper treatment can stop the loss of vision. People suffering from diabetic retinopathy are seldom changes Visual, especially at the beginning of his illness, when it may be treatable, which highlights the usefulness of periodic inspections.
• Falls: falls are a darkening of the lens that blocks or change the way in which the light reaches the eye.
• Glaucoma: which is an increase of pressure of the fluid inside the eye that damages the optic nerve and vision loss. People with diabetes have twice the risk of developing glaucoma than the rest of the people.
• Macular edema: a buildup of fluid in the most sensitive area of the retina that causes blurred vision in the central or lateral part of the visual field.
• Retinal detachment: one of the most common causes of blindness in diabetes, which occurs when the blood vessels separates the retina from the back of the eye.
Changes in graduation
In addition to these potential problems, in diabetics fluctuations in blood glucose levels cause refractive variations, resulting in gains or loss of visual acuity. Before an episode of hyperglycemia, the Crystal experience variations that lead to myopia, which will cause the affected person have difficulties to watch from afar. When fast controlling blood glucose, is produced just the opposite effect.
All these variations are temporary until you get to stabilize blood glucose. So much so that the continuous refractive changes may indicate that the patient suffers from diabetes, while already-diagnosed people usually demonstrate a lack of metabolic control.
Disposable contact lenses, workaround
In these periods of time that are perceived refractive changes due to a lack of glycemic control, it is recommended to use disposable contact lenses. It is a convenient, fast and efficient solution that avoids changing the lenses of the glasses until graduation to stabilize.
It is a convenient, fast and efficient solution that avoids changing the lenses of the glasses until graduation to stabilize.
Therefore, the ideal is that diabetics have in mind the need to undergo periodic reviews of their vision in order to detect these complications to times and avoid problems as blindness.
Diabetic peripheral neuropathyPeripheral neuropathy is a disease that damages the peripheral nerves of the patient. The nerves that make up the peripheral nervous system function as a communication network that connects the brain and spinal cord to the rest of the body. These nerves transmit information to the brain about everything we see, hear, touch, smell... and warn about potential dangers, in such a way that the brain, in turn, can send the appropriate orders to protect the body and protect it from injury. Thus, for example, if we burn we hand to reach for something very hot, or if the toes get cold too, peripheral nerves sent this information immediately to the brain so that the individual will act accordingly.
However, when peripheral nerves are injured, interference in this system of communication, and information is interrupted or distorted.
There are many disorders that affect the peripheral nerves and impair them, preventing that the messages flow correctly between the brain and the different areas of the body. Nerve damage has varying degrees of severity, and the symptoms are also highly variable. Patients may experience prickling or itching, transient numbness, loss of sensation in the affected area that prevents to appreciate if something is too hot or cold, weakness or cramps in the muscles, and even severe pain in the extremities. When the disease is severe also alters the functioning of various organs of the body and can make it difficult to swallow or even breathing.
Peripheral neuropathy can occur for many reasons, such as trauma, compression of a nerve - as in carpal tunnel syndrome-, the consumption of certain drugs or toxic substances, infection, an autoimmune disorder, but, frequently, peripheral neuropathy appears associated with another disease, i.e., is a symptom or a complication of another disease, such as in the case of diabetes. This disease is characterized because the blood sugar levels are high and this can cause damage to the nervous tissue, giving rise to what is known as peripheral diabetic neuropathy.
2. What is hypoglycemia and causes?
• The body consumes glucose present in the blood too rapidly.
• Glucose is released into the bloodstream too slowly.
• Releases an excess of insulin into the bloodstream.
This is a relatively common disorder in people with diabetes. Diabetes is a disease that is basically the situation facing hypoglycemia, i.e., people with diabetes have a too high concentration of glucose in the blood, due to a deficiency in the production of insulin by the pancreas (diabetes type I or juvenile diabetes), or an inadequate response to the same part of the body (type II diabetes).
The treatment of this disease is based on the administration of insulin or drugs that facilitate glucose uptake by cells. However, a diabetic individual may suffer an episode of hypoglycemia if:
• Consume a too high dose of insulin or any medications for diabetes.
• Do not respect the schedule of treatment with insulin or other antidiabetic therapies.
• Do not eat enough food, i.e. available glucose has on the body, or to be stored or to be consumed.
• Carried out a sudden physical exercise that requires one greater energy input available to your body.
Infants infant children of diabetic mothers frequently have very low blood sugar at birth.
Hypoglycemia: Sugar and insulinSugars have a mainly energy role in the body. They are essential for muscles, brain and other organs and tissues to carry out their normal activities. Glucose is the main sugar used by cells of our body to obtain this energy; and the main source of glucose are the foods and, in particular, carbohydrates (the body also manufactures certain amounts of glucose from other compounds).
So one of the goals of feeding is to keep blood glucose levels appropriate to the requirements of our organs and tissues. When we eat, for example, a pasta dish, this will be degraded into increasingly smaller compounds, which may finally be absorbed in the intestine. One of these compounds is glucose. After its absorption in the intestine, and before moving on to the general circulation, this sugar is transported to the liver, where a part is stored in the form of glycogen (compound formed by various chains of glucose). Glucose that has not been stored will leave the liver and will be transported by the blood to nourish all the cells of the body.
At one point the level of sugar in the blood can decrease, either because we have been without eating, or because we have made an effort requiring that energy. If at that time we not eat foods that provide the glucose needed to cover this lack, in the liver will begin to degrade glycogen and glucose obtained from this process will pass into the blood and will again reach the concentration needed to feed our tissues. It could be said that the hepatic reserve is a fairly efficient security system.
In addition to the liver, the human body has another store of glucose, the muscles. Unlike the reserve formed in the liver, muscle reserve is in principle of exclusive use of this fabric.
InsulinSo the sugar that is found in the blood can be used by the Agency is necessary for the body to secrete insulin, which is a hormone that is synthesized in the pancreas, which allows cells capture the glucose that is found in the blood. This hormone is released when an increase in the level of glucose in the blood, i.e. after the intake of food. There is also a small amount that is released from a more regular during periods of fasting.
Risk factors of hypoglycemiaPersons suffering from certain endocrine disruption are susceptible to hypoglycaemic episodes. They are risk factors of hypoglycemia:
• Hypopituitarism: abnormally low production of hormones secreted by the pituitary gland. The pituitary or pituitary gland, controls the activity of other many secretory glands, so that tampering causes disorders in various parts of metabolism.
• Hypothyroidism: deficit of the activity of the thyroid gland. Hypothyroidism can be given by a bug in the pituitary gland, which is responsible for regulating its activity, or own thyroid gland malfunction. The main hormone secreted by the thyroid is thyroxine, which is necessary to maintain the basal metabolic rate (resting metabolic rate) within the levels.
• Hypoadrenalism: decrease in the activity of the adrenal gland. Adrenaline is a hormone that at certain times is responsible for, among other things, increase the levels of glucose in the blood by its action on liver and muscles; If it is not present in the amount and at the right time, the Agency will not receive the contribution of glucose you need.
• Patients with liver or kidney diseases , are also among the susceptible population to suffer from this disorder.
Cases of hypoglycemia do not have to be always related to other illnesses, hypoglycemia can also appear occasionally in healthy individuals. This situation can come by excessive physical exercise, a deficit of food, or by a sudden increase in the levels of insulin produced by the pancreas.
Alcohol consumption It can also trigger the hypoglycemic process in some cases. Ethanol-containing beverages cause increased insulin production; If the individual swallows it in a State of prolonged fasting, sugar reserves will be consumed, and there will be many possibilities of suffering from a steep descent of glucose. High consumption is not necessary to produce this situation, which can occur in chronic alcoholic individuals both in healthy patients.
Symptoms of hypoglycemiaThe symptoms of a hypoglycemic State vary from some people to others and, depending on the level of hypoglycemia of the patient, usually begin when blood levels are close to 50 mg/dl, although this value varies for each individual.
The effects that a patient who is suffering a decline in sugar will feel will be in the majority of cases: fatigue, malaise, numbness and trembling. Also the presence of cold sweats, palpitations, dizziness, anxietynausea, dizziness, muscle aches, and paleness is very common.
Since the main nutrient of the nervous system is glucose, a decrease of the same will have neurological consequences. They may experience Visual symptoms (double or blurred vision), headache, seizures, disorders of behavior, excessive hunger, nervousness and inability to concentration, among others.
In diabetic patients who are being treated, the symptoms of Hypoglycemia may not manifest until the moment in which the glucose has already reached very low levels. In these cases the patient may suffer fainting, seizures and even coma.
Diagnosis of hypoglycemiaShall be an individual who presents the symptoms described first an assessment of blood sugar. Levels below 70 mg/dl is considered to be associated to a hypoglycemic State. The clinical history may help if the patient has any disease that can be related to decreases in glucose. Similarly, it would be useful to ask the patient about their eating habits, alcohol consumption and lifestyle in general. While the diagnosis of this pathology is relatively simple, because of the coincidence of many of their symptoms with other disorders, determine the origin of them can be a real puzzle. Hence the importance of knowing the clinical data, history and lifestyle of the patient prior to the study.
One of the first steps will be the administration of glucose to stabilize the patient; If you notice an improvement in symptoms after the Administration will confirm the diagnosis. Normally it is not necessary to carry out more tests, but there are certain measurable parameters in the blood sample, apart from the level of glucose, which may indicate a hypoglycemic State: increased hematocrit (amount of red blood cells) and hemoglobin (the protein that carries oxygen inside red blood cells), the presence of abundant neutrophils (one of the types of white blood cells), etc. Observation of the electrocardiogram also certain characteristic aspects of the fall in sugar can be deducted, but this test is not usually used, since does not provide crucial data for diagnosis.
Sometimes there may be suspicion that the hypoglycemia has an immune origin; in these cases will be carried out tests to detect antibodies against the insulin in the blood of the patient.
Treatment of hypoglycemiaThe fastest method to increase sugar levels once there has been its descent is to eat any sugary food, to be possible accompanied by some other food with some fat and protein content.
Another possibility is to have glucose tablets. These tablets are absorbed at high speed and are increasing the level of 5 mg/dl for each gram of ingested blood glucose.
It is very important to note that these actions are aimed at eliminating the hypoglycemic process, not its symptoms (at least not directly). Why not expect an immediate disappearance of the discomfort, which may take several minutes to disappear. In the same way, should be especially careful with do not produce a hyperglycemia (abnormally high blood glucose level), namely, that it is necessary to know the dose right before administering it (previously it will have conducted a measure of blood glucose level with a specific meter).
In the most serious cases treatment will consist in the application of injections of glucose or glucagon (hormone produced by the pancreas and whose function is to control blood glucose levels).
Prevention of hypoglycemiaThe best choice for people who tend to suffer reductions of sugar is to take strict control both their power and their schedules.
Distribute the number of daily meals in five or six (and not skip any) is usually recommended, in order to evenly distribute the amount of ingested glucose throughout the day, and maintain a regular level in the body as well.
As to the composition of food, the consumption of complex carbohydrates (which are absorbed slowly and are used by the body more efficiently), fiber and fat (to be possible to not abuse of saturated fats) favors metabolism balance. We must reduce the consumption of alcohol, and never drink it on an empty stomach. Fruit juices and simple sugars (for quick absorption), meanwhile, are helpful when they feel the first symptoms of a decline in sugar.
Another point to consider is the physical exercise. You must not never be in excess, and is highly recommended to have on hand some sugary food if arises a hypoglycemic episode during his practice.
People with diabetes must follow the directions of the doctor in a strict way, not skipping meals, and applied doses of insulin at the time and appropriate measure.
3. gestational diabetes
Written by Natalia Dudzinska waiter, biologist
Glucose is the main source of energy for the body. During the process of digestion the glucose contained in ingested food is released and passes into the blood to be distributed by the body. So the cells of various organs and tissues can make this circulating sugar is required the presence of insulin, a hormone released by the beta cells of the pancreas that is closely regulated by glucose levels in blood or blood sugar.
Diabetes is a condition characterized by an abnormally elevated presence of blood sugar. These high levels may be the result of a deficiency in the production of insulin, or a malfunction of the process carried out by the same. Depending on its cause, one can distinguish two types of diabetes:
Diabetes mellitus type I, juvenile or insulin-dependentThis type of diabetes, usually of autoimmune origin, characterized by very low or even absence of insulin production, and usually appears in childhood or in young adults. Requires the administration of insulin of by life.
Diabetes mellitus type II, or adultCells from individuals with type II diabetes have resistance to insulin. This type of diabetes usually appears in adults, and certain situations constitute a key risk factor in the onset of the disease: obesity, certain hereditary diseases (syndrome of Down, Porphyria, Klinefelter Syndrome, hemochromatosis or Turner syndrome), and some endocrine disorders and the the polycystic ovary syndrome, which give rise to imbalances that can lead to an insulin resistance.
Gestational diabetesGestational diabetes is usually included within the type II diabetes mellitus. It tends to be diagnosed for the first time on the 24-28 weeks of gestation, and is presented in 3-10% of pregnant women.
Then you will learn what is his appearance, its possible consequences for pregnant women, the development of pregnancy and future baby, and how you can control it by diet.
Why gestational diabetes occursThe development of the fetus in the mother's body is an important energy expenditure; to meet this demand, the body needs to modify the amount and form of assimilation of glucose, among other mechanisms. During the first two trimesters of pregnancy occurs basically the outline of all the structures of the fetus; There is a high growth of the fetus or placenta. At this stage, the mother's body is metabolically prepared to constitute the energy reserve that give support to the further fetal growth. It will increase food intake, which contributes to the generation of a store of fat; on the other hand, high levels of insulin (hyperinsulinemia) can be seen, and maternal tissues are an appropriate response to it.
In the third quarter the fetus will begin to grow at high speed at the expense of maternal reserves. Glucose is one of the compounds required in large amounts (the fetus will consume up to 50% of the glucose from the mother); to facilitate this contribution to baby tissues of the mother going to express certain levels of insulin resistance, so that blood sugar levels (and, therefore, available to the fetus) will be greater.
In these circumstances of insulin resistance, the pregnant woman is susceptible to develop gestational diabetes. In the majority of cases the alteration has the characteristics of a diabetes type II (non-autoimmune origin) and only a small percentage of the population presents pre-pregnancy diabetes (those diagnosed before pregnancy).
Risk factors for gestational diabetesCircumstances relating to the health and physical condition of the woman, before and during pregnancy, can pose important risk factors in the occurrence of this pathology, among them:
• Pregnancies in women over age 30.
• Women with a family history of diabetes or gestational diabetes.
• Presence of overweight before pregnancy.
• First child with a 4 kg birth weight, or a congenital defect.
• Women with a history of miscarriages, stillbirths or spontaneous (pregnancy in which the fetus dies during childbirth or in the second half of pregnancy).
• Excess amniotic fluid.
• High blood pressure.
Symptoms of gestational diabetesIn pregnant women who suffer from this disorder symptoms can be mild or invaluable, or manifest itself with the appearance of the typical hassles of disease. In routine analysis can detect abnormally high levels of sugar in blood and not find no other evidence of disease. Other patients, on the other hand, may notice some of the following symptoms:
• Blurred vision.
• Thirst and polydipsia (large water consumption).
• Polyuria: increase urination.
• Nausea and vomiting.
• Weight loss.
• Urinary tract infections, vaginal candidiasis.
Possible consequences for the mother• High incidence in disorders of the conception (as improper implantation of the embryo in the uterus or spontaneous abortions).
• Increased incidence of diabetes mellitus in the years after pregnancy.
Possible consequences on the development of pregnancy• Fetal growth retardation.
• High incidence of congenital malformations.
• Macrosomia: size of the fetus high in relation to their age.
• Intrauterine fetal death.
Possible consequences for baby• Tendency to obesity.
• Tendency to Dyslipidemia (alteration of normal lipid levels in blood) and diabetes in adulthood.
Diagnosis of gestational diabetesOne of routine testing which is currently subject to pregnant women is a test of screening (test carried out at apparently healthy individuals in order to detect those at high risk of suffering from some disease) named Test O´Sullivan. This test is to determine the level of glucose in the blood after ingestion of 50 g of glucose, regardless of the time of day and prior food intake. A result equal to or greater than 140 mg/dl mean positive for gestational diabetes.
This test is done to all pregnant women who are between the 24th and 28th week of gestation; in cases where factors of high risk (mother of 35 years, obesity, etc.) are detected, the test will be performed in the first trimester of pregnancy.
If the O´Sullivan test is positive you will proceed to perform a confirmatory diagnostic test using oral overload of glucose (SOG). To carry out this test, the patient should be on fasting and have followed a diet without carbohydrate restriction in the three days prior to it. Before administering glucose will be a first extraction of blood; then the woman should drink 100 grams of glucose dissolved in water or any other liquid. Later extractions shall be the hour, two hours, and three hours, to measure blood sugar levels. To avoid altered results, it is recommended that women remain at rest during the development of the test.
If two or more values obtained are equal to or greater than normal, the result will be as positive. If one of the values is greater, the diagnosis will be impaired glucose tolerance in pregnancy tests must be repeated to three or four weeks.
Treatment of gestational diabetesOnce diagnosed, gestational diabetes will be handled mainly by the diet, since the oral hypoglycaemic are contraindicated during pregnancy. The aim of this treatment is the regulation of the maternal metabolism and normal development of pregnancy and childbirth.
It is important to take into account the need for weight gain of the pregnant mother, especially during the second and third trimester (350 - 400 g per week); Therefore, the caloric intake should be approximately 30-40 kcal per kg of weight and day. In obese women, the contribution will be somewhat less, about 24 kcal per kg of ideal body weight and day. It is also recommended to make around six meals throughout the day (lunch and dinner to be the biggest load caloric), avoiding fasting situations, which are little recommended during pregnancy. A medical nutritionist will be which must indicate the type and composition of the diet of pregnant women according to the characteristics of each patient.
So the woman can take a blood sugar control is provide a glucose meter with which a House self-analysis should be performed. With this unit, the patient may obtain their Glycemic level data and can be compared to the ideal value; If this value is exceeded twice or more in the course of one or two weeks, be to introduce an insulin treatment. The insulin therapy applies only in those patients who do not respond adequately to the diet.
Monitoring during laborThe importance of gestational diabetes detection is, at the time of delivery, in which the son of an untreated diabetic mother will have high possibilities of presenting macrosomia (bigger than normal fetal size); This leads to trauma from childbirth, shoulder dystocia (once went the head, the baby's shoulders are embedded in the birth canal), and the need for Cesarean in the majority of cases.
Women that has been followed a dietary treatment with satisfactory results will not require any special monitoring during labor. On the other hand, those which has been taken them to apply a treatment with insulin, should be subjected to analysis every hour during childbirth to manage loads of glucose and insulin at the right time, and thus prevent neonatal hypoglycemia.
Follow-up after birthIn the majority of cases the blood sugar levels return to normal after delivery. Insulin administration tends to be suspended at this time.
Six weeks after childbirth, will be again the proof of SOG, which will be reclassified to the patient as (normal) normoglucemica, with altered basal glucose (in fasting is detected one higher than normal blood sugar), glucose intolerant or diabetic. If the results of oral overload are suitable will be changed to only carry out annual checks, which are highly recommended, since there is a high percentage of occurrence of diabetes in the aftermath of a pregnancy with this type of complication.
Lipid profile also tends to be altered in these patients; to prevent cardiovascular risks, it is advisable to perform regular monitoring.
In addition to clinical recommendations, specialists advise to follow a balanced diet, avoid overweight, and moderate physical exercise.
Prevention of gestational diabetesKnowing the risk factors, it is relatively simple to deduce patterns of prevention for gestational diabetes. Weight control and a balanced diet, before and after conception, will be a first step to ensure a healthy pregnancy.
Occasionally pregnant women tend to keep a too high intake throughout pregnancy; to avoid that this contributes to the appearance of complications, please to the expectant mother, explaining how to control your diet so that their weight increase within the appropriate limit.
Moderate exercise (walking at least an hour a day) helps to maintain weight, and hormone and lipid, profile within the appropriate values.
4. diabetes insipidus
But there is another less known diabetes and less frequent, diabetes insipidus -insipidus, non-, which is characterized by abundant urination of very dilute urine. This disease is due to that the patient can not concentrate urine due to a defect, in the secretion of the hormone that performs this action over the kidney, vasopressin (AVP: arginine-vasopressin) ADH (antidiuretic hormone, ADH), or either in the response of the kidney to this hormone. In both cases, the result is the same: the Elimination of large volumes of urine (polyuria) and increased thirst sensation associated with the ingestion of large amounts of liquid (polydipsia).
Vasopressin acts on certain cells of the kidney (epithelial cells of tube collectors) to increase reabsorption of water, giving rise to the urine concentration and dilution of the blood. This action is required for the maintenance of the balance of ions and water in the blood. Its secretion is regulated by the osmolarity of plasma, i.e., by the concentration of ions in the blood; in a healthy person, two extreme situations would be: when the osmolarity is higher (more ions) is secret vasopressin and this acts on the kidney tubules resorb more water; When the osmolarity is lower (fewer ions, i.e., the blood is more diluted) not be secret vasopressin, water in the renal tubules is not absorbed and is excreted in the urine.
In a patient with diabetes insipidus not there it would be or would not act the vasopressin (depending on the type of diabetes insipidus) when it is needed, i.e. when the osmolarity of the blood is greater and, therefore, the water which should reabsorb the blood is eliminated with the urine, so the urine is very dilute.
Causes and types of diabetes insipidusDepending on the causes that caused the disease, two types of diabetes insipidus are distinguished:
Diabetes Insipidus-central, hypothalamic and neurohypophysealIt is a poor production of the hormone vasopressin (also known as arginine-vasopressin [AVP] and [MU'AADH] antidiuretic hormone) due to lesions in the hypothalamus (a region of the brain where vasopressin is synthesized) or in the pituitary gland (endocrine organ connected to the hypothalamus, where it accumulates vasopressin), specifically in the posterior pituitary gland. The causes of central diabetes insipidus may be:
• Sporadic forms: caused by any mechanism that prevents the release of vasopressin. If the injury includes the destruction of neurons in the hypothalamus is produced a permanent diabetes insipidus; but, sometimes, after trauma or surgical treatment there is an inflammation of the pituitary gland which is reversible, in which case the diabetes insipidus may be transient. Possible causes include tumors, head injuries, hypothalamus-pituitary surgery, granulomatosis (diseases in which form granulomas, which are inflammatory lesions that contain macrophages - a type of immune cell - which appear in response to the presence in the tissues of the body's biological or inert particles that are difficult to remove. An example of granulomatosis or granulomatous disease is sarcoidosis), infections, cerebrovascular diseases and, in some cases, the cause may be unknown (idiopathic) or autoimmune. Sporadic central diabetes insipidus may be associated deficits of other pituitary hormones and, sometimes, higher production of prolactin (hyperprolactinemia), which also is a pituitary hormone.
• Familiar forms: are hereditary.
Diabetes Insipidus, NephrogenicAs its name suggests, the cause is in the kidney. The situations in which the kidney does not respond to the action of vasopressin are:
• Acquired forms: renal failure, hypokalemia (potassium concentration in the blood lower than normal values), hypercalcemia (concentration of calcium in the blood than normal values), or by drugs or lithium intoxication.
• Familiar forms: less frequent than those acquired. They are usually linked to sex (X-linked recessive inheritance); affected males are resistant to vasopressin, and women are asymptomatic or have mild polyuria. 90% of patients have an alteration in a receptor for vasopressin in the renal tubules, the V2 receptor.
Symptoms of diabetes insipidusThe main symptom of central diabetes insipidus is polyuria, i.e., the Elimination of large volumes of urine. In addition, accompanied by polydipsia (thirst sensation increase associated with the ingestion of large volumes of liquid) and nocturia (urinating especially at night).
In patients with diabetes insipidus urine is hypotonic (has few ions) and daily volume ranges between 4 and 10 litres.
Diabetes insipidus symptoms usually appear suddenly; the patient needs to drinking at all hours, day and night, especially cold drinks.
It is also found hypernatremia in the blood, i.e. an increase of the concentration of sodium in blood, since the water needed to dilute it is lost in the urine. You can even produce dehydration in the case that the sick, for various reasons, can not drink.
Diagnosis of diabetes insipidusThe diagnosis of diabetes insipidus should serve, first of all, to differentiate of the Nephrogenic diabetes insipidus central. To do so, is a "test of dehydration", in which ions in the urine (osmolarity) are measured at different times when the patient is without drinking for a few hours, and subsequently administered vasopressin: If the defect is corrected, is a central diabetes insipidus; If not corrected, it is Nephrogenic. If the deficit of vasopressin secretion is partial, the defect is corrected partially.
To demonstrate the cause of diabetes insipidus central is an MRI, where you can see different types of injury in the area of the pituitary gland and the hypothalamus. Diabetes Insipidus, Nephrogenic must investigate the causes which have led to the disease: toxicity from drugs, hypokalemia (potassium concentration in the blood lower than normal values), hypercalcemia (concentration of calcium in the blood than normal values), or if there is an acquired or congenital renal disease.
Before a clinical picture of polyuria (urinating much) and polydipsia (drinking plenty and often need) should rule out primary polydipsia or psychogenic. It's the excessive ingestion of water chronically without any deficit or the action of vasopressin secretion. In general, it occurs in patients with a psychiatric disorder. Polydipsia in psychogenic polydipsia and polyuria tend to be irregular, non-continuous and maintained as in diabetes insipidus, and nor do they tend to be nocturnal polyuria. This clinical picture of diabetes insipidus with the above mentioned water deprivation test can be distinguished: blood and urine osmolality values are similar to those found in a person without diabetes insipidus, and administration of vasopressin does not produce changes.
The diagnosis of idiopathic diabetes insipidus or cause unknown (occasionally from autoimmune character) only occurs after the exclusion of all possible known causes.
Treatment of diabetes insipidusCentral diabetes insipidus treatment is the administration of desmopressin, a synthetic analogue of vasopressin. Administered subcutaneously for initial control of the disease and in unconscious patients; then, in general, is given intranasally, dose the patient adjusts depending on what urine. It may also be given orally.
The main treatment with desmopressin risk is to be administered a dose higher than necessary, resulting in hyponatremia (low blood sodium concentrations). As these patients may experience a rapid and severe dehydration, it is convenient to carry a document or plate indicating their illness and treatment.
In the case of central diabetes insipidus that may be reversible (as mentioned earlier, this could happen in some cases of traumatic brain injury, or after a surgical manipulation near the area hypothalamus-pituitary), must be controlled if it begins to produce vasopressin again, in which case you should suspend treatment with desmopressin.
The general treatment of Nephrogenic diabetes insipidus is fluid restriction and administration of tiacidas, diuretics, which have a paradoxical effect on diabetes insipidus, since they reduce the volume of the urine and get more focused. On the other hand, the Nephrogenic diabetes insipidus requires a complex nefrológico approach (may require dialysis or other treatment), whether it is an intoxication as if it is another type of kidney failure.
5 nutrition and diabetes
The ideal diet is one that conforms to the needs, tastes and level of physical activity and lifestyle of each.
The recommendations of the diet for a diabetic patient do not differ from the diet for the general population, except the need to divide the intake of carbohydrates throughout the day and in the number of outlets.
It is recommended that the patient understands his diet and the principles on which is based, to be able to design their own menus and make important decisions regarding their diet. When the professional design you a diet, diabetic patients can and should be done freely planned, once received the appropriate guidelines. In this way you will exchange daily food for others to make the menu appropriate to its possibilities.
The basic objectives that must comply with a diabetes diet are:
• Be nutritionally complete (balanced diet).
• Maintain or reach the ideal weight.
• Help normalize blood sugar levels.
• Reduce the cardiovascular risk (lipid and blood pressure levels).
• Help improve the course of the complications that may arise.
• Adapt to the tastes of the patients.
Feeding tips for diabeticA healthy diet is one of the keys in the control of the diabetic patient. Here are some very useful tips to achieve this:
Control the level of glucose in bloodWhen you eat foods with a high glycemic index, the body glucose increases very fast in blood, as consequence secreted insulin in high quantities; the cells can not burn so much glucose and fat metabolism is activated. This glucose is transformed into fat, which is then stored in the adipose tissue. The insulin that we had managed to segregate, after two or three hours, using all glucose and we reach hypoglycemia, feeling the need to eat again.
Therefore, are going to prefer foods that contain a glycemic index low, and still preferred the simple, to the extent possible sugars. It is recommended the consumption of whole grains and foods rich in fiber.
Maintaining a proper weightPlease select healthy food choices and be physically active, to prevent overweight and the obesidad.3
Balancing the proportion of nutrientsThe best value in the supply of nutrients is 65% carbohydrates, 15% protein, and 30% fat.
In addition, food should provide an adequate amount of nutrients such as vitamins and minerals, essential fatty acids, and so on. You must be a project individualized to each person's needs, preferences and lifestyle.
We must achieve a level of adequate blood lipidsDiabetics for its metabolism, are one of the main group of risk of cardiovascular disease. For this reason, should try to cook with less fat and limit consumption of foods that are high in saturated fat, since they increase cholesterol levels.
Try to eat fresh foods and avoid processed foodsIt is preferable to eat cereal, fresh fruit or fresh vegetables, processed as industrial bakery, ready meals, canned food...
Reduce or eliminate from your diet the amount of foods high in fat as sausages, butter, salad dressings, fatty pork, etc.
Eat five times a dayThe proportions of meals should be smaller, so for example you can use smaller dishes.
The balance of glucose in blood, distributing daily food to be possible in four or five meals.
It is important to always be food at the same time, avoiding skip meals and following the diet plan the best thing possible.
Take care of kidneysThe kidney is usually an organ affected in people with diabetes, since this makes a strain when there is a lack of insulin, for which excess sodium can become dangerous.
Cooking with less salt and reduce foods with high sodium content.
Limit their intake of foods high in sugar, such as drinks flavoured with fruit, carbonated soft drinks, tea or coffee sweetened with sugar...
Limit consumption of alcoholic beverages.
Consuming foods rich in fiberThese include cereals, oatmeal, brown rice, etc. Foods rich in fiber slows the passage of food through the stomach and the intestine, decreasing the absorption of carbohydrates.
Physical exerciseThe practice of physical exercise is essential along with the diet and medication. Improvement:
• Insulin sensitivity.
• Blood pressure figures.
• Weight reduction.
• Lipid profile.
• Cardiovascular function.
• Feeling of well-being.
Diabetes is a disease in which the body is unable to use and properly store glucose, which causes their permanence in blood in quantities greater than the normal. This circumstance altera, on the whole, the metabolism of carbohydrates, lipids and proteins.
They are the two most common types of diabetes: type 1 and type 2 diabetes.
Symptoms, among others, that may appear are: thirst, increasing the amount of urine, increased appetite, itching, infections or cardiovascular illnesses.
To control them, the treatment of diabetes is based on six pillars:
• Meal plan.
• Exercise plan.
• General hygiene habits.
• Self-control plan.
• Regular checks.
Glucose in diabetes controlOne of the factors that will most affect glucose will be the amount of carbohydrates that you eat in each intake. If every day consume different amounts, glucose will oscillate. Therefore, one of the main objectives is that the meal plan focuses on daily meals keep always the same amount of carbohydrate. Tables of equivalence of different food groups are used for this.
The amount of glucose in the blood is considered normal when it is less than 110 mg/dl. We are talking about diabetes if:
• Blood glucose in fasting venous plasma is greater than or equal to 126 mg/dl on two occasions at least.
• The symptoms of diabetes and a blood glucose at random in venous plasma greater than or equal to 200 mg/dl; even if it is not in fasting, wouldn't need a second test.
• Two hours of oral testing, greater than or equal to 200 mg/dl blood glucose in venous plasma.
Oral overload is a diagnostic test which consists of administering a dose of glucose from 75 g in water, with the subsequent extraction of blood at different times (0 Min, 30 min, 60 min, etc), thus determining the level of blood glucose.
6. oral care for diabetics
Oral problems• Patients with diabetes are more likely to have inflammation of the gums, which can cause pain and bleeding.
• More options to suffer severe periodontitis, which can even lead to the loss of the teeth, since diabetics are more susceptible to developing infections.
• Bacterial plaque buildup.
• Xerostomia or dry mouth.
• Fungal infection, known as thrush.
• A small but painful whitish ulcers in the oral cavity if not controlled blood sugar levels.
Obviously, all these problems have their consequences, and can lead to a progression of the disease. For example, a severe gum disease affects the control of blood glucose levels, while tooth loss that occurs in periodontitis causes that the patient do not chew properly foods, making it difficult to track a healthy and balanced diet needed to control blood glucose.
Dental tips for diabeticsTherefore, we have developed a series of recommendations for patients with diabetes oral, using as a source to Vitaldent, of the Spanish society of Diabetes (SED) and the Federation of Spanish diabetics (FEDE) specialists:
Extreme levels of blood sugar control, to keep blood glucose levels closer to normal.
Going to the dentist on a regular basis, every six months.
The teeth should brush at least twice a day, and always after each meal.
Complete cleaning with dental floss or at least use it once a day to remove plaque and bacteria deposited between the teeth.
He has reviewed the mouth daily, piece by piece and including gums, with the aid of a Speculum that is similar to that used by dentists.
If you wear dentures, maximise your hygiene and your State, and ensure that it fit well and do not produce friction or injury.
Undergo periodontal treatments, if necessary, in order to achieve a proper state of bone and gum to prevent tooth loss.
Some diabetics suffering from xerostomia or dry mouth syndrome. Chewing gum without sugar, sugar-free mints, drinking water frequently or suck on ice cubes may help alleviate this feeling.
In all cases, it is advisable to make a biennial review to the dentist and always notify the existence of diabetes.