Diabetes

Unbalanced diets and lack of exercise often lead to obesity which, age helping, leads to a number of complications. The reunion of these risk factors in a single individual forms what is today known as a "metabolic syndrome", a tell-tale manifestation in our society, increasingly considered as a true scourge by specialists. This article reviews one of the metabolic syndrome's most widespread form: diabetes.

What is diabetes?
When the body is working properly, it draws all the carbohydrates it needs from a healthy and balanced diet. Once absorbed, these carbohydrates are transported via the bloodstream to the cells (liver, muscle, brain cells) to be used as sources of energy. This is where insulin, a hormone secreted by the pancreas, plays a crucial part as it enables the diffusion of glucose into the cells. With diabetes, blood sugar levels are permanently too high (hyperglycaemia); fasting blood sugar levels above 1.26 g/L sign the presence of diabetes.

Two types of diabetes for two types of people...
There are two different types of diabetes: insulin-dependent diabetes (type 1) and non-insulin-dependent diabetes (type 2).

Type 1 diabetes mellitus
In most cases, youth-onset diabetes is insulin-dependent. This predominantly genetic disease involves a lack of insulin production by the pancreas. Dietary carbohydrates can not reach the organs any more. They remain in the bloodstream and a small part is eliminated in the urine.
Characteristic signs include intense thirst, a strong ketonic body odour, unexplained tiredness and major weight loss. "Mellitus", a Latin word meaning "honey-tasting", refers to the high sugar content of diabetic patients' urine. Indeed, in diabetes mellitus, the body eliminates large amounts of sugar in the urine.
Treatment consists in daily insulin administration in order to compensate for the body's deficient insulin production.
In France, it is estimated that 200,000 people suffer from type 1 diabetes.

Type 2 diabetes mellitus or "fat diabetes"
This mainly affects people who are over 50 and obese. For the WHO, this disease qualifies as a true epidemic and health professionals are extremely concerned by current forecasts: the already preoccupying number of diabetics is continuously increasing, in perfect correlation with the number of obese people, the general ageing of the population, the increasingly sedentary lifestyles and poor dietary habits.

How do you become a type-2 diabetic?
Being obese or overweight is one of the main causes of type-2 diabetes mellitus: fat progressively accumulates in the cells until it makes them insensitive to insulin which is then unable to do its job. The result is an accumulation of glucose in the bloodstream.

This disease of modern times can lead to numerous complications that are seldom insignificant. Without proper treatment, diabetes may lead to cardiac disease, blindness, cataract, impotency and limb amputation. The small blood vessels in our kidneys and eyes, as well as our nerve cells, are the first to suffer from excess glucose in the blood: obstruction impedes the blood flow to certain parts of our body which may then degenerate and die through lack of adequate blood supply.

The first sign is a sensory reduction in the extremities, usually the feet: because of poor innervation, the foot becomes fragile and unable to cope with external injuries which leads to pain and infection. The most severe cases require amputation.

The eye, particularly the highly vascularized retina, is also damaged by excessively high blood sugar levels. The first manifestation of such damage is the occurrence of visual disorders that can not be corrected. Advanced cases lead to blindness.

The kidney is also affected. Its essential eliminating function is altered as the damaged cells become unable to filter the blood properly and large molecules, such as albumin, escape into the urine. Renal failure patients may require dialysis, or even transplantation, in order to counter a potentially fatal disease progression.

Lastly, diabetes-related complications also include damage to the larger blood vessels which increases the risk of cardiovascular disease and is responsible for one in two deaths in diabetic patients.

Whether you suffer from diabetes or not, adopting a healthy lifestyle helps reduce the risk of becoming diabetic and/or limits diabetes-related complications. One thing is obvious: the occurrence of this disease should be prevented from childhood through education to a healthy lifestyle, the promotion of good dietary habits and weight control. Not only will integrating these measures to our lifestyle improve our quality of life, it will also slow down the occurrence of diabetes-related complications with the additional benefit of reducing obesity, hypertension and raised cholesterol levels.

• the inhibition of new fat formation (lipogenesis)
• the stimulation of existing fat dissolution (lipolysis)
• a reduction of appetite
• the preservation of the muscle mass

This method should only be used under medical supervision. It is particularly indicated in metabolic syndrome prevention (cardiovascular diseases, diabetes, venous insufficiency...)

Aiming for a balanced diet, adapted to circumstances.
With the help of your doctor, you will progressively be able to stabilise your weight whilst perfecting your nutritional knowledge. The basic principle of a quality diet are:

• eat a balanced breakfast every day
• eat less white bread, or none at all at lunchtime and dinner, and more wholegrain cereals
• considerably reduce your simple carbohydrate intake
• respect recommended fat quantities and prefer vegetable oils
• eat proteins of varied animal and vegetable sources
• never skip a meal

... And move!
Exercise is a vital part of a healthy lifestyle. The practice of sports is beneficial to both body and mind. Exercise helps:

• lower your blood sugar. Exercise "eats up" carbohydrates, thus preventing their accumulation in the bloodstream
• manage diabetes which becomes easier to balance
• increase weight loss or maintain a healthy weight through increased energy expenditure.

"Walk at least half an hour a day!" is the health promotion message launched by the French government in February 2004 in the frame of its National Plan for Health and Nutrition.

Practise simple sports such as gymnastics, walking, jogging, cycling or swimming. Pick the sport you feel motivated by. When choosing a form of exercise, don't hesitate to get advice from your doctor who will take your general condition and specific needs into account.

If your health or your timetable don't allow you to practise a sport, take a stroll after meals, use the staircase rather than the lift, get off the underground a few stops before your usual stop, park your car at a small distance from your destination...

* (Philippe Passa - La Revue du Praticien - Médecine Générale. Tome 16. Issue #563 dated 11 February 2002 - 01/03/2005 – Panorama Santé “le diabète en France”).