diabetes mellitus

DIABETES MELLITUS (DIABETIC DISEASE):

Definition: Diabetes is the disease that occurs as a result of insulin deficiency and or insulin resistance as a result of increased blood sugar. Due to reasons such as sedentary life, unhealthy diet and weight gain, the number of patients with diabetes is increasing rapidly in our country and all over the world, almost like an epidemic. In the recent TURDEP-2 study conducted in our country, 13.7% of the population was found to have diabetes. A more dire result of the study is that approximately 28% of our country’s population has a sugar metabolism disorder, which we call prediabetes. Although the picture is very bad in our country, the figures in the world are similar to our country.

Classification: There are various types of diabetes. To be roughly summarized without going into too much detail

1.Type 1 Diabetes Mellitus: It is the other name of Insulin-Dependent Diabetes Mellitus, which occurs with the cessation of insulin production as a result of the autoimmune destruction of the beta cells that produce insulin in the pancreatic gland. Type 1 diabetes accounts for approximately 10% of all diabetes cases. It usually starts in the childhood age group. Patients are usually frail. Absolute insulin needs are required for treatment.

2.Type 2 Diabetes Mellitus: It is the form that occurs as a result of partial insulin deficiency and predominantly insulin resistance. It accounts for 90% of all diabetes cases. Patients are usually over 30 years old and overweight. Although insulin synthesis continues in the body in type 2 diabetes, resistance to the effect of this insulin develops and blood sugar rises, especially with the effect of obesity and other factors. It is the rapidly increasing form of diabetes all over the world.

3.Gestational Diabetes Mellitus: It is the form of diabetes that occurs for the first time during pregnancy in pregnant women who did not have diabetes before pregnancy.

4.Secondary Diabetes Mellitus: It is a form of diabetes that occurs due to many different reasons such as surgery, trauma, drugs, hormones and infections that impair the production and use of insulin in the body.

Diagnostic Criteria and Symptoms: In general, people with high blood sugar experience symptoms such as drinking a lot of water, urinating a lot, dry mouth, blurred vision, burning in the hands and feet, and weakness. Presence of one or more of the diagnostic values ​​in the table below establishes the diagnosis of diabetes. After the diagnosis is made, the type of diabetes is determined together with the clinical characteristics of the patient (age, weight, family history, etc.) and additional laboratory findings (c-peptide, insulin, diabetes autoantibodies, etc.).

(OGTT: Oral Glucose Tolerance Test or Sugar Loading test)

of diabetes Complications: Diabetes complications are divided into two groups as Acute and Chronic. Acute complications develop suddenly and can be life-threatening if not treated quickly and correctly. Chronic complications, on the other hand, occur as a result of high blood sugar damage over the years, especially the vessels and nerves, and damage to other organs (Eye, Kidney, Foot, Heart, etc.).

Acute Complications:

Hyperglycemia (High Blood Glucose)

Hypoglycemia (Low blood sugar)

Diabetic Ketoacidosis (Diabetes Coma)

Hyperosmolar Non-Ketotic Coma (Diabetes Coma)

Chronic Complications:

Diabetic Retinopathy (Eye Involvement)

Diabetic Nephropathy (Kidney Involvement)

Diabetic Neuropathy (Nervous System Involvement)

Coronary Heart Disease

Diabetic Foot (Permanent Foot Wounds)

Cerebrovascular Events (Stroke-Paralysis)

Sexual Dysfunction

Diabetes Treatment: The aim of treatment is to keep blood sugar within normal ranges as much as possible and to prevent Acute and Chronic complications that may develop due to diabetes and to ensure well-being in the person. There are basically three main elements in the treatment of diabetes.

1- Lifestyle Changes: It consists of a healthy diet (Diet) and an active lifestyle (Exercise). It is one of the most important steps in the treatment of diabetes, which we can say if it cannot be done, and which is often neglected by patients and doctors.

Diet: Every patient diagnosed with diabetes must be consulted with a dietitian. A suitable nutrition program should be started for the patient, taking into account other risk factors (Obesity, Hyperlipidemia, Heart Disease, Hypertension, Gout, etc.). Hypoglycemia symptoms should be explained to patients receiving insulin and drug therapy and what to do when they encounter such a situation. Although there may be changes specific to the patient, the points to be considered in the diabetic diet can be listed as follows.

– Nutrition with 3 main and 3 snacks without skipping meals.

– Low glycemic index (Simple Carbohydrate) diet

– Increasing dietary fiber-fiber content

– Increasing fluid consumption. (Minimum 2.5-3 liters per day)

– Calorie-restrictive diet for weight loss in overweight patients

Exercise: Diabetic patients should be warned about regular physical activity. In addition to many other benefits, regular exercise contributes positively to the blood sugar profile by reducing insulin resistance. The exercise program should be personalized (considering additional diseases such as heart disease). What diabetic patients should pay attention to when exercising

– Although it varies according to the type of exercise, it should be roughly in the range of 30-60 minutes 3-5 days a week.

– Exercise should not be done in case of blood sugar<100 mg/dl and blood sugar>250 mg/dl.

– Exercise should not be done on an empty stomach immediately after a meal. Ideally, it should be started 1-2 hours after a meal.

– Patients should have simple sugar-containing foods with them to be used during Hypoglycemia that may develop during exercise.

– Patients carry identification cards showing that they have diabetes.

– Patients with diabetes-related retinopti and nephropathy should especially avoid heavy exercises.

– Since the sugar-lowering effect of exercise can last for 12-24 hours, it is necessary to be prepared for hypoglycemia that may develop after exercise.

2- Drug Treatment: They are generally preferred agents in the treatment of patients with Type 2 Diabetes. While some of these drugs are taken orally, they have recently been used in drugs injected under the skin, just like insulin. Antidiabetic drugs generally lower blood sugar by using the hormone insulin produced by the person’s own body. For this reason, in order for a diabetic patient to benefit from an antidiabetic drug, there must be sufficient insulin reserve in his body. There are many different drugs used in the treatment of diabetes. The choice of these drugs should be decided by considering the other characteristics and diseases of the patients. In other words, one should be aware that the only goal in the treatment of a patient with diabetes is not to reduce blood sugar, but also to combat other problems (weight, cholesterol, hypertension, etc.), and the drugs to be used should be decided accordingly. Drugs used in the treatment of diabetes can be grouped as follows.

Metformin

Sulfanylurea group drugs

Glinides

Alpha glycosidase inhibitors

Glitazones

DPP4 inhibitors

SGLT-2 inhibitors

GLP-1 Agonists (used by subcutaneous injection)

Amylin analogs (used by subcutaneous injection)

3- Insulin Therapy: Insulin is the hormone that lowers sugar. Insulin is used in the treatment of Type 1 Diabetes and Type 2 diabetes that cannot be controlled by antidiabetic therapy. While there are currently insulin pens that can only be used by subcutaneous injection in our country, insulin preparations (Afrezza) used by inhaler (respiratory) route have also been used abroad. Insulin therapy is the most potent sugar-lowering therapy. For this reason, patients who will be started on insulin therapy should be informed in detail about the effects and side effects of the treatment, and especially the patients should be educated against hypoglycemia coma. In insulin therapy, the number of daily injections (only basal or basal bolus therapy) is decided according to the blood sugar profile of the patients. The insulins used are divided into 3 groups according to their duration of action

Short and rapid-acting insulins

Intermediate-acting insulins

Long (basal)-acting insulins.

Treatment Goals in Diabetes:

Other Treatment Methods Used in Diabetes Treatment: Thousands of scientists around the world continue their studies in order to find new drugs and methods that can be used in the treatment of diabetes. As a result of this, there are many new drugs and methods that have been used in the recent past, but there are also methods and drugs on which studies continue. To list some of them

Diabetes Surgery (Metabolic Surgery): It is applied in currently eligible patients

Continuous subcutaneous insulin infusion (Insulin Pump): Insulin pumps can be used in the treatment of diabetic patients with appropriate indications. Details are explained in our insulin pump therapy section.

Inhaler (Respiratory Tract) Insulin: It is a form of insulin used by inhaling with the breath. Although it is not yet available in our country, it has been used abroad. Initial results indicate that the treatment is effective.

Pancreas Transplantation: Classical organ transplantation therapy

Pancreas Islet Cell Production (iPSC) and Transplantation: It is an experimental treatment method that is expected to break new ground in diabetes treatment. At this stage, quite satisfactory results have been obtained. If this method is successful, there is a possibility of permanent treatment for diabetes in the near future.