Diabetes

What is diabetes?

The disease is characterized by elevated blood glucose levels, caused either by a lack of insulin production in the pancreas or by reduced insulin effectiveness in individuals with excess body fat. Insulin transports glucose into the cells and allows it to be converted into energy for the body’s balanced functioning.

When not properly controlled, high blood glucose levels can lead to damage in blood vessels and nerves, resulting in complications such as dysfunction and failure of organs like the kidneys, eyes, and heart.

Types and Causes

There are several types of diabetes, with the most common being:

• type 1 diabetes: the immune system attacks the pancreas, destroying the cells responsible for producing the hormone insulin
• type 2 diabetes: accounting for approximately 90% of diabetes cases, this type is associated with excess body fat. Common in individuals with obesity, it occurs because abdominal fat accumulation hinders insulin action
• gestacional diabetes: occurs during pregnancy due to hormones produced by the placenta that lead to insulin resistance. Most cases resolve after childbirth, but women who have had gestational diabetes are at higher risk of developing type 2 diabetes later in life

Risk Factors

Family history of diabetes, altered blood glucose levels, abdominal fat accumulation, obesity and overweight, high blood pressure, physical inactivity, and a diet low in fruits, vegetables, and legumes.

Incidence

In Brazil, according to the Brazilian Diabetes Society, the disease affects 12% of the population between the ages of 30 and 69. Among people over 65, this rate rises to 18%.

Worldwide, more than 240 million people are living with diabetes. It is estimated that 10% have type 1 diabetes, which primarily affects young adults. Type 2 diabetes, the most common form of the disease, develops in individuals with excess body fat. Gestational diabetes occurs in up to 5% of pregnant women.

Symptoms

Most patients do not show symptoms in the early stages of diabetes, which is why individuals with risk factors should undergo regular blood tests to screen for the disease. It is estimated that 50% of people are unaware they have diabetes. Therefore, regular check-ups with a doctor are essential for early diagnosis.

When blood glucose levels are extremely high, symptoms may include frequent urination, excessive thirst and hunger, fatigue, vision changes, mood swings, nausea and vomiting, weakness, weight loss, leg pain, recurring skin infections, slow-healing wounds, tingling or numbness, especially in the feet.

Diagnosis

Diagnosis is made through tests that detect blood glucose levels. The fasting blood glucose test measures blood sugar levels in the morning. A normal blood glucose level is below 100 mg/dL. If glucose levels are between 100 and 126 mg/dL, there is a high risk of developing diabetes—this condition is referred to as pre-diabetes. If fasting glucose is above 126 mg/dL in two separate tests, the diagnosis of diabetes is confirmed. Another test that can be performed is the glycated hemoglobin (HbA1c) test, which reflects the average blood glucose over the past three months. Values below 5.7% are considered normal, between 5.7% and 6.4% indicate a risk for diabetes, and values above 6.5% (confirmed with two samples) indicate diabetes.

Finally, in uncertain cases, a specific test called the oral glucose tolerance test (OGTT) can be used. It measures blood glucose levels one and two hours after ingesting 75g of glucose.

Treatment

Patients who are unable to produce insulin—such as those with type 1 diabetes or long-standing type 2 diabetes—are considered insulin-dependent and require daily insulin replacement in various forms.

For individuals with diabetes who still produce insulin, such as most patients with type 2 diabetes, treatment involves medications that, improve the cells’ response to insulin, stimulate insulin secretion (production and release) by the pancreas, reduce glucose absorption in the intestines, or increase glucose elimination through the urine. 

Most of these medications are taken orally in tablet form.

Currently, there are also injectable medications that mimic the effects of gut hormones, enhancing insulin production and aiding in weight loss.

Semaglutide and tirzepatide, for example, are treatment options that have shown good results in people with type 2 diabetes, but their use must be prescribed and monitored by a healthcare professional.

In cases of gestational diabetes, a balanced diet and physical activity are usually sufficient to control blood glucose levels. If diet and exercise are not enough, insulin injections may be recommended.

Regardless of the type of diabetes, specialized medical follow-up is essential, along with adherence to treatment and healthy habits such as a balanced diet, regular physical activity, and continuous glucose monitoring.

Prevention

The first step is to identify modifiable risk factors, such as excess weight, increased abdominal fat, physical inactivity, and an unbalanced diet.

A 5% reduction in body weight combined with 150 minutes of physical activity per week can reduce the incidence of diabetes by 58% in high-risk individuals. The main ally is a healthy lifestyle, including a balanced diet, regular physical activity, and routine medical check-ups.

By the Einstein Editorial Board