“Obesity is determined by Body Mass Index (BMI) which is easily calculated, if we divide the weight in kilograms by the square of the height in meters, of the individual “.
• BMI less than 18.5 indicates that the person is underweight
• BMI between 18.5 and 24.9 indicates that the person is of normal weight
• BMI between 25 and 29.9 indicates that the person is overweight
• BMI 30 and higher indicates that the person is obese
Other important risk factors for developing type 2 SD include:
• Dyslipidemia (low levels of “good” cholesterol [HDL-C] 150mg/dL)
• Age over 45 years (although type 2 SD increases dramatically in younger populations due to obesity).
• Patients who have first-degree relatives (eg parent or sibling), perhaps second-degree patients with type 2 diabetes, are at increased risk of developing the disease. Having third-degree relatives with type 2 SD is not considered a significant risk factor for developing diabetes.
• Those who develop Prediabetes (increased fasting glucose: Sugars from 100-125mg / dl, or on a sugar curve: sugars at 2 hours, after taking 75 g of glucose, from 140 to 199mg / dl).
• History of pregnancy or the birth of a baby weighing more than 4.2 kg
• Polycystic ovary syndrome
• Hypertension (blood pressure [BP]≥ 140/90 mm Hg) increases a person’s chances of developing type 2 SD, especially in the white race.
Hypotension is not considered a significant risk factor for developing diabetes.
• Other clinical conditions related to insulin resistance and metabolic syndrome (eg increased waist circumference, obesity, pigmentation, history of cardiovascular disease, etc.)
• Hispanics, Native Americans, non-Hispanic blacks (ie African), of Asian descent or from the Pacific Islands.
Patients in all age groups who are physically active but on a low calorie diet do not have an increased risk of developing type 2 SD. carbohydrates) are at increased risk of developing diabetes.
What are the causes of SD2? Is it the consumption of sweets or the bad psychology?
Genetic and environmental factors contribute to the complex pathophysiology of SD, creating “insulin resistance and hyperinsulinemia” resulting in insufficient insulin secretion.
While the genetic predisposition does not change, the “inherited” insulin resistance worsens with weight gain and this is unfortunately due to the diabetic modern lifestyle (excessive calorie intake, insufficient caloric expenditure, sedentary lifestyle and obesity). Insufficient insulin secretion, which eventually leads to SDt2, occurs mainly due to this combination and could be reversed.
Pancreatic atrophy due to inflammation (eg pancreatitis), hypertension and sweets are not part of the pathogenesis of diabetes.
Pancreatic atrophy, hypertension, and the consumption of sweets in obese individuals are often present in patients with type 2 SD, but none of the three is necessary for the development of the disease.
Old age, depression, and patients with schizophrenia due to the use of second-generation antipsychotics also have an increased risk of developing type 2 SD, but neither bad psychology nor schizophrenia as a disease, nor even the consumption of sugar and sweets are part of the pathogenesis. SD type 2.
Signs and symptoms
Many patients with type 2 diabetes are asymptomatic for many years (up to 10 years from onset). Unfortunately this can be very aggravating and dangerous to health.
Clinical manifestations include the following:
Classic symptoms: Initial polyuria with consequent polydipsia. As insulin deficiency increases, there is significant weight loss with increased appetite and overeating which without treatment can lead to increased fatigue, drowsiness or even confusion or even coma.
Other symptoms: Blurred vision, cramps, hallucinations of the lower extremities, hyperpigmentation of the skin, especially in the lower legs. fungal infections, especially of the genitals
How is the diagnosis made?
Diagnostic criteria from medical companies worldwide include the following:
• Fasting glucose measurements of 126 mg / dL (7.0 mmol / L) or higher, at least 2 measurements on different days.
• Glucose measurements 200 mg / dL (11.1 mmol / L) or higher at 2 hours after tolerance test with 75 g oral glucose
• A random plasma glucose measurement of 200 mg / dL (11.1 mmol / L) or higher in a patient with classic Diabetes symptoms
• Whether a glycosylated hemoglobin (HbA1c) level of 6.5% or higher should be the primary diagnostic criterion or an optional criterion remains a matter of controversy, What is certain is that lower HbA1c values do not rule out the diagnosis of type 2 SD.
The goals of treatment are:
1. Precautionary
2. Therapeutics
3. Reduce the risk of complications
The best treatment is the reversal of SD and the return of blood sugar to normal values. It can be achieved especially in the initial stages with little weight loss (5-10% of the original), but will be maintained for at least 5 years. Proper Nutrition, training, systematic daily moderate physical exercise (20-40 ‘per day even simple walking) and of course regular communication with the treatment team as the foundation of the treatment program.
Finally, in people with Prediabetes-SD2, it is very often necessary to treat the other risk factors (eg hypertension, cholesterol, etc.) to reduce complications and especially the greatly increased cardiovascular risk, ie ischemic heart attacks and stroke.
Writes:
Mr. Antonios P. Lepouras, Pathologist – Diabetologist,
Director of the Pathology – Diabetology Clinic and the Metropolitan General Diabetes Center
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