The doctor. Fernández is a prominent gynecologist who serves as Medical Director of the EGR Institute of Medicine , where he directs the unit of fetal psychopathology and prenatal diagnosis and high-risk pregnancy, as well as the menopause unit.. In the following article, and on the occasion of World Diabetes Day, explains what is the relationship between this pathology and aging.
Diabetes is a group of metabolic diseases characterized by the presence of an increase in blood sugar, a consequence of failure in the secretion and / or in the action of insulin. Its long-term consequences affect various organs and systems, especially ocular, renal, nervous and cardiovascular.
Types of diabetes
- Type 1 diabetes : characterized by an absolute deficiency of insulin secretion, whose cause must be sought in the presence of an autoimmune disease supported by a genetic predisposition
- Diabetes type 2: that is a consequence of the resistance to the metabolic action of insulin added to the decrease in the secretory response of the same in the pancreas.
Causes of diabetes
The causes that generate type 2 diabetes are multiple, but age and obesity are the most important.
Obesity occupies the first place because it generates, in itself, an insulin resistance, which can end up causing a metabolic alteration similar to those produced in type 1 diabetes. The progressivity of hyperglycemia, being gradual, makes the clinical identification of the disease difficult.
In general, these alterations in the secretion and action of insulin respond adequately to different therapies, ranging from weight reduction to pharmacological treatment.
Relationship between diabetes and menopause
The effect of insulin resistance is enhanced in menopause due to the absence of hormones. The increase in the number of women suffering from an increase in body weight and / or obesity in this stage of a woman's life causes the incidence of type 2 diabetes to increase its appearance.
Identifying patients with a high risk of developing diabetes of this type in the future is an invaluable aid in the prevention of this disease. In this sense, in the EGR Institute of Medicine we carry out the blood identification test for women in this stage of life and with a risk profile. The benefits of early detection are invaluable.
Based on the American Diabetes Association 2013 Clinical Practice Guidelines , they should be subject to control as a population at risk to:
- Adults with Body Mass Index (BMI)> 25, who also have: physical inactivity; family history of diabetes, Caucasian ethnicity; women with children who have weighed more than 4 kilos at birth or who have had gestational diabetes, high blood pressure (HBP), HDL cholesterol <35 mg / dl and / or triglycerides> 250 mg / dl g; Severe obesity, history of cardiovascular diseases.
- Testing over 45 years without any antecedent.
- Depending on the result and the initial status, the test must be repeated at least every 3 years.
How to prevent type 2 diabetes
In those women who detect a deterioration of insulin action without clinical effect, it is necessary to implement prevention and follow-up protocols.. Physical exercise and weight loss are the pillars of prevention.
Obesity is a predisposing factor of the first magnitude. Abdominal fat can be considered an endocrine organ capable of secreting substances that are intimately related to insulin resistance and the subsequent development of type 2 diabetes.
Weight loss is recommended in all overweight or obese women, who have risk factors for diabetes. Both low-carbohydrate and low-energy diets, such as the Mediterranean diet, are effective in short periods of time. Low carbohydrates require controls on lipid, kidney and glucose levels. Fundamental the individualization of each diet.
Finally, alcoholic drinks must be restricted, combining vitamin and antioxidant complexes.
The recommended physical activity should be at least 150 minutes per week, of moderate intensity, aerobic, spread over no less than three days and avoiding more than two consecutive sessions.
From the pharmacological point of view, oral antidiabetics such as Metformin can be used preventively in those patients under 60 years of age, with analytically defined glucose intolerance and / or with a history of gestational diabetes.
Oral estrogens would be associated with an increase in the secretion of growth hormone and a possible protective effect on the onset of type 2 diabetes, since the absence of hormones that occurs at menopause does generate an increase in resistance to insulin.
Treatment of type 2 diabetes
Metformin is the first-line drug of choice for the treatment of type 2 diabetes, provided there is no contraindication and is well tolerated. Its application must be supported by weight control and the practice of physical exercise (12).
In this type of patients, insulin will be applied when there is marked symptomatology and / or elevated blood glucose levels.
If the non-insulin monotherapies are not able to obtain an adequate response in 6 months, a second oral antidiabetic drug or insulin should be associated.
Bariatric surgery should be considered in adults with BMI> 35 and type 2 diabetes, especially in those who associate pathology that hinders the control of it, despite having established adequate pharmacological and lifestyle treatments. It has been observed a normalization of blood glucose between 40% and 95% according to the studies consulted.
Pathologies derived from diabetes
Type 2 diabetes is associated with increased risk of pancreatic, hepatic, endometrial, colorectal, breast and bladder cancer. This relationship is established by sharing risk factors such as obesity, age and lack of physical activity, without forgetting that hyperinsulinemia and hyperglycemia play precursor roles in their development.
The risk of bone fracture, in general, is increased in any type of diabetes, regardless of sex. In type 1 diabetes they are associated with osteoporosis , however, in type 2, the bone mineral density is higher than expected. In patients with a high risk of osteoporotic fracture, prevention strategies for the same and even specific pharmacological therapy should be associated.
The different specialists of the EGR Institute of Medicine work in constant communication and collaboration to approach each case in a multidisciplinary way, involving the specialties of gynecology, endocrinology, psychology, nutrition, urology, etc.
Our advice as a center is, whenever possible, to practice preventive medicine , using all the current tools, which will allow us to anticipate and react in time, prevent pathologies and their complications. If you are within the risk groups, consult your specialist doctor; gynecologist or endocrine