¿Qué es el Día Mundial de la Diabetes?
El Día Mundial de la Diabetes (DMD) es la campaña de concienciación sobre la diabetes más importante del mundo. Fue instaurado por la Federación Internacional de Diabetes (FID) y la Organización Mundial de la Salud (OMS) en 1991, como respuesta al alarmante aumento de los casos de diabetes en el mundo. En 2007, Naciones Unidas celebró por primera vez este día tras la aprobación de la Resolución en diciembre de 2006 del Día Mundial de la Diabetes, lo que convirtió al ya existente Día Mundial de la Diabetes en un día oficial de la salud de la ONU.
Su propósito es dar a conocer las causas, los síntomas, el tratamiento y las complicaciones asociadas a la enfermedad. El Día Mundial de la Diabetes nos recuerda que la incidencia de esta grave afección se halla en aumento y continuará esta tendencia a no ser que emprendamos acciones desde ahora para prevenir este enorme crecimiento.
Se celebra cada año el 14 de noviembre. Se escogió esta fecha siendo el aniversario de Frederick Banting quien, junto con Charles Best, concibió la idea que les conduciría al descubrimiento de la insulina, en octubre de 1921. Mientras muchos eventos se desarrollan durante o alrededor de ese día, la campaña se desarrolla a lo largo de todo el año.
El logotipo del Día Mundial de la Diabetes
El logotipo del Día Mundial de la Diabetes es un círculo azul – el símbolo mundial de la diabetes
que fue creado como parte de la campaña de concientización Unidos por la Diabetes. El
logotipo fue adoptado en 2007 para conmemorar la aprobación de la Resolución de Naciones
Unidas sobre el Día Mundial de la Diabetes. El significado del símbolo del círculo azul es increíblemente positivo. En muchas culturas, el círculo simboliza la vida y la salud. El color azul representa el cielo que une a todas las naciones, y es el color de la bandera de Naciones Unidas. El círculo azul simboliza la unidad de la comunidad internacional de la diabetes en respuesta a la pandemia de la diabetes.
Ahora, ¿Qué es la diabetes?¿Cuales son sus tipos y como se caracteriza cada uno?
¿Qué es…?
La diabetes mellitus es una enfermedad metabólica caracterizada por niveles de azúcar (glucosa) en sangre elevados. A la glucosa que circula por la sangre se le llama glucemia.El aumento de glucemia es el resultado de defectos en la secreción de insulina, en su acción o en ambas. La insulina es una hormona que fabrica el páncreas y que permite que las células utilicen la glucosa de la sangre como fuente de energía.
Un fallo de la producción de insulina, de la acción de la misma, o de ambas cosas, genera un aumento de los niveles de glucosa en la sangre (hiperglucemia). De no controlarse adecuadamente, a largo plazo, la presencia continua de glucosa alta en la sangre puede provocar alteraciones en la función de diversos órganos, especialmente los ojos, los riñones, los nervios, el corazón y los vasos sanguíneos.
Tipos de diabetes
La diabetes mellitus es una enfermedad que se presenta con mucha frecuencia entre la población general. Los dos principales tipos de diabetes son la diabetes tipo 1, antes llamada infanto-juvenil, y la tipo 2, antes conocida como la del adulto.
Esta última supone en torno al 90 % del total de los casos de diabetes y su incidencia está aumentando de manera muy llamativa en los últimos años, en relación con los cambios en el estilo de vida, cada vez más sedentario y con una dieta que favorece la ganancia de peso.
Recientemente se ha acuñado el término “diabesidad” unificando estas dos enfermedades muy estrechamente asociadas, diabetes tipo 2 y obesidad. De hecho, el 85 % de las personas con diabetes tipo 2 tienen exceso de peso. En los últimos tiempos se está viendo un fenómeno nuevo, el diagnóstico de diabetes tipo 2, la anteriormente conocida como del adulto, en niños. Esto va en paralelo con la obesidad infantil, que está creciendo de manera exponencial.
La diabesidad se podría considerar la epidemia del siglo XXI. En España, el estudio di@bet.es (publicado en 2012) encontró que el 13,8 % de los mayores de 18 años presenta diabetes tipo 2, lo que equivale a más de 5 millones de personas. De éstas, más del 40 % desconocían que presentaban la enfermedad. En este tipo de diabetes la capacidad de producir insulina no desaparece pero el cuerpo presenta una resistencia a esta hormona. En fases tempranas de la enfermedad, la cantidad de insulina producida por el páncreas es normal o alta. Con el tiempo la producción de insulina por parte del páncreas puede disminuir.
La diabetes tipo 1, por el contrario, no está relacionada con el estilo de vida. A pesar de ello, su incidencia también está aumentando, aunque de manera mucho más moderada. No se conoce la causa de dicho incremento, aunque se han postulado diferentes teorías, ninguna confirmada. La mayoría de las diabetes tipo 1 se originan por un proceso autoinmune, que afecta a las células del páncreas que producen la insulina.
Causas:
Factor genético o hereditario. La diabetes tipo 2 tiene mayor riesgo hereditario que la tipo 1. En casi todos los casos un padre o un abuelo tienen la enfermedad. En el caso de gemelos idénticos, si uno tiene la enfermedad, el otro tiene un 80% de posibilidades de desarrollarla.
Estilo de vida. El 85 % de las personas con diabetes tipo 2 tienen exceso de peso. El porcentaje restante a menudo tiene un defecto hereditario que causa resistencia a la insulina.
Cuadro clínico y diagnóstico según la OMS.
DBT Tipo I
Cuadro clínico
- Aumento de la frecuencia urinaria (poliuria), sed (polidipsia), hambre (polifagia) y baja de peso inexplicable.
- Entumecimiento de las extremidades, dolores (disestesias) de los pies, fatiga y visión borrosa.
- Infecciones recurrentes o graves.
- Pérdida de la conciencia o náuseas y vómitos intensos (causantes de cetoacidosis) o estado de coma. La cetoacidosis es más común en la diabetes de tipo 1 que en la de tipo 2.
Diagnóstico
- Se establece por la presencia de los signos clásicos de hiperglucemia y una prueba sanguínea anormal: una concentración plasmática de glucosa ≥7 mmol/L (o 126 mg/dL) o bien ≥11,1 mmol/L (o 200 mg/dL) 2 horas después de haber bebido una solución con 75 g de glucosa.
- Si no aparecen las manifestaciones clínicas clásicas, el diagnóstico se puede efectuar cuando hay sendas pruebas sanguíneas anormales en dos días distintos.
- Aunque no siempre se puede efectuar en los países de pocos recursos, la prueba de la hemoglobina glucosilada (HbA1C) se practica para conocer aproximadamente el control metabólico del azúcar sanguíneo en los 2 o 3 meses precedentes, a fin de orientar las decisiones de tratamiento.
DBT Tipo II
Cuadro clínico
- Los pacientes a veces no presentan manifestaciones clínicas o estas son mínimas durante varios años antes del diagnóstico.
- Pueden presentar aumento de la frecuencia urinaria (poliuria), sed (polidipsia), hambre (polifagia) y baja de peso inexplicable.
- También pueden padecer entumecimiento de las extremidades, dolores (disestesias) de los pies y visión borrosa.
- Pueden sufrir infecciones recurrentes o graves.
- A veces la enfermedad se manifiesta por pérdida de la conciencia o coma; pero esto es menos frecuente que en la diabetes de tipo 1.
Diagnóstico
- Se establece mediante la presencia de los signos clásicos de hiperglucemia y una prueba sanguínea anormal: una concentración plasmática de glucosa ≥7 mmol/L (o 126 mg/dL) o bien ≥11,1 mmol/L (o 200 mg/dL) 2 horas después de beber una solución con 75 g de glucosa.
- Si no aparecen las manifestaciones clínicas clásicas, el diagnóstico se puede efectuar cuando hay sendas pruebas sanguíneas anormales en dos días diferentes.
- Aunque no siempre se puede efectuar en los países de pocos recursos, la prueba de la hemoglobina glucosilada (HbA1C) se practica para conocer aproximadamente el control metabólico del azúcar sanguíneo en los 2 o 3 meses precedentes, a fin de orientar las decisiones de tratamiento. Esta prueba se puede usar también para diagnosticar la diabetes de tipo 2.
- En algunos pacientes asintomáticos el diagnóstico se establece mediante el «tamizaje oportunista» de grupos de riesgo elevado; es decir, en una visita ordinaria al médico, este puede reconocer que el paciente tiene un riesgo elevado de contraer la diabetes y recomendar que se le haga una prueba de tamizaje.
- Por ejemplo, tener 45 años o más de edad, presentar un índice de masa corporal de >25 kg/m2, pertenecer a determinado grupo étnico o la presencia de hipertensión arterial pueden llevar a recomendar la prueba de tamizaje;
- A veces, es el propio individuo quien solicita la prueba.
¿Como se trata y como se previene?
TRATAMIENTO
- El objetivo global del tratamiento es disminuir las concentraciones sanguíneas de glucosa a los valores normales para aliviar los signos y síntomas y prevenir o posponer la aparición de complicaciones.
- Los pacientes son tratados con dieta y ejercicio solos o añadiendo algún antidiabético oral; con una combinación de medicamentos orales e insulina; o con insulina únicamente.
- Glucómetros para la vigilancia de la glucosa sanguínea por el propio enfermo (con una frecuencia menor que en la diabetes de tipo 1.
- Detección temprana y tratamiento oportuno de las complicaciones, a intervalos recomendados por las directrices nacionales e internacionales:
- Examen de los ojos, prueba de orina, cuidado de los pies y remisión con el especialista cuando sea necesario;
- Educación del paciente en materia de vigilancia para reconocer los signos y síntomas de la hipoglucemia (como hambre, palpitaciones, temblores, sudores, somnolencia y mareo) y la hiperglucemia;
- Educación del paciente en materia de alimentación, ejercicio y cuidado de los pies.
PREVENCIÓN
- Perder peso y mantenerlo. El control del peso es una parte importante de la prevención de la diabetes. Es posible que pueda prevenir o retrasar la diabetes al perder entre el cinco y el 10 por ciento de su peso actual. Por ejemplo, si pesa 200 libras (90.7 kilos), su objetivo sería perder entre 10 y 20 libras (4.5 y 9 kilos). Y una vez que pierde el peso, es importante que no lo recupere
- Seguir un plan de alimentación saludable. Es importante reducir la cantidad de calorías que consume y bebe cada día, para que pueda perder peso y no recuperarlo. Para lograrlo, su dieta debe incluir porciones más pequeñas y menos grasa y azúcar. También debe consumir alimentos de cada grupo alimenticio, incluyendo muchos granos integrales, frutas y verduras. También es una buena idea limitar la carne roja y evitar las carnes procesadas
- Haga ejercicio regularmente. El ejercicio tiene muchos beneficios para la salud, incluyendo ayudarle a perder peso y bajar sus niveles de azúcar en la sangre. Ambos disminuyen el riesgo de diabetes tipo 2. Intente hacer al menos 30 minutos de actividad física cinco días a la semana. Si no ha estado activo, hable con su proveedor de salud para determinar qué tipos de ejercicios son los mejores para usted. Puede comenzar lentamente hasta alcanzar su objetivo
- No fume. Fumar puede contribuir a la resistencia a la insulina, lo que puede llevar a tener diabetes tipo 2. Si ya fuma, intente dejarlo
- Hable con su proveedor de atención médica para ver si hay algo más que pueda hacer para retrasar o prevenir la diabetes tipo 2. Si tiene un alto riesgo, su proveedor puede sugerirle tomar algún medicamento para la diabetes.
DIABETES DEL EMBARAZO
Se caracteriza por hiperglucemia de intensidad variable diagnosticada durante el embarazo (sin que haya habido diabetes anteriormente) y que de ordinario, aunque no siempre, desaparece en el plazo de 6 semanas después del parto.
Los riesgos que el trastorno plantea son anomalías congénitas, peso excesivo al nacer y riesgo elevado de muerte perinatal.Aumenta el riesgo de que en etapa posterior de la vida la mujer contraiga diabetes de tipo 2.
Causa:
No se conoce bien el mecanismo, pero al parecer las hormonas del embarazo alteran el efecto de la insulina.
Cuadro clínico
- La sed intensa (polidipsia) y la mayor frecuencia urinaria (poliuria) se observan a menudo, aunque puede haber otras manifestaciones.
- Como el embarazo por sí mismo causa aumento de la frecuencia urinaria, es difícil determinar cuándo es anormal.
- El desarrollo de una criatura más grande de lo normal (que se detecta en un examen prenatal ordinario) puede llevar a efectuar las pruebas de tamizaje para descartar la diabetes del embarazo.
Diagnóstico
- Entre las semanas 24 y 28 de la gestación se practica la prueba de tolerancia oral a la glucosa tras un ayuno nocturno (se determina la glucosa plasmática en ayunas y luego dos horas después de ingerir una solución con 75 g de glucosa).
- Una concentración ≥7,8 mmol/L (o 140 mg/dL) establece el diagnóstico de diabetes del embarazo.
- Si las concentraciones sanguíneas de sangre en ayunas y en la fase posprandial aparecen elevadas en el primer trimestre del embarazo, ello puede indicar que la diabetes sacarina ya estaba presente antes de este, lo que se considera un trastorno distinto con diferentes implicaciones.
Tratamiento
- Control metabólico estricto de la glucosa sanguínea para disminuir los riesgos obstétricos.
- Las pacientes son tratadas mediante dieta y ejercicio, a los que a veces se agregan antidiabéticos orales o insulina.
- Glucómetros para que la paciente vigile la glucosa sanguínea.
- Educación de la paciente en materia de dieta y ejercicio.
- Educación de la paciente para que después del parto adelgace y haga ejercicio con el fin de evitar la diabetes en el futuro.
- Tamizaje de por vida para la diabetes de tipo 2, pues la paciente estará en la categoría de alto riesgo.
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