Diabetes, or more accurately diabetes mellitus, is a chronic disease characterized by an excess of a sugar, “glucose,” in the blood, resulting in hyperglycemia. The glucose present in our diet must be metabolized because it is an important source of energy, and this metabolism is influenced by a hormone known as insulin, which is produced by the pancreas. Diabetes mellitus can result from an insufficient production of insulin from a “quantitative” perspective or from a reduced ability of the body to use the insulin it produces, known as “insulin resistance.”

The acute complications of hyperglycemia are related to the onset of comatose states (ketoacidotic coma and hyperosmolar coma), while the chronic complications are related to organ complications: kidneys, retina, peripheral nerves, and the cardiovascular system.

Types of Diabetes Mellitus

There are two main forms of diabetes mellitus: type 1 diabetes and type 2 diabetes.

Type 1 diabetes represents about 10% of cases and is characterized by reduced insulin production. It usually develops from childhood/adolescence or at a young age: it is an irreversible condition, related to genetic and environmental factors.

The only therapy capable of controlling hyperglycemia in this case is the administration of insulin, obviously in association with a correct lifestyle (healthy diet and physical activity). Rapid-acting insulins are available for correcting hyperglycemia after meals, and long-acting insulins are available for basal insulinization, which aims to cover the entire day.

There are forms of type 1 diabetes with clearly genetic transmission, also occurring in youth or immediately thereafter.

Type 2 diabetes is the most common form of diabetes and is determined by insulin resistance, or the progressive inability of insulin, whose production is often increased, to perform its function. It usually develops after the age of 40 due to predisposing factors, an improper diet, or an incorrect lifestyle (obesity, sedentary lifestyle). It is only rarely related to the dysfunction of endocrine glands (secondary diabetes mellitus: for example, in hypercorticosurrenalism).

Type 2 diabetes initially does not require treatment with insulin. Among the well-known drugs used for treatment is metformin, introduced into therapy almost 65 years ago, which acts by regulating the temporal relationship between blood sugar increase and insulin production, sulfonylureas that increase insulin production, and glimepiride (which acts on both the pancreas and the peripheral utilization of insulin).

Today, there are also other drugs belonging to different categories available: thiazolidinediones, especially effective in elderly individuals, DPP-4 inhibitors (gliptins), also effective in type 2 diabetes, and SGLT-2 inhibitors (gliflozins), which inhibit the renal glucose transporter SGLT-2. Recent studies propose evaluating the use of SGLT-2 inhibitors in type 1 diabetes as well.

Insulin is only administered in case of treatment failure with the aforementioned medications.

For type 2 diabetes, it is also essential to follow a correct diet both qualitatively and quantitatively and to engage in regular physical activity.

There is also “gestational diabetes,” which can occur in 6-7% of pregnant women. In addition to the risk of fetal health problems (early abortion and congenital malformations), consideration should be given to the risk for the woman and later in the child to develop type 2 diabetes.

Diabetes is a sneaky disease, often latent for a long time and sometimes diagnosed incidentally with a blood test performed for other purposes and without clear clinical references. This is because, especially in adults, it does not present any specific symptoms until the disease has progressed to an advanced stage; unfortunately, at this point, organ complications may already be present.

The classic symptoms in diabetic patients include: increased thirst and urination, fatigue, weight gain or loss despite a normal calorie intake and preserved appetite, general malaise, abdominal pain, and recurring infections.

The damages that diabetes can cause, the so-called “organ complications,” are many, including:

• Neurological (altered functionality of the central or peripheral nervous system; worsening of sensory, motor, visual, or auditory capacities)
• Renal (loss of proteins and organ failure)
• Ocular (blood vessel alterations leading to decreased vision, up to the risk of blindness)
• Cardio-cerebrovascular (coronary artery disease, stroke, peripheral arterial disease)

To prevent or better diagnose diabetes early, it is advisable for every individual, especially those over forty years old and even if asymptomatic, to undergo blood tests, including simple fasting blood sugar and glycated hemoglobin, a true sensor of glycemic control.

However, true prevention of diabetes consists of adhering to a healthy lifestyle, which can reduce the incidence of type 2 diabetes by 60%. For example: practicing 20-30 minutes of moderate-intensity aerobic physical activity per day to avoid excessive weight gain, following a healthy diet rich in fruits and vegetables, and limiting the consumption of saturated fats (animal fats) in favor of unsaturated fats.

Diabetes in the elderly

The likelihood of developing diabetes mellitus increases with age, particularly affecting the population around 70-75 years old.

The diagnosis of diabetes in elderly patients generally occurs during assessments or hospitalizations for concomitant, sometimes disabling, diseases: myocardial infarction, stroke, reduced vision (with possible presence of cataracts), or renal failure.

In the elderly, diabetes practically represents one of the main causes of other pathologies, including depression, cognitive decline and dementia, urinary and fecal incontinence, falls with trauma, and consequent – even transient – disability. In order to diagnose the disease as early as possible, it is important to undergo annual screening under the supervision of the general practitioner and specialists.

Once the diagnosis of diabetes mellitus is made, it is necessary to establish glycemic goals and guide the patient towards a correct lifestyle, including a healthy diet and regular physical activity. Additionally, the patient must learn to practice self-monitoring of blood glucose levels and undergo personalized therapeutic paths.