Management and treatment of different types of diabetes
The different types of diabetes
Before addressing the issue of treatment and management of diabetes, it is necessary to define this pathology.
Diabetes is a chronic disease manifested by hyperglycemia. People who suffer from it have excess sugar in their blood.
In the context of diabetes, the amount of sugar present in their blood on an empty stomach is equal to or greater than 1.26 g per liter.
There are two types of diabetes:
Type 1 diabetes
The body of a person with type 1 diabetes makes little or no insulin. The latter is a hormone secreted by the pancreas allowing sugar to penetrate into cells and meet part of the body's energy needs.
The non-production of insulin by the body, causes a build-up of sugar in the blood and the cells are no longer supplied.
This type of diabetes often manifests before the age of 30 in children, adolescents and young adults;
Type 2 diabetes Type 2
Diabetes affects 90% of people with diabetes in France. This represents 3 million French people.
It is caused by mismanagement of insulin by the body. At first, the cells develop a form of resistance to insulin. To overcome this resistance, the pancreas secretes more insulin.
This situation lasts for a while (it can be years) until the pancreas eventually becomes exhausted and cannot secrete insulin.
Type 2 diabetes manifests very gradually and is more common after a certain age. It can be favored by excess weight, a diet that is too rich and a sedentary lifestyle.
Note the hereditary nature of diabetes.
Symptoms of this disease
Symptoms vary depending on the type of diabetes diagnosed.
. Regarding type 1 diabetes, the most common symptoms are: fatigue, an urge to urinate more often than normal, abnormal thirst and weight loss;
These symptoms can get worse if no treatment for diabetes is prescribed. Other disorders thus appear such as loss of appetite, an abnormal smell of urine, loss of sight, drowsiness, or even a coma.
. The type 2 diabetes is a disease more "insidious" symptoms experienced by people are fatigue, frequent urination, especially at night, increased infections (cystitis, fungal infections ...).
Treatment of diabetes
The treatment of diabetes , whether type 1 or 2, is based on the need to assimilate sugar into the body's cells and provide the body with the necessary amount of insulin.
Treatment of type 1 diabetes
In association with the classic hygieno-dietetic rules (balanced diet, physical activities), this diabetes is treated by different means:
. The conventional insulin therapy consisting of insulin injection 2 to 3 times a day;
. The functional insulin of trying to reproduce the natural secretion of insulin. The person with diabetes should receive 4 or 5 insulin injections per day or have an insulin pump.
Insulin injections are given under the skin, using an injection pen, syringe or insulin pump.
The treatment of diabetes is not limited to these injections. Adapting to a new restrictive lifestyle, knowing how to identify the symptoms at risk is also part of the diabetes treatment process. Real work must be done by sick people.
Treatment of type 2 diabetes
The treatment of type 2 diabetes is different from that of type 1 diabetes. The main aim of this is to regulate the level of sugar in the blood so that it is "normal".
People with diabetes must adopt a healthy and balanced lifestyle. Thus, the practice of a regular sporting activity, a balanced diet (avoid foods containing a lot of sugars and fats), respect for mealtimes, quitting smoking are all things that will limit the evolution of disease. To this must be added a limited alcohol consumption .
Drug treatment against diabetes may be considered when the above precautions are not sufficient.
There are different antidiabetic drugs:
. Alpha-glucosidase inhibitors: they slow down the absorption of dietary carbohydrates;
. Metformin: this medication decreases the amount of sugar sent into the blood by the liver;
. Sulphonylureas and Glinides: they increase insulin secretion by the pancreas and make cells more receptive to insulin.
These drugs are in the form of tablets to be ingested. They can be combined according to the individual cases and their needs.
Additional treatment may be prescribed for the person with diabetes to limit the risk of developing cardiovascular disease.
Self-monitoring
The effectiveness of the treatment must be effected by blood sugar control carried out by the patient himself. 2 methods are possible:
. Using a lancing device that takes a drop of blood from the fingertip. This will be placed on a strip which will be inserted into a blood glucose meter.
. Self-monitoring of interstitial glucose by flash system (since 2017), with:
. a sensor attached to the back of the arm to measure glucose concentration every minute for 14 days;
. And a reader that gives the blood sugar measurement, the trend and the history over 8 hours.
Management of diabetes
Type 1 and 2 diabetes are on the list of long-term exemptive illnesses established by the Health Insurance. In fact, on a day-to-day basis, treatment for diabetes and various medical care is provided through the “care protocol”. This is the document that allows people with long-term illnesses to be fully supported. This document must be presented at each visit to a doctor or specialist.
Concretely, this means that the person with diabetes benefits from exemption from user fees.
Health Insurance therefore provides 100% coverage for medical care related to diabetes (except for flat-rate participation, excess fees, hospital flat-rate and acts or services not reimbursed by Health Insurance).
Equipment :
. Non-disposable injection pens within the limit of one device per year;
. Bites up to the limit of 1 per year for adults and 2 per year for adolescents under 18 and children;
. Blood glucose meters within the limit of 1 for a period of 4 years for adults and 2 for a period of 4 years for those under 18;
. Test strips;
. Insulin pumps within the limit of one every 4 years and only on rental;
. The equipment necessary for monitoring the ketone bodies of people with type 1 diabetes aged 18 and under and pregnant women;
. In the event of self-monitoring by measuring interstitial glucose, under certain conditions, a kit is covered every 4 years, as well as a sensor every 14 days.
The case of the management of foot examinations
The foot is a part of the body that must be monitored in people with diabetes. It is a part of the body at risk. People with diabetes quite frequently present with injuries and lesions. These should not be overlooked because the sick person risks amputation in the most serious cases.
Health Insurance covers people with grade 2 and 3 diabetes. People with grade 2 diabetes suffer from sensory neuropathy and / or arteritis; people with grade 3 diabetes have a history of foot ulceration and / or lower limb amputation.
For people who have reached grade 2: a maximum of 4 sessions per year are covered.
For people who have reached grade 3: a maximum of 6 sessions per year are covered.
For information, the care sessions include: an examination of the feet, chiropody care, an assessment of the footwear ... The professional must also provide educational advice to the patient but also advice concerning the appropriate footwear.
They must be prescribed by the attending physician or diabetologist of the person concerned. Care must also be performed by a qualified professional who has undergone adequate training. They cannot be done at home.
It should be noted that the specialist doctor who will perform this treatment cannot bill for excess fees.
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