The complications related to diabetes are of two types:
Microvascular complications (affecting small vessels) can affect the retina (blindness), kidneys and nerves, and are directly related to blood sugar levels;
macro-vascular complications (affecting arteries) can affect the carotid (AVC), coronary (myocardial infarction) or arteries of the leg (arteritis); They are related to blood sugar and other factors.
The important thing for diabetic patients is to convey a much more positive message about the chronic disease they suffer from. For this, Dr. Huet gave Doctissimo his 10 tips to live with diabetes, but without complications.
This is the first thing you should do to avoid complications. "The goal at the beginning is always a good control of your blood sugar level," advises Dr. Huet. Beyond the control of blood sugar every day that is performed autonomously at home, diabetics should check their glycosylated hemoglobin every 3 to 4 months by their doctor. "This is a much more reliable indicator than the simple concentration of glucose in the blood, to see if this concentration is controlled in the long term and not only on an ad hoc basis," explains Dominique Huet. "If the glycosylated hemoglobin remains below 7%, the risk of microvascular complications is almost zero."
Both factors are important to prevent macrovascular complications. "Diabetic patients should maintain a blood pressure below 14 / 8.5 mmHg," says diabetologist Dominique Huet.
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With respect to blood lipids (cholesterol and triglycerides), the controls will focus on LDL (bad cholesterol). "LDL should be less than 1.30 g / l for patients with diabetes," says Dr. Huet, "however, these figures vary if other risk factors are involved." LDL should be less than 1 g / L for diabetics they smoke and even lower than 0.7 g / L if there is, in addition to a history of cardiovascular disease. "
Tobacco does not have a direct influence on diabetes. On the other hand, it is a recognized risk factor for vascular disorders. People with diabetes who smoke significantly increase their risk of developing serious macrovascular complications, which can cause a stroke, myocardial infarction or arteritis in the lower extremities. If, unfortunately, the diabetes factor can not be eliminated, it is possible to suppress the tobacco factor helping to stop smoking.
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"The rights of patients with diabetes, is not that of not having to suffer complications, in addition to their disease," Dr. Huet insists, but along with these rights, there are also obligations, the first to monitor their diet to control their diabetes. " It is not surprising that diabetic patients can not do anything when they sit down to eat. A healthy and varied diet is essential, "as for the rest of the population," says the specialist. In other words, the general recommendations of the National Health and Nutrition Program (PNNS) apply. "The term" diabetic diet "is also increasingly used, patients can eat everything in a balanced way.
Weight is also a factor to watch. "We're not asking diabetics to lose weight at all costs, they should just be around their weight in a way," recommends Dominique Huet. In case of overweight, you can consider a diet that limits, in particular, the intake of fats (meats, butter, cheese, etc.). The director of the Department of Diabetology of the Saint-Joseph Hospital Group in Paris insists on the importance of making overweight diabetics feel better. "Overweight or obesity are not necessarily the trigger of your disease, at least not the only one, so do not overwhelm them, but encourage them to take care of their health."
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Once again, nothing surprising: "People with diabetes should take charge and commit themselves to practicing a minimum of physical exercise, just as non-sick people should," advises diabetologist Dominique Huet. The National Nutrition Program for Health (PNNS) recommends, on average, that adults practice the equivalent of 30 minutes of vigorous walking each day.
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Diabetics who practice an intensive sport should, however, learn to integrate these peaks of activity in the control of their blood sugar, to avoid hypoglycemia.
The benefits of sports are recognized in the prevention of many chronic diseases, cardiovascular diseases, overweight and obesity, but also to improve overall well-being and reduce stress.
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"Different controls are mandatory, at least once a year, to avoid complications related to diabetes," says Dr. Huet.
According to the head of the Department of Diabetology of the Paris Saint-Joseph Hospital Group, these controls include:
an electrocardiogram to check the health of the heart;
a posterior part of the eye to control the state of the retina;
a review of renal function;
looking for nervous complications;
a dental examination;
an examination of the feet.
These examinations carried out regularly allow detecting the smallest sign of a possible complication. Health Insurance created a program (called "Sophia") to help patients create a control routine, "in order to raise awareness, without frightening them," says Dr. Huet. "Nurses regularly call patients enrolled in this program to see if they are up-to-date in their check-ups and refer them when necessary," says the diabetologist. Participation in this program is free and without obligation, by simple registration by mail (see details on the CPAM website).
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"This is not an obligation, as for the rest of the population," says Dr. Dominique Huet, but being up-to-date on their vaccines can be recommended for diabetics, especially to prevent certain infectious diseases. "Diseases can unbalance diabetes that It is perfectly controlled, even if this imbalance is far from being systematic Influenza, for example, can be a problem for people with diabetes, which is why the director of the Department of Diabetology at Paris Saint-Joseph "recommends vaccination" systematically to patients who see in consultation
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Sometimes the feet are the obsession of patients, who fear one of the most common complications of diabetes: gangrene and, ultimately, amputation. But daily monitoring is not justified for all patients. "It is recommended only for those who already suffer from neuropathy, nerve damage," explains Dominique Huet. "These patients do not feel much, they do not feel pain, so they can be hurt without realizing it and these injuries themselves cause complications."
Conversely, patients who do not have nerve damage should not concentrate on their feet. According to the diabetologist, "it is necessary to dramatize this complication, a monitoring during the checks made to the doctor is sufficient". Make sure that this control is done well, because all professionals do not practice it systematically.
Easy to say, still! "Stress can not create diabetes, but it can unbalance it," says Dr. Dominique Huet. As stress hormones increase blood sugar levels, this is an important factor to consider in people with diabetes. Sleep disorders can also have a detrimental effect on the control of blood glucose.
"We always start our consultations by asking the patient," How are you? "It's not just a matter of routine, but a way to ensure that you are not subject to stress that could cause problems in the control of your disease," concludes the head of the Department of Diabetology at Paris Saint-Joseph.
As a risk factor often neglected for the complications of diabetes, stress should not be taken lightly. Remember to tell your doctor about any new sources of stress (trauma, bereavement, separation, dismissal, etc.), to make sure that this episode does not have a detrimental effect on your diabetes.
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