Some 4 million people have diabetes in Argentina.And being a disease that can be asymptomatic about half could ignore it.Studies suggest that more than 50% of patients in intensive treatment for diabetes will suffer from hypoglycemia.New treatments allow improving your control.
Not only is it the most frequent complication of diabetes treatment, it is also the most feared by people who live with this chronic disease characterized by high levels of sugar (glucose) in the blood."The most frequent fear in patients with diabetes who use insulin is hypoglycemia and secondary, but much further back, weight gain," said Dr. Ariel Zisman, specialist in endocrinology, diabetes and metabolism, medical director of the endocrine adventure center, Miami, United States, visiting the country on the occasion of the 4th Latin American Congress on disputes and consensus in diabetes, obesity and hypertension (CoHy), recently conducted in Buenos Aires.
Hunger, tremor, sweating, drowsiness, confusion, difficulty in speaking and dizziness are some of the usual symptoms of an episode of hypoglycemia, which can occur suddenly and that in most cases is mild and can easily revertPortion of food or drink with high glucose content.However, hypoglycemia is a dangerous condition;Not only because in extreme cases it can be fatal, but because in its most severe forms the person who experiences it can vanish, suffer seizures or lose control of itself, which places it at risk, for example, of suffering an accidenttraffic.
Hypoglycemia occurs when insulin level exceeds what the body needs, which makes blood glucose levels below normal values.In people with diabetes under treatment, hypoglycemia may be due to an excessive dose of medication, to eat little or delay food, as well as to the realization of too much physical activity or to do it in an unplanned way.A thorough analysis of thirty clinical studies suggests that hypoglycemia episodes are much more frequent than it is believed, both in patients with type 1 diabetes and in patients with type 2 diabetes. In the United States, these episodes cause about 282,000Visits to emergency rooms a year.
“While hypoglycemia are very common, studies with continuous glucose sensors have shown that there are patients suffering from minor hypoglycemia frequently and do not know.Many times they are not perceived, they are confused with other symptoms, the patient does not record them, ”explained Dr. Zisman.
"Actually, how frequent they are hypoglycemia has no accurate response because there is a great sub-registration, what we can say is that it is very common and is one of the great concerns of both the doctor and the patient," said Dr. Félix Puchulu, Head of the Diabetology Division of the José de San Martin Hospital, UBA (MN: 70.143)
A frequent form of hypoglycemia among people with diabetes who receive insulin treatment is the so -called nightly hypoglycemia, which occurs while the patient sleeps.Studies suggest that more than 50% of patients in intensive treatment for diabetes will suffer from hypoglycemia.Although some people wake up during the episode it may happen that the symptoms are inadvertent during the night.The frequent indicators of having suffered nocturnal hypoglycemia can be: awakening with a headache;Feel that he has fallen asleep without apparent cause;feel unusually tired;Awakening with wet bedding for having transpired excessively.
Whether it occurs during the day orDuring the night, the fear that the possibility of experiencing hypoglycemia generates among people living with diabetes is a factor that usually plays against the correct compliance with the treatment.Well, to avoid suffering these episodes, patients sometimes reduce or omit the doses of insulin that have been prescribed by the doctor, resulting in a sub-optimal control of the disease that increases the risk of developing chronic diabetes complications.
The abnormally high levels of blood sugar present in diabetes result from the organism's inability to produce sufficient insulin or an inability of body cells to use that hormone properly (insulin resistance).Hence your treatment aims to maintain these levels within normal parameters.“The patient with type 1 diabetes has an autoimmune destruction of their beta cells that are those that produce insulin, and need immediate insulin replacement, both basal and prandial (linked to meals).The patient with type 2 diabetes has the capacity to produce insulin, but has resistance to his action, so his pancreas loses ability to generate an answer and eventually stop producing it, requiring the administration of exogenous insulin .. ofMade in both American and European therapeutic guides, early basal insulin inclusion is suggested in patients with type 2 diabetes, ”explained Dr. Zisman.
“In type 1 diabetes, it is still unknown how to detect it early and prevent it.These patients will be from the beginning ´Isulinorrequirientes´.On the other hand, in type 2 diabetes the failures of the organism are progressive and the treatment begins with diet and exercise, then with oral medication (up to 2 or 3) and if control goals are not reached, insulin begins to be used.While they are not dependent insulin patients, about 40% of these patients should be insulinized becoming insulinorrequirientes, and in practice in many countries this does not happen, ”added Dr. Puchulu.
There are currently new treatments that allow better control of unwanted effects.“From the discovery of insulins their results were improving and therefore the benefits for patients.First, glucose levels were expected to control, after the average of glycosylated hemoglobin (marker that reflects the degree of control of the last 2 - 3 months) and that it remained stable over time.Then it was seen that one of the unwanted effects of the insulins that are hypoglycemia and that was the objective of the investigations, to modify the insulins to achieve it, "said Dr. Félix Puchulu and added" another goal is that its effect is that its effect is that its effectIt seems as much as possible to what the healthy organism usually does.The healthy body, through the pancreas secretly a basal amount of insulin.So, what was sought with the new insulins is that they meet the basal requirements, that is, that they meet 24 hours, that the first insulins did not cover.Scientists were modifying the molecule to try to achieve this situation and continue to investigate to achieve an insulin as reproducible as possible.When we say it is reproducible, we mean that the results are similar, knowing what to expect every day, that the body react similarly. ”
During the 4th Latin American Congress on Disputes and consensus in diabetes, obesity and hypertension (CoHy) a new generation insulin was presented in the country, Glargina U-300, which has demonstrated the same effectiveness as standard treatments but with less risk of hypoglycemiaNight, in addition to controlGlucémica beyond 24 hours and lower weight gain with a single dose per day and good cardiovascular security profile.
"The U-100 Glargina insulin is a well-known and efficient molecule, it was the first available in Argentina in the category of slow ´Alogues' about 14 years ago, being today the pattern of treatment, which means that allNew treatments that appear must be compared to it.The new U-300 Glargina insulin is the same mother drug, it is included in the ultra-lent analogues, but is modified to achieve better results.The studies and acceptance of patients have shown that it has much less unwanted effects such as hypoglycemia, mainly nocturnal, which are the ones that most concern us.Its concentration showed that it favors and acquires properties that differentiate it from standard treatment, it is not simply more or less volume, but some action characteristics were modified and it is what makes it more attractive, ”said Dr. Puchulu.
“It has a longer action, for more than 24 hours, which allows imitating the physiology of a person without diabetes, is more stable and favors the reduction of hypoglycemia.It is injected once a day, it has more flexibility in the injection schedule and all this is a great advantage for the patient.In daily practice one can see that this would facilitate better adhesion to treatment, ”added Zisman.
“It has been scientifically demonstrated in controlled studies that this new insulin, used for patients with type 1 and 2 diabetes, compared to other insulins, based on blood glucose levels, it is much more stable.This insulin proposes to act for more than 24 hours, covering the basal requirements.In patients with type 1 diabetes, it covers the period between meals and sleep, but in this patient profile we must accompany it with the "fast" insulin.In the case of patients with type 2 diabetes, although the organism itself will define it, the proposal is that a single dose is used a day of this basal insulin and perhaps does not require from other doses, ”added Puchulu.
“We must also work with the cultural barrier on how the patient perceives insulin injection because this has evolved in recent years.In modern devices, new insulin injectors look like a pen, the needle is almost not seen, they are almost thin and they almost do not feel.Industry and knowledge have been adapted to make the insulin application process in the patient much easier, ”said Dr. Zisman."The pens are very practical, the dosage is more precise and have been very useful for patients," confirmed Dr. Puchulu.
Diabetes in Argentina
In Argentina, one in ten adult Argentines lives with diabetes, revealed the third national risk factors survey.“The prevalence, the number of people who have diabetes in Argentina is, according to the last statistic, 9.8%, over 18 years.This means that 4 million people have diabetes in Argentina.90% correspond to type 2 diabetes which is the most common.It is an asymptomatic disease so near half he does not know that he has diabetes, ”said Dr. Puchulu.
According to statistics recorded in the first world report on diabetes of the World Health Organization (WHO), the number of 18 years old living with diabetes worldwide amounts to 422 million.Since the 80's, the worldwide prevalence of this disease has almost doubled, as it amounted from 4.7% to 8.5% in the adult population.
