What is diabetes?
Diabetes is a disease that prevents the body from using sugar properly as an energy source.

    Sugar: provides our body with energy through insulin.

    Insulin: a hormone secreted by the pancreas, allows sugar to enter our cells more easily.

Diabetes is characterised by a lack of insulin and, as a result, too much sugar in the blood (hyperglycaemia).

There are two main types of diabetes

TYPE I diabetes

TYPE II Diabetes

Some figures:

• 8% Belgian population with diabetes = about 1 million Belgians affected
• 30% not diagnosed
• One in 10 Belgians over the age of 65 has type 2 diabetes, but one in two has not been screened.

The diabetes of greatest concern for cardiovascular risk is type 2 diabetes. 

The number of people with type 2 diabetes will grow exponentially in the coming years.

    The reason: our increasingly sedentary lifestyle, the rise in obesity and our poor eating habits.

Why is this serious?
Excess sugar in the blood damages the walls of the blood vessels and clogs them. The blood no longer flows properly to the organs, which no longer receive the elements they need to function (oxygen, glucose, etc.)

 50% of people with diabetes die of cardiovascular disease!

Cardiovascular complications are the leading cause of death in diabetes. The probability of dying from a heart attack is 2 to 3 times higher in diabetics.

Type II diabetes is in most cases an asymptomatic disease at the beginning: with the exception of hyperglycaemia, it is difficult to detect without specific screening at the doctor’s (fasting blood test).

 But who is at risk?

• 45+ years
• Overweight (especially in the abdomen)
• Hypertension
• Excess cholesterol
• Tobacco
• Family history

Diabetes and the cardiovascular system

The cardiovascular fragility of diabetics can be explained in two ways.

• On the one hand, the excess of glucose in the blood favours the deposit of abnormal products in practically all the vessels, both the large arteries, those that irrigate the brain, the heart or the lower limbs, including the very small arteries that irrigate the retina or the glomeruli of the kidneys, for example. These abnormal deposits weaken the vessels and make them more sensitive to the effects of smoking, cholesterol and high blood pressure.
• On the other hand, diabetes increases the risk of high blood pressure, atherosclerosis, coronary heart disease and stroke. The risk is even higher if blood sugar levels are poorly controlled by treatment.

In diabetics, the risk of arteritis (which can lead to gangrene) is multiplied by 4 to 6 and the risk of stroke by 2 to 3.

As far as heart attacks are concerned, the danger is twofold: not only is the risk of having a heart attack higher, but the risk of death by heart attack is also higher, 2 to 3 times higher than in the non-diabetic. And even if the subject gets away with it, the subsequent risk of mortality will remain higher, about double that observed in the general population!

In addition, it should be noted that cardiovascular disease in diabetics is often silent, so that a myocardial infarction may be the first and sometimes the last manifestation of coronary artery disease. This explains why all diabetics should be screened for coronary artery disease.

There is clear evidence that control of all cardiovascular abnormalities and risk factors is at least as important as, if not more important than, glycaemic control for the long-term prognosis of diabetics.

Special mention should be made of blood pressure, which in diabetics should be reduced and maintained at even lower values than in non-diabetics because of the particularly harmful impact of high pressure on kidney function. In diabetics 130/80 mmHg is the maximum acceptable. The same applies to LDL-c, which should be kept below 1 g/l.

But as always in medicine, prevention is better than cure. When it comes to type 2 diabetes, a healthy lifestyle, i.e. a healthy and varied diet combined with a reasonable amount of physical activity, is the best way to maintain a healthy weight and prevent the onset of diabetes.