Diabetes—life style and food risk factors

 Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.

Insulin is a hormone that regulates blood glucose. Over time, it can cause serious health problems, such as heart disease, vision loss, and kidney disease. Lifestyle risk factors, such as obesity, physical inactivity, smoking, and having an unhealthy diet are significantly associated to the risk of developing diabetes.

Diabetes is usually diagnosed by the blood test that indicates average blood sugar level. These levels were questioned in the post https://twitter.com/Arachnidualny/status/1703698131030782022 on the X platform (formerly Twitter) submitted for fact-checking. The author, Arachnid (@Arachnidual), observed by more than 14,000 people, wrote: "I went to the doctor and discovered something new. For years, at my home there have been people with diabetes and I know that at one time the normal level in his blood was 120 mg/dl. Now, the WHO has recommended that this level should be lowered to 90-100 mg/dl and that anyone above it should be prescribed diabetes medication...”
This is not true. The World Health Organisation (WHO) recommended standards for venous plasma glucose levels to diagnose diabetes have not changed since 1999. Back then, the fasting blood glucose result was lowered from 140 mg/dl to 126 mg/dl. But these have to be two measurements taken on two different days.
It is worth mentioning that the WHO did not change the norms concerning normal blood glucose in 1999. Both before that year and at present the level is between 70 and 99 mg/dl. Before 1990, levels between 100 and 139 mg/dl were classified as pre-diabetic. Currently, these levels are between 100 and 125 mg/dl.

It should be noted that a fasting glucose laboratory test is not the only way to diagnose the disease. It can also be confirmed by the so-called "random blood glucose test", that is, at any time of day, irrespective of when the last meal was consumed. In this case, according to the recommendations of the Polish Diabetological Association, the basis for diagnosis of diabetes will be any result above 200 mg/dl, if it is accompanied by symptoms of hyperglycaemia, such as increased thirst, polyuria or weakness.
Another relatively new criterion for diagnosing diabetes is the determination of the glycated haemoglobin value (HbA1c) performed in a laboratory using a method certified by the NGSP (National Glycohemoglobin Standardization Program). In this case, a value equal to or exceeding 6.5 percent (48 mmol/ mol) is the basis for the diagnosis of diabetes. Recommendations from the Polish Diabetes Association included glycated haemoglobin (HbA1c) testing in the 2021 obligatory diagnostic criteria.
On of the main first-line medication for the treatment of type 2 diabetes, particularly in people who are overweight, is metformin. The drug became a popular topic of fake news, and such was the article published on a website https://tynandrgarla.store/.

It is not true that metformin kills. On the contrary, studies have shown that, when used in patients with newly diagnosed diabetes, it reduces the risk of heart attack and death from cardiovascular disease complications.
"The claim that metformin kills is complete nonsense. Metformin protects against heart attacks. It is a drug used in the first-line treatment of diabetes. Studies have shown that when given to patients with newly diagnosed diabetes, it reduces the risk of heart attack and death from cardiovascular disease complications," said Prof. Krzysztof Strojek, national consultant in diabetology, specialist in internal medicine, diabetology and hypertensiology, and head of the Clinical Department of Internal Medicine Diabetology and Cardiometabolic Disorders at the Silesian Medical University, who also heads the Regional Diabetes Clinic.

"It is untrue to say that people taking metformin have skin problems and that their internal organs suffer. The drug has been used to treat diabetes for 60 years. There is no data proving that it causes organ damage. In about 5 percent of patients, the drug causes gastrointestinal side-effects in the form of diarrhoea. For the majority of patients, these symptoms resolve after a few days of taking the drug. If they do not disappear, metformin is withdrawn from treatment," he added.
According to Grzegorz Mizerski, M.D., from the Department of Family Medicine at the Medical University of Lublin, it is recommended to start metformin treatment at a low dose of 500 mg once per day, then increase the dose until either the therapeutic dose or the maximum tolerated dose is reached. The drug is recommended to be taken before meals. The therapeutic effect appears after a few days and stabilises after about two weeks of treatment.

In isolated cases, allergic side effects have been reported. The most common are gastrointestinal disorders and lactic acidosis. Gastrointestinal symptoms include nausea, flatulence, abdominal pain, diarrhoea, a metallic taste in the mouth and loss of appetite. These usually occur at the beginning of treatment and may resolve spontaneously. Sometimes it is required to take the drug with or immediately after a meal or a change to a sustained-release form. In extreme cases, discontinuation of the drug is necessary.
In the article 'Metformin—invariably the gold standard in the treatment of type 2 diabetes' written by Dorota Stołtny, Dominika Rokicka, Marta Wróbel and Krzysztof Strojek, the authors wrote that “metformin, in addition to its antidiabetic and cardioprotective effects, has a beneficial effect on weight reduction and lipid metabolism parameters, and is therefore widely used in the treatment of pre-diabetic states, i.e., impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or both, insulin resistance syndromes other than in the diabetes, and polycystic ovary syndrome.

In the 1990s, a hypothesis emerged that suggested links between type 1 diabetes and the early introduction of cow's milk proteins into infants' diets. A series of comprehensive studies were carried out to prevent type 1 diabetes by giving infants modified milk containing hydrolysed cow's milk instead of standard milk mixture when their mothers were no longer breastfeeding.
A proper diet is one of the ways to control diabetes, so there are more and more posts on social media concerning food products and their effects on the disease. The claim that milk causes diabetes, which appeared on the TikTok website https://www.tiktok.com/@drhumbertoarruda/video/7069719946854550789?is_from_webapp=1&web_id=7257449074734990874, is fake news.

The Trial to Reduce Insulin-dependent diabetes mellitus in the Genetically at Risk (TRIGR) study, which lasted 25 years, was conducted in Europe, North America and Australia. More than 2,000 infants with close relatives with type 1 diabetes and an increased genetic risk of type 1 diabetes were included in the randomised, double-blind, placebo-controlled trial, which had a 10-year follow-up period. One group of infants was given hydrolysed modified milk after breastfeeding, while others were given modified milk based on cow's milk, but with the addition of hydrolysate so that it did not differ in smell or taste from the others.
In 2018, the results of the TRIGR study were published and showed no difference between the two groups. "The fact that we do not know what causes type 1 diabetes means that we need further research," the researchers concluded. As far as type 2 diabetes (T2D) is concerned, several meta-analyses have proven an inverse relationship (i.e. a protective effect) between dairy intake and T2D risk.
The study found out that cow's milk does not cause type 1 diabetes. As far as type 2 diabetes is concerned, milk is not only a recommended component of a diabetic's diet, but according to scientists, it can even prevent type 2 diabetes and hypertension. So, people with diabetes can drink milk, but should do so in moderation, as it also contains carbohydrates that can affect blood sugar levels.

As Brazilian researchers wrote in an article published in the journal ‘Arquivos Brasileiros de Endocrinologia’: “the calcium and vitamin D content of dairy products can have a beneficial effect on glucose metabolism and the renin/angiotensin system (provides a balance to the whole body), as well as regulating body weight'.
"Milk lowers blood glucose levels due to its high concentration of vitamin D, which helps reduce the blood glucose. In addition, it contains calcium, magnesium and other minerals that help balance blood sugar levels. The proteins in milk also slow down the absorption of carbohydrates into the bloodstream, which keeps blood sugar levels steady over time,” the researchers argued

06.10.23