“These bodies are not mature enough to deal with type 2 diabetes,” warns the endocrinologist.
By: Alexander Triana Yanquen
The rates on diabetes in Puerto Rico are alarming, a study by the Abarth Health laboratory, in conjunction with the Puerto Rican Association of diabetes in which it was revealed that close to half of the population (48%) have or could have diabetes on the island.
Specifically, the study reports that 20% of the population suffers from the disease and the remaining 28% are patients with prediabetes, with a high incidence in the child and adolescent population.
In an exclusive interview for the Revista de Medicina y Public healthwe spoke with Dr. Margarita Ramírez Vick, director of the Department of Endocrinology of the Medical Sciences Campus, about this fact and assures that “we are seeing much more obesity and sedentary lifestyle in children.”
A generational problem
The expert assures that: “the problem that is being seen is that these children who start with diabetes type 2, in childhood or early adolescence, develop complications of diabetes much earlier (…) Those bodies are not mature enough to deal with a diabetes type 2,” he says.
These complications are increasing and Martínez explains that they directly affect the following generations: “we are going to have a whole generation of youngsters who are not going to reach 50 years of age, or they are going to arrive on dialysis, with amputations (…) it is very sad. It is very serious and that parents do not realize the magnitude of the problem, and the children that arrive will be disabled, which is the worst, they will not be able to lead a normal active life or be productive ”, he affirms.
This could be seen directly as a problem of public health to which the authorities and the population in general must pay attention.
Why is the incidence seen in the child population?
Explains Dr. Martínez, who has to do with cultural changes, ensuring that before the population was more active and now, the evidence shows that the child and adolescent population are exposed and subjected to mobile devices, and social networks that limit their being proactive.
“In our time, one was always on the street, the mothers had to shout three times at five in the afternoon for them to come in to eat. That is not something that we see at the moment… Right now the children do everything through cell phones, through handheld games, there is no physical activity, apart from the diet that we are currently following, we know that it is terrible, ”says Martínez.
Parental responsibility?
Data from the American Association of Diabetesit is estimated that around 600 thousand people suffer from a type of diabetes in Puerto Rico, and more than a third of these patients are from diabetes type 2.
“Unfortunately parents, you see how they are taking them to Burgers King, to those kinds of places after they leave school, so it makes these children develop obesity, which leads them to diabetes type 2”, emphasizes Martínez.
Now, it is important to mention that the diabetes type 2 was not evident in the children, who presented type 1 in their majority. Dr. Martínez comments that this has led to direct changes in the case care of pediatric specialists: “pediatricians have had to learn to manage diabetes type 2 because they had never seen that”, he adds that this phenomenon and incidence in said population, “has been seeing that for about 15 years”.
Cardiovascular complications of diabetes
Much has been said about the complications and effects of treatments in diabetic patients. We know that the diabetes It brings with it affectations in the cardiovascular, nervous, renal and neurological systems. Sugar deficiency or malfunction of the body in the production and regulation of insulin is decisive.
However, according to Dr. Martínez, the greatest complication in diabetic patients is evident in the cardiovascular system: “the greatest mortality is not in renal complications, but in cardiovascular ones because one can die of a heart attack at the moment . In the kidney problem, usually with dialysis one can prolong the life of the patient, but in cardiovascular causes one can die quickly”, she says.
Martínez explains that in the case of diabetic patients, “it is no different from any other patient who has heart disease,” he adds that: “they already have that high risk, so it is important that each patient, including prediabetes, have a routine check-up with a cardiologist, because one is not necessarily going to feel the same as a non-diabetic patient”, he assures.
For his part, he clarifies that the non-diabetic patient: “usually when he begins to suffer from the heart he begins to get what we know as angina pectoris, he fatigues more easily, he tires more easily. In the diabetic it does not necessarily give typical chest pain and tends to be atypical. Especially if the patient has diabetic neuropathy, he will not feel chest pain like a patient without diabetes. So he can drop dead to the ground without prior warning, ”says the expert.
Neurological complications of diabetes
In the case of neuropathy, it is clear to explain that some people can present it with discomfort in the legs and lose sensitivity in the lower extremities, losing balance and falling frequently and without prior warning: “There may be neuropathy at the cardiovascular level in where you will not feel chest pain, ”says Martínez.
Therefore, it is important not only to have good control of the diabetesbut blood pressure, as well as cholesterol control, and making changes in lifestyle: exercising, taking care of diet: “people do not realize the importance of at least taking a 20-minute walk a day and can prevent it from falling into these processes ”, he explains.
Now, it is vital to mention that in the check-ups, the specialists will first notice changes in glucose: “when our glucose is very high, that is when one will feel that one’s legs are falling asleep, runny nose, or as if they were sticking with pins, and may improve after one gains control of his diabetesso for normal sugars, one should not have neuropathy, unless the patient has been uncontrolled for so many years that they already have neurological damage that is irreversible, and even if that patient is controlled, they can still have neuropathy”, he clarifies.
As if that were not enough, one of the characteristics of neuropathy is the development of diabetic foot, a quite common derivation of the disease, in which the doctor estimates. “60% can have it and it will correlate with the lack of control of sugar. That’s why an uncontrolled patient is usually going to have these sensation problems,” she says.
Kidney complications of diabetes
Diabetic retinopathy is one of the main causes of blindness and visual impairment in Puerto Rico and in many parts of the world. The diabetic patient requires multidisciplinary and team treatment and supervision: “the problem of retinopathy, which is what is most affected in the eye area in diabetics, begins to occur from the prediabetes stage,” says Martínez.
This is how endocrinologists usually recommend that “patients, since they are diagnosed with prediabetes, go to the ophthalmologist annually,” emphasizes the expert. She adds that “it is something progressive, and it is a condition that if one is controlled well from the beginning (sugars), it should not occur; or if it does occur, it occurs much later in the condition,” she concludes.
See the full interview here: