” Diabetes Type 2 ” (T2D) or ” non-insulin dependent diabetes ” (DNID) (also called “insulin-resistant diabetes” or “middle-aged diabetes”, sometimes “acquired diabetes”), is a metabolic disease affecting glycoregulation . It sometimes has a genetic component, but has experienced an epidemic development for several decades, which suggests that it has environmental causes, perhaps linked to exposure to certain endocrine disruptors 2 . It is characterized by insulin resistance in the body and by reactive hyperinsulinemia. The pancreas makes more and more insulinuntil exhaustion. When the amount of insulin is no longer enough to counter resistance, the glucose level increases abnormally and the person becomes directly diabetic insulin resistant . Over time the pancreas is unable to release insulin ( relative insulinopenia ), then it no longer ensures glycoregulation (this is the insulin-requiring phase ).

The hyperglycemia chronic induced lesions ( microvascular and macrovascular) that may over time to be more numerous and severe. The blood sugar threshold not ideally to be exceeded is still under discussion.
Often asymptomaticfor years, the disease is detected by the biological examination of fasting blood sugar or after stimulation by the ingestion of sugar (postprandial glycemia or induced hyperglycemia ).
The cost of the epidemic of type II diabetes has been estimated at more than 20 billion euros / year by the European Union borne by patients and society, while the industry (agrochemical, packaging, and food) could be at fault 2 .

Causes of Diabetes Type 2

This diabetes is not secondary diabetes (as in hemochromatosis ), nor induced by taking certain medications (for example, prolonged use of steroids ). According to the WHO , the risk factors are polygenic and environmental and those for which the level of evidence is “convincing” or “probable” are ⁸  :

Overweight and obesity (especially abdominal)
The majority of victims of type 2 diabetes are obese. Chronic obesity induces increased resistance to insulin which can progress to diabetes. However, voluntary weight loss reduces the risk of diabetes.

Sedentary lifestyle Lack of physical activity increases the risk, and conversely regular intensive physical activity decreases the risk, whatever the level of obesity;

Maternal diabetes
It explains only a small part of the cases, but maternal diabetes is a risk factor: a child born to a diabetic mother is three times more likely to become so in turn than if he was born before it becomes. Having family members (especially first degree) with type 2 diabetes is an important risk factor for developing it as well. For real twins, if one of the two becomes type 2 diabetic, there is a more than 90% risk that the second also becomes type 2 diabetic ⁹ . The bias of the family environment must still be clarified (in the same family, including in utero, siblings may be exposed to the same environmental factors).

Poor diet
A diet too rich in saturated fatty acids  ; while unsaturated fatty acids of vegetable origin reduce the risk; in addition, replacing saturated fatty acids with unsaturated fatty acids in a diabetic person improves glucose tolerance and increases insulin sensitivity if the total fat intakeis not excessive (maximum 37% of l ‘total energy);
In addition, a diet poor innon-starch polysaccharides (which are part of dietary fiber );

Intrauterine growth retardation
Low birth weight could promote the development of type 2 diabetes ¹⁰ .

According to other sources, these two risk factors are also mentioned:

Medicines
Taking statins can increase patients’ blood sugar levels and promote the development of type 2 diabetes ¹¹ . 

Endocrine
Disruption A disturbance of the circadian rhythm: too short or too long sleep time (compared to the average) seems to increase the risk of diabetes type 2 or glucose intolerance(2.5 times more) ¹² . It is not yet known whether this is a risk factor, or a disorder associated with the cause of diabetes.
A study suggests that the circadian rhythm (and therefore the hormone system controlled by melatonin ) has beendisturbed, which seems to increase the risk of pre-diabetes ¹³ .
Certain endocrine disruptors , many of which are pollutantsemerging seem to be at issue ² .
In rodents, in the laboratory, exposure (in particular to bisphenol A ) causes anomalies in the regulation of insulin secretion by the beta-pancreatic cell and its action at the peripheral level, but also a clear adipocyte differentiation, which can induce insulin resistance and metabolic syndrome with obesity typical of type 2 diabetes ² .
In humans, a direct epidemiological link between accidental or wartime exposure to certain persistent organic pollutants ( organochlorine pesticides , dioxins and polychlorinated biphenyls ) and the occurrence ofmetabolic syndrome or type 2 diabetes after acute exposure, for example during the Seveso accident or among Vietnamese Veterans exposed to Agent Orange during the Vietnam War ) ² .
Some epidemiological studies ( longitudinal ), found higher rates of endocrine disruptors in obese and / or type 2 diabetes (including persistent organic pollutants or POPs), which are now considered risk factors for insulin resistance and contributor to the epidemic of obesity and type 2 diabetes ²

Prevention

Drinking coffee seems to decrease the risk of type 2 diabetes ¹⁴ .

A study (2001) ¹⁵ on 522 overweight and glucose intolerant people asked 50% of people to follow five lifestyle recommendations: body mass reduction of 5% or more, total fat consumption less than 30% of daily energy intake , consumption of saturated fatty acids less than 10% of daily energy intake, consumption of dietary fiber of at least 15 g per 1000 kcal and at least 30 minutes of moderate exercise per day. Frequent consumption of whole grain foods, vegetables, fruits, milk and low-fat meats, soft margarines and vegetable oils rich in monounsaturated fatty acids was recommended.
None of the 64 people who followed at least four of the five basic recommendations developed diabetes during the three years of follow-up, compared to 31% of people in the control group who did not follow any of the recommendations (data to the other group) ¹⁵ .

Evolution 

At the onset of the disease , the pancreas normally produces insulin. Weight gain stimulates muscle cells, which preferably use fatty acids as an energy source. The cells in the body responsible for capturing and using glucose are said to become insensitive to insulin . Since glucose cannot enter cells, beta cells in the islets of Langerhans in the pancreas will produce more insulin to force the cells to take up glucose. The further the disease progresses, the more the beta cells are depleted, until they disappear. The blood glucose level ( glycemia ) will increase up to exceeds 6g / l (stage ofglucotoxicity  ; display HI).
The toxicity of glucose (at this dose) leads to insulin resistance and direct destruction of beta cells in the islets of Langerhans. A vicious circle is created where insulin resistance and reduced insulin secretion worsen diabetes with the rise in blood sugar.

Diabetes Type 2 is one of the cardiovascular risk factors (increased likelihood of having arterial atheroma , which results in reduced blood flow).

Treatment

It seeks to avoid or delay complications related to the progression of the disease (see complications of diabetes ). Check the Halki Diabetes Remedy – REVIEW

Therapeutic patient education

Once the diagnosis has been made, the doctor and the patient first seek to adapt the treatment to the patient’s life and the degree of the disease.

He should practice regular physical exercise (30 minutes of walking 3 times a week minimum) and reduce his overweight. The doctor adapts the diet to the patient’s life. To limit undesirable variations in blood sugar, the patient must comply with diet and drug prescriptions.

The level of glycated hemoglobin should be monitored every 3 months.

The attending physician coordinates the treatment and supports the patient on a therapeutic, dietetic and psychological level. He must teach him to pay attention to the extremities of his body, which are the first affected (monitoring of the diabetic foot ).
The diabetic must learn as much as possible about his illness and his treatments, to be an actor / interlocutor and not a passive patient.

Hygienic-dietetic measures 

Dietary change. This is the basis of the treatment: the diet based on whole foods of plant origin is the most effective according to various studies, making it possible in the majority of cases to reduce the use of drugs or even to stop it completely ¹⁶ . This type of diet notably allows a drastic reduction in glycemic load and weight loss , two objectives targeted in the treatment of diabetes.

There is controversy over the long-term benefits of carbohydrate diets ^17 , 18 .

Physical exercises: possibly within the framework of adapted physical activities , they make it possible to obtain a better balance of diabetes. This applies to endurance exercises (walking, cycling, swimming, etc.) ¹⁹ , but also for anaerobic exercises (weight training, etc.) ²⁰ . The optimal intensity of practice – called lipoxmax – for which the lipid substrates are primarily used is determined by a metabolic effort test . Training at this intensity improves the sensitivity of insulin receptors, as well as body composition and lipid oxidation . ²¹

Oral treatments 

Main articles: Antidiabetic , Glycated hemoglobin , Insulin , Conventional insulin therapy and Functional insulin therapy .

The next step (if necessary) is to take oral anti-diabetics. Insulin therapy may sometimes be necessary to maintain normal blood sugar . This type of treatment, which has been practiced for decades, has been questioned by recent studies because it does not reduce the mortality rate and because of the many side effects linked to this treatment ¹⁶ .

The treatment seeks to reduce mortality, symptoms and complications related to diabetes. Glycemic control is generally appreciated through glycated hemoglobin (or HbA1C ). To date, only metformin ²² and possibly glibenclamide ²³ , among oral anti-diabetics, has been shown to reduce the morbidity and mortality associated with type 2 diabetes ²⁴ , Certain anti-diabetic drugs ²⁵ are intended to decrease the absorption of carbohydrates from the intestines, others stimulate the cells of the pancreas to produce more insulin, while other drugs may increase sensitivity to insulin.