There is another plague in the world, quieter and no less violent than the corona: Hundreds of millions of people live in the world with diabetes, which raises not only victims, but immense morbidity, disability and mortality. Hundreds of thousands of people in Israel suffer from the disease, and a similar amount is probably already in a pre-diabetic state without them knowing it.
Data from the Ministry of Health are published on the occasion of International Diabetes Day, starting today (Sunday), and present data from the National Diabetes Registration Report, which began its work in 2019. 4.7% in 1980 to 8.5% in 2014. The number of people living with diabetes increased from 108 million people in 1980 to 451 million in 2017, and it is estimated that it may reach 578 million in 2030. Two years ago It is estimated that 463 million people in the world aged 79-20 have diabetes, about 9.3% of the world population at this age, and that about 4.2 million people have died from diabetes and its complications.
The global increase in the rate of diabetes is due to a combination of an increase in life expectancy and an increase in the presence of major risk factors for disease in the population: poor eating habits, overweight and obesity and lack of physical activity. In Israel, too, diabetes is one of the most common chronic diseases.
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It is estimated that hundreds of thousands of Israelis are already in a pre-diabetic state without knowing it
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In 2014, the National Diabetes Registry was established in Israel at the National Center for Disease Control at the Ministry of Health, in cooperation with the HMOs. In 2019, 550,310 diabetics aged 2 years and older made up 6.5% of the population were reported. Most of the patients were men. The data also showed that from the age of 35 the rate of diabetes increases until the age of 84, after which there is a decrease. The proportion of patients living in neighborhoods with a low and medium-low socio-economic index is higher than the rate in neighborhoods with a medium-high and high socio-economic index. According to the data, the diabetes rate among people aged 20 and over in Israel, which stands at 9.7% of the population, is higher than the average in European countries, where it stands at 6.3%.
Nearly 124,000 patients are treated with insulin, and they make up about one-fifth of all patients. The rest of the patients, who are not treated with insulin, probably suffer from “type 2 diabetes”, adult-onset diabetes, which has not yet degenerated into a state of destruction in the pancreas that produces insulin, and are content with a proper diet and oral medication.
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Almost 124,000 Israeli patients are treated with insulin, and they constitute about one-fifth of all diabetics
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Diabetes is divided into two types: type 1 diabetes, also called juvenile diabetes, and type 2 diabetes, also called adult-onset diabetes. Juvenile diabetes is a congenital disease in which the body attacks the cells in the pancreas that are responsible for the production of the hormone insulin. Insulin is responsible for introducing sugar from the blood into the body’s cells for energy. About 10% of all diabetics have juvenile diabetes, and the rest have adult-onset diabetes.
This disease usually appears after the age of 40, due to reduced sensitivity of the body to insulin. In this condition, the pancreas secretes increasing amounts of the hormone, until the insulin stores are completely depleted. Many of these patients are forced to inject insulin daily. Juvenile diabetes occurs in childhood, around age five-seven and around age 14-10. However, the disease can actually appear at any age, even in infants up to the age of six months, so it is called Neonatal and is most often due to a genetic disease in the pancreas or the action of the pancreatic cells that produce insulin.
There are some genes that put you at risk for type 1 diabetes, but the matter is more magnetic. Proof of this is that in identical twins the chance of the other twin developing juvenile diabetes is only 50% and not 100%. According to the hypotheses, there is another factor to which the patient was exposed before the outbreak of the disease – possibly a virus. Even children who do not breastfeed in the first months of life are at higher risk for diabetes.
In some cases, diabetes can be predicted: When a family has a child with diabetes, and the parents are concerned about the chances of other children getting the disease, they can measure the presence of antibodies against beta cells, such as the GAD antibody, anti-insulin antibody or anti-oil antibody. However, there is no way to prevent the outbreak of the disease.
Diabetics are advised to avoid consuming simple sugars like sweets made from table sugar or grape sugar. Instead, it is better to choose products with artificial sweeteners, with a standard mark of the Israeli Diabetes Association. Diabetics are also advised not to consume alcohol: it inhibits the metabolism designed to maintain blood sugar levels, and can cause a sharp drop in blood sugar levels. If you still have to drink, the recommendation is to limit the amount of drink, eat something beforehand, measure your sugar level often and stay close to friends.
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10% of all diabetics have juvenile diabetes, and the rest have adult-onset diabetes
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Since the invention of the insulin injection, the lives of millions of diabetics around the world have been saved, who can now lead a normal lifestyle. In the past it was customary to give an injection of insulin called NPH twice a day: the substance reached its peak within eight hours and disappeared within 12 to 18 hours. It differs from regular insulin because it would reach peak levels, while regular insulin is secreted in a fixed amount throughout the day. Patients are currently being treated with the Lantos or Lamvir insulins, which are approaching the original insulin action, and their duration of activity is about 20 to 22 hours.
Meanwhile, patients receive short-term insulin given during or before meals. In Israel, there are three types: Novorphide, Lispero and Epidra, which are given about 15 minutes before or during a meal. This insulin reaches its peak of effect after about an hour, and its action is complete after about three hours. In this method, the patient receives one or two injections of insulin in the morning or in the evening, in addition to short-term insulin for large meals – and a total of about five to seven injections a day.
Another option is to use an insulin pump, a device that connects to the body through a tube that is replaced every three days. Insulin is released automatically according to pre-programming in a flexible program. In addition, during meals, more insulin can be released at the push of a button. The insulin pump has made a real revolution in treatment and saves the many injections that the patient has to deal with every day.
The latest innovation in pumps is an “artificial pancreas” that constantly monitors the sugar levels in the body, without multiple punctures, and injects itself the required insulin. In such a situation the patient is required, for safety, to perform a few sugar tests, just to make sure that the insulin pump is working properly. The information from the pump is also transmitted to a smartphone, close family members and even a doctor, and may alert when there is a malfunction in the device, or when the sugar levels are very low or high, so that it prevents life-threatening situations.
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