THE DIABETES

DEDICATION

To God, for his immense and infinite Love,

And for his invaluable gift: LIFE
To our dear parents,
That with their example they guide me through
The path of study and overcoming
For the achievement of our objectives and goals
And thus achieve to be excellent professionals
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GRATITUDE
With special gratitude to our teacher
responsible for our training
in recognition of the effort,
Wise teachings and for your advice that
We will always keep in mind the daily walk
Of our life.
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PRESENTATION

The present Informative Research Work on Diabetes, has been carried out in
order to learn more about the reality of this disease. Our main purpose is not only
to disseminate the information gathered in the research, but also to nourish the
knowledge of all those interested in this kind of topics, and also inspire further
research to achieve research excellence.
Diabetes is a chronic disease currently considered a public health problem. This
disease produces a significant socioeconomic impact in the country that
translates into a high demand for outpatient services, prolonged hospitalization,
absenteeism, disability and mortality due to acute and chronic complications.
The prevalence of diabetes varies between 2 and 5% of the world population. In
the United States, diagnosed cases of diabetes reach 5.9% of the total
population, with predominance of the African-American, Mexican-American and
Hispanic race.
In Peru, the prevalence of diabetes is 1 to 8% of the general population, with
Piura and Lima being the most affected. It is mentioned that currently diabetes
mellitus affects almost two million Peruvians and less than half have been
diagnosed, according to official data from the Ministry of Health. The worst thing
is that this figure is increasing and it is estimated that half of those affected ignore
their condition .

The high social and economic costs that they generate require increasing. The
high social and economic costs that they generate require transcendental
measures to avoid complications and improve the quality of life. The multiple
preventive programs that have been implemented seem not to stop the cases of
diabetes. Therefore, this study arises with the purpose of disseminating
knowledge about diabetes in our population, as well as giving due importance
and due importance to family support.
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INDEX
1. DEDICATION
2. GRATITUDE
3. PRESENTATION
4. INTRODUCTION
CHAPTER I THEORETICAL FRAMEWORK
5. DIABETES
6. DIABETES TYPE 1
7. DIABETES TYPE 2
8. GENERALITIE
9. CAUSES
10. FACTORS
11. DIABETES SYMPTOMS
12. DIAGNOSIS
13. GENERAL TREATMENT
14. RISK FACTOR'S
15. GENETIC FACTORS
16. THERAPEUTIC OPTIONS
17. REHABILITATION
18. PHARMACOTHERAPY
19. DEMOGRAPHIC CHARACTERISTIC
20. COMPLICATIONS
21. GROUPS OF PEOPLE AT GREATER RISK TO THE DM
22. EPIDEMIOLOGICAL AND GENETIC ASPECTS OF THE DIABETES
MELLITUS IN THE PERUVIAN POPULATION.
23. SITUATION IN PERU
24. TERMINOLOGICAL GLOSSARY
25. CONCLUSIONS

26. BIBLIOGRAPHIC REFERENCES

27. ANEXOS
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INTRODUCTION
Diabetes is the group of metabolic diseases characterized by hyperglycemia
resulting from defects in the secretion and / or action of insulin. The chronic
hyperglycaemia of diabetes is associated with long-term complications,
dysfunction and failure of several organs, especially the eyes, kidneys, nerves,
blood vessels and heart1.

Type 1 diabetes is characterized by the destruction of pancreatic islets of beta

cells and total insulinopenia; so that individuals present the tendency towards
ketosis in basal conditions. It is one of the most frequent chronic diseases of
childhood, whose incidence is increasing, especially in children under 5 years of
age; it significantly affects the health of the population, especially through its
chronic or long-term complications, which cause frequent morbidity and
significantly reduce life expectancy.

There is no specific cause for type 1 diabetes. Research shows that type 1
diabetes has something to do with genes. Genes are not solely responsible for
this type of diabetes. Actually, genetic causes in combination with certain viral
infections can cause type 1 diabetes. Type 1 diabetes can not be prevented. It is
very difficult to determine who will get and who will not. When you have diabetes
for the first time, you may experience the following symptoms:

• Eat a lot: you tend to eat a lot because you will not get the necessary amount of
energy.
• Drink a lot: frequent thirst makes you drink a lot of water.

• Frequent urination: the body tries to get rid of the excessive amount of sugar in
the blood through the urine.

• Fatigue: Since the body can not use sugar for energy, it tends to feel tired and
exhausted all the time.
• Losing weight: since the body can not use sugar for energy, it starts using fat
and muscles for fuel.
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DIABETES
Diabetes) is a chronic disease, of different etiologies, characterized by
hyperglycemia, which results from a deficit in the secretion and / or action of
insulin. The chronic hyperglycemia conditions, in the long term, the development
of nephropathy, retinopathy, neuropathy and cardiovascular complications, which
determines high morbidity and mortality of diabetic patients with respect to the
general population.

Likewise, it can be defined as a chronic process that affects a large number of

people, being an individual and public health problem of enormous proportions,
which is progressively increasing.

It includes a heterogeneous group of pathologies, whose characteristic is

hyperglycemia (elevation of blood glucose), resulting from defects in the
synthesis, secretion and / or action of insulin.

The chronic hyperglycemia of diabetes is accompanied by alterations in protein

and lipid metabolism, which can cause acute and chronic multiorganic
complications, affecting mainly eyes, kidneys, nerves, heart and blood vessels.
Today we know that a large part of the complications associated with diabetes
mellitus can be prevented; For this reason, early diagnosis of the disease, strict
control of blood glucose levels and high patient involvement are essential. The
symptoms of a marked hyperglycemia are: polyuria, polydipsia, weight loss,
sometimes with polyphagia, and thinning. The most serious, potentially fatal
consequences of uncontrolled diabetes mellitus are hyperglycemia with
ketoacidosis and hyperosmolar non-ketotic syndrome.

Diabetes occurs, therefore, by an abnormality in the functioning or production of

insulin by the pancreas or a failure of insulin receptors in tissues or cells.

There are two types of Diabetes: When there is no insulin, as in young diabetics
(Type 1) by a total destruction of the cells of the pancreas responsible for
producing insulin (Beta cells), or because it does not work properly, as occurs in
adults (Type 2), in which the sugar does not pass from the blood to the organs
and the functioning is deficient. At the time, the sugar accumulates in the blood
in amounts higher than normal, appearing hyperglycemia.

There is a growing worldwide prevalence of diabetes, due in large part to

inadequate lifestyles such as inadequate diet and sedentary lifestyle, especially
affecting developing countries.
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What are the different types of diabetes?

There are three types of diabetes: type 1 diabetes and type 2 diabetes and
gestational diabetes according to the World Health Organization-

In Type 1 diabetes (also called juvenile or insulin-dependent diabetes), the body

completely stops producing insulin, a hormone that allows the body to use
glucose from food to produce energy.

Patients with type 1 diabetes should use insulin injections daily to survive. This
form or type of diabetes usually develops in children or young adults, but can
occur at any age.

Type 2 diabetes (also called late onset or non-insulin dependent diabetes) results
when the body does not produce enough insulin and / or is unable to use insulin
properly (insulin resistance).
DIABETES TYPE 1

t is the result of the destruction of pancreatic beta cells, which leads to an absolute
deficiency of insulin. It represents only five and ten percent of all patients with
diabetes. It usually appears in childhood or youth, although it can appear at any
time of life and has antibodies (IAA, IA2, DAD), which is why it is considered an
autoimmune disease. At first. It usually presents the classic symptoms of
diabetes, polyuria, polydipsia, weight loss, ketonemia, etc., being necessary for
its treatment the use of insulin since its inception
DIABETES TYPE 2
It represents 90-95% of all cases of diabetes. It is characterized by a relative,
rather than absolute, insufficiency of insulin and a resistance to its action. It
usually appears in adult life, above 40 years and does not always need treatment
with insulin.

The risk of developing this form of diabetes increases with age, weight and lack
of physical activity, being more frequent in obese, hypertensive and dyslipemic
patients. It may take years to recognize it because hyperglycemia develops
slowly and in the early stages, it is often not so severe that the patient notices
any of the classic symptoms of diabetes. Diabetes Mellitus II is a chronic
metabolic disorder that results from defects in the secretion of insulin as well as
its action. Insulin resistance and the failure of pancreatic beta cells are
determined to a certain extent genetically, however, environmental factors
contribute to exacerbate both abnormalities.
Individuals with Diabetes Mellitus II (Diabetes M. II) are also characterized by a
reduction in the pancreatic beta cell mass by an increase in cellular apoptosis.
 THE DIABETES

Gestational diabetes GDM)

It is defined as any degree of glucose intolerance with initial onset or recognition

during pregnancy, regardless of whether treatment with diet or insulin is initiated,
since oral antidiabetics are contraindicated. It affects 4-6% of pregnant women.
Other types
secondary diabetes and genetic alterations.

An intermediate group of subjects has been recognized whose glucose levels,

although they do not meet the criteria of diabetes, are too high to be considered
normal. They would include impaired glucose tolerance (ATG) and impaired
fasting glucose (AGA). Of these patients, it can be said that they have "Pre-
diabetes", which indicates a relatively high risk to develop diabetes.
GENERALITIES

Diabetes mellitus (DM) is a chronic disease considered a problem for public

health, both in developed and developing countries. In many countries it is a
major cause of death, disability and high costs of health care. The World Health
Organization (WHO) estimates that diabetes affects millions of people - and will
affect even more in the short term worldwide, many of whom have no access to
effective treatment for their disease.

In 1989, recognizing that diabetes is an international public health problem, the

42nd World Health Assembly unanimously adopted a resolution requesting all
Member States to measure and assess national mortality by DM and implement
measures.
DM is a metabolic, heterogeneous and complex disease, characterized by a
permanent prolongation of blood glucose levels, due to a lower production and /
or action of insulin, which results in the body's inability to metabolize the
appropriate nutrients.

Several genetic factors and environmental conditions are the etiology and
evolution of diabetes, the important differences between different countries and
ethnic or cultural groups, the prevalence of the disease and the frequency of its
complications.

DM includes diverse clinical forms such as DM type one (insulin dependent), DM

two (non-insulin dependent), and gestational DM. There are also people who
show a decrease in their ability to adequately metabolize glucose, glucose
intolerance, and who have a higher risk than the general population for the
development of DM.
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CAUSES
Glucose is a sugar that comes from the food we eat, circulates through the blood
and is used by the body to obtain the necessary energy to develop any type of
work. Insulin is a hormone that makes the pancreas, whose mission is to facilitate
the passage of sugars from the blood to the cells. There is also, in each cell,
insulin receptors. Making an analogy, the glucose to enter the cell and thus
produce energy requires a key (insulin) and a lock (receiver): if the "key" and
"lock" work properly the use of glucose is optimal. If one of them fails, that is to
say, the insulin or the receptor (the key or the lock) the glucose can not enter the
cell and increases in the blood producing the diabetes mellitus.
FACTORS

Genetic factor: Keep in mind that you only inherit the predisposition to have
diabetes, not diabetes itself. Only 13% of children and adolescents with diabetes
have a father or brother with this disease.

• Autoimmune factor: The immune system of our body is responsible for

protecting us, but in certain diseases (known as autoimmune diseases) the
person's own immune system turns against it. In the case of diabetes, a reaction
occurs against the insulin-producing cells.

• Environmental factor: This factor can be a virus, toxic elements, something in

the food, or elements that we still do not know. It is believed that it is the link
between the genetic factor and autoimmunity.
DIABETES SYMPTOMS

Type 1 diabetes can appear gradually or suddenly. A person may have diabetes
and not realize it because the symptoms are not always obvious and may take a
long time to manifest.

• Polyuria Having a high concentration of sugar in the blood, our body tries to
eliminate it through urine, but to do so, it needs to dissolve in very large amounts
of water, for this reason the diabetic urinates many times.

• Polydipsia: To compensate for the loss of water the body sets in motion a
defense mechanism, therefore, these people are very thirsty.

• Polyphagy: Although there is sugar in the blood, the cells cannot use it because
they do not have insulin, which is responsible for entering the glucose inside. The
brain emits messages of lack of food which gives rise to another characteristic
symptom, hunger.
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•Weightloss: Even if you eat more, the glucose does not reach the cells and the
person with diabetes loses weight. The body needs energy to function and if it
does not get it from glucose it starts using the reserve fuel that is accumulated in
the form of fat, that is to say it starts to burn fat to transform it into glucose
WHAT IS THE MOST FREQUENT DIABETES?
Of every ten people with diabetes, nine have type 2 diabetes,
the vast majority are overweight or obese
Almost half of adults with diabetes DO NOT KNOW THEIR CONDITION.
DIAGNOSIS AND TREATMENT
DIAGNOSIS:
• Fasting glucose greater than 125 mg / dl. In 2 shots on different days.
• A random blood glucose, at any time of the day, greater than 200 mg / dl.

• A plasma glucose level 2 hours after performing the Oral Glucose Tolerance
Test ≥ 200 mg / dl.

• Glycosylated hemoglobin greater than 7 (although this test is usually used

mostly for the monitoring and control of the diabetic patient)
Goals of blood glucose control

The current European Consensus presents some recommendations for glycemic

control based on three variables:

• HbA1c glycosylated hemoglobin less than or equal to 6.5 (indicates the mean
blood glucose levels during the last 3 months).
• Fasting blood glucose (plasma venous) less 110 mg / dl.

• Home autoanalysis before meals of 100 mg / dl and two hours after meals of
135 mg / dl.
Objectives of the treatment
• Eliminate symptoms and achieve normal glucose levels.
• Prevent and treat acute complications early.
• Avoid hypoglycaemia (glucose drops below 60 mg / dl).

• Control cardiovascular risk factors and delay the onset of cardiovascular

complications.
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• Guarantee adequate nutrition.

• Promote self-care.
• Improve the quality of life of the diabetic patient.

GENERAL TREATMENT:
It is based on 5 pillars:
1. Dietary diet.
2. Physical exercise.
3. Analytical self-control at home.
4. Pharmacological treatment: tablets or insulin.
5. Education in diabetes (workshops, clubs, etc).
1. Diet:

The diet is a balanced diet, healthy, and that does not require an additional
economic cost.
The objectives are:

• Limit the amount of simple sugars, that is, those that are quickly absorbed by
the intestine, which causes rapid increases in blood glucose. The diabetic should
avoid them or limit them in their daily consumption. These sugars are: all kinds of
sugar, honey, jams, soft drinks, gelatins, candies, chocolate, preserved fruit,
beer, sweet wine, cakes, cakes, sweets. Fresh fruit, natural juices without sugar,
compotes without sugar, contain natural sugars so to avoid rapid rises in blood
glucose should not be taken in large quantities in a single meal.
Foods rich in fibers are highly recommended, as the fiber is not digested, adds
volume and slows the passage of food through the stomach and intestine,
decreasing the absorption of carbohydrates (sugars). Foods rich in fiber are:
whole wheat bread, natural fruit with skin, fresh vegetables, cooked vegetables,
dried beans ... 40 g of fiber per day are recommended.

• Proteins: 1 gram per kilo of weight per day is recommended. They are necessary
for the growth of the body and the repair of tissues. The foods rich in them are:
meats, fish, eggs, cheese, milk.

• Fats: We must moderate the consumption of fats, but more important is to

prevent the elevation of cholesterol in the blood. For this you have to reduce the
 THE DIABETES

consumption of animal or saturated fat. The ideal would be to take 80% vegetable
fats and 20% animals.

• Reduce weight in obese diabetics, by limiting the amount of calories and keep
it in those diabetics of normal weight. Most diabetics use diets between 1,250
and 1,750 kilocalories, depending on their degree of physical activity.
• Schedule and distribution of meals: The distribution of the diet in at least 4-5
meals a day helps maintain the balance of blood glucose levels. This will be done
breakfast, mid-morning, lunch, snack, dinner and a small supplement before
bedtime.

• It is important to make meals at the same time because it contributes to better

diabetic control.

• Special foods for diabetics: DO NOT SET UP. Most do not offer advantages,
because they have the same calories. Some products with artificial sweeteners
or sweeteners such as saccharins, sucralose, aspartame may be useful, as long
as they are low in calories.

• Alcoholic beverages: AVOID those that have alcohol and high sugar content
such as beer, sweet wines, sweet ciders, liqueurs.

2.- Physical exercise

It is one of the best allies for long-term glucose control and to prevent
complications. Cardiovascular exercise should be performed such as walking,
aerobics, cycling, swimming, among others, for a time not less than 30 minutes
per day and preferably daily. This produces higher glucose consumption with less
need for drugs or insulin. It also helps to lose weight. It should be done with the
knowledge of your doctor to adjust your medication and avoid episodes of
hypoglycemia.
3.- Home self-control

There is a wide variety of equipment in the market, at reasonable prices, with

increasingly friendly technologies, which allow accurate monitoring of glucose
values throughout the day to optimize treatment. They are also useful for cases
of suspected acute decompensation.

4.-Smoking
The tobacco habit constitutes an unfavorable condition for all individuals,but to a
greater extent for the patient with risk factors and / or diabetes, so that treatment
for the cessation of smoking should be instituted for every patientdiabetic who
smokes
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5.- Pharmacological treatment

There are different levels of action of the products for the control of diabetes, from those
that stimulate the secretion of insulin by the pancreas, those that improve the quality of
the insulin receptor, the replacement of insulin in extreme cases, with daily injections of
insulin. the same, to more modern therapies, in which 2 products are combined: one that
slightly stimulates the pancreatic secretion of insulin and another that facilitates the
action of the receptor. It is up to the doctor to choose the drug that best suits their needs.

6.- Education in workshops.

It is an invaluable support: the best patient is the educated patient, who knows about his
illness and the care he must have to obtain a good quality of life and avoid the
complications of this disease, which in many cases can be disabling or even fatal.
Nutrition information is provided, about health care, scope of the disease, experiences
are shared and allows to better cope with the disease.

RISK FACTOR'S
It is very important to bear in mind all the risk factors that at a given moment are triggers of type
2 diabetes. The more risk factors present in the same person, the more you will be at risk of
developing diabetes.

GENETIC FACTORS

Certain ethnic groups seem particularly exposed to developing diabetes, such as

American Indians, Pacific Island communities, South Asian populations,
Australian aborigines, African Americans, and Hispanics. It is estimated that
people who have a sibling or family member with type 2 diabetes are at a 40%
risk of developing diabetes throughout their lives. These genetic risk factors
cannot be modified so far.Studies on twins provide additional evidence of the
involvement of genetic factors in diabetes Initial reports showed that there was a
60-100% agreement between identical twins (from a single placenta). In
concordances of less than one hundred%, it is considered that there is an
influence of non-genetic factors in the development of diabetes.

The classification of diabetic human beings

It is characterized by insulin resistance and by "dysfunctional" beta cells. The total

amounts of secreted insulin may be increased, decreased or normal compared
to the normal fasting animal. Regardless of this, that amount of insulin is
insufficient to overcome the resistance to it in peripheral tissues. Insulin secretion
prevents ketoacidosis in most patients with type 2 diabetes. These patients may
have IDDM or NIDDm, depending on the severity of insulin resistance and the
functional status of beta cells. Both types of diabetes mellitus are recognized in
both dogs and cats.
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Therapeutic options
Among the therapeutic options for the management of people with diabetes
mellitus
is it so:
 Insulin secretagogues (sulfonylureas and meglitinides)
 Insulin sensitizers (biguanides and glitazones)
 Inhibitors of alphas glucosidase
 Combination of oral therapy (biguanides + sulfunileuras / biguanides
glitazones)
 Insulin therapy
 Combination therapy (oral medications in the day + insulin night dose)
Rehabilitation
The proper measures of physical medicine and rehabilitation start from the first
levelwhere it is important to prevent not only the appearance and prevalence of the
disease,but educating the patient about the need to maintain normal figures of
glycemia through a proper diet, the medications indicated by theoptional, the practice of
physical exercises and healthy lifestyles, such asimportant measure in the prevention of
the sequelae or complications of diabetesand avoid the appearance of disabilities that
affect the performance of the person in your activities of daily life.
Criteria of reference to other specialties:
 For cardiology:
Suspicion or presence of ischemic heart disease. Ex. Post. Pancreatec-tomía.
High blood pressure difficult to manage.
 For peripheral vascular:
Decrease in the intensity of the pulses.
 For neurology:
Transient cerebral ischemia.Mononeuropathy
 For nephrology: Presence of diabetic nephropathy.
 For dentistry:
Gingivitis or periodontitis.History of bleeding after tooth brushing.
Other.
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PHARMACOTHERAPY
In those patients who, after a period of three months of dietary treatment, of
physical exercise and education about their disease, do not observe a reasonable
improvement in their blood glucose, according to the individual objectives
established, pharmacological treatment should be incorporated into their
treatment plan. As already indicated, drugs should be used as a means to
increase the effects of diet and physical exercise, and not as a means to replace
them. The selection of the treatment will be based on the knowledge of the
underlying metabolic alteration and the functional state of the insulin secretion.
The treatment with oral antidiabetic drugs (in monotherapy or association) is only
effective while the pancreatic beta cells maintain a certain secretory capacity of
insulin; As a consequence of this decrease in the ability to secrete insulin, which
is part of the natural progression of the disease, it can happen that the
pharmacological treatment with which excellent glycemic control has been
achieved can, over time, be inadequate.

DEMOGRAPHIC CHARACTERISTIC

Age. Before the age of 30, there are few patients with type 2 diabetes, but as
age increases, patients with type 2 diabetes also increase. The average age at
diagnosis of type 2 diabetes is lower in groups racial (Hispanics, among others),
who have a high genetic load for the development of diabetes.
Sex. Despite the inconsistencies in the studies, national data indicate that the
frequency of patients diagnosed with type 2 diabetes after 20 years of age is
similar between non-Hispanic white women and men (4.5% and 5.2%
respectively), but it is much higher in Mexican American women (10.9%) than in
Mexican American men (7.7%).
Race. People of Hispanic origin have 2 to 3 times higher risk of developing type
2 diabetes than people of Caucasian origin.

COMPLICATIONS

Diabetes can produce 2 types of complications: acute complications and late

manifestations of the disease.

• Within the acute can produce a sudden increase in blood glucose (hyperglycemia) that
can reach even to coma and dehydration. It is usually due to poor control of the disease
or a decompensating factor such as an infection. Or also a sudden drop in glucose
(hypoglycemia) that also leads to characteristic symptoms such as generalized
weakness, profuse sweating, even to the loss of consciousness (coma).
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• Within the delayed manifestations, they can be (1) Microvascular, when the small blood
vessels of the organism are damaged: as neuropathy (leg pain), nephropathy (which can
end in dialysis), retinopathy (leading to blindness) and ( 2) Macrovascular, when the
great arteries are damaged: coronary disease (myocardial infarctions occur), peripheral
arteriopathy (lower limb amputation), cerebrovascular accidents that produce
hemiplegia.

GROUPS OF PEOPLE AT GREATER RISK TO THE DM

There are populations or groups of people who have a higher risk of developing
Diabetes:
• Children of diabetic parents.
• People who are overweight. The greater the weight, the greater the risk of
Diabetes, especially if this overweight is due to an increase in abdominal
diameter.
• Very sedentary people.
• The risk of Diabetes increases with age.
• The dark race greater risk than the white race.
• There are populations with very high genetic risk, such as the Pima Indians of
northern Mexico (65%) compared to the Mapuche Indians of Chile (2%).
• Migration from rural and poor areas to urban areas.
• Low birth weight conditions an adaptive change, called a saving phenotype,
which also causes an increased risk of diabetes.
• Hypertensive patients have an increase of two and a half times higher risk of
diabetes than non-hypertensive patients.

EPIDEMIOLOGICAL AND GENETIC ASPECTS OF THE DIABETES

MELLITUS IN THE PERUVIAN POPULATION.
Diabetes mellitus is a chronic disease characterized by an insufficient production
of insulin by the beta cells of the pancreas, which produces an elevation of blood
glucose (hyperglycemia) and other alterations related to the metabolism of fats
and proteins. There are two major divisions in its classification: diabetes mellitus
type I or insulin-dependent, which occurs in children and mainly juvenile
population, characterized by a total deficit of endogenous insulin production and
therefore requires insulin as an essential treatment for survival , and type II or
non-insulin-dependent diabetes mellitus, which occurs in the adult and elderly
population, with a partial deficit of endogenous insulin production and resistance
phenomena to its action and which is treated with oral agents.
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Of these two classes described, type II diabetes represents the most frequent
hyperglycemic picture represented by 90% of diabetics while type I diabetes
occurs in about ten% of diabetics.
From the epidemiological point of view, type II diabetes has a prevalence in the
world population that ranges from between five to five% except for the native
populations of North America and the Pacific, highlighting the group of over sixty-
five years old that reach
have a prevalence of up to 20%, that is, one in five elderly people is a carrier of
diabetes.
Our figures are closer to those found in Asian populations or in populations with
a high degree of racial miscegenation, but with a large Amerindian component,
as is the case of Mexico, for example.
Given the advance of genetic engineering and that, unlike type II diabetes, type I
diabetes has well-identified genetic markers related to the short arm of
chromosome 6, current research has confirmed with certainty that this disease is
transmitted with the same genetic markers in any population or ethnic group, but
there are populations in which the lower prevalence of these genes associated
with protective genes, condition their lower incidence.
This last explanation seems to apply to our population, which unlike those in
which high incidences have been found such as the Caucasian populations of
Europe and North America, is constituted by a great racial mixture throughout its
history.In Peru, whose first settlers came from Asian immigrants during the
Pleistocene period and who came to America from Europe through the Behring
Strait, it was one of the scenarios of the greatest process of racial mixing in history
since the arrival in the fifteenth century of a "pool" of European genes from Spain,
which populated the Americas from Cape Horn to the Rio Grande, in the current
territories that cover the southern part of the USA and Mexico in the north and
throughout South America by the south.
To this process were added the black ethnic groups that were brought as slaves
from Africa, during the period of discovery and conquest of America, 15th century
to 18th century, as well as recent Asian immigrations after World War II,
especially Japanese and Chinese.
Peru and Mexico, which in the twelfth century represented the most advanced
cultures of America, the Incas and the Aztecs respectively, were territorially
constituted in the central axis of this process of racial miscegenation between
Europe and Africa with America, giving rise to a mestizo population whose
genetic study shows a native component of thirty-fifty%, Spanish of forty-sixty%
and black of eight-ten%, according to the different degrees of interracial mixing
occurred.
It is predictable then, that in this miscegenation predisposing genes of type I
 THE DIABETES

diabetes have been dispersed in the normal population and that the genetic
constitution of the Peruvian population is also a carrier of protective genes against
this disease, to explain its low incidence. The genetic studies carried out during
one hundred and ninety-ninety-three years, in collaboration with the Complutense
University of Madrid, in which investigating Peruvian diabetic and non-diabetic
children, we have shown that the gene of DQB1 * 0201 transmits the disease and
the gene DQB1 * 0301 protects against the disease and is found in high
percentages in the normal population. Since the genetic factor only explains
fifty% of the cause of this disease since in monozygotic twins in which one of
them has type I diabetes, only half of their partners are affected and therefore it
is not a hereditary disease, it is It is important to consider that the other factor to
take into account is the environmental and life conditions of the affected
populations, which explain the other fifty% of the etiology.

SITUATION IN PERU

Diabetes mellitus has become one of the most frequent chronic diseases in
children and adolescents, so much so that every day more than two hundred
children develop this disease throughout the world. Although in Peru the
incidence of type one diabetes is low in relation to other countries, approximately
one per one hundred thousand children, however, for the past ten years there
has been an increase in the number of cases, diabetes due to obesity. This was
announced by the President of the Diabetes Association of Peru (ADIPER), who
showed his concern about the increase of type diabetes in our country, especially
in children between twelve and eighty years of age, since this disease is
presented only in people older than forty and five years as a result of sedentary
lifestyle, obesity and stress, and therefore it was also known as adult's diabetes.
Due to the lack of lifestyle choices and poor nutrition, the current generation of
children and adolescents is growing at the risk of developing Type Diabetes,
which is increasing more and more. So much so that in some countries the
prevalence of this type of diabetes is greater than type 1 diabetes which is given
by the genetic and autoimmune factor
Children and adolescents with type 2 diabetes are at greater risk of developing
complications at an early age, since despite receiving adequate treatment, more
than half of them have complications such as: retinopathy, cardiovascular
diseases, diabetic foot, kidney failure and problems neurological twelve years
after the disease was diagnosed.
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TERMINOLOGICAL GLOSSARY
Dibetic ketoacidosis:
Diabetic complication that appears when the blood sugar rises excessively and stays
that way for hours or days. It arises as a result of the production of harmful substances
derived from proteins and fats called ketone bodies. The diabetic individual returns to the
typical symptoms (polyuria and polydipsia), becomes dehydrated and his blood acidifies;
Finally, he goes into a coma if he is not treated on time.
Glucagon
substance that works contrary to insulin, that is, rapidly increases blood glucose. It is
used in case of severe hypoglycemia (convulsion or loss of consciousness)
intramuscularly, subcutaneously or intravenously; Every diabetic should have it.
Glycemia
levels of sugar (glucose) in blood.
Hyperglycaemia
elevated blood glucose levels (greater than 200 mg / dL). No symptoms unless it is frank
and maintained.
Hypoglycemia
low blood glucose levels (less than 60 mg / dL). The symptoms are varied: sensation of
hunger, pallor, sweating, tremor, sleep and, in very serious cases, convulsion or coma.

Hemoglobina glicosilada (HbA1C)

La hemoglobina es una molécula proteica contenida en los glóbulos rojos de la
sangre cuya función es trasportar el oxígeno de la sangre a todo el organismo.
En personas no diabéticas una pequeña fracción de esta proteína, entre el cinco
y el seis%, está unida a glucosa; en los diabéticos un buen control exige estar
por debajo del ocho %.
Lipodystrophy
Accumulation (or, rarely, loss) of the fat under the skin where insulin is usually
punctured. It is a common and reversible complication that can be avoided by
taking care not to always puncture in the same place.
Diabetic foot
late complication due to poor control of diabetes for years. It implies lack of
sensitivity and poor vascularization (less blood arrives) which predisposes to the
appearance of ulcers and infections.
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CONCLUSIONS
• DM is a chronic disease that represents a public health problem of enormous
proportions. In our country, the studies carried out indicate a prevalence of known
DM of between 2.8-3.9%.
• A new classification for DM has recently been proposed, together with new
criteria for its detection and diagnosis.
• Health education activities are an essential aspect of the therapeutic approach
for people with DM. Increasingly, the management of DM will be in the hands of
the patient himself, with health professionals acting as advisers and collaborators
of the latter.

• The existence of an association between the appearance of complications and

high blood glucose levels has been evident for some time. Increasing evidence
accumulates that highlights the benefits derived from an intensive control of blood
glucose in patients with DM.
• Within the treatment of DM, the following general objectives have been
proposed: eliminate symptoms and promote a sense of well-being; prevent acute
complications; prevent, delay or minimize neuropathic and microvascular
complications and, reduce the morbidity and mortality of macrovascular
complications.
• Treatment objectives should be individualized according to the characteristics
of the patient. Although achieving a close control of blood glucose is an ideal goal
for any patient, getting it is not always possible.
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BIBLIOGRAPHIC REFERENCES

(1) PFIZER (1982). Epidemiology of diabetes mellitus in the world. Manual of

Diabetes Mellitus. 1st Edition. Costa Rica.
(2) SECLÉN, S. and others (1999). Prevalence of diabetes mellitus, hypertension,
hypercholesterolemia and obesity as coronary and cerebrovascular risk factors
in the adult population of the Peruvian highlands and jungle. Acta Med Perú 1999.
(3) RUIZ LÓPEZ, Carmen Adriana. Diabetes Mellitus: Introduction and
Pharmacological Treatment. Part II Diabetes Mellitus II. Pharmaceutical Sciences
Dept. of Chemistry-Biology - Univ. De Las Americas - Puebla - Mexico. 2005.
 THE DIABETES

ANEXOS
Diabetic retinopathy
Diabetic retinopathy is an ocular complication of diabetes, caused by the
deterioration of the blood vessels that irrigate the retina of the fundus eye. These
weakened blood vessels can leak fluid or blood, form brittle, brush-like branches
and enlarge in certain places.
When blood or fluid that comes out of the vessels injures or forms tissues fibrous
in the retina, the image sent to the brain becomes blurred. Patients who have had
diabetes for a long time are at great risk of developing diabetic retinopathy. About
60% of patients with
15 years or more of evolution have damaged blood vessels in the eyes Only a
small percentage have serious vision problems and an even lower percentage
develops blindness. Despite this, retinopathy Diabetic is a frequent cause of
blindness among adults. It is estimated that diabetic patients are 25 times more
likely to be blindnon-diabetics.

Nefropatía diabética
La nefropatía diabética es una complicación de la diabetes mellitus producto de
la hiperglicemia sostenida a través del tiempo (10 a 15 años). En ellas se
producen daños al sistema glomerular, ocasionando un ensanchamiento y
engrosamiento del mismo. Al inicio, los riñones se aumentan de tamaño, lo que
se ve reflejado en un incremento de la tasa de filtración glomerular.
Posteriormente, hay presencia de microalbuminuria. Se define como
microalbuminuria la eliminación de 30 a 300 mg de albúmina en orina de 24
horas. Una vez iniciada la fase de macroalbuminuria, se da un descenso
constante de la función renal y de la tasa de filtración glomerular, reflejándose
en el aumento de los niveles séricos de creatinina. El control metabólico estricto
de la diabetes ayuda a corregir la microalbuminuria y la progresión de la
nefropatía.
Diabetic foot
It is the ulcerative disorder of the feet and lower extremities that presents in
people with diabetes mellitus, which are produced by an abnormal distribution of
pressure due to the damage caused in the peripheral nerves and arteries of the
foot due to sustained hyperglycemia. This leads to a decrease in sensitivity and
blood flow, which results in lack of oxygenation and the consequent tissue
damage which evolves towards an ulcerative and / or necrotizing process that
can conclude with the amputation of the affected area. Guide for comprehensive
care for people with diabetes mellitus These injuries often appear without pain,
which aggravates the damage before the patient goes to a health facility.