Eladio Losada: "The problem of diabetes is that it does not hurt" (interview)

Diabetes, a pathology of which this week has commemorated world day, is one of the main diseases that the Endocrinology of the Can Misses hospital is, explains Eladio Losada, one of the two specialists who attends this service.

He was born and studied medicine in Barcelona and completed the residence at the Vall d'Hebron hospital.When it ended, the opportunity to work in Ibiza arose.His idea was a "temporary" stay before returning to his hometown.He has been here eleven years.

Will we end up all diabetics?
No, but there is a tendency to increase and the prevalence of diabetes because we live more years and, in addition, for sedentary lifestyle and poor diet.It will reach the epidemic level, but we will not be all diabetic.Catastrophists, fair.

What do we do wrong?
Basically, life habits.There is an increase in obesity, which is the main risk factor.How is it solved?With good nutrition and a less sedentary life.It is a mantra.

There are two types of diabetes, what are different?
Type 1 diabetes is a defect in insulin production due to a pancreas dysfunction.Insulin use is indispensable because the body does not have it.In type 2 the resistance to the effect of insulin increases, the pancreas must generate more, but over time it is exhausted and is not able to segregate enough to overcome that resistance.It is treated with oral drugs and also with insulin.

Isn't there possible cure?A pancreas transplant?
Diabetes is currently a chronic disease.It has treatment, but not heals.There are several studies with pancreatic cell transplant, but they are very experimental and, in addition, they have not given excellent results.That line of research is a little stopped.It is an incurable chronic disease.Type 2, if in the initial phases you manage to reduce risk factors you can be without treatment.What are you going to have a predisposition to develop it as time goes by?Yes, but if you lead a healthier life, you lose weight and exercise it is possible that you can control it.

A friend was diagnosed with diabetes.She took it as if nothing and her mother began to cry.Who was right?
Let's see ... depends on the type of diabetes.Type 1 is not the same, with which you need insulin for life, than gestational diabetes that disappears after pregnancy or a type 2 with risk factors you can control.Possibly, neither one nor the other were right.The daughter should have jumped a little alarms and the mother should not have taken it so tremendous.

How do people take it?
There is everything.Generally, those of type 1, when you tell them that they will have to take insulin for life, the changes and the controls they must carry remain more in shock.In very young people the family is usually worse than the affected person.With type 2, in general, there is no perception that it is a serious illness.You have to take care of yourself, take pills, but they don't have the feeling that it is serious.They take it worse when they change the insulin pills, there they see that it is more serious.

Type 1 is usually diagnosed in children and adolescents, right?
Yes, it is more frequent in children and adolescents, but those patients are seen by pediatricians.They arrive from the age of 14.

What does your life change?
In type 1, in which insulin is mandatory, you have to do controls before any activity to know how you are and adjust the medication.You have to know how to adjust it before exercising, for example, and implies dietary changes.Know what foods you can take freely and which with restrictions.Type 2 requires a change of lifestyle: exercise more, feed better, do your controls and start having a littleImportance awareness of the disease.

We are very sorry for children, but do adults have worse?
That is known by pediatricians, I see them from the age of 15, in adolescence.At first the parents have worse, who are more aware of the situation.

Adolescence is complicated.
Yes, for everything.There are some who accept it very well and who even serves to lead a healthier lifestyle.They are more monitored with food, take care of the weight ... but the opposite effect is also given.People who make a denial and put insulin because they have to put it on, but who controls little and does not tell family and friends who are diabetic.Each case is a world.It depends on the age, the vital moment and the capacity and resources that the person has to manage with the disease.

Adolescence, bottle ... A diabetic person can't drink alcohol, right?
It can moderately.

Is it one of the diabetes myths?
Yes, I suppose.Alcohol is not prohibited for a diabetic.If you drink a glass of wine or beer, nothing happens.It can cause hypoglycemia, but it is not prohibited.

And the sweets?
They are not prohibited either.You can take cake, but you must adjust your insulin dose.There are no total prohibitions, there are important recommendations.All foods with a high glycemic index, such as sweets or carbohydrates, must be taken in small quantity and occasionally.With sweets, in a timely manner, there is no problem if you adjust the dose.And hydrates are necessary on a day -to -day basis but you have to take them in adequate amounts.Nothing will happen to you through a piece of cake or a glass of wine.But for that you must have the ability to handle the disease and know how to adjust the doses.The more knowledge you have, the more independent you will be.Patients should take care of their illness, in daily life it is they who handle it.There are people who think: «As I don't handle myself very well, I take this at all.As I am afraid that I will give me a low sugar when exercising I am not going on an excursion with friends ».In diabetes, the more knowledge you have, the more freedom.

Should we make mathematics?
With the old story you solve everything.They are only sums and subtraction, we must not do Neperian logarithms.

Do patients self -control well or are they a bit disaster?
In recent years we have the feeling that it is driving better.We have improved in the last ten years, but it is a very individual disease.It depends a lot on how responsible you are.

So do each one have the diabetes to seek?
No, there are very aggressive and complicated diabetes.It does not have an equal pattern for everyone.

What do you mean aggressive?
To what is more difficult to control.You see patients who are doing things well and one has progressed a lot and another, doing the same and with the same control, has not progressed so much.Patients who in ten years develop an affectation of retinal and renal and others who do the same do not have it.Some diabetes are very labile.They go up and down and make many excursions between hypoglycemia and hyperglycemia.

What is the worst that can happen to a diabetic?
Acute complications can take you to the hospital at one time.A type 1 diabetic can suffer a diabetic ketoacidosis.It is related to exaggerated hyperglycemia and triggers a metabolic acidosis that is hospital admission.

Can you take you to a coma?
It can be deadly, although it has not been seen for a long time because we always arrive on time.Another risk would be severe hypoglycemia, which takes you to hypoglycemic coma.In type 2 the risks would be, above all, the hypoglycemia that can be severe or not.There is also hyperosmolar coma, related to excessive hyperglycemia.

I have always heard that it is worseA decrease in sugar than a climb.
It is true, it is a more acute complication.Hyperglycemia are usually more chronic processes and hypoglycemia occurs at the time and the patient perceives it worse.Hyperglycemia, by itself, does not produce any symptoms, but will cause you complications.Patients fear what can happen to them, but think at ten or fifteen years seen ...

Among those complications is blindness?
The retinal, yes, and the kidney involvement.Also diabetic neuropathy, peripheral arteriopathy and the risk of ischemic heart disease or a cerebrovascular disease.In developed countries Diabetes is the most frequent cause of blindness and chronic renal failure that requires dialysis.

Do you have back?
In early stages they could turn back.After that moment we can only aspire not to go to anymore.

Are these effects that the patient is aware that diabetes is not nonsense?
Until they take the step to insulin, they see some affectation in an acquaintance, they are told that the kidney begins to be touched, they feel alterations in the sensitivity of the feet, they have erectile dysfunction or begin to see worse are not aware.Until that moment they feel fear many times there is no reaction.The problem is that sometimes we react too late.The diabetes problem is that it is a disease that does not hurt and it is complicated to consider preventing the long loop.I understand.Tell someone, at 2rd, to control because maybe within another 20 years will have an eye involvement ... At age 20 you think they are very far.

Are they still amputating feet?
Yes. We have a diabetic foot unit that is working very well and has decreased the number of amputations, which is the goal.While there are diabetics there will be amputations.

What is the goal?
Keep a metabolic control, not only glycemic, to reduce the risk of complications.Control cholesterol, blood pressure, smoking, obesity ... treat everything in an integral way to reduce possible complications.Everything is likely.

There are major diabetics who do not understand that the family doctor controls them and not the endocrine
It is such a prevalent disease that it would be impossible for specialists to handle all patients.In primary care they are absolutely trained to take controls and make diagnoses.They are really doing well.When there is no possibility of controlling the disease with primary care tools, it is when we are referred to the patient.

That is, you better not see them.
If you stay in primary, it is that the progression of the disease is good.In addition, there are patients who can move less, very old, to which they are more comfortable to go to the health center, which is next.

With all the advances there is, how do you not invented something to avoid punctures?
We have blood glucose sensors to avoid punctures that will be financed for type 1 patients with poor control, who need many punctures.Also for pregnant women and children.Before the end of the year we will distribute them.Right now, the future are long -term insulins that require less punctures, which are inevitable right now.

If someone does not fit insulin well, does it have effects to pass?
Happens.There are patients who become few controls and, when they are highlighted, more insulin are placed.The trend is getting more and more insulin.That can cause a drop with bouncing peaks, and enter a spiral.

If a woman with diabetes wants to get pregnant ...
The ideal is to plan pregnancy.That when you make the decision you have good control.Being pregnant with a bad metabolic control may involve fetal affectation.

What consequences can you have?
Malformations inThe fetus and spontaneous abortions, basically.For the mother, carrying bad control can worsen the typical complications of diabetes, especially in the retina.

And the same with gestational diabetes?
No, gestational diabetes is totally different.We try to detect patients who, during pregnancy, present higher than normal sugar after meals.There, the risk is that there is a greater growth of the fetus, with the complications that implies in childbirth.

Some pregnant women do not want to undergo the 50 grams of sugar.
They do not tolerate her.They try it twice and can't.Vomit.You are not going to force them.In those cases we try to control throughout a week with the refractometer.It is not the ideal solution, but it allows us to place ourselves.

Beyond diabetes, what does an endocrine?
Too many things.We basically dedicate ourselves to diabetes, obesity, nutrition and three glands: thyroid, adrenal and pituitary.

Thyroid cancer is spoken of little.Does it have little incidence?
There is more and more because we detect it more early.We make high resolution consultations.We make an ultrasound, if necessary it is punctured and in two weeks we have the results.It has been seen that early detection does not decrease mortality.Within cancers, it is one of the least aggressive.The vast majority are going well and has very little mortality.

And in nutrition?
It is not weight loss but nutrition of patients who need to be fed by probe or malnutrition in cancer patients or who have gone through broad colon resection surgeries.Managing weight is something that is done in primary care, and they don't do it worse than us.

That is, when celebrities say they go to the endocrine ...
It is because it is better to say that they go to the family doctor.

Are they enough?
No. We are two and we are at the limit of service capacity.Almost two years ago we asked for a third endocrine and management has told us that it is a priority for this year.

What could they do?
We could consider more specialized consultations.With two people, when you have vacations or have to go to Formentera or are low ... in Menorca, with 80,000 people, they also have two endocrine, the same as here, where we surround the 150,000 patients.We are few but we carry it with dignity.