nearly 30% of French people are sick without knowing it

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Last year, Doctor Aglaé Terray joined the center diabetology of CH Eure-Seine, one of the only ones in the Eure department. The endocrinologist based at Vernon hospital (Eure), discusses the effects of this disease which are not always taken seriously by patients despite their gravity.

Can you explain the role of an endocrinologist and how they are involved in the treatment of diabetes?

An endocrinologist is a specialist doctor in glands and hormones. Diabetes is a disease of the pancreas which will present a defect in the secretion of insulin, a hormone allowing glucose to enter the cells to be used as source of energy.

When are you considered diabetic and what are the symptoms?

There are two types of diabetes. Type 1 begins quite suddenly with recognizable symptoms: a need to drink and urinate very often, a weight loss, severe fatigue.

For type 2 diabetes, it’s more sneaky. We can suffer from the same symptoms but in most cases it is asymptomatic and the diagnosis is therefore generally made during a routine check-up. We speak of diabetes when blood sugar (blood sugar content, Editor’s note) is greater than 1.26 g per liter of blood. A normal blood sugar level is between 0.70 grams and 1 gram and we speak of prediabetes between 1 gram and 1.26 g.

What are the risks of developing this disease?

First there is the genetic factor. When we have a first-degree relative (parent) or second-degree relative (grandparent) who is affected, we are more likely to become diabetic. But this is not inevitable. Lifestyle has a huge influence. We see that sedentary lifestyle and obesity are increasing within the population and these are also risk factors. The intake of fat and sugar will increase insulin resistance, in other words, the fact that the body’s cells respond much less well to insulin.

Is diabetes a reversible disease?

Type 1 diabetes is irreversible because it is a autoimmune disease. The body will create antibodies directed against our pancreas which will require the use of insulin by injection.

Cases of remission

For type 2 diabetes, we have seen cases of remission when patients drastically change their lifestyle with a weight loss associated. The patient can be treated with a new lifestyle. We sometimes put patients on treatments and then stop them when there is a clear improvement. However, the most common case is the treatment of diabetes for life. Whether it is type 1 or type 2, we are not talking about healing but in remission. The patient will need medication at some point but having a good lifestylethis may delay this deadline.

What consequences can this disease have in the long term?

There can be complications on small vessels, particularly in the eyes. In developing countries, diabetes is the leading cause of blindness. In France, we detect this complication before it occurs, so it is extremely rare to be blind because of it.

The dangers of diabetes

Diabetes has an impact on the kidneys and it is in fact the leading cause of dialysis today. It can also lead to neuropathy which causes insensitivity in the feet which can lead to sores. However, it is extremely rare to reach the point of amputation. Diabetes can also affect large vessels, such as the coronary arteries, and thus contribute to the appearance of cardiovascular disease, the leading cause of mortality in type 2 diabetic patients. As a result, there is a risk of stroke. We track cardiovascular risk factors to better treat patients.

You talk about the importance of a healthy lifestyle, but how can you put it into practice?

We work a lot with nutritionists. Furthermore, diabetologists are all almost nutritionists, this is part of the training range. We also get a lot of help from dietitians, our main allies, but also from sports coaches and physiotherapists who will help patients find physical activity according to their mobility.

Diet and physical activity are essential. We therefore advise avoiding ultra-processed productssodas but also orange juices because they are full of sucre.

Cooking at home is essential. For those with a sweet tooth, we do not recommend turning to alternatives. It is better to focus on rebalancing your diet by eating everything but paying attention to the proportions. The idea is to avoid frustration and snacking between meals which increase the glycemic index.

Obesity and diabetes are often associated. What about it?

Indeed, obesity is a risk factor. The more weight you lose, the less risk you have of contracting the disease. Moreover, losing 10% of your weight when you are overweight reduces the risk of becoming diabetic.

This will transform the lives of doctors (laughs)! In fact, we will be able to regulate the patient more easily. However, obese people are not systematically diabetic. There can be metabolically healthy obesity.

Wegovy: risk of stock shortage

We often hear about stock shortages regarding treatments for diabetes. Is this still the case?

Yes, there are always risks of shortages, particularly of Wegovy, a recent medication that helps reduce blood sugar and regulate hormones.

At first it was an anti-diabetic but we found that it allowed us to lose a lot of weight, which was a big step forward in the obesity treatment. However, there have been quite a few diversions given its effectiveness.

The ANSM (National Agency for the Safety of Medicines and Health Products) regularly sends us messages to restrict indications in order to avoid stock shortages. This helps reduce the risk of diversion for patient safety and allows time forpharmaceutical industry to make them.

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