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November is Diabetes Month

November is Diabetes Month, and we are going to give you a lot of information about this multisystemic disease. Its prevalence figures continue to grow, inevitably resulting in the appearance of macro and microvascular complications. These could have devastating consequences, with a major impact on the life of the diabetic patient.

Sunday is a day of rest and leisure for most Portuguese, but at HPA we never give up on health literacy. That's why we're back, in this November of Diabetes, to elucidate why this condition is so feared by the small but valuable kidneys. It is time for nephrologist Alexandre Baptista to tell us about Diabetic Nephropathy and to carefully read his advice: Act Before Bankruptcy.

The kidneys are primarily responsible for maintaining our body's internal balance. In fact, they are responsible for eliminating toxins, are an integral part of blood and bone regulation, help control blood pressure and regulate chemical balance, in addition to maintaining control of the amount of liquid in our body.

When the kidneys fail, toxins build up in the blood and "Uremia" develops. This condition of “failure” or “failure” is called Chronic Kidney Disease, which is characterized by the progressive and irreversible loss of kidney function. Diabetes, obesity and high blood pressure are the main causes for the development of Chronic Kidney Disease and the need for dialysis.

The early stage of Chronic Kidney Disease is usually symptom free, which causes a large part of the population to undervalue, ignore or postpone taking care of the health of their kidneys. This initial lack of symptoms results from the fact that the kidneys need to be badly damaged for symptoms resulting from the accumulation of toxins to emerge.

Thus, only in the advanced stage of the disease can we find symptoms such as frequent urination (especially at night), pain or burning when urinating, pink urine (with blood) or foam, swelling of the eyes, hands and feet or high blood pressure no longer controlled. We can also find in these patients with very damaged kidneys complaints such as difficulty in sleeping, easy tiredness, generalized weakness, nausea, vomiting or lack of appetite. Usually when these last complaints arise, it means almost complete failure of the kidneys. When the kidneys no longer work properly, dialysis may be necessary. Most of the time, treatment should be done for life if there is no possibility of receiving a kidney transplant.

Unfortunately, the only way to diagnose Chronic Kidney Disease is through blood and urine tests, so frequent monitoring of kidney health is recommended.

Treatment depends on the stage the kidneys are in. The main concern of the nephrologist (kidney disease doctor) is to control the main diseases that can damage the kidneys, so that the progression of the disease can be delayed. And this concern will be present throughout the follow-up. At a more advanced stage, a patient may even receive an injection to control the anemia that develops over time.

In the end, both the patient and the nephrologist have the same expectations. Delay the progression of Chronic Kidney Disease, given that it is irreversible when a moderate/advanced phase is reached.

True to our promises, we remain strong in the fight against Diabetes, today, on World Diabetes Day. Therefore, we have for you the text by our cardiologist Gonçalo Cardoso about the silent but terrible cardiovascular disease in Diabetes.

Every year, hundreds of thousands of people die from complications from Diabetes. Most of these deaths are caused by cardiovascular disease (e.g., Acute Myocardial Infarction, Stroke, Heart Failure, etc.).

About 60% of diabetic patients develop cardiovascular disease, which is often asymptomatic. Up to 60% of strokes in these patients are “silent” and are often only detected on a routine electrocardiogram.

In a cardiology consultation, the patient's risk of cardiovascular disease should be assessed. Based on this calculation, the patient is classified as low, moderate, high and very high risk. Intensification of therapy depends on the patient's risk. Patients at higher risk have more demanding therapeutic goals. Patients with Diabetes and one more cardiovascular risk factor are classified as very high risk, with other patients with Diabetes being classified as high risk.

Prevention by controlling risk factors is always the best strategy.

Today, we return to Diabetes, specifically the diabetic foot, through the voice of surgeon César Carvalho and with an extremely important text: Attacking the Fearful Diabetic Foot

General Surgery is one of the various specialties that contribute to a multidisciplinary approach in monitoring diabetic patients, whether it is the prevention or treatment of complications often associated with this pathology.

Diabetic foot infection, one of the most feared complications, is also one of the most challenging with regard to its resolution, often requiring rapid and adequate surgical intervention in order to remove infected or devitalised tissues, thereby increasing the success rates and reducing treatment time.

In this context, a multidisciplinary approach is extremely important, aiming not only at early referral, but especially at synchronous and structured planning to optimize the patient's recovery. In many cases, this avoids the amputation of fingers (and sometimes of larger areas), in order to control local infection and prevent potentially fatal generalized infections.

However, it is extremely important to emphasise that strict blood glucose control is the most important element, both in the treatment and prevention of these complications. Monitoring in a diabetology consultation is also a fundamental component in terms of planning scheduled surgeries in order to optimise healing and prevent surgical wound infections.

We start with Dr. Ricardo Louro, internist and responsible for the Diabetes Consultation at HPA – Alvor, with a topic of particular importance: Why should diabetes be treated in a multidisciplinary way?

Type 2 Diabetes Mellitus (DM) is a disease with an increasing prevalence (9.9% according to the OECD report), and there is a very important number of patients still undiagnosed.

The guidelines for the diagnosis and treatment of diabetic disease have been regularly updated with some important changes in recent years, but keeping prevention, delaying complications, and promoting quality of life as the main objectives of the treatment of type 2 DM.

DM has been seen for some time as a multidisciplinary disease due to its complex pathophysiology and multiple complications that require the intervention of several specialised areas. Aiming to treat patients and not diseases, we seek to promote individualised treatment, with aggregation of the various professionals needed to monitor their pathology and its complications.

The diabetic patient is regularly followed up at the Diabetes Consultation with the support of the Diabetes Day Hospital and its Nursing team. Associated with this regular control, there is also Nutrition and Physiotherapy as basic disciplines in the implementation of healthy lifestyles, which are the basis of the patient's metabolic control. This metabolic control aims to prevent complications associated with DM. However, when these occur, it is necessary, in due time, to promote specialised monitoring to avoid their aggravation and/or treatment.

14th November 2021

27, November 2021