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Diabete tipo 2-SALUTE

Diabete mellito di tipo 2











Il diabete mellito di tipo 2, un tempo noto come diabete non insulino-dipendente dell’adulto, rappresenta un gruppo eterogeneo di disordini caratterizzati da gravi variabili d’insulino-resistenza, con aumentata produzione epatica e riduzione dell’uptake periferico di glucosio, oltre che da alterata secrezione insulinica. Questa forma di DM può non essere riconosciuta per anni, in quanto l’iperglicemia è frequentemente asintomatica. La diagnosi viene effettuata in corso di malattie intercorrenti e spesso le complicanze croniche del diabete sono già presenti. La maggioranza dei pazienti con DM di tipo 2 sono obesi: l’obesità stessa causa o peggiora l’insulino-resistenza. la chetoacidosi si verifica raramente. Probabilmente il DM di tipo 2 riconosce molteplici cause. Sebbene la specifica eziologia non sia nota, non vi sono segni di distruzione autoimmune delle cellule beta, né di altre cause note come DM e non è associato a particolari antigeni HL. Tuttavia il DM di tipo 2 è caratterizzato da una forte predisposizione genetica. Nei soggetti con suscettibilità genetica sviluppare il DM di tipo 2,  lo sviluppo della malattia può   essere favorito da fattori ambientali quali: 

  • obesità 
  • elevato apporto calorico
  • sedentarietà





L’obesità: per lo più viscerale, è presente in oltre l’ 80% dei pazienti con DM di tipo 2. Essa si accompagna a insulino-resistenza e a iperinsulinismo, compensatorio all’ iperglicemia. Nei soggetti geneticamente predisposti a sviluppare il DM di tipo 2 
l’insulino-resistenza rende clinicamente evidente il deficit della secrezione insulinica. L’iperinsulinismo di per sé comporta una riduzione del numero dei recettori per l’insulina, ma spesso coesistono difetti post-recettoriali che sono la causa principale dell’ insulino-resistenza. 




Sedentarietà: l’esercizio fisico migliora il controllo glicemico  ed è parte integrante del piano di trattamento del diabete.




Familiarità: rende il soggetto maggiormente predisposto a diventare diabetico.


Alimentazione: si può non essere obesi ma avere un’alimentazione ricca di grassi e zuccheri semplici che può favorire la comparsa del diabete.




SOGGETTI  MAGGIORMENTE A RISCHIO



E’ necessario approfondire quando si presenta qualcuna di queste condizioni: 

  • Familiarità per diabete di tipo 2 
  • Sovrappeso e obesità (BMI > 25) 
  • Ipertensione arteriosa 
  • Cardiopatia ischemica 
  • Familiarità per cardiopatia ischemica Storia del diabete gestazionale 
  • Sindrome dell’ovaio policistico



In questi casi è necessario:

  • Misurare lo zucchero del sangue (glicemia) a digiuno per scoprire se sono necessari esami più approfonditi
  • Eseguire un prelievo per i livelli di colesterolo
  • Misurare la circonferenza vita e peso corporeo
  • Misurare la pressione arteriosa




MISURAZIONE GLICEMIA




Dopo almeno 12 ore di digiuno



MINORE DI 100 MG/DL              Normale


TRA 100 E 126 MG/DL                 Alterata glicemia a digiuno


SUPERIORE A 126 MG/DL         Possibile diabete


 

 

 L’ insulino-resistenza non è un tratto fisiopatologico esclusivo

del diabete mellito di tipo 2. Si riscontra anche nell’ ipertensione

arteriosa, nell’obesità e nella disipidemia. Condizioni che sono 

talvolta presenti contemporaneamente nella stessa persona e

contribuiscono a danneggiare i vasi sanguigni e quindi a

facilitare la comparsa di malattie come l’infarto e l’ictus.

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