Vaccine, mortality rate, mode of transmission, origin… here we take stock of the information available on the Wuhan coronavirus, now officially named Covid-19.
According to a latest assessment issued by the Chinese authorities on Thursday 13 February, the coronavirus – officially called Covid-19 by the WHO – has caused more than 1,300 deaths and contaminated nearly 60,000 people in China since the beginning of the epidemic in December. An epidemic that worries and is conducive to the spread of intoxication on the subject.
What is The Contagion Rate?
In a study published by the American journal NEJM, Chinese researchers estimated that each patient infected an average of 2.2 people (this is the “basic reproduction rate” of the disease, or R0). This is more than influenza (1.3), much less than measles (more than 12), and comparable to SARS (3).
However, “a small number of cases could be the spark for a larger fire,” warned WHO’s N.1, Tedros Adhanom Ghebreyesus on Monday.
The director was referring to the case of a British man who has been described as a “super propagator”. Contaminated in Singapore, he transmitted the virus to about ten people in total, in France and then in Great Britain.
The prospect of a multiplication of this type of case is worrying. Because for each infected patient, the health authorities of the country concerned must find the people with whom he or she has come into contact and make sure that they do not contaminate others in turn. If the number of infections outside China increases, this procedure known as “contact tracing” will become increasingly complicated to implement.
How Long Is The Incubation Period?
By analyzing data from cases in China, a team of Chinese researchers estimates the median incubation time at three days, according to their article posted online Monday. These preliminary estimates have led to setting the observation or quarantine period for suspected cases and returnees at 14 days.
However, according to data from Chinese experts published Monday, the incubation period could be as long as 24 days in rare cases.
What Are The Symptoms?
Most of the patients had fever and two-thirds had coughing, but cases of diarrhoea or vomiting remained rare. A quarter of them had at least one pre-existing disease (hypertension, lung disease…).
How is The Virus Transmitted?
The virus is transmitted mainly through the respiratory tract and through physical contact. Respiratory transmission occurs in the droplets of saliva expelled by the patient, for example when coughing. Scientists estimate that this requires a close contact distance of about one metre. Diarrhoea could also be a secondary route of transmission.
To protect themselves from contamination, health authorities insist on the importance of barrier measures: wash your hands frequently, cough or sneeze into the crook of your elbow or into a disposable handkerchief, wear a mask if you are ill…
What is the Mortality Rate?
More deadly than seasonal influenza but less virulent than previous epidemics linked to a coronavirus: this is where the danger of Covid-19 seems to lie, even if its mortality rate is not yet precisely known.
As of Thursday 13 February, 1,367 deaths have been recorded and nearly 60,000 people have been officially contaminated in mainland China. Outside mainland China, the virus has killed two people, one in the Philippines and one in Hong Kong, and more than 400 cases of infection have been confirmed in some 30 countries and territories.
In a study made public on Monday, researchers at Imperial College London estimate the mortality rate at 18% among the cases detected in Hubei province, the epicentre of the epidemic. On the other hand, at the global level, they estimate it at “around 1%”, with a range of uncertainty from 0.5% to 4%. They base this on the proportion of positive cases among passengers repatriated to Japan and Germany, including an estimate of symptom-free cases.
Estimates of mortality rates should be taken with caution as it is not known how many people are actually infected.
What is The Patient Profile?
The median age of these patients is 47 years (only 0.9% are less than 15 years old), 58% are male and just over 2% are health professionals.
Of the 173 patients who were considered serious cases when they were admitted to hospital, the median age was 7 years higher and more than a third already had another disease.
What is the Status of The Vaccine?
There is no vaccine or medication against Covid-19, and management consists of treating the symptoms. However, some patients are given antivirals, the effectiveness of which is currently being evaluated.
However, several pharmaceutical companies and institutes have started research into a vaccine – in the United States, China, France, Germany and Australia – but it could take several years to develop and distribute it.
At the end of January, an important first step was taken. Researchers at the Pasteur Institute in Paris succeeded in isolating and culturing strains of the new coronavirus, a first in Europe.
“A whole range of research has been made possible” by taking this step, said Arnaud Fontanet, Director of the Global Health Department at the Pasteur Institute.
Heat in General kills This kind of Virus.
The American president Donald Trump had affirmed that “by April, or during the month of April, the heat in general kills this kind of virus”, suggesting that this could mean the end of the epidemic of the new coronavirus, which is a variety of viruses.
The U.S. president’s assertion has been met with great reservation by scientists. For Didier Raoult, a specialist in infectious diseases and director of the IHU Méditerranée Infection, interviewed by 20 Minutes, Donald Trump’s remarks were based on “intelligent thinking”. And he explains: “Almost all respiratory viruses have a seasonality, so we can imagine that this is the case for the coronavirus. It is, in any case, reasonable to consider it for a respiratory disease.”
However, according to the specialist, “Seasonality is a complex phenomenon that nobody understands. For example, parvoviruses, which are similar to influenza, are, for some, more frequent in autumn and, for others, more present in winter in temperate countries. The Sras stopped suddenly in the summer [in July 2003] and for H1N1, I was extremely careful at first, because the epidemic started in the spring  and peaked in October, which never happens with the flu. As soon as the cold arrived on December 25, there were no more cases, even though something explosive was expected. We don’t know why, it’s still mysterious,” the researcher prefers to qualify.
Where Does the Virus Come From?
The new coronavirus probably originated in bats, but scientists believe that it passed through another species before being transmitted to humans.
Chinese researchers have claimed that this intermediate animal could be the pangolin, a small scaled mammal threatened with extinction. The international scientific community considered this hypothesis plausible, but added that it needed to be verified.
Lyme Disease – All you Need to know
Lyme Borreliosis, more commonly known as Lyme disease, is a bacterial infection that can be transmitted to humans through tick bites. This infection is widespread throughout the world and there are a few thousand cases per year in France. When left untreated, the disease can take several years to develop. Researchers speak of an emerging disease, as the number of cases is increasing.
Symptoms of Lyme Disease
Tick bites most commonly occur in the lower limbs. It can also occur on the child’s face. The disease progresses in three phases, the duration of which can vary greatly from one individual to another. The symptoms of Lyme disease are therefore numerous and spread over several phases.
In addition, the periods between phases may be asymptomatic from one individual to another. Nevertheless, several symptoms will help you detect the presence of this infection.
First Phase of the Disease
The skin lesion represents the so-called primary phase of Lyme disease. You should be able to visually diagnose the infection since the most common features appear on the skin. A more or less red spot, very similar to a mosquito bite, should appear very quickly on your skin. The bite of a tick, however, evolves over time, since after 3 days, this spot can spread and have a diameter of two centimetres.
After a month, the bite will continue to grow and should reach 10 centimetres in diameter. In some cases, it can even exceed 45 centimetres in diameter. This spot, called chronic erythema (or ECM), does not itch and always progresses centrifugally. The ECM may sometimes be surrounded by a red ring. Be careful, inflammation may be present if this area is hot.
During this first phase, you may notice some :
- Fever flare-ups;
- Joint and muscle pain.
It should be noted that 20% of people affected by this disease, the ECM remains very discreet, disappears after a month and the individual will not have noticed its presence. Lyme disease will go totally unnoticed and no treatment will have been taken. These cases can be serious, since the disease may become more complicated during the second phase.
Second Phase of the Disease
The second stage of Lyme disease may occur a few weeks or even months after the first stage, when a tick bite is given and no treatment has been taken by the individual. This second phase can be defined by several points as dizziness associated with general fatigue. But it is important to watch the following points:
- An appearance, as in the first phase, of skin lesions, or red blotches;
- Pain in the joints will begin to appear, with arthritis in the large joints such as knees, shoulders, elbows, etc. ;
- Neurological disorders, meningitis, even facial paralysis;
- Cardiac disorders in some cases, syncopations, palpitations, etc. have already been observed.
It becomes essential to treat the disease, otherwise the third phase could develop, years later for some individuals, in conditions that can be very serious.
Third Phase of the Disease
If Lyme disease has not been treated in the first two phases, the third phase could prove fatal to the infected individual. All of the above symptoms will slowly worsen, becoming chronic, during this last phase, which can occur years after infection.
All organs may be infected and will spread to nerves, eyes, joints, and even the heart and spleen. In addition, atrophy of skin patches may be observed. The skin will become very thin, even transparent and will give a crumpled paper effect with a reddish-violet tinge. The cardiac consequences can also be serious depending on the infection.
It should be noted that the evolution towards this third phase remains extremely rare, even if the individual has not taken any treatment.
Causes, Transmissions and Recommendations
Lyme disease is transmitted through the bite of ticks. It is transmissible in humans but also in many animals. There are a very large number of forms of the Borrelia bacteria.
Unfortunately, there is no real way to avoid being bitten outside of places where ticks might be present, such as forests etc. In addition, their presence and the incidence of infection may vary depending on where you are.
The only solution therefore remains to be vigilant. When working in the wilderness, or taking your Sunday walk in the forest, try to favour long clothing for example. Ticks generally attack the lower limbs, so pants should be sufficient. Beware of children, who can be bitten on the upper limbs. You will therefore have to be very careful. Once your activity is over, it is strongly advised to inspect yourself meticulously to see if a tick has hooked on. They are fairly simple to identify with their four pairs of legs and their eyeless head. The tick’s swollen belly means that it has stung you, since it has started to drink your blood.
Do not try to remove it by scratching. We advise you to use tweezers as close to the skin as possible and avoid the ether. Once the tick has been removed, disinfect the area.
How is it Diagnosed?
As we have seen above, it is very difficult to diagnose Lyme disease. Symptoms can be very numerous but can also be painless or even almost “invisible”. In addition, it is very easy to confuse the symptoms described with other diseases. When you notice these symptoms, it is advisable to go to the doctor quickly and tell him or her if you have been bitten by a tick. When the individual does not know if he or she has been bitten by a tick, he or she will be able to tell the doctor if he or she has been in places that are likely to contain ticks; for example, during walks in the forest. It should be noted that blood tests do not always validate the presence of the infection, especially if the patient is still in the early stage of the disease. The doctor may also perform an electrocardiogram to check for possible atrioventricular disorders. In these cases, the patient will have to be hospitalized.
In advanced cases of Lyme disease, i.e. from the second stage onwards, neurological examinations will be necessary. They will reveal a decrease in sensations, muscular strength and possible nerve inflammation.
Treatment of Lyme Disease
Antibiotics are mandatory to treat the infection caused by ticks. These antibiotics will completely eliminate the presence of Borrelia bacteria anywhere in the body. The complications of Lyme disease can be multiple.
However, depending on the time since the infection, and therefore the phase of the disease, the treatment and dosage may be completely different. Antibiotics should be taken for a minimum of two weeks and up to three weeks depending on the areas affected by the infection. The symptoms should therefore begin to disappear and any complications can be avoided.
In the most advanced cases of the disease, class 3 antibiotics should be prescribed by the doctor. These drugs will have to be taken intravenously over a period of time that can be much longer. In cases of hospitalization, a corticoid is often administered. Fortunately, most of the symptoms can be eradicated.
Complications towards the third phase are extremely rare, but they do occur. It is therefore important to consult a doctor immediately if you think you have been bitten by a tick. In addition, not all of the symptoms described above will always disappear completely. Treatment for Lyme disease will therefore have to be taken to try to alleviate the symptoms that have become chronic.
The Mysteries of the Thyroid: The 8 Symptoms That Can Reveal a Thyroid Problem
By Dr Jacques Amselem – General practitioner
Many people suffer from thyroid dysfunction. It is often a specific symptom that prompts patients to consult their doctor. Dr. Jacques Amselem, a general practitioner, reminds us of the signs that should alert us.
What is the thyroid?
The thyroid is a butterfly-shaped gland, located at the base of the neck, which produces hormones necessary for the regulation of the whole body. A malfunction can cause many inconveniences on general health. For example, when the thyroid gland produces too many hormones it is called hyperthyroidism, often associated with autoimmune Basedow’s disease.
Conversely, when the gland slows down, the patient suffers from hypothyroidism. Often, alerted by certain signs, patients consult their general practitioner. The latter will then prescribe, depending on the case, a blood test with thyroid hormone dosage, an ultrasound or a scintigraphy.
Extreme Fatigue, a Sign of Hypothyroidism
General fatigue is often the first sign of hypothyroidism. This is because the lack of hormones causes the body to function in slow motion. The patient then suffers from sleep disorders and muscle fatigue. This tiredness is also accompanied by concentration and memory problems.
Thyroid dysfunction often leads to weight fluctuations. In the case of hyperthyroidism, patients often experience weight loss while eating normally. Conversely, those with hypothyroidism often report weight gain, even though they do not eat more.
Problems With Temperature Regulation
The thyroid also controls body temperature. Hypothyroidism is manifested by coldness and lower temperatures on the extremities (toes, nose, etc.).
Conversely, hyperthyroid people often feel too hot, sweat with the slightest effort and complain of sweaty hands.
A Skin and Sander Modification
In hypothyroidism patients experience dry skin, hair falling out and fingernails turning.
Mood disorders, a sign to be taken into account
Nervousness, anxiety, persistent depression for no apparent reason or emotional instability are also signs of thyroid dysfunction.
An Accelerating Heart Rate
An increased or decreased heart rate may be a sign of thyroid problems. In detail, a slower heart rate is a sign of hypothyroidism, while a faster heart rate is often a sign of hyperthyroidism.
Among the symptoms of hypothyroidism, the lack of hormones can manifest itself as constipation or bloating. Conversely, hyperthyroidism can cause diarrhea.
A Palpated Nodule
If you notice a small lump in your thyroid gland, whether painful or not, you should consult a doctor. The doctor will look for clinical signs of a thyroid disorder and will prescribe additional tests.
If you think you have a hypothyroid or hyperthyroid profile, you should first talk to your doctor (GP, gynaecologist, endocrinologist), as the symptoms of thyroid dysfunction can vary from person to person and may also be an expression of other diseases. A complete check-up will allow you to know for sure and, if necessary, to undertake an appropriate treatment.
Weight and Diabetes: Dangerous Connections!
Being overweight and diabetes are intimately linked. Three-quarters of type 2 diabetics are obese. What are the causal links between these two diseases? What influence do diabetes treatments have on kilos? Can new drugs act on both levels? Answers to your questions.
Diabetes and obesity are two major epidemics on the march around the world. The fact is simple: there are 400 million obese adults on Earth, and there will be more than 700 million by 2025. Obesity could become the leading cause of death in the USA in the near future.
As for diabetes, there are 246 million diabetics in the world. Every year, 7 million people develop diabetes, that is two every second! There will be 380 million in 2025. While the number of cases is increasing in Europe and America, there is a real explosion in China and India. Diabetes doubles the risk of death and is responsible for 3 million deaths and 1 million amputations.
Obesity and Diabetes: Strongly Linked Diseases
If the epidemics of diabetes and obesity seem to follow the same progression, it is not by chance: these two diseases are so closely linked that we often speak of an epidemic of “diabetes”.
First of all, a distinction must be made between diabetes types 1 and 2: it is the latter, which accounts for 90% of diabetics, which is directly linked to being overweight. “While not all obese people become diabetics, conversely, three-quarters of diabetic patients are obese,” emphasises Prof. Michel Pinget, head of the endocrinology department at Strasbourg University Hospital.
Obesity and Diabetes: Common Causes?
So how can we explain these links between the two diseases? The observation is simple: 90% of type 2 diabetes appears after weight gain. But as Prof. Pinget points out: “Being overweight alone is not enough to cause the disease. If you are not predisposed, even if you weigh 200 kg, you will never get diabetes”.
It is therefore necessary to have a prior genetic terrain, which will lead to diabetes in the event of an unbalanced diet and significant weight gain. In this case, it is the mechanism at the origin of diabetes that is directly linked to kilos: insulin resistance. Because before real diabetes appears, the disease develops insidiously, with a progressive resistance to the action of insulin (a hormone that reduces the level of sugar in the blood and stores it). The body is forced to produce more and more of it, until it is no longer sufficient, and that is diabetes.
The causes of insulin resistance are: ageing (including age-related muscle wasting); fatty and sweet foods; sedentary lifestyles; and urbanisation and stress. The observation is therefore simple: two of the four causes of insulin resistance are common to obesity: diet and sedentary lifestyle.
Treating overweight to cure diabetes
When diabetes is managed, treatment should prevent complications, especially cardiovascular complications. This is based on various factors: control of glycemia, cholesterol and blood pressure (70% of diabetics are hypertensive). But above all, the diabetic must lose 10% of his weight and must practice regular physical activity. Overweight greatly increases the risk of complications.
“The problem is that 80% of patients who are told to eat better and exercise do not follow their recommendations,” says Prof. Pinget.
The problem is that 80% of patients who are told to eat better and exercise do not follow their recommendations,” says Prof. Pinget, which means that patients must be put on oral antidiabetic drugs and then on insulin.
Anti-Diabetic Treatments That Promote Weight Gain
In addition to diet and physical activity, type 2 diabetics can be put on treatment (oral antidiabetic drugs or insulin). However, there is a real paradox, as Prof. Pinget points out: “The better you treat diabetes, the more you control blood sugar levels, and the more people gain weight”! This phenomenon is notably linked to a better glycemic balance: no more sugar is lost in the urine…but the calories are better stored, and we regain a few kilos… This is particularly true for oral antidiabetic drugs (except for Metformin, which has a “fat-burning” effect).
But when patients switch to insulin, they also gain a few kilos (5 on average in the first year). In fact, weight gain on insulin is the second most important concern for patients, after the fear of hypoglycemia. There are many reasons for this weight gain:
- A “defensive” food intake, to avoid the hypoglycemia that can occur with insulin injections;
- An effect of insulin on the central nervous system;
- An anabolic effect of insulin, which promotes fat storage.
This weight gain under treatment can have a deleterious effect in patients who are already overweight or obese, in particular by making it more difficult to achieve the goals set. And this may reduce compliance…
However, it should be noted that not all insulins have the same effect, and the most recent ones do not have the same impact on weight. In particular, the insulin Detemir (Levemir ®) leads to less weight gain in diabetics.
Anti-diabetic and anti-kilos treatments
Today, treatments have targeted actions on both overweight and diabetes.
One example is Xenical, which the Xendos study has shown to be able to help lose weight while reducing the incidence of diabetes.
And today, a new drug still being tested seems particularly effective against both diabetes and obesity: Novo-Nordisk’s Liraglutide, which acts on both insulin production and appetite. Not only does it reduce blood sugar levels, but it also causes weight loss. In trials on patients with a body mass index of 35 (often more than 100 kg), an average of 7 kg was lost: 75% lost more than 5% of their weight, 25% even lost more than 10%.
It will be necessary to wait for further trials to see if this new treatment keeps all its promises.
But whatever the treatment, the recommendation to eat a more balanced diet remains essential. And physical activity is also a must to help control both weight and blood sugar levels.
Whether you are overweight or not, whether you are diabetic or not, eating and being active remain the keys to health. Because it’s never too late to do the right thing…
What is The Incubation Period of Coronavirus?
The incubation period of the new coronavirus in China, respectively from exposure to the onset of disease symptoms, is on average 5.2 days, but varies considerably from patient to patient, shows one of the largest studies on this epidemic.
While acknowledging that the estimate is “inaccurate”, the Chinese researchers conducting the study, published in the New England Journal of Medicine, said they based their conclusions on medical observations made for 14 days in people exposed to the virus.
The World Health Organization announced Monday that the incubation period for the coronavirus infection, which has symptoms of fever, cough and respiratory problems, ranges from two to 10 days.
Researchers studied the first 425 patients diagnosed with the virus to establish two other key characteristics of the epidemic. Since the first outbreak in Wuhan in December, the number of patients has doubled every 7.4 days.
In addition, the researchers estimate that each patient infected an average of 2.2 people.
The figure does not predict the size of the epidemic, but it is useful, as researchers believe it is small, close to the size of an influenza season (1.3) and comparable to that of the 2002-2003 acute respiratory syndrome (SARS) epidemic.
Researchers also found that human-to-human transmission has been occurring since mid-December 2019.
The results of the new study are similar to those of a team of researchers in the Netherlands, who found that the incubation period is 5.8 days, with wide variations.
How to Protect Yourself Against Coronavirus
By Tom Moorcroft |
Osteopathic Physician Specializing in Infectious Diseases.
While respiratory coronavirus disease is spreading rapidly in its country of origin, China, fear is also spreading rapidly on the web and social networks. With five confirmed cases of coronavirus in the United States (as of Tuesday, January 28), we wanted to investigate the likelihood of Americans – especially those who have not recently travelled to China – getting the new coronavirus strain, 2019 Novel Coronavirus (2019 -nCoV).
With the help of Dr. Tom Moorcroft, an osteopathic physician specializing in infectious diseases, we discuss the current risk of becoming infected with the coronavirus, how to protect oneself and how to stay informed.
What is the Likelihood of Getting Coronavirus?
Right now, the risk is low for Americans, Moorcroft told CNET. “We don’t want to be blown away by this and not worry,” he said, “but there’s no need for mass hysteria because the risk is so low right now.
As of January 28, there were only five confirmed cases of coronavirus in the United States, California, Washington, Illinois and Arizona. All had recently travelled to Wuhan, China, the source of the outbreak, and all were hospitalized.
Robert Redfield, director of the Centers for Disease Control and Prevention, tweeted that the risk of coronavirus in the United States is low and that nCoV 2019 is not spreading in the United States at this time.
“Five controlled cases relative to the U.S. population are really not a threat,” says Moorcroft. “Even if you represented the 70 or so cases that are still outstanding, overall there are a small number.” At the time of writing, there were 92 cases in the United States at the moment. Moorcroft has given its opinion when that number was lower.
We understand that people may be worried about the new #coronavirus. In today’s connected world, an outbreak anywhere can be a risk everywhere. The risk depends on exposure. 2019-nCoV is not spreading in the United States at this time. The CDC continues to believe that the risk to the American public is now low.
– Dr. Robert R. Redfield (@CDCDirector) January 27, 2020
Should the Americans be concerned about the coronavirus?
According to Moorcroft, “it’s not something you should be losing sleep over right now.”
There’s no confirmed human-to-human transmission in the US, and the CDC and the World Health Organisation are working hard to make sure it stays that way. Investigative and protective efforts are fully in effect, from airport entry controls and travel restrictions to patient isolation.
Combined with Wuhan’s quarantine of its nearly 11 million citizens, the risk to the people of the United States remains low.
“Don’t roll the dice just because you live in the United States,” Moorcroft said. “Could [coronavirus] spread here? Yes, absolutely. Be aware. But right now there are only five confirmed cases in the US and we have contagious control here.”
How do You Protect Yourself From Coronavirus
For now, stick to the basics,” says Moorcroft.
The corona virus is spread by breathing in vapour, for example when someone sneezes or coughs into the air around you. Influenza and common cold viruses are also spread this way.
“What you need to do to protect yourself from coronavirus is something you need to do every day,” he says. “The only thing you can do to prevent respiratory illness is to practice good personal hygiene.”
Moorcroft also reiterates the CDC’s advice to avoid coronavirus (and other respiratory illnesses):
- Wash your hands with soap or use an alcohol-based hand sanitizer.
- Sneeze and cough into tissues or into your elbow. If you get snot or spit on your skin, clean it up immediately. Avoid touching your face with unwashed hands.
- Avoid close contact with sick people, especially those with breathing problems and fever.
- Stay home when you are sick.
- Regularly and thoroughly clean surfaces, e.g. counters and door handles with disinfectant.
Again, all basic protection should be normal, everyday things. Moorcroft believes that additional protection, such as wearing medical masks, is not really necessary at this time, unless you have the virus or are tested for it.
“I’m travelling to LA this weekend and I haven’t even thought about wearing a mask,” he says. “As long as people don’t sneeze, cough or otherwise put their respiratory secretions on you, you should be fine.”
In addition to basic disease prevention, Moorcroft says the best (and only real) defence against disease is a strong immune system. Your body is better able to fight off disease when your immune system is booming,” he says, “and everyone should try to get them back into shape. That means getting enough sleep at night, staying hydrated, minimizing over-processed foods and getting enough micronutrients in your diet.
How can I protect myself when travelling?
The CDC has advised everyone to avoid non-essential travel to China, and Chinese authorities have closed travel to and from Wuhan and other cities in Hubei province.
If you must travel to China, the CDC encourages you to talk to your doctor first, avoid others who are ill, and avoid animals and animal markets.
If you are traveling anywhere, you should practice basic hygiene that can help you get sick on the plane.
Although the risk is low at the moment, Moorcroft encourages everyone to stay armed with facts. You should not ignore or ignore the virus just because you live in the United States, but do not become overly stressed or worried about it.
And if you really want to know what’s going on, Moorcroft recommends monitoring the CDC Web site, where officials post regular updates on coronavirus events. It’s easy to get carried away by the ever-increasing amount of information available online, as well as the fear factor of social media, and the best way is to get your information from the actual health organizations that are investigating the problem first.
“I hope people will feel empowered by knowing the facts,” says Moorcroft, “and say: ‘I have access to information, I know how to take care of my body and I can stay safe.
The information contained in this article is for educational and informational purposes only and is not intended as medical or health advice. Always consult a physician or other qualified health care professional with any questions you may have regarding a medical condition or health purpose.
Should I Wear a Mask to Protect Myself From the Coronavirus?
In Wuhan, where the disease emerged last month, authorities have forced residents to wear masks covering their nose and mouth in public places. Regular and thorough hand washing is still the most effective.
How to effectively protect yourself from the new 2019-nCoV virus? The question is of concern to health authorities worldwide, who are powerless to deal with this still poorly known coronavirus, whose death toll, on Friday 24 January, was 830 cases and 26 deaths. In Wuhan, China’s eighth-largest city, where the disease emerged in December, residents are forced to wear masks covering their nose and mouth in public places, reports CNN.
So, are these devices really effective in preventing infection?
Can Surgical Masks Be Effective?
Authorities believe that these masks can help patients limit the transmission of the coronavirus. The World Health Organization recommends covering the mouth and nose when coughing and sneezing to prevent the spread of the infection. In France, the Ministry of Foreign Affairs invites travellers who have visited Asia and who must come into contact with other people to wear a surgical mask “in case of symptoms of respiratory infection (fever, cough, breathing difficulties)”. This recommendation is explained by the fact that coronavirus 2019-nCoV pneumonia “is transmitted by sputum (sneezing, coughing),” as the Ministry of Health reminds us.
Questioned by HuffPost, Sandrine Belouzard, a CNRS researcher at the Lille Centre for Infection and Immunity, believes that “wearing a mask plays an obvious barrier role”, especially to avoid “excretion [i.e. the release of virus from the body]. However, the specialist warns that surgical masks “cannot be 100% effective”. Because they are not sealed to the face (fortunately), these masks leave gaps around the mouth and do not filter all the air that is breathed in and out.
In Which Cases Are They Useless (or even worse)?
There is no need to equip yourself if you are in great shape, says the Ministry of Health. On its website, the ministry states “that the wearing of this type of mask by the non-ill population in order to avoid catching the disease is not recommended”, and that “its effectiveness has not been proven”.
These accessories could even prove counterproductive. “We are concerned that people may feel they are better protected by the mask than they really are,” Julie Vaishampayan, a physician and chair of the Public Health Committee of the American Society of Infectious Diseases, told the New York Times. Most people put their hand under the mask to scratch their face or rub their nose,” says Amesh Adalja, a specialist in infectious diseases at the Johns Hopkins University Health Security Center in Baltimore, USA, who was also interviewed by the daily. This can bring the mask wearer into contact with contaminating agents and take away from the object all its interest.
A specialist in infectious diseases at the University of Toronto, Susy Hota even recommends not wearing this type of mask, so as not to fuel psychosis in the population. “It makes people nervous [around you] and there’s no evidence that it protects you,” she told Radio-Canada.
What Precautions Should Be Taken?
It’s not spectacular, but the best way to prevent infection by the 2019-nCoV virus is to behave as “every cold or flu season,” Dr. John Wiesman, head of health issues in Washington state, where the first U.S. case of coronavirus was reported, told CNN. “As with the seasonal flu episode, the ‘barrier measures’ are effective,” the Health Department says. Here are a few rules: cough into your elbow (not your hand), use disposable tissues, and above all wash your hands regularly and thoroughly.
Cervical Cancer: Symptoms, Screening, Treatment
By: Dr. Jean C., Pharmacist
Cervical cancer is the development of a malignant tumour of the lining of the cervix. It is considered a slowly progressing tumour disease of infectious origin. In the majority of cases, cervical cancer occurs after prolonged exposure to human papillomavirus (HPV).
This is because the long-term presence of the virus in the mucous membrane has a deleterious effect on healthy cells that can develop into cancer cells. It is the proliferation of these cancerous cells, which are initially few in number, that leads to the appearance of a more or less organised mass known as a tumour.
Since tumours appear in the mucous membrane, they are also called squamous cell carcinomas and account for almost 85% of cervical cancer cases.
In 2015, nearly 2,797 new women were newly diagnosed with cervical cancer. This low annual number of new cases makes it the 12th most common cancer in women. This cancer is, on average, diagnosed at the age of 51 and was responsible for 1,092 deaths in 2015 in France. It is a cancer qualified as having a good prognosis, as its 5-year survival rate is 67%, i.e. 67% of cervical cancer patients are alive 5 years after diagnosis. Improved screening through regular cervical smear testing (UTC) has almost halved both the number of new cases and the number of cervical cancer-related deaths. It is estimated that with optimal screening, the number of cervical cancers could be reduced by almost 90%.
Having one or more risk factors does not necessarily lead to the development of cancer. They increase the likelihood of developing cancer compared to an unexposed person. However, a cancer can develop without any risk factors being present.
Namely! A risk factor is an element that can promote the development of cancer.
Human Papillomavirus (HPV)
It is the main inducer of cervical cancer. Indeed, a prolonged infection of 10 to 15 years by the human papillomavirus is responsible for nearly 70% of cervical tumours.
HPV is transmitted by contact with the skin and mucous membranes, most often during sexual intercourse. Infection with this virus is very common and mostly cures spontaneously. However, in 10% of cases, the virus persists in the lining of the cervix, which can lead to precancerous lesions that can develop into cancer.
To know! There are more than 80 strains of papillomavirus and only a small number of them cause cervical cancer.
Since 2007, there are two vaccines against HPV types 16 and 18. It is a very good means of prevention for this type of cancer, but it does not replace gynaecological monitoring.
Other risk factors
A scientific link has been established between factors other than HPV and the development of cervical cancer:
- Early sexual debut;
- Multiple sexual partners: The more different partners you have, the greater the chance of being exposed to HPV, and therefore the greater the risk of developing cancer;
- HIV infection (AIDS) or taking an immunosuppressive treatment: because in both cases our immune system is less efficient, which leads to a loss of efficiency in the fight against HPV viruses.
- Having several children ;
- Taking birth control pills;
- Sexually transmitted diseases: such as genital herpes and Chlamydia.
Precancerous Lesions of the Cervix
Precancerous lesions are changes in the cells of the epithelium of the cervical mucosa (cells covering the mucosa) that are not yet cancerous, i.e. the tissue is abnormal but not yet cancerous. The precancerous lesion is not designated as a cancer because it does not have all the criteria for malignancy of a cancer. These disorders are most often caused by the long-term presence of the human papillomavirus (HPV) in the cervix. The viral infection leads to cellular suffering that reflects the evolution of the tissue into cervical cancer. Precancerous lesions may spontaneously regress or progress to cancer.
Precancerous lesions are also called cervical intraepithelial neoplasia or CIN. They exist in more or less severe forms. A classification allows us to distinguish three main types of lesions according to their severity:
- CIN 1: the abnormal cells affect 1/3 of the thickness of the epithelium;
- CIN2: the abnormal cells affect 2/3 of the thickness of the epithelium;
- CIN3: the abnormal cells affect the entire epithelium.
Depending on the grade of precancerous lesion, there is a probability of progression to higher grade CIN, cervical cancer or spontaneous regression.
Probabilities of regression, persistence and progression of CIN (Ostor, 1993)
|Lesions||Regression||Persistence||Progression to higher CIN||Progression to invasive cancer|
| CIN1|| 57%|| 32%|| 11%||1%|
| CIN2|| 43%|| 35%|| 22%||5%|
| CIN3|| 32%|| 56%|| –||>12|
We can retain from this table that:
Low-grade precancerous lesions (CIN 1) are more likely to regress than to progress to a higher grade. The higher the CIN, the greater the risk of progression to cancer and the more limited the likelihood of spontaneous regression.
The evolution of these precancerous lesions into cancer is a slow, progressive phenomenon that can be demonstrated by a cervico uterine smear (UCS). It is therefore possible to identify and treat them before they become cervical cancers.
Because of its slow progression and the presence of curable precancerous lesions, cervical cancer can be detected at an early stage, and can even be completely prevented by detecting precancerous lesions.
Screening is mainly based on a cervical smear, which is a collection of cells from the surface of the cervix that are then analysed using a microscope. The appearance of the cells as well as the organization of the tissue allows biologists to observe possible precancerous lesions or the presence of cervical cancer.
To know! It is recommended every three years, after 2 normal smears spaced one year apart for all women aged 25 to 65.
Cervical cancer often develops without causing any particular symptoms, especially at an early stage. This is why it is essential to have a gynaecological follow-up with cervico uterine smears in order to detect it as early as possible.
There is also a set of symptoms that are not specific to cervical cancer, but whose persistence or intensity may suggest a tumour:
- Induced metrorrhagia: which is low grade bleeding caused by sexual intercourse;
- Spontaneous metrorrhagia: Bleeding that occurs without apparent cause;
- Pain during intercourse;
- White vaginal discharge;
- Pain in the lower abdomen with difficulty in urinating, a continual urge to have a bowel movement;
- Lower back pain.
These symptoms can be found in the disease other than cervical cancer, but it is important to report them to your doctor so that he or she can determine their origin.
The diagnostic work-up for cervical cancer begins after an abnormal screening test or the appearance of suggestive symptoms. Complementary examinations are then set up with the aim of :
- Confirm the diagnosis of cancer and define the type of cells involved.
- Determine the stage of the disease in order to propose an appropriate treatment.
- Identify possible contraindications to certain treatments
Definitive confirmation of the diagnosis of cervical cancer is only possible after analysis of a biopsy (removal of a fragment of tissue).
This assessment takes place in a gynaecological practice. The doctor examines the surface of the cervix and vagina using a coloscope, which is a powerful magnifying glass with a light at its tip. This exam examines the abnormal areas, deposits liquids that reveal precancerous lesions, and takes biopsies (samples of a thin fragment of the cervix). Colposcopy is not painful but may cause discomfort during the procedure.
Conical biopsy or conization
This examination consists of removing a conical fragment of the hard-to-reach lesions of the cervix. The conization is performed under local or general anaesthesia. The aim is essentially diagnostic, but in some cases the conical biopsy removes all the cells presumed to be cancerous and in this case no further treatment will be necessary.
It is the microscopic examination of tissue fragments obtained by biopsy or conization. It is the standard test to confirm the diagnosis of cervical cancer.
The analyses performed on the cells help to define the cancer-causing cell and its characteristics.
Therapeutic Management of the cervix
The choice of treatment in cervical cancer depends on 2 criteria:
- Characteristics of the tumor: including size, location, stage and grade of tumor;
- The general condition of the patient.
Using these criteria, health professionals develop a protocol of care in a multidisciplinary consultation meeting (MDC). The opinion of the RCP is then submitted to the patient by the referring physician. It is therefore a consultation between patient and doctor that gives the “green light” to therapeutic management. The patient validates the opinion of the RCP by his or her informed consent, i.e. by having understood the issues and risks related to the proposed treatments.
The treatment of cervical cancer is organized around 3 axes: surgery, radiotherapy and chemotherapy. The protocols can be used alone or in combination and aim, depending on the case, to: destroy the tumour(s), reduce the risk of relapse, slow down the development of the tumour and treat the symptoms linked to the disease.
This therapeutic axis is mainly used to treat local and small tumours of the cervix. Surgery removes the entire tumour and thus cures the disease. Several interventions exist. The choice is made according to the extent of the cancer, but also according to the age and the patient’s possible desire for pregnancy.
It is the most performed surgical procedure for the treatment of cervical cancer. During this operation, the surgeon removes the entire uterus and the upper part of the vagina. In addition, the ovaries are also frequently removed. This treatment is only possible for patients with a limited cervical tumour smaller than 4 cm.
The removal of ganglionic networks
Cancers can spread throughout the body through the lymph nodes. The removal of the lymph nodes near the uterus limits the risk of spreading the disease as well as the risk of relapse.
During this operation, the surgeon removes only the uterus, leaving the upper part of the vagina intact. Hysterectomy is a treatment indicated for small tumours that are very limited to the cervix.
A trachelectomy involves removing only the cervix. Once the removal is complete, the surgeon uses special sutures called cerclage to partially close the uterus where the cervix used to be. This new opening allows blood to drain out during menstruation. [/column]
This operation is only possible in tumours that are limited to the cervix and do not exceed 2 centimetres in size. This surgery is called conservative because it preserves the uterus and therefore the fertility of young women wishing to become pregnant in the future.
Radiotherapy is a local treatment using high-energy ionizing radiation to destroy cancer cells. This therapeutic method makes it possible to very precisely target an area to be treated in order to irradiate the tumour while preserving the surrounding healthy tissue as much as possible. Two types of radiation therapy can be used in cervical cancer.
External radiotherapy: is a technique in which the source of the radiation is outside the patient. The radiation beam is directed against the patient’s tumour, guided by landmarks. Several sessions per week are necessary, spread over a few months.
Internal radiotherapy or brachytherapy: consists of placing an applicator containing the radiation source in the vagina and in contact with the tumour. The irradiation of the cancer is therefore continuous. This therapy can be used in cervical cancer, especially before surgery to reduce the size of the tumour. During brachytherapy, the patient is considered “radioactive” because the source of radiation is in her body.
Chemotherapy comprises all the drug therapies acting on cancer cells with the aim of either destroying them or limiting their multiplication. It is the only therapeutic axis that acts on the whole organism. Chemotherapy treatments can be used by the venous or oral route depending on the molecules used.
In cervical cancer, chemotherapy is indicated either to reduce the size of a tumour in order to increase the success of a surgical operation, or in the treatment of cancers at high risk of spreading or metastatic. The most commonly used molecules are :
- 5-FluoroUracil (5-FU): which is an anti-cancer agent that blocks the tumour’s DNA synthesis, preventing it from multiplying.
- Platinum salts: which are anti-cancer drugs that can bind to DNA and stop the proliferation of cancer cells.
Type 2 Diabetes: Symptoms, Causes, Diagnosis, and Treatment
By: Dr. Fabienne Langlois, Endocrinologist
Type 2 diabetes is a disease characterized by chronic hyperglycemia, which means too much glucose (sugar) in the blood. It usually occurs in older adults and is more common in people who are obese or overweight.
In a healthy individual, blood sugar control is achieved through insulin, a hormone secreted by the pancreas. Insulin allows sugar to enter the cells to be used as fuel, particularly in the muscles and liver. In a person with type 2 diabetes, the body becomes unable to regulate blood sugar, or the level of glucose in the blood. This is when blood glucose levels rise (called hyperglycemia). In the long term, if blood sugar levels are not lowered by treatment, this can cause serious health problems, especially cardiovascular problems.
This chronic disease requires individualized treatment and close monitoring by the affected person and the medical team. Healthy lifestyle habits are the basis of treatment. If these habits are not enough to lower blood sugar levels, medication may be used.
There are 2 main forms of diabetes, type 1 diabetes and type 2 diabetes, both characterized by chronic hyperglycemia.
Type 1 diabetes occurs in young people and often appears in childhood. It is caused by autoimmune destruction of the pancreas, which no longer produces insulin. The cause is poorly known and there is no prevention currently possible. People affected are therefore dependent on insulin, which must be administered by injection.
Type 2 diabetes, which accounts for 90% of diabetes cases, occurs later in life. It is mainly due to a state of insulin resistance and is associated with being overweight.
A disease in Strong Progression
The number of people with type 2 diabetes is steadily increasing and this trend is attributed to the “Western” lifestyle, which is associated with sedentary living and obesity, as well as an aging population. Globally, the International Diabetes Federation predicts that the number of people with diabetes could increase from 285 million in 2010 to 438 million in 2030.
In Canada, in 2009, 6% of people over the age of 12 years reported having diabetes. This rate increases with age, reaching nearly 18% among those 65 years and older. In total, more than 9 million Canadians have diabetes or prediabetes, including 650,000 Quebecers. In addition, many cases of diabetes are unknown because they are not detected.
Type 2 diabetes generally manifests itself after the age of 40, but is now affecting more and more children and adolescents because of obesity, which is affecting more and more young people.
Diabetes results from a combination of genetic, environmental and lifestyle factors. In general, each person carries a hereditary baggage that predisposes them to diabetes or protects them from it. Researchers now know several genes that put an individual at risk of developing type 2 diabetes. In people who are genetically predisposed to the disease, it is generally overweight and particularly the accumulation of fat in the organs of the abdomen that leads to insulin resistance, the first step towards type 2 diabetes.
Initially, to compensate for insulin resistance, the pancreas starts to produce more insulin. However, over time, the pancreas becomes depleted and insulin secretion decreases. As a result, there is a relative lack of insulin and blood glucose levels remain continuously high.
Type 2 diabetes is therefore the result of 2 phenomena: firstly, resistance to insulin, and secondly, the exhaustion of the pancreas.
Because type 2 diabetes rarely has early symptoms, it is often discovered incidentally during a routine medical examination.
Blood glucose tests can detect it: a fasting or random blood glucose test and sometimes a test for induced hyperglycemia. The latter test consists of a blood glucose reading 2 hours after ingesting a sweet juice containing 75 g of glucose. Fasting blood glucose levels often rise gradually over the years from a normal level to an intermediate state of prediabetes and then to the diabetic threshold.
Blood glucose levels can be measured by taking a blood sample or estimated using a blood glucose meter (glucometer), which allows the blood glucose level to be analysed on a drop of blood taken from the fingertip.
Even if the results are normal, it is usually recommended that these tests be done at regular intervals to detect disease as early as possible.
For information on acute complications (hypoglycemia and hyperglycemia due to treatment adjustment and hyperosmolar hyperglycemia syndrome in untreated diabetics), see our Diabetes Fact Sheet (Overview).
In the long term, many diabetics see their health condition worsen as a result of their disease, especially if the diabetes is not well controlled and monitored. Chronically high blood sugar levels gradually damage nerves and blood vessels, mainly in the eyes and kidneys. Diabetes can lead to cardiovascular disease, irreversible vision loss, pain due to nerve damage or kidney failure. For more information, see our Diabetes Complications fact sheet.
Symptoms of type 2 diabetes
In its early stages, type 2 diabetes causes few or no symptoms. It can go unnoticed for many years. However, some people may experience symptoms caused by high blood sugar, such as :
- A frequent urge to urinate, especially at night. The kidneys produce more urine to try to eliminate excess glucose from the blood;
- An increase in hunger and thirst, with a dry mouth feeling;
- Excessive drowsiness, especially after meals;
- Blurred vision;
- More frequent bacterial or fungal infections (urinary tract infections, vaginitis, etc.).
Risk Factors for Type 2 Diabetes
Persons at Risk
- People who have a first-degree relative (mother, father, brother or sister) with type 2 diabetes;
- People who are obese or overweight, especially when the fat is concentrated in the abdomen rather than on the hips and thighs. This is because the fat in the organs of the abdomen (especially the liver) is the fat that interferes the most with insulin function. More than 80% of type 2 diabetics are overweight;
- Certain populations are at higher risk, including Africans, Latin Americans, Asians and North American indigenous populations.
- Being over 40 years old. Type 2 diabetes affects mostly adults, and its prevalence increases with age;
- Have a sedentary lifestyle and consume too many calories;
- For women, having had gestational diabetes or having given birth to a baby weighing more than 4 kg;
Have a metabolic syndrome. In the clinic, the physician will assess the presence of the following factors (3 are sufficient to diagnose this syndrome):
- abdominal obesity, determined by measuring waist circumference;
- high blood triglycerides;
- Low blood HDL (“good”) cholesterol;
- High blood pressure;
- High fasting blood sugar.
Prevention of Type 2 Dabetes
The need for screening for diabetes in the absence of symptoms will be assessed with the physician.
The earlier the disease is detected – even before the onset of symptoms – and the earlier intervention to restore normal blood glucose levels, the lower the risk of complications (cardiovascular, eye, kidney or neurological disorders, etc.). There is growing evidence of the effectiveness of early intervention.
Here are some recommendations: :
- Assessment of the risk of diabetes in adults should be done by the physician at the time of the annual check-up;
- Fasting blood glucose testing should be undertaken every 3 years in all adults 40 years of age and older, with or without symptoms. This screening should be done earlier or more frequently when risk factors have been found. A test for induced hyperglycemia may be undertaken for further analysis to establish the diagnosis;
- Screening for the disease in high-risk children every 2 years is advised.
Basic preventive measures: Weight control, healthy eating and exercise
Type 2 diabetes can be prevented by simple means. One study, the Diabetes Prevention Program, showed that at-risk individuals who participated in 30 minutes of physical activity per day and were able to lose 5% to 7% of their weight decreased their risk of developing diabetes by 58%.
Being overweight increases insulin requirements and overstrains the pancreas. A person’s healthy weight is determined by their body mass index (BMI). Calculate yours with our Body Mass Index (BMI) and Waist Circumference test. It’s not a question of aiming for a healthy weight at all costs, but a weight loss of 5% to 10% in 6 months already provides significant health benefits.
A healthy and varied diet helps maintain a healthy weight. It also helps maintain a relatively stable blood sugar level throughout the day, as well as good blood pressure. To do this, eat as many as possible 3 meals a day at regular times, avoid excess animal fat and added sugars (glucose, fructose, dextrose, etc.) and favour foods rich in fibre. For an overview of the basic principles to follow, see How to eat well?
Regular physical activity also contributes to maintaining a healthy weight or to eliminating excess weight if necessary. Being active also helps insulin work more effectively. It is recommended to be active for at least 2.5 hours a week, spreading physical activity throughout the week in periods of at least 10 minutes at a time (brisk walking, swimming, jogging, cycling, etc.). It is important to start gradually and gradually increase the duration and intensity of the activity. Physical activity in itself can significantly reduce the risk of becoming diabetic.
Measures to prevent complications
It is important that the antidiabetic treatment is well adjusted. Adequate control of blood glucose levels prevents complications. To ensure that treatment is effective, regular self-monitoring of blood glucose levels with a blood glucose meter and medical follow-up are essential. Your doctor will use the level of glycated or glycosylated hemoglobin (HbA1c) in your blood (measured at least twice a year), which reflects the average blood glucose levels over the last 3 months.
Blood glucose targets to aim for that reflect good control :
- a blood glucose level of 4 mmol/l to 7 mmol/l before meals;
- a blood glucose level between 7 and 10 mmol/l 2 hours after a meal;
- a glycated hemoglobin level of less than 7%.
Medical Treatments for Type 2 Diabetes
Diabetics can expect to lead an active, independent and dynamic life without any limitations. It remains important to respect certain basic principles, in particular with regard to :
- an appropriate diet;
- the adoption of an active lifestyle;
- monitoring of capillary blood glucose levels.
For more details on lifestyle management for type 2 diabetes, please see our Diabetes Overview fact sheet, where you will find :
- A diagram of glucose absorption;
- a video showing how to use a blood glucose meter;
- a table of optimal blood glucose values for teenagers and adults with diabetes;
- an eating plan (see also our Special Diet: Diabetes fact sheet).
- Suggestions for physical exercise;
- Ways to manage stress.
For some people, regular adherence to this lifestyle will be enough to control blood sugar levels, while for others, medication will also be necessary. The goal of treatment is to keep blood glucose (sugar) levels within normal ranges. The means to achieve this are different for each person.
There is no cure for diabetes. It is a chronic disease and lifelong treatment is necessary. However, better nutrition and regular physical activity is a real way to treat diabetes and can help avoid the need for medication. If these measures are not enough, doctors may prescribe one or more of the following diabetes medications, all of which have the effect of lowering blood sugar levels or helping to control them.
- Metformin (Glucophage® or Glumetza®) is the cornerstone of treatment for the vast majority of people with type 2 diabetes. It works by decreasing insulin resistance, which helps the body use glucose more efficiently without the risk of hypoglycemia. It also promotes weight loss;
- Medications that increase insulin secretion (or insulin secretors) include sulfonylureas (Diabeta®, Diamicron®, Diabeta®) and glinides (Starlix®, GlucoNorm®). They directly stimulate insulin production by the pancreas through various mechanisms. They are very effective in controlling blood sugar levels, but with the potential risk of causing hypoglycemia;
- Thiazolidinediones (or glitazones), a class of drugs that includes rosiglitazone (Avandia®) and pioglitazone (Actos®), improve blood glucose levels by decreasing insulin resistance. These drugs are being prescribed less and less in Canada and warnings have been issued by regulatory agencies because of the risk of heart attacks and fractures in certain populations. It should be noted that rosiglitazone-based drugs were withdrawn from the European market at the end of 2010 due to their cardiovascular adverse effects;
- Acarbose, which is an alpha-glucosidase inhibitor (Glucobay®), reduces the absorption of carbohydrates in the gut. They must be taken with a meal to be effective and may cause bloating and flatulence caused by unabsorbed sugars;
- Incretinomimetics (or incretins) are a new family of drugs that includes Januvia® (sitagliptin), Byetta® (exaenatide), Onglyza® (saxagliptin) and Victoza® (liraglutide). They work by increasing insulin secretion after a meal without causing hypoglycemia. Oral medications (sitagliptin and saxagliptin) have a neutral effect on weight. Victoza® is a newcomer to the market, is administered by injection and is associated with weight loss. However, it is not indicated for first-line use and its long-term effects and safety are unknown.
Weight-loss medications such as orlistat (Xenical®) may be considered in diabetic patients suffering from obesity. They are useful for improving blood glucose levels by allowing weight loss. However, their cost is high and they are not appropriate for all patients.
Insulin treatment with injections is a very valid option, although it is often used after failure of oral medications. It can also be used temporarily, for example, in cases of severe hyperglycemia, infection, hospitalization, or surgery. Insulin injections may be required when medications are no longer sufficient because insulin secretion decreases over time in people with type 2 diabetes. Injections are usually given once a day, often in the evening. Some people can also be treated with an insulin pump.
Type 2 Diabetes – Our Doctor’s Opinion
If you have type 2 diabetes, you can have some control over your disease by taking an active role in your treatment. Diabetes is a demanding disease, but it has the advantage of being able to change the course of the disease by being involved in its treatment. You will reap long-term benefits.
There are many tools to improve your blood glucose levels, and adopting a healthy lifestyle is the basis of treatment. It is also important to monitor your blood glucose levels regularly. This will tell you right away if your diabetes is well controlled or not. The frequency of monitoring varies from person to person, but should be increased at least 1 week before your doctor’s appointment to allow him or her to analyze changes in your capillary blood glucose levels during the day and to better adjust your treatment. In addition, the prevention of complications related to diabetes involves, among other things, stopping smoking and controlling blood pressure and cholesterol levels, which your doctor will assess.
The goal is to achieve and maintain an acceptable average blood sugar level without hypoglycemia. This average is reflected in the measurement of glycated hemoglobin. You can ask your doctor to share your results with you so that you know where you stand in relation to the targets.
Finally, several avenues have been studied to prevent this disease, including medications. However, simple healthy eating and exercise are the most effective. These recommendations are achievable and free of side effects, but more importantly, they provide health benefits that go far beyond diabetes prevention.
Type 2 diabetes – Complementary Approaches
Warning. Self-medication for diabetes can cause serious problems. When you start treatment that changes your blood glucose levels, you must monitor your blood glucose levels very closely. It is also necessary to inform your doctor so that he or she can review the dosage of conventional blood-glucose-lowering drugs if necessary.
- Ginseng (Panax ginseng and Panax quinquefolium). A growing number of good quality studies are validating the traditional use of ginseng roots and rootlets to treat diabetes, but trials involving a larger number of subjects would allow more reliable conclusions to be reached4. 4 Ginseng is thought to help normalize blood glucose levels in people with diabetes,28 particularly after meals.
- Psyllium (Plantago ovata). The main effect of taking psyllium with a meal is to lower the total glycemic index of the meal. This causes glucose and insulin levels to decrease by 10% to 20% after the meal. Psyllium works in a similar way to acarbose, a medication used by some people with type 2 diabetes: it slows down the absorption of carbohydrates into the digestive system. A 2010 review of 7 randomized studies concluded that psyllium is an interesting treatment option for type 2 diabetics who are on medication and still have high blood glucose levels after meals.
- Glucomannan. a soluble fibre, similar to psyllium but even more absorbent and emollient than psyllium. It is made from konjac flour (a type of tuber) in a purified form. The results of several clinical trials indicate that glucomannan may be useful in reducing or controlling blood sugar levels in people with diabetes or obesity.
- Oats (Avena sativa). Research indicates that consumption of oatmeal helps to prevent the rise in blood glucose levels following a meal (postprandial hyperglycemia). Oatmeal may also help to control blood glucose levels over the long term. Like psyllium, oatmeal contains high levels of soluble fibre, which slows gastric emptying.
- Chromium. a trace element essential to human health, naturally present in many foods. In particular, it increases tissue sensitivity to insulin, which helps normalize blood sugar levels. In 2007, a meta-analysis of 41 trials (including 7 in patients with type 2 diabetes) showed that chromium supplements decreased glycated hemoglobin levels by 0.6% and fasting blood glucose levels by 1 mmol/L41. However, the use of chromium supplements (from 200 μg to 1,000 μg per day) by people with diabetes remains controversial given the highly variable quality of the studies conducted to date.
- Fenugreek (Trigonella foenum-graecum). The results of a few clinical studies in diabetics have shown that fenugreek seeds may help regulate blood glucose levels in type 216-18 diabetes. Although promising, these trials had a number of flaws, so it is not possible at this time to suggest a treatment protocol19.
- Cinnamon (Cinnamomum verum or C. cassia). Some small studies have shown that cinnamon can reduce blood glucose levels in people with diabetes, but more comprehensive studies will be needed to confirm these results.
- Tai-chi. Some researchers have speculated that tai-chi may help regulate blood glucose levels in people with diabetes. To date, the various studies have presented contradictory results. Some studies show improvements, others do not.
- Aloe (Aloe vera). Aloe is one of the plants to which Ayurvedic medicine (from India) attributes hypoglycemic or anti-diabetic properties. Studies conducted to date tend to confirm this use, but are few in number. Dosage: Although the efficacy of the gel as a hypoglycemic substance is not clearly established, it is usually recommended to take 1 tbsp twice a day before meals.
- Blueberry or bilberry (Vaccinium myrtilloides and Vaccinium myrtillus). In Europe, blueberry leaves have been used for more than 1,000 years to lower blood glucose levels. Tests carried out on animals tend to confirm this traditional use. However, the use of blueberry leaves for this disease has not been tested on humans. Dosage: Practitioners recommend infusing 10 g of leaves in 1 litre of boiling water and taking 2 to 3 cups of this infusion per day.
- Gymnema (Gymnema sylvestre). In many countries (India, Japan, Vietnam, Australia…), traditional doctors use gymnnema to lower glucose levels in diabetics24,28,29. However, no double-blind clinical trial with placebo has been conducted, so there is no scientifically valid evidence of its effectiveness. Dosage: Rather than dried leaves, a standardized 24% gymnemic acid extract is used nowadays. This extract, often referred to as GS4, is the raw material for the majority of commercial products. Take 200 mg to 300 mg of this extract twice a day with food.
- Momordica (Momordica charantia). Momordica, also known as margose, is a tropical climbing plant that produces fruits that look like cucumbers. Traditionally, several peoples have used its fruit to treat a variety of ailments. The consumption of fresh fruit juice is believed to help regulate blood sugar levels in diabetics, for example, by lowering blood sugar levels. This effect has been confirmed by several in vitro and animal tests. Studies in humans are at the preliminary stage. Dosage: Traditionally, it is recommended to drink 25 ml to 33 ml of fresh fruit juice (about the equivalent of 1 fruit) 2 to 3 times a day before meals.
- Nopal (Opuntia ficus indica). The stems of the nopal, a cactus from the desert regions of Mexico, have been used in traditional medicine to reduce fasting blood glucose in diabetics. This effect has been observed in a few clinical trials conducted by Mexican researchers. Rich in dietary fibre, nopal is believed to act mainly by reducing glucose absorption. Dosage: In studies with positive results, 500 g of roasted nopal flesh was used per day.
- Naturopathy. The American naturopath J.E. Pizzorno suggests, among other things, that diabetics should take a multivitamin and mineral supplement,36 as the disease would lead to an increased need for nutrients. In his experience, this practice improves blood glucose control and helps prevent the major complications of diabetes. A double-blind, placebo-controlled study of 130 subjects (45 years and older) showed that people with diabetes who took multivitamins for one year had fewer respiratory infections and flu than untreated diabetics.
Moreover, the naturopath considers important that diabetics consume a large quantity of flavonoids, in food form, for their antioxidant effect. Indeed, there are more oxidation and inflammation reactions in the body of people with diabetes. Flavonoids are found mainly in fruits and vegetables (artichoke, onion, asparagus, red cabbage and spinach) and in even greater quantities in berries. They are also found in the form of supplements.
Type 2 Diabetes – Websites and Support Groups
These do not treat diabetes but could improve overall health. See our Naturopathy fact sheet.
The mission of this association is to inform about diabetes and to promote research on this disease. Diabetes Québec also provides services and defends the socio-economic interests of people with the disease.
See suggestions for recipe books in the Books and Materials section: www.diabete.qc.ca
Canadian Diabetes Association (Association canadienne du diabète)
Very complete site in English (some documents are available in French): www.diabetes.ca
Of particular note on this site, about the exercise: www.diabetes.ca
Health Canada – Diabetes
An up-to-date dossier on diabetes, in French and English.
Programs and services for people with diabetes: www.phac-aspc.qc.ca
Prevention program for Aboriginal populations: www.phac-aspc.qc.ca
Quebec Government Health Guide
To learn more about drugs: how to take them, what are the contraindications and possible interactions, etc., click here.
American Diabetes Association
International Diabetes Federation: For its news articles, presentation of epidemiological data, announcement of international congresses, etc., it is the ideal partner for the company. (in English only, French and Spanish translations in development).
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