Diabetes

Diabetes mellitus is a pathological painful increase in blood sugar levels when blood sugar tests exceed 125 mg/dL or 7.0 mmol/L.

There is also the so-called border zone blood sugar levels between 110 and 125 mg/dl, corresponding to values greater than 6.1 and less than 7.0 mmol/l.

Blood sugar levels are regulated by the hormone insulin produced in the pancreas. There are two types of diabetes:

• type 1 affects mainly young people under the age of 40 and is accompanied by complete destruction of beta cells (pancreas) and resulting insulin deficiency.
• Diabetes type 2 This is a typical increase in blood sugar levels in older people. This type of disease is characterized by insulin resistance caused by excess weight, as well as a decrease in insulin production.

Causes

In Germany, there are approximately 10 million people with diabetes. Of these, 7 million are being treated, and approximately 3 million have not been tested and do not know they have the disease.

The starting points for the onset of the disease are four factors that doctors call the metabolic syndrome, or rather accurately the "death quartet". This "death quartet" includes:

• high blood pressure,
• fat metabolism disorders
• obesity (especially in the abdomen),
• as well as impaired glucose metabolism.

The basis for all troubles is the adipose tissue between the intestinal loops, as well as the adipose tissue of the liver. The resulting insulin resistance leads most type 2 diabetics to greatly elevated blood sugar levels.
Changes occur differently in type 1 diabetics. In this case, we are talking about the progressive destruction of insulin-producing pancreatic beta cells, starting already at a young age. This destruction can lead already in childhood and adolescence to such increases in blood sugar levels, which are accompanied in some cases by the onset of severe ketoacidotic coma.

Prevention

Numerous large-scale scientific observations clearly prove that lifestyle changes can prevent the onset of diabetes. Reducing body weight by 5-10 percent, four hours of sports activity per week, and changing eating habits (reducing fat intake and increasing fiber-rich foods) leads to an increase in insulin sensitivity of cells and a decrease in the risk of diabetes. Only 25 percent of people with a predisposition to diabetes fail to completely eliminate the risk of diabetes using the above measures. There is no other way to prevent diabetes.

Things look different in type 1 diabetes. The cause of diabetes in this case is not overweight or insulin resistance, but the attack of one's own imbalanced immune system against insulin-producing cells in the pancreas (in the form of antibody production).

You can check your own risk of developing diabetes with a special test. If you score more than 12 points in this case, you should not postpone the start of preventive measures. If you do not take more than 15 or even more than 20 points, you are at an acute risk of developing diabetes.

Symptoms

The number of estimated 3 million diabetics in Germany who have not yet been diagnosed with diabetes shows that the symptoms of early diabetes are hardly perceived. Only a significant increase in blood sugar levels leads to a decrease in concentration, as well as loss of fluid from the body as a result of increased urine production. In addition, sugar appears in the urine, so that the urine becomes sweet. Sometimes frequent nighttime urination with high blood sugar is the first symptom of diabetes. In type 1 diabetics, as a result of a lack of insulin, a ketoacidotic coma may occur, accompanied by clouding of consciousness.

Sometimes diabetes is diagnosed based on its complications, such as a stroke or myocardial infarction.

Diagnostics

A reliable method for diagnosing diabetes is to measure the level of fasting blood sugar, as well as to conduct an analysis with a sugar load. With this test, a blood sugar level above 200 mg/dl clearly indicates the presence of diabetes mellitus. A blood glucose level between 140 and 200 mg/dl as measured twice within an hour indicates a pre-diabetic glucose utilization disorder.

To check for diabetic metabolic disorders, a so-called long-term memory test of blood sugar, lykylated hemoglobin, or an HbA1C test is used. This test should be done every three months and should not exceed 6.5 in well regulated diabetics.

To establish susceptibility to insulin, the homiamine or proinsulin index is determined.

Treatment

The treatment of type 2 diabetes is based on three pillars. 

• 1. Movement therapy.
• 2. Changing eating habits.
• 3. Drug treatment, including insulin injections.

We have numerous possibilities for the medical treatment of diabetes. Firstly, it is known for many years and well-established drug "Metformin", which is the main drug for obese diabetics and reduces insulin resistance. Sulfonyl preparations have also been used for many years. This group of drugs acts on the beta cells of the pancreas and increases insulin production.
Other drugs are so-called insulin sensitivity enhancers. This group includes the drugs Rosiglitazone* (Rosiglitazone*) and Pioglitazone (Pioglitazone). Both of these drugs should increase the susceptibility of tissues to insulin and reduce blood sugar levels due to this.

These medicines have been used in Germany since May 2007. They affect the production of incretins - a group of hormones that are produced by the intestinal mucosa during digestion. These medications lower blood sugar levels based on food intake.

For most type 2 diabetics, three to five years after the onset of diabetes, there is a moment when the regulatory capacity of the pancreas is exhausted and medical treatment becomes insufficient. In this case, the introduction of insulin is necessary. There are currently approximately 1.9 million people in Germany using insulin.

Thanks to modern insulin delivery devices and modern ultra-short-acting insulin preparations that are administered immediately after a meal, most diabetics can lead a completely normal life. Type 1 diabetics are more dependent on insulin from the start.

Currently, the so-called intensive insulin therapy is widespread. That is, the patient injects himself once or twice a day with long-acting basal insulin, as well as the so-called short-acting insulin immediately before meals. Numerous examples show that people with diabetes can play sports up to overcoming marathon distances. The expression "Healthy as a diabetic" is no longer just a joke.

A balanced adjustment of blood sugar levels in diabetes can prevent the occurrence of complications typical of diabetes.

Diabetes mellitus leads to a significant increase in the risk of myocardial infarction and an increase in the risk of cerebrovascular accident, as well as to progressive kidney damage. More than 50 percent of patients receiving hemodialysis are diabetic today.

Diabetic damage to the nervous system, caused by impaired circulation of the peripheral nerves, is not only very painful and unpleasant for patients, but also leads to the so-called diabetic foot disease. It results in approximately 20,000 lower limb amputations per year in Germany, operations that could have been avoided. Consistent adjustment of sugar levels and successful coordination of doctors of various specialties, including diabetologists, surgeons, podologists, angiologists (specialists in blood vessels), as well as uncompromising treatment of wounds of the lower extremities, can prevent such a highly unpleasant operation as amputation.

The increased risk of cardiovascular disease (increased risk of myocardial infarction) leads to the fact that the main treatment for diabetes is not only the adjustment of sugar levels, but also the simultaneous adjustment of risk factors such as cholesterol and blood pressure. The required follow-up examinations are oriented towards the so-called "diabetic blue passport" of the German Diabetes Society and include quarterly monitoring of metabolic parameters, blood pressure and body weight, as well as an annual detailed examination of the peripheral vascular condition and an examination of the fundus.