Type 2 diabetes mellitus: causes, treatment, prognosis

Introduction: What is Type 2 Diabetes?

Diabetes mellitus summarizes a group of metabolic disorders, all of which are associated with high blood sugar levels (hyperglycemia). With about 6.6 million people affected in Germany, diabetes mellitus type 2 is the main representative of this group. Trend rising in recent years. Type 2 diabetes is a multifactorial disease. This means that disease development can not be explained by a single cause. Rather, many factors have to work together in unknown ways to cause diabetes. In addition to environmental influences and lifestyle factors, genetics also seems to have a considerable influence on the development of the disease.

Unlike type 1 diabetes, there is no absolute insulin deficiency in type 2 diabetes (the so-called old-age diabetes): The pancreas continues to produce insulin for a long time and releases it into the blood. However, the body cells no longer respond to the hormone, which raises the blood sugar level. In contrast, type 1 diabetes is an autoimmune disease caused by the destruction of the insulin-producing cells of the pancreas. This leads to absolute insulin deficiency.

 

Accordingly, the treatment of type 2 diabetes differs from that of type-1. While type 1 is the only treatment option for insulin use, type 2 exercise, nutrition and obesity are far more important and are essential for successful treatment.

Read the basics:
All questions and answers on the basics of diabetes >>

Causes of Type 2 Diabetes

In the development of diabetes mellitus type 2, many causes work together. On the one hand, there is a genetic predisposition to develop the disease. This is hereditary and can not be influenced: Anyone who has parents or siblings who are suffering from type 2 diabetes, carries an approximately 60% risk of contracting. On the other hand, so-called "lifestyle factors" are blamed for the development of type 2 diabetes. Obesity and physical inactivity can lead to insulin resistance in the long term and thus contribute to the development of the disease.

In healthy people, blood sugar levels are regulated by two hormones, both of which are produced by the pancreas: Insulin is produced in the beta cells of the pancreas and ensures that the blood sugar does not increase too much after a meal. It does so by promoting the absorption of sugar from the blood vessel system into the body's cells. Glucagon is the antagonist of insulin. It is produced in the alpha cells of the pancreas and is responsible for ensuring that the blood sugar level does not fall below a certain level even if the body has not been fed for a while. Cells no longer respond adequately to insulin

An insulin resistance, as occurs regularly in diabetes mellitus type-2, is characterized in that although sufficient insulin is still produced, the body cells, however, no longer adequately respond. As a result, the excess sugar is not absorbed from the blood and the blood sugar level rises. Especially overweight or certain hormones that are released from the fatty tissue into the blood, promote the development of insulin resistance. Furthermore, lack of exercise is considered a major cause of the disease.

In response to rising blood sugar levels, the pancreas produces more and more insulin and, despite its lack of effect, releases the hormone into the bloodstream. Thus, insulin levels in the blood even increase at the beginning of the disease (hyperinsulinemia). A vicious circle develops, which results in exhaustion of the pancreas and ever-increasing blood sugar levels.

Read about causes too:
All questions and answers about the causes of diabetes >>

Symptoms of Type 2 Diabetes

Since the body can get used to slowly rising blood sugar levels, the type 2 diabetes causes long no complaints.But that's exactly what makes it so dangerous: When the disease is diagnosed, secondary damage has often already occurred to other organs. For this reason, it is important, especially in the case of a family history and the presence of risk factors, to have blood glucose levels from the age of 35 examined in the biennial check-up.

Symptoms of the disease occur when the blood glucose level rises above a certain level. The body then tries to excrete the sugar through the urine. Since sugar binds a lot of water, the body loses important fluids. Typical complaints are:

  • frequent urination
  • great thirst
  • general weakness
  • dry skin

In many cases, however, the diabetes also manifests itself through completely different, much more unspecific complaints. These include:

  • power reduction
  • Deterioration of vision
  • wound healing
  • frequent infections

Prolonged elevated blood sugar levels especially damage the small vessels, which can worsen the circulation situation, especially on the extremities, and can lead to non-healing wounds. The same is true of infectious diseases: Diabetes weakens the immune system and creates a milieu in which pathogens can multiply well. As a result, common cold and flu, but also bladder infections and vaginal or athlete's foot can occur.

Read about symptoms too:
All questions and answers about the symptoms of diabetes >>

Diagnosis of type 2 diabetes

The diagnosis of type 2 diabetes mellitus is usually made by persistently elevated blood sugar levels by a physician. Speak for a diabetes:

  • an occasional blood glucose of 200 mg / dL (11.1 mmol / L) and more at any time during the day;
  • a fasting glucose value (8 hours since the last meal) of 126 mg / dL (7.0 mmol / L) and more;
  • an elevated HbA1c (long-term blood glucose) value of 6.5% (48 mmol / mol) and more

The result can be confirmed on the following day by another blood glucose measurement. Typically, fasting blood glucose is 100 mg / dL (5.6 mmol / L). The diagnosis of diabetes can be made from values ​​of 126 mg / dl (7.0 mmol / l). Everything that lies between these two limits has to be controlled. It is possible that there is already a prediabetes, a kind of precursor, from which develops a diabetes requiring treatment within the next months to years.

Oral glucose tolerance test

Unlike type 1 diabetes, the diagnosis of type 2 diabetes often includes the oral glucose tolerance test (oGTT). The test is particularly useful when there is a suspicion of diabetes due to borderline fasting or occasional blood glucose. But even with a family history or in the presence of risk factors such as excessive obesity, the test is used.

Typically, when administering the oGTT, you must drink 250 ml of water containing 75 g of glucose on an empty stomach. Before drinking the glucose solution and one and two hours later, the doctor will take your blood and determine the blood glucose level from the plasma. The test is positive if the fasting value is greater than 126 mg / dl (7.0 mmol / l) and if the value measured after two hours has risen above 200 mg / dl (11.1 mmol / l).

Further investigations

If diabetes or increased blood sugar is detected, the additional examination of the urine using test strips (Urinstix) makes sense. Urinstix can directly detect glucose in the urine and provide information about whether the body is already trying to compensate for the elevated blood sugar level by excretion of sugar via the urine. However, the sole detection of sugar in the urine is not sufficient to make the diagnosis of a type 2 diabetes. Because many other diseases can lead to increased urinary glucose concentrations via damage to the kidney. However, the test strip may also detect albumin in the urine, which, in the context of the diagnosis of diabetes mellitus, indicates the onset of diabetic nephropathy (kidney damage caused by persistently high blood sugar levels).

Read on the subject of diagnosis also:
All questions and answers on the diagnosis of diabetes >>

Therapy of type 2 diabetes

You can contribute a great deal to successful treatment of type 2 diabetes mellitus yourself. Because sometimes the disease is based on an unhealthy lifestyle, consisting of little exercise, unhealthy diet and obesity. These things must first be counteracted in order to normalize the disturbed sugar metabolism. If these measures can not be implemented or if the diabetes continues despite lifestyle changes, one or more medications may be used to normalize blood sugar levels.

treatment goals

Depending on how advanced the diabetes has progressed and how great your motivation is to do something for your own health, the treatment goals are set individually with a doctor.Successful treatment is not only aimed at optimally adjusted blood glucose levels, but also aims to prevent complications such as vascular and nerve damage. Long-term diabetes episodes such as heart attack or stroke can only be prevented by a comprehensive therapy. For this reason, in addition to the blood glucose values, a number of other blood values ​​must be checked and adjusted at regular intervals. However, some of these values ​​can be very well influenced by a healthy lifestyle. A point that you should always keep in mind.

Possible therapy goals in type 2 diabetes are:

  • Overweight reduction through exercise and balanced nutrition
  • No smoking and excessive alcohol consumption
  • Long-term blood glucose (HbA1c <7%)
  • Fasting blood glucose: 80-110 mg / dL (4.5-6.1 mmol / L)
  • Blood pressure: <130 / 80mmHg
  • LDL cholesterol: <100 mg / dl (2.6 mmol / l)
  • HDL cholesterol:> 45 mg / dl (> 1.2 mmol / l)
  • Triglycerides: <150 mg / dL (<1.7 mmol / L)

Read about therapy goals also:
Diabetes: everyday life and lifestyle

Step diagram of type 2 diabetes therapy

The treatment of diabetes mellitus type 2 is carried out according to a graduated scheme, consisting of four stages. The aim of each stage is to normalize blood glucose within 3-6 months or to lower it according to agreed goals. If the respective goal is not reached, the treatment is from then on to the next higher level.

Step 1:

The so-called basic therapy of type 2 diabetes does not provide for any medication. This stage is about changing your lifestyle and working towards a healthier lifestyle. These include above all:

  • physical movement
  • balanced, Mediterranean diet
  • Overweight reduction
  • quitting smoking
  • reasonable handling of alcohol

If the therapy goals agreed with the doctor are achieved within half a year, all further stages of the scheme are superfluous. The diabetes must continue to be monitored, but the use of a drug is not necessary in the first place.

Level 2:

If the baseline measures of the first treatment level are not sufficient, a drug is prescribed after 3-6 months in addition to the lifestyle change. As a rule, metformin is chosen because it has a good effect on metabolism and blood sugar, especially in overweight (more on this ingredient below). Alternatively, however, it is also possible to use other active substances, such as, for example, sulfonylureas, DPP-4 inhibitors or alpha-glucosidase inhibitors, which can be taken as metformin as a tablet. Likewise, the beginning of insulin, which must be injected, conceivable.

Level 3:

If the blood sugar level has not fallen sufficiently after another 3-6 months, the treatment is carried out according to the third stage. This provides the additional gift of a second drug, in addition to the treatment measures of level 2. The effect of the second drug should optimally add up to that of the first and thus ensure a successful glycemic control. In most cases, two oral antidiabetics are used at this stage. Alternatively, however, a monotherapy with insulin can be started.

Level 4:

In the final stage of treatment for type 2 diabetes, insulin therapy is always started. Here are various schemes for administering the drug available.

Also conceivable would be a combination of three oral antidiabetics, ie three different tablets. However, there are as yet no studies for this treatment option, which can be proof of success. Another disadvantage is that at least three tablets alone would have to be swallowed for diabetes adjustment.

basic therapy

The basic therapy is the most important element of the treatment of type 2 diabetes. It is part of every stage of therapy and is able to effectively lower blood sugar - if used consistently.

To learn a healthier lifestyle, diabetes training is essential. Here you will learn how you can influence your illness through healthy nutrition and exercise.

Elemental: movement

Sport is an important element of this: on the one hand, it promotes the sensitivity of the cells to the still-produced insulin. As a result, the sugar in the blood can be transported better into the cells and the blood sugar level drops. And secondly, sport leads to sustained weight loss, regulates the feeling of hunger and boosts the metabolism.

Movement does not always have to take place on the sports field. Much more is about incorporating them into everyday life. Climbing stairs, instead of using the elevator, or leaving the car in front of the bike, are the first steps that should be taken consciously to stay physically active. At best, you should walk 10,000 steps (about half an hour) on at least five days a week. What sounds like a lot at first glance, will soon become routine. Diet change: not so dramatic

The second pillar of basic therapy is nutrition. In principle, the same recommendations apply here as for people without diabetes. The German Society for Nutrition (DGE) emphasizes: "The ideal diet of a diabetic does not differ from the nutritional recommendations of the general population". This means that diabetics do not have to resort to diabetic foods or have to do without sugar altogether. Nevertheless, you should pay attention to a balanced, low-sugar diet. A balanced diet includes about 55% carbohydrates, 15% protein and 30% fats with an average calorie requirement of about 25 kcal per kilogram of body weight a day.

It should be noted that certain carbohydrates cause blood sugar to rise more than others. For example, wholemeal and high-fiber carbohydrates lead to a less pronounced increase in sugar than pure white flour products. What foods are best for you is best learned in a comprehensive diabetes education course offered by many medical specialists and other institutions.

Read about exercise also:
All questions and answers about sports and exercise

Oral antidiabetics (diabetes tablets)

If blood sugar levels can not be adequately adjusted despite the change in lifestyle through the basic therapy, oral antidiabetics are used. These are diabetes medications that - unlike insulin - can be taken as a tablet and do not need to be injected.

Read about diabetes tablets also:
Worth knowing about diabetes tablets >>

Biguanides (metformin)

Metformin is currently the only major biguanide agent and the first choice drug for the treatment of type 2 diabetes. Metformin has many effects on the blood sugar metabolism:

  • It reduces sugar absorption from the intestine.
  • It improves blood sugar uptake and sugar utilization in body cells.
  • It prevents the body from producing sugar and releasing it into the blood (gluconeogenesis).
  • It reduces hunger and appetite, which has proven to be very effective especially in overweight.

However, metformin can sometimes trigger severe side effects: nausea and nausea can severely restrict the quality of life. Since there are some, though rare, dangerous side effects, kidney function must always be checked regularly with metformin. The reason: If this is limited, the drug can not or only partially eliminated from the body, making the occurrence of side effects more likely.

Sulfonylureas: Glibenclamide, Glimepiride & Co

Sulfonylureas such as glibenclamide or glimepiride are used when metformin can not be used or does not produce sufficient effect. Drugs of this class lead to an increased release of insulin from the pancreas, which still produces sufficient amounts of the hormone at the beginning of the diabetes disease. In the course of the disease, however, this function dries up and the sulfonylureas lose their effect.

Although sulfonylureas can effectively lower blood sugar. However, it can also lead to weight gain during treatment. Other side effects include nausea, diarrhea and vomiting.

If you are getting sulfonylureas, you should be aware of regular food intake. Because insulin is released by the medication, regardless of whether the blood sugar level is currently too high or not. This can lead to dangerous hypoglycemia if there is insufficient food intake, after sporting activities and during stress or infections. If there is kidney weakness, sulfonylureas should not be used as the risk of hypoglycaemia is even greater.

Read about sulfonylureas also:
What kind of tablets are sulfonylureas?

Glinide: nateglinide and repaglinide

Similar to the sulfonylureas, the sulfonylurea analogues nateglinide and repaglinide act. They too increase insulin production in the pancreatic beta cells and thus lead to food-independent regulation of blood sugar. The blood sugar level is reduced less by Glinide than sulfonylureas, however, their effects are very fast, making it necessary to take a dose just before eating. This is a significant advantage, as the dosage can be optimally adapted to the food portion. As with the sulfonylureas, side effects include low blood sugar, gastrointestinal discomfort, and mild weight gain.

Alpha-glucosidase inhibitors: Arcabose and Miglitol

Alpha-glucosidase is an enzyme that catalyzes the breakdown of starch and sucrose into individual sugar molecules in the intestine so that they can be absorbed into the blood via the intestinal wall. Alpha-glucosidase inhibitors such as Arcabose and Miglitol prevent this mechanism, so that the sugar molecules do not orincompletely broken down into their individual parts and so the intestinal wall can not pass. Consequently, you will be excreted with the chair. A key benefit of this class of drugs is that they reduce blood sugar rise after meals without causing hypoglycaemia. However, bloating, abdominal pain and diarrhea often occur due to the sugar molecules in the intestine, which significantly reduces the popularity of the alpha-glucosidase inhibitors.

Incretins: exenatide, liraglutide, sitagliptin, vildagliptin

The group of incretins includes two classes of drugs that can lower blood sugar levels through a similar mechanism:

  • GLP-1 receptor agonists - also called incretin mimetics
  • DPP-4 inhibitors - also called gliptins

The basic idea of ​​this group of drugs is as follows: In healthy people, incretins are hormones that are released in the intestine when ingested and transported via the blood to the pancreas. There they provide glucose-dependent insulin release from the pancreas by binding to the so-called GLP-1 receptors. Once the incretins reach their site of action, activate the receptor and promote the release of insulin, they are degraded by dipeptidyl-pepididase-4 (DPP-4) and thus lose their effectiveness.

Two ways to the same destination

GLP-1 receptor agonists such as exenatide and liraglutide are engineered to mimic the physiological mechanism of hormones by binding to and activating GLP-1 receptors.

Gliptins (sitagliptin, vildagliptin), on the other hand, inhibit the enzyme DPP-4, which is responsible for the degradation of the incretins, thus preventing the loss of the hormone. So, ultimately, both drugs cause the GLP-1 receptor to stay activated longer and release more insulin into the blood.

Both incretin mimetics and gliptins are typically used in combination with other agents, such as metformin, when metformin monotherapy fails to lower blood sugar levels. Both drugs may cause gastrointestinal discomfort as an adverse reaction and are suspected to be related to the onset of pancreatitis (pancreatitis).

insulin therapy

Insulin is the only one of the listed medicines that can not be taken as a tablet. Chemically, insulin is a protein that, when taken orally in the stomach, would be decomposed by gastric acid and become ineffective. For this reason, insulin must be injected into the subcutaneous fatty tissue by means of insulin pens. You can also do this therapy after thorough training.

The advantage of insulin therapy is that it (properly dosed) leads to fewer side effects and allows a maximum flexible daily routine. But not every insulin therapy is the same. There are different schemes to spray on. Common to all schemes is that they are a combination of two types of insulin: a long-acting insulin (such as Levemir®, Lantus®) that covers the baseline throughout the day, and a short-acting insulin (such as Humalog®, NovoRapid® , Apidra®), which is administered only with meals and buffers the blood sugar spikes. As a rule, you and your doctor will decide which of the following treatment schemes suits you best.

Read about insulin also:
Worth knowing about insulin therapy

Conventional insulin therapy

Conventional insulin therapy is no longer commonly used today. In this regimen, both types of insulin are administered together at fixed times of the day and in a fixed mixing ratio. A clear advantage of this method is the relatively simple application that can be learned quickly in a training course. The disadvantage is that the planned insulin doses presuppose a very rigid daily routine: Portion size and the time of food intake must always be consistent. Basically, what is previously administered to insulin is eaten, not the other way around, as the body would naturally do. If the body once needed more or less insulin than it was injected, it can lead to over- or under-sugar, which is difficult to counteract.

For people who live a flexible daily routine, travel a lot and can not or do not want to take every meal at home, conventional insulin therapy is rather inappropriate. Much better then is the intensified conventional insulin therapy.

Intensified conventional insulin therapy

In this regimen, the insulin dose is always adjusted directly to the current blood sugar level. The intensified conventional insulin therapy, which is based on the so-called basic bolus principle, allows the greatest possible freedom, but must be well monitored by regular blood glucose measurements.

The scheme provides for the administration of the above-mentioned types of insulin (long-term and short-term insulin) at different times of day and after individual dosing: firstly, once a day, usually in the evening at 22 o'clock, a long-term insulin is injected (based), the basal insulin requirement covering over 24 hours.

At each meal, a fast-acting and short-acting insulin (bolus) is also administered, which captures blood sugar spikes after eating.

Eat when you want

The advantage of this method is that you can adjust the bolus injections of fast and short-acting insulin directly with the size and timing of food intake and do not have to eat at fixed times of the day or to abstain from eating. In order to get a feeling for the own blood sugar, with this method, particularly at the beginning, frequent blood glucose measurements must be carried out: It is important the value determinations particularly before each Bolusgabe and one and a half to two hours after a meal. On the basis of these values, it is then possible to calculate how much insulin has to be injected and to check whether the dose of the medication used was appropriate.

Dealing with the basic bolus principle requires a lot of practical skill, knowledge and, above all, experience. At first, this form of insulin therapy is far more complex, but over time it allows a great deal of freedom. The blood sugar can always be adjusted when the situation changes, as it is for example in sports, night shifts, long-distance travel or acute illnesses. The quality of life increases and the blood sugar levels usually have much better long-term values.

Read about insulin therapy also:
All questions and answers about insulin therapy >>

insulin Pump therapy

While the administration of insulin by means of insulin pen always takes place in portions and therefore also produces larger blood sugar fluctuations, a constant supply of insulin can only be achieved with the help of an insulin pump. The insulin pump is an external pump that is about the size of a pack of cigarettes and is worn on the body. Insulin is continuously released into the subcutaneous fatty tissue via a small cannula located under the skin. So a basic supply of the drug can be achieved. At mealtimes, a bolus of short-acting and fast-acting insulin must be dispensed at the press of a button to prevent the appearance of blood sugar spikes.

The use of an insulin pump has the advantage that you can save yourself the multiple daily injections. However, in this type of insulin administration, the blood sugar must be measured even more frequently than in the intensified conventional insulin therapy. In addition, dealing with the insulin pump is not quite trivial and requires a very thorough training and technical skill. Another disadvantage is that the cost assumption of this form of therapy is not regular and not done by all health insurance. Only in children, pregnant women and inadequate metabolic control of type 1 diabetes, the device is usually always refunded. In the case of type 2 diabetes, however, a case-by-case examination by the health insurance funds is necessary.

Read about insulin pump therapy also:
All questions and answers about the insulin pump >>

Possible consequences of diabetes type 2

Diabetes mellitus type 2 is particularly dangerous because of its sequelae on numerous organs: persistently high blood sugar levels cause damage especially to small and large vessels as well as to the nervous system. As blood glucose levels in Type 2 diabetes usually increase slowly over a long period of time, the body adapts and the disease goes unnoticed. What can have fatal consequences.

Diseases of the cardiovascular system

Diabetes is one of the most important risk factors for the development of arteriosclerosis. Vascular wall calcification is a phenomenon of old age that affects almost everyone at some point. In the case of diabetes, atherosclerotic wall changes on the vessels develop significantly more frequently and much earlier. If the vessels of the heart are affected, a coronary heart disease develops, which can express itself through a feeling of tightness as well as through pain in the chest and not infrequently the harbinger of a heart attack. Due to the damaged nerves, these symptoms may also be completely absent, so that a heart attack can proceed without any symptoms (mute infarction) and thus severely damages the heart muscle. For this reason, if you have diabetes mellitus type 2, ECG checks are essential and should be performed at regular intervals.

Similar to the vessels of the heart, the vessels of the brain or the main arteries can also be affected by the calcification process. In severe cases, a stroke is the result, which can cause serious brain damage.

In order to prevent atherosclerosis, it is not only important to adjust the blood sugar well, but also to pay attention to a well-adjusted blood pressure and stop smoking.

Diseases of the nervous system

As already mentioned above, nerve cells can sustain damage due to persistently high blood sugar levels (diabetic nephropathy). The nerves then pass on information only inadequately or incorrectly, which can lead, for example, to discomfort such as numbness, tingling or burning. Also, the loss of the ability to perceive temperatures or touch are typical signs of diabetic nephropathy. The feet are particularly affected by this process. But nerve damage can also occur on other organs. In the internal organs are then, for example, digestive and bladder emptying disorders and impotence the result.

Diseases of the eye

The vessels of the eye are very sensitive to elevated blood sugar levels: Vascular occlusions, fat deposits and bleeding are possible reactions in the retina to a non-adjusted diabetes. They can lead to a shortage of oxygen and nutrients. The retina reacts with the formation of new vessels, which, however, are fragile, easily rupture and, in the worst case, can lead to retinal detachment. To detect changes in the retina at an early stage, it is important to have the fundus examined every two years. In case of recognizable bleeding or neovascularization there is the possibility of a laser therapy in the early stage.

Diseases of the kidney

Similar to the eye, a permanently elevated blood sugar can damage the kidney vessels. The kidney's job is to filter the blood of the body, get rid of pollutants through the urine and preserve nutrients. If the renal vessels are damaged, this function can no longer be performed to 100%, the body is flooded by pollutants, while valuable substances are lost. If the diabetes is not treated in time, the consequences for the kidney may be irreversible and lead to chronic renal insufficiency.

Diseases of the extremities: diabetic foot

Long-term elevated blood sugar levels may favor the development of chronic wounds. These occur in most cases on distal limbs and especially on the feet. The so-called diabetic foot syndrome is caused by a small injury such as a small skin tear, which is inflamed and becomes a chronic open wound. The cause of the poor wound healing is the reduced blood flow through which repair processes can take place only very slowly. Furthermore, the wounds often go unnoticed, since no pain occurs due to the nerve damage and especially wounds on the feet continue to be burdened and treated only inadequately. If a chronic wound can not be sufficiently treated by a doctor, the affected limb must be amputated in the worst case.

Actively fight episodes of diabetes

The sequelae of type 2 diabetes mellitus are all severe and associated with a significant reduction in the quality of life. And they threaten life. But they can be prevented: By a consistent and strict adjustment of blood sugar.

Authors: Lisa Wunsch & Dr. med. med. Jörg Zorn

 

Sources:

  • Helmut Schatz, Andreas F.H. Pfeiffer: Diabetology compact: Fundamentals and Practice, Springer Verlag, 2014
  • Evidence-based dietary recommendations for the treatment and prevention of diabetes mellitus, https://www.dge.de/fileadmin/public/doc/ws/EBL-Ernaehrung.pdf, last accessed: 01.01.2017
  • Association of Scientific Medical Societies: "National VersogungsLeitlinie Therapy of Type 2 Diabetes" http://www.deutsche-diabetes-gesellschaft.de/fileadmin/Redakteur/Leitlinien/Evidenzbasierte_Leitlinien/NVL_Typ-2_Therapie-lang_Apr_2014.pdf, last accessed on : 20.02.2017
  • Heinz Lüllmann, Klaus Mohr, Martin Wehling: Pharmacology and Toxicology, Thieme Verlag, 2015

 

The most important questions and answers about diabetes: a comment

Can you die of diabetes? Yes. Can you get rid of diabetes again? Yes. Between these two extremes, a metabolic disorder occurs, which is estimated to affect more than 6 million people in Germany. Experts assume a significantly higher number of unreported cases, as they suspect unrecognized diabetes in many other German citizens. The terms diabetes and diabetes have become firmly established in our language. Medically correct is called diabetes mellitus, because there is still a diabetes that has nothing to do with diabetes. Today it is no longer differentiated into expert youth in youth and old-age diabetes, but in type 1 and type 2.

Differences between diabetes type 1 and type 2

Type 2 diabetes is usually meant when talking about diabetes. Type 2 accounts for approximately 90-95% of all diabetes cases. He is closely related to the metabolic syndrome and is significantly supported by three factors: Obesity, lack of exercise and a carbohydrate-rich diet. Accordingly, he also usually makes himself felt only at an older age, mostly beyond the 60 years. However, the number of under-40s has recently risen sharply.

In diabetes mellitus insulin resistance or insulin deficiency leads to a derailed sugar metabolism, increased blood sugar levels and subsequent discomfort. Type 1 is an absolute insulin deficiency. The diagnosis is usually, but not always, made at an early age. The beta cells in the pancreas are no longer able to adequately produce the blood sugar regulating hormone in the affected individuals. Responsible for this are probably autoimmune processes, that is, an attack of the body's defense against structures of these cells. Type 1 diabetics are therefore dependent on the supply of insulin for life. But they can often get this disease under control so well that they can live a largely normal life. People with this condition have even become Olympic champions, Ironman or Miss America. Only they can not get rid of their diabetes.

The big danger: consequential damages

In type 2 diabetes, "old-age diabetes", it is not a primary lack of insulin that is the problem, but, above all, the resistance of the body's cells to its effects. Insulin has the task of transporting the sugar or glucose molecules from the blood into the body's cells. There, the glucose is needed as an energy supplier. In diabetes mellitus type 2, this does not work as it should. The blood sugar level rises. And thus the danger that different cell or tissue structures glycated, so provided with sugar components and thus damaged.

What may initially seem relatively harmless, unfortunately, in the long run serious or life-shortening consequences. The most common are cardiovascular problems, in which diabetics die prematurely, half of them have strokes. The problem: The consequential damages are not noticeable for a long time. When they do, they are often difficult or impossible to undo.

The dangerous companions of diabetes mellitus

More specifically: The diabetes mellitus is accompanied by some dangerous "companions". These are diseases that are more common in diabetics than in the general population. An example is hypertension (hypertension). With about 44% it is already very widespread in our society anyway. In diabetic patients, however, it occurs in the long term to 80%, and thus almost twice as often.

Diabetics have up to a 50-fold increased amputation risk compared to non-diabetics. The health report Diabetes 2015 states: A badly adjusted blood sugar leads in Germany to 40,000 amputations, 2,000 new blinds and 2,300 dialysis cases each year.

Basic therapy: lifestyle change

We do not want to scare you with these numbers. However, we want to make you more receptive to the important message: Do not just find yourself with your type 2 diabetes, even if you are receiving medical treatment. Because even then threatens a deterioration of your health situation. With a change in your lifestyle and eating habits, you - and only you - can do something about it. Therefore, the lifestyle change is now considered in professional circles as the crucial basic therapy of diabetes mellitus type 2, even before the drugs.

Anyone who starts with it changes their habits through positive experience

For a type 1 diabetic, a healthy lifestyle also only brings benefits. For them there is also positive news from the international experts. Thus, the differences in life expectancy between this patient population and the general population in several countries have become statistically much smaller. It used to be 15 years or more. This is mainly due to the improved treatment options.

So take your blood sugar levels and the recommended treatment very seriously. But also take care of your other "vital parameters" (such as weight, blood pressure, etc.) and the tips and advice on healthy diet, weight control, physical activity, mental fitness and mental awareness. Start with it! Because not (only) the knowledge of the benefits, but above all the positive experience promotes the long-term implementation - and changes your habits.

Author: Dr. Hubertus Glaser