Diabetes - what is it?
Diabetes mellitus is associated with high blood sugar levels. It is important to treat the disease in time to prevent damage to organs such as the heart, eyes and kidneys
Diabetes mellitus, colloquially also called diabetes, is a chronic metabolic disease. The two most important forms are type 1 and type 2 diabetes.
Type 1 diabetes usually begins in childhood or adolescence. In this case there is an absolute deficiency of the body's own hormone insulin. This is usually caused by an abnormal reaction of the immune system, which causes insulin-producing cells in the pancreas to die. As a result, the blood sugar level rises and patients have to inject insulin.
Diabetes often manifests itself through a strong urge to urinate and constant thirst. But symptoms such as fatigue, dry skin and frequent infections can also be a sign of diabetes.
Unhealthy nutrition, overweight and lack of exercise increase the risk of type 2 diabetes. The unhealthy lifestyle leads through various mechanisms to too much glucose in the blood. Most diabetics suffer from type 2 diabetes. In addition to regular physical activity and a healthy diet, special drugs help to control blood sugar levels. Sometimes, however, insulin injections are also necessary for type 2 diabetes.
A simple blood test for glucose gives an indication of whether diabetes mellitus is actually present with the corresponding symptoms.
Diabetes mellitus type 1
What is type 1 diabetes?
Diabetes mellitus type 1 is an autoimmune disease in which affected persons produce little or no insulin. It develops when the body's own immune system, which primarily serves to defend against pathogenic germs, attacks and destroys the insulin-producing beta cells of the pancreas. As a result, insulin production often ceases very quickly.
The hormone insulin has the task of transporting the sugar taken in with food from the blood into the cells. They need it to produce energy. When there is a lack of insulin, the sugar accumulates in the blood: The blood sugar level rises.
What happens in the body with type 1 diabetes
People with type 1 diabetes must take insulin
Without insulin supply from outside, a severe metabolic derailment - a ketoacidosis - occurs within a short time. Without countermeasures, this can be fatal. In the long term, elevated blood sugar levels also damage the blood vessels, nerves and numerous organs. To prevent this, people with type 1 diabetes must inject insulin several times a day or take the hormone with an insulin pump.
Type 1 diabetes usually develops before the age of 40, often in childhood and adolescence. This is why it used to be known as juvenile diabetes. The autoimmune reaction initially proceeds without symptoms. However, the corresponding antibodies can be detected by blood tests months to years before the onset of diabetes.
There is no cure for type 1 diabetes. However, with an individually tailored insulin treatment, it is possible to live well with the metabolic disease. According to the Diabetes Surveillance of the Robert Koch Institute, about 341,000 adults and 32,000 children and adolescents in Germany have type 1 diabetes. There are no reliable figures because diabetes is not a notifiable disease in Germany. According to data from the World Health Organization, this has also risen enormously.
Diabetes mellitus type 1: causes
In type 1 diabetes, the body's own immune system attacks cells of the pancreas. Why this happens is not yet known exactly.
The trigger for type 1 diabetes is almost always an autoimmune reaction. This means that the defense cells of the immune system attack and destroy the insulin-producing beta cells in the body. The beta cells - together with the alpha cells, which produce the blood sugar increasing hormone glucagon - are located in the pancreas. This organ, located in the upper abdominal cavity, releases the hormones insulin and glucagon directly into the blood.
What leads to this autoimmune reaction is still unclear. It is possible that certain environmental factors or viral infections promote the development of type 1 diabetes. Hereditary factors play a certain role. In the meantime, some genes have been identified that appear to be associated with the development of type 1 diabetes.
But by no means does everyone who has a parent with type 1 diabetes fall ill themselves. The risk is only a few percent. Around 90 percent of patients with type 1 diabetes have no known cases of the disease in their close relatives.
In addition to the form of type 1 diabetes (type 1a) described above, there is another form in which the beta cells are destroyed, but without detectable antibodies against insulin or other parts of the beta cells. It is called idiopathic type 1 diabetes (type 1b). It is not yet clear what causes this variant of type 1 diabetes.
Another special form of type 1 diabetes is called LADA (latent autoimmune diabetes in adults). It mostly occurs in adults of normal weight and shows particularly mild symptoms. LADA has characteristics of type 1 and type 2 diabetes: The patients have the autoantibodies characteristic of type 1. Nevertheless, tablets are often sufficient for treatment in the beginning. For this reason, LADA is often confused with type 2 diabetes, especially at the beginning. After a few years at the latest, however, LADA patients usually also need treatment with insulin.
Diabetes mellitus type 1: symptoms
Once the insulin deficiency has reached a critical level, the typical signs of type 1 diabetes usually appear
In the beginning, type 1 diabetes does not cause any symptoms. Only when about 80 percent of the beta cells of the pancreas have been destroyed is the remaining insulin no longer sufficient to introduce enough sugar into the cells. The typical symptoms of type 1 diabetes then appear within days to weeks:
Symptoms that point to diabetes:
-frequent urge to urinate
-Tiredness and exhaustion
-dry, itchy skin
-Acetone smell of the air we breathe (reminiscent of nail polish remover or rotten fruit)
-nausea, vomiting, abdominal pain
If the body needs more insulin for a while, the insulin deficiency can also become noticeable earlier. This is the case, for example, with fever, major surgery, permanent stress or certain medications such as cortisone.
Type 1 diabetes: diagnosis
Type 1 diabetes can be detected by a simple blood glucose test
The decisive factor in the diagnosis of type 1 diabetes is the concentration of sugar in the blood. A doctor can determine it using various methods. A diabetes is present:
a blood sugar level of 200 mg/dl (11.1 mmol/l) or more at any time (i.e. fasting or after a meal)
a fasting blood glucose level of 126 mg/dl (7.0 mmol/l) or higher in venous blood drawn by the doctor
a long-term blood glucose (HbA1c) value of 6,5 percent (48 mmol/mol) or more
The diagnosis of diabetes is considered confirmed when a second test on the following day confirms the result. An oral glucose stress test (OGTT), which is often used to diagnose type 2 diabetes, is generally not necessary for type 1.
Type 1 diabetes: therapy
For a functioning metabolism, people with type 1 diabetes must inject insulin. Each person requires a treatment tailored to their individual needs
People with type 1 diabetes carry out the therapy largely independently in everyday life. In children, the parents take over a large part of the work. New patients learn what is important after diagnosis in special training courses. The treatment of type 1 diabetes essentially consists of three components:
-Blood glucose monitoring
-Calculate carbohydrates in food
Once diagnosed, people with diabetes also need to be adjusted. This means that a doctor usually determines during a stay in hospital which insulins are best suited, what amounts of insulin and what injection schedule someone needs. In addition, depending on metabolism and individual circumstances, individual therapy goals are set with regard to blood sugar levels. The achievement of these goals is checked by those affected together with the attending physician at regular check-up appointments.
Blood glucose monitoring
People with type 1 diabetes should check their current sugar levels several times a day in order to detect or avoid acutely high or low levels in good time. Especially before meals, blood glucose checks are important in order to calculate the amount of insulin needed. Measurements are also necessary at other times, such as when exercising, before going to bed or if there are signs of hypoglycaemia. In the case of acute illnesses and infections, blood sugar should be checked more frequently overall.
Info: Too high and too low values
Both too high and too low blood sugar levels can be dangerous in type 1 diabetes. If the sugar level falls too low, hypoglycaemia occurs and people can lose consciousness. You can read more about hypoglycaemia here.
Elevated levels can cause numerous secondary damages in the long term (see chapter "secondary diseases"). Ketoacidoses are also possible in the short term. This rare but severe metabolic derailment occurs in cases of absolute insulin deficiency and requires immediate countermeasures. You can read more about ketoacidosis in our diabetes lexicon.
In conventional blood glucose monitoring, people with type 1 diabetes prick themselves with a lancet into the side of a fingertip to extract a drop of blood. They apply the drop to a blood glucose test strip inserted in a measuring device. The meter then determines the current sugar level in the blood vessels within a few seconds. People with type 1 diabetes learn how to use this procedure correctly in a training course at the start of therapy.
More and more people with type 1 diabetes are using an FGM (Flash Glucose Monitoring) or CGM (Continuous Glucose Monitoring) system to control their metabolism. In both systems, a short sensor thread constantly measures the sugar content in the subcutaneous fatty tissue. In CGM systems, a transmitter on the skin permanently transmits the values to a receiver, such as a smartphone. This then automatically displays the current tissue sugar data. With FGM systems, a reader (scanner) or cell phone must be held against the sensor to see the current sugar data.
Depending on the system, a new sensor is installed every six to 14 days. In the case of long-term CGM, the sensor is implanted under the skin and replaced after 180 days at the latest.
Both systems have an alarm function that warns the wearer as soon as individually defined lower and upper limits are exceeded. CGM systems have additional alarm functions. Some of them already warn, for example, when hypoglycaemia is imminent due to the rapid drop in sugar levels.
Diabetes mellitus type 2
In type 2 diabetes, the sugar levels in the blood are elevated. Untreated, the disease can lead to acute metabolic disorders and long-term health problems. A change in lifestyle and treatment with medication can prevent this
What is type 2 diabetes?
Type 2 diabetes is a chronic metabolic disease. The disease is characterized by an elevated blood sugar level. The reason for this is usually a combination of hereditary predisposition, unhealthy diet and lack of exercise, which leads to insulin resistance. Insulin resistance means that the body cells respond less well to the hormone insulin. Insulin has the task of transporting sugar (glucose) from the blood into the cells that need it as an energy source. Insulin resistance does not achieve this sufficiently. The sugar therefore accumulates in the blood.
On the one hand, drugs prescribed by a doctor are important during treatment in order to lower the blood sugar level. At the same time, the patient plays a key role: a change in lifestyle - above all a healthy diet, losing weight and lots of exercise - can improve the metabolic situation and prevent the dangerous long-term consequences of diabetes.
Why is type 2 diabetes dangerous?
Elevated blood sugar levels often do not cause any symptoms for a long time. Inside the body, however, they cause long-term damage to blood vessels, nerves and numerous organs. Cardiovascular diseases in particular, such as a heart attack, are typical complications of type 2 diabetes.
Often the first damage is already present at the time of diagnosis of type 2 diabetes, as the disease is not discovered until years later. Therefore, regular routine check-ups at the doctor's office are important in order to detect possible secondary diseases at an early stage and take appropriate countermeasures.
The most important secondary diseases are myocardial infarction, stroke, kidney weakness, retinal damage, nerve disorders and circulatory disorders of the legs and feet, up to the so-called diabetic foot syndrome, which in the worst case can lead to amputation. These diseases usually develop insidiously over a long period of time.
How common is type 2 diabetes?
There are no reliable data on the incidence in Germany, as diabetes is not a notifiable disease. There are probably at least 7.5 million people in Germany with diabetes treated with medication - the majority (about 95 percent) have type 2 diabetes. In addition, there are probably up to two million people who have diabetes but know nothing about it. Every day, around 1,300 people in Germany are newly diagnosed with type 2 diabetes.
Does type 2 diabetes only occur in old age?
In the past, type 2 diabetes was often referred to as "adult-onset diabetes". In fact, it is primarily older people who suffer from it. However, younger people are increasingly suffering from type 2 diabetes as well. The reason for this is that more and more people are already heavily overweight at a young age and do little exercise. More and more frequently, doctors are also diagnosing the disease in children and adolescents. In the USA, around a quarter of young people have diabetes or a precursor stage of it. The term "old-age sugar" has therefore long since ceased to be correct.
Can type 2 diabetes be cured by losing weight?
Type 2 diabetes can be cured by losing weight in many people. This is shown by the British DiRECT study, which was published in 2017: Almost half of the participants were able to reduce their diabetes within one year by means of a highly calorie-reduced diet with subsequent nutritional advice. For those who had managed to lose 15 kilos, the success rate was even 86 percent. However, this effect is only permanent if a healthy lifestyle is maintained. If those affected fall back into old habits, diabetes will also return.
Type 2 diabetes: Causes
The most important risk factors for type 2 diabetes are, in addition to a hereditary predisposition, an unhealthy diet, overweight and lack of exercise
The predisposition to type 2 diabetes is hereditary. If close relatives (especially parents, siblings) have type 2 diabetes, the probability of developing the disease is significantly increased. However, it is not only genes that play a role in this familial risk, but also life habits such as nutritional patterns that are passed on within a family.
Lifestyle is crucial
Despite hereditary predisposition, type 2 diabetes does not necessarily have to occur. Decisive for the onset of the disease is above all an unhealthy lifestyle with an unhealthy diet, severe overweight and lack of exercise. These factors promote insulin resistance.
Insulin resistance means that the cells of the body, especially the liver and muscles, no longer react correctly to insulin. The hormone from the pancreas channels the sugar from the blood into the cells so that the cells gain energy from it and store some of it. If the cells do not respond to insulin, or hardly respond at all, the hormone can no longer perform this task adequately.
Fatty tissue interferes with insulin sensitivity
Obesity favors this development because fatty tissue, especially the fatty tissue around the abdomen, releases messenger substances that promote insulin resistance. Lack of exercise increases the insulin resistance of the muscle cells.
First, the body tries to overcome insulin resistance by releasing more insulin. In an early stage of diabetes, the insulin level in the blood is therefore elevated (hyperinsulinemia). Finally, insulin production decreases increasingly. The blood sugar level rises - until it is so high that the criteria for the diagnosis of diabetes mellitus are met.
Type 2 diabetes: symptoms
Type 2 diabetes usually causes little discomfort at first. Therefore it can remain undiscovered for a long time
Type 2 diabetes causes no symptoms for a long time. Therefore it often remains undetected for many years. The disease is often diagnosed when patients are treated in hospital for another reason - for example, a heart attack that was promoted by the diabetes.
Nevertheless, there are several signs that can point to diabetes. If blood sugar levels are high, symptoms include frequent urination, thirst and dry, itchy skin. This is because when blood sugar levels rise, the body tries to excrete excess sugar with urine. The urge to urinate increases, and those affected experience increased thirst.
Signs that indicate elevated blood sugar levels:
-Tendency to infections
-badly healing wounds
-dry or itchy skin
-Infections in the genital area
Since diabetes weakens the immune system, people with diabetes are also more susceptible to infectious diseases such as athlete's foot or vaginal mycosis and cystitis. They are also more frequently affected by colds or flu. Wound healing disorders can also indicate a circulatory disorder, which also occurs more frequently in people with diabetes.
This is another reason why diabetes is often not noticed: These complaints are very unspecific. In other words, there are a number of possible causes for them, and many people do not associate them with diabetes, but simply blame them on age, for example. However, anyone who notices one or more of these symptoms in themselves should definitely have their blood sugar checked to make sure they don't miss a diabetes.
Type 2 Diabetes: Diagnosis
Type 2 diabetes can be diagnosed with a simple blood glucose test
The family doctor can often determine whether type 2 diabetes is present with the help of a simple blood sugar test. To confirm the diagnosis, the sugar must be determined from the venous blood the doctor draws from the arm.
Diabetes is considered to be proven if:
the blood sugar level is 126 mg/dl (7.0 mmol/l) or higher on at least two independent fasting measurements.
the blood glucose level (fasting or not) is above 200 mg/dl (11.1 mmol/l) or higher on at least two independent measurements or.
the long-term blood glucose value HbA1c is 6.5 percent (48 mmol/mol) or higher.
In healthy people, fasting blood glucose is usually below 100 mg/dl (5.6 mmol/l). Fasting values between 100 and 125 mg/dl indicate prediabetes, a precursor of diabetes.
n cases of doubt, a sugar stress test helps to confirm the diagnosis (oral glucose tolerance test, in short: OGTT). In this test, the patient is given a precisely defined glucose solution to drink by the doctor. Before this, the patient must have remained fasting for 10 to 16 hours and have eaten a carbohydrate-rich diet for three days. Before and two hours after drinking the glucose solution, the blood sugar level in the venous blood is determined. If the value rises above 200 mg/dl (11.1 mmol/l), diabetes is confirmed.
Type 2 diabetes: secondary diseases
Eyes, kidneys, heart: Type 2 diabetes can cause damage to numerous parts of the body. An overview
Type 2 diabetes can lead to numerous secondary diseases. They are the result of damage to the small and large arteries and often also to the nerves. The probability of developing diabetes-related secondary diseases is increased in the early stages of diabetes (prediabetes). It is therefore important to recognize and treat diabetes in good time. Below you will find an overview of important diseases that can occur together with diabetes type 2 or as a consequence of it.
Consequences of type 2 diabetes
Diabetic foot syndrome
Nerve damage to the feet is a common reason for amputations. If the perception of pain is disturbed, people with diabetes often do not notice pressure points or minor injuries in time. These can then become infected. Since the blood circulation is often also impaired, the wounds also heal poorly. Ulcers can form that reach deep into the tissue and also damage the bones. Without timely treatment, such as restoration of blood circulation, amputation of the limb may become necessary.
These serious consequences can be avoided if you care for your feet carefully and examine them regularly for changes. It is also important to consult a physician at an early stage in the event of the slightest changes, such as cornification.
Type 2 diabetes: treatment
Losing weight, exercise, tablets, insulin: patients with type 2 diabetes usually need a mix of several measures to control their blood sugar levels
After diagnosis, people with type 2 diabetes are usually given a drug immediately to lower their blood sugar. Usually this is metformin. If the treatment does not work as desired, the doctor may prescribe another or an additional drug. Many people affected also have to inject additional insulin during the course of the disease or switch to insulin treatment altogether.
In addition to the medication, changes in everyday behavior are important for the success of the treatment. Patients should eat a healthier diet, lose excess weight, and take a lot of exercise in everyday life. All these factors can help to improve the insulin effect. If the diabetes is still in an early stage, these lifestyle changes may be sufficient to get the diabetes under control.
Treatment goals: Always individual
Important to know: Every person with type 2 diabetes needs his or her own mix of measures according to his or her individual life situation and the accompanying diseases. The therapy modules therefore depend on the individual case.
This also applies to the treatment goals that the doctor and patient determine together. The German Diabetes Society advises people with type 2 diabetes to aim for a long-term blood glucose level of HbA1c of 6.5 to 7.0 percent. However, if there is a risk of hypoglycemia in the patient, for example, a higher target value can be agreed. This often makes sense for elderly people, for example: In their case, the risks of a too "strict" blood glucose reduction with an increased tendency to hypoglycaemia must be carefully weighed up in each individual case against the risks of long-term secondary damage caused by high blood glucose levels.
Therapeutic measures at a glance
Being very overweight is one of the biggest risk factors for the development of type 2 diabetes. This is particularly true when the fatty tissue accumulates on the abdomen. This so-called internal or visceral fat produces substances that impair the effect of insulin. The reduction of overweight can help to restore insulin resistance. Sometimes losing weight is as effective as - or even more effective than - taking tablets.
Patients agree on weight targets together with their doctor. The doctor can also give tips on the correct procedure. A healthy diet is crucial for successful weight loss. Exercise plays only a small role, but is nevertheless very important, as it improves blood sugar and blood pressure levels and helps to prevent secondary diseases of diabetes. Self-help groups, training courses and weight loss programs in clinics and practices can help with this.
In type 2 diabetes, a healthy diet not only supports weight loss, but also helps to avoid sugar peaks after meals and to improve insulin action.
There are no prohibitions. People with diabetes are allowed to eat the same as healthy people. However, sugar should be avoided. Even highly processed ("refined") carbohydrates, which are mainly found in products made from white flour and which quickly raise blood sugar levels, should be eaten as rarely as possible. This also applies to ready meals. For bread, noodles or rice, it is recommended to use the whole grain varieties. They contain complex carbohydrates that enter the bloodstream more slowly and cause the blood sugar level to rise and fall less sharply.
Fiber is particularly valuable in the diet of type 2 diabetes. These are plant fibers that the human digestive tract cannot process. This helps to avoid peaks in blood sugar levels and ensures a longer feeling of satiety. In addition, dietary fiber has many other health benefits, for example by aiding digestion and supporting intestinal bacteria. Dietary fibers are found in whole grain products, legumes and many types of fruit and vegetables.