The diabetes symptoms go away

Diabetes mellitus

Diabetes [mellitus] ("Honey-sweet flow", diabetes): Chronic disturbance of the blood sugar metabolism with restricted absorption of the body cells of sugar (glucose) from the blood, which leads to an increase in the blood sugar level (Hypoglycemia, Hyperglycemia).

The number of diabetics is increasing sharply worldwide, in Germany currently ~ 7% of the population are affected, almost 90% of them suffer from type 2 diabetes. It is a serious illness because, in addition to acute complications, there is a risk of long-term damage such as nerve, kidney and eye damage, but also heart attack or stroke, and life expectancy is correspondingly reduced.

In addition to the primary forms of diabetes discussed below, there are also secondary forms of diabetes in which the diabetes is the result of pregnancy (gestational diabetes), an illness or long-term therapy with diabetogenic drugs (drugs that can trigger diabetes), such as: B. in the case of cortisone steroid diabetes. As a rule, the diabetes disappears again when the underlying disease is treated or the drug is discontinued (if possible) - or after pregnancy. A symptom-free (latent) glucose tolerance disorder remains in all secondary forms of diabetes. B. Women with gestational diabetes have a ~ 45% risk of developing overt diabetes ten years after giving birth. If long-term therapy z. B. is inevitable with cortisone, the symptoms of steroid diabetes are treated like those of type 2 diabetes.

Type 1 diabetes (juvenile diabetes mellitus, insulin-dependent diabetes, IDDM): Autoimmune disease in which, as a result of a malfunction of the immune system, the insulin-producing beta cells of the pancreas are usually rapidly destroyed. As a result, the pancreas is no longer able to produce insulin (absolute insulin deficiency), which results in a greatly increased blood sugar level. In order to replace the body's missing insulin, type 1 diabetics have to inject insulin for life (insulin dependence). The disease begins before the age of 40, usually in childhood and adolescence. The trigger is often a stressful situation such as B. a serious infection or surgery. The predisposition to type 1 diabetes is hereditary and the corresponding genes have already been identified.

Type 1 diabetes is incurable, but after intensive training and regular self-monitoring, a largely normal life can be led; Long-term damage to the vascular system can only be postponed, but not prevented. The main cause of death is kidney damage from chronic kidney failure.

Type 2 diabetes (Adult, adult diabetes, non-insulin-dependent diabetes, NIDDM): Decreased insulin sensitivity, i.e. insulin resistance of the body in combination with limited or delayed insulin production, which leads to a relative insulin deficiency comes. This realtive insulin deficiency turns into an absolute, i.e. complete insulin deficiency with a corresponding insulin dependence (i.e. the need to inject insulin). Type 2 diabetes is caused by a combination of hereditary predispositions and unfavorable environmental factors, which are much more significant than type 1 diabetes. Among them, obesity and lack of exercise are the most important and, according to scientific estimates, 90% responsible for the development of type 2 diabetes.

Type 2 diabetes is also incurable, but any long-term damage that occurs can be postponed. Type 2 diabetes used to occur almost exclusively in people over the age of 50. Nowadays, the elderly continue to make up the majority of those affected (almost 20% of those over 70 years of age are type 2 diabetics). However, increasingly younger people and even children are falling ill due to overeating and lack of exercise.

A recent study suggests that some mutations in the so-called MT gene, which affect the hormone melatonin, also increase the risk of diabetes. Melatonin is released by the body in the dark and controls our sleep-wake cycle. It also regulates the insulin in our body. Those mutations prevent the melatonin from binding to the cells and contributing to insulin regulation. MT2 mutations are rare, but should not be ruled out.

Leading complaints

Type 1 diabetes.

  • Great thirst combined with frequent visits to the toilet
  • Visual disturbances, dryness of the skin and tongue
  • Stunted growth and bed-wetting in children
  • Weight loss
  • Exhaustion
  • Feeling of pressure in the head

Type 2 diabetes.

Symptoms-free for a long time, at most general symptoms such as

Metabolic imbalance. In the case of metabolic imbalances (type 1 and type 2 diabetes alike):

  • If the blood sugar level is completely too high: nausea and abdominal pain, impaired consciousness, often with a fruity acetone odor in the breath.
  • If the blood sugar level is severely lowered, e.g. due to overdosing of blood sugar-lowering medication: Cravings, especially for sugar, restlessness, cold sweats and a fast heartbeat.

When to the doctor

In the next few days with the complaints mentioned

Immediately in the event of apathy, drowsiness or other signs of metabolic imbalance.

The illness

Blood sugar and glucose. Glucose ([Grape] sugar) is our main source of energy and is mainly obtained through the digestion of carbohydrates from food. Is it the smallest unit of carbohydrates, i.e. glucose molecules that are transported by the blood and z. B. are required for metabolic processes, so one speaks of Blood sugar.

Glucose in the form of blood sugar is transported through the blood to all body cells in order to supply them with the necessary energy. If there is more blood sugar available than is required by the cells, the excess blood sugar in the form of glucose is mainly stored in the liver (glycogen) and in adipose tissue as an energy reserve. If necessary, the supply is then evenly released back into the blood.

Insulin. A kind of “lock keeper” is required so that blood sugar can get inside the cell. This is the metabolic hormone Insulin, which enables blood sugar to pass from the bloodstream into the cell interior. At the same time, insulin inhibits the breakdown of glucose stores in the liver. Both effects cause the blood sugar level to drop.

Insulin is used by the Beta cells (B cells, ß cells) are formed, cell groups within the islets of Langerhans in the pancreas (structure of the pancreas). The insulin release is triggered by an oversupply of blood sugar (glucose in the blood) - a process that starts regularly 30 minutes after a meal, especially when carbohydrates such as cane, grape and / or malt sugar (all consist of sugar molecules, i.e. glucose) were eaten.

If the feedback between the release of insulin and the supply of blood sugar works smoothly, the amount of blood sugar (glucose in the blood) fluctuates only very slightly. If the beta cells no longer produce enough or no insulin at all, or if the insulin released does not work properly, the blood sugar level rises (hypoglycaemia). At the same time, however, the body's cells lack glucose as an energy supplier.

Limits of the blood sugar level (all data in mg / dl): Below a value of 60 there is hypoglycaemia, above 140 it is known as hyperglycaemia. The kidney threshold is exceeded from a blood sugar concentration of 180, which means that the kidney is no longer able to absorb the sugar (glucose) released into the urine and return it to the blood. As a result, glucose is found in the urine (glucosuria). Glucosuria is detected by a simple test with urine test strips.
www.salevent.de, Michael Amarotico, Munich

Effects of hypoglycaemia. If the blood sugar level remains significantly increased (> 180 mg / dl), the kidneys can no longer return the sugar (glucose) from the primary urine to the blood. The result is glucose excretion with the urine (Glucosuria), which also causes an increased amount of urine (polyuria). Although those affected drink a lot (polydipsia, pathologically increased thirst) to compensate for the loss of fluid, typical symptoms of dehydration (desiccosis) such as wrinkled, cold, dry skin and a rough, dry tongue occur. There is also a risk of visual disturbances as a result of the loss of fluid in the lens and eyeball. At some point the brain also restricts its service - and life-threatening clouding of consciousness up to a diabetic coma are the result.

Much more dramatic than the short-term, however, are the long-term effects of an increased blood sugar level: Diabetes accelerates all processes of arteriosclerosis like a turbo charger with serious consequences such as visual disturbances, blindness and kidney failure. This damage threatens all diabetics - particularly at risk are diabetics whose blood sugar level is poorly controlled, who suffer from other metabolic diseases or who smoke. The disease has also been shown to increase the risk of several cancers - the most common of which are pancreatic cancer and liver cell cancer.

Absolute insulin deficiency in type 1 diabetes. In type 1 diabetes, the insulin-producing beta cells are destroyed, which quickly leads to an absolute insulin deficiency. The cause is an autoimmune reaction in which the immune system forms antibodies against the beta cells that are incorrectly recognized as "foreign bodies". Why the immune system is directed against the body's own structures has not yet been definitively clarified. Most likely, environmental factors and, here, probably virus infections - based on a hereditary predisposition - trigger the disease. How quickly the destruction of the beta cells leads to the complete cessation of insulin production varies from patient to patient: In general, there is still some residual function at first, but sooner or later all beta cells perish and the body's own insulin has to be supplied from outside for life Insulin to be replaced. A lowered insulin value in the stimulation test (oGTT) can indicate type 1 prediabetes even before the onset of type 1 diabetes. In the meantime, risk groups can also be identified using a genetic test on newborns.

Relative insulin deficiency in type 2 diabetes. In contrast to type 1 diabetes, the starting point in type 2 diabetes is the insulin resistance of muscles, adipose tissue and liver - all of these body structures no longer react sensitively enough to insulin and can therefore no longer make sufficient use of the blood sugar supply (impaired glucose tolerance, glucose tolerance disorders , Glucose intolerance, IGT). As a result, the sugar (glucose) is no longer transported from the blood into the cells and the blood sugar level remains high.

In addition to insulin resistance, there is a disturbance in the release of insulin - it occurs after a meal in particular with a time delay - which further increases the blood sugar concentration. First of all, the organism succeeds in keeping the blood sugar level largely normal by increasing the production of insulin (hyperinsulinemia). However, if the insulin level is constantly high and the cell is constantly being offered too much glucose, the insulin receptors (structures of the cell to which the insulin molecules dock) "weaken", which increases the insulin resistance; the beta cells also "weaken", which reduces insulin production.

There is a relative lack of insulin and the blood sugar level is now permanently elevated - type 2 diabetes is noticeable. This relative insulin deficiency results in an absolute insulin deficiency over time.

This process takes place gradually over the years without those affected noticing anything. This explains why the diagnosis of type 2 diabetes is usually discovered during a medical check-up or blood test.

That's what the doctor does

Diagnostic assurance

To clarify a questionable diabetes, the doctor serves not only a physical examination but also the morning one Fasting blood sugar, determined from the blood of the fingertip (capillary whole blood) or an arm vein (limit values).

While the fasting blood sugar in type 1 diabetics usually increases significantly and the diagnosis can therefore be made quickly, in type 2 patients it can still be almost within the normal range, and even a repetition of the test does not provide any clarity.

This is followed by further examinations for clarification: a Daily blood sugar profile (BG daily profile) created for which the blood sugar is determined on an empty stomach, shortly before and two hours after each meal. The postprandial blood sugar level measured after a meal (postprandial = after a meal) is practically always increased in the case of manifest type 2 diabetes as a result of impaired insulin secretion.

This can also be carried out in outpatient practice oral glucose tolerance test (oGTT, [blood] sugar stress test). It reliably proves whether diabetes and / or impaired glucose tolerance - often a preliminary stage of diabetes - exists. For this purpose, after 12 hours without food, the fasting blood sugar is first determined in the morning and then a sugar solution made from glucose and water is drunk. After two hours, the doctor again determines the blood sugar concentration (values).

In order to differentiate type 1 from type 2 diabetes, the doctor also measures the concentration of C-peptide, a protein fragment that is split off during insulin formation. (In type 1 diabetes, the C-peptide level is lowered as a result of the insulin deficiency; in type 2 diabetes, on the other hand, it is usually higher due to the increased insulin production.)

In type 1 diabetes, autoantibodies can often be detected in the blood as a sign of the autoimmune process, both against components of the islet cells (GADA, ICA, IA-2) and against insulin (insulin autoantibodies, IAA).

A screening program for type 1 diabetes has existed in Bavaria since 2014. For this purpose, children between the ages of two and five are examined by family doctors or pediatricians for islet autoantibodies in the blood, which predicts type 1 diabetes. If successful, a nationwide screening program is planned.

The measurement of the sugar content in urine, which used to be common practice, is no longer recommended as part of the initial diagnosis; it is too imprecise.

Laboratory diagnostics for long-term care of the diabetic. After measuring the HbA1c (glycated hemoglobin, glycohemoglobin) the doctor determines whether the diabetes setting, i.e. the dose of the administered insulin, is sufficient. This value represents the metabolic setting within the last 8-10 weeks and is therefore referred to as "blood sugar memory". It measures what percentage of the red blood pigment hemoglobin (Hb) has combined with the blood sugar - the higher the blood sugar values, the higher the “saccharification” of the hemoglobin.

It is recommended to have the HbA1c determined every three months, and every two months if the blood sugar level fluctuates significantly. Experts from the German Diabetes Society (DDG) recommend doctors to use the HbA1c value to diagnose diabetes mellitus in high-risk patients in the future - instead of the previously usual method of determining fasting blood sugar. The advantage here: a one-time HbA1c determination is sufficient for the diagnosis. In addition, the HbA1c value is not subject to fluctuations in the daytime and remains stable, even if the patient has eaten something beforehand. The HbA1c value also allows the type of diabetes to be determined. This means that a value above 6.5 percent is type 2 diabetes and a value below 5.7 is type 1 diabetes. With a value between 5.7 and 6.5 percent, the experts continue to advocate fasting blood sugar determination. They also point out that the HbA1c value is not suitable for diagnosing diabetes in patients with iron deficiency, kidney or liver diseases or during pregnancy.

The fructosamine test determines the protein content, especially albumin, on which blood sugar molecules are stored. It allows a statement to be made about the blood sugar control for the last two weeks. Compared to the HbA1c determination, however, the test is less reliable and therefore negligible.

therapy

Overview. The aim of diabetes treatment is to keep blood sugar levels as normal as possible in order to restore well-being and performance and to prevent long-term damage. While in type 1 diabetes this means a lifelong injection of insulin in addition to an adequate diet, in type 2 diabetes this is only necessary if the beta cells themselves no longer produce enough insulin. The basis of every type 2 diabetes therapy is therefore a diet suitable for diabetes, regular exercise and the reduction of excess weight.

Basic building blocks of diabetes therapy. A diabetes-appropriate diet plays a decisive role in both type 1 and type 2 diabetes.
www.salevent.de, Michael Amarotico, Munich

Treatment of type 1 diabetes. Type 1 diabetes always requires insulin therapy.If possible, insulin therapy is intensified: On the one hand, it allows a high degree of flexibility with regard to the timing, the number of meals and the determination of the amount of carbohydrates. On the other hand, ICT reduces the risk of diabetes-related late damage, because the frequent blood sugar measurements and the insulin doses, which are always adjusted to current conditions, make it possible to correct blood sugar fluctuations promptly.

Secondary prevention. What is new is the possibility of curbing the decline in the body's own insulin production at an early stage of the disease through immunotherapy. Three approaches are currently being explored:

  • Anti-inflammatory approach to stop inflammation in the pancreas so that the destruction of the insulin-producing beta cells in the pancreas is stopped.
  • Immune cell-directed approach to attack the destructive immune cells. The use of anti-CD3 antibodies and anti-CD20 antibodies is being tested here. One study found: Patients who are given the CD3 antibody “ChAgly” on six consecutive days produce even more insulin than untreated patients even after several years.
  • Antigen-specific approach: Vaccination, with the aim of restoring immune tolerance to the body's own antigens. Vaccines are currently in development.

The approach of giving patients at very high risk for type 1 diabetes insulin as a nasal spray before the onset of the disease goes even further. This so-called antigen-based immunotherapy is currently being tested in the INIT study. It should prevent or at least delay the manifestation of the metabolic disease. The idea is that one day children and adolescents who are particularly at risk of diabetes will be primarily protected from diabetes.

Treatment of type 2 diabetes. Modern diabetes therapy has a holistic approach: Today, in addition to the stage of the disease, age and body weight of the person affected are just as important as risk factors and previous illnesses. The European guidelines recommend target-oriented therapy according to the risk profile. It is important to know that there are risk factors that we cannot influence (age, ethnic origin, genetic predisposition, concomitant diseases), but there are also risk factors that we can influence and thus make a significant contribution to a successful therapy :

  • In almost 20% of type 2 diabetics, the metabolism normalizes itself through a consistent change in lifestyle, so that the diabetes can no longer be detected. The most important measures are weight loss, a long-term adapted diet and regular exercise. Studies have shown that a diet based on the Mediterranean diet is more effective than a diet aimed only at weight loss. Nevertheless, a long-term weight reduction of five to seven percent leads to a significantly reduced risk of diabetes and is therefore recommended. Moderate lifestyle changes such as a healthy diet, increased physical activity and weight reduction can prevent diabetes mellitus or delay the onset of the disease, especially in high-risk patients. Weight reduction is an essential component in the prevention of diabetes mellitus.
  • Eating nuts also has a positive effect on blood sugar levels. As a study shows, a daily serving of 75 grams of nuts lowers the HbA1c value of diabetics - provided they cut out other calories for it. Whale, pecan and macadamia nuts, almonds, pistachios and cashews are ideal.
  • If these measures are not (no longer) sufficient, a drug-based blood sugar lowering is necessary.
  • If a satisfactory blood sugar level is still not achieved or if the body's own insulin production continues to decline, insulin therapy is necessary.
  • In order to avoid spraying, inhalable insulins are currently being tested (e.g. Afrezza®), which are inhaled with meals. The blood sugar lowering effect sets in after 15 minutes and lasts for up to three hours. Type 1 diabetics still have to inject long-acting insulin once a day. No statement can yet be made on the clinical relevance.
  • In the case of diabetics over 70 years of age and with a limited life expectancy, intensive and therefore sometimes dangerous treatment is often dispensed with and therapy concentrates on preventing both the risk of severe hypoglycaemia and the risk of hypoglycaemia.
  • Drug therapy to lower blood sugar requires - like insulin therapy - regular blood sugar self-checks.
  • According to studies, the active ingredient increases Pioglitazone (e.g. Actos®) the risk of bladder cancer. The Federal Institute for Drugs and Medical Devices (BfArM) advises doctors against prescribing drugs containing pioglitazone to new patients. Diabetics who are already taking such supplements should speak to their doctor first before stopping the medication.
  • In order to avoid diabetes complications: The connection between LDL hypercholesterolemia and atherosclerosis has been proven in numerous studies, so that the adjustment of the lipid metabolism plays a central role in the prevention of coronary artery calcification with subsequent heart attack.

Special text: Blood sugar lowering drugs (oral anti-diabetic drugs and insulins)

Special text: Blood sugar self-control - the alpha and omega of diabetes therapy

Therapy regimen.

In the conventional insulin therapy Insulin is injected twice a day, namely a fixed dose of an individually adapted mixed insulin, always at the same time and always half an hour before a meal. In addition, the amount and carbohydrate content of a meal should fluctuate only slightly. This form of therapy is particularly suitable for older people who are no longer at work and can stick to a fixed daily routine.

For an irregular rhythm of life, on the other hand, is suitable intensified conventional insulin therapy (ICT), but it requires personal responsibility and training. Before each meal, the blood sugar must be measured and the required amount of insulin for the current metabolic situation calculated and injected. In addition, the basic requirement is met with 1 (–2) daily injections of a long-acting delay insulin. So you can eat a lot or little, insert a snack or skip a meal - just as the daily routine requires. When carried out correctly, the blood sugar control is also better than with conventional insulin therapy, so the blood sugar fluctuates less.

Above: Conventional insulin therapy: Twice a day - before breakfast and before the evening meal - a medium-acting mixed insulin (red and yellow curve) is injected. Below: Example of an intensified conventional insulin therapy (ICT): The basic supply of insulin takes place with an injection of a long-acting delay insulin before going to bed, in addition, the current blood sugar is measured before each meal and a corresponding amount of short-acting normal insulin (red curve) is injected.
www.salevent.de, Michael Amarotico, Munich

When used correctly, ICT is superior to conventional insulin therapy because the body's need for insulin can fluctuate considerably: it increases, for example, with infections, but also on vacation, but sometimes it also decreases for apparently inexplicable reasons - usually shortly after the introduction of insulin therapy: The beta cells seem to recover temporarily after the first few doses of insulin. They release more insulin again, so that the blood sugar levels initially normalize without any further external insulin supply. However, this honeymoon phase (remission phase) is over within a few weeks or months.

If the body still produces a certain amount of insulin itself, it may initially be sufficient to only inject normal insulin during meals. In so-called combination therapy, insulin and blood sugar-lowering tablets are often combined with one another, often as an introduction to lifelong insulin therapy.

A new glucose measuring system has been on the market for several years: continuous interstitial glucose measurement with real-time measuring devices (rtCGM). In the upper arm or abdomen, a 5 mm long sensor is inserted into the skin and fixed there. This measures the blood sugar concentration in the intercellular fluid of the subcutaneous fat every 5 minutes - not the blood sugar like conventional measuring devices do. A transmitter transmits the values ​​and the trends that can be derived from them to a small, portable measuring station, where the patient reads them off. Alternatively, the patient can read out the sensor with a handy scanner. The sensor is changed by the patient every seven days. Since 2016, rtCGM can be prescribed at the expense of the statutory health insurance companies if the following requirements are met:

  • Insulin-dependent diabetes mellitus
  • Treatment with intensified insulin therapy
  • Individual therapy goal cannot be achieved with conventional measuring devices
  • Fulfillment of quality assurance measures: prescription from a specialist, expert opinion on the medical necessity, timely training in handling the rtCGM system, determination and review of the individual therapy goal using the rtCGM system by doctor and patient, rtCGM system has approval as a medical product, Use of the measured values ​​without access by third parties (e.g. the manufacturer) is possible

However, rtCGM systems cannot completely replace conventional blood sugar measurement. There are two reasons:

  • The sugar level in the intercellular fluid of the subcutaneous fatty tissue lags the sugar level in the blood by 5–20 minutes.
  • Every new sensor must be calibrated using a conventional blood glucose test.

A continuous subcutaneous insulin infusion of regular or analog insulin via Insulin pump (CSII, continuous subcutaneous insulin infusion) is an option if the injection therapy does not achieve satisfactory results, but also in pregnancy, rapidly progressing secondary diseases (e.g. extremely painful diabetic neuropathies) and other situations that require precise metabolic control. A needle that remains in place for several days is inserted into the subcutaneous fatty tissue of the abdomen and fixed, through which the insulin is automatically released. However, patients can still respond to special needs and manually adjust the insulin delivery on the pump.

Practice of insulin administration. Insulin always has to be injected. This is best done subcutaneously, i.e. under the skin into the fatty tissue, e.g. B. from the abdomen or thigh, from where the insulin slowly enters the bloodstream. Insulin injected into the abdomen is absorbed a little faster. It is important that the injection points are always changed according to a certain scheme in order to avoid damage to the subcutaneous fatty tissue. With each injection, a distance of at least 2 cm from the last viewing point must be maintained. By heat, e.g. B. a bath in warm water, but also through physical exertion or rubbing the injection point, the insulin effect occurs more quickly. Delay insulin solutions must be mixed before injecting.

In the meantime, so-called insulin pens have become established because they are easy to use and dose very precisely. In addition, pre-filled insulin syringes with a preset amount of insulin are available, and insulin nasal sprays are currently being tested.

Fresh insulin bottles are stored in the refrigerator at 2–8 ° C, opened bottles should be stored at room temperature (25-30 ° C) away from light. After opening, they can be kept for four to six weeks, depending on the preparation. Heat and freezing (below 2 ° C) make the insulin less effective. For vacation trips, thermally insulated pockets for insulin pens are available in pharmacies. In general, insulin that has changed in color or texture (e.g. streaking) must no longer be used. In 2006, an inhalable insulin (Exubera®) was sold in Germany for a short time. Since it was approved and there was a possible risk of lung cancer in the room, it was hardly prescribed and production stopped again.

forecast

The prognosis for diabetes generally depends on how well it is possible to steer the blood sugar level permanently in the normal way possible in order to delay late damage as long as possible. The cooperation of the patient is correspondingly important because it has a decisive influence on the further course of his illness.

For type 1 diabetes, the prognosis depends on the age at which the disease occurs: If the patient is ~ 10 years old, this can mean a shortening of life by an average of ~ 15 years, with chronic kidney damage being the main cause of death.

The course of type 2 diabetes is mainly determined by the consequences of the vascular damage: ~ 75% of patients die from vascular complications such as heart attacks or strokes. However, the prognosis improves significantly if the patient loses his or her excess weight through an appropriate diet and physical training. Type 2 diabetics also have an increased risk of developing dementia. If acute hypoglycaemia occurs in the course of the disease, the risk of dementia increases by 26%, and after two such events even by 80%.

Your pharmacy recommends

Every beginning is difficult.

If a diagnosis of diabetes is made, it will mean a huge change. Initially, the main concern was that the spray would not be able to cope with it. Injecting yourself is not easy at first, but with the right technique it hardly hurts. In general, the puncture is even felt less than the one during the self-monitoring of blood sugar. After all, after a few months most patients are better at injecting than their doctors. But: injecting insulin, calculating the doses and correctly assessing the possibilities and limits of insulin treatment - all of this has to be learned. Training by specialist staff is therefore essential.

Diabetes education - helping people to help themselves.

Successful diabetes therapy is based on comprehensive training that helps you to be active and responsible for your life despite diabetes. Doctors, nutritionists, podiatrists and physiotherapists will teach you how to properly measure blood sugar and inject insulin, what to look out for when taking medication, what to do in the event of complications such as hypoglycaemia and hypoglycaemia, which diet and which sport are best for you , or what measures a good skin and foot care is based on. With hardly any other illness, the long-term success of the therapy requires such a high level of precise knowledge, personal responsibility and discipline: Regularly checking your blood sugar levels and - possibly - injecting yourself several times a day, practicing self-observation in order to show signs of a Recognize hypoglycaemia or hypoglycaemia and consistently change unfavorable habits that may have dominated daily life for many years. Ultimately, it depends on each person affected whether diabetes controls life or the patient controls diabetes. A good basis for coping with the “self-therapeutic” requirements, which is not always easy, is provided by diabetes training, in which theoretical and practical skills for dealing with diabetes are learned.

Nutrition.

One of the basic pillars of diabetes therapy is diet suitable for diabetes. During the diabetes training or nutritional advice, you can have an individual diet plan created that corresponds to your therapy goals, but does not neglect the enjoyment. In addition, there are now many good cookbooks (info box) and cooking courses for diabetics (e.g. at the adult education centers) with suggestions for healthy and at the same time tasty food. It is not necessary to use special diabetic foods: as studies have shown, it brings Replacing sugar with other sweeteners has no benefits. Now the federal government has decided to even take food from the market for diabetics.

Carbohydrates and bread units.

Carbohydrates are nothing more than sugar molecules (glucose, fructose, galactose, starch) in different compositions. Insulin-injecting diabetics need to know the exact amount of carbohydrates in a meal in order to calculate their insulin dose. The unit of measurement for the amount of carbohydrates is the Bread unit (BE; Carbohydrate exchange unit), which roughly corresponds to the amount of food that contains 12 g of digestible carbohydrates. Exchange tables with information on the bread units of the various foods make it easier to put together meals, especially at the start of therapy. Another possibility is to weigh the food with an accurate diet scale in order to then calculate the bread units. After a certain amount of time, you can also do this without weighing or with the help of kitchen measurements (e.g. spoons, cups, plates, ladles) - however, it is best to learn how to correctly assess carbohydrate portions during diabetes education.

Move.

Regular physical activity plays an important role in diabetes therapy. Diabetics should also not shy away from weight training.As one study (namely) has shown, people who build their muscles are more sensitive to insulin, so that more glucose from the blood reaches the body cells. If you have not done sport for a long time, you should start again slowly and gradually increase the activity. In the beginning it is important to check your blood sugar not only before and after training, but also during it. If the value is below 100 mg / dl, you should first stop exercising and change therapy, as there is a risk of hypoglycaemia. The same applies if there are strongly fluctuating or poorly adjustable sugar levels or an acute infection.

For diabetics who require insulin, it is advisable to keep a log booklet (diabetic passport, diabetic diary) in which blood sugar levels, time of measurement, duration and intensity of exercise as well as additional carbohydrates and the occurrence of hypoglycaemia are noted. It is also important to have a piece of glucose to hand at all times so that you can act immediately in the event of (threatened) hypoglycaemia.

Special text: Traveling with diabetes

Complementary medicine

Herbal medicine.

There is currently speculation as to whether an observational study will open up new possibilities for diabetes treatment: In addition to their diabetes therapy, non-insulin-dependent type 2 diabetics took cassia cinnamon powder daily for 40 days and achieved a significant (significant) reduction in blood sugar levels. Further studies have to clarify whether cinnamon is actually suitable as an accompanying therapy for type 2 diabetes. It is known that large amounts of cassia cinnamon can cause liver and kidney damage because of the coumarin it contains. Cassia cinnamon cannot therefore be recommended without reservation. The costs per day are around one euro (three capsules) and are not covered by the health insurers.

Standardized finished drugs with high-dose evening primrose oil seem to alleviate the symptoms of diabetic neuropathy.

Magnetic Therapy.

There is evidence that magnetic therapy can relieve pain caused by peripheral diabetic neuropathy. Insoles with pulsating magnetic fields are especially recommended for leg problems.

People with cardiac pacemakers are not allowed to undergo magnetic field therapy, as this can lead to interactions with the control electronics.

Further information

  • www.deutsche-diabetes-gesellschaft.de - German Diabetes Society (DDG, Bochum): Scientifically held, very comprehensive information website - also about the metabolic syndrome (keyword search).
  • www.diabetikerbund.de - Website of the largest self-help organization for diabetics in Germany, Kassel: In addition to a lot of information, it offers a diabetes lexicon for all technical terms, practical tips and brochures as well as the European emergency card for download.
  • www.diabetes-risk.de - Website of the German Diabetes Foundation, Munich: The focus is on "Detecting Diabetes - Avoiding Risk", with a specialist lexicon, diabetic recipes and helpful links - also provides information on the metabolic syndrome (keyword search).
  • www.diabetes-verlag.de - Website with a lot of information on the subject, the Diabetes Pass can be ordered here for a nominal fee: Kirchheim-Verlag, Postfach 2524, 55015 Mainz.
  • P. Hien; B. Böhm: Diabetes Handbook. Instructions for practice and clinic. Springer, 2005. Factual specialist advice.
  • A. Bopp: Diabetes. Stiftung Warentest, 2001. Comprehensible guide on the causes, complaints and treatment of diabetes with numerous tips for dealing with the disease on a daily basis, as well as an extra chapter on the subject of getting pregnant despite diabetes.
  • H. Lauber: Feast like a diabetic. Kirchheim-Verlag, 2005. Cookbook with seasonal recipes compiled by a diabetic taking 100 diabetes-friendly foods into account.

Authors

Dr. med. Arne Schäffler, Dr. Nicole Schaenzler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 15:44