Diabetes mellitus causes therapy

Diabetes – still controllable in old age with a lot of supportDiabetes mellitus is the most common concomitant disease in old age. One in two diabetics is over 65 years old. But with good medical and nursing support, many diabetics manage to cope well with this metabolic disorder and lead an almost normal life.

Diabetes mellitus, also known as diabetes, is one of the most widespread diseases. Including a high number of unreported cases, the German Diabetes Society (DDG 2013) estimates that ten million people have type 2 diabetes mellitus. Half of all type 2 diabetics are older than 65, which is why diabetes is classified as a disease typical of old age. This means that further increases in the number of cases can be expected simply due to the demographic trend toward an aging population. Other reasons for the increasing number of type 2 diabetics worldwide are probably that many people are heavily overweight, eat the wrong foods, suffer from high blood prere and exercise too little. As a result, it can be observed that younger people are also increasingly suffering from type 2 diabetes.

Diabetes mellitus causes therapy

Many people are diagnosed with diabetes mellitus out of the blue. This is because the metabolic disorder develops insidiously and causes no or only minor symptoms for a long time. First signs such as general weakness, fatigue or an increased feeling of thirst are easily misjudged by the affected persons themselves or by their caregivers. It is not uncommon for diabetes to be discovered in the course of other examinations, or for initial complications to lead to diagnosis – with the result that patients have been diabetic for an average of seven years at the time of diagnosis and are already suffering from irreversible long-term damage.

Diabetes mellitus – a chronic disorder of carbohydrate metabolism

Diabetes mellitus causes therapy

A large part of our diet consists of carbohydrates, which are broken down in the small intestine and transported to the liver as glucose, the simplest human sugar compound. From here, the glucose is used as "fuel" passed on to the body's cells for energy production.

However, the glucose transported in the blood cannot easily reach the body's cells. Entry into the cells is only possible through certain "gates", sog. receptors, in the cell walls possible, which were previously "unlocked" by the hormone insulin must be.

Insulin is produced in the pancreas in the B-cells of the so-called "blood cells". islets of Langerhans produced. Released directly into the blood. How much insulin is needed depends on the glucose concentration in the blood. If this rises, more insulin is released accordingly. If glucose concentration drops, secretion is inhibited. With this regulatory system, the body can respond well to the changing supply of carbohydrates, but also to the varying demand for glucose. A high glucose requirement arises, for example, from increased physical activity.

However, if the pancreas is no longer able to produce insulin (absolute insulin deficiency) or if insulin production can no longer be adapted to requirements, glucose accumulates in the blood, the blood glucose concentration increases. At high concentrations, the filtration capacity of the kidneys is also overtaxed – from about 180 mg/dl glucose in the blood, the sugar appears in the urine.

Not all diabetes is the same

Diabetes mellitus causes therapy

There are several forms of diabetes: type 1 and type 2. In addition, there are other forms such as gestational diabetes or diabetes due to diseases of the pancreas.

Diabetes mellitus type 1 Occurs mainly in childhood and adolescence, but can also show up in later years. This form of diabetes is caused by a gradual destruction of the insulin-producing B cells in the pancreas, resulting in an absolute lack of insulin. Insulin must be injected for treatment.

Type 2 diabetes mellitus is by far the more common form of diabetes, affecting about 90% of diabetics. The age of manifestation is usually after the age of 50. Type 2 diabetes is also known colloquially as "adult-onset diabetes" or "old-age diabetes is called. The causes of type 2 diabetes are considered to be congenital or. acquired insulin insensitivity (insulin resistance), which is aggravated by overeating and lack of exercise with subsequent obesity. Treatment is by weight reduction, calorie-appropriate diet, plenty of exercise and medication, sog. Antidiabetics. Different groups of substances are available, which have different effects on carbohydrate metabolism. As the metabolic disorder progresses. Increasing insulin deficiency is injected with insulin.

Age complicates treatment and care

Regardless of the type of diabetes and thus the age, three goals are paramount in the treatment of diabetes mellitus:

– Ensuring a permanently balanced carbohydrate metabolism with blood glucose levels as close to normal as possible, d. h. Blood glucose levels should be as close as possible to those of a healthy person – avoidance of acute metabolic derailments such as hyperglycemia (= high blood glucose), hypoglycemia (= low blood glucose) or diabetic coma – avoidance of possible secondary complications, which primarily affect the vascular and nervous systems

In order to achieve these goals, intensive medical treatment is required in accordance with specific therapy guidelines laid down by medical associations such as the German Diabetes Association. Ultimately, however, the active cooperation and discipline of the diabetic patient is decisive for the lasting success of the treatment.

And this can become quite difficult at an advanced age. Although there are also many independent and still largely independent people in the age group of old and elderly people, who can certainly work on their own responsibility to control their metabolic disorder. These patients will need guidance and motivation above all, because it's not easy to have to make sudden and disciplined changes to one's lifestyle at an advanced age in order to maintain quality of life despite diabetes.

Far more often, however, the elderly patient with diabetes will also be a "geriatric patient" who has to contend with many, often severe, disabilities and impairments. These include, for example, an increased susceptibility to health disorders as a result of the natural ageing changes, the presence of several diseases (which is referred to as multimorbidity) with inter-organ interactions, but also the frequent presence of typical geriatric syndromes such as incontinence, tendency to fall, chronic wounds, malnutrition, depression or dementia in various stages. If diabetes occurs in addition, this means a considerable deterioration in living conditions for those affected – and the need for treatment, care and all-round support also increases enormously. A so-called interdisciplinary therapy approach – specified by the guidelines of the German Diabetes Society – between diabetologist, family doctor, nursing and relatives is then indispensable for the success of the treatment.

Diabetic care is not an easy task

If you have taken over the care of a relative who also suffers from diabetes mellitus in addition to his geriatric illnesses, you will be faced with a number of tasks that are not easy to manage. You should therefore obtain information from the health insurance company or the health insurer. Care insurance fund of the person in need of care, which assistance offers are available specifically for diabetes. In particular, it must be clarified what the benefits of the insurance companies are for the numerous aids that a diabetic requires. These are, for example, blood glucose meters, test strips, lancing devices or insulin pens. Some important aspects of care in diabetes mellitus are summarized below.

A supporting pillar of any diabetes treatment is adherence to a diabetes-appropriate diet. Today, a balanced mixed diet is recommended, with a preference for slow-acting, high-fiber carbohydrates (polysaccharides) over fast-acting carbohydrates (monosaccharides). two-fold sugar) should be given preference. Practically, this means: more fruits, vegetables, legumes (if they are tolerated by the diabetic) and cereal products. Usually this type of diet can be carried out at home without major problems. A reduction diet for weight reduction or. BE-calculated food is less often necessary with increasing age.

Malnutrition means an undersupply of one or more of the nutritional groups: Carbohydrates, proteins, essential fatty acids, vitamins and minerals. It can arise because too little is eaten overall or because there is a deficiency of some nutrient. Old-age diabetics are at high risk from both constellations. Malnutrition can be caused, for example, by a lack of appetite as a result of a reduced sense of taste, a decreased feeling of hunger (not infrequently caused by taking medication) or disturbances in chewing function due to problems with ill-fitting dentures. In the case of old-age diabetics living at home, limited mobility often plays a major role, making it difficult to obtain fresh food and to prepare meals.

Another therapeutic measure for diabetes mellitus is exercise. Physical activity increases energy expenditure, makes cells more sensitive to insulin, and thus contributes to blood glucose reduction. However, sufficient exercise with a blood sugar-lowering effect in old age is usually only possible for active, mobile diabetes patients. In very old, multimorbid diabetes patients, this measure for optimizing blood glucose control is no longer possible.

Efficient diabetes treatment is not possible without regular blood glucose monitoring. Knowledge of current blood glucose levels is the basis for the individually required insulin dosage, helps to identify hypoglycemia and hyperglycemia, and generally allows evaluation of the effectiveness of other blood glucose-lowering measures. Who should measure their blood glucose, how often and when, depends on the type and severity of diabetes mellitus and the type of treatment, so it is best to follow the doctor's instructions.

Depending on their general status, elderly diabetics will also need more or less support in monitoring blood glucose levels in order to avoid erroneous measurement results. For example, many diabetics are not aware of how important clean hands are for correct blood glucose measurement. This is because if hands have come into contact with substances containing sugar, such as peeling an orange, prior to measurement, this can cause blood glucose levels to rise such that u. U. dangerous corrections are made in the administration of insulin or oral antidiabetics.

High blood prere (hypertension) plays a decisive role in the development of all vascular diseases, but is particularly risky when combined with diabetes mellitus. According to recommendations of the German Diabetes Society (DDG), blood prere values in diabetics should be reduced below the range of 135 / 85 mmHg. If there is already kidney or eye damage, the blood prere should be lowered even further below 125 / 85 mmHg. The blood prere status of individual diabetics is determined by blood prere checks at the doctor's office. In addition, regular self-measurement is recommended, especially in the case of existing high blood prere. With the easy-to-use blood prere monitors, this is not a problem even for older people.

Not all mechanisms that lead to skin damage and disease in diabetes mellitus have yet been clarified. However, the effects on the skin organ are clear: the diabetic suffers from dry, cracked skin and sometimes very intense itching and is more susceptible to skin infections and eczema diseases. The only preventive measure is intensive skin and body care with particularly suitable cleansing and care products. Since the mucous membranes are also affected by diabetes, diseases of the mucous membranes, such as yeast infections, should be detected in good time by means of regular inspections.

Both diabetes mellitus and urinary incontinence are typical age-related diseases that occur completely independently of each other, but very often together. In older diabetics, urinary incontinence is the third most common complication. The causes are manifold, but recurrent urinary tract infections, age-related changes, cognitive deficits and bladder neuropathies are likely to play an important role. Accordingly, urinary incontinence often manifests itself as sog. neuropathic bladder or as urge incontinence. The type of urinary incontinence should be carefully diagnosed. Then can be treated specifically. To prevent damage caused by moisture and the aggressive decomposition products of urine, absorbent incontinence products with comprehensive skin protection should be used as a preventive measure.

Consequential damage to the feet is the most common complication of diabetes, so a daily inspection should be performed. However, since older diabetics are hardly able to control themselves due to increasing movement restrictions, this is the task of nursing care. Washing is a good opportunity to inspect the feet – especially the toes and heels – for prere points, calluses, blisters, redness and injuries, because these can all too easily develop into fatal ulcers. For the foot care itself, such as cutting nails or removing calluses properly, it is advisable to employ a trained chiropodist.

All forms of leg wounds (diabetic ulcers) that have developed as a long-term consequence of diabetes should be treated from the outset in specialized wound and vascular centers because of their high risk of infection. The risk of gangrene with subsequent amputation is too high. In addition, the treatment of diabetic ulcers is so complex that interdisciplinary cooperation, for example between general practitioners / internists, diabetologists and vascular surgeons, is required. Under no circumstances should a diabetic foot lesion, which is often only small at first, be treated "on one's own" for weeks with the aid of wound ointments and/or wound dressings. Every wound, no matter how small, must be diagnosed and treated and cared for according to the findings.

Careful foot care saves feet

Diabetes mellitus causes therapy

– Inspect feet regularly, if possible daily; if movement is restricted, with the help of a mirror or a spyglass. by another person. After long walks or hikes or. when breaking in new shoes, foot inspection is best done immediately. Special attention should be paid to: Skin discoloration, prere points, blisters, nail changes, corneal thickening, dry, cracked skin, eczema, corns, the smallest injuries; ask about sensory disturbances. – Daily feet washing at the water temperature of 37-38 °C, duration max. 5 minutes. Dry feet carefully, especially the spaces between the toes. Never bathe with open wounds because of the risk of infection. – Care for feet with urea-containing, moisturizing creams, z. B. Foot butter marigold-rosemary from Kneipp. – File toenails straight (only file off a little at the edge to avoid nail ingrowth), do not use cutting tools, remove callus with pumice stone, do not use sharp rasps. – Have calluses and corns removed by a medical chiropodist. Caution: calluses are always a sign of incorrect prere distribution! – Never walk barefoot or in stockings – there is a risk of injury! – Do not use direct heat sources such as hot water bottles or heating pads to warm cold feet, use wool socks instead. – Avoid anything that could cause prere points on the feet: Shoes must be wide enough at the forefoot and must not have any pinching seams or chafing linings; inspect for any foreign objects before putting them on. Socks and stockings should have no seams and constricting elastic bands. – Wear orthopedic shoes in case of foot deformities. – Even minor injuries must be disinfected and bandaged and shown to the doctor at an early stage! – Particularly important: nail and foot fungus must be treated early and consistently.

Treat late lesions consistently, even in old age

With improved therapies, diabetics reach an age when they are increasingly caught up with the long-term consequences of diabetes, often exacerbated by age-related disability and multimorbidity. However, this is not a reason not to take action.

People with diabetes mellitus are acutely at risk from conditions with too high sugar levels (hyperglycemia) and too low blood sugar levels (hypoglycemia). In both cases, it can lead to a threatening coma or. Come shock state.

Furthermore, diabetes can result in diseases and damage, especially of the large and small blood vessels, which is called macro- and microangiopathies (macro / micro = large / small, angio = the vessel, pathie = disease) and also lead to damage of the nervous system (neuropathies). All damages develop due to years of poor blood glucose control. They often go unnoticed and without major symptoms for a long time before the problems become obvious.

However, the slow progression of the disease also offers a great opportunity – even if the diabetes is discovered at a late stage – to protect the beta cell mass from destruction through consistent blood glucose control close to normal, a diabetes-appropriate diet, and, if necessary. Specific treatment of the damage already caused to prevent progression of secondary diseases or. to slow down.

Regular control examinations are indispensable for the earliest possible detection of secondary diseases. They are an important step in improving and maintaining the quality of life not only in younger diabetics, but also in old age.

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