Diabetes mellitus development and treatment

In Germany, about 8% of the total population is diagnosed with diabetes mellitus. The disease is commonly considered one of the so-called diseases of affluence and often occurs together with high blood prere, obesity and high blood lipid levels. Often the onset is insidious and the damage caused is not noticed at the beginning, because the development proceeds very slowly. The longer the disease remains undetected (and thus untreated), the longer consequential damage can develop in almost all organ systems of the body.

Diabetes mellitus – popularly known simply as "sugar", meaning "sweet flow" or "honey-sweet flow". The term was coined a few hundred years ago by doctors and healers who made the diagnosis very simply by means of their sense of taste – they simply tasted the urine of the sufferers. If this tasted sweetish, the patient suffered from "sweet flow". Therapy is a balanced diet. Regular physical activity.

Causes of diabetes

Blood glucose levels are normally fully automatically regulated by the body. In the pancreas, the hormones insulin and glucagon are produced and released in special cells. Insulin is secreted when blood glucose levels are high and causes glucose to be absorbed from the bloodstream at its target cells in the liver, muscles, and adipose tie. This causes insulin levels to drop. Sugar is converted and stored in the target cells. Glucagon is (one of) the antagonists of insulin. When blood glucose levels are low, it causes glucose to be released from the body's stores. Not all diabetes is the same. Although the mechanisms that ultimately lead to damage to the body are the same, the two different types of diabetes have very different underlying causes.

Causes of Diabetes Mellitus Type I

This form of diabetes is very rare. Only about five to ten percent of those affected suffer from this form of the disease. The cause is a malfunction of the immune system, type I diabetes is therefore a so-called autoimmune disease.

The body's own immune cells (lymphocytes) attack the insulin-producing cells in the pancreas and destroy them. The pancreas can only compensate for the failure up to a certain point by increasing insulin production by the remaining cells.

If more than 80% of these cells are destroyed, the body's own insulin is no longer sufficient to keep blood glucose levels in check. It usually does not take long for insulin production to come to a definitive halt, at which point an "absolute insulin deficiency" is present. This form of diabetes is hereditary.

Furthermore, type I diabetes can also be caused by an infection with certain viruses (e.g. mumps or a rubella infection during pregnancy) are triggered.

Causes of Diabetes Mellitus Type II

This type of diabetes occurs most frequently and is also hereditary. What happens during the disease? In simple terms, the target cells of insulin, which absorb and metabolize sugar from the bloodstream, are resistant to insulin to some extent. Larger amounts of insulin are needed to get you to work than in healthy individuals.

The typical lifestyle in industrialized nations, with an excess of food and too little exercise, also has a major influence. The accompanying constant intake of food. Congenital "insulin resistance" ensures a constantly elevated insulin level. Over the years, the cells on which the insulin is supposed to act become accustomed to the constantly elevated levels and later need ever greater amounts of the hormone to be able to perform their function properly.

At some point, the pancreas is no longer able to provide the required amounts of the hormone. Insulin is still produced for a relatively long time, but since the amount is no longer sufficient for the required effect, this case is referred to as "relative insulin deficiency".

Gestational diabetes (pregnancy diabetes)

During pregnancy, changes in the hormonal balance of the woman can lead to a reduced effect of insulin on the target cells.

If the capacity of the pancreas is not sufficient to meet the increased demand, diabetes develops at ca. 3% of pregnant women have gestational diabetes.

After delivery, the disease almost always disappears as quickly as it occurred.

Symptoms of diabetes

Most diabetics only notice over time that something is wrong with them. Constant feeling of thirst (polydipsia), increased urination (polyuria), weight loss and a general lack of performance are the most common symptoms. The difference between type I and type II diabetes is, among other things, that type I diabetics usually experience the above symptoms at once – they notice quite quickly that something is wrong.

Complications and consequential damage

A rare, life-threatening complication is the "coma diabeticum" (diabetic coma). The increased blood sugar and the loss of water lead to a total derailment of the water, sugar and acid-base balance of the body, which results in clouding of consciousness and even comatose states. Coma diabeticum often occurs in type I diabetics before diagnosis (sudden onset with nonspecific symptoms) and in type II diabetics when gross medication or dietary errors are made in the course of therapy.

However, the constantly elevated blood sugar often goes unnoticed. It damages especially the blood vessels. Thus favors the development of arteriosclerosis. Through additional symptoms such as high blood prere. high blood lipids increase the risk of heart attack or stroke.

Small vessels in the retina of the eye ("diabetic retinopathy") and in the kidney ("diabetic nephropathy") are damaged, resulting in circulatory disorders and nerve damage (nerves are also supplied by blood vessels), which can also lead to erectile dysfunction.

The smaller the blood vessels, the earlier they are affected by the disease. Consequential damage can be observed particularly early in areas of the "end-stream pathway" (the smallest branches of the blood vessels that ultimately supply the ties with oxygen and nutrients). A typical example is the "diabetic foot. Blood flow decreases, sensation decreases, and small injuries occur, which often go unnoticed for days or weeks and become infected. In the worst case, this can lead to amputation of the affected body part.

Diagnosis in diabetes

Often the diagnosis of diabetes is made purely by chance, since in many cases the disease starts slowly and the sufferers get used to the changes that happen to their body. They do not perceive the small signals. Blood glucose levels are often routinely determined during laboratory tests and are often the reason for the family doctor to take a closer look.

Blood glucose levels should not exceed 100mg/dl when fasting and should not exceed 140mg/dl 2 hours after a meal. Both values can be disturbed without the disease having become fully established. The term "impaired fasting glucose" or "impaired glucose tolerance" is used. Both conditions can be considered as precursors to the diagnosis of diabetes mellitus.

If the sugar levels are elevated over a longer period of time, the sugar molecules begin to accumulate on the red blood cells (erythrocytes). The longer diabetes is left untreated, the more red blood cells have a sugar attachment.

The so-called HbA1c value allows the physician to track the course of the disease over the last eight to ten weeks. In diabetics, it should be below 6.5%.

Furthermore, the sugar content of the urine can be determined by means of test strips or a glucose load test can be carried out. For this purpose, a patient's fasting glucose is measured and then a precisely defined amount of a glucose solution is administered and the blood glucose is determined again after two hours.

Therapy for diabetes

Especially the so-called fast sugars, which are mainly used in sweets and soft drinks, upset the body's sugar balance due to their enormously fast absorption. Slow sugars, such as those z.B. These sugars, which are found in bread and pasta, must first be broken down by enzymes in the intestines before they can enter the bloodstream. The organism is not suddenly flooded with huge amounts of sugar. The organ systems involved in regulation can go about their work in peace. A healthy and balanced diet is therefore the best way to protect against the disease and its immense consequential damage.

Once the diagnosis of diabetes mellitus is confirmed, those affected often face drastic changes. Most patients have to radically change their eating habits. Getting used to the daily intake of medication.

Depending on the type of disease, there are various drug therapies available. In type I diabetes, the insulin-producing cells are often already so severely damaged that treatment with artificial insulin must be started immediately. Type II diabetics usually have the option of treating their disease with medication in tablet form for the time being.

Preparations used for diabetes:

Biguanides (z.B. Metformin) delay the absorption of glucose from the intestine and increase the uptake of glucose from the bloodstream into the liver and muscles. Side effects are mainly flatulence, stomach prere and metallic taste sensations. Sulfonylureas (z.B. Glibenclamide) increase insulin secretion from the cells of the pancreas. Before therapy, however, a normalization of body weight should be aimed for. Side effects include hypoglycemia (blood glucose levels that are too low) and allergies. Alpha-glucosidase inhibitors (z.B.Acarbose) inhibit an enzyme in the intestine that cleaves larger sugar molecules before they are absorbed, delaying the absorption of glucose from the intestine. Side effects are diarrhea and flatulence. Glitazones (z.B.Rosiglitazone) cause an improved effect of the body's own insulin on the target cells. Side effects include weight gain, diarrhea, flatulence, and edema (water retention).

Insulin therapy

If the body's own insulin production is no longer sufficient, those affected must administer insulin themselves. This is done with the "pen" (pencil), with which the insulin is injected under the skin.

Insulin therapy should always be accompanied by appropriate dietary changes. Patients need to measure their blood glucose levels regularly and assess how a meal affects their blood glucose levels.

Special diabetic training courses are available for learning how to do this – the therapy is complicated and requires discipline. Over time, however, diabetics learn to cope with their situation, to interpret their body's signs correctly, and to integrate the therapy into their daily lives.

The special case of gestational diabetes or. Pregnancy in diabetic women always requires intensive and close monitoring and treatment of elevated blood glucose levels to prevent possible damage to the unborn child.

Herbal remedies for diabetes?

The treatment of diabetes with natural agents such as cinnamon or aloe vera is still little researched. Approaches from Far Eastern healing practices (u.a. Ayurveda, traditional Chinese medicine and acupuncture) are becoming increasingly popular because of the side effects of conventional medical therapy, which are often perceived as very disturbing. However, robust, large-scale studies on natural agents and their potency as well as possible side effects are largely lacking. In comparative studies, herbal preparations in every case lagged behind the efficacy of conventional medical therapies and the effects of a healthy lifestyle. They should be considered therefore at most as supplementing measures. Always be taken after consultation with the attending physician.

In medical research, for example, the use of cinnamon bark in diabetes has been discussed for some time, and corresponding preparations can already be found in the trade, for example cinnamon capsules in the form of dietary supplements. Actually in animal experiments a blood sugar lowering effect could be proven. Similar results are also emerging from initial human studies. So far, however, there is no clear evidence of their efficacy in the form of clinical studies. There is also no standardization of the active ingredient cinnamon as an approved drug for use in diabetes.

Preparations with cinnamon bark can therefore be used in the form of dietary supplements as a supportive measure and only under medical supervision, as they can influence blood sugar control. According to the current state of knowledge, they can in no way replace conventional treatment.

– Weight loss of unclear cause – Gross changes in drinking quantity and/or urine quantity – Clouding of consciousness, poor performance Nausea and vomiting, dry skin and mucous membranes. These symptoms can be signs of coma diabeticum – emergency! – Sudden onset of symptoms during pregnancy or. Desire to have children or unwanted pregnancy with known diabetes. – Problems with the therapy (side effects, frequent hypoglycemia, etc.) are not easy to solve. Patient guideline diabetes. Pregnancy of the German Diabetes Association. – General information portal on diabetes. – Nerve pain guide for information on neuropathies in diabetes – Gerhard-Walter Schmeisl: Training book for diabetics. – Peter Hien, Bernhard Bohm and Simone Claudi-Bohm : Diabetes handbook: Guidance for practice and clinic. – Matthias Riedl: 300 questions about diabetes.

– K.Arasteh, H.-W. Baenkler, C. Bieber: Dual Series Inner Medicine, 2. Edition: Thieme; 2009. – G.Herold and colleagues: Inner Medzin 2008.

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