The term Diabetes mellitus (Diabetes mellitus) describes an endocrine-metabolic disease complex characterized by a defined elevation of blood glucose levels (hyperglycemia).
The hormone insulin, which is produced in the islet cells of Langerhans in the pancreas, is necessary for the human body to be able to utilize the sugar it takes in. Insulin activates the glucose transporters in the cell membranes so that the cells can absorb glucose.
In addition, the hormone plays important roles in the hormonal interplay of the metabolism of carbohydrates, amino acids and fats. Related to insulin and partly similar in effect, the hormone leptin. Its relevance within the different forms of diabetes has been insufficiently considered so far.
Diabetes is caused by disorders or diseases in the hormone-producing (endocrine) part of the pancreas. Diabetes also develops when the ability of cells to sense the insulin or leptin signal decreases. The metabolic disorder affects about five percent of the western population. Is thus considered the most common endocrine-metabolic disease. In the last 50 years, a rapid increase can be observed in industrialized nations. In the USA, as much as 50% of the population is said to have diabetes or its early stages.
A distinction is made between gestational diabetes, which rarely occurs, and special forms (e.g.B. LADA, MODY), type 1 and type 2 diabetes. With increasing age, the likelihood of developing diabetes increases.
Type 2 in particular manifests itself here, which can be detected in almost 95 percent of all cases. Increasingly, many children also suffer from this variant of the disease. The formerly used term "adult-onset diabetes" therefore no longer seems justified.
A Type 1 diabetes results from a destruction of the insulin-producing B cells, causing an absolute insulin deficiency. This form is more common at a young age, between the ages of 15 and 25. and the 25. Type 2 diabetes is often diagnosed at the age of six (= juvenile diabetes), but it can also appear from birth onwards. causes are genetic predisposition and viral infections, which lead to autoimmune diseases with antibodies specifically directed against the islet cells.
The intestinal flora also appears to play a role in the development of type 1 diabetes: In animal experiments, the onset of the disease could be prevented by altering the intestinal flora.
For the future, researchers hope these findings will provide a deeper understanding of how diabetes develops, as well as better prophylaxis and treatment options.
The Type 2 diabetes (also adult-onset diabetes) results from insulin resistance or relative insulin deficiency. These causes can be congenital or acquired.
Resistance may develop from a persistent excessive supply of sugary foods. Due to the constantly increased glucose concentration in the body, the insulin receptors become less sensitive to stimuli, but the cells of the pancreas produce insulin unstoppably and until they are exhausted.
Signs and symptoms of diabetes
Diabetics often have a typical picture, which is called metabolic syndrome (also called disease of affluence). In addition to increased adiposity (obesity), especially around the abdomen, many sufferers also have lipometabolic disorders (hyperlipidemia and hypercholesterolemia) as well as high blood prere (hypertension).
Depending on the severity of the diabetes, the symptoms include a strong, sometimes insatiable thirst, poor physical performance, fatigue, increased urination, increased susceptibility to infections, ravenous appetite and itching. If left untreated, the entire organism will be damaged in the course of the disease.
This primarily affects the eye (retinopathy) (see also eye diseases) and the vessels (microangiopathies), with increased neurological disorders (neuropathies), kidney diseases (nephropathies) and erectile dysfunction.
Diabetics also typically have altered skin (often dry, brittle, cracked) (skin diseases), which can quickly lead to small wounds (microlesions). Due to circulatory disturbances and altered wound healing, these lesions can lead to large skin defects, which usually heal poorly, degenerate into gangrene and lead to total tie breakdown via necrosis. Not infrequently, there is then a threat of (surgical) loss of body parts (z.B. toe, foot, lower leg) to stop further migration of tie decay.
In addition to extensive organ damage, excessively elevated blood glucose levels can lead to life-threatening coma diabetic (complete loss of consciousness, sometimes with impending organ failure).
Diagnosis
The first indication is provided by the sugar status. In the fasting state, the glucose value of the blood should not exceed 100 mg/dl. Glucose in urine should not exceed 160 mg/dl.
An abnormal change is defined as values between 110 and 126 mg/dl in the blood; measurement results above this level indicate diabetes. The C-peptide, which is cleaved from insulin for activation, indexes the concentration of insulin. The normal value here is between 1.5 and 4 mg/dl.
An HbA1c value above 6% of total hemoglobin indicates that the red blood pigment has already bound too much glucose. This reaction takes place without the participation of enzymes. Thus generates an indicator of average blood glucose over the past 3 months.
During this period, the red blood cells perish and new ones are formed. Although the test cannot reveal occasional glucose spikes, which can lead to damage to blood vessels and nerves. However, it can be used as a marker, especially for diagnosing type 2 diabetes. The HbA1c is also called "long-term glucose" or "blood glucose memory.
Therapy
Therapy is based on the type of diabetes present.
The substitution of insulin in type 1 diabetes is generally done by insulin injections. Recently, treatment with injected leptin has been discussed. The results were even better in animal studies.
In the case of type 2, the primary goal is a change in diet with weight reduction. The focus is on the restriction of carbohydrates. Moderation of protein consumption is also recommended.
Sufficient dietary fiber should also be ensured. Foods rich in omega-3 fatty acids such as fish. Shellfish should be preferred to the omega-6 fatty acids of vegetable fats. Prebiotics and probiotics maintain a balanced composition of the intestinal flora, which is beneficial in any case, but belongs more to the topic of "prevention".
Vitamin deficiency can be involved in the development of the disease, which is why attention should be paid to sufficient vital substances. Harmful substances such as plasticizers and pesticides should be kept as low as possible.
If these measures do not have a (sufficient) effect, oral antidiabetic drugs are administered; in severe cases, injection therapy with insulin or insulin analogues is used. In the future, leptin could replace insulin completely or partially.
The HbA1c value should be reduced to the healthy person's level of 6%. According to studies conducted in recent years, this no longer applies to all patients.
More and more diabetologists strive for an individual adjustment of blood glucose. In particular, diabetics of advanced age do not benefit from strict glucose lowering. The likelihood of hypoglycemia increases and with it dangerous falls, heart rhythm disturbances and heart attacks. One study shows that mortality increases by 20% when seniors are set at the 6% level.
In older patients, the HbA1c value should be more like 7.5% to 8%. If a type 2 diabetic has reached the age of 70, the lowering of blood glucose should be dispensed with altogether.
With regard to the development of long-term consequences, this is sufficient, because such diseases take many years to manifest themselves. Studies also show that lowering long-term glucose to 6% does little to protect seniors from strokes.
Only in younger type 2 diabetics should the 6 % target apply today. However, it is always advisable to adjust the blood glucose setting according to personal requirements.
HbA1c by itself is not a sufficient criterion for treatment. This is already the case because some diseases that exist in addition to diabetes can influence the value and falsify the diagnosis. This can occur with iron deficiency, blood loss and kidney and spleen diseases.
The sugar value is not a fixed value, but for each diabetic an optimal value to be assessed by the doctor. The more consistently the individual follows the requirements (u.a. Diet, renunciation of alcohol, increased endurance sports or / weight training), the more positively this affects a normal life expectancy.
What I also find helpful is autogenic training for diabetes.
Naturopathic methods can also help. Homeopathic remedies are recommended against the after-effects of diabetes, but they cannot be used without a change in lifestyle (diet, nutrition, etc.)!) do nothing. A change to a moderate and healthy diet can protect against type 2 diabetes as a preventive measure. In addition, it should be noted that some drugs have a diabetogenic potential.
Fasting is an excellent method to balance the metabolism in diabetes mellitus. In the case of type 2 diabetes, a cure can even be achieved by fasting if the course of the disease is not yet far advanced.