What is diabetes?Colloquially known as diabetes, diabetes is a serious disease with a high prevalence worldwide and steadily increasing case numbers. Under the technical term diabetes mellitus (lat. "honey-sweet flow"), different manifestations of a chronic disease are summarized, which affected 463 million people worldwide in 2019.
The International Diabetes Federation (IDF) estimates that by 2030, the global prevalence will increase to 573 million cases, meaning that about 7.7 percent of the world's population will suffer from the disease.
How sugar metabolism works?
Forms of the disease that are summarized under the medical term diabetes mellitus are accompanied by an excess of sugar in the blood (hyperglycemia). The cause of the disorder is an impairment of metabolic functions in the area of influence of the hormone insulin.
The human body produces insulin in a specialized collection of cells (islets of Langerhans) in the pancreas. The β-cells active there register the level of blood glucose and are responsible for the production and secretion of insulin.
The concentration of sugar (glucose) in the blood increases, especially after a carbohydrate-rich meal. Insulin is the only hormone that has a blood sugar lowering effect. Comparable to a key, it has the ability to dock onto receptors of a cell and open the cell membrane for the passage of glucose.
In particular, the cells of the liver and of muscle and adipose tie are capable of absorbing large amounts of glucose and subsequently converting or storing it for energy. If the control circuit of the sugar metabolism functions smoothly, the values of the blood sugar level remain within the calculated normal range.
1. Fasting:70-99 milligrams per deciliter (mg/ol), equivalent to 3.9-5.5 millimoles/liter (mmol), 2. Immediately after a high carbohydrate meal:Maximum 160 mg/ol (8.9 mmol/l) 3. Two hours after a carbohydrate-rich meal:below 140 mg/ol (7.8 mmol)
When fasting glucose levels exceed 126 mg/dl (
– Type 1 diabetes is an autoimmune disease that leads to complete failure of insulin production and lasts a lifetime. is a metabolic disease in which insulin production is not impaired, but the uptake of the hormone by the body's cells and/or its release from the pancreas is no longer fully functional.
While type 1 is referred to as an absolute insulin deficiency from a medical perspective, type 2 is referred to as a relative insulin deficiency by physicians.
How does type 1 diabetes develop??
In type 1, the patient's own immune system directs itself against the insulin-producing β-cells in the pancreas and causes their destruction due to a misreaction that has not yet been fully explained. The result is a complete decline in insulin production within a period of a few days or weeks. When about 80% of the β-cells are destroyed, there is a rapid increase in blood glucose levels because there is no more insulin to transport the sugar that enters the body through food from the blood into the cells.
In most cases, type 1 diabetes occurs in childhood and adolescence. There is a genetic component that increases the risk of disease to 20% if both parents already have type 1 diabetes. However, 90% of patients have no other relative affected by type 1. Therefore, other risk factors such as viral infections or environmental factors are taken into consideration.
An evaluation of the long-term BABYDIAB study by the Diabetes Research Group at the Technical University of Munich also showed that children born by cesarean section have twice the risk of type 1 diabetes as children who are delivered naturally. In Germany, an estimated 300.000 people develop type 1 diabetes.
How does diabetes type 2 develop?
Type 2 usually develops after the age of 40. The disease is diagnosed at the age of 50 and often remains undetected for years if it progresses gradually. In this disorder, the body's cells lose their sensitivity to insulin, which is ultimately no longer able to transport sugar from the blood into the cells. Problems with the release of insulin are often also (partly) responsible for the impairment of the regulatory mechanisms.
The pancreas does register the elevated blood glucose level and tries to compensate for the imbalance by producing more and more insulin. However, the reaction misses its mark. Despite increased insulin levels, less and less sugar reaches the body's cells. The probability of developing type 2 diabetes is influenced by clearly defined risk factors:
– A genetic predisposition is considered a basic warning signal, – Severe obesity increases the risk of disease, and – Lack of exercise has an additional negative effect on metabolic functions.
If elevated blood lipid levels and high blood prere go hand in hand with diabetes – or prediabetes – the doctor speaks of a metabolic syndrome.
How diabetes manifests itself?
In most cases, many months or years pass before diabetes is diagnosed, because the symptoms are insidious and often nonspecific. They can therefore easily be confused with other causes. The general accompanying symptoms of diabetes include:
– fatigue, tiredness – reduced performance, feeling of weakness – dry, itchy skin – strong thirst – frequent urge to urinate – increased susceptibility to infections, poor wound healing – calf cramps
Typical symptoms of type 1 diabetes
In the course of type 1 diabetes, symptoms such as:
– unexplained weight loss – nausea, vomiting and abdominal pain – dry mouth, acetone odor – diabetic coma in about 15 to 25 percent of cases, which is the first sign of diagnosis
These symptoms only occur when there is no longer enough insulin in the body to transport sugar into the cells, i.e. a large proportion of the beta cells have already been destroyed. In some cases, however, the symptoms appear earlier, for example during surgery, prolonged stress or fever, and while taking medications such as cortisone.
Typical symptoms of diabetes type 2
As a result of its gradual progression, type 2 diabetes does not cause any symptoms for a long time. Indications of the permanently elevated blood glucose level due to insulin resistance may include:
What happens during diabetes hypoglycemia?
Especially in type 1 diabetes, hypoglycemia is an unavoidable consequence of treatment. However, it can also occur in type 2 diabetes if it is treated with insulin or certain blood glucose-lowering medications.
If the blood sugar level drops because too much insulin was injected or it was utilized better than expected, certain symptoms occur:
– sweating – heart palpitations – dilated pupils – tremor
These symptoms occur because the body releases the stress hormone adrenaline. If the sugar level continues to drop, the lack of energy in the brain (which is dependent on glucose as an energy supplier) leads to neurological symptoms such as headaches, lack of concentration, as well as speech and vision disorders.
Hypoglycemia can have its own symptoms in each diabetic patient. Some sufferers also exhibit behavioral disturbances and experience seizures when their blood sugar is low.
In very severe cases, there is also a so-called sugar shock.
What happens during a diabetes sugar shock?
Sugar shock is the colloquial name for severe hypoglycemia. which can also lead to death if it is prolonged and blood sugar levels are very low. In diabetes, sugar shock can occur as a complication of excessive insulin intake or severe physical exertion.
To prevent sugar shock, every insulin-injecting diabetic must carry an emergency supply of glucose and take it at the first sign of hypoglycemia.
What are the late effects of diabetes?
If diabetes mellitus is not treated properly, there is a risk of serious secondary diseases. In Germany, about 5 to 10 percent of the national health care budget is currently used for the treatment of diabetes mellitus. Late effects can cause serious damage to various organs and body regions.
If diabetes mellitus type 1 is not treated, after a few weeks of the onset of the disease, malaise, weight loss, frequent urination or a severely altered acid-base balance in the body follows. In extreme cases, this leads to diabetic coma, which can also be fatal.
In contrast, sequelae occur mainly in type 2 diabetics, because due to a lack of clear symptoms, the diagnosis of this disease is often very late. At this stage, significant consequential damage to individual organs may already be apparent.
The cause of such diseases is that untreated diabetes can severely damage the small and large blood vessels due to constantly elevated blood sugar levels.
Microangiopathy or macroangiopathy occurs. It is characterized by damaged blood vessel walls, which prevent sufficient blood flow to the organism due to unfavorable blood flow properties. Individual nerve areas are also negatively affected.
The later diabetes mellitus is diagnosed, the more likely or acute the secondary diseases are. There is a direct connection between potential secondary diseases. The severity as well as the duration of blood glucose elevation. Likewise, possible concomitant diseases influence the development of adverse sequelae due to diabetes.
Diseases of the heart and blood vessels
Type 2 diabetics of both sexes often exhibit the following concomitant symptoms:
– excessively high blood sugar – elevated blood lipid levels (cholesterol) – metabolic syndrome (obesity in the abdominal region)
If these values are not treated, secondary diseases such as stroke, myocardial infarction or peripheral arterial occlusive disease can develop in the course of time.
Diabetic nephropathy (kidney disease)
Kimmelstiel-Wilson disease (nodular glomerulocclerosis) are nodular calcifications of the renal vessels. These result from diabetic concomitants such as:
– high cholesterol level – elevated blood sugar level – high concentration of growth factors
As a result, the functioning of the kidneys deteriorates. This restriction can be detected by certain protein values in the urine.
Diabetic foot syndrome (disease of the foot)
Continuously elevated blood glucose levels damage nerves and blood vessels. For example, malum perforans occurs as a secondary disease in affected diabetics. It is a chronic wound, often located on the heel or ball of the foot. The primary cause is the severely reduced sensation of pain. A large number of pathogens enter the body via the non-healing wound. Occasionally causes severe inflammations. In addition, diabetics with diabetic foot syndrome have an increased susceptibility to bone fractures as well as a high number of deformations of foot bones (Charcot foot).
Diabetic retinopathy (eye disease)
Cause the secondary effects of diabetes mellitus:
– Hemorrhages – Fatty deposits – Water retention – Vessel formation with very fast bleeding properties – Microaneurysm (vessel bulges)
A progression of this causes vascular, retinal.- or vitreous damage. The dangerous nature of this type of damage caused by diabetes mellitus is that affected individuals only notice it when their vision is significantly impaired. At this stage, the damage is so advanced that it often leads to blindness.
In fact, 25 percent of type 2 diabetics suffer from diabetic retinopathy. Twice as many type 1 diabetics are affected by it. In most cases, consequential damage only becomes noticeable after 15 years. Diabetic retinopathy is the most common cause of blindness during working age.
Diabetic neuropathy (nerve damage caused by diabetes mellitus)
Peripheral sensorimotor polyneuropathy occurs in 80 percent of all diabetics. This mostly affects the nerve pathways of the legs and arms.
This is primarily due to damage to the nerves that transmit commands to the corresponding muscle groups or certain sensations to the brain. Mostly diabetics show this secondary disease on the legs. Characteristic of this is a symmetrical pattern of affection that rises from the feet upwards.
Typical symptoms of diabetic neuropathy:
– Sensory disturbances – tingling sensation – burning feet – reduced sensation of pain (see diabetic foot syndrome)
Diabetics with diabetic neuropathy are more likely to develop secondary diseases such as incontinence or gastroparesis. In addition, there is a strong link between diabetes and erectile dysfunction. Up to ten percent of diabetics suffer from impotence during their lifetime.
How is diabetes diagnosed?
The above symptoms are the first clues to suspect diabetes. However, further characteristics are necessary for a reliable diagnosis. These include traces of sugar in the urine, which can be detected from a blood glucose level of 180 mg/dl using simple test strips. Even more important is the blood glucose concentration, which must not exceed the following limits in certain situations:
– 126 mg/dl (7.0 mmol/l) in venous plasma in fasting state (morning before breakfast) – 200 mg/dl (11.1 mmol/l) at any time (occasional blood glucose) – 6.5% (48 mmol/mol) HbA1c (long-term blood glucose value)
If the sugar concentration is above these values, the test must be repeated the next day. If the same results are then shown, the diagnosis of diabetes is considered confirmed. If there is any doubt as to which type of diabetes is involved, the antibodies typical of the respective type can provide information.
How to treat type 1 diabetes?
Since patients with type 1 no longer produce their own insulin, it must be supplied externally. This is usually done by injecting with the aid of a pen. Today, the so-called intensified conventional therapy (ICT) is mainly used and only rarely the "conventional insulin therapy" that was common in the past is applied. Every insulin therapy needs some practice. Is individually tailored to each patient's needs.
Above all, patients must learn how to use the pen correctly, and special diabetes training courses are offered for this purpose. During these training sessions, patients learn how to measure their blood glucose themselves. This is usually necessary at least four times a day and additionally on special occasions such as during/after sports or on long car journeys.
Knowledge of the current blood glucose level is a prerequisite for the correct dosage of insulin. The dosage is very important, because if the injected insulin is not sufficient to permanently lower the blood sugar, secondary diseases may result. If, on the other hand, the blood glucose level is too low, a dangerous state of hypoglycemia can occur, which must also be prevented.
An alternative to the pen is the insulin pump, which delivers insulin into the body through a cannula. Insulin is administered continuously and can also be triggered by the wearer of the pump if necessary (for example, after a meal). Correctly adjusted, patients with type 1 diabetes do not have to avoid certain foods, nor are they dependent on special foods for diabetics.
The goal of any diabetes therapy is to improve the patient's quality of life, prevent acute health problems, and prevent secondary diseases and late complications.
Treatment of type 2 diabetes with prescription drugs on euroClinix
Type 2 diabetes mellitus (diabetes) can be effectively treated with the antidiabetic drug metformin. As this drug is available only on prescription, it cannot be purchased in the EU without a prescription ied by a doctor.
The online clinic euroClinix offers an uncomplicated and safe alternative here. euroClinix enables you to buy metformin through a professional online consultation.
To do this, fill out a patient medical form with the necessary health information, which will be immediately forwarded to our physicians. These check your information taking into account your personal medical history, which can determine the individual suitability from the drug for diabetes mellitus type-2 (diabetes). The shipment of the drug is carried out immediately by the mail order pharmacy.
Shipping and packaging
The estimated delivery time of the medication by UPS is already displayed on the website. You will find out the exact time in the e-mail directly after ordering. Thanks to the 24-hour delivery service, the medication is delivered promptly. Delivered directly to an address of your choice.
Can I order Metformin online without prescription?
It is not advisable to buy the antidiabetic drug Metformin without a prescription on the Internet. The verification of the indicated symptoms and the prescription of the appropriate medication by a qualified physician avoid the risks of misdiagnosis. In the worst case, the disease can even worsen. With euroClinix you can always rely on an uncomplicated, discreet and safe service.