Diabetes does not hurt. Most sufferers don't realize that something is wrong until very late – when the sugar has already damaged the veins.
Diabetics feel quite well for a long time and only feel a little weak now and then. But this can have many reasons. The fact that they may have diabetes probably occurs to very few people. Type 2 diabetes in particular does not cause any symptoms at first – these only appear later with poor blood glucose levels. Too much sugar in the blood damages the veins in the long term and causes consequential damage to the eyes, heart and kidneys.
Unfortunately, the body does not report when the blood contains too much sugar. The pain alarm system does not respond in this case. Particularly at the beginning of the disease, those affected do not notice what is actually happening in their body. Doctors usually discover elevated sugar levels by accident – during a checkup or before surgery.
However, physicians only speak of diabetes when the blood sugar levels are permanently too high. This is the case for people with type 2 diabetes. Because their body cells do not react properly to the insulin. This hormone acts like a key to open the door to the body's cells so that they can take up sugar as an energy source. In people with type 2 diabetes, this key hangs more and more over the years until eventually it doesn't fit at all.
As a reaction to this, the pancreas produces too much insulin at the beginning of the disease in order to channel sugar into the cells. But over time, the body's cells become increasingly insensitive to the hormone. At some point, experts suspect, the overworked, insulin-producing cells burn out and produce less insulin or none at all. The sugar remains in the blood and in the long term damages the veins, especially those of the eyes, kidneys, nerves or heart. This is why the risk of heart attack and stroke is two to four times higher in people with diabetes than in healthy people.
Interplay of heredity and lifestyle
Around six million people in Germany have already been diagnosed with diabetes. Ninety percent of them suffer from type 2, or adult-onset diabetes. Experts estimate that 14 to 21 percent of older people over the age of 65 are diabetic – including more men than women. From the age of 70. The ratio is reversed at the age of four.
Whether someone develops type 2 diabetes is determined by the interaction of heredity and lifestyle. Genes alone are not responsible. If you are not overweight and get plenty of exercise, you may be able to counteract your predisposition to the disease.
Studies show that 50 percent of people at increased risk for diabetes did not become diabetic because they exercise a lot and watch their weight. However, women who developed diabetes during their pregnancy or had a child who weighed more than four kilograms are particularly at risk. Twelve percent of these women become diabetic within six years of giving birth.
Therefore, have your blood sugar level checked regularly by your family doctor. It is better to detect type 2 diabetes in good time and not when it has already caused damage. For people over 35 years of age, the statutory health insurance pays for this as part of the so-called check-up 35. This check-up, which you can do every two years, also includes an examination of the heart and circulatory system.
Type 2 diabetes creeps up on you on the quiet. Several years can pass before it is detected. Doctors often discover the disease by chance during another examination. Or before surgery, because the stress before the surgical procedure spikes blood sugar and insulin requirements. The same is true for a heart attack or stroke. Even in such situations, doctors often discover diabetes by surprise. They feel fatigued. Have a great need for sleep. You are constantly thirsty. Have to go to the toilet often. – Lose weight without intending to. – The skin on your feet is very dry. – Your body's skin itches a lot. – The skin in the genital area becomes inflamed, and perhaps a fungus also settles there.
Destroyed nerves stop working
Vision problems can also be a consequence of diabetes. Affected persons then no longer see so well at close range, reading is difficult. Diabetes can also affect your love life: In women, the vagina does not moisten as quickly, and later the ability to feel pleasure diminishes. In men, it makes it harder to get a limb erection.
Too much sugar in the blood attacks the nerves, which is why one in ten diabetics has neuropathy, or nerve damage. The fact that the tactile nerves are affected can be recognized by the fact that the feet tingle, the skin can also feel numb there. Nerve damage can also upset the stomach and intestines in rare cases: These patients then suffer more frequently than healthy people from abdominal pain, flatulence, constipation or diarrhea.
Maybe you suspect that you might have diabetes because you feel tired all the time, are very thirsty or need a lot of sleep. You may want clarification because someone in your family already has diabetes. Or you may be overweight. Do not feel physically fit. All these factors increase your risk of becoming diabetic.
Tell your family doctor exactly how you are feeling. He will ask further questions. Probably recommend a blood test. This test shows how high the sugar level is in your blood. The test value shows whether you have diabetes or not:
– If you haven't eaten anything, your blood glucose level should be below 5.6 millimoles per liter (100 milligrams per deciliter). After a meal, your level may rise to 7.8 millimoles per liter (140 milligrams per deciliter). These are the values for healthy people. – It is alarming if your blood glucose after a meal is between 7.8 and 11 millimoles per liter (between 140 and 199 milligrams per deciliter). Doctors refer to this as impaired glucose tolerance. For these people, the risk of developing diabetes is twenty times higher than for people with normal levels. – Those whose blood glucose levels reach or exceed 7 millimoles per liter (126 milligrams per deciliter) when fasting or 11.1 millimoles per liter (200 milligrams per deciliter) after eating are considered diabetic. The doctor can also determine diabetes on the basis of the so-called long-term blood glucose value HbA1c. Anyone who reaches or exceeds a value of 48 millimoles per liter (6.5 percent) is diabetic.
If the doctor diagnoses diabetes, he or she will probably advise further testing.
You should do everything possible to lower the blood glucose level. The type of treatment the doctor suggests to you depends on your personal characteristics. For example, if you are overweight and generally do little exercise, the motto is: avoid sugary foods, lose weight, and exercise more. Both of these factors cause the blood glucose level to fall. This may already be enough. You do not need pills or injections.
If your diet and exercise program does not show success, the doctor will prescribe you medication. However, tablets are only an option if your body still produces its own insulin. There are different tablets with different active ingredients; they each target different points in the body. Sulfonylureas such as glibenclamide or glimepiride, for example, stimulate the pancreas to release more insulin. The active ingredient metformin, on the other hand, supports the hormone insulin in its work.
You can check whether tablets are sufficient for you yourself by means of a urine test. If the test strip shows sugar in your urine, your blood glucose level is too high. Then your last meal was too rich or your medication is not enough. The doctor may then advise you to take a higher dose or a completely different therapy.
End of the line for insulin? No!
If pills can't lower blood sugar enough, you have to get used to the idea of injecting insulin. This is also true if your pancreas has already stopped producing insulin. The range is wide: there are natural and synthetic, fast-acting and long-acting insulins. Some diabetics only need injections at mealtimes, while others have regular injections in the morning and evening. Others inject insulin. Take additional tablets.
Many people with diabetes fear that once they have injected insulin, there is no going back. But this is not true. If you have been taking tablets up to now, you can – after consulting your doctor – safely try out whether you might manage better with insulin. It is also wrong to think that you will have to increase your insulin dose over time. On the contrary, the body's cells often react more sensitively to the hormone again over time.
You can learn how to deal with injections and how to lose your fear of injections in the diabetes training program. There you can also learn everything about your disease. How to cope with it in everyday life.
You have forgotten a tablet? Do not panic! Measure your blood or urine sugar. If it is too high, try to lower it by eating less or skipping a meal. Do not take the tablet after the fact.
If you are hypoglycemic and don't have any glucose at hand, it's best to drink a cola or a sweetened lemonade – not diet cola or diabetic juices: such drinks contain no carbohydrates, only sweeteners that cannot raise blood glucose levels.
You may be new to the diagnosis of diabetes. Then you do not yet know what hypoglycemia feels like. Play through this situation in the presence of your doctor – so you get a feel for the typical signs, at the same time you lose the fear of it.
Do not drive a car with low blood sugar!
Regardless of whether you need pills or insulin: You should always have glucose and some cookies handy in the glove compartment of your car. How to get through a traffic jam or a breakdown without hypoglycemia.
Check your blood sugar level before every trip. Stop immediately if you notice that you are hypoglycemic while driving. You should then no longer drive the car. Eat your emergency ration of glucose and wait until your blood sugar level returns to normal. Only then can you continue driving.
If you take only the blood sugar-lowering tablet metformin, you cannot get hypoglycemia.
stern.de expert Professor Andreas Pfeiffer, head of the Clinic for Endocrinology, Diabetes and Nutritional Medicine at Berlin's Charite hospital, answers your questions:
I have type 2 diabetes. Can I reverse the disease?
It depends on the individual case. For example, if you are a very overweight, inactive person who drinks a lot of sweet drinks, you should change your lifestyle and lose weight – then the diabetes can disappear again. Basically, it can be said that being overweight plays a huge role because it limits the effectiveness of insulin. In addition, half of people with diabetes have a strong genetic component. This limits their insulin production. Anyone who is overweight, does little exercise or eats a lot of carbohydrates needs more insulin than their body can produce. If you lose weight, become physically active and eat fewer carbohydrates, you can make the sugar in the early stages of diabetes disappear again.
What consequences do I have to watch out for if I am diabetic??
Ten percent of people with type 2 diabetes develop neuropathy. That is nerve damage accompanied by numbness and a great risk of ulcers on the feet and legs. Twelve percent develop retinopathy. It is a retinal disease that severely impairs vision and can even lead to blindness. However, secondary diseases depend to a large extent on how well the blood sugar is adjusted.
Is it true that sleep disorders can trigger type 2 diabetes?
Sleep apnea promotes diabetes. In this disease, pauses in breathing during sleep and wake-up reactions in the body occur, which prevent deep sleep phases. In addition, the so-called circadian rhythms are changing. Because we have a series of genes that regulate the timing of our bodily processes. They regulate sleeping and waking, but also our eating rhythm. Today, we see a very close connection between sleep patterns, obesity and diabetes. If you let someone sleep less than four hours for three days, he gets insulin resistance like a diabetic. This is because you mess up the circadian rhythms and the insulin sensitivity that depends on the time of day. Disorders like sleep apnea change the energy balance. They increase the risk of both obesity and diabetes.