Diabetes Mellitus: Forms, Causes And Consequences

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Around six million people in Germany suffer from diabetes mellitus. What exactly is diabetes, also known as sugar disease? How does this chronic metabolic disorder come about and what are the consequences of the diagnosis for those affected?

Diabetes mellitus (“honey-sweet flow”) is a disease of the metabolism, more precisely of the sugar metabolism. The chronic disease has various causes and is playing an increasingly important role worldwide. In Germany, about seven to eight percent of all people are affected – and the trend is rising. There are also people with impaired glucose tolerance, which is regarded as a precursor to diabetes (prediabetes). In addition, a high number of unreported cases is assumed.

There are basically two main forms of diabetes mellitus: type 1 diabetes and type 2 diabetes . There are also rarer special forms such as diabetes insipidius, LADA (latent autoimmune diabetes in adults – type 1 diabetes that occurs late), MODY (maturity onset diabetes of the young – adult diabetes that occurs in children and adolescents) and gestational diabetes . They differ significantly in terms of causes and therapies.

At a glance:

Causes of Diabetes

Our body cells prefer sugar for energy. Insulin takes on the role of a door opener: It informs the cells that the doors have to be opened because sugar is at the door. If there is a lot of sugar in the blood, the pancreas gets the information to provide insulin to make the sugar accessible to the cells. The insulin is carried via the blood to the cells, which can then use the sugar to generate energy.

According to the WHO, a distinction is made between the two main forms of type 1 and type 2 diabetes:

In type 1 diabetes , there is a dysfunction of the beta cells (islet cells) of the pancreas (Lagerhans islets in the pancreas). This results in an absolute lack of insulin . This form of diabetes is therefore also known as insulin-dependent diabetes. It usually shows up in childhood and adolescence. The cause of the non-functioning beta cells is either immunologically mediated or unknown (idiopathic), which is usually the case. Type 1 diabetes is inherited, meaning it is genetic. Up to ten percent of people with diabetes have this form of diabetes.
In type 2 diabetes , the islet cells are initially insulin sensitive. Over time, there is a predominant insulin resistance with relative insulin deficiency up to complete insulin resistance. This means that although the pancreas initially produces enough insulin, the body cells become increasingly insensitive to it until they no longer react to the hormone at all ( insulin resistance ). The insulin no longer works well here and does not open the cells properly for the absorption of sugar. In most cases, there is also a genetic predisposition. However, other factors must also come into play: Obesityand physical inactivity are the most important. They are responsible for the cell doors “jamming”. More than 90 percent of diabetics suffer from type 2 diabetes.

Symptoms and signs of diabetes mellitus

Typical symptoms of type 1 diabetes are constant thirst and an increased urge to urinate. Severe weight loss is also a sign of type 1 diabetes. Other symptoms can be:

Tiredness/weakness/lack of drive
Intense hunger or loss of appetite
Sudden weight loss
Poorly healing wounds
Increased susceptibility to infections
visual disturbances (“blurred vision”)

Type 2 diabetes is usually not so obvious based on typical symptoms. These are usually less pronounced and less specific. Signs of type 2 diabetes can include:

Lack of drive and performance, tiredness, lack of concentration
Depressive mood
Excessive appetite and excessive eating
susceptibility to infection
itching
In the worst case, already secondary diseases

Examinations and diagnosis in diabetes mellitus

If you suspect diabetes, you should first see your family doctor. However, the symptoms are often so ambiguous that diabetes is not even considered. People who have recently felt unusually thirsty, have to go to the toilet frequently (including at night), feel exhausted and have a family history of diabetes should definitely consult a doctor.

After taking the history of the disease (anamnesis), the doctor will carry out the following examinations:

Determination of the fasting blood sugar in the blood
Determination of the HbA1c value (long-term blood sugar) in the blood
Oral Glucose Tolerance Test (OGTT) , also known as the Sugar Load Test

values in diabetes

The various examinations that the doctor can carry out if diabetes is suspected result in several values that are conspicuous in diabetes:

Fasting blood sugar : If it is repeatedly above 126 mg/dl, you have diabetes. Multiple fasting blood sugar levels between 100 and 125 mg/dl indicate prediabetes. A normal fasting sugar level is below 125, preferably below 100 mg/dl.
HbA1c value : If the HbA1C is 6.5 percent or higher, diabetes is present. If the HbA1c is between 5.7 and 6.4 percent, prediabetes already exists. Healthy people have an HbA1c value below 5.7 percent.
Oral Glucose Tolerance Test (OGTT) : Two hours after ingestion of a glucose solution, levels above 200 mg/dl are very likely to indicate diabetes.

In type 1 diabetes, antibodies against the pancreas or insulin can also be detected in the blood. 90 percent of newly infected people carry them.

treatment of diabetes

In type 1 diabetes, the absolute lack of insulin must be compensated. Insulin can be delivered to the body in a number of ways: by syringe or pump. There are also different types of insulin.

On the one hand, non-drug treatment measures play an important role in type 2 diabetes, and on the other hand, there are a number of drugs available to regulate blood sugar levels. All treatment measures are intended to prevent serious secondary diseases in nerves, vessels and organs. It is also absolutely necessary to control the blood sugar level through regular blood sugar measurement.

The most important non-drug measures are:

right nutrition,
enough movement and thus
reduction of excess weight

Medications for diabetes include:

oral hypoglycemic drugs
insulin

Type 2 diabetics only have to inject insulin in a few advanced cases. Blood sugar levels are usually well controlled through proper diet, adequate exercise and blood sugar-lowering medication. When the pancreas is relieved, it is easier for insulin to transport blood into the cells again.

There are a variety of treatment options available today that can help you get a good grip on living with diabetes. Modern and easy-to-use blood glucose meters make checking the blood glucose level much easier than it was a few years ago.

complications of diabetes

If diabetes is poorly controlled, there is a high risk that fine and large blood vessels, nerves and organs such as the kidneys will be damaged by persistently high blood sugar. This is why the following secondary diseases are particularly common in diabetes:

Diabetic foot (wound healing disorder)
Diabetic retinopathy (eye disease)
Diabetic neuropathy (nerve disease)
cardiovascular diseases
Diabetic nephropathy (kidney damage)

Due to the possible secondary diseases, the feet, the eyes and the blood pressure as well as the blood lipid levels should be examined regularly. The feet are particularly at risk, since the possibly poor blood circulation can cause even small wounds to lead to major problems due to delayed wound healing.

Prognosis and prevention in diabetes

Current research shows that good self-management in relation to the chronic disease significantly extends the life of diabetics. This applies to both type 1 and type 2 diabetes.

Type 1 diabetes is a chronic disease that cannot be cured. In type 1 diabetics, the lifelong supply of insulin plays a very important role. With today’s treatment options, an almost normal life is possible. However, the risk of secondary diseases is high, but this is significantly reduced with good attitude.

Type 2 diabetes is also not curable, but it can be managed well. This includes lifestyle and diet changes. Losing weight in this way often leads to the normalization of the blood sugar level. This can significantly reduce the risk of secondary diseases.

As part of a DMP program for diabetes with the family doctor (disease management program), blood values and feet are checked regularly so that the therapy can be adjusted at any time. This close monitoring is intended to significantly reduce the risk of the known secondary diseases.

If there is a genetic predisposition and other risk factors, the onset of type 2 diabetes can be prevented. If the blood sugar levels are increased from time to time, the following measures are recommended, which in most cases prevent the onset of diabetes:

Weight loss of 5-7 percent within three months
At least 2.5 hours of physical activity per week
At least 15 grams of fiber per 1,000 calories
A maximum of 30 percent fat in the diet
No more than 10 percent saturated fat in the diet

In addition, blood sugar should be checked regularly and coordinated with an internist or diabetologist so that the diabetes does not progress and vessels, nerves and organs are spared.