Diabetes mellitus  >> back to the newsletter overview

There are currently more than 7 million people being treated for diabetes mellitus in Germany of whom about 90% suffer from type 2 diabetes and about 5-10 % from type 1 diabetes. The number of type 2 diabetics, in particular, has been steadily increasing for years due to an ever growing number of overweight people as a result of changed eating habits and a lack of exercise.

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The sugar metabolism of healthy people

 Glucose is a type of sugar and a by-product of carbohydrates taken up with food, decomposed by enzymes in the digestive tract and absorbed into the bloodstream through the intestinal walls.

The sugar metabolism is mainly regulated by two hormones - insulin and glucagon – that are both produced in the pancreas. Insulin, as a chemical messenger, is responsible for the transportation of glucose into the cells where it is consumed to produce energy. In addition, insulin causes the storage of glucose in form of glycogen in the liver and muscle cells, which helps maintain the blood sugar level of healthy people after eating within narrow limits (60-140 mg/dl or 3.3-7.7 mmol/l).

What actually is diabetes mellitus?

 The term diabetes mellitus refers to a group of metabolic disorders under which the blood sugar level is constantly elevated. The blood sugar limit for patients with an empty stomach is at over 126 mg/dl (7.0 mmol/l) or/and at over 200 mg/dl (11.1 mmol/l) after eating. Causes of diabetes mellitus are an absolute insulin deficiency (type 1) or a relative insulin deficiency due to a reduced efficiency of insulin = insulin resistance (type 2) or both at the same time. A genetic predisposition accounts for most forms of diabetes mellitus.

The guidelines of the German Diabetes Association name the following types:

• Type 1 diabetes mellitus: the destruction of beta cells in the pancreas leads to an absolute insulin deficiency. There are often so-called antibodies against endogenous tissue detectable in the blood, which is why this form is also considered an autoimmune disease. Type 1 mostly manifests before patients turn 40.
  
  

• Type 2 diabetes mellitus: this form is due to an insulin resistance with a relative insulin deficiency. At a later stage of the disease, an additional absolute insulin deficiency can partly occur. This form of diabetes often affects overweight people and is mostly associated with other problems of the metabolic syndrome (e.g. dyslipidemia, high blood pressure, increased levels of uric acid in the blood).
  
  
• Diabetes mellitus in association with other pancreas diseases (e.g. through inflammatory processes or after surgery).
  
  
• Diabetes mellitus in association with other metabolic diseases or hormonal disorders (e.g mucoviscidosis, hemochromatosis, PCOS or adrenal gland tumors).
  
  
• Diabetes mellitus in cases of genetic deficiencies (e.g. MODY).
  
  
• Diabetes during pregnancy (gestational diabetes) is a glucose tolerance disorder occurring for the first time in patients during pregnancy.
  
  

Why is an increased blood sugar level a problem?

 A heavy increase of the blood sugar level (to over 250 mg/dl or higher) within a short period of time (hours up to days) because of a malfunction in its regulation can lead to a life-threatening situation that needs immediate treatment at a hospital. The body then increasingly excretes sugar and also water through the kidneys. Due to the extreme loss of fluids, the body might completely dehydrate – a dangerous state that can even lead to a diabetic coma in the worst of all cases. Warning symptoms are an excessive thirst, a frequent urge to pass water and fatigue.

In cases of type 1 diabetes, abnormal blood sugar levels also reduce the body’s fat reserves to produce energy. Ketones are built that eventually lead to an excessive acidity of the blood, a so-called ketoacidosis. Warning symptoms are fatigue, nausea, vomiting and stomach pain.

If the blood sugar level remains significantly elevated over a longer period of time it may harm other organ systems. The large and small blood vessels (arteriosclerosis) as well as the nerves can be affected in particular. As a consequence, secondary diseases such as circulatory disturbances of the coronary blood vessels (angina pectoris, heart attack), of the neck and brain arteries (stroke), the leg arteries (intermittent claudication), the eyes (visual loss until complete loss of sight) or the kidneys may develop.

How to detect diabetes

 Diabetes is often detected by happenstance while getting a preventive checkup as only massively elevated blood sugar levels will show symptoms such as heavy thirst, a frequent urge to pass water or a loss of power.

If a blood test reveals an elevated level of blood sugar of more than 126 mg/dl (7.0 mmol/l) for a patient with an empty stomach or/and more than 200 mg/dl (11.1 mmol/l) after eating diabetes mellitus will be the diagnosis.

In addition, diagnostics will also measure the HbA1c value which shows the average blood sugar level of the last 3 months. An HbA1c level of 6.5% or above confirms the diagnosis of diabetes mellitus. HbA1c in the gray area between 5.7 and 6.4% will make an oral glucose tolerance test (OGTT) necessary in which the patient has to drink a sugar solution and then undergo a test with a venous blood sample taken after 2 hours.

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How to treat diabetes

Treatments differ with the forms of diabetes. Type 1 diabetes requires an immediate treatment with insulin due to the complete lack of an endogenous insulin production. It is administered by means of an insulin pen or an insulin pump into the subcutaneous fat tissue.

Type 2 diabetes often starts with an increased endogenous insulin production and a reduced sensitivity of the receptors for endogenous insulin at the muscle and fat cells. This is called insulin resistance. Reducing the patient’s body weight and calorie uptake while getting sufficient exercise may then help normalize the blood sugar level. If these measures are not enough medication will become necessary to improve the insulin sensitivity or stimulate the insulin production. After a longer time of suffering from type 2 diabetes (about 10-15 years) the endogenous insulin production will be exhausted though, and a treatment with insulin becomes necessary.

Diabetes that occurs for the first time during pregnancy is called gestational diabetes. The blood sugar level is then elevated because of the hormonal change and can mostly be treated well with a dietary change. For some patients, however, an insulin therapy may become necessary.

Regular blood sugar level tests by patients themselves are indispensable to treat diabetes mellitus, especially during a change in therapy and each time before administering insulin to reach a blood sugar level that is as balanced as possible. This enables patients to see for themselves, if their blood sugar level is within the recommended range, and it is the best way to avoid dangerous situations (metabolic imbalances) and secondary diseases in consequence.

What we can do for you

If there are known cases of diabetes in your family or you notice symptoms such as an excessive thirst, a frequent urge to pass water or fatigue for yourself you should undergo the necessary blood tests. Screenings for diabetes are an essential part of preventive medical checkups.

In case you are diagnosed with diabetes mellitus you will immediately have many questions: what do I have to take into account in particular; what are the consequences for my life, my family, job and leisure time? To be able to understand the disease and how to deal with it patients need to be thoroughly informed, advised and trained. Specialists in internal medicine and diabetology are the ones to ask in such cases.

The necessary knowledge and some training is what patients need to safely deal with diabetes in their everyday life. We want to support and accompany them. We provide our patients with all the necessary information and discuss appropriate treatments with them.

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