Diabetes mellitus (popularly called diabetes) is the most common metabolic disorder it is estimated that suffer in the West about 6 to 8% of the population in diabetes. Sugar or sugar (glucose) is a carbohydrate and is the main energy supplier of the body. The glucose concentration in blood is normally sober 60-110 mg / dl. With increased energy requirements (such as sports, physical labor), an endogenous control system ensures that these levels do not drop too much. With a greater supply of carbohydrates increases the glucose level temporarily. The reduction in blood glucose levels is caused primarily by insulin. Insulin is a hormone produced in the pancreas (pancreas). It causes the cells to open their gates for sugar. If the pancreas is not able to produce enough insulin or the insulin by changing the cells no longer perform his job, not get glucose into the cells. Thus, the cells suffer from lack of glucose, while the sugar levels in the blood and excess sugar is excreted in the urine.
The following symptoms may occur in diabetes:
* Excessive thirst and large amounts of urine. The excretions of sugar causes always large amounts of water are excreted. The fluid loss leads to dehydration and a strong thirst.
* Depending on the type of diabetes may be weight loss and weakness. The lack of sugar in the cells is offset by the increased degradation of protein and fats, which can lead to weight loss and weakness due to protein deficiency.
* Blurred vision, muscle cramps.
* Tendency to skin, mucous membrane and gum disease and itching.
* Infections, slow healing wounds.
* Decrease in sexual interest and potency. In the worst case it's a diabetic coma with rapid breathing, nausea, vomiting, abdominal pain, excessive thirst, and finally unconsciousness. The exhaled air smells as a result of increased fat loss by acetone.
The following late complications are to be feared:
* Vascular disease. By increased accumulation of sugars and fatty substances (atherosclerosis) in the small and large vessels leads to arterial disease. There is for example the risk of heart attack, stroke or peripheral arterial disease. A so-called diabetic foot can develop because of circulatory problems or neuropathy (see below).
* Diabetic retinopathy (retinopathy). Because of diabetic vascular disease results in a circulatory disorder of the retina. It can cause bleeding and the formation of new vessels, and finally to the restriction of vision to blindness. In addition, diabetics often suffer from cataracts and glaucoma at.
* Disorders of the nervous system (neuropathy). The nerves are less sensitive to stimuli, which may first be felt in a tingling or burning sensation in hands or feet. Injuries (eg cutting the toes) are not felt and heal poorly. It can develop unnoticed ulcers that destroy tissues and bones.
* Kidney damage caused by changes of the small vessels in the kidney to renal failure and dialysis.
* Impotence in men.
There are two main types of diabetes:
1. Type I diabetes (also known as insulin dependent diabetes or juvenile diabetes called). It depends, usually in childhood or adolescence, the destruction of the insulin-producing cells of the pancreas, until finally no insulin can be more distributed. Reason is a defensive reaction of the organism against the body. Also exists, as a rule, a genetic predisposition. If more than 80 percent of the insulin-producing cells have been destroyed, the diabetes becomes apparent. The patient must make insulin. In this case, insulin requirements must be adapted exactly to the requirements. Importantly, the amount and type of food eaten and physical activity reduces the need for insulin. Through periodic blood or Harnzuckermessungen, the exact need for insulin can be determined. More insulin is supplied as needed, so there may be Unterzuckerungszuständen (hypoglycemia) can occur. These are manifested in hunger, sweating, pallor, mild headache, tremors, heart palpitations or anxiety. With strong hypoglycaemia can lead to real mental disorders (the patient could be considered drunk). In insulin deficiency (hyperglycemia) occur, the symptoms described above.
2. Type II diabetes (formerly called adult onset diabetes). This type of diabetes is much more common than Type I diabetes. Cause is a growing body of insensitivity to insulin. Trigger is usually a permanent increase calories - and glucose intake. The organism reacts to the increased formation of insulin. For a while, the excess glucose can still cost recovered. But at some point, the insulin-producing cells are depleted; their production is no longer enough. In addition, there is a growing change in the cells where the insulin, she seems to be insensitive to the hormone and no longer respond. The vast majority of patients are overweight. Due to our increasingly unhealthy eating and living habits of the patients with type 2 diabetes are younger, are now already many children and young people affected.
A special form of diabetes is gestational diabetes (gestational diabetes). He first appears in pregnancy and usually ends with her. Up to 12 percent of all pregnant women are affected. Causes probably are hormones that are produced mainly in the second half of pregnancy. They cause an increased glucose release from the cells. This in turn stimulates the pancreas to increase insulin production. In response some of the affected pregnant women but the cells no longer sufficient to insulin, in another part of creating the pancreas does not increase production enough. In both cases, results in an excess glucose.
Risk factors for gestational diabetes are:
* Obesity
* Diabetes in the family
* Number of previous miscarriages
* A separate g birth weight of more than 4000
* A child born with already more than 4000 g birth weight
The typical symptoms of diabetes in pregnant women are rarely available, therefore, are -. Especially in high-risk patients - regular checks of blood glucose and, where appropriate, further tests required by the physician to recognize this complication early. If left untreated, threatens a sharp increase in the amniotic fluid and significantly increased growth of the baby, although its development is also delayed. Gestational diabetes is treated the first with a focused, low-fat, high fiber diet. If this conversion is not sufficient, the pregnant women are set to insulin. Blood sugar-lowering drugs in tablet form (see below) are not because of possible hazards to the child appropriate. After birth, the diabetes is usually returns almost always complete. However, the women have become ill after a significantly increased risk in the next 10 years on permanent diabetes. And the risk of gestational diabetes in another pregnancy is 50 percent. Concerned should therefore be checked regularly and after childbirth and medical advice.
What can you do?
* As a diabetic, you should strictly follow your doctor's instructions.
* Check regularly using test strips from a pharmacy in your urine or blood sugar.
* Obese people with diabetes should reduce their excess weight with a low carbohydrate diet. Often go the blood glucose levels and related symptoms after a successful diet significantly or even completely back.
* Under-or normal-weight diabetics (mostly type 1 diabetics) should eat in calories, but sugar-free as possible.
* The food should be spread over at least six small meals a day, since so the insulin can be better utilized.
* Food or drinks that are sweetened with sugar should be avoided. For sweetening, sugar substitutes (fructose, sorbitol, xylitol) or sweeteners (e.g. saccharin) are used. These are also used for the production of diabetic sweets.
* The Alcohol may occasionally dry wines or beers to drink diet. Sweet drinks and normal or non-alcoholic beer should be avoided because of the sugar content.
* Physical activity contributes to the fact that more energy is consumed. It also increases the sensitivity of cells to insulin. Thanks so much movement, the need for drugs or insulin are reduced.
* In special diabetes training you can learn how to deal with the disease.
* To avoid Unterzuckerungszustände (see above), should always be a piece of bread or glucose will be available.
When you need a doctor?
* If you feel a sudden strong feeling thirsty or have other of the above complaints.
* If you are overweight and have diabetes in your family.
* If you get a sugar test, which you e.g. received in a pharmacy, is positive.
* With strong Unterzuckerungszuständen (see above).
* Diabetics should go regularly, at least once a year to the eye doctor.
* Diabetics need for poorly healing wounds (especially in the foot), seek medical attention.
What your doctor can do?
* If the control of blood sugar can find the doctor whether diabetes mellitus is present. Here the limits are in the fasted state at about 120 mg / dl plasma and about an hour after eating at 160-180 mg / dl. For values that are close to that, the doctor can perform a so-called glucose tolerance test. It measures how high blood sugar levels two hours after ingestion of 75g of sugar.
* In obese diabetic patients, the doctor recommends, first, to reduce weight by reducing the blood sugar level.
* In case of unsuccessful dieting can hypoglycemic drugs are prescribed. The so-called sulfonylureas (eg glibenclamide) increase including the release of insulin from the pancreas. Biguanides (eg metformin) improve insulin sensitivity and increase the utilization of the glucose, while inhibiting the uptake and formation of additional glucose. Acarbose delays the degradation of dietary sugar in the intestine, reducing the amount of glucose taken. Glitazone reduces insulin resistance and increases insulin sensitivity.
* Drugs do not have enough control of blood sugar available, so the patient must be treated with insulin. Type I diabetics are directly dependent on a dose of insulin.
* The doctor determined in the recruitment phase with the patient the appropriate and required insulin dosage. This is adapted to the daily conditions (food, exercise, illness, etc.) and checks usually by at least four times daily glucose monitoring. For insulin therapy is now used almost exclusively human insulin. In addition, biosynthetically produced insulin is used. A distinction is insulin, which act very quickly (such as regular insulin), and the custodian or delay insulin at medium or long duration or combinations. The latest development there is even insulin that is injected only once a day, but does all day. Insulin should be stored in the refrigerator. Small quantities for immediate use may be stored outside the refrigerator. The insulin is usually injected into the abdomen or the thigh. The dosage and application, through modern injection systems (pen), which look much like a filler to be easier. There is also the possibility of an insulin pump to your belt or carry in your pocket, set to deliver a needle into the abdominal wall at intervals insulin.
* The doctor performs a series of periodic studies of metabolism (blood, urine, etc.) and the nerves to detect any complications or a poor sugar-setting time.
* The eye doctor regularly examines the back of the eye to detect diabetic retinopathy early and treated, for example with laser. The regular measurement of intraocular pressure to detect a developing glaucoma in time belongs to the diabetic study.
Prevention:
* Do not leave without complaints from and lead to a blood sugar test with a doctor or a pharmacist or even run through a urine sugar test from the pharmacy. Often, just the type II diabetes is detected too late and treated.
* People with hereditary stress can prevent the onset of type II diabetes or at least delay, by:
* Maintain normal weight or overweight reduced.
* Physical exercise.
* Enjoy alcohol in moderation.
* The outbreak of a type I diabetes cannot now be prevented by appropriate prevention.
Prevention of diabetic damages (see above):
* Always ensure optimal control of blood glucose levels. Under-or hypoglycaemia avoided.
* Do not smoke as possible. Smoking aggravates all ischemic diseases.
* Healthy lifestyle with regular exercise and a healthy, balanced diet.
* Diabetics with nerve damage should regularly go to the care of diabetic feet or tend to their own care and protection from any type of injury by appropriate footwear.
The following symptoms may occur in diabetes:
* Excessive thirst and large amounts of urine. The excretions of sugar causes always large amounts of water are excreted. The fluid loss leads to dehydration and a strong thirst.
* Depending on the type of diabetes may be weight loss and weakness. The lack of sugar in the cells is offset by the increased degradation of protein and fats, which can lead to weight loss and weakness due to protein deficiency.
* Blurred vision, muscle cramps.
* Tendency to skin, mucous membrane and gum disease and itching.
* Infections, slow healing wounds.
* Decrease in sexual interest and potency. In the worst case it's a diabetic coma with rapid breathing, nausea, vomiting, abdominal pain, excessive thirst, and finally unconsciousness. The exhaled air smells as a result of increased fat loss by acetone.
The following late complications are to be feared:
* Vascular disease. By increased accumulation of sugars and fatty substances (atherosclerosis) in the small and large vessels leads to arterial disease. There is for example the risk of heart attack, stroke or peripheral arterial disease. A so-called diabetic foot can develop because of circulatory problems or neuropathy (see below).
* Diabetic retinopathy (retinopathy). Because of diabetic vascular disease results in a circulatory disorder of the retina. It can cause bleeding and the formation of new vessels, and finally to the restriction of vision to blindness. In addition, diabetics often suffer from cataracts and glaucoma at.
* Disorders of the nervous system (neuropathy). The nerves are less sensitive to stimuli, which may first be felt in a tingling or burning sensation in hands or feet. Injuries (eg cutting the toes) are not felt and heal poorly. It can develop unnoticed ulcers that destroy tissues and bones.
* Kidney damage caused by changes of the small vessels in the kidney to renal failure and dialysis.
* Impotence in men.
There are two main types of diabetes:
1. Type I diabetes (also known as insulin dependent diabetes or juvenile diabetes called). It depends, usually in childhood or adolescence, the destruction of the insulin-producing cells of the pancreas, until finally no insulin can be more distributed. Reason is a defensive reaction of the organism against the body. Also exists, as a rule, a genetic predisposition. If more than 80 percent of the insulin-producing cells have been destroyed, the diabetes becomes apparent. The patient must make insulin. In this case, insulin requirements must be adapted exactly to the requirements. Importantly, the amount and type of food eaten and physical activity reduces the need for insulin. Through periodic blood or Harnzuckermessungen, the exact need for insulin can be determined. More insulin is supplied as needed, so there may be Unterzuckerungszuständen (hypoglycemia) can occur. These are manifested in hunger, sweating, pallor, mild headache, tremors, heart palpitations or anxiety. With strong hypoglycaemia can lead to real mental disorders (the patient could be considered drunk). In insulin deficiency (hyperglycemia) occur, the symptoms described above.
2. Type II diabetes (formerly called adult onset diabetes). This type of diabetes is much more common than Type I diabetes. Cause is a growing body of insensitivity to insulin. Trigger is usually a permanent increase calories - and glucose intake. The organism reacts to the increased formation of insulin. For a while, the excess glucose can still cost recovered. But at some point, the insulin-producing cells are depleted; their production is no longer enough. In addition, there is a growing change in the cells where the insulin, she seems to be insensitive to the hormone and no longer respond. The vast majority of patients are overweight. Due to our increasingly unhealthy eating and living habits of the patients with type 2 diabetes are younger, are now already many children and young people affected.
A special form of diabetes is gestational diabetes (gestational diabetes). He first appears in pregnancy and usually ends with her. Up to 12 percent of all pregnant women are affected. Causes probably are hormones that are produced mainly in the second half of pregnancy. They cause an increased glucose release from the cells. This in turn stimulates the pancreas to increase insulin production. In response some of the affected pregnant women but the cells no longer sufficient to insulin, in another part of creating the pancreas does not increase production enough. In both cases, results in an excess glucose.
Risk factors for gestational diabetes are:
* Obesity
* Diabetes in the family
* Number of previous miscarriages
* A separate g birth weight of more than 4000
* A child born with already more than 4000 g birth weight
The typical symptoms of diabetes in pregnant women are rarely available, therefore, are -. Especially in high-risk patients - regular checks of blood glucose and, where appropriate, further tests required by the physician to recognize this complication early. If left untreated, threatens a sharp increase in the amniotic fluid and significantly increased growth of the baby, although its development is also delayed. Gestational diabetes is treated the first with a focused, low-fat, high fiber diet. If this conversion is not sufficient, the pregnant women are set to insulin. Blood sugar-lowering drugs in tablet form (see below) are not because of possible hazards to the child appropriate. After birth, the diabetes is usually returns almost always complete. However, the women have become ill after a significantly increased risk in the next 10 years on permanent diabetes. And the risk of gestational diabetes in another pregnancy is 50 percent. Concerned should therefore be checked regularly and after childbirth and medical advice.
What can you do?
* As a diabetic, you should strictly follow your doctor's instructions.
* Check regularly using test strips from a pharmacy in your urine or blood sugar.
* Obese people with diabetes should reduce their excess weight with a low carbohydrate diet. Often go the blood glucose levels and related symptoms after a successful diet significantly or even completely back.
* Under-or normal-weight diabetics (mostly type 1 diabetics) should eat in calories, but sugar-free as possible.
* The food should be spread over at least six small meals a day, since so the insulin can be better utilized.
* Food or drinks that are sweetened with sugar should be avoided. For sweetening, sugar substitutes (fructose, sorbitol, xylitol) or sweeteners (e.g. saccharin) are used. These are also used for the production of diabetic sweets.
* The Alcohol may occasionally dry wines or beers to drink diet. Sweet drinks and normal or non-alcoholic beer should be avoided because of the sugar content.
* Physical activity contributes to the fact that more energy is consumed. It also increases the sensitivity of cells to insulin. Thanks so much movement, the need for drugs or insulin are reduced.
* In special diabetes training you can learn how to deal with the disease.
* To avoid Unterzuckerungszustände (see above), should always be a piece of bread or glucose will be available.
When you need a doctor?
* If you feel a sudden strong feeling thirsty or have other of the above complaints.
* If you are overweight and have diabetes in your family.
* If you get a sugar test, which you e.g. received in a pharmacy, is positive.
* With strong Unterzuckerungszuständen (see above).
* Diabetics should go regularly, at least once a year to the eye doctor.
* Diabetics need for poorly healing wounds (especially in the foot), seek medical attention.
What your doctor can do?
* If the control of blood sugar can find the doctor whether diabetes mellitus is present. Here the limits are in the fasted state at about 120 mg / dl plasma and about an hour after eating at 160-180 mg / dl. For values that are close to that, the doctor can perform a so-called glucose tolerance test. It measures how high blood sugar levels two hours after ingestion of 75g of sugar.
* In obese diabetic patients, the doctor recommends, first, to reduce weight by reducing the blood sugar level.
* In case of unsuccessful dieting can hypoglycemic drugs are prescribed. The so-called sulfonylureas (eg glibenclamide) increase including the release of insulin from the pancreas. Biguanides (eg metformin) improve insulin sensitivity and increase the utilization of the glucose, while inhibiting the uptake and formation of additional glucose. Acarbose delays the degradation of dietary sugar in the intestine, reducing the amount of glucose taken. Glitazone reduces insulin resistance and increases insulin sensitivity.
* Drugs do not have enough control of blood sugar available, so the patient must be treated with insulin. Type I diabetics are directly dependent on a dose of insulin.
* The doctor determined in the recruitment phase with the patient the appropriate and required insulin dosage. This is adapted to the daily conditions (food, exercise, illness, etc.) and checks usually by at least four times daily glucose monitoring. For insulin therapy is now used almost exclusively human insulin. In addition, biosynthetically produced insulin is used. A distinction is insulin, which act very quickly (such as regular insulin), and the custodian or delay insulin at medium or long duration or combinations. The latest development there is even insulin that is injected only once a day, but does all day. Insulin should be stored in the refrigerator. Small quantities for immediate use may be stored outside the refrigerator. The insulin is usually injected into the abdomen or the thigh. The dosage and application, through modern injection systems (pen), which look much like a filler to be easier. There is also the possibility of an insulin pump to your belt or carry in your pocket, set to deliver a needle into the abdominal wall at intervals insulin.
* The doctor performs a series of periodic studies of metabolism (blood, urine, etc.) and the nerves to detect any complications or a poor sugar-setting time.
* The eye doctor regularly examines the back of the eye to detect diabetic retinopathy early and treated, for example with laser. The regular measurement of intraocular pressure to detect a developing glaucoma in time belongs to the diabetic study.
Prevention:
* Do not leave without complaints from and lead to a blood sugar test with a doctor or a pharmacist or even run through a urine sugar test from the pharmacy. Often, just the type II diabetes is detected too late and treated.
* People with hereditary stress can prevent the onset of type II diabetes or at least delay, by:
* Maintain normal weight or overweight reduced.
* Physical exercise.
* Enjoy alcohol in moderation.
* The outbreak of a type I diabetes cannot now be prevented by appropriate prevention.
Prevention of diabetic damages (see above):
* Always ensure optimal control of blood glucose levels. Under-or hypoglycaemia avoided.
* Do not smoke as possible. Smoking aggravates all ischemic diseases.
* Healthy lifestyle with regular exercise and a healthy, balanced diet.
* Diabetics with nerve damage should regularly go to the care of diabetic feet or tend to their own care and protection from any type of injury by appropriate footwear.
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