About Diabetes
What is diabetes?
Diabetes mellitus is a disease in which glucose metabolism is impaired and blood glucose levels are increased. The term diabetes mellitus goes back to the ancient Greeks; it means "honey sweet siphon" and refers to the fact that some of the blood glucose is excreted within excessive amounts of (sweet) urine. Fasting plasma glucose levels ≥ 126 mg/dl (7.0 mmol/l) are indicative for the diagnosis of diabetes. Furthermore, it is diagnosed when a patient has blood glucose levels ≥ 200 mg/dl (11.1 mmol/l) two hours after drinking 75g of glucose solution (a procedure called oral glucose tolerance test = oGTT). There are different types of diabetes, depending on the cause of the disease.
Type 1 diabetes
Type 1 diabetes is an autoimmune disease in which defence proteins (so-called antibodies) attack the body's own tissues. In this case antibodies attack the insulin-producing beta cells of the islets of Langerhans in the pancreas. As a consequence, the body produces only small quantities of insulin or even no insulin at all. The hormone insulin is responsible for the transfer of glucose from the blood into all cells of the body. Since insulin is the organism's only hormone enabling this transfer, increased blood glucose levels are observed if insulin deficiency is left untreated.
Type 2 diabetes
Type 2 diabetes is generally characterised by poor insulin efficacy (= insulin resistance), which means that, despite the presence of insulin, the transfer of glucose from the blood into the cells is not sufficient. Similar to type 1 diabetes, blood glucose levels are increased, while cells are short of glucose. Beside genetic (inheritable) predisposition and higher age, additional common causes for type 2 diabetes are overweight and/or lack of exercise. In order to compensate the lack of insulin efficacy, the organism may increase insulin production over years. However, advanced reduction of insulin levels is commonly found at the time when type 2 diabetes is diagnosed. Type 2 diabetes occurs more often at higher age, but nowadays it is increasingly observed in younger persons as well.
Gestational diabetes
Gestational diabetes means that increased blood glucose levels are found during pregnancy for the first time. There is an increased risk of gestational diabetes in women who are overweight prior to pregnancy, who have close relatives suffering from diabetes, or in those who already gave birth to a child with high birth weight. In order to ensure the health of the unborn child, reduced limit values apply to the diagnosis of gestational diabetes.
Therapy
Along with a balanced diet, type 1 diabetes treatment always includes insulin injections. Injections are required because insulin is destroyed by gastric acid without developing any efficacy when taken orally as a tablet. In cases of type 2 diabetes, the cause can be treated with tablets; however, insulin may be injected in addition. Also, a healthy lifestyle with a balanced diet is beneficial as well as exercise and - in cases of overweight - weight reduction. Today, specific nutritional regimens are no longer recommended, and strict prohibition e.g. of sweets has become a thing of the past. Instead, a balanced diet including a lot of vegetables and fruit, less use of fats and of sugar-rich food is recommended as well as participation in diabetes training sessions. Nutritional recommendations in gestational diabetes are similar. However, if elevated blood glucose levels persist during pregnancy, additional insulin therapy is required.
Signs of diabetes
may be
- frequent tiredness, exhaustion, and listlessness
- increased thirst
- frequent urination
- susceptibility for infections
- impaired wound healing
- weight loss
Dr. Winfried Keuthage (MD)
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