Diabetes - signs, causes and treatment

Diabetes mellitus
Diabetes type II is spreading more rapidly in Germany. In Germany meanwhile nearly nine million humans are to be affected. The unreported number of unrecognized cases is expected to be around four million. But the Enlightenment proceeds with less steps than the disease itself.

contents

• definition
• Shapes and divisions
• diagnostics
• Blood sugar analysis
• Laboratory examination of urine
• Oral Glucose Tolerance Test (oGTT)
• Glycohemoglobins (HbA1)
• Diabetic coma
• Ketoacidotic coma
• Hyperosmolar coma
• Hypoglycemic shock (low sugar)
• sequelae
• Diabetic macroangiopathy and microangiopathy
• Diabetic nephropathy
• Diabetic polyneuropathy
• eye complications
• Diabetic foot syndrome
• Diabetic cardiomyopathy
• Conventional therapy
• Diet in diabetes
• Oral drug therapy
• Insulin therapy
• Naturopathy in diabetes
• Nutritional Therapy Diabetes
• Homeopathy Diabetes
• Rules therapy
• Orthomolecular therapy
• Phytotherapy Diabetes
• Stevia
• Osteopathy and diabetes

definition

The term Diabetes mellitus comes from the Greek and means something like "honey-sweet flow", an allusion to the main symptom of diabetes: the sugar contained in the urine. Diabetes mellitus is a disease term for various forms of glucose metabolic disorder. The cause of diabetes can either be insulin deficiency or insulin resistance, ie sensitivity, or both.

The pancreas produces the hormone insulin in its cells of the islets of Langerhans. This mediates to the cells the transport of glucose (glucose) into the cell interior, from where it is used for energy production (glycolysis). Insulin causes the absorption of glucose into the body cells for energy, as well as the storage in the form of glycogen in the liver and muscle cells. In diabetes, insulin production is disrupted and glucose can not be absorbed into the cells. At the same time, there is no inhibition of the formation of new sugars in the liver. The glucose thus remains in the blood, causing a rise in blood sugar.

If the blood sugar level is permanently increased, this damages the blood vessels, which in turn can lead to secondary diseases. These include myocardial infarction, stroke, circulatory disorders of the legs and feet, changes in the retina, disorders of kidney function and erectile dysfunction. Damaged nerves can cause numbness and emotional disorders. To come to such suffering beforehand, a lifelong and careful blood sugar adjustment is inevitable. Different forms of diabetes are distinguished.

Shapes and divisions

Diabetes mellitus type 1
Type 1 diabetes mellitus is also referred to as juvenile diabetes or insulin dependent (IDDM) because it manifests itself in childhood, adolescence and young adulthood, and those affected need to add insulin throughout their lives.
Cause is with high probability an autoimmune antibody process in which the body's immune system? Cells of the pancreas destroyed.

This is how Diabetes Type2 arises. Picture: Picture dwarf / fotolia

Diabetes mellitus type 2
About 90 percent of all diabetics suffer from type 2 diabetes. Type 2 diabetes is also referred to as non-insulin dependent (NIDDM) or adult-onset diabetes because it used to be primarily for older people. Meanwhile, those affected are getting younger and younger. This type belongs to the so-called metabolic syndrome. In his case, the body's own insulin production is maintained, initially even mostly increased.

Lack of exercise slows down glucose metabolism. Insulin secretion is disrupted, often with the addition of rapidly absorbed carbohydrates. The insulin concentration in the blood increases as a result, while the number of insulin receptors and thus the insulin sensitivity of the target cells decreases. This is called insulin resistance.

Secondary diabetes
In this form, diabetes develops from previous illnesses such as pancreatic diseases (eg, pancreatitis, pancreatic cancer), diseases with increased production of hormones that counteract insulin (M. Cushing, acromegaly), renal insufficiency, or by taking medications such as corticosteroids or diuretics the type of benzothiadiazines.

Pregnancy diabetes (gestational diabetes)
This form of diabetes develops in 3% of pregnant women in the last trimester of pregnancy and usually returns to normal after childbirth. However, there is an increased residual risk for the development of maternal diabetes mellitus. The child is usually born by means of surgical delivery and has a significantly increased birth weight of over 4500g (large growth / macrosomia). Respiratory distress syndrome, hypoglycemia (hypoglycaemia) and jaundice (jaundice) in the newborn are not uncommon.

Symptoms of Type 1 Diabetes
Type 1 occurs suddenly. There is an increased urinary excretion, although the person usually drinks more to compensate for the loss of fluid again. The increasing metabolic disorder is associated with nausea and weakness to dysregulation. Often, diabetes mellitus type 1 patients are quite slim despite abundant food intake.

Symptoms of Type 2 Diabetes
The Type 2 develops slowly and is often recognized late. General symptoms such as weakness and decreased performance are associated with fungal infections of the skin, itching, blurred vision and recurrent urinary tract infections (e.g., cystitis). In addition, sufferers usually have disorders of lipid metabolism, high blood pressure (hypertension) and overweight (obesity). Compared to type 1 diabetes, the characteristic symptoms of type 2 diabetes, such as thirst or urinary tract dysfunction, such as increased urine output (polyuria), appear later.

For male patients of both types, there is an increased risk of having potency disorders during the course of the disease, while female patients are more likely to be menstruated (amenorrhea).

diagnostics

The diagnosis of type 1 can be made relatively easily based on the elevated blood sugar level in the fasted state. In type 2, on the other hand, at the time of diagnosis, the disease often has been present for years, so that it is often diagnosed only on the basis of secondary diseases.

The diagnosis is a bit more complicated because the fasting blood glucose level is usually close to normal. To confirm the suspected diagnosis, the blood sugar examination, the laboratory values ​​of urine and the oral glucose tolerance test are used. In addition, blood lipids, liver enzymes, uric acid, creatine and creatinine clearance, as well as an examination of the urine for microalbumin, a resting ECG and an exercise ECG and an ultrasound examination (sonography) of the upper abdomen are required in the course and position of the first diagnosis.

Blood sugar analysis

Using a rapid blood glucose test, the patient's blood sugar levels can be determined within two minutes. If the value of fasting blood glucose is below 80 mg / dl, diabetes is unlikely. From a value of 120 mg / dl, we speak of a manifest diabetes mellitus. It makes sense to create a blood glucose daily profile. Here, the values ​​are measured before meals and about an hour afterwards. In healthy people, this value is below 120 mg / dl, in diabetics over 180 mg / dl.

Laboratory examination of urine

If the blood sugar level in the blood rises above 120 mg / dl in the blood, the so-called renal threshold is exceeded and glucose is proven to be excreted in the urine (glucosuria). If the urine Sticktest indicates that the kidney precipitates ketone body (acetonuria), threatens a hyperglycemic coma. With increasing damage to the kidney corpuscles, proteins from the blood reach the urine (microalbuminuria). This is a sign of damage to the kidney membrane. As a result, patients lose complex proteins, resulting in visible protein deficiency edema.

Oral Glucose Tolerance Test (oGTT)

It should be noted that the performance of an oral glucose tolerance test is contraindicated for already pathological fasting blood sugar levels. In addition, he should not be done in case of fever, after a heart attack or during menstruation. The use of various medications such as benzothiadiazines, corticosteroids or estrogens increase the blood sugar level and distort the values ​​accordingly. Before the test, the patient will consume at least 150 g of carbohydrate on three consecutive days, but remain sober for 12 hours before the test. After determination of fasting blood glucose, the patient takes 75 g of glucose in the form of a juice within 5 minutes. 2 hours later, the blood sugar level is measured again. If this is now over 200 mg / dl high, diabetes is present. Values ​​between 140 and 200 mg / dl indicate a pathological glucose intolerance.

Glycohemoglobins (HbA1)

The glycohemoglobin value allows you to make a statement about the blood sugar value within the last 6 to 8 weeks and thus serves as a follow-up and to check the drug setting and cooperation of the diabetic patient. In this case, drawn venous blood is thickened. Depending on the laboratory, the values ​​given may vary. In general, the value is under good attitude under 7 percent, worse than 9 percent.

Diabetic coma

The diabetic coma occurs at extremely high blood sugar levels and is also referred to as hyperglycemic shock. One reason may be insufficient insulin, such as insulin dosage too low or missed injections. Also, the need for a higher insulin requirement (eg dietary errors or infections) can lead to diabetic coma.

A distinction is made between ketoacidotic and hypersomalous coma. Both forms are characterized beforehand by the same symptoms as loss of appetite, increased thirst (polydipsia), increased urinary excretion (polyuria), vomiting, weakness, increased respiratory rate (tachypnoea), consciousness clouding, as well as shock symptoms (increased pulse rate and low blood pressure, palpitations ). The therapy of both forms takes place in the intensive care unit, where insulin is supplied and the fluid loss and the electrolyte balance are compensated.

Ketoacidotic coma

The ketoacidotic coma mainly affects type 1 diabetes and develops within hours or days. Many patients complain of abdominal pain, they can feel a strikingly hard stomach. It comes to a hypoglycemia with blood sugar levels of 300 to 700 mg / dl and fat loss with concomitant production of ketone bodies. As a result, a fruit-like acetone odor in the air (so-called Kussmaulatmung) is generated.

Hyperosmolar coma

The hyperosmolar coma usually affects type 2 diabetics. It gradually develops with blood sugar levels of over 600 mg / dl. Due to the high fluid loss as a result of the increased excretion of urine, there is a loss of electrolytes and internal dehydration (exsiccosis). The skin of those affected is dry and warm.

Hypoglycemic shock (low sugar)

In hypoglycemic shock is a low blood sugar level of mostly below 50 mg / dl as a result of an overdose of insulin or Sufonylharnstoffen compared to carbohydrate intake. Alcohol consumption or heavy physical stress can also trigger the shock. This develops suddenly and can occur within minutes. He shows himself by cravings, excessive sweating, inner restlessness and trembling. The pulse rate increases significantly while the blood pressure drops. In addition, it can lead to impaired consciousness to unconsciousness, as well as cramps and central respiratory and circulatory disorders.

A diabetic should be given immediate glucose in the form of sugar (eg glucose, chocolate, apple juice, cola) in case of suspected or indicated hypoglycaemia. In addition, the cause of the onset of hypoglycaemia should always be sought in order to prevent re-shock.

sequelae

Patients suffering from diabetes are often affected by secondary diseases. Here we show the most important complications of diabetes mellitus.

Diabetic macroangiopathy and microangiopathy

Macro- and microangiopathy are called diabetic vascular damage. The disease of the large blood vessels (macroangiopathy) leads to arteriosclerosis, which results in an increased risk of CHD (coronary heart disease), stroke (apoplexy), and the peripheral arterial disease. Due to the nerve damage (polyneuropathy), the sensation of pain is reduced, so that the first warning symptoms for a heart attack such as angina pectoris seizures or intermittent claudication in an arterial occlusive disease are missing. The diseases of the small blood vessels (microangiopathy) include diabetic nephropathy, diabetic polyneuropathies, ocular complications, diabetic foot syndrome and diabetic cardiomyopathy.

Diabetic nephropathy

In diabetic nephropathy (glomerulosclerosis Kimmelstiel-Wilson) enlarges the Kapillarbnäuel (glomerolysis) of the kidney. The glomerular capillary walls thicken and nodules form in the capillary balls (glomeruli). Early shows an increased protein excretion in the urine (albuminuria) on the basis of urine laboratory values. About 50 percent of dialysis patients are diabetics.

Diabetic polyneuropathy

Diabetic polyneuropathies refer to non-injury peripheral nerve diseases. They are characterized by sensory disturbances, abnormal sensations especially of the lower leg and the feet, pain and possibly paralysis. Often there is a participation of the autonomic nervous system with cardiac arrhythmias, blood pressure regulation disorders, dizziness, gastric emptying disorders, nausea, disorders of bladder function, diarrhea (diarrhea) or constipation (constipation). Also sexual dysfunction in men and women are possible.

eye complications

Diabetic retinopathy refers to the retinal damage caused by neovascularization and hemorrhage, as well as retinal detachment by microangiopathy. In addition, cataract and increased intraocular pressure (glaucoma) can be the result of diabetes.

Diabetic foot syndrome

About a quarter of diabetics develop diabetic foot syndrome. The interaction of macroangiopathy and microangiopathy and the associated susceptibility to infection can lead to ulcers with bone involvement and gangrene even in the smallest injuries and pressure points on the foot. In the initial stage, pressure relief from orthopedic shoes is promising, but in the final stage surgery or amputation is often essential. For this reason, the prophylaxis of the development of an injury, for example by targeted medical foot care, must be strictly observed.

Diabetic cardiomyopathy

The exact cause of diabetic cardiomyopathy, ie disease of the heart muscle, is still unclear. Presumably, it is due to metabolic disorders and a microangiopathy, so a damage to the small vessels.

Conventional therapy

The Type 1 diabetic is insulin-dependent from the start and will stay there all his life. Depending on the severity of the disease, the form in which this happens is different. In addition, a regular follow-up is advisable. In both forms of diabetes, the goal of therapy is optimal performance and well-being beyond a normal blood sugar level. In type 2 diabetes, this is initially attempted through consistent diet and exercise therapy to reduce body weight. If this does not achieve a sufficient reduction in blood sugar levels, medical therapy is indispensable. In addition, as a rule, the body's insulin production diminishes with age, which in this case also leads to a secondary insulin requirement.

Diet in diabetes

In diabetes treatment, the diet is the basis of a successful treatment. It essentially corresponds to a balanced whole diet. The basis of the diet is the consideration of carbohydrate and fat intake. At the same time, the energy and nutrient requirements depend on age, gender, occupation and leisure activities. For type 1 diabetics, it is essential to know the exact amount of carbohydrates in individual foods. For type 2 diabetes, the calorie content of foods is at the forefront of the diet.

Basically, food intake should be spread over six to seven smaller meals rather than three main meals. Percentage of the food should be composed of 50% carbohydrates, 35% fats and 15% protein. Cheese, sausage and meat should be absorbed only to a small extent. The diet should have a low content of monosaccharides (white flour, sugar), instead polysaccharides (potatoes, wholegrain, rice) are preferred.

The menu should include grape sugar, sucrose and honey. Alternatively, sugar substitutes such as fructose, lactose, sorbitol or xylitol should be used. Suitable drinks are mineral water and unsweetened herbal teas. In addition, the alcohol consumption should be less than 20 g per day. Diabetic beer and dry wines are allowed.

Oral drug therapy

Oral drug therapy is indicated in type 2 diabetics if the normalization of blood glucose levels is absent despite weight reduction. The production of endogenous insulin by the pancreas is a prerequisite for the performance of oral drug therapy. The following active ingredients are available for oral therapy:

sulfonylureas:
Sulfonylureas (included in Rp Gluborid® or Rp Euglucon®) are the most commonly used drug in oral drug therapy. It stimulates the insulin secretion of the pancreas and thus reduces blood sugar. In the advanced stage of diabetes, combination with insulin is possible. This can lead to side effects such as gastrointestinal discomfort or allergies. If ingested, hypoglycemia may result.

Guar gum and acarbose:
Guar gums (e.g., in Glucotard®) and enzyme inhibitors such as acarbose (such as Rp Glucobay®) inhibit carbohydrate absorption in the gastrointestinal tract. This can prevent blood sugar spikes after meals. The two antidiabetics are commonly used in type 1 diabetics to support insulin therapy. Initial side effects such as flatulence and diarrhea (diarrhea) are not uncommon.

Biguanide:
Biguanides (metformin such as Rp Glucophage®) delay carbohydrate absorption from the gut. At the same time they promote the uptake of glucose into the muscles, inhibit the formation of new glucose, such as lactic acid in the liver, and facilitate weight loss as they reduce appetite. However, due to the risk of blood changes and metabolic acidosis due to lactate proliferation in the blood, they are only prescribed in isolated cases.

Insulin therapy

Insulin therapy is indicated for all type 1 diabetes and type 2 diabetes when diet, exercise therapy and oral antidiabetic medication are inadequate.

It can also be used on a short-term basis, for example in larger operating rooms in diabetes patients and in diabetic coma. Meanwhile, over 90 percent of all diabetics are treated with genetically engineered human insulin. Patients who have been well-adjusted with porcine or bovine insulin a long time ago are no longer being changed.

The insulin is administered by syringe. The patient or the nursing staff usually injects alternately into the subcutaneous tissue of the abdomen or the thigh as part of a permanent prescription. There are insulin disposable syringes or so-called insulin pens, with the help of which the dosage can be set by pressing a button. Rarely, type 1 diabetes uses insulin pumps that continuously deliver insulin through a catheter in the subcutaneous fatty tissue. The dosage is given in international units (IU). A distinction is made between short-acting insulins, delayed insulins, long-term insulins and mixed insulins.

Short-acting insulins:
They are used in acute metabolic disorders as well as in intensified conventional insulin therapy. They work after 15 to 30 minutes and have their peak after one to two hours. After four to six hours, no effect is noticeable.

Long-term insulins:
Long-term insulins are used in intensified insulin therapy. Their working time starts after three to four hours and lasts up to 28 hours.

mixing insulins
Mixed insulins are a mixture of normal and delayed insulins. They are available in different mixing ratios. The main field of application is conventional insulin therapy.

Insulins:
Intermediate insulins (such as Insulman Basal, Humininsulin Basal) are used in older patients with a stable metabolic status and as a component of mixed insulin. They have a duration of action of 12 to 18 hours which starts after about 30 to 45 minutes. The maximum is reached after about four to eight hours.

Naturopathy in diabetes

In the case of diabetes mellitus type 1 disease is an autoimmune disease against the insulin-producing pancreatic cells. Accordingly, a naturopathic therapy makes little sense. However, type 2 can certainly be positively influenced by therapies and funds from the naturopathic spectrum.

Nutritional Therapy Diabetes

Basically, the guidelines apply to a healthy diet adapted to the actual calorie requirement. High carbohydrate intake of carbohydrates such as vegetables, Jerusalem artichokes, potatoes, fruits, whole grains and raw foods is recommended. Dietary fiber ensures that carbohydrates are released into the intestine only with a delay. As a result, the blood sugar level remains constant and a rapid rise in blood sugar during meals can be prevented. Broccoli and spinach in particular, but also cucumbers and grapefruit should have a favorable effect on the metabolic disorder.

White flour, husked rice and finished products should be avoided due to the presence of refined carbohydrates. Sugar and sugary foods are absolutely forbidden. Since sweetener increases the craving for sweet foods, it should be used wisely. Foods with many unsaturated fatty acids, such as sausage or meat, it is only to consume in moderation. Instead of animal fats, high-quality vegetable oils should be preferred. Helpful to stimulate the metabolism may be a drinking cure with sulphate or magnesium-containing medicinal waters.

Homeopathy Diabetes

A homeopathic treatment can not be expected to cure diabetes effectively, but improvement in the metabolic state is possible, as can normal weight and pleasure. The following constitutional remedies may be indicated for treatment: Acidum phosphoricum, Carcinosin, Helonias, Lac Defloratum, Lycopodium, Lycopus, Phosphorus, Plumbum, Sulfur, Tarantula. Complex means of support usually contain Syzygium jambolanum (a proven indication for diabetes melitus), creosote (in subsequent conditions such as itching or gangrene), Acidum phosphoricum (in nervous fatigue or memory impairment) or Natrum sulphuricum (in disorders of the liver and pancreas or depressive mood).

Rules therapy

Important for diabetic patients is regular physical activity such as walking, cycling or swimming. Thus, the glucose tolerance can be improved and overweight can be reduced. In case of overweight, a gentle weight reduction has an advantageous effect on the normalization of the blood sugar level. Since stress can lead to significant blood sugar fluctuations, it should be turned off as much as possible. The correcting factors are sufficient sleep and regular daily routine. Nicotine and alcohol should be avoided.

Orthomolecular therapy

For diabetics, zinc is very important because it is biochemically and functionally closely related to insulin: As a zinc-insulin complex, insulin is stored in the pancreas. This complex is split upon insulin release. Many diabetic patients are considered to have a disorder in this process and are often diagnosed with a decreased zinc plasma level as a result of urinary zinc excretion. In this case, orthomolecular medicine recommends the use of zinc, which can increase insulin intensity and regulate insulin degradation. Hyperglycaemia and disturbed fat metabolism put many diabetes patients under considerable oxidative stress. Antioxidant vitamins such as vitamin C or vitamin E can counteract this.

Another suitable dietary supplement for diabetics is brewer's yeast, which due to its chromium content increases glucose tolerance (the glucose tolerance factor is chromium-containing) and enhances the effect of insulin. To alleviate the risk of nerve damage, it is advisable to administer B vitamins. For diabetic neuropathies,? -Liponic acid is recommended.

Phytotherapy Diabetes

Various medicinal plants have a positive effect on the sugar metabolism and stabilize the blood sugar level. To them counts dandelion (Taraxacum officinale), which detoxifies and harmonizes the liver metabolism. Since the liver, in addition to the pancreas, is the central organ for the regulation of the sugar balance, this has a positive effect on the patient.

Chicory (Cichorium intybus) regulates the activity of the upper abdominal organs spleen, pancreas and liver and can thus also have a balancing effect on blood sugar fluctuations, centaury(Centaurium erythraea) shows a similar effect. artichoke(Cynara scolymus) is great for lowering elevated blood glucose levels and regulates the conversion of fat into sugar in the liver.

wild garlic (Allium ursinum) can break down deposits on the inner wall of the vessel and improve blood flow. Furthermore, the cinnamon bark is said to have a beneficial effect on type 2 diabetes mellitus, which could be demonstrated at a daily dose of 1-6 g in one study.

Stevia

For a long time voices have been heard from naturopathy, which demand the increased use of the stevia plant as a sweetener. The leaves of the native South American plant can provide over 30 times the cane sugar. A property that the Indians of South America have been using for centuries. For diabetics, the honeywort, as the plant is also called, would be good because there would be no increase in blood sugar levels. Stevia Rebaudiana should not have the unpleasant side effects of sugar intake such as tooth decay and increasing weight and even lower blood sugar. In natural medicine Stevia is therefore already used for high blood pressure and heartburn. The approval of the European Commission (EC) as food has not yet been done, but it should give aspirations of large corporations such as Coca Cola to obtain patents for individual ingredients.

Osteopathy and diabetes

In the case of diabetes, treatment with the hands of affected patients and outsiders themselves is usually strange and unthinkable. But in pancreas areas that are still functional, mechanical intervention can be a supportive measure. As early as 1906, the osteopath Marion Edward Clark described in his book "Applied Anatomy" the relationship between dysfunctions of the pancreas and the sixth, seventh and eighth thoracic vertebrae, as well as the associated ribs. In addition, dysfunctions of the gallbladder and the vagus nerve are to influence the function of the pancreas.

The founder of osteopathy, Andrew Taylor Still, described in his book "Research and Practice" four years later than Clark that diabetes and obesity "are effects of severe subluxations around the first, second, third, and fourth thoracic bodies." These would, from the mechanical point of view of osteopathy, cause irritation to the fifth and sixth nerve that runs between the ribs. He suggested that "sensation, exercise and nutrition be considered" in this area. Furthermore, he advised, among other things, "gently pull the stomach and the intestines from the right to the left side". (Js)

Proof: Michael Horn / pixelio.de