Diabetes, also known as diabetes mellitus, is a chronic circulatory disorder with raised blood sugar levels. Medicine differentiates between two types: Type 1 diabetes, which has a frequency of approx. 10 %, and the far more common type 2 diabetes, which accounts for around 90 % of diabetic illnesses. In both cases, the insulin function, which regulates the blood sugar level as a hormone, is upset in different ways. Chronic elevation of the blood sugar also facilitates the development of arteriosclerosis and frequently causes damage to different organs. It is very important to recognise diabetes in good time and to treat it so as to prevent complications such as these.

Type 1 diabetes

Type 1 diabetes usually starts in childhood or adolescence. The cause is an autoimmune disease in which the body's own immune cells turn again the insulin-producing beta cells in the pancreas. It is still unclear why this autoimmune reaction occurs. Amongst other things, it is presumed that the immune cells are stimulated by viruses and bacteria which have similar characteristics to the beta cells in the pancreas. Genetic factors also seem to play a role.

With the destruction of the beta cells, the body loses its capacity to produce insulin. As insulin should regulate the blood sugar level, this rises as a consequence. The excessive sugar is excreted over the urine,  which causes the typical symptoms of frequent urination and extreme thirst. This is often accompanied by fatigue, loss of appetite and loss of weight. Due to the disturbed sugar metabolism, the body produces increased acetone, which is breathed out over the breath. This manifests itself in a typical breath odour, which smells like overripe fruit or nail polish remover.

Type 1 diabetes is diagnosed based on the characteristic symptoms, by measuring the blood sugar levels and through an examination of the urine. In more than 90 % of the affected parties, antibodies against the beta cells can also be detected.

Patients with diabetes Type 1 must inject themselves with insulin life-long, as the body is no longer capable of producing insulin itself. Nowadays this usually happens with a small insulin pump which is implanted under the skin. It measures the blood sugar level on an ongoing basis and administers the correct dose of insulin into the fat tissue under the skin.

Regular checks are necessary to monitor the blood sugar level and to recognise possible consequential damages caused by diabetes in good time.

Type 2 diabetes

Type 2 diabetes makes up around 90 % of diabetes illnesses and generally occurs only in people of an advanced age. However, young people are being affected more and more frequently as a result of the increasing weight problems in the population. The precursor to diabetes, diabetic syndrome is also being diagnosed in overweight youth more frequently.  Excessive weight, unhealthy eating and a lack of movement are also the main risk factors for the development of type 2 diabetes. These risk factors cause the body to react less and less strongly to its own insulin as time goes by, which results in insulin resistance. Insulin is responsible for ensuring that the sugar from the blood reaches the body's cells. If this function is disturbed, the organism first reacts by producing increased amounts of insulin to compensate for the insulin resistance. With time, however, the insulin production is exhausted, which leads to a further increase in insulin resistance. The consequence is a high blood sugar level.

The symptoms are similar to type 1 diabetes: Thirst, increased urination and fatigue. However, these symptoms are often less pronounced. Type 2 diabetes is sometimes only recognised when complications such as cardiovascular diseases or eye diseases have already occurred. Increased predisposition to infection or badly healing wounds can be the initial signs of diabetes.

Gestational diabetes is a special form of diabetes. During pregnancy, it results in elevated blood sugar levels. This usually disappears again after the birth, but the patient has an increased risk of falling ill with actual diabetes later on in life.

Type 2 diabetes is diagnosed by repeated measuring of the fasting blood sugar and by measuring the long-term blood glucose level HbA1c. It is a haemoglobin changed by the blood sugar and can be viewed as a blood sugar memory value. By measuring HbA1c, it is possible to assess how the blood sugar has reacted over the last 2–3 months.

The treatment depends on the severity of the disease. However, regular weight control, a change in diet as well as intensive training in how to deal correctly with the disease are part of every treatment plan. It is particularly important to recognise the symptoms of hypoglycaemia. Medication which lowers the blood glucose levels is often to lower raised blood glucose levels. Patients with type 2 diabetes must therefore rarely even inject any insulin – at least in the early stages of the disease. There are different medications with different efficacy profiles which lower blood glucose levels. Every patient’s individual situation will determine which medication is used.

Patients with diabetes should adhere strictly to the treatment and monitor their diabetes with regular check-ups. This is the only way to prevent frightening complications such as heart attack, renal damage, eye damage or circulatory disorders in the legs.

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