Detecting, preventing and treating diabetes
Diabetes can manifest as clear symptoms such as thirst and frequent urination, but can also develop gradually and go unnoticed. Find out here how to recognise type 1 and type 2 diabetes and what you can do about metabolic diseases.
Diabetes (also known as diabetes mellitus) is a metabolic disorder that leads to elevated blood sugar levels because the hormone insulin cannot transfer sugar in the blood into the cells for various reasons.
In Switzerland, around 500,000 people suffer from diabetes, around 90% of whom have type 2 diabetes.
Type 1 diabetes is an autoimmune disease in which the immune system destroys the insulin-producing beta cells in the pancreas. The disease usually first appears in childhood, but in some cases, it does not develop until adulthood. The latter is referred to as LADA (late onset (or latent) autoimmune diabetes in adults). Type 1 diabetes is also referred to as insulin-dependent diabetes because sufferers require insulin therapy.
Type 2 diabetes usually occurs only in adults. Although their bodies can make insulin, the cells do not respond to it (this is known as insulin resistance). During the course of the disease, the pancreas may become exhausted due to the constant overproduction of insulin. This leads to an absolute insulin deficiency, as with type 1 diabetes.
There are other forms of diabetes, such as gestational diabetes (diabetes during pregnancy) or MODY 3 (type 3 diabetes), which is similar to type 2, but is caused by genetic mutations.
Characteristic diabetes symptoms include:
- Frequent urination (polyuria)
- Extreme thirst (polydipsia)
- Weight loss
In type 1 diabetes, these symptoms are often more severe. Type 2 diabetes, on the other hand, develops gradually and is therefore often only discovered when complications occur. These include, for example:
- Poorly healing wounds
- Dry, itchy skin
- Frequent infections
- Impaired vision
Gestational diabetes usually manifests itself as non-specific symptoms, such as frequent urinary tract infections, elevated amniotic fluid volume or increased sugar excretion in the urine. Pregnant women are therefore tested for gestational diabetes by a gynaecologist between the 24th and 28th week of pregnancy. High-risk patients (e.g. those who are overweight or have diabetes in the family) are tested earlier.
Regardless of the type of diabetes, permanently elevated blood sugar levels can lead to serious complications:
- Damage to nerves (diabetic neuropathy) which, for example, promotes diabetic foot syndrome, but can also trigger gastrointestinal complaints.
- Blood vessel disorders, which may lead to cardiovascular diseases (such as a heart attack or stroke) or damage to the eyes (diabetic retinopathy) and kidneys (diabetic nephropathy).
Acute metabolic disorders such as hypoglycaemia and hyperglycaemia (which can lead to diabetic coma) are also possible. These are medical emergencies (dial the emergency number 144!).
Type 1 diabetes is an autoimmune disease in which the immune system fights insulin-producing beta cells in the pancreas. The disease is believed to be caused by a combination of hereditary predisposition and environmental factors.
Risk factors for type 2 diabetes include:
- Being overweight
- Lack of exercise
- High-fat diet
- Excessive alcohol consumption
- Older age
- A history of gestational diabetes
- Hormonal diseases
By leading a healthy lifestyle, you can avoid many of these risk factors and do a lot to prevent type 2 diabetes.
First, the doctor will take the patient’s medical history and perform a physical examination. This includes measuring the patient’s height, weight and blood pressure, for example, and assessing him or her for typical consequential damage (such as to the feet).
Laboratory values also play a role in the assessment, especially fasting blood sugar and long-term blood sugar (HbA1c).
Fasting blood sugar of at least 7.0 mmol/l and an HbA1c value of at least 6.5% indicate diabetes.
Pre-diabetes is defined by fasting blood glucose levels of 5.6 to 6.9 mmol/l and a long-term blood glucose level of at least 5.7%. This means that there is a high risk of developing type 2 diabetes unless lifestyle changes are made. Fasting blood sugar of less than 5.6 mmol/l (100 mg/dl) is normal. In Switzerland, mmol/l are the commonly used units, but mg/dl is also used abroad.
It is also possible to test yourself for diabetes at home using a blood glucose meter or urine test strips. However, this is only a guide. A clear diagnosis can only be made by the doctor.
The aim of diabetes treatment is to maintain long-term blood sugar levels in a healthy range and to minimise the risk of complications.
Insulin therapy is indispensable for type 1 diabetics. As it is no longer produced by the body, this hormone must be supplied externally (e.g. by injection, insulin pen or pump).
The standard treatment is intensive insulin therapy (basal-bolus regimen). Long-acting basal insulin is administered once or twice a day to cover the body’s basic insulin needs. Additional bolus insulin is injected before meals depending on the planned carbohydrate intake (sugar intake). If patients are unable to follow this regimen, e.g. due to old age or because they need care, identical-dose mixed insulin is used.
The basic treatment for type 2 diabetes includes a lifestyle intervention in the form of a change in diet, physical activity and, if necessary, weight loss. This is often enough to correct the long-term blood sugar to the desired level.
If this does not work, patients may also take antidiabetic tablets to lower their blood sugar levels. The recommended medication is metformin, which can be combined with other drugs (e.g. SGLT2 inhibitors or GLP-1 analogues). If this therapy is not successful, the patient may also be treated with insulin.
Treatment for gestational diabetes
For most pregnant women with gestational diabetes, a change in diet is sufficient to keep blood sugar in a healthy range. If this is not the case, the patients must inject insulin, as they are not allowed to use oral antidiabetics. Gestational diabetes usually disappears on its own after the end of pregnancy. However, 25% to 60% of patients later develop type 2 diabetes.
Measuring blood sugar in diabetes
Diabetics who are taking insulin therapy must test their blood sugar daily using blood glucose monitors. For type 1 diabetics, this is necessary, for example, before eating, before exercising and before driving a car. It may be worthwhile for them to switch to continuous glucose monitoring (CGM), in which a sensor under the skin continuously measures glucose levels in the tissue. Diabetics can access the results at any time with a receiver, such as an app on their smartphone.
Well controlled blood sugar can prevent complications. A healthy diet helps to patients to avoid major fluctuations in blood sugar levels. Diabetics therefore benefit from the same recommendations that also apply to healthy people: they should eat as many plant-based foods such as vegetables, fruits and pulses as possible. Slowly digestible carbohydrates from whole grains, healthy fats from vegetable oils, and low sugar, meat and sausage consumption ensure that blood sugar levels rise only moderately.
- Guideline der mediX Schweiz: Diabetes mellitus (Stand: Februar 2021), unter www.medix.ch (Abrufdatum 13.12.22)
- S3-Leitlinie der Deutschen Diabetes Gesellschaft (DDG): Therapie des Typ-1-Diabetes (Stand: 2018), unter: www.awmf.org (Abrufdatum: 13.12.2022)
- Diabetes Schweiz: Über Diabetes, unter: www.diabetesschweiz.ch (Abrufdatum: 13.12.2022)
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- Diabetesinformationsportal: Was ist Diabetes Typ 2?, unter: www.diabinfo.de (Abrufdatum: 13.12.2022)
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- Diabetesinformationsportal: Wie entsteht Diabetes Typ 1?, unter: www.diabinfo.de (Abrufdatum: 13.12.2022)
- Gregg EW, Zhuo X, Cheng YJ et al. (2014) Trends in lifetime risk and years of life lost due to diabetes in the USA, 1985–2011: a modelling study. Lancet Diabetes 2(11):867–874