Diabetes mellitus, diabetes or simply diabetes is a common chronic metabolic disease. A typical feature of it is elevated blood glucose levels. Diabetes mellitus should be treated by a doctor in any case, because the consequential damage can lead to death.
What is diabetes mellitus?
Infographic on the anatomy and cause of diabetes mellitus type 2. Click image to enlarge. Diabetes mellitus (” honey-sweet flow”) or diabetes is a chronic metabolic disease. It is characterized by chronically elevated blood glucose levels (hyperglycemia). Diabetes mellitus is due to an insulin deficiency (absolute or relative), or a decreased response of the body to insulin. Insulin is produced in the pancreas. Its main function is to absorb glucose from the bloodstream into the cells. If this hormone is missing, the glucose can no longer be taken into the cells. As a result, diabetes mellitus causes blood glucose levels to rise.
Causes
The two main forms of diabetes mellitus, type 1 and type 2, have entirely different causes. Only about five percent of diabetics are affected by type 1 diabetes mellitus. The disease usually begins at a young age and is therefore also called juvenile (adolescent) diabetes. It is an autoimmune disease favored by genetic predisposition and viral infections (especially measles, mumps and influenza viruses). In type 2 diabetes mellitus, the cells no longer respond adequately to the body’s own hormone insulin. A relative insulin deficiency develops and, as a consequence, insulin resistance – insulin is present, but the cells do not respond to it. In most of those with the disease, physical changes are found that are summarized as the “affluence syndrome”. These include severe obesity (more than 80% of those affected), lipid metabolism disorders (high cholesterol), high blood pressure and disturbed sugar metabolism. Hereditary predisposition also plays a major role in type 2 diabetes mellitus.
Diagnosis and progression
To diagnose diabetes mellitus, the so-called fasting blood glucose (the glucose concentration present in the blood) is measured and a glucose load test is performed. If this reveals an elevated blood glucose level on at least two days, this is considered an indication of diabetes mellitus. In the course of the disease, malfunctioning of organs can occur without treatment or if the blood glucose level is set incorrectly. In extreme cases, various organs may even fail completely. In addition, without appropriate treatment, patients with type 1 diabetes usually lose weight, feel unwell and often have to urinate. In type 2, on the other hand, the symptoms are much less pronounced.
Symptoms, complaints, and signs
The body tries to excrete the increased accumulation of sugar in the blood through the urine. Strong urge to urinate can therefore be a sign of diabetes mellitus. The urine then tastes sweet and may smell sour and fruit-like. The frequent urination causes sufferers to feel thirsty all the time. In addition, dry, itchy skin can be a sign of the disturbed fluid balance caused by diabetes. Other possible complaints are fatigue, exhaustion and difficulty concentrating because sugar is less able to reach the cells as an energy supplier. This can also lead to weight loss, because the body subsequently helps itself to fat reserves. On the other hand, diabetes can also cause hunger attacks and weight gain. Since diabetes mellitus also affects the immune system, affected individuals are often more susceptible to infections such as bladder infections, fungal infections and colds, or observe delays in wound healing. Furthermore, vision and erectile dysfunction, tingling in the hands and feet, and cardiovascular problems may occur. While the symptoms of type 2 diabetes often occur insidiously and are not so easy to assign, type 1 diabetes usually makes itself felt within a few weeks. The doctor can undoubtedly measure increased or decreased blood glucose levels. If the signs of diabetes are ignored, life-threatening symptoms such as dehydration, kidney failure or unconsciousness in the form of diabetic coma (hyperglycemia) or diabetic shock (hypoglycemia) can occur.
History
The course and prognosis of diabetes mellitus depend primarily on how well it is possible to keep blood glucose levels at a constant level. In type 1 diabetes mellitus, changes in the body’s acid-base balance occur within a few weeks without treatment. This can result in a diabetic coma, which can lead to death. Type 2 diabetes mellitus develops more slowly and is often only discovered after years of progression. Symptoms of both types include increased thirst, frequent urination, weight loss, tendency to infections, calf cramps, itching and visual disturbances. The course is mainly determined by secondary diseases (eye damage, kidney damage, nerve damage, circulatory disorders). Common causes of death as a result of diabetes mellitus are stroke, heart attack, and kidney failure.
Complications
Both acute complications and long-term organ damage can occur with untreated or poorly controlled diabetes mellitus. Severely elevated blood glucose levels (hyperglycemia) often lead to a derailment of sugar metabolism with unconsciousness and circulatory failure; without immediate treatment, the patient may slip into a diabetic coma. In contrast, the administration of too much insulin or too little carbohydrate intake can trigger an equally life-threatening hypoglycemia with the risk of hypoglycemic shock. If high blood glucose levels do not cause acute symptoms and therefore remain untreated for a long time, they damage the small blood vessels of vital organs. One of the most common complications is diabetic retinopathy, which affects the vessels in the retina of the eyes. If detected too late, it can lead to blindness. The blood vessels of the kidneys are also affected by a prolonged elevation in blood glucose levels (diabetic nephropathy). The filtering capacity of the organ decreases, and other secondary diseases of diabetes mellitus such as high blood pressure and lipid metabolism disorders additionally affect the kidneys. Damage to the nerves caused by diabetes mellitus is referred to by physicians as diabetic polyneuropathy, and is manifested by sensory disturbances. Poorly healing wounds and ulcers, which occur mainly on the feet and can lead to the death of tissue, are another consequence of poorly adjusted blood glucose levels.
When should you see a doctor?
In type 1 diabetes mellitus, the body’s own antibodies destroy the insulin-producing cells in the pancreas. As a result, no or too little insulin is produced. Patients must take insulin substitutes for the rest of their lives. Type 1 diabetes mellitus is the most common form of diabetes in children. If this disorder is suspected, the doctor must always be consulted immediately. Diabetes mellitus type 1 is accompanied by a number of typical symptoms. These include, in particular, severe thirst, increased urge to urinate, regular attacks of ravenous appetite and non-specific itching. Patients also feel constantly fatigued and are very susceptible to infectious diseases. Anyone who observes such symptoms in themselves or their child should have their blood glucose levels tested immediately. Many pharmacies also offer this test at a low price. If the sugar level is abnormal, a doctor should definitely be consulted. If there are no abnormalities, the test should be repeated as a precaution. Diabetes mellitus type 2 is the most common form of diabetes in adults and is mainly caused by overweight, obesity and lack of exercise. This form of diabetes is usually less dangerous, but can still lead to serious complications if left untreated. In addition, poorly controlled diabetics not only reduce their quality of life, but also their life expectancy. Regular visits to the doctor are therefore also essential in this case.
Treatment and therapy
To avoid acute symptoms and late effects of diabetes mellitus, good blood glucose control is of primary importance. The focus here is on a healthy lifestyle. In addition to more exercise and weight reduction in overweight people, it is important to achieve normal blood lipid levels and normal blood pressure. In order to bring blood sugar within an appropriate range in diabetes mellitus, a healthier lifestyle is often not enough. In this case, a range of drugs, so-called antidiabetics in tablet form (biguanides, sulfonylureas, glucose regulators, insulin sensitizers) are available.Type 1 diabetics must inject insulin from the onset of the disease, as their pancreas is unable to produce insulin itself. Consequential diseases can be prevented or delayed if diabetes mellitus and its accompanying diseases are treated properly. If blood glucose levels are well controlled, diabetics can lead a life without restrictions and discomfort.
Outlook and prognosis
The prognosis of diabetes mellitus is tied to the type of diabetes diagnosed and differs immensely among the different types. In addition, the behavior of the patient strongly influences the course of the present disease. This can have a positive as well as a negative influence on all forms of diabetes. However, despite all efforts, diabetes cannot be cured, as it is a chronic underlying disease. According to the current scientific possibilities, a complete recovery of the metabolic disorder is not possible. However, if the patient is well controlled, the secondary diseases of diabetes are reduced to a considerable extent. The life expectancy of the affected person also depends on the adjustment as well as the regular control of the blood glucose level. Under negative conditions, the patient may die prematurely in the most severe cases. This is especially true if there is no treatment as well as continuous control of blood glucose. Under optimal conditions, the patient has a chance to achieve a good lifestyle with diabetes mellitus. This requires a change in food intake as well as suboptimal lifestyle habits and the use of drug treatment. The metabolic disease can become a well-manageable disease with a healthy lifestyle and avoidance of intake of harmful substances in long-term therapy.
Follow-up
Diabetes mellitus is a chronic disease and requires regular follow-up. Since the disease affects various organs and organ systems, various specialists must be consulted accordingly for follow-up care in order to detect and treat secondary diseases at an early stage. Once the disease has been recognized, the patient should be educated to prepare him or her for taking the medication and to inform him or her about follow-up care. In general, blood glucose should be checked regularly to determine whether the patient is well adjusted to the antidiabetic drugs or insulin, so that the medication can be changed if necessary. In the case of long-term diabetes mellitus, an annual check-up with an ophthalmologist is necessary, because the disease can damage small vessels in the back of the eye and thus lead to visual disturbances or even blindness. For this purpose, a fundoscopy is necessary to detect early changes in the retina. Since diabetes mellitus also frequently affects the kidneys, regular monitoring by a nephrologist is necessary. Diabetes mellitus can lead to kidney failure if left untreated. Regular checks of the feet should also be carried out by the family doctor, as a diabetic foot is a frequent complication of untreated diabetes mellitus. The patient should also see a neurologist, as damage to the nerves from elevated blood glucose is not uncommon.
What you can do yourself
Everyday behavior and self-help measures when suffering from diabetes mellitus can be important for the course of the disease. With correct control and management of blood glucose and by following a few rules of behavior, there are virtually no limitations for diabetes sufferers, nor are there any losses in life expectancy. This applies to both acquired diabetes type 2 and genetic diabetes type 1, which accounts for only about five percent of all diabetes diseases. The difference in treatment between type 1 and type 2 diabetes is that in type 1 diabetes, which involves an autoimmune disease, the specialized cells of the pancreas can no longer produce insulin, so the necessary insulin must be injected because it would be ineffective if administered orally through the digestive system. In the acquired variant diabetes type 2, the pancreas is still able to produce insulin.Regardless of the need to inject insulin, both types of the disease require strict adherence to an individually tailored diet and exercise therapy, which is reflected in individual sports programs. It is advisable for those affected to attend a training course on diabetes mellitus and the consequences in terms of behavior. Sports activities as part of the recommended exercise therapy, in addition to a conscious diet and effective adjustment of blood pressure, are important building blocks for the prevention of secondary diseases such as damage to the vessels in important organs, for example, the kidneys and the retina of the eyes.
