The term diabetes mellitus means as much as honey-sweet (Latin: mellitus = honey-sweet) flow (Greek: diabetes = flow, increased urine flow). It is understood to be a chronic disorder of sugar metabolism triggered by a deficiency of the hormone insulin. The result is an excessively high sugar content in the blood. The two main forms of diabetes mellitus are referred to as type 1 and type 2, with type 2 affecting around 90 to 95 percent of diabetics. The two forms differ fundamentally in their causes and thus in their effects and course.
Causes of type 1 diabetes
The cause of type 1 diabetes is a complete failure of insulin production (absolute insulin deficiency). Because in this form the patient’s own antibodies (autoantibodies) against the insulin-producing islet cells of the pancreas can be detected in the blood of the affected person, type 1 diabetes is classified as an autoimmune disease. This also seems to be confirmed by the fact that there is a family history of the disease (about 20 percent of those affected also have a type 1 diabetic relative). In addition, it is assumed that certain viruses (for example rubella viruses) or certain toxins could initiate an autoimmune reaction. The irreversible destruction of insulin-producing cells results in symptoms of high blood glucose already appearing at a young age (usually in late childhood), hence the term juvenile diabetes.
Causes of type 2 diabetes
Quite different from the juvenile type, the cause of type 2 diabetes is usually lifestyle. Although genetic factors also play a very significant role in this case, there is a very close association with a diet that is too fatty, too high in sugar, and generally too high in calories, as well as lack of exercise and obesity. Two disorders play the main role in its development:
- A disturbed insulin release by the pancreas.
- A decreased insulin action on the cells and organs.
This means that even if insulin levels in the blood are high (as can occur in type 2 diabetics), the hormone will have no effect if the receptors no longer function or are diminished. Just as a formerly fitting key (insulin) is unable to open a now defective lock (insulin receptor). This is called relative insulin deficiency or insulin resistance. Occasionally, pregnancy (gestational diabetes), hormonal imbalances, stress factors (infections, injuries, surgery), and certain medications (for example, cortisone) can also cause a diabetic metabolic condition.
Type 2 diabetes: course
In contrast to diabetes type 1, diabetes type 2 often progresses insidiously. Since the body in this case only develops insulin resistance over time, it can often take years before increased symptoms appear and are noticed. The first signs of type 2 diabetes include fatigue and poor performance. Cravings and increased sweating can also occur. An increased urge to urinate, a greater feeling of thirst, or itchy and dry skin often develop as the disease progresses. By the time these symptoms are properly diagnosed, organs may already be damaged. If diabetes is not treated with the help of behavioral changes (for example, dietary changes and fitness), insulin or oral antidiabetics, the course of the disease can be severe. Damage to the vessels in the eyes, feet, heart or kidneys can be the result. This in turn increases the risk of other diseases, such as strokes or kidney failure. Nerve damage can also occur. More information on secondary diseases in diabetes can be found here.
Prognosis in type 2 diabetes
With consistent adherence to therapeutic recommendations and regular checkups, the course of diabetes type 2 can be mitigated or slowed. The risk of secondary diseases decreases, which in turn has a positive effect on life expectancy. The course of type 2 diabetes is therefore often strongly dependent on consistent implementation of the therapy and changes in one’s own lifestyle, especially with regard to diet and exercise. For this reason, early diagnosis can improve prognosis.
Type 1 diabetes: course and prognosis
Due to the absolute lack of insulin in type 1 diabetes, the first symptoms appear very quickly in this form of diabetes mellitus.These include frequent urination and excessive thirst, gastrointestinal problems, fatigue and weight loss. This weight loss occurs because the cells begin to burn fat due to the lack of glucose. The resulting metabolic product, acetone, causes hyperacidity of the blood (ketoacidosis). The body tries to release acetone through the air it breathes. This results in gasping for breath and a bad breath reminiscent of slightly rotten fruit. Since the metabolism no longer functions properly, those affected suffer from stomach pain. If left untreated, the course of type 1 diabetes is dramatic: frequent urination leads to dehydration, which can lead to kidney failure. As the disease progresses, the affected person falls into a diabetic coma, which in the worst case can be fatal.
Proper therapy positively influences course
If type 1 diabetes is treated with insulin in time and blood sugar is well adjusted, a largely normal life is possible. However, the life expectancy of type 1 diabetics is still lower than that of healthy people. According to a Scottish study from 2015, at that time a 20-year-old man with type 1 diabetes had a life expectancy that was 11 years shorter, and for a 20-year-old woman it was even almost 13 years. This is mainly due to hyperglycemia or the higher risk of developing kidney disease. However, some recent studies from other European countries indicate that the life expectancy of people with type 1 diabetes has increased in recent decades. Improved treatment methods, a well-controlled long-term value and the appropriate therapy can therefore positively influence the course of type 1 diabetes.
