Synonyms in a broader sense
Sugar, diabetes, adult-onset diabetes, type I, type II, gestational diabetes Literal translation: “honey-sweet flow
- Diets and weight normalization,
- Physical activity, as this increases the sensitivity of muscle cells to insulin,
- AbstentionReduction of nicotine and alcohol.
- Medicines: oral antidiabetics or insulin
- Training of the patient
- Measures to avoid complications (prophylaxis) and therapy of the same.
The target value for the diabetes setting long-term parameter HbA1c (“sugar memory“) is below 6.5% (for an explanation of the parameter, see “Course and Prognosis”). Other risk factors, which, in addition to diabetes, promote vascular changes, should be eliminated. In concrete terms, this means that smoking should be stopped and the patient’s blood pressure values should be reduced to low normal values (below 130/80 mmHg).
Medical studies show that lowering the anterior systolic blood pressure by 10 mmHg results in a 12% reduction in diabetic complications. In addition to all these preventive measures, it is important that patients present themselves to their physician (internist – family doctor) for regular check-ups. These examinations can identify any late complications of the sugar disease and the doctor has the opportunity to initiate appropriate therapy immediately.
Specific therapy of diabetes type 1
The treatment of type 1 diabetics is based on insulin injections under the skin (subcutaneous injection) using so-called “pens”, since insulin cannot be taken as a tablet because of its instability to the acid in the stomach. Diet, physical activity and intensive patient training are also part of the therapy. The patient’s diet and insulin intake must be optimally coordinated to ensure that a normal high blood glucose level is permanently achieved.
A distinction is made between conventional and intensified conventional insulin therapy and insulin pump therapy, which is a form of intensified insulin therapy. In conventional therapy with intermediate or mixed insulin, the patient must adjust his or her meals to a strictly prescribed insulin therapy schedule: He/she administers insulin twice a day, 2/3 to 3⁄4 of the necessary daily dose before breakfast and the rest before dinner, with a 30-minute injection/eating interval in each case. This means that the insulin is injected and should be eaten 30 minutes later.
This procedure leads to an optimal insulin effect. The rigid meal schedule must be adhered to, as the patient injects a certain dose of insulin and “catches” it through the meals. The patient must therefore eat because he has injected insulin.
If he eats too little, his insulin dose is too high and he enters a state of hypoglycemia; if he eats too much, his insulin dose is too low and too much glucose remains in the blood. Treatment of hypoglycemia consists in the administration of glucose and in hypoglycemic shock 1 mg glucagon must be injected into the upper arm muscle (intramuscular injection) or under the skin (subcutaneous injection). Because of the possible occurrence of such an emergency, the patient’s relatives or environment should be informed about the disease and familiarized with emergency treatment.
The intensified conventional insulin therapy for type 1 diabetics is based on the basic bolus principle. The amount of insulin required by the patient during the course of the day is divided into a basic quantity (basic bolus principle) of insulin and additional, meal-dependent doses of insulin (basic bolus principle). Twice a day, an intermediary insulin is administered for basic insulin supply, which covers 40-50% of the total daily insulin dose.
The other 50 – 60% is divided between meal-related bolus doses, which consist of normal insulin or a short-acting insulin analogue. The amount of each premeal bolus depends on the size of the following meal, the time of day (the body’s insulin sensitivity varies with the time of day), the amount of physical activity still to be done and the blood glucose level measured before the meal (preprandial blood glucose level).Since all these components must be taken into account in this form of therapy, good training and a high sense of responsibility on the part of the patient are required. In contrast to conventional therapy, there is no need to maintain a spray-eat distance, as the effect is immediate with normal insulin or short-acting analogues.
The insulin pump therapy is performed by means of an external pump, i.e. the device that delivers normal insulin under the skin is located outside the body. The pump device is the size of a cigarette box and can be worn attached to a belt, for example. The basal rate delivered by the device is programmable and is automatically delivered to the patient. The bolus dispensations for the individual meals are called up by the patient himself, depending on the desired amount of food and the previously measured blood sugar value. Indications for choosing this form of therapy are pregnancy and imminent late complications of diabetes.
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