The term diabetes mellitus comes from the Greek or Latin and means honey-sweet (lat .: mellitus = honey sweet) flow (gr.: Diabetes = flow, increased urine flow). This is understood as a chronic disorder of the sugar metabolism, triggered by a relative or absolute lack of the hormone insulin. The result is too high a sugar content of the blood. Diabetes is roughly subdivided into a juvenile form (type 1) and a type that used to affect mostly older people (type 2 = trivializing often called adult onset diabetes). However, the two forms of diabetes differ fundamentally.
Cause (s) - Type 1 diabetes
The cause of type 1 diabetes is a complete failure of insulin production (absolute insulin deficiency). Because this form of self-antibodies (autoantibodies) can be detected against the insulin-producing islet cells of the pancreas in the blood of the patient, it is believed that it is an autoimmune disease. The familial accumulation (about 20 percent of those affected are also in the relationship of a type 1 diabetic) seems to confirm this.
The irrevocable destruction of the insulin-producing cells has the consequence that symptoms of high blood sugar levels already appear at a young age (usually in late childhood). Only about 50 percent of the identical twin siblings of a type 1 diabetic also suffer from diabetes. Therefore, one suspects that there is another reason for the disease. Thus, it is believed that certain viruses (for example, rubella viruses) or certain poisons could initiate an autoimmune reaction.
Cause (s) - Type 2 diabetes
Unlike the youthful type, a social phenomenon is in the foreground here. Together with diseases such as obesity, gout, vascular calcification, hypertension and lipid metabolism disorders, type 2 diabetes can be classified among the wealth syndromes. Although here also genetic factors play a very important role (almost all identical twins of a diabetic are also affected with appropriate nutrition!) There is a very close connection with a too fatty, too sugary and generally high calorie diet and lack of exercise.
The rapid increase in type 2 diabetes in recent years, especially among younger people, seems to confirm this relationship. In the genesis mechanism, two disorders play the main role:
- a disturbed insulin delivery by the pancreas and
- a reduced insulin action on the end organs.
This means that even with a high insulin level in the blood (as it can occur in type 2 diabetics), the hormone at reduced or dysfunctional receptors has no effect - just as a formerly matching key (insulin) a now defective lock (insulin receptor) unable to open (= relative insulin deficiency or insulin resistance). Occasionally, pregnancy (gestational diabetes), hormonal imbalances, stress factors (infections, injuries, surgery) and certain medications (for example cortisone) can cause a diabetic metabolic condition.
While the symptoms of type 1 diabetes usually appear very quickly, the type 2 goes unnoticed for a long time. Frequently, the disease is first detected as part of a routine blood and urine examination. Initially, general symptoms such as general weakness and increased fatigue - as they are with many other illnesses - stand in the foreground. These are then food cravings and excessive sweating.
In the further course, the high sugar content in the blood leads to increased urination, increased feeling of thirst and weight loss, which the patient attempts to compensate for with an increased drinking volume. Reason: From a certain sugar concentration (= renal threshold) in the blood, the sugar is eliminated via the kidneys. However, this can only happen if at the same time a large amount of water (sugar must be hydrated, that is he "pulls" water) is excreted. This also clarifies the question of the "honey-sweet" urine.
Unfortunately, the longer the disease lasts, the smaller and smallest vessels are damaged. These micro- and macroangiopathies mainly affect the eye, kidney, heart, feet, heart and brain. Skin discomfort occurs in the form of itching, increased skin infections (with fungi and bacteria) and skin changes (redness and structural changes).
In the Middle Ages, the "honey sweet flow" was recognized by the doctor by the cost of urine (sweet taste = diabetes). Today, the disease is diagnosed in addition to the clinical evidence by measuring the sugar content in the blood and urine. With a test strip, proteins in the urine can be easily detected simultaneously with the sugar. These can give an indication of the degree of kidney damage.
Since the sugar level fluctuates, the blood additionally measures the degree of "saccharification" of hemoglobin (HbA1c) and components of insulin (C-peptide). To assess the dynamics of the sugar utilization disorder, an oral glucose tolerance test (OGTT) is performed. After oral ingestion (over the mouth) of 75 g dextrose (= glucose) in fasted condition, the glucose concentration in the blood is measured after two hours. This test should only be performed if the fasting blood sugar level is not clearly elevated.
Probably more than any other disease, the prognosis - especially in type 2 diabetes - depends on the early stage of the diagnosis. Therefore, it is not a luxury to include the clarification in the routine examinations at the family doctor. Especially because there are no clear symptoms that the patient could associate with diabetes.
With timely and correct intervention, life expectancy need not be lower than that of non-diabetics (especially for type 1 diabetics). The main cause of death in diabetics is myocardial infarction, followed by kidney failure. The often occurring blindness can often be prevented today. However, if there is no or insufficient therapy, irreversible damage occurs, which significantly reduces the lifetime and quality.