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Diabetes mellitus

 

Lives with the diabetes


Universal


Why we do not use the more familiar word "Diabetes" instead of the foreign word coming from the Greek "diabetes". The name Diabetes mellitus describes the findings of the known micturition sugar excretion and says that a micturition increase with sweet taste of the urine is observed.


A foot with diabetes mellitus

 

 

 

Although it must be added that there are also diabetics who eliminate no sugar with special kidney relations, probably show, however, the entscheidenen findings of the blood glucose projection. Diabetes mellitus is the second-most frequent metabolism illness in western industrial states. Only in Germany about 4.5 million diabetics give cheers, the dark figure is. A reason for it: Often geriatric sugar is getting late to and only by chance is recognised. Besides, untimely recognising is important to avoid late damages.


Blood glucose measurement

 

 

 

The different sugar types


Typ-I:


Mostly this sugar type at the youth old person appears as quick and noticeable, however, can seem also absolutely with quite old people. The portion in the Gesammtzahl of the ill ones amounts to 5%. The complaints with these sugar types appear as mostly acute. With the Typ-I an absolute insulin deficiency of unclear cause (virus infection is given?).


Typ-II:


This sugar type often seems stealthily and unnoticed from an old person of 40, with overweight. Besides, the pancreas does not produce the insulin any more meeting demand, and the cells worse react to the hormone. In the beginning an insulin treatment is not often necessary, the observance of a diet plan can be sometimes sufficient as a sole treatment. Classical symptoms are frequent urinary tract infections, boils (bacterial skin infections), impaired vision, infirmity, itch, mostly only late frequent urge to pass water and increased thirst feeling. Particularly in the initial stages phases with sitomania, sweat outbreaks and cephalalgias often appear. If the blood glucose on a certain value has risen, he is eliminated about the kidneys and then appears in the urine. In such situations an unusually strong thirst feeling mostly appears. The affected persons drink by the litre humor and surprise, why the thirst, nevertheless, is not satisfied. Moreover, they are tormented by a constant urge to pass water which they often explain by the big drinking amounts. The disorders of the humor household and the mineral household can sometimes lead to night cramps in the calf. Often the impaired vision which is caused by movements of the humor salary in the ocular also appears in this connection. Not seldom is also a constant skin itch. Also bacterial or fungus infections (particularly in the oral area or genital area) seem with not treated diabetics piled up.


What is a diabetes mellitus


With diabetes mellitus the pancreas puts all or part the production of insulin, a vital hormone for the transformation of blood glucose into energy. If insulin is absent the blood sugar level rises. This can lead on a continuing basis to impairments of the blood vessels as well as the nervous system. The results: f.e. Herzinfakt, stroke or also illnesses of kidneys and eyes. To these late complications can be bent forward with a good adjustment of the blood sugar level.


Symptoms and disease genesis


The symptoms of the illness are often typical, are not often noted, however, also by the affected persons. They exist generally in an increased thirst feeling, xerodermia, frequent Wasserlassen also at night, weakness and achievement crutch as well as a weight decrease in spite of increased ingestion.
For the disease genesis seems a corresponding one disposition condition would pale to be. Nevertheless, for the real outbreak of the illness this is not apparently sufficient. Rather it must be assumed from the fact that, in addition, external influence must come like infections, hormonal influence and hyperalimentation which would not lead for their part without suitable hereditary factor also to the illness.


Complications of the diabetes


Untreated the diabetes lead by a derailment of the metabolism without fail to a deadly coma. The essential late complications which are significant for the life expectancy of the "badly" opposed diabetic hang together in particular with certain vessel changes which stand with the diabetes in connection.


One divides the vessel damages into an impairment of the big vessels and the smallest vessels. The big vessels correspond basically to the Arterienverklakung. Results of these vessel changes can be, for example, a hypertension, heart deseases, a stroke or circulatory disturbances. Impairments of the small vessels can lead to serious kidney impairments.


Also the ocular retina can be affected by the vessel change and lead under circumstances to the loss of sight. Also the nerves are damaged under circumstances. One of these nerve impairments shows in particular in the area of the shanks and feet by skin Miss's feelings which walk along with a skin burning. Often the vibration feeling of the affected skin places is also lifted. In the heart the nerve disorder can lead, for example, to cardiac rhytm disorders.


In the gastrointestinal tract appear in this connection the different disorders which can walk along with blockade in the change with diarrheas after the meals and other dyspepsias. Not seldom the nerve impairments lead in the micturition tract also to disorders of the vesical evacuation which favours for their part urinary tract infections. Also the impairment of the skin nerves leads to a dry, thin skin, so that at the certain places which are put out to a special pressure often bedsores can study. Finally, can get worse within the scope of the blood circulation of a twill segment in such a way that it dies formally (often to toes).


hypoglycaemia


With hypoglycaemia it should come with a piece of sugar cubesonders or better still glucose, to the need also to a sweet drink or chocolate fast for the improvement.


An hypoglycaemia with existing, medicinally opposed diabetes can have varied causes. A Überdosierung of insulin or "sugar tablets" is very frequent if the diabetics eat within the scope of another illness (e.g., severe cold) though less, but take your drug an unchanged dosage to himself.


On the other hand, there is a huge number of other drugs which strengthen the effect of the "sugar tablets" with concurrent Einahme, and in this manner can cause an Unterzuckerung. Also unusual strong strain or excessive consumption of alcohol can end with unchanged Medikamenteneinahme in an hypoglycaemia.


Health care


Vital materials are very important


Importantly for the nutrition with sugar it is above all gesunheitsbewusste vielfälltige food selection, to the e.g. fresh fruit and vegetables, salad, gets thin lacteal product and meat product, fish as well as Volkornprodukte belong. In addition, vital materials with sugar play an important role. Thus the consumption is raised by Antioxidantien as for example vitamin C, E and Beta-Carotin, B vitamins are important for the carbohydrate metabolism and chrome the insulin effect improves.

Antioxidantien is in: Kiwis, oranges, green paprika, olives and olive oil. Chrome is in: Liver, yeast and wheat germs.


With an optimum treatment plan diabetics can reach a good well-being. A badly opposed sugar against it is not only one of the most frequent causes for loss of sight, also arterioscleroses can be a result. These appear, e.g., as circulatory disturbances. Beside regular controls with the ophthalmologist which are an absolute must for diabetics pedicure and comfortable shoes also belong for diabetics to the active health care.


Eyes on!


Sugar is valid as the most frequent loss of sight cause at the old person fit for work. Two thirds are concerned by this krannkhaften change of the blood vessels or also blood capillaries in the retina. Her progress can be put off by timely treatment, regular controls with the ophthalmologist and a nutrition conscious of eye. With a nutrition conscious of eye important micronutrients should be supplied like zinc, chrome and special Anthocyane, in sufficient amounts. These vital materials can contribute to protection of the blood capillaries which improve insulin effect and influence the regularisation of a disturbed sugar metabolism. Thus every diabetic himself can contribute, to the delay or decrease with late complications.


At least half of all diabetics has a retinopathy. A timely laser treatment is very successful as a rule. Before all things with the type I diabetic the loss of sight often threatens as a result of a suddenly starting network-shaped neoplasm of vessels and increase of bleeding in the vitreous and the retina within few weeks if the developing retinopathy is recognised not on time.


Zinc is in: Pumpkin nuclei, garlic, eggs, fungi, sardines, oat, lamb and chicken. Anthocyanen bind themselves in: Red cabbage, blueberrys, red grapes and elderberries.


eat something!


Overweight is with geriatric sugar for approx. 80-90 percent of the patients a recurring topic. Besides, is able everybody which pays attention to his nutrition, is physically active and, besides, prefers perseverance sports like walking, swimming or riding a bike, act a lot against it.


In principle, is valid for diabetics what is valid for all people: Weighed out and rich in vitamins eat is healthy. Besides, food with richly saturated fatty acids and hidden fats should contain, like they, e.g., in many ready products, fat cheese, fat sausage and fat meat, but also in chocolates and cake are, are consumed rather seldom and in tiny amounts.


Food rich in carbohydrate and rich in vitamin and those with unsaturated fatty acids should be preferred against it as for example: Noodles, rice, potatoes, fruit, vegetables, legumes and Volkornprodukte. Today for epicures with sugar there is especially developed food like chocolate, cake and ice.


What is that: The bread unit (bread unit)?


The bread unit (bread unit) is an auxiliary rake size to the calculation of the carbohydrate amount for the diet with sugar (1 carbohydrates BE=12g). It corresponds


1 bread unit resembles:


12 g of sugar


20 g of white bread


25 g of brown bread or grey bread


25 g of dry legumes


60 g of potatoes


60 g of bananas


100 g of apple


0.25 l of milk


A bread unit contains on average 60 calories (about 250 joules, J). 1 calorie (cal) = 4,184 joules, (J).


The diabetic mussauch pay attention to the fact that he also cocalculates the calorie salary (1 g of alcohol = to 29 kilojoule) with alcoholic beverages beside the bread unit.


100 g of apples one substitutes, e.g., with 140 g of blackberries or 15 g of rusk or with 20 g of crispbread, 30 g of cheese (with 60% i. Tr.) one substitutes, e.g., with 90 g of incision cheese (20% i. Tr.) or by 1000 g of low-fat curd cheese or 45 g of beer ham.


Tooth care


Diabetics should pay attention especially well to her tooth hygiene. Examinations proved, the patient with tooth illnesses are often unrecognized diabetic. Besides, about half of these patients anticipate often nothing of theirs to high cholesterin-worth. Scientists identify, the raised blood lipid concentration the concentration Entzündungs of förderner materials in the mouth raised. Hence, it is to be lived importantly low-fat to maintain teeth and gums thoroughly and to visit regularly the dentist.


Educational place of the insulin


Already in 1889 one could prove by an experiment that the diabetes, with a disorder of the function of the pancreas hang together in the farthest sense. At that time the researchers of Mehring and Minkowski investigated that dogs became diabetic if one had removed surgically the pancreas to them. By this experiment it became clear that the pancreas is not only a digestion gland, but also an important organ explains to the ptosis or regularisation of the blood glucose.


Only around the turn of the century one identified that the educational place of the insulin the so-called Langerhans islands are which had been described already in 1869 first and were named after her discoverer Paul Langerhans, to a Berlin pathologist.


The Langerhans islands are small (diameter possibly 0,1-0,2mm) cell groups which seem scattered in the whole pancreas tissue and stand richly with blood vessels (blood capillaries) and nerves in connection. They put out a total of only 1-2% of the pancreas tissue. The Langerhans islands consist of three different cell kinds (A cells, B cells and D cells) which produce in each case different hormones. 50-70% of the islands are the so-called B cells. In them the insulin is formed.


In the A cells which put about 20-30% of the islands another hormone is formed, the so-called Glucagon. Remaining 10% of the island cells. The D cells, produce the hormone Somatostatin.


The isolation of the insulin from the pancreas tissue bumped first into technical difficulties and succeeded in cleaned form only in 1922 by Banting and Best of all in 1955 the molecule structure of the insulin could be cleared up first, and in 1963 it was produced for the first time by different research groups in the lab artificially.


From the pancreas of an adult person one can win possibly 6-10mg insulin. Nevertheless, the amount in insulin is not ordinarily given in milligramme. One uses for it an international agreed size, the so-called insulin unity. The insulin unity refers to the biological activity of the insulin. 6-10mg insulins correspond therefore 150-250 units insulin. Nevertheless, the day need in insulin amounts to only about 40 units. This means that in the pancreas an insulin amount holds stored which could be sufficient for 3-6 days, without new insulin would have to be produced.


In the B cells of the Langerhans islands stored insulin one can recognise under the microscope with the help of special Färbemethoden in the form of small cinder (= granules). If the blood sugar level increases (e.g., by a luxuriant meal rich in carbohydrate), this Körnung disappears in the B cells because the insulin stored in them is delivered in the bloodstream to lower the blood sugar level again upon normally values. By contrast a lot of insulin is stored, e.g., with a starvation stage in the B cells. Under the microscope one recognises this storage by the fact that the number of the cinder increases.


Effect of the insulin


Originally one examined long time merely how the insulin adjusts the carbohydrate metabolism of the organism. Nevertheless, it became clear bit by bit that the insulin in varied manner on the whole metabolism of the different body tissues (liver, musculature and fat) have an effect.


To the cell edge of muscle cells and fat cells insulin promotes the transport of glucose, amino acids and potassium of the blood in the cells. In the cells of the body tissues it promotes all "being based" metabolism process, as for example the storage of the blood glucose in the form of glycogen as important ernergiereserve for muscle cells, hepatocytes and fat cells. Also the protein education in the cells (above all for hepatocytes and muscle cells of great importance) is promoted. And, finally, the fat connection is started in liver and fat cells by insulin.


With diabetics the infiltration of the vital energy-delivering glucose is considerably complicated by the blood in the cells because of the insulin deficiency. Only with very high and for the organism to noxious blood sugar levels enough sugar can penetrate into the cell. Though with the diabetes the affected persons have high blood glucose values, nevertheless, the somatic cells lack sugar: They starve formally, while the sugar with the blood in them vorbeiströmt.


In the fats the insulin deficiency leads to the fact that the fat cells are not able by the inhibition of the fat synthesis any more enough to convert the fatty acids anflutenden about the bloodstream into memory fats (Triglyceride). The fatty acids leave the cells, therefore, again and reach - rearound above the blood way - in the liver. There they are diminished to so-called ketone bodies. The ketone bodies can be pulled up by the muscle cells then as a substitute (instead of the sugar) to the power production. However, they also have eien disagreeable effect because they make worse the permeability for sugar which is already complicated by the insulin deficiency in the somatic cells even more. The metabolism position of the sugar is thereby aggravated, in addition.


Insulin as a drug


Interesting facts about insulin


- Insulin lowers the blood sugar level
- It promotes the dismantling of glycogen (memory sugar) in liver and muscles.
- It promotes the construction of fat of carbohydrates and protein.


What is insulin?


Insulin is a hormone which can be produced as a drug and is used to the treatment of the insulin-destitute diabetic. It must become injeziert, e.g., s.c. (hypodermically) because it would be destroyed in the digestion canal. One distinguishes old insulin and depot insulin after the effect entry.


Old insulin is an insulin as it is produced by the B cells of the Langerhansschen islands. It looks quick, but even maximum 6 hours.


Depot insulin is an insulin whose effect starts delayed. The effect from depot insulin stops from 12 to 18 hours.


How is insulin injected?


Hypodermically (under the skin) in the front of the femurs, in the abdominal wall and in the Streckseite of the upper arm.


When is insulin injected?


Always before the meals.


What must one know about insulin injections?


One has to go:


1. Know his insulin kind and use (old insulin or depot insulin). Do not use the wrong insulin.


2. The concentration of his insulin, e.g., U / 100 or U / 40 units ever know ml.


3. Know dose and exactly keep.


4. in exact amount gather.


5. Suitable injection places know.


6. Control the technology of the hypodermic injection.

 

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