created: 25.09.2004
last modified: 21.09.2004
SYMPTOMS
There are several indicators that can point to diabetes. Should one or several of the following symptoms occur regularly or constantly, a doctor should be consulted.
The following symptoms are typical for type-1 diabetes:
The symptoms for type-2 are similar. But they don't occur that intensely and might remain undiscovered for several years:
DIAGNOSIS
In the end only a doctor can diagnose diabetes. First of all he determines the blood glucose level with empty stomach. Therefore the patient should not have eaten anything for 8 hours and only have drunken water. If the blood glucose level with empty stomach is over 120mg/dl, a pathological change is the case and the test is going to be repeated at least once. In cases that are not clear or for an early detection the doctor does a urine glucose test. If the blood glucose lies between 160 and 180 mg/dl the kidney can't keep the sugar any more. That's why this level is called the kidney barrier. But the urine test stripe in the morning is no substitute for the blood test.
In some cases, for example during a pregnancy, or if the values are unclear, the doctor will do an oral glucose tolerance test. Here the patient is given 75g of grape sugar, solved in water, after the first taking of a blood sample in the morning. This drink is to be consumed slowly within 10 minutes. 60 and 120 minutes after the drink other blood samples are taken. If the level with empty stomach is over 120mg/dl and the 2-hours level over 200mg/dl then the diagnosis is diabetes mellitus. If the last level is between 140 and 200mg/dl then the diagnosis is merely a glucose tolerance.
The HbA1c-level test is to control the disease. It's also called "ong term blood glucose" because it shows how good the diabetes was adjusted during the last 12 weeks.
TREATMENT
How to treat diabetes depends first of all on the Type of the disease.
Type-1
Diabetics who are suffering from this type of diabetes have to inject insulin because they can't produce it themselves. The therapy can be designed in various ways:
Conventional Therapy:
Here, the quantity of food is adjusted to the insulin dose. Normally the patients inject insulin twice a day, in the morning and in the evening. Meals are taken when the insulin concentration is high. Also, the amount of carbohydrates that one is allowed to consume is strictly fixed.
Intensive Conventional Therapy (ICT):
This therapy has various names, for example Functional Insulin Therapy (FIT) or Basic Bolus Therapy (BBT), but the way they work is always the same. By frequently controlling the blood glucose level and injecting small doses of insulin, the metabolic status of a healthy person is to be imitated. Long acting insulin is the basis of this form of therapy. It enables the patient to a "normal" metabolism throughout 24 hours. In addition "regular insulin" ("old insulin") that has a stronger and shorter effect is given with the meals. It takes care that the body's cells can take in the glucose.
Doctor and patient determine a target level that is to be reached in morning with an empty stomach and during the time before the meals. How high that level is depends on several factors. These are for example the age, a present pregnancy or the fact that the patient is hardly able to recognise hypoglycaemia. The ICT enables the patients to a more flexible daily routine: they can eat whatever they want to at any time. But they need to be willing to check the blood glucose level and inject insulin more than once or twice a day.
Insulin Pump Therapy:
For this form of therapy there's also an abbreviation: CDII (Continuous subcutaneous insulin infusion). The diabetic permanently carries an insulin pump of the approximate size of a cigarette box. This pump normally has a catheter that injects insulin into the lower fat tissue of the abdomen. The patient is able to increase the dose for meals according to the demands. The new models are inconspicuous and can even be worn while taking a shower. Intensive training is required for this form of therapy.
Type-2
About 60% of all newly diagnosed type-2 diabetics have overweight. That's why it's highly important for them to reduce their weight. 3 to 5 kilograms less already have a positive impact on the blood glucose level. A fat reduced and balanced diet is the first and last thing. Also sugar should be excluded from the diet if possible. Sport is highly important for diabetics. On one hand it helps to reduce weight and on the other it helps the metabolic system to make a better use of the insulin, the muscles can take in the insulin a lot easier.
A diabetic should be active in general. Beside the specific sport exercise, everyday life offers many opportunities to get the muscles moving. Mowing the lawn, working in the garden, cleaning the house are physical efforts as well. If the changing of the diet and increasing the sporting activities aren't enough the doctor will prescribe pills. These can be divided into three groups:
Metformin and insulin-sensitizer enable the body's cells to take in the insulin easier. They make the body more sensitive towards insulin. Sulfonylurea and Glimepiride support the release of insulin from the pancreas. This can lead to hypoglycaemia because the Sulfonylurea have this effect constantly. Glimepiride only work during the meals, because diabetics only take them with their meals. This limits the danger of hypoglycaemia to a minimum. Resorption delayers have the effect of slowing down the glucose transport into the vascular system in the intestines. These pills antagonize the peak glucose level after a meal. The body doesn't need to produce that much insulin and the pancreas gets spared. But this type of medication is only suitable for slightly increased blood glucose levels or in combination with other medication that decreases the blood glucose level.
If all these measure don't have the desired effect the type-2 diabetic has to switch to insulin injections. Then the therapy follows the same guidelines like in case of a type-1 diabetes.
