Diabetes mellitus (Greek) = "honey-sweet flow"

™ Main symptom: excretion of sugar in the urine

There are two main types: Type 1 & Type 2 diabetes mellitus

There is high blood sugar due to a lack of insulin or an excess of insulin (depending on the type). Often, insulin resistance is also linked to diabetes mellitus disease (overweight / obese people).

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Why is nutritional therapy important?

Nutritional therapy helps you to keep your blood sugar in the normal range. This is extremely important in order to avoid any consequential damage / negative effects in various areas of your body (e.g. heart, kidneys, eyes, nerves, feet, impotence, peripheral occlusive disease) from the steadily increased blood sugar. The therapy proceeds according to a step-by-step scheme, whereby the adapted nutritional therapy plays a central role for you from the start in positively influencing your health.

A long-term high blood glucose level  Damages the blood vessels, leading to atherosclerosis lead and among other things a  Stroke can favor.

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Nutritional therapy supports you in reducing your symptoms overall and thereby positively influencing your health. An energy-adjusted wholesome diet under the supervision of a certified nutritionist can lead to your long-term success. The diet is adapted to your current weight and a jointly defined goal for weight gain / or loss.

The aim is to supply all of the fatty acids, micronutrients (vitamins and minerals) that are important to you, energy and protein in the measure that your body is optimally supplied with. For this purpose, foods that promote inflammation are specifically avoided and plenty of anti-inflammatory foods are consumed.

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Carbohydrate metabolism hormones:

The islets of Langerhan in the pancreas

form the 2 central hormones for the regulation of carbohydrates in the body

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B cells: insulin -> lowers the blood glucose level

A cells: Glucagon -> increases the BZ level (breakdown of glycogen in the liver is increased)

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The pancreas:

The head of the pancreas has a primarily exocrine function (enzyme production for food utilization)

The tail of the pancreas has a primarily endocrine function (hormone production to regulate carbohydrate metabolism)

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Nutritional therapy

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• If you are overweight, you should aim for weight reduction.

• Energy-efficient full nutrition with anti-inflammatory components

• Holistic therapy - do you have any comorbidities that need to be taken into account during the consultation?

• Avoid micronutrient and mineral deficiencies

• how many total carbohydrates are allowed per day?

• What Kind of Carbohydrates Should I Eat Preferred?

• get enough fiber (> 30 g / day)

• Get enough Omgea-3 fatty acids and essential fatty acids

• anti-inflammatory diets for disease prevention

• Dissolve insulin resistance, increase insulin sensitivity through appropriate nutrition

• which oils are good for me? What should I watch out for in relation to the anti-inflammatory diet?

• How much fat spread (butter / margarine / vegetable fat) can I use and which products are recommended?

• How can I boost and support my metabolism with natural foods?

• Further topics: Glycemic index & glycemic load, meal frequency, protein requirement, energy requirement, targeted weight loss and the estimated time for this

• Classification of foods rich in carbohydrates, possibly KE (carbohydrate units)

• Allocation of meals, the amount of carbohydrates and the definition of the total amount, tailored to your specific needs

• what should be considered with drinks, which alcoholic drinks are possible and how often

• How does exercise affect your body and thus also your diet?

• Avoid blood sugar fluctuations, reduce the HbA1c value (target 6.5%) and maintain it in the long term, avoid blood sugar peaks

• Dealing with low sugar (hypoglycemia) and high sugar levels (hyperglycemia)

• Sweetening foods - sweeteners, glucose, fructose, sugar and sugar substitutes, what can I use and in what quantities? How high is the respective sweetness of the different products?

• what needs to be considered when baking and cooking

• what are cheap snacks / main meals

• Eating out - what should you watch out for?

• Driving a car - do I need extra glucose to avoid hypoglycaemia? What alternatives are there for me?

• Distribution of KE over the meals of the day, carbohydrate exchange table, learning to estimate KE quantities

• Dietary therapy including oral antidiabetic agents and / or insulin therapy

• Additional therapy options

• Food supplements - under certain circumstances, a supplement can be useful

• Dietetic products in support of nutritional therapy

• and other topics

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BMI and interpretation: BMI: body mass index

Formula: Body weight in kg : (body height in m) 2

Underweight: <18.5

Normal weight: 18.5 - 24.9

Overweight = pre-obesity: 25-29.9

Obesity grade I: 30 - 34.9

Obesity grade II: 35-39.9

Obesity grade III:> 40 = per magna

Waist circumference in cm & interpretation:

Risk of Metabolic and Cardiovascular Complications:

Men (increased risk ≥ 94 cm, significantly increased risk (102 cm)

Women (increased risk ≥ 80 cm, significantly increased risk (88 cm)

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Fat distribution pattern: "apple type" or so-called "pear type"

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Classification: Types of Diabetes

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I) type 1 diabetes

II) Type 2 diabetes

III) Other special forms:

• Genetic defects of the B-cell function e.g. MODY-Diabetes (aturity nset iabetes of the oung)

• Genetic defects in the action of insulin, e.g. defect in the insulin receptor

• Diseases of the pancreas = pancreopriver diabetes eg pancreatic tumor, pancreatitis

• Other endocrine diseases e.g. hyperthyroidism, Cushing's syndrome (= excess cortisone in the body, making you insulin resistant)

• Drug-induced e.g. glucocorticoids (hepatic glucose production increases)

IV) Gestational diabetes = diabetes during pregnancy

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Blood glucose testing:

Normal: fasting: <100 mg / dl      

Prediabetes = increased fasting glucose fasting: 100 - 126 mg / dl

Diabetes: fasting:> 126 mg / dl (always with 2nd measurement for confirmation!)

OGTT: 12 hours on an empty stomach à OGTT of 75g dissolved glucose:

Normal: <140 mg / dl

Increased fasting glucose: 100 - 125 mg / dl

Diabetes: 140-200 mg / dl

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Type 2 diabetes mellitus

Cause, definition: Increase in blood glucose values due to a

• decreased insulin effect

• decreased or inadequate insulin secretion of BSD

Insulin resistance and β-cell dysfunction have genetic causes, the origin of which is not yet known exactly.

Risk factors of developing a type 2:

• So people who are relatives with type 2 have a hereditary tendency to diabetes

• People who are overweight or obese (BMI> 25)

Occurrence:

• worldwide, most common type of diabetes in Germany

• around 200 million people are affected worldwide

• in Germany approx. 6 million

• the number will continue to increase over the next few decades, because obesity and lack of exercise will also increase sharply

Illness peak:  Approx. 60 years of age

How do obesity and lack of exercise lead to type 2 diabetes?

Both obesity and lack of exercise lead to people becoming less sensitive to insulin (increased insulin resistance)

Insulin resistance develops slowly. Insulin resistance develops as slowly as weight gain. In comparison Type 1: Develops very quickly: within a few weeks.

Clinical symptoms:

• Slowly developing disease: often no symptoms at the beginning, therefore often an incidental finding

• increased thirst

• increased urination

• weak immune system, increased susceptibility to infections, e.g. urinary tract infections, fungal infections of the skin, sore throat, pneumonia

• increased weakness and fatigue

• Difficulty concentrating

• Poor eyesight

• Often the patients are also overweight

Therapy of type 2 diabetes:

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• Basic therapy: diet modification and exercise

Objective: to increase insulin sensitivity and lower blood glucose levels

• Diabetes education

• Oral antidiabetic drugs: blood sugar lowering tablets

Different classes of activity:

• increase insulin sensitivity

• increase insulin secretion

• inhibit glucose uptake in the intestine

Step therapy

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Stage 4: Intensified insulin therapy> 12 years

Level 3: OAD + insulin (usually 1 syringe of basal insulin) 8-12 years

Level 2: OAD, 1 tablet or Komipreparat 4-7 years.

Stage 1: Basic therapy: sport, nutrition, training, lifestyle change 1-3 years

Therapy always goes one step further if the therapy goal is not achieved.

Therapy goal: HbA1c value: 6.5%

Oral anti-diabetic drugs:

- Biguanides: Metformin®, Glucophage®

- Sulphonylureas: Glimeclamide: Euglucon®, Maninil®, Glimepirid: Amaryl®

- Glinide: Repaglinide®, Novonorm®, Nateglinide®, Starlix®

- Glitazone: Rosiglitazone: Avandia®, Pioglitazone: Actos®

- α-Glucosidase inhibitors: Acarbose: Glucobay®, Miglitol: Diastabol®

- Incretins: Exenatide: Byetta®, Liraglutide: Victoza®

- DPP4 inhibitors: Sitagliptin: Januvia®, Xelevia®, Vildagliptin: Galvus50®

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Diabetic complications occur as a result of vascular damage to the following organs:

1) heart:

- Coronary heart disease with occlusion of the coronary arteries

- Arrhythmias caused by damage to the autonomic nervous system in the heart

- frequent cardiac muscle diseases (approx. 70% of diabetics die as a result of cardiovascular diseases)

2) kidney:

- Increased blood glucose values damage the glomeruli (glomerular sclerosis).

   This also results in an increased excretion of albumin in the urine = albuminuria in diabetics

- If the glomeruli are damaged, the kidneys will not function properly = renal insufficiency

- If renal insufficiency progresses, dialysis may be required

- Albuminuria indicates diabetic kidney damage in the early stages and can easily be determined in a urine sample. Check-ups every 3 months are recommended

3) Eyes: diabetic retinopathy

- Diabetes is the most common cause of blindness in industrialized nations.

- Diabetic vascular damage to the fundus, which leads to rupture of vessels and then to bleeding from the fundus and to vitreous hemorrhage. If detected early, diseased vessels can be obliterated by laser therapy. (Through 1 x annual fundus mirroring)

- Macular degeneration due to damage to the optic nerve

4) Diabetic Nerve Damage:

a) peripheral neuropathy, affects peripheral nerves:

- Reduced sensitivity: temperature and pain sensation, pointed / stump differentiation

b) autonomic neuropathy: starts from the autonomic nervous system

c) autonomic nervous system: cardiac arrhythmias, gastrointestinal paralysis

= diabetic gastroparesis, leads to delayed emptying of the stomach and intestines with nausea, vomiting and diarrhea

5) diabetic foot:

Occurs on the one hand from circulatory disorders and on the other hand from nerve damage (= peripheral polyneuropathy) on the foot

Therapy: ulcer prevention through patient education and foot care

For ulcers:

• antibiotic therapy

• Pressure relief of the foot

• Improve blood circulation

• Surgical wound healing

6) Erectile Dysfunction = Impotence

Results from nerve and vascular damage in the pelvis and genital area

7) peripheral occlusive disease (PAD)

Occlusion of arteries in the pelvic, upper and lower leg floors

Particularities:

1. In MODY patients, at least one parent or sibling also has diabetes.

The cause is an enzyme disorder in the B cells.

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Type 1 diabetes

Definition:

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It is an autoimmune disease, ie its own immune system attacks the B cells of the islets of Langerhans. Cytotoxic T lymphocytes are formed, which attack the B cells & thereby initially lead to an inflammatory reaction and as a result usually lead to the death of the B cells. As a result of this immune reaction, an antigen-antibody reaction takes place.

Elevated AKs for insulin and islet cells, for example, are found in the blood. The causes of the autoimmune attack that leads to type 1 have not been clarified with certainty. However, previous virus infections (e.g. mumps, flu) that could trigger such a false reaction of the immune system are discussed. Further reasons: Hereditary tendency à genes. Drinking cow's milk early (breastfeeding for less than 6 months or not breastfeeding at all could possibly lead to diabetes mellitus)

Frequency: Approx. 500,000 type 1 diabetics in Germany, peak disease around the 18th year of age (1 year to 30 years)

Clinical symptoms:

• Increased thirst (polydipsia)

• Increased urination (polyuria)

• Tiredness, exhaustion

• Weight loss (dehydration of the body, fat mass decreases, muscle mass decreases)

• Coma diabetic

• Acetone odor due to increased ketone body formation from fat breakdown (increased β-oxidation for energy production, typical for type 1)

Therapy of type 1 diabetes:

• Patients must be treated with insulin

• BG-lowering tablets are ineffective and therefore not allowed

• Nutritional Therapy:

  • Increases slowly absorbable carbohydrates

  • restrict free sugars

  • The patient has to learn to estimate KH

  • Balanced healthy diet

1. nourishment

2. Exercise (3 x weekly ½ h endurance sports)

3. Diabetes nutritional advice

4. Insulin therapy

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What insulin therapy is there for type 1 diabetics?

Insulins:

1. Short-acting insulins (bolus insulins): effect from 20 min up to 4 h, are used before the MZ (F, ME, AE)

2. Slow insulins (basal insulins): Effect from 60 min to 12 h, are used to cover the basic need for insulin, which is always available regardless of meals. (Basal metabolic rate / brain power)

3. Mixed insulin: consist of a ready-made, fixed mixture of short-acting and long-acting insulin, e.g. 30% short-acting and 70% long-acting insulin

Insulin therapy forms:

1. Intensified conventional insulin therapy (ICT) according to the basal bolus principle: means: inject long-acting insulin in the morning and before going to sleep and inject short-acting insulin about 20 minutes before each meal. Is the best insulin therapy for type 1 because it provides a high degree of flexibility

2. Conventional insulin therapy (CT) means: inject mixed insulin in the morning and in the evening. It is hardly suitable for type 1 diabetics because of its low flexibility, only good for very old patients.

3. Insulin therapy with an insulin pump

Gestational diabetes

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Definition:

Diabetes that only occurs during pregnancy and 90% of which disappears after the baby is born.

Root cause:

Rise in certain hormones and placental factors during pregnancy

à mainly through the so-called placental lactogen that makes insulin insensitive.

This does not lead to gestational diabetes in all pregnant women but in those who are overweight and who have a positive family history of diabetes.

About 4% of all pregnant women have gestational diabetes

Risks of gestational diabetes:

For the child: macrosomia (> 4000g) very overweight at birth. A caesarean section is usually required.

Dangers: lack of organ maturity, eg lung maturity, heart defects, other organ defects, stillbirth.

For the mother:

• Strong weight gain

• Increased water retention

• High blood pressure

• Often urinary tract infections

• Premature births and miscarriages

Therapy of gestational diabetes:

Particularly strict blood sugar guidelines apply here.

The blood sugar  & the HbA1c value must be normal (target 5.0 - 5.5%).

In more than 50% of the cases, these goals can be achieved through a change in diet alone.

In addition, it may only be treated with insulin; oral antidiabetic drugs are not allowed during pregnancy.

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Any questions? I look forward to your call or email. To contact form

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Assistance:

• KISS self-help groups

• Self-help network

• DDG- German Diabetes Society

• German Diabetes Foundation

• German Diabetics Association V.

• Self-help group for insulin-dependent diabetics