Diabetes mellitus can easily be described as a widespread disease: In Germany, around 8.7 million people live with diagnosed type 2 diabetes and around 372,000 with type 1 diabetes. In addition, there are around 2 million people who do not yet know anything about their illness.
The diagnosis is comparatively easy, says Dr. Meinolf Behrens, diabetologist at the Minden Diabetes Center, in front of rural women from the Minden-Porta-Oeynhausen local association. If the fasting blood sugar level is below 126 mg/dl, it is diabetes. The result is usually confirmed using an oral glucose tolerance test. To do this, the patient drinks a sugar solution. If the blood sugar level is over 200 mg/dl two hours later, the diagnosis is confirmed.
Different types of diabetes
In healthy people, the hormone insulin, which is produced in the pancreas, regulates blood sugar levels. It ensures that sugar is transported from the blood into the cells. If the blood sugar level is too high, there can be various reasons:
Insulin deficiency: The pancreas produces too little or no insulin at all.
Insulin resistance: Although insulin is produced, it cannot work properly on the cells.
A combination of both is also possible.
In adults, there is usually insulin resistance, sometimes associated with insulin deficiency, and thus type 2 diabetes. If children or young people develop diabetes, it is usually type 1 diabetes. The pancreas stops producing insulin completely. There are also other, rarer forms of diabetes, as well as diabetes during pregnancy, known as gestational diabetes.
Genetics as a possible cause
To date, it has not been clearly researched why a person develops diabetes. Type 1 diabetes occurs spontaneously and can be triggered by infections, for example. In type 2 diabetes, lifestyle, such as unhealthy diet and too little exercise, are often responsible for the disease. But it’s not just that. “Then we would have many more people with diabetes,” says the diabetologist. Genetics also play an important role. That’s why the doctor warns against stigmatizing people with diabetes.
The tricky thing about diabetes is that it often goes unnoticed for a long time. If the classic symptoms occur, such as frequent urination, intense thirst or unexplained weight loss, then the disease has often already caused initial damage. Over time, diabetes can lead to serious complications, such as heart attacks, strokes, amputations, kidney damage and blindness.
To prevent such damage, it is important to diagnose and treat diabetes early. The therapy is based on four pillars: nutrition, exercise, stress reduction and medication. Nutrition is particularly important. However, there are many, often contradictory, recommendations.
Simple recommendations
Dr. Meinolf Behrens therefore gives his patients four clear messages: Eat
- protein-focused,
- low in sugar,
- reduced carbohydrates and
- fat modified.
To be more precise: A Mediterranean diet is recommended, consisting of around 20 energy percent protein, 40% carbohydrates and 40% fats, with high-quality fats being preferred. The doctor also advises choosing predominantly fresh, seasonal and regional foods. But he is also certain: the diet must suit the patient.
Bring movement into everyday life
Movement also plays an important role. The following applies: It is worthwhile to bring more exercise into your everyday life at any age. Dr. However, Behrens notes that people are removing many opportunities for exercise from their everyday lives. Robotic lawn mowers, electric garage doors, online shopping and online meetings ensure that people have to move as little as possible. “Take back your everyday activities,” says Dr. Meinolf Behrens takes care of his patients. Above all, they should reduce sitting time.
Approximately one in two people with type 2 diabetes could be treated well with diet changes, weight loss, special training and exercise alone. If medication is also used, it is to pursue two goals: to prevent acute metabolic disorders and secondary diseases of diabetes. There are different medications with different effects. They are used individually, combined or in combination with insulin therapy.
Weight loss injection works
Many people have high hopes for the so-called weight loss injection. Various medications are now on the market. Depending on the active ingredient, they are injected about once a week and cause the appetite to decrease. Studies show that it works.
With the drug Ozempic, which is approved for diabetics and contains the active ingredient semaglutide, patients lose an average of 10% of their body weight. With the drug Mounjaro or the active ingredient tirzepatide it is even up to 20%.
However, there are currently major supply bottlenecks for these products. They are also very expensive. While therapy with the most common diabetes drug metformin costs €0.20 per day, Mounjaro costs €12 per day.
And there is something else that Dr. Behrens: The products have been tested very well. However, no one can currently say with certainty what their impact will be over the course of ten years.
Sugar tax as an opportunity
While Germany is still discussing the introduction of a sugar tax, around 100 countries have already introduced it. In Mexico, for example, a special tax has been levied on sugary drinks since 2014. Britain introduced a tax in 2018 that increases gradually depending on the sugar content in the drink. Some manufacturers then changed their recipes so that the drinks contain less sugar.
A study examined what effects a sugar tax based on these models in Germany could have on people between the ages of 30 and 90. According to this, 132,000 cases of type 2 diabetes could be avoided by taxation according to the Mexican model by 2043. With the British model, the number of diabetes cases could fall by 244,000 over the same period.
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