Diabetes Complications: A Weekly Magazine for Agriculture and Rural Life

Diabetes can easily be described as a common disease. About 8.7 million people in Germany live with type 2 diabetes and about 372,000 with type 1 diabetes. In addition, there are about 2 million people who still do not know anything about their disease.

Diagnosis is relatively easy, says Dr. Mynolf Behrens, diabetologist at the Minden Diabetes Center, before the rural women of the local association Minden-Porta-Oeinhausen. If the fasting blood sugar level is below 126 mg/dL, then it is diabetes. The result is usually confirmed by an oral glucose tolerance test. For this, the patient drinks a sugar solution. If after two hours the blood sugar level exceeds 200 mg/dL, then the diagnosis is confirmed.

Different types of diabetes

In healthy people, the hormone insulin, 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.

Insulinmangel. The pancreas produces little or no insulin.

Insulin resistance. Although insulin is produced, it cannot work properly on the cells.

A combination of both is also possible.

Insulin resistance is commonly seen in adults, sometimes associated with insulin deficiency and thus type 2 diabetes. If diabetes develops in children or young adults, it is usually type 1 diabetes. The pancreas completely stops producing insulin. There are other, less common 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 studied why diabetes develops in humans. Type 1 diabetes occurs spontaneously and can be caused by, for example, infections. In type 2 diabetes, lifestyle factors such as an unhealthy diet and too little exercise are often responsible for the disease. But that's not all. “Then we would have many more people with diabetes,” says the diabetologist. Genetics also play an important role. That is 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 appear, such as frequent urination, intense thirst or unexplained weight loss, 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. Therapy is based on four pillars: nutrition, exercise, stress reduction, and medication. Nutrition is especially important. However, there are many, often conflicting, recommendations.

Simple recommendations

Dr. So Maynolf Behrens gives his patients four clear messages: eat

  • protein focused
  • low sugar
  • reduced carbohydrates and
  • modified fat.

To be more precise. A Mediterranean diet is recommended, consisting of about 20% energy from protein, 40% carbohydrates, and 40% fat, with high-quality fats being preferred. The doctor also recommends choosing mostly fresh, seasonal and regional foods. But he is also convinced that the diet should correspond to the patient.

Bring movement into everyday life

Movement also plays an important role. The following applies: at any age it pays to incorporate more exercise into your daily life. Dr. However, Behrens notes that people remove many opportunities for exercise from their daily routines. Robotic lawnmowers, electric garage doors, online shopping and online meetings ensure that people have to move as little as possible. “Take back your daily activities,” says Dr. Mynolf Behrens takes care of his patients. Above all, they need to reduce sitting time.

About 1 in 2 people with type 2 diabetes can 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 drugs with different effects. They are used individually, in combination or together with insulin therapy.

Weight loss injection works

Many have high hopes for the so-called weight loss injection. There are various drugs on the market now. Depending on the active ingredient, they are injected about once a week and lead to a decrease in appetite. Studies show it works.

With Ozempic, a drug approved for diabetics and containing the active ingredient semaglutide, patients lose an average of 10% of their body weight. In the case of the drug Mounjaro or the active ingredient tirzepatide, it is even up to 20%.

However, there are currently major barriers to the supply of these products. They are also very expensive. While therapy with the most common diabetes drug metformin costs €0.20 a day, Mounjaro costs €12 a day.

And there is one more thing that Dr. Behrens. The products tested very well. But at present, no one can say for sure what the impact will be in ten years.

A sugar tax as an opportunity
While Germany is still considering introducing a sugar tax, nearly 100 countries have already introduced it. In Mexico, for example, a special tax has been levied for sweet drinks since 2014. Britain introduced a tax in 2018, which gradually increases depending on the sugar content of the drink. Some manufacturers later changed their recipes so that the drinks contained less sugar.
The study looked at the effect a sugar tax based on these models would have on people aged 30 to 90 in Germany. Accordingly, by 2043, it will be possible to avoid 132 thousand cases of type 2 diabetes through taxation according to the Mexican model. In the case of the British model, the number of diabetes cases may decrease by 244 thousand during the same period.

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