What is an anti-ketogenic hormone

Diabetes mellitus

Abstract

Diabetes mellitus refers to a group of metabolic diseases, the common characteristic of which is an increase in glucose in the blood (hyperglycaemia). The two most important representatives of the group are type 1 and 2 diabetes mellitus. In the former, an autoimmune reaction destroys the insulin-producing β cells in the pancreas. The more common type 2 diabetes mellitus has both a strong genetic component and a significant association with overeating. A disturbed action of the insulin on the body cells (insulin resistance) and an (initially compensatory increased and in the course) decreased insulin secretion of the β-cells lead to hyperglycaemia. Fatally, this type of diabetes often remains clinically inapparent for many years, but due to the pathological metabolic situation via microangiopathies and macroangiopathies, it leads to serious organ damage, especially of the heart, circulation, kidneys, eyes and nervous system.

Other risk factors (such as arterial hypertension) must be treated therapeutically and an attempt must be made to normalize the glucose metabolism as far as possible. Theoretically, in type 2 diabetics, weight normalization, physical activity, and a balanced diet would often be sufficient to prevent the disease from manifesting and progressing. Unfortunately, this only works very rarely, so that to control blood sugar (in addition to dietary instructions), oral antidiabetic drugs are required first and, in the case of secondary failure, insulin injections are required. In type 1 diabetes, on the other hand, the absolute insulin deficiency must be compensated for by meal-controlled insulin doses that correspond to the carbohydrate-defined food intake (no diet!). Intensive patient training is required in order to avoid life-threatening hypoglycaemia and hyperglycaemia and to achieve the goal of a normoglycaemic metabolic situation.

Epidemiology

  • Increasing prevalence in recent years
  • Clear geographical differences
  • Lifetime prevalence (D): Approx. 8% of 18 to 79 year olds, significantly increasing from the age of 60

Unless otherwise stated, the epidemiological data refer to Germany.

etiology

classification

According to WHO and American Diabetes Association (ADA)

  1. Type 1 diabetes mellitus (formerly also called "juvenile diabetes")
    • Immunological (type 1A)
    • Idiopathic (type 1B)
  2. Type 2 diabetes mellitus (formerly also called "adult diabetes")
  3. Other specific types of diabetes (type 3)
  4. Gestational diabetes (type 4)

Pathophysiology

insulin

  • Secretion: multi-step process
  • Effect: Diverse, physiological goals are the creation of energy reserves, the reduction of the serum glucose concentration and the supply of the tissue with glucose

Type 1 diabetes mellitus

Type 2 diabetes mellitus

Several factors play a role in developing type 2 diabetes:

Long term consequences

  • Microangiopathy (in all forms): After approx. 5–10 years of hyperglycaemic metabolism
    • Consequential damages: nephropathy, retinopathy and neuropathy
  • Macroangiopathy (more common in type 2): In myocardial infarction, for example, there is a complex pathogenesis due to the metabolic syndrome.

Symptoms / clinic

Clinical differential diagnosis

  • Type 1 diabetes mellitus
    • Rapid manifestation of the clinical picture in mostly young patients
    • Coma diabeticum possible as the first manifestation
    • Frequent occurrence following a viral infection
  • Type 2 diabetes mellitus
    • Creeping development in mostly elderly patients
    • Often as a chance finding or during a check-up due to increased fasting blood sugar or increased HbA1c noticeable
    • Even hypoglycaemia is possible at the onset of the disease!
    • In the course of the disease, the secretion of insulin decreases ("burning out of the endocrine pancreatic function") and increasing hyperglycaemia
  • See also DD: Diabetes mellitus type 1 vs type 2

General symptoms of diabetes mellitus

  • Reduced performance, fatigue
  • Polyuria → Tormenting thirst (polydipsia): Polyuria is caused by glucosuria
    • As an osmotically active particle, glucose draws water with it and thus leads to increased urine excretion.
  • Calf cramps
  • Pruritus
  • Visual disturbances: Strong blood sugar fluctuations can lead to a transitory change in refraction (often myopia) due to osmotic swelling of the lens
  • With absolute insulin deficiency: weight loss

Diagnosis

Confirmation of the diagnosis of diabetes mellitus

Determination from venous blood plasmaDiabetes mellitus"Prediabetes"Healthy
Glucose in mg / dL (fasting)≥126 (≥7.0 mmol / L)100-125 (5.6-6.9 mmol / L) = abnormal fasting glucose

HbA1c in %

≥6.5 (≥48 mmol / molHb)5.7-6.4 (39-47 mmol / molHb)
2-hour value of the OGTT * in mg / dL≥200 (≥11.1 mmol / L)140-199 (7.8-11.0 mmol / L) = pathological glucose tolerance

* OGTT = Oral Glucose Tolerance Test: Not used in routine clinical practice, but only when the diagnosis is unclear. However, it can also be carried out to rule out impaired glucose tolerance. The determination of the HbA1c-The blood content is unsuitable for this, as it can remain normal for a long time.

Further general research