Diabetes is not just destiny

Around 500,000 people in Switzerland suffer from diabetes, popularly known as “sugar disease” – and the trend is rising. More than 90 percent are diagnosed with type 2 diabetes mellitus, commonly referred to as “adult-onset diabetes”. Even if a genetic disposition cannot be dismissed out of hand, those affected are jointly responsible for the development of the disease, emphasizes Dr. medical Annic Baumgartner, Senior Physician for Endocrinology, Diabetology and Metabolism; Co-Head of Competence Center Nutrition, Eating Disorders and Obesity (KEEA) of the KSA Group.

Diabetes is a disorder of blood sugar metabolism: the body produces too little insulin or produces a lot but cannot use it efficiently to transport glucose from the blood to the cells. The result: the blood sugar level is permanently elevated.

Diabetes often goes undetected

“We basically differentiate between three forms of diabetes,” explains Annic Baumgartner. “In type 1, autoimmune diabetes, the body produces little or no insulin because the corresponding cells in the pancreas have been destroyed by the body’s own immune system. Type 2 occurs when the body has developed insulin resistance and the insulin cannot work effectively – usually caused by too much body fat.”

And further: “By type 3 we mean the so-called pancreatoprivic diabetes, in which the function of the pancreas is restricted, for example by inflammation or the pancreas has been removed.”

But how do you spot diabetes? The typical symptoms are intense thirst and excessive urination, often accompanied by weight loss. Tiredness, concentration or vision disorders are less common as the main symptoms.

Since the symptoms of type 2 diabetes are not always pronounced, the disease often remains undetected for years. Anyone who is genetically predisposed should therefore have a preventive examination. Diabetes is usually diagnosed by determining the long-term blood sugar level HbA1c.

“We also advise sick people to have their eyes, kidneys and feet checked every year,” says the doctor. Because these are particularly affected by the diabetes-related calcification of the small vessels (atherosclerosis). In the worst case, the disease can result in blindness, a kidney transplant or a foot amputation.

Lifestyle changes are often enough

While the administration of insulin is indispensable in the treatment of types 1 and 3 diabetes, personal responsibility is the top priority for type 2 diabetes. Because the extent of insulin resistance is primarily determined by body weight.

“Diabetes is not just destiny,” sums up the expert. Diet and exercise habits play a decisive role – both preventively and after a diagnosis has already been made. The good news: Those affected can positively influence the severity of the disease. A considerable proportion of all patients manages without drug treatment thanks to a controlled weight.

The diet should consist of a balanced, Mediterranean diet. Means: fresh, unprocessed foods, legumes, whole grain cereal products with a high fiber content, high-quality vegetable fats and little meat. Simple carbohydrates should be preferred to complex ones. Better whole grain than white flour. In general, foods with a low glycemic index are better – i.e. foods that do not cause blood sugar levels to rise too much. Caution should therefore also be exercised with fruit. “Sweet, juicy varieties such as grapes or oranges increase the blood sugar level in no time at all,” points out Annic Baumgartner. “Fruit is often given too much space. Vegetables should clearly dominate.”

Ms. Baumgartner, diabetes also has a genetic component. Can people with a genetic predisposition prevent the onset of the disease through an appropriate lifestyle?

Even in the case of type 2 diabetes sufferers with a genetic predisposition, there are always ways of significantly influencing the severity of the blood sugar disorder by changing their eating or exercise behavior. This could mean, for example, that a weight reduction of ten percent of body weight enables a reduction in antidiabetic drugs (dosage of insulin or number of blood sugar-lowering drugs). The number of medications or the insulin dosage can also be positively influenced by reducing the amount of carbohydrates per meal or by not having regular snacks or drinks rich in carbohydrates. Last but not least, exercise improves metabolic processes and blood sugar control. Regular exercise significantly reduces insulin requirements. In working diabetics on insulin therapy, for example, significantly more insulin is needed on days with office work than on days with physical activity. Depending on the intensity, gardening, housework or a regular 30-minute walk after a meal has the same effect.

How often should people who are prone to diabetes check their blood sugar levels?

With a corresponding risk profile, a determination of long-term glucose (HbA1c) is recommended at least once a year, for example as part of a general practitioner check-up. Otherwise, if you experience a significantly increased feeling of thirst and increased urination combined with weight loss, you should see your family doctor.

Even very young people develop diabetes. Do you see an increasing trend here?

Yes, we care for significantly more young patients with type 2 diabetes mellitus. This is particularly the case for patients who are significantly overweight. But we also observe this in patients with a migration background, for example from African countries. The change in lifestyle and eating behavior in these people, even if they gain less weight and have a “normal BMI” by Western standards, result in an unfavorable change in the metabolic processes and can lead to the early onset of type 2 diabetes mellitus. (zt)