The name is misleading, complains the sugar industry: The "diabetes" has nothing to do with sugar, especially with the sugar, which one likes to take and often with sweets or cakes. But although various studies are supposed to prove that the consumption of sugar is not causally related to the development of diabetes, overweight and malnutrition are now high on the list as factors in diabetes mellitus.
For the term "diabetes" there are historical reasons: in untreated diabetics, the blood sugar level can rise so high that it exceeds the renal threshold and is excreted in the urine. And as the doctors in ancient Greece discovered, this urine tastes really sweet.
Frequency of diabetes
In Germany already 6 million diabetics are being treated, of which an increasing number are children and adolescents. According to the World Health Organization's definition, diabetes mellitus is a group of metabolic diseases characterized by high blood sugar as a result of a lack of insulin release or insulin action or both.
What is diabetes?
Patients who suffer from diabetes often feel limp and without energy. One reason for this is the disruption of the energy intake of the cells, in which the hormone insulin is significantly involved. The hormone is produced in the pancreas and ensures that the body cells are supplied with glucose from the food.
Insulin is the only hormone in the body that can do this job. If the blood sugar level rises after eating, then more insulin is formed, which ensures that the blood sugar is absorbed more quickly into the cells. If this finely tuned mechanism gets mixed up, it leads to "diabetes".
Forms of diabetes
- Type 1 Diabetes
In type 1 diabetics, the pancreas no longer produces insulin. Type 1 diabetics are with it always relied on the supply of insulin from outside. This type of diabetes is often referred to as adolescent diabetes, because the disorder makes itself felt early on. However, type 1 diabetes can also occur in the elderly.
- Type 2 diabetes
In type 2 diabetes, the pancreas produces insulin, but the body's cells are no longer responsive to the hormone. Through this so-called insulin resistance the existing insulin can no longer achieve its effect. Among other things, insulin resistance can be caused by infections, disturbances in the electrolyte balance or by missing insulin receptors (receptors). The precursor to type 2 diabetes is the metabolic syndrome, which is characterized by obesity, elevated blood lipid levels, high blood pressure, and insulin resistance, and is now considered a typical affluent disease. Although there is a genetic component in the development of type 2 diabetes, the cause is often the unhealthy diet due to lack of exercise.
- Other specific types of diabetes
Other specific types of diabetes are diabetes disorders that are caused by certain genetic defects, pancreatic infections or diseases. A diabetes mellitus, which is triggered by drugs, belongs in this group.
- Gestational diabetes (gestational diabetes)
Gestational diabetes is a disorder of the glucose metabolism that occurs during pregnancy and is diagnosed, but usually disappears at the end of pregnancy. The reason for the "pregnancy sugar" lies in the stress on the body during pregnancy.
Pancreas: production of various hormones
Of all the cells of the pancreas only two percent are involved in the formation of hormones. These cells consist of small bandages that are distributed like islands in the middle of the tissue of the pancreas. Therefore, they are also named after their discoverer Langerhans Islands or islet cells The Langerhans Islands consist of three different types of cells:
- The A cells produce the hormone glucagon. Glucagon is the antagonist of insulin. About 20 percent of the islet cells are A-cells.
- The B-cells make up the hormone insulin. With a share of 70 percent, they are most frequently represented in the islets.
- The D cells form the hormone somatostatin. The D cells occur throughout the digestive tract. Somatostatin has the function to inhibit the secretion of gastric juice and pancreas.
Insulin is always produced in the body when the concentration of glucose in the blood rises. However, insulin is not formed continuously, but rather in waves and released.
Insulin - genetic engineering in use
People with diabetes, especially those with type-1 diabetes, need to deliver insulin to their bodies from the outside. In 1922, for the first time, a person was treated with insulin. The patient, a 13-year-old boy, was already in diabetic coma and could be rescued with the insulin dose.
The first insulin was obtained from the pancreas of cattle and pigs. In their effect, the animal insulins correspond to the human insulin, but some of the patients developed antibodies against the foreign protein.
Meanwhile, insulin is genetically engineered in cell cultures of various yeasts or by Escherichia coli bacteria. In fact it was Insulin the first genetically engineered preparation, thus paving the way for innovative drug production.
Insulin types: differences in the duration of action
Practically, the different insulins are differentiated according to their duration of action in:
- Short-acting insulins
- Insulin of medium duration of action
- Long-acting insulins
- mixing insulins
In general, the larger the amount of insulin sprayed, the later the effect will take effect and the longer it will last. Disseminated insulin injected under the skin tends to assemble into larger molecules. This results in a kind of soluble storage form of insulin in the subcutaneous fatty tissue. This reservoir is then dissolved in the period between injection and food, and insulin begins to enter the body. The reason is the chemical structure of this particular insulin.
Short and medium duration of action: insulin before eating
Fast-acting insulins, like the new analog insulins, work immediately, but only 2-3 hours. A spray-eating distance is not required. A fast-acting insulin is z. As insulin lispro, in which the two amino acids Lysin and Perlin are interchanged.
Insulins of medium duration of action, which include the normal insulin. They work after about 15-30 minutes for about 4-6 hours. These fast and short-acting bolus insulins (for meals) are suitable for meal-related insulin requirements as part of the so-called basic bolus therapy (ICT) and can be injected under the skin into the abdomen for each meal. Accurate time is difficult, because it comes through the individually different absorption from the subcutaneous fat tissue deviations.
Basal insulin: Long-lasting effect
A long duration of action have so-called insulins, They reach a duration of action of up to 24 hours and are mainly used as basal insulins in the basic bolus therapy (ICT).
Long-acting insulins are characterized after subcutaneous injection by a delayed onset of action and a long duration of action. Synonyms used for long-acting insulins are synonymous Delay insulin, depot insulin or basal.
People with diabetes who use conventional therapy (CT) usually receive insulin blends that consist of a short-acting bolus insulin and a delay insulin. These insulin mixtures are available in different mixing ratios.
Insulin glargine for low blood sugar
Also among the long-acting insulins is the genetically engineered insulin glargine, which has been on the market since 2000. In contrast to other types of insulin, insulin glargine has a 24-hour effect and the nighttime hypoglycaemia that occurs in many diabetics does not occur.
However, long-term studies with statements about the long-term effect of the new insulin are still missing. However, an initial suspicion of cancer could not be substantiated.