Around six million people in Germany have diabetes, that is, their blood glucose levels are too high. Ninety percent are affected by type 2 diabetes, which in most cases is a result of overweight/obesity and lack of exercise. Type 1 diabetes is an autoimmune disease and the most common metabolic disease in children and adolescents. The number of new cases is rapidly increasing in both forms of diabetes. Every day around 1000 new cases of diabetes are diagnosed. Experts estimate that about two million people in Germany have diabetes without being aware of it.
Diabetes is diagnosed by measuring the blood glucose level and/or the long-term blood glucose value HbA1c, which is more meaningful. Type 1 diabetes patients can only maintain a healthy blood glucose level through the injection of insulin. Usually, type 2 diabetes can initially be treated by a change in lifestyle and/or oral antidiabetic medication. Patients who have advanced type 2 diabetes must also inject insulin. To prevent or delay serious secondary diseases which affect the vascular system and the nerves (including eye and kidney damage, heart attack, stroke, foot complications), diabetes patients should receive treatment early on in accordance with diabetes guidelines.
The partners of the German Center for Diabetes Research (DZD), thus also Helmholtz Zentrum München, conduct joint research into the causes of metabolic disease, approaches to prevention, and new treatment options to prevent the emergence and / or to halt the progression of the disease.
The telephone campaign on diabetes was carried out together with the German Center for Diabetes Research (DZD), the German Research Foundation (DDS) and the Diabetes Information Service of Helmholtz Zentrum München. The diabetes experts Professor Andreas Fritsche, Professor Martin Hrabé de Angelis, Professor Rüdiger Landgraf and Dr. Katharina Warncke answered readers’ questions.
My primary care physician says that I don’t yet need to take any medication to lower my blood glucose levels, but my cardiologist, who is treating me for vasoconstriction in the coronary arteries, thinks I should take metformin. What should I do?
Apart from its blood-glucose-lowering effect, metformin is known to be able to protect against cardiovascular diseases such as heart attack. That is why it is the first-choice drug for the treatment of type 2 diabetes. Helmholtz Zentrum München and the German Center for Diabetes Research are currently investigating the exact mechanism of action of metformin und and how the positive effect of the drug can be predicted individually. It is generally recommended to take metaformin if the HbA1c value cannot be kept in the normal range of under 6.5 percent.
During pregnancy I had diabetes. How high is my diabetes risk in the coming years?
Following gestational diabetes, blood glucose levels should continue to be monitored. Even with a healthy lifestyle – a healthy diet, exercise, no smoking and low alcohol consumption – long-term blood glucose levels should be measured every one or two years. Current studies show that women with gestational diabetes who breastfeed their babies have a 40 percent decreased risk of developing type 2 diabetes.
Why are the recommended fasting blood glucose values lower now than they were a few years ago?
Scientific societies such as the German Diabetes Society determine the levels of blood glucose and blood pressure based on the best available evidence. That means the values have been lowered because scientific clinical studies have shown that a significant vascular risk was observed at lower levels than were previously specified.
I was diagnosed with diabetes after a kidney transplant. Do I need to worry about my feet?
Every diabetes patient must pay attention to blood circulation in the feet. Your feet should be monitored regularly, and your physician should also regularly check your feet for circulatory disorders. Particularly important for diabetes patients: Do not smoke!
I have the impression that the number of children with type 1 diabetes is increasing. Is this true and what is being done about it?
During the last decade there has in fact been an increase in the incidence of type 1 diabetes, especially in children under five. Scientists at Helmholtz Zentrum München, in collaboration with international researchers, have made an important breakthrough towards finding an effective prevention of type 1 diabetes. In current studies they are investigating whether insulin in the form of an oral vaccine for children who will develop type 1 diabetes can delay or prevent the progression to insulin dependence. The principle corresponds to the desensitization for allergies.
My 13-year-old daughter was recently diagnosed with type 1 diabetes. She is an athlete in competitive sports. May she be active in sports despite the disease?
People with type 1 diabetes may and even should take part in sports. In such a new situation, parents and children need to initially gain experience in how the body responds to insulin, carbohydrates and exercise. We have found that children who have received training in how to cope with their diabetes and who are active in sports cope very well with their diabetes, because they are aware that they can only perform well in sports if they have their blood glucose levels under control. In no case should sports be prohibited – then the child would feel that because of the disease he or she is being punished because of the disease and therefore has to renounce sports.
I’ve read that prospective parents who eat an unhealthy diet and don’t exercise much not only increase their own risk of diabetes, but also pass on this risk to their children. Is this true?
In fact, studies in mice show that an unhealthy diet influences important switching sites in the genome. First human studies point in the same direction. Prospective parents not only increase their own risk of obesity and diabetes, but also that of their future children. This is true for both fathers and mothers. Scientists of the German Center for Diabetes Research at Helmholtz Zentrum München have found that the lifestyle of both parents affects the epigenetic code and the related activation of genes. Epigenetics is a subfield of genetics, which investigates the regulation and influence of genes by environmental factors. These changes are inherited during conception via sperm and egg cells to the next generation. Since epigenetic inheritance, unlike genetic inheritance, is in principle reversible, it is especially important for prospective parents to pay attention to their own weight and their own metabolism.
Is there a way to find out if you are at risk for diabetes?
With the German Diabetes Risk Test® or with FINDRISK, adults can determine their personal risk of developing type 2 diabetes within the next five years. When you take the test you get tips on how to reduce your diabetes risk or prevent the disease. The online version of the respective test is available at www.dzd-ev.de or www.diabetesstiftung.de. More information on diabetes can also be found at www.diabetesinformationsdienst-muenchen.de.