High Demand for Diabetes Counseling

Every day, nearly 1,000 people are diagnosed with diabetes; in Germany more than six million people have the disease. Most have type 2 diabetes, the non-autoimmune form of the disease. On average, type 2 diabetes is diagnosed eight to ten years too late, and this is problematic for the patients. But just how can the disease be detected? Is the administration of insulin always necessary? What long-term consequences are there and how can they be avoided? What is the best way to support my child with type 1 diabetes in everyday life? In a telephone campaign on November 11, 2014, diabetes experts from universities and diabetes research centers in Dresden, Düsseldorf, Giessen, Hannover, Leipzig, Munich, Tübingen and Ulm answered these questions.

The campaign was jointly organized by the Competence Network Diabetes Mellitus together with the German Center for Diabetes Research. Here is a selection of the many questions:

I was recently diagnosed with type 2 diabetes. With this diagnosis, what daily regimen do I need to follow to lead a “normal” life "?

Often what is needed is a change in lifestyle. In many cases, weight loss and regular exercise can normalize blood glucose levels. At least, this usually improves the blood glucose control. Furthermore, eating habits must be reviewed and, if necessary, they must be adjusted to the new situation, since diet and exercise are related. Weight loss usually can be achieved through a change in diet, in particular through calorie reduction and increased exercise. Weight loss is always paramount to reducing the diabetes risk. To optimize the lipid metabolism, which is also often disturbed, the type of diet is particularly important.

How do I know if I have diabetes? Are there symptoms?
In fact there are warning signals that need to be clarified by a physician. These include frequent urination, strong feelings of thirst, dry or itchy skin, and fatigue. In some cases there may be weight loss, impaired wound healing and increased susceptibility to infection.
In order to detect an increased risk of diabetes even before these symptoms are manifest, it is advisable to take a diabetes risk test at regular intervals. By means of the DIfE – GERMAN DIABETES RISK TEST®, which you can take online at, you can determine your individual risk of developing diabetes within the next five years. Furthermore, you can find recommendations to reduce the risk of diabetes.

Can I prevent diabetes?
Avoiding excess weight is the most important rule to prevent type 2 diabetes. We now know that abdominal adipose tissue – "belly fat" – is a highly active metabolic organ. Some of the cytokines produced in this tissue intervene negatively in the blood glucose metabolism. Patients who reduce this abdominal fat respond significantly better to insulin – also to the body’s own insulin – and blood glucose levels drop. The situation is different in type 1 diabetes. Here the body itself destroys the insulin-producing cells in the pancreas. The incidence of type 1 diabetes is increasing to such an extent that this cannot be explained solely by genetic causes. The onset of the disease occurs increasingly at an earlier age. Environmental factors are likely reasons for this increase. However, it is not yet clear which environmental factors are at work here. Perhaps these are factors resulting from our "modern lifestyle": Thus, early contact with many antigens – similar to the "dirt" theory of allergies – may possibly have a protective effect, while a more "sterile" environment may increase the risk for autoimmunity.

How is diabetes treated?
Consistent, optimal blood glucose control and a healthy lifestyle have a positive effect on both the quality of life and life expectancy. Early structured treatment in combination with diabetes education tailored to the individual patient is particularly important for these reasons. In all cases of diabetes, regular monitoring of blood glucose is important in order to avoid complications as far as possible.

What complications are there?
Many people with diabetes underestimate the dangers of a permanent increase in blood glucose levels because they do not cause pain. Diabetic eye disease, diabetic feet or diseases of the nerves and vessels are typical, but mostly avoidable consequences. Recent studies also show that diabetics suffer more frequently from depression than healthy people. Especially in the elderly, the risk of major complications and mortality is much higher.

Are there any dietary requirements for diabetes?
Diabetics should follow modern principles of healthy eating. Even cake, chocolate or a glass of wine are not necessarily ruled out. Since for overweight patients with type 2 diabetes, weight loss is a major goal of treatment, it is important to eat sweets only in moderation. People with diabetes should always keep track of their blood glucose levels and should estimate the amount of carbohydrates in their food and beverages. Thus, they can actively participate in a good blood glucose control and are therefore free to choose their food. Basically, a diet that is rich in animal fats should be avoided because it increases the risk of cardiovascular disease. In addition, diabetics should eat plenty of high-fiber foods because they have a favorable effect on blood glucose levels.

Does insulin need to be injected in each case?
This is a question most newly diagnosed diabetes patients ask. However, the question cannot be answered in general. While patients with type 1 diabetes need to begin with the injection of insulin immediately because the pancreas produces no insulin, in patients with type 2 diabetes several years can be bridged with oral antidiabetic agents before insulin must be injected. Then insulin therapy usually begins with only one injection a day.
My daughter has diabetes. Since turning 15, she no longer takes her diabetes seriously at all. What can I do?

Parents only have limited influence on their children during this often difficult stage of puberty. You should motivate your kids to try to obtain the best possible blood glucose control on their own. If young people reject the support of parents, an open discussion should take place about where to seek help elsewhere. Ultimately, perhaps a best friend or a relative can help.

How can I help my overweight child lose weight?
For effective weight loss and prevention of type 2 diabetes in obese children and adolescents, the focus should be on a balanced diet and more physical activity. In addition, a food log should be kept in which parents write down what the child has eaten and drunk. The clinician can use the log to identify adverse nutritional habits of the family which should be changed to prevent diabetes. The goal is always weight loss without feeling hungry.