What is diabetes? Focus on diabetes

Veröffentlicht am: October 08, 2024
Dr. med. Wolfgang  Bachmann
Dr. med. Wolfgang Bachmann

General practitioner

Diabetes, or "sugar disease", is a metabolic disorder that is affecting more and more people. Today, there are already 415 million people worldwide. There are three types of diabetes: type 1, type 2 and prediabetes (early-stage diabetes). In addition, diabetes can lead to numerous secondary diseases. Early detection and correct treatment of diabetes is therefore particularly important. Here you can find out more about the symptoms, causes and treatment of diabetes, as well as the different forms of diabetes and how treatment can be achieved by controlling blood sugar levels, changing your diet and exercising.

Contents

What is diabetes? 

Diabetes is a disease in which the blood sugar level (glucose level) is too high. The glucose comes from the food we eat. Normally, the pancreas (an organ located behind the stomach) secretes insulin so that the body can store and utilize sugar and fats from food. Insulin is a hormone that causes glucose to be transported into the cells where it is available as energy.

Persistently high blood sugar levels over a long period of time can have serious consequences. The eyes, kidneys and nerves can be affected. Diabetes also leads to heart disease, strokes and sometimes even amputations.

The diagnosis is made with the help of a blood test. An A1C test also provides information on how well a patient has their diabetes under control. You can control your diabetes by exercising, controlling your weight and sticking to a diet. You also need to keep an eye on your blood sugar levels and take prescribed medication regularly.

Diabetes is a lifelong condition. Around 18.2 million people in the USA have diabetes. Almost a third of them (about 5.2 million) are not even aware of it. In addition, 41 million Americans suffer from prediabetes. So far, there is no cure. Therefore, those affected must bring their disease under control in order to stay healthy for as long as possible.

The role of insulin in diabetes

Let's first take a look at how the body converts food into energy. This helps us to understand the role insulin plays in diabetes. The human body consists of millions and millions of cells. These cells need food in a very simple form in order to obtain energy from it. The food we eat or drink is largely broken down into simple sugars called glucose. The glucose is transported via the blood to every single cell in the body. There it is then available as energy, which the body urgently needs for all its functions.

How much glucose is contained in the blood is controlled by insulin. This hormone is constantly released in small quantities by the pancreas. As soon as the blood glucose level rises above a certain level, the pancreas releases more insulin so that this excess glucose is transported into the cells. This increases the glucose level in the blood.

To prevent your blood sugar level from falling below a certain level (hypoglycemia or low blood sugar), your body signals you to eat something and releases glucose, which is stored in the liver.

People with diabetes either cannot produce insulin or the body's cells are resistant to insulin. This leads to too much sugar circulating in your blood. This condition is known as a high blood sugar level. By definition, you are said to have diabetes as soon as your fasting blood sugar level (no food overnight) reaches a level of 126 milligrams per deciliter (mg/dl) or more.

How do I recognize diabetes?

Your blood glucose level gives you information about your state of health, for example whether you are at risk of developing diabetes or whether you already have diabetes.

The diagnosis consists of the following tests:

  • fasting plasma glucose test measures your blood glucose level after you have not eaten for at least eight hours. This test can be used to diagnose both diabetes and prediabetes.
  • In an oral glucose tolerance test, your blood glucose level is measured after eight hours without food and a second time two hours after you have drunk a glucose solution. This test can be used to diagnose both diabetes and prediabetes.
  • In a random plasma glucose test, the doctor measures your blood glucose level without taking into account when you last ate. This test is used together with the evaluation of symptoms to diagnose diabetes. It cannot detect prediabetes.
  • hemoglobin A1C test provides information about the average blood glucose level over the last two to three months. It is also known as HbA1C, glycohaemoglobin test or glycated haemoglobin.

Positive test results should be confirmed by a fasting plasma glucose test or an oral glucose tolerance test on another day. After the initial diagnosis, your doctor may advise a zinc transporter 8 antibody test (ZnT8Ab). This blood test - along with other information and test results - is used to determine whether someone has type 1 diabetes. With the help of the ZnT8AB test, a quick and accurate diagnosis can be made so that treatment can begin quickly.

The fasting plasma glucose test (FPG)

The FPG test provides the most reliable results when performed in the morning. The results and what they mean can be found in Table 1. If your fasting glucose level is between 100 and 125 mg/dl, you have a form of prediabetes called impaired fasting glucose (IFG). This means that you do not yet have type 2 diabetes, but you are at an increased risk of developing it. A blood glucose level of 126 mg/dl or more, confirmed by another test on another day, means that you have diabetes.

 Plasma glucose values (mg/dl)

Diagnosis

99 and less

normal

100 to 125

Prediabetes (impaired fasting blood glucose level)

125 and higher

Diabetes*

*confirmed by repeating the test on another day

The blood glucose values can be given in different units of measurement. Either in milligrams per deciliter or in millimoles per liter. The conversion formulas are as follows:

  • mg/dl x 0.0555 = mmol/l
  • mmol/l x 18.02= mg/dl

Oral glucose tolerance test (OGTT)

Research confirms that the OGTT is better than an FPG test for diagnosing prediabetes. However, the procedure is a little uncomfortable. You must not have eaten for at least eight hours before an OGTT is carried out. The blood glucose level is measured directly before the test and two hours afterwards. For the test, you must drink a sugar solution consisting of 75 grams of glucose dissolved in water. The results and what they mean can be found in Table 2. If your blood glucose level is between 140 and 199 mg/dl two hours after taking the glucose solution, you have a form of prediabetes called impaired fasting glucose (IFG). This means that you do not yet have type 2 diabetes, but you are at an increased risk of developing it. A blood glucose level of 200 mg/dl or more, confirmed by another test on another day, means that you have diabetes.

Plasma glucose values (mg/dl) after two hours

Diagnosis

139 and less

normal

140 to 199

Prediabetes (impaired fasting blood glucose level)

200 and higher

Diabetes*

*confirmed by repeating the test on another day

Random plasma glucose test

A random blood glucose level of 200 mg/dl or more and the occurrence of the following symptoms means that you probably have diabetes.

Symptoms:

  • Increased urge to urinate
  • Increased thirst
  • Unexplained weight loss

Other symptoms include fatigue, blurred vision, increased hunger and sores that won't heal. Your doctor will test your blood glucose levels either by an FPG test or an OGTT on another day to confirm the diagnosis.

Hemoglobin A1C test

People with diabetes must carry out this test regularly to ensure that their values remain stable. The test provides information on whether any medication needs to be adjusted. However, it is also used to make a diagnosis.

Newer guidelines recommend the A1C test as a diagnostic test for prediabetes or diabetes. (This test is usually used to determine how well diabetics' blood glucose levels are controlled over several months).

Haemoglobin is a protein contained in red blood cells. This protein gives the blood cells their red color. Haemoglobin is responsible for transporting oxygen. The sugar in the blood is called glucose. The more glucose accumulates in the blood, the more hemoglobin it binds in the red blood cells. The A1C test measures how much glucose is bound. Red blood cells have a lifespan of about three months. The test therefore provides average values for glucose levels over the last three months. If your glucose levels have been elevated for the last few weeks, the hemoglobin A1C test will also show higher values.

People without diabetes normally have values between four and 5.6 percent. HbA1C values of 5.7 to 6.4 percent are consistently found in patients suffering from prediabetes. With these values, a disease can still be averted by a change in lifestyle. An HbA1C value of 6.5 percent or more is typical for diabetes.

The target value for diabetics is normally less than seven percent. The higher the HbA1C value, the higher the risk of complications related to the disease.

Diabetics should have an A1C test carried out every three months to ensure that the target value is not exceeded. If you have your diabetes well under control, blood tests at longer intervals are also sufficient. However, you should have a test carried out at least twice a year.

Patients suffering from diseases that affect the haemoglobin level, e.g. anaemia, may receive incorrect test results. The test results can also be influenced by the intake of vitamin C and vitamin E supplements or a high cholesterol level. Kidney or liver disease can also affect the test.

How is diabetes kept under control?

There is currently no cure for diabetes, but the disease can be kept under control.

The following goals are being pursued:

  • Keep your blood sugar levels as normal as possible by ensuring a good balance between diet, medication and exercise.
  • Keep your blood cholesterol and triglyceride (lipid) levels as normal as possible by avoiding products with added sugars and processed starches and reducing your overall intake of saturated fats and cholesterol.
  • Check your blood pressure. Your blood pressure should not exceed 130/80.
  • You should delay or avoid the occurrence of health problems associated with diabetes as much as possible.

You have it in your hands and can keep your diabetes under control by:

  • plan exactly what you eat and follow a balanced diet plan.
  • exercise regularly.
  • Take medication as prescribed by your doctor (quantity and time/way of administration).
  • Check your blood sugar level and blood pressure at home.
  • keep all appointments with your doctor or diabetes consultant and have laboratory tests carried out at the specified time.

Remember, what you do at home affects your blood sugar levels more than what your doctor can do at check-ups every few months.

doctor can do as part of check-ups every few months.

Forms of diabetes

  • Type 1 diabetes
  • Type 2 diabetes
  • Prediabetes
  • Gestational diabetes

With type 1 diabetes , your body cannot produce insulin. In type 2 diabetes, the more common type, your body cannot produce or utilize insulin. Without sufficient insulin, glucose remains in your blood. You may also suffer from prediabetes. This means that your blood glucose level is higher than normal, but not high enough to be classified as diabetes. With prediabetes, there is a higher risk of type 2 diabetes. Pregnant women can also develop diabetes. In this case, it is called gestational diabetes.

The causes, symptoms and, more specifically, the treatment of type 1 and type 2 diabetes are discussed in more detail below.

How does type 1 diabetes develop?

Type 1 diabetes occurs when the insulin-producing cells of the pancreas (known as beta cells) are destroyed by the immune system. This is known as an autoimmune response. Patients suffering from type 1 diabetes do not produce insulin and need insulin injections to keep their blood sugar levels under control.

Type 1 diabetes often occurs in people under the age of 20, but can develop at any age.

The main reasons for this are:

  • Family history: If relatives suffer from diabetes, you are at a higher risk of also developing the disease. So if your mother, father, brother or sister has type 1 diabetes, you should also be tested. A simple blood test is sufficient for a diagnosis.
  • Pancreatic diseases: This reduces the ability to produce insulin.
  • Infections or diseases: Some infections or diseases, most of them rare, can destroy the pancreas.

The diagnosis of "type 1 diabetes" initially frightens and overwhelms many of those affected. Many questions also arise: Why did I develop the disease? What does it mean for my long-term health and how will it change my everyday life?

The first few months after diagnosis are like a rollercoaster ride for most patients. Make the most of this time together with your family and learn as much as possible about your condition so that everything associated with it (determining blood glucose levels yourself, visits to the doctor, daily insulin doses, etc.) becomes part of your daily routine.

You should also discuss with your doctor or nursing staff what other options are available to you, particularly with regard to medical and psychological support. These include, for example, group meetings, appointments with nutritionists or social workers, nursing courses or recommended books, websites or magazines.

Despite the risks associated with type 1 diabetes, most people affected can lead an active life and enjoy the foods and activities they did before their diagnosis. Diabetes also does not mean the end of feasting on special occasions, such as a birthday cake. With forward planning, most people with diabetes can enjoy almost all the same activities as healthy people.

What are the symptoms of type 1 diabetes?

Diabetes often develops over several months or even years without any symptoms appearing at all. A high blood sugar level and corresponding accompanying symptoms (frequent urination, thirst) usually only occur after more than 90 percent of the insulin-producing cells have been destroyed. Symptoms usually occur suddenly and are often very severe.

These include:

  • Increased thirst
  • Increased hunger (especially after a meal)
  • Dry mouth
  • Frequent urge to urinate
  • Unexplained weight loss (even though you are eating and hungry)
  • Tiredness (you feel tired and dull.)
  • blurred vision
  • Shortness of breath, heavy breathing (Kußmaul breathing)
  • Fainting (rare)

How does type 2 diabetes develop?

In contrast to people with type I diabetes, patients with type II diabetes produce insulin. The pancreas either does not release enough insulin or the body is resistant to this hormone. Without enough insulin or if insulin cannot be utilized in the intended way, glucose cannot be transported into the body cells.

Type 2 diabetes is the most common form of diabetes. It affects around 18 million Americans. Although most of these cases could be prevented, diabetes is still the leading cause of secondary diseases such as blindness, non-traumatic amputations and chronic kidney failure requiring dialysis. Type 2 diabetes usually occurs in people over the age of 40 who are overweight. However, it can also affect people of normal weight. Type 2 diabetes is sometimes referred to as "adult onset diabetes". However, due to the increase in obesity among children, more and more young people are also affected.

Some people manage to keep their type 2 diabetes under control by watching their weight and diet and exercising regularly. Other patients have to take additional tablets so that the body can better utilize the insulin, or need insulin injections.

Doctors are often able to determine the risk of type 2 diabetes before it occurs. This condition is known as prediabetes. A person's blood glucose level is elevated, but not high enough for a diagnosis of "type 2 diabetes" to be made.

Adults are often affected by this disease, but it can occur at any age.

The main reasons for this are:

  • Obesity or being overweight: research confirms that this is the main cause of type 2 diabetes. As obesity among children in the USA has increased in recent years, adolescents are also increasingly affected.
  • Impaired glucose tolerance: Prediabetes is considered a mild form and can be diagnosed with a simple blood test. If you have it, you will most likely also develop type 2 diabetes.
  • Insulin resistance: The disease often begins when cells become resistant to insulin. This means that the pancreas has to work harder to produce enough insulin to meet the body's needs.
  • Ethnic background: Diabetes appears to be more common among Americans of Hispanic, African and Asian descent, Native Americans, Pacific Islanders and Alaska Natives.
  • Gestational diabetes: If you suffered from diabetes during your pregnancy, you had gestational diabetes. This puts you at an increased risk of developing type 2 diabetes in the course of your life.
  • Sedentary lifestyle: This means that you exercise less than three times a week.
  • Family history: One of your parents or siblings suffers from diabetes.
  • Polycystic ovary syndrome: There is an increased risk for women who suffer from polycystic ovary syndrome.
  • Age: If you are over 45 years old and overweight or have symptoms suggestive of diabetes, talk to your doctor and have a simple diagnostic test done.

What are the symptoms of type 2 diabetes?

The symptoms are basically the same as those listed under type 1 diabetes. However, in most cases there are no symptoms at all or they develop very gradually over a longer period of time.

Other symptoms are

  • Slow-healing wounds or cuts
  • Itching on the skin (usually in the genital area or groin)
  • Yeast infections
  • recent weight gain
  • Numbness or tingling in the hands and feet
  • Impotence or erectile dysfunction

Consequences of diabetes

Long-term complications develop gradually over a long period of time. The longer you have diabetes - and the less you have your blood glucose levels under control - the higher the risk of complications. With well-controlled blood glucose levels, the risk of many complications can be significantly reduced. These complications can affect important organs such as the heart, blood vessels, nerves, eyes or kidneys. If left untreated, these complications can lead to severe impairment (disability) or even death.

Possible problems include:

  • Cardiovascular diseases: Diabetes significantly increases the risk of various cardiovascular diseases. These include coronary heart disease with chest pain (angina), heart attack, stroke and narrowing of the arteries (atherosclerosis). If you have diabetes, you are at a higher risk of heart disease and strokes.
  • Nerve damage (neuropathy): Excess sugar can damage the walls of tiny blood vessels (capillaries). These blood vessels nourish the nerves, especially in the legs. This causes tingling or numbness or a burning sensation or pain that usually starts in the tips of the toes or fingers and spreads from there. If left untreated, you may lose all feeling in the affected limbs over time. Nerve damage affecting the digestive tract can lead to nausea, vomiting, diarrhea or constipation. In men, it can also lead to erectile dysfunction.
  • Kidney damage (nephropathy): The kidneys consist of millions of small clusters of blood vessels (glomerula) that filter waste products from the blood. Diabetes can damage this sensitive filter system. Severe damage leads to kidney failure or irreversible kidney disease requiring dialysis or a kidney transplant.
  • Eye damage (retinopathy): Diabetes can damage the blood vessels in the retina (diabetic retinopathy), which can lead to blindness over time. Diabetes also leads to an increased risk of other serious eye diseases, such as cataracts and glaucoma.
  • Damage to the feet: Nerve damage in the feet or poor circulation in the feet increase the risk of serious damage. If left untreated, cuts and blisters can lead to serious infections that often heal poorly. These infections can ultimately necessitate amputation of the toe, foot or entire leg.
  • Skin and mouth complaints: Diabetes can make you more susceptible to infections of the skin or mouth. These include bacterial or fungal infections. Inflammation of the gums or dry mouth are also common.
  • Hearing loss:Hearing damage is more common among diabetics.
  • Alzheimer's disease: Type 2 diabetes may increase the risk of developing Alzheimer's disease. The more poorly the blood sugar level is controlled, the higher the risk appears to be. There are various theories as to how the two diseases are linked. However, none of them have yet been proven.
  • Complications during pregnancy: A high blood sugar level can be dangerous for both the expectant mother and the baby. The risk of miscarriage, stillbirth and birth defects is significantly increased if the diabetes is not brought under control. For the mother, there is an increased risk of diabetic ketoacidosis, diabetic eye damage (retinopathy), pregnancy-induced high blood pressure and pre-eclampsia.

How can I prevent or delay complications associated with diabetes?

The best way to prevent complications is to keep your blood sugar levels within the normal range and follow your doctor's instructions exactly.

Here are some tips on how you can achieve this:

  • Follow your doctor's instructions carefully regarding the administration of insulin.
  • Eat a healthy and varied diet. Avoid fatty, cholesterol-rich foods with lots of salt or added sugar.
  • Maintain a normal weight. If you are overweight, your doctor will give you valuable tips on how to lose weight safely.
  • Keep your blood pressure at a normal level (below 130/80 mm Hg).
  • Watch your cholesterol level (below 200 mg).
  • Exercise regularly or move frequently.
  • Stop smoking.
  • Take care of your feet and check them every day for signs of injury or infection.
  • Visit your eye doctor at least once a year.
  • Go to the dentist at least twice a year and have your teeth and gums checked.
  • Make sure you are optimally vaccinated. Get vaccinated against flu every year and against tetanus every ten years.
  • Learn to deal with stress.
  • See your doctor regularly, even if you feel healthy. Your doctor will examine you for early signs of complications.
  • Contact your doctor immediately if you notice any of the symptoms listed here.

A blood glucose level that is as close to normal as possible significantly reduces the risk of long-term complications. To achieve this, you need to check your blood sugar several times a day yourself, administer insulin, pay close attention to what you eat and visit your doctor or diabetes counselor regularly.

Medication for the treatment of diabetes - insulin, metformin & co

You can keep your blood sugar under control with various medications. These include oral tablets, for example. Most patients with type 2 diabetes start with this. However, oral medication does not work for everyone. They are not suitable for treating type 1 diabetes and those affected require insulin therapy. Insulin therapy is also necessary for some patients with type 2 diabetes. If you need insulin, you must inject it yourself (either with a syringe or an insulin pen). Your doctor will explain to you which medication you need and why.

Medication for type 1 diabetes

Insulin

Diabetes mellitus is a lifelong disease that can be kept under control with appropriate lifestyle changes and medication. A well-controlled blood glucose level can prevent or significantly reduce complications. Treatment with insulin is part of the therapy for patients with type 1 diabetes. Everyone with type 1 diabetes needs insulin at some point. Insulin is injected under the skin or delivered continuously via an insulin pump.

Insulin treatment replaces or supplements the body's own insulin with the aim of preventing ketosis and diabetic ketoacidosis and achieving normal or near-normal blood glucose levels. Many different types of insulin treatment can successfully control blood glucose levels. The best treatment for you depends on a variety of individual factors. With a little more planning, people with diabetes who take insulin can lead full lives and keep their blood glucose under control.

Many types of insulin are suitable for treating diabetes. They are categorized according to how quickly they work and how long the effect lasts.

The different types of insulin include

  • fast-acting
  • short-acting
  • medium-long acting
  • long-acting
  • premixed

Initially, it will take a while to find the right dose for you. Appropriately trained specialist staff will support you in adjusting the dose. You will be trained accordingly so that you can check your blood glucose level several times a day.

Insulin requirements change frequently and depend on your weight, what you eat, your state of health (including pregnancy), activity level, workload, etc.

Most patients adjust the dose on their own, but need help from time to time. Normally, you will visit a doctor or diabetes consultant every three to four months. Your blood glucose level and insulin dose will be checked and appropriate adjustments made.

Your doctor will work with you to determine the type and dose of insulin required to treat your diabetes.

The choice depends on various factors:

  • how you react to insulin (how long your body needs to absorb it and how long it remains active in your body. These parameters vary from person to person).
  • your personal lifestyle (what you eat, how much alcohol you drink, how often you exercise - these are all things that affect how your body uses insulin).
  • Your willingness to inject yourself several times a day
  • how often you check your blood glucose level
  • Your age
  • Your personal target value (blood glucose level)

A well-known, fast-acting insulin for inhalation has been approved by the FDA (US Food and Drug Administration) for use before meals for both type 1 and type 2 diabetes. The drug peaks in about 15-20 minutes and is metabolized by the body within two to three hours. Patients with type 1 diabetes must take it together with long-acting insulin.

The following table lists the types of injectable insulin with details of the onset (time for the insulin to reach the bloodstream and begin to lower blood glucose), peak (period of time when it is most effective at lowering blood glucose) and duration (how long the insulin works). These three values vary. The last column provides an overview of the "coverage" of the different types of insulin in relation to meals.

Type of insulin and brand name

Start

Highlight

Duration

Role in blood glucose management

Fast acting

Lispro (Humalog)

15-30 min.

30-90 min.

3-5 hours

Fast-acting insulin covers the insulin requirement during meals, which are taken at the same time as an injection. This type of insulin is often taken together with long-acting insulin.

Aspart (Novolog)

10-20 min.

40-50 min.

3-5 hours

Glulisine

20-30 min.

30-90 min.

1-2.5 hours

Short-acting insulin

Regular (R) or Novolin

30 min-1 hour

2-5 hours

5-8 hours

Short-acting insulin covers the insulin requirement for meals that are eaten within the next 30 to 60 minutes.

Velosulin (for use in insulin pumps)

30 min-1 hour

1-2 hours

2-3 hours

Medium-long acting insulin

NPH (N)

1-2 hours

4-12 hours

18-24 hours

Medium-acting insulin covers the insulin requirement for half a day or night. This form of insulin is often taken in conjunction with rapid-acting or short-acting insulin.

Long-acting insulin

Insulin glargine (Lantus, Toujeo)

1-1.5 hours

No peak insulin is delivered consistently

20-24 hours

Long-acting insulin covers the insulin requirement for an entire day. This form is often combined with fast-acting or short-acting insulin if necessary.

Insulin detemir (Levemir)

1-2 hours

6-8 hours

Up to 24 hours

Insulin degludec (Tresiba)

30-90 min.

No highlight

42 hours

Premixed insulin

Humulin 70/30

30 min.

2-4 hours

14-24 hours

This type of insulin is often taken two or three times a day before meals.

Novolin 70/30

30 min.

2-12 hours

Up to 24 hours

Novolog 70/30

10-20 min.

1-4 hours

Up to 24 hours

Humulin 50/50

30 min.

2-5 hours

18-24 hours

Humalog mix 75/25

15 min.

30 min-2.5 hours

16-20 hours

*Premixed insulin combines certain amounts of intermediate-acting insulin with short-acting insulin in a bottle or insulin pen. (The numbers after the brand name indicate the percentage of each type of insulin).

 

Follow your doctor's instructions exactly as to when you should take or administer the insulin. The time between insulin administration and the meal varies depending on which insulin you are taking.

In general, however, you should align the insulin administration with your meals. The table on page 1 shows in the "Start" column when the insulin begins to take effect in your body. The aim is for you to start eating at the same time.

Good timing will help you to avoid low blood sugar levels.

  • Fast-acting insulin: about 15 minutes before the meal
  • Short-acting insulin: 30 to 60 minutes before the meal
  • Medium-long acting insulin: up to one hour before a meal
  • Premixed insulin: between ten minutes or 30 to 45 minutes before the meal, depending on the product

Exceptions regarding dosage and timing:

Long-acting insulin is not linked to meals. Detemir (Levemir) is taken once or twice a day, regardless of the time of meals. Glargine (Lantus, Toujeo) is taken once a day, always at the same time. Deglutec is taken once a day; the timing may vary from day to day. Some patients need to combine a long-acting insulin with a shorter-acting type or another medication, which must then be taken at mealtimes.

Fast-acting medications can also be taken together with a meal and not 15 minutes before. Some types can be taken directly before going to bed.

For more information on taking insulin, see the "Dosage and administration" section of the package leaflet that came with your insulin preparation or talk to your doctor.

Amylinomimetics

Pramlintide (SymlinPen 120, SymlinPen 60) is one of the amylinomimetics. This medication is injected before meals. It delays the time it takes for the stomach to empty and reduces the release of glucagon after a meal. This lowers your blood sugar level. The appetite is also curbed by a central mechanism.

Medication for type 2 diabetes

Most medication for type 2 diabetes must be taken orally. However, injections are sometimes also necessary. Some patients with type 2 diabetes also need to take insulin.

Alpha-glucosidase inhibitors

These drugs help the body break down starchy foods and table sugar. This lowers your blood sugar level. You will achieve the best effect if you take this medication before meals.

Biguanides

Biguanides reduce the amount of sugar produced by the liver. They also reduce the amount of sugar absorbed by the intestines and promote the body's sensitivity to insulin. They help the muscles to absorb glucose. The most widely used biguanide is metformin (Glucophage, metformin hydrochloride ER, Glumetza, Riomet, Fortamet).

Metformin can be combined with other medications for the treatment of type 2 diabetes.

It is a component of the following medicines:

  • Metformin-canagliflozin (Invokamet)
  • Metformin-dapagliflozin (Xigduo XR)
  • Metformin-emmagliflozin (Synjardy)
  • Metformin-Glipizide
  • Metformin glyburide (Glucovance)
  • Metformin-linagliptin (Jentadueto)
  • Metformin-Pioglitazone
  • Metformin-repaglinide (PrandiMet)
  • Metformin-Rosiglitazone
  • Metformin-Saxagliptin (Kombiglyze XR)
  • Metformin-sitagliptin (Janumet)

Dopamine agonist

Bromocriptine (Parlodel) is a dopamine agonist. The exact mode of action in the treatment of type 2 diabetes is not known. It may influence certain body rhythms and prevent insulin resistance.

DPP-4 inhibitors

DPP-4 inhibitors support the body in the production of insulin. They lower the blood sugar level without the risk of hypoglycemia (low blood sugar). These drugs also help the pancreas to produce more insulin.

These drugs include:

  • (Nesina)
  • (Kazano)
  • (Oseni)
  • Linagliptin (Tradjenta)
  • Linagliptin-emmagliflozin (Glyxambi)
  • Linagliptin-metformin (Jentadueto)
  • Saxagliptin (Onglyza)
  • Saxagliptin-Metformin (Kombiglyze XR)
  • Sitagliptin (Januvia)
  • Sitagliptin-metformin (Janumet and Janumet XR)
  • Sitagliptin and simvastatin (Juvisync)

Glucagon-like peptides (incretin mimetics)

These drugs are very similar to a natural hormone called incretin. They promote the growth of B-cells and the amount of insulin in the body. They reduce appetite and the amount of glucagon the body utilizes. They also slow down gastric emptying. All of these factors are very important for people with diabetes.

These drugs include:

  • Albiglutide (Tanzeum)
  • Dulaglutide (Trulicity)
  • Exenatide (Byetta)
  • Exenatide extended release (Bydureon)
  • Liraglutide (Victoza)

Meglitinide

These medications help the body to release insulin. In some cases, however, they lead to an excessive drop in blood sugar levels. These medications are not suitable for everyone.

These include:

  • Nateglinide (Starlix)
  • Repaglinide (Prandin)
  • Repaglinide-metformin (Prandimet)

SGLT-2 inhibitors

These drugs have the effect that the kidneys do not store the glucose. Instead, it is excreted in the urine.

These drugs include:

  • Dapagliflozin (Farxiga)
  • Dapagliflozin-metformin (Xigduo XR)
  • Canagliflozin (Invokana)
  • Canagliflozin-metformin (Invokamet)
  • Empagliflozin (Jardiance)
  • Empagliflozin-linagliptin (Glyxambi)
  • Empagliflozin-metformin (Synjardy)

Sulfonylureas

These are some of the oldest diabetes medications. They are still used today. They stimulate the pancreas with the help of beta cells. This stimulates the body to produce more insulin.

These drugs include:

  • Glimepiride-pioglitazone (Duetact)
  • Glimeperide-rosiglitazone (Avandaryl)
  • Gliclazide
  • Glipizide (Glucotrol)
  • Glipizide-metformin (Metaglip)
  • Glyburide (DiaBeta, Glynase, Micronase)
  • Glyburide metformin (Glucovance)
  • Chlorpropamide (diabinesis)
  • Tolazamide (Tolinase)
  • Tolbutamide (Orinase, Tol-Tab)

Thiazolidinedione

These drugs reduce the glucose content in the liver. They also support fat cells in the utilization of insulin. However, they also increase the risk of heart disease. If your doctor prescribes such a preparation, he or she will monitor your heart function very closely.

These drugs include:

  • Rosiglitazone
  • Rosiglitazone glimepiride (Avandaryl)
  • Rosiglitizone-metformin
  • Pioglitazone (Actos)
  • Pioglitazone (Oseni)
  • Pioglitazone-glimepiride (Duetact)
  • Pioglitazone-metformin

Other medications

In addition, diabetics (type 1 and 2) often require further medication to treat side effects.

These medications may include

  • Aspirin for the heart
  • Cholesterol reducer
  • Blood pressure medication

Alternative medicine for diabetes

Alternative medication should never be used alone to treat diabetes. However, in addition to medication, a proper diet and sufficient exercise, you can help your body to control your blood sugar and prevent complications.

Chromium does have an influence on insulin and glucose metabolism. Nevertheless, there is no evidence to suggest that taking chromium supplements can help in the treatment of diabetes. However, chromium is found in many healthy foods, such as green vegetables, nuts and cereals. Studies provide evidence that biotin (vitamin H) together with chromium can improve glucose metabolism in diabetics. However, biotin on its own showed no effect.

Vitamin B6 and B12 can help treat nerve pain due to diabetes. This is true if you suffer from a deficiency that increases nerve pain. Beyond that, there is no evidence that these vitamins help.

Vitamin C can compensate for low insulin levels in the blood, which normally helps the cells to absorb the vitamin. An optimally balanced vitamin C level can help the body to keep cholesterol and blood sugar levels under control. However, too much vitamin C can lead to kidney stones and other problems. Therefore, ask your doctor whether a vitamin C supplement can help you.

Vitamin E can help limit damage to blood vessels and protect against kidney and eye disease. Too much leads to serious illnesses and increases the risk of strokes. So be sure to talk to your doctor before taking it.

Magnesium helps the body to control blood sugar levels. Some diabetics suffer from a severe magnesium deficiency. In such cases, magnesium supplements can improve the effect of insulin.

Mind-body medicine

Guided visualization, biofeedback, meditation, hypnotherapy and yoga reduce stress hormones, which is useful in stabilizing blood sugar levels. Biofeedback can also help lower blood pressure, but more research is needed to determine its role in the treatment of diabetes and hypertension.

Herbal remedies

Capsaicin cream, a topical ointment made from cayenne, has been shown to relieve pain in the hands and feet caused by diabetic neuropathy in some patients. However, patients with sensory disturbances in the hands or feet should be careful when using capsaicin as they may not experience a burning sensation. Talk to your doctor if you are thinking about using it.

Evening primrose oil can allegedly help with diabetic nerve pain. However, conclusive evidence for this has not yet been provided.

Ginkgo, garlic, Indian basil leaves, fenugreek seeds, ginseng and hawthorn are other herbs that some people use to relieve the symptoms of their diabetes. However, further research is needed to determine what role these medicinal plants play. Be sure to talk to your doctor before using any medicinal herbs.

The right diet for diabetes

A balanced diet is essential for diabetics. Create a menu plan together with your doctor or nutritionist. For type 1 diabetes, the insulin dose depends on your activity level and diet. When and how much you eat is just as important as what you eat. As a rule, doctors recommend three small meals and three to four snacks a day to maintain the right balance between sugar and insulin in the blood.

A healthy balance of carbohydrates, proteins and fats helps to keep blood sugar levels as close to normal as possible. How much depends on your weight and personal preferences, for example. Keep a close eye on the amount of carbohydrates you consume. The key to blood sugar control is to know exactly how much carbohydrate you need and how much you are eating. If you are overweight, either a low-carb, low-fat/low-calorie or Mediterranean diet can help you reach your weight goal. The proportion of saturated fats should not exceed seven percent. You should avoid trans fats altogether.

Understanding the role of carbohydrates and fiber in diabetes

As a diabetic, you need to pay attention to your diet, especially your intake of carbohydrates, as these have a faster effect on blood sugar levels than proteins or fats.

Carbohydrates are found in sweets, fruit, milk, yogurt, bread, breakfast cereals, rice, pasta, potatoes and vegetables.

It is helpful if you start counting the carbohydrates you eat and divide them evenly between meals. This way they are in line with the amount of insulin produced by the body or provided by medication. If you eat more carbohydrates than the insulin can process, your blood sugar level will rise. If you eat too few carbohydrates, your blood sugar level is at risk of dropping too low.

When counting carbohydrates, simply follow the information on the product packaging and plan your meals accordingly.

This approach is particularly recommended for all those who have to take insulin several times a day or who wear an insulin pump. But it is also very helpful if you simply want a little more flexibility and variety. The amount and type of insulin you are prescribed can affect the flexibility of your meals.

You don't have to count carbohydrates either. You can simply stick to the food substitution list for diabetes. Ask your doctor or nutritionist what advice they can give you on this.

Support through dietary fiber

Dietary fiber helps the body to control blood sugar levels. They also help to reduce "bad" LDL cholesterol levels.

Most Americans do not consume enough fiber. They often only get about half of their daily requirement.

Dietary fiber is found in plant-based foods.

So include the following foods in your diet more often:

  • Fresh fruit and vegetables
  • Cooked dry beans and peas
  • Wholemeal bread, cereals and crackers
  • Brown rice
  • Bran
  • Nuts and seeds

The best source of fiber is food. However, the requirement can also be met with appropriate supplements. These include psyllium and methylcellulose, for example.

Increase your fiber intake slowly to prevent bloating and cramps. At the same time, you need to drink more.

Food and glycemic index

Some foods lead to a rapid rise in blood sugar levels. This is because carbohydrates such as granulated sugar and bread are more easily converted into glucose by the body. The body uses glucose as energy. Vegetables or whole grain products are carbohydrates that are digested more slowly. So if you consume a large amount of easily digestible carbohydrates every day, you will find it difficult to keep your blood sugar levels under control despite insulin and other medication.

The glycaemic index allows you to differentiate between slowly breaking down "good carbohydrates" and quickly digestible "bad carbohydrates". This allows you to refine your carbohydrate counting and keep your blood sugar levels more constant.

What is the glycemic index?

The glycaemic index is a number that indicates how quickly the body converts carbohydrates into glucose. Two foods with the same carbohydrate content can have a different glycemic index.

The smaller the number, the lower the effect on the blood sugar level.

  • 55 or less = low (good)
  • 56- 69 = medium
  • 70 or higher = high (bad)

The glycemic index is sometimes indicated on the product packaging. You can also find a list of common foods on the internet. Harvard University lists more than 100 foods and their glycemic index. You can also obtain information about this from your dietician.

Foods that have not been processed at all or only minimally processed tend to have a lower glycemic index than refined or processed products.

The glycemic index can change.

The figure given is only valid on paper. On the plate, a food can reach a completely different value, depending on various factors.

Preparation: Fats, fiber and acid (e.g. lemon juice or vinegar) lower the glycemic index. The longer you cook starchy foods such as pasta, the higher the respective glycemic index.

Degree of ripeness: The glycemic index increases in fruits (e.g. bananas) with increasing degree of ripeness.

Other foods consumed at the same time: Lower the glycemic index of a meal by combining foods with a high index with others with a low index.

Your age, activity level and how quickly your body digests food will also affect how your body reacts to carbohydrates. If you suffer from a digestive disorder called gastroparesis, your stomach empties slowly. The body therefore also absorbs food with a delay.

In context: Glycemic load and good nutrition

However, the glycemic index should not be the only thing you should consider when choosing your food. Just because a product has a low glycemic index doesn't mean it's healthy or that you should consume it in large quantities. Calories, vitamins and minerals are still important.

For example, potato chips have a lower glycemic index than porridge oats and about the same as green peas. However, porridge and green peas contain more nutrients.

Portion size also plays a role. The more carbohydrates you consume, regardless of the type of food, the greater the effect on your blood sugar level. Statements about this are made via the glycemic load. This is a number that is often mentioned together with the glycemic index. In a way, it is the glycemic index for a certain amount of a food.

The glycaemic load therefore provides information on both the quantity and quality of carbohydrates. Less than 10 is low, more than 20 is high.

Lower your glycemic load by taking this into account in your diet:

  • Eat more wholegrain products, nuts, pulses, fruit and vegetables without starch and other foods with a low glycemic index.
  • Eat fewer foods with a high glycemic index such as potatoes, white rice and white bread.
  • Eat less sugary foods including sweets, cookies, cakes and sweet drinks.

Of course, you can still eat foods with a high glycemic index. Simply enjoy smaller portions and combine them with nutrient-rich foods with a low glycemic index.

What does a healthy, balanced diet for diabetes look like?

What you eat not only affects how well you control your diabetes, but also how well you feel and how much energy you have for the day.

  • How much you need to eat and drink depends on your age, gender, activity level and what your nutritional goals are.
  • Our portion sizes have gotten bigger and bigger over the years - at the same rate as our plates and bowls have gotten bigger. Use smaller dishes to reduce the portion sizes of your meals. This will make it seem like there is more food on your plate.
  • No food has all the nutrients you need in exactly the right quantities. You must therefore consume something from all product groups every day.

Fruit and vegetables

Naturally low in fat and calories and packed with vitamins, minerals and fiber, fruits and vegetables add flavor and variety to any meal. They can also protect against strokes, heart disease, high blood pressure and some cancers.

How often?

Everyone should eat at least five portions a day. Fresh, frozen, dried or canned fruit and vegetables - everything counts. Base your selection on the colors of the rainbow. Eat colorful foods to get as many different vitamins and minerals as possible.

Try it:

  • take a piece of fruit (apple, banana, pear, orange) with you to work
  • a breakfast of a piece of melon or grapefruit together with low-fat yogurt or a handful of berries, fresh dates, apricots or prunes for breakfast
  • Carrots, peas and green beans in a pasta bake
  • a handful of extra vegetables for lunch: peas with rice, spinach with lamb or onions with chicken

Starchy foods

Potatoes, rice, pasta, bread, chapati, naan and plantain all contain carbohydrates, which the body breaks down into glucose and uses as energy. Other starchy foods - such as wholemeal bread, wholemeal pasta, basmati and wild and brown rice - contain more fiber and therefore support the digestive system and keep it healthy. These foods are digested more slowly (they have a lower glycemic index) and provide a lasting feeling of satiety.

How often?

If possible, you should eat starchy foods every day:

  • Two slices of wholemeal toast with a little spreadable fat and Marmite (spicy spread made from yeast extract) or peanut butter
  • Rice, pasta (wholemeal) or risottos, salads or stir-fries
  • Potatoes in any form - except deep-fried - preferably with skin (contains valuable fiber) Low-fat side dishes and toppings such as cottage cheese or beans
  • Baked sweet potato with skin for an extra portion of fiber
  • Cooked manioc seasoned with chili and lemon
  • Chapati made from brown or wholemeal atta (Indian wheat flour)

Meat, fish, eggs, pulses, beans and nuts

These foods contain a lot of protein, which is needed to build and maintain muscles. They also contain many minerals, such as iron, which is needed for the formation of red blood cells. Oily fish, such as mackerel, salmon and sardines, also provide omega-3, which protects the heart. Beans, pulses, soy and tofu are also good sources of protein.

How often?

If possible, you should eat at least something from this list every day. Fish should be on your menu once or twice a week.

Try it:

  • Grilled, roasted or flash-fried meat, poultry or a vegetarian alternative
  • a small handful of nuts and seeds as a snack or in a green salad 
  • Beans and pulses in a casserole as a (partial) substitute for meat
  • Grilled fish with masala (Indian spice mix), fish pie or a homemade fish cake
  • Scrambled, poached or boiled eggs - the choice is yours!

Dairy products

Milk, cheese and yogurt contain calcium, which children need for growth and for strong bones and teeth. These foods also provide an extra portion of protein. However, some dairy products also contain a lot of fat, especially saturated fat. Therefore, switch to low-fat products (but make sure there is no added sugar). Low-fat milk contains more calcium than whole milk. Toddlers under the age of two should still only drink whole milk, as they urgently need the calories and vitamins. Milk with a fat content of less than one percent should be given to children from the age of five at the earliest.

How often?

Consume dairy products every day, but in moderation.

Try it:

  • Milk simply from a glass with a little cinnamon or in porridge for breakfast
  • Yogurt with fruit or in a curry dish
  • Cottage cheese with carrot sticks
  • a bowl of cereal for breakfast with low-fat milk
  • a cheese sandwich and a salad during the lunch break
  • a refreshing lassie or plain yogurt for dinner

Foods high in fat and sugar

You can enjoy foods from this category from time to time as part of a balanced diet. However, remember that sugary foods and drinks also contain a lot of calories. Sugary drinks lead to a rise in blood sugar levels. It is therefore better to opt for sugar-free light versions with few calories. Or simply drink water - it contains no calories at all! Fat contains a lot of calories. So use oils or butter sparingly when cooking. Use unsaturated oils such as sunflower oil, rapeseed oil or olive oil. These are also much better for your heart.

How often?

The rarer, the better.

Salt

Too much salt increases the risk of high blood pressure and strokes. Industrially processed foods often contain a lot of salt. Cook from scratch at home. This way you can measure the amount of salt precisely. Stock up on a wide range of different spices so that you only need to use salt sparingly.

How often?

Adults should not consume more than one teaspoon of salt (6g) per day, children much less.

Try it:

  • banish the salt shaker from the table. You should always have black pepper to hand.
  • Refine dishes with herbs and spices rather than salt. Try ginger, lime and coriander with stir-fries or use a spicy harissa paste for soups, pasta dishes and couscous.
  • a fresh, homemade chutney made from coriander leaves (dhaniya), fresh mint, chopped green chili pepper and lime juice.
  • Measure salt with a teaspoon when cooking and gradually reduce the amount. Then your family will hardly notice!
  • Season salads with lemon juice, chili powder and pepper.
  • Prepare your own tandoori marinade in seconds using red chili powder, garam masala, paprika powder, low-fat natural yogurt, garlic, ginger and tomato paste.
  • Add finely chopped coriander leaves to your lassi and sprinkle with cumin and coriander seeds.

10 foods that every diabetic should eat every day

Choosing healthy foods is essential for people with type 2 diabetes to keep their blood sugar under control. In addition, we list foods that not only keep blood sugar levels under control, but also improve overall diabetes and general health - basically in the same way that calcium improves bone health. Scientists have been able to identify some foods that appear to improve the course of the disease and potentially reduce risks.

1. blueberries

Eat this little blue fruit every day and provide yourself with plenty of nutrients as well as some of your daily carbohydrates. Research suggests that regular consumption of blueberries - as well as other berries - improves insulin sensitivity. This means that the cells respond better to the body's own insulin. Researchers suspect that the anti-inflammatory effect of phytochemicals in berries may reduce some of the risks of cardiovascular disease type 2 diabetes.

2. oranges

Oranges, grapefruits, clementines - research shows that eating citrus fruits has positive long-term effects on blood sugar and cholesterol levels thanks to the anti-inflammatory compound hesperidin and a healthy dose of soluble fiber. Additional research from the Harvard School of Public Health suggests that eating the whole fruit instead of the juice is associated with a lower risk of developing type 2 diabetes.

3. chickpeas

Chickpeas, beans and lentils are well-known foods with a low glycaemic index. They are therefore particularly suitable for diabetes. Recent research suggests that eating legumes may actually have a therapeutic effect. In a study published in the Archives of Internal Medicine in 2012, people with type 2 diabetes consumed one cup of legumes daily as part of their carbohydrate intake for three months. Compared to other study participants, those who consumed legumes daily showed a greater decrease in hemoglobin A1C levels and a decrease in blood pressure.

4. tomatoes

Whether raw or cooked, tomatoes are full of lycopene. This is a powerful substance that can reduce the risk of cancer (especially prostate cancer), heart disease and macular degeneration.

Like other non-starchy fruits, tomatoes have a low GI. One study found that 200 grams of raw tomatoes (or about 1.5 medium tomatoes) a day lowered blood pressure. The researchers concluded that eating tomatoes could counteract the risk of cardiovascular disease associated with type 2 diabetes.

5. plant-based meals

Vegetarians have a significantly lower risk of developing type 2 diabetes. It was long assumed that they also generally have a lower BMI. However, a 2012 study in the Journal of Preventive Medicine found that a high-nutrient-dense diet (HND), which essentially comprises the daily intake of fruit, vegetables, nuts and pulses while avoiding meat, has a major impact on diabetics. After a seven-month HND diet, the study participants showed a significant decrease in their HgbA1c value, blood pressure and triglyceride levels. At the same time, HDL levels increased significantly and 62 percent had blood glucose levels within the normal range.

6. olive oil

A key recommendation for each of us is to replace saturated fats and trans fats with healthier unsaturated fats. For diabetics (type 2), the type of fat plays an even greater role in health. This is because diabetes is associated with an increased risk of heart disease and strokes. In addition to weight control, an active lifestyle and monitoring blood sugar levels through food, it is important that heart-healthy fats and oils are the main fats in the diet. Consuming extra virgin olive oil is not only associated with a reduced risk of diabetes. Some research also suggests that it can improve glucose utilization by cells thanks to its anti-inflammatory effects. Use olive oil daily for cooking or in salad dressings. Incorporate nuts, seeds, avocado and cold-water fish into your diet every week.

7. green vegetables

More leafy greens and consumption of non-starchy green vegetables showed a decrease in HgbA1C levels and a significant reduction in the risk of cardiovascular disease in diabetics (type 2) aged 65 and over. Scientists are still trying to determine whether these effects are due to the nutrient density of vegetables - particularly vitamins A, C and E and magnesium, whose intake has been linked to better blood sugar control - or the substitution of these vegetables for less nutrient-dense foods. The best results were achieved when subjects consumed at least 200 g of vegetables daily, with at least 70 g coming from green vegetables.

8. nuts

Five servings of nuts per week (1 serving = 30 g of nuts or 1 tablespoon of nut butter) is associated with a significant reduction in heart disease and stroke risk in women with type 2 diabetes. This was the result of a long-term study called the Nurses Health Study. A 2011 study published in the journal Diabetes Care concluded that those with diabetes had improved blood sugar control and blood lipids who consumed two servings of nuts (60g) a day instead of carbohydrates. So consider replacing some carbohydrates from processed foods with walnuts or almonds - but watch the portion size and salt content!

9. probiotics

Over the past few years, researchers have conducted several studies to investigate the effects that "good" bacteria can have on the regulation of glucose levels, with some focusing on the intake of yogurt and others on the intake of probiotics. Initial results from all studies suggest that consuming foods high in probiotics, such as yogurt, significantly increases fasting glucose levels and/or HgbA1C when consumed regularly for more than eight weeks.

10. cinnamon

Savory-sweet spiced cinnamon appears to increase insulin sensitivity and thus helps to lower blood sugar levels. The exact mechanism is unknown, as is the daily amount that diabetics should consume. Most studies show clear evidence that cinnamon can support blood sugar control on a daily and long-term basis. So far, no side effects have been noted, other than a pinch of extra flavor in your dishes. Just add a little cinnamon to your oatmeal, yogurt or nut butter.

Diabetes and alcohol

If you have diabetes, drinking alcohol can cause your blood sugar to either rise or fall. Alcohol also contains a lot of calories.

Therefore, only drink alcohol occasionally if your diabetes is under control and your blood sugar levels are well regulated. If you follow a calorie-controlled diet plan, you must count one alcoholic drink as two fat replacements.

It is best to talk to your doctor about whether and to what extent you can drink alcohol.

Effects of alcohol on diabetes

Alcohol consumption can have these effects on diabetes:

  • Moderate alcohol consumption can raise blood sugar levels. Excess alcohol can lower blood sugar levels. This sometimes leads to extreme drops, especially in people who suffer from type 1 diabetes.
  • Beer and sweet wines contain carbohydrates that raise blood sugar levels.
  • Alcohol stimulates the appetite. You may eat too much, which has a negative effect on your blood sugar level.
  • Alcoholic drinks often contain a lot of calories. This makes it more difficult to lose weight.
  • Alcohol also impairs your judgment or willpower, causing you to make unhealthy food choices.
  • Alcohol can impair the positive effects of oral diabetes medication or insulin.
  • Alcohol can lead to an increase in triglyceride levels.
  • Alcohol can increase blood pressure.
  • Alcohol can lead to nausea, increased heart rate and bawling.

This can mask the symptoms of low blood sugar levels or be mistaken for them.

Exercise and sport for diabetes

Another crucial element in a treatment program for diabetes is exercise. Whatever form you suffer from, talk to your doctor before starting an exercise program.

Most diabetics are recommended to begin at least 150 minutes per week of moderate aerobic physical activity, such as walking. Strength training is recommended at least two days per week. Talk to your doctor about which exercise program is best for you.

Why should I exercise if I have diabetes?

Physical activity is an important part of successfully controlling your blood sugar levels and staying healthy. Physical activity has many health benefits.

Exercise can reduce the likelihood of a heart attack or stroke, improve blood circulation and lower blood pressure. The body's own use of insulin is improved and blood sugar levels are lowered. It also promotes stress reduction. Exercise can help people with type 2 diabetes to lower their blood sugar levels, lose weight and prevent the development of diseases in at-risk groups.

If you are overweight, combining physical activity with a calorie-restricted eating plan can lead to even more benefits. In the Look AHEAD: An Action for Health in Diabetes study of overweight adults with type 2 diabetes confirmed that the subjects who ate less and exercised more showed greater long-term health benefits compared to those who did not make these lifestyle changes. The positive health effects included improved cholesterol levels, reduced sleep apnea and the ability to exercise better.

Even short periods of physical activity have a positive effect. Experts recommend at least 30 minutes of moderate or vigorous physical activity five days a week. Moderate exercise will make you sweat a little, vigorous intensity will make you sweat a lot. If you want to lose or maintain your weight, you need to do at least 60 minutes of physical activity five days a week.

Be patient. You may only notice the positive effects of this physical activity after a few weeks.

How can I exercise safely if I have diabetes?

Drink enough water before, during and after exercise to stay well hydrated. Here are some tips on how to exercise safely despite diabetes:

Plan ahead

Talk to your doctor before you start a new exercise plan, especially if you have any pre-existing medical conditions. Your doctor or nutritionist will tell you exactly what blood sugar levels you should maintain and how you can exercise without risk.

You will also receive advice on when you should exercise. This depends on your daily schedule, your diet plan and the type and dosage of your medication. If you are taking insulin, you must plan your training sessions according to your insulin dose and your meals so that your blood glucose level does not drop too low.

Avoid low blood sugar levels

Physical activity lowers blood sugar levels. Protect yourself from low blood sugar levels, also known as hypoglycemia. The risk of this is greater if you are taking insulin or certain other diabetes medications, such as sulfonylurea. Hypoglycemia can also occur after a long, intensive training session or if you have skipped a meal before exercising. It occurs within 24 hours after the training session.

However, this can be avoided with good planning. For example, if you are taking insulin, your doctor or nutritionist may advise you to take less insulin or eat a carbohydrate-rich snack immediately, during or after your workout, especially during strenuous workouts.

You may need to measure your blood glucose levels before, during and after your training session.

Be careful if your blood sugar level rises too high

Diabetics (type 1) should avoid intensive workouts if ketone bodies have been detected in their urine or blood. This is a chemical substance that the body produces when blood sugar levels are too high and insulin levels are too low. If you exercise intensively in such a situation, your blood sugar level will rise even further. Ask your doctor at what ketone levels a workout could become dangerous and how you can test yourself. Ketone bodies rarely occur in type 2 diabetics.

Take care of your feet

Diabetics often have discomfort in their feet. This is due to the poorer blood circulation and nerve damage caused by high blood sugar levels. You should therefore wear comfortable, supportive shoes and take care of your feet before, during and after your workout.

What physical activities can I do as a diabetic?

As a diabetic, you can perform most types without any problems and thus keep your diabetes under control. For some patients, however, some types pose a risk that can lead to visual damage or nerve damage in the feet. Ask your doctor which activities are safe for you. Most people go running with friends or family members.

However, you will benefit most from a varied training program. This will also help you avoid boredom and reduce your risk of injury. Try the following suggestions:

Incorporate more exercise into your everyday life

If you have hardly ever exercised before or want to start a new program, start with five to ten minutes a day. Increase the duration slowly. Move a little more every day by spending less time in front of the TV or other devices.

With these simple tips, you can bring more movement into your everyday life:

  • Walk around the room while talking on the phone or watching commercials on TV.
  • Do some housework and gardening: Rake the leaves, clean the house or wash your car.
  • Park at the far end of the supermarket and walk the rest of the way.
  • Take the stairs and not the elevator.
  • Plan family time outside together. Go for a walk or a bike ride together.

If you sit at your desk or in front of the TV for long periods of time, take a short break every half hour and move around for three minutes. 

For example with:

  • Lift and stretch your legs.
  • Stretch your arms.
  • Turn around your chair.
  • Move your upper body.
  • Do a few lunges.
  • Run on the spot.

Aerobic training

Aerobic training increases your heart rate. You will notice that you need to breathe faster. You should do 30 minutes of aerobic exercise most days of the week. However, you don't have to do it in one go. Simply spread these 30 minutes throughout the day.

You will achieve the greatest benefits if you do moderate to intensive aerobic training.

Try it:

  • fast running or hiking
  • Climbing stairs
  • swimming or water aerobics
  • Dancing
  • Cycling (also exercise bike)
  • a course at the gym
  • Basketball, tennis or other sports

Talk to your doctor about how to warm up before training and which exercises you should do at the end of your workout.

Strength training to build muscle

Strength training is light to moderate physical activity that builds muscle and keeps bones healthy. Strength training is important for both men and women. The more muscle and the less body fat you have, the more calories you burn. Only by burning calories can you lose weight or maintain your weight.

You can do strength training with dumbbells, elastic bands or on machines. If possible, you should do strength training two to three times a week. Start slowly. Gradually increase the weights used.

You can do strength training with dumbbells, elastic bands or on equipment.

Stretching exercises

Stretching exercises involve light to moderate physical exercise. They increase your flexibility, reduce stress and prevent sore muscles.

Choose from a variety of different stretching exercises. Yoga is also one of them. Here you concentrate on your breathing. You can relax better. Yoga can even help with restricted movement or balance problems. Attend a seated yoga class. You do the exercises sitting down or while holding on to a chair. Your diabetes advisor will also be happy to help you with this.

Other topics relating to diabetes

What do urine tests reveal about diabetes?

About a third of all diabetics have problems with their kidneys. Timely and close monitoring of your blood glucose levels and blood pressure together with some medication can ensure that your kidneys work as they should.

To check this, your doctor can arrange for an examination to determine the protein content in your urine (microalbuminuria). This occurs when small amounts of albumin (the main protein in your blood) leach into your urine. Without treatment to slow down the process, the kidneys can become damaged and eventually fail.

You should have this test carried out annually as soon as you find out about your diabetes diagnosis (type 2). Your blood glucose level was probably already elevated several years before your diagnosis. Therefore, there is no time to lose now.

Type 1 diabetics are usually tested five years after diagnosis at the earliest.

What does a positive result mean?

A positive test means that your kidneys are no longer working as they should. You also suffer from a blood vessel disease that can damage your heart.

In addition to medication, your doctor will suggest lifestyle changes to avoid the following problems:

  • Kidney damage: You may need to take medication to prevent further damage. If your microalbumin level is high, your doctor will carry out a further test for which you will need to collect urine samples for a whole day. This will make it easier to determine the extent to which organs have already been damaged and how well they are still working overall.
  • High blood glucose levels: Studies show that close monitoring of blood glucose levels can limit damage to the kidneys. Your doctor may adjust your treatment plan accordingly.
  • Blood pressure: Lower blood pressure reduces the risk of kidney damage associated with diabetes. Have your blood pressure checked at every doctor's visit. Diabetics should generally have a blood pressure of no more than 130/80.
  • Cholesterol: Your microalbuminuria test suggests an increased risk of heart disease. Your doctor will therefore also take a closer look at your cholesterol levels and other fats and try to optimize them.

Tests for high blood sugar levels

Your doctor may ask you to be tested for ketones. Your body produces these when it does not have enough insulin available and attacks fat stores to generate energy for body cells. In large quantities, ketones have a toxic effect. This leads to the development of life-threatening ketoacidosis.

How can I test myself?

Your doctor can determine the percentage of ketones. However, self-tests are also available. All you have to do is dip a test strip into your urine. Compare the color of the test strip with the enclosed table and determine your result.

When should I test myself?

If you have type 1 diabetes, you should get tested if you

  • feel ill (cold, flu or other illnesses) and suffer from nausea and vomiting.
  • you are pregnant.
  • Your blood sugar level exceeds 300 mg/dl.
  • you have symptoms of high blood sugar levels, for example severe thirst or tiredness, you feel foggy or your breath smells fruity.
  • your doctor asks you to do so.

If you have type 2 diabetes, you will probably not have too many ketones, even if you take insulin. However, in the course of a serious illness this can happen. Your doctor will advise you to have a urine test if you:

  • feel ill (cold, flu or other illnesses) or suffer from unexplained nausea and vomiting.
  • Your blood sugar level exceeds 300 mg/dl and continues to rise throughout the day.

When should I call a doctor?

A ketone test should always be negative. Call your doctor immediately if you get a positive test result. This also applies to persistently high blood sugar levels, stomach pain, nausea, vomiting, rapid breathing, sweet-smelling breath or an increased urge to urinate.

Your doctor may ask you to do this:

  • drink plenty of water to reduce the amount of ketones and keep the body hydrated.
  • continue to check your blood glucose level. If it remains high, you may need to administer fast-acting insulin.
  • Go to the nearest emergency room to get an infusion and insulin.

How do I record my test results?

Keep accurate records of the results of all the tests you carry out. This will give you an accurate overview and problems will become more apparent. Always take your records with you to doctor's appointments.

6 tips on how to lower your A1C level

As mentioned above, you should monitor your A1C levels closely. (see hemoglobin A1C test)

You can lower your A1C level with just a few small changes to your exercise program, diet, medications and overall lifestyle. If you already have diabetes, you should know your optimal level. For example, people at increased risk for hypoglycemia need to make sure their A1C level does not fall below seven percent.

1. create a plan.

Keep a detailed record of your goals and challenges. This plan provides answers to important questions and helps you to identify the biggest challenges for you, such as weight loss, exercise, dealing with stress or healthy eating. In this way, you can set yourself small goals that you can achieve in small steps within a reasonable period of time.

2. create a diabetes management plan

Create a diabetes management plan together with your doctor. In addition to emergency contacts, this should also include medical instructions, a list of medications, the blood glucose target value and the manner and frequency with which tests must be carried out. Everyone involved should always have the same level of information. This is the best way to lower the A1C level.

3. make a note of what you eat.

Use an online tool or a simple table and write down what you eat and when. This will make you aware of what you are eating and you can correct your eating behavior accordingly. This way, you always know exactly what carbohydrates you are consuming. This is particularly important if you want to keep your blood sugar levels under control.

4. eat a healthier diet.

Consume fewer calories than you burn. Eat less saturated fat and less industrially processed food. Take advice from the book "Food Rules" by Michael Pollan: "If it comes from a plant, eat it. If it comes from a factory, avoid it."

You don't need to give up "healthy" carbohydrates to lower your A1C. It's more about keeping a close eye on how many carbohydrates you consume during a meal. Healthier, nutrient-rich carbohydrates such as fruit or sweet potatoes are better. But the same applies here: always keep an eye on the amount per meal. For most diabetics, the following applies: 45 to 60 grams of carbohydrates for a main meal and 15 to 30 grams for a snack. For a watermelon, this means: 11 g of carbohydrates per portion (one coffee cup of diced watermelon).

Scientists have confirmed that a diet based on plant foods with lots of unsaturated fats is better for blood sugar levels and heart health.

5. set yourself a target for how much weight you want to lose.

It is important that you lose weight. On the other hand, you cannot control your diabetes with a poor diet. The key lies in a fundamental change in diet. A healthy, balanced, whole-food, low-fat, low-calorie eating plan that you can incorporate into your daily routine will help you make these changes in your life. Keep a fat and calorie calculator handy so you can make sensible choices. Even a weight loss of just five or ten percent reduces the likelihood of developing diabetes by 58 percent. Small amounts make a big difference.

6. move around.

Increase your activity level; your A1C level will thank you. Start with a 20-minute walk after lunch. Increase up to 150 minutes of extra exercise each week. Before you start, discuss your plan with your doctor. The University of Pittsburgh maintains a diabetes prevention program. Active living is the key. Remember, something is better than nothing. Even two minutes of exercise every hour could lower the risk of diabetes!

Mastering sick days

Diabetics often suffer from more than just a runny nose and constant sneezing when they are ill. A cold, the flu or any illness that is accompanied by diarrhea and vomiting can also affect blood sugar levels. The same applies to infections.

You must therefore always keep an eye on your blood sugar level.

Here are some recommendations:

  • Check your blood sugar level every four hours.
  • Test your ketone levels if you have type 1 diabetes and your blood glucose level is more than 240 mg/dl, or if your doctor advises you to do so. Ketones are a type of waste product that diabetics (type 1) produce when they are under stress (as in an illness). Call your doctor immediately if there are ketones in your urine. Depending on how sick you are, they may recommend that you go to the emergency room.
  • Measure your body temperature regularly.
  • Drink plenty of fluids, especially if you are not eating solid food. Drink at least one cup every hour to avoid dehydration. If you are also unable to keep fluids down, you will need to go to the emergency room or hospital.
  • Continue to take your insulin even if you cannot keep solid food down. You may need to eat or drink something containing sugar so that your blood sugar level does not drop too much.
  • If you have type 2 diabetes, you may need to stop taking oral medication for the duration of your condition. Talk to your doctor if you are unsure.
  • If you need over-the-counter medication for a cough or cold, ask for sugar-free preparations.

What should I eat?

Eat 30 to 50 grams of carbohydrates every three to four hours. This will provide your body with nutrients and prevent it from continuing to produce ketones. In addition, your blood sugar level will not drop too much.

If you have difficulty eating, try the following foods. Each product corresponds to one bread unit.

  • 1 cup of clear soup or broth
  • 1/2 cup normal gelatine
  • 1/2 cup lemonade, e.g. 7-Up or Sprite
  • 1/2 water ice
  • 1/2 cup unsweetened apple sauce
  • 1/3 cup apple juice
  • 1/2 cup sports drink, e.g. Gatorade

Drink calorie-free drinks such as water and 1/2 cup of broth or bouillon.

When should I call a doctor?

Call a doctor if:

  • Your blood glucose level is higher than 180 mg/dl or lower than 70 mg/dl.
  • you cannot keep liquids or solid food down.
  • Your temperature is more than 38.5 °C.
  • you suffer from vomiting or diarrhea.

 

How stress affects diabetes

In diabetics, stress can affect blood sugar levels in two ways:

  • Stressed people don't take particularly good care of themselves. They drink more alcohol and exercise less. They forget to check their blood sugar levels or don't have time to plan balanced meals.
  • Stress hormones also have a direct effect on blood sugar levels.

Scientists investigated the effects of stress on glucose levels in animals and humans. Diabetic mice that suffered from physical or mental stress showed increased glucose levels. In people with type 1 diabetes, the effects are different. For most, mental stress leads to an increase in blood glucose levels. For some, however, it can also decrease. In people with type 2 diabetes, mental stress often leads to an increase. Physical stress, such as illness or injury, causes blood sugar levels to rise in both types of diabetics.

You can easily determine the effects of mental stress on your blood sugar levels. Before you test your values, write down your stress level on a scale from 1 to 10. Next to it, write down your blood sugar level. Continue to do this for a week or two and see if you can recognize a pattern. If you draw a curve, the effects are usually easier to see. Is a high stress level associated with a high blood sugar level and a low stress level with a low blood sugar level? If so, stress has an effect on your blood sugar control.

Make changes and reduce mental stress

You can avoid some of the stress in your life. If you are always annoyed in traffic jams, see if you can take an alternative route or leave earlier to avoid the traffic jam. If your job is driving you crazy, ask if you could be transferred or work out suggestions for improvement with your manager. Or look for a new job. If you have fallen out with a friend or family member, take the first step to sort things out. With these kinds of problems, stress is often a warning signal that we need to make changes.

  • However, you can also reduce stress in other ways:
  • Do sport or become a member of a sports team.
  • Learn to dance.
  • Find a new hobby or learn a new skill.
  • Volunteer at a hospital or charitable organization.

Coping style

Your coping style also plays a role in how well you can deal with stress. Coping style refers to how well someone can deal with stress. Some people always pursue a problem-solving strategy. They ask themselves: "What can I do to solve this problem?" They try to change their situation to reduce the stress.

Others convince themselves that the problem is okay. They say to themselves: "The problem isn't actually that bad."

These two coping styles are very helpful. People who use these methods tend to have less of a spike in blood sugar in response to mental stress.

Learn to relax

For some people with diabetes, controlling stress through relaxation therapy seems to be helpful, although it is more likely to help people with type 2 diabetes than people with type 1 diabetes. This difference makes sense. Stress blocks the release of insulin in people with type 2 diabetes, so stress reduction may be more helpful for these people. People with type 1 diabetes do not produce insulin, so less stress may not have these effects either. Some people with type 2 diabetes also appear to be more sensitive to stress hormones. Relaxation can help by reducing this sensitivity.

A variety of relaxation methods are available to you:

  • Breathing exercises

Sit or lie down and let your arms and legs relax. Breathe in deeply. Now expel as much air as possible. Breathe in and out and this time consciously relax your muscles as you breathe out. Continue to breathe and relax for another five to 20 minutes. Do these breathing exercises at least once a day.

  • Progressive relaxation therapy

You can learn this method in a practice or using an audio recording. You tense individual muscle groups and then relax them.

  • Sport

Make sure you relax by moving. Reduce stress in three ways: circular movements, stretching or shaking individual parts of your body. It's even more fun if you listen to music.

  • Replace bad thoughts with good ones.

Every time you have a bad thought, consciously think of something positive that makes you happy or proud. Memorize a poem, a prayer or a quote and use it to replace bad thoughts.

Whichever method you choose, practise it. Just as it takes time to learn a new sport, it takes time to learn relaxation.

Dealing with stress due to diabetes

Some stress will never leave you, no matter what you do. This includes your diabetes. However, there are some ways you can reduce this stress. Support groups can help you. Getting to know other people who are in a similar situation will make you feel less alone. You can also learn from the experiences of others. You can also reduce diabetes-related stress by making friends with other group members.

It also helps if you deal directly with the aspects of your illness that you find most stressful. Maybe it's the medication you're taking or the fact that you have to check your blood sugar levels regularly. Maybe it's the extra exercise or your diet plan?

If you need help with any of these issues, contact your diabetes counselor. Sometimes stress can make you feel overwhelmed. In this case, psychotherapy or counseling may be helpful. Talking to your therapist will make you aware of how you can get a grip on your problems. You will learn new techniques and find out how you can change your behavior.

Pregnancy and diabetes

Family planning is a little more difficult if you are a mother-to-be with diabetes. Just follow these simple steps to make sure your pregnancy is safe and your baby is born healthy.

Go to the doctor.

First, you should make an appointment with your doctor, which should be about three to six months before your planned pregnancy. At this visit, your doctor will:

  • Perform an A1C test to determine if your blood sugar levels are well controlled so you can stop birth control.
  • Check your blood and urine for signs of diabetes-related kidney disease.
  • look for other damage to organs, nerves, the heart, etc. associated with diabetes.
  • Check your blood pressure.
  • Exclude thyroid disease (for type 1 diabetes).
  • determine the cholesterol and triglyceride levels (blood lipids).
  • recommend a check-up with an ophthalmologist to rule out glaucoma, cataracts and retinopathy.
  • recommend pregnancy counseling.

What happens during this pregnancy consultation?

Pregnancy counseling before the actual pregnancy is very important for diabetics. You will be educated and prepared both physically and emotionally for a healthy pregnancy. The following will be discussed during the consultation:

Your weight: Try to reach your ideal weight before pregnancy. Lose extra pounds to prevent diabetes-related pregnancy complications. If you are underweight, you should gain a few pounds, otherwise your baby could also be born underweight.

Your lifestyle: Stop smoking and drinking alcohol. Smoking before and during pregnancy harms both you and your baby before, during and after birth. Smoking releases nicotine (the addictive substance in cigarettes), carbon monoxide and other toxins into your bloodstream and directly to your baby. These toxins

  • reduce the oxygen content in both your and your baby's bloodstream.
  • increase your baby's heart rate.
  • increase the probability of a miscarriage or stillbirth.
  • increase the likelihood of a premature birth or an underweight baby.
  • increase the risk of your child developing lung or breathing problems later on.

Alcohol during pregnancy can lead to various birth defects, including mental retardation and certain physical disabilities. There is no specific amount of alcohol that pregnant women can safely consume and no specific time when it is safe to do so.

Prenatal vitamins: You should take daily vitamins and folic acid at least one month before your planned pregnancy. Studies show that this can reduce the risk of having a baby with a neural tube defect such as spina bifida, a serious condition in which the brain and spinal cord do not develop normally. The Center for Disease Control and Prevention (CDC) recommends 400 micrograms of folic acid daily before conception and during pregnancy. Over-the-counter vitamins for pregnant women are available at most drugstores and pharmacies.

Your blood glucose level: The doctor will check whether your blood glucose level is well adjusted. This is very important, especially because a pregnancy can only be detected two to four weeks after conception. A high blood glucose level within the first 13 weeks can lead to birth defects and miscarriages and increases the risk of secondary diseases associated with your diabetes. 

Your medication: During pregnancy, especially during the last three months, you will need more insulin. Your doctor will explain to you how to adjust your dose. If you are currently taking tablets, your doctor will switch you to insulin, as some of these medications are harmful to the baby. The same applies to some antihypertensives. CONCLUSION: Discuss all medications with your doctor.

Planning your meals: During pregnancy, you need to make some changes to avoid fluctuations in blood sugar levels. You also need to increase your calorie intake. After all, the baby also needs to be fed.

Foot care tips for diabetes

As a diabetic, you probably check your blood glucose level several times a day. You want to make sure that it is within the normal range. You should also check your feet once a day.

Why? Diabetes can impair blood circulation in the feet. Small cuts or wounds no longer heal as well.

Insufficiently regulated blood sugar levels can also lead to numbness in the feet. You may not even notice minor injuries. Diabetes leads to dry skin on the feet and cracked heels.

There is a high risk of infection. Bacteria or fungi penetrate small cracks or cuts.

If you suspect that you have become infected, call your doctor immediately. Early treatment can prevent the infection from spreading. This will also prevent more serious problems. Some diabetics with severe infections may even have to undergo surgery to remove part or all of their foot.

You should therefore examine your feet daily. Keep the skin clean and ensure optimal moisturization. Avoid injuries and protect your feet from cuts, corns, calluses, blisters and injuries.

Checking your feet every day - a checklist

  • Set a time to check your feet every day.
  • Make sure you have good lighting so that you don't miss anything.
  • If you are unable to bend forward this far, you should get someone to help you.
  • Examine your feet, toes and heels for cuts, sores, pressure points, calluses, blisters, scratches and changes in skin color.
  • Check for cuts or fungal infections between the toes, which can lead to athlete's foot.
  • Also look at your toenails and pay attention to changes.
  • Look out for dry, cracked skin on the feet, toes and heels.

Pedicure tips

Wear thick, soft socks that protect your feet when walking. Avoid socks with seams that rub against the skin and can cause blisters.

Wear comfortable, well-fitting shoes. Shoes that are too tight or too loose can cause blisters.

Do not walk barefoot. You don't want to risk cuts from stones, broken glass, etc. Wear slippers indoors.

Make sure that the inside of your shoes and socks are clean and free of all pebbles etc. so that you do not injure yourself.

Keep your feet clean. Do not soak them in water for too long. This can dry out the skin.

Dry your feet well after showering or bathing. Also dry the spaces between your toes.

Apply cream to your feet after bathing and drying off. Massage a lotion or Vaseline well into the skin and heels to prevent them from drying out or cracking. You should not apply lotion to the toes. This can lead to infections.

In winter, cold weather and dry heating air can dry out the skin. Take extra good care of your feet and keep them warm. Also wear socks at night if you are cold.

Toenails and pedicure

Make sure that toenails do not grow into the skin.

File your toenails. You can also go for regular pedicures. However, take your own pedicure tools with you.

Do not use sharp objects to remove dirt from under the toenails. You could accidentally injure yourself, which could lead to an infection. Use a pumice stone to smooth your heels after showering or bathing. Do not rub too hard.

Supports the prevention of infections

Exercise regularly to maintain healthy blood circulation.

Watch your blood sugar levels and eat as recommended by your doctor. Good blood sugar control and maintaining your weight can prevent foot problems.

Do not smoke. Smoking constricts the blood vessels and increases the risk of foot problems.

Pay attention to even the smallest cracks, scratches, blisters, corns and calluses. Let your doctor or podiatrist know if you need medical treatment.

When you should inform your doctor

Look out for redness, swelling and water retention, which could indicate an infection. If you think it could be an infection, seek medical treatment.

Look out for sores or ulcers on the feet. These usually develop on the ball of the foot or on the underside of the toes. If you suspect ulcers on your feet, consult your doctor.

Nails that appear thicker, yellow, change shape, striped or do not grow normally could be a sign of injury or infection.

If your foot, ankle or toe is swollen, looks red, feels hot or has changed shape or size, or hurts with normal movement, it may be a sprain or fracture. Seek medical treatment immediately. Nerve damage, called diabetic neuropathy, can significantly increase the risk of a serious condition called Charcot foot. This causes a change in the shape of the foot.

Call your doctor if you have minor foot problems such as bunions, hammertoes, plantar warts or athlete's foot, a fungal infection. Treat these problems before they spread.

If you discover a wart, corn or callus on your foot, do not try to treat it yourself with over-the-counter pads or liquids. Do not cut them out of your skin either. Ask your doctor or podiatrist to remove them safely.

 

Diabetic pain and cramps in the legs: tips for treatment

Understanding complications related to diabetes

Diabetes can lead to various problems. Pain and cramps in the legs occur as a result of nerve damage. This is known as diabetic neuropathy. When diabetes damages nerves in the arms or legs, it is called diabetic peripheral neuropathy. This condition can be the direct result of high blood sugar levels over a long period of time (hyperglycemia).

Pain, burning, tingling and numbness are among the most common symptoms. Peripheral neuropathy can also cause serious damage to the feet or legs. Early diagnosis of nerve damage is extremely important to avoid early symptoms. In this way, amputations can be avoided.

There are several options available to you to relieve pain and cramps in the legs due to diabetic neuropathy. This is important to avoid further complications and improve your overall quality of life.

Treating the pain with medication

Diabetic neuropathy occurs mainly in the legs and feet. Without treatment, it can lead to paralysis. The best way to reduce your risk of any complications, including diabetic neuropathy, is to keep your blood glucose levels within the prescribed range.

You also need to monitor your blood sugar levels if you already have neuropathy. But that is by no means all.

It is equally important to treat the pain with medication. Moderate pain can be relieved with over-the-counter pain relievers such as acetaminophen and ibuprofen. The U.S. Food and Drug Administration (FDA) recently approved two medications for the treatment of diabetic peripheral neuropathy:

  • Duloxetine (Cymbalta)
  • Pregabalin (Lyrica)

Opiates or topical ointments or sprays can also help.

What dietary supplements can do for you

Certain supplements can also help relieve pain, including damage to the legs. Some nutrients may play a role in repairing nerve tissue and may even protect against future damage. Scientists are currently investigating the following supplements as a treatment for diabetic neuropathy.

  • Alpha-linolenic acid (ALA)
  • Acetyl-L-carnitine
  • Vitamin B12
  • Vitamin D

ALA is an antioxidant that has recently attracted a lot of attention as a home remedy for diabetes. ALA is found in broccoli and carrots, for example, and is also available as a dietary supplement. Diabetics take ALA to relieve pain and possibly prevent further nerve damage. Some, but not all, studies support the use of ALA.

Acetyl-L-carnitine imitates chemical substances found in the human body. It is believed that the substance supports the formation of healthy nerve cells. However, side effects such as vomiting sometimes occur. It also interacts with blood thinners. However, one study came to the conclusion that acetyl-L-carnitine can alleviate pain caused by diabetic peripheral neuropathy.

Vitamin B12 is found in meat and fish and supports the formation of red blood cells. B12 presumably also contributes to healthy nerve function and prevents damage. Metformin is a common medication used to treat type 2 diabetes, but metformin lowers B12 levels. Talk to your doctor and make sure you do not develop a deficiency. B12 deficiency can cause neurological damage that can be mistaken for diabetic neuropathy. Vitamin D can also support healthy nerve function and relieve swelling that can cause pain.

Diabetics need to eat a healthy diet. This will help you stay healthy and relieve leg pain. Food supplements cannot cure leg pain. Their effectiveness and safe use is still being investigated. In addition, not all diabetics need dietary supplements as they get all the nutrients they need from food.

It is therefore essential that you speak to your doctor before taking any supplements to treat diabetic leg pain - especially if you are taking other medication.

Home remedy

Diabetic pain and cramps in the legs may require more than medication or supplements. These methods can relieve inflammation and pain, but take time to work. In addition, taking certain medications, such as opiates, for an extended period of time is associated with side effects.

As part of physiotherapy, you will learn an exercise program that you can use to relieve pain in your legs. Other treatment options include electrical nerve stimulation and light therapy. Both methods may be used as part of physiotherapy. Some studies have investigated the effect of acupuncture as a possible treatment method.

You can also do the following to relieve the pain in your legs:

  • Go for regular walks. Short walks are sufficient.
  • Exercise on an exercise bike to improve blood circulation.
  • Soak your legs in warm water.
  • Use a frame that holds the comforter up so that your feet are comfortable.

Observe pain in the legs

Always tell your doctor if you have pain in your legs, even if the symptoms do not affect you. Frequent cramps or sharp pains can be a sign of worsening diabetic neuropathy. Therefore, be sure to report frequent symptoms to your doctor.

Even mild pain and cramps in the legs should be discussed with your doctor. If you do not suffer from neuropathy, these symptoms may be signs of peripheral arterial disease (PAD).

Diabetes significantly increases the risk of PAD. This serious disease is characterized by clogged blood vessels in the legs. PAD increases your risk of heart attack and stroke. The National Heart, Lung and Blood Institute estimates that one in three adults with diabetes over the age of 50 has PAD. However, most people are unaware of their condition because the symptoms tend to be subtle.

In general, you should inform your doctor if anything seems wrong - it could potentially save your life.

Diabetes and skin care

Diabetes can lead to dry skin. The risk of injury increases, you are more likely to suffer from infections and the healing process takes longer. Follow these skin care tips to keep your skin healthy.

Protect yourself from the elements

Protect your ears and face, including your nose, from the cold and wind. Wear a hat. Wear warm gloves and shoes or boots.

Pay attention to the following:

  • Use lip balm to prevent chapped lips.
  • Avoid dry skin, especially when temperatures drop. Use a humidifier to avoid dry heated air indoors.
  • Bathe or shower with warm (not hot) water and use a mild moisturizing soap.
  • Do not bathe or shower for too long.
  • Pat your skin dry - do not rub.
  • Apply a mild lotion after washing and drying off.
  • Do not scratch if you suffer from dry skin. Apply moisturizer instead.
  • Always keep a bottle of lotion within easy reach and apply lotion to your hands after washing.
  • Limit yourself to a few skin care products so as not to cause any undesirable skin reactions.
  • If you are prone to acne, talk to your dermatologist before choosing a face lotion. Some cause acne or make it worse.
  • Look for the words "non-comedogenic" or "non-acnegenic".

Put together a first aid kit for your skin

Always have a first aid kit for your hands and feet to hand. It should contain:

  • Antibacterial ointment
  • Gauze bandage
  • Hypoallergenic plaster
  • Moist cleaning cloths (if soap and water are not available)

The treatment of blisters

  • Do not open any blisters. The skin protects the area from infection.
  • Wash the area carefully with mild soap and water.
  • Apply antibacterial ointment to the bladder.
  • Cover it with a cotton cloth or gauze bandage. Secure the gauze bandage with a hypoallergenic plaster.
  • Change the dressing at least once a day.
  • If you have blisters on your feet due to uncomfortable shoes, you should wear another pair until the blister has healed.

Treating minor cuts

  • Wash the area carefully with mild soap and water.
  • Apply antibacterial ointment.
  • Cover the wound with a cotton cloth or gauze bandage. Secure the gauze bandage with a hypoallergenic plaster.
  • Change the dressing at least once a day.

Treat minor skin injuries such as scratches

  • Gently wash the area with mild soap and water and pat dry.
  • Cover the area with a cotton cloth or gauze bandage. Secure the gauze bandage with a hypoallergenic plaster.
  • Check frequently so that the area does not deteriorate.
  • Change the dressing at least once a day.

Treating minor burns

  • Cool the wound under cold running water.
  • Do not open any bubbles.
  • Gently wash the area with mild soap and water and pat dry.
  • Cover the wound with a cotton cloth or gauze bandage. Secure the gauze bandage with a hypoallergenic plaster.
  • Change the dressing at least once a day.

Treating chilblains

  • Call an ambulance immediately.
  • Hold the area under warm (not hot) water (approx. 36 to 40°C).
  • Do not rub the area under any circumstances and do not apply any cream.
  • Do not step on the foot or use the affected hand.

When you should call your doctor or podiatrist

As a diabetic, your feet need special attention. In addition to daily foot care, you should inform your doctor or podiatrist if:

  • Small injuries do not improve the next day after treatment.
  • pain or discomfort persists for more than two days.
  • you have a fever.
  • You notice pus in or around the wound.

 

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