Running out of diabetes

People with diabetes are treated extensively in the clinic for endocrinology, diabetology and geriatrics with the special expertise of Professor Ralf Lobmann.

Too much sugar in food

2Six million people are affected by diabetes alone in Germany. Too late or inadequately treated, chronic metabolic disease leads to serious sequelae. In the future, all patients with diabetes will be advised by the Diabetes team at the Klinikum Stuttgart.

“Great Britain wants to introduce taxes on sugary beverages,” a mid-March announcement came, which made it into the TV news and in all the newspapers. The idea is not new. In many countries such a tax is now being discussed. “Together with our lifestyle, the household sugar in our food is the main problem and cause for overweight and diabetes,” says Professor Dr. Ralf Lobmann, Medical Director of the Clinic for Endocrinology, Diabetology and Geriatrics at the hospital in Bad Cannstatt. A problem with growing importance: According to the Robert Koch Institute, the number of people affected by diabetes rose by 38 percent between 1998 and 2012. Each year 270,000 new cases are added.

By 2030 a rise to eight million patients is expected. One important reason is that we take much more sugar, which is hidden in many foods and just in the sweet soft drinks, to us as the body needs. Whether the problem can be solved with a tax, Professor Lobmann is not quite convinced. It is much more important to be easier and to identify in which food is too much sugar. “The traffic light on the packaging is certainly better than nothing at all. If I already have three products with a red traffic light in the shopping basket, I might prefer the two next ones with a yellow or green traffic light, which stands for low sugar content. ”


Diabetes advice for every patient

csm_zucker_grafik__98d56913b7How urgent the problem is, the diabetologist experiences daily in the clinic. “About 30 to 40 percent of hospital patients have diabetes mellitus as their primary or secondary diagnosis,” Professor Lobmann reports. “This must be taken into account in the vast majority of procedures and treatments.” The diabetologist has therefore set the goal of prescribing and advising a doctor or diabetes consultant in the diabetic console in all diabetic patients.

“This works very well at the Bad Cannstatt hospital, and we are on the right track in the other hospitals in Stuttgart,” says Professor Lobmann. “Diabetes patients who, for example, undergo a planned intervention in orthopedics expect good work from their surgeon. However, they also assume that their diabetes, which often determines their daily life, is taken into account. “However, some patients do not even know they have diabetes. The diabetology team is now automatically notified when the laboratory has detected a blood glucose value of more than 200 in a patient. “We can identify a newly diagnosed or poorly adjusted diabetes so quickly.” This is also important, for example, for patients in the dermatology clinic who are often treated with cortisone at high doses. A diabetes can then quickly derail if the blood sugar is not adjusted accordingly.

About 95 percent of diabetic patients suffer from the so-called type 2 diabetes. In those affected, the body cells react more insensibly and finally resistant to the body-borne sugar transport agent insulin. The hormone produced in the pancreas is virtually the door opener for the sugar that the cells use as an energy source. Because the body cells become insensitive to insulin even with increasing age, they were also referred to as age sugar. In the meantime, however, more and more people in middle age and even adolescents are becoming ill with type 2 diabetes. The overweight also favors the development, as adipose tissue – especially the abdominal fat – empties messengers that promote insulin resistance. For the muscle cells, lack of movement has the same effect. Increased blood fats, hypertension and a genetic predisposition are further diabetes risk factors. The body reacts first with an increased insulin production and can thus keep the sugar in the blood still a while in the normal range. Finally, the insulin-producing cells are exhausted, the sugar can no longer enter the cells and the blood glucose level rises threateningly.

Especially if the diabetes is recognized late or the blood glucose is insufficiently adjusted, the health consequences for the patients can be serious. The risk of stroke and myocardial infarction and the risk of renal insufficiency increase significantly. As the vascular system is attacked, it may lead to retinal diseases leading to blindness or diabetic foot syndrome with the risk of amputation.

With the treatment of the diabetic foot syndrome Professor Lobmann and his team have particularly extensive experiences. The chief physician is not only a member of the board of the German Diabetes Association since May 2016, but also a spokesperson for the work group, which deals specifically with this serious diabetes disease, and chairman of the Diabetic Foot Study Group of the European Association for the Study of Diabetes (EASD). The clinic is also certified as one of two centers in Stuttgart for the treatment of the diabetic foot. Diarrhea caused by diabetes due to diarrhea will result in reduced blood circulation, especially of the feet. The affected tissue dies, dark necrotic sites develop. An amputation is unavoidable in some cases. “The amputation risk for patients with a diabetic foot is between ten and 20 percent in Germany,” says Professor Lobmann. “In centers like ours, the risk is only 3.1 per cent.” He therefore calls for a second opinion before a planned amputation, and to examine the possibilities of an effective treatment.


Special treatment of foot syndrome

210x140px_lobmannIn addition, Professor Lobmann and the orthopedic surgeon in the hospital in Bad Cannstatt will also focus on a special form of the diabetic foot syndrome: the so-called Charcot foot or neuroostheoarthropathy. Affected are often men between 45 and 50 years, in which the bones “crumble” inside and finally break. “If a wrong diagnosis is made here and the patient orders movement, for example, this can have fatal consequences.”

So far, there is only one large treatment center in Rheine. Professor Lobmann therefore wants to establish a South German Center for Diagnostics and Therapy of the Charcot Foot in his clinic. However, about half of the patients with Type 2 diabetes can initially be treated with tablets, while 30% have to inject insulin in addition or exclusively. “In the last few years, a lot has happened with the use of new medicines in diabetes medicines,” Professor Lobmann reports. “Studies with diabetic patients who are additionally suffering from a heart disease and are therefore classified as a high-risk group have resulted in a 30 percent lower death rate with the new drugs.” For cardiac patients with diabetes, the new drug appears to be life-prolonging along with a good blood glucose control. In addition, a change in lifestyle, a balanced diet and, above all, movement at every stage of the disease help to keep diabetes at bay. After the meal, a quarter of an hour of walking has already a very positive effect, because the sugar is then not stored in the fat, but is immediately processed in the muscle, Professor Lobmann explains: “This way you can run away from the diabetes.”

In any case, diabetic patients must regularly determine their blood glucose levels. Apart from an insulin requirement, every meal, as well as sports activities, influence the blood sugar level. Patients with type 1 diabetes are most likely to have their blood glucose levels measured. In these patients, an autoimmune disease has often destroyed the insulin-producing cells in the pancreas as a child. They must therefore always supply the body with insulin and live in a permanent rhythm from measuring, calculating and injecting. “Especially in patients who have to measure their blood glucose and insulin at least six times a day, a system has been very successful in the last six months, which continuously measures the blood glucose,” says Professor Lobmann. A sensor, five millimeters high and 35 millimeters in diameter, is glued to the skin at the back of the upper arm. When placed, a flexible, sterile tip pushes underneath the skin through which the tissue sugar is continuously measured. The collected measurement results are read out using a reader using RFID near-field radio technology. “The tissue sugar value with a time difference of five to ten minutes is nearly as up-to-date as the blood glucose value,” says Professor Lobmann. It is particularly helpful, however, that the device allows for a trend display from the close-knit, automatic measurements. Does the sugar level rise or fall? This is an important indication for the exact determination of the amount of insulin to be injected, especially for type 1 diabetics. “Half a unit more or less can be crucial for patients.” After 14 days, the sensor has to be replaced. It is waterproof and also keeps under the shower or swimming without problems.


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