Diabetes mellitus, or diabetes, in short, is a chronic metabolic disorder that can happen to anyone. The body is no longer able to contain the blood sugar level within the acceptable limits. These patients also often have a disturbed fat metabolism and high blood pressure. Some people run a greater risk of becoming diabetic than others. There are several types of diabetes and the most common types are type 1 diabetes and type 2 diabetes. In both cases, the blood sugar level is too high.
Type 1 With people who have type 1 diabetes, the body is not or no longer able to produce insulin. Type 1 diabetes develops quite quickly, and usually at a young age (0-25). Patients with type 1 diabetes always have to inject insulin. The risk factors for the development of type 1 diabetes are largely still unknown, but it is possibly related to viruses, environmental factors, and nutrition. A genetic susceptibility plays a role to some extent.
Type 2 With regard to type 2 diabetes patients, the pancreas produces not enough insulin and/or the insulin is no longer sufficiently effective as there is a certain resistance in the tissues that affects the working of the insulin (insulin resistance). Type 2 diabetes mostly occurs with elderly people and people who are overweight, which include increasingly often young children and adolescents. The treatment consists of a combination of lifestyle advice (exercise and diet), medication, and sometimes, ultimately, insulin as well. Risk factors for the development of type 2 diabetes are a genetic predisposition, severe overweight, an unfavourable fat distribution, lack of physical activities, smoking, and nutritional factors. Especially people who eat too much saturated fats and insufficient unsaturated fats and fibres have an increased risk of developing type 2 diabetes. The increase in the number of people with type 2 diabetes is mainly caused by obesity. Type 2 diabetes has more and more become a lifestyle disease.
THE SYMPTOMS OF TYPE 1 DIABETES
Type 1 diabetes develops when the body is no longer able to produce insulin as the immune system attacks the insulin-producing cells. Type 1 diabetes is less common than type 2 and has a bigger impact on someone’s daily life because people with type 1 diabetes need to measure their blood sugar level and inject insulin every day. In order to maintain a proper insulin level, these patients need to consider the amount of insulin they need with every meal. The exact cause of type 1 diabetes is unknown. We do know that a genetic susceptibility plays a role to some extent. The symptoms of type 1 diabetes are:
- The need to drink and urinate a lot
- Sudden weight loss
- Feeling sick
- Feeling hungry or rather a loss of appetite
- blurred vision
THE SYMPTOMS OF TYPE 2 DIABETES
Type 2 diabetes is more common than type 1 and has less impact on someone’s daily life. With people who have type 2 diabetes, the pancreas produces insufficient insulin and/or the insulin is no longer sufficiently effective. This is because a certain resistance has been built up in the tissues against the working of insulin. 90% of the diabetes patients have type 2 diabetes. The exact cause of type 2 diabetes is also not entirely clear. The chance of someone developing type 2 diabetes increases when the illness already runs in the family, when someone is overweight, and when someone does not get sufficient physical exercise. The symptoms of type 2 diabetes are:
- Feeling thirsty and the need to urinate often
- Suffering from eye problems
- Wounds that heal slowly
- Shortness of breath
- Regularly recurring infections
The diagnosis is usually done by the GP. By taking a drop of blood, the GP can determine whether the glucose level in your blood is too high. An increased blood sugar level can also be discovered by coincidence. When the GP suspects that you may have type 1 diabetes, he will refer you to an internist. When it is clear that you have type 2 diabetes, the GP will start the treatment.
THE TREATMENT OF DIABETES
Type 1 Diabetes With type 1 diabetes, the pancreas is unable to produce any insulin. Insulin can only be administered by injections and you will learn how to inject yourself on the first day of the treatment. You also need to learn how to measure your blood glucose, for which you use a small device. You learn how to count the carbohydrates in your food and to adjust the amount of insulin to the intake of carbohydrates.
Type 2 Diabetes When you are overweight, losing weight can already greatly improve the glucose level in your blood. This may allow you to postpone the use of medication. A good distribution of the intake of carbohydrates over the day is also important. The GP can describe several kinds of medications. The GP may refer to the internist when there are complications or when adjusting your glucose level proves to be difficult.
CONSULTATIONS The first consultation will always be with the internist, who will also conduct a physical examination. We will ask a wide range of questions about your medical history, lifestyle, and complaints. You will get also get a blood test form for the laboratory. During the second consultation, the results of the tests will be discussed and a treatment plan is set up. When your diabetes mellitus can be treated relatively simply and there are no other complications, you can be referred back to your GP. When you need treatment that involves insulin, the follow-up consultations will be with the diabetes specialist nurse who will always discuss your condition with one of the internists. When the use of an insulin pump is required, then these checkups will be more frequent.
3 Monthly check Diabetes patients need to have checkup appointments once every 3 months, alternately with the physician and the diabetes specialist nurse. First, a blood sample is taken and the result will be discussed. We also check your blood pressure and blood sugar values. When everything goes well, we will plan the next appointment in 3 months time. When things are not going so well and there are or have been complications such as hypos or your blood sugar levels are too high, we may want to see you again sooner. Together, we will try to find a way of creating a better balance. This can sometimes be done with small adjustments to your diet, or the amount of insulin must be adjusted.
Annual checkup We will do a more thorough checkup once a year. Your feet will be checked on defects, you will get an appointment with the ophthalmologist, and we will to a more extensive blood test.
Consultation diabetes and sports Medical Centre Jan van Goyen has started a special consultation called Diabetes and Sports for type 1 diabetes patients. During this consultation, we discuss the outcome of the questionnaire you received by email prior to the meeting and, together with the patient, we will define the problem and the treatment goal. In order to get a better understanding of the glucose profile during sports, we offer the option to do a continuous glucose reading for two weeks. The company Abbott has offered to reimburse one Freestyle Libre glucose monitoring system per patient to enable the sports consultation. The patient will then keep a continuous glucose registration for two weeks in which sports activities, nutrition, alcohol consumption, and insulin administration is recorded in a diary. During a consultation with internist-endocrinologist Iris Wentholt and diabetes specialist nurse Trins van der Linden, the continuous glucose reading and the content of the diary will be analysed, together with the patient, after which we can offer an advice that is most suitable for your situation and condition. Company Abbott has agreed to one per patient Freestyle libre meter for the benefit of the sports consultation. The patient then keeps a continuous glucose record for two weeks in which sports activities, nutrition, alcohol consumption and insulin administration are recorded in a diary. During a consultation with an internist-endocrinologist Iris Wentholt and diabetes nurse Trins van der Linden, the continuous glucose measurement together with the contents of the diary will be analyzed together with the patient, after which tailor-made advice can be given.
THE DIABETES TEAM
The treatment is entirely focused on you. With regard to diabetes, a good contact between the patient and the diabetes team is essential. You will always see the same physician and specialist nurse, so you will be able to form a good relationship.
Lifestyle adjustments form the basis of the treatment, which is why we give you tailor-made advice. We look at what suits you and together we determine a goal to work towards.
Who will you be dealing with? The internist treats the medical aspect of diabetes and will conduct, i.a., an extensive physical examination. Based on the results, the internist will propose a treatment plan. The internist will refer you to the diabetes specialist nurse, the dietician, and other experts when this is necessary.
The diabetes nurse Coping with diabetes in your daily life is not an easy feat. You suddenly have to consider all kinds of things you never had to think of before. What and when shall I eat? What is the effect of this walk on my blood sugar? The diabetes specialist nurse can help you with all this. She will teach you how to check your blood glucose level and how to inject the insulin yourself. She will guide you through everything that concerns your diabetes. Getting insight into your medical condition is important and the diabetes specialist nurse will explain how you can do this in the best possible way. The objective, eventually, is that you learn to deal with your diabetes yourself. The nurse is specialised in the insulin pump therapy and has experience with the sensors. It is also possible to assess the blood glucose levels for a certain period by email in order to come to better settings and values.
Young adults: She is also very experienced in assisting adolescents and young adults with type 1 diabetes and we have evening consultation hours for this group of patients. So if you just turned 18 you need to start seeing the internist instead of your paediatrician, then we would like to meet you and see if you and our team click.young adults In addition, she has a lot of knowledge in the field of adolescents and young adults with type 1 diabetes. It is also possible for them to get an appointment in the evenings. So if you have just turned 18 and are ready to switch from the pediatrician to the internist, just come and meet us to see if it clicks.
The dietician The dietician gives advice and information about nutrition and diabetes. Nutrition is a very important aspect of the treatment of diabetes as nutrition (especially the carbohydrates) and medication must be properly attuned to each other. The dietician informs you on a healthy diet and helps with fitting the nutrition advice into your daily life.
COMPLICATIONS IN DIABETES
The main reason to keep the blood glucose level as normal as possible is to prevent complications. When you have had diabetes for a long time, blood vessels and nerves may get damaged. As a result, several organs may start to deteriorate.
Heart and vessels People with diabetes have a greater risk of getting a heart attack or stroke. Additionally, the blood vessels in the legs may cause problems such as vascular claudication or badly healing wounds on the feet.
Eyes The small blood vessels in the retina can start to leak. When this is not treated with a laser treatment, this may eventually lead to blindness.