Diabetes Mellitus (DM)

Overview
Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar
(glucose). Glucose is vital to your health because it's an important source of energy for the cells
that make up your muscles and tissues. It's also your brain's main source of fuel.

Diabetes is a chronic (long-lasting) health condition that affects how your body turns food into
energy. Your body breaks down most of the food you eat into sugar (glucose) and releases it into
your bloodstream. When your blood sugar goes up, it signals your pancreas to release insulin.

The underlying cause of diabetes varies by type. But, no matter what type of diabetes you have,
it can lead to excess sugar in your blood. Too much sugar in your blood can lead to serious
health problems.

Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible
diabetes conditions include prediabetes and gestational diabetes. Prediabetes occurs when your
blood sugar levels are higher than normal, but not high enough to be classified as diabetes. And
prediabetes is often the precursor of diabetes unless appropriate measures are taken to prevent
progression. Gestational diabetes occurs during pregnancy but may resolve after the baby is
delivered.

Symptoms
Diabetes symptoms vary depending on how much your blood sugar is elevated. Some people,
especially those with prediabetes or type 2 diabetes, may sometimes not experience symptoms.
In type 1 diabetes, symptoms tend to come on quickly and be more severe.

Some of the signs and symptoms of type 1 diabetes and type 2 diabetes are:

 Increased thirst
 Frequent urination
 Extreme hunger
 Unexplained weight loss
 Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and
fat that happens when there's not enough available insulin)
 Fatigue
 Irritability
 Blurred vision
 Slow-healing sores
 Frequent infections, such as gums or skin infections and vaginal infections

Type 1 diabetes can develop at any age, though it often appears during childhood or adolescence.
Type 2 diabetes, the more common type, can develop at any age, though it's more common in
people older than 40.
Symptoms of diabetes

Diabetes symptoms are caused by rising blood sugar.

General symptoms

The general symptoms of diabetes include:

Symptoms in men

In addition to the general symptoms of diabetes, men with diabetes may have:

A decreased sex drive

Erectile dysfunction (ED)

Poor muscle strength

Symptoms in women

Women with diabetes can have symptoms such as:

Vaginal dryness

Urinary tract infections

Yeast infections

dry, itchy skin

It may also result in mood changes.

When to see a doctor

 If you suspect you or your child may have diabetes. If you notice any possible diabetes
symptoms, contact your doctor. The earlier the condition is diagnosed, the sooner
treatment can begin.
 If you've already been diagnosed with diabetes. After you receive your diagnosis,
you'll need close medical follow-up until your blood sugar levels stabilize.

Causes
To understand diabetes, first you must understand how glucose is normally processed in the
body.

How insulin works

Insulin is a hormone that comes from a gland situated behind and below the stomach (pancreas).

 The pancreas secretes insulin into the bloodstream.

 The insulin circulates, enabling sugar to enter your cells.
 Insulin lowers the amount of sugar in your bloodstream.
 As your blood sugar level drops, so does the secretion of insulin from your pancreas.

The role of glucose

Glucose — a sugar — is a source of energy for the cells that make up muscles and other tissues.

 Glucose comes from two major sources: food and your liver.
 Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
 Your liver stores and makes glucose.
 When your glucose levels are low, such as when you haven't eaten in a while, the liver
breaks down stored glycogen into glucose to keep your glucose level within a normal
range.

Causes of type 1 Diabetes

The exact cause of type 1 diabetes is unknown. What is known is that your immune system —
which normally fights harmful bacteria or viruses — attacks and destroys your insulin-producing
cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into
your cells, sugar builds up in your bloodstream.

Type 1 is thought to be caused by a combination of genetic susceptibility and environmental

factors, though exactly what those factors are is still unclear. Weight is not believed to be a
factor in type 1 diabetes.

Causes of Prediabetes and type 2 Diabetes

In Prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, your cells become
resistant to the action of insulin, and your pancreas is unable to make enough insulin to
overcome this resistance. Instead of moving into your cells where it's needed for energy, sugar
builds up in your bloodstream.

Exactly why this happens is uncertain, although it's believed that genetic and environmental
factors play a role in the development of type 2 diabetes too. Being overweight is strongly linked
to the development of type 2 diabetes, but not everyone with type 2 is overweight.

Causes of gestational diabetes

During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones
make your cells more resistant to insulin.
Normally, your pancreas responds by producing enough extra insulin to overcome this
resistance. But sometimes your pancreas can't keep up. When this happens, too little glucose gets
into your cells and too much stays in your blood, resulting in gestational diabetes.

Risk factors
Risk factors for diabetes depend on the type of diabetes.

Risk factors for type 1 diabetes

Although the exact cause of type 1 diabetes is unknown, factors that may signal an increased risk
include:

 Family history. Your risk increases if a parent or sibling has type 1 diabetes.
 Environmental factors. Circumstances such as exposure to a viral illness likely play
some role in type 1 diabetes.
 The presence of damaging immune system cells (autoantibodies). Sometimes family
members of people with type 1 diabetes are tested for the presence of diabetes
autoantibodies. If you have these autoantibodies, you have an increased risk of
developing type 1 diabetes. But not everyone who has these autoantibodies develops
diabetes.
 Geography. Certain countries, such as Finland and Sweden, have higher rates of type 1
diabetes.

Risk factors for Prediabetes and type 2 Diabetes

Researchers don't fully understand why some people develop prediabetes and type 2 diabetes and
others don't. It's clear that certain factors increase the risk, however, including:

 Weight. The more fatty tissue you have, the more resistant your cells become to insulin.
 Inactivity. The less active you are, the greater your risk. Physical activity helps you
control your weight, uses up glucose as energy and makes your cells more sensitive to
insulin.
 Family history. Your risk increases if a parent or sibling has type 2 diabetes.
 Race or ethnicity. Although it's unclear why, certain people — including Black,
Hispanic, American Indian and Asian American people — are at higher risk.
 Age. Your risk increases as you get older. This may be because you tend to exercise less,
lose muscle mass and gain weight as you age. But type 2 diabetes is also increasing
among children, adolescents and younger adults.
 Gestational diabetes. If you developed gestational diabetes when you were pregnant,
your risk of developing prediabetes and type 2 diabetes increases. If you gave birth to a
baby weighing more than 9 pounds (4 kilograms), you're also at risk of type 2 diabetes.
 Polycystic ovary syndrome. For women, having polycystic ovary syndrome — a
common condition characterized by irregular menstrual periods, excess hair growth and
obesity — increases the risk of diabetes.
 High blood pressure. Having blood pressure over 140/90 millimeters of mercury (mm
Hg) is linked to an increased risk of type 2 diabetes.
  Abnormal cholesterol and triglyceride levels. If you have low levels of high-density
lipoprotein (HDL), or "good," cholesterol, your risk of type 2 diabetes is higher.
Triglycerides are another type of fat carried in the blood. People with high levels of
triglycerides have an increased risk of type 2 diabetes. Your doctor can let you know
what your cholesterol and triglyceride levels are.

Risk factors for gestational diabetes

Pregnant women can develop gestational diabetes. Some women are at greater risk than are
others. Risk factors for gestational diabetes include:

 Age. Women older than age 25 are at increased risk.

 Family or personal history. Your risk increases if you have prediabetes — a precursor
to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2
diabetes. You're also at greater risk if you had gestational diabetes during a previous
pregnancy, if you delivered a very large baby or if you had an unexplained stillbirth.
 Weight. Being overweight before pregnancy increases your risk.
 Race or ethnicity. For reasons that aren't clear, women who are Black, Hispanic,
American Indian or Asian American are more likely to develop gestational diabetes.

Complications
Long-term complications of diabetes develop gradually. The longer you have diabetes — and the
less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes
complications may be disabling or even life-threatening. Possible complications include:

 Cardiovascular disease. Diabetes dramatically increases the risk of various

cardiovascular problems, including coronary artery disease with chest pain (angina), heart
attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you're
more likely to have heart disease or stroke.
 Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels
(capillaries) that nourish your nerves, especially in your legs. This can cause tingling,
numbness, burning or pain that usually begins at the tips of the toes or fingers and
gradually spreads upward.

Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the
nerves related to digestion can cause problems with nausea, vomiting, diarrhea or
constipation. For men, it may lead to erectile dysfunction.

 Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel
clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate
filtering system. Severe damage can lead to kidney failure or irreversible end-stage
kidney disease, which may require dialysis or a kidney transplant.
 Eye damage (retinopathy). Diabetes can damage the blood vessels of the retina
(diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of
other serious vision conditions, such as cataracts and glaucoma.
  Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk
of various foot complications. Left untreated, cuts and blisters can develop serious
infections, which often heal poorly. These infections may ultimately require toe, foot or
leg amputation.
 Skin conditions. Diabetes may leave you more susceptible to skin problems, including
bacterial and fungal infections.
 Hearing impairment. Hearing problems are more common in people with diabetes.
 Alzheimer's disease. Type 2 diabetes may increase the risk of dementia, such as
Alzheimer's disease. The poorer your blood sugar control, the greater the risk appears to
be. Although there are theories as to how these disorders might be connected, none has
yet been proved.
 Depression. Depression symptoms are common in people with type 1 and type 2
diabetes. Depression can affect diabetes management.

Complications of gestational diabetes

Most women who have gestational diabetes deliver healthy babies. However, untreated or
uncontrolled blood sugar levels can cause problems for you and your baby.

Complications in your baby can occur as a result of gestational diabetes, including:

 Excess growth. Extra glucose can cross the placenta, which triggers your baby's pancreas
to make extra insulin. This can cause your baby to grow too large (macrosomia). Very
large babies are more likely to require a C-section birth.
 Low blood sugar. Sometimes babies of mothers with gestational diabetes develop low
blood sugar (hypoglycemia) shortly after birth because their own insulin production is
high. Prompt feedings and sometimes an intravenous glucose solution can return the
baby's blood sugar level to normal.
 Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a
higher risk of developing obesity and type 2 diabetes later in life.
 Death. Untreated gestational diabetes can result in a baby's death either before or shortly
after birth.

Complications in the mother also can occur as a result of gestational diabetes, including:

 Preeclampsia. This condition is characterized by high blood pressure, excess protein in

the urine, and swelling in the legs and feet. Preeclampsia can lead to serious or even life-
threatening complications for both mother and baby.
 Subsequent gestational diabetes. Once you've had gestational diabetes in one
pregnancy, you're more likely to have it again with the next pregnancy. You're also more
likely to develop diabetes — typically type 2 diabetes — as you get older.

Complications of Prediabetes

Prediabetes may develop into type 2 diabetes.

Prevention
Type 1 diabetes can't be prevented. However, the same healthy lifestyle choices that help treat
prediabetes, type 2 diabetes and gestational diabetes can also help prevent them:

 Eat healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on
fruits, vegetables and whole grains. Strive for variety to prevent boredom.
 Get more physical activity. Aim for about 30 minutes of moderate aerobic activity on
most days of the week, or at least 150 minutes of moderate aerobic activity a week.
 Lose excess pounds. If you're overweight, losing even 7% of your body weight — for
example, 14 pounds (6.4 kilograms) if you weigh 200 pounds (90.7 kilograms) — can
reduce the risk of diabetes.

Don't try to lose weight during pregnancy, however. Talk to your doctor about how much
weight is healthy for you to gain during pregnancy.

To keep your weight in a healthy range, focus on permanent changes to your eating and
exercise habits. Motivate yourself by remembering the benefits of losing weight, such as
a healthier heart, more energy and improved self-esteem.

Sometimes medication is an option as well. Oral diabetes drugs such as metformin (Glumetza,
Fortamet, others) may reduce the risk of type 2 diabetes — but healthy lifestyle choices remain
essential. Have your blood sugar checked at least once a year to check that you haven't
developed type 2 diabetes.

Diagnosis
Symptoms of type 1 diabetes often appear suddenly and are often the reason for checking blood
sugar levels. Because symptoms of other types of diabetes and prediabetes come on more
gradually or may not be evident, the American Diabetes Association (ADA) has recommended
screening guidelines. The ADA recommends that the following people be screened for diabetes:

 Anyone with a body mass index higher than 25 (23 for Asian Americans), regardless
of age, who has additional risk factors, such as high blood pressure, abnormal cholesterol
levels, a sedentary lifestyle, a history of polycystic ovary syndrome or heart disease, and
who has a close relative with diabetes.
 Anyone older than age 45 is advised to receive an initial blood sugar screening, and
then, if the results are normal, to be screened every three years thereafter.
 Women who have had gestational diabetes are advised to be screened for diabetes
every three years.
 Anyone who has been diagnosed with prediabetes is advised to be tested every year.
Tests for type 1 and type 2 diabetes and prediabetes

 Glycated hemoglobin (A1C) test. This blood test, which doesn't require fasting,
indicates your average blood sugar level for the past two to three months. It measures the
percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red
blood cells.

The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached.
An A1C level of 6.5% or higher on two separate tests indicates that you have diabetes.
An A1C between 5.7 and 6.4 % indicates prediabetes. Below 5.7 is considered normal.

If the A1C test results aren't consistent, the test isn't available, or you have certain conditions that
can make the A1C test inaccurate — such as if you are pregnant or have an uncommon form of
hemoglobin (known as a hemoglobin variant) — your doctor may use the following tests to
diagnose diabetes:

 Random blood sugar test. A blood sample will be taken at a random time. Regardless of
when you last ate, a blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1
millimoles per liter (mmol/L) — or higher suggests diabetes.
 Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting
blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar
level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126
mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.
 Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar
level is measured. Then you drink a sugary liquid, and blood sugar levels are tested
periodically for the next two hours.

A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than
200 mg/dL (11.1 mmol/L) after two hours indicates diabetes. A reading between 140 and
199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes.

If type 1 diabetes is suspected, your urine will be tested to look for the presence of a byproduct
produced when muscle and fat tissue are used for energy because the body doesn't have enough
insulin to use the available glucose (ketones). Your doctor will also likely run a test to see if you
have the destructive immune system cells associated with type 1 diabetes called autoantibodies.

Tests for gestational diabetes

Your doctor will likely evaluate your risk factors for gestational diabetes early in your
pregnancy:

 If you're at high risk of gestational diabetes — for example, if you were obese at the
start of your pregnancy; you had gestational diabetes during a previous pregnancy; or you
have a mother, father, sibling or child with diabetes — your doctor may test for diabetes
at your first prenatal visit.
 If you're at average risk of gestational diabetes, you'll likely have a screening test for
gestational diabetes sometime during your second trimester — typically between 24 and
28 weeks of pregnancy.
Your doctor may use the following screening tests:

 Initial glucose challenge test. You'll begin the glucose challenge test by drinking a
syrupy glucose solution. One hour later, you'll have a blood test to measure your blood
sugar level. A blood sugar level below 140 mg/dL (7.8 mmol/L) is usually considered
normal on a glucose challenge test, although this may vary at specific clinics or labs.

If your blood sugar level is higher than normal, it only means you have a higher risk of
gestational diabetes. Your doctor will order a follow-up test to determine if you have
gestational diabetes.

 Follow-up glucose tolerance testing. For the follow-up test, you'll be asked to fast
overnight and then have your fasting blood sugar level measured. Then you'll drink
another sweet solution — this one containing a higher concentration of glucose — and
your blood sugar level will be checked every hour for a period of three hours.

If at least two of the blood sugar readings are higher than the normal values established
for each of the three hours of the test, you'll be diagnosed with gestational diabetes.

Treatment
Depending on what type of diabetes you have, blood sugar monitoring, insulin and oral
medications may play a role in your treatment. Eating a healthy diet, maintaining a healthy
weight and participating in regular activity also are important factors in managing diabetes.

Treatments for all types of diabetes

An important part of managing diabetes — as well as your overall health — is maintaining a

healthy weight through a healthy diet and exercise plan:

 Healthy eating. Contrary to popular perception, there's no specific diabetes diet. You'll
need to center your diet on more fruits, vegetables, lean proteins and whole grains —
foods that are high in nutrition and fiber and low in fat and calories — and cut down on
saturated fats, refined carbohydrates and sweets. In fact, it's the best eating plan for the
entire family. Sugary foods are OK once in a while, as long as they're counted as part of
your meal plan.

Yet, understanding what and how much to eat can be a challenge. A registered dietitian
can help you create a meal plan that fits your health goals, food preferences and lifestyle.
This will likely include carbohydrate counting, especially if you have type 1 diabetes or
use insulin as part of your treatment.

 Physical activity. Everyone needs regular aerobic exercise, and people who have
diabetes are no exception. Exercise lowers your blood sugar level by moving sugar into
your cells, where it's used for energy. Exercise also increases your sensitivity to insulin,
which means your body needs less insulin to transport sugar to your cells.
 Get your doctor's OK to exercise. Then choose activities you enjoy, such as walking,
swimming or biking. What's most important is making physical activity part of your daily
routine.

Aim for at least 30 minutes or more of aerobic exercise most days of the week, or at least
150 minutes of moderate physical activity a week. Bouts of activity can be as brief as 10
minutes, three times a day. If you haven't been active for a while, start slowly and build
up gradually. It's also a good idea to avoid sitting for too long — aim to get up and move
if you've been sitting for more than 30 minutes.

Treatments for type 1 and type 2 diabetes

Treatment for type 1 diabetes involves insulin injections or the use of an insulin pump, frequent
blood sugar checks, and carbohydrate counting. Treatment of type 2 diabetes primarily involves
lifestyle changes, monitoring of your blood sugar, along with diabetes medications, insulin or
both.

 Monitoring your blood sugar. Depending on your treatment plan, you may check and
record your blood sugar as many as four times a day or more often if you're taking
insulin. Careful monitoring is the only way to make sure that your blood sugar level
remains within your target range. People with type 2 diabetes who aren't taking insulin
generally check their blood sugar much less frequently.

People who receive insulin therapy also may choose to monitor their blood sugar levels
with a continuous glucose monitor. Although this technology hasn't yet completely
replaced the glucose meter, it can significantly reduce the number of fingersticks
necessary to check blood sugar and provide important information about trends in blood
sugar levels.

Even with careful management, blood sugar levels can sometimes change unpredictably.
With help from your diabetes treatment team, you'll learn how your blood sugar level
changes in response to food, physical activity, medications, illness, alcohol, stress — and
for women, fluctuations in hormone levels.

In addition to daily blood sugar monitoring, your doctor will likely recommend regular
A1C testing to measure your average blood sugar level for the past two to three months.

Compared with repeated daily blood sugar tests, A1C testing better indicates how well
your diabetes treatment plan is working overall. An elevated A1C level may signal the
need for a change in your oral medication, insulin regimen or meal plan.

Your target A1C goal may vary depending on your age and various other factors, such as
other medical conditions you may have. However, for most people with diabetes, the
American Diabetes Association recommends an A1C of below 7%. Ask your doctor what
your A1C target is.

 Insulin. People with type 1 diabetes need insulin therapy to survive. Many people with
type 2 diabetes or gestational diabetes also need insulin therapy.
 Many types of insulin are available, including short-acting (regular insulin), rapid-acting
insulin, long-acting insulin and intermediate options. Depending on your needs, your
doctor may prescribe a mixture of insulin types to use throughout the day and night.

Insulin can't be taken orally to lower blood sugar because stomach enzymes interfere with
insulin's action. Often insulin is injected using a fine needle and syringe or an insulin pen
— a device that looks like a large ink pen.

An insulin pump also may be an option. The pump is a device about the size of a small
cellphone worn on the outside of your body. A tube connects the reservoir of insulin to a
catheter that's inserted under the skin of your abdomen.

A tubeless pump that works wirelessly is also now available. You program an insulin
pump to dispense specific amounts of insulin. It can be adjusted to deliver more or less
insulin depending on meals, activity level and blood sugar level.

In September 2016, the Food and Drug Administration approved the first artificial
pancreas for people with type 1 diabetes who are age 14 and older. A second artificial
pancreas was approved in December 2019. Since then systems have been approved for
children older than 2 years old.

An artificial pancreas is also called closed-loop insulin delivery. The implanted device
links a continuous glucose monitor, which checks blood sugar levels every five minutes,
to an insulin pump. The device automatically delivers the correct amount of insulin when
the monitor indicates it's needed.

There are more artificial pancreas (closed loop) systems currently in clinical trials.

 Oral or other medications. Sometimes other oral or injected medications are prescribed
as well. Some diabetes medications stimulate your pancreas to produce and release more
insulin. Others inhibit the production and release of glucose from your liver, which
means you need less insulin to transport sugar into your cells.

Still others block the action of stomach or intestinal enzymes that break down
carbohydrates or make your tissues more sensitive to insulin. Metformin (Glumetza,
Fortamet, others) is generally the first medication prescribed for type 2 diabetes.

Another class of medication called SGLT2 inhibitors may be used. They work by
preventing the kidneys from reabsorbing sugar into the blood. Instead, the sugar is
excreted in the urine.

 Transplantation. In some people who have type 1 diabetes, a pancreas transplant may be
an option. Islet transplants are being studied as well. With a successful pancreas
transplant, you would no longer need insulin therapy.

But transplants aren't always successful — and these procedures pose serious risks. You
need a lifetime of immune-suppressing drugs to prevent organ rejection. These drugs can
 have serious side effects, which is why transplants are usually reserved for people whose
diabetes can't be controlled or those who also need a kidney transplant.

 Bariatric surgery. Although it is not specifically considered a treatment for type 2

diabetes, people with type 2 diabetes who are obese and have a body mass index higher
than 35 may benefit from this type of surgery. People who've undergone gastric bypass
have seen significant improvements in their blood sugar levels. However, this procedure's
long-term risks and benefits for type 2 diabetes aren't yet known.

Treatment for gestational diabetes

Controlling your blood sugar level is essential to keeping your baby healthy and avoiding
complications during delivery. In addition to maintaining a healthy diet and exercising, your
treatment plan may include monitoring your blood sugar and, in some cases, using insulin or oral
medications.

Your doctor also will monitor your blood sugar level during labor. If your blood sugar rises, your
baby may release high levels of insulin — which can lead to low blood sugar right after birth.

Treatment for prediabetes

If you have prediabetes, healthy lifestyle choices can help you bring your blood sugar level back
to normal or at least keep it from rising toward the levels seen in type 2 diabetes. Maintaining a
healthy weight through exercise and healthy eating can help. Exercising at least 150 minutes a
week and losing about 7% of your body weight may prevent or delay type 2 diabetes.

Sometimes medications — such as metformin (Glucophage, Glumetza, others) — also are an

option if you're at high risk of diabetes, including when your prediabetes is worsening or if you
have cardiovascular disease, fatty liver disease or polycystic ovary syndrome.

In other cases, medications to control cholesterol — statins, in particular — and high blood
pressure medications are needed. Your doctor might prescribe low-dose aspirin therapy to help
prevent cardiovascular disease if you're at high risk. However, healthy lifestyle choices remain
key.

Signs of trouble in any type of diabetes

Because so many factors can affect your blood sugar, problems may sometimes arise that require
immediate care, such as:

 High blood sugar (hyperglycemia). Your blood sugar level can rise for many reasons,
including eating too much, being sick or not taking enough glucose-lowering medication.
Check your blood sugar level as directed by your doctor, and watch for signs and
symptoms of high blood sugar — frequent urination, increased thirst, dry mouth, blurred
vision, fatigue and nausea. If you have hyperglycemia, you'll need to adjust your meal
plan, medications or both.
 Increased ketones in your urine (diabetic ketoacidosis). If your cells are starved for
energy, your body may begin to break down fat. This produces toxic acids known as
 ketones. Watch for loss of appetite, weakness, vomiting, fever, stomach pain and a sweet,
fruity breath.

You can check your urine for excess ketones with an over-the-counter ketones test kit. If
you have excess ketones in your urine, consult your doctor right away or seek emergency
care. This condition is more common in people with type 1 diabetes.

 Hyperglycemic hyperosmolar nonketotic syndrome. Signs and symptoms of this life-

threatening condition include a blood sugar reading over 600 mg/dL (33.3 mmol/L), dry
mouth, extreme thirst, fever, drowsiness, confusion, vision loss and hallucinations.
Hyperosmolar syndrome is caused by sky-high blood sugar that turns blood thick and
syrupy.

It is seen in people with type 2 diabetes, and it's often preceded by an illness. Call your
doctor or seek immediate medical care if you have signs or symptoms of this condition.

 Low blood sugar (hypoglycemia). If your blood sugar level drops below your target
range, it's known as low blood sugar (hypoglycemia). If you're taking medication that
lowers your blood sugar, including insulin, your blood sugar level can drop for many
reasons, including skipping a meal and getting more physical activity than normal. Low
blood sugar also occurs if you take too much insulin or an excess of a glucose-lowering
medication that promotes the secretion of insulin by your pancreas.

Check your blood sugar level regularly, and watch for signs and symptoms of low blood
sugar — sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision,
heart palpitations, irritability, slurred speech, drowsiness, confusion, fainting and
seizures. Low blood sugar is treated with quickly absorbed carbohydrates, such as fruit
juice or glucose tablets.

Clinical trials
Lifestyle and home remedies
Diabetes is a serious disease. Following your diabetes treatment plan takes round-the-clock
commitment. Careful management of diabetes can reduce your risk of serious — even life-
threatening — complications.

 Make a commitment to managing your diabetes. Learn all you can about diabetes.
Establish a relationship with a diabetes educator, and ask your diabetes treatment team
for help when you need it.
 Choose healthy foods and maintain a healthy weight. If you're overweight, losing just
5% of your body weight can make a difference in your blood sugar control if you have
prediabetes or type 2 diabetes. A healthy diet is one with plenty of fruits, vegetables, lean
proteins, whole grains and legumes, with a limited amount of saturated fat.
 Make physical activity part of your daily routine. Regular exercise can help prevent
prediabetes and type 2 diabetes, and it can help those who already have diabetes to
maintain better blood sugar control. A minimum of 30 minutes of moderate exercise —
 such as brisk walking — most days of the week is recommended. Aim for at least 150
minutes of moderate aerobic activity a week.

It's also a good idea to spend less time sitting still. Try to get up and move around for a
few minutes at least every 30 minutes or so when you're awake.

Lifestyle for type 1 and type 2 diabetes

In addition, if you have type 1 or type 2 diabetes:

 Identify yourself. Wear a tag or bracelet that says you have diabetes. Keep a glucagon
kit nearby in case of a low blood sugar emergency — and make sure your friends and
loved ones know how to use it.
 Schedule a yearly physical and regular eye exams. Your regular diabetes checkups
aren't meant to replace yearly physicals or routine eye exams. During the physical, your
doctor will look for any diabetes-related complications and screen for other medical
problems. Your eye care specialist will check for signs of retinal damage, cataracts and
glaucoma.
 Keep your vaccinations up to date. High blood sugar can weaken your immune system.
Get a flu shot every year, and your doctor may recommend the pneumonia vaccine, as
well. The Centers for Disease Control and Prevention (CDC) also currently recommends
hepatitis B vaccination if you haven't previously been vaccinated against hepatitis B and
you're an adult ages 19 to 59 with type 1 or type 2 diabetes.

The most recent CDC guidelines advise vaccination as soon as possible after diagnosis
with type 1 or type 2 diabetes. If you are age 60 or older, have diabetes, and haven't
previously received the vaccine, talk to your doctor about whether it's right for you.

 Pay attention to your feet. Wash your feet daily in lukewarm water. Dry them gently,
especially between the toes. Moisturize with lotion, but not between the toes. Check your
feet every day for blisters, cuts, sores, redness or swelling. Consult your doctor if you
have a sore or other foot problem that doesn't heal promptly on its own.
 Keep your blood pressure and cholesterol under control. Eating healthy foods and
exercising regularly can go a long way toward controlling high blood pressure and
cholesterol. Medication may be needed, too.
 Take care of your teeth. Diabetes may leave you prone to more-serious gum infections.
Brush and floss your teeth at least twice a day. And if you have type 1 or type 2 diabetes,
schedule regular dental exams. Consult your dentist right away if your gums bleed or
look red or swollen.
 If you smoke or use other types of tobacco, ask your doctor to help you quit.
Smoking increases your risk of various diabetes complications. Smokers who have
diabetes are more likely to die of cardiovascular disease than are nonsmokers who have
diabetes, according to the American Diabetes Association. Talk to your doctor about
ways to stop smoking or to stop using other types of tobacco.
 If you drink alcohol, do so responsibly. Alcohol can cause either high or low blood
sugar, depending on how much you drink and if you eat at the same time. If you choose
to drink, do so only in moderation — one drink a day for women and two drinks a day for
men — and always with food.
 Remember to include the carbohydrates from any alcohol you drink in your daily
carbohydrate count. And check your blood sugar levels before going to bed.

 Take stress seriously. The hormones your body may produce in response to prolonged
stress may prevent insulin from working properly, which will raise your blood sugar and
stress you even more. Set limits for yourself and prioritize your tasks. Learn relaxation
techniques. And get plenty of sleep.

What are 3 key actions of insulin?

Insulin is a peptide hormone secreted by the β cells of the pancreatic islets of Langerhans
and maintains normal blood glucose levels by facilitating cellular glucose uptake,
regulating carbohydrate, lipid and protein metabolism and promoting cell division and
growth.

What is the mechanism of diabetes?

It develops when the body's immune system destroys pancreatic beta cells, the only cells in
the body that make the hormone insulin, which regulates blood glucose. Only 5% of people
with diabetes have this form of the disease. To survive, people with type 1 diabetes must
have insulin delivered by injection or a pump.

If your pancreas doesn’t produce enough insulin or if the insulin in your body doesn’t work
properly, blood sugar will remain in your bloodstream and not be moved to your cells or to
your liver for storage.

Tests for Type 1 Diabetes, Type 2 Diabetes, and Prediabetes

Your doctor will have you take one or more of the following blood tests to
confirm the diagnosis:

A1C Test

The A1C test measures your average blood sugar level over the past 2 or 3
months. An A1C below 5.7% is normal, between 5.7 and 6.4% indicates you have
prediabetes, and 6.5% or higher indicates you have diabetes.

Fasting Blood Sugar Test

This measures your blood sugar after an overnight fast (not eating). A fasting
blood sugar level of 99 mg/dL or lower is normal, 100 to 125 mg/dL indicates you
have prediabetes, and 126 mg/dL or higher indicates you have diabetes.
 Glucose Tolerance Test

This measures your blood sugar before and after you drink a liquid that contains
glucose. You’ll fast (not eat) overnight before the test and have your blood drawn
to determine your fasting blood sugar level. Then you’ll drink the liquid and have
your blood sugar level checked 1 hour, 2 hours, and possibly 3 hours afterward.
At 2 hours, a blood sugar level of 140 mg/dL or lower is considered normal, 140
to 199 mg/dL indicates you have prediabetes, and 200 mg/dL or higher indicates
you have diabetes.

Random Blood Sugar Test

This measures your blood sugar at the time you’re tested. You can take this test
at any time and don’t need to fast (not eat) first. A blood sugar level of 200
mg/dL or higher indicates you have diabetes.

Fasting Blood Sugar Glucose Tolerance Random Blood Sugar

Result* A1C Test Test Test Test
Diabetes 6.5% or 126 mg/dL or above 200 mg/dL or above 200 mg/dL or above
above
Prediabetes 5.7 – 6.4% 100 – 125 mg/dL 140 – 199 mg/dL 140 – 199 mg/dL
Normal Below 5.7% 99 mg/dL or below Below 140 mg/dL Below 140 mg/dL
*Results for gestational diabetes can differ. Ask your health care provider what your
results mean if you’re being tested for gestational diabetes.
Source: American Diabetes Association

If your doctor thinks you have type 1 diabetes, your blood may also tested for
autoantibodies (substances that indicate your body is attacking itself) that are
often present in type 1 diabetes but not in type 2 diabetes. You may have your
urine tested for ketones (produced when your body burns fat for energy), which
also indicate type 1 diabetes instead of type 2 diabetes.

Tests for Gestational Diabetes

Gestational diabetes is diagnosed using blood tests. You’ll probably be tested
between 24 and 28 weeks of pregnancy. If your risk is higher for getting
gestational diabetes (due to having more risk factors), your doctor may test you
earlier. Blood sugar that’s higher than normal early in your pregnancy may
indicate you have type 1 or type 2 diabetes rather than gestational diabetes.
Glucose Screening Test

This measures your blood sugar at the time you’re tested. You’ll drink a liquid
that contains glucose, and then 1 hour later your blood will be drawn to check
your blood sugar level. A normal result is 140 mg/dL or lower. If your level is
higher than 140 mg/dL, you’ll need to take a glucose tolerance test.

Glucose Tolerance Test

This measures your blood sugar before and after you drink a liquid that contains
glucose. You’ll fast (not eat) overnight before the test and have your blood drawn
to determine your fasting blood sugar level. Then you’ll drink the liquid and have
your blood sugar level checked 1 hour, 2 hours, and possibly 3 hours afterward.
Results can differ depending on the size of the glucose drink and how often your
blood sugar is tested. Ask your doctor what your test results mean.

Prevent Type 2 Diabetes

If your test results show you have prediabetes, ask your doctor or nurse if the
lifestyle change program offered through the CDC-led National Diabetes
Prevention Program is available in your community. You can also search for an
online or in-person program. Having prediabetes puts you at greater risk for
developing type 2 diabetes, but participating in the program can lower your risk
by as much as 58% (71% if you’re over age 60).

Diabetes Treatment Plan

If your test results show you have type 1, type 2, or gestational diabetes, talk with
your doctor or nurse about a detailed treatment plan—including diabetes self-
management education and support services—and specific steps you can take to
be your healthiest.
 Diabetes in Pakistan

33 million people living with type 2 diabetes in Pakistan—the third largest diabetes
population globally. An additional 11 million adults in Pakistan have impaired glucose
tolerance, while approximately 8·9 million people with diabetes remain undiagnosed.

DAWN.COM

TODAY'S PAPER | NOVEMBER 14, 2023

Every fourth person in Pakistan is diabetic

Our Correspondent Published November 12, 2023 Updated November 12, 2023 06:59am

LAHORE: Every fourth person in Pakistan is suffering from diabetes and millions of
people around the world are suffering from eye problems, heart and kidney diseases due to
diabetes.

This disease causes more complications in human health if someone depends on tips and
gets treatment from quacks so citizens should get their treatment from a qualified
physician, he said.

According to medical experts, more than 33m people in Pakistan are suffering from
diabetes, out of which 25pc do not even know that they have fallen prey to this disease and
due to lack of attention towards proper treatment, they suffer from kidney, eye and heart
diseases too with the passage of time.

The improper diet, obesity, poor lifestyle are the main causes of this disease, apart from
this, if a person in the family is suffering from diabetes, such a person has strong chances to
suffer from other diseases. Highlighting the symptoms of diabetes, medical experts say if
someone feels thirsty, urinates frequently and suddenly loses weight, they should consult a
qualified doctor immediately because they may be suffering from diabetes, which can
damage every part of the body.

With the latest development in medical science, diseases like diabetes can be controlled and
the patients can live a healthy life by adopting preventive measures, medicines, exercise
and diet.
Published in Dawn, November 12th, 2023

Diabetes from A to Z
Scientific support: Prof. Dr. Norbert Stefan
A B C D E F G H I J K L M N O P Q R S T U V W X
Y Z

A
Abdominal obesity

See Fat distribution.

Abnormal fasting glucose

This is the term for fasting blood sugar levels above the normal range but below the
threshold for diabetes. In this case, the fasting blood sugar level is between 100 and
125 mg/dl.
Abscess

An abscess is an encapsulated collection of pus caused by often bacterial infection.

Acarbose – See alpha-glucosidase inhibitor

Acarbose is a drug in tablet form and is classified as an oral antidiabetic. It is used as

part of the blood sugar-reducing therapy of type 2 diabetes.
ACE inhibitors

ACE inhibitors belong to the blood pressure-reducing class of drugs. They inhibit the
activity of the "Angiotensin Converting Enzyme“ (ACE). This blocks the development of
vasoconstrictor angiotensin II. Among other things, angiotensin II increases blood
pressure.
Acetone

Acetone is a metabolic product that can develop, for example, in cases of insulin
deficiency. Without insulin, the body cannot generate enough energy from sugar
(glucose). In this case, the body’s cells use fat to generate energy. This leads to the
production of ketone bodies, including acetone. If they accumulate in the blood,
acidosis can develop.
Adenosine triphosphate (ATP)

This chemical compound is the most important energy store of the human body cells.
Adrenaline
Adrenaline is a stress hormone that, among other things, increases heartrate, oxygen
consumption, and fat burning, and dilates the bronchial tubes. The hormone also
increases the blood sugar level by inhibiting the release of insulin, reducing the effects
of insulin, and promoting the conversion of the liver's sugar stores (glycogen)
into glucose .
Albuminuria

Albumin is a blood protein that is produced in the liver. Albuminuria is the excretion of
albumin with the urine. This can be a sign of kidney disease . Albumin is normally not
excreted by the kidneys. See also microalbuminuria and macroalbuminuria.
Alpha cells

Alpha cells are the cells that produce the blood sugar-releasing hormone glucagon.
They are arranged in small cell clusters in the pancreas. These cell clusters are known
as the islets of Langerhans.
Alpha-glucosidase inhibitors

Alpha-glucosidase inhibitors are oral antidiabetics and are used in tablet form to reduce
blood sugar levels. They delay the breakdown of carbohydrates by inhibiting the
intestinal enzymes responsible for breaking down carbohydrates. This means sugar is
more slowly absorbed by the blood and the blood sugar increase after a meal is
reduced.
Alpha-glucosidase inhibitors have a limited effect on blood sugar levels and are
nowadays rarely used in diabetes therapy.
Amino acids

Amino acids are the building blocks for protein production. The proteins in the body are
made up of 20 different types of amino acids. The body is able to produce most of
these. Some of the amino acids must be obtained from food. These are known as
essential amino acids.
Anamnesis

The anamnesis or medical history is when the physician compiles information about the
onset and course of an illness, among other things.
Android fat distribution

See Fat distribution.

Angina pectoris

The sudden onset of a dull pain in the chest. The symptoms can radiate into other parts
of the body, e.g., the arms. Coronary heart disease (CHD) is often the underlying cause.
This means the blood vessels of the heart are narrowed, which obstructs blood flow.
Angiopathy

This is a term to describe vascular diseases. In the case of diabetes, a distinction is

made between microangiopathy and macroangiopathy.
Antigens
Antigens are usually foreign protein structures but can also be carbohydrates, fats, or
other components. The immune system reacts to antigens by producing antibodies.
For example, antigens can be found on the surface of many types of bacteria.
Antibodies

Antibodies are proteins that bind to foreign substances (antigens), such as pathogens,
to tag them. The immune system can then initiate a counterattack to combat the
intruders.
Antioxidants

Antioxidants are plant-based substances that protect cells and genetic information from
reactive oxygen species. Antioxidants can be found in many types of fruits and
vegetables.
Artery

Arteries are blood vessels that transport oxygen-rich blood from the heart throughout
the body.
Arteriosclerosis

Arteriosclerosis is incorrectly described as “vascular calcification”. There is a

pathological build-up of deposits along the inner walls of the blood vessels, causing
them to narrow and harden. These deposits are also known as plaques. Vascular
narrowing can result in vascular occlusion, e.g., a heart attack. Arteriosclerosis
develops slowly and often over many years.
ASH

ASH stands for alcoholic steatohepatitis. ASH is fatty liver inflammation caused by
excessive alcohol consumption.
ATP

See adenosine triphosphate.

Autoimmune disease

Autoimmune diseases cause the immune system, the body’s defense system, to stop
functioning. The immune system is then incapable of differentiating between the body's
own cells and foreign intruders, such as bacteria or viruses. In the case of type 1
diabetes, the insulin-producing cells in the pancreas are destroyed.
B
Bariatric surgery

Bariatric surgery is the surgical treatment of extreme obesity, also known as adiposity.
The surgery consists of a gastrointestinal procedure. The aim is to reduce food intake or
the absorption of energy-rich nutrients. An example of a surgical procedure to treat
obesity is gastric bypass.
Basal insulin
Basal insulin is responsible for the basic insulin requirement, independent of meals,
even at night. Depending on the type, basal insulin is injected, at least once daily. NPH
insulin and the insulin analogs glargine, detemir and degludec are available for this
purpose.
Basal metabolic rate

The basal metabolic rate is the term used to describe the energy required to maintain
vital function when resting. The basal metabolic rate depends on body weight, height,
age, gender, climate, body temperature, and muscle mass.
Basal rate

When using insulin pump therapy, the basal rate meets the individual basic insulin
requirement. It is independent of meals.
Basal-supported oral therapy (BOT)

Basal-supported oral therapy, known as BOT, is a type of insulin therapy. It combines

the use of oral antidiabetics with insulin injections. A long-acting basal insulin is used.
BOT is a form of therapy that can be used for people with type 2 diabetes. It is
prescribed when blood sugar levels cannot be adequately reduced despite changes to
lifestyle and the use of oral antidiabetics. The advantages of this therapy may include
less weight gain and fewer hypoglycemic events compared with treatment using only
insulin.
Basic bolus concept

This is a type of insulin therapy that uses long-acting insulin to meet the basic insulin
(basic) and mealtime insulin (bolus) requirements.
Beta blockers

Beta blockers are a type of medicine used to treat cardiovascular diseases, such as
high blood pressure, cardiac insufficiency, or angina pectoris.
Beta cells

Beta cells are the cells that produce the blood sugar-reducing hormone insulin. They
are arranged in small cell clusters in the pancreas. These cell clusters are known as
the islets of Langerhans. During the course of type 1 diabetes, the beta cells are
destroyed by the body's immune system. In type 2 diabetes, beta cells initially produce
increased amounts of insulin to counteract insulin resistance until they become
exhausted and the insulin production dries up.
Biguanide

See metformin.
Biomarkers

Biomarkers are biological properties that can be measured and evaluated in blood and
tissue samples. Biomarkers indicate both pathological and healthy processes in the
body. Hence, every laboratory value is a classic biomarker.
Biopsy
A biopsy is a diagnostic procedure to collect a tissue or cellular sample for laboratory
testing.
Blood sugar value, blood sugar level

The blood sugar value describes the amount of sugar (glucose) present in the blood. It
is influenced by factors such as food intake, physical activity, and especially by the
hormones insulin and glucagon.
Body mass index (BMI)

The body mass index (BMI) describes the ratio of body weight to body height. BMI is
calculated as follows:

BMI = Body weight in kilograms : Height in meters squared

The BMI is a guideline value used to determine if someone is overweight or not. The
following categories are used, although age also plays a role:

 Underweight: Less than 18.5 kg/m²

 Normal weight (optimal weight): 18.5 to 24.9 kg/m²
 Overweight: 25 to 29.9 kg/m²

A BMI of 30 kg/m² or above indicates obesity (adiposity). Because BMI does not
distinguish between fat and muscle mass, it cannot be used as an indicator of fat mass
in athletes with high levels of muscle mass, for example.
Bolus insulin

Bolus insulin is the fast-acting insulin that is normally injected directly or using an
injection-meal interval at mealtimes. Both human insulin and insulin analogs can be
used. Bolus insulin can also be used to correct elevated blood sugar levels when no
food is eaten. The bolus dosage is then usually much lower than the bolus dosage
taken before mealtimes.
Bread unit (BU)

A bread unit (BU) is an older unit used to calculate the amount of carbohydrates
contained in food. The BU is equal to 12 grams of carbohydrates. Nowadays, instead of
the BU, the carbohydrate unit (CU) is used. One CU is equal to 10 grams
of carbohydrates, making it easier to use in calculations.
Bronchial system

The bronchial system is an extensive system of tubes that carries the air we breathe
from the windpipe to the small pulmonary alveoli. This is where the air breathed in is
transferred to the blood and carbon dioxide is absorbed from the blood and removed
(exhaled) via the bronchial system.
Bypass

A bypass is a surgically created circumvention of an obstacle. For example, this can

include the grafting of blood vessels from other parts of the body. This enables narrow
or fully blocked vessels to be “bypassed” to ensure the flow of blood. During a gastric
bypass, the stomach is divided. A small part of the stomach is separated and connected
directly to the small intestine through which the food pulp flows. After surgery, the food
pulp bypasses the remainder of the stomach.
C
Cachexia

Cachexia is a severe form of emaciation, i.e., pathological weight loss.

Calorie

A calorie is a unit used to indicate the energy contained in food and the energy
requirements of the body. Calorie is often used colloquially when referring to a
kilocalorie, i.e., 1000 calories. A kilocalorie is the energy required to heat 1 liter of water
from 14.5 degrees Celsius to 15.5 degrees Celsius.
Carbohydrates

Carbohydrates are sugar molecules of different sizes. We consume carbohydrates with

the food we eat. Carbohydrates also act as an energy store in the body. As needed,
they are broken down into simple sugars, e.g., glucose.
Carbohydrate unit (CU or CHU)

A carbohydrate unit, abbreviated as CU or CHU, is a unit that enables people with

diabetes to determine the amount of carbohydrates in their food. They can use this
amount to derive how much insulin they need to inject. 1 carbohydrate unit is equal to
10 grams of carbohydrates.
Cardiometabolic

Cardiometabolic is a specialist medical term and means “relating to the cardiovascular

system and the metabolism”. Diabetes mellitus, high blood pressure, fat metabolism
disorders, and obesity are examples of cardiometabolic disorders.
Cardiovascular

Cardiovascular is a specialist medical term and means “relating to the heart and blood
vessels”. Cardiovascular diseases are also known as circulatory system diseases.
CGM (Continuous glucose monitoring)

CGM stands for continuous glucose monitoring. A sensor continuously measures the
glucose levels in the tissue fluid of the subcutaneous adipose tissue. It should always
be taken into account that the glucose value in the tissue fluid does not correspond to
the current blood glucose value but rather to the blood glucose value 15 minutes prior.
The transmitter, usually located on the abdomen or upper arm under the skin, relays the
value to a display device. Some models sound an alarm when the pre-determined
warning threshold has been reached, e.g., lower blood sugar levels. Depending on the
manufacturer, the sensor must be replaced once a week and calibrated before use.
Charcot foot
Charcot foot is a serious complication associated with long-term diabetes. It leads to
destruction of the bone and joint structures of the foot. Charcot foot is a special form
of diabetic foot syndrome and can develop in patient suffering from neuropathy and
blood circulatory disorders. Acute Charcot foot is an emergency requiring urgent
attention.
Cholesterol

Cholesterol is a fat-like substance It can enter the body through food, but is more
commonly produced by the body, primarily in the liver. It is a component of the cell walls
and a building block of many types of hormones. There are various forms of
cholesterol, which can be low-density (LDL) or high-density (HDL). The ratio between
these two types of cholesterol correlates to the risk for heart disease. Low LDL levels
and high HDL levels are associated with a lower risk of cardiovascular disease.
Cirrhosis

Cirrhosis is the hardening and scarring of organ tissue. Cirrhosis develops as a result of
inflammation and a pathological increase of connective tissue.
CLAMP technique

In the CLAMP technique, a fixed amount of insulin and variable amount of dextrose
(glucose) are administered intravenously (directly into the vein) until a normal blood
sugar level is achieved. This technique can be used to identify insulin resistance. The
glucose infusion rate correlates to insulin sensitivity. The more glucose that can be
administered with a pre-defined insulin dosage, the more effective the insulin.
Clearance

Clearance can be used to describe the detoxification performance of organs such as the
kidneys. Therefore, it can be used to examine kidney function. Clearance corresponds
to the amount of blood (excluding blood cells) cleared of a certain substance, for
example creatinine, in the kidneys within a certain time.
Closed loop system

This is an artificial pancreatic system, i.e., a medical device that automatically measures
tissue sugar levels. Tissue sugar is the glucose level in the subcutaneous adipose
tissue. A pre-determined amount of insulin is released via a insulin pump. The system
consists of a sensor that continuously measures the tissue sugar level, a pump that
releases insulin into the body depending on the sugar level, and a mini-computer that
analyzes the measurement data from the sensor and controls the pump. These types of
systems have been subject to extensive testing in trials for many years; however, they
have not yet been approved for sale.
Cohort study

A cohort study is a comparative observational study during which a group of people

(cohort) with or without certain characteristics is observed over a predefined period of
time. This enables the identification of differences in the onset of the target disease.
Cohort studies are particularly helpful in determining the specific risk factors of a
disease. For example, if one group are smokers and the other group are non-smokers,
then it can be studied how this affects their health status in the long-term.
Compliance

Compliance refers to the willingness of a patient to cooperate in the treatment of a

disease or in a study.
Continuous glucose monitoring

See CGM.
Conventional insulin therapy (CT)

During conventional insulin therapy (CT), people with diabetes administer themselves
individually specified amounts of mixed insulin at scheduled times during the day. Mixed
insulin contains both long-acting basal insulin as well as short-acting bolus insulin.
Along with the insulin dosage, this treatment form also predetermines the time and size
of meals. Only by adhering to a strict mealtime plan can severe blood sugar level
fluctuations be avoided and the therapy be successful. Blood sugar levels should
always be tested before administering the insulin. Conventional insulin therapy is
normally used for people with type 2 diabetes. It is used only in temporarily or in
exceptional cases for people with type 1 diabetes.
Coronary heart disease (CHD)

Coronary heart disease is a disease affecting the coronary vessels of the heart. It is
usually caused by arteriosclerosis, in which deposits of fat and other substances build
up in the arteries. Coronary heart disease causes a size reduction in the cross section
of the coronary arteries. This leads to reduced blood flow and oxygen supply. As the
disease progresses, the probability of further cardiac disease, such as heart attack,
increases.
Correction factor

The correction factor refers to the amount of insulin the body requires to reduce
elevated blood sugar levels by approx. 30 to 40 mg/dl (1.6-2.2 mmol/l) per unit of
insulin. The individual correction factor must be determined as part of a diabetes
training program and by testing under medical supervision.
Correction insulin

Correction insulin refers to the insulin dosage that must be additionally administered to
correct elevated blood sugar levels. It is generally administered together with mealtime
insulin in a course of intensified insulin therapy.
Cortisone

Cortisone, also known as cortisol, is a hormone produced in the adrenal cortex. Is it

produced in high amounts during times of stress and is also known as the stress
hormone. It promotes the build-up of glucose, i.e. gluconeogenesis. Cortisone is also
released in large amounts to counteract hypoglycemia (low blood sugar levels).
C-peptide
Together with insulin, C-peptide is produced by the beta cells in the pancreas. It is part
of what is known as proinsulin, the precursor of insulin. In certain cases, the C-peptide
value is determined to ascertain how well the beta cells are still functioning.
C-reactive protein (CRP)

C-reactive protein (CRP) is a protein that appears at elevated levels in the blood in
cases of inflammation.
Creatinine

Creatinine is a metabolic product of the muscles that is excreted via the kidneys.
Increased creatinine levels in the blood can be a sign of kidney damage. People with
reduced muscle mass, such as old people, may have reduced creatinine levels. For this
reason, even if the creatinine levels in the blood are normal, kidney function is impaired.
In contrast, elevated creatinine levels are often observed when there are muscle
injuries.
Creatinine clearance

Creatinine clearance can be used to assess kidney function. The term “clearance”
refers to the detoxification performance of the kidneys. The calculation requires the
creatinine concentration in blood plasma and urine, the amount of urine collected (over
a 24-hour period) and a correction factor. When the respective creatinine clearance
value is available, the glomerular filtration rate can be estimated.
D
Dapagliflozin

This blood sugar-reducing drug is given to adults with type 2 diabetes when the
commonly administered active ingredient metformin is not well-tolerated and lifestyle
changes did not reduce the blood sugar level sufficiently. Dapagliflozin is a SGLT-2
inhibitor. It can be taken in combination with other blood sugar-reducing agents.
Dawn phenomenon

The dawn phenomenon refers to the increase in blood sugar levels during the early
hours of the morning. This increase is caused by hormones that are released in greater
quantities by the body at that time. This causes the liver to produce more sugar
(glucose), resulting in an increase in the amount of insulin required. For some people,
their diabetes cannot be adequately managed using conventional or intensified insulin
therapy. This is one of reasons for insulin pump therapy. Using an insulin pump and
increasing the basal rate early in the morning can compensate for the morning rise in
blood glucose. Using long-acting insulin in the evening as part of intensified insulin
therapy or increasing the dose can help counteract the early-morning blood sugar
increase.
Degludec

Degludec is a long-acting insulin analog containing modified individual components

(amino acids) of the molecular structure of human insulin. This makes its effects last
significantly longer. It is one of the basal insulins.
Detemir

Detemir is a long-acting insulin analog (see insulin analogs) to which individual

components (amino acids) of the molecular structure of human insulin have been
added. This makes its effects last significantly longer. It is one of the basal insulins.
Dextrose

See glucose.
Diabetes insipidus

This is a disorder of the body’s water balance with unnatural levels of urine production
(between 5 and 20 liters per day). The disease is accompanied by an increased feeling
of thirst and, correspondingly, the intake of more liquids. The cause is a urine
concentration disorder in the kidneys. This can usually be traced back to a deficiency or
the lack of production of a certain type hormone that inhibits the excretion of water by
the kidneys.
Diabetic coma

A diabetic coma is a life-threatening metabolic imbalance caused by a lack of insulin in

people with diabetes. The resulting extremely high blood sugar levels can cause the
patient to lose consciousness. People who have fallen into a diabetic coma require
urgent medical attention and intensive care treatment. There are two main forms: The
ketoacidotic coma, which is more common in people with type 1 diabetes. People
with type 2 diabetes are more likely to suffer a hyperosmolar coma.
Diabetic foot

Diabetic foot, also known as diabetic foot syndrome, is a complication of diabetes.

Due to nerve and circulatory disorders, people with diabetes often also lose sensation in
their feet. This can result in foot problems, such as impaired wound healing.
Diabetologist

A diabetologist is a medical specialist (e.g., a specialist for internal medicine or

gynecologist) with an additional qualification for the medical treatment of people with
diabetes.
Dialysis

Dialysis is a method of treatment to remove urinary substances from the blood. These
substances are usually excreted via the kidneys. Dialysis, also known as blood
cleansing, involves removing toxins from the blood using an artificial kidney or by
flushing sterile fluids through the peritoneum. This treatment becomes necessary when
the kidney function is severely impaired and the kidneys are no longer able to carry out
this task.
Disaccharides

This is the specialist term for double sugars. This compound, a carbohydrate, is
comprised of two simple sugars (monosaccharides). An example of this is the classic
household sugar known as sucrose, which is comprised of the simple
sugars glucose and fructose.
Disease management program (DMP)

A disease management program is a treatment program for chronically ill people. It is

offered by health insurance providers and participation is free. The program consists of
training, regular visits to the physician, and predetermined examinations. People with
diabetes can usually register for the program by asking their treating physician.
DNA

Deoxyribonucleic acid (DNA) is a long-chain molecule in which genetic information is

stored. DNA consists of sugar molecules, phosphate, and 4 bases (adenine, guanine,
cytosine, and thymine). The order of the bases determines the genetic code. DNA is
made up of 2 strands running in opposite directions and joined together like a zipper.
Two bases always fit perfectly together. Adenine only links with thymine and guanine
only links with cytosine.
Doppler ultrasound

Using a Doppler ultrasound, a physician can make blood flow and possible narrowing of
the arteries visible on a screen.
Double sugars (disaccharides)

A double sugar is a larger sugar molecule comprised of two linked single sugar
molecules. An example of a disaccharide is sucrose – classic household sugar.
DPP-4 inhibitors (gliptins)

DPP-4 inhibitors are oral antidiabetics, i.e., medication in tablet form that is used to
treat patients with type 2 diabetes. Dipeptidyl peptidase-4, also known as DPP-4, is an
enzyme that breaks down certain types of protein. When the enzyme is inhibited,
certain gastrointestinal hormones in the blood are broken down more slowly, which has
a positive effect on the release of insulin. As a result, the blood sugar level after meals
is reduced, but not when in a fasting state. It also reduces the production of sugar in the
liver.
Duloxetine

Duloxetine is a drug used for pain management associated with diabetic neuropathy,
a complication of diabetes.
E
Edema

An edema is the collection of excess fluid in the tissue.

Elastography

Elastography is a special type of diagnostic imaging. It is a further advancement of the

ultrasound. It examines the stiffness of the organ tissue.
Electrocardiogram, ECG

This method is used to measure the electrical activity of the heart. The ECG is carried
out either resting (lying down) or during exertion (on a bicycle ergometer). It allows
conclusions to be drawn regarding heartrate and heart rhythm. Furthermore, the
excitation processes within the heart muscle can be measured. Excitation processes
are electric cardiac currents that power the heartbeat. This allows information to be
collected on any changes to the heart's form or structure.
Electroneurography

This examination tests the electrical function of the nerves and can identify
possible nerve damage.
Emergency BU (Emergency bread unit)

The term describes emergency bread units, or snacks containing carbohydrates, that
can be quickly absorbed by the body. They enable the rapid counteraction of
impending hypoglycemia (low blood sugar levels) . Dextrose tablets, muesli bars, or
fruit juice are good examples.
Energy balance

The energy balance is the ratio between energy use and energy intake. The energy
balance is positive when the energy intake is greater than the energy use. This is the
case during physical growth. After the growth phase is complete, a positive energy
balance leads to weight gain. Weight loss is only possible with a negative energy
balance, i.e., when energy intake is less than energy use.
Empagliflozin

This blood sugar-reducing drug is given to adults with type 2 diabetes when the
commonly administered active ingredient metformin is not well-tolerated and lifestyle
changes did not reduce the blood sugar level sufficiently. Empagliflozin is a SGLT-2
inhibitor. It can be taken in combination with other blood sugar-reducing agents.
Enzymes

Enzymes are proteins that trigger or speed up chemical reactions. Enzymes are
involved in almost all metabolic reactions in the body.
Epidemiology

The field of epidemiology studies the distribution and causes of diseases within the
population. Epidemiological diabetes research examines how many people within a
certain period of time develop diabetes and how many people in the population are
living with diabetes. The geographic distribution of the disease is often analyzed.
Factors such as age, gender, and social class are also important aspects in describing
the development of diabetes.
Excess mortality
Excess mortality means an above-average death rate. In the context of diabetes,
excess mortality shows how many deaths can be traced back to diabetes in comparison
to people who do not have diabetes.
F
Fasting glucose (fasting blood sugar)

The fasting glucose level or fasting blood sugar level are the terms used to describe the
blood sugar level on an empty stomach, i.e., after at least 8 hours without eating.
Fat

Alongside carbohydrates and proteins, fats are an important source of energy in the
body. Dietary fats are made up of glycerin and fatty acids.
Fat distribution

In addition to obesity, the way fat is distributed throughout the body also poses a health
risk. Accumulation of fat in the abdomen is associated with a high risk of diabetes and
cardiovascular diseases. In contrast to fat stored on the hips, abdominal fat is
metabolically very active. The abdominal (abdomen=stomach) or male (android) fat
distribution (apple-shaped) stands in contrast to the less risky hip deposited female
(gynoid) fat distribution. This is known as pear-shaped. Fat distribution can be
determined using the waist-to-hip ratio. Men are deemed apple-shaped when the
waist-to-hip ratio exceeds 0.90. For women, the threshold is 0.85.
Fatty acids

Fatty acids are components of the fats found in food. Depending on whether they are
chemically linked by single bonds only or also contain one or more chemical double
bonds, there are categorized as saturated or unsaturated fatty acids. Saturated fatty
acids can be found in foods such as butter, cheese, and meat. Unsaturated fatty acids
are found in olive oil, rapeseed oil, or nuts, for example.
Fatty liver

Fatty liver describes an increased fat content within the liver tissue. It can be a
precursor to liver cirrhosis (hardening of the liver). It is considered a risk factor for the
onset of type 2 diabetes.
Fiber

Dietary fibers are food components that the body is unable or only partially able to
digest, e.g., cellulose. They give a feeling of fullness and promote healthy bowel
movements. They also delay the absorption of sugar and cholesterol by the intestinal
tract. Most dietary fibers are complex carbohydrates, also known
as polysaccharides.
Fibrosis

Fibrosis is a pathological increase in connective tissue within an organ.

Fructosamines
Fructosamine values are used to examine metabolic adjustment in people with
diabetes. Fructosamines are proteins in the blood onto which blood sugar (glucose) has
been deposited. Because these proteins have a life expectancy of approx. 20 days, the
fructosamine value reflects the metabolic adjustment over the course of the last 1 to 3
weeks. The higher the blood sugar level, the higher the fructosamine concentration. In
some cases, the fructosamine value is determined alongside the HbA1c value;
however, it cannot replace it.
Fructose

Fructose is a simple sugar that is found in fruit and honey, among other things. It is
also a component of household sugar (sucrose). Fructose causes a slower increase in
blood sugar level than glucose and is metabolized independently of insulin. However,
a certain amount of fructose is converted into glucose, meaning that people with
diabetes should only consume fructose in moderation. It is just as energy-rich as
household sugar or glucose.
G
Gastroparesis, Diabetic

Gastroparesis is paralysis of the stomach and can be a complication of diabetes. It

develops upon damage to autonomic nervous system of the gastrointestinal tract
(polyneuropathy). It can result in severe blood sugar level fluctuations in the form of
severe low blood sugar levels (see reactive hypoglycemia).
Genes

A gene is a carrier of hereditary information. It is the term for a section of DNA that
contains genetic information. This functions as a code for human cells, which they
require, in particular, for the production of proteins.
Gestational diabetes

Pregnancy diabetes (gestational diabetes) is a type of diabetes that develops during

pregnancy. Pregnancy diabetes is one of the most common diseases accompanying
pregnancy. This form of metabolic disorder usually disappears after giving birth.
However, the disease increases the risk that the mother will later develop type 2
diabetes.
Glargine

Glargine is a long-acting insulin analog to which individual components (amino acids)

of the molecular structure of human insulin have been added. This significantly
prolongs the effect of the insulin. It is one of the basal insulins.
Glimepiride

Glimepiride is an oral antidiabetic from the class of sulfonylureas and is used in the
treatment of type 2 diabetes. This blood-reducing active ingredient increases the
release of insulin in the body.
Glinides
Glinides are oral antidiabetics. They increase the release of insulin by the pancreas.
This increased production improves the absorption of sugar from food by the body's
cells. Insulin release is faster and is less prolonged than with sulfonylureas. Therefore,
glinides are taken at mealtimes.
Gliptins

Gliptins are oral antidiabetics used in the treatment of type 2 diabetes. They belong
to the drug class of DPP-4 inhibitors. The gliptins include active ingredients such as
sitagliptin, vildagliptin, or saxagliptin are gliptins.
Glitazones

Glitazones are oral antidiabetics. They improve blood sugar levels by increasing the
insulin sensitivity of the fatty tissue, muscles, and liver. This increase in sensitivity
allows more blood sugar to be absorbed and processed by the cells. Due to the side
effects, glitazones are only used in exceptional cases in the treatment of type 2
diabetes.
Glomerular filtration rate

The glomerular filtration rate is a marker for how well the kidneys are working. The
name comes from the word glomeruli. These are very thin vessels in the kidneys that
are responsible for filtering the blood.
GLP-1

The abbreviation GLP-1 stands for Glucagon-like Peptide. This is a hormone produced
in the gastrointestinal cells as soon as new food arrives in the digestive tract. The
gastrointestinal cells then release GLP-1 into the blood. GLP-1 simulates
the pancreas to release more insulin. At the same time, GLP-1 inhibits the release
of glucagon, the counterpart of insulin, by the pancreas. GLP-1 plays a role in reducing
blood sugar levels. GLP-1 also inhibits the emptying of the stomach, meaning that a
feeling of fullness occurs quicker. In the long-term, this usually results in weight loss.
However, GLP-1 is rapidly broken down in the blood by the enzyme dipeptidyl
peptidase-4 (DDP-4). Therefore, people with diabetes are treated using medication that
inhibits DDP-4 so that the concentration of GLP-1 in the blood remains high for as long
as possible. These types of medications are known as DDP-4 inhibitors.
Glucagon

Glucagon is a hormone in the pancreas. It is produced in the alpha cells in the islets
of Langerhans. This hormone increases blood sugar levels and is considered the
counterpart of insulin.
Gluconeogenesis

This is the production of new glucose in the liver and, to a lesser extent, in the kidneys,
using fats, protein building blocks, and lactic acid. For example, gluconeogenesis
maintains the energy supply to the brain and muscles when not
enough carbohydrates are consumed.
Glucose
Glucose is a specialist term for dextrose. Glucose is a simple sugar and belongs to
the carbohydrate nutrient group. Carbohydrates are broken down in the intestines to
create glucose. The glucose is then transferred to the blood (blood sugar). Glucose is
the most important supplier of energy for the human body and its organs. It is absorbed
via insulin into the cells, which use it as fuel.
Glucose tolerance, Impaired

This is when the blood sugar level does not drop sufficiently within a certain time after
consuming sugar, but type 2 diabetes is not yet present. Impaired glucose tolerance is
defined as a blood sugar level between 140 mg/dl (7.8 mmol/l) and 200 mg/dl (11.1
mmol/l) 2 hours after drinking a solution with 75 g glucose as part of an oral glucose
tolerance test. People with these blood sugar levels have an elevated risk of
developing diabetes or cardiovascular diseases. Lifestyle changes, together with a
balanced diet and physical activity, can help improve impaired glucose tolerance.
Glycosuria

This is the increased excretion of glucose with the urine via the kidneys.
Glycemic index

The glycemic index is a scale to determine how a food containing carbohydrates will
affect the blood sugar levels. It explains how quickly and how severely the blood sugar
level will increase after eating. Dextrose (glucose) acts as the reference value, as it
triggers the greatest increases in blood sugar levels. It has the highest glycemic index
value at 100.
Glycogen

Glycogen is the stored form of dextrose (glucose). The body can convert dextrose into
glycogen and store it primarily in the liver and muscles. If the blood sugar level is low
or the body has increased energy requirements, then the stored glycogen can be
converted back into dextrose. This is then provided to the organs and cells as an energy
source. Glycogen is a polysaccharide.
Glycogenolysis

This term is used to describe the breaking down of the stored sugar form glycogen into
glucose, especially in the liver and muscles. When glycogen is required by the body as
an energy source, the hormones adrenaline and glucagon help transform the glycogen
into glucose.
Growth hormone

This hormone is produced in the pituitary gland. This hormone promotes growth during
childhood and cell renewal in adults. For example, growth hormone increases blood
sugar levels due to the increased generation of glucose (gluconeogenesis).
Gynoid fat distribution

See Fat distribution.

H
HbA1c

The HbA1c is also known as the long-term blood sugar value or blood sugar memory.
Hb stands for the red blood pigment hemoglobin in the red blood cells. Sugar attaches
itself to this red blood pigment. The higher the blood sugar level, the more sugar
accumulates. Because the life cycle of a red blood cell (and correspondingly the
hemoglobin) is 3 months, the average body sugar level during the last 3 months can be
determined using the HbA1c value. Therefore, the HbA1c value is a marker for the
quality of the blood sugar level management.

The HbA1c value increases physiologically as we age. To prevent the complications

of diabetes, guidelines recommend the maintenance of graduated HbA1c target values
that take age and possible comorbidities into account (between 6.5 and 8 percent).
Heart scintigraphy

A heart scintigraphy produces an image of the blood circulation in the heart muscles.
During this examination, carried out under resting and exertion conditions, a low-
radioactive substance is injected into an arm vein. It accumulates in the heart muscles
and a special camera takes images of the heart.
Hepatitis

Hepatitis is inflammation of the liver. It has various causes.

Hereditary predisposition

Hereditary predisposition describes the inborn susceptibility or predisposition to a

particular disease.
High blood sugar

This is a term for increased blood sugar levels, see hyperglycemia.

Hormones

Hormones are messenger substances that are produced in glandular tissues and
transported via the blood circulatory system. They use signals to control various
processes in the body, e.g., they regulate the blood sugar level.
Human insulin

Human insulin is a medication used in the treatment of diabetes. It is identical to

the insulin naturally produced in the pancreas. It is produced using genetically-
modified bacteria and yeasts.
Hydramnios

Hydramnios, also known as polyhydramnios, is a common complication associated

with gestational diabetes. The term is used to describe a pathological increase of
amniotic fluid to an amount exceeding 2 liters. Too much amniotic fluid can cause
severe abdominal tension or breathing difficulties, among other things. It can also result
in premature membrane rupture and trigger the premature onset of contractions.
Hyperglycemia (high blood sugar levels)
Hyperglycemia is the specialist term for high blood sugar levels associated with
diabetes or prediabetes. A fasting blood sugar level of 200 mg/dl (11.1 mmol/l) or
higher indicates the existence of diabetes.
Hyperlipidemia

Hyperlipidemia is an excess of lipids or fats in the blood, such as elevated total or LDL
cholesterol or elevated triglyceride levels. This puts people at risk of cardiovascular
diseases.
Hypertension

Hypertension is the specialist medical term for high blood pressure. High blood pressure
is present when values of 140/90 mmHg or higher are measured repeatedly. High blood
pressure increases the risk of heart attack, stroke, kidney failure, and other diseases.
The risk of such diseases is further increased when high blood pressure is coupled with
diabetes. The risk of high blood pressure can be reduced by adopting a healthy lifestyle,
e.g., a healthy diet and more physical activity.
Hypoglycemia (low blood sugar levels)

Hypoglycemia is the specialist term for low blood sugar levels. A low blood sugar level
is the most common side effects of treatment with insulin and/or certain types of blood
sugar-reducing medications. It develops when the amount of insulin or antidiabetic
tablets does not correspond to the available amount of carbohydrates, for example, in
the following situations:

 Incorrect estimate of the amount of carbohydrates consumed

 Waiting too long between injecting and eating
 After physical activity
 After drinking alcohol
 During gastrointestinal diseases
 As a result of drug interactions

Hypoglycemia unawareness

This is the impaired ability to identify the warning symptoms of low sugar levels. It is
especially prevalent in patients with type 1 diabetes.
Hypothalamus

The hypothalamus is a region of the brain that acts as the interface between the
hormonal and nervous system. The hypothalamus can receive nerve signals and then
activate the pituitary gland, triggering the release of certain hormones into the
bloodstream. Many nerve cells in the hypothalamus are able to directly perceive
glucose, enabling them to act as a sensor for blood sugar levels.
I
IGT

IGT stands for impaired glucose tolerance.

Incretin mimetics

Incretin mimetics, for example exenatide or liraglutide, are blood sugar-

reducing medications used in the treatment of type 2 diabetes. This active
ingredient class is also known as GLP-1 analogs or GLP-1 receptor agonists. They are
similar in their composition to the GLP-1 hormone. They increase the release of insulin
while inhibiting the release of glucagon. They also delay the emptying of the stomach.
Low blood sugar levels are usually only a concern when incretin mimetics are
administered simultaneously with insulin, sulfonylureas or glinides, because incretin
mimetics only trigger the release of insulin in the event of high blood sugar levels.
Similar to insulin, incretin mimetics are injected under the skin.
Injection

This term refers to the administering of a pharmaceutical agent into the body. The
pharmaceutical agent can be injected under the skin, into a vein, or into a muscle.
Injection-meal interval

The injection-meal interval is the time between administering insulin and eating a meal.
Special attention must be paid to the injection-meal intervals when using human
insulin.
Insulin

Insulin is the body’s own essential hormone. It is a messenger substance produced in

the beta cells of the pancreas and then released into the blood. It enables the
absorption of sugar (glucose) by the cells. Insulin inhibits the release of glucose from
the liver into the blood. This causes the blood sugar levels to drop. Severe metabolic
disorders can develop without insulin. The amount of sugar in the blood increases
resulting in the onset of diabetes.
Insulin analogs

Insulin analogs are a medication used in the treatment of diabetes. They are produced
by switching and modifying certain building blocks of insulin. This enables the time and
duration of effect to be changed. This makes for a better control of insulin therapy.
They are produced using genetically modified bacteria and yeasts.
Insulin pen

An insulin pen is a device that looks like a fountain pen, which is used to
administer insulin.
Insulin pump

An insulin pump is a device used in the treatment of diabetes. An insulin pump remains
attached to patient’s body and only administers short-acting insulin. It is continuously
administered via a cannula (known as a needle) into the subcutaneous adipose tissue.
If additional insulin is required, e.g., before a meal, this can be administered by pressing
a button. This removes the need for multiple injections throughout the day.
Insulin purging
Insulin purging is when no insulin or not enough insulin is injected to stop sugar from
food being adsorbed by the body. It is then excreted via the kidneys. This results in
weight loss. However, the consequences of extremely high blood sugar levels include
damage to the blood vessels, kidneys, and nerves. In the worst case, this can result in
the development of highly dangerous ketoacidosis.
Insulin resistance

This is when the effect of the blood sugar-reducing hormone insulin is less than
expected. Insulin resistance is a precursor and a disease mechanism of type 2
diabetes. Insulin resistance causes the cells, especially in the muscles, liver, and fatty
tissue, to no longer sufficiency react to the hormone insulin. This means that the insulin
can no longer effectively transport sugar from the blood into the cells. To achieve the
same levels of insulin effectiveness as healthy people, people with insulin resistance
must produce more insulin.
Insulin receptor

An insulin receptor is the binding site for insulin on the surface of the cell. These binding
sites are found especially in muscle, liver, and fat cells. The binding of insulin with the
receptor “opens the door” of the cells and allows for the increased absorption
of glucose by the cells.
Insulin unit

An international unit, abbreviated I.U., corresponds to 0.042 milligrams of pure insulin. 1

milligram of insulin corresponds to approx. 28 insulin units.
Intensified conventional insulin therapy (ICT)

Intensified conventional insulin therapy (ICT) is the separate application of fast-

acting bolus insulin and long-acting insulin (basal insulin) to meet the basic insulin
requirements. Human insulins or insulin analogs are used as short-acting insulin. The
long-acting insulins are either NPH delayed-onset insulins or long-acting insulin
analogs.
Interleukins

Interleukins are messenger substances in the body. They regulate the reactions of the
immune system. Certain types of interleukins promote inflammation while others have
anti-inflammatory effects.
Interventional study

An interventional study is a study during which the research team assigns different
treatments (e.g., treatment using types of medication) to the participants. The research
team applies the different treatments to the participants, observes, and examines any
changes. Scientists want to find out how effective certain measures are, for example,
those used in the treatment of diabetes.
Intravenous

This is the administration of a medication in the form of an injection or infusion into the
vein.
Intravenous glucose tolerance test (ivGTT)

This test is used to diagnose diabetes and is carried out in cases in which an oral
glucose tolerance test is not possible. During an intravenous glucose tolerance test,
the physician injects a dextrose solution directly into the blood. They then measure how
much insulin is produced by the beta cells in the pancreas. The test is used to
examine how well the insulin production of the beta cells is functioning.
iscCGM, intermittently scanned CGM

isCGM is a measurement system used to determine tissue sugar levels in the

subcutaneous adipose tissue without the need for device calibration. The isCGM
system consists of a sensor and a reader. It is attached to the upper arm with the help
of an adhesive and is left in the same position for up to 14 days. A filament is attached
to the sensor and placed under the skin. This filament continuously measures the tissue
sugar between the cells in the subcutaneous adipose tissue. The measurements can be
accessed at any time using the reader/scanner device.
Islet cells

See islets of Langerhans.

Islets of Langerhans

The islets of Langerhans are cell clusters located in the pancreas, which is where the
hormones glucagon and insulin are produced. They are primarily made up of alpha
cells and beta cells.
J
Joule

A joule is the unit of measurement for the nutritional value of food. 1 joule corresponds
to 0.239 kilocalories. The energy content of food is indicated using two type of units:
Kilojoule (kJ) and kilocalorie (kcal).
K
Ketoacidosis

Diabetic ketoacidosis is an acute complication that affects those with type 1

diabetes in particular. It is caused by a large increase in blood sugar levels resulting
from a lack of insulin. An insulin deficiency or a large increase in the amount of insulin
required can also occur during a serious infection with fever, vomiting, and/or diarrhea
or during the onset of serious conditions such as heart attack, stroke or unidentified
hyperthyroidism. If there is not enough insulin available, then sugar cannot be
transferred from the blood into the cells. As a result, the cells do not have enough
energy for metabolic processes. The body then begins to burn fat to meet its energy
needs. The fat is broken down into fatty acids and these are then incompletely broken
down into what are known are ketone bodies. The elevated concentration of ketone
bodies leads to dangerous hyperacidity of the blood. Ketoacidosis develops with the
following range of possible symptoms:

 Increased urination (polyuria),

 increased thirst (polydipsia),
 visual impairment,
 bodily dehydration (exsiccosis),
 muscle cramps,
 and nausea and vomiting.

A diabetic ketoacidosis coma can also develop, which, in the worst-case scenario, may
result in death.
Ketonemia

Ketonemia describes the increase of ketone bodies in the blood.

Ketone bodies

Ketone bodies are substances that are produced in increased amounts during the
breakdown of fat as a result of lack of insulin. For example, they include acetone.
Above a certain concentration, they can cause ketoacidosis.
Ketone test

A ketone test can be used to detect excess ketone body production in the blood or
urine. They may also indicate a serious metabolic imbalance, ketoacidosis, which can
affect people with type 1 diabetes in particular. Test strips for a ketone urine test,
which display the result using staining, can be found at the pharmacy.
Ketonuria

This is the term for when ketone bodies are excreted with the urine. Especially in
cases of type 1 diabetes with insulin deficiency, ketonuria can be a sign
of ketoacidosis. The excretion of the ketones with the urine can be measured using
test strips (ketone test).
Kussmaul breathing

When suffering from ketoacidosis, a characteristic acetone-like smell (comparable

with nail polish remover or rotten fruit) can be detected in the breath. The smell
develops from metabolic products (ketone bodies) released in the body when fat is
broken down to generate energy. Since glucose cannot enter the cells of most organs
without insulin, alternative metabolic pathways must be found. The patient’s breathing is
also stimulated to enable the increased carbon dioxide (CO2) resulting from hyperacidity
to be exhaled. This type of breathing is named after the physician Adolf Kußmaul, who
was the first to report it in 1874.
L
Lactic acidosis
Lactic acidosis is rare and is usually associated with the use of metformin when
attention is not paid to the contraindications. Blood sugar is normally broken down in the
presence of oxygen. When this is not the case, there is a buildup of lactic acid. It cannot
be broken down to the same extent as normal by the liver. The symptoms of lactic
acidosis are non-specific but can include weakness, nausea, and abdominal pain. The
patient can fall into an unconscious state within a few hours accompanied by a deep
and rapid breathing pattern. This is known as Kussmaul breathing.
Latent autoimmune diabetes in adults (LADA)

LADA is a special form of type 1 diabetes that develops in adulthood. In this form of
diabetes, the insulin deficiency develops relatively slowly. Initially, it is often incorrectly
diagnosed as type 2 diabetes because the symptoms are similar. However, people
with LADA have islet cell antibodies (ICA) and/or antibodies against the enzyme
glutamate decarboxylase (GAD) in their blood serum. The presence of these antibodies
is evidence that the immune system is turning against the body. This prevents the
production of insulin.
Legacy effect

This describes the long-term reduction of the complications of diabetes associated

with good blood sugar management, especially in the early stages of the disease.
Leptin

Leptin is a hormone produced in the fatty tissue. It plays a role in the sensations of
hunger and fullness. It relays the fullness status of the fatty tissue to the brain and is
involved in the regulation of the body’s fat mass. High leptin levels in the blood suppress
the appetite of people with a normal body weight. This is not the case if the person is
overweight. Therefore, it is assumed that obesity is accompanied by leptin resistance.
Lipohypertrophy

Lipohypertrophy is an area of increased fatty tissue at an insulin injection site. A lump

develops because the tissue is hardened and swollen. The injection of insulin promotes
the growth of fat cells at the site. The absorption of the insulin at the swollen site begins
to change over time. For this reason, the injection site should be changed regularly.
Liver enzymes

These are enzymes, i.e. proteins, that are characteristic of the liver cells. In the event of
liver disease, they can provide essential information regarding the type and extent of the
disease.
Long-term blood sugar value (HbA1c)

This value provides information on blood sugar levels during the previous 8 to 12
weeks. This is the long-term memory for blood sugar levels and is indicated using
the HbA1c value.
Low blood sugar

This is a term for reduced blood sugar levels, see hypoglycemia.

Lymphocytes
Lymphocytes are a type of white blood cell. They combat dangerous foreign substances
in the body and are a component of the immune system. Elevated or reduced levels
point to various types of diseases.
M
Macrosomia

Macroangiopathy is pathological damage to the major blood vessels (arteries). This

often leads to the buildup of deposits on the walls of the large arteries in various organs,
such as the heart and brain, but also in the legs.
Macroalbuminuria

Albumin is a blood protein that is produced in the liver. Macroalbuminuria is the greatly
increased excretion of albumin in the urine. The excretion is at levels above 300
milligrams per day. It is a warning sign for diabetic kidney damage.
Macroangiopathy

Macroangiopathy is pathological damage to the major blood vessels (arteries). This

often leads to the buildup of deposits on the walls of the large arteries in various organs,
such as the heart and brain, but also in the legs.
Macrovascular

Macrovascular is a specialist medical term that means “relating to the medium and large
blood vessel (arteries)” (see also macroangiopathy).
Malformation

Malformation is the specialist medical term used to describe the abnormal formation of a
part of the body.
Maltit

See sugar substitutes.

Mannitol

See sugar substitutes.

Maturity onset diabetes of the young (MODY)

MODY was previously known in Germany as type 3a diabetes. This form of diabetes
stems from genetic defects. These defects cause a functional impairment of the beta
cells (beta cell dysfunction). MODY affects less than 5% of diabetes suffers worldwide.
Generally, MODY is found in familial clusters of adults with normal weight below 25
years of age. Patients with MODY are often initially diagnosed with type 1 or type 2
diabetes. The mutations can only be identified using genetic testing. There are
currently 13 types of MODY known to science.
Metabolic decompensation
Metabolic decompensation is when blood sugar levels are within a very low or a very
high range. In both situations, quick action is required. In extreme cases, very low
blood sugar levels (severe hypoglycemia) and very high blood sugar levels
(severe hyperglycemia) can lead to diabetic coma and can be life-threatening. Read
here what to do in a diabetes emergency.
Metabolic syndrome

Metabolic syndrome is the term used for a combination of various risk factors for
numerous complications. A metabolic syndrome is diagnosed when at least 3 of the
following 5 risk factors are evident:

 A waist circumference measurement exceeding 88 cm in women and 102 in men

 Elevated triglyceride values exceeding 150 mg/dl
 HDL cholesterol levels below 40 mg/dl in women and below 50 mg/dl in men
 A blood pressure level exceeding 130/85 mmHg
 Elevated fasting blood sugar levels above 100 mg/dl (above 5.6 mmol/l) or the
presence of type 2 diabetes

Metabolism, glucose metabolism

Metabolism is the term for all the processes in the body during which the body absorbs,
transforms, and breaks down substances it requires to maintain function.

The term glucose metabolism encompasses all the processes in the body during
which glucose is used to generate energy. The intestines, liver, and muscles are
important organs for these processes. However, all other bodily functions and organs
also require energy and are therefore involved in the glucose metabolism.
Metformin

Metformin is an oral antidiabetic often used to treat type 2 diabetes. It belongs to the
biguanide class of substances. It improves the insulin sensitivity of the cells and
reduces the release of sugar (glucose) from the liver. This results in a fall in blood
sugar levels, even in a fasting state. The release of insulin is unaffected by metformin,
meaning that therapy with metformin alone presents no risk of low blood sugar levels.
Microalbuminuria

Albumin is a blood protein that is produced in the liver. Microalbuminuria is a slightly

increased excretion of albumin in the urine, in contrast to macroalbuminuria. Excretion
is at levels between 20 to 200 mg/l or 30 to 300 mg/day. It can be an early sign
of diabetic kidney damage.
Microangiopathy

Microangiopathy is pathological damage to the smaller blood vessels (arteries). In

cases with diabetes, the smaller blood vessels in the eyes (retinopathy), kidneys
(nephropathy), nerves (neuropathy), and feet (diabetic foot syndrome) are affected.
Microvascular
Microvascular is a specialist medical term meaning “relating to the smallest blood
vessels (capillaries)” (see also microangiopathy).
Mixed insulin

Mixed insulin is a manufactured mix of short- and long-acting insulin to meet both basic
requirements and the insulin requirements after meals.
Monosaccharides

This is the specialist term for what are known as simple sugars.
Multiple sugars

These are very large sugar molecules, comprised of many simple sugars linked
together. The storage substances starch and glycogen belong to this category.
N
NAFLD

NAFLD stands for non-alcoholic fatty liver disease. Fatty liver causes deposits of fat to
build up in the liver cells. Fatty liver disease can have serious consequences when the
liver becomes inflamed as a result of steatosis (see NASH).
NASH

The abbreviation NASH stands for non-alcoholic steatohepatitis. It is a more hazardous

form of fatty liver disease (see NAFLD). It causes inflammation of the steatotic liver
cells.
Nephropathy, Diabetic

Diabetic nephropathy is a complication of diabetes. It results in increased loss of filter

function in the kidneys because high blood sugar levels damage the renal
vessels. Diabetic nephropathy is characterized by continuously elevated protein
excretion levels in the urine (Microalbuminuria). Later, the creatinine
clearance begins to drop.
Neuropathy, Diabetic

Diabetic neuropathy is nerve damage associated with

diabetes (see polyneuropathy).
NPH insulin

NPH stands for neutral protamine hagedorn. Delayed onset NPH insulins have a long-
lasting effect because the human insulin has been bound to the delayed onset
substance neutral protamine hagedorn (NPH). Delayed onset NPH insulins are basal
insulins and are used to meet the body's basic insulin requirements.
O
Obesity
Obesity, also known as adiposity, is extreme overweightness due to an excessive
increase in fat levels. Someone is considered obese when their body mass index
(BMI) is above 30 kg/m². The BMI is calculated by dividing body weight (in kg) by height
(in meters squared). Obesity is divided into three different severity categories. Obesity
increases the risk of type 2 diabetes, especially if the fat is predominantly located in
the abdominal region.
Off-label use

Off-label use is when a drug is prescribed for use outside of the scope of application for
which it was originally approved. For example, a drug is used off-label when the
indications, dosage, or age of the patient deviate from the original scope of approval.
This is often the case in the treatment of rare diseases, children, and pregnant or
breastfeeding women.
Oral antidiabetics

Oral antidiabetics are a type of medication in tablet form used to reduce blood sugar
levels and are used more in the treatment of type 2 diabetes. They are used when
a change to the diet or improvements in lifestyle are not sufficient. There are
differences in the modes of action of the various oral antidiabetics. The following oral
antidiabetics are used in the treatment of type 2 diabetes:

 Metformin
 Sulfonylureas
 Glinides
 DPP-4 inhibitors
 SGLT-2 inhibitors
 Alpha-glucosidase inhibitors
 Glitazones

Oral glucose tolerance test (OGTT)

An oral glucose tolerance test (OGTT) is used to determine blood sugar levels. It is
carried out when diabetes mellitus is suspected. The sugar tolerance test takes place
with the patient resting either lying down or sitting up after an 8- to 12-hour period
without food or smoking. To begin the test, the premixed sugar solution with 75 grams
of glucose is drunk within 5 minutes. Before drinking the solution, and between 1 and 2
hours after, a venous blood sample is collected. The blood sugar level is then
determined. An elevated fasting value (above 126 mg/dl or 7.0 mmol/l) and an
elevated 2-hour value (above 200 mg/dl or 11.1 mmol/l) indicate diabetes.
Orlistat

The active ingredient orlistat is a medication in tablet form used to treat obesity. The
body needs to break down fats using the enzyme lipase before they can be absorbed
and utilized. Orlistat inhibits the enzyme in the intestines, reducing the absorption of fat
by approx. 30 percent. The use of this medication can result in an additional weight loss
of approx. 2 kilograms. Common side effects are soft stool, an increased urge to empty
bowels, and flatulence. There may also be reduced absorption of fat-soluble vitamins.
Oxidative stress

Oxidative stress is a disparity between the production and breakdown of free radicals.
Free radicals are highly reactive. It there are more free radicals present than the body
can eliminate, then oxidative stress develops. There are various different triggers for
oxidative stress. These include smoking, drinking alcohol, medications, or stress.
Oxidative stress can result in temporary or permanent damage and accelerate the
effects of aging.
P
Pancreas

The pancreas is an organ located in the upper abdominal region behind the stomach. It
releases various substances into the intestine or directly into the blood and therefore
plays a role in the digestion of food. It also produces the
hormones insulin and glucagon.
Pancreatitis

Pancreatitis is inflammation of the pancreas.

Pen

See insulin pen.

Periodontal disease

Periodontitis is the chronic bacterial inflammation of the periodontium. The disease

progresses slowly and gradually leads to bone loss. The affected teeth begin to loosen.
If left untreated, it leads to tooth loss. Gum inflammation is a precursor to periodontitis.
Peripheral artery disease (PAD)

PAD stands for peripheral artery disease, also known as intermittent claudication. PAD
is a disorder affecting blood flow in the pelvis, arms, and legs. PAD frequently results in
calcification of the blood vessels of the legs, causing them to become severely
narrowed or blocked. Blood then no longer reaches the feet, meaning they do not
receive sufficient oxygen or nutrients. The initial stage of the circulatory disorder is
usually symptom-free. The first PAD symptoms are aching and cramp-like pain when
walking that forces the sufferer to stop.
Placebo

A placebo is a substance with no active ingredient. Placebos are used as a method for
comparison in scientific studies. They allow observations made during the study to be
compared with one another. For example, if certain effects are observed both in the
placebo group as well as in the group receiving the real active ingredient, then the
effects cannot stem from the active ingredient.
Plasma
(Blood) plasma is the term used to describe all the liquid components of blood. It
consists of water, proteins, nutrients, salts, metabolic
products, enzymes and hormones. Blood plasma no longer contains blood cells or
blood platelets. In contrast to serum, plasma still contains coagulation factors.
Podiatrist

This is the legally protected professional title for a medical specialist for foot care.
Polydipsia

Polydipsia is pathologically excessive thirst. It is accompanied by excessive fluid intake.

Polyneuropathy, Diabetic

Diabetic polyneuropathy is a disease affecting several nerves that can develop as a

result of diabetes mellitus. It can affect both the voluntary (somatic) part of the
peripheral nervous system and the involuntary (autonomic) nervous system. The latter,
for example, regulates breathing, heartrate, and bowel movements. Damage to these
systems is often only noticed once it has already become more pronounced. “Negative
symptoms” are when function is reduced: Touch, differences in temperature, and pain
stimuli are gradually perceived less and less. In contrast, “positive symptoms” are when
sensations are perceived that should not be: This includes numbness, tingling, or many
types of pain (burning, searing, stabbing, dull, or piercing). These sensory disturbances
often manifest when resting in the evening and improve with movement.
Polysaccharides

This is the specialist term for what are also known as multiple sugars.
Polyuria

Polyuria is the excretion of excessive amounts of urine (more than 2 liters per day). It
can be a sign of diabetes mellitus or diabetes insipidus.
Postprandial

Postprandial means “after eating” or “after a meal” (see also preprandial).

Prediabetes

The term prediabetes refers to a state with elevated blood sugar levels (fasting blood
sugar 100 to 125 mg/dl (5.6 to 6.9 mmol/l) and/or 2-hour glucose value in the 75
gram oral glucose tolerance test of 140 to 199 mg/dl (7.8 to 11 mmol/l) and/or
elevated HbA1c values (5.7 percent to 6.4 percent (38.8 to 46.5 mmol/mol)) that are
however below the threshold value for diabetes.
Pregabalin

Pregabalin is an active substance used in the pain therapy of diabetic foot syndrome,
a complication of diabetes.
Pregnancy diabetes

See gestational diabetes.

Preprandial
Preprandial means “before eating” or “before a meal” (see also postprandial).
Prevalence

Prevalence is a specialist medical term for the frequency of a disease. For example, it
indicates what percentage of people at a certain point in time or during a period in time
are suffering from a specific type of disease.
Prospective

Prospective means “likely to happen in the future” or “forward looking”. In a prospective

study, the outcome analyzed by the research team, e.g., a specific type of disease, has
not yet occurred by the start of the study. During the study, the research team
investigates when and how frequently the disease occurs. The opposite of prospective
is retrospective (see also retrospective).
Prostaglandins

Prostaglandins are tissue hormones. They play a crucial role in pain, inflammation, and
blood coagulation.
Proteins

Proteins are naturally occurring substances that are comprised exclusively or mainly
of amino acids. They are an essential component of all living organisms and,
alongside carbohydrates and fats, belong to the basic nutrients. They assume a wide
range of tasks in the body.
Proteinuria

Proteinuria is when more than 150 milligrams of protein per day is excreted via the
urine. An albumin test is often carried out to diagnose the condition (see
also albuminuria).
Q
Quercetin

Quercetin is a natural pigment from the flavonoid group of polyphenols. Quercetin can
be found in fruits, nuts, seeds, and tea, among other things. Studies with animals
showed that the intake of quercetin reduced elevated blood sugar levels and slightly
improved the complications of diabetes. Currently, there is no good data on its
effectiveness in humans and the possible side effects of quercetin use.
R
Randomized controlled trial (RCT)

For example, during a randomized controlled trial, the participants are randomly
assigned to two different groups. Researchers then use different measures on the
groups and then compare them with one another. For example, one group is given a
new drug and the other a placebo, i.e., a medication without an active substance. The
research team then studies, for example, how the symptoms of a disease change in
both groups.
Reactive hypoglycemia

Reactive hypoglycemia is a special form of low blood sugar. It occurs following the
excessive release of insulin after eating a carbohydrate-rich meal. There can be
numerous causes. For example, it can occur during the early stages of diabetes.
Furthermore, it can develop as a result of a stomach emptying disorder stemming from
damage to the autonomic nervous system (see polyneuropathy). This is known
as diabetic gastroparesis. Reactive hypoglycemia can also develop after stomach
surgery.
Remission

Remission is the regression or temporary subsidence of the symptoms of a disease.

For example, type 1 diabetes can have a remission phase. In this phase, after the
initiation of insulin therapy, the metabolic state can show significant improvement with
only very little or no insulin required. The duration of this phase varies.

In the case of type 2 diabetes, symptom remission can occur as the result of lifestyle
changes, weight loss, or obesity-surgery, sometimes permanently, but usually only
temporarily.
Renal insufficiency

Renal sufficiency is the impaired function or failure of one or both kidneys. This causes
an increase in the concentration of urinary substances, such as creatinine, urea, or uric
acid in the blood. A difference is made between acute kidney failure and chronic
kidney failure.
Renal insufficiency, Acute kidney failure

These are the names given to an acute drop in kidney function. This causes an increase
in the concentration of urinary substances, such as creatinine, urea, or uric acid in the
blood. Their build up in the body results in signs of intoxication. Furthermore, the fluid
and electrolyte balances and the acid-base homeostasis are disrupted. Acute kidney
failure requires urgent medical attention, otherwise it can be life-threatening.
Renal insufficiency, Chronic kidney failure

Chronic kidney failure is the result of an irreversible reduction in renal function. Diabetic
nephropathy is the most common kidney disease that leads to chronic renal
insufficiency.
Restrictive lung disease

For many different reasons, restrictive lung disease causes the lungs to no longer fully
expand. The disease manifests in restricted breathing and it can also be
a complication of diabetes.
Retinopathy, diabetic
Diabetic retinopathy is damage to the retina associated with diabetes. Approximately
25% of people with type 1 diabetes suffer from retinopathy during their lifetime. On
average, it is observed in 12.5% of people with type 2 diabetes, which is only half as
many. In one-third of cases, changes to the retina have already occurred when diabetes
is diagnosed. Retinopathy is caused by changes to small blood vessels located in the
fundus of the eye (see also microangiopathy). This can lead to visual defects or
deterioration. In the most severe cases, and without treatment, the retina can become
detached. When left untreated, a detached retina can lead to blindness.
Retrospective

Retrospective means “looking to the past” or “with hindsight”. In a retrospective study,

the outcome analyzed by the research team, e.g., a specific type of disease, had
already occurred by the start of the study. The risk factors for the disease are analyzed
using hindsight.
S
Secretion

The release of substances by tissue, usually glands.

Serum

Serum is the liquid component of blood and contains no solid parts, such as red and
white blood cells or blood platelets. It consists of water, proteins, nutrients, salts,
metabolic products, enzymes and hormones. Blood serum cannot coagulate because it
lacks a coagulation protein.
SGLT-2 inhibitors

SGLT-2 inhibitors are oral antidiabetics, primarily used to treat type 2 diabetes.
SGLT-2 inhibitors reduce blood sugar levels by blocking the sodium-glucose transporter
2 (SGLT-2) in the kidneys. This inhibiting action enables more sugar to be excreted in
the urine via the kidneys. The blood sugar level drops. Additionally, this mode of action
leads to a fall in body weight and blood pressure levels.
Simple sugars

These are sugars (carbohydrates) that are made up of only one building block. The
most well-known simple sugar is glucose (dextrose). When several sugars are linked
together, they are known as a double sugars or polysaccharides.
Sitagliptin

See gliptins.
Somogyi effect, also known as rebound hyperglycemia

The Somogyi effect, also known as rebound hyperglycemia is characterized by an

early morning increase in blood sugar levels following low blood sugar levels during
the night. The blood sugar level initially drops as a result of administering too high an
insulin dosage in the evening. This causes the body to launch counter regulation
measures. The various mechanisms, especially the release of the stress hormone
adrenaline, cause an increase in blood sugar levels in the morning.
Stents

Stents are meshed vascular devices made from metal or plastic. They are often used in
blood vessels, e.g., in the treatment of the coronary arteries, to keep the arteries open
and ensure that occlusions do not reoccur.
Stratification

Stratification means “layering” or “formation of layers”. In research, for example,

participants in a population study, based presence of specific characteristics, are
divided into smaller groups known as strata. Commonly used characteristics for
stratification include age or gender. This system helps researchers obtain more
accurate results for certain subgroups while avoiding calculation errors.
Stress hormone

As the name suggests, the body releases stress hormones, such as

adrenaline, cortisone, or growth hormone, when in stressful situations.
Subcutaneous (abbreviation: s.c.)

Subcutaneous means “under the skin”. For example, insulin is injected under the skin.
Fatty tissue is located below the skin. This is known as subcutaneous fat.
Sugar

Sugars are carbohydrates and are a crucial source of energy for the body. Depending
on their size, they are categorized as simple sugars, double sugars and multiple
sugars.
Sugar substitutes

In contrast to sweeteners, sugar substitutes do provide energy, but less than household
sugar (sucrose). They are metabolized independently of insulin and, as a result,
influence blood sugar levels to a lesser extent than sugar. They also do not cause
caries. Fructose, maltitol, mannitol, and xylitol are examples of sugar substitutes.
Sulfonylureas

Sulfonylureas are oral antidiabetics used in the treatment of type 2 diabetes. They
trigger the release of insulin by the pancreas into the bloodstream. However, their
effectiveness decreases over time, meaning that they are only partially suitable as a
long-term therapy for diabetes. They are often used for patients who cannot be treated
using metformin. In contrast to metformin, therapy with sulfonylureas carries the risk of
low blood sugar levels.
Sweeteners

This is a term used to describe sugar substitutes. They have a far greater sweetening
effect than household sugar (sucrose) and a negligible nutritional value. They contain
almost no calories. Examples of sweeteners include aspartame, cyclamate, or
saccharine.
T
TENS

TENS stands for Transcutaneous electrical nerve stimulation and is a healing method
from naturopathy. This technique uses electricity to combat pain. The device generates
an electrical impulse that is transmitted to the nervous system via the skin. The
electrical impulse stimulates the nerves and reduces or completely eliminates pain.
Time in range

Time in range is a new benchmark for diabetes management and metabolic control.
Measurement is only possible using what is known as a CGM or iscCGM system.
These systems measure blood sugar levels continuously throughout the day. This
allows the determination of how many hours a day the blood sugar value was within a
specific target range.
Tissue Doppler echocardiography

The tissue Doppler echocardiography can help identify disorders of the heart muscles
(myocardium). It is a special type of echocardiography – a type of diagnostic imaging.
Using ultrasound waves, it is able to assess the structure and function of the heart.
Titration phase

The titration phase refers to the starting period when the dosage is tested and adjusted
to determine the individual effective dosage.
Trace elements

Trace elements are minerals of which the body requires only tiny amounts. Iodine, zinc,
selenium, or iron are examples of trace elements. If the body does not receive a
sufficient amount of these elements over a longer period of time, the symptoms of
deficiency can develop.
Transcription factor

Transcription factors are specific types of proteins required to read the information
stored in the genes.
Triglycerides

Triglycerides are also known as neutral fats. They consist of a glycerin molecule, known
as sugar alcohol, linked to 3 fatty acids.
U
V
Veins

Veins are blood vessels that transport low-oxygen blood to the heart.
Vitamin D

Vitamin D can be found in small amounts in eggs and dairy products. The largest
source of vitamin D comes via the skin. The skin is able to use sunlight to produce its
own vitamin D. Vitamin D plays a crucial role in bone growth.
W
Wagner’s classification

The severity of diabetic foot syndrome can be classified using the Wagner scale. The
scale grades using wound depth. The classification can be expanded by adding
Armstrong’s criteria describing the presence of infection or ischaemia (circulatory
disorder).
Waist-to-hip ratio

Waist-to-hip ratio indicates the ratio between the circumference of the waist and hips. A
measurement tape is placed around the hips to determine the circumference. The tape
is placed around the lowest rib to measure the waist. If the ratio between waist and hip
circumference is greater than 0.85 for women and 1.0 for men, then this deemed an
unfavorable ratio. These findings also correlate to an increased risk of cardiovascular
diseases and diabetes.
X
Xylit

See sugar substitutes.

Y
Z