"Sometimes there is also trickery"

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Living with diabetes requires discipline - lose weight, exercise, count bread units. At first most of them are highly motivated, then their will often slacks. A diabetologist explains in a interview why cheating doesn't work

Dr. med. Silvia Zschau

Dr. med. Silvia Zschau is a diabetologist and co-owner of a diabetes center in Munich (http://www.diabetes-zentrum-muenchen.de)

Miss Dr. Zschau *, in your practice, people in their mid-forties are at the height of their careers and you are confronting them with the diagnosis of diabetes. How do you react?

Anyone who hears something like this is of course shocked at first.In fact, when most people think of diabetes, they think of age, obesity, insulin injections, and weekly visits to the doctor. If you are slim yourself - which can certainly happen - your self-image can get quite out of joint.

What worries the patient most?

The first thing many think is: For God's sake, now I am no longer allowed to eat what I like. I'm going blind, maybe I'll lose my feet. There is a real horror scenario going on in our heads.

Then you are first asked as a comforter and pastor.

It is important to get rid of these worries in the first conversation and to inform the patient calmly - most fears are actually unfounded. In modern diabetes therapy, many things are no longer so strict, there is a lot of space for individual solutions. And if a patient's blood sugar is very well controlled, the risk of secondary diseases is no higher than that of a non-diabetic.

Provided that the disease was recognized in time.

Yes, there is a big problem in that. It often takes up to ten years before a diagnosis of diabetes mellitus is made. Years that naturally leave their mark on the body. In younger patients in particular, the general practitioner does not associate fatigue or increased thirst with possible diabetes. We therefore advise people whose families are already known to have type 2 diabetes to take a glucose load test every one to two years, which can reveal diabetes at a very early stage.

What exactly happens in this test?

That is completely undramatic. In the two or three days before the test, patients should eat normally. From eight o'clock in the evening until the examination the next morning, they stay sober. After the first blood sample, we give them a sugar solution to drink, one and two hours afterwards we take another blood sample. The sugar values ​​determined from this then allow a very precise statement as to whether there is a disturbed glucose tolerance or whether diabetes is already present.

Not everyone will be happy to swallow the consequences.

No, we experience huge differences. The highly motivated, who want to understand in the first conversation what they need to change and how to get their blood sugar under control. But also those who say first: I definitely won't do without my sweet fruit juice.

How much do patients enjoy being looked into the depths of their diet?

In the beginning, most of them write down what they are eating, because they have no idea what the mistakes might be. Sometimes bad things come to light: two cubes of sugar in every cup of coffee, the daily pretzels, lots of bread, juice spritzers and many snacks in between. The problem with diabetes is that you don't always feel it. The body can even get so used to blood sugar that has been elevated over the years that the patient initially feels worse than before after switching to normal values.

Then a therapy is particularly difficult to convey.

Yes, this is why comprehensive education and good training are extremely important. The key to successful diabetes therapy is insight. Otherwise nobody can hold out for long. The person concerned must have the feeling that he is allowed to make the decisions himself.

What makes a good diabetic training course?

The mixture of group dynamics and individual support. On the one hand, it is very important for patients to experience that they are not alone with their diabetes. Observing other affected people in group lessons often provides important insights - for example, when the patients see how well a certain nutrition plan or treatment with insulin is working. On the other hand, we want to convey in one-on-one discussions that there is a solution for everyone and that the cherished piece of cake is sometimes allowed in the afternoon. An important basic rule is to eat one high-carbohydrate meal only three times a day.

Diabetes therapy is a tight corset. Doesn't the will wane at some point - especially when things are going well?

Yes, we have the experience. After the training, the patients are initially very motivated: They receive their diabetes passport, in which they enter all their values ​​and are very proud when they get better. But at some point the zeal subsides and some then let it slide. We therefore ask such patients to come to our center every three months for an appointment where we can check the success of the therapy and motivate them again.

Do you sometimes use tricks?

Yes, absolutely. Sometimes we read the best blood sugar values ​​in the log, but the memory of the measuring device contains completely different ones, and the long-term marker in the blood - the HbA1c value - sounds the alarm. It is even more difficult if the patient does not show up again until after two years. Then we can start all over again.

Is it possible to get rid of diabetes completely?

Unfortunately, this is rather the exception. But this case occurs occasionally, especially in young, physically active patients. Physical activity increases the sensitivity of all people to insulin in the body. It happens that patients who initially had to inject insulin to get their blood sugar under control eventually get by without injections at all. Type 2 diabetes is not a one-way street.

Miss Dr. Zschau, thank you very much for the interview.

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