Diabetology

Diabetes mellitus type 2 is increasing at a rate comparable to few other diseases. According to an estimate by the Robert Koch Institute, approx. 7.2 % of the German population suffer from diagnosed type 2 diabetes. An additional 2.1% are affected as well but have not been diagnosed (1). In the Augsburg region, type 2 diabetes was manifest in 16 % among the age group 55 to 74 (2).

In the biographical context of a person, type 1 Diabetes typically becomes manifest during adolescence whereas type 2 diabetes predominantly affects older adults. However, type 2 diabetes as well as metabolic syndrome increasingly affect younger people as well. Both forms lead to micro- and macrovascular secondary diseases that are characterized by arteriosclerotic changes of the small and large blood vessels, respectively. This underlines the fundamental gesture of diabetes mellitus as a sclerotic disease.

The first third of a person’s biography serves the purpose of fostering a bond between the soul-spiritual being and the physical organization. The body is formed into an instrument of the individual human being. The “arrival” of the soul-spiritual being is called into question by type 1 diabetes: when insulin treatment was first introduced by Frederick Banting in 1922, this disease often resulted in an early death of the patient. Insulin treatment allowed patients to sufficiently manage blood sugar levels and thus potentially have long lives. In many cases, this creates the biographical task of combining the newly gained possibility of life with a sense of orientation, a fulfilment of meaning and with identifiable biographical aims.

The management of blood sugar levels is thus situated within an expanded therapeutic concept that includes these biographical questions.

The metabolic syndrome and type 2 Diabetes thus constitute a “premature detachment”. Depending on the metabolic situation, these result in a more or less pronounced reduction in life expectancy.
In this context, especially arteriosclerotic changes, loss of rhythm (e.g. reduced heart rate variability) and other age-specific conditions occur. The obstacles hampering “arrival” in the context of type 1 diabetes are opposed by the premature “departure” in patients with type 2 diabetes.

This text is based on the article titled Diabetologie (3), published in 2009 in the Merkurstab, a prepublication of the chapter Diabetologie from the book Geriatrie, published in 2014 by Salumed (4).

1. Heidemann C, Du Y, Scheidt-Nave C. Wie hoch ist die Zahl der Erwachsenen mit Diabetes in Deutschland? Robert-Koch-Institut Berlin. Verfügbar unter http://www.rki.de/DE/Content/Gesundheitsmonitoring/Studien/Degs/degs_w1/Symposium/degs_diabetes.pdf?__blob=publicationFile (18.01.2012).
2. Rathmann W, Haastert B, Icks A, Lowel H, Meisinger C, Holle R u. a. High prevalence of undiagnosed diabetes mellitus in Southern Germany: target populations for efficient screening. The KORA survey 2000. Diabetologia. 2003;46(2):182–189.
3. Girke M, Zerm R. Diabetologie. Der Merkurstab. 2009;62(5):444–54.
4. Girke M (Hg). Geriatrie: Grundlagen und therapeutische Konzepte der Anthroposophischen Medizin. Berlin: Salumed Verlag; 2014.