How is polyuria due to diabetes treated

Diabetes mellitus

Diabetes: Brief Overview

  • Important forms:Type 1 diabetes, type 2 diabetes, gestational diabetes
  • Common symptoms: severe thirst, frequent urination, itching, dry skin, weakness, tiredness, weak immune system
  • Possible complications: Low blood sugar (hypoglycemia), high blood sugar (hyperglycemia) with diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome
  • Possible secondary diseases: Retinal damage (diabetic retinopathy), kidney disease (diabetic nephropathy), diabetic foot, cardiovascular diseases, etc.
  • Investigations: Measurement of blood sugar and HbA1c, oral glucose tolerance test (oGTT), test for autoantibodies (in type 1 diabetes)
  • Treatment: Diet change, regular physical activity, blood sugar-lowering tablets (oral anti-diabetic drugs), insulin therapy

Diabetes: symptoms and consequences

The pathologically increased blood sugar levels resolve Diabetes mellitus the most varied of symptoms. This applies both to the two main forms of diabetes (type 1 and type 2 diabetes) and to the less common forms.

Acute symptoms of diabetes mainly occur when the metabolism is derailed and the blood sugar level is extremely high. Then there are strong changes in the water and mineral balance. At the same time, there is a severe lack of energy in the body cells and in the central nervous system. The main acute diabetes symptoms are:

Increased need to urinate

If the blood sugar level is permanently elevated, more sugar (glucose) is excreted via the kidneys with the urine (glucosuria). Since sugar physically binds water, those affected also excrete large amounts of urine (polyuria) - they have to go to the toilet very often. Many diabetics are plagued by an annoying need to urinate, especially at night. The urine released is usually clear and only slightly yellow in color.

Polyuria is a typical sign of diabetes mellitus, but it can also have other causes. An increased urge to urinate also occurs with various kidney diseases and during pregnancy.

By the way: The sugar in the urine of diabetics gives it a slightly sweet taste. This is where the technical term diabetes mellitus comes from: It means "honey-sweet flow". The days when doctors tasted their patients' urine to make a diagnosis are long gone, however. Today, the sugar content can be detected with a rapid diabetes test with indicator sticks.

Strong thirst

The strong urge to urinate triggers an excruciating feeling of thirst in diabetes patients: the body wants to compensate for the loss of fluid by drinking more. But this often does not succeed sufficiently. Even if those affected drink a lot, the thirst cannot really be quenched.

Weakness, fatigue and difficulty concentrating

Inefficiency is also a common sign of diabetes. Because there is a lot of energy-rich glucose in the blood of people with diabetes. However, this cannot get into the cells to be used. This creates a lack of energy within the cells. As a result, the patients often feel powerless and are physically less productive.

Most of the glucose the body needs during the day is destined for the brain. A glucose deficiency therefore affects normal brain function. It can cause poor concentration and fatigue through to severe impaired consciousness and a coma.

Visual disturbances

If diabetes mellitus is not or not adequately treated, the blood sugar level is not only very high, it also fluctuates greatly. These strong fluctuations can cause the lens in the eye to swell. This changes their optical power and thus their visual acuity - the patients get visual disturbances. These usually last for a few hours and then subside again.

Alarm signal itching

  • Itching as a warning

    It has plagued almost everyone at one point or another: annoying itching, also called pruritus by doctors. Mostly it is harmless, short-lived and quickly forgotten - a prime example: the mosquito bite. However, serious illnesses can also be behind it. A skin disease is not always the cause. Read here what itching can be a warning signal for!
  • Excited nerve fibers

    Itching is caused by the release of messenger substances, which stimulate certain nerve fibers. It is actually something like a call for help from the body. Because the mechanical friction of scratching should remove disruptive external influences such as lice or fleas. Depending on the cause, the itching occurs locally or all over the body - and can even be chronic. If it lasts longer, you should consult a doctor!
  • Sick skin

    If the skin is visibly inflamed in addition to the itching, there is usually a skin disease behind it. This is the case in around 42 percent of chronic itching cases. Atopic dermatitis and psoriasis in particular cause problems for many people. But not only: Fungal infestation and eczema or parasites such as the itch mite can also be very itchy. You can often tell by looking at the skin that something is wrong with it: it flakes heavily, is red or forms wheals and pustules.
  • Allergic reaction

    The nasty itch can also be caused by an allergy. In most cases, the itching arises after direct contact with the allergy-causing substances. This can be, for example, pollen, metals, latex or pets. The excessive immune system produces copious amounts of histamine. The messenger substance not only mobilizes the body's defenses, but also causes itching.
  • Internal organs

    Sometimes the cause of the itching is not on the skin, but inside the body. Bile, kidneys or liver, for example, are suspected here. Disturbed bile drainage or liver damage (cirrhosis of the liver) can cause the bile pigment bilirubin to rise. As a result, not only does the skin turn yellow, it also itches. Itching can also occur with chronic kidney failure and especially after dialysis.
  • Metabolism and hormonal disorders

    The hormonal turbulence in pregnancy, menopause and during the period can cause itching all over the body. Pathological changes in hormones (e.g. due to an overactive thyroid) can also be the reason for this. Other triggers include gluten intolerance, malnutrition, iron deficiency or diabetes. In diabetes, nerve damage causes the annoying itching, often exacerbated by fungal skin infections.
  • cancer

    Itching all over the body or only in the area of ​​the lymph nodes can be a sign of a malignant tumor of the lymphatic system - as occurs, for example, in Hodgkin's disease. Sometimes it itches years before. In addition, other cancers, such as breast cancer or lung cancer, can be associated with itching, albeit rarely. Itching is also a common side effect of radiation or chemotherapy for cancer.
  • Neurological diseases

    Damage to the central nervous system can also cause itching. This is the case, among other things, with multiple sclerosis. In this inflammatory disease of the nervous system, nerve structures are destroyed. Parasitic sensations in the skin are one of the first symptoms. Polyneuropathies, i.e. the disease of several peripheral nerves (= outside the brain and spinal cord), lead to itching - for example in Lyme disease.
  • Side effect of medication

    Medicines can also cause itching. This is often the case, for example, with antibiotics, psychotropic drugs, agents for high blood pressure or anticoagulants. AIDS patients are also familiar with the problem, as antiviral therapy often triggers itching.
  • Dry skin

    However, itching often also has harmless causes, such as dry skin. Usually the tendency is predisposed to it. External factors such as sunlight, cold winter air or improper care also dry out the skin. In addition, a healthy diet and fluids are important for good skin care. Older people generally struggle with dry skin more often because the moisture and fat content decrease over time.
  • Of
    Medical editor and biologist

Itching (pruritus) and dry skin

Sometimes diabetes causes itching and very dry skin. One reason for this is the high loss of fluid as a result of the increased urine excretion (glucosuria). However, other mechanisms are also suspected that may be responsible for increased itching in diabetics. These could, for example, be stress hormones such as adrenaline and cortisol, which the adrenal gland releases into the blood in increased amounts when the blood sugar is too high or too low. Changes in the blood vessel walls may also contribute to the development of itching in diabetics.

Weakened immune system

The increased blood sugar weakens the immune system against infections in a not yet fully understood way. That is why many diabetics suffer more often and for longer than non-diabetic patients from bronchitis, pneumonia, skin infections or various fungal diseases, for example. The flu vaccination and the pneumococcal vaccine are recommended for protection against diabetes patients (pneumococci cause lung and meningitis, for example).

In the following table you will find a comparison between the clinical pictures type 1 and type 2 diabetes:

* Beta cells: insulin-producing cells of the pancreas (pancreas)

Long-term Diabetes Symptoms

Late symptoms of diabetes mellitus mainly arise when the blood sugar levels are not well controlled and are often or latently too high. Then blood vessels and nerves are irreversibly damaged - with serious consequences for various organ systems and body functions.

Nerve damage (polyneuropathy)

Over time, high blood sugar levels damage the peripheral nervous system. Both motor (controlling the muscles) as well as sensitive (feeling) and vegetative (controlling the organs) nerve tracts are affected. As a result, diabetics often have a disturbed sense of pain. For example, they do not perceive injuries to the skin or a heart attack as pain. Muscle coordination during movement can also suffer.

The function of internal organs (such as the digestive tract) can also be impaired in diabetes: Diarrhea and other digestive problems can result from this. If the high blood sugar values ​​damage the autonomic nervous system that supplies the digestive tract, this can lead to nerve paralysis of the stomach (gastroparesis) or the intestines. Possible consequences are bloating and vomiting, gas, diarrhea or constipation.

Damage to the blood vessels (angiopathies)

High blood sugar levels usually trigger changes in the inner wall layer in the small and smallest blood vessels (capillaries) (microangiopathy). Over time, the medium and large blood vessels can also be damaged (macroangiopathy). The vascular damage results in circulatory disorders up to and including complete occlusion. A wide variety of organs can be affected. Here are the most important examples:

  • Heart: Narrowing or blocking of small blood vessels means that the heart muscle is poorly supplied with oxygen. Possible consequences are Heart failure (Heart failure), Coronary heart disease (KHK) and Heart attack.
  • Brain: Circulatory disorders in the brain impair brain performance and can be chronic neurological deficits trigger. In the worst case, it comes to one stroke.
  • Eyes: damage to the blood vessels in the retina of the eye (diabetic retinopathy) cause symptoms like "Flashes of light“, Visual blur, limited color vision and finally Loss of vision up to blindness.
  • Kidneys: Here, circulatory disorders cause changes and damage to the tissue. These diabetic nephropathy can eventually result in impaired kidney function (Renal failure) flow. If the kidneys fail completely, patients are dependent on blood washing (dialysis) in the long term.
  • Skin: Damage to the small skin vessels makes the skin more susceptible to colonization with germs (Skin infections). In addition, one observes one poor wound healing. Poor healing chronic wounds and ulcers in the area of ​​the lower legs / feet will be diabeticfoot called.

Diabetes and depression

About a quarter of all diabetes patients suffer from a depressive mood or depression. The trigger is usually the diabetes itself, as well as possible long-term effects that can put a lot of psychological stress on those affected.

Conversely, people with depression also have an increased risk of developing type 2 diabetes. One reason for this could be that depressed people pay less attention to a healthy lifestyle, for example eating unhealthily and doing little exercise. Such factors contribute to the development of type 2 diabetes. In addition, depression could change the hormonal system and metabolism of the patient via various signaling pathways in such a way that diabetes is favored.

Regardless of the precise connection between diabetes and depression, both diseases should be treated properly. Otherwise the health of the person concerned may deteriorate. For example, many depressed patients neglect blood sugar-lowering therapy - they no longer take blood sugar tablets or insulin injections so carefully.

Diabetes and impotence

Many male diabetics complain of erectile dysfunction (erectile dysfunction). The reason: the high blood sugar levels damage the blood vessels in the erectile tissue of the penis. This can interfere with the blood flow necessary for an erection. Damage to the autonomic nervous system, which is important for erection, and the sensitive nerve tracts can also play a role in the development of impotence in diabetes mellitus.

Diabetes gnaws at potency
Men with diabetes often have problems with potency. How widespread is the lack of stability in bed among diabetics? From Christiane Fux

Diabetes: causes and risk factors

There is one common to all forms of diabetes mellitus impaired blood sugar regulation underlying. You can only understand more precisely if you know the basics of blood sugar regulation:

After a meal, food components such as sugar (glucose) are absorbed into the blood through the small intestine, causing the blood sugar level to rise. This stimulates certain cells in the pancreas - the so-called "Langerhans beta islet cells" (beta cells for short) - to release insulin. This hormone ensures that the glucose from the blood reaches the body cells, where it serves as an energy supplier for the metabolism. So insulin lowers the sugar level in the blood.

In the case of diabetes, this blood sugar regulation is disturbed in (at least) one important point.

Type 1 diabetes mellitus

In type 1 diabetes mellitus, the location of the disturbed blood sugar regulation is the pancreas: In patients, the insulin-producing beta cells are destroyed by the body's own antibodies. These autoantibodies mistakenly consider the beta cells to be dangerous or foreign and attack them.

Type 1 diabetes is therefore an autoimmune disease. It is not yet known exactly why it occurs. Experts assume a genetic predisposition and various risk factors (such as infections) that promote the development of this diabetes.

The destruction of the beta cells creates a absolute insulin deficiency. People with type 1 diabetes have to inject insulin for life to compensate.

You can read more about the development, treatment and prognosis of this form of diabetes in the article Type 1 diabetes.

Type 2 diabetes mellitus

In type 2 diabetes, the starting point of the disturbed blood sugar regulation lies in the body cells: the pancreas usually still produces enough insulin at the beginning. However, the body cells are becoming increasingly insensitive to it. These Insulin resistance solves one relative insulin deficiency From: Actually there would be enough insulin, but it can only develop its effect insufficiently. In response, the body causes the beta cells to make more and more insulin. The pancreas does not last forever with this overproduction: Over time, the beta cells exhaust themselves, so that insulin production declines. Then it turns out absolute insulin deficiency a.

It is not known exactly why these pathological developments and thus type 2 diabetes occur in some people. However, unfavorable lifestyle factors play a major role:

Most type 2 diabetics are overweight or even obese. The fat cells in the abdominal area in particular form inflammatory substances that can cause insulin resistance. An increased waist size therefore increases the risk of type 2 diabetes mellitus. The same applies to other factors such as smoking and lack of exercise. In addition, a genetic component is ascribed to type 2 diabetes mellitus.

You can read more about this most common form of diabetes in the article Type 2 Diabetes.

Gestational diabetes

Some women get transient diabetes during pregnancy. Doctors then speak of gestational diabetes (or type 4 diabetes). Various factors seem to be involved in its development:

During pregnancy, more hormones are released that are antagonists of insulin (e.g. cortisol, estrogens, progesterone, prolactin). In addition, affected women apparently have a chronically reduced insulin sensitivity: The body cells therefore respond less to insulin. This becomes even more pronounced as the pregnancy progresses.

In addition, there are some factors that increase the risk of gestational diabetes. These include, for example, being overweight and having diabetes in the family.

Read more about the development, symptoms, risks and treatment of gestational diabetes in the article Gestational diabetes.

Type 3 diabetes mellitus

There are some rare forms of diabetes that are sometimes grouped under the term type 3 diabetes. They have causes other than type 1 and type 2 diabetes and gestational diabetes.

One example is MODY (maturity onset diabetes of the young), also known as type 3a diabetes. It includes various forms of adult diabetes that already occur in children and adolescents. They are caused by certain genetic defects in the beta cells of the pancreas.

On the other hand, type 3b diabetes is based on genetic defects that impair the action of insulin. If certain chemicals or drugs are the cause of diabetes, doctors speak of type 3e.