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BerlinIt can be read everywhere. Older people in particular are particularly seriously ill with Covid 19 infection and have to go to the clinic. Often even in the intensive care unit. But in the meantime it turned out that the older age is not necessarily in the foreground for the course of the disease. Concomitant and pre-existing diseases are much more crucial. This also includes diabetes, one of the most common diseases. About one in ten Berliners – around 370,000 people – is affected. One or the other may ask the question: Why are we particularly at risk?
Michael Ritter knows the answer. The chief physician of the Clinic for Angiology, Diabetology and Endocrinology of the Helios Clinic Berlin-Buch runs one of the few large diabetes special centers in the capital. He says: “Those who keep their blood sugar levels in the normal range generally have nothing to fear. But an undetected or poorly adjusted diabetes affects the immune system. “Even without a corona, surgery, normal influenza flu diseases or pneumonia could be more difficult for a diabetic and lead to more complications, says chief physician Ritter:” That’s why it’s important for you As a protection against infection, it is important for people with diabetes at all times that their blood sugar is well adjusted. “
Ritter can explain how diabetes weakens the immune system: “The high blood sugar levels change certain protein building blocks and thus disrupt the function of the white blood cells, which are responsible for body defense. You can even see this in the laboratory under the microscope. The immune cells digest the pathogens worse. ”
But there are other risk factors that diabetics need to watch out for now. “If there are also high blood pressure and cardiovascular problems, diabetes patients with a weakened immune system with a Sars-CoV-2 infection have an even higher risk of a severe course of the disease,” said Ritter. “The virus mainly affects the lungs and has to be fought there by the immune system. However, this struggle can in turn put a massive strain on the heart via the circulatory system. ”This impairment is even more dangerous than the lungs damaged by the virus. The lack of oxygen could be compensated for by artificial respiration, and in an extreme emergency the entire lungs would even be replaced by a machine. “But the heart has to pump a lot more because all organs are affected. This can ultimately lead to cardiovascular failure, ”said Ritter.
What is completely new is the realization that even being overweight is one of the risk factors. Recent scientific studies from France and China have shown that more than three quarters of corona patients in the intensive care unit suffered from obesity.
Because diabetes patients, unlike healthy people, are more at risk from corona, they need medical advice and help now more than ever if their blood sugar levels are not right. “The first contacts here are general practitioners, internists and ideally diabetologists,” says expert Ritter.
But the next problem is already looming here. The German Diabetes Society (DDG) has already observed a sharp decline in the number of patients in practices and outpatient clinics. “There is great public uncertainty,” warned DDG President Monika Kellerer. “Many people no longer notice important medical appointments or stay at home with acute complaints. Be it out of consideration for the health system, due to misunderstood exit restrictions or for fear of infection with the Corona virus, ”says Monika Kellerer, who is also Medical Director of the Center for Internal Medicine I at the Marienhospital in Stuttgart. It calls for the symptoms of illness to be taken seriously. In particular, diabetes patients with multiple illnesses should seek medical help immediately if their blood sugar levels are bad or their health changes.
Michael Ritter also advises: “Like us in our outpatient clinic, other colleagues in Berlin now offer telephone or video consultation hours. Even measured values can be sent to the doctor before the phone call and then given advice. “
This applies at least to those affected, who the doctor already knows. However, because diabetes does not hurt and often causes no symptoms for a long time, you should have your blood glucose checked every two years by your family doctor from the age of 35. In people with a high risk of diabetes, closer controls are advisable. This includes patients who are overweight, do little exercise, have high blood pressure and high cholesterol.
Urine examinations with test strips from the pharmacy only show any existing diabetes late. But in Corona times even these inaccurate values could at least provide first indications.
However, caution is advised when the first symptoms appear. For example, those affected then feel tired and tired. They have to urinate frequently, are very thirsty and drink a lot. Wounds heal worse. Inexplicable weight loss can occur. If you experience numbness in your arms or legs or even visual disturbances, diabetes can even be very advanced.
If you already know that you have diabetes, you should now check your values more closely. This is particularly true for diabetics with high blood pressure, cardiovascular diseases and overweight.
The normal blood sugar value must not exceed 200 milligrams per deciliter or 11.1 millimoles per liter – the unit that used to be common in the GDR. The long-term blood sugar level HbA1c should be below 7.5 percent.
Diabetics are used to performing self-measurements regularly. “However, if you are in quarantine or are experiencing cold symptoms, we advise you to determine the values about twice as often,” says chief physician Ritter. He also advises to continue taking the medication prescribed by the doctor concerned and exactly as directed.
In type 2 diabetes, these are often the active substances metformin, which inhibits the formation of new glucose in the liver, and the so-called gliflozins, which remove excess sugar from the body with the urine. However, if those affected have actually been infected with the corona virus and the course of the disease is severe, it is usually necessary to discontinue these medications and temporarily switch to insulin injections. “However, this is initiated in the clinic,” says diabetologist Ritter. “You shouldn’t do that on your own.”
Although all clinics in Berlin are required to keep beds free for Covid 19 patients and to postpone non-urgent treatments, there is always enough capacity for diabetes patients in an emergency. “Most diabetics can be employed on an outpatient basis by the resident doctor,” says chief physician Ritter. “A hospital stay is only necessary if this does not work or if the diabetes is derailed.” However, this is possible at any time because serious illnesses must be prevented.
Contact person: Anyone looking for a diabetes specialist in their area can find the addresses of certified practices and clinics on the Internet at www.deutsche-diabetes-gesellschaft.de
Expert tips: More exercise, less food
- Remedy without medication is sometimes possible: The more common type 2 diabetes can often be favorably influenced by switching to healthier eating and living habits. In the early stages, regular exercise and weight loss alone can help patients normalize or at least improve sugar levels even without medication, according to experts.
- Nutrition: “Especially in times of great tension, like now with the exit restrictions, many tend to eat unhealthy,” warns chief physician Michael Ritter. “You then eat too much sweet, too much salty and too much fat. Healthy eating is now more important than ever. ”For frustration eaters, the diabetologist still has a tip:“ Have fresh fruit or vegetables in portions every day. For example, peeled and cut carrots. You can access it every now and then. ”
- Sports: In addition, Ritter advises you to exercise more, but you shouldn’t overdo it when you get in, but simply increase a little every day. Nordic walking, cycling or just brisk walking for older people are particularly suitable: “If the exercise program is then mixed with gymnastics and maybe organized together with the family, it can even be very fun.” Alba Berlin’s daily sports lesson (www.youtube.com/albaberlin) is particularly suitable for this: “Everyone can do this, of course by video, together with children, parents, grandparents or friends. It is really fun and increases the health effect. ”
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