Type 2 diabetes
Type 2 diabetes: blood sugar that stays too high because insulin doesn't work properly. Often preventable – and if tackled early, it can go into remission.
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In type 2 diabetes, blood sugar stays permanently too high because the body's cells no longer respond properly to insulin and the pancreas eventually can't keep up with the extra demand. It used to be called “adult-onset diabetes” – today, young adults and occasionally even teenagers develop it too.
According to Germany's annual diabetes health report (Deutscher Gesundheitsbericht Diabetes), more than eight million people in Germany have been diagnosed with diabetes, over 90% of them with type 2; on top of that, an estimated two million have it without knowing. It is diagnosed by a fasting blood sugar of 126 mg/dl or higher, an HbA1c of 6.5% or higher, or an oral glucose tolerance test (two-hour value of 200 mg/dl or higher).
An important distinction: type 1 diabetes is an autoimmune disease in which the insulin-producing cells are destroyed. It often affects children and has nothing to do with diet or weight. Type 2, on the other hand, develops from a combination of genetic predisposition, belly fat, lack of exercise, lack of sleep and age – this isn't about blame, it simply shows where the levers are.
And those levers are powerful. In the US Diabetes Prevention Program (2002), a lifestyle programme – with a target of 150 minutes of exercise a week and around 7% weight loss – cut the risk of developing the disease by 58% in people with prediabetes, more than the drug being tested. The British DiRECT study (2018) showed that among people diagnosed no more than six years earlier, almost half were back below the diabetes threshold without diabetes medication after a year on a medically supervised programme with a formula diet; among those who lost 15 kg or more, the figure was 86%. Experts speak of remission, not cure: the predisposition remains, and so do regular check-ups.
Warning signs include extreme thirst, frequent urination, tiredness, wounds that heal poorly and vision problems – but often there are no symptoms at all for a long time. That's why blood sugar is part of the routine health check-up offered in Germany from the age of 35. Left untreated, high blood sugar damages blood vessels, nerves, kidneys and eyes over the years; with well-managed diabetes, you can lead a long and active life.