Zwei Männer sitzen auf einem Baumstamm neben einem Flusslauf. Der Mann im Vordergrund hält ein Blutzuckermessgerät in seinen Händen. Ausreichen Bewegung und eine regelmäßige Kontrolle des Blutzuckers sind bei einer Erkrankung von Diabetes äußerst wichtig.

Diabetes is a widespread condition. The problem is the difficulty of its early detection. The signs of diabetes are often recognized late because they aren’t very obvious. We will explain how to prevent the condition and recognize signs to avoid serious health problems by starting treatment early. Also find out what you need to bear in mind once you’ve been diagnosed with diabetes.

What is diabetes?

Diabetes mellitus refers to a metabolic disorder. A distinction is made between two types: those affected either have a lack of the hormone insulin (Type 1) or poor insulin effectiveness (Type 2). A combination of a lack and reduced effectiveness is also possible.

The hormone insulin is produced in the pancreas and is responsible for the reduction of blood sugar. If this function is no longer guaranteed or the effectiveness of the insulin reduces because of the condition, the concentration of blood sugar will increase.

Risks of diabetes

An excessive level of sugar in the blood damages tissue and organs – in particular, this affects blood vessels, nerves, and internal organs. This can therefore lead to numerous secondary diseases, which may even have life-threatening complications:

  • increased risk of stroke and heart attack
  • vessel damage (diabetic angiopathy)
  • damage to the retina (retinopathy)
  • kidney problems (nephropathies)
  • neurological conditions (diabetic neuropathy/polyneuropathy)
  • peripheral arterial disease (PAD)
  • increased risk of dementia
  • chronic wounds and ulcers, especially on legs and feet (diabetic foot syndrome)
  • impaired functioning of the cardiovascular system, digestive system, and the locomotor system


In the following article, we’d like to focus on the different types of diabetes and their secondary diseases, and explain causes, symptoms, and treatment to you.


Straight to Type 1 diabetes

Straight to Type 2 diabetes

Straight to secondary diseases of diabetes



Eine Frau mit Wanderstöcken und Outdoorkleidung läuft einen Wanderweg entlang. Ausreichend körperliche Bewegung ist vorteilhaft, um die Durchblutung sowie die Leistungsfähigkeit des Herzens zu verbessern und somit diabetische Angiopathie vorzubeugen.

Type 1 diabetes mellitus

What is Type 1 diabetes mellitus?

In the case of Type 1 diabetes, the body’s own antibodies attack the cells in the pancreas that produce insulin, and destroy them. Insulin breaks down sugar. If insufficient or no insulin gets into the blood stream, the body’s cells will not be able to absorb enough sugar. It builds up in the blood and causes a permanently increased and therefore dangerous blood sugar level.

Type 1 diabetes mainly affects adolescents and young adults between the ages of 12 and 24.

How does Type 1 diabetes develop?

The reason why the immune system attacks and destroys the body’s own tissue is not yet known. That’s why diabetes can currently not be cured. The diagnosis therefore remains for the person’s whole life. It is likely that congenital factors as well as environmental influences are involved in the development of Type 1 diabetes. A clear connection, however, has not yet been proven.

How to recognize Type 1 diabetes mellitus?

Typical symptoms of the early stages of Type 1 diabetes can include:

  • tiredness, exhaustion
  • weight loss
  • strong thirst
  • frequent urinating
  • stomach pain, nausea, and vomiting without an obvious cause
  • dry or itching skin
  • chemical (acetone) smell on the breath

How can Type 1 diabetes be prevented

Since this is a congenital condition that occurs primarily without the influence of external factors, there are no scientifically proven measures yet for preventing Type 1 diabetes mellitus.

How is Type 1 diabetes treated?

The crucial aspect when dealing with Type 1 diabetes mellitus is supplying patients with insulin because the body can no longer guarantee its own supply. The goal is to regulate the insulin supply which must be provided via an external source as precisely as possible based on nutrition, level of activity, and current lifestyle.


While Type 1 diabetes is caused by a lack of insulin, Type 2 diabetes is a resistance to insulin.

Type 2 diabetes mellitus

What is Type 2 diabetes mellitus?

Type 2 diabetes mellitus is an increased blood sugar level based on an insulin resistance. It means that there may be sufficient insulin in the body but it has no effect because the body’s cells no longer respond to the insulin. They can no longer absorb sugar, which builds up in the blood. The body subsequently produces more insulin and compensates for the resistance for a few years. However, the pancreas cannot maintain this increased insulin production for long, meaning that the supplied quantity decreases as the condition progresses, and the first symptoms occur. This is referred to as manifest Type 2 diabetes.

How does Type 2 diabetes develop?

Many factors encourage the development of Type 2 diabetes. On the one hand, genetic issues seem to play a part because it seems to run in families. On the other hand, lifestyle also contributes to the disease, as obesity and a sedentary lifestyle, in particular, can commonly be found in the medical history of people with Type 2 diabetes. Fatty tissue produces messenger substances that can promote insulin resistance. Additional risk factors include high blood pressure, an unhealthy diet, alcohol consumption, smoking, stress and impaired fat metabolism.

What are the symptoms of Type 2 diabetes mellitus

The first symptoms of Type 2 diabetes are usually quite non-specific: tiredness and fatigue, an increased susceptibility to infection, dry skin or poorly healing wounds initially aren’t identified as a sign of a serious metabolic disorder. That’s why Type 2 diabetes often goes unnoticed in the beginning or is detected only by coincidence as part of a blood test. Typical symptoms that may be an indication of Type 2 diabetes type include increased thirst and a frequent urge to urinate, as the body is trying to get rid of the excess sugar via the urine. Those who notice these symptoms should therefore have their blood sugar level checked by a physician.

How can Type 2 diabetes be prevented?

Technically, everyone can reduce his/her individual diabetes risk. In addition to congenital factors, lifestyle in particular plays an important role in the development of Type 2 diabetes. A balanced diet, abstaining from alcohol and nicotine, as well as regular physical activity contribute a lot to lowering the risk of this illness occurring. In the case of obesity, weight loss is recommended, and lipid metabolism disorders should be medically treated.

How is Type 2 diabetes treated?

The condition is initially treated with movement therapy and weight loss, combined with drug therapy. In many cases, weight loss can contribute to significantly reduce blood sugar levels. Regular physical activity also helps the sugar metabolism level off, improving the cells’ sensitivity to insulin. In this way, insulin injections to control blood sugar can often be delayed by many years.

As the condition progresses, however, insulin will be used when the pancreas’ hormone production decreases because of age. It’s important to keep the blood sugar level in a healthy range to prevent secondary diseases such as diabetic foot syndrome.

Ein Ehepaar steht auf einem Wanderpfad und schaut sich eine Wanderkarte an. Die Frau trägt einen Rucksack auf ihren Rücken und hat Wanderstöcke in ihren Händen. Ausreichend Bewegung ist hilfreich, um die Durchblutung sowie die Leistungsfähigkeit des Herzens zu verbessern und damit die Entstehung einer Diabeteserkrankung vorzubeugen.

Common secondary diseases caused by diabetes

Diabetes patients have increased health risks because various conditions can be caused by diabetes. In order to recognize potential risks more easily and to prevent them – if possible – we will explain the most common secondary diseases caused by diabetes:

Diabetic angiopathy

what is diabetic angiopathy?

The term “diabetic angiopathy” summarizes vascular diseases that can develop as a result of diabetes. It causes narrowing of the arteries that transport blood high in oxygen and nutrients to the body’s organs. This results in an insufficient supply that impairs the function of the affected organs and can damage them long-term.

There are basically two types: microangiopathy, which mainly affects the small vessels, and macroangiopathy, which leads to a narrowing of larger blood vessels (stenosis). Microangiopathy usually affects the blood vessels of the kidneys, eyes, brain, or the heart muscle. Macroangiopathy, on the other hand, causes narrowing of the large arteries in the brain or the neck, as well as coronary arteries or the large arteries in the legs.

How does diabetic angiopathy develop?

In cases of diabetic angiopathy, the cells that line the arteries on the inside are often affected. In a healthy person, they form a smooth layer (endothelium) to which deposits cannot stick. If this endothelium is damaged by the elevated blood sugar, rough patches develop, on which deposits – or plaques – can form. In the early stages of the condition, they don’t cause any problems. Over time, however, more plaques deposit on these sites, and they gradually calcify. A bottleneck develops impeding blood flow, meaning an insufficient supply to the organs and tissue behind it. This, in turn, impairs their function and – depending on which organ is affected and where the stenosis forms – causes problems such as an increased risk of stroke or heart attack.


How does diabetic angiopathy manifest?

Typical angiopathy symptoms are difficult to specify because stenosis can occur practically anywhere in the body and can go unnoticed for a long time.

  • Microangiopathy of the kidneys is often detected by coincidence during routine laboratory tests if a certain protein (albumin) is excreted in an unusually high concentration.
  • If the eye is affected, there are also no symptoms for a long time. Only later on, vision problems occur such as blurry, cloudy vision as well as dark spots in the visual field. These are the first indications of a condition called retinopathy, which can lead to blindness in severe cases.
  • If vessels in the brain are affected, indications may include problems concentrating or remembering, mood swings, or depression.
  • In the early stages, angiopathy in larger vessels (macroangiopathy) can lead to a decreased heart rate as well as cold feet and hands, or pain during extended periods of walking.

It’s very difficult to detect angiopathy early. That’s why people suffering from diabetes should have regular medical check-ups in order to identify early symptoms in time.

How can diabetic angiopathy be treated?

Angiopathy treatment mainly aims at minimizing risk factors, such as a high blood sugar level, smoking, alcohol, obesity, and high blood pressure. Improving circulation is just as important. Initially, the main focus is getting the blood sugar level right.

Treatment of microangiopathy is not easy because the affected blood vessels are too small to perform surgery on. Instead, the objective is to improve the blood’s flow properties to increase blood supply to the affected area. Stenoses in larger blood vessels can be expanded using various surgical procedures, including:


  • removal of plaques (calcium deposits)
  • stretching of the narrowed vessel using a balloon catheter (balloon catheter dilation)
  • bypass surgery
  • implanting a stent that keeps narrowed vessels open, thus improving blood flow

Diabetic neuropathy

What is diabetic neuropathy?

Diabetic neuropathy is a specific type of disorder of the peripheral (outside the brain and spinal cord) nervous system that exclusively affects people suffering from diabetes.

Why does diabetic neuropathy develop?

The excessive sugar concentration in the blood damages nerve cells, causing impaired functioning and even dying of the nerves. Depending on which nerve paths are affected, diabetic neuropathy can have very different indicators. Nerves that control organs such as the liver, heart or kidneys, or relay sensory stimuli, can be affected and consequently cause impaired functioning.


How does diabetic neuropathy manifest?

Nerve cells run through all organs in our body. They control movements and organ functions, for example, transmit tactile and other sensory perceptions to the brain and spinal cord, and, as pain fibers, signal injuries and damage. The tasks these nerves carry out are very versatile. That means that the indicators of diabetic neuropathy can also be very varied:

  • If nerve fibers that transmit environmental and tactile stimuli are damaged, there can be paresthesia, tingling, itching, burning, pins and needles or numbness, as well as reduced or abnormal temperature perception.
  • If pain fibers are damaged, those affected suffer from pain without a detectable cause, or a lack of pain perception.
  • If organ nerves are damaged (autonomic neuropathy), irregular heartbeat or digestive problems can develop that can manifest as blood pressure fluctuations, nausea, vomiting, bladder weakness, problems swallowing, or impotence.
  • If motor nerves are damaged, muscle weakness, muscle wasting, paralysis, an unsteady gait, or tripping can be symptoms.
  • If the nerve fibers of the eye are affected (diabetic retinopathy), indications include impaired vision; in severe cases, it can lead to blindness.

Wie lässt sich eine Diabetische Neuropathie behandeln?

Die ärztliche Behandlung besteht überwiegend in der Patientenaufklärung und in einer strikten Kontrolle und Einstellung des Blutzuckers, um eine fortschreitende Schädigung des Nervensystems aufzuhalten. Dabei ist die Mitarbeit des Betroffenen entscheidend.

Eigenständige Kontrollen des Blutzuckerspiegels und des Blutdrucks sowie eine gesunde Lebensweise mit Verzicht auf Nikotin und Alkohol, die ihrerseits Nerven schädigen können, sind dazu unverzichtbar. Je nach Beschwerdebild können verschiedene Maßnahmen eingeleitet werden, um die Lebensqualität der Betroffenen zu verbessern:

  • Gewichtsreduzierung bei Übergewicht
  • Schmerztherapie
  • medikamentöse Therapie
  • Einlagen, orthopädische Schuhe oder Schienen
  • Physiotherapie (Wärme- oder Kältetherapie, Elektrotherapie, Bewegungstherapie wie Gymnastik oder Gangschule, Massage)
  • bei Funktionsstörungen innerer Organe gezielte Therapien, um die Funktionsstörung auszugleichen (zum Beispiel ACE-Hemmer oder Antiarrhythmika bei Herzrhythmusstörungen oder Implantation eines Magenschrittmachers bei schweren Störungen der Magenfunktion)
  • begleitende Psychotherapie oder Selbsthilfegruppen

Diabetic foot syndrome

What is diabetic foot syndrome?

Diabetic foot syndrome is a consequence of an impaired metabolism or neurological diseases owing to diabetes. The main symptoms of diabetic foot syndrome (DFS) are chronic wounds that, if the condition develops unfavorably, may deteriorate into gangrene. The consequences can be life-threatening. When the dead tissue is colonized by bacteria, comprehensive infection of the surrounding tissue including bone structures as well as blood poisoning may be the result. Severe deformities (Charcot foot) or even amputation of the affected foot can be a consequence. That is why even small wounds or open areas on the foot must be closely monitored and correctly cared for and treated.

How does diabetic foot syndrome develop?

In the medical background of diabetic foot, the following factors often play a role:

  • Disorders of the small and minute vessels (diabetic angiopathy)
  • Nerve damage (diabetic polyneuropathy)
  • Impaired circulation (peripheral arterial disease, PAD)

High blood pressure and smoking are additional risk factors for PAD. Nerve damage means that those affected are no longer able to feel pain – for example in the case of incorrect posture or strain on the feet, because of tight or rubbing footwear, or foreign substances in the shoe.

That’s how small wounds on the toes or balls of the feet initially go unnoticed. Their development is also encouraged by increasingly dry and cracked skin, which is a consequence of neuropathy. Owing to reduced circulation and impaired metabolism, wounds don’t heal well and become chronic. Diabetes patients are particularly vulnerable to developing diabetic foot syndrome if several risk factors (obesity, smoking, lack of movement, impaired metabolism or circulation, high blood pressure) are present at the same time.


How does diabetic foot syndrome manifest?

The first symptoms can often be detected long before the development of diabetic foot:

  • Paresthesia in the feet (itching, tingling, pins and needles)
  • Poor sense of touch (“feet fall asleep”)
  • Foot pulse hardly or not at all detectable
  • Painful legs after walking long distances that force frequent stopping (also known as “window-shopper’s disease” or intermittent claudication)

These can be indicators of impaired circulation, early peripheral arterial disease (PAD) or damaged nerves. Poorly healing wounds are the main symptom of diabetic foot syndrome.

How can diabetic foot syndrome be avoided?

Appropriate footwear is particularly important to minimize one’s risk. It mustn’t pinch, rub, or constrict, especially when the sense of touch and sensitivity are reduced. Comfort shoes with soft, seamless inner lining and padding or foot orthoses with soft cushioning can decrease the risk of pressure points on and injuries to the feet. Individually tailored orthopedic footwear (custom-made shoes for people suffering from diabetes) also helps.

Furthermore, regular check-ups and care of the feet are vital. The following aspects must be taken into account:

  • Check your feet daily for visible changes (increased callusing, cracks under or between the toes, reddening) or small wounds
  • Use pH neutral, lipid-replenishing soap for foot care
  • Keep foot baths short (about three minutes) to prevent the skin from going soft, use lukewarm water (check with a bath thermometer if needed)
  • Dry your feet carefully with a soft towel, especially between the toes
  • Have calluses or corns removed regularly by a diabetologically trained podiatrist – many health insurance providers will reimburse the costs of medical foot care
  • Ensure careful foot hygiene with a daily change of socks
  • File toenails instead of cutting them, round off the corners of the nails to prevent ingrowing
  • Use non-scented skin cream rich in lipids on your feet every day to prevent dry skin and the formation of cracks (products suitable for people suffering from diabetes are often labeled accordingly)
  • Do not walk bare-foot to reduce your risk of injury
  • Do not self-treat or have foot baths if you have small injuries – skin injuries on the feet should be shown to the treating physician immediately

Additionally, all measures that promote circulation in the feet and legs help, such as frequent, short walks or leg and foot exercises. Sports for people with diabetes in suitable exercise groups can also help to promote circulation and maintain physical fitness.

People suffering from diabetes have a life-long risk of developing diabetic foot syndrome. That’s why proficient management of the condition is essential. Diabetes education training courses convey the required basic knowledge and should be taken by all who are affected.



People suffering from diabetes have a life-long risk of developing diabetic foot syndrome. That’s why proficient management of the condition is essential. Diabetes education training courses convey the required basic knowledge and should be taken by all who are affected.

How can soft cushioning foot orthoses help with diabetes?

High-quality soft cushioning foot orthoses such as the ErgoPad soft Diabetes protect the feet by relieving them in critical areas. They should therefore be worn even before the first symptoms occur.

Its multilayer design absorbs pressure loads and distributes these across the entire tread during walking. This prevents pressure points especially on the heel and the metatarsophalangeal joint of the big toe, which are subjected to a particularly high level of strain during walking. Combined with appropriate footwear that features soft cushioning on the inside and no pinching seams, or comfort shoes, the foot orthoses effectively protect the feet from pressure points, thus reducing the risk of diabetic foot syndrome.

ErgoPad® soft Diabetes

ErgoPad® soft Diabetes

Softly cushioning foot orthosis for the prevention of diabetic foot syndrome
ErgoPad soft Diabetes offers an optimal footbed for patient with diabetes in risk groups 0 to II. It distributes pressure evenly over the entire foot.