Grundlagen, Möglichkeiten und Risiken der Somatischen Diabetestherapie

  • M. Haslbeck

Zusammenfassung

Um die psychische Belastung des Patienten bei der lebensbegleitenden Erkrankung Diabetes mellitus richtig abschätzen zu können ist es unumgänglich, einige wesentliche Punkte der Klassifikation, der Atiopathogenese und Diagnose der Stoffwechselerkrankung aufzuzeigen. Mehr als bei anderen häufigen Krankheiten hängen Diagnose und Therapiekontrollen von Laboruntersuchungen ab. Verlaufskontrollen und eine erfolgreiche Behandlung sind aber heute ohne intensive Patientenschulung mit Einbeziehung der Stoffwechselselbstkontrolle nicht mehr durchzuführen. Das therapeutische Spektrum umfaßt vielfältige Möglichkeiten und Probleme die sich je nach Diabetestyp aus den prinzipiellen Behandlungsstufen mit Diät alleine, mit Diät und oralen Antidiabetika sowie mit Diät und Insulin ergeben. Hinzu kommen neue Behandlungsmethoden z.B. mit Insulindosiergeräten oder Pankreas-transplantation. Die Therapieziele orientieren sich an einer optimalen, Norm-nahen Diabeteseinstellung, am Diabetestyp, am Lebensalter und an bereits bestehenden Begleit- und Folgeerkrankungen. Schwerpunkte sind die Vermeidung von Akut- und Langzeitkomplikationen. Risiken für den Patienten, die zugleich auch zu erheblichen psychischen Problemen führen können sind akute metabolische Komplikationen, insbesondere die Hypoglykämie sowie die Folgen der Mikroangiopathie, der Makroangiopathie und der Neuropathie. Die klassischen Grundpfeiler der Diabetesbehandlung, Diät, Medikamente und Muskelarbeit werden heute durch die verstärkte Einbeziehung des Patienten in den Therapieplan (Schulung, Selbstkontrolle, Anpassung der Insulintherapie) erweitert. Hinzu kommt ein neuer Schwerpunkt, der durch das Konzept des “biopsychosozialen Gleichgewichts” umschrieben wurde. Dabei sind psychologische Probleme nach ihren spezifischen somatischen Ursachen zu analysieren und zugeordnete Bewältigungsstrategien zur verbesserten Mitarbeit und Eigenverantwortung des Diabetikers zu entwickeln.

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© Springer-Verlag Berlin Heidelberg 1988

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  • M. Haslbeck

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