Diabetes mellitus is a collective term for various metabolic disorders, with excessive blood sugar (hyperglycaemia) as the primary finding. Mechanisms leading to hyperglycaemia are mainly associated with insulin, the primary regulatory hormone for carbohydrate metabolism in the human body: an absolute shortage of insulin, a relative shortage of insulin due to reduced efficacy of the insulin (insulin resistance) or both together.

Type 1 diabetes

This type is an autoimmune disorder. The body’s immune system destroys the insulin-producing beta cells of the pancreas in the course of an inflammatory reaction called insulitis. This loss of beta cells leads to in increasing insulin shortage. Type 1 diabetes only manifests when about 80-90 per cent of the beta cells are destroyed. In the initial phase of the disease, there may still be minor residual insulin production – measurable through the c-peptide.

Type 2 diabetes

This is a disorder where insulin is present, but cannot work properly at its destination, the cell membrane (insulin resistance). In the first few years of the disease, the pancreas can compensate for this by producing ever larger volumes of insulin. But eventually the pancreas is no longer able to maintain this excessive insulin production. The volume of insulin produced is no longer sufficient to control the blood glucose level and type 2 diabetes mellitus develops. A type 2 diabetic produces far more insulin than a person with no metabolic disorder. But because of high insulin resistance, the level of circulating glucose rises anyway. In some cases, the relative deficiency leads to an absolute insulin deficiency later on.

Even in the 1990s, type 2 diabetes was trivialised in that it was called maturity-onset diabetes since it usually only occurred with advanced age. However, younger people are increasingly being diagnosed with type 2 diabetes as well. MODY (maturity-onset diabetes of the young) is diagnosed in children and young people with increasing frequency. The term ‘maturity onset diabetes’ is no longer appropriate because the disease develops at younger ages and there is a risk of developing massive damage to the health of affected individuals over the course of lifetime.

Gestational diabetes

A distinction is made between diabetes mellitus that already existed before pregnancy and diabetes that is first diagnosed in the course of pregnancy (gestational diabetes).

Early diagnosis is important with gestational diabetes since excessive blood glucose levels can lead to serious disorders of the embryo or foetus.

A healthy diet and regular, moderate exercise help normalise blood sugar.

Type 1 diabetes mellitus

Today, the development of type 1 diabetes mellitus is understood as a multifactorial process, involving both genetic and environmental factors.

Environmental factors

An autoimmune reaction occurs when the immune system is exposed to a foreign antigen that is similar or identical to one of the body’s own surface proteins. The resulting immune response targets the foreign antigen as well as the body’s own proteins on the islet cells of the pancreas. It is also assumed that exposure to foreign antigens, especially in the first few months of life, has an immunomodulating effect that can increase the risk of developing type 1 diabetes (e.g. vitamin D deficiency: vitamin D supplements for infants not only prevent rickets but can also reduce their risk of developing diabetes later).

Other environmental factors being discussed are:

• The consumption of cow’s milk in the first three months of life by children who are only nursed for a short time.
• Very early exposure to the protein gluten, which is found in various types of grain. A special intestinal flora that develops as a result of gluten consumption is suspected as a cause for the development of hyperglycaemia and type 1 diabetes in mice.

Type 2 diabetes mellitus

Type 2 diabetes is also a multifactorial disease, with excess weight as the leading cause. Its influence is altered by genes and other possible factors.

Excess weight is considered to be one of the main causes of this type of the disease. In addition to congenital insensitivity to insulin, being overweight results in additional insulin resistance of the body cells that depend on it. The exact mechanism of insulin resistance is still not fully understood.

Nutrition also influences the risk of developing type 2 diabetes mellitus.

One key factor is genetic predisposition and it appears likely that numerous genes are involved (polygenetic disease). It is likely that genetic differences are behind differences in the course of the disease.

Lifestyle factors

An increase in the body’s own gluconeogenesis (sugar production) in the liver is another factor affecting the course of the illness.

High levels of vitamin D cut the risk of diabetes in half.
A lack of melatonin, which is mainly released at night, appears to increase the risk of type 2 diabetes.

Regarding the risk of developing type 2 diabetes, a cohort study showed that the risk of women dropped by about 15 per cent for each year of nursing. The protective effect lasts for a few years after weaning.

Acute complication ‘diabetic coma’:

Diabetic coma is the most severe hyperglycaemic complication of diabetes, and is life threatening.

Possible accompanying and resulting disorders (after 11 or more years) in type 2 diabetics:

• High blood pressure
• Diabetic retinopathy
• Neuropathy
• Peripheral arterial occlusive disease (PAOD)
• Heart attack
• Diabetic nephropathy (renal insufficiency)
• Stroke
• Diabetic foot syndrome (DFS)
• Amputation (see ‘Amputation/prosthetic foot or leg’)
• Blindness

Type 1 diabetes

With type 1 diabetes, insulin, the lacking hormone, has to be provided artificially in the form of insulin supplements. The objective of this insulin therapy is not to heal type 1 diabetes but to replace the body’s own insulin, which is lacking. Treatment must, therefore, be continued until the end of life. No cure has been found yet.

Type 2 diabetes

• Comprehensive lifestyle changes (more exercise, weight reduction, healthy diet)
• Medications to normalise blood sugar
• Medications against high blood pressure
• Intestinal tract operation

Numerous risk factors and secondary disorders associated with diabetes can be positively influenced with kybun:

• The soft, elastic material of the springy mat or the kybun shoe sole is very comfortable and motivates you to move more often for longer. You regain the joy of movement and lose excess body weight at the same time.
• In addition to normalising blood sugar levels, increased physical activity also lowers high blood pressure and reduces the risk of nerve and blood vessel diseases (heart attack, blindness, amputation).
• Your feet are gently cradled by the soft, elastic kybun material, protecting them against injury. At the same time, you can gently feel the ground (stones, cobbles, natural soil) through the material, which improves foot sensitivity.
• The rollover of the foot also significantly improves circulation (in the foot and lower leg). Good circulation is important in order to prevent or heal injuries.
• The soft, elastic material allows your foot full freedom of movement. The natural rollover improves the health of the foot: Mobility, coordination and strength increase. Thanks to improved function, the foot can absorb the forces acting upon the body, for example while walking, thereby protecting the higher joints against improper and excessive strain.

• Do not make your steps too long when walking in the kybun shoe.
• Be sure to maintain an upright body posture without cramping up!
• Keep your gaze forward while keeping the shoulders and arms loose.
• Everyday/leisure: Walk with the kybun shoe or use the kybun mat as much as possible. Rest if tired > perform the kybun exercises regularly and take a short break if needed.
• Job: Sit as little as possible. In the beginning, alternate between sitting and standing, and take along replacement shoes to change into.
• If you feel unsafe/too unstable in the kybun shoe even after a test session, we recommend a kybun shoe model with a lower rebound effect. These models have a somewhat wider sole in the area of the midfoot, providing added stability. Seek advice from your local kybun expert.
• If a sole with a lower rebound effect is too unstable for you as well, we recommend the kybun mat. You can choose the thickness you are comfortable with (the thicker, the less stable, the more intensive the training). You can also hold on to a fixed object.
• Precise movements are essential, especially if you suffer from joint pain or osteoarthritis. Pay attention to exact movements and be sure to take a break in case of fatigue or weakness. Lateral/medial rolling of the ankle joint on the soft, elastic material has to be corrected so that the load is applied to the foot, knee and hip with proper axial alignment. Read more under ‘Lateral/medial rolling of the ankle joint’.
• Take your time! The kybun shoe/kybun mat are intensive ‘training devices’ and pose a major challenge for the body. It may take a few months before you can walk in the kybun shoe or stand on the kybun mat for several hours in a row. The duration of use is highly individual and depends on numerous factors. It also varies from day to day. Listen to your body and accept your limits.
• Contact a kybun dealer you trust if you have further questions, feel insecure or if there is no alleviation of pain when using the kybun shoe even though you are following the tips.

• kybun interval walking is particularly well suited for weight reduction and training the circulatory system (http://www.kybun.ch/ratgeber/kybun-uebungen/kyboot.html):

  Reduce your walking speed a little in the beginning and only walk at a pace that allows you to talk to your partner.
  If you are under the care of a doctor, we advise you to wear a pulse meter so you can keep to a pulse set for you personally by your doctor.

  You should feel well at all times during kybun training! Feeling unwell is a sign that you are overtaxing your body and/or heart. Once again, adjust the speed of both intervals so that you feel good during training and avoid overstraining your body.

  Check your body posture regularly: You should walk upright and keep the arms, shoulders and feet loose.
  When you push the limits of your fitness, you tend to cramp up. This restricts blood circulation and the organs no longer receive an adequate supply of oxygen, which would force you to stop training after a short time.