Diabetes mellitus - Treatment
The aim of treating both type 1 and type 2 diabetes mellitus is to keep blood glucose levels at a normal level. Although diabetes cannot be cured, well-controlled patients can lead a symptom-free life.
Why being overweight leads to cancer
Adipose tissue is an active endocrine organ that produces estrogens and inflammatory messengers. Oestrogens can drive the growth of some types of cancer. Chronic low-threshold inflammation is also considered to be cancer-promoting. In addition, obesity causes the body to release more insulin, which is suspected of promoting the growth of cancer cells. The interrelationships are complex and not yet fully understood. The immune system also appears to be impaired by severe obesity.
The early detection, diagnosis and treatment of cancer can also be more difficult if you are overweight. In addition, overweight patients show an altered drug metabolism. Effective prevention therefore aims to avoid obesity from the outset or to systematically reduce it.
Endometrial cancer, cancer of the uterus, is a particularly impressive example. For this highly hormone-dependent type of cancer, the risk increases in parallel with the BMI, up to a seven-fold risk in patients with grade 3 obesity (BMI > 40). However, it is particularly important to note that being overweight increases the risk of developing many of the most common types of cancer, such as bowel, breast and pancreatic cancer. Excess weight also plays a role in the early detection, diagnosis and treatment of cancer.
Important preventive examinations such as colonoscopy can be more difficult to perform. Studies also show that severely overweight patients are less likely to take part in preventive programs such as mammography screening. Early detection is key here. In turn, therapy can be complicated if the patient is very overweight. For example, complications occur more frequently during surgical procedures, and the optimal dosage of cancer drugs is more difficult.
This is also higher for at least some types of cancer. This has been proven for bowel and breast cancer, for example. It is therefore important to tackle obesity after successful treatment in order to reduce the risk of a relapse. It makes particular sense for those affected to seek medical help from specialists.
That is a false conclusion. On the one hand because of the risks mentioned above, on the other hand, severe weight loss due to cancer is an unfavorable prognostic sign regardless of the initial weight.
Obesity is often a question of lifestyle: too much red meat, too much processed food, too much alcohol. Added to this is a lack of exercise. A holistic approach is therefore needed: nutrition, muscle building, psychological support. Accordingly, we work closely together at the Comprehensive Cancer Center of the USZ. All expertise is combined in one place. That is a great advantage.
This is based on the very good intention of contributing to the success of cancer therapy by changing the diet. It is important to approach nutrition during cancer therapy together with our nutrition specialists. There are no patent solutions that are right for all cancer patients, only principles on which a nutrition plan should be based. However, deficiency symptoms must be avoided at all costs in cancer therapy. We also advise against more radical, scientifically insufficiently proven dietary measures. We are fully committed to science.
Avoiding obesity from the outset is the best prevention. To achieve this, we need to start with children and young people. But it is never too late in life. Cancer is just one of the many health risks associated with being overweight. The quality of life suffers in many different ways.
How often does the injection have to be repeated and how long does the treatment last?
Saxenda is injected under the skin daily, Wegovy once a week using a pen. The dose is increased in steps to ensure good familiarization. After one month, most people have already lost around two to three kilograms. The products are used for at least several months.
What happens when the injection is discontinued?
This is what happens after every diet if diet and lifestyle have not been changed: Appetite increases and you gain weight again. For obesity sufferers in particular, however, an initial significant weight loss offers the chance that exercise and sport will be possible again. Additional movement can have a lasting effect.
To what extent are weight loss injections an option for our increasingly overweight society?
At the USZ, we clearly do not use the syringes as lifestyle diet aids. From a medical point of view, however, promoting weight loss in this way is to be welcomed in severely overweight people. This allows us to reduce the risk of secondary diseases such as type 2 diabetes or cardiovascular problems. From a cost perspective, too, it is ultimately cheaper to prevent cardiovascular problems than to finance rehabilitation after a heart attack.
Well treatable
However, insulin resistance is reversible. “If you reduce your weight and adjust your lifestyle in good time, you have a good chance of significantly improving your blood sugar levels,” says Claudia Cavelti-Weder encouragingly. It is often enough to lose a few kilograms so that the insulin is sufficient to process the blood sugar again.
The USZ’s internal diabetes and nutrition counseling services provide valuable support in weight reduction. Because turning your life upside down can be a major inhibition. “As a rule, we don’t start insulin therapy for people with type 2 diabetes, but instead focus on lifestyle changes,” explains Ruth Hirschmann, Head of Diabetes Counseling at the USZ.
Insulin as the last option
If lifestyle changes do not bring any improvement, there are various medications available to treat type 2 diabetes, with insulin being the last option. “However, as this is a chronic, progressive disease, insulin and the use of a glucose sensor may still be necessary at a later stage.” By changing long-standing behavioral patterns, weight can be reduced and maintained in the long term. “But not everything is banned,” emphasizes nutritionist Noela Vontobel.
An assessment is always followed by individual nutritional therapy. However, it takes time for behavioral patterns to change. Once the first few kilos have been lost and the first improvements have been made, nothing stands in the way of sustainably healthy eating habits.
Patient at the center
Approximately 30,000 anesthesias are performed at the USZ every year. A variety of different procedures are offered and different anesthetics are used. In addition to safety and the best possible medical care for the patient, the sustainability of the various anesthesia procedures is of great importance in the choice of procedure. There is no “one size fits all” concept in anesthesia at the USZ: the procedure is discussed and coordinated individually with each patient.
Implementation even before the directive
Targeted measures were taken on the initiative of the Institute. In addition to desflurane, the most climate-damaging anesthetic gas, the second most harmful, isoflurane, was also banned from the operating theaters at the USZ before 2022. Since the beginning of 2022, there has been a directive in place in anesthesiology that limits the use of climate-damaging anesthetic gases. For example, only sevoflurane is currently used in anesthesia at the USZ. Nitrous oxide, which also has a climate and ozone-damaging effect, has not been administered for over twenty years and is now only used in obstetrics clinics – but even there it is becoming increasingly rare.
Propofol as an alternative
For most operations, intravenous anesthetics such as propofol can be used instead of anesthetic gases. “At the USZ, we made total intravenous anesthesia the standard anesthesia. However, there are certain clearly defined medical indications for which inhaled anesthesia with sevoflurane is still necessary and sensible,” says Corinna von Deschwanden, Head Physician and Sustainability Officer at the Institute of Anesthesiology. Many seriously ill patients are treated at the USZ, which is why anesthesia with Propofol cannot be administered in every case – for example after a long stay in the intensive care unit and long-term sedation with Propofol.
The order for anesthesia with sevoflurane is issued by the responsible senior physician on the basis of the instructions. Since their introduction, consumption of the only remaining anesthetic gas sevoflurane has already been halved by 2022. At the Institute of Anesthesiology, many employees are constantly working towards greater sustainability in anesthesiology.
The reduction or elimination of inhaled anaesthetics is one of several projects: “We are in a process that is far from complete. Completely climate-neutral anesthesia is difficult to achieve,” says Corinna von Deschwanden. The switch to Propofol as the standard anesthetic also requires adjustments to the work processes. For example, the wake-up phase for these patients takes many times longer than with inhaled anesthetic gases. As a result, they need medical care for longer. Decisions relating to sustainability are always multidimensional and usually complex.
More is always possible
Until now, the gases have been removed using the so-called anesthetic gas transport system. It is a copper pipe system that extracts the inhaled anesthetic gases using a hose and discharges them via the roof or façade. In addition to greatly reducing its use, the USZ is also keen to recycle the remaining quantity of inhaled anesthetics and thus further reduce its ecological footprint. “Carbon-based filters are one way of binding these gases and thus recycling them,” says Fabio Tonina. To this end, a market analysis was carried out in which various products were compared. “In the next step, we want to carry out tests,” says the Technical Project Manager for Medical Gas Supply, looking to the future.
