Looking ahead Annual Report 2016

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In 2014, my uncle Bing was diagnosed with type 2 diabetes. The news shocked me. We are very close. When I was a child, we often visited him and my aunt on weekends, and I played with my little cousin. Later, I also was their babysitter. I have memories of outings and trips to the movies together. Even now, Bing often comes to visit us. He is a quiet, educated man, a real family man who helps his wife a lot with domestic chores. The diagnosis was a complete surprise. My uncle is in his late forties and had never been seriously ill before. Sure, he liked to eat and was somewhat stout, but he wasn’t obese. He smoked and occasionally had a drink, but nothing in excess. When I asked around, I discovered that diabetes is widespread among my acquaintances. Almost everyone knows someone in their family or circle of friends who suffers from it.

We were therefore even more relieved to learn that the diabetes was at an early stage and that his sugar levels were only slightly higher than normal. Bing had to make a few changes to his daily routines, but none of them restrict him in any way. He takes a pill each morning before breakfast now. He no longer drinks alcohol and eats less, avoiding sweets. Other than that, he just continues to lead a normal life. We are optimistic that my uncle will stay healthy for many more years to come. He has to go to the hospital every three months for a check-up. His health insurance pays for the treatment. Ever since he felt sick at the office one day, he has carried some grape sugar (dextrose) in his pocket for emergencies. And there is always sweetened yogurt in the refrigerator at home. Because the doctors didn’t give my uncle very much information material about diabetes, we researched a lot together online. Colleagues who have experience with diabetes also give him advice. I think it’s great that Bing is more active now and that he often walks instead of taking the subway or a taxi. He has also quit smoking. I hope my father will follow his example.

„Old Shanghai is like an elegant lady – the modern part of the city is as exciting and stunning as New York. I love this contrast.“

– Xiaoqian

Blood glucose: Out off control - The global phenomenon of diabetes can lead to serious secondary diseases

Whatever we do: whether it’s running or laughing, breathing or thinking – the highly efficient metabolism of our body provides us with necessary energy in every situation. Among other things, this is obtained from carbohydrates in our food, which are first broken down completely into glucose. Glucose enters body cells using the hormone insulin and is converted into energy there. But what if this control mechanism no longer works and the glucose accumulates in the blood? Then we are faced with dealing with diabetes.

While around 415 million people were already living with diabetes worldwide in 2015, it is estimated there will be 642 million in 2040. Many would think that Europe and the US have the highest number of diabetics, however, China, with 109.6 million people affected, is the country with the most diabetics, and India follows with 69.2 million. The numbers also are growing rapidly in Africa and Latin America. In addition, one out of two patients does not know about his/her diabetes and remains untreated.

The reason is that symptoms such as fatigue, thirst, or weight loss are often overlooked or considered harmless, and are therefore not associated with diabetes. There also are different forms of the disease: In the case of type 1 diabetes, the body cannot produce insulin. The trigger is usually an autoimmune reaction which leads to the destruction of insulin-producing cells. Those affected need to regularly supply the missing insulin – which is directly impacted by food intake, physical activity and various other influencing factors – from the outside. This is the only way to keep the blood glucose level within the normal range.

In the case of the significantly more frequent type 2 diabetes, there is a more or less pronounced insulin resistance of the cells. In this case, the insulin has a reduced effect. In contrast to type 1, type 2 is a classic lifestyle disease, which is primarily caused by obesity, a lack of exercise and a carbohydrate- rich diet. The good news: By means of a healthy lifestyle with a balanced diet and exercise, patients can significantly delay the progress of the disease. If required, a medication is typically given in pill form or by insulin injection.

However, whether type 1 or 2: In both cases, regular monitoring of blood glucose levels is the basis for daily therapy and life management using precise measuring devices. The consequences of too high or low blood glucose levels equally affect both patient groups. If blood glucose is too low, there is a risk of unconsciousness. If blood glucose is too high, the patient may fall into a coma – which can be fatal. In addition, permanently elevated blood glucose levels lead to severe consequences such as cardiovascular disease, impaired renal function, ocular diseases, nerve damage or the diabetic foot syndrome.

Equally important as the monitoring is documenting the glucose levels as well as all other important influencing factors. In addition to the amount of insulin administered and the type and portion of the meals consumed, excessive physical stress also influence blood glucose levels. The more precisely these factors are documented, the better the causes of blood glucose fluctuations in everyday life can be detected and intercepted by appropriate adaptations of insulin therapy – the best conditions for a good therapy process and the reduction of the risk of possible long-term effects.

B. Braun has been committed to the field of diabetes for many years with its high-quality products and services. Our goal is to help patients with diabetes lead a normal, self-determined life despite their illness. They can use the Omnitest® measurement system to precisely determine their blood glucose levels within seconds. And thanks to the Omnican® Lance device, the necessary needle penetration is less painful. The Omnican® fine pen needle for insulin pens as well as various insulin syringes make injections comfortable for insulin-dependent patients. For easy-to-use and secure data management, we offer patients with diabetes the diabetes diary Omnitest® Center for smartphones, tablets or computers.

However, even with the best possible therapy, diabetes may still attack the kidneys. In a healthy state, the kidneys filter waste products from approximately 1,500 liters of blood each day and secrete it via the urine. In addition, they regulate body fluid composition and produce hormones. However, worldwide diseases such as hypertension or diabetes can lead to chronic renal failure. The fact that 30 to 40 percent of all diabetics eventually suffer from renal disease shows how strongly both diseases are linked.

If, however, permanently elevated blood glucose damages the kidneys, they can gradually no longer fulfill their functions. The fact is the earlier the damage is detected, the more effectively the process can be slowed. In the first stages, nutritional therapies and medications help slow the loss of kidney function. Whether it leads to renal failure is, however, not fully controllable. In all stages of chronic renal failure, however, there are still opportunities to continue to live an active and self-determined life despite this illness – mainly thanks to modern methods such as hemodialysis.

In this case, instead of the kidneys, a special filter – the dialyzer – cleans the blood. The patient is connected to a dialysis machine via a specially placed vascular access, and the blood flows through the filter by means of a tubing system. In addition to dialysis, many doctors prescribe medication to their patients. Adjustment of nutrition also may be necessary, for example in the form of altered protein and restricted potassium intake.

B. Braun has been for many decades helping renal patients. In this health care space, we are one of the largest suppliers worldwide. In more than 350 renal and dialysis centers in more than 30 countries in Africa, Asia, Europe and Latin America we provide patients with holistic medical care – from
initial education, prevention and early diagnosis to dialysis.

For us, patients and clinicians are always our top priority: By taking care of organizational and logistical tasks in the centers – such as billing or personnel search – we help doctors and nurses concentrate on their patients. In order for our employees to continue to provide optimal service to patients and keep their expertise up-to-date, they regularly attend training courses.

We not only operate kidney and dialysis centers, but also manufacture equipment and consumables – for hemo- and acute-dialysis as well as for special blood purification procedures, for example for the therapy of fat metabolism disorders. It is important to us to offer an integrated system with coordinated components. In addition to dialysis machines, these include therapy options, software solutions, water treatment systems, technical service as well as process consulting, planning, documentation, installation, and further education.

Even though technological possibilities are groundbreaking, they do not replace the exchange between people. This applies to doctors and their patients, as well as to us: By maintaining direct dialog with them, we recognize their needs to continue developing innovative solutions in diabetes management and dialysis.

„A breath of fresh air: Songnan Park is a green oasis in the megametropolis. My uncle Bing and me enjoy the peacefulness.“

– Xiaoqian