Endocrinology and Diabetology | Specialists and Information

Hormones are biochemical substances produced by the body. Their production is governed by regulatory cycles—some of which are complex—that are finely tuned to one another.

Hormones play a very important role in many of the body’s functions. If the body produces too many or too few hormones, this has far-reaching effects on the body. The response of the hormone-producing cells is also crucial.

The Endocrine System @ bilderzwerg /AdobeStock

The endocrine glands produce hormones that act within the body. These glands release the hormones directly into the bloodstream, which then transports them to other parts of the body where they exert their effects.

Endocrinology therefore deals with hormonal balance and potential disorders, such as those related to:

• Growth
• Reproduction
• Development, as well as
• Responses to stress and strain

An endocrinologist deals with diseases that affect hormonal balance or the hormone-producing organs, such as:

• the thyroid and parathyroid glands
• Pancreas
• Pituitary gland
• Adrenal glands
• Reproductive organs (testes and ovaries)

Conditions and disorders in the field of endocrinology include, among others:

• Thyroid disorders: hypothyroidism, hyperthyroidism, goiter
• Diabetes mellitus
• Obesity
• Lipid metabolism disorders, such as hypercholesterolemia (high cholesterol)
• Disorders of the gonads (ovarian or testicular dysfunction), such as polycystic ovary syndrome (PCOS) and hypogonadism
• Pituitary disorders, such as Cushing’s disease
• Osteoporosis (bone loss)
• Hormone-producing tumors

Symptoms of hypothyroidism @ bilderzwerg /AdobeStock

The diagnostic process begins with a medical history, which involves asking the patient about:

• Symptoms
• Lifestyle
• Medication use and
• Medical history, including that of immediate family members

This is followed by a physical examination by the doctor. This provides the doctor with initial clues as to an underlying condition.

Depending on the suspected diagnosis, laboratory tests are then performed, followed by imaging studies, to diagnose a hormonal imbalance.

Hormonal and metabolic disorders can often be identified through abnormal lab results. For example, blood levels of certain hormones are often too high or too low. Or blood sugar may be too high.

Laboratory tests are therefore a key component in the diagnosis of endocrine disorders. These are performed before imaging procedures.

Imaging procedures include, for example:

• Ultrasound (sonography), for example, of the thyroid gland when a thyroid disorder is suspected, or of the ovaries when PCOS is suspected
• Computed tomography (CT) or magnetic resonance imaging (MRI), for example, when hormone-producing tumors are suspected
• Bone density measurement (examination of the hip and lumbar spine), for example, during corticosteroid therapy or when osteoporosis is suspected
• Doppler ultrasound of blood vessels, for example, in cases of lipid metabolism disorders

In most cases, medications can correct hormonal imbalances through targeted hormone or drug therapy.

Often, a gradual adjustment is necessary to reach the optimal dosage. In some cases, this treatment must be continued for life (for example, in cases of thyroid disorders).

This requires close monitoring by the treating physician. Depending on the cause of the hormonal disorder—for example, a hormone-producing tumor—surgery may be necessary.

A change in diet and overall lifestyle is often necessary (for example, in cases of diabetes mellitus). In these cases, it is important to provide the patient with thorough counseling. Regular physical activity can also have a positive impact on treatment.

If mental health issues have led to hormonal imbalances, psychological or psychiatric treatment may be helpful.

Diabetology deals with the prevention, diagnosis, treatment, and research of diabetes mellitus. 

The main types of diabetes are:

• Type 1 diabetes mellitus
• Type 2 diabetes mellitus 
• Metabolic syndrome, as well as
• gestational diabetes

A diabetologist is also responsible for managing complications and comorbidities, such as:

• Hypoglycemia (low blood sugar)
• Hyperglycemia (high blood sugar) Diabetic foot syndrome
• Kidney disease (diabetic nephropathy),
• Nerve damage (diabetic neuropathy or polyneuropathy)

Diabetes-related eye diseases (retinal changes) are treated by an ophthalmologist.

Diabetes diagnostics include:

• Repeated measurements of fasting blood glucose (or plasma glucose levels) and
• If necessary, an oral glucose tolerance test (oGTT)

The glucose tolerance test is also part of prenatal care to rule out gestational diabetes.

If the value is 200 mg/dl or higher after 120 minutes, the diagnosis is diabetes.

If the value is 200 mg/dl or higher after 120 minutes, the diagnosis is diabetes. A value between 140 and 200 mg/dl indicates impaired glucose tolerance @ PH-HY /AdobeStock

Depending on the specific condition, various therapies and supportive measures are used in the treatment of diabetes mellitus, such as:

• Insulin therapy, with an insulin pump if necessary
• Blood sugar-lowering medications
• Educational programs (for example, on proper nutrition, self-monitoring of blood glucose, medication use, and the use of an insulin pump)

Throughout the course of treatment, the doctor performs regular checks of blood glucose levels and long-term blood glucose levels (HbA1c).

Diabetes mellitus is caused either by a lack of insulin or by insulin resistance. This means that the target cells are less sensitive to insulin.

Since insulin is a hormone, the medical discipline that deals with diabetes mellitus is also part of endocrinology. It is called diabetology.

General practitioners often detect disorders of glucose metabolism—and thus diabetes mellitus—during early detection screenings or routine examinations.

For this reason, many general practitioners complete advanced training in the field of diabetology.

After completing medical school, a physician licensed in Germany can pursue further training in various specialties. For example, they can become a specialist in internal medicine, general practice, or internal medicine with a focus on endocrinology and diabetology.

This requires five to six years of practice. During this time, the physician must perform a specified number of diagnostic procedures and treatments.

This enables the specialist to gain in-depth knowledge in all areas of the diagnosis and treatment of hormonal disorders.

Specialists in internal medicine or general practice can obtain certification as a DDG-certified diabetologist from the German Diabetes Society (DDG). This certification is granted upon successful completion of the advanced training program.

This quality certification demonstrates their comprehensive knowledge in the care of patients with diabetes.

Diabetology deals with the prevention (prophylaxis), diagnosis, treatment, and research of diabetes mellitus, commonly known as diabetes. Physicians who specialize in this field are called diabetologists.

Both adults and children can receive treatment.

The specialty covers the following conditions:

• Type 1 diabetes mellitus: This is the rare, congenital form of diabetes mellitus. In this condition, the body’s own immune system destroys the insulin-producing cells in the pancreas. This leads to insulin deficiency. Those affected are mostly children and adolescents. They require lifelong insulin therapy.
• Type 2 diabetes mellitus: Accounting for 90% of cases, this is the most common form of diabetes mellitus. It is often associated with obesity and typically does not develop until adulthood.

Possible causes include:

• The cells do not respond adequately to insulin and therefore do not absorb enough sugar (insulin resistance)
• The pancreas produces too little insulin.

Often, both causes occur together.

• Metabolic syndrome: Can develop from type 2 diabetes and is characterized by a combination of various features, such as:
• Abdominal obesity
• Insulin resistance
• Impaired glucose and lipid metabolism
• High blood pressure
• Gestational diabetes: First appears during pregnancy. Although it usually resolves after pregnancy, it increases the risk of developing type 2 diabetes later in life.

Woman with gestational diabetes measuring her blood sugar @ tonefotografia /AdobeStock

Possible complications and comorbidities also fall within the scope of practice of a diabetologist or a primary care physician with appropriate additional training.

Complications and associated conditions may include:

• Hypoglycemia (low blood sugar, blood sugar level too low) up to hypoglycemic shock
• Hyperglycemia (high blood sugar, blood sugar levels that are too high) up to diabetic coma
• Kidney disease (diabetic nephropathy)
• Foot complications such as non-healing wounds and lesions (injuries) up to diabetic foot syndrome
• Nerve damage leading to various forms of diabetic neuropathy or polyneuropathy

An ophthalmologist diagnoses and treats diabetes-related eye diseases (retinal changes).

In this context, diabetologists are responsible not only for diagnosis and treatment, but also for:

• long-term medical counseling and care
• conducting educational sessions and
• emergency care for patients with diabetes

Diabetologists treat both patients who have already been diagnosed with diabetes mellitus and patients suspected of having diabetes.

The diagnosis includes:

• Taking a medical history, including medications taken and lifestyle habits
• Repeated measurement of fasting blood glucose levels (plasma glucose levels)
• Conducting an oral glucose tolerance test (oGTT; also known as a glucose challenge test)

Measuring the HbA1c level also provides information about blood sugar levels over the past eight to twelve weeks. The HbA1c level reflects long-term blood sugar control and represents the form of hemoglobin to which sugar has attached.

If diabetes mellitus is diagnosed, the endocrinologist offers not only treatment but also educational sessions for patients and their families. 

In these educational sessions, patients learn:

• How to make lifestyle changes
• What kind of diet is important
• How to measure their blood sugar on their own
• How and when to take medication or administer insulin

Diabetologists are typically internists who specialize in diabetes mellitus @ metamorworks /AdobeStock

If the patient needs an insulin pump that automatically delivers insulin, the doctor also provides the patient with in-depth counseling.

To monitor the progression of the disease on a regular basis, the diabetologist conducts regular checkups. During these visits, the doctor draws blood and measures not only the blood sugar level but also the HbA1c level. 

Based on the HbA1c level, it can be determined to what extent medication adjustments are necessary.

During these checkups, the doctor monitors for potential complications and comorbidities. If necessary, the doctor refers the patient to other specialists (such as an ophthalmologist).

In emergency care, the diabetologist also treats patients with hypoglycemia. In such cases, they administer a glucose infusion to restore blood sugar levels to normal.

After completing medical school, a physician licensed in Germany can pursue further training in various specialties. For example, they can become a specialist in internal medicine or a specialist in internal medicine, endocrinology, and diabetology.

This requires five to six years of clinical experience. During this time, they perform a specified number of diagnostic procedures and treatments.

After successfully passing the specialist examination, certification as a DDG-certified diabetologist by the German Diabetes Society (DDG) is possible. 

An additional requirement for being allowed to use the additional title “Diabetologist” is 24 months of further training at a recognized diabetes facility. 

A specialist in Internal Medicine, Endocrinology, and Diabetology is not required to complete this additional training again.

Diabetologists can work independently in their own practices, where they perform diagnosis, treatment, and emergency care. 

However, it is also possible to work as a salaried diabetologist in a large specialty practice or in a hospital.

Many clinics have now specialized in treating diabetes patients. Care and treatment in these clinics are provided by diabetologists.

Medical support staff who have completed specialized training in diabetology also play a role in the care of diabetes patients.

These include, for example:

• Diabetes counselor
• Diabetes assistants

Diabetes counselors provide care and counseling to patients with type 1 and type 2 diabetes mellitus, as well as to pregnant women with gestational diabetes.

The duties of diabetes assistants include:

• Care
• Counseling and 
• training of patients with type 2 diabetes mellitus

They also provide support in the care of patients with type 1 diabetes.

While diabetes counselors may be employed or self-employed, a diabetes assistant reports to the supervising physician. This means that a diabetes assistant is always employed and works as part of a team.

For both continuing education programs, a completed training in a healthcare profession (for example, medical assistant, healthcare/nursing professional, geriatric care worker) is a prerequisite.

Prospective diabetes counselors must also complete practical work in diabetology under the supervision of a diabetologist during their continuing education. Therefore, diabetes assistants can also undergo further training to become diabetes counselors.