Diet in diabetes mellitus
introduction
Diabetes mellitus (Diabetes) is a chronic disease of the entire metabolism. It is characterized by inadequate insulin action or insulin deficiency. This initially affects the carbohydrate metabolism, but the fat and protein metabolism are also disturbed.
Insulin is a hormone that regulates the sugar balance. It is in the so-called
„Langerhans Islands" in the pancreas formed and released into the bloodstream as needed. The gland reacts to the blood sugar level. Normally, as soon as the blood sugar level rises after eating, enough insulin is released to lower it and thus keep it normal. The empty blood sugar level should be between 80 and 110 mg / dl. After eating, a value that does not exceed 145 mg / dl is to be considered normal. Diabetes is present when fasting blood sugar concentrations> 126 mg / dl and after a dose of 75 g dextrose> 200 mg / dl are detectable.
There's two types of diabetes that are also called Type I diabetes and type II diabetes are designated. The second form, with more than 90% of all diabetes patients, is far more common.
Type I diabetes is when the pancreas is not able to produce enough insulin. This form is usually genetically determined and occurs in early childhood or adolescence.
In type II diabetes, the body is usually resistant to insulin, which develops in the course of life and usually only leads to the onset of the disease in adulthood.
Both types of diabetes also differ in their therapy. While type I diabetics are lifelong dependent on insulin injections, milder forms of type II diabetes can often be treated with the help of tablets and lifestyle changes.
If the blood sugar rises sharply, the so-called kidney threshold (around 180 mg / dl) is exceeded and sugar appears in the urine. Diabetes mellitus means translated "honey-sweet flow" or "sugar urine riot". Increased thirst (sugar needs solvents) and increased urination are often the first signs and lead the patient to the doctor.
As soon as there is a lack of insulin, the sugar is no longer properly distributed in the organism, as a result of which the organ functions and the performance of the body's cells are severely impaired. Of course, the cells want to compensate for their glucose deficit and to do so, they draw in the glucose stored in the liver carbohydrates (Glycogen).
If this energy reserve is exhausted, protein is also converted into sugar in the liver. However, this disrupts the protein metabolism and attacks the cells. In addition, the sugar is only partially utilized and some of it is excreted through the kidneys. The loss of protein and energy eventually leads to muscular dystrophy and Weight loss.
The fat reserves provided for energy supply can also only be insufficiently metabolized in the liver when there is a lack of sugar. The misdirected breakdown of fat creates the so-called ketone bodies, which acidify the blood, are excreted in the urine and can be measured there as acetone.
Their detection indicates an advanced stage of the disease. The sweetish scent of acetone in the air is also characteristic.
primary and secondary forms of diabetes
A distinction can be made between primary and secondary forms of diabetes.
Secondary forms of diabetes:
These types of diabetes occur as a result of various diseases.
These are diseases of the pancreas, Condition after removal of the pancreas, chronic liver disease, iron storage disease or diseases that are associated with an increased production of hormones that increase blood sugar levels (Antagonist of insulin). A diabetic metabolic condition can also develop during pregnancy with the appropriate predisposition.
Primary forms of diabetes:
Type 1 diabetes
This type of diabetes is characterized by decreased insulin delivery or complete insulin deficiency. At the onset of the disease, insulin-producing cells are destroyed as a result of inflammation. Insulin production comes to a complete or partial standstill. The cause is likely an immune system malfunction.
This type of diabetes mainly begins in adolescence (even in children), but also in adulthood. The beginning is quick and often manifests itself through the so-called Coma diabeticum. Obesity is rare. The blood sugar is increased and often fluctuates greatly. The level of insulin in the blood is too low. There is a risk of ketosis (hyperacidity). Treatment with insulin is always required. Proper nutrition is necessary, see dietary recommendations
Read more on the topic: Diabetes in Children
Type 2 diabetes
This type of diabetes is characterized by decreased insulin effectiveness. The existing insulin is not able to smuggle the sugar into the cells, the sugar remains in the blood and the blood sugar rises. The cause can also be a decreased insulin delivery. This form of diabetes mainly begins in middle and older age, slowly and often unnoticed at first. Overweight is very common. The blood sugar is elevated but rarely fluctuating. The insulin level in the blood is usually normal or increased at the beginning. Type 2 diabetics tend to have high blood lipid levels. Treatment with blood-sugar-lowering drugs is usually effective, and sometimes a change in diet is enough. Insulin treatment not required at the beginning of the disease.
Appropriate, proper diet is required and sometimes the only treatment sufficient.
How do I recognize diabetes?
The first indications of a diabetes disease can be frequent urination, as well as being very thirsty and persistent fatigue. Diabetes can also occur in babies, toddlers, or children and can also be manifested by frequent urination and severe thirst.
Pregnant women can also be affected by diabetes, but they do not show the typical signs.
Nutritional therapy for diabetes mellitus
Nutritional therapy is in principle for everyone Types of diabetes the same and aims to compensate for the diabetic metabolic defect. The diet is combined with physical activity and, if necessary, with blood sugar-lowering drugs or insulin. For type 2 diabetes, nutritional therapy is sometimes sufficient as the sole treatment.
This prevents the occurrence of acute (for example hypoglycaemia) and chronic (nerve damage, vascular changes in the eyes and kidneys, diabetic foot, Heart attack, Stroke) complications. The development of Consequences of diabetes depends essentially on the quality of a long-term optimal metabolic adjustment.
Metabolic control target values:
Blood glucose on an empty stomach: 80 - 110 mg / dl, after food intake up to 145 mg / dl.
HbA1 below 8.0%.
The diabetic himself can measure fasting blood sugar and blood sugar after ingestion with the help of Blood glucose meters determine. However, this is only a snapshot and blood sugar can fluctuate significantly over the course of the day. For this reason, a long-term parameter is determined at certain intervals, the so-called HbA1. HbA1 means hemoglobin A1. Hemoglobin is the red blood pigment in red blood cells and, depending on the level of blood sugar, glucose molecules accumulate. One speaks of glycosylation.In metabolically healthy people with always normal blood sugar levels, the HbA1 is up to 7%; in poorly controlled diabetics, levels of 16% and more can be achieved. Corresponding to the lifespan of the red blood cells of 120 days, this value is an indicator of the metabolic status in the last few weeks and months.
Further goals are: Urinary glucose 0%, serum cholesterol below 200mg / dl, HDL> 40mg / dl, triglycerides below 150mg / dl, body mass index in women 19 to 24 in men 20 to 25, blood pressure below 140/90 mmHg
In the case of insulin-dependent diabetics, attempts are made to achieve the best possible adaptation between food intake and insulin administration. One wants to avoid hypoglycemia or hypoglycemia. The meals must be planned in terms of their composition.
In overweight diabetics, the Weight reduction the main goal of nutritional therapy. The distribution of food throughout the day and the amount of food also depend on physical activity. If these measures are not sufficient, blood sugar-lowering drugs are also used and meals must be adapted to this therapy.
What should you consider when eating?
Since the body can no longer regulate the sugar metabolism independently in diabetes, this must be actively and consciously controlled from the outside. In addition, it is of great importance that those affected deal well with their disease and are well informed Diabetes training learn how they can change their eating habits and lifestyle in the future. The disease can be positively influenced by a change in lifestyle and diet.
In some cases, the blood sugar level even normalizes completely with strict dietary changes and no drug therapy is necessary. However, this requires some Discipline and commitment of the patient. The family doctor can help by providing thorough, individualized information about the changes that are required and working with the patient to consider what measures he or she can take. For example, sports that those affected used to enjoy but were then given up can be resumed. When it comes to nutrition, alternatives should also be found that are healthy but are still eaten with pleasure. For the lifestyle change, realistic suggestions should be developed that the patient can implement and that can be easily integrated into the individual's everyday life.
The lifestyle change can not last Reduce secondary diseases or even prevent it entirely. For this, however, the blood pressure must be consistently in the normal range, the weight and blood lipid levels must be monitored and the long-term sugar level in the blood (also: HbA1c, see above) must not exceed 6.5-7.5% in the long term. This value is checked regularly by the family doctor.
If diet and lifestyle are not optimized, there is a risk Long-term damage on the retina of the eyes, on the kidneys or damage to the nervous system with the so-called diabetic foot syndrome and other complications. Regular control of these organ systems as part of screening examinations is also an important part of diabetes therapy.
Recommended foods for diabetes
Diabetics should especially focus on one balanced nutrition respect, think highly of. The same dietary recommendations apply as for healthy people, you can in principle eat anything, but the carbohydrate content plays an even more important role. It is particularly important for diabetics who require insulin to carefully calculate the carbohydrate units before eating and to adjust the amount of insulin afterwards.
According to the German Diabetes Society, the choice of food should be made individually. The family doctor can help by responding individually to those affected and discussing with them exactly the foods that are eaten with pleasure and often. There is no general ban on sugar, but type II diabetics should be able to reliably identify foods that contain a lot of quickly usable carbohydrates and thus cause blood sugar to rise quickly in order to at least reduce them. These include, above all, sweets and table sugar; these should be avoided if possible. But products with white flour such as pasta or white rolls are also included; these can go through Whole grain products or dishes with vegetables or eggs be replaced. With a high-fiber diet, for example Salad to eat, the absorption of carbohydrates can be delayed and the metabolic situation relieved.
Fruits and vegetables are recommended, but vegetables usually contain less sugar than fruit and are therefore preferable to them.
Vegetable fats such as olive oil such as Fish, nuts and seeds are also suitable for a healthy diet.
The sweetener stevia, for example, offers a good alternative for sweetening drinks or meals. When buying, however, you should make sure that the product actually contains stevia, as sometimes incorrect declarations can be found on the label.
In the current nutritional recommendations of the German Diabetes Society, the Weight reduction This is an important pillar especially for overweight type II diabetics. This also lowers the risk of vascular diseases and other sequelae. This means that you should also pay attention to the number of calories in order to reduce excess weight if possible. But sport can also help.
Is of great importance in the context of diet in diabetes Regularity and the number of meals. If possible, three meals should be given at set times, without skipping one or eating continuously in between.
In the case of insulin-dependent diabetics, the carbohydrate content of the food should be calculated before eating in order to adjust the amount of insulin accordingly and to avoid derailments in the sugar balance. For the calculation or estimation of the carbohydrate units, food cards or tables should be used as an aid, at least in the initial phase. They can quickly provide those affected with good orientation.
Foods to Avoid
There is no general ban on food for diabetics as long as the diet is balanced and healthy. Consumption of Highly sugary foods such as chocolate, chips or fast food as well as beverages with a high sugar content such as soft drinks or juices should be avoided or at least reduced or be compensated by the other foods.
An example of the reduction of rapidly absorbable carbohydrates would be the Reduction in the amount of pasta and the substitute with vegetables or salad.
Frequent and profuse consumption of very fatty foods should also be restricted, including foods such as sausages, fatty cheeses and various ready-made products.
It is essential to adhere to the Avoiding large amounts of alcohol. Excessive consumption of this can lead to derailments in the sugar balance and even acute seizures in the context of hypoglycaemia. After all, heavy alcohol consumption inhibits the release of sugar from the liver, as this organ is then primarily concerned with breaking down the ethanol. This can be very dangerous, especially for diabetics who need insulin. There is no general alcohol ban, however, according to the German Diabetes Society, consumption should be limited to between one and a maximum of two small glasses per day.
Apart from the sugar content, the fat and salt content of the food should also be taken into account in the case of diabetes, as successful diabetes therapy also includes good blood pressure and blood lipid control.
Nutritional example
When choosing the food, it is important to focus on one balanced nutrition to pay attention. For example, the first meal of the day can consist of oatmeal with milk and fruit. Whole grain bread is also a good alternative, as it contains less readily available carbohydrates and more fiber than white bread or rolls. You can also drink a cup of tea or coffee, but when sweetening it you should pay attention to the amount or type of sweetener. A total of about 4 bread units can be estimated for breakfast.
For lunchtime it is important to calculate roughly the same number of units. An example of a meal would be carbohydrates in the form of pasta or potatoes with vegetables on the side. Whole grain pasta is a healthier alternative. Meat can also be eaten as long as it is not too fat and too much. Fish can also be a good alternative to meat.
In the evening, the amount of bread units should be reduced to about 2. A few slices of whole grain bread with some vegetables or light cream cheese can be on the menu, for example. Low-fat quark or natural yogurt are also recommended.
For weight loss, it is helpful to completely avoid carbohydrates in the evening and to eat eggs, vegetables, quark or salad, for example.
It is important not to eat sweets in between.
General diet tips for diabetes
In general, what is healthy for everyone is also good for diabetics.
According to the German Diabetes Society, there are no general bans for diabetics. On the contrary, diabetes patients should ensure that their diet is as varied as possible and that it is individually adapted to their own taste. Diet should only be used as a yardstick if possible Half of carbohydrates, one third of fats and about 15% of protein. Only in the case of sugar, fats and especially alcohol is it necessary to reduce consumption as much as possible.
Furthermore, diabetics should be continuously under medical care in order to be able to regularly check blood lipids and blood pressure as well as blood sugar levels and thus prevent long-term damage. Doctors can also provide information on the carbohydrate and calorie content of individual foods.
Adequate exercise is also of fundamental importance and, in addition to weight loss, has a very positive effect on the course of the disease.
Overall, diabetes is nowadays a disease that can be treated well. Some sufferers manage to keep their blood sugar within the normal range without medication, only through their own commitment. The associated weight normalization can often lead to a better attitude towards life. The change in lifestyle is a challenge, but it can also be enriching and used as a motivation to listen to the needs of your own body and to integrate sport, physical activity and healthy nutrition into your everyday life.
Further therapeutic measures for diabetes
The basic therapy for type II diabetes mellitus initially consists of a lifestyle change in terms of a balanced diet, sufficient physical activity and normalization of weight. These measures alone usually help significantly to lower the blood sugar level in the blood.
If the blood sugar level cannot be controlled despite these measures, drug therapy should be considered. Metformin is the drug of choice. There are several other active ingredients in tablet form. If this is not enough, the administration of insulin must also be considered in type II diabetics.
Read more on this topic: Medication for diabetes
Furthermore, blood pressure and blood lipids should be optimally adjusted.
The therapy of type I diabetics consists from the beginning of an insulin intake adapted to the food, as there is a in their body absolute insulin deficiency predominates, which means there is no insulin at all.
Both type I and type II diabetics should see their family doctor regularly during the course of their illness in order to ensure that the important parameters are continuously monitored. Checking the feet for any wounds or injuries is also part of these preventive examinations. In addition, diabetics should also have ophthalmological care, as a dreaded complication of this disease is damage to the retina.
With consistent adherence to these precautionary measures and discipline on the part of those affected, diabetes mellitus is a disease that is relatively easy to control and in which the complications can be completely prevented or greatly delayed.
