Diet for diabetes

Diabetes mellitus is a common disease that perhaps every adult has heard of. It can be congenital or acquired during life, but in any case it is chronic and cannot be completely cured. Many have heard that diabetes is not a disease but a way of life. After all, the patient must follow a special diet for life and use individually selected drugs, and not always insulin injections. In general, nutrition in diabetes mellitus cannot be considered a diet in the widespread sense of the word, because there are not so many restrictions, and most of the prohibited products can be replaced with similar taste properties, but safe for the sensitive body of a diabetic.

What is diabetes mellitus and its types

Diabetes mellitus is a chronic disease in which there is a violation of glucose metabolism. It can be a consequence of a decrease in the amount of insulin hormone produced by the cells of the pancreas, so type 1 (insulin-dependent) diabetes mellitus is diagnosed or it becomes the result of regular overeating leading to obesity, severe stress and other factors, then type 2 (non-insulin-dependent) diabetes mellitus develops.

Insulin is a biologically active substance released into the blood by capturing a glucose molecule and transporting it to the desired cells.

It is type 2 diabetes that is most often diagnosed today and requires increased attention from doctors, as well as adherence to special nutritional principles, as it becomes a consequence of the unhealthy lifestyle that a person leads. With the regular intake of a large amount of carbohydrates in the body, the pancreas works for wear and eventually ceases to cope with its function or produces "damaged" insulin, which cells and tissues do not perceive. This means that such insulin is unable to capture glucose and transport it to its destination, as the cells "don't see it", that is. develops insensitivity to it. Not the last role in this is played by the changes in the hormonal background that inevitably arise with age.

In both cases, there will be a sharp increase in the concentration of glucose (sugar) in the blood and the development of characteristic symptoms:

• increased thirst;
• dry mouth;
• weakness;
• deterioration of vision;
• increased appetite, etc.

Type 2 diabetes mellitus is diagnosed more often, i. e. in 85-90% of patients. It usually occurs after the age of 40 and especially after the age of 65. Such a susceptibility of the elderly to the development of carbohydrate metabolism disorders is a consequence of a decrease in physical activity and a decrease in muscle mass, which is the main consumer of glucose, and increasingly observed abdominal obesity is becoming a another factor that increases the risk of developing non-insulin-dependent diabetes.

Abdominal obesity is the predominant deposition of fatty tissue in the abdomen.

Diagnosing diabetes is not difficult. For this, a blood glucose test is performed. Getting more indicators serves as a reason for further examination and selection of optimal treatment tactics, one of the mandatory components of which is nutritional correction.

Why it is important to follow the basic nutritional principles

With any type of diabetes mellitus, the blood sugar level rises, but despite this the cells cannot receive it due to insulin deficiency or the development of insulin resistance. Since glucose is a monosaccharide that is a product of the breakdown of carbohydrates, it acts as the body's main source of energy. Therefore, if the tissues do not receive it in sufficient quantities, they experience hunger, which, due to the transmission of the corresponding nerve impulses to the brain, leads to the appearance of a similar sensation in humans. Therefore, with diabetes, patients may want to eat something, especially sweet, even an hour after a large meal.

As a result, patients openly eat high-calorie, carbohydrate-rich foods, which in type 2 diabetes mellitus rapidly lead to weight gain and the progression of obesity. This leads to an even greater increase in blood glucose levels, an increase in the load on the pancreas, an increase in the production of insulin, an increase in tissue resistance to it, a worsening of the condition, that is, the formation of a vicious circle.

In such situations, if action is not taken promptly and this cycle is interrupted, high sugar levels (hyperglycemia) will lead to the development of ketoacidosis and diabetic coma. Initially, the patient will feel a strong thirst and often go to the toilet, then weakness, shortness of breath will quickly merge, a characteristic smell of acetone from the mouth and urine will appear, nausea and vomiting will occur. In the absence of competent medical care, confusion and ultimately diabetic coma will result.

In addition, long-term uncontrolled (decompensated) diabetes mellitus can lead to the development of:

• retinal lesions with subsequent irreversible blindness;
• impaired renal function and chronic renal failure;
• poorly healing trophic ulcers on the legs, very difficult to treat;
• osteoporosis, fraught with the possibility of getting a fracture of any of the bones of the skeleton, including the spine, even with a minor impact;
• disorders of the heart and blood vessels, organs of the digestive system, etc.

Therefore, it is important not only to diagnose diabetes mellitus in time and take the drugs prescribed by the endocrinologist, but also to strictly follow the recommendations related to nutrition.

Features of the diet

The diet for type 1 and type 2 diabetes mellitus has some differences that patients should understand. Regarding nutrition for insulin-dependent diabetes, in which patients receive lifelong replacement therapy in the form of regular insulin injections, doctors in different countries consider the need to limit simple carbohydrates in different ways.

Foreign endocrinologists believe that it is not necessary to reduce the amount of their consumption in type 1 diabetes with properly selected insulin therapy. Home doctors believe that this is fraught with undesirable consequences and insist on the need to limit the consumption of simple carbohydrates, but not completely abandon them, as in non-insulin-dependent diabetes. In type 2 diabetes mellitus, such disputes are inadequate, since with it the use of sugar can turn into disastrous consequences, which is not questioned in any country.

Additionally, people with type 1 diabetes should be able to count bread units (XE) and people with type 2 diabetes should be able to determine the glycemic index (GI). Nutrition should be structured in such a way that these indicators of the daily diet correspond to the developed norms.

Therefore, today with diabetes mellitus, patients are prescribed the so-called diet No. 9 in various modifications, the differences of which are insignificant. Which table is most suitable for a particular patient is determined by the endocrinologist, based on the results of the analyzes and the condition of the person.

In general, diet No. 9 is designed in such a way as to normalize carbohydrate metabolism by reducing the amount of simple carbohydrates consumed and, consequently, reducing the blood glucose level. As a result, it is possible to bring the amount of sugar in the blood back to normal, prevent the development of possible disorders of fat metabolism and complications of the disease.

Diet No. 9 assumes a complete rejection of simple carbohydrates against the background of the daily consumption of no more than 300 g of complex carbohydrates while maintaining the amount of protein foods within the physiological norm.

Basic nutritional principles

In case of diabetes mellitus of any type, the following recommendations should be observed:

• food must definitely be fractional and consist of at least 5 meals, especially with an insulin-dependent form;
• breakfast is a mandatory meal;
• when drawing up the menu, the physiological ratio of proteins (meat, fish dishes, dairy products), carbohydrates (cereals, bread) and vegetables should be respected, they should account for 25%, 25% and 50% respectively;
• the nutritional advantage is always given to foods with a low glycemic index and a high percentage of vegetable fiber;
• each meal begins with vegetables, and proteins are left at the end;
• the amount of salt should not exceed 5 g per day;
• fasting for diabetes is prohibited, if necessary, to reduce weight, this is done by increasing physical activity;
• when choosing a method of cooking vegetables, it is recommended to give preference to minimal heat treatment or completely abandon it, boiling, baking and steaming are ideal;
• A vegetarian diet for diabetes is not the best choice, although it helps improve the course of the disease and increase insulin sensitivity, you can only switch to it with the permission of an endocrinologist.

Nutrition for type 1 diabetes

Insulin-dependent diabetes is usually diagnosed from childhood. Since the cause of its development is the destruction of insulin-synthesizing cells in the pancreas, patients should be prescribed insulin therapy, and the drug and dosage are selected individually. Insulin injections completely cover the deficit in hormone production in the body, so no significant dietary restrictions are required, but the child's parents, and therefore himself, must learn to correctly calculate the amount of carbohydrates consumed to match the dose of insulin administered. For this purpose, tables have been created that indicate the number of so-called grain units in each product.

In type 1 diabetes mellitus, it is necessary to refuse only:

• any sugary drinks, including juices;
• ready breakfast cereals;
• confectionery.

You cannot eat more than 7 XE per meal and up to 25 XE per day. In this case, the amount of all carbohydrates consumed per serving volume is added together. For example, 2 XE is contained in 3 tbsp. L. finished dough, 4 tbsp. L. rice, 14 tbsp. L. legumes or 420 g of tomatoes.

1 XE equals 12g of carbohydrates or 20g of bread.

Sweets are not strictly prohibited, but only those who check the level of glucose in the blood several times a day can afford them, accurately count XE and can independently adjust the dose of insulin administered.

In severe type 1 diabetes mellitus, patients are prescribed diet No. 9b and large doses of insulin. It involves the use of 400-450 g of carbohydrates and is very close to the diet of most modern people. It is allowed to consume 20-30 g of sugar per day.

The endocrinologist who monitors the patient's condition will surely tell you how to distribute the amount of food between individual doses, depending on the type of drug she has prescribed. So, with the introduction of insulin twice a day (morning and afternoon), it is necessary to compose the menu so that almost 2/3 of the total daily carbohydrate intake falls within this period. Also, after each injection, you need to eat 2 times - 15 minutes after the injection and 3 hours after that. Fractional nutrition and control of the amount of XE are the basis of the diet for type 1 diabetes.

If, after the injection, the patient suddenly feels weak, this indicates a lack of glucose in the body. In such situations, you should immediately eat a piece of dark chocolate.

Therefore, with an insulin-dependent form of the disease, the main difficulty lies in the need to check not the type of food, but its volume and count the units of bread.

Nutrition for type 2 diabetes

In most cases, obesity is the main cause of the disease. Therefore, the type 2 diabetes diet is the first and main component of the treatment and prevention of complications. With its help, it will be possible to normalize sugar levels and control weight, thereby preventing the occurrence of unwanted changes and deterioration of the condition.

All patients should independently monitor their blood glucose levels on a daily basis using home glucose meters, and if stable elevated rates are obtained, seek immediate medical attention.

If the patient is diagnosed with an insulin-independent form of the disease of mild or moderate degree and his weight is within the normal range, he is assigned the basic diet No. 9 with a daily calorie intake of up to 2500 kcal. In such situations, you cannot consume more than 275-300g of complex carbohydrates from different sources per day.

In the presence of obesity, it is necessary not only to keep the glucose level within normal limits, but also to reduce weight, since its excess negatively affects the effectiveness of treatment and the well-being of patients. Therefore, in such cases, patients are prescribed the so-called reduced diet No. 9, which is characterized by a reduced calorie content due to an even greater restriction of the permissible amount of complex carbohydrates consumed daily. In this case, the endocrinologist individually calculates this rate based on the degree of obesity. Therefore, in several cases, patients may be allowed to consume 100 to 225 g of carbohydrates, and the total calorie intake should not exceed 1700 kcal per day.

What is not allowed

So, with type 2 diabetes mellitus, it is necessary to completely exclude from the diet foods containing so-called fast carbohydrates, that is, those that are broken down into glucose and absorbed into the bloodstream within 15 minutes. They quickly give an energy boost, but don't create a feeling of fullness, so after eating them, hunger returns very quickly. These include:

• sugar;
• honey;
• pastry, classic pastry;
• ice cream, chocolate;
• jams, marmalades, jams, preserves;
• sweet vegetables, fruits, berries (grapes, bananas, dates, pineapples, persimmons, dried fruits);
• white bread, loaf;
• semolina;
• smoked meats, fatty dishes;
• Mayonnaise;
• fast food, snacks.

For diabetics, special recipes, including permissible products, have been created for baking.

Diet number 9 does not require complete rejection, but recommends minimizing the amount consumed as much as possible:

• potatoes;
• beets;
• Corn;
• carrots;
• soy products;
• pasta;
• of bread.

If you are obese, you will have to completely abandon all high-fat foods:

• butter and vegetable oil, spreads;
• sour cream, fatty cheeses, cottage cheese, cream;
• lard, fatty meat and fish, chicken with skin;
• nuts, seeds;
• alcohol, etc.

In such situations, it is recommended to replace these products with vegetables that have a beneficial effect on carbohydrate metabolism. These are green leafy vegetables, eggplant, cucumber, turnip, cauliflower, squash, zucchini, radish, etc.

It is imperative to try to completely abandon foods with a large amount of fat, especially canned food, products of the meat processing industry, preserving sauces. They are replaced with boiled or stewed diet meat (chicken, rabbit, turkey, low-fat yogurt without additives).

What can

Carbohydrates are an indispensable part of the daily diet and must be on the diabetes menu, but only in acceptable quantities. Patients can only eat foods with slow-absorbing carbohydrates and high in fiber. it:

• vegetables;
• wholemeal bread with bran;
• whole grains (8-10 tablespoons), with the exception of refined rice.

Since sugar in any form is forbidden for diabetics, its substitutes that do not contain glucose have been specially created. Many of them are many times sweeter than sugar and can be used in minimal quantities. Modern sweeteners include xylitol, stevia, sorbitol, fructose. But studies have shown that some of them can have a negative effect on the body. Stevia is considered the safest sugar substitute today. It is obtained from natural raw materials and in sweetness exceeds sugar by 10-30 times (depending on the form of release: a powder of a herb or an extract called stevioside).

It is important that patients know the glycemic index of foods. Today there are special tables that help you navigate the choice and correctly calculate the permissible consumption rate. In diabetes, preference should be given to foods with a GI below 55 (apples, cucumbers, cherries, broccoli, lettuce, milk, cauliflower, etc. ). They break down slowly and lead to little or no increase in blood sugar levels. Such products can be consumed up to 200 g during a meal, but preferably together with protein foods.

Heat treatment increases the IG.

It is allowed to use:

• potatoes (no more than 200 g per day);
• meat dishes and vegetable broth;
• lean meats and fish (chicken, turkey, cod, pike, hake);
• Lentils;
• low-fat fermented milk and dairy products, cheeses with a fat content of less than 30%;
• eggs (3-4 per week, but not more than 1 per day);
• vegetable oil (no more than 1 tbsp. l per day);
• special sweets, waffles, diabetic bread.

When making homemade compotes, sweeteners are added instead of sugar.

Nutrition for gestational diabetes

Pregnant women with a genetic predisposition to the development of diabetes mellitus can face the development of so-called gestational diabetes at 20-24 weeks. It arises against the background of the presence of a hereditary reduced sensitivity of tissues to inulin, amplified by hormones produced during pregnancy in increased quantities: estrogen, prolactin, cortisol. They are able to block insulin and cause a rise in blood sugar.

Often, after childbirth, carbohydrate metabolism gradually returns to normal, as the hormonal background normalizes. However, if the basic principles of nutrition and diet are not followed, there is not only the risk of preserving diabetes mellitus, but also the development of complications that can lead to premature birth, pyelonephritis in the mother, pathologies of the fund and complications during childbirth. It is for the purpose of early detection of gestational diabetes during pregnancy that blood glucose tests are performed regularly and, if hyperglycemia is detected, a diet is prescribed.

In such situations, women are advised to:

• completely exclude simple carbohydrates from the diet (the same sugar, confectionery, chocolate, pastries, black and white bread, bananas, grapes, juices, nuts, etc. );
• limit your intake of complex carbohydrates to the quantities recommended by your doctor;
• remove most of the daily diet for unsweetened vegetables, fruits;
• refuse to eat fatty foods, fried foods, semi-finished products, a variety of sausages, smoked products;
• when choosing a method of cooking products, give preference to baking, stewing, steaming;
• eat in a fractional manner, preferably every 2 hours, highlighting 3 main meals (breakfast, lunch and dinner), as well as 2 additional ones (second breakfast, afternoon snack);
• drink at least 1. 5 liters of water.

Pregnant women with gestational diabetes are advised to measure their blood sugar after each meal.

All these recommendations are relevant for the postpartum period. In any case, in the first months of a child's life, a nursing woman is forced to follow a hypoallergenic diet and refuse fried and fatty foods. The same diet will help eliminate gestational diabetes and avoid its transition to a chronic disorder of carbohydrate metabolism within 2-3 months after childbirth. If, after this period of time, the blood glucose level does not return to normal, the woman should consult an endocrinologist for the examination and development of treatment tactics.

Products that reduce sugar

There are a number of foods that can help reduce blood glucose levels. They are called hypoglycemic agents and are recommended for patients with diabetes mellitus. But since each person is a unique biological system and has individual characteristics, he can react to certain types of food in his own way, and not just give allergic reactions. Therefore, although hypoglycemic foods can provide invaluable help to patients with diabetes mellitus, especially type 2, it is worth consulting an endocrinologist before starting their daily use.

So, foods that reduce sugar include:

• Cherries (GI 22) - contains anthocyanin, which helps lower blood sugar and blood pressure and eliminate so-called bad cholesterol. The daily norm is 100 g.
• Grapefruit (GI 29) - Contains naringin, a powerful antioxidant that helps increase insulin sensitivity in the tissues. It is recommended to consume 1 medium-sized grapefruit or freshly squeezed juice per day (commercial not suitable). But grapefruit can adversely affect the quality of absorption of various drugs, so consultation with your doctor is required before including it in the menu.
• Cinnamon is a source of polyphenols that help keep blood sugar levels in check. The daily rate is 1/2 tsp. It can be added to cottage cheese, oatmeal and is very suitable for making casseroles with apples.
• Broccoli is a valuable source of fiber, which is very beneficial for diabetes, and the substances it contains help slow down the absorption rate of sugar in the intestine. The daily norm is 200 g.
• Blueberries are one of the healthiest foods for diabetics, as they contain valuable glycosides, tannins, anthocyanins, which help maintain normal glucose levels and reduce the risk of developing damage to the diabetic retina. The daily norm is 200 g.
• Oatmeal and millet porridge are high in fiber, which help maintain sugar levels.
• Jerusalem artichoke is a natural source of insulin, thanks to which its use contributes to the normalization of glucose levels, and the presence of fructose in the composition provides a pleasant sweet taste, which allows it to be used raw or added to salads.
• Garlic is one of the healthiest foods for everyone, as it contains many antioxidants, natural antibacterials, and other substances. Its use causes the pancreas to work more actively, which is very valuable for patients with type 1 diabetes.
• Fish: It is proven that fish diabetics eat at least 2 times a week and, when possible, try to replace meat dishes with it. Helps normalize sugar levels and obtain essential polyunsaturated fatty acids.

Therefore, nutrition for diabetes mellitus can be varied and tasty. With a competent approach to planning the menu, it will not cause rejection, but, on the contrary, will help to increase energy and efficiency, since it largely corresponds to the principles of rational nutrition. But remember, in diabetes it is important to maintain a normal level of physical activity, as exercise increases the sensitivity of the tissue to insulin.