Diabetes Mellitus

INTRODUCTION

Diabetes is a devastating medical condition-affecting people of all ages, genders, and nationalities. The term diabetes mellitus derives from the Greek word diabainen ‘to pass through’ and the Latin word mellitus ‘sweetened with honey’.

Diabetes Mellitus is caused by an insufficient production of insulin by the pancreas . Without insulin the body cannot utilize glucose which results in an increase of glucose in the blood , poor utilization of glucose by the tissues or insensitivity of the cells to respond to the insulin that is present. Such abnormal levels of glucose in the blood often lead to vascular damage which is responsible for conditions like kidney failure, neuropathy, urinary problems and diabetic retinopathy .

TYPES OF DIABETES :

Diabetes Mellitus is divided into two categoies;

Type 1 is known as insulin dependent or juvenile diabetes. This is probably the result of a viral infection or autoimmune damage that destroys the insulin producing cells in the pancreas as a result almost no insulin is produced. Type 1 diabetes mostly occurs in children from 10-16 years or young adults. The symptoms of type 1 diabetes include abnormal thirst, nausea, vomiting frequent urination and excessive hunger. People suffering from this type of diabetes need to take a daily dose of insulin.

Type 2 diabetes is a more common form of diabetes. It results from gradual loss of body’s ability to make or to properly utilize insulin. It is also called maturity onset diabetes and generally occurs in people above 40 years of age. Sedentary life style, unhealthy eating habits and obesity are main causes of type 2 diabetes.

Gestational diabetes occurs during pregnancy and disappears after pregnancy. However it tends to lead to the later development of type 2 diabetes

WARNING SIGNS OF DIABETES

There are certain warning signs that will alert us about the presence of diabetes:

• Frequent urination
• Excessive thirst
• Extreme hunger
• Sudden weight loss
• Weakness, drowsiness or fatigue
• Tingling numbness in the limbs
• Irritability
• Wounds that heal slowly
• Sudden vision change or blurred vision

LONG- TERM COMPLICATIONS OF DIABETES

A very good reason to take care of your diabetes on a day to day basis is that this will prevent many health problems that diabetes could cause otherwise. People generally become aware of this condition only when they develop or experience some of the below mentioned complications.

• Diabetes and Eyesight
• Diabetes is the leading cause of new cases of blindness in people ages 20-74. Diabetics should go for an eye check up once a year.
• Kidney Disease
• The kidneys perform the vital task of cleansing your blood of toxic waste products. These abnormal levels of glucose in the bloodstream can lead to kidney failure.

Nerve Disease

About 60% to 70%of diabetics suffer from diseases of the small and large blood vessels, which can impair circulation of blood to all vital organs and the limbs. This can lead to death of tissues, infections and eventually can lead to lower limb amputations.

Heart Disease And Stroke

Diabetics are 4 times more likely to have heart disease, a condition present in 75 percent of all diabetes related deaths. They are also 4% more likely to suffer a stroke.

DIET FOR DIABETICS

It is important for diabetics to follow some lifestyle changes.

Diet in Type 1 diabetes

With use of insulin therapy for control of blood glucose, the patient must understand the action and the duration of the insulin being used as well as the effect of the timing of the intake of food on the insulin action. It is unreasonable to expect the patient to maintain a constant meal plan and insulin regimen. Insulin dosing and timing flexibility must be taught to the patient. This flexibility can be adapted by using the result of the blood glucose determination and the response to intake and timing of food.

Diet in Type 2 Diabetes

Weight loss and maintenance of weight loss result in a decrease in the insulin resistance of most patients with type 2 diabetes. A negative caloric balance can decrease insulin resistance. In the process of attaining a decrease in weight, blood glucose levels will improve Patients do not have to achieve ideal body weight to improve control of blood glucose, control of hypertension, and lipid levels. Loss of as few as 10 to 20 lb (4.5 to 9 kg) will be helpful, but the weight loss must then be maintained and exercise programs must be continued.

NUTRITIONAL COMPOSITION OF THE DIET

There is no clear cut formula diets for diabetics. Obesity is common among type 2 diabetics and a weight control program with life style changes are usually all that is required to control this type of diabetes. The key here is a thought to the caloric intake versus caloric output. The motivation for adherence to nutrition programs is the patient’s understanding of the effect of these actions on blood glucose, blood lipids and blood pressure.

Carbohydrate Intake

Currently, the average amount of carbohydrate recommended for patients with diabetes is 60 to 65% of the total caloric intake.

Fat Intake

Normal intake of fat should be limited to a maximum of 20% of the total caloric intake. With type 2 diabetes, weight is usually a factor in planning the treatment. In overweight persons or those with dyslipidemia, fat intake should be reduced to as low as 15% of the caloric intake. In persons with dyslipidemia, a concentrated effort should be made to avoid saturated fat and to substitute unsaturated fat or monounsaturated fat. The content should be as low in calories and in fat as tolerated.

Protein Intake

Intake of protein should be 20% of the total daily caloric intake. No evidence has indicated that patients with diabetes need a lower than average intake of dietary protein to protect against the onset of renal disease.

Fibre Intake

People with diabetes cannot properly process sugar. The fiber in carbohydrates helps protect against Type 2 diabetes. Most sugar comes from low-fiber foods, while high-fiber foods are often low in sugar. Therefore, eating more sugar usually means decreasing fiber-a mistake for diabetics. Whole foods, such as beans, whole raw fruit, and pasta, are preferred to processed sugary foods and fried snacks. Replace low-fiber, high-sugar foods (such as fruit juice) or starch (such as white bread) with high-fiber whole foods.

High-fiber supplements, such as psyllium, guar gum (found in beans), pectin (from fruit), oat bran, improve glucose tolerance. Eat more fruits, vegetables, seeds, oats, and whole-grain products. It is also recommended to consume 1-3 ounces of powdered fenugreek seeds per day.

Use of Alcohol

The effect of alcohol on blood glucose in diabetes has always been confusing. If possible, patients with diabetes should avoid or limit the use of alcohol because predicting or anticipating its effect on blood glucose is difficult. The effect of blood glucose depends not only on the amount of alcohol ingested but also on the amount of alcohol ingested in relationship to food and the content of the food ... Triglycerides can increase in response to consumed alcohol; thus, hyperlipidemia can worsen when alcohol is ingested. Because insulin is not required to metabolize alcohol, no food group should be eliminated from the calculated intake. Nevertheless, calories are added. Alcohol is currently counted as a fat exchange. Patients with pancreatitis, dyslipidemia, or neuropathy should especially avoid the use of alcohol.

Smoking

Diabetics who smoke are at higher risk for kidney damage, heart disease, and other diabetes-linked problems.

DIETARY CHANGES;

It is important to follow a regular meal pattern. Consume 6 small frequent meals. The gap between two meals however should not exceed 3-4 hours in order to maintain blood glucose levels.

• Make proper food choices while eating out. Avoid junk foods and empty calories e.g. Burgers, pizzas, alcohol, cola drinks etc.
• Avoid foods with high glycemic indexes.
• Do not skip a meal after insulin or anti diabetic drugs. This may result in hypoglycemia (low blood glucose levels). If hypoglycemic symptoms occur (e.g. hunger, sweating, trembling, dizziness, palpitation, weakness, headache, restlessness) immediately eat some quantity of sugar or jaggery. Follow it with a small snack e.g. sandwich, a fruit or even low fat biscuits.
• Do not fast or feast.

BENEFICIAL FOODS

• Onions, garlic, cinnamon, high fiber foods, beans, lentils, fenugreek seeds, barley, broccoli.
• Whole grains specially millet and wheat.
• Vegetables whole and cooked fruits

The following foods have an insulin-like action and should be included regularly:

• Brussels sprouts
• Cucumber, garlic
• Green beans
• Oatmeal or oat flour, wheat germ, buckwheat
• Soya bean and tofu
• Raw green vegetables
• Avocados

FOODS TO AVOID

• Foods rich in fat, especially animal foods
• Sugar
• White flour, sago
• Papad, pickle
• Fruit juice, milk shakes, aerated drinks
• Fried foods, sweets and desserts.

GESTATIONAL DIABETES

Diabetes can pose a serious problem for a pregnant woman. The risks include early labor, urinary tract infection, elevated blood pressure and possibility of delivery by caesarean section. Babies are also at risk which includes difficult birthing, increased risk of congenital abnormality, low blood sugar at birth or prolonged jaundice.

In the second and third trimesters of pregnancy the insulin requirement of the mother increases by 2 to 3 times. With healthy life style and eating pattern most women can fulfill this need.

DIET IN GESTATIONAL DIABETES

The goal of therapy in patients with gestational diabetes is to maintain normal fasting blood as well as normal postprandial blood glucose levels. Each diet must be individualized and altered during the progress of the pregnancy to ensure adequate caloric intake without inappropriate weight gain or weight loss and to avoid the development of ketonuria.

Follow this healthy, high fiber diet for diabetes.

Start morning with 30ml of aloe vera juice followed by 2 glasses of warm water.

Breakfast	Oats with skim milk ( add no sugar )
Mid morning	1 fruit ( choose from pear, apple, orange, papaya, melon , grape fruit )
Lunch	2 millet rotis ( choose from nachni, jowar or whole wheat ) 1 bowl of vegetables, cooked in less oil 1 bowl of salads with sprouts., or 1 cup lentils
Evening	1 cup of green tea or herbal tea A few almonds and walnuts or any diet snack
6 pm	1 glass of fresh veg juice made from bottle gourd, tomato and celery
Dinner(bet 7 and 7.30pm)	1 bowl of mixed veg soup, 1 millet roti or flat bread Vegetables sautéed in less oil.

Avoid the following :

Desserts, sugar, white flour, biscuits and cookies, soft drinks and juices, fried potato, white rice , alcohol, fried snacks, pickles and salad dressings.