Diabetes diet

Diabetes mellitus is a common disease that, perhaps, every adult has heard about. 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 be on 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 in it, 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 glucose metabolism is impaired. It may be a consequence of a decrease in the amount of insulin hormone produced by the cells of the pancreas, then type 1 diabetes mellitus (insulin-dependent) is diagnosed, or it becomes the result of regular overeating leading to obesity, severe stress and other factors, then type 2 diabetes mellitus (non-insulin dependent) develops.

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

It is type 2 diabetes that is most often diagnosed today and requires more close attention of doctors, as well as adherence to special principles of nutrition, since 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 tear and ultimately either 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, since the cells "do not see" it; develops insensitivity to it. Not the least role in this is played by the changes in the hormonal background inevitably arising 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.

Diabetes mellitus type 2 is diagnosed most often, namely in 85-90% of patients. It usually occurs after 40 years, and especially often after 65 years. Such a susceptibility of elderly people 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 the increasingly observed abdominal obesity is becoming an additional factor that increases the risk of developing non-insulin dependent diabetes.

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

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

Why it is important to follow the basic principles of nutrition

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 feeling in humans. Therefore, with diabetes, patients may feel like eating something, especially sweet, even an hour after a hearty meal.

As a result, patients openly overeat high-calorie carbohydrate foods, which in type 2 diabetes mellitus quickly leads to weight gain and progression of obesity. This leads to an even greater jump 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, i. e. , the formation of a vicious vicious circle.

In such situations, if you do not intervene in a timely manner and do not break this cycle, high sugar levels (hyperglycemia) will lead to the development of ketoacidosis and diabetic coma. Initially, the patient will feel strong thirst and often go to the toilet, then weakness, shortness of breath will quickly join, a characteristic smell of acetone from the mouth and from urine will appear, nausea and vomiting will occur. In the absence of competent medical care, confusion and, ultimately, a diabetic coma will ensue.

In addition, long-term uncontrolled diabetes mellitus (decompensated) 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, digestive tract organs, 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 regarding nutrition.

Diet features

The diet for type 1 and type 2 diabetes mellitus has some differences that patients should understand. With regard to nutrition for insulin-dependent diabetes, in which patients receive lifelong substitution therapy in the form of regular injections of insulin, doctors in different countries look at 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. Domestic doctors believe that this is fraught with undesirable consequences and insist on the need to limit the consumption of simple carbohydrates, but not to abandon them completely, as in non-insulin dependent diabetes. In type 2 diabetes mellitus, such disputes are inappropriate, since with it, the use of sugar can turn into disastrous consequences, which is not questioned in any country.

In addition, people with type 1 diabetes should be able to count units of bread (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 between which are insignificant. Which table is most suitable for a particular patient is determined by the endocrinologist, based on the results of 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 consumed simple carbohydrates and, accordingly, reducing the level of glucose in the blood. As a result, it is possible to bring the amount of sugar in the blood 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 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 should be certainly fractional and consist of at least 5 meals, especially with an insulin-dependent form;
• breakfast is a compulsory meal;
• when drawing up the menu, one should adhere to the physiological ratio of proteins (meat, fish dishes, dairy products), carbohydrates (cereals, bread) and vegetables, they should account for 25%, 25% and 50%, respectively;
• nutritional advantage is always given to foods with a low glycemic index and a high percentage of plant fiber;
• each meal begins with vegetables, and the protein is left at the very 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, cooking, baking and steaming are ideal;
• A vegetarian diet for diabetes is not the best choice, although it helps to improve the course of the disease and increase insulin sensitivity, you can switch to it only with the permission of an endocrinologist.

Nutrition for type 1 diabetes

Insulin-dependent diabetes is usually diagnosed during childhood. Since the cause of its development is the destruction of the cells of the pancreas synthesizing insulin, patients must be prescribed insulin therapy, and the drug and dosage are selected individually. Insulin injections completely cover the deficiency in the production of the hormone in the body, so significant dietary restrictions are not required, but the parents of the child, and then himself, must learn to correctly calculate the amount of carbohydrates consumed so that it corresponds to the dose of insulin administered. For this purpose, tables have been specially created indicating the number of so-called grain units in each product.

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

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

For one meal, you can eat no more than 7 XE, and a day - up to 25 XE. In this case, the amount of all eaten carbohydrates per serving volume is summed up. For example, 2 XE is contained in 3 tbsp. l. finished pasta, 4 tbsp. l. rice, 14 tbsp. l. legumes or 420 g of tomatoes.

1 XE is equal to 12 g of carbohydrates or 20 g of bread.

Sweets are not strictly prohibited, but only those who control the level of glucose in the blood several times a day can afford them, they accurately count XE and can independently regulate 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 daily.

The endocrinologist who monitors the patient's condition will definitely tell you how to distribute the amount of food between individual doses, depending on what type of drug he has prescribed. So, with the introduction of insulin twice a day (in the morning and in the afternoon), it is necessary to compose the menu so that almost 2/3 of the total daily intake of carbohydrates falls on this time. Moreover, 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 glucose deficiency in the body. In such situations, you should immediately eat a piece of dark chocolate.

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

Nutrition for type 2 diabetes

In most cases, obesity is the main cause of the disease. Therefore, the diet for type 2 diabetes 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 need to independently monitor their blood glucose levels on a daily basis using household glucometers, and if stable high rates are obtained, immediately consult a doctor.

If a 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 a basic diet No. 9 with a daily caloric intake of up to 2500 kcal. In such situations, you can consume no more than 275-300 g of complex carbohydrates from different sources per day.

In the presence of obesity, it is required not only to maintain the glucose level within the normal range, 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 different cases, patients may be allowed to consume from 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 the so-called fast carbohydrates, that is, those that are broken down to glucose and absorbed into the bloodstream within 15 minutes. They quickly give a boost of energy, but do not create a feeling of fullness, so after eating them, hunger returns very quickly. These include:

• sugar;
• honey;
• confectionery, classic pastries;
• ice cream, chocolate;
• marmalade, jam, jam, preserves;
• sweet vegetables, fruits, berries (grapes, bananas, dates, pineapple, persimmon, dried fruits);
• white bread, loaf;
• semolina;
• smoked meats, fatty dishes;
• mayonnaise;
• fast food, snacks.

For diabetics, special recipes have been created, including permitted products, 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 need to completely abandon all foods high in fat:

• 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 leafy greens, eggplants, cucumbers, turnips, cauliflower, pumpkin, zucchini, radishes, etc.

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

What can

Carbohydrates are an indispensable part of the daily diet, and they must be present on the menu for diabetes, but only in acceptable quantities. Patients are allowed to eat only foods with slowly absorbed carbohydrates and a high content of dietary fiber. It:

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

Since sugar in any form is prohibited for diabetics, its substitutes that do not contain glucose have been specially created. Many of them are many times more sweet 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 it surpasses sugar by 10-30 times (depending on the form of release: a powder from a herb or an extract called stevioside).

It is important for patients to 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 of less than 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 eaten up to 200 g during one meal, but preferably together with protein food.

Heat treatment increases GI.

It is allowed to use:

• potatoes (no more than 200 g per day);
• dishes based on meat and vegetable broth;
• lean meats and fish (chicken, turkey, pollock, 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, breads for diabetics.

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

Nutrition for gestational diabetes

Pregnant women with a genetic predisposition to the development of diabetes mellitus may 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 the hormones produced during pregnancy in increased amounts: estrogen, prolactin, cortisol. They are capable of blocking insulin and causing blood sugar to rise.

Often after childbirth, the metabolism of carbohydrates gradually returns to normal, as the hormonal background is normalized. But still, if the basic principles of nutrition and diet are not followed, there is not only a risk of preserving diabetes mellitus, but also the development of complications that can lead to premature birth, pyelonephritis in the mother, fundus pathologies, as well as complications during childbirth. It is for the purpose of timely detection of gestational diabetes during pregnancy that blood glucose tests are regularly carried out, 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, white and black bread, bananas, grapes, juices, dried fruits, etc. );
• limit the intake of complex carbohydrates to the amounts recommended by the doctor;
• take away most of the daily diet for vegetables, unsweetened 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 fractionally, preferably every 2 hours, highlighting 3 main meals (breakfast, lunch and dinner), as well as 2 additional (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 baby's life, a breastfeeding woman is forced to sit on a hypoallergenic diet and give up fried, 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 needs to consult an endocrinologist for examination and development of treatment tactics.

Sugar-lowering products

There are a number of foods that can help lower blood glucose levels. They are called hypoglycemic 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 only give allergic reactions. Therefore, although glucose-lowering 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, sugar-lowering foods include:

• Cherries (GI 22) - contains anthocyanin, which helps to reduce blood sugar and blood pressure, and eliminate the so-called bad cholesterol. The daily norm is 100 g.
• Grapefruit (GI 29) - Contains naringin, a powerful antioxidant that helps increase insulin sensitivity in tissues. It is recommended to consume 1 medium-sized grapefruit or freshly squeezed juice from it per day (commercial not suitable). But grapefruit can adversely affect the quality of absorption of various drugs, so consultation with your doctor before including it in the menu is required.
• Cinnamon is a source of polyphenols that help keep blood sugar levels in check. The daily rate is 1/2 teaspoon. 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 so beneficial for diabetes, and the substances it contains help slow the rate of absorption 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 diabetic retinal damage. The daily norm is 200 g.
• Oatmeal and millet porridge are high in fiber, which helps to maintain sugar levels.
• Jerusalem artichoke is a natural source of insulin, due 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 antibacterial and other substances. Its use makes the pancreas work more actively, which is very valuable for patients with type 1 diabetes.
• Fish - fish diabetics are shown to eat at least 2 times a week, and whenever possible they try to replace meat dishes with it. It helps to normalize sugar levels and also obtain essential polyunsaturated fatty acids.

Thus, 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, it's important in diabetes to maintain a normal level of physical activity, as exercise increases the tissue's sensitivity to insulin.