Member - Academy Of Nutrition & Dietetics. USA.
Diabetes Mellitus Nutrition
We often see people grumbling at their inability to eat sweets and sugary candies. The culprit for this is none other than diabetes. In simple words ‘diabetes’ is nothing but impaired blood glucose levels in the body. The blood sugar levels are very high (hyperglycemia) for long durations which can result in complications and death if steps are not taken to control the disease. Glucose comes from the food we consume and insulin is the hormone that helps the glucose get into our cells to furnish us with energy.
Pathophysiology
Diabetes is classified as type 1 and type 2 diabetes generally. Rather than christening a person with a particular type, the focus should be to understand the root cause of the disease and treat it effectively.
Pre-diabetes
Pre-diabetics are like the ‘cat on the wall’ tale. Prediabetes means that your blood sugar levels are higher than normal but not high enough to be pushed into the diabetes category.
Type1 Diabetes
Type 1 diabetes is characterized by absolute insulin deficiency, that is, your body does not make insulin. This happens mostly in children and adults younger than 30 years of age. Most common symptoms are tiredness, frequent urination, excessive thirst, tremendous weight loss and hyperglycemia. Genetic, environmental and autoimmune factors contribute to type 1 diabetes.
Type 2 Diabetes
This is the primary guilty party for widespread prevalence of diabetes among people. In this type the body either does not make insulin or the insulin made is not used smartly. Risk factors include genes, obesity, physical inactivity, older age, gestational and prediabetes. Symptoms include excessive thirst, hyperglycemia, polyphagia or excessive hunger, urge to urinate frequently and weight loss. Lifestyle strategies and blood glucose monitoring to adjust diet intake helps to manage type 2 diabetes.
Gestational Diabetes Mellitus
Gestational Diabetes Mellitus (GDM) is diabetes which occurs for the first time when a woman is pregnant. GDM is usually diagnosed during the second or third trimester of pregnancy. That’s the reason your doc insists on a blood glucose test often during these trimesters. Early treatment to control this type of diabetes is best for the mother and the child inside her womb.
Diabetes might also occur sometimes due to certain genetic syndromes, drugs, surgery, malnutrition and other illnesses. This accounts for 1% to 5% of the total cases diagnosed.
Diagnostic and Screening Criteria
The diagnostic criteria for diabetes are given in tabular form below. FPG indicates Fasting Plasma Glucose, CPG indicates Casual Plasma Glucose and PG means Postload Glucose.
Diagnosis
Criteria
Diabetes
FPG≥126mg/dl
CPG≥200mg/dl
2hPG≥200mg/dl
Pre-diabetes
FPG 100-125mg/dl
2hPG 140-199mg/dl
Normal
FPG < 100mg/dl
2hPG < 140mg/dl
Screening for diabetes is absolutely necessary in adults aged 45 and above, particularly in those who come under the obese category. Testing should be done in individuals with a family history for diabetes, who are physically inactive, have PCOS problem and have a BMI ≥25 kg/m2.
Management of Pre-Diabetes
Lifestyle modification is the best solution for pre-diabetes. The three musketeers of lifestyle changes are diet, exercise and weight loss. Medication comes only second in managing pre-diabetes. Studies have clearly proven that lifestyle changes stand a better chance in delaying or preventing diabetes than medication. In no other disease has lifestyle modifications played a tremendous role in prevention of the disease than in diabetes. Whole grains and dietary fibers work like magic pills to reduce the risk of diabetes. Physical activity coupled with weight loss helps to reduce obesity and hence diabetes. Unless this is done the future is bleak as the percentage of people affected with diabetes is said to increase drastically by 25%.
Management of Diabetes
Medical Nutrition Therapy (MNT) is essential to manage and control diabetes. The aid of a registered dietitian (RD) is recommended to implement the latest principles and recommendations for diabetes. Constant monitoring of glucose levels, weight and quality of life with individualized treatment based on metabolic profiles is the best solution. Healthy food choice along with physical activity is the best recommended treatment for diabetes.
Generally carbohydrates include sugars, starch and fiber. Though there is a serious misconception that sugars such as sucrose must be restricted, it has been proved through various studies that starch has a much greater impact on glycemia than sugars. Carbohydrates present in foods such as whole grains, fruits, vegetables and low-fat milk are great sources of essential nutrients for all including diabetic people. People with diabetes are stimulated to consume fiber-rich foods such as legumes, fruits, veggies, fiber-rich cereals and whole grains. Though sucrose does not alter glycemic levels, it is always suggested to carefully choose while having high-sucrose-content food as they have high carbohydrate and fat content. The role of protein in diabetes depends on the state of insulinization and the degree of glycemic control.
When MNT alone does not give you the desired result, the use of newer glucose-lowering medications with MNT -provides efficient solution. When both MNT and medications become futile insulin, either alone or in combination with other medications, is required.
Self-monitoring of blood glucose has become popular presently. But it is always safe to rely on laboratory measurements. The frequency of monitoring depends on the severity of diabetes and therapy used.
Summarizing, an active lifestyle with healthy food habits and a positive mind helps to prevent diabetes. It is always easier said than done. Though diet restrictions may seem to be tiring and people may often get discouraged, it is in the hands of the immediate surrounding people to bring in positivity and encourage the diabetic person to work towards a particular goal. Come what may, think of the benefits and you will definitely work towards your goal.