Diabetes is currently a global problem. In the last ten years the number of people suffering from diabetes has more than doubled, reaching 425 million and, according to forecasts, by 2045 their number could reach 629 million.
Diabetesis a group of endocrine diseases associated with impaired glucose absorption and which develop due to an absolute or relative deficiency of the hormone insulin, resulting in hyperglycemia - a persistent increase in blood glucose levels. This disease is characterized by a chronic course, as well as a violation of all types of metabolism due to a violation of carbohydrate metabolism; the metabolism of fats, proteins, minerals and sea salt is also disturbed.
Let's look at the reasons for the development of this disease. Type 1 diabetes is characterized by the destruction or destruction of pancreatic cells. This usually leads to an absolute insulin deficiency. The development of type 1 diabetes involves both genetic and environmental factors: viral infections, nutrition, toxins, hygiene. Type 2 diabetes mellitus is characterized by the development of insulin resistance and relative, rather than absolute, insulin deficiency and is manifested by persistent hyperglycemia. The main problem with any type of diabetes is an increase in blood glucose levels and a shortage of carbohydrates in the cells, since glucose cannot enter them, but floats inactively in the blood.
The treatment of diabetes mellitus is based on diet therapy. General principles of nutrition, regardless of the type of diabetes, suggest that the patient is advised to reduce the carbohydrate load in the diet to 5-7% and increase the consumption of vegetable fats. Previously, diabetics were advised to completely eliminate simple carbohydrates, but today more and more emphasis is placed on personalized diets with an individual selection of food baskets and calorie calculation. The slogan is currently very fashionable: "With diabetes there are no restrictions, there is only the right lifestyle".
The diet for patients with diabetes is based on the glycemic index. Essentially, this index reflects the speed with which the sugar they contain is absorbed into the blood. High index products - jams, biscuits, cakes - have a high absorption rate. Products with a low index - cereals, fruits - have a lower index. The slower the absorption rate, the easier it will be for the pancreas to cope with the load. Therefore, foods with a GI of up to 55 are broken down gradually and almost do not cause an increase in sugar.
Also, don't forget about the food insulin index, which reflects the amount of insulin increase in response to food consumption. The insulin index of foods is important to take into account so that people with diabetes can predict the body's reaction when consuming specific foods and correctly calculate the doses of insulin preparations (short-acting and long-acting) that will be used for injection after meals.
Any meal, even protein, causes a large release of the hormone insulin. And the greater the changes in insulin during the day, the greater the likelihood of developing insulin resistance, which will subsequently lead to type 2 diabetes. Everyone's favorite snacks in the form of dairy and fermented milk products, such as cottage cheese , kefir and yogurt, have a very, very high insulin index, which means that the insulin swing will swing very strongly along with your mood and irritability.
Let's consider different options and features of diets depending on the type of diabetes.
Basic nutritional rules for type 1 diabetes
With the first typepatients are completely dependent on insulin injections and the diet is designed taking its administration into account. Diabetics need to study the presence of carbohydrates (bread units) in foods to determine the dose of the hormone that will help absorb them. A unit of bread is a conventional concept that implies a certain amount of any product containing 12 grams of carbohydrates. It is recommended to consume no more than 12 units of bread per day. Insulin is administered half an hour before meals, so it is important to know exactly what you will eat and in what quantity to absorb the carbohydrates present in the food. For each main meal it is not necessary to eat more than 5-6 units of bread and 2-3 for an additional one.
You should almost completely avoid foods containing easily digestible (simple) carbohydrates. These are sweets, jam, condensed milk, marshmallows, jam, halva, cakes, jam, etc. , As well as oatmeal and semolina porridge, mashed potatoes. Reducing the amount of carbohydrates in the diet, which raise blood sugar, reduces the need for medications. Consuming the same doses as before switching to a low-carb diet can cause hypoglycemia. You should measure your blood sugar level regularly while starting this diet and adjust your medication dosage accordingly.
The daily calorie intake is distributed throughout the day in 4-5 meals. According to the BJU report, the distribution looks like this: proteins make up 20-25% of the total diet, fats - 30%, of which saturated no more than 10%, carbohydrates 45-50%.
Basic nutritional rules for type 2 diabetes
More severe restrictions are needed for non-insulin-dependent variants of the disease. This is due to the fact that this form usually appears against the background of obesity, and not only high levels of glucose, but also insulin are found in the blood. However, it very often happens that insulin resistance, which can subsequently lead to type 2 diabetes mellitus, does not manifest itself in any way for a long time, and even people with insulin resistance are not always overweight, but the blood glucose level the blood is constantly maintained at a high level and this situation leads to very sad consequences. Dietary nutrition for type 2 diabetes helps restore the cells' ability to absorb sugar and helps restore cellular sensitivity to insulin.
Type 2 diabetes mellitusit is primarily a disorder of carbohydrate metabolism. But at the same time, other types of metabolism suffer: lipids, proteins, minerals. Treatment for type 2 diabetes mellitus includes diet, moderate exercise, stress management, and medications (diabetes medications).
The type 2 diabetes diet is based on key principles:
- Plenty of vegetables– The amount of vegetables consumed may depend on age, gender and frequency of weekly exercise. As a general rule, women who exercise up to 30 minutes a day are advised to consume at least 500 grams of vegetables a day. For more intense exercise it is recommended to increase the amount of vegetables to 800 grams. For men the recommended amount of vegetables is 600 and 1000 grams respectively.
- Unsaturated fats– the presence of an adequate amount of polyunsaturated and monounsaturated fats in the diet helps maintain cholesterol levels within normal limits and reduces the risk of developing cardiovascular disease, one of the most common long-term complications of diabetes. Unsaturated fats are found in many foods, including nuts, avocados, fatty sea fish and olive oil.
- Avoid processed foods– nutritionists and doctors agree that avoiding processed foods has a positive effect on health. Because of the substances added to ensure a long shelf life, processed foods tend to have a high glycemic index. Regular consumption of such foods can negatively affect the health of a diabetic.
Healthy foods for diabetes
Green leafy vegetables
Spinach, kale and bok choy are low in calories but rich in nutrients like vitamin C, beta-carotene and magnesium, which help prevent diabetes. One serving (about 106 g) per day reduces the risk of developing type 2 diabetes by 14%.
Legumes
These fiber-rich foods can help stabilize blood sugar levels. Legumes are low in saturated fat, which can be harmful to the heart.
Fish
omega-3 fatty acids– excellent helpers in the prevention of diabetes, reducing the risk of cardiovascular diseases. Omega 3 is necessary for the body for the synthesis of red blood cells and cell membranes, helps the body absorb other vitamins and, above all, suppresses chronic inflammation, which is a sure companion of resistance to insulin.
Olive oil
A staple of the Mediterranean diet, it is important for heart health as it is rich in monounsaturated fatty acids. These fats (also present in large quantities in walnuts) are important in the prevention of diabetes by helping the body to effectively control blood sugar levels.
Peanuts
Being a source of monounsaturated fatty acids, dried fruit is rich in magnesium, another important nutrient. Global research shows that people who regularly eat nuts have lower rates of diabetes.
Citrus fruits
All citrus fruits contain antioxidants, which are excellent helpers in maintaining the balance of insulin in the blood.
Whole grains
Eating wholemeal bread, quinoa and brown rice reduces the risk of developing diabetes. Whole grains are rich in fiber, which helps the body control blood sugar levels. Complex carbohydrates are a kind of buffer that protects us from sharp increases in blood glucose, so if you want to eat a product with a high glycemic index, combine it with complex carbohydrates.
Cinnamon
The tasty spice helps the body regulate insulin levels. Cinnamon is a kind of insulin sensitizer, that is, it helps improve the sensitivity of cells to insulin. The spice helps against hypertension (chronic blood pressure), when used systematically in the required dosages it reduces blood sugar concentration, improves general well-being and has a positive effect on metabolic processes.
Ginger
It is a catalyst of metabolic processes, reduces sugar levels, cholesterol and blood clotting indicators. Recommended for fresh daily consumption as a condiment or base for tea.
Foods prohibited for diabetes
Today, doctors try not to strictly limit patients with diabetes and not to force them to strict limits regarding permitted and prohibited foods. Even with type 2 diabetes, where diet plays a role, it is possible to eat a varied diet, but there are a number of foods that people with this disease will still need to eliminate from their diet. In fact, the following list is recommended for anyone who cares about their health to exclude from their diet.
Sweet
The black list includes sugar and all products containing it in excess. We must forget about ice cream, chocolate, jam, jam, sweets, preserves, halva and other sweets.
Oven
Sweet baked goods are prohibited: muffins, biscuits, focaccia, white loaf and bread.
Fat food
These dishes can significantly increase glucose levels. For this reason, a diabetic should avoid duck, pork, lamb, lard, mayonnaise and cream. It is also recommended to exclude sweet yogurt, fatty cottage cheese and cheese.
Semi-finished products
They contain a large number of flavourings, stabilizers and flavor enhancers. You should not eat fish sticks, ready-made industrial cutlets, dumplings, sausages and sausages.
Trans fats
Their consumption will harm not only a diabetic, but also a healthy person. Banned products include margarine, confectionery fats, spreads, chips, hot dogs and hamburgers.
Fruit
It is not recommended to consume some fruits and dried fruits which cause a sharp increase in blood sugar. Among them are dried apricots, dates, figs, raisins, persimmons, melon, grapes, bananas.
Table no. 9 for diabetes
This diet was developed by scientists specifically for diabetics and has long been used in treatment both in hospitals and at home.Table no. 9 includes:
- 300 g of fruit;
- 80 g of vegetables;
- 100 g of mushrooms;
- 1 tablespoon. natural fruit juices;
- 300 g of meat or fish;
- 200 g of low-fat ricotta, 500 ml of fermented milk products;
- 100-200 g of bran, rye, wholemeal bread mixed with rye flour or 200 g of cereals (already ready), potatoes;
- 40-60 g of fat.
Main dishes
- Soups: vegetable soup, cabbage, beetroot soup, borscht, vegetable and meat okroshka, light fish or meat broth, mushroom soup with cereals and vegetables.
- Poultry meat: rabbit, veal, chicken, stewed, minced, boiled, turkey.
- Fish: pike perch, navaga, cod, pike and lean seafood, stewed, steamed, boiled, baked in juice.
- Snacks: vegetable mix, vinaigrette, fish and dietary meat jelly, vegetable caviar, unsalted cheese, seafood salad with butter.
- Sweets:desserts made from berries, fresh fruit, berry mousse, sugar-free fruit jellies, sugar-free jams and marmalades.
- Egg-based dishes: soft-boiled eggs, egg white omelette, on plates.
Other dietary strategies for diabetes
Of course, we must not forget that all diets are compiled strictly individually, taking into account the age, gender of the patient and his level of physical activity.
Therefore, today there are several options for dietary strategies for diabetes. If it is necessary to normalize body weight in a patient with type 2 diabetes mellitus, it has proven effective.Mediterranean diet, which is based on daily physical activity.
The basic principles of the diet are:
- split meals 5 times a day - 3 main meals and 2 snacks;
- breakfast should be richer in carbohydrates, consisting mainly of complex carbohydrates;
- light dinner consisting of lean proteins and vegetables;
- During the day it is necessary to consume more than 1 kg of vegetables and various aromatic herbs;
- It is important to maintain an alcohol consumption regime: at least 7-8 glasses of water per day.
The main sources of fat in the diet are– unrefined olive oil, sometimes you can use sesame, canola and peanuts. Animal fats are limited in the Mediterranean diet.
Particular attention is paid to Omega-3 fatty acids and oleic acid, present in oils, fatty fish and seafood. These fatty acids have a huge impact on preventing atherosclerosis, improve insulin sensitivity, and help immune cells detect inflammation and suppress it.
Carbohydrates in the Mediterranean diet are predominantly complex with a low glycemic index: durum wheat pasta, beans, rice, lentils, coarse bread, seasonal vegetables and fruit.
Protein comes in the form of low-fat soft cheeses, eggs, fish, seafood and rarely poultry.
Another diet option for diabetes isLCHFand keto diet. The essence of this diet strategy is to consume low amounts of carbohydrates and high amounts of fat. Carbohydrates in fatty diets are limited to 50 grams per day, and in the keto diet the restriction is even more severe: no more than 10 grams of carbohydrates.
The following foods are completely excluded from the keto diet::
- sugar, honey, artificial sweeteners;
- sweet carbonated drinks;
- leavened bread, pastries;
- cereals, porridges, flakes and breakfast cereals;
- skimmed milk, kefir, yogurt;
- sweet curd;
- margarine.
In the concept of the LCHF diet, insulin is a dangerous thing, because after eating something high in carbohydrates, carbohydrates are broken down into glucose, the blood sugar level begins to rise sharply and as a result the insulin level increases notably for transporting glucose to the muscles, liver and fat cells, i. e. insulin is "responsible for our obesity". Additionally, protein can increase insulin levels just like carbohydrates. And fats don't increase insulin at all, which is good for insulin resistance and, if necessary, improving the sensitivity of cells to insulin.
Diabetes mellitus in children
Diabetes mellitus in children can be caused by a hereditary predisposition, poor nutrition, including the consumption of excessive amounts of simple and sweet carbohydrates, and the disease can also occur as a result of mental or physical trauma. Treatment of diabetes in children, as well as in adults, consists of a therapeutic diet and insulin administration for type 1 diabetes.
The diet of children with diabetes should be rich in vegetables such as white cauliflower, onions, spinach and garlic. You can eat unsweetened fruits, meat, poultry and fish. It is advisable to give milk and cottage cheese those that have a small percentage of fat, provided that the child does not have intolerance to cow's milk proteins. When cooking meat or fish, you can use spices to help better absorption of proteins.
All confectionery products, sweets, grapes, apricots, rice, baked goods, biscuits, plums should be excluded. Parents of a child with diabetes need to learn to calculate the consumption of bread units when feeding the child and calculate the necessary dose of insulin. The child himself also needs to be taught these skills as early as possible.
Gestational diabetes mellitus
Anothertype of diabetes– gestational diabetes mellitus in pregnant women, quite common today.
Increased blood sugar during pregnancyand it is one of the most common metabolic disorders in expectant mothers. The so-called gestational diabetes mellitus or diabetes of pregnant women is diabetes that appears during pregnancy and is limited to the duration of pregnancy. During pregnancy, the production of sex hormones (estrogen and progesterone, hCG) and the hormone cortisol, which suppress the action of insulin, increases significantly. As a result, blood glucose levels increase in pregnant women. High blood sugar during pregnancy negatively affects both the health of the woman herself and the health of the fetus and therefore requires timely diagnosis and subsequent correction.
Women are particularly at risk:
- overweight or obese (BMI greater than 25 kg/m²– the risk doubles, above 30 – triples);
- with multiple pregnancy;
- after in vitro fertilization;
- with polycystic ovaries;
- with a large weight gain during actual pregnancy;
- with glycosuria (glucose in the urine);
- have close relatives with diabetes;
- with a previous burdened pregnancy - GDM, birth of a large fetus, intrauterine fetal death.
Gestational diabetes is dangerous not only for the mother, but also affects the health of the unborn child. Therefore, at the age of 4-5 years, these children are much more likely to experience overweight and obesity, at 10-11 years - increased blood pressure, in adolescence the risk of developing diabetes is 20-40%, the risk of developing non-alcoholic fatty liver disease significantly increases.
If GDM is not detected timely or the expectant mother does not take any action to treat it, thenthe risk increases significantly:
- premature aging of the placenta and, consequently, delay in fetal development;
- premature birth;
- polyhydramnios;
- formation of a large or disproportionate or edematous fetus;
- increased blood pressure, preeclampsia;
- the need for a cesarean section;
- traumatization of women and children during childbirth;
- hypoglycemia (low blood sugar) and breathing problems in a newborn;
- The most serious complication of untreated GDM is fetal death.
Therefore, it is important to understand that diabetes is not some kind of life sentence; it only imposes certain obligations on a person regarding diet and physical activity. A correct and balanced diet is of fundamental importance for any type of diabetes. And although reducing carbohydrates and saturated fats in the diet contributes to weight loss, which type 2 diabetics often suffer from, it is very important to change the lifestyle itself and eating habits. And if in type 2 diabetes a good effect in lowering blood sugar levels is achieved not only with appropriately selected foods, but also with a series of physical exercises that help improve the glucose transport function in muscle cells, then in type 1 diabetes nutrition plays a leading role.