Diabetic diet

Diabetes mellitus is a common disease that perhaps every adult has heard of. It can be congenital or acquired over a lifetime, but in all cases 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 broad sense of the word, since there are not so many restrictions, and most of the prohibited products can be replaced with similar taste properties, butsafe for the sensitive body of a diabetic.

What is diabetes mellitus and its types

Diabetes mellitus is a chronic disease characterized by a violation of glucose metabolism. This can be the consequence of a decrease in the amount of the hormone insulin 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 toobesity, severe stress from other factors, then type 2 (non-insulin-dependent) diabetes develops.

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

It is type 2 diabetes that is most often diagnosed today and requires more attention from physicians, as well as adherence to particular nutritional principles, as it becomes a consequence of unhealthy lifestyle. a person. With the regular intake of a large amount of carbohydrates in the body, the pancreas works against wear and tear and eventually stops coping with its function or produces "damaged" insulin, which cells and tissues do not. not perceive. This means that such insulin is unable to capture glucose and transport it to its destination, because the cells do not "see" it, that is to say. develops insensitivity to it. The changes in the hormonal background that inevitably occur with age do not play the slightest role.

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 most often, in 85-90% of patients. It usually occurs after 40 years, and especially often after 65 years. Such 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, the main consumer of glucose, and abdominal obesity increasingly observedbecomes an additional factor in increasing the risk of developing non-insulin-dependent diabetes.

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

Diagnosing diabetes is not difficult. For this, a blood sugar test is performed. Obtaining increased indicators warrants further consideration and selection of optimal treatment tactics, one of the mandatory components of which is nutritional correction.

Why it's important to follow 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 which 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 want to eat something, especially sweet, even an hour after a heavy meal.

As a result, patients overtly eat too many carbohydrate-rich foods, which in type 2 diabetes quickly leads to weight gain and the progression of obesity. This leads to an even greater increase in blood sugar, 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, it isthat is, the formation of a vicious vicious circle.

In such situations, if you do not intervene in time and break this cycle, high sugar levels (hyperglycemia) will lead to the development of ketoacidosis and diabetic coma. At first, 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 urine will appear, nausea and vomiting will occur. Without competent medical attention, confusion and ultimately a diabetic coma will ensue.

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

• retinal damage followed by irreversible blindness;
• renal failure and chronic renal failure;
• poorly healing trophic ulcers on the legs, very difficult to treat;
• osteoporosis, 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 tract, etc.

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

Diet characteristics

There are some differences between the diet for type 1 and type 2 diabetes mellitus that patients should understand. When it comes to insulin-dependent diabetes nutrition, where patients are given lifelong replacement therapy in the form of regular insulin injections, doctors in different countries are looking 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 well-chosen insulin therapy. National doctors believe that this is fraught with unwanted consequences, and insist on the need to limit the consumption of simple carbohydrates, but do not completely abandon them, as in non-insulin-dependent diabetes. In type 2 diabetes, such disputes are inappropriate, because with it the use of sugar can have dire 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 daily diet correspond to the standards developed.

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

In general, Diet # 9 is designed to normalize carbohydrate metabolism by reducing the amount of simple carbohydrates consumed and, as a result, lowering the level of glucose in the blood. 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 a maximum daily intake of 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:

• the food must certainly be fractionated and consist of at least 5 meals, especially with an insulin-dependent form;
• breakfast is a compulsory meal;
• when developing the menu, the physiological ratio of proteins (meat, fish dishes, dairy products), carbohydrates (cereals, bread) and vegetables should be respected, they should represent 25%, 25% and 50 respectively%;
• the nutritional advantage is always given to foods with a low glycemic index and a high percentage of vegetable fibers;
• each meal begins with vegetables and 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 to abandon it completely, boiling, cooking and steaming are ideal;
• A vegetarian diet for diabetes is not the best choice, although it does help improve the course of the disease and increase insulin sensitivity, you can only switch to it with permission froman endocrinologist.

Nutrition for type 1 diabetes

Insulin-dependent diabetes is usually diagnosed as early as childhood. Since the cause of its development is the destruction of insulin-synthesizing pancreatic cells, patients should be prescribed insulin therapy, and the drug and dosage are selected individually. Insulin injections completely cover the deficit in the production of the hormone in the body, so severe dietary restrictions are not necessary, but the parents of the child, and then himself, must learn how to correctly calculate the amount ofcarbohydrate consumed to match the insulin dose given. For this purpose, tables have been specially created indicating the number of so-called grain units in each product.

In type 1 diabetes mellitus, refuse only:

• all sugary drinks, including fruit juices;
• ready-to-eat breakfast cereals;
• confectionery.

You cannot eat more than XE 7 per meal and up to XE 25 per day. In this case, the amount of all carbohydrates consumed per serving volume is added 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 equivalent to 12g of carbohydrate or 20g 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 the XE and can independently regulate the dose of insulin given.

In severe type 1 diabetes mellitus, patients are prescribed Diet # 9b and high doses of insulin. It involves the use of 400-450g of carbohydrates and is very similar to the diet of most modern people. It is allowed to consume 20-30 g of sugar per day.

The endocrinologist who is monitoring the patient's condition will certainly tell you how to divide the amount of food between the individual doses, depending on the type of medicine 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 in such a way that almost 2/3 of the total daily carbohydrate intakefall on this period. In addition, after each injection, you need to eat 2 times - 15 minutes after the injection and 3 hours after. Fractional nutrition and controlling the amount of XE is the basis of the diet for type 1 diabetes.

If after the injection the patient suddenly feels weak, this indicates a deficiency of glucose 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 to count the units of bread.

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 foremost component in the treatment and prevention of complications. With its help, it will be possible to normalize sugar levels and control weight, preventing the appearance of unwanted changes and deterioration of the condition.

All patients should independently monitor their blood sugar daily using household glucose monitors and, if stable elevated levels are achieved, 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 caloric intake of up to 2500kcal. 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 maintain the level of glucose in 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 depending on the degree of obesity. Therefore, in different cases, patients may be allowed to consume 100-225 g of carbohydrate, 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 into 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, pineapples, persimmon, dried fruits);
• white bread, loaf of bread;
• semolina;
• smoked meats, fatty dishes;
• Mayonnaise;
• fast food, snacks.

For diabetics, special recipes were created, including permitted products, for cooking.

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

• potatoes;
• beets;
• But;
• carrots;
• soy products;
• Pasta;
• in bread.

If you are obese, you will need to completely give up all foods high in fat:

• butter and vegetable oils, spreads;
• sour cream, fatty cheeses, cottage cheese, cream;
• lard, fatty meats 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 high fat content, including canned goods, products of the meat processing industry, in-store sauces. They are replaced by boiled or cooked dietary meat (chicken, rabbit, turkey, skimmed yogurt without additives).

Which can

Carbohydrates are an essential part of the daily diet, and they should be part of the diabetes menu, but only in acceptable amounts. Patients are only allowed to eat foods containing slowly absorbed carbohydrates and high in fiber. He:

• vegetables;
• whole grain bread with bran;
• whole grains (8-10 tablespoons), except refined rice.

Since sugar in any form whatsoever is prohibited for diabetics, its substitutes which do not contain glucose have been specially created. Many of these are several times sweeter than sugar and can be used in minimal amounts. Modern sweeteners include xylitol, stevia, sorbitol, and 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 smoothly surpasses sugar by 10 to 30 times (depending on the form of release: an herb powder 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 rate of allowable consumption. 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 cause little or no increase in blood sugar levels. These products can be consumed up to 200 g during a meal, but preferably with protein foods.

Heat treatment increases GI.

It is allowed to use:

• potatoes (not 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 milk 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 it instead of sugar.

Nutrition for gestational diabetes

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

Often after childbirth, carbohydrate metabolism gradually returns to normal, as the hormonal background is normalized. But nevertheless, if the basic principles of nutrition and diet are not followed, not only is there 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 early detection of gestational diabetes during pregnancy that blood sugar 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, white and black bread, bananas, grapes, juices, dried fruits, etc. );
• limit the consumption of complex carbohydrates to the amounts recommended by the doctor;
• remove 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 cooking, stewing, steaming;
• eating in portions, preferably every 2 hours, with an emphasis on 3 main meals (breakfast, lunch and dinner), as well as 2 more (second breakfast, afternoon snack);
• drink at least 1. 5 liters of water.

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

All of these recommendations are relevant for the postpartum period. In any case, in the first months of a baby'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 prevent its transition to a chronic disorder of carbohydrate metabolism within 2-3 months after childbirth. If after this period of time the blood sugar does not return to normal, the woman should see an endocrinologist for examination and development of treatment tactics.

Hypoglycemic products

There are a number of foods that can help lower blood sugar. 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, they can react to certain types of food in their own way, and not just cause allergic reactions. Therefore, although hypoglycemic foods can be of great help to patients with diabetes mellitus, especially type 2, it is worth consulting an endocrinologist before starting their daily use.

So, hypoglycemic foods include:

• Cherries (IG 22) - Contains anthocyanins, which help lower blood sugar and blood pressure, and eliminate so-called bad cholesterol. The daily norm is 100 g.
• Grapefruit (IG 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 per day (commercial is not suitable). But grapefruit can adversely affect the quality of absorption of various drugs, so it is necessary to consult your doctor before including it in the menu.
• Cinnamon is a source of polyphenols that help control blood sugar. 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 in it help slow the rate of sugar absorption in the gut. The daily norm is 200 g.
• Blueberries are one of the healthiest foods for diabetics because they contain valuable glycosides, tannins, and 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 is high in fiber, which helps 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 gives a pleasant sweet taste, which allows it to be used raw or added tosalads.
• Garlic is one of the healthiest foods for everyone because it contains many antioxidants, natural antibacterials, and other substances. Its use makes the pancreas work more actively, which is of great benefit to patients with type 1 diabetes.
• Fish - Diabetics with fish have been shown to eat at least 2 times a week, and where possible, they try to replace meat dishes with it. It helps normalize sugar levels as well as obtain essential polyunsaturated fatty acids.

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