The prevention and control the type-2 diabetes by changing lifestyle and dietary pattern

J Educ Health Promot. 2014; 3: 1.

Mohammad Asif

Department of Pharmacy, GRD Institute of Management and Technology, Dehradun, (Uttarakhand), India

Department of Pharmacy, GRD Institute of Management and Technology, Dehradun, (Uttarakhand), India

Address for correspondence: Dr. Mohammad Asif, Department of Pharmacy, GRD Institute of Management and Technology, Dehradun, (Uttarakhand) – 248 009, India. E-mail: moc.liamg@123fisaa

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

This article has been cited by other articles in PMC.

Abstract

Type-2 diabetes is a major, non-communicable disease with increasing prevalence at a global level. Type-2 diabetes results when the body does not make enough insulin or the body cannot use the insulin it produces. Type-2 diabetes is the leading cause of premature deaths. Improperly managed, it can lead to a number of health issues, including heart diseases, stroke, kidney disease, blindness, nerve damage, leg and foot amputations, and death. Type-2 diabetes or adult-onset diabetes is most common type of diabetes, usually begins when a person is in his or her mid-50s, but diabetes is not inevitable. Minor changes in your lifestyle can greatly reduce your chances of getting this disease. Therefore, in order to prevent this condition, action should be taken regarding the modifiable factors that influence its development-lifestyle and dietary habits. However, with proper testing, treatment and lifestyle changes, healthy eating as a strategy, promote walking, exercise, and other physical activities have beneficial effects on human health and prevention or treatment of diabetes, promoting adherence to this pattern is of considerable public health importance.

Keywords: Diet, lifestyle, non-communicable disease, public health, type-2 diabetes

INTRODUCTION

Diabetes mellitus or type-2 diabetes, is one of the major non-communicable and fastest growing public health problems in the world, is a condition difficult to treat and expensive to manage. It has been estimated that the number of diabetes sufferers in the world will double from the current value of about 190 million to 325 million during the next 25 years.[1,2,3] Individuals with type-2 diabetes are at a high risk of developing a range of debilitating complications such as cardiovascular disease, peripheral vascular disease, nephropathy, changes to the retina and blindness that can lead to disability and premature death. It also imposes important medical and economic burdens. Genetic susceptibility and environmental influences seem to be the most important factors responsible for the development of this condition. However, a drastic increase of physical inactivity, obesity, and type-2 diabetes has been recently observed. The fact indicates that obesity and physical inactivity may constitute the main reasons for the increasing burden of diabetes in the developed world.[4,5,6,7,8,9,10]

Fortunately, because environmental factors are modifiable, disease manifestation from these factors is largely preventable. Diet is one of the major factors now linked to a wide range of diseases including diabetes. The amount and type of food consumed is a fundamental determinant of human health. Diet constitutes a crucial aspect of the overall management of diabetes, which may involve diet alone, diet with oral hypoglycemic drugs, or diet with insulin.[11,12,13,14,15] Diet is individualized depending on age, weight, gender, health condition, and occupation etc. The dietary guidelines as used in this review are sets of advisory statements that give quick dietary advice for the management of the diabetic population in order to promote overall nutritional well-being, glycogenic control, and prevent or ameliorate diabetes-related complications.

Objectives of dietary treatment of diabetes

The aims of dietary treatment of diabetes are:

• To achieve optimal blood glucose concentrations.

• To achieve optimal blood lipid concentrations.

• To provide appropriate energy for reasonable weight, normal growth, and development, including during pregnancy and lactation.

• To prevent, delay, and treat diabetes-related complications.

• To improve health through balanced nutrition.

The attempts to adhere to the conventional food measurements in order to comply with prescriptions of the so-called ‘diabetic diet’ usually result in unnecessary restrictions, overindulgence, or monotonous consumption of certain food items, e.g., unripe plantain/beans. This is a consequence of illiteracy, poverty, and cultural misconceptions about the role of diet in the management of diabetes. This is usually the most problematic aspect of diabetes care. The usually recommended daily energy intake for the non-obese diabetic patient is between 1500 and 2500 calories per day, the average allowance being 2000 k calories per day. The recommendation for the overweight diabetic patient is between 800 and 1500 k calories per day, while the underweight (including growing children and adolescents) should be allowed at least 2500 k calories/day.[16,17]

DIET AND DIABETES

The beneficial effect of the dietary pattern on diabetes mellitus and glucose metabolism in general and traditional food pattern was associated with a significant reduction in the risk of developing type-2 diabetes. The dietary pattern emphasizes a consumption of fat primarily from foods high in unsaturated fatty acids, and encourages daily consumption of fruits, vegetables, low fat dairy products and whole grains, low consumption of fish, poultry, tree nuts, legumes, very less consumption of red meat.[18,19,20] The composition of diet is one of the best known dietary patterns for its beneficial effects on human health that may act beneficially against the development of type-2 diabetes, including reduced oxidative stress and insulin resistance. High consumption of vegetables, fruits, legumes, nuts, fish, cereals and oil leads to a high ratio of monounsaturated fatty acids to saturated fatty acids, a low intake of trans fatty acids, and high ingestion of dietary fiber, antioxidants, polyphenols. The diets are characterized by a low degree of energy density overall; such diet prevent weight gain and exert a protective effect on the development of type-2 diabetes, a condition that is partially mediated through weight maintenance. Greater adherence to the diet in combination with light physical activity was associated with lower odds of having diabetes after adjustment for various factors.[21,22,23,24,25] On the other hand, a paleolithic diet (i.e., a diet consisting of lean meat, fish, shellfish, fruits and vegetables, roots, eggs and nuts, but not grains, dairy products, salt or refined fats, and sugar) was associated with marked improvement of glucose tolerance while control subjects who were advised to follow a diet did not significantly improve their glucose tolerance despite decreases in weight and waist circumference.[26,27,28] People most likely to get diabetes are: People who are overweight, upper-body obesity, have a family history of diabetes, age 40 or older, and women (50% more often than men).

TREATMENTS OF DIABETES

Each person needs individualized treatment. Type-1 diabetes always requires insulin, diet, and exercise. Type-2 diabetics require insulin or oral hypoglycemic agents (medication that helps lower blood sugar), if diet and exercise alone fail to lower blood glucose. If you have diabetes, you need to have a medical team (doctor, nutritionist, and health educator or nurse) working with you. Whichever type of diabetes you have, the key to proper control is balancing the glucose and the insulin in the blood. This means adjusting your diet, activity, and sometimes taking medication.[29,30]

GENERAL DIETARY GUIDELINES

Modern dietary management of diabetes essentially involves modifications of the quality and quantity of food to be taken by the diabetic patient. The following guidelines are applicable to diabetes irrespective of type, weight status, age, gender, or occupation.[31,32,33,34,35,36,37,38,39,40]

• Most of the carbohydrate consumed should be in the form of starch (polysaccharides) such as maize, rice, beans, bread, potatoes etc.

• All refined sugars such as glucose, sucrose, and their products (soft drinks, sweets, toffees, etc.) and honey should be avoided, except during severe illness or episodes of hypoglycemia. These foods contain simple sugar, which is easily absorbed causing rapid rise in blood sugar.

• Non-nutritive sweeteners, e.g., Canderel, saccharine, NutraSweet, aspartame are suitable sugar substitutes for diabetic subjects.

• Animal fat such as butter, lard, egg yolk, and other foods high in saturated fatty acids and cholesterol should be reduced to a minimum and be replaced with vegetable oils, particularly polyunsaturated fats.

• Salt should be reduced whether hypertensive or not.

• Protein (fish, meat, beans, crab, crayfish, soyabean, chicken, etc.) and salt are restricted for those with diabetic nephropathy.

• Cigarette smoking should be avoided by diabetic patients. Alcohol should be taken only in moderation.

• The items allowed for free consumption include: Water, green leafy vegetables, tomatoes, onions, cucumber, aubergine, peppers, vegetable salad without cream. Any brand of tea, coffee, or drinks that contain very low or no calories.

• For patients too ill to eat solid food, a fluid or semi-solid diet should be substituted (papaya, soya bean, custard, etc.).

• Patients treated with insulin or certain oral hypoglycemic agents, e.g., sulfonylureas must be advised to eat regularly and often to prevent hypoglycemia- 3 meals a day plus suitable snacks in between, e.g., fresh fruits.

• Small meals spaced over the day, rather than 1 or 2 big meals, are helpful in avoiding post-pyramidal peaks in blood sugar.

When overweight diabetic patients drop some weight by trimming down ‘serving sizes’ and calories, insulin sensitivity improves, thereby optimizing drug therapy. The fundamental principle behind maintenance of body weight is the energy balance. This group should be encouraged to maintain their current weight by: Maintaining current ‘serving sizes,’ eating about the same amount of food each day, eating at about the same times each day, taking their drugs at the same times each day, and exercising at the same times each day. These patients should also endeavor to choose their daily foods from starches, vegetables, fruits, and protein, while limiting the amount of fats.[41,42,43,44,45]

Dietary approaches to diabetes

Food can be powerful in preventing and reversing diabetes. However, dietary approaches have changed as we have learned more about the disease. The traditional approach to diabetes focuses on limiting refined sugars and foods that release sugars during digestion-starches, breads, fruits, etc. With carbohydrates reduced, the diet may contain an unhealthful amount of fat and protein. Therefore, diabetes experts have taken care to limit fats- especially saturated fats that can raise cholesterol levels, and to limit protein for people with impaired kidney function. The new approach focuses more attention on fat. Fat is a problem for people with diabetes. The more fat there is in the diet, the harder time insulin has in getting glucose into the cells. Conversely, minimizing fat intake and reducing body fat help insulin do its job much better. Newer treatment programs drastically reduce meats, high-fat dairy products, and oils.[46,47,48,49,50] At the same time, they increase grains, legumes, fruits, and vegetables. The study found that patients on oral medications and patients on insulin were able to get off of their medications after some days on a near-vegetarian diet and exercise program. During 2 and 3-year follow-ups, most people with diabetes treated with this regimen have retained their gains. The dietary changes are simple, but profound, and they work.[51,52,53]

EFFECTS OF THE FRUIT AND VEGETABLES ON THE HUMAN HEALTH

Fruits constitute a commercially important and nutritionally indispensable food commodity. Being a part of a balanced diet, fruits play a vital role in human nutrition by supplying the necessary growth regulating factors essential for maintaining normal health. They have been especially valuable for their ability to prevent vitamin C and vitamin A deficiencies. Fruits and vegetables are good source of vitamins, minerals, flavonoids (anti-oxidants), saponins, polyphenols, carotenoids (vitamin A-like compounds), isothiocyanates (sulfur-containing compounds), and several types of dietary fibers. The fruits and vegetables not only prevent malnutrition but also help in maintaining optimum health through a host of chemical components that are still being identified, tested, and measured. They prevent various chronic diseases like stroke, hypertension, birth defects, cataracts, diabetes, heart disease, cancers, diverticulosis, obstructive pulmonary disease (asthma and bronchitis), and obesity etc.[53,54,55,56] Diets that are high in insoluble fiber may offer the best protection against this disease. Fruits and vegetables are high in cellulose-a type of insoluble fiber. Diets that are high in fiber may be able to help in the management of diabetes. Soluble fiber delays glucose absorption from the small intestine and thus may help prevent the spike in blood glucose levels that follow a meal or snack. The long-term effect may be insignificant, however, due to the many other factors that affect blood glucose. The effects of the fruit and vegetables on the human health allowed to once again measuring the enormous stakes.[57,58,59,60] More and more emphasis is put on the importance of the diversity of food, and in particular of the fruit and vegetables. This new and effective approach to diabetes is remarkably simple. Here are 4 simple steps to managing your blood sugar (and weight, blood pressure, and cholesterol) with diet.[61,62,63,64,65,66,67,68,69,70]

Begin a vegan diet: Avoid animal products

Animal products contain fat, especially saturated fat, which is linked to heart disease, insulin resistance, and certain forms of cancer. These products also contain cholesterol and, of course, animal protein. It may surprise you to learn that diets high in animal protein can aggravate kidney problems and calcium losses. Animal products never provide fiber or healthful carbohydrates. A vegan diet is one that contains no animal products at all. Therefore, you’ll have to avoid red meat, poultry, fish, dairy products, and eggs.

Go high fiber

Aim for 40 grams of fiber a day, but start slowly. Load up on beans, vegetables, and fruits. Choose whole grains (barley, oats, millet, whole-wheat, etc.). Aim for at least 3 grams per serving on food labels and at least 10 grams per meal.

Low-fat, vegetarian diets are ideal for people with diabetes

The health benefits of a low-fat vegetarian diet such as portions of vegetables, grains, fruits, and legumes (excluding animal products) in people with type-2 diabetes. The vegan diet is based on American Diabetes Association (ADA) guidelines; the results of this study were astounding: Forty-three percent of the vegan group reduced their diabetes medications. Among those participants who didn’t change their lipid-lowering medications, the vegan group also had more substantial decreases in their total and LDL cholesterol levels.

Avoid added vegetable oils and other high-fat foods (avoid)

Although most vegetable oils are in some ways healthier than animal fats, you will still want to keep them to a minimum. All fats and oils are highly concentrated in calories. A gram of any fat or oil contains 9 calories, compared with only 4 calories for a gram of carbohydrate. Avoid foods fried in oil, oily toppings, and olives, avocados, and peanut butter. Aim for no more than 2-3 grams of fat per serving of food, e.g., white or wheat bread, most cold cereals, watermelon, pineapple, baking potatoes, sugar.

Favor foods with a low glycemic index (enjoy)

The glycemic index identifies foods that increase blood sugar rapidly. This handy tool allows you to favor foods that have much less effect on blood sugar. High-glycemic-index foods include sugar itself, white potatoes, most wheat flour products, and most cold cereals, e.g., pumpernickel, rye, multigrain, or sourdough bread, old-fashioned oatmeal, bran cereals, grape-nuts, most fruits, sweet potatoes, pasta, rice, barley, couscous, beans, peas, lentils, most vegetables [].

Table 1

Classification of foods on basis of Glycemic index

Food groups

Choose unlimited amounts of grains, legumes, fruits, and vegetables. Modest amounts of non-fat condiments, alcohol, and coffee are also fine.

Reduce salt (“sodium”) in diet

High blood pressure may also be present with your diabetes. Limiting how much salt you eat can help keep your blood pressure low. Decrease the amount of salt you add during cooking and reduce salt in recipes, before adding salt at the table, taste first, try seasoning your food with (salt-free) herbs, spices, and garlic. Lemon juice brings out the natural saltiness of foods. Avoid processed foods that are high in salt (sodium chloride) such as canned or packaged foods and condiments such as mustard, watch for “Na” (sodium) on food labels. Chips, pretzels, and other such snacks are very high in salt, and check with your physician before using salt substitutes.

Alcohol

• Limit alcohol to less than 2 drinks per day (1 drink = 12 oz beer = 1.5 oz liquor = 4 oz wine)

• Drinking alcohol is not recommended if you: Have high triglycerides (blood fats), have high blood pressure, have liver problems, are pregnant or breastfeeding.

• If you choose to drink alcohol, remember: To drink with your meal or snack (not on an empty stomach!), to drink slowly or dilute with water or diet soda, that liqueurs, sweet wines and dessert wines have a lot of sugar, to wear your Medic Alert (Alcohol can cause hypoglycemia/low blood glucose), reducing alcohol can promote weight loss and help you lower your blood pressure.

Caffeine

Drink no more than four (4) cups of coffee or caffeine-containing beverages per day.

Food preparation

Avoid adding sugar during cooking. use Splenda (sucralose) instead of sugar if baking or cooking, use low-fat and low sugar sauces and marinades, use reduced-fat cooking methods such as barbecuing, broiling, roasting, and steaming and avoid frying and deep-fat frying.

FOODS TO ALWAYS CHOOSE

Whole grain products

Whole and multi grain breads, whole wheat pasta, brown rice, low-fat and multigrain crackers, low-sugar, whole-grain cereals, oatmeal, bran, bulgur, buckwheat, low-fat, whole grain baked goods with added bran or oat bran [].

Table 2

List of foods to always choose

Vegetables and fruits

Eat green leafy vegetables; eat an abundance fresh/frozen vegetables and unsweetened, fresh, frozen, or canned fruits

Milk/Dairy products

Dairy products with less than 1% fat and cheese should be 10-20% MF.

Meat and alternatives

Fish (canned in water, fresh, frozen), seafood, skinless chicken and turkey, lean meats with fat trimmed, wild game, lean cold cuts (but watch the salt content), legumes, tofu, eggs (up to 8 per week).

Other foods and fats

Olive, canola, soybean, sesame, sunflower oils (3 tsp or less per day), non-hydrogenated soft margarines, low-calorie dressings and mayonnaise, light peanut butter, nuts (watch salt and calories), unsalted seeds: Flax, pumpkin, sunflower, defatted gravy and low-sugar condiments, cocoa powder or a small piece of dark chocolate.

Sweets (in very small amounts)

Sugar substitutes and artificial sweeteners, low sugar jams/jellies/syrups, sugar-free candies, gelatins, gum, low-sugar and high fiber baked goods, and low-fat and low-sugar frozen dessert

Snack foods

Popcorn without salt, butter, or hydrogenated oils and choose low fat, low sugar snack foods.

ROLE OF PHYSICAL ACTIVITY OR EXERCISE

Regular physical activity helps the body cells take up glucose and thus lower blood glucose levels. Regular physical activity also helps with weight loss as well as controlling blood cholesterol and blood pressure. You need to let your doctor and dietitian know about the kinds of physical activities you do regularly. Your doctor and dietitian will help you balance your physical activity with your medication and diabetic meal plan. If you are not physically active now, your doctor may recommend that you increase physical activity. Important benefits of a regular aerobic exercise program in diabetes management include decreased need for insulin, decreased risk of obesity, and decreased risk for heart disease. Exercise decreases total cholesterol, improves the ratio of low-density lipoprotein (LDL) to high-density lipoprotein cholesterol (HDL), and reduces blood triglycerides. It may also decrease blood pressure and lower stress levels. Walking is one of the easiest and healthiest ways to exercise. This is one activity that anyone can do for a lifetime without special equipment and with little risk of injury. Talk to your doctor about exercise. Supervised activity is best because of the risk of an insulin imbalance. Use the buddy system when you exercise.[71,72,73,74,75,76,77]

List of foods/drinks to be avoided and their alternatives

Reducing weight

Eat smaller portions of foods and remember that your lunch and dinner plate should be 1/4 protein, 1/4 starch (including potatoes), and 1/2 vegetables. Eat 3 balanced meals per day (no more than 6 hours apart), and don’t skip meals; snack with fruit between meals. Choose foods lower in fat and sugar; choose low GI index foods whenever possible; avoid “white” foods (white flour and white sugar).

Glucose testing

Your diabetic meal plan, physical activity, and medication are all balanced to help keep your blood glucose levels normal. You need to check your blood glucose levels at home to keep track of how you are doing. Soon you will learn how the foods you eat and your physical activity affect your blood glucose level. The best defense against diabetic complications is to keep blood glucose in control and take good care of yourself. Keeping your blood glucose in control will help you feel better now and stay healthy in the future.[78,79,80]

DISCUSSION

The breakfast should be 1/3 fruit, 1/3 starchy fiber foods (multigrain bread and cereal products), and 1/3 protein (nuts, eggs, tofu, beans, lentils, low-fat dairy products). The lunch and dinner plates should be 1/2 vegetables, 1/4 starchy fiber foods, and 1/4 protein. Choose whole grains, such as whole wheat pasta, whole wheat bread, and brown rice to increase fiber intake. Most of these are low in fat. Choose only lean meat and poultry.[81,82,83,84] Remove skin and trim fat before cooking (50-100 g or 2-4 oz). See the milk fat (MF) of all dairy products. Use skim or 1% milk products and low-fat cheese (less than 20% MF), or choose fortified soy products. Reduce your total fat intake (less than 25% – 35% of your daily calories). To achieve this, always try to choose low fat foods and avoid fried foods. Limit saturated and trans fats to less than 10% of your daily calories. Try to always choose unsaturated fats such as olive and canola oils and non-hydrogenated margarine (in moderation). Saturated and trans fats raise blood cholesterol levels, while unsaturated fats lower blood cholesterol. Saturated fats are solid at room temperature and are usually of animal origin. They are found in meats, whole milk, dairy products, butter, and hard margarines.[85,86,87,88,89,90] Trans fats are found in baked and pre-packaged foods. Hydrogenation is a process that changes liquid vegetable oil into a solid fat such as hard margarine. The hydrogenation process changes some of the good fats into cholesterol-raising saturated and trans fats. People with diabetes are at a greater risk of developing or have already high levels of fats in their heart and blood vessels. Omega-3 fatty acids are found in cold water fish such as herring, mackerel, salmon, trout, sardines and tuna, and in flaxseeds (2 tbsp per day, freshly ground).[90,91,92,93] Three to four servings of fish per week is recommended as part of a healthy, balanced diet. Omega-enriched foods are also available in supermarkets such as omega-3 eggs and omega-3 enriched dairy products. Omega-3 supplements: Always look for the active ingredients DHA and EPA. Recommendations are 600-900 mg/day. Always check with your doctor or registered dietitian before taking any supplements. Increase fiber in your diet by eating more whole grain foods, vegetables, fruits, and legumes.[94,95,96] These foods also contain vitamins, minerals, and antioxidants and have a lower glycemic index. Low glycemic index foods will help to keep your blood sugar levels in the target range.[97,98,99]

CONCLUSION

In conclusion, effective lifestyle modifications including counseling on weight loss, adoption of a healthy dietary pattern like the Mediterranean diet, together with physical activity are the cornerstone in the prevention of type-2 diabetes. Therefore, emphasis must be given to promoting a healthier lifestyle and finding solutions in order to increase adherence and compliance to the lifestyle modifications, especially for high-risk individuals. Results from epidemiological studies and clinical trials evaluating the role of the Mediterranean dietary pattern regarding the development and treatment of type-2 diabetes indicate the protective role of this pattern. As a result, promoting adherence to the Mediterranean diet is of considerable public health importance as this dietary pattern, apart from its various health benefits, is tasty and easy to follow in the long-term. Diet is an important aspect in the management of a diabetic patient. The diabetic healthcare provider and the patient should understand the basic dietary needs of the patient. In this form, there may be plenty of insulin in the bloodstream, but the cells are resistant to it. Glucose cannot easily get into the cells, and it backs up in the bloodstream. Over the short run, people with uncontrolled diabetes may experience fatigue, thirst, frequent urination, and blurred vision. In the long run, they are at risk for heart disease, kidney problems, disorders of vision, nerve damage, and other difficulties.

There is no cure for diabetes. However, you candu manage or delay diabetes through diet, exercise, weight control and, if necessary, medication.

-Jacquelyn W. McClelland

Footnotes

Source of Support: Nil

Conflict of Interest: None declared

REFERENCES

1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–53. [PubMed] [Google Scholar]2. Giugliano D, Esposito K. Mediterranean diet and metabolic diseases. Curr Opin Lipidol. 2008;19:63–8. [PubMed] [Google Scholar]3. Martinez-Gonzalez MA, de la Fuente-Arrillaga C, Nunez-Cordoba JM, Basterra-Gortari FJ, Beunza JJ, Vazquez Z, et al. Adherence to Mediterranean diet and risk of developing diabetes: Prospective cohort study. BMJ. 2008;336:1348–51. [PMC free article] [PubMed] [Google Scholar]4. Sanchez-Tainta A, Estruch R, Bullo M, Corella D, Gomez-Gracia E, Fiol M. Adherence to a Mediterranean-type diet and reduced prevalence of clustered cardiovascular risk factors in a cohort of 3,204 high-risk patients. Eur J Cardiovasc Prev Rehabil. 2008;15:589–93. [PubMed] [Google Scholar]5. Panagiotakos DB, Pitsavos C, Chrysohoou C, Stefanadis C. The epidemiology of Type 2 diabetes mellitus in Greek adults: The ATTICA study. Diabet Med. 2005;22:1581–8. [PubMed] [Google Scholar]6. Geneva: WHO; 1999. World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications. Part 1. Report of WHO consultation. [Google Scholar]7. Report of the WHO consultation on obesity. Geneva: WHO; 1998. Prevention and Management of the Global Epidemic of Obesity. [Google Scholar]8. Otuyelu F. Diabetic diet for the Nigerian. Niger Med Pract. 1982;3:48–51. [Google Scholar]9. Fadupin GT, Keshinro OO. Factors influencincing dietary compliance and glycaemic control in adult diabetic patients in Nigeria. Diabetes Int. 2001;11:59–61. [Google Scholar]10. Fadupin GT, Keshinro OO, Sule ON. Dietary recommendations: Example of advice given to diabetic patients in Nigeria. Diabetes Int. 2000;10:68–70. [Google Scholar]11. Sofi F, Innocenti G, Dini C, Masi L, Battistini NC, Brandi ML, et al. Low adherence of a clinically healthy Italian population to nutritional recommendations for primary prevention of chronic diseases. Nutr Metab Cardiovasc Dis. 2006;16:436–44. [PubMed] [Google Scholar]13. Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med. 1995;122:481–6. [PubMed] [Google Scholar]14. Feskins EJ, van Dam RM. Dietary fat and the etiology of type 2 diabetes: An epidemiological perspective. Nutr Metab Cardiovasc Dis. 1999;9:87–95. [PubMed] [Google Scholar]15. Bergnman RN, Ader L. Free fatty acids and the pathogenesis of type 2 diabetes mellitus. Trends Endocrinol Metab. 2001;3(suppl):S11–9. [Google Scholar]16. Panagiotakos DB, Polystipioti A, Papairakleous N, Polychronopoulos E. Long-term adoption of a Mediterranean diet is associated with a better health status in elderly people; a cross-sectional survey in Cyprus. Asia Pac J Clin Nutr. 2007;16:331–7. [PubMed] [Google Scholar]17. Panagiotakos DB, Tzima N, Pitsavos C, Chrysohoou C, Zampelas A, Toussoulis D, et al. The association between adherence to the Mediterranean diet and fasting indices of glucose homoeostasis: The Attica Study. J Am Coll Nutr. 2007;26:32–8. [PubMed] [Google Scholar]19. American Diabetes Association: Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications (Position Statement) Diabetes Care. 2003;26(Suppl 1):S51–61. [PubMed] [Google Scholar]20. Barnard ND, Scialli AR, Turner-McGrievy G, Lanou AJ, Glass J. The effects of a lowfat, plant-based dietary intervention on body weight, metabolism, and insulin sensitivity. Am J Med. 2005;118:991–7. [PubMed] [Google Scholar]21. American Diabetes Association. Standards of Medical Care in Diabetes-2008. Diabetes Care. 2008;31:S12–S54. [PubMed] [Google Scholar]22. Barnard ND, Scialli AR, Turner-McGrievy GM, Lanou AJ. Acceptability of a low-fat vegan diet compares favorably to a step II diet in a randomized, controlled trial. J Cardiopulm Rehabil. 2004;24:229–35. [PubMed] [Google Scholar]23. Barnard RJ, Jung T, Inkeles SB. Diet and exercise in the treatment of NIDDM: The need for early emphasis. Diabetes Care. 1994;17:1–4. [PubMed] [Google Scholar]24. Wieland H, Seidel D. A simple specific method for precipitation of low density lipoproteins. J Lipid Res. 1983;24:904–9. [PubMed] [Google Scholar]25. Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362:1090–101. [PubMed] [Google Scholar]26. Holt SH, Brand Miller JC, Petocz P, Farmakaladis E. A satiety index of common foods. Eur J Clin Nutr. 1995;49:675–90. [PubMed] [Google Scholar]27. Nicholson AS, Sklar M, Barnard ND, Gore S, Sullivan R, Browning S. Toward improved management of NIDDM: A randomized, controlled, pilot intervention using a low-fat, vegetarian diet. Prev Med. 1999;29:87–91. [PubMed] [Google Scholar]28. UK Prospective Diabetes Group. Intensive bloodglucose control with sulphonylureas and insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) Lancet. 1998;352:837–53. [PubMed] [Google Scholar]29. Wolf AM, Conaway MR, Crowther JQ, Hazen KY, L Nadler J, Oneida B, et al. Translating lifestyle intervention to practice in obese patients with type 2 diabetes: Improving control with activity and nutrition (ICAN) study. Diabetes Care. 2004;27:1570–6. [PubMed] [Google Scholar]30. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86. [PubMed] [Google Scholar]31. The International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32:1327–34. [PMC free article] [PubMed] [Google Scholar]32. Sinitskaya N, Gourmelen S, Schuster-Klein C, Guardiola-Lemaitre B, Pevet P, Challet E. Increasing fat-to-carbohydrate ratio in a high-fat diet prevents the development of obesity but not a prediabetic state in rats. Clin Sci. 2007;113:417–25. [PubMed] [Google Scholar]33. Sjostrom CD, Peltonen M, Wedel H, Sjostrom L. Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension. 2000;36:20–5. [PubMed] [Google Scholar]34. Schroder H. Protective mechanisms of the Mediterranean diet in obesity and type 2 diabetes. J Nutr Biochem. 2007;18:149–60. [PubMed] [Google Scholar]35. Selvin E, Crainiceanu CM, Brancati FL, Coresh J. Short-term variability in measures of glycemia and implications for the classification of diabetes. Arch Intern Med. 2007;167:1545–51. [PubMed] [Google Scholar]36. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, et al. Weight loss with a lowcarbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359:229–41. [PubMed] [Google Scholar]37. Lindeberg S, Jönsson T, Granfeldt Y, Borgstrand E, Soffman J, Sjöström K, et al. A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. Diabetologia. 2007;50:1795–807. [PubMed] [Google Scholar]38. Lovejoy JC, Windhauser MM, Rood JC, de la Bretonne JA. Effect of a controlled high-fat versus low-fat diet on insulin sensitivity and leptin levels in African-American and Caucasian women. Metabolism. 1998;47:1520–4. [PubMed] [Google Scholar]39. American Diabetes Association. Clinical practice recommendations-2007. Diabetes Management in Correctional Institutions: Diabetes Care. 2007;30(Supp 1):S77–84. [PubMed] [Google Scholar]41. Bouchard C, Tremblay A, LeBlanc C, Lortie G, Savard R, Theriault G. A method to assess energy expenditure in children and adults. Am J Clin Nutr. 1983;37:461–7. [PubMed] [Google Scholar]42. Drewnowski A. Energy density, palatability, and satiety: Implications for weight control. Nutr Rev. 1998;56:347–53. [PubMed] [Google Scholar]43. Duncan KH, Bacon JA, Weinsier RL. The effects of high and low energy density diets on satiety, energy intake, and eating time of obese and nonobese subjects. Am J Clin Nutr. 1983;37:763–7. [PubMed] [Google Scholar]44. Eaton SB, Eaton SB, Konner MJ, Shostak M. An evolutionary perspective enhances understanding of human nutritional requirements. J Nutr. 1996;126:1732–40. [PubMed] [Google Scholar]45. Esposito K, Maiorino MI, Di Palo C, Giugliano D. Adherence to a Mediterranean diet and glycaemic control in Type 2 diabetes mellitus. Diabet Med. 2009;26:900–7. [PubMed] [Google Scholar]46. Franz MJ, Splett PL, Monk A, Barry B, McClain K, Weaver T, et al. Cost-effectiveness of medical nutrition therapy provided by dietitians for persons with non-insulin-dependent diabetes mellitus. J Am Diet Assoc. 1995;95:1018–24. [PubMed] [Google Scholar]47. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of lowdensity lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499–502. [PubMed] [Google Scholar]48. Garg A, Bantle JP, Henry RR, Coulston AM, Griver KA, Raatz SK, et al. Effects of varying carbohydrate content of the diet in patients with non-insulin-dependent diabetes mellitus. JAMA. 1994;271:1421–8. [PubMed] [Google Scholar]49. Garg A. High-monosaturated fat diets for patients with diabetes mellitus: A meta-analysis. Am J Clin Nutr. 1998;67:577S–82. [PubMed] [Google Scholar]50. Howarth NC, Saltzman E, Roberts SB. Dietary fiber and weight regulation (Review) Nutr Rev. 2001;59:129–39. [PubMed] [Google Scholar]51. Pérez-Jiménez F, López-Miranda J, Pinillos MD, Gómez P, Paz-Rojas E, Montilla P, et al. A Mediterranean and a high-carbohydrate diet improve glucose metabolism in healthy young persons. Diabetologia. 2001;44:2038–43. [PubMed] [Google Scholar]52. Schakel SF, Sievert YA, Buzzard IM. Sources of data for developing and maintaining a nutrient database. J Am Diet Assoc. 1988;88:1268–71. [PubMed] [Google Scholar]53. Simopoulos AP. The Mediterranean diets: What is so special about the diet of Greece? The scientific evidence. J Nutr. 2001;131:3065S–73. [PubMed] [Google Scholar]54. Wilson DH, Bogacz JP, Forsythe CM, Turk PJ, Lane TL, Gates RC, et al. Fully automated assay of glycohemoglobin with the Abbott IMx analyzer: Novel approaches for separation and detection. Clin Chem. 1993;39:2090–7. [PubMed] [Google Scholar]55. Weiss R, Dufour S, Taksali SE, Tamborlane WV, Petersen KF, Bonadonna RC, et al. Prediabetes in obese youth: A syndrome of impaired glucose tolerance, severe insulin resistance, and altered myocellular and abdominal fat partitioning. Lancet. 2003;362:951–7. [PMC free article] [PubMed] [Google Scholar]56. Sparks LM, Xie H, Koza RA, Mynatt R, Hulver MW, Bray GA, et al. A highfat diet coordinately downregulates genes required for mitochondrial oxidative phosphorylation in skeletal muscle. Diabetes. 2005;54:1926–33. [PubMed] [Google Scholar]57. Centers for Disease Control and Prevention. Transmission of hepatitis B virus among persons undergoing blood glucose monitoring in long-term-care facilities–Mississippi, North Carolina, and Los Angeles County, California, 2003–2004. MMWR Morb Mortal Wkly Rep. 2005;54:220–3. [PubMed] [Google Scholar]58. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al. Effects of a Mediterranean-style diet on cardiovascular risk factors: A randomized trial. Ann Intern Med. 2006;145:1–11. [PubMed] [Google Scholar]59. Federal Bureau of Prisons. Washington, DC: Federal Bureau of Prisons; 2007. Federal Bureau of Prisons, Clinical practice guidelines: Preventive health care. [Google Scholar]60. Goff LM, Bell JD, So PW, Dornhorst A, Frost GS. Veganism and its relationship with insulin resistance and intramyocellular lipid. Eur J Clin Nutr. 2005;59:291–8. [PubMed] [Google Scholar]61. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2008. [Last accessed on 2010 May 18]. Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States 2007. [Google Scholar]62. Field AE, Willett WC, Lissner L, Colditz GA. Dietary fat and weight gain among women in the Nurses’ Health Study. Obesity. 2007;15:967–6. [PubMed] [Google Scholar]63. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults. Findings fromthe Third National Health and Nutrition Survey. JAMA. 2001;287:356–9. [PubMed] [Google Scholar]64. Fraser GE. Diet, Life Expectancy, and Chronic Disease. Oxford UK: Oxford University Press; 2003. Vegetarianism and obesity, hypertension, diabetes, and arthritis; pp. 129–48. [Google Scholar]65. Trichopoulou A. Mediterranean diet: The past and the present. Nutr Metab Cardiovasc Dis. 2001;11:1–4. [PubMed] [Google Scholar]66. US Preventive Services Task Force. Screening for type 2 diabetes mellitus in adults: US Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2008;148:846–54. [PubMed] [Google Scholar]67. Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, Heine RJ for the A1C-derived Average Glucose (ADAG) Study Group. Translating the A1C assay into estimated average glucose values. Diabetes Care. 2008;31:1473–8. [PMC free article] [PubMed] [Google Scholar]68. Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: The Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20:537–44. [PubMed] [Google Scholar]69. Patel RB, Burke TF. Urbanization: An emerging humanitarian disaster. N Engl J Med. 2009;361:741–3. [PubMed] [Google Scholar]70. Petersen KF, Dufour S, Befroy D, Garcia R, Shulman GI. Impaired mitochondrial activity in the insulin-resistant offspring of patients with type 2 diabetes. N Engl J Med. 2004;350:664–71. [PMC free article] [PubMed] [Google Scholar]71. Qi L, Hu FB, Hu G. Genes, environment, and interactions in prevention of type 2 diabetes: A focus on physical activity and lifestyle changes. Curr Mol Med. 2008;8:519–32. [PubMed] [Google Scholar]72. Abelson R. New York: The New York Times; 2010. An insurer’s new approach to diabetes; p. 14. [Google Scholar]73. Hu FB. Dietary fat and meat intake in relation to risk of type 2 diabetes in men. Diabetes Care. 2002;25:417–24. [PubMed] [Google Scholar]74. Hua NW, Stoohs RA, Facchini FS. Low iron status and enhanced insulin sensitivity in lacto-ovo vegetarians. Br J Nutr. 2001;86:515–9. [PubMed] [Google Scholar]75. Kendall A, Levitsky DA, Strupp BJ, Lissner L. Weight loss on a low-fat diet: Consequence of the imprecision of the control of food intake in humans. Am J Clin Nutr. 1991;53:1124–9. [PubMed] [Google Scholar]76. Kleges RC, Kleges LM, Haddock CK, Eck LH. A longitudinal analysis of the impact of dietary intake and physical activity on weight change in adults. Am J Clin Nutr. 1992;55:818–22. [PubMed] [Google Scholar]77. Rolls BJ. The role of energy density in the over consumption of fat. J Nutr. 2000;130:268S–71. [PubMed] [Google Scholar]78. Zammit VA, Waterman IJ, Topping D, McKay G. Insulin stimulation of hepatic triacylglycerol secretion and the etiology of insulin resistance. J Nutr. 2001;131:2074–7. [PubMed] [Google Scholar]79. Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world-a growing challenge. N Engl J Med. 2007;356:213–5. [PubMed] [Google Scholar]80. Ackerman RT, Finch EA, Brizendine E, Zhou H, Marrero DG Translating the Diabetes Prevention Program into the community. The Deploy Pilot Study. Am J Prev Med. 2008;35:357–63. [PMC free article] [PubMed] [Google Scholar]81. Allain CC, Poon LS, Chan CS, Richmond W, Fu PC. Enzymatic determination of total serum cholesterol. Clin Chem. 1974;20:470–5. [PubMed] [Google Scholar]82. Gaede PH, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med. 2008;358:580–91. [PubMed] [Google Scholar]83. Guldstrand M, Adamson U, Ahrxen B. Improved β-cell function after standardized weight reduction in severely obese subjects. Am J Physiol Endocrinol Metab. 2003;284:E557–65. [PubMed] [Google Scholar]84. Haber GB, Heaton KW, Murphy D, Burroughs LF. Depletion and disruption of dietary fibre: Effects on satiety, plasma-glucose, and serum-insulin. Lancet. 1977;2:679–82. [PubMed] [Google Scholar]85. Laitinen JH, Ahola IE, Sarkkinen ES, Winberg RL, Harmaakorpi-Iivonen PA, Uusitupa MI. Impact of intensified dietary therapy on energy and nutrient intakes and fatty acid composition of serum lipids in patients with recently diagnosed noninsulin- dependent diabetes mellitus. J Am Diet Assoc. 1993;93:276–83. [PubMed] [Google Scholar]86. Mattson JS, Cerutis RD. Diabetes mellitus: A review of the literature and dental implications. Compend Contin Educ Dent. 2001;22:757–70. [PubMed] [Google Scholar]87. Mokdad AH. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001;286:1195–200. [PubMed] [Google Scholar]88. Morgan SA, O’Dea K, Sinclair AJ. A low-fat diet supplemented with monounsaturated fat results in less HDL-C lowering than a very-low-fat diet. J Am Diet Assoc. 1997;97:151–6. [PubMed] [Google Scholar]89. Jenkins DJ, Kendall CW, Marchie A, Faulkner DA, Wong JM, de Souza R, et al. Effects of a dietary portfolio on cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA. 2003;290:502–10. [PubMed] [Google Scholar]90. Jenkins DJ, Kendall CW, Marchie A, Jenkins AL, Augustin LS, Ludwig DS, et al. Type 2 diabetes and the vegetarian diet. Am J Clin Nutr. 2003;78:610S–6. [PubMed] [Google Scholar]91. Krentz AJ, Bailey CJ. Oral antidiabetic agents: Current role in type 2 diabetes mellitus (Review) Drugs. 2005;65:385–411. [PubMed] [Google Scholar]92. Asif M. The role of fruits, vegetables, and spices in diabetes. Int J Nutr Pharmacol Neurol Dis. 2011;1:26–34. [Google Scholar]93. Roberts CK, Vaziri ND, Barnard RJ. Effect of diet and exercise intervention on blood pressure, insulin, oxidative stress, and nitric oxide availability. Circulation. 2002;106:2530–2. [PubMed] [Google Scholar]94. Stubbs RJ, Johnstone AM, Harbron CG, Reid C. Covert manipulation of energy density of high carbohydrate diet in ‘pseudo free-living’ humans. Int J Obes. 1998;22:885–92. [PubMed] [Google Scholar]95. Tremblay A. Nutritional determinants of the insulin resistance syndrome. Int J Obes. 1995;19(suppl):S60–5. [PubMed] [Google Scholar]96. Vrieze A, Holleman F, Zoetendal EG, de Vos WM, Hoekstra JB, Nieuwdorp M. The environment within: How gut microbiota may influence metabolism and body composition. Diabetologia. 2010;53:606–13. [PMC free article] [PubMed] [Google Scholar]97. Wieland H, Seidel D. A simple specific method for precipitation of low density lipoproteins. J Lipid Res. 1983;24:904–9. [PubMed] [Google Scholar]98. Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362:1090–101. [PubMed] [Google Scholar]99. Holt SH, Brand Miller JC, Petocz P, Farmakaladis E. A satiety index of common foods. Eur J Clin Nutr. 1995;49:675–90. [PubMed] [Google Scholar]

Controlling Type 2 Diabetes | Diet and Exercise

Benefits of Controlling Type 2 Diabetes with Diet and Exercise

---

Many people who have Type 2 diabetes use medication to control high blood sugar levels. But although medication can play an important role in Type 2 diabetes management, it may be possible to lower blood sugar levels by making lifestyle changes, such as diet and exercise.

What causes Type 2 diabetes?

If you have Type 2 diabetes, it means that your pancreas either doesn’t make enough of a hormone called insulin, which helps your body convert sugar in your bloodstream to energy, or your cells do not respond normally to insulin. As sugar builds up in your bloodstream, it causes high blood sugar.

Researchers aren’t sure why Type 2 diabetes causes these problems with the way your body processes sugar. However, being overweight or obese is the biggest risk factor for developing Type 2 diabetes. Having excess body fat in your abdomen, lack of physical activity, family history and age also increase your risk.

How does diet help control Type 2 diabetes?

Eating a healthy diet that is centered on high-fiber, low-fat foods such as fruits, vegetables, and whole grains can help to control your blood sugar levels. That’s because many high-fiber foods have a low glycemic index, which means they help stabilize your blood sugar. Eating foods with a high glycemic index — such as animal products, processed foods, and sweets — can cause your blood sugar to rise quickly.

How does exercise help control Type 2 diabetes?

Regular physical activity will help to lower your blood sugar. You should try to get 30 minutes of aerobic exercise — such as walking, swimming or riding a bike — five days a week and do some type of resistance training a few days a week. Combining aerobic exercise with resistance training, such as weight-lifting or yoga, may help to control blood sugar better than doing either type of exercise by itself.

Diet and exercise also can work together to help you lose weight, which may help to move your blood sugar levels closer to the normal range. That’s because losing excess body fat can boost insulin production and/or help your body use insulin more effectively. If you are overweight or obese, losing 10 percent of your body weight may be enough to make a difference in your blood sugar levels.

Although some people can completely reverse Type 2 diabetes through diet, exercise and weight loss, it may not be possible for everyone. Even if you are unable to completely reverse Type 2 diabetes, you may be able to improve your blood sugar levels, cut back on your medications (with your primary care provider’s permission, of course) and reduce your risk of complications.

Before you start a diet and exercise program, it’s important to talk to your primary care provider.

Need more support?

How to Reverse Type 2 Diabetes Naturally – Diet Doctor

Do you have type 2 diabetes, or are you at risk for diabetes? If so, then you’ve come to the right place.

This guide gives you an overview of what you need to know about treating and reversing type 2 diabetes. Our other guides can teach you more about the symptoms of diabetes, as well as provide specific information about type 2 diabetes and type 1 diabetes.

Many people with diabetes or prediabetes have improved their health with dietary changes. You can too! Making these changes may allow you to reduce or eliminate diabetes medication, and help you lose weight as well.

Keep reading to see if this could work for you!

Start your FREE 30-day trial!

Get instant access to healthy low-carb and keto meal plans, fast and easy recipes, weight loss advice from medical experts, and so much more. A healthier life starts now with your free trial!

Start FREE trial!

---

1. What is diabetes?

Simply put, diabetes is a disorder of blood sugar (glucose) and insulin.  In diabetes, something is wrong with the way a person makes and/or uses insulin, a pancreatic hormone that lowers blood sugar by moving it out of the bloodstream and into the body’s cells.

Type 1 diabetes results when, for autoimmune or other rare reasons, the pancreas becomes damaged and fails to produce insulin. This form of diabetes is most often diagnosed in childhood but can occur in adults.

In type 2 diabetes, there are defects in both the production of insulin by the pancreas (insulin deficiency) and the use of insulin by the body (insulin resistance). When damage to the pancreas’ insulin-producing cells progresses to the point where the pancreas can no longer spontaneously release enough insulin to overcome the body’s resistance to it, blood sugar levels rise.

Excess glucose in the blood is a problem because it can damage blood vessels. What’s more, the body’s tissues can’t effectively use glucose for energy because too much of it stays in the bloodstream instead of entering the cells.

It is important to recognize that high glucose levels are a consequence of an underlying process that has been going on for years before blood sugar becomes high.

The good news is that diet and exercise can help decrease insulin resistance and its associated weight gain, which may help prevent or even reverse diabetes.

To learn more about diabetes, click here:

Early on the road to developing high blood sugar and getting diagnosed with type 2 diabetes, an insulin-resistant person usually has too much insulin in the blood. This is due to the pancreas reacting to the death and/or dysfunction of its insulin-producing beta cells.

Essentially, the pancreas realizes that it has two problems: its overall ability to make insulin is getting worse, and the insulin that it is able to make isn’t working very well. So, the pancreas cranks out more insulin to flood the body’s insulin receptors and overcome the resistance. This works to keep blood sugars normal, until so much beta cell function is lost that the pancreas can no longer crank out excess insulin

Other than its implications for blood glucose and progression of type 2 diabetes, why is it bad to have high insulin levels?

Insulin increases the storage of fat and reduces the body’s ability to use fat for fuel. This can lead to weight gain, which plays an integral role in the development and worsening of insulin resistance. Left unchecked, you can see how this will lead to a vicious cycle: insulin resistance leads to high insulin levels, which make it easier to gain weight by accumulating fat, which increases insulin resistance, which leads to high insulin levels, which leads to more weight gain, and so on goes the cycle.

Type 2 diabetes

Type 2 diabetes is by far the most common form of diabetes, accounting for over 90% of all cases.

Type 2 diabetes begins when an individual makes more insulin than the body can handle. When people are diagnosed with type 2 diabetes, they often have ten times more insulin in their bodies than normal. Consistently elevated blood insulin levels can cause weight gain and other symptoms of insulin resistance.

Over time, the pancreas can no longer make enough insulin to keep blood sugar levels in check — even though it may still be making a lot! That’s because cells have become increasingly resistant to insulin’s effect. When this happens, blood sugar levels start to rise, and a person may be diagnosed with prediabetes or type 2 diabetes.

Type 2 diabetes often affects people who are middle-aged or older, although it is becoming increasingly common in teenagers and young adults in poor metabolic health.

Common symptoms of diabetes

• Increased thirst and urination
• Severe fatigue
• Feeling hungrier than usual
• Unexplained weight loss
• Delayed healing of injuries
• Blurred vision
• Numbness and tingling in hands, feet or toes
• Dark patches of skin
• Skin rashes and lesions
• Yeast and urinary tract infections (women)
• Erectile dysfunction (men)

For more details about these conditions, see our guide to symptoms of diabetes. However, please note that with prediabetes and early stages of type 2 diabetes, you  may not notice any symptoms.

If you think you have any of the warning signs of diabetes, see your doctor.

---

2. Testing blood sugar

Our guide on what you need to know about blood sugar can help you learn more about both high and low blood sugar. This guide focuses specifically on the high blood sugar levels that occur in diabetes.

How do you know if you have too much sugar in your blood? If you don’t know already, it’s simple to test in a few seconds, either in your doctor’s office or with your own inexpensive blood glucose meter.

Compare your own blood sugar reading with the ranges below:

• Normal blood sugar: Less than 100 mg/dL (5.6 mmol/L ) after fasting overnight, and up to 140 mg/dL (7.8 mmol/L ) two hours after a meal
• Prediabetes: Between 100-125 mg/dL (5.6-7.0 mmol/L) after fasting overnight
• Diabetes: 126 mg/dL (7.0 mmol/L) or higher after fasting overnight, or higher than 200 mg/dL (11.1 mmol/L) at any time

Keep in mind that you should not use glucometer readings alone to make a diagnosis of diabetes or prediabetes. If your blood sugar is high on a glucometer, ask your doctor to run a blood test to confirm the diagnosis. Also, most guidelines state that a single abnormal blood sugar reading is not sufficient to secure a diagnosis of diabetes; at least two are needed.

If you are already on a low-carbohydrate diet and you are concerned about the measurements you’re getting, find out how a low-carb diet affects blood sugar measurements.

Learn more about how to test your blood sugar

If you are testing your blood sugar at home, read and follow the directions that come with your blood sugar meter. For most meters, the general procedure goes like this:

1. With clean hands, place a test strip in your blood sugar meter.
2. Prick the side of a finger with the lancet to draw a drop of blood.
3. Place the tip of the test strip on the drop of blood.
4. After a few seconds, the blood sugar meter will give you a reading.

---

3. Food & diabetes

People with diabetes have difficulty keeping blood sugar levels in a normal range. The blood turns “too sweet” as glucose levels rise.

Sugar in your blood comes from two places: your liver and the food that you eat. You can’t do much to control the amount of sugar your liver makes, but you can control the foods you eat.

Foods are made up of three broad categories known as macronutrients (major nutrients): carbohydrate, protein, and fat. Many foods are a combination of two or all three macronutrients, but we often group foods according to whether they are mostly carbohydrate, protein, or fat.

Carbohydrates and blood sugar

Carbohydrates, or carbs, usually come from starches or sugars and turn into glucose when they are digested. When glucose enters the bloodstream, it’s called blood glucose, or blood sugar.

Carbohydrates

The more carbohydrate eaten in a meal, the more sugar is absorbed into the bloodstream and usually the higher the blood sugar will be.

Although very few people would agree that sugary foods are good for you, some foods that we think of as “healthy” — such as fruit — can have a lot of sugar. And many people don’t know that starchy foods — such as bread, rice, pasta, and potatoes — quickly turn to sugar when you digest them.

For some people, eating a potato could raise blood sugar as much as eating 9 teaspoons of sugar! It can be hard to predict exactly how someone’s blood sugar will respond, as this will likely vary based on genetics and baseline insulin sensitivity. By testing your blood sugar before eating and every 30-minutes after eating for up to two hours, you can quickly learn how different foods affect your blood glucose level. The results may surprise you!

Chart: Dr. David Unwin

Protein

Protein containing foods include eggs, poultry, meat, seafood and tofu. Although individuals have different responses to these foods, consuming moderate amounts of protein at a meal generally has a mild to no effect on blood sugar.

Fat

Dietary fat by itself has practically no effect on blood sugar. However, we seldom eat fat all by itself. Some foods, like cheese, are made up of mostly protein and fat. These foods probably won’t raise your blood sugar very much.

But other foods, like doughnuts and French fries, are made up mostly of carbohydrate and fat. Because they’re high in carbs and fat together, these foods are likely to significantly raise your blood sugar.

---

4. How to lower blood sugar with diet

What happens if you remove foods that raise your blood sugar from your diet? Is there anything good left to eat? We think so. In fact, we have a whole guide on the best foods to control diabetes.

But a picture is worth a thousand words. These are just a few of the delicious foods that don’t raise blood sugar for just about everyone:

Many people with type 2 diabetes are now choosing a diet based primarily on low-carb foods, and many clinicians are catching on as well.

A person with type 2 diabete will often notice that, starting with the first meal, their blood sugar improves. The need for medications, especially insulin, is usually dramatically reduced. Substantial weight loss and health marker improvements often follow. Finally, people usually feel better and have more energy and alertness.

Choosing foods low in carbs is an effective way to help you control your blood sugar and is safe for most people. However, if you are taking medications for your diabetes, you must work with your healthcare provider to adjust your medications when you change your diet since the need for medications, especially insulin, may be greatly reduced.

If you are looking for a doctor who will work with you to control your diabetes with a change in diet, our map may help you find one.

---

5. The science of diabetes reversal

In 2019, the American Diabetes Association (ADA) stated that reducing carbohydrate intake was the most effective nutritional strategy for improving blood sugar control in those with diabetes.

Research shows that low-carb diets are a safe and effective option for treating type 2 diabetes. This body of evidence includes systematic reviews and meta-analyses of randomized controlled trials (the highest quality of evidence by our ratings.).

A meta-analysis from 2017 found that low-carb diets reduced the need for diabetes medication and also improved certain bio-markers in people with type 2 diabetes. This included reductions in hemoglobin A1c (HbA1c), triglycerides, and blood pressure; and increases in high-density lipoprotein (HDL) cholesterol, sometimes called the “good” cholesterol.

Additionally, in a non-randomized trial from Virta Health, the intervention group of subjects with type 2 diabetes followed a very low-carb diet and received remote monitoring by physicians and health coaches. After one year, 94% of those in the low-carb group had reduced or stopped their insulin use. Furthermore, 25% had an HgbA1c in the normal range without needing any medications, suggesting their disease was in remission, and an additional 35% did the same with only metformin.

At the two-year mark, a high proportion of subjects continued to demonstrate sustained improvements in glycemic control.

Other interventions have also demonstrated efficacy for inducing remission of type 2 diabetes, although there is a lack of consistency with how different trials define “remission.” The DiRECT trial reported severe caloric restriction (eating around 850 calories per day) resulted in 46% remission at one-year. And bariatric surgery demonstrates between 25% and 50% diabetes remission up to ten-years post surgery.

This evidence suggests that type 2 diabetes does not have to be a progressive and irreversible disease. It is clearly a treatable disease.

---

6. A message of hope

As recently as 50 years ago, type 2 diabetes was extremely rare. Now, around the world, the number of people with diabetes is increasing rapidly and is heading towards 500 million. This is a worldwide epidemic.

In the past, type 2 diabetes was thought to be a progressive disease with no hope for reversal or remission. People were — and sometimes still are — taught to “manage” type 2 diabetes, rather than to try to reverse the underlying process.

But now people with type 2 diabetes can hope to regain their health! Today we know that the hallmarks of type 2 diabetes — high blood sugar and high insulin — can often be reversed with a very low-carb diet, severe caloric restriction, or weight loss surgery.

People don’t just have to “manage” their diabetes as it progresses. Instead, they can often lower their blood sugar to normal levels with diet alone, and may be able to avoid or discontinue most medications.

Normal blood sugar levels and fewer or no medications likely means no progression of disease, and no progression of complications. People with a diagnosis of type 2 diabetes may be able to live long, healthy lives, with toes, eyesight, and kidneys intact!

If you are not on any medications, you can start your journey back to health today. If you are on medications for diabetes or for other conditions, consult your doctor before beginning any lifestyle change, such as a low-carb diet, so your medications are adjusted safely as your blood sugars improve.

When you’re ready, here’s where to start: A low-carbohydrate diet for beginners. During your own journey, you might be inspired by some spectacular diabetes success stories.

If you want to learn more about how you can improve your health and the health of your family, start here by keeping up with the latest news from Diet Doctor.

 

Start your FREE 30-day trial!

Get instant access to healthy low-carb and keto meal plans, fast and easy recipes, weight loss advice from medical experts, and so much more. A healthier life starts now with your free trial!

Start FREE trial!

Type 2 Diabetes Diet: A Complete Guide

Rather than trying a complete overhaul all at once, create lasting good habits by focusing on small, simple, and maintainable changes, Palinski-Wade says. Otherwise, you may feel overwhelmed and revert to any previous unhealthy eating habits. “Being consistent with change, no matter how small, is the key to long-term weight loss success,” she adds.

Here are some of the basic rules for building — and then sticking with — a diabetes meal plan.

Consult the experts. Connect with your primary doctor and a registered dietitian nutritionist (RDN) who is also a certified diabetes care and education specialist (CDCES) — search for one near you at EatRight.org — to figure out how many carbohydrates you should eat per meal based on your individual needs as well as the optimal eating approach for your preferences and health goals.

Veg out. Add in one extra serving of nonstarchy vegetables at dinner. Consider adding vegetables to snacktime, too.

Sweeten things up with fruit. To satisfy your sweet tooth, opt for fruit in moderation. Previous research shows that eating berries, apples, and pears is associated with weight loss.

Diabetes-friendly fruits tend to be especially fiber-rich choices. All other fruits count, too — just be sure to factor them into your carbohydrate servings.

Beware of sauces and dressings. Sugar hides in many condiments, like ketchup, barbecue sauce, and marinades. Always read the label, and choose the lower-sugar option that best fits your diet and goals.

Don’t skip breakfast. Breakfast is one habit of long-term weight-losers.

Plain yogurt with fruit; nuts and fruit; or scrambled eggs and whole-grain toast are all diabetes-friendly breakfasts that will set up your daily blood sugar management for success.

Simplify beverages. Instead of reaching for sweetened drinks, opt for water (sparkling without added sugar also counts!), unsweetened tea, and coffee.

Cut back on salt. Aim for less than 2,300 milligrams (mg) of sodium per day (and less than 1,500 mg daily if you have heart disease) as a way to help manage blood pressure and heart disease risk — a common diabetes complication.

Try seasoning foods with dried herbs and spices instead. They’re sodium- and calorie-free!

Don’t fear grains. They’re a great source of heart-healthy fiber. Aim to make at least half of your grain intake whole grains when you’re managing type 2 diabetes.

Diabetes-friendly options include brown rice, quinoa, 100 percent whole-wheat bread, whole-grain pasta, barley, and whole farro.Add fiber to your diet. Fiber isn’t digested by the human body, so fiber-rich foods with carbohydrates do not raise blood sugar levels as quickly because they are processed more slowly. Fiber-rich foods can also help you feel fuller for longer, possibly aiding weight loss.

Unfortunately, most adults don’t eat enough fiber.

Regardless of diabetes status, women should get at least 25 g of fiber per day, while men need at least 38 g per day, Palinski-Wade says.

Choose dairy mindfully. Opt for nonfat or low-fat (1 percent) with milk, cottage cheese, and plain yogurt. Also, remember that while these sources offer protein, they are also another source of carbs, so you need to factor them into your carb allotment. Unsweetened nondairy milk, such as soy and almond milk, are also diabetes-friendly.

Treating Type 2 Diabetes (for Parents)

After kids or teens are diagnosed with type 2 diabetes, the next step is to create a diabetes management plan to help them stay healthy and active.

Treatment plans for type 2 diabetes are based on each child’s needs and the suggestions of the diabetes health care team.

Type 2 Diabetes Treatment Basics

Treatment goals for kids with diabetes are to control the condition in a way that helps them have normal physical and emotional growth and development, and prevents short- and long-term health problems. To do this, parents and kids should try to keep blood sugar levels as close to normal as possible.

It is also important to treat other conditions that can be associated with type 2 diabetes, like obesity, high blood pressure, or abnormal blood lipid (cholesterol) levels.

In general, kids with type 2 diabetes need to:

• eat a healthy, balanced diet and follow a meal plan
• get regular exercise
• take medicines as prescribed
• monitor blood sugar levels regularly

Helping kids with type 2 diabetes switch to healthier habits is a key part of treatment. Because most kids are overweight when they’re diagnosed, it’s important to promote healthy eating and physical activity to prevent further weight gain or to encourage weight loss while making sure they grow and develop properly.

P

Healthy Eating and Following a Meal Plan

Weight gain happens when someone consumes more calories than he or she uses up through physical activity. The body stores those extra calories as fat. Over time, excessive weight gain can lead to obesity and diseases related to obesity, such as type 2 diabetes and heart disease.

Kids with type 2 diabetes who are trying to manage their weight still need energy to develop normally. To get it, they’ll need enough calories to grow without gaining too much fat. The best way is to eat nutritious foods and get regular exercise.

Many parents worry about what to feed their kids with type 2 diabetes. The key is a balanced, healthy diet. Kids with diabetes benefit from the same kind of diet as those without diabetes — one that includes a variety of nutritious foods that help the body grow and function properly.

The three main types of nutrients found in foods are carbohydrates (carbs), proteins, and fats, which provide energy in the form of calories. Foods containing carbs cause blood sugar levels to go up the most. Foods that are mostly protein and/or fat don’t affect blood sugar levels nearly as much.

Our bodies need many nutrients — in different amounts — to work as they should. So when you and the diabetes health care team create a diabetes meal plan to help keep your child’s blood sugar within the target range, it will include a variety of nutrients.

Meal plans usually include breakfast, lunch, and dinner with small, scheduled between-meal snacks. The plan won’t restrict your child to specific foods, but will guide you in selecting from the basic food groups to achieve a healthy balance.

Meal plans are based on a child’s age, activity level, schedule, and food likes and dislikes, and should be flexible enough for special situations like parties and holidays. The meal plan should make it easier to keep blood sugar within your child’s goal range.

The meal plan also might recommend limiting extra fat and “empty” calories (foods with lots of calories but few nutrients). Everyone should limit these foods anyway — eating too much of them can lead to excess weight gain or long-term health problems like heart disease, for which people with diabetes are already at risk.

Controlling Portions

Portion control — even of healthy foods — is important for kids with type 2 diabetes. As you follow your child’s meal plan, be wary of special foods marketed to people with diabetes. Sugar-free and fat-free foods are not always calorie-free or even low-calorie foods.

A registered dietitian (RD) can help you choose and cook healthier foods, read food labels, and learn how much food your child should be eating in a day. The RD also can adjust meal plans based on how your child is meeting weight management goals. If you don’t have a dietitian on the diabetes health care team, ask your doctor for a referral to see one.

p

Getting Regular Exercise

Regular physical activity is an important part of diabetes treatment.

Exercise helps improve the body’s response to insulin, which helps to control blood sugar levels. It also helps the body burn more calories, which can reduce excess body fat. And it’s healthier for growing kids who are overweight to burn more calories through exercise than to severely restrict the food they eat.

Exercise also can help kids with diabetes:

• keep blood cholesterol and blood pressure under control
• get and keep their heart, lungs, and blood vessels in good shape
• do things that kids without diabetes can do

Kids don’t have to be athletic to get the benefits of physical activity. Things like walking the dog, helping around the house, and playing outside with friends are great — anything that gets them moving regularly can go a long way toward helping control diabetes.

Avoiding Problems During Exercise

To help avoid problems during exercise, kids with type 2 diabetes might need to:

• have an extra snack before the activity
• carry snacks, water, and supplies with them when they exercise
• check their blood sugar levels before, during, and after exercise
• make sure their coaches know about their diabetes and what to do if problems happen

Make sure your child wears a medical identification bracelet (this should always be worn, but it’s even more important during exercise, sports, and fitness activities).

The care team will offer tips to help your child get ready for exercise or join a sport. They’ll also give instructions to help you and your child respond to any diabetes problems that could happen during exercise, like hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar).

p

Taking Medicines as Prescribed

Sometimes, diet and exercise are enough to control blood sugar levels in kids with type 2 diabetes. But some will need to take pills that help their own insulin work better. These pills are not a form of insulin.

Sometimes pills for diabetes — even when combined with diet and exercise — still aren’t enough to keep blood sugar levels under control, and a child with type 2 diabetes must take insulin. The acids and digestive juices in the stomach and intestines would break down and destroy insulin if it was swallowed, so it can’t be taken in a pill. The only way to get insulin into the body is with an injection or an insulin pump.

There is no-one-size-fits-all insulin schedule. The types of insulin used and number of daily injections a child needs will depend on the diabetes management plan. Usually, two different types of insulin are needed to handle blood sugar needs both after eating and between meals.

Eating meals at regular times can make this easier. Eating on schedule may work well for younger kids, but sticking to a routine can be a challenge for older kids, whose school, sleep, and social schedules vary. The diabetes health care team can help you work through problems with scheduling meals and insulin injections.

Remember, a balanced diet, regular physical activity, and a healthy weight can improve blood sugar levels greatly. Some kids who follow the treatment plan for type 2 diabetes can even stop taking insulin altogether.

Monitoring Blood Sugar Levels

Treating type 2 diabetes also involves checking blood sugar levels regularly and responding to the results. Controlling blood sugar levels helps kids with diabetes feel well, grow and develop normally, and reduce the risk of long-term diabetes complications.

The diabetes treatment plan will recommend how many times a day to check blood sugar levels, which is the only way to know the effectiveness of your child’s day-to-day treatment plan.

The diabetes health care team also will explain what your child’s target blood sugar levels are. In general, kids with type 2 diabetes should test their blood sugar levels with a blood glucose meter at least twice a day, but might need to test more often if they’re taking insulin, have been just diagnosed, or have problems with blood sugar control.

The care team may recommend that your child use a continuous glucose monitor (CGM). A CGM is a wearable device that can measure blood sugar every few minutes around the clock. It’s measured by a thread-like sensor that’s inserted under the skin and secured in place. Sensors can stay in place for about a week before they have to be replaced. The more frequent CGM blood sugar readings can help you and the care team do an even better job of troubleshooting and adjusting your child’s insulin doses and diabetes management plan to improve blood sugar control.

A blood glucose meter or CGM measures the blood sugar level at the moment of testing. Another blood sugar test, the glycosylated hemoglobin (hemoglobin A1c or HbA1c) test, shows how blood sugar levels have been running over the past few months.

Putting it All Together

Treating and managing diabetes can seem overwhelming at times. But the diabetes health care team is there for you.

Your child’s diabetes management plan should be easy to understand, detailed, and written down for easy reference. You also should have the names and phone numbers of the health care team members in case of emergencies or if you have questions.

You might hear of alternative or complementary treatments, such as herbal remedies and vitamin or mineral supplements. Although research continues into their possible benefits, studies thus far haven’t proved their effectiveness. They also could be dangerous for kids and teens with type 2 diabetes, especially if used to replace medically recommended treatments. Talk to the diabetes health care team if you have questions.

Each day, researchers all over the world are working to find a cure for diabetes, and advances have made treatment easier and more effective. Insulin might soon be available in patch and spray forms, and scientists continue to improve results of pancreas or islet cell transplants. Versions of an “artificial pancreas” — a device that senses blood sugar continuously and gives insulin directly based on the blood sugar level — also are being tested. 

Your diabetes health care team keeps track of the latest research developments, and will introduce new products as they become available.

Diabetes type 2 – meal planning Information | Mount Sinai

Your main focus is on keeping your blood sugar (glucose) level in your target range. To help manage your blood sugar, follow a meal plan that has:

• Food from all the food groups
• Fewer calories
• About the same amount of carbohydrates at each meal and snack
• Healthy fats

Along with healthy eating, you can help keep your blood sugar in target range by maintaining a healthy weight. People with type 2 diabetes are often overweight or obese. Losing even 10 pounds (4.5 kilograms) can help you manage your diabetes better. Eating healthy foods and staying active (for example, 60 total minutes of walking or other activity per day) can help you meet and maintain your weight loss goal. Activity lets your muscles use sugar from the blood without needing insulin to move the sugar into the muscle cells.

HOW CARBOHYDRATES AFFECT BLOOD SUGAR

Carbohydrates in food give your body energy. You need to eat carbohydrates to maintain your energy. But carbohydrates also raise your blood sugar higher and faster than other kinds of food.

The main kinds of carbohydrates are starches, sugars, and fiber. Learn which foods have carbohydrates. This will help with meal planning so that you can keep your blood sugar in your target range. Not all carbohydrates can be broken down and absorbed by your body. Foods with more non-digestible carbohydrates, or fiber, are less likely to increase your blood sugar out of your goal range. These include foods such as beans and whole grains.

MEAL PLANNING FOR CHILDREN WITH TYPE 2 DIABETES

Meal plans should consider the amount of calories children need to grow. In general, three small meals and three snacks a day can help meet calorie needs. Many children with type 2 diabetes are overweight. The goal should be able to reach a healthy weight by eating healthy foods and getting more activity (150 minutes in a week).

Work with a registered dietitian to design a meal plan for your child. A registered dietitian is an expert in food and nutrition.

The following tips can help your child stay on track:

• No food is off-limits. Knowing how different foods affect your child’s blood sugar helps you and your child keep blood sugar in target range.
• Help your child learn how much food is a healthy amount. This is called portion control.
• Have your family gradually switch from drinking soda and other sugary drinks, such as sports drinks and juices, to plain water or low-fat milk.

PLANNING MEALS

Everyone has individual needs. Work with your health care provider, registered dietitian, or diabetes educator to develop a meal plan that works for you.

When shopping, read food labels to make better food choices.

A good way to make sure you get all the nutrients you need during meals is to use the plate method. This is a visual food guide that helps you choose the best types and right amounts of food to eat. It encourages larger portions of non-starchy vegetables (half the plate) and moderate portions of protein (one quarter of the plate) and starch (one quarter of the plate).

EAT A VARIETY OF FOODS

Eating a wide variety of foods helps you stay healthy. Try to include foods from all the food groups at each meal.

VEGETABLES (2½ to 3 cups or 450 to 550 grams a day)

Choose fresh or frozen vegetables without added sauces, fats, or salt. Non-starchy vegetables include dark green and deep yellow vegetables, such as cucumber, spinach, broccoli, romaine lettuce, cabbage, chard, and bell peppers. Starchy vegetables include corn, green peas, lima beans, carrots, yams and taro. Note that potato should be considered a pure starch, like white bread or white rice, instead of a vegetable.

FRUITS (1½ to 2 cups or 240 to 320 grams a day)

Choose fresh, frozen, canned (without added sugar or syrup), or unsweetened dried fruits. Try apples, bananas, berries, cherries, fruit cocktail, grapes, melon, oranges, peaches, pears, papaya, pineapple, and raisins. Drink juices that are 100% fruit with no added sweeteners or syrups.

GRAINS (3 to 4 ounces or 85 to 115 grams a day)

There are 2 types of grains:

• Whole grains are unprocessed and have the entire grain kernel. Examples are whole-wheat flour, oatmeal, whole cornmeal, amaranth, barley, brown and wild rice, buckwheat, and quinoa.
• Refined grains have been processed (milled) to remove the bran and germ. Examples are white flour, de-germed cornmeal, white bread, and white rice.

Grains have starch, a type of carbohydrate. Carbohydrates raise your blood sugar level. For healthy eating, make sure half of the grains you eat each day are whole grains. Whole grains have lots of fiber. Fiber in the diet keeps your blood sugar level from rising too fast.

PROTEIN FOODS (5 to 6½ ounces or 140 to 184 grams a day)

Protein foods include meat, poultry, seafood, eggs, beans and peas, nuts, seeds, and processed soy foods. Eat fish and poultry more often. Remove the skin from chicken and turkey. Select lean cuts of beef, veal, pork, or wild game. Trim all visible fat from meat. Bake, roast, broil, grill, or boil instead of frying. When frying proteins, use healthy oils such as olive oil.

DAIRY (3 cups or 245 grams a day)

Choose low-fat dairy products. Be aware that milk, yogurt, and other dairy foods have natural sugar, even when they do not contain added sugar. Take this into account when planning meals to stay in your blood sugar target range. Some non-fat dairy products have a lot of added sugar. Be sure to read the label.

OILS/FATS (no more than 7 teaspoons or 35 milliliters a day)

Oils are not considered a food group. But they have nutrients that help your body stay healthy. Oils are different from fats in that oils remain liquid at room temperature. Fats remain solid at room temperature.

Limit your intake of fatty foods, especially those high in saturated fat, such as hamburgers, deep-fried foods, bacon, and butter.

Instead, choose foods that are high in polyunsaturated or monounsaturated fats. These include fish, nuts, and vegetable oils.

Oils can raise your blood sugar, but not as fast as starch. Oils are also high in calories. Try to use no more than the recommended daily limit of 7 teaspoons (35 milliliters).

WHAT ABOUT ALCOHOL AND SWEETS?

If you choose to drink alcohol, limit the amount and have it with a meal. Check with your health care provider about how alcohol will affect your blood sugar and to determine a safe amount for you.

Sweets are high in fat and sugar. Keep portion sizes small.

Here are tips to help avoid eating too many sweets:

• Ask for extra spoons and forks and split your dessert with others.
• Eat sweets that are sugar-free.
• Always ask for the smallest serving size or children’s size.

YOUR DIABETES CARE TEAM IS THERE TO HELP YOU

In the beginning, meal planning may be overwhelming. But it will become easier as your knowledge grows about foods and their effects on your blood sugar. If you’re having problems with meal planning, talk with your diabetes care team. They are there to help you.

How to manage diabetes with diet

Eating healthy is important for everyone, but it’s even more
important for people living with type 2 diabetes. A healthy, balanced
diet is – together with exercise – your most powerful tool for
managing the disease.

From childhood to old age, food is central to social life. Meals
structure the day and define relationships with other people.
Furthermore, what gets served and eaten depends on occasion, time of
year, cultural norms and more.

To help you navigate through all that, I have put together some tips
and pointers which will make living and eating with diabetes both
enjoyable and easy.

“I can eat it all, but in moderation.”

-Phyllisa Deroze

A new way to look at food when you are living with diabetes

Getting started

If you’re newly diagnosed with diabetes, you might be wondering what
it will mean for the way you eat. You may worry that you don’t know
enough about diet and nutrition to establish the food habits that
work and keep symptoms manageable.

Share

“I don’t use the word diet. It’s a meal plan.” 

-Phyllisa Deroze
TWEET THIS

Share This

Let’s get into it! First, try not to think of yourself as someone
“following a diet”. Why not say “meal plan” instead? It’s not set in
stone, after all! You could always revise it if something doesn’t work
out for you. 

Consider learning one of these 3 methods:

The Glycaemic Index method

1 – The plate method

The easiest of the three, this method reminds you that no single food
group provides you with all the energy and nutrients you need.

Many people living with type 2 diabetes can control their blood
sugar levels by simply getting portion sizes right. Instead of
counting carbs – which we’ll get to in the next method – the plate
method offers a quick visual shortcut to healthy balanced eating.

Learn it, apply it to three meals per day, and you won’t go entirely wrong.

Why is it called the plate method? Because it requires you to look at
your actual plate (9 inches across is the ideal size). Now divide it
into 4 quadrants. As you put food on the plate, cover 2 quadrants with
non-starchy vegetables (such as broccoli, spinach or cabbage), 1 with
lean protein (such as white-fleshed fish or white-meat poultry without
the skin) and 1 with carbohydrates (or carbs). Carbs include grains,
bread or starchy foods but are found in other foods as well.

Whether you also need snacks in between meals depends on your
insulin regimen. Your doctor, nurse or dietitian can give you further
advice on adjusting your carb intake with your insulin dose.

2 – Carb counting

Do people living with diabetes need to avoid carbs altogether? No! In
fact, that would be a mistake because carbs coexist with important
vitamins and minerals in many foods.

Share

“When I’m carb counting, I’m not depriving myself of any carbs. I’m
exchanging the carbs.”

-Phyllisa Deroze
TWEET THIS

Share This

When it comes to carbs, you need to learn to count them. That lets
you do two things: keep your blood sugar level under steady control
and provide your brain and muscles with the fuel they need to
function.

Successfully managing diabetes is all about discovering how what you
eat and enjoy – and also when you eat – affects your blood
sugar levels and your overall health, including your mood.
Specifically, here we’re talking about carbs.

Living with diabetes is all about controlling the glucose level in
the blood. And because carbs are turned into glucose when absorbed,
people with diabetes need to be mindful of their carb intake.

Women with diabetes typically aim for 45-60 grams of carbs per meal
(60-75 for men) – and a third of that per snack. What matters when you
count carbs is the amount – not the type. That’s where food labels
come in.

Find the “Total Carbohydrate” number on the
“Nutrition Facts” panel of the food (if packaged). This will
tell you how many grams of carbs you use up out of your total carb
average per meal by eating one serving size.

Do the same for other foods you plan to eat. Aim for your carb
window – not by depriving yourself of foods you like, but by eating
them in moderation. Make your meal plan diverse and exciting!

Fresh foods without a label force you to guess the number of carbs
they contain. A good rule of thumb is that a serving of fruit, milk or
starch has about 15 grams of carbs. Get yourself a pocket guide or app
that lists carb counts and portion sizes.

The precise amount of grams of carbs you need depends on how
physically active you are and which medicines you take. Your doctor or
a registered dietitian can help you identify the right balance.

Here’s something you need to know about carbs: They come in a simple
and complex type. If you are living with diabetes, complex carbs are
better for you because they take longer for your body to digest and
absorb, which means that they act as a buffer against fluctuations in
blood sugar level – also known as hypoglycaemia and hyperglycaemia.

So aim to get the majority of your carbs from nutrient-rich and
slow-acting complex carbs. Choose brown rice, oatmeal, quinoa, farro,
millet and bulgur over simple carbs such as processed and refined
sugars. And go “whole-meal” if possible when you choose breads, pasta
and crackers. A great tip for eating out or travelling is to download
an app that gives you a quick overview of food types that are
unfamiliar to you.

3 – The Glycaemic Index method

You now know that the amount of complex and simple carbs in a given
food is relevant to how much you can eat. But there’s another method
you need to know: the glycaemic index.

The glycaemic index ranks food on a scale of 0 to 100 according to
the food’s impact on your blood sugar. The higher the index, the
quicker the food is digested and absorbed, leading to an increase in
the level of glucose in the blood.

Maybe you are particularly fond of certain
foods. If that’s the case, I suggest looking up their glycaemic index
first. You need to know how they score in terms of quickly causing
your blood sugar levels to rise, because your safety, well-being and
ability to function depend on this. As you get used to this method,
you’ll gain a sense of how much – or how many – of a certain food type
you can eat without causing your blood sugar levels to either plummet
or spike.

Grocery shopping

Many people living with diabetes find that there are certain foods
they have to cut out – completely. But you can choose a “glass
half-full” way of looking at groceries. Give a little thought to your
grocery shopping and you won’t run out of interesting options in the kitchen.

Share

“There are these things that are on my I Don’t Eat That Anymore list.”

-Phyllisa Deroze
TWEET THIS

Share This

A great tip when you go to the supermarket is to spend more time
among the fresh produce than the packaged foods. You can generally
find the healthiest foods along the perimeter of the store. Don’t rush
past them in pursuit of processed foods, and try to concentrate on
fruits and vegetables as well as dairy, meat, chicken and fish.

Why this prioritisation? Because the dietary pitfalls primarily
haunt packaged and canned foods. If you read the food label this fact
will be clear as day. (Always consult the food label so you avoid
surprising reactions to the food.) And needless to say, some packaged
foods are perfectly fine for someone living with diabetes – e.g.
canned tuna, beans and oatmeal.

Here’s another tip that is both easy and charming. When you go
grocery shopping and consider buying a new type of food, ask yourself
if your great-grandmother would have recognised it. If the answer is
yes, then you probably don’t have to be suspicious of its nutritional value.

Another really useful tip touches on the colour of foods. Darker
foods are to be preferred over lighter variants. Pick spinach over
iceberg lettuce, brown rice over white rice, sweet potatoes over white
potatoes, etc. Skip pale foods and opt for whole-grain ones as they
will balance your blood sugar and raise your general well-being.

Dining out when living with diabetes

When you go out to a restaurant, the trick is to keep your focus!
Don’t let the many options throw you off your “meal-plan” game.

Consider and plan your way through the whole meal – from a starter
through the main course to dessert. Focus on the carbs in each dish
and use an app to help you do the estimates (unless the menu provides
the nutritional details).

Share

“I always view dessert as: it’s my entire carb count for the meal.”

-Phyllisa Deroze
TWEET THIS

Share This

So what about dessert? Some people with diabetes use the rule of
thumb that having dessert uses up all the carbs they can have for the
meal. So choosing dessert means having a salad instead of a carb-heavy
starter and main course. This is why it’s important to consider your
entire meal from start to finish, before you make any final
selections.

When there is a buffet, the same advice applies. Familiarise
yourself with all the options before you dig in, otherwise you’ll
likely run out of carbs before you make it to some of the foods you
were looking forward to.

Living well with diabetes will make you a pro at putting together a
delicious meal without breaking the rules on which your well-being hinges.

Putting “food pushers” in their place

People who love to push food on you are a special kind of challenge
for people living with diabetes. They may say things like “Just take a
little piece” or “I made it just for you” or “My feelings will be hurt
if you don’t try this.” Typically charming and well-meaning, they
unfortunately make sticking to a meal plan a bit more difficult.
Occasionally, food pushers constitute a real problem.

Food is about more than metabolism. It is a big part of daily
socializing, and is tied to relationships, love and warmth – often
with people we don’t want to reject. Having to reject the food they
try to offer can feel like rejecting their love or otherwise putting a
damper on the relationship.

There may be no easy way out when a food pusher threatens to upset
your meal plan, but here is a tip anyway. Smile and say, “I can’t eat
that now but I’ll save it for later.”

Living with diabetes means putting your health and well-being before
other concerns and priorities. This is not selfishness. It is a
prerequisite for being useful and available to those who matter to us.

It’s about the long haul

Living with diabetes is a journey, and you’re always moving forward.
Some days will be better than others. Some days your methods and
metabolic rhythm are going to be a perfect match – and some days
you’ll wonder what you’re doing wrong.

Share

“Sometimes I get the diabetes management right. And then there are
days where I’m like, It just didn’t pan out perfectly today.”

-Phyllisa Deroze
TWEET THIS

Share This

When you get it wrong, the first rule is: Don’t beat yourself up! A
day that didn’t pan out perfectly is not the end of the world – and
you shouldn’t carry the disappointment forward with you. If something
goes wrong at breakfast, you can still ace lunch! If the balance is
off at lunch, you can still succeed at dinner! And if a whole day
leaves you unimpressed with yourself, look ahead to tomorrow and aim
to do better.

Should people with and without diabetes eat the same?

A person with diabetes has essentially the same nutritional needs as
someone without the condition. This means that no special foods are
necessary for those with diabetes. As with any healthy eating program,
those with diabetes should focus more on their overall dietary pattern
than obsess over specific foods.

However, people living with diabetes have a good reason to avoid
some of the things that can more freely be enjoyed by those without
diabetes. As we have seen, the role of carbs is central to building a
meal plan when living with diabetes. This is a clue to the differences
between how people with and without the condition can approach their
food intake. Take simple carbs such as are found in candy, cakes, soft
drinks, white bread and white rice. These can be useful when your
blood sugar level runs low, but are not conducive to stable blood
sugar levels for someone living with diabetes.

The glycaemic index will suggest which foods someone with diabetes
might try to limit or avoid – and the reverse. High-fiber,
slow-release carbs should be favoured over foods that merely spike
your blood sugar level. For instance, high-fiber, low-sugar cereal is
to be preferred over a sugary breakfast cereal. Peas or leafy greens
are to be preferred over corn, and so on.

Something to look forward to

A type 2 diabetes diagnosis doesn’t mean you can no longer enjoy
food. Committing to a healthy and realistic meal plan means that food
can still be a delightful and satisfying part of your life. If you
adopt a mindset that respects the needs of your body, you can live
life to the fullest. When you review some of your habits around food,
you’ll find that living with diabetes can actually reveal many
exciting options. There are countless new foods and recipes waiting to
be discovered!

90,000 Type 2 Diabetes Diet

Diet for type 2 diabetes

Switching to a healthy diet and weight loss are the major changes required of a newly diagnosed type 2 diabetes patient. Overweight is not only one of the risk factors for developing type 2 diabetes, but also a factor that determines the likelihood of insulin dependence in a patient with already diagnosed diabetes. In order to achieve the most consistent results in the fight against excess weight, it is recommended to perform a complete overhaul of your diet.

The type 2 diabetes diet is based on 3 key principles:

Abundance of vegetables

The amount of vegetables consumed may vary by age, gender, and weekly exercise frequency. As a general rule, women who exercise up to 30 minutes daily are advised to consume at least 500 grams of vegetables daily. With 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 fat

The presence in the diet of an adequate amount of polyunsaturated and monounsaturated fats helps maintain cholesterol levels within normal values ​​and reduces the risk of developing cardiovascular diseases, one of the most common long-term complications of diabetes. The National Health Service recommends “increase the amount of fiber and reduce the intake of fat (especially saturated)” ² .

Unsaturated fat is found in many foods, including nuts, avocados, fish (tuna and mackerel), and olive oil.

Refusal of processed products

Dietitians and doctors alike agree that avoiding processed foods has a positive effect on health. Processed foods tend to have a high glycemic index (GI) because of the substances that are added to ensure a long shelf life. Regular consumption of such foods can negatively affect the health of a diabetic.

90,000 Weight loss in type 2 diabetes, indications, recommendations, treatment

Every year there are more and more type 2 diabetics.Most of the patients are overweight, which is a key factor in the development of the disease and its complications. Type 2 diabetes cannot be cured, but by reducing body weight to acceptable levels, it can improve its course.

Why you need to lose weight in type 2 diabetes

After the breakdown of food, the hormone insulin, which is synthesized in the pancreas, is responsible for the transfer of glucose from the blood. With type 2 diabetes, the sensitivity of cells to the hormone changes, that is, insulin resistance develops.Blood glucose levels rise despite normal or elevated insulin levels.

There are many reasons for the development of the condition, but in 90% of cases, type 2 diabetes provokes excess body weight. The greater the weight, the higher the likelihood that a person will develop the disease, and if they already have it, the higher the risk of diabetic complications. Weight loss is the main point in the complex treatment of type 2 diabetes mellitus.

Due to adherence to diet and weight loss, diabetics achieve an improvement in blood counts, avoid dangerous complications.The disease develops slowly, often people do not pay attention to the first symptoms of diabetes. More often it is diagnosed after 4-5 years, when doses of insulin cannot be dispensed with without drug therapy. After weight loss, patients have the opportunity to reduce the dosage of drugs or completely abandon them and control sugar levels through proper diet, weight control.

The higher the weight, the more glucose in the blood and the more pronounced insulin resistance – the cells completely cease to perceive insulin.The pancreas works for wear and tear, producing more and more portions of the hormone.

Features of weight loss in type 2 diabetes

Weight loss should be under the supervision of a physician, especially for people taking antidiabetic drugs. With a decrease in the amount of carbohydrates, the level of glucose decreases, therefore, dosage adjustment of drugs may be required. When losing weight in type 2 diabetes mellitus, the following important points should be taken into account:

1. You can not starve – such weight loss is dangerous to health.Refusal to eat more often leads to breakdowns and a return to the usual diet, which entails the return of excess weight and an increase in glucose. A person should stick to a diet, and not give up food.
2. The diet should be low in carbohydrates and low in calories.
3. You need to lose weight slowly – fast weight loss in diabetes mellitus is undesirable. The optimal loss is about 500 g per week.
4. Observe the drinking regime. When fat cells break down, toxic substances appear in the blood, and fluid intake contributes to their rapid elimination.The average volume of water per day is about 1.5 liters.
5. The body must receive all the necessary vitamins, therefore, in addition, doctors recommend multivitamin preparations to patients. When losing weight, chromium is especially important, which reduces cravings for sweets and has a positive effect on the sensitivity of cells to insulin.
6. The diet should be combined with moderate physical activity. A set of exercises should be made based on the capabilities and condition of the body. Many exercises are contraindicated for those suffering from severe obesity, so a specialist should deal with their selection.The best option for all patients is daily walks.

Weight loss in type 2 diabetes with the help of diets and exercise are key points, but the psychological attitude plays an important role, therefore in some cases the help of psychologists is required. Obese people often face complexes, depression due to being overweight.

Specialists motivate to lose weight, increase self-esteem, help in case of failures. Thanks to psychologists, it is easier to endure the disease, the likelihood that a person will break down, quit the diet and the goal of losing weight is reduced.Even the loss of a few pounds will be a significant event that will stimulate further fight against obesity.

A proper diet should become a way of life. You need to follow a diet for type 2 diabetes mellitus for life, even after losing excess weight and improving the course of the disease.

What should be excluded from the diet

Animal fats, fast (easily digestible) carbohydrates, which are quickly absorbed, increasing glucose levels, are primarily excluded from the diet.High-calorie foods should be rejected. The correct menu does not include:

• sugar, honey, jam, jam;
• marshmallows, sweets, chocolate;
• canned food, smoked meats, lard;
• rich pastries, cakes, pastries;
• mayonnaise, fat sour cream and cheese, cream, margarine, spread;
• sweet, carbonated, alcoholic drinks;
• fatty meats, fish;
• white bread;
• nuts, seeds.

Should limit the use of cereals, potatoes, pasta, carrots, beets (has a high glycemic index).

Patients with type 2 diabetes are prohibited from sugar (fast carbohydrate), but if the person is on insulin, it may be required in the event of a sharp drop in glucose. At first, it is difficult to give up eating many dishes, but over time, the body is rebuilt, getting used to the new menu.

Frequency and rules of food intake

This disease often suffers from hunger. This is due to the fact that glucose is fuel for tissues, but because of insulin resistance, it cannot get into them in the proper amount and remains in the blood.Therefore, cells lacking glucose send a signal to the hypothalamus to activate the hunger center.

To lose weight in diabetes mellitus, you need to eat fractionally, 5-6 times a day. If a person is not hungry, it is not necessary to eat exactly 6 times a day, but it is also impossible to divide the entire amount of food into 2-3 meals. When calculating calories, you need to take into account that their amount should be less than the body spends. In obese diabetes, diets reduced in energy value are prescribed, that is, the diet should be varied, but contain fewer calories.

Replacing high-calorie foods is not difficult, for example, sausage can be replaced with boiled, lean meat, and butter in a sandwich for a tomato or other vegetable. The diabetic will satisfy hunger, but consume fewer calories. When losing weight with type 2 diabetes, you need to limit seeds and nuts, which many do not perceive as food, although they are high-calorie foods. It is better to exclude them from the diet altogether.

To lose weight in type 2 diabetes, it is important to consider the glycemic index of foods (GI).The indicator reflects the effect of foods on the amount of glucose in the blood after consumption. Diabetics benefit from food with a GI below 55, which is absorbed more slowly.

Bariatric surgery for treatment

Not everyone is able to lose weight in diabetes and maintain normal blood counts even with the help of effective diets and medications. With the ineffectiveness of conservative therapy, a high BMI, especially in combination with complications, they decide on a surgical method of treatment. Bariatrics is a branch of surgery that includes various methods of weight loss through surgery.

The effectiveness of bariatric surgery in the treatment of obesity and diabetes mellitus has been proven by numerous studies. One operation is enough to lose weight. After surgical treatment, all patients have a positive result. Diabetics lose weight, and the level of glycated hemoglobin, glucose returns to normal. In some patients, type 2 diabetes goes into remission, which helps to stop taking medications or to reduce their dosage as much as possible.

Bariatric surgeons achieve weight loss by reducing the size of the stomach and / or reducing the absorption of nutrients from food into the intestines.Types of operations:

1. Gastric ballooning.
2. Longitudinal gastric resection (Sleeve operation).
3. Gastroplication.
4. Stomach banding.
5. Biliopancreatic shunting.
6. Gastric bypass.

Except for endoscopic ballooning, operations are performed laparoscopically. This is a minimally invasive technology that has a minimal risk of complications and a quick rehabilitation period.

According to numerous studies for obese type 2 diabetes, gastric bypass is the most effective treatment.

It refers to a combined type of surgery and includes 2 principles: restriction (a decrease in the volume of food due to resection of the stomach) and malabsorption (a decrease in food absorption by creating an anastomosis). During the operation, the surgeon cuts off part of the stomach and leaves a small pouch with a volume of about 50 ml. It creates an anastomosis between it and part of the small intestine so that food goes around the duodenum.After the operation, the person is quickly saturated with a small portion of food. The digestion process begins in the distal intestines, which promotes weight loss.

In people with overweight and first degree obesity, it is extremely difficult to reduce weight only by diet, physical activity. With excess weight over 45 kg, conservative weight loss methods are often ineffective. If weight does not decrease, diabetes progresses, then the only way to solve the problem is bariatric surgery.

Diabetes mellitus diagnosis: now what?

You have just been diagnosed with diabetes. Now what? How will your life change? What do you need
to take to correct this disease? One correct answer to these and many others
no questions, because everyone has different stories and situations. But there is a certain order
actions, the observance of which will allow you to achieve the goals set by the attending specialist and well
feel yourself.We propose to talk about it.

---

What is diabetes mellitus?

Diabetes mellitus is a chronic disease in which the body
ceases to assimilate glucose, due to which its concentration in the blood many times
increases. This is due to insufficient insulin production or due to
the inability to use this hormone by the body.

Diabetes mellitus is of two types:

In this condition, the pancreas produces little or no insulin
him at all. Various factors can trigger the development of type 1 diabetes.
including genetics. Usually the disease develops in children and adolescents
age, less often it is found in adults.

Diabetes treatment aims to control blood sugar levels through injection
insulin and lifestyle correction. ¹

In this disease, the pancreas produces insulin, but the cells
don’t use it properly.

The condition is diagnosed in middle-aged and older patients, however
type 2 diabetes has been detected in recent years
in children and adolescents. This is due to an increase in the incidence of obesity due to
sedentary lifestyle. Also, the development of type 2 diabetes can be promoted by
genetics, metabolic syndrome, disruption of communication between body cells.Treatment of this
diseases
aims to control and correct blood sugar levels with
medicines, diet and lifestyle correction. ²

There is also so-called gestational diabetes, which develops in pregnant women.
against the background of metabolic disorders.With proper timely correction, it is safe for
child and mother and passes after pregnancy.

General advice for people with diabetes

^{3, 4, 5}

Regardless of what type of diabetes you have, there are general rules that
it is worth sticking to in order to control this condition and feel good.

Model image used for illustrative purposes

• 1.Learn basic terms. Know your targets.

  Familiarity with diabetes terminology will help you better understand the condition. All useful
  you can find out the definitions here.
  Also, the diagnosis of diabetes mellitus means
  need
  control of blood sugar levels. This is important for understanding whether you are high or low.
  blood glucose level at any time.General criteria
  diagnoses are: ≥ 7.0 on an empty stomach and ≥ 11.1 at random.

Model image used for illustrative purposes

• 2. Incorporate sports and healthy eating into your lifestyle.

  A balanced diet and sports are especially relevant for people with type 2 diabetes,
  but also useful in type 1 diabetes. It is important to plan for foods containing
  carbohydrates, try to eliminate sugar from the diet, make a meal plan or flexible diet,
  appropriate to the lifestyle.Physical activity can be aerobic
  exercise, strength training, stretching, yoga. If you do not have the strength or desire to practice, find
  a sports partner who enjoys the same loads as you.

• 3. Never stop studying diabetes.

  By getting to know him better, you will learn how to control him. Find useful content
  about diabetes, join thematic forums, communicate with people living with diabetes.Of course, your life will change. But diabetes can’t stop you from reaching your goal.
  and make dreams come true.

Diabetes mellitus Q&A

Diabetes mellitus in questions and answers

4th November is World Diabetes Day. Within the framework of this day, the endocrinologist of the Central City Hospital Larisa Pankova answers the most frequently asked questions from patients.

Diabetes mellitus is a disease caused by a complete or relative lack of insulin (a hormone of the pancreas), as a result of which blood sugar levels rise and energy metabolism disorders occur, sometimes quite significant.

Diabetes mellitus is a group of diseases that manifest themselves in a similar way, but have different causes. Diabetes mellitus type 1 occurs in childhood or young age, proceeds violently, is characterized by a strong feeling of thirst, carries the danger of a significant violation of energy metabolism, is treated with insulin. Diabetes mellitus type 2 is more common in old age, is often accompanied by obesity, its symptoms are not as obvious as in type 1 diabetes, treatment can be started with diet or taking antidiabetic drugs – in the form of pills. Diabetes mellitus can be caused by other diseases (the so-called specific types of diabetes), for example, diseases of the pancreas, it can be caused by treatment with corticosteroids.

• How is diabetes mellitus manifested?

It manifests itself as fatigue, thirst, excretion of large amounts of urine, itchy skin, weight loss, inflammation of the bladder and kidneys, and furunculosis.If diabetes is not treated for a long time, it can lead to a complete disruption of the basic functions of the human body, dehydration, loss of consciousness and even death. Diabetes mellitus type 1 is characterized by a sharp manifestation and development of all symptoms of the disease. Diabetes mellitus type 2 develops more slowly, its symptoms are less pronounced. The disease may not manifest until late complications of diabetes appear.

• Can diabetes mellitus go on without symptoms?

Diabetes mellitus type 2 at the onset of the disease often does not appear at all and can be detected during a routine examination by an increase in blood glucose and the appearance of sugar in urine.

• Is diabetes mellitus hereditary?

Yes, both types of diabetes mellitus , especially type 2 diabetes, can be inherited in a certain way, more precisely, a predisposition to this disease is transmitted.

• Can drugs or other illnesses cause diabetes?

This type of diabetes is called secondary diabetes (or specific type of diabetes). The development of this diabetes can be triggered by the intake of certain medications, such as corticosteroids used in the treatment of rheumatic diseases, asthma, a number of non-specific intestinal diseases, skin diseases and other autoimmune diseases.

• What is impaired glucose tolerance?

Previously, this condition was called “latent” (dormant, asymptomatic) Diabetes mellitus . It is found only in laboratory analysis, with the so-called glucose tolerance test, when the patient drinks a glucose solution (75 g in 100 ml of water) and the level of glucose in the blood after 2 hours reveals how fully his body is able to assimilate this glucose. This test shows the ability of the pancreas to produce the required amount of insulin per meal.In case of violation of glucose tolerance, medical supervision, adherence to a diet, and sufficient physical activity are necessary.

• When is diabetes mellitus diagnosed?

If the patient has symptoms typical of diabetes (thirst, strong urination, weight loss), a blood sugar test is sufficient. If its level in capillary blood on an empty stomach is more than 7.1 mmol / l (two-fold determination), this is diabetes mellitus. If the patient does not have symptoms typical for diabetes, but there is only a suspicion of diabetes mellitus, a glucose tolerance test is performed, the principle of which is described above.According to the body’s reaction to this load (the glycemic level after 2 hours is more than 11.1 mmol / l), it is determined whether it is really about diabetes mellitus or only about impaired glucose tolerance (the level of glycemia after 2 hours is more than 7.8 mmol / l) …

• Is it possible to plan a pregnancy with a diagnosis of diabetes mellitus?

Yes. However, before pregnancy (about 1 year) and throughout pregnancy, it is necessary to strictly control the compensation of the disease and adequately treat diabetes.During pregnancy, insulin must be administered, pills are not used so as not to harm the fetus and not endanger its life. To assess the compensation of the disease, it is necessary to control the level of glycated hemoglobin once every 3 months.

• Is it possible to go in for sports, work with diabetes mellitus?

With diabetes mellitus , you can go in for sports, do physical work, if the sugar is not more than 12-13 mmol / g. Physical education and increased physical activity are usually desirable.This increases the sensitivity of the tissues to insulin and helps maintain an optimal weight. With heavy loads, it is necessary to consult a doctor, choose a diet and doses of insulin or antihyperglycemic drugs, taking into account the load in order not to cause hypoglycemia (a strong decrease in sugar levels). With regard to work, the patient should choose a type of activity with the ability to maintain a correct diet, with uniform physical activity throughout the week.

• How is diabetes treated?

The main objective of treatment is to achieve normal blood sugar levels and maintain this level throughout life.This is necessary to prevent complications of diabetes . Treatment is based on changing the optimal exercise and diet. It is necessary to achieve weight loss in excess of it. If physical activity and diet are not enough to achieve normal sugar levels, antidiabetic drugs (pills or insulin) must be added. In type 1 diabetes, insulin treatment is necessary from the beginning of the diagnosis, as it is associated with primary damage to the cells of the pancreas.

• What should be the diet for diabetes?

The diabetes diet is about more than avoiding sugar, sweets and sugary foods. Each patient should have an individually designed diet with a certain amount of carbohydrates, fats, proteins and calories so that blood sugar levels are normal, fat metabolism is not disturbed, the patient has an ideal weight and maintains it. Simple sugars should be eliminated from the diet, which are quickly absorbed, causing a sharp rise in blood sugar.The total amount of carbohydrates should be 55-60%, with a predominance of coarse fiber, fats – 25-30% (with a predominance of vegetable fats), proteins – 15-20%.

• Do I need to follow a diet if I take pills or insulin?

Yes, you must! Diet (good nutrition) is necessary for every patient, even if he is taking pills or taking insulin.

• A if I do not follow the diet ?

If the diet is not followed, there is a risk of poor compensation with the risk of complications.If you do not follow a diet and increase the dose of drugs or insulin doses, the patient may gain weight, worsen the sensitivity of cells to insulin, and treat diabetes will fall into a vicious circle. The only way to avoid these complications is to adjust the diet in such a way as to normalize and maintain weight.

• Why may some patients take pills while others need insulin right away?

It depends on the diabetes type . In patients with type 1 diabetes, the pancreas does not produce insulin and therefore insulin must be used from the onset of the disease.In patients with type 2 diabetes, the lack of insulin is only relative, often at the initial stage of the disease, it is enough to follow a diet and take medications that improve the body’s sensitivity to insulin or increase its secretion by the cells of the pancreas. If pill treatment stops working, insulin should be started.

• How many times a day do you need to “inject” insulin?

When treating diabetes, we strive to match blood sugar levels with those of healthy people.Different schemes of insulin administration are used, which depend on the type of diabetes and the course of the disease. Often in young patients and patients with complications, intensive insulin therapy regimens are used, that is, the patient injects insulin 3-5 times a day. In elderly patients, the number of insulin injections and the dose depend on the course of the disease.

• How to evaluate the quality of diabetes care?

A well-compensated patient should feel like a healthy person, not experiencing intense thirst or hunger, his body weight is maintained at an ideal level, there is no loss of consciousness due to hypoglycemia.How well diabetes is compensated for can be determined with blood and urine sugar tests. When properly treated, urine is sugar-free. Blood sugar should, if possible, be monitored at home throughout the day for proper nutritional and medication intake. Once every 3 months, it is necessary to determine the level of glycated hemoglobin by which one can judge the correctness of treatment for this period, which is currently the main criterion for compensating for carbohydrate metabolism.

• What is hypoglycemia?

Hypoglycemia is a condition caused by low blood sugar. This occurs as a result of a mismatch between the intake of sugar from food and the consumption of sugar, associated with physical activity or the intake of an inadequate dose of antidiabetic drugs. Hypoglycemia often occurs when a patient falls asleep and forgets to eat after taking antidiabetic drugs or as a result of increased physical activity.With mild hypoglycemia, the patient experiences hunger, with more severe – sweating, weakness, dizziness, with severe – loss of consciousness may occur.

• How can hypoglycemia be avoided and how is it treated?

Hypoglycemia can be avoided by following the correct diet. With the expected increase in the load, it is necessary to increase the consumption of carbohydrates with food, maybe even reduce the dose of insulin or glucose-lowering drugs. Hypoglycemia should be treated at the initial stage – give the patient sweet tea, cookies, candy.In severe condition, it becomes necessary to inject a glucose solution into a vein or intramuscularly injecting glucagon. The drug glucagon is desirable for patients with a tendency to hypoglycemia, since it can be administered by the patient or a relative.

• How often should I see an endocrinologist?

It depends on the diabetes type , the method of treatment and the state of compensation. Patients with type 2 diabetes with good compensation, once every 3 months is enough, patients with complications of diabetes and an intensive insulin regimen need monthly monitoring.But a trained patient can help himself to compensate for diabetes by doing a blood test for himself during the day with the help of a glucometer (a device for measuring blood sugar), controlling the administration of insulin, and choosing the right treatment for himself.

• What are the complications of diabetes?

Complications can be early or late, with damage to small vessels (microangiopathy) or large vessels (macroangiopathy). Early complications include the following: ketoacidosis ( with poor compensation, ketone bodies are formed – products of fat metabolism, which, together with high blood sugar levels, can lead to disruption of the functions of the main biological systems of the body with the threat of loss of consciousness and death), hypoglycemia.

Late complications occur with long-term, poorly compensated diabetes. The eyes (changes in the retina with the danger of blindness), the kidneys (renal failure may develop with the need for hemodialysis), the vessels of the lower extremities are affected (which can lead to gangrene with the need for amputation), the gastrointestinal tract, the cardiovascular system and the nervous system. The doctor’s task is to acquaint the patient with possible complications and explain how to prevent them.

• How to avoid complications of diabetes?

First of all, long-term compensation of diabetes is necessary (the level of glycated hemoglobin is below 7%), which depends on adherence to a properly established diet, correct treatment and adequate physical activity. Regular monitoring of blood sugar is required. To prevent vascular complications, in addition, it is necessary to regularly monitor and maintain a normal blood pressure level (below 130/80 mm.Hq). the level of triglycerides (below 1.7 mmol / l), blood cholesterol (below 4.4 mmol / l). Taking into account the special sensitivity of the feet to damage and the danger of the so-called “diabetic foot”, constant care of the feet is needed, which consists in wearing comfortable shoes, treating small wounds and hygienic care of the skin of the feet.

• What should a diabetic patient carry with him outside the home and on the road?

Each patient must have a certificate with passport data and a telephone number, with clear instructions on the drugs used, a supply of antidiabetic drugs or insulin.Do not forget about a few lumps of sugar in your pocket in case of hypoglycemia, often a glucometer is also needed.

• What diseases or medications make the condition worse?

If a patient develops another disease, two situations may arise:

1. The disease will worsen the diabetes compensation and sugar levels will rise, which will necessitate an increase in the dose of medication or insulin.

2. The patient does not eat in case of illness, and hypoglycemia may occur, then it is necessary to double-check the blood sugar level and possibly reduce the dose of the antihyperglycemic drug.For serious illnesses, the patient should be admitted to a hospital and diabetes compensation adjusted quickly. Therefore, in case of infectious diseases with a high temperature, before planned operations, in diseases of the gastrointestinal tract with a lack of appetite and vomiting, medical supervision is necessary, and if necessary, the patient must be admitted to a hospital.

• Do I need to have a blood test every time I visit a doctor, maybe a urine test is enough?

Urinalysis data is insufficient, a blood test for glycemia or glycated hemoglobin will better determine the state of compensation and will allow, if necessary, to change the treatment regimen.

• Self-management of diabetes.

At present, the patient’s treatment and the achievement of normal blood sugar levels require self-monitoring of blood sugar at home. This requires a meter with test strips. The use of the g lucometer is taught in “diabetes schools”. In our hospital there is a “School of Diabetes Mellitus” on Tuesdays: Tuesday 1 and 3 – from 12.45 to 13.30, Tuesday 2 and 4 – from 13.00 to 13.45, where endocrinologists tell patients about diabetes in great detail.

Currently, diabetes is no longer a disease that would deprive patients of the opportunity to live, work and play sports normally. Subject to the diet and the correct regimen, with the modern possibilities of treatment with insulin and pills, the patient’s life is no different from the life of healthy people.

90,000 Diabetes Nutrition Principles. What foods should not be eaten with diabetes

Symptoms of diabetes are caused by unstable sugar levels.And jumping glucose is a consequence of improper nutrition. Today we learn about diet for type 1 diabetes and Type 2 . Let’s pay attention to what you can’t eat with diabetes, and what you can and should eat with diabetes mellitus. All this you need to know in order not only to keep diabetes mellitus under control, but also to feel more vigorous, more active and better.

Diet for diabetes mellitus.

4 principles of therapeutic nutrition:

1. Compliance with the diet. Food intake – every 3-4 hours. It is this regime that positively affects the stomach (after all, it does not overstretch) and intestinal motility, all the necessary enzymes for digestion have time to be synthesized. In addition, the hormone insulin is excreted in excess. All these factors contribute to weight loss, improvement of gastrointestinal tract motility and, as a result, diabetes compensation.
2. Individual approach . Treat the patient, not the disease in general! It is always necessary to collect all information about the patient and the state of his body (in medical terminology – “medical history”).After all, a person with diabetes may have additional concomitant diseases that must be taken into account when drawing up a diet. For example: for people with high blood pressure, the amount of salt is additionally limited, for people with severe renal disease, the amount of fluid, protein and foods fortified with potassium is limited. The diet for diabetes mellitus for pregnant women will also be different.
3. Correct way of cooking . Heat treatment is extremely important. Heat treatment affects not only the vitamin composition of the product, but also the calorie content and glycemic index.Better to give preference to steaming, boiling and baking. With these methods of heat treatment, most vitamins and microelements are retained, so the products retain maximum benefit and taste. And it is advisable to limit frying dishes as much as possible in the diet of a person with diabetes. The frying process negatively affects liver function, additional oil increases the calorie content of the dish.
4. Menu variety . More different products – more necessary and useful microelements for the body.Each product (vegetables, fruits, meat, fish, cereals) has not only a different calorie content and ratio of fats, proteins and carbohydrates, but also a different vitamin and microelement composition. Therefore, the more different types of food you have on your plate, the more balanced your diet will be. There is no need to remember which product contains more or less vitamins – in practice, it is enough to use a simple rule: the more flowers on your plate, the more various useful microelements and vitamins will enter your body.For example: millet groats (yellow) will go better with a tomato (red) than with a pumpkin (yellow).

The idea of ​​a personalized diet is now leading in medicine. Its peculiarity is that the dietitian draws up the menu individually, taking into account all pathological conditions. But until recently, the Pevzner diet was the official treatment for overweight people. This diet has also been used to treat people with type 2 diabetes who are overweight or obese.Therefore, as the basis for drawing up an individual menu, you can use tables according to Pevzner (namely: table number 9). This diet is not only aimed at reducing the amount of carbohydrates in the diet, but also takes into account the glycemic index of foods. We will talk about the composition of the products of this diet a little later.

Today, it has been proven that nutrition schemes have long been known to the population to be effective in the fight against obesity. They have been clinically tested and used worldwide to help normalize body weight.These ready-made “meal plans” include:

• DASH diet;
• Mediterranean diet;
• vegetarian / vegan;
• carbohydrate-restricted diet;
• fat-restricted diet;
• intermittent hunger.

All of these eating patterns need to be adjusted depending on your health condition and the goal you are striving for. It is these proven and effective dietary patterns that athletes, actors, first ladies, presidents, and generally all people who care about their health are guided by.

But how to choose the healthiest foods for diabetes? How to make the right menu for diabetes?

Nutrition for type 1 diabetes

grain units. Bread units are used to make it easier to calculate the required dose of insulin.1 IU of insulin utilizes 12 g of carbohydrates. It is 12 g of carbohydrates that are contained in 1 piece of ordinary bread weighing 20 g. Therefore, they called it “ grain unit ” (HO). So, 1 XE = 1 U of insulin = 12 g of carbohydrates. Bread units (that is, carbohydrates) are found in almost all foods to a greater or lesser extent.

For example: in a medium-sized apple 1 XE, 1 small potato – also 1 XE, 1 tablespoon of cereal – also 1 XE. By the way, insulin doses can also be counted in grams of carbohydrates (this is done in Europe and America), but in Ukraine they are already accustomed to such numbers (XE).

Unlike the type 2 diabetes diet, there is a golden rule for type 1 diabetes – adherence to the “liberalized diet” . It is necessary to calculate the bread units depending on the amount of carbohydrates, and on the basis of this indicator – the dose of insulin . If the wrong dose of insulin is given, the sugar level can either rise sharply (hyperglycemia) or drop sharply (hypoglycemia). Both high and low sugar, as well as sudden changes, lead to complications of diabetes.Therefore, normal sugar and correct doses of insulin are prerequisites for compensated diabetes without complications. In order to facilitate the calculation of insulin doses, it is advisable to exclude from the diet those dishes in which it is impossible to accurately estimate the amount of carbohydrates: sweets, confectionery and sweet fruits (including products on fructose “for diabetics”). The more insulin is injected at a time, the higher the risk of a sudden drop in blood sugar (a state of hypoglycemia). Therefore, it is not recommended to consume more than 7 bread units per meal.

Insulin counts only on carbohydrates. If there are proteins in food, then the patient does not consider insulin on them.

What can you eat with diabetes?

Pay attention to the usual products! A person with diabetes who does not have severe kidney disease is not limited in the amount of protein per day. Protein does not affect sugar levels, while at the same time it makes you feel full for a long time. Protein foods – meat, fish, eggs, sausage, cheese – are interchangeable.For example, one egg = 30 g of hard cheese.

Fats also do not significantly affect blood sugar levels, but are the most nutritious macronutrient. Therefore, the amount of fat in the diet of an overweight person should be moderate. It is not only the quantity that matters, but also the quality of the fat. The most beneficial are mono- and polyunsaturated fatty acids. They are found mainly in vegetable oil (primarily olive oil), nuts, avocados, and white varieties of sea fish. It is these products that should be preferred.Animal fats, such as lard, fatty meats, fatty sour cream and cream, raise cholesterol levels and cause atherosclerosis, so they are best minimized in the diet. This will lower your risk of heart disease.

! The rate of increase in glucose after consuming carbohydrates with the same BU will differ depending on the glycemic index.

Glycemic Index (GI) – the rate and level of increase in blood sugar (in percentage) compared to the rise in sugar after consuming standard glucose.The GI of sugar is 100%, all other foods are compared with the GI of glucose. The more simple carbohydrates (sugar) in the product and less dietary fiber (fiber), the higher the glycemic index. Consequently, the blood glucose level rises even higher. Distinguish between foods with a high, medium and low glycemic index. Foods with a low glycemic index are absorbed more slowly and therefore raise blood glucose levels more slowly than foods with a high glycemic index. The glycemic index of each food is a tabular value.But the glycemic index is influenced by both the type of product itself and its consistency, that is, the method of preparation. The highest glycemic index will be in a sweet liquid – a liquid product is always absorbed faster than a solid one.

! GI is influenced by food consistency, heat treatment, fat and fiber content. For example, in mashed potatoes it is twice as high as in jacket potatoes. That is, choosing the right culinary treatment, cooling or drying the product, you can make it more useful for a patient with type 2 or 1 diabetes.

Foods for type 1 diabetes

In addition to insulin administration, the main rule for nutrition for type 1 diabetes is a diet with a low glycemic index. It is necessary to replace high-GI foods with low-GI foods. This eliminates sharp jumps in blood sugar levels.

And don’t forget to count the carbs you consume!

Nutrition for type 2 diabetes mellitus

The basis of type 2 diabetes mellitus nutrition is complex carbohydrates with low GI (up to 50-60% of them in the diet).It is recommended to reduce the consumption of high-calorie foods and take timely blood glucose measurements.

Regular sugar can be replaced with sweeteners, they do not affect either sugar level or body weight. It is advisable to give up dried fruits: raisins, dates, figs. This is a source of excess sugar. Dried fruits in moderation (3-4 raisins) are very difficult to eat. In addition, all dried fruits are poured with sugar syrup. Therefore, they quickly raise blood sugar levels and contribute to weight gain.

What can you eat with diabetes?

9000 Milk products : kefir, sour cream (15-20% fat), cottage cheese (up to 4% fat), hard cheeses with a low fat content (up to 17%)

4 pancakes with flour

4 Cakes, pies, biscuits. Confectionery made with unsaturated margarines, sweeteners

905 , fondant

Food	Recommended for regular consumption	Recommended for moderate consumption		09000 herbs, mustard, spices	Low fat salad dressings	Ketchup, mayonnaise, hot, fatty and salty sauces.Excessive salt intake
Soups	Fish soup, vegetable soup, lean borsch	Borsch in broth	Fat soups	Milk products
Low fat yogurt, 2 eggs per week, cheeses (up to 30 % fat)	Cream, fatty cheeses, condensed milk, fatty yoghurt, sweet curd cheeses
Fish	Any varieties of white and low-fat fish (boiled, baked with vegetables) 9000 fried in vegetable oil, in batter; caviar, canned in oil	Fat fish, fried in animal fat, smoked
Seafood	Mussels, oysters, lobster		Shrimps sauces
Meat	Turkey, chicken (without skin!), veal, game	Lean beef, ham, veal or chicken sausage.Liver and fresh lard (no more than twice a month)	Duck, goose, pies with meat, pate, sausage, sausages, fatty meat, poultry skin
Fats	Butter in porridge, olive, grape oil in salad	Polyunsaturated oils: olive, corn, sunflower	Butter in large quantities, fried pork lard, fat, lard
desserts Fruit salad	Jelly prepared with low-fat milk; ice cream (no more than twice a week)	Diabetic ice cream, pudding, jam.”Diabetic” sweets, sweets based on fructose, sweeteners
Baking	Biscuit biscuits, like “Maria”, “Zoological”, rusks	Cheesecakes
Sweets	Dark chocolate (25-30 g)	Marzipan, oriental sweets, halva, nougat and
Nuts	Walnuts (2-3 pcs.per day)	Hazelnuts, peanuts, almonds, pistachios	Coconut, salted nuts, seeds
Drinks	Tea, mineral water, juice	Coffee drinks, packaged juices, dried fruit compote	Sweet soda. Chocolate drinks

What is prohibited in diabetes mellitus?

When composing a diet for diabetes, pay attention to even seemingly completely healthy food.There are foods containing carbohydrates that need to be counted (increase blood glucose):

1. Cereals (baked goods, starch, cereals, pasta).
2. Certain vegetables (potatoes; potato dishes such as mashed potatoes, fried and boiled potatoes, chips; large quantities of corn, carrots and beets).
3. Milk and fatty fermented milk products (yoghurt, kefir, yogurt, fermented baked milk, cream).
4. Products containing sugar (refined sugar, granulated sugar, honey, sweets).
5. Fruits, berries.

These foods increase blood glucose at different rates. In order not to ask the question later: “How to reduce blood sugar?” – you need to avoid them.

• Sugar in various forms, sugar-sweetened drinks, especially sweet soda, do this very quickly;
• fast – products made from wheat flour, without added protein and fat (rolls, crackers, corn flakes, toasts).
• Moderately the level of glucose in the blood increases when the patient takes combined (carbohydrates, proteins, fats) foods: potato stew, some other vegetables, meat with sauce, dessert (like a pudding), a sandwich with cheese or sausage, ice cream with cream …
• Slowly increase blood glucose from foods rich in fiber (vegetables) and / or fats. These are coarse bread with butter, salads, muesli.

Please note that absolutely you cannot eat for diabetes!

It is recommended to exclude alcohol, mayonnaise and ketchup, “diabetic foods” on fructose, dried fruits (raisins, figs, dried apricots, etc.) from the diet for type 1 and 2 diabetes mellitus.), sweet fruits (grapes, watermelon, banana, persimmon, clementine, etc.), sweet waters and fruit juices. The diet for diabetes in children should also exclude these foods.

Fruit – light carbohydrates, therefore, with diabetes only 200-300 grams per day are allowed: apple, kiwi, grapefruit, pomegranate, fresh seasonal berries (strawberries, raspberries, blueberries, gooseberries with a volume of 1 plastic cup, 150 grams per day) … It is advisable to use fruits and berries separately for a snack, and not as a dessert for the main course.

Vegetables contain fiber and have a fairly low glycemic index. Therefore, they should make up 50% of the total diet. For each main meal, it is allowed to eat up to 200 grams of vegetables (in the form of salads or stews, first courses). That is, a person with diabetes mellitus can consume up to 600 g of vegetables in different forms per day.

The therapeutic diet for diabetes is actually more like eating well. Patients with diabetes should observe it every day. Picnic on May Day or New Year’s Eve – no exception! Rational nutrition in diabetes should become a healthy habit, a way of life.

Sources:

1. https://care.diabetesjournals.org/
2. https://idf.org/
3. https://www.easd.org/
4. https: // www. ncbi.nlm.nih.gov/books/NBK279012/

Sugar Control ⋆ Prof. Dr. Alper Celik

For sugar sufferers, keeping blood sugar under control is vital. To keep your blood sugar levels under control, it is important to live a moderate lifestyle. It is also easier to control sugar with oral medications or insulin.These drugs are half of the treatment, while the other half is a moderate lifestyle, a healthy diet and regular exercise.

There is fear in society in the first place when it comes to diabetes. However, if certain rules are followed, diabetics will continue their lives with high health standards for the rest of their lives. Because the rules needed for diabetes patients to stabilize sugar control are actually rules that are necessary for many people to live healthy.However, these rules are becoming a little more binding and specific for diabetics. A healthy diet is imperative for diabetics to maintain their blood sugar levels at normal levels. Healthy patients will be protected from many of the chronic diseases and complications that rise in blood sugar. There are some golden rules for diabetics to keep their blood sugar in check. For example, these patients need to know what food they should eat, how much they should consume, and make it the standard of living.When they do this, patients will get rid of the psychology of diet and achieve a quality standard of living. If there are patients with overweight or obesity problems, the main goal should be to reduce body fat. At this point, it will be helpful to get help from a dietitian. In addition, the diet program should include foods that do not raise blood sugar levels. Surgery should also be among the options as an effective option for these patients.

Why does blood sugar rise?

In order to keep your blood sugar level under control, first of all, it is important to know why your blood sugar level is going up.The main problem that raises the level of sugar in the blood is that the hormone insulin, which should be insufficient in the body or not at all, or in some cases the existing insulin does not have the desired effect. The hormone that balances the blood sugar levels in the body is the hormone insulin. However, as you know, diabetic patients have problems with the secretion of the hormone insulin. Therefore, blood sugar levels rise. At this stage, this problem can be controlled with a regular and balanced diet.When it comes to diabetes, it’s not just what you need to eat that matters, but the amount of food you eat. In this regard, informational trainings are carried out in a wide range of medical institutions. It is very important that people with diabetes mellitus participate in these trainings. For example, the carbohydrate intake of diabetic patients is a very important issue. There can be no question of removing carbohydrates completely. However, if carbohydrate foods such as bread, pasta, rice, baked goods, fruits, sugar, and honey are taken above the specified level, blood sugar levels will be higher than normal.Through these trainings, the patient will know the amount of carbohydrates to be taken and what type of carbohydrates can be consumed, therefore, the standard of living will improve. The diet includes carbohydrates, as well as fats and proteins. Of course, quantity is also important. If you think you have difficulty adjusting and implementing these agreements in the first step, it will be helpful to get the help of a nutritionist. Regardless of the type of diabetes you have 1 or 2, your dietitian will receive comprehensive information about your treatment in the first step, and will prepare your nutrition program in the light of this information.A diet plan accompanied by a dietitian will keep your blood sugar at a normal level and help you lose weight.

Foods that increase blood sugar

Certain foods can lower or increase blood sugar levels quite quickly. We can give you an idea of ​​some of these foods that create blood sugar imbalances. For example, whole grain bread raises sugar levels much later and more slowly than white bread.You can think of cookies with the same logic. Whole grain biscuits have a significantly lower glycemic index than white flour biscuits. Therefore, it is a healthier food. If you need to choose from fruits, then grapefruit and apple are recommended for diabetics more than other fruits. In general, choosing whole grains is more beneficial for your blood sugar values ​​when choosing carbohydrates in general. Using bulgur instead of rice with the same logic is important to balance your values. However, applying this rule may get annoying at some point.It should be noted that this is a healthy choice. After balancing the portions, you can choose other options under the supervision of your doctor. Let’s not forget that quantity is key.

How is blood sugar checked and monitored in diabetes?

Early diagnosis during illness saves lives. Sugar control is also vital in diabetes. Therefore, you must measure your sugar regularly. Regular measurements are measurements taken daily, or even in some cases, several times a day.Your level of illness will be determined by the frequency of these measurements. It will be very difficult to constantly go to institutions such as hospitals, clinics and so on to take measurements frequently. Therefore, the most economical way to take these measurements is to do it yourself at home. For this, there are many insulin devices to help you. Insulin measurements should generally be taken in the morning on a fast, after lunch, dinner, and overnight meals. These measurements should be repeated not only when you feel any changes in your body, but also when everything is in order.Type 2 diabetics who cannot control their blood sugar and do not use insulin should repeat the measurements before breakfast in the morning on a fast and within 2 hours after eating. This method is the most common. It should be noted that each patient is different and the disease progresses differently, as determined by the doctors. You should prepare a measurement chart that is most suitable for you on the advice of your doctor.

Diet for type 2 diabetes

About 80% of patients with type 2 diabetes mellitus are overweight, which weakens the action of insulin (intrinsic and injected), significantly reduces the effectiveness of antihyperglycemic drugs and leads to an increase in blood sugar.Therefore, the primary task in this situation is to reduce weight (not to the full norm, but by 5-10% of the original) and maintain it at this level due to the continued adherence to the diet. Therefore, “the best diet is one that the patient can follow throughout his life.”

This diet should be tasty, varied, not hungry, but contain fewer calories than the patient previously consumed. This is absolutely realistic if you use the principle of food replacement: for example, replacing sausages (they are more high-calorie) with an equal amount of boiled meat (or butter on a sandwich – for a cucumber or a slice of tomato) leads to the fact that the feeling of hunger is satisfied with fewer calories.

Food planning (type 2 diabetes mellitus with overweight)

Group 1. These foods should be excluded from the diet

a). Strongly increase blood sugar :

Sugar, honey, dried fruits, fruit juices, confectionery, sweets, preserves, lemonades (“Fanta”, “Pepsi”, etc.), natural kvass.

Semolina porridge, mashed potatoes, heavily boiled porridge

b). Contains a lot of calories:

Butter, vegetable oil (especially in salads, vinaigrettes and when heating food), sour cream, mayonnaise, butter substitutes (Rama, etc.)etc.),

lard, sausages and wieners, sausages and pates, smoked meats, fatty meat, fatty fish, meat offal (liver, chicken), chicken legs, poultry skin,

fatty (“yellow” and processed) cheeses, cream, fat cottage cheese,

nuts and seeds, pies and pies

Group 2. Reduce consumption by half

Bread (black or white), cereals (rice, buckwheat, oatmeal, etc.),

potatoes, pasta products, corn and soy products,

crackers, dryers (unsweetened), etc.p.

Fruit: distribute during the day, but not more than 3 “equal to an apple” per day

“Diabetic” sweets, waffles, etc.: in the form of an “infrequent delicacy” (once a week)

Allowed in moderation: lean meat, fish, cottage cheese

Group 3. Increase consumption

Vegetables (but without added fat) in the form of vegetable side dishes : cabbage, cauliflower, carrots, beets, turnips, radishes, cucumbers, tomatoes, greens

Drinks without sugar (mineral water, tea) or with sugar substitutes (Bell, Diet Pepsi, Coca-Cola Light, etc.).

---

Sweeteners: natural preferable, such as stevia

Fructose undesirable (increases blood sugar)

---

The main reasons for fat loss failures are:

• There are many foods, 9000 so-called hidden fats). These are all sausages, sausages, wieners, nuts, seeds, cheeses with a fat content of> 15%, etc. With these products, you can get a lot of calories unnoticed.

• Fat is high in calories, so even a small amount of “extra” fat (for example, a teaspoon or tablespoon of vegetable oil in a salad) can negate all day weight loss efforts.

The need for fat in an adult is low. It is completely covered by meat, fish, cottage cheese, soups, etc. But dressing salads with fats (vegetable oil, sour cream, mayonnaise) is already “extra” fats.

Principles of nutrition for patients without excess weight

1. Avoid foods that sharply increase sugar levels (group 1a from the list above)
2. Do not eat large quantities of foods that moderately increase sugar (“slow carbohydrates” are plant foods from group 2 of this list)
3. Nutritional fraction: the daily amount of food should be divided not into 2-3 large meals, but into 5-6 small ones
4. Increased physical activity

Physical activity

• Individual selection, taking into account the patient’s age, the presence of complications and concomitant diseases .