Diabetes mellitus: symptoms, diagnosis, treatment.

Diabetes mellitus is a clinical syndrome of chronic hyperglycemia and glycosuria, caused by absolute or relative insulin deficiency, leading to metabolic disorders, vascular lesions (various angiopathies), neuropathy, and pathological changes in various organs and tissues.

Accurately assess the prevalence of diabetes mellitus (DM) is currently not possible, because in many countries there are no diabetological registries. However, diabetes mellitus is considered a "non-infectious epidemic", which has covered more than 150 million people in the world (by 2010, 220 million patients are predicted).

In the US, there are currently more than 16 million people with diabetes. Diabetes mellitus type 2, according to the most recent data, accounts for about 95%, and type 1 diabetes - only 5% of the total number of patients. The incidence of type 1 diabetes is highest in developed countries and ranges from 10: 100,000 (in Austria, Great Britain, France) to 30: 100,000 people per year (in Finland and on the island of Sardinia in Italy).

Type 1 diabetes

The principle of treating a patient with type 1 diabetes is exogenous administration of insulin, without which hyperglycemic, ketoacidotic coma develops. The goal of treating patients with type 1 diabetes is to achieve normoglycemia and to ensure the normal growth and development of the body, especially since the main contingent of these patients is children, adolescents and young people.

When a diagnosis of type 1 diabetes is established, insulin therapy, which is lifelong, should be started immediately. Timely initiated and well-planned insulin therapy allows in 75–90% of cases to achieve temporary remission ("honeymoon"), and in the future - to stabilize the course of the disease and delay the development of complications.

Insulin therapy for patients with type 1 diabetes is advisable to be carried out in the mode of multiple injections. There are different options for the mode of repeated injections of insulin, but the most acceptable are two of them:

The short-acting insulin (Actrapid, Humulin R, Insuman Rapid, etc.) before the main meals and the average duration of insulin action (Monotard, Protafan, Humulin NPH, Insuman Bazal, etc.) before breakfast and before bedtime.
Short-acting insulin (Actrapid, Humulin R, Insuman Rapid, etc.) before the main meals and the average duration of insulin action (Monotard, Protafan, Humulin NPH, Insuman Bazal, etc.) just before bedtime.

The daily dose of short-acting insulin is distributed as follows: 40% is administered before breakfast, 30% before dinner, and 30% before dinner. The total daily insulin dose is approximately 0.6–1.0 U / kg, where the ratio of the amount of short-acting insulin to the average duration of action is approximately 25% and 75%, respectively. Under fasting glucose control, the dose of insulin of average duration of action, administered at bedtime, should be adjusted, and the dose of insulin of average duration of action, administered before breakfast, should be adjusted according to the level of glycemia before lunch. The dose of short-acting insulin is adjusted under the control of postprandial glycemia.

Currently, in a number of countries in Western Europe, in the USA, Canada and Australia, a program of primary prevention of type 1 diabetes is underway. The purpose of such programs is to identify and treat people at the late stage of the preclinical period of type 1 diabetes. Scheme 1presents therapeutic measures aimed at achieving clinical remission or prevention of type 1 diabetes.

Since the diagnosis of type 1 diabetes mellitus, only human insulin should be prescribed to children and adolescents.

Type 2 diabetes

Despite the many publications and reports on the treatment of type 2 diabetes, in the vast majority of patient’s compensation of carbohydrate metabolism is not achieved, although their general well-being may remain good. This deceptive state can last for several years and later turn into a disability or even the death of a patient. The diabetic is not always aware of the importance of self-control and the study of glycemia is carried out from time to time, as a rule, after a feast. The illusion of relative well-being, based on a satisfactory state of health, delays the onset of drug therapy in many patients with type 2 diabetes. In addition, the presence of morning normoglycemia does not exclude a high level of glycated hemoglobin in such patients. This indicator is an objective criterion for assessing the degree of compensation for diabetes.

When prescribing treatment, it is necessary to take into account the way of life and the nature of the patient’s food, especially the course and severity of type 2 diabetes. The key to success in treating patients with type 2 diabetes is diabetes education. The physician needs to communicate more often with patients and to support them in their desire to fight the disease. It is necessary to motivate the patient to the need for weight loss, because even a moderate weight loss (5–10% of the initial weight) makes it possible to achieve a significant reduction in blood glucose, blood lipids and blood pressure. In some cases, the condition of patients improves so much that there is no need for antidiabetic agents.

In 90% of patients with type 2 diabetes, there is some degree of overweight, therefore, weight loss through low-calorie nutrition and well-designed physical activity is of paramount importance.

A low-calorie diet can be balanced and unbalanced. With a balanced low-calorie diet, the total caloric content of food decreases without changing its qualitative composition, in contrast to an unbalanced diet with a high carbohydrate content and a low-fat content. In the diet of patients should be foods high in fiber (grains, vegetables, fruits, wholemeal bread). In the diet, you can include fiber fiber - pectin or guar in the amount of 15 g / day. With the complexity of limiting fats in food, it is necessary to take orlistat, which prevents the splitting and absorption of 30% of the received fat and, according to some data, reduces insulin resistance. The result of monotherapy diet can be expected only with a decrease in weight by 10% or more from the initial, when insulin resistance is clearly reduced. This can be achieved by increasing physical activity along with a low-calorie balanced diet.

Physical activity is an addition to the main therapeutic measures and should be carried out taking into account the capabilities and condition of the patient. Daily exercise is mandatory, no matter how advanced the age of the patient. This increases the absorption of glucose by the muscles, the sensitivity of peripheral tissues to insulin, improves the blood supply to organs and tissues, which leads to a decrease in hypoxia - the inevitable companion of poorly compensated diabetes at any age, especially the elderly. The amount of exercise in the elderly, hypertensive patients and having a myocardial infarction in history should be determined by a doctor. If there are no other prescriptions, then you can limit yourself to a daily 30-minute walk (3 times for 10 minutes). When decompensated diabetes exercise is ineffective. With heavy physical exertion, hypoglycemic states may develop, therefore the doses of hypoglycemic drugs (and especially insulin) should be reduced by 20%.

If diet and exercise fail to achieve normoglycemia, you should resort to medical treatment for type 2 diabetes.

More than 60% of patients with type 2 diabetes are treated with oral hypoglycemic agents. For more than 40 years, sulfonylurea has remained the basis of oral hypoglycemic therapy for type 2 diabetes mellitus. The main mechanism of action of sulfonylurea drugs (Glyurene and others) is to stimulate the secretion of insulin. After oral administration, any sulfonylurea drug binds to a specific protein on the b-cell membrane of the pancreas and stimulates insulin secretion. In addition, some sulfonylurea drugs restore (increase) the sensitivity of b-cells to glucose. Sulfonylureadrugs are attributed to the action of increasing the sensitivity of fatty, muscular, hepatic and some other tissue cells to the action of insulin, enhancing glucose transport in skeletal muscle, enhancing the activity of certain liver enzymes, suppressing fat breakdown, etc.

For patients with type 2 diabetes mellitus with a well-preserved insulin secretion function, the combination of a sulfonylurea drug with a biguanide is effective. Interest in biguanide metformin has now increased dramatically. This is due to the peculiarities of the mechanism of action of this drug. It can be said that the main effect of metformin is an increase in the sensitivity of tissues to insulin, suppression of glucose production by the liver and, of course, reduction of fasting glucose, slowing down the absorption of glucose in the gastrointestinal tract. There are additional effects of this drug that have a positive effect on fat metabolism, blood clotting and blood pressure.

The expediency of using sulfonylurea preparations is beyond doubt, because the most important link in the pathogenesis of type 2 diabetes is a b-cell secretory defect. On the other hand, insulin resistance is an almost constant symptom of type 2 diabetes, which necessitates the use ofmetformin . Metformin in combination with sulfonylurea drugs is an effective form of therapy that has been used extensively by clinicians for many years and allows for a reduction in the dose of sulfonylurea drugs [5]. According to researchers [6], combination therapy with metformin andsulfonylurea drugs is as effective as combination therapy with insulin and sulfonylurea drugs or insulin monotherapy in patients with poor effect from previous therapy. Confirmation of the observations that the combination therapy with sulfonylurea and metformin has significant advantages over monotherapy, contributed to the creation of an officinal form of the drug, containing both components.

The arsenal of glucose - lowering drugs used in the treatment of type 2 diabetes mellitus is quite large and continues to grow. In addition to sulfonylurea and biguanide derivatives, this includes secretagens — amino acid derivatives, insulin sensitizers — thiazolidinediones, a- glucosidase inhibitors, and insulins.

Based on data from studies proving the important role of amino acids (in addition to glucose) in the process of insulin secretion by b-cells directly in the process of eating, the study of the glucose-lowering activity of phenylalanine and benzoic acid analogues, which resulted in the synthesis of nateglinide and repaglinide, was started.

Insulin secretion, stimulated by nateglinide and repaglinide, is close to the physiological early phase of hormone secretion in healthy individuals after a meal, which leads to an effective decrease in the "peaks" of the glucose concentration in the postprandial period. They have a quick and short-term effect on insulin secretion, due to which they prevent a sharp increase in blood glucose after eating. When you skip a meal, these drugs do not apply. Drugs do not interact with widespread drugs and do not accumulate in the body.

Another prandial regulator is acarbose. The effect of acarbose takes place in the upper part of the small intestine, where it reversibly blocks a- glucosidase (glucoamylase, sucrase, maltase) and thereby prevents the enzymatic cleavage of poly- and oligosaccharides. This prevents the absorption of monosaccharides (glucose) and reduces the sharp rise in blood sugar after a meal. Inhibition of a– glucosidase acarbose occurs according to the principle of competition for the active center of an enzyme located on the surface of the microvilli of the small intestine. Preventing the rise of glycemia after a meal, acarbose significantly reduces the level of insulin in the blood, which helps to improve the quality of metabolic compensation, as evidenced by a decrease in the level of glycated hemoglobin (HbA1c). The use of acarbose as the only oral antidiabetic agent is enough to cause a significant improvement in metabolic disorders in patients with type 2 diabetes who are not compensated by just one diet. In the same cases when such a tactic does not lead to the desired results, the prescription of acarbose with sulfonylurea drugs ( Glurenorm ) leads to a significant improvement in metabolic parameters. This is especially important for elderly patients who are not always ready to switch to insulin therapy. This combination significantly reduces the dose of sulfonylurea drugs. In patients with type 2 diabetes who received insulin therapy,acarbose improved metabolic compensation and increased the sensitivity of tissues to insulin by increasing the expression of Gluta 4 predominantly in muscle tissue. As a result, the daily insulin dose was reduced by an average of 10 units, while in patients receiving placebo, the insulin dose increased by 0.7 units. The advantage of acarbose is that with monotherapy it does not cause hypoglycemia. Some doctors are alerted by such a side effect of acarbose, as flatulence. It should be recalled that this side effect is inherent in the mechanism of action of acarbose, because unsplit carbohydrates in the distal intestine are fermented. From this it can be concluded that a restriction in the diet of carbohydrates will minimize this side effect. On the other hand, for most elderly patients with a tendency to constipation, this effect is positive, because it regulates the stool without additional intake of laxatives.

With unsuccessful therapy with oral medications, insulin therapy is undoubtedly an effective treatment. According to the American Diabetes Association (1995), after 15 years, insulin will be required for most patients with type 2 diabetes. However, a direct indication for mono-insulin therapy in type 2 diabetes mellitus is a progressive decrease in insulin secretion by pancreatic b-cells. Experience shows that approximately 40% of patients with type 2 diabetes mellitus need insulin therapy, but in fact this percentage is much lower, more often because of the resistance of patients. A false opinion took root that once prescribed insulin therapy is lifelong. The remaining 60% of patients who are not shown monoinsulin therapy, unfortunately, treatment with sulfonylurea also does not lead to compensation for diabetes. But it should be noted that none of the side effects that may accompany insulin therapy cause such serious concern as to justify the unjustified delay of insulin therapy in patients with unsuccessful therapy with pre- treated hypoglycemic drugs. At the same time, the presence of these side effects dictates us to search for ways to minimize the insulin dose while maintaining good glycemic control. According to WHO experts, "insulin therapy for type 2 diabetes should begin "not too early and not too late. " Analyzing the situation, we concluded that in the vast majority of patients’ monotherapy with sulfonylureaderivatives does not lead to the achievement of compensation for diabetes mellitus. If even during daylight it is possible to reduce glycemia, then practically everyone retains morning hyperglycemia, which is caused by the night production of glucose by the liver.

The use of insulin in this group of patients leads to an increase in body weight, which aggravates insulin resistance and increases the need for exogenous insulin, in addition, the inconvenience caused to the patient by frequent dosing of insulin and several injections per day should be taken into account. Excess insulin in the body is also of concern to endocrinologists, because it is associated with the development and progression of atherosclerosis, arterial hypertension, etc. There are at least 2 ways to limit insulin doses in patients who are not compensated for only one therapy with sulfonylureas, which constitute the strategy for the combined treatment of type 2 diabetes:

The combination of the drug sulfonylurea with insulin prolonged action (especially at night).
The combination of the sulfonylurea drug with metformin.

Combined therapy with sulfonylurea and insulin has significant advantages, and it is based on complementary mechanisms of action of both drugs. A high level of glucose in the blood has a "toxic" effect on b-cells, and therefore insulin secretion is reduced, and insulin administration by reducing glycemia can restore the pancreas response to sulfonylurea. Insulin inhibits the formation of glucose in the liver at night, which leads to a decrease in fasting glycemia, and sulfonylurea causes an increase in insulin secretion after a meal, thereby controlling the level of glycemia during the day. In a number of studies, comparisons were made between two groups of patients with type 2 diabetes mellitus, of which one group received only insulin therapy, and the other group combined insulin therapy for the night with sulfonylurea. It turned out that after 3 and 6 months, glycemic indicators, glycated hemoglobin decreased significantly in both groups, but the average daily insulin dose in the group of patients receiving the combined treatment was 14 units, and in the mono-insulin group - 57 items per day. The dose of drugs must be selected individually. According to I.Yu. Demidova, the average daily dose of prolonged insulin at bedtime to suppress the nightly production of glucose by the liver is usually 0.16 U / kg / day. Such a combination showed an improvement in glycemic control, a significant decrease in the daily insulin dose and, accordingly, a decrease in the insulin level in the blood. Patients noted the convenience of such therapy and expressed a desire to more accurately comply with the prescribed regimen.

Complications of diabetes

The risk of developing late complications increases with the duration of diabetes. Metabolic disorders in diabetes leads to the defeat of all organs and systems to one degree or another. In diabetes, both micro– and macroangiopathies develop. In patients with type 2 diabetes, makroangiopatii more often develop, although in parallel with them there is a lesion and small vessels (microangiopathy). Clinical manifestations of microangiopathy - retinopathy, nephropathy, neuropathy. Typical manifestations of diabetic macroangiopathy are myocardial infarction, stroke, peripheral vascular disease. The earliest manifestation of late diabetic complications in patients with type 2 diabetes are signs of neuropathy, the most common form of which is polyneuropathy. Distal polyneuropathy is a typical diabetic lesion of peripheral nerves. Patients are worried about tingling, numbness, chilliness of the feet or a burning sensation, pain in the extremities. For several years, these complaints have been noted mainly in a state of rest, interfering with night sleep, and subsequently become permanent and intense. Already in the debut of the disease, it is often possible to identify these or other sensitivity disorders: a decrease in reflexes, movement disorders. Most often there is a decrease in reflexes in the lower extremities (Achilles, knees) than in the upper ones. Patients decrease pain, temperature,vibration sensitivity, motor disturbances occur.

The risk of developing late complications increases with the duration of diabetes. Metabolic disorders in diabetes leads to the defeat of all organs and systems to one degree or another. With diabetes develop both. In patients with type 2 diabetes, makroangiopatii more often develop, although in parallel with them there is a lesion and small vessels (microangiopathy). Clinical manifestations of microangiopathy - retinopathy, nephropathy, neuropathy. Typical manifestations of diabetic macroangiopathy are myocardial infarction, stroke, and peripheral vascular diseases. The earliest manifestation of late diabetic complications in patients with type 2 diabetes are signs of neuropathy, the most common form of which is. Distal polyneuropathy is a typical diabetic lesion of peripheral nerves. Patients are worried about tingling, numbness, chilliness of the feet or a burning sensation, pain in the extremities. For several years, these complaints have been noted mainly in a state of rest, interfering with night sleep, and subsequently become permanent and intense. Already in the debut of the disease, it is often possible to identify these or other sensitivity disorders: a decrease in reflexes, movement disorders. Most often there is a decrease in reflexes in the lower extremities (Achilles, knees) than in the upper ones. Patients decrease pain, temperature, vibration sensitivity, motor disturbances occur.

In diabetic polyneuropathy, the effectiveness of a- lipoic acid preparations ( Thiogamma ) has been proven . Based on the studies of ALADIN, DEKAN, it was shown that the use of a- lipoic acid was accompanied by a decrease in the manifestations of neurological disorders without a significant effect on the symptoms associated with neuropathy. With the advent of the fat-soluble form of vitamin B1 - benfotiamine, it is possible to speak about a certain progress in the use of preparations of the B vitamins in the treatment of diabetic neuropathy. The combination of benfotiamine and vitamin B6 - Milgamma (dragee) is especially effective. The use of Milgamma according to the scheme 1 pills 3 p / day for 4–6 weeks leads to a significant reduction in the intensity of pain and improvement in vibration sensitivity thresholds.

A number of double-blind, placebo-controlled studies confirmed Actovegin 's high efficacy in the treatment of diabetic polyneuropathy. The use of Actovegin in doses of 400 mg 3 times a day orally and 250 ml of a 20% solution of Actovegin intravenously leads to an improvement in energy metabolism and blood supply in the peripheral nervous system, which is manifested by an increase in JI, duration of painless walking, improved sensitivity and general well-being of patients.

In addition to peripheral, autonomic neuropathy is also developing. For example, when the cardiovascular form of autonomic neuropathy is characterized by a sudden decrease in blood pressure, painless myocardial infarction, palpitations and even sudden death, for the gastrointestinal form - abdominal distension, paresis of the gallbladder, diarrhea, dysfunction of the esophagus, constipation, and in some cases incontinence feces, with urinogenital form, there is a delay in urination (due to atony of the bladder) and impaired sexual function. Autonomic neuropathy is also characterized by asymptomatic hypoglycemia and impaired sweating (sweating of the face and upper half of the body while eating).

It should be noted that the cause of all complications of diabetes mellitus is an uncontrolled for a long-time hyperglycemia. For their prevention, it is necessary to regularly examine the level of glucose in the blood and keep it within the normal range.

Along with the glycemic level, it is necessary to control and not to increase the cholesterol level more than 5.2 mmol / l, triglycerides more than 2.0 mmol / l, HbA1c more than 7.0% and blood pressure more than 130/85 mm Hg.

Thus, the best means of prevention and treatment of late vascular complications of diabetes mellitus is a stable compensation of carbohydrate metabolism with the achievement of normoglycemia. In cases where certain violations are detected that lead to a decrease in the patient's quality of life, it is recommended to resort to specific therapy for complications along with antidiabetic drugs Diabetic nephropathy is a terrible complication of diabetes mellitus that develops in 20-25% of both types of patients. Usually, 15–20 years after the onset of the disease, 40% of patients develop end-stage renal failure. The mechanism of development of diabetic nephropathy is well described in numerous manuals and textbooks.

How to treat diabetes?

The goal of any diabetes treatment plan is to control blood sugar levels and prevent health problems or complications. However, each person has their own individual needs, so you need your own special diabetes treatment plan1.

Joint efforts

Experts recommend a team approach to treating diabetes. And you are the most important member of this team, since it is you who are susceptible to this disease and are struggling with it every day.

You can also involve your family or close friends who will help you with the planning and preparation of food, will do physical exercises with you, go to the doctor with you, or just listen to you. You can also try to find a diabetic support group nearby.

Your diabetes care team

Now let's talk about who can join your team. The composition of your team will depend on a number of factors. Plus, you may need the help of specialists. Treatment will also depend on the capabilities of your health care system.

Specialists who can join your diabetes care team:

Primary care physician (therapist): A physician who you can contact for general examinations or when you are sick.

Endocrinologist: A doctor with specialized training in the field of hormonal diseases such as diabetes.

Diabetes care consultant: a nurse who has special training and experience in the care and education of people with diabetes and their family members.

Nutritionist: A nutritionally trained specialist who can help you choose healthy foods based on your nutritional needs, weight, lifestyle, medications, and other goals you want to achieve in relation to your health.

Ophthalmologist: A doctor who specializes in diseases of the eye, including eye diseases associated with diabetes, and who is trained to recognize their presence.

Social Worker / Psychologist / Psychiatrist / Psychotherapist: A mental health specialist who can help you with the personal and emotional aspects of life and the problems that arise in diabetes.

Pediatrician: A doctor specializing in the treatment of feet and other problems of the lower extremities.

Dentist: a doctor who treats your teeth and gums.

Physical Therapist for Physical Exercise: A medical professional trained in the science of exercise that can help you effectively incorporate exercise into your diabetes treatment plan.

Certified Diabetes Consultant (CDE): Certified counselors may be nurses, nutritionists, doctors, pharmacists, pediatricians, counselors, or other health care professionals who have special training in diabetes.

How can you manage diabetes?

The main objectives of diabetes management are:

careful monitoring of blood glucose levels to reduce the risk of side effects of low and high blood glucose levels
preventing or slowing the onset of diabetes-related health problems.

5 tips to help you manage your diabetes effectively:

Check your blood glucose levels as recommended by your doctor.
Take your medications as prescribed by your doctor, be it pills or injectables such as insulin.
Go to a healthy diet.
Include regular exercise recommended by your medical professional in your plan.
Learn as much as you can about diabetes and how to manage it.

Blood Glucose Measurement

Measuring blood glucose, also known as Self-monitoring of blood glucose, is a method of checking how much glucose (sugar) is in human blood, using a glucometer anytime and anywhere. Your doctor may also find out your glucose level by taking a blood sample that is being tested in a laboratory.

Normal glucose values for men and non-pregnant women

Before meals 4.4–7.2 mmol / l

After eating 10.0 mmol / l

Your doctor uses the so-called HbA1c test (glycated hemoglobin test), which allows you to estimate the average level of blood glucose over the past 3 months. This analysis, used for all types of diabetes, shows you and your doctor how well you respond to your treatment regimen. The recommended goal is to keep the level below seven percent (7%), but your doctor will discuss with your which goal is right for you. Analysis of HbA1c analysis sometimes called hemoglobin HbA1c, or glycated hemoglobin.

The importance of self-checking

The result of HbA1c analysis will not show the daily impact of food choices and physical activity on blood glucose levels. That is why the blood glucose meter is one of the best solutions for regularly monitoring fluctuations in blood glucose levels depending on diet, physical activity and other changes. Using a glucometer allows you to take immediate action to bring the level of glucose to the levels recommended by your doctor. Your doctor may also rely on measurements taken with a blood glucose meter, in addition to the results of the HbA1c analysis, to evaluate and adjust the treatment plan.

Medication for diabetes

It is very important to take the medication according to your doctor’s prescription, including the time and method of administration.

When taking medication for diabetes is important:

Know which drug you are taking and understand its mechanism of action.

Ask the doctor about potential side effects of the drug. They are also listed on the package leaflet in the product packaging.

Immediately inform your doctor if you have any reaction to the medicine.

Insulin - what is insulin?

Insulin is a hormone produced by the pancreas. It is needed to transfer glucose (sugar) from the bloodstream to the cells of the body, where it is used for energy.

Why you may need to take insulin?

If you have type 1 diabetes, your pancreas does not produce insulin. For this reason, you should always administer your insulin. This is the only way to control your diabetes.

If you have type 2 diabetes, you may also be given insulin when your blood glucose level remains high despite the fact that you take the pills as prescribed by a doctor. However, other ways to control blood glucose levels do not give the desired results. Starting insulin does not mean that you have not managed to control diabetes. Type 2 diabetes tends to change over time, and therefore you may need to change your treatment regimen.

Understanding how food affects blood sugar levels

Food has a direct effect on blood glucose levels. Some foods increase blood glucose levels more than others. To successfully manage your diabetes, you need to know what foods and how much you can eat, and follow a nutritional plan that fits your lifestyle and helps you control your blood glucose. Foods contain 3 main types of nutrients: carbohydrates, proteins and fats.

Carbohydrates

Carbohydrates are starches, sugar, and fiber in foods such as grains, fruits, vegetables, dairy products, and sweets. They increase the level of glucose in the blood faster and more than other nutrients contained in food - proteins and fats. Knowing which foods have carbohydrates and how many carbohydrates are in food is helpful in controlling glucose levels in the blood. Carbohydrates from sources such as vegetables, fruits, and wholemeal groats (rich in fiber) are preferable to carbohydrates from sources with added sugars, fat, and salt.

Squirrels

Proteins are an integral part of a balanced diet and relieve you of hunger. Unlike carbohydrates, they do not increase the level of glucose in the blood. However, in order to avoid gaining weight, it is necessary to control the size of portions of foods containing proteins. In people with type 2 diabetes, protein makes insulin work faster, so you should not try to cope with low blood glucose levels with protein shakes and blends. Using 15 grams of fast-acting carbohydrates containing glucose, such as juice, other sugar-containing beverages, glucose gel or tablets, is the preferred treatment for low blood sugar.

Fat

Fats are an integral part of a balanced diet. Especially useful are fats that are found in fatty fish, nuts, and seeds. They do not increase blood glucose levels, but contain a large number of calories and can cause weight gain.

Aim to include all 3 types of nutrients in your meals to balance your diet.

Choice of healthy food

Your nutritionist or diabetes counselor can help you develop a nutrition plan that suits you and fits into your lifestyle.

Some recommendations for a healthy diet:

A healthy diet for a person with diabetes is a healthy diet for the whole family.
Enjoy food by eating regularly healthy meals with appropriate portion sizes. Your doctor can help you learn how to choose healthy foods and the correct serving sizes.
Eat a variety of foods rich in nutrients, for each prieme food, including healthy fats, lean meat or proteins, whole grains and low-fat dairy products in suitable amounts.
Choose fiber-rich foods as often as possible, such as fruits, vegetables, and whole grains (bran, whole-wheat pasta, brown rice).
Try replacing meat with lentils, beans or tofu.
Drink low-calorie drinks, such as tea or coffee without sugar, and water.
Enter into the diet sweeteners.
Choose foods with a lower salt content.

The possibility of a visual assessment of the serving size is in your hands

Choose food and its amount depending on your blood glucose level. If you eat more than you need, your blood glucose level will increase. For successful diabetes management, it is very important to be able to correctly determine the size of the portions. Fortunately, the tool for this is always at your fingertips - these are your palms.

How to choose useful products

Before going to the store:

Plan your meals for a certain period of time (for example, from several days to a week) and include various foods that contain all kinds of nutrients in the diet.
Make a list of foods based on your meal plan.

In the shop:

Take a list with you and stick to it.
Do not go shopping when you are hungry, as this often leads to the choice of less healthy food.
Choose products that are on the perimeter (outer edges) of the store. For example, in those sections where "real food" is sold, and not canned.
Do not buy sweet drinks, sweets and chips.
Check food labels to make the right choice.

Keep an active lifestyle

Physical activity is an important part of your diabetes management plan. It includes all movements that increase energy consumption, increase heart rate and respiration, raising them above the level of physical rest. A reasonable exercise time is at least 10 minutes at a time and about 30 minutes or more per day during most days of the week. Physical activity may include walking, cleaning the house, dancing or special exercises. Physical activity can help you improve blood glucose control, manage weight, reduce the risk of heart disease and improve overall well-being.

Exercise precautions for physical exercise:

If you have been inactive for a certain time, talk with your doctor before you begin an exercise program.
Start with small loads and gradually increase the exercise time as they are tolerated.
Check your blood glucose before exercise. You may need to eat some carbohydrate-containing foods before you start exercising, especially if you take insulin, and your blood glucose is less than 5.6 mmol / L.
Carry your glucose tablets or other fast-acting carbohydrates (sweetened beverage, skimmed milk, sweets) in case your blood glucose levels fall during exercise. Wear suitable shoes: sneakers or other comfortable shoes.

Start with warm-up exercises and finish them gradually

Check your feet for injuries, ulcers or corns before and after exercise, and limit exercise as needed.

Drink plenty of water before, on time and after exercise.

Overcoming barriers

Here are some tips to help you deal with some of the barriers that prevent you from being more physically active:

Set realistic goals. Do not compare yourself with other people

Be prepared to try different types of physical activity. Set yourself new challenges as you improve.

See your doctor if you have any other medical conditions besides diabetes or physical limitations.

Set aside time for the exercises and make them part of your daily routine.

Find a partner with whom you can do exercises together. This will help improve your motivation.

Find a place to exercise, where it is most convenient, or close to home.

If you are not able to go to the gym, purchase cheap home equipment, such as an expander, a mat, some dumbbells and exercise videos, or perform exercises using your own body weight.

Remember the long periods of inactivity during the day: if you sit for a long time, take breaks every 30 minutes to stand and / or walk a bit, if possible.

Set yourself new challenges as you feel better.