Healthy food is important for any person.If the diagnosis is “type 2 diabetes”, then the diet will have to pay maximum attention.Now you need to keep an eye on what you eat and how much.The main goals are weight and sugar control.Now, prohibited foods in type 2 diabetes are not supposed to appear on your table.What does it concern?
- Features of type 2 diabetes and the importance of healthy nutrition
- Food recommended to diabetics
- What foods are prohibited for use in type 2 diabetes
- How to prepare meals
- How to manage food
Features of diabetes2 types and importance of healthy nutrition
Type 2 disease is also called insulin-independent.In this case, the body does not need insulin injections.According to statistics, the number of people suffering from this type of disease is 4 times higher than the number of patients with type 1 diabetes.
In patients with type 2 pancreas still produces insulin.However, it is either not enough for full-fledged work, or the body loses its ability
to recognize and use it correctly.As a result of such problems, glucose does not enter the tissue cells.Instead, it accumulates directly in the blood of a person.Normal functioning of the body is disturbed.
Why does it sometimes happen that a person develops this disease?This question is difficult to give an unambiguous answer.Often, type 2 diabetes is diagnosed in several members of the same family.That is, there is a hereditary aspect.
If there are any cases of illness in your family, it is better to take preventive measures in advance.It is worth talking about with an endocrinologist.Periodically hand over the necessary tests to timely identify the problem.Also, the likelihood of disease increases with age.The risk gradually increases to 45 years, reaching a maximum after 65.
The following factors repeatedly increase the likelihood of developing type 2 diabetes mellitus:
- overweight, obesity
- frequent consumption of fatty food
- systematic drinking of alcohol
- sedentary imageLife
- elevated blood levels of triglycerides( ie fats)
Problems with weight and pressure are often the result of malnutrition and the abuse of high-calorieAnd products.Sedentary work and lack of physical activity lead to a slowdown and a disturbance in metabolism.All this does not have the best effect on the work and condition of the body.
As a result of negligent attitude to the diet, a person can get a lot of problems, including the development of diabetes.Choose healthy, natural products and give up harmful preferably in advance for preventive purposes.
Food recommended to diabetics
In diabetics, you need to choose foods in a certain way.Food should slow down the absorption of carbohydrates to prevent an increase in blood glucose levels.Selection of the menu is quite strict, because the further course of the disease depends on it.
If a person has type 2 diabetes, the list of prohibited foods will be quite impressive.However, without this, you can get a full-fledged diet rich in all the necessary vitamins and microelements.
The following food is recommended for use:
The most useful is the use in raw form.However, you can cook with the help of stewing, cooking or baking.We welcome the use of those vegetables that are able to slow the absorption of carbohydrates.These include: cabbage( raw, stewed, pickled), eggplants( stewed or boiled), sweet peppers, tomatoes, cucumbers, greens, onions and garlic.An excellent choice is eggplant caviar.Tasty and healthy.
Boiled carrots and beets are eaten in extremely limited quantities.In this form, these vegetables raise sugar very quickly.But raw carrots will do more for the benefit, but only in a minimal amount.
Of course, meat should be present in the diet of diabetics.Preference should be given to lean beef and chicken breast.Meat can easily be replaced with mushrooms.This product is also recommended for type 2 diabetes.Choose low-fat fish.
Bread can and should be included in the menu.Just choose rye or wheat-rye( wheat flour should be 1 or 2 varieties).
Cereals and pulses
Cereals are a source of vitamins and fiber.The daily portion is 8-10 tbsp.Spoons.You can buckwheat, pearl barley, oats, millet.Beans, lentils and peas are consumed in a boiled form and more restricted.The sides are followed by wheat and rice.
Dairy products, eggs
Ideal – low-fat dairy products, cottage cheese, milk.In small amounts of cheese( fat content up to 30%).For breakfast, a steam omelet or hard-boiled eggs is suitable.
It’s worth to be careful with fruits, many of them are pretty sweet.Eat grapefruits, lemons, cranberries.In small quantities – cherry, apples, tangerines, plums.
Best drinks: compotes without sugar, green tea, tomato juice, mineral water.Occasionally you can pamper yourself with black natural coffee.
The first dish is vegetable soups.Salads are seasoned with lemon juice or a small amount of olive oil.You can eat nuts a little bit.
The diabetics menu should consist mainly of low-calorie products.Food is prepared in a certain way.The best solution is steaming.You can use special sweeteners and sweeteners.They are natural and artificial.However, they do not need to overdo it.
What foods are prohibited for use in type 2 diabetes
If a person has pancreatic diseases( such as treating diabetes), you need to know clearly what you can not eat.Unsuitable food exacerbates the situation, provokes a jump in glucose levels.
Products prohibited for type 2 diabetes are the following.
Of course, the first thing on the “black” list is sugar and products containing it in excess.Should forget about: jam, marmalade, chocolate, ice cream, candy, halva, caramel, jam and other similar sweets.Not recommended and the addition of honey.
Glucose from these products instantly penetrates into the blood.If you really want a sweet, it is better to eat some fruit, baking from wholemeal flour or nuts.
Under the ban of baked bread products – white bread, loaf, rolls, biscuits, muffins, fast food items.
Fatty dishes are slower to digest than carbohydrates.But they are also able to significantly raise the blood sugar level to high marks.In addition, fatty foods contribute to weight gain and obesity.
Refuse should be from: sour cream, cream, mayonnaise, lard, fatty meat( lamb, pork, ducklings).Also exclude fatty cheeses, cottage cheese and sweet yogurt.Do not prepare soups for fatty meat and fish broths.
Semi-finished products in addition to a large amount of fat have a lot of harmful flavor enhancers, flavors and stabilizers.So do not look aside sausages, sausages, wieners, ready-made industrial patties and fish sticks.
Food saturated with trans fats will not benefit either diabetics or healthy people.These foods include: margarine, spreads( butter substitutes), confectionary fat, popcorn, French fries, burgers, hot dogs.
Unfortunately, with diabetes, many fruits and dried fruits are not recommended.Most of them have an impressive amount of fast carbohydrates.Do not include in the diet of bananas, grapes, melon, persimmons, raisins, figs, dates, dried apricots.
Do not eat some vegetables.It is better to refuse or to minimize the consumption of potatoes, beets and carrots.
Some drinks contain a huge amount of sugar and calories.This applies to sweet juices( especially packaged), alcoholic cocktails and soda.Tea should not be sweetened, or resort to the help of sugar substitutes.Juices are better to drink vegetable.Not recommended for use and beer.
Do not add spices and spices, pork, goose or chicken fat when cooking.You will also have to give up semolina and pasta.Do not use sharp or salty sauces.Marinades and pickles are forbidden.Do not be tempted to absorb pancakes, dumplings, pies or dumplings.
Food has a huge impact on people suffering from type 2 diabetes.Moreover, the fact of an increase in glucose in the blood, as consequences, is not so terrible.And these are strokes, heart attacks, vision loss, nervous system disorders.
Tips for preparing dishes
It is important for diabetics to monitor not only the amount of sugar consumed, but also the fat content of the dishes.It is necessary to strictly control your weight and not allow it to be typed.Caloric content of food is largely determined by the method of heat treatment.
Of course, with type 2 diabetes it is worth forgetting about frying in a lot of oil.Also it is worth remembering about portions, not making them too bulky.
Follow the following cooking rules:
- It should be noted that even for cooking vegetables are taken fresh.Do not take frozen and especially canned foods.
- Soups should be cooked on the second broth.After boiling, the first one must be drained and poured again with water.
- The best meat for soup is lean beef.You can boil the broth on the bones.
- Rassolniki, borscht or bean soup are included in the menu no more than once a week.
- In order for the dish to have a more attractive taste, the vegetables are pre-lightly fried in a small amount of butter.
The most useful for diabetics are fresh salads from raw vegetables.This is the most preferred method of preparation.Further on the usefulness is cooking in water and steam.Baking is done after cooking or as an independent method of processing.The least likely to resort to extinguishing.
Nutritionists have the following recommendations for organizing healthy eating for patients with type 2 diabetes:
- During the observance of therapeutic diets, fractional meals are shown.Do not become an exception eating diabetics.The daily ration is better divided into five parts.In this case, the portions should be small.
- Nutritionists are advised to always start a meal with a portion of fresh vegetable salad.This method will help slow the absorption of carbohydrates.
- Despite the low caloric content of meals, the total number of calories per day should be 2000-3000 kcal, provided that physical activity is observed.
- It is necessary to monitor the weight, trying to reduce it with excess.
- Be sure to use slow carbohydrates.Their sources are beans, cereals and leafy vegetables.
- It is necessary to distribute the food load correctly.The maximum amount of carbohydrate meal should be eaten for breakfast.The least calories will be the last meal of the day.
- Have to give up alcohol.In fact, they have a high caloric value and fuels appetite.
To prevent complications of the disease, you can drink broths of some herbs: St. John’s wort, chicory, flaxseed, nettle, blueberry, ginseng.Chicory is a perfect substitute for coffee.These plants do not lead to a breakdown in metabolism, and you can drink them instead of tea.They perfectly tone up the body and normalize the work of the nervous system.
Proper diabetic nutrition should become not just a temporary diet, but a way of life.Only in this case it is possible to count on an effective fight against the disease.In addition to properly selected products, it is worthwhile to monitor the amount of servings and total calorie content.Also an important aspect of treatment is weight loss and exercise.The combination of all elements gives the best result.
Type 2 diabetes mellitus imposes significant restrictions on the diet.In the case of this disease, health and well-being depend directly on proper nutrition.You should be aware of what products are prohibited to eat.
If the rules of eating and eating harmful foods are not respected, the course of the disease can be significantly complicated.It is better to compile an individual diet program with your doctor.
About that.What should be a diet for a diabetic patient – on the video:
Type 1 diabetes mellitus arises as a resultFailure of the pancreas. With the indicated endocrine disease, the production of the hormone insulin, which controls the level of glucose, ceases. Insulin is produced when there is a lot of sugar in the blood. In type 1 diabetes, the hormone is not secreted, and the patient’s immune system destroys the cells that must produce insulin.
Causes of type 1 diabetes mellitus
Type 1 diabetes mellitus (as it is customarily called inMedical environment, insulin-dependent diabetes), can occur at any age, but usually endocrine disruption is manifested in young people. Although the exact causes of the development of pathology are not known, it is still established that often type 1 diabetes mellitus occurs in individuals whose parents also suffered from this disease or had type 2 diabetes.
Factors provoking the development of endocrine disease are:
- Severe or prolonged stress conditions;
- Infectious diseases;
- Some types of intoxication of the body (it is known that pancreatic cells destroy rat poison);
- Reception of the antibiotic Streptozocin used in the treatment of pancreatic cancer.
Symptoms of type 1 diabetes mellitus
Type 1 diabetes mellitus is acute, and, in the absence of treatment, the patient’s general condition deteriorates noticeably. The signs of insulin-dependent diabetes are:
- Unreasonable thirst;
- Frequent urination;
- Constant feeling of hunger;
- High fatigue, general weakness;
- Weight change;
- Decreased vision;
- Long unhealed wounds from microtraumas;
- In women – menstruation disorders, in men – erectile dysfunction.
When you pass urine and blood for analysis, they find an increased level of sugar.
Treatment of type 1 diabetes mellitus
In the absence of therapy, type 1 diabetes mellitus is fraught with serious complications: nerves, kidneys, heart, eyes, etc. are affected. A high level of sugar can cause:
- Diabetic ketoacidosis, hyperosmolar coma;
- Diabetic nephropathy (renal failure);
- Diabetic encephalopathy (symptoms of central nervous system intoxication);
- Heart attack, stroke;
The disease can even lead to death.
Patients with type 1 diabetes require insulin therapy to maintain the proper level of sugar and normalize metabolic processes.
Diet for type 1 diabetes mellitus
One of the conditions for maintaining the body’s functions isThe relative norm in diabetes is the organization of proper nutrition. There are a number of products, the use of which is prohibited, among them:
- Sweets and pastries;
- Sweet juices, carbonated drinks;
- Fatty meat, fish, cottage cheese, yoghurt;
- Some fruits, incl. Bananas, grapes, raisins, dates;
The patient’s diet is determined by the doctor individually, taking into account the state of the patient’s body. Daily diabetics should consume:
- Raw, boiled and stewed vegetables;
- Low-fat dairy products, meat, fish;
- Porridge, cooked on water or not whole milk (except semolina);
- vegetable oil;
- Unsweetened fruits;
- green tea;
- In small quantities of bread, preferably bran or rye.
Prevention of diabetes mellitus
Like many diseases, diabetes is easier to prevent, than in consequence to treat throughout life. The system of prevention of type 1 diabetes mellitus includes:
- Adherence to a healthy diet;
- Maintaining a physically active lifestyle;
- Fighting stressful conditions;
- Prevention of infectious diseases.
If there are cases of diabetes in blood relatives, you need to monitor the weight and control the sugar level.
Type 1 diabetes typically presents in childhood or early adult life. It can be distinguished from type 2 diabetes by the presence of immune and genetic markers of immune-mediated disease, and delayed diagnosis may result in diabetic ketoacidosis. Immunological changes appear many years before the clinical onset of diabetes, and the condition may respond to immunological intervention in its early stages. The incidence of type 1 diabetes is increasing rapidly worldwide, although it is most common in people of European descent. It is characterised by loss of most (but not necessarily all) of the insulin-secreting beta cells in the pancreas, and therefore requires insulin treatment. The risk of late complications of diabetes increases with cumulative exposure to elevated blood glucose levels, and treatment that returns circulating glucose to near-normal levels protects against these long-term complications. Prospects for future therapy include early prevention, islet or stem cell transplantation, regeneration of surviving beta cells and gene therapy.
The classic childhood form of type 1 diabetes affects 1 in 250–350 people in western countries by the age of 20 years. Presentation is typically acute in children, with a history of thirst, polyuria and weight loss extending over several weeks; a proportion (now well below 25% in most countries) will present with diabetic ketoacidosis. Occasional deaths still occur when diagnosis has been delayed, particularly in the very young.
Clinical presentation in adults is typically less acute, presentation with ketoacidosis is unusual, and the distinction between immune-mediated and non-immune-mediated diabetes may become blurred.
Replacement therapy with insulin sustains many millions of people but fails to restore normal glucose homeostasis. It therefore reduces but does not abolish the risk of late microvascular and macrovascular complications of diabetes. There has been steady improvement in the prognosis of childhood onset type 1 diabetes over recent decades, but results from specialised centres merely emphasise the extent of our failure elsewhere.
The benefits of optimised therapy have yet to reach the majority of affected children worldwide, and as a result some 20–30% will still die of or with diabetic nephropathy, and 50% will develop visual problems or require laser therapy to protect their vision.
Type 1 diabetes may present at any age, but most commonly does so between the age of 5 years and puberty. The diagnosis is suggested by onset in childhood or early adult life, slim build, acute or rapid onset with an early requirement for insulin, and presentation in diabetic ketoacidosis or with ketonuria.
Circulating autoantibodies directed against islet constituents are present in 90–95% of cases, and more than 80% of young patients carry HLA-DR3 and/or -DR4. The diagnosis is not always clear cut, and difficulties may arise in adolescents and young adults with features of type 1 diabetes in association with characteristics of type 2 diabetes such as obesity and insulin resistance; this has been referred to as ‘double diabetes’.
Older people tend to progress more slowly to dependence on insulin, and a slow-onset form known as latent autoimmune diabetes in adults (LADA) has been described. Neonatal diabetes should be considered in children who present under the age of 18 months, and maturity onset diabetes of the young (MODY) should be considered in those with a family history suggestive of dominant inheritance of early-onset diabetes.
Type 1 diabetes affects all ethnic groups, but has in the past been most common in those of European descent, with the world’s highest incidence in Finland, followed by Sardinia. The incidence of type 1 diabetes is rising rapidly, for unknown reasons, with an approximate doubling time in Europe of 20–25 years. Rapid increases have been reported in most other populations around the world. The increase in children under the age of 5 years has been particularly steep. Boys and girls are equally affected under the age of puberty, but men are more commonly affected in young adult life. In contrast to type 2 diabetes, individual lifestyle is not known to influence the risk of type 1 diabetes.
In western populations, each child has a 0.3–0.4% risk of developing diabetes by the age of 20 years; the risk rises 15-fold to 6% in siblings of an affected child. Lifetime risks may be about twice as high as this. Some 50% of the genetic risk of type 1 diabetes is conferred by genes in the human leucocyte antigen (HLA) region on chromosome 6. Many other genes (more than 40) make a minor contribution to type 1 diabetes, and a number of these influence different aspects of immune function. Their ability to predict the development of diabetes is, however, limited.
Type 1 diabetes is an immune-mediated disorder, and there is clinical overlap with a range of other autoimmune disorders. It is characterised by lymphocytic infiltration of the islets (insulitis), and by humoral and cell-mediated immunity directed against islet constituents.
These features have been intensively investigated in animal models of immune-mediated diabetes, most notably the non-obese diabetic (NOD) mouse. Immune intervention can delay beta cell loss in humans.
Type 1 diabetes progresses to severe insulin deficiency, and the consequences include loss of regulation of a range of metabolic processes. Unrestrained gluconeogenesis by the liver results in hyperglycaemia, which is associated with the breakdown of fat and muscle protein.
Accelerated catabolism explains the rapid weight loss characteristic of the condition, and leads to overproduction of ketones by the liver. These are first detected in the urine, but in greater excess can lead to diabetic ketoacidosis.
Insulin is the mainstay of management, but will not be fully effective without due attention to food intake and exercise. Insulin therapy aims to imitate natural secretion of insulin from the pancreas by supplying constant background levels of insulin in conjunction with rapid peaks when food is consumed. This is most commonly achieved by multiple injections of long- and short-acting insulin, but can be more reliably obtained by continuous subcutaneous insulin delivery via a portable external device.
Transplantation of pancreas or isolated islets can reverse insulin dependence for longer or shorter periods of time, but this approach to therapy is limited to a few selected cases by the risks of surgery and immunosuppression, limited availability of donor human pancreas, and cost.
Prospective studies from birth have shown that islet autoantibodies appear in the circulation within the first few years of life. Combinations of two or three antibody types carry a >50% risk of clinical diabetes within 5 years. Evidence of failing beta cell function first appears as loss of the first-phase insulin response to intravenous glucose, and the 5-year risk of diabetes rises to 90% in those who also have circulating antibodies. Oral glucose tolerance deteriorates in parallel, and mild hyperglycaemia may become apparent many months before clinical onset, even when the latter is apparently abrupt.
Prevention may be attempted at three levels: in the general childhood population (primary prevention); in those at increased genetic risk or with predictive markers of diabetes (secondary prevention); and in the attempt to rescue residual beta cell function in the newly diagnosed (tertiary prevention). To date, the role of environmental factors is not well understood, limiting the potential of primary prevention, but a trial of cow’s milk avoidance in infancy is under way. Secondary prevention trials have been undertaken with oral, inhaled or injected insulin, and with nicotinamide, but the results have been disappointing. Many tertiary prevention studies have been undertaken. Ciclosporin A is relatively effective but has unacceptable adverse effects; anti-CD3 antibodies appear more promising and are currently in clinical trials.
The prognosis of type 1 diabetes was transformed by the discovery of insulin, but was nonetheless limited by late complications of diabetes, including renal failure and heart disease. The Diabetes Control and Complications Trial (DCCT) clearly demonstrated that small vessel complications of diabetes affecting the eyes and kidneys could largely be prevented by near-normal glucose control, with a smaller but still useful reduction in coronary risk.
Despite encouraging reports from specialised centres, up to one-third of children are still likely to run the risk of kidney disease, although this can be prevented or delayed by therapies such as angiotensin-converting enzyme (ACE) inhibitors. The outlook for established retinopathy can be greatly improved by antihypertensives and skilled laser therapy.
Preservation and (if possible) restoration of beta cell function remains the Holy Grail of research into type 1 diabetes. Preservation may be achieved by the prevention strategies outlined above. Restoration could ideally be achieved by stem cell therapy, enabling the patient to generate new beta cells. Alternatively, functional beta cells can be supplied by whole pancreas or islet transplantation, but the low availability of donor human pancreas and the need for immunosuppression limit this approach to therapy. Finally, many attempts have been made to grow beta cells in culture and to devise ways in which these might be introduced into the body without provoking their immune destruction.
^ Some authorities define type 1 diabetes in terms of insulin deficiency, and then divide it into type 1A (immune-mediated) and type 1B (non-immune mediated).
– Wikipedia, the free encyclopedia
Dependent diabetes (insulin-dependent diabetes, diabetes mellitus type 1, juvenile diabetes) – , the main diagnostic feature of which is chronic – high blood glucose, , as a consequence – , weight loss, excessive appetite, or lack thereof; unwell. occurs when the various , leading to a decrease in the synthesis and secretion of . The role of genetic factors being investigated.
Diabetes mellitus type 1 (insulin-dependent diabetes, juvenile diabetes) – a disease of the endocrine system, characterized by absolute insulin deficiency caused by destruction of . Type 1 diabetes can develop at any age, but most often fall ill young persons (children, adolescents, adults younger than 30 years). The clinical picture is dominated by the classic symptoms: , , weight loss, .
Etiology and Pathogenesis
At the core pathogenetic mechanism of development of type 1 diabetes is impairment of insulin production by endocrine cells ( ) caused by their destruction under the influence of various pathogenic factors (viral , , and others). Type 1 diabetes is 10-15% of all cases of diabetes often develops in childhood or adolescence. For this type of diabetes characterized by the appearance of major symptoms, which rapidly progressed over time. The main method of treatment is , normalizing the patient’s metabolism. In untreated type 1 diabetes progresses rapidly and leads to severe complications such as and , ending in the death of the patient .
Classification by , 1983
I. Clinical forms:
- Primary: genetic, essential (from or not).
- Secondary (symptomatic): pituitary, steroid, thyroid, adrenal, pancreatic (inflammation of the pancreas, the tumor of its defeat, or removal), bronze (with ).
- severe course.
III. Types of diabetes mellitus (flow pattern):
- type – insulin-dependent (labile with a tendency to and , mainly youthful);
- type – (stable, diabetes, elderly).
IV. State of compensation of carbohydrate metabolism:
V. The presence of (I, II, III stage), and .
- – , , capillaropathy lower extremities or other sites.
- – with a primary lesion vessels of the heart, brain, , .
- Universal micro-and macroangiopathy.
- (peripheral, autonomic, or visceral).
VI. : , , , , and others).
VII. Acute complications of diabetes:
Pathogenesis and patogistologiya
Deficiency in the body develops due to inadequate secretion of its .
The photo shows , struck autoimmune insulitom – a group of are replaced by connective tissue.
Due to insulin deficiency, insulin-dependent tissues ( , and ) lose their ability to utilize glucose and, consequently, increased blood glucose levels ( ) – the cardinal diagnostic feature of diabetes. Due to insulin deficiency in adipose tissue is stimulated by the collapse , which increases their level in the blood and muscle tissue – stimulated by the decay of , which leads to an increased flow of in the blood. Substrates of fats and proteins are transformed by the liver into , which are used insulin-dependent tissues (mainly ) to maintain energy balance on the background of insulin deficiency.
is adaptive mechanism of increased removal of glucose from the blood when the glucose level exceeds the threshold for the value (about 10 mg / dL). Glucose is osmoaktivnym substance and increase its concentration in urine stimulates increased excretion and water ( ), which ultimately can lead to , if the water loss is not compensated adequately increased fluid intake ( ). Together with increased water loss in the urine is lost and mineral salts – develops deficit , , and , , and .
There are 6 stages of development dependent diabetes (insulin-dependent):
- Genetic predisposition to diabetes, associated with a system HLA.
- Hypothetical starting point. Damage by different diabetogenic factors and triggering of immune processes. Patients have antibodies to islet cells in the small credits, but insulin secretion is not affected.
- Active autoimmune insulin. The antibody titer is high, reduces the number of β-cells, reduced insulin secretion.
- Reduced glucose-stimulated insulin secretion. In stressful situations, the patient can identify transient impaired glucose tolerance (IGT) and Impaired Glucose plasma glucose (NGPN).
- The clinical manifestation of diabetes, including a possible episode of “honeymoon”. Insulin dramatically reduced, since killed more than 90% β-cells.
- Complete destruction of β-cells, a complete cessation of insulin secretion.
The clinical picture
Clinical manifestations of the disease are caused not only by the type , but also the duration of its course, the degree of compensation of carbohydrate metabolism, the presence of vascular complications and other disorders. Conventionally, clinical symptoms are divided into two groups :
- that indicate decompensation of the disease;
- symptoms associated with the presence and severity of , , and other .
- causes the appearance of glycosuria. Signs of high blood sugar (hyperglycemia): , , weight loss with increased appetite, dry mouth, weakness
- microangiopathy (diabetic , , )
- macroangiopathy ( , , , the lower limbs), the syndrome of
- associated pathology: , , , urinary tract infection and so on.
In clinical practice, sufficient criteria for diagnosis of type 1 diabetes is the presence of typical symptoms of hyperglycemia (polyuria and polydipsia), and laboratory confirmation Hyperglycemia – blood glucose in capillary blood glucose over 7.0 mmol / l and / or at any time more than 11.1 mmol / x
In establishing a diagnosis of a doctor operates on the following algorithm.
- Exclude diseases that manifest similar symptoms (thirst, polyuria, weight loss): diabetes insipidus, psychogenic polydipsia, hyperparathyroidism, chronic renal failure, etc. This phase ends with a statement of the laboratory syndrome hyperglycemia.
- TBD nosological form CD. The first rule out diseases that are included in the group “Other specific types of diabetes.” And only then solved the problem type 1 diabetes or type 2 diabetes patient is suffering. Carried out determining the level of C-peptide fasting and after loading. The same estimated level of concentration in the blood of GAD-antibodies.
See also: .
- (in the case of insulin overdose)
- Diabetic micro-and macro- – a violation of permeability , increasing their fragility, increased propensity to , the development of vessels;
- – peripheral , pain along the nerves, , and ;
- – pain in the , “crunch”, restriction of mobility, reducing the amount of synovial fluid and increase its viscosity;
- Diabetic – the early development of (lens opacities), (damage );
- – kidney damage with the appearance of protein and blood cells in urine and in severe cases, with the development of and ;
- Diabetic – change and mood, emotional lability or , symptoms of intoxication .
The main goals of treatment:
- Elimination of all clinical symptoms of diabetes
- Achieving optimal metabolic control for a long time.
- Prevention of acute and chronic complications of diabetes
- Ensuring the quality of life of patients.
To achieve these goals apply:
- metered individual physical activity (DIFN)
- teaching patients self-management and simple method of treatment (management of their disease)
- constant self-
Insulin based on the simulation of physiological insulin secretion, which includes:
- Basal secretion (BS), insulin
- stimulated (food), insulin secretion
Basal secretion provides the optimum level of glycemia in mezhpischevaritelny period and during sleep, promotes utilization of glucose entering the body outside of meals (gluconeogenesis, glycolysis). Its rate is 0,5-1 U / hour or 0,16-0,2-0,45 units per kilogram of actual body weight, ie 12-24 units per day. When fiznagruzke and hunger BS decreased to 0.5 units / hour. Secretion stimulated – Eating insulin corresponds to the level of postprandial glycemia. The level of SS depends on the level of carbohydrates eaten. At 1 grain per unit (XE) is produced by about 1-1,5 units. insulin. Insulin secretion is subject to daily fluctuations. In the early morning hours (4-5 hours), it is the highest. Depending on time of day on 1 secreted XE:
- for breakfast – 1,5-2,5 units. insulin
- Lunch 1,0-1,2 units. insulin
- dinner 1,1-1,3 units. insulin
1 unit of insulin lowers blood sugar by 2.0 mmol / unit, and 1 XE increases it to 2.2 mg / dL. From an average daily dose (MICs) of insulin quantity of food insulin is approximately 50-60% (20-30 units). And the share of basal insulin has 40-50% ..
Principles of insulin therapy (IT):
- Average daily dose (MICs) of insulin should be close to the physiological secretion
- the distribution of insulin during the day 2 / 3 MICs should be administered in the morning, afternoon and early evening, and 1 / 3 – in the late evening and overnight
- using a combination of short-acting insulin (ICD) and long-acting insulin. Only this allows approximately simulate the daily secretion I.
During the day the ICD is as follows: before breakfast – 35%, before lunch – 25%, before dinner – 30%, on the night – 10% of the MICs of insulin. If necessary, 5-6 am, 6.4 units. ICD. Should not be in a single injection type> 14-16 units. If you must enter the high dose, it is better to increase the number of injections, reducing the intervals of administration.
Correction of insulin on blood glucose levels for dose adjustments introduced ICD Forsch recommended for every 0.28 mmol / l glucose greater than 8.25 mmol / L, an additional input of 1 unit. I. Hence, for every “extra” 1 mmol / L glucose, an additional 2.3 units to enter. AND
Correction of insulin on glycosuria patient must be able to hold it. For a day in intervals between injections of insulin to collect urine 4 servings: 1 serving – between breakfast and lunch (pre, before breakfast, the patient should empty the bladder), 2 – between lunch and dinner, 2 – between dinner and 22 hours, 4 – from 22 hours and before breakfast. In each serving allow for diuresis, define% glucose and calculate the amount of glucose in grams. In identifying glycosuria to fix it for every 4-5 g glucose injected additional 1 unit. insulin. The next day, after collecting the urine dose of insulin increased. After achieving compensation or approaching her patient should be transferred to a combination of ICD and ISD.
Conventional insulin therapy (IT). Reduces the number of insulin injections to 1-2 times per day. When TIT simultaneously introduced ISD and ICD 1 or 2 times a day. In this case, the share of ISD has 2 / 3 SS, and ICDs – 1 / 3 MIC. Advantages:
- ease of administration
- ease of understanding the treatment of patients, their relatives, medical staff
- no need for frequent blood glucose monitoring. Sufficient to control glycemia 2-3 times a week, and if you can not self – 1 time per week
- treatment can be carried out under the supervision of glyukozuricheskogo Profile
- the need for a hard diet in accordance with the selected dose and
- the need for strict observance of regulations of the regime of the day, sleep, rest, exercise
- mandatory 5-6razovy meal at a fixed time tied to the introduction and
- inability to maintain blood glucose within the physiological fluctuations
- constant hyperinsulinemia accompanying the TIT increases the risk of hypokalemia, hypertension, atherosclerosis.
TIT is shown
- elderly people, if they can not assimilate the requirements of IIT
- persons with mental illness, low educational level
- patients in need of constant care
- undisciplined patients
Calculation of insulin at TIT 1. Pre-determined MICs of insulin 2. Distribute the MICs of insulin by time of day: 2 / 3 before breakfast and 1 / 3 before dinner. Of these, the share of ICDs should account for 30-40% ISD – 60-70% of SSc.
IIT (intensive IT) Basic principles of IIT:
- need basal insulin is provided by 2 injections of ISD, which is injected in the morning and evening (using the same drugs as in the TIT). Total dose of ISD was not> 40-50% of SSc, 2 / 3 of the total dose ISD introduced before breakfast, 1 / 3 – before dinner.
- Food – bolus insulin simulates the introduction of ICD. Needed dose of ICDs are calculated taking into account the planned reception for breakfast, lunch and dinner of XE and the level of blood glucose before meals IIT provides for a mandatory blood glucose control before each meal, 2 hours after meals and at bedtime. That is, the patient should be monitored blood glucose 7 times per day.
- simulation of physiological secretion and (basal-stimulated)
- the possibility of a freer mode of life and daily routine in a patient
- patient can use the “liberalized” diet changing the time of meals, a set of products as they wish
- higher quality of life of the patient
- effective control of metabolic disorders, providing a warning of late complications
- need to educate patients on diabetes, issues of compensation, the calculation of XE, and the ability of selection of doses and produces motivation, understanding the need for good compensation, prevention of complications of diabetes.
- the need for continuous self-monitoring blood glucose levels up to 7 times a day
- need to educate patients in the schools of patients with diabetes, changes in their lifestyles.
- additional training costs and means of self-control
- tendency to hypoglycemia, especially in the first months of ITI
Mandatory conditions of the possibility of using IIT are:
- sufficient intelligence patient
- ability to learn and implement newly acquired skills into practice
- the possibility of acquiring the means of self-control
IIT is shown:
- with type 1 diabetes is desirable virtually all patients, and for newly diagnosed diabetes is obligatory
- during pregnancy – a translation into IIT for the entire period of pregnancy, unless the patient before the pregnancy was carried out at IFT
- gestational diabetes, in case of failure of diet and DIFN
Scheme of the patient when applying IIT
- Calculation of daily kalorazha
- The calculation for the planned use for the day the amount of carbohydrates in the XE, protein and fat – in grams. Хотя больной находится на ?либерализованной? диете, он не должен съедать за сутки углеводов больше расчетной дозы в ХЕ. Не рекомендуется на 1 прием более 8 ХЕ
- Вычисление ССД И
≈ расчет суммарной дозы базального И проводится любым из вышеуказанных способов ≈ расчет суммарного пищевого (стимулированного) И проводится исходя из количества ХЕ, которое больной планирует для употребления в течение дня
- Распределение доз вводимого И в течение суток.
- Самоконтроль гликемии, коррекция доз пищевого И.
Более простые модифицированные методики ИИТ:
- 25% суточной дозы инсулина вводят перед ужином или в 22 часа в виде препарата, пролонгированного действия. Инсулин кроткого действия (составляет 75% суточной дозы инсулина) распределяют следующим образом: 40% перед завтраком, 30% перед обедом и 30% перед ужином
- 30% суточной дозы инсулина вводят в виде пролонгированного препарата: 2/3 дозы перед завтраком, 1/3 перед ужином. 70% суточной дозы инсулина вводят в виде инсулина короткого действия: 40% дозы перед завтраком, 30% перед обедом, 30% перед ужином.
В дальнейшем ≈ коррекция дозы инсулина.