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BASIC INSTRUCTIONS FOR DIABETICS/ Dr.Raaste/2013
Doctors often have difficulty in motivating their patients to control their diabetes well. Diabetes, especially type 2, does not cause many symptoms until the blood sugar is extremely high, which means that the patient feels quite well in spite of his/her diabetes. There is no organ in the body to sense glucose levels, so the only way of knowing is by measuring. Often has the blood sugar been many years too high before diabetes is diagnosed and there is already damage in various tissues. The diabetes is detected earlier if instead of checking the fasting blood glucose the post- prandial test is used. It means measuring the blood glucose 45-60 minutes after a meal as for example breakfast (bread, flakes, marmalade, juice etc.) Another possibility is to measure the HbA1C. At least people with hereditary predisposition or overweight should do tests regularly.
Elevated blood sugar is harmful, and causes slow damage to different organs. High blood sugar is especially damaging to nervous tissue, blood vessels, the heart and kidneys. Numbness in the feet is one of the first symptoms of nerve damage. Diabetics also have a considerably increased risk of heart infarctions and strokes. Loss of eyesight is usual and is caused by diabetic retinopathy. The kidneys are also easily damaged and the accelerated arteriosclerosis causes poor circulation and even gangrene, where the surgeon needs to amputate some part of the (usually lower) extremities.
By the time the patient has injuries in different organs, it is already too late!! The only way is to treat oneself as perfectly as possible from the beginning. The key is Prevention!!
WHAT DOES GOOD TREATMENT COMPRISE OF?
Good treatment keeps the blood sugar mostly at the same level as that of healthy person. (both fasting, and aftert-meal levels)
These days there are excellent tools, which make the controlling of blood sugar easy at home and there are also several different medication options.
Your doctor will be in charge of a certain part of the treatment, but mainly, it is the patient him/herself who is responsible. As you do frequent blood sugar controls, especially at the beginning, you learn how different factors influence your blood sugar levels. This way, you learn to manage your disease.
A healthy person has automatic blood sugar regulation. When she/he eats food containing CARBOHYDRATES (the part of foods which is quickly converted into sugar in the body), the blood sugar levels begin to rise. The amount of the rise depends on the quality and quantity of the carbohydrates. Certain cells in the body detect this rise and start to liberate insulin from the pancreas. With the help of insulin the cells in our body are capable of using the sugar as a source of energy and the amount of sugar in the blood decreases. Our blood sugar levels change continuously from one moment to another! A healthy individual’s blood sugar levels will stay between 70 and 140mg% (4 to 7.8 mmol/l).
After a meal, the blood sugar will rise for 30 to 60 minutes, and then gradually descend to a fasting level (appendix 2). This is why we must measure the blood sugar approximately 45 minutes after the meal in order to see the effect of different foodstuffs. Measuring before meals will show whether there is any effect in our bodies from the previous meal. (Motion consumes energy and lowers blood sugar, as well as increases the metabolism which reduces insulin resistance). To get a picture of sugar balance over a longer time period of 3 months, doctors use a test called HbA1C. In a healthy individual, the value will be close to 5%. Type 2 diabetes is well-managed when the value is below 6.5% and for type 1 diabetes the limit is 7%. The higher the HbA1C, the worse the glucose balance.
A diabetic person’s automatic blood sugar regulation is impared. This is due to either: a. the production of insulin decreasing, or b. the ability of the cells to make use of the insulin worsening (resistance), or a combination of a and b. By doing a glucose and insulin tolerance test we can distinguish between these different types of diabetes and choose the appropriate treatment.
The treatment principle is to keep the blood sugar level of the diabetic person as close to healthy levels as possible. The regulation is easier in type 2 diabetes than in insulin diabetes in which the body depends on insulin injections.
OVERVIEW OF THE TREATMENT
1. THE DIET, regulates the amount of energy
2. PHYSICAL EXERCISE, regulates the use of energy
3. MEDICATION, repairs the shortages of the body
4. DIETARY SUPPLEMENTS, to protect the body
The three first components must be in the right proportion to each other and the timing must be right in order to obtain a perfect blood sugar balance!
THE DIET:
Diabetes = Carbohydrate intolerance!
In any form of diabetes the treatment is based on a correct diet!
Because the organism of a diabetic has difficulty in dealing with food, especially that containing carbohydrates, the first treatment measure is to find the right type and quantity of food. We cannot eliminate carbohydrates from our food entirely. They are a necessary source of energy, but a diabetic person must reduce the amount considerably. The tolerance of carbohydrates is individual between 25 and 100 gr/day. Greater amounts of carbohydrates increase the insulin production and -need and boost accumulation of fat. For diabetics the only reasonable diet is the low carbohydrate diet (LCHF). The diabetes diet is substantially free from: BREAD, PORRIDGE, FLAKES, MUESLI, PASTA, RICE or POTATOES.!!
Sugar is 100% carbohydrate and potato contains approximately 15% of its weight in carbohydrates. The more carbohydrates we eat and the quicker they are absorbed the higher and quicker the rise of the blood sugar. From this we can deduce that it is better to eat smaller amounts at a time eg over 6 meals and to select foodstuffs which release their carbohydrates slowly.
Without a scale and a food composition analysis list (http://www.nutritionanalyser.com) it is completely impossible to learn to evaluate the carbohydrate amounts in our diet. A small example of how to calculate the carbohydrate content of a meal:
A ham omelet containing cooked ham, eggs, 50 ml milk - milk is the only ingredient containing 5% carbohydrate so the total amount is 2.5 gr.
Cooked green beans 150 gr - contains about 11,5 gr carbohydrate.
Salad 100 gr (tomato, cucumber, onion, lettuce) - about 4 gr carbohydrate.
2 dl of red wine contains about 1 gr carbohydrate.
The total amount of carbohydrates in this meal is 19 gr
If the amount of carbohydrates is adequate and the medication is correct, the blood sugar level should not rise over 140 mg% (7.8 mmol/l) when measured about 45 minutes after any meal.
PHYSICAL EXERCISE:
Regular exercise is very important because it accelerates the metabolism and diminishes insulin resistance. Besides the effect of lowering blood glucose, exercise has several other beneficial effects on our health. The functioning of the heart and the circulation of blood improve. Bloodpressure declines. Cholesterol declines and so on.
The minimal amount of daily exercise recommended is 30-44 minutes of vigorous walking (or some other corresponding exercise
MEDICATION:
The principle is to keep medication to a minimum – enough to keep the blood sugar within the guideline limits (after eating correctly in the first place).
When the maximal treatment with tablets is no longer controlling the sugar levels, if is important to begin with insulin immediately. Sometimes insulin and tablets can be used in combination. With good diabetes management, which includes diet, weight control, exercise, (medication), one can slow down the progress of the disease and postpone the need for insulin injections.
DIETARY SUPPLEMENTS:
Many scientific studies have confirmed the importance of certain dietary supplements for diabetic patients. They protect sensitive organs against the poisonous effects of high blood sugar. You can find information at www.biovita.com. In my opinion the most important supplements are: E-Epa, Carnosine, Benfotiamin, Folic acid and B-vitamins and out of the minerals: Chromium, Magnesium and Zinc.
If one treats diabetes well one can avoid many disagreeable complications and problems!
A LIST OF SOME COMMON FOODSTUFFS AND THEIR CARBOHYDRATE CONTENT and their Glycaemic Index=GI
(The Glycaemic Index measures the blood glucose rise of the foodstuff compared with sugar, which has the value 100. The lower the GI number the better for diabetes)
Different grains and flours : (Carbohydrates) Ch 65-80%, GI 80
Rice Ch 79%, GI 45-88 depending of the brand.
Oats Ch 66%, GI of porridge 70
Bread (fresh) wholemeal Ch 55%, GI 70, Bread white Ch 57, GI 70-80
Biscuits (not sweet) Ch 75%, Cereals Ch 85%, GI 83
Potato Ch 18%, GI boiled 57, smashed GI 73
Carrot Ch 10%, GI 50, Rutabaga Ch 8%, GI 50
Cabbage Ch 5%, GI 50, Cauliflower Ch 5%, GI 50, Lettuce Ch 3%, GI 50, Watermelon Ch 6%, GI 72, Mushrooms Ch 6%, GI 50
Dry beans Ch 62%, GI 28, Fresh green beans Ch 6%, GI 50, Fresh peas Ch 16%, GI 50
Cucumber Ch 3%, GI 50, Tomato Ch 4%, GI 50, Pepper Ch 7%, GI 50
Apple Ch 15%, GI 38, Orange Ch 11%, GI 44, Grape Ch 16%, GI 46, Banana Ch 23%, GI 54
Milk Ch 5%, GI 27, Berries Ch 3%, Dry white wine/red wine Ch 0,5%
A more complete list can be found at: http://www.nutritionanalyser.com
APPENDIX 2 : The graphs show that blood glucose is at its highest 30-60 min. after the glucose intake
Glucose Tolerance Test (Healthy person) Corresponding Insulin secretion
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