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Diabetes 1 PDF Print E-mail

DIABETES  1, engl.Dr. Raaste 2013

Good management of diabetes 1, is more demanding than that of diabetes 2. In diabetes 1 the insulin production of pancreas is almost inexistent and the patient is depending on insulin injections that the cells of our body can use the energy of the food. Before the invention of insulin did the diabetics not live for long.
I recommend that you also read my “Basic instructions for diabetics” which contains some important basic facts.
With insulin treatment the patient can have almost as good life as others, although depending on how well he treats himself.
 In the instructions for diabetes 2, I have already explained the consequences of the high blood sugar levels.
The goal of the treatment is to maintain blood sugar levels as close to healthy levels as possible! (80-130mg%=4,5-7,2mmol/l)  Avoid even harmful   postprandial glucose spikes and even more dangerous blood sugar falls. The insulin doses need to be adjusted individually according to the needs and habits of every patient.
Diabetes 1 patient needs a quite regular life because there are otherwise too many influencing factors to bee controlled and everything gets more complicated.
The very high blood glucose produces the so-called keto-acidosis ending in coma and the very low blood sugar causes the diabetic chock.
COMA: starts slowly with symptoms like thirst, urinating a lot, headache, nausea, vomiting, difficult respiration, abdominal pain, drowsiness, blurred vision and finally unconsciousness.
CHOC: starts quickly in minutes with symptoms like hunger, weakness, shivering, dizziness, sweating, confusion and unconsciousness. If this state continues for too long ,it can cause permanent brain damage.
The DAWN phenomenon: In the morning can insulin have 20% less effect than later during the day. This means that the breakfast should be especially low in carbohydrates.
Gastro paresis: is a lesion of the nerves of the stomach and the gut caused usually of too high blood sugar levels. (The same mechanism as the neuropathy of the legs). It does that food is processed more slowly and retards the blood sugar maximum. A medicine called Motilium can help.
Insulin resistance: Usually people with overweight (metabolic syndrome) have a decreased response to insulin. They need 2-3 times higher insulin doses. The treatment is to reduce carbohydrates in the diet and increase exercise.  
EVERY PATIENT IS HER/HIS OWN DOCTOR!! One has to learn to treat oneself and to learn how ones body reacts to the different influencing factors such as, food, motion, mood etc. We don´t have a sense for blood sugar level, so it must be monitored often enough to learn how to stay within the normal limits of blood sugar.
The other necessary object of measurement is, the amount of carbohydrates in the food and the patients needs at least in the beginning a scale and a list of carbohydrate content in different food.
I give you here, in a concentrated form, some basic facts that make the management of the disease easier.
 Our body needs a small basic amount of insulin 24 hours a day even if we do not eat. This basic insulin is usually given as a long acting insulin (Lantus)
As we eat we need more insulin in order to be able to use the energy from the food. For this need it is best to use short acting insulin as Lispro or Aspart. Their effect does not last much longer than 4-5 hours. This system is quite flexible and does not cause so much danger for low blood sugar episodes. It is also a good practice to inject the long acting insulin in the morning, to avoid blood sugar falls at night.
The total insulin needed has been estimated to 0.5 units / kg of the patient weight. But this amount has been used with the “old” diet recommendations which contained a lot carbohydrates, so it should be too high for the patient eating a low carbohydrate diet. The insulin amounts must be tested for each patient individually.
The energy in the food is basically composed of carbohydrates, proteins and fat. For the diabetic patient the Carbohydrates affects the blood sugar most. The proteins are the building blocs of the cells and the fat is concentrated energy and carrier of some important vitamins.
To control the blood sugar, the calculation of the carbohydrate content of every meal is the most important factor.
We know that for Type 1 diabetics, who do not produce any insulin itself, reduces 1 unit of insulin blood sugar by about 2 mmol/ 36mg%  in a 65 kg adult. We also know that 4 grams of carbohydrate usually increases blood sugar by about 1 mmol/18mg%. Thus covers 1 unit of insulin usually 8 g carbohydrates. We also know that 1 unit of insulin covers 40 g protein which means 200gr of meat..
Even the patient with diabetes 1, is better off having a low carbohydrate diet (LCHF) and lower insulin amounts. The recommended daily total carbohydrate amount is 30 to 50gr. This means less than 20gr carbohydrates/ meal. Ideal would be 6-8gr carbohydrates at breakfast and 12 to 16gr at lunch and dinner. The needed insulin amounts for a 65 kg person would be 1 to2 units for breakfast and 2-3 units for lunch and dinner. Managing the diabetes with these small amounts makes the possible errors smaller and the blood sugar more stable and easier to handle! The type of carbohydrates should be mainly the so-called slow acting that keeps the blood sugar more even. The diet consists mainly of vegetables, meat, poultry, fish, eggs, some fruit and milk products. Bread, porridge, muesli, cereals, pasta, potatoes are no good. They have big amounts of carbohydrates that enter quickly into the blood stream. The protein-vegetable-fat diet also keeps you less hungry. For the body to adapt to the low-carb diet takes usually 3-4 weeks.
The quicker carbs cause a more accelerated rise in the blood sugar and the descending curve is also steeper. One feels hungry and has cravings of sugar, even if the blood sugar level is not too low. This leads easily to overweight.
There is one more thing to remember: If you fill your stomach much even with 0 carbohydrates, the distension of the stomachs wall causes an increase of glucagon secretion and that makes the liver to liberate glucose to the bloodstream.
After a meal the blood sugar usually reaches the maximum in 30-60min. That is why the effect of the meal should be measured 45-60min after a meal. The short acting insulin should be taken to cover the energy from the meal. The blood sugar after the meal should not rise over 140mg% (7,8 mmol/l) in a good treatment. Every time the blood sugar rises over the healthy limits, it causes some tissue damage.
In order to be able to calculate the amount of carbohydrates in your meals you need a good scale and a list of food composition like:
Regular exercise is important. It helps to keep the metabolism rate up and to lower the insulin resistance. It is also important in keeping the lungs, the muscles , the bones and the cardiovascular system healthy. Exercise has a lowering effect on the blood sugar. The recommended exercise is minimum 30 min brisk walk or equivalent every day. When learning your body’s reactions you need to measure the blood sugar more often. You need to know the blood sugar level before you start the exercise and then every 30 min for a few hours. You should not beguine hard exercise if the blood sugar level is lower than 110mg% or higher tan 250mg%. You must also carry with you extra food like banana, or other fruit, or some sweet snacks for possible blood sugar falls.
Other factors:
Fever increases the need of insulin and carbohydrates.
Stress and strong emotions increases the blood sugar.
The Somoguy effect: The reason for un explained high blood sugar in the morning, might be that the blood sugar has been too low during the night, and then the liver releases sugar as a emergency measure. The treatment might be to lower the insulin amount or have something to eat before going to bed.
Dietary supplements are an important part of the treatment. There is an increased need of specially omega-3 fatty acids, carnosine, vitamins B, C and E, chromium, magnesium, selenium and zinc.
More details:    “Guidelines for Good Management of Diabetes”



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