Diabetes Mellitus: What You Should Know

The goal of treatment is twofold: short-term and long-term. Short term to prevent situations of hypoglycemic and hyperglycemic already long term, to avoid complications associated with sustained hyperglycemia, dyslipidaemia, arterial hypertension, obesity, smoking, etc.

The immediate ideal goal It is to maintain blood glucose between 70 and 110 mg / dl, and below 140 mg / dl after two hours of eating; the long-term goal to avoid long-term complications is to keep glycated hemoglobin (HbA1c) below 7%. To achieve this, the treatment of all types of diabetes is based on four fundamental points, which must be coordinated with each other: food, physical exercise, medication and diabetes education.

1. Food

Food is a basic pillar in treatment. It should be focused not only on sugar but also on other factors that increase the chances of producing more long-term damage to organs and tissues: high blood pressure, changes in blood fats (cholesterol and triglycerides) and obesity .

Also, antidiabetic drugs and insulin injections are more effective when you eat a balanced diet. The priority objectives that the diet must meet are the following:

• Avoid immediate and late complications: hypoglycemia and hyperglycemia, respectively.
• Prevent or delay late complications: injury to the kidney (nephropathy), injury to the nerves (neuropathy), injury to the retina (retinopathy), injury to the motility of the digestive tract (gastropathy), and injury to the heart and arteries (cardiovascular diseases).

Other objectives of diet in diabetes are to be nutritionally complete and adapt to requirements set by insulin or antidiabetic drugs and by the physical activity that the individual does.

The prescription of food in the diabetic individual must be accompanied by adequate nutritional education, that is, the patient must be given a series of nutritional advice. These tips should include ways of adapting to changes that can occur in any circumstance, for example, a social meal or a trip.

The diet must be focused on each patient, that is, a personalized diet must be made. Factors such as:

• Whether it is type 1 or type 2 diabetes
• If there is obesity or overweight
• If there is an alteration of cholesterol and triglycerides
• The physical activity that the patient does
• The work activity that the patient does
• If there are already complications of diabetes such as nephropathy, neuropathy, gastropathy, etc.

The characteristics of the diet in diabetes mellitus are:

• The calories Totals for the day will depend on weight, age, physical exercise, and work activity.
• The protein They represent 10-20% of the total daily calories. High protein diets are not recommended.
• The fats they will be 20-35% of the daily caloric total, distributed as follows:
  • Saturated fat should be 7% of total calories.
  • Polyunsaturated fats should be 7-10% of total calories.
  • Monounsaturated fats the rest.
  • Trans fats should be less than 2% and, if possible, should be eliminated from the diet of the diabetic.
• The polyunsaturated fatty acids omega 3 type should be ingested in an amount of 2–3 g / day of oil in the form of fish. This can be achieved with the consumption of 200-300 grams per week of blue fish.
  • The total cholesterol in the diet should not be more than 300 mg / day and, if possible, less than 200 mg / day.
  • Carbohydrates will be 45-65% of the total caloric intake. Low carbohydrate diets are not recommended. But the majority (80-90%) should be complex carbohydrates.
  • Fiber intake will be the same as the general population (about 35g / day).
  • Sodium: Avoid excessive amounts. Simply removing the salt shaker from the table is sufficient.
  • Alcohol: It can be consumed in moderate amounts if diabetes is well controlled and if there is no overweight or obesity. It must be taken into account that alcohol increases the risk of producing hypoglycemia (not noticed by the patient himself) and increases in triglycerides.
  • Vitamins and minerals: As in the general population. Do not give supplements in pill form.

On the other hand, the particularities in diabetic patients with respect to the general population are diverse:

In diabetic patients, regularity in the schedule and in the amount of carbohydrates ingested at each meal, and this to be able to coordinate with the insulin regimen or the doses of pills (antidiabetics) and with physical activity. If the amount of carbohydrates or the schedules are continuously modified, situations of hyperglycemia and hypoglycemia will occur. In type 2 diabetes mellitus, it is advisable to distribute the carbohydrate intake in 5 or 6 servings a day, in such a way that spikes in blood sugar are limited as far as possible after ingestion.

Feeding tips

• Although the diabetic individual consumes healthy foods, for example legumes, these can cause problems if they eat them in excessive amounts: hyperglycemia, sugar spikes, weight gain, and poor long-term control of sugar with the appearance of serious complications.
• Sweet foods (with simple or fast-absorbing carbohydrates) should be taken in small amounts and only occasionally.
• Foods with plenty of plant fiber can reduce fluctuations in postprandial blood glucose.
• Use alternative sweeteners to table sugar, such as saccharin.
• Follow the healthy diet recommended by your doctor or dietitian.
• Eat food at the same time every day.
• A monotonous diet (same foods every day) should not be followed as it cannot be followed in the long term and also runs the risk of being nutritionally incomplete.
• There are products on the market marketed as "diet foods for diabetics." In some of these, the sugar has been reduced but the proportion of fat is very high, resulting in hypercaloric, in addition to being harmful if the fat is saturated. In other foods, sucrose has been replaced by fructose or another class of carbohydrates, despite which all of them maintain an important hyperglycemic effect. In general, it is preferable not to use them.

2. Physical activity

The practice of physical activity on a regular basis is an essential aspect in the treatment of diabetes mellitus. Physical exercise has multiple benefits: it reduces blood glucose (not only during exercise but also after exercise), increases sensitivity to the action of insulin, lowers blood pressure, improves LDL cholesterol levels. , HDL cholesterol and triglycerides, helps reduce body fat and lose weight, reduces the capacity for blood thrombosis, and lowers cardiovascular risk. In addition, it produces a feeling of well-being. And all this in both type 1 and type 2 diabetics.

The diabetic patient must perform physical exercise regularly, at least 30 minutes almost every day. The type of physical activity will depend on the patient's own tastes: walking, running, cycling, skiing, soccer, jumping rope, swimming, tennis, athletics, maintenance gymnastics, etc.

During the practice of physical exercise, episodes of hypoglycemia but also hyperglycemia can occur, depending on what the blood sugar values ​​were before starting the exercise, the insulin values ​​in the blood and the level of certain hormones such as catecholamines induced by exercise.

To avoid the hyperglycemia or hypoglycemia that arises with exercise, it is advisable to practice moderate intensity exercises on a regular basis, know the individual's own response to the exercise performed and measure blood sugar before exercise.

3. Medication

For drug treatment we have pills (globally called antidiabetic drugs) and insulin. Antidiabetic drugs are used in type 2 diabetes (and some in type 1), while insulin is mandatory in type 1 diabetes and optional in type 2. There are several groups of antidiabetic drugs based on their mechanism of action:

• Drugs that increase insulin secretion by the pancreas: family of sulfonylureas (chlorpropamide, glibenclamide, glycazide, glimepiride, glipizada, glisentide, glyquidone) and family of meglitinides (nateglinide, repaglinide).
• Drugs that reduce sugar production by the liver and improve insulin utilization by organs and tissues: biguanide family (metformin).
• Drugs that improve insulin utilization by organs and tissues: family of thiazolidinediones or glitazones (pioglitazone, rosiglitazone)
• Drugs that delay or slow the absorption of sugars (glucose) in the intestine: alpha-glucosidase inhibitors (acarbose, miglitol)
• Drugs (incretins) that stimulate insulin secretion (but not directly like sulfonylureas but indirectly, mediated by glucose in the blood): family of gliptins (sitagliptin).

All of them are for type 2 diabetes except alpha-glucosidase inhibitors, which can also be used in type 1.

Pharmacological treatment can be monotherapy, that is, a single drug, or combined therapy, which is a combination of oral antidiabetics, and even the combination of insulin and oral antidiabetics. Insulin is given by prick under the skin (subcutaneous). Insulin is classified into four general types:

• Ultra-fast acting insulin: aspart and lispro
• Fast Acting Insulin: Regular
• Intermediate-acting insulin: NPH, lens
• Long-acting or ultra-slow-acting insulin: ultralenses, glargine, detemir.

There are various insulin guidelines and combinations thereof. The slow and the intermediate ones provide a constant level of insulin in the blood, while the fast or ultrafast ones are used to balance the sugar consumed in meals. An alternative, very effective in type 1 diabetes, is the continuous drip of insulin subcutaneously through an electronic device.

4. diabetes education

It is very important to educate the patient about their illness and how to handle the different situations that can occur on a daily basis, such as hyperglycemia, hypoglycemia, having to take a trip or a social meal, etc. Also how to recognize a drop in blood sugar before it becomes serious.

As elements of help, the individual must carry out self-monitoring of blood glucose with a glucometer, a device that allows to determine the amount of sugar that is currently in the blood with a small prick on the fingertip.