Diet in diabetes

diabetes mellitus affects a large number of people around the world. Approximately 3-6% of the Spanish population is diabetic. And it is a disorder that carries immediate damage because very low blood sugar levels can be reached (hypoglycemia) and long-term damage due to persistently high blood sugar levels (hyperglycemia). For this reason, strict control of the sugar that the diabetic has in the blood is required.

But, in addition to sugar, in type 2 diabetics other factors are added that increase the chances of causing more long-term damage to organs and tissues. They are high blood pressure, changes in blood fats (cholesterol and triglycerides) and obesity. Therefore, strict control of these factors is also required in diabetics.

In the control of sugar, triglycerides, cholesterol, excess weight, and high blood pressure, diet is an essential element in the treatment of these patients, together with the practice of physical activity, the elimination of tobacco and taking the medication indicated by the doctor.

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 (balanced diet), to adapt to the tastes of the individual, to favor its acceptance by the individual (since it will be a diet for life), and to adapt to some requirements marked 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 aimed at teaching what a healthy and balanced diet is, trying to correct any errors that may be made. the patient and that can lead in the long run to a failure of the same. These tips should include ways of adapting to the 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 a change in cholesterol and triglycerides
• the physical activity that the patient does
• the work activity that the patient does
• if there are already present complications of diabetes such as nephropathy, neuropathy, gastropathy, etc.

We must not forget that the recommended diet in diabetes mellitus is similar to that of anyone who follows a healthy diet, that is, reducing saturated fats and simple carbohydrates (quickly absorbed), reducing or eliminating fats trans, moderate salt intake, increase fiber intake, include fruits and vegetables, drink semi-skimmed or skimmed milk Although there are some differential aspects that we will comment on later.

The characteristics of the diet in diabetes mellitus are:

• The total calories for the day will depend on weight, age, physical exercise, and work activity.
• Proteins represent 10-20% of total daily calories. High protein diets are not recommended.
• Fats will be 20-35% of the total daily calories, 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.
• Polyunsaturated fatty acids of the 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.

The particularities in diabetic patients with respect to the general population are the following:

• In diabetic patients, regularity in the schedule and in the amount of carbohydrates ingested at each meal is essential, and this in order to be able to coordinate with the insulin regimen or the doses of pills (antidiabetics) and with physical activity. The administration of a given dose of insulin or the antidiabetic will be based on a supposed contribution of carbohydrates; This contribution of carbohydrates in that meal will increase blood sugar and the amount of insulin or antidiabetic drug administered will have the objective of controlling that blood sugar does not skyrocket with ingested carbohydrates. If the amount of carbohydrates or the schedules are continuously modified, situations of hyperglycemia and hypoglycemia will occur. For its part, physical exercise will reduce blood sugar, so the diet should provide more carbohydrates (and reduce the intake of insulin or antidiabetic drugs) to avoid situations of severe hypoglycemia.
• 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.

Some useful recommendations are:

• 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.