Diabetes is a disease that does not allow the body to control the rise in blood sugar. It occurs when the pancreas does not produce enough insulin or when the cells within the body are not enough to respond to insulin production. If left untreated, it can damage almost any organ, including the kidneys, eyes, heart, and even the nervous system. However, nowadays it is a largely manageable pathology at any age. Although it is not technically "curable", with insulin therapy and the adoption of healthy habits, it does not compromise the quality of life. Read on to learn how to control this disease and avoid any complications.
Steps
Part 1 of 6: Improving Your Nutrition
Step 1. Increase your consumption of vegetables and beans
Generally, the body is not able to synthesize in adequate quantities the fibers contained in foods that are rich in it, so they help to lower the glycemic index. Especially beans contain large amounts of fiber, potassium, magnesium and, of course, vegetable protein. Therefore, they satisfy the protein needs and, at the same time, allow you to decrease the consumption of red meat, as well as the intake of fats that are harmful to health.
Green leafy vegetables, such as spinach, lettuce, and kale, offer a high vitamin content with low calories. Non-starchy vegetables, such as asparagus, broccoli, cabbage, carrots, and tomatoes, are also healthy. They are excellent sources of fiber and vitamin E
Step 2. Include fish in your diet regularly
Thanks to its high content of omega-3 fatty acids, it should be one of the cornerstones of your diet. Salmon and tuna are particularly rich in it and are also very light and healthy foods. However, keep in mind that almost all fish are a healthy and flavorful food source. Consider mackerel, herring, trout, and sardines.
Nuts also contain essential fatty acids, especially walnuts and flax seeds. By adding them to your diet (try them in salads), you can increase your intake of these nutrients. Furthermore, by increasing your consumption of fish, you will decrease that of red meat and, consequently, you will reduce the intake of fat and calories
Step 3. Choose fat-free dairy products
Milk, yogurt, and cheese are all great food choices if they are low in fat. In this way, you will not give up the nutrients they contain, namely calcium, magnesium and vitamins, but you will avoid taking in fats that are harmful to health.
This is not to say that all fats are bad. The body can assimilate them in the form of unsaturated natural fats, such as those contained in olive oil, sunflower oil and sesame oil
Step 4. Eliminate refined carbohydrates
Replace flour, bread, pasta, and white rice with whole grains that contain much higher amounts of magnesium, chromium, and fiber. Also, eat sweet potatoes instead of white potatoes.
Also, you need to stay away from fried foods, as the breading is often made up of mostly white flours. Instead, learn how to cook your food on the grill or in the oven. You will be surprised at how much more delicious and succulent they are
Step 5. Minimize your sugar intake
You can find it in many food sources: fruits, sugary drinks, ice cream, desserts, and pastries. Rather, consume products that contain artificial sweeteners, such as saccharin or sucralose, as you will not give up the pleasure of a sweet bite, but it will not be broken down into glucose within the body, inevitably increasing the glycemic index.
- You can easily add a sweetener to foods and drinks. Furthermore, the presence of sweeteners or sugar substitutes is indicated on many food products. When shopping, read the packaging to understand what options you have.
- Among the fruit, you can occasionally eat apples, pears, berries and peaches. Avoid those that contain high amounts of sugar, such as watermelon and mango.
Step 6. Respect your calorie needs
It is important not only to assimilate the right amount of calories, but also to choose the right "type" of calories. Everyone is different, so your doctor should recommend a diet based on the insulin doses you need to take, your general health condition, and the progression of your diabetes.
- Generally, diabetic patients are recommended to consume 36 calories / kg for men and 34 calories / kg for women. A normal diet should consist of approximately 50-60% carbohydrates, 15% protein, 30% fat and limited salt intake.
- For patients suffering from type 2 diabetes, the main goal is to lose around 5-10% of their body weight. It is not necessary to limit the calorie intake, but to reduce the intake of fats and carbohydrates.
Part 2 of 6: Keeping You Active
Step 1. Consult your doctor to find out which workout is best suited to your needs
Get an exercise tolerance test to let your doctor know about exercises you should avoid. In this way, he will be able to evaluate which are the intensity and duration of the effort most suitable for your health conditions and outline a program that allows you to lose weight without losing motivation.
In general, physical activity contributes to improving the health of diabetic patients, favoring an "improvement" of the disease even if it is not in an advanced stage. In addition, regular training helps you lose weight, leading to a lowering of the glycemic index, blood pressure and cholesterol. It is an excellent goal to achieve because it allows you to slow down the progression of the disease, keep your physical conditions stable and even improve them
Step 2. Incorporate cardio exercises into your daily routine
Aerobic activity increases insulin sensitivity and helps obese patients to control their body weight. To include it in your days, try brisk walking, jumping rope, jogging, or playing tennis. The ideal would be to introduce 30 minutes of cardio work a day about 5 times a week. If you are not used to moving, start with 5-10 minutes and gradually increase the time. Anything is better than nothing!
- One of the easiest exercises, which does not require any special equipment or even membership in the gym, is to walk. While it may seem like little, a walk a day can improve health, breathing, thinking and mood, lower glycemic index and blood pressure, and relieve anxiety. Cycling and swimming are also pleasant and not very monotonous activities that you might add to your daily life.
- Control of the cardiovascular system is important in patients who have suffered from cardiovascular disorders, in the elderly or in people with diabetes-related complications. Just make sure you start exercising under your doctor's supervision.
Step 3. Muscle strengthening also begins
Anaerobic training is the next step after aerobic because it allows you to tone your body. When the muscle structure is stronger, it burns more calories and, consequently, promotes weight loss and the management of blood sugars. It is advisable to perform anaerobic exercises together with aerobic ones twice a week.
You don't necessarily have to join the gym. You could also pick up full water bottles when you are at home. Also, keep in mind that housework and gardening are fully part of anaerobic work if they involve a little extra effort
Step 4. Make a commitment to lose weight
In most cases, patients are encouraged to lose weight and achieve an ideal BMI. This is especially true in those who are obese and with type 2 diabetes. BMI (or BMI, body index mass) is calculated by dividing weight (mass) in kilograms by height squared.
The ideal BMI is 18.5-25. So, if it is below 18.5, it means that you are underweight, while if it is above 25, it means that you are obese
Step 5. Stick to your training routine
Make sure you have a plan that you can stick to and that makes it easier for you. We need motivation to be consistent in physical activity. A partner, friend or family member who can support you, encourage you and remind you of the benefits you can get from exercising, is able to give you the stimulus you need.
Also, when you hit a milestone in your weight loss program, try to reward yourself (not a bar of chocolate!). All this will give you additional energy and the demonstration that you can achieve the goal you have set for yourself, but also improve the quality of your life
Part 3 of 6: Using Insulin if You Have Type 1 Diabetes
Step 1. Start taking your insulin
There are three basic types of insulin: fast-acting, intermediate-acting, and long-acting. Although it is mostly used in cases of type 1 diabetes, it is "taken" to treat both types. Your doctor will decide which type is suitable for your health condition. Currently, insulin delivery can only be done by injection.
- Fast-acting insulin is used to quickly lower the glycemic index. The preparations available on the market are Lispro (Humalog) and Humulin R. They have a fast-acting effect, with an onset within 20 minutes and lasting about 3-5 hours. They can be administered by subcutaneous, intramuscular or intravenous injection.
- Intermediate-acting insulin serves to gradually lower the glycemic index. Among the preparations present on the market there is Humulin N, which has an intermediate duration. Onset occurs within two hours and lasts for nearly a day. Neutral Protainne Hagedron (NPH) is also used and is only given by injection under the skin.
- Long-acting insulin serves to lower the glycemic index more slowly. Among the preparations are included insulin glargine (Basaglar, Lantus) or insulin detemir (Levemir). The action begins very slowly, after about six hours, and lasts for a day. They are given only by subcutaneous injection.
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For example, it is possible to prescribe Humulin R 20 IU, three times a day. It is administered on a full stomach in order to ensure the achievement of the necessary glycemic index.
In type 2 diabetes, an adequate diet and proper exercise may be enough to keep this condition under control. If not, oral hypoglycemic drugs are prescribed
Step 2. Please note that you can also take a combination of different types of insulin
Some preparations, such as Humulin Mixtard, contain a blend of fast-acting and intermediate-acting insulin. They are specially formulated to produce immediate and long lasting effects.
While this seems like the best solution, it is only advisable in certain situations. Your doctor will know what type of insulin (and how much) is right for your needs and health condition
Step 3. Inject the insulin with a "pen"
It is a device that allows you to take or administer insulin. Each cartridge contains multiple doses. It can save you time and reduce frustration. It adjusts according to the prescribed therapy and is less painful than a normal needle. You can easily carry it even when you need to go to work or stay away from home.
Regardless of whether you are using a pen or a syringe, human insulin is preferable to derivatives of animal origin because it does not produce antigenic responses and is not recognized by the body as a foreign substance. Normally, insulin increases the uptake of glucose by the responsible cells, promotes energy reserves of glycogen and reduces gluconeogenesis (glucose production)
Step 4. Store your insulin at the right temperature
All insulin preparations should be stored in the refrigerator and not in the freezer. However, although pharmaceutical companies produce pens that are stable at room temperature, some studies have shown that these devices must be stored in the refrigerator before starting to take them.
- After giving the first dose, you need to keep them out of the refrigerator and at room temperature to prevent the insulin from crystallizing.
- Additionally, insulin injected at refrigerator temperature was found to be more painful than insulin stored at room temperature.
Step 5. Proceed to check your glycemic index
All diabetic patients must monitor their blood sugar levels. This is important because, in this way, they can regulate the intake of prescribed medications to keep their blood sugar in check. Otherwise, it is possible that hypoglycemia, which is a lowering of sugars in the bloodstream, may occur, which leads to numerous complications, such as blurred vision and dehydration.
- Check the glycemic index half an hour before eating and after meals, because once food is ingested, blood sugar levels are altered. In this way, you will also avoid the occurrence of macrovascular, microvascular and neuropathic complications.
- Generally, to reduce pain, it is preferable to take a blood sample from the lateral areas of the finger, not the tip, because they are less innervated than the extremities. You should write down the readings in a special notebook, like a kind of glycemic calendar, so that the doctor can easily interpret them.
Step 6. Learn about the problems associated with insulin therapy
Unfortunately, there are some problems with insulin therapy that patients need to be aware of. The most common ones are:
- Hypoglycemia. It mostly occurs when the patient has not eaten adequately before the dose or due to an insulin overdose.
- Allergies to insulin. They can occur if this hormone comes from animal sources. In these cases, the doctor should replace it with human insulin preparations, adding some topical steroids or antihistamines to reduce the allergic reaction, itching, swelling or pain.
- Insulin resistance. It can occur especially if it is accompanied by other complications typical of diabetes. If so, you need to see a doctor as you may need to increase your insulin dose or change your treatment plan.
- Weight gain and feeling of hunger, especially in type 2 diabetes patients who took oral hypoglycemic drugs and then started adding insulin.
- Insulin lipodystrophy. It is a hypertrophy of the adipose tissues that occurs in the subcutaneous layer of the areas where insulin is injected. It is also a widespread problem among people with diabetes.
Part 4 of 6: Consider Additional Medical Treatments
Step 1. Consider taking sulfonylureas
These are drugs that lower the glycemic index by causing the pancreas to produce more insulin in order to regulate the blood sugar level. Glucose goes down so fast that it is necessary to take them with meals to maintain insulin balance. In this way, they prevent the sugar level from dropping so much that it goes into hypoglycemia.
- An example of hypoglycemic drugs is tolbutamide, which is prescribed between 500 and 3000 mg per day. It is produced in tablet form and can be safely given to patients with kidney disease and the elderly.
- An alternative is chlorpropamide. The daily dosage, in the form of tablets, is up to 500 mg. However, it can cause hyponatremia (low sodium concentration in the blood).
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The second generation hypoglycemic drugs are glibenclamide (Daonil, one 5 mg tablet per day), gliclazide (Diamicron, one 80 mg tablet per day, does not involve risks in case of kidney disorders), glipizide (Mindiab, a 5 mg tablet per day) and glimepiride (Amaryl, in 1, 2 and 3 mg tablets).
These drugs contain sulfanilamide. If you are allergic, consider other oral hypoglycemic agents. In addition, they should be prescribed with caution to patients with kidney disease and the elderly
Step 2. Try meglitinides
These are drugs that work by increasing the production of insulin by the pancreas. They take effect within one hour of taking. Usually, they are given about half an hour before meals to reduce the risk of hypoglycaemic episodes.
This class of drugs is aimed at lowering the glycemic index as they are metabolized. The indicated dose is 500 mg-1 g once or twice a day, depending on the patient's blood glucose values
Step 3. Consider the biguanides
They decrease the absorption of glucose in the gastrointestinal tract and its production by the liver. They also work by improving insulin resistance and increase anaerobic glucose metabolism. They are often used with sulfonylureas as adjunct therapy in obese patients. However, they do produce some side effects, such as stomach pain and diarrhea, and those with liver or kidney problems can develop lactic acidosis.
This class of drugs includes metformin (Glucophage, in tablets of 500 and 850 mg, with a daily dose of up to 2000 mg), repaglinide (Novonorm, 0, 5 or 1 mg to be taken before meals) and pioglitazone (Glustin, 15 or 30 mg once a day)
Step 4. In severe cases, consider a pancreas transplant
Pancreas transplantation can be done where the patient experiences severe diabetes-related complications. In these circumstances, it is possible to resort to the implantation of a healthy pancreas, which can regularly produce insulin. It is only recommended when all other roads have been beaten.
- The pancreas can be removed from a patient who has just died or part of it can be removed from a person who is still alive.
- Your doctor will be able to assess whether the prospect of an intervention is adequate for your needs. In most cases, insulin therapy, proper nutrition, and exercise are sufficient to manage diabetes.
Part 5 of 6: See Your Doctor
Step 1. Get a blood glucose test
To perform this test, it is necessary to refrain from consuming food and drinks, except water, for about 6-8 hours in advance in order to obtain accurate results. Normal fasting values are between 75-115 mg / dl. If they are at the limit (such as 115 or 120 mg / dl), the patient should undergo additional tests, such as the oral glucose tolerance test, or OGTT (Oral Glucose Tolerance Test).
The post-meal blood glucose test is usually given two hours after starting a meal or two hours of taking 75 mg glucose. Normal values are below 140 mg / dl. If they are higher than 200 mg / dl, they confirm the diagnosis of diabetes mellitus
Step 2. Alternatively, take an oral glucose tolerance test
Generally, it is done when the blood glucose test values are at the limit, when a person is suspected of having diabetes or in the case of gestational diabetes. With this test, the patient must follow a normal diet for at least three days, after which a fasting blood sample is taken and the glucose level is measured. It is necessary to empty the bladder before sampling.
- Adult patients are given 75 mg of glucose orally; in the case of pregnant women, a 100 mg glucose tablet is administered. Subsequently, blood and urine samples are taken at intervals, such as 30 minutes, every one, two and three hours.
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It is normal for fasting values to be below 126 mg / dl and after meals below 140 mg / dl, with a peak that does not exceed 200 mg / dl.
However, some abnormalities may be found in the OGTT, including impaired glucosuria or an absence of reactions. It happens when the difference between fasting and peak is about 20-25 mg / dl, due to dysfunction in absorption due to excessive insulin production
Step 3. Make sure you understand how to take and how to use your medications
In case of diabetes, the most important thing is patient education. In addition to the risks, interactions and side effects, you need to understand how drugs are taken, their mechanisms of action, why you need to take them, and why your doctor has prescribed them for you.
This awareness, combined with dietary control and physical activity, will allow you to better manage the disease and stem the development of any complications. At the same time, it will allow you to improve your lifestyle and keep yourself healthy
Step 4. See your doctor if you notice any changes
During medical visits, report any complications or new symptoms. Your doctor will carry out a physical exam to evaluate your neurological condition, will assess if your lower limbs have the typical signs of diabetic foot, ulcers or infections, and will prescribe all necessary tests, such as blood and urine tests, profile lipid, tests indicative of renal and hepatic functions and serum creatinine values.
Your doctor should talk to you about the risk of diabetic foot and encourage you to control it with prompt antibiotic therapy. In addition, to prevent the progression of gangrene it is useful to take care of your personal hygiene
Part 6 of 6: Understanding Diabetes
Step 1. Recognize the initial symptoms
At the beginning, this pathologist presented some not very evident symptoms:
- Frequent urination. In other words, the patient has to empty his bladder several times during the day and night. It occurs because the glycemic index rises and the absorption of water into the bloodstream increases. In turn, this phenomenon increases the amount of urine to be expelled.
- Increased thirst. Even if the patient takes a large amount of water (more than eight glasses a day), he cannot quench his thirst. It occurs because, by excreting more urine, the body remains dehydrated and, consequently, increases thirst.
- Increased hunger. The patient eats larger portions than usual. It occurs because the amount of insulin needed for the glucose transported to the cells to be used to supply energy to the body is lacking. In the absence of insulin, the cells have no glucose and trigger a feeling of hunger in the patient.
Step 2. Recognize the symptoms of the late stage
As the disease progresses, it manifests itself with gradually more severe symptoms:
- Presence of ketones in the urine. It occurs when carbohydrates and sugars in the body are inadequate due to increased blood sugar. The body breaks down stored fatty acids and fats to provide energy, and this process results in the formation of ketones.
- Exhaustion. In other words, the patient gets tired easily due to insulin deficiency. This hormone allows glucose to be transported to cells from which it is used to supply energy to the body. This process reduces the amount of glucose in the cells, causing fatigue.
- Delay in the healing process. It occurs in cases where the patient is injured and takes longer than usual to heal. This phenomenon is due to the increase in the glycemic index. The blood carries the nutrients needed for healing, and when glucose is in excess, nutrients are not properly delivered to the wound site, slowing healing.
Step 3. Know the risk factors
Some people are at an increased risk of developing diabetes due to circumstances they cannot manage. Risk factors include:
- Obesity. Diabetes is common in overweight people who have high cholesterol values. The latter is transformed into sugar and transported to the bloodstream. The increase in glucose is so high that, despite being partially assimilated by the cells, it remains in large quantities in the bloodstream, thus causing diabetes.
- Inheritance. Diabetes can develop in people with a genetic makeup who is resistant to insulin or whose pancreas does not produce sufficient amounts of this hormone.
- Sedentary lifestyle. Exercise is necessary for the body for the metabolism to function properly. When regular physical activity is not practiced, the glucose present in the blood is not properly absorbed by the cells, with the consequent risk of diabetes.
Step 4. Learn about diabetes-related complications
If treated, diabetes does not compromise quality of life. However, if left untreated, complications are numerous and the following can occur:
- Cell damage. The accumulation of alcohol within cells due to glucose causes osmotic damage that favors cellular lesions of the nerves, kidneys, lens and blood vessels. Therefore, try to prevent this damage as much as possible.
- Hypertension. Glycosylated collagen increases the thickness of the basement membrane and constricts the lumens, compromising the blood vessels of the retina. The result is that the blood vessels undergo sclerosis due to the glycation of proteins and glycogen. This phenomenon increases clotting and blood pressure.
- Xanthomas. It is the technical term for the formation of yellowish lipid plaques on the skin or eyelids due to hyperlipidemia.
- Skin complications. They are common in the form of fungal and bacterial infections, boils and neuropathic foot ulcers. They usually do not cause pain because the supply of oxygen and nutrients in the blood is insufficient and, as a result, neuropathy (damage to the nerves) and lack of sensation occurs.
- Eyesight problems. New abnormal blood vessels can form in the iris and, over time, cataracts can also develop in the lens.
- Complications affecting the nervous system. They include slowing the speed of nerve conduction, nephropathy, retinopathy and neuropathy as a result of the deterioration of small blood vessels in all vital organs.
- Macrovascular complications. They include atherosclerosis, coronary heart disease, stroke, peripheral ischemia especially in the lower limbs, and claudication (pain in the lower limbs).
- Foot gangrene. It is also known as "diabetic foot".
- Complications affecting the kidneys. They come in the form of urinary tract infections, often recurring.
- Gastrointestinal complications. They include constipation, diarrhea and gastroparesis with gastric dyspepsia.
- Complications affecting the genitourinary system. In men, impotence can arise due to poor blood circulation. On the other hand, vulvovaginal infections (infections of the lining of the vagina) and dyspareunia (pain during sexual intercourse, mainly due to vaginal dryness) are common in women.
Step 5. Learn the difference between type 1 diabetes and type 2 diabetes
The first type is mainly an autoimmune disease that causes an almost total deficiency in insulin production. Its onset is acute and, in most cases, patients are thinner and younger. Three out of four people have type 1 diabetes and develop it before the age of 20.
Type 2 diabetes involves a reduction in insulin production and resistance to this hormone. The body continues to produce it, but the muscles, fat and liver cells do not react properly. It requires higher amounts of insulin for the glucose tolerance threshold to be normal (without any value) and, consequently, the sugar index and the insulin index increase. Typically, the affected population is older, overweight or obese, and in most cases asymptomatic
Advice
- Flavor your dishes using healthy fats, such as those in nuts, olive oil or peanut butter, to eliminate the sugars and fats that are harmful to health.
- In the case of non-obese patients with type 2 diabetes, sulfonylureas are probably the first treatment option recommended by the doctor, followed by biguanides. Insulin therapy is prescribed if the former are not enough to stabilize the disease.
- Refrain from refined carbohydrates as they are not suitable for your health condition. They include cookies, chocolates, pastries, breakfast cereals, and most importantly, fizzy drinks.
- Dairy and milk-based foods are full of carbohydrates, so you should always avoid them.
- The consumption of white flour-based bread, rice and pasta is also responsible for worsening diabetes in patients with this disease.
- Eggs and meat contain unhealthy fats, so you can replace them with plant-based proteins, including beans, seitan, and legumes. You should try to eat these foods twice a day to bring your blood sugar levels back to normal. Green beans, azuki beans, and white beans help regulate blood sugar, so they are considered an effective remedy. Apart from these, fish is also effective!
- Vegetables, such as garlic and onion, are considered to be one of the best diabetes treatments.
- Try to increase your consumption of fruits, vegetables, and different types of salads. If you don't want to eat them directly, you can make extracts rich in vitamins and nutrients. Always refrain from consuming industrial foods, rich in chemical flavors and preservatives. The best solution is to eat organic foods.
- Grains such as oats, millet, wheat, rye, and amaranth can help you restore proper body functioning.
- Good fats are also present in nuts, pumpkin seed oil and olive oil.
- Margarine products contain industrial fats that are harmful to the pancreas.
Warnings
- It is important for the patient to know the symptoms of hypoglycemia (lowering of blood sugar levels) and to have a source of glucose available if needed. Signs of hypoglycemia include sweating, hunger, headache, and irritability. Preferable sources of glucose are milk, orange juice, or a simple candy.
- Patients with diabetes should not take more than 300 mg of cholesterol per day.
