DIABETES (DIABETES MELLITUS)
DEFINITION:
Diabetes mellitus is a disease characterized by carbohydrate, protein and fat metabolism disorders that occur as a result of insufficiency or deficiency of insulin hormone secreted from the pancreas. It is chronic and progressive. It is a disease that requires lifelong medical treatment and medical nutrition therapy for the individual. Treatment is as important as diagnosis.
CLASSIFICATION:
- Type 1 DM: It arises with insulin deficiency as a result of damage to pancreatic cells and is an insulin-dependent progressive type.
- Type 2 DM: It is a non-insulin dependent type characterized by insulin resistance.
- Gestational Diabetes: It is the type of diabetes that occurs during pregnancy. Diagnosis can be made at 24 to 28 weeks.
- Other Specific Types: Includes certain genetic syndromes, exocrine pancreatic diseases, endocrinopathies, drug- or chemical-associated diabetes.
CLINICAL FINDINGS:
- GLYCOSURIA (excretion of glucose in the urine as a result of hyperglycemia)
- POLYURIA (increased water output with urine)
- POLYDIPSY (constant desire to drink water as a result of water loss)
- POLYPHAGIA (increased feeling of hunger)
- TIREDNESS
- LATE HEALING OF SKIN WOUNDS
- Frequent Infection
- BLURRED VISION
COMPLICATIONS:
When the necessary treatment principles are not applied in diabetic patients, blood sugar remains high and may cause complications. For this reason, individuals with diabetes should not neglect their controls.
Diabetic ketoacidosis: Due to insulin deficiency, carbohydrates cannot be used enough and the body starts to provide energy from fats. As a result, ketones appear in the blood and urine. Infection, insufficient insulin therapy, excessive carbohydrate intake, eating disorders are among the causes of diabetic ketoacidosis.
Diabetic Nonketotic Hyperosmolar Coma: Diabetes is characterized by hyperglycemia (plasma glucose>500 mg/dL), dehydration without ketoacidosis.
Hypoglycemia: It is characterized by plasma glucose being 50 mg/dL and below. Tremors, palpitations, weakness, sleepiness, and speech difficulties are among the symptoms. Hypoglycemia may be caused by skipping meals, failure to administer medical treatment or dose errors, and heavy exercise.
Nephropathy, Retinopathy, Neuropathy, Gastroparesis, Constipation, Atherosclerosis, Diabetic foot
DIAGNOSTIC CRITERIA:
Diabetes diagnosis criteria for the American Diagnostic Society (ADA) and the World Health Organization (WHO) are as follows:
– Fasting blood glucose level ≥126 mg/dL, or
– 2nd hour blood glucose level ≥200 mg/dL in the oral blood glucose tolerance test (OGTT), or
– Random blood glucose level ≥200 mg/dL and the presence of classic symptoms of diabetes (polyuria, polydipsia, nocturia, enuresis, weight loss, polyphagia), or
-HbA1c> 6.5%
TREATMENT:
Insulin therapy, nutrition and exercise are a combination for diabetes treatment. Treatment should aim to reduce chronic complications by providing optimal glycemic control. Studies show that correct and adequate administration of insulin therapy reduces the risk of cardiovascular complications.
To reduce the risk of complications arising from diabetes, smoking should be avoided and blood pressure and cholesterol levels should be kept within appropriate ranges.
Nutrition programs of diabetic patients should be specially planned by the dietitian. The person’s height, weight, blood parameters, drugs used are important data for the program prepared.
SUGGESTIONS:
- Complex carbohydrates, which take longer to digest, should be preferred instead of simple carbohydrates.
- Nutrition program should be sustainable for life and should be made into a lifestyle.
- It should be known that the consumption of legumes, vegetables, fruits, whole grain bread is important.
- Saturated fat consumption should be avoided and healthy fats such as olive oil and butter should be consumed.
- Pastry, fried food, packaged foods should not be preferred.
- Water consumption should not be neglected during the day, care should be taken to consume an average of 2-2.5 liters of water per day.
- Exercise is as important as nutrition and medication.
- Nutrition program should include the number of meals as the patient needs, and if there is no opposite, it should be aimed at maintaining the ideal weight.
- Fiber slows down the absorption of carbohydrates, so foods high in fiber are important to keep sugar levels under control.
- Avoid foods with high glycemic index.
- Consumed foods should be grilled, baked or boiled.
- Omg-3 intake is important, so fish consumption is recommended 2 days a week.
- Fat, sugar and salt should be consumed as little as possible.
- Insomnia and stress make it difficult to comply with the diet and can lead to weight gain.
