Type 2 diabetes: diet and treatment

Type 2 diabetes

Type 2 diabetes mellitus (DM) is a common chronic noncommunicable disease. It affects both men and women, most often after the age of 40. Many underestimate the danger of type 2 diabetes and, in fact, some patients are simply not told that they are susceptible to the disease. And those of the patients who are aware of their pathology often do not know what it is - diabetes mellitus, what it threatens, and they are unaware of its danger. As a result, type 2 diabetes can become severe and lead to life-threatening conditions. Meanwhile, proper treatment and proper nutrition in type 2 diabetes can stop the development of the disease.

Causes

When a person develops diabetes, the causes of this fact can be varied. The second type of disease often leads to:

  • wrong diet;
  • lack of physical activity;
  • overweight;
  • inheritance;
  • stress;
  • self-medication with drugs, for example, glucocorticosteroids.

In fact, there is often no prerequisite, but a whole complex of reasons.

If we consider the appearance of the disease from the point of view of pathogenesis, type 2 diabetes mellitus is caused by a relative lack of insulin in the blood. This is the name of the state when the insulin protein produced by the pancreas becomes inaccessible to insulin receptors located on cell membranes. As a result, the cells are deprived of the ability to absorb sugar (glucose), which leads to a lack of glucose supply to the cells, and also, no less dangerously, to the accumulation of glucose in the blood and its deposition in various tissues. Based on this criterion, non-insulin-dependent diabetes mellitus is distinguished from type 1 diabetes, in which the pancreas produces insufficient insulin.

Symptoms

The symptoms of the disease largely depend on the stage of the disease. In the early stages, the patient may not feel a serious ailment, with the exception of increased fatigue, dry mouth, increased thirst and appetite. This condition is usually attributed to improper diet, chronic fatigue syndrome, stress. However, in fact, the cause is latent pathology. As the disease progresses, symptoms may include:

  • poor wound healing
  • weakening of the immune system
  • pain and swelling in the extremities,
  • Headaches,
  • dermatitis.

However, patients often fail to interpret even one set of such symptoms correctly, and diabetes progresses unhindered until it reaches untreatable stages or leads to life-threatening conditions.

Type 2 diabetes mellitus, treatment

In fact, there are no sufficiently effective methods that increase the absorption of glucose by cells, so the main emphasis in treatment is on lowering the concentration of sugar in the blood. In addition, efforts should be aimed at reducing the patient's excess weight, normalizing it, since the abundance of adipose tissue plays an important role in the pathogenesis of diabetes.

The main factor influencing the likelihood of complications in type 2 diabetes is a violation of lipid metabolism. An excessive amount of cholesterol that differs from the norm can lead to the development of angiopathy.

The risk of developing angiopathy in diabetes Small Means, medium High
Total cholesterol, mmol/l <4. 8 4. 8-6. 0 >6. 0
LDL, mmol/l <3, 0 3. 0-4. 0 >4. 0
Triglycerides, mmol/l <1. 7 1. 7-2. two >2. 2

treatment methods

Type 2 diabetes mellitus is a disease that requires prolonged and persistent treatment. In fact, all the methods used are divided into three groups:

  • taking drugs,
  • diet,
  • lifestyle change.

Effective treatment of type 2 diabetes involves the fight not only with diabetes itself, but also with concomitant diseases, such as:

  • obesity,
  • hypertension,
  • angiopathy,
  • neuropathy,
  • depression.

Type 2 diabetes is treated on an outpatient basis and at home. Only patients with hyperglycemic and hyperosmolar coma, ketoacidosis, severe forms of neuropathy and angiopathy, and cerebrovascular accidents are subject to hospitalization.

diabetes medications

In fact, all medications fall into two main groups: those that affect insulin production and those that don't.

The main drug of the second group is from the class of biguanides. This medication is most often prescribed for type 2 diabetes. Without affecting the cells of the pancreas, it maintains blood glucose at normal levels. The drug does not threaten a critically low decrease in glucose levels. In addition, the drug burns fat and reduces appetite, which leads to a decrease in the patient's excess weight. However, an overdose of the drug can be dangerous, since a serious pathological condition with a high mortality rate can occur - lactic acidosis.

Typical representatives of another group of drugs that affect insulin production are sulfonylurea derivatives. They directly stimulate the beta cells of the pancreas, causing them to produce more insulin. However, an overdose of these drugs threatens the patient with a hypoglycemic crisis. Sulfonylurea derivatives are usually taken together with biguanides.

There are other types of drugs. Incretin mimetics (GLP-1 agonists) and DPP-4 inhibitors belong to the class of drugs that enhance insulin production depending on glucose concentration. These are new drugs, and so far they are quite expensive. They inhibit the synthesis of the sugar-increasing hormone glucagon, enhance the action of incretins, gastrointestinal hormones that increase insulin production.

There is also a drug that prevents the absorption of glucose in the gastrointestinal tract: an alpha-glucosidase inhibitor. This tool does not affect the production of insulin. The drug is often prescribed for prophylactic purposes, to prevent diabetes.

There are also drugs that improve the excretion of glucose in the urine and drugs that increase the sensitivity of cells to glucose.

Medical insulin is rarely used in the treatment of type 2 diabetes. Most often, it is used with the ineffectiveness of therapy with other drugs, with a decompensated form of diabetes mellitus, when the pancreas is exhausted and cannot produce enough insulin.

Type 2 diabetes is also often accompanied by comorbidities:

  • angiopathy,
  • depression
  • neuropathies,
  • hypertension
  • Lipid metabolism disorders.

If such diseases are found, drugs are prescribed for their treatment.

Varieties of drugs for the treatment of type 2 diabetes.

Writes Mechanism of action
Sulfonylureas stimulation of insulin secretion
Glinids stimulation of insulin secretion
biguanides decreased production of glucose by the liver and tissue resistance to glucose
Glitazones decreased production of glucose by the liver and tissue resistance to glucose
Alpha-glucosidase inhibitors slow absorption of glucose in the intestine
Glucanogon-like peptide receptor agonists glucose-dependent stimulation of insulin secretion and decreased glucagon secretion
Gliptins (dipeptidyl peptidase-4 inhibitors) glucose-dependent stimulation of insulin secretion and decreased glucagon secretion
insulins increased glucose utilization

Diet

The essence of changing the diet in DM is the regulation of nutrients entering the gastrointestinal tract. The necessary nutrition must be determined by the endocrinologist individually for each patient, taking into account the severity of diabetes, concomitant diseases, age, lifestyle, etc.

There are several types of diets used for non-insulin dependent diabetes (table number 9, low carbohydrate diet, etc. ). All of them have proven themselves and differ from each other only in some details. But they agree with the basic principle: the norms of carbohydrate intake in case of illness should be strictly limited. First of all, this applies to products that contain "fast" carbohydrates, that is, carbohydrates that are very quickly absorbed in the gastrointestinal tract. Fast carbohydrates are found in refined sugar, jams, sweets, chocolate, ice cream, desserts, baked goods. In addition to reducing the amount of carbohydrates, it is necessary to strive to reduce body weight, since weight gain is a factor that aggravates the course of the disease.

Other instructions

It is recommended that you increase your water intake to replace fluid loss due to frequent urination that often accompanies diabetes. Along with this, it is necessary to completely abandon sugary drinks: cola, lemonade, kvass, juices and tea with sugar. In fact, you can only drink drinks that do not contain sugars: mineral water and plain water, tea and coffee without sugar. It should be remembered that drinking alcohol can also be harmful, due to the fact that alcohol disrupts glucose metabolism.

Meals should be regular - at least 3 times a day, and best of all - 5-6 times a day. You should not sit at the dinner table immediately after exercise.

How to control blood glucose levels

The essence of diabetes therapy is self-control by the patient. In type 2 diabetes, the blood sugar level should be within or close to the normal range. Therefore, the patient needs to control his sugar level by himself to avoid critical increases. To do this, it is advisable to keep a diary in which the values of the concentration of glucose in the blood will be recorded. You can perform glucose measurements with special portable glucose meters equipped with test strips. It is advisable to carry out the measurement procedure every day. The best time to measure is early in the morning. Before the procedure, it is forbidden to take any food. If possible, the procedure can be repeated several times a day, and the sugar level can be determined not only in the morning on an empty stomach, but also after meals, before bedtime, etc. Knowing the blood glucose change graph, the patient can quickly adjust his diet and lifestyle, so that the glucose indicator is in the normal state.

However, the presence of a glucometer does not exempt the patient from the need to regularly monitor blood sugar levels in the outpatient clinic, since the values obtained in the laboratory are more accurate.

It is not that difficult to control sugar levels when consuming food, since most foods are labeled with their energy value and the amount of carbohydrates they contain. There are diabetic analogues of conventional food, in which carbohydrates are replaced by low-calorie sweeteners (sorbitol, xylitol, aspartame).

Fasting blood sugar level

Stage Glucose level, mmol/l
state of the rule 3. 3-5. 5
Impaired glucose tolerance 5. 6-6. 0
diabetes, early stage 6. 1-8. 0
Diabetes, middle stage 8. 1-14. 0
Diabetes, severe stage >14. 1

Fruits and vegetables

Is it possible to eat fruits and berries with type 2 diabetes? Preference should be given to vegetables that contain a large amount of indigestible fiber, but useful for digestion, and less sugar. However, many vegetables, such as potatoes, beets, and carrots, are high in starch and should be limited. Fruits can be consumed in moderation, and only those that do not contain very high amounts of carbohydrates. Among fruits, bananas hold the record for carbohydrate content, followed by grapes and melons. Their use is not recommended as they can increase blood sugar levels.

Home remedies

Folk remedies involve taking decoctions of medicinal herbs. Such therapy can not only lower blood glucose levels, but also reduce appetite and reduce excess weight. However, home remedies can only be taken in addition to taking medication and in consultation with your doctor.

Physical exercise

An auxiliary method of therapy is physical exercises. During moderate-intensity exercise, the body burns large amounts of glucose. The metabolism returns to normal, the cardiovascular system is strengthened. Physical exercise is essential every day. However, the exercises should not be strenuous, as this can only achieve the opposite effect. With severe fatigue, appetite increases, and a large meal can cancel out all the positive effects of physical activity. Fatigue causes stress and the release of adrenal hormones, which increases blood glucose levels. Therefore, it is recommended to select the type of physical activity that suits the patient's athletic form: simple exercises, exercises with dumbbells or walking, jogging, swimming, cycling.

Energy costs for various activities.

type of activity Costs, kcal/h Foods that contain a similar amount of energy
rest lying down 80 apple, 20 g walnuts
rest sitting hundred apple, 20 g walnuts
foot rest 140 a glass of milk
Homework 180 a glass of milk
Slow walking, light field work 220 120g of ice cream
Cycling 250 100g of white bread
Walk fast, swim slow, dance slow, row 300 150 g of black bread
volleyball, badminton, table tennis 350 90g crackers or cheese

Forecast

In severe cases, when type 2 diabetes mellitus reaches the stage of decompensation, then, as a rule, it is already impossible to reverse the disease and return glucose levels to normal, due to the depletion of the resources of the pancreas and the body as whole. Therefore, type 2 diabetes in such a situation is an incurable disease. However, correct treatment of type 2 diabetes can prolong the patient's life for many years. In the initial stage of type 2 diabetes mellitus, it is possible to control the concentration of glucose in the blood and keep it within acceptable limits only by changing the diet and lifestyle, and increasing physical activity. As a result, the patient can live for many decades and not face any diabetes complications.