Treatment of Diabetes Mellitus

Diabetics who know more about the disease, its complications and how to cope with it can live longer than those who are aware about it.

Diabetes is a disease which can be controlled by Diet, exercise, oral medications and Insulin. There is no shortcut as regard management of diabetes is concerned. Treatment plan has to be discussed with patient. He has to be informed about side effects of medicines and about complications of Diabetes which will develop if untreated. It requires patience by both patient as well as his or her relatives. Chances of complications can be significantly reduced if Blood Sugar is kept under control.

Diet

The most important thing you can do to balance your Blood Sugar is to eat the right food. You should follow a well balanced food plan. Each person requires different amount of calories per day depending upon weight, height and type of work the individual is doing. Food you eat consists of carbohydrate, protein, fat, vitamins, minerals, fibre and water. Each one gm of carbohydrate gives 4 calories, I gm of fat gives 9 calories and each 1 gm of protein gives 4 calories. Extra weight puts a strain on your system. Your body is less able to use Insulin, and it is difficult for your tablets to control your blood Sugar. Extra weight leads to poor control of Diabetes and may contribute to serious complications. Your doctor will help you to lose weight. Don't try to lose weight any faster than 0.5 kg per week.

Your Diet Contains

Carbohydrate which provides 50 to 60% energy. This is present In sugar, honey, jam, cereals, flour, bread, rice, and dairy products.

Protein: Is required for growth and provides 10 to 20% energy. Protein is present in milk, milk products, meat, nuts, eggs, cereals and pulses.

Fat: Fat provides 30% of energy. Fat consists of fatty acids, and glycerol.

1. Fat Rich in Saturated Fatty Acids: Animal fat (meat products), Dairy products (ghee, butter, cream), and coconut oil. Animal fat contains plenty of cholesterol.
2. Mono Saturated Fats: These are: olive oil, plam oil, ground nut oil.
3. Fat Rich in Poly-Unsaturated Fatty Acids (PUFA): These are, sun flower oil, safflower oil, soyabean oil, corn oil, cotton seed oil, fish oil, High temperature destroys the structure of above oils (PUP A). Hence deep frying should be avoided.

Fibre in Diet: Includes indigestible plant cell components present in diet. These are present in cereals, pulses, vegetables, fruits and nuts.

Fibre is of two types.

One: Which is present in skin, and husks of fruits. It helps in preventing constipation as it has laxative effect.

Other type: It holds water and form gel. Isafgol is an important source, other sources are fenu greek, oats, barley, plums, raisins beans and carrots.

Fibre in diet helps in

1. Controlling diabetes by preventing excessive rise in blood glucose after meals.
2. Helps in decreasing blood cholesterol and triglycerides so less chances of getting heart attack.
3. Helps in reducing weight: Becomes bulky and gives feeling of fullness thereby lowers appetite and calorie intake.

How Much Calories are Needed

If you are over weight- 20 cal/kg/day
If you are ideal weight -30 callkg/day
If you are under weight-40 callkg/day

Weight is calculated as per the height and body frame tables.The basic principles behind creating high quality Health Foods are:

1. Add alteast 2% dietary fibres to all preparations.
2. Use only those ingredients which are rich in fibres, vitamins, minerals and flavonoids, such as, whole grains, vegetables/fruits.
3. Use ingredients which are rich in EFAs, sterols and antioxidant Vitamin E, like wheat germs, soyabean, sesame and almond/apricot.
4. Keep density of foods light and make these balanced, i.e. proper ratio of proteins, carbohydrates, fibres and fats.

Artificial/Alternate Sweeteners-Saccharine

Saccharine should be added after cooking not before cooking. Saccharine should be avoided in pregnancy. Use should be restricted to a maximum of7 tablets.

Aspartame - 1 packet contains 35 gm aspartame. Available as Sweeter, sugar free, equal etc. All above sweeters should be avoided in pregnancy and in children.

Alcohol - One has not to give up alcohol because he is diabetic. You should keep the use within sensible limits--( one or two drinks, i.e. 30-45ml of alcohol). Alcohol provides empty calories. It can interfere with tablets you take for diabetes control and may cause very low Blood Sugar.

Fruits

Which fruits and vegetables can be taken

• Fruits are good low calorie snack with valuable fibre, vitamins and minerals. Fruit juices may be taken in small quantity, if at all.
• Salad vegetables are filling and also valuable sources of vitamins, minerals and fibre.
• Pulses vegetables, e.g. peas, beans and lentils have a beneficial effect on blood glucose and lipid levels andare a good source of Protein with soluble fibre.
• Encourage fruit and vegetable as a part of overall healthy eating.

Fats

• Fats are Major Source of Energy and to cut down on fat intake is important especially if weight reduction is required.
• Hidden source of fats-Biscuits, fatty meals, pies, pastry, full fat dairy products, should be avoided.

Protiens

• Avoid excessive Proteins in long standing diabetes if patient is passing protein in urine. Proteins are restricted in diet.
• Pulses - Peas, beans, lentils are high in soluble fibre and Iron. Fish can be taken - 2-3 times in a week.

Which Sweeteners

Not Honey As It Equates With Sugar Non-nutritive sweetners, e.g., Saccharine, Aspartame are suitable especially if weight is a problem. Avoid Sorbitol and Fructose.

Ghee or Refind Vegetable Oil

There has been a sudden and sharp rise in prevalence of many diseases specially heart disease, kidney disease and Diabetes. It is because, we have deviated from our traditional low fat diet and have adopted fast food culture.

This fast, fatty, fried, refined, processed and preserved food has ill-balanced high fat content. It is deficit in an important essential fatty acid which is found in' green leafy vegetables, mustard oil and seeds, fish oil, flax seed, and methy. This type of food contains n:6 fatty acids and high content of nsaturated fats.

People have been using ghee, butter and milk and yet they were having good health. Since the case of these vegetable redefined oils, there has been sharp increase in use of diabetes and heart diseases. Intake of storage fat and refined vegetable oils lead to weight gain and obesity. These adverse effect can be attributed to high content of olyunsaturated n:6 fat contained in these animal fats and vegetable oils. Cholesterol in ghee and milk is limited in quantity. Indians consuming typical Indian diet do not get even the half the required quantity of cholesterol. One can use 2-3 teaspoon full of Ghee per person per day or 1/2 kg per month. Don't fry the items in Ghee. In India we have used these for centuries without any harm. The reason was people were using ghee, milk or butter and were doing regular exercise. Life was not sedentary as it is today. You can use Desi Ghee, milk and butter but should do regular exercise for at lease 30 minutes a day.

Dietitian

Every Diabetic should consult Dietitian who is expert in food and nutrition. Dietitian can help you to find out your food needs based on your weight, lifestyle and the type of treatment you are taking.

Fats in Blood

Fats include Cholesterol and Triglycerides. Our body make cholesterol and triglycerides. We can also get them from animal foods.

Cholesterol is used by body for making cell walls and certain vitamins and minerals. Triglyceride is stored fat, and gives you energy reserves. Triglycerdes keep you warm and protect the body organs.

Triglycerides and cholesterol are carried in Blood by Lipoproteins.

1. ULDL: Carries cholesterol and triglycerides and other fats in fat tissues.
2. Low-Density Lipoprotein (L.D.L.): L.p.L. carries cholesterol to parts of the body that need it. L.D.L. can stick to blood vessel walls. Cholesterol on Blood vessel wall leads to occlusion and thus coronary Artery Disease. The less L.D.L. in your Blood, the better.
3. High Density Lipoprotein (H.D.L.): It carries cholesterol away from the blood vessel walls to the liver. Liver breaks the cholesterol down and sends it out of the body. The more H.D.L. in your blood, the better.

What should be your Blood fat Levels

• Total Cholesterol LESS THAN 180 Mg/dl
• L.D.L. Cholesterol LESS THAN 100 Mg/dl
• H.D.L Cholesterol MORE THAN women >55Mg/dl, Men> 45 Mg/dl
• Triglycerides LESS THAN ISO Mg/dl

How to Improve Your Blood fat Levels

• Control Your. Blood Sugar Levels.
• If you are over-weight, then lose few kilograms. Losing weight raises your good H.D.L. Cholesterol.
• More fat you eat, the more V.L.D.L. the liver makes More V.L.D.L. Means Bad L.D.L. Cholesterol.
• Replace saturated fats (Desi Ghee and Butter) with unsaturated fats (Vegetable oils). Saturated fats raise your L.D.L. and unsaturated fats lower them.
• Avoid foods which have high Cholesterol.
• Eat foods, high in fiber. Beans, peas, fresh fruits are rich in fiber.
• Aerobic exercises such as brisk walk, jogging, and swimming, raise your good H.D.L. Cholesterol.
• Smoking lowers good H.D.L. Cholesterol. So quit or cut down.

Have your Lipid profile tested at least once a year

Diabetes and High Blood Pressure

People with Diabetes are more likely to have high blood pressure than non-diabetics. High blood pressure is a Risk factor for having a heart attack, or stroke and may cause or worsen kidney disease and retinopathy (eye disease).

Blood pressure is the force of your blood as it travels through your blood vessels. The higher your blood pressure, the more force on your blood vessels and this can weaken and damage blood vessels and finally damages organs and nerves.

Diabetic patients have high blood fats and these high levels make them prone to develop heart disease, heart-attack, and stroke.

Symptoms

High Blood Pressure (Hypertension) leads to

• Weakness, Headache,
• Fatigue, Tiredness
• Irritability

On each visit to your doctor you must get your blood pressure checked. It is reported as systolic and diastolic Blood pressure. Systolic Blood Pressure is the force of your blood when your heart contracts. Diastolic pressure is the force of your blood when heart relaxes.

Blood pressure is written as 130/80 mm of Hg 130 is Systolic Blood pressure. 80 is Diastolic Pressure. It is measured as m.m./hg.

Target Blood Pressure

In adults with Diabetes

• Normal less than 130/80
• Mild hypertension 130/80 to 140/90
• Moderae Hypertension '140/90 to 160/1 00
• Severe Hypertension 160/100 and above

Many people still think Blood pressure for different age groups is different. They calculate Blood Pressure as age + 100.

This is wrong. For all adults blood pressure should be less than 130/80.

In patients with Type I Diabetes, High Blood Pressure is often caused by underlying diabetic kidney disease.

In Type II Diabetic patients it is present in more than 50% of cases at the time of diagnosis, as a part of diabetic metabolic disorder.

Aggressive blood pressure control reduces the vascular complications of diabetes.

To Lower Your Blood Pressure

1. Reduce excess weight :- Loosing few kg weight can bring your blood pressure to normal. Best way to lose weight is to follow a weight-loss diet and an exercise programme.
2. Stop Smoking :- Smoking plays important role in causing blood pressure by damaging blood vessls. Stopping smoking can help not only in lowering the risk of Hypertension related death but also reduces the number of blood pressure controlling medicines.
3. Reduce Alcohol lntake:- More than 60ml intake of alcohol everyday may cause high blood pressure. 30ml alcohol twice or three times a week may be taken if one cannot live without it.
4. Eat less salt :- Reducing the amount of salt may be enough to lower your blood pressure.
5. Reduce stress :- Stress may increase your blood pressure. During stress blood vessels constrict and Heart has to work hard. If blood pressure does not come down then your doctor may put you on drugs to lower your blood pressure.