Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia due to multiple etiologies. Hyperglycemia is caused by a defect in insulin secretion or action, or both. In addition to carbohydrates, there are abnormalities in protein and fat metabolism. Insulin resistance and B-cell failure are its main causes.
The International Diabetes Institute reported in 2003 that there are about 194 million people with diabetes (diagnosed) worldwide, and it will exceed 333 million by 2025. 21st century diabetes will be prevalent in Asian countries such as China, India and Japan. Currently, there are 25 million people with diabetes (diagnosed) in China, and with the potential population, the total number exceeds about 45 million. Nearly 60 million people have increased blood glucose, but fail to meet the diagnostic criteria for diabetes. There is one Chinese person in every five diabetic patients in the world. It is expected that the number of people with diabetes in China will reach 80 million in 2015. Diabetes has posed a great threat to the health of the people. Its complications causing disability and death have become the third largest disease in the world threatening human health at present. Therefore, it is crucial to detect and treat diabetes as early as possible to reduce complications.
Diabetes typing.
There are type 1 diabetes, type 2 diabetes, gestational diabetes and other special types of diabetes.
Type 1 diabetes: It refers to the absolute lack of insulin due to the destruction of insulin cells.
Type 2 diabetes mellitus: It refers to the predominant insulin resistance with insulin deficiency or insulin deficiency with or without insulin resistance.
Type 2 diabetes is common in obese people, especially those with abdominal obesity (general belly).
The onset of type 2 diabetes is insidious. Only 50% of people have the symptoms of “three more and one less” (three more: drink more, eat more, urinate more, one less: weight loss). It is most often detected by infection, vision loss, renal insufficiency, cardiovascular disease, limb numbness or health check-ups.
Gestational diabetes: refers to varying degrees of hyperglycemia caused by abnormal glucose tolerance that is detected or develops during pregnancy. Most women with gestational diabetes return to normal blood glucose after delivery.
Special type of diabetes: refers to diabetes that has a clear cause or other co-morbidities.
Diabetes-prone people.
1.Family history of diabetes mellitus.
2.People over 45 years old/obese.
3.Persons with long-term high-calorie diet.
4.Hypertension/hyperlipidemia/smokers.
5.People with a history of huge fetus pregnancy.
6.Persons with highly stressful work.
Diagnosis of diabetes mellitus.
There are many tests for diabetes mellitus. They include blood glucose, urine routine, blood insulin C-peptide, blood lipids, liver and kidney function, glycated hemoglobin, etc. But there is only one diagnostic criterion, which is blood glucose. The symptoms of diabetic patients are sometimes not obvious and easy to be ignored, so they must rely on blood glucose examination.
Diagnostic criteria.
1, diabetic symptoms + any event plasma glucose level ≥ 11.1mmol/L (200mg/dl).
2, fasting glucose level ≥ 7.0mmol/L (126mg/dl).
3, 2hPG (2 hours postprandial glucose) level ≥ 11.1mmol/L (200mg/dl) in oral glucose tolerance test (OGTT).
Note: The diagnostic criteria for diabetes mellitus in children are the same as those for adults.
Main symptoms of diabetes mellitus.
The vast majority of patients with diabetes mellitus have no typical clinical manifestations in the early stage, or even no symptoms. A significant proportion of patients are only discovered during physical examination or when complications occur. Therefore, attention should be paid to identifying early manifestations, and those who develop the following symptoms should seek medical attention and undergo diabetes screening as soon as possible.
1.People who lose weight rapidly in a short period of time, especially those who were originally obese appear to lose weight significantly in a short period of time, and at the same time feel fatigue and weakness, back pain.
2.Numbness, unresponsiveness and abnormal sensation in both hands and feet.
3.Recurrent episodes of skin itching, boils and ulcers that do not heal for a long time.
4.Recurrent episodes of vulvar itching or urinary tract infection symptoms such as urinary urgency, frequency and pain.
5. Unexplained sexual dysfunction, such as impotence, loss of libido, menstrual disorders or amenorrhea in women.
6, oral disorders, such as periodontitis, oral ulcers for a long time.
7, unexplained thrombotic diseases and peripheral vascular diseases
8.Symptoms such as unexplained panic, weakness, excessive sweating, trembling or obvious hunger often occur several hours after or before meals.
9.No obvious willingness to appear blurred vision, dryness of both eyes, vision loss.
10.Symptoms such as abdominal distension, dry and uneven stools, alternating diarrhea and constipation without obvious reasons.
11, family history of diabetes, history of trauma, history of hyperthyroidism, history of pancreatic or thyroid surgery, etc.
Hazards of diabetes mellitus.
It is mainly manifested in the following aspects.
Acute complications: can directly endanger the patient’s life: such as diabetic ketoacidosis, hyperglycemic coma syndrome with hypertonic non-ketosis, lactic acidosis, hypoglycemia, etc.
Chronic complications: the patient’s health and quality of life are greatly reduced, and even disability and premature death. For example: cardiovascular diseases (coronary heart disease, cerebral thrombosis, peripheral vascular occlusion, hypertension, etc.), dyslipidemia, diabetic retinopathy, cataract, diabetic neuropathy, diabetic nephropathy, sexual dysfunction, diabetic foot, infections (e.g. tuberculosis).
Uncontrolled diabetes in children can seriously affect their growth and development.
The vast majority of diabetes requires lifelong treatment, which is financially burdensome. Therefore, early detection, proper treatment, and reduction of harm are the top priorities of every diabetic patient. It is also the duty and responsibility of medical professionals who are involved in the prevention and treatment of diabetes.
What preventive measures should be taken by diabetic patients to reduce risk factors.
1. have regular checkups, including exercise stress test, electrocardiogram, lipid analysis, blood pressure check and urine microprotein test.
2. refrain from smoking and alcohol abuse.
3, control blood glucose, do daily blood glucose testing (once a week if blood glucose is stable) and monitor glycosylated hemoglobin (Hb1AC) about once every 2-3 years.
4, alert to hypertension (can further cause vascular damage, diabetes combined with hypertension requires blood pressure ≤ 130/80mmHg or less).
5. vigilance against hyperlipidemia (thickening of blood vessel walls).
6, appropriate exercise.
7, reasonable, balanced diet.
Diabetic dietary principles:
If you can not pay attention to good diet and nutrition, then type 2 diabetes is unlikely to be effectively controlled, and may also develop associated cardiovascular risk factors, such as hypertension, dyslipidemia and obesity. Nutritional principles include.
1. Moderate weight control.
2. 25-30% of total dietary calories should come from fats and oils.
3.Carbohydrate supply should account for 55%-65% of total calories, mainly complex carbohydrates and carbohydrates rich in soluble dietary fiber, such as vegetables and whole grains.
4.Protein should not be more than 15% of the total calories.
5.The choice of food can be guided according to the different food varieties of each country and according to local conditions.
6.Patients who take oral hypoglycemic drugs or use insulin should distribute the amount of food evenly every day.
Alcohol can cause hypoglycemia in patients treated with sulfonylurea or insulin.
8.Available non-caloric sweeteners (sorbitol and fructose)
9.Limit salt to 6g/day or less.
What foods can diabetic patients eat
Diabetic patients need to control the diet, for sweet food, staple food often have more restrictions. There are many low-sugar, sugar-free foods on the market today, and some “sugar-free” desserts, and even on the packaging of these foods, also marked with the words “specifically for diabetes”, in fact, all food, mostly processed from rice and flour, although marked with “The so-called “sugar-free mooncakes, sugar-free cookies”, diabetic patients should not indulge their appetite and enjoy their appetite.
The diet of diabetic patients is mainly to control the total calories, strictly speaking, as long as the total calories are within the permissible range, there is generally no restriction on the type of food, if the nutrition is balanced. Although fruit is high in sugar, the calories generated by eating fruit, if included in the total daily calories (then other foods should be reduced!) The diabetic patient can eat fruit “without restriction”.
”Eating too much” is one of the main symptoms of diabetes. “Hunger” is a major pain for diabetic patients. Therefore, the choice of foods to “feed” the patient is also an important part of the diabetic diet.
Diabetic patients should choose protein-rich food as a side dish. China produces soybeans in abundance, and a wide variety of soy products provide good dietary resources for diabetic patients. If conditions allow, lean meat, fish, duck, eggs, milk and other foods can be used. In terms of fat, you can eat soybean oil, peanut oil, canola oil, corn oil, etc. in moderation. Among animal fats, chicken oil and duck oil contain less saturated fatty acids than lard; while among vegetable fats, such as coconut oil and olive oil contain more saturated fatty acids. Therefore, animal fats should not be rejected in general or vegetable fats should not be applied blindly. The following vegetables can be preferred by diabetic patients: cabbage, rape, spinach, leek, cauliflower, green pepper, bitter melon, loofah, tomatoes, mung bean sprouts, lettuce, eggplant, hollow cabbage, etc.
All kinds of diets that cause a rapid rise in blood sugar in diabetic patients should be listed as contraindicated
1. Pay attention to fasting blood sugar but not postprandial blood sugar. There are many patients who do not have high fasting blood sugar, but have high postprandial blood sugar. And high postprandial blood sugar is harmful to cardiovascular and cerebrovascular.
2. Pay attention to blood glucose but not glycated hemoglobin. Blood glucose can only respond to changes within 10-15 minutes, glycated hemoglobin can respond to the overall level of blood glucose for 3 months, and it mainly responds to the level of postprandial blood glucose.
3.Can’t eat sweet food. Diabetic patients mainly can not eat food containing sucrose and glucose, for the food made with meringue, xylitol, Abasweet, etc. is allowed to intake.
4, do not eat staple foods. Diabetes diet is first of all a balanced diet, a certain ratio between various nutrients need to be maintained. If carbohydrates are not consumed in the proportion of 50-60%, it may lead to excessive decomposition of fat, ketosis, and even acidosis. Therefore, the amount of staple food for diabetic patients should not be less than 150-200 grams in general. The sugar content is about the same, flour is 75%, rice is 74%, millet is 74% and corn is 76%. Coarse grains are rich in plant fiber, and plant fiber can inhibit the absorption of intestinal glucose.
5, do not eat meat. If meat food intake is reduced, it will inevitably make the body protein deficiency, easily lead to reduced resistance of patients, more prone to infection. Lack of meat food recipes, because there is no fat satiety, patients are very easy to hunger, so it is not easy to adhere to the diet treatment.
6, fine grains contain high sugar, coarse grains contain low sugar. The fiber of coarse and fine grains can inhibit the absorption of glucose in the intestine.
7, nuts contain very low sugar, it is okay to eat. Melon seeds, peanuts low in sugar, but high in fat, 100 grams of peanuts contain the same amount of calories as 200 grams of steamed buns. And fat in the body can become sugar.
8, the fruit contains high sugar content. The sweetness of fruit is mainly determined by fructose, but the metabolism of fructose does not require insulin. If the post-meal blood sugar is lower than 10, you can consume some fruits. It is best to eat fruit between two meals with additional meals, not only to not too high blood sugar, but also to prevent hypoglycemia from occurring. The sugar content of fruit is 4-20%, watermelon is 4%, apple pear is 10%-14%, banana is 20%.
9, diabetes can smoke. Smoking can lead to diabetic foot.
1, dietary treatment of thought preparation: In the early stage of diabetic diet therapy, it is a difficult task for patients and their families. In want to eat more and can not eat more, love to eat and can not eat the contradiction, must recognize the occurrence of diabetes, development, prognosis and the relationship between diet therapy, firm confidence, adhere to diet therapy.
2, appropriate control of the amount of staple foods: in general, resting patients eat staple foods (rice, noodles, corn, millet, buckwheat, etc.) 250-300 grams per day; light manual laborers 350-400 grams per day; heavy manual laborers 450-550 grams per day. Foods high in carbohydrates such as sweet potatoes, potatoes, yams, lotus vegetables, vermicelli, vermicelli, etc., can reduce the amount of staple foods accordingly if consumed. After the blood sugar drops and urine sugar (+) is reduced, the staple food can also be increased appropriately by 25-50 grams. Staple food should be consumed in rotation or mixed to improve the nutritional value. Patients should pay attention to summarize the change rule between meal and blood sugar and urine sugar, so that the condition is stable and the staple food is fixed, and the condition fluctuates and timely adjustment is made. To be flexible and specific application to adapt to the needs of the body, so that the weight is maintained within the standard range
3, control diet in no way means to eat as little as possible, because long-term hunger, calorie deficiency can lead to the body’s own consumption, not only will appear wasting, resistance to weaken, and can aggravate diabetes. Therefore, diabetic patients should follow medical advice, reasonable arrangements for the total daily calories, protein, fat and carbohydrates in the appropriate proportion, set out their own more ideal recipes.
4, diabetic patients daily meal time, the number of meals should remain somewhat stable, try not to snack, quit smoking, avoid alcohol.
5, middle-aged and elderly diabetics and combined with coronary heart disease, hyperlipidemia patients, in the diet also strictly limit the intake of cholesterol. Animal fat, animal offal contains high cholesterol, should eat less or not, eggs up to two per day.
6, food should be coarse rather than fine. In the quantitative range of staple foods as much as possible to eat more coarse grains and legumes, vegetables, to green leafy vegetables, such as rape, cabbage, leeks, spinach, celery, etc.. These foods are rich in vitamins and inorganic salts, but also contains more crude fiber, can effectively prevent the absorption of blood sugar too fast, and lower cholesterol, prevent atherosclerosis and the role of constipation.
7, strictly limit sucrose and sweets. Diabetic patients should not eat table sugar, candy, honey and sweets and sugary drinks. These high-sugar foods are easily absorbed by the body and contribute to the increase in blood sugar, increasing the burden on the pancreas, thereby aggravating the disease.
8, the patient and family members to learn some knowledge of nutritional therapy, basic mastery of the main nutrients contained in commonly used foods, especially the amount of sugar. At the same time, to understand which foods can be eaten, which foods can be eaten less, which foods are forbidden, to be aware of, but also know the nutritional value of food interchange law.
9, can diabetics eat fruit, which is a great concern to patients and families. Fruits contain high fructose and glucose, and easy to digest and absorb, so eat fruit will make a rapid rise in blood sugar, to the detriment of the patient. However, it is not possible to prevent patients from eating fruits in general. It should be flexible according to the control of blood sugar and urine sugar of the patient. If fasting blood sugar does not exceed 11 mmolh (2000 mg/dl), urine sugar does not exceed 3 plus, and there is no ketoacidosis, you can eat a small amount of fruit, but you have to control it well, do not eat a lot, and eat up to 150-200 grams a day. According to the determination: bananas, oranges, apples, pears contain medium sugar: melon, watermelon, cherries contain less sugar, can be preferred to eat; tomatoes, cucumbers contain very low sugar, can be appropriate to eat more instead of fruit.
If diabetic patients can follow the above dietary requirements carefully, and persistently, to control the disease, the prevention of comorbidities will be effective.