Nutrition in diabetes: basic rules and permitted foods

Diabetes is currently a global problem. Over the past ten years, the number of people suffering from diabetes has more than doubled to 425 million, and according to forecasts, by 2045, their number may reach 629 million.

Diabetesis a group of endocrine diseases associated with impaired absorption of glucose and developing as a result of an absolute or relative deficiency of the hormone insulin, which leads to the development of hyperglycemia - a constant increase in blood sugar levels. This disease is characterized by a chronic course, as well as a violation of all types of metabolism due to a violation of carbohydrate metabolism; the fat, protein, mineral and water-salt exchange is also disturbed.

Let's look at the reasons for the development of this disease. Type 1 diabetes is characterized by the destruction or destruction of pancreatic cells. This usually leads to absolute insulin deficiency. The development of type 1 diabetes involves both genetic factors and environmental factors - viral infections, nutrition, toxins, hygiene. Type 2 diabetes mellitus is characterized by the development of insulin resistance and relative, rather than absolute, insulin deficiency and is manifested by persistent hyperglycemia. The main problem with any type of diabetes is the increase in blood sugar levels and carbohydrate starvation of the cells, since glucose cannot enter it, but floats around in the blood.

Treatment of diabetes mellitus is based on diet. The general principles of nutrition, regardless of the type of diabetes, are that the patient is recommended to reduce the carbohydrate load in the diet to 5-7% and increase the consumption of vegetable fats. Previously, diabetics were advised to completely eliminate simple carbohydrates, but today there is an increasing emphasis on personalized diets with individual selection of food baskets and caloric calculations. At the moment, the slogan is very popular: "There are no restrictions in diabetes, there is only the right way of life".

The diet for diabetic patients is based on the glycemic index. Basically, this index reflects the speed with which sugar from them is absorbed into the blood. Products with a high index - jam, biscuits, cakes - have a high degree of absorption. Products with a low index - cereals, fruits - have a lower index. The slower the absorption rate, the easier it is for the pancreas to cope with the load. Thus, foods with a GI of up to 55 are broken down gradually and hardly cause a rise in sugar.

Also, do not forget about the insulin index of foods, which reflects the degree of increase in insulin in response to food consumption. The insulin index of foods is important to consider for people with diabetes in order to predict the body's reaction to the consumption of certain foods and to correctly calculate the doses of insulin preparations (short and long-acting) that will be used for injection afterfeeding.

Any meal, even protein, provokes a large release of the hormone insulin. And the more insulin fluctuations you have throughout the day, the more likely you are to develop insulin resistance, which will eventually lead to type 2 diabetes. Favorite breakfast options in the form of dairy and fermented milk products, such as cottage cheese, kefir and yogurt, havea very, very high insulin index, which means that the insulin swing will swing very hard along with your mood and irritability.

Let's look at different options and characteristics of diets depending on the type of diabetes.

Basic rules for nutrition in type 1 diabetes

With the first kindpatients are completely dependent on insulin injections and the diet is composed taking into account its administration. Diabetics should study the presence of carbohydrates (bread units) in foods to determine the dose of hormone that will help them absorb. A bread unit is a conventional concept that implies a certain amount of any product containing 12 grams of carbohydrates. It is recommended to consume no more than 12 bread units per day. Insulin is administered half an hour before a meal, so it is important to know exactly what will be eaten and in what amount to absorb the carbohydrates in the food. For each main meal, you should eat no more than 5-6 bread units and 2-3 for additional.

You should almost completely avoid foods containing easily digestible (simple) carbohydrates. These are sweets, jam, condensed milk, marshmallows, marmalade, halva, cakes, jam, etc. , As well as oatmeal and semolina, mashed potatoes. Reducing the amount of carbohydrates in the diet that raise blood sugar reduces the need for medication. Consuming the same doses as before switching to a low-carb diet can cause hypoglycemia. It is necessary to measure your blood sugar regularly while starting this diet and adjust the dosage of the drugs accordingly.

The daily caloric intake is distributed throughout the day in 4-5 meals. According to the BJU ratio, the distribution looks like this: proteins make up 20-25% of the total diet, fats - 30%, of which no more than 10% are saturated, carbohydrates 45-50%.

Basic rules for nutrition in type 2 diabetes

More serious restrictions are needed in non-insulin-dependent variants of the disease. This is due to the fact that this form usually appears against the background of obesity and not only high levels of glucose but also insulin are found in the blood. However, it very often happens that insulin resistance, which can subsequently lead to type 2 diabetes, does not manifest itself in any way for a very long time, and even people with insulin resistance are not always overweight, but the level of glucose inthe blood is constantly maintained at a high level and This situation leads to very sad consequences. Dietary nutrition in type 2 diabetes helps restore cells' ability to absorb sugar and helps restore cells' sensitivity to insulin.

Diabetes mellitus type 2is a major disorder of carbohydrate metabolism. But at the same time, other types of metabolism suffer - lipid, protein, mineral. Treatment for type 2 diabetes includes diet, moderate exercise, stress management, and medication (diabetes medications).

The type 2 diabetes diet is based on key principles:

1. Plenty of vegetables– The amount of vegetables consumed may depend on age, gender and frequency of exercise per week. As a general rule, women who exercise up to 30 minutes a day are advised to consume at least 500 grams of vegetables a day. For more intense workouts, it is recommended to increase the amount of vegetables to 800 grams. For men, the recommended amount of vegetables is 600 and 1000 grams, respectively.
2. Unsaturated fats- the presence of a sufficient amount of polyunsaturated and monounsaturated fats in the diet helps to maintain cholesterol levels within normal limits and reduces the risk of developing cardiovascular disease, one of the most common long-term complications of diabetes. Unsaturated fats are found in many foods, including nuts, avocados, oily fish, and olive oil.
3. Avoid processed foods– nutritionists and doctors agree that avoiding processed foods has a positive effect on health. Due to the substances that are added to ensure a long shelf life, processed foods tend to have a high glycemic index. Regular consumption of such foods can negatively affect the health of a diabetic.

Healthy foods for diabetes

1. Green leafy vegetables

   Spinach, cabbage, and bok choy are low in calories but rich in nutrients like vitamin C, beta-carotene, and magnesium that help prevent diabetes. One serving (about 106 g) a day reduces the risk of developing type 2 diabetes by 14%.

2. Legumes

   These fiber-rich foods can help stabilize your blood sugar levels. Legumes are low in saturated fat, which can be bad for your heart.

3. Fish

   Omega-3 fatty acids– great helpers to prevent diabetes, reduce the risk of cardiovascular diseases. Omega 3 is needed by the body for the synthesis of red blood cells and cell membranes, helps the body absorb other vitamins, and most importantly - suppresses chronic inflammation, which is a sure companion of insulin resistance.

4. Olive oil

   A staple of the Mediterranean diet, it's important for heart health because it's full of monounsaturated fatty acids. These fats (which are also found in high amounts in nuts) are important in preventing diabetes by helping the body effectively control blood sugar levels.

5. Nuts

   As a source of monounsaturated fatty acids, nuts are rich in magnesium, another important nutrient. Global research shows that people who regularly eat nuts have lower rates of diabetes.

6. Citrus

   All citrus fruits contain antioxidants - great helpers in maintaining the balance of insulin in the blood.

7. Whole grains

   Eating whole grain bread, quinoa and brown rice reduces the risk of developing diabetes. Whole grains are rich in fiber, which helps the body control blood sugar levels. Complex carbohydrates are a kind of buffer that protects us from high blood sugar spikes, so if you want to eat a product with a high glycemic index, combine it with complex carbohydrates.

8. cinnamon

   The delicious spice helps the body regulate insulin levels. Cinnamon is a type of insulin sensitizer, that is, it helps to improve the sensitivity of cells to insulin. The spice helps with hypertension (chronic high blood pressure), reduces the concentration of sugar in the blood when used systematically in the necessary doses, improves general well-being and has a positive effect on metabolic processes.

9. ginger

   It is a catalyst of metabolic processes, reduces sugar levels, cholesterol and blood clotting indicators. Recommended for daily fresh consumption as a spice or tea base.

Forbidden foods in diabetes

Today, doctors try not to strictly restrict patients with diabetes and not to force them into strict restrictions regarding permitted and prohibited foods. Even with type 2 diabetes, where diet plays a role, you can eat a varied diet, but there are a number of foods that people suffering from this disease will still need to eliminate from their diet. In fact, the list below is recommended for anyone who cares about their health to exclude from their diet.

1. Sweetie

   The black list includes sugar and all products that contain it in excess. We must forget about ice cream, chocolate, marmalade, jam, sweets, preserves, halva and other sweets.

2. Bakery

   Sweet bakery products are prohibited: buns, biscuits, muffins, white bread and bread.

3. Unhealthy foods

   These meals can significantly increase glucose levels. For this reason, diabetics should avoid duck, pork, lamb, lard, mayonnaise and cream. It is also recommended to exclude sweet yogurt, fatty cottage cheese and cheese.

4. Semi-finished products

   They contain a large number of aromas, stabilizers and flavor enhancers. You should not eat fish sticks, ready-made industrial cutlets, dumplings, sausages and sausages.

5. Trans fats

   Their consumption will harm not only a diabetic, but also a healthy person. Prohibited items include margarine, shortening, shortening, French fries, hotdogs and burgers.

6. Fruits

   The consumption of certain fruits and dried fruits, which cause a strong increase in blood sugar, is not recommended. Among them are dried apricots, dates, figs, raisins, persimmons, melons, grapes, bananas.

Table No. 9 for diabetes

This diet was developed by scientists specifically for diabetics and has long been used in treatment both in hospital and at home.Table No. 9 includes:

• 300 g of fruit;
• 80 g of vegetables;
• 100 g of mushrooms;
• 1 tbsp natural fruit juice;
• 300 g of meat or fish;
• 200 g of low-fat cottage cheese, 500 ml of fermented milk products;
• 100-200 g of bran, rye, wheat bread mixed with rye flour or 200 g of cereals (prepared), potatoes;
• 40-60 g of fat.

Main dishes

• Soups: vegetable, cabbage soup, beet soup, borscht, vegetable and meat okroshka, fish or light meat broth, mushroom soup with cereals and vegetables.
• Birds, meat: rabbit, beef, chicken, stewed, chopped, boiled, turkey.
• Fish: pike, navaga, cod, pike and lean seafood, stewed, steamed, boiled, baked in juice.
• snacks: vegetable mix, vinaigrette, jellied diet fish and meat, vegetable caviar, unsalted cheese, seafood salad with butter.
• Sweets:berry desserts, fresh fruit, berry mousses, sugar-free fruit jelly, sugar-free jam and marmalade.
• Dishes with eggs: soft-boiled eggs, egg-white omelette, in dishes.

Other Dietary Strategies for Diabetes

Of course, we must not forget that all diets are composed strictly individually, taking into account the age and gender of the patient and the level of his physical activity.

Thus, there are several options for dietary strategies for diabetes today. If it is necessary to normalize body weight in a patient with diabetes mellitus type 2, it has proven itself well.Mediterranean diet, which is based on daily physical activity.

The basic principles of the diet are:

• small meals 5 times a day - 3 main meals and 2 intermediate meals;
• breakfast should be richer in carbohydrates, consisting mainly of complex carbohydrates;
• a light dinner consisting of lean proteins and vegetables;
• During the day, you should consume more than 1 kg of different vegetables and herbs;
• It is important to observe a drinking regime - at least 7-8 glasses of water per day.

The main sources of fat in the diet are– unrefined olive oil, sometimes sesame, rapeseed and peanut. In the Mediterranean diet, animal fats are limited.

Particular attention is paid to Omega-3 fatty acids and oleic acid contained in oils, fatty fish and seafood. These fatty acids have a huge impact on the prevention of atherosclerosis, improve insulin sensitivity and help immune cells detect inflammation and suppress it.

Carbohydrates in the Mediterranean diet are mostly complex with a low glycemic index - durum wheat pasta, beans, rice, lentils, wholemeal bread, seasonal vegetables and fruits.

Protein comes in the form of low-fat soft cheeses, eggs, fish, seafood, and less commonly poultry.

Another diabetes diet option isLCHFand keto diet. The essence of this diet strategy is to consume small amounts of carbohydrates and large amounts of fat. Carbohydrates in fatty diets are limited to 50 grams per day, and in a keto diet the restriction is even more serious - no more than 10 grams of carbohydrates.

The following foods are completely excluded from the keto diet::

• sugar, honey, artificial sweeteners;
• sweet carbonated drinks;
• bread with yeast, sweets;
• cereals, porridges, flakes and breakfast cereals;
• skimmed milk, kefir, yogurt;
• sweet curds;
• margarine.

In the LCHF diet concept, insulin is a dangerous thing because after we eat something high in carbohydrates, the carbohydrates are broken down into glucose, the blood sugar level starts to rise, and accordingly the insulin level rises a lot to transport glucose tomuscles, liver and fat cells, that is, insulin is "responsible for our obesity". Also, protein can raise insulin levels just as well as carbohydrates. And fat does not raise insulin at all, which is good for insulin resistance and, if necessary, to improve the sensitivity of cells to insulin.

Diabetes mellitus in children

Diabetes mellitus in children can be caused by a hereditary predisposition, improper nutrition, including the consumption of excessive amounts of simple carbohydrates and sweets, and the disease can also occur as a result of mental or physical trauma. Treatment of diabetes in children, as in adults, consists of a therapeutic diet and the administration of insulin in type 1 diabetes.

The diet of children with diabetes should be rich in vegetables such as white and cauliflower, onions, spinach and garlic. You can eat unsweetened fruit, meat, poultry and fish. It is recommended to give milk and cottage cheese, which have a small percentage of fat content, provided that the child does not have an intolerance to cow's milk protein. When cooking meat or fish, you can use spices to promote better protein absorption.

All confectionery, sweets, grapes, apricots, rice, pastries, biscuits, plums should be excluded. Parents of a child with diabetes should learn how to calculate the consumption of units of bread when feeding the child and calculate the required dose of insulin. The child himself should also be taught these skills as early as possible.

Gestational diabetes mellitus

Anothertype of diabetes- gestational diabetes mellitus in pregnant women, which is quite common today.

High blood sugar during pregnancyand is one of the most common metabolic disorders in an expectant mother. The so-called gestational diabetes mellitus or diabetes of pregnant women is diabetes that occurs during pregnancy and is limited to the duration of pregnancy. During pregnancy, the production of sex hormones (estrogens and progesterone, hCG) and the hormone cortisol, which suppress the action of insulin, increases sharply. As a result, blood sugar levels in pregnant women rise. High blood sugar during pregnancy negatively affects both the health of the woman herself and the health of the fetus, which is why it requires timely diagnosis and subsequent correction.

Women are at particular risk:

• overweight or obesity (BMI over 25 kg/m2²– the risk doubles, over 30 – triples);
• with multiple pregnancy;
• after IVF;
• with polycystic ovaries;
• with a large weight gain during a true pregnancy;
• with glycosuria (glucose in the urine);
• presence of close relatives with diabetes;
• with burdened previous pregnancy - GDM, birth of a large fetus, intrauterine death of the fetus.

Gestational diabetes is dangerous not only for the mother, but also for the health of the unborn child. Thus, at the age of 4-5, such children are many times more likely to be overweight and obese, at the age of 10-11 - increased blood pressure, in adolescence the risk of developing diabetes is 20-40%, the risk of developing non-alcoholicFatty disease significantly enlarges the liver.

If GDM is not detected in time or the expectant mother does not take any action to treat it, thenthe risk increases significantly:

• early aging of the placenta and, as a result, delayed fetal development;
• premature birth;
• polyhydramnios;
• formation of a large or disproportionate or edematous fetus;
• increased blood pressure, preeclampsia;
• the need for cesarean section;
• traumatizing women and children during childbirth;
• hypoglycemia (low blood sugar) and breathing problems in a newborn;
• The most serious complication of untreated GDM is fetal death.

Therefore, it is important to understand that diabetes is not some kind of life sentence, but only imposes certain obligations on a person in terms of diet and physical activity. A proper, balanced diet is paramount for any type of diabetes. And although the reduction of carbohydrates and saturated fats in the diet contributes to weight loss, the excess from which type 2 diabetics often suffer, it is very important to change the very lifestyle and eating habits. And if in type 2 diabetes a good effect on lowering blood sugar levels is achieved not only through properly selected foods, but also through a set of physical exercises that help improve the transport function of glucose in muscle cells, then in type 1 diabetesnutrition plays a leading role.