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Diabetes is defined as a metabolic disorder requiring continuous medical care, where the organism cannot adequately utilize carbohydrates, fats, and proteins due to a deficiency in the insulin hormone or impairments in insulin action. The insulin hormone transports glucose in the blood into body cells to be stored or used for energy. The bodies of individuals with diabetes cannot secrete enough insulin or cannot effectively use the insulin they produce.
In healthy individuals, a fasting blood glucose level in the range of 70-100 mg/dL is considered normal. The first medical intervention to diagnose diabetes is usually measuring Fasting Blood Sugar (FBS) or performing an Oral Glucose Tolerance Test (OGTT). If the Fasting Blood Sugar measurement result is in the range of 100-125 mg/dL (pre-diabetes), it indicates latent diabetes (impaired fasting glucose), and 126 mg/dL and above indicates the presence of diabetes. If the blood sugar is in the range of 140-199 mg/dL at the end of the 2nd hour after OGTT glucose loading, it is diagnosed as pre-diabetes, and if it is 200 mg/dL or above, it is diagnosed as diabetes.
Due to high blood glucose, many symptoms are seen in individuals, such as polyuria (frequent urination), polydipsia (excessive thirst), polyphagia (excessive eating), nocturia (frequent urination at night), numbness and pain in the hands and feet, delayed wound healing, dry and itchy skin, blurred vision, and frequent infections.
Types of Diabetes
Type 1 Diabetes
It is an insulin deficiency that occurs as a result of autoimmune damage to the β cells that secrete insulin in the pancreas, originating from the body’s own defense system. Because the insulin hormone cannot be adequately secreted in the body, there is an absolute need for insulin. In people with Type 1 diabetes, the pancreas cannot produce enough insulin. Due to insulin deficiency, circulating glucose cannot enter the cell and be converted into the necessary energy. The inability of glucose to enter the cell causes blood sugar to rise and be filtered by the kidneys and excreted in the urine. The presence of glucose in the urine causes fluid loss. Typical symptoms of diabetes such as weakness and fatigue emerge. Although it can occur at any age, it is frequently observed in people under 30 years of age. The effect of genetic factors in the occurrence of the disease is significant.
Type 2 Diabetes
It is one of the most common types of diabetes. Although Type 2 diabetes is known as diabetes seen in adults, today an increase is seen in childhood type-2 diabetes disease. In individuals with Type 2 diabetes, the body becomes resistant to insulin, and the insulin hormone cannot be used efficiently. This results in the pancreas trying to produce more insulin, over time damage occurs to the cells in the pancreas, and impairments in insulin secretion occur. A sedentary lifestyle and excessive food intake trigger obesity, obesity causes insulin resistance, and as a result, diabetes emerges as an inevitable outcome. Weight loss, an adequate and balanced diet, providing blood sugar regulation, and exercise can help keep this disease under control.
Gestational Diabetes
Gestational diabetes is high blood sugar developing with insulin resistance that emerges after the 24th week of pregnancy, and it poses a risk for the development of type 2 diabetes even after pregnancy. Gestational Diabetes is one of the most common problems seen during pregnancy. Gestational diabetes is seen in an average of 10% of pregnancies. All pregnant women should have a glucose loading test between the 24th and 28th weeks of pregnancy. Diabetes in the family, inadequate physical activity, obesity, and high blood pressure are among the risk factors for gestational diabetes.
Nutritional Treatment in Diabetes
Nutritional treatment of diabetes is an indispensable component of the treatment in the prevention and management of prediabetes, diabetes, and diabetes-related complications. The American Dietetic Association recommends consulting a dietitian within the first month following the diagnosis for individuals with type 1 and type 2 diabetes, and within the first week following the diagnosis for Gestational Diabetes cases.
With effective nutritional treatment, weight loss and improvement in blood glucose level, blood pressure, and blood fat levels are achieved in patients. Studies have shown that nutritional treatment lowers HbA1c in type 1 and type 2 diabetics, and a 1% decrease in HbA1c provides a reduction in diabetes-related complications.
A personalized nutrition program forms the basis of treatment for individuals with diabetes to show a healthy and quality lifestyle. A good nutrition plan, especially prepared for individuals with Type II diabetes, is important to keep blood glucose levels at normal ranges.
45-60% of the energy requirement can be met from carbohydrates, 10-20% from proteins, and 20-35% from fats. Providing <30% of energy from fats, <7% from saturated fats, and having trans fat intake <1% is effective in preventing cardiovascular diseases.
Carbohydrates: The type and amount of carbohydrates should be adjusted according to dietary habits and targeted blood glucose and lipid levels. Diets with carbohydrates below 130 g/day are not recommended. Approximately 45%-55% of total daily calorie intake should be provided from carbohydrates. The glycemic index and glycemic load of the carbohydrate are as important as the amount of carbohydrate taken.
Foods recommended as carbohydrate sources for diabetic individuals are whole grains, bread, dry legumes, vegetables, fruits, and milk and dairy products. Instead of processed white flour, complex carbohydrates with high fiber ratio, unrefined, such as whole wheat bread, brown rice, and whole wheat pasta should be preferred. Whole grains are rich in fiber, vitamins, and minerals.
Fiber: Dietary fiber is one of the food components resistant to digestive enzymes. Indigestible fiber is used by beneficial bacteria in the intestines and has very positive effects on intestinal health. Dietary fiber slows down carbohydrate absorption and prevents blood glucose from rising rapidly. It prevents blood fats from rising. Fruits, vegetables, whole grains, and dry legumes are nutrients rich in fiber. The recommended daily amount of fiber is 25-35 grams.
Fruits and vegetables are highly rich nutrients in terms of fiber, vitamins, minerals, and antioxidants. Consuming the fruit itself instead of fruit juice allows benefiting from the fiber of the fruit. Having a food from the protein or fat group next to the fruit consumed between meals helps in better managing blood sugar regulation. The fiber and water content of vegetables is high, so it provides a feeling of fullness with fewer calories.
Fat and cholesterol: To reduce the risk of cardiovascular disease, lower triglyceride and cholesterol levels, and prevent the decrease of HDL cholesterol, the intake of saturated fat, cholesterol, and trans fat needs to be reduced. Including monounsaturated and polyunsaturated fats, called ‘healthy fats’ in nutrition, can help lower cholesterol levels. Nuts such as olive oil, avocados, hazelnuts, peanuts, and walnuts can be added to the diet. Besides these, fish rich in omega-3 fatty acids such as salmon, sea bass, and mackerel should be included in the diet.
Meal Planning
Irregular food intake of diabetic individuals leads to hypoglycemia and hyperglycemia. By distributing foods throughout the day, insulin production becomes more appropriate, and the need for insulin is reduced. Feeding with at least 5 meals and with intervals between meals not exceeding 3-4 hours helps prevent sudden spikes or drops in blood glucose levels.
The Relationship Between Diabetes and Obesity
The prevalence of Type-2 diabetes is three times higher in obese individuals than in non-obese individuals. High blood fats in the body reduce the effect of the insulin hormone and create resistance to insulin. Depending on this resistance formed, various impairments in insulin production occur. All these impairments lead to hyperglycemia, impaired glucose tolerance, and the development of type-2 diabetes. Therefore, providing weight control has an important place in protection against diabetes and other chronic diseases.
Diabetes and Physical Activity
In controlling blood glucose in diabetes, physical activity shows a protective effect as much as nutrition and drug use. Physical activity accelerates the use of glucose by cells after the glucose formed as a result of the breakdown of foods is absorbed and passes into the blood. Thus, a decrease in blood glucose levels is achieved. Physical activity has an important place, especially in body weight control. With physical activity, body weight is kept at an ideal level. It shows an effect reducing the need for drugs. It ensures the lowering of cholesterol and triglycerides, raises HDL cholesterol (good cholesterol), and lowers LDL cholesterol (bad cholesterol). It helps in improving and protecting lung health.
