Diet in Diabetes

Diabetes mellitus is a disorder of carbohydrate, fat, and protein metabolism cycles, manifested mainly by chronic hyperglycemia due to insulin secretion and impaired metabolism.

Types of Diabetes Mellitus (DM):
• Type 1 diabetes mellitus, also known as insulin-dependent diabetes mellitus. It is treated with insulin, as well as dietary management.
• Type 2 diabetes mellitus, also known as non-insulin-dependent diabetes mellitus. This type of DM is directly related to weight problems. Obesity leads to intracellular insulin resistance. Insulin secretion is also important in the pathogenesis of type 2 DM, so calling it non-insulin-dependent DM is not entirely accurate.

 Treatment
– reduction of hyperglycemia;
– restriction of high glycemic index foods;
– planning physical activity;
– medications that reduce glucose levels;
– insulin injections.
• Gestational diabetes is first diagnosed during pregnancy by detecting hyperglycemia. Usually, dietary adjustments are made, and sometimes insulin therapy is required.

Dietary Adjustment for Diabetes Mellitus
• Choose a balanced healthy diet.
• Maintain optimal metabolic balance:
– ensure good glycemic control to reduce the risk of DM-related diseases;
– lose weight, reduce the risk of dyslipidemia, hypertension, heart, and vascular diseases.
• Optimize laboratory data in cases of diabetic nephropathy, celiac disease, cystic fibrosis, and other conditions. Dietary recommendations should be provided through a comprehensive healthcare model, including pharmacological, physical activity, cognitive, and smoking cessation programs. Patients with DM do not need to follow a special diet. It is recommended to adhere to healthy balanced diet recommendations.

Dietary Recommendations for Diabetes Mellitus
1. Eat regularly foods containing starchy carbohydrates, e.g., whole grain bread, white wholemeal flour bread, potatoes, rice, pasta. Choose products made from coarse grains, e.g., wholemeal bread, oatmeal, and other unrefined cereals.
2. Reduce fat intake, especially animal fats. Eat less butter, margarine, cheese, fatty meat. Choose low-fat dairy products, skimmed milk, and low-fat yogurt. Cook food on grills, steam, or bake. Use oil containing monounsaturated fatty acids, such as olive oil, rapeseed oil: pour 2–3 tbsp into salads, cooked dishes.
3. Eat at least 5 portions of fruits and vegetables per day.
4. Limit sugar and sweet food intake.
5. Use less salt. Choose herbs and spices instead.
6. Drink alcohol in moderation; for women – up to 2 units / day, for men – up to 3 units / day. Do not drink alcohol on an empty stomach as it can cause hypoglycemia.
7. Reduce weight by 0.5–1.0 kg / week. Avoid rapid weight loss.

Recommended daily nutrient intake:
• Proteins: ≤ 1 g / kg / IBW (BMI 22). Should account for 12–20% of daily energy needs (meat, fish, dairy products, legumes); protein products – 2–3 servings / day, dairy products – 2–3 servings / day.

• Riebalų: < 30% of daily energy intake, saturated fatty acids and trans isomeric acids < 10% of daily energy intake. When producing margarines, trans isomers of fatty acids are formed. Their spatial structure differs from the acids found in natural products, which have a cis configuration. Monounsaturated fatty acids should account for 10–20% of total energy consumption, i.e. olive oil, rapeseed oil, etc. Polyunsaturated fatty acids should account for no less than 10% of daily energy intake (omega 6 polyunsaturated fatty acids – 5–8%, omega 3 fatty acids – 1–2%). Therefore, it is recommended to eat fish, especially fatty fish, 1–2 times / week.
• Carbohydrates: 50–60% of daily energy intake. Soluble dietary fibers have a positive effect on lipid metabolism and reducing glucose levels in the blood. Insoluble dietary fibers are also beneficial for health. Consume 6–11 servings / day of starchy foods, 2–4 servings / day of fruits, 2–3 servings / day of dairy products, 3–5 servings / day of vegetables (lettuce, cucumbers, tomatoes, radishes, cabbage, leeks, spinach).
• Choose food rich in vitamins and antioxidants naturally.
• Consume salt ≤ 6 g / day.
  Eat often and in small portions. Divide daily food intake into three main meals (breakfast, lunch, and dinner), as well as have 2–3 snacks.
  Choose a variety of foods, but maintain the ratio of carbohydrates, proteins, and fats in the daily diet.
  Distribute carbohydrate-rich foods evenly throughout the day as they are absorbed in the form of glucose.

Glycemic Index
The Glycemic Index (GI) shows how quickly and to what extent blood glucose levels rise after consuming a certain food. It is expressed in relative units, compared to glucose or white bread. Glucose has a glycemic index of 100. Foods with a high GI are significant for diabetes prognosis. The GI of products varies depending on the processing or preparation method, degree of ripeness, and consumption.
Products with low GI: oats and their products, legumes, pasta, unripe fruits, milk, plain yogurt.
Products with medium GI: rice, grain dishes, rye bread, potatoes, cereals.
Products with high GI: white bread, wheat and corn flakes, new potatoes, potato porridge, fruit juices, honey.

Food and Insulin
Hypoglycemia can be controlled by administering insulin and consuming an adequate amount of carbohydrates. It is best when insulin is prescribed taking into account each patient’s lifestyle, eating habits, rather than the other way around – adjusting the patient’s lifestyle to the insulin dose.
The spectrum of short, medium, and long-acting insulin allows for a more flexible adjustment of the insulin regimen and diet. However, for individuals whose lifestyle and eating habits constantly change, it is better to eat regularly, even if not at set times. Rapid-acting analog insulin starts working in 5–15 minutes, so carbohydrates must be consumed at that time. All patients treated with insulin, especially those using analog insulin, should be aware of the likelihood of hypoglycemia. BecauseInsulin is an anabolic, its dose is increased to control glycemia. This can lead to excessive food intake. This can lead to weight gain and make it difficult to control blood sugar levels. It is important that dietary advice for patients taking insulin provides comprehensive information not only about the short-term effects of food on glycemia, but also about the importance of a diet that helps maintain optimal glucose levels in the blood.

Weight regulation and glycemic monitoring
More than 80% of people diagnosed with type 2 diabetes are overweight. Weight needs to be regulated in both type 1 and type 2 diabetes to help reduce insulin resistance, control blood glucose levels, and protect against the risk of long-term complications. Although preventing weight gain and/or reducing excess body weight is not easy, it is important for the course of diabetes. Dietary regulation is a cornerstone. Effective diabetes treatment involves proper nutrition, physical activity, medication, and giving up harmful habits.

Blood glucose control monitoring
Glycated hemoglobin (HbA1c) levels should be tested at least once a year. The marker should be ≤ 7%, as it reduces the risk of complications for most patients with type 1 and type 2 diabetes.

Gestational diabetes
In most cases, adjusting the diet is sufficient, but some women may also be allowed to use insulin.
Recommendations for pregnant women
• Eat properly to provide the body with all the necessary nutrients during pregnancy. Eat regularly, consume plenty of slowly absorbed carbohydrates.
• Control calorie intake to maintain optimal body weight. Minimal weight gain is recommended for women diagnosed with gestational diabetes.
• Limiting weight gain during pregnancy is controversial.
Reducing obesity in women with gestational diabetes is associated with a reduced risk of hypertension, the likelihood of cesarean section, and the high birth weight of babies, but does not increase the risk of premature birth or low birth weight babies.

Source | Dietary Treatment in General Practice | Dietitian Doctor Jūratė Dobrovolskienė