diabetes

[Guest guest]

Non-drug Therapies: Introduction

From ancient times until the discovery of insulin in the 1920's, nutritional

therapy was the only available means of treating diabetes. The availability of a

broad and ever-increasing array of drugs to treat diabetes has led to an

unfortunate de-emphasis of proper nutritional counseling and exercise. Although

every discussion of diabetes therapy begins with a statement that dietary

modification with weight loss is the first line of defense, patients and

physicians alike often skip over this recommendation and head directly for

medication. Indeed, weight loss through proper nutrition and exercise is hard

work, and ultimately most of us struggle to maintain our ideal body weight.

Despite this, diet and exercise can truly benefit almost all patients, even with

relatively modest degrees of weight loss. The goals of therapy include the

maintenance of near normal blood glucose levels, which help reduce diabetic

complications such as nephropathy, retinopathy, neuropathy, and cardiovascular

disease. Weight loss through diet and exercise can also lower cholesterol levels

and blood pressure, thereby reducing the risk of cardiovascular disease commonly

associated with diabetes. It is recommended that every patient with diabetes

meet periodically with a nutritionist who specializes in diabetes to develop a

diet that meets his or her specific needs.

Dietary Therapy

Type 1 Diabetes:

The goal of dietary therapy for most patients with type 1 diabetes is

normalization of blood glucose levels. For children with type 1 diabetes,

attention must be paid to providing sufficient calories and insulin to allow

normal growth and development. Patients with type 1 diabetes are prone to wide

swings in blood glucose, and therefore should eat regularly paced meals with

similar caloric content, timed properly with their particular insulin

preparation. More frequent injections and the use of rapid-acting insulins allow

for increased flexibility in meal content and timing. As patients learn more

about their diabetes, they can make subtle adjustments to their insulin regimen

that allows them to compensate for changes in their diet on a meal-to-meal

basis.

Type 2 Diabetes:

In the United States, most patients with type 2 diabetes are obese, and the

goals of dietary therapy are primarily directed at weight loss. It is important

for patients and physicians to understand that even a modest reduction of 10-20

lbs. can dramatically improve insulin sensitivity (the body's ability to use its

own insulin effectively), glucose and cholesterol levels, and blood pressure,

regardless of starting weight. In order to achieve this through dietary therapy,

patients are started on diets that are usually 250-500 calories less than their

typical diets. Even this limited decrease in caloric intake is difficult for

many patients.

Specific Dietary Recommendations:

Carbohydrates

Patients with diabetes often believe that their blood sugar levels directly

reflect the amount of sugar that they consume in their diet. They therefore

reason that simply avoiding sugary foods should keep their blood sugar under

control, and they are subsequently disappointed and frustrated when this does

not prove to be the case. Blood glucose comes from a variety of sources,

including dietary sugar (usually eaten in the form of complex carbohydrates such

as rice and breads) in addition to the natural production of sugars that occurs

all the time through normal bodily metabolism. The increase in blood glucose

levels that follows the ingestion of carbohydrates varies depending on the

individual and the specific type of carbohydrate eaten (fruit versus starch, for

example), but most nutritionists who specialize in diabetes recommend that

attention be paid to the total amount of carbohydrate, rather than the specific

type.

Protein

According to current guidelines, diabetic patients should eat roughly the same

amounts of protein as non-diabetic patients. Patients with significant kidney

disease, however, should restrict their protein intake modestly.

Fat

More patients with diabetes will die from cardiovascular disease, especially

heart attack and stroke, than any other cause. While diabetes itself is a risk

factor for these complications, part of the risk is attributable to high levels

of fat in the blood. Combined with the need for weight loss in most patients

with type 2 diabetes, this represents a good reason to reduce fat intake.

Specific recommendations include cutting saturated and polyunsaturated fats

(such as lard) each to less than 10% of total caloric intake. Monounsaturated

fats, such as olive and canola oils, can make up 10-15% of the diet.

Alcohol In general, recommendations on limiting alcohol intake to two drinks per

day for men (one for women) apply similarly to people with diabetes and those

without. There are specific issues to remember with diabetes, however. Alcohol

cannot be broken down to glucose, and it also inhibits glucose production by the

liver. This means that if a person taking insulin or a sulfonylurea drinks

alcohol without food, hypoglycemia can result. For people with Pancreatitis. No

Alcohol intake, is the rule!