Diabetes: Types, Symptoms, Causes, Complications and Dietary management


World Health Organization Survey’s report says that within 2030 year the number of diabetic affected patients will be more than 8 crores 70 lakhs.  Every 3 or 4 persons of 10 persons will suffer from diabetes. So doctors are saying that you all should lead a healthy life style. It is the only way to prevent diabetes.
prevention of diabetes


Diabetes is a metabolic disorder. Diabetes is occurred due to the deficiency of the hormone named “Insulin”. This hormone secrets from the β cells of the islets of Langerhans of pancreas. Energy is produced by the metabolism of the blood glucose. Insulin helps in the metabolic activity of cells. If secretion of insulin decreases or number of insulin receiver cell decreases in the target cell, it hampers the metabolic function of carbohydrate. So, glucose is increased in the blood of diabetes patient.
Throughout the literature from the earliest times, this disease was accompanied by the passage of the large amount of urine and other symptoms. English physician, Thomas Wills, discovered that the urine of this disease is sweet. Dobson discovered that urine of the diabetic patient is fermented like alcohol and then he came to the conclusion that the taste of urine is sweet which was observed by Thomas Wills due to the presence of sugar. This sugar is mainly dextrose, glucose which are obtained from the carbohydrate or starchy materials or some amount comes from the protein which is taken as a food.

Types of diabetes:

  1. IDDM (Insulin Dependent Diabetes Mellitus) –

This diabetes is known as type I diabetes or Juvenile diabetes. This is seen among children and adolescent. During childhood or adolescence period pancreas is unable to produce enough insulin due to attacking of virus or any other reason.

  1. NIDDM (Non Insulin Dependent Diabetes Mellitus) –

This diabetes is known as type II diabetes or adult diabetes. This is seen among adults. In this diabetes pancreas produces enough insulin but function of insulin does not work properly due to overweight. So patient should maintain a good diabetic diet. By diet therapy and weight loss therapy this disease can be cured.

  1. MRDM (Malnutrition Related Diabetes Mellitus)  -  

This type of diabetes is mainly seen among young people (between 15 – 30 years of age). Usually people who suffer from MRDM are undernourished. Like type I diabetes, in this diabetes pancreas fails to produce adequate amount of insulin. So requirement of insulin is needed in this diabetes.

  1. GD (Gestational Diabetes) –

This type of diabetes is seen in pregnancy. During pregnancy the level of plasma insulin is raised by the action of placental hormones. When body needs excess insulin, pancreas fulfils the demand of insulin. But when pancreas is unable to meet this demand of insulin, glucose level is increased in the blood because cells cannot use the glucose due to lack of insulin, the result is gestational diabetes.

Symptoms:

Early signs of diabetes include mainly 3 symptoms-
  • Polydipsia (excessive thirst)
  • Polyphagia (excessive hunger)
  • Polyuria (passing large quantities of urine)

Other symptoms:

  • Glycosuria - The presence of sugar in the urine (160 – 180 mg/ 100ml) is known as glycosuria but its presence does not always signify the diabetes. Sometimes taken of excessive amount of starchy food causes presence of sugar in the urine.
  • Hyperglycemia – blood sugar increased above normal limits.
  • Acidosis – It is the condition in which there is not enough alkali in the blood. Body burns the fatty acids and produces acidic ketone bodies. The treatment of it is to supply of insulin and intravenous fluids.
  • Tongue becomes dry, red and glaze.
  • Saliva becomes scanty.
  • Gum becomes swollen.
  • Patient becomes very thin.
  • Tiredness

Causes of diabetes:

  1. Insulin dependent diabetes mellitus:

  • Infections:
Many viruses attack in pancreas and impair the function of insulin and ultimately destroy the β cells.
  • Stress:
Some hormones like adrenaline, noradrenaline and cortisol raise the blood glucose level.

  1. Non – insulin dependent diabetes mellitus:

  • Genetics:
This type of diabetes is associated with genetic factors. Some genes affect insulin secretion. The gene glucokinase is associated with diabetes.
  • Life style:
High intake of refined grains, over eat, sedentary life style are the reasons of diabetes. It is mainly associated with obesity.
  • Abdominal fat:
People with high waist hip ratio indicate the large amount of abdominal fat which is risk for diabetes. It is associated with insulin insensitivity because high amount of free fatty acids remain in the portal circulation as abdominal fat cells release high amount of fatty acids.

Complications of diabetes:

    1. Coma –

The most severe complication of diabetes is coma.  It is caused by poisoning of the blood. In coma patient’s pulse becomes weak, seen difficulty in breathing and loss consciousness. Then goes into a deep coma and finally dies. Before going into coma, some symptoms are observed such as headache, thick speech, staggering gait, weakness, giddiness and livid hands and feet.

    1. Skin eruptions –

In diabetes, some skin problems are very common. Bolis and carbuncles are seen in diabetes. Besides these, eczema and itching are observed. Sweat may occur. Skin becomes bronzing. There is the possibility of the foot gangrene.

  1.     3.  Diabetic retinopathy -

Diabetic patient is more prone to be blind than normal person.  If one suffers from diabetes for long time, retina may be damaged. This is called diabetic retinopathy. As a result diabetic patient may be blind permanently.

           4. Diabetic nephropathy and heart disease -

If glucose level is increased in the blood, triglyceride and cholesterol level are also increased in the blood and as a result increase the risk of heart disease.
Diabetes can cause diabetic nephropathy or kidney problem. Waste material accumulates in the blood and as a result sepsis is occurred. The symptoms of diabetic nephropathy are nausea, anorexia, ficklenesses, sleeplessness, distasteful, weight loss etc.

              5. Other Complications -

Diabetic patient is liable to lung and tuberculosis problem. Pneumonia is observed and kidney problem is also seen. Apart from these, neuritis, neuralgia, numbness and tingling in the limbs are seen. A diabetic patient becomes morose, restless and anxious. Patient is unable to lead a good sexual life. Impotence is common. It is rare to conceive for a diabetic woman. But a diabetic woman may bear a healthy child. It is not that a diabetic woman give birth a diabetic baby.

Dietary management:

The diet of a diabetic patient is similar to a normal person. There is no big difference between diet of diabetic patient and normal person. Diabetic patient is given 60 – 65% carbohydrate of total calorie, 15 – 25 % fat and other should come from protein.  But these percentages may be changed depending on patient’s age, height, weight, physical activity and life style. In case of children, requirement of protein should be high. So it should be kept in mind before menu planning.
  1. Carbohydrate:
Restriction of carbohydrate weakens the insulin sensitivity. High carbohydrate and high fibre diet improves the insulin binding and monocyte insulin receptor binding. Note that, carbohydrate should be with low glycemic index and high fibre. Some carbohydrates (for example - sugar) increase the glucose level in the blood but starch increases the glucose in the blood slowly. Low glycemic index foods help in this matter because low glycemic index foods reduce the rate of glucose absorption so low glycemic index foods should be eaten.
The sources of carbohydrate are whole grain, fruits and vegetables.

Glycemic index (GI) of foods:


Classification
GI range
Example
Low GI
55 or less
Fruits, vegetables, legumes, whole grains, nuts, fructose.
Medium GI
56 – 69
Whole wheat products, basmati rice, sweet potato.
High GI
70 and above
Baked potato, water melon, white bread, white rice, cornflakes, glucose and maltose.

  1. Protein:
Protein is needed for growth in children and adult needs for maintaining tissue regeneration. But high protein is not needed because high protein diet creates a pressure on kidney to excrete excess N2.

  1. Fat:
Low fat diet should be given to the patient. Low fat diet helps in insulin binding and also helps in reducing LDL (Low Density Lipoprotein) and VLDL (Very Low Density Lipoprotein) level. So it helps in reducing the risk of atherosclerosis.
  1. Vitamins:
Vitamin C and vitamin E is necessary to reduce stress and oxidative damage as these vitamins are rich in antioxidant.
Vitamin C –
This vitamin is necessary for NIDDM (Non Insulin Dependent Diabetes Mellitus) patient. Ascorbic acid helps in blood sugar regulation. It has proved that vitamin C rich foods help in lowering the LDL cholesterol and triglyceride.
Vitamin E –
Vitamin E contains healing properties. It helps in reducing any diabetic related lesions. Vitamin E improves the insulin activity and prevents the complication of diabetes like neuropathy.
  1. Minerals:
Minerals play an indisputable role in preventing diabetes. Chromium, magnesium, zinc are helping in metabolism of glucose.
Zinc -
Zinc enriched diet plays an important role in preventing diabetes. Three dimers of insulin are conjugated in presence of zinc which forms insulin hexamer. This prevents the degradation of insulin. Thus insulin activity is maintained and diabetes can be prevented.
  1. Fibre:
Dietary fibre rich diet is another important factor for the prevention of diabetes. Dietary fibre absorbs glucose molecule and thus glucose absorption is diminished. Dietary fibre reduces the retention time of digested food material in small intestine. Thereafter translocation of glucose from gastro intestinal tract to blood vessel is diminished which helps to prevent diabetes. Other benefits of diabetes are it lowers the insulin requirement, decreases serum cholesterol and triglyceride level, controls blood pressure, prevents constipation problem and helps in reducing body weight which are associated with diabetes.

  1. Artificial sweeteners:
Diabetic patients are advised to intake artificial sweeteners instead of sugar. These sweeteners are calorie free. Sweeteners are aspartame, polyols, cyclamate etc. low calorie sweeteners are polyols and high calorie sweeteners are cyclamate, aspartame, saccharin, sucrolose. But keep in mind that these artificial sweeteners should be eaten in limited amount. It may cause health hazards.
Many dietitians say that it is better to eat sugar in limited amount instead of artificial sweeteners.

Other ingredients which help to control diabetes mellitus –

  1. α-lipoic acid:
lipoic acid is rich in antioxidant. It is effective for the treatment of polyneuropathy.
  1. Fish oil:
Fish oil increases the blood flow to arteries and reduces the clumping of RBC (Red Blood Cells).
  1. Exercise:
Exercise is very important method for the prevention of diabetes. So with diabetic diet, do exercise regularly for a healthy life.

Wrong belief about diabetic diet:

 Some people think that consuming of rice is bad for the diabetic patient and consuming of wheat is good. This is not right. Rice and wheat have almost same glycemic index. These have same capacity to raise the blood glucose level. So you can take anyone of these two items but total quantity should be restricted. Many people have tendency to eat rice in large quantity. So measuring of total quantity is important for the diabetic patient.

Dietary guidelines:

  • Intake fibre rich foods with complex carbohydrate. Fenugreek seeds contain high fibre. So it is effective for the treatment of diabetes. 25 – 50 gm/day of fenugreek seeds can be eaten. You can use fenugreek seeds in dhal, vegetables, chapathi and rice. Fenugreek seeds contain trigonelline an alkaloid which help to reduce sugar level and also serum cholesterol level and triglyceride level.
  • Intake low glycemic index food.
  • Eliminate sugar and refined grains from the menu.
  • Do not consume fried foods.
  • Junk food should be avoided.
  • Use skimmed milk instead of full fat milk.
  • Consume protein as per requirement. Avoid over intake of protein.
  • Patient should maintain a proper body weight. It should be 10 percent lower than patient’s ideal body weight.
  • Do exercise regularly.
  • Cook with mixed oil 1:1 portion. Half portion of mustard oil and half portion of sunflower oil.
  • Take meal in small quantity at short interval.
  • Drink adequate amount of water.
  • Avoid spicy food.

A sample menu for a diabetic patient:


Specific characteristics of the patient:

  1. Height- 155 cm
  2. Weight- 77 kg
  3. Age- 65 years
  4. BMI- 32.04 kg/m2  BMI= [weight (kg)/ height in m2]
  5. Sex- Female
  6. Activity level- Sedentary
  7. Socio economic condition- Middle income family
  8. Religion- Hindu
  9. Ideal body weight- 52 kg Ideal Body Weight  as Broca’s Index = [Female =  Body weight – 103, Male =  Body weight - 100]
  10. Suffering any disease- Type II diabetes
  11. Any type of food allergy- No
  12. Food habits- Non vegetarian
  13. Any likes or dislikes- No

 Nutrional requirement of the patient: 

 Calorie= 1822 kcal
 Carbohydrate= 296 gm
 Protein= 68 gm
 Fat= 40 gm

Time table
Menu
Early morning
Tea (without milk and sugar) + oats biscuits (2 pieces)
Breakfast
Oats porridge (1 medium bowl) + egg (1piece only white portion)
Mid morning
Guava (1 piece=100g gm)
Lunch
Rice (1 small bowl 70 gm) + dhal (1 small bowl) + chicken curry (2 pieces chicken 50 gm) +  vegetables (2 small bowl) + salad with cucumber (1 plate) + soured curd (1 cup homemade)
Afternoon
Tea (without milk and sugar)  + oats biscuits (2 pieces)
Evening snacks
Ghugni with kabuli chola ( kabuli chola 30 gm homemade 1 medium bowl)
Dinner
Methi (fenugreek) stuffed roti (2 pieces whole wheat flour 70 gm) + dhal (1 small bowl) + vegetables (1 small bowl) + fisch curry (1 small piece bata)
Bed time
Skimmed milk (1 small glass 125 ml)







0 comments:

Post a Comment

Search